The American surgeon
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The American surgeon · Jan 2009
The number of gunshot wounds does not predict injury severity and mortality.
It is presumed that as the number of gunshot wounds (GSWs) increases, so do the Injury Severity Score (ISS) and mortality risk. We hypothesized that the number of bullet wounds relates to ISS and death; however, a single GSW to the head is ominous. We reviewed the charts of all GSW patients admitted to a trauma center from 2004 to 2006 (n = 531). ⋯ For those who sustained both head and body GSWs, each additional GSW did not increase mortality (r2 = 0.007). Our study shows that the number of GSWs has no affect on mortality or ISS. Internal triage and management of gunshot victims should not be affected by the categorization of patients as having a single versus multiple GSWs.
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The American surgeon · Jan 2009
Enterocutaneous fistula complicating trauma laparotomy: a major resource burden.
Enterocutaneous fistula (ECF) is an uncommon and poorly studied postoperative complication. The objective of this study was to analyze the incidence and resource utilization of patients who developed an ECF after trauma laparotomy. All patients with an ECF occurring after trauma laparotomy at a Level I trauma center were identified through a review of both the Trauma Registry and the Morbidity and Mortality reports for a 9-year period ending in December 2006. ⋯ The development of an ECF was associated with significantly increased ICU length of stay (28.5 +/- 30.5 vs 7.6 +/- 9.3 days, P = 0.004), hospital length of stay (82.1 +/- 100.8 vs 16.2 +/- 17.3 days, P < 0.001), and hospital charges ($539,309 vs $126,996, P < 0.001). In conclusion, the development of an enterocutaneous fistula after laparotomy for trauma resulted in a significant impact on resource utilization including longer ICU and hospital length of stay and higher hospital charges. Further investigation into the prevention and treatment of this costly complication is warranted.
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The American surgeon · Jan 2009
Persistent hyperglycemia in severe traumatic brain injury: an independent predictor of outcome.
In patients with severe traumatic brain injury (TBI), admission hyperglycemia is associated with poor outcome. The effect of persistent hyperglycemia (PH) on outcome in severe TBI, however, remains unknown. We performed a retrospective review of all blunt trauma patients with severe TBI (head Abbreviated Injury Score > or = 3) admitted to the intensive care unit at a Level I trauma center from January 1998 through December 2005. ⋯ Patients with PH were older, more severely injured, and had worse head injury compared with patients without PH. After adjusting for significant risk factors, PH was identified as an independent risk factor for mortality (odds ratio (OR): 4.91 [95% confidence interval (CI), 2.88-8.56, P < 0.0001]). PH is associated with significantly higher mortality rates in severe TBI patients.
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The American surgeon · Jan 2009
Letter Case ReportsHigh-pressure water jet injury to the neck and arm.