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Biomedical subjects

I Civil

Publications and source records attributed to I Civil.

17 recordsLinked to original sources
PubMed2001

Trauma and co-morbidity--a pilot study.

AIMS: To study the adult trauma patient population at the Auckland Hospital in order to determine the age distribution of trauma, the prevalence and importance of co-morbid conditions and any effect of the latter on the length of stay in the hospital. METHODS: Data were collected on 78 consecutive patients admitted to the Auckland Hospital under the Trauma team between December 1999 and January 2000. Data were collected by interviewing the patient, as well as reviewing patient's medical notes and the Trauma Registry. RESULTS: The prevalence of co-morbidities was 14.7%. No co-morbidity was found below the age of 40 years, but the prevalence of co-morbidity increased with age. The average length of stay for patients with no comorbidities and an Injury Severity Score (ISS) >15 was 19 days while for those with co-morbidities was 24.5 days--an increase of 29%. CONCLUSION: This pilot study has found that a significant number of trauma patients being admitted to Auckland Hospital have a pre-existing co-morbid condition that may alter their length of stay. It is an important issue that warrants further investigation, in order to devise a more accurate prognostic scoring system.

Adolescent↗
PubMed2001

Editorial.

Explore the source record for details and available documents.

Humans↗
PubMed2001

Ruptured abdominal aortic aneurysms: clinical presentation in Auckland 1993-1997.

BACKGROUND: Rupture of an abdominal aortic aneurysm (RAAA) carries a reported mortality rate in the range of 32-95%. Survival requires prompt diagnosis and surgical management. The presenting features, however, are varied, often insidious and potentially misleading with Osler noting nearly 100 years ago that a correct premortem diagnosis was achieved in only 33% of cases. The present study aims to review our present accuracy in diagnosing this condition and outline demographic and presenting features of patients with RAAA. METHODS: A review was undertaken of hospital and Coroner's files of all patients residing in the Auckland Coronial region who had RAAA between 1 January 1993 and 31 December 1997. RESULTS: Three hundred and twenty-nine cases of RAAA were identified, and they occurred most commonly in the 8th decade. The male:female ratio was 3:1 and at least 73% of patients were Caucasian. The overall mortality was 71%. Nearly half underwent surgery and the hospital averaged mortality rate was 46%. No patient survived without surgery. Classic presenting features of RAAA were absent in many cases. Abdominal pain, back pain and a palpable mass occurred in only 49%, 36% and 18% of patients, respectively. Other common presenting symptoms included vomiting, general malaise and pelvic or hip pain. Forty-three patients (16%) were initially misdiagnosed. CONCLUSIONS: Although our ability to correctly diagnose a RAAA has improved since Osler's time, the initial misdiagnosis rate of 16% leaves no room for complacency. Ruptured abdominal aortic aneurysms must be included in the differential diagnosis of any patient over the age of 55 years who presents with shock, even if the pain is non-specific or atypical.

Aged↗
PubMed2000

Trauma form documentation in major trauma.

AIMS: To examine the impact of a standardised trauma form for documentation in cases of major trauma, a prospective study was undertaken. METHODS: Records written by medical staff pertaining to the assessment and treatment of major trauma patients in the resuscitation room were scored against a panel of parameters derived from advanced trauma life support guidelines. Demographics, aetiology, trauma scores and outcome data were obtained from a trauma registry. Attitudes of medical staff involved in major trauma to the trauma form were assessed using a questionnaire. RESULTS: The trauma form was used in 53 of 69 (76.8%) consecutive cases of major trauma seen over a three month period. No significant differences existed in demographics, aetiology, trauma scores or outcome between form and formless groups. In the form group, a median of 44 of 51 (86.3%) relevant information parameters were documented versus 32 of 51 (62.7%) in the formless group, p < 0.0001. A positive approach to the trauma form was indicated by the questionnaire results. CONCLUSION: The use of a standardised form improves documentation in major trauma.

Accidents, Traffic↗
PubMed2000

Pelvic fracture pattern predicts pelvic arterial haemorrhage.

BACKGROUND: The association between pelvic fracture pattern and the need for pelvic arterial embolization remains controversial. To address this issue, a study of the experience at Auckland Hospital was undertaken. METHODS: Review was undertaken of a trauma database, blood bank database, patient records and pelvic radiographs. Of the 364 pelvic fracture patients admitted over a 4-year period, 76 were transfused with 6 or more units of blood in the first 24 h and these constitute the study population. RESULTS: Embolized patients were older (median age 42 vs 29.5 years; P < 0.05) and had a higher abbreviated injury score for the pelvic girdle (median 3 vs 2; P < 0.05) compared to non-embolized patients. Revised trauma score (median 7.69 vs 7.55), injury severity score (median 29 vs 30.5), morbidity (55 vs 39%) and mortality (45 vs 32.1%) rates did not differ significantly between embolized and non-embolized groups, respectively. The median blood transfusion requirement in the first 6 h from injury was 14 units in embolized and 8 units in non-embolized patients (P = 0.005). Embolization was required in 12 of 27 (44.4%) patients with fracture patterns indicative of major pelvic ligament disruption, whereas seven of 38 (18.4%) patients without these fracture patterns required embolization (P < 0.05). CONCLUSIONS: The need for pelvic embolization correlated with fracture patterns that indicated major ligament disruption, although the relationship was not sufficiently strong to warrant change to current indications for pelvic angiography.

Adolescent↗
PubMed2000

Blunt traumatic small bowel rupture: are children different?

BACKGROUND: In order to identify differences between children and adults with small bowel rupture (SBR) and to determine if a single diagnostic approach could be taught to paediatric and adult surgeons, a review of the experience at a children's and an adults' hospital was performed. METHODS: Using the hospital patient database 17 children were identified with SBR over a 13.6-year period, and clinical records were available for review for 14. Using a trauma registry 16 adults were identified with SBR over a 4.7-year period and clinical records were reviewed in all 16. RESULTS: The population incidence was 0.48/100000 per annum in children and 0.58/100000 per annum in adults. Motor vehicle crash was a less common mechanism of injury in children (35.7%) than in adults (75%). The time from injury to presentation (presentation interval) was significantly longer in children than in adults, even after excluding child abuse cases (median 2.9 h vs 65 min, respectively). The injury severity score was lower in children (median: 10) than in adults (median: 16.5). Peritoneal signs on follow-up examination were documented in 54.6% of children and in 90.9% of adults in whom follow-up examination was performed. Clinical findings on admission, findings on computed tomography, indications for operation and outcome were similar in children and adults. CONCLUSION: Children differed from adults in aetiology, longer presentation interval and fewer associated injuries. Similarities in diagnostic parameters suggest that a single diagnostic approach could be taught for children and adults provided that the limitations of physical examination in small children are recognized.

Abdominal Injuries↗
PubMed1999

Adult splenic injuries: treatment patterns and predictive indicators.

BACKGROUND: With the trend towards conservation in splenic trauma, the ability to identify a group of patients for whom we can safely offer conservative treatment becomes an important factor. METHODS: Data were reviewed from the trauma register at the Auckland Hospital, Auckland, New Zealand, in an attempt to isolate any predictive factors that may allow more appropriate allocation of treatment modalities in the future. Methods of treatment were determined and the success or failure of conservative management noted. Differences in the demographics, Injury Severity Score (ISS) and computed tomographic (CT) findings were particularly sought. RESULTS: Over a period of 111 weeks 48 patients were admitted with splenic injuries. Fifteen (31.2%) had immediate splenectomy, 27 (56.2%) were initially treated non-operatively and six (10.1%) died pre-operatively. Of the non-operative group eight (29.6%) failed this management at an average of 4.125 days into their hospital stay. No differences were found in age, mechanism, gender or ISS between the failed and successfully treated group. Using the Buntain classification of CT-graded splenic injury, 13 (87%) who had successful non-operative treatment had a grade II or III compared with six (86%) who failed this management being grade IV. CONCLUSION: Although these results did not reach statistical significance, by coupling the trends seen together with other work, CT grading of splenic injury is a predictive indicator and does appear to have a role in the early allocation of patients to appropriate treatment plans.

Adolescent↗
PubMed1998

The management of anterior abdominal stab wounds in Australasia.

BACKGROUND: The low incidence of stab wounds in Australasia has led to a more operative approach for the management of anterior abdominal stab wounds. A survey of Australasian surgeons interested in trauma was undertaken to analyse current practice. METHODS: Ninety-seven early management of severe trauma surgical instructors (known as ATLS in Australasia) were surveyed using a four-part, single-page questionnaire. RESULTS: Sixty-five instructors completed the survey. Thirty-nine instructors stated that they would admit patients with stab wounds even if the wound appeared superficial or 'skin only'. For 14 surgeons the decision to perform a laparotomy was dependent on fascial penetration and for 17 the decision depended upon peritoneal penetration. Six felt that all but the most superficial wounds should have a laparotomy. Laparoscopy, diagnostic peritoneal lavage and other investigations were also thought to be helpful. Thirteen surgeons felt that the presence of peritonism or tenderness were the most important determinants. There was no hospital protocol for 44 respondents and there was a wide variation in individual approach to this problem. However, all agreed that peritonism and haemodynamic instability were indications for immediate laparotomy. CONCLUSIONS: There is still a low threshold for laparotomy in Australasia and this approach is not without risks. However, the alternative of using serial observation should be regarded as an active form of management and protocols must be established to ensure regular repeat examinations by experienced personnel. The low incidence of abdominal stab wounds in Australasia makes this approach difficult. A safe approach for the Australasian situation is described.

Abdominal Injuries↗
PubMed1996

Trauma data collection using a customised trauma registry: a New Zealand experience.

AIM: To describe the process of selection and adaptation of a trauma registry and the initial experience with its use. METHOD: The decision-making processes involved in selection of a data set and computer software are described. The problems associated with collection of data, recording and analysis are outlined. RESULTS: In the 6 months from 1 January to 30 June 1995, 615 patients were entered on the Auckland Hospital trauma registry. 590 patients were discharged or transferred alive and 25 (4.1%) died in hospital. Median length of stay of survivors was 6 days (mean 9.03 days) with median ICU stay being 0 days (mean 0.81 days). A range of difficulties including data collection, recording and analysis were experienced. CONCLUSION: Despite some teething problems, establishment of a trauma registry has proven to be an achievable task within the trauma service. Recording of data which allows assessment of the quality of care, resource use and outcome has been possible. Effectiveness of the trauma service has been enhanced by the availability of this data.

Data Collection↗
PubMed1989

Injury severity scoring: a comparison of early clinical versus discharge diagnosis.

The Abbreviated Injury Scale (AIS) and the Injury Severity Score (ISS) are objective means of assessing injury. Accepted methodology involves retrospective scoring of injury based on discharge diagnoses. Recently, early clinical scoring, supplemented by review at discharge, has been introduced. A prospective study was instituted to compare these methodologies. Four hundred sixty consecutive victims of blunt trauma were scored using both clinical and retrospective methodologies by independent, blinded observers. Of these, 333 patients had a change in ISS, 174 with a change of greater than four points. The population mean ISS remained unchanged; however, paired values were significantly different (p less than .03). We conclude that either methodology is applicable for studies of large populations of trauma victims. When accurate individual AIS or ISS scoring is required, the clinical method combined with discharge review is most appropriate.

Accidents, Traffic↗
PubMed1988

DRG reimbursement for trauma: the demise of the trauma center (the use of ISS grouping as an early predictor of total hospital cost).

All institutional reimbursement for inpatient care in the State of New Jersey is administered by the DRG methodology (Prospective Payment System). This system is essentially identical to federal Medicare. In 1983 our hospital was designated the Level I trauma center for southern New Jersey (population, 2.6 million). Prehospital triage guidelines based on anatomic injury were implemented, and, as a result, an annual 30% increase in severe trauma cases (ISS greater than 16) was realized. In late 1984 serious financial shortfalls were noticed, especially in the higher ISS cases. A 1-year study (1985) of all patients admitted through the Trauma Center to an intensive care unit was completed (523 patients; mean ISS, 15.16; ISS greater than 16, 37.8%). All patients were stratified to one of five ISS groups (A: ISS 1-8; B: ISS 9-15; C: ISS 16-24; D: ISS 25-40; E: ISS greater than 40). Average cost, reimbursement, ISS, LOS, and mortality were reviewed for the entire aggregate and each severity group. The system of ISS grouping was an accurate method of cost analysis, and prospectively, ISS grouping allowed prediction of length of stay and total hospital cost. In addition, these data allowed early fiscal management decisions and resource allocation. As a reimbursement system, DRG falls short of the cost of care for all ISS levels and groups. As severity of injury rose, costs increased in a linear manner, but reimbursement did not, resulting in a substantial financial loss. The net loss to the hospital in 1 year was $1.86 million.(ABSTRACT TRUNCATED AT 250 WORDS)

Diagnosis-Related Groups↗
PubMed1986

Saline-expanded group O uncrossmatched packed red blood cells as an initial resuscitation fluid in severe shock.

Despite an excellent military experience with the use of the "universal donor" as an immediately available blood component, considerable reluctance to use uncrossmatched Group O packed cells (TOB) remains. In addition, problems continue with rapid blood acquisition in the emergency department. To study the safety of TOB used as an immediate resuscitation component, a 30-month prospective study of all patients arriving at a single trauma unit was undertaken. By protocol TOB (O-, female; O+, male) was delivered to the shock room prior to patient arrival and was expanded to 500 mL by adding 250 mL prewarmed saline (39.4 C) to the existing RBC unit. Transfusion was ordered on clinical signs of Class III or Class IV hemorrhage. Ninety-nine patients entered the protocol, receiving a total of 1,136 units of blood (11.5 units/patient). Four hundred ten units (4.1 units/patient) of uncrossmatched blood were administered on patient arrival--322 units of TOB and 88 units of type-specific blood (TSB). Seven patients (7.4%) had prior transfusions, and 14 (58%) women had prior pregnancies. Complications included disseminated intravascular coagulation, 12%; adult respiratory distress syndrome, 8%; and hepatitis, 1%. Forty-nine patients (49%) required massive transfusion (greater than 10 units/24 hr). All patients were followed clinically and by the blood bank for any signs of transfusion reactions or incompatibility throughout their hospital courses; none developed. There were no deaths related to transfusion incompatibility. We conclude that TOB used as an immediate resuscitative blood component is safe.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Exsanguinating upper extremity vascular injury: is an initial approach by clavicular resection adequate?

Clavicular resection has been recommended by some as an acceptable approach to the repair of subclavian and axillary vascular injuries. We believe this may not be the best approach in patients with severe trauma and exsanguinating injuries. During the last 5 years, we have treated 11 patients with trauma to the subclavian or axillary vessels, four of whom presented in shock from exsanguinating injuries. After initial fluid resuscitation, we operated on each patient by resecting the medial portion of the clavicle. Three of the four patients required further surgery or extension of the incision to control bleeding. In our experience, clavicular resection as a primary approach to exsanguinating injuries did not provide either adequate tamponade of bleeding or the exposure needed to repair injured vessels safely. Clavicular resection may be acceptable for hemodynamically-stable patients with minimal soft tissue damage and simple, right-sided vessel lacerations, but we cannot recommend it as an initial approach in patients with severe, exsanguinating injuries.

Accidents, Traffic↗