Injury
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In patients with severe head injuries, transportation to a trauma centre within the "golden hour" are important markers of trauma system effectiveness but evidence regarding impacts on patient outcomes is limited. ⋯ A survival benefit exists in patients arriving earlier to hospital after severe head injury but the benefit may extend beyond the golden hour. There was evidence of improved functional outcomes in patients arriving within 60 min of injury time.
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Greater Sydney Area Helicopter Emergency Medical Service (GSA-HEMS) operates a doctor and paramedic team providing pre-hospital and inter-hospital retrieval. Falls are an important cause of morbidity and mortality among trauma patients. In NSW, patients injured by falling comprise 38% of those with serious to critical injuries (ISS>15). The mortality of falls in this group is 15.2%, higher than the mortality rate for other common injury mechanisms. Mortality rate for high falls (>5m) is similar to that of low/medium falls. ⋯ Our experience describes a HEMS system that is often called to falls not just based on injury severity or requirement for advanced pre-hospital intervention, but also due to geographical and topographical impediments to access and transport of the patient by ground. This may have implications in forward planning and activation of HEMS services.
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Multicenter Study Comparative Study
Liver cirrhosis but not alcohol abuse is associated with impaired outcome in trauma patients - a retrospective, multicentre study.
Liver cirrhosis has been shown to be associated with impaired outcome in patients who underwent elective surgery. We therefore investigated the impact of alcohol abuse and subsequent liver cirrhosis on outcome in multiple trauma patients. ⋯ Patients suffering from liver cirrhosis presented impaired outcome after multiple injuries. Pre-existing condition such as cirrhosis should be implemented in trauma scores to assess the individual mortality risk profile.
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Comparative Study
Selective non-operative management of abdominal gunshot wounds: survey of practise.
There is a growing body of evidence attesting to the effectiveness and safety of selective non-operative management (SNOM) of abdominal gunshot wounds. However, much of the research which supports this conclusion has originated from a few centres, and the actual utilisation of SNOM by trauma surgeons is not known. We therefore conducted a survey to assess the acceptance of this strategy and evaluate variations in practise. ⋯ SNOM of abdominal gunshot wounds is practised by trauma surgeons in all four countries surveyed, but is not universally accepted, and there are variations in how it is practised.