BACKGROUND:The purpose of this study is to detect the mortality predictive power of new Glasgow coma scale, age, and arterial pressure (GAP) scoring system in major trauma patients admitted to the emergency department (ED).
GAP score with a simple use being a score developed for the estimation of mortality of trauma patients seems to be usable also for the nontraumatic patients with triage category 1-2 in the ED.
Aim. Injuries are among the main causes of mortality and morbidity all over the world, and effective initial triage of these patients can determine the thin line between death and life. Tractor accidents and related injuries are significant problems particularly in rural areas. However, major trauma classification systems do not include tractor accidents as a criterion for trauma team activation or transportation of the patients to a trauma center. This study evaluated the general characteristics and outcomes of tractor accidents in comparison to motorcycle accidents, which are considered as a comparison criterion for major trauma. Materials and Methods. This is a multicenter study conducted in 6 emergency departments in 4 cities over a six month period. All cases over 18 years of age who were admitted to emergency service due to tractor or motorcycle accidents and meet the criteria were included in the study. The general characteristics and outcomes of both trauma types were compared to determine whether tractor accident should be considered as major traumas. Results. Eighty-eight patients had a tractor accident, and 339 patients had a motorcycle accident. The tractor accident victims were significantly younger (p<0.001), and the proportion of females was higher in this group (p=0.001). Glasgow coma score (p=0.062), revised trauma score (p=0.201), duration from incident to admission (p=0.481), and route of admission (p=0.810) were similar between both accident types. The rates of thoracic traumas (42% versus 23%, p<0.001) and spinal injuries (17% versus 5.9%, p=0.002) were significantly higher in tractor accidents. The hospitalization rates of the patients were significantly higher in tractor accidents (p=0.008). Conclusion. The findings of this study support the hypothesis that tractor accidents should be included in the criteria of ATLS major trauma classification system and trauma team activation procedures.
Head trauma usually causes hemorrhage, but in children ischemia of basal ganglia may develop. Traumatic stroke occasionally develops after dissection of brain vessels, leading to disseminated cerebral embolism. Stretching forces in cerebral intraparenchymal arteries can cause vascular damage followed by an occluding thrombus. An 18-month-old girl presented to our emergency department with the complaint of head trauma after falling down while playing. Her parents recognized the weakness of her left site extremity after 6 hours after the event. After initial physical examination and further imaging studies brain magnetic resonance imaging (MRI) showed an infarct affecting the caudate nucleus in the right cerebral hemisphere. In childhood, ischemic stroke due to mild head trauma is an exceedingly rare event and may be overlooked in emergency medicine practice. We aimed to emphasize that mild head trauma may cause critical situations such as acute infarct in children.
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