J Trauma
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Common iliac artery injury from blunt trauma is uncommon. We describe two cases of common iliac artery injury from blunt abdominal trauma resulting in occlusion in one case and aneurysm in the other. ⋯ Vessel wall damage may not manifest itself initially but may result in thrombosis, subintimal hemorrhage, dissection, or aneurysmal dilatation. These can result in hemorrhage, pain, or ischemia developing remotely from the initial trauma.
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Comparative Study
Incidence, costs, and DRG-based reimbursement for traumatic brain injured patients: a 3-year experience.
A 3-year prospective study was conducted to establish the incidence of traumatic brain injury (TBI) and related characteristics of age, sex, length of stay (LOS), intensive care unit LOS (ICU/LOS), direct hospital charges, and reimbursement using a prospective DRG-based reimbursement system. The study identified TBI patients using ICD-9-Codes. The mean LOS for the two groups of patients with intracranial injury differed (p less than 0.05). ⋯ Of the 71 DRGs assigned to the study population, 15 reimbursed more than the actual charges. The severity of TBI victims and the complexity of caring for them in a Level I trauma center generates hospital charges of which only half are reimbursed through an all-payor DRG system. Strategies to correct what could be a financial disincentive are: documenting the uniqueness of this population to justify additional reimbursement, calculating a more precise mean LOS for TBI-related DRGs to more accurately identify outliers, and calculating DRG rates for TBI diagnoses derived from a representative sample at varying severity levels and hospitalized in facilities with and without rehabilitation services.
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Spinal cord injury in children frequently occurs without fracture or dislocation. The clinical profiles of 55 children with spinal cord injury without radiographic abnormalities (SCIWORA) are reported in detail to illustrate features of this syndrome. No patient had vertebral fracture or dislocation on plain films and tomographies. ⋯ The long-term neurologic outcome in children with SCIWORA is solely determined by their admission neurologic status. Realistically, the outcome can thus only be improved by: 1) ruling out occult fractures and subluxation which will require surgical fusion; 2) identifying patients likely to have delayed deterioration; and 3) preventing recurrent SCIWORA. Our experience and recommendations in these regards are discussed.
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The Trauma Score (TS) has been revised. The revision includes Glasgow Coma Scale (GCS), systolic blood pressure (SBP), and respiratory rate (RR) and excludes capillary refill and respiratory expansion, which were difficult to assess in the field. Two versions of the revised score have been developed, one for triage (T-RTS) and another for use in outcome evaluations and to control for injury severity (RTS). ⋯ RTS is a weighted sum of coded variable values. The RTS demonstrated substantially improved reliability in outcome predictions compared to the TS. The RTS also yielded more accurate outcome predictions for patients with serious head injuries than the TS.
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There were 225 patients with penetrating neck wounds admitted over a 4-year period. Mechanism of injury included stab wounds in 59%, gunshot wounds in 32%, and shotgun wounds in 9%. Location of injury was Zone 1, 16%, Zone 2, 42%, Zone 3, 18%, posterior triangle, 12%, and multiple, 12%. ⋯ There were no missed injuries in Groups 4 or 5. Two missed esophageal injuries occurred in Group 2, and a missed carotid injury occurred in Group 3. The following guidelines for management have resulted. 1) Unstable patients require immediate exploration. 2) Stable patients with equivocal physical findings can be managed according to results of esophageal examination and angiography. 3) Patients with low probability of injury due to location and clinical presentation can be observed.(ABSTRACT TRUNCATED AT 250 WORDS)