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At least 19 recordsLinked to original sources
PubMed1992

[Bronchoscopy for initial care following severe thoracic trauma--basically indicated?].

UNLABELLED: The study objective was to determine the usefulness of routine early (within 24 h after admission) and late (on the 3rd posttraumatic day) flexible fiberoptic bronchoscopy in patients with severe chest trauma. METHODS: By history, physical examination, and radiologic findings, we identified 15 consecutive patients, all of whom were anaesthetized, orally intubated, and mechanically ventilated. There was no change in ventilation, including FIO2, for bronchoscopy. The patients had continuous cardiovascular monitoring and peripheral pulse oximetry. The bronchoscope was inserted through a tight-fitting side port at the endotracheal tube connector. Pulse rate, mean arterial pressure, and arterial blood gases were recorded before, 1 min after, and 10 min after bronchoscopy, as were intracranial pressure (ICP) in 7 patients with an ICP probe (early bronchoscopy only) and the duration of the examination. Statistical significance was tested by means of the Wilcoxon test for correlating samples. Significance was assumed at P less than 0.05 in a two-sided test. RESULTS: Early bronchoscopy revealed two bronchial avulsions, two aspirations, and ruled out one suspected aspiration. Late bronchoscopy showed plugging of at least 3 segmental bronchi by clots in 4 patients, none of whom was able to expectorate effectively. In general, changes in the observed vital parameters were minimal. There was a significant but clinically irrelevant increase in mean pulse rate before and 1 min after early bronchoscopy. DISCUSSION: We conclude that bronchoscopy should always be considered in patients with severe chest trauma, the decision being based on typical radiological findings as well as clinical signs and symptoms. Given the proper indication, bronchoscopy supplies valuable information at minimal risk to the patient.

Adult↗
PubMed1990

[Triage. Initial diagnosis of life-threatening injuries based on functional state and mechanism of injury].

Functional status expressed as Trauma Score (TS) and mechanism of injury were evaluated as criteria for diagnosing severe trauma in 253 traffic accident victims. An Injury Severity Score (ISS) of greater than or equal to 16 was considered a severe, potentially life-threatening injury. In 67 patients with ISS greater than or equal to 16, either TS was less than or equal to 13 or the history suggested risk of high energy trauma in 72%. When one or both of these criteria were met, ISS was greater than or equal to 16 in 54%. In addition, five patients (3%) with ISS less than 16 had potentially life-threatening injuries in the abdomen or in the thorax. Of these, two had a history indicating high energy trauma. Identifying severely injured patients by assessment of function and mechanism of injury gave an overtriage of 46%, which is acceptable, and an undertriage of 12%. Caution should be exercised in excluding severe trauma on these criteria. Considered together, decreased TS and a history indicating high energy injury, gave high sensitivity (72%) and specificity (78%) for diagnosing severe trauma, ISS greater than or equal to 16.

Accidents, Traffic↗
PubMed1992

[The type of coma as prognostic indicator in severe cranial trauma in childhood].

Various methods are used by neurologists to evaluate posttraumatic brain damage. The most important and reliable are the length of posttraumatic amnesia and coma. In previous papers we have already described the value of the type of coma in the prognosis of serious head injury in childhood (Baracchini-Muratorio et al. 1985; Pruneti et al. 1985). In this study, 30 children (aged 6-12 years) with serious closed head injury and subsequent coma were evaluated. The children were divided into two groups according to the type of coma, using the Plum and Posner coma classification (1966) modified by Pagni et al. (1974). The children were followed up for at least two years (9 for five years) after the trauma by means of neurological, physical, EEG, CT scan and neuropsychological examinations. The neuropsychological test results confirm the hypothesis of a different evolution of sequelae in relation to the type of coma, independently of length of coma and site of brain damage.

Adolescent↗
PubMed1990

Blunt renal trauma in childhood. Features indicating severe injury.

The clinical presentation of children with blunt renal trauma may differ from that of adults. The clinical features at presentation of 50 consecutive children (20 severe injuries, no pedicle injuries) admitted over a period of almost 8 years were reviewed to determine if there were clinical clues to major renal trauma in childhood. Gross haematuria and low haematocrit were the most helpful factors at the time of presentation and correlated well with severe renal injury. Hypotension was seen in 4 patients and only 1 had severe renal trauma. Suspicion of a major renal injury should be high when there is gross haematuria or a low haematocrit. In this study only 1 of 20 patients with major renal injury demonstrated clinical signs of shock. Unlike adults, hypotension does not appear to be a reliable indicator of the severity of renal injury in children and diagnostic evaluation should not be reserved only for those in shock.

Adolescent↗
PubMed1985

[The PMN elastase plasma level, a biochemical parameter of the severity of trauma].

Polytrauma patients with defined severity of trauma showed a significant release of lysosomal enzymes as measured by PMN leucocyte elastase-alpha 1 proteinase inhibitor complex in plasma. A positive correlation was found between the amount of liberated elastase and the severity of trauma (- indicated by means of extent of tissue trauma and blood loss). The concentration of elastase complexed with alpha 1 proteinase inhibitor may serve as an indicator for the severity of trauma and as an objective parameter supplementing the scales and scores used until now, which all are based upon subjective judgement.

Adolescent↗
PubMed1990

Predictive value of the Glasgow Coma Scale for tracheotomy in head-injured patients.

Patients with severe head trauma often require prolonged intubation and subsequent tracheotomy. The Glasgow Coma Scale (GCS), an indicator of the severity of head injury, may help identify that subpopulation of trauma victims who will ultimately undergo tracheotomy. This retrospective study demonstrates through discriminant analysis that the likelihood of tracheotomy is significantly greater in patients with a GCS rating less than or equal to 7 than it is in patients with a GCS rating greater than 7 (p = .0001). Conversely, the presence of thoracoabdominal or maxillofacial injury is associated with but not predictive of eventual tracheotomy. In the hope of minimizing complications and enhancing the utilization of hospital resources, this study argues for early tracheotomy in patients with a GCS score less than or equal to 7 who do not undergo craniotomy and are otherwise stable.

Adolescent↗
PubMed1991

Defining the major trauma patient and trauma severity.

Criteria for defining the major trauma patient have been specified by physicians using Injury Patient Management Categories (PMCs), a computerized classification that can be used effectively with routinely collected discharge abstract data from non-trauma center hospitals as well as trauma centers. These criteria for major trauma not only include the more severe and complex single injuries, but also include criteria for identifying combinations of injuries that require tertiary level care. Major trauma patients identified as tertiary using PMCs are compared with existing and frequently used measures of injury severity such as AIS and ISS. Analyses suggest that the Injury PMCs identify major trauma patients accurately and more specifically than other indicators of severity that are commonly used. In addition, unlike other measures that are generally limited to registries, PMC tertiary patient criteria differentiate major trauma patients at both trauma centers and non-trauma centers without additional data collection. Using this method thus facilitates trauma systems evaluation and patient outcome assessment.

Databases, Factual↗
PubMed1990

Comparisons of the thoracic trauma index with other models.

The thoracic trauma index (TTI) provides an indication of the severity of injuries received by motor vehicle occupants in side-impact collision environments. The index was derived from results on two sets of cadaver tests. Using a variety of statistical and numerical methods, the authors reanalyzed the data from these 80+ cadaver tests to construct a better measure of injury than TTI. Indices generated by these analyses were compared with TTI using the following quantitative measures: monotonicity, overlap, percentage correct, and sensitivity. The values of these measures are broadly similar for all indices and none of the new indices consistently performs better than TTI. This suggests that TTI is as good a predictor of injury as any of the several alternative models created.

Accidents, Traffic↗
PubMedDate not supplied

Principles of treatment and indications for surgery in severe multiple trauma.

Despite major advances, pitfalls in diagnosis and emergency treatment influence the survival chances of multitraumatized patients considerably. Diagnosis of traumatic shock cannot be made by blood pressure, pulse rate and shock index. Immediate shock therapy is indicated in all cases with severe trauma of two body regions, combined injury of one body cavity and long bone fractures and in all cases with one major thoracic or pelvic injury. In a consecutive series of 418 multitrauma patients, extremity injuries were present in 90%, severe head injuries in 65%, major thoracic trauma in 50% and abdominal or pelvic injuries in 40%. The most frequent pattern of multitrauma was long bone fractures with associated head trauma and one thoracic, abdominal or pelvic injury. Priorities of treatment are based on a 4-stage-schedule: Stage 1 includes intubation and hyperventilation for cerebral trauma, volume replacement by central venous catheter, emergency x-ray of cervical spine, chest, abdomen, pelvis and diagnostic peritoneal lavage. In 25% of admitted cases, diagnosis of abdominal hemorrhage was missed by the referring surgeon despite hemorrhagic shock, falsely attributed to cerebral trauma. At Stage 2, emergency surgery of internal and external bleeding is indicated. Wide open fractures are stabilized by external fixation. Stage 3 is concerned with stabilization of vital systems and further diagnostic evaluation, its duration varying from 2 hours to 2 days. At Stage 4, internal fixation of fractures and other non-emergency-operations are indicated. Operating time can be reduced considerably by 2 surgical teams operating simultaneously or overlapping. Early shock diagnosis, immediate intubation, ventilator treatment and the "4-stages-schedule" are considered the most successful steps in the management of multitrauma, as well as volume replacement with Fox' hypertonic saline solution and blood constituents instead of colloids. This has reduced mortality due to respiratory failure from 31% to 20%.

Abdominal Injuries↗
PubMed1989

Serum somatomedin activity following adult tibial shaft fractures.

Serum somatomedin (SM) activity was measured serially in 27 adults with closed tibial shaft fractures. SM activity was found to be normal in all but one specimen. The results indicate that SM activity does not reflect severity of trauma or the ability to heal on time in these fractures.

Adolescent↗
PubMed1989

[Reimplantation of a free graft of the nasal septum. Technic and indications].

Severe nasal trauma produces concomitant lesions of the pyramid and septum. These functional and cosmetic sequelae are inseparable and must be treated during the same operative procedure. Among the procedures for nasal straightening, the method of choice is ablation of the septum, intra-operative reconstruction of a continuous plate followed by reimplantation in an intact perichondro-mucosal sleeve.

Humans↗
PubMed1991

Post-traumatic stress disorder in an urban trauma population.

This descriptive study examined the incidence of post-traumatic stress disorder (PTSD) in individuals who experienced physical traumas within the past 6 months and the relationship between severity of physical injury and PTSD. The sample consisted of 92 subjects who were treated at a Level 1 trauma center in an urban hospital. Scores on the Impact of Event Scale indicated that over half of the sample had medium or high levels of PTSD. However, the severity of physical injury from trauma was not related to PTSD development.

Adolescent↗
PubMed1991

Survival after trauma--experience at an acute-care general hospital.

OBJECTIVE: To assess the effectiveness of the management of acute traumatic illness at an acute-care general hospital. DESIGN: The study was conducted prospectively for the calendar year 1989. The Trauma Score (TS) and the revised Trauma Score (RTS) were calculated on arrival at hospital. These clinical indices were used, with the Injury Severity Score (ISS) and the age, to predict the probability of survival (Ps) and the probability of mortality. The predicted probabilities were compared with the probabilities of survival and mortality derived from a recognised baseline. SETTING: The Trauma Service of The Sutherland Hospital Caringbah, including the Emergency and Intensive Care Departments and the Departments of Surgery and Anaesthetics. PATIENTS: 74 patients of all ages who were brought to the Emergency Department because of acute traumatic illness with an ISS greater than 16. Only patients with signs of life on arrival were included in the study group. Data were complete in all 74 patients. RESULTS: There were 60 survivors and 14 deaths compared to figures predicted using data from the baseline group of 52.6 survivors and 21.4 deaths. There were no preventable deaths. There were five survivors whose probability of survival was less than 0.50. Three cases of late diagnosis were noted; the late diagnoses did not significantly affect the outcomes--they occurred because specialist assessment was delayed. CONCLUSIONS: It is possible, with few resources, to quantitatively and qualitatively assess the effectiveness of a trauma care service.

Adult↗
PubMed1991

Base deficit as an indicator of significant abdominal injury.

OBJECTIVE: To determine the relative predictive value of the arterial base deficit (BD) as an indicator of intra-abdominal injury (AI) and to compare BD with other indicators (chest injuries, pelvic fractures) of AI. DESIGN: Retrospective case-control analysis. SETTING: University of California San Diego Medical Center. MEASUREMENTS AND MAIN RESULTS: Between January 1985 and July 1988, 3,223 blunt trauma patients were admitted, with complete records available on 3,011. Using a "best fit" multiple logistic regression, BD less than or equal to -6 was the single most important indicator of AI (P less than or equal to .0001), and the odds ratio for AI increased with each category of increasing severity of BD. Admission hypotension, major chest injury, pelvic fracture, and field hypotension (in odds ratio order) also were significantly associated with AI. CONCLUSION: BD is a powerful indicator of AI. A normal BD does not exclude AI, but the presence of a BD less than or equal to -6 in a blunt trauma patient should be considered a strong indication for objective evaluation of the abdomen (ie, diagnostic peritoneal lavage).

Abdominal Injuries↗
PubMed1991

[Stable metal osteosynthesis in fractures of long tubular bones and cranio-cerebral trauma].

On the basis of an experience of application of modern methods of trans-osseous (123), intraosseous (67) and osseous (3) metallo-osteosynthesis and their combinations (30) in 159 victims (aged 4.5-86 years) with associated craniocerebral injury is drawn a conclusion on the expediency of application of different methods of metallo-osteosynthesis of long bones depending on a number of indications. In this case the severity of the craniocerebral injury and the victim state, the character and association of the bone fractures, the period of the traumatic disease are taken into consideration. The most efficient is the early application of stable metallo-osteosynthesis. Combination of the stable connection of fractured fragments with the principle of minimum intervention damaging is of special significance. For this reason in the period of early compensation (2 initial post-traumatic days) the trans-osseous osteosynthesis is preferable. Metallo-osteosynthesis is expedient according to the rigorous indication in the period of stable compensation (9-21 post-traumatic days), preferably at the closed fractures of femur and forearm. The results of treatment have been evaluated with 123 (77.36%) operated patients. The positive outcomes have been noted with 95% of patients that is indicative of the efficiency of the applied methods.

Adolescent↗
PubMed1990

[Surgical tactics in splenic injuries and the sequelae of splenectomy].

Traumas of the spleen in overwhelming majority of patients are followed by destruction of the organ which results in 86% of absolute indications for forced splenectomy. Organ-preserving operations in patients with the injured spleen should be welcome. However their real possibilities can be realized in 8% of the victims only. Immediate outcomes of the surgery are dependent not on its volume on the injured spleen, but on the character and severity of the trauma. Removal of the spleen from the organism of adults due to its trauma is followed only by transitory disturbances of the cellular composition of the peripheral blood, defects of the immune competent system and disturbances of hemostatic properties of blood. In remote terms no higher susceptibility of infection was found.

Adolescent↗