The current role of magnetic resonance imaging for diagnosing cervical spine injury in blunt trauma patients with negative computed tomography scan.

Clearance of cervical spine (CS) precautions in the neurologically altered blunt trauma patient can be difficult. Physical examination is not reliable, and although computed tomography (CT) may reveal no evidence of fracture, it is generally believed to be an inferior modality for assessing ligamentous and cord injuries. However, magnetic resonance imaging (MRI) is expensive and may be risky in critically ill patients. Conversely, prolonged rigid collar use is associated with pressure ulceration and other complications. Multidetector CT raises the possibility of clearing CS on the basis of CT alone. We performed a retrospective review at our Level I trauma center of all blunt trauma patients with Glasgow Coma Scale Score 14 or less who underwent both CT and MRI CS with negative CT. One hundred fourteen patients met inclusion criteria, of which 23 had MRI findings. Seven (6%) of these had neurologic deficits and/or a change in management on the basis of MRI findings. Although use of the single-slice scanner was significantly associated with MRI findings (odds ratio, 2.62; P=0.023), no significant clinical risk factors were identified. Patients with MRI findings were heterogeneous in terms of age, mechanism, and Injury Severity Score. We conclude that CS MRI continues play a vital role in the workup of neurologically altered patients.

Risk factors for traumatic injury findings on thoracic computed tomography among patients with blunt trauma having a normal chest radiograph.

HYPOTHESIS: We sought to identify risk factors that might predict acute traumatic injury findings on thoracic computed tomography (TCT) among patients having a normal initial chest radiograph (CR). DESIGN: In this retrospective analysis, Abbreviated Injury Score cutoffs were chosen to correspond with obvious physical examination findings. Multivariate logistic regression analysis was performed to identify risk factors predicting acute traumatic injury findings. SETTING: Urban level I trauma center. PATIENTS: All patients with blunt trauma having both CR and TCT between July 1, 2005, and June 30, 2007. Patients with abnormalities on their CR were excluded. MAIN OUTCOME MEASURE: Finding of any acute traumatic abnormality on TCT, despite a normal CR. RESULTS: A total of 2435 patients with blunt trauma were identified; 1744 (71.6%) had a normal initial CR, and 394 (22.6%) of these had acute traumatic findings on TCT. Multivariate logistic regression demonstrated that an abdominal Abbreviated Injury Score of 3 or higher (P = .001; odds ratio, 2.6), a pelvic or extremity Abbreviated Injury Score of 2 or higher (P < .001; odds ratio, 2.0), age older than 30 years (P = .004; odds ratio, 1.4), and male sex (P = .04; odds ratio, 1.3) were significantly associated with traumatic findings on TCT. No aortic injuries were diagnosed in patients with a normal CR. Limiting TCT to patients with 1 or more risk factors predicting acute traumatic injury findings would have resulted in reduced radiation exposure and in a cost savings of almost $250,000 over the 2-year period. Limiting TCT to this degree would not have missed any clinically significant vertebral fractures or vascular injuries. CONCLUSION: Among patients with a normal screening CR, reserving TCT for older male patients with abdominal or extremity blunt trauma seems safe and cost-effective.

Epidemiology and risk factors for hospital-acquired methicillin-resistant Staphylococcus aureus among burn patients.

Methicillin-resistant Staphylococcus aureus (MRSA) is a substantial source of morbidity among burn patients. The objectives of this study were to determine the feasibility and efficacy of surveillance cultures and isolation precautions on limiting the transmission of MRSA among burn patients and to determine risk factors for the development of hospital-acquired MRSA (HA-MRSA). All patients admitted to the burn service from January 2007 to June 2009 were screened by nasal swab culture on admission and weekly thereafter. Other sites were cultured based on clinical suspicion. Patients with MRSA were immediately placed on isolation precautions. Community-acquired MRSA (CA-MRSA) and HA-MRSA were defined as identification of the organism <72 hours from admission (CA-MRSA) or ≥72 hours after admission (HA-MRSA). Charts were retrospectively analyzed to identify risk factors for development of HA. Screening compliance was 100%. Seventy MRSA cases were identified in 752 admissions (9% incidence), including 30 cases of CA-MRSA and 40 cases of HA-MRSA. Over the 30-month study period, HA-MRSA incidence decreased according to a significant linear trend. Independent risk factors for the development of HA-MRSA on multivariate analysis included length of stay >7 days (odds ratio [OR] 12.0, 95% confidence interval [CI] 1.6-91), TBSA affected >10% (OR 6.1, CI 2.6-14.2), age >30 years (OR 4.9, CI 2.0-12.0), and inhalation injury (OR 3.5, CI 1.0-11.7). Surveillance cultures with isolation precautions are practical and effective for preventing HA-MRSA among burn patients. Older patients with prolonged hospital stays, large wounds, and inhalation injury are at greatest risk.

Cartilage regeneration in the rabbit nasal septum.

OBJECTIVE: Rhinoplasty frequently includes harvesting of nasal septal cartilage. The objective of this prospective basic investigation is to determine whether cartilage can regenerate after submucosal resection (SMR) of the nasal septum in the rabbit. Neocartilage formation has not heretofore been described in this model. METHODS: By lateral rhinotomy, SMR was performed on 17 rabbits followed by reapproximation of the perichondrium. After 7 months, septi were fixed, sectioned, and examined histologically. Findings were photographed and data tabulated according to location and extent. RESULTS: Sites of matrix-secreting isogenous chondrocyte islands were identified between the perichondrial flaps of every animal, principally in the anterior inferior septum. The width of the islands averaged 190 microm, and the mean neocartilage height was found to be 840 microm. The newly formed cartilage consisted of chondrocytes within chondrons and was comparable in shape and structure to native septal cartilage. CONCLUSIONS: After SMR, rabbit cartilage tissue can regenerate and form matrix within the potential space created by surgery. The surrounding stem cell-rich perichondrium may be the site of origin for these chondrocytes. These findings suggest that after SMR of the human nasal septum, it may be possible for new cartilage tissue to develop provided the mucosa is well approximated. This biologic effect may be enhanced by insertion of cytokine-rich tissue scaffolds that exploit the native ability of septal perichondrium to regenerate and repair cartilage tissue.