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1.
Kopelman TR Leeds S Berardoni NE O'Neill PJ Hedayati P Vail SJ Pieri PG Feiz-Erfan I Singer Pressman MA 《American journal of surgery》2011,202(6):684-689
Background
It has been suggested that specific cervical spine fractures (CSfx) (location at upper cervical spine [CS], subluxation, or involvement of the transverse foramen) are predictive of blunt cerebrovascular injury (BCVI). We sought to determine the incidence of BCVI with CSfx in the absence of high-risk injury patterns.Methods
We performed a retrospective study in patients with CSfx who underwent evaluation for BCVI. The presence of recognized CS risk factors for BCVI and other risk factors (Glasgow coma score ≤ 8, skull-based fracture, complex facial fractures, soft-tissue neck injury) were reviewed. Patients were divided into 2 groups based on the presence/absence of risk factors.Results
A total of 260 patients had CSfx. When screened for high-risk pattern of injury for BCVI, 168 patients were identified and 13 had a BCVI (8%). The remaining 92 patients had isolated low CSfx (C4–C7) without other risk factors for BCVI. In this group, 2 patients were diagnosed with BCVI (2%). Failure to screen all patients with CSfx would have missed 2 of 15 BCVIs (13%).Conclusions
We propose that all CS fracture patterns warrant screening for BCVI. 相似文献2.
INTRODUCTION
Management of blunt splenic injury has been controversial with an increasing trend towards splenic conservation. A retrospective study was performed to identify the effect of this changed policy on splenic trauma patients and its implications.PATIENTS AND METHODS
Data regarding patient demography, mode of splenic injury, CT grading, blood transfusion requirement, operative findings hospital stay and follow-up were collected. Statistical analysis of the data was performed using non-parametric Mann–Whitney testsRESULTS
Over an 8-year period, only 21 patients were admitted with blunt splenic injury. Ten patients were managed operatively and 11 non-operatively. Non-operative management failed in one patient due to continued bleeding. Using Buntain''s CT grading, the majority of grades I and II splenic injuries were managed non-operatively and grades III and IV were managed operatively (P = 0.008). Blood transfusion requirement was significantly higher among the operative group (P = 0.004) but the non-operative group had a significantly longer hospital stay (P = 0.029). Among those managed non-operatively (median age, 24.5 years), a number of patients were followed up with CT scans with significant radiation exposure and unknown long-term consequences.CONCLUSIONS
Non-operative management of blunt splenic trauma in adults can be performed with an acceptable outcome. Although CT is classed as the ‘gold standard’, initial imaging for detection and evaluation of blunt splenic injury, ultrasound can play a major role in follow-up imaging and potentially avoids major radiation exposure. 相似文献3.
Background
The epidemiology of pediatric blunt intraabdominal arterial injury is ill defined. We analyzed a multiinstitutional trauma database to better define injury patterns and predictors of outcome.Methods
The American College of Surgeons National Trauma Database was evaluated for all patients younger than 16 years with blunt intraabdominal arterial injury from 2000 to 2004. Injury distribution, operative treatment, and variables associated with mortality were considered.Results
One hundred twelve intraabdominal arterial injuries were identified in 103 pediatric blunt trauma patients. Single arterial injury (92.2%) occurred most frequently: renal (36.9%), mesenteric (24.3%), and iliac (23.3%). Associated injuries were present in 96.1% of patients (abdominal visceral, 75.7%; major extraabdominal skeletal/visceral, 77.7%). Arterial control was obtained operatively (n = 46, 44.7%) or by endovascular means (n = 6, 5.8%) in 52 patients. Overall mortality was 15.5%. Increased mortality was associated with multiple arterial injuries (P = .049), intraabdominal venous injury (P = .011), head injury (P = .05), Glasgow Coma Score less than 8 (P < .001), cardiac arrest (P < .001), profound base deficit (P = .007), and poor performance on multiple injured outcomes scoring systems (Revised Trauma Score [P < .001], Injury Severity Score [P = .001], and TRISS [P = .002]).Conclusion
Blunt intraabdominal arterial injury in children usually affects a single vessel. Associated injuries appear to be nearly universal. The high mortality rate is influenced by serious associated injuries and is reflected by overall injury severity scores. 相似文献4.
Avery C. Rossidis Sasha J. Tharakan Sourav K. Bose Karuna V. Shekdar Michael L. Nance Thane A. Blinman 《Journal of pediatric surgery》2018,53(1):141-145
Background/purpose
Blunt cerebrovascular injury (BCVI) is clinically challenging because these injuries are hard to detect and can have serious neurological consequences, and optimal screening criteria have not been established for children. This study aims to determine risk factors for BCVI in pediatric patients and to evaluate screening practices in a single institutional series.Methods
A retrospective review of all pediatric blunt trauma patients evaluated over a 10-year period was performed. Demographic, clinical, and radiographic data were reviewed, including the presence of adult risk factors for BCVI. Logistic regression analyses were performed with statistical significance established at p < 0.05.Results
Of the 11,596 patients evaluated during the study period, 1018 (8.8%) had at least one adult risk factor for BCVI, but only 62 (6.1% of those with risk factors) underwent angiographic evaluation. Overall, 11 BCVIs were observed, resulting in an incidence of 0.095%. All 11 patients with BCVI had at least one risk factor. Multivariate logistic regression analysis identified cervical spine fracture (OR 36.88 [8.36, 169.95]), GCS score ≤ 8 (OR 16.42 [2.16, 102.33]), male gender (OR 10.52 [1.33, 363.30]), Le Fort II or III facial fracture (OR 63.71 [2.16, 1124.68]), and ISS (unit OR 1.10 [1.04, 1.17]) as independent risk factors for BCVI.Conclusion
Adult screening criteria for BCVI appear appropriate for pediatric patients, but most at-risk children are not being screened.Level of evidence
Level III (retrospective case-control study). 相似文献5.
David M. Notrica Bethany L. Sussman Nilda M. Garcia Charles M. Leys R. Todd Maxson Amina Bhatia Robert W. Letton Todd Ponsky Karla A. Lawson James W. Eubanks Adam C. Alder Cynthia Greenwell Daniel J. Ostlie David W. Tuggle Shawn D. St. Peter 《Journal of pediatric surgery》2019,54(2):340-344
Background
APSA guidelines do not recommend routine reimaging for pediatric blunt liver or spleen injury (BLSI). This study characterizes the symptoms, reimaging, and outcomes associated with a selective reimaging strategy for pediatric BLSI patients.Methods
A planned secondary analysis of reimaging in a 3-year multi-site prospective study of BLSI patients was completed. Inclusion required successful nonoperative management of CT confirmed BLSI without pancreas or kidney injury and follow up at 14 or 60?days. Patients with re-injury after discharge were excluded.Results
Of 1007 patients with BLSI, 534 (55%) met inclusion criteria (median age: 10.18 [IQR: 6, 14]; 62% male). Abdominal reimaging was performed on 27/534 (6%) patients; 3 of 27 studies prompting hospitalization and/or intervention. Abdominal pain was associated with reimaging, but decreased appetite predicted imaging findings associated with readmission and intervention.Conclusion
Selective abdominal reimaging for BLSI was done in 6% of patients, and 11% of studies identified radiologic findings associated with intervention or re-hospitalization. A selective reimaging strategy appears safe, and even reimaging symptomatic patients rarely results in intervention. Reimaging after 14?days did not prompt intervention in any of the 534 patients managed nonoperatively.Level of evidence
Level II, Prognosis. 相似文献6.
Introduction
Little consensus exists over the management of high-grade renal injuries, with continued debate over observation versus invasive surgery. Blunt renal artery injury (BRAI) is a high-grade injury that may result in renal dysfunction, hypertension, or failure.Materials and methods
Management of BRAI at a level I trauma centre during a decade was retrospectively reviewed to determine incidence, assess management strategy, and evaluate hospital outcomes. Data collected included demographics, injury details, standardised scoring, renal injury grade, haemodynamic stability, diagnostic modalities, medical interventions, mortality, and hospitalisation length.Results
Thirty-eight BRAI patients (21 Grade IV and 17 Grade V injuries) were admitted, representing 0.16% of trauma admissions, and consisting primarily of young males. Ultrasonography and CT was performed in 92.1% and 76.3% of patients, respectively. Primary management included exploratory laparotomy in 42.9%, angiography and embolisation in 34.3%, and observation in 22.9%. Six nephrectomies and one revascularisation were performed. The incidence of BRAI and use of angiography are higher than those reported in previous studies.Conclusion
Over the past decade, increased use of CT as a diagnostic tool for confirming renal injury in haemodynamically stable patients at our institution may have contributed to the increase in BRAI detection. Higher utilisation of angiography has enabled a more conservative approach. In this series, angiography had a success rate of 94.4%. Angiography and embolisation or observation with careful monitoring are viable management options in haemodynamically stable patients with isolated BRAI. 相似文献7.
The incidence of gastric rupture after abdominal blunt injury ranges between 0.02% and 1.7% and is associated with a high morbidity (Tejerina Alvarez EE, Holanda MS, Lopex-Espadas F, Dominguez MJ, Ots E, Diaz-Reganon J. Gastric rupture from blunt abdominal trauma. Injury. 2004;35:228-231, Allen GS, Moore FA, Cox CS. Hollow visceral injury and blunt trauma. J Trauma. 1998;45:69-75.). Stomach transection represents an even rarer type of blunt gastric injury. Although not specifically included in the accepted classification of stomach injury, its clinical manifestation is dramatic, requiring immediate surgical management. We present a case report from our institution and reviewed the international literature focusing on the pediatric patient to illustrate this injury in terms of mechanism of injury, clinical presentation, and surgical management. 相似文献
8.
Christopher M. Dodgion Ankush Gosain Andrew Rogers Shawn D. St. Peter Peter F. Nichol Daniel J. Ostlie 《Journal of pediatric surgery》2014
Purpose
Recent reports suggest that an abbreviated bed rest protocol (ABRP) may safely reduce length of stay (LOS) and resource utilization in pediatric blunt spleen and liver injury (BSLI) patients. This study evaluates national temporal trends in BLSI management and estimates national reduction in LOS using an ABRP.Methods
Pediatric patients (< 18 years old) sustaining BLSI were identified in the Kids’ Inpatient Database from 2000 to 2009. Yearly rates of injury and operative intervention were examined and stratified by type of injury. APSA guidelines and the reported ABRP were applied based on abbreviated injury score (AIS) and compared with actual LOS.Results
22,153 patients were identified. Over the study period, operative rates for spleen and liver injuries and overall mortality significantly declined: LOS = 3.1 days (± 1.6) and 2.7 days (± 1.9) for spleen and liver, respectively. If APSA guidelines were followed, the rates were LOS = 3.7 days (± 1.1) and 3.4 days (± 0.7), respectively. Application of the ABRP would result in LOS = 1.3 days (± 0.5) for all BSLI patients. An ABRP could potentially save 1.7 hospital days/patient or 36,964 patient hospital days nationally.Conclusion
Our study confirms a significant national decrease in operative intervention and overall mortality in patients with BSLI. Additionally, it appears that a shorter observation period than the APSA guidelines is being utilized. The implementation of ABRP holds potential in further reducing LOS and resource utilization. 相似文献9.
We describe two cases of traumatic `degloving' of the colon in blunt abdominal trauma. This is an extremely rare injury with the potential to present late. The mechanism of injury appears to be a combination of focal blunt abdominal trauma associated with a shearing force. The potential diagnostic dilemma posed by colonic `degloving' is outlined and following review of the literature we conclude that CT scanning is the most reliable way of detecting such injuries, if emergency laparotomy is not indicated. 相似文献
10.
Matthew Alexander Ahmad Zaghal Kristel Wetjen Julia Shelton Joel Shilyansky 《Journal of pediatric surgery》2019,54(1):155-159
Purpose
We sought to evaluate value impact of transition from an adult trauma center treating children (ATC) to a verified pediatric trauma center (PTC) in children with blunt splenic injury (BSI).Methods
Children with BSI from FY 2005 to FY 2017 were extracted from the hospital trauma registry. February 2009 distinguished “ATC” treated children from “PTC” treated children. Cohorts were subcategorized into “isolated injury” and “multisystem injury”. Quality and financial characteristics were statistically compared. Analysis of covariance was used to evaluate changes in quality and financial trends over the transition period. A multiple linear regression was performed to identify variables independently predictive of hospital and professional charges.Results
126 children with BSI were identified (ATC, n?=?56; PTC, n?=?70). Splenic procedure rates and hospital charges decreased. Quality and cost metrics for isolated BSI remained unchanged while multisystem BSI children experienced improvements. PTC designation, ISS, splenic procedure, isolated BSI, average hospital LOS, and mortality were all independently predictive of hospital and professional charges.Conclusions
PTC verification improves the value of BSI management, but the associated decrease in operative rate is only partially responsible. Multisystem injury children experience the greatest value benefit from PTC verification.Type of study
Treatment and cost-effectiveness study.Level of evidence
Level III. 相似文献11.
St Peter SD Keckler SJ Spilde TL Holcomb GW Ostlie DJ 《Journal of pediatric surgery》2008,43(1):191-194
Objective(s)
The current management of blunt spleen/liver injury in children requires a number of days of bed rest equal to the grade of injury plus 1. This protocol is used even when there is no clinical indication of ongoing bleeding. To establish a prospective protocol with an abbreviated period of bed rest, we conducted a retrospective review of our blunt spleen and liver trauma experience to examine the safety of such an attenuated protocol.Methods
A retrospective analysis of our most recent 10-year experience (January 1996 to December 2005) with blunt spleen or liver injury was performed. Patient demographics, vital signs, hemoglobin levels, need for transfusion, operations, and outcomes were measured. An abbreviated protocol using 1 night of bed rest for grades 1 and 2 injuries and 2 nights of bed rest for higher grades was designed. This protocol was then applied to our patient population to assess its safety. Data are expressed as mean ± SD.Results
During the study period, 243 patients were admitted with blunt spleen and/or liver injury. The mean patient age was 9.0 ± 4.6 years, and the mean weight was 35.3 ± 19.3 kg. Sixty-three percent were male. The spleen was injured in 148 (61.2%) patients and the liver in 121 (50.0%), and 26 (10.6%) had both. The mean grade was 2.0 ± 1.1, for which the mean bed rest was 3.5 ± 1.1 days. This resulted in 5.6 ± 6.5 days of hospitalization. There were 9 patients who died, 7 with severe brain injury and 2 with massive liver hemorrhage on presentation. No patient required an operation or transfusion after 2 nights of observation who did not have clinically obvious signs of ongoing blood loss. Implementation of the abbreviated protocol would have affected 65.8% of our patients and would have saved a mean of 2.0 ± 1.5 hospital days per patient.Conclusions
According to our data, an abbreviated trauma protocol with overnight bed rest for grades 1 and 2 injuries and 2 nights for higher grades could be safely used. This protocol would immensely improve current resource use. Based on these retrospectively collected data, we have initiated a prospective consecutive controlled series to assess the safety of such an attenuated protocol. 相似文献12.
Micah G. Katz Zachary J. Kastenberg Mark A. Taylor Carol D. Bolinger Eric R. Scaife Stephen J. Fenton Katie W. Russell 《Journal of pediatric surgery》2019,54(2):354-357
Background/purpose
Nonoperative management of blunt solid organ injuries continues to progress and improve cost-effective utilization of resources while maximizing patient safety. The purpose of this study is to compare resource utilization and patient outcomes after changing admission criteria from a grade-based protocol to one based on hemodynamic stability.Methods
A retrospective review of isolated liver and spleen injuries was done using prospectively collected trauma registry data from 2013 to 2017. The 2?years preceding the change were compared to the 2?years after protocol change. All analyses were performed using SAS 9.4.Results
There were 121 patients in the preprotocol cohort and 125 patients in the postprotocol cohort. Baseline demographics were similar along with injury mechanisms and severity. The ICU admission rate decreased from 40% to 22% (p?=?0.002). There were no adverse events on the floor and no patient needed to be transferred to the ICU.Conclusions
A protocol for ICU admission based on physiologic derangement versus solely on radiologic grade significantly reduced admission rates to the ICU in children with solid organ injury. The protocol was safe and effectively reduced resource utilization.Level of evidence
Level II, prospective comparison study. 相似文献13.
《中华创伤杂志(英文版)》2022,25(6):392-394
Blunt traumatic tracheobronchial injury is rare, but can be potentially life-threatening. It accounts for only 0.5%–2% of all trauma cases. Patients may present with non-specific signs and symptoms, requiring a high index of suspicion with accurate diagnosis and prompt treatment. A 26-year-old female was brought into the emergency department after sustained a blunt trauma to the chest from a high impact motor vehicle accident. She presented with signs of respiratory distress and extensive subcutaneous emphysema from the chest up to the neck. Her airway was secured and chest drain was inserted for right sided pneumothorax. CT of the neck and thorax revealed a collapsed right middle lung lobe with a massive pneumothorax, raising the suspicion of a right middle lobe bronchus injury. Diagnosis was confirmed by bronchoscopy. In view of the difficulty in maintaining her ventilation and persistent pneumothorax with a massive air leak, immediate right thoracotomy via posterolateral approach was performed. The right middle lobar bronchus tear was repaired. There were no intra- or post-operative complications. She made an uneventful recovery. She was asymptomatic at her first month follow-up. A repeated chest X-ray showed expanded lungs. Details of the case including clinical presentation, imaging and management were discussed with an emphasis on the early uses of bronchoscopy in case of suspected blunt traumatic tracheobronchial injury. A review of the current literature of tracheobronchial injury management was presented. 相似文献
14.
目的探讨腹腔镜早期探查术应用于腹部钝性外伤继发肠损伤中的临床效果,提高其治疗效果。方法回顾性分析在本院住院治疗的腹部钝性外伤继发肠损伤早期实施腹腔镜探查术患者40例的临床资料,并与同期早期(受伤后开始手术不超过6小时)手术患者38例进行比较。结果两组患者一般资料、肠管损伤部位及程度比较,差异无统计学意义(P〉0.05);两组患者死亡率均较低,差异无统计学意义(P〉0.05),但是观察组患者住院时间、ICU监护时间、机械通气时间及并发症发生率均低于对照组,差异存在统计学意义(P〈0.05)。结论腹腔镜探查术是集诊断和治疗为一体的现代化外科微创技术,在技术和设备许可的情况下,正确把握适应征,可以使腹部钝性外伤继发肠损伤患者获得最佳的诊治效果。 相似文献
15.
目的探讨右美托咪定对撞击性肺损伤大鼠肺部的保护机制。方法清洁级成年雄性SD大鼠40只,随机均分为五组:正常对照组(C组)、右美托咪定组(D组)、胸部创伤模型组(T组)、胸部创伤模型~+右美托咪定处理组(TD组)和胸部创伤模型~+右美托咪定~+育亨宾(α2肾上腺素能受体阻断剂)组(TDY组)。C和D组只麻醉不创伤,T、TD、TDY组复制大鼠胸部撞击模型。持续监测五组大鼠创伤后0.5、1、2、4和6h的有创平均动脉血压(MIAP),处死前抽取动脉血0.5ml行动脉血气分析;采用免疫组织法检测肺组织NF-κBp65的表达;酶联免疫吸附实验(ELISA)检测血清中TNF-α和IL~(-1)β浓度;检测支气管肺泡灌洗液(BALF)中中性粒细胞占白细胞百分比(PMN),计算肺湿/干比(W/D);HE染色光镜下观察肺组织病理改变。结果创伤后0.5、1、2h时D组MIAP明显高于T组,创伤后4和6h时D组MIAP明显低于C和T组(P0.05);创伤后1hTDY组MIAP明显高于,创伤后4和6hTDY组MIAP明显低于C和TD组(P0.05)。T、TD和TDY组PaO_2、PaCO_2明显低于,pH、TNF-α和IL~(-1)β浓度明显高于C组(P0.01)。D、TD和TDY组PaO_2、PaCO_2明显高于,血清TNF-α和IL~(-1)β浓度明显低于T组(P0.01),T组pH明显高于D组,但明显低于TD、TDY组(P0.01)。D组肺组织NF-κBp65,T、TD和TDY组肺组织NF-κBp65、W/D和PMN明显高于C组(P0.05);D、TD、TDY组肺组织NF-κBp65、M/D和PMN明显低于T组(P0.01);TDY组肺组织NF-κBp65、M/D和PMN明显高于TD组(P0.01)。结论盐酸右美托咪定可通过抑制肺组织和血清中炎症因子的表达减轻创伤性肺损伤的程度。 相似文献
16.
Miglietta MA Moore JA Bernstein MP Frangos SG Ginsburg H Pachter HL 《Journal of pediatric surgery》2006,41(9):1604-1606
Hepatic artery injuries sustained as a result of blunt abdominal trauma are rare. This case represents the first reported hepatic artery transection and the second hepatic artery injury described in children. Hepatic artery injuries are associated with high mortality, and their management is complex and controversial. 相似文献
17.
Afif N. Kulaylat Brett W. Engbrecht Carolina Pinzon-Guzman Vance L. Albaugh Susan E. Rzucidlo Jane R. Schubart Robert E. Cilley 《Journal of pediatric surgery》2014
Background
Pleural effusion is a potential complication following blunt splenic injury. The incidence, risk factors, and clinical management are not well described in children.Methods
Ten-year retrospective review (January 2000–December 2010) of an institutional pediatric trauma registry identified 318 children with blunt splenic injury.Results
Of 274 evaluable nonoperatively managed pediatric blunt splenic injures, 12 patients (4.4%) developed left-sided pleural effusions. Seven (58%) of 12 patients required left-sided tube thoracostomy for worsening pleural effusion and respiratory insufficiency. Median time from injury to diagnosis of pleural effusion was 1.5 days. Median time from diagnosis to tube thoracostomy was 2 days. Median length of stay was 4 days for those without and 7.5 days for those with pleural effusions (p < 0.001) and 6 and 8 days for those pleural effusions managed medically or with tube thoracostomy (p = 0.006), respectively. In multivariate analysis, high-grade splenic injury (IV–V) (OR 16.5, p = 0.001) was associated with higher odds of developing a pleural effusion compared to low-grade splenic injury (I–III).Conclusions
Pleural effusion following pediatric blunt splenic injury has an incidence of 4.4% and is associated with high-grade splenic injuries and longer lengths of stay. While some symptomatic patients may be successfully managed medically, many require tube thoracostomy for progressive respiratory symptoms. 相似文献18.
Suhail Yaqoob Hakim Husham Abdelrahman Insolvisagan Natesa Mudali Ayman El-Menyar Ruben Peralta Hassan Al-Thani 《International journal of surgery case reports》2014,5(12):1106-1109
INTRODUCTION
Blunt trauma as a cause of pneumoperitoneum is less frequent and its occurrence without a ruptured viscus is rarely seen.PRESENTATION OF CASE
We report a case of blunt neck trauma in which a motorcycle rider hit a fixed object causing severe laryngotracheal injury. The patient developed pneumothorax bilaterally and had pneumoperitoneum despite no injury to the internal viscus. Bilateral chest tube drainage and abdominal exploratory laparotomy was performed.CONCLUSION
Free air in the abdomen after blunt traumatic neck injury is very rare. If pneumoperitoneum is suspected in the presence of pneumothorax, exploratory laparotomy should be performed to rule out intraabdominal injury. As, there is no consensus for this plan yet, further prospective studies are warrant. Conservative management for pneumoperitoneum in the absence of viscus perforation is still a safe option in carefully selected cases. 相似文献19.
IntroductionThe most common mechanism of aortic injury involves motor vehicle collisions resulting in aortic disruptions, occurring almost exclusively in the chest. Injury to the abdominal aorta following blunt trauma is nearly twenty times less likely to occur than the thoracic aorta. Because of the low incidence, there are few reports regarding the presentation and repair of these particular injuries, especially in the pediatric population.Presentation of caseWe present a case of a 7-year-old boy involved in a high speed motor vehicle accident with an abdominal aorta transection at the aortic bifurcation extending into the left iliac artery. The injury was repaired using bovine pericardium with the adventitia and intima of the vessel approximated over the bovine bridge.DiscussionPrimary repair of thoracic aortic injury has been thoroughly described in the literature with good outcomes yet, abdominal aortic repair remains ambiguous. Few techniques and materials have been described with even less data surrounding the long-term outcomes.ConclusionBovine pericardium is a strong and stable acellular collagenous material with the potential to accelerate endothelialization and tissue regeneration. This remains an interesting field of research as stenosis and pseudo-coarction data have yet to be determined. 相似文献
20.
CT scan-detected pneumoperitoneum: An unreliable predictor of intra-abdominal injury in blunt trauma
Ashley P. Marek Ryan F. Deisler John B. Sutherland Gopal Punjabi Anne Portillo Jon Krook Chad J. Richardson Rachel M. Nygaard Arthur L. Ney 《Injury》2014