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Papers by R. Lawrence Reed, II

Archives of surgery (Chicago, Ill. : 1960), 2010

Minimizing time to definitive care in an effort to optimize outcomes is the goal of trauma system... more Minimizing time to definitive care in an effort to optimize outcomes is the goal of trauma systems. Toward this end, some systems have imposed standards on time to interfacility transfer. This study evaluates compliance and outcome in a system with a 2-hour transfer rule. Retrospective review. State trauma registry data from 1999 to 2003. Trauma patients who underwent interfacility transfer and those who did not. Time to transfer; Injury Severity Score; mortality; and time to operating room at second facility. These variables were then stratified by time to transfer. During the study period, there were 22 447 interfacility transfers. Overall transfer rate was 10.4%. Of the transfers, 4502 (20%) occurred within 2 hours. Median transfer time was 2 hours 21 minutes. Injury Severity Score, mortality, and number of patients with operation performed on same day of transfer were all higher for the group transferred within 2 hours in comparison with patients transferred on the same day of i...

The Journal of Trauma: Injury, Infection, and Critical Care, 1998

ABSTRACT Background: Blunt vascular injuries to the head and neck (BHVI) represent some of the mo... more ABSTRACT Background: Blunt vascular injuries to the head and neck (BHVI) represent some of the most devastating and morbid injuries seen by a trauma surgeon. This series reviewed the experience of a single institution to determine if diagnostic and therapeutic guidelines can be established for these uncommon injuries. In particular, the utility of anticoagulation in the treatment of these injuries is examined. Methods: The institutional trauma registry of a single state-designated Level I trauma center was examined for patients with BHVI, Patients were identified and their charts reviewed individually with regard to multiple data points including the type of injury, its presentation, the treatment of the injury, and the functional outcome of the patient. Results: Twenty-nine BHVI in 23 patients were reviewed from 1989 to 1997, No mortalities were noted. Among the injuries noted were 14 internal carotid artery dissections and 8 carotid artery tears. Thirteen patients had accompanying closed head injuries. Ten patients were diagnosed after an abnormal neurologic examination, and eight others were diagnosed after having carotid canal fractures. Heparin was started within 48 hours of injury in 4 patients (17%) and was used in a total of 12 patients (52%), No patient worsened neurologically after diagnosis independent of the use of heparin, Thirteen patients (57%) had no or minimal deficits upon discharge. Conclusion: BHVI represent a serious cause of morbidity in the patient with multiple injuries. Patients with closed head injuries and carotid canal fractures appear most at risk, A multicenter, randomized trial involving antiplatelet therapy, full systemic anticoagulation, or observation with a long-term functional assessment is indicated to determine the optimal management of these injuries.

The American Journal of Surgery, 1988

A prospective study was performed on the use of a standard outpatient intervention technique to i... more A prospective study was performed on the use of a standard outpatient intervention technique to induce inpatient alcoholic trauma patients into accepting alcoholism treatment. Interventions were performed on 17 trauma patients. All patients who underwent intervention accepted treatment and were immediately transferred to a 28-day inpatient treatment facility. Alcoholic trauma patients are highly susceptible to intervention for their disease. We found that intervention performed upon discharge from the trauma service successfully initiates alcoholism treatment.