Renal Trauma Classification and Management: Validating the Revised Renal Injury Grading Scale.

PURPOSE: To better characterize traumatic renal injury a revision to the 1989 American Association for the Surgery of Trauma renal injury scale was proposed in which grade IV includes all collecting system and segmental vascular injuries and grade V includes main renal hilar injury. We sought to validate the 2009 grading scale, emphasizing reclassifications between the 1989 and 2009 versions, and subsequent management. MATERIALS AND METHODS: Patient demographics and renal injury characteristics, computerized tomography imaging, radiology reports and subsequent management were recorded in a prospective trauma database. Multivariable logistic regression models for intervention were compared using 1989 and 2009 grades to evaluate which grading scale better predicted management. RESULTS: Of 256 renal injury cases 56 (21.9%) were reclassified using the revised 2009 scale, including 50 (19.5%) which were upgraded, 6 (2.3%) which were downgraded and 200 (78.1%) which were unchanged. Of grade III or higher cases management was nonoperative in 112 (78.9%), angioembolization in 9 (6.3%), nephrectomy in 9 (6.3%) and renorrhaphy in 12 (8.5%). Management was significantly associated with original and revised grades (chi-square p=0.02 and <0.001, respectively). Further, the multivariable model using the 2009 grades significantly outperformed the 1989 model. Radiology reports rarely included renal injury scales. CONCLUSIONS: Using the revised renal injury grading scale led to more definitive classification of renal injury and a stronger association with renal trauma management. Applying the revised criteria may facilitate and improve the multidisciplinary care of renal trauma.

Predictive value of transabdominal intestinal sonography in critically ill patients: a prospective observational study.

BACKGROUND: This study examined the feasibility of transabdominal intestinal ultrasonography in evaluating acute gastrointestinal injury (AGI). METHODS: A total of 116 patients were included. Intestinal ultrasonography was conducted daily within 1 week after admission to the intensive care unit. Ultrasonography indicators including intestinal diameter, changes in the intestinal folds, thickness of the intestinal wall, stratification of the intestinal wall, and intestinal peristalsis (movement of the intestinal contents) were observed to determine the acute gastrointestinal injury ultrasonography (AGIUS) score. The gastrointestinal and urinary tract sonography ultrasound (GUTS) protocol score was also calculated. During the first week of the study, the gastrointestinal failure (GIF) score was determined daily. The correlations between transabdominal intestinal scores (AGIUS and GUTS) and the GIF score were analyzed to clarify the feasibility of evaluating AGI through observation of the intestine. The utility of intestinal ultrasonography indicators in predicting feeding intolerance was investigated to improve the ability of clinicians to manage AGI. RESULTS: A total of 751 ultrasonic examinations were performed with 511 images (68%) considered to be of "good quality." AGIUS and GUTS scores differed significantly between AGI patients (GIF score 0-2) and non-AGI patients (GIF score 3-4) (p < 0.001). Both scores correlated positively with GIF score (r = 0.54, p < 0.001; r = 0.66, p < 0.001). These ultrasonography indicators could predict feeding intolerance, with an area under the receiver operating characteristic curve of 0.60 (0.48-0.71; intestinal diameter), 0.76 (0.67-0.85; intestinal folds), 0.71 (0.62-0.80; wall thickness), 0.77 (0.69-0.86; wall stratification), and 0.78 (0.68-0.88; intestinal peristalsis). Compared to patients with a normal rate of peristalsis (5-10/min), patients with abnormal peristalsis rates (< 5/min or > 10/min) have increased risk for feeding intolerance (16/83 vs. 25/33, p < 0.001). CONCLUSIONS: The transabdominal intestinal ultrasonography represents an effective means for assessing gastrointestinal injury in critically ill patients. Intestinal ultrasonography indicators, especially the degree of intestinal peristalsis, may be used to predict feeding intolerance. TRIAL REGISTRATION: ClinicalTrial.gov, NCT03589248. Registered 04 July 2018-retrospectively registered.

[The therapeutic experience of blunt pancreatic trauma].

Objective: To summarize the experience of treatment for blunt pancreatic trauma. Methods: The clinical data of 52 patients with blunt pancreatic trauma admitted to the Department of Pancreatic and Biliary Surgery of the First Affiliated Hospital of Harbin Medical University from January 2013 to June 2018 were analyzed retrospectively.There were 40 male and 12 female patients, aging from 12 to 112 years with a median age of 35.5 years.According to the organ injury scale by American Association for the Surgery of Trauma(AAST) for pancreatic injury severity, 15 cases were in grade Ⅰ(28.8%), 20 cases were in grade Ⅱ(38.5%), 10 cases were in grade Ⅲ(19.2%),5 cases were in grade Ⅳ(9.6%) and 2 cases were in grade Ⅴ(3.8%). Isolated blunt pancreatic trauma occurred in 11(21.2%) patients including 5 cases of grade Ⅰ,5 cases of grade Ⅱ and 1 case of grade Ⅲ, and associated injuries existed in 41 patients(78.8%). Results: Among 52 patients, 36 patients(69.2%) were transferred from other hospitals and 16(30.8%) patients were admitted through the emergency department. Finally, 49 patients(94.2%) were cured and 3 patients (5.8%) died.For the 15 cases of grade Ⅰ,9 patients were managed non-operatively, 5 cases underwent peritoneal lavage and drainage after surgery for the other injured abdominal organs, and 1 patient received percutaneous catheter drainage(PCD) with non-operative treatment. For the 20 cases of grade Ⅱ,4 cases only received non-operative treatment and 2 cases also received PCD. Besides, 2 cases underwent debridement and drainage for peripancreatic necrotic tissue and external drainage for pancreatic pseudocyst retrospectively after about 25 days of getting injured. As for patients who received exploratory laparotomy, 5 patients underwent suture repair associated with external drainage, and 7 patients were managed only with external drainage. For the 10 cases of grade Ⅲ,6 patients were cured through distal pancreatectomy and splenectomy with external drainage, while 2 patients underwent endoscopic retrograde cholangiopancreatography and ductal stenting, and the other 2 patients just received debridement and drainage for peripancreatic necrotic tissue.For the 5 cases of grade Ⅳ,2 patients underwent jejunostomy and abdominal cavity drainage, 1 patient had a pancreaticoduodenectomy with drainage,1 patient received suture repair of the pancreas and pancreaticojejunostomy, and 1 patient was managed with suture repair of the head of pancreas and external drainage.For the 2 patients of grade Ⅴ,1 patient received exploratory laparotomy and gauze compression packing hemostasis, and the other patient underwent pancreaticoduodenal repair, gastrointestinal anastomosis, duodenal exclusion surgery and external drainage. Conclusion: According to the AAST classifications, associated injuries, physiological status and intraoperative situation, it could be better to make a comprehensive judgment, achieve early diagnosis and take appropriate individualized treatment strategy, and to improve the overall therapeutic effect for blunt pancreatic trauma.

CT imaging signs of surgically proven bowel trauma.

The objective of this study was to determine the incidence and interobserver agreement of individual CT findings as well as the bowel injury prediction score (BIPS) in surgically proven bowel injury after blunt abdominal trauma. This HIPAA-compliant retrospective study was IRB approved and consent was waived. All patients 14 years or older who sustained surgically proven bowel injury after blunt abdominal trauma between 1/1/2004 and 6/30/2015 were included. Admission trauma MDCT scans were independently interpreted by two abdominal fellowship-trained radiologists who recorded the following CT findings: intraperitoneal fluid, mesenteric hematoma/fat stranding, bowel wall thickening/hematoma, active intravenous contrast extravasation, free intraperitoneal air, bowel wall discontinuity, and focal bowel hypoenhancement. Subsequently, the electronic medical records of the included patients, admission abdominal physical exam results, admission white blood cell count, and findings at exploratory laparotomy of the included patients were recorded. Thirty-three patients met the inclusion criteria. The incidence and interobserver agreement of the CT findings were as follows: intraperitoneal fluid 93.9 %, kappa = 0.784 (good); mesenteric hematoma/fat stranding 84.8 %, kappa = 0.718 (good); bowel wall thickening/hematoma 42.4 %, kappa = 0.491 (moderate); active IV contrast extravasation 36.3 %, kappa = 1.00 (perfect); free intraperitoneal air 21.2 %, kappa = 0.904 (very good), bowel wall discontinuity 6.1 %, kappa = 1.00 (perfect); and focal bowel hypoenhancement 6.1 %, kappa = 0.468 (moderate). An absence of the specified CT findings was encountered in 9.1 % with surgically proven bowel injuries (kappa = 1.00, perfect). In our study, 9/16 patients or 56.3 % had a bowel injury prediction score (BIPS) of 2 or more as defined by McNutt et al. (J Trauma Acute Care Surg 78(1):105-111, 2014). The presence of intraperitoneal fluid and mesenteric hematoma/fat stranding are the most common CT findings in bowel injuries proven at laparotomy. A small percentage of patients have no abnormal CT findings. This grading system did not prove to be useful in our study likely due to our inherently small patient population; however, the use of BIPS deserves further investigation as it may help in identifying blunt bowel and mesenteric injury patients with often subtle or nonspecific CT findings.

Organ laceration grading adherence by radiologists.

American Association for the Surgery of Trauma (AAST) abdominopelvic organ laceration grading is used to determine which patients can be managed non-operatively. We assess a change in the use of AAST grading system by radiologists at a single, large, academic institution before and after a one-time departmental intervention and reviewed non-graded reports evaluating if grading could be inferred. After IRB approval, a keyword search for "laceration" identified traumatic abdominopelvic CT reports in a 2-year period before and after the one-time intervention. Reports were reviewed to determine if an organ laceration was seen, if it was graded by AAST criteria, and if grading could be inferred for non-graded reports. T test was performed to assess statistical significance. Before the intervention, 348 reports contained the keyword "laceration," 81 with lacerations, 31 graded (38 %). After the intervention, 302 reports were found, 79 with lacerations, 59 graded (75 %). The increase was statistically significant (p < 0.0001). A decreasing trend in grading was seen over time following the intervention. Two out of 50 (4 %) pre-intervention and four out of 20 (20 %) post-intervention reports gave enough detailed descriptions for the grading to be inferred when it was not explicitly stated. Non-graded reports did not describe laceration parenchymal depth and subcapsular hematoma surface area percentage; however, the presence/absence of active extravasation, omitted in the 20-year-old AAST grading scheme, was described in every report. One-time departmental intervention yielded a significant increase in adherence to AAST laceration grading. Lack of perfect compliance, which diminished over time, suggests a need for further reinforcement.

Effectiveness of contrast-enhanced ultrasound in the classification and emergency management of abdominal trauma.

OBJECTIVE: To analyse the correlation between contrast-enhanced ultrasound (CEUS)-based classification of the severity of abdominal parenchymal organ trauma and clinical outcomes, and to explore CEUS in classifying patients with such trauma, expecting that the use of CEUS will potentially enhance the quality and speed of the emergency management of abdominal trauma. METHODS: Three hundred six consecutive patients with blunt abdominal parenchymal organ trauma who received CEUS examination were retrospectively analysed. Two CEUS radiologists (identified as Reader A and Reader B in this study) who were not involved in the CEUS examinations of the patients were then asked to classify the patients independently according to their CEUS results. The classification results were later compared with patients' clinical outcomes using Spearman's rank correlation. RESULTS: The final clinical outcomes showed that 25.5 % (78/306) of patients received conservative treatment, 52.0 % (159/306) received minimally invasive treatment, and 22.5 % (69/306) received surgery. Spearman's rank correlation coefficients between the CEUS-based classification and clinical outcome were 0.952 from Reader A and 0.960 from Reader B. CONCLUSIONS: CEUS can play an important role in the emergency management of abdominal trauma through the classification of patients for different treatment methods. KEY POINTS: • The severity of abdominal trauma was classified by contrast-enhanced ultrasound (CEUS) • There was a high correlation between CEUS-based classification and clinical outcomes • CEUS-based classification is helpful for surgeons in the emergency management of abdominal trauma.

Liver injury following blunt abdominal trauma: a new mechanism-driven classification.

PURPOSES: The current classifications for blunt liver trauma focus only on the extent of liver injury. However, these scores are independent from the localization of liver injury and mechanism of trauma. METHODS: The type of liver injury after blunt abdominal trauma was newly classified as type A when it was along the falciform ligament with involvement of segments IVa/b, III, or II, and type B when there was involvement of segments V-VIII. With the use of a prospectively established database, the clinical, perioperative, and outcome data were analyzed regarding the trauma mechanism, as well as the radiological and intraoperative findings. RESULTS: In 64 patients, the type of liver injury following blunt abdominal trauma was clearly linked with the mechanism of trauma: type A injuries (n = 28) were associated with a frontal trauma, whereas type B injuries (n = 36) were found after complex trauma mechanisms. The demographic data, mortality, ICU stay, and hospital stay showed no significant differences between the two groups. Interestingly, all patients with type A ruptures required immediate surgical intervention, whereas six patients (16.7 %) with type B ruptures could be managed conservatively. CONCLUSIONS: This new classification for blunt traumatic hepatic injury is based on the localization of parenchymal disruption and correlates with the mechanism of trauma. The type of liver injury correlated with the necessity for surgical therapy.

[The morphological characteristic of hepatorrhesis in the subjects with the blunt abdominal injury].

We have elucidated certain consistent patterns of the development of hepatic lesions associated with blunt abdominal trauma including primary and secondary local and distant ruptures of the liver of different localization, e.g. in the direction of the injurious force (central and anti-shock) and apart from it (peripheral). A kick in the stomach causes local (primary and secondary) or distant ruptures of the liver. A strong impact gives rise to local secondary and distant ruptures. Compression of the body with massive objects is associated with local primary ruptures whereas falling down on the stomach results only in anti-shock ruptures. Local (primary and secondary) as well as distant (anti-shock and peripheral) ruptures of hepatic parenchyma have different morphological properties and surface relief which makes it possible to discriminate between them. The consistent patterns of hepatorrhesis provide a methodological basis for the explanation of the physical nature of liver deformation and destruction of its tissue after a blunt abdominal trauma.

[Forensic medical assessment of the origin of the missed early post-traumatic abortions].

The objective of the present study was to develop an algorithm for the forensic medical assessment of the origin of the missed early post-traumatic abortions. The analysis of the available data on the main variants of traumatic pregnancy interruption was carried out. Diagnostic features of the missed early post-traumatic abortions are considered along with the possible errors in the use of the current approaches to forensic medical assessment of their origin. The proposed algorithm for the forensic medical assessment of the origin of the missed early post-traumatic abortions takes into consideration the specific features of the objects of interest and includes the analysis of the results of ultrasonic studies of the uterine cavity and histological investigations of the scraps of endometrial tissue. Absolute and probabilistic criteria for spontaneous and traumatic origin of the missed early post-traumatic abortions. The proposed algorithm is recommended for the use in routine clinical practice for the elucidation of the causes of the missed early post-traumatic abortions.

Management of splenic injury.

Traumatic splenic injury is a potentially life-threatening complication of both blunt and penetrating trauma to the abdomen and thorax. The spleen is susceptible to injury in the presence or absence of damage to surrounding viscera and can lead to haemodynamic instability and hypovolaemic shock. This review examines the classification, investigation and management of this condition with both non-operative and operative techniques.

[Stages of diagnosis and surgical treatment for combined bladder injuries].

62 case histories of patients with bladder injuries who were admitted in the Department of Urology and Emergency Surgery of the Republican Scientific Center of Emergency Medicine (RRCEM) from 2001 to 2010 were retrospectively analyzed. 15 (24.2%) patients with hematuria or urethremorrhagia were admitted in the emergency room within an hour after the injury onset. Three (4.8%) patients were hospitalized in the period 1-3 h since injury onset, 12 (19.3%) patients since 3-6 hours, 5 (8.1%) - since 6 to 12 h, 16 (25 8%) patients - since 12 to 24 hours, and 11 (17.7%) patients - after 24 hours. Concomitant injury of the bladder with fractures of the pelvic occurred in 21 (33.8%) cases. At the time of admission in the emergency room, I-II degree traumatic shock was diagnosed in 37 (60%) of patients, III-IV degree traumatic shock - in 11 (17,7%). All 62 patients had a complete rupture of the bladder, 37 (59.6%) of patients had intraperitoneal rupture, 23 (37.1%) - extraperitoneal rupture, and only 2 (3.3%) - mixed rupture. Strict adherence to the RRCEM algorithm of diagnosis and treatment of patients with bladder injuries have substantially improved the efficiency of complex of medical and diagnostic measures and improved the outcomes of this group of patients - mortality was 12.9%.

[The forensic medical classification of damages to the liver in the case of a blunt abdominal injury].

The present work had the objective to evaluate the existing classifications of damages to the liver associated with a blunt abdominal injury. An original forensic medical classification of hepatic lesions has been developed taking into consideration both localization and mechanisms of blunt abdominal injuries. It is proposed that such injuries should be categorized into three groups: local primary injuries developing as a result of abdominal wall deformation at the site of the application of the traumatic force; local secondary injuries developing in conjunction with the primary ones at the site of the application of the traumatic impact from the fractured costal fragments resulting from chest deformation; late post-traumatic injuries developing simultaneously with the local ones both in the direction of the traumatic force and far away from its application site as a result of the general deformation, displacement, and concussion of the organ. The scope of classifications overviewed in this paper provide a basis for the transition to the next stage of systematization, namely the estimation of morphological features of hepatic injuries depending on the form of blunt abdominal injuries, i.e. blow, compression, etc.

[The general characteristic of abdominal injuries inflicted by a blow of an unarmed man].

The experience gained in the course of the many-year forensic medical practice as regards abdominal injuries caused by a blow of an unarmed man is described. The data on the occurrence and frequency of different variants of such injuries are presented. Their morphological features are considered in much detail. The relationship between the nature of the injurious factor (the part of the human body with which a given injury was inflicted) and the character of the traumas. It is concluded that these data should be taken into account when resolving forensic medical problems related to the possibility of formation of an abdominal injury inflicted by a blow of an unarmed man.

[Endovideosurgical interventions for thoracoabdominal wounds].

The authors presented results of examination and treatment of 1347 patients with different injuries of the chest and abdomen. Medico-diagnostic measures used in treatment of such kind of patients with rational application of endovideosurgical techniques such as thoraco- and laparoscopy are described which proved to be the final kind of operative treatment.

Factors Associated With Increased Mortality in Severe Abdominopelvic Injury.

BACKGROUND: Associated injuries are thought to increase mortality in patients with severe abdominopelvic trauma. This study aimed to identify clinical factors contributing to increased mortality in patients with severe abdominopelvic trauma, with the hypothesis that a greater number of concomitant injuries would result in increased mortality. METHODS: This was a retrospective review of the Trauma Quality Improvement Program (TQIP) database of patients ≥ 18 years with severe abdominopelvic trauma defined as having an abdominal Abbreviated Injury Score (AIS) ≥ 3 with pelvic fractures and/or iliac vessel injury (2015-2017). Primary outcome was in-hospital mortality based on concomitant body region injuries. Secondary outcomes included mortality at 6 h, 6 to 24 h, and after 24 h based on concomitant injuries, procedures performed, and transfusion requirements. RESULTS: A total of 185,257 patients were included in this study. Survivors had more severely injured body regions than non-survivors (4 vs. 3, P < 0.001). Among those who died within 6 h, 28.5% of patients required a thoracic procedure and 43% required laparotomy compared to 6.3% and 22.1% among those who died after 24 h (P < 0.001). Head AIS ≥ 3 was the only body region that significantly contributed to overall mortality (OR 1.26, P < 0.001) along with laparotomy (OR 3.02, P < 0.001), neurosurgical procedures (2.82, P < 0.001) and thoracic procedures (2.28, P < 0.001). Non-survivors who died in < 6 h and 6-24 h had greater pRBC requirements than those who died after 24 h (15.5 and 19.5 vs. 8 units, P < 0.001). CONCLUSION: Increased number of body regions injured does not contribute to greater mortality. Uncontrolled noncompressible torso hemorrhage rather than the burden of concomitant injuries is the major contributor to the high mortality associated with severe abdominopelvic injury.

[Injury to the liver in patients with severe combined traumas].

Experience with treatment of 220 patients with a severe combined trauma who were subjected to surgical intervention on abdominal organs was analyzed. In 164 of them (74.8%) there was a closed trauma, in 56 (26.2%) abdominal wounds were diagnosed. Injuries of the liver resulting from the closed trauma of the abdomen were revealed in 41 (25.6%) patients. For the assessment of severity of the injury and determination of the strategy of treatment the authors have developed a classification of liver injuries.

Factors Associated With Functional Impairment After Pediatric Injury.

Importance: Short- and long-term functional impairment after pediatric injury may be more sensitive for measuring quality of care compared with mortality alone. The characteristics of injured children and adolescents who are at the highest risk for functional impairment are unknown. Objective: To evaluate categories of injuries associated with higher prevalence of impaired functional status at hospital discharge among children and adolescents and to estimate the number of those with injuries in these categories who received treatment at pediatric trauma centers. Design, Setting, and Participants: This prospective cohort study (Assessment of Functional Outcomes and Health-Related Quality of Life After Pediatric Trauma) included children and adolescents younger than 15 years who were hospitalized with at least 1 serious injury at 1 of 7 level 1 pediatric trauma centers from March 2018 to February 2020. Exposure: At least 1 serious injury (Abbreviated Injury Scale score, ≥3 [scores range from 1 to 6, with higher scores indicating more severe injury]) classified into 9 categories based on the body region injured and the presence of a severe traumatic brain injury (Glasgow Coma Scale score <9 or Glasgow Coma Scale motor score <5). Main Outcomes and Measures: New domain morbidity defined as a 2 points or more change in any of 6 domains (mental status, sensory, communication, motor function, feeding, and respiratory) measured using the Functional Status Scale (FSS) (scores range from 1 [normal] to 5 [very severe dysfunction] for each domain) in each injury category at hospital discharge. The estimated prevalence of impairment associated with each injury category was assessed in the population of seriously injured children and adolescents treated at participating sites. Results: This study included a sample of 427 injured children and adolescents (271 [63.5%] male; median age, 7.2 years [interquartile range, 2.5-11.7 years]), 74 (17.3%) of whom had new FSS domain morbidity at discharge. The proportion of new FSS domain morbidity was highest among those with multiple injured body regions and severe head injury (20 of 24 [83.3%]) and lowest among those with an isolated head injury of mild or moderate severity (1 of 84 [1.2%]). After adjusting for oversampling of specific injuries in the study sample, 749 of 5195 seriously injured children and adolescents (14.4%) were estimated to have functional impairment at hospital discharge. Children and adolescents with extremity injuries (302 of 749 [40.3%]) and those with severe traumatic brain injuries (258 of 749 [34.4%]) comprised the largest proportions of those estimated to have impairment at discharge. Conclusions and Relevance: In this cohort study, most injured children and adolescents returned to baseline functional status by hospital discharge. These findings suggest that functional status assessments can be limited to cohorts of injured children and adolescents at the highest risk for impairment.

A multicenter trial of current trends in the diagnosis and management of high-grade pancreatic injuries.

BACKGROUND: Outcomes following pancreatic trauma have not improved significantly over the past two decades. A 2013 Western Trauma Association algorithm highlighted emerging data that might improve the diagnosis and management of high-grade pancreatic injuries (HGPIs; grades III-V). We hypothesized that the use of magnetic resonance cholangiopancreatography, pancreatic duct stenting, operative drainage versus resection, and nonoperative management of HGPIs increased over time. METHODS: Multicenter retrospective review of diagnosis, management, and outcomes of adult pancreatic injuries from 2010 to 2018 was performed. Data were analyzed by grade and time period (PRE, 2010-2013; POST, 2014-2018) using various statistical tests where appropriate. RESULTS: Thirty-two centers reported data on 515 HGPI patients. A total of 270 (53%) had penetrating trauma, and 58% went directly to the operating room without imaging. Eighty-nine (17%) died within 24 hours. Management and outcomes of 426 24-hour survivors were evaluated. Agreement between computed tomography and operating room grading was 38%. Magnetic resonance cholangiopancreatography use doubled in grade IV/V injuries over time but was still low.Overall HGPI treatment and outcomes did not change over time. Resection was performed in 78% of grade III injuries and remained stable over time, while resection of grade IV/V injuries trended downward (56% to 39%, p = 0.11). Pancreas-related complications (PRCs) occurred more frequently in grade IV/V injuries managed with drainage versus resection (61% vs. 32%, p = 0.0051), but there was no difference in PRCs for grade III injuries between resection and drainage.Pancreatectomy closure had no impact on PRCs. Pancreatic duct stenting increased over time in grade IV/V injuries, with 76% used to treat PRCs. CONCLUSION: Intraoperative and computed tomography grading are different in the majority of HGPI cases. Resection is still used for most patients with grade III injuries; however, drainage may be a noninferior alternative. Drainage trended upward for grade IV/V injuries, but the higher rate of PRCs calls for caution in this practice. LEVEL OF EVIDENCE: Retrospective diagnostic/therapeutic study, level III.

Serial white blood cell counts in trauma: do they predict a hollow viscus injury?

BACKGROUND: The significance of serial white blood cell (WBC) counts in trauma patients with a suspected hollow viscus injury (HVI) is unknown. The purpose of this study was to examine the role of serial WBC counts in the diagnosis of a HVI. METHODS: After institutional review board approval, all injured patients admitted to a Level I trauma center from January 2003 to December 2007 with at least one WBC measurement were included in a retrospective analysis. The WBC profiles for patients with a HVI were compared against those without HVI. All WBC counts are reported as [x10(3)/microL]. RESULTS: The mean WBC count of the overall study population (n = 5,950) on admission was 11.6 +/- 5.3. Overall, 59.2% had an elevated WBC count on admission. A significant relationship between increasing Injury Severity Score and increasing WBC count on admission was found by linear regression. When comparing patients with HVI (n = 267) with patients without HVI (n = 5,683), no significant difference was found for admission WBC count. The highest WBC count within the first 24 hours for patients with HVI was 16.7 +/- 4.7. This was significantly higher than that for the 4,520 patients without any intraabdominal injury (13.0 +/- 5.2, adjusted p < 0.001). Penetrating injury, a concomitant severe thoracic trauma (chest Abbreviated Injury Scale value >or=3), and highest WBC count >or=20.0 in the first 24 hours were independent risk factors for HVI. A maximal WBC count or=20.0 are independently associated with a HVI, whereas counts

Clinical importance of ultrasonographic pelvic fluid in pediatric patients with blunt abdominal trauma.

BACKGROUND: The aim of this study was to evaluate the significance of the ultrasonographic finding of pelvic fluid as a predictor of organ injury in pediatric patients with blunt abdominal trauma. METHODS: We reviewed retrospectively the medical records of 85 consecutive pediatric patients who admitted to the Emergency Department of Dicle University from January 2008 to December 2008 with blunt abdominal trauma. Age, gender, mechanism of injury, isolated injuries, surgical interventions, hospitalization, and mortality were evaluated according to the location of fluid. RESULTS: A total of 85 pediatric patients (63 male, 22 female; mean age: 7.88+/-3.403 years) with blunt abdominal trauma were included in the present study. Forty percent of the patients had intraperitoneal fluid, while 60% had pelvic fluid. The majority (35.3%) of patients applied due to falling from height. The difference between the mechanism of the injuries and location and presence of the fluid was not statistically significant (p>0.05). Twenty-nine patients had solid organ injuries. Splenic injuries showed the highest association with intraperitoneal fluid (p<0.001). Of the patients, 15.3% underwent exploratory laparotomy and 44.7% required blood transfusion. The presence of intraperitoneal fluid statistically increased the probability of the exploratory laparotomy and necessity of blood transfusion (p<0.001). Mortality rate was 4.8%. CONCLUSION: In ultrasound examination, it was determined that the probability of solid organ injury was lower in the presence of pelvic fluid, while it was higher in the presence of intraperitoneal fluid outside the pelvis.