CDC field triage criteria accurately predicts outcomes in high impact trauma.

BACKGROUND: The precision of emergency medical services (EMS) triage criteria dictates whether an injured patient receives appropriate care. The trauma triage protocol is a decision scheme that groups patients into triage categories of major, moderate and minor. We hypothesized that there is a difference between trauma triage category and injury severity score (ISS). METHODS: This retrospective, observational study was conducted to investigate a difference between trauma triage category and ISS. Bivariate analysis was used to test for differences between the subgroup means. The differences between the group means on each measure were analyzed for direction and statistical significance using ANOVA for continuous variables and chi square tests for categorical variables. Logistic and linear regressions were performed to evaluate factors predicting mortality, ICU length of stay. RESULTS: With respect to trauma triage category, our findings indicate that minor and moderate triage categories are similar with respect to ISS, GCS, ICU LOS, hospital LOS, and mortality. However, after excluding for low impact injuries (falls), differences between the minor and moderate categories were evident when comparing to ISS, GCS, ICU LOS, and hospital LOS. Additionally, after excluding for low impact injures, ISS, ICU LOS, and hospital stay were found to correlate well with trauma triage category. CONCLUSIONS: In this retrospective, observational study significant differences were not seen when comparing ISS with the trauma triage categories of moderate and minor during our initial analysis. However, a difference was found after excluding for low impact injuries. These findings suggest that CDC criteria accurately predicts outcomes in high impact trauma.

Gown-glove interface: a possible solution to the danger zone.

The gown-glove interface is the weakest point in the present barrier system of gown and glove protection for the surgeon and other healthcare professionals who come into direct contact with body liquids. Try it yourself: put on a fluid-resistant gown and surgical gloves. See that the glove cuff is well proximal to the stockinette. Hold your wrist and forearm for a moment under running water. Wait a minute to see if your forearm is wet. A wet forearm during surgery would be a blooded one. We propose a gown redesign that creates a dart at the terminal forearm, sealed by a liquid-proof method, and then similarly sealing the proximal end of the glove to the sleeve.

Aseptic barriers in surgery: their present status.

Aseptic barriers are employed in the form of surgical gowns, drapes, and wrappers for sterile goods. They possess many of the attributes of textiles, but must also protect sterile zones from microbial invasion. Surgeons rely on them to resist penetration by liquids and other bacterial vehicles. A large variety of both woven and nonwoven materials are being produced for this purpose. The user is faced with difficult choices. The provider of the barrier materials must assure the surgeon of their barrier quality under the usual conditions of their use in operating rooms. Identical standards of quality can be and should be applicable whether these materials are created to be used once and discarded or are reusable.

Surgical glove powders bind latex antigens.

Latex surgical gloves have recently been identified as a potential source of allergens. Much of the current information suggests that the soluble proteins in latex may cause significant reactions in sensitive individuals. The starch powders used as a lubricant on some latex gloves have also been identified as potential allergens in some patients. In this study, we determined these powders to act as potential carriers of latex allergens. We have produced a polyclonal antiserum to be used as a reagent to study latex proteins. By Western blot analysis, we identified a significant interaction between latex proteins and starch powders. The binding of latex proteins to starch particles results in a glove particle that may have an increased potential to act as an allergen. The latex protein-starch particles represent a potential mechanism for exposure and sensitization of health care workers to latex allergens. Elimination of these particles from the operating room should reduce the route of sensitization and the potential for adverse reactions to latex.

Choosing surgical illumination.

(1) Lighting systems for the surgical task are combinations of ambient room lighting to complement the operating task light. The two must match to produce a good effect. (2) Only a few surgical task lights are available, and their characteristics and relative merits should be studied. (3) Ideally the surgeon should test the task light to judge its suitability for his taste.

Effect of povidone iodine dermatologic ointment on wound healing.

OBJECTIVE: To evaluate the effect of topical povidone iodine ointment on wound healing. MATERIALS AND METHODS: 60 female mice randomly divided into four groups, A-D. Each mouse had a 2 cm linear incision made on the dorsal skin. Group A had povidone iodine ointment, and group B had ointment base applied for 7 days to the healing incision. Group C were given steroids for 7 days, and group D were allowed to heal without treatment. On Day 8, the strength of the incision was tested with an in vivo tensometer, and the hydroxyproline content of the incision was determined. RESULTS: Using ANOVA and Fischer's LSD test (P < 0.05), povidone iodine as well as steroid groups had significantly reduced wound strengths as compared to the controls and the group with ointment base. No significant difference in the hydroxyproline content was seen. CONCLUSIONS: Povidone iodine significantly reduces wound strength without reducing the total hydroxyproline content of the wound.

Acute appendicitis. A 5-year review.

A startling 31 per cent rate of perforated appendicitis in 1984 prompted a 5-year review at the Guthrie Medical Center. An increase over previous rates of 13 per cent and 0 per cent in 1964 and 1944 was confirmed in this study. Perforation accompanied 44 of 240 cases of appendicitis (18.3%); diagnostic accuracy in 295 cases undergoing operation was 81.4 per cent. Groups at risk for perforation were patients in the first decade of life (34.3% with perforations) and those over 50 years of age (48% perforated). Perforation rates were generally inversely related to accuracy. Accuracy was poorest in women in the second to fourth decade or those in the mid-portion of the menstrual cycle. When the appendix was not perforated, complications occurred in 8.7 per cent of patients while 29.5 per cent with a perforation had a complication. The mean hospital stay was prolonged by 2.5 days if the appendix was perforated. An increased awareness of the risk by both the public and physicians is essential to reduce the number of perforations.

Appendicitis: the perforation rate when reviewed by decades in a general hospital.

Acute appendicitis at this medical center for 1984 was reviewed and compared with previous studies reporting 1944 and 1964. In 1984, the perforation rate was strikingly higher than the earlier years. It was zero in 1944, rose to 13.6 per cent in 1964, and to 31.4 per cent in 1984. One quarter of perforations in 1984 occurred during the first decade of life. In 1984, 14 per cent (10/70) of all patients with appendicitis were examined by a physician prior to eventual hospitalization; nine had perforated the appendix, representing 41 per cent of all perforations. Major factors responsible for the increase in perforations included (1) an increase in patients less than ten years old (a group at high risk for perforation), and (2) physician or patient delay in hospitalization. We suggest that physician and public education, which has proven effective in the past, should be reinstituted. Critical review of appendicitis should be carried out at individual institutions to identify, and thus, modify trends in this disease. Perforation increases morbidity and cost, yet is easily avoidable.

Barrier breach of surgical gloves.

The barrier properties of natural rubber latex gloves have been of clinical interest since the concept of using an integrity monitor was introduced by me over 30 years ago. Although surgeons expect their gloves to serve as an effective barrier during use, products can and do fail. Failure is often unrecognized, resulting in the wearer's exposure to potential pathogens and the patient to microorganisms shed by surgical team members. Although a variety of solutions have been suggested (double gloving, cut-resistant gloves), these remedies do not alert the surgeon to a breach of barrier, the cost and consequences of which are astronomical to the health system. As a result, some form of breach detection device is now recommended to minimize the likelihood of exposure, infection, and/or allergy.

Medical waste. The growing issues of management and disposal.

When addressing the impact of medical waste management and regulatory controls on the health care industry, it is important to remember that as long as modern medicine continues to maintain and sustain its current quality of life and wellness standards, industry will continue to generate various byproducts that have adverse effects on both people and the environment. It is important, therefore, to carefully evaluate the impact of societal demands. Unless government, industry, environmental groups, and health care providers abandon their current adversarial relationships and work together to solve shared problems, there will be no improvement in the growing problem of medical waste. The long-term solutions to today's growing waste problems depend to a great extent on human factors and the willingness of industry, medical community, and governmental bodies to cooperate with each other, recognizing the cause-effect relationship of a continued demand for disposable products. There are many pieces to the waste management puzzle. Obviously, surgeons cannot perform surgery without exposure to blood, tissue or body fluids, and nurses cannot maintain asepsis without sterile products. Because the health care team cannot totally eliminate the source of medical waste, they must learn to more effectively manage and control it. Health care professionals must encourage industry and government to work together to develop standards for products and materials used as barriers and use more biodegradable materials. Health care facilities must learn to minimize the amount of medical waste designated as regulated or infectious. Segregating potentially infectious material from clean waste at the point of generation may reduce both volume and cost.