No abstract available.
Korea* ; Trauma Centers*

PURPOSE: Over the past few decades, the treatment of traumatic splenic injuries has shifted to nonoperative management from surgical intervention. Although some nonoperative management failure have been reported, in most trauma centers, nonoperative management is now believed to be the treatment of choice in hemodynamically stable patients. Then, in this study, we have retrospectively evaluated our experience with traumatic splenic injury. METHODS: From January 2005 to July 2009, 150 patients with blunt splenic injuries were managed in our hospital. Patients' charts were retrospectively reviewed to analyze their treatment, the patients were grouped according to those who had been admitted before October 2006, defined as the "early group", and those who had been admitted after October 2006, defined as the "late group". After the patients had been divided into two group, physiologic parameters and differences between the treatments were compared. RESULTS: 150 patients were admitted to our hospital with blunt splenic trauma. In late group, both the surgical management rate and the nonoperative management failure rate were lower than they were in the early group. CONCLUSION: We expect angioembolization to effectively replace surgery for the treatment of selected patients with blunt splenic injury and to result in fewer complications.
Humans ; Retrospective Studies ; Trauma Centers

The American trauma system is designed to provide an organized response to injury. It draws its foundations from lessons learned from America's involvement in the wars of the 20th century as well as principles developed in urban community hospitals. Although run at the local and state government level, it is guided by national societies and has become a world class example. It also currently faces challenges with declining reimbursement and providing equal access to care for all Americans. Professional societies and legislative bodies are continuing to work together for fair and equitable solutions to these issues.
Humans ; Trauma Centers ; organization & administration ; United States

The number of massive transfusions for pediatric patients has risen owing to the increasing number of complex surgeries and trauma centers. However, as there are only a few studies on pediatric massive transfusion, adult massive transfusion protocols are used for pediatric patients in many hospitals and institutions. Although massive transfusion protocols would improve the outcomes and reduce the received blood products during transfusion, pediatric patients differ from adults in the tolerability to transfusion, incidence of coagulopathy, and mechanisms of injuries. Therefore clinical physicians have requested for a pediatric massive transfusion protocol. Herein, we reviewed pediatric massive transfusion protocols that have been used in various clinical settings. To date, only a few single-center studies with a small number of pediatric patients have been performed. Even though these studies did not show improvement in outcomes such as mortality and side effects, they reported a short preparation time for fresh frozen plasma products and a low coagulopathy rate in pediatric massive transfusion groups. Therefore, large, prospective, multicenter studies are needed to identify the empiric ratio of blood products for improving outcomes of pediatric patients who need massive transfusion.
Adult ; Humans ; Incidence ; Mortality ; Plasma ; Prospective Studies ; Trauma Centers

OBJECTIVEInjuries are common and important problem in Tehran, capital of Iran. Although therapeutic centers are not essentially established following the constructional principles of developed countries, the present opportunities and equipments have to be used properly. We should recognize and reduce the deficits based on the global standards. This study deliberates the trauma resources and capacities in university hospitals of Tehran based on Arizona trauma center standards, which are suitable for the assessment of trauma centers.

METHODSForty-one university hospitals in Tehran were evaluated for their conformity with "Arizona trauma center standards" in 2008. A structured interview was arranged with the "Educational Supervisor" of all hospitals regarding their institutional organization, departments, clinical capabilities, clinical qualifications, facilities and resources, rehabilitation services, performance improvement, continuing education, prevention, research and additional requirements for pediatric trauma patients. Relative frequencies and percentages were calculated and Student's t test was used to compare the mean values.

RESULTSForty-one hospitals had the average of 77.7 (50.7%) standards from 153 Arizona trauma center standards and these standards were present in 97.5 out of 153 (63.7%) in 17 general hospitals. Based on the subgroups of the standards, 64.8% items of hospital resources and capabilities were considered as a subgroup with the maximum criteria, and 17.7% items of research section as another subgroup with the minimum standards.

CONCLUSIONSOn the basis of our findings, no hospital meet all the Arizona trauma center standards completely. The hospitals as trauma centers at different levels must be promoted to manage trauma patients desirably.

The mortality of patients with hemodynamic instability due to severe pelvic fracture is high despite multidisciplinary management. Current management algorithms for these patients emphasize pelvic angioembolization (AE) for hemorrhage control. However, a surgical procedure is often needed because AE is time-consuming and approximately only 15% of patients have arterial bleeding. Most hemorrhages from severe pelvic fracture originate from venous or bone injury. Current research demonstrates the effectiveness of preperitoneal pelvic packing (PPP) in hemorrhage control. However, there are no reports of its use in Korea. Accordingly, we present our early experiences of PPP for control of hemorrhage due to severe pelvic fracture in a trauma center in Korea.
Angiography* ; Hemodynamics* ; Hemorrhage ; Humans ; Korea ; Mortality ; Pelvis ; Trauma Centers

In a narrow sense, the trauma team is intra-hospital organization that perform the initial assessment and resuscitation for the victims. Cooperation with the administrative and governance body of the hospital is essential for the function as a trauma center. The hospital could be as a core of the trauma care system with this support. Essential to this core position is a hospital trauma program that regulates and supports the trauma team activities. This trauma program consists of the hospital governance, administration, the trauma team and leader, trauma program manager, the registrar and the multidisciplinary committee of the performance improvement program. The essential elements of the trauma team include a trauma surgeon, an emergency physician, emergency department nurses, a laboratory and radiology technician, an anesthesiologist and a scribe. The team leader should be a trauma surgeon and coordinate the multidisciplinary professions in the team during the entire trauma care process. Clear criteria for the trauma team activation should be defined in advance. The composition of the team and the activation criteria may vary with the hospital capacity, the severity of injury, and the level of activation. The tiered criteria are based on clinical information from the field: physiologic and anatomic conditions and mechanism of injury and are recommended. The multidisciplinary committee for the performance improvement should monitor and assess trauma program outcomes. These activities will lead to trauma care improvements.
Emergencies ; Emergency Service, Hospital ; Resuscitation ; Trauma Centers ; Triage

With the continuous development of China's urbanization and socio-economic, death and disability caused by trauma has increased prominently, and trauma has become the first cause of death in the people younger than 45 years old. Compared with the treatment of other diseases, China are facing many problems and challenges in terms of trauma treatment, specifically focused in three areas: First, the medical profession and society had not attach enough attention to trauma; Second, trauma centers in our country is insufficient; The level of trauma care vary greatly between different regions, the doctors and nurses commitment to trauma care lack of standardized training; Third, scientific treatment process and treatment system that compliance with international standards and meet the geographical features of China is insufficient. In view of the above situation and existing problems, learn from the successful experience of foreign countries, we think we should proceed from the following three aspects to change the status of China's treatment of trauma gradually: First of all, we should establish Traumatology that deals with the treatment of serious wounds and injuries. Secondly we should establish the right trauma care system that suitable for China's conditions; The third point is the establishment of trauma specialist training system composed by "basic training" and "targeted training"; Final we should establish severe trauma multidisciplinary treatment team model in the process of trauma care. Thereby improving our overall level of trauma treatment through above means, reduce the disability and mortality caused by trauma, thus promoting the development of trauma forward.
China ; Delivery of Health Care ; Humans ; Trauma Centers ; Wounds and Injuries ; therapy

Humans ; Trauma Centers ; Emergency Medical Services ; Wounds and Injuries/therapy*

Humans ; Trauma Centers ; COVID-19/epidemiology* ; Workflow ; Singapore/epidemiology* ; Pandemics