Letters

Thyrotoxicosis in multiple trauma

BMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7082.752a (Published 08 March 1997) Cite this as: BMJ 1997;314:752

Pre-existing medical conditions must be taken into account in multiple trauma

  1. T D Wardle, Consultant physiciana,
  2. P A Driscoll, Senior lecturerb,
  3. M Woodford, Coordinator, major trauma outcome studyb
  1. a Countess of Chester NHS Trust, Chester CH2 1UP
  2. b University Department of Emergency Medicine, Hope Hospital, Salford M6 8HD
  3. c Department of Anaesthesia and Intensive Care, St James's Hospital, Dublin 8, Republic of Ireland
  4. d City Hospital, Nottingham NG5 1PB
  5. e Adult Intensive Care Unit, Queen's Medical Centre, Nottingham NG7 2UH

    Editor—Jo Fitz-Henry and Bernard Riley's account of thyrotoxicosis in a patient with multiple trauma indicates the need for a full and accurate medical history, even in critically injured patients.1 Pre-existing medical conditions are common in patients with trauma in Britain. Our recent retrospective examination of data from 33 497 patients in the British major outcome study showed that 38.8% had pre-existing medical conditions.2 We also showed that pre-existing medical conditions were present in all age groups and that their incidence increased significantly with advancing age. Unfortunately, as Fitz-Henry and Riley say, such conditions are not often considered.

    In a more detailed study the presence and number of pre-existing medical conditions were both shown to be significant independent risk factors adversely affecting outcome after major trauma. This study also showed that cardiovascular (21%), respiratory (15%), and psychiatric (18%) conditions accounted for 54% of all pre-existing medical conditions. Furthermore, cardiovascular, renal, and hepatic diseases were responsible for a fourfold increase in mortality. …

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