title: Design and prospective evaluation of an algorithm for penetrating truncal injuries.
abstract: The major aim was to develop a branch-chain decision tree for penetrating truncal injury and to subject this to a prospective trial of its feasibility to track management decisions. In contrast to the conventional trauma study which focuses on highly selected, well-defined surgical problems, this algorithmic approach was designed to look at the whole gamut of problems of unselected patients with penetrating injury as they enter the ED. The branch-chain algorithm primarily focuses on priorities, order of procedures, and the immediate therapeutic options. The algorithm was used to track clinical management of 280 consecutive patients with penetrating truncal injuries; 31 were dead on arrival, 12 were alive on admission but died during their hospitalization. Of 209 patients whose management was in satisfactory compliance, four (2%) died; eight (20%) of 40 patients who had major deviations from the algorithm died (p less than .01).
authors.affiliation: Department of Surgery, King-Drew Medical Center, Los Angeles, CA.
authors.forename: M
authors.initials: M
authors.lastname: Liu
authors.forename: W C
authors.initials: WC
authors.lastname: Shoemaker
authors.forename: H B
authors.initials: HB
authors.lastname: Kram
authors.forename: H D
authors.initials: HD
authors.lastname: Harrier
mesh_terms: D000465:Algorithms; D002985:Clinical Protocols; D003663:Decision Trees; D004630:Emergencies; D006323:Heart Arrest / Q000209:etiology / Q000401:mortality; D006801:Humans; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000401:mortality; D014950:Wounds, Penetrating / Q000150:complications / Q000401:mortality / Q000628:therapy*