Prehospital classification combined with an in-hospital trauma radio system response reduces cost and duration of evaluation of the injured patient.

BACKGROUND: This study was undertaken to determine whether a prehospital trauma classification system (PHTCS) in combination with an in-hospital trauma radio system response (IHTRSR) impacts emergency care of the injured patient. METHODS: In 1991 our trauma center used no prehospital trauma classification system. A PHTCS was implemented in 1992, and in 1993 the PHTCS was integrated with an IHTRSR: RESULTS: Implementation of the PHTCS and IHTRSR resulted in a significant reduction in the time required for initial evaluation of the trauma patient with an associated reduction in cost. Reduction in time of the initial trauma evaluation was noted in both adult and pediatric populations, in patients with a blunt mechanism of injury, and in the injured patients posing the greatest strain to health care resources. CONCLUSIONS: Integration of a PHTCS with an IHTRSR has a significant impact on the cost and time of emergency treatment of the trauma victim with no adverse effect on patient outcome. Use of an integrated trauma response provides cost-effective and expeditious care of the injured patient and should be considered in trauma system development.

Early placement of prophylactic vena caval filters in injured patients at high risk for pulmonary embolism.

OBJECTIVE: Pulmonary embolism (PE) is a major problem in patients with multiple injuries. We present our experience with early placement of prophylactic vena caval filters (VCFs). DESIGN: Prospective study group with historical control. MATERIALS AND METHODS: From March 1993 to December 1993, VCFs were placed in 40 consecutive patients with three or more risk factors for PE and had demographic, physiologic, venous thromboembolic prophylaxis, and outcome data collected prospectively (VCF group). They were compared to 80 injured patients admitted between November 1991 and February 1993 who survived > 48 hours and who were matched with the VCF group for mechanism of injury and risk factors for PE (NO VCF group). MEASUREMENTS AND MAIN RESULTS: VCF placement affected a significant reduction in the incidence of PE (2.5% vs. 17%) and a clinical reduction in PE-related mortality. Embolic trapping was suggested by a 10% incidence of documented vena caval thrombi and although two patients developed significant venous stasis disease, no other VCF-related morbidity was noted. CONCLUSIONS: In spite of long-term morbidity, early prophylactic VCF placement is safe and should be considered in the prophylaxis of PE in the high-risk injured patients. This intervention may be effective in eliminating PE as a major cause of posttrauma morbidity and mortality.

Immobilized polyphosphate kinase: preparation, properties, and potential for use in adenosine 5'-triphosphate regeneration.

Polyphosphate kinase (ATP:polyphosphate phosphotransferase; EC 2.7.4.1), partially purified from Escherichia coli, has been immobilized on glutaraldehyde-activated aminoethyl cellulose with a 10% retention of enzymatic activity. The immobilized enzyme can carry out the synthesis of ATP from ADP, using long-chain inorganic polyphosphate as a phosphoryl donor. Chromatographic analyses of the product mixture produced from ADP and [32P]polyphosphate demonstrated that 98% of the 32P was incorporated into ATP, indicating that the immobilized polyphosphate kinase is substantially free from contaminating polyphosphate phosphohydrolase (EC 3.6.1.11), adenosine triphosphatase (EC 3.6.1.4), and adenylate kinase (EC 2.7.4.3). Immobilized polyphosphate kinase loses no activity when stored in an aqueous suspension for 2 months at 5 degrees C or for 1-2 weeks at 25 degrees C. It may be stored indefinitely as a lyophilized powder at -10 degrees C. Michaelis constants for ADP and polyphosphate were determined to be 160 and 120 microM, respectively, for the immobilized enzyme. A small-batch reactor was found to produce ATP linearly with time up to 65% conversion of polyphosphate into ATP and to attain greater than 85% conversion to ATP at equilibrium. The ease of purification and immobilization of E. coli polyphosphate kinase, its storage stability, the purity and yield of its ATP product, and the low values of the Michaelis constants for its substrates make it a highly promising enzyme for ATP regeneration.