In the wake of Hurricane Isabel: a prospective study of postevent trauma and injury control strategies

Preventing hurricane-related injuries (HRI) has historically centered on the pre-event and event phases of the disaster. To date, no study has focused on injuries occurring during the postevent phase. We examined HRI that occurred after Hurricane Isabel struck a U.S. urban city. HRI presenting 1 week prior to the hurricane were collected from emergency department electronic records. HRI that presented to our level 1 trauma center were prospectively collected for 1 week after the hurricane. Nine hundred seventy-eight patients with possible HRI were identified. Fifty-one patients with trauma directly attributed to the hurricane were used for analysis. The number of HRI occurring before, during, and after the hurricane were 7 (14%), 3 (6%), and 41 (80%), respectively. The majority of HRI (37%) occurred on posthurricane day 1. Head, chest, upper and lower extremities accounted for 9 (18%), 8 (16%), 13 (26%), and 14 (28%) of HRI. More than one third of HRI patients were admitted to the hospital, and 12 (24%) underwent an operation. The average hospital length of stay was 4.7 days. Of our trauma alerts, 75 per cent had an Injury Severity Score (ISS) >8, and 20 per cent had an ISS >15. Tree-related injuries (TRI) accounted for 59 per cent of HRI. Males, ages 50-60, had the highest incidence of injury (63%). Significant injuries occur in the wake of a hurricane. Optimization of disaster preparation must include prevention strategies targeted to the postevent recovery phase of disasters.

Blunt trauma and the role of routine pelvic radiographs

We evaluated clinical factors that are predictive of pelvic X-ray findings. We sought to identify whether routine pelvic films are necessary in blunt trauma and addressed whether removal of these films would minimize cost. We performed a retrospective chart review of 111 patients without pelvic fractures and 108 with pelvic fractures seen at our Level 1 trauma center between August 1998 and September 1999. We evaluated initial hemodynamics, physical examination findings, laboratory data, and hospital charges. Patients with fractures had higher Injury Severity Scores (P < 0.001), a higher number of associated injuries (P < 0.001), and lower blood pressures (P < 0.001). The back and pelvic examinations were significantly associated with X-ray results (P < 0.001), and the potential savings with selective radiography was $168,300.00 per year. We believe that clinical factors identified in our study predict the need for pelvic X-ray. Because removal of these films would minimize cost we recommend the elimination of routine pelvic films for the awake and alert blunt trauma patient.

Intussusception after Roux-en-Y gastric bypass

Intussusception is a common pediatric surgical problem. Its occurrence in adults is rare and usually involves a specific lead point such as a small bowel tumor or other mass. We describe two adults who developed intussusception after Roux-en-Y gastric bypass. Signs and symptoms of small bowel obstruction were seen in both of these patients, but the responsible pathology was unusual. Because of the increasing frequency with which these gastric bypass procedures are being performed, a high index of suspicion must be employed when dealing with these postoperative patients who present with abdominal complaints.