Minimally Invasive Management of Civilian Gunshot Wounds to the Lumbar Spine: A Case Series and Technical Report

2020 ◽  
Vol 19 (3) ◽  
pp. 219-225 ◽  
Author(s):  
Clifford L Crutcher ◽  
John M Wilson ◽  
Anthony M DiGiorgio ◽  
Erin S Fannin ◽  
Jessica A Shields ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Minimally Invasive ◽  
Trauma Center ◽  
Case Series ◽  
Gunshot Wounds ◽  
Tubular Retractor ◽  
Neurologic Recovery ◽  
Level 1 ◽  
Level 1 Trauma Center ◽  
Minimally Invasive Decompression

Abstract BACKGROUND Treatment of penetrating gunshot wounds (GSW) to the spine remains controversial. The decision to operate is often based on surgeon preference and experience. We present a case series of 7 patients who underwent minimally invasive thoracolumbar/sacral decompression and bullet removal at a level 1 trauma center. OBJECTIVE To describe the use of minimally invasive techniques to achieve decompression and bullet removal for GSW to the spine. METHODS From 2010 to 2017, 7 patients with spinal GSW underwent minimally invasive decompression and bullet removal at an academic level 1 trauma center. RESULTS Patient ages ranged from 20 to 55 yr (mean: 31 yr). The mechanisms of injury were GSW to the abdomen/pelvis (n = 6) and direct GSW to the spine (n = 1). Based on the neurological examination, the injuries were characterized as complete (n = 1) or incomplete (n = 6). Decompression and bullet removal were performed using a tubular retractor system. All patients with incomplete injuries who had postdischarge follow-up demonstrated some neurologic recovery. There were no postoperative wound infections, cerebrospinal fluid (CSF) fistulas, or other complications related to the procedure. CONCLUSION Minimally invasive decompression and bullet removal is a safe technique that may help reduce the risk of postoperative infections and CSF fistulas in patients with GSW to the lumbar spine compared to the standard open technique. This approach appears to be particularly beneficial in patients with incomplete injuries and neuropathic pain refractory to medical treatment.

scholarly journals Seasonal Trends in Operative Pediatric Supracondylar Humerus and Femoral Shaft Fractures at a Pediatric Level 1 Trauma Center

2021 ◽  
Vol 4 (2) ◽  
Keyword(s):  
Trauma Center ◽  
Pediatric Trauma ◽  
Case Series ◽  
Femoral Shaft ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Temperature And Precipitation ◽  
Census Methods ◽  
Level 1 ◽  
Level 1 Trauma Center

Background: Supracondylar humerus (SCHF) and femoral shaft (FSF) fractures are two common injuries at pediatric trauma centers. While anecdotally we see an increase in injuries with warmer weather, the purpose of this study was to objectively describe the seasonal variation in these operative fractures, and their relative burden on hospital census. Methods: We performed an IRB-approved, retrospective review of 1626 SCHF and 601 FSF treated operatively from 2013-2018 at a single level 1 pediatric trauma center. Dates of injury were categorized with hospital census information, and temperature and precipitation data were obtained through the National Weather Service. Results: For every 10º F increase in temperature, there was a 5% increased likelihood of FSF (p=0.048) and a 26% increased likelihood of SCHF (p=<0.0001). FSF were less likely to occur on weekdays than weekends (OR 0.59, p<0.0001) and less likely to occur on days with precipitation (OR 0.41, p= 0.03). SCHF demonstrated no significant weekly or precipitation-related trends. SCHF represent a significantly larger burden on orthopedic volume during summer months. The ratio of operative FSF relative to the total orthopedic volume per month did not correlate with season. Conclusions: As often anecdotally reported, SCHF volumes mirror temperature variations annually. FSF appear to have more complex trends, with increased incidence on weekends regardless of season. Geographic variation in weather contributes strongly to pediatric trauma volume, and the ability to forecast a hospital system’s operative fracture volume allows for responsible resource allocation during key periods. Level of Evidence: Retrospective case series, Level IV

scholarly journals Etiology and Outcomes of Spinal Cord Infarct: A Case Series From a Level 1 Trauma Center

2019 ◽  
Vol 10 (6) ◽  
pp. 735-740
Author(s):  
Laurence Ge ◽  
Karan Arul ◽  
Michael Stoner ◽  
Addisu Mesfin
Keyword(s):  
Spinal Cord ◽  
Surgical Complications ◽  
Trauma Center ◽  
Spinal Cord Injuries ◽  
Case Series ◽  
Spinal Cord Infarction ◽  
Ischemic Infarction ◽  
Severity Of Injury ◽  
Level 1 ◽  
Level 1 Trauma Center

Study Design: Retrospective study. Objectives: To evaluate the demographics, prevalence, etiology, severity, and outcomes of spinal cord injuries (SCIs) resulting from ischemic infarction. Methods: All patients with SCI and a diagnosis of cord infarct who were admitted to the inpatient rehabilitation unit at a level 1 trauma center from January 2003 to January 2014 were identified using an administrative billing database. Outcomes measures were evaluated. Results: Among 685 unique SCI patients who were identified, 30 (4.4%) had SCI due to spinal ischemic infarction. The mean age was 59 years (range 17-80 years). Fifty percent of patients had ASIA (American Spinal Injury Association) A and B severity. Most common causes were the following: 6 (20%) abdominal aortic aneurysm (AAA) repairs, 6 (20%) arteriovenous fistulas, and 6 (20%) with an unknown cause. Surgical complications led to 4 (13.3%) cord infarcts and was associated with a higher severity of injury ( P = .02) compared with other etiologies. Other causes included systemic hypotension, AAA rupture, trauma, diabetic ketoacidosis, and after radiation therapy. At follow-up, 6 (20%) of patients were able to ambulate normally without assistance, 7 (23.3%) were ambulating with assistance, and 17 (56.7%) were still wheelchair bound. Clinical improvement in ambulatory status was noted in 6 (20%) patients and was associated with less severe initial injury ( P = .02). Conclusions: While the existing literature associates spinal cord infarction with aortic pathologies and surgery, these caused less than 30% of cases, while nonaortic surgical complications were associated with the most severe injuries. Outcomes were worse than previously reported in the literature.

scholarly journals Increase in gunshot wounds at a level 1 trauma center following the COVID19 pandemic

2021 ◽  
Vol 4 (4) ◽  
pp. e159
Author(s):  
Anokha A. Padubidri ◽  
Amy Rushing ◽  
George Ochenjele ◽  
John Sontich ◽  
Joshua Napora ◽  
...  
Keyword(s):  
Trauma Center ◽  
Gunshot Wounds ◽  
Level 1 ◽  
Level 1 Trauma Center

scholarly journals Kinetic Projectile Injuries Treated During Civil Protests in Los Angeles: A Case Series

2021 ◽  
Vol 5 (4) ◽  
pp. 385-389
Author(s):  
Rachel Pearl ◽  
Sam Torbati ◽  
Joel Geiderman
Keyword(s):  
Public Health ◽  
Law Enforcement ◽  
Los Angeles ◽  
Trauma Center ◽  
Case Series ◽  
Emergency Department Visits ◽  
The Public ◽  
Crowd Control ◽  
Level 1 ◽  
Level 1 Trauma Center

Introduction: During protests following the death of George Floyd, kinetic impact projectiles (KIP) were used by law enforcement as a method of crowd control . We describe the injuries seen at a single Level 1 trauma center in Los Angeles over a two-day period of protests to add to the collective understanding of the public health ramifications of crowd-control weapons used in the setting of protests. Case Series: We reviewed the emergency department visits of 14 patients who presented to our facility due to injuries sustained from KIPs over a 48-hour period during civil protests after the death of George Floyd. Conclusion: Less lethal weapons can cause significant injuries and may not be appropriate for the purposes of crowd control, especially when used outside of established guidelines.

scholarly journals Identifying trauma patients with benefit from direct transportation to Level-1 trauma centers

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Charlie A. Sewalt ◽  
Benjamin Y. Gravesteijn ◽  
Daan Nieboer ◽  
Ewout W. Steyerberg ◽  
Dennis Den Hartog ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Trauma Center ◽  
Trauma Patients ◽  
Trauma Centers ◽  
Absolute Benefit ◽  
Predicted Probability ◽  
Prehospital Triage ◽  
Level 1 ◽  
Level 1 Trauma Center ◽  
Level 2

Abstract Background Prehospital triage protocols typically try to select patients with Injury Severity Score (ISS) above 15 for direct transportation to a Level-1 trauma center. However, ISS does not necessarily discriminate between patients who benefit from immediate care at Level-1 trauma centers. The aim of this study was to assess which patients benefit from direct transportation to Level-1 trauma centers. Methods We used the American National Trauma Data Bank (NTDB), a retrospective observational cohort. All adult patients (ISS > 3) between 2015 and 2016 were included. Patients who were self-presenting or had isolated limb injury were excluded. We used logistic regression to assess the association of direct transportation to Level-1 trauma centers with in-hospital mortality adjusted for clinically relevant confounders. We used this model to define benefit as predicted probability of mortality associated with transportation to a non-Level-1 trauma center minus predicted probability associated with transportation to a Level-1 trauma center. We used a threshold of 1% as absolute benefit. Potential interaction terms with transportation to Level-1 trauma centers were included in a penalized logistic regression model to study which patients benefit. Results We included 388,845 trauma patients from 232 Level-1 centers and 429 Level-2/3 centers. A small beneficial effect was found for direct transportation to Level-1 trauma centers (adjusted Odds Ratio: 0.96, 95% Confidence Interval: 0.92–0.99) which disappeared when comparing Level-1 and 2 versus Level-3 trauma centers. In the risk approach, predicted benefit ranged between 0 and 1%. When allowing for interactions, 7% of the patients (n = 27,753) had more than 1% absolute benefit from direct transportation to Level-1 trauma centers. These patients had higher AIS Head and Thorax scores, lower GCS and lower SBP. A quarter of the patients with ISS > 15 were predicted to benefit from transportation to Level-1 centers (n = 26,522, 22%). Conclusions Benefit of transportation to a Level-1 trauma centers is quite heterogeneous across patients and the difference between Level-1 and Level-2 trauma centers is small. In particular, patients with head injury and signs of shock may benefit from care in a Level-1 trauma center. Future prehospital triage models should incorporate more complete risk profiles.

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