Articles: trauma.
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Cahiers d'anesthésiologie · Jan 1991
[Complications of local and regional anesthesia. An analysis of closed files of insurance companies].
We report a review of closed insurance claims for local and regional anaesthesia mishaps in the main private professional insurance companies. Twenty eight cases with extensive written documentation were discovered, spanning a 6 years interval between 1983 and 1989, involving 21 epidural, 6 spinal and 1 caudal anaesthesias, half with surgical and half obstetrical indication, and excluding all other blocks. Twenty four out of the 28 patients were relatively healthy. ⋯ Twenty two had a poor outcome: 8 deaths, 7 severe neurological injuries, a baby was dead and another child had severe neurobehavioral sequellae. The author points out the limitation of this study--a biased sample of all adverse events and inability to derive an incidence. However some of these events reveal patterns of anaesthetic management which lead to poor outcomes.
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Over a 3 1/2-year period, a series of 20 chronic pain patients with back pain and with documented organic difficulties were treated by means of implanted spinal cord stimulation. Short-term treatment outcome was found to be significantly related to diagnosis, with single nerve root injury and mononeuropathy patients having better treatment outcomes than arachnoiditis patients with multiply injured nerve roots. Outcome was not related to the psychological evaluation, or age, sex, number of previous pain surgeries, pain location, the Minnesota Multiphasic Personality Inventory, or the Pain Assessment Index. Implications for patient selection are discussed.
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Journal of neurosurgery · Oct 1986
California Association of Neurological Surgeons' Emergency Services Committee report: guidelines for establishment of trauma centers.
The CANS supports the concept of organized neurological trauma care consisting of an appropriate amalgamation of prepared communities, institutions, and adequate numbers of committed neurosurgeons. It further supports the guidelines of the ACS regarding institutions designated to receive trauma cases. ⋯ It supports the concept of prehospital triage of trauma victims as conducted by well-trained field personnel and reasonable triage criteria agreed upon by the local neurosurgical community. It further supports audit systems that include neurosurgeons to assess and improve the quality of neurosurgical care.