J Trauma
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Comparative Study
Outcome and cost of trauma among the elderly: a real-life model of a single-payer reimbursement system.
As our population ages, the number of elderly trauma patients (age > or = 65 years) increases. Studies have demonstrated increased mortality and cost for a given injury severity in the elderly compared with younger patients. The financial viability of trauma centers in the United States has been an area of concern for many years. As reimbursement diminishes for privately insured patients, the ability to finance the care of the indigent is jeopardized. Medicare, the single-payer insurance plan for the elderly, reimburses at a lower rate than standard private insurance carriers. We examined the differences in outcome and cost between the elderly and younger patients and the financial burden imposed by care for elderly trauma. Our hypothesis was that elderly trauma patients would have poorer outcomes, higher cost, and generate greater financial losses than younger patients. ⋯ Despite higher injury severity and lower survival probability for the elderly, the length of hospital and intensive care unit stays, as well as the percentage of admissions to the intensive care unit, were similar. The per capita cost of hospital care for the elderly was lower than for younger patients, whereas reimbursement was higher, primarily because 98% of elderly patients were insured. Medicare, the single-payer insurance plan for the elderly, adequately reimburses for elderly trauma care. This implies that universal insurance coverage for all trauma patients would be desirable, even if reimbursement rates decreased significantly. The increased mortality in the elderly requires continued study and diligence.
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We determined the ability of a packaged fibrin glue (FG) product to terminate severe bleeding in a new porcine model of complex hepatic injury. ⋯ FG stopped bleeding and eliminated the need for packing in a model of severe liver injury. Further work in the clinical arena is warranted to determine the potential benefits of FG in arresting hemorrhage in hypotensive, hypothermic, coagulopathic trauma patients with complex visceral injuries.
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Multicenter Study
Percutaneous computed tomographic-controlled ventriculostomy in severe traumatic brain injury.
Percutaneous computed tomographic (CT)-controlled ventriculostomy (PCV) was introduced for the monitoring of intracranial pressure in patients with severe traumatic brain injury who did not require simultaneous decompressive trepanation. ⋯ Distinct time savings are the major advantages of PCV, allowing exact catheter positioning even with very narrow ventricles.
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Maintenance of an airway in the air medically transported patient is of paramount importance. The purpose of this study is to compare preflight versus en route rapid sequence intubation (RSI)-assisted intubations and to determine the value of air medical use of RSI. ⋯ Air medical intubations, both preflight and en route, for both scene calls and interhospital transports, can be done with a very high success rate. Rapid sequence intubation may improve the success rate. For scene calls, there was a significant decrease in ground time, and there was a trend toward fewer multiple intubation attempts when the patient was intubated en route instead of preflight.
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Comparative Study
Treatment of clavicular aseptic nonunion: comparison of plating and intramedullary nailing techniques.
The aim of this retrospective study was to investigate and compare the effects of plating and intramedullary nailing in the treatment of clavicular aseptic nonunion. ⋯ Intramedullary nailing may have a higher union rate with a lower complication rate than plating (p > 0.05). At least in common situations, it is not inferior to plating. Whenever possible, therefore, intramedullary nailing should be used preferentially to treat clavicular aseptic nonunion without previous operative treatment. Nevertheless, both techniques have relatively higher nonunion rates in the treatment of clavicular nonunion than in the treatment of other long-bone nonunions. Gentle handling of surrounding soft tissues to reduce bony fragments should be strictly executed.