Measuring Trauma Systems
Dutton RP, Stansbury LG, Leone S, et al. Trauma mortality in mature trauma systems: Are we doing better? An analysis of trauma mortality patterns, 1997–2008. J Trauma. 2010;69:620–626.
Some of us can remember when trauma patients were transported to the closest facility, regardless of the severity of their injuries. But even then, EMS providers knew which hospitals could deliver the best care to their injured patients, developing an “unofficial” triage system. This study evaluates the type of patients and overall mortality in the past 30 years at the R. Adams Cowley Shock Trauma Center in Baltimore, Maryland.
Based on research by Donald Trunkey, MD, in 1983, we know that there are three primary peaks in trauma-related deaths: immediate, early and late. The goal of trauma systems was to have an effect on the patients in the early death group—those with the likelihood of dying within two to three hours of their injury. The authors of this study reported that over the past 30 years, a significant decrease occurred in the mortality among this group; however, trauma mortality overall didn’t improve. The authors also document no increase in length of hospital stay despite the increased severity of the injuries.
The study pointed out that the success of trauma systems is due in a large part to the role of EMS. Despite no change in overall mortality in the past 30 years, a significant difference was identified in the group that relies on early and appropriate EMS care.
Renal Injuries in Motor Vehicle Trauma
Smith TG, Wessells HB, Mack CD, et al. Examination of the impact of airbags on renal injury using a national database. J Am Coll Surg. 2010;211:355–360.
We’re well aware of the reduction in mortality from motor vehicle collisions (MVCs) since the implementation of restraint systems and airbags. As you know, restraint systems and airbags are designed to reduce injuries to the head, neck and chest. But could they also provide protection for other organ systems? This study evaluates the role airbags play in reducing renal trauma in front- and side-impact collisions.
Using the Crash Injury Research and Engineering Network national database, these authors found that frontal airbag deployment in a front-end collision reduced the likelihood of renal injury by 45%.
In the side-impact collision group, the overall number of injuries was lower in those vehicles with side airbags. Interestingly, 95% of frontal airbags deployed in a front-end collision, and only 58% of side airbags deployed in side impact crashes.
Clearly, these authors have identified a role for front and side airbags in the reduction of abdominal organ injuries. So even though airbags are saving more lives, their design and deployment isn’t improved, we’ll likely see an increase in life-changing abdominal injuries.
Tubular Gauze Dressings
Balfour GW. Hazards of tubular gauze finger dressings. Am J of Emerg Med. 2010;28:839–840.
Many of you are familiar with tubular gauze dressings. Some of you may have applied them. Putting on a tube gauze dressing seems simple. First, you find the right side finger frame and cover it with tube gauze, then you go up and down over the finger, twisting at each end, until you have achieved complete coverage. Finally, the end is tied around the wrist. Although this process sounds simple enough, it can be misleading.
In a survey of members of the American Society for Surgery of the Hand, the author found that nearly one third of respondents had encountered a complication that resulted from using this dressing. The majority of the complications involved the dressing being too tight, but others included blister-like burns, depigmentation and amputation of the digit.
Before you’re asked to use this dressing again, consider reviewing the proper technique with your educator. Somebody’s finger may be glad you did.
Nesiama JAO, Sinn DP. Tooth Avulsion. Clin Ped Emerg Med. 2010:11;108–111.
We’ve all been given instruction on what to do if a child knocks out a tooth, but what’s the pathophysiology behind our actions? In this study, the authors discuss the various parts of the tooth and ways to clean and store one prior to re-implantation.
According to these authors, an avulsed tooth should be cleaned under cold water for no more than 10 seconds and, in the ideal situation, be re-implanted into the socket. Survivability of a tooth depends on time and the way it’s stored. For an optimal outcome, a tooth should be re-implanted within 30 minutes of the injury. The authors of this study also discussed how to handle the tooth to improve survivability as well as optimal storage if it can’t be re-implanted.
We often skip this type of study because “we know how it’s done.” But even the simplest tasks can take on a great deal of significance to your patient. JEMS
A Farewell Note: This is my last Research Review column for JEMS because I have moved to a new focus in my career. It has been my privilege to write this column for too many years to count. I thank all of you who’ve read it, and I hope I may have encouraged one or two of you to look at the role of research in your professional life. The column will continue under the expert guidance of David Page, MS, NREMT-P, from Inver Hills Community College. Thanks to JEMS for continuing this column for all these years despite its “nerdiness,” and to all of you for reading it.
This article originally appeared in December 2010 JEMS as “Research Review.”