Injury
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Comparative Study
A comparison between non-powder gun and powder-gun injuries in a young pediatric population.
Non-powder guns (NPG) are viewed as toys for children by the general public. Literature on firearm injuries in the pediatric population is increasing, however there are still large gaps in the published literature regarding NPG. We intended to identify and compare the epidemiology, circumstances of injury and outcomes of children with NPG versus powder-gun injuries (GSW). ⋯ Our results highlight two important findings. First, NPG injuries were accidental and thus preventable with improved legislation and public education. Second, health disparities related to gun violence among African-Americans are prevalent even in early childhood and prevention efforts should include this younger population.
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Observational Study
Differential effects of the Glasgow Coma Scale Score and its Components: An analysis of 54,069 patients with traumatic brain injury.
The Glasgow Coma Scale (GCS) is widely used in the assessment of clinical severity and prediction of outcome after traumatic brain injury (TBI). The sum score is frequently applied, but the differential influence of the components infrequently addressed. We aimed to investigate the contribution of the GCS components to the sum score, floor and ceiling effects of the components, and their prognostic effects. ⋯ The GCS-components contribute differentially across the spectrum of consciousness to the sum score, each having floor and ceiling effects. The specific component-profile is related to outcome and the three components combined contain higher prognostic value than the sum score across different TBI severities. We, therefore, recommend a multidimensional use of the three-component GCS both in clinical practice, and in prognostic studies.
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This study aimed to provide an overview of the current falls prevention activities in community-dwelling elderly with an increased risk of falling in the Netherlands. Therefore, we determined: a) how health professionals detect community-dwelling elderly with an increased risk of falling; b) which falls prevention activities are used by health professionals and why; c) how elderly can be stimulated to participate in falls prevention programs; and d) how to finance falls prevention. ⋯ This Delphi study showed clear directions for improving falls prevention activities and how to increase participation rates.
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Review
Management of war-related vascular wounds in French role 3 hospital during the Afghan campaign.
To describe the management of war-related vascular injuries in the Kabul French military hospital. ⋯ This was the first French reported series of war-related vascular injuries during the last decade's major conflicts. The majority of injuries occurred in the limbs. Autologous vein graft remains the treatment of choice for arterial repair. Functional severity of these injuries justifies specific training for military surgeons.
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The Agency for Health Care Research and Quality (AHRQ) developed patient safety indicators (PSIs) to identify events with a high likelihood of representing medical error. The purpose of this study was to validate PSIs attributed to trauma surgeons and compare validated PSIs to performance improvement (PI) and morbidity and mortality (M&M) data. We hypothesized that PSIs are not an indicator of quality of care in trauma. ⋯ Overall, PSIs have low validity and do not reflect quality of care in trauma.