Presentation, clinical course and complications in trauma patients with concomitant COVID-19 infection

BACKGROUND

This study investigated the impact of COVID-19 infection on hospitalized trauma patients.

METHODS

A retrospective review of hospitalized trauma patients at a level I trauma center was performed from March-December 2020. Data pertaining to patient demographics, presentation and hospital course was compared between COVID positive and negative trauma patients.

RESULTS

There were 4,912 patients and 179 (3.64%) were COVID-19 positive. Demographics and clinical presentation did not differ significantly between those with and without concomitant COVID-19. However, COVID positive trauma patients had higher rates of acute kidney injury (p = 0.016), sepsis (p = 0.016), unplanned intubation (p = 0.002) and unplanned return to the ICU (p = 0.01). The COVID positive cohort also had longer hospital stays (p < 0.01) with no significant difference in mortality.

CONCLUSIONS

In the setting of an ongoing pandemic, awareness of the complications COVID positive trauma patients are predisposed to is important for providers.

Penetrating carotid artery: uncommon complex and lethal injuries

Carotid arterial injuries are the most difficult and certainly the most immediately life-threatening injuries found in penetrating neck trauma. Their propensity to bleed actively and potentially occludes the airway and makes surgical intervention very challenging. Their potential for causing fatal neurological outcomes demands that trauma surgeons exercise excellent judgment in the approach to their definitive management. The purpose of this article is to review the diagnosis and management of these injuries.

A signal/noise analysis of quasi-static MR elastography

In quasi-static magnetic resonance elastography, strain images of a tissue or material undergoing deformation are produced. In this paper, the signal/noise (S/N) ratio [SNR] of elastographic strain images, as measured by a phase-contrast technique, is analyzed. Experiments are conducted to illustrate how diffusion-mediated signal attenuation limits maximum strain SNR in small displacement cases, while the imaging point-spread function limits large displacement cases. A simple theoretical treatment agrees well with experiments and shows how an optimal displacement encoding moment can be predicted for a given experimental set of parameters to achieve a maximum strain SNR. A further experiment demonstrates how the limitation on strain SNR posed by the imaging point-spread function may potentially be overcome.

Two-dimensional MR elastography with linear inversion reconstruction: methodology and noise analysis

A methodology for imposing approximate plane strain conditions in magnetic resonance elastography through physical constraint is described. Under plane strain conditions, data acquisition and analysis may be conducted in two dimensions, which reduces imaging and reconstruction time significantly compared with three-dimensional analysis. Simulations and experiments are performed to illustrate the constraint concept. A signal/noise analysis of a two-dimensional linear inversion technique for relative elastic modulus is undertaken, and modifications to the numerical method are described which can reduce the SNR requirements by a factor of two to four. Experimentally measured data are reconstructed to illustrate the performance of the method.

Visualization and quantification of breast cancer biomechanical properties with magnetic resonance elastography

A quasistatic magnetic resonance elastography (MRE) method for the evaluation of breast cancer is proposed. Using a phase contrast, stimulated echo MRI approach, strain imaging in phantoms and volunteers is presented. First-order assessment of tissue biomechanical properties based on inverse strain mapping is outlined and demonstrated. The accuracy of inverse strain imaging is studied through simulations in a two-dimensional model and in an anthropomorphic, three-dimensional finite-element model of the breast. To improve the accuracy of modulus assessment by elastography, inverse methods are discussed as an extension to strain imaging, and simulations quantify MRE in terms of displacement signal/noise required for robust inversion. A direct inversion strategy providing information on tissue modulus and pressure distribution is described along with a novel iterative method utilizing a priori knowledge of tissue geometry. It is shown that through the judicious choice of information from previous contrast-enhanced MRI breast images, MRE data acquisition requirements can be significantly reduced while maintaining robust modulus reconstruction in the presence of strain noise. An experimental apparatus for clinical breast MRE and preliminary images of a normal volunteer are presented.