RESUMEN
PURPOSE: Neither the performance of CT in diagnosing penetrating gastrointestinal injury nor its ability to discriminate patients requiring either observation or surgery has been determined. MATERIALS AND METHODS: This was a prospective, single-institutional observational study of patients with penetrating injury to the torso who underwent CT. Based on CT signs, reviewers determined the presence of a gastrointestinal injury and the need for surgery or observation. The primary outcome measures were operative findings and clinical follow-up. CT results were compared with the primary outcome measures. RESULTS: Of one hundred and seventy-one patients (72 gunshot wounds, 99 stab wounds; age range, 18-57 years; median age, 28 years) with penetrating torso trauma who underwent CT, 45 % were followed by an operation and 55 % by clinical follow up. Thirty-five patients had a gastrointestinal injury at surgery. The sensitivity, specificity, and accuracy of CT for diagnosing a gastrointestinal injury for all patients were each 91 %, and for predicting the need for surgery, they were 94 %, 93 %, 93 %, respectively. Among the 3 % of patients who failed observation, 1 % had a gastrointestinal injury. CONCLUSION: CT is a useful technique to diagnose gastrointestinal injury following penetrating torso injury. CT can help discriminate patients requiring observation or surgery. KEY POINTS: ⢠The most sensitive sign is wound tract extending up to gastrointestinal wall. ⢠The most accurate sign is gastrointestinal wall thickening. ⢠Triple-contrast CT is a useful technique to diagnose gastrointestinal injury. ⢠Triple-contrast CT helps to discriminate patients requiring observation and surgery.
Asunto(s)
Tracto Gastrointestinal/lesiones , Tomografía Computarizada Multidetector/normas , Heridas por Arma de Fuego/diagnóstico por imagen , Heridas Punzantes/diagnóstico por imagen , Traumatismos Abdominales/diagnóstico por imagen , Adolescente , Adulto , Anciano , Medios de Contraste , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tomografía Computarizada Multidetector/métodos , Examen Físico , Estudios Prospectivos , Estándares de Referencia , Sensibilidad y Especificidad , Traumatismos Torácicos/diagnóstico , Adulto JovenRESUMEN
OBJECTIVE: Craniocervical distraction injury is a class of injuries that involve the skull base, the atlas, and the axis. Although these injuries often are overt imaging and clinical findings, the injury can be masked during unreliable physical examinations and difficult to identify during diagnostic imaging. The goal of this study was to identify on coronal and sagittal CT multiplanar reformations precise measurements and qualitative relations between anatomic landmarks that can help in establishing the diagnosis of craniocervical distraction injury. MATERIALS AND METHODS: We performed a retrospective review of the cases of 35 patients with craniocervical distraction injury admitted to our trauma center from 2000 to 2006. Two independent radiologists made several qualitative and quantitative anatomic assessments on reformatted CT images through the craniocervical junctions (skull base through C2) of the 35 patients and of 50 other patients sustaining blunt trauma who were discharged without findings of cervical spinal injury. Logistic regression, recursive partitioning, and multivariate analysis were performed in an attempt to find measurements that differentiated the groups. RESULTS: Among the patients with craniocervical distraction injury, statistically significant positive correlations were found in several measurements, including midline occiput-C1 spinolaminar distance (p=0.0016), midline C1-C2 spinolaminar distance (p<0.0001), basion-dens distance (p<0.0001), sum of condylar displacement (p=0.0002), and basion-posterior axial line distance (p<0.0001). CONCLUSION: Several quantitative parameters on sagittal and coronal multiplanar CT reformations can be used to differentiate patients with craniocervical distraction injury from patients without this injury.
Asunto(s)
Articulación Atlantoaxoidea/diagnóstico por imagen , Articulación Atlantoaxoidea/lesiones , Articulación Atlantooccipital/diagnóstico por imagen , Articulación Atlantooccipital/lesiones , Base del Cráneo/diagnóstico por imagen , Base del Cráneo/lesiones , Tomografía Computarizada por Rayos X/métodos , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Traumatismos del Sistema Nervioso/diagnóstico por imagenRESUMEN
US air bag regulations were changed in 1997 to allow tests of unbelted male dummies in vehicles mounted and accelerated on sleds, resulting in longer crash pulses than rigid-barrier crashes. This change facilitated depowering of frontal air bags and was intended to reduce air bag-induced deaths. Controversy ensued as to whether sled-certified air bags could increase adult fatality risk. A matched-pair cohort study of two-vehicle, head-on, fatal collisions between drivers involving first-generation versus sled-certified air bags during 1998-2005 was conducted by using Fatality Analysis Reporting System data. Sled certification was ascertained from public information and a survey of automakers. Conditional Poisson regression for matched-pair cohorts was used to estimate risk ratios adjusted for age, seat belt status, vehicle type, passenger car size, and model year for driver deaths in vehicles with sled-certified air bags versus first-generation air bags. For all passenger-vehicle pairs, the adjusted risk ratio was 0.87 (95% confidence interval: 0.77, 0.98). In head-on collisions involving only passenger cars, the adjusted risk ratio was 1.04 (95% confidence interval: 0.85, 1.29). Increased fatality risk for drivers with sled-certified air bags was not observed. A borderline significant interaction between vehicle type and air bag generation suggested that sled-certified air bags may have reduced the risk of dying in head-on collisions among drivers of pickup trucks.
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Accidentes de Tránsito/mortalidad , Airbags/efectos adversos , Conducción de Automóvil/legislación & jurisprudencia , Automóviles/legislación & jurisprudencia , Seguridad de Equipos , Regulación Gubernamental , Medición de Riesgo/métodos , Adulto , Airbags/normas , Conducción de Automóvil/estadística & datos numéricos , Humanos , Maniquíes , Oportunidad Relativa , Distribución de Poisson , Estudios Prospectivos , Informática en Salud Pública , Medición de Riesgo/estadística & datos numéricos , Factores de Riesgo , Cinturones de Seguridad/efectos adversos , Cinturones de Seguridad/normas , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVE: The purpose of this study was to compare the usefulness of two CT grading systems of blunt splenic trauma in predicting which patients need surgery or angioembolization. MATERIALS AND METHODS: Four hundred patients in hemodynamically stable condition admitted with blunt splenic injury were included in the study. All patients underwent contrast-enhanced MDCT. Grade of splenic injury was prospectively assigned according to the American Association for the Surgery of Trauma (AAST) splenic injury scale. Patients were treated with surgical intervention, splenic arteriography with or without embolization, or observation alone. All MDCT images were retrospectively reviewed and regraded according to a novel grading system that specifically incorporates the findings of active bleeding or splenic vascular injury, including pseudoaneurysm and arteriovenous fistula. Receiver operating characteristics curves were generated with both grading systems for all splenic interventions, and statistical analyses were performed. RESULTS: The area under the ROC curves for the new splenic grading system for splenic arteriography, surgery, and both interventions exceeded 80%. The area under the curve for the new splenic grading system was greater than that for the AAST injury scale for all interventions. Differences were found to be statistically significant for splenic arteriography (p = 0.0036) and the combination of arteriography and surgery (p = 0.0006). CONCLUSION: The proposed CT grading system is better than the AAST system for predicting which patients with blunt splenic trauma need arteriography or splenic intervention.
Asunto(s)
Embolización Terapéutica/métodos , Interpretación de Imagen Radiográfica Asistida por Computador/métodos , Bazo/diagnóstico por imagen , Bazo/lesiones , Tomografía Computarizada por Rayos X/métodos , Heridas no Penetrantes/diagnóstico por imagen , Heridas no Penetrantes/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Selección de Paciente , Pronóstico , Garantía de la Calidad de Atención de Salud/métodos , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , Heridas no Penetrantes/cirugíaRESUMEN
OBJECTIVE: This study aimed to determine whether a persuasive educational intervention could increase licensure among motorcycle owners. Unlicensed motorcycle operators appear to be disproportionately involved in police-reported motorcycle crashes in Maryland, accounting for about 27% of motorcycle operators in police-reported crashes, although unlicensed owners comprise 17% of primary motorcycle owners. METHODS: A randomized controlled trial was conducted among unlicensed owners. Linking Maryland records of registered motorcycles with license files, 8,499 unlicensed owners who had no licensed co-owners were identified. Half were randomized to receive a persuasive educational mailing in early June 2005 from Maryland Motor Vehicle Administration (MVA). Motorcycle licenses can be attained by passing an accredited motorcycle training class or passing knowledge and skills tests administered by the state driver licensing agency. Licensure rates and motorcycle class enrollment were followed for 6 months post-intervention. RESULTS: As of December 16, 2005, 280 intervention group owners had obtained Class M motorcycle licenses and 158 had obtained Class R motorcycle learner's permits. The comparison group obtained 209 M licenses and 122 R permits. The overall success rate in the intervention group, defined as obtaining Class M or R, was 10.4% compared with 7.9% in the comparison group (licensure ratio (LR) = 1.33; 95% confidence interval (CI) = 1.16-1.52). The intervention was most successful among men, whose LR for obtaining M licenses was 1.45 (95% CI = 1.21-1.75). LRs were higher among owners ages 40-48 and 49+ receiving the intervention compared with younger groups. Motorcycle training class enrollment rates were higher in the intervention group, particularly among those taking a course for riders with intermediate skills (enrollment ratio = 2.24; 95% CI = 1.41-3.55). CONCLUSION: The intervention appeared to increase licensure, yet the licensure rate remained low among the intervention group. Potential risks and benefits of increasing the percentage of motorcyclists who are licensed need to be studied.
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Educación , Concesión de Licencias/estadística & datos numéricos , Motocicletas/estadística & datos numéricos , Accidentes de Tránsito/prevención & control , Adulto , Examen de Aptitud para la Conducción de Vehículos , Femenino , Humanos , Masculino , Maryland , Persona de Mediana Edad , Servicios PostalesRESUMEN
This study investigated correlations between American Spinal Injury Association (ASIA) clinical injury motor scores in patients with traumatic cervical cord injury and magnetic resonance (MR) diffusion tensor imaging (DTI) parameters. Conventional imaging and DTI were performed to evaluate 25 patients (age, 39.7±13.9 years; 4 women, 21 men) with blunt spinal cord injury and 11 volunteers (age, 31.5±10.7 years; 3 women, 8 men). Cord contusions were hemorrhagic (HC) in 13 and non-hemorrhagic (NHC) in 12 patients. The spinal cord was divided into three regions to account for spatial and pathological variation in DTI parameters. Comparisons of regional and injury site mean diffusivity (MD), fractional anisotropy (FA), radial diffusivity ( λ(â¥)), and longitudinal diffusivity ( λ(â)) were made with control subjects. ASIA motor scores were correlated with DTI using linear regression analysis. HC and NHC patients showed significant reduction (p<0.001) in MD and λ(â) in all three regions. At the injury site, significant decreases in FA and λ(â) were seen for both injury groups (p<0.001). λ(â¥) values were significantly increased only for patients with NHC (p<0.05). Significant reduction in FA and λ(â) (p<0.0001) was observed at the whole cord level between the injured (NH and NHC) and control groups. Within the NHC group, strong correlations were observed between ASIA motor scores and average MD, FA, λ(â¥), and λ(â) at the injury site. However, no correlation was observed within the HC group between any of the DTI parameters and ASIA motor scores. DTI parameters reflect the severity of spinal cord injury and correlate well with ASIA motor scores in patients with NHC.
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Hemorragia/diagnóstico , Destreza Motora/fisiología , Traumatismos de la Médula Espinal/diagnóstico , Adulto , Vértebras Cervicales , Imagen de Difusión Tensora , Femenino , Hemorragia/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Traumatismos de la Médula Espinal/fisiopatologíaRESUMEN
OBJECTIVE: After automakers were allowed the option of using sled tests for unbelted male dummies to certify the frontal crash performance of vehicles, most frontal air bags were depowered, starting in model year 1998, to reduce deaths and serious injuries arising from air bag deployments. Concern has been expressed that depowering air bags could compromise the protection of adult occupants. This study aimed to determine the effects of changes in air bag designs on risk of death among front-seat occupants. METHODS: Deaths among drivers and right-front passengers per involvement in frontal police-reported crashes during calendar years 1998-2004 were compared among vehicles with sled-certified air bags (model years 1998-2004) and first-generation air bags (model years 1994-97). Frontal crash deaths were identified from the Fatality Analysis Reporting System. National estimates of police-reported crashes were derived from the National Automotive Sampling System/General Estimates System. Sled certification status for model years 1998-2004 was ascertained from published federal data and a survey of automobile manufacturers. Passenger cars, pickup trucks, sport utility vehicles, and minivans were studied. Stratified analyses were done to compute risk ratios (RR) and 95% confidence intervals (95% CI) for driver and right-front passenger deaths by air bag generation and crash, vehicle, and driver characteristics. RESULTS: In frontal crashes, overall RRs were 0.89 for driver deaths (95% CI = 0.74-1.08) and 0.89 for right-front passenger deaths (95% CI = 0.74-1.07) in sled-certified vehicles compared with first-generation air bag-equipped vehicles. Child right-front passengers (ages 0-4, 5-9) in vehicles with sled-certified air bags had statistically significant reductions in risk of dying in frontal collisions, including a 65% reduced risk among ages 0-4 (RR = 0.35; 95% CI = 0.21-0.60). No differences in effects of sled-certified air bags were observed between drivers ages 15-59 and 60-74 in sled-certified vehicles, both of whom had RRs slightly below 0.90 (non-significant). Among occupants killed in sled-certified vehicles, police-reported belt use was somewhat higher than in first-generation vehicles. CONCLUSIONS: No differences in risk of frontal crash deaths were observed between adult occupants with sled-certified and first-generation air bags. Consistent with reports of decreases in air bag-related deaths, this study observed significant reductions in frontal deaths among child passengers seated in the right-front position in sled-certified vehicles. Higher restraint use rates among children in sled-certified vehicles and other vehicle design changes might have contributed partially to these reductions.