Journal of trauma management & outcomes
-
J Trauma Manag Outcomes · Jan 2014
Mortality after road traffic crashes in a system with limited trauma data capability.
Africa has 4% of the global vehicles but accounts for about one tenth of global vehicular deaths. Major trauma in Kenya is associated with excess mortality in comparison with series from trauma centers. The determinants of this mortality have not been completely explored. ⋯ Trauma mortality rates in this study exceed those from mature trauma systems. Head injury and injury severity based on the ISS are independent predictors of mortality after traffic trauma. Improvements in neurosurgical and critical care services ingrained within wider primary and secondary prevention initiatives are logical targets.
-
Aim of this study was to evaluate prognosis of severely injured patients. ⋯ Even severely injured patients after multiple trauma have a good prognosis. The ISS is an established tool to assess severity and prognosis of trauma, whereas prediction of clinical outcome cannot be deducted from this score.
-
J Trauma Manag Outcomes · Jan 2013
Inter-observer reliability assessment of the Schatzker, AO/OTA and three-column classification of tibial plateau fractures.
The purpose of our study was to evaluate inter-observer reliability of the Three-Column classifications with conventional Schatzker and AO/OTA of Tibial Plateau Fractures. ⋯ Three-Column classification, which is dependent on the understanding of the fractures using CT scans as well as the 3D reconstruction can identity the posterior column fracture or fragment. It showed "substantial agreement" in the assessment of inter-observer reliability, higher than the conventional Schatzker and AO/OTA classifications. We finally conclude that Three-Column classification provides a higher agreement among different surgeons and could be popularized and widely practiced in other clinical centers.
-
J Trauma Manag Outcomes · Jan 2012
Calculating trauma triage precision: effects of different definitions of major trauma.
Triage is the process of classifying patients according to injury severity and determining the priority for further treatment. Although the term "major trauma" represents the reference against which over- and undertriage rates are calculated, its definition is inconsistent in the current literature. This study aimed to investigate the effects of different definitions of major trauma on the calculation of perceived over- and undertriage rates in a Norwegian trauma cohort. ⋯ Although the proportion of patients who were defined as having sustained major trauma increased when NISS-based definitions were substituted for ISS-based definitions, the outcomes of the triage precision calculations did not differ significantly between the two scales. Additionally, expanding the purely anatomic definition of major trauma by including proximal penetrating injury, 30-day mortality, ICU LOS greater than 2 days and transferred intubated out of the hospital at ≤2 days did not significantly influence the perceived triage precision. We recommend that triage precision calculations should include anatomical injury scaling according to NISS. To further enhance comparability of trauma triage calculations, researchers should establish a consensus on a uniform definition of major trauma.
-
J Trauma Manag Outcomes · Jan 2012
The song remains the same although the instruments are changing: complications following selective non-operative management of blunt spleen trauma: a retrospective review of patients at a level I trauma centre from 1996 to 2007.
Despite a widespread shift to selective non-operative management (SNOM) for blunt splenic trauma, there remains uncertainty regarding the role of adjuncts such as interventional radiological techniques, the need for follow-up imaging, and the incidence of long-term complications. We evaluated the success of SNOM (including splenic artery embolization, SAE) for the management of blunt splenic injuries in severely injured patients. ⋯ SNOM was the initial treatment strategy for most patients with blunt splenic trauma with 13% requiring subsequent operative intervention intended for the spleen. Cases of delayed splenic rupture occurred up to two months following initial injury. The low use of both follow-up imaging and SAE make assessment of the utility of these adjuncts difficult and adherence to formalized protocols will be required to fully assess the benefit of multi-modality management strategies.