J Trauma
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The Acute Physiology and Chronic Health Evaluation (APACHE) II system is inaccurate in predicting the risk of death in trauma patients, especially those without head injury. Using multivariate analysis of the APACHE II system in a development set, a new predictive equation was modeled. The four variables that were independently associated with mortality were PaO2/FiO2 ratio, mean arterial pressure, temperature, and the need for inotropic support. This model was tested prospectively in an independent validation set of 300 patients. ⋯ The model accurately predicted the risk of death for the entire group. It is superior to the APACHE II system and is the highest reported sensitivity for 24-hour intensive care unit predictive models that have been applied to the critically injured.
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To determine if the quantity of skeletal injuries (and the timing to fixation) increases the mortality or pulmonary morbidity in patients with and without chest injuries. ⋯ The combination of skeletal and chest injuries does not seem to amplify the pulmonary morbidity and mortality compared with chest injury alone. The quantity of the skeletal injury and the time to fixation of structures affecting mobilization seem to have an effect on pulmonary morbidity and mortality. Better scientific studies on the effects of skeletal injury and timing to fixation in relation to pulmonary morbidity and mortality are required.