J Trauma
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The purpose of this study was to identify risk factors for thoracic/lumbar spine fractures in patients with blunt injuries and subsequently establish indications for obtaining surveillance thoracolumbar radiographs. Retrospective review of all patients with blunt injuries (n = 1485) admitted in 1992 to a level I trauma center with a discharge diagnosis of thoracolumbar spine fracture established entrance criteria for a 4-month prospective study. Relative risk of fracture (RR) was calculated. ⋯ Our data define these indications for obtaining thoracolumbar radiographs in patients with blunt injuries: back pain (RR1), fall > or = 10 feet, ejection from motorcycle/motor vehicle crash > or = 50 mph, GCS score < or = 8, (all RR2), and neurologic deficit (RR10). The sensitivity of our surveillance radiography protocol has increased to 100%. The absence of back pain does not exclude significant thoracolumbar trauma.
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Penetrating thoracoabdominal trauma presents a difficult diagnostic dilemma. Violation of the diaphragm may be very difficult to establish. Conventional diagnostic procedures such as chest radiography, computed tomography, and diagnostic peritoneal lavage have been shown to be unreliable. ⋯ There were no procedure-related complications. Thoracoscopy is a safe, accurate, reliable diagnostic technique for evaluating thoracoabdominal penetrating trauma. It is less invasive than celiotomy and has the added benefit of diagnosis and therapy of the intrathoracic injuries.
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A possible way to circumvent the continuing decline in the number of autopsies is to perform computed tomography after death. The present study compares the pathologic findings of postmortem CT tomography (PMCT) in trauma fatalities with those disclosed upon conventional forensic autopsy. Within 6 hours of death, the bodies of 25 trauma victims underwent total body CT scanning, all with permission of the relatives, followed by conventional autopsy in 13 cases under court order. ⋯ In all, PMCT revealed 70.5% and autopsy 74.8% of the pathologic states. Although PMCT was not more effective than conventional autopsy in exposing pathologic entities, it increased the yield of findings when combined with conventional autopsy. Where conventional autopsy is unattainable, PMCT may be effective in shedding light on the pathologic state and mechanism of death in trauma fatalities.
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An instrument was developed using routinely available field data to identify the sizable subgroup of stable vehicular trauma victims initially triaged to the trauma center by mechanism indicators alone who are in reality at minimal risk for serious injury. The six most common vehicular mechanism indicators seen at a level I trauma center were evaluated: rollover, head-on greater than 30 mph, intrusion, prolonged extrication, other death in same vehicle, and ejection. Review of 1235 consecutive trauma team activations yielded 349 victims with a qualifying vehicular mechanism. ⋯ Retrospectively, use of this instrument would have excluded 56% of the MI group from unproductive trauma team referral, but nearly none of the SI group. We conclude that an identifiable subset of trauma patients referred by vehicular mechanism criteria alone could be safely evaluated on arrival in the emergency department as a form of secondary triage rather than by referral to the trauma team. The use of an appropriate exclusionary instrument can still preserve the sensitivity of trauma team activation for severely injured victims.
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Retraction Of Publication
Retraction of papers published in The Journal of Trauma.