American journal of surgery
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The impulse to catalogue injuries is as old as human history, but the actual measurement of injury severity began only 40 years ago. The rapid development of objective measures for trauma required enormous investments of time and money to accrue large enough data bases to validate these measures. Tools are now available to measure both physical injury (injury severity score) and physiologic injury (revised trauma score), as well as their synergistic combination into the probability of survival score, and these tools are in everyday use at most trauma centers. ⋯ The current injury severity scoring system is based on clinically assigned injury severity rather than measured outcome, and considers only one injury per body region. Both of these shortcomings should be addressed. The advent of large computerized data bases will facilitate this process.
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A major problem for patients who survive a traumatic injury is morbidity due to infectious complications; this risk increases when there is injury to the liver, pancreas, or colon, the abdominal trauma index is > 25, and/or surgery is prolonged. For major injuries of either the liver or pancreas, the use of closed suction drainage decreases the risk of infection; sump drainage should be avoided. ⋯ A brief course of appropriate antibiotic treatment should be initiated as soon as possible after wounding and should be continued for 24 hours. Prolonged courses of antibiotic provide no added benefits.