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1.
Surgery ; 167(5): 829-835, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32143843

RESUMO

BACKGROUND: Splenectomy is the life-saving treatment for high-grade spleen trauma. Splenectomized patients are at a significant infection risk. However, the trauma-induced splenectomy results in less incidence of postsplenectomy infection than the hematologic disorder. We conducted a large-scale study to identify the infection rate and management strategy in trauma-related splenic injuries. METHODS: We included patients with the diagnosis of spleen injury in Taiwan from January 2003 to December 2013 by using the National Health Insurance Database and divided them into spleen preserved and splenectomized groups. The demographic factors including age, sex, hospital level, year of injury, trauma mechanism, associated injuries, whether injury severity score ≧16, and comorbidities were extracted. A 1:1 propensity score match was performed, and we analyzed the long-term outcome as the presence of infection-related disease (septicemia, pneumonia, and meningitis) after spleen trauma. The multivariate logistic regression analysis was used to identify the risk factor for each outcome. RESULTS: During the 11 years included in this study, a total of 8,897 patients with spleen trauma were identified. A total of 3,520 (39.6%) patients were splenectomized, and 5,377 (60.4%) were spleen preserved. After propensity score matching, 3,099 pairs of patients were enrolled for further analysis. In univariate analysis, the incidence of pneumonia is significantly higher in the splenectomized group (8.5% vs 7.0%, P = .037). There was no significant difference in septicemia and meningitis between the 2 groups. In multivariate analysis, splenectomy is an independent risk factor for pneumonia in long-term follow-up. CONCLUSION: Compared with the spleen preserved group, splenectomy is related to an increased likelihood of long-term pneumonia onset but not to an increase in the possibility of other infections.


Assuntos
Traumatismos Abdominais/epidemiologia , Pneumonia/epidemiologia , Pneumonia/etiologia , Esplenectomia/efeitos adversos , Traumatismos Abdominais/complicações , Traumatismos Abdominais/cirurgia , Adulto , Comorbidade , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Vigilância da População , Pontuação de Propensão , Medição de Risco , Fatores de Risco , Esplenectomia/métodos , Esplenectomia/estatística & dados numéricos , Adulto Jovem
3.
Ulus Travma Acil Cerrahi Derg ; 25(5): 489-496, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31475332

RESUMO

BACKGROUND: In most respects, the vast majority of pelvic injuries is not of a life-threatening status, but co-presence of other injuries needs to be diagnosed. This study aims to evaluate associated pelvic and extra-pelvic visceral organ injuries of the patients with closed pelvic fractures. METHODS: This retrospective study was conducted with 471 adult patients who had been admitted to our Emergency Service with the diagnosis of pelvic fractures. Type of fractures, accompanying visceral organ injuries, the demographic data, type of operation, mortality rates were recorded and analysed statistically. RESULTS: The rate of operations carried out by the general surgery clinic or other surgical clinics in each type of fracture according to AO classification did not differ (p=0.118). In patients with A2, A3 and B1 types of fractures, the operation rate of general surgery clinic did not show a significant difference. However, most of the patients who had extrapelvic surgery were in the mild severity pelvic trauma, such as AO A2 and A3. A total of 31 patients were ex-patients, 17 of whom had AO-A2 type of fractures. The findings showed that there was a significant difference between abdominal ultrasonography outcome that was normal and non-orthopedic surgery types (p<0.001). There was no significant difference between the types of surgery performed and Abdominal CT outcome, which was normal (p=0.215). CONCLUSION: In the management of patients with pelvic fractures irrespective of its type or grade, the findings suggests that greater attention should be paid to not to overlook the associated injuries. Early blood and imaging tests are encouraged after the patient's hemodynamic status is stabilized.


Assuntos
Traumatismos Abdominais , Fraturas Ósseas , Ossos Pélvicos/lesões , Traumatismos Abdominais/complicações , Traumatismos Abdominais/epidemiologia , Fraturas Ósseas/complicações , Fraturas Ósseas/epidemiologia , Humanos , Estudos Retrospectivos
4.
Ethiop J Health Sci ; 29(4): 503-512, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31447524

RESUMO

Background: Abdominal injury is among the major causes of trauma admissions. The aim was to determine etiology, commonly injured organs, indication and outcome of patients with abdominal injuries requiring laparotomy. Methods: A retrospective study of all adult patients who underwent laparotomy for abdominal injury at St. Paul's Hospital Millennium Medical College was conducted from January 2014 to December 2016. The factors associated with outcome were identified with bivariate and multivariate logistic regressions. Results: Laparotomy for abdominal injury was performed for 145 patients. Of these, 129 (89%) case records were retrieved. The male to female ratio was 6.2:1. The mean age was 29 years, and most of them were unemployed. Penetrating trauma was the commonest injury, stab (46, 35.7%) and Road Traffic Accidents (RTA) (27, 20.9%) being the leading causes. Extra-abdominal injuries were seen in 33.3% (46) of the cases. Hollow organs were commonly injured than solid organs. Small intestine (35, 43.8%) and Spleen (17, 34.7%) were the leading injured organs in penetrating and blunt respectively. The main procedure performed was repair of hollow and solid organ laceration/perforation (70,54.3%). The negative laparotomy rate was 4.6% (6). Complications were seen in 23(17.8%) patients, the commonest being irreversible shock (7,30.4%). The mortality rate was 8.5 % (11), and it was significantly associated with blunt abdominal injury (AOR=7.25; 95% CI 1.09-48.37; p=0.041) and systolic blood pressure<90mmHg (AOR=8.66; 95% CI 1.1-68.41; p=0.041). Conclusion: Stab and RTA were the commonest indications of laparotomy. The mortality was significantly associated with blunt abdominal injury and hypotension (SBP<90mmHg).


Assuntos
Traumatismos Abdominais/cirurgia , Hospitais de Ensino/estatística & dados numéricos , Laparotomia/estatística & dados numéricos , Traumatismos Abdominais/epidemiologia , Traumatismos Abdominais/mortalidade , Traumatismos Abdominais/patologia , Adulto , Etiópia/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Ferimentos não Penetrantes/epidemiologia , Ferimentos não Penetrantes/patologia , Ferimentos não Penetrantes/cirurgia , Ferimentos Penetrantes/epidemiologia , Ferimentos Penetrantes/patologia , Ferimentos Penetrantes/cirurgia , Adulto Jovem
5.
S Afr J Surg ; 57(3): 54, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31392866

RESUMO

BACKGROUND: Humans come into contact and interact with an array of animals in a number of areas and environments. We set out to review our experience with animal-related injuries in Pietermaritzburg, KwaZulu-Natal, South Africa. METHOD: All patients who sustained an injury secondary to an interaction with an animal in the period December 2012-December 2017 were identified from the Hybrid Electronic Medical Registry (HEMR). RESULTS: There were 104 patients in the study sample. The mean age of patients in the study was 32.8 years, with a range from 1 to 76 years old. 75% (n = 78) were male and 25% (n = 26) female. Out of the 104 animal-related injuries, 67 were blunt trauma, 39 penetrating trauma and 3 a combination of blunt and penetrating trauma. The species causing trauma included dogs (53), horses (29), cows (18), buffalo (1), warthog (1), impala (1) and a single goat (1). The median time from injury to hospitalisation was 46.62 hours (range from 0 to 504 hours). Injuries occurred to the head (n = 32), face (n = 9), neck (n = 32), abdomen (n = 22), urogenital system (n = 6), upper limb (n = 39) and lower limb (n = 39). The Injury Severity Score (ISS) mean for the patients was 8.16, the range 1-4, the median 9 and the standard deviation 6.88. In 49 patients the treatment was non-operative. In the remaining 55 patients, a total of 68 operative procedures were required. Operations included wound debridement/surgical washout (n = 38), laparotomy (n = 9), arterial repair/ligation (n = 8), skin graft (n = 4), craniotomy (n = 5), fasciotomy (n = 2), amputation (n = 1), and placement of an ICP monitor (n = 1). 49 of these operations were for patients with dog bite injuries. The mean hospital stay was 0.13 days with a range of 0-4 days. Four patients were admitted to the Intensive Care Unit (ICU) and two patients died. CONCLUSION: Human interactions with animals may result in injuries which require surgical treatment. The most common animal injury is a dog bite but in the case of the larger domestic farm animals, blunt force type injuries and goring can result in significant injuries which require complex surgical interventions.


Assuntos
Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/cirurgia , Traumatismos Abdominais/epidemiologia , Adolescente , Adulto , Idoso , Animais , Bovinos , Criança , Pré-Escolar , Traumatismos Craniocerebrais/epidemiologia , Traumatismos Craniocerebrais/terapia , Cães , Feminino , Cavalos , Humanos , Lactente , Escala de Gravidade do Ferimento , Tempo de Internação , Extremidade Inferior/lesões , Masculino , Pessoa de Meia-Idade , Lesões do Pescoço/epidemiologia , Lesões do Pescoço/terapia , Estudos Retrospectivos , África do Sul/epidemiologia , Tempo para o Tratamento , Centros de Traumatologia , Extremidade Superior/lesões , Sistema Urogenital/lesões , Ferimentos e Lesões/terapia , Adulto Jovem
6.
World J Emerg Surg ; 14: 43, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31467588

RESUMO

Background: Abdominal aortic injury (AAI) is a life-threatening condition that occurs in only 0.1% of all trauma admissions. Because of its rarity, the clinical features of AAI remain unclear. We investigated the characteristics, treatments, and clinical outcomes among patients with AAI. Methods: This retrospective cohort study was performed using the Japanese Diagnosis Procedure Combination database. We identified patients with a confirmed diagnosis of AAI with emergency admission from 1 July 2010 to 31 March 2017. Eligible patients were divided into three groups: those who were treated with no surgery or endovascular treatment (non-repair group), those who underwent surgery without endovascular treatment (open repair group), and those who received endovascular treatment without surgery (endovascular repair group). Results: A total of 238 patients met the inclusion criteria during the study period. Of these, 191 (80.3%) were allocated to the non-repair group, 20 (8.4%) were allocated to the open repair group, and 27 (11.3%) were allocated to the endovascular repair group. The proportions of patients in the non-repair group from July 2010 to March 2012, April 2012 to March 2014, April 2014 to March 2016, and April 2016 to March 2017 were 93.5%, 75.9%, 80.6%, and 73.2%, respectively. The crude in-hospital mortality rate was 26.2%, 35.0%, and 18.5% in the non-repair, open repair, and endovascular repair group, respectively. Conclusions: In this cohort, the proportion of non-repair for AAI decreased from 2010 to 2017, whereas the proportion of endovascular repair increased. Younger patients were more likely to undergo open repair, whereas older patients were more likely to undergo endovascular repair.


Assuntos
Traumatismos Abdominais/cirurgia , Aorta Abdominal/lesões , Avaliação de Resultados em Cuidados de Saúde/normas , Traumatismos Abdominais/complicações , Traumatismos Abdominais/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Aorta Abdominal/cirurgia , Estudos de Coortes , Feminino , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Estudos Retrospectivos , Resultado do Tratamento
7.
Pan Afr Med J ; 32: 77, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31223368

RESUMO

Pancreatic pseudocyst is a rare benign condition, in particular among children. It is an intra or extra pancreatic juice collection lacking of an epithelial lining. We conducted a retrospective study of 7 children whose medical record data were collected in the Department of Paediatric Surgery at the University Hospital Hassan II in Fez, over a period of 11 years, from 1 January 2005 to 31 December 2016. All children were male, their average age was 6.6 years (15 months - 12 years). An history of abdominal trauma was found in 4 cases, abdominal bloating, pain, vomiting and transit disorders were the primary reason for consultation. Clinical examination showed epigastric tenderness and an alteration of the general state in all cases. Abdominal ultrasound as well as abdominal CT scan helped to diagnose pancreatic pseudocyst before surgery. Six patients, out of a total of seven, underwent surgery; we opted for internal bypass (gastro-cystic anastomosis) in 4 cases, external bypass in 2 cases and therapeutic abstention in one case. Pancreatic pseudocysts are rare. Nevertheless, they are the most frequent (80% of pancreatic cystic lesions are pseudocysts and due to acute and/or chronic pancreatitis, pancreatic trauma or pancreatic ductal obstruction).


Assuntos
Traumatismos Abdominais/epidemiologia , Dor Abdominal/etiologia , Pseudocisto Pancreático/diagnóstico por imagem , Traumatismos Abdominais/complicações , Dor Abdominal/epidemiologia , Criança , Pré-Escolar , Hospitais Universitários , Humanos , Lactente , Masculino , Pseudocisto Pancreático/fisiopatologia , Pseudocisto Pancreático/cirurgia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Vômito/epidemiologia , Vômito/etiologia
8.
J Laparoendosc Adv Surg Tech A ; 29(8): 1052-1059, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31237470

RESUMO

Purpose: To characterize injury patterns and institutional trends associated with the utilization of laparoscopy in the management of pediatric abdominal trauma. Methods: The National Trauma Data Bank (2010-2014) was queried for encounters involving patients ≤14 years who underwent an open or laparoscopic abdominal operation within 48 hours of emergency department arrival. Patient, injury, and hospital characteristics associated with each approach were identified. Multivariate logistic regression was used to evaluate the influence of patient and hospital characteristics on operative approach. Results: Laparoscopy comprised 7.8% (n = 355) of all abdominal trauma operations. Patients undergoing laparoscopy had lower injury severity scores and higher Glasgow Coma Scale scores on arrival compared with laparotomy subjects (P < .001). Laparoscopic patients also had a shorter length of hospital stay (5.0 versus 8.6 days, P < .001), but longer time to the operating room (9.2 versus 6.3 hours, P < .001) compared with their open counterparts. The proportion of cases managed laparoscopically increased from 6.2% in 2010 to 10.1% in 2014 (P = .013), with increase in utilization primarily driven by university hospitals (P = .026) and level I pediatric trauma centers (P = .043). Conversion to laparotomy was uncommon (18.6%), and mortality in the laparoscopic cohort was low (0.4%). Conclusions: Use of laparoscopy has increased in the pediatric abdominal trauma population, typically in a less injured cohort of patients. As familiarity with and availability of minimally invasive techniques increase, this trend will likely continue.


Assuntos
Traumatismos Abdominais/cirurgia , Laparoscopia/estatística & dados numéricos , Laparotomia/estatística & dados numéricos , Procedimentos Cirúrgicos Minimamente Invasivos/estatística & dados numéricos , Ferimentos e Lesões/cirurgia , Traumatismos Abdominais/epidemiologia , Adolescente , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Humanos , Tempo de Internação , Modelos Logísticos , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Estados Unidos , Ferimentos e Lesões/epidemiologia
9.
Rev. cuba. cir ; 58(2): e766, mar.-jun. 2019. tab
Artigo em Espanhol | LILACS | ID: biblio-1093158

RESUMO

RESUMEN Introducción: El trauma de abdomen tiene alta incidencia y con frecuencia afecta el colon y el recto, se aboga por el tratamiento mediante sutura primaria. Objetivo: Identificar diferencias en las características clínico-quirúrgicas y resultados terapéuticos de pacientes con lesiones traumáticas de colon y recto, tratados con sutura primaria y técnicas derivativas. Método: Se realizó un estudio multicéntrico descriptivo ambispectivo para determinar características clínico-quirúrgicas y resultados terapéuticos en pacientes con lesiones traumáticas de colon y recto en los hospitales Carlos J. Finlay, Joaquín Albarrán, Calixto García y Enrique Cabrera de La Habana, en el periodo 2010-2015. El universo estuvo conformado por todos los pacientes intervenidos quirúrgicamente por trauma de colon y/o recto. Resultados: La colostomía fue el proceder más frecuente (53,1 por ciento). Los pacientes en edades medias de la vida (promedio: 43,5 años), sexo masculino (71,4 por ciento), evolución hasta el tratamiento quirúrgico menor de 12 horas (73,4 por ciento); causadas por empalamientos y otros (49 por ciento) y heridas con arma blanca (38,8 por ciento). La magnitud del daño de colon y recto fue baja, con mayor afectación de colon izquierdo. La frecuencia de complicaciones graves y mortalidad fue alta en la colostomía. Conclusiones: La sutura primaria muestra mejores resultados terapéuticos y debe ser la técnica de elección en las lesiones traumáticas de colon y recto intraperitoneal(AU)


ABSTRACT Introduction: Abdominal trauma presents high incidence and often affects the colon and rectum; primary suture is the preferred treatment. Objective: To identify differences between the clinical-surgical characteristics and the therapeutic outcomes in patients with traumatic lesions of the colon and rectum, treated with primary suture and derivative techniques. Method: A multicentric, descriptive and ambispective study was carried out to determine the clinical-surgical characteristics and the therapeutic outcomes in patients with traumatic colon and rectal lesions in Carlos J. Finlay, Joaquín Albarrán, Calixto García and Enrique Cabrera Hospitals in Havana, in the period from 2010 to 2015. The study population was made up of all patients surgically intervened for colon and/or rectal trauma. Results: The colostomy was the most frequent procedure (53.1 percent). Patients in middle ages of life (average: 43.5 years), male sex (71.4 percent), evolution to surgical treatment under 12 hours (73.4 percent); caused by impalement and others (49 percent) and cutting wounds (38.8 percent). The magnitude of colon and rectum damage was low, with greater involvement of the left colon. The frequency of serious complications and mortality was high in the colostomy. Conclusions: Primary suture shows better therapeutic results and should be the technique of choice in traumatic lesions of the intraperitoneal colon and rectum(AU)


Assuntos
Humanos , Masculino , Adulto , Reto/lesões , Colostomia/mortalidade , Técnicas de Sutura/efeitos adversos , Colo/lesões , Traumatismos Abdominais/epidemiologia , Epidemiologia Descritiva
10.
Ulus Travma Acil Cerrahi Derg ; 25(3): 238-246, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31135937

RESUMO

BACKGROUND: Knowledge of the utility of angiographic embolization (AE) in pediatric cases of blunt abdominal solid organ trauma injuries is limited. The current study is an examination of AE as an effective and reliable method to control bleeding in patients with persistent bleeding due to blunt trauma-induced abdominal solid organ injury. METHODS: This was a retrospective examination of patients <17 years of age who had experienced blunt abdominal solid organ injury and who presented at a single institution within 4 years. A statistical analysis of the data was performed. RESULTS: The mean length of intensive care unit stay was 4 days for those who underwent embolization (n=11), and the mean length of hospital stay was 12 days. The average pre-AE blood loss, as measured by the decrease in hematocrit (%) from admission to embolization, was -7.33+-5.3% (p<0.001). The average post-AE blood loss, as measured by the change in hematocrit 72 hours post AE, was 2+-0.97% (p>0.05). All of the patients were discharged with a full recovery. CONCLUSION: AE was a safe and effective method to control solid organ hemorrhage in pediatric patients with blunt abdominal injuries.


Assuntos
Traumatismos Abdominais , Angiografia , Embolização Terapêutica , Hemorragia , Traumatismos Abdominais/diagnóstico por imagem , Traumatismos Abdominais/epidemiologia , Traumatismos Abdominais/terapia , Adolescente , Criança , Hemorragia/diagnóstico por imagem , Hemorragia/epidemiologia , Hemorragia/terapia , Humanos , Tempo de Internação/estatística & dados numéricos , Estudos Retrospectivos
11.
Am Surg ; 85(4): 390-396, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-31043200

RESUMO

In the past, injuries to the adrenal glands due to blunt trauma were considered rare, and were reported to be associated with high Injury Severity Scores (ISSs) and high mortality. Recent reports have reported a much high incidence associated with lower ISS and lower mortality. The purpose of this study was to assess the incidence of adrenal gland injuries due to blunt trauma in a large state trauma registry and determine whether these injuries are associated with a higher ISS and increased risk for mortality. A retrospective review was performed on the New York State Trauma Registry comparing blunt injured adults with adrenal injuries to those who did not. Concurrent organ injuries, ISS, and inhospital mortality were compared. Three hundred thirty-nine patients with adrenal gland injuries were identified. Concurrent liver and kidney injuries were more prevalent in the adrenal injured group, and concurrent injuries to the small and large intestine and spleen were more prevalent in the nonadrenal injured group. There was no difference in ISS or mortality between the adrenal injured and nonadrenal injured populations. The results of this study are consistent with recent smaller studies which identified incidence rates which were higher than previously reported and that ISS and mortality risk were unchanged by the presence of blunt adrenal gland injuries. Adrenal gland injuries due to blunt trauma are not uncommon, with an incidence rate of 0.61 per cent. Adrenal gland injuries are not associated with higher ISS or an increased risk of mortality.


Assuntos
Traumatismos Abdominais/epidemiologia , Glândulas Suprarrenais/lesões , Ferimentos não Penetrantes/epidemiologia , Traumatismos Abdominais/diagnóstico , Adulto , Idoso , Feminino , Humanos , Incidência , Escala de Gravidade do Ferimento , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , New York/epidemiologia , Sistema de Registros , Estudos Retrospectivos , Ferimentos não Penetrantes/diagnóstico
12.
Pediatr Surg Int ; 35(7): 793-801, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31076868

RESUMO

PURPOSE: Distribution and outcomes of traumatic injury of the esophagus (TIE) in pediatric versus adult populations are unknown. Our study sought to perform a descriptive analysis of TIE in children and adults. METHODS: We reviewed the National Trauma Data Bank (NTDB) for the years 2010-2015. Demographics, characteristics, and outcomes of pediatric (age < 16 years) and adult TIE patients were described and compared. RESULTS: Among 526,850 pediatric and 3,838,895 adult trauma patients, 90 pediatric (0.02%) and 1,411 (0.04%) adult TIE patients were identified. Demographics and esophageal injury severity did not differ. Children were more likely to sustain blunt trauma (63% versus 37%), with the most common mechanism being transportation-related accidents, were less-severely injured (median ISS 14 versus 22), and had fewer associated injuries (79% versus 95%) and complications (30% versus 51%) (all p < 0.001). Children had shorter hospitalizations (median 5 versus 10 days) and were more likely to be discharged home (84% versus 64%) (both p = 0.01). In-hospital mortality did not differ significantly between children and adults (10% versus 19%, p = 0.09). CONCLUSION: TIE in the pediatric population has unique characteristics compared to adults: it is more likely to be a result of blunt trauma, has lower injury burden, and has more favorable clinical outcomes.


Assuntos
Traumatismos Abdominais/epidemiologia , Esôfago/lesões , Traumatismo Múltiplo , Sistema de Registros , Traumatismos Torácicos/epidemiologia , Centros de Traumatologia/estatística & dados numéricos , Ferimentos não Penetrantes/epidemiologia , Traumatismos Abdominais/diagnóstico , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Mortalidade Hospitalar/tendências , Humanos , Incidência , Lactente , Recém-Nascido , Escala de Gravidade do Ferimento , Tempo de Internação/tendências , Masculino , Traumatismos Torácicos/diagnóstico , Estados Unidos/epidemiologia , Ferimentos não Penetrantes/diagnóstico , Adulto Jovem
13.
Am Surg ; 85(3): 292-293, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30947777

RESUMO

The aim of this study was to characterize the outcomes of traumatic abdominal and pelvic vascular injuries. Using the 2012 National Trauma Data Bank, we identified 5858 patients with major abdominal and/or pelvic vascular injury. Patients were stratified by age group, gender, race, Injury Severity Score (ISS), and mechanism of injury. We evaluated the percentage of patients with blunt and penetrating trauma by demographic and correlated the mechanism of injury to the ISS score, emergency room disposition, and hospital disposition. We performed a logistic regression analysis to calculate predictors of death. In the final cohort, 1458 patients (25%) with abdominal/pelvic vascular injury died of trauma. In total, 3368 patients (57%) had a blunt mechanism of injury, whereas 2353 (40%) were victims of a penetrating trauma. Patients with penetrating injuries were 1.72 times more likely to die from their injuries than those with blunt traumas. Patients with higher ISS scores (>16) were more likely to die from their injuries than patients with lower ISS scores. Men were more likely to experience a penetrating vascular injury than women (48% vs 17%). Similarly, 77 per cent of black patients had a penetrating mechanism of injury compared with 20 per cent of white patients. There were 1910 patients with penetrating injuries (81%) that went immediately from the emergency room to the OR, compared with 1287 patients with blunt injuries (38%). Of the patients with blunt injuries, 695 (21%) died, whereas 727 (31%) patients with penetrating injuries died. Abdominal and pelvic traumatic vascular injuries carry a high mortality rate. Penetrating mechanism of injury, ISS score, and race are independent predictors of mortality.


Assuntos
Traumatismos Abdominais/epidemiologia , Lesões do Sistema Vascular/epidemiologia , Traumatismos Abdominais/diagnóstico , Traumatismos Abdominais/terapia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Humanos , Lactente , Recém-Nascido , Escala de Gravidade do Ferimento , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida , Estados Unidos/epidemiologia , Lesões do Sistema Vascular/diagnóstico , Lesões do Sistema Vascular/terapia , Adulto Jovem
14.
Isr Med Assoc J ; 21(4): 279-282, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31032572

RESUMO

BACKGROUND: Horse riding has become increasingly popular in recent years and is a common activity among children. As a result, pediatric horse-related injuries are frequently encountered in emergency departments. OBJECTIVES: To examine the characteristics of horse-related injuries in the pediatric population. METHODS: We collected and analyzed the data on all pediatric horse-related injuries presented to a tertiary hospital, level one trauma center, during the years 2006-2016. RESULTS: A total of 53 children with horse-related injuries were documented. Forty-two patients were male (79%) and their mean age was 11.13 ± 4.72 years. The most common mechanism of injury was falling off a horse (31 patients, 58%) and the most common type of injury was skeletal (32 patients, 60%). Head injuries occurred in 16 patients (30%) and facial injuries in 12 (23%). The mean Injury Severity Score (ISS) was 10.5 ± 6.32, and 15 patients (28%) had severe trauma (ISS > 15). Twenty-nine patients (55%) required trauma team intervention, 12 (23%) were admitted to the intensive care unit, and 24 (45%) required surgery. The mean length of hospitalization was 4.3 ± 3.14 days. CONCLUSIONS: Our study suggests that horse-related trauma may involve serious injuries and it exhibits typical injury patterns. Young boys are at highest risk. The potential severity of these injuries merits a thorough evaluation. We suggest that these injuries be triaged appropriately, preferably to a medical facility with proper trauma capabilities.


Assuntos
Traumatismos Abdominais/epidemiologia , Acidentes por Quedas/estatística & dados numéricos , Traumatismos Craniocerebrais/epidemiologia , Fraturas Ósseas/epidemiologia , Traumatismos da Coluna Vertebral/epidemiologia , Ferimentos não Penetrantes/epidemiologia , Fatores Etários , Animais , Criança , Feminino , Cavalos , Hospitalização/estatística & dados numéricos , Humanos , Escala de Gravidade do Ferimento , Israel , Tempo de Internação/estatística & dados numéricos , Masculino , Fatores Sexuais
15.
Rev Col Bras Cir ; 46(1): e2064, 2019 Mar 21.
Artigo em Português, Inglês | MEDLINE | ID: mdl-30916209

RESUMO

OBJECTIVE: to evaluate the evolution of severe abdominal trauma patients, for whom the massive transfusion protocol was triggered, and who were submitted to Computed Axial Tomography (CAT) in the emergency room (ER), in order to verify the patient's prognosis and the diagnostic efficiency of CAT in this scenario. METHODS: retrospective, longitudinal and observational study performed at a referral center for trauma care in Curitiba, Parana, Brazil. We selected 60 severe abdominal trauma patients who had massive transfusion protocol activation and divided them into two groups: patients who underwent CAT at ER and patients who did not. We verified the diagnostic accuracy of CAT-scan examination and compared the number of deaths, hospitalization time, and transfused blood components in both groups. RESULTS: considering the 60 patients, 66.67% received red blood cells at ER; 33.3% underwent CAT on admission due to hemodynamic improvement, and 66.7% did not perform the examination at the entrance. The percentage of deaths was 35% in both groups. Considering the two groups, the difference between the mean lengths of hospital stay was not statistically significant, as well as the difference between the mean numbers of transfused red blood cells. In the group that underwent CAT, 45% did not require exploratory laparotomy. CONCLUSION: CAT could be rapidly performed in patients with hemodynamic instability on arrival at ER, sparing some patients from an unnecessary exploratory laparotomy and not significantly influencing mortality.


Assuntos
Traumatismos Abdominais/diagnóstico por imagem , Transfusão de Sangue , Choque Hemorrágico/diagnóstico por imagem , Traumatismos Abdominais/classificação , Traumatismos Abdominais/epidemiologia , Adulto , Brasil , Confiabilidade dos Dados , Feminino , Humanos , Laparotomia , Tempo de Internação , Masculino , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Choque Hemorrágico/epidemiologia , Tomografia Computadorizada por Raios X
16.
Mil Med ; 184(Suppl 1): 261-264, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30901412

RESUMO

BACKGROUND: To fully understand the injury mechanisms during an underbody blast (UBB) event with military vehicles and develop new testing standards specific to military vehicles, one must understand the injuries sustained by the occupants. METHODS: Injury data from Service Members (SM) involved in UBB theater events that occurred from 2010 to 2014 were analyzed. Analysis included the investigation of prominent skeletal and visceral torso injuries. Results were categorized by killed-in-action (n = 132 SM) and wounded-in-action (n = 1,887 SM). RESULTS: Over 90% (553/606 SM) of casualties in UBB events with Abbreviated Injury Scale (AIS) 2+ injury sustained at least one skeletal fracture, when excluding concussion. The most frequent skeletal injuries from UBB were foot fractures (13% of injuries) for wounded-in-action and tibia/fibula fractures (10% of injuries) for killed-in-action. Only 1% (11/1037 SM) of all casualties with AIS 2+ injuries had visceral torso injuries without also sustaining skeletal fractures. In these few casualties, the coded injuries were likely due to trauma from a loading path other than direct UBB loading. CONCLUSION: Skeletal fractures are the most frequent AIS 2+ injury resulting from UBB events. Visceral torso injuries are infrequent in individuals that survive and they generally occur in conjunction with skeletal injuries.


Assuntos
Traumatismos por Explosões/complicações , Militares/estatística & dados numéricos , Veículos Off-Road/estatística & dados numéricos , Traumatismos Abdominais/epidemiologia , Traumatismos por Explosões/epidemiologia , Explosões/estatística & dados numéricos , Humanos , Traumatismos da Perna/epidemiologia , Veículos Off-Road/normas , Sistema de Registros/estatística & dados numéricos , Terrorismo/estatística & dados numéricos , Traumatismos Torácicos/epidemiologia , Estados Unidos/epidemiologia
17.
J Pediatr Surg ; 54(8): 1621-1627, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30773396

RESUMO

BACKGROUND/PURPOSE: Our objective was to evaluate hospital factors, including children's hospital status, associated with higher costs for blunt solid organ pediatric abdominal trauma. METHODS: We queried the 2012 Healthcare Cost and Utilization Project (HCUP) Kid's Inpatient Database (KID) for patients 18 years or younger with low-grade and high-grade blunt abdominal trauma. We calculated total hospital costs and adjusted cost ratios (CR) controlling for patient and hospital-level characteristics. RESULTS: The 2012 KID included 882 low-grade and 222 high-grade pediatric abdominal trauma patients. Median (interquartile range) per hospitalization costs were similar at children's and nonchildren's hospitals for both low-grade (children's = $6575 [$4333-$10,862], nonchildren's $7027 [$4230-$12,219] p = 0.47) and high-grade (children's = $10,984 [$6211- $20,007] nonchildren's $10,156 [$5439-$18,404] p = 0.55) groups. Adjusted cost ratios demonstrated higher costs in the West and among investor owned hospitals for low-grade and high-grade injuries, respectively. Costs at rural hospitals were higher in both groups (low-grade CR = 2.35 95% CI 2.02, 2.74, high-grade CR = 2.78 95% CI 2.13, 3.63) compared to urban teaching hospitals. Cost ratios did not differ based on children's hospital status. CONCLUSION: Hospital costs were similar for children's and nonchildren's hospitals caring for pediatric abdominal trauma. Costs at rural hospitals are higher and may suggest financial instability or nonstandardized care of pediatric trauma patients. LEVEL OF EVIDENCE: III.


Assuntos
Traumatismos Abdominais , Custos Hospitalares/estatística & dados numéricos , Ferimentos não Penetrantes , Traumatismos Abdominais/economia , Traumatismos Abdominais/epidemiologia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estados Unidos/epidemiologia , Ferimentos não Penetrantes/economia , Ferimentos não Penetrantes/epidemiologia
18.
Cir Cir ; 87(2): 183-189, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30768058

RESUMO

Introduction: Trauma is a leading cause of morbimortality in the world. Intraabdominal compartment is the third most affected anatomical region and bleeding from this origin is difficult to identify, therefore the importance to predict possible lesions to the abdominal cavity. Objective: To describe and analyze the sociodemographic profile and injuries found in patients with abdominal trauma in a western hospital in Mexico. Method: Consecutive patients included in the local registry GDL-SHOT were analyzed. Results: From 4961 patients, 91.4% were men, with a mean age of 28.7 years. Regarding the mechanism of trauma, 39.7% were stab wounds, 33% blunt abdominal trauma and 27.3% gunshots. The most affected organs were: small bowel (20.9%), liver (18.2%), and colon (14.2%). The mean hospital stay was 6.95 days with a mortality of 6.74%. Conclusion: In Mexico, abdominal trauma represents an important cause of morbidity and mortality, especially in young patients. We found an important amount of penetrating trauma.


Assuntos
Traumatismos Abdominais/epidemiologia , Ferimentos por Arma de Fogo/epidemiologia , Ferimentos não Penetrantes/epidemiologia , Ferimentos Perfurantes/epidemiologia , Traumatismos Abdominais/etiologia , Traumatismos Abdominais/mortalidade , Adulto , Colo/lesões , Feminino , Mortalidade Hospitalar , Humanos , Intestino Delgado/lesões , Tempo de Internação/estatística & dados numéricos , Fígado/lesões , Masculino , México/epidemiologia , Distribuição por Sexo , Fatores Socioeconômicos , Baço/lesões , Ferimentos por Arma de Fogo/etiologia , Ferimentos por Arma de Fogo/mortalidade , Ferimentos não Penetrantes/etiologia , Ferimentos não Penetrantes/mortalidade , Ferimentos Perfurantes/etiologia , Ferimentos Perfurantes/mortalidade
19.
Emergencias (Sant Vicenç dels Horts) ; 31(1): 15-20, feb. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-182431

RESUMO

Objetivo. Conocer la epidemiología y distribución de los traumatismos abdominales en nuestro medio. Evaluar el comportamiento y fiabilidad de la aplicación de índices pronósticos de gravedad analizando su correlación con las decisiones terapéuticas y los resultados obtenidos Método. Estudio retrospectivo en el que se han incluido todos los pacientes con diagnóstico de traumatismo abdominal grave ingresados en un hospital español de referencia, entre 2009 y 2015. Se registraron variables epidemiológicas, clínicas y de resultados, así como la puntuación de distintos índices pronósticos. Resultados. Muestra 153 pacientes, con mediana de edad de 38 años y predominio masculino (73,9%). Correspondieron a traumatismos de tipo cerrado (94,1%) y su etiología principal los accidentes de tráfico (60,1%). El bazo fue el órgano más frecuentemente afectado (44,4%), seguido por el hígado (36,6%). La mediana de la estancia hospitalaria fue de 11 días y la mortalidad global de 13%. Aunque el 62,7% se manejó con éxito de forma conservadora, se observó una mayor puntuación de Injury Severity Score (ISS) y Trauma and Injury Severity Score (TRISS) en aquellos pacientes que precisaron tratamiento quirúrgico (p = 0,0001), en los que fallecieron (p = 0,0001) y en aquellos con mayor estancia hospitalaria (RTS -Reevised Trauma Score- p = 0,001 y TRISS p = 0,016). Conclusiones. La etiología de los traumatismos abdominales y los balances lesionales en nuestro medio fueron similares a los observados a nivel nacional. La puntuación en las escalas estudiadas tuvo una asociación directa con la necesidad de tratamiento quirúrgico, los días de estancia hospitalaria, la morbilidad y la mortalidad


Objectives. To describe the abdominal injuries treated in our hospital. We assessed the behavior and reliability of prognostic scales, analyzing the correlations between them and therapeutic decisions and outcomes. Methods. Retrospective study including all patients with major abdominal injuries admitted to our hospital between 2009 and 2015. We gathered epidemiologic and clinical data, outcomes, and scores on several prognostic scales. Results. The median age of the 153 patients we identified from case records was 38 years; 73.9% were males. Most cases involved blunt trauma (94.1%) sustained in traffic accidents (60.1%). The spleen and the liver were the organs most often affected (in 44.4% and 36.6%, respectively). The median length of stay in the hospital was 11 days, and overall mortality was 13%. Although conservative management was successful in 62.7% of the cases, we found that patients who had a higher ISS (Injury Severity Score) or TRISS (Trauma and Injury Severity Score) assessments more often required surgery or died (P=.0001, both comparisons). Those who had longer hospital stays had a higher Revised Trauma Score or TRISS (P=.001 and P=.016, respectively). Conclusions. The causes of abdominal injuries and the types treated in our hospital were similar to those described for the rest of Spain. Punctuation on prognostic severity scales correlated directly with the need for surgery, length of hospital stay, complications, and mortality


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Traumatismos Abdominais/epidemiologia , Índices de Gravidade do Trauma , Traumatismos Abdominais/diagnóstico , Traumatismos Abdominais/terapia , Prognóstico , Estudos Retrospectivos , Espanha/epidemiologia , Resultado do Tratamento , Centros de Atenção Terciária
20.
Emergencias ; 31(1): 15-20, 2019 02.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30656868

RESUMO

OBJECTIVES: To describe the abdominal injuries treated in our hospital. We assessed the behavior and reliability of prognostic scales, analyzing the correlations between them and therapeutic decisions and outcomes. MATERIAL AND METHODS: Retrospective study including all patients with major abdominal injuries admitted to our hospital between 2009 and 2015. We gathered epidemiologic and clinical data, outcomes, and scores on several prognostic scales. RESULTS: The median age of the 153 patients we identified from case records was 38 years; 73.9% were males. Most cases involved blunt trauma (94.1%) sustained in traffic accidents (60.1%). The spleen and the liver were the organs most often affected (in 44.4% and 36.6%, respectively). The median length of stay in the hospital was 11 days, and overall mortality was 13%. Although conservative management was successful in 62.7% of the cases, we found that patients who had a higher ISS (Injury Severity Score) or TRISS (Trauma and Injury Severity Score) assessments more often required surgery or died (P=.0001, both comparisons). Those who had longer hospital stays had a higher Revised Trauma Score or TRISS (P=.001 and P=.016, respectively). CONCLUSION: . The causes of abdominal injuries and the types treated in our hospital were similar to those described for the rest of Spain. Punctuation on prognostic severity scales correlated directly with the need for surgery, length of hospital stay, complications, and mortality.


Assuntos
Traumatismos Abdominais/epidemiologia , Traumatismos Abdominais/diagnóstico , Traumatismos Abdominais/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Espanha/epidemiologia , Centros de Atenção Terciária , Índices de Gravidade do Trauma , Resultado do Tratamento , Adulto Jovem
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