Alcohol's Role on the Reliability of Clinical Examination to Rule Out Pelvic Fractures

2009 ◽  
Vol 75 (3) ◽  
pp. 257-259 ◽  
Author(s):  
Therèse M. Duane ◽  
Tracey Dechert ◽  
Luke G. Wolfe ◽  
Holly Brown ◽  
Michel B. Aboutanos ◽  
...  
Keyword(s):  
Blunt Trauma ◽  
Clinical Examination ◽  
Pelvic Fractures ◽  
Blood Alcohol ◽  
X Rays ◽  
Clinical Factors ◽  
Lower Systolic Blood Pressure ◽  
Subset Analysis ◽  
Prospective Comparison ◽  
Rule Out

The objective of this study was to determine if clinical examination accurately ruled out pelvic fractures in intoxicated patients sustaining blunt trauma A prospective comparison of intoxicated (blood alcohol level [BAL] greater than 0.08 g/dL) to nonintoxicated (BAL less than 0.08 g/dL) patients sustaining blunt trauma was performed between February 2004 and March 2007. Clinical factors were compared and subset analysis performed in which patients with factors known to compromise the clinical examination were excluded. Two hundred ninety-six intoxicated patients were compared with 1071 nonintoxicated patients. Intoxicated patients were younger and more often male. Intoxicated patients had a higher heart rate (97.1 beats/min ± 17.9 vs 91.4 beats/min ± 18.7, P < 0.0001) and lower systolic blood pressure (136.2 mmHg ± 21.2 vs 141.9 mmHg ± 26.6, P = 0.0005) than nonintoxicated patients. Intoxicated patients had a lower incidence of pelvic fracture (6.1 vs 10.6%). In subset analysis, the majority of the intoxicated patients did not have exclusion factors on examination and could be evaluated (66.6%). There were eight pelvic fractures diagnosed in this group and no missed injuries on clinical examination (sensitivity 100%). Clinical examination was not compromised by intoxication. Routine pelvic x-rays are not needed in the alert, intoxicated patient sustaining blunt trauma.

scholarly journals The value of clinical examination in diagnosing pelvic fractures in blunt trauma patients: a brief review

2011 ◽  
Vol 37 (4) ◽  
pp. 373-377 ◽  
Author(s):  
T. A. W. den Boer ◽  
M. Geurts ◽  
L. T. van Hulsteijn ◽  
A. Mubarak ◽  
J. Slingerland ◽  
...  
Keyword(s):  
Blunt Trauma ◽  
Clinical Examination ◽  
Pelvic Fractures ◽  
Trauma Patients

Clinical Examination is Superior to Plain Films to Diagnose Pelvic Fractures Compared to CT

2008 ◽  
Vol 74 (6) ◽  
pp. 476-480 ◽  
Author(s):  
TherÈSe M. Duane ◽  
Tracey Dechert ◽  
Luke G. Wolfe ◽  
Holly Brown ◽  
Michel B. Aboutanos ◽  
...  
Keyword(s):  
Glasgow Coma Scale ◽  
Negative Predictive Value ◽  
Blunt Trauma ◽  
Clinical Examination ◽  
Glasgow Coma Scale Score ◽  
Predictive Value ◽  
Screening Tool ◽  
Pelvic Fractures ◽  
Plain Films ◽  
The Right

We prospectively compared clinical examination (CE) with plain films (PXR) and both tools with CT in patients sustaining blunt trauma. There were 1388 patients who had both PXR and CT of whom 168 (12.1%) were diagnosed with a fracture by CT. CE findings most predictive of fracture included age (OR, 1.025; CI, 1.011–1.039), hip pain (OR, 4.971; CI, 2.508–9.854), internal rotation of the leg (OR, 4.880; CI, 1.980–12.027), or tenderness to palpation over the sacrum (OR, 2.297; CI, 1.144–4.612), over the right or left hip (OR, 3.626; CI, 1.823–7.214), or diffusely throughout the pelvis (OR, 16.445; CI, 4.277–63.237). These factors were still predictive of pelvic fractures even in patients with a Glasgow Coma Scale score less than 13. There were 136 fractures identified by PXR all of which were identified by CE (sensitivity 100% [136 of 136], negative predictive value 100% [619 of 619]). There were six patients with negative clinical examinations and positive CTs (sensitivity 96.4% [162 of 168], negative predictive value 99.03% [613 of 619]), none of which were hemodynamically significant. The sensitivity for PXR compared with CT was 79.17 per cent (133 of 168) and the NPV was 97.2 per cent (1217 of 1252). CE is a reliable way to diagnose pelvic fractures and PXR is a poor screening tool for these injuries compared with CT. Because the majority of patients undergo CT after blunt trauma, routine screening radiographs should be eliminated.

scholarly journals Comparative analysis between identified injuries of victims of fall from height and other mechanisms of closed trauma

2014 ◽  
Vol 41 (4) ◽  
pp. 285-291 ◽  
Author(s):  
José Gustavo Parreira ◽  
Lucas R. Kanamori ◽  
Guilherme C. J. Valinoto ◽  
Jacqueline A. Giannini Perlingeiro ◽  
Silvia Cristine Soldá ◽  
...  
Keyword(s):  
Blunt Trauma ◽  
Head Injuries ◽  
Pelvic Fractures ◽  
Trauma Patients ◽  
Retroperitoneal Hemorrhage ◽  
Lower Systolic Blood Pressure ◽  
Severity Of Injury ◽  
Thoracic And Abdominal ◽  
The Impact ◽  
Group 1

OBJECTIVE:to identify predictors of death in blunt trauma patients sustaining pelvic fractures and, posteriorly, compare them to a previously reported series from the same center.METHOD: Retrospective analysis of trauma registry data, including blunt trauma patients older than 14 y.o. sustaining pelvic fractures admitted from 2008 to 2010. Patients were assigned into group 1 (dead) or 2 (survivors). We used Student's t, qui square and Fisher's tests for statistical analysis, considering p<0.05 as significant. Posteriorly, we compared predictors of death between both periods.RESULTS: Seventy-nine cases were included. Mean RTS, ISS and TRISS were, respectively, 6.44 + 2.22, 28.0 + 15.2 e 0.74 + 0.33. Nineteen patients died (24,0%). Main cause of death was hemorrhage (42,1%). Group 1 was characterized by (p<0.05) lower systolic blood pressure and Glasgow coma scale means on admission, higher heart rate, head AIS, extremity AIS and ISS means, as well as, higher frequency of severe head injuries and complex pelvic fractures. Comparing both periods, we notice that the anatomic and physiologic severity of injury increased (RTS and ISS means). Furthermore, there was a decrease in the impact of associated thoracic and abdominal injuries on the prognosis and an association of lethality with the presence of complex pelvic fractures.CONCLUSION: There were significant changes in the predictors of death between these two periods. The impact of thoracic and abdominal associated injures decreased while the importance of severe retroperitoneal hemorrhage increased. There was also an increase in trauma severity, which accounted for high lethality.

The reliability of clinical examination in detecting pelvic fractures in blunt trauma patients: a meta-analysis

2004 ◽  
Vol 124 (2) ◽  
pp. 123-128 ◽  
Author(s):  
Stefan Sauerland ◽  
Bertil Bouillon ◽  
Dieter Rixen ◽  
Marcus R. Raum ◽  
Timmo Koy ◽  
...  
Keyword(s):  
Blunt Trauma ◽  
Clinical Examination ◽  
Meta Analysis ◽  
Pelvic Fractures ◽  
Trauma Patients

scholarly journals Osteoporosis-Related Simultaneous Four Joints Fractures and Dislocation after a Seizure: A Case Report

2010 ◽  
Vol 2010 ◽  
pp. 1-4
Author(s):  
Abdullah S. AlOmran
Keyword(s):  
Vitamin D ◽  
Case Report ◽  
Clinical Examination ◽  
Epileptic Seizures ◽  
Antiresorptive Therapy ◽  
Multiple Fractures ◽  
Steroid Use ◽  
Skeletal Injury ◽  
History Of ◽  
Rule Out

A case of steroid-induced osteoporosis-related multiple fractures and dislocations are described after a seizure is reported. Patient had two years history of steroid use with no supplement or antiresorptive therapy. There was a delay in the diagnosis which affected an otherwise good outcome in such situations. It is recommended that patients on steroid should be given calcium, vitamin D, and an antiresorptive. Furthermore, a meticulous clinical examination is required in patients who are on steroids and suffer epileptic seizures to rule out skeletal injury.

scholarly journals Corrigendum to “Routine pelvic X-rays in asymptomatic hemodynamically stable blunt trauma patients: A meta-analysis” [Injury 49 (11) (2018) 2024–2031]

Injury ◽  
2019 ◽  
Vol 50 (2) ◽  
pp. 621
Author(s):  
Jessica van Trigt ◽  
Niels Schep ◽  
Rolf Peters ◽  
Carel Goslings ◽  
Tim Schepers ◽  
...  
Keyword(s):  
Blunt Trauma ◽  
Meta Analysis ◽  
Trauma Patients ◽  
X Rays

scholarly journals The Paradox of Happy Hypoxia in COVID 19

2021 ◽  
pp. 119-124
Author(s):  
Madhu Bansode ◽  
Pankaj Bansode
Keyword(s):  
Young Patients ◽  
The Elderly ◽  
Clinical Implications ◽  
X Rays ◽  
The Novel ◽  
Human Race ◽  
Self Monitoring ◽  
Diagnostic Modalities ◽  
High Index Of Suspicion ◽  
Rule Out

Ever since the human race has been exposed to the novel COVID 19 illness, newer and newer intriguing features of the COVID viral plethora are seen with each passing day. Many manifestations of the COVID 19 illness have been baffling and unexplainable to researchers currently. One such unusual presentation seen is ‘happy hypoxia’ or silent hypoxemia in a third of patients' total number. This review article is intending to put some light on the puzzling condition of happy hypoxia. We authors refer you through various theories postulated for happy hypoxia. It has definite clinical implications in the sense that it can be lifesaving if detected early and promptly in a COVID patient. We conclude that happy hypoxia or silent hypoxemia is a new entity and should be diagnosed with a high index of suspicion in COVID suspect patients in both young patients with no co morbidities and the elderly and diabetics. Diagnostic modalities like pulse oximeter should be widely used at hospitals and clinics and for self-monitoring by the patients at homes. Also, chest X-rays or HRCT imaging of the lungs is essential in the early stages to identify the early infective changes with compromised lung function and rule out this happy hypoxia. Also, further research is essential to find the exact ethologic of this subclinical though ominous prognostic entity.

scholarly journals Forensic odontological examinations of alleged torture victims at the University of Copenhagen 1997-2011

2018 ◽  
Vol 24 (1) ◽  
pp. 8
Author(s):  
Sára O. Arge ◽  
Steen Holger Hansen ◽  
Niels Lynnerup
Keyword(s):  
Clinical Examination ◽  
Oral Pathology ◽  
X Rays ◽  
Copenhagen School ◽  
Background Data ◽  
School Of Dentistry ◽  
Torture Victims ◽  
The University

Background: Clinical forensic examinations of alleged torture victims have been performed by forensic pathologists at the University of Copenhagen since 1995. In 13.2%/33 of these cases, the examinations were supplemented by a forensic odontological clinical examination. In this study, the forensic odontological cases from the years 1997-2011 are presented and discussed. Methods: This study includes 33 reports from alleged torture victims (4 females, 29 males) who have been examined by a forensic odontologist at the Copenhagen School of Dentistry in the years 1997-2011. The material available consisted of copies of medical forensic reports and the forensic odontological reports including x-rays. Background data, anamnestic data and results of the forensic odontological clinical examinations were registered as well as the conclusion of the clinical examinations. Findings: The forensic odontological clinical examinations were complicated by the presence of unspecific injuries and various degrees of active oral pathology. In 27 of the cases it was concluded that the findings were consistent with the alleged torture, in six of the cases the findings were concluded to be highly consistent with the alleged torture.

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