ABSTRACT
Background : Liver injury is a challenging intraabdominal injury with a high morbidity and mortality rate. We describe details of this interesting injury that was treated at Siriraj Hospital. Objective : To review mechanism of injury, severity of injury, treatment and mortality rate of liver injury at Siriraj Hospital. Methods : A retrospective study of liver injuries that occurred during May 1997 and March 2000 was done. Analysis of the data was made be a simple statistical method using mean and percentage. Results : Sixty-eight patients with liver injury who were admitted of and had completely recorded data from Siriraj Hospital were analyzed, including 56 males and 12 females. Mean age was 28.6 yr. (4.60). Regarding mechanism of injury,39 (57.4%) were affected from blunt ingury,26 (38.2%) were had stab wounds, and 3 (4.4%) had gunshot wounds. Fifty-five patents with liver injury (80.9%) had at least one site of other organ injury (77 sites in 55 patents). The most common other injury was chest in injury (28 sites including 13 sites of diaphragmatic injury) This study included 23 (33.8%), 24 (35.3%), 18 (26.5%), 1 (1.5%) and2 (2.9%) patients who were classified as grade I, II, III, IV and V of liver injury respectively. Surgery was performed in 66 patients whereas only 2 patients were observed and CT scanning for successful nonoperative management. Cauterizaton and suture of injured liver were the two most common procedures that were performed in our hospital, 52.9% and 23.5% of cases respective, had they were limited to only grade I, II and III liver injury. The overall mortality rate was 11.8%, with only 8.5% being grade I and II but markedly increased to 19% in grades III, IV and V. Conclusion : More than half of the liver injuries in this study were from blunt injury, the other 42.6% were from penetrating injury. There was a high rate of associated injury. Most hepatic injuries were minor (69.2%) In this study surgery was per formed in 66 patients whereas only 2 patients were observed. Nonoperative management was not widely used, In case of an operation, one or more surgical procedures were used, including electrocautery, suturing of liver parenchyma or vessels, packing of the liver ligating the hepatic artery and repairing the vena cava. In complex hepatic injury, we prefer the conventional method by perihepatic packing. The overall mortality rate was 11.8%
ABSTRACT
Introduction: Presently many hospitals are pursuing hospital accreditation. One important issue is the improvement of medical recording. Accurate medical recording is very important in order to provide quality patient follow-up, medical education and legal evidence. Because of limitation of time in trauma patient care, important patient data from previous medical record is sometimes missed or not available. The development of a well-organized medical recording system may help to improve accuracy in data recording. Objective of the study: To compare the new medical record form with the previous one using the hospital accreditation scoring system for medical records. Methodology: After collecting both new and previous records that were filled-in by the same group of physicians and sixth year medical students in the Trauma Services Unit of Siriraj Hospital from December 1st – 31st 2001, these 30 records in each recording system were randomly placed into the study. Scoring and comparison of the records were performed by staff of the Division of Trauma Surgery, Department of Surgery. Results: Six parts of the record were compared (patient profile, patient history, physical examination, diagnosis, laboratory and management). By using student’s t-test, the new record showed more statistically significant improvement of data recording than the old record in four areas, i.e. patient history, physical examination, diagnosis and management. The laboratory record section could not be compared because different patients needed different investigations. Both new and previous records were recorded completely in the patient profile section. Conclusion: The new medical recording system will improve recording and therefore improve the care given to injured patients.