J Trauma
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Occult fractures of the scaphoid bone occur frequently and may lead to nonunions. In a prospective blind study, we performed magnetic resonance imaging (MRI) examinations on 32 patients who had sustained a wrist injury and in whom a scaphoid fracture was clinically suspected, but could not be confirmed on the original set of two routine and four scaphoid view radiographs. The MRI examinations were performed an average time of 2.8 days after the trauma. ⋯ Sensitivity and specificity of MRI were 100%. This conventional method could save $7,200 (US) per 100,000 inhabitants in providing an immediate and correct diagnosis and avoiding unnecessary cast immobilization. Additional injuries that may be misdiagnosed by conventional radiographs are also detected with a specificity and sensitivity of 100%.
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To determine the preventable death rate (PDR) and the frequency and types of inappropriate medical care in a large, rural region of Michigan. ⋯ A relatively small percentage of trauma fatalities in rural Michigan could have been prevented by more appropriate or timely medical care. Efforts to improve the care of injured persons in rural Michigan should be directed primarily at the emergency department and inpatient phases of trauma system care.
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The present trend towards conservative management of hemodynamically stable pediatric trauma patients may be increasing the risk of delay in the diagnosis of traumatic hollow viscus perforations (HVP). The purpose of this study is to determine whether there is a delay in the diagnosis of HVP because of expectant management. A survey of factors leading to diagnostic delay was also made and the value of current diagnostic tools were reevaluated. ⋯ There is an apparent delay in the diagnosis of traumatic HVP in this series. Signs of peritoneal irritation are the most consistent findings of HVP after blunt abdominal trauma in children. Persistence of abdominal signs indicates peritoneal lavage, which has a high diagnostic sensitivity for HVP compared to other diagnostic modalities.
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Provincial air ambulance transports of injured patients were quality reviewed prospectively to determine utilization and appropriateness of care. ⋯ A low overtriage rate was documented, raising concerns that the undertriage rate may be too high. Injured patients air transported without physician accompaniment more often received inappropriate care, suggesting that physician accompaniment is beneficial.
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To determine whether abnormal results of admission serum chemistry profiles (P7: sodium (Na), potassium (K), chloride (Cl), carbon dioxide content (CO2), blood urea nitrogen (BUN), creatinine (Cr), and glucose (GLU), amylase (AMY), and coagulation profiles (CP: prothrombin time (PT) and partial thromboplastin time (PTT) in trauma patients lead to clinical interventions, and to characterize frequency of abnormal results, we prospectively gathered laboratory data on 500 consecutive patients seen in our Level 1 trauma center. Clinicians were blinded to the study. ⋯ We conclude that information provided by routine admission chemistry and coagulation profiles in trauma patients seldom lead to clinical interventions. These tests should not be ordered routinely on admission in trauma patients.