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Background: Tension pneumothorax requires emergent decompression. Unfortunately, some needle thoracostomies (NTs) are unsuccessful because of insufficient catheter length. All previous studies have used thickness of the chest wall (based on cadaver studies, ultrasonography or computed tomography [CT]) to extrapolate probable catheter effectiveness. The objective of this clinical study was to identify the frequency of NT failure with various catheter lengths.Methods: We evaluated the records of all patients with severe blunt injury who had a prehospital NT before arrival at a level-1 trauma centre over a 48-month period. Patients were divided into 2 groups: helicopter (4.5-cm catheter sheath) and ground ambulance (3.2 cm) transport. Success of the NT was confirmed by the absence of a large pneumothorax on subsequent thoracic ultrasonography and CT.Results: Needle thoracostomy decompression was attempted in 1.5% (142/9689) of patients. Among patients with blunt injuries, the incidence was 1.4% (101/7073). Patients transported by helicopter (74%) received a 4.5-cm sheath. The remainder (26% ground transport) received a 3.2-cm catheter. A minority in each group (helicopter 15%, ground 28%) underwent immediate chest tube insertion (before thoracic ultrasound) because of ongoing hemodynamic instability. Failure to decompress the pleural space by NT was observed via ultrasound and/or CT in 65% (17/26) of attempts with a 3.2-cm catheter, compared with only 4% (3/75) of attempts with a 4.5-cm catheter (p < 0.001).Conclusion: Tension pneumothorax decompression using a 3.2-cm catheter was unsuccessful in up to 65% of cases. When a larger 4.5-cm catheter was used, fewer procedures (4%) failed. Thoracic ultrasonography can be used to confirm NT placement. [ABSTRACT FROM AUTHOR]

Background: Trauma care benefits from the use of imaging technologies. Trauma patients and trauma team members are exposed to radiation during the continuum of care. Knowledge of exposure amounts and effects are important for trauma team members.Methods: We performed a review of the published literature; keywords included "trauma," "patients," "trauma team members," "wounds," "injuries," "radiation," "exposure," "dose" and "computed tomography" (CT). We also reviewed the Board on Radiation Effects Research (BEIR VII) report, published in 2005 and 2006.Results: We found no randomized controlled trials or studies. Relevant studies demonstrated that CT accounts for the single largest radiation exposure in trauma patients. Exposure to 100 mSv could result in a solid organ cancer or leukemia in 1 of 100 people. Trauma team members do not exceed the acceptable occupation radiation exposure determined by the National Council of Radiation Protection and Management. Modern imaging technologies such as 16- and 64-slice CT scanners may decrease radiation exposure.Conclusion: Multiple injured trauma patients receive a substantial dose of radiation. Radiation exposure is cumulative. The low individual risk of cancer becomes a greater public health issue when multiplied by a large number of examinations. Though CT scans are an invaluable resource and are becoming more easily accessible, they should not replace careful clinical examination and should be used only in appropriate patients. [ABSTRACT FROM AUTHOR]

Background: For decades, trauma registries have been the primary source of data for resource allocation, quality improvement efforts and hypothesis-generating research in trauma care. Surprisingly, the quality and completion of data in these registries has rarely been reported. In preparation for a research program on population-based epidemiology of severe trauma, we evaluated the Calgary component of the Alberta Trauma Registry (ATR). Methods: We identified the ATR records of all adult trauma patients (aged >/= 16 yr) admitted to hospitals in the Calgary Health Region (CRH) between April 1, 2001 and March 31, 2002 with severe injuries (Injury Severity Score >/= 12). From these registry data, we randomly selected 100 patient records, and we compared 14 fields, sampling parameters from prehospital care to discharge, with information from the hospital chart. Results: Only 9 of 100 records were found to be incomplete. Of these, none had more than 1 field incomplete. Of the approximately 1400 data fields assessed, only 9 were missing data, resulting in a 99% (1391/1400) completion rate. Of 100 records, 22 were found to have inaccurate data; of these, 18 had 1 incorrect field, 2 had 2 incorrect fields and 2 had 3 incorrect fields. Overall, the ATR is 98% accurate. Conclusions: The Calgary component of the ATR can be considered accurate and complete. Some of its inaccuracy is attributable to a change in the way time to operating room was recorded. Data from all other fields collected in a standard manner can continue to be used with confidence for administrative and research purposes. [ABSTRACT FROM AUTHOR]

BACKGROUND: Severe trauma arising from electrocution is uncommon, and we wished to study the incidence, risk factors and outcome to identify potential areas of prevention. We therefore studied an active population of adult victims of severe electrical trauma in a large area of Canada (the Calgary Health Region [CHR]). METHODS: From 3 databases, we collected data on all adult (> or = 18 yr) residents of the CHR who suffered electrical injury associated with an Injury Severity Score of 12 or greater or died as a result of electrocution between Apr. 1, 1996, and Mar. 1, 2002. Of particular interest were the incidence, the age and sex of the victims, the mechanism, the type of electrical power and the outcome. RESULTS: Ten cases of severe electrical trauma were identified (2.4 per 1 million population annually). Victims' ages were a mean (and standard deviation) of 38.2 (10.3) years. All 10 victims were male for an annual sex-specific incidence of 4.9 per 1 million people. Men aged 18-49 years were nearly 3 times more likely to be victims of electrocution than older men, although this result was not statistically significant (6.1 v. 2.1 per 1 million annually; relative risk 2.9; 95% confidence interval 0.4-127.5). All episodes of electrocution were unintentional, and 7 were occupationally related. All 10 electrocutions resulted from domestically generated current, and 9 were related to power-line exposure. Overall, 6 patients died for a death rate due to severe electrical trauma of 1.4 per 1 million people annually. CONCLUSION: This population-based study demonstrates that severe electrocution is rare but is associated with death in the majority of cases in this large Canadian region. [ABSTRACT FROM AUTHOR]

The term occult pneumothorax (OP) describes a pneumothorax that is not suspected on the basis of clinical examination or plain radiography but is ultimately detected with thoracoabdominal computed tomography (CT). This situation is increasingly common in trauma care with the increased use of CT. The rate is approximately 5% in injured people presenting to hospital, with CT revealing at least twice as many pneumothoraces as suspected on plain radiography. Whereas pneumothorax is a common and treatable cause of mortality and morbidity, there is substantial disagreement regarding the appropriate treatment of OP. The greatest controversy is in patients in the critical care unit who require positive-pressure ventilation. There is little current evidence to direct the proper management of ventilated trauma patients with OP, and no studies have focussed specifically on these patients. Future randomized trials will need to consider the potential effects of OP on pulmonary mechanics and potential influences on the known risks of ventilator-induced lung injury associated with mechanical ventilation. [ABSTRACT FROM AUTHOR]