J Trauma
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To develop a simple model for identification of trauma patients who are likely to have a blood alcohol concentration > or = 50 mg/dL (BAC + 50). ⋯ Injured patients with a high probability of being alcohol positive can be identified using a simple scoring system based on readily available demographic and clinical information.
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Reliable prediction of outcome after head injury is a daunting task. Although previous reports have highlighted the difficulties of determining outcome in the cohort of severe head injury Glasgow Coma Scale (GCS) score < or = 8), we wondered within the very severely injured population (GCS score 3-5) if a simple combination of clinical parameters may be predictive of poor outcome. ⋯ Within the population of very severely head injured patients (GCS score 3-5), the simple combination of age and admission GCS score appears to predict accurately non-functional outcome in almost one third of patients. If confirmed at other centers, this may have wide-ranging implications regarding counseling of families, utilization of resources, and the design of head injury studies.
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To determine the frequency and extent of hemothorax, pneumothorax, and hemopneumothorax missed by auscultation in penetrating chest injury. ⋯ Hemopneumothorax and hemothorax are the conditions most likely to be missed by auscultation, especially in patients with gunshot wounds. Auscultation has a high positive predictive value because it indicates injury with a fair degree of certainty; however, a negative auscultation does not rule out injury.
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To determine the neurologic risks associated with early fracture fixation (FF) in multitrauma patients with head injuries. ⋯ Early FF leads to greater fluid administration in patients with head injuries. Hypoxemia and hypotension, risk factors for secondary brain injury, may contribute to a poor neurologic outcome after early fixation. Prospective studies evaluating the impact of the timing of FF on head injury are indicated.
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Comparative Study
Statewide, population-based, time-series analysis of the frequency and outcome of pulmonary embolus in 318,554 trauma patients.
The low occurrence, nonspecific signs and symptoms, and high rate of associated morbidity and mortality of pulmonary embolus (PE) create major problems in the prevention, diagnosis, and treatment of PE. The purpose of this study was to analyze the frequency and outcome of PE in an entire state's trauma population using a large, population-based, hospital discharge data base. With the inclusion of an entire population, the reported incidence, high risk groups of patients, and specific risk factors regarding PE were assessed. A multivariate, logistic regression model was created from the data to determine predictive power of selected risk factors in patients at risk. ⋯ Using a large, population-based data base, we were able to determine the reported incidence of PE among trauma patients and establish specific risk factors. The reported incidence of PE in this population is low, 0.30%. The mortality among those with PE, however, is significant at 26%. In this study, age, Injury Severity Score, and injury to specific body regions (soft tissue, extremity, chest) were associated with an increased risk of PE. The investigation of prophylaxis of PE and the general management of injured patients may be influenced by the overall low reported frequency of PE and the specific high risk populations described in this study. In light of the low incidence of PE in patients without specific risk factors, prophylactic interventions cannot be routinely recommended unless their benefits clearly outweigh their risks.