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ABSTRACT: Prehospital intubation and airway control is routinely performed by paramedics in critically injured patients. Despite the advantages provided by this procedure, numerous potential risks exist when this is performed in the field. We reviewed the outcome of patients with severe head injury, to determine whether prehospital intubation is associated with an improved outcome.
A retrospective review of registry data of patients admitted to an urban trauma center with severe head injury (field Glasgow Coma Scale score of < or =8 and head Abbreviated Injury Scale score of > or =3) was performed. Patients were stratified by methods of airway control performed by prehospital personnel: not intubated, intubated, or unsuccessful intubation. Mortality was determined for each group. To control for significant variables between these populations, matching and multivariate analysis were performed.
Patients requiring prehospital intubation or in whom intubation was attempted had an increased mortality (81% and 77%, respectively) when compared with nonintubated patients (43%). The mortality for patients who had prehospital intubation performed did not demonstrate an improved survival using matching. In fact, intubated patients had a significantly higher relative risk (RR) of mortality when compared with nonintubation (RR = 1.74,p < 0.001) and unsuccessful intubation patients (RR = 1.53, p = 0.008)
For patients with severe head injury, prehospital intubation did not demonstrate an improvement in survival. Further prospective randomized trials are necessary to confirm these results.
The Journal of trauma 12/2000; 49(6):1065-70. · 2.48 Impact Factor
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ABSTRACT: Subclavian and axillary vascular injuries are notorious for their mortality and their difficult surgical exposure. In the present study we analyze our experience with 79 patients and describe the techniques used for surgical access to these vessels.
Retrospective review of the medical records of all patients with penetrating injuries to the subclavian or axillary vessels who had been admitted to 2 Los Angeles trauma centers during a 4-year, 3-month period.
Seventy-nine patients were admitted during the study period January 1993 to March 1997 (58 gunshot injuries, 21 other penetrating injuries). The artery was injured in 59 patients and the vein in 40 (20 patients had both arterial and venous injuries). Eighteen patients (23%) were admitted with no signs of life or were in extremis and underwent an emergency room thoracotomy without any survivors. Fifty-eight patients underwent exploration in the operating room, 1 patient with an arteriovenous subclavian fistula was successfully managed with a radiologically placed endovascular stent, and 2 patients with minimal subclavian artery injuries were managed nonoperatively. Overall mortality was 34.2%. Excluding the ER thoracotomies the overall mortality was 14.8%. The mortality for isolated arterial injuries was 20.5%, for isolated venous injuries 50%, and for both vessels 45.0%. The mortality in venous injuries was significantly higher than in arterial injuries (p < 0.05). The standard clavicular incision provided adequate exposure in 32 (50.0%) of the operating room cases. In the other 50% of operating room cases a combination of a clavicular incision with a median sternotomy or thoracotomy was necessary. Proximal subclavian injuries may be accessed through a clavicular incision combined with a median sternotomy irrespective of left or right site location.
Subclavian and axillary vascular injuries remain lethal. A clavicular incision provides satisfactory surgical exposure in about half the patients. In patients with proximal injuries addition of a median sternotomy provides adequate surgical access in both right and left subclavian vessels.
Journal of the American College of Surgeons 03/1999; 188(3):290-5. · 4.55 Impact Factor
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ABSTRACT: Advanced perforated appendicitis with localized findings has classically been treated with either operative therapy or with percutaneous drainage. The role of nonoperative therapy followed by interval appendectomy (IA) remains controversial. We assessed the safety and efficacy of conservative management for perforated appendicitis in a 5-year review of patients treated conservatively for perforated appendicitis with localized abscess or phlegmon. Patients were treated initially with intravenous antibiotics, and CT-guided drainage was used only if the patient failed to improve after 48 to 72 hours. Patients still not improving underwent appendectomy. Patients responding to conservative therapy were recommended IA in 6 to 12 weeks. Sixty-six patients with 54 abscesses and 10 phlegmons were treated. Fifty-one patients (92%) improved without surgery. Only 58 per cent of the abscesses required percutaneous drainage. The mean length of stay for conservative therapy was 7.6 days. Forty-one patients underwent IA with a 10 per cent morbidity and a mean length of stay of 1.4 days. Conservative management of appendicitis with localized perforation or phlegmon is safe and effective. Percutaneous drainage is frequently not required. IA is associated with low morbidity without prolonged hospitalization.
The American surgeon 11/1998; 64(10):970-5. · 1.28 Impact Factor
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ABSTRACT: The objective of this study is to identify and differentiate the injury patterns and causes of death among patients who died within the 1st hour and those in the period between 1 and 48 hours after hospital admission. Information was collected from the 1994 to 1996 trauma data base at an urban Level I trauma center. The records of 155 trauma patients who died within the 1st hour (immediate trauma death, ITD) and between 1 and 48 hours (early trauma death, ETD) were examined retrospectively. Total and constituent Injury Severity Score (ISS), Trauma Score (TS), and Glasgow Coma Score were analyzed. ITDs constituted 49 per cent of all deaths within 48 hours. Blunt mechanisms accounted for 37 per cent of ITDs and 40 per cent of ETDs (not significant), whereas penetrating trauma accounted for 59 per cent of ITDs and 56 per cent of ETDs (not significant). Exsanguination most commonly caused death among ITDs (54%) and head injury (51%) among ETDs (P < 0.01). Patients who died within the 1st hour had higher ISS (42.6 +/- 23.2, P < 0.03), lower TS (1.7 +/- 1.9, P < 0.0001), and lower Glasgow Coma Score (3.1 +/- 1.1, P < 0.0001) than those who died after the 1st hour. Patients with ITD had a significantly worse chest ISS than those with ETD (47.4 +/- 28.6 vs 19.0 +/- 19.1, P < 0.0001). We conclude that 1) ITD is caused primarily by exsanguination, whereas ETD is largely due to the sequelae of severe neurologic injury; 2) ITD has a significantly lower TS and higher ISS than ETD; and 3) thoracic injuries are more severe among patients with ITDs than among those with ETDs. The severity of thoracic injury among ITDs suggests that rapid surgical intervention is critical during the resuscitation of these severely injured patients.
The American surgeon 10/1998; 64(10):950-4. · 1.28 Impact Factor
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ABSTRACT: Femoral hernia has always presented more difficulty in diagnosis than other external abdominal hernias. The incidence of incarceration and strangulation is higher in our series than the published literature would suggest. A retrospective study was performed at our institution from February 1990 to June 1995. In that period, 22 patients were operated on for femoral hernia. There were 16 women and 6 men, average ages 51 and 48 years, respectively. The men weighed on average 209 lb, and the women, 154 lb. Three of our patients had elective repair of their hernias (16%); 19 were performed urgently or emergently (86%). Of the emergency repairs, 3 had strangulated small bowel requiring resection (16%), 1 had a strangulated vermiform appendix with abscess formation (5%), 3 had strangulated omentum requiring excision (16%), giving a total of 7 patients with strangulation and necrosis of the hernial contents (36%). The remainder had viable contents in the hernia sac. The time from the onset of symptoms to presentation at the hospital varied from 1 day to 3 years. The time from strangulation to presentation was between a few hours and 4 days. Surgery was performed on the day of admission (within 24 hours) on all but 2 of our patients. Procedures performed were McVay repair, 13; Bassini, 4; laparoscopic with Marlex mesh, 1 patient; drainage of a groin abscess in 2 patients with later repair; and on 2 patients the type of repair was not specified. One of the patients died. Postoperative wound infection occurred in 2 heavily contaminated patients, and 3 had pneumonia. Patients with no regular physician and no routine physical examinations are at higher risk for developing strangulation of femoral hernias. Emergency physicians and general practitioners are in the best position to diagnose these hernias early, when treatment can be elective.
American Journal of Emergency Medicine 12/1997; 15(7):680-2. · 1.98 Impact Factor
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ABSTRACT: The role of early CT scanning in acute gallstone pancreatitis remains ill defined. The purpose of our study was to: 1) determine whether our previously identified admission prognostic factors for gallstone pancreatitis [white blood cell (WBC) count > or = 14.5 x 10(9)/L, blood urea nitrogen (BUN) > or = 12 mmol/L, Acute and Chronic Health Evaluation II score > or = 5, glucose > or = 150 mg/dL, and heart rate > or = 100 beats/min)] correlate with the severity of pancreatic inflammation on CT scan, and 2) to determine the utility of early CT scanning in the management of gallstone pancreatitis. Admission clinical and laboratory variables were collected prospectively. Early CT scan findings were graded using the Balthazar scoring system and subgrouped into mild-moderate (Balthazar grades A-C) or severe (grades D and E) by a radiologist blinded to the patients' clinical status. Ninety-seven patients underwent surgery during their initial hospitalization without preoperative CT scanning. Four had operative complications (4%). Forty-two patients underwent early CT scan (grade A, 19%; B, 5%; C, 21%; D, 10%; and E, 45%), but only four (all grade E) had surgery delayed because of necrotizing pancreatitis, abscess, or pseudocyst. All four had persistent abdominal pain. There was one (2.5%) operative complication in the CT group and no deaths. Admission WBC count > or = 14.5 x 10(9)/L and BUN > or = 12 mmol/L correlated with severe pancreatitis (grades D and E) on CT (P < .05). We conclude that in patients with gallstone pancreatitis, 1) admission WBC count > or = 14.5 x 10(9)/L and BUN > or = 12 mmol/L correlate with the severity of pancreatic inflammation on CT scan, and 2) CT scan findings rarely influence management decisions and CT is therefore unnecessary, except in the minority of patients with objective indications of severe or unresolving pancreatitis.
The American surgeon 10/1997; 63(10):904-7. · 1.28 Impact Factor
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ABSTRACT: We retrospectively reviewed all pediatric patients (< 18 years old) who presented to a Level I trauma center from 1984 to 1994 with noniatrogenic vascular trauma. There were 48 patients (42 male and 6 female) ages 2 to 17 years. Mechanism of injury included gunshot wounds (34) stab wounds (10), and blunt trauma (4). The lower extremities were most commonly injured (31), followed by upper extremity (17), trunk (8), and neck (4). Twenty-one (44%) patients had associated nonvascular injuries (primarily orthopedic or peripheral nerve). Eighteen (37%) patients underwent preoperative angiography for suspected extremity (15) or carotid injuries (3). Twenty-nine patients went to surgery without angiography based on severe ischemia (11) or hemorrhage (18). Arterial injuries (45) were managed by interposition reverse saphenous vein graft (16), primary repair (15), ligation (5), or other operative (5) and nonoperative treatment (4). Venous injuries (15) were treated with primary repair (8), patch (3), ligation (3), and nonoperative management (1). Fasciotomy was performed in six (12%). There were three deaths (6%), all due to aortic and/or caval injuries. Limb salvage in survivors was 100 per cent. There were no complications from angiography. Postoperative duplex scans demonstrated patency in six of the seven patients studied with venous injuries. We conclude that 1) noniatrogenic pediatric vascular trauma is uncommon, and 2) using an aggressive approach to both the diagnosis and treatment of these injuries can achieve excellent limb salvage rates with a low morbidity and mortality.
The American surgeon 09/1997; 63(9):781-4. · 1.28 Impact Factor
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ABSTRACT: We present 6 patients with obturator hernia, from Harbor-UCLA Medical Center and Natalspruit Hospital, South Africa, bringing the total in the English literature to 676. This study was undertaken to examine the pitfalls in diagnosis and methods of treatment of this highly fatal condition.
All patients were women, with an average age of 79 years. All were emaciated and in poor general condition, with dementia (4 patients), airway disease (3), cardiac disease (3), and disseminated carcinoma (1). For 5 of the 6 patients, the diagnosis was made at laparotomy. One patient died postoperatively.
The diagnosis was made from a lump in the upper thigh, felt vaginally or rectally, and a positive Howship-Romberg and/or a Hannington-Kiff sign. Radiographs, contrast studies, computed tomography scans, and herniography are helpful in making a diagnosis. In an emergency situation, lower midline laparotomy is preferred. Electively, other procedures and laparoscopic repair may be performed.
Mortality (10% to 50%) is common due to the poor condition of the patients and the delay in diagnosis. Earlier diagnosis may lower the high morbidity and mortality associated with this condition.
The American Journal of Surgery 08/1997; 174(1):72-5. · 2.78 Impact Factor
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ABSTRACT: The role of diagnostic laparoscopy in penetrating trauma continues to evolve. We reviewed our experience to determine the effect of laparoscopy on therapeutic laparotomy rates, length of hospital stay, and hospital charges. Laparoscopy was performed on 106 hemodynamically stable patients with penetrating abdominal injuries (66 had gunshot wounds, 40 had stab wounds). All patients with laparoscopically identified peritoneal penetration underwent open laparotomy. At laparoscopy, 41 (39%) had positive findings, whereas 65 (61%) had none. Two patients with retroperitoneal hematomas and one with ecchymosis of the peritoneum were not explored. Thus 68 (64%) did not require laparotomy. Among the 38 who underwent laparotomy, 29 (76%) had positive findings and 9 (24%) had a negative laparotomy. Nineteen patients (50%) had a therapeutic laparotomy. This compares with a therapeutic laparotomy rate of 18% had all 106 patients undergone mandatory laparotomy. Data for length of stay and hospital charges were analyzed. Due to the extended stay associated with tube thoracostomy (n = 21), a subgroup excluding patients with chest tubes was also analyzed. In this subgroup, there was a significant difference in hospital stay between those who had only a laparoscopy and those who underwent a negative laparotomy (2.6 +/- 1.7 vs. 4.7 +/- 1.6, p < 0.01). The average nonsurgical charge for patients who had a negative laparotomy was more than double that for those who had laparoscopy only ($8275 +/- 4692 vs. $3762 +/- 3786, p < 0.01). We conclude that the use of diagnostic laparoscopy to identify peritoneal penetration resulted in an improved therapeutic laparotomy rate as well as significant reduction in hospital stay and hospital charges.
Journal of laparoendoscopic surgery 11/1996; 6(5):285-91.
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Seminars in Vascular Surgery 10/1996; 9(3):266-74. · 1.71 Impact Factor
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ABSTRACT: The purpose was 1) to prospectively determine the prevalence of adverse events necessitating intensive care unit (ICU) monitoring in gallstone pancreatitis (GP) and 2) To identify admission prognostic indicators that predict the need for ICU unit monitoring. Prospective laboratory data, physiologic parameters, and APACHE II scores were gathered on 102 patients with GP over 14 months. Adverse events were defined as cardiac, respiratory, or renal failure, gastrointestinal bleeding, stroke, sepsis, and necrotizing pancreatitis. Patients were divided into Group 1 (no adverse events, n=95) and Group 2 (adverse events, n=7). There were no deaths and 7 (7%) adverse events, including necrotizing pancreatitis (3), cholangitis (2), and cardiac (2). APACHE 11 > or = 5 (P < 0.005), blood urea nitrogen (BUN) > or = 12 mmol/L (P < 0.005), white blood cell count (WBC) > or = 14.5 x 10(9)/L, (P < 0.001), heart rate > or = 100 bpm (P < 0.001), and glucose > or = 150 mg/dL (P < 0.005) were each independent predictors of adverse events. The sensitivity and specificity of these criteria for predicting severe complications requiring ICU care varied from 71 to 86 per cent and 78 to 87 per cent, respectively. The prevalence of adverse events necessitating ICU care in GP patients is low. Glucose, BUN, WBC, heart rate, and APACHE II scores are independent predictors of adverse events necessitating ICU care. Single criteria predicting the need for ICU care on admission are readily available on admission.
The American surgeon 10/1996; 62(10):815-9. · 1.28 Impact Factor
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Annals of Surgery 09/1996; 224(2):238. · 7.49 Impact Factor
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ABSTRACT: Gang related violence in Los Angeles County has increased, with homicides increasing from 205 in 1982 to 803 in 1992. This study examines the medical and financial consequences of such violence on a level I trauma center. Of 856 gunshot injuries over a 29-month period, 272 were gang related. There were 55 pediatric and 217 adult patients. Eighty-nine percent were male and 11% were female. Trauma Score averaged 14.7 +/- 3.1, Glasgow Coma Scale average score was 13.7 +/- 3.4, and the mean Injury Severity Score was 10.8 +/- 14. Twenty-two percent of the gunshots were to the head and neck, 20% to the chest, 20% to the abdomen, 6% had a peripheral vascular injury, and 33% sustained an extremity musculoskeletal injury. Emergency surgery was performed on 43%, including laparotomy 58 (49%), craniotomy 16 (13%), laparoscopy 14 (12%), vascular procedures 10 (8%), orthopedic procedures 6 (5%), head and neck endoscopies 4 (3%), thoracotomies 2 (2%), and 10 (8%) unspecified. There were 25 deaths (9%), primarily caused by head injuries and exsanguinating hemorrhage. Eighty-six percent entered the hospital during the hours of minimal staffing that preempted the use of facilities for other emergent patients. Charges totaled $4,828,828 (emergency room, surgical procedures, intensive care, and surgical ward stay) which equated to $5,550 per patient per day. Fifty-eight percent had no third party reimbursement, 22% had Medi-Cal, and 20% had medical insurance. Because of dismal reimbursement rates, the costs of gang violence are passed on to the tax payer. The cost of gang related violence cannot be derived from hospital charges only, because death, disability, and pain are not entered into the calculation. Education, increased social programs, and strict criminal justice laws and enforcement may decrease gang related violence and the drain it has on financial and medical resources.
The Journal of trauma 06/1996; 40(5):810-5. · 2.48 Impact Factor
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ABSTRACT: Venous oximetry catheters provide useful realtime information about mixed venous hemoglobin saturation (Svo2). Currently available systems utilize either two or three wavelengths of light to obtain these measurements. Previous animal and clinical studies have attempted to compare the accuracy of these two devices under similar circumstances. However, the relative accuracy of the two-wavelength versus three-wavelength systems has never been assessed under identical conditions. For this purpose, we designed an animal model for simultaneous measurement of Svo2, over a wide range of physiologic and pathologic states.
Seven anesthetized swine underwent simultaneous placement of two- and three-wavelength catheters. Paired data points consisted of values obtained from a reference oximeter and from each of the catheters. Observations were obtained every 15 min during the following manipulations: (1) eucarbic hypoxia induced by reducing FiO2 to 0.18, 0.15, and 0.12 for 15 min each; (2) stimulated surgical manipulation; and (3) hypovolemic shock produced by hemorrhage to a mean arterial pressure of 50 torr for 1 hr. Data were analyzed by calculation of mean error (bias) and precision for each system in comparison with the oximeter.
The overall error of the two-wavelength system was +0.15%, with a precision of +/- 2.52%. The three-wavelength system had an overall error of +3.71%, with a precision of +/- 2.30%. Overall correlation between catheter Svo2 and oximeter values was the same for both devices (r = 0.99).
Both currently available in vivo spectrophotometric systems are capable of producing satisfactory results over wide ranges of Svo2. In contradistinction to older reports, we found that the two-wavelength Svo2 system produced results equivalent to those obtained from the three-wavelength device. In this regard, there is no detectable advantage in accuracy to measuring in vivo Svo2 with three rather than with two wavelengths.
Journal of Clinical Monitoring 10/1995; 11(5):329-34.
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ABSTRACT: Demonstrate the effect that increased intra-abdominal pressure (IAP) has on visceral oxygen delivery and bowel tissue oxygenation (TPO2).
Six Duroch swine underwent abdominal insufflation with helium to pressures of 15 and 25 mm Hg for 1 hour. Animals were instrumented with a pulmonary artery flotation catheter to measure cardiac output and calculate systemic oxygen delivery. Fluorescence quenching optodes were implanted in the terminal ileum and the subcutaneous tissue of an axillary fold to measure bowel and systemic (control) tissue oxygen levels, respectively.
Bowel tissue oxygen fell from 43 +/- 12 mm Hg at baseline to 31 +/- 12 mm Hg, with 15 mm Hg of abdominal pressure at 60 minutes. With 25 mm Hg IAP, bowel TPO2 fell from 24 +/- 12 to 12 +/- 8 mm Hg (p < 0.02). No change in axillary TPO2 was observed during either period of increased IAP. Cardiac output (CO), systemic oxygen delivery, and mixed-venous oxygen saturation (Svo2) also declined, although blood pressure and oxygen consumption remained constant.
Increased IAP produces significant decreases in bowel submucosal TPO2 without similar changes in extra-abdominal (subcutaneous) TPO2. This decline is dependent on the extent and duration of the elevation in IAP. Readily accessible parameters, such as CO and Svo2, also decline with increased IAP and may be useful variables to monitor as relative indicators of bowel hypoperfusion and TPO2.
The Journal of trauma 09/1995; 39(3):519-24; discussion 524-5. · 2.48 Impact Factor
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ABSTRACT: Pelvic fractures present major therapeutic challenge requiring systematic diagnostic and management strategies. This article describes a 50-year-old female with a massive pelvic fracture after being crushed under the wheels of a bus. All aspects of her management are presented in detail. The current indications and role of exploratory laparotomy, internal and external fixation, and diagnostic and therapeutic angiography are discussed.
Journal of the National Medical Association 02/1995; 87(1):33-8. · 1.16 Impact Factor
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ABSTRACT: Laparoscopic surgery holds great promise as a technique for reducing hospital stay and convalescence. Although advantages in hospital cost cannot be shown for all such procedures, improvements in technique and operator experience will undoubtedly improve the situation. Analysis of the pertinent physiologic aspects and complication rates indicates that laparoscopy is not minimally invasive, but rather exposes the patient to many of the risks normally incurred by open procedures. Enthusiasm for the use of these techniques must be tempered by good judgment and scientific evidence supporting equivalent or better long-term results at equal or lower rates of morbidity and mortality.
Current Problems in Surgery 12/1994; 31(11):857-924. · 2.33 Impact Factor
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ABSTRACT: Treatment costs for victims of gang violence have fueled the withdrawal of hospitals from trauma networks. Not included in such tallies are the medical resources that these seriously ill and medically indigent patients divert from other areas. We examined the surgical care requirements, costs incurred, and outcomes at a Level I trauma center. Local law enforcement records were matched with hospital admissions over a 1-year period to identify with hospital admissions over a 1-year period to identify casualties of gang violence. Of 191 gunshot wound admissions, 107 (56%) were gang related. The majority were males (92%); ages ranged from 14 to 50 and trauma scores from 1-16. Eighty-six were admitted during periods of minimum staffing (7:00 PM to 7:00 AM), pre-emptying the use of limited resources for other medical/surgical emergencies. Fifty-eight (54%) needed emergency surgery: laparotomy (38), thoracotomy (5), and neck/extremity (15). Forty required multiple surgical procedures, and eight patients required nine subsequent surgeries. There were two deaths. Average hospital stay ranged from 1 to 180 days; inpatient days totalled 1003, 270 of which were spent in the ICU. Total charges neared +2.0 million. Ninety-four patients (88%) were medically indigent. On discharge, 75 patients were disabled, six permanently. We conclude: 1) Gang activity caused the majority of gunshot wounds at our trauma center; 2) multiple injuries predominated, requiring extensive ICU use; 3) the combination of indigent patients and high hospital costs underestimate the financial burden as valuable resources are diverted from other areas; 4) subsequent community costs include rehabilitation and chronic care.
The American surgeon 01/1994; 59(12):831-3. · 1.28 Impact Factor
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ABSTRACT: Candidemia in critically ill patients is a significant source of mortality. To identify perioperative risk factors accounting for patient death, we performed a retrospective study of 46 surgical patients with fungemia during the period from 1981 to 1990. Twenty patients survived (43%), and 26 died (57%). Mortality was associated with age older than 46 (p < 0.02, unpaired Student's t-test) and concomitant renal failure, hepatic failure, postoperative shock, or adult respiratory distress syndrome (p < 0.0001, p < 0.0001, and p < 0.05, respectively, chi 2 test). Survival was not influenced by the presence of diabetes, chronic obstructive pulmonary disease, gastrointestinal hemorrhage, pneumonia, alcohol consumption, steroid use, or enteral/parental nutrition. Bacterial speticemia developed in 26 patients (11 lived, 15 died) and typically preceded or was concomitant with the onset of fungal sepsis (88%). Candida albicans was the fungal species most commonly isolated from blood cultures (30 of 46). Its was cultured from other sites in addition to blood in 30 patients. Candidemia carries a higher risk of mortality in older patients and in those with multiple organ dysfunction. Other immunocompromised conditions such as diabetes and steroid use did not increase mortality. These findings suggest that the pathogenicity of Candida sepsis is not solely related to opportunistic superinfections but may reflect failure of other host defense mechanisms. Moreover, the frequent occurrence of bacterial septicemia prior to the development of Candida sepsis further emphasizes the importance of fungal surveillance cultures to detect early fungal colonization in the critically ill.
The American Journal of Surgery 12/1993; 166(6):617-9; discussion 619-20. · 2.78 Impact Factor
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ABSTRACT: Spinal cord trauma frequently results from high energy vehicular accidents which produce multisystem trauma. Because of the priorities of resuscitation, other injuries may escape early diagnosis. This study was undertaken to examine the extent and implications of "missed injuries" associated with spinal trauma. We reviewed the charts of 24 patients (23 men, one woman) with spinal cord injuries, who presented during a consecutive 9-year period. The median age was 31 years. Two patients died. There were 13 cervical, 10 thoracic, and one lumbar injuries. Blunt trauma was responsible for injuries in 18 cases, other mechanisms were the cause in six cases. The average initial Glasgow coma score was 13 +/- 0.8 (SEM). Average revised trauma score (RTS) was 6.7 +/- 0.3 (SEM). Other injuries noted at the time of presentation included: head and neck (8), thoracic (6), extremity (2), and major vascular (1). There were 11 initially undiagnosed injuries in 10 patients (42%); six were "nonspinal" and five were "spinal," diagnosed between 1 and 30 days after admission. Average trauma scores were the same among those with and without missed injuries. Missed spinal injuries included: fractures of C5-6 (2), C4 (1), T7 (1), and L1 presenting as a progressive deficit (1). Nonspinal injuries were: pneumothorax (3), hemopneumothorax (1), paralyzed hemidiaphragm (1), and renal contusion (1). Prolonged hospital stay and/or the need for additional surgery were the most common sequelae of delayed diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)
The American surgeon 07/1993; 59(6):371-4. · 1.28 Impact Factor
