J Trauma
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Comparative Study
Comparison of the costs of acute treatment for gunshot and stab wounds: further evidence of the need for firearms control.
Gun control is proposed primarily to decrease the incidence of injury and death from gunshot wounds (GSWs). We hypothesize that decreasing the number of GSWs will also produce significant economic savings, even if personal violence were to continue at the same rate, maintaining the same overall incidence of penetrating trauma. We analyzed charges and reimbursements for the treatment for all patients with GSWs (n = 1116) and stab wounds (SWs) (n = 1529) admitted to a level I trauma center from 1986 through 1992. ⋯ Thus, if all patients with GSWs instead suffered SWs, there would be an annual savings of $1,290,000 overall and of $981,000 of public funds from this institution alone. Treatment costs for GSWs are higher than those for SWs and are rising more rapidly, with an increasing amount of public funds going to meet these costs. Considerable savings to society would accrue from any effort that decreased firearm injuries, even if the same level of violence persisted using other weapons.
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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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We present an uncommon case of traumatic atlantoaxial distractive instability which manifested itself clinically in a respirator-dependent quadriplegic. The initial radiographic finding was anterior atlantoaxial dislocation. The patient was managed initially by halo traction and, 8 weeks later, demonstrated occipitocervical fusion with gratifying results.
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A case of blunt extraperitoneal rupture of the right hemidiaphragm and an accompanying abnormal hepatobiliary scan that revealed the rupture are presented. Associated major injuries, the fact that right-sided ruptures have less immediate herniation, and plugging of the defect by the liver are difficulties that can be encountered in establishing the diagnosis. Most diagnostic tests are not helpful and about half of these ruptures are found at laparotomy or thoracotomy. All should be closed surgically.
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The accuracy and reliability of the relationship between arterial and end-tidal carbon dioxide (PETCO2 and PaCO2), expressed as the gradient, P(a-ET)CO2, was assessed with 171 comparisons in nine mechanically ventilated trauma patients. The P(a-ET)CO2 was 14 +/- 11 mm Hg. (mean +/- standard deviation.) The positive correlation between PaCO2 (44 +/- 10 mm Hg) and PETCO2 (30 +/- 10 mm Hg) for the study population (reflected by r = 0.64, p = 0.001; but r2 = 0.41) indicated statistical significance, but only 40% of the changes reflected a linear relationship. ⋯ Changes in PETCO2 erroneously predicted the PaCO2 changes in 27% of comparisons with 15% false decreases and 12% false increases. Trends in P(a - ET)CO2 magnitude are not reliable, and concordant direction changes in PETCO2 and PaCO2 are not assured.