Anxiety in high-functioning children with autism.

High-functioning children with autism were compared with two control groups on measures of anxiety and social worries. Comparison control groups consisted of children with specific language impairment (SLI) and normally developing children. Each group consisted of 15 children between the ages of 8 and 12 years and were matched for age and gender. Children with autism were found to be most anxious on both measures. High anxiety subscale scores for the autism group were separation anxiety and obsessive-compulsive disorder. These findings are discussed within the context of theories of autism and anxiety in the general population of children. Suggestions for future research are made.

The role of preoperative localization in primary hyperparathyroidism.

Hyperparathyroidism is being increasingly recognized by the detection of hypercalcemia on routine blood chemistry. Improvement in preoperative localization has been proposed as a way to decrease operative time and decrease morbidity and mortality. The purpose of this study was to retrospectively review the Guthrie Clinic experience of parathyroidectomy with and without preoperative localization. One hundred nineteen patients who presented with primary hyperparathyroidism between 1983 and 1990 were evaluated. There were 27 males and 91 females with an average age of 61. Preoperative localization resulted in a significant decrease in operative time with preoperative localization decreasing operative time from 97 minutes without localization to 70 minutes with localization. Also, complications were less in patients undergoing preoperative localization (5.8% versus 13.9%). Preoperative localization was positively affected by gland size, with larger glands being easier to localized. In conclusion, accurate preoperative localization decreases operative time and decreases complications in this series of patients undergoing exploration for primary hyperparathyroidism. In our institution the thallium technitium scan is most accurate and is the localization procedure of choice.

Predicting severity of trauma by admission white blood cell count, serum potassium level, and arterial pH.

Traumatized patients frequently have leukocytosis, hypokalemia, and acidosis. The purpose of this study was to determine whether the admission serum potassium level (K+), white blood cell count (WBC), and arterial pH predicted the severity of injury in trauma patients. The injury severity score (ISS), total length of stay in the hospital (tLOS), and length of stay in the intensive care unit (LOS-ICU) were used to measure the severity of the injury. The charts of 156 consecutive trauma patients admitted to a level II trauma center were reviewed. Acidosis (arterial pH < 7.35) was associated with an increased mean ISS, tLOS, and LOS-ICU. Leukocytosis (WBC > or = 10,500/mm3) correlated with a higher mean ISS, and LOS-ICU. Patients with hypokalemia (K+ < 3.6 mEq/L) had an increased mean ISS and tLOS. Our findings suggest that the admission white blood cell count, serum potassium level, and arterial pH have a predictive value as to the severity of injury.

TRISS unexpected survivors--a statistical phenomenon or a clinical reality?

Data from patients treated in Pennsylvania-accredited trauma centers during 1989 were analyzed. TRISS expected and unexpected survivors (1.6% of all survivors) differed in many ways. Unexpected survivors were more than twice as likely to have been transferred from a nondesignated trauma center (45.8% vs. 22.8%, p < 0.001). Unexpected survivors had significantly higher frequencies of motor vehicle injuries (56.2% vs. 38.3%, p < 0.001), pedestrian injuries (9.6% vs. 5.4%, p < 0.01), and gunshot wounds (7.3% vs. 4.7%, p < 0.01). Expected survivors were injured more frequently in falls (26.1% vs. 10.8%, p < 0.001) and were less frequently male (64.5% vs. 75%, p < 0.001). Unexpected survivors had significantly longer average hospital stay (29.6 s vs. 9.3 days, p < 0.001) and more frequent (98.8% vs. 36.8%, p < 0.001) and longer average stays in the ICU (13.3 s vs. 4.1 days, p < 0.001). The percentage of unexpected survivors discharged to rehabilitation centers (61.9%) was significantly greater than that for expected survivors (8.7%), (p < 0.001). Unexpected survivors were more frequently judged "completely dependent" in five measures of functional disability than expected survivors. We conclude that unexpected survivors are a seriously injured and clinically relevant patient set, not just a statistical phenomenon.

Development of a statewide trauma registry.

In October 1986, the Pennsylvania Trauma Systems Foundation (PTSF) developed a statewide registry. Development concentrated on four major issues: 1) data elements; 2) patient selection; 3) confidential mandatory involvement for trauma centers; and 4) reporting/analysis. The overall compliance of the trauma centers was 81.5%. Documentation of prehospital run times and admission trauma scores were 21% and 70%, respectively. PTSF patients 55 years or older (27.9%) had twice the mortality as younger patients. Falls accounted for 76% of injuries to elderly patients. Finally, 42.6% of survivors had moderate to severe disabilities. Defining the "major trauma patient" is extremely difficult. A registry must have uniform quality data without undue costs. To obtain such data, maintenance of an active registry must be viewed as important as medical care, if organized trauma systems are to remain cost effective.

Direct transport to the operating room for resuscitation of trauma patients.

Two hundred forty trauma patients were transported directly from the scene to a specially designed operating room (OR) for resuscitation, bypassing the Emergency Department (ED). Triage criteria included a systolic BP less than or equal to 80 mm Hg, penetrating torso trauma, multiple long-bone fractures, major limb amputation, extensive soft-tissue wounds, severe maxillofacial hemorrhage, and witnessed arrest (WA). The mechanism of injury, transport mode, age, sex, admitting Revised Trauma Score (RTS), Injury Severity Score (ISS), Abbreviated Injury Scale (AIS), operative procedures, and outcome were recorded. Utilizing the current weights from the Major Trauma Outcome Study, the predicted survival (TRISS) of the total group and of several subgroups was compared to the observed survival. The mean ISS was 29.3. The survival rate for the total group was 70.4%. For the 58.7% who required major operative intervention, the mean time of OR arrival to anesthesia induction was 8.5 minutes. Non-arrested, hypotensive blunt trauma victims requiring therapeutic laparotomy had a higher than predicted survival observed survival = 0.75 versus average TRISS = 0.55; p less than 0.0002) and therefore appeared to benefit from this technique. Patients suffering witnessed arrest in the field did not benefit.

Utility of routine pelvic X-ray during blunt trauma resuscitation.

To assess the utility of a routine pelvic X-ray in resuscitation of blunt trauma patients, 669 patients were studied prospectively over a 2-year period. One hundred twelve patients (16.7%) had positive pelvic X-rays (PPX). When compared with the negative pelvic X-ray group (NPX), the PPX group had a significantly higher mean Injury Severity Score, 24-hour mean requirement for blood and component therapy, and higher incidence of associated injury of chest and abdomen. Despite the higher injury parameters, the mortality between the groups was not significantly different. When compared with five standard resuscitative assessment variables, a pelvic X-ray performed as an additional predictor of injury severity and 24-hour blood requirement. A pelvic X-ray should be performed routinely in victims of blunt trauma as part of the early resuscitation X-ray protocol since a positive finding has immediate prognostic and therapeutic implications.

Clinical investigation involving the use of the Haemonetic Cell Saver in elective and emergency vascular operations.

Fifty-five patients undergoing elective and emergency vascular operations using the Haemonetic Cell Saver unit were studied. The advantages and complications associated with autotransfusion are reviewed with special emphasis on this new method of blood salvage. Also technical improvements and protocol for use of the Cell Saver are described.