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Petrak A, McNabb EA, Nguyen BP, Kirkpatrick VE, Cassaro S. Seat Belt Injury and Efferent Loop Laceration Following a Single Anastomosis Duodenal Switch: A Case Report. Cureus 2024; 16:e61388. [PMID: 38947652 PMCID: PMC11214639 DOI: 10.7759/cureus.61388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2024] [Indexed: 07/02/2024] Open
Abstract
Blunt abdominal trauma patients who have had prior bariatric procedures may present a diagnostic and therapeutic challenge. The single anastomosis duodenal-ileal bypass with sleeve (SADI-S) is a modified duodenal switch procedure that is relatively uncommon. This case report describes a patient who previously underwent a SADI-S for the management of obesity and subsequently sustained a seat belt injury in a motor vehicle collision resulting in a laceration of the efferent loop. The patient presented with symptoms of acute abdominal pain and was diagnosed through imaging studies. Prompt surgical intervention was performed with resection and primary anastomosis of the damaged section of the jejunum, and repair of a large mesenteric laceration. We discuss the importance of early recognition and intraoperative decision-making in the case of this patient concerning her SADI-S.
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Affiliation(s)
- Alex Petrak
- Department of Surgery, Kaweah Health Medical Center, Visalia, USA
| | - Emily A McNabb
- Department of Surgery, Kaweah Health Medical Center, Visalia, USA
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Hartung B, Schäuble A, Peldschus S, Schüssler M, Meyer HL. The Documentation of Injuries Caused by Traffic Accidents. DEUTSCHES ARZTEBLATT INTERNATIONAL 2024; 121:27-36. [PMID: 38055024 PMCID: PMC10916764 DOI: 10.3238/arztebl.m2023.0145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/22/2023] [Accepted: 05/22/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Persons injured in traffic accidents may have injuries of characteristic types that are of significance for the complex reconstruction of the accident and whose medicolegally sound clinical documentation is highly important. This is of particular relevance for the approximately 55 000 persons who are severely injured in traffic accidents in Germany each year. Gaps in documentation are often disadvantageous for the injured persons. METHODS This review is based on pertinent publications retrieved by a selective literature review, with additional consideration of relevant textbooks in traffic medicine and legal medicine, as well as the guidelines of the AWMF (Association of the Scientific Medical Societies in Germany). RESULTS Injuries in traffic accidents typically differ depending on the mode of participation of the injured person in traffic. They must be examined with a view toward the sequence of events of the accident and documented in medicolegally sound fashion. In particular, because of the different mechanical forces involved, it is important to document the seat that the injured person occupied in the automobile, the nature of the collision (pedestrian vs. automobile; bicycle, e-bike, e-scooter, and motorcycle accidents), and the protective devices that were in use. CONCLUSION The precise documentation of injuries and examination findings, with critical consideration of their plausibility in relation to the sequence of events of the accident as far as it is known, is an important duty of the physician. This documentation serves as the basis for further judicial steps leading to compensation when legally appropriate.
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Affiliation(s)
- Benno Hartung
- Institute of Forensic Medicine, Essen University Hospital, Essen, Germany
| | | | - Steffen Peldschus
- Institute of Forensic Medicine, Biomechanics and Accident Analysis, LMU Munich, Munich, Germany
| | - Maximilian Schüssler
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, Essen University Hospital, Essen, Germany
| | - Heinz-Lothar Meyer
- Clinic for Trauma, Hand and Reconstructive Surgery Essen University Hospital, Essen, Germany
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Montas G, Nwaiwu C, Stephen AH, Heffernan DS. The Impact of Protective Devices Across the Spectrum of Trauma Care and Across Racial Groupings. Am Surg 2023; 89:5140-5146. [PMID: 36349424 DOI: 10.1177/00031348221135783] [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] [Indexed: 12/22/2023]
Abstract
INTRODUCTION Protective devices such as seat belts and helmets save lives. Most studies only address one aspect of the injury profile - compliance or mortality - not the entire spectrum of trauma care, and little attention is paid to racial differences in the use or impact of protective devices. METHODS Patients with blunt mechanisms where using protective devices would be expected were included and were divided into utilizing (P) vs not utilizing protection (Non-P). Chart review included demographics, injuries sustained, hemodynamics, and blood alcohol level. Outcomes included need for emergent operation, complications and death. RESULTS Non-P patients were more likely male, presented at night and intoxicated. Highest risk behavior (intoxicated Non-P) presented at night (25.7% of nighttime presentations), and rarely during daytime (6.7% daytime presentations). Non-P were more likely hypotensive and sustain a traumatic brain injury. No race related differences were noted among young patients. Among older (>/=50 years) patients, White patients were least likely Non-P and least likely presented at night. Non-P required more emergent operative intervention, ICU admission, and longer hospital stay. Overall, Non-P was associated with increased risk of death (OR = 1.6 (95% CI = 1.28 - 2.11). CONCLUSION Given unique age and racial differences, we advocate for culturally and age specific public service campaigns.
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Affiliation(s)
- Genevieve Montas
- Division of Trauma & Surgical Critical Care, Department of Surgery, Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Chibueze Nwaiwu
- Division of Trauma & Surgical Critical Care, Department of Surgery, Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Andrew H Stephen
- Division of Trauma & Surgical Critical Care, Department of Surgery, Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Daithi S Heffernan
- Division of Trauma & Surgical Critical Care, Department of Surgery, Brown University, Rhode Island Hospital, Providence, Rhode Island
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Furukawa M, Fujiyoshi K, Okubo T, Yanai Y, Matsubayashi K, Kato T, Kobayashi Y, Konomi T, Yato Y. Effects of Bone Cross-Link Bridging on Fracture Mechanism and Surgical Outcomes in Elderly Patients with Spine Fractures. Asian Spine J 2023; 17:676-684. [PMID: 37408292 PMCID: PMC10460660 DOI: 10.31616/asj.2022.0319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/14/2022] [Accepted: 11/24/2022] [Indexed: 07/07/2023] Open
Abstract
STUDY DESIGN This study adopted a cross-sectional study design. PURPOSE This study was designed to investigate the effects of bone cross-link bridging on fracture mechanism and surgical outcomes in vertebral fractures using the maximum number of vertebral bodies with bony bridges between adjacent vertebrae without interruption (maxVB). OVERVIEW OF LITERATURE The complex interplay of bone density and bone bridging in the elderly can complicate vertebral fractures, necessitating a better understanding of fracture mechanics. METHODS We examined 242 patients (age >60 years) who underwent surgery for thoracic to lumbar spine fractures from 2010 to 2020. Subsequently, the maxVB was classified into three groups: maxVB (0), maxVB (2-8), and maxVB (9-18), and parameters, including fracture morphology (new Association of Osteosynthesis classification), fracture level, and neurological deficits were compared. In a sub-analysis, 146 patients with thoracolumbar spine fractures were classified into the three aforementioned groups based on the maxVB and compared to determine the optimal operative technique and evaluate surgical outcomes. RESULTS Regarding the fracture morphology, the maxVB (0) group had more A3 and A4 fractures, whereas the maxVB (2-8) group had less A4 and more B1 and B2 fractures. The maxVB (9-18) group exhibited an increased frequency of B3 and C fractures. Regarding the fracture level, the maxVB (0) group tended to have more fractures in the thoracolumbar transition region. Furthermore, the maxVB (2-8) group had a higher fracture frequency in the lumbar spine area, whereas the maxVB (9-18) group had a higher fracture frequency in the thoracic spine area than the maxVB (0) group. The maxVB (9-18) group had fewer preoperative neurological deficits but a higher reoperation rate and postoperative mortality than the other groups. CONCLUSIONS The maxVB was identified as a factor influencing fracture level, fracture type, and preoperative neurological deficits. Thus, understanding the maxVB could help elucidate fracture mechanics and assist in perioperative patient management.
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Affiliation(s)
- Mitsuru Furukawa
- Department of Orthopaedics Surgery, Murayama Medical Center, Tokyo, Japan
| | - Kanehiro Fujiyoshi
- Department of Orthopaedics Surgery, Murayama Medical Center, Tokyo, Japan
| | - Toshiki Okubo
- Department of Orthopaedics Surgery, Murayama Medical Center, Tokyo, Japan
| | - Yoshihide Yanai
- Department of Orthopaedics Surgery, Murayama Medical Center, Tokyo, Japan
| | - Kohei Matsubayashi
- Department of Orthopaedics Surgery, Murayama Medical Center, Tokyo, Japan
| | - Takashi Kato
- Department of Orthopaedics Surgery, Murayama Medical Center, Tokyo, Japan
| | - Yoshiomi Kobayashi
- Department of Orthopaedics Surgery, Murayama Medical Center, Tokyo, Japan
| | - Tsunehiko Konomi
- Department of Orthopaedics Surgery, Murayama Medical Center, Tokyo, Japan
| | - Yoshiyuki Yato
- Department of Orthopaedics Surgery, Murayama Medical Center, Tokyo, Japan
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Ahmad I, Wong DJN. Recognising oesophageal intubation. Anaesthesia 2022; 77:1321-1325. [DOI: 10.1111/anae.15894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2022] [Indexed: 11/06/2022]
Affiliation(s)
- I. Ahmad
- Department of Anaesthesia and Peri‐operative Medicine Guy's and St Thomas' NHS Foundation Trust London UK
- King's College London UK
| | - D. J. N. Wong
- Department of Anaesthesia and Peri‐operative Medicine Guy's and St Thomas' NHS Foundation Trust London UK
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O’Donovan S, van den Heuvel C, Baldock M, Humphries M, Byard RW. Seasonal variation in cutaneous seat belt markings in fatal vehicle crashes. AUST J FORENSIC SCI 2022. [DOI: 10.1080/00450618.2022.2117413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Siobhan O’Donovan
- Adelaide Medical School, the University of Adelaide, Adelaide, Australia
- Forensic Science SA, Adelaide, Australia
| | | | - Matthew Baldock
- Centre for Automotive Safety Research, the University of Adelaide, Adelaide, Australia
| | - Melissa Humphries
- School of Mathematical Sciences, the University of Adelaide, Adelaide, Australia
| | - Roger W. Byard
- Adelaide Medical School, the University of Adelaide, Adelaide, Australia
- Forensic Science SA, Adelaide, Australia
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Do signs of abdominal wall injury on computed tomography predict intra-abdominal injury in trauma patients with a seatbelt sign? Injury 2022; 53:2988-2991. [PMID: 35853789 DOI: 10.1016/j.injury.2022.06.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/26/2022] [Accepted: 06/27/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND A seatbelt sign in patients with blunt abdominal injury is associated with both abdominal wall and intra-abdominal injuries. This study aimed to assess the association between signs of abdominal wall injury on computed tomography (CT) and rates of intra-abdominal injury in patients with a blunt abdominal injury and a clinical seatbelt sign. METHODS This study includes hemodynamically stable trauma patients with blunt abdominal injury and a clinical seatbelt sign who were hospitalized in two regional trauma centers in Israel, during 2014-2019. All data were collected via the medical center's trauma registry in both centers. RESULTS We identified 123 stable blunt abdominal trauma patients with a seatbelt sign, of which 101 (82.1%) and 22 (17.9%) had a low-grade and high-grade abdominal wall injury according to CT findings, respectively. Laparotomy rates were significantly higher in patients with signs of high-grade abdominal wall injury (p<0.0001). No differences in the timing of laparotomy between low and high-grade injuries were found. CONCLUSIONS In stable patients with blunt abdominal trauma and a clinical seatbelt sign, the severity of abdominal wall injury, as represented by CT findings, may predict a need for surgical treatment.
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Hörauf JA, El Saman A, Nau C, Enterlein G, Marzi I, Störmann P. Motor Vehicle Accident during Pregnancy with Two Lifes at Risk: A Case Report. J Orthop Case Rep 2021; 11:65-69. [PMID: 34790607 PMCID: PMC8576764 DOI: 10.13107/jocr.2021.v11.i07.2320] [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: 06/03/2021] [Revised: 06/20/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction: Major trauma is the leading non-pregnancy-related cause of maternal and fetal deaths. In particular, traffic accidents account for the majority of accident causes and present the highest mortality for the mother and fetus. Seat belt use has reduced mortality rates for both the mother and the unborn child, however, certain potential patterns of injury occur due to the restraining mechanical forces of the worn seat belts on the body. Since life-threatening injuries in pregnancy are nevertheless rare, trauma care of pregnant women continues to be an exceptional situation and a particularly stressful situation for the attending physicians, including the fact that two lives are potentially at stake. Case Report: In this article, we report on a patient in the 37th week of pregnancy who was involved in a high-speed trauma as a front passenger of a car. Initially awake as well as responsive and hemodynamically stable, the patient’s condition deteriorated on the way to the emergency room (ER). On arrival in the ER, according to the Advanced Trauma Life Support concept, interdisciplinary consensus had to be reached between the departments involved regarding further diagnostic and therapeutic procedures. With the knowledge of the special anatomical and physiological changes in the context of pregnancy, both the mother and the child could be stabilized in order to subsequently gain further important information about the present injury pattern during the performed diagnostics and finally to be able to adequately treat the trauma sequelae. Conclusion: Because the care of traumatic life-threatening injuries in pregnancy is rare overall, it poses a special challenge for the attending trauma team in the ER. In order to avert the fatal fate of both the mother and the unborn child, a structured, symptom and patient-oriented interdisciplinary approach is indispensable, especially in these exceptional situations, in order to achieve the best possible outcome for those affected.
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Affiliation(s)
- Jason-Alexander Hörauf
- Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe - University Frankfurt am Main, Germany
| | - André El Saman
- Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe - University Frankfurt am Main, Germany
| | - Christoph Nau
- Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe - University Frankfurt am Main, Germany
| | - Gernot Enterlein
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Hospital of the Johann Wolfgang Goethe - University Frankfurt am Main, Germany
| | - Ingo Marzi
- Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe - University Frankfurt am Main, Germany
| | - Philipp Störmann
- Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe - University Frankfurt am Main, Germany
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Algahtany MA, El Maksoud WA. Pattern and In-Hospital Mortality of Thoracoabdominal Injuries Associated with Motor Vehicle Accident-Related Spinal Injury: A Retrospective Single-Center Study. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:9514169. [PMID: 34721829 PMCID: PMC8553470 DOI: 10.1155/2021/9514169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 09/28/2021] [Accepted: 10/13/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Motor vehicle accident (MVA) is a global health hazard that results in spinal, thoracic, and abdominal injuries. Detailed studies on the association between MVA-related traumatic spinal injury (TSI) and thoracoabdominal injuries are lacking. This study aims to elucidate the prevalence, pattern of association between these injuries, and related outcomes in terms of in-hospital mortality. METHODS This is a retrospective single-center study of MVA-related TSI with thoracoabdominal associated injuries. Descriptive analysis was performed for gender, age, spinal injury level, thoracoabdominal injury region, admission day, hospital stay duration, and discharge category. The association between TSI and thoracoabdominal injury was analyzed, and the chi-square test was used to test the significance of differences. A statistically significant difference was considered at P values less than 0.05. RESULTS The cohort had a mean age of 33.6 ± 17.7 years with predominantly more males (85.1%). Thoracoabdominal injuries were present in 10.5% of MVA-related TSIs, and 9.2% of victims died during their hospital stay. There is a significant (P=0.045) association between the level of the spinal and the region of thoracoabdominal injuries. The presence of TSI-associated thoracic injury significantly (P=0.041) correlated with increased in-hospital mortality more than abdominal injury. CONCLUSION Thoracoabdominal injuries concomitant with MVA-related TSI cause considerable mortality. A pattern of association exists between the level of spinal and region of thoracoabdominal injury. Knowledge of this pattern is helpful in the routine practice of trauma health partitioners.
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Affiliation(s)
- Mubarak Ali Algahtany
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Walid Abd El Maksoud
- Division of General Surgery, Department of Surgery, College of Medicine, King Khalid University, Abha, Saudi Arabia
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10
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Byard RW. Vertebral artery transection: an unusual lethal seat belt injury. Forensic Sci Med Pathol 2021; 18:103-105. [PMID: 34655043 DOI: 10.1007/s12024-021-00429-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2021] [Indexed: 11/28/2022]
Abstract
An 89-year-old man involved in a vehicle crash was found at autopsy to have a linear seat belt mark on the right side of his neck associated with extensive injuries of the right paraspinal muscles with fracture-dislocation and separation of cervical vertebrae 5 and 6. There was also fracture of the right facet joint between cervical vertebrae 5 and 6 and laceration of the right vertebral artery. Death was due to a cervical seat belt injury with spinal fracture and laceration of the right vertebral artery. The presence of extensive injuries to the right paraspinal muscles and cervical vertebra 5-6 fact joint beneath the seat belt mark would be in keeping with trauma due to the belt webbing, rather than mere hyperextension/flexion of the cervical spine. This report demonstrates a rare form of seat belt injury, transection of the vertebral artery, and suggests that the finding of seat belt markings on the lateral aspect of the neck should prompt examination for this type of lethal vascular injury at autopsy.
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Affiliation(s)
- Roger W Byard
- Forensic Science SA, Adelaide, Australia. .,Adelaide Medical School, The University of Adelaide, Level 2, Room N237, Helen Mayo North, Frome Road, Adelaide, SA, 5005, Australia.
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11
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Akbari M, Lankarani KB, Tabrizi R, Heydari ST, Vali M, Motevalian SA, Sullman MJM. The effectiveness of mass media campaigns in increasing the use of seat belts: A systematic review. TRAFFIC INJURY PREVENTION 2021; 22:495-500. [PMID: 34355980 DOI: 10.1080/15389588.2021.1921168] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE This systematic review and meta-analysis was conducted to determine the effectiveness of mass media campaigns for increasing the use of seat belts among drivers and front seat passengers. METHODS We systematically searched the PubMed, EMBASE, Web of Science (WOS), and Scopus databases from November 1974 until June 2020 to identify before-after studies investigating the effect of mass media campaigns on seat belt use. The quality of all included studies was assessed using the National Institute of Health (NIH) tool. Chi-Squared tests and the I2 statistic were used to evaluate inter-study heterogeneity, while the odds ratio (OR) was used as a measure of effect size. RESULTS Of the 793 records initially identified, twenty articles were found to be appropriate for the current meta-analysis. Of these, 13, 5, and 2 studies were rated as good, fair, and poor quality, respectively. The meta-analysis finding using random effects model showed that mass media campaigns resulted in statistically significant increases in seat belt usage among drivers (OR= 1.40, 95% CI: 1.18- 1.68) and front seat passengers (OR= 1.54, 95% CI: 1.31- 1.82). Due to the presence of heterogeneity (I2: 99.7% for drivers; I2: 99.1% for front passengers), additional analyses were also undertaken. Sensitivity analyses showed that the pooled ORs remained consistent after removing each study one by one. Statistically significant increases in seat belt use among drivers were found in mass media campaigns which: had measurement periods longer than 12 months, were used in combination with enforcement activities, were published after 2000, and had good quality scores. CONCLUSION The current meta-analysis found that mass media campaigns can lead to an increase in seat belt use among drivers and front passengers. However, these results should be interpreted with some degree of caution, due to the high degree of heterogeneity between studies and the fact that most of the studies were from high-income countries without control groups. Despite the apparent favorable impact of mass media campaigns, more robust long term studies are needed.
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Affiliation(s)
- Maryam Akbari
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kamran B Lankarani
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Tabrizi
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Seyed Taghi Heydari
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohebat Vali
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Abbas Motevalian
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Mark J M Sullman
- Department of Social Sciences, University of Nicosia, Nicosia, Cyprus
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12
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O'Donovan S, Langlois NE, Heuvel CVD, Byard RW. Lethal mechanisms in cases of inverted suspension from the lap component of seat belts. MEDICINE, SCIENCE, AND THE LAW 2021; 61:227-231. [PMID: 33583255 DOI: 10.1177/0025802421993990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
A retrospective review of autopsy files at Forensic Science South Australia in Adelaide, Australia, was undertaken over a five-year period from January 2014 to December 2018 for all motor vehicle crashes with rollovers ending with the vehicle inverted and the occupants suspended by the lap component of their seat belts. There were five cases, all male drivers (aged 18-67 years; Mage = 32 years). Acute neck flexion or head wedging was noted in four cases, with facial petechiae in four and facial congestion in one. Deaths were due to positional asphyxia in four cases, with the combined effects of positional asphyxia and head trauma accounting for the remaining case. Although all drivers had evidence of head impact which may have caused incapacitation, in only one case was this considered severe enough to have contributed to death. A blood alcohol level above the legal limit for driving was detected in two cases, but no other drugs were detected. This series demonstrates another subset of cases of seat belt-associated deaths where suspension upside down by the lap component of a seat belt had occurred after vehicle rollovers. Predisposing factors include incapacitation of the victim and delay in rescue. The postulated lethal mechanism involved respiratory compromise from the weight of abdominal viscera on the diaphragm, as well as upper airway compromise due to kinking of the neck and wedging of the head.
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Affiliation(s)
- Siobhan O'Donovan
- Adelaide Medical School, The University of Adelaide, Australia
- Forensic Science South Australia, Australia
| | - Neil Ei Langlois
- Adelaide Medical School, The University of Adelaide, Australia
- Forensic Science South Australia, Australia
| | | | - Roger W Byard
- Adelaide Medical School, The University of Adelaide, Australia
- Forensic Science South Australia, Australia
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13
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Sorber R, Pedroso FE, Cappiello CD, Kunisaki SM, Jelin EB, Rhee DS. Pediatric traumatic abdominal wall hernia as a component of the seatbelt syndrome: a case series and review of the literature. Pediatr Surg Int 2021; 37:511-517. [PMID: 33385244 DOI: 10.1007/s00383-020-04796-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/25/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Blunt impact-induced traumatic abdominal wall hernia (TAWH) is an uncommon pediatric surgical problem classically associated with handlebar injury but increasingly seen with seatbelt use in motor vehicle collisions (MVC). Herein we describe the largest case series of pediatric TAWH to date and review the literature to establish the unique syndromic characteristics of MVC-associated TAWH. METHODS In this single-institution series, we discuss four pediatric patients, all with seatbelt-associated TAWH after high-speed MVC characterized by full-thickness disruption of the lateral abdominal wall. We then performed a review of the literature to identify additional pediatric MVC-associated TAWH and define the characteristics of patients who sustained this unique injury. RESULTS In addition to the four patients in our case series, five additional pediatric patients presenting with TAWH after restrained MVC were identified in the literature. Of these nine patients, eight (89%) presented with an obvious seatbelt sign (bruising/laceration to the abdominal wall). Six (67%) had associated injuries typical of the seatbelt syndrome, including four spinal flexion injuries (44%) and five bowel injuries requiring repair or resection (56%). Overall, 56% of seatbelt-associated TAWH occurred in children with a BMI percentile > 95%. CONCLUSIONS In this case series and literature review, we note a high rate of seatbelt syndrome injuries in pediatric patients presenting with TAWH after restrained MVC. Suspicion for TAWH should be high in children presenting with a seatbelt sign and should trigger a low threshold for pursuing additional axial imaging. LEVEL OF EVIDENCE Level IV; case series.
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Affiliation(s)
- Rebecca Sorber
- Division of Pediatric Surgery, Department of Surgery, The Johns Hopkins Hospital Bloomberg Children's Center, 600 N Wolfe St, Halsted 668, Baltimore, MD, 21287-8611, USA.
| | - Felipe E Pedroso
- Division of Pediatric Surgery, Department of Surgery, The Johns Hopkins Hospital Bloomberg Children's Center, 600 N Wolfe St, Halsted 668, Baltimore, MD, 21287-8611, USA
| | - Clint D Cappiello
- Division of Pediatric Surgery, Department of Surgery, The Johns Hopkins Hospital Bloomberg Children's Center, 600 N Wolfe St, Halsted 668, Baltimore, MD, 21287-8611, USA
| | - Shaun M Kunisaki
- Division of Pediatric Surgery, Department of Surgery, The Johns Hopkins Hospital Bloomberg Children's Center, 600 N Wolfe St, Halsted 668, Baltimore, MD, 21287-8611, USA
| | - Eric B Jelin
- Division of Pediatric Surgery, Department of Surgery, The Johns Hopkins Hospital Bloomberg Children's Center, 600 N Wolfe St, Halsted 668, Baltimore, MD, 21287-8611, USA
| | - Daniel S Rhee
- Division of Pediatric Surgery, Department of Surgery, The Johns Hopkins Hospital Bloomberg Children's Center, 600 N Wolfe St, Halsted 668, Baltimore, MD, 21287-8611, USA
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14
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Road Traffic Injuries and Related Safety Measures: A Multicentre Analysis at Military Hospitals in Tabuk, Saudi Arabia. Emerg Med Int 2021; 2021:6617381. [PMID: 33708446 PMCID: PMC7932803 DOI: 10.1155/2021/6617381] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 01/14/2021] [Accepted: 01/25/2021] [Indexed: 11/17/2022] Open
Abstract
Background Road traffic injuries are one of the major public safety issues around the world, as they put a great burden on countries' economies. Saudi Arabia has a good road transportation system, but still, road-related fatalities are higher in this country. The main purpose of this study was to determine the association between the severity of injuries caused by road traffic collision and safety measures taken by the drivers admitted to the emergency departments at two military hospitals in Tabuk, a city in Saudi Arabia. Methods A total of 342 male drivers who had injuries due to road traffic collision took part in this multicentre, cross-sectional study. The research sites were King Salman Armed Forces Hospital and King Khalid Armed Forces Hospital in Tabuk, Saudi Arabia. The data were collected using a common protocol and a self-reported questionnaire with the help of convenience sampling approach. Descriptive statistics and logistic regression analysis were done using IBM SPSS version 23. Results Nearly 62.0% of the male drivers were aged less than 36 years. About 90% of the drivers were from low- and middle-income groups. Logistic regression analysis indicated that drivers who had road traffic collision and used mobile phones while driving were four times more likely to have severe injuries (OR = 3.89; 95% CI (2.53, 5.95)), those who drove the vehicle at an excessive speed limit were three times more likely to have severe injuries (OR = 2.71; 95% CI (1.01, 4.97)), and those who attempted to overtake another vehicle were two times more likely to have severe injuries (OR = 1.85; 95% CI (1.24, 3.77)). Conclusion Based on the results of the present study, the most important safety measures which contributed the most to road traffic collision were use of mobile phones while driving the vehicle, driving at an excessive speed limit, irregularity in maintaining the vehicle, attempt to pass other vehicles, and not following the traffic rules. All the safety measures are protective, but if care is not taken, they will risk the life. There is an urgent need to spread traffic safety awareness in this region.
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15
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Fetisov VA, Karavayev VM, Burakova VI, Meshcheryakova SA, Tamberg DK. [Forensic assessment of seat belt injuries caused to a minor passenger in the rear seat]. Sud Med Ekspert 2020; 63:46-52. [PMID: 32686391 DOI: 10.17116/sudmed20206304146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The purpose of this work is to draw attention to the problem of child injuries in road traffic accidents. Children are the most vulnerable road users. Seat belts as elements of passive safety of cars cannot always provide the necessary protection. In some cases, they act as traumatic objects. A case of a thoracic spine injury (fractures of the bodies of two thoracic vertebrae) in a minor child who was on a booster and fixed with a standard seat belt is presented. The data of clinical and special research methods are presented, as well as options for solving some forensic issues are considered.
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Affiliation(s)
- V A Fetisov
- S.M. Kirov Military Medical Academy of Ministry of Defense of Russia, St. Petersburg, Russia.,St. Petersburg State Budgetary Health Institution Bureau of Forensic Medical Examination, St. Petersburg, Russia
| | - V M Karavayev
- St. Petersburg State Budgetary Health Institution Bureau of Forensic Medical Examination, St. Petersburg, Russia
| | - V I Burakova
- St. Petersburg State Budgetary Health Institution Bureau of Forensic Medical Examination, St. Petersburg, Russia
| | - S A Meshcheryakova
- S.M. Kirov Military Medical Academy of Ministry of Defense of Russia, St. Petersburg, Russia
| | - D K Tamberg
- S.M. Kirov Military Medical Academy of Ministry of Defense of Russia, St. Petersburg, Russia
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16
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Greenston M, Wood RL, Reinhart L. Clinical Significance of the Seat Belt Sign as Evidence of a Compromised Occupant–Seat Belt Relationship. J Emerg Med 2019; 56:624-632. [DOI: 10.1016/j.jemermed.2019.01.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/23/2019] [Accepted: 01/30/2019] [Indexed: 10/27/2022]
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17
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A negative computed tomography may be sufficient to safely discharge patients with abdominal seatbelt sign from the emergency department: A case series analysis. J Trauma Acute Care Surg 2019. [PMID: 29521798 DOI: 10.1097/ta.0000000000001872] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The presence of an abdominal seatbelt sign (ASBS) following a motor vehicle collision (MVC) is associated with a high risk for occult intra-abdominal injury, prompting imaging studies and a prolonged period of clinical observation. The aim of this study was to determine how a negative computed tomography (CT) of the abdomen/pelvis (A/P) can serve in the safe disposition of these patients. Our hypothesis was that in the setting of a negative CT, the presence of occult intra-abdominal injuries requiring a delayed intervention is extremely unlikely. METHODS The medical charts of patients admitted from January 2014 to December 2016 to a Level I trauma center following an MVC were reviewed for a documentation of an ASBS. Patients who did not have a CT A/P upon admission were excluded. The CT A/P of the remaining patients were then classified as negative if there were no findings of acute vascular, visceral or bony injury or positive if any of these findings was present. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of CT A/P for the presence of an intra-abdominal injury were calculated. RESULTS Over the 3-year study period, 1,108 patients were admitted after an MVC. Of those, 196 (17.7%) had an ASBS upon presentation and 183 (93.4%) of 196 underwent a CT A/P. A total of 114 (62.3%) of 183 had a negative CT A/P. These patients remained hospitalized for a median of 2 (1-35) days with none (0.0%) requiring a delayed laparotomy. The sensitivity of CT A/P in identifying patients requiring an exploratory laparotomy was 100.0%, specificity was 67.9%, NPV was 100.0%, and PPV was 21.7%. The negative likelihood ratio was 0.00. CONCLUSION For patients with an ASBS following an MVC, a negative CT A/P may be sufficient for safe discharge from the emergency department without any need for additional clinical observation. LEVEL OF EVIDENCE Therapuetic, level IV.
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18
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Niewinski P, Jagielski D, Josiak K, Nowak K, Biel B, Tubek S, Walczak T, Szemplinska I, Siennicka A, Banasiak W, Ponikowski P. Seat belts-related behaviors in car drivers with cardiac implantable electronic devices. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:400-406. [PMID: 30740756 DOI: 10.1111/pace.13617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 01/21/2019] [Accepted: 01/28/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Seat belt use is the single most effective means of reducing fatal injuries in road traffic accidents. The presence of a cardiac implantable electronic device (CIED) might influence seat belt-related behaviors due to the physical proximity of the seat belt and left subclavian area in which the device is usually implanted. Understanding the underlying mechanisms of improper seat belt use may improve safety of these patients. METHODS We performed a prospective study using a structured questionnaire with 120 CIED recipients (age, 63.9 ± 10.9 years) attending a pacing outpatient clinic. All study participants were active drivers and predominantly male. The majority of patients (79%) had undergone high-energy device implantation. RESULTS We found that 18% of study participants do not fasten seat belts on a regular basis or use the seat belt in an atypical fashion (such as under the armpit). Moderate or high level of discomfort from the interaction between seat belt and CIED was present in 27%, while more than half (51%) were afraid of seat belt-induced CIED damage. In multifactorial analysis, we found the following independent predictors of improper seat belt use: (1) at least moderate level of discomfort at the CIED site (P = 0.02); (2) fear of CIED damage (P = 0.009); and (3) irregular seat belt use prior to CIED implantation (P = 0.037). CONCLUSIONS Improper seat belt-related behaviors are common in CIED recipients. They arise from previous habits and from CIED-related physical and psychological factors. Patients' education regarding the importance and safety of proper seat belt use is a priority.
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Affiliation(s)
- Piotr Niewinski
- Department of Cardiology, Centre for Heart Disease, 4th Military Hospital, Wroclaw, Poland.,Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Dariusz Jagielski
- Department of Cardiology, Centre for Heart Disease, 4th Military Hospital, Wroclaw, Poland
| | - Krystian Josiak
- Department of Cardiology, Centre for Heart Disease, 4th Military Hospital, Wroclaw, Poland.,Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Krzysztof Nowak
- Department of Cardiology, Centre for Heart Disease, 4th Military Hospital, Wroclaw, Poland.,Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Bartosz Biel
- Department of Cardiology, Centre for Heart Disease, 4th Military Hospital, Wroclaw, Poland
| | - Stanislaw Tubek
- Department of Cardiology, Centre for Heart Disease, 4th Military Hospital, Wroclaw, Poland.,Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Tomasz Walczak
- Department of Cardiology, Centre for Heart Disease, 4th Military Hospital, Wroclaw, Poland.,Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Iwona Szemplinska
- Department of Cardiology, Centre for Heart Disease, 4th Military Hospital, Wroclaw, Poland
| | - Agnieszka Siennicka
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.,Department of Physiology, Wroclaw Medical University, Wroclaw, Poland
| | - Waldemar Banasiak
- Department of Cardiology, Centre for Heart Disease, 4th Military Hospital, Wroclaw, Poland
| | - Piotr Ponikowski
- Department of Cardiology, Centre for Heart Disease, 4th Military Hospital, Wroclaw, Poland.,Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
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Jing X, Gong Z, Zhang N, Chen G, Li F, Chen Q, Xu Z, Zhang R. Fracture and dislocation of lumbar vertebrae with entrapment of small bowel: A case report and literature review. J Int Med Res 2019; 47:1043-1051. [PMID: 30618309 PMCID: PMC6381458 DOI: 10.1177/0300060518816205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Traumatic incarceration of the small bowel accompanied by vertebral fractures and dislocation is rare and usually misdiagnosed until laparotomy. This report presents a rare case of jejunum entrapment between lumbar spine fractures. A 43-year-old man was clamped between two railway tracks on the upper abdomen and lower back. Following ineffective conservative treatment, he underwent a laparotomy due to the development of guarding and rebound tenderness. Loss of vitality of the jejunal loop, which was incarcerated between the L3 and L4 vertebrae, was observed. The necrotic bowel was removed and end-to-end anastomosis was performed. When his condition was stable, anterior and posterior lumbar fixation surgery was performed. The patient had no abdominal complications and lower limb nerve function deficiency during the follow-up period. A review of the literature since 1979 on incarceration of the bowel associated with lumbar fracture and dislocation identified 12 cases: five patients showed persistent neurological symptoms, but none of the patients died as a result of their injuries. It should be borne in mind that patients with hyperextension or flexion-distraction injury of the lumbar spine could show symptoms of intestinal obstruction and bowel incarceration. Enhanced computed tomography or magnetic resonance imaging will be helpful for diagnosis.
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Affiliation(s)
- Xiaowei Jing
- 1 Department of Orthopaedic Surgery, Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, Zhejiang Province, China
| | - Zhiyuan Gong
- 1 Department of Orthopaedic Surgery, Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, Zhejiang Province, China
| | - Ning Zhang
- 2 Department of Orthopaedic Surgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Gang Chen
- 2 Department of Orthopaedic Surgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Fangcai Li
- 2 Department of Orthopaedic Surgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Qixin Chen
- 2 Department of Orthopaedic Surgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Zhengkuan Xu
- 2 Department of Orthopaedic Surgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Rui Zhang
- 1 Department of Orthopaedic Surgery, Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, Zhejiang Province, China
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Özçay N, Brosova I, Ferkodic M, Özant A, Arslan K, Besim H. Two cases of intestinal injuries due to seat belt without seat belt sign. J Surg Case Rep 2018; 2018:rjy298. [PMID: 30443316 PMCID: PMC6232281 DOI: 10.1093/jscr/rjy298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 10/19/2018] [Indexed: 11/15/2022] Open
Abstract
Although seat belts save lives after motor vehicle accidents, they may cause different types of injuries such as abdominal wall, intra-abdominal, neck and spine or vascular injuries. Seat belt sign indicates the severity of injuries, and usually the risk of intra-abdominal injuries is high when the seat belt sign exists. Here, we present two cases of intra-abdominal injuries caused by seat belts without seat belt sign.
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Affiliation(s)
- Necdet Özçay
- Department of General Surgery, Near East University, Nicosia, Cyprus
| | - Iveta Brosova
- Department of General Surgery, Near East University, Nicosia, Cyprus
| | - Martin Ferkodic
- Department of General Surgery, Near East University, Nicosia, Cyprus
| | - Ali Özant
- Department of General Surgery, Near East University, Nicosia, Cyprus
| | - Kalbim Arslan
- Department of General Surgery, Near East University, Nicosia, Cyprus
| | - Hasan Besim
- Department of General Surgery, Near East University, Nicosia, Cyprus
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21
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Berland M, Oger M, Cauchois E, Retornaz K, Arnoux V, Dubus JC. Pulmonary contusion after bumper car collision: Case report and review of the literature. Respir Med Case Rep 2018; 25:293-295. [PMID: 30370214 PMCID: PMC6199181 DOI: 10.1016/j.rmcr.2018.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 10/08/2018] [Accepted: 10/08/2018] [Indexed: 12/25/2022] Open
Abstract
Thoracic trauma is a major source of morbi-mortality in injured children. Their pliable chest wall makes pulmonary contusion the most common chest injury. It is most often secondary to blunt trauma caused by traffic accidents. We report a case of severe chest trauma caused by a bumper car collision in an 8-years old girl. She sustained right lung contusion that led to complete atelectasis. After a week of supportive therapy, bronchoscopy removed a mucous plug from the main bronchus, resulting in significant clinical improvement. We aim to raise awareness of the risk of severe chest injuries during bumper car collisions.
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Affiliation(s)
- Mahé Berland
- Department of Pediatrics, Nord University Hospital, Marseille, France
- Corresponding author. Department of Pediatrics, Timone Children's University Hospital, Marseille, France.
| | - Marjolaine Oger
- Department of Anesthesia and Intensive Care, Neonatal and Pediatric Intensive Care Unit, Nord University Hospital, Marseille, France
| | - Emi Cauchois
- Department of Anesthesia and Intensive Care, Neonatal and Pediatric Intensive Care Unit, Nord University Hospital, Marseille, France
| | - Karine Retornaz
- Department of Pediatrics, Nord University Hospital, Marseille, France
| | - Valérie Arnoux
- Department of Pediatrics, Nord University Hospital, Marseille, France
| | - Jean-Christophe Dubus
- Department of Pediatrics, Nord University Hospital, Marseille, France
- Department of Pediatrics, Timone Children's University Hospital, Marseille, France
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22
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Schinco M, Udekwu P. An Unusual Blunt Traumatic Retro-Aortic Hernia. Am Surg 2018. [DOI: 10.1177/000313481808400919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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23
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Positive Seatbelt Sign with Avulsed Leiomyoma following Motor Vehicle Accident Leading to Hemoperitoneum. Case Rep Emerg Med 2018; 2018:4251408. [PMID: 30225150 PMCID: PMC6129369 DOI: 10.1155/2018/4251408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 08/12/2018] [Indexed: 11/18/2022] Open
Abstract
A positive seatbelt sign following a motor vehicle accident is associated with an increased risk of intra-abdominal injury and hemoperitoneum. Injury to the uterus in reproductive-age women can also occur. In this report, we describe a 29-year-old nulligravida female who presented to the emergency room following a motor vehicle accident at freeway speeds. A positive seatbelt sign was noted, and a focused assessment with sonography for trauma revealed hemoperitoneum with an incidental finding of uterine leiomyomata. Upon exploratory laparotomy, a free-floating intraperitoneal mass was identified as an avulsed uterine leiomyoma. A uterine laceration containing a subserosal leiomyoma was also identified. The gynecological team was consulted, and a myomectomy of the subserosal leiomyoma followed by a closure of the uterine laceration was performed. The patient was transfused with a total of three units of packed red blood cells and two units of fresh frozen plasma. The postoperative course was without major complication. A positive seatbelt sign and hemoperitoneum in a reproductive-age woman with leiomyomata should increase the clinical suspicion for uterine injury and decrease the threshold for obtaining a gynecological consultation.
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Yumoto T, Kondo Y, Kumon K, Masaoka Y, Hiraki T, Yamada T, Naito H, Nakao A. Delayed hydronephrosis due to retroperitoneal hematoma after a seatbelt injury: A case report. Medicine (Baltimore) 2018; 97:e11022. [PMID: 29879068 PMCID: PMC5999472 DOI: 10.1097/md.0000000000011022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
RATIONALE Hydronephrosis caused by retroperitoneal hematoma after a seatbelt injury is a unique clinical entity. PATIENT CONCERNS A 21-year-old man, who had been wearing a seatbelt, was brought to our hospital after a motor vehicle collision, complaining of abdominal pain. Computed tomography (CT) revealed retroperitoneal hematoma in the upper pelvic region. Since he was hemodynamically stable throughout admission, he was managed conservatively. Seventeen days after initial discharge, the patient revisited our emergency department due to right back pain. DIAGNOSES CT scans indicated retroperitoneal hematoma growth resulting in hydronephrosis of the right kidney. INTERVENTIONS Laparoscopic drainage of the retroperitoneal hematoma was successfully performed. OUTCOMES His symptoms resolved after the surgery. Follow-up CT scans three months later demonstrated complete resolution of the hydronephrosis and retroperitoneal hematoma. LESSONS Our case highlights a patient with delayed hydronephrosis because of retroperitoneal hematoma expansion after a seatbelt injury.
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Affiliation(s)
- Tetsuya Yumoto
- Advanced Emergency and Critical Care Medical Center, Okayama University Hospital
| | - Yoshitaka Kondo
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Kento Kumon
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Yoshihisa Masaoka
- Department of Radiology, Okayama University Medical School, Okayama, Japan
| | - Takao Hiraki
- Department of Radiology, Okayama University Medical School, Okayama, Japan
| | - Taihei Yamada
- Advanced Emergency and Critical Care Medical Center, Okayama University Hospital
| | - Hiromichi Naito
- Advanced Emergency and Critical Care Medical Center, Okayama University Hospital
| | - Atsunori Nakao
- Advanced Emergency and Critical Care Medical Center, Okayama University Hospital
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25
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Gayer G, Park C. Abdominal Wall Masses: CT Findings and Clues to Differential Diagnosis. Semin Ultrasound CT MR 2018; 39:230-246. [DOI: 10.1053/j.sult.2018.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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