Southern medical journal
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We have described a 14-month-old white boy with a laceration of the right upper eyelid draining CSF. Careful evaluation, including computerized tomography, revealed a penetrating injury of the right frontal fossa. Determination of the glucose level in fluid draining from upper eyelid lacerations aids in the diagnosis of CSF fistulas.
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Trauma kills more Americans from age 1 to 34 than all diseases combined. Until recently, trauma care in the United States was delivered in a nonorganized, nonintegrated fashion, with trauma victims being transported to the medical facility closest to the scene of the accident. Many recent studies confirm an unacceptably high incidence--up to 75% in some studies--of preventable deaths in trauma victims treated under the nearest hospital system. ⋯ The decision on whether to take a patient to the closest hospital or to the regional trauma center is a form of triage, with far-reaching consequences medically, ethically, and financially. Various triage instruments have been developed to try to identify those patients who would benefit from the resources of a trauma center, and to avoid overcrowding those centers with patients having less serious injuries. These triage tools are based on a combination of mechanism of injury, anatomic criteria, physiologic criteria, and co-morbidity factors.