J Trauma
-
Comparative Study
Could a regional trauma system in eastern Switzerland decrease the mortality of blunt polytrauma patients? A prospective cohort study.
In Europe and Switzerland, hardly any studies have been performed on regional trauma systems. We therefore decided to conduct a prospective study in our region to establish whether an organized trauma system derived from the American model would have a beneficial effect on the survival of blunt polytrauma patients. ⋯ It is likely that a regional trauma system in eastern Switzerland for polytrauma patients with an ISS of 8 or more would have a moderately positive effect on mortality. During the period of observation, transferred admissions from regional hospitals to our trauma center had a 46% higher mortality than predicted. In absolute terms, therefore, with a regional trauma system, it might have been possible to avoid between one death every 2 to 3 years and two to three deaths every year.
-
Patients injured in rural counties are hypothesized to have improved survival if local hospitals are categorized as Level III, Level IV, and Level V trauma centers. ⋯ In states with a prevailing practice of promptly transferring brain-injured patients, survival of these patients may not be enhanced by categorization of hospitals as rural trauma centers. To further improve the outcome of these patients, policy makers should adjust statewide trauma system guidelines to enhance integration and to perfect coordination among sequential decision makers.
-
The efficacy of transarterial embolization (TAE) for severe blunt hepatic injury has been reported. We performed a prospective study evaluating the efficacy and the limitation of TAE from January 1996 to December 2000. ⋯ It was considered that the combination of the presence of a CT scan grade 4 or 5 lesion and the fluid requirements of more than 2,000 mL/h to maintain normotension indicated the absolute necessity of surgery. We felt that these patients were not candidates for TAE, and should undergo immediate laparotomy.
-
We present a series of adult patients treated under a protocol for severe lung failure (acute respiratory distress syndrome [ARDS]) that uses positive end-expiratory pressure (PEEP) optimization and intermittent prone positioning (IPP) to reduce shunt, improve oxygen (O(2)) delivery, and reduce FiO(2). ⋯ IPP was independently responsible for an increase in PF ratio and SVO(2). We effectively and safely used IPP in our patients with ARDS, including many with issues generally considered to be contraindications. IPP and best-PEEP therapy enabled us to wean all of our patients' Fio2 to < or = 0.50 within 48 hours of ARDS onset.
-
The core of general surgery supports multiple disciplines, each of which entails similar operative care for different diseases. The purpose of this study was to compare variations of practice patterns of four general surgeons to define the general surgical core that each shared in common, and to determine the effect of subspecialization in surgical critical care on the scope of practice and efficiency of revenue production. ⋯ These data demonstrate that subspecialization in surgical critical care provides valid additional earning capacity to surgical practitioners. Reimbursement is at least as good as for traditional operative care, and fees generated can actually exceed revenue from operative care. With impending decreases in global reimbursement, and attempts to unbundle operative fees, this additional capability becomes an important consideration in potential career choice, as well as a major component in the fiscal stability of trauma programs.