PubMed Health⌕ Search

Biomedical subjects

R Rutledge

Publications and source records attributed to R Rutledge.

At least 37 records · Page 2Linked to original sources
PubMed1997

Trauma registry injury coding is superfluous: a comparison of outcome prediction based on trauma registry International Classification of Diseases-Ninth Revision (ICD-9) and hospital information system ICD-9 codes.

BACKGROUND: Trauma registries are an essential but expensive tool for monitoring trauma system performance. The time required to catalog patients' injuries is the source of much of this expense. Typically, 15 minutes of chart review per patient are required, which in a busy trauma center may represent 25% of a full-time employee. We hypothesized that International Classification of Disease-Ninth Revision (ICD-9) codes generated by the hospital information system (HI) would be similar to those coded by a dedicated trauma registrar (TR) and would be as accurate as TR ICD-9 codes in predicting outcome. METHODS: One thousand eight hundred twelve patients admitted to a Level I trauma center during 2 years had International Classification of Disease Injury Severity Scores (ICISS) calculated based on HI and TR ICD-9 codes. The relative predictive powers of these two ICISSs were then compared for every patient using Receiver Operator Characteristic Curve Area (ROC) and Hosmer Lemeshow Statistics. RESULTS: Eighty-nine percent of patients (1,608 of 1,812) had identical HI and TR ICISSs. Eleven patients' ICISSs differed by >0.1, and only two patients' scores differed by >0.2. ICISS proved to be a powerful predictor of outcome whether derived from HI (ROC = 0.884; 95% confidence interval (CI) = 0.850-0.917) or TR (ROC = 0.872; 95% CI = 0.837-0.908). Although these predictive powers were not significantly different (p = 0.076), the trend was for HI to perform better than TR. ISS calculated for the same data set using the MacKenzie dictionary proved significantly less predictive of outcome than either ICISS (ROC(MacKenzie) = 0.843; 95% CI = 0.792-0.884; p = 0.034). CONCLUSION: We conclude that in our hospital TR data on individual injuries can be replaced by HI data without loss of predictive power. ISS based on the MacKenzie dictionary should be abandoned because it is much less predictive of outcome than ICISS.

Adolescent↗
PubMed1997

A comparison of the association of helicopter and ground ambulance transport with the outcome of injury in trauma patients transported from the scene.

INTRODUCTION: Comprehensive emergency medical services and helicopter aeromedical transport systems have been developed based on the principle that early definitive care improves outcome. The purpose of this study was to compare outcomes between patients transported by helicopter and those transported by ground. METHODS: Data were obtained from the North Carolina Trauma Registry for the period between 1987 and 1993 on all patients transported by helicopter and ground admitted to one of the eight state designated trauma centers. Study patients included only those who were transported directly from the scene of injury to the trauma center (interhospital transfers were excluded). Mortality (outcome) was compared after patient stratification by injury severity and transport time, using Cochran-Mantel-Haenszel statistics and logistic regression-derived probabilities of survival. RESULTS: One thousand three hundred forty-six patients (7.3% of the total) were transported from scene to trauma center by helicopter and 17,144 were transported by ground. In patients transported by helicopter, the mean Trauma Score was lower (12 +/- 3.6) versus 14.3 +/- 3.6 (p < 0.001) and the mean Injury Severity Score was higher (17 +/- 11.1) versus 10.8 +/- 8.4 (p < 0.001). A trend toward increased survival was observed among patients transported by helicopter with a higher Injury Severity Score. Statistical significance was achieved only for patients with a Trauma Score between 5 and 12 and Injury Severity Score between 21 and 30. CONCLUSION: The large majority of trauma patients transported by both helicopter and ground ambulance have low injury severity measures. Outcomes were not uniformly better among patients transported by helicopter. Only a very small subset of patients transported by helicopter appear to have any chance of improved survival based on their helicopter transport. This study suggests that further effort should be expended to try to better identify patients who may benefit from this expensive and risky mode of transport.

Air Ambulances↗
PubMed1997

Can medical school-affiliated hospitals compete with private hospitals in the age of managed care? An 11-state, population-based analysis of 351,201 patients undergoing cholecystectomy.

BACKGROUND: The purpose of this study was to use an 11-state, population-based hospital discharge database to assess the charges for care of patients undergoing cholecystectomy at both medical school affiliated hospitals (MSAHs) and private hospitals (nonMSAHs). It was our hypothesis that MSAHs could indeed provide efficient, competitively priced patient care. STUDY DESIGN: Data were obtained from the Healthcare Cost Utilization Project of the Agency for Health Care and Policy Research. The database tracks information on all hospitalized patients from 11 states for the years 1988-1992. RESULTS: Represented in the study were 849 nonMSAHs (82%) and 191 MSAHs (18%). During the 5 years of the study, 351,201 patients underwent cholecystectomy. The mean charges and the lengths of stay were similar in the two diagnosis related groups (DRGs) studied (197,198). The analysis demonstrated that during this same period, MSAHs led in both the adoption of laparoscopic cholecystectomy and decreased use of intraoperative cholangiography. CONCLUSIONS: Others have reported that MSAHs cannot compete with nonMSAHs in providing competitively priced care. The present study shows that for cholecystectomy, charges and length of hospital stay are comparable in MSAHs and nonMSAHs. This study supports the hypothesis that the leadership provided at United States medical schools may also extend to the area of cost-efficient care and hints at further areas of improvement.

Cholangiography↗
PubMed1996

A statewide, population-based time-series analysis of the outcome of ruptured abdominal aortic aneurysm.

OBJECTIVES: The purpose of this study was to perform the first statewide, population-based, time-series analysis of the frequency of ruptured abdominal aortic aneurysm (RAAA), to determine the outcomes of RAAA, and to assess the association of patient, physician, and hospital factors with survival after RAAA. The hypotheses of the study were as follows: 1) the rate of RAAA would increase over time and 2) patient, surgeon, and hospital factors would be associated with survival. BACKGROUND: Ruptured abdominal aortic aneurysm is a life-threatening emergency that presents the surgeon with a technically demanding challenge that must be met and surmounted in a short time if the patient is to survive. METHODS: Data were obtained from the following four separate data sources: 1) the North Carolina Hospital Discharge database, 2) the North Carolina American Hospital Association database, 3) the North Carolina State Medical Examiner's database, and 4) the Area Resource File. All patients with the diagnosis of an abdominal aortic aneurysm (AAA) were selected for initial assessment. Patients were grouped into those with and those without rupture of the abdominal aneurysm. RESULTS: During the 6 years of the study, 14,138 patients were admitted with a diagnosis of AAA. Of these, 1480 (10%) had an RAAA. The yearly number of patients with elective AAAs increased 33% from 1889 in 1988 to 2518 in 1993. The yearly number of RAAAs increased 27% from 203 to 258. The mortality rate for AAA was 5%, as compared with 54% in RAAA patients. The patient's age was found to be the most powerful predictor of survival. Univariate logistic regression analyses demonstrated an association of the surgeon's experience with RAAA and patient survival after RAAA. Analysis of the survival rates of board-certified and nonboard-certified surgeons demonstrated that patients with RAAAs who were treated by board-certified surgeons had significantly better survival. When the survival was compared in small (less than 100 beds) and large (more than 100 beds) hospitals, survival was significantly better in the larger hospitals. CONCLUSIONS: Ruptured abdominal aortic aneurysm remains a highly lethal lesion, even in the best of hands. Despite the many improvements in the care of seriously ill patients, there was no significant improvement in the survival of RAAA during this study. This suggests that early diagnosis is the best hope of survival in these patients. The study demonstrated that survival after RAAA was related most strongly to patient age at the time of the RAAA. The physician's and the hospital's experience with RAAA, the physician's background as measured by board certification, and the type of hospital at which the operation was performed (small vs. large) also may be associated with survival. These findings may have important implications for the regionalization of care and the education and credentialling of physicians. Given the lack of recent progress of improving the outcome of RAAA, aggressive efforts to treat patients before rupture are appropriate.

Age Distribution↗
PubMed1996

Patient, hospital, and surgeon factors associated with breast conservation surgery. A statewide analysis in North Carolina.

OBJECTIVE: The objective of this study was to determine the trend of breast conservation surgery (BCS) in North Carolina over a 6-year period and to identify patient, hospital, and surgeon factors associated with the use of BCS. SUMMARY BACKGROUND DATA: Despite evidence that BCS is an appropriate method of treatment for early stage breast cancer, surgeons in the United States have been slow to adopt this treatment method. METHODS: Cases of primary breast cancer surgery in all 157 hospitals in the state from 1988 to 1993, inclusive (N = 20,760), were obtained from the State Medical Database Commission, Area Resource File, American Hospital Association and State Board of Medical Examiner's Databases. Multiple logistic regression was used to generate odds ratios (ORs) and 95% confidence intervals (CIs) to determine factors associated with BCS. RESULTS: The rate of BCS doubled from 7.3% in 1988 to 14.3% in 1993, with an overall rate of 10.2% (2117/ 20.760). Multiple logistic regression identified the following factors associated with BCS: patient age younger than 50 years of age (OR = 1.7, 95% CI = 1.4, 2.1), patient age 50 to 69 years of age (OR = 1.2, 95% CI = 1.1, 1.4), private insurance (OR = 1.2, 95% CI = 1.0, 1.4), hospital bed size 401+(OR = 2.0, 95% CI = 1.6, 2.5), bed size 101 to 400 (OR = 1.7, 95% CI = 1.3, 2.1), and surgeon graduation from medical school since 1981 (OR = 1.6, 95% CI = 1.2, 2.0). CONCLUSIONS: Rates of BCS in North Carolina are low. Least likely to have BCS were women older than 70 years of age, without private insurance, treated at small hospitals by older surgeons. To increase the use of BCS, widespread education of surgeons, other health care providers, policy makers, and the general public is warranted.

Age Factors↗
PubMed1996

The Injury Severity Score is unable to differentiate between poor care and severe injury.

UNLABELLED: The Injury Severity Score (ISS) has been the most frequently used tool for stratifying injured patients. The primary hypothesis of this study was that ISS fails to differentiate between severe injury and mismanagement. METHODS: Data models were generated for mismanaged and ideally managed patients for isolated injuries for each body system. Flow charts of care, outcomes, and Abbreviated Injury Scale (AIS) and ISS scores were generated for each model. RESULTS: Multiple models demonstrated that minor injuries that were mismanaged would result in AIS and ISS scores that were the same as ideally managed severe injuries. Three examples are summarized as follows: A comparison of two patients with splenic injuries demonstrates that ISS is unable to differentiate between mismanagement of a minor splenic laceration as compared to a severely lacerated spleen. In the case of the minor injury to the spleen (initial AIS = 2) that was missed by the treating physicians and allowed to bleed into shock and near arrest because of massive hemorrhage that could have been prevented by early recognition and treatment, the final AIS is coded as 4 in this mismanaged patient, the same AIS and ISS as a severely lacerated spleen (AIS = 4) managed well. Both result in a discharge ISS of 16. Similarly, the ISS at discharge is the same for a well-managed severe head injury (AIS = 4) and a mismanaged minor head injury that is unrecognized, progresses and leads to coma (AIS = 4). Finally AIS, ISS does not differentiate between a well-managed cervical fracture with complete cord injury and a mismanaged cervical spine fracture that initially does not involve a cord injury, but because of mismanagement and lack of immobilization, progresses to complete cord injury because of poor care. Both result in the same injury severity assessment (AIS = 5, ISS = 25 in both). CONCLUSIONS: This study demonstrates a fact that should be recognized by all who rely upon the ISS for comparing quality of care: ISS fails to differentiate severe injury from mismanagement of injury. Because the ISS mixes outcome data with injury severity, ISS incorrectly assigns increased severity to the lesser injuries of mismanaged patients. These findings have important implications for use of the ISS in quality of care assessments.

Abbreviated Injury Scale↗
PubMed1996

Trauma care reimbursement in rural hospitals: implications for triage and trauma system design.

UNLABELLED: American College of Surgeons triage guidelines recommend rapid identification and transfer of seriously injured patients to regional trauma centers, bypassing local hospitals if necessary. This approach raises concerns about the potential negative financial impact of implementing such triage strategies on already strained rural hospitals. OBJECTIVE: The purpose of this study was to determine the association between injury severity and reimbursement for trauma care in rural hospitals. It was our hypothesis that the seriously injured would be high cost and relatively low reimbursement patients, and thus be a significant financial liability to the rural hospital. This would imply that concerns by the rural hospital about triage of such patients to trauma centers would be unfounded. METHODS: Data on every injured patient seen in the emergency department during two 3-month periods were obtained from three rural hospitals in the state using the American College of Surgeons Trauma Registry data base. RESULTS: One thousand six hundred thirty patients had complete data available for analysis. The analyses demonstrated that as the injury severity increased, there was an increase in hospital charges, length of stay, and risk of dying. In contrast, the reimbursement changed little as the charges and severity increased. Thus, hospital losses increased in an exponential fashion as injury severity increased above 15. CONCLUSION: The study demonstrates that as injury severity increases, costs and charges increase, but reimbursement does not keep pace with these increased charges. The rural hospital was projected to lose an average of $25,000 for each patient with an Injury Severity Score over 15. This study supports the rapid triage and transport of the seriously injured patient from the rural hospital to the regional trauma center both for improved patient outcome and for the hospital's best interest. The potential impact of such a system on the trauma center also needs to be addressed.

Adolescent↗
PubMed1996

ICISS: an international classification of disease-9 based injury severity score.

BACKGROUND: The Injury Severity Score (ISS) has served as the standard summary measure of human trauma for 20 years. Despite its stalwart service, the ISS has two weaknesses: it relies upon the consensus derived severity estimates for each Abbreviated Injury Scale (AIS) injury and considers, at most, only three of an individual patient's injuries, three injuries that often are not even the patient's most severe injuries. Additionally, the ISS requires that all patients have their injuries described in the AIS lexicon, an expensive step that is currently taken only at hospitals with a zealous commitment to trauma care. We hypothesized that a data driven alternative to ISS that used empirically derived injury severities and considered all of an individual patient's injuries would more accurately predict survival. METHODS: Survival risk ratios were derived for every International Classification of Disease 9th Edition (ICD-9) injury category (800-959.9) using the North Carolina State Discharge Database experience with 300,000 trauma patients over 5 years. An ICD-9 Injury Severity Score (ICISS) was then defined as the product of all survival risk ratios for an individual patient's traumatic ICD-9 codes. We compared the performance of ISS and ICISS in a group of 3,142 patients accrued at the University of New Mexico Trauma Center over 4 years. These patients had both AIS and ICD-9 descriptors meticulously assigned prospectively by designated trauma data base personnel. RESULTS: ICISS outperformed ISS at a level that was highly statistically significant (p < 0.0001) and may be clinically important: ISS misclassification rate 7.67%, ISS Receiver Operator Characteristic Curve area = 0.872; ICISS misclassification rate 5.95%, ICISS Receiver Operator Characteristic Curve area = 0.921. Moreover, these improvements are largely preserved when ICISS is used in a probability of survival model that includes age, mechanism, and revised trauma score. About half of ICISS's improvement in predictive power is because of its use of an individual patient's worst three injuries regardless of body region. The remainder is because of better modeling of individual injuries and allowing all injuries to contribute to the final score. CONCLUSIONS: We conclude that ICISS is a much better predictor of survival than ISS in injured patients. The use of the ICD-9 lexicon may avoid the need for AIS coding, and thus may add an economic incentive to the statistical appeal of ICISS. It is possible that a similar data driven revision of ISS using the AIS vocabulary might perform as well or better than ICISS. Indeed, the actual lexicon used to divide up the injury "landscape" into individual injuries may be of little consequence so long as all injuries are considered and empirically derived SRRs are used to calculate the final injury measure.

Disease↗
PubMed1996

Appropriate use of the Glasgow Coma Scale in intubated patients: a linear regression prediction of the Glasgow verbal score from the Glasgow eye and motor scores.

UNLABELLED: The Glasgow Coma Scale (GCS) has been shown to be a valuable tool in assessing the neurologic and physiologic status of critically ill patients. Unfortunately, the GCS requires assessment of the verbal response of the patient and this can be blocked by intubation. The purpose of this study was to assess the ability of a regression model based upon the eye and motor components of the GCS to accurately predict the verbal response of the GCS. The primary hypothesis was that the verbal response could be derived from the motor and eye responses of the GCS. METHODS: Data were collected prospectively in an intensive care unit computer data base. Patients were divided into training and test data sets. Linear regression was used to derive a model of verbal score from the motor and eye scores of the GCS in the training data set. Correlation between the actual and the predicted verbal scores was calculated. RESULTS: A total of 2,521 GCS assessments were available for analysis. The second order multiple regression model was an accurate predictor of the verbal score (Pearson's Correlation r = 0.9, R2 = 0.8, p = 0.0001) in 1,463 observations in the training data set. Second Order Multiple Regression Model: Estimated GCS Verbal = (2.3976) + [GCS Motor x (-0.9253)] + [GCS Eye x (-0.9214)] + [(GCS Motor)2 x (0.2208)] + [(GCS Eye)2 x (0.2318)] where r = 0.91, R2 = 0.83, and p = 0.0001. The accuracy of this model was confirmed by comparing the predicted verbal score to the actual verbal score in the test data set (n = 736, r = 0.92, R2 = 0.85, p = 0.0001) CONCLUSIONS: The GCS is a useful tool in the intensive care unit and a critical part of the APACHE II assessment of patient acuity. GCS has been shown to be a useful tool in its own right as a predictor of outcome in the critically ill. Its use is limited with intubation. (See Segatore M, Way C: Heart Lung 21:548, 1992; and Lieh-Lai MW, Theodorou AA, Sarnaik AP, et al: J Pediatr 120:195, 1992.) The present study demonstrates that a relatively simple regression model can use the eye and motor components of the GCS to predict the expected verbal component of the GCS, thus allowing the calculation of the GCS sum score in intubated patients.

Adult↗
PubMed1996

Survival, quality of life, and charges in critically III surgical patients requiring prolonged ICU stays.

UNLABELLED: Critical care consumes a significant portion of health care costs. Although there are currently increasing pressures to limit expenditures, data are not always available to allow physicians and patients to make informed therapeutic or triage decisions regarding prolonged intensive care unit (ICU) stays. The purpose of this study was to evaluate long-term outcome, quality of life, and charges in surgical patients requiring prolonged ICU stays (> 14 days). METHODS: Adults requiring over 14 days of surgical ICU care from January 1991 to September 1993 were selected from our ICU data base. Survivors to hospital discharge were evaluated for outcome and quality of life by mail survey and/or telephone interview in addition to chart review. RESULTS: Eighty-three patients spent over 14 days in the surgical ICU during the study period. Fifty-two patients (62.6%) survived to hospital discharge. Average age was 53 years, average ICU length of stay was 26 days, and average hospital length of stay was 50 days. Complete follow-up data were available for 39 patients (75%). Thirty of the 39 patients (77%) were alive at an average follow-up of 18 months. Long-term survival in patients over 65 years old was 67% compared with 83% for younger patients (p < 0.05). Seventy percent reported less than 50% functional recovery. Seventy percent wer living at home and 23% were on disability. Of 11 patients employed before discharge, five had returned to work. Eighty percent of respondents reported good to fair quality of life, and 81% stated that they would undergo critical care again. The average ICU charge was $51,512 per patient, and the average hospital charge was $164,019 per patient. The average charge to achieve one long-term survivor was $247,812. CONCLUSIONS: In this population, prolonged ICU stays resulted in acceptable quality of life and a relatively high survival rate despite significant economic investment. This study does not support withdrawal of therapy or triage decisions based solely or primarily on age or length of ICU stay.

Adult↗
PubMed1996

The impact of laparoscopic cholecystectomy on the management and outcome of biliary tract disease in North Carolina: a statewide, population-based, time-series analysis.

BACKGROUND: Laparoscopic cholecystectomy (LC) has had a major impact on the treatment of patients with biliary tract disease, but the magnitude and the details of its effects on biliary surgery remain incompletely described. The purpose of this study was to perform a statewide, population-based, time-series analysis of the effects of LC on biliary surgery. STUDY DESIGN: Patient data were obtained from the statewide hospital discharge database that collects data from all 157 hospitals in the state of North Carolina. All patients with hospital admissions for biliary tract disease from 1988 through 1993 were selected for analysis. RESULTS: The use of open cholecystectomy (OC) dropped from 100 percent of all cholecystectomies in 1988 to 32.3 percent in 1993, while LC increased from eight cases in 1988 to over 7,800 per year in 1993. The increase in the rate of LC was not associated with an increase in the overall rate of cholecystectomy. Bile duct (BD) repairs increased from 13 in 1988 to a high of 36 in 1992. There was a strong, statistically significant correlation between the rate of LCs and the rate of BD repairs (R = 0.89, p = 0.0001). Hospital charges and component charges were lower for patients having elective LC compared to those having elective OC (p = 0.001). This remained true after stratification by age and type of gallbladder disease. Hospital stays were shorter for patients having LC than for those having OC (p = 0.001 for all). Surgeons in smaller hospitals were slower at adopting LC. Younger and board certified surgeons adopted LC more rapidly than older and non-board certified surgeons. CONCLUSIONS: In North Carolina, LCs progressed from nonexistent to the dominant approach for managing patients with cholelithiasis in a matter of a few years. Associated with this change were shorter hospitalizations and lower charges. Contrary to other published reports, North Carolina did not experience an increase in the overall rate of cholecystectomy with the adoption of LC. There was a highly correlated increase in the rate of bile duct repairs in the first years of the study.

Adolescent↗
PubMed1996

Management and outcome of splenic injury: the results of a five-year statewide population-based study.

Although splenectomy was the preferred method of treating the injured spleen in the past, the methods of splenorrhaphy and nonoperative management have appeared to gain in popularity. The purpose of this study was to determine whether the management of splenic injuries has changed over the course of time and if there has been any differences in the morbidity and mortality associated with different methods of treatment. We retrospectively examined the discharge records from 2627 patients with splenic injuries from the North Carolina Discharge Database. There were 2258 adults and 369 pediatric patients for evaluation. The rate of nonoperative therapy increased from 33.9 per cent to 46.3 per cent over the 5 years of the study, whereas the rate of splenectomy decreased from 52.9 per cent to 43.4 per cent over the same time period. Splenorrhaphy was used in approximately 10 per cent of the injuries over the course of the entire study period. Adults treated nonoperatively required late operation 6.0 per cent (49/811) of the time. The pediatric late operation rate for nonoperative management was 0.4 per cent(1/231). Reoperation after splenorrhaphy was 2.9 per cent (7/240) for adult patients and 4.3 per cent (2/47) for pediatric patients. The majority of adults (57.2%) with an Injury Severity Score (ISS) < or = 15 were able to be cared for via nonoperative methods, whereas the majority of adults (66.4%) with an ISS > 15 required splenectomy. The majority of pediatric patients were able to be cared for in a nonoperative fashion in both the ISS < or = 15 (83.4%) and ISS > 15 (45.5%).

Adult↗
PubMed1995

An acetohydroxy acid synthase mutant reveals a single site involved in multiple herbicide resistance.

Acetohydroxy acid synthase (AHAS) is an essential enzyme for many organisms as it catalyzes the first step in the biosynthesis of the branched-chain amino acids valine, isoleucine, and leucine. The enzyme is under allosteric control by these amino acids. It is also inhibited by several classes of herbicides, such as the sulfonylureas, imidazolinones and triazolopyrimidines, that are believed to bind to a relic quinone-binding site. In this study, a mutant allele of AHAS3 responsible for sulfonylurea resistance in a Brassica napus cell line was isolated. Sequence analyses predicted a single amino acid change (557 Trp-->Leu) within a conserved region of AHAS. Expression in transgenic plants conferred strong resistance to the three classes of herbicides, revealing a single site essential for the binding of all the herbicide classes. The mutation did not appear to affect feedback inhibition by the branched-chain amino acids in plants.

Acetolactate Synthase↗
PubMed1995

Use of the APACHE II scoring system to determine mortality of gynecologic oncology patients in the intensive care unit.

OBJECTIVE: To determine if an elevated score on the Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring system is associated with mortality of acutely ill gynecologic oncology patients. METHODS: Gynecologic oncology patients admitted to the surgical intensive care unit (ICU) were identified from the ICU data base. Their admission APACHE II score and type of gynecologic cancer were also extracted from the data base. Charts were reviewed to determine the disease status and reason for admission to the surgical ICU. Patient mortality was correlated with APACHE II scores. RESULTS: Forty-five gynecologic oncology patients were admitted to the surgical ICU from June 1988 to January 1992. They had a mean age of 62 years and various cancers: ovarian (24), cervical (16), and endometrial (five). The mean APACHE II score was 12 (range 2-26). Eight of 45 (18%) patients died. There was a significant correlation between APACHE II scores and mortality; patients with an APACHE II score of 20 or greater had a 78% risk of death compared to a 3% risk if the score was less than 20 (P < .001, chi 2 test). CONCLUSION: Elevated APACHE II scores are associated with mortality in acutely ill gynecologic oncology patients.

APACHE↗
PubMed1995

The goals, development, and use of trauma registries and trauma data sources in decision making in injury.

Trauma is the leading killer of Americans under the age of 40 years and the fourth most common cause of death for all Americans. Its impact has not been studied adequately or understood completely. Rational decisions in the care and treatment of trauma patients, the prevention of injury, and the reduction of trauma's annual $177 billion costs can only be made with adequate information on the effectiveness of prevention and treatment measures. This information includes current and accurate data on who is at risk, what types of injuries are sustained, how they are treated, the severity of their consequences, and their outcomes. The availability of this information enables local and national agencies and hospitals to establish priorities, characterize high-risk groups, target prevention and treatment measures within each community, and evaluate the effectiveness of injury-control interventions. The value of hospital trauma registries as a major research tool is recognized increasingly because of their role in improving the care of the trauma patient and bringing about better resource utilization.

Hospital Information Systems↗
PubMed1995

Carotid artery trauma: a review of contemporary trauma center experiences.

PURPOSE: Many issues surrounding the management and outcome of carotid artery injuries remain controversial. The purpose of this study was to review a large contemporary experience with such injuries in the setting of designated trauma centers. METHODS: A statewide computerized trauma registry was used to identify all patients with injuries to the common or internal carotid arteries from October 1987 to June 1993. The records of 82 such patients were retrieved and analyzed. RESULTS: Overall mortality and stroke rates were 17% and 28%, respectively. Patients presenting with coma or shock had a particularly bad prognosis (50% and 41% mortality, respectively). Internal carotid injuries resulted in mortality and stroke rates of 21% and 41%, respectively, compared with 11% each for common carotid injuries. Patients with blunt injuries had a much higher stroke rate (56% vs 15%) but had lower mortality (7% vs 22%) than did patients with penetrating injuries. Airway compromise and associated injuries did not affect prognosis. Operative repair and percutaneous balloon occlusion had the best survival and functional outcomes. CONCLUSIONS: Operative repair offers the best chances for recovery in all categories of patients regardless of injury mechanism. Ligation is useful only as a last-resort lifesaving effort. Shock and neurologic impairment are poor prognostic factors but should not negate repair.

Adolescent↗
PubMed1995

Management and outcome of abdominal shotgun wounds. Trauma score and the role of exploratory laparotomy.

OBJECTIVE: The management and outcome of 138 abdominal shotgun wounds were examined over a 5-year period. SUMMARY BACKGROUND DATA: It has been proposed that exploratory laparotomy may be unnecessary and even overused in a subset of patients with abdominal shotgun wounds. METHODS: Data on shotgun wound patients from October 1987 through March 1992 from a statewide trauma registry were examined. Patients with abdominal shotgun wounds were identified and compared with patients with nonabdominal shotgun wounds. RESULTS: Of 516 shotgun wound patients, 138 (26.7%) had abdominal wounds and 88 (63.8%) had exploratory laparotomies. Abdominal shotgun wounds resulted in significantly longer number of intensive care unit days (4.3 vs. 2.5, p < 0.05), a greater number of blood units transfused (7.8 vs. 2.4, p < 0.05), and a higher mortality (15.9% vs. 4.8%, p < 0.05) when compared with nonabdominal shotgun wounds. When stratified for trauma score, the mortality for abdominal shotgun wounds always was significantly greater than for nonabdominal shotgun wounds. All abdominal shotgun wound patients with trauma scores less than ten died. The negative laparotomy rate for abdominal shotgun wound patients with normal trauma scores was 9.4%. No patient with a negative laparotomy died. CONCLUSION: Abdominal shotgun wounds are a particularly lethal subset of shotgun wounds. Although some abdominal shotgun wound patients can be managed without laparotomy, the morbidity and mortality for these injuries are substantial, even in patients with normal trauma score. Clinical judgment is an excellent predictor of the need for laparotomy.

Abdominal Injuries↗