Civilian vascular trauma, treatment and outcome at a level 1-trauma centre.

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.

Strain Elastography Evaluation of Rectal Tumors: Inter- and Intraobserver Reproducibility.

PURPOSE: Elastography is a promising method for the identification and differentiation of malignant tissue in several organ systems. The primary aim was to evaluate the inter- and intraobserver reproducibility of endorectal strain elastography differentiation of adenomas and adenocarcinomas. The secondary aim was to compare the performance of strain elastography to endorectal ultrasonography (ERUS) examinations. MATERIALS AND METHODS: Consecutive inclusion of 95 ERUS examinations and 110 elastography video loops with ERUS overlay mode. Video loops were randomized and evaluated by eight observers on two separate occasions. Observers were blinded to all clinical information except the circumferential location of the tumor. A continuous visual analog scale (VAS) and a categorical scale (W-score) were used for elastography evaluation. ERUS loops were T-staged according to the TNM classification system. Histopathological evaluation of surgical resection specimen was used as the reference standard. RESULTS: Strain elastography visual evaluation yielded intraobserver variability from 0.86 to 0.97 and interobserver variability of 0.99. VAS strain elastography differentiation of adenomas (pT0) and adenocarcinomas (pT1 - 4) yielded sensitivity, specificity, accuracy, positive and negative predictive values of 0.94, 0.71, 0.89, 0.92 and 0.78, respectively. The corresponding ERUS values were 0.83, 0.64, 0.79, 0.88 and 0.54, respectively. CONCLUSION: Visual evaluation of elastography loops is highly reproducible in an offline setting with blinded observers, and correlates significantly with pT-stages. Strain elastography performs better than ERUS and might consequently improve staging.