J Trauma
-
Case Reports
Pediatric blunt liver injury and coagulopathy managed with packs and a silo: case report.
Packing the abdomen can be lifesaving when severe hepatic trauma is complicated by refractory hypothermia, coagulopathy, and continuing hemorrhage requiring large-volume transfusion. This report describes the successful use of abdominal packs and a modified silo in a child following blunt liver injury.
-
The Major Trauma Outcome Study (MTOS) is a retrospective descriptive study of injury severity and outcome coordinated through the American College of Surgeons' Committee on Trauma. From 1982 through 1987, 139 North American hospitals submitted demographic, etiologic, injury severity, and outcome data for 80,544 trauma patients. Motor vehicle related injuries were most frequent (34.7%). ⋯ Survival probability norms use the Revised Trauma Score, Injury Severity Score, patient age, and injury mechanism. Patients with unexpected outcomes were identified and statistical comparisons of actual and expected numbers of survivors made for each institution. Results provide a description of injury and outcome and support evaluation and quality assurance activities.
-
Comparative Study
Cadaveric organ donor availability: regional trauma center vs. community hospital.
Organ donor shortage is now the greatest limitation to the success of organ transplantation. To assess and compare the role of a regional trauma center in identifying and referring cadaveric organ donors to that of a community hospital, we retrospectively reviewed records of potential cadaveric organ donors during a comparable 5-year period in each. The trauma center (TC) contributed 44 donors, while the community hospital (CH) supplied seven. ⋯ Inability to obtain consent was the major obstacle in obtaining good candidates (70% at CH, 83% at TC). Failure to recognize and refer possible donors occurred in 2% of the cases at CH, compared to 0.4% at the TC. We conclude that regional trauma centers can play an important role in alleviating organ donor shortage.
-
The purpose of this study was to evaluate the ability of diagnostic peritoneal lavage (DPL) to predict intra-abdominal injuries that required surgical repair. To do this, we retrospectively reviewed 944 patients with blunt and penetrating abdominal trauma who underwent 975 DPLs. ⋯ Initial DPL in 336 patients with penetrating trauma had a sensitivity of 87%, a specificity of 89%, an accuracy of 89%, a PPV of 75%, and a NPV of 95%. When utilizing final lavage results on the 944 patients, DPL had a sensitivity of 91%, a specificity of 94%, an accuracy of 93%, a PPV of 80%, and a NPV of 98% in predicting intra-abdominal injury requiring surgical repair.