scholarly journals P014: Incidental findings in trauma whole-body CT scans: a systematic review

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S69-S69
Author(s):  
V. Tsang ◽  
K. Bao ◽  
J. Taylor
Keyword(s):  
Systematic Review ◽  
Incidental Findings ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Subsequent Treatment ◽  
Whole Body ◽  
Trauma Patients ◽  
Patient Demographics ◽  
Study Results

Introduction: Whole-body computed tomography scans (WBCT) are a mainstay in the work-up of polytrauma or multiple trauma patients in the emergency department. While incredibly useful for identifying traumatic injuries, WBCTs also reveal incidental findings in patients, some of which require further diagnostic testing and subsequent treatment. Although the presence of incidental findings in WBCTs have been well documented, there has been no systematic review conducted to organize and interpret findings, determine IF prevalence, and document strategies for best management. Methods: A systematic review was conducted using MEDLINE, PUBMED, and EMBASE. Specific journals and reference lists were hand-mined, and Google Scholar was used to find any additional papers. Data synthesis was performed to gather information on patient demographics, prevalence and type of incidental findings (IFs), and follow-up management was collected. All documents were independently assessed by the two reviewers for inclusion and any disagreements were resolved by consensus. Results: 1231 study results were identified, 59 abstracts, and 12 included in final review. A mean of 53.9% of patients had at least one IF identified, 31.5% had major findings, and 68.5% had minor findings. A mean of 2.7 IFs per patient was reported for articles that included number of total IFs. The mean age of patients included in the studies were 44 years old with IFs more common in older patients and men with more IFs than women. IFs were most commonly found in the abdominal/pelvic region followed by kidneys. Frequency of follow-up documentation was poor. The most common reported mechanisms of injury for patients included in the study were MVA and road traffic accidents (60.0%) followed by falls from >3m (23.2%). Conclusion: Although there is good documentation on the mechanism of injury, patient demographics, and type of IF, follow-up for IFs following acute trauma admission lacks documentation and follow-up and is an identified issue in patient management. There is great need for systematic protocols to address management of IFs in polytrauma patients.

scholarly journals Impact of the SARS-COV-2 Outbreak on Epidemiology and Management of Major Trauma in France: Registry-Based Study. The COVITRAUMA Study

2021 ◽  
Author(s):  
Jean-Denis Moyer ◽  
Arthur James ◽  
Clément Gakuba ◽  
Mathieu Boutonnet ◽  
Emeline Angles ◽  
...  
Keyword(s):  
Health Care ◽  
Hospital Care ◽  
Traffic Accidents ◽  
Major Trauma ◽  
Road Traffic ◽  
Trauma Patients ◽  
Road Traffic Accidents ◽  
Patient Demographics ◽  
The Difference ◽  
Pandemic Wave

Abstract BackgroundEvidence increases to suggest that the reallocation of health care resources during considerable the COVID-19 pandemic impacts considerably any health system. This study describes the epidemiology and the outcome of major trauma patients admitted to centers in France during the first wave of the COVID-19 outbreak. MethodsThis retrospective observational study included all consecutive trauma patients aged 15 years and older admitted into 15 centers participating to the TraumaBase® registry in France during the first wave of the SARS-CoV-2 pandemic in France. ResultsOver a 4 years-study period, 5762 patients were admitted between the first week of February and mid-June. This cohort was split between patients admitted during the first 2020 pandemic wave in France (pandemic period, 1314 patients) and those admitted during the corresponding period in the three previous years (2017-2019, 4448 patients). Patient demographics changed substantially during the pandemic and more specifically during the lockdown period specially with a reduction in both absolute numbers admitted and the proportion of road traffic accidents (348 annually 2017-2019 [55.4 % of trauma admissions] vs 143 [36.8 %] in 2020 p<0.005). Mortality during the pandemic period and the difference between predicted and observed mortality was not different compared to the non-pandemic years. ConclusionsDuring this first wave of COVID-19 in France, management of trauma patients admitted to regional Traumacenters was not significantly altered, despite medical resources being reallocated and reorganized. Mortality as well as prehospital and in hospital care remained stable throughout the period of the first pandemic wave despite a massive increase in demand for acute care beds.

The Trauma Pan Scan: What Else Do you Find?

2014 ◽  
Vol 80 (9) ◽  
pp. 855-859 ◽  
Author(s):  
Katherine A. Baugh ◽  
Leonard J. Weireter ◽  
Jay N. Collins
Keyword(s):  
Incidental Findings ◽  
Injury Severity ◽  
Renal Cysts ◽  
Retrospective Chart Review ◽  
Ct Scans ◽  
Trauma Patients ◽  
Patient Demographics ◽  
Head Neck ◽  
Discharge Summaries

The objective of this study was to investigate the prevalence of incidental findings in pan-computed tomography (CT) scans of trauma patients and the communication of significant findings requiring follow-up to the patient. A retrospective chart review of adult trauma patients was performed during the period of January 1, 2011, to August 31, 2011. During that period, 990 patient charts were examined and 555 charts were selected based on the inclusion criteria of a pan-CT scan including the head, neck, abdomen/pelvis, and chest. Patient demographics such as age, gender, mechanism of injury, and Injury Severity Score were collected. Nontraumatic incidental findings were analyzed to establish the prevalence of incidental findings among trauma patients. Discharge summaries were also examined for follow-up instructions to determine the effectiveness of communication of the significant findings. Between the 555 pan-CT scans (1759 total scans), 1706 incidental findings were identified with an incidence of 3.1 incidental findings per patient and with the highest concentration of findings occurring in the abdomen/pelvis. The majority of findings were benign including simple renal cysts with a prevalence of 7.7 per cent. However, 282 significant findings were identified that were concerning for possible malignancy or those requiring further evaluation, the most common of which were lung nodules, which accounted for 21.6 per cent of significant findings. However, only 32.6 per cent of significant findings were documented as reported to the patient. With the use of pan scans on trauma patients, many incidental findings have been identified to the benefit of the patient. The majority of these are clinically insignificant; however, only 32.6 per cent of potentially significant findings were communicated to the patient. The advantage of early detection comes from proper communication and this study demonstrates that there could be improvement in conveying findings to the patient.

scholarly journals Vascular injuries of the upper extremity

2006 ◽  
Vol 5 (4) ◽  
pp. 271-276 ◽  
Author(s):  
Raafat Shalabi ◽  
Yoysifh Al Amri ◽  
Elham khoujah
Keyword(s):  
Limb Salvage ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Vascular Trauma ◽  
Lower Extremity Injury ◽  
Surgical Approaches ◽  
Trauma Patients ◽  
Vascular Injuries ◽  
Peripheral Vascular ◽  
Study Results

OBJECTIVE: This study analyzes the causes of injuries, presentations, surgical approaches, outcome and complications of vascular trauma of the upper limbs, in spite of limited hospital resources. METHODS: A 5-year retrospective analysis. From 01/01/2001 to 31/12/2005, 165 patients were operated for vascular injuries at King Fahd Hospital, Medina, Saudi Arabia. Of all peripheral vascular trauma patients (115), upper limb trauma was present in 58. Diagnosis was made by physical examination and hand-held Doppler alone or in combination with Doppler scan/angiography. Primary vascular repair was performed whenever possible; otherwise, the interposition vein graft was used. Fasciotomy was considered when required. Patients with unsalvageable lower extremity injury requiring primary amputation were excluded from the study. RESULTS: Fifty patients were male (86%) and eight were female (14%), aged between 2.5-55 years (mean 23 years). Mean duration of presentation was 8 h after the injury. The most common etiological factor was road traffic accidents, accounting for 50.5% in the blunt trauma group and 33% among all penetrating and stab wound injuries. Incidence of concomitant orthopedic injuries was very high in our study (51%). The brachial artery was the most affected (51%). Interposition vein grafts were used in 53% of the cases. Limb salvage rate was 100%. CONCLUSION: Patients who suffer vascular injuries of the upper extremities should be transferred to vascular surgery centers as soon as possible. Decisive management of peripheral vascular trauma will maximize patient survival and limb salvage. Priorities must be established in the management of associated injuries, and delay must be avoided when ischemic changes are present.

scholarly journals Incidental Findings on Whole-body Computed Tomography in Major Trauma Patients: Who and What?

2021 ◽  
pp. 000313482199868
Author(s):  
Ping-Yuan Liu ◽  
Ling-Wei Kuo ◽  
Chien-Hung Liao ◽  
Chi-Hsun Hsieh ◽  
Francesco Bajani ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Incidental Findings ◽  
Major Trauma ◽  
Neck Region ◽  
Whole Body ◽  
Trauma Patients ◽  
Computed Tomography Images ◽  
Whole Body Computed Tomography ◽  
Head Neck

Purpose Whole-body computed tomography (WBCT) scans are frequently used for trauma patients, and sometimes, nontraumatic findings are observed. We aimed to investigate the characteristics of patients with nontraumatic findings on WBCT. Methods From 2013 to 2016, adult trauma patients who underwent WBCT were enrolled. The proportions of nontraumatic findings in different anatomical regions were studied. Nontraumatic findings were classified and evaluated as clinically important findings and findings that needed no further follow-up or treatment. The characteristics of the patients with nontraumatic findings were analyzed and compared with those of patients without nontraumatic findings. Results Two hundred seventeen patients were enrolled in this study during the 3-year study period, and 89 (41.0%) patients had nontraumatic findings. Nontraumatic findings were found more frequently in the abdomen (69.2%) than in the head/neck (17.3%) and chest regions (13.5%). In total, 31.3% of the findings needed further follow-up or treatment. Patients with nontraumatic findings that needed further management were significantly older than those without nontraumatic findings (57.3 vs. 38.9; P < .001), particularly those with abdominal nontraumatic findings (57.9 vs. 41.3; P < .001). A significantly higher proportion of women were observed in the group with head/neck nontraumatic findings that needed further management than in the group without nontraumatic findings (56.3% vs 24.9%; P = .015). Conclusions Whole-body computed tomography could provide alternative benefits for nontraumatic findings. Whole-body computed tomography images should be read carefully for nontraumatic findings, particularly for elderly patients or the head/neck region of female patients. A comprehensive program for the follow-up of nontraumatic findings is needed.

scholarly journals Incidental Findings on Whole-body Computed Tomography in Major Trauma Patients: Who and What?

2020 ◽  
Author(s):  
Ping-Yuan Liu ◽  
Ling-Wei Kuo ◽  
Chien-Hung Liao ◽  
Chi-Hsun Hsieh ◽  
Francesco Bajani ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Incidental Findings ◽  
Major Trauma ◽  
Neck Region ◽  
Whole Body ◽  
Trauma Patients ◽  
Whole Body Computed Tomography ◽  
Head Neck ◽  
Thyroid Lesions

Abstract Background The use of whole-body computed tomography (WBCT) scans has greatly increased in the management of patients with major trauma. Sometimes, nontraumatic findings on WBCT are observed. In the current study, we aimed to investigate the proportion of nontraumatic findings on WBCT in major trauma patients and the characteristics of patients with nontraumatic findings on WBCT.Methods From June 2013 to May 2016, adult trauma patients who received WBCT were enrolled. The proportions of nontraumatic findings in different anatomical regions were studied. Nontraumatic findings were classified and evaluated as clinically important findings and findings that did not need further follow-up or treatment. The characteristics of patients with nontraumatic findings were analyzed and compared with those of patients without nontraumatic findings.Results A total of 217 patients were enrolled in this study during the 3-year study period, and 89 (41.0%) patients had nontraumatic findings. Nontraumatic findings were found more frequently in the abdomen (69.2%) than in the head/neck (17.3%) and chest regions (13.5%). In total, 31.3% of the findings needed further follow-up or treatment. Patients with nontraumatic findings that needed further management were significantly older than patients without nontraumatic findings (57.3 vs. 38.9, p<0.001), especially those with abdominal nontraumatic findings (57.9 vs. 41.3, p<0.001). A significantly higher proportion of females was observed in the group with head/neck nontraumatic findings that needed further management than in the group without nontraumatic findings (56.3% vs. 24.9%, p=0.015).Conclusions WBCT could provide alternative benefits for nontraumatic findings. The WBCT images should be read carefully for nontraumatic findings, especially for elderly patients. For female patients, the head/neck region should be carefully evaluated with WBCT for possible thyroid lesions. A comprehensive program for the follow-up of nontraumatic findings is needed.

scholarly journals Renal Trauma in the West of Ireland — A Regional Review

2009 ◽  
Vol 9 ◽  
pp. 137-143 ◽  
Author(s):  
O. A. Raheem ◽  
M. S. Floyd ◽  
R. G. Casey ◽  
I. M. Cullen ◽  
M. O. Corcoran ◽  
...  
Keyword(s):  
Traffic Accidents ◽  
Road Traffic ◽  
Renal Trauma ◽  
The West ◽  
Patient Demographics ◽  
Emergency Department Management ◽  
Improve Patient ◽  
Renal Injuries ◽  
West Of Ireland

There is a paucity of data regarding renal trauma. The majority of cases of renal trauma are amenable to conservative management. We sought to streamline the management of renal trauma in the west of Ireland. Patients presenting with a computerised tomogram–confirmed renal injury were assessed over 5 years. Patient demographics, injury details, initial emergency department management, definitive management, and follow-up were assessed. Renal trauma was graded in a blind fashion (I-V). Twenty-five patients were identified; male:female (23:2). The mean age was 26 years. The majority of renal traumas were managed conservatively (92%); 8% patients underwent nephrectomy. The common mechanisms of renal injuries were road traffic accidents (44%). The majority of cases of renal injuries occur as a result of blunt trauma and can be conservatively treated. Two nephrectomies (8%) were performed. We believe this study potentially can be beneficial as part of an all-Ireland trauma database to improve patient outcome.

scholarly journals Impact of the SARS-COV-2 outbreak on epidemiology and management of major traumain France: a registry-based study (the COVITRAUMA study)

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Jean-Denis Moyer ◽  
◽  
Arthur James ◽  
Clément Gakuba ◽  
Mathieu Boutonnet ◽  
...  
Keyword(s):  
Health Care ◽  
Traffic Accidents ◽  
Major Trauma ◽  
Road Traffic ◽  
Trauma Patients ◽  
Trauma Centers ◽  
Patient Demographics ◽  
Rescue Chain ◽  
Pandemic Wave

Abstract Background Emerging evidence suggests that the reallocation of health care resources during the COVID-19 pandemic negatively impacts health care system. This study describes the epidemiology and the outcome of major trauma patients admitted to centers in France during the first wave of the COVID-19 outbreak. Methods This retrospective observational study included all consecutive trauma patients aged 15 years and older admitted into 15 centers contributing to the TraumaBase® registry during the first wave of the SARS-CoV-2 pandemic in France. This COVID-19 trauma cohort was compared to historical cohorts (2017–2019). Results Over a 4 years-study period, 5762 patients were admitted between the first week of February and mid-June. This cohort was split between patients admitted during the first 2020 pandemic wave in France (pandemic period, 1314 patients) and those admitted during the corresponding period in the three previous years (2017–2019, 4448 patients). Trauma patient demographics changed substantially during the pandemic especially during the lockdown period, with an observed reduction in both the absolute numbers and proportion exposed to road traffic accidents and subsequently admitted to traumacenters (348 annually 2017–2019 [55.4% of trauma admissions] vs 143 [36.8%] in 2020 p < 0.005). The in-hospital observed mortality and predicted mortality during the pandemic period were not different compared to the non-pandemic years. Conclusions During this first wave of COVID-19 in France, and more specifically during lockdown there was a significant reduction of patients admitted to designated trauma centers. Despite the reallocation and reorganization of medical resources this reduction prevented the saturation of the trauma rescue chain and has allowed maintaining a high quality of care for trauma patients.

Thoracic trauma in small animals: road traffic accidents

2021 ◽  
Vol 12 (1) ◽  
pp. 15-19
Author(s):  
Kate Sheard
Keyword(s):  
Traffic Accidents ◽  
Thoracic Trauma ◽  
Road Traffic ◽  
Positive Outcome ◽  
Multiple Organ ◽  
Trauma Patients ◽  
Small Animals ◽  
Road Traffic Accidents ◽  
Blunt Force Trauma ◽  
Organ Systems

Thoracic trauma is common in small animals and can be caused by a variety of insults from penetrating wounds to blunt force trauma. Patients that have sustained any form of thoracic trauma require immediate attention and intensive nursing care in order to have a positive outcome for the patient. These cases can prove challenging as multiple organ systems can be affected and surgery is often required. However, combined with the appropriate medical care, the outcome can be successful.

Children and Terror Casualties Receive Preference in ICU Admissions

2012 ◽  
Vol 6 (1) ◽  
pp. 14-19 ◽  
Author(s):  
Kobi Peleg ◽  
Michael Rozenfeld ◽  
Eran Dolev ◽  
Keyword(s):  
Traffic Accidents ◽  
Injury Severity ◽  
Road Traffic ◽  
Age Groups ◽  
Trauma Patients ◽  
Trauma Centers ◽  
Severe Injuries ◽  
Level I ◽  
Hospital Emergency Departments ◽  
Trauma Type

ABSTRACTObjective: Trauma casualties caused by terror-related events and children injured as a result of trauma may be given preference in hospital emergency departments (EDs) due to their perceived importance. We investigated whether there are differences in the treatment and hospitalization of terror-related casualties compared to other types of injury events and between children and adults injured in terror-related events.Methods: Retrospective study of 121 608 trauma patients from the Israel Trauma Registry during the period of October 2000-December 2005. Of the 10 hospitals included in the registry, 6 were level I trauma centers and 4 were regional trauma centers. Patients who were hospitalized or died in the ED or were transferred between hospitals were included in the registry.Results: All analyses were controlled for Injury Severity Score (ISS). All patients with ISS 1-24 terror casualties had the highest frequency of intensive care unit (ICU) admissions when compared with patients after road traffic accidents (RTA) and other trauma. Among patients with terror-related casualties, children were admitted to ICU disproportionally to the severity of their injury. Logistic regression adjusted for injury severity and trauma type showed that both terror casualties and children have a higher probability of being admitted to the ICU.Conclusions: Injured children are admitted to ICU more often than other age groups. Also, terror-related casualties are more frequently admitted to the ICU compared to those from other types of injury events. These differences were not directly related to a higher proportion of severe injuries among the preferred groups.(Disaster Med Public Health Preparedness. 2012;6:14–19)

scholarly journals Epidemiology of Road Traffic Accidents and Injuries in Nigeria: A Protocol for Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Samuel Osobuchi Ngene ◽  
Olatoun Adefunke Adeola ◽  
Chi-kadibia T Ukoma ◽  
Augustine Nwakuche Duru ◽  
Kayode Olaoluwa Olaniyan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Standard Error ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Cochrane Library ◽  
Economic Losses ◽  
Road Traffic Accidents ◽  
Road Traffic Injuries ◽  
Pooled Prevalence ◽  
Registration Number

Abstract Background: About 1.35 million people die annually worldwide due to road traffic accidents. Road traffic injuries cause considerable economic losses to individuals, their families, and to nations as a whole. About 93% of the world's fatalities on the roads occur in low-and middle-income countries, even though these countries have approximately 60% of the world's vehicles. Road Traffic Accidents constitute the third leading cause of trauma related deaths in Nigeria. It is a substantial public health problem that deserves a systematic review.Methods and Analysis: We developed a search strategy using MeSH, text words and entry terms. Nine databases will be searched, including PubMed, African Journal Online, Embase, Google Scholar, Scopus, Cochrane Library, CINAHL, Web of Science and ResearchGate. Only observational studies, retrievable in the English language will be included. The primary outcome is prevalence of road traffic injuries in Nigeria. The secondary outcomes include proportion of road traffic accidents in Nigeria, patterns, predictors and consequences of road traffic accidents in Nigeria. Identified studies will be screened and selected based on inclusion criteria using Rayyan QCRI screening tool, by independent reviewers with dual blinding. Data items will be extracted into predefined forms in Microsoft Excel before exporting to CMA version 3 for analysis. Every selected study will have their NIH quality scores and Cochrane risk of bias reported. Studies will be assessed for methodological and statistical heterogeneity. Publication bias will be assessed using Funnel Plots and test of asymmetry. Results will include forest plots, pooled prevalence with standard error, variance, relative weights assigned to studies and heterogeneity test. Further analysis will include subgroup analysis and meta-regression using both categorical and quantitative variables.Discussion: This protocol will enable a transparent, accurate and reliable method for determining pooled prevalence, standard error and 95% CI of road traffic injuries in Nigeria. Patterns and outcomes of RTA in Nigeria will also be assessed. Evidence generated by this protocol will likely inform policy on prevention of RTA in NigeriaTrial Registration Number: This protocol is registered with PROSPERO, with registration number CRD42021226956.

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