The impact of demographics, injury severity, and trauma type on the likelihood of survival in child and adolescent trauma patients.

OBJECTIVE: The purpose of this study was to examine the influence of demographics, clinical factors, and injury types on the likelihood of survival. DESIGN: This cross-sectional analysis was restricted to persons younger than 18 years, treated in trauma centers in 1990. MATERIALS: A total of 3,540 individuals from the 1990 Virginia Statewide Trauma Registry was included in the analysis. METHODS AND MEASUREMENTS: The outcome variable was the patient's survival likelihood after injury. The independent variables included Injury Severity Score (ISS), demographics (age, gender, and race), and injury types -- motor vehicle collision (MVC) or gunshot wound (GSW). Correlation coefficients were obtained from the study variables. Logistic regression evaluated the effect of injury severity, controlling for demographics and type of injury. MAIN RESULTS: Three variables (ISS, GSW, and MVC) exerted significant effects of survival. Individuals with more severe injuries were more likely to die than their counterparts. Patients with gunshot wounds and motor vehicle injuries were more likely to die than those who had other injuries. After adjusting for demographics and injury type, injury severity (beta = -0.323) was found to be the most influential predictor of survival. CONCLUSIONS: The overall findings suggest a need for hospitals to collect data routinely for calculating injury severity for the management and treatment of injured patients.

Eastern European public health: opportunity and challenge.

Allied health professionals in the United States have a unique opportunity to help people living in countries of the former Eastern Bloc. The United States government has shown its willingness to help by including Czechoslovakia in the 1990 SEED (Support for East European Democracies) Act which gives financial support and favored treatment. The National Institutes of Health have allocated three million dollars a year for the past three years for projects in Eastern Europe. However, money and laws alone will not solve the ongoing problems in Eastern Europe. It will require people who appreciate what they have and care enough to make a difference in the world community. By educating, facilitating, and temporarily executing change, a health care tragedy can be turned around. It is an inherent violation of our oaths and ethical contracts if we turn our backs when so very little time and effort can make so great a difference.

Infections related to venous access devices in patients with AIDS.

The use of implanted venous access devices (VADs) for long-term administration of medications and fluids in HIV/AIDS patients has become common. This retrospective study compared infection rates in implanted external catheters and totally implanted ports. The study also investigated possible relationships between infection, type of VAD, frequency of use, compliance, home care, frequency of clinic visits, and number of inpatient hospital days. The sample consisted fo 48 AIDS patients with a total of 54 VADs. The external catheters had an infection rate of 36.5%, while the ports had an infection rate of 30.8%. A significant relationship was found between lack of compliance with care of the VAD and infection rates.

HECs: are they evaluating their performance?

Although the incidence and composition of HECs has been well characterized, little is known about how HECs assess their performance. In order to describe the incidence of HEC self-evaluation, the methods HECs use to evaluate their performance, and the characteristics of HECs that influence self-evaluation, we surveyed the readers of Hospital Ethics. 290 HECs in 45 U.S. states, the District of Columbia, Puerto Rico and three Canadian provinces, completed questionnaires. Of the 241 HECs included in the data analysis, 97.9% had performed some self-evaluation. Responding committees largely made formative rather than summative evaluations and appeared to evaluate performance in light of their own objectives rather than basing assessments on specific structural, process, and outcome measures of quality. Responding committees used certain evaluation criteria more extensively than others--among these, the number of participants and staff knowledge of the service provided--with the choice of criteria differing with the function being evaluated. Eight characteristics of HECs influenced the probability of self-evaluation, including age, number of beds and meetings, the existence of a mission statement, and a budget. The presence of certain characteristics made HECs six times more likely to evaluate their performance than HECs without the characteristic.