J Trauma
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The present paper explores the rationale for the development of severity indices and the role such indices can play in various research and evaluation situations. Concrete examples from Emergency Medical Services research and evaluation settings are used to illustrate the potential shortcomings of designs that fail to incorporate measures of severity. A short critical review of existing indices is presented, and the ways that the indices can be refined and improved, and better used to evaluate emergency care, are summarized.
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A patient with myocardial trauma following blunt chest injury is presented who returned 4 months later with persistent cardiac symptoms. Left ventriculography showed asynergy of the mid-diaphragmatic surface of the left ventricle while coronary angiography showed normal coronary arteries. The value of cardiac catheterization and coronary angiography in patients in whom symptoms persist after traumatic myocardial contusion and in patients in whom additional coronary artery or other cardiac disease is suspected is emphasized.