J Trauma
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Comparative Study
Differences in mortality between elderly and younger adult trauma patients: geriatric status increases risk of delayed death.
Elderly patients suffer higher mortality rates after trauma than younger patients. This increased mortality is attributable to age, preexisting disease, and complications as well as injury severity. ⋯ Elderly trauma patients more frequently suffer late mortality than younger patients because of the combination of injury and increased preexisting disease and complications after injury. Aggressive treatment of the elderly trauma patient is warranted; however, in the face of significant preexisting disease or complications, survival is less likely. Predictive models of survival can be developed, taking into account preexisting disease and complications as well as admission parameters such as age, ISS, and RTS, and specific risk of mortality quantitated.
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Comparative Study
The ICD-9-based illness severity score: a new model that outperforms both DRG and APR-DRG as predictors of survival and resource utilization.
This project is designed to develop and validate a predictive model that is a useful benchmarking and quality of care assessment tool based on International Classification of Diseases, Ninth Revision (ICD-9), diagnoses and procedures. This model, the ICD-9-Based Illness Severity Score (ICISS), was developed from the Agency for Health Care Policy Research's Health Care Utilization Project database and is used to predict hospital survival, hospital length of stay, and hospital charges of injured patients admitted to University of North Carolina Hospitals. The study also compared the outcome predictions of ICISS with those of the long-established diagnosis-related groups (DRG) and the 3M product APR-DRG systems. ⋯ This study demonstrates that an ICD-9-based predictive model (ICISS) can markedly outperform both DRG and APR-DRG as a predictor of survival, hospital length of stay, and hospital charges.
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We determined the ability of a packaged fibrin glue (FG) product to terminate severe bleeding in a new porcine model of complex hepatic injury. ⋯ FG stopped bleeding and eliminated the need for packing in a model of severe liver injury. Further work in the clinical arena is warranted to determine the potential benefits of FG in arresting hemorrhage in hypotensive, hypothermic, coagulopathic trauma patients with complex visceral injuries.
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Since 1992, the Consultative Committee on Road Traffic Fatalities in Victoria, Australia, has identified problems including those contributing to death and the potential preventability of deaths in road fatalities who survived until at least the arrival of ambulance services. The present analysis examines the outcomes at a Level I trauma center compared with other hospital groups in Victoria. ⋯ Management of patients with major trauma at a Level I trauma center was associated with fewer problems contributing to death and fewer preventable and potentially preventable deaths than at the different hospital groups. A trauma system in Victoria, including bypass of major trauma patients to designated hospitals with 24-hour trauma services, is likely to decrease the frequency of problems, including the preventable death rates.
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Comparative Study
Effectiveness of helicopter versus ground ambulance services for interfacility transport.
Helicopters provide rapid interfacility transport, but the effect on patients is largely unknown. ⋯ The patients transported by helicopter did not have improved outcomes compared with patients transported by ground. These data argue against a large advantage of helicopters for interfacility transport. A randomized trial is needed to address these issues conclusively.