J Trauma
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The Trauma Score (TS) has been revised. The revision includes Glasgow Coma Scale (GCS), systolic blood pressure (SBP), and respiratory rate (RR) and excludes capillary refill and respiratory expansion, which were difficult to assess in the field. Two versions of the revised score have been developed, one for triage (T-RTS) and another for use in outcome evaluations and to control for injury severity (RTS). ⋯ RTS is a weighted sum of coded variable values. The RTS demonstrated substantially improved reliability in outcome predictions compared to the TS. The RTS also yielded more accurate outcome predictions for patients with serious head injuries than the TS.
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Two hundred fifty consecutive children hospitalized with severe injuries (at least one injury with an Abbreviated Injury Score [AIS] greater than or equal to 4 or two or more injuries with AIS scores greater than or equal to 2) were studied to determine their functional status at discharge and 6 months later using questions from the RAND Health Insurance Study (HIS) and the Glasgow Outcome Scale (GOS). Of the 217 surviving patients, 190 (88%) had one or more functional limitations by the HIS scale at discharge. Ten (5%) were in a vegetative state, 40 (18%) severely disabled, 97 (45%) moderately disabled, and 70 (32%) healthy by the GOS. ⋯ Seven (4%) were in a vegetative state, 17 (11%) severely disabled, 50 (32%) moderately disabled, and 82 (53%) healthy by the GOS. A substantial proportion of the whole group of children hospitalized for the treatment of severe injuries had ongoing physical disabilities that limited their participation in normal activities 6 months after they were discharged. This suggests a need for greater emphasis on the rehabilitation of pediatric trauma patients.
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Blunt thoracic trauma is a frequent cause of death in multiple trauma victims. Myocardial rupture may occur in up to 65% of patients who die with thoracic injuries. Two cases are presented with intrapericardial transection of the inferior vena cava, pericardial rupture, and myocardial rupture from blunt thoracic trauma. Both patients died.
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Not every patient with a penetrating stab wound of the abdomen requires laparotomy. This report evaluates use of computerized tomographic (CT) scan in assessment of stable asymptomatic patients, with penetrating abdominal stab wounds, as an indicator of the necessity of abdominal exploration. In a prospective study, 50 patients with abdominal stab wounds were treated successfully with observation only, after admission abdominal CT scan interpretation was negative for pathology in 45 patients. ⋯ Of these 28 patients, 22 had correct CT scan findings verified by laparotomy, three were false positive for intra-abdominal injury resulting in negative explorations, and three patients had such nonspecific findings as fluid or air in the abdomen incompatible with precise organ injury identification. Our study shows that CT scan in patients with abdominal stab wounds identifies solid organ injury with great specificity and sensitivity, evaluates the retroperitoneum well, and detects peritoneal penetration by demonstrating intraperitoneal fluid or air. CT scan was unreliable in detection of bowel injury and does not demonstrate diaphragmatic injuries.