Myths and Misinformation About Gunshot Wounds may Adversely Affect Proper Treatment.

Background: Poorly designed experiments and popular media have led to multiple myths about wound ballistics. Some of these myths have been incorporated into the trauma literature as fact and are included in Advanced Trauma Life Support (ATLS). We hypothesized that these erroneous beliefs would be prevalent, even among those providing care for patients with gunshot wounds (GSWs), but could be addressed through education.

Prehospital hypotension in blunt trauma: identifying the "crump factor".

Background: Trauma activation for prehospital hypotension in blunt trauma is controversial. Some patients subsequently arrive at the trauma center normotensive, but they can still have life-threatening injuries. Admission base deficit (BD)≤-6 correlates with injury severity, transfusion requirement, and mortality.

Prone ventilation in trauma or surgical patients with acute lung injury and adult respiratory distress syndrome: is it beneficial?

Background: To compare the effectiveness of supine versus prone kinetic therapy in mechanically ventilated trauma and surgical patients with acute lung injury (ALI) and adult respiratory distress syndrome (ARDS).

Methods: A retrospective review of all patients with ALI/ARDS who were placed on either a supine (roto-rest) or prone (roto-prone) oscillating bed was performed. Data obtained included age, revised trauma score (RTS), base deficit, Injury Severity Score (ISS), head Abbreviated Injury Scale score (AIS), chest (AIS), PaO2/FiO2 ratio, FiO2 requirement, central venous pressure (CVP), days on the bed, ventilator days, use of pressors, complications, mortality, and pulmonary-associated mortality.

Aggressive traffic enforcement: a simple and effective injury prevention program.

Purpose: To investigate whether an aggressive traffic violation enforcement program could reduce motor vehicle crashes (MVCs), injury collisions, fatalities, and fatalities related to speed, and decrease injury severity in crash victims treated at the trauma center.

Methods: A vigorous enforcement program was established within Fresno, Calif, city boundaries using increased traffic patrol officers. Data on citations, collisions, fatal collisions, and fatalities related to speed, as well as injury severity from the trauma registry, were collected for the year before program onset (2002), during the first year (2003), and after full implementation (2004).

Management of adult blunt splenic injuries: comparison between level I and level II trauma centers.

Background: The factors important in determining outcome when managing adult blunt splenic injuries continue to be debated. Whether trauma center level designation (Level I versus Level II) affects patient management has not been evaluated.

Study Design: We conducted a retrospective analysis of prospectively gathered data from the Pennsylvania Trauma Outcome Study database that collected information from 27 statewide trauma centers (Level I [15], Level II [17]).

Hepatic dysfunction increases length of stay and risk of death after injury.

Background: The relative importance of dysfunction or failure of different organ systems to recovery from critical illness is unclear. The purpose of this study was to evaluate the contribution of hepatic dysfunction to outcome after injury.

Methods: We retrospectively evaluated patients admitted to our trauma center from 1994 to 1998 for the development of hepatic dysfunction, defined as serum bilirubin > or = 2.

A brief episode of hypotension increases mortality in critically ill trauma patients.

Objective: Hypotension is associated with increased mortality, however previous studies have failed to account for the depth and duration of hypotension. We evaluated the effect of the duration of hypotension on outcome in injured patients.

Methods: Trauma patients admitted to the intensive care unit (ICU) from 1999 to 2000 were prospectively evaluated.