J Trauma
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This study summarizes all 2,550 trauma-related rural ambulance trip reports filed for the period January 1 through December 31, 1991 from the 12 rural counties surrounding Augusta, Georgia. There were 13.1 trauma-related ambulance runs per 1,000 population. Nearly one third of all rural ambulance runs are trauma related. ⋯ Only 51.5% of runs had a rural hospital as a destination, 14.2% went directly to a trauma center, and nearly 20% to another urban hospital. Of the 71 severe trauma cases received by ambulance, rural hospitals transferred out only 13 cases, most of these to the regional trauma center. Of the 47 trauma cases transferred to the trauma center, 33 were not severe.
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Comparative Study
Comparison of nonbronchoscopic techniques with bronchoscopic brushing in the diagnosis of ventilator-associated pneumonia.
To determine the diagnostic accuracy of quantitative cultures obtained via nonbronchoscopic protected specimen brushing (PSB) and nonbronchoscopic bronchoalveolar lavage (BAL) compared with quantitative cultures obtained by bronchoscopic PSB in surgical patients suspected of ventilator-associated pneumonia. ⋯ Nonbronchoscopic PSB and BAL provide similar microbiologic data to bronchoscopic PSB in the diagnosis of ventilator-associated pneumonia while shortening procedure time significantly.
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To evaluate whether aeromedical transport of trauma patients who sustain an out-of-hospital cardiac arrest (OHCA) is justified. ⋯ These results suggest that: (1) trauma patients who are resuscitated to a sinus rhythm after OHCA should be transported to a trauma center; (2) Revised Trauma Score and Injury Severity Score are useful to predict survival; and (3) neurologic outcome is not accurately predicted by this model.
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The purpose of this prospective study was to assess the impact of a two-tiered trauma response protocol on the expediency of identification, evaluation, and treatment of trauma patients in the Emergency Department. ⋯ Implementation of a two-tiered trauma response significantly decreased Emergency Department length of stay, allowed Emergency Medicine physicians to more rapidly identify, evaluate, and treat trauma patients requiring hospitalization, improved identification of patients requiring operating room or intensive care unit resources, and was time efficient and resource efficient.
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To describe the epidemiology of severe assault and gun injuries to children in an urban population and consider the impact of a comprehensive injury prevention program. ⋯ Comprehensive interventions may be effective in curbing the incidence of severe assault injuries to urban youth. Further controlled evaluations are needed to confirm the effectiveness of programs such as this and to better understand the prevention of violent injuries.