Clinical predictors of intra-abdominal injury in severe blunt trauma patients: a retrospective study

2006 ◽  
Vol 13 (5) ◽  
pp. A4
Author(s):  
Goh Pak Liang
Keyword(s):  
Retrospective Study ◽  
Blunt Trauma ◽  
Abdominal Injury ◽  
Trauma Patients ◽  
Clinical Predictors

Clinical Predictors of Intra-Abdominal Injury in Severe Blunt Trauma Patient

2009 ◽  
Vol 16 (2) ◽  
pp. 76-83
Author(s):  
PL Goh ◽  
MJ Schull
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Blunt Trauma ◽  
Pelvic Fracture ◽  
Chest Tube ◽  
Abdominal Injury ◽  
Trauma Patients ◽  
Clinical Predictors ◽  
Tube Insertion ◽  
Chest Tube Insertion

Introduction The early recognition of intra-abdominal injury (IAI) in patients with blunt trauma is essential, yet physical examination is often unreliable. Computed tomography (CT) scans are used widely to further evaluate possible IAI but these require time and expense. IAI may be associated with certain objective risk factors or other specific injuries, but this association has not been widely studied. Identification of such risk factors will help to prioritize patients in need for further evaluation of possible IAI. Methods A retrospective chart review was conducted of all 622 adult severe blunt trauma patients (Injury Severity Score [ISS] >12) presenting to a level 1 trauma centre in 2004. Various clinical predictors of IAI were analyzed statistically with univariate and multivariate analysis using SAS software. Results In multivariate analysis, four significant predictors of IAI were found: positive focused assessment with sonography for trauma (FAST) (OR=48.5, p<0.0001), presence of pelvic fracture (OR=2.4, p=0.0002), chest tube insertion (OR=1.8, p=0.0211), and systolic blood pressure (SBP), where every 10 mmHg decrease indicates a 14% increase in risk (OR=0.986, p=0.001). The absence of all four predictors predicted the absence of IAI with a specificity of 0.776 (95% CI 0.741 to 0.808) and a LR of 2.7 (95% CI 2.0 to 3.5). Conclusion This study suggests that positive FAST, presence of pelvic fracture, chest tube insertion, and SBP are significant predictors of IAI in adult blunt trauma patients with ISS > 12. The absence of all four predictors is associated with a reduced risk of IAI.

Chest and Pelvis X-Rays as a Screening Tool for Abdominal Injury in Geriatric Blunt Trauma Patients

2021 ◽  
pp. 000313482199866
Author(s):  
Emily Leede ◽  
Tatiana C. P. Cardenas ◽  
Brent J. Emigh ◽  
Lawrence H. Brown ◽  
Pedro G. Teixeira ◽  
...  
Keyword(s):  
Blunt Trauma ◽  
High Specificity ◽  
Data Bank ◽  
Abdominal Injury ◽  
Trauma Patients ◽  
X Rays ◽  
X Ray ◽  
National Trauma ◽  
National Trauma Data Bank ◽  
Hospital Days

Background This study evaluates the utility of chest (CXR) and pelvis (PXR) X-ray, as adjuncts to the primary survey, in screening geriatric blunt trauma (GBT) patients for abdominal injury or need for laparotomy. Methods We performed a retrospective analysis of patients 65-89 years in the 2014 National Trauma Data Bank. X-ray injuries were identified by ICD9 codes and defined as any injury felt to be readily detectable by a non-radiologist. X-ray findings were dichotomized as “both negative” (no injury presumptively apparent on CXR or PXR) or “either positive” (any injury presumptively apparent on CXR or PXR). Rates of abdominal injuries and laparotomy were compared and used to calculate sensitivity and specificity. The primary outcomes were abdominal injury and laparotomy. The secondary outcomes included mortality, ventilator days, and hospital days. Results A total of 202 553 patients met criteria. Overall, 9% of patients with either positive X-rays had abdominal injury and 2% laparotomy vs. 1.1% and .3% with both negative ( P < .001). The specificity for any positive X-ray was 79% for abdominal injury and 78% for laparotomy. The sensitivity was 69% for abdominal injury and laparotomy. The either positive group had fewer ventilator days (.3 vs. .8, P < .0001), longer length of stay (7 vs. 5, P < .0001), and higher mortality (6% vs. 4%, P < .0001) vs both negative. Conclusion CXR and PXR can be used to assess for intra-abdominal injury and need for laparotomy. GBT patients with either positive X-rays should continue workup regardless of mechanism due to the high specificity of this tool for abdominal injury and need for laparotomy.

Radiographic and Clinical Predictors of Bladder Rupture in Blunt Trauma Patients with Pelvic Fracture

2006 ◽  
Vol 13 (5) ◽  
pp. 573-579 ◽  
Author(s):  
Greg Avey ◽  
C. Craig Blackmore ◽  
Hunter Wessells ◽  
Jonathan L. Wright ◽  
Lee B. Talner
Keyword(s):  
Blunt Trauma ◽  
Pelvic Fracture ◽  
Bladder Rupture ◽  
Trauma Patients ◽  
Clinical Predictors

Repairing the injured bronchus in blunt chest trauma – A case series

Trauma ◽  
2021 ◽  
pp. 146040862098811
Author(s):  
Anith Nadzira Riduan ◽  
Narasimman Sathiamurthy ◽  
Benedict Dharmaraj ◽  
Diong Nguk Chai ◽  
Narendran Balasubbiah
Keyword(s):  
Blunt Trauma ◽  
Chest Trauma ◽  
Surgical Intervention ◽  
Case Series ◽  
Trauma Patients ◽  
Lung Collapse ◽  
Comprehensive Management ◽  
Lung Capacity ◽  
Management Algorithm ◽  
Operative Outcomes

Introduction Traumatic bronchial injury (TBI) is uncommon, difficult to diagnose and often missed. The incidence of TBI among blunt trauma patients is estimated to be around 0.5–2%. Bronchoplastic surgery is indicated in most cases to repair the tracheobronchial airway and preserve lung capacity. There is limited existing literature addressing the management of this condition in view of its rarity. The comprehensive management and outcomes of these patients are discussed. Methods The case notes of all patients who presented with persistent lung collapse due to trauma since July 2017 were reviewed retrospectively. Those patients requiring surgical intervention were included in the review. The mode of injury, clinical, radiological and bronchoscopy findings, concurrent injuries, type of surgery, length of stay (LOS) and operative outcomes were reviewed. Results Out of 11 patients who presented with persistent lung collapse post-blunt trauma, four (36%) were found to have structural bronchial disruption. All of them underwent successful repair of the injured bronchus, without the need of a pneumonectomy. The other seven patients were successfully treated conservatively. Conclusion The repair of the injured bronchus is essential in improving respiratory function and to prevent a pneumonectomy. Routine bronchoscopic evaluation should be performed for all suspected airway injuries as recommended in our management algorithm. Delayed presentations should not hinder urgent referral to thoracic centers for tracheobronchial reconstruction.

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