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Rodriguez VI, Perez B, Fernandez A, Varela C, Teran A. Hollow viscus perforation in blunt abdominal trauma: A 14-year experience from a trauma center. World J Surg 2024; 48:855-862. [PMID: 38353292 DOI: 10.1002/wjs.12096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 01/15/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND Isolated perforations of hollow viscus (HV) represent less than 1% of injuries in blunt abdominal trauma (BAT). When they do present, they are generally due to high-impact mechanisms in the segments of the intestine that are fixed. The aim of this study is to determine the incidence of major HV injuries in BAT at the "Dr. Domingo Luciani" General Hospital (HDL), and address the literature gap regarding updated HV perforations following BAT, especially in low-income settings. METHODS A retrospective review was conducted on the medical records of patients admitted to our trauma center with a diagnosis of complicated BAT with HV perforation over 14 years. RESULTS AND DISCUSSION Seven hundred sixty-one patients were admitted under the diagnosis of BAT. Of them, 36.79% underwent emergency surgical resolution, and 6.04% had HV perforation as an operative finding. Almost half (44.44%) of these cases presented as a single isolated injury, while the remaining were associated with other intra-abdominal organ injuries. The most common lesions were Grade II-III jejunum and Grade I transverse colon, affecting an equal proportion of patients at 13.33%. In recent years, an increased incidence of HV injuries secondary to BAT has been observed. Despite this, in many cases, the diagnosis is delayed, so even in the presence of negative diagnostic studies, the surgical approach based on the trauma mechanism, hemodynamic status, and systematic reevaluation of the polytraumatized patient should prevail.
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Affiliation(s)
- Veronica I Rodriguez
- Department of General Surgery, Hospital General del Este "Dr. Domingo Luciani", Universidad Central de Venezuela, Caracas, Venezuela
- Catherine and Joseph Aresty Department of Urology, Keck Medicine of USC, Los Angeles, California, USA
| | - Barbara Perez
- Department of General Surgery, Hospital General del Este "Dr. Domingo Luciani", Universidad Central de Venezuela, Caracas, Venezuela
| | - Andrea Fernandez
- Department of General Surgery, Hospital General del Este "Dr. Domingo Luciani", Universidad Central de Venezuela, Caracas, Venezuela
| | - Cristopher Varela
- Department of General Surgery, Hospital General del Este "Dr. Domingo Luciani", Universidad Central de Venezuela, Caracas, Venezuela
| | - Adrian Teran
- Department of General Surgery, Hospital General del Este "Dr. Domingo Luciani", Universidad Central de Venezuela, Caracas, Venezuela
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Liu Y, Gao Y, Chen Z, Cui J, Liang W, Wang Z, Sun L, Pang C, Lv Y, Liu G, Lu T, Zhang G, Dong X, Xu H, Yao S, Liang F, Liu G, Chen G, He J, Xu W, Wei B, Xi H, Chen L. Comparison of Clinical Characteristics, Therapy, and Short-Term Prognosis between Blunt and Penetrating Abdominal Trauma: A Multicentric Retrospective Cohort Study. Emerg Med Int 2024; 2024:5215977. [PMID: 38380077 PMCID: PMC10878762 DOI: 10.1155/2024/5215977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 12/31/2023] [Accepted: 01/28/2024] [Indexed: 02/22/2024] Open
Abstract
Objective Large-scale studies on the characteristics and management of abdominal trauma in megacities in China are lacking. The aim of this study was to analyze and present the clinical patterns and treatment status of abdominal trauma in regional medical centers. Methods Cases of abdominal trauma treated at seven medical centers in Beijing from 2010 to 2021 were collected. Clinical information about age, sex, injury cause, geographic distribution, abbreviated injury scale/injury severity score (AIS/ISS) value, injury-hospital time, preoperative time, surgically identified organ injuries, type of surgery, causes of reoperation and 90-day mortality was included in this study. Clinical characteristics, treatment methods, and short-term prognoses (90-days survival) were compared between blunt abdominal trauma (BAT) and penetrating abdominal trauma (PAT) cases. Non-normally distributed data are described as medians (IQR), and the Mann‒Whitney U test was performed; qualitative data were analyzed using the X2 test. Univariate and multivariate survival analyses were performed by the Cox proportional hazards model. Results A total of 553 patients (86.98% male) with a median age of 36.50 (27.00-48.00) years were included. The BAT group had a significantly higher proportion of serious injury (P=0.001), lower initial hemoglobin level (P=0.001), and a lower laparoscopy surgery rate (P=0.044) compared to the PAT group. Additionally, more BAT cases were from the area around Beijing (P=0.008) and a longer injury-regional hospital time (10.47 (5.18-22.51) hours vs. 7.00 (3.80-15.38) hours, P=0.001). In the hollow viscus injury subgroup, the BAT group had a significantly longer injury-regional hospital time and preoperative time compared to the PAT group (injury-regional hospital time: 10.23 (6.00-21.59) hours vs. 7.07 (3.99-13.85) hours, P=0.002; preoperative time: 3.02 (2.01-5.58) hours vs. 2.81 (1.85-3.63) hours, P=0.047). The overall 90-day mortality was 11.9%, and longer injury-regional hospital time (HR: 1.01, 95% CI: 1.00-1.02, P=0.008), receipt of ICU treatment (HR: 4.69, 95% CI: 2.54-8.65, P=0.001), and severe ISSs (ISS > 25 vs. ISS < 16, HR: 2.78, 95% CI: 1.38-5.601, P=0.004) had a worse impact on survival. Conclusion More patients with BAT were transferred to higher-level hospital, leading to significantly longer prehospital and preoperation time. In the subgroup of hemodynamically stable individuals, more patients with BAT experienced hollow viscus injuries. For those patients, aggressive diagnostic laparoscopic exploration may be beneficial. Patients with longer injury-regional hospital intervals, the need for ICU care, and higher injury severity scores (ISSs) suffered from worse prognoses.
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Affiliation(s)
- Yi Liu
- Department of Abdominal Trauma Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Yunhe Gao
- Department of Gastric Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Zhida Chen
- Research Institute of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Jianxin Cui
- Department of Abdominal Trauma Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Wenquan Liang
- Department of Gastric Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Ze Wang
- Department of Abdominal Trauma Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Linde Sun
- Department of Abdominal Trauma Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Chuan Pang
- Department of General Surgery, The Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China
| | - Yuan Lv
- Department of General Surgery, The Seventh Medical Center of Chinese PLA General Hospital, Beijing 100007, China
| | - Guoxiao Liu
- Department of Abdominal Trauma Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Tingting Lu
- Research Institute of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Gan Zhang
- Research Institute of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Xiaoyu Dong
- Research Institute of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Hong Xu
- Department of General Surgery, The Third Medical Center of Chinese PLA General Hospital, Beijing 100039, China
| | - Sheng Yao
- Department of General Surgery, The Fourth Medical Center of Chinese PLA General Hospital, Beijing 100048, China
| | - Feng Liang
- Department of General Surgery, The Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China
| | - Gang Liu
- Department of General Surgery, The Sixth Medical Center of Chinese PLA General Hospital, Beijing 100048, China
| | - Gang Chen
- Department of General Surgery, The Seventh Medical Center of Chinese PLA General Hospital, Beijing 100007, China
| | - Jianmiao He
- Department of General Surgery, The Eighth Medical Center of Chinese PLA General Hospital, Beijing 100091, China
| | - Wentong Xu
- Department of Abdominal Trauma Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Bo Wei
- Department of Abdominal Trauma Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Hongqing Xi
- Department of Abdominal Trauma Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Lin Chen
- Department of Abdominal Trauma Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
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Sethi I, Aicher AE, Zawin M, Samuel M, Mukhi A, Vosswinkel J, Jawa RS. Index CT-Based Scoring Systems in Operative Blunt Bowel and Mesenteric Injury Identification. J Surg Res 2024; 294:240-246. [PMID: 37924561 DOI: 10.1016/j.jss.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 09/20/2023] [Accepted: 10/02/2023] [Indexed: 11/06/2023]
Abstract
INTRODUCTION Determining the need for surgical management of blunt bowel and mesenteric injury (BBMI) remains a clinical challenge. The Faget score and Bowel Injury Prediction Score (BIPS) have been suggested to address this issue. Their efficacy in determining the need for surgery was examined. METHODS A retrospective review of all adult blunt trauma patients hospitalized at a level 1 trauma center between January 2009 and August 2019 who had small bowel, colon, and/or mesenteric injury was conducted. We further analyzed those who underwent preoperative computed tomography (CT) scanning at our institution. Final index CT reports were retrospectively reviewed to calculate the Faget and BIPS CT scores. All images were also independently reviewed by an attending radiologist to determine the BIPS CT score. RESULTS During the study period, 14,897 blunt trauma patients were hospitalized, of which 91 had BBMI. Of these, 62 met inclusion criteria. Among patients previously identified as having BBMI in the registry, the retrospectively applied Faget score had a sensitivity of 39.1%, specificity of 81.2%, positive predictive value (PPV) of 85.7%, and negative predictive value (NPV) of 31.7% in identifying patients with operative BBMI. The retrospectively applied BIPS score had a sensitivity of 47.8%, specificity of 87.5%, PPV of 91.7%, and NPV of 36.8% in this cohort. When CT images were reviewed by an attending radiologist using the BIPS criteria, sensitivity was 56.5%, specificity 93.7%, PPV 96.3%, and NPV 42.8%. CONCLUSIONS Existing BBMI scoring systems had limited sensitivity but excellent PPV in predicting the need for operative intervention for BBMI. Attending radiologist review of CT images using the BIPS scoring system demonstrated improved accuracy as opposed to retrospective application of the BIPS score to radiology reports.
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Affiliation(s)
- Ila Sethi
- Division of Trauma, Department of Surgery, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York
| | - Aidan E Aicher
- Division of Trauma, Department of Surgery, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York
| | - Marlene Zawin
- Department of Radiology, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York
| | - Michael Samuel
- Department of Radiology, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York
| | - Ambika Mukhi
- Division of Trauma, Department of Surgery, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York
| | - James Vosswinkel
- Division of Trauma, Department of Surgery, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York
| | - Randeep S Jawa
- Division of Trauma, Department of Surgery, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York.
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Kaewlai R, Chatpuwaphat J, Maitriwong W, Wongwaisayawan S, Shin CI, Lee CW. Radiologic Imaging of Traumatic Bowel and Mesenteric Injuries: A Comprehensive Up-to-Date Review. Korean J Radiol 2023; 24:406-423. [PMID: 37133211 PMCID: PMC10157329 DOI: 10.3348/kjr.2022.0998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 02/15/2023] [Accepted: 03/29/2023] [Indexed: 05/04/2023] Open
Abstract
Diagnosing bowel and mesenteric trauma poses a significant challenge to radiologists. Although these injuries are relatively rare, immediate laparotomy may be indicated when they occur. Delayed diagnosis and treatment are associated with increased morbidity and mortality; therefore, timely and accurate management is essential. Additionally, employing strategies to differentiate between major injuries requiring surgical intervention and minor injuries considered manageable via non-operative management is important. Bowel and mesenteric injuries are among the most frequently overlooked injuries on trauma abdominal computed tomography (CT), with up to 40% of confirmed surgical bowel and mesenteric injuries not reported prior to operative treatment. This high percentage of falsely negative preoperative diagnoses may be due to several factors, including the relative rarity of these injuries, subtle and non-specific appearances on CT, and limited awareness of the injuries among radiologists. To improve the awareness and diagnosis of bowel and mesenteric injuries, this article provides an overview of the injuries most often encountered, imaging evaluation, CT appearances, and diagnostic pearls and pitfalls. Enhanced diagnostic imaging awareness will improve the preoperative diagnostic yield, which will save time, money, and lives.
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Affiliation(s)
- Rathachai Kaewlai
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Jitti Chatpuwaphat
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Worapat Maitriwong
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sirote Wongwaisayawan
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Cheong-Il Shin
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Choong Wook Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Badawy M, Solomon N, Elsayes KM, Soliman M, Diaz-Marchan P, Succi MD, Pourvaziri A, Lev MH, Mellnick VM, Gomez-Cintron A, Revzin MV. Nonaccidental Injury in the Elderly: What Radiologists Need to Know. Radiographics 2022; 42:1358-1376. [PMID: 35802501 DOI: 10.1148/rg.220017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Elder abuse may result in serious physical injuries and long-term psychological consequences and can be life threatening. Over the past decade, attention to elder abuse has increased owing to its high prevalence, with one in six people aged 60 years and older experiencing some form of abuse worldwide. Despite this, the detection and reporting rates remain relatively low. While diagnostic imaging is considered critical in detection of child abuse, it is relatively underused in elder abuse. The authors discuss barriers to use of imaging for investigation and diagnosis of elder abuse, including lack of training, comorbidities present in this vulnerable population, and lack of communication among the intra- and interdisciplinary care providers. Moreover, imaging features that should raise clinical concern for elder abuse are reviewed, including certain types of fractures (eg, posterior rib), characteristic soft-tissue and organ injuries (eg, shoulder dislocation), and cases in which the reported mechanism of injury is inconsistent with the imaging findings. As most findings suggesting elder abuse are initially discovered at radiography and CT, the authors focus mainly on use of those modalities. This review also compares and contrasts elder abuse with child abuse. Empowered with knowledge of elderly victims' risk factors, classic perpetrator characteristics, and correlative imaging findings, radiologists should be able to identify potential abuse in elderly patients presenting for medical attention. Future recommendations for research studies and clinical workflow to increase radiologists' awareness of and participation in elder abuse detection are also presented. An invited commentary by Jubanyik and Gettel is available online. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Mohamed Badawy
- From the Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (M.B., K.M.E.); Department of Radiology and Biomedical Imaging, Yale University, New Haven, Conn (N.S., M.V.R.); Department of Radiology, Northwestern University, Chicago, Ill (M.S.); Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (P.D.M.); Department of Radiology, Harvard Medical School, Boston, Mass (M.D.S., A.P., M.H.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Diagnostic Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (A.G.C.)
| | - Nadia Solomon
- From the Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (M.B., K.M.E.); Department of Radiology and Biomedical Imaging, Yale University, New Haven, Conn (N.S., M.V.R.); Department of Radiology, Northwestern University, Chicago, Ill (M.S.); Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (P.D.M.); Department of Radiology, Harvard Medical School, Boston, Mass (M.D.S., A.P., M.H.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Diagnostic Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (A.G.C.)
| | - Khaled M Elsayes
- From the Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (M.B., K.M.E.); Department of Radiology and Biomedical Imaging, Yale University, New Haven, Conn (N.S., M.V.R.); Department of Radiology, Northwestern University, Chicago, Ill (M.S.); Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (P.D.M.); Department of Radiology, Harvard Medical School, Boston, Mass (M.D.S., A.P., M.H.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Diagnostic Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (A.G.C.)
| | - Moataz Soliman
- From the Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (M.B., K.M.E.); Department of Radiology and Biomedical Imaging, Yale University, New Haven, Conn (N.S., M.V.R.); Department of Radiology, Northwestern University, Chicago, Ill (M.S.); Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (P.D.M.); Department of Radiology, Harvard Medical School, Boston, Mass (M.D.S., A.P., M.H.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Diagnostic Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (A.G.C.)
| | - Pedro Diaz-Marchan
- From the Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (M.B., K.M.E.); Department of Radiology and Biomedical Imaging, Yale University, New Haven, Conn (N.S., M.V.R.); Department of Radiology, Northwestern University, Chicago, Ill (M.S.); Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (P.D.M.); Department of Radiology, Harvard Medical School, Boston, Mass (M.D.S., A.P., M.H.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Diagnostic Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (A.G.C.)
| | - Marc D Succi
- From the Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (M.B., K.M.E.); Department of Radiology and Biomedical Imaging, Yale University, New Haven, Conn (N.S., M.V.R.); Department of Radiology, Northwestern University, Chicago, Ill (M.S.); Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (P.D.M.); Department of Radiology, Harvard Medical School, Boston, Mass (M.D.S., A.P., M.H.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Diagnostic Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (A.G.C.)
| | - Ali Pourvaziri
- From the Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (M.B., K.M.E.); Department of Radiology and Biomedical Imaging, Yale University, New Haven, Conn (N.S., M.V.R.); Department of Radiology, Northwestern University, Chicago, Ill (M.S.); Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (P.D.M.); Department of Radiology, Harvard Medical School, Boston, Mass (M.D.S., A.P., M.H.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Diagnostic Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (A.G.C.)
| | - Michael H Lev
- From the Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (M.B., K.M.E.); Department of Radiology and Biomedical Imaging, Yale University, New Haven, Conn (N.S., M.V.R.); Department of Radiology, Northwestern University, Chicago, Ill (M.S.); Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (P.D.M.); Department of Radiology, Harvard Medical School, Boston, Mass (M.D.S., A.P., M.H.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Diagnostic Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (A.G.C.)
| | - Vincent M Mellnick
- From the Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (M.B., K.M.E.); Department of Radiology and Biomedical Imaging, Yale University, New Haven, Conn (N.S., M.V.R.); Department of Radiology, Northwestern University, Chicago, Ill (M.S.); Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (P.D.M.); Department of Radiology, Harvard Medical School, Boston, Mass (M.D.S., A.P., M.H.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Diagnostic Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (A.G.C.)
| | - Angel Gomez-Cintron
- From the Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (M.B., K.M.E.); Department of Radiology and Biomedical Imaging, Yale University, New Haven, Conn (N.S., M.V.R.); Department of Radiology, Northwestern University, Chicago, Ill (M.S.); Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (P.D.M.); Department of Radiology, Harvard Medical School, Boston, Mass (M.D.S., A.P., M.H.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Diagnostic Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (A.G.C.)
| | - Margarita V Revzin
- From the Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (M.B., K.M.E.); Department of Radiology and Biomedical Imaging, Yale University, New Haven, Conn (N.S., M.V.R.); Department of Radiology, Northwestern University, Chicago, Ill (M.S.); Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (P.D.M.); Department of Radiology, Harvard Medical School, Boston, Mass (M.D.S., A.P., M.H.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Diagnostic Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (A.G.C.)
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Wang TJ, Barrett S, Ali I, Khosa F, Nicolaou S, Murray N. Dual-Energy CT in the Acute Setting: Bowel Trauma. FRONTIERS IN RADIOLOGY 2022; 2:835834. [PMID: 37492664 PMCID: PMC10365276 DOI: 10.3389/fradi.2022.835834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/14/2022] [Indexed: 07/27/2023]
Abstract
Traumatic bowel and mesenteric injuries (TBMI) have significant morbidity and mortality. The physical examination is often limited and sometimes not feasible in the trauma patient. Multidetector CT (MDCT) detection of TBMI is challenging and can be life-saving. Dual-energy CT (DECT) utilizes iodine overlay, monoenergetic imaging, and metal artifact reduction to enhance the conspicuity of TBMI. DECT may improve the conspicuity of TBMI leading to increased diagnostic accuracy and confidence. The aim of the article is to review the state of the art and applications of DECT in bowel trauma.
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Diagnostic Accuracy of Computed Tomography for the Prediction of the Need for Laparotomy for Traumatic Hollow Viscus Injury: Systematic Review and Meta-Analysis. J Pers Med 2021; 11:jpm11121269. [PMID: 34945741 PMCID: PMC8708608 DOI: 10.3390/jpm11121269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Traumatic hollow viscus injury (THVI) is one of the most difficult challenges in the trauma setting. Computed tomography (CT) is the most common modality used to diagnose THVI; however, various performance outcomes of CT have been reported. We conducted a systematic review and meta-analysis to analyze how precise and reliable CT is as a tool for the assessment of THVI. METHOD A systematic review and meta-analysis were conducted on studies on the use of CT to diagnose THVI. Publications were retrieved by performing structured searches in databases, review articles and major textbooks. For the statistical analysis, summary receiver operating characteristic (SROC) curves were constructed using hierarchical models. RESULTS Sixteen studies enrolling 12,514 patients were eligible for the final analysis. The summary sensitivity and specificity of CT for the diagnosis of THVI were 0.678 (95% CI: 0.501-0.809) and 0.969 (95% CI: 0.920-0.989), respectively. The summary false positive rate was 0.031 (95% CI 0.011-0.071). CONCLUSION In this meta-analysis, we found that CT had indeterminate sensitivity and excellent specificity for the diagnosis of THVI.
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Chen SA, Wang CY, Hsu CP, Lin JY, Cheng CT, Ouyang CH, Huang JF, Liao CH. The Current Diagnostic Accuracy on Free Peritoneal Fluid in Computed Tomography to Determinate the Necessity of Surgery in Blunt Bowel and Mesenteric Trauma-Systemic Review and Meta-Analysis. Diagnostics (Basel) 2021; 11:diagnostics11112028. [PMID: 34829375 PMCID: PMC8620381 DOI: 10.3390/diagnostics11112028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/28/2021] [Accepted: 10/29/2021] [Indexed: 01/09/2023] Open
Abstract
Traumatic bowel mesenteric injury (TBMI) is a challenge in trauma care. The presence of free peritoneal fluid (FF) in computed tomography (CT) was considered the indication for surgical intervention. However, conservative treatment should be applied for minor injuries. We conduct a systematic review to analyze how reliable the FF is to assess the TBMI. Publications were retrieved by structured searching among databases, review articles and major textbooks. For statistical analysis, summary receiver operating characteristic curves (SROCs) were computed using hierarchical models. Fourteen studies enrolling 4336 patients were eligible for final qualitative analysis. The SROC line was created by a hierarchical summary receiver operating characteristic model. The summary sensitivity of FF to predict surgical TBMI was 0.793 (95% CI: 0.635-0.894), and the summary specificity of FF to predict surgical TBMI was 0.733 (95% CI: 0.468-0.896). The diagnostic odds ratio was 10.531 (95% CI: 5.556-19.961). This study represents the most robust evidence (level 3a) to date that FF is not the absolute but an acceptable indicator for surgically important TBMI. However, there is still a need for randomized controlled trials to confirm.
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Affiliation(s)
- Szu-An Chen
- Department of Traumatology and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33328, Taiwan; (S.-A.C.); (C.-P.H.); (J.-Y.L.); (C.-T.C.); (C.-H.O.); (J.-F.H.)
| | - Chen-Yu Wang
- Department of Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33328, Taiwan;
| | - Chih-Po Hsu
- Department of Traumatology and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33328, Taiwan; (S.-A.C.); (C.-P.H.); (J.-Y.L.); (C.-T.C.); (C.-H.O.); (J.-F.H.)
| | - Jia-Yen Lin
- Department of Traumatology and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33328, Taiwan; (S.-A.C.); (C.-P.H.); (J.-Y.L.); (C.-T.C.); (C.-H.O.); (J.-F.H.)
| | - Chi-Tung Cheng
- Department of Traumatology and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33328, Taiwan; (S.-A.C.); (C.-P.H.); (J.-Y.L.); (C.-T.C.); (C.-H.O.); (J.-F.H.)
| | - Chun-Hsiang Ouyang
- Department of Traumatology and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33328, Taiwan; (S.-A.C.); (C.-P.H.); (J.-Y.L.); (C.-T.C.); (C.-H.O.); (J.-F.H.)
| | - Jen-Fu Huang
- Department of Traumatology and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33328, Taiwan; (S.-A.C.); (C.-P.H.); (J.-Y.L.); (C.-T.C.); (C.-H.O.); (J.-F.H.)
| | - Chien-Hung Liao
- Department of Traumatology and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33328, Taiwan; (S.-A.C.); (C.-P.H.); (J.-Y.L.); (C.-T.C.); (C.-H.O.); (J.-F.H.)
- Correspondence: ; Tel.: +886-3281200 (ext. 3651)
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9
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Dreizin D, Rosales R, Li G, Syed H, Chen R. Volumetric Markers of Body Composition May Improve Personalized Prediction of Major Arterial Bleeding After Pelvic Fracture: A Secondary Analysis of the Baltimore CT Prediction Model Cohort. Can Assoc Radiol J 2021; 72:854-861. [PMID: 32910695 PMCID: PMC8011455 DOI: 10.1177/0846537120952508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
METHODS This work is a retrospective secondary analysis of a single institution cohort used in the development of the Baltimore CT prediction model. The cohort includes 115 consecutive patients that underwent admission contrast-enhanced CT of the abdomen and pelvis for blunt trauma with pelvic ring disruption followed by conventional angiography. Major arterial injury requiring angioembolization served as the outcome variable. Angioembolization was required in 73/115 patients (63% of the cohort). Average age was 46.9 years (±SD 20.4). Body composition measurements were determined as 2-dimensional (2D) or 3-dimensional (3D) parameters and included mid-L3 trabecular bone attenuation, abdominal visceral fat area or volume, and percent muscle fat fraction (as a marker of sarcopenia) measured using segmentation and histogram analysis. RESULTS Models incorporating 2D (Model B) or 3D markers (model C) of body composition showed improvement over the original Baltimore model (model A) in all parameters of performance, quality, and fit (area under the receiver-operating curve [AUC], Akaike information criterion, Brier score, Hosmer-Lemeshow test, and adjusted-R2). Area under the receiver-operating curve increased from 0.83 (A), to 0.86 (B), and 0.88 (C). The greatest improvement was seen with 3D parameters. CONCLUSION Once automated, quantitative visualization tools providing "free" 3D body composition information can be expected to improve personalized precision diagnostics, outcome prediction, and decision support in patients with bleeding pelvic fractures.
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Affiliation(s)
- David Dreizin
- Department of Diagnostic Radiology and Nuclear Medicine, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Remberto Rosales
- Department of Diagnostic Radiology and Nuclear Medicine, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Guang Li
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Hassan Syed
- Department of Diagnostic Radiology and Nuclear Medicine, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Rong Chen
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
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10
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Use of Enteric Contrast Material for Abdominopelvic CT in Penetrating Traumatic Injury in Adults: Comparison of Diagnostic Accuracy Systematic Review and Meta-Analysis. AJR Am J Roentgenol 2020; 217:560-568. [PMID: 32997519 DOI: 10.2214/ajr.20.24636] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND. Scarce evidence exists on the diagnostic benefit of enteric contrast administration for abdominopelvic CT performed in the setting of penetrating trauma. OBJECTIVE. The purpose of this systematic review and meta-analysis is to compare the diagnostic accuracy of CT using enteric contrast material with that of CT not using enteric contrast material in penetrating traumatic abdominopelvic injury in adults. EVIDENCE ACQUISITION. A protocol was registered a priori (PROSPERO CRD42019139613). MEDLINE and EMBASE databases were searched until June 25, 2019. Studies were included that evaluated the diagnostic accuracy of abdominopelvic CT either with or without enteric (oral and/or rectal) contrast material in patients presenting with penetrating traumatic injury. Relevant study data metrics and risk of bias were assessed. Bivariate random-effects meta-analyses and meta-regression modeling were performed to assess and compare diagnostic accuracies. EVIDENCE SYNTHESIS. From an initial sample of 829 studies, 12 studies were included that reported on 1287 patients with penetrating injury (389 with confirmed bowel, mesenteric, or other abdominopelvic organ injury). The enteric contrast material group (seven studies; 506 patients; 124 patients with confirmed penetrating injury) showed a sensitivity of 83.8% (95% CI, 73.7-90.5%) and specificity of 93.8% (95% CI, 83.6-97.8%). The group without enteric contrast administration (six studies; 781 patients; 265 patients with confirmed penetrating injury) showed a sensitivity of 93.0% (95% CI, 86.8-96.4%) and a specificity of 90.3% (95% CI, 81.4-95.2%). No statistically significant difference was identified for sensitivity (p = .07) or specificity (p = .37) between the groups with and without enteric contrast material according to meta-regression. Nine of 12 studies showed risk of bias in at least one QUADAS-2 domain (most frequently limited reporting of blinding of radiologists or lack of blinding of radiologists, insufficient clinical follow-up for the reference standard, and limited reporting of sampling methods). CONCLUSION. The use of enteric contrast material for CT does not provide a significant diagnostic benefit for penetrating traumatic injury. CLINICAL IMPACT. Eliminating enteric contrast administration for CT in penetrating traumatic injury can prevent delays in imaging and surgery and reduce cost.
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11
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Beltzer C, Bachmann R, Strohäker J, Axt S, Schmidt R, Küper M, Königsrainer A. [Value of laparoscopy in blunt and penetrating abdominal trauma-a systematic review]. Chirurg 2020; 91:567-575. [PMID: 32193565 DOI: 10.1007/s00104-020-01158-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The range of indications for laparoscopic procedures has been continuously widened in recent years. At the same time, however, the diagnostic and therapeutic role of laparoscopy in the management of blunt and penetrating abdominal trauma remains controversial. METHODS A systematic literature search was carried out in PubMed from 2008 to 2019 on the use of laparoscopy in blunt and penetrating abdominal trauma. Studies were analyzed in terms of relevant operative and perioperative event rates (rate of missed injuries, conversion rate, postoperative complication rate). On the basis of this analysis, an algorithm for the use of laparoscopy in abdominal trauma was developed for clinical practice. RESULTS A total of 15 full texts with 5869 patients were found. With a rate of 1.4%, laparoscopically missed injuries were very rare for both penetrating and blunt abdominal trauma. Of all trauma laparoscopies 29.3% were converted to open surgery (laparotomy). Among the non-converted laparoscopies 60.5% were therapeutic. Complications occurred after trauma laparoscopy in 8.6% of cases. CONCLUSION By means of systematic laparoscopic exploration, missed injuries in abdominal trauma are extremely rare, so that concerns in this respect no longer seem justified. A large proportion of intra-abdominal injuries can be treated using laparoscopy or laparoscopically assisted procedures.
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Affiliation(s)
- Christian Beltzer
- Universitätsklinik für Allgemeine‑, Viszeral- und Transplantationschirurgie, Hoppe-Seyler-Straße 3, 72076, Tübingen, Deutschland. .,Klinik für Allgemein‑, Viszeral- und Thoraxchirurgie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland.
| | - Robert Bachmann
- Universitätsklinik für Allgemeine‑, Viszeral- und Transplantationschirurgie, Hoppe-Seyler-Straße 3, 72076, Tübingen, Deutschland
| | - Jens Strohäker
- Universitätsklinik für Allgemeine‑, Viszeral- und Transplantationschirurgie, Hoppe-Seyler-Straße 3, 72076, Tübingen, Deutschland
| | - Steffen Axt
- Universitätsklinik für Allgemeine‑, Viszeral- und Transplantationschirurgie, Hoppe-Seyler-Straße 3, 72076, Tübingen, Deutschland
| | - Roland Schmidt
- Klinik für Allgemein‑, Viszeral- und Thoraxchirurgie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland
| | - Markus Küper
- Klinik für Unfall- und Wiederherstellungschirurgie, Berufsgenossenschaftliche Unfallklinik Tübingen, Schnarrenbergstraße 95, 72076, Tübingen, Deutschland
| | - Alfred Königsrainer
- Universitätsklinik für Allgemeine‑, Viszeral- und Transplantationschirurgie, Hoppe-Seyler-Straße 3, 72076, Tübingen, Deutschland
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12
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Hamid S, Nicolaou S, Khosa F, Andrews G, Murray N, Abdellatif W, Qamar SR. Dual-Energy CT: A Paradigm Shift in Acute Traumatic Abdomen. Can Assoc Radiol J 2020; 71:371-387. [DOI: 10.1177/0846537120905301] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abdominal trauma, one of the leading causes of death under the age of 45, can be broadly classified into blunt and penetrating trauma, based on the mechanism of injury. Blunt abdominal trauma usually results from motor vehicle collisions, fall from heights, assaults, and sports and is more common than penetrating abdominal trauma, which is usually seen in firearm injuries and stab wounds. In both blunt and penetrating abdominal trauma, an optimized imaging approach is mandatory to exclude life-threatening injuries. Easy availability of the portable ultrasound in the emergency department and trauma bay makes it one of the most commonly used screening imaging modalities in the abdominal trauma, especially to exclude hemoperitoneum. Evaluation of the visceral and vascular injuries in a hemodynamically stable patient, however, warrants intravenous contrast-enhanced multidetector computed tomography scan. Dual-energy computed tomography with its postprocessing applications such as iodine selective imaging and virtual monoenergetic imaging can reliably depict the conspicuity of traumatic solid and hollow visceral and vascular injuries.
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Affiliation(s)
- Saira Hamid
- Emergency and Trauma Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Savvas Nicolaou
- Emergency and Trauma Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Faisal Khosa
- Emergency and Trauma Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gordon Andrews
- Emergency and Trauma Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nicolas Murray
- Emergency and Trauma Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Waleed Abdellatif
- Emergency and Trauma Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sadia Raheez Qamar
- Emergency and Trauma Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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13
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Alabousi M, Mellnick VM, Kashef Al-Ghetaa R, Patlas MN. Imaging of blunt bowel and mesenteric injuries: Current status. Eur J Radiol 2020; 125:108894. [PMID: 32092685 DOI: 10.1016/j.ejrad.2020.108894] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 02/10/2020] [Accepted: 02/11/2020] [Indexed: 12/26/2022]
Abstract
Blunt abdominal trauma often presents a diagnostic challenge. Clinical examination demonstrates low reliability in detecting abdominal injury (16 %) when there is a history of head injury or loss of consciousness. This can prove detrimental, as delays in the diagnosis of traumatic bowel injury of 8 h or less can result in increased morbidity and mortality, as well as prolonged hospitalization. Although hemodynamically unstable patients will require an urgent laparotomy following clinical assessment, MDCT is the modality of choice for comprehensive imaging of blunt abdominal trauma in hemodynamically stable patients. Despite the use of MDCT, blunt injury to the bowel and mesentery, which accounts for up to 5% of injuries in cases of trauma, may be difficult to detect. The use of a constellation of direct and indirect signs on MDCT can help make the diagnosis and guide clinical management. Direct signs on MDCT, such as bowel wall discontinuity, and extraluminal gas may assist in the diagnosis of traumatic bowel injury. However, these signs are not sensitive. Therefore, the astute radiologist may have to rely on indirect signs of injury, such as free fluid, bowel wall thickening, and abnormal bowel wall enhancement to make the diagnosis. This review will focus on MDCT imaging findings of bowel and mesenteric injuries secondary to blunt abdominal trauma.
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Affiliation(s)
- Mostafa Alabousi
- Department of Radiology, McMaster University, Hamilton, ON, Canada.
| | - Vincent M Mellnick
- Abdominal Imaging Section, Mallinckrodt Institute of Radiology, Washington University, St Louis, MO, USA.
| | - Rayeh Kashef Al-Ghetaa
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
| | - Michael N Patlas
- Department of Radiology, McMaster University, Hamilton, ON, Canada.
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14
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Ghumman Z, Monteiro S, Mellnick V, Coates A, Engels P, Patlas M. Accuracy of Preoperative MDCT in Patients With Penetrating Abdominal and Pelvic Trauma. Can Assoc Radiol J 2020; 71:231-237. [DOI: 10.1177/0846537119888375] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose: This study aims to evaluate the overall diagnostic accuracy of preoperative multidetector computed tomography (MDCT) in penetrating abdominal and pelvic injuries (PAPI). Method and Materials: We used our hospitals’ trauma registry to retrospectively identify patients with PAPI from January 1, 2006, to December 31, 2016. Only patients who had a 64-MDCT scan at presentation and subsequently underwent laparotomy or laparoscopy were included in our study cohort. Each finding noted on MDCT was rated using a 5-point scale to indicate certainty of injury, with a score of 0 being definitive. Using surgical findings as the gold standard, the accuracy of radiology reports was analyzed in 2 ways. A κ statistic was calculated to evaluate each pair of values for absolute agreement, and ratings for all organ systems were analyzed using a repeated measures analysis of variance (ANOVA) to determine whether radiology and surgical findings were similar enough to be clinically meaningful. Qualitative review of the radiology and surgical reports focused on the gastrointestinal (GI) tract was conducted. Results: Our cohort consisted of 38 males and 4 females with a median age of 29 years and a median injury severity score of 15.6. For this study, 12 different organ groups were categorized and analyzed. Of those organ groups, absolute agreement between MDCT and surgical findings was found only for liver and spleen (κ values ranging from 0.2 to 0.5). Additionally, the ANOVA revealed an interaction between finding type and organ system ( F 1, 33 = 7.4, P < .001). The most clinically significant discrepancies between MDCT and surgical findings were for gallbladder, bowel, mesenteric, and diaphragmatic injuries. Qualitative review of the GI tract revealed that radiologists can detect significant findings such as presence of injury, however, localization and extent of injury pose a challenge. Conclusion: The detection of clinically significant injuries to solid organs in trauma patients with PAPI on 64-MDCT is adequate. However, detection of injury to the remaining organ groups on MDCT, especially bowel, mesentery, and diaphragm, remains a challenge.
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Affiliation(s)
- Zonia Ghumman
- Department of Diagnostic Radiology, McMaster University, Hamilton, Ontario, Canada
| | - Sandra Monteiro
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Vincent Mellnick
- Department of Diagnostic Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Angela Coates
- Department of Trauma and Surgery, McMaster University, Hamilton General Hospital, Hamilton, Ontario, Canada
| | - Paul Engels
- Department of Trauma and Surgery, McMaster University, Hamilton General Hospital, Hamilton, Ontario, Canada
| | - Michael Patlas
- Department of Diagnostic and Emergency Radiology, McMaster University, Hamilton General Hospital, Hamilton, Ontario, Canada
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15
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Koto MZ, Matsevych OY, Mosai F, Patel S, Aldous C, Balabyeki M. Laparoscopy for blunt abdominal trauma: a challenging endeavor. Scand J Surg 2018; 108:273-279. [PMID: 30522416 DOI: 10.1177/1457496918816927] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS Laparoscopy in blunt abdominal trauma is challenging because of multiple associated injuries, higher trauma score values and higher morbidity and mortality, as compared with patients with penetrating abdominal trauma. The aim of this study was to investigate the role of laparoscopy in the management of blunt abdominal trauma patients and to highlight related challenges. MATERIAL AND METHODS Over a 4-year period, patients managed laparoscopically for blunt abdominal trauma were retrospectively analyzed. Perioperative details, indications for laparoscopy and conversion, complications, and length of hospital stay were discussed. RESULTS A total of 35 stable patients underwent laparoscopy. The mean Injury Severity Score was 12 (4-38). Therapeutic laparoscopy was performed in 15 (56%) and diagnostic in 12 (44%) patients. Eight (23%) patients were converted to therapeutic laparotomy. Intraoperative bleeding, complex injuries, visualization problem, and equipment failure necessitated conversion. Three (30%) patients with negative computed tomography scan had therapeutic laparoscopy for mesenteric injuries. There were no missed injuries. The mean length of hospital stay was 11 days in both groups. CONCLUSION Laparoscopy for stable patients is feasible and safe. Multiple injuries make laparoscopy more difficult, and advanced laparoscopic skills are required. The conversion rate is high; however, the non-therapeutic laparotomies were completely eliminated in this study.
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Affiliation(s)
- M Z Koto
- Department of Surgery, Dr George Mukhari Academic Hospital, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - O Y Matsevych
- Department of Surgery, Dr George Mukhari Academic Hospital, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - F Mosai
- Department of Surgery, Dr George Mukhari Academic Hospital, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - S Patel
- Department of Surgery, Dr George Mukhari Academic Hospital, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - C Aldous
- University of KwaZulu-Natal, Durban, South Africa
| | - M Balabyeki
- Department of Surgery, Dr George Mukhari Academic Hospital, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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16
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Loftus TJ, Morrow ML, Lottenberg L, Rosenthal MD, Croft CA, Smith RS, Moore FA, Brakenridge SC, Borrego R, Efron PA, Mohr AM. Occult bowel injury after blunt abdominal trauma. Am J Surg 2018; 218:266-270. [PMID: 30509454 DOI: 10.1016/j.amjsurg.2018.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 10/31/2018] [Accepted: 11/15/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Following blunt abdominal trauma, bowel injuries are often missed on admission computed tomography (CT) scan. METHODS Multicenter retrospective analysis of 176 adults with moderate-critical blunt abdominal trauma and admission CT scan who underwent operative exploration. Patients with a bowel injury missed on CT (n = 36, 20%) were compared to all other patients (n = 140, 80%). RESULTS The missed injury group had greater incidence free fluid without solid organ injury on CT scan (44% vs. 25%, p = 0.038) and visceral adhesions (28% vs. 6%, p = 0.001). Independent predictors of missed bowel injury included prior abdominal inflammation (OR 3.74, 95% CI 1.37-10.18), CT evidence of free fluid in the absence of solid organ injury (OR 2.31, 95% CI 1.03-5.19) and intraoperative identification of visceral adhesions (OR 4.46, 95% CI 1.52-13.13). CONCLUSIONS Patients with visceral adhesive disease and indirect evidence of bowel injury on CT scan were more likely to have occult bowel injury.
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Affiliation(s)
- Tyler J Loftus
- University of Florida Health, Department of Surgery, Gainesville, FL, USA; University of Florida Health, Sepsis and Critical Illness Research Center, Gainesville, FL, USA.
| | - Megan L Morrow
- Florida Atlantic University, Department of Surgery, Boca Raton, FL, USA; St. Mary's Medical Center, Department of Surgery, West Palm Beach, FL, USA.
| | - Lawrence Lottenberg
- Florida Atlantic University, Department of Surgery, Boca Raton, FL, USA; St. Mary's Medical Center, Department of Surgery, West Palm Beach, FL, USA.
| | - Martin D Rosenthal
- University of Florida Health, Department of Surgery, Gainesville, FL, USA; University of Florida Health, Sepsis and Critical Illness Research Center, Gainesville, FL, USA.
| | - Chasen A Croft
- University of Florida Health, Department of Surgery, Gainesville, FL, USA.
| | - R Stephen Smith
- University of Florida Health, Department of Surgery, Gainesville, FL, USA.
| | - Frederick A Moore
- University of Florida Health, Department of Surgery, Gainesville, FL, USA; University of Florida Health, Sepsis and Critical Illness Research Center, Gainesville, FL, USA.
| | - Scott C Brakenridge
- University of Florida Health, Department of Surgery, Gainesville, FL, USA; University of Florida Health, Sepsis and Critical Illness Research Center, Gainesville, FL, USA.
| | - Robert Borrego
- Florida Atlantic University, Department of Surgery, Boca Raton, FL, USA; St. Mary's Medical Center, Department of Surgery, West Palm Beach, FL, USA.
| | - Philip A Efron
- University of Florida Health, Department of Surgery, Gainesville, FL, USA; University of Florida Health, Sepsis and Critical Illness Research Center, Gainesville, FL, USA.
| | - Alicia M Mohr
- University of Florida Health, Department of Surgery, Gainesville, FL, USA; University of Florida Health, Sepsis and Critical Illness Research Center, Gainesville, FL, USA.
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17
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The Impact of Prior Laparotomy and Intra-abdominal Adhesions on Bowel and Mesenteric Injury Following Blunt Abdominal Trauma. World J Surg 2018; 43:457-465. [PMID: 30225563 DOI: 10.1007/s00268-018-4792-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Early recognition of bowel and mesenteric injury following blunt abdominal trauma remains difficult. We hypothesized that patients with intra-abdominal adhesions from prior laparotomy would be subjected to visceral sheering deceleration forces and increased risk for bowel and mesenteric injury following blunt abdominal trauma. METHODS We performed a multicenter retrospective cohort analysis of 267 consecutive adult trauma patients who underwent operative exploration following moderate-critical (abdominal injury score 2-5) blunt abdominal trauma, comparing patients with prior laparotomy (n = 31) to patients with no prior laparotomy (n = 236). Multivariable regression was performed to identify predictors of bowel or mesenteric injury. RESULTS There were no significant differences between groups for injury severity scores or findings on abdominal ultrasound, diagnostic peritoneal aspirate/lavage, pelvic radiography, or preoperative CT scan. The prior laparotomy cohort had greater incidence of full thickness bowel injury (26 vs. 9%, p = 0.010) and mesenteric injury (61 vs. 31%, p = 0.001). The proportion of bowel and mesenteric injuries occurring at the ligament of Treitz or ileocecal region was greater in the no prior laparotomy group (52 vs. 25%, p = 0.003). Prior laparotomy was an independent predictor of bowel or mesenteric injury (OR 5.1, 95% CI 1.6-16.8) along with prior abdominal inflammation and free fluid without solid organ injury (model AUC: 0.81, 95% CI 0.74-0.88). CONCLUSIONS Patients with a prior laparotomy are at increased risk for bowel and mesenteric injury following blunt abdominal trauma. The distribution of bowel and mesenteric injuries among patients with no prior laparotomy favors embryologic transition points tethering free intraperitoneal structures to the retroperitoneum.
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18
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Matsevych OY, Koto MZ, Balabyeki M, Mashego LD, Aldous C. Diagnostic laparoscopy or selective non-operative management for stable patients with penetrating abdominal trauma: What to choose? J Minim Access Surg 2018; 15:130-136. [PMID: 30178773 PMCID: PMC6438062 DOI: 10.4103/jmas.jmas_72_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Selective non-operative management (NOM) and diagnostic laparoscopy (DL) are well-accepted approaches in the management of stable patients with penetrating abdominal trauma (PAT). The aim of this pilot study was to investigate the advantages and disadvantages of early DL in stable asymptomatic or minimally symptomatic patients with PAT as opposed to NOM, a standard of care in this scenario. The secondary aim was to suggest possible indications for DL. Methods Patients managed with DL or NOM over a 12-month period were included in this study. The age, gender, mechanism and location of injuries, trauma scores, haemodynamic and metabolic parameters, intraoperative findings and length of hospital stay (LOS) were recorded and correlated with outcomes. Results Thirty-six patients were in the NOM group and 35 in the DL group. Stab wounds were more common. The most common location of injury was the anterior abdominal wall in the NOM group and the lower chest in the DL group. Computed tomography (CT) scan was performed more often in the NOM group (75% vs. 17.1%). The injury severity score (ISS), New ISS and PAT Index were higher in the DL group. Nearly 23 (66%) patients in the DL group had a penetration of the peritoneum, but no significant abdominal injuries. LOS in the NOM group was 2 days versus 3.1 days in the DL group. There were no missed injuries, complications or mortality. Conclusion NOM is a preferred modality for minimally symptomatic stable patients. However, there is a risk of missed injuries and delayed treatment. DL accurately visualizes injuries, decreases unnecessary CT scans and avoids nontherapeutic laparotomies.
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Affiliation(s)
- Oleh Yevhenovych Matsevych
- Department of Surgery, Sefako Makgatho Health Sciences University, Dr. George Mukhari Academic Hospital, Pretoria; University of KwaZulu-Natal, Nelson R Mandela (NRMSM) Campus, Durban, South Africa
| | - Modise Zacharia Koto
- Department of Surgery, Sefako Makgatho Health Sciences University, Dr. George Mukhari Academic Hospital, Pretoria; University of KwaZulu-Natal, Nelson R Mandela (NRMSM) Campus, Durban, South Africa
| | - Moses Balabyeki
- Department of Surgery, Sefako Makgatho Health Sciences University, Dr. George Mukhari Academic Hospital, Pretoria, South Africa
| | - Lehlogonolo David Mashego
- Department of Surgery, Sefako Makgatho Health Sciences University, Dr. George Mukhari Academic Hospital, Pretoria, South Africa
| | - Colleen Aldous
- University of KwaZulu-Natal, Nelson R Mandela (NRMSM) Campus, Durban, South Africa
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Choi AY, Bodanapally UK, Shapiro B, Patlas MN, Katz DS. Recent Advances in Abdominal Trauma Computed Tomography. Semin Roentgenol 2018; 53:178-186. [PMID: 29861009 DOI: 10.1053/j.ro.2018.02.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Andrew Y Choi
- Department of Radiology, NYU Winthrop Hospital, Mineola, NY.
| | - Uttam K Bodanapally
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Center, R. Adams Cowley Shock Trauma Center, Baltimore, MD
| | - Boris Shapiro
- Department of Radiology, NYU Winthrop Hospital, Mineola, NY
| | - Michael N Patlas
- Division of Emergency Radiology, Department of Radiology, McMaster University, Hamilton, ON, Canada
| | - Douglas S Katz
- Department of Radiology, NYU Winthrop Hospital, Mineola, NY
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Mingoli A, La Torre M, Brachini G, Costa G, Balducci G, Frezza B, Sgarzini G, Cirillo B. Hollow viscus injuries: predictors of outcome and role of diagnostic delay. Ther Clin Risk Manag 2017; 13:1069-1076. [PMID: 28883735 PMCID: PMC5574689 DOI: 10.2147/tcrm.s136125] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Hollow viscus injuries (HVIs) are uncommon but potentially catastrophic conditions with high mortality and morbidity rates. The aim of this study was to analyze our 16-year experience with patients undergoing surgery for blunt or penetrating bowel trauma to identify prognostic factors with particular attention to the influence of diagnostic delay on outcome. METHODS From our multicenter trauma registry, we selected 169 consecutive patients with an HVI, enrolled from 2000 to 2016. Preoperative, intraoperative, and postoperative data were analyzed to assess determinants of mortality, morbidity, and length of stay by univariate and multivariate analysis models. RESULTS Overall mortality and morbidity rates were 15.9% and 36.1%, respectively. The mean length of hospital stay was 23±7 days. Morbidity was independently related to an increase of white blood cells (P=0.01), and to delay of treatment >6 hours (P=0.033), while Injury Severity Score (ISS) (P=0.01), presence of shock (P=0.01), and a low diastolic arterial pressure registered at emergency room admission (P=0.02) significantly affected postoperative mortality. CONCLUSION There is evidence that patients with clinical signs of shock, low diastolic pressure at admission, and high ISS are at increased risk of postoperative mortality. Leukocytosis and delayed treatment (>6 hours) were independent predictors of postoperative morbidity. More effort should be made to increase the preoperative detection rate of HVI and reduce the delay of treatment.
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Affiliation(s)
- Andrea Mingoli
- Emergency Department, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
- Department of Surgery P Valdoni, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Marco La Torre
- Emergency Department, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
- Department of Surgery P Valdoni, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Gioia Brachini
- Emergency Department, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
- Department of Surgery P Valdoni, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Gianluca Costa
- Surgical Department of Clinical Sciences, Biomedical Technologies and Translational Medicine, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Genoveffa Balducci
- Surgical Department of Clinical Sciences, Biomedical Technologies and Translational Medicine, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Barbara Frezza
- Surgical Department of Clinical Sciences, Biomedical Technologies and Translational Medicine, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Bruno Cirillo
- Emergency Department, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
- Department of Surgery P Valdoni, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
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Laparoscopic-assisted approach for penetrating abdominal trauma: A solution for multiple bowel injuries. Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.06.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Patlas MN. Invited Commentary on “Multidetector CT of Surgically Proven Blunt Bowel and Mesenteric Injury”. Radiographics 2017; 37:625-627. [DOI: 10.1148/rg.2017160183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Michael N. Patlas
- Department of Radiology, Hamilton General Hospital Hamilton, Ontario, Canada
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