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Detection of bruising in living animal victims of abuse can be challenging due to animal temperament and anatomy. Visual assessment, combined with physical and serum biochemical evaluation, can fail to detect injuries. However, development and validation of a noninvasive, antemortem method for detecting bruising in domestic species could have important medicolegal implications. Key clinical message: Thermal imaging utilizing infrared wavelengths can assist in detection of trauma in cases of animal abuse where no visible injuries are apparent, aiding in providing appropriate medical treatment and guidance for the legal system.
Thermographie infrarouge pour la détection de traumatismes contondants lors d'enquêtes sur la maltraitance des animauxLa détection des ecchymoses chez les animaux vivants victimes de maltraitance peut s'avérer difficile en raison du tempérament et de l'anatomie de l'animal. L'évaluation visuelle, combinée à l'évaluation physique et une analyse biochimique sérique, peut ne pas détecter les blessures. Cependant, le développement et la validation d'une méthode ante-mortem non invasive pour détecter les meurtrissures chez les espèces domestiques pourraient avoir d'importantes implications médico-légales.Message clinique clé :L'imagerie thermique utilisant des longueurs d'onde infrarouges peut aider à détecter les traumatismes dans les cas de maltraitance animale où aucune blessure visible n'est apparente, contribuant ainsi à fournir un traitement médical approprié et à guider le système judiciaire.(Traduit par Dr Serge Messier).
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Bienestar del Animal , Termografía , Heridas no Penetrantes , Animales , Perros/lesiones , Contusiones/veterinaria , Contusiones/diagnóstico , Rayos Infrarrojos , Termografía/veterinaria , Termografía/métodos , Heridas no Penetrantes/veterinaria , Heridas no Penetrantes/diagnóstico por imagenRESUMEN
We experienced an extremely rare case of blunt traumatic aortic arch pseudoaneurysm( BTAAPA) and report it with literature review. A 40-year-old asymptomatic man with chest X-ray abnormality visited our hospital. Contrast-enhanced computed tomography( CT) scans revealed saccular aortic-isthmus aneurysm, and BTAAPA was diagnosed because of a history of multiple severe traffic trauma 21 years before. The patient underwent replacement of the distal aortic arch and proximal descending aorta under partial cardiopulmonary bypass through left posterolateral thoracotomy. The postoperative course was uneventful. BTAAPA is exceedingly uncommon, and our comprehensive literature search identified only 9 cases including the present case. The age at diagnosis was 10 to 76 years, 7 cases were males, and most of the traumas were due to traffic accidents. The present case had the longest duration (21 years) from the trauma to the diagnosis. Six patients underwent thoracic endovascular aortic repair with good prognosis.
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Aneurisma Falso , Aorta Torácica , Heridas no Penetrantes , Humanos , Masculino , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/cirugía , Aneurisma Falso/etiología , Adulto , Aorta Torácica/lesiones , Aorta Torácica/cirugía , Aorta Torácica/diagnóstico por imagen , Heridas no Penetrantes/complicaciones , Heridas no Penetrantes/cirugía , Heridas no Penetrantes/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Injury to the popliteal artery after knee dislocation, if not promptly diagnosed and properly treated, can have devastating results. The purpose of this retrospective study was to describe the diagnostic and the treatment protocol we use, as well as provide long-term outcomes for a series of patients treated in our tertiary hospital, emphasizing on the importance of ankle-brachial index (ABI) measurement as an integral component of the diagnostic approach. METHODS: A retrospective analysis of all admissions to our hospital trauma center between November 1996 and July 2023, with a diagnosis of knee dislocation and the presence or absence of concomitant arterial injury resulting from blunt high-energy trauma, was conducted. Before 2006, digital subtraction angiography (DSA) and/or computed tomography angiography (CTA) were part of the diagnostic approach (group A). After 2006, the ABI was used as a first-line test to diagnose arterial damage (group B). The Tegner and Lysholm scores were chosen to assess patients' postoperative impairment between groups, taking also into account the presence or absence of vascular injury. The Mann-Whitney U test and a univariate analysis of variance were used for the statistical analysis of scores. RESULTS: Overall, 55 patients were identified, and 21 of them (38.2%) had injuries to the popliteal artery, all of which were treated with a reversed great saphenous venous bypass. Out of the 21 patients, 4 (4.3%) developed compartment syndrome, which was treated with fasciotomies, and 1 leg (1.8%) was amputated above the knee. With no patients lost to follow-up, all but one (95%) of the vascular repairs are still patent, and the limbs show no signs of ischemia after a mean follow-up of 6 years. The Tegner and Lysholm score means were similar between groups A and B and independent of the presence of vascular injury and the diagnostic protocol used. Interestingly, an ABI below 0.9 proved to be predictive of arterial injury. CONCLUSIONS: A high level of awareness for the presence of popliteal artery injury should exist and an ABI measurement should be routinely performed in the management of all cases of knee dislocation. This way, fewer patients will undergo unnecessary CTA scanning, and hardly any popliteal artery injuries can go missing, as suggested by our study.
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Índice Tobillo Braquial , Luxación de la Rodilla , Arteria Poplítea , Lesiones del Sistema Vascular , Heridas no Penetrantes , Humanos , Arteria Poplítea/lesiones , Arteria Poplítea/diagnóstico por imagen , Arteria Poplítea/cirugía , Arteria Poplítea/fisiopatología , Estudios Retrospectivos , Masculino , Femenino , Luxación de la Rodilla/diagnóstico por imagen , Luxación de la Rodilla/complicaciones , Luxación de la Rodilla/cirugía , Luxación de la Rodilla/etiología , Luxación de la Rodilla/terapia , Heridas no Penetrantes/diagnóstico por imagen , Heridas no Penetrantes/terapia , Heridas no Penetrantes/complicaciones , Heridas no Penetrantes/cirugía , Lesiones del Sistema Vascular/diagnóstico por imagen , Lesiones del Sistema Vascular/cirugía , Lesiones del Sistema Vascular/etiología , Lesiones del Sistema Vascular/terapia , Resultado del Tratamiento , Adulto , Factores de Tiempo , Persona de Mediana Edad , Angiografía de Substracción Digital , Adulto Joven , Angiografía por Tomografía Computarizada , Procedimientos Quirúrgicos Vasculares/efectos adversos , Factores de Riesgo , Valor Predictivo de las Pruebas , Anciano , Adolescente , Amputación Quirúrgica , Recuperación de la FunciónRESUMEN
INTRODUCTION: The assessment of hemodynamic status in polytrauma patients is an important principle of the primary survey of trauma patients, and screening for ongoing hemorrhage and assessing the efficacy of resuscitation is vital in avoiding preventable death and significant morbidity in these patients. Invasive procedures may lead to various complications and the IVC ultrasound measurements are increasingly recognized as a potential noninvasive replacement or a source of adjunct information. AIMOF THIS STUDY: The study aimed to determine if repeated ultrasound assessment of the inferior vena cava (diameter, collapsibility (IVC- CI) in major trauma patients presenting with collapsible IVC before resuscitation and after the first hour of resuscitation will predict total intravenous fluid requirements at first 24 h. PATIENTS & METHODS: The current study was conducted on 120 patients presented to the emergency department with Major blunt trauma (having significant injury to two or more ISS body regions or an ISS greater than 15). The patients(cases) group (shocked group) (60) patients with signs of shock such as decreased blood pressure < 90/60 mmHg or a more than 30% decrease from the baseline systolic pressure, heart rate > 100 b/m, cold, clammy skin, capillary refill > 2 s and their shock index above0.9. The control group (non-shocked group) (60) patients with normal blood pressure and heart rate, no other signs of shock (normal capillary refill, warm skin), and (shock index ≤ 0.9). Patients were evaluated at time 0 (baseline), 1 h after resucitation, and 24 h after 1st hour for:(blood pressure, pulse, RR, SO2, capillary refill time, MABP, IVCci, IVCmax, IVCmin). RESULTS: Among 120 Major blunt trauma patients, 98 males (81.7%) and 22 females (18.3%) were included in this analysis; hypovolemic shocked patients (60 patients) were divided into two main groups according to IVC diameter after the first hour of resuscitation; IVC repleted were 32 patients (53.3%) while 28 patients (46.7%) were IVC non-repleted. In our study population, there were statistically significant differences between repleted and non-repleted IVC cases regarding IVCD, DIVC min, IVCCI (on arrival) (after 1 h) (after 24 h of 1st hour of resuscitation) ( p-value < 0.05) and DIVC Max (on arrival) (after 1 h) (p-value < 0.001). There is no statistically significant difference (p-value = 0.075) between repleted and non-repleted cases regarding DIVC Max (after 24 h).In our study, we found that IVCci0 at a cut-off point > 38.5 has a sensitivity of 80.0% and Specificity of 85.71% with AUC 0.971 and a good 95% CI (0.938 - 1.0), which means that IVCci of 38.6% or more can indicate fluid responsiveness. We also found that IVCci 1 h (after fluid resuscitation) at cut-off point > 28.6 has a sensitivity of 80.0% and Specificity of 75% with AUC 0.886 and good 95% CI (0.803 - 0.968), which means that IVCci of 28.5% or less can indicate fluid unresponsiveness after 1st hour of resuscitation. We found no statistically significant difference between repleted and non-repleted cases regarding fluid requirement and amount of blood transfusion at 1st hour of resuscitation (p-value = 0.104). CONCLUSION: Repeated bedside ultrasonography of IVCD, and IVCci before and after the first hour of resuscitation could be an excellent reliable invasive tool that can be used in estimating the First 24 h of fluid requirement in Major blunt trauma patients and assessment of fluid status.
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Servicio de Urgencia en Hospital , Fluidoterapia , Resucitación , Ultrasonografía , Vena Cava Inferior , Heridas no Penetrantes , Humanos , Vena Cava Inferior/diagnóstico por imagen , Femenino , Masculino , Adulto , Heridas no Penetrantes/diagnóstico por imagen , Heridas no Penetrantes/terapia , Fluidoterapia/métodos , Resucitación/métodos , Persona de Mediana Edad , Hospitales Universitarios , Adulto Joven , Estudios Prospectivos , IránRESUMEN
Diagnosis of relevant organ injury after blunt abdominal injury (AI) in multiple-injury/polytraumatised patients is challenging. AI can be distinguished between injuries of parenchymatous organs (POI) of the upper abdomen (liver, spleen) and bowel and mesenteric injuries (BMI). Still, such injuries may be associated with delays in diagnosis and treatment. The present study aimed to verify laboratory parameters, imaging diagnostics, physical examination and related injuries to predict intraabdominal injuries. This retrospective, single-centre study includes data from multiple-injury/polytraumatised patients between 2005 and 2017. Two main groups were defined with relevant abdominal injury (AI+) and without abdominal injury (AI-). The AI+ group was divided into three subgroups: BMI+, BMI+/POI+, and POI+. Groups were compared in a univariate analysis for significant differences. Logistic regression analysis was used to determine predictors for AI+, BMI+ and POI+. 26.3% (271 of 1032) of the included patients had an abdominal injury. Subgroups were composed of 4.7% (49 of 1032) BMI+, 4.7% (48 of 1032) BMI+/POI+ and 16.8% (174 of 1032) POI+. Pathological abdominal signs had a sensitivity of 48.7% and a specificity of 92.4% for AI+. Transaminases were significantly higher in cases of AI+. Pathological computed tomography (CT) (free fluid, parenchymal damage, Bowel Injury Prediction Score (BIPS), CT Grade > 4) was summarised and had a sensitivity of 94.8%, a specificity of 98%, positive predictive value (PPV) of 94.5% and, negative predictive value (NPV) of 98.2% for AI+. The detected predictors for AI+ were pathological abdominal findings (odds ratio (OR) 3.93), pathological multi-slice computed tomography (MSCT) (OR 668.9), alanine (ALAT) ≥ 1.23 µmol/ls (OR 2.35) and associated long bone fractures (OR 3.82). Pathological abdominal signs, pathological MSCT and lactate (LAC) levels ≥ 1.94 mmol/l could be calculated as significant risk factors for BMI+. For POI+ pathological abdominal MSCT, ASAT ≥ 1.73 µmol/ls and concomitant thoracic injuries had significant relevance. The study presents reliable risk factors for abdominal injury and its sub-entities. The predictors can be explained by the anatomy of the trunk and existing studies. Elevated transaminases predicted abdominal injury (AI+) and, specifically, the POI+. The pathological MSCT was the most reliable predictive parameter. However, it was essential to include further relevant parameters.
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Traumatismos Abdominales , Traumatismo Múltiple , Humanos , Traumatismos Abdominales/diagnóstico por imagen , Traumatismos Abdominales/diagnóstico , Masculino , Femenino , Estudios Retrospectivos , Traumatismo Múltiple/diagnóstico por imagen , Traumatismo Múltiple/diagnóstico , Adulto , Persona de Mediana Edad , Diagnóstico Precoz , Tomografía Computarizada por Rayos X/métodos , Heridas no Penetrantes/diagnóstico , Heridas no Penetrantes/diagnóstico por imagen , Heridas no Penetrantes/complicaciones , AncianoRESUMEN
Pulmonary contusion (PC), defined as damage to the lung parenchyma with edema and hemorrhage, has classically been associated with acceleration-deceleration injuries. It is a frequent pathology in clinical practice. However, its clinical presentation and imaging findings are nonspecific. Patients with this entity can present with findings that can range from mild dyspnea to life-threatening respiratory failure and hemodynamic instability. We present the case of a 61-year-old man, a former smoker, who presented to the emergency department after suffering blunt chest trauma. On admission, he complained of only mild shortness of breath, and his vital signs were typical. Initial imaging identified asymmetric pulmonary infiltrates and mediastinal lymphadenopathy; this was suspicious for additional pathology in addition to PC. After an exhaustive evaluation, a neoplastic or infectious disease process was ruled out. Even though the patient presented with a clinical deterioration of respiratory function compatible with secondary acute respiratory distress syndrome, there was a complete recovery after supportive measures and supplemental oxygen. In conclusion, the nonspecific clinical and imaging findings in patients with pulmonary contusion warrant a complete evaluation of these cases. An early diagnosis is essential to establish adequate support and monitoring to prevent possible complications that could worsen the patient's prognosis.
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Contusiones , Lesión Pulmonar , Heridas no Penetrantes , Humanos , Masculino , Persona de Mediana Edad , Contusiones/diagnóstico por imagen , Lesión Pulmonar/diagnóstico por imagen , Lesión Pulmonar/etiología , Heridas no Penetrantes/complicaciones , Heridas no Penetrantes/diagnóstico por imagen , Síndrome de Dificultad Respiratoria/etiología , Síndrome de Dificultad Respiratoria/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Pulmón/diagnóstico por imagen , Disnea/etiologíaRESUMEN
BACKGROUND: Obesity may serve as a protective factor in blunt abdominal trauma (BAT) patients due to a "cushion effect". In this study, we aim to use computed tomography (CT) scans to measure abdominal adiposity and its correlation with injury severity in BAT patients. METHODS: We conducted a retrospective analysis of male BAT patients who had undergone CT scans. Subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) were manually measured and height-normalized for analysis at lumbar levels L2 and L3. Statistical methods were used to compare differences in adiposity between patients with and without severe abdominal injuries. For controls, we also compared adipose tissue in patients with and without severe trauma to the chest, where less fat typically accumulates. RESULTS: We included 361 male participants and conducted a comparative analysis of their demographic and injury characteristics. Patients without severe abdominal injuries had significantly higher SAT and VAT indices at both L2 and L3 (p < 0.05). However, these measures showed no significant differences between patients with and without severe chest trauma. Solid organ injuries, particularly liver injuries, were associated with decreased SAT and VAT. CONCLUSION: Increase abdominal adiposity was linked to lower abdominal injury severity and solid organ injuries, particularly liver injuries. In addition to conventional BMI for evaluating obesity, either subcutaneous or visceral adipose tissue over lumbar levels L2 and L3 can be used to assess the "cushion effect."
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Traumatismos Abdominales , Tomografía Computarizada por Rayos X , Heridas no Penetrantes , Humanos , Masculino , Heridas no Penetrantes/diagnóstico por imagen , Traumatismos Abdominales/diagnóstico por imagen , Estudios Retrospectivos , Adulto , Persona de Mediana Edad , Obesidad , Índice de Masa Corporal , Grasa Intraabdominal/diagnóstico por imagen , Adiposidad/fisiología , Puntaje de Gravedad del TraumatismoRESUMEN
OBJECTIVES: Nonoperative management (NOM) of blunt splenic injury (BSI) is well accepted in appropriate patients. Splenic artery embolization (SAE) in higher-grade injuries likely plays an important role in increasing the success of NOM. We previously implemented a protocol requiring referral of all BSI grades III-V undergoing NOM for SAE. It is unknown the risk of complications as well as longitudinal outcomes. We aimed to examine the splenic salvage rate and safety profile of the protocol. We hypothesized the splenic salvage rate would be high and complications would be low. METHODS: A retrospective study was performed at our Level 1 trauma center over a 9-year period. Injury characteristics and outcomes in patients sustaining BSI grades III-V were collected. Outcomes were compared for NOM on protocol (SAE) and off protocol (no angiography or angiography but no embolization). Complications for angiographies were examined. RESULTS: Between January 2010 and February 2019, 570 patients had grade III-V BSI. NOM was attempted in 359 (63 %) with overall salvage rate of 91 % (328). Of these, 305 were on protocol while 54 were off protocol (41 no angiography and 13 angiography but no SAE). During the study period, for every grade of injury a pattern was seen of a higher salvage rate in the on-protocol group when compared to the off-protocol group (Grade III, 97 %(181/187) vs. 89 %(32/36), Grade IV, 91 %(98/108) vs. 69 %(9/13) and Grade V, 80 %(8/10 vs. 0 %(0/5). The overall salvage rate was 94 %(287) on protocol vs. 76 %(41) off protocol (p < 0.001, Cochran-Mantel-Haenszel test). Complications occurred in only 8 of the 318 who underwent angiography (2 %). These included 5 access complications and 3 abscesses. CONCLUSION: The use of a protocol requiring routine splenic artery embolization for all high-grade spleen injuries slated for non-operative management is safe with a very low complication rate. NOM with splenic angioembolization failure rate is improved as compared to non-SAE patients' at all higher grades of injury. Thus, SAE for all hemodynamically stable patients of all high-grade types should be considered as a primary form of therapy for such injuries.
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Embolización Terapéutica , Bazo , Centros Traumatológicos , Heridas no Penetrantes , Humanos , Heridas no Penetrantes/terapia , Heridas no Penetrantes/diagnóstico por imagen , Estudios Retrospectivos , Embolización Terapéutica/métodos , Masculino , Bazo/lesiones , Bazo/diagnóstico por imagen , Femenino , Adulto , Persona de Mediana Edad , Resultado del Tratamiento , Angiografía , Radiología Intervencionista , Puntaje de Gravedad del Traumatismo , Arteria Esplénica/lesiones , Arteria Esplénica/diagnóstico por imagen , Traumatismos Abdominales/terapia , Traumatismos Abdominales/diagnóstico por imagen , Terapia RecuperativaRESUMEN
SUMMARY: We present a previously healthy 13-year-old male, who sustained a handlebar injury after falling from his bicycle. The computerised tomography (CT) scan indicated a probable pancreatic neoplasm associated with a retroperitoneal haematoma which was, following resection, confirmed histologically to be a solid pseudopapillary neoplasm of the pancreas. These are rare tumours of the pancreas, especially in young males. The rarity of this neoplasm and the mechanism that led to its presentation make this an interesting and unique case.
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Traumatismos Abdominales , Neoplasias Pancreáticas , Tomografía Computarizada por Rayos X , Heridas no Penetrantes , Humanos , Masculino , Neoplasias Pancreáticas/diagnóstico por imagen , Neoplasias Pancreáticas/cirugía , Tomografía Computarizada por Rayos X/métodos , Heridas no Penetrantes/diagnóstico por imagen , Heridas no Penetrantes/complicaciones , Heridas no Penetrantes/cirugía , Adolescente , Traumatismos Abdominales/diagnóstico por imagen , Traumatismos Abdominales/cirugía , Traumatismos Abdominales/complicaciones , Hematoma/diagnóstico por imagen , Hematoma/etiología , Hematoma/cirugía , Ciclismo/lesionesRESUMEN
OBJECTIVES: Thoracic endovascular aortic repair (TEVAR) is the preferred treatment for severe blunt thoracic aortic injuries (BTAI). Successful outcomes rely on accurate endograft sizing, but initial imaging may underestimate aortic diameters. This study examines the impact of intravascular ultrasound (IVUS) on endograft sizing and clinical outcomes in BTAI patients. METHODS: A prospectively collected multi-institutional dataset from the Aortic Trauma Foundation was analyzed. Patients with BTAI undergoing TEVAR with IVUS were compared to patients who underwent TEVAR alone. Demographics and operative variables were compared, focusing on IVUS effects on endograft sizing by examining maximal proximal and distal aortic diameter on initial CT imaging compared to the graft diameters used during TEVAR. RESULTS: 293 patients underwent TEVAR for BTAI with IVUS utilized in 124 cases (42.3%). The average graft size in the IVUS and non-IVUS groups were similar proximally (26.91 ± 4.3 mm IVUS vs 27.77 ± 4.7 mm non-IVUS, P = 0.116) and distally (25.96 ± 4.7 mm IVUS vs 26.51 ± 4.7 mm non-IVUS). IVUS did not impact the difference between graft size and initial CT measurements proximally (4.32 ± 4.8 mm IVUS vs 4.23 ± 3.9 mm non-IVUS, P = 0.859) or distally (4.17 ± 5.9 mm IVUS vs 4.50 ± 4.3 mm non-IVUS, P = 0.606). Although delayed hemorrhagic and ischemic stroke occurred less frequently in IVUS patients (0.8% IVUS vs 7.1% non- IVUS, P = 0.024), in-hospital mortality was similar between groups (5.6% IVUS vs 7.7% non-IVUS, P = 0.581). CONCLUSIONS: IVUS is not associated with significant changes in endograft sizing compared to sizing based on CT scan alone in BTAI patients. IVUS was not associated with differences in mortality but was associated with a decrease in delayed hemorrhagic and ischemic stroke. Routine IVUS in BTAI patients may not be necessary for accurate sizing, but there may be a relationship between IVUS and stroke.
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Aorta Torácica , Implantación de Prótesis Vascular , Prótesis Vascular , Procedimientos Endovasculares , Valor Predictivo de las Pruebas , Diseño de Prótesis , Ultrasonografía Intervencional , Lesiones del Sistema Vascular , Heridas no Penetrantes , Humanos , Masculino , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/instrumentación , Procedimientos Endovasculares/mortalidad , Heridas no Penetrantes/diagnóstico por imagen , Heridas no Penetrantes/cirugía , Heridas no Penetrantes/mortalidad , Femenino , Aorta Torácica/diagnóstico por imagen , Aorta Torácica/cirugía , Aorta Torácica/lesiones , Lesiones del Sistema Vascular/diagnóstico por imagen , Lesiones del Sistema Vascular/cirugía , Lesiones del Sistema Vascular/mortalidad , Persona de Mediana Edad , Resultado del Tratamiento , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/instrumentación , Implantación de Prótesis Vascular/mortalidad , Adulto , Bases de Datos Factuales , Estudios Retrospectivos , Traumatismos Torácicos/diagnóstico por imagen , Traumatismos Torácicos/cirugía , Traumatismos Torácicos/mortalidad , Factores de Riesgo , Factores de Tiempo , Estados Unidos , Anciano , Aortografía , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/mortalidadRESUMEN
OBJECTIVES: Blunt abdominal trauma is a common cause of emergency department admission. Computed tomography (CT) scanning is the gold standard method for identifying intra-abdominal injuries in patients experiencing blunt trauma, especially those with high-energy trauma. Although the diagnostic accuracy of this imaging technique is very high, patient admission and prolonged observation protocols are still common practices worldwide. We aimed to evaluate the incidence of intra-abdominal injury in hemodynamically stable patients with high-energy blunt trauma and a normal abdominal CT scan at a Level-1 Trauma Center in Colombia, South America, to assess the relevance of a prolonged observation period. METHODS: We performed a retrospective study of patients admitted to the emergency department for blunt trauma between 2021 and 2022. All consecutive patients with high-energy mechanisms of trauma and a normal CT scan at admission were included. Our primary outcomes were the incidence of intra-abdominal injury identified during a 24-hour observation period or hospital stay, ICU admission, and death. RESULTS: We included 480 patients who met the inclusion criteria. The median age was 33 (IQR 25.5, 47), and 74.2% were male. The most common mechanisms of injury were motor vehicle accidents (64.2%), falls from height (26%), and falls from bikes (3.1%). A total of 99.2% of patients had a Revised Trauma Score of 8. Only 1 patient (0.2%) (95% CI: 0.01-1.16) presented with an abdominal injury during the observation period. No ICU admissions or deaths were reported. CONCLUSION: The incidence of intra-abdominal injury in patients with hemodynamically stable blunt trauma and a negative abdominal CT scan is extremely low, and prolonged observation may not be justified in these patients.
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Traumatismos Abdominales , Servicio de Urgencia en Hospital , Tomografía Computarizada por Rayos X , Heridas no Penetrantes , Humanos , Heridas no Penetrantes/diagnóstico por imagen , Heridas no Penetrantes/epidemiología , Masculino , Femenino , Adulto , Estudios Retrospectivos , Traumatismos Abdominales/diagnóstico por imagen , Traumatismos Abdominales/epidemiología , Incidencia , Persona de Mediana Edad , Colombia/epidemiología , Tiempo de Internación/estadística & datos numéricos , Hemodinámica , Centros TraumatológicosRESUMEN
Blunt force trauma remains a serious threat to many populations and is commonly seen in motor vehicle crashes, sports, and military environments. Effective design of helmets and protective armor should consider biomechanical tolerances of organs in which they intend to protect and require accurate measurements of deformation as a primary injury metric during impact. To overcome challenges found in velocity and displacement measurements during blunt impact using an integrated accelerometer and two-dimensional (2D) high-speed video, three-dimensional (3D) digital image correlation (DIC) measurements were taken and compared to the accepted techniques. A semispherical impactor was launched at impact velocities from 14 to 20 m/s into synthetic ballistic gelatin to simulate blunt impacts observed in behind armor blunt trauma (BABT), falls, and sports impacts. Repeated measures Analysis of Variance resulted in no significant differences in maximum displacement (p = 0.10), time of maximum displacement (p = 0.21), impact velocity (p = 0.13), and rebound velocity (p = 0.21) between methods. The 3D-DIC measurements demonstrated equal or improved percent difference and low root-mean-square deviation compared to the accepted measurement techniques. Therefore, 3D-DIC may be utilized in BABT and other blunt impact applications for accurate 3D kinematic measurements, especially when an accelerometer or 2D lateral camera analysis is impractical or susceptible to error.
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Imagenología Tridimensional , Fenómenos Biomecánicos , Heridas no Penetrantes/diagnóstico por imagen , Heridas no Penetrantes/fisiopatología , Fenómenos Mecánicos , HumanosRESUMEN
BACKGROUND: Cervical spine injuries in children are uncommon but potentially devastating; however, indiscriminate neck imaging after trauma unnecessarily exposes children to ionising radiation. The aim of this study was to derive and validate a paediatric clinical prediction rule that can be incorporated into an algorithm to guide radiographic screening for cervical spine injury among children in the emergency department. METHODS: In this prospective observational cohort study, we screened children aged 0-17 years presenting with known or suspected blunt trauma at 18 specialised children's emergency departments in hospitals in the USA affiliated with the Pediatric Emergency Care Applied Research Network (PECARN). Injured children were eligible for enrolment into derivation or validation cohorts by fulfilling one of the following criteria: transported from the scene of injury to the emergency department by emergency medical services; evaluated by a trauma team; and undergone neck imaging for concern for cervical spine injury either at or before arriving at the PECARN-affiliated emergency department. Children presenting with solely penetrating trauma were excluded. Before viewing an enrolled child's neck imaging results, the attending emergency department clinician completed a clinical examination and prospectively documented cervical spine injury risk factors in an electronic questionnaire. Cervical spine injuries were determined by imaging reports and telephone follow-up with guardians within 21-28 days of the emergency room encounter, and cervical spine injury was confirmed by a paediatric neurosurgeon. Factors associated with a high risk of cervical spine injury (>10%) were identified by bivariable Poisson regression with robust error estimates, and factors associated with non-negligible risk were identified by classification and regression tree (CART) analysis. Variables were combined in the cervical spine injury prediction rule. The primary outcome of interest was cervical spine injury within 28 days of initial trauma warranting inpatient observation or surgical intervention. Rule performance measures were calculated for both derivation and validation cohorts. A clinical care algorithm for determining which risk factors warrant radiographic screening for cervical spine injury after blunt trauma was applied to the study population to estimate the potential effect on reducing CT and x-ray use in the paediatric emergency department. This study is registered with ClinicalTrials.gov, NCT05049330. FINDINGS: Nine emergency departments participated in the derivation cohort, and nine participated in the validation cohort. In total, 22 430 children presenting with known or suspected blunt trauma were enrolled (11 857 children in the derivation cohort; 10 573 in the validation cohort). 433 (1·9%) of the total population had confirmed cervical spine injuries. The following factors were associated with a high risk of cervical spine injury: altered mental status (Glasgow Coma Scale [GCS] score of 3-8 or unresponsive on the Alert, Verbal, Pain, Unresponsive scale [AVPU] of consciousness); abnormal airway, breathing, or circulation findings; and focal neurological deficits including paresthesia, numbness, or weakness. Of 928 in the derivation cohort presenting with at least one of these risk factors, 118 (12·7%) had cervical spine injury (risk ratio 8·9 [95% CI 7·1-11·2]). The following factors were associated with non-negligible risk of cervical spine injury by CART analysis: neck pain; altered mental status (GCS score of 9-14; verbal or pain on the AVPU; or other signs of altered mental status); substantial head injury; substantial torso injury; and midline neck tenderness. The high-risk and CART-derived factors combined and applied to the validation cohort performed with 94·3% (95% CI 90·7-97·9) sensitivity, 60·4% (59·4-61·3) specificity, and 99·9% (99·8-100·0) negative predictive value. Had the algorithm been applied to all participants to guide the use of imaging, we estimated the number of children having CT might have decreased from 3856 (17·2%) to 1549 (6·9%) of 22 430 children without increasing the number of children getting plain x-rays. INTERPRETATION: Incorporated into a clinical algorithm, the cervical spine injury prediction rule showed strong potential for aiding clinicians in determining which children arriving in the emergency department after blunt trauma should undergo radiographic neck imaging for potential cervical spine injury. Implementation of the clinical algorithm could decrease use of unnecessary radiographic testing in the emergency department and eliminate high-risk radiation exposure. Future work should validate the prediction rule and care algorithm in more general settings such as community emergency departments. FUNDING: The Eunice Kennedy Shriver National Institute of Child Health and Human Development and the Health Resources and Services Administration of the US Department of Health and Human Services in the Maternal and Child Health Bureau under the Emergency Medical Services for Children programme.
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Vértebras Cervicales , Reglas de Decisión Clínica , Servicio de Urgencia en Hospital , Traumatismos Vertebrales , Heridas no Penetrantes , Humanos , Estudios Prospectivos , Niño , Heridas no Penetrantes/diagnóstico por imagen , Preescolar , Femenino , Vértebras Cervicales/lesiones , Vértebras Cervicales/diagnóstico por imagen , Masculino , Lactante , Adolescente , Traumatismos Vertebrales/diagnóstico por imagen , Traumatismos Vertebrales/diagnóstico , Recién Nacido , Algoritmos , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Unlike large hemothoraces (HTX), small HTX after blunt trauma may be observed without drainage. We aimed to study if there were risk factors that would predict the need for intervention in initially observed small HTX. METHODS: A retrospective review of patients with blunt traumatic HTX from 2016 to 2022 was performed. Patients with small HTX (pleural fluid volume <400 mL on admission chest computerized tomography [CT]) were included. Patients were considered as being "initially observed" if there was no intervention for the HTX within 48 hours after admission. Primary outcome was any HTX-related intervention (open, thoracoscopic or percutaneous procedures) occurring after 48 hours and up to 6 months after injury. Univariable and multivariable statistical analyses were employed. A P-value of <.05 was considered significant. RESULTS: Of 335 patients with HTX, 188 (59.6%) met inclusion criteria. Median (interquartile range) HTX volume was 90 (36-134) ml. One hundred and twenty-seven (68%) were initially observed. Of these, 31 (24%) had the primary outcome. These patients had a larger HTX volume (median, 129 vs 68 mL, P = .0001), and number of rib fractures (median, 7 vs 4, P = .0002) compared to those without the primary outcome. Chest-related readmission occurred in 8 (6%) with a median of 20 days from injury. Of these, 7 required an HTX-related intervention. Logistic regression analysis found that both the number of rib fractures and HTX volume independently predicted the primary outcome. CONCLUSION: For small HTX initially observed, number of rib fractures and initial volume predicted delayed HTX-related intervention.
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Hemotórax , Heridas no Penetrantes , Humanos , Estudios Retrospectivos , Masculino , Femenino , Adulto , Heridas no Penetrantes/terapia , Heridas no Penetrantes/diagnóstico por imagen , Persona de Mediana Edad , Hemotórax/etiología , Hemotórax/terapia , Tomografía Computarizada por Rayos X , Traumatismos Torácicos/terapia , Traumatismos Torácicos/diagnóstico por imagen , Drenaje , Factores de Riesgo , Fracturas de las Costillas/terapia , Fracturas de las Costillas/diagnóstico por imagenRESUMEN
BACKGROUND AND PURPOSE: The cervical spine in children has marked anatomical and biomechanical differences compared to adults, leading to significantly different patterns and incidence of spinal injury, and consequently to different X-ray and computed tomography (CT) imaging recommendations. Magnetic resonance imaging (MRI) has been validated to clear cervical spine trauma in adults, but not in pediatric patients. We hypothesized that MRI findings have a low probability to change management in children with spine trauma and negative CT findings. MATERIALS AND METHODS: We reviewed records for admitted pediatric patients due to blunt trauma from January 2011 to May 2021, and identified 212 patients who underwent MRI within 3 days of a negative CT. Two neuroradiologists independently reviewed all CT and MRI images for the following categories: fracture, subluxation, spinal canal compromise, ligamentous injury, spinal canal hemorrhage, cord contusion and soft tissue hemorrhage. We identified follow-up MRI examinations as negative or positive for the above categories, and calculated the prevalence of each category as a percentage of cases with negative CT. We also evaluated whether negative and positive MRI groups differed significantly with respect to age and sex of the patients. RESULTS AND CONCLUSIONS: In our study of 212 children with cervical spine trauma and a negative CT, most follow-up MRI scans were found to be negative (79.9 %). Positive MRI findings consisted mainly of ligamentous sprain without disruption (15.1 %). Ligamentous disruption and epidural or soft tissue hemorrhage were found in 4.5 %, and focal cord contusion in 0.5 %. There was no statically significant difference between negative and positive MRI groups with respect to age (P = 0.45) and sex (P = 0.52). CONCLUSION: In our patient group with a negative CT, MRI did not significantly impact management nor contribute to cervical spine clearance in children.
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Vértebras Cervicales , Imagen por Resonancia Magnética , Traumatismos Vertebrales , Tomografía Computarizada por Rayos X , Heridas no Penetrantes , Humanos , Masculino , Femenino , Imagen por Resonancia Magnética/métodos , Heridas no Penetrantes/diagnóstico por imagen , Vértebras Cervicales/diagnóstico por imagen , Vértebras Cervicales/lesiones , Niño , Tomografía Computarizada por Rayos X/métodos , Preescolar , Traumatismos Vertebrales/diagnóstico por imagen , Adolescente , Estudios Retrospectivos , LactanteRESUMEN
Cerebrovascular complications from blunt trauma to the skull base, though rare, can lead to potentially devastating outcomes, emphasizing the importance of timely diagnosis and management. Due to the insidious clinical presentation, subtle nature of imaging findings, and complex anatomy of the skull base, diagnosing cerebrovascular injuries and their complications poses considerable challenges. This article offers a comprehensive review of skull base anatomy and pathophysiology pertinent to recognizing cerebrovascular injuries and their complications, up-to-date screening criteria and imaging techniques for assessing these injuries, and a case-based review of the spectrum of cerebrovascular complications arising from skull base trauma. This review will enhance understanding of cerebrovascular injuries and their complications from blunt skull base trauma to facilitate diagnosis and timely treatment.
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Base del Cráneo , Humanos , Base del Cráneo/diagnóstico por imagen , Base del Cráneo/lesiones , Heridas no Penetrantes/diagnóstico por imagen , Heridas no Penetrantes/complicaciones , Trastornos Cerebrovasculares/diagnóstico por imagen , Trastornos Cerebrovasculares/etiología , Traumatismos Cerebrovasculares/diagnóstico por imagenRESUMEN
OBJECTIVE: The PEDSPINE I and PEDSPINE II scores were developed to determine when patients require advanced imaging to rule out cervical spine injury (CSI) in children younger than 3 years of age with blunt trauma. This study aimed to evaluate these scores in an institutional cohort. METHODS: The authors identified patients younger than 3 years with blunt trauma who received cervical spine MRI from their institution's prospective database from 2012 to 2015. Patient demographics, injury characteristics, and imaging were compared between patients with and without CSI using chi-square and Wilcoxon rank-sum tests. RESULTS: Eighty-eight patients were identified, 8 (9%) of whom had CSI on MRI. The PEDSPINE I system had a higher sensitivity (50% vs 25%) and negative predictive value (93% vs 92%), whereas PEDSPINE II had a higher specificity (91% vs 65%) and positive predictive value (22% vs 13%). Patients with CSI missed by the scores had mild, radiologically significant ligamentous injuries detected on MRI. Both models would have recommended advanced imaging for the patient who required halo-vest fixation (risk profile: no CSI, 81.9%; ligamentous, 10.1%; osseous, 8.0%). PEDSPINE I would have prevented 52 (65%) of 80 uninjured patients from receiving advanced imaging, whereas PEDSPINE II would have prevented 73 (91%). Using PEDSPINE I, 10 uninjured patients (13%) could have avoided intubation for imaging. PEDSPINE II would not have spared any patients intubation. CONCLUSIONS: Current cervical spine clearance algorithms are not sensitive or specific enough to determine the need for advanced imaging in children. However, these scores can be used as a reference in conjunction with physicians' clinical impressions to reduce unnecessary imaging.
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Vértebras Cervicales , Imagen por Resonancia Magnética , Traumatismos Vertebrales , Heridas no Penetrantes , Humanos , Heridas no Penetrantes/diagnóstico por imagen , Masculino , Femenino , Vértebras Cervicales/lesiones , Vértebras Cervicales/diagnóstico por imagen , Lactante , Preescolar , Traumatismos Vertebrales/diagnóstico por imagen , Sensibilidad y Especificidad , Estudios Retrospectivos , Estudios Prospectivos , Valor Predictivo de las PruebasAsunto(s)
Traumatismos Abdominales , Traumatismos Craneocerebrales , Tomografía Computarizada por Rayos X , Heridas no Penetrantes , Humanos , Traumatismos Abdominales/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Heridas no Penetrantes/diagnóstico por imagen , Traumatismos Craneocerebrales/diagnóstico por imagen , NiñoRESUMEN
Background: Intravenous (IV) contrast improves the sensitivity and specificity of injury detection in computerized tomography (CT). Its use is recommended in the workup of trauma patients by the American College of Surgeons and American College of Radiology. On May 9, 2022, the Food and Drug Administration declared a shortage of iodinated contrast due to the COVID-19 pandemic. Although the shortage has ended, the temporary lack of IV contrast forced physicians to be prudent in ordering CT scans with IV contrast. We sought to determine if there was a change in the percentage of CT contrast studies performed during the contrast shortage and if this change affected patient outcomes.Methods: Retrospective chart review was performed on all adult tier 2 trauma patients at a 619-bed community-based level II trauma center who received CT chest, abdomen, and pelvis imaging as initial workup for blunt trauma from 5/9/2021-6/30/2021 (pre-shortage) and 5/9/2022-6/30/2022 (during shortage).Results: Patients were predominantly male with median age of 31-52 and of White or Hispanic ethnicity. Before the contrast shortage, all 110 trauma patients were scanned with contrast. During the shortage, 29 of 114 patients were scanned with contrast (P < 0.001). Injuries were identified in 59% of patients scanned with contrast (P < 0.001). There were no significant differences in blood transfusion needs, repeat CT, disposition, or mortality when comparing pre-shortage to during shortage or when comparing between non-contrast and contrast studies during the shortage.Discussion: There was a decrease in the percentage of CT contrast studies performed during the shortage. A higher percentage of injuries were identified in the patients scanned with contrast. However, there were no significant differences in patient outcomes. Certain trauma patients may be safely scanned without contrast.
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Medios de Contraste , Tomografía Computarizada por Rayos X , Centros Traumatológicos , Heridas no Penetrantes , Humanos , Masculino , Heridas no Penetrantes/diagnóstico por imagen , Femenino , Adulto , Estudios Retrospectivos , Persona de Mediana Edad , Traumatismos Torácicos/diagnóstico por imagen , Pelvis/lesiones , Pelvis/diagnóstico por imagen , Pelvis/irrigación sanguínea , Traumatismos Abdominales/diagnóstico por imagen , COVID-19/epidemiologíaRESUMEN
BACKGROUND: Ultrasound has established utility within pediatric emergency medicine and has an added benefit of avoiding excessive radiation exposure. The serial focused assessment with sonography in trauma (sFAST) examination is a potential alternative to improve pediatric trauma evaluation. We sought to evaluate the accuracy of sFAST in pediatric patients with blunt abdominal trauma. METHODS: We performed a multicenter, retrospective observational study of electronic medical records, trauma registry data, and image archiving records of previous sFAST examinations. Examinations from pediatric patients (18 years or younger) who presented to an emergency department with blunt abdominal trauma were eligible for inclusion as long as the period between the first and second FAST was at least 30 minutes but no more than 24 hours. Demographic data and patient and outcomes were collected. RESULTS: Data collected from 3 institutions found a total of 38 sFAST performed between July 2017 and September 2021 on eligible patients. Of these, there were 6 (15.4%) FAST examinations that were positive after an initial negative or indeterminate interpretation. The overall sensitivity and specificity of sFAST were 66.7% (95% confidence interval 22.3-95.7%) and 93.8% (79.2-99.3%), respectively. CONCLUSIONS: This pilot study found that sFAST can enhance blunt trauma evaluation and improve sensitivity and diagnostic accuracy. More data are needed to determine how sFAST can be utilized in pediatric patients with blunt abdominal trauma.