J Trauma
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Comparative Study
An evaluation of expert human and automated Abbreviated Injury Scale and ICD-9-CM injury coding.
Two hundred ninety-five injury descriptions from 135 consecutive patients treated at a level-I trauma center were coded by three human coders (H1, H2, H3) and by TRI-CODE (T), a PC-based artificial intelligence software program. Two study coders are nationally recognized experts who teach AIS coding for its developers (the Association for the Advancement of Automotive Medicine); the third has 5 years experience in ICD and AIS coding. A "correct coding" (CC) was established for the study injury descriptions. ⋯ Coders H1 and H2 were in excellent agreement. Coder H3 was in good agreement with H1 and H2. However, errors among the human coders often occur for different codes, accentuating the variability.(ABSTRACT TRUNCATED AT 250 WORDS)
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To evaluate the role of nonoperative management in the treatment of blunt liver trauma we examined all victims of blunt hepatic trauma admitted to our institution during a 36-month period under a protocol of nonoperative management. One hundred twenty-six patients had the diagnosis of blunt hepatic injury confirmed by abdominal computed tomographic (CT) scanning, surgical exploration, or autopsy. Twenty-four patients went to the operating room without CT scanning because of hemodynamic instability (16), peritoneal signs (two), or positive results on DPL (six). ⋯ The transfusion requirement in the first 24 hours for the nonoperative group was significantly lower than that for the group undergoing surgery (1.2 +/- 1.7 vs. 12.2 +/- 14 units). There were no instances of hemobilia, intrahepatic bile collections, or abdominal abscess in the nonoperative group. The grade of hepatic injury as diagnosed by CT scan does not predict the need for surgery.(ABSTRACT TRUNCATED AT 250 WORDS)
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It has been suggested that the adult respiratory distress syndrome (ARDS) is a manifestation of a generalized vascular permeability defect. Low-level urinary albumin excretion reflects changes in systemic vascular permeability in a variety of acute inflammatory conditions including trauma. To test the hypothesis that impaired pulmonary function is associated with increased systemic vascular permeability, 44 trauma patients with Injury Severity Scores (ISS) ranging from 9 to 75 were studied over 3 days. ⋯ During the first posttrauma period the log ACR and the PO2/FIO2 ratio were inversely related (r = -0.712; p < 0.001), and the log ACR predicted PO2/FIO2 independent of ISS (p = 0.001). The log mean ACR (SD) for groups I and III were 34.0 (5.6) and 8.7 (2.9) mg/mmol, respectively (Mann Whitney p = 0.013). Following trauma, pulmonary dysfunction is associated with increased vascular permeability in remote organs.
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A case of a 28-year-old man surviving traumatic hemipelvectomy is presented. This patient is the first reported survivor in Australia of traumatic hemipelvectomy and one of few survivors reported in the world literature. ⋯ Associated dislocation of the contralateral hip with sciatic nerve damage and subsequent heterotopic calcification has not been previously reported and presents a significant obstacle to rehabilitation. Early attention to the psychological status of the patient and early involvement of rehabilitation specialists is advocated.
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Multicenter Study
Measuring health status among survivors of burn injury: revisions of the Burn Specific Health Scale.
This study examined the reliability of a revised version of the Burn Specific Health Scale (BSHS). Two hundred fifty-four former patients recruited from eight burn centers in the southeastern United States participated in the study. Data were collected via chart review and mailed questionnaire. ⋯ Each subscale exhibited a high level of reliability (Cronbach's alpha ranged from 0.82 to 0.94). Each subscale also correlated in a predictable manner with measures used for validation. The revised measure should improve the ability of both researchers and clinicians to assess the impact of non-fatal burn injury accurately and comprehensively.