Blunt Traumatic Bladder Rupture: A 10-year Perspective

2013 ◽  
Vol 79 (6) ◽  
pp. 589-593 ◽  
Author(s):  
Kinzie A. Matlock ◽  
Alan H. Tyroch ◽  
Ziad N. Kronfol ◽  
Susan F. McLean ◽  
Miguel A. Pirela-Cruz
Keyword(s):  
Blunt Trauma ◽  
Injury Severity ◽  
Motor Vehicle ◽  
Motor Vehicle Crash ◽  
Bladder Rupture ◽  
Rectal Injury ◽  
Associated Injuries ◽  
Hollow Viscus ◽  
Colonic Injury ◽  
The Mean

The purpose of this study was to determine the incidence, features, and associated injuries of intraperitoneal (IP) and extraperitoneal (EP) bladder rupture (BR) resulting from blunt trauma. A retrospective study from September 2001 to August 2011 was performed for blunt traumatic BR in adults. Demographics, mean Injury Severity Score (ISS), mean length of stay (LOS), incidence, mortality, operative repair, and associated injuries were evaluated. Of 15,168 adult blunt trauma admissions over 10 years, 54 patients had BR (EP = 22, IP = 27, EP + IP = 5; incidence = 0.36%). Sixty-three per cent were male. The mean age, ISS, and LOS were 40 years, 29, and 15 days, respectively. The mortality rate was 11 per cent. Fifty-two per cent of BR was the result of a motor vehicle crash. Most BRs were diagnosed by computed tomography cystogram. Eighty per cent had pelvic fracture. Hollow viscus injury was present in 34.5 per cent of patients. Colonic injury was seen in 24 per cent and 9.3 per cent had a rectal injury. Although BR is rare in adult blunt trauma, it is associated with high ISS, LOS, and mortality. Pelvic fractures are essentially present in all patients with EP BR. Hollow viscus injuries, especially colonic and rectal injuries, are more prominent in IP BR.

scholarly journals Impaired driving charges in injured impaired drivers requiring treatment in an emergency department

CJEM ◽  
2012 ◽  
Vol 14 (05) ◽  
pp. 290-294 ◽  
Author(s):  
Warren Fieldus ◽  
Ed Cain
Keyword(s):  
Emergency Department ◽  
Injury Severity ◽  
Motor Vehicle ◽  
Trauma Centre ◽  
Motor Vehicle Crash ◽  
Impaired Driving ◽  
Legal Limit ◽  
Vehicle Crash ◽  
Police Records ◽  
The Mean

ABSTRACTObjective:To determine the percentage of injured impaired drivers brought to the only trauma centre in Nova Scotia who were charged with impaired driving.Methods:This retrospective observational study identified alcohol impaired drivers involved in a motor vehicle crash (MVC) brought to the emergency department (ED). Patients were selected based on blood alcohol concentrations (BACs) found to be above the legal limit. Medical records were examined to determine if the patient was the driver in an MVC. Patient records were then cross-referenced with a police database to determine the percentage of injured impaired drivers who were charged with impaired driving.Results:Between April 1, 2006, and April 1, 2008, 1,102 patients brought to the QEII Health Sciences Centre (QEII HSC) ED were found to have BACs over the legal limit. Of these patients, only 57 (5.2%) were found to have been the driver in an MVC. The majority of patients were male (49; 86%), with an average age of 32 years. Most injuries (51; 89.5%) were the result of a single-vehicle crash. The mean Glasgow Coma Scale score was 12.6, and the mean Injury Severity Score was 14.4. Cross-referencing with police records showed that only 22.8% (13 of 57) of injured drivers were charged with impaired driving. Those drivers not charged with impaired driving had a significantly lower median BAC and median age.Conclusion:During the study, the majority of alcoholimpaired drivers injured in an MVC who were brought to the QEII HSC ED for assessment of their injuries were not charged with impaired driving.

scholarly journals Pediatric and Adult Blunt Traumatic Bladder Rupture: A Comparative Review

2015 ◽  
Vol 4 (1) ◽  
pp. 11-15
Author(s):  
Alan Henry Tyroch ◽  
Kinzie Matlock
Keyword(s):  
Length Of Stay ◽  
Injury Severity Score ◽  
Blunt Trauma ◽  
Pelvic Fracture ◽  
Injury Severity ◽  
Bladder Rupture ◽  
Associated Injuries ◽  
Gross Hematuria ◽  
Diagnostic Modality ◽  
Comparative Review

ABSTRACT Background To determine the incidence, features and associated injuries of pediatric bladder rupture (BR) vs adult BR due to blunt trauma. Materials and methods A retrospective study from 1st January 2001 to 31st December 2012 was performed for blunt traumatic BR in pediatric and adult patients. Demographics, mean injury severity score, mean length of stay, incidence, mortality, diagnostic modality, management and associated injuries were evaluated. Results Of 4,884 pediatric blunt trauma admissions, eight children had BR. Sixty-six adults sustained BR out of 18,283 blunt trauma admissions. Gross hematuria was present in a majority of both groups. Computed tomography (CT) cystogram was the most frequent diagnostic modality utilized. Pelvic fracture and intra-abdominal injury were the most commonly associated injuries in both groups. Conclusion Although blunt traumatic BR is extremely rare, BR is associated with high injury severity score, prolonged length of stay and associated injuries. Diagnosis and treatment are essentially identical for both population. All patients with gross hematuria (with or without pelvic fracture), microscopic hematuria with anterior pelvic fracture and pelvic fracture with pelvic fluid on CT scan warrant evaluation with cystography. Intraperitoneal BR and combined intraperitoneal and extraperitoneal BR should be repaired operatively. Most extraperitoneal BR may be treated nonoperatively with transurethral catheter. How to cite this article Tyroch AH, Matlock K. Pediatric and Adult Blunt Traumatic Bladder Rupture: A Comparative Review. Panam J Trauma Crit Care Emerg Surg 2015;4(1):11-15.

Associated Injuries in Traumatic Sternal Fractures: A Review of the National Trauma Data Bank

2013 ◽  
Vol 79 (7) ◽  
pp. 702-705 ◽  
Author(s):  
Tolulope A. Oyetunji ◽  
Hope T. Jackson ◽  
Augustine C. Obirieze ◽  
Danier Moore ◽  
Marc J. Branche ◽  
...  
Keyword(s):  
Injury Severity ◽  
Motor Vehicle ◽  
Cardiac Injury ◽  
Data Bank ◽  
Motor Vehicle Crash ◽  
Associated Injuries ◽  
Severe Injuries ◽  
National Trauma ◽  
National Trauma Data Bank ◽  
Sternal Fractures

Sternal fractures occur infrequently with blunt force trauma. The demographics and epidemiology of associated injuries have not been well characterized from a national trauma database. The National Trauma Data Bank was queried for patients with closed sternal fractures. The demographics were analyzed by age, gender, mechanism and indicators of anatomic and physiologic injuries. Types of commonly associated injuries were also determined. A total of 23,985 records were analyzed. Males accounted for 68.3 per cent and whites 70.9 per cent. Motor vehicle crash was the leading mechanism. More than 56 per cent had severe injuries based on Injury Severity Score (greater than 15) and 17 per cent with Glasgow Coma Score 8 or less. Crude mortality was 7.9 per cent. The majority (57.8%) and approximately one-third (33.7%) of the patients had rib fractures and lung contusions, respectively, 22.0 per cent with closed pneumothorax, 21.6 per cent had a closed thoracic vertebra fracture, 16.9 per cent with lumbar spine fracture, 3.9 per cent with concussion, and blunt cardiac injury in 3.6 per cent. Sternal fractures are usually associated with severe blunt trauma. Lung contusion remains the leading associated injury followed by vertebral spine fractures. Cardiac injuries are less frequent and vascular injuries less so. Mechanism of injury and presence of sternal fractures should alert providers to these potential associated injuries.

scholarly journals Psychological distress following a motor vehicle crash: evidence from a statewide retrospective study examining settlement times and costs of compensation claims

BMJ Open ◽  
2017 ◽  
Vol 7 (9) ◽  
pp. e017515 ◽  
Author(s):  
Rebecca Guest ◽  
Yvonne Tran ◽  
Bamini Gopinath ◽  
Ian D Cameron ◽  
Ashley Craig
Keyword(s):  
At Risk ◽  
Psychological Distress ◽  
Retrospective Study ◽  
Injury Severity ◽  
Motor Vehicle ◽  
Multivariate Logistic Regression Analysis ◽  
Musculoskeletal Injury ◽  
Motor Vehicle Crash ◽  
Insurance Companies ◽  
Vehicle Crash

ObjectiveTo determine whether psychological distress associated with musculoskeletal injuries sustained in a motor vehicle crash (MVC), regardless of time of onset, impacts compensation outcomes such as claim settlement times and costs. Second, to identify factors routinely collected by insurance companies that contribute to psychological distress during the compensation process.DesignStatewide retrospective study.Data sourceAnalysis of the New South Wales statewide (Australia) injury register for MVC survivors who lodged a compensation claim from 2011 to 2013.Participants6341 adults who sustained a musculoskeletal injury and who settled a claim for injury after an MVC. Participants included those diagnosed with psychological distress (n=607) versus those not (n=5734).Main outcome measuresTime to settlement and total costs of claims, as well as socio-demographic and injury characteristics that may contribute to elevated psychological distress, such as socio-economic disadvantage, and injury severity.ResultsPsychological distress in those with a musculoskeletal injury was associated with significantly longer settlement times (an additional 17 weeks) and considerably higher costs (an additional $A41 575.00 or 4.3 times more expensive). Multivariate logistic regression analysis identified risk factors for psychological distress including being female, social disadvantage, unemployment prior to the claim, not being at fault in the MVC, requiring ambulance transportation and rehabilitation as part of recovery.ConclusionsResults provide compelling evidence that psychological distress has an adverse impact on people with musculoskeletal injury as they progress through compensation. Findings suggest that additional resources should be directed toward claimants who are at risk (eg, the socially disadvantaged or those unemployed prior to the claim), the major aim being to reduce risk of psychological distress, such as post-traumatic stress disorder, and associated risk of increased settlement times and claim costs. Prospective studies are now required that investigate treatment strategies for those at risk of psychological distress associated with an MVC.

scholarly journals Isolated Cecal Rupture after Blunt Abdominal Trauma

2020 ◽  
Vol 17 (3) ◽  
Author(s):  
Alemayehu Ginbo Bedada ◽  
Elijah Wade Riddle ◽  
Alemayehu Bekele Eshetu ◽  
Georges Azzie
Keyword(s):  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
High Speed ◽  
Motor Vehicle ◽  
Right Hemicolectomy ◽  
Motor Vehicle Crash ◽  
Hiv Positive ◽  
Colon Anastomosis ◽  
Hollow Viscus ◽  
Superficial Wound

Cecal perforation following blunt abdominal trauma is an uncommon and challenging injury. We report a 19-year-old HIV-positive woman who presented with abdominal pain after a high-speed motor vehicle crash. Abdominal exam revealed a seatbelt sign with evidence of peritonitis; Focused Assessment with Sonography for Trauma showed free intraperitoneal fluid. After fluid resuscitation and antibiotics, the patient was taken for urgent laparotomy. Intraoperatively, we discovered hemoperitoneum and an isolated rupture of the cecum. A right hemicolectomy with end-to-end ileo-transverse colon anastomosis was performed. Her only significant postoperative complication was a superficial wound infection. We review the epidemiology of hollow viscus injury in blunt trauma and discuss important considerations in diagnosis and treatment. Keywords: Blunt abdominal trauma, Cecal rupture, HIV positive, Hollow viscus

An Injury Severity-, Time Sensitivity-, and Predictability-Based Advanced Automatic Crash Notification Algorithm Improves Motor Vehicle Crash Occupant Triage

2016 ◽  
Vol 222 (6) ◽  
pp. 1211-1219.e6 ◽  
Author(s):  
Joel D. Stitzel ◽  
Ashley A. Weaver ◽  
Jennifer W. Talton ◽  
Ryan T. Barnard ◽  
Samantha L. Schoell ◽  
...  
Keyword(s):  
Injury Severity ◽  
Motor Vehicle ◽  
Motor Vehicle Crash ◽  
Vehicle Crash ◽  
Time Sensitivity

scholarly journals The assessment of clinical evaluation and treatment results of high-energy blunt polytrauma patients

Medicina ◽  
2007 ◽  
Vol 43 (2) ◽  
pp. 137 ◽  
Author(s):  
Algimantas Pamerneckas ◽  
Andrei Pijadin ◽  
Giedrius Pilipavičius ◽  
Gintaras Tamulaitis ◽  
Vytautas Toliušis ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Hospital Stay ◽  
Injury Severity ◽  
Motor Vehicle ◽  
High Energy ◽  
Ventilation Time ◽  
Polytrauma Patients ◽  
The Mean

The aim of this study was to evaluate the mechanism of high-energy blunt trauma, age and gender of patients, severity of regional and multiple injury, ventilation time, length of stay in intensive care unit and in-hospital stay, in-hospital complications, and treatment outcome. Materials and methods. Data on 159 patients with severe multiple injuries, meeting inclusion criteria, were collected prospectively and evaluated retrospectively. Results. The mean age of multiple trauma patients was 43.9±1.4 years; males were injured 2.5 times more often than females (P<0.001). More than half (66.7%) of patients were 17–64-year-old males. Majority (83%) of all patients were injured in motor vehicle crashes, and 52.2% of these patients were pedestrians. The mean Injury Severity Score was 29.5±0.8, and severe (Abbreviated Injury Scale score of 3 and more) injuries of extremities, head, and chest made up 69.1% of all injuries. The mean ventilation time, mean length of stay in intensive care unit, and mean in-hospital stay were 5.5±0.7, 7.0±0.8, and 23.6±1.6 days, respectively. Acute lung complications were the most common (25.2%). Systemic inflammatory response syndrome developed in 7.5% of patients, and sepsis in 3.8% of patients. More than one-fifth (20.8%) of polytrauma patients died. Conclusions. Working-age male pedestrians (17–64 years old) made up two-thirds of all polytrauma patients. Severe injuries of extremities, head, and chest were present in 69.1% of all cases. Lung complications were the most common.

scholarly journals Simple repair is sufficient for most injuries to the duodenum - a case series of 23 patients

2016 ◽  
Vol 12 (1) ◽  
Author(s):  
Munir Ahmad Rathore ◽  
Syed Muzahir Najfi ◽  
Muhammad Farooq Afzal ◽  
Abdul Majeed Chaudhry
Keyword(s):  
Injury Severity ◽  
Primary Repair ◽  
Time Lag ◽  
Case Series ◽  
Operation Time ◽  
Associated Injuries ◽  
Hollow Viscus ◽  
Senior Registrar ◽  
Duodenal Injuries ◽  
Simple Repair

Background: Duodenal injury is the most important hollow viscus injury in the abdomen. The study analysed the outcome of duodenal injuries at the unit. Patients & Methods: Prospectively collected data on a case series involving 23 patients over 3 years. It involved demographic details, part of duodenum injured, injury severity according to the AAST, injury-operation time lag, mode of repair, and the extent of significant associated injuries. Results: M:F ratio was 4.75:1. Mean age 33yrs. Patients with non-perforating injury were excluded. All were operated by a senior registrar or senior. 7/23 were blunt, 13/23 firearm & 3/23 stab injuries. D2 was involved in 87%. Injury severity was graded according to AAST (American Association for Surgery of Trauma). 17/23 were Grade II/III, 3 Grade IV & 3 Grade V injuries. Four had injury-operation lag of >18hrs. Two injuries were missed. All injuries up to Grade IV had simple repair. Two of them had T-tube duodenostomy. None had pyloric exclusion. Complex repairs wer e required for 3/23 patients. Five patients died, as a result of associated insults. One delayed repair developed duodenal fistula. Intra-abdominal abscess, septicaemia and wound dehiscence were seen in two patients each. Duodenum-related mortality was zero. Adverse prognostic factors towards morbidity were injury severity >GIII and injury-operation lag >18hrs. The mortality was related to associated injuries. Conclusion: Primary repair is sufficient for most non-resectional duodenal injuries.

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