J Trauma
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To determine the current role of rural hospitals and prehospital agencies in the care of motor vehicle crash victims in a remote, rural county prior to the statewide regionalization of trauma care. Specifically, we determined the proportion of crashes that required a response by emergency medical services (EMSs), the timeliness of the response, the proportion of patients treated in local hospitals, and the factors that predicted referral to trauma centers. ⋯ The linkage of data from police, prehospital agencies, and hospitals can reveal important information about the sequence of health care for trauma patients. The rural hospitals in this county currently play a major role in the stabilization and treatment of motor vehicle crash victims.
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To identify characteristics of blunt trauma admissions associated with mortality and to derive a linear logistic model for predicting the probability of mortality. ⋯ The authors propose that use of this model may provide a more accurate evaluation of the mortality of British trauma admissions than would be obtained using models based on data from American trauma cases.
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Cultured autologous epithelium in patients with burns of ninety percent or more of the body surface.
The increasing survival of patients with very large burns has driven an interest in innovative permanent wound closure techniques, one of which is the use of cultured autologous epithelium (CAE). To document our ability to achieve wound closure with CAE in patients with very large burns, we report our 19-month experience with this technology in five patients with burns of 90% or more of the body surface. ⋯ The initial enthusiasm for CAE has been tempered by demonstrations of low-initial engraftment rates, graft fragility, delayed graft loss, and cost. Such liabilities become more tolerable as usable donor site decreases below 5% to 10% of the body surface. CAE can materially contribute to wound closure in patients with very extensive burns, but gram-negative sepsis is associated with complete graft loss.
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Multicenter Study
Validation of TRISS and ASCOT using a non-MTOS trauma registry.
To validate the Trauma and Injury Severity Score (TRISS) and A Severity Characterization of Trauma (ASCOT) models for patients with blunt injuries using an independent trauma registry, and to develop new TRISS and ASCOT models for types of patients with blunt injuries and examine their fit. ⋯ New TRISS and ASCOT coefficients should be derived if survival for patients with blunt injuries is to be predicted accurately in independent trauma registries. Also, it may be wise to consider developing separate models for subgroups of patients, particularly if hospitals in the registry have different mixes of patient types.
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The pain associated with multiple rib fractures can be surprisingly variable. The objective of this study was to determine the efficacy of an indwelling, percutaneously placed intercostal catheter in relieving the pain associated with multiple rib fractures. ⋯ These results confirm that an indwelling intercostal catheter provides a continuous nerve block resulting in a simple, safe procedure that can ameliorate the pain and splinting associated with multiple rib fractures. Although we experienced no complications, additional investigation is clearly needed.