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Giangrosso GV, Bayliss T, Rahimpour A, Murphy A, Ray P, Denning D, Barry R. Cost-Benefit Analysis of the CT of the Face in the Evaluation of Traumatic Facial Fractures in an Appalachian Tri-state Geriatric Population. Cureus 2024; 16:e63830. [PMID: 39099990 PMCID: PMC11297675 DOI: 10.7759/cureus.63830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2024] [Indexed: 08/06/2024] Open
Abstract
OBJECTIVE This study aimed to evaluate the cost vs. benefits of the CT face imaging study in the trauma workup of those over the age of 65. METHODS We performed a retrospective chart review of 169 trauma patients in our trauma database aged 65 years or older who underwent a CT of the head, a CT of the face, or a CT of the head and CT of the face that resulted in findings of a facial fracture from 2017-2022. Injuries and the treatment they received were documented. If a patient underwent both a CT of the face and a CT of the head, then the author first viewed the CT of the head, documented any injury, and then recorded treatment based on the CT of the head. The CT of the face was then viewed, injuries were recorded, and treatment based on the CT of the face was documented. Statistical analysis was then performed using the paired T-test, McNemar test, and number needed to harm analysis. RESULTS Of the 169 patients sampled, 159 underwent both CT of the head and the face. There were no patients who underwent a CT of the face exclusively, and only 10 patients underwent a CT of the head exclusively. Of the 159 that had both a CT of the head and the face, the average number of injuries noted on CT of the head + CT of the face vs. CT of the head was 2.42 vs. 1.36, P<.0.0001. The number needed to avoid missing a surgical facial fracture when only a CT of the head was obtained was 14.68. CONCLUSION The risks of missing a surgical facial fracture outweigh the monetary, radiation, and patient-desired necessity benefits of only performing a CT of the head. A CT of the face should be included in the trauma workup for those over the age of 65 when facial fractures are suspected.
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Affiliation(s)
- Gerard V Giangrosso
- General Surgery, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Ty Bayliss
- General Surgery, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Armein Rahimpour
- General Surgery, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Abigail Murphy
- General Surgery, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Peter Ray
- Plastic Surgery, King's Daughters Medical Center, Ashland, USA
- Plastic and Reconstructive Surgery, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - David Denning
- General Surgery, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Rahman Barry
- Plastic and Reconstructive Surgery, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
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Bahramian M, Shahbazi P, Hemmati N, Mohebzadeh P, Najafi A. Extremity Fractures as the Most Common Missed Injuries: A Prospective Cohort in Intensive Care Unit Admitted Multiple Trauma Patients. Indian J Crit Care Med 2023; 27:201-204. [PMID: 36960108 PMCID: PMC10028718 DOI: 10.5005/jp-journals-10071-24426] [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: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 03/05/2023] Open
Abstract
Background Although an intensive care unit (ICU) admission is a risk factor for missed injury, there has been some disagreement on whether missed injuries in trauma ICU patients have a longer length of stay (LOS). With this in mind, these patients' frequency of missed injuries and related factors were investigated. Materials and methods This was a prospective cohort study on multiple trauma injury patients in a tertiary referral trauma center's trauma intensive care unit (TICU) from March 2020 to March 2021. A tertiary survey was conducted in the TICU by attending physicians to find the types I and II missed injuries (any injury discovered after primary and secondary surveys during the hospital stay). A logistic regression model was designed for predictors of missed injuries in ICU-admitted multiple trauma patients. Results Out of 290 study participants, 1,430 injuries were found, and of those injuries, 74 cases (25.5%) had missed injuries. In other words, there were 103 missed injuries, resulting in a missed injury detection rate of 7.2%. The most frequently missed injuries (43.4%) were concluded as extremities fractures. The regression model showed that the patients with missed injuries are prone to longer TICU LOS [odds ratio (OR) = 1.15; p = 0.033], and cases who underwent a computed tomography (CT) scan are less likely to have missed injuries (OR = 0.04; p < 0.001). The abbreviated injury scale (AIS) range was 1-3 in missed injuries. Conclusion Our research underlines the importance of finding missed injuries and the necessity of CT scan to decrease them. In teaching centers, life-threatening injuries decrease with increasing visits and examination times. Although these missed injuries do not increase mortality, they cause longer TICU LOS and costs. How to cite this article Bahramian M, Shahbazi P, Hemmati N, Mohebzadeh P, Najafi A. Extremity Fractures as the Most Common Missed Injuries: A Prospective Cohort in Intensive Care Unit Admitted Multiple Trauma Patients. Indian J Crit Care Med 2023;27(3):201-204.
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Affiliation(s)
- Mehran Bahramian
- Department of Emergency Medicine, Shahid Madani Hospital, Alborz University of Medical Sciences, Karaj, Iran
| | - Parmida Shahbazi
- Department of Orthopedic Surgery, Shahid Madani Hospital, Alborz University of Medical Sciences, Karaj, Iran
| | - Nima Hemmati
- Firoozgar Clinical Research Development Center (FCRDC), Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Parisa Mohebzadeh
- Department of Emergency Medicine, Shahid Madani Hospital, Alborz University of Medical Sciences, Karaj, Iran
| | - Arvin Najafi
- Department of Orthopedic Surgery, Shahid Madani Hospital, Alborz University of Medical Sciences, Karaj, Iran
- Arvin Najafi, Department of Orthopedic Surgery, Shahid Madani Hospital, Alborz University of Medical Sciences, Karaj, Iran, Phone: +98 9128576268, e-mail:
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Al Babtain I, Almalki Y, Asiri D, Masud N. Prevalence of Missed Injuries in Multiple Trauma Patients at a Level-1 Trauma Center in Saudi Arabia. Cureus 2023; 15:e34805. [PMID: 36923204 PMCID: PMC10010447 DOI: 10.7759/cureus.34805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2023] [Indexed: 02/11/2023] Open
Abstract
Background Missed injuries are defined as injuries neither detected in the emergency department (ED) nor after admission to the hospital. The objective of this research was to identify missed injury rates, contributing factors, and clinical outcomes. Methods A total of 657 trauma patients' records were retrospectively reviewed after admission to King Abdulaziz Medical City (KAMC) during the period from January 2016 to December 2018. Patients' demographic characteristics, presence of a missed injury, and Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), and Injury Severity Score (ISS) were assessed. Results Among 657 patients who were admitted to our emergency department, only 11 (1.7%) patients were reported to have a missed injury during the hospital stay. None of those missed injuries contributed to the overall mortality. Higher GCS is a protective factor for missed injury with OR=0.12-0.81 and p-value=0.01. RTS and intensive care unit (ICU) stays were borderline although p-value=0.05 and OR=9 for RTS. Both longer ICU stays and high RTS were related to a higher risk of missed injury. Conclusion In our study, the prevalence of missed injuries was on the lower end of the spectrum in comparison to multiple published data. The most common missed injuries were fractures and joint dislocations of extremities. None of those missed injuries were life-threatening or contributed to overall mortality. Higher GCS was a protective factor against missed injuries while high RTS and longer ICU stays were related to a higher likelihood of developing missed injuries during the hospital course.
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Affiliation(s)
| | - Yara Almalki
- General Surgery, King Abdulaziz Medical City, Riyadh, SAU
| | - Deemah Asiri
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Nazish Masud
- Department of Biostatistics, Epidemiology and Environmental Health Sciences, Georgia Southern University, Statesboro, USA
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4
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Parson M, Pickard A, Simpson D, Treece M, Rampersad L. UK-wide major trauma center tertiary trauma survey pro forma review and aggregation and consolidation into a redesigned document. Trauma Surg Acute Care Open 2023; 8:e000903. [PMID: 36632529 PMCID: PMC9827263 DOI: 10.1136/tsaco-2022-000903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 03/15/2022] [Indexed: 01/09/2023] Open
Abstract
Objectives The trauma tertiary survey (TTS) is an essential part of the continued care for major trauma patients which is performed to ensure that all injuries have been identified and none have been overlooked during the patient's stay. Although the Advanced Trauma Life Support Course states a need for a tertiary survey, there is currently no standard for what this survey comprises. Methods Using local consultant expert opinion and a literature search we identified a set of 32 TTS potential features that may be included within a TTS pro forma. Major trauma center (MTC) documents were requested from every MTC within the UK. 4 investigators sequentially interrogated each MTC TTS document looking for (1) presence of each feature and (2) how well the feature was represented on the document (0 to 4 Likert Scale). Any previously unidentified potential TTS features were noted and later reviewed for a second round of document analysis. Results A total of 21 out of all 26 UK MTCs had a TTS pro forma document. A total of 68 possible features were identified. Respiratory and Abdominal assessment sections were the most frequently identified features (present in 90.4% of the TTS pro formas; n=19. Neck assessment and neurological assessment were included within 85.7% of the TTS pro formas (n=18). Further aspects identified for Round 2 analysis typically included features that were thought to be important but highly specific. For example, pregnancy test and DNACPR discussions were found in 1 MTC TTS each (4%). Conclusion This article presents a review of the existing documents at 21 MTCs in the UK, identification of features used and proposes a gold standard TTS which can be used by any doctor to perform the tertiary survey and reduce the risk of missed injuries in trauma patients. Level of Evidence 3.
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Affiliation(s)
- Mark Parson
- Anaesthetics, Royal Sussex County Hospital, Brighton, UK
| | - Adam Pickard
- Intensive Care Medicine, Royal Sussex County Hospital, Brighton, UK
| | - Dan Simpson
- Intensive Care Medicine, Royal Sussex County Hospital, Brighton, UK
| | - Michael Treece
- Emergency Department, Medway Maritime Hospital, Gillingham, UK
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Smyth L, Bendinelli C, Lee N, Reeds MG, Loh EJ, Amico F, Balogh ZJ, Di Saverio S, Weber D, Ten Broek RP, Abu-Zidan FM, Campanelli G, Beka SG, Chiarugi M, Shelat VG, Tan E, Moore E, Bonavina L, Latifi R, Hecker A, Khan J, Coimbra R, Tebala GD, Søreide K, Wani I, Inaba K, Kirkpatrick AW, Koike K, Sganga G, Biffl WL, Chiara O, Scalea TM, Fraga GP, Peitzman AB, Catena F. WSES guidelines on blunt and penetrating bowel injury: diagnosis, investigations, and treatment. World J Emerg Surg 2022; 17:13. [PMID: 35246190 PMCID: PMC8896237 DOI: 10.1186/s13017-022-00418-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 01/26/2022] [Indexed: 02/08/2023] Open
Abstract
The aim of this paper was to review the recent literature to create recommendations for the day-to-day diagnosis and surgical management of small bowel and colon injuries. Where knowledge gaps were identified, expert consensus was pursued during the 8th International Congress of the World Society of Emergency Surgery Annual (September 2021, Edinburgh). This process also aimed to guide future research.
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Affiliation(s)
- Luke Smyth
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Cino Bendinelli
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia.
| | - Nicholas Lee
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Matthew G Reeds
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Eu Jhin Loh
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Francesco Amico
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Zsolt J Balogh
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | | | - Dieter Weber
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | | | - Fikri M Abu-Zidan
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | | | - Solomon Gurmu Beka
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Massimo Chiarugi
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Vishal G Shelat
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Edward Tan
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Ernest Moore
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Luigi Bonavina
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Rifat Latifi
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Andreas Hecker
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Jim Khan
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Raul Coimbra
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Giovanni D Tebala
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Kjetil Søreide
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Imtiaz Wani
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Kenji Inaba
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | | | - Kaoru Koike
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Gabriele Sganga
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Walter L Biffl
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Osvaldo Chiara
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Thomas M Scalea
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Gustavo P Fraga
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Andrew B Peitzman
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Fausto Catena
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
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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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Suda AJ, Baran K, Brunnemer S, Köck M, Obertacke U, Eschmann D. Delayed diagnosed trauma in severely injured patients despite guidelines-oriented emergency room treatment: there is still a risk. Eur J Trauma Emerg Surg 2021; 48:2183-2188. [PMID: 34327544 PMCID: PMC9192381 DOI: 10.1007/s00068-021-01754-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 07/18/2021] [Indexed: 11/28/2022]
Abstract
Purpose Emergency trauma room treatment follows established algorithms such as ATLS®. Nevertheless, there are injuries that are not immediately recognized here. The aim of this study was to evaluate the residual risk for manifesting life-threatening injuries despite strict adherence to trauma room guidelines, which is different to missed injuries that describe recognizable injuries. Methods In a retrospective study, we included 2694 consecutive patients admitted to the emergency trauma room of one single level I trauma center between 2016 and 2019. In accordance with the trauma room algorithm, primary and secondary survey, trauma whole-body CT scan, eFAST, and tertiary survey were performed. Patients who needed emergency surgery during their hospital stay for additional injury found after guidelines-oriented emergency trauma room treatment were analyzed. Results In seven patients (0.26%; mean age 50.4 years, range 18–90; mean ISS 39.7, range 34–50), a life-threatening injury occurred in the further course: one epidural bleeding (13 h after tertiary survey) and six abdominal hollow organ injuries (range 5.5 h–4 days after tertiary survey). Two patients (0.07% overall) with abdominal injury died. The “number needed to fail” was 385 (95%–CI 0.0010–0.0053). Conclusion Our study reveals a remaining risk for delayed diagnosis of potentially lethal injuries despite accurate emergency trauma room algorithms. In other words, there were missed injuries that could have been identified using this algorithm but were missed due to other reasons. Continuous clinical and instrument-based examinations should, therefore, not be neglected after completion of the tertiary survey. Level of evidence Level II: Development of diagnostic criteria on the basis of consecutive patients (with universally applied reference “gold” standard).
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Affiliation(s)
- Arnold J Suda
- Department of Orthopaedics and Trauma Surgery, AUVA Trauma Center Salzburg, Academic Teaching Hospital of Paracelsus Medical University, Dr. Franz-Rehrl-Platz 5, 5010, Salzburg, Austria.
| | - Kristine Baran
- Department of Orthopaedics and Trauma, Medical Faculty, University Medical Center Mannheim, Mannheim of Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Suna Brunnemer
- Department of Orthopaedics and Trauma, Medical Faculty, University Medical Center Mannheim, Mannheim of Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Manuela Köck
- Department of Orthopaedics and Trauma, Medical Faculty, University Medical Center Mannheim, Mannheim of Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Udo Obertacke
- Department of Orthopaedics and Trauma, Medical Faculty, University Medical Center Mannheim, Mannheim of Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - David Eschmann
- Department of Orthopaedics and Trauma, Medical Faculty, University Medical Center Mannheim, Mannheim of Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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Wadhwa M, Kumar R, Trehan M, Singla S, Sharma R, Ahmed A, Sharma R. Blunt Abdominal Trauma With Hollow Viscus and Mesenteric Injury: A Prospective Study of 50 Cases. Cureus 2021; 13:e13321. [PMID: 33738164 PMCID: PMC7957336 DOI: 10.7759/cureus.13321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction Hollow viscus injury following blunt abdominal trauma is an infrequent diagnosis. Blunt hollow viscus and mesenteric injury (HVMI) is not only an uncommon finding but its timely diagnosis is also difficult. Due to its less frequency, this injury has not been studied in detail prospectively. Aims and objectives The aim of this study is to determine the causes, pattern, management, and outcome of HVMI following blunt abdominal trauma. Methodology This study was conducted from January 2015 to June 2016 in a high-volume tertiary care trauma center and teaching hospital in North India. All patients with blunt HVMI admitted during this period were included in this study. Data were collected regarding medical history, physical findings, demographics, injury dates and times, laboratory results, diagnostic tests, delay in surgical intervention, type of surgical procedure performed, site of injury, complications, and mortality. Results Out of a total of 6,570 trauma admissions, 465 blunt abdominal injuries were identified, and HVMI was found only in 50 patients. The small bowel was the most common injury, with the jejunum being the most commonly involved segment. All patients were managed surgically. The mean time to operative intervention after hospital admission was 4.5 hours (IQR: 2-8 hours). Primary repair was performed in 54% of patients. Mortality rate was high in patients with HVMI (22% patients). Septic shock was the most common cause of death. Conclusion Hollow viscus injury in blunt abdominal trauma is not so common finding. Early diagnosis and treatment is an important but difficult task. Prognosis depends on age, associated injuries, co-morbid conditions, and delay in operative intervention.
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Affiliation(s)
- Manish Wadhwa
- Surgery, Maharishi Markandeshwar Medical College and Hospital, Solan, IND
| | - Rajesh Kumar
- Surgery, Maharishi Markandeshwar Medical College and Hospital, Solan, IND
| | - Munish Trehan
- Surgery, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Sanjeev Singla
- Surgery, Dayanand Medical College and Hospital, Ludhiana, IND
| | - R Sharma
- Surgery, Maharishi Markandeshwar Medical College and Hospital, Solan, IND
| | - Asma Ahmed
- General Surgery, Ramaiah Medical College and Hospital, Bangalore, IND
| | - Renuka Sharma
- Surgery, Maharishi Markandeshwar Medical College and Hospital, Solan, IND
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9
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Munera F, Martin A. Use of Triaging Algorithms to Decrease CT Use Following Blunt Head and Neck Trauma. Radiology 2021; 298:630-631. [PMID: 33439099 DOI: 10.1148/radiol.2021204103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Felipe Munera
- From the Department of Radiology, University of Miami Miller School of Medicine, Jackson Memorial Hospital/Ryder Trauma Center, 1611 NW 12th Ave, WW-279, Miami, FL 33136
| | - Adam Martin
- From the Department of Radiology, University of Miami Miller School of Medicine, Jackson Memorial Hospital/Ryder Trauma Center, 1611 NW 12th Ave, WW-279, Miami, FL 33136
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10
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Yehia Elbarmelgi M, AbdAllah Salman M. Role of conservative management in low energy transfer penetrating shotgun abdominal injuries. TRAUMA-ENGLAND 2020. [DOI: 10.1177/1460408620916630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and aims Penetrating abdominal trauma can be caused by a variety of weapons which require different management protocols. After a long era of mandatory laparotomy for abdominal gunshot wounds, the concept of selective laparotomy and conservative management in the form of serial observations has been introduced in some centers. This study aims to assess the feasibility and safety of conservative management and close observation of victims of low energy transfer shotgun penetrating abdominal injury. Methods A prospective cohort study of hemodynamically stable patients who had sustained low energy transfer shotgun injuries to the abdomen who presented to the surgical emergency department of Cairo University Hospitals from May 2016 to January 2019. They were subjected to a conservative management and follow-up protocol. Results A total of 250 patients (167 males and 83 females) were included. The conservative management protocol was successful in 217/250 patients (86.8%), unsuccessful in 22 patients (8.8%) where abdominal exploration was done either open or laparoscopically. Delayed diagnosis of bowel injury occurred in one patient (0.4%). There was one death (0.4%) and abdominal exploration was negative in 10 (4%) patients. Conclusion We recommend this conservative protocol for the victims of low energy transfer penetrating shotgun injuries which may save many patients from the morbidities of unnecessary laparotomy. We accept that the injury pattern may not be sufficiently common in many countries to allow comfort with this non-operative approach.
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11
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Azuma M, Nakada H, Kitatani K, Shinkawa N, Khant ZA, Ochiai H, Hirai T. Conditional unnecessity of head CT for whole-body CT of traffic accident victims: a pilot study. Emerg Radiol 2020; 28:273-278. [PMID: 32918636 DOI: 10.1007/s10140-020-01851-9] [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: 07/10/2020] [Accepted: 09/04/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate whether head CT should be included in whole-body CT in road traffic accident victims. METHODS A review of electronic medical records identified 124 patients (81 males, 43 females; age 4 to 92 years, mean 47.7 years) involved in a road traffic accident in a 12-month period. All had undergone whole-body CT and physical and neurologic examinations. We recorded their age, sex, Glasgow Coma Scale (GCS), systolic blood pressure (SBP), the type of traffic accident, and the presence/absence of visible trauma above the clavicles (VTCs) and of acute traumatic brain injury (TBI) on CT. Statistical analyses were performed to evaluate predictors of acute TBI. RESULTS Of 124 patients, 34 (27%) manifested acute TBI on CT. Univariate analysis identified their age, GCS, SBP, VTCs, and the accident type as statistically significant factors for acute TBI (p < 0.05). Multivariate analysis demonstrated VTCs, GCS score < 15, and SBP ≤ 90 mmHg were significant independent predictors of acute TBI (p = 0.001, p = 0.001, and p = 0.004, respectively); the odds ratio was 16.07 for VTCs, 14.85 for GCS score < 15, and 13.78 for SBP ≤ 90 mmHg. No patients without both decrease in GCS score and VTCs manifested acute TBI. CONCLUSION Our pilot study showed that visible trauma above the clavicles and decrease in GCS score were highly associated with the presence of acute TBI in road traffic accident victims. In whole-body CT, a head CT may not be indicated in patients without these factors.
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Affiliation(s)
- Minako Azuma
- Department of Radiology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
| | - Hiroshi Nakada
- Department of Radiology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Keiji Kitatani
- Department of Radiology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Norihiro Shinkawa
- Department of Radiology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Zaw Aung Khant
- Department of Radiology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Hidenobu Ochiai
- Center for Emergency and Critical Care Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Toshinori Hirai
- Department of Radiology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
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12
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Durso AM, Paes FM, Caban K, Danton G, Braga TA, Sanchez A, Munera F. Evaluation of penetrating abdominal and pelvic trauma. Eur J Radiol 2020; 130:109187. [DOI: 10.1016/j.ejrad.2020.109187] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 07/11/2020] [Accepted: 07/17/2020] [Indexed: 12/17/2022]
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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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Beak P, Gabbott B, Williamson M, Hing CB. Four years of experience as a major trauma centre results in no improvement in patient selection for whole-body CT scans following blunt trauma. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 30:473-477. [PMID: 31705403 DOI: 10.1007/s00590-019-02592-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 11/02/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Management of major trauma patients with evidence of polytrauma involves the use of immediate whole-body CT (WBCT). Identification of patients appropriate for immediate WBCT remains challenging. Our study aimed to assess for improvement in patient selection for WBCT over time as a major trauma centre (MTC). METHODS We conducted a retrospective study of patients who presented to our MTC during distinct two-month periods, one in 2013 and the other in 2017. Patients over 18 years of age who presented primarily following blunt trauma and activated a major trauma call were included. All patients underwent either immediate WBCT or standard ATLS workup. Those undergoing WBCT had the results of their scan recorded as positive or negative. RESULTS A total of 516 patients were included, 232 from 2 months in 2013 and 284 from 2 months in 2017. There was no significant difference in the proportion of patients undergoing WBCT (61.6% vs 59.5%), selective CT (31.9% vs 32.4%) or no CT (6.5% vs 8.1%) between the cohorts. There was no improvement in the rate of negative WBCT observed between 2013 and 2017 (47.6% vs 39.6%, p = 0.17). CONCLUSION There was no improvement in patient selection for WBCT following trauma at our institution over a three-year period. Optimal patient selection presents an ongoing clinical challenge, with 39-47% of patients undergoing a scan demonstrating no injuries.
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Affiliation(s)
- Philip Beak
- Department of Trauma and Orthopaedics, St George's Hospital, St George's University Hospitals NHS Foundation Trust, London, UK.
| | - Ben Gabbott
- Department of Trauma and Orthopaedics, St George's Hospital, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Michael Williamson
- Department of Trauma and Orthopaedics, St George's Hospital, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Caroline B Hing
- Department of Trauma and Orthopaedics, St George's Hospital, St George's University Hospitals NHS Foundation Trust, London, UK
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15
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Lannes F, Scemama U, Maignan A, Boyer L, Beyer-Berjot L, Berdah SV, Chaumoître K, Leone M, Bège T. Value of early repeated abdominal CT in selective non-operative management for blunt bowel and mesenteric injury. Eur Radiol 2019; 29:5932-5940. [PMID: 31025065 DOI: 10.1007/s00330-019-06212-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 03/28/2019] [Accepted: 04/02/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To evaluate the performance of an early repeated computed tomography (rCT) in initially non-operated patients with blunt bowel and mesenteric injuries (BBMI). METHODS This was a monocentric retrospective observational study from 2009 to 2017 of patients with a BBMI on initial CT (iCT). Patients initially non-operated on were scheduled for a rCT within 48 h. Initial CT and rCT diagnostic performance were compared based on a surgical injury prediction score previously described. For statistical analysis, we used the chi-square analyses for paired data (McNemar test). RESULTS Eighty-four patients (1.9% of trauma) had suspected BBMI on iCT. Among these patients, 22 (26.2%) were initially operated on, 18 (21.4%) were later operated on, and 44 (52.4%) were not operated on. The therapeutic laparotomy rate was 85%. Thirty-four patients initially non-operated on had a rCT. The absolute value of the CT scan score increased for 15 patients (44.1%). The early rCT diagnostic performance, compared with iCT, showed an increase in sensitivity (from 63.6 to 91.7%), in negative predictive value (from 77.4 to 94.7%), and in AUC (from 0.77 to 0.94). CONCLUSION In initially non-operated patients with BBMI lesions, the performance of an early rCT improved the sensitivity of lesion detection requiring surgical repair and the security of patient selection for non-operative treatment. KEY POINTS • Selective non-operative treatment for hemodynamically stable patients with blunt bowel and/or mesenteric injuries on CT is developing but remains controversial. • An early repeated CT improved the sensitivity of lesion detection requiring surgical repair and the security of patient selection for conservative treatment.
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Affiliation(s)
- F Lannes
- Aix-Marseille University, Marseille, France. .,Department of General Surgery, APHM, CHU Nord, Marseille, France.
| | - U Scemama
- Aix-Marseille University, Marseille, France.,Department of Radiology, APHM, CHU Nordz, Marseille, France
| | - A Maignan
- Aix-Marseille University, Marseille, France.,Department of General Surgery, APHM, CHU Timone, Marseille, France
| | - L Boyer
- Aix-Marseille University, Marseille, France.,Public Health and Chronic Disease Research Unit, APHM, CHU Timone, Marseille, France
| | - L Beyer-Berjot
- Department of General Surgery, APHM, CHU Nord, Marseille, France.,LBA UMR T24, Aix-Marseille University, Marseille, France
| | - S V Berdah
- Department of General Surgery, APHM, CHU Nord, Marseille, France.,LBA UMR T24, Aix-Marseille University, Marseille, France
| | - K Chaumoître
- Aix-Marseille University, Marseille, France.,Department of Radiology, APHM, CHU Nordz, Marseille, France
| | - M Leone
- Aix-Marseille University, Marseille, France.,Department of Anesthesiology and Reanimation, APHM, CHU Nord, Marseille, France
| | - T Bège
- Department of General Surgery, APHM, CHU Nord, Marseille, France.,LBA UMR T24, Aix-Marseille University, Marseille, France
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Mattsson B, Ertman D, Exadaktylos AK, Martinolli L, Hautz WE. Now you see me: a pragmatic cohort study comparing first and final radiological diagnoses in the emergency department. BMJ Open 2018; 8:e020230. [PMID: 29331979 PMCID: PMC5781021 DOI: 10.1136/bmjopen-2017-020230] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES To (1) compare timely but preliminary and definitive but delayed radiological reports in a large urban level 1 trauma centre, (2) assess the clinical significance of their differences and (3) identify clinical predictors of such differences. DESIGN, SETTING AND PARTICIPANTS We performed a retrospective record review for all 2914 patients who presented to our university affiliated emergency department (ED) during a 6-week period. In those that underwent radiological imaging, we compared the patients' discharge letter from the ED to the definitive radiological report. All identified discrepancies were assessed regarding their clinical significance by trained raters, independent and in duplicate. A binary logistic regression was performed to calculate the likelihood of discrepancies based on readily available clinical data. RESULTS 1522 patients had radiographic examinations performed. Rater agreement on the clinical significance of identified discrepancies was substantial (kappa=0.86). We found an overall discrepancy rate of 20.35% of which about one-third (7.48% overall) are clinically relevant. A logistic regression identified patients' age, the imaging modality and the anatomic region under investigation to be predictive of future discrepancies. CONCLUSIONS Discrepancies between radiological diagnoses in the ED are frequent and readily available clinical factors predict their likelihood. Emergency physicians should reconsider their discharge diagnosis especially in older patients undergoing CT scans of more than one anatomic region.
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Affiliation(s)
- Björn Mattsson
- Departement des urgences, Hôpital neuchâtelois, Neuchâtel, Switzerland
| | - David Ertman
- Department of Emergency Medicine, Inselspital (University Hospital of Bern), Bern, Switzerland
| | | | | | - Wolf E Hautz
- Department of Emergency Medicine, Inselspital (University Hospital of Bern), Bern, Switzerland
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17
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Lucas JW, Chen A, Simhan J. The Role of Surgery in the Management of Complex Extraperitoneal Bladder Injury. CURRENT TRAUMA REPORTS 2017. [DOI: 10.1007/s40719-017-0107-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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18
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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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19
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Naiem AA, Taqi KM, Al-Kendi BH, Al-Qadhi H. Missed Gastric Injuries in Blunt Abdominal Trauma: Case report with review of literature. Sultan Qaboos Univ Med J 2016; 16:e508-e510. [PMID: 28003902 DOI: 10.18295/squmj.2016.16.04.019] [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: 04/09/2016] [Revised: 06/07/2016] [Accepted: 06/30/2016] [Indexed: 11/16/2022] Open
Abstract
Hollow viscus injuries of the digestive tract are an uncommon occurrence in blunt abdominal trauma. We report a 39-year-old male who was hit by a vehicle as a pedestrian and admitted to the Sultan Qaboos University Hospital, Muscat, Oman, in 2015. He underwent an exploratory laparotomy which revealed injuries to the distal stomach, liver and descending colon. Postoperatively, the patient was febrile, tachycardic and hypotensive. Abdominal examination revealed distention and tenderness. The next day, a repeat laparotomy identified a gastric injury which had not been diagnosed during the initial laparotomy. Although the defect was repaired, the patient subsequently died as a result of multiorgan failure. Missed gastric injuries are rare and are associated with a grave prognosis, particularly for trauma patients. Delays in diagnosis, in addition to associated injuries, contribute to a high mortality rate.
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Affiliation(s)
- Ahmed A Naiem
- General Surgery Residency Program, Oman Medical Specialty Board, Muscat, Oman
| | - Kadhim M Taqi
- General Surgery Residency Program, Oman Medical Specialty Board, Muscat, Oman
| | - Badriya H Al-Kendi
- General Surgery Residency Program, Oman Medical Specialty Board, Muscat, Oman
| | - Hani Al-Qadhi
- Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman
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20
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Swarbrick MT, Powell SE, Haggett EF. Computed tomography of nuchal ligament andsemispinalis capitistendon avulsions in a foal. EQUINE VET EDUC 2016. [DOI: 10.1111/eve.12627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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21
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Shannon L, Peachey T, Skipper N, Adiotomre E, Chopra A, Marappan B, Kotnis N. Comparison of clinically suspected injuries with injuries detected at whole-body CT in suspected multi-trauma victims. Clin Radiol 2015. [DOI: 10.1016/j.crad.2015.06.084] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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22
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Zou Q, Fu Q. Diagnosis and treatment of acute urogenital and genitalia tract traumas: 10-year clinical experience. Pak J Med Sci 2015; 31:925-9. [PMID: 26430431 PMCID: PMC4590363 DOI: 10.12669/pjms.314.6116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: To report our 10-year diagnosis and treatment experience of acute urogenital and genitalia tract traumas and outline the management of the traumatic injury. Methods: We reviewed the diagnoses and treatments of 208 cases of acute kidney, ureter, bladder, urethra, or male genitalia injuries in our department between March 2002 and March 2012. The patient data including general information, injury position and mechanism, diagnosis and treatment, the follow-up information was analyzed and summarized. Results: Of 62 patients with renal injury examined by ultrasound and computed tomography (CT) examination, 45 were treated conservatively, 9 with superselective arterial embolization, and 8 with nephrectomy. Intravenous pyelogram (IVP) was conducted in two patients with ureteral injury, one was treated with cystoscopic ureteral catheterization and the other with ureteric reimplantation. Bladder injury (6 patients) confirmed with a waterflood susceptibility test combined with CT scans underwent laparotomy and the bladder suturing was done. Of 92 patients with urethral injury, 6 were treated with a nonoperative approach (indwelling catheter), 18 with urethral realignment, 35 with cystoscopic urethral realignment, 29 with end-to-end anastomotic urethroplasty, and 4 with urethral repairmen. Of the 24 cases with penile injuries, 1 underwent conservative treatment, 8 were treated with debridement and suture ligation, and 15 were managed with suture repair of the penis white membrane. Of the 24 cases with penile injuries, 1 underwent conservative treatment, 8 were treated with debridement and suture ligation, and 15 were managed with suture repair of the penis white membrane. During the follow-up period, 62 patients with renal injury had normal renal function. Neither of the two patients with ureteral injury developed hydronephrosis. Twenty-nine patients with urethral injury suffered from urethral structure. All patients with vesical or genital injury recovered. Conclusions: Urethra and kidney injuries are the most common acute urogenital system traumas. Superselective arterial embolization can effectively cease bleeding and maximally protect renal function and ureterorenoscopic realignment is an easily operative and minimally invasive technique in the treatment of urethral injuries. As diagnosis and treatment techniques continue to evolve, minimally invasive procedures should be widely used in acute urogenital trauma.
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Affiliation(s)
- Qingsong Zou
- Qingsong Zou, MD. Department of Urology, the Affiliated Sixth People's Hospital of Shanghai Jiaotong University, Shanghai 200233, China
| | - Qiang Fu
- Qiang Fu, MD. Department of Urology, the Affiliated Sixth People's Hospital of Shanghai Jiaotong University, Shanghai 200233, China
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The role of computed tomography in determining delayed intervention for gunshot wounds through the liver. Eur J Trauma Emerg Surg 2015; 42:219-23. [PMID: 26038041 DOI: 10.1007/s00068-015-0523-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 03/22/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Gunshot wounds through the liver are highly lethal and are prone to delayed morbidity due to late complications. METHODS A retrospective study was performed to determine the incidence, morbidity, and need for late interventions in patients shot through the liver, and the role of post-injury CT in making those determinations. RESULTS 83 patients were shot through the liver. Injury grades were: Grade V-12 (14 %), Grade IV-41 (49 %), Grade III-12 (14 %), Grade II-8 (10 %), Grade I-1 (1 %), and nine were ungraded. Ten (12 %) died in the ED, three (4 %) died in the OR, and two (2 %) died postoperatively. Of the 68 survivors, 52 (76 %) had follow-up CT scans performed a median of 7 days (95 % CI 2-13 days) after injury. Seventeen (33 %) had 25 complications related to the bullet tract: 12 (48 %) abscesses, 6 (24 %) infected hematomas, 3 (12 %) bilomas, 3 (12 %) unclassified fluid collections, and 1 (4 %) hepatic necrosis. Treatment included CT-guided drainage in 15 (60 %), ultrasound-guided drainage in 3 (12 %), surgical drainage and debridement in 2 (8 %), and observation in 5 (20 %). Overall morbidity rate including hepatic and non-hepatic complications was 74 % (50/68). Patients having their CT scan-determined intervention (for all complications) within 7 days of injury (n = 24), compared to those having their CT scan-determined intervention on day 8 or later (n = 28), had a significantly decreased rate of overall complications and morbidity (p = 0.03). This difference was due to early detection and intervention for abscesses, anastomotic breakdown, and missed injuries. Those having a CT scan within 7 days of injury also had a significantly reduced length of stay compared to those scanned on day 8 or later (median 14 days, 95 % CI 4-24 days versus 18 days, 95 % CI 6-30 days, p = 0.05). CONCLUSIONS Gunshot wounds to the liver have a high morbidity and mortality rate. Survivors should have a follow-up CT scan performed within 7 days to allow detection and intervention for complications, as this dramatically decreases the overall morbidity rate and length of stay.
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24
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The validity of abdominal examination in blunt trauma patients with distracting injuries. J Trauma Acute Care Surg 2015; 78:1095-100 ; discussion 1100 - 1. [DOI: 10.1097/ta.0000000000000650] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Gordic S, Alkadhi H, Hodel S, Simmen HP, Brueesch M, Frauenfelder T, Wanner G, Sprengel K. Whole-body CT-based imaging algorithm for multiple trauma patients: radiation dose and time to diagnosis. Br J Radiol 2015; 88:20140616. [PMID: 25594105 DOI: 10.1259/bjr.20140616] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To determine the number of imaging examinations, radiation dose and the time to complete trauma-related imaging in multiple trauma patients before and after introduction of whole-body CT (WBCT) into early trauma care. METHODS 120 consecutive patients before and 120 patients after introduction of WBCT into the trauma algorithm of the University Hospital Zurich were compared regarding the number and type of CT, radiography, focused assessment with sonography for trauma (FAST), additional CT examinations (defined as CT of the same body regions after radiography and/or FAST) and the time to complete trauma-related imaging. RESULTS In the WBCT cohort, significantly more patients underwent CT of the head, neck, chest and abdomen (p < 0.001) than in the non-WBCT cohort, whereas the number of radiographic examinations of the cervical spine, chest and pelvis and of FAST examinations were significantly lower (p < 0.001). There were no significant differences between cohorts regarding the number of radiographic examinations of the upper (p = 0.56) and lower extremities (p = 0.30). We found significantly higher effective doses in the WBCT (29.5 mSv) than in the non-WBCT cohort (15.9 mSv; p < 0.001), but fewer additional CT examinations for completing the work-up were needed in the WBCT cohort (p < 0.001). The time to complete trauma-related imaging was significantly shorter in the WBCT (12 min) than in the non-WBCT cohort (75 min; p < 0.001). CONCLUSION Including WBCT in the initial work-up of trauma patients results in higher radiation doses, but fewer additional CT examinations are needed, and the time for completing trauma-related imaging is shorter. ADVANCES IN KNOWLEDGE WBCT in trauma patients is associated with a high radiation dose of 29.5 mSv.
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Affiliation(s)
- S Gordic
- 1 Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
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26
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Aladelusi T, Akinmoladun V, Olusanya A, Akadiri O, Fasola A. Analysis of Road Traffic Crashes-Related Maxillofacial Injuries Severity and Concomitant Injuries in 201 Patients Seen at the UCH, Ibadan. Craniomaxillofac Trauma Reconstr 2014; 7:284-9. [PMID: 25383148 DOI: 10.1055/s-0034-1378183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Accepted: 11/04/2013] [Indexed: 10/25/2022] Open
Abstract
The objective of this study was to determine the prevalence of road traffic crashes (RTC)-related maxillofacial injuries, the concomitant injuries occurring with them, and to assess the relationship between the severity of maxillofacial and concomitant injuries. This was a prospective study involving 201 victims of RTC seen at the Accident and Emergency Department of the University College Hospital, Ibadan with maxillofacial injuries during the study period. Demographic data of the patients, the types of maxillofacial injuries, and concomitant injuries sustained were recorded. Severity of maxillofacial injury was determined using the maxillofacial injury severity scale (MFISS), while the severity of concomitant injuries was based on the ISS. Correlations between types and severity of maxillofacial injury and types and severity of concomitant injury were conducted to determine the predictability of concomitant injuries based on maxillofacial injury severity. Data were processed using SPSS Statistical software (SPSS, version 20.0 for windows, IBM SPSS Inc, Chicago, IL). Maxillofacial injuries constituted 25.4% of RTC-related admission by the Accident and Emergency Department. A total of 151 (75.1%) patients who presented with concomitant injuries participated in the study. Eighty-one (53.6%) sustained injuries to more than one body region. Head injury was the commonest (99, 65.6%) concomitant injury, followed by orthopedic injury (69, 45.7%). Increasing severity of maxillofacial injury showed a positive correlation with increasing ISS. Also, positive correlation was noted with increasing severity of maxillofacial injury and presence of polytrauma (p = 0.01), traumatic brain injury (p = 0.034), and eye injuries (p = 0.034). There was a high prevalence of maxillofacial injuries in victims of RTC. There was a high incidence of concomitant injuries noted with these maxillofacial injuries. Significantly, this study showed a direct relationship between the severity of maxillofacial injury and head, ocular and polytrauma. This study further emphasizes the need for thorough examination of patients presenting with RTC-related maxillofacial injuries.
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Affiliation(s)
- Timothy Aladelusi
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria ; Department of Oral and Maxillofacial Surgery, University College Hospital, Ibadan, Oyo, Nigeria
| | - Victor Akinmoladun
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria ; Department of Oral and Maxillofacial Surgery, University College Hospital, Ibadan, Oyo, Nigeria
| | - Adeola Olusanya
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria ; Department of Oral and Maxillofacial Surgery, University College Hospital, Ibadan, Oyo, Nigeria
| | - Oladimeji Akadiri
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Port Harcourt, Port Harcourt, Rivers State, Nigeria
| | - Abiodun Fasola
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria ; Department of Oral and Maxillofacial Surgery, University College Hospital, Ibadan, Oyo, Nigeria
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Evolution in the management of traumatic diaphragmatic injuries: a multicenter review. J Trauma Acute Care Surg 2014; 76:1024-8. [PMID: 24662867 DOI: 10.1097/ta.0000000000000140] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Traumatic diaphragmatic injury (TDI) is uncommon and has historically been identified by chest x-ray and repaired by laparotomy with nonabsorbable suture. Blunt TDI was more frequently (90%) detected on the left. With advances in imaging and operative techniques, our objective was to evaluate evolution in incidence, location, and management of TDI. METHODS The medical records of patients admitted to three Wisconsin regional trauma centers with TDI from 1996 to 2011 were reviewed. Patients were stratified into blunt and penetrating injury and early (1996-2003) and recent (2004-2011) periods. p < 0.05 was significant. RESULTS A total of 454 patients was included, 87% were men. Median Injury Severity Score (ISS) was 22 and 19 in the early and recent periods, respectively. Diagnostic modality for TDI did not change over time when comparing chest x-ray, computed tomography, or intraoperative diagnosis for blunt (p = 0.214) or penetrating (p = 0.119) TDI. More right-sided penetrating TDI were identified in the recent versus early group (49% vs. 27%). Perihiatal injury was rare (2%). Minimally invasive repairs increased in the recent versus early group of penetrating TDI (5.8% vs. 0.9%, p = 0.040). Complex repairs (mesh, transposition) were required in only three patients. In-hospital mortality was 15% and 4% for blunt and penetrating TDIs, respectively (p < 0.001). CONCLUSION A large increase in the frequency of both blunt and penetrating TDIs in our region was documented. While no difference was observed regarding diagnosis of blunt TDI during the two study periods, our data show a change from historical reports; more injuries were detected by computed tomography. An increase in right-sided penetrating TDI was also observed. A small but previously unreported incidence of perihiatal/pericardial injury occurred with both blunt and penetrating TDIs. While the majority of injuries were repaired with laparotomy, minimally invasive repairs were used more frequently in the recent period. LEVEL OF EVIDENCE Epidemiologic study, level III. Therapeutic study, level IV.
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The value of digital rectal examination in assessing for pelvic fracture-associated urethral injury: what defines a high-riding or nonpalpable prostate? J Trauma Acute Care Surg 2014; 75:913-5. [PMID: 24158216 DOI: 10.1097/ta.0b013e3182a68668] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The Advanced Trauma Life Support Manual (8th ed.) recommend a digital rectal examination (DRE) as part of the initial evaluation of all trauma patients. A "high-riding" or "nonpalpable" prostate is a contraindication to urethral catheterization and an indication for urethrography. However, there are no published guidelines on, definitions of, or predictive values for high riding. Moreover, prostate evaluation can be difficult in the supine/trauma position. METHODS A total of 100 patients underwent DRE in lateral decubitus position. Prostate size and distance from anal verge to the prostate apex were recorded. DRE in the supine position was then performed, noting the most proximal part of the prostate that was palpable. High-riding prostate was defined as the apex being one or more SDs farther from the anal verge than the mean. Fifty index finger lengths were measured to ensure that DRE findings were applicable to the average examiner. RESULTS A total of 100 prostates were evaluated. Mean (SD) distance from the anal verge to the prostate apex in patients with palpable prostates was 4.86 (1.38) cm (range, 2.5-8 cm). The prostate was nonpalpable in the decubitus position in 8 of the 100 patients and in the supine position in 42 of the 100 patients. Mean (SD) body mass index in the nonpalpable group was 32.6 (5.8) kg/m versus palpable group with 28.1 (5.7) kg/m (p < 0.01). Of the 100 patients, 26 had prostates that were "high riding" (defined as >6.2 cm from the anal verge), 2 of which were palpable in the supine position. Palpable prostates were closer to the anal verge at 4.13 cm compared with nonpalpable at 6.15 cm (p < 0.01). Mean (SD) index finger length is 7.3 (0.60) cm. CONCLUSION DRE in the pelvic fracture trauma setting to evaluate for urethral disruption is unreliable. Patients with a larger body mass index were less likely to have a palpable prostate. The use of the criteria of "nonpalpable" prostate has a high false-positive rate. Our objective definition of high-riding prostate should be incorporated into all trauma protocols. LEVEL OF EVIDENCE Epidemiologic study, level V.
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Hsiao KH, Dinh MM, McNamara KP, Bein KJ, Roncal S, Saade C, Waugh RC, Chi KF. Whole-body computed tomography in the initial assessment of trauma patients: Is there optimal criteria for patient selection? Emerg Med Australas 2013; 25:182-91. [DOI: 10.1111/1742-6723.12041] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Kai Hsun Hsiao
- Emergency Department; Royal Prince Alfred Hospital; Sydney; New South Wales; Australia
| | | | - Kylie P McNamara
- Department of Intensive Care; John Hunter Hospital; Newcastle; New South Wales; Australia
| | - Kendall J Bein
- Emergency Department; Royal Prince Alfred Hospital; Sydney; New South Wales; Australia
| | - Susan Roncal
- Trauma Services; Royal Prince Alfred Hospital; Sydney; New South Wales; Australia
| | - Charbel Saade
- Department of Radiology; Royal Prince Alfred Hospital; Sydney; New South Wales; Australia
| | - Richard C Waugh
- Department of Radiology; Royal Prince Alfred Hospital; Sydney; New South Wales; Australia
| | - Kee Fung Chi
- Department of Radiology; Royal Prince Alfred Hospital; Sydney; New South Wales; Australia
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Evidence-based guidelines are equivalent to a liberal computed tomography scan protocol for initial patient evaluation but are associated with decreased computed tomography scan use, cost, and radiation exposure. J Trauma Acute Care Surg 2012; 73:573-8; discussion 578-9. [PMID: 22929486 DOI: 10.1097/ta.0b013e318265cb95] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND We hypothesized that trauma patient evaluations using evidence-based treatment guidelines (evidence-based group [EBG]), which include serial examinations and limited computed tomography (CT) scans in an established trauma center, would be associated with equivalent outcomes but with decreased CT scan usage, decreased cost, and less radiation exposure compared with a liberal CT scan approach (conventional group [CONV]). METHODS Fifteen evidence-based treatment guidelines were developed using published literature and in collaboration with other institutional departments. These were implemented on July 1, 2010. Prospectively collected data during a 4-month period were compared with a similar period in 2008 when CONV was used. RESULTS In 2010 (EBG), there were 611 patients compared with 612 in 2008 (CONV). Their average Injury Severity Score was 11.93 versus 8.77 (p < 0.0001), and the total CT scans were 757 and 1194, respectively (p < 0.001). The average APACHE II and hospital length of stay did not significantly vary. No missed or delayed injuries were identified. Estimated CT scan charges were $1,842,534 versus $2,935,024. The average number of scans per patient were 1.2 (EBG) versus 1.9 (CONV). Regarding radiation dosimetry, the estimated average computed tomography dose index (CTDI) per patient were 36.7 versus 53.31 mGy, and the estimated average dose-length product per patient were 889.91 versus 1364.11 mGy·cm. CONCLUSION EBG, including serial examinations, provided equivalent diagnostic data to CONV for initial workup but reduced CT scan usage, CT scan charges, and average radiation exposure per patient. This strategy may be beneficial in institutions where serial monitoring can be assiduously provided. LEVEL OF EVIDENCE Case management study, level IV.
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Dreizin D, Munera F. Blunt polytrauma: evaluation with 64-section whole-body CT angiography. Radiographics 2012; 32:609-31. [PMID: 22582350 DOI: 10.1148/rg.323115099] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Blunt polytrauma remains a leading cause of death and disability worldwide. With the major advances in computed tomography (CT) technology over the past decade, whole-body CT is increasingly recognized as the emerging standard for providing rapid and accurate diagnoses within the narrow therapeutic window afforded to trauma victims with multiple severe injuries. With a single continuous acquisition, whole-body CT angiography is able to demonstrate all potentially injured organs, as well as vascular and bone structures, from the circle of Willis to the symphysis pubis. As its use becomes more widespread, the large volume of information inherent to whole-body CT poses new challenges to radiologists in providing efficient and timely interpretation. An awareness of trauma scoring systems and injury mechanisms is essential to maintain an appropriate level of suspicion in the search for multiple injuries, and the use of multiplanar reformation and three-dimensional postprocessing techniques is important to maximize efficiency in the search. Knowledge of the key injuries that require urgent surgical or percutaneous intervention, including major vascular injuries and active hemorrhage, diaphragmatic rupture, unstable spinal fractures, pancreatic injuries with ductal involvement, and injuries to the mesentery and hollow viscera, is also necessary.
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Affiliation(s)
- David Dreizin
- Department of Radiology, University of Miami Leonard Miller School of Medicine, University of Miami Health System, Jackson Memorial Hospital, and Ryder Trauma Center, 1611 NW 12th Ave, West Wing 279, Miami, FL 33136, USA
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Walker ML, Akpele I, Spence SD, Henderson V. The Role of Repeat Computed Tomography Scan in the Evaluation of Blunt Bowel Injury. Am Surg 2012. [DOI: 10.1177/000313481207800939] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The precise role of repeat abdominal computed tomography (CT) imaging in the diagnosis and management of bowel injury is unclear. We reviewed 540 patients with blunt abdominal trauma managed at a Level II trauma center over a 5-year period to better define the role of repeat imaging. One hundred patients had a repeat abdominal CT scan within 72 hours of admission. These patients were young with multisystem injuries (mean ± standard deviation age, 34 ± 15 years; Injury Severity Score, 21 ± 12; Glasgow Coma Score [GCS], 12 ± 5). There were 14 patients with bowel injuries. All bowel-injured patients survived without abdominal morbidity. Time to repeat CT was shortest in the bowel injured group (20 ± 10 hours). The repeat CT was most helpful in patients with significant closed head injury (mean GCS, 3 ± 1) and in those with occult bowel injury. The repeat scan resulted in a change in clinical management in 26 patients. Regarding the presence of bowel perforation, the follow-up scan enhanced sensitivity from 30 to 82 per cent. The repeat abdominal CT is best used selectively in patients with blunt abdominal trauma and can provide clinically useful information to exclude bowel injury.
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Affiliation(s)
- Mark L. Walker
- Department of Surgery Atlanta Medical Center and Surgical Health Collective, Atlanta, Georgia
| | - Ignatius Akpele
- Department of Surgery Atlanta Medical Center and Surgical Health Collective, Atlanta, Georgia
- AIE Surgical Practice, Atlanta, Georgia
| | - Stanston D. Spence
- Department of Surgery Atlanta Medical Center and Surgical Health Collective, Atlanta, Georgia
| | - Vernon Henderson
- Department of Surgery Atlanta Medical Center and Surgical Health Collective, Atlanta, Georgia
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Kepros JP, Opreanu RC, Samaraweera R, Briningstool A, Morrison CA, Mosher BD, Schneider P, Stevens P. Whole body imaging in the diagnosis of blunt trauma, ionizing radiation hazards and residual risk. Eur J Trauma Emerg Surg 2012; 39:15-24. [PMID: 26814919 DOI: 10.1007/s00068-012-0201-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 06/06/2012] [Indexed: 02/06/2023]
Abstract
Ever since the introduction of radiographic imaging, its utility in identifying injuries has been well documented and was incorporated in the workup of injured patients during advanced trauma life support algorithms [American College of Surgeons, 8th ed. Chicago, 2008]. More recently, computerized tomography (CT) has been shown to be more sensitive than radiography in the diagnosis of injury. Due to the increased use of CT scanning, concerns were raised regarding the associated exposure to ionizing radiation [N Engl J Med 357:2277-2284, 2007]. During the last several years, a significant amount of research has been published on this topic, most of it being incorporated in the BEIR VII Phase 2 report, published by the National Research Council of the National Academies [National Academy of Sciences, Washington DC, 2006]. The current review will analyze the scientific basis for the concerns over the ionizing radiation associated with the use of CT scanning and will examine the accuracy of the typical advanced trauma life support work-up for diagnosis of injuries.
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Affiliation(s)
- J P Kepros
- Department of Surgery, College of Human Medicine, Michigan State University, 1215 East Michigan Avenue, Suite 655, Lansing, MI, 48912, USA. .,Trauma and Surgical Critical Care, Sparrow Hospital, Lansing, MI, USA.
| | - R C Opreanu
- Department of Surgery, College of Human Medicine, Michigan State University, 1215 East Michigan Avenue, Suite 655, Lansing, MI, 48912, USA.
| | - R Samaraweera
- Department of Radiology, Sparrow Hospital, Lansing, MI, USA
| | - A Briningstool
- Emergency Department, Sparrow Hospital, Lansing, MI, USA
| | - C A Morrison
- Department of Surgery, College of Human Medicine, Michigan State University, 1215 East Michigan Avenue, Suite 655, Lansing, MI, 48912, USA.,Trauma and Surgical Critical Care, Sparrow Hospital, Lansing, MI, USA
| | - B D Mosher
- Department of Surgery, College of Human Medicine, Michigan State University, 1215 East Michigan Avenue, Suite 655, Lansing, MI, 48912, USA.,Trauma and Surgical Critical Care, Sparrow Hospital, Lansing, MI, USA
| | - P Schneider
- Department of Surgery, College of Human Medicine, Michigan State University, 1215 East Michigan Avenue, Suite 655, Lansing, MI, 48912, USA.,Trauma and Surgical Critical Care, Sparrow Hospital, Lansing, MI, USA
| | - P Stevens
- Trauma and Surgical Critical Care, Sparrow Hospital, Lansing, MI, USA
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Abstract
PURPOSE OF REVIEW The field of urogenital trauma is undergoing constant improvement mainly due to better diagnostic tools, a shift toward standardized treatments and better trauma care. The purpose of this review is to summarize the most relevant studies published within the last 3 years on the subject. RECENT FINDINGS Computerized tomography grading of renal trauma is an excellent predictor of the need for surgery and the final renal outcome in these patients, as most patients can be treated conservatively. Computerized tomography cystography has become the standard for the diagnosis of bladder rupture in which the indications for surgical intervention may be changing. The most common urethral trauma is posterior urethral injury due to pelvic fracture. The best results in adults and children are achieved by urethroplasty. SUMMARY The diagnosis and treatment of genitourinary trauma is still evolving. The long-term sequels of these injuries may best be treated by urologists expert in urogenital reconstruction. In the future, tissue engineering may have an important place in the treatment of these patients.
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Multi detector computed tomography in the diagnosis of bowel injury. Indian J Surg 2012; 74:445-50. [PMID: 24293897 DOI: 10.1007/s12262-011-0405-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Accepted: 12/22/2011] [Indexed: 10/14/2022] Open
Abstract
Bowel Injuries are uncommonly associated with traumatic abdominal injuries. However, they are associated with significant morbidity and mortality and require operative intervention unlike solid organ injuries. Hence, early diagnosis is of paramount importance. Computed tomographic (CT) scan is a well-established and highly accurate imaging modality for the detection of solid organ injury after blunt abdominal trauma. However, its role in diagnosing hollow viscus injury remains controversial. The aim of our study was to analyze the accuracy of multidetector CT (MDCT) in the diagnosis of bowel injury. Imaging features of surgically proven cases of bowel injury were identified over 8-year period (i.e., from January 2003 to December 2010) and were retrospectively analyzed. There were 32 patients with age range of 3-90 years. There was only one female. Sensitivity of various CT signs specific to bowel injury (i.e., extravasation of contrast and discontinuity of bowel wall) was 15.62, and 28.12%, respectively. While that of signs suggestive of bowel injury were pneumoperitoneum, 62.5%; gas in the vicinity, 40.62%; bowel wall hematoma, 21.87%; bowel wall thickening, 75%; ascites, 78.12%; mesenteric hematoma, 46.87%; and mesenteric stranding, 40.62%. Based on the major and minor signs, a diagnosis of bowel injury could be made in all patients except one. The minor signs showed a higher sensitivity than the major signs. Hence, we recommend that multidetector CT should be used as the modality of choice in case of patients with suspected bowel injury. We also suggest that the minor signs should be given as much importance as the major signs.
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