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1.
Ann R Coll Surg Engl ; 103(3): e98-e100, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33645284

RESUMO

Pneumothorax resulting from traumatic thoracic injury is a potentially life-threatening emergency requiring prompt recognition and management with an intercostal drain. A 34-year-old woman was brought into the emergency department after sustaining a stab injury to the right upper outer quadrant of the right breast. She described noticing a jelly-like substance from her wound, on the background of a prior cosmetic breast augmentation. On examination, it was noted that the right breast was significantly swollen. Computed tomography demonstrated a large right sided pneumothorax with associated punctured right breast implant, a 'pneumocapsule' and extensive subcutaneous emphysema of the breast. This case highlights that the fibrous tissue capsule around a breast implant can function as an anatomical space in continuity with the thoracic cavity, masking the diagnosis of pneumothorax in penetrating trauma.


Assuntos
Implantes de Mama , Pneumotórax/diagnóstico por imagem , Traumatismos Torácicos/diagnóstico por imagem , Ferimentos Perfurantes/diagnóstico por imagem , Adulto , Mama/diagnóstico por imagem , Mama/lesões , Tubos Torácicos , Feminino , Humanos , Lacerações , Fígado/diagnóstico por imagem , Fígado/lesões , Pneumotórax/etiologia , Pneumotórax/terapia , Enfisema Subcutâneo , Traumatismos Torácicos/complicações , Toracostomia , Tomografia Computadorizada por Raios X , Ferimentos Perfurantes/complicações
2.
J Surg Res ; 257: 69-78, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32818786

RESUMO

BACKGROUND: Despite improvements in operative techniques, major abdominal complications (MACs) continue to occur after penetrating abdominal trauma (PAT). This study aimed to evaluate the burden of MAC after PAT. METHODS: The (2012-2015) National Readmission Database was queried for all adult (age ≥18 y) trauma patients with penetrating injuries who underwent exploratory laparotomy and were readmitted within 6 mo of index hospitalization discharge. Patients were stratified by firearm injuries (FIs) and stab injuries (SIs). Primary outcomes were rates of MAC: intra-abdominal abscesses (IAAs), superficial surgical site infection (SSI), and fascial dehiscence within 6 mo after discharge. Secondary outcomes were both nonabdominal complications and mortality, postdischarge, and 6-mo readmission. Regression analysis was performed. RESULTS: A total of 4473 patients (FI, 2326; SI, 2147) were included in the study; the mean age was 32 ± 14 y, the Injury Severity Score was 19 (15-25), and 23% underwent damage control laparotomy (DCL). The rate of MAC within 6 mo was 22% (IAA 19%, SSI 7%, and fascial dehiscence 4%). Patients with FIs had a higher rate of IAA (27% versus 10%; P < 0.01), SSI (11% versus 3%; P < 0.01), fascial dehiscence (5% versus 3%; P = 0.03), nonabdominal complications (54% versus 24%; P < 0.01), and postdischarge mortality (8% versus 6%; P < 0.01) compared with patients with SIs . On regression analysis, DCL (P < 0.01), large bowel perforation (P < 0.01), biliary-pancreatic injury (P < 0.01), hepatic injury (P < 0.01), and blood transfusion (P = 0.02) were predictors of MAC. CONCLUSIONS: MAC developed in one in five patients after PAT. FIs have a higher potential for hollow viscus injury and peritoneal contamination, and are more predictive of MAC and nonabdominal complications, especially after DCL. LEVEL OF EVIDENCE: Level III Prognostic.


Assuntos
Abdome/cirurgia , Traumatismos Abdominais/cirurgia , Laparotomia , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Ferimentos Penetrantes/cirurgia , Abscesso Abdominal/epidemiologia , Traumatismos Abdominais/complicações , Traumatismos Abdominais/mortalidade , Adolescente , Adulto , Feminino , Humanos , Escala de Gravidade do Ferimento , Laparotomia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Deiscência da Ferida Operatória/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia , Ferimentos por Arma de Fogo/complicações , Ferimentos por Arma de Fogo/cirurgia , Ferimentos Penetrantes/complicações , Ferimentos Penetrantes/mortalidade , Ferimentos Perfurantes/complicações , Ferimentos Perfurantes/cirurgia , Adulto Jovem
3.
Medicine (Baltimore) ; 99(41): e22482, 2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33031280

RESUMO

RATIONALE: Acute pancreatitis (AP) is one of the most common diseases of gastroenterological emergency with a highly variable clinical course and the incidence being on the rise in recent years. Posttraumatic diaphragmatic hernia is an uncommon disease and may manifest immediately or several years after the incident. Delayed presentation of traumatic diaphragmatic hernia associated with AP is relatively rare. PATIENT CONCERNS: A 26-year-old male with history of left chest knife injury 10 years ago, had AP due to delayed traumatic diaphragmatic hernia 5 days after Dragon Boat Race. DIAGNOSES: Thoracoabdominal computerized tomography detected left diaphragmatic hernia with pancreatic head displacement. Emergency surgery confirmed the diagnosis. INTERVENTIONS: Emergency surgery to reduce and repair the hernia. OUTCOMES: The patient was discharged from the hospital on the sixth postoperative day and no recurrence of pancreatitis during follow-up. LESSONS: For patients without obvious etiology of AP, clinicians should be highly vigilant and inquire the history in detail. For patients with trauma, the relevant examination should be improved, and the pancreatitis caused by traumatic diaphragmatic hernia should be treated with emergency operation immediately.


Assuntos
Hérnia Diafragmática Traumática/complicações , Pancreatite/etiologia , Doença Aguda , Adulto , Hérnia Diafragmática Traumática/diagnóstico por imagem , Hérnia Diafragmática Traumática/cirurgia , Humanos , Masculino , Fatores de Tempo , Tomografia Computadorizada por Raios X , Ferimentos Perfurantes/complicações
6.
Vasc Endovascular Surg ; 54(5): 449-454, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32372719

RESUMO

BACKGROUND: Renal artery-inferior vena cava (IVC) fistula is usually caused by penetrating injury to the back. However, it is a very rarely reported entity with only 20 cases reported in the literature. They may present acutely with hemodynamic instability or chronically as congestive heart failure. A thorough examination and adequate imaging are required to avoid missing such injuries. CASE PRESENTATION: A 28-year-old gentleman presented after sustaining stab injury to the back. The stab had penetrated the renal artery and IVC, leading to arteriovenous fistula. He was managed surgically, as he went into hemorrhagic shock, with a successful outcome. The case is also unique as an accessory renal artery was also involved in the fistula. CONCLUSION: Early identification and management of renal artery-IVC fistula is important to ensure a successful outcome. Such fistulas can be managed by either endovascular approach or surgical approach. The decision of approach depends on the level of expertise available and hemodynamic status of the patient.


Assuntos
Fístula Arteriovenosa/cirurgia , Artéria Renal/cirurgia , Lesões do Sistema Vascular/cirurgia , Veia Cava Inferior/cirurgia , Ferimentos Perfurantes/complicações , Adulto , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/etiologia , Fístula Arteriovenosa/fisiopatologia , Hemodinâmica , Humanos , Masculino , Artéria Renal/diagnóstico por imagem , Artéria Renal/lesões , Artéria Renal/fisiopatologia , Choque Hemorrágico/etiologia , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/etiologia , Lesões do Sistema Vascular/fisiopatologia , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/lesões , Veia Cava Inferior/fisiopatologia
7.
Am J Case Rep ; 21: e920196, 2020 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-32146480

RESUMO

BACKGROUND Thyrocervical trunk pseudoaneurysms are rare complications that have been documented after internal jugular or subclavian venous cannulation. Even less common, these pseudoaneurysms can arise after blunt or penetrating trauma. Clinical hallmarks include an expanding supraclavicular mass with local compressive symptoms such as paresthesias, arterial steal syndrome, and Horner's syndrome. Patients may be asymptomatic, however, or present with overlying ecchymosis or the presence of a new bruit or thrill. With the risk of rupture, thyrocervical trunk pseudoaneurysm is associated with significant morbidity and mortality. CASE REPORT We report the case of a 27-year-old man who presented after sustaining a self-inflicted stab wound to zone I of his neck. Initial examination revealed only a superficial small laceration, but a chest x-ray revealed a pneumothorax, and tube thoracostomy returned 300 mL of bloody output. After resolution of the hemothorax and removal of the thoracostomy tube, the patient reaccumulated blood, requiring a repeat tube thoracostomy. Angiography at that time revealed a pseudoaneurysm of the thyrocervical trunk, and coil embolization was performed to obliterate the pseudoaneurysm. CONCLUSIONS Thyrocervical trunk pseudoaneurysms can be asymptomatic, often have a delayed presentation, and can be life-threatening due to the risk of rupture and subsequent hemodynamic decline or airway compromise. While these pseudoaneurysms are well-known complications of deep penetrating injuries, they can also present following superficial penetrating injury to zone I of the neck. Selective angiography is the imaging modality of choice. Open surgical repair was traditionally the criterion standard for treatment; however, endovascular approaches are minimally invasive, feasible, and safer alternatives with reduced complications and are becoming more common.


Assuntos
Falso Aneurisma/etiologia , Falso Aneurisma/terapia , Embolização Terapêutica , Hemotórax/etiologia , Hemotórax/terapia , Ferimentos Perfurantes/complicações , Adulto , Humanos , Masculino , Lesões do Pescoço/complicações , Toracostomia
9.
Surg Endosc ; 34(1): 261-267, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-30963262

RESUMO

BACKGROUND: Management of patients with thoracoabdominal penetrating injuries is challenging. Thoracoabdominal penetrating trauma may harbor hollow viscus injuries in both thoracic and abdominal cavities and occult diaphragmatic lesions. While radiological tests show poor diagnostic performance in these situations, evaluation by laparoscopy is highly sensitive and specific. Furthermore, minimally invasive surgery may avoid unnecessary laparotomies, despite concerns regarding complication and missed injury rates. The objective of the present study is to evaluate the diagnostic and therapeutic performance of laparoscopy in stable patients with thoracoabdominal penetrating injuries. METHODS: Retrospective analysis of hemodynamically stable patients with thoracoabdominal penetrating wounds was managed by laparoscopy. We collected data regarding the profile of the patients, the presence of diaphragmatic injury, perioperative complications, and the conversion rate. Preoperative imaging tests were compared to laparoscopy in terms of diagnostic accuracy. RESULTS: Thirty-one patients were included, and 26 (84%) were victims of a stab wound. Mean age was 32 years. Ninety-three percent were male. Diaphragmatic lesions were present in 18 patients (58%), and 13 (42%) had associated injuries. There were no missed injuries and no conversions. Radiography and computerized tomography yielded an accuracy of 52% and 75%, respectively. CONCLUSION: Laparoscopy is a safe diagnostic and therapeutic procedure in stable patients with thoracoabdominal penetrating wound, with low complication rate, and may avoid unnecessary laparotomies. The poor diagnostic performance of preoperative imaging exams supports routine laparoscopic evaluation of the diaphragm to exclude injuries in these patients.


Assuntos
Diafragma , Laparoscopia , Laparotomia , Sobremedicalização/prevenção & controle , Complicações Pós-Operatórias , Traumatismos Torácicos , Tomografia Computadorizada por Raios X/métodos , Ferimentos Perfurantes , Traumatismos Abdominais/cirurgia , Adulto , Brasil , Conversão para Cirurgia Aberta/estatística & dados numéricos , Diafragma/diagnóstico por imagem , Diafragma/lesões , Feminino , Hemodinâmica , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Laparotomia/efeitos adversos , Laparotomia/métodos , Masculino , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Traumatismos Torácicos/etiologia , Traumatismos Torácicos/fisiopatologia , Traumatismos Torácicos/cirurgia , Procedimentos Desnecessários , Ferimentos Penetrantes/diagnóstico , Ferimentos Penetrantes/cirurgia , Ferimentos Perfurantes/complicações , Ferimentos Perfurantes/diagnóstico , Ferimentos Perfurantes/cirurgia
12.
J Med Case Rep ; 13(1): 172, 2019 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-31164170

RESUMO

BACKGROUND: Aspergillus terreus, a saprophytic fungus, is recognized as an emerging pathogen in various infections in humans. However, bone and joint involvement is uncommon. To the best of our knowledge, only seven cases of spondylodiscitis caused by Aspergillus terreus have been reported previously in humans. We report a case of a patient with Aspergillus terreus spondylodiscitis following an abdominal stab wound. CASE PRESENTATION: A 74-year-old Japanese man with no particular medical history fell from a ladder and sustained a left abdominal stab wound from an L-shaped metal peg. Computed tomography showed the trace of the L-shaped metal peg from the left abdomen to the left rib and left kidney. The scan also showed an anterolateral bone avulsion of the left side of the T12 vertebral body, as well as fractures of the L1 left transverse process and the left 10th-12th ribs. He was hospitalized and treated with conservative therapy for 6 weeks. He was readmitted to the hospital with complaints of sudden back pain, numbness of both legs, and inability to walk 13 weeks after the fall. Magnetic resonance imaging findings were typical of spondylodiscitis. Gadolinium-enhanced T1-weighted magnetic resonance imaging indicated increased signal intensity at T11-T12 vertebral bodies and severe cord compression and epidural abscess at T11-T12 associated with infiltration of soft paravertebral tissues. On the seventh day after admission, he underwent partial laminectomy at T11 and posterior fusion at T9 to L2. The result of his blood culture was negative, but Aspergillus terreus was isolated from the material of T11-T12 intervertebral disc and vertebral bodies. His Aspergillus antigen was positive in a blood examination. Histological examination showed chronic suppurative osteomyelitis. On the 35th day after admission, he underwent anterior fusion at T11 and T12 with a rib bone graft. For 5 months, voriconazole was administered, and he wore a rigid corset. Posterior partial laminectomy at T11 and anterior fusion at T11 and T12 resulted in a good clinical course. The patient's neurological dysfunction was completely recovered, and his back pain disappeared. Two years after the operation, computed tomography was performed and showed bone fusion at T11 and T12. Magnetic resonance imaging revealed no evidence of increased signal intensity at T11-T12 vertebral bodies and severe cord compression and epidural abscess at T11-T12. CONCLUSIONS: To our knowledge, this is the first report of spondylodiscitis caused by Aspergillus terreus after an abdominal penetrating injury. The histological finding of chronic suppurative osteomyelitis and the radiological findings strongly suggested direct inoculation of Aspergillus terreus.


Assuntos
Traumatismos Abdominais/diagnóstico por imagem , Aspergilose/diagnóstico por imagem , Discite/diagnóstico por imagem , Abscesso Epidural/diagnóstico por imagem , Osteomielite/diagnóstico por imagem , Ferimentos Perfurantes/diagnóstico por imagem , Traumatismos Abdominais/complicações , Acidentes por Quedas , Idoso , Antifúngicos/uso terapêutico , Aspergilose/etiologia , Aspergilose/terapia , Discite/etiologia , Discite/terapia , Abscesso Epidural/etiologia , Abscesso Epidural/terapia , Fratura Avulsão/complicações , Fratura Avulsão/diagnóstico por imagem , Humanos , Laminectomia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/lesões , Imagem por Ressonância Magnética , Masculino , Osteomielite/etiologia , Osteomielite/terapia , Fraturas das Costelas/complicações , Fraturas das Costelas/diagnóstico por imagem , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/terapia , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/lesões , Voriconazol/uso terapêutico , Ferimentos Perfurantes/complicações
13.
World Neurosurg ; 129: 295-297, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31229754

RESUMO

BACKGROUND: Direct penetrating trauma to the spinal cord as a result of stabbing is rare. The vertebral column is strongly suited to protecting the vital neural structures underneath, especially in the midline. CASE DESCRIPTION: A 25-year-old woman experienced a direct stabbing injury to her spinal cord, through the midline structures, resulting in bilateral dorsal column injury. She remained intact with regard to motor function despite bilateral sensory and proprioception loss. CONCLUSIONS: Owing to the strength of the protective elements of the osseous structures surrounding the spinal cord, direct stabbing injuries usually result in incomplete neurologic deficits. This is generally manifested as a Brown-Sequard syndrome because of the midline ligamentous structures and spinous processes deflecting injuries laterally. Our patient experienced a direct midline puncture, resulting in a unique case of bilateral dorsal column injury. These injuries are generally treated conservatively, in the absence of a retained foreign body. Spinal cord stabbing injuries are a rare entity with interesting clinical and anatomic correlations.


Assuntos
Distúrbios Somatossensoriais/etiologia , Traumatismos da Medula Espinal/complicações , Ferimentos Perfurantes/complicações , Adulto , Vértebras Cervicais , Feminino , Humanos , Distúrbios Somatossensoriais/patologia , Traumatismos da Medula Espinal/patologia , Ferimentos Perfurantes/patologia
14.
Ann Vasc Surg ; 60: 479.e5-479.e9, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31195105

RESUMO

We report a case of an 18-year-old woman who developed a delayed pseudoaneurysm of the right anterior tibial artery (ATA), 14 days after a knife accidental trauma. The patient was admitted to our emergency department for acute onset of pain in the right limb after a domestic trauma. At a physical examination, the limb was tense and tender, with a pulsatile mass in the anterior compartment. Femoral, popliteal, and distal pulses were palpable on both limbs. Duplex ultrasound scan (DUS) and computed tomography angiography showed the presence of an ATA pseudoaneurysm. An urgent endovascular treatment was performed under local anesthesia via percutaneous access. Pseudoaneurysm was excluded implanting 2 coronary covered balloon-expandable stents (BeGraft; Bentley Innomed GmbH, Hechingen, Germany). Postoperative course was uneventful and the patient was discharged on the second postoperative day under dual antiplatelet therapy. One- and 13-month scheduled follow-up visits and DUS revealed the presence of a normal pedal pulse, complete pseudoaneurysm exclusion, and patency of the stent grafts and the entire ATA with triphasic waveforms. In conclusion, endovascular treatment of an ATA pseudoaneurysm seems to be a feasible option. Further experience with this technique is needed to validate its safety and long-term patency, especially in young and healthy subjects.


Assuntos
Falso Aneurisma/terapia , Angioplastia com Balão , Artérias da Tíbia/lesões , Lesões do Sistema Vascular/terapia , Ferimentos Perfurantes/complicações , Adolescente , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Angioplastia com Balão/instrumentação , Feminino , Humanos , Stents , Artérias da Tíbia/diagnóstico por imagem , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/etiologia , Ferimentos Perfurantes/diagnóstico
15.
BMJ Case Rep ; 12(4)2019 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-31040138

RESUMO

We present two children treated with endovascular techniques to gain proximal arterial control of the internal carotid and vertebral artery prior to removal of penetrating objects from the skull base. Both siblings (8-month-old and 22-month-old boys) were injured by different sharp objects (knife and scissor) by a guardian. They were transported to the emergency room where vascular control, including coil embolisation and internal carotid balloon occlusion, was performed in the neuroendovascular suite for safe removal of penetrating objects. Both minors recovered and were discharged home without any focal neurological deficits. In two children with scissor and knife stab with intracranial penetration, endovascular technique allowed safe removal of objects and ensured proximal arterial control was maintained to control for possible extravasation of blood on removal from the skull base.


Assuntos
Oclusão com Balão , Artéria Carótida Interna/diagnóstico por imagem , Corpos Estranhos/cirurgia , Artéria Vertebral/diagnóstico por imagem , Ferimentos Perfurantes/cirurgia , Oclusão com Balão/métodos , Artéria Carótida Interna/cirurgia , Angiografia Cerebral , Vítimas de Crime , Embolização Terapêutica , Procedimentos Endovasculares , Corpos Estranhos/diagnóstico por imagem , Humanos , Lactente , Masculino , Procedimentos Neurocirúrgicos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares , Artéria Vertebral/cirurgia , Ferimentos Perfurantes/complicações , Ferimentos Perfurantes/diagnóstico por imagem , Ferimentos Perfurantes/fisiopatologia
16.
World Neurosurg ; 127: 237-240, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30965173

RESUMO

BACKGROUND: We describe endovascular coil embolization of the internal carotid artery before removing a retained knife blade partially occluding the lacerum segment of the internal carotid artery. CASE DESCRIPTION: A 21-year-old male presented to the emergency department with a retained transcranial knife after sustaining a stab to the left temporal scalp. He was hemodynamically stable and neurologically intact on presentation. Computed tomography angiography followed by digital subtraction angiography revealed narrowing of the lacerum segment of the left internal carotid artery by the tip of the knife blade with adequate blood flow from the contralateral internal carotid artery. Embolization and occlusion of the internal carotid artery proximal and distal to the knife tip were performed. The patient was transferred to the neurosurgical operating room for extraction of the knife. A repeat left carotid artery angiogram post knife extraction showed no displacement of the coils and no extravasation of contrast. Follow-up imaging confirmed a good outcome. CONCLUSIONS: A staged approach of digital subtraction angiography and endovascular therapy followed by surgical treatment is a safe and effective management strategy for patients presenting with a retained transcranial knife and suspected vascular injury.


Assuntos
Artéria Carótida Interna/cirurgia , Procedimentos Endovasculares , Corpos Estranhos/cirurgia , Traumatismos Cranianos Penetrantes/cirurgia , Ferimentos Perfurantes/cirurgia , Artéria Carótida Interna/diagnóstico por imagem , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/etiologia , Traumatismos Cranianos Penetrantes/complicações , Traumatismos Cranianos Penetrantes/diagnóstico por imagem , Humanos , Masculino , Ferimentos Perfurantes/complicações , Ferimentos Perfurantes/diagnóstico por imagem , Adulto Jovem
18.
J Trauma Acute Care Surg ; 86(5): 774-782, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30741884

RESUMO

BACKGROUND: The management of high-grade renal trauma (HGRT) and the indications for intervention are not well defined. The American Association for the Surgery of Trauma (AAST) renal grading does not incorporate some important clinical and radiologic variables associated with increased risk of interventions. We aimed to use data from a multi-institutional contemporary cohort to develop a nomogram predicting risk of interventions for bleeding after HGRT. METHODS: From 2014 to 2017, data on adult HGRT (AAST grades III-V) were collected from 14 level 1 trauma centers. Patients with both clinical and radiologic data were included. Data were gathered on demographics, injury characteristics, management, and outcomes. Clinical and radiologic parameters, obtained after trauma evaluation, were used to predict renal bleeding interventions. We developed a prediction model by applying backward model selection to a logistic regression model and built a nomogram using the selected model. RESULTS: A total of 326 patients met the inclusion criteria. Mechanism of injury was blunt in 81%. Median age and injury severity score were 28 years and 22, respectively. Injuries were reported as AAST grades III (60%), IV (33%), and V (7%). Overall, 47 (14%) underwent interventions for bleeding control including 19 renal angioembolizations, 16 nephrectomies, and 12 other procedures. Of the variables included in the nomogram, a hematoma size of 12 cm contributed the most points, followed by penetrating trauma mechanism, vascular contrast extravasation, pararenal hematoma extension, concomitant injuries, and shock. The area under the receiver operating characteristic curve was 0.83 (95% confidence interval, 0.81-0.85). CONCLUSION: We developed a nomogram that integrates multiple clinical and radiologic factors readily available upon assessment of patients with HGRT and can provide predicted probability for bleeding interventions. This nomogram may help in guiding appropriate management of HGRT and decreasing unnecessary interventions. LEVEL OF EVIDENCE: Prognostic and epidemiological study, level III.


Assuntos
Hemorragia/etiologia , Nefropatias/etiologia , Rim/lesões , Nomogramas , Adulto , Feminino , Hemorragia/diagnóstico por imagem , Hemorragia/cirurgia , Hemorragia/terapia , Humanos , Escala de Gravidade do Ferimento , Rim/diagnóstico por imagem , Rim/cirurgia , Nefropatias/diagnóstico por imagem , Nefropatias/cirurgia , Nefropatias/terapia , Masculino , Pessoa de Meia-Idade , Medição de Risco , Centros de Traumatologia/estatística & dados numéricos , Resultado do Tratamento , Estados Unidos , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/cirurgia , Ferimentos não Penetrantes/terapia , Ferimentos Perfurantes/complicações , Ferimentos Perfurantes/diagnóstico por imagem , Ferimentos Perfurantes/cirurgia , Ferimentos Perfurantes/terapia , Adulto Jovem
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