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Grisel B, Gordee A, Kuchibhatla M, Ginsberg Z, Agarwal S, Haines K. Outcomes by time-to-OR for penetrating abdominal trauma patients. Am J Emerg Med 2024; 79:144-151. [PMID: 38432154 DOI: 10.1016/j.ajem.2024.02.018] [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] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 02/09/2024] [Indexed: 03/05/2024] Open
Abstract
INTRODUCTION Time-To-OR is a critical process measure for trauma performance. However, this measure has not consistently demonstrated improvement in outcome. STUDY DESIGN Using TQIP, we identified facilities by 75th percentile time-to-OR to categorize slow, average, and fast hospitals. Using a GEE model, we calculated odds of mortality for all penetrating abdominal trauma patients, firearm injuries only, and patients with major complication by facility speed. We additionally estimated odds of mortality at the patient level. RESULTS Odds of mortality for patients at slow facilities was 1.095; 95% CI: 0.746, 1.608; p = 0.64 compared to average. Fast facility OR = 0.941; 95% CI: 0.780, 1.133; p = 0.52. At the patient-level each additional minute of time-to-OR was associated with 1.5% decreased odds of in-hospital mortality (OR 0.985; 95% CI:0.981, 0.989; p < 0.001). For firearm-only patients, facility speed was not associated with odds of in-hospital mortality (p-value = 0.61). Person-level time-to-OR was associated with 1.8% decreased odds of in-hospital mortality (OR 0.982; 95% CI: 0.977, 0.987; p < 0.001) with each additional minute of time-to-OR. Similarly, failure-to-rescue analysis showed no difference in in-hospital mortality at the patient level (p = 0.62) and 0.4% decreased odds of in-hospital mortality with each additional minute of time-to-OR at the patient level (OR 0.996; 95% CI: 0.993, 0.999; p = 0.004). CONCLUSION Despite the use of time-to-OR as a metric of trauma performance, there is little evidence for improvement in mortality or complication rate with improved time-to-OR at the facility or patient level. Performance metrics for trauma should be developed that more appropriately approximate patient outcome.
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Affiliation(s)
- Braylee Grisel
- Division of Trauma and Acute Care Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
| | - Alexander Gordee
- Department of Biostatistics, Duke University School of Medicine, Durham, NC, USA.
| | | | - Zachary Ginsberg
- Division of Trauma and Acute Care Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
| | - Suresh Agarwal
- Division of Trauma and Acute Care Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
| | - Krista Haines
- Division of Trauma and Acute Care Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
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Garcia L, de Virgilio C, Nahmias J, Keeley JA, Grigorian A. The Relationship Between the COVID-19 Pandemic and Pediatric Trauma. J Surg Res 2024; 298:169-175. [PMID: 38615550 DOI: 10.1016/j.jss.2024.03.034] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 02/19/2024] [Accepted: 03/21/2024] [Indexed: 04/16/2024]
Abstract
INTRODUCTION The COVID-19 pandemic created difficulties in access to care. There was also increased penetrating trauma in adults, which has been attributed to factors including increased firearm sales and social isolation. However, less is known about the relationship between the pandemic and pediatric trauma patients (PTPs). This study aimed to investigate the national incidence of penetrating trauma in PTPs, hypothesizing a higher rate with onset of the pandemic. We additionally hypothesized increased risk of complications and death in penetrating PTPs after the pandemic versus prepandemic. METHODS We included all PTPs (aged ≤17-years-old) from the 2017-2020 Trauma Quality Improvement Program database, dividing the dataset into two eras: prepandemic (2017-2019) and pandemic (2020). We performed subset analyses of the pandemic and prepandemic penetrating PTPs. Bivariate analyses and a multivariable logistic regression analysis were performed. RESULTS Of the 474,524 PTPs, 123,804 (26.1%) were from the pandemic year. The pandemic era had increased stab wounds (3.3% versus 2.8%, P > 0.001) and gunshot wounds (5.5% versus 4.0%, P < 0.001) compared to the prepandemic era. Among penetrating PTPs, the rates and associated risk of in-hospital complications (2.6% versus 2.8%, P = 0.23) (odds ratio 0.90, confidence interval 0.79-1.02, P = 0.11) and mortality (4.9% versus 5.0%, P = 0.58) (odds ratio 0.90, confidence interval 0.78-1.03, P = 0.12) were similar between time periods. CONCLUSIONS This national analysis confirms increased penetrating trauma, particularly gunshot wounds in pediatric patients following onset of the COVID-19 pandemic. Despite this increase, there was no elevated risk of death or complications, suggesting that trauma systems adapted to the "dual pandemic" of COVID-19 and firearm violence in the pediatric population.
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Affiliation(s)
- Lorena Garcia
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, California.
| | | | - Jeffry Nahmias
- Department of Surgery, University of California, Irvine, Orange, California
| | - Jessica A Keeley
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, California
| | - Areg Grigorian
- Department of Surgery, University of California, Irvine, Orange, California
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Field X, Crichton JCI, Kong V, Ko J, Laing GL, Bruce J, Clarke DL. AAST grade of liver injury is not the single most important consideration in decision making for liver trauma. Injury 2024:111526. [PMID: 38644076 DOI: 10.1016/j.injury.2024.111526] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 02/28/2024] [Accepted: 04/02/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND The liver is one of the most injured organs in both blunt and penetrating trauma. The aim of this study was to identify whether the AAST liver injury grade is predictive of need for intervention, risk of complications and mortality in our patient population, and whether this differs between blunt and penetrating-trauma mechanisms. METHODS Retrospective review of all liver injuries from a single high-volume metropolitan trauma centre in South Africa from December 2012 to January 2022. Inclusion criteria were all adults who had sustained traumatic liver injury. Patients were excluded if they were under 15 years of age or had died prior to operation or assessment. Statistical analysis was undertaken using both univariate and multivariate models. RESULTS 709 patients were included, of which 351 sustained penetrating and 358 blunt trauma. Only 24.3 % of blunt compared to 76.4 % of penetrating trauma patients underwent laparotomy (p< 0.001). In blunt trauma, increasing AAST grade correlated directly with rates of laparotomy with an odds ratio of 1.7 (p < 0.001). In penetrating trauma, there was no statistical significance between increasing AAST grade and the rate of laparotomy. The rate of bile leak was 4.5 % (32/709) and of rebleed was 0.7 % (5/709). Five patients underwent ERCP and endoscopic sphincterotomy for bile leak, and three required angio-embolization for rebleeding. Increasing AAST grades were significantly associated with the odds of bile leak in both blunt and penetrating trauma. There was a statistically significant increase in the odds of a rebleed with increasing AAST grade in penetrating trauma. Five patients rebled, of which three died. Seven patients developed hepatic necrosis. Seventy-six patients died (10 %). There were 34/358 (9 %) deaths in the blunt cohort and 42 /351 (11 %) deaths in the penetrating trauma cohort. CONCLUSION AAST grade in isolation is not a good predictor of the need for operation in hepatic trauma. Increasing AAST grade was not found to correlate with increased risk of mortality for both blunt and penetrating hepatic trauma. In both blunt and penetrating trauma, increasing AAST grade is significantly associated with increased bile leak. The need for ERCP and endoscopic sphincterotomy to manage bile leak in our setting is low. Similarly, the rate of rebleeding and of angioembolization was low.
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Affiliation(s)
- Xavier Field
- Department of Surgery, Waikato Hospital, Hamilton, New Zealand
| | - James C I Crichton
- Department of Surgery, Waikato Hospital, Hamilton, New Zealand; Department of Surgery, Christchurch Hospital, Christchurch, New Zealand
| | - Victor Kong
- Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa; Department of Surgery, University of KwaZulu Natal, Durban, South Africa.
| | - Jonathan Ko
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Grant L Laing
- Department of Surgery, University of KwaZulu Natal, Durban, South Africa
| | - John Bruce
- Department of Surgery, University of KwaZulu Natal, Durban, South Africa
| | - Damian L Clarke
- Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa; Department of Surgery, University of KwaZulu Natal, Durban, South Africa
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Serapiglia VE, Patel KA, Varre JSV, Dusseau BT, DeVoe WB. Attempted repair of chest wall injury following penetrating injury with surgical stabilization rib and autologous bone graft: A case report. Trauma Case Rep 2024; 50:100984. [PMID: 38496000 PMCID: PMC10940907 DOI: 10.1016/j.tcr.2024.100984] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2024] [Indexed: 03/19/2024] Open
Abstract
Rib fractures are one of the most common injuries following blunt trauma. When associated with penetrating trauma, the projectile velocity and immense energy transfer cause significant rib fracture displacement and fragmentation. As a result, these patients are potentially exposed to an even higher risk of complications compared to those seen in more simple rib fractures. Unfortunately, there is limited research regarding technical considerations for surgical stabilization of rib fractures (SSRF) in severely displaced rib fractures with bone loss following penetrating injury. We present the case of a 21-year-old male gunshot wound victim with severely displaced and comminuted rib fractures in which we utilized an autologous bone graft bridge during SSRF to enhance fracture unionization, chest wall stability, and cosmesis. Unfortunately, the bone graft failed to incorporate into surrounding tissue.
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Affiliation(s)
- Vincent E. Serapiglia
- Department of General Surgery, Riverside Methodist Hospital, 3545 Olentangy River Rd Ste 525, Columbus, OH 43214, United States of America
| | - Krishna A. Patel
- Department of General Surgery, Riverside Methodist Hospital, 3545 Olentangy River Rd Ste 525, Columbus, OH 43214, United States of America
| | - Jaya Sai V. Varre
- Department of General Surgery, Riverside Methodist Hospital, 3545 Olentangy River Rd Ste 525, Columbus, OH 43214, United States of America
| | - Brian T. Dusseau
- Department of General Surgery, Riverside Methodist Hospital, 3545 Olentangy River Rd Ste 525, Columbus, OH 43214, United States of America
| | - William B. DeVoe
- Department of General Surgery, Riverside Methodist Hospital, 3545 Olentangy River Rd Ste 525, Columbus, OH 43214, United States of America
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Adami EA, Poillucci G, Di Saverio S, Khan M, Fransvea P, Podda M, Rampini A, Marini P. A critical appraisal of emergency resuscitative thoracotomy in a Western European level 1 trauma centre: a 13-year experience. Updates Surg 2024; 76:677-686. [PMID: 37839047 DOI: 10.1007/s13304-023-01667-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/29/2023] [Indexed: 10/17/2023]
Abstract
Emergency Resuscitative Thoracotomy (ERT) is a lifesaving procedure in selected patients. Outcome mostly in blunt trauma is believed to be poor. The primary aim of this study was to determine the predictors of postoperative mortality following ERT. We retrospectively reviewed 34 patients ≥ 18 years who underwent ERT at San Camillo-Forlanini Hospital (Rome, Italy) between January 2009 and December 2022 with traumatic arrest for blunt or penetrating injuries. Of 34 ERT, 28 (82.4%) were for blunt trauma and 6 (17.6%) were for penetrating trauma. Injury Severity Score (p-value 0.014), positive E-FAST (p-value 0.023), Systolic Blood Pressure (p-value 0.001), lactate arterial blood (p-value 0.012), pH arterial blood (p-value 0.007), and bicarbonate arterial blood (p-value < 0.001) were significantly associated with postoperative mortality in a univariate model. After adjustment, the only independent predictor of postoperative mortality was Injury Severity Score (p-value 0.048). Our experience suggests that ERT is a technique that should be utilized for patients with critical penetrating injuries and blunt trauma in patients in extremis. Our study highlights as negative prognostic factors high values of ISS and lactate arterial blood, a positive E-FAST, and low values of Systolic Blood Pressure, pH arterial blood and bicarbonate arterial blood.
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Affiliation(s)
- Ennio Alberto Adami
- General and Emergency Surgery, St. Camillo Forlanini's Hospital, Rome, Italy
| | - Gaetano Poillucci
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, San Matteo Hospital, Spoleto, Italy.
| | - Salomone Di Saverio
- Department of General Surgery, San Benedetto del Tronto General Hospital, San Benedetto del Tronto, Italy
| | - Mansoor Khan
- University Hospitals Sussex NHSFT, Eastern Rd, Brighton, UK
| | - Pietro Fransvea
- Emergency Surgery and Trauma, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Mauro Podda
- Department of Surgical Science, Policlinico Universitario "Duilio Casula", University of Cagliari, Cagliari, Italy
| | - Alessia Rampini
- General and Emergency Surgery, St. Camillo Forlanini's Hospital, Rome, Italy
| | - Pierluigi Marini
- General and Emergency Surgery, St. Camillo Forlanini's Hospital, Rome, Italy
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Alcasid NJ, Banks KC, Susai CJ, Victorino GP. Early Abnormal Vital Signs Predict Poor Outcomes in Normotensive Patients Following Penetrating Trauma. J Surg Res 2024; 295:393-398. [PMID: 38070252 DOI: 10.1016/j.jss.2023.11.018] [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] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 10/17/2023] [Accepted: 11/12/2023] [Indexed: 02/25/2024]
Abstract
INTRODUCTION Because trauma patients in class II shock (blood loss of 15%-30% of total blood volume) arrive normotensive, this makes the identification of shock and subsequent prognostication of outcomes challenging. Our aim was to identify early predictive factors associated with worse outcomes in normotensive patients following penetrating trauma. We hypothesize that abnormalities in initial vital signs portend worse outcomes in normotensive patients following penetrating trauma. METHODS A retrospective review was performed from 2006 to 2021 using our trauma database and included trauma patients presenting with penetrating trauma with initial normotensive blood pressures (systolic blood pressure ≥90 mmHg). We compared those with a narrow pulse pressure (NPP ≤25% of systolic blood pressure), tachycardia (heart rate ≥100 beats per minute), and elevated shock index (SI ≥ 0.8) to those without. Outcomes included mortality, intensive care unit admission, and ventilator use. Chi-squared, Mann-Whitney tests, and regression analyses were performed as appropriate. RESULTS We identified 7618 patients with penetrating injuries and normotension on initial trauma bay assessment. On univariate analysis, NPP, tachycardia, and elevated SI were associated with increases in mortality compared to those without. On multivariable logistic regression, only NPP and tachycardia were independently associated with mortality. Tachycardia and an elevated SI were both independently associated with intensive care unit admission. Only an elevated SI had an independent association with ventilator requirements, while an NPP and tachycardia did not. CONCLUSIONS Immediate trauma bay NPP and tachycardia are independently associated with mortality and adverse outcomes and may provide an opportunity for improved prognostication in normotensive patients following penetrating trauma.
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Affiliation(s)
- Nathan J Alcasid
- Department of Surgery, University of California, San Francisco- East Bay, Oakland, California.
| | - Kian C Banks
- Department of Surgery, University of California, San Francisco- East Bay, Oakland, California
| | - Cynthia J Susai
- Department of Surgery, University of California, San Francisco- East Bay, Oakland, California
| | - Gregory P Victorino
- Department of Surgery, University of California, San Francisco- East Bay, Oakland, California
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Al Tannir AH, Biesboer EA, Pokrzywa C, Golestani S, Kukushliev V, Jean X, Harding E, de Moya MA, Morris R, Kugler N, Schellenberg M, Murphy PB. Open versus endovascular repair of penetrating non-aortic arterial injuries: A systematic review and meta analysis. Injury 2024; 55:111368. [PMID: 38309083 DOI: 10.1016/j.injury.2024.111368] [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: 12/12/2023] [Revised: 01/15/2024] [Accepted: 01/17/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND Non-aortic arterial injuries are common and are associated with high morbidity and mortality. Historically, open surgical repair (OSR) was the conventional method of repair. With recent advancements in minimally invasive techniques, endovascular repair (ER) has gained popularity. We sought to compare outcomes in patients undergoing endovascular and open repairs of traumatic non-aortic penetrating arterial injuries. METHODS A systematic review and meta-analysis was conducted using MEDLINE (OVID), Web of Science, Cochrane Library, and Scopus Database from January 1st, 1990, to March 20th, 2023. Titles and abstracts were screened, followed by full text review. Articles assessing clinically important outcomes between OSR and ER in penetrating arterial injuries were included. Exclusion criteria included blunt injuries, aortic injuries, pediatric populations, review articles, and non-English articles. Odds ratios (OR) and Cohen's d ratios were used to quantify differences in morbidity and mortality. RESULTS A total of 3770 articles were identified, of which 8 met inclusion criteria and were included in the review. The articles comprised a total of 8369 patients of whom 90 % were male with a median age of 28 years. 85 % of patients were treated with OSR while 15 % underwent ER. With regards to injury characteristics, those who underwent ER were less likely to present with concurrent venous injuries (OR: 0.41; 95 %CI: 0.18, 0.94; p = 0.03). Regarding hospital outcomes, patients who underwent ER had a lower likelihood of in-hospital or 30-day mortality (OR: 0.72; 95 %CI: 0.55, 0.95; p = 0.02) and compartment syndrome (OR: 0.29, 95 %CI: 0.12, 0.71; p = 0.007). The overall risk of bias was moderate. CONCLUSION Endovascular repair of non-aortic penetrating arterial injuries is increasingly common, however open repair remains the most common approach. Compared to ER, OSR was associated with higher odds of compartment syndrome and mortality. Further prospective research is warranted to determine the patient populations and injury patterns that most significantly benefit from an endovascular approach. LEVEL OF EVIDENCE Level III, Systematic Reviews & Meta-Analyses.
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Affiliation(s)
- Abdul Hafiz Al Tannir
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Elise A Biesboer
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Courtney Pokrzywa
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Simin Golestani
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Vasil Kukushliev
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Xavier Jean
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Eric Harding
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Marc A de Moya
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rachel Morris
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Nathan Kugler
- Department of Surgery, Division of Vascular & Endovascular Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Morgan Schellenberg
- Department of Surgery, Division of Acute Care Surgery, University of Southern California, Los Angeles, CA, USA
| | - Patrick B Murphy
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
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Levaro F, Hill EJR, Bertelli JA. A cut throat: a case of C5-C8 brachial plexus root transection providing evidence of T1 innervation of thumb and finger extensors. Br J Neurosurg 2024; 38:128-130. [PMID: 36062588 DOI: 10.1080/02688697.2022.2118233] [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] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/23/2022] [Indexed: 11/02/2022]
Abstract
The T1 nerve root is not routinely thought of as innervating the extensors of the thumb and fingers. Work by Bertelli and Ghizoni proposed that the pattern of brachial plexus paralysis with intact hand function and thumb and finger extensors traditionally attributed to C5/6/7 root injury is in fact a C5/6/7/8 injury, with only T1 remaining intact - a 'T1 hand'. This case presents a 19-year-old male who was stabbed in the neck; exploratory surgery determined complete transection of the brachial plexus, with only the T1 nerve root remaining intact. Clinical examination demonstrated grade M4 pronation (with pronator quadratus), wrist extension (with extensor carpi ulnaris), thumb and finger extension (with extensor policis longus and brevis, extensor digitorum communis and extensor index proprius), wrist flexion (with palmaris longus), finger flexion (with flexor digitorum superficialis and profundus), thumb flexion (with flexor policis longus), and thenar and hypothenar muscles. Extensor carpi radialis longus and brevis, flexor carpi radialis and flexor carpi ulnaris were paralyzed. Triceps scored M2. This case provides unequivocal evidence that the T1 root provides significant innervation to the extrinsic thumb and finger extensors.
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Affiliation(s)
- Fernando Levaro
- Department of Orthopaedic Surgery, The University of Texas, Houston, TX, USA
| | - Elspeth Jane Rose Hill
- Department of Orthopaedic Surgery, Governador Celso Ramos Hospital, Florianópolis, Brazil
- Department of Medicine and Surgery, Harris Manchester College, Oxford University, Oxford, England
| | - Jayme Augusto Bertelli
- Department of Orthopaedic Surgery, Governador Celso Ramos Hospital, Florianópolis, Brazil
- Center of Biological and Health Sciences, Department of Neurosurgery, University of the South of Santa Catarina (Unisul), Tubarão, Brazil
- Department of Plastic Surgery, Joana de Gusmão Children's Hospital, Florianópolis, Brazil
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Ramsey WA, O'Neil CF, Shatz CD, Lyons NB, Cohen BL, Saberi RA, Gilna GP, Meizoso JP, Pizano LR, Schulman CI, Proctor KG, Namias N. Nationwide Analysis of Firearm Injury Versus Other Penetrating Trauma: It's Not All the Same Caliber. J Surg Res 2024; 294:106-111. [PMID: 37866065 DOI: 10.1016/j.jss.2023.09.067] [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] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/25/2023] [Accepted: 09/24/2023] [Indexed: 10/24/2023]
Abstract
INTRODUCTION Ballistic injuries cause both a temporary and permanent cavitation event, making them far more destructive and complex than other penetrating trauma. We hypothesized that global injury scoring and physiologic parameters would fail to capture the lethality of gunshot wounds (GSW) compared to other penetrating mechanisms. METHODS The 2019 American College of Surgeons Trauma Quality Programs participant use file was queried for the mortality rate for GSW and other penetrating mechanisms. A binomial logistic regression model ascertained the effects of sex, age, hypotension, tachycardia, mechanism, Glasgow Coma Scale, ISS, and volume of blood transfusion on the likelihood of mortality. Subgroup analyses examined isolated injuries by body regions. RESULTS Among 95,458 cases (82% male), GSW comprised 46.4% of penetrating traumas. GSW was associated with longer hospital length of stay (4 [2-9] versus 3 [2-5] days), longer intensive care unit length of stay (3 [2-6] versus 2 [2-4] days), and more ventilator days (2 [1-4] versus 2 [1-3]) compared to stab wounds, all P < 0.001. The model determined that GSW was linked to increased odds of mortality compared to stab wounds (odds ratio 4.19, 95% confidence interval 3.55-4.93). GSW was an independent risk factor for acute kidney injury, acute respiratory distress syndrome, venous thromboembolism, sepsis, and surgical site infection. CONCLUSIONS Injury scoring systems based on anatomical or physiological derangements fail to capture the lethality of GSW compared to other mechanisms of penetrating injury. Adjustments in risk stratification and reporting are necessary to reflect the proportion of GSW seen at each trauma center. Improved classification may help providers develop quality processes of care. This information may also help shape public discourse on this highly lethal mechanism.
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Affiliation(s)
- Walter A Ramsey
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida; Ryder Trauma Center, Jackson Memorial Hospital, Miami, Florida.
| | - Christopher F O'Neil
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida; Ryder Trauma Center, Jackson Memorial Hospital, Miami, Florida
| | - Connor D Shatz
- University of Miami Miller School of Medicine, Miami, Florida
| | - Nicole B Lyons
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida; Ryder Trauma Center, Jackson Memorial Hospital, Miami, Florida
| | - Brianna L Cohen
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida; Ryder Trauma Center, Jackson Memorial Hospital, Miami, Florida
| | - Rebecca A Saberi
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida; Ryder Trauma Center, Jackson Memorial Hospital, Miami, Florida
| | - Gareth P Gilna
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida; Ryder Trauma Center, Jackson Memorial Hospital, Miami, Florida
| | - Jonathan P Meizoso
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida; Ryder Trauma Center, Jackson Memorial Hospital, Miami, Florida
| | - Louis R Pizano
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida; Ryder Trauma Center, Jackson Memorial Hospital, Miami, Florida
| | - Carl I Schulman
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida; Ryder Trauma Center, Jackson Memorial Hospital, Miami, Florida
| | - Kenneth G Proctor
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida; Ryder Trauma Center, Jackson Memorial Hospital, Miami, Florida
| | - Nicholas Namias
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida; Ryder Trauma Center, Jackson Memorial Hospital, Miami, Florida
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10
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Lilford RD, Hossain I, Dahlberg M, Wahlgren CM, Bellander BM, Rostami A, Günther M, Bartek J, Rostami E. Increased Incidence and Mortality of Civilian Penetrating Traumatic Brain Injury in Sweden: A Single-Center Registry-Based Study. World Neurosurg 2024; 182:e493-e505. [PMID: 38040331 DOI: 10.1016/j.wneu.2023.11.129] [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] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/26/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Penetrating trauma to the head and neck has increased during the past decade in Sweden. The aim of this study was to characterize these injuries and evaluate the outcomes for patients treated at a tertiary trauma center. METHODS Swedish trauma registry data were extracted on patients with head and neck injuries admitted to Karolinska University Hospital (Stockholm, Sweden) between 2011 and 2019. Outcome information was extracted from hospital records, with the primary endpoints focusing on the physiological outcome measures and the secondary endpoints on the surgical and radiological outcomes. RESULTS Of 1436 patients with penetrating trauma, 329 with penetrating head and neck injuries were identified. Of the 329 patients, 66 (20%) had suffered a gunshot wound (GSW), 240 (73%) a stab wound (SW), and 23 (7%) an injury from other trauma mechanisms (OTMs). The median age for the corresponding 3 groups of patients was 25, 33, and 21 years, respectively. Assault was the primary intent, with 54 patients experiencing GSWs (81.8%) and 158 SWs (65.8%). Patients with GSWs had more severe injuries, worse admission Glasgow coma scale, motor, scores, and a higher intubation rate at the injury site. Most GSW patients underwent major surgery (59.1%) as the initial procedure and were more likely to have intracranial hemorrhage (21.2%). The 30-day mortality was 45.5% (n = 30) for GSWs, 5.4% (n = 13) for SWs, and 0% (n = 0) for OTMs. There was an annual increase in the incidence and mortality for GSWs and SWs. CONCLUSIONS Between 2011 and 2019, an increasing annual trend was found in the incidence and mortality from penetrating head and neck trauma in Stockholm, Sweden. GSW patients experienced more severe injuries and intracranial hemorrhage and underwent more surgical interventions compared with patients with SWs and OTMs.
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Affiliation(s)
- Robert D Lilford
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Iftakher Hossain
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Neurosurgery, Neurocentre, Turku University Hospital, Turku, Finland; Neurosurgery Unit, Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom; Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Martin Dahlberg
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Carl-Magnus Wahlgren
- Department of Molecular Medicine and Surgery, Centre for Trauma Research, Karolinska Institute, Stockholm, Sweden; Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Bo-Michael Bellander
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Amir Rostami
- Department of Social Work and Criminology, University of Gävle, Gävle, Sweden; Institute for Future Studies, Stockholm, Sweden
| | - Mattias Günther
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Jiri Bartek
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
| | - Elham Rostami
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden.
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11
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Ashoobi MA, Homaie Rad E, Rahimi R. Diagnostic performance of sonography in penetrating torso trauma: a systematic review and meta-analysis. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02446-6. [PMID: 38261075 DOI: 10.1007/s00068-024-02446-6] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024]
Abstract
BACKGROUND This systematic review investigates the diagnostic value of ultrasound in the evaluation of torso injuries following a penetrating trauma. METHODS We searched PubMed, Scopus, and WOS databases for related original articles until May 7, 2023, and extracted data related to diagnostic performance. The bivariate model and hierarchic summary receiver operating characteristic (HSROC) approach were used to calculate pooled diagnostic values. Cochrane Q test and I-squared were performed to evaluate heterogeneity. We assessed heterogeneity with meta-regression. RESULTS Seventeen studies were included, which involved a total number of 1866 patients. According to meta-analysis, sonography demonstrated a pooled sensitivity of 56% (45-67%) and specificity of 96% (94-97%), positive likelihood ratio (LR +) of 13.66 (8.03-23.23), and negative likelihood ratio (LR-) of 0.45 (0.35-0.59) for detecting abdominal injuries. In pericardial penetrating trauma, pooled sensitivity was 100% (45-100%), pooled specificity was 99% (96-100%), LR + was 136.7 (24.8-752.3), and LR- was 0.00 (0.00-1.22). For thoracic penetrating trauma, pooled sensitivity was 99% (93-100%) and specificity was 100% (98-100%). CONCLUSIONS Sonography demonstrated promising diagnostic value in the initial assessment of torso penetrating trauma, particularly in the thoracic and pericardial regions. However, the sensitivity of sonography is limited in abdominal penetrating trauma and a combination with other imaging modalities should be considered in these cases.
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Affiliation(s)
- Mohammad Amin Ashoobi
- Guilan Road Trauma Research Center, Trauma Institute, Guilan University of Medical Sciences, Rasht, Iran
| | - Enayatollah Homaie Rad
- Social Determinants of Health Research Center, Trauma Institute, Guilan University of Medical Sciences, Rasht, Iran
| | - Rayehe Rahimi
- Guilan Road Trauma Research Center, Trauma Institute, Guilan University of Medical Sciences, Rasht, Iran.
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12
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Ząbkowski T, Brzozowski R, Durma AD. Renal injuries in conflict zones: a 6-year study of traumatic cases in Afghanistan. Confl Health 2024; 18:6. [PMID: 38183150 PMCID: PMC10770980 DOI: 10.1186/s13031-023-00566-1] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/28/2023] [Indexed: 01/07/2024] Open
Abstract
PURPOSE During hostilities, gunshot wounds are the most common cause of penetrating injuries. In 8-10% of abdominal injuries kidneys are involved. The treatment method include surgical or conservative treatment (fluids + blood components). METHODS Of 1266 combat trauma cases treated during 6 to 14 rotation of the Polish Military Contingent in Afghanistan, we extracted a subgroup of 44 kidney injuries. Corelation of trauma mechanism, PATI score, treatment methods, and outcomes was evaluated. RESULTS Out of the 41 renal injuries, 20 considered left, 18 right, and 3 both kidneys. There were no statistical significancy in injury lateralization (p = 0.669), and no differences regarding side of a trauma and quantity of blood component used for the treatment (p = 0.246). Nephrectomy was performed on 17 patients (13 left vs. 4 right). A significant correlation between PATI score and the need for a nephrectomy (p = 0.027) was confirmed. Penetrating trauma recquired higher number of blood components comparing to blunt trauma (p < 0.001). The renal salvage rate was in study group was 61.36%. The overall survival (OS) rate was 90.25% - 4 patients died due to trauma. CONCLUSIONS The damage side does not result in a statistically significant increase in the need for blood transfusions or differences in the PATI score. The mechanism of trauma does, however, affect the number of blood components required for treatment, particularly in cases of penetrating trauma. With the introduction of proper treatment, the overall survival rate exceeds 90%, even when opting for conservative treatment.
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Affiliation(s)
- Tomasz Ząbkowski
- Department of Urology, Miliary Institute of Medicine - National Research Institute, Warsaw, Poland
| | - Robert Brzozowski
- Department of General and Oncological Surgery, 5th Military Clinical Hospital with Polyclinic, Cracov, Poland
| | - Adam Daniel Durma
- Department of Endocrinology and Radioisotope Therapy, Miliary Institute of Medicine - National Research Institute, Warsaw, Poland.
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13
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Zwemer CH, Mohamed T, Wu S, Farag CM, Zebley J, Kartiko S. Do Females Have Worse Outcomes in Penetrating Trauma: A Single-Center Analysis. J Surg Res 2024; 293:632-638. [PMID: 37837819 DOI: 10.1016/j.jss.2023.09.045] [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] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 08/15/2023] [Accepted: 09/03/2023] [Indexed: 10/16/2023]
Abstract
INTRODUCTION Penetrating trauma occurs less frequently in females than in males. Studies on penetrating injuries are conducted in predominantly male populations. We aim to elucidate the demographics and outcomes of penetrating trauma specifically in females to mitigate disparities of care in females. MATERIALS AND METHODS A retrospective review of hospitalized adult trauma patients suffering penetrating trauma from 2015 to 2021 was performed in an urban American College of Surgeon-verified level 1 trauma center. Patients were stratified by sex (females or males) and mechanism of injury (gun-related versus nongun-related). The primary outcome was mortality, and secondary outcomes included incidence of blood transfusion, incidence of surgical/interventional radiology (IR) interventions, hospital length of stay (LOS), and complications. Descriptive statistics were employed with a significance defined as P value <0.05. A multivariate logistic regression was used to determine the impact of sex on mortality, surgical/IR interventions, and hospital LOS. RESULTS Females with penetrating injury had lower Injury Severity Score (1 versus 4, P < 0.05) than males, but had similar mortality rates (4% versus 6%, P = 0.06). In multivariable logistic analysis adjusting for age and Injury Severity Score, while females experience 33% fewer OR/IR intervention, there was no statistically significant difference in mortality rates, hospital LOS, and complication rates between males and females. CONCLUSIONS Despite receiving fewer surgical/IR intervention, females with penetrating injuries have similar outcomes to their male counterparts. Further study is needed to study this discrepancy.
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Affiliation(s)
- Catherine H Zwemer
- Department of Surgery, Center for Trauma and Critical Care, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Troy Mohamed
- Department of Surgery, Center for Trauma and Critical Care, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Sophia Wu
- Department of Surgery, Center for Trauma and Critical Care, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Christian M Farag
- Department of Surgery, Center for Trauma and Critical Care, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - James Zebley
- Department of Surgery, Center for Trauma and Critical Care, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Susan Kartiko
- Department of Surgery, Center for Trauma and Critical Care, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.
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14
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Sozzi M, Inaba K, Schellenberg MA, Matsushima K, Martin MJ. Dangerous passage: the utility and accuracy of modern chest computed tomography in penetrating thoracic injuries with potential transmediastinal trajectory. Eur J Trauma Emerg Surg 2023; 49:2439-2445. [PMID: 37358631 PMCID: PMC10728241 DOI: 10.1007/s00068-023-02315-8] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 06/20/2023] [Indexed: 06/27/2023]
Abstract
AIM The aim of this study is to evaluate utility and reliability of chest CT as a standalone screening modality for stable patients with thoracic GSWs and potential transmediastinal trajectories. METHODS All patients with thoracic GSWs over a 5-year period were identified. Unstable patients requiring immediate surgery were excluded and the remaining underwent chest CT with intravenous contrast. Sensitivity and specificity for clinically significant injuries were tested against an aggregate gold standard of discharge diagnosis including imaging, operative and clinical findings. RESULTS A total of 216 patients met inclusion criteria and underwent chest CT. After imaging, 65 (30.1%) had indication for immediate surgery, of which 10 (4.6%) underwent a thoracic procedure for chest injuries while 151 (69.9%) were selected for nonoperative management (NOM). 11 (5.1%) required a delayed thoracic operation, none due to injuries missed on CT. The remaining 140 (64.8%) underwent successful NOM. Up to 195 (90.3%) patients had successful NOM of thoracic injuries. Only 9.2% required additional imaging, all negative. CT identified a cardiac injury in one case and a vascular injury in two cases, all confirmed by surgery, while one thoracic IVC injury missed on CT was found intraoperatively. 2 patients had CT suspicious for esophageal injury, ruled out by following investigations. There was one death in the total cohort, none in the NOM group. CONCLUSIONS Modern high-quality CT provides highly accurate and reliable screening modality for penetrating chest and mediastinal injuries and can be used as a standalone study in most patients or to guide further tests. Chest CT facilitated successful NOM.
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Affiliation(s)
- Marco Sozzi
- Los Angeles County + USC Medical Center, 2051 Marengo Street, Room C5L100, Los Angeles, CA, 90033, USA.
| | - Kenji Inaba
- Los Angeles County + USC Medical Center, 2051 Marengo Street, Room C5L100, Los Angeles, CA, 90033, USA
| | - Morgan A Schellenberg
- Los Angeles County + USC Medical Center, 2051 Marengo Street, Room C5L100, Los Angeles, CA, 90033, USA
| | - Kazuhide Matsushima
- Los Angeles County + USC Medical Center, 2051 Marengo Street, Room C5L100, Los Angeles, CA, 90033, USA
| | - Matthew J Martin
- Los Angeles County + USC Medical Center, 2051 Marengo Street, Room C5L100, Los Angeles, CA, 90033, USA
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15
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Perrin JM, Monchal T, Texier G, Salou-Regis L, Goudard Y. Concordance of CT imaging and surgical lesions in penetrating abdominal trauma. J Visc Surg 2023; 160:407-416. [PMID: 37481414 DOI: 10.1016/j.jviscsurg.2023.06.010] [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] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
OBJECTIVE The management of penetrating abdominal wounds has greatly benefited from the development of computed tomography (CT), particularly in stable patients. In this setting, the scanner is the reference examination. Our study aims to evaluate the performance of preoperative CT in the assessment of penetrating abdominal lesions. MATERIAL AND METHODS Between January 1, 2015 and January 1, 2022, 81 patients were hospitalized following penetrating abdominal trauma at the Army Training Hospitals of Sainte-Anne and Laveran. Fifty-one stable patients who had an abdominopelvic CT scan and thereafter underwent abdominal surgery (laparotomy or laparoscopy) were included. Radiological and surgical data were collected from the electronic record and compared by a descriptive analysis (calculation of the sensitivity, specificity, positive and negative predictive value of the CT for the detection of lesions of the various organs) and by a correlation of the CT findings with surgical findings using Kripendorff's alpha coefficient. RESULTS The cohort was largely male (n=45; 88%), with injuries by knife wound in 62.7% of cases (n=32) and gunshot in 35.3% (n=18) of cases. The median age was 36years (25-47). The median index of severity score (ISS) was 17 (10-26). Excellent agreement between predicted and actual findings was obtained for solid organs (α=0.801) with high sensitivity and specificity (81.8% and 96.6%, respectively). The largest discrepancies were observed for the hollow organs (α=26.2%, sensitivity of 53.3% and specificity of 76.2%) and the diaphragm (α=67.3%, sensitivity 75%, specificity 92.3%). Surgical exploration was non-therapeutic for five patients (9.8%). The failure rate for non-operative treatment was 10% (n=1). CONCLUSION CT detection of solid organ lesions in patients with penetrating abdominal wounds is excellent. However, the detection of hollow organ and diaphragmatic wounds remains a challenge with a risk of over- and underdiagnosis. Laparoscopic exploration should be able to fill in the gaps in the CT findings.
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Affiliation(s)
- Jean-Mathieu Perrin
- Visceral Surgery Department, Military Teaching Hospital Laveran, Marseille, France.
| | - Tristan Monchal
- Visceral Surgery Department, Military Teaching Hospital Sainte-Anne, Toulon, France
| | - Gaëtan Texier
- Aix Marseille University, IRD, AP-HM, SSA, VITROME, IHU Méditerrannée Infection, Marseille, France; Centre d'épidémiologie et de Santé Publique des Armées (CESPA), Marseille, France
| | - Laure Salou-Regis
- Visceral Surgery Department, Military Teaching Hospital Laveran, Marseille, France
| | - Yvain Goudard
- Visceral Surgery Department, Military Teaching Hospital Laveran, Marseille, France
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16
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Dell'Aversana F, Comune R, Scognamiglio M, Grassi F, Durante A, Avallone R, Tonerini M, Affinito P, Tamburro F, Scaglione M. Gunshot vaginal trauma. Radiol Case Rep 2023; 18:4544-4548. [PMID: 37868007 PMCID: PMC10587674 DOI: 10.1016/j.radcr.2023.09.060] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 09/17/2023] [Accepted: 09/20/2023] [Indexed: 10/24/2023] Open
Abstract
Nonobstetric vaginal or vulva trauma is an extremely rare occurrence, with an incidence of < 0.2% of traumas. CT represents the gold standard in the diagnosis of gunshot lesions due to its ability to detect and stage injuries with very high sensitivity and specificity. A standardized protocol for penetrating trauma is still under debate for the use of intravenous contrast only or also rectal and oral contrast. Herein, we report a case of gunshot vaginal trauma in a 43-year-old patient presenting with vaginal bleeding. In our case, the protocol was "patient's tailored," the intravaginal selective use of air was administered due to symptoms (vaginal bleeding) and CT findings, this 2-step protocol increased diagnostic confidence and allow a correct and challenging diagnosis.
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Affiliation(s)
- Federica Dell'Aversana
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | - Rosita Comune
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | - Marco Scognamiglio
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | - Francesca Grassi
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | - Adele Durante
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | - Roberta Avallone
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | - Michele Tonerini
- Department of Emergency Radiology, Cisanello Hospital, Pisa, Italy
| | - Pietro Affinito
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | - Fabio Tamburro
- Department of Radiology, Ospedale del Mare-ASL NA1 Centro, Naples, Italy
| | - Mariano Scaglione
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Piazza Università, Sassari, Italy
- Department of Radiology, James Cook University Hospital, Middlesbrough, UK
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17
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Chenna VSH, Palle LRA, Emmanuel S, Gupta A, Francis DT, Hussain A, Dahal R, Carredo CKC, Francis SM, Garg T, Akuma O, Khan AM. A rare case of perforating chest wall including pericardial sac with penetrating trivial injury: A case report and literature review. Trauma Case Rep 2023; 48:100962. [PMID: 37964982 PMCID: PMC10641277 DOI: 10.1016/j.tcr.2023.100962] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2023] [Indexed: 11/16/2023] Open
Abstract
Perforating chest wall injuries involving the pericardial sac in pediatric patients are exceedingly rare and pose a unique clinical challenge. Thoracic trauma in the pediatric population remains a significant cause of morbidity and mortality. We present a case of an 8-year-old boy with an acute history of a sharp injection needle embedded in his chest wall presented with severe chest pain and diaphoresis. Diagnostic evaluations included computed tomography revealed a hyperdense focus with a metallic artefact seen impacted in the interventricular septa and perforating the heart. He underwent a thoracotomy and cardioplegic arrest for needle retrieval and subsequent cardiac repair. Our case underscores the importance of a multidisciplinary approach, meticulous monitoring, and a profound understanding of the unique anatomical considerations in pediatric chest injuries. Summary This article presents a rare and challenging case of an 8-year-old male who arrived at the emergency department with a sharp injection needle embedded in his chest wall. Despite being relatively rare in children, thoracic injuries can be severe and potentially life-threatening. A fast and accurate diagnostic approach is crucial to prevent fatal complications. Thoracic trauma in the pediatric population remains a significant cause of morbidity and mortality. Timely diagnosis and appropriate interventions are critical in improving patient outcomes. The presented case highlights the need for caution and a well-planned approach in managing such rare and complex injuries in children.
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Affiliation(s)
| | | | | | | | - Deepa Treesa Francis
- Department of Internal Medicine, Windsor University School of Medicine, Cayon, Saint Kitts and Nevis
| | | | - Rojaj Dahal
- Department of Internal Medicine, Manipal College of Medical Sciences (MCOMS), Pokhara, Nepal
| | | | - Sandra Mary Francis
- Department of Internal Medicine, Windsor University School of Medicine, Cayon, Saint Kitts and Nevis
| | - Tulika Garg
- Government Medical College and Hospital, Chandigarh, India
| | | | - Aadil M. Khan
- Department of Trauma Surgery, OSF St Francis Medical Center, Peoria, USA
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18
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Zhao J, D'Souza DM. Thoracic Emergencies for the General Surgeon. Surg Clin North Am 2023; 103:1085-1095. [PMID: 37838457 DOI: 10.1016/j.suc.2023.07.005] [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] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
In this review article, we aim to provide an overview of common and uncommon general surgery thoracic emergencies as well as basic thoracic anatomy, common diagnostic tests, and operative positioning and access considerations. We also describe specific thoracic procedures. We hope that this article simplifies some of the challenges associated with the management of thoracic emergencies.
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Affiliation(s)
- Jane Zhao
- Division of Thoracic Surgery, Department of Surgery, The Ohio State Wexner Medical Center, 410 West 10th Avenue, N835 Doan Hall, Columbus, OH 43210, USA
| | - Desmond M D'Souza
- Division of Thoracic Surgery, Department of Surgery, The Ohio State Wexner Medical Center, 410 West 10th Avenue, N835 Doan Hall, Columbus, OH 43210, USA. Desmond.D'
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19
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Renberg M, Dahlberg M, Gellerfors M, Rostami E, Günther M. Prehospital and emergency department airway management of severe penetrating trauma in Sweden during the past decade. Scand J Trauma Resusc Emerg Med 2023; 31:85. [PMID: 38001526 PMCID: PMC10675952 DOI: 10.1186/s13049-023-01151-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/11/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Prehospital tracheal intubation (TI) is associated with increased mortality in patients with penetrating trauma, and the utility of prehospital advanced airway management is debated. The increased incidence of deadly violence in Sweden warrants a comprehensive evaluation of current airway management for patients with penetrating trauma in the Swedish prehospital environment and on arrival in the emergency department (ED). METHODS This was an observational, multicenter study of all patients with penetrating trauma and injury severity scores (ISSs) ≥ 15 included in the Swedish national trauma register (SweTrau) between 2011 and 2019. We investigated the frequency and characteristics of prehospital and ED TI, including 30-day mortality and patient characteristics associated with TI. RESULT Of 816 included patients, 118 (14.5%) were intubated prehospitally, and 248 (30.4%) were intubated in the ED. Patients who were intubated prehospitally had a higher ISS, 33 (interquartile range [IQR] 25, 75), than those intubated in the ED, 25 (IQR 18, 34). Prehospital TI was associated with a higher associated mortality, OR 4.26 (CI 2.57, 7.27, p < 0.001) than TI in the ED, even when adjusted for ISS (OR 2.88 [CI 1.64, 5.14, p < 0.001]). Hemodynamic collapse (≤ 40 mmHg) and low GCS score (≤ 8) were the characteristics most associated with prehospital TI. Traumatic cardiac arrests (TCAs) occurred in 154 (18.9%) patients, of whom 77 (50%) were intubated prehospitally and 56 (36.4%) were intubated in the ED. A subgroup analysis excluding TCA showed that patients with prehospital TI did not have a higher mortality rate than those with ED TI, OR 2.07 (CI 0.93, 4.51, p = 0.068), with OR 1.39 (0.56, 3.26, p = 0.5) when adjusted for ISS. CONCLUSION Prehospital TI was associated with a higher mortality rate than those with ED TI, which was specifically related to TCA; intubation did not affect mortality in patients without cardiac arrest. Mortality was high when airway management was needed, regardless of cardiac arrest, thereby emphasizing the challenges posed when anesthesia is needed. Several interventions, including whole blood transfusions, the implementation of second-tier EMS units and measures to shorten scene times, have been initiated in Sweden to counteract these challenges.
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Affiliation(s)
- Mattias Renberg
- Department of Anesthesiology and Intensive Care, Södersjukhuset, Sjukhusbacken, 10, S1 SE-118 83, Stockholm, Sweden.
| | - Martin Dahlberg
- Department of Surgery, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Gellerfors
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
- Rapid Response Car, Capio, Stockholm, Sweden
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
- Swedish Air Ambulance (SLA), Mora, Sweden
| | - Elham Rostami
- Experimental Traumatology Unit, Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Sciences, Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Mattias Günther
- Department of Anesthesiology and Intensive Care, Södersjukhuset, Sjukhusbacken, 10, S1 SE-118 83, Stockholm, Sweden
- Experimental Traumatology Unit, Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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20
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Atkins K, Schneider A, Gallaher J, Cairns B, Charles A. Who benefits from resuscitative thoracotomies following penetrating trauma: The patient or the learner? Injury 2023; 54:111033. [PMID: 37716863 PMCID: PMC10591838 DOI: 10.1016/j.injury.2023.111033] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/23/2023] [Accepted: 09/08/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Resuscitative thoracotomy (RT) is a salvage procedure following traumatic cardiac arrest. We aim to evaluate RT trends and outcomes in adults with cardiac arrest following penetrating trauma to determine the effect on mortality in this population. Further, we aim to estimate the effect of hospital teaching status on the performance of resuscitative thoracotomies and mortality. METHODS We reviewed the National Trauma Data Bank (2017-2021) for adults (≥16 years old) with penetrating trauma and prehospital cardiac arrest, stratified by the performance of a RT. We performed multivariable logistic regressions to estimate the effect of RT on mortality and the effect of hospital teaching status on the performance of resuscitative thoracotomies and mortality. RESULTS 13,115 patients met our inclusion criteria. RT occurred in 12.7% (n = 1,664) of patients. Rates of RT trended up over the study period. Crude mortality was similar in RT and Non-RT patients (95.6% vs. 94.5%, p = 0.07). There was no statistically significant difference in the adjusted odds of mortality based on RT status (OR 0.82, 95%CI 0.56-1.21). University-teaching hospitals had an adjusted odds ratio of 1.68 (95% CI 1.31-2.17) for performing a RT than non-teaching hospitals. There was no difference in the adjusted odds of mortality in patients that underwent RT based on hospital teaching status. CONCLUSION Despite up-trending rates, a resuscitative thoracotomy may not improve mortality in adults with penetrating, traumatic cardiac arrest. University teaching hospitals are nearly twice as likely to perform a RT than non-teaching hospitals, with no subsequent improvement in mortality.
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Affiliation(s)
- Kathryn Atkins
- Department of Surgery, University of North Carolina at Chapel Hill, USA
| | - Andrew Schneider
- Department of Surgery, University of North Carolina at Chapel Hill, USA
| | - Jared Gallaher
- Department of Surgery, University of North Carolina at Chapel Hill, USA
| | - Bruce Cairns
- Department of Surgery, University of North Carolina at Chapel Hill, USA
| | - Anthony Charles
- Department of Surgery, University of North Carolina at Chapel Hill, USA.
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21
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Yu Q, Lionberg A, Zane K, Ungchusri E, Du J, Nijhawan K, Clarey A, Navuluri R, Ahmed O, Prakash P, Leef J, Funaki B. Transarterial interventions in civilian gunshot wound injury: experience from a level-1 trauma center. CVIR Endovasc 2023; 6:47. [PMID: 37843596 PMCID: PMC10579195 DOI: 10.1186/s42155-023-00396-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 10/04/2023] [Indexed: 10/17/2023] Open
Abstract
PURPOSE To assess the effectiveness of trans-arterial vascular interventions in treatment of civilian gunshot wounds (GSW). MATERIALS AND METHODS A retrospective review was performed at a level-1 trauma center to include 46 consecutive adults admitted due to GSW related hemorrhage and treated with endovascular interventions from July 2018 to July 2022. Patient demographics and procedural metrics were retrieved. Primary outcomes of interest include technical success and in-hospital mortality. Factors of mortality were assessed using a logistic regression model. RESULTS Twenty-one patients were brought to the endovascular suite directly (endovascular group) from the trauma bay and 25 patients after treatment in the operating room (OR group). The OR group had higher hemodynamic instability (48.0% vs 19.0%, p = 0.040), lower hemoglobin (12.9 vs 10.1, p = 0.001) and platelet counts (235.2 vs 155.1, p = 0.003), and worse Acute Physiology and Chronic Health Evaluation (APACHE) score (4.1 vs 10.2, p < 0.0001) at the time of initial presentation. Technical success was achieved in all 40 cases in which targeted embolization was attempted (100%). Empiric embolization was performed in 6/46 (13.0%) patients based on computed tomographic angiogram (CTA) and operative findings. Stent-grafts were placed in 3 patients for subclavian artery injuries. Availability of pre-intervention CTA was associated with shorter fluoroscopy time (19.8 ± 12.1 vs 30.7 ± 18.6 min, p = 0.030). A total of 41 patients were discharged in stable condition (89.1%). Hollow organ injury was associated with mortality (p = 0.039). CONCLUSION Endovascular embolization and stenting were effective in managing hemorrhage due to GSW in a carefully selected population. Hollow organ injury was a statistically significant predictor of mortality. Pre-intervention CTA enabled targeted, shorter and equally effective procedures.
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Affiliation(s)
- Qian Yu
- Department of Radiology, University of Chicago Medical Center, 5841 S Maryland Ave, Chicago, IL, 60637, USA.
| | - Alex Lionberg
- Department of Radiology, University of Chicago Medical Center, 5841 S Maryland Ave, Chicago, IL, 60637, USA
| | - Kylie Zane
- Department of Radiology, University of Chicago Medical Center, 5841 S Maryland Ave, Chicago, IL, 60637, USA
| | - Ethan Ungchusri
- Department of Radiology, University of Chicago Medical Center, 5841 S Maryland Ave, Chicago, IL, 60637, USA
| | - Jonathan Du
- Department of Radiology, University of Chicago Medical Center, 5841 S Maryland Ave, Chicago, IL, 60637, USA
| | - Karan Nijhawan
- Department of Radiology, University of Chicago Medical Center, 5841 S Maryland Ave, Chicago, IL, 60637, USA
| | - Austin Clarey
- Department of Radiology, University of Chicago Medical Center, 5841 S Maryland Ave, Chicago, IL, 60637, USA
| | - Rakesh Navuluri
- Department of Radiology, University of Chicago Medical Center, 5841 S Maryland Ave, Chicago, IL, 60637, USA
| | - Osman Ahmed
- Department of Radiology, University of Chicago Medical Center, 5841 S Maryland Ave, Chicago, IL, 60637, USA
| | - Priya Prakash
- Department of Surgery, University of Chicago Medical Center, Chicago, IL, 60637, USA
| | - Jeffrey Leef
- Department of Radiology, University of Chicago Medical Center, 5841 S Maryland Ave, Chicago, IL, 60637, USA
| | - Brian Funaki
- Department of Radiology, University of Chicago Medical Center, 5841 S Maryland Ave, Chicago, IL, 60637, USA
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22
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Ishiki Y, Takiguchi T, Kim S, Arai M, Ishii H, Hagiwara J, Hagiwara O, Ogasawara T, Teraoka S, Ogawa F, Yokobori S. Delayed stomach necrosis in a patient with injured celiac artery branches after penetrating abdominal trauma. Trauma Case Rep 2023; 47:100904. [PMID: 37608874 PMCID: PMC10440351 DOI: 10.1016/j.tcr.2023.100904] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2023] [Indexed: 08/24/2023] Open
Abstract
Injuries of the celiac artery and its branches are rare, but potentially lethal. Ligation of these arteries is performed to control significant hemorrhage. However, few reports have described the adverse effects of ligating these arteries. A 69-year-old woman with a self-inflicted stab wound was brought to our hospital. Her blood pressure could not be measured, therefore aortic cross-clamping was performed, and epinephrine was administered for resuscitation, an emergency laparotomy was performed, and the roots of splenic artery and common hepatic artery were ligated. The left gastric artery which was anomalous and arose directly from the aorta, was also injured and had to be ligated. Norepinephrine was required after the surgery. Enhanced computed tomography performed on hospital day 4 revealed a disrupted celiac artery. The patient developed gastric necrosis on hospital day 23 and, hence, underwent total gastrectomy was performed. The possibility of delayed stomach necrosis should be considered during the postoperative management of patients who undergo ligation of all of the celiac artery branches and experience global hypoperfusion after the surgery.
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Affiliation(s)
- Yoshito Ishiki
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
- Department of Emergency and Critical Care Medicine, Kawaguchi Municipal Hospital, Saitama, Japan
| | - Toru Takiguchi
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
- Department of Emergency and Critical Care Medicine, Kawaguchi Municipal Hospital, Saitama, Japan
| | - Shiei Kim
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Masatoku Arai
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Hiromoto Ishii
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Jun Hagiwara
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Osahiko Hagiwara
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Tomoko Ogasawara
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Shintaro Teraoka
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Futoshi Ogawa
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
- Department of Emergency and Critical Care Medicine, Kawaguchi Municipal Hospital, Saitama, Japan
| | - Shoji Yokobori
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
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23
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Renberg M, Dahlberg M, Gellerfors M, Rostami A, Günther M, Rostami E. Prehospital transportation of severe penetrating trauma victims in Sweden during the past decade: a police business? Scand J Trauma Resusc Emerg Med 2023; 31:45. [PMID: 37684674 PMCID: PMC10492387 DOI: 10.1186/s13049-023-01112-x] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/03/2023] [Indexed: 09/10/2023] Open
Abstract
INTRODUCTION Sweden is facing a surge of gun violence that mandates optimized prehospital transport approaches, and a survey of current practice is fundamental for such optimization. Management of severe, penetrating trauma is time sensitive, and there may be a survival benefit in limiting prehospital interventions. An important aspect is unregulated transportation by police or private vehicles to the hospital, which may decrease time but may also be associated with adverse outcomes. It is not known whether transport of patients with penetrating trauma occurs outside the emergency medical services (EMS) in Sweden and whether it affects outcome. METHOD This was a retrospective, descriptive nationwide study of all patients with penetrating trauma and injury severity scores (ISSs) ≥ 15 registered in the Swedish national trauma registry (SweTrau) between June 13, 2011, and December 31, 2019. We hypothesized that transport by police and private vehicles occurred and that it affected mortality. RESULT A total of 657 patients were included. EMS transported 612 patients (93.2%), police 10 patients (1.5%), and private vehicles 27 patients (4.1%). Gunshot wounds (GSWs) were more common in police transport, 80% (n = 8), compared with private vehicles, 59% (n = 16), and EMS, 32% (n = 198). The Glasgow coma scale score (GCS) in the emergency department (ED) was lower for patients transported by police, 11.5 (interquartile range [IQR] 3, 15), in relation to EMS, 15 (IQR 14, 15) and private vehicles 15 (IQR 12.5, 15). The 30-day mortality for EMS was 30% (n = 184), 50% (n = 5) for police transport, and 22% (n = 6) for private vehicles. Transport by private vehicle, odds ratio (OR) 0.65, (confidence interval [CI] 0.24, 1.55, p = 0.4) and police OR 2.28 (CI 0.63, 8.3, p = 0.2) were not associated with increased mortality in relation to EMS. CONCLUSION Non-EMS transports did occur, however with a low incidence and did not affect mortality. GSWs were more common in police transport, and victims had lower GCS scorescores when arriving at the ED, which warrants further investigations of the operational management of shooting victims in Sweden.
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Affiliation(s)
- Mattias Renberg
- Department of Anesthesiology and Intensive Care, Södersjukhuset, Stockholm, Sweden
| | - Martin Dahlberg
- Department of Surgery, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Gellerfors
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
- Rapid Response Car, Capio, Stockholm, Sweden
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
- Swedish Air Ambulance (SLA), Mora, Sweden
| | - Amir Rostami
- Department for Social Work and Criminology, University of Gävle, Gävle, Sweden
| | - Mattias Günther
- Department of Anesthesiology and Intensive Care, Södersjukhuset, Stockholm, Sweden.
- Experimental Traumatology Unit, Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden.
- Department of Clinical Science and Education, Section for Anesthesiology and Intensive Care, Södersjukhuset, Karolinska Institutet, Sjukhusbacken 10, S1, 118 83, Stockholm, Sweden.
| | - Elham Rostami
- Experimental Traumatology Unit, Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Sciences, Section of Neurosurgery, Uppsala University Hospital , Uppsala, Sweden
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24
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Orantes C, Chan HK, Walter D, Chavez S, Ugalde IT. Pediatric firearm injury epidemiology at a level 1 trauma center from 2019 to 2021: including time of the COVID-19 pandemic. Inj Epidemiol 2023; 10:41. [PMID: 37550792 PMCID: PMC10405374 DOI: 10.1186/s40621-023-00448-3] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 07/06/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Firearms are a leading cause of death in children. The demand for firearms increased following COVID-19 "stay-at home orders" in March 2020, resulting in record-breaking firearm sales and background checks. We aim to describe the changes in pediatric firearm-related injuries, demographics, and associated risk factors at a Level 1 trauma center in Houston before and during the COVID 19 pandemic. RESULTS The total number of pediatric firearm-related injury cases increased during March 15th to December 31st, 2020 and 2021 compared to the same time period in 2019 (104 verses 89 verses 78). The demographic group most affected across years were males (87% in 2019 vs 82% in 2020 and 87% in 2021) between 14 and 17 years old (83% in 2019 vs 81% in 2020 and 76% in 2021). There was an increase in firearm injuries among black youth across all years (28% in 2019 vs 41% in 2020 vs 49% in 2021). Injuries in those with mental illness (10% in 2019 vs 24% in 2020 vs 17% in 2021), and injuries where the shooter was a known family member or friend (14% in 2019 vs 18% in 2020 vs. 15% in 2021), increased from 2019 to 2020. CONCLUSION The total number of pediatric firearm-related injuries increased during the COVID-19 pandemic compared to the previous year despite a decline in overall pediatric emergency department visits. Increases in pediatric firearm-related injuries in already vulnerable populations should prompt further hospital initiatives including counseling on safe firearm storage, implementation of processes to identify children at risk for firearm injuries, and continued research to mitigate the risk of injury and death associated with firearms in our community.
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Affiliation(s)
- Cynthia Orantes
- Department of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), 6431 Fannin Street, JJL 475, Houston, Texas 77030 USA
| | - Hei Kit Chan
- Department of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), 6431 Fannin Street, JJL 475, Houston, Texas 77030 USA
- Texas Emergency Medicine Research Center, McGovern Medical School, Houston, USA
| | - Daniel Walter
- Department of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), 6431 Fannin Street, JJL 475, Houston, Texas 77030 USA
- Texas Emergency Medicine Research Center, McGovern Medical School, Houston, USA
| | - Summer Chavez
- Department of Health Systems and Population Health Sciences, Tilman J. Fertitta Family College of Medicine, University of Houston, 5055 Medical Circle Rm 1316, Houston, TX 77204 USA
| | - Irma T. Ugalde
- Department of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), 6431 Fannin Street, JJL 475, Houston, Texas 77030 USA
- Texas Emergency Medicine Research Center, McGovern Medical School, Houston, USA
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25
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Rodríguez-Ramos A, Zapata-Castilleja CA, Treviño-González JL, Palacios-Saucedo GC, Sánchez-Cortés RG, Hinojosa-Amaya LG, Nieto-Sanjuanero A, de la O-Cavazos M. Frontal penetrating arrow injury: A case report. World J Clin Cases 2023; 11:4117-4122. [PMID: 37388790 PMCID: PMC10303610 DOI: 10.12998/wjcc.v11.i17.4117] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/02/2023] [Accepted: 05/19/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Penetrating arrow injuries of the head and neck are exceedingly rare in pediatric patients. This pathology has high morbidity and mortality because of the presence of vital organs, the airway, and large vessels. Therefore, the treatment and removal of an arrow is a challenge that requires multidisciplinary management.
CASE SUMMARY A 13-year-old boy was brought to the emergency room after an arrow injury to the frontal region. The arrowhead was lodged in the oropharynx. Imaging studies showed a lesion of the paranasal sinuses without compromising vital structures. The arrow was successfully removed by retrograde nasoendoscopy without complications, and the patient was discharged.
CONCLUSION Although rare, maxillofacial arrow injuries have high morbidity and mortality and require multidisciplinary management to preserve function and aesthetics.
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Affiliation(s)
- Alejandra Rodríguez-Ramos
- Department of Pediatrics, Hospital Universitario “Dr. José Eleuterio González,” Universidad Autónoma de Nuevo León, Monterrey 64460, Nuevo León, Mexico
| | - Carlos A Zapata-Castilleja
- Department of Pediatrics, Hospital Universitario “Dr. José Eleuterio González,” Universidad Autónoma de Nuevo León, Monterrey 64460, Nuevo León, Mexico
| | - José L Treviño-González
- Department of Pediatrics, Hospital Universitario “Dr. José Eleuterio González,” Universidad Autónoma de Nuevo León, Monterrey 64460, Nuevo León, Mexico
| | - Gerardo C Palacios-Saucedo
- Department of Pediatrics, Hospital Universitario “Dr. José Eleuterio González,” Universidad Autónoma de Nuevo León, Monterrey 64460, Nuevo León, Mexico
| | - Ramón G Sánchez-Cortés
- Department of Pediatrics, Hospital Universitario “Dr. José Eleuterio González,” Universidad Autónoma de Nuevo León, Monterrey 64460, Nuevo León, Mexico
| | - Leonor G Hinojosa-Amaya
- Department of Pediatrics, Hospital Universitario “Dr. José Eleuterio González,” Universidad Autónoma de Nuevo León, Monterrey 64460, Nuevo León, Mexico
| | - Adriana Nieto-Sanjuanero
- Department of Pediatrics, Hospital Universitario “Dr. José Eleuterio González,” Universidad Autónoma de Nuevo León, Monterrey 64460, Nuevo León, Mexico
| | - Manuel de la O-Cavazos
- Department of Pediatrics, Hospital Universitario “Dr. José Eleuterio González,” Universidad Autónoma de Nuevo León, Monterrey 64460, Nuevo León, Mexico
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26
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A G, D W, H K C, S W, N H, R H, I U, S C. Changes in adult trauma at a level 1 trauma center before and during the COVID-19 pandemic. JEM Rep 2023; 2:100024. [PMID: 37124345 PMCID: PMC10122564 DOI: 10.1016/j.jemrpt.2023.100024] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/01/2023] [Accepted: 03/15/2023] [Indexed: 05/02/2023]
Abstract
Background Prior research has shown the COVID-19 pandemic is associated with changes in ED volumes, trauma caseloads and distribution of disease. Objectives We aim to characterize the impact of the COVID-19 pandemic at a diverse, high-volume Level 1 trauma center in the US. Methods We performed a retrospective review of our institutional trauma registry at our center from 2018 through 2021 to study changes before and after COVID-19. We established March 14 - December 31 as the study period of interest for each year. We analyzed the data with descriptive statistics and created Poisson regression models to determine the estimated percentage year-to-year changes. Results Total number of trauma cases increased with each subsequent year from 2018 (N = 4605) to 2021 (N = 7331) (total N = 23,727). In general, the proportion of Black or African American patients increased over time (2018: 19.2%, 2021: 23.0%). The proportion of patients insured by Medicaid (8.0% vs 10.5%) and Medicare (26.5% vs 32.8%) increased from 2018 to 2021. Comparing 2019 to 2020, we found increases in violent traumas: GSW (+88.6%, 95% CI 63.8%-117.2%) and stabbings (+39.6%, 95% CI 8.1%-80.3%). Trauma patient ED LOS decreased from 300 min (67-400 IQR) in 2018 to 249 min in 2021 (104-510 IQR). Conclusion This analysis identified increased trauma volumes, especially violent trauma (GSW, stabbing, other penetrating). There was a greater proportion of Black/African American patients and those insured with Medicare or Medicaid during the pandemic. TED LOS decreased over time while ED mortality and hospital LOS remained stable.
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Affiliation(s)
- Garcia A
- Department of Emergency Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Walter D
- Department of Emergency Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Chan H K
- Department of Emergency Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
- Texas Emergency Medicine Research Center, McGovern Medical School, Houston, TX, USA
| | - Walia S
- Department of Emergency Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Hoot N
- Department of Emergency Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
- Texas Emergency Medicine Research Center, McGovern Medical School, Houston, TX, USA
| | - Huebinger R
- Department of Emergency Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
- Texas Emergency Medicine Research Center, McGovern Medical School, Houston, TX, USA
| | - Ugalde I
- Department of Emergency Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
- Texas Emergency Medicine Research Center, McGovern Medical School, Houston, TX, USA
| | - Chavez S
- Department of Emergency Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
- Department of Health Systems and Population Health Sciences, Tilman J. Fertitta Family College of Medicine, University of Houston, Houston, TX, USA
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27
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Grigorian A, Martin M, Schellenberg M, Emigh B, Nahmias J, Matsushima K, Lewis M, Inaba K. Methamphetamine use associated with gun and knife violence: A matched cohort analysis. Surg Open Sci 2023; 13:71-74. [PMID: 37187917 PMCID: PMC10176051 DOI: 10.1016/j.sopen.2023.04.010] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/24/2023] [Accepted: 04/24/2023] [Indexed: 05/17/2023] Open
Abstract
Introduction There may be an association between violence and methamphetamine use. We hypothesized that trauma patients screening positive for methamphetamines are more likely to present after penetrating trauma and have increased mortality. Methods The 2017-2019 TQIP was used to 1:2 match methamphetamine (meth+) patients to patients testing negative for all drugs (meth-). Patients with polysubstance/alcohol use were excluded. Bivariate and logistic regression analyses were performed. Results The rate of methamphetamine use was 3.1 %. After matching, there was no difference in vitals, injury severity score, sex, and comorbidities between cohorts (all p > 0.05). Compared to meth-, the meth+ group was more commonly sustained penetrating trauma (19.8 % vs. 9.2 %, p < 0.001) with stab-wounds being the most common penetrating mechanism (10.5 % vs. 4.5 %, p < 0.001). The meth+ group more commonly underwent surgery immediately from the emergency department (ED) (20.3 % vs. 13.3 %, p < 0.001). The associated risk of death in the ED was higher for the meth+ group (OR 2.77, CI 1.45-5.28, p = 0.002), however, the risk was similar for patients that were admitted or received an operation (p = 0.065). Conclusion Trauma patients using methamphetamine more commonly presented after gun or knife violence and required immediate surgical intervention. They also have increased associated risk of death in the ED. Given these serious findings, a multidisciplinary approach in helping curtail the worsening epidemic of methamphetamine use appears warranted as it is related to penetrating trauma and outcomes. Level of evidence IV.
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Affiliation(s)
- Areg Grigorian
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
- Corresponding author at: Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, 3200 Chapman Ave #6200, Orange, CA, USA.
| | - Matthew Martin
- University of Southern California, Department of Surgery, Los Angeles, CA, USA
| | - Morgan Schellenberg
- University of Southern California, Department of Surgery, Los Angeles, CA, USA
| | - Brent Emigh
- Warren Alpert Medical School at Brown University, Department of Surgery, Division of Trauma and Critical Care, Providence, RI, USA
| | - Jeffry Nahmias
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Kazuhide Matsushima
- University of Southern California, Department of Surgery, Los Angeles, CA, USA
| | - Meghan Lewis
- University of Southern California, Department of Surgery, Los Angeles, CA, USA
| | - Kenji Inaba
- University of Southern California, Department of Surgery, Los Angeles, CA, USA
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28
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Kong V, Cheung C, Buitendag J, Rajaretnam N, Xu W, Varghese C, Bruce J, Laing G, Clarke D. Abdominal stab wounds with retained knife: 15 years of experience from a major trauma centre in South Africa. Ann R Coll Surg Engl 2023; 105:407-412. [PMID: 35175869 PMCID: PMC10149242 DOI: 10.1308/rcsann.2021.0321] [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] [Subscribe] [Scholar Register] [Accepted: 10/28/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION This study reviews our cumulative experience with the management of patients presenting with a retained knife following an abdominal stab wound (SW). METHODS A retrospective study was conducted at a major trauma centre in South Africa over a 15-year period from July 2006 to December 2020 including all patients who presented with a retained knife in the abdomen following a SW. RESULTS A total of 42 cases were included: 37 males (93%) with a mean age of 26 years. A total of 18 knives (43%) were in the anterior abdomen and 24 were posterior abdomen. Plain radiography was performed in 88% (37/42) of cases and computed tomography was performed in 81% (34/42); 90% (38/42) underwent extraction in the operating theatre. Laparotomy was performed in 62% (26/42). Of all the laparotomies performed, 77% (20/26) were positive for intra-abdominal organ or visceral injury. Overall morbidity was 31%. There were two mortalities (5%). Laparotomy was less commonly required for the posterior abdomen (33% (8/24) vs 100% (18/18), p<0.001). For retained knives in the anterior abdomen, 72% (13/18) of the laparotomies were positive for intra-abdominal organ or visceral injury. For the posterior abdomen, 7 of the 8 (88%) were positive for intra-abdominal organ or visceral injury. There were no differences in the need for intensive care unit admission, length of hospital stay, morbidities or mortalities. CONCLUSIONS Uncontrolled extraction of a retained knife in the abdomen outside of the operating theatre must be avoided. Retained knives in the anterior abdomen usually require formal laparotomy, but this is generally not required for posterior abdomen.
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Affiliation(s)
- V Kong
- University of the Witwatersrand, Johannesburg, South Africa
| | - C Cheung
- Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | | | | | - W Xu
- University of Auckland, Auckland, New Zealand
| | - C Varghese
- University of Auckland, Auckland, New Zealand
| | - J Bruce
- University of KwaZulu Natal, Durban, South Africa
| | - G Laing
- University of KwaZulu Natal, Durban, South Africa
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Ong HN, Chen IH, Hsieh YH, Hsu CH, Weng TI, Chang CC. Comparison of fatal traumatic medico-legal cases with postmortem computed tomography and autopsy: A pilot study in Taiwan. J Formos Med Assoc 2023; 122:351-354. [PMID: 36253239 DOI: 10.1016/j.jfma.2022.09.015] [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] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 11/07/2022] Open
Abstract
In order to determine the performance of postmortem computed tomography (PMCT) in identifying traumatic-relevant macroscopic findings in medico-legal cases, this retrospective observational pilot study involving nine trauma casualties who had received PMCT prior to autopsy. The comparison of these findings in six anatomical regions as dictated in Injury Severity Score (ISS) were performed. 104 traumatic-relevant findings were identified with achievement of 51% congruent findings. PMCT and autopsy had additionally found 22 and 29 findings respectively. PMCT had highest sensitivity for extremity injury (81.82%), followed by chest (73.91%), head, neck and face (71.43%), and abdomino-pelvic area (50%). It had excellent detection rate in abnormal air collection, fracture, foreign body localization, internal ballistic and intracranial pathology. However, the solid organ and vascular injuries as well as integumentary lesions were the major drawback. In conclusion, incorporation of PMCT to autopsy in medico-legal investigation helps to preserve the most abundant traumatic-relevant injuries compared to either modality.
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Affiliation(s)
- Hooi-Nee Ong
- Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan, University College of Medicine, Taipei, Taiwan; Department and Graduate Institute of Forensic Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - I-Hung Chen
- Department of Forensic Pathology, Institute of Forensic Medicine, Ministry of Justice, New Taipei City, Taiwan
| | - Yu-Hsuan Hsieh
- Department and Graduate Institute of Forensic Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Cho-Hsien Hsu
- Department of Forensic Pathology, Institute of Forensic Medicine, Ministry of Justice, New Taipei City, Taiwan
| | - Te-I Weng
- Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan, University College of Medicine, Taipei, Taiwan; Department and Graduate Institute of Forensic Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Chin-Chen Chang
- Department and Graduate Institute of Forensic Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Medical Imaging, National Taiwan University Hospital and National Taiwan, University College of Medicine, Taipei, Taiwan.
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30
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Knüsel CJ, Thibeault A, Villotte S. A cranial injury from the earliest Gravettian at the Cro-Magnon rock shelter (Vézère Valley, Dordogne, southwest France). J Hum Evol 2023; 177:103329. [PMID: 36870149 DOI: 10.1016/j.jhevol.2023.103329] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 01/24/2023] [Accepted: 01/24/2023] [Indexed: 03/06/2023]
Abstract
Discovered over 150 years ago, the early Upper Paleolithic human remains from the Cro-Magnon rock shelter have an iconic status, but because of skeletal commingling after discovery, their bio-profiles remain incomplete and contentious. The defect on the frontal bone of the cranium known as Cro-Magnon 2 has been interpreted as both an antemortem injury and a postmortem (i.e., taphonomic) artifact previously. This contribution considers the cranium in order to clarify the status of the defect on the frontal bone and to situate these remains among others of Pleistocene date with similar types of lesions. The diagnostic criteria used to assess the cranium are drawn from recent publications of actualistic experimental studies of cranial trauma and from those associated with cranial trauma due to violence in forensic anthropological and bioarchaeological contexts. The appearance of the defect and comparison with more recent documented cases from the preantibiotic era suggest that the defect is a result of antemortem trauma with survival for a short period. The location of the lesion on the cranium provides growing evidence for interpersonal aggression in these early modern human groups, and the place of burial also provides insight into related mortuary behavior.
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Affiliation(s)
| | - Adrien Thibeault
- UMR 5199 PACEA, Université de Bordeaux, CNRS, 33600 Pessac, France
| | - Sébastien Villotte
- UMR7206 Éco-Anthropologie, CNRS, MNHN, Université Paris Cité, 75116 Paris, France; Operational Directory Earth and History of Life, Royal Belgian Institute of Natural Sciences, 1000 Brussels, Belgium; Unité de Recherches Art, Archéologie Patrimoine, Université de Liège, B-4000 Liège, Belgium
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31
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Bailey JA, Jacovides CL, Butler D, Bass GA, Seamon MJ, Cannon J, Martin ND. Adolescent Gun Violence Shows an Age Group to Focus Trauma Prevention. J Surg Res 2023; 283:853-857. [PMID: 36915012 DOI: 10.1016/j.jss.2022.10.011] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 10/03/2022] [Accepted: 10/17/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Gun violence continues to escalate in America's urban areas. Peer groups of gun wound victims are potential targets for violence prevention initiatives; identification of this cohort is pivotal to efficient deployment strategies. We hypothesize a specific age at which the incidence of penetrating trauma increases significantly in adolescence, below which should be the focus on future trauma prevention. METHODS Adolescent trauma patients with gunshot wounds seen from July 2011 through June 2021 at a well-established, urban, academic level 1 trauma center were reviewed retrospectively and grouped by age. A linear regression and repeated measured analysis of variance evaluated the change in gunshot wound victims over this time, grouped by age. Demographics were extrapolated, and standard statistical analysis was performed. RESULTS A total of 1304 adolescent trauma patients were included. Those aged 15 y and under had an unchanged incidence of gunshot wounds. However, those aged 16 y and more experienced the majority of increased gun violence; 92% were Black and 90% were male with a mortality of 12%. Adolescents aged 15 y and below were 95% Black and 84% male, with a mortality of 18%. CONCLUSIONS Primary prevention efforts to mitigate gun violence should be focused on adolescents below 16 y of age. Prevention of gun violence should include community outreach efforts directed toward middle school-aged children and younger, hoping to decrease the incidence of injury due to gun violence in older adolescents in the future.
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Affiliation(s)
- Joanelle A Bailey
- University of Pennsylvania, Division of Traumatology, Surgical Critical Care and Emergency Surgery, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania.
| | - Christina L Jacovides
- University of Pennsylvania, Division of Traumatology, Surgical Critical Care and Emergency Surgery, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania
| | - Dale Butler
- University of Pennsylvania, Division of Traumatology, Surgical Critical Care and Emergency Surgery, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania
| | - Gary A Bass
- University of Pennsylvania, Division of Traumatology, Surgical Critical Care and Emergency Surgery, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania
| | - Mark J Seamon
- University of Pennsylvania, Division of Traumatology, Surgical Critical Care and Emergency Surgery, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania
| | - Jeremy Cannon
- University of Pennsylvania, Division of Traumatology, Surgical Critical Care and Emergency Surgery, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania
| | - Niels D Martin
- University of Pennsylvania, Division of Traumatology, Surgical Critical Care and Emergency Surgery, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania
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Vasse M, Leone M, Boyer L, Michelet P, Goudard Y, Cardinale M, Paris R, Avaro JP, Thomas PA, de Lesquen H. Impact of the implementation of a trauma system on compliance with evidence-based clinical management guidelines in penetrating thoracic trauma. Eur J Trauma Emerg Surg 2023; 49:351-360. [PMID: 36063196 DOI: 10.1007/s00068-022-02071-1] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 08/05/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Since 2014, a trauma system (TS) for the Provence-Alpes-Cote-d'Azur (PACA) region has been set up with protocols based on the European guidelines for the management of bleeding trauma patients. The present study aims to assess compliance with protocols in penetrating thoracic trauma on admission to a level I trauma centre and to determine whether compliance impacts morbidity and mortality. METHODS This multicentric pre-post study included all penetrating thoracic trauma patients referred to Marseille area level I centres between January 2009 and December 2019. On the basis of the European guidelines, eight objectively measurable recommendations concerning the in-hospital trauma care for the first 24 h were analysed. Per-patient and per-criterion compliance rates and their impact on morbidity and mortality were evaluated before and after TS implementation. RESULTS A total of 426 patients were included. No differences between the two groups (before and after 2014) were reported for demographics or injury severity. The median (interquartile range) per-patient compliance rate increased from 67% [0.50; 0.75] to 75% [0.67; 1.0] (p < 0.01) after implementation of a TS. The 30-day morbidity-mortality was, respectively, of 17% (30/173) and 13% (32/253) (p = 0.18) before and after TS implementation. A low per-patient compliance rate was associated with an increase in the 30-day morbidity-mortality rate (p < 0.01). Severity score-adjusted per-patient compliance rates were associated with decreased 30-day morbidity-mortality (odds ratio [IC 95%] = 0.98 [0.97; 0.99] p = 0.01). CONCLUSION Implementation of a TS was associated with better compliance to European recommendations and better outcomes for severe trauma patients. These findings should encourage strict adherence to European trauma protocols to ensure the best patient outcomes.
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Affiliation(s)
- Matthieu Vasse
- Department of Thoracic and Vascular Surgery, Sainte Anne Military Teaching Hospital, French Military Health Service, Toulon, France
| | - Marc Leone
- Department of Anesthesiology and Intensive Care, Hôpital Nord, Aix Marseille University, Hôpitaux Universitaires de Marseille, Marseille, France
| | - Laurent Boyer
- CEReSS-Health Service Research and Quality of Life Center, Department of Medical Information, Aix Marseille University, Hôpitaux Universitaires de Marseille, Marseille, France
| | - Pierre Michelet
- Emergency Department, Hôpital de la Timone, Aix Marseille University, Hôpitaux Universitaires de Marseille, Marseille, France
| | - Yvain Goudard
- Department of Visceral Surgery, Laveran Military Teaching Hospital, French Military Health Service, Marseille, France
| | - Michael Cardinale
- Department of Anesthesiology and Intensive Care, Sainte Anne Military Teaching Hospital,, French Military Health Service, Toulon, France
| | - Raphael Paris
- Department of Anesthesiology and Intensive Care, Laveran Military Teaching Hospital, French Military Health Service, Marseille, France
| | - Jean Philippe Avaro
- Department of Thoracic and Vascular Surgery, Sainte Anne Military Teaching Hospital, French Military Health Service, Toulon, France
| | - Pascal Alexandre Thomas
- Department of Thoracic Surgery, Diseases of the Esophagus and Lung Transplantation, Hôpital Nord, Aix Marseille University, Hôpitaux Universitaires de Marseille, Marseille, France
| | - Henri de Lesquen
- Department of Thoracic and Vascular Surgery, Sainte Anne Military Teaching Hospital, French Military Health Service, Toulon, France.
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Rolff HC, Storkholm JH. Major vascular and pancreatic penetrating trauma in patient with pre-existing MALS. Trauma Case Rep 2023; 43:100757. [PMID: 36691628 PMCID: PMC9860451 DOI: 10.1016/j.tcr.2023.100757] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2023] [Indexed: 01/08/2023] Open
Abstract
We report a case regarding a 24-year-old male with severe intraabdominal complex vascular lesions involving the superior mesenteric vein (SMV), portal vein (PV), inferior vena cava (IVC), the Common Hepatic and Gastroduodenal arteries (CHA and GDA) in combination with a total transection of the pancreatic neck following a single penetrating trauma to the upper abdomen. The management of the splanchnic vascular lesions were further complicated by the patient having pre-existing vascular condition known as Median Arcuate Ligament Syndrome (MALS). The MALS aspect makes this case unique and interesting to all trauma surgeons. Furthermore, this case report also reflects on the management of severe pancreatic trauma in the setting of the aforementioned vascular lesions.
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Pahlavani A, Hosseini Nejad Mir N, Karimi Rouzbahani A, Mahmoudvand G, Rezaei P, Pahlevani A, Shahmoradi MK. Electrodiagnostic Evaluation of Prognostic Factors Influencing the Surgical Outcomes of Upper Extremity Nerve Injuries Caused by Penetrating Trauma: A Cross-sectional Study. World J Plast Surg 2023; 12:90-100. [PMID: 38130381 PMCID: PMC10732289 DOI: 10.52547/wjps.12.2.90] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 09/10/2023] [Indexed: 12/23/2023] Open
Abstract
Background Peripheral nerve damage is a major cause of disability, which can lead to serious limitations in daily and occupational activities. Although primary repair can restore the function of the damaged organ remarkably, factors predicting the prognosis of nerve repair are a topic of constant debate. We aimed to investigate the factors affecting the outcomes of primary nerve repair in patients afflicted by upper extremity nerve injuries following penetrating trauma. Methods This cross-sectional study was conducted on 51 patients referred to Shohada-ye Ashayer Hospital in Khorramabad, Iran, from 2016 to 2021. Data including the patient's age, gender, education, type, severity, and mechanism of injury, the damaged nerve, time and of method repair, the surgeon's specialty, as well as the electrodiagnostic findings, were collected and analyzed using SPSS software version 22. Results The mean age of the patients was 30.41 ± 12.63 years, and the majority of them (84.3%) were men. A significant relationship was found between the sensory amplitude with education (P=0.002), the type of damaged nerve (P=0.048), and the severity of injury (P=0.012). The positive sharp wave was significantly associated with the surgeon's specialty (P=0.034). Besides, the motor amplitude was considerably related to the patient's age (P=0.040) and the surgeon's specialty (P=0.035). Conclusion Factors determining the outcome of peripheral nerve repair following penetrating trauma to the upper extremity include age, education, the type of damaged nerve, the severity of the injury, and the surgeon's specialty.
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Affiliation(s)
- Amin Pahlavani
- Department of General Surgery, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
- These authors contributed equally to the study
| | - Nahid Hosseini Nejad Mir
- Department of Internal Medicine, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
- These authors contributed equally to the study
| | - Arian Karimi Rouzbahani
- Student Research Committee, Lorestan University of Medical Sciences, Khorramabad, Iran
- USERN Office, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Golnaz Mahmoudvand
- USERN Office, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Pardis Rezaei
- USERN Office, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Ali Pahlevani
- Student Research Committee, Lorestan University of Medical Sciences, Khorramabad, Iran
- USERN Office, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Mohammad Kazem Shahmoradi
- Department of General Surgery, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
- USERN Office, Lorestan University of Medical Sciences, Khorramabad, Iran
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Ganga A, Leary OP, Sastry RA, Asaad WF, Svokos KA, Oyelese AA, Mermel LA. Antibiotic prophylaxis in penetrating traumatic brain injury: analysis of a single-center series and systematic review of the literature. Acta Neurochir (Wien) 2023; 165:303-13. [PMID: 36529784 DOI: 10.1007/s00701-022-05432-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/19/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Penetrating traumatic brain injury (pTBI) is an acute medical emergency with a high rate of mortality. Patients with survivable injuries face a risk of infection stemming from foreign body transgression into the central nervous system (CNS). There is controversy regarding the utility of antimicrobial prophylaxis in managing such patients, and if so, which antimicrobial agent(s) to use. METHODS We reviewed patients with pTBI at our institution and performed a PRISMA systematic review to assess the impact of prophylactic antibiotics on reducing risk of CNS infection. RESULTS We identified 21 local patients and 327 cases in the literature. In our local series, 17 local patients received prophylactic antibiotics; four did not. Overall, five of these patients (24%) developed a CNS infection (four and one case of intraparenchymal brain abscess and meningitis, respectively). All four patients who did not receive prophylactic antibiotics developed an infection (three with CNS infections; one superficial wound infection) compared to two of 17 (12%) patients who did receive prophylactic antibiotics. Of the 327 pTBI cases reported in the literature, 216 (66%) received prophylactic antibiotics. Thirty-eight (17%) patients who received antibiotics developed a CNS infection compared to 21 (19%) who did not receive antibiotics (p = 0.76). CONCLUSIONS Although our review of the literature did not reveal any benefit, our institutional series suggested that patients with pTBI may benefit from prophylactic antibiotics. We propose a short antibiotic course with a regimen specific to cases with and without the presence of organic debris.
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Reilly JJ, Naumann DN, Morris L, Blackburn L, Brooks A. Injury by knife crime amongst children is associated with socioeconomic deprivation: an observational study. Pediatr Surg Int 2022; 39:8. [PMID: 36441280 PMCID: PMC9705482 DOI: 10.1007/s00383-022-05298-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/06/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Children who live in areas of socioeconomic deprivation may be at higher risk of being victims of violent crime such as knife wounds. The current study investigated whether socioeconomic disparity was associated with higher risk of knife crime. METHODS An observational study included patients aged ≤ 17 years at a UK Major Trauma Centre injured by knife trauma from 2016 to 2022. Indices of deprivation were recorded according to the zip code of residence and compared with those of all of England. These included Index of Multiple Deprivation (IMD); income; employment; education and skills; health and disability; crime; barriers to housing and services; living environment; and Income Deprivation Affecting Children Index (IDACI). RESULTS There were 139 patients (96% male) with median age of 16 years. When compared with the whole of England, patients had worse indices of IMD (p = 0.021); income (p < 0.001); employment (p < 0.001); education and skills (p < 0.001); health and disability; and IDACI (p < 0.001). There were no significant differences in indices of crime, barriers to housing and services or living environment. CONCLUSIONS Paediatric knife injury was associated with poor socioeconomic status in multiple domains. Focussed efforts to address socioeconomic disparities should be a priority as a public health measure for vulnerable children.
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Affiliation(s)
- John-Joe Reilly
- Department of Major Trauma, East Midlands Major Trauma Centre, Queens Medical Centre, Nottingham, UK
| | - David N Naumann
- Department of Major Trauma, East Midlands Major Trauma Centre, Queens Medical Centre, Nottingham, UK.
- University of Birmingham, Birmingham, UK.
| | - Louise Morris
- Department of Major Trauma, East Midlands Major Trauma Centre, Queens Medical Centre, Nottingham, UK
| | - Lauren Blackburn
- Department of Major Trauma, East Midlands Major Trauma Centre, Queens Medical Centre, Nottingham, UK
| | - Adam Brooks
- Department of Major Trauma, East Midlands Major Trauma Centre, Queens Medical Centre, Nottingham, UK
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Hodgson S, Weegenaar C, Avery P, Snell T, Lockey D. Use of a national trauma registry to target violence reduction initiatives. Injury 2022; 53:3227-32. [PMID: 35817608 DOI: 10.1016/j.injury.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 06/21/2022] [Accepted: 07/03/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND The incidence of interpersonal violence resulting in penetrating traumatic injury has increased in the UK. Violence reduction initiatives vary across the world, from reactive diversionary schemes to proactive educational intervention. To be successful a collaborative public health approach to violence reduction is vital. We examined regional data collected in a trauma network area as part of mandatory national trauma data submission to establish whether useful data could be extracted from this type of registry to inform regional violence reduction initiatives. Key information required to accurately target initiatives includes: who are the victims? where do incidents occur? and when do incidents occur? METHODS Data were obtained from the national Trauma Audit and Research Network (TARN). This study utilised TARN inclusion criteria. Data for penetrating trauma patients from hospital sites in the Severn Major Trauma Network over an eight-year period were included in the analysis (1 June 2012 to 5 April 2020). The data were analysed using SPSS Statistics V27 and TARN analytics software. Existing ethical approval for anonymised registry data (PIAG section 60) was used. RESULTS Over the eight-year study period, 299 cases of penetrating trauma were registered in the Major Trauma Network. Overall, the incidence of penetrating trauma is increasing (R value +0.470, and +0.900 when 2020 excluded). Male victims account for 87.3% of cases (n=261). Younger individuals are more likely to be victims of penetrating trauma. The proportion of victims aged 13-18 years increased from 0% in 2012 to 21.6% in 2019. There were 43 (14.3%) incidents of victims presenting more than once during the study period. The early evening and hour after midnight had the highest numbers of penetrating trauma incidents. Most incidents occurred in a small proportion of postcodes. All the postcodes identified as having high incidence of penetrating injuries were also areas with high deprivation. CONCLUSION This study demonstrated that national trauma registry data can be used to establish valuable information about serious penetrating trauma in a region. This data provides key information with which to target a proactive approach to violence reduction in our region with implications for public health, police, and clinical policymakers.
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Smyth L, Bendinelli C, Lee N, Reeds MG, Loh EJ, Amico F, Balogh ZJ, Di Saverio S, Weber D, Ten Broek RP, Abu-Zidan FM, Campanelli G, Beka SG, Chiarugi M, Shelat VG, Tan E, Moore E, Bonavina L, Latifi R, Hecker A, Khan J, Coimbra R, Tebala GD, Søreide K, Wani I, Inaba K, Kirkpatrick AW, Koike K, Sganga G, Biffl WL, Chiara O, Scalea TM, Fraga GP, Peitzman AB, Catena F. WSES guidelines on blunt and penetrating bowel injury: diagnosis, investigations, and treatment. World J Emerg Surg 2022; 17:13. [PMID: 35246190 PMCID: PMC8896237 DOI: 10.1186/s13017-022-00418-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 01/26/2022] [Indexed: 02/08/2023] Open
Abstract
The aim of this paper was to review the recent literature to create recommendations for the day-to-day diagnosis and surgical management of small bowel and colon injuries. Where knowledge gaps were identified, expert consensus was pursued during the 8th International Congress of the World Society of Emergency Surgery Annual (September 2021, Edinburgh). This process also aimed to guide future research.
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Affiliation(s)
- Luke Smyth
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Cino Bendinelli
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia.
| | - Nicholas Lee
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Matthew G Reeds
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Eu Jhin Loh
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Francesco Amico
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Zsolt J Balogh
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | | | - Dieter Weber
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | | | - Fikri M Abu-Zidan
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | | | - Solomon Gurmu Beka
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Massimo Chiarugi
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Vishal G Shelat
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Edward Tan
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Ernest Moore
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Luigi Bonavina
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Rifat Latifi
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Andreas Hecker
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Jim Khan
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Raul Coimbra
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Giovanni D Tebala
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Kjetil Søreide
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Imtiaz Wani
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Kenji Inaba
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | | | - Kaoru Koike
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Gabriele Sganga
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Walter L Biffl
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Osvaldo Chiara
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Thomas M Scalea
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Gustavo P Fraga
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Andrew B Peitzman
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Fausto Catena
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
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Cremonini C, Lewis MR, Jakob D, Benjamin ER, Chiarugi M, Demetriades D. Diagnosing penetrating diaphragmatic injuries: CT scan is valuable but not reliable. Injury 2022; 53:116-121. [PMID: 34607700 DOI: 10.1016/j.injury.2021.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/25/2021] [Accepted: 09/10/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The diagnosis of penetrating isolated diaphragmatic injuries can be challenging because they are usually asymptomatic. Diagnosis by chest X-ray (CXR) is unreliable, while CT scan is reported to be more valuable. This study evaluated the diagnostic ability of CXR and CT in patients with proven DI. METHODS Single center retrospective study (2009-2019), including all patients with penetrating diaphragmatic injuries (pDI) documented at laparotomy or laparoscopy with preoperative CXR and/or CT evaluation. Imaging findings included hemo/pneumothorax, hemoperitoneum, pneumoperitoneum, elevated diaphragm, definitive DI, diaphragmatic hernia, and associated abdominal injuries. RESULTS 230 patients were included, 62 (27%) of which had isolated pDI, while 168 (73%) had associated abdominal or chest trauma. Of the 221 patients with proven DI and preoperative CXR, the CXR showed hemo/pneumothorax in 99 (45%), elevated diaphragm in 51 (23%), and diaphragmatic hernia in 4 (1.8%). In 86 (39%) patients, the CXR was normal. In 126 patients with pDI and preoperative CT, imaging showed hemo/pneumothorax in 95 (75%), hemoperitoneum in 66 (52%), pneumoperitoneum in 35 (28%), definitive DI in 56 (44%), suspected DI in 26 (21%), and no abnormality in 3 (2%). Of the 57 patients with isolated pDI the CXR showed a hemo/pneumothorax in 24 (42%), elevated diaphragm in 14 (25%) and was normal in 24 (42%). CONCLUSIONS Radiologic diagnosis of DI is unreliable. CT scan is much more sensitive than CXR. Laparoscopic evaluation should be considered liberally, irrespective of radiological findings.
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Affiliation(s)
- Camilla Cremonini
- Division of Trauma, Emergency Surgery and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, 2051 Marengo Street, IPT, C5L100, Los Angeles, CA, 90033, USA; General, Emergency and Trauma Surgery Department, Pisa University Hospital, via Paradisa 2, 56124, Pisa, Italy.
| | - Meghan R Lewis
- Division of Trauma, Emergency Surgery and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, 2051 Marengo Street, IPT, C5L100, Los Angeles, CA, 90033, USA.
| | - Dominik Jakob
- Division of Trauma, Emergency Surgery and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, 2051 Marengo Street, IPT, C5L100, Los Angeles, CA, 90033, USA.
| | - Elizabeth R Benjamin
- Division of Trauma, Emergency Surgery and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, 2051 Marengo Street, IPT, C5L100, Los Angeles, CA, 90033, USA.
| | - Massimo Chiarugi
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, via Paradisa 2, 56124, Pisa, Italy.
| | - Demetrios Demetriades
- Division of Trauma, Emergency Surgery and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, 2051 Marengo Street, IPT, C5L100, Los Angeles, CA, 90033, USA.
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Kong V, Cheung C, Buitendag J, Rajaretnam N, Varghese C, Elsabagh A, Bekker W, Bruce J, Laing G, Clarke D. Management of penetrating thoracic trauma with retained knife blade: 15-year experience from a major trauma centre in South Africa. Ann R Coll Surg Engl 2021; 104:308-313. [PMID: 34931547 DOI: 10.1308/rcsann.2021.0182] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION This study reviews our experience with the management a retained knife in the setting of thoracic stab wounds. METHODS A retrospective study was conducted at a major trauma in South Africa over a 15-year period from January 2004 to December 2018. RESULTS There were 40 patients, of whom 37 were males (93%). Median age was 24 years; 78% of cases (31 of 40) were a retained knife and 23% (9 of 40) were a retained blade. The locations of the stab wounds were 19 (48%) anterior and 21 (53%) posterior. Plain x-ray was performed in 85% (34) of patients and computed tomography angiography was performed in 85% (34). Six patients had haemodynamic instability and were expedited to the operating room without further imaging. Three of these had cardiac tamponade and three a massive haemothorax. Simple extraction and wound exploration were performed in 58% (23 of 40) of cases and the remaining 43% (17 of 40) required operative exploration and extraction. The operative approach was anterolateral thoracotomy in nine cases, posterolateral thoracotomy in four and median sternotomy in three cases. One patient required extraction and concurrent vertebral laminectomy due to cord compression. Twelve patients (30%) experienced complications (nine wound sepsis and three hospital-acquired pneumonia). There was one mortality (3%). The median length of hospital stay was 6 days. CONCLUSION Uncontrolled extraction of a retained thoracic knife outside the operating room must be avoided. An unstable patient should proceed directly for operative exploration. For stable patients, cross-sectional imaging will allow for planned extraction in operating room.
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Affiliation(s)
- V Kong
- University of the Witwatersrand, Johannesburg, South Africa
| | - C Cheung
- Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | | | | | - C Varghese
- University of Auckland, Auckland, New Zealand
| | - A Elsabagh
- Flinders Medical Centre, Adelaide, Australia
| | - W Bekker
- University of KwaZulu Natal, Durban, South Africa
| | - J Bruce
- University of KwaZulu Natal, Durban, South Africa
| | - G Laing
- University of KwaZulu Natal, Durban, South Africa
| | - D Clarke
- University of KwaZulu Natal, Durban, South Africa
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41
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McFadgen H, Bentley VL, Helyer L. Extraperitoneal rectal trauma in a patient with multiple gunshot wounds: A case report and literature review. Trauma Case Rep 2021; 36:100554. [PMID: 34825043 DOI: 10.1016/j.tcr.2021.100554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Accepted: 11/09/2021] [Indexed: 11/22/2022] Open
Abstract
Penetrating rectal trauma is an uncommon presentation, particularly in centres with low rates of trauma, and requires a high index of suspicion to identify and treat. Management of penetrating rectal trauma has evolved over several decades and previously included proximal diversion, distal rectal washout, and presacral drainage as the primary surgical maneuvers to reduce mortality. Recently, a more conservative approach has been adopted, as the applicability of combat experience to the civilian setting has been questioned. In this report, a case of extraperitoneal rectal injury in a patient with multiple gunshot wounds provides a backdrop for literature review and discussion of the modern diagnostic and management approaches to penetrating rectal trauma.
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Magyar CTJ, Bednarski P, Jakob DA, Schnüriger B. Severe penetrating trauma in Switzerland: first analysis of the Swiss Trauma Registry (STR). Eur J Trauma Emerg Surg 2021; 48:3837-3846. [PMID: 34727193 DOI: 10.1007/s00068-021-01822-w] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/25/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The purpose of this study was to examine the epidemiology, demographics, injury characteristics and outcomes of patients who presented to Swiss trauma centers following severe penetrating trauma. METHODS Swiss Trauma Registry (STR)-cohort analysis including patients with severe (ISS ≥ 16 or AIS head ≥ 3) penetrating trauma between 2017 and 2019. Primary outcome was mortality. Secondary outcomes were hospital and intensive care unit (ICU) length of stay (LOS), and prehospital times. RESULTS During the 3-year study period, 134 (1.6% of entire STR) patients with severe penetrating trauma were identified [64 (48%) gunshot wounds (GSW), 70 (52%) stab wounds (SW)]. Median age was 40.5 (IQR 29.0-59.0) and 82.8% were male. Mortality rate was 50% for GSW; 9% for SW. Overall, prehospital time [incident to arrival emergency department (ED)] was 65 (IQR 45-94) minutes. The median number of patients admitted for a severe GSW/SW per center and year was 2 (range 0-14). Of 64 patients who sustained a GSW, 42 (65.6%) were self-inflicted. Mortality in self-inflicted GSW reached 66.7%, with the head being severely injured in 78.6%. The 67 patients with severe isolated torso GSW/SW had an ISS of 20 (IQR 16-26) and a mortality of 15%. Multivariable analysis identified severe chest trauma, ED Glasgow Coma Scale ≤ 8, age, self-infliction, massive blood transfusion and ISS as independent predictors for mortality. CONCLUSION Severe penetrating trauma is very rare in Switzerland. Mortality ranges from 9% in SW to 67% in self-inflicted GSW. Particularly in the setting of GSW/SW to the torso, reduction in prehospital time may further improve patient outcomes.
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Affiliation(s)
- Christian T J Magyar
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Piotr Bednarski
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Dominik A Jakob
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Beat Schnüriger
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland.
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Mauser M, Kruger D, Pather S, Plani F. Posttraumatic natural killer cell decrease is associated with septic complications. J Surg Res 2021; 270:94-103. [PMID: 34649071 DOI: 10.1016/j.jss.2021.08.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 05/22/2021] [Accepted: 08/27/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND There has been paucity in prospective studies investigating trauma-induced changes in the cellular immunity of HIV-seropositive patients and their impact on the clinical outcome after trauma surgery. The role of natural killer (NK) cells especially has not yet been fully elucidated, and the function of this lymphocyte subtype in the immune defense after trauma is still under debate. METHODS This prospective study included patients requiring surgery for abdominal gunshot wounds. A blood specimen was obtained on admission, 48 hours after the index operation and, in case of damage control surgery, 48 hours after the first planned second look operation. The quantity and changes of T-, B- and NK cells were analyzed via flow cytometry to investigate whether these numbers had an impact on the postoperative outcome. RESULTS A total of 62 patients were recruited in the analysis of which 38 were HIV-negative and 24 HIV-seropositive. After surgery, HIV-negative patients had a more severe decrease of their CD4+ T cells compared to the HIV-seropositive patients. Trauma resulted in a severe decrease of NK cells irrespective of the HIV-serostatus. Patients with more extensive NK cell drop had a significantly higher postoperative complication rate. CONCLUSIONS Our data support the association of trauma-induced NK cell decrease with a subsequent significantly higher rate of septic and surgical complications and suggest that these immune cells might play an important role in antibacterial immunity. Strengthening the NK cell function or limiting their decrease in the postoperative course might be of therapeutic value in severely injured trauma patients.
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Simpson C, Tucker H, Hudson A. Pre-hospital management of penetrating neck injuries: a scoping review of current evidence and guidance. Scand J Trauma Resusc Emerg Med 2021; 29:137. [PMID: 34530879 PMCID: PMC8447707 DOI: 10.1186/s13049-021-00949-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 09/02/2021] [Indexed: 01/15/2023] Open
Abstract
Penetrating injuries to the neck pose a unique challenge to clinicians due to the proximity of multiple significant anatomical structures with little protective soft tissue coverage. Injuries to this area, whilst low in incidence, are potentially devastating. Respiratory, vascular, gastro-oesophageal and neurological structures may all be involved, either in isolation or combination. These injuries are particularly difficult to manage in the resource poor, often austere and/or remote, pre-hospital environment. A systematic scoping review of the literature was conducted to evaluate the current available research pertaining to managing this injury profile, prior to the patient arriving in the emergency department. The available research is discussed in sections based on the commonly used trauma management acronym ‘cABCD’ (catastrophic haemorrhage, Airway, Breathing, Circulation, Disability) to facilitate a systematic approach and clinical evaluation familiar to clinicians. Based on the available reviewed evidence, we have proposed a management algorithm for this cohort of patients. From this we plan to instigate a Delphi process to develop a consensus statement on the pre-hospital management of this challenging presentation.
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Affiliation(s)
- Christopher Simpson
- Emergency Department, St. George's Hospital Trust, Blackshaw Rd., Tooting, London, SW17 0QT, UK.
| | - Harriet Tucker
- Emergency Department, St. George's Hospital Trust, Blackshaw Rd., Tooting, London, SW17 0QT, UK.,Air Ambulance Kent Surrey Sussex, Redhill Airfield, Redhill, RH1 5YP, Surrey, UK
| | - Anthony Hudson
- Emergency Department, St. George's Hospital Trust, Blackshaw Rd., Tooting, London, SW17 0QT, UK.,Air Ambulance Kent Surrey Sussex, Redhill Airfield, Redhill, RH1 5YP, Surrey, UK
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45
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Hynes AM. Finding the missing bullet: A case report of an unusual trajectory from the left scapula into the left orbit. Trauma Case Rep 2021; 35:100530. [PMID: 34485668 PMCID: PMC8403750 DOI: 10.1016/j.tcr.2021.100530] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2021] [Indexed: 11/05/2022] Open
Abstract
Evaluating a traumatically injured patient requires a systematic evaluation that can rapidly detect life threatening injuries. When there is a discrepancy in the number of expected retained bullets, one must re-evaluate the initial work-up. This case consists of an extremely unusual trajectory course of a scapular wound where the ballistic then traversed off the scapula through the neck entering the para-pharyngeal space, travelling through the facial bones, and coming to rest within the left eye, itself. This case herein reinforces the importance for the evaluating provider to quickly recognize when the work-up is inconsistent with the initial assessment. Failure to recognize this discrepancy may lead to an inappropriate work-up with subsequent devastating life-threatening consequences. Trajectory delineates anatomic injury. To rapidly detect all injuries, follow the entire pathway of the penetrating object. Aerodigestive & carotid injuries are associated with a high morbidity & mortality.
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Affiliation(s)
- Allyson M Hynes
- Division of Traumatology, Surgical Critical Care & Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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46
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Gavrilovski M, Griggs JE, Ter Avest E, Lyon RM. The contribution of helicopter emergency medical services in the pre-hospital care of penetrating torso injuries in a semi-rural setting. Scand J Trauma Resusc Emerg Med 2021; 29:112. [PMID: 34348780 PMCID: PMC8336281 DOI: 10.1186/s13049-021-00929-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 07/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although the merit of pre-hospital critical care teams such as Helicopter Emergency Medical Services (HEMS) has been universally recognized for patients with penetrating torso injuries who present with unstable physiology, the potential merit in patients initially presenting with stable physiology is largely undetermined. The ability to predict the required pre-hospital interventions patients may have important implications for HEMS tasking, especially when transport times to definitive care are prolonged. METHODS We performed a retrospective cohort study of patients who sustained a penetrating torso injury and were attended by the Air Ambulance Kent Surrey Sussex (AAKSS) over a 6-year period. Primary outcome was defined as the percentage of patients with penetrating torso injuries requiring HEMS-specific interventions anytime between HEMS arrival and arrival at hospital. Secondary outcomes were the association of individual patient- and injury characteristics with the requirement for HEMS interventions. RESULTS During the study period 363 patients met inclusion criteria. 90% of patients were male with a median age of 30 years. 99% of penetrating trauma incident occurred more than 10-min drive from a Major Trauma Centre (MTC). Presenting GCS was > 13 in 83% of patients. Significant hemodynamic- or ventilatory compromise was present in more than 25% of the patients. Traumatic cardiac arrest was present in 34 patients (9.4%), profound hypotension with SBP < 80 mmHg in 30 (8.3%) and oxygen saturations < 92% in 30 (8.3%). A total of 121 HEMS-specific interventions were performed. Although HEMS-specific interventions were associated with presenting physiology (TCA OR 1.75 [1.41-2.16], SBP < 80 mmHg (OR 1.40 [1.18-1.67] and SpO2 < 92% (OR 1.39 [1.17-1.65], a minority of the patients presented initially with stable physiology but deteriorated on route to hospital and required HEMS interventions (n = 9, 3.3%). CONCLUSION HEMS teams provide potentially important contribution to the pre-hospital treatment of patients with penetrating torso injuries in rural and semi-rural areas, especially when they present with unstable physiology. A certain degree of over-triage is inevitable in these patients, as it is hard to predict which patients will deteriorate on route to hospital and will need HEMS interventions. The results of this study showing a potentially predictable geographical dispersion of penetrating trauma could inform multi-agency knife crime prevention strategy.
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Affiliation(s)
- M Gavrilovski
- Air Ambulance Kent Surrey Sussex Trust, Rochester City Airport, Maidstone Road, Kent, ME5 9SD, UK.
| | - J E Griggs
- Air Ambulance Kent Surrey Sussex Trust, Rochester City Airport, Maidstone Road, Kent, ME5 9SD, UK.,Department of Health Sciences, University of Surrey, Guildford, GU2 7XH, UK
| | - E Ter Avest
- Air Ambulance Kent Surrey Sussex Trust, Rochester City Airport, Maidstone Road, Kent, ME5 9SD, UK.,University Medical Center Groningen, Department of Emergency Medicine, University of Groningen, Groningen, The Netherlands
| | - R M Lyon
- Air Ambulance Kent Surrey Sussex Trust, Rochester City Airport, Maidstone Road, Kent, ME5 9SD, UK.,Department of Health Sciences, University of Surrey, Guildford, GU2 7XH, UK
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Saar S, Jorgensen J, Lemma AN, Gaarder C, Naess PA, Leppäniemi A, Sallinen V, Pius R, Reinsoo A, Lepp J, Talving P. Selective non-operative management of penetrating abdominal injuries at Northern European trauma centers: the NordiPen Study. Eur J Trauma Emerg Surg 2021; 48:2023-2027. [PMID: 34309723 DOI: 10.1007/s00068-021-01749-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 07/18/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE A selective nonoperative management (SNOM) of penetrating abdominal injuries (PAI) is a standard of care in numerous established trauma centers. However, available evidence supporting SNOM of PAI in European settings remains scarce. Thus, we performed a multi-center study at selected Northern European trauma centers to investigate the management and outcomes of PAI. We hypothesized that despite a low number of penetrating injuries in included trauma centers, SNOM is successfully utilized with outcomes comparable with trauma centers with a high number of PAI. METHODS All adult patients admitted to participating trauma centers in the Northern European region with PAI between 1/2015 and 12/2016 were retrospectively reviewed. Primary outcomes were mortality and success rate of SNOM. RESULTS Overall, 119 patients were included. Median age was 38 (28-47) years. SNOM was initiated in 55 patients (46.0%) with 94.5% success rate. Three patients (5.5%) failed SNOM and had a delayed laparotomy with one gastric injury, one small bowel injury and one patient with a bleeding from mesentery. Overall mortality of the cohort was 5.0%. However, all patients in the SNOM group survived. Higher median ISS, median Abbreviated Injury Scale score of the abdomen, rate of combined anterior and posterior wounds, rate of in-hospital complications and longer hospital length of stay were observed in the immediate laparotomy group compared to the SNOM group. CONCLUSIONS SNOM of PAI is a safe practice even in regions with a low prevalence of penetrating injuries. The outcomes in our study are comparable with results from trauma centers treating larger numbers of patients with PAI.
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Affiliation(s)
- Sten Saar
- Division of Acute Care Surgery, Department of Surgery, North Estonia Medical Centre, Tallinn, Estonia. .,Department of Surgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia.
| | - Joakim Jorgensen
- Department of Traumatology, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Christine Gaarder
- Department of Traumatology, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Pal A Naess
- Department of Traumatology, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ari Leppäniemi
- Department of Abdominal Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Ville Sallinen
- Department of Abdominal Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Riinu Pius
- The University of Edinburgh, Edinburgh, Scotland
| | - Arvo Reinsoo
- Division of Acute Care Surgery, Department of Surgery, North Estonia Medical Centre, Tallinn, Estonia.,Department of Surgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Jaak Lepp
- Division of Acute Care Surgery, Department of Surgery, North Estonia Medical Centre, Tallinn, Estonia
| | - Peep Talving
- Department of Surgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia.,North Estonia Medical Centre, Tallinn, Estonia
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Campisi A, Ciarrocchi AP, Grani G, Argnani D, Salvi M, Stella F. Penetrating left ventricular injuries management: single General Thoracic Center experience. Gen Thorac Cardiovasc Surg 2021; 69:1254-7. [PMID: 34041690 DOI: 10.1007/s11748-021-01650-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 05/10/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Left ventricular penetrating injuries are rare but often lethal. Transport times greater than 30 min have been shown to increase the injury severity; thus early recognition of cardiac tamponade, prompt pericardial decompression, and control of cardiac hemorrhage are mandatory. METHODS We retrospectively reviewed our record to include patients with penetrating trauma of the heart. RESULTS Four hemodynamically unstable young male patients with left ventricular penetrating injury of the heart were referred to our unit between January 2007 and December 2015. Median time from trauma to surgery was 16 min (range 14-21). A cardiorrhaphy through sternotomy with no extracorporeal support was performed. We had no in-hospital mortality. CONCLUSION According to our experience, in patients with hemodynamic shock and penetrating cardiac injury, a timely recognition of injuries and referral to the closest thoracic surgery unit may increase patient survival if it is located closer than a level I trauma center.
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Nyatsambo C, Pillay K, Moeng MS, Savage-Reid MJ, Lubout M. A case report on a rare cause of bowel ischaemia in penetrating trauma. Int J Surg Case Rep 2021; 83:106010. [PMID: 34058460 PMCID: PMC8175396 DOI: 10.1016/j.ijscr.2021.106010] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 05/16/2021] [Accepted: 05/17/2021] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Gastric mucormycosis is a rare condition that usually manifests in immunocompromised patients. It's a lethal disease with a poor prognosis requiring prompt diagnosis and aggressive management. Although found more commonly in immunocompromised patients, it can also affect the immunocompetent patient, highlighting the importance of clinical suspicion when dealing with a critically ill patient. CASE PRESENTATION This is a case report on a patient who presented with penetrating trauma to the abdomen requiring surgical intervention. Damage control surgery was performed in the form of a right hemicolectomy ('clip and drop') for extensive colonic injuries (AAST Grade V) with contamination of the abdominal cavity [1]. In the days subsequent to the injury, he developed sepsis and progressive bowel ischaemia and necrosis, requiring surgical debridement. Histological findings revealed mucormycosis of the gastrointestinal tract. CLINICAL DISCUSSION The diagnosis of mucormycosis depends on high clinical suspicion as well as histopathological evidence. The management comprises of surgical debridement and appropriate antifungal therapy. Timeous diagnosis and adequate treatment may improve the prognosis. CONCLUSION This was a challenging case for the clinicians involved, highlighting that the clinician should consider this infection as a rare cause of bowel ischaemia in the back of their minds when dealing with such patients.
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Affiliation(s)
- Chido Nyatsambo
- Division of Trauma, Department of General Surgery, Charlotte Maxeke Johannesburg Academic Hospital, 5 Jubilee Street, Parktown, Johannesburg, South Africa.
| | - Krevosha Pillay
- Division of Trauma, Department of General Surgery, Charlotte Maxeke Johannesburg Academic Hospital, 5 Jubilee Street, Parktown, Johannesburg, South Africa.
| | - Maeyane Steve Moeng
- Division of Trauma, Department of General Surgery, Charlotte Maxeke Johannesburg Academic Hospital, 5 Jubilee Street, Parktown, Johannesburg, South Africa.
| | - Michael John Savage-Reid
- Division of Anatomical Pathology, National Health Laboratory Service, Charlotte Maxeke Johannesburg Academic Hospital, 5 Jubilee Street, Parktown, Johannesburg, South Africa
| | - Megan Lubout
- Division of Trauma, Department of General Surgery, Charlotte Maxeke Johannesburg Academic Hospital, 5 Jubilee Street, Parktown, Johannesburg, South Africa
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Giummarra MJ, Dipnall JF, Gibson G, Beck B, Gabbe BJ. Health status after penetrating major trauma in Victoria, Australia: a registry-based cohort study. Qual Life Res 2021; 30:3511-3521. [PMID: 34032955 DOI: 10.1007/s11136-021-02876-4] [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] [Subscribe] [Scholar Register] [Accepted: 05/05/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE As few studies have examined long-term health after penetrating injury, this population-based registry study sought to assess health outcomes up to 24 months post-injury. METHODS Major trauma patients with penetrating trauma (2009-2017) were included from the Victorian State Trauma Registry (N = 1,067; 102 died, 208 were lost to follow-up). The EQ-5D-3L was used to measure health status at 6, 12 and 24-months. Mixed linear and logistic regressions were used to examine predictors of summary scores, and problems versus no problems on each health dimension. RESULTS Average health status summary scores were 0.70 (sd = 0.26) at 6 and 12 months, and 0.72 (sd = 0.26) at 24 months post-injury. Prevalence of problems was consistent over time: mobility (24-26%), self-care (17-20%), usual activities (47-50%), pain/discomfort (44-49%), and anxiety/depression (54-56%). Lower health status and reporting problems was associated with middle-older age, female sex, unemployment; pre-injury disability, comorbid conditions; and assault and firearm injury versus cutting/piercing. CONCLUSION Problems with usual activities, pain/discomfort and anxiety or depression are common after penetrating major trauma. Risk factor screening in hospital could be used to identify people at risk of poor health outcomes, and to link people at risk with services in hospital or early post-discharge to improve their longer-term health outcomes.
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Affiliation(s)
- Melita J Giummarra
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
- Caulfield Pain Management and Research Centre, Caulfield Hospital, Caulfield, VIC, Australia.
| | - Joanna F Dipnall
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine , Deakin University, Geelong, VIC, Australia
| | - Georgia Gibson
- Institute for Social Neuroscience, Ivanhoe, VIC, Australia
| | - Ben Beck
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Belinda J Gabbe
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
- Health Data Research UK, Swansea University Medical School, Singleton Park, Swansea University, Swansea, UK, SA2 8PP, Wales
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