J Trauma
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The purpose of this study was to attempt to identify those blunt trauma patients in whom expensive diagnostic studies such as computed tomography and diagnostic peritoneal lavage are unnecessary to exclude intra-abdominal injury. The medical records of 1096 blunt trauma patients evaluated at an urban level I trauma center were reviewed. Because of the urgent need to exclude intra-abdominal hemorrhage in patients with hypotension (blood pressure < 90 mm Hg), and the difficulty in obtaining reliable information from abdominal examination in patients with Glasgow Coma Scale scores < 11 or spinal cord injury, 140 patients meeting these criteria were reviewed but excluded from statistical analysis. ⋯ All of the 44 significant intra-abdominal injuries occurred in the group of 253 patients that had either an abnormal abdominal examination, one of the statistically significant risk factors, or both, for a sensitivity of 100%. Of the 703 patients with a normal abdominal examination and no risk factors, none had a significant abdominal injury, for a negative predictive value of 100%. This study suggests that patients with either an abnormal abdominal examination or one of the two statistically derived risk factors require adjunctive diagnostic evaluation with diagnostic peritoneal lavage or computed tomography scan to exclude intra-abdominal injury.(ABSTRACT TRUNCATED AT 250 WORDS)
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To measure the functional outcome we analyzed 723 consecutive patients with multiple injuries (Abbreviated Injury Scale (AIS)/Injury Severity Score (ISS) > or = 16, mean ISS 30.1) treated at the University Hospital Groningen, the Netherlands, between 1985 and 1989. Age, sex, type of accident, AIS/ISS, discharge destination, length of hospital stay and functional outcome (measured by the Glasgow Outcome Scale) are described. The patients were young (mean age 33.4 years) and 186 died (25.7%) mainly because of severe head injuries. ⋯ These injuries, together with spinal cord injuries, appeared to be responsible for the majority of permanent disabilities. Although the functional outcome deteriorated linearly with increasing AIS/ISS, the final functional result was good: in the first half year after injury there was considerable recovery; after that there was further slight recuperation. Two years after injury, 68% had mild or no disabilities, 19% were moderately disabled, and 7% severely disabled.
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To determine the value of abdominal roentgenograms after aortography for detecting additional organ injuries, we retrospectively evaluated the abdominal and pelvic roentgenograms after aortography of 170 trauma patients who underwent arch aortography to detect aortic rupture. In 160 (94%) of 170 patients, the results of arch studies were normal. ⋯ Thirty-one (18%) of 170 patients had associated injuries demonstrated by the roentgenograms taken after aortography, including pelvic or femoral fractures (13%), pelvic hematomas (5.8%), renal injuries (1.1%), and bladder ruptures (2.9%). We conclude that abdominal and pelvic pain roentgenograms should be part of a routine arch aortography performed for blunt chest trauma to detect additional organ injuries that frequently accompany injuries from motor vehicle crashes.
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Hypertonic saline solution treatment of uncontrolled hemorrhagic shock (UCHS) leads to increased bleeding from injured vessels, fall in arterial blood pressure, and increased mortality. The effect of dehydration induced by either water deprivation or heating on this response was studied in rats. The animals were divided into four groups: group 1 (n = 32), normal rats; group 2 (n = 30), water deprivation for 12 hours; group 3 (n = 30), heating at 37 degrees C for 5 hours; and group 4 (n = 30), heating as in group 3 and water deprivation as in group 2. ⋯ Tail resection in group 1a resulted in bleeding of 4.9 +/- 0.3 mL, and fall in mean arterial pressure (MAP) to 50 +/- 3 mm Hg (p < 0.001). Blood loss and fall in hematocrit in groups 2, 3, and 4 was significantly lower than in group 1. The fall in MAP and pulse rate was similar in all four groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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Accurate assessment of injury severity is critical for decision making related to the prevention, triage, and treatment of injured patients. Presently, the standard method of controlling for variations of injury severity between groups has been based upon the Injury Severity Score (ISS) and the Trauma Score and the Trauma and Injury Severity Score (TRISS) methodology. The purpose of this study was to attempt to build upon previous work using International Classification of Diseases, ninth revision (ICD-9) coded diagnosis, and procedure information available from standard hospital discharge abstracts (UB-82 Billing format) to create a hierarchical network to provide a tool for predicting injury severity and probability of survival. ⋯ Given the recognized limitations of the ISS, the widespread availability of the ICD-9 coded diagnoses and procedures, and the availability of many state and regional data bases that have no ISS or Trauma Score, the purpose of this study was to assess the ability of a network derived from limited but widely available hospital discharge data to predict the outcome of injured patients. The study confirms previous work showing that the ICD-9 codes were strongly associated with outcome. The study demonstrated that the network created from these data was a better predictor of outcome than the derived ISS. When the results of the network were compared with other published series, the network, created without access to physiologic information, was almost as accurate, sensitive, and specific as reported values for TRISS and A Severity Characterization of Trauma (ASCOT). Because the present study is the first of its type, further investigations are needed to validate these findings. If other studies corroborate this study, a network model based upon ICD-9 codes could become the principal method for grading injury severity. This would provide superior predictive power of injury severity with important cost savings and universal application.