The American surgeon
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The American surgeon · Jan 1998
Comparative StudyInterhospital versus direct scene transfer of major trauma patients in a rural trauma system.
The purpose of organized trauma systems is to ensure the expeditious transfer of seriously injured patients to the facility best equipped to care for their injuries. Patients are referred to our trauma center, either by ambulance or helicopter, directly from the scene or through interhospital transfer. We examined the difference in outcome between those patients sent directly to the trauma center versus those seen at other hospitals and subsequently referred to the trauma center. ⋯ In addition, there were significantly fewer deaths in patients with a probability of survival > 0.5 and a slightly lower overall mortality in those patients who survived at least 1 day. This study demonstrates that patients with major trauma taken directly to the trauma center had shorter hospital and intensive care unit stays and lower mortality. The study supports the paradigm that, when possible, major trauma patients should be sent to trauma centers directly from the injury scene.
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The American surgeon · Jan 1998
The long-term complications of percutaneous dilatational tracheostomy.
Percutaneous dilatational tracheostomy was adopted at our institution, because it was demonstrated to be more cost effective than standard open tracheostomy in critically ill patients. The objective of this study was to evaluate the long-term outcome and complication rate of percutaneous dilatational tracheostomy in critically ill patients. We performed a consecutive case study of all Level I trauma patients from August 1991 to May 1994 who underwent percutaneous dilatational tracheostomy. ⋯ Of the study group patients undergoing percutaneous dilatational tracheostomy, 27 per cent complained of symptoms a minimum of 1 year posttracheostomy. Of these patients, 60 per cent underwent fiberoptic laryngoscopy, and no subglottic lesions were identified. Our findings suggest that percutaneous dilatational tracheostomy is a safe, cost-effective alternative to standard tracheostomy in critically ill patients.
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The American surgeon · Jan 1998
Method of urinary diversion in nonurethral traumatic bladder injuries: retrospective analysis of 70 cases.
Management of intraperitoneal, nonurethral bladder injuries by urinary diversion using suprapubic (SP) catheters versus transurethral (TU) Foley catheters was examined retrospectively in a attempt to determine which were most effective. A total of 8500 trauma admissions (6/89-1/96) were screened for bladder injuries. Mechanism, degree, treatment, and morbidity of injury in association with SP or TU Foley catheter placement were evaluated. ⋯ No urethral strictures, urinary tract infections, or retention occurred in isolated bladder injuries treated with TU catheters alone. Average SP and TU catheter duration was 42 and 13 days, respectively. TU catheters for management of blunt and penetrating bladder trauma are effective, cause fewer strictures and less morbidity, and may be removed more rapidly than SP catheters for any degree of bladder injury.