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Vieira B, Taranu V, Vieira A, Soares D, Soares A, Silva A, Galvão D, Bagnari I, Melo D, Pimentel F, Sousa J, Martins L, Pinheiro L, Vargas M, Reis Ó, Valente S, Bettencourt R, Oliveira T, Mora A. [Trauma Injuries Associated with Rope Bullfights in the Azores: A Cross-Sectional Study]. ACTA MEDICA PORT 2024; 37:267-273. [PMID: 38452740 DOI: 10.20344/amp.19440] [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: 12/05/2022] [Accepted: 05/26/2023] [Indexed: 03/09/2024]
Abstract
INTRODUCTION The aim of the study was to describe trauma injuries associated with rope bullfights in the Azores, Portugal, regarding the cause of the incident, trauma mechanism, most affected anatomical areas, and injury severity. METHODS Two-year cross-sectional study in the local hospital with prospective data collection. Patients who were consecutively admitted to the local hospital's emergency department with trauma injuries from the bull's direct impact or from falls either during the bull's escape or when handling the rope, were included. Data on general demographics, lesion characteristics, treatments, need for hospitalization and mortality were collected. RESULTS Fifty-six incidents and 80 trauma injuries were identified. The main cause of trauma was the bull's direct impact (37; 66.07%) and the mechanism of injury was blunt trauma in all patients (100%; 56). Head and neck injuries (27; 33.75%) were the most common. The median Injury Severity Score at the emergency department admission was 4. Major trauma was noted in five patients (8.92%). Ten patients (17.85%) needed hospitalization with a median hospital stay of seven days. Three of the 10 hospitalized patients (30%) were previously admitted to the intensive care unit. Surgery was performed in six patients (10.71%). CONCLUSION The main cause of trauma was the bull's direct impact, and the mechanism of injury was blunt trauma. The most affected anatomical areas were the head and neck. These findings are a wake-up call to the impact of these events regarding the economic costs they entail, the costs for the health of the local population, the safety measures currently implemented and the availability of the necessary means to treat these patients.
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Affiliation(s)
- Bárbara Vieira
- Serviço de Cirurgia Geral. Hospital de Santo Espírito da ilha Terceira. Angra do Heroísmo. Portugal
| | - Viorel Taranu
- Serviço de Cirurgia Geral. Hospital Lusíadas Amadora. Lisboa. Portugal
| | - Ana Vieira
- Serviço de Cirurgia Geral. Hospital de Santo Espírito da ilha Terceira. Angra do Heroísmo. Portugal
| | - Duarte Soares
- Serviço de Cirurgia Geral. Hospital de Santo Espírito da ilha Terceira. Angra do Heroísmo. Portugal
| | - Ana Soares
- Serviço de Cirurgia Geral. Hospital de Santo Espírito da ilha Terceira. Angra do Heroísmo. Portugal
| | - Anaísa Silva
- Serviço de Cirurgia Geral. Hospital de Santo Espírito da ilha Terceira. Angra do Heroísmo. Portugal
| | - Diogo Galvão
- Serviço de Cirurgia Geral. Hospital de Santo Espírito da ilha Terceira. Angra do Heroísmo. Portugal
| | - Inês Bagnari
- Serviço de Cirurgia Geral. Hospital de Santo Espírito da ilha Terceira. Angra do Heroísmo. Portugal
| | - Débora Melo
- Serviço de Cirurgia Geral. Hospital de Santo Espírito da ilha Terceira. Angra do Heroísmo. Portugal
| | - Fernando Pimentel
- Serviço de Ortopedia e Traumatologia. Hospital de Santo Espírito da Ilha Terceira. Angra do Heroísmo. Portugal
| | - José Sousa
- Serviço de Cirurgia Geral. Hospital de Santo Espírito da ilha Terceira. Angra do Heroísmo. Portugal
| | - Lisandra Martins
- Serviço de Cirurgia Geral. Hospital de Santo Espírito da ilha Terceira. Angra do Heroísmo. Portugal
| | - Luís Pinheiro
- Serviço de Ortopedia e Traumatologia. Hospital de Santo Espírito da Ilha Terceira. Angra do Heroísmo. Portugal
| | - Marília Vargas
- Serviço de Cirurgia Geral. Hospital de Santo Espírito da ilha Terceira. Angra do Heroísmo. Portugal
| | - Óscar Reis
- Serviço de Cirurgia Geral. Hospital de Santo Espírito da ilha Terceira. Angra do Heroísmo. Portugal
| | - Sofia Valente
- Serviço de Cirurgia Geral. Hospital de Santo Espírito da ilha Terceira. Angra do Heroísmo. Portugal
| | - Rui Bettencourt
- Serviço de Cirurgia Geral. Hospital de Santo Espírito da ilha Terceira. Angra do Heroísmo. Portugal
| | - Teresa Oliveira
- Serviço de Ortopedia e Traumatologia. Hospital de Santo Espírito da Ilha Terceira. Angra do Heroísmo. Portugal
| | - António Mora
- Serviço de Cirurgia Geral. Hospital de Santo Espírito da ilha Terceira. Angra do Heroísmo. Portugal
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Gruenewald LD, Koch V, Eichler K, Bauer J, Gruber-Rouh T, Booz C, Yel I, Mahmoudi S, Vogl TJ, El Saman A. Injury patterns of the spine following blunt trauma: A per-segment analysis of spinal structures and their detection rates in CT and MRI. Heliyon 2023; 9:e17396. [PMID: 37408923 PMCID: PMC10318444 DOI: 10.1016/j.heliyon.2023.e17396] [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: 05/03/2023] [Revised: 06/13/2023] [Accepted: 06/15/2023] [Indexed: 07/07/2023] Open
Abstract
Rationale and objectives To provide a detailed analysis of injury patterns of the spine following blunt trauma and establish the role of supplementary MRI by evaluating discrepancies in the detection rates of damaged structures in CT and MRI. Method 216 patients with blunt trauma to the spine who underwent CT followed by supplementary MRI were included in this study. Two board-certified radiologists blinded to clinical symptoms and injury mechanisms independently interpreted all acquired CT and MRI images. The interpretation was performed using a dedicated catalogue of typical findings associated with spinal trauma and assessed for spinal stability using the AO classification systems. Results Lesions to structures associated with spinal instability were present in 31.0% in the cervical spine, 12.3% in the thoracic spine, and 29.9% in the lumbar spine. In all spinal segments, MRI provided additional information regarding potentially unstable injuries. Novel information derived from supplementary MRI changed clinical management in 3.6% of patients with injury to the cervical spine. No change in clinical management resulted from novel information on the thoracolumbar spine. Patients with injuries to the vertebral body, intervertebral disc, or spinous process were significantly more likely to benefit from supplementary MRI. Conclusion In patients that sustained blunt spinal trauma, supplementary MRI of the cervical spine should routinely be performed to detect injuries that require surgical treatment, whereas CT is the superior imaging modality for the detection of unstable injuries in the thoracolumbar spine.
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Affiliation(s)
- Leon David Gruenewald
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Vitali Koch
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Katrin Eichler
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Jasmin Bauer
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Tatjana Gruber-Rouh
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Christian Booz
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Ibrahim Yel
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Scherwin Mahmoudi
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Thomas J. Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - André El Saman
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
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Gamberini L, Scquizzato T, Tartaglione M, Chiarini V, Mazzoli CA, Allegri D, Lupi C, Gordini G, Coniglio C, Brogi E. Diagnostic accuracy for hemoperitoneum, influence on prehospital times and time-to-definitive treatment of prehospital FAST: A systematic review and individual participant data meta-analysis. Injury 2023:S0020-1383(23)00280-2. [PMID: 36997363 DOI: 10.1016/j.injury.2023.03.024] [Citation(s) in RCA: 1] [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: 02/20/2023] [Revised: 03/15/2023] [Accepted: 03/17/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND Focused assessment sonography for trauma (FAST) performed in the prehospital setting may improve trauma care by influencing treatment decisions and reducing time to definitive care, but its accuracy and benefits remain uncertain. This systematic review evaluated the diagnostic accuracy of prehospital FAST in detecting hemoperitoneum and its effects on prehospital time and time to definitive diagnosis or treatment. METHODS We systematically searched PubMed, Embase, and Cochrane library up to November 11th, 2022. Studies investigating prehospital FAST and reporting at least one outcome of interest for this review were considered eligible. The primary outcome was prehospital FAST diagnostic accuracy for hemoperitoneum. A random-effect meta-analysis, including individual patient data, was performed to calculate the pooled outcomes with 95% confidence intervals (CI). Quality of studies was assessed using the QUADAS-2 tool for diagnostic accuracy. RESULTS We included 21 studies enrolling 5790 patients. The pooled sensitivity and specificity of prehospital FAST for hemoperitoneum were 0.630 (0.454 - 0.777) and 0.970 (0.957-0.979), respectively. Prehospital FAST was performed in a median of 2.72 (2.12 - 3.31) minutes without increasing prehospital times (pooled median difference of 2.44 min [95% CI: -3.93 - 8.81]) compared to standard management. Prehospital FAST findings changed on-scene trauma care in 12-48% of cases, the choice of admitting hospital in 13-71%, the communication with the receiving hospital in 45-52%, and the transfer management in 52-86%. Patients with a positive prehospital FAST achieved definitive diagnosis or treatment more rapidly (severity-adjusted pooled time ratio = 0.63 [95% CI: 0.41 - 0.95]) compared with patients with a negative or not performed prehospital FAST. CONCLUSIONS Prehospital FAST had a low sensitivity but a very high specificity to identify hemoperitoneum and reduced time-to-diagnostics or interventions, without increasing prehospital times, in patients with a high probability of abdominal bleeding. Its effect on mortality is still under-investigated.
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Affiliation(s)
- Lorenzo Gamberini
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | - Tommaso Scquizzato
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Tartaglione
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy.
| | - Valentina Chiarini
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | - Carlo Alberto Mazzoli
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | - Davide Allegri
- Department of Clinical Governance and Quality, Bologna Local Healthcare Authority, Bologna, Italy
| | - Cristian Lupi
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | - Giovanni Gordini
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | - Carlo Coniglio
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | - Etrusca Brogi
- Department of Anesthesia and Intensive care, University of Pisa, Pisa, Italy
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Hoffman H, Otite FO, Chin LS. Venous Injury in Patients with Blunt Traumatic Brain Injury: Retrospective Analysis of a National Cohort. Neurocrit Care 2021; 36:116-122. [PMID: 34244919 DOI: 10.1007/s12028-021-01265-6] [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: 03/04/2021] [Accepted: 04/23/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cerebral venous injury (CVI) includes injury to a dural venous sinus or major vein and leads to poorer outcomes for patients with blunt traumatic brain injury (TBI). We sought to identify the incidence, associated factors, and outcomes associated with CVI in a large national cohort. METHODS Adult patients with blunt TBI were identified from the National Trauma Databank (2013-2017). Outcomes included inpatient mortality, discharge disposition, stroke, length of stay (LOS), intensive care unit LOS, and duration of mechanical ventilation. Multivariate regression models were used to identify the association between exposure variables and CVI, as well as each outcome. RESULTS There were 619,659 patients with blunt TBI who met the inclusion criteria. CVI occurred in 1792 (0.3%) patients. Mixed intracranial injury type had the strongest association with CVI (odds ratio [OR] 2.89, 95% confidence interval [CI] 2.38-3.50), followed by isolated TBI (OR 1.76, 95% CI 1.54-2.02) and skull fracture (OR 1.72, 95% CI 1.55-1.91). CVI was associated with increased odds of mortality (OR 1.38, 95% CI 1.19-1.60), nonroutine discharge (OR 1.26, 95% CI 1.12-1.40), and stroke (OR 1.95, 95% CI 1.33-2.86). It was also associated with longer LOS (β 2.02, 95% CI 1.55-2.50) and intensive care unit LOS (β 0.14, 95% CI 0.13-0.16). Among locations of venous injury, superior sagittal sinus injury had significant associations with mortality (OR 2.93, 95% CI 1.62-5.30) and nonroutine discharge disposition (OR 1.94, 95% CI 1.12-3.35), whereas the others did not. CONCLUSIONS We identified a 0.3% incidence of CVI in all-comers with blunt TBI as well as several injury-related variables that may be used to guide investigation for dural venous sinus injury. CVI was associated with poorer outcomes, with superior sagittal sinus injury having the strongest association.
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Affiliation(s)
- Haydn Hoffman
- Department of Neurosurgery, State University of New York Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA.
| | - Fadar O Otite
- Department of Neurology, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Lawrence S Chin
- Department of Neurosurgery, State University of New York Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA
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Takahashi H, Shoko T, Okamoto H, Shimizu T, Oshiro A, Onishi S, Morishita Y, Nara S. Blunt traumatic iliac vein injury without pelvic fracture - A case report. Trauma Case Rep 2021; 32:100412. [PMID: 33665308 DOI: 10.1016/j.tcr.2021.100412] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2021] [Indexed: 11/20/2022] Open
Abstract
A 48-year-old man fell asleep while driving a 4-t truck, hit an 11-t truck from behind, and was injured. Contrast-enhanced computed tomography revealed retroperitoneal hematoma and extravasation of contrast medium in the left common iliac vein. No obvious pelvic fracture was observed. The patient showed no hemodynamic deterioration, so conservative management was selected. Computed tomography images obtained 2 days after injury showed that the hematoma around the left common iliac vein had shrunk and no clear vein thrombus was observed. No findings suggestive of deep vein thrombosis or pulmonary embolism were seen after the start of gait training. Iliac vein injury without pelvic fracture due to blunt trauma is particularly rare. This rare injury was attributed to sudden extension of the hip and force in the direction of the long axis of the common iliac vein. Conservative management is the recommended first choice for isolated iliac vein injury with stable hemodynamics.
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Heydari F, Ashrafi A, Kolahdouzan M. Diagnostic Accuracy of Focused Assessment with Sonography for Blunt Abdominal Trauma in Pediatric Patients Performed by Emergency Medicine Residents versus Radiology Residents. Adv J Emerg Med 2018; 2:e31. [PMID: 31172094 PMCID: PMC6549207 DOI: 10.22114/ajem.v0i0.89] [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] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Focused assessment with sonography for trauma (FAST) has been shown to be useful to detect intraperitoneal free fluid in patients with blunt abdominal trauma (BAT). OBJECTIVE We compared the diagnostic accuracy of FAST performed by emergency medicine residents (EMRs) and radiology residents (RRs) in pediatric patients with BAT. METHOD In this prospective study, pediatric patients with BAT and high energy trauma who were referred to the emergency department (ED) at Al-Zahra and Kashani hospitals in Isfahan, Iran, were evaluated using FAST, first by EMRs and subsequently by RRs. The reports provided by the two resident groups were compared with the final outcome based on the results of the abdominal computed tomography (CT), operative exploration, and clinical observation. RESULTS A total of 101 patients with a median age of 6.75 ± 3.2 years were enrolled in the study between January 2013 and May 2014. These patients were evaluated using FAST, first by EMRs and subsequently by RRs. A good diagnostic agreement was noted between the results of the FAST scans performed by EMRs and RRs (κ = 0.865, P < 0.001). The sensitivity, specificity, positive and negative predictive values, and accuracy in evaluating the intraperitoneal free fluid were 72.2%, 85.5%, 52%, 93.3%, and 83.2%, respectively, when FAST was performed by EMRs and 72.2%, 86.7%, 54.2%, 93.5%, and 84.2%, respectively, when FAST was performed by RRs. No significant differences were seen between the EMR- and RR-performed FAST. CONCLUSION In this study, FAST performed by EMRs had acceptable diagnostic value, similar to that performed by RRs, in patients with BAT.
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Affiliation(s)
- Farhad Heydari
- Emergency Medicine Research Center, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ayoub Ashrafi
- Department of Emergency Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohsen Kolahdouzan
- Department of Thoracic Surgery, Isfahan University of Medical Sciences, Isfahan, Iran
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Kucuk G, Ates U, Gollu G, Yagmurlu A. [Conservative management of tracheal rupture in a child after blunt trauma]. ARCH ARGENT PEDIATR 2016; 114:e454-e456. [PMID: 27869433 DOI: 10.5546/aap.2016.eng.e454] [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: 05/09/2016] [Accepted: 06/23/2016] [Indexed: 11/12/2022]
Abstract
La rotura traqueal tras una contusión es rara, aunque potencialmente mortal. En general, se recomienda el tratamiento quirúrgico para la rotura traqueal, aunque también se ha informado recientemente el abordaje conservador en los pacientes con signos vitales y parámetros respiratorios estables. El objetivo de este estudio es informar sobre un caso de rotura traqueal tras una contusión en el cuello producto de un accidente de bicicleta que se trató de manera conservadora.
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Affiliation(s)
- Gonul Kucuk
- Ankara University School of Medicine. Department of Pediatric Surgery, Ankara, Turkey
| | - Ufuk Ates
- Ankara University School of Medicine. Department of Pediatric Surgery, Ankara, Turkey
| | - Gulnur Gollu
- Ankara University School of Medicine. Department of Pediatric Surgery, Ankara, Turkey.
| | - Aydin Yagmurlu
- Ankara University School of Medicine. Department of Pediatric Surgery, Ankara, Turkey
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Abstract
Traumatic pulmonary pseudocyst is uncommon and usually regresses spontaneously with conservative treatment. In rare cases, surgical intervention may be necessary. A pseudocyst may be treated surgically to prevent potential complications if the patient undergoes a thoracotomy for another reason. We present a patient with hemopneumothorax and traumatic pulmonary pseudocyst after a motor vehicle accident, who was operated on electively due to massive air leak.
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Affiliation(s)
- Gultekin Gulbahar
- Division of Thoracic Surgery, Dr. Nafiz Korez Sincan State Hospital, Ankara, Turkey
| | | | - Tevfik Kaplan
- Department of Thoracic Surgery, Ufuk University, Ankara, Turkey
| | - Bulent Kocer
- Division of Thoracic Surgery, Numune Teaching and Research Hospital, Ankara, Turkey
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