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Ali AA, Hussein AM, Albay E, Siyad AAA, Hassan MO, Ahmed SA. A blunt traumatic giant pseudoaneurysm of the brachiocephalic artery: A case report from Somalia. Int J Surg Case Rep 2024; 116:109329. [PMID: 38325112 PMCID: PMC10859269 DOI: 10.1016/j.ijscr.2024.109329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/27/2024] [Accepted: 01/29/2024] [Indexed: 02/09/2024] Open
Abstract
INTRODUCTION Pseudoaneurysm of the brachiocephalic artery is a rare condition that can occur as a result of various causes, including trauma, iatrogenic injury, and infection. The clinical presentation of brachiocephalic artery pseudoaneurysms can vary depending on the size and location of the pseudoaneurysm. The treatment options for innominate artery pseudoaneurysms include both surgical and endovascular approaches. Our goal of the study is to increase awareness and early detection of blunt injuries in the chest, clavicle, or sternoclavicular joint that may cause a vascular injury. CASE PRESENTATION We present here A 24-year-old male came to present with an acute onset of dyspnea, stridor (an abnormal, high-pitched respiratory sound produced by irregular airflow in a narrowed airway), a worsening cough, and chest pain that had been worsening over several months. His medical history was significant for blunt chest trauma secondary to a bicycle fall 3 months earlier. DISCUSSION A traumatic giant pseudoaneurysm of the innominate artery is a rare but potentially life-threatening condition. Treatment options for brachiocephalic artery pseudoaneurysm include both endovascular and surgical approaches. This case report contributes to the current literature when any patient has a blunt injury in the chest, clavicle, or sternoclavicular joint and is highly suspect of a vascular injury. To increase awareness, we first need to exclude if there is any vascular injury, which helps to detect it early and intervene. CONCLUSION Brachiocephalic artery traumatic large pseudoaneurysm is an uncommon but potentially fatal disorder that can arise from a number of different sources. Achieving favorable results requires prompt diagnosis and proper care, which may include open surgical repair and endovascular procedures. To better comprehend the condition and optimize its management approaches, more investigation and case studies are required.
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Affiliation(s)
- Abdijalil Abdullahi Ali
- Department of cardiovascular surgery at Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia.
| | - Abdinafic Mohamud Hussein
- Department of cardiovascular surgery at Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Erkan Albay
- Department of cardiovascular surgery at Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Ali Abdulkadir Ali Siyad
- Department of cardiovascular surgery at Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Mohamed Omar Hassan
- Department of Cardiology at Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Said Abdirahman Ahmed
- Department of Cardiology at Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia
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Elsaied Hussein MH, Fadl Mahmoud I, MS. Eita Y, Ahmed Aglan MA, Esmaiel MSA, Abdelshafy Ibrahim Farag G, Abdmokhles Abdelmottaleb N, Elkahely MA, A Mansour M. A Prospective Study of Chest Trauma Scoring System as A Morbidity and Mortality Predictor in Patients with Blunt Chest Trauma. Med J Islam Repub Iran 2024; 38:4. [PMID: 38434224 PMCID: PMC10907050 DOI: 10.47176/mjiri.38.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Indexed: 03/05/2024] Open
Abstract
Background Predicting the outcome of blunt chest trauma by scoring systems is of utmost value. We aimed to assess the role of the chest trauma scoring system (CTS) in predicting blunt chest trauma outcomes among Egyptians. Methods A prospective observational study included 45 patients admitted to the cardiothoracic emergency unit of Al-Azhar University hospitals. We documented their demographic data, history, cause and mode of trauma, vital parameters, and necessary investigations (e.g., chest X-ray and Computed Tomography) when the patient was admitted to the cardiothoracic department. All patients were assessed using the chest trauma scale (CTS) and followed up till death or discharge. Results The patient's age ranged between 18 to 76 years (mean 42.67 years). Eighty percent were males, and 48% needed mechanical ventilation (MV). The period of MV was ranged from 1 to 5 days (mean 2.81 days). Twenty-two patients had pneumonia. Eight patients died with a chest trauma scale ranging from 2 to 12 with a median of 6. About 87 percent of patients had unilateral lesions, and 5 had criminal causes. Road traffic accidents were the most typical cause of trauma (60%). There was a significant relation between mortality among the studied patients and each MV, length of ICU duration, chest trauma scale, laterality of trauma, and associated injuries. There was a statistically significant relation between the chest trauma scale and the need for MV, the timing of MV, the presence of pneumonia, and mortality. Conclusion CTS ≥ 6.5 can predict mortality with 100.0% sensitivity, specificity of 62.2%, and accuracy of 68.9%. However, a score of ≥ 5.5 can predict the development of pneumonia with a sensitivity of 81.8%, specificity of 78.3%, and accuracy of 80%.
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Affiliation(s)
- Mahmoud Helmy Elsaied Hussein
- Department of Forensic Medicine and Clinical Toxicology, Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | - Ibrahim Fadl Mahmoud
- Department of Intensive Care and Pain Medicine, Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | - Yasser MS. Eita
- Department of Intensive Care and Pain Medicine, Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | - Mohamed A. Ahmed Aglan
- Department of Forensic Medicine and Clinical Toxicology, Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | | | | | - Neazy Abdmokhles Abdelmottaleb
- Department of Anesthesia, Intensive Care and Pain Medicine, Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | - Mohamed Attia Elkahely
- Department of Cardiothoracic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohamed A Mansour
- Department of Cardiothoracic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
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Dantes G, Kolousek A, Doshi N, Dutreuil V, Sciarretta JD, Sola R, Shah J, Smith RN, Smith AD, Koganti D. Utilization of Angiography in Pediatric Blunt Abdominal Injury at Adult versus Pediatric Trauma Centers. J Surg Res 2024; 293:561-569. [PMID: 37832307 DOI: 10.1016/j.jss.2023.08.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 07/24/2023] [Accepted: 08/26/2023] [Indexed: 10/15/2023]
Abstract
INTRODUCTION Angiography has been widely accepted as an adjunct in the management of blunt abdominal trauma in adults. However, the role of angiography with or without angioembolization (AE) is still being defined in pediatric solid organ injury. We sought to compare the use of angiography in solid organ injury (SOI) at pediatric trauma centers (PTCs) versus an adult trauma center (ATC) in a large metropolitan city. METHODS Data were drawn from a collaborative effort of three Trauma centers (one adult and two pediatric) in Atlanta, GA. All pediatric patients (ages 1-18) treated for SOI between January 1, 2016 and December 31, 2021 were included (n = 350). Registry data obtained included demographics, mechanism of injury, injury grade, injury severity score (ISS), procedures performed, and transfusions. Multivariate regression analysis was used to identify factors associated with angiography. RESULTS A total of 350 patients were identified during the study period with 101 treated at ATC and 249 treated at the two PTCs. The median age at the ATC was 17 y (IQR 16, 18) compared to nine (6, 13) at the PTCs. ISS was significantly higher at the ATC 22 (14, 34) compared to 16 (9, 22) at PTCs (P < 0.001). At the ATC, 11 (10.9%) patients underwent angiography, 4 (4.9%) of which underwent AE compared to seven (2.8%) patients who underwent angiography and AE at PTCs. In the multivariate analysis, factors associated with angiography use included age (OR 1.44, 95% CI 1.09-1.90, P = 0.010) and ISS (OR 1.05, 95% CI 1.02-1.09, P = 0.004). Through setting, ATC versus PTC was significant on univariable analysis, it did not remain a significant predictor of angiography on multivariable regression. CONCLUSIONS Our study demonstrated increased utilization of angiography for the management of SOI in pediatric patients treated at ATCs versus PTCs. On regression analysis, age and ISS remained significant predictors for angiography utilization, while setting (ATC versus PTC) was notably not a significant predictor. This data would suggest that differences in angiography utilization for pediatric SOI at PTCs and ATCs are influenced by differing patient populations (older and higher ISS), with otherwise uniform use. These findings provide a basis for future treatment algorithm revisions for pediatric blunt abdominal trauma that include angiography and provide support for the development of formal guidelines.
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Affiliation(s)
- Goeto Dantes
- Department of Surgery, Emory University, Atlanta, Georgia.
| | | | - Neil Doshi
- Morehouse School of Medicine, Morehouse University, Atlanta, Georgia
| | - Valerie Dutreuil
- Pediatric Biostatistics Core, Department of Pediatrics, Emory School of Medicine Atlanta, Georgia
| | - Jason D Sciarretta
- Department of Surgery, Emory University, Atlanta, Georgia; Department of Trauma Surgery, Emory University, Grady Memorial Hospital, Atlanta, Georgia
| | - Richard Sola
- Morehouse School of Medicine, Morehouse University, Atlanta, Georgia
| | - Jay Shah
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Randi N Smith
- Department of Surgery, Emory University, Atlanta, Georgia; Department of Trauma Surgery, Emory University, Grady Memorial Hospital, Atlanta, Georgia; Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Alexis D Smith
- Department of Surgery, Emory University, Atlanta, Georgia; Pediatric Biostatistics Core, Department of Pediatrics, Emory School of Medicine Atlanta, Georgia
| | - Deepika Koganti
- Department of Surgery, Emory University, Atlanta, Georgia; Department of Trauma Surgery, Emory University, Grady Memorial Hospital, Atlanta, Georgia; Rollins School of Public Health, Emory University, Atlanta, Georgia
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Lambart L, Nollen NL, Mayo MS, Funk O, Leavens E, Cruvinel E, Brown A, Ahluwalia JS, Sanderson Cox L. The impact of blunt use on smoking abstinence among Black adults: Secondary analysis from randomized controlled smoking cessation clinical trial. Addict Behav 2024; 148:107877. [PMID: 37804748 DOI: 10.1016/j.addbeh.2023.107877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 09/20/2023] [Accepted: 10/02/2023] [Indexed: 10/09/2023]
Abstract
INTRODUCTION People who smoke cigarettes are more likely than people who do not to use cannabis, including blunts, a tobacco product containing nicotine and marijuana. Blunts represent a challenge for cessation trials because nicotine could make stopping cigarettes more difficult. Few studies have examined the impact of blunt use on individuals actively engaged in a cigarette quit attempt. METHODS Blunt use was assessed at baseline, Weeks 4, 8, 12, 16, and 26 among Black adult people who smoke enrolled in a double-blind, placebo-controlled, randomized trial of varenicline (VAR, n = 300) versus placebo (PBO, n = 200) for smoking cessation. Participants were categorized as ever blunt (blunt use reported at any timepoint) versus non-blunt (no blunt use reported). The primary outcome was salivary cotinine-verified 7-day point prevalence smoking abstinence at Weeks 12 and 26. Logistic regression examined the effects of treatment and blunt use on abstinence. RESULTS 75 participants (mean age 45.6 years (SD = 12.5, range: 22,80); 32 (42%) female) reported blunt use. Logistic regression analyses showed no treatment by blunt use interaction or significant main effect of blunt use on smoking abstinence at Weeks 12 or 26 (p > 0.05). After adjusting for treatment, those who used blunts had statistically similar odds of quitting at Week 12 (OR: 0.68, 95% CI: 0.31, 1.5) and Week 26 (OR: 0.84, 95% CI: 0.38, 1.87) as those who never used blunts during the study. DISCUSSION Blunt use had no statistically significant impact on cessation among participants in a smoking cessation clinical trial. Future trials are needed in which the target of cessation is all combustible products.
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Affiliation(s)
- Leah Lambart
- Department of Population Health, University of Kansas School of Medicine, Kansas City, USA.
| | - Nicole L Nollen
- Department of Population Health, University of Kansas School of Medicine, Kansas City, USA; The University of Kansas Comprehensive Cancer Center, USA
| | - Matthew S Mayo
- The University of Kansas Comprehensive Cancer Center, USA; Department of Biostatistics & Data Science, University of Kansas School of Medicine, Kansas City, USA
| | - Olivia Funk
- Department of Population Health, University of Kansas School of Medicine, Kansas City, USA
| | - Eleanor Leavens
- Department of Population Health, University of Kansas School of Medicine, Kansas City, USA; The University of Kansas Comprehensive Cancer Center, USA
| | - Erica Cruvinel
- Department of Population Health, University of Kansas School of Medicine, Kansas City, USA
| | - Alexandra Brown
- Department of Biostatistics & Data Science, University of Kansas School of Medicine, Kansas City, USA
| | - Jasjit S Ahluwalia
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island Legorreta Cancer Center at Brown University, Providence, RI, USA
| | - Lisa Sanderson Cox
- Department of Population Health, University of Kansas School of Medicine, Kansas City, USA; The University of Kansas Comprehensive Cancer Center, USA
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Johns JD, Pittman C, Briggs SE. Temporal Bone Trauma. Otolaryngol Clin North Am 2023; 56:1055-1067. [PMID: 37385862 DOI: 10.1016/j.otc.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
Temporal bone trauma represents a potentially underrecognized condition during head injuries and remains an important consideration during the evaluation of these patients. The temporal bone contains many critical neurovascular structures in addition to the primary organs of the auditory and vestibular systems that may be violated during these injuries. Despite the lack of consensus guidelines on the management of these injuries, this review highlights the current literature regarding the diagnosis and management of temporal bone trauma and its potential complications.
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Affiliation(s)
- James Dixon Johns
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Gorman Building, 1st Floor, 3800 Reservoir Road NW, Washington DC 20007, USA; Department of Otolaryngology-Head and Neck Surgery, MedStar Washington Hospital Center, 106 Irving Street Northwest, Suite 2700, Washington, DC 20010, USA
| | - Corinne Pittman
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Gorman Building, 1st Floor, 3800 Reservoir Road NW, Washington DC 20007, USA; Department of Otolaryngology-Head and Neck Surgery, MedStar Washington Hospital Center, 106 Irving Street Northwest, Suite 2700, Washington, DC 20010, USA
| | - Selena E Briggs
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Gorman Building, 1st Floor, 3800 Reservoir Road NW, Washington DC 20007, USA; Department of Otolaryngology-Head and Neck Surgery, MedStar Washington Hospital Center, 106 Irving Street Northwest, Suite 2700, Washington, DC 20010, USA.
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Vargees C, Stroup AM, Niznik T, Dunn D, Wyatt R, Hoetger C, Taleb ZB, Cohn AM, Cobb CO, Fetterman JL. Patterns of use, perceptions, and cardiopulmonary health risks of cigar products: a systematic review. BMC Public Health 2023; 23:2357. [PMID: 38017396 PMCID: PMC10685631 DOI: 10.1186/s12889-023-17216-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/13/2023] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVE A systematic review was conducted to evaluate the use patterns, health perceptions, and cardiopulmonary health effects of cigars. DATA SOURCES PubMed and Google Scholar were searched for peer-reviewed articles published between June 2014 and February 2021. Search keywords included cigars, cigarillos, little cigars, and cardiopulmonary health outcomes. STUDY SELECTION Of 782 papers identified, we excluded non-English articles, review articles, commentaries, and those without empirical data on cigars. Three coders independently reviewed all articles and compared codes to resolve discrepancies. 93 articles met the inclusion criteria and were included. DATA SYNTHESIS Cigars have evolved from premium cigars to encompass little cigars and cigarillos (LCCs). LCCs are available in an array of flavors and at a price advantage, and as a result, are used by different groups compared to premium cigars. LCCs are more frequently used by youth, young adults, and those who identify as Black/African American. LCCs are often used in combination with other tobacco products, alcohol, and cannabis. Despite limited regulation, cigars generate smoke of a similar composition as cigarettes. Among the studies identified, evidence suggests that cigar use is associated with cardiovascular and pulmonary toxicity. Higher all-cause and cancer-related mortalities are associated with cigar use, particularly with more frequent and deeper inhalation, compared to non-tobacco users. CONCLUSIONS LCCs are used more frequently by at-risk groups compared to premium cigars. Recent studies evaluating cigar cardiopulmonary health effects are limited but suggest cigars have similar health risks as conferred by cigarette smoking. With the use of LCCs and targeted marketing on the rise among high-risk groups, there is a critical need for continued research in this area.
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Affiliation(s)
- Comreen Vargees
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, 600 Albany Street, Boston, MA, USA
| | | | - Taylor Niznik
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Delaney Dunn
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Riley Wyatt
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Cosima Hoetger
- Department of Psychology, Virginia Commonwealth University, 806 W Franklin St, Richmond, VA, 23284, USA
- Center for the Study of Tobacco Products, Virginia Commonwealth University, 100 W Franklin St, Richmond, VA, 23220, USA
- Institute for Integrative Health Care and Health Promotion (IGVF), Witten/Herdecke University, Alfred-Herrhausen-Straße 50, Witten, 58455, Germany
| | - Ziyad Ben Taleb
- Department of Kinesiology, College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, USA
| | - Amy M Cohn
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, USA
- Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Caroline O Cobb
- Department of Psychology, Virginia Commonwealth University, 806 W Franklin St, Richmond, VA, 23284, USA
- Center for the Study of Tobacco Products, Virginia Commonwealth University, 100 W Franklin St, Richmond, VA, 23220, USA
| | - Jessica L Fetterman
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, 600 Albany Street, Boston, MA, USA.
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Hunn SA, Bhattarai K. Delayed chest wall hematoma complicated by infection and osteomyelitis of the rib: A case report and brief review. Trauma Case Rep 2023; 47:100902. [PMID: 37705927 PMCID: PMC10495649 DOI: 10.1016/j.tcr.2023.100902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2023] [Indexed: 09/15/2023] Open
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Mouradian GP, Wessel E, Hance K, Hunter J. Isolated celiac artery avulsion from blunt abdominal trauma. Trauma Case Rep 2023; 46:100844. [PMID: 37274543 PMCID: PMC10238870 DOI: 10.1016/j.tcr.2023.100844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 06/06/2023] Open
Abstract
Trauma-related celiac artery injuries are a rare and life-threatening pathology that often requires urgent multidisciplinary care. Rarer still are cases of celiac artery avulsion in the setting of blunt trauma. There is little literature describing such injury patterns. The farthest-reaching is a case series by Kronich et al. 2017, which compiles eleven cases. The majority of these injuries were incomplete intimal injuries only appreciated on admission imaging. A further literature review reveals five cases of full avulsions in the setting of blunt trauma. Management varied dramatically among these cases. The multidisciplinary nature of vascular trauma, in combination with new vascular repair techniques provides a paradox of choice regarding acute management in unusual presentations. With intuitional review board approval, we report a case of blunt trauma with complete celiac trunk avulsion in a patient with aberrant visceral vascular anatomy, managed with open exploration and ligation.
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Hwang CK, Moore S, Lee Z, Skokan AJ, Hagedorn JC. Blunt traumatic female urethral and bladder neck injuries: a 15-year single-institution experience. Int Urol Nephrol 2023:10.1007/s11255-023-03620-2. [PMID: 37198516 DOI: 10.1007/s11255-023-03620-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 04/27/2023] [Indexed: 05/19/2023]
Abstract
PURPOSE To describe our experience in the management and outcomes of female patients with urethral or bladder neck (BN) injury at a high-volume Level 1 trauma center. METHODS A retrospective chart review of all female patients with urethral or BN injury by blunt trauma mechanism admitted to a Level 1 trauma center between 2005 and 2019 was performed. RESULTS Ten patients met study criteria with median age 36.5 years. All had concomitant pelvic fractures. All injuries were confirmed operatively, with no delayed diagnoses. Two patients were lost to follow up. One patient was not eligible for early repair of urethral injury and had two repairs of a urethrovaginal fistula. Two of seven (29%) patients who underwent early repair of their injury had an early Clavien grade > 2 complication, with none reporting long-term complications at median follow-up of 15.2 months. CONCLUSIONS Intraoperative evaluation is critical in the diagnosis of female urethral and BN injury. In our experience, acute surgical complications are not uncommon after the management of such injuries. However, there were no reported long-term complications in those patients who had prompt management of their injury. This aggressive diagnostic and surgical strategy is instrumental in attaining excellent surgical outcomes.
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Affiliation(s)
| | - Stanley Moore
- Department of General Surgery, Sutter Health, Sacramento, USA
| | - Ziho Lee
- Department of Urology, Northwestern Medicine, Chicago, USA
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Emigh B, Grigorian A, Dilday J, Condon F, Nahmias J, Schellenberg M, Martin M, Matsushima K, Inaba K. Risk factors and outcomes in pediatric blunt cardiac injuries. Pediatr Surg Int 2023; 39:195. [PMID: 37160488 DOI: 10.1007/s00383-023-05478-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/23/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE Unlike adults, less is known of the etiology and risk factors for blunt cardiac injury (BCI) in children. Identifying risk factors for BCI in pediatric patients will allow for more specific screening practices following blunt trauma. METHODS A retrospective review was performed using the Trauma Quality Improvement Program (TQIP) database from 2017 to 2019. All patients ≤ 16 years injured following blunt trauma were included. Demographics, mechanism, associated injuries, injury severity, and outcomes were collected. Univariate and multivariate regression was used to determine specific risk factors for BCI. RESULTS Of 266,045 pediatric patients included in the analysis, the incidence of BCI was less than 0.2%. The all-cause mortality seen in patients with BCI was 26%. Motor-vehicle collisions (MVCs) were the most common mechanism, although no association with seatbelt use was seen in adolescents (p = 0.158). The strongest independent risk factors for BCI were pulmonary contusions (OR 15.4, p < 0.001) and hemothorax (OR 8.9, p < 0.001). CONCLUSIONS Following trauma, the presence of pulmonary contusions or hemothorax should trigger additional screening investigations specific for BCI in pediatric patients.
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Affiliation(s)
- Brent Emigh
- Division of Trauma and Critical Care, Department of Surgery, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA.
- Department of Surgery, Rhode Island Hospital, 593 Eddy Street, APC 454, Providence, RI, 02903, USA.
| | - Areg Grigorian
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange, CA, USA
| | - Joshua Dilday
- Division of Trauma and Surgical Critical Care, Department of Surgery, LAC+USC, University of Southern California, Los Angeles, CA, USA
| | - Freeman Condon
- Division of General Surgery, Department of Surgery, Tripler Army Medical Center, Honolulu, HI, USA
| | - Jeffry Nahmias
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange, CA, USA
| | - Morgan Schellenberg
- Division of Trauma and Surgical Critical Care, Department of Surgery, LAC+USC, University of Southern California, Los Angeles, CA, USA
| | - Matthew Martin
- Division of Trauma and Surgical Critical Care, Department of Surgery, LAC+USC, University of Southern California, Los Angeles, CA, USA
| | - Kazuhide Matsushima
- Division of Trauma and Surgical Critical Care, Department of Surgery, LAC+USC, University of Southern California, Los Angeles, CA, USA
| | - Kenji Inaba
- Division of Trauma and Surgical Critical Care, Department of Surgery, LAC+USC, University of Southern California, Los Angeles, CA, USA
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Matson PA, Flessa SJ, Hoff A, Alinsky R, Alexander K, Lich KH, Johnson RM. "What Do You Consider Use?" Perspectives of Black Youth on Cannabis Use. J Adolesc Health 2023; 72:254-259. [PMID: 36443160 DOI: 10.1016/j.jadohealth.2022.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 08/30/2022] [Accepted: 09/17/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Adolescent health surveillance systems are critical for understanding patterns of cannabis use; however, their limitations underscore the need for studies that generate new insights, particularly from individuals who are most impacted by negative outcomes. Our objectives were to learn about youths' cannabis use and their perceptions of their peers' cannabis use; their perspectives about trajectories of cannabis use over time and factors that influence trajectories; and perceived risks and benefits associated with cannabis use. METHODS A group model building approach was used to gather data about cannabis use from a sample of urban, Black youth. Information about participants' cannabis use was assessed on eligibility screener, enrollment survey, and through structured activities over the course of four group model building workshops. RESULTS Participants [(n = 20) mean age 18; 35% male and 95% Black] exclusively used the terms weed and blunts for cannabis. Youth who consume peers' blunts would not characterize themselves as cannabis users. Collectively, youth estimated the majority of Baltimore youth used cannabis by age 16 and that most used daily. Youth described cannabis as more beneficial than harmful. There were no gender differences in prevalence of use, but there were gender dynamics to shared use. DISCUSSION Participatory research with urban, Black youth suggests youths' perceptions are misaligned with the ways that researchers conceptualize cannabis use. To better understand the scope of youth cannabis use and its harms, it is critical to leverage input from youth with lived experience to ensure survey tools adequately capture the way youth see themselves using cannabis.
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Affiliation(s)
- Pamela A Matson
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Sarah J Flessa
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Annika Hoff
- College of Arts and Sciences, Cornell University, Ithaca, New York
| | - Rachel Alinsky
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Kristen Hassmiller Lich
- Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, North Carolina
| | - Renee M Johnson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Aziz HA, Bugaev N, Baltazar G, Brown Z, Haines K, Gupta S, Yeung L, Posluszny J, Como J, Freeman J, Kasotakis G. Management of adult renal trauma: a practice management guideline from the eastern association for the surgery of trauma. BMC Surg 2023; 23:22. [PMID: 36707832 PMCID: PMC9881253 DOI: 10.1186/s12893-023-01914-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 01/16/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The kidney is the most frequently injured component of the genitourinary system, accounting for 5% of all trauma cases. Several guidelines by different societies address the management of urological trauma. However, unanswered questions remain regarding optimal use of angioembolization in hemodynamically stable patients, indications for operative exploration of stable retroperitoneal hematomas and renal salvage techniques in the setting of hemodynamic instability, and imaging practices for patients undergoing non-operative management. We performed a systematic review, meta-analysis, and developed evidence-based recommendations to answer these questions in both blunt and penetrating renal trauma. METHODS The working group formulated four population, intervention, comparator, outcome (PICO) questions regarding the following topics: (1) angioembolization (AE) usage in hemodynamically stable patients with evidence of ongoing bleeding; (2) surgical approach to stable zone II hematomas (exploration vs. no exploration) in hemodynamically unstable patients and (3) surgical technique (nephrectomy vs. kidney preservation) for expanding zone II hematomas in hemodynamically unstable patients; (4) frequency of repeat imaging (routine or symptom based) in high-grade traumatic renal injuries. A systematic review and meta-analysis of currently available evidence was performed. RevMan 5 (Cochran Collaboration) and GRADEpro (Grade Working Group) software were used. Recommendations were voted on by working group members and concurrence was obtained for each final recommendation. RESULTS A total of 20 articles were identified and analyzed. Two prospective studies were encountered; the majority were retrospective, single-institution studies. Not all outcomes projected by PICO questions were reported in all studies. Meta-analysis was performed for all PICO questions except PICO 3 secondary to the discrepant patient populations included in those studies. PICO 1 had the greatest number of articles included in the meta-analysis with nine studies; yet, due to differences in study design, no critical outcomes emerged; similar differences among a smaller set of articles prevented observation of critical outcomes for PICO 4. Analyses of PICOs 2 and 3 favored a non-invasive or minimally invasive approach in-line with current international practice trends. CONCLUSION In hemodynamically stable adult patients with clinical or radiographic evidence of ongoing bleeding, no recommendation could be made regarding the role of AE vs. observation. In hemodynamically unstable adult patients, we conditionally recommend no renal exploration vs. renal exploration in stable zone II hematomas. In hemodynamically unstable adult patients, we conditionally recommend kidney preserving techniques vs. nephrectomy in expanding zone II hematomas. No recommendation could be made for the optimal timing of repeat imaging in high grade renal injury. LEVEL OF EVIDENCE Guideline; systematic review, level III.
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Affiliation(s)
- Hiba Abdel Aziz
- grid.260024.20000 0004 0627 4571Midwestern University, Drowners Grove, USA
| | - Nikolay Bugaev
- grid.67033.310000 0000 8934 4045Tufts Medical Center, Boston, USA
| | - Gerard Baltazar
- grid.240324.30000 0001 2109 4251New York University Langone Medical Center, New York, USA
| | - Zachary Brown
- grid.427904.c0000 0001 2315 4051United States Department of Army, Arlington County, USA
| | - Krista Haines
- grid.414179.e0000 0001 2232 0951Duke Medical Center, Durham, USA
| | - Sameer Gupta
- grid.412034.00000 0001 0300 7302Nassau University Medical Center, East Meadow, USA
| | - Lawrence Yeung
- grid.15276.370000 0004 1936 8091University of Florida, Gainesville, USA
| | - Joseph Posluszny
- grid.16753.360000 0001 2299 3507Northwestern University, Evanston, USA
| | - John Como
- grid.411931.f0000 0001 0035 4528Metrohealth Medical Center, Cleveland, USA
| | - Jennifer Freeman
- grid.264766.70000 0001 2289 1930Texas Christian University, Fort Worth, USA
| | - George Kasotakis
- grid.412100.60000 0001 0667 3730Duke University Health System, Durham, USA
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13
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Demiroren K. Management of Gastrointestinal Foreign Bodies with Brief Review of the Guidelines. Pediatr Gastroenterol Hepatol Nutr 2023; 26:1-14. [PMID: 36816435 PMCID: PMC9911172 DOI: 10.5223/pghn.2023.26.1.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 07/09/2022] [Accepted: 08/30/2022] [Indexed: 01/15/2023] Open
Abstract
Foreign body (FB) ingestion is a common health problem that affects children more than adults. According to gastroenterologists' guidelines, the management of FB ingestion differs slightly between adult and children. This review aimed to compile adult and children guidelines and establish an understandable association to reveal the requirements and timing of the endoscopic procedure, which is the most effective and least complicated technique for gastrointestinal FBs. Coins, pins, and chicken and fish bones have been the most commonly ingested FBs. However, with their increasing use in recent years, large batteries with lithium-ion conversion, stronger magnets composed of rare earth metals, such as neodymium, and superabsorbent objects have become the most morbid and mortal, necessitating new management strategies. Although the approach to gastrointestinal FBs is controversial, with different treatment options available in different disciplines, many studies have demonstrated the efficacy and safety of endoscopic procedures. Many factors influence the timing of endoscopy, including the nature, size, and location of the ingested object and the patient's clinical condition.
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Affiliation(s)
- Kaan Demiroren
- Department of Pediatric Gastroenterology, University of Health Sciences, Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
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14
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Johannesdottir BK, Geisner T, Gubberud ET, Gudbjartsson T. Civilian vascular trauma, treatment and outcome at a level 1-trauma centre. Scand J Trauma Resusc Emerg Med 2022; 30:74. [PMID: 36544205 PMCID: PMC9773450 DOI: 10.1186/s13049-022-01059-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Outcomes after vascular injuries in wartime are well documented, but studies on vascular injuries in a civilian European populations are scarce. METHODS A retrospective study on all adults admitted to a North-European level 1-trauma centre 2009-2018 with The Abbreviated Injury Scale-codes for non-iatrogenic vascular trauma (VT). Data were extracted from both national and regional trauma-registries, as well as patient charts. Patient demographics, mechanism, and location of vascular injury were registered as well as its treatment. Incidence and injury scores (ISS, NISS and TRISS) were calculated and overall survival (Kaplan-Meier) estimated. RESULTS Of 4042 trauma-patients, 68 (1.7%) (median age 44 years, 76% males) sustained 81 vascular injuries (69 arterial; 12 venous); 46 blunt and 22 (32%) penetrating injuries. The total incidence of vascular injuries was 1.45/100,000 inhabitants and did not change over the study-period (95% confidence interval 1.13-1.82). The injuries were located in thorax (n = 17), neck (n = 16) and abdominal region (n = 15); most of the blunt injuries followed traffic (n = 31) or falling accidents (n = 10), and with 17 of the 22 penetrating injuries due to stabbing. The median ISS and NISS-scores were 22 and 33, with 50 (74%) and 55 (81%) patients having scores > 15, respectively. Forty-three (63%) patients had open surgical repair and 8 (12%) received endovascular treatment. Twenty-one patients died within 30-days (31%), 33% and 27% after blunt and penetrating injuries, respectively. Half of the patients that died within 24 h sustained aortic injury. CONCLUSIONS Traumatic vascular injuries are rare in civilian settings and are less than 2% of major trauma admissions. These patients are often seriously injured and their treatment can be challenging with high 30-day mortality. TRIAL REGISTRATION Retrospectively registered.
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Affiliation(s)
- B. K. Johannesdottir
- grid.412008.f0000 0000 9753 1393Department of Vascular Surgery, Haukeland University Hospital, Jonas Lies vei 65, P.O. Box 1400, 5021 Bergen, Norway ,grid.14013.370000 0004 0640 0021Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - T. Geisner
- grid.412008.f0000 0000 9753 1393Western Norway Trauma Centre, Haukeland University Hospital, Bergen, Norway
| | - E. T. Gubberud
- grid.412008.f0000 0000 9753 1393Department of Vascular Surgery, Haukeland University Hospital, Jonas Lies vei 65, P.O. Box 1400, 5021 Bergen, Norway
| | - T. Gudbjartsson
- grid.410540.40000 0000 9894 0842Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavík, Iceland ,grid.14013.370000 0004 0640 0021Faculty of Medicine, University of Iceland, Reykjavík, Iceland
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15
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McGuinness MJ, Harmston C. Management and outcomes of rib fractures in patients with isolated blunt thoracic trauma: Results of the Aotearoa New Zealand RiBZ study. Injury 2022; 53:2953-2959. [PMID: 35489820 DOI: 10.1016/j.injury.2022.03.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 03/24/2022] [Accepted: 03/25/2022] [Indexed: 02/02/2023]
Abstract
AIM Rib fractures are common and associated with significant morbidity and mortality. There is limited literature on patient care and outcomes in Aotearoa New Zealand (AoNZ). The aim of this study is to describe key clinical outcomes and management interventions for patients with rib fractures across AoNZ. METHODS A national prospective multicenter observational cohort study was performed. Patients admitted between 1 December 2020 and 28 February 2021 with one or more radiologically proven rib fractures and an Abbreviated Injury Score of the head or abdomen of less than 3 were included. The primary outcomes of interest were the rates of thirty-day pneumonia, re-presentation and mortality. The secondary outcomes of interest were rate of surgical stabilisation of rib fractures (SSRF) and pain management of patients with rib fractures. Binomial logistic regression was performed for the primary outcomes and funnel plots were created of the inter-hospital variation in pneumonia. RESULTS Fourteen AoNZ hospitals and 407 patients were included. Mean age was 57.4 (SD 18.7), 28% were female, 15% Māori and 85% non-Māori. The median number of rib fractures was 4. The rate of pneumonia, re-presentation and mortality was 11%, 8% and 2%, respectively. Logistic regression found the odds of pneumonia increased with each additional rib fracture (OR 1.15 95% CI 1.05-1.25) and the odds of re-presentation increased with age (OR 1.028 95% CI 1.005-1.051) and Māori ethnicity (OR 2.754 95% CI 1.077-7.045). The funnel plot of inter-hospital variation in pneumonia rate adjusted for clinically plausible variables found no centre lay outside the 95% confidence interval. SSRF was performed in 2% of patients. 58% of patients had a pain team review and 23% a regional block. CONCLUSION This study describes clinical outcomes for patients with isolated rib fractures from multiple hospitals in AoNZ. A moderate pneumonia rate of 11% was found which is likely amendable to reduction with quality improvement initiatives. Consideration should be given to further resource and improve the access to SSRF and regional analgesia given the low utilization found across AoNZ. A higher re-presentation rate in Māori and elderly patients was found which needs further investigation.
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Affiliation(s)
- Matthew J McGuinness
- University of Auckland; Surgical Department, Whangārei Hospital, Manu Road, Whangārei, New Zealand.
| | - Christopher Harmston
- University of Auckland; Surgical Department, Whangārei Hospital, Manu Road, Whangārei, New Zealand
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16
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Gao JM, Li H, Du DY, Yang J, Kong LW, Wang JB, He P, Wei GB. Management and outcome of bronchial trauma due to blunt versus penetrating injuries. World J Clin Cases 2022; 10:5185-5195. [PMID: 35812647 PMCID: PMC9210895 DOI: 10.12998/wjcc.v10.i16.5185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 11/21/2021] [Accepted: 04/04/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The number of patients with bronchial trauma (BT) who survived to hospital admission has increased with the improvement of prehospital care; early diagnosis and treatment should be considered, especially among blunt trauma patients, whose diagnosis is frequently delayed.
AIM To describe the early recognition and surgical management considerations of blunt and penetrating BTs, and to elaborate the differences between them.
METHODS All patients with BTs during the past 15 years were reviewed, and data were retrospectively analyzed regarding the mechanism of injury, diagnostic and therapeutic procedures, and outcomes. According to the injury mechanisms, the patients were divided into two groups: Blunt BT (BBT) group and penetrating BT (PBT) group. The injury severity, treatment procedures, and prognoses of the two groups were compared.
RESULTS A total of 73 patients with BT were admitted during the study period. The proportion of BTs among the entire cohort with chest trauma was 2.4% (73/3018), and all 73 underwent thoracotomy. Polytrauma patients accounted for 81.6% in the BBT group and 22.9% in the PBT group, and the mean Injury Severity Score was 38.22 ± 8.13 and 21.33 ± 6.12, respectively. Preoperative three-dimensional spiral computed tomography (CT) and/or fiberoptic bronchoscopy (FB) were performed in 92.1% of cases in the BBT group (n = 38) and 34.3% in the PBT group (n = 35). In the BBT group, a delay in diagnosis for over 48 h occurred in 55.3% of patients. In the PBT group, 31 patients underwent emergency thoracotomy due to massive hemothorax, and BT was confirmed during the operation. Among them, 22 underwent pulmo-tractotomy for hemostasis, avoiding partial pneumonectomy. In this series, the overall mortality rate was 6.9% (5/73), and it was 7.9% (3/38) and 5.7% (2/35) in the BBT group and PBT group, respectively (P > 0.05). All 68 survivors were followed for 6 to 42 (23 ± 6.4) mo, and CT, FB, and pulmonary function examinations were performed as planned. All patients exhibited normal lung function and healthy conditions except three who required reoperations.
CONCLUSION The difference between blunt and penetrating BTs is obvious. In BBT, patients generally have no vessel injury, and the diagnosis is easily missed, leading to delayed treatment. The main cause of death is ventilation disturbance due to tension pneumothorax early and refractory atelectasis with pneumonia late. However, in PBT, most patients require emergency thoracotomy because of simultaneous vessel trauma and massive hemothorax, and delays in diagnosis are infrequent. The leading cause of death is hemorrhagic shock.
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Affiliation(s)
- Jin-Mou Gao
- Department of Traumatology, Chongqing University Central Hospital, Chongqing Emergency Medical Center, Chongqing 400014, China
| | - Hui Li
- Department of Traumatology, Chongqing University Central Hospital, Chongqing Emergency Medical Center, Chongqing 400014, China
| | - Ding-Yuan Du
- Department of Traumatology, Chongqing University Central Hospital, Chongqing Emergency Medical Center, Chongqing 400014, China
| | - Jun Yang
- Department of Traumatology, Chongqing University Central Hospital, Chongqing Emergency Medical Center, Chongqing 400014, China
| | - Ling-Wen Kong
- Department of Cardiothoracic Surgery, Chongqing University Central Hospital, Chongqing Emergency Medical Center, Chongqing 400014, China
| | - Jian-Bai Wang
- Department of Traumatology, Chongqing University Central Hospital, Chongqing Emergency Medical Center, Chongqing 400014, China
| | - Ping He
- Department of Traumatology, Chongqing University Central Hospital, Chongqing Emergency Medical Center, Chongqing 400014, China
| | - Gong-Bin Wei
- Department of Traumatology, Chongqing University Central Hospital, Chongqing Emergency Medical Center, Chongqing 400014, China
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17
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Almond P, Morton S, OMeara M, Durge N. A 6-year case series of resuscitative thoracotomies performed by a helicopter emergency medical service in a mixed urban and rural area with a comparison of blunt versus penetrating trauma. Scand J Trauma Resusc Emerg Med 2022; 30:8. [PMID: 35081989 PMCID: PMC8793242 DOI: 10.1186/s13049-022-00997-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 01/14/2022] [Indexed: 11/16/2022] Open
Abstract
Background Resuscitative thoracotomy (RT) is an intervention that can be performed in the prehospital setting for relieving cardiac tamponade and/or obtaining vascular control of suspected sub-diaphragmatic haemorrhage in patients in traumatic cardiac arrest. The aim of this retrospective case study is to compare the rates of return of spontaneous circulation (ROSC) in RTs performed for both penetrating and blunt trauma over 6 years in a mixed urban and rural environment. Methods The electronic records of a single helicopter emergency medical service were reviewed between 1st June 2015 and 31st May 2021 for RTs. Anonymised data including demographics were extracted for relevant cases. Data were analysed with independent t-tests and Χ2 tests. A p value < 0.05 was considered statistically significant. Results Forty-four RTs were preformed within the 6 years (26 for blunt trauma). Eleven ROSCs were achieved (nine blunt, two penetrating) but no patient survived to discharge. In contrast to RTs for penetrating trauma, twelve of the RTs for blunt trauma had a cardiac output present on arrival of the prehospital team (p = 0.01). Two patients had an RT performed in a helicopter (one ROSC) and two on a helipad (both achieving ROSC), likely due to the longer transfer times seen in a more rural setting. Four of the RTs for blunt trauma (15%) were found to have a cardiac tamponade versus seven (39%) of the penetrating trauma RTs. Conclusion Prehospital RT remains a procedure with low rates of survival but may facilitate a ROSC to allow patients to reach hospital and surgery, particularly when distances to hospitals are greater. A higher-than-expected rate of cardiac tamponade was seen in RTs for blunt trauma, although not caused by a right ventricular wound but instead due to underlying vessel damage. Supplementary Information The online version contains supplementary material available at 10.1186/s13049-022-00997-4.
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Affiliation(s)
- Phillip Almond
- Essex and Herts Air Ambulance, Earls Colne, Colchester, Essex, CO6 2NS, UK
| | - Sarah Morton
- Essex and Herts Air Ambulance, Earls Colne, Colchester, Essex, CO6 2NS, UK.
| | - Matthew OMeara
- Essex and Herts Air Ambulance, Earls Colne, Colchester, Essex, CO6 2NS, UK
| | - Neal Durge
- Essex and Herts Air Ambulance, Earls Colne, Colchester, Essex, CO6 2NS, UK
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18
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Hon K, Roach D, Dawson J. A case report of blunt intraoral cerebrovascular injury in a child following intraoral trauma: The pen is mightier than the sword. Trauma Case Rep 2022; 37:100567. [PMID: 34988277 PMCID: PMC8693459 DOI: 10.1016/j.tcr.2021.100567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2021] [Indexed: 11/21/2022] Open
Abstract
Carotid artery dissection in the paediatric population is uncommon and in rare cases it can be due to intraoral blunt trauma associated with a stick-like object such as pen or chopstick in the mouth at the time of injury. Given the rarity of the condition, there is significant knowledge gap in evidence-based diagnosis and management of paediatric blunt cerebrovascular injury (BCVI). This case report presents a rare case of asymptomatic carotid artery dissection due to intraoral blunt trauma in a young patient and the successful conservative management. This report also demonstrated the sonographic progression of the carotid artery dissection on follow up imaging.
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Affiliation(s)
- Kay Hon
- Department of Vascular & Endovascular Surgery, Royal Adelaide Hospital, South Australia, Australia.,Faculty of Health & Medical Sciences, The University of Adelaide, South Australia, Australia
| | - Denise Roach
- Faculty of Health & Medical Sciences, The University of Adelaide, South Australia, Australia.,South Australia Medical Imaging, Central Adelaide Local Health Network, South Australia, Australia
| | - Joseph Dawson
- Department of Vascular & Endovascular Surgery, Royal Adelaide Hospital, South Australia, Australia.,South Australia Medical Imaging, Central Adelaide Local Health Network, South Australia, Australia.,Trauma Surgery Unit, Royal Adelaide Hospital, South Australia, Australia
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19
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Alkhaibary A, Alharbi A, Alsubaie N, Alghanim N, Khairy S, Ozair N, Baydhi L, Musawnaq F, Almuntashri M, Alarifi A, Alwohaibi M, Aloraidi A, Alokaili R, Alkhani A. Traumatic superficial temporal artery pseudoaneurysm: Successful management using endovascular embolization. Radiol Case Rep 2021; 17:416-419. [PMID: 34934467 PMCID: PMC8654609 DOI: 10.1016/j.radcr.2021.10.064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 10/25/2021] [Accepted: 10/27/2021] [Indexed: 11/30/2022] Open
Abstract
Superficial temporal artery pseudoaneurysms are uncommon but can be potentially life-threatening. Considering their rarity, the present article outlines the clinical presentation, radiological findings, intervention, and outcome of traumatic pseudoaneurysm of the superficial temporal artery. An 83-year-old female sustained a traumatic injury to the temple, resulting in right-sided swelling of the forehead. Brain computed tomography and cerebral angiogram revealed a right-sided homogenously-enhancing pseudoaneurysm in the frontal region. Successful occlusion of the lesion was achieved utilizing endovascular embolization. Three months after discharge, the patient reported no complaints or recurrence. Subsequent management included reassurance and observation with periodic clinical assessments. The unusual presentation of superficial temporal artery pseudoaneurysms requires clinicians to have thorough knowledge on the clinical presentation, proper steps in diagnosis, and the approach of choice in management. Endovascular embolization of superficial temporal artery pseudoaneurysms remains a valid approach to achieve successful occlusion of the lesion.
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Affiliation(s)
- Ali Alkhaibary
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Ahoud Alharbi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Noura Alsubaie
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Noor Alghanim
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Sami Khairy
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Nabil Ozair
- Medical Imaging Department, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Laila Baydhi
- College of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Fahd Musawnaq
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Makki Almuntashri
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Medical Imaging Department, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Abdulaziz Alarifi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Mohammed Alwohaibi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Ahmed Aloraidi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Riyadh Alokaili
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Ahmed Alkhani
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
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20
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Evaggelakos CI, Alexandri M, Tsellou M, Dona A, Spiliopoulou CA, Papadodima SA. Subdural and epidural hematoma occurrence in relation to the head impact site: An autopsy study. J Forensic Leg Med 2021; 85:102283. [PMID: 34794084 DOI: 10.1016/j.jflm.2021.102283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/07/2021] [Accepted: 11/11/2021] [Indexed: 11/23/2022]
Abstract
Blunt head injury is a major public health and socioeconomic problem causing death and disability particularly among the young population throughout the world. The purpose of the present study was to evaluate if the impact site is correlated with the subdural and epidural hematoma occurrence. A retrospective analysis of consecutive autopsy cases submitted to our Department during a 5-year period was performed. The basic criterion for inclusion in the study was death due to blunt head injury. The recorded variables included the circumstances of death, the existence, and location of head injuries, the primary impact site, age, gender, and toxicological results. A total number of 683 fatal head injury cases was recorded, with most of them being male (74.1%). In 424 cases (62.1%) fatal head injuries were due to road traffic accidents. Fall (from height or on the ground) was the cause of death in 220 (32.2%) cases followed by inflicted impact-assault in 26 (3.8%) cases. A subdural hematoma was found more frequently (26.9%) than epidural (5.0%). Epidural hematomas were found only under the primary impact site, whereas subdural hematomas were coup, contrecoup, or bilateral. An epidural hematoma was found to be almost 5 times more frequent in cases in which a subdural hematoma was present. A higher proportion of subdural, as well as epidural hematoma, was found when the site of impact was the temporal region, followed by the parietal one. Sex did not exert any influence on the probability of subdural and epidural hematoma, whereas for age, a 10% increase in the probability of subdural hematoma occurrence was observed with 10-year age increase.
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21
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Yeates EO, Grigorian A, Inaba K, Dolich M, Schubl SD, Lekawa M, Schellenberg M, de Virgilio M, Nahmias J. Blunt Trauma Massive Transfusion (B-MaT) Score: A Novel Scoring Tool. J Surg Res 2021; 270:321-326. [PMID: 34731729 DOI: 10.1016/j.jss.2021.09.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/14/2021] [Accepted: 09/22/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Multiple tools predicting massive transfusion (MT) in trauma have been developed but utilize variables that are not immediately available. Additionally, they only differentiate blunt from penetrating trauma and do not account for the large range of blunt mechanisms and their difference in force. We aimed to develop a Blunt trauma Massive Transfusion (B-MaT) score that accounts for high-risk blunt mechanisms and predicts MT needs in blunt trauma patients (BTPs) prior to arrival. MATERIALS AND METHODS The adult 2017 Trauma Quality Improvement Program database was used to identify BTPs who were divided into 2 sets at random (derivation/validation). First, multiple logistic regression models were created to determine risk factors of MT (≥6 units of PRBCs within 4-hours or ≥10 units within 24-hours). Next, the weighted average and relative impact of each independent predictor was used to derive a B-MaT score. Finally, the area under the receiver-operating curve (AROC) was calculated. RESULTS Of 172,423 patients in the derivation-set, 1,160 (0.7%) required MT. Heart rate ≥ 120bpm, systolic blood pressure ≤ 90mmHg, and high-risk blunt mechanisms were identified as independent predictors for MT. B-MaT scores were derived ranging from 0 -9, with scores of 6, 7, and 9 yielding a MT rate of 11.7%, 19.4%, and 32.4%, respectively. The AROC was 0.86. The validation-set had an AROC of 0.85. CONCLUSIONS B-MaT is a novel scoring tool that predicts need for MT in BTPs and can be calculated prior to arrival. B-MaT warrants prospective validation to confirm its accuracy and assess its ability to improve patient outcomes and blood product allocation.
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Affiliation(s)
- Eric O Yeates
- Department of Surgery, University of California Irvine (UCI), Orange, California
| | - Areg Grigorian
- Department of Surgery, University of California Irvine (UCI), Orange, California; Department of Surgery, University of Southern California (USC), Los Angeles, California
| | - Kenji Inaba
- Department of Surgery, University of Southern California (USC), Los Angeles, California
| | - Matthew Dolich
- Department of Surgery, University of California Irvine (UCI), Orange, California
| | - Sebastian D Schubl
- Department of Surgery, University of California Irvine (UCI), Orange, California
| | - Michael Lekawa
- Department of Surgery, University of California Irvine (UCI), Orange, California
| | - Morgan Schellenberg
- Department of Surgery, University of Southern California (USC), Los Angeles, California
| | | | - Jeffry Nahmias
- Department of Surgery, University of California Irvine (UCI), Orange, California.
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22
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Evain F, Lovblad KO, Fracasso T. Tympanal bone fracture in forensic practice. Int J Legal Med 2021; 135:2653-2658. [PMID: 34599364 PMCID: PMC8523497 DOI: 10.1007/s00414-021-02682-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/09/2021] [Indexed: 11/28/2022]
Abstract
A tympanal bone fracture is an uncommon complication of head trauma and is mostly associated with a mandibular or petrous bone fracture. Upon reviewing the medicolegal literature, we could not find any publications on this topic. Tympanal bone fracture may lead to chronic complications (including external auditory canal stenosis and conductive hearing loss), with an important impact in both the medical and judiciary fields (e.g., chronic disabilities with loss of income). We decided to investigate the prevalence and mechanisms of tympanal bone fractures by means of a retrospective observational study on living victims who underwent head computed tomography after blunt head trauma and clinical forensic investigation at our center. We selected 159 cases of living victims with blunt head trauma (following an assault, traffic accident, or work accident) between January 2016 and December 2020. Re-examination of head imaging revealed 12 cases of tympanal bone fracture. Seven individuals showed cranial fractures involving the petrous bone (on the same side as the tympanal bone fracture). Three individuals had a temporomandibular fracture after a fall with chin impact. Only two victims exhibited an isolated tympanal bone fracture.
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Affiliation(s)
- France Evain
- Forensic Pathology, University Center of Legal Medicine, Geneva University Hospitals and University of Geneva, rue Michel-Servet 1, CH-1211, Geneva 4, Switzerland.
| | - Karl-Olof Lovblad
- Division of Neuroradiology, Diagnostic Department, Geneva University Hospitals, rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Tony Fracasso
- Forensic Pathology, University Center of Legal Medicine, Geneva University Hospitals and University of Geneva, rue Michel-Servet 1, CH-1211, Geneva 4, Switzerland
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23
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Gaitanidis A, Sinyard RT, Nederpelt CJ, Maurer LR, Christensen MA, Mashbari H, Velmahos GC, Kaafarani HMA. Lower Mortality with Cryoprecipitate During Massive Transfusion in Penetrating but Not Blunt Trauma. J Surg Res 2021; 269:94-102. [PMID: 34537533 DOI: 10.1016/j.jss.2021.07.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 06/23/2021] [Accepted: 07/13/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Balanced blood product transfusion improves the outcomes of trauma patients with exsanguinating hemorrhage, but it remains unclear whether administering cryoprecipitate improves mortality. We aimed to examine the impact of early cryoprecipitate transfusion on the outcomes of the trauma patients needing massive transfusion (MT). METHODS All MT patients 18 years or older in the 2017 Trauma Quality Improvement Program (TQIP) were retrospectively reviewed. MT was defined as the transfusion of ≥10 units of blood within 24 hours. Propensity score analysis (PSA) was used to 1:1 match then compare patients who received and those who did not receive cryoprecipitate in the first 4 hours after injury. Outcomes included in-hospital mortality, 1-day mortality, in-hospital complications and transfusion needs at 24 hours. RESULTS Of 1,004,440 trauma patients, 1,454 MT patients received cryoprecipitate and 2,920 did not. After PSA, 877 patients receiving cryoprecipitate were matched to 877 patients who did not. In-hospital mortality was lower among patients who received cryoprecipitate (49.4% v. 54.9%, P = 0.022), as was 1-day mortality. Sub-analyses showed that mortality was lower with cryoprecipitate in patients with penetrating (37.5% versus. 48%, adjusted P = 0.008), but not blunt trauma (58.5% versus. 59.8%, adjusted P = 1.000). In penetrating trauma, the cryoprecipitate group also had lower 1-day mortality (21.8% versus. 38.6%, P <0.001) and a higher rate of hemorrhage control surgeries performed within 24 hours (71.4% versus. 63.3%, P = 0.018). CONCLUSIONS Cryoprecipitate in MT is associated with improved survival in penetrating, but not blunt, trauma. Randomized trials are needed to better define the role of cryoprecipitate in MT.
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Affiliation(s)
- Apostolos Gaitanidis
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts; Center for Outcomes & Patient Safety in Surgery (COMPASS), Massachusetts General Hospital, Boston, Massachusetts
| | - Robert T Sinyard
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts
| | - Charlie J Nederpelt
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts
| | - Lydia R Maurer
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts; Center for Outcomes & Patient Safety in Surgery (COMPASS), Massachusetts General Hospital, Boston, Massachusetts
| | - Mathias A Christensen
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts
| | - Hassan Mashbari
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts; Center for Outcomes & Patient Safety in Surgery (COMPASS), Massachusetts General Hospital, Boston, Massachusetts
| | - George C Velmahos
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts
| | - Haytham M A Kaafarani
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts; Center for Outcomes & Patient Safety in Surgery (COMPASS), Massachusetts General Hospital, Boston, Massachusetts.
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24
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Williams CH, Scott EM, Dorfman JD, Simon BJ. Traumatic Injury Under COVID-19 Stay-at-home Advisory: Experience of a New England Trauma Center. J Surg Res 2021; 269:165-170. [PMID: 34563843 PMCID: PMC8352668 DOI: 10.1016/j.jss.2021.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 07/13/2021] [Accepted: 08/04/2021] [Indexed: 02/07/2023]
Abstract
Background With the onset of the COVID-19 pandemic and subsequent widespread stay-at-home advisories throughout early 2020, hospitals have noticed a decrease in illnesses unrelated to COVID-19. However, the impact on traumatic injury is relatively unknown. This study aims to characterize patterns of trauma during the COVID-19 pandemic at a Level I Trauma Center. Materials & methods A retrospective review was performed of adult trauma patients from March to June, in the years 2018 through 2020. Primary outcome was the number of trauma activations (volume). Secondary outcomes included activation level, mechanism of injury, mortality rate, and length of stay, and other demographic background. Trauma patterns of the 2018 and 2019 periods were combined as historical control, and compared to patterns of the biweekly-matched period of 2020. Results A total of 2,187 patients were included in analysis (Pre-COVID n = 1,572; COVID n = 615). Results were significant for decreased trauma volume but longer length of stay during COVID cohort, and for an increased proportion of males. No significant difference was found for other demographic variables, trauma mechanisms, or severity. Trauma volume patterns mirrored COVID rates in the state. Conclusions Despite a decline in trauma volume, other trauma patterns including severity and mechanism remained unchanged during the COVID-19 period. The decreased volume was not associated with a markedly lower clinical workload, change in team structure, or provider coverage re-distribution. Our data suggests that trauma volume and severity remained high enough during COVID-19 peak to necessitate full staffing, which may provide guidance in the event of a pandemic resurgence.
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Affiliation(s)
- Chloe H Williams
- Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Erin M Scott
- Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Jon D Dorfman
- Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts.
| | - Bruce J Simon
- Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts
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25
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Liguori G, Rebez G, Larcher A, Rizzo M, Cai T, Trombetta C, Salonia A. The role of angioembolization in the management of blunt renal injuries: a systematic review. BMC Urol 2021; 21:104. [PMID: 34362352 PMCID: PMC8344199 DOI: 10.1186/s12894-021-00873-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 07/20/2021] [Indexed: 12/22/2022] Open
Abstract
Background Recently, renal angioembolization (RAE) has gained an important role in the non-operative management (NOM) of moderate to high-grade blunt renal injuries (BRI), but its use remains heterogeneous. The aim of this review is to examine the current literature on indications and outcomes of angioembolization in BRI. Methods We conducted a search of MEDLINE, EMBASE, SCOPUS and Web of Science Databases up to February 2021 in accordance with PRISMA guidelines for studies on BRI treated with RAE. The methodological quality of eligible studies and their risk of bias was assessed using the Newcastle–Ottawa scale Results A total of 16 articles that investigated angioembolization of blunt renal injury were included in the study. Overall, 412 patients were included: 8 presented with grade II renal trauma (2%), 97 with grade III renal trauma (23%); 225 with grade IV (55%); and 82 with grade V (20%). RAE was successful in 92% of grade III–IV (294/322) and 76% of grade V (63/82). Regarding haemodynamic status, success rate was achieved in 90% (312/346) of stable patients, but only in 63% (42/66) of unstable patients. The most common indication for RAE was active contrast extravasation in hemodynamic stable patients with grade III or IV BRI. Conclusions This is the first review assessing outcomes and indication of angioembolization in blunt renal injuries. The results suggest that outcomes are excellent in hemodynamic stable, moderate to high-grade renal trauma. Supplementary Information The online version contains supplementary material available at 10.1186/s12894-021-00873-w.
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Affiliation(s)
- Giovanni Liguori
- Azienda Sanitaria Universitaria Giuliano-Isontina, Strada di Fiume 447, 34149, Trieste, Italy
| | - Giacomo Rebez
- Azienda Sanitaria Universitaria Giuliano-Isontina, Strada di Fiume 447, 34149, Trieste, Italy.
| | | | - Michele Rizzo
- Azienda Sanitaria Universitaria Giuliano-Isontina, Strada di Fiume 447, 34149, Trieste, Italy
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26
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Zhao J, Dang YL, Lin JM, Hu CH, Yu ZY. Rare isolated extra-hepatic bile duct injury: A case report. World J Clin Cases 2021; 9:5661-5667. [PMID: 34307622 PMCID: PMC8281421 DOI: 10.12998/wjcc.v9.i20.5661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/21/2021] [Accepted: 04/28/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Extra-hepatic bile duct injury (EHBDI) is very rare among all blunt abdominal injuries. According to literature statistics, it only accounts for 3%-5% of abdominal injuries, most of which are combined injuries. Isolated EHBDI is more rare, with a special injury mechanism, clinical presentation and treatment strategy, so missed diagnosis easily occurs.
CASE SUMMARY We report a case of unexplained abdominal effusion and jaundice following blunt abdominal trauma in our department. Of which, surgical exploration of the case was performed and a large amount of bile leakage in the abdominal cavity was found. No obvious abdominal organ damage or bile duct rupture was found. Surgery was terminated after the common bile duct indwelled with a T tube. After 2 wk, a T-tube angiography revealed the lesion in the common bile duct pancreatic segment, confirming isolated EHBDI. And 2 mo later, the T tube was pulled out with re-examined magnetic resonance cholangiopancreatography, indicating narrowing of the common bile duct injury, with no special treatment due to no clinical symptoms and no abnormality in the current follow-up.
CONCLUSION This case was featured by intraoperative bile leakage and no EHBDI. This type of rare isolated EHBDI is prone to missed and delayed diagnosis due to its atypical clinical manifestations and imaging features. Surgery is still the main treatment, and the indications and principles of bile duct injury repair must be followed.
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Affiliation(s)
- Jian Zhao
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Yunnan University (The Second People's Hospital of Yunnan Province), Kunming 650000, Yunnan Province, China
| | - Yan-Li Dang
- Department of Obstetrics, The First People's Hospital of Yunnan Province, Kunming 650000, Yunnan Province, China
| | - Jia-Ming Lin
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Yunnan University (The Second People's Hospital of Yunnan Province), Kunming 650000, Yunnan Province, China
| | - Chun-Hai Hu
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Yunnan University (The Second People's Hospital of Yunnan Province), Kunming 650000, Yunnan Province, China
| | - Zhi-Yong Yu
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Yunnan University (The Second People's Hospital of Yunnan Province), Kunming 650000, Yunnan Province, China
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27
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ALShareef B, ALJurushi R, ALSaleh N. Delayed presentation of an isolated sigmoid Colon injury following blunt abdominal trauma: A case report with review of literature. Int J Surg Case Rep 2021; 83:105989. [PMID: 34029844 PMCID: PMC8163958 DOI: 10.1016/j.ijscr.2021.105989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/08/2021] [Accepted: 05/09/2021] [Indexed: 11/08/2022] Open
Abstract
Introduction and importance Isolated Colon injury due to blunt abdominal trauma is very rare. Due to lack of a definitive diagnostic method; it's very challenging to detect such injury and this will lead to delay in treatment and subsequently resulting in high morbidity and mortality. The current literature is relatively sparse concerning the management of blunt colon injuries. Case presentation Here, we report a case of a 17-year-old male patient with isolated sigmoid injury presented 5 days after MVC. He underwent sigmoid resection and end colostomy followed by reversal 6 weeks later. Currently, the patient is disease-free with a completely healed wound. Conclusion The purpose behind this paper is to raise clinical suspicion regarding delayed presentation of blunt abdominal trauma and it effect on operative decision, so that timely diagnosis and proper management could be carried out. And to discuss the applicability of the defined management algorithm for penetrating colon injury on delay blunts colonic injury. Isolated Colon injury due to blunt abdominal trauma is very rare and its very challenging to detect. We have found that only few cases have been reported for Delayed Presentation Of An Isolated Colonic Injury Following Blunt Abdominal Trauma. The purpose of this report is to discuss surgical management in light of our experience. We believe that the defined management algorithm for penetrating colon injury can’t be applied to delay injury as in this case the colon are more vulnerable which increases risk of post-operative complication. Additional research is needed to completely define the patient population that benefits from fecal diversion after delayed blunt colon injury requiring resection.
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Affiliation(s)
- Basem ALShareef
- Department Of Surgery, College Of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia; Al-Noor Specialist Hospital, Department of General Surgery, Makkah, Saudi Arabia.
| | - Raghad ALJurushi
- Al-Noor Specialist Hospital, Department of General Surgery, Makkah, Saudi Arabia
| | - Nourah ALSaleh
- Al-Noor Specialist Hospital, Department of General Surgery, Makkah, Saudi Arabia.
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28
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Malloum Boukar K, Moore L, Tardif PA, Soltana K, Yanchar N, Kortbeek J, Champion H, Clement J. Value of repeat CT for nonoperative management of patients with blunt liver and spleen injury: a systematic review. Eur J Trauma Emerg Surg 2021. [PMID: 33484276 DOI: 10.1007/s00068-020-01584-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 12/27/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the effectiveness of routine repeat computed tomography (CT) for nonoperative management (NOM) of adults with blunt liver and/or spleen injury. METHODS We conducted a systematic review of randomized and non-randomized controlled trials (RCTs), quasi-experimental and observational studies of repeat CT in adult patients with blunt abdominal injury. We searched Medline, Embase, Web of Science, and Cochrane Central from their inception to October 2020 using Cochrane guidelines. Primary outcomes were change in clinical management (e.g., emergency surgery, embolization, blood transfusion, clinical surveillance), mortality, and complications. Secondary outcomes were hospital readmission and length of stay. RESULTS Search results yielded 1611 studies of which 28 studies including 2646 patients met our inclusion criteria. The majority reported on liver (n = 9) or spleen injury (n = 16) or both (n = 3). No RCTs were identified. Meta-analyses were not possible because no study performed direct comparisons of study outcomes across intervention groups. Only seven of the twenty-eight studies reported whether repeat CT was routine or prompted by clinical indication. In these 7 studies, among the 254 repeat CT performed, 188 (74%) were routine and 8 (4%) of these led to a change in clinical management. Of the 66 (26%) repeated CT prompted by clinical indication, 31 (47%) led to a change in management. We found no data allowing comparison of any other outcomes across intervention groups. CONCLUSION Routine repeat CT without clinical indication is not useful in the management of patients with liver and/or spleen injury. However, effect estimates were imprecise and included studies were of low methodological quality. Given the risks of unnecessary radiation and costs associated with repeat CT, future research should aim to estimate the frequency of such practices and assess practice variation. LEVEL OF EVIDENCE Systematic reviews and meta-analyses, Level II.
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29
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Abstract
Traumatic cerebrovascular injuries are common in both military and civilian populations. Whether such injuries occur in the aftermath of blunt or penetrating trauma has major implications for characteristics, classification, diagnosis, and optimal management of these lesions. Advances in screening methods, including particularly the dramatic rise of high-quality CT angiography, have facilitated early detection of these lesions. Fortunately, these diagnostic advances have occurred alongside improvements in pharmacological treatment and endovascular intervention, which now play an important role alongside surgical intervention in reducing the likelihood of adverse clinical outcomes. While the management of victims of trauma remains challenging, improved understanding of and ability to appropriately manage traumatic cerebrovascular lesions promises to yield better clinical outcomes for these vulnerable patients.
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Affiliation(s)
- Akash P Kansagra
- Departments of Radiology, Neurological Surgery, and Neurology, Washington University School of Medicine, St. Louis, MO, United States.
| | - Vamshi Balasetti
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States
| | - Michael C Huang
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, United States
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30
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Ravindra VM, Bollo RJ, Dewan MC, Riva-Cambrin JK, Tonetti D, Awad AW, Akbari SH, Gannon S, Shannon C, Birkas Y, Limbrick D, Jea A, Naftel RP, Kestle JR, Grandhi R. Comparison of anticoagulation and antiplatelet therapy for treatment of blunt cerebrovascular injury in children <10 years of age: a multicenter retrospective cohort study. Childs Nerv Syst 2021; 37:47-54. [PMID: 32468243 DOI: 10.1007/s00381-020-04672-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 05/10/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE Blunt cerebrovascular injury (BCVI) is uncommon in the pediatric population. Among the management options is medical management consisting of antithrombotic therapy with either antiplatelets or anticoagulation. There is no consensus on whether administration of antiplatelets or anticoagulation is more appropriate for BCVI in children < 10 years of age. Our goal was to compare radiographic and clinical outcomes based on medical treatment modality for BCVI in children < 10 years. METHODS Clinical and radiographic data were collected retrospectively for children screened for BCVI with computed tomography angiography at 5 academic pediatric trauma centers. RESULTS Among 651 patients evaluated with computed tomography angiography to screen for BCVI, 17 patients aged less than 10 years were diagnosed with BCVI (7 grade I, 5 grade II, 1 grade III, 4 grade IV) and received anticoagulation or antiplatelet therapy for 18 total injuries: 11 intracranial carotid artery, 4 extracranial carotid artery, and 3 extracranial vertebral artery injuries. Eleven patients were treated with antiplatelets (10 aspirin, 1 clopidogrel) and 6 with anticoagulation (4 unfractionated heparin, 2 low-molecular-weight heparin, 1 transitioned from the former to the latter). There were no complications secondary to treatment. One patient who received anticoagulation died as a result of the traumatic injuries. In aggregate, children treated with antiplatelet therapy demonstrated healing on 52% of follow-up imaging studies versus 25% in the anticoagulation cohort. CONCLUSION There were no observed differences in the rate of hemorrhagic complications between anticoagulation and antiplatelet therapy for BCVI in children < 10 years, with a nonsignificantly better rate of healing on follow-up imaging in children who underwent antiplatelet therapy; however, the study cohort was small despite including patients from 5 hospitals.
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Affiliation(s)
- Vijay M Ravindra
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt Lake City, UT, 84132, USA.,Division of Pediatric Neurosurgery, Primary Children's Hospital, Salt Lake City, UT, USA
| | - Robert J Bollo
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt Lake City, UT, 84132, USA.,Division of Pediatric Neurosurgery, Primary Children's Hospital, Salt Lake City, UT, USA
| | - Michael C Dewan
- Department of Neurosurgery, Vanderbilt University, Nashville, TN, USA.,Division of Pediatric Neurosurgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Jay K Riva-Cambrin
- Department of Clinical Neurosciences, Division of Pediatric Neurosurgery, University of Calgary, Calgary, Alberta, Canada
| | - Daniel Tonetti
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Al-Wala Awad
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt Lake City, UT, 84132, USA.,Division of Pediatric Neurosurgery, Primary Children's Hospital, Salt Lake City, UT, USA
| | - S Hassan Akbari
- Department of Neurosurgery, Washington University in St. Louis, St. Louis, MO, USA.,Division of Pediatric Neurosurgery, St. Louis Children's Hospital, St. Louis, MO, USA
| | - Stephen Gannon
- Department of Neurosurgery, Vanderbilt University, Nashville, TN, USA.,Division of Pediatric Neurosurgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Chevis Shannon
- Department of Neurosurgery, Vanderbilt University, Nashville, TN, USA.,Division of Pediatric Neurosurgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Yekaterina Birkas
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt Lake City, UT, 84132, USA.,Division of Pediatric Neurosurgery, Primary Children's Hospital, Salt Lake City, UT, USA
| | - David Limbrick
- Department of Neurosurgery, Washington University in St. Louis, St. Louis, MO, USA.,Division of Pediatric Neurosurgery, St. Louis Children's Hospital, St. Louis, MO, USA
| | - Andrew Jea
- Department of Neurosurgery, Indiana University, Bloomington, IN, USA.,Division of Pediatric Neurosurgery, Riley Children's Hospital, Indianapolis, IN, USA
| | - Robert P Naftel
- Department of Neurosurgery, Vanderbilt University, Nashville, TN, USA.,Division of Pediatric Neurosurgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - John R Kestle
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt Lake City, UT, 84132, USA.,Division of Pediatric Neurosurgery, Primary Children's Hospital, Salt Lake City, UT, USA
| | - Ramesh Grandhi
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt Lake City, UT, 84132, USA. .,Division of Pediatric Neurosurgery, Primary Children's Hospital, Salt Lake City, UT, USA.
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Kuorikoski J, Brinck T, Willa K, Heinänen M, Handolin L, Söderlund T. Major blunt trauma causes increased mortality up to 12 years: Long-term survival in 3 557 patients compared to 35 502 control persons. Injury 2020; 51:2517-2523. [PMID: 32838959 DOI: 10.1016/j.injury.2020.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/23/2020] [Accepted: 08/07/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Trauma registries usually report 30-day or in-hospital mortality as an outcome measure. However, some studies criticize this measure as inadequate; the impact of a major trauma could last longer than 1 month after the injury. We studied the long-term mortality of patients who sustained a major trauma. METHODS The Helsinki University Hospital's trauma registry was used for patient identification from 2006 to 2015 (New Injury Severity Score ≥ 16 and blunt mechanism of injury). For each trauma registry patient, 10 control persons matched by age, sex, and county of residency were obtained from the Population Register Center of Finland. Cause of death information was obtained from Statistics Finland. RESULTS We included 3 557 trauma registry patients and 35 502 control persons. Follow-up ranged from 1 year 7 months to 11 years 7 months. The 1-year mortality was 11 times higher in the trauma-patient group (22% vs. 2%). The long-term (approximately 12 years) mortality after the injury was 2.6 times higher in the trauma-patient group (46% vs. 18%). For patients surviving at least 1 year post-trauma, the mortality at 12 years was 2.2 times higher than in the control group (31% vs. 14 %). The cause of death was a disease in 73.3% of the trauma patients and 93.6% of the controls. Accidents were more often a cause of death in the patient population than in the control population (21.2% vs. 4.1%). Suicide was the cause of death in 3.0% of patients and 1.1% in controls. Several factors associated with increased mortality were identified. CONCLUSIONS Major trauma patients had significantly higher long-term mortality compared to controls. To the best of our knowledge, this is the first study on this subject with a follow up of this duration with patients this severely injured and a cohort this large.
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Affiliation(s)
- Joonas Kuorikoski
- Surgical unit, Central Hospital of Central Finland, Jyväskylä, Finland.
| | - Tuomas Brinck
- Trauma Unit, HUH Musculoskeletal and Plastic Surgery, Helsinki University Hospital, Helsinki, P.O. Box 266, 00029 HUS, Finland.
| | - Kirsi Willa
- Helsinki University Hospital, Helsinki, Finland.
| | - Mikko Heinänen
- Trauma Unit, HUH Musculoskeletal and Plastic Surgery, Helsinki University Hospital, Helsinki, P.O. Box 266, 00029 HUS, Finland.
| | - Lauri Handolin
- Trauma Unit, HUH Musculoskeletal and Plastic Surgery, Helsinki University Hospital, Helsinki, P.O. Box 266, 00029 HUS, Finland.
| | - Tim Söderlund
- Trauma Unit, HUH Musculoskeletal and Plastic Surgery, Helsinki University Hospital, Helsinki, P.O. Box 266, 00029 HUS, Finland.
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Amico F, Anning R, Bendinelli C, Balogh ZJ. Grade III blunt splenic injury without contrast extravasation - World Society of Emergency Surgery Nijmegen consensus practice. World J Emerg Surg 2020; 15:46. [PMID: 32746885 PMCID: PMC7397620 DOI: 10.1186/s13017-020-00319-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/07/2020] [Indexed: 11/25/2022] Open
Abstract
Background Recent trauma guidelines recommend non-operative management for grade III splenic injury without contrast extravasation on computed tomography. Nevertheless, such recommendations rely on low-quality evidence, and practice variation characterizes clinical management for this type of injury. We aimed to identify the role of eleven selected clinical factors influencing the management of grade III splenic injury without contrast extravasation by expert consensus and a modified Delphi approach. Methods A questionnaire was developed with the endorsement of the World Society of Emergency Surgery (WSES). This was delivered and answered live by acute care surgeons attending the 6th WSES congress in Nijmegen in 2019. A dedicated mobile phone application was utilized to collect the answers. All answers were evaluated for areas of discrepancy with an 80% threshold for consensus between respondents. Results Three factors generated discrepancy in opinion for managing this pattern of injury: the patients’ injury severity, the presence of a bleeding diathesis, and an associated intra-abdominal injury. Agreement was obtained for the other eight factors. Conclusion Researchers should focus their efforts on the identified area of discrepancy. Clinicians should use additional care in the presence of the three factors for which discordant opinions were found.
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Affiliation(s)
- Francesco Amico
- Department of Traumatology, John Hunter Hospital, Locked Bag 1, Hunter Region Mail Centre, Newcastle, NSW, 2310, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Rebecca Anning
- Department of Surgery, John Hunter Hospital, Newcastle, NSW, Australia
| | - Cino Bendinelli
- Department of Traumatology, John Hunter Hospital, Locked Bag 1, Hunter Region Mail Centre, Newcastle, NSW, 2310, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Zsolt J Balogh
- Department of Traumatology, John Hunter Hospital, Locked Bag 1, Hunter Region Mail Centre, Newcastle, NSW, 2310, Australia. .,School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia.
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Nijdam TMP, Spijkerman R, Hesselink L, Leenen LPH, Hietbrink F. Predictors of surgical management of high grade blunt splenic injuries in adult trauma patients: a 5-year retrospective cohort study from an academic level I trauma center. Patient Saf Surg 2020; 14:32. [PMID: 32774457 DOI: 10.1186/s13037-020-00257-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/21/2020] [Indexed: 12/13/2022] Open
Abstract
Backgrounds Splenic injury accounts for 40% of all injuries after blunt abdominal trauma. Blunt splenic injury in hemodynamically unstable patients is preferably treated by splenectomy. Nowadays hemodynamically stable patients with low grade splenic injuries are mostly treated by non-operative management (NOM). However no consensus exists about the management of high grade splenic injuries in hemodynamically stable patients. Therefore the aim of this study was to analyze patients with high grade splenic injuries in our institution. Methods We retrospectively included all patients with a splenic injury presented to our level I trauma center during the 5-year period from January 1, 2012, until December 31, 2017. Baseline characteristics, data regarding complications and mortality were collected from the electronic patient registry. Patients were grouped based on splenic injury and the treatment they received. Results A total of 123 patients were included, of which 93 (75.6%) were male with a median age of 31 (24–52) and a median injury severity score of 27 (17–34). High grade injuries (n = 28) consisted of 20 Grade IV injuries and 8 grade V injuries. Splenectomy was required in 15/28 (53.6%) patients, of whom all remained hemodynamically unstable after resuscitation, including all grade V injuries. A total of 13 patients with high grade injuries were treated with spleen preserving therapy. Seven of these patients received angio-embolization. One patient went for laparotomy and the spleen was treated with a hemostatic agent. Secondary hemorrhage was present in 3 of these patients (initial treatment: 1 embolization/ 2 observational), resulting in a success rate of 76.9%. There is no mortality seen in patient with high grade splenic injuries. Conclusion Non-operative treatment in high grade splenic injuries is a safe treatment modality in hemodynamically stable patients. Hemodynamic status and peroperative bleeding, not injury severity or splenic injury grade were the drivers for surgical management by splenectomy. This selected cohort of patients must be closely monitored to prevent adverse outcomes from secondary delayed bleeding in case of non-operative management.
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Gorman E, Bukur M, Frangos S, DiMaggio C, Kozar R, Klein M, Pachter HL, Berry C. Increasing age is associated with worse outcomes in elderly patients with severe liver injury. Am J Surg 2020; 220:1308-11. [PMID: 32653089 DOI: 10.1016/j.amjsurg.2020.06.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/07/2020] [Accepted: 06/25/2020] [Indexed: 01/15/2023]
Abstract
While the incidence of geriatric trauma continues to increase, outcomes following severe blunt liver injury (BLI) are unknown. We sought to investigate independent predictors of mortality among elderly trauma patients with severe BLI. A retrospective study of the NTDB (2014-15) identified patients with isolated, high-grade BLI. Patients were stratified into two groups, non-elderly (<65 years) and elderly (≥65 years), and then two management groups: operative within 24 h of admission and non-operative. Demographics and outcomes were compared. Multivariable logistic regression was used to estimate association with mortality. A total of 1133 patients met our inclusion criteria. 107 patients required surgery and 1011 patients were managed non-operatively. Age was independently associated with mortality (AOR 1.04, p < .001). For patients <65 years, need for operative intervention was associated with a 55 times greater likelihood of death (AOR 55.1, p < .001). In patients ≥65 years, operative intervention was associated with a 122 times greater likelihood of death (AOR 122.09, p = .005). Age is independently associated with mortality in patients with high grade BLI.
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Paes FM, Durso AM, Danton G, Castellon I, Munera F. Imaging evaluation of diaphragmatic injuries: Improving interpretation accuracy. Eur J Radiol 2020; 130:109134. [PMID: 32629213 DOI: 10.1016/j.ejrad.2020.109134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/10/2020] [Accepted: 06/15/2020] [Indexed: 11/18/2022]
Abstract
Diaphragmatic Injuries (DIs) remain a challenging diagnosis with potential catastrophic delayed complications. A high degree of suspicion in every case of severe blunt thoracoabdominal trauma or penetrating thoracoabdominal injury is essential. This review will present the evidence and controversies on this topic providing a practical tutorial for radiologists hoping to improve their interpretive accuracy for both blunt and penetrating DIs. The imaging signs of diaphragmatic injuries will be explained with emphasis on multidetector CT. Diagnostic pitfalls, available protocols and other issues will be presented.
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Affiliation(s)
- Fabio M Paes
- Department of Diagnostic Radiology, University of Miami - Leonard Miller School of Medicine, Jackson Memorial Hospital & Ryder Trauma Center, Miami, FL, USA.
| | - Anthony M Durso
- Department of Diagnostic Radiology, University of Miami - Leonard Miller School of Medicine, Jackson Memorial Hospital & Ryder Trauma Center, Miami, FL, USA.
| | - Gary Danton
- Department of Diagnostic Radiology, University of Miami - Leonard Miller School of Medicine, Jackson Memorial Hospital & Ryder Trauma Center, Miami, FL, USA.
| | - Ivan Castellon
- Department of Diagnostic Radiology, University of Miami - Leonard Miller School of Medicine, Jackson Memorial Hospital & Ryder Trauma Center, Miami, FL, USA.
| | - Felipe Munera
- Department of Diagnostic Radiology, University of Miami - Leonard Miller School of Medicine, Jackson Memorial Hospital & Ryder Trauma Center, Miami, FL, USA.
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Abstract
Trauma to the face and neck is a frequent reason for emergency department attendance. Imaging is invaluable in the characterisation of such injuries, enabling delineation of fracture patterns as well as identification of vascular and other soft tissue injuries. It may also be used to prevent long-term mortality and morbidity and provide a roadmap for surgical intervention so that form and function may be restored. This article gives a pictorial review of the imaging of craniofacial trauma, stratified according to the thirds of the face, followed by a review of blunt and penetrating trauma of the neck. It discusses appropriate imaging modalities for each trauma category, describes major patterns of craniofacial trauma on cross-sectional imaging and identifies clinically relevant imaging features that should trigger subspecialist review or be of relevance to pre-surgical planning. It starts with the upper third comprising frontal sinus fractures before describing the component fractures of the middle third (including nasal, zygomaticomaxillary and orbital fractures) and then focusing on the lower third (specifically mandibular and dentoalveolar fractures). The article concludes with a review of soft tissue injuries of the neck, particularly penetrating, blunt and laryngeal trauma.
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Affiliation(s)
- George Bitar
- Department of Radiology, Royal Marsden Hospital, Royal Marsden NHS Foundation Trust, London, UK
| | - Philip Touska
- Department of Radiology, Guy's Hospital, Guy's and St. Thomas' Hospitals NHS Foundation Trust, London, UK
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Ibrahim AH, Osman AJ, Alarfaj MA, Alzamil AM, Abahussain MA, Alghamdi H. Case report: Evisceration of abdomen after blunt trauma. Int J Surg Case Rep 2020; 72:207-211. [PMID: 32544830 PMCID: PMC7298532 DOI: 10.1016/j.ijscr.2020.05.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/21/2020] [Accepted: 05/21/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Abdominal evisceration is uncommon after blunt abdominal trauma; therefore, it warrants urgent laparotomy. We report a young adult male who sustained multiple injuries due to a high impact mechanism resulting in blunt abdominal injury and underwent numerous laparotomies. CASE REPORT In a high-speed motorcycle accident, a twenty-six-year-old male sustained a direct, blunt injury to his abdomen, which resulted in a right hemothorax, perforation of the stomach, and small bowel. Multiple mesenteric vessels tear, a retroperitoneal hematoma, liver, and pancreatic injury. The abdominal wall split transversely, extruding intact bowel. After resuscitation, according to the ATLS protocol, the patient underwent eight laparotomies for damage control. After 45 days in the Surgical Intensive Care Unit, then 11 days in the surgical ward, he was discharged in a satisfactory condition. Eight months later, he was admitted electively for ileostomy reversal, which was uneventful. CONCLUSION Patients with high trauma mechanisms have high mortality and morbidity rate. Blunt injury with eviscerated abdominal contents requires prompt, expeditious, and timely intervention, particularly at the initial operative intervention with damage control procedures, both prompt management and structured approach, were tailored depending in the magnitude of the injury. A multidisciplinary approach is mandatory throughout the period of treatment until recovery and rehabilitation.
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Affiliation(s)
- Arwa H Ibrahim
- College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Saudi Arabia.
| | - Adel J Osman
- King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Department of Surgery, Saudi Arabia
| | - Mosab A Alarfaj
- King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Department of Surgery, Saudi Arabia
| | - Areej M Alzamil
- College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Saudi Arabia
| | - Munirah A Abahussain
- College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Saudi Arabia
| | - Hanan Alghamdi
- King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Department of Surgery, Saudi Arabia
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Montgomery L, Mantey DS, Peters EN, Herrmann ES, Winhusen T. Blunt use and menthol cigarette smoking: An examination of adult marijuana users. Addict Behav 2020; 102:106153. [PMID: 31704435 DOI: 10.1016/j.addbeh.2019.106153] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/29/2019] [Accepted: 10/01/2019] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Use of menthol cigarettes remains highly prevalent among African American smokers and has increased among White and Hispanic/Latino smokers. Research is needed to examine if behavioral factors, such as marijuana use, are differentially associated with menthol cigarette use among racially/ethnically diverse samples of marijuana users. METHODS Using data from the 2017 National Survey on Drug Use and Health, this study examined the association between past month marijuana (blunt versus non-blunt) and cigarette (non-menthol cigarette versus menthol cigarette versus no cigarette) use, as well as racial/ethnic differences in this relationship. RESULTS Among all marijuana users (N = 5,137), 34.1% smoked blunts, 28.7% smoked non-menthol cigarettes and 18.0% smoked menthol cigarettes, with the highest rates of blunt (63.8%) and menthol cigarette (38.9%) use found among African American adults. Multinomial logistic regression analyses revealed a significant association between blunt use and non-menthol cigarette use (versus non-use) and menthol cigarette use (versus non-menthol cigarette and no cigarette use) among the full sample. When stratified by race/ethnicity, this finding was consistent for non-Hispanic White (n = 3,492) and partially consistent for Hispanic/Latino (n = 839) adults. However, among African American adults (n = 806), blunt use was not significantly associated with non-menthol cigarette use or menthol cigarette use. DISCUSSION Blunt use is associated with increased odds of non-menthol and menthol cigarette use, but only among Hispanic/Latino and White adults. Examining racial/ethnic differences in the association between marijuana and tobacco use is important to understanding disparities and informing prevention and treatment interventions and drug policies.
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Affiliation(s)
- LaTrice Montgomery
- Department of Psychiatry and Behavioral Neuroscience, Addiction Sciences Division, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Suite 204, Cincinnati, OH 45229, United States.
| | - Dale S Mantey
- University of Texas School of Public Health, 1616 Guadalupe, Suite 6.300, Austin, TX 78701, United States.
| | - Erica N Peters
- Battelle Public Health Center for Tobacco Research, Battelle Memorial Institute, 6115 Falls Road, Suite 200, Baltimore, MD 21209, United States.
| | - Evan S Herrmann
- Battelle Public Health Center for Tobacco Research, Battelle Memorial Institute, 6115 Falls Road, Suite 200, Baltimore, MD 21209, United States.
| | - Theresa Winhusen
- Department of Psychiatry and Behavioral Neuroscience, Addiction Sciences Division, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Suite 104, Cincinnati, OH 45229, United States.
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Warnack E, Bukur M, Frangos S, DiMaggio C, Kozar R, Klein M, Berry C. Age is a predictor for mortality after blunt splenic injury. Am J Surg 2020; 220:778-782. [PMID: 32061397 DOI: 10.1016/j.amjsurg.2020.01.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 01/31/2020] [Accepted: 01/31/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND While the incidence of geriatric trauma continues to increase, the management of high-grade blunt splenic injury (BSI) in the elderly remains controversial. Among this population, data evaluating survival rates following non-operative and operative management are inconsistent. We analyzed mortality risk in geriatric patients with high-grade BSI based on operative vs. non-operative management. METHODS A retrospective analysis of the National Trauma Database identified patients with isolated, high-grade (AIS ≥ 3) BSI from 2014 to 2015. Patients were stratified into three groups: non-elderly (<65 years), elderly (65-79 years), and advanced age (80 years and older). Each age group was stratified into three management groups: non-operative (including embolization), initial operative management (OR within 24 h), and failed non-operative management. Patient characteristics and outcomes were compared. Multivariable logistic regression estimated association with mortality. RESULTS 5560 patients with isolated, high-grade BSI were identified. In the group that failed NOM, mortality was 2% in non-elderly patients, versus 22.2% in elderly patients and 50% in patients of advanced age (p < .01). In this group, patients over 80 years old spent an average of 6.5 days longer in the ICU vs. non-elderly patients (median 10.5 days, IQR [6.75, 19.5] vs. 4 days, IQR [3,6], p = 0.02). In patients with isolated, high grade BSI, age was independently associated with mortality (AOR 1.02; p < 0.01). Elderly patients who required surgery were over three times more likely to die (AOR 3.39; p < 0.01). Advanced age patients who required surgery were over eight times more likely to die (AOR 8.1; p < 0.01). CONCLUSIONS For patients with BSI, age is independently associated with death in both operative and non-operative cases.
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Affiliation(s)
- Elizabeth Warnack
- NYU School of Medicine/Bellevue Hospital, NYU School of Medicine Department of Surgery, 462 First Avenue, NY, 10016, USA.
| | - Marko Bukur
- NYU School of Medicine/Bellevue Hospital, NYU School of Medicine Department of Surgery, 462 First Avenue, NY, 10016, USA.
| | - Spiros Frangos
- NYU School of Medicine/Bellevue Hospital, NYU School of Medicine Department of Surgery, 462 First Avenue, NY, 10016, USA.
| | - Charles DiMaggio
- NYU School of Medicine/Bellevue Hospital, NYU School of Medicine Department of Surgery, 462 First Avenue, NY, 10016, USA.
| | - Rosemary Kozar
- University of Maryland R. Adams Cowley Shock Trauma Center, 22 S Greene St, Baltimore, MD, 21201, USA.
| | - Michael Klein
- NYU School of Medicine/Bellevue Hospital, NYU School of Medicine Department of Surgery, 462 First Avenue, NY, 10016, USA.
| | - Cherisse Berry
- NYU School of Medicine/Bellevue Hospital, NYU School of Medicine Department of Surgery, 462 First Avenue, NY, 10016, USA.
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Streck JM, Hughes JR, Klemperer EM, Howard AB, Budney AJ. Modes of cannabis use: A secondary analysis of an intensive longitudinal natural history study. Addict Behav 2019; 98:106033. [PMID: 31326775 DOI: 10.1016/j.addbeh.2019.106033] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 06/05/2019] [Accepted: 06/23/2019] [Indexed: 11/21/2022]
Abstract
INTRODUCTION There is a paucity of research on modes of cannabis use (e.g., joint vs. blunt), and further, little consensus on how to accurately assess both modes of use and route of administration. This secondary analysis used a longitudinal design with data collected daily to characterize mode of cannabis use. METHODS 193 adult daily cannabis users who were considering quitting at some point enrolled in the study. No treatment was provided. Each day for 84 days, participants reported on mode of cannabis use (i.e., joints, blunts, pipes/vaporizer and food) using an interactive voice response system. We report on single and poly-use of modes across study days and weeks and examine characteristics associated with different modes of use. RESULTS White participants were most likely to use pipes/vaporizer, with use on 57% of study days, while Black participants were most likely to use blunts with use on 53% of days. Thus, joint use was less common in both groups. Poly-use of different modes within the same week was very common (i.e., 56% of weeks among White participants and 60% of weeks in Black participants). Age, gender, race, cannabis dependence, presence of others during cannabis use, and alcohol use were associated with different modes of use. CONCLUSIONS The major limitation of this study was use of a convenience sample and lack of detailed data on vaporizer use. Joint use is no longer the most common mode of use in either White or Black participants and exclusive use of a single modality is uncommon.
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Hefny AF, Kunhivalappil FT, Paul M, Almansoori TM, Zoubeidi T, Abu-Zidan FM. Anatomical locations of air for rapid diagnosis of pneumothorax in blunt trauma patients. World J Emerg Surg 2019; 14:44. [PMID: 31497066 PMCID: PMC6720854 DOI: 10.1186/s13017-019-0263-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 08/22/2019] [Indexed: 12/22/2022] Open
Abstract
Background Bedside diagnostic ultrasound for traumatic pneumothorax is easy and reliable. However, the thoracic anatomical locations to be examined are debateable. We aimed to study the anatomical locations of blunt traumatic pneumothoraces as defined by chest CT scan to identify the areas that should be scanned while performing bedside diagnostic ultrasound. Methods This is a retrospective analysis of a data collected for a previous study in blunt trauma patients at our hospital during a 4-year-period with CT confirmed pneumothoraces. The anatomical distribution of the pneumothoraces and their volume were analyzed. Advanced statistical analysis was performed using repeated measures logistic regression models. Results Seven hundred three patients had a CT scan of the chest. Seventy-four patients (10.5%) were confirmed to have a pneumothorax. Only 64 were included in the study as they did not have a chest tube inserted before the CT scan. Twelve (18.8%) patients had bilateral pneumothorax. Seventy-six pneumothoraces were identified for which 41 patients had a right-sided pneumothorax and 35 patients had a left-sided pneumothorax. 95.1 % of the pneumothoraces detected on the right side were in the whole parasternal area with 75.6% seen in the lower parasternal region only. Similarly, 97.1 % of the pneumothoraces on the left side were seen in the whole parasternal area with 80% seen in the lower parasternal region only. Conclusions The current study showed that air pockets of blunt traumatic pneumothoraces are mainly located at the parasternal regions especially in pneumothorax with small volume. We recommend a quick ultrasound scanning of the parasternal regions on both sides of the chest from proximal to distal as the appropriate technique for the detection of pneumothoraces in blunt trauma setting.
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Affiliation(s)
- Ashraf F Hefny
- 1Trauma group, Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, P O Box 18532, Al-Ain, United Arab Emirates
| | | | - Manoj Paul
- Department of Radiology, Al Rahba Hospital, Abu Dhabi, United Arab Emirates
| | - Taleb M Almansoori
- 3Department of Radiology, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Taoufik Zoubeidi
- 4Department of Statistics, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Fikri M Abu-Zidan
- 1Trauma group, Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, P O Box 18532, Al-Ain, United Arab Emirates
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Shimomura M, Ishihara S, Iwasaki M, Inoue M. Successful thoracoscopic evacuation of an extrapleural hematoma with delayed symptomatic pleural effusion: a case report. Surg Case Rep 2019; 5:133. [PMID: 31414255 PMCID: PMC6694359 DOI: 10.1186/s40792-019-0691-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 08/07/2019] [Indexed: 11/10/2022] Open
Abstract
Background Traumatic extrapleural hematoma is a rare condition and is usually managed conservatively until spontaneous resolution unless active bleeding or expansion is found. Case presentation An 80-year-old man taking an anticoagulant medication was referred to our hospital after accidentally falling in a street ditch while riding a bike. Chest X-ray and computed tomography (CT) scan showed multiple fractures on ribs 7–9, hemothorax, and extrapleural hematoma in the posterior chest wall. Though the patient’s hemothorax was improved by chest tube drainage, the extrapleural hematoma still remained. He was transferred to another hospital for rehabilitation, but he was readmitted to our hospital because of dyspnea with accumulation of left pleural effusion, including a subpopulation of neutrophils, but without bacterial infection. We performed thoracoscopic evacuation of the hematoma on day 57 after the initial blunt chest trauma. The patient has had no recurrence of pleuritis for 6 months after surgery. Conclusion Since posttraumatic extrapleural hematoma may result in delayed secondary intractable pleural effusion causing dyspnea, careful observation is necessary when considering indications of surgical intervention.
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Affiliation(s)
- Masanori Shimomura
- Division of Thoracic Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan.
| | - Shunta Ishihara
- Division of Thoracic Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan
| | - Masashi Iwasaki
- Department of General Thoracic Surgery, Ayabe City Hospital, Ayabe, Japan
| | - Masayoshi Inoue
- Division of Thoracic Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan
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Matsuzaki S, Endo M, Tomimatsu T, Nakagawa S, Matsuzaki S, Miyake T, Takiuchi T, Kakigano A, Mimura K, Ueda Y, Kimura T. New dedicated blunt straight needles and sutures for uterine compression sutures: a retrospective study and literature review. BMC Surg 2019; 19:33. [PMID: 30866898 DOI: 10.1186/s12893-019-0495-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 03/01/2019] [Indexed: 11/16/2022] Open
Abstract
Background We developed a dedicated blunt straight needle with No. 2 polydioxanone sutures (2-Monodiox®) for uterine compression sutures (UCSs) and aimed to assess the outcomes and complication rates of UCSs for postpartum hemorrhage by comparing with commercially available needle and suture types. Methods A retrospective analysis was performed between January 2010 and February 2018. During the study period, two types of commercially available sutures and 2-Monodiox® were used. PubMed, MEDLINE, and Scopus databases were searched for English articles published between January 1997 and May 2017 using search terms related to the suture and needle types for UCSs to discuss the dedicated needles and sutures for UCS. Results The analysis included 47 cases of UCSs for the uterine body with three suture types (No. 0 polydioxanone, 7 cases; No. 1 poliglecaprone 25, 21 cases; and No. 2 polydioxanone, 19 cases). B-Lynch suture using No. 0 sutures was associated with a significantly lower uterine preservation rate than those with Nos. 1 and 2 sutures (42.9% vs. 95.2 and 89.5%, respectively; p < 0.01). A modified Hayman suture technique was performed using 2-Monodiox® sutures, which achieved a similar uterine preservation rate compared with B-Lynch suture using No. 1 poliglecaprone 25 sutures. No patients developed severe complications. The literature review showed that no dedicated sutures have developed for UCSs. Three dedicated needles for UCSs have been developed, and 2-Monodiox® is the first dedicated blunt straight needle for UCSs. Conclusion Our data showed that No. 0 sutures should not be used for B-Lynch suture. The uterine preservation rate is similar for 2-Monodiox® with modified Hayman suture and No. 1 poliglecaprone 25 sutures with B-Lynch suture, without the occurrence of severe complications. Electronic supplementary material The online version of this article (10.1186/s12893-019-0495-7) contains supplementary material, which is available to authorized users.
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Malekpour M, Widom K, Dove J, Blansfield J, Shabahang M, Torres D, Wild JL. Management of computed tomography scan detected hemothorax in blunt chest trauma: What computed tomography scan measurements say? World J Radiol 2018; 10:184-189. [PMID: 30631406 PMCID: PMC6323492 DOI: 10.4329/wjr.v10.i12.184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 09/17/2018] [Accepted: 10/24/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the hemothorax size for which tube thoracostomy is necessary.
METHODS Over a 5-year period, we included all patients who were admitted with blunt chest trauma to our level 1 trauma center. Focus was placed on identifying the hemothorax size requiring tube thoracostomy.
RESULTS A total number of 274 hemothoraces were studied. All patients with hemothoraces measuring above 3 cm received a chest tube. The 50% predicted probability of tube thoracostomy was 2 cm. Pneumothorax was associated with odds of receiving tube thoracostomy for hemothoraces below 2 cm (Odds Ratio: 4.967, 95%CI: 2.225-11.097, P < 0.0001).
CONCLUSION All patients with a hemothorax size greater than 3% underwent tube thoracostomy. Prospective studies are warranted to elucidate the clinical outcome of patients with smaller hemothoraces.
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Affiliation(s)
- Mahdi Malekpour
- Department of Surgery, Section of Trauma and Acute Care Surgery, Geisinger Medical Center, Danville, PA 17822, United States
| | - Kenneth Widom
- Department of Surgery, Section of Trauma and Acute Care Surgery, Geisinger Medical Center, Danville, PA 17822, United States
| | - James Dove
- Department of Surgery, Section of Trauma and Acute Care Surgery, Geisinger Medical Center, Danville, PA 17822, United States
| | - Joseph Blansfield
- Department of Surgery, Section of Trauma and Acute Care Surgery, Geisinger Medical Center, Danville, PA 17822, United States
| | - Mohsen Shabahang
- Department of Surgery, Section of Trauma and Acute Care Surgery, Geisinger Medical Center, Danville, PA 17822, United States
| | - Denise Torres
- Department of Surgery, Section of Trauma and Acute Care Surgery, Geisinger Medical Center, Danville, PA 17822, United States
| | - Jeffrey L Wild
- Department of Surgery, Section of Trauma and Acute Care Surgery, Geisinger Medical Center, Danville, PA 17822, United States
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van Trigt J, Schep NWL, Peters RW, Goslings JC, Schepers T, Halm JA. Routine pelvic X-rays in asymptomatic hemodynamically stable blunt trauma patients: A meta-analysis. Injury 2018; 49:2024-2031. [PMID: 30220636 DOI: 10.1016/j.injury.2018.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 07/30/2018] [Accepted: 09/05/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION There is no consensus on how pelvic X-rays should be ordered selectively in blunt trauma patients which may save time, reduce radiation exposure and costs. The aim of this systematic review and meta-analysis was to assess the need for routine pelvic X-rays in awake, respiratory and hemodynamically (HD) stable blunt trauma patients without signs of pelvic fracture. Criteria to identify patients who could safely forgo pelvic X-ray were evaluated. METHODS A literature search was performed for prospective comparative cohort studies. Inclusion criteria were: blunt force trauma, hemodynamically and respiratory stable and awake patients, physical examination (PE) for pelvic fractures was adequately described, and the reliability of negative PE findings could be evaluated. Primary outcome was the negative predictive value (NPV) of PE for all and for clinically relevant pelvic fractures. Additionally sensitivity, specificity and positive predictive value (PPV) were calculated. RESULTS Ten studies were included; yielding a total of 11,423 patients. The NPV of PE for all pelvic fractures ranged from 0.96 to 1.00 with a median of 0.996. Combining studies, total NPV was 0.991. For clinically relevant fractures, the NPV of PE ranged from 0.996 to 1.00 with a median of 1.00. In patients with negative findings during PE, 0.9% had fractures, and 0.1% had clinically relevant fractures, none requiring surgical management. CONCLUSIONS In awake, hemodynamically and respiratory stable blunt trauma patients, PE could identify those patients who could safely forgo pelvic X-ray. Selective ordering of pelvic X-ray may lead to a decrease in patient work-up time, lower radiation exposure, and reduce costs. A decision making flow chart is proposed..
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Affiliation(s)
- Jessica van Trigt
- Trauma Unit, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Niels W L Schep
- Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands
| | - Rolf W Peters
- Trauma Unit, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - J Carel Goslings
- Department of General and Trauma Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Tim Schepers
- Trauma Unit, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Jens A Halm
- Trauma Unit, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands.
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Givergis R, Munnangi S, Fayaz M Fomani K, Boutin A, Zapata LC, Angus LDG. Evaluation of massive transfusion protocol practices by type of trauma at a level I trauma center. Chin J Traumatol 2018; 21:261-266. [PMID: 29776837 PMCID: PMC6235793 DOI: 10.1016/j.cjtee.2018.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 01/08/2018] [Accepted: 03/08/2018] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To evaluate massive transfusion protocol practices by trauma type at a level I trauma center. METHODS A retrospective analysis was performed on a sample of 76 trauma patients with MTP activation between March 2010 and January 2015 at a regional trauma center. Patient demographics, transfusion practices, and clinical outcomes were compared by type of trauma sustained. RESULTS Penetrating trauma patients who required MTP activation were significantly younger, had lower injury severity score (ISS), higher probability of survival (POS), decreased mortality, and higher Glasgow Coma scale (GCS) compared to blunt trauma patients. Overall, the mortality rate was 38.16%. The most common injury sustained among blunt trauma patients was head injury (36.21%), whereas the majority of the penetrating trauma patients sustained abdominal injuries (55.56%). Although the admission coagulation parameters and timing of coagulopathy were not significantly different between the two groups of patients, a significantly higher proportion of penetrating trauma patients received high plasma content therapy relative to blunt trauma patients (p < 0.01). CONCLUSION Despite the use of the same MTP for all injured patients requiring massive transfusion, significant differences existed between blunt trauma patients and penetrating trauma patients. These differences in transfusion characteristics and outcomes following MTP activation underscore the complexity of implementing MTPs and warrant vigilant transfusion practices to improve outcomes in trauma patients.
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Affiliation(s)
- Roshan Givergis
- Department of Emergency Medicine, Nassau University Medical Center, East Meadow, NY, USA
| | - Swapna Munnangi
- Department of Emergency Medicine, Nassau University Medical Center, East Meadow, NY, USA,Corresponding author.
| | | | - Anthony Boutin
- Department of Emergency Medicine, Nassau University Medical Center, East Meadow, NY, USA
| | - Luis Carlos Zapata
- Department of Emergency Medicine, Nassau University Medical Center, East Meadow, NY, USA
| | - LD George Angus
- Department of Surgery, Nassau University Medical Center, East Meadow, NY, USA
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Moskowitz EE, Garabedian L, Hardin K, Perkins-Pride E, Asfaw M, Preslaski C, Leasia KN, Lawless R, Burlew CC, Pieracci F. A double-blind, randomized controlled trial of gabapentin vs. placebo for acute pain management in critically ill patients with rib fractures. Injury 2018; 49:1693-1698. [PMID: 29934099 DOI: 10.1016/j.injury.2018.06.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 06/02/2018] [Accepted: 06/02/2018] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Achieving adequate pain control for rib fractures remains challenging; prescription of alternatives to narcotics is imperative to curtail the current opioid epidemic. Although gabapentin has shown promise following elective thoracic procedures, its efficacy in patients with rib fractures remains unstudied. We hypothesized that gabapentin, as compared to placebo, would both improve acute pain control and decrease narcotic use among critically ill patients with rib fractures. MATERIALS AND METHODS Adult patients admitted to the trauma surgery service from November 2016 - November 2017 at an urban, Level I trauma center with one or more rib fractures were randomized to either gabapentin 300 mg thrice daily or placebo for one month following their injury. Daily numeric pain scores, opioid consumption, oxygen requirement, respiratory rate, and incentive spirometry recordings during the index admission, as well as and one-month quality of life survey data were abstracted. RESULTS Forty patients were randomized. The groups were well matched with respect to age, gender, prior narcotic use, tobacco use, and prior respiratory disease. Although the median RibScore did not differ between groups, the gabapentin group had a higher median number of ribs fractured as compared to the placebo group (7 vs. 5, respectively). Degree of pulmonary contusion and injury severity score were similar between groups. Use of loco-regional anesthetic modalities did not differ between groups. Daily numeric pain scores, opioid consumption, oxygen requirement, respiratory rate, and incentive spirometry recordings were similar between both groups. No benefit was observed when adding gabapentin to a multi-modal analgesic regimen for rib fractures. There were no instances of pneumonia, respiratory failure, or mortality in either group. Hospital and intensive care unit length of stay were similar between groups. Both overall and chest-specific quality of life was equivalent between groups at one month follow-up. CONCLUSIONS In this group of critically ill patients with rib fractures, gabapentin did not improve acute outcomes for up to one month of treatment.
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Affiliation(s)
- Eliza E Moskowitz
- Denver Health Medical Center University of Colorado School of Medicine, United States.
| | - Lucin Garabedian
- Denver Health Medical Center University of Colorado School of Medicine, United States.
| | - Kimberly Hardin
- Denver Health Medical Center University of Colorado School of Medicine, United States.
| | - Emily Perkins-Pride
- Denver Health Medical Center University of Colorado School of Medicine, United States.
| | - Menilik Asfaw
- Denver Health Medical Center University of Colorado School of Medicine, United States.
| | - Candice Preslaski
- Denver Health Medical Center University of Colorado School of Medicine, United States.
| | - Kiara N Leasia
- Denver Health Medical Center University of Colorado School of Medicine, United States.
| | - Ryan Lawless
- Denver Health Medical Center University of Colorado School of Medicine, United States.
| | - Clay Cothren Burlew
- Denver Health Medical Center University of Colorado School of Medicine, United States.
| | - Fredric Pieracci
- Denver Health Medical Center University of Colorado School of Medicine, United States.
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Tsugu T, Nagatomo Y, Tanigawa T, Endo J, Itabashi Y, Murata M, Mitamura H. Delayed hemopericardium due to non-penetrating chest trauma: a report of new case and literature review. J Med Ultrason (2001) 2019; 46:159-62. [PMID: 30094767 DOI: 10.1007/s10396-018-0895-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 07/03/2018] [Indexed: 10/28/2022]
Abstract
To our knowledge, only 15 cases of delayed traumatic hemopericardium resulting from non-penetrating chest trauma have been reported. We present the case of a 63-year-old man with delayed hemopericardium, 2 months after striking the anterior chest on a mailbox when he fell down three steps during a postal delivery. Our case and review of the previously reported cases suggest that some cases might show quite slow progression of blood accumulation. Therefore, careful observation of patients who have experienced blunt trauma of the anterior chest is necessary.
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Willett JK. Imaging in trauma in limited-resource settings: A literature review. Afr J Emerg Med 2018; 9:S21-S27. [PMID: 30976496 PMCID: PMC6440922 DOI: 10.1016/j.afjem.2018.07.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 06/16/2018] [Accepted: 07/20/2018] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Trauma is a leading health problem and cause of death throughout both the developed and the developing world. In Africa and South Africa in particular, trauma-related injury has an increased morbidity and mortality when compared to the rest of the world, with numbers approaching a staggering two to six times the global average. Rapid diagnosis is key when it comes to identification and treatment of traumatic injuries. In locations that are limited in finances, infrastructure, and resources, a stepwise approach to imaging in trauma can lead to decreased morbidity and mortality. Tailored recommendations for imaging trauma in resource-limited settings can lead to improved diagnostics and treatment and in turn, decrease mortality. METHODS A systematic literature review was conducted, using a compilation of English-language articles found on PubMed, EMBASE, Medline, and Cochrane Library searches relevant to imaging in trauma. A total of 31 journals articles, published from 1991 to 2017 were reviewed. RESULTS From the search, 26 original articles were selected and reviewed in detail, as well as an additional five original research articles. DISCUSSION As imaging continues to evolve, its importance in the role of diagnostic algorithms in trauma settings is important. In most settings, imaging is relied upon as an adjunct to the primary survey. In most developed settings, CT scan remains the mainstay for imaging in trauma, but in limited-resource settings, other imaging studies such as LODOX, X-ray, and especially ultrasound can play a large role. As ultrasound is directly related to user operation, data are limited and variable; more research as this field evolves will be beneficial.
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Muckart DJJ, Hardcastle TC, Skinner DL. Pneumomediastinum and pneumopericardium following blunt thoracic trauma: much ado about nothing? Eur J Trauma Emerg Surg 2019; 45:927-31. [PMID: 29687275 DOI: 10.1007/s00068-018-0960-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 04/18/2018] [Indexed: 12/27/2022]
Abstract
PURPOSE Pneumomediastinum is the hallmark of intrathoracic aerodigestive trauma, but rare following blunt injury. AIM review of blunt thoracic trauma (BTC) for the incidence and outcome of patients with pneumomediastinum or pneumopericardium (PM/PC) on Computerised Tomographic scanning. METHODS Admissions to the level I trauma ICU at IALCH, Durban, ZA following BTC from April 2007 to March 2014. Patients with Chest-CT-scan were analysed. Variables included age, sex, mechanism of injury, and Injury Severity Score (ISS). Specific injury patterns: isolated thoracic trauma, flail chest, bilateral injury and presence of haemothorax or pneumothorax were analysed. RESULTS Three hundred and eighty-nine patients were included. Males (70.9%) accounted for the majority of patients. The median Injury Severity Score was 32 (IQR 24-41). Motor vehicle collisions accounted for 94% of injury mechanisms. Twenty-three (5.9%) were identified with pneumomediastinum, 6 (1.5%) with both pneumomediastinum and pneumopericardium, and 1 (0.2%) with isolated pneumopericardium. No patient required surgery for thoracic trauma. Increasing age (p < 0.001) and a flail chest (p = 0.005) were significant associations. The mortality rate was almost identical in those with or without air within the mediastinum. No patient died from a missed mediastinal aero-digestive injury. CONCLUSION The presence of PM/PC following BTC is incidental and benign. Increased injury severity with a flail chest is associated with a significant increase in the presence of free gas within the mediastinum. In the absence of complications, no obvious injury to the intrathoracic aero-digestive tract on CT scanning, and no difference in mortality, a conservative management policy is warranted.
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