J Trauma
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Triage decisions must be based on accurate information with a valid understanding of injury patterns and their sources. Only a data base that includes both medical and collision factors can best provide the breadth of information required to achieve this goal. In the study reported here we assessed the accuracy of automobile collision data collected by emergency physicians compared with Police Accident Reports. ⋯ When data obtained by emergency physicians are compared with the information in Police Accident Reports, there are notable differences on several collision factors. Triage decisions must be based on accurate information with a valid understanding of injury patterns and their sources. Only a data base that includes both medical and collision factors can best provide the breadth of information required to achieve this goal.
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Analyses were conducted to estimate the effectiveness of airbags in reducing driver fatalities in motor vehicle crashes. ⋯ Various estimates of airbag effectiveness are beginning to yield consistent results. These analyses confirm that driver airbags are reducing fatalities in the frontal crashes for which they are designed.
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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.
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Comparative Study
Hypertonic acetate dextran achieves high-flow-low-pressure resuscitation of hemorrhagic shock.
For resuscitation of hemorrhagic hypovolemia, we compared the effectiveness of (1) isotonic lactated Ringer's solution (LRS), (2) 2400 mOsm of 7.5% NaCl:6% dextran 70 (HSD), and (3) 2400 mOsm of 7.9% sodium acetate:1.9% NaCl:6% dextran 70 (HAD). ⋯ Small-volume infusion with HAD resulting in "high-flow-low-pressure" resuscitation may offer unique hemodynamic and metabolic advantages for the initial treatment of hemorrhage from trauma.