J Trauma
-
The risk of arterial injury with knee dislocation is well known. The most effective method for rapidly and accurately diagnosing arterial injury in this setting remains a topic of debate. Both physical examination and arteriography have been advocated, although each of these methods has its critics. The authors propose that the ankle-brachial index (ABI) can accurately predict whether patients with knee dislocations have sustained vascular injury. ⋯ The ABI is a rapid, reliable, noninvasive tool for diagnosing vascular injury associated with knee dislocation. Routine arteriography for all patients with knee dislocation is not supported.
-
Comparative Study
Prospective evaluation of computed tomographic scanning for the spinal clearance of obtunded trauma patients: preliminary results.
Screening methods for detecting cervical spine injury in obtunded ventilated patients continue to evolve. This study compared the use of plain radiography to computed tomographic (CT) scanning of cervical spines in the obtunded blunt trauma patient. The accuracy of plain radiography and CT scanning in detecting clinically significant cervical spine injury in the obtunded blunt trauma patient was evaluated. ⋯ CT scanning in conjunction with plain films enhances the number of cervical spine injuries seen radiographically. Application of a protocol of plain radiographs and CT scanning may be used to clear cervical spines in the obtunded trauma patient. Ongoing evaluation of this protocol is required.
-
Multicenter Study Comparative Study
The New Injury Severity Score: a more accurate predictor of in-hospital mortality than the Injury Severity Score.
The purpose of this study was to determine whether the New Injury Severity Score (NISS) is a better predictor of mortality than the Injury Severity Score (ISS) in general and in subgroups according to age, penetrating trauma, and body region injured. ⋯ The NISS is a more accurate predictor of in-hospital death than the ISS and should be chosen over the ISS for case-mix control in trauma research, especially in certain subpopulations such as head/neck-injured patients.
-
Comparative Study
Ballistic impact to the forehead, zygoma, and mandible: comparison of human and frangible dummy face biomechanics.
Currently, there is a greater use of nonlethal force in law enforcement and military operations. Because facial injuries have been observed, there is a need to understand the human response to ballistic impacts involving various regions of the face. This study aimed to establish blunt ballistic response corridors for high-speed, low-mass facial impacts to the forehead, zygoma, and mandible, and to determine how these responses compare with those of the frangible Hybrid III headform. Correlation of the human and dummy responses allows injury risk assessment for munitions used in the field. ⋯ Higher impact force can be tolerated on the forehead and mandible than on the zygoma. Normalized force-deflection and force-time corridors were established for the human response. The frangible Hybrid III face is an effective surrogate for assessing ballistic injury risks, but greater compliance would make it more biofidelic. Initial human tolerance levels of 6.0 kN for the forehead, 1.6 kN for the zygoma, and 1.9 kN for the mandible have been established for ballistic impacts to the face.
-
Serum protein S100B determinations have been recently suggested as markers of traumatic brain injury. However, little is known about the effects of extracranial injuries on S100B levels in trauma patients. ⋯ We conclude that serum S100B is a sensitive marker of brain injury, which correlates with the severity of the injury. Large extracranial injuries also elevate S100B levels. However, S100B has a high negative predictive power, and the finding of a normal S100B value shortly after trauma should thus exclude significant brain injury with a high accuracy.