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Blunt liver trauma at sunnybrook Medical Centre: a 13 year experience.

https://arctichealth.org/en/permalink/ahliterature226417
Source
HPB Surg. 1991 May;4(1):49-58
Publication Type
Article
Date
May-1991
Author
S S Hanna
G. Pagliarello
G. Taylor
H. Miller
H M Scarth
F. Brenneman
Author Affiliation
Department of Surgery, Sunnybrook Medical Centre, University of Toronto, Ontario, Canada.
Source
HPB Surg. 1991 May;4(1):49-58
Date
May-1991
Language
English
Publication Type
Article
Keywords
Cause of Death
Combined Modality Therapy
Drainage
Hemostatics - therapeutic use
Humans
Injury Severity Score
Liver - injuries
Ontario - epidemiology
Retrospective Studies
Survival Rate
Wounds, Nonpenetrating - epidemiology - mortality - therapy
Abstract
Between June 1, 1976 and June 30, 1989 The Regional Trauma Unit at Sunnybrook Medical Centre in Toronto, Ontario, Canada received 3730 patients. Of these 335 (9%) sustained a liver injury, 95% being due to blunt trauma. Open peritoneal lavage was performed on 80% of liver trauma patients (267/335), 99% being true positive. A laparotomy was performed on 97% of patients (324/335). Major surgical treatment was required in 132 patients (41%) and minor treatment in 192 patients (59%). The remaining 11 patients were treated conservatively (n = 3) or died during resuscitation (n = 8). Morbidity directly related to the liver injury was seen in 29 of 249 surviving patients (11%) although overall morbidity was 27% (67/249). Reoperation was required in 6% (14/249) with abscess or hematoma accounting for 11 of 14 operations. The overall mortality rate was 26% (86/335). Eighty two percent of patients (n = 276) had a grade I, II or III liver trauma according to Moore's classification with a mortality of 12% (n = 32). The remaining 18% of patients (n = 59) had a grade IV or V liver trauma with a mortality of 44% (n = 26). Of the 86 deaths, head injury accounted for 48 (56% of deaths); liver hemorrhage for 17 (20%), liver sepsis for 1 (1%) and other causes for 20 deaths (23%). Thus death due to the liver injury itself (hemorrhage and sepsis) occurred in 18 out of 335 patients (5% overall). Head injury accounted for the death of 48 out of 335 patients (14% overall). Over the past 13 years a trend has occurred at our institution whereby we are seeing less liver trauma in our population of multiply injured patients from 12% (1976-1983) down to 7% (1985-1989); with a gradual decline in overall mortality from 32% (1976-1983) to 19% (1985-1989), whereas the percentage of deaths due to head injuries and liver injury have increased.
PubMed ID
1911476 View in PubMed
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A Canadian survey of transfusion practices in critically ill patients. Transfusion Requirements in Critical Care Investigators and the Canadian Critical Care Trials Group.

https://arctichealth.org/en/permalink/ahliterature206271
Source
Crit Care Med. 1998 Mar;26(3):482-7
Publication Type
Article
Date
Mar-1998
Author
P C Hébert
G. Wells
C. Martin
M. Tweeddale
J. Marshall
M. Blajchman
G. Pagliarello
I. Schweitzer
L. Calder
Author Affiliation
Critical Care Program, University of Ottawa, ON, Canada.
Source
Crit Care Med. 1998 Mar;26(3):482-7
Date
Mar-1998
Language
English
Publication Type
Article
Keywords
Adult
Aged
Canada
Critical Care - statistics & numerical data
Erythrocyte Transfusion - statistics & numerical data - utilization
Female
Health Care Surveys
Hemoglobins - analysis
Humans
Male
Middle Aged
Abstract
To characterize the contemporary red cell transfusion practice in the critically ill and to define clinical factors that influence these practices.
Scenario-based national survey.
Canadian critical care practitioners.
We evaluated transfusion thresholds before transfusion and the number of red cell units ordered, under the given conditions. Of 254 Canadian critical care physicians, 193 (76%) responded to the survey. The primary specialty of most respondents was internal medicine (56%). Internal medicine respondents were in practice for an average of 8.4 +/- 5.7 (SD) yrs, and worked most often in combined medical/surgical intensive care units. Baseline hemoglobin transfusion thresholds averaged from 8.3 +/- 1.0 g/dL in a scenario involving a young stable trauma victim to 9.5 +/- 1.0 g/dL for an older patient after gastrointestinal bleeding. Transfusion thresholds differed significantly (p .05), all clinical factors (including age, Acute Physiology and Chronic Health Evaluation II score, preoperative status, hypoxemia, shock, lactic acidosis, coronary ischemia, and chronic anemia) significantly (p
PubMed ID
9504576 View in PubMed
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The Integrated Trauma Program: a model for cooperative trauma triage.

https://arctichealth.org/en/permalink/ahliterature223341
Source
J Trauma. 1992 Aug;33(2):198-203; discussion 203-4
Publication Type
Article
Date
Aug-1992
Author
G. Pagliarello
A. Dempster
D. Wesson
Author Affiliation
Integrated Trauma Program, University of Toronto, Ontario, Canada.
Source
J Trauma. 1992 Aug;33(2):198-203; discussion 203-4
Date
Aug-1992
Language
English
Publication Type
Article
Keywords
Adult
Algorithms
Child
Female
Hospitals, University - organization & administration
Humans
Male
Ontario
Patient Transfer - statistics & numerical data
Referral and Consultation - statistics & numerical data
Regional Medical Programs - organization & administration
Trauma Centers - organization & administration - utilization
Triage - organization & administration
Abstract
The Integrated Trauma Program (ITP) is the cooperative trauma triage service of the University of Toronto trauma and burn hospitals and the Ontario Ministry of Health. It provides physicians in referring hospitals direct access to a trauma team leader (TTL) in one of several trauma centers through a single phone number. Three adult trauma centers, one pediatric trauma center, and one burn center, all affiliated with the University of Toronto, participate in this program. This article describes the system during the first two years of operation. From July 1989 to June 1991, 1530 requests for patient transfers from a total of 97 hospitals were processed. Of these transfer requests, 77% were accepted by the TTL to a trauma service as multiple trauma cases, 16% were accepted directly to a surgical service without involving the trauma team, 4% were refused by the TTL as inappropriate referrals, and 3% of requests were cancelled by the referring physician. The transfer requests are distributed to a specific trauma center by request of the referring physician (10%), according to a rotation (70%), or as selected by the ITP (20%) when the scheduled hospital is not readily available. Closure of all adult trauma centers occurred on 43 occasions. During these closures, 48 patients bypassed the Toronto trauma centers and were transferred to other cities. The ITP office also keeps an ongoing data base of patients transferred. The mechanism of injury in the majority of cases is vehicular crashes. The mean Injury Severity Score is 24 for adults and 17 for children.(ABSTRACT TRUNCATED AT 250 WORDS)
PubMed ID
1507281 View in PubMed
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The involvement of anesthetists in critical care medicine.

https://arctichealth.org/en/permalink/ahliterature229123
Source
Can J Anaesth. 1990 May;37(4 Pt 2):S119
Publication Type
Article
Date
May-1990
Author
J H Devitt
G. Pagliarello
J. Simons
Author Affiliation
Canadian Critical Care Society, Toronto, Ontario.
Source
Can J Anaesth. 1990 May;37(4 Pt 2):S119
Date
May-1990
Language
English
Publication Type
Article
Keywords
Anesthesiology - manpower
Canada
Critical Care - manpower
Humans
Referral and Consultation - utilization
PubMed ID
2361255 View in PubMed
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Mead Johnson Critical Care Symposium for the Practising Surgeon. 1. Transport of critically ill adult patients.

https://arctichealth.org/en/permalink/ahliterature232570
Source
Can J Surg. 1988 Sep;31(5):319-22
Publication Type
Article
Date
Sep-1988
Author
M J Girotti
G. Pagliarello
Author Affiliation
Department of Surgery, University of Toronto, Toronto General Hospital, Ont.
Source
Can J Surg. 1988 Sep;31(5):319-22
Date
Sep-1988
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Canada
Critical Care
Diagnosis-Related Groups
Hospitals, General
Humans
Middle Aged
Severity of Illness Index
Time Factors
Transportation of Patients - methods - standards
Abstract
Interhospital transportation of critically ill patients over long distances is common in the tiered health care systems of North America. The authors describe their 1-year experience with a physician-assisted transport system, operating out of the surgical intensive care unit at the Toronto General Hospital. The application of a well-known severity of illness measure (therapeutic intervention scoring system) allowed them to correlate severity of illness, as assessed over the telephone before patient transfer, with eventual outcome after admission to the surgical intensive care unit. Their analysis of 107 critically ill patients transported by this system led them to conclude that the system is reliable and is associated with acceptable morbidity and mortality.
PubMed ID
3138018 View in PubMed
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Physician-accompanied transport of surgical intensive care patients.

https://arctichealth.org/en/permalink/ahliterature233106
Source
Can J Anaesth. 1988 May;35(3 ( Pt 1)):303-8
Publication Type
Article
Date
May-1988
Author
M J Girotti
G. Pagliarello
T R Todd
W. Demajo
J. Cain
P. Walker
A. Patterson
Author Affiliation
Department of Surgery, Toronto General Hospital, Ontario.
Source
Can J Anaesth. 1988 May;35(3 ( Pt 1)):303-8
Date
May-1988
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Critical Care
Evaluation Studies as Topic
Humans
Middle Aged
Ontario
Physicians
Transportation of Patients
Abstract
During a one-year period, 107 critically ill adult patients were transferred by a physician-accompanied transport system (PATS). Most patients required both tracheal intubation (82 per cent) and mechanical ventilation (71 per cent), while continuous vasopressor support was required in 27 per cent of transfers. Patients were classified as either potential organ donors (n = 21) or nondonor patients (n = 86). Nondonor patients had a mean time of patient transfer documented from the initial telephone contact to final arrival of the patient in the ICU of 345 +/- 221 min (range 65-1350 min); the mean time the patients were out-of-hospital was 73 +/- 58 min (range 5-330 min); the average distance travelled by the patient and PATS was 342 +/- 692 km (range 1-4000 km). Ultimate nonsurvivors of ICU admission (36 per cent) had shorter out-of-hospital times, shorter travel distances, and increased interventional support, as assessed by the Therapeutic Intervention Scoring System applied over the telephone and prior to departure at the referring hospital. Significant interventions were undertaken by PATS in 23 per cent of the nondonor patients prior to departure. During the transport process, there was at least a seven per cent morbidity (arrhythmia, hypotension, and vehicular difficulties) and a 0.9 mortality rate. We conclude that PATS offered significant advantages to this patient population through its ability to maintain acceptable morbidity and mortality rates while transferring patients over long distances and for prolonged periods of time.
PubMed ID
3383322 View in PubMed
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The relative influence of alcohol and seatbelt usage on severity of injury from motor vehicle crashes.

https://arctichealth.org/en/permalink/ahliterature229344
Source
J Trauma. 1990 Apr;30(4):415-7
Publication Type
Article
Date
Apr-1990
Author
J A Andersen
B A McLellan
G. Pagliarello
W R Nelson
Author Affiliation
Sunnybrook Medical Centre, Toronto, Ontario, Canada.
Source
J Trauma. 1990 Apr;30(4):415-7
Date
Apr-1990
Language
English
Publication Type
Article
Keywords
Accidents, Traffic
Adult
Age Factors
Alcohol Drinking
Ethanol - blood
Female
Humans
Injury Severity Score
Length of Stay
Male
Ontario
Prospective Studies
Seat Belts
Trauma Severity Indices
Abstract
Seatbelt usage has been consistently documented to decrease mortality and injury severity from motor vehicle crashes (MVC); however, conflicting results are available comparing mortality and injury severity, and blood alcohol positivity. Prospective testing on all MVC admissions showed that 51.5% of the non-belted, and 22% of the shoulder-belted drivers had a positive blood alcohol content (p less than 0.001). A comparison of belted and non-belted MVC drivers revealed a significantly higher mean length of stay (LOS) (p less than 0.05) and Injury Severity Score (ISS) (p less than 0.01) for the non-belted drivers. A comparison of groups positive and negative for blood alcohol revealed no significant differences in LOS or ISS, suggesting that these parameters are related to seatbelt use and not alcohol consumption.
PubMed ID
2325170 View in PubMed
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Transfusion requirements in critical care. A pilot study. Canadian Critical Care Trials Group.

https://arctichealth.org/en/permalink/ahliterature215141
Source
JAMA. 1995 May 10;273(18):1439-44
Publication Type
Article
Date
May-10-1995
Author
P C Hébert
G. Wells
J. Marshall
C. Martin
M. Tweeddale
G. Pagliarello
M. Blajchman
Author Affiliation
Critical Care Program, University of Ottawa (Ontario), Canada.
Source
JAMA. 1995 May 10;273(18):1439-44
Date
May-10-1995
Language
English
Publication Type
Article
Keywords
APACHE
Adult
Aged
Blood Transfusion - standards
Canada
Critical Care - standards
Critical Illness - mortality - therapy
Female
Hemoglobins - analysis
Humans
Male
Middle Aged
Multiple Organ Failure
Pilot Projects
Prospective Studies
Survival Analysis
Abstract
To evaluate the effects of a restrictive and a liberal red blood cell (RBC) transfusion strategy on mortality and morbidity in critically ill patients.
Multicenter, prospective, randomized clinical trial.
Sixty-nine normovolemic critically ill patients admitted to one of five tertiary level intensive care units with hemoglobin values less than 90 g/L within 72 hours of admission.
Patients were randomly allocated to one of two RBC transfusion strategies. Hemoglobin values were maintained between 100 and 120 g/L in the liberal transfusion group and between 70 and 90 g/L in the restrictive group.
Primary diagnosis and mean +/- SD age (58.6 +/- 15 vs 59.0 +/- 21 years and Acute Physiology and Chronic Health Evaluation II score (20 +/- 6.2 vs 21 +/- 7.2) were similar in the restrictive and liberal groups, respectively. Daily hemoglobin values averaged 90 g/L in the restrictive group vs 109 g/L in the liberal group (P .99). In addition, survival analysis comparing time until death in both groups did not reveal any significant difference (P = .93) between groups. Organ dysfunction scores were also similar (P = .44).
In this small randomized trial, neither mortality nor the development of organ dysfunction was affected by the transfusion strategy, which suggests that a more restrictive approach to the transfusion of RBCs may be safe in critically ill patients. However, the study lacked power to detect small but clinically significant differences. Therefore, further investigations of RBC transfusion strategies are warranted.
Notes
Erratum In: JAMA 1995 Sep 27;274(12):944
PubMed ID
7723158 View in PubMed
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8 records – page 1 of 1.