Trauma

Risk: For over 100 years, injury has been a leading public health problem in the US. At highest risk are children, minorities, and the elderly (Nwariaku). One of every 3 individuals has a traumatic injury each year. As a consequence, trauma is the fourth leading cause of death for all ages and is the leading cause of death for those between the ages of 1 and 44. Because trauma is a disease of the young and carries the potential for permanent disability, it is responsible for significant loss in productive work years. Job-related injuries in 2002 accounted for 3.7 million workers being disabled, but two-thirds of American workers suffer disabling injuries away from the job site ("Report"). In economic terms, it is estimated that 115 million days of productivity are lost annually secondary to disabling injuries.

Incidence and Prevalence: Trauma results in 100,000 people losing their lives every year. In 2001, motor vehicle accidents resulted in over 40,000 deaths, with firearm fatalities not far behind ("Basic Summary"). Another 14,500 deaths were attributed to falls ("Report"). Recent studies report 8 to 9 million people in the US have a disabling injury each year ("Penn State"). These injuries may result from automobile crashes, fires, burns, falls, drowning, or poisoning. Among black males between 15 and 34 years of age, homicide is the leading cause of death, and overall, homicide is the second leading cause of death in those between 15 and 24 years. Each year 60,000 people are hospitalized and 7,000 die because of burns; 50,000 people are injured in bicycle-related accidents and almost 800 will die as a result; and falls result in 10,000 deaths in those over 65 years. Of the almost 40 million people who visit emergency rooms each year, 42% come because of injury (Nwariaku).

History: The victim or witnesses report trauma to local ambulance, fire, police, or emergency room personnel. The individual or witnesses may report circumstances of the injury that are helpful in the diagnosis, including injury mechanism (fall, gunshot, motor vehicle accident), speed of impact, amount of damage to the vehicles, use of restraints (seatbelts) or helmet, length of the fall, position or condition of the victim at the scene, evidence of blood loss, and any known medical alert information about the individual (i.e., recent or chronic illnesses or history of drug or alcohol use).

Physical exam: The physical assessment of a trauma victim is composed of a primary survey to look for life-threatening injury, followed by a secondary survey. In the primary survey, evidence of airway or breathing problems such as pale or bluish complexion, noisy breathing, shallow or slow respirations, foreign objects, and sucking chest wounds may be found. There may be evidence of neurological impairment such as decreased level of consciousness. Hypotension or shock may be present and pulse may be rapid or weak. Individuals may present with areas of tenderness, bone deformity, bruising, and lacerations.

Tests: X-rays and CT are done as needed. The routine procedure for blunt trauma is to obtain portable radiographs of the cervical spine, chest, and pelvis. Three studies are used to evaluate blunt abdominal or chest trauma: diagnostic peritoneal lavage (DPL), CT scanning, and ultrasonography (US). Management of penetrating abdominal trauma differs from that caused by blunt injury. All gunshot wounds that penetrate the abdomen require surgical exploration (laparotomy) because of the high incidence of significant injury. The surgical exploration serves as a tool for diagnosis as well as treatment of injuries. Urinalysis complete blood count (CBC) may be performed; glucose, urea, ammonia, electrolytes, alcohol, blood urea nitrogen (BUN), creatinine, blood type and crossmatch, liver profile, and arterial blood gases may be measured. A spinal tap and tests on cerebral spinal fluid may be done.