J Trauma
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Randomized Controlled Trial Clinical Trial
Primary repair of colon injuries: a prospective randomized study.
Due to the results of a 6-year experience with civilian penetrating colon injuries at Mount Carmel/Grace Hospital, in Detroit, Michigan, which had favored primary repair of colon injuries, a prospective randomized study was performed. Seventy-one patients with penetrating colon injuries were entered in a prospective randomized study. Forty-three patients were treated with primary repair or resection and anastomosis, and 28 patients were treated with diversion. ⋯ An analysis was also made within the primary repair group comparing the subgroups of primary repair with, and without, resection of colon. It appears that the primary repair with resection of colon may have fewer complications; however, this conclusion is based on a statistically insufficient sample size. The authors contend that primary repair or resection with anastomosis is the method of choice for treatment of all penetrating colon injuries in the civilian population despite any associated risk factors for adverse outcomes.
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The aims of this study were to determine if angiographic findings can be used to predict successful nonoperative therapy of splenic injury and to determine if coil embolization of the proximal splenic artery provides effective hemostasis. ⋯ (1) Hemodynamically stable patients with splenic injuries of all grades and no other indications for laparotomy can often be managed nonoperatively, especially when the injury is further characterized by arteriography. (2) The absence of contrast extravasation on splenic arteriography seems to be a reliable predictor of successful nonoperative management. We suggest its use to triage CT-diagnosed splenic injuries to bed rest or intervention. (3) Coil embolization of the proximal splenic artery is an effective method of hemostasis in stabilized patients with splenic injury. It expands the number of patients who can be managed nonoperatively.
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The goal of this study was to evaluate helicopter transport to an urban level I trauma center from the scene of injury for patients with self-inflicted gunshot wounds to the head. ⋯ The use of helicopter scene flights from the scene of injury for patients with a self-inflicted gunshot wound to the head provides no medical advantage to the victims, but provides a high-yield source of desperately needed organs. The prompt establishment of an airway in the field may prolong patient survival long enough to allow evaluation for organ donation. Helicopter transport of these patients is justified only as a means of rapidly delivering the personnel capable of providing advanced airway skills to the scene. Patients requiring CPR in the field after isolated gunshot wounds to the head will not live long enough to become organ donor candidates; therefore, there is no benefit to helicopter transport for these patients.
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The goal of this study was to determine patient and injury characteristics that predict undertriage and overtriage. ⋯ In a developed trauma system, severely injured elderly trauma patients (especially females) are at risk for undertriage. The characteristics of patients at risk for overtriage reflect the difficulties of prospective out-of-hospital triage.