The Australian and New Zealand journal of surgery
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A ten year review of penetrating thoracic and abdominal trauma examined pattern of injury, patient management and outcome. Ninety-six patients were included in the study, 55 with injury to the abdomen, 31 the thorax and 10 with injury to both areas. Fifty-eight cases were managed non-operatively; 5 combined abdominal and thoracic injuries, 26 thoracic and 27 abdominal. ⋯ Of the 28 abdominal cases, nine were found on laparotomy to have no significant visceral or vessel injury, one, however, was performed for omentum protruding through the wound. While a negative laparotomy was a relatively safe procedure, non-operative management had the advantages of a shorter hospital stay without wound-related morbidity. Selective non-operative management was found to be a relatively safe approach in this series.
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A total of 76 patients with traumatic extradural haematoma were treated within a period of 3 years. Four patients developed delayed extradural haematomas. These cases are reported in view of the unusual sequence and the importance of early diagnosis.
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This is a retrospective, hospital based study of the resuscitative management of 40 consecutive, multitrauma patients (Injury Severity Score (ISS) > 25) admitted directly from an inner metropolitan environment over a one year period. The aim was to identify physiological, anatomical and time variables that correlated with an adverse outcome. Such information would facilitate the development of management protocols to improve future care. ⋯ The time frame from accident to operating theatre should be kept under 90 min. Warmed blood, fresh frozen plasma and platelets should be used early in the resuscitation. An early move to definitive control of bleeding should accompany vigorous volume resuscitation.
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TRISS methodology is a statistical technique by which the probability of survival in injury can be estimated. It combines an anatomical index of injury severity (the injury severity score, ISS), a physiological index (the revised trauma score, RTS), age and the mechanism of injury. In this study TRISS was used to assess 198 patients with penetrating injury at Baragwanath Hospital. ⋯ The respective probabilities of survival for these four patients, as derived by TRISS, were 0%, 0%, 6% and 46%. TRISS demonstrated that the outcome of the patients as a group was comparable to other centres. TRISS is a useful method for monitoring the effectiveness of a trauma unit and objectively identifying cases for peer review.