https://ogma.newcastle.edu.au/vital/access/ /manager/Index en-au 5 https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:9499 15/year] underwent autopsy and were prospectively evaluated during 2005. High-energy (HE) and low-energy (LE) deaths were categorized based on the mechanism of the injury, time frame (prehospitalization, <48 hours, 2–7 days, >7 days), and cause [which was determined by an expert panel and included central nervous system-related (CNS), exsanguination, CNS + exsanguination, airway, multiple organ failure (MOF)]. Data are presented as a percent or the mean ± SEM. Results: There were 175 deaths during the 12-month period. For the 103 HE fatalities (age 43 ± 2 years, ISS 49 ± 2, male 63%), the predominant mechanisms were motor vehicle related (72%), falls (4%), gunshots (8%), stabs (6%), and burns (5%). In all, 66% of the patients died during the prehospital phase, 27% died after <48 hours in hospital, 5% died after 3 to 7 days in hospital, and 2% died after >7 days. CNS (33%) and exsanguination (33%) were the most common causes of deaths, followed by CNS + exsanguination (17%) and airway compromise 8%; MOF occurred in only 3%. Six percent of the deaths were undetermined. All LE deaths (n = 72, age 83 ± 1 years, ISS 14 ± 1, male 45%) were due to low falls. All LE patients died in hospital (20% <48 hours, 32% after 3–7 days, 48% after 7 days). The causes of deaths were head injury (26%) and complications of skeletal injuries (74%). Conclusions: The HE injury mechanisms, time frames, and causes in our study are different from those in the earlier, seminal reports. The classic trimodal death distribution is much more skewed to early death. Exsanguination became as frequent as lethal head injuries, but the incidence of fatal MOF is lower than reported earlier. LE trauma is responsible for 41% of the postinjury mortality, with distinct epidemiology. The LE group deserves more attention and further investigation.]]> Sat 24 Mar 2018 08:35:36 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:14338 18 years presenting to John Hunter Hospital (JHH), Newcastle, Australia, from January 2007 until July 2007 requiring arterial blood gas sampling had a peripheral venous blood gas performed simultaneously. A survey of JHH trauma clinicians and members of the American Association for the Surgery of Trauma was performed to determine a clinically relevant difference between two serial base deficit measurements. Pearson correlation and Bland-Altman tests were performed. During the 7-month period, 127 patients (79% men, mean age, 46.3 [±18.4 years] and median injury severity score of 15 [interquartile range, 8–23; range, 1–75]) were included into the study. The average peripheral ABD (pABD) and pVBD were −2.2 mmol/L ± 3.8 mmol/L and −1.3 mmol/L ± 3.8 mmol/L, respectively. The average difference between measurements was 0.9 (range, −1.7 to +3.5; 95% confidence interval, 0.7–1.0) with pVBD > pABD. The Pearson test showed highly significant correlation (r = 0.97, p < 0.0001). The survey of 11 JHH and 56 American Association for the Surgery of Trauma clinicians determined 2 mmol/L as clinically relevant difference between two base deficit measurements. All individual paired sample's difference sat within the clinically relevant limits and >95% (121 of 127) of samples sat within the 1.96 standard deviation acceptable by the Bland-Altman plot. There is near perfect correlation and clinically acceptable agreement between pABD and pVBD values on simultaneous testing. pVBD is an acceptable test to assess trauma patients' initial metabolic status when occult blood loss suspected.]]> Sat 24 Mar 2018 08:21:25 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:18382 Sat 24 Mar 2018 07:52:42 AEDT ]]>