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Biomedical subjects

R H Cales

Publications and source records attributed to R H Cales.

11 recordsLinked to original sources
PubMed1986

Injury severity determination: requirements, approaches, and applications.

Injury severity determination serves multiple purposes in trauma care systems by aiding prehospital triage, assisting clinical management, and facilitating outcome evaluation. Numerous authors have described methods for quantifying injury severity, most of which use physiologic status or anatomic injury. For prehospital triage, such determination assists decisions regarding patient priority, disposition, and destination. For clinical management, it provides essential information on initial condition and eventual course, including response to therapy. Finally, for outcome evaluation, it enables objective assessment of care quality, using techniques that determine appropriateness of disability, morbidity, mortality, and reimbursement, based on case mix.

Emergencies↗
PubMed1985

Utilization of medical care in Orange County: the effect of implementation of a regional trauma system.

To determine the effect of implementation of a regional trauma system on utilization of medical care we studied ambulance transports, emergency department (ED) visits, and hospital days for trauma and nontrauma patients before and after system implementation. Serious injury affects approximately one of every 1,000 persons each year and accounts for approximately one of every 250 ED visits, one of every 100 hospital days, and one of every 20 ambulance transports. Following system implementation the trauma hospitals experienced insignificant changes in annual percentage of market share of ED visits and hospital days and in annual rate of growth of ED visits and hospital days. We conclude that implementation of a medically directed regional trauma system has resulted in a predictable redistribution of a small number of seriously injured patients, and has not been associated with significant changes in utilization of EDs or hospitals.

California↗
PubMed1985

The trauma registry: a method for providing regional system audit using the microcomputer.

Medical accountability is an essential component of a system for trauma care. The microcomputerized regional trauma registry provides a simple method of providing accountability by integrating medical and system information to evaluate quality of care, adequacy of system criteria, and system compliance. The regional trauma registry is developed by identifying all patients who are suspected or known to have sustained a serious injury, whether or not they received trauma system care, and documenting their course from initial contact through final disposition. The microcomputer provides an inexpensive and readily available method for storing and evaluating the database. Information derived from the regional trauma registry is useful for profiling the nature and extent of trauma and for monitoring and modifying the system to improve patient access and medical care.

California↗
PubMed1984

Trauma mortality in Orange County: the effect of implementation of a regional trauma system.

One hundred eighteen deaths from motor vehicle accidents were reviewed retrospectively to evaluate the effect of implementation of a regional trauma system. Fifty-eight deaths occurring prior to implementation and 60 occurring after were reviewed by teams of four physicians. Following implementation the proportion of potentially salvageable deaths dropped from 34% (20/58) to 15% (9/60) (P less than .02). Seven of the nine potentially salvageable deaths occurred in 13 patients treated in non-trauma facilities (54%), while only two potentially salvageable deaths occurred in 47 patients treated in trauma facilities (4%) (P less than .0002). The median age of patients dying of trauma rose from 22 to 27 years (P less than .04); the median Injury Severity Score rose from 42.5 to 52.0 (P less than .03). The 1981 death rate for vehicular trauma dropped to 13.93 per 100,000 population compared to a projected rate of 15.72 (P less than .03); the 1982 rate dropped to 12.37 compared to a projected rate of 15.80 (P less than .02). Implementation of a regional trauma system has resulted in significant improvements in trauma care and a reduction in the death rate from vehicular trauma.

Accidents, Traffic↗
PubMed1983

Impact of regionalization. The Orange County experience.

Prior to the designation of a trauma system in Orange County, Calif, 73% of the in-hospital non-CNS deaths secondary to motor vehicular trauma were judged by the autopsy method to have been preventable. In June 1980, a regional system of trauma care with designated trauma centers was established in Orange County. We used the autopsy method to evaluate the first year's experience with this new system and compared the results with previous studies in Orange County for 1974, San Francisco County in 1974, and Orange County in 1978-1979. The results indicate a severe reduction in the number of deaths judged preventable. In addition, a more aggressive approach to the traumatized patient was noted as indicated by an increased percentage of patients who received appropriate surgical intervention.

Adult↗
PubMed1981

Cardiac arrest from gas embolism in scuba diving.

The case of a scuba diver who suffered a cardiac arrest is presented. The history of a short, lucid interval after surfacing followed by cardiac arrest, the finding of hemoptysis, and the characteristic response to recompression therapy are consistent with the diagnosis of gas embolism. The clinical presentation and pathophysiology of gas embolism are discussed, and an approach to emergency stabilization and definitive management of gas embolism is reviewed, with emphasis on cardiac arrest.

Barotrauma↗