An 'Erg' of epidemiology

Article Abstract:

Human beings most often die from either infectious disease or injury. Young people are more afflicted by trauma; more years of life are lost through trauma than from cancer or heart disease combined. In the mid-1980s the National Research Council and Institute of Medicine produced a study on injuries which identified five areas for attacking the problem of trauma: epidemiology, prevention, biomechanics, acute treatment and rehabilitation. A pilot program to administer a national injury control program was established at the Centers for Disease Control. This project, known as the Center for Environmental Health and Injury Control, has funded five injury prevention research centers, and works in collaboration with eight other centers. These centers have produced public and private programs in injury control. Opportunities for education in injury prevention are available for all levels of health care personnel, from emergency medical technicians to PhDs. The public is involved in injury prevention. Politicians, school personnel, athletes and media people, as well as parents and others are promoting awareness of various dangers such as handguns, drugs and alcohol, the benefits of using seatbelts and motorcycle helmets. Hospital medical records contain answers to many questions about injury epidemiology. It is important that information about the injury be included in both the summary and the diagnosis. Our national injury epidemic is being addressed by scientists, politicians and local leaders. Physicians can work within their institutions to gather more complete information and use external cause of injury codes routinely in their recording of medical records. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prevention, United States. Centers for Disease Control and Prevention, editorial

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Hypothermia and acidosis worsen coagulopathy in the patient requiring massive transfusion

Article Abstract:

In cases of severe trauma, patients may require massive blood transfusion (more than 12 units of packed red blood cells within 24 hours). Transfusions of this quantity can cause abnormalities of electrolytes, clotting factors in the blood, oxygenation and body temperature. It has recently been suggested that temperature has a significant effect on vasoconstriction (constriction of the blood vessels), platelet activation and secretion and clot formation; all are important elements in coagulopathy (abnormal blood clotting). The records of 45 trauma patients were reviewed to evaluate the relationship of hypothermia (low body temperature) and acidosis (abnormal pH of the blood) to the development of coagulopathy. All patients had required at least 12 units of packed red blood cells; the average transfusion consisted of 22.5 units. Mortality was 33 percent (15 of 45 patients). The patients who died were more likely: to have a penetrating injury (88 percent compared with 55 percent of the survivors); to have received more transfusions (26.5 units versus 18.6 for survivors); to have lower blood pH (7.04 versus 7.18); and to have lower body core temperature (88 degrees F versus 93.5 F). Patients who died had a higher rate of coagulopathy (73 percent versus 23 percent). Severe hypothermia (body temperature below 93.5) occurred in 80 percent of the patients who died, compared with 36 percent of the survivors. Significant refractory bleeding developed in patients who demonstrated hypothermia and blood acidosis. It is suggested that avoidance or correction of hypothermia may prevent refractory coagulopathy in patients who require massive transfusion. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Blood clotting disorders, Blood coagulation disorders, Hypothermia, Blood transfusion

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Utility of arteriography in penetrating extremity injuries

Article Abstract:

Patients who suffer penetrating injury of an extremity with explicit signs of vascular injury generally undergo surgery. However, patients with penetrating injury without clear signs of vascular injury may be diagnosed on the basis of history and physical examination, vascular studies and arteriography; surgery is not routinely performed in such cases. There is continuing debate over the routine use of contrast arteriography, X-ray examination of an artery following injection of radio-opaque contrast dye. A review was undertaken of 82 consecutive patients treated for penetrating trauma over a five-year period; the indications for arteriogram and their results are presented. Gunshot wounds accounted for 71 percent of the injuries and stab wounds, 29 percent. Average patient age was 27 and 66 of the 82 patients were male. There were 98 wounds, for which 68 arteriograms were performed. Eight of these arteriograms were performed to locate what appeared to be a vascular injury; 57 were performed because of the proximity of the wound to a major neurovascular (nerve and vascular) bundle. Eleven of these 57 arteriograms (19 percent) identified vascular injury, and six of the injuries required surgery. Arteriograms were positive in six of the eight studies performed because of suspected vascular injury. There was no follow-up beyond the first visit following hospital discharge for any patient. These findings suggest that the continued aggressive use of arteriogram is warranted, particularly for a patient population with an exceptionally poor history of follow-up. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, X-rays, Extremities (Anatomy), Arteries, Imaging

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