J Trauma
-
The Glasgow Coma Scale (GCS) score is widely accepted as the cornerstone in the assessment of neurologic function after trauma and is being used to select patients for enrollment in prehospital (Ph) intervention trials. This study was performed to assess the degree of agreement between Ph-GCS and emergency department (ED)-GCS scores in our trauma system patients. ⋯ In this study, differences between Ph-GCS and ED-GCS were seen in the patient population with moderate to severe head injury. Individual component score agreement was moderate for all categories, with agreement worsening for patients with longer transport times. Although this suggests improvement in the patient's condition during transport, inter-rater variability between Ph and ED personnel cannot be excluded. The utility of Ph-GCS in Ph interventional trials for determining the presence of significant head injury will need to be further evaluated.
-
An estimated 5.3 million people in the United States live with permanent disability related to traumatic brain injury (TBI). Access to rehabilitation after TBI is important in minimizing these disabilities. Ethnic disparities in access to health care have been documented in other diseases, but have not been studied in trauma care. We hypothesized that access to rehabilitation after TBI is influenced by race or ethnicity. ⋯ Ethnic minority patients are less likely to be placed in rehabilitation than NHW patients are, even after accounting for insurance status, suggesting existence of systematic inequalities in access. Such inequalities may have a disproportionate impact on long-term functional outcomes of African American and Hispanic TBI patients, and suggest the need for an in-depth analysis of this disparity at a health policy level.
-
It is widely accepted that all-terrain vehicles (ATVs) can be dangerous to operators. Understanding the mechanisms of ATV crashes, especially rollovers, can provide important insight to consumers, legislators, and manufacturers on ATV safety and protection of the users. ⋯ These findings suggest that nonrandom, modifiable factors are likely involved. Our data provide unique insight into specific mechanisms of ATV crashes, particularly rollovers, and those involving children. Findings may be applicable to changes in ATV design and education of users.
-
Although injured persons presenting to nontertiary hospitals are routinely transferred for further care, it is unknown whether there is an outcome benefit associated with this practice. We sought to assess whether the transfer of injured patients from nontertiary hospital emergency departments (EDs) is associated with improved survival. ⋯ After adjusting for injury severity and the nonrandom selection of patients for transfer, trauma patients transferred from nontertiary EDs to major trauma centers had lower inhospital mortality than patients remaining in nontrauma hospitals. Recognition and early transfer of at-risk rural trauma patients may improve survival in a regionalized trauma system.
-
Comparative Study
Proximal femoral nail for the treatment of reverse obliquity intertrochanteric fractures compared with gamma nail.
The reverse obliquity fracture of the proximal femur (AO/OTA 31-A3) is mechanically different from most intertrochanteric fractures. The purpose of this study was to compare the results of proximal femoral nail (PFN) fixation with those of gamma nail (GN) fixation for these fractures. ⋯ There was no difference in clinical outcome between the PFN and GN groups. However, the PFN demonstrated better results biomechanically than the GN did in terms of less sliding of lag screw, less change of neck-shaft angle, and less complications for the treatment of reverse obliquity intertrochanteric fractures.