Continuous hemoglobin monitoring in pediatric trauma patients with solid organ injury

2018 ◽  
Vol 53 (10) ◽  
pp. 2055-2058 ◽  
Author(s):  
Emily Welker ◽  
Jennifer Novak ◽  
Lindsey Jelsma ◽  
Tracy Koehler ◽  
Alan Davis ◽  
...  
Keyword(s):  
Pediatric Trauma ◽  
Organ Injury ◽  
Trauma Patients ◽  
Solid Organ ◽  
Solid Organ Injury

Rib Fracture Patterns Predict Thoracic Chest Wall and Abdominal Solid Organ Injury

2010 ◽  
Vol 76 (8) ◽  
pp. 888-891 ◽  
Author(s):  
Ammar Al-Hassani ◽  
Husham Abdulrahman ◽  
Ibrahim Afifi ◽  
Ammar Almadani ◽  
Ahmed Al-Den ◽  
...  
Keyword(s):  
Chest Wall ◽  
Rib Fractures ◽  
Organ Injury ◽  
Trauma Patients ◽  
Solid Organ ◽  
Solid Organ Injury ◽  
High Association ◽  
Multiple Rib Fractures ◽  
Scapular Fractures ◽  
Sternal Fractures

Blunt trauma patients with rib fractures were studied to determine whether the number of rib fractures or their patterns were more predictive of abdominal solid organ injury and/or other thoracic trauma. Rib fractures were characterized as upper zone (ribs 1 to 4), midzone (ribs 5 to 8), and lower zone (ribs 9 to 12). Findings of sternal and scapular fractures, pulmonary contusions, and solid organ injures (liver, spleen, kidney) were characterized by the total number and predominant zone of ribs fractured. There were 296 men and 14 women. There were 38 patients with scapular fracture and 19 patients with sternal fractures. There were 90 patients with 116 solid organ injuries: liver (n = 42), kidney (n = 27), and spleen (n = 47). Lower rib fractures, whether zone-limited or overlapping, were highly predictive of solid organ injury when compared with upper and midzones. Scapular and sternal fractures were more common with upper zone fractures and pulmonary contusions increased with the number of fractured ribs. Multiple rib fractures involving the lower ribs have a high association with solid organ injury, 51 per cent in this series. The increasing number of rib fractures enhanced the likelihood of other chest wall and pulmonary injuries but did not affect the incidence of solid organ injury.

The Management of Blunt Abdominal Trauma Patients with Computed Tomography Scan Findings of Free Peritoneal Fluid and No Evidence of Solid Organ Injury

2006 ◽  
Vol 72 (10) ◽  
pp. 943-946 ◽  
Author(s):  
Sara Yegiyants ◽  
Gilbert Abou-Lahoud ◽  
Edward Taylor
Keyword(s):  
Computed Tomography ◽  
Peritoneal Fluid ◽  
Medical Center ◽  
Organ Injury ◽  
Trauma Patients ◽  
Solid Organ ◽  
Solid Organ Injury ◽  
Abdominal Sonography ◽  
Ct Findings ◽  
Free Peritoneal Fluid

Modalities available for the diagnosis of blunt abdominal traumatic (BAT) injuries include focused abdominal sonography for trauma, diagnostic peritoneal lavage, and computed tomography (CT) of the abdomen/pelvis. Hollow viscous and/or mesenteric injury (HVI/MI) can still be challenging to diagnose. Specifically, there is debate as to the proper management of BAT when CT findings include free peritoneal fluid but no evidence of solid organ injury (SOI). Our objective was to determine the incidence of HVI/MI and to evaluate the management of BAT patients with CT findings of peritoneal fluid without evidence of SOI. An Institutional Review Board-approved retrospective chart review was conducted of all BAT patients with peritoneal fluid on CT admitted to Kern Medical Center from January 1, 2003 to July 31, 2004. A total of 2651 trauma admissions yielded 79 patients. Fourteen of these had no evidence of SOI. Nonoperative management was successful in only 2 of these 14, whereas 12 required an operation, with 11 being therapeutic. Trigger to operate and time from presentation to laparotomy was hypotension in three patients (164 minutes), signs of HVI/MI on CT in two patients (235 minutes), diaphragm injury on CT in one patient (95 minutes), and for peritoneal signs in six patients (508 minutes). In BAT patients with peritoneal fluid on CT without evidence of SOI, there should be a high suspicion of HVI/MI. Relying on increasing abdominal tenderness to trigger laparotomy can result in delayed treatment.

TRAUMA PATIENTS WITH SOLID ORGAN INJURY: RESULTS FROM A BORDER TOWN HOSPITAL IN TURKEY

2014 ◽  
Author(s):  
Ahmet Cem Dural ◽  
Candas Ercetin ◽  
Tugan Tezcaner ◽  
Mahir Kirnap ◽  
Nazli Ferhan Sayit ◽  
...  
Keyword(s):  
Organ Injury ◽  
Trauma Patients ◽  
Solid Organ ◽  
Solid Organ Injury ◽  
Town Hospital ◽  
Border Town

In the Modern Era of CT, Do Blunt Trauma Patients with Markers for Blunt Bowel or Mesenteric Injury Still Require Exploratory Laparotomy?

2017 ◽  
Vol 83 (7) ◽  
pp. 722-727 ◽  
Author(s):  
Katelyn Young ◽  
Melina Benson ◽  
Andrew Higgins ◽  
James Dove ◽  
Marie Hunsinger ◽  
...  
Keyword(s):  
Blunt Trauma ◽  
Bowel Perforation ◽  
Organ Injury ◽  
Acute Injury ◽  
Common Finding ◽  
Wall Thickening ◽  
Trauma Patients ◽  
Solid Organ ◽  
Solid Organ Injury ◽  
Mesenteric Injury

After blunt trauma, certain CT markers, such as free intraperitoneal air, strongly suggest bowel perforation, whereas other markers, including free intraperitoneal fluid without solid organ injury, may be merely suspicious for acute injury. The present study aims to delineate the safety of non-operative management for markers of blunt bowel or mesenteric injury (BBMI) that are suspicious for significant bowel injury after blunt trauma. This was a retrospective review of adult blunt trauma patients with abdominopelvic CT scans on admission to a Level I trauma center between 2012 and 2014. Patients with CT evidence of acute BBMI without solid organ injury were included. The CT markers for BBMI included free intraperitoneal fluid, bowel hematoma, bowel wall thickening, mesenteric edema, hematoma and stranding. Two thousand blunt trauma cases were reviewed, and 94 patients (4.7%) met inclusion criteria. The average Injury Severity Score was 13.6 ± 10.1 and the median hospital stay was four days. The most common finding was free fluid (74 patients, 78.7%). The majority of patients (92, 97.9%) remained asymptomatic or clinically improved without abdominal surgery. After a change in abdominal examination, two patients (2.1%) underwent laparotomy with bowel perforation found in only one patient. Thus, 93 patients did not have a surgically significant injury, indicating that these markers demonstrate 1.1 per cent positive predictive value for bowel perforation. The presence of these markers after blunt trauma does not mandate laparotomy, though it should prompt thorough and continued vigilance toward the abdomen.

Outcomes of Geriatric Trauma Patients on Preinjury Anticoagulation: A Multicenter Study

2017 ◽  
Vol 83 (6) ◽  
pp. 527-535 ◽  
Author(s):  
Darwin Ang ◽  
Stan Kurek ◽  
Mark Mckenney ◽  
Scott Norwood ◽  
Brian Kimbrell ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Vitamin K ◽  
Thromboxane A2 ◽  
Antiplatelet Agents ◽  
Organ Injury ◽  
Geriatric Trauma ◽  
Trauma Patients ◽  
Solid Organ ◽  
Solid Organ Injury ◽  
P2y12 Inhibitors

Outpatient anticoagulation in the geriatric trauma patient is a challenging clinical problem. The aim of this study is to determine clinical outcomes associated with class of preinjury anticoagulants (PA) used by this population. This is a multicenter retrospective cohort study among four Level II trauma centers. A total of 1642 patients were evaluated; 684 patients were on anticoagulation and 958 patients were not. Patients on PA were compared with those who were not. Drug classes were divided into thromboxane A2 inhibitors, vitamin K factor-dependent inhibitors, antithrombin III activation, platelet P2Y12 inhibitors, and thrombin inhibitors. Multivariate regression was used to adjust for age, gender, race, mechanism of injury, and Injury Severity Score. No single or combination of anticoagulation agents had a significant association with mortality; however, there were positive trends toward increased mortality were noted for all antiplatelet groups involving thromboxane A2 inhibitors and platelet P2Y12 inhibitors classes. The likelihood of complications was significantly higher with platelet P2Y12 inhibitors adjusted odds ratio (aOR) 2.39 [95% confidence interval (CI) 1.32, 4.3]. The likelihood of blood transfusion was increased with vitamin K inhibitors aOR 2.89 (95% CI 1.3, 6.5), P2Y12 inhibitors aOR 2.76 (95% CI 1.12, 6.76), and combined thromboxane A2 and P2Y12 inhibitors aOR 2.89 (95% CI 1.13, 7.46). P2Y12 inhibitors were also more likely associated with traumatic brain injury aOR 2.16 (95% CI 1.01, 4.6). All classes of PA were associated with solid organ injury. There were no significant differences in the use of antiplatelet agents between patients with major indications for PA and those without major indications. Geriatric trauma patients on outpatient anticoagulants have a higher likelihood of developing complications, packed red blood cell transfusions, traumatic brain injury, and solid organ injury. Attention should be paid to patients on platelet P2Y12 inhibitors, vitamin K inhibitors, and thromboxane A2 inhibitor agents combined with platelet P2Y12 inhibitors. Opportunities exist to address the use of antiplatelet agents among patients without major indications to improve patient outcomes.

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