Quality trauma care: the future?
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Australia↗
Biomedical subjects
M Sugrue
Publications and source records attributed to M Sugrue.
Presence of pressure ulcer prevention methods used among patients considered at risk versus those considered not at risk.
PURPOSE: This study examined pressure ulcer-prevention strategies available for patients considered at risk versus those considered not at risk. DESIGN: The study used a prospective, longitudinal design. SETTING AND SUBJECTS: Six hundred ninety-four patients from units of five acute care hospitals, a rehabilitation facility, and two nurses' home care caseloads participated in the investigation. INSTRUMENTS: Data-collection instruments included the Braden Scale for risk assessment, demographic information, and the Pressure Ulcer-Prevention Strategies tool, which assessed for the presence of 16 pressure ulcer-prevention strategies. METHODS: All patients admitted to a participating unit during a 2-month period were followed up until discharge. Depending on the site, patients were assessed for the presence of pressure ulcer-prevention strategies one to three times per week. RESULTS: Patients in the at-risk group versus those in the not-at-risk group were more likely (p < 0.01) to have the head of the bed in a low position, a pressure-reducing bed surface, pressure ulcer prevention charted, a positioning wedge, incontinence cleanser and ointment, heel protection, a prevention care plan, a trapeze, and a posted turning schedule. The at-risk group had significantly (p < 0.01) more prevention strategies present than did the not-at-risk group. However, the percentage of patients placed on a pressure ulcer-prevention program was low for both groups. CONCLUSIONS: Pressure ulcer prevention was evident for the at-risk group, but at a low rate. Institutions must continue to explore this critical area affecting patient outcomes.
Aged↗
Occurrence of skin lesions/conditions in ill persons.
The purpose of this study was to examine the occurrence of common skin lesions that potentially may be misdiagnosed as a pressure ulcer, and to examine the characteristics of ill persons who have these skin changes. This was a prospective, descriptive study which included five acute care hospitals, a rehabilitation hospital, and a home care agency. Results indicated that patients with skin lesions/conditions were significantly older and had longer lengths of stay, more diseases, lower Braden Scale scores, and lower serum albumin levels. Nurses must gain knowledge about identifying and treating skin conditions. Assessment of the patient's skin should occur throughout their length of stay.
Age Distribution↗
In vivo adsorption of isohemagglutinins with fresh frozen plasma in major ABO-incompatible bone marrow transplantation.
Despite techniques to deplete red cells from major ABO-incompatible allogeneic bone marrow (BM) or to remove recipient isohemagglutinins (IHGs) before transplantation, delayed erythropoiesis and hemolysis, red cell aplasia, and increased red cell transfusion requirements may occur. Twenty-nine recipients of major ABO-incompatible allografts received donor-type frozen fresh plasma (FFP) infusions twice daily to adsorb IHGs in vivo. Engraftment and transfusion requirements were compared between the 29 FFP-treated major ABO-incompatible allograft recipients, 5 recipients of major ABO-incompatible BM who did not receive FFP infusions, 35 recipients of minor ABO-incompatible BM, and 172 recipients of ABO-compatible BM. No significant differences in either transfusion requirements or engraftment were seen in the FFP-treated major ABO-incompatible vs. minor ABO-incompatible or ABO-compatible groups (p values > or = 0.10). The infusion of donor-type FFP represents a simple, effective treatment strategy to neutralize IHGs and to prevent adverse consequences of major ABO incompatibility in the setting of allogeneic BM transplantation. The role of this strategy in the care of patients receiving ABO-incompatible solid organs remains to be defined.
ABO Blood-Group System↗
Intraabdominal pressure and gastric intramucosal pH: is there an association?
This study evaluated the potential association between increased intraabdominal pressure (IAP) and abnormally low gastric intramucosal pH (pHi) (</= 7.32) in postoperative patients and assessed its effect on patient outcome. Altogether 73 patients undergoing major abdominal surgery over a 9-month period were studied prospectively. All underwent gastric tonometry and intravesical IAP measurements three time daily. An IAP of >/= 20 mmHg and a pHi of </= 7.32 were considered abnormal. The development of the following complications were also documented: hypotension [mean aortic pressure (MAP) < 80 mmHg], abdominal sepsis, renal impairment, and death. The median APACHE II score was 16 (range 5-34). Twenty-two patients had upper gastrointestinal (GI) surgery, 27 lower GI surgery, and 24 aortic surgery; 44 of these patients underwent emergency surgery. Abnormal pHi (</= 7.32) occurred in 36 patients while on the intensive care unit. Compared to patients with normal pHi, abnormal pHi patients were 11.3 times (3.2-43.5) [odds ratio +/- 95% CI] more likely to have an increased IAP. Abnormal pHi was significantly associated with hypotension (chi2 = 6.8;p = 0.009), sepsis (chi2 = 3.7;p = 0.06), renal impairment (chi2 = 28.3;p = 0. 0000001), relaparotomy (chi2 = 4.1;p = 0.04), and death (chi2 = 9. 7;p = 0.002). This study demonstrated a significant clinical association between increased IAP and abnormal pHi. An abnormally low pHi was associated with poor outcome.
Abdomen↗
Is penetrating injury on the increase in south-western Sydney?
BACKGROUND: Few Australian studies describe the epidemiology of penetrating trauma. This study describes the incidence and demographic features of penetrating injuries with emphasis on trends and severity analysis. METHODS: Case analysis was performed utilizing data from the Liverpool Hospital Trauma Registry (1989-94), NSW Department of Health Hospital Separations (1991-93), and the NSW Bureau of Crime Statistics (1991-93) with reference to the Liverpool and Fairfield Local Government Areas (LGA). RESULTS: The Trauma Registry revealed 251 of penetrating trauma. The median age was 26 years (interquartile range 21-33). Ninety-one per cent of the victims were male. Fourteen per cent of patients had an Injury Severity Score (ISS) > 15. Sixty-five per cent of cases were stab injuries and 20% gunshot injuries with the abdomen being the most commonly injured site. Twenty-one per cent of patients underwent laparotomy, 1.6% thoracotomy and 1.2% thoracotomy and laparatomy. There were 10 (4%) deaths. Trends in incidence of penetrating trauma and violent crime involving weapons were analysed. Static trends were observed for the annual incidence of penetrating trauma from the Liverpool Hospital Trauma Registry. Separations for penetrating trauma from Liverpool and Fairfield hospitals showed a slightly increasing trend. Violent crimes involving weapons in the Liverpool and Fairfield LGA showed a static trend. Nevertheless, separations for penetrating trauma and rates of violent crimes involving weapons were higher in south-western Sydney than metropolitan Sydney or NSW. Eight per cent of the LGA population are Vietnamese but this study identified 16% of victims as being Vietnamese. CONCLUSIONS: This study found no significant increase in penetrating trauma or violent crime predisposing to penetrating injury in south-western Sydney.
Adolescent↗
Prospective study of intra-abdominal hypertension and renal function after laparotomy.
The value of postoperative monitoring of intra-abdominal pressure (IAP) in surgical patients has not been established. This study prospectively evaluated the occurrence of increased IAP and its association with renal impairment and outcome in surgical patients admitted to an intensive care unit. One hundred consecutive patients after laparotomy were studied, 88 of whom had complete IAP measurements. IAP was measured using an intravesical catheter and was considered increased when equal to 20 mmHg or above. Renal impairment was defined as a postoperative serum creatinine concentration of greater than 130 mumol/l, or an increase in serum creatinine of greater than 100 mumol/l within 72 h of surgery. The median (range) APACHE (Acute Physiology And Chronic Health Evaluation) II score of the patients was 13.5 (4-43). The incidence of raised IAP was 29 of 88 (33 per cent). Renal impairment was present in 29 of 88 (33 per cent), of whom 20 of 29 (69 per cent) had raised IAP (P < 0.01). The odds ratios (95 per cent confidence interval) for the development of renal impairment and death in patients with increased IAP were 12.4 (3.8-41.7) and 11.2 (2.8-47.9) respectively. There is a clinically significant association between increased IAP and renal impairment in patients admitted to an intensive care unit after laparotomy.
Abdomen↗
Laparoscopic repair of penetrating intra-abdominal injuries.
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Adult↗
A comparison of peripheral blood stem cell apheresis using the Fenwal CS3000 Plus and COBE Spectra.
We have compared the leukapheresis products collected on the Fenwal CS3000 Plus and COBE Spectra in a well-controlled patient population. While statistically significant differences were found, i.e. in product hematocrit, volume, number of granulocytes and platelets collected, these are not felt to be physiologically important. Similar efficiency in collecting mononuclear cells and colony forming unit assay results indicate that each instrument is capable of harvesting hematopoietic progenitor cells from peripheral blood.
Adult↗
Characterization of reactions after exclusive transfusion of white cell-reduced cellular blood components.
BACKGROUND: Potential adverse effects of white cells (WBCs) within transfused cellular blood components include febrile nonhemolytic transfusion reactions (FNHTRs), alloimmunization, transmission of infectious diseases, transfusion-related acute lung injury, and immunomodulation. Although exclusive use of WBC-reduced components to prevent alloimmunization and cytomegalovirus transmission has been studied, the use of these components to avert FNHTR has not been examined. STUDY DESIGN AND METHODS: Transfusion reactions (FNHTRs, allergic reactions, and others) were characterized in recipients of 12,277 WBC-reduced single-donor apheresis platelets (SDAPs) and/or red cells (RBCs). Medical and laboratory evaluations for possible infectious and immunologic (alloimmunization) causes of each reaction were undertaken, and the benefit of further modification of components for the prevention of subsequent reactions was also evaluated. RESULTS: Transfusion reactions occurred after 481 (3.92%) of 12,277 transfusions. Allergic reactions occurred more commonly after transfusion of SDAPs (3.69%) than of RBCs (0.51%). Conversely, FNHTRs occurred more commonly after transfusion of RBCs (2.15%) than of SDAPs (1.58%). HLA antibodies were present in a posttransfusion sample from 27 (10.6%) of 255 patients; bacterial contamination was a possible cause of only 2 (0.42%) of 481 reactions. In patients with recurrent FNHTRs, further WBC reduction in components did not wholly prevent further FNHTRs. CONCLUSION: The incidence of FNHTRs and alloimmunization after exclusive transfusion of WBC-reduced RBCs and SDAPs was low. Further WBC reduction in components transfused to patients with a history of recurrent FNHTRs does not completely prevent subsequent reactions.
Antibodies↗
A prospective study of the performance of the trauma team leader.
This study assessed the performance of the trauma team leader in 50 consecutive trauma resuscitations at Liverpool Hospital over a two-month period. The trauma team consists of intensive care (ICU), emergency, and surgical registrars, three nurses, a wardsman, a radiographer, and a social worker. The team leader position alternates between the ICU and emergency registrar on a fortnightly roster. A panel of specialists experienced in trauma management evaluated 38 aspects of the initial resuscitation. Individual variables received different weightings. The maximum possible score for team leader performance was 80. The mean team leader score was 70.4 +/- 8 (SD). The main deficiencies in the team leader's performances were in their interpersonal communications and in the adequacy of documentation of the history of the injury. In 20% of resuscitations there were failures to completely expose the patient. Medical skills were uniformly well performed. Poor communication with other team members were the main pitfall of the team leader in this study. The team leader score may prove a useful tool in improving the quality of the trauma team.
Clinical Competence↗
Evaluation of the prevalence of drug and alcohol abuse in motor vehicle trauma in south western Sydney.
This study estimated prospectively the prevalence of high drug and alcohol levels in road trauma cases who met the criteria for activation of the Liverpool Hospital's trauma team. Urine analysis of road trauma victims between October 1992 and October 1993 was undertaken for drug and alcohol estimation. A total of 164 drivers were studied. A urine alcohol concentration (UAC) exceeding 0.08 g/dL was detected in 27 drivers (16.5%). Cannabinoids were detected in the urine of 25 drivers (15.2%), in 17 the concentrations exceeded 400 ng/mL. In one instance amphetamine, cocaine and heroin were detected in the same injured driver. Combined use of alcohol with some other drugs was detected in only four drivers. Alcohol and cannabinoid levels were prevalent in the urine of injured drivers in this study, particularly in young males who remain over-represented in the group of injured drivers. In the population surveyed other drugs were rarely detected. The role of cannabinoids in road trauma and the use of cannabinoids in young male drivers will however need to be monitored more extensively.
Accidents, Traffic↗
A modified combination technique for performing diagnostic peritoneal lavage.
Existing open diagnostic peritoneal lavage techniques (DPL) use small bore catheters, through a small lower midline incision or infra-umbilical incision. This study evaluated a modified DPL technique using a 10 mm umbilical incision, with open insertion of a 20 French peritoneal lavage catheter. The catheter has 27 radial side holes in the terminal distal 13 cm, and a female Leur lock connector. Warmed saline is infused via a cystoscopy infusion set. The time required to perform a new technique was studied in 10 patients. The median time to catheter insertion was 2.4 +/- 3.8 min, infusion time 0.75 +/- 0.3 min, effusion time 0.3 +/- 1.7 min, and a median total time of 7.6 +/- 4.2 min (median +/- s.d.). There was no complications. This technique of DPL is cosmetically attractive, much quicker than existing techniques and we have found its initial use encouraging.
Abdominal Injuries↗
Hypothermia and severe trauma.
During the period from May 1992 until April 1993, 108 patients were admitted to Liverpool Hospital with Injury Severity Scores (ISS) > 15. Temperatures had been recorded in 100. Of these, 17 had a core temperature of less than 35 degrees C documented within 24 h of arrival. The hypothermic group presented with more severe injuries and contained a disproportionate number of females. Hypothermia was found to be more common in the winter months, but it was not associated with a delay in reaching hospital from the time of injury. When injuries were ranked by ISS, both hypothermic and normothermic patients were equally likely to have received a blood transfusion; however, the mean number of units of packed cells transfused was greater for the hypothermic group with ISS < 41 than for the similarly injured normothermic group. Two patients in the hypothermic group had sustained burns, and both of these were hypothermic on arrival. All of the hypothermic patients who required surgery developed hypothermia in the operating theatre.
Accidental Falls↗
Intra-abdominal pressure measurement using a modified nasogastric tube: description and validation of a new technique.
OBJECTIVE: This study assessed the accuracy of an intragastric method of measuring intra-abdominal pressure (IAP). DESIGN: Prospective sequential study with simultaneous paired measurement of gastric and urinary bladder pressures. SETTING: Operating theatre, University Teaching Hospital. PATIENTS: 9 patients undergoing laparoscopic cholecystectomy were studied. INTERVENTIONS: Intraperitoneal pressures were monitored during peritoneal insufflation at laparoscopy up to a pressure of 20 mmHg. MEASUREMENTS AND RESULTS: Intra-abdominal pressure measurements were recorded simultaneously using a gastric balloon and urinary catheter. Gastric pressure may be up to 4 mmHg higher or 3 mmHg lower than urinary bladder pressure. CONCLUSIONS: Intra-abdominal pressure can be measured easily in this new fashion, allowing a continuous pressure trend to be obtained without interfering with urinary output estimation.
Abdomen↗
Computerized phonoenterography: the clinical investigation of a new system.
We assessed bowel sounds in controls and patients with acute abdominal conditions using a new computer-aided sound analysis system (C.A.S.A.S.). Sixty-three controls and 61 patients with an acute abdomen had 10-min recordings of bowel sounds in a silent environment with computer analysis of the digitized acoustic signal. Mean bowel sound length was 20 +/- 1.3 ms in controls, 32 +/- 30 ms in cholecystitis, and 37 +/- 35 ms in intestinal obstruction (p < 0.05; mean +/- sd, Mann-Whitney U test). Similar significant differences existed between controls and acute abdomens in the number of sounds generated, sound intensity, and intervals between sounds. Although they were significantly longer in intestinal obstruction, bowel sounds were reduced in number (0.6 sounds/s) as compared to controls (0.4 sounds/s; p < 0.05). Significant differences were seen in all acoustic parameters in patients stratified for the presence or absence of peritonitis. C.A.S.A.S. allowed an objective scientific assessment of bowel sounds and identified significant differences between bowel sound patterns in controls and patients with an acute abdomen.
Abdomen, Acute↗
Laparoscopic versus open appendicectomy: a prospective evaluation.
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Appendectomy↗
Removal of bulky tissue at laparoscopic surgery.
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Appendectomy↗