J Trauma
-
Current American College of Surgeons Committee on Trauma criteria for major resuscitation include prehospital respiratory compromise or obstruction and/or intubation and mandate an attending trauma surgeon's presence on patient's arrival to the emergency department (ED). A substantial number of trauma patients arrive intubated, with no other physiologic compromise. We hypothesized that field or ED intubation in the absence of other major criteria does not require trauma surgeon presence on patient arrival. ⋯ Intubated patients with central stab wounds represent a high-risk group and should mandate trauma surgeon presence on patient arrival. Excluding stab wounds, field or ED intubation alone rarely requires emergent surgical decision-making. Therefore, field or ED intubation alone should not mandate trauma surgeon presence on patient arrival.
-
We hypothesize that data collected from computed tomographic (CT) scans obtained for workup of chest or abdominal injuries provide data that are sufficient to screen for spinal fractures and will decrease the cost and time of spine evaluation after trauma. ⋯ We recommend using the data acquired from CT scans to evaluate the spine, supplementing them with additional studies only when needed for further clarification.
-
Penile fracture is not a frequent event. It consists of rupture of the tunica albuginea of the corpora cavernosa. Fracture occurs when the penis is erect, as the tunica is very thin and not flexible. ⋯ Penis fracture is a true urologic emergency. It should be treated surgically as early as possible to ensure a better outcome.
-
Preresuscitation Glasgow Coma Scale (P-GCS) score is frequently obtained in injured patients and incorporated into mortality prediction. Data on functional outcome in head injury is sparse. A large group of patients with head injuries was analyzed to assess relationships between P-GCS score, mortality, and functional outcome as measured by the Functional Independence Measure (FIM). ⋯ Although the P-GCS score is related to functional outcome as measured by the FIM score and mortality in head injury, current mortality prediction models may need to be modified to account for the nonlinear relationship between P-GCS score and mortality. The P-GCS score is not a good clinical tool for outcome prediction in individual head-injured patients, given the variability in mortality rates and functional outcomes at all scores.
-
TRISS remains a standard method for predicting survival and correcting for severity in outcome analysis. The National Trauma Data Bank (NTDB) is emerging as a major source of trauma data that will be used for both primary research and outcome benchmarking. We used NTDB data, to determine whether TRISS is still an accurate predictor of survival coefficients and to determine whether the ability of TRISS to predict survival could be improved by updating the coefficients or by building predictive models that include information on co-morbidities. ⋯ In the NTDB the traditional TRISS had limited ability to predict survival after trauma. Accuracy of prediction was improved by recalculating the TRISS coefficients, but further improvements were not seen with models that included information about co-morbidities.