Risks, costs, and the expected complication of re-injury.

Background: The purpose of this study was to determine the characteristics of young victims of violence and the risk of rehospitalization due to intentional injury (recidivism) and to estimate the potential cost of these injuries.

Materials And Methods: Trauma admissions from January 1, 1991 to December 31, 1993, at San Francisco General Hospital of youths < 25 years old who were victims of gunshot wounds (GSWs), assault, and stab wounds were screened. Five hundred and fifty-two charts were reviewed after sampling every other chart.

Trauma centers in a managed care environment.

Health care reform will affect the relationship of trauma centers to health maintenance organizations and other managed care plans. We studied Kaiser Permanente Medical Center (Kaiser) members admitted to the Trauma Center at San Francisco General Hospital (SFGH) to determine: (1) variables predicting transfer from SFGH to a Kaiser Hospital (repatriation), (2) the length of hospital stay (LOS), and (3) the cost of their care. The SFGH trauma registry provided data on 7,794 patients admitted before 1994.

Development of a surgical/trauma intermediate care unit.

During these times of escalating health care costs and increased demand for critical care beds, hospitals are often unable to provide the intensive level of nursing care that is required. One large urban trauma center found that 36% of the surgical intensive care unit patients required a level of nursing care intermediate between the intensive care unit and the general ward. A multidisciplinary team met to plan and develop a surgical/trauma intermediate care unit to provide this level of care.

Can adult trauma surgeons care for injured children?

Large urban trauma centers care for injured children as well as adults in many areas of the country, but the quality of care in these hospitals has not been evaluated versus that available at pediatric trauma centers. The recent validation of TRISS methodology in pediatric populations allowed us to evaluate the quality of pediatric trauma care being provided in a level I trauma center treating injured patients of all ages. We reviewed the records of 353 injured children (aged 0-17 years) who were admitted to our trauma center over a 30-month period for the following data: demographics, mechanism of injury, initial physiologic status (RTS), surgical procedures required, need for intensive care, nature and severity of the injuries (ISS), and outcome.

Safety of pre-hospital therapy with morphine sulfate.

The safety of prehospital pharmacologic therapy has not been well studied. The authors evaluated field use of morphine sulfate (MS) in San Francisco County over a 6-month period. Paramedics assessed patients for ischemic chest pain (ICP) and/or pulmonary edema (PE), made base hospital contact, and administered 2- to 4-mg doses of intravenous morphine according to treatment protocols.