Assessment of the “Wisconsin Criteria” for Obtaining Maxillofacial Computed Tomography in Trauma Patients at a Community Trauma Center

Objective. We sought to describe the trend in abdominal CT use in adult trauma patients after a point-of-care emergency ultrasound program was introduced. We hypothesized that abdominal CT use would decrease as FAST use increased.Methods. We performed a retrospective study of 19940 consecutive trauma patients over the age of 18 admitted to our level one trauma center from 2002 through 2011. Data was collected retrospectively and recorded in a trauma registry. We plotted the rate of FAST and abdominal CT utilization over time. Head CT was used as a surrogate for overall CT utilization rates during the study period.Results. Use of FAST increased by an average of 2.3% (95% CI 2.1 to 2.5,P<0.01) while abdominal CT use decreased by the same rate annually. The percentage of patients who received FAST as the sole imaging modality for the abdomen rose from 2.0% to 21.9% while those who only received an abdominal CT dropped from 21.7% to 2.3%.Conclusions. Abdominal CT use in our cohort declined while FAST utilization grew in the last decade. The rising use of FAST may have played a role in the reduction of abdominal CT performed as decline in CT utilization appears contrary to overall trends.

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The Trauma Bay Chest Radiograph in Stable Blunt-Trauma Patients: Do We Really Need It?

The American Surgeon ◽

10.1177/000313480607200108 ◽

2006 ◽

Vol 72 (1) ◽

pp. 31-34 ◽

Cited By ~ 3

Author(s):

Joao A. Lopes ◽

Heidi L. Frankel ◽

S. Jamal Bokhari ◽

Matthew Bank ◽

Manish Tandon ◽

...

Keyword(s):

Computed Tomography ◽

Blunt Trauma ◽

Chest Radiograph ◽

Trauma Center ◽

Trauma Patients ◽

Thoracic Injuries ◽

Traumatic Injuries ◽

Chest Computed Tomography ◽

Level I ◽

Trauma Bay

The current study evaluates the need for trauma bay chest radiographs (CXR) in stable blunt-trauma patients who are scheduled for chest computed tomography (CCT). A retrospective review of 157 randomly selected, stable, adult blunt-trauma patients who were admitted to a level I trauma center between 2000 and 2002, who underwent both CXR and CCT (GE Light-Speed Scanner), was performed. Stable patients were defined as unintubated, normotensive (SBP >100 mm Hg), and without hypoxia (O2 saturation >90%). No interventions were conducted in the trauma bay based on chest radiograph findings. Among 95 patients with a “normal” CXR, 38 patients (40%) were found on CCT to have traumatic injuries. Among 62 patients with an “abnormal” CXR, 18 (29%) were found to be normal on CCT. Of the remaining 44 patients, 34 had additional findings on CCT. In 32 patients, CCT led to changes in management. CCT was more sensitive in diagnosing thoracic injuries and led to significant changes in management. We feel that CXR could be safely eliminated in favor of CCT in stable blunt-trauma patients.

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Computed Tomography Blush and Splenic Injury: Does it always Require Angioembolization?

The American Surgeon ◽

10.1177/000313481307901027 ◽

2013 ◽

Vol 79 (10) ◽

pp. 1089-1092 ◽

Cited By ~ 7

Author(s):

Rebecca Post ◽

Delphine Engel ◽

Jacqueline Pham ◽

Cristobal Barrios

Keyword(s):

Computed Tomography ◽

Blunt Trauma ◽

Trauma Center ◽

Splenic Injury ◽

American Association ◽

Subsequent Treatment ◽

Low Grade ◽

Trauma Patients ◽

Patient Groups ◽

Level I

The implication of splenic contrast blush on computed tomography (CT) in blunt trauma patients and whether it is an indication for angioembolization (AE) remains controversial. Our objective was to determine whether CT blush and its subsequent treatment have any impact on outcomes in blunt trauma patients with low-grade splenic injuries. A retrospective review identified adult patients with splenic injury (American Association for the Surgery of Trauma grades 1 to 3) from blunt abdominal trauma who were evaluated with a CT scan over a 3.5-year period at a Level I trauma center. Patient groups analyzed included: observation patients with no CT blush (n = 110), observation patients with CT blush (n = 18), and AE patients with CT blush (n = 22). Patients with CT blush who were observed did not demonstrate significantly worse outcomes compared with the patients with no CT blush. Additionally, patients with CT blush who underwent AE did not show any significant improvement in outcomes compared with patients who were observed with CT blush. Our study suggests that CT blush does not predict worse outcomes for blunt trauma patients with low-grade splenic injury who underwent observation. Furthermore, AE does not seem to provide any advantage to this subset of patients.

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Implementing a REBOA program outside of the ivory tower: initial case series and lessons learned at a community trauma center.

Journal of Endovascular Resuscitation and Trauma Management ◽

10.26676/jevtm.v2i3.64 ◽

2018 ◽

Vol 2 (3) ◽

Author(s):

Jacob J Glaser ◽

Adam Czerwinski ◽

Ashley Alley ◽

Michael Keyes ◽

Valentino Piacentino ◽

...

Keyword(s):

Acute Care ◽

Trauma Center ◽

Systolic Pressure ◽

Case Series ◽

Lessons Learned ◽

Hospital Environment ◽

Open Approach ◽

Improvement Program ◽

Clinical Series ◽

Community Trauma

Background: REBOA has become an established adjunct to hemorrhage control. Prospective data sets are being collected, primarily from large, high volume trauma centers. There are limited data, and guidelines, to guide implementation and use outside of highly resourced environments. Smaller centers interested in adopting a REBOA program could benefit from closing this knowledge gap. Methods: A clinical series of cases utilizing REBOA from Grand Strand Medical Center, Myrtle Beach, South Carolina were reviewed. This represents early data from a busy community trauma center (ACS Level 2), from January 2017 to May 2018. Seven cases are identified and reported on, including outcomes. Considerations and ‘lessons learned’ from this early institutional experience are commented on. Results: REBOA was performed by trauma and acute care surgeons for hemorrhage and shock (blunt trauma n=3, penetrating trauma n=2, no- trauma n=2). All were placed in Zone 1 (one initially was placed in zone 3 then advanced). Mean (SD) systolic pressure (mmHg) before REBOA was 43 (30); post REBOA pressure was 104 (19). N=4 were placed via an open approach, n=3 percutaneous (n=2 with ultrasound). All with arrest before placement expired (n=3) and all others survived. Complications are described. Conclusions: REBOA can be a feasible adjunct for shock treatment in the community hospital environment, with outcomes comparable to large centers, and can be implemented by acute care and trauma surgeons. A rigorous process improvement program and critical appraisal process are critical in maximizing benefit in these centers.

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Faculty Opinions recommendation of Plain radiography does not add any clinically significant advantage to multidetector row computed tomography in diagnosing cervical spine injuries in blunt trauma patients.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1157915.617976 ◽

2009 ◽

Author(s):

Elfyn Thomas

Keyword(s):

Computed Tomography ◽

Cervical Spine ◽

Blunt Trauma ◽

Plain Radiography ◽

Multidetector Row Computed Tomography ◽

Trauma Patients ◽

Cervical Spine Injuries ◽

Multidetector Row ◽

Spine Injuries ◽

Clinically Significant

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The Frequency of Random Findings on Abdominal / Pelvis Computed Tomography in Pediatric Trauma Patients

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/1573405616666201217110021 ◽

2020 ◽

Vol 16 ◽

Author(s):

Betül Tiryaki Baştuğ

Keyword(s):

Computed Tomography ◽

Incidental Findings ◽

Pediatric Population ◽

Pediatric Trauma ◽

Trauma Patients ◽

Injured Child ◽

Level 3 ◽

Male Patients ◽

Clinically Significant ◽

Discharge Summaries

Aims: In this study, we aimed to find the percentage of random pathologies and abdominopelvic region anomalies that are not related to trauma in pediatric patients. Background: An abdominal assessment of an injured child usually involves computed tomography imaging of the abdomen and pelvis (CTAP) to determine the presence and size of injuries. Imaging may accidentally reveal irrelevant findings. Objectives: Although the literature in adults has reviewed the frequency of discovering these random findings, few studies have been identified in the pediatric population. Methods: Data on 142( 38 female, 104 male) patients who underwent CTAP during their trauma evaluation between January 2019 and January 2020 dates were obtained from our level 3 pediatric trauma center trauma records. The records and CTAP images were examined retrospectively for extra traumatic pathologies and anomalies. Results: 67 patients (47%) had 81 incidental findings. There were 17 clinically significant random findings. No potential tumors were found in this population. Conclusion: Pediatric trauma CTAP reveals random findings. For further evaluation, incidental findings should be indicated in the discharge summaries.

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Infectious Complications of Noncombat Trauma Patients Provided Care at a Military Trauma Center

Military Medicine ◽

10.7205/milmed-d-09-00098 ◽

2010 ◽

Vol 175 (5) ◽

pp. 317-323 ◽

Cited By ~ 8

Author(s):

Heather C. Yun ◽

Lorne H. Blackbourne ◽

John A. Jones ◽

John B. Holcomb ◽

Duane R. Hospenthal ◽

...

Keyword(s):

Trauma Center ◽

Infectious Complications ◽

Trauma Patients ◽

Military Trauma

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Accuracy of Contrast Extravasation on Computed Tomography for Diagnosing Severe Pelvic Hemorrhage in Pelvic Trauma Patients: A Meta-Analysis

Medicina ◽

10.3390/medicina57010063 ◽

2021 ◽

Vol 57 (1) ◽

pp. 63

Author(s):

Sung Nam Moon ◽

Jung-Soo Pyo ◽

Wu Seong Kang

Keyword(s):

Computed Tomography ◽

Meta Analysis ◽

Characteristic Curve ◽

Pelvic Trauma ◽

Test Accuracy ◽

Trauma Patients ◽

Positive Finding ◽

Summary Receiver Operating Characteristic ◽

Contrast Extravasation ◽

Pelvic Hemorrhage

Background and objective: The early detection of underlying hemorrhage of pelvic trauma has been a critical issue. The aim of this study was to systematically determine the diagnostic accuracy of computed tomography (CT) for detecting severe pelvic hemorrhage. Materials and Methods: Relevant articles were obtained by searching PubMed, EMBASE, and Cochrane databases through 28 November 2020. Diagnostic test accuracy results were reviewed to obtain the sensitivity, specificity, diagnostic odds ratio, and summary receiver operating characteristic curve of CT for the diagnosis in pelvic trauma patients. The positive finding on CT was defined as the contrast extravasation. As the reference standard, severe pelvic hemorrhage was defined as an identification of bleeding at angiography or by direct inspection using laparotomy that required hemostasis by angioembolization or surgery. A subgroup analysis was performed according to the CT modality that is divided by the number of detector rows. Result: Thirteen eligible studies (29 subsets) were included in the present meta-analysis. Pooled sensitivity of CT was 0.786 [95% confidence interval (CI), 0.574–0.909], and pooled specificity was 0.944 (95% CI, 0.900–0.970). Pooled sensitivity of the 1–4 detector row group and 16–64 detector row group was 0.487 (95% CI, 0.215–0.767) and 0.915 (95% CI, 0.848–0.953), respectively. Pooled specificity of the 1–4 and 16–64 detector row groups was 0.956 (95% CI, 0.876–0.985) and 0.906 (95% CI, 0.828–0.951), respectively. Conclusion: Multi-detector CT with 16 or more detector rows has acceptable high sensitivity and specificity. Extravasation on CT indicates severe hemorrhage in patients with pelvic trauma.

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

BMC Emergency Medicine ◽

10.1186/s12873-021-00487-3 ◽

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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