RESUMEN
Prehospital hypotension has been utilized for decades as a surrogate marker of injury severity. Several studies have discussed the correlation between injury and hypotension both in the field as well as in the emergency department. Increases have been noted in injury severity score and mortality. Resource utilization is higher in this patient population. This study revisits our original work from 2000 and reviews the current literature regarding hypotension and injury severity. We also examine the role of prehospital hypotension as an indicator of trauma team activation and resource allocation. This review serves as a part of a Literary Festschrift in honor of Dr J David Richardson's role as the Editor-in-Chief of The American Surgeon.
Asunto(s)
Hipotensión/historia , Centros Traumatológicos/historia , Triaje/historia , Servicios Médicos de Urgencia/historia , Historia del Siglo XXI , Humanos , Hipotensión/etiología , Puntaje de Gravedad del Traumatismo , Kentucky , Traumatología/historia , Traumatología/métodos , Triaje/métodos , Heridas y Lesiones/diagnóstico , Heridas y Lesiones/historia , Heridas y Lesiones/terapiaAsunto(s)
Cirujanos , Centros Traumatológicos/historia , Heridas y Lesiones/cirugía , Objetivos , Historia del Siglo XX , Humanos , Intención , Cultura Organizacional , Filosofía , Rol del Médico , Responsabilidad Social , Cirujanos/ética , Cirujanos/psicología , Centros Traumatológicos/organización & administración , Estados UnidosAsunto(s)
Unidades de Quemados/historia , Medicina Militar/historia , Cirujanos/historia , Centros Traumatológicos/historia , Anciano de 80 o más Años , Unidades de Quemados/estadística & datos numéricos , Historia de la Medicina , Historia del Siglo XX , Humanos , Masculino , Texas/epidemiología , Centros Traumatológicos/estadística & datos numéricosRESUMEN
Trauma is the leading cause of death among patients 46 years or younger, and having a system in place for the care of the injured is of paramount importance to the health of a community. The growth and development of civilian trauma systems has not been an easy process. The concept of regionalized health care that the trauma system models has been emulated by other specialized and time-sensitive areas of medicine, notably stroke and acute cardiac events. Continued process improvement, public education, support and involvement, a sound infrastructure, and integrated technology should remain our focus.
Asunto(s)
Centros Traumatológicos , Heridas y Lesiones/terapia , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Programas Médicos Regionales/historia , Centros Traumatológicos/historia , Centros Traumatológicos/organización & administración , Centros Traumatológicos/estadística & datos numéricos , Resultado del Tratamiento , Estados Unidos , Heridas y Lesiones/historiaRESUMEN
Since the inception of the P50 Research Center in Injury and Peri-operative Sciences (RCIPS) funding mechanism, the National Institute of General Medical Sciences has supported a team approach to science. Many advances in critical care, particularly burns, have been driven by RCIPS teams. In fact, burns that were fatal in the early 1970s, prior to the inception of the P50 RCIPS program, are now routinely survived as a result of the P50-funded research. The advances in clinical care that led to the reduction in postburn death were made by optimizing resuscitation, incorporating early excision and grafting, bolstering acute care including support for inhalation injury, modulating the hypermetabolic response, augmenting the immune response, incorporating aerobic exercise, and developing antiscarring strategies. The work of the Burn RCIPS programs advanced our understanding of the pathophysiologic response to burn injury. As a result, the effects of a large burn on all organ systems have been studied, leading to the discovery of persistent dysfunction, elucidation of the underlying molecular mechanisms, and identification of potential therapeutic targets. Survival and subsequent patient satisfaction with quality of life have increased. In this review article, we describe the contributions of the Galveston P50 RCIPS that have changed postburn care and have considerably reduced postburn mortality.
Asunto(s)
Investigación Biomédica/historia , Quemaduras/mortalidad , Quemaduras/terapia , Insuficiencia Multiorgánica/historia , National Institute of General Medical Sciences (U.S.)/historia , Apoyo a la Investigación como Asunto/historia , Centros Traumatológicos/historia , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Estados UnidosRESUMEN
The history of the National Institute of General Medical Sciences (NIGMS) Research Centers in Peri-operative Sciences (RCIPS) is the history of clinical, translational, and basic science research into the etiology and treatment of posttraumatic multiple organ failure (MOF). Born out of the activism of trauma and burn surgeons after the Viet Nam War, the P50 trauma research centers have been a nidus of research advances in the field and the training of future academic physician-scientists in the fields of trauma, burns, sepsis, and critical illness. For over 40 years, research conducted under the aegis of this funding program has led to numerous contributions at both the bedside and at the bench. In fact, it has been this requirement for team science with a clinician-scientist working closely with basic scientists from multiple disciplines that has led the RCIPS to its unrivaled success in the field. This review will briefly highlight some of the major accomplishments of the RCIPS program since its inception, how they have both led and evolved as the field moved steadily forward, and how they are responsible for much of our current understanding of the etiology and pathology of MOF. This review is not intended to be all encompassing nor a historical reference. Rather, it serves as recognition to the foresight and support of many past and present individuals at the NIGMS and at academic institutions who have understood the cost of critical illness and MOF to the individual and to society.
Asunto(s)
Investigación Biomédica/historia , Insuficiencia Multiorgánica/historia , National Institute of General Medical Sciences (U.S.)/historia , Centros Traumatológicos/historia , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Estados UnidosRESUMEN
OBJECTIVE: To review the history of the innovation of damage control (DC) for management of trauma patients. BACKGROUND: DC is an important development in trauma care that provides a valuable case study in surgical innovation. METHODS: We searched bibliographic databases (1950-2015), conference abstracts (2009-2013), Web sites, textbooks, and bibliographies for articles relating to trauma DC. The innovation of DC was then classified according to the Innovation, Development, Exploration, Assessment, and Long-term study model of surgical innovation. RESULTS: The "innovation" of DC originated from the use of therapeutic liver packing, a practice that had previously been abandoned after World War II because of adverse events. It then "developed" into abbreviated laparotomy using "rapid conservative operative techniques." Subsequent "exploration" resulted in the application of DC to increasingly complex abdominal injuries and thoracic, peripheral vascular, and orthopedic injuries. Increasing use of DC laparotomy was followed by growing reports of postinjury abdominal compartment syndrome and prophylactic use of the open abdomen to prevent intra-abdominal hypertension after DC laparotomy. By the year 2000, DC surgery had been widely adopted and was recommended for use in surgical journals, textbooks, and teaching courses ("assessment" stage of innovation). "Long-term study" of DC is raising questions about whether the procedure should be used more selectively in the context of improving resuscitation practices. CONCLUSIONS: The history of the innovation of DC illustrates how a previously abandoned surgical technique was adapted and readopted in response to an increased understanding of trauma patient physiology and changing injury patterns and trauma resuscitation practices.
Asunto(s)
Centros Traumatológicos/historia , Heridas y Lesiones/historia , Heridas y Lesiones/cirugía , Femenino , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Masculino , Evaluación de Resultado en la Atención de SaludAsunto(s)
Academias e Institutos/historia , Anatomía/historia , Investigación Biomédica/historia , Docentes Médicos/historia , Cirugía General/historia , Hospitales Militares/historia , Centros Traumatológicos/historia , Libros/historia , Historia del Siglo XX , Humanos , Guerra de Corea , Liderazgo , Rumanía , Choque/historia , Estados UnidosRESUMEN
AIM: To examine characteristics of traumatic injury in adults and children at the Royal Darwin Hospital (RDH) over a 10 year period. METHOD: A retrospective review of the RDH Trauma Registry data from 1 January 2003 to 31 December 2012, with analysis of patient demographics, mechanism of injury, Injury Severity Score (ISS), and outcome. PARTICIPANTS: Two thousand seven hundred twenty-five patients with an ISS greater than or equal to 9 and met all other study inclusion criteria. RESULTS: Motor vehicle crashes, assaults and falls consistently remained the three most common mechanisms of injury throughout the 10 year period. Indigenous admissions showed a significant downward trend (p = 0.009). Upward trends were noted in presentations from patients aged greater than 44 (p = 0.002), all-terrain vehicle accidents (p <0.001), and hangings (p = 0.003). No other trends were noted to significant at a p <0.05 level. Admitted Indigenous patients were significantly more likely to be present due to assault (p <0.001) and female patients were more likely to present due to assault, falls and motor vehicle crashes (p <0.01) than their counterparts. CONCLUSION: Presentations for traumatic injury to Royal Darwin Hospital have remained in the most part, consistently stable for the period of 2003-2012. Though there were some increases/decreases in regard to specific demographics and mechanisms, few were found to be statistically significant at a p < 0.05 level.
Asunto(s)
Sistema de Registros/estadística & datos numéricos , Centros Traumatológicos/historia , Heridas y Lesiones/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Historia del Siglo XXI , Humanos , Lactante , Recién Nacido , Puntaje de Gravedad del Traumatismo , Masculino , Persona de Mediana Edad , Nativos de Hawái y Otras Islas del Pacífico , Northern Territory , Estudios Retrospectivos , Centros Traumatológicos/organización & administración , Heridas y Lesiones/historia , Heridas y Lesiones/mortalidad , Adulto JovenRESUMEN
Emergency medicine evolved into a medical specialty in the 1960s under the leadership of physicians in small communities across the country. This paper uses three case studies to investigate the political, societal, and local factors that propelled emergency medicine along this path. The case studies-Alexandria Hospital, Hartford Hospital, and Yale-New Haven Hospital-demonstrate that the changes in emergency medicine began at small community hospitals and later spread to urban teaching hospitals. These changes were primarily a response to public demand. The government, the American public, and the medical community brought emergency medical care to the forefront of national attention in the sixties. Simultaneously, patients' relationships with their general practitioners dissolved. As patients started to use the emergency room for non-urgent health problems, emergency visits increased astronomically. In response to rising patient loads and mounting criticism, hospital administrators devised strategies to improve emergency care. Drawing on hospital archives, oral histories, and statistical data, I will argue that small community hospitals' hiring of full-time emergency physicians sparked the development of a new specialty. Urban teaching hospitals, which established triage systems and ambulatory care facilities, resisted the idea of emergency medicine and ultimately delayed its development.
Asunto(s)
Medicina de Emergencia/historia , Connecticut , Servicios Médicos de Urgencia/historia , Servicio de Urgencia en Hospital/historia , Servicio de Urgencia en Hospital/legislación & jurisprudencia , Servicio de Urgencia en Hospital/organización & administración , Médicos Generales/historia , Historia del Siglo XX , Hospitales Comunitarios/historia , Hospitales de Enseñanza/historia , Hospitales de Enseñanza/organización & administración , Humanos , Estudios de Casos Organizacionales , Centros Traumatológicos/historia , Estados Unidos , VirginiaRESUMEN
The purpose of this review is to evaluate the historical development, growth and evolution in the past decade of the Italian network for emergencies of the hand. The complete story from its roots to model of efficiency that required so many efforts and fatigue to be created and tuned up.
Asunto(s)
Conducta Cooperativa , Traumatismos de la Mano/historia , Traumatismos de la Mano/cirugía , Comunicación Interdisciplinaria , Microcirugia/historia , Sociedades Médicas/historia , Sociedades Médicas/organización & administración , Centros Traumatológicos/historia , Centros Traumatológicos/organización & administración , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Italia , EspecializaciónRESUMEN
Much has been written about public hospitals relative to their mission to care for the underserved, their role in medical education, and the continuous financial challenges that they encounter. But, despite doubts about their viability, public hospitals have not only withstood the test of time, but have thrived and have evolved into a new entity, i.e., the safety net hospital. Like with any long-standing institution, the development of public hospitals holds valuable lessons that provide insight into how they will continue to evolve and potentially strengthen, even in the face of adversity. Their rich heritage includes many medical "firsts" in the United States such as the first municipal ambulance service, first blood bank, first trauma center(s), first cardiac catherization, and first civilian burn center. If safety net hospitals care for their communities and continue in their educational mission, they will thrive in the tradition of service.
Asunto(s)
Economía Hospitalaria/historia , Hospitales Públicos/historia , Centros Traumatológicos/historia , Historia del Siglo XIX , Historia del Siglo XX , Historia del Siglo XXI , Hospitales Públicos/organización & administración , Humanos , Centros Traumatológicos/organización & administración , Estados UnidosRESUMEN
BACKGROUND: Since its inception, the man suffered injuries through falls, fire, drowning and interpersonal conflict. While the mechanism and frequency of different specific injuries has changed passing of millennia, trauma remains an important cause of mortality and morbidity in modern society. Although the war is presented as one of the four knights of the Apocalypse, we must emphasize the important developments of surgical experience during war. The purpose of this study is to highlight the lessons learned during the history and how they changed the modern trauma care. METHOD: Systematic review of English language literature using computer searching of Library of Medicine and the National Institutes of Health International MEDLINE database using PubMed Entre interface. RESULTS: The first historical record of a trauma medical care is 3605 years ago. Over the past decades, one of the most important changes in trauma patient care is the selective nonoperative management (SNOM) of significant abdominal visceral injuries. SNOM was first described in 1968, for splenic trauma, by Upadhyay and Simpson. It was accepted much later for liver injuries. Beginning from 1960 - 1970, SNOM was introduced for abdominal stab wounds. Exploratory laparotomy remains the standard approach for abdominal gunshot wounds until 1990, when centers from United States and South Africa first reported cases successfully managed nonoperatively. CONCLUSIONS: The trauma surgery has evolved continuously over the centuries, according to more and more severe modem injuries.
Asunto(s)
Traumatismos Abdominales/historia , Centros Traumatológicos/historia , Heridas y Lesiones/historia , Traumatismos Abdominales/terapia , Servicios Médicos de Urgencia/historia , Europa (Continente) , Historia del Siglo XV , Historia del Siglo XVI , Historia del Siglo XVII , Historia del Siglo XVIII , Historia del Siglo XIX , Historia del Siglo XX , Historia del Siglo XXI , Historia Antigua , Historia Medieval , Humanos , Laparotomía/historia , Sudáfrica , Estados Unidos , Guerra , Heridas y Lesiones/cirugía , Heridas y Lesiones/terapia , Heridas por Arma de Fuego/historia , Heridas por Arma de Fuego/terapia , Heridas no Penetrantes/historia , Heridas no Penetrantes/terapia , Heridas Punzantes/historia , Heridas Punzantes/terapiaAsunto(s)
Salud Pública/historia , Violencia/prevención & control , Heridas y Lesiones/prevención & control , Heridas y Lesiones/terapia , Centers for Disease Control and Prevention, U.S. , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Publicaciones Periódicas como Asunto/historia , Centros Traumatológicos/historia , Estados Unidos/epidemiología , Heridas y Lesiones/epidemiologíaRESUMEN
Surgeons working within the United Kingdom's National Health Service have an established history of clinical innovation, research, and development in the field of vascular surgery but lack a unified trauma system to deliver optimal care for patients with vascular injury. The low incidence of vascular trauma, combined with lack of regional trauma systems, works against optimal delivery of care to the polytrauma patient. Providing care, robust data capture, and opportunities for training and education in vascular injury lag behind other elective domains of vascular practice. The challenge is to define ideal care pathways, referral networks, and standards of practice and to integrate the care of such patients. In 2010, a trauma system for London was introduced; it has provided vascular surgeons with a unique opportunity to study and advance the care of patients with vascular injury. This article discusses developing trauma network issues, particularly the organization and evolution of vascular trauma services in the United Kingdom.
Asunto(s)
Prestación Integrada de Atención de Salud , Centros Traumatológicos , Procedimientos Quirúrgicos Vasculares , Lesiones del Sistema Vascular/cirugía , Certificación , Competencia Clínica , Prestación Integrada de Atención de Salud/historia , Prestación Integrada de Atención de Salud/organización & administración , Educación de Postgrado en Medicina , Historia del Siglo XVII , Historia del Siglo XVIII , Historia del Siglo XIX , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Centros Traumatológicos/historia , Centros Traumatológicos/organización & administración , Reino Unido , Procedimientos Quirúrgicos Vasculares/educación , Procedimientos Quirúrgicos Vasculares/historia , Procedimientos Quirúrgicos Vasculares/organización & administración , Lesiones del Sistema Vascular/epidemiología , Lesiones del Sistema Vascular/historiaRESUMEN
This brief annotation summarises the particular contributions made by the annual Edinburgh International Trauma Symposium in various areas of research into aspects of orthopaedic trauma and the management of acutely injured patients, during the 25 years since its establishment.
Asunto(s)
Congresos como Asunto/historia , Ortopedia/historia , Centros Traumatológicos/historia , Traumatología/historia , Historia del Siglo XX , Historia del Siglo XXI , Humanos , EscociaAsunto(s)
Traumatismos Craneocerebrales/prevención & control , Promoción de la Salud/historia , Centros Traumatológicos/historia , Distinciones y Premios , Coma , Promoción de la Salud/métodos , Historia del Siglo XXI , Humanos , Vehículos a Motor Todoterreno , Ohio , Centros Traumatológicos/organización & administraciónRESUMEN
The origins of the US Civilian Trauma and Emergency Medical Services Systems (EMSS) started in the 1970s are presented. The conceptual basis, strategic, and tactical implementation approaches used to establish the national program are described. The trauma and other clinical systems were extensions of proven clinical methods initially from cardiac and trauma units and deployed in new settings. The overall systems design was regionalization. Professionals, governmental agents, the public, and politicians all worked together to establish local, regional, state, and a nationwide comprehensive trauma/EMSS program that touch every state, territory, and community. A historical narrative is presented.