The management of injuries--a review of deaths in hospital

A prospective review was undertaken of the management of 111 consecutive patients who died in hospital after admission for treatment of injuries. A standard set of data relating to each patient was reviewed by each member of a trauma death audit committee and then by the whole committee. Autopsy reports were available on all patients. Conclusions were drawn concerning defective aspects of patient management and possible avoidance of each death. Injury severity was assessed using the Trauma Score (TS) and Injury Severity Score (ISS). The possibly avoidable death (PAD) rate was 17%. The most common defects in management were related to inadequate fluid resuscitation and delays in definitive management. The greatest contributions to the PAD rate were from inadequate fluid resuscitation, delays and inadequate perception of the severity of injuries or significance of clinical deterioration. Increasing age was related to a higher frequency of PAD. PAD rate in the presence of severe head injury was 8%, but was 63% in the absence of a severe head injury. It is concluded that review of all trauma deaths is an achievable, beneficial and essential part of a hospital-based integrated trauma service. TS and ISS are not sufficiently sensitive to justify their use in selecting deaths for review. Improved blood volume replacement, earlier and more direct management and supervision by senior specialist staff, and elimination of causes of delay in patient management should all decrease the death rate from injuries particularly in patients without severe head injury.     

OAK knee evaluation. A new way to assess knee ligament injuries

The Orthop?dische Arbeitsgruppe Knie (OAK) documentation is based on clinical evaluation during functional knee stability testing near extension and near flexion. Increased compartmental translations and rotations, which result from structural defects because of anatomic lesions in a given knee injury, are clinically evaluated. The synopsis of the clinically detectable abnormal knee motion is graphically documented. A clinically applicable grading system of the true and reversed pivot shift phenomena completes the assessment of compartmental knee instability. Important contributing factors such as the constitutional laxity, the morphotype, and the range of motion are registered on the documentation form. The evaluation form presents four categories that represent subjective, objective, and functional criteria reflecting the overall results of repaired ligaments. This evaluation format establishes selected criteria to compare results from different centers.     

Detection of circulating anticellular antibodies by indirect immunofluorescence on HEp-2 cell substrates: study of the clinical value of rare fluorescence patterns

We detected anticellular antibodies (Ab) in 867 sera from patients with inflammatory rheumatic disorders by indirect immunofluorescence technique on HEp-2 cells and searched for clinically relevance of the rare fluorescence staining pattern (n = 133). We could find associations of 1. spekled nuclear pattern and Ab to U1-nRNP and La, 2. nucleolar pattern and scleroderma, 3. peripheral nuclear membrane pattern, Ab to dsDNA and SLE, 4. centromere staining and CRST syndrome, 5. intermedi?r filament pattern and permanent cellular destructions in erosive arthritis, 6. mitochondrial staining and inflammatory hepatic disorders. The anticellular Ab staining patterns on HEp-2 cells might be precious additionally markers for diagnosis and prognosis of inflammatory rheumatic diseases.