J Trauma
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To present an analysis for identifying important factors related to the mortality of trauma patients. ⋯ Practical aspects of univariate and multivariate techniques are discussed, particularly with the nonstatistician in mind. The derivation and application of the linear logistic regression model are considered, and a checklist of information is suggested for reporting results from such an analysis. A brief comparison of the logistic model is made with other relevant types of statistical models.
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Comparative Study
Comparison of mortality, morbidity, and severity of 59,713 head injured patients with 114,447 patients with extracranial injuries.
An analysis of the completed Major Trauma Outcome Study (MTOS) data set was undertaken to compare the incidence, mortality, morbidity, and injury severity of patients with head injuries (HI) with those of patients with extracranial injuries (ECI). The MTOS was completed recently after data from 174,160 patients submitted from 165 trauma centers from 1982 through 1989 were collated and validated. Data were analyzed with regard to the effect of injury causation for vehicular-related, nonvehicular-related, and penetrating injuries for patients with HI, ECI, or both. ⋯ The overall MTOS mortality rate was 8.3%, but was three times higher in the HI group (14.5%) than in the NHI patients (5.1%). Injury severity measured by AIS-85 had, as expected, a profound influence on mortality of both HI and NHI groups. A similar high correlation was found between Glasgow Coma Scale score and mortality for head injured patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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Acute brain injury followed by hemorrhagic shock (HEM) causes prohibitive mortality in trauma patients because these combined events lead to low cerebral blood flow (CBF) and cerebral oxygen delivery (co2del). Proper treatment therefore requires rapid correction of cerebral perfusion deficits. Previous studies have shown that hypertonic crystalloid resuscitation significantly improves CBF and co2del in a model of brain injury and HEM when compared to lactated Ringer's (LR) solution. ⋯ Swine were randomized to receive either hypertonic sodium lactate (HSL) or LR fluid resuscitation. The HSL resuscitation produced a significant and sustained elevation in cerebral perfusion pressure and pial arteriole diameter (p < 0.05), and a sustained elevation in CBF after brain injury and HEM when compared with LR. These data suggest that hypertonic fluid resuscitation following brain injury and HEM improves CBF, at least in part, by causing vasodilation of cerebral resistance vessels.
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To develop a statistically valid method for trauma reimbursement and quality assurance (QA) length-of-stay filters. This is needed because diagnosis related group (DRG)-based trauma payment systems assume a random sampling of injury severities from a normally distributed population and thus result in economic disincentives to level I trauma centers. ⋯ These models provide a valid method of reimbursement for MSI trauma for level I trauma centers, since the data imply that good care associated with survival from specific complications of MSI are the major determinants of COST, rather than the specific type of injury or the resultant ISS. Moreover, using survival and ISS plus the disease-related complications as determinants of LOS, this method can be applied to any U.S. region since local factors can be used to adjust hospital COST as a highly correlated function of LOS. This method also permits identification of LOS outliers for QA, taking into account the influence of injury complications.
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To analyze the demographics, hospital course, functional outcome, and reimbursement for elderly patients sustaining multisystem trauma. ⋯ Mortality rates are high for elderly patients who sustain multisystem trauma. Most deaths occur within the first 24 hours, and most injuries are severe CHIs. More than half of survivors are discharged home, and most are independent at long-term follow-up. Reimbursement is not commensurate with the functional outcome achieved and the care provided.