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971.
Kathleen M. Adelgais Lorin Browne Maija Holsti Ryan R. Metzger Shannon Cox Murphy Nanette Dudley 《Journal of pediatric surgery》2014
Background
Guidelines for evaluating the cervical spine in pediatric trauma patients recommend cervical spine CT (CSCT) when plain radiographs suggest an injury. Our objective was to compare usage of CSCT between a pediatric trauma center (PTC) and referral general emergency departments (GEDs).Methods
Patient data from a pediatric trauma registry from 2002 to 2011 were analyzed. Rates of CSI and CSCT of patients presenting to the PTC and GED were compared. Factors associated with use of CSCT were assessed using multivariate logistic regression.Results
5148 patients were evaluated, 2142 (41.6%) at the PTC and 3006 (58.4%) at the GED. Groups were similar with regard to age, gender, GCS, and triage category. GED patients had a higher median ISS (14 vs. 9, p < 0.05) and more frequent ICU admissions (44.3% vs. 26.1% p < 0.05). CSI rate was 2.1% (107/5148) and remained stable. CSCT use increased from 3.5% to 16.1% over time at the PTC (mean 9.6% 95% CI = 8.3, 10.9) and increased from 6.8% to 42.0% (mean 26.9%, CI = 25.4, 28.4) at the GED. Initial care at a GED remained strongly associated with CSCT.Conclusions
Despite a stable rate of CSI, rate of CSCT increased significantly over time, especially among patients initially evaluated at a GED. 相似文献972.
973.
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
Introduction
Free intra-peritoneal air in blunt trauma is a classic sign associated with hollow viscus injury, traditionally mandating laparotomy. In blunt abdominal trauma, the CT scan has become the diagnostic modality of choice. The increased sensitivity of CT scans may lead to detection of free intra-peritoneal air that is not clinically significant.Objective
To characterize conditions and findings that allow for the safe observation of blunt trauma patients with free air and to propose a patient management algorithm to decrease rates of non-therapeutic laparotomy.Design
A retrospective review of 5877 blunt trauma patients who had an abdominal CT scan upon admission to our hospital from 2003 to 2011. A secondary CT review was performed by a single radiologist to further characterize the CT findings in the 74 patients with free air reported on initial scan. Management and hospital course were reviewed in these patients.Results
Of the 74 patients with intra-abdominal free air, 36 patients with a benign clinical picture were observed and 38 patients underwent urgent exploratory laparotomy. Eleven patients received a non-therapeutic laparotomy. The majority (61%) of patients, 45 of 74, had free air and no significant injury suggesting the presence of benign free air. Patients who had intra-abdominal injury also typically had other clinical or radiologic signs of injury. Findings that were highly predictive of intra-abdominal injury in the setting of free air were free fluid (P < 0.001), radiographic signs of bowel trauma (P < 0.001) as well as clinical and/or radiographic seatbelt sign (P = 0.004).Conclusions
CT scans may detect free air that is not always clinically significant. Free fluid, seatbelt sign or radiographic signs of bowel trauma in the presence of pneumoperitoneum is highly predictive of injury and these patients should be explored. Based on the results of our study, we created an algorithm to aid in identifying those patients with intra-abdominal free air who may be observed safely. 相似文献974.
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Michael A. Jhung Tiffany D'Mello Alejandro Pérez Deborah Aragon Nancy M. Bennett Tara Cooper Monica M. Farley Brian Fowler Stephen M. Grube Emily B. Hancock Ruth Lynfield Craig Morin Arthur Reingold Patricia Ryan William Schaffner Ruta Sharangpani Leslie Tengelsen Ann Thomas Diana Thurston Kimberly Yousey-Hindes Shelley Zansky Lyn Finelli Sandra S. Chaves 《American journal of infection control》2014
979.