J Trauma
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Randomized Controlled Trial Comparative Study Clinical Trial
Prospective, randomized trial of hypertonic sodium lactate versus lactated Ringer's solution for burn shock resuscitation.
We prospectively randomized 51 adult burned patients on admission to study fluid, electrolyte, and physiologic parameters during burn resuscitation with the use of hypertonic saline (HSL, Na 250 mEq/L, 514 mOsm) or lactated Ringer's solution (LR, Na 130 mEq/L, 268 mOsm). Patients suffered at least 20% total body surface area burns (BSA); the mean BSA injury was 36.7% BSA, with a range of 20 to 74% BSA. All patients were admitted to our Burn Center within at least 12 hours of injury. ⋯ Regression analysis was used to compare sodium intake (mEq/kg) and fluid intake (cc/kg) between the HSL and the LR groups in relation to % BSA. Our data show no advantage of HSL over conventional therapy with LR for burn resuscitation. We were not able to demonstrate decreased fluid requirements, improved tolerance of feedings, or decrease in per cent weight gain.(ABSTRACT TRUNCATED AT 250 WORDS)
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Comparative Study
Mortality of patients with head injury and extracranial injury treated in trauma centers.
The types and severity of injuries of 49,143 patients from 95 trauma centers were coded according to the 1985 version of the Abbreviated Injury Scale (AIS). This paper analyzes the causes, incidence, and mortality in 16,524 patients (33.6% of the trauma center patients) with injury to the brain or skull and compares them to patients without head injury. Relative to its incidence, patients with head injury composed a disproportionately high percentage (60%) of all the deaths. ⋯ The cause of death in head-injured patients was approximated and it was found that 67.8% were due to head injury, 6.6% to extracranial injury, and 25.6% to both. Head injury is thus associated with more deaths (3,010 vs. 1,972) than all other injuries and causes almost as many deaths (2,040 vs. 2,170) as extracranial injuries. Because of its high mortality, head injury is the single largest contributor to trauma center deaths.
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Inhalation injury is a frequent complication in burned patients. Upper airway injury is reliably diagnosed endoscopically, but early diagnosis of pulmonary parenchymal injury is less reliable. Radiographic diagnosis in such cases is inconsistent. ⋯ Of these patients with serious inhalation injury, 84% showed some abnormality on CXR within 48 hours after injury. When abnormalities were present on CXR, pulmonary dysfunction (increases EVLW, increases Qs/Qt, decreases compliance) was clinically important. These data suggest that this grading scale may have utility in reports of CXR findings in inhalation injury.
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Two hundred five patients with stab wounds to the back were evaluated with CT scans using both oral and IV contrast material. One hundred sixty-nine patients had a negative scan. Thirty (17.8%) of the 169 patients were operated upon because of clinical concern. ⋯ Ten of these 15 patients had minor isolated renal or hepatic injuries seen on scan. None of these developed complications. It is concluded that abdominal computed tomography, with a sensitivity of 89%, specificity of 98%, and accuracy of 97% is a reliable study in the evaluation of patients with stab wounds to the back.