RESUMO
Currently, level II trauma center standards allow trauma surgeons to take call out-of-hospital. To address the concern that this practice may adversely influence outcome, we tested the hypothesis that the survival of injury victims treated at a level II trauma center is significantly different from that predicted by the Major Trauma Outcome Study (MTOS). In addition, we examined the impact of trauma surgeons taking call out-of-hospital on the survival of patients with severe thoracoabdominal injury. Over a 26-month period, a total of 3,689 consecutive injured patients who were treated at a community hospital level II trauma center were entered into this study. There was no significant difference between the MTOS survival and the actual survival in the overall population (96% vs. 97%, respectively; Z statistic = ns). Among the patients with severe thoracoabdominal injury (i.e., Abbreviated Injury Scale score greater than or equal to 3), there was no significant difference in survival between the patients whose arrival time corresponded to the presence of an in-hospital surgeon (0700-1800 hours) versus those who arrived when a surgeon was generally out-of-hospital (1801-0659 hours), (76% vs. 81%, respectively; p = ns). From these data we conclude that there was no significant difference between the survival observed and that predicted by the MTOS at our community hospital, which complies with level II trauma center standards. Furthermore, in the cohort with severe thoracoabdominal injury, the response of trauma surgeons from out-of-hospital did not adversely influence survival.
Assuntos
Hospitais Comunitários , Avaliação de Resultados em Cuidados de Saúde , Centros de Traumatologia/organização & administração , Sistemas de Comunicação entre Serviços de Emergência , Escala de Coma de Glasgow , Hospitais com mais de 500 Leitos , Humanos , Escala de Gravidade do Ferimento , Análise Multivariada , Oklahoma , Triagem , Ferimentos e Lesões/mortalidade , Ferimentos e Lesões/cirurgiaRESUMO
Six patients with gastric rupture secondary to blunt abdominal trauma are presented in detail. The salient features of each case are briefly discussed, along with a further analysis of the review by Yajko and colleagues. The aggressive operative treatment of these patients is emphasized along with the vigorous attention that must be given to postoperative intra-abdominal sepsis caused by the initial contamination leading to morbidity and mortality.
