Injury
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In an attempt to develop a model to measure the competence of physicians providing emergency care under difficult field conditions, 75 Israeli army medical corps physicians were evaluated through the use of four instruments: a debriefing interview, peer assessment, self-assessment and written examination. The special on-site assessment model was designed to examine actual events, enabling an assessment of performance in real situations rather than simulated cases. ⋯ It was concluded that it is advantageous to use a combination of knowledge (written examination) and performance (peer assessment or self-assessment) measures in order to arrive at a more comprehensive assessment of competence. In addition, the written examination format should be expanded and developed to include more clinical vignettes requiring treatment decisions, making this instrument a more clinically oriented measure of physician competence in trauma care.
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As part of a study of the early management of severe head injury, the use of the Glasgow Coma Score (GCS), Injury Severity Score (ISS) and TRISS was investigated. These injury scores were compared in correlating with outcome at one year as assessed by the Glasgow Outcome Score (GOS) and mortality. One hundred and thirty-one patients had a severe head injury, as defined by an ISS of 16 or higher, in whom the Abbreviated Injury Score (AIS) for craniocerebral injury was 3 or higher. ⋯ TRISS was slightly better than GCS for predicting outcome based on both GOS and mortality, however this difference was not significant. TRISS identified patients who died that are not considered as severe head injury by GCS. Use of TRISS allows the effects of systemic factors and other injuries to be taken into account when assessing severity of head injury.
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Post-traumatic multiple organ dysfunction syndrome--infection is an uncommon antecedent risk factor.
A pattern of multiple organ dysfunction syndrome (MODS) and risk factors following blunt trauma was identified, based on analyses of clinical data from 3611 patients who were admitted directly to a level I trauma centre and had hospital stays > or = 3 days. Five system dysfunctions were simultaneously associated (P < 0.05) with death (adjusted odds ratio): adult respiratory distress syndrome (ARDS) (4.9), renal failure (6.7), hyperglycaemia (3.6), recurrent acidosis (4.8) and hypoalbuminaemia (1.8). Mortality increased with the number of system dysfunctions. ⋯ Seven admission risk factors were independently associated (P < 0.003) with MODS [adjusted odds ratio]: pre-existing condition (3.4), age > 50 (3.1), Injury Severity Score > or = 25 (6.4), hypotension (2.8), acidaemia (2.2), 24 h blood loss > 1 l (3.7), and major base deficit (1.6). Only 13 per cent with MODS had an infection in the 5 days before or at initiation of MODS. Haemodynamic instability, acidosis, blood loss, pre-existing condition, age and serious injury were risk factors independently related to life-threatening MODS, but infection was an uncommon precursor except in late MODS.(ABSTRACT TRUNCATED AT 250 WORDS)
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To assess the effect of alcohol intoxication on injury severity and head injury assessment, blood alcohol concentrations (BAC) were related to the severity of injuries (Injury Severity Score and Assault Trauma Score) and Glasgow Coma Scores (GCS) in 242 consecutive victims of weekend, night-time assault, none of whom had head injuries. No correlation was found between degree of intoxication and severity of injury. ⋯ The median BAC in patients with a normal GCS was 115 mg/100 ml. Neurological assessments need to take account of the highly variable, depressive effects of alcohol.