J Trauma
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Comparative Study
Does on-scene resuscitation affect in-hospital "do not resuscitate" decisions and mortality in patients with severe head injuries?
To evaluate the effect of on-scene versus in-hospital resuscitation of patients with severe head injuries with regard to "do not resuscitate" (DNR) decisions and in-hospital mortality, 561 patients were prospectively studied. Patients were grouped according to whether resuscitation initially occurred at the scene of the injury (group 1), in a regional hospital before transfer (group 2), or after direct admission to our neurosurgical center (group 3). ⋯ We conclude, however, that primary aggressive treatment at the scene of the injury did not increase DNR and in-hospital mortality rates within the 48-hour follow-up period, nor for the total stay in the SICU. Investigation of long-term outcome will be important to further establish the efficacy of this approach.
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Review Case Reports
Delayed myelopathy after a stab wound with a retained intraspinal foreign body: case report.
A case of delayed myelopathy appearing 15 years after a stab wound to the thoracic spine with a retained foreign body in the spinal canal is reported. Severe inflammatory reaction to iron corrosion was found, with granuloma and sterile pus formation. Removal of the foreign body and partial excision of the granuloma resulted in clinical improvement. Reaction to foreign body corrosion is believed to be the major cause of delayed neurologic deficit and is an important guideline for removal of asymptomatic intraspinal foreign bodies.
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The Abbreviated Injury Scale (AIS) score and the Injury Severity Score (ISS) were calculated for all passengers and crew of the M1 Kegworth aircraft crash. Regional injury scores were significantly higher in nonsurvivors than survivors of the impact. ⋯ The use of injury scoring has highlighted variations in the severity of injuries sustained by occupants involved in an impact crash of an airliner. This information has demonstrated that other factors in addition to the force of the impact were involved in the causation of injury, such as structural integrity, attempts by occupants to protect adjoining passengers, and rear-facing seats.