Appropriate use of the Glasgow Coma Scale in intubated patients: a linear regression prediction of the Glasgow verbal score from the Glasgow eye and motor scores.

Unlabelled: The Glasgow Coma Scale (GCS) has been shown to be a valuable tool in assessing the neurologic and physiologic status of critically ill patients. Unfortunately, the GCS requires assessment of the verbal response of the patient and this can be blocked by intubation. The purpose of this study was to assess the ability of a regression model based upon the eye and motor components of the GCS to accurately predict the verbal response of the GCS.

ICISS: an international classification of disease-9 based injury severity score.

Background: The Injury Severity Score (ISS) has served as the standard summary measure of human trauma for 20 years. Despite its stalwart service, the ISS has two weaknesses: it relies upon the consensus derived severity estimates for each Abbreviated Injury Scale (AIS) injury and considers, at most, only three of an individual patient's injuries, three injuries that often are not even the patient's most severe injuries. Additionally, the ISS requires that all patients have their injuries described in the AIS lexicon, an expensive step that is currently taken only at hospitals with a zealous commitment to trauma care.

The impact of laparoscopic cholecystectomy on the management and outcome of biliary tract disease in North Carolina: a statewide, population-based, time-series analysis.

Background: Laparoscopic cholecystectomy (LC) has had a major impact on the treatment of patients with biliary tract disease, but the magnitude and the details of its effects on biliary surgery remain incompletely described. The purpose of this study was to perform a statewide, population-based, time-series analysis of the effects of LC on biliary surgery.

Study Design: Patient data were obtained from the statewide hospital discharge database that collects data from all 157 hospitals in the state of North Carolina.

The Injury Severity Score is unable to differentiate between poor care and severe injury.

Unlabelled: The Injury Severity Score (ISS) has been the most frequently used tool for stratifying injured patients. The primary hypothesis of this study was that ISS fails to differentiate between severe injury and mismanagement.

Methods: Data models were generated for mismanaged and ideally managed patients for isolated injuries for each body system.

Trauma care reimbursement in rural hospitals: implications for triage and trauma system design.

Unlabelled: American College of Surgeons triage guidelines recommend rapid identification and transfer of seriously injured patients to regional trauma centers, bypassing local hospitals if necessary. This approach raises concerns about the potential negative financial impact of implementing such triage strategies on already strained rural hospitals.

Objective: The purpose of this study was to determine the association between injury severity and reimbursement for trauma care in rural hospitals.

A statewide, population-based time-series analysis of the outcome of ruptured abdominal aortic aneurysm.

Objectives: The purpose of this study was to perform the first statewide, population-based, time-series analysis of the frequency of ruptured abdominal aortic aneurysm (RAAA), to determine the outcomes of RAAA, and to assess the association of patient, physician, and hospital factors with survival after RAAA. The hypotheses of the study were as follows: 1) the rate of RAAA would increase over time and 2) patient, surgeon, and hospital factors would be associated with survival.

Background: Ruptured abdominal aortic aneurysm is a life-threatening emergency that presents the surgeon with a technically demanding challenge that must be met and surmounted in a short time if the patient is to survive.

Thoracic aorta injuries: management and outcome of 144 patients.

Rupture of the thoracic aorta from blunt injury is often lethal. Methods of operative repair vary, based on the surgeon's preference and circumstances. The primary hypothesis of this study was that operative management choices would correlate with outcome.

Cost containment strategies by private hospitals: their effectiveness, importance, and use.

This article presents a study that identifies cost issues and strategies in a highly competitive hospital service area. Specifically, the study seeks to determine the most important cost issues that are currently facing hospitals and to examine the effectiveness of various cost containment strategies. Additionally, the study examines the extent of agreement among hospitals regarding the effectiveness of cost containment strategies.

RPR 101821, a new potent cholesterol-lowering agent: inhibition of squalene synthase and 7-dehydrocholesterol reductase.

RPR 101821 (trans-2-[4-(benzoxazol-2-yl)-phenylmethoxy] amino cyclohexane hydrochloride) is a potent cholesterol-lowering agent in rodents and marmoset. The compound inhibited rat liver microsomal squalene synthase (IC50 = 1 nM) and 7-dehydrocholesterol (7DHC) reductase (IC50 = 1 microM; Lewis et al. 1995).

A statewide, population-based time-series analysis of the increasing frequency of nonoperative management of abdominal solid organ injury.

Unlabelled: Emergency operative intervention has been one of the cornerstones of the care of the injured patient. Over the past several years, nonoperative management has increasing been recommended for the care of selected blunt abdominal solid organ injuries. The purpose of this study was to utilize a large statewide, population-based data set to perform a time-series analysis of the practice of physicians caring for blunt solid organ injury of the abdomen.

The goals, development, and use of trauma registries and trauma data sources in decision making in injury.

Trauma is the leading killer of Americans under the age of 40 years and the fourth most common cause of death for all Americans. Its impact has not been studied adequately or understood completely. Rational decisions in the care and treatment of trauma patients, the prevention of injury, and the reduction of trauma's annual $177 billion costs can only be made with adequate information on the effectiveness of prevention and treatment measures.

Injury severity and probability of survival assessment in trauma patients using a predictive hierarchical network model derived from ICD-9 codes.

Unlabelled: Accurate assessment of injury severity is critical for decision making related to the prevention, triage, and treatment of injured patients. Presently, the standard method of controlling for variations of injury severity between groups has been based upon the Injury Severity Score (ISS) and the Trauma Score and the Trauma and Injury Severity Score (TRISS) methodology. The purpose of this study was to attempt to build upon previous work using International Classification of Diseases, ninth revision (ICD-9) coded diagnosis, and procedure information available from standard hospital discharge abstracts (UB-82 Billing format) to create a hierarchical network to provide a tool for predicting injury severity and probability of survival.

Management and outcome of abdominal shotgun wounds. Trauma score and the role of exploratory laparotomy.

Objective: The management and outcome of 138 abdominal shotgun wounds were examined over a 5-year period.

Summary Background Data: It has been proposed that exploratory laparotomy may be unnecessary and even overused in a subset of patients with abdominal shotgun wounds.

Methods: Data on shotgun wound patients from October 1987 through March 1992 from a statewide trauma registry were examined.

An acetohydroxy acid synthase mutant reveals a single site involved in multiple herbicide resistance.

Acetohydroxy acid synthase (AHAS) is an essential enzyme for many organisms as it catalyzes the first step in the biosynthesis of the branched-chain amino acids valine, isoleucine, and leucine. The enzyme is under allosteric control by these amino acids. It is also inhibited by several classes of herbicides, such as the sulfonylureas, imidazolinones and triazolopyrimidines, that are believed to bind to a relic quinone-binding site.

Carotid artery trauma: a review of contemporary trauma center experiences.

Purpose: Many issues surrounding the management and outcome of carotid artery injuries remain controversial. The purpose of this study was to review a large contemporary experience with such injuries in the setting of designated trauma centers.

Methods: A statewide computerized trauma registry was used to identify all patients with injuries to the common or internal carotid arteries from October 1987 to June 1993.

Use of the APACHE II scoring system to determine mortality of gynecologic oncology patients in the intensive care unit.

Objective: To determine if an elevated score on the Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring system is associated with mortality of acutely ill gynecologic oncology patients.

Methods: Gynecologic oncology patients admitted to the surgical intensive care unit (ICU) were identified from the ICU data base. Their admission APACHE II score and type of gynecologic cancer were also extracted from the data base.

Field triage of trauma patients based upon the ability to follow commands: a study in 29,573 injured patients.

Unlabelled: If a trauma system is to deliver "the right patient to the right hospital at the right time," a simple triage tool that can be used in the field to rapidly identify patients with a significant risk of morbidity and mortality is vital.

Objective: The purpose of this study was to evaluate the effectiveness of the Glasgow Coma Scale's Motor Response Component (GMR) in identifying such patients.

Methods: From patient records in a well established state trauma registry, the predictive power of the Glasgow Motor Score was compared with the predictive power of the Injury Severity Score (ISS), Trauma Score, and whole Glasgow Coma Scale Score (GCS), using discriminant analysis and logistic regression.

Effect of inhalation injury, burn size, and age on mortality: a study of 1447 consecutive burn patients.

The relative impact of inhalation injury, burn size, and age on overall outcome following burn injury was examined in 1447 consecutive burn patients over a five and a half year period. The overall mortality for all patients was 9.5% (138 of 1447).

American College of Surgeons trauma quality indicators: an analysis of outcome in a statewide trauma registry.

Quality assurance/quality improvement (QA-QI) is a priority for maintaining the highest standards of care in trauma systems. To be an effective tool for system review, the QA-QI indicators should identify patients with higher rates of morbidity and mortality from injury. While the American College of Surgeons (ACS) and the Joint Commission on Accreditation of Health Care Operations have identified certain audit filters within the trauma system, there are few data to substantiate the value of these audit filters for trauma care.

Incidence, management, and outcome of femoral shaft fracture: a statewide population-based analysis of 2805 adult patients in a rural state.

Unlabelled: Early surgical management of femoral shaft fracture (FSF) is considered the standard but patients are still treated nonsurgically. The purpose of this study was to analyze the results of management of FSF in a large population based data base.

Methods: Data were obtained from a statewide hospital discharge data base for 1989-1992.

A population-based study of the association of medical manpower with county trauma death rates in the United States.

Objective: To determine the association between measures of medical manpower available to treat trauma patients and county trauma death rates in the United States. The primary hypothesis was that greater availability of medical manpower to treat trauma injury would be associated with lower trauma death rates.

Summary Background Data: When viewed from the standpoint of the number of productive years of life lost, trauma has a greater effect on health care and lost productivity in the United States than any disease.

A population-based multivariate analysis of the association of county demographic and medical system factors with per capita pediatric trauma death rates in North Carolina.

Objective: This study analyzed the association between demographic and medical system factors and the pediatric trauma death rate in North Carolina.

Summary Background Data: Trauma is the leading cause of death in children. Various medical system factors have been suggested to reduce pediatric morbidity and mortality rates, but the association with these rates has not been tested.

Report on the clinical workstation and clinical data repository utilization at UNC Hospitals.

On December 1, 1993, we implemented version 2.1 of the Clinical Workstation-Clinical Data Repository application in the Ambulatory Care Center. This version of the workstation allowed access of laboratory data from the clinical data repository that had been populated by a real-time HL7 interface between the Clinical Data Repository and the Laboratory Information System.