The aim of this study was to analyze the length of ICU/hospital stay of trauma patients to assess "Medical resources" using JTDB. We classified 60,580 cases registered between 2004 and 2010 in JTDB by hospital wards on emergency admission. A total of 9,564 ICU patients could move to the general ward before hospital transfer or discharge, while 6,217 cases were transferred to another hospital and 9,444 cases were discharged directly from the ICU. The length of ICU/hospital stay was correlated with the injury severity score (ISS). Sixty-eight percent (5,856 cases) of non-survivors died within 3 days. The length of ICU stay by patients not moving to a general ward was long, which means that these cases consumed a large amount of medical resources.
Objective : We investigated how concomitant injuries influence the outcome of head injuries. Methods : One hundred sixty-five cases of head abbreviated injury scale (AIS) ≥3 with/without multiple trauma admitted to our advanced emergency center during the past 33 months were studied retrospectively. The patients were divided into an MT group (n=36), in which head injury was associated with concomitant injuries of AIS≥3 and an H group (n=129), who suffered only head injury. Results : MT group presented with a higher frequency of shock on arrival (p<0.01) and the hospital stay period was longer than H group (p<0.01). There were no significant differences in mortality between 22.2% in MT group and 18.6% in H group. Multivariate logistic regression analysis showed that age and Glasgow coma scale (GCS) had an effect on outcome. The association of thoracic injuries AIS grade 4 or higher may contribute to the mortality of head injury (p=0.05). Conclusions : We conclude that the association with concomitant injuries increases the level of intensity of systemic treatment but has no significant influence on the overall mortality rate in multiple trauma with head injuries.
The patient was a man in his 30s, who collided with a utility pole while driving a mini-car. Bilateral hemopneumothorax was diagnosed and two trocars were inserted on each side. Circulatory and respiratory conditions stabilized on the 6th hospital day, but inflammatory reactions persisted. Increased free air in the abdominal cavity and mild ascites were observed on CT. To rule out intestinal injury, laparoscopic surgery was performed in consideration of pneumoperitoneum. Abdominal injury was not confirmed by laparoscopy. Although there are many negative opinions with regard to laparoscopic surgery for trauma because of concerns over a marked influence on respiratory and circulatory dynamics, low-invasive laparoscopic surgery is one option. This was a valuable case in which abdominal free air was considered to be caused by thoracic injury and to have been increased by positive-pressure ventilation that started at the time of injury.
We report a rare pediatric case that was considered to be indicated for surgical treatment for extraperitoneal bladder injury accompanied by disruption of the abdominal wall musculature by a bicycle handlebar. A 13-year-old boy fell while riding a bicycle and was hit in the lower abdomen by the bicycle's handlebar. Abdominal CT revealed extraperitoneal bladder wall laceration, disruption of abdominal wall musculature, and subcutaneous fluid collection from around the bladder. Conservative treatment with urethral catheterization was chosen. Abdominal distention gradually reduced, and disruption of the abdominal wall musculature became palpable. Because surgical treatment was indicated for the abdominal wall injury and the bladder wall laceration did not change in size, both the abdominal wall and bladder injuries were repaired on hospital day 4. Although conservative treatment is the treatment of choice for extraperitoneal bladder injury, surgical intervention was appropriate in this case.
A 69-year-old man injured in a truck accident was admitted to our hospital in shock and underwent iliac artery embolization and external fixation for an unstable pelvic fracture. We performed retrograde cystography and intravenous urography but no injury of the urinary system was apparent. On hospital day 10, computed tomography showed abscesses on both thighs and cystography showed leakage of contrast media from the bladder into both thighs. We debrided the bladder circumference in both femoral regions and corrected the bladder injury, but suture rupture occurred. Because leakage persisted, we constructed bilateral ureterocutaneous fistulas on day 42 and the patient was transferred to a rehabilitation hospital on day 85. Physicians should be cognizant that extraperitoneal bladder injury requiring surgical repair may not be detected by diagnostic imaging tests on admission, and repeat examination should be performed in patients with persistent hematuria.
We herein report a case of traumatic subarachnoid hemorrhage and fracture of facial bones in a 71-year-old man with idiopathic thrombocytopenic purpura (ITP). He was initially admitted to another hospital following a fall from a height of 2.5 m. He suffered dyspnea and facial hemorrhagic complications, and emergency nasootracheal intubation was performed.
Computed tomography revealed a subarachnoid hemorrhage and fracture of facial bones. His platelet count was 1.0×104/mm3 on admission, and a platelet and fresh-frozen plasma transfusion was performed. Blood was then transfused. Enteral nutrition was begun the next day. He underwent tracheostomy after 3 days and percutaneous endoscopic gastrostomy after 5 days. After surgical fixation of his fractures, he suffered no major hemorrhagic complications, infection, or airway obstruction, and his subsequent clinical course was uneventful.
Surgical procedures should be performed after control of platelet counts above 2.0×104/mm3, even when ITP is present.