J Trauma
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In Norway, most patients with severe head injuries are transported to, and operated in, the neurosurgical unit of the regional university hospital. However, some patients are still occasionally operated on in county central hospitals by orthopedic or general surgeons who do not have neurosurgical expertise. The aim was to analyze this surgical activity outside the neurosurgical units. ⋯ The present study indicates that, in Norway and countries with a similar hospital system, it must be difficult for general and orthopedic surgeons to achieve and maintain the skills required for emergency operations in patients with acute severe head injuries. Thus, it is probably to the patients' benefit to improve the general hospitals' competency and speed in the detection of candidates for surgical decompression, and stress the importance of these patients being transferred without unnecessary delay to a neurosurgical unit.
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We conducted a prospective study in patients with multiple injuries investigating the time course of trauma-related changes of systemic immunologic defense mechanisms. ⋯ In patients who died of severe trauma and in whom the cause of death was multiple organ failure, a significantly lower production of antiendotoxin antibodies was measured shortly before death. An insufficient immune defense (dysergy) may be involved in the pathomechanisms leading to the development of organ dysfunction.
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To quantify pulmonary contusions on chest x-ray film and to evaluate factors correlating with the size of the pulmonary contusions, changes in the first 24 hours, the need for ventilatory assistance, and death. ⋯ Quantifying and noting changes in the extent of the pulmonary contusions and PaO2/FIO2 ratio during the first 24 hours may be of value in determining the need for ventilatory assistance and predicting outcome.
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Trauma registries frequently do not include the deaths of patients who do not get to trauma centers (TCs). Thus, complementary methods of monitoring the impact of trauma system initiatives should be considered. The objective of this study is to use National Highway Safety Traffic Administration's Fatality Analysis Reporting System (FARS) and New York State Department of Motor Vehicles data and to study the impact of state and regional initiatives over a 10-year period in the seven-county Hudson Valley New York (HV) region with one regional TC in Westchester County (WC) and to assess its face validity. ⋯ The drops in motor vehicle crash death rates may reflect injury prevention as well as trauma system initiatives. Thus, although FARS and New York State Department of Motor Vehicles data cannot establish cause and effect relationships, it can monitor the aggregated impact of multiple initiatives. Taken together with increasing percentages of seriously injured trauma patients going to trauma centers and comparisons with national FARS data, the association of decreasing deaths with the implementation of a trauma system seems to have face validity.
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The current literature defines the costs of trauma care in terms of hospital costs and charges. We sought to define the qualitative and quantitative labor costs of trauma care by measuring the various components of bedside care provided by surgeons at a community hospital. ⋯ A significant labor cost (TT) was required for the care of blunt trauma patients, and the majority of that cost was not spent in the operating room but involved the performance of cognitive services. Significant correlation existed between ISS and labor cost. The presence of ethanol intoxication significantly increased this commitment. These data might be of use in creating provider reimbursement schemes for trauma care. This methodology may have applications in the design of hospital systems for trauma care.