J Trauma
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This study was designed to assess the accuracy of the urine dipstick and its ability to predict injury to the urinary tract when compared to routine urinalysis: 1,485 patients had dipstick and microscopic urinalysis performed as part of their evaluation for blunt and penetrating trauma. Dipstick analysis was recorded as either positive or negative. Microhematuria was defined as greater than 0-1 RBC/HPF on microscopic analysis. ⋯ There were no cases of a missed injury in the group of 100 false negatives. Cost savings by conversion to the use of dipsticks would have saved our institution about $63,000 per year. It is concluded that the urinary dipstick is a safe, accurate, and reliable screening test for the presence or absence of hematuria in patients sustaining either blunt or penetrating abdominal trauma.
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There is continuing controversy over the use of Advanced Life Support (ALS) in the treatment of multisystem injury. In this study, performed to define the role of ALS in the management of motor vehicle accidents (MVA), 538 ambulance run reports (ARR) and hospital records of patients involved in MVA in South Carolina for 1983 were examined. Of these, 248 were reviewed in depth by a trauma review committee (TRC). ⋯ Thirty-two per cent of ALS patients demonstrated an increased blood pressure en route compared to 12% of BLS patients. The TRC felt prehospital care was beneficial in 85% of cases, while 11.7% had inappropriate or inadequate care. Resuscitation and ALS in MVA appears to be beneficial in the treatment of multisystem trauma in a rural state.
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A microcomputer system was developed which allows the user to draw the contour of a burn on a diagram on the computer screen. The per cent body surface area is then determined by direct area measurement by the computer. ⋯ Excellent correlation between the computer system and the manual Lund and Browder chart method (correlation coefficient, 0.962; p less than 0.0001) was obtained. Computerized planimetry provides a rapid, simple method of recording data and calculating total per cent burn which compares well with the manual Lund and Browder diagram.
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The Trauma Scores, CRAMS scales, and mechanisms of injury of 500 trauma patients were evaluated for their ability to identify a seriously injured patient. Serious injury was defined as one of the following: Injury Severity Score (ISS) greater than 15, or emergency-room Trauma Score less than or equal to 14, or injuries requiring greater than 3 days hospitalization, or death. ⋯ With these same mechanisms, the sensitivity of a CRAMS scale of less than or equal to 8 increased from 66% to 93%, with a specificity of 30%. The addition of these mechanisms of injury to standard field triage scoring appears to improve the identification of seriously injured patients while retaining an acceptable level of overtriage.
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Two-wheeler trauma in developing countries differs in some respects when compared to that in developed countries. A total of 302 cases involved in motorcycle, scooter, and moped accidents were analyzed. There were 201 drivers and 101 passengers. ⋯ Female passengers, sitting sideways, and involved in collisions, sustained fewer injuries than did a comparable group of male passengers who sat astride; the ISS of female passengers was also lower. Helmet users had a much lower incidence and severity of head injury than riders who did not use helmets. Turbans appeared to offer partial protection from head injury.