Challenges of diagnosis of COVID-19 in trauma patients: A case series

Background

Diagnosis of COVID-19 can be challenging in trauma patients, especially those with chest trauma and lung contusion.

Methods

We present a case series of patients from February and March 2020 who were admitted to our trauma center at Rajaee Hospital Trauma Center, in Shiraz, Iran and had positive SARS-CoV-2 PCR test or chest CT scan suggestive of COVID-19 and were admitted to the specific ICU for COVID-19.

Results

Eight COVID-19 patients (6 male) with mean age of 40 (SD = 16.3) years old, were presented. All patients were cases of trauma injuries, with multiple injuries including chest trauma and lung contusion, admitted to our trauma center for management of their injuries, but they were diagnosed with COVID-19 as well. Two of them had coinfection of influenza type-B and SARS-CoV-2. All patients were treated for COVID-19 and three of them died; the rest were discharged from hospital.

Conclusion

Since PCR for SARS-CoV-2 is not always sensitive enough to confirm the cause of pneumonia, chest CT manifestations can be helpful, though, they are not always differentiable from lung contusion. Therefore, both the CT scan and the clinical and paraclinical presentation and course of improvement can be beneficial in diagnosing COVID-19 in the trauma setting.

A Multicenter Survey on the Trend of Chest CT Scan Utilization: Tracing the First Footsteps of COVID-19 in Iran

BACKGROUND

Chest computed tomography (CT) scan has been used widely to diagnose COVID-19 in Iran.

OBJECTIVES

To trace the footsteps of COVID-19 in Iran by exploring the trend in using chest CT scans and its economic impact on radiology departments. Methods: In this cross-sectional study, the number of imaging examinations from 33 tertiary radiology departments in 9 large cities of Iran was collected from September 23, 2019 to March 20, 2020 (Months 1 to 6) and the corresponding months in 2018-2019.

RESULTS

A 50.2% increase was noted in the chest CT scan utilization in 2019-2020 compared to 2018-2019. This increase was +15%, +15%, +27%, +2%, +1% in Months 1-5 of 2019-2020, respectively. In Month 6 of 2019-2020, a 251% increase in the acquisition of chest CT scans was observed compared to the Month 6 of 2018-2019. Following negative balance of revenue from Month 1 to 5 with respect to the inflation rate, the total income in Month 6 was further 1.5% less than the same Month in 2018-19.

CONCLUSION

The observed peak in chest CT utilization in Month 3 prior to the surge in Month 6 could be explained by the seasonal influenza. However, unawareness about an emerging viral disease, i.e. COVID-19, might have underutilized chest CT in Months 4 and 5 before the official announcement in Month 6. The unbalanced increase in the workload of radiology departments in the shortage of cardiothoracic radiologists with the simultaneous decrease in income initiated a vicious cycle that worsened the economic repercussions of the pandemic.

New and Emerging Mobile Technologies for Healthcare (mHealth): A Horizon Scanning Study

Introduction: The popularity of mobile phone applications (Apps) and wearable devices for medical and health purposes is on the rise, but not all the mobile health (mHealth) innovative solutions that hit the news every day will sustain and have an impact on the health of people. The aim of this news-based horizon scanning study was to explore and identify new and emerging mobile technologies that are likely to impact the future of health and medical care.Methods: We conducted a systematic search on top ranking technology websites, according to Alexa Ranking, to identify health-related mobile-based technologies. We followed the EuroScan guide for horizon scanning, which recommends four steps: identification, filtering, prioritization, evaluation and conclusion. Technologies of interest were mHealth technologies regardless of their maturity level. The impact of technologies was assessed and scored in four areas: user, technology, safety, and cost.Results: Five hundred news articles were identified through the electronic search. After screening, 106 mHealth innovative technologies were included in this study. We categorized the included technologies into three groups: mobile apps (n=37), smart-connected devices (n=19), and wearables (n=50). mHealth technologies were most frequently developed for preventive health services, mental health services and rehabilitation services. There was no remarkable difference between the technology groups in terms of safety and adverse effects, but the groups were significantly different in terms of the target population, technology, and cost.Conclusion: An increasing number of solutions based on mobile technology is being developed by both public and private sectors but a low proportion of them undergo proper scientific evaluations. Despite the commercial availability of many innovative mobile apps, wearables, and smart connected devices, few of them have been actually used in clinics, hospitals, and health centers. There is a clear need for changes in healthcare service models to unlock the full potential of these innovative technologies.

The Predictive Value of Repeated Abdominal Ultrasonography in Patients with Multiple Trauma and Decreased Level of Consciousness: The Experience of a Resource-Limited Centre

Objective

To determine the predictive value of repeated abdominal ultrasonography in patients with multiple trauma and decreased level of consciousness (LOC).

Methods

This prospective cross-sectional study was conducted over a six-month period at Shahid Rajaee Trauma Hospital, Shiraz, Iran. We included hemodynamically stable blunt abdominal trauma patients with a decreased LOC (Glasgow Coma Scale ≤ 13) who were referred to the neurosurgery ICU ward. Included cases underwent 1 contrast-enhanced CT scan and two-time ultrasonographic study of the abdomen with an interval of 48 hours. The diagnostic accuracy of the ultrasonography was determined according to the CT-scan results.

Results

Overall 80 patients with mean age of 37.75 ± 18.67 years were included. There were 17 (21.3%) women and 63 (78.8%) men among the patients. Compared with the CT-Scan, the first ultrasonography showed a sensitivity of 60%, specificity of 80%, PPV of 16.60%, NPV of 96.80%, and a diagnostic accuracy of 70%. The same values for the second ultrasonographic study were 80%, 79%, 20%, 98%, and 79%, respectively. In 4 (5%) patients whose first ultrasonography and CT scan results were negative, the second ultrasonography was positive for injury.

Conclusion

In patients with blunt trauma to the abdomen, when the only indication of abdominal CT scan is a decreased LOC, two ultrasonographic studies can replace a CT imaging.

Staging of Fatty Liver Diseases Based on Hierarchical Classification and Feature Fusion for Back-Scan-Converted Ultrasound Images

Fatty liver disease is progressive and may not cause any symptoms at early stages. This disease is potentially fatal and can cause liver cancer in severe stages. Therefore, diagnosing and staging fatty liver disease in early stages is necessary. In this paper, a novel method is presented to classify normal and fatty liver, as well as discriminate three stages of fatty liver in ultrasound images. This study is performed with 129 subjects including 28 normal, 47 steatosis, 42 fibrosis, and 12 cirrhosis images. The proposed approach uses back-scan conversion of ultrasound sector images and is based on a hierarchical classification. The proposed algorithm is performed in two parts. The first part selects the optimum regions of interest from the focal zone of the back-scan-converted ultrasound images. In the second part, discrimination between normal and fatty liver is performed and then steatosis, fibrosis, and cirrhosis are classified in a hierarchical basis. The wavelet packet transform and gray-level co-occurrence matrix are used to obtain a number of statistical features. A support vector machine classifier is used to discriminate between normal and fatty liver, and stage fatty cases. The results of the proposed scheme clearly illustrate the efficiency of this system with overall accuracy of 94.91% and also specificity of more than 90%.

Comparison between Computed Tomography and Ultrasonography in Detecting Foreign Bodies Regarding Their Composition and Depth: An In Vitro Study

STATEMENT OF THE PROBLEM

Impaction of foreign bodies in the soft tissues is a sequela of traumatic and penetrating injuries. Such foreign bodies should be removed due to the complications they cause. Patient's history, clinical evaluation and imaging examinations aid in the proper detection and localization of the foreign bodies.

PURPOSE

The aim of the present study was to compare the sensitivity of computed tomography (CT) and ultrasonography for detecting foreign bodies in in-vitro models simulating facial soft tissues.

MATERIALS AND METHOD

Fifty foreign particles with five different compositions including wood, glass, metal, plastic, and stone were embedded in five calf tongues at 1, 2, 3, 4 and 5 cm depths. CT and ultrasonography were compared regarding their capability of detecting and localizing the foreign bodies.

RESULTS

Wood and plastic foreign bodies were demonstrated more clearly on ultrasonography images. High density materials such as metal, stone, and glass were detected with almost the same accuracy on CT and ultrasonography examinations. Visibility of the foreign bodies deteriorated on ultrasonography images as their depth increased; however, CT appearances of the foreign particles were not influenced by their depths.

CONCLUSION

Ultrasonography is an appropriate technique for detection of foreign bodies especially the ones with low density. Therefore, it seems logical to perform ultrasonography in combination with CT in cases with the suspicion of foreign body impaction.

The Feasibility of Ultrasonography in Defining the Size of Jaw Osseous Lesions

STATEMENT OF THE PROBLEM

Jaw bone lesions are common pathologic conditions. The role of ultrasonography in evaluation of the extra-osseous lesions is confirmed, however, this imaging modality is not the diagnostic routine for the intra-osseous jaw lesions.

PURPOSE

The purpose of this study was to evaluate the efficiency of ultrasonography in diagnosis of intra-osseous jaw lesions concerning their size and content and also to study its correlation with the histopathological findings.

MATERIALS AND METHOD

For this study, 15 patients with intra-osseous jaw lesions in the maxilla and mandible were selected from those referred to the Department of Oral Surgery. Panoramic imaging, computed tomography (CT) or cone beam computed tomography (CBCT) and ultrasonography (USG) were performed for all the lesions. The size of the lesions was measured by USG and then compared with CT or CBCT. Moreover, the correlation amongst the echographic patterns and histopathologic results was evaluated.

RESULTS

In 12 cases, size values were in complete agreement with CT or CBCT. The size of 3 lesions could not be measured by the radiologist due to the thickness of buccal cortical plate.

CONCLUSION

Findings of this study suggested that USG might be feasible in estimating the size of intra-osseous jaw lesions with little underestimation. This study also confirmed that ultrasound imaging was a very useful imaging technique which could provide significant diagnostic information regarding the content of jaw bone lesions where the buccal bone thickness was thin enough.

Clinical and economic effects of selective radiological evaluation of high-energy trauma patients: a prospective experience of a level 1 busy trauma centre

INTRODUCTION

Cervical spine, thoracic and pelvic fractures are the main causes of devastation in patients who have suffered blunt trauma. Radiographic imaging plays an important role in diagnosing such injuries. Nevertheless, the present dominant approach, the routine use of X-ray studies, seems to have no cost-benefit justification for healthcare systems.

METHODS

This prospective cross-sectional study was performed over a 3-month period. During the determined time frame, all haemodynamically stable, high-energy blunt trauma patients were included. Based on the predefined criteria, selective radiographic images of the neck, chest and pelvis were obtained. Patients were followed during their hospital stay and for a 2-week period after discharge.

RESULTS

1002 cases were included in the final survey. 247/1002 (24.6%) cervical radiographic images, 500/1002 (49.9%) CXRs and 171/1002 (17%) pelvic radiographic images of the patients were taken on the first day of hospital admission. New X-ray images required during the patients' hospital stay resulted in 5/1002 (0.4%) cervical, 4/1002 (0.3%) chest and 8/1002 (0.7%) pelvic radiographies. In the 2-week period after discharge, 4/1002 cases (0.3%) needed to repeat neck radiography. Overall, 697.44 mSv X-ray radiation was potentially prevented and US$426,450 were potentially saved.

CONCLUSIONS

Selective radiographic imaging of the neck, chest and pelvis together with a precise history-taking and physical examination in cases of high-energy blunt trauma could eliminate unnecessary costs to patients and healthcare systems, and significantly save resources.

Ultrasonographic findings of mesenchymal chondrosarcoma of the mandible: report of a case

Today, ultrasound imaging is being widely used to assess soft tissue lesions in the maxillofacial region. However, ultrasound investigations of intra-osseous lesions are rare, especially for tumors of the jaws. This report emphasized the capability of this useful imaging modality in identification of the characteristics of malignant conditions involving the bone. Mesenchymal chondrosarcoama, one of the unusual malignant conditions of the jaw, was presented in a young male with significant facial swelling. Different imaging modalities parallel with the histopathologic investigation confirmed the diagnosis. Interestingly, destruction of the bony cortex and new bone formation with a characteristic "sun ray appearance", highly suggestive of sarcomas, was manifested on the ultrasonograph. Thus, this report presented the ultrasonographic features of chondrosarcoma of mandible and considered the ultrasonography to be a useful imaging modality to evaluate intra-osseous jaw lesions.