J Trauma
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: Although there is no debate that patients with peritonitis or hemodynamic instability should undergo urgent laparotomy after penetrating injury to the abdomen, it is also clear that certain stable patients without peritonitis may be managed without operation. The practice of deciding which patients may not need surgery after penetrating abdominal wounds has been termed selective management. This practice has been readily accepted during the past few decades with regard to abdominal stab wounds; however, controversy persists regarding gunshot wounds. Because of this, the Eastern Association for the Surgery of Trauma Practice Management Guidelines Committee set out to develop guidelines to analyze which patients may be managed safely without laparotomy after penetrating abdominal trauma. A secondary goal of this committee was to find which diagnostic adjuncts are useful in the determination of the need for surgical exploration. ⋯ : Although the rate of nontherapeutic laparotomies after penetrating wounds to the abdomen should be minimized, this should never be at the expense of a delay in the diagnosis and treatment of injury. With this in mind, a routine laparotomy is not indicated in hemodynamically stable patients with abdominal stab wounds without signs of peritonitis or diffuse abdominal tenderness. Likewise, it is also not routinely indicated in stable patients with abdominal gunshot wounds if the wounds are tangential and there are no peritoneal signs. Abdominopelvic computed tomography should be considered in patients selected for initial nonoperative management to facilitate initial management decisions. The majority of patients with penetrating abdominal trauma managed nonoperatively may be discharged after 24 hours of observation in the presence of a reliable abdominal examination and minimal to no abdominal tenderness. Diagnostic laparoscopy may be considered as a tool to evaluate diaphragmatic lacerations and peritoneal penetration in an effort to avoid unnecessary laparotomy.
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: Generations of clinicians have used the Baux score, defined as the sum of age in years and percent body burn, to predict percent mortality after trauma, but advances in burn care have rendered the predictions of this score too pessimistic. Additionally, this score does not include the effects of inhalation injury. ⋯ : Our proposed revised Baux score is simple enough for mental calculation, and its inverse logit transformation (provided with a calculator or nomogram) can provide precise predictions of mortality. Better predictions can be obtained using our more complex statistical model. Burn surgeons and nurses accustomed to using the original Baux score may welcome an updated version.
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: Recent media and political attention have focused on a "rising tide" of youth violence and alcohol-related problems in Scotland. Facial injuries in Scotland are most commonly sustained as a result of interpersonal violence, and young men are a high risk group for facial injuries. Facial injuries are known to be associated with alcohol consumption but the sociodemographic determinants are not fully known. ⋯ : The role of poverty as the major determinant of alcohol-related facial injuries has thus far not been explicitly acknowledged. Interventions to change behavior alone are unlikely to succeed unless they are supported by measures designed to improve socioeconomic circumstances and to reduce socioeconomic inequalities.