Indicators of the need for ICU admission following suicide bombing attacks

<p>Abstract</p> <p>Introduction</p> <p>Critical hospital resources, especially the demand for ICU beds, are usually limited following mass casualty incidents such as suicide bombing attacks (SBA). Our primary objective was to identify easily diagnosed external signs of injury that will serve as indicators of the need for ICU admission. Our secondary objective was to analyze under- and over-triage following suicidal bombing attacks.</p> <p>Methods</p> <p>A database was collected prospectively from patients who were admitted to Hadassah University Hospital Level I Trauma Centre, Jerusalem, Israel from August 2001-August 2005 following a SBA. One hundred and sixty four victims of 17 suicide bombing attacks were divided into two groups according to ICU and non-ICU admission.</p> <p>Results</p> <p>There were 86 patients in the ICU group (52.4%) and 78 patients in the non-ICU group (47.6%). Patients in the ICU group required significantly more operating room time compared with patients in the non-ICU group (59.3% vs. 25.6%, respectively, <it>p </it>= 0.0003). For the ICU group, median ICU stay was 4 days (IQR 2 to 8.25 days). On multivariable analysis only the presence of facial fractures (<it>p </it>= 0.014), peripheral vascular injury (<it>p </it>= 0.015), injury ≥ 4 body areas (<it>p </it>= 0.002) and skull fractures (<it>p </it>= 0.017) were found to be independent predictors of the need for ICU admission. Sixteen survivors (19.5%) in the ICU group were admitted to the ICU for one day only (ICU-LOS = 1) and were defined as over-triaged. Median ISS for this group was significantly lower compared with patients who were admitted to the ICU for > 1 day (ICU-LOS > 1). This group of over-triaged patients could not be distinguished from the other ICU patients based on external signs of trauma. None of the patients in the non-ICU group were subsequently transferred to the ICU.</p> <p>Conclusions</p> <p>Our results show that following SBA, injury to ≥ 4 areas, and certain types of injuries such as facial and skull fractures, and peripheral vascular injury, can serve as surrogates of severe trauma and the need for ICU admission. Over-triage rates following SBA can be limited by a concerted, focused plan implemented by dedicated personnel and by the liberal utilization of imaging studies.</p

A Case of Small Bowel Obstruction Due to a Paracecal Hernia

Internal hernias are rare causes of small bowel obstruction, and one such internal hernia is the paracecal hernia. We report a case of a small bowel obstruction related to a paracecal hernia in which a preoperative diagnosis was made on computed tomography. A laparotomy was performed for definitive diagnosis and treatment. The surgery achieved a good outcome

Diffraction problems for quasilinear parabolic systems with boundary intersecting interfaces

Stability of Unilateral Posterior Crossbite Correction in the Mixed Dentition - an RCT-study with 3-year Follow-Up. Aim: To compare and evaluate long-term stability of crossbite correction with Quad Helix or expansion plate in the mixed dentition. Methods: In this RCT-study 35 patients with unilateral posterior crossbite were randomized to be treated with either Quad Helix or expansion plate. The inclusion criteria were: mixed dentition, unilateral posterior crossbite, no sucking habits or previous orthodontic treatment. Stability was evaluated after 3 years by study cast measurements. Twenty subjects with normal occlusion were included as controls. Success rate, maxillary and mandibular transverse dimensions, overjet, overbite and arch length were registered. Results: Stability was equal for the two treatment methods. Small, albeit significant, differences between the groups were assessed with reference to transverse dimensions. No significant difference was seen for overjet and overbite. The treated patients never reached the same transversal width as the normal control group. Conclusions: The long-term stability of posterior crossbite correction with Quad helix and expansion plate was equal. The maxillary width was greater in the control group than the treated groups