Epidemiologic study, level III.

Errors in a trauma registry database cause invalid frequencies, rates, time estimates and statistical measures and affect QA/PI in trauma care. Every functioning trauma registry should develop an on-going program for DV.

SummaryMacrophage plasticity is essential for innate immunity, but in-depth signaling mechanism(s) regulating their functional phenotypes are ill-defined. Here we report that interferon (IFN) γ priming of naive macrophages induces store-mediated Ca2+ entry and inhibition of Ca2+ entry impairs polarization to M1 inflammatory phenotype. In vitro and in vivo functional analyses revealed ORAI1 to be a primary contributor to basal Ca2+ influx in macrophages, whereas IFNγ-induced Ca2+ influx was mediated by TRPC1. Deficiency of TRPC1 displayed abrogated IFNγ-induced M1 inflammatory mediators in macrophages. In a preclinical model of peritonitis by Klebsiella pneumoniae infection, macrophages showed increased Ca2+ influx, which was TRPC1 dependent. Macrophages from infected TRPC1−/− mice showed inhibited expression of M1-associated signature molecules. Furthermore, in human patients with systemic inflammatory response syndrome, the level of TRPC1 expression in circulating macrophages directly correlated with M1 inflammatory mediators. Overall, TRPC1-mediated Ca2+ influx is essential for the induction/shaping of macrophage polarization to M1 inflammatory phenotype.

No abstract

Nonreconstructed computerized tomography detected fractures of the thoracolumbar spine more accurately than plain radiographs did and is recommended for the diagnosis of thoracolumbar spine fractures in acute trauma patients with altered mental status. Reconstructions do not need to be ordered unless an abnormality that is found on the nonreconstructed computerized tomographic scan needs additional elucidation.

No abstract

Over the past 4 years, 7.4% of deaths caused by strangulation in Peoria County, Ill., involved children under 18 years of age. Clinical review of a consecutive series of 13 children treated from 1985 through 1994 revealed an incidence of 32 of 10,000 intensive care unit admissions with a 5.5:1 male bias. Accidental causes were seen in six children, with suicide or autoerotic causes prevalent in older children and adolescents. Five children had behavioral disorders before injury. The initial Glasgow Coma Scale score was 8 or below in seven children. Cervical roentgenograms in all patients and computed tomographic examinations performed in seven children were interpreted as normal. Seven children required ventilatory assistance, and four had pneumonia or acute lung injury. Intracranial pressure monitoring in three children failed to reveal sustained elevations of pressure. Serial changes in electroencephalograms in five patients paralleled improvements in their clinical examinations. Ten children were normal on follow-up; one adolescent reported mild neurologic sequelae and one adolescent showed severe disability. One adolescent died 2 days after injury. Comparison of this series with previous reports of 26 children indicated that the extent of the initial injury and effectiveness of resuscitation were major determinates for outcome. Pulmonary complications were common, whereas the development of elevated intracranial pressure indicated a poor prognosis and suggested the use of telemetry in children, with clinical evidence of severe injury. Continued awareness of preventative measures for accidental strangulation in infants and intentional hanging in children with behavioral disorders may reduce the incidence of these injuries.

Discharge to a nursing home (NH) because of chronic debilitating diseases or old age is generally a terminal event. The purpose of this study was to evaluate the NH outcome of senior citizens injured in motor vehicle crashes (MVC) discharged to a NH. From 2000 through 2004, 157 patients 75 years and older were admitted to the hospital for MVC. Of these, 32 patients were discharged to a NH, and these patients or their proxies were interviewed by telephone in June 2005 to request information as to driving status before and after the MVC, feeding, expression, and locomotion status, and/or date of death. After discharged from the NH, 72 per cent (23/32) of the patients lived at home, 52.2 per cent (12/23) among the drivers returned to drive, and those with functional impairments (excluding the five NH deaths and four still remaining in a NH) at the time of hospital discharge had 100 per cent or partial improvement in three functional independent measures at the time of the interview: 5 cases in feeding, 2 in expression, and 20 in locomotion. Eleven of the 20 individuals dependent or partially dependent in locomotion status were fully independent. The majority of the senior patients discharged to a NH after a MVC returned to a normal life by going back home, driving again, and regaining functional activities after NH discharge. Discharge to a NH for elderly MVC trauma patients may be regarded as a stepping-stone to independent living rather than a final resting place.