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Shenkutie WT, Kaso T, Kaso AW, Agero G. Outcomes and Its Associated Factors among Patients with Abdominal Trauma Requiring Laparotomy at Asella Referral and Teaching Hospital, South Central Ethiopia: A Retrospective Cross-Sectional Study. ScientificWorldJournal 2024; 2024:5572633. [PMID: 39081823 PMCID: PMC11288692 DOI: 10.1155/2024/5572633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 06/05/2024] [Accepted: 06/13/2024] [Indexed: 08/02/2024] Open
Abstract
Trauma is a serious public health problem, and abdominal injuries are among the leading causes of hospitalization after trauma. Therefore, this study aimed to determine the outcome of abdominal trauma and its predictors in patients who underwent laparotomy at Asella Referral and Teaching Hospital (ARTH), South Central Ethiopia. We conducted a retrospective institutional based cross-sectional study of patients who underwent laparotomy for abdominal trauma at ARTH from October 1, 2015, to September 30, 2020. Bivariate and multivariate logistic regressions were used to determine associations between independent factors and mortality due to abdominal trauma, and a P value of <0.05 indicated statistical significance. Out of 139 patients, 110 (79.1%) were males and 88 (63.3%) aged <30 years old, with a mean age of 29 ± 15.73 years. The most common mechanism of injury was penetrating trauma, which accounted for 94 (67.6%) patients. The mortality rate was 21 (15.1%). Factors such as blunt mechanism of injury (95% CI: AOR: 3.36, 1.24-9.09), SBP < 90 mmHg at presentation (95% CI: AOR = 9.37, 3.28-26.80), time >6 hours from trauma to admission (95% CI: AOR: 5.44, 1.78-16.63), unstable intraoperative patient condition (95% CI: AOR = 8.82, 3.05-25.52), and patients who need blood transfusion (95% CI: AOR: 6.63, 1.92-22.91) were significantly associated with mortality. The mortality rate of abdominal trauma patients who underwent laparotomy was high. Therefore, healthcare providers should provide priority for traumatic patients as prolonged waiting time to get healthcare results in poor outcomes for the patients.
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Affiliation(s)
| | - Taha Kaso
- Department of SurgeryCollege of Health ScienceArsi University, Asella, Ethiopia
| | - Abdene Weya Kaso
- Department of Public HealthCollege of Health ScienceArsi University, Asella, Ethiopia
| | - Gebi Agero
- Department of Public HealthCollege of Health ScienceArsi University, Asella, Ethiopia
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Endeshaw D, Delie AM, Adal O, Tareke AA, Bogale EK, Anagaw TF, Tiruneh MG, Fenta ET. Mortality and its predictors in abdominal injury across sub-Saharan Africa: systematic review and meta-analysis. BMC Emerg Med 2024; 24:57. [PMID: 38605305 PMCID: PMC11008034 DOI: 10.1186/s12873-024-00982-3] [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: 12/13/2023] [Accepted: 04/03/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Abdominal injuries exert a significant impact on global morbidity and mortality. The aggregation of mortality data and its determinants across different regions holds immense importance for designing informed healthcare strategies. Hence, this study assessed the pooled mortality rate and its predictors across sub-Saharan Africa. METHOD This meta-analysis employed a comprehensive search across multiple electronic databases including PubMed, Africa Index Medicus, Science Direct, and Hinari, complemented by a search of Google Scholar. Subsequently, data were extracted into an Excel format. The compiled dataset was then exported to STATA 17 statistical software for analysis. Utilizing the Dersimonian-Laird method, a random-effect model was employed to estimate the pooled mortality rate and its associated predictors. Heterogeneity was evaluated via the I2 test, while publication bias was assessed using a funnel plot along with Egger's, and Begg's tests. RESULT This meta-analysis, which includes 33 full-text studies, revealed a pooled mortality rate of 9.67% (95% CI; 7.81, 11.52) in patients with abdominal injuries across sub-Saharan Africa with substantial heterogeneity (I2 = 87.21%). This review also identified significant predictors of mortality. As a result, the presence of shock upon presentation demonstrated 6.19 times (95% CI; 3.70-10.38) higher odds of mortality, followed by ICU admission (AOR: 5.20, 95% CI; 2.38-11.38), blunt abdominal injury (AOR: 8.18, 95% CI; 4.97-13.45), post-operative complications (AOR: 8.17, 95% CI; 4.97-13.44), and the performance of damage control surgery (AOR: 4.62, 95% CI; 1.85-11.52). CONCLUSION Abdominal injury mortality is notably high in sub-Saharan Africa. Shock at presentation, ICU admission, blunt abdominal injury, postoperative complications, and use of damage control surgery predict mortality. Tailored strategies to address these predictors could significantly reduce deaths in the region.
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Affiliation(s)
- Destaw Endeshaw
- Department of Adult Health Nursing, School of Health Science, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Amare Mebrat Delie
- Department of Public Health, College of medicine and health science, Injibara University, Injibara, Ethiopia
| | - Ousman Adal
- Department of emergency and critical care nursing, School of Health Science, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Abiyu Abadi Tareke
- Amref Health in Africa, COVID-19 vaccine/EPI technical assistant at West Gondar zonal health department, Gondar, Ethiopia
| | - Eyob Ketema Bogale
- Health Promotion and Behavioral science department, College of medicine and health science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Tadele Fentabel Anagaw
- Health Promotion and Behavioral science department, College of medicine and health science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Misganaw Guadie Tiruneh
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Eneyew Talie Fenta
- Department of Public Health, College of medicine and health science, Injibara University, Injibara, Ethiopia
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Liu T, Fang X, Bai Z, Liu L, Lu H, Qi X. Outcomes of selective non-operative management in adults with abdominal gunshot wounds: a systematic review and meta-analysis. Int J Surg 2024; 110:1183-1195. [PMID: 38051918 PMCID: PMC10871643 DOI: 10.1097/js9.0000000000000915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 11/05/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND AND AIMS Abdominal gunshot wounds (GSWs), a clinically devastating injury, can result in a variety of severe and lethal complications. Traditionally, exploratory laparotomy is the first-line approach for the management of abdominal GSWs, but it is associated with a considerable amount of unnecessary surgeries. At present, selective non-operative management (SNOM) of abdominal GSWs is becoming an effective and well-recognized approach, but it remains widely disputed since many surgeons are skeptical about the validity of SNOM in clinical practice. This meta-analysis aims to estimate the outcomes of SNOM and immediate laparotomy in patients with GSWs by collecting the currently available evidence. METHODS The PubMed , EMBASE , and Cochrane Library databases were searched. A random-effects model was employed. A pooled proportion with 95% confidence intervals (CIs) was calculated. Heterogeneity was evaluated using Cochran's Q test and I2 statistics. RESULTS Overall, 53 studies involving 60 291 participants were included. The pooled proportions of SNOM and SNOM failure were 27.0% (95% CI=24.0-30.0%) and 10.0% (95% CI=7.0-13.0%), respectively. The pooled mortality after SNOM and SNOM failure were 0.0% (95% CI=0.0-1.0%) and 0.0% (95% CI=0.0-0.0%), respectively. The pooled proportions of immediate laparotomy and unnecessary immediate laparotomy were 73.0% (95% CI=70.0-76.0%) and 10.0% (95% CI=8.0-13.0%), respectively. The pooled mortality after immediate laparotomy and unnecessary immediate laparotomy was 10.0% (95% CI=8.0-13.0%) and 0.0% (95% CI=0.0-1.0%), respectively. Heterogeneity was statistically significant in nearly all meta-analyses. CONCLUSION Immediate laparotomy is still the mainstay approach for the management of abdominal GSWs. Approximately one-third of patients with abdominal GSWs undergo SNOM. SNOM failure is not frequent, and its related mortality is also rare.
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Affiliation(s)
- Tingwei Liu
- Military Medical Research Group, General Hospital of Northern Theater Command, Shenyang, Liaoning Province
- Meta-Analysis Interest Group, Department of Gastroenterology, General Hospital of Northern Theater Command
- Graduate School, Jinzhou Medical University, Jinzhou, People’s Republic of China
| | - Xiaohui Fang
- Military Medical Research Group, General Hospital of Northern Theater Command, Shenyang, Liaoning Province
- Meta-Analysis Interest Group, Department of Gastroenterology, General Hospital of Northern Theater Command
- Shenyang Pharmaceutical University, Shenyang
| | - Zhaohui Bai
- Military Medical Research Group, General Hospital of Northern Theater Command, Shenyang, Liaoning Province
- Meta-Analysis Interest Group, Department of Gastroenterology, General Hospital of Northern Theater Command
- Shenyang Pharmaceutical University, Shenyang
| | - Lu Liu
- Military Medical Research Group, General Hospital of Northern Theater Command, Shenyang, Liaoning Province
| | - Hui Lu
- Military Medical Research Group, General Hospital of Northern Theater Command, Shenyang, Liaoning Province
| | - Xingshun Qi
- Military Medical Research Group, General Hospital of Northern Theater Command, Shenyang, Liaoning Province
- Meta-Analysis Interest Group, Department of Gastroenterology, General Hospital of Northern Theater Command
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Ndong A, Togtoga L, Bah MS, Ndoye PD, Niang K. Prevalence and mortality rate of abdominal surgical emergencies in Sub-Saharan Africa: a systematic review and meta-analysis. BMC Surg 2024; 24:35. [PMID: 38267892 PMCID: PMC10809467 DOI: 10.1186/s12893-024-02319-0] [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: 10/04/2023] [Accepted: 01/10/2024] [Indexed: 01/26/2024] Open
Abstract
INTRODUCTION Abdominal surgical emergencies remain prevalent in various healthcare settings, particularly in regions with limited access to basic surgical care, such as Africa. The aim of this literature review is to systematically assess publications on abdominal surgical emergencies in adults in sub-Saharan Africa to estimate their prevalence and mortality rate. METHODOLOGY A systematic review was conducted. The latest search was performed on October 31, 2022. We estimated the pooled prevalence with a 95% confidence interval (CI) for each abdominal surgical emergency, as well as overall postoperative mortality and morbidity rates. RESULTS A total of 78 studies were included, and 55.1% were single-center retrospective and monocentric studies. The mean age of the patients was 32.5 years, with a sex ratio of 1.94. The prevalence of each abdominal surgical emergency among all of them was as follows: appendicitis: 30.0% (95% CI: 26.1-33.9); bowel obstruction: 28.6% (95% CI: 25.3-31.8); peritonitis: 26.6% (95% CI: 22.2-30.9); strangulated hernias: 13,4% (95% CI: 10,3-16,5) and abdominal trauma: 9.4% (95% CI: 7.5-11.3). The prevalence of complications was as follows: mortality rate: 7.4% (95% CI: 6.0-8.8); overall postoperative morbidity: 24.2% (95% CI: 19.4-29.0); and surgical site infection 14.4% (95% CI: 10.86-18.06). CONCLUSION Our study revealed a high prevalence of postoperative complications associated with abdominal surgical emergencies in sub-Saharan Africa. More research and efforts should be made to improve access and quality of patient care.
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Affiliation(s)
- Abdourahmane Ndong
- Department of Public Health and Social Medicine, Faculty of Health Sciences, Gaston Berger University, Saint-Louis, Senegal.
- General Surgery Department, Regional Hospital Center of Saint Saint-Louis, Saint-Louis, Senegal.
| | - Lebem Togtoga
- Department of Public Health and Social Medicine, Faculty of Health Sciences, Gaston Berger University, Saint-Louis, Senegal
| | - Mamadou Saïdou Bah
- Department of Public Health and Social Medicine, Faculty of Health Sciences, Gaston Berger University, Saint-Louis, Senegal
| | - Papa Djibril Ndoye
- Department of Public Health and Social Medicine, Faculty of Health Sciences, Gaston Berger University, Saint-Louis, Senegal
| | - Khadim Niang
- Department of Public Health and Social Medicine, Faculty of Health Sciences, Gaston Berger University, Saint-Louis, Senegal
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Moeng MS, Viljoen F, Makhadi S. The Role for Preperitoneal Pelvic Packing in Low-to-Middle-Income Countries: A 16-Year Experience at a Johannesburg Trauma Unit. World J Surg 2023; 47:2651-2658. [PMID: 37716931 PMCID: PMC10545629 DOI: 10.1007/s00268-023-07173-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2023] [Indexed: 09/18/2023]
Abstract
INTRODUCTION Preperitoneal pelvic packing for early pelvic haemorrhage control reduces mortality. Bleeding noted with pelvis fractures is predominantly due to associated venous complex injuries. More studies are advocating for angiography as first-line therapy for haemodynamic instability in pelvic fractures; however, these facilities are not in abundance in middle- and low-income countries. We hypothesized that PPP improves outcomes under these circumstances. METHODS Retrospective analysis of data from the patients charts over a period of 16 years from 01 January, 2005 to 31 December, 2020. All patients over the age of 18 years who presented with haemodynamic instability from a pelvic fracture and required PPP were included. The demographics, physiological parameter in emergency department, blood products transfused, morbidity and mortality were analysed. RESULTS There were 110 patients identified in the study period who underwent pelvic preperitoneal packing for refractory shock or ongoing bleeding. The majority (75.5%) of patients were men (n = 83). The median age was 38 years. The most common mechanism of injury was pedestrian vehicle collision (51%), followed by motor vehicle collisions (27.3%). The median ISS and NISS were 35 and 40, respectively. The median RTS in ED was 4.8(3-6.8). None of our patients rebleed after pack removal and no one needed repacking or adjunct angioembolization in our study group. The in-hospital mortality rate was 43.6% (n = 48) in patients who underwent preperitoneal pelvic packing. The operating room table mortality was 20% (n = 22/110), and the mortality rate of those who survived to ICU transfer was 29.5% (n = 26/88). CONCLUSIONS Pelvic preperitoneal packing has a role in the acute management of haemodynamically abnormal patients with pelvic fractures in our environment. In the absence of immediate angioembolization, preperitoneal packing can be lifesaving.
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Affiliation(s)
- Maeyane Stephens Moeng
- Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 2193, South Africa
| | - Francois Viljoen
- Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 2193, South Africa
| | - Shumani Makhadi
- Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 2193, South Africa.
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Kim Y, Yu B, Jeon SB, Lee SH, Cho J, Gwak J, Park Y, Choi KK, Lee MA, Lee GJ, Lee J. Epidemiology and outcomes of patients with penetrating trauma in Incheon Metropolitan City, Korea based on National Emergency Department Information System data: a retrsopective cohort study. JOURNAL OF TRAUMA AND INJURY 2023; 36:224-230. [PMID: 39381703 PMCID: PMC11309264 DOI: 10.20408/jti.2022.0055] [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: 11/07/2022] [Revised: 12/01/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose Patients with penetrating injuries are at a high risk of mortality, and many of them require emergency surgery. Proper triage and transfer of the patient to the emergency department (ED), where immediate definitive treatment is available, is key to improving survival. This study aimed to evaluate the epidemiology and outcomes of patients with penetrating torso injuries in Incheon Metropolitan City. Methods Data from trauma patients between 2014 and 2018 (5 years) were extracted from the National Emergency Department Information System. In this study, patients with penetrating injuries to the torso (chest and abdomen) were selected, while those with superficial injuries were excluded. Results Of 66,285 patients with penetrating trauma, 752 with injuries to the torso were enrolled in this study. In the study population, 345 patients (45.9%) were admitted to the ward or intensive care unit (ICU), 20 (2.7%) were transferred to other hospitals, and 10 (1.3%) died in the ED. Among the admitted patients, 173 (50.1%) underwent nonoperative management and 172 (49.9%) underwent operative management. There were no deaths in the nonoperative management group, but 10 patients (5.8%) died after operative management. The transferred patients showed a significantly longer time from injury to ED arrival, percentage of ICU admissions, and mortality. There were also significant differences in the percentage of operative management, ICU admissions, ED stay time, and mortality between hospitals. Conclusions Proper triage guidelines need to be implemented so that patients with torso penetrating trauma in Incheon can be transferred directly to the regional trauma center for definitive treatment.
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Affiliation(s)
- Youngmin Kim
- Department of Trauma Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Byungchul Yu
- Department of Trauma Surgery, Gachon University Gil Medical Center, Incheon, Korea
- Department of Traumatology, Gachon University College of Medicine, Incheon, Korea
| | - Se-Beom Jeon
- Department of Trauma Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Seung Hwan Lee
- Department of Trauma Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Jayun Cho
- Department of Trauma Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Jihun Gwak
- Department of Trauma Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Youngeun Park
- Department of Trauma Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Kang Kook Choi
- Department of Trauma Surgery, Gachon University Gil Medical Center, Incheon, Korea
- Department of Traumatology, Gachon University College of Medicine, Incheon, Korea
| | - Min A Lee
- Department of Trauma Surgery, Gachon University Gil Medical Center, Incheon, Korea
- Department of Traumatology, Gachon University College of Medicine, Incheon, Korea
| | - Gil Jae Lee
- Department of Trauma Surgery, Gachon University Gil Medical Center, Incheon, Korea
- Department of Traumatology, Gachon University College of Medicine, Incheon, Korea
| | - Jungnam Lee
- Department of Trauma Surgery, Gachon University Gil Medical Center, Incheon, Korea
- Department of Traumatology, Gachon University College of Medicine, Incheon, Korea
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Singh Y, Motilall S, Khulu BL, Jackson BS. The impact of colon injuries on the outcome of gunshot wounds to the abdomen. Langenbecks Arch Surg 2023; 408:328. [PMID: 37612518 PMCID: PMC10447282 DOI: 10.1007/s00423-023-03067-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 08/14/2023] [Indexed: 08/25/2023]
Abstract
PURPOSE Factors predicting morbidity and mortality in patients with colon-related gunshot injuries and the management of these injuries are not always straightforward. This aimed to assess the impact of abdominal gunshot wounds with colonic injuries on patients' overall outcomes. METHODS This cross-sectional prospective observational study compared patients with colon injuries and without colon injuries. Data was collected from admission, theatre and postoperative care. Patients were recruited between 1 January 2020 and 20 October 2021. RESULTS Of 132 patients with abdominal gunshot injuries, 71 (54.0%) had colon injuries. The colon injury group had a higher incidence of laparotomy wound sepsis (p<0.0001), bullet exit wound infection (p<0.0001), tract necrotizing fasciitis (p<0.0001), relook laparotomies (p<0.0001) and a longer hospital stay (p<0.0001). Septicaemia (p=0.002) or anastomotic leak (p=0.041) was associated with a penetrating abdominal trauma index (PATI) ≥25. Most patients who developed tract necrotizing fasciitis did not have their tract debrided/ lavaged (p=0.004). The type of colon repair did not influence the length of hospital stay (p=0.688) or the development of a colon-related complication (p=0.578). Between 18 and 25 years (p<0.0001) and >2 organs injured (p=0.018) were associated with colon-related complications. Patients between 18 and 25 years were 4.748 times more likely to develop a colon-related complication (p=0.046). CONCLUSION Gunshot wounds to the abdomen with associated colonic injuries had a worse outcome with an increased risk of developing wound infections. There is no difference in the operative management of colonic injury. Patients between the ages of 18 and 25 years or >2 organs injured are more likely to develop a complication.
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Affiliation(s)
- Yonita Singh
- Department of Surgery, Tembisa Provincial Tertiary Hospital, University of Pretoria, Pretoria, 0007, South Africa.
| | - Sooraj Motilall
- Department of Surgery, Steve Biko Academic Hospital, University of Pretoria, Pretoria, 0007, South Africa
| | - Bongani L Khulu
- Department of Surgery, Tembisa Provincial Tertiary Hospital, University of Pretoria, Pretoria, 0007, South Africa
| | - Brandon S Jackson
- Department of Surgery, Kalafong Provincial Tertiary Hospital, University of Pretoria, Pretoria, 0007, South Africa
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Baptiste SJ, van den Boogaard W, Letoquart JP, NDong JG, Jonacé G, Télémaque LF. Les traumatismes abdominaux en Haïti. Public Health Action 2023; 13:1-6. [PMID: 37529552 PMCID: PMC10380416 DOI: 10.5588/pha.23.0008] [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] [Received: 02/12/2023] [Accepted: 04/12/2023] [Indexed: 08/03/2023] Open
Abstract
CONTEXT Abdominal trauma (AT) appears to be frequent in Haiti, which is confronted with recurrent socio-political violence. OBJECTIVE To study patients admitted for AT to the Médecins Sans Frontières (MSF) Tabarre trauma centre (Port-au-Prince), and the circumstances of occurrence. DESIGN This was a cross-sectional study with retrospective data from January 2020 to December 2021. RESULTS Of 3,211 patients admitted for trauma, 541 (17.3%) had an AT, of which 500 (91.4%) were related to sociopolitical events. Their median age was 30 years (interquartile range [IQR] 23-38); 429 (85.8%) were male. A gunshot wound was noted in 371 (74.2%). The median distance from the scene of violence to the hospital was 11 km (IQR 7-15); however, 9 (1.8%) came within 1 hour of the trauma; transfusion was not done or insufficient in 169 (33.8%). An adverse outcome (death, referral, discharge against medical advice) was noted in 57 (11.4%), with 8.0% of deaths. Political instability was the main cause of violence. An adverse outcome was associated with inadequate transfusion (hazard ratio [HR] 2.4, 95% CI 1.4-4.3; P = 0.006) or gunshot wound (HR 2.4, 95% CI 1.1-5.2; P = 0.002). CONCLUSION Firearm injuries were common during the period of sociopolitical events 2020-2021. The lack of blood products had a negative impact on patient outcomes. Safety measures and blood collection still need to be maintained and strengthened.
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Affiliation(s)
- S J Baptiste
- Centre Traumatologie Tabarre, Médecins Sans Frontières (MSF), Port-au-Prince, Haïti
| | - W van den Boogaard
- Département Médicale, Unité recherche opérationnel (LuxOR), MSF, Luxembourg
| | | | - J-G NDong
- Centre Traumatologie Tabarre, Médecins Sans Frontières (MSF), Port-au-Prince, Haïti
| | - G Jonacé
- Centre Traumatologie Tabarre, Médecins Sans Frontières (MSF), Port-au-Prince, Haïti
| | - L-F Télémaque
- Département Chirurgie-traumatologie, Ministère de la Santé Publique et de la Population, Port-au-Prince, Haïti
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Tito MG, Makelele JPK, van den Boogaard W, Ade S, Deselets A, Briskin E, Badjo C, Salviati D, Akem ET, Hejdenberg M. Reference des cas de traumatisme par arme à feu en Afrique. Public Health Action 2023; 13:30-35. [PMID: 37529555 PMCID: PMC10380415 DOI: 10.5588/pha.23.0006] [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: 02/11/2023] [Accepted: 05/22/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND In a war-torn African country, Médecins Sans Frontières supports two regional referral hospitals to address emergencies, including the treatment of firearm-related traumas. It facilitates access to healthcare and referrals, which are often hindered due to non-medical reasons. OBJECTIVE To determine the factors influencing the unfavourable outcome of cases referred for firearm trauma (December 2020-November 2021). METHOD This was a cross-sectional study using routinely collected data. RESULTS A total of 381 patients who were victims of firearm-related trauma were admitted, with an average age of 29 years; 28.3% had severe injuries, including thoraco-abdominal injuries and fractures. The mortality rate was 4.9%, and 7.9% left against medical advice. Patients affiliated with the irregular armed forces accounted for 45.4%, and had a two-thirds higher rate of unsuccessful referral for non-medical reasons. Patients with severe injuries at triage, affiliation with the irregular forces and being in the regular army had 2 times (P < 0.01), 5.9 times (P < 0.01) and 8.1 times (P < 0.01), respectively, a higher risk of an unfavourable outcome. CONCLUSION Serious cases caused by firearm injuries were more likely to have an adverse outcome. The risk was higher in those with a specific affiliation, who were more often denied access to higher referral care based on socio-political rather than medical reasons.
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Affiliation(s)
- M G Tito
- Médecins Sans Frontières (MSF) Centre Opérationnel Amsterdam, Amsterdam, Pays-Bas
| | | | - W van den Boogaard
- MSF-Luxembourg, centre Opérationnelle Bruxelles, Département Médicale, Unité recherche opérationnelle (LuxOR), Ville de Luxembourg, Luxembourg
| | - S Ade
- Faculté de Médecine, Université de Parakou, Parakou, Bénin
| | - A Deselets
- University for Peace (UN-mandated) - Department of International Law, Costa Rica
| | | | - C Badjo
- Médecins Sans Frontières (MSF) Centre Opérationnel Amsterdam, Amsterdam, Pays-Bas
| | - D Salviati
- Médecins Sans Frontières (MSF) Centre Opérationnel Amsterdam, Amsterdam, Pays-Bas
| | - E T Akem
- Médecins Sans Frontières (MSF) Centre Opérationnel Amsterdam, Amsterdam, Pays-Bas
| | - M Hejdenberg
- Médecins Sans Frontières (MSF) Centre Opérationnel Amsterdam, Amsterdam, Pays-Bas
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Makhadi S, Lubout M, Moeng MS. Introduction of Laparoscopy in an Urban High-Volume Sub-Saharan Trauma Centre. World J Surg 2023; 47:1657-1661. [PMID: 36995401 DOI: 10.1007/s00268-023-06980-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2023] [Indexed: 03/31/2023]
Abstract
INTRODUCTION Trauma is a major disease burden in low and middle-income countries like South Africa. Abdominal trauma is one of the leading reasons for emergency surgery. The standard of care for these patients is a laparotomy. In selected trauma patients, laparoscopy has both diagnostic and therapeutic usage. The trauma burden and the number of cases seen in a busy trauma unit make laparoscopy challenging. AIM We wanted to describe our journey with laparoscopy in the management of abdominal trauma in a busy urban trauma unit in Johannesburg, South Africa. METHODS We reviewed all trauma patients who underwent diagnostic laparoscopy (DL) or therapeutic laparoscopy (TL) between 01 January 2017 and 31 October 2020 for blunt and penetrating abdominal trauma. The demographic data, indications for laparoscopy, injuries identified, procedures performed, intraoperative laparoscopic complications, conversion to laparotomy, morbidity, and mortality were evaluated. RESULTS A total of 54 patients who had laparoscopy were included in the study. The median age was 29 years (IQR 25-25). Most injuries were penetrating 85.2% (n = 46/54) and 14.8% blunt trauma. Most patients were males, 94.4% (n = 51/54). Indications for laparoscopy included diaphragm evaluation (40.7%), pneumoperitoneum for evaluation of potential bowel injury (16.7%), free fluid with no evidence of solid organ injury (12.9%) and colostomy (5.5%). There were 8 (14.8%) cases converted to laparotomy. There were no missed injuries or mortality in the study group. CONCLUSION Laparoscopy in selected trauma patients is safe even in a busy trauma unit. It is associated with less morbidity and shortened hospital length of stay.
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Affiliation(s)
- Shumani Makhadi
- Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 2193, South Africa.
| | - Megan Lubout
- Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 2193, South Africa
| | - Maeyane S Moeng
- Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 2193, South Africa
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Wolmarans A, Fru PN, Moeng MS. Accuracy of CT Scan for Detecting Hollow Viscus Injury in Penetrating Abdominal Trauma. World J Surg 2023; 47:1457-1463. [PMID: 36859569 PMCID: PMC10156834 DOI: 10.1007/s00268-023-06954-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND In penetrating abdominal trauma, computed tomography (CT) is routinely performed to evaluate stable patients for selective non-operative management (SNOM). Triple-contrast CT (oral, rectal, and IV) has traditionally been used. However, due to its disadvantages, most trauma centres, including our unit at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), now perform single-contrast intravenous-only CT scans. We performed a retrospective review to determine the accuracy of single-contrast CT scans for detecting hollow viscus injuries (HVI) in penetrating abdominal trauma. METHODS A retrospective review of all patients who presented to CMJAH with penetrating abdominal injuries was performed between 01 August 2017 and 31 August 2019 and were evaluated for SNOM with CT (IV contrast only). Patient records were reviewed to determine pertinent demographics, mechanism, and site of injury, as well as metabolic parameters. CT findings were compared to findings at laparotomy. RESULTS A total of 437 patients met the inclusion criteria. The majority were male (92.7%), with a mean age of 31.5 yrs (SD 8.7). Injuries were predominantly due to stab wounds (72,5%, n = 317). CT scan was negative in 342 patients, of which 314 completed SNOM successfully. A total of 93 patients proceeded to laparotomy. CT had a sensitivity of 95.1%, specificity of 44.2%, positive predictive value of 57.4%, and negative predictive value of 92%. CONCLUSION Single-contrast CT in penetrating abdominal trauma is a valuable investigative tool in identifying patients for SNOM. Features of HVI on single-contrast CT are not very specific and should be interpreted along with other clinical factors including wound trajectory and serial abdominal examinations. Other associated injuries such as diaphragmatic and solid organ injuries should be considered in the final management plan.
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Affiliation(s)
- Anika Wolmarans
- Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa.
| | - Pascaline N Fru
- Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa
| | - Maeyane S Moeng
- Trauma Surgery Department, Charlotte Maxeke Johannesburg Academic Hospital, 17 Jubilee Road, Parktown, Johannesburg, 2193, South Africa
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Yasin NA, Ali AM, Ahmed MA, Keleşoğlu Sİ. Epidemiological Characteristics, Antimicrobial Susceptibility Profile, and Surgical Outcome of Complicated Intra-Abdominal Infection at a Tertiary Hospital in Somalia. Int J Gen Med 2022; 15:7427-7434. [PMID: 36172084 PMCID: PMC9512019 DOI: 10.2147/ijgm.s379711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/09/2022] [Indexed: 11/30/2022] Open
Abstract
Background Intra-abdominal infections (IAIs) are common surgical emergencies and one of the leading causes of non-trauma deaths in hospitals worldwide. Because of limited resources, most patients in low-income countries experience delayed diagnosis and treatment. To the best of our knowledge, this is the first study to evaluate the epidemiological characteristics, antimicrobial susceptibility profile, and outcome of patients with complicated IAI at a tertiary hospital in Somalia. Methods This study included all patients with confirmed IAIs who underwent laparotomy or percutaneous drainage, either emergency or elective, and whose cultures showed growth. Sociodemographic and clinical characteristics, culture results, antimicrobial susceptibility profile, and the type of source control were reviewed. Results The prevalence of CIAI was 5.3%, 144 (70%) were male, and 61 (30%) were female. The mean age was 38.6±8.5 years. Appendicitis was the most common source of infection, accounting for 32%, followed by bowel perforation in 37 (18%). Out of 15 patients with liver abscesses, ten patients had diabetes (67%). E. coli 82 (40%) was the most common isolated organism, followed by Klebsiella pneumonia (n = 44, 21.5%). The prevalence of extended-spectrum beta-lactamase-producing and multidrug-resistant pathogens was 6.8% and 5.9%, respectively. The pathogens revealed a higher antimicrobial resistance against penicillins in 62%, cephalosporins in 54%, and fluoroquinolones in 44%. E. coli showed 2.5–13% antimicrobial resistance against carbapenems, lower than Klebsiella pneumonia in about 4.5%. Tigecycline, teicoplanin, and linezolid revealed the highest sensitivity against pathogens, about 100%. Source control was achieved by laparotomy in 81%, while the 19% were managed in a percutaneous approach. The mortality rate in our study was 9.3%. Conclusion The prevalence of CIAI in our study was 5.3%, with an increasing number of MDR microorganisms isolated from cultures. CIAI and intra-abdominal abscess are significant sources of high morbidity and mortality with sepsis and poor clinical outcome; thus, early detection and intervention are crucial.
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Affiliation(s)
- Nor Abdi Yasin
- Department of General Surgery, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia
- Correspondence: Nor Abdi Yasin, Tel +252 615732173, Email
| | - Abdihamid Mohamed Ali
- Department of General Surgery, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Mohamed Abdi Ahmed
- Department of General Surgery, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Salim İdris Keleşoğlu
- Department of General Surgery, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia
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Robinson B, Purcell LN, Kajombo C, Gallaher J, Charles A. Outcomes of stab wounds presenting to Kamuzu Central Hospital in Malawi. Malawi Med J 2021; 33:1-6. [PMID: 34422227 PMCID: PMC8360291 DOI: 10.4314/mmj.v33i1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction Injuries are a leading cause of morbidity and mortality worldwide, necessitating that we understand the local burden of injury to improve injury-related trauma care and patient outcomes. The characteristics, outcomes, and risk factors for mortality following stab wounds in Malawi are poorly delineated. Methods This is a retrospective, descriptive analysis of patients presenting to Kamuzu Central Hospital in Lilongwe, Malawi, with stab wounds from February 2008 to May 2018. Univariate and bivariate analyses were performed to compare patient and injury characteristics based on mortality. We performed Poisson multivariate regression to predict the factors that increase the relative risk of mortality. Results During the study, 32,297 patients presented with assault. Of those patients, 2,352 (7.3%) presented with stab wounds resulting in a 3.2% (n=74) overall mortality. The majority of wounds were to the head or cervical spine (n=1,043, 44.6%), while injuries to the chest (n=319, 13.7%) were less frequent. We found an increased relative risk of mortality in patients who presented with an injury to the chest (RR 3.95, 95% CI 1.79-8.72, p=0.001) and who were brought in by the police (RR 33.24, 95% CI 11.23-98.35, p<0.001). Conclusion In this study, stab wounds accounted for 7.3% of all assault cases, with a 3.2% mortality. Though the commonest site of stab was the head, wounds to the chest conferred the highest relative risk of mortality. A multifaceted approach to reducing mortality is needed. Incorporating training of first responders in basic life support, including the police, may reduce stab-related mortality.
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Affiliation(s)
- Brittany Robinson
- School of Medicine, University of California San Francisco, San Francisco, California
| | - Laura N Purcell
- Department of Surgery, University of North Carolina at Chapel Hill
| | | | - Jared Gallaher
- Department of Surgery, University of North Carolina at Chapel Hill
| | - Anthony Charles
- Department of Surgery, University of North Carolina at Chapel Hill
- Kamuzu Central Hospital, Lilongwe, Malawi
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Time to surgery: Is it truly crucial in initially stable patients with penetrating injury? Injury 2021; 52:195-199. [PMID: 33004205 DOI: 10.1016/j.injury.2020.09.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/02/2020] [Accepted: 09/19/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Treatment recommendations for patients with penetrating abdominal injury are well established. Trauma victims with clear indications for surgery, should undergo immediate operative intervention without any delay or additional imaging. However, the optimal time for surgery remains unclear. There are some significant advantages in preoperative abdominal CT, including gathering essential information regarding a few difficult to reach anatomical areas, avoiding unnecessary explorations associated with increased morbidity and assessing the existence of extra-abdominal injuries that may have non-expectable impact on initial therapeutic plan. The aim of this study was to determine the impact of "time-to-surgery" on final medical outcomes in patients with penetrating abdominal trauma with normal blood pressure on admission. METHODS A retrospective cohort study using the Israeli National Trauma Registry was conducted from 2000- 2018. This study included trauma patients with penetrating injuries and a systolic blood pressure of 90mmHg or above on admission. All patients included in the study were divided into three groups according to the time that lapsed from their admission to surgery: half an hour, an hour, and two hours. We assessed the outcome for each patient, including length of hospital stay, need for intensive care and mortality. Statistical analysis was performed using the Chi-square test, ANOVA test. A p-value of less than 0.05 was considered statistically significant. RESULTS The study included 1,136 penetrating trauma patients. Among these, 78.0% (886) had sustained low-energy penetrating injury (SWPI) and 22.0% (250) had sustained high-energy penetrating injury (FAPI). Males accounted for 93.5% (1,062) of the patients. Mean age was 30.4. About 29% (327) of all the patients underwent surgery within 30 minutes from admission, 42% (475) within 30-60 min, and 29% (334) patients were operated within one to two hours. Patients who underwent surgery within 30 minutes, had worse ISS and GCS scores and were, therefore, more likely to have worse clinical outcomes. No other differences in outcomes were found in patients who were operated upon within 2 hours. CONCLUSIONS Time to surgery within two hours from admission has no impact on final outcomes in trauma patients with penetrating injury and normal blood pressure on admission.
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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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Feldhaus I, Carvalho M, Waiz G, Igu J, Matthay Z, Dicker R, Juillard C. Thefeasibility, appropriateness, and applicability of trauma scoring systems in low and middle-income countries: a systematic review. Trauma Surg Acute Care Open 2020; 5:e000424. [PMID: 32420451 PMCID: PMC7223475 DOI: 10.1136/tsaco-2019-000424] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 03/27/2020] [Accepted: 04/17/2020] [Indexed: 11/18/2022] Open
Abstract
Background About 5.8 million people die each year as a result of injuries, and nearly 90% of these deaths occur in low and middle-income countries (LMIC). Trauma scoring is a cornerstone of trauma quality improvement (QI) efforts, and is key to organizing and evaluating trauma services. The objective of this review was to assess the appropriateness, feasibility, and QI applicability of traditional trauma scoring systems in LMIC settings. Materials and methods This systematic review searched PubMed, Scopus, CINAHL, and trauma-focused journals for articles describing the use of a standardized trauma scoring system to characterize holistic health status. Studies conducted in high-income countries (HIC) or describing scores for isolated anatomic locations were excluded. Data reporting a score’s capacity to discriminate mortality, feasibility of implementation, or use for QI were extracted and synthesized. Results Of the 896 articles screened, 336 were included. Over half of studies (56%) reported Glasgow Coma Scale, followed by Injury Severity Score (ISS; 51%), Abbreviated Injury Scale (AIS; 24%), Revised Trauma Score (RTS; 19%), Trauma and Injury Severity Score (TRISS; 14%), and Kampala Trauma Score (7%). While ISS was overwhelmingly predictive of mortality, 12 articles reported limited feasibility of ISS and/or AIS. RTS consistently underestimated injury severity. Over a third of articles (37%) reporting TRISS assessmentsobserved mortality that was greater than that predicted by TRISS. Several articles cited limited human resources as the key challenge to feasibility. Conclusions The findings of this review reveal that implementing systems designed for HICs may not be relevant to the burden and resources available in LMICs. Adaptations or alternative scoring systems may be more effective. PROSPERO registration number CRD42017064600.
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Affiliation(s)
- Isabelle Feldhaus
- Department of Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Melissa Carvalho
- Department of Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Ghazel Waiz
- Department of Surgery, Center for Global Surgical Studies, University of California San Francisco, San Francisco, California, USA
| | - Joel Igu
- Johns Hopkins University Carey Business School, Baltimore, Maryland, USA
| | - Zachary Matthay
- Department of Surgery, Center for Global Surgical Studies, University of California San Francisco, San Francisco, California, USA
| | - Rochelle Dicker
- Department of Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Catherine Juillard
- Department of Surgery, University of California Los Angeles, Los Angeles, California, USA
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Alenazi AK, Almutairi NA, Alhuzaimi YK, Altamimi SS, Alayed YS, Alanazi ZG. The nature and severity of stab wounds at tertiary care hospitals in Kingdom of Saudi Arabia. Pan Afr Med J 2019; 34:212. [PMID: 32180885 PMCID: PMC7060908 DOI: 10.11604/pamj.2019.34.212.20533] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 11/13/2019] [Indexed: 11/11/2022] Open
Abstract
Introduction Fights, domestic violence and street crimes are the major causes of stab wounds in the Kingdom of Saudi Arabia (KSA). The objective of the study was to describe the nature and severity of stab wounds at a tertiary care hospital in KSA. Methods A cross-sectional study, which included 106 patients, was conducted at the King Khalid Hospital and Prince Sultan Centre for Health Care in Al Kharj. The patients that fulfilled the inclusion criteria were recruited for the study after having confirmed their consent. The authors procured and analysed the patients' clinical notes to obtain information that was pertinent to the study. The authors recorded all data within a Microsoft Excel document. SPSS 22.0 was utilized for statistical analysis. Results Of 106 patients, the majority were adolescents and young adults under the age of 40 (n = 77). Eighty-seven point seven percent of patients were male and 84.0% were Saudis. Demographic details were tabulated. The top three causes were fights (20.8%) followed by domestic violence (18.9%) and street crime (17.0%). Degree of shock, stabbing zones, injury to vessels, nerves and bones, injury severity score (ISS) and Glasgow Coma Scale (GCS) were tabulated. Conclusion The nature and severity of stab wounds should be carefully evaluated and properly managed, as these may lead to serious complications.
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Affiliation(s)
| | | | | | | | | | - Ziad Ghanem Alanazi
- Prince Sattam Bin Abdulaziz University, Colleges of Medicine, Al-Kharj, Saudi Arabia
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18
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Conde N, Bah M, Diallo A, Konate G, Diallo A, Camara O, Tolno F, Oulare S, Diallo T, Savane H, Traore N, Bah H. Les plaies par armes blanches à Conakry : aspects épidémiologique et médicolégal. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.medleg.2019.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Johannesdottir U, Jonsdottir GM, Johannesdottir BK, Heimisdottir AA, Eythorsson E, Gudbjartsson T, Mogensen B. Penetrating stab injuries in Iceland: a whole-nation study on incidence and outcome in patients hospitalized for penetrating stab injuries. Scand J Trauma Resusc Emerg Med 2019; 27:7. [PMID: 30674331 PMCID: PMC6343331 DOI: 10.1186/s13049-018-0582-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 12/27/2018] [Indexed: 11/10/2022] Open
Abstract
Background Studies on penetrating injuries in Europe are scarce and often represent data from single institutions. The aim of this study was to describe the incidence and demographic features of patients hospitalized for stab injury in a whole nation. Materials and methods This was a retrospective nationwide population-based study on all consecutive adult patients who were hospitalized in Iceland following knife and machete-related injuries, 2000–2015. Age-standardized incidence was calculated and Injury Severity Score (ISS) was used to assess severity of injury. Results Altogether, 73 patients (mean age 32.6 years, 90.4% males) were admitted during the 16-year study period, giving an age-standardized incidence of 1.54/100,000 inhabitants. The incidence did not vary significantly during the study period (P = 0.826). Most cases were assaults (95.9%) occurring at home or in public streets, and involved the chest (n = 32), abdomen (n = 26), upper limbs (n = 26), head/neck/face (n = 21), lower limbs (n = 10), and the back (n = 6). Median ISS was 9, with 14 patients (19.2%) having severe injuries (defined as ISS > 15). The median length of hospital stay was 2 days (range 0–53). Forty-seven patients (64.4%) underwent surgery and 26 of them (35.6%) required admission to an intensive care unit (ICU), all with ISS scores above 15. Three patients did not survive for 30 days (4.1%); all of them had severe injuries (ISS 17, 25, and 75). Conclusion Stab injuries that require hospital admission are rare in Iceland, and their incidence has remained relatively stable. One in every five patients sustained severe injuries, two-thirds of whom were treated with surgical interventions, and roughly one-third required ICU care. Although some patients were severely injured with high injury scores, their 30-day mortality was still low in comparison to other studies.
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Affiliation(s)
- Una Johannesdottir
- Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland
| | | | | | | | - Elias Eythorsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Department of Internal Medicine, Landspitali University Hospital, Reykjavik, Iceland
| | - Tomas Gudbjartsson
- Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Brynjolfur Mogensen
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland. .,Department of Emergency Medicine, Landspitali University Hospital, Reykjavik, Iceland.
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Chu KM, Karjiker P, Naidu P, Kruger D, Taylor A, Trelles M, Dominguez L, Rayne S. South African General Surgeon Preparedness for Humanitarian Disasters. World J Surg 2018; 43:973-977. [DOI: 10.1007/s00268-018-04881-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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21
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Al Rawahi AN, Al Hinai FA, Boyd JM, Doig CJ, Ball CG, Velmahos GC, Kirkpatrick AW, Navsaria PH, Roberts DJ. Outcomes of selective nonoperative management of civilian abdominal gunshot wounds: a systematic review and meta-analysis. World J Emerg Surg 2018; 13:55. [PMID: 30505340 PMCID: PMC6260713 DOI: 10.1186/s13017-018-0215-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 11/05/2018] [Indexed: 01/05/2023] Open
Abstract
Background Although mandatory laparotomy has been standard of care for patients with abdominal gunshot wounds (GSWs) for decades, this approach is associated with non-therapeutic operations, morbidity, and long hospital stays. This systematic review and meta-analysis sought to summarize outcomes of selective nonoperative management (SNOM) of civilian abdominal GSWs. Methods We searched electronic databases (March 1966-April 1, 2017) and reference lists of articles included in the systematic review for studies reporting outcomes of SNOM of civilian abdominal GSWs. We meta-analyzed the associated risks of SNOM-related failure (defined as laparotomy during hospital admission), mortality, and morbidity across included studies using DerSimonian and Laird random-effects models. Between-study heterogeneity was assessed by calculating I2 statistics and conducting tests of homogeneity. Results Of 7155 citations identified, we included 41 studies [n = 22,847 patients with abdominal GSWs, of whom 6777 (29.7%) underwent SNOM]. The pooled risk of failure of SNOM in hemodynamically stable patients without a reduced level of consciousness or signs of peritonitis was 7.0% [95% confidence interval (CI) = 3.9-10.1%; I2 = 92.6%, homogeneity p < 0.001] while the pooled mortality associated with use of SNOM in this patient population was 0.4% (95% CI = 0.2-0.6%; I2 = 0%, homogeneity p > 0.99). In patients who failed SNOM, the pooled estimate of the risk of therapeutic laparotomy was 68.0% (95% CI = 58.3-77.7%; I2 = 91.5%; homogeneity p < 0.001). Risks of failure of SNOM were lowest in studies that evaluated patients with right thoracoabdomen (3.4%; 95% CI = 0-7.0%; I2 = 0%; homogeneity p = 0.45), flank (7.0%; 95% CI = 3.9-10.1%), and back (3.1%; 95% CI = 0-6.5%) GSWs and highest in those that evaluated patients with anterior abdomen (13.2%; 95% CI = 6.3-20.1%) GSWs. In patients who underwent mandatory abdominopelvic computed tomography (CT), the pooled risk of failure was 4.1% versus 8.3% in those who underwent selective CT (p = 0.08). The overall sample-size-weighted mean hospital length of stay among patients who underwent SNOM was 6 days versus 10 days if they failed SNOM or developed an in-hospital complication. Conclusions SNOM of abdominal GSWs is safe when conducted in hemodynamically stable patients without a reduced level of consciousness or signs of peritonitis. Failure of SNOM may be lower in patients with GSWs to the back, flank, or right thoracoabdomen and be decreased by mandatory use of abdominopelvic CT scans.
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Affiliation(s)
| | - Fatma A. Al Hinai
- Department of Surgery, University of Calgary, Calgary, Alberta Canada
| | - Jamie M. Boyd
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta Canada
| | - Christopher J. Doig
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta Canada
| | - Chad G. Ball
- Department of Surgery, University of Calgary, Calgary, Alberta Canada
- Regional Trauma Program, University of Calgary and the Foothills Medical Centre, Calgary, Alberta Canada
| | - George C. Velmahos
- Division of Trauma, Emergency Surgery, and Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA USA
| | - Andrew W. Kirkpatrick
- Department of Surgery, University of Calgary, Calgary, Alberta Canada
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta Canada
- Regional Trauma Program, University of Calgary and the Foothills Medical Centre, Calgary, Alberta Canada
| | - Pradeep H. Navsaria
- Department of Surgery, University of Cape Town Health Sciences Faculty, Cape Town, South Africa
- Trauma Centre, Groote Schuur Hospital, Observatory, Cape Town, South Africa
| | - Derek J. Roberts
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, The Ottawa Hospital, Civic Campus, Room A280, 1053 Carling Avenue, Ottawa, Ontario K1Y 4E9 Canada
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Characteristics and management of penetrating abdominal injuries in a German level I trauma center. Eur J Trauma Emerg Surg 2018; 45:315-321. [DOI: 10.1007/s00068-018-0911-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 01/13/2018] [Indexed: 10/18/2022]
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Eaton J, Grudziak J, Hanif AB, Chisenga WC, Hadar E, Charles A. The effect of anatomic location of injury on mortality risk in a resource-poor setting. Injury 2017; 48:1432-1438. [PMID: 28551054 DOI: 10.1016/j.injury.2017.05.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 05/10/2017] [Accepted: 05/15/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Injury is a significant cause of death, with approximately 4.7 million people mortalities each year. By 2030, injury is predicted to be among the top 20 causes of death worldwide. We sought to characterize and compare the mortality probability in trauma patients in a resource-poor setting based on anatomic location of injury. METHODS We performed a retrospective analysis of prospectively collected data using the trauma database at Kamuzu Central Hospital (KCH) in Lilongwe, Malawi. We included all adult trauma patients (≥16years) admitted between 2011 and 2015. We stratified patients according to anatomic location of injury, and used descriptive statistics to compare characteristics and management of each group. Bivariate analysis by mortality was done to determine covariates for our adjusted model. A Cox proportional hazard model was performed, using upper extremity injury as the baseline comparator. Descriptive statistics were used to describe the trend in incidence and mortality of head and spine injuries over five years. RESULTS Of the 76,984 trauma patients who presented to KCH from 2011 to 2015, 49,126 (63.8%) were adults, and 8569 (17.4%) were admitted. The most common injury was to the head or spine, seen in 3712 patients (43.6%). The highest unadjusted hazard ratio for mortality was in head and spine injury patients, at 3.685 (95% CI=2.50-5.44), which increased to 4.501 (95% CI=2.78-7.30) when adjusted for age, sex, injury severity, transfer status, injury mechanism, and surgical intervention. Abdominal trauma had the second highest adjusted hazard of mortality, at 3.62 (95% CI=1.92-6.84) followed by thoracic trauma (HR=1.3621, 95% CI=0.49-3.56). CONCLUSION In our setting, head or spine injury significantly increases the hazard of mortality significantly compared to all other anatomic injury locations. The prioritization of timely operative and non-operative head injury management is imperative. The development of head injury units may help attenuate trauma- related mortality in resource poor settings.
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Affiliation(s)
- Jessica Eaton
- UNC -Project Malawi, Lilongwe, Malawi; University of Louisville School of Medicine, Louisville, KY, United States
| | - Joanna Grudziak
- Department of Surgery, University of North Carolina, Chapel Hill, NC, United States
| | - Asma Bilal Hanif
- Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi
| | | | - Eldad Hadar
- Department of Neurosurgery, University of North Carolina, Chapel Hill, NC, United States
| | - Anthony Charles
- UNC -Project Malawi, Lilongwe, Malawi; Department of Surgery, University of North Carolina, Chapel Hill, NC, United States; Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi.
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Barrie J, Jamdar S, Iniguez MF, Bouamra O, Jenks T, Lecky F, O'Reilly DA. Improved outcomes for hepatic trauma in England and Wales over a decade of trauma and hepatobiliary surgery centralisation. Eur J Trauma Emerg Surg 2017; 44:63-70. [PMID: 28204851 PMCID: PMC5808051 DOI: 10.1007/s00068-017-0765-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 01/20/2017] [Indexed: 11/30/2022]
Abstract
Background Over the last decade trauma services have undergone a reconfiguration in England and Wales. The objective is to describe the epidemiology, management and outcomes for liver trauma over this period and examine factors predicting survival. Methods Patients sustaining hepatic trauma were identified using the Trauma Audit and Research Network database. Demographics, management and outcomes were assessed between January 2005 and December 2014 and analysed over five, 2-year study periods. Independent predictor variables for the outcome of liver trauma were analysed using multiple logistic regression. Results 4368 Patients sustained hepatic trauma (with known outcome) between January 2005 and December 2014. Median age was 34 years (interquartile range 23–49). 81% were due to blunt and 19% to penetrating trauma. Road traffic collisions were the main mechanism of injury (58.2%). 241 patients (5.5%) underwent liver-specific surgery. The overall 30-day mortality rate was 16.4%. Improvements were seen in early consultant input, frequency and timing of computed tomography (CT) scanning, use of tranexamic acid and 30-day mortality over the five time periods. Being treated in a unit with an on-site HPB service increased the odds of survival (odds ratio 3.5, 95% confidence intervals 2.7–4.5). Conclusions Our study has shown that being treated in a unit with an on-site HPB service increased the odds of survival. Further evaluation of the benefits of trauma and HPB surgery centralisation is warranted.
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Affiliation(s)
- J Barrie
- Department of Hepato-pancreatobiliary Surgery, Manchester Royal Infirmary, Central Manchester Foundation Trust, Oxford Rd, Manchester, M13 9WL, UK
| | - S Jamdar
- Department of Hepato-pancreatobiliary Surgery, Manchester Royal Infirmary, Central Manchester Foundation Trust, Oxford Rd, Manchester, M13 9WL, UK
| | - M F Iniguez
- Trauma Audit and Research Network (TARN), Manchester Academic Health Science Centre, The University of Manchester, Manchester, M6 8HD, UK
| | - O Bouamra
- Trauma Audit and Research Network (TARN), Manchester Academic Health Science Centre, The University of Manchester, Manchester, M6 8HD, UK
| | - T Jenks
- Trauma Audit and Research Network (TARN), Manchester Academic Health Science Centre, The University of Manchester, Manchester, M6 8HD, UK
| | - F Lecky
- Trauma Audit and Research Network (TARN), Manchester Academic Health Science Centre, The University of Manchester, Manchester, M6 8HD, UK.,EMRiS Group, HSR Section, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - D A O'Reilly
- Department of Hepato-pancreatobiliary Surgery, Manchester Royal Infirmary, Central Manchester Foundation Trust, Oxford Rd, Manchester, M13 9WL, UK. .,School of Medical Sciences, The University of Manchester, Manchester, UK.
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Abri B, Shams Vahdati S, Paknezhad S, Sepehri majd P, Alizadeh S. Blunt abdominal trauma and organ damage and its prognosis. JOURNAL OF ANALYTICAL RESEARCH IN CLINICAL MEDICINE 2016. [DOI: 10.15171/jarcm.2016.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Evisceration caused by the explosion of mobile phone battery: A rare form of domestic accident in a child. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2016. [DOI: 10.1016/j.epsc.2016.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Ahn S, Kim DJ, Paik KY, Chung JH, Park WC, Kim W, Lee IK. A Comparison of Self-Inflicted Stab Wounds Versus Assault-Induced Stab Wounds. Trauma Mon 2016; 21:e25304. [PMID: 28184363 PMCID: PMC5292019 DOI: 10.5812/traumamon.25304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 12/15/2014] [Accepted: 12/19/2014] [Indexed: 11/18/2022] Open
Abstract
Background Although self-inflicted and assault-induced knife injuries might have different mortality and morbidity rates, no studies have actually evaluated the importance of the cause of knife injuries in terms of patient outcomes and treatment strategies. Objectives The aims of this study were to assess the difference between the outcomes of patients presenting with self-inflicted stab wounds (SISW) versus assault-induced stab wounds (AISW). Patients and Methods A retrospective review of the relevant electronic medical records was performed for the period between January 2000 and December 2012 for patients who were referred to the department of surgery for stab wounds by the trauma team. The patients were divided into either SISW (n = 10) or AISW groups (n = 11), depending on the cause of the injury. Results A total of 19 patients had undergone exploratory laparotomy. Of the nine patients with SISW undergoing this procedure, no injury was found in seven of the patients. In the AISW group, eight of the ten laparotomies were therapeutic. Three patients in the AISW group died during hospital admission. The average number of stab wounds was 1.2 for the SISW group and 3.5 for the AISW group. Organ injuries were more frequent in the AISW group, affecting the lung (2), diaphragm (3), liver (5), small bowel (2), colon (2), and kidney (1). Conclusions Although evaluations of the initial vital signs and physical examinations are still important, the history regarding the source of the stab wounds (AISW vs. SISW) may be helpful in determining the appropriate treatment methods and predicting patient outcomes.
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Affiliation(s)
- Sanghyun Ahn
- Departments of Surgery, Mary’s Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - Dong Jin Kim
- Departments of Surgery, Mary’s Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - Kwang Yeol Paik
- Departments of Surgery, Mary’s Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - Jae Hee Chung
- Departments of Surgery, Mary’s Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - Woo-Chan Park
- Departments of Surgery, Mary’s Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - Wook Kim
- Departments of Surgery, Mary’s Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - In Kyu Lee
- Departments of Surgery, Mary’s Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea
- Corresponding author: In Kyu Lee, Departments of Surgery, Mary’s Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea. Tel: +82-237791063, Fax: +82-27860802, E-mail:
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Abstract
The objective of this study was to determine if admission abdominal/pelvic CT on trauma patients can be used as a novel method to evaluate the inferior vena cava (IVC) anatomy and facilitate potential IVC filter placement. Consecutive trauma admission CT's were reviewed. The potential landing zone for filters was determined by the IVC mid portion between the renal and iliac veins. The IVC landmarks were described anatomically using the thoracic and lumbar vertebral bodies as reference points. The IVC diameter and anatomic anomalies which would affect filter placement were also evaluated from the CT. The records of 610 Trauma patients were reviewed. There were 518 (84.9%) that had an admission CT, forming the basis of the study. The CT for 500 of 518 (96.5%) was of sufficient quality to accurately evaluate the IVC. The third lumbar location of the IVC was a safe landing zone in 476 of 500 (95.2%). Anatomic anomalies were present in 47 of 500 (9.4%). We had the following three conclusions. The admission CT in over 96% of trauma patients can be used to determine the IVC filter landing zone. The third lumbar region of the IVC was a safe landing zone in over 95%. Anatomical anomalies affecting IVC filter placement were revealed in 9.4%.
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Manzini N, Madiba TE. The management of retroperitoneal haematoma discovered at laparotomy for trauma. Injury 2014; 45:1378-83. [PMID: 24606980 DOI: 10.1016/j.injury.2014.01.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 01/11/2014] [Accepted: 01/25/2014] [Indexed: 02/02/2023]
Abstract
AIM To review our local experience with presentation and management of retroperitoneal haematomas (RPH) discovered at laparotomy and factors affecting outcome. METHODS Patients with retroperitoneal haematomas (RPHs) were identified from a prospective database. Data collected included demographics, clinical presentation, zones and organs involved, management and outcome. RESULTS Of a total of 488 patients with abdominal trauma, 145 (30%) with RPH were identified 136 of whom were male (M:F=15:1). Mean age was 28.8 (SD 10.6) years and median delay before surgery was 7h. The injury mechanisms were firearms (109), stabs (24), and blunt trauma (12). Twenty-four patients (17%) presented with shock. There were 58 Zone I, 69 Zone II, and 38 Zone III haematomas. The median injury severity score (ISS) was 9. Fifty-two patients (36%) developed complications and 26 (18%) patients died. Sixty-four (44%) patients required ICU with median ICU stay of 3 days. All Zone I injuries were explored; Zones II and III were explored selectively. The mortality for Zones I, II, III and IV was 14%, 4%, 29% and 35%, respectively. Mortality was highest for blunt trauma and lowest for stabs (p=0.146). Twelve of 24 patients with shock died (50%) compared to 14 of 121 (12%) without shock (p<0.0001). Eighteen of 64 patients with <6-h delay before surgery died (28%) compared to 8 of 81 (10%) with >6-h delay (p<0.017). Mortality increased with increasing ISS. Median hospital stay was 8 days. CONCLUSION RPH accounted for 30% of abdominal trauma. Injury mechanism, presence of shock, delay before surgery and ISS showed a significant association with mortality.
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Affiliation(s)
- N Manzini
- Department of Surgery, University of KwaZulu-Natal, King Edward VIII Hospital, Durban, South Africa
| | - T E Madiba
- Department of Surgery, University of KwaZulu-Natal, King Edward VIII Hospital, Durban, South Africa.
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Selective non operative management of gunshot wounds to the abdomen: a collective review. Int Emerg Nurs 2014; 23:22-31. [PMID: 25023337 DOI: 10.1016/j.ienj.2014.06.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 06/19/2014] [Accepted: 06/19/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND Over the past four decades there has been a shift from operative to selective conservatism in trauma. Selective nonoperative management (SNOM) of stab wounds to the abdomen is widely accepted in trauma centres. However, selective conservatism with gunshot wounds to the abdomen is controversial. This collective review assesses the evidence of SNOM of gunshot wounds to the abdomen. METHODS A Medline search between 1 January 1960 and 31 July 2013 was conducted identifying studies that investigated SNOM of gunshot wounds to the abdomen. Case reports, review articles and editorials were excluded. All other studies that investigated SNOM of gunshot wounds to the abdomen and its outcomes were included. RESULTS A total of 37 studies were included of which 22 were prospective, 14 were retrospective and 1 case series. A total of 21330 patients with gunshot wounds to the abdomen were included, of which 6468 (30.3%) were managed nonoperatively. Successful SNOM was possible in 5510 (85.18%) patients and 958 (14.8%) failed SNOM and underwent delayed laparotomies. SNOM reduces rates of non-therapeutic laparotomies and the associated morbidity. Special aspects reviewed include the prehospital and nursing involvement in this modality of care. CONCLUSIONS Current evidence supports SNOM of gunshot wounds to the abdomen. It is associated with a decreased rate of non therapeutic laparotomy. Careful patient selection and specially designed protocols should be established and adhered to.
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Okuş A, Sevinç B, Ay S, Arslan K, Karahan Ö, Eryılmaz MA. Conservative management of abdominal injuries. ULUSAL CERRAHI DERGISI 2013; 29:153-7. [PMID: 25931868 DOI: 10.5152/ucd.2013.2300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 10/25/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Non-operative management of abdominal injuries has recently become more common. Especially non-operative treatment of blunt abdominal trauma is gaining wide acceptance. In this study, the efficacy of non-operative treatment in abdominal trauma (blunt penetrating) is discussed. MATERIAL AND METHODS All patients who received treatment due to abdominal trauma from November 2008 to January 2013 were retrospectively analyzed. The demographic characteristics, type of injury, injured organ, type of treatment (operative vs. nonoperative) and mortality data were evaluated. RESULTS The study includes 115 patients treated for abdominal trauma in our department. The mechanism of trauma was stab wounds in 60%, blunt abdominal trauma in 23.5% and gunshot wounds in 16.5%. Forty-two patients (36.5%) were operated for hemodynamic instability and/or peritonitis on admission. The remaining 63.5% of patients (n=73) were treated nonoperatively, 10 of whom required laparotomy during follow-up. The remaining 63 patients were treated with non-operative management. The success rate for non-operative treatment was 86.3% and there was no difference in terms of the types of injuries. The mortality rate was 4.3% (n= 5) in the whole series, but there were no deaths among the patients who had received non-operative treatment. In the whole patient group 54.2% (n=63) were treated nonoperatively. CONCLUSION Nonoperative treatment in abdominal trauma is safe and effective. Patients with clinical stability and normal physical examination findings can be treated nonoperatively with close monitoring.
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Affiliation(s)
- Ahmet Okuş
- Department of General Surgery, Faculty of Medicine, Mevlana University, Konya, Turkey
| | - Barış Sevinç
- Department of General Surgery, Konya Teaching Hospital, Konya, Turkey
| | - Serden Ay
- Department of General Surgery, Konya Teaching Hospital, Konya, Turkey
| | - Kemal Arslan
- Department of General Surgery, Konya Teaching Hospital, Konya, Turkey
| | - Ömer Karahan
- Department of General Surgery, Konya Teaching Hospital, Konya, Turkey
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