J Trauma
-
The purpose of this paper is to identify factors associated with improved utilization of health care resources in the treatment of patients with injury. A prospective cohort study was conducted of all trauma patients admitted to a trauma center from April 15, 1987 to February 28, 1988. Altogether, 877 patients were entered into the study: 673 (76.7%) scene patients, and 204 (23.3%) interhospital transfers. ⋯ The elderly utilize more resources than young patients when matched for severity of injury. It is beneficial to the patients and the health care system to have severely injured trauma patients transported directly to a trauma center from the scene of an injury. Helicopter emergency medical services can enhance the ability of a trauma care system to decrease health care costs.
-
Evaluation of abdominal trauma in pregnant patients presents a number of dilemmas. Few series compare the various modalities available in this situation. The present review characterizes various techniques and their results. ⋯ Diagnostic peritoneal lavage proved to be safe and accurate in these patients. Diagnostic peritoneal lavage proved to be safe and accurate in these patients. CT scan and ultrasonography are other modalities which merit further assessment as a primary diagnostic technique in abdominal trauma occurring during pregnancy.
-
Patients suffering blunt leg trauma resulting in below-knee fracture, tibial artery injury, and soft-tissue damage are at major risk for amputation. In an attempt to identify the factors which may forecast limb loss despite vascular surgical repair, all patients with tibial fractures admitted between 1980-1988 were reviewed. Forty-four of 366 (12%) patients presented with clinical evidence of tibial artery injury. ⋯ Patients who required amputation had a significantly greater incidence (Fisher's exact test) of three or more fascial compartments involved in muscular injury (p = 0.005), two or more injured tibial vessels (p = 0.01), failed vascular reconstruction (p = 0.03), a cadaveric foot at initial exam (p = 0.03), and severe muscle crush injury or muscle tissue loss (p = 0.03). No extremity was salvaged when more than two of these factors was present, and a failed vascular reconstruction led to limb amputation in all cases. These factors will predict an irretrievable extremity following blunt tibial artery trauma, allowing amputation before life-threatening wound sepsis develops.
-
Multicenter Study Clinical Trial
Preventable trauma deaths in The Netherlands--a prospective multicenter study.
The data of all trauma fatalities occurring in 12 Dutch hospitals during a period of 1 year were reviewed for management errors and preventable deaths by a panel of five surgeons trained in trauma care. Management errors occurred in 38% of the fatalities. There was a significantly higher percentage of management errors in small general hospitals (72%) than in large general (29%) and in university hospitals (34%). ⋯ A significantly higher preventable death rate occurred in small general hospitals (48%), than in large general (14%) and university hospitals (19%). From these results, it can be concluded that management errors and preventable deaths are general phenomena occurring in any hospital. However, they occur significantly more frequently in hospitals not especially equipped to manage severely injured patients.