J Trauma
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Pre-injury ASA physical status classification is an independent predictor of mortality after trauma.
The ability of an organism to withstand trauma is determined by the injury per se and inherent properties of the organism at the time of injury. We analyzed whether pre-injury morbidity scored on a four-level ordinal scale according to the American Society of Anesthesiologists Physical Status (ASA-PS) classification system predicts mortality after trauma. ⋯ Pre-injury ASA-PS score was an independent predictor of mortality after trauma, also after adjusting for the major variables in the traditional TRISS (Trauma and Injury Severity Score) formula. Including pre-injury ASA-PS score might improve the predictive power of a survival prediction model without complicating it.
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Traumatic carotid cavernous fistula (TCCF) is a rare vascular complication of traumatic brain and facial injury. The purpose of this study was to analyze the incidence of this disorder in different types of basilar skull fracture, determine whether particular clinical factors impacted outcomes, and discuss ways of improving prognosis. ⋯ A relatively high incidence of TCCF occurred in patients with middle fossa fractures, especially those with transverse or oblique fractures. Prompt diagnosis and intervention should be emphasized in the management of patients with TCCF, and noninvasive techniques for early detection of TCCF should be considered in cases of middle fossa fractures under certain conditions after brain or facial trauma to ensure positive outcomes.
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Deep vein thrombosis (DVT) is a significant cause of morbidity and mortality in trauma patients, even with appropriate prophylaxis. Many national agencies (Agency for Healthcare Research and Quality, Joint Commission, National Quality Forum) have suggested DVT incidence as a measurement of health care quality, but none has recommended a standardized screening approach. Duplex ultrasound serves an important role as a noninvasive diagnostic tool for detection of DVT. However, screening of asymptomatic patients for DVT is somewhat controversial and these practices vary widely among trauma centers. We hypothesized that as the number of screening duplex examinations in trauma patients increases, the rate of DVT identification will also increase. ⋯ Increasing the number of duplex screening exams resulted in an increased rate of DVT identification. In the absence of standardized surveillance, DVT rates may be more influenced by how often caregivers look for these events rather than the quality of care provided.
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The severity of pelvic ring fractures (PRFs) can range from minor injury with low-energy mechanism to high-energy injury causing prehospital death. The purpose of this study was to prospectively describe the comprehensive pelvic fracture occurrence in an inclusive trauma system. ⋯ LE-PRF and HE-PRF are equally frequent among hospital admissions. They represent two distinct demographic groups with similar mortality rate. Most PRF-related deaths occur prehospitally. Bleeding remains the primary cause of PRF-related mortality in all groups.