Single System Injury Research Articles

Outcome of selective CT vs. pan-CT scan in elderly trauma patients: A retrospective cohort study in a level 1 trauma center

PurposeThere are currently no clear guidelines for use of pan- or selective CT in elderly trauma patients and this subject matter remains controversial. The aim of this study is to compare the outcome of elderly trauma patients in a level 1 trauma centre who required a pan- or selective CT scan on admission. MethodsThe Trauma Audit Research Network database was reviewed to identify eligible patients (≥65 years) over a one-year period, from January 2018 to January 2019. Patients’ demographics, mechanism of injury, injury severity score, length of hospital stay (LOS), mortality and type of CT scans done were recorded. The inclusion criteria were elderly patients ≥65 years involved in acute trauma setting (less than one day between incident and emergency department presentation and blunt mechanism of injury). Exclusion criteria were patients <65 years, perforating mechanism of injury and patients with delayed presentation more than one day after the incident, and patients who have not got any CT scan at presentation. Statistical analyses were undertaken on SPSS (version 25.0; IBM, New York, USA). ResultsIn total, 481 patients with the mean age of 80.8 years were evaluated (48.6% male). Among them 232 cases were multiple injuries while 249 were single system injuries. And 235 patients (48.8%) underwent pan-CT in whom 66.8% were multiple injuries; 246 (51.1%) did selective CT scan in whom 69.5% were single system injuries. In multiple injury patients, performing a pan-CT scan on presentation was associated with shorter LOS compared to those who had a selective CT, in which 76.4% patients spent < 21 days in the pan-CT group compared to 16.0% for those investigated by selective CT scan (p < 0.001); and 2.5% spent > 60 days in pan-CT group compared to 64% in selective CT group (p < 0.0001). Performing pan-CT was also associated with lower need to repeat CT (p < 0.01). In patients with a single system injury, no differences were found in LOS or the need to repeat CT if either pan-CT or selective CT were requested. ConclusionWe recommend doing pan-CT scan in all elderly patients with multiple system injuries as it decreases the LOS and the need for another CT during hospital stay. No difference in LOS or the need to repeat another CT if pan-CT or selective CT were requested initially in single system injuries. Although age and injury severity score are poor predictors for the need to do pan-CT, the mechanism of injury may be helpful.

Geospatial assessment of helicopter emergency medical service overtriage.

Despite evidence of benefit after injury, helicopter emergency medical services (HEMS) overtriage remains high. Scene and transfer overtriage are distinct processes. Our objectives were to identify geographic variation in overtriage and patient-level predictors, and determine if overtriage impacts population-level outcomes. Patients 16 years or older undergoing scene or interfacility HEMS in the Pennsylvania Trauma Outcomes Study were included. Overtriage was defined as discharge within 24 hours of arrival. Patients were mapped to zip code, and rates of overtriage were calculated. Hot spot analysis identified regions of high and low overtriage. Mixed-effects logistic regression determined patient predictors of overtriage. High and low overtriage regions were compared for population-level injury fatality rates. Analyses were performed for scene and transfer patients separately. A total of 85,572 patients were included (37.4% transfers). Overtriage was 5.5% among scene and 11.8% among transfer HEMS (p < 0.01). Hot spot analysis demonstrated geographic variation in high and low overtriage for scene and transfer patients. For scene patients, overtriage was associated with distance (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.01-1.06 per 10 miles; p = 0.04), neck injury (OR, 1.27; 95% CI, 1.01-1.60; p = 0.04), and single-system injury (OR, 1.37; 95% CI, 1.15-1.64; p < 0.01). For transfer patients, overtriage was associated with rurality (OR, 1.64; 95% CI, 1.22-2.21; p < 0.01), facial injury (OR, 1.22; 95% CI, 1.03-1.44; p = 0.02), and single-system injury (OR, 1.35; 95% CI, 1.18-2.19; p < 0.01). For scene patients, high overtriage was associated with higher injury fatality rate (coefficient, 1.72; 95% CI, 1.68-1.76; p < 0.01); low overtriage was associated with lower injury fatality rate (coefficient, -0.73; 95% CI, -0.78 to -0.68; p < 0.01). For transfer patients, high overtriage was not associated with injury fatality rate (p = 0.53); low overtriage was associated with lower injury fatality rate (coefficient, -2.87; 95% CI, -4.59 to -1.16; p < 0.01). Geographic overtriage rates vary significantly for scene and transfer HEMS, and are associated with population-level outcomes. These findings can help guide targeted performance improvement initiatives to reduce HEMS overtriage. Therapeutic, level IV.

Trauma Nursing: From Resuscitation Through Rehabilitation, Fifth Edition

We live in a time when natural disasters and mass casualties occur with greater frequency than ever before. In many of these situations, patients have been taken to both trauma and nontrauma centers for treatment. Trauma Nursing is a book for both trauma nurses and nontrauma nurses who care for injured patients. This book is a comprehensive text about care of the trauma-injured patient, from prevention and prehospital care to initial evaluation, resuscitation, operative care, and critical and progressive care nursing applications. The authors complete the cycle of care by reviewing considerations for rehabilitation.Trauma Nursing is divided into 4 sections. The first half of part 1 tackles general issues related to trauma nursing, such as the evolution and development of the trauma system and the economic and administrative factors affecting trauma care, including quality, safety, and legal/ethical issues. The second half of part 1 delves into injury prevention and pre-hospital care of trauma victims. This section also contains a comprehensive look at disaster preparedness and mass casualty response.Section 2 covers trauma basics, including the most important of the foundational tools a nurse needs when caring for victims of trauma, that is, knowledge of the pathophysiology of trauma, also known as the mechanism of injury. Other topics in this section include management of traumatic shock; infection and infection prevention; wound healing; nutritional management; and management of pain, anxiety, and delirium. This section is the most important one for non-trauma nurses caring for a trauma victim.The authors cover single-system injuries in section 3. Topics include traumatic brain injury, facial trauma, spinal cord trauma, and thoracic and abdominal trauma. Each system injury is discussed in detail, from pathophysiology to the latest evidence-based care.Section 4 examines special populations and their unique response to traumatic injury. These populations include pregnant patients, pediatric and geriatric patients, and bariatric patients. In addition, Trauma Nursing discusses the impact of substance abuse on trauma care, which is an important aspect of trauma care. Other special care issues include care of burn patients and organ and tissue donors.Lastly, Trauma Nursing provides a comprehensive look at the knowledge needed to obtain the TCRN certification examination and includes certification review questions. This evidence-based book is a handy resource for both non-trauma nurses and nurses working in a trauma setting.

Experiences and challenges of managing mass casualty during industrial action in Aminu Kano Teaching Hospital, Kano

Introduction: A mass casualty incident (MCI) is an infrequent event that requires coordinated action under time constraints. With the emergence of Boko Haram, coupled with industrial disharmony and recurrent strike actions among health workers; there were series of terrorist's attacks when either the Doctors or other health-care providers were on strikes. Objective: The aim of this study is to determine the pattern of injuries, presentation-intervention interval and the challenges of mass casualty management. Methods: This was a retrospective study among 37 multiply injured patients of suicide bombing and shooting who were admitted at Aminu Kano Teaching Hospital from 28th November 2014 to 5th February 2015. Their case notes were retrieved, information obtained includes types of the injuries and intervention among others which were analysed using SPSS version 16. Results are presented in tables and figures. Results: There were a total of 194 patients who presented to the accident and emergency unit of the hospital. The mean age (±standard deviation) was 33.4 ± 19.25 years. Twenty (10%) were dead on arrival, 37 (20%) had major injuries. More than half of the victims were operated within 6 h of presentation. About 78% had single system injuries, whereas 22% had multiple organ system injured. Up to 25% had at least two units of blood transfused. Conclusion: We were able to intervene in 3% of patients within the first 3 h of presentation and another 30% within 6 h. We would have done better if there were no industrial disputes.

Başkent Üniversitesi Hastanesine Trafik Kazası Nedeniyle Başvuran Adli Olguların İncelenmesi

Amaç: Bu çalışmada, 2013 yılında trafik kazası sonucu yaralanarak Başkent Üniversitesi Ankara Hastanesi Acil Servisine başvuran hastaların adli bildirim raporları retrospektif olarak incelenerek; yaş, cinsiyet, olayın oluş yeri, olay tipi, olay zamanı, yaralanmanın tipi ve lokalizasyonu gibi özelliklerinin yanı sıra hazırlanan bildirim raporlarının eksikliklerinin de değerlendirilmesi amaçlanmıştır.Gereç ve Yöntem: Tanımlayıcı nitelikteki bu araştırmanın örneklemini, Başkent Üniversitesi Ankara Hastanesi Acil Servisinde 2013 yılında hazırlanan 2397 adli bildirim raporu oluşturmaktadır. Çalışma, bu raporların trafik kazalarına ait 553’ünün (%23,07) değerlendirmesini içermektedir. Bulgular: Çalışma kapsamına alınan 553 adli olgunun; %38,52’si kadın, %47,92’si erkek, %6,51’i kız çocuk ve %7,05’i erkek çocuktur. Yaş bilgisine ulaşılan 537 olgunun (%13,97)’si &lt;18, (%51,96)’sı 18-40, (%24,58)’i 41-63, (%9,49)’u ise ≥ 64 yaş arasındaki bireylerden oluşmaktadır. Kazaların %67,81’i araç içi, %29.48’i araç dışı trafik kazasıdır. Lezyon bulgusu olan 407 olgudan 329’unda (%80.84) tek sistem yaralanması mevcuttur. Baş-boyun (n:123, %30.23) ve alt ekstremite (n: 101, %24,82) bölgelerine ait yaralanmalar ilk iki sırada yer almaktadır. Bu yaralanma lokalizasyonları nedeniyle de sıklıkla ortopedi ve beyin cerrahisi kliniklerinden konsültasyon istendiği verisi elde edilmiştir. Trafik kazası nedeniyle başvuran hastaların yaralanmalarının sadece %1,88’unda (n:10) yaşamsal tehlikenin olduğu belirlendi.Sonuç: Adli raporlardaki eksiklikler hak kayıplarına neden olabilir. Trafik kazalarında vatandaşların hakkının korunması, haksızlığın engellenmesi için adli raporların dikkatle düzenlenmesi gereklidir. Acil servis hekimleri adli olgulara yaklaşım konusunda eğitilmeli, adli tıp anabilim dallarından konsültasyon istemeli ve koordineli çalışmalıdırlar.

Utilisation of a Level 1 Trauma Centre in KwaZulu‐Natal: Appropriateness of Referral Determines Trauma Patient Access

Appropriate referral of major trauma patients to an accredited Level 1 Trauma facility is associated with improved outcome. A new Level 1 Trauma Centre was opened at Inkosi Albert Luthuli Central Hospital in March 2007. This study sought to audit the referral pattern of external consults to the trauma unit and ascertain whether the unit was receiving appropriate referrals and has adequate capacity. An audit was performed of the referral proformas used in the unit to record admission decisions and of the computerised trauma database. The audit examined referral source (scene vs. interhospital), regional distribution, and final decision regarding admission of the injured patients. The study was approved by the UKZN Ethics Committee (BE207/09 and 011/010). Of the 1,212 external consults, 540 were accepted for admission while the rest were not accepted for various reasons. These included 206 cases where no bed was available, 233 did not meet admission criteria (minor injury or futile situation), and 115 were for subspecialty management of a single-system injury. Finally, 115 were initially refused pending stabilisation for transfer at a regional facility. Twenty-six percent of the cases were referrals from the scene, with an acceptance rate of 96%. Most patients (59%) were from the local eThekwini region. Major multiorgan system trauma remains a significant public health burden in KwaZulu-Natal. A Level 1 Trauma Service is used appropriately in most circumstances. However, the additional need for more hospital facilities that provide such services across the whole province to enable effective geographical coverage for those trauma patients requiring such specialised trauma care is essential.

Trauma caused by falling objects at construction sites

Workplace-related injuries carry a significant health care challenge. The state of Qatar is developing rapidly, with much construction and an expanding industrial work force. This study aimed to assess the incidence and social impact of work-related injuries requiring hospitalization caused by falling objects at the construction sites. We performed a prospective study for all admissions, which resulted from falling objects between January 2008 and June 2010 at the only trauma center in the state of Qatar. Data were analyzed, and outcomes were described (mortality, length of hospital stay, and safety measures). Of the total injured patients (N = 4,302) admitted between January 2008 and June 2010, 185 (4%) had injuries caused purely by falling objects. Patients' mean age was 29 years, and 97% of the patients were men. All injuries occurred at construction sites. Most patients (86%) were brought by ambulance, and the reminder was brought by private vehicles. After initial evaluation and resuscitation, 120 patients (65%) were found to have a single-system injury, and 65 (35%) had multisystem injury. Operative interventions were required in 50% of the patients. Mean length of hospital stay varied from 6.5 days for single-system injuries to 19 days for multisystem injuries. Safety devices were used in 32 patients (17.3%). All of the 16 mortality cases (8.6%) were reported in multiple injuries. Traumatic injury caused by falling object represents a significant problem in a rapidly developing country. Many of these injuries could be prevented by following established safety guidelines. Epidemiologic study, level III.

Training in Trauma Care

In a dubious distinction for the country, the World Health Organization has revealed in its first ever Global Status Report on Road Safety that more people die in road accidents in India than anywhere else in the world, including the more populous China. (Dipak Kumar Dash, TNN, Aug 17, 2009, 04.10 am IST. New Delhi) About 250 people die in road accidents in India everyday (‘Strategy on road safety must’ TOI on 7th March, 2009) and the total number of deaths every year due to road accidents has now passed the 135,000 mark, according to the latest report of National Crime Records Bureau or NCRB. Besides road traffic accidents we have our share of victims of terrorist activities, accidents at work places, natural and man-made disasters, etc. Out of these about 78% are men in age group of 20–44 years, causing significant impact on productivity. (Joshipura MK, Shah HS, Patel PR, Divatia PA. Trauma care systems in India—An overview. Indian J Crit Care Med 2004;8:93-7) No credible data is available to ascertain the outcome of trauma victims; it is generally perceived that outcomes in patients with single system injury (e.g. musculoskeletal trauma) have improved. Unfortunately, the same cannot be said for polytrauma. There is a high mortality rate amongst those with multisystem injuries, which can be attributed to the primitive state of trauma-care systems, lack of prehospital care and inadequate critical care. It is established that the mortality in serious (ISS > 16) injuries is six times worse in a developing country such as India compared to a developed country. (Mock CN, Jurkovich GJ, nii-Amon-Kotei D, Arreola-Risa C, Maier RV. Trauma mortality patterns in three nations at different economic levels: Implications for global trauma system development. J Trauma 1998;44:804-14.) For any improvement in this area, it is essential to establish trauma system in the country and have health care professionals trained to provide efficient care to trauma victims at every step—pre-hospital, in-hospital and rehabilitation. Establishment of trauma system would fall within the purview of central and state government authorities. But professional bodies such as The Association of Surgeons of India can play pivotal role in training of health care professionals. Unfortunately such efforts have remained restricted to a few pockets in our country.

Quality of Care Within a Trauma Center Is not Altered by Injury Type

: Previous studies have demonstrated variations in severity-adjusted mortality between trauma centers. However, it is not clear if outcomes vary by the type of injury being treated. : National Trauma Data Bank was used to identify patients 16 years or older with moderate to severe injuries (Abbreviated Injury score > or =3) treated at level I or II trauma centers (n = 127,439 patients, 105 centers). Observed-to-Expected mortality ratios (O/E ratios, 95% confidence interval [CI]) were calculated for each trauma center within each of the three injury types: blunt multisystem (two or more body regions; n = 27,980; crude mortality, 15%), penetrating torso (neck, chest, or abdomen; n = 9,486; crude mortality, 9%), and blunt single system (n = 89,973; crude mortality 5%). Multivariate logistic regression was used to adjust for age, gender, mechanism, transfer status, and injury severity (Glasgow Coma Scale, blood pressure). For each injury type, trauma centers' performance was ranked as high (O/E with 95% CI <1), low (O/E with 95% CI >1), or average performers (O/E overlapping 1). : Almost three quarters of the trauma centers achieved the same performance rank in each of the three injury categories. There were 14 low-performing trauma centers in blunt multisystem injuries, six in penetrating torso injuries, and nine in the blunt single system injuries group. None of these centers achieved high performance in any other type of injury. : Risk-adjusted outcomes are consistent within trauma centers across different types of injuries, suggesting that quality improvement efforts should measure, analyze, and focus on hospital-wide systems of care, rather than on isolated quality domains related to specific types of injury.

The Trauma Quality Improvement Program: Pilot Study and Initial Demonstration of Feasibility

The American College of Surgeons Committee on Trauma has created a "Trauma Quality Improvement Program" (TQIP) that uses the existing infrastructure of Committee on Trauma programs. As the first step toward full implementation of TQIP, a pilot study was conducted in 23 American College of Surgeons verified or state designated Level I and II trauma centers. This study details the feasibility and acceptance of TQIP among the participating centers. Data from the National Trauma Data Bank for patients admitted to pilot study hospitals during 2007 were used (15,801 patients). A multivariable logistic regression model was developed to estimate risk-adjusted mortality in aggregate and on three prespecified subgroups (1: blunt multisystem, 2: penetrating truncal, and 3: blunt single-system injury). Benchmark reports were developed with each center's risk adjusted mortality (expressed as an observed-to-expected [O/E] mortality ratio and 90% confidence interval [CI]) and crude complication rates available for comparison. Reports were deidentified with only the recipient having access to their performance relative to their peers. Feedback from individual centers regarding the utility of the reports was collected by survey. Overall crude mortality was 7.7% and in cohorts 1 to 3 was 16.4%, 12.4%, and 5.1%, respectively. In the aggregate risk-adjusted analysis, three trauma centers were low outliers (O/E and 90% CI <1) and two centers were high outliers (O/E and 90% CI >1) with the remaining 18 centers demonstrating average mortality. Challenges identified were in benchmarking mortality after penetrating injury due to small sample size and in the limited capture of complications. Ninety-two percent of survey respondents found the report clear and understandable, and 90% thought that the report was useful. Sixty-three percent of respondents will be taking action based on the report. Using the National Trauma Data Bank infrastructure to provide risk-adjusted benchmarking of trauma center mortality is feasible and perceived as useful. There are differences in O/E ratios across similarly verified or designated centers. Substantial work is required to allow for morbidity benchmarking.

Effects of a nonsurgical hospitalist service on trauma patient outcomes

The American College of Surgeons criteria for Level I trauma centers calls for >90% of trauma patients to be admitted directly by a trauma surgeon or surgical subspecialist; however, the efficiency of the trauma system may be increased if patients presenting with comorbid conditions and minor injuries are treated by a hospitalist team (nonsurgical Trauma MEDical [TMED] service). We hypothesized outcomes would be equivalent for patients treated under TMED versus a surgical service. This retrospective review compared mortality, hospital length of stay (LOS), Emergency Department (ED) LOS, placement to rehabilitation facilities, and complication rates for patients who could have been treated by TMED as identified by an algorithm. The study population for 2003 (pre-TMED) was compared with the study population for 2006 (post-TMED). Univariate analyses and multivariate logistic and linear regression were used to identify outcomes that were different for patients treated in 2003 versus 2006. Sensitivity, specificity, and percent kappa agreement were calculated for patients who were treated by the TMED team in 2006 versus patients in 2006 who were identified using the algorithm. The algorithm had reasonable sensitivity (78%) and specificity (90%); the kappa agreement was excellent (0.88). No differences were found in mortality (P = .31), rate of complications (P = .08), ED LOS (P = .77), or placement to rehabilitation facilities (P = .29) for patients identified in 2003 versus 2006. Hospital LOS was increased in 2006 (3.7 vs 4.1 days; P = .02). These data support admission of trauma patients with nonsevere, single-system injuries to a nonsurgical hospitalist service. We hypothesize that overall system efficiency may be improved by applying this alternative model in other trauma centers.

Has the trauma surgeon become house staff for the surgical subspecialist?

Background The role of the trauma surgeon is perceived to be mostly supportive of other procedure-oriented specialties. We designed this study to characterize the surgical and nonsurgical responsibilities of the contemporary trauma surgeon. Methods Trauma patients admitted to an urban academic level I trauma center were studied using trauma registry data for 2004. Results The large majority of patients admitted to trauma service has mild single-system injuries to 1 or 2 anatomic regions. Most (57%) did not have injuries to the neck, chest, or abdomen. Head and extremity injuries were present in 45% and 46% of patients, respectively. Surgeries were performed by orthopedists in 28%, trauma surgeons in 11%, and neurosurgeons in 6% of patients. Conclusions The contemporary trauma surgeon has little surgical opportunity and provides a disproportionate amount of nonsurgical care in support of consultant specialists. This is a major deterrent to general surgeon interest in trauma care and must be addressed as the acute-care surgeon evolves.

Workload Redistribution: A New Approach to the 80-Hour Workweek

The new Accreditation Council for Graduate Medical Education-mandated 80-hour resident work week has resulted in busy trauma services struggling to meet these strict guidelines, or face loss of accreditation. Beginning in July 2003, our Level I trauma service began a policy of direct admission of isolated neurosurgical or orthopedic injuries to the specific subspecialty service after complete evaluation by the trauma service in the emergency department for associated injuries. Complications, missed injuries, delayed diagnoses, and admission rates were compared in two 6-month periods: PRE, before the policy change; and POST, after the new policy had been instituted. Resident work hours were likewise compared over the two time periods. Selected single-system injury admission to subspecialty services resulted in a 15% reduction in admissions to the trauma service. There were no significant differences in the overall complication rate, delayed diagnoses, or missed diagnoses between the PRE and POST time periods. Overall, there was a 9.7% reduction in resident work hours (p = 0.45; analysis of variance) between the PRE and POST periods, which allowed them, on average, to meet the Accreditation Council for Graduate Medical Education 80-hour workweek mandate. Direct admission of patients with isolated injuries to subspecialty services is safe and decreases the workload of residents on busy trauma services.

Examination of the injured eye: single system injury

Eye trauma is common and all trauma doctors should receive instruction in ocular examination techniques. This article considers different elements of eye examination: facial asymmetry and orbital fractures, lacerations, eye movements, pupils, anterior segment, posterior segment, and the optic nerve. Emphasis is placed on paediatric patients and those who will be particularly difficult to examine, such as those patients with occult rupture of the eye or brain penetration. The eye should be examined as part of the secondary survey in all trauma patients once they have been stabilized as blinding injuries can be treated and sight saved.

Airway management in the multi trauma patient

Physiologic responses to trauma are many and complex. When assessing the effects of trauma, it can be seen that just one single system injury can affect many other systems both initially, and further on as the body's various compensatory and healing mechanisms come into play. This paper addresses the necessity of judicious airway management in the primary survey, and represents but a portion of the ocean of knowledge and skills necessary to effectively deal with the trauma patient.

Triage, Initial Assessment, and Early Treatment of the Pediatric Trauma Patient

It should be clear from this overview of triage, assessment, and initial care that early involvement by the leader of the trauma team is essential. Because operative intervention is so often necessary, the trauma team leader should be a surgeon with specialized training in trauma. The complex decision-making process involves prioritizing approaches by emergency room physicians, pediatricians, and surgical specialties in patients with multiple injuries. Even with single-system injury a rapid and logical approach to assessment and treatment is necessary in light of an overall longer term management plan.

INTERHOSPITAL TRANSFER IN THE MANAGEMENT OF ACUTE TRAUMA

During an 8-month period, 538 injured patients were transferred from primary hospitals to a referral hospital for further management of their injuries. Delay at the primary hospital was identified in 20% of all transfers and in 40% of patients transferred for management of head injury or multisystem injury. Delay at the primary hospital resulted in a median time from injury to arrival at the second hospital of 4 h. Defects in clinical management during transport included inexperienced escorts, inadequate airway control, ventilation, fluid resuscitation and stabilization of chest injuries. Nearly half of transfers were inappropriate because of the relatively minor nature of the injuries. Most of these had solitary musculoskeletal injuries to the extremities. These patients reflect the marked deficiency of specialist orthopaedic services in western Sydney during the study. Development of a metropolitan regional system of trauma care in western Sydney requires urgent action towards reducing the frequency of transfer, minimizing delays in transfer and maximizing basic resuscitation of seriously injured patients. Some designation of hospital roles is required and needs to be accompanied by a prehospital triage process. The population also has a right to expect adequate specialty services at suburban hospitals to enable treatment of minor and moderate single system injuries. Future trauma system developments should adequately reflect population growth and technological advances in clinical care.

Trauma Physiology

The complexity of physiologic responses to trauma presents a challenge to the trauma nurse. A single-system injury impacts on multiple-body systems and patient care must be prioritized appropriately to support healing and prevent further injury. Nurses are thus obligated to have extensive knowledge of trauma physiology to improve the quality of patient care and facilitate the expansion of nursing in trauma care.

Trauma Nursing: From Resuscitation through Rehabilitation

Part 1 General concepts in trauma nursing: evolution of the trauma cycle administrative issues in trauma care economic issues in trauma care legal concerns in trauma nursing ethical issues in trauma care nursing practice through the trauma cycles. Part 2 Clinical management concepts: mechanism of injury pathophysiology of traumatic shock initial management of traumatic shock psychosocial responses to trauma family systems adaptation infection control wound management nutritional management pain management rehabilitation. Part 3 Single system injuries: closed head injury spinal cord injury thoracic injuries abdominal injuries musculoskeletal injuries maxillofacial injuries ocular injuries renal trauma. Part 4 Unique patient populations: the pregnant trauma patient pediatric trauma trauma in the elderly thermal injuries trauma Pt with a pre-existing psychiatric disorder substance abuse the organ donor.

Paediatric trauma: urban epidemiology and an analysis of methods for assessing the severity of trauma in 598 injured children.

This study is based on a 12 month prospective analysis of 598 paediatric trauma admissions, drawn principally from an urban environment. The spectrum of trauma is described, highlighting the minor nature of most injuries and the rarity of penetrating trauma. A subgroup of seriously injured children was identified and further analysed. All deaths were examined. The predictive value of the Trauma Score (TS) and Method of Injury (MOI) were assessed in terms of eventual injury severity using the Injury Severity Score (ISS), and morbid outcome. Most of the patients were not seriously injured, and sustained single system injury only. The injuries were related principally to falls (62%). Seventy-nine children (13%) were identified as seriously injured (ISS greater than or equal to 16). In this group pedestrian injuries were the major cause of injury (29%). Amongst seriously injured children, cranial injury was identified in 91%, followed by abdominal injury in 33%. There were nine deaths in the series, representing 1.5% of all paediatric trauma admissions, and 11% of seriously injured patients. All deaths were associated with a significant head injury. Although the TS had a specificity of 99% in predicting serious injury and a positive predictive value of 94%, its sensitivity was only 26%. The MOI was associated with an overtriage rate of 200%. Of children admitted following pedal cycle accidents, 86% of the total and 91% of seriously injured children were not wearing a helmet. Of passengers in a motor car, 37% of the total number were unrestrained. The results suggest triage in children requires more than a physiological measure (TS) or MOI.(ABSTRACT TRUNCATED AT 250 WORDS)