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1.
Niger J Clin Pract ; 23(9): 1221-1228, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32913160

RESUMO

Background: : Vascular injuries are commonly seen in both emergency services and forensic medicine practise. They are often life-threatening, with high morbidity and mortality rates. Aims: This study aimed to retrospectively evaluate extremity vascular injuries and the associated treatment approaches. Methods: After obtaining approval from the ethics committee of the university, those patients admitted to the emergency department of Adiyaman between 1 February 2013 and 31 August 2018 were included in this study. The patients' data were obtained through the electronic records system, and the cases were evaluated according to the age, gender and cause of injury, including blunt force trauma injuries (accidents, traffic accidents, crush injuries and occupational accidents) and penetrating injuries (stabbing, gunshot wounds, suicide attempts and assaults). Additionally, the injuries were evaluated based on the extremity, according to the anatomical location and whether the injury was life-threatening. Results: This study included 76 patients with extremity vascular injuries; 65 were males (85.52%), 11 were females (14.48%) and their average age was 33.24 ± 15.85 years. Forty-five (59.2%) of the patients had upper extremity vascular injuries, and 31 (40.3%) had lower extremity vascular injuries. In addition to arterial injuries, 26 (34.21%) of the patients had venous injuries and 22 (28.94%) had nerve injuries. Nine of these patients had neurological deficits due to their nerve injuries. All of the patients were revascularized within 3-5 hours, and none of the patients required amputations. Conclusion: The primary goals in extremity vessel injury cases are to prevent mortality, especially after major vascular injuries, and save the extremity from amputation. With a fast, effective and multi-disciplinary approach, an accurate diagnosis and effective surgical intervention can prevent morbidity and mortality as well as reduce the rate of undesirable complications.


Assuntos
Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/lesões , Procedimentos Cirúrgicos Vasculares/métodos , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/cirurgia , Ferimentos Penetrantes/diagnóstico por imagem , Acidentes de Trânsito , Adolescente , Adulto , Artérias/diagnóstico por imagem , Artérias/lesões , Angiografia por Tomografia Computadorizada , Extremidades , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Ferimentos por Arma de Fogo/complicações , Ferimentos por Arma de Fogo/epidemiologia , Ferimentos por Arma de Fogo/cirurgia , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/epidemiologia , Ferimentos Penetrantes/epidemiologia , Ferimentos Penetrantes/cirurgia , Adulto Jovem
2.
Chin J Traumatol ; 23(5): 280-283, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32762981

RESUMO

PURPOSE: To investigate the accuracy and efficiency of bedside ultrasonography application performed by certified sonographer in emergency patients with blunt abdominal trauma. METHODS: The study was carried out from 2017 to 2019. Findings in operations or on computed tomography (CT) were used as references to evaluate the accuracy of bedside abdominal ultrasonography. The time needed for bedside abdominal ultrasonography or CT examination was collected separately to evaluate the efficiency of bedside abdominal ultrasonography application. RESULTS: Bedside abdominal ultrasonography was performed in 106 patients with blunt abdominal trauma, of which 71 critical patients received surgery. The overall diagnostic accordance rate was 88.68%. The diagnostic accordance rate for liver injury, spleen injury, kidney injury, gut perforation, retroperitoneal hematoma and multiple abdominal organ injury were 100%, 94.73%, 94.12%, 20.00%, 100% and 81.48%, respectively. Among the 71 critical patients, the diagnostic accordance rate was 94.37%, in which the diagnostic accordance rate for liver injury, spleen injury, kidney injury, gut perforation and multiple abdominal organ injury were 100%, 100%, 100%, 20.00% and 100%. The mean time for imaging examination of bedside abdominal ultrasonography was longer than that for CT scan (4.45 ± 1.63 vs. 2.38 ± 1.19) min; however, the mean waiting time before examination (7.37 ± 2.01 vs. 16.42 ± 6.37) min, the time to make a diagnostic report (6.42 ± 3.35 vs. 36.26 ± 13.33) min, and the overall time (17.24 ± 2.33 vs. 55.06 ± 6.96) min were shorter for bedside abdominal ultrasonography than for CT scan. CONCLUSION: Bedside ultrasonography application provides both efficiency and reliability for the assessment of blunt abdominal trauma. Especially for patients with free peritoneal effusion and critical patients, bedside ultrasonography has been proved obvious advantageous. However, for negative bedside ultrasonography patients with blunt abdominal trauma, we recommend further abdominal CT scan or serial ultrasonography scans subsequently.


Assuntos
Traumatismos Abdominais/diagnóstico por imagem , Certificação , Diagnóstico Precoce , Auxiliares de Emergência/normas , Testes Imediatos , Ultrassonografia/métodos , Ferimentos não Penetrantes/diagnóstico por imagem , Traumatismos Abdominais/epidemiologia , Análise de Dados , Emergências , Humanos , Estudos Retrospectivos , Sensibilidade e Especificidade , Tecnologia Radiológica , Fatores de Tempo , Tomografia Computadorizada por Raios X , Ferimentos não Penetrantes/epidemiologia
5.
AJR Am J Roentgenol ; 214(6): 1359-1368, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32228329

RESUMO

OBJECTIVE. The purpose of this study was to describe the epidemiology and imaging characteristics of cervical spine injuries in children with blunt trauma. MATERIALS AND METHODS. We conducted a retrospective review of the records of all patients 16 years old or younger with a diagnosis of cervical spine injury in the trauma registry of our level 1 trauma center between July 2006 and June 2018. RESULTS. Two hundred thirty-five patients were included in the study: 125 with subaxial cervical spine injuries, 87 with upper cervical spine injuries, and 23 with both subaxial and upper cervical spine injuries. The frequency of isolated upper cervical spine injuries was 73% in patients younger than 3 years old, 48% in patients 3-8 years old, and 29% in patients older than 8 years old. Seventy-one percent of occipital condyle fractures were avulsions, and 26% of dens fractures were avulsions. Type II dens fractures were found only in patients older than 8 years old. Type I and III dens fractures were almost exclusively in patients 8 years old or younger. Injuries classified as AOSpine types A, B, and C comprised 65.6%, 17.2%, and 17.2% of subaxial injuries, respectively. Despite similar mechanism of injury distribution across age groups, the frequency of AOSpine type A injuries in patients older than 8 years old (70.6%) was significantly higher compared with patients younger than 3 years old (40.0%) and those who were 3-8 years old (45.0%). The frequency of AOSpine type B injuries in patients younger than 3 years old (40.0%) was slightly higher than patients who were 3-8 years old (30.0%) and almost three times higher than in patients older than 8 years old (13.8%). CONCLUSION. Pediatric patients have high rates of upper cervical spine injuries, which tend to be distraction injuries that are frequently associated with avulsion fractures. Injury patterns in pediatric patients vary significantly by age, with patients younger than 3 years old being particularly prone to distraction type injuries.


Assuntos
Vértebras Cervicais/lesões , Imagem por Ressonância Magnética , Traumatismos da Coluna Vertebral/diagnóstico por imagem , Traumatismos da Coluna Vertebral/epidemiologia , Tomografia Computadorizada por Raios X , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/epidemiologia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Sistema de Registros , Estudos Retrospectivos , Fraturas da Coluna Vertebral/classificação , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/epidemiologia , Traumatismos da Coluna Vertebral/classificação , Centros de Traumatologia
6.
J Surg Res ; 251: 303-310, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32200321

RESUMO

BACKGROUND: There is minimal evidence evaluating the risks and benefits of laparoscopy use in hemodynamically stable children with suspected abdominal injuries. The objective of this study was to evaluate postoperative outcomes in a large cohort of hemodynamically stable pediatric patients with blunt abdominal injury. METHODS: Using the 2015-2016 National Trauma Data Bank, all patients aged <18 y with injury severity score (ISS) ≤25, Glasgow coma scale ≥13, and normal blood pressure who underwent an abdominal operation for blunt abdominal trauma were included. Patients were grouped into three treatment groups: laparotomy, laparoscopy, and laparoscopy converted to laparotomy. Treatment effect estimation with inverse probability weighting was used to determine the association between treatment group and outcomes of interest. RESULTS: Of 720 patients, 504 underwent laparotomy, 132 underwent laparoscopy, and 84 underwent laparoscopy converted to laparotomy. The median age was 10 (IQR: 7-15) y, and the median ISS was 9 (IQR: 5-14). Mean hospital length of stay was 2.1 d shorter (95% confidence interval [CI]: 0.9-3.2 d) and mean intensive care unit length of stay was 1.1 d shorter (95% CI: 0.6-1.5 d) for the laparoscopy group compared with the laparotomy group. The laparoscopy group had a 2.0% lower mean probability of surgical site infection than the laparotomy group (95% CI: 1.0%-3.0%). CONCLUSIONS: In this cohort of hemodynamically stable pediatric patients with blunt abdominal injury, laparoscopy may have improved outcomes over laparotomy.


Assuntos
Traumatismos Abdominais/cirurgia , Laparoscopia/estatística & dados numéricos , Laparotomia/estatística & dados numéricos , Ferimentos não Penetrantes/cirurgia , Traumatismos Abdominais/epidemiologia , Adolescente , Criança , Feminino , Humanos , Masculino , Estudos Retrospectivos , Estados Unidos/epidemiologia , Ferimentos não Penetrantes/epidemiologia
7.
J Pediatr Surg ; 55(5): 917-920, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32089272

RESUMO

BACKGROUND: The incidence of blunt cerebrovascular injuries (BCVIs) in children is unknown. We aimed to determine the rate and consequences of BCVIs in pediatric blunt trauma patients. METHODS: We queried the National Trauma Data Bank (NTDB) for all blunt trauma patients between 2007 and 2014. BCVI patients were identified by ICD-9 codes. Demographic, emergency room, and concomitant injury data were analyzed. RESULTS: There were 732,702 blunt trauma patients, and 1682 BCVIs were identified (0.23%). 791 (47%) sustained carotid artery injuries (CAIs), 957 (57%) had vertebral artery injuries (VAIs), and 4% of patients sustained both. A majority of the injuries occurred in white patients (61%) and in motor vehicle accidents (53%). The average age was 12.1 ±â€¯5.4 years. CAIs had more skull base fractures (55% vs 35%, p < 0.0001), and cervical spine fractures were more common in VAIs (26 vs 11%, p < 0.0001). Intensive care length of stay was longer in the CAI patients (9.2 vs 7.9 days, p = 0.03), as was length of stay (12.5 vs 9.7 days, p = 0.0002). 5% of CAI patients were coded for stroke, versus 2% of VAIs (p = 0.002). CONCLUSIONS: BCVIs are rare in children. Vertebral injuries are more common. Carotid injuries are associated with a longer length of stay and higher stroke rates. TYPE OF STUDY: Retrospective cohort study. LEVEL OF EVIDENCE: III.


Assuntos
Traumatismo Cerebrovascular/epidemiologia , Ferimentos não Penetrantes/epidemiologia , Adolescente , Adulto , Lesões das Artérias Carótidas/epidemiologia , Lesões das Artérias Carótidas/etiologia , Criança , Bases de Dados como Assunto , Feminino , Humanos , Incidência , Masculino , Estudos Retrospectivos , Fatores de Risco , Fraturas da Coluna Vertebral/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Estados Unidos/epidemiologia , Ferimentos não Penetrantes/complicações
9.
Ann Emerg Med ; 76(2): 143-148, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-31983495

RESUMO

STUDY OBJECTIVE: In the current era of frequent chest computed tomography (CT) for adult blunt trauma evaluation, many minor injuries are diagnosed, potentially rendering traditional teachings obsolete. We seek to update teachings in regard to thoracic spine fracture by determining how often such fractures are observed on CT only (ie, not visualized on preceding trauma chest radiograph), the admission rate, mortality, and hospital length of stay of thoracic spine fracture patients, and how often thoracic spine fractures are clinically significant. METHODS: This was a preplanned analysis of prospectively collected data from the NEXUS Chest CT study conducted from 2011 to 2014 at 9 Level I trauma centers. The inclusion criteria were older than 14 years, blunt trauma occurring within 6 hours of emergency department (ED) presentation, and chest imaging (radiography, CT, or both) during ED evaluation. RESULTS: Of 11,477 enrolled subjects, 217 (1.9%) had a thoracic spine fracture; 181 of the 198 thoracic spine fracture patients (91.4%) who had both chest radiograph and CT had their thoracic spine fracture observed on CT only. Half of patients (49.8%) had more than 1 level of thoracic spine fracture, with a mean of 2.1 levels (SD 1.6 levels) of thoracic spine involved. Most patients (62%) had associated thoracic injuries. Compared with patients without thoracic spine fracture, those with it had higher admission rates (88.5% versus 47.2%; difference 41.3%; 95% confidence interval 36.3% to 45%), higher mortality (6.3% versus 4.0%; difference 2.3%; 95% confidence interval 0 to 6.7%), and longer length of stay (median 9 versus 6 days; difference 3 days; P<.001). However, thoracic spine fracture patients without other thoracic injury had mortality similar to that of patients without thoracic spine fracture (4.6% versus 4%; difference 0.6%; 95% confidence interval -2.5% to 8.6%). Less than half of thoracic spine fractures (47.4%) were clinically significant: 40.8% of patients received thoracolumbosacral orthosis bracing, 10.9% had surgery, and 3.8% had an associated neurologic deficit. CONCLUSION: Thoracic spine fracture is uncommon. Most thoracic spine fractures are associated with other thoracic injuries, and mortality is more closely related to these other injuries than to the thoracic spine fracture itself. More than half of thoracic spine fractures are clinically insignificant; surgical intervention is uncommon and neurologic injury is rare.


Assuntos
Hospitalização/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Mortalidade , Traumatismo Múltiplo/epidemiologia , Fraturas da Coluna Vertebral/epidemiologia , Traumatismos Torácicos/epidemiologia , Vértebras Torácicas/lesões , Ferimentos não Penetrantes/epidemiologia , Acidentes por Quedas , Acidentes de Trânsito , Adulto , Idoso , Vértebras Cervicais/lesões , Clavícula/lesões , Feminino , Hemotórax/epidemiologia , Humanos , Escala de Gravidade do Ferimento , Vértebras Lombares/lesões , Masculino , Pessoa de Meia-Idade , Motocicletas , Pedestres , Radiografia Torácica , Fraturas das Costelas/epidemiologia , Escápula/lesões , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Tomografia Computadorizada por Raios X , Ferimentos não Penetrantes/diagnóstico por imagem
10.
Ann Vasc Surg ; 66: 250-262, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31923601

RESUMO

BACKGROUND: Isolated dissections of the celiac artery (CA) after blunt trauma are rarely described. This retrospective analysis and systematic review analyzes epidemiology, radiologic examinations, patterns of injuries, therapeutic measures, clinical courses, and outcomes. METHODS: Retrospective analysis of polytraumatized patients admitted between 1997 and 2012 to a trauma center level I. Systematic literature search was carried out on pubmed.gov, eurorad.org, and google.com. RESULTS: Isolated traumatic dissections of the CA had an incidence of 0.17% in a retrospective collective (n = 9). Mean age was 31.7 years in 6 male (66.7%) and 3 female (33.3%) patients. Systematic literature search identified 12 primary sources describing 13 males (100%) with a mean age of 41.3 years. Traffic accidents and falls were the most common causes of injury. An intimal flap (77.7%) and a thrombosed false lumen (59.1%) were the most common computed tomographic findings. Twenty-two patients were analyzed, and 16 patients were treated conservatively. The CA was bypassed in 2 symptomatic patients. One patient was treated with a stent. Two patients died because of massive bleeding, and 1 patient died because of liver failure. About 19 discharged patients were asymptomatic on follow-up. Long-term follow-up with magnetic resonance angiography showed stable dissections (n = 1), medium stenosis (n = 1), resolution of the dissection (n = 2), high-grade stenosis of the CA combined with a small pseudoaneurysm (n = 1), or occlusion of the CA with sufficient collateralization (n = 3). Pharmaceutical treatment was individualized with low-molecular-weight heparin, heparin, or warfarin, and acetylicsalicylic acid. CONCLUSIONS: Traumatic CA dissections are mostly caused by traffic accidents and falls. Visceral perfusion should be monitored clinically and radiologically. Beginning visceral ischemia requires early invasive treatment. Endovascular and open surgery are possible options. Benefits of specific pharmaceuticals are still up for debate. Follow-up via magnetic resonance imaging or computed tomography angiography is essential to rule out vascular complications. LEVEL OF EVIDENCE: III (Retrospective therapeutic study and systematic literature review).


Assuntos
Aneurisma Dissecante/epidemiologia , Artéria Celíaca/lesões , Lesões do Sistema Vascular/epidemiologia , Ferimentos não Penetrantes/epidemiologia , Adolescente , Adulto , Idoso , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/mortalidade , Aneurisma Dissecante/cirurgia , Artéria Celíaca/diagnóstico por imagem , Tratamento Conservador , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/mortalidade , Lesões do Sistema Vascular/cirurgia , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/mortalidade , Ferimentos não Penetrantes/cirurgia
11.
Ulus Travma Acil Cerrahi Derg ; 26(1): 80-85, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31942746

RESUMO

BACKGROUND: This study aims to investigate the factors associated with mortality in patients with traumatic diaphragmatic rupture (TDR). METHODS: The records of patients who were operated on at a single hospital with the indication of blunt or penetrating thoracoabdominal injuries between January 2010 and June 2018 and who were perioperatively diagnosed with a diaphragmatic injury were evaluated retrospectively. The details of demographic characteristics, the type and localization of the trauma, presence and number of associated organ injuries, vital signs at admission, time from admission until surgery, type of operation, type of diaphragmatic repair, therapeutic approach, complications and Injury Severity Score (ISS) were analyzed. RESULTS: A total of 92 patients were included in this study. The mortality rate throughout the postoperative period was 15.2%. A penetrating injury was detected in 77.2% of the patients. Associated organ injury was most frequently in the liver, which was significant as a factor that increased mortality (p=0.020). The mortality rate was significantly lower among patients who underwent repair of diaphragmatic rupture when compared with untreated patients (p=0.003). Atelectasis was the most common complication. An ISS ≥24 points in patients with TDR was found to be an independent risk factor associated with mortality (p=0.003). CONCLUSION: Other organs are frequently involved in cases of TDR, and mortality increased significantly in cases with associated liver injury. An ISS of ≥24 was determined to be an independent risk factor associated with mortality. Since the main determinant of mortality was the presence or absence of additional organ injuries, it is important that this should be taken into consideration in these patients.


Assuntos
Diafragma/lesões , Traumatismos Torácicos/epidemiologia , Ferimentos não Penetrantes/epidemiologia , Ferimentos Penetrantes/epidemiologia , Humanos , Escala de Gravidade do Ferimento , Estudos Retrospectivos , Ruptura
12.
Injury ; 51(1): 59-65, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31431334

RESUMO

BACKGROUND: Data for establishing the optimal management modalities for pancreatic injury are lacking. Herein, we aimed to describe the epidemiology, identify mortality predictors, and determine the optimal management strategy for pancreatic injury. METHODS: We identified patients with pancreatic injury between 2004 and 2017 recorded in the Japan Trauma Data Bank. The primary outcome was mortality. Multivariable logistic regression analyses were used to identify factors significantly associated with mortality and to develop a predictive model. Patients were also classified according to the Organ Injury Scaling of the American Association for the Surgery of Trauma (AAST grade I/II or III/IV). Outcomes were compared based on significant confounder-adjusted treatment strategy. RESULTS: Overall, 743 (0.25%) patients had pancreatic injury. Traffic accident was the most common aetiology. The overall mortality rate was 17.5%, while it was 4.7% for isolated pancreatic injury. AAST grade, Revised Trauma Scale score on arrival, age, and coexistence of severe abdominal injury aside from pancreatic injury were independently associated with mortality. A predictive model for mortality comprising these four variables showed excellent performance, with an area under the receiver operating characteristic curve of 0.89 (95% confidence interval [CI], 0.85-0.93). The in-hospital mortality was higher in patients who underwent celiotomy than in those who did not among those with AAST grade I/II (15.1% vs. 5.3%) and III/IV (13.8% vs. 12.3%). After adjusting for confounders, these differences were not significant with the adjusted odds ratios of 1.41 (95% CI, 0.55-3.60) and 0.54 (95% CI, 0.17-1.67) for AAST grade I/II and III/IV, respectively. CONCLUSIONS: AAST grade, Revised Trauma Scale score on arrival, age, and coexistence of severe abdominal injury aside from pancreatic injury were prognostic factors of mortality after pancreatic injury. Confounder-adjusted analysis did not show that operative management was superior to non-operative management for survival. Non-operative management may be a reasonable strategy for select pancreatic injury patients, especially in institutions where expertise in interventional endoscopy is available.


Assuntos
Traumatismos Abdominais/epidemiologia , Gerenciamento Clínico , Pâncreas/lesões , Pancreatopatias/epidemiologia , Ferimentos não Penetrantes/epidemiologia , Traumatismos Abdominais/complicações , Traumatismos Abdominais/terapia , Adulto , Idoso , Feminino , Mortalidade Hospitalar/tendências , Humanos , Incidência , Escala de Gravidade do Ferimento , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Pancreatopatias/etiologia , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/terapia , Adulto Jovem
13.
Am J Emerg Med ; 38(8): 1572-1575, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-31500924

RESUMO

OBJECTIVES: Computed tomography (CT) utilization is widespread in contemporary Emergency Departments (EDs). CT overuse leads to radiation exposure, contrast toxicity, overdiagnosis, and incidental findings. This study explores the prevalence of clinically significant injuries in patients identified as low-risk trauma patients (LRTPs) using newly created criteria that account for the patient's age, trauma mechanism, assessability (which relies on level of consciousness, intoxication, and neurologic deficits), vital signs and other evidence of hypoperfusion, bleeding risk, and past medical history. METHODS: This was a 6-month retrospective chart review of all LRTPs presenting to a level 1 trauma center in Queens, New York. Data abstraction was performed independently by two abstractors and discrepancies adjudicated by the senior author. Patients were identified using the hospital trauma registry and two reports, created by the researchers, identifying selected chief complaints and discharge diagnoses. RESULTS: 750 patients were identified of which 352 (46.93%) received one or more CT scans. There were a total of 790 CT scans ordered, of which 731 (92.53%) were negative for acute injury. There were 13 clinically significant injuries of which only one (0.13%) required immediate intervention. There were no mortalities in this LRTP group. CONCLUSION: The prevalence of clinically significant injuries in this population is very low and injuries requiring immediate intervention are even lower. CT utilization in LRTPs should be guided by an explicit consideration of benefit and harm for each patient.


Assuntos
Tomografia Computadorizada por Raios X , Centros de Traumatologia , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/epidemiologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Cidade de Nova Iorque/epidemiologia , Prevalência , Estudos Retrospectivos
14.
Ann Vasc Surg ; 67: 67-70, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31678545

RESUMO

BACKGROUND: The prevalence of a bovine aortic arch configuration is higher in patients treated for thoracic aortic aneurysms and type B dissection; its prevalence in aortic isthmic trauma has not been described. METHODS: A case control study was performed comparing consecutive patients treated at our institution for acute isthmic aortic transection after blunt trauma between 2002 and 2019 and a control group of consecutive sex-matched individuals undergoing imaging for nonaortic disease. Imaging and clinical findings were reviewed. Subjects were divided into bovine and nonbovine groups and prevalence was compared. The length of the aortic segment between the left subclavian artery (LSA) and the next proximal great vessel was measured in the control population and a comparison was performed between bovine and nonbovine aortic arch subjects. RESULTS: Thirty-three consecutive (30 male) patients were reviewed, 66 individuals (60 male) were included in the control group. A higher incidence of bovine arch in trauma patients was found: 57.6% vs. 34.8% (P = 0.007). The median (range, mm) and mean (SD) distance between the bovine trunk and the LSA were 13 mm (2-27) and 12.4 mm (5.9), respectively, compared with 5 mm (1-27) and 7.8 mm (6.1) between the left common carotid and LSA in nonbovine aortic arches (P < 0.005). CONCLUSION: A higher incidence of bovine arch in patients reaching out for surgical treatment for traumatic isthmic aortic transection was found in our population. Clinical interpretation of this finding can lead to several alternatives. Confirmation with larger series and data on prevalence of this anatomic variation in nonsurvivors is needed to provide a better understanding of this finding.


Assuntos
Aorta Torácica/anormalidades , Malformações Vasculares/epidemiologia , Procedimentos Cirúrgicos Vasculares , Lesões do Sistema Vascular/cirurgia , Ferimentos não Penetrantes/cirurgia , Adolescente , Adulto , Idoso , Pontos de Referência Anatômicos , Aorta Torácica/diagnóstico por imagem , Aortografia , Estudos de Casos e Controles , Chile/epidemiologia , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prevalência , Artéria Subclávia/diagnóstico por imagem , Malformações Vasculares/diagnóstico por imagem , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/epidemiologia , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/epidemiologia , Adulto Jovem
15.
J Surg Res ; 247: 541-546, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31648812

RESUMO

BACKGROUND: Retained rectal foreign bodies are a common but incompletely studied problem. This study defined the epidemiology, injury severity, and outcomes after rectal injuries following foreign body insertion. METHODS: Twenty-two level I trauma centers retrospectively identified all patients sustaining a rectal injury in this AAST multi-institutional trial (2005-2014). Only patients injured by foreign body insertion were included in this secondary analysis. Exclusion criteria were death before rectal injury management or ≤48 h of admission. Demographics, clinical data, and outcomes were collected. Study groups were defined as partial thickness (AAST grade I) versus full thickness (AAST grades II-V) injuries. Subgroup analysis was performed by management strategy (nonoperative versus operative). RESULTS: After exclusions, 33 patients were identified. Mean age was 41 y (range 18-57), and 85% (n = 28) were male. Eleven (33%) had full thickness injuries and 22 (67%) had partial thickness injuries, of which 14 (64%) were managed nonoperatively and 8 (36%) operatively (proximal diversion alone [n = 3, 14%]; direct repair with proximal diversion [n = 2, 9%]; laparotomy without rectal intervention [n = 2, 9%]; and direct repair alone [n = 1, 5%]). Subgroup analysis of outcomes after partial thickness injury demonstrated significantly shorter hospital length of stay (2 ± 1; 2 [1-5] versus 5 ± 2; 4 [2-8] d, P = 0.0001) after nonoperative versus operative management. CONCLUSIONS: Although partial thickness rectal injuries do not require intervention, difficulty excluding full thickness injuries led some surgeons in this series to manage partial thickness injuries operatively. This was associated with significantly longer hospital length of stay. Therefore, we recommend nonoperative management after a retained rectal foreign body unless full thickness injury is conclusively identified.


Assuntos
Tratamento Conservador/estatística & dados numéricos , Corpos Estranhos/complicações , Reto/lesões , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Ferimentos não Penetrantes/epidemiologia , Adolescente , Adulto , Feminino , Corpos Estranhos/terapia , Humanos , Escala de Gravidade do Ferimento , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Reto/diagnóstico por imagem , Reto/cirurgia , Estudos Retrospectivos , Centros de Traumatologia/estatística & dados numéricos , Resultado do Tratamento , Ferimentos não Penetrantes/diagnóstico , Ferimentos não Penetrantes/etiologia , Ferimentos não Penetrantes/terapia , Adulto Jovem
16.
Acad Emerg Med ; 27(4): 291-296, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31811732

RESUMO

BACKGROUND: In the era of frequent head-to-pelvis computed tomography (CT) for adult blunt trauma evaluation, we sought to update teachings regarding aortic injury by determining 1) the incidence of aortic injury; 2) the proportion of patients with isolated aortic injury (without other concomitant thoracic injury); 3) the clinical implications of aortic injury (hospital mortality, length of stay [LOS], and rate of surgical interventions); and 4) the screening value of traditional risk factors/markers (such as high-energy mechanism and widened mediastinum on chest x-ray [CXR]) for aortic injury, compared to newer criteria from the recently developed NEXUS Chest CT decision instrument (DI). METHODS: We conducted a preplanned analysis of patients prospectively enrolled in the NEXUS Chest studies at 10 Level I trauma centers with the following inclusion criteria: age > 14 years, blunt trauma within 6 hours of ED presentation, and receiving chest imaging during ED trauma evaluation. RESULTS: Of 24,010 enrolled subjects, 42 (0.17%, 95% confidence interval [CI] = 0.13% to 0.24%) had aortic injury. Most patients (79%, 95% CI = 64% to 88%) had an associated thoracic injury, with rib fractures, pneumothorax/hemothorax, and pulmonary contusion occurring most frequently. Compared to patients without aortic injury this cohort had similar mortality (9.5%, 95% CI = 3.8% to 22.1% vs. 5.8%, 95% CI = 5.4% to 6.3%), longer median hospital LOS (11 days vs. 3 days, p < 0.01), and higher median Injury Severity Score (29 vs. 5, p < 0.001). High-energy mechanism and widened mediastinum on CXR had low sensitivity for aortic injury (76% [95% CI = 62% to 87%] and 33% [95% CI = 21% to 49%], respectively), compared to the NEXUS Chest CT DI (sensitivity 100% [95% CI = 92% to 100%]). CONCLUSIONS: Aortic injury is rare in adult ED blunt trauma patients who survive to receive imaging. Most ED aortic injury patients have associated thoracic injuries and survive to hospital discharge. Widened mediastinum on CXR and high-energy mechanism have relatively low screening sensitivity for aortic injury, but the NEXUS Chest DI detected all cases.


Assuntos
Aorta/lesões , Traumatismos Torácicos/epidemiologia , Ferimentos não Penetrantes/epidemiologia , Adulto , Idoso , Aorta/diagnóstico por imagem , Estudos de Casos e Controles , Feminino , Mortalidade Hospitalar , Humanos , Incidência , Escala de Gravidade do Ferimento , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Tomografia Computadorizada por Raios X/métodos , Centros de Traumatologia/estatística & dados numéricos , Imagem Corporal Total , Ferimentos não Penetrantes/diagnóstico por imagem
17.
World Neurosurg ; 133: e385-e390, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31521761

RESUMO

BACKGROUND: Optimal management of patients with extracranial blunt cerebrovascular injury (BCVI) remains controversial, with both anticoagulation and antiplatelet therapy being recommended. The purpose of this study was to evaluate the efficacy and safety of using acetylsalicylic acid (ASA) in the management of BCVI. METHODS: Patients with BCVI were identified from the registry of a Level 1 trauma center between 2010 and 2017. Digital imaging and electronic medical records were reviewed for patient information including demographic characteristics, injury type, therapy, outcomes, and follow-up. RESULTS: Over the study period, 13,578 patients were admitted following blunt trauma, with 94 (0.7%) having confirmed BCVI (mean age, 42 years; 72% male). Mean Injury Severity Score and Glasgow Coma Score were 27 and 10, respectively. BCVI was identified in 130 vessels with Biffl grade I (38%) and grade II injury (29%) being most common. Twelve (13%) patients experienced an ischemic event, but only 3 events occurred after diagnosis. ASA was primary treatment for 56 (60%) patients. Thirty patients (32%) received no treatment; 21 patients died within 24 hours of primary injury. Only 4 patients had ASA contraindications. Four patients (7%) had ASA-related complications; there were 2 cases of intracranial hemorrhage progression and 2 cases of gastrointestinal bleeding. Follow-up vascular imaging at a mean of 36 days demonstrated stable or improved levels of BCVI in 94% of patients. CONCLUSIONS: An ASA-based management strategy for BCVI was efficacious and relatively safe in this study. This approach may be the preferred treatment for BCVI, but confirmation is needed.


Assuntos
Aspirina/uso terapêutico , Traumatismo Cerebrovascular/tratamento farmacológico , Inibidores da Agregação de Plaquetas/uso terapêutico , Ferimentos não Penetrantes/tratamento farmacológico , Adolescente , Adulto , Idoso , Aneurisma Dissecante/etiologia , Anticoagulantes/efeitos adversos , Anticoagulantes/uso terapêutico , Aspirina/efeitos adversos , Lesões das Artérias Carótidas/tratamento farmacológico , Artéria Carótida Interna , Traumatismo Cerebrovascular/complicações , Traumatismo Cerebrovascular/epidemiologia , Gerenciamento Clínico , Avaliação de Medicamentos , Feminino , Hemorragia/induzido quimicamente , Mortalidade Hospitalar , Humanos , Escala de Gravidade do Ferimento , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/epidemiologia , Inibidores da Agregação de Plaquetas/efeitos adversos , Estudos Retrospectivos , Acidente Vascular Cerebral/etiologia , Artéria Vertebral/lesões , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/epidemiologia , Adulto Jovem
18.
Am J Emerg Med ; 38(8): 1588-1593, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-31699428

RESUMO

OBJECTIVE: It is unclear if additional computerized tomography (CT) imaging is warranted after injuries are identified on CT in blunt trauma patients. The objective of this study was to determine the incidence and significance of injuries identified on secondary CT imaging after identification of injuries on initial CTs in blunt trauma patients. METHODS: This was a retrospective cohort study at an academic Level 1 trauma center with a two-tiered trauma system. INCLUSION CRITERIA: age ≥ 18, level 2 trauma activation, injury identified on initial CT, and secondary CTs ordered. Secondary injuries were categorized as resulting in: no changes, minor changes, or major changes in management. RESULTS: 537 patients underwent 1179 initial CT scans which identified 744 injuries. There were 1094 secondary CTs which identified 143 additional injuries in 94 (18%) patients. 9 (1.7%) patients had at least one major management change and 64 (12%) had at least one minor management change. Rib fracture(s) was the most common injury on secondary scans [45/143 (32%)]. The major management changes were: tube thoracostomy for pneumothorax (4 patients), blood transfusion for hemoperitoneum (1 patient), surgery for acetabular fracture (1 patient), thoracolumbar brace for spine fracture (2 patients) and angiography for splenic injury (1 patient). CONCLUSION: While a significant proportion of patients (18%) had injuries on secondary CT, only 1.7% of patients had a resultant major management change. Future research is warranted to determine the need for additional CT imaging after an initial selective imaging strategy in blunt trauma patients.


Assuntos
Retratamento/estatística & dados numéricos , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/epidemiologia , Adulto , Idoso , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Centros de Traumatologia
19.
Injury ; 51(2): 334-339, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31866131

RESUMO

INTRODUCTION: Bladder rupture following blunt pelvic trauma is rare though can have significant sequelae. We sought to determine whether machine learning could help predict the presence of bladder injury using certain factors at the time of presentation of blunt pelvic trauma. MATERIALS AND METHODS: Adult patients at a Level I trauma center with blunt trauma pelvic fractures from January 1, 2005 to December 31, 2017 were identified. Patients with admission urinalysis data, fracture ICD 9 codes, and mechanism of injury available in the trauma registry were included. Patients with bladder rupture and pelvic fracture were compared to those with pelvic fracture alone. The classification of results was performed using the MATLAB Classification Learner Tool. The classification performances were tested by machine learning algorithms in the domains of Decision Tree, Logistic Regression, Naïve Bayes, Support Vector Machine (SVM), Nearest Neighbor (KNN), and Ensemble classifiers. RESULTS: Of the 3063 eligible pelvic fracture patients identified, 208 (6.8%) had concomitant bladder ruptures. Twenty machine learning algorithms were then tested based on pelvic fracture ICD-9 code, admission urinalysis, and mechanism of injury. The best classification results were obtained using the Gaussian Naïve Bayes and Kernel Naïve Bayes classifiers, both with accuracy of 97.8%, specificity of 99%, sensitivity of 83%, and area under the curve (AUC) of the ROC curve of 0.99. CONCLUSION: Machine learning algorithms can be used to help predict with a high level of accuracy the presence of bladder rupture with blunt pelvic trauma using readily available information at the time of presentation. This has the potential to improve selection of patients for additional imaging, while also more appropriately allocating hospital resources and reducing patient risks.


Assuntos
Fraturas Ósseas/epidemiologia , Aprendizado de Máquina , Ossos Pélvicos/lesões , Bexiga Urinária/lesões , Ferimentos não Penetrantes/epidemiologia , Área Sob a Curva , Teorema de Bayes , Bases de Dados Factuais , Árvores de Decisões , Fraturas Ósseas/diagnóstico por imagem , Humanos , Modelos Logísticos , Ossos Pélvicos/diagnóstico por imagem , Curva ROC , Radiografia , Estudos Retrospectivos , Ruptura/diagnóstico , Ruptura/epidemiologia , Bexiga Urinária/diagnóstico por imagem , Doenças da Bexiga Urinária/classificação , Washington/epidemiologia , Ferimentos não Penetrantes/diagnóstico por imagem
20.
S Afr Med J ; 110(11): 1110-1112, 2020 10 28.
Artigo em Inglês | MEDLINE | ID: mdl-33403988

RESUMO

BACKGROUND: Trauma care places a significant burden on the South African (SA) healthcare system, and this has not changed significantly in recent history. We speculated that the COVID-19 lockdown regulations (travel restriction and alcohol ban) would affect trauma patterns. OBJECTIVES: To compare the burden and nature of trauma over the COVID-19 lockdown period with the equivalent period over the past 5 years using routinely collected data from the Pietermaritzburg Metropolitan Trauma Service in KwaZulu-Natal Province, SA. METHODS: All trauma patients admitted to Grey's Hospital in Pietermaritzburg between 23 March 2015 and 31 May 2020 were identified and reviewed. RESULTS: A total of 8 859 trauma patients were admitted over the 6-year period, with a total of 1 676 admitted during the periods 23 March - 31 May. These 1 676 formed the study cohort. Of these patients, 998 had sustained blunt trauma, 665 penetrating trauma, and 13 a combination of blunt and penetrating trauma. A total of 14 categories of blunt trauma were reviewed, of which the three most common were assault, motor vehicle accidents (MVAs) and pedestrian vehicle accidents (PVAs). Between 23 March and 31 May 2020, a total of 23 patients were victims of blunt assault. The median number of assault victims over the equivalent period during the previous 5 years was 48. The 5 preceding years had a median of 56 MVAs and 33 PVAs, compared with 23 and 10 during the lockdown. The median number of gunshot wound (GSW) victims for the preceding years was 41, compared with 30 during the lockdown. During the lockdown, 24 stab wound victims were admitted, compared with a median of 73 for the preceding years. The proportion of females who sustained penetrating trauma and blunt assault increased significantly during the lockdown. The proportion of females sustaining a GSW or blunt trauma secondary to an MVA remained constant. CONCLUSIONS: The study showed that during the period of lockdown in SA there was a significant decrease in MVAs, PVAs and interpersonal violence. Assaults involving a knife seemed to decrease dramatically, but the rate of GSWs remained constant.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Distribuição por Sexo , Violência/estatística & dados numéricos , Ferimentos por Arma de Fogo/epidemiologia , Ferimentos não Penetrantes/epidemiologia , Ferimentos Perfurantes/epidemiologia , Feminino , Humanos , Masculino , Pedestres , África do Sul/epidemiologia , Ferimentos e Lesões/epidemiologia
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