J Trauma
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Comparative Study
Functional limitation after major trauma: a more sensitive assessment using the Quality of Well-being scale--the trauma recovery pilot project.
Little is known about the degree of disability and quality of life of patients after major trauma. We conducted a prospective study to examine the incidence and predictors of functional limitation (FL). Between January 1, 1990 and March 30, 1990, 61 eligible trauma patients were enrolled in the study (admission GCS score > or = 12, LOS > 24 hours). ⋯ The QWB scores improved between discharge and follow-up; discharge mean = 0.457 (+/- 0.048), follow-up mean = 0.613 (+/- 0.118), but the mean QWB score at follow-up still reflected a significant degree of functional limitation. The mean percentage of change in QWB scores was 34.5% (+/- 25.5%) with a range of -6.34% to 103.8%. The discharge mean FDS was 29 (+/- 6.2) while the follow-up FDS mean was 17 (+/- 3.8), reflecting that most patients at follow-up reported near-perfect ADL functioning.(ABSTRACT TRUNCATED AT 250 WORDS)
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Comparative Study
The role of echocardiography in blunt chest trauma: a transthoracic and transesophageal echocardiographic study.
Previous studies assessing the value of transthoracic echocardiography (TTE) in blunt chest trauma are limited because patients with severe chest wall injury often have suboptimal echocardiographic findings. Transesophageal echocardiography (TEE) can provide high quality images when the transthoracic image quality is poor. To provide complete echocardiographic assessment of cardiac structure and function we prospectively performed TTE in 105 patients with severe blunt chest trauma and TEE in 20 of the 105 patients (19%) whose TTE examination results were suboptimal. ⋯ We conclude that myocardial contusion is common following blunt chest trauma, rarely requires treatment, and is associated with a favorable prognosis. Only patients who develop cardiac complications benefit from echocardiography. Transesophageal echocardiography is of value when the TTE examination results are suboptimal and when aortic injury is suspected.
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Comparative Study
Fiberoptic bronchoscopy for the early diagnosis of subglottal inhalation injury: comparative value in the assessment of prognosis.
The aim of this study was to determine the value of bronchoscopy in the early diagnosis of inhalation injury. A total of 130 burn patients underwent bronchoscopy on admission to a specialized center. In order to validate the method and the bronchoscopist's conclusions, they underwent staged bronchial biopsies. ⋯ In a one-dimensional analysis, bronchoscopy-proven inhalation injury was one of the most strongly predictive variables for the onset of ARDS and death. The analysis of survival curves confirmed that inhalation injury portends a bad outcome in burn patients. It was used to predict the likelihood of ARDS and death at the time of admission with a view to early specific treatment.
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The rapid treatment of patients with a severe head injury often includes prehospital intubation and sedation, but such measures compromise the ability to obtain an accurate Glasgow Coma Scale (GCS) score in the emergency department (ED). Major head injury centers in the United States were surveyed to determine how they currently obtain initial GCS scores when these or other complicating circumstances exist. A two-page questionnaire was distributed to seven members of the trauma team at 17 major neurotrauma centers in which they were asked who usually determines the initial GCS score, where they are assessed, and when. ⋯ Most neurosurgeons said that hypotension and hypoxia are stabilized before the initial GCS scores are assessed and that intubated patients receive a non-numerical designation. But the majority of non-neurosurgical ED personnel said that they determine the initial GCS scores immediately after arrival of the patients in their department, regardless of hypoxia or hypotension. There also were significant discrepancies between attending neurosurgeons and their residents with regard to who actually assesses the GCS scores and how the scores are determined for patients who have received neuromuscular paralysis or sedation or who have severe periorbital swelling.(ABSTRACT TRUNCATED AT 250 WORDS)
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A review of the literature identified a need for a prospective study of the complete range of craniofacial trauma. The aims of this study were to determine the incidence, etiology, and mechanisms of craniofacial and associated injuries, enabling a greater understanding of their range and magnitude. Nine hundred fifty consecutive patients seen at an urban university hospital with any degree of craniofacial trauma were prospectively investigated. ⋯ Craniofacial soft-tissue injuries overall occurred most frequently on the forehead, nose, lips, and chin, and a method for their classification is proposed. The commonest craniofacial fracture was that of the nasal bones (45%), followed by cranial bones (24%), mandible (13%), zygoma (13%), orbital blow-out (3%), and maxilla (2%). The incidence of craniofacial trauma can be greatly reduced by improvements in interior home design, school education in alcohol abuse and handling potentially hostile situations (especially for men), improvement in automotive safety devices and compliance by motor vehicle occupants, and utilization of full-face helmets by bicyclists and motorcyclists.