Diagnostic techniques in thoracic trauma

Offshore telementored ultrasound: a quality assessment study

Background

Telementored ultrasound (US) connects experts to novices through various types of communication and network technologies with the overall aim to bridge the medical imaging gap between patients’ diagnostic needs and on-site user experience. The recurrent theme in previous research on remote telementored US is the limited access to US machines and experienced users. This study was conducted to determine whether telementored US was feasible in a remote offshore setting. The aim was to assess if an onshore US expert can guide an offshore nurse through focused US scanning protocols by connecting an US machine to existing videoconference units at the offshore hospitals and to evaluate the diagnostic quality of the images and cineloops procured.

Results

The diagnostic quality of cineloops was scored on a five-point scale. The percentage of cineloops suitable for interpretation (score 3 ≥) for the FATE and e-FAST protocols was 96.4 and 79.1. Lung sliding and seashore sign could be identified in all volunteers. The scan time for the FAST protocol (n = four scanning positions), FATE protocol (n = six scanning positions) and both lungs (n = two scanning positions) was 1 min 20 s, 4 min 15 s and 32 s, respectively.

Conclusion

A novice US user can be guided by a remote expert through focused US protocols within an acceptable time frame and with good diagnostic quality using existing communication and network systems found onboard offshore oil rigs.

Digital radiography of crush thoracic trauma in the Sichuan earthquake

AIM: To investigate the features of crush thoracic trauma in Sichuan earthquake victims using chest digital radiography (CDR).

METHODS: We retrospectively reviewed 772 CDR of 417 females and 355 males who had suffered crush thoracic trauma in the Sichuan earthquake. Patient age ranged from 0.5 to 103 years. CDR was performed between May 12, 2008 and June 7, 2008. We looked for injury to the thoracic cage, pulmonary parenchyma and the pleura.

RESULTS: Antero-posterior (AP) and lateral CDR were obtained in 349 patients, the remaining 423 patients underwent only AP CDR. Thoracic cage fractures, pulmonary contusion and pleural injuries were noted in 331 (42.9%; 95% CI: 39.4%-46.4%), 67 and 135 patients, respectively. Of the 256 patients with rib fractures, the mean number of fractured ribs per patient was 3. Rib fractures were mostly distributed from the 3rd through to the 8th ribs and the vast majority involved posterior and lateral locations along the rib. Rib fractures had a significant positive association with non-rib thoracic fractures, pulmonary contusion and pleural injuries (P < 0.001). The number of rib fractures and pulmonary contusions were significant factors associated with patient death.

CONCLUSION: Earthquake-related crush thoracic trauma has the potential for multiple fractures. The high number of fractured ribs and pulmonary contusions were significant factors which needed appropriate medical treatment.

Earthquake-related injuries: evaluation with multidetector computed tomography and digital radiography of 1491 patients

PURPOSE

The aim of this study was to evaluate the common features of earthquake-related injuries using radiography and computed tomography.

MATERIALS AND METHODS

We retrospectively reviewed the radiography and multidetector computed tomography features of 1491 patients injured in 2008 Sichuan earthquake. We categorized patients by age group (<35, 35-64, and ≥ 65 years) and time to imaging. Injuries were categorized by anatomical distribution.

RESULTS

We detected earthquake-related trauma in 1197 patients (80.28%), including head injuries, facial fractures, thoracic injuries, abdominal injuries, pelvic fractures, spinal injuries, and extremity fractures in 91, 41, 354, 30, 204, 299, and 732 (61.15%) patients, respectively (χ(2) = 1844.747, P < .001). Injuries in 2 or more anatomical locations occurred in 384 cases. We discovered significant difference in the anatomical distribution of injuries among the 3 age groups (χ(2) = 104.113, P < .001) and among the time-to-imaging categories (χ(2) = 64.420, P < .001). Twenty-two patients (1.48%) eventually died. Abdominal injuries (B = 2.285, P = .004), head injuries (B = 2.194, P < .001), thoracic injuries (B = 1.989, P < .001), and age (B = 1.539, P < .001) were all associated with patient death.

CONCLUSIONS

The Sichuan earthquake most commonly resulted in extremity fractures, but there was a high incidence of injuries to multiple body areas. Head, abdominal, and thoracic injuries and age older than 64 years all were significant risk factors for earthquake mortality.