scholarly journals Emergency Ultrasound Predicting the Need for Therapeutic Laparotomy among Blunt Abdominal Trauma Patients in a Sub-Saharan African Hospital

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
P. C. M. Musiitwa ◽  
M. Galukande ◽  
S. Bugeza ◽  
H. Wanzira ◽  
R. Wangoda
Keyword(s):  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Standard Of Care ◽  
Routine Practice ◽  
Trauma Patients ◽  
Diagnostic Challenge ◽  
Mortality And Morbidity ◽  
Portable Ultrasound ◽  
Sub Saharan ◽  
Overall Mortality

Background. The trauma burden globally accounts for high levels of mortality and morbidity. Blunt abdominal trauma (BAT) contributes significantly to this burden. Patient’s evaluation for BAT remains a diagnostic challenge for emergency physicians. SSORTT gives a score that can predict the need for laparotomy. The objective of this study was to assess the accuracy of SSORTT score in predicting the need for a therapeutic laparotomy after BAT.Method. A prospective observational study. Eligible patients were evaluated for shock and the presence of haemoperitoneum using a portable ultrasound machine. Further evaluation of patients following the standard of care (SOC) protocol was done. The accuracy of SSORTT score in predicting therapeutic laparotomy was compared to SOC.Results. In total, 195 patients were evaluated; M : F ratio was 6 : 1. The commonest injuries were to the head 80 (42%) and the abdomen 54 (28%). A SSORTT score of >2 appropriately identified patients that needed a therapeutic laparotomy (with sensitivity 90%, specificity 90%, PPV 53%, and NPV 98%). The overall mortality rate was 17%.Conclusion. Patients with a SSORTT score of 2 and above had a high likelihood of requiring a therapeutic laparotomy. SSORTT scoring should be adopted for routine practice in low technology settings.

scholarly journals An analysis of injury patterns of abdominal trauma in patients attending surgical emergency department of rural hospital, Karnataka, India

2017 ◽  
Vol 4 (11) ◽  
pp. 3736
Author(s):  
Narasimhaiah Krishnappa ◽  
Asif Khan ◽  
Saraswathi Sakranaik
Keyword(s):  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Public Health Problem ◽  
Major Public Health Problem ◽  
Trauma Patients ◽  
Abdominal Injuries ◽  
Mortality And Morbidity ◽  
Revised Trauma Score

Background: Globally, abdominal trauma is a major public health problem irrespective of socioeconomic levels. Severe blood loss and infection are the serious complication of any abdominal trauma. A detailed assessment for early identification and prompt management is required to reduce the mortality and morbidity in any abdominal trauma. Hence this study was designed to assess the incidence and patterns of abdominal injuries in trauma patients.Methods: It was assorted and identified the incidence and sub type of abdominal injuries and associated trauma, and identified variables related to morbidity and mortality.Results: A total of 150 abdominal trauma cases were analyzed; 103 patients with blunt abdominal trauma and 47 with penetrating. The most frequent type of abdominal trauma was blunt trauma; its most common cause was motor vehicle accident. Most abdominal trauma patients presented with other injuries, especially patients with blunt abdominal trauma. Mortality was higher among penetrating abdominal trauma patients.Conclusions: Type of abdominal trauma, associated injuries, and Revised Trauma Score are independent risk factors for mortality in abdominal trauma patients.

scholarly journals A novel streamlined trauma response team training improves imaging efficiency for pediatric blunt abdominal trauma patients

2019 ◽  
Vol 54 (9) ◽  
pp. 1854-1860 ◽  
Author(s):  
Benjamin K. Nti ◽  
Megan Laniewicz ◽  
Tracy Skaggs ◽  
Keith Cross ◽  
Mary E. Fallat ◽  
...  
Keyword(s):  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Team Training ◽  
Trauma Patients ◽  
Response Team ◽  
Trauma Response

scholarly journals Traumatic gastric rupture following blunt abdominal trauma: a case report about an atypical modality of presentation

2017 ◽  
Vol 13 (1) ◽  
Author(s):  
Dario Giambelluca ◽  
Dario Picone ◽  
Natalino Carmelo Pennisi ◽  
Bruno Luciani ◽  
Giuseppe Lo Re ◽  
...  
Keyword(s):  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Rare Presentation ◽  
Operative Morbidity ◽  
Mortality And Morbidity ◽  
Vehicle Accident ◽  
Gastric Rupture ◽  
History Of

Gastric rupture following blunt abdominal trauma is a rare presentation with a reported incidence of 0.02-1.7% in current literature. Traumatic gastric rupture is usually associated with other visceral injuries, such as splenic lesions and fractures. Prompt diagnosis and early intervention reduce mortality and morbidity. History of a recent meal has been implicated in traumatic gastric rupture. 2 We report a case of blunt abdominal trauma with an isolated gastric rupture after a motor vehicle accident, managed successfully without any post-operative morbidity and mortality.

The Utility of Sonography for the Triage of Blunt Abdominal Trauma Patients to Exploratory Laparotomy

2007 ◽  
Vol 188 (2) ◽  
pp. 415-421 ◽  
Author(s):  
Brett C. Lee ◽  
Eleanor L. Ormsby ◽  
John P. McGahan ◽  
Giselle M. Melendres ◽  
John R. Richards
Keyword(s):  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Exploratory Laparotomy ◽  
Trauma Patients

scholarly journals Blunt Abdominal Trauma in a European Trauma Setting: Need for Complex or Non-Complex Skills in Emergency Laparotomy

2019 ◽  
Vol 109 (2) ◽  
pp. 89-95 ◽  
Author(s):  
J. Kosola ◽  
T. Brinck ◽  
A. Leppäniemi ◽  
L. Handolin
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Organ Injury ◽  
General Surgeon ◽  
Emergency Laparotomy ◽  
Trauma Patients ◽  
Emergency Procedures ◽  
Complex Skills

Background and Aims: Blunt abdominal trauma can lead to substantial organ injury and hemorrhage necessitating open abdominal surgery. Currently, the trend in surgeon training is shifting away from general surgery and the surgical treatment of blunt abdominal trauma patients is often done by sub-specialized surgeons. The aim of this study was to identify what emergency procedures are needed after blunt abdominal trauma and whether they can be performed with the skill set of a general surgeon. Materials and Methods: The records of blunt abdominal trauma patients requiring emergency laparotomy (n = 100) over the period 2006–2016 (Helsinki University Hospital Trauma Registry) were reviewed. The organ injuries and the complexity of the procedures were evaluated. Results: A total of 89 patients (no need for complex skills, NCS) were treated with the skill set of general surgeons while 11 patients required complex skills. Complex skills patients were more severely injured (New Injury Severity Score 56.4 vs 35.9, p < 0.001) and had a lower systolic blood pressure (mean: 89 vs 112, p = 0.044) and higher mean shock index (heart rate/systolic blood pressure: 1.43 vs 0.95, p = 0.012) on admission compared with NCS patients. The top three NCS procedures were splenectomy (n = 33), bowel repair (n = 31), and urinary bladder repair (n = 16). In patients requiring a complex procedure (CS), the bleeding site was the liver (n = 7) or a major blood vessel (n = 4). Conclusion: The majority of patients requiring emergency laparotomy can be managed with the skills of a general surgeon. Non-responder blunt abdominal trauma patients with positive ultrasound are highly likely to require complex skills. The future training of surgeons should concentrate on NCS procedures while at the same time recognizing those injuries requiring complex skills.

Blunt Abdominal Trauma Patients: Can Organ Injury Be Excluded without Performing Computed Tomography?

2004 ◽  
Vol 57 (5) ◽  
pp. 1072-1081 ◽  
Author(s):  
Pierre A. Poletti ◽  
Stuart E. Mirvis ◽  
K Shanmuganathan ◽  
Tasuyoshi Takada ◽  
Karen L. Killeen ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Organ Injury ◽  
Trauma Patients

Educational Review of Predictive Value and Findings of Computed Tomography Scan in Diagnosing Bowel and Mesenteric Injuries after Blunt Trauma: Correlation with Trauma Surgery Findings in 163 Patients

2017 ◽  
Vol 68 (3) ◽  
pp. 276-285 ◽  
Author(s):  
Francesco Cinquantini ◽  
Gregorio Tugnoli ◽  
Alice Piccinini ◽  
Carlo Coniglio ◽  
Sergio Mannone ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Predictive Value ◽  
Gold Standard ◽  
Clinical Management ◽  
Trauma Surgery ◽  
Trauma Patients ◽  
Increased Risk

Background and Aims Laparotomy can detect bowel and mesenteric injuries in 1.2%–5% of patients following blunt abdominal trauma. Delayed diagnosis in such cases is strongly related to increased risk of ongoing sepsis, with subsequent higher morbidity and mortality. Computed tomography (CT) scanning is the gold standard in the evaluation of blunt abdominal trauma, being accurate in the diagnosis of bowel and mesenteric injuries in case of hemodynamically stable trauma patients. Aims of the present study are to 1) review the correlation between CT signs and intraoperative findings in case of bowel and mesenteric injuries following blunt abdominal trauma, analysing the correlation between radiological features and intraoperative findings from our experience on 25 trauma patients with small bowel and mesenteric injuries (SBMI); 2) identify the diagnostic specificity of those signs found at CT with practical considerations on the following clinical management; and 3) distinguish the bowel and mesenteric injuries requiring immediate surgical intervention from those amenable to initial nonoperative management. Materials and Methods Between January 1, 2008, and May 31, 2010, 163 patients required laparotomy following blunt abdominal trauma. Among them, 25 patients presented bowel or mesenteric injuries. Data were analysed retrospectively, correlating operative surgical reports with the preoperative CT findings. Results We are presenting a pictorial review of significant and frequent findings of bowel and mesenteric lesions at CT scan, confirmed intraoperatively at laparotomy. Moreover, the predictive value of CT scan for SBMI is assessed. Conclusions Multidetector CT scan is the gold standard in the assessment of intra-abdominal blunt abdominal trauma for not only parenchymal organs injuries but also detecting SBMI; in the presence of specific signs it provides an accurate assessment of hollow viscus injuries, helping the trauma surgeons to choose the correct initial clinical management.

scholarly journals Lactate clearance: its relationship with the success of non-operative management in patient with blunt abdominal trauma

2017 ◽  
Vol 4 (5) ◽  
pp. 1738
Author(s):  
Reno Rudiman ◽  
Nova Saragih ◽  
Andriana Purnama
Keyword(s):  
Hemorrhagic Shock ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Operative Management ◽  
Lactate Clearance ◽  
Trauma Patients ◽  
Solid Organ ◽  
Chi Square ◽  
History Of ◽  
Non Operative Management

Background: Occult ongoing bleeding has become the second highest cause of death in blunt abdominal trauma. Undetected abdominal injury has caused morbidity and mortality in patients at the early phases of trauma. Non-operative Management (NOM) in solid organ trauma is safe and effective, and this strategy has become widely used. Lactate clearance (LC) has important clinical benefits in patients with acute trauma that is superior to initial lactate examination.  Methods: This study was a prospective cohort study of patients with history of hemorrhagic shock caused by blunt abdominal trauma that came to emergency room of Hasan Sadikin Hospital Bandung from August 2015 to July 2016. The tests were including initial blood lactate, 2 hours, and 4 hours post-resuscitation and then calculation of LC. Analysis using SPSS with chi square for the significance of relationships and Spearman correlation to determine the strength of the relationship between variables. Comparison test between LC2 and LC4 were calculated using Mann-Whitney tests.Results: During one year period, from August 2015 to July 2016, there were 34 patients. Age was in the range of 15-65 years, with a range of 15-25 years were 19 (55.8%), 25-50 years were 11 (32.4%), and >50 years as many as four (11.8%). By sex, there were 28 (82.4%) male gender and 6 (17.6%) women. Based on the type of trauma, there were 11 (32.4%) single trauma patients and 23 (67.6%) multiple trauma patients. Based on the results of statistical analysis with chi square, there was a significant correlation between lactate clearance 2 hours (LC2) and lactate clearance 4 hours (LC4) with the success of NOM (p <0.001) with the Odds Ratio (OR) are 3.750 and 6.500 respectively. Based on non-parametric test (Mann Whitney) showed that there were no significant differences between the LC2 and LC4 in determining the successful of NOM (p>0.05).Conclusions: There was a significant relationship between lactate clearance 2 hours (LC2) and lactate clearance 4 hours (LC4) in determining the success of non-operative management (NOM) in patients with history of hemorrhagic shock caused by blunt abdominal trauma. In addition, there are no significant differences between the LC2 and LC4 in determining the success of the NOM, so that either LC2 or LC4 may be used in predicting the success of NOM, as LC4 is the first preference. The low level of lactate clearance may be used as one of indicators to terminate non-operative management and proceed with surgery right before all symptoms of hemorrhagic shock arise.

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