PubMed Health⌕ Search

Biomedical subjects

W Sacco

Publications and source records attributed to W Sacco.

8 recordsLinked to original sources
PubMed1992

Differences in trauma care among pediatric and nonpediatric trauma centers.

To characterize pediatric trauma care, state trauma registry data from all designated trauma centers in Pennsylvania were divided into three categories, that from: (1) pediatric centers, (2) urban nonpediatric centers, (3) and rural nonpediatric centers. From October 1, 1986 through September 30, 1989 (3 years), 4,615 patients less than 15 years old were admitted to 28 trauma centers in Pennsylvania. Nonpediatric centers cared for the majority of children (2,734, 59.2%), but the average number of children treated per nonpediatric institution (105.1 per year) was far fewer than the average treated in the pediatric centers (940.5). Pediatric trauma centers in the state treated a younger population (6.4 +/- 4.2 years, mean +/- SD) compared with urban and rural nonpediatric centers (8.4 +/- 4.2 and 8.1 +/- 4.3 years, respectively; P less than .05). Pediatric centers received proportionately more children by transfer (56.2%), victims of falls (34.6%), pedestrian injuries (16.8%), and head and neck injuries (41.8%, all P less than .05). Nonpediatric centers received children directly from the scene of injury more frequently than transferred from other hospitals. The male:female sex ratio in urban nonpediatric centers was significantly higher (70.1%, P less than .05) than in the other two groups. Rural nonpediatric centers cared for a higher proportion of motor vehicle passengers (28.5%) and patients classified as "other" in the state registry, a category to which bicycle injuries are assigned (28.2%, P less than .05). Mortality was highest in rural nonpediatric centers (6.2%). The death rate in pediatric centers and urban nonpediatric centers were similar (4.1%) and significantly lower (P less than .05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Cost effectiveness of trauma quality assurance audit filters.

The American College of Surgeons Committee on Trauma (ACSCOT) has published recommended minimal audit filters for trauma quality assurance. In this study ten filters were assessed through variable sample sizes over a 1-year period for cost and efficiency. Each filtered case was screened by trauma nurse coordinators. The trauma director reviewed possible deviations from standard and presented cases at peer review conferences for consensus on problem identification. While several filters had reasonable yield, most filters had minimal or no yield. Ten de novo problems were identified at a cost of +1,000 per de novo problem. Six filters were modified based on common reasons for overfiltration, resulting in a substantial reduction in filtration rate without losing problem identification. We conclude that ACSCOT audit filters 1 (unexpected deaths), 4 (ICU LOS greater than twice the average), 5 (trauma surgeon response), and 9 (major surgery greater than 24 hours) have a reasonable yield. Filters 2, 3, 7, 8, 11, and 12 have limited value to an established suburban trauma center and are not cost effective. Modifications of these filters can reduce cost without obvious impact on effectiveness. Specific audit filters recommended for future study are presented.

Cost-Benefit Analysis↗
PubMed1982

An analysis of fatal and non-fatal head wounds incurred during combat in Vietnam by U.S. forces.

Analysis of data obtained from U.S. military personnel who received either a lethal or non-lethal brain or head wound in Vietnam indicate that: 1. Bullets caused more fatal brain wounds that did fragments. 2. Most bullet wounds were received at close range, 40.9 m average. Most fatal fragment wounds to the brain occurred at a very close range, 2.9 m average. 3. Clinically significant intracranial blood clots occurred in only 7% of all fatal brain wounds. Only one man with a non fatal brain wound had an associated clot, 3.3%. 4. Helmets offered no protection against bullets but gave significant protection against fragments. 5. Men who sustained either fetal or non fatal brain wounds became immediately militarily non effective.

Brain Injuries↗
PubMed1976

Subjective feelings and vascular responses in reaction to reduced control over aversiveness.

Subjects were exposed to an aversive, modified Sidman avoidance procedure. One group had relative control over the aversiveness in that they could exercise an option for unlimited rest periods, and they could avoid electric shock by an appropriately fast-response rate on a monitoring task. The second group was yoked to subjects in Group I both with respect to rests and shocks, thereby producing decreased capability of behavioral control. The effects of this manipulation were evaluated by three types of dependent measures: vascular arousal (systolic and diastolic blood pressure), verbal reports of subjective feelings, and performance on a subsequent problem-solving task. The findings suggested motivational deficits along with reduced vascular arousal among the yoked subjects, a pattern of results which may clarify some of the alternative hypotheses pertinent to "learned helplessness".

Arousal↗