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Wed, 9 Jan 2002 08:53:58 -0500

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Rick, 

A good and important question.  I suppose we're all inclined to one degree
or another to store data in our own choice of boxes.  Congratulations for
once again drawing our attention outside of them.

Be that as it may, ratios of blunt to penetrating trauma have long been used
to characterized trauma centers and systems.  We may stipulate, for example,
that blunt trauma requires generally less operative intervention than the
penetrating sort.  There's also data to suggest that penetrating trauma--for
this and surely many other reasons--is harder on trauma center
reimbursement.  Of course, these judgments have been historically dependent
on investigators' opinions of what is blunt and what is penetrating... But
in any event, the characterization is surely not a matter of convenience:
smart and dedicated people are merely trying to make information measurable
and comparable.

Perhaps it's important here to discuss if in fact the discrimination is of
ongoing use: clinically, forensically, financially, academically, socially?
If so, then Kate's original question deserves an answer; however, I wonder
whether it's truly a binary question.  Blunt vs. Penetrating?  One or the
other?  Is there room for 'mixed?'   It's enough to put a statistician on H2
blockers.

Anyhow, thanks for fostering a very blunt and penetrating discussion.

Pret

 -----Original Message-----
From: DocRickFry@aol.com [mailto:DocRickFry@aol.com]
Sent: Wednesday, January 09, 2002 8:15 AM
To: trauma-list@trauma.org
Subject: Re: penetrating trauma definition

In a message dated 1/9/2002 8:01:00 AM Eastern Standard Time, pbjorn@emh.org
writes:

When more than one injury type is present, the predominant type, i.e., the
type most responsible for mortality/morbidity will be assessed in the
hospital at a time considered appropriate. Core data mandatorily must
include data as to whether the trauma is blunt or penetrating. In general,
all trauma is classified as blunt, including amputation, crush, laceration,
and asphyxia with the exception of stab, spike, or missile injuries, which
are classed as penetrating trauma.

Good luck nailing this one down.  Since you're writing a data dictionary, 

Here we go again--why do we try to fix reality to conform to our convenient
forms, rather than fix our record-keeping methods to conform to reality?
ERF 

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<DIV><FONT color=#800000 face=Arial size=2><SPAN class=930502313-09012002>Rick, 
</SPAN></FONT></DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=930502313-09012002></SPAN></FONT>&nbsp;</DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN class=930502313-09012002>A good 
and important question.&nbsp; I suppose we're all inclined to one degree or 
another to store data in our own choice of boxes.&nbsp; Congratulations for once 
again drawing our attention outside of them.</SPAN></FONT></DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=930502313-09012002></SPAN></FONT>&nbsp;</DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN class=930502313-09012002>Be 
that as it may, ratios of blunt to penetrating trauma have long been used to 
characterized trauma centers and systems.&nbsp; We may stipulate, for example, 
that blunt trauma&nbsp;requires generally less operative intervention than the 
penetrating sort.&nbsp; There's also data to suggest that penetrating 
trauma--for this and surely many other reasons--is harder on trauma center 
reimbursement.&nbsp; Of course, these judgments have been historically dependent 
on investigators' opinions of what is blunt and what is penetrating... But in 
any event, the characterization is surely not a matter of convenience: smart and 
dedicated people are merely trying to make information measurable and 
comparable.</SPAN></FONT></DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=930502313-09012002></SPAN></FONT>&nbsp;</DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=930502313-09012002>Perhaps it's important here to discuss if in fact the 
discrimination is of ongoing use: clinically, forensically, financially, 
academically, socially?&nbsp; If so, then Kate's original question deserves an 
answer; however, I wonder whether it's truly a binary question.&nbsp; 
</SPAN></FONT><FONT color=#800000 face=Arial size=2><SPAN 
class=930502313-09012002>Blunt vs. Penetrating?&nbsp; One or the other?&nbsp; Is 
there room for 'mixed?'&nbsp;&nbsp; It's enough to put a statistician on H2 
blockers.</SPAN></FONT></DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=930502313-09012002></SPAN></FONT>&nbsp;</DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=930502313-09012002>Anyhow, thanks for fostering a very blunt and 
penetrating discussion.</SPAN></FONT></DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=930502313-09012002></SPAN></FONT>&nbsp;</DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=930502313-09012002>Pret</SPAN></FONT></DIV>
<DIV><FONT face=Tahoma><FONT size=2><SPAN 
class=930502313-09012002></SPAN></FONT></FONT>&nbsp;</DIV>
<DIV><FONT face=Tahoma><FONT size=2><SPAN 
class=930502313-09012002></SPAN></FONT></FONT>&nbsp;</DIV>
<DIV><FONT face=Tahoma><FONT size=2><SPAN 
class=930502313-09012002>&nbsp;</SPAN>-----Original Message-----<BR><B>From:</B> 
DocRickFry@aol.com [mailto:DocRickFry@aol.com]<BR><B>Sent:</B> Wednesday, 
January 09, 2002 8:15 AM<BR><B>To:</B> trauma-list@trauma.org<BR><B>Subject:</B> 
Re: penetrating trauma definition<BR><BR></DIV></FONT>
<BLOCKQUOTE></FONT><FONT face=arial,helvetica><FONT color=#0000ff 
  face="Comic Sans MS" lang=0 size=2 FAMILY="SCRIPT"><B>In a message dated 
  1/9/2002 8:01:00 AM Eastern Standard Time, pbjorn@emh.org 
  writes:<BR><BR></FONT><FONT color=#000000 face=Arial lang=0 size=2 
  style="BACKGROUND-COLOR: #ffffff" FAMILY="SANSSERIF"></B><BR>
  <BLOCKQUOTE 
  style="BORDER-LEFT: #0000ff 2px solid; MARGIN-LEFT: 5px; MARGIN-RIGHT: 0px; PADDING-LEFT: 5px" 
  TYPE="CITE"><BR></FONT><FONT color=#000000 face=Arial lang=0 size=3 
    style="BACKGROUND-COLOR: #ffffff" FAMILY="SANSSERIF">
    <BLOCKQUOTE 
    style="BORDER-LEFT: #0000ff 2px solid; MARGIN-LEFT: 5px; MARGIN-RIGHT: 0px; PADDING-LEFT: 5px" 
    TYPE="CITE">When more than one injury type is present, the predominant 
      type, i.e., the type most responsible for mortality/morbidity will be 
      assessed in the hospital at a time considered appropriate. Core data 
      mandatorily must include data as to whether the trauma is blunt or 
      penetrating. <U>In general, all trauma is classified as blunt, including 
      amputation, crush, laceration, and asphyxia with the exception of stab, 
      spike, or missile injuries, which are classed as penetrating 
      trauma</U>.</FONT><FONT color=#000000 face=Arial lang=0 size=2 
      style="BACKGROUND-COLOR: #ffffff" 
    FAMILY="SANSSERIF"><BR><BR></BLOCKQUOTE><BR></FONT><FONT color=#0000ff 
    face="Comic Sans MS" lang=0 size=2 style="BACKGROUND-COLOR: #ffffff" 
    FAMILY="SCRIPT"><B><BR></FONT><FONT color=#800000 face=Arial lang=0 size=2 
    style="BACKGROUND-COLOR: #ffffff" FAMILY="SANSSERIF">Good luck nailing this 
    one down.&nbsp; Since you're writing a data dictionary, </FONT><FONT 
    color=#000000 face=Arial lang=0 size=2 style="BACKGROUND-COLOR: #ffffff" 
    FAMILY="SANSSERIF"></BLOCKQUOTE><BR><BR></FONT><FONT color=#0000ff 
  face="Comic Sans MS" lang=0 size=2 style="BACKGROUND-COLOR: #ffffff" 
  FAMILY="SCRIPT">Here we go again--why do we try to fix reality to conform to 
  our convenient forms, rather than fix our record-keeping methods to conform to 
  reality?<BR>ERF</B></FONT> </FONT></BLOCKQUOTE></BODY></HTML>

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