J Trauma
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The quantity of fluid retained during the first 48 hours of resuscitation has been suggested as an indicator of burn severity and mortality (13). In this study of 82 adult burned patients with more than 20% total body surface burns we found that the net fluid retention during the first 48 hours of resuscitation was a predictor of burn mortality and additionally 230 cc of retained fluid per kilogram of lean body mass in the initial 48 hours postburn was an excellent means for separating survivors from nonsurvivors. Fluid retention as an indicator of burn severity and mortality was compared to other methods of predicting burned patient mortality. ⋯ A comparison was made between fluid retention data, per cent body surface area burned, and the calculated Abbreviated Burn Severity Index and patient mortality. The power of each variable to predict mortality was evaluated by stepwise regression analysis. From this analysis net fluid retention during the first 48 hours of resuscitation was as accurate as the Abbreviated Burn Severity Index and was a better predictor of mortality than individual components of that Index.
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Comparative Study Clinical Trial Controlled Clinical Trial
Prospective randomized evaluation of antishock MAST in post-traumatic hypotension.
During an 18-month period, among 35,000 injured patients presenting to an urban trauma center, more than 3,500 were admitted, and 1,500 underwent surgery on the General Surgical Service. Three hundred fifty-two patients with prehospital systolic blood pressures of less than 90 mm Hg were randomized on an alternate day basis to receive treatment with 'MAST' (163 patients) or 'No-MAST' (189 patients). Age, mechanism of injury, prehospital management times, prehospital trauma scores, prehospital fluids administered, Injury Severity Scores, emergency center treatment, operative protocol, and calculated probability of survival were virtually identical for both groups. ⋯ There was no statistically significant difference in evaluation and outcome data between the groups. Within a controlled catchment, only 2.5% of injured patients and 22% of those undergoing operation qualified for prehospital use of MAST. We conclude that for penetrating trauma with prehospital times of 30 minutes or less, MAST provide no advantage with regard to survival, length of hospital stay, or reduced hospital costs.
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To assess the need for a trauma system in San Diego County, a concurrent audit of trauma care was performed by an independent consultant in 1982. During the study period from 15 March through 15 June 1982, 591 consecutive major trauma victims (MTV) were collected by the 30 participating hospitals. All medical records, including autopsy reports, were audited for the timeliness and appropriateness of diagnosis and definitive care. ⋯ The care of MTV was considered suboptimal in 32% of patients before regionalization, compared to 4.2% after regionalization (p less than 0.01). Preventable deaths occurred in 13.6% of fatalities occurring before implementation of a trauma system, compared to 2.7% after implementation (p less than 0.01). Regionalization of trauma care significantly reduced delays, inadequate care, and preventable deaths due to trauma.
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Performance of surgery for trauma is an important part of residency training, yet what constitutes an adequate exposure to trauma surgery is ill defined. A retrospective review of records at a metropolitan receiving hospital was carried out for the academic year 1981-1982. Of the 50,902 patients treated in the Emergency Room more than one third were seen by a surgical resident. ⋯ An adequate education in trauma must be based on a large experience in the nonoperative resuscitation, diagnosis, and treatment of trauma victims. Nevertheless, the number of cases performed as operating surgeon provides a useful means of evaluation experience in trauma. Thirty cases are suggested as an appropriate level of exposure to the surgery of trauma, yet only one third of applicants to the American Board of Surgery attained this level.
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Burn injury cases were identified from a population-based sample of trauma visits to hospital emergency departments in northeastern Ohio during 1977. The 199 cases represented 2.4% of all trauma incidence visits by residents of the five-county study region. Ninety-five per cent of the burn cases were released from the emergency department directly after treatment. ⋯ Most burns occurred at home or the workplace. The youngest employed age group sustained the highest rate of work-related burns. Hot or corrosive substances caused two thirds of all burns; fire and flames caused one fourth.