A novel streamlined trauma response team training improves imaging efficiency for pediatric blunt abdominal trauma patients

Background and Aims: Blunt abdominal trauma can lead to substantial organ injury and hemorrhage necessitating open abdominal surgery. Currently, the trend in surgeon training is shifting away from general surgery and the surgical treatment of blunt abdominal trauma patients is often done by sub-specialized surgeons. The aim of this study was to identify what emergency procedures are needed after blunt abdominal trauma and whether they can be performed with the skill set of a general surgeon. Materials and Methods: The records of blunt abdominal trauma patients requiring emergency laparotomy (n = 100) over the period 2006–2016 (Helsinki University Hospital Trauma Registry) were reviewed. The organ injuries and the complexity of the procedures were evaluated. Results: A total of 89 patients (no need for complex skills, NCS) were treated with the skill set of general surgeons while 11 patients required complex skills. Complex skills patients were more severely injured (New Injury Severity Score 56.4 vs 35.9, p < 0.001) and had a lower systolic blood pressure (mean: 89 vs 112, p = 0.044) and higher mean shock index (heart rate/systolic blood pressure: 1.43 vs 0.95, p = 0.012) on admission compared with NCS patients. The top three NCS procedures were splenectomy (n = 33), bowel repair (n = 31), and urinary bladder repair (n = 16). In patients requiring a complex procedure (CS), the bleeding site was the liver (n = 7) or a major blood vessel (n = 4). Conclusion: The majority of patients requiring emergency laparotomy can be managed with the skills of a general surgeon. Non-responder blunt abdominal trauma patients with positive ultrasound are highly likely to require complex skills. The future training of surgeons should concentrate on NCS procedures while at the same time recognizing those injuries requiring complex skills.

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Abstract No. 112: Optimizing Multidetector CT for Visualization of Splenic Vascular Injury. Validation by Splenic Arteriography in Blunt Abdominal Trauma Patients

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2008.12.094 ◽

2009 ◽

Vol 20 (2) ◽

pp. S44

Author(s):

S. Atluri ◽

H.M. Richard ◽

K. Shanmuganathan

Keyword(s):

Vascular Injury ◽

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Multidetector Ct ◽

Trauma Patients

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Blunt Abdominal Trauma Patients: Can Organ Injury Be Excluded without Performing Computed Tomography?

Journal of Trauma and Acute Care Surgery ◽

10.1097/01.ta.0000092680.73274.e1 ◽

2004 ◽

Vol 57 (5) ◽

pp. 1072-1081 ◽

Cited By ~ 78

Author(s):

Pierre A. Poletti ◽

Stuart E. Mirvis ◽

K Shanmuganathan ◽

Tasuyoshi Takada ◽

Karen L. Killeen ◽

...

Keyword(s):

Computed Tomography ◽

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Organ Injury ◽

Trauma Patients

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Educational Review of Predictive Value and Findings of Computed Tomography Scan in Diagnosing Bowel and Mesenteric Injuries after Blunt Trauma: Correlation with Trauma Surgery Findings in 163 Patients

Canadian Association of Radiologists Journal ◽

10.1016/j.carj.2016.07.003 ◽

2017 ◽

Vol 68 (3) ◽

pp. 276-285 ◽

Cited By ~ 8

Author(s):

Francesco Cinquantini ◽

Gregorio Tugnoli ◽

Alice Piccinini ◽

Carlo Coniglio ◽

Sergio Mannone ◽

...

Keyword(s):

Computed Tomography ◽

Ct Scan ◽

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Predictive Value ◽

Gold Standard ◽

Clinical Management ◽

Trauma Surgery ◽

Trauma Patients ◽

Increased Risk

Background and Aims Laparotomy can detect bowel and mesenteric injuries in 1.2%–5% of patients following blunt abdominal trauma. Delayed diagnosis in such cases is strongly related to increased risk of ongoing sepsis, with subsequent higher morbidity and mortality. Computed tomography (CT) scanning is the gold standard in the evaluation of blunt abdominal trauma, being accurate in the diagnosis of bowel and mesenteric injuries in case of hemodynamically stable trauma patients. Aims of the present study are to 1) review the correlation between CT signs and intraoperative findings in case of bowel and mesenteric injuries following blunt abdominal trauma, analysing the correlation between radiological features and intraoperative findings from our experience on 25 trauma patients with small bowel and mesenteric injuries (SBMI); 2) identify the diagnostic specificity of those signs found at CT with practical considerations on the following clinical management; and 3) distinguish the bowel and mesenteric injuries requiring immediate surgical intervention from those amenable to initial nonoperative management. Materials and Methods Between January 1, 2008, and May 31, 2010, 163 patients required laparotomy following blunt abdominal trauma. Among them, 25 patients presented bowel or mesenteric injuries. Data were analysed retrospectively, correlating operative surgical reports with the preoperative CT findings. Results We are presenting a pictorial review of significant and frequent findings of bowel and mesenteric lesions at CT scan, confirmed intraoperatively at laparotomy. Moreover, the predictive value of CT scan for SBMI is assessed. Conclusions Multidetector CT scan is the gold standard in the assessment of intra-abdominal blunt abdominal trauma for not only parenchymal organs injuries but also detecting SBMI; in the presence of specific signs it provides an accurate assessment of hollow viscus injuries, helping the trauma surgeons to choose the correct initial clinical management.

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Lactate clearance: its relationship with the success of non-operative management in patient with blunt abdominal trauma

International Surgery Journal ◽

10.18203/2349-2902.isj20171631 ◽

2017 ◽

Vol 4 (5) ◽

pp. 1738

Author(s):

Reno Rudiman ◽

Nova Saragih ◽

Andriana Purnama

Keyword(s):

Hemorrhagic Shock ◽

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Operative Management ◽

Lactate Clearance ◽

Trauma Patients ◽

Solid Organ ◽

Chi Square ◽

History Of ◽

Non Operative Management

Background: Occult ongoing bleeding has become the second highest cause of death in blunt abdominal trauma. Undetected abdominal injury has caused morbidity and mortality in patients at the early phases of trauma. Non-operative Management (NOM) in solid organ trauma is safe and effective, and this strategy has become widely used. Lactate clearance (LC) has important clinical benefits in patients with acute trauma that is superior to initial lactate examination. Methods: This study was a prospective cohort study of patients with history of hemorrhagic shock caused by blunt abdominal trauma that came to emergency room of Hasan Sadikin Hospital Bandung from August 2015 to July 2016. The tests were including initial blood lactate, 2 hours, and 4 hours post-resuscitation and then calculation of LC. Analysis using SPSS with chi square for the significance of relationships and Spearman correlation to determine the strength of the relationship between variables. Comparison test between LC2 and LC4 were calculated using Mann-Whitney tests.Results: During one year period, from August 2015 to July 2016, there were 34 patients. Age was in the range of 15-65 years, with a range of 15-25 years were 19 (55.8%), 25-50 years were 11 (32.4%), and >50 years as many as four (11.8%). By sex, there were 28 (82.4%) male gender and 6 (17.6%) women. Based on the type of trauma, there were 11 (32.4%) single trauma patients and 23 (67.6%) multiple trauma patients. Based on the results of statistical analysis with chi square, there was a significant correlation between lactate clearance 2 hours (LC2) and lactate clearance 4 hours (LC4) with the success of NOM (p <0.001) with the Odds Ratio (OR) are 3.750 and 6.500 respectively. Based on non-parametric test (Mann Whitney) showed that there were no significant differences between the LC2 and LC4 in determining the successful of NOM (p>0.05).Conclusions: There was a significant relationship between lactate clearance 2 hours (LC2) and lactate clearance 4 hours (LC4) in determining the success of non-operative management (NOM) in patients with history of hemorrhagic shock caused by blunt abdominal trauma. In addition, there are no significant differences between the LC2 and LC4 in determining the success of the NOM, so that either LC2 or LC4 may be used in predicting the success of NOM, as LC4 is the first preference. The low level of lactate clearance may be used as one of indicators to terminate non-operative management and proceed with surgery right before all symptoms of hemorrhagic shock arise.

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Epidemiology and injury pattern in blunt trauma abdomen in pediatric population: a two-year experience in a tertiary care institute of Kashmir, India

International Surgery Journal ◽

10.18203/2349-2902.isj20184650 ◽

2018 ◽

Vol 5 (11) ◽

pp. 3713

Author(s):

Arshid Iqbal Qadri ◽

Younis Ahmad ◽

Gowhar Aziz Bhat ◽

Aamir A. Khan ◽

Khalid Bashir

Keyword(s):

Blunt Trauma ◽

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Predictive Value ◽

Road Traffic ◽

Pediatric Population ◽

Tertiary Care ◽

Pediatric Trauma ◽

Injury Pattern ◽

Trauma Patients

Background: Blunt abdominal trauma is a frequent cause for presentation of children to the Emergency Department. Children are prone to sustain injuries to intra-abdominal organs after blunt abdominal trauma because of their peculiar body habitus and relatively immature musculoskeletal system. Objectives of this study is to assess the various epidemiological parameters that influences the causation of trauma as well as injury pattern in blunt trauma abdomen in pediatric population.Methods: The present observational hospital based prospective study was carried out in 96 blunt abdominal trauma patients of both sexes aged up to 12 years, over a period of 2 years. The parameters such as age group, sex, mode of trauma, type of injury, and the overall mortality as well as mortality were assessed.Results: The most common mode of injury was road traffic accidents (54.2%) followed by fall from height (41.70%). Splenic injury was the most common in 58.30%, followed by hepatic injuries 34.40% and renal injuries 12.50 %. The accuracy of ultrasonography (USG) was 83.33% while accuracy of computed tomography (CECT) as a diagnostic test was 93.33%. When comparing USG findings with operative findings sensitivity of USG was 88% with positive predictive value (PPV) of 91.66% while as specificity was 60% with negative predictive value (NPV) of 50%. Sensitivity of CT scan was 96.00% with PPV of 96.00% and specificity of CECT scan was 80.00% with NPV of 80.00%.Conclusions: The majority of pediatric injuries are preventable by knowing the epidemiology and pattern of pediatric trauma.

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Role Of Laparoscopy In Blunt Abdominal Trauma: A Comparative Prospective Cohort Study Between Laparoscopy And Laparotomy In Patients With Blunt Abdominal Trauma

QJM ◽

10.1093/qjmed/hcab097.046 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Tarek Ismail Ouf ◽

Mohamed ElSayed ElShinawi ◽

Ahmed Adel Abbas ◽

Mostafa El Sayed Nagy

Keyword(s):

Cohort Study ◽

Respiratory Tract ◽

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Respiratory Tract Infections ◽

Operative Time ◽

Trauma Patients ◽

Exclusion Criteria ◽

Tract Infections

Abstract Background Trauma is considered to be the main leading cause of death in young adults under 35 years old. Blunt mechanisms accounts for about 95% of injuries. Generally, laparotomy is considered to be the standard procedure used in the trauma cases. Recently, laparoscopic techniques have been increasingly introduced as an alternative to open surgery in trauma cases. This study aims to assess the efficacy of Laparoscopy in management of patients with Blunt abdominal trauma in order to avoid unnecessary laparotomies. Objective To investigate the effectiveness and role of laparoscopy in the management of blunt abdominal trauma patients. Patients and Methods Observational prospective cohort study. Ain Shams University Surgery Hospital. All isolated blunt abdominal trauma patients at Ain Shams University Surgery hospital from 1/3/2019 to 1/9/2019. Eligibility and exclusion criteria applied as following: Eligibility criteria All patients with blunt abdominal trauma presented to ASUH. Patients with class I &class II according to ATLS guidelines for hemorrhagic shock in trauma patients. Patients aged 18 years old or above. Exclusion criteria: Patients with class III &class IV according to ATLS guidelines for hemorrhagic shock in trauma patients. Pregnant patients. Patients with old trauma presented after 24 hours. Patients discharged on demand. Results Laparoscopy decreased the operative time in comparison with laparotomy, the mean operative time for patients underwent laparoscopy is 123.28 minutes while in patients underwent laparotomy is 150.48. Also, time to pass gas post operative after laparoscopy is 1-3 days compared to 2-4 days after laparotomy which is in favor of laparoscopy which is associated with rapid recovery of patients. Laparoscopy is associated with decreased post operative ICU stay (1-3) days in comparison with Laparotomy (2-5) days and decreased total hospital stay. The rate of complications after laparoscopy is much less than after laparotomy, 2 patients with respiratory tract infections after laparoscopy and no mortality while six patients with respiratory tract infections, 6 patients with wound infection, one patient with deep venous thrombosis and 2 patients died after laparotomy. Conclusion Laparoscopy is found to be a good alternative to laparoscopy, as it is considered to be reliable and safe as a diagnostic and treatment method in hemodynamically stable patients with blunt abdominal trauma, it can be used to reduce the laparotomy rate, and it is associated with lower morbidity and mortality.

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