scholarly journals Evisceration Versus Enucleation Following Ocular Trauma, a Retrospective Analysis at a Level One Trauma Center

2019 ◽  
Vol 185 (3-4) ◽  
pp. 409-412 ◽  
Author(s):  
Donovan Reed ◽  
Alexandra Papp ◽  
Wesley Brundridge ◽  
Aditya Mehta ◽  
Joseph Santamaria ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Surgical Outcomes ◽  
Trauma Center ◽  
Ocular Trauma ◽  
Sympathetic Ophthalmia ◽  
Complication Rates ◽  
Mechanism Of Injury ◽  
Level 1 ◽  
Scleral Shell ◽  
Level 1 Trauma Center

Abstract Introduction Penetrating and perforating ocular trauma is often devastating and may lead to complete visual loss in the traumatized eye and subsequent compromise of the fellow eye. Enucleation is commonly utilized for management of a non-salvageable eye following penetrating and perforating ocular injuries. Recently, the use of evisceration for non-salvageable traumatized eyes has increased. As a technically easier alternative, evisceration offers several advantages to the ocular trauma surgeon to include faster surgical times, better cosmesis and motility, and improved patient outcomes. Debate still persists concerning whether or not evisceration is a viable option in the surgical management of a non-salvageable eye following ocular trauma given the theoretical increased risk of sympathetic ophthalmia and technical difficulty in construction of the scleral shell with extensive and complex corneoscleral lacerations. A retrospective analysis at a level 1 trauma center was performed to evaluate the practicality of evisceration in ocular trauma. Materials and Methods Eyes that underwent evisceration or enucleation following ocular trauma at San Antonio Military Medical Center, a level 1 trauma center, between 01 January 2014 and 30 December 2016 were examined. Factors evaluated include mechanism of injury, defect complexity, ocular trauma score, and time from injury to surgical intervention. Surgical outcomes were assessed. Results In total, 29 eyes were examined, 15 having undergone evisceration and 14 enucleation. The average size of the scleral defect before evisceration was 20 mm in length, and 23 mm before enucleation. The mechanism of injury and characterization of the defects among the two groups were relatively similar and described. Overall comparison of the two study groups in terms of surgical outcomes and complications was also relatively similar, as demonstrated. No cases of postoperative persistent pain, sympathetic ophthalmia, infection, or hematoma were identified for either group. Conclusions The postoperative outcomes demonstrated for the evisceration group are comparable to enucleation, which is consistent with the recent literature. Defect size and complexity did not affect surgical construction of the scleral shell during evisceration. If consistently proven to be a safe and viable alternative to enucleation, evisceration can offer shorter surgical times and better cosmesis for patients. More research into the long-term complication rates and more cases of evisceration for use following ocular trauma should be assessed. Still, this analysis demonstrates that evisceration is a viable surgical alternative and perhaps superior to enucleation for the management of a non-salvageable eye following extensive ocular trauma in many cases.

scholarly journals Utility Of Angioembolization In Patients with Abdominal and Pelvic Traumatic Bleeding: Descriptive Observational Analysis From A Level 1 Trauma Center

2020 ◽  
Author(s):  
Hassan Al-Thani ◽  
Husham Abdelrahman ◽  
Ali Barah ◽  
Mohammad Asim ◽  
Ayman El-Menyar
Keyword(s):  
Blood Transfusion ◽  
Success Rate ◽  
Trauma Center ◽  
Clinical Success Rate ◽  
Trauma Patients ◽  
Solid Organ ◽  
Complication Rates ◽  
Traumatic Bleeding ◽  
Level 1 ◽  
Level 1 Trauma Center

Abstract Background: Massive bleeding is a major preventable cause of early death in trauma. It often requires surgical or endovascular intervention. We aimed to describe the utilization of angioembolization in patients with abdominal and pelvic traumatic bleeding at a level 1 trauma center.Methods: We conducted a retrospective analysis for all trauma patients who underwent angioembolization post-traumatic bleeding between January 2012 and April 2018. Patients’s data and details of injuries, angiography procedures and outcomes were extracted from the Qatar national trauma registry.Results: A total of 175 trauma patients underwent angioembolization during the study period (103 for solid organ injury , 51 for pelvic injury and 21 for other injuries). The majority were young males. The main cause of injury was blunt trauma in 95.4% of patients. The most common indication of angioembolization was evident active bleeding on the initial CT scan (contrast pool or blushes). Blood transfusion was needed in two-third of patients. The hepatic injury cases had higher ISS, higher shock Index and more blood transfusion Absorbable particles (Gelfoam) was the most commonly used embolic material. The overall technical and clinical success rate was 93.7% and 95% respectively with low rebleeding and complication rates. The hospital and ICU length of stay were13 and 6 days respectively. The median injury to intervention time was 320 min while hospital arrival to intervention time was 274 min. The median follow-up time was 215 days. The overall cohort mortality was 15%. Conclusion: Angioembolization is an effective intervention to stop bleeding and support nonoperative management for both solid organ injuries and pelvic trauma. It has a high success rate with a careful selection and proper implementation.

Ethnicity/race and service-connected disability disparities in civilian traumatic brain injury mechanism of injury and VHA health services costs in military veterans: Evidence from a Level 1 Trauma Center and VA Medical Center

Trauma ◽  
2020 ◽  
pp. 146040862091443
Author(s):  
CE Dismuke-Greer ◽  
SM Fakhry ◽  
MD Horner ◽  
TK Pogoda ◽  
MJ Pugh ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
African American ◽  
Brain Injury ◽  
Military Service ◽  
Trauma Center ◽  
Mechanism Of Injury ◽  
Level 1 ◽  
Level 1 Trauma Center ◽  
African American Race ◽  
Hispanic White

Introduction The objective of this study was to examine the association of military veteran socio-demographics and service-connected disability with civilian mechanism of traumatic brain injury and long-term Veterans Health Administration (VHA) costs. Methods We conducted a 17-year retrospective longitudinal cohort study of veterans with a civilian-related traumatic brain injury from a Level 1 Trauma Center between 1999 and 2013, with VHA follow-up through 2016. We merged trauma center VHA data, and used logit to model mechanism of injury, and generalized linear model to model VHA costs. Results African American race or Hispanic ethnicity veterans had a higher unadjusted rate of civilian assault/gun as mechanism of injury (15.38%) relative to non-Hispanic White (7.19%). African American race or Hispanic veterans who were discharged from the trauma center with traumatic brain injury and followed in VHA had more than twice the odds of assault/gun (OR 2.47; 95% CI 1.16:5.26), after adjusting for sex, age, and military service-connected disability. Veterans with service-connected disability ≥50% had more than twice the odds of assault/gun (OR 2.48; 95% CI 0.97:6.31). Assault/gun was associated with significantly higher annual VHA costs post-discharge ($16,807; 95% CI 672:32,941) among non-Hispanic White veterans. Military service-connected disability ≥50% was associated with higher VHA costs among both non-Hispanic White ($44,987; 95% CI $17,159:$72,816) and African American race or Hispanic ($37,901; 95% CI $4,543:$71,258) veterans. Conclusions We found that African American race or Hispanic veterans had higher adjusted likelihood of assault/gun mechanism of traumatic brain injury, and non-Hispanic White veterans had higher adjusted annual VHA resource costs associated with assault/gun, post trauma center discharge. Veterans with higher than 50% service-connected disability had higher likelihood of assault/gun and higher adjusted annual VHA resource costs. Assault/gun prevention efforts may be indicated within the VHA, especially in minority and service-connected disability veterans. More data from Level 1 Trauma Centers are needed to assess the generalizability of these findings.

scholarly journals Retrospective analysis of eFAST ultrasounds performed on trauma activations at an academic level-1 trauma center

2020 ◽  
Vol 11 (1) ◽  
pp. 12
Author(s):  
Samantha Shwe ◽  
Lauren Witchey ◽  
Shadi Lahham ◽  
Ethan Kunstadt ◽  
Inna Shniter ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Trauma Center ◽  
Academic Level ◽  
Level 1 ◽  
Level 1 Trauma Center

scholarly journals Smoking Increases Postoperative Complications After Distal Radius Fracture Fixation: A Review of 417 Patients From a Level 1 Trauma Center

Hand ◽  
2018 ◽  
Vol 15 (5) ◽  
pp. 686-691 ◽  
Author(s):  
Daniel E. Hess ◽  
S. Evan Carstensen ◽  
Spencer Moore ◽  
A. Rashard Dacus
Keyword(s):  
Distal Radius ◽  
Trauma Center ◽  
Operative Procedure ◽  
Distal Radius Fractures ◽  
Hardware Removal ◽  
Complication Rates ◽  
Radius Fractures ◽  
Level 1 ◽  
Level 1 Trauma Center ◽  
Wrist Stiffness

Background: Unstable distal radius fractures that undergo surgical stabilization have varying complication rates in the literature. Smoking is known to affect bone healing and implant fixation rates but has never been definitively shown to affect postoperative outcomes of surgically managed distal radius fractures. Methods: A retrospective review was performed of patients with surgically treated distal radius fractures at a Level 1 Trauma Center who had at least 6 weeks of follow-up over a 5-year period. Charts were reviewed for basic demographic information, comorbidities, details about the operative procedure, and early complications. Notable physical examination findings were noted, such as wrist stiffness and distal radius tenderness to palpation. Statistical analysis was performed to compare the smoking and nonsmoking groups. To control for confounding differences, a hierarchical multivariable regression analysis was performed. Results: Four hundred seventeen patients were included in the study, and 24.6% were current smokers at the time of surgery. The overall complication rate for smokers was 9.8% compared with 5.6% in nonsmokers. The smoking cohort showed significantly higher rates of hardware removal, nonunion, revision procedures, wrist stiffness, and distal radius tenderness. When controlling for the confounding variables of diabetes and obesity, smokers still had significantly higher rates of the same complications. Conclusion: Patients who smoke have a statistically significant higher rate of postoperative distal radius tenderness, wrist stiffness, nonunion, hardware removal, and revision procedures compared with those who do not smoke in a review of 417 total patients undergoing surgical fixation for distal radius fractures.

Retrospective analysis of equestrian-related injuries presenting to a level 1 trauma center

2019 ◽  
Vol 26 (6) ◽  
pp. 639-645 ◽  
Author(s):  
Cameron R. Adler ◽  
Alix Hopp ◽  
Dawn Hrelic ◽  
Jim T. Patrie ◽  
Michael G. Fox
Keyword(s):  
Retrospective Analysis ◽  
Trauma Center ◽  
Level 1 ◽  
Level 1 Trauma Center

scholarly journals Pediatric blunt cerebrovascular injury: the McGovern screening score

2018 ◽  
Vol 21 (6) ◽  
pp. 639-649 ◽  
Author(s):  
Joseph P. Herbert ◽  
Sidish S. Venkataraman ◽  
Ali H. Turkmani ◽  
Liang Zhu ◽  
Marcia L. Kerr ◽  
...  
Keyword(s):  
Blunt Trauma ◽  
Trauma Center ◽  
Mr Angiography ◽  
Screening Tool ◽  
Digital Subtraction ◽  
Mechanism Of Injury ◽  
Blunt Cerebrovascular Injury ◽  
Cerebrovascular Injury ◽  
Level 1 ◽  
Level 1 Trauma Center

OBJECTIVEThe objective of this study was to assess the incidence, diagnosis, and treatment of pediatric blunt cerebrovascular injury (BCVI) at a busy Level 1 trauma center and to develop a tool for accurately predicting pediatric BCVI and the need for diagnostic testing.METHODSThis is a retrospective cohort study of a prospectively collected database of pediatric patients who had sustained blunt trauma (patient age range 0–15 years) and were treated at a Level 1 trauma center between 2005 and 2015. Digital subtraction angiography, MR angiography, or CT angiography was used to confirm BCVI. Recently, the Utah score has emerged as a screening tool specifically targeted toward evaluating BCVI risk in the pediatric population. Using logistical regression and adding mechanism of injury as a logit, the McGovern score was able to use the Utah score as a starting point to create a more sensitive screening tool to identify which pediatric trauma patients should receive angiographic imaging due to a high risk for BCVI.RESULTSA total of 12,614 patients (mean age 6.6 years) were admitted with blunt trauma and prospectively registered in the trauma database. Of these, 460 (3.6%) patients underwent angiography after blunt trauma: 295 (64.1%), 107 (23.3%), 6 (1.3%), and 52 (11.3%) patients underwent CT angiography, MR angiography, digital subtraction angiography, and a combination of imaging modalities, respectively. The BCVI incidence (n = 21; 0.17%) was lower than that in a comparable adult group (p < 0.05). The mean patient was age 10.4 years with a mean follow-up of 7.5 months. Eleven patients (52.4%) were involved in a motor vehicle collision, with a mean Glasgow Coma Scale score of 8.6. There were 8 patients (38.1%) with carotid canal fracture, 6 patients (28.6%) with petrous bone fracture, and 2 patients (9.5%) with infarction on initial presentation. Eight patients (38.1%) were managed with observation alone. The Denver, modified Memphis, Eastern Association for the Surgery of Trauma (EAST), and Utah scores, which are the currently used screening tools for BCVI, misclassified 6 (28.6%), 6 (28.6%), 7 (33.3%), and 10 (47.6%) patients with BCVI, respectively, as “low risk” and not in need of subsequent angiographic imaging. By incorporating the mechanism of injury into the score, the McGovern score only misclassified 4 (19.0%) children, all of whom were managed conservatively with no treatment or aspirin.CONCLUSIONSWith a low incidence of pediatric BCVI and a nonsurgical treatment paradigm, a more conservative approach than the Biffl scale should be adopted. The Denver, modified Memphis, EAST, and Utah scores did not accurately predict BCVI in our equally large cohort. The McGovern score is the first BCVI screening tool to incorporate the mechanism of injury into its screening criteria, thereby potentially allowing physicians to minimize unnecessary radiation and determine which high-risk patients are truly in need of angiographic imaging.

Sign in / Sign up

Export Citation Format

Share Document