Background: Human polymerized hemoglobin (PolyHeme, Northfield Laboratories) is a universally compatible oxygen carrier developed to treat life-threatening anemia. This multicenter phase III trial was the first US study to assess survival of patients resuscitated with a hemoglobin-based oxygen carrier starting at the scene of injury.
Study Design: Injured patients with a systolic blood pressure=90 mmHg were randomized to receive field resuscitation with PolyHeme or crystalloid.
Background: State-legislated trauma systems have been enacted in an attempt to improve trauma care. Blunt splenic injury incidence without a legislated trauma system was examined for changes in care with a hypothesis that a voluntary system may perform equally with a legislated system.
Methods: Data from a statewide discharge database for the years 1993 to 2002 were examined.
Surg Infect (Larchmt)
March 2005
Background: We conducted a retrospective evaluation of the overall safety of drotrecogin alfa (activated) in surgical patients with severe sepsis enrolled in PROWESS.
Methods: A blinded Surgical Evaluation Committee (SEC) verified surgical patients as having undergone a significant operative procedure within 30 days prior to enrollment. Serious and treatment-emergent bleeding events, both during the study drug infusion period (120 h) and the entire 28-day study period were analyzed by surgical status and by treatment assignment.
The policy of routine angiography (ANG) for all penetrating neck wounds results in a high rate of negative studies. The medical records of all patients who presented to Wishard Memorial Hospital and Methodist Hospital of Indiana with penetrating injuries to the neck from January 1992 to April 2001 were reviewed. All patients who were hemodynamically stable underwent four-vessel ANG to evaluate for vascular injury irrespective of findings on physical examination (PE).
View Article and Find Full Text PDFEarly enteral feeding is beneficial to critically ill patients, although it is often a challenge to accomplish. When required, placing feeding tubes into the small bowel can be costly and difficult to carry out in a timely manner, often requiring fluoroscopic or endoscopic guidance. We implemented a modified protocol that enabled nurses to place feeding tubes at the bedside without fluoroscopy.
View Article and Find Full Text PDFWomens Health Issues
December 2000
We attempted to evaluate the preventive health services received by minority women aged 45-64 in an underserved region of Boston. We compared two surveys of disease burden and preventive health services to national data sets and the goals of Healthy People 2000. We found that minority women seen both in community health centers and within the community had many cardiovascular risk factors (41-45% had hypertension, 24-29% had cholesterol > 200 mg/dL, and 49-56% had a body mass index of >27.
View Article and Find Full Text PDFIn summary, BAI is a lethal result of severe blunt trauma. It should be considered in all patients who sustained injury by a deceleration or acceleration mechanism, especially in the face of physical or radiographic findings suggestive of mediastinal injury. Angiography remains the "gold standard" for diagnosis, although CT scanning is taking more of a role, especially for screening.
View Article and Find Full Text PDFUnlabelled: In the clinical trial of diaspirin cross-linked hemoglobin (DCLHb), optimal therapy required the immediate enrollment of patients with severe, uncompensated, traumatic hemorrhagic shock. When it was not feasible to obtain prospective consent, an exception to informed consent was used according to FDA regulation 21 CFR 50.24.
View Article and Find Full Text PDFContext: Severe, uncompensated, traumatic hemorrhagic shock causes significant morbidity and mortality, but resuscitation with an oxygen-carrying fluid might improve patient outcomes.
Objective: To determine if the infusion of up to 1000 mL of diaspirin cross-linked hemoglobin (DCLHb) during the initial hospital resuscitation could reduce 28-day mortality in traumatic hemorrhagic shock patients.
Design And Setting: Multicenter, randomized, controlled, single-blinded efficacy trial conducted between February 1997 and January 1998 at 18 US trauma centers selected for their high volume of critically injured trauma patients, but 1 did not enroll patients.
Hypothesis: This study was undertaken to identify mechanisms of injury, diagnostic modalities, surgical management, and outcome in children with traumatic aortic disruptions.
Design: Retrospective study.
Setting: University-affiliated private hospital.
Objective: To determine if reamed femoral intramedullary nailing increases the pulmonary complications seen in chest-injured patients.
Design: Retrospective review of prospectively collected trauma database data from January 1991 to October 1994.
Setting: Methodist Hospital, Indianapolis, Indiana, Level I Trauma Center.
Objective: To compare the accuracies and complication rates of diagnostic peritoneal lavage (DPL) in trauma patients with and without previous abdominal surgery.
Methods: A retrospective review of DPL accuracy and complication rate was performed using all ED trauma patients who underwent DPL during 1993 as identified by the trauma registry. Care was provided at a Level-1 trauma center, a 1,100-bed, central-city teaching hospital with an annual ED census of 84,000.
Background: Blunt aortic injury is a major cause of death from blunt trauma. Evolution of diagnostic techniques and methods of operative repair have altered the management and posed new questions in recent years.
Methods: This study was a prospectively conducted multi-center trial involving 50 trauma centers in North America under the direction of the Multi-institutional Trial Committee of the American Association for the Surgery of Trauma.
Objective: To analyze the indications for and the success rate, complications, and neurologic outcomes of surgical cricothyroidotomy when performed in the field by ambulance paramedics.
Methods: The ambulance and hospital records of all trauma patients on whom a surgical cricothyroidotomy was attempted in the field by ambulance paramedics over a 5-year period were reviewed. A telephone survey of survivors was used to assess long-term complications and neurologic outcome.
Objective: To calculate the financial break-even point and illustrate how changes in third-party reimbursement and eligibility could affect a program's fiscal standing.
Methods: Demographic, clinical, and financial data were collected retrospectively for 446 patients treated in a fast-track program during June 1993. The fast-track program is located within the confines of the emergency medicine and trauma center at a 1,050-bed tertiary care Midwestern teaching hospital and provides urgent treatment to minimally ill patients.
The investigators examined the demographic and clinical factors associated with the collection experience in a series of 786 patients who were treated in an urban hospital emergency department (ED) but not admitted to the hospital. They found that 57% of the total net charge of $150,489 had been paid within 180 days. This rate can be compared with an average inpatient collection rate of 85% at 180 days.
View Article and Find Full Text PDFRupture of the distal thoracic esophagus is an unusual injury following blunt abdominal trauma. We recently encountered this injury in a patient following a relatively minor motor vehicle accident. An improperly positioned seatbelt was presumed contributory in this case.
View Article and Find Full Text PDFEmergency helicopter services provided by trauma centers are now being perceived as contributing to the financial burden of the hospital because of recent changes in trauma reimbursement under the Medicare Prospective Payment System (PPS) and because of the general perception that collection rates are lower among trauma patients. The use of helicopters to transfer patients from one acute care facility to another may also be concentrating the patients with low collection rates at the receiving hospital. We examined retrospectively the demographic and clinical factors associated with the collection experience in a series of 288 trauma patients transferred by helicopter from another acute care facility to an inner-city hospital.
View Article and Find Full Text PDFTrauma centers are now being perceived as financial burdens because of recent changes in trauma reimbursement for the Medicare Prospective Payment System population and the perception that collection rates are lower among trauma patients. We examined the demographic and clinical factors associated with the collection experience in a series of 114 trauma patients transferred by helicopter from the accident site to an inner-city trauma center. Factors affecting payment at 30, 60, 90, and 180 days included patient age, insurance class, and discharge status.
View Article and Find Full Text PDFA consecutive series of 67 patients who had sustained self-inflicted gunshot wounds of the brain was reviewed retrospectively to evaluate factors determining outcome. Weapon caliber, site of bullet entry, degree of brain wounding on computerized tomographic scan, and presenting Glasgow Coma Scale (GCS) score were examined. Overall mortality, degree of disability in survivors, and survival time after injury in fatally wounded patients were assessed.
View Article and Find Full Text PDFCrit Care Med
February 1985
Suction applied to a chest-tube drainage system produces subambient pressure within the chest tube and may increase or decrease the flow of gas passing from the airway through a bronchopleural fistula. Such gas may have participated in gas exchange and contain more CO2 and less O2 than inspired gas. Calculated or measured variables dependent upon exhaled CO2 and O2 will be erroneous unless the fistula gas values are considered.
View Article and Find Full Text PDFA multicenter study was conducted to compare a new peripheral intravenously given solution containing 3 per cent amino acids, 3 per cent glycerol and a complete pattern of maintenance electrolytes--ProcalAmine--with an isonitrogenous amino acid control solution--FreAmine III--in patients undergoing elective gastrointestinal or vascular operations. Fifty-two patients received the control solution and 48 patients received the experimental solution in a double-blind, randomized trial for five consecutive postoperative days. A complete hematologic and biochemical assessment was carried out daily throughout the five day infusion period and two days after the termination of infusion.
View Article and Find Full Text PDF