J Trauma
-
Injured children represent 25% of all injured patients in the United States and have unique needs that may require treatment at a pediatric trauma center or a trauma center with pediatric commitment. This work attempts to determine if there is existing evidence that pediatric trauma centers, trauma centers with pediatric commitment, or trauma systems have improved the care of injured children. ⋯ Further analysis is necessary to demonstrate whether trauma systems make a difference in pediatric outcome. Injury prevention will have the greatest impact on future pediatric injury outcomes.
-
Comparative Study
Comparison of alternative methods for assessing injury severity based on anatomic descriptors.
There is mounting confusion as to which anatomic scoring systems can be used to adequately control for trauma case mix when predicting patient survival. ⋯ Results support the integrity of the AIS and argue for its continued use in research and evaluation. The modified Anatomic Profile, Anatomic Profile, and New Injury Severity Score, however, should be used in preference to the Injury Severity Score as an overall measure of severity.
-
Comparative Study
Thoracic epidural analgesia versus intravenous patient-controlled analgesia for the treatment of rib fracture pain after motor vehicle crash.
Pain from rib fracture pain may affect pulmonary function, morbidity, and length of intensive care unit stay. Previous trials have varied epidural technique within the study and have used several outcome variables. ⋯ Thoracic epidural analgesia with bupivacaine and fentanyl provided superior analgesia than intravenous patient-controlled analgesia morphine.
-
To evaluate prospectively components of general health outcome after trauma and to report on the further validation of the Michigan Critical Events Perception Scale (MCEPS), an instrument that predicts increased risk for posttraumatic stress disorder (PTSD). ⋯ Within hours of injury, the MCEPS identifies patients who are three times more likely to develop PTSD. PTSD compromises self-reported general health outcome in injured adults independent of baseline status, Injury Severity Score, or degree of physical recovery. These data suggest that psychological morbidity is an important part of the patient's perceived general health.
-
Commotio cordis is a term used to describe cases of blunt thoracic impact causing fatality without gross structural damage of the heart and internal organs. Death is attributed to ventricular fibrillation or cardiac arrhythmia aggravated by traumatic apnea. The biomechanical response related to the risk of commotio cordis has not been determined. ⋯ Based on this in-depth analysis, the viscous criterion is the relevant biomechanical response to assess the risk of commotio cordis and more severe thoracic injury in high-speed blunt impact.