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Kok D, Oud S, Giannakópoulos GF, Scheerder MJ, Beenen LFM, Halm JA, Treskes K. Delayed diagnosed injuries in trauma patients after initial trauma assessment with a total-body computed tomography scan. Injury 2024; 55:111304. [PMID: 38171970 DOI: 10.1016/j.injury.2023.111304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 12/03/2023] [Accepted: 12/27/2023] [Indexed: 01/05/2024]
Abstract
INTRODUCTION Even when using the Advanced Trauma Life Support (ATLS) guidelines and other diagnostic protocols for the initial assessment of trauma patients, not all injuries will be diagnosed in this early stage of care. The aim of this study was to quantify how many, and assess which type of injuries were diagnosed with delay during the initial assessment of trauma patients including a total-body computed tomography (TBCT) scan in a Level 1 Trauma Center in the Netherlands. METHODS We conducted a retrospective cohort study of 697 trauma patients who were assessed in the trauma bay of the Amsterdam University Medical Center (AUMC), using a TBCT. A delayed diagnosed injury was defined as an injury sustained during the initial trauma and not discovered nor suspected upon admission to the Intensive Care Unit (ICU) or surgical ward following the initial assessment, diagnostic studies, or during immediate surgery. A clinically significant delayed diagnosis of injury was defined as an injury requiring follow-up or further medical treatment. We aimed to identify variables associated with delayed diagnosed injuries. RESULTS In total, 697 trauma patients with a median age of 46 years (IQR 30-61) and a median Injury Severity Score (ISS) of 16 (IQR 9-25) were included. Delayed diagnosed injuries were found in 97 patients (13.9 %), of whom 79 injuries were clinically significant (81.4 %). Forty-eight of the delayed diagnosed injuries (49.5 %) were within the TBCT field. Ten delayed diagnosed injuries had an Abbreviated Injury Scale (AIS) of ≥3. Most injuries were diagnosed before or during the tertiary survey (60.8 %). The median time of delay was 34.5 h (IQR 17.5-157.3). Variables associated with delayed diagnosed injuries were primary ICU admission (OR 1.8, p = 0.014), an ISS ≥ 16 (OR 1.6, p = 0.042), and prolonged hospitalization (40+ days) (OR 8.5, p < 0.001). CONCLUSION With the inclusion of the TBCT during the primary assessment of trauma patients, delayed diagnosed injuries still occurs in a significant number of patients (13.9 %). Factors associated with delayed diagnosed injuries were direct admission to ICU and an ISS ≥ 16.
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Affiliation(s)
- D Kok
- Trauma Unit, Department of Surgery, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105, AZ Amsterdam, the Netherlands.
| | - S Oud
- Trauma Unit, Department of Surgery, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105, AZ Amsterdam, the Netherlands
| | - G F Giannakópoulos
- Trauma Unit, Department of Surgery, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105, AZ Amsterdam, the Netherlands
| | - M J Scheerder
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105, AZ Amsterdam, the Netherlands
| | - L F M Beenen
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105, AZ Amsterdam, the Netherlands
| | - J A Halm
- Trauma Unit, Department of Surgery, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105, AZ Amsterdam, the Netherlands
| | - K Treskes
- Trauma Unit, Department of Surgery, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105, AZ Amsterdam, the Netherlands
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Horie K, Ihama Y, Aso S, Kuninaka H, Mochizuki H, Yamashiro T, Kato S, Utsunomiya D. Identification of aortic injury site using postmortem non-contrast computed tomography in road traffic accident. Radiol Case Rep 2021; 16:5-8. [PMID: 33144902 DOI: 10.1016/j.radcr.2020.10.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/14/2020] [Accepted: 10/17/2020] [Indexed: 11/23/2022] Open
Abstract
In high-speed motor vehicle accidents, it is necessary to investigate the manner of death. Postmortem computed tomography (PMCT) provides important information on the mechanism of death, but identification of the aortic injury is still challenging on non-contrast PMCT. A man in his 50s had multiple injuries on the face and chest in the high-speed motor vehicle accident. The traumatic aortic rupture was clearly depicted on thin-slice and multiplanar reformation PMCT images. Traumatic aortic disruption was confirmed by forensic autopsy. The high contrast between the aortic wall and the lumen visualized the traumatic rupture in the distal aortic arch. For the evaluation of aortic rupture on PMCT, it may be important to trace the continuity of the high-density aortic wall by reviewing thin-slice CT and multiplanar reformation images.
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Ter Avest E, McWhirter E, Dunn S, Griggs JE, Lyon RM. Prehospital Death After Traumatic Cardiac Arrest: Time for Better Feedback? Air Med J 2019; 38:78-81. [PMID: 30898288 DOI: 10.1016/j.amj.2018.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 11/01/2018] [Accepted: 11/16/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The aim of this study was to establish if in patients who die at scene as a result of traumatic cardiac arrest (TCA), their cause of death could be determined through coroners reports, and to ascertain the quality of the feedback provided. METHODS This is a retrospective study of all patients presenting in TCA who were attended by the Air Ambulance Kent, Surrey and Sussex between January 1, 2015, and June 30, 2016. RESULTS In total, 159 patients were attended to during the study period. Postmortem reports could not be obtained for 37 patients, mainly because of unestablished identities at the scene. Forty of the 122 reports obtained were full postmortem reports, 3 were inquest reports, and for 79 patients only their (presumed) cause of death was provided. A specific cause of death was provided for 68 patients, whereas in the remaining 54 patients the cause of death was given as "multiple injuries." In 32% of the patients with a full postmortem report, injuries were identified during the postmortem examination that had not been noted on scene. CONCLUSION Feedback from coroners to prehospital teams after patients die as a result of TCA is important but currently suboptimal.
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Affiliation(s)
- Ewoud Ter Avest
- Kent, Surrey and Sussex Air Ambulance Trust, Redhill, Surrey, UK; Medical Center Leeuwarden, Leeuwarden, Netherlands.
| | - Emily McWhirter
- Kent, Surrey and Sussex Air Ambulance Trust, Redhill, Surrey, UK; Royal Hospital for Neuro-disability, London, UK
| | - Sophy Dunn
- Kent, Surrey and Sussex Air Ambulance Trust, Redhill, Surrey, UK
| | - Joanne E Griggs
- Kent, Surrey and Sussex Air Ambulance Trust, Redhill, Surrey, UK
| | - Richard M Lyon
- Kent, Surrey and Sussex Air Ambulance Trust, Redhill, Surrey, UK; University of Surrey, Surrey, UK
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Scantling D, Teichman A, Kucejko R, McCracken B, Eakins J, Burns R. Identifying preventable trauma death: does autopsy serve a role in the peer review process? J Surg Res 2017; 215:140-145. [DOI: 10.1016/j.jss.2017.03.068] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 03/27/2017] [Accepted: 03/31/2017] [Indexed: 11/25/2022]
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Euler SA, Kastenberger T, Attal R, Rieger M, Blauth M, Petri M. Do we still need autopsy in times of modern multislice computed tomography?-Missed diagnoses in the emergency room. Arch Orthop Trauma Surg 2017; 137:43-47. [PMID: 27826651 PMCID: PMC5216103 DOI: 10.1007/s00402-016-2588-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Indexed: 10/30/2022]
Abstract
INTRODUCTION In spite of increasing quality of emergency room (ER) assessment in trauma patients and improved accuracy of modern multislice computed tomography (MSCT), the number of potentially missed diagnoses is still controversial. The aim of this study was to compare the initial findings of ER assessment and MSCT to the findings during autopsy in trauma patients not surviving the first 48 h after admission. We hypothesized that autopsy was more accurate than MSCT in diagnosing potentially fatal diagnoses. PATIENTS AND METHODS Between January 2004 and September 2007, all trauma patients undergoing ER treatment in our institution who deceased within 48 h after admission were analyzed regarding diagnoses from initial ER assessment, including MSCT, and diagnoses from autopsy. Data were prospectively collected and retrospectively analyzed. Autopsy reports were compared to diagnoses of ER assessment and MSCT. Missed diagnoses (MD) and missed potentially fatal diagnoses (MPFD) were analyzed. RESULTS Seventy-three patients with a mean age of 53.2 years were included into the study. Sixty-three percent were male. Autopsy revealed at least one missed diagnosis in 25% of the patients, with the thoracic area accounting for 67% of these. At least one MPFD was found in 4.1% of the patients, all of them being located in the thorax. Total numbers of MD and MPFD were significantly lower for the newer CT generation (64 MSCT, N = 11), compared to older one (4 MSCT, N = 26). CONCLUSIONS As determined by autopsy, modern multislice computed tomography is an accurate method to diagnose injuries. However, 25% of all diagnoses, and 4.1% of potentially fatal diagnoses are still missed in trauma patients, who deceased within the first 48 h after admission. Therefore, autopsy seems to be necessary to determine potentially missed diagnoses for both academic and medicolegal reasons as well as for quality control.
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Affiliation(s)
- S. A. Euler
- Department of Trauma Surgery, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - T. Kastenberger
- Department of Trauma Surgery, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - R. Attal
- Department of Trauma Surgery, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - M. Rieger
- Department of Diagnostic & Interventional Radiology, Hall Regional Hospital, Milserstr. 10, 6060 Hall in Tirol, Austria
| | - M. Blauth
- Department of Trauma Surgery, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - M. Petri
- Trauma Department, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625 Hannover, Germany
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Jalalzadeh H, Giannakopoulos GF, Berger FH, Fronczek J, van de Goot FRW, Reijnders UJ, Zuidema WP. Post-mortem imaging compared with autopsy in trauma victims--A systematic review. Forensic Sci Int 2015; 257:29-48. [PMID: 26284976 DOI: 10.1016/j.forsciint.2015.07.026] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 06/25/2015] [Accepted: 07/13/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Post-mortem imaging or virtual autopsy is a rapidly advancing field of post-mortem investigations of trauma victims. In this review we evaluate the feasibility of complementation or replacement of conventional autopsy by post-mortem imaging in trauma victims. MATERIALS AND METHODS A systematic review was performed in compliance with the PRISMA guidelines. MEDLINE, Embase and Cochrane databases were systematically searched for studies published between January 2008 and January 2014, in which post-mortem imaging was compared to conventional autopsy in trauma victims. Studies were included when two or more trauma victims were investigated. RESULTS Twenty-six studies were included, with a total number of 563 trauma victims. Post-mortem computer tomography (PMCT) was performed in 22 studies, post-mortem magnetic resonance imaging (PMMRI) in five studies and conventional radiography in two studies. PMCT and PMMRI both demonstrate moderate to high-grade injuries and cause of death accurately. PMCT is more sensitive than conventional autopsy or PMMRI in detecting skeletal injuries. For detecting minor organ and soft tissue injuries, autopsy remains superior to imaging. Aortic injuries are missed frequently by PMCT and PMMRI and form their main limitation. CONCLUSION PMCT should be considered as an essential supplement to conventional autopsy in trauma victims since it detects many additional injuries. Despite some major limitations, PMCT could be used as an alternative for conventional autopsy in situations where conventional autopsy is rejected or unavailable.
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Affiliation(s)
- Hamid Jalalzadeh
- Department of Trauma Surgery, VU University Medical Centre, De Boelelaan 1117, 1081 HZ Amsterdam, The Netherlands; Department of General Surgery, Slotervaartziekenhuis, Louwesweg 6, 1066 EC Amsterdam, The Netherlands.
| | - Georgios F Giannakopoulos
- Department of Trauma Surgery, VU University Medical Centre, De Boelelaan 1117, 1081 HZ Amsterdam, The Netherlands; Department of General Surgery, Slotervaartziekenhuis, Louwesweg 6, 1066 EC Amsterdam, The Netherlands
| | - Ferco H Berger
- Department of Radiology and Nuclear Medicine, VU University Medical Centre, De Boelelaan 1117, 1081 HZ Amsterdam, The Netherlands
| | - Judith Fronczek
- Department of Pathology, VU University Medical Centre, De Boelelaan 1117, 1081 HZ Amsterdam, The Netherlands; Department of Pathology, Symbiant, Medisch Centrum Alkmaar, Wilhelminalaan 12, 1815 JD Alkmaar, The Netherlands
| | - Frank R W van de Goot
- Department of Pathology, VU University Medical Centre, De Boelelaan 1117, 1081 HZ Amsterdam, The Netherlands; Department of Pathology, Symbiant, Medisch Centrum Alkmaar, Wilhelminalaan 12, 1815 JD Alkmaar, The Netherlands
| | - Udo J Reijnders
- Department of Forensic Medicine, Public Health Service, P.O. Box 2200, 1000 CE Amsterdam, The Netherlands
| | - Wietse P Zuidema
- Department of Trauma Surgery, VU University Medical Centre, De Boelelaan 1117, 1081 HZ Amsterdam, The Netherlands
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Abstract
Death from trauma is a significant and international problem. Outcome for patients suffering out-of-hospital cardiac arrests is significantly improved by early cardiopulmonary resuscitation. The usefulness of first aid given by laypeople in trauma is less well established. The aim of this study was to review the existing literature on first aid provided by laypeople to trauma victims and to establish how often first aid is provided, if it is performed correctly, and its impact on outcome. A systematic review was carried out, according to preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines, of all studies involving first aid provided by laypeople to trauma victims. Cochrane, Embase, Medline, Pubmed, and Google Scholar databases were systematically searched. Ten eligible articles were identified involving a total of 5836 victims. Eight studies were related to patient outcome, while two studies were simulation based. The proportion of patients who received first aid ranged from 10.7% to 65%. Incorrect first aid was given in up to 83.7% of cases. Airway handling and haemorrhage control were particular areas of concern. One study from Iraq investigated survival and reported a 5.8% reduction in mortality. Two retrospective autopsy-based studies estimated that correct first aid could have reduced mortality by 1.8-4.5%. There is limited evidence regarding first aid provided by laypeople to trauma victims. Due to great heterogeneity in the studies, firm conclusions can not be drawn. However, the results show a potential mortality reduction if first aid is administered to trauma victims. Further research is necessary to establish this.
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Affiliation(s)
- T. D. TANNVIK
- Department of Anaesthesiology and Intensive Care Hammerfest Hospital Hammerfest Norway
| | - H. K. BAKKE
- Anaesthesia and Critical Care Research Group, Faculty of Health Sciences University of Tromsø Tromsø Norway
| | - T. WISBORG
- Department of Anaesthesiology and Intensive Care Hammerfest Hospital Hammerfest Norway
- Anaesthesia and Critical Care Research Group, Faculty of Health Sciences University of Tromsø Tromsø Norway
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Giannakopoulos GF, Saltzherr TP, Beenen LF, Reitsma JB, Bloemers FW, Goslings JC, Bakker FC; REACT Study Group. Missed injuries during the initial assessment in a cohort of 1124 level-1 trauma patients. Injury 2012; 43:1517-21. [PMID: 21820114 DOI: 10.1016/j.injury.2011.07.012] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Revised: 07/12/2011] [Accepted: 07/15/2011] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Despite the presence of diagnostic guidelines for the initial evaluation in trauma, the reported incidence of missed injuries is considerable. The aim of this study was to assess the missed injuries in a large cohort of trauma patients originating from two European Level-1 trauma centres. METHODS We analysed the 1124 patients included in the randomised REACT trial. Missed injuries were defined as injuries not diagnosed or suspected during initial clinical and radiological evaluation in the trauma room. We assessed the frequency, type, consequences and the phase in which the missed injuries were diagnosed and used univariate analysis to identify potential contributing factors. RESULTS Eight hundred and three patients were male, median age was 38 years and 1079 patients sustained blunt trauma. Overall, 122 injuries were missed in 92 patients (8.2%). Most injuries concerned the extremities. Sixteen injuries had an AIS grade of ≥ 3. Patients with missed injuries had significantly higher injury severity scores (ISSs) (median of 15 versus 5, p<0.001). Factors associated with missed injuries were severe traumatic brain injury (GCS ≤ 8) and multitrauma (ISS ≥ 16). Seventy-two missed injuries remained undetected during tertiary survey (59%). In total, 31 operations were required for 26 initially missed injuries. CONCLUSION Despite guidelines to avoid missed injuries, this problem is hard to prevent, especially in the severely injured. The present study showed that the rate of missed injuries was comparable with the literature and their consequences not severe. A high index of suspicion remains warranted, especially in multitrauma patients.
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Smekal D, Hansen T, Sandler H, Rubertsson S. Comparison of computed tomography and autopsy in detection of injuries after unsuccessful cardiopulmonary resuscitation. Resuscitation 2012; 84:357-60. [PMID: 22776515 DOI: 10.1016/j.resuscitation.2012.06.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Revised: 06/14/2012] [Accepted: 06/24/2012] [Indexed: 10/28/2022]
Abstract
AIM Computed tomography (CT) has been suggested as an aid or even a replacement for autopsy. The aim of this trial was to study the conformity of the two methods in finding injuries in non-surviving patients after unsuccessful cardiopulmonary resuscitation. METHODS In this prospective study, 31 patients were submitted to a CT prior to autopsy after unsuccessful resuscitation attempts. Pathological findings were noted by both the radiologist and the pathologists in a specified protocol. The pathologists and radiologist were blinded from each other's results. RESULTS CT and autopsy revealed rib fractures in 22 and 24 patients respectively (kappa=0.83). In 8 patients, CT revealed more rib fractures than autopsy; and in 12 patients, autopsy revealed more rib fractures than CT. In 7 patients, neither method showed any rib fractures. The mean difference between the two methods in detecting rib fractures was 0.16 (S.D.: ± 3.174, limits of agreement: -6.19 to 6.51). The kappa value for sternal fractures was 0.49. A total of 260 pathological findings were noted by CT and 244 by autopsy. The average patient showed a median of 9 injuries (every fracture counted as one injury), independent of the method used in detecting the injuries. CONCLUSIONS There was a strong concordance between the two methods in finding rib fractures but not sternal fractures and these results support the concept of CT as a valuable complement to autopsy in detecting rib fractures after unsuccessful cardiopulmonary resuscitation but not as a replacement. Other injuries did not show the same concordance.
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Affiliation(s)
- David Smekal
- Department of Surgical Sciences - Anaesthesiology & Intensive Care, Uppsala University, S-751 85 Uppsala, Sweden.
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Abstract
Background Finnmark County is the northernmost county in Norway. For several decades, the rate of mortality after injury in this sparsely inhabited region has remained above the national average. Following documentation of this discrepancy for the period 1991–1995, improvements to the trauma system were implemented. The present study aims to assess whether trauma-related mortality rates have subsequently improved. Methods All injury-associated fatalities in Finnmark from 1995–2004 were identified retrospectively from the National Registry of Death and reviewed. Low-energy trauma in elderly individuals and poisonings were excluded. Results A total of 453 cases of trauma-related death occurred during the study period, and 327 of those met the inclusion criteria. Information was retrievable for 266 cases. The majority of deaths (86%) occurred in the prehospital phase. The main causes of death were suicide (33%) and road traffic accidents (21%). Drowning and snowmobile injuries accounted for an unexpectedly high proportion (12 and 8%, respectively). The time of death did not show trimodal distribution. Compared to the previous study period, there was a significant overall decline in injury-related mortality, yet there was no change in place of death, mechanism of injury, or time from injury until death. Conclusions Changes in injury-related mortality cannot be linked to improvements in the trauma system. There was no change in the epidemiological patterns of injury. The high rate of on-scene mortality indicates that any major improvement in the number of injury-related deaths lies in targeted prevention.
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Affiliation(s)
- Håkon Kvåle Bakke
- Institute of Clinical Medicine, University of Tromsø, 9037, Tromsø, Norway
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Scholing M, Saltzherr TP, Fung Kon Jin PHP, Ponsen KJ, Reitsma JB, Lameris JS, Goslings JC. The value of postmortem computed tomography as an alternative for autopsy in trauma victims: a systematic review. Eur Radiol 2009; 19:2333-41. [PMID: 19458952 PMCID: PMC2758189 DOI: 10.1007/s00330-009-1440-4] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Revised: 03/01/2009] [Accepted: 04/13/2009] [Indexed: 11/28/2022]
Abstract
The aim of this study was to assess the role of postmortem computed tomography (PMCT) as an alternative for autopsy in determining the cause of death and the identification of specific injuries in trauma victims. A systematic review was performed by searching the EMBASE and MEDLINE databases. Articles were eligible if they reported both PMCT as well as autopsy findings and included more than one trauma victim. Two reviewers independently assessed the eligibility and quality of the articles. The outcomes were described in terms of the percentage agreement on causes of death and amount of injuries detected. The data extraction and analysis were performed together. Fifteen studies were included describing 244 victims. The median sample size was 13 (range 5–52). The percentage agreement on the cause of death between PMCT and autopsy varied between 46 and 100%. The overall amount of injuries detected on CT ranged from 53 to 100% compared with autopsy. Several studies suggested that PMCT was capable of identifying injuries not detected during normal autopsy. This systematic review provides inconsistent evidence as to whether PMCT is a reliable alternative for autopsy in trauma victims. PMCT has promising features in postmortem examination suggesting PMCT is a good alternative for a refused autopsy or a good adjunct to autopsy because it detects extra injuries overseen during autopsies. To examine the value of PMCT in trauma victims there is a need for well-designed and larger prospective studies.
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Affiliation(s)
- M Scholing
- Academic Medical Center, Trauma Unit, Department of Surgery, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
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Söderlund T, Tulikoura I, Niemelä M, Handolin L. Traumatic deaths in the emergency room: A retrospective analysis of 115 consecutive cases. Eur J Trauma Emerg Surg 2009; 35:455-62. [DOI: 10.1007/s00068-009-8179-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2008] [Accepted: 02/10/2009] [Indexed: 10/20/2022]
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Moharamzad Y, Taghipour H, Hodjati Firoozabadi N, Hodjati Firoozabadi A, Hashemzadeh M, Mirjalili M, Namavari A. Mortality pattern according to autopsy findings among traffic accident victims in Yazd, Iran. Chin J Traumatol 2008; 11:329-34. [PMID: 19032846 DOI: 10.1016/s1008-1275(08)60067-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To describe mortality pattern and to determine undiagnosed fatal injuries according to autopsy findings among road traffic accident victims in Yazd, Iran. METHODS In this retrospective study, 251 victims of road traffic accidents who were admitted to a tertiary trauma hospital over a two-year period (2006 and 2007) and received medical cares were included. Hospital records were reviewed to gather demographic characteristics, road user type, and medical data. Autopsy records were also reviewed to determine actual causes of death and possible undiagnosed injuries occurred in the initial assessment of the emergency unit or during hospitalization. RESULTS There were 202 males (80.5%) and 49 females (19.5%). The mean (+/-SD) age of fatalities was 34.1 (+/-21.5) years. Pedestrian-vehicle accidents were the most common cause of trauma (100 cases, 39.8%). The most common cause of death was central nervous system injury (146 cases, 58.1%). The other causes were skull base fractures (10%), internal bleeding (8%), lower limb hemorrhage (8%), skull vault fractures (4%), cervical spinal cord injury (3.6%), airway compromise (3.2%), and multifactor cases (5.1%), respectively. Thirty-six fatal injuries in 30 victims (12%) mainly contributed to death according to autopsy, but were not diagnosed in initial assessments. The head (72.2%) and cervical spine (13.8%) regions were the two most common sites for undiagnosed injuries. CONCLUSION Training courses for emergency unit medical staff with regard to interpreting radiological findings of head and neck and high clinical suspicion for cervical spine injuries are essential to improve the quality of early hospital care and reduce the mortality and morbidity of traffic accident patients.
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Affiliation(s)
- Yashar Moharamzad
- Trauma Research Center, Baqiyatallah Medical Sciences University, Tehran, Iran
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