Annals of emergency medicine
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Observational Study
Injury Severity Score Inflation Resulting From Pan-Computed Tomography in Patients With Blunt Trauma.
All articles that demonstrate a mortality benefit from liberal pan-computed tomography (CT) use in patients with blunt trauma have relied on Injury Severity Score (ISS) to control for morbidity. This mortality benefit may be artifact, the result of an increased use of a sensitive diagnostic modality rather than a true benefit. We quantify the magnitude of ISS inflation in patients with blunt trauma who are undergoing routine pan-CT compared with patients who receive more selective scanning. ⋯ Although the median ISS for our study was lower than that of previous studies claiming a mortality benefit, ISS inflation appears to be a real phenomenon and may confound studies that use ISS to control for morbidity.
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Pediatric intubation is a core paramedic skill in some emergency medical services (EMS) systems. The literature lacks a detailed examination of the challenges and subsequent adjustments made by paramedics when intubating children in the out-of-hospital setting. We undertake a descriptive evaluation of the process of out-of-hospital pediatric intubation, focusing on challenges, adjustments, and outcomes. ⋯ Pediatric intubation by paramedics was performed infrequently in this EMS system. Although overall intubation success was high, a detailed evaluation of the process of intubation revealed specific challenges and adjustments that can be anticipated by paramedics to improve first-pass success, potentially reduce complications, and ultimately improve clinical outcomes.