The American surgeon
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The American surgeon · Mar 2002
Comparative StudyFactors affecting the outcome of patients with splenic trauma.
This is a report of 546 consecutive patients with penetrating and blunt splenic trauma seen over a 17 1/2-year period (1980-1997). The etiology of the splenic injuries and the associated mortality rates were: blunt injuries 45 of 298 (15%), gunshot wounds 48 of 199 (24%), and stab wounds four of 49 (8%). The overall mortality rate was 97 of 546 (18%). ⋯ Operative splenic salvage is reduced in patients subjected to laparotomy who are candidates for nonoperative treatment. Improved results with splenic injury should be obtained by rapid control of bleeding. This may require more liberal criterial in selecting patients with splenic trauma for early operative treatment.
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The American surgeon · Mar 2002
Comparative StudyEvaluation of vascular injury in penetrating extremity trauma: angiographers stay home.
The debate over the use of diagnostic angiography (DA) to exclude arterial injury in penetrating extremity trauma (PET) continues. This review evaluates our current protocol for PET and identifies indications for DA. Patients presenting to our urban Level I trauma center between January 1997 and September 2000 with PET were included. ⋯ We conclude that PE with DPI is an appropriate way to identify significant vascular injuries from PET. Patients with normal PE and DPI can be safely discharged. DA is only indicated for asymptomatic patients with abnormal DPI.
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The American surgeon · Feb 2002
Impact of a voluntary trauma system on mortality, length of stay, and cost at a level I trauma center.
Trauma systems have been shown to decrease injury-related mortality; however, their development has been slow often requiring legislative codification. The purpose of this study was to evaluate the impact of a voluntary regional trauma system on outcomes at a Level I trauma center. We conducted a retrospective cohort study in an American College of Surgeons-verified Level I trauma center including all patients admitted to a Level I trauma center during the periods April 1995 through March 1996 (T-1) and April 1997 through March 1998 (T-2). ⋯ Among the most severely injured patients (Injury Severity Score > or = 16) T-2 patients had a shorter length of stay (16.5 vs 19.5 days; P < 0.05) and lower mean cost of care ($29,795 vs $34,983; P < 0.05). A voluntary trauma system can be implemented without the need for legislative mandate. After system implementation patient and financial outcomes were improved at an individual Level I trauma center.
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The American surgeon · Feb 2002
The economic benefit of practice guidelines for stress ulcer prophylaxis.
The development of practice guidelines is an effective way to provide consistent and cost-effective patient care. Despite much progress in developing practice guidelines for various other clinical problems data documenting the efficacy of these guidelines are lacking. The purpose of this study was to compare usage patterns and cost effectiveness of a stress ulcer prophylaxis guideline in a trauma intensive care unit. ⋯ No patients developed clinically important gastrointestinal bleeding. The estimated annual savings of $102,895 in patient charges and $11,333 in actual drug costs in our trauma intensive care unit were due to the implementation of stress ulcer prophylaxis guidelines. We conclude that use of practice guidelines can significantly reduce patient charges without compromising patient care.
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The American surgeon · Feb 2002
Withholding/withdrawal of life support in trauma patients: is there an age bias?
Our objective was to examine patterns of withholding/withdrawal (WH/WD) of life support in trauma patients and to determine whether WD/WH of life support is used more frequently in elderly patients. This is a retrospective cohort study of injured elderly (> or = 65 years) and young patients (< 65 years) from 1994 through 1998 treated at a surgical intensive care unit in a community tertiary-care hospital. We studied the cases of 82 patients (30 elderly and 52 young patients) with WH/WD of life support after injury. ⋯ We conclude that the elderly were no more likely to have WH/WD of life support than were younger patients. However, the older patients were less severely injured as measured by Injury Severity Score and percentage with Abbreviated Injury Score head of 5. Other factors such as the presence of pre-existing disease may influence the decision to withhold or withdraw life support to a greater degree than the actual severity of injuries.