Southern medical journal
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Southern medical journal · Feb 1990
Comparative StudyTrauma in the elderly: determinants of outcome.
Severity of injury, patient age and preexisting medical conditions, time from injury to treatment, and quality of care rendered are generally recognized as major determinants of outcome after trauma. In a retrospective review, we compared 456 elderly patients (age greater than or equal to 65 years) with traumatic injuries to 985 younger patients (age less than 65). We compared cause of injury, injury severity score (ISS), seven risk factors indicating preexisting disease, complications, length of stay, and mortality. ⋯ Preexisting risk factors were not significantly associated with outcome. We conclude that trauma in the elderly causes higher mortality with less severe injury, and that the mortality is related to the cause and severity of the trauma and the number of complications, and not to pre-existing disease. Length of stay increases with the severity of injury, except in the severely injured, who die.
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Southern medical journal · Jan 1990
Comparative StudyIncreased infection rate in double-lumen versus single-lumen Hickman catheters in cancer patients.
Over the 48-month period from January 1983 through December 1986, 51 single-lumen (SL) and 94 double-lumen (DL) indwelling central venous (Hickman) catheters were placed in 118 patients with malignant disease. We reviewed these cases retrospectively to determine the types and frequency of complications requiring catheter removal. The catheters were in place a total of 18,397 days. ⋯ SL catheters that became infected averaged 213 days of use before removal, whereas DL catheters becoming infected averaged only 78 days before removal (P less than or equal to .02). The infection rate was significantly less in SL (one infection per 1,210 days) than in DL catheters (one infection per 496 days) (P less than or equal to .02). Thus because of its significantly reduced risk of infection, the single-lumen Hickman may be the preferred catheter for long-term venous access in many patients.
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Southern medical journal · Jan 1990
Case ReportsComplications in the emergency transport of pregnant women.
Emergency transport of pregnant women is increasing in frequency. The physiologic changes of pregnancy cause a gravid woman and her fetus to be particularly vulnerable during transport. As the uterus enlarges, it compresses the vena cava and the aorta of the mother when she is in the supine position. ⋯ In addition, aortocaval compression is associated with placental abruption. This report presents three cases that illustrate the tragic outcomes of transporting pregnant women in the supine position. Pregnant women should be transported in a position of lateral tilt.
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Southern medical journal · Dec 1989
Comparative StudyPleural effusion: comparison of clinical judgment and Light's criteria in determining the cause.
Pleural fluid analysis is often the initial diagnostic test used to determine the cause of a pleural effusion. We prospectively studied 33 consecutive patients with pleural effusions to determine whether the fluid arose from a transudative or an exudative process. Clinical judgment by an internist before thoracentesis and both serum and pleural fluid protein and lactic dehydrogenase levels (commonly referred to as "Light's criteria") were compared to the patient's final diagnosis. ⋯ Clinical judgment and Light's criteria are comparable in their ability to predict whether an exudative or transudative process was responsible for the effusion. Both methods are associated with errors, though of different kinds; these errors occurred infrequently. Recognizing the limitations of these methods will permit the most accurate effusion categorization.