RESUMO
BACKGROUND: In stable patients with blunt abdominal trauma, accurate diagnosis of visceral injuries is crucial. OBJECTIVES: To determine whether repeating ultrasound exam will increase the sensitivity of focused abdominal sonography for trauma (FAST) through revealing additional free intraperitoneal fluid in patients with blunt abdominal trauma. PATIENTS AND METHODS: We performed a prospective observational study by performing primary and secondary ultrasound exams in blunt abdominal trauma patients. All ultrasound exams were performed by four radiology residents who had the experience of more than 400 FAST exams. Five routine intraperitoneal spaces as well as the interloop space were examined by ultrasound in order to find free fluid. All patients who expired or were transferred to the operating room before the second exam were excluded from the study. All positive ultrasound results were compared with intra-operative and computed tomography (CT) findings and/or the clinical status of the patients. RESULTS: Primary ultrasound was performed in 372 patients; 61 of them did not undergo secondary ultrasound exam; thus, were excluded from the study.Three hundred eleven patients underwent both primary and secondary ultrasound exams. One hundred and two of all patients were evaluated by contrast enhanced CT scan and 31 underwent laparotomy. The sensitivity of ultrasound exam in detecting intraperitoneal fluid significantly increased from 70.7% for the primary exam to 92.7% for the secondary exam. Examining the interloop space significantly improved the sensitivity of ultrasonography in both primary (from 36.6% to 70.7%) and secondary (from 65.9% to 92.7%) exams. CONCLUSIONS: Performing a secondary ultrasound exam in stable blunt abdominal trauma patients and adding interloop space scan to the routine FAST exam significantly increases the sensitivity of ultrasound in detecting intraperitoneal free fluid.
RESUMO
BACKGROUND: Asthma is one of the most common chronic diseases in the world, leading to an increased rate of hospitalization. We performed this study to better understand the factors leading to admission among asthmatic children. METHODS: We performed a study among asthmatic children in a referral hospital for asthma and allergy in Tehran. Sixty-three cases were selected from asthmatic children admitted to the emergency room (ER) who still had an indication for ward or intensive care unit admission after primary treatment. Our control group was the asthmatic children discharged after primary treatment and patients who were referred to the asthma and allergy clinic (63 patients). Data were obtained by structured questionnaires filled out during clinical interviews. RESULTS: There was a significant difference in mean age (5 years for cases vs. 6 years for controls; p = 0.049), personal and familial allergic history (69.8 and 57.1% for cases vs. 34.9 and 36.5% for controls; p < 0.01 and p = 0.02, respectively), history of recent respiratory infections (79.4% for cases vs. 49.2% for controls; p < 0.01), hospitalization history due to asthma (57.1% for cases vs. 23.8% for controls; p < 0.01) and regular use of inhaled corticosteroid (66.7% for cases vs. 33.3% for controls; p < 0.01). CONCLUSIONS: Our findings confirm most previous observations, suggesting that recent respiratory infections, hospitalization, personal or familial allergy, disease severity and lower ages are important factors leading to hospitalization. We also found that regular clinical follow-up, regular use of inhaled corticosteroids, higher IgE levels and O2 saturation may lower the probability of hospitalization during asthmatic attacks.
