The Journal of surgical research
-
Rural hospitals have variable degrees of involvement within the nationwide trauma system because of differences in resources and operational goals. "Secondary overtriage" refers to the patient who is discharged home shortly after being transferred from another hospital. An analysis of these occurrences is useful to determine the efficiency of the trauma system as a whole. ⋯ Secondary overtriage may result from the hospital's limited resources. Some of these limitations are the availability of surgical specialists, blood products, and overall coverage during the "graveyard-shift." However, some of these transfers may be appropriate even though patients are ultimately discharged shortly after transfer.
-
In an expanding elderly population, traumatic brain injury (TBI) remains a significant cause of death and disability. Guidelines for management of TBI, according to the Brain Trauma Foundation (BTF), include intracranial pressure (ICP) monitoring. Whether ICP monitoring contributes to outcomes in the elderly patients with TBI has not been explored. ⋯ Our findings suggest that the use of ICP monitoring according to BTF guidelines in elderly TBI patients does not provide outcomes superior to treatment without monitoring. The ideal group to benefit from ICP monitor placement remains to be elucidated.
-
Patients who present emergently with hernia-related concerns may experience increased morbidity with repair when compared with those repaired electively. We sought to characterize the outcomes of patients who undergo elective and nonelective ventral hernia (VH) repair using a large population-based data set. ⋯ Patients undergoing elective VH repair in the United States tend to be younger, Caucasian, and more likely to have a laparoscopic repair. Nonelective VH is associated with a substantial increase in morbidity and mortality. We recommend that patients consider elective repair of VHs because of the increased morbidity and mortality associated with nonelective repair.
-
Comparative Study
Abdominal gunshot wounds-a comparative assessment of severity measures.
Penetrating abdominal trauma is a common feature of trauma treated in low- and middle-income countries (LMICs). The penetrating abdominal trauma index (PATI) and the injury severity score (ISS) are severity-measures most often used to gauge injury severity. It remains unclear which measure better accounts for the severity of sustained injuries. This study compares the predictive ability of both injury severity measures in patients presenting to an LMIC in South Asia. ⋯ The predictive ability of ISS and PATI severity measures was found to be comparable. The results suggest that both measures can be used to risk-stratify patients with isolated abdominal gunshot wounds in an LMIC.
-
State-supported trauma systems have a proven association with improved mortality, but to date, there are no data reported on what mechanism leads to this benefit. Our hypothesis is that trauma systems with funding support are associated with increased number of trauma centers (TCs). ⋯ Our study shows that the number of level 3 TCs significantly and independently correlated with the presence of a funded trauma system. The number of level 1 and 2 centers showed no such correlation. Further study will determine if increased number of level 3 centers leads to improved clinical outcome.