Short- and long-term survival after cardiopulmonary resuscitation.

BACKGROUND: The objective was to evaluate the effect of patient characteristics and other factors on cardiopulmonary resuscitation (CPR) survival, hospital discharge survival and function, and long-term survival. METHODS: All patients 18 years and older experiencing in-hospital CPR from December 1983 through November 1991 at Marshfield Medical Center (Marshfield Clinic and adjoining St Joseph's Hospital), Marshfield, Wis, were selected. We performed a retrospective medical record review and augmented these data with updated vital status information. MAIN OUTCOME MEASURES: Cardiopulmonary resuscitation survival, hospital discharge survival and function, and long-term survival. RESULTS: Of 948 admissions during which CPR was performed, 61.2% of patients survived the arrest and 32.2% survived to hospital discharge. Mechanism of arrest was the most important variable associated with hospital discharge. Patients with pulseless electrical activity had the worst chance of hospital discharge, followed by those with asystole and bradycardia. Follow-up information was available for 298 patients who survived to discharge. One year after hospital discharge, 24.5% of patients, regardless of age, had died. Survival was 18.5% at 7 years in those 70 years or older, compared with 45.4% in those aged 18 to 69 years. Heart rhythm at the time of arrest strongly influenced long-term survival. Bradyarrhythmias produced a nearly 2-fold increased mortality risk compared with normal sinus rhythm. CONCLUSIONS: Survival until hospital discharge after CPR at our institution during an 8-year period was higher than previously reported for other institutions. Long-term survival after discharge was equal to or higher than reported estimates from other institutions. Hospital admission practices and selection of patients receiving CPR may account for these findings.

Basketball injuries in a rural area.

This study was conducted to determine the frequency and nature of basketball injuries occurring in a rural setting. More than 6000 patients with sports-related injuries presented to a rural emergency department between June 1, 1988 and June 1, 1994. Of these patients, 1189 (19% of the total) were injured playing basketball. A chart abstraction form was utilized to retrospectively review injuries noting demographics, types and sites of injuries, as well as referral and treatment plans. Approximately two-thirds (66.4%) of those injured were males, with most injuries (53%) occurring during school-related activities. Almost four-fifths (78%) of injuries occurred between the ages of 10 and 19. The ankle (33.1%) was the body site most commonly injured, followed in frequency by finger injuries (19.3%), sprains and strains, which accounted for the majority (55%) of injuries. The most common mechanism of injury was recorded in which no contact with other players occurred (37.4%). The vast majority (99%) of injuries were managed as outpatients. The majority of cases (72%) were expected to recover within 2 weeks. Similarities were noted regarding sites of injury and age of distribution of patients when compared to the previous studies.

Football injuries in a rural area.

This study was conducted to analyze the frequency and characteristics of football injuries in a rural hospital setting and compare it to the national data. More than 6,000 patients with a sport-related injury presenting to the emergency medicine department at the Marshfield Clinic between June 1, 1988 and June 1, 1994 were collected prospectively. Eight hundred forty-three (14% of total) patients sustained football-related injuries. A chart abstraction form was then used to retrospectively review football injuries documenting types, sites, and mechanism of injury, along with demographic aspects. The peak age sustaining football injuries was 17 years old (17.5%). Most of the football injuries occurred during school activities (73.7%). The most common site injured was the finger (16.5%), followed by the knee (15.7%). Sprains/strains were the most common diagnosis representing 40.2% of injuries overall. The most common mechanism resulting in a football-related injury was as a result of being blocked or tackled (52.7%). Surgery was required on 4.9% of individuals injured while playing football. Most patients (69.7%) were expected to recover from their injury within 14 days. There were more injured football players from our area in the age group 15 to 24 years as compared to the national data available. Diagnosis, site injured, and mechanism of injury from our study were comparable to other national publications. Prospective studies are needed to address the problem of football-related injuries. Such studies would require a multidiscipline team of experts.

The relationship of farm residency status to demographic and service characteristics of agricultural injury victims in central Wisconsin.

This study performed a surveillance of a defined population in central Wisconsin during a two-year period that included six months of follow-up. The study included those who worked and lived on farms and those who only worked on farms. The injury rate for farm residents was 3.15 injuries per 100 persons per year. However, 195 of the 510 injuries (38.2%) involved persons who were not farm residents. For nonfarm residents, 88.7 percent of the victims were male, whereas for farm residents 79 percent of the victims were male. More than one half of the farm residents who were injured were the owners and an additional 21 percent were juvenile children. Of those aged 18 to 29 years, 51.3 percent were nonfarm resident victims and 15.2 percent were farm resident victims. Of nonfarm residents, 41.1 percent were married; of farm residents, 65.3 percent were married. More than one half of all injured nonfarm residents were seen within two hours of injury while one quarter of the injured farm residents were seen more than 24 hours after the injury. Only 4 percent of the injured farm residents were self-insured, but 15 percent of the nonfarm residents were self-insured. However, the time of injury, actual injuries, diagnoses rendered, and services received were similar for injured farm residents and injured nonfarm residents. Effective attempts to intervene on agricultural injuries will need to consider different risk factors for injuries for nonfarm residents as compared to farm residents.

The spectrum of emergency care of agricultural trauma in central Wisconsin.

Agriculture is among the most dangerous occupations in the United States. When injuries do occur, the emergency department (ED) is the primary source of care. Over a 2-year period, the emergency medicine section of the Marshfield Clinic/St Joseph's Hospital, cared for 913 victims of agricultural trauma. Although 11% were initially admitted and 4% were later treated, the remainder received their care solely in the ED. Unlike most occupational injuries, people of any age may be involved in agricultural injuries; 27% in this series were less than 18 years of age and 5% were 65 years or older. Just over half of all injuries were from mechanical devices, including tractor and farm machinery. The remainder were from animals, falls, or exposure. Although several different types of injuries occurred, the most common diagnoses were soft tissue injuries and fractures and the most common procedure was diagnostic radiography followed by wound and fracture care. An ED in a rural setting should be prepared to deal with agricultural trauma.