The American journal of orthopedics
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We conducted this study to evaluate the hypothesis that the need for a higher level of care is the most important reason for the transfer of patients with hand trauma to a level I trauma center. We prospectively assessed 53 patients transferred to our level I trauma center for evaluation of an acute hand injury. ⋯ On the basis of injury severity, we judged that 40 of the 53 patients required the immediate care of a hand surgeon but that only 13 required the resources of a level I trauma center. Most of the patients were transferred without prior evaluation by a hand surgeon, despite there being an on-staff surgeon at many of the hospitals.
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Pulmonary embolism (PE) is a potentially fatal complication of total joint arthroplasty. Therefore, it is essential to have reliable means for diagnosis and evaluation of severity. In the study reported here, we evaluated the reliability of common clinical signs and symptoms in the diagnosis of PE. ⋯ Overall, clinical signs and symptoms as well as severity of hypoxia did not correlate with size and location of PE. Patients with PE demonstrated a significant decrease in arterial oxygen content; an abnormal alveolar-arterial gradient was the most consistent finding in these patients. Common clinical signs and symptoms, as well as changes in vital signs, have a low sensitivity for diagnosis.