These findings confirm a higher risk for AE, especially serious type 1 reactions, with ID therapy than with newer intravenous iron products and also suggest that IS carries the lowest risk for hypersensitivity reactions.

Objective:To compare the efficacy of IV chlorpromazine with that of IV metoclopramide in the treatment for acute migraine headache in the ED. Methods:A prospective randomized double-blind trial was undertaken at two university-affiliated urban EDs with a combined annual census of more than 85,000 patients. Included in the study were patients presenting to the E D with a diagnosis of migraine headache. The subjects were randomized to receive 0.1 mg/kg/dose IV of either chlorpromazine (CPZ) or metoclopramide (MC), up to a total of three doses.Results: Ninety-one patients completed the protocol; 44 received MC and 47 received CPZ. The demographics of the two groups were similar. Both drugs provided, for the majority of patients, adequate pain relief as measured on a visual analog scale (VAS) completed every 15 minutes from T = 0 minutes t o T = 45 minutes. The average pain relief over 45 minutes (AVAS) for CPZ was 4.87 cm, vs 4.34 cm for MC (p = 0.35). There also was no statistically significant difference in blood pressure (BP) changes (ABP < 2 mm Hg for both systolic and diastolic BPs, p = 0.47 and 0.33) or numbers of patients reporting adverse effects (AEs) (CPZ: 16 of 35; MC: 13 of 29, p = 0.43). There was no severe A € with either study drug. Conclusions:Metoclopramide and chlorpromazine administered 1V are both effective in the management of acute migraine headache. They are associated with similar minor side-effect profiles.

In a Level I trauma center, the outcomes of trauma patients with an ISS > 12 are statistically significantly better if the trauma team is activated than if the patients are managed on an individual service-by-service basis.

No abstract

Objectives: The primary purpose of this study was to evaluate whether severely injured geriatric patients were as likely to be treated at designated trauma centers (TCs) within the statewide trauma system. The secondary objective was to compare the demographic and injury characteristics of severely injured older and young patients who received care in TCs with the characteristics of those patients cared for in non-TCs. Methods: The authors reviewed files for all acute injury discharges in Pennsylvania for 1997. Injury diagnoses were mapped to Abbreviated Injury Scale (AIS) scores using ICDMAP software; the Injury Severity Score (ISS) was computed. The frequency of hospital discharges for injury from TC and non-TC hospitals in both the older (E) ($65 years) and younger (Y) (,65 years) groups were computed, and compared using chisquare testing for significance. Logistic regression was performed to assess the influence of various factors. Severity of injury was controlled for with both ISS and Maximum AIS (MAIS). Results: 107,358 patients were admitted to hospitals in the state because of injury; 8,980 had an ISS . 15; 5,855 were Y and 3,125 were E. Forty-seven percent of the Y patients received TC care compared with only 36.6% of the E patients (p , 0.001). Logistic regression analysis showed that age was a strongly negative predictor for TC care when injury severity was controlled. Conclusions: Seriously injured older patients were less likely to receive care in a trauma center than younger patients.

No abstract

Outcomes analysis of patient care programs has become increasingly necessary for a variety of reasons in recent years. This has been particularly true for trauma programs. The Trauma and Injury Severity Score (TRISS) methodology was developed for this purpose in the context of the Major Trauma Outcome Study (MTOS). It provides an estimate of the probability of survival for individual patients, based on anatomic, physiologic, and etiologic factors. In addition, it allows hospitals and groups of hospitals to compare survival rates with other hospitals submitting data to the data base. However, the published coefficients for TRISS analysis have been derived from the MTOS data base. Patterns of practice, time to treatment, and other variables may be significantly different in other jurisdictions. To compare outcomes among similar hospitals within the province of Ontario, Canada, a regression analysis was performed to develop TRISS coefficients specific to the province. Data were obtained from the 12 trauma centers in the province treating the most severely injured patients (Injury Severity Score > 12). A total of 3,880 cases were eligible for TRISS analysis, over a 3-year period. Of these, 3,672 were patients with blunt trauma, and 208 were victims of penetrating injury. Standard TRISS analysis of the patients with blunt trauma revealed z scores ranging from -10.260 to +1.849, with a mean of -6.648. Four centers had negative z scores that were significant (an absolute value of > 1.96 is considered statistically significant). Using Ontario TRISS coefficients, z scores ranged from -4.125 to +2.782, with a mean of 0.000. Four scores were significant with the Ontario coefficients, only one of which had been significant using the MTOS norms. The other three z scores were all positive, indicating more deaths than would have been predicted, but they were not significant when compared to the MTOS norms. The mean was also, of course, no longer significant. The area under the receiver operating characteristic curve analysis was strongly positive, and the Hosmer-Lemeshow Goodness-of-Fit analysis indicated good calibration. The new coefficients were subsequently validated by applying them to a subsequent year's data from patient records that did not form part of the original data set. This resulted in slightly improved z scores overall, and in most of the hospitals. This use of regional norms allows comparison with outcomes of patients cared for in hospitals within the same jurisdiction that are more similar to one another than to those in the MTOS, and helps to identify unexpected outcomes and outliers.

In June 1990, the Ministry of Health designated 11 hospitals throughout Ontario to be lead hospitals in trauma care. An integral part of a trauma system is the evaluation of care, in particular, outcome of the trauma patients. The Trauma and Injury Severity Score (TRISS) methodology, which offers a standard approach for evaluating outcomes for different populations of trauma patients, was used to determine if there was an improvement in outcomes after the designation of trauma centers of patients involved in motor vehicle crashes (ICD-9-CM, E810.0-825.9), with an Injury Severity Score > 12 for two 12-month periods: one predesignation (1989/1990) and one postdesignation (1992/1993). The Revised Trauma Score, Injury Severity Score, age, and outcome were calculated or abstracted from the hospital chart of each patient at the trauma center. The probability of survival of each patient, the z- and W-statistics of both years were calculated. A measurable improvement was shown in z-statistics between the 2 years from z = -0.40 predesignation to z = +0.72 postdesignation. When the bias introduced by patients intubated before arrival at the trauma center being excluded from TRISS analysis was removed, using a TRISS-like (as per Offner et al: J. Trauma 32:32, 1992) logistic regression equation that allows analysis of intubated patients, the improvement was even greater, with z = +1.34 predesignation and z = +2.97 postdesignation. Only the statistically significant z-score of the postdesignated year required the W-score to be calculated, W = +5.60.(ABSTRACT TRUNCATED AT 250 WORDS)