Injury
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To assess the relationship between blood alcohol concentration (BAC) and injury severity in an unselected population of road accident victims, case notes of 820 consecutive road accident victims presenting to hospital in a 12 month period were reviewed retrospectively. Five hundred and thirty-five of these were eligible for BAC analysis and results, obtained from the Victoria Police and the Road Safety and Traffic Bureau were available in 429 cases. These were expressed as mg/100 ml (per cent). ⋯ Second, the median ISS for intoxicated patients (4) was significantly higher than that for sober patients (1) (P < 0.05). Third, when patients were grouped according to ISS, the prevalence of intoxication in each group rose with increasing injury severity (chi 2: P < 0.01). We conclude that there is a significant positive correlation between BAC and injury severity in road accident victims treated at a Melbourne hospital.
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The philosophy of medical audit and methods of data collection and statistical analysis have been extensively reviewed but less has been written about the effect of audit on medical practice. The measurement of performance is only valuable if it identifies areas of concern and stimulates appropriate change. ⋯ Problems remain and there is continuing concern about trauma management in the hospital. This has been reinforced by performance feedback through the Trauma Audit Group which has attracted the interest of senior clinicians in several specialties.
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Wounds of the back and flank pose a risk of injury to retroperitoneal structures which may be missed on physical examination. Recently, a selective approach to these wounds has been advocated. In order to document the incidence, management, and outcome of patients with penetrating wounds of the back and flank, we undertook a retrospective review of patients admitted over the past 5 years. ⋯ There were no missed injuries, no deaths and no delayed operations. There were two complications in the operative group, and one liver abscess in the nonoperative group. We conclude that selective management is a safe approach in penetrating posterior abdominal trauma without obvious indications for laparotomy.
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This paper describes, by case histories and a literature review, the cause, diagnosis and therapy of pseudoaneurysm of the superficial temporal artery. Two patients with a traumatic pseudoaneurysm of the superficial temporal artery were examined by physical examination and histology of the excised lesions. Blunt injury caused a histologically proved pseudoaneurysm in two reported cases. ⋯ Pseudoaneurysm of the superficial temporal artery is an uncommon complication of blunt head injury. Symptoms are limited and diagnosis can be made by noninvasive means. A high suspicion level for arterial injury and sufficient follow-up of patients is necessary for the detection of arterial injury.
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The management of penetrating injuries of the anterior triangle of the neck is controversial and poses several problems. A policy of mandatory neck exploration of these injuries is followed in the Department of General Surgery at the State Hospital, Windhoek. A retrospective study of patients presenting to one of the four surgical firms at The State Hospital was performed to see if this policy was justified. ⋯ This may have been because exploration was limited to injuries involving the anterior triangle of the neck in this series. All 14 patients with positive clinical findings were found to have injuries at exploration and five of 13 patients (38 per cent) with no clinical signs were found to have injuries. Given these results and in the setting of The State Hospital it was felt that the policy of mandatory exploration was justified.