CT Chest with IV Contrast Compared with CT Angiography after Blunt Trauma

Blunt aortic injury (BAI) after chest trauma is a potentially lethal condition that requires rapid diagnosis for appropriate treatment. We compared CT with IV contrast (CTI) with CT with angiography (CTA) during the initial phase of care at an urban Level I trauma center from January 1, 2010 to December 31, 2013. Overall, 281 patients met inclusion criteria with 167 (59%) CTI and 114 (41%) CTA. There were no differences between cohorts in age, gender, initial heart rate, systolic blood pressure, and Glasgow Coma Scale. Mortality rates were similar for CTI and CTA (4% vs 8%, P = 0.20). CTI identified any chest injury in 54 per cent of patients compared with 46 per cent with CTA ( P = 0.05). The rate of BAI was similar with CTI and CTA (2% vs 2%, P = 0.80), and neither modality was falsely negative. We conclude that CTI and CTA are similar at evaluating trauma patients for BAI, although CTI may be preferable during the initial assessment phase because the contrast injection may be combined with abdominal scanning and image time is reduced when whole-body CT is required.

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CT Chest with IV Contrast Compared with CT Angiography after Blunt Trauma

The American Surgeon ◽

10.1177/000313481608200122 ◽

2016 ◽

Vol 82 (1) ◽

pp. 41-45 ◽

Cited By ~ 2

Author(s):

Andrea A. Zaw ◽

Donovan Stewart ◽

Jason S. Murry ◽

David M. Hoang ◽

Beatrice Sun ◽

...

Keyword(s):

Blunt Trauma ◽

Chest Trauma ◽

Aortic Injury ◽

Initial Evaluation ◽

Whole Body ◽

Initial Assessment ◽

Trauma Patients ◽

Intravenous Contrast ◽

Whole Body Ct ◽

Level I

Blunt aortic injury (BAI) after chest trauma is a potentially lethal condition. Rapid diagnosis is important to appropriately treat patients. The purpose of this study was to compare CT with intravenous contrast (CTI) to CT with angiography (CTA) in the initial evaluation of blunt chest trauma patients. This was a retrospective review of all blunt trauma patients who received a CTI or CTA during the initial evaluation at an urban Level I trauma center from January 1, 2010 to December 31, 2013. Two-hundred and eighty-one trauma patients met inclusion criteria. Most, 167/281 (59%) received CTI and 114/281 (41%) received CTA. There were no differences between cohorts in age, gender, initial heart rate, systolic blood pressure, and Glasgow Coma Scale in emergency department. Mortality rates were similar for CTI and CTA (4% vs 8%, P = 0.20). CTI identified an injury in 54 per cent compared with 46 per cent in CTA ( P = 0.05). Overall, 2 per cent of patients had BAI with similar rates in CTI and CTA (2% vs 2%, P = 0.80). BAI was not missed using either CTI or CTA. Trauma patients studied with CTI had similar diagnostic findings as CTA. CTI may be preferable to CTA during the initial assessment for possible BAI because of a single contrast injection for whole body CT.

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Usefulness of Pelvic Radiographs in the Initial Trauma Evaluation with Concurrent CT: Is Additional Radiation Exposure Necessary?

International Journal of Pediatrics ◽

10.1155/2018/6260954 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Anne K. Misiura ◽

Autumn D. Nanassy ◽

Jacqueline Urbine

Keyword(s):

Trauma Center ◽

Pediatric Trauma ◽

Trauma Patients ◽

Additional Information ◽

Pelvic Radiographs ◽

Pelvic Radiograph ◽

Digital Radiograph ◽

Urban Level ◽

Level I ◽

Pediatric Trauma Center

Trauma patients in a Level I Pediatric Trauma Center may undergo CT of the abdomen and pelvis with concurrent radiograph during initial evaluation in an attempt to diagnose injury. To determine if plain digital radiograph of the pelvis adds additional information in the initial trauma evaluation when CT of the abdomen and pelvis is also performed, trauma patients who presented to an urban Level I Pediatric Trauma Center between 1 January 2010 and 7 February 2017 in whom pelvic radiograph and CT of the abdomen and pelvis were performed within 24 hours of each other were analyzed. A total of 172 trauma patients had pelvic radiograph and CT exams performed within 24 hours of each other. There were 12 cases in which the radiograph missed pelvic fractures seen on CT and 2 cases in which the radiograph suspected a fracture that was not present on subsequent CT. Furthermore, fractures in the pelvis were missed on pelvic radiographs in 12 of 35 cases identified on CT. Sensitivity of pelvic radiograph in detecting fractures seen on CT was 65.7% with a 95% confidence interval of 47.79-80.87%. Results suggest that there is no added diagnostic information gained from a pelvic radiograph when concurrent CT is also obtained, a practice which exposes the pediatric trauma patient to unnecessary radiation.

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Plain Radiography May Be Safely Omitted for Selected Major Trauma Patients Undergoing Whole Body CT: Database Study

Emergency Medicine International ◽

10.1155/2012/432537 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5 ◽

Cited By ~ 6

Author(s):

Sarah Hudson ◽

Adrian Boyle ◽

Stephanie Wiltshire ◽

Lisa McGerty ◽

Sara Upponi

Keyword(s):

Major Trauma ◽

Research Network ◽

Whole Body ◽

Trauma Patients ◽

X Rays ◽

Database Study ◽

Primary Survey ◽

Whole Body Ct ◽

Plain Films ◽

Body Ct

Introduction. Whole body CT is being used increasingly in the primary survey of major trauma patients. We evaluated whether omitting plain films of the chest and pelvis in the primary survey was safe. We compared the probability of survival of patients and time to CT who had plain X-rays to those who did not.Method. We performed a database study on major trauma patients admitted between 2008 and 2010 using data from Trauma, Audit and Research Network (TARN) and our PACS system. We included adult major trauma patients who has an ISS of greater than 15 and underwent whole body CT.Results. 245 patients were included in the study. 44 (17.9%) did not undergo plain films. The median time to whole body CT from the time of admission was longer (47 minutes) in patients having plain films, than those who did not have plain films performed (30 minutes),P<0.005. Mortality was increased in the group who received plain films, 9.5% compared to 4.5%, but this was not statistically significant (P=0.77).Conclusion. We conclude that plain films may be safely omitted during the primary survey of selected major trauma patients.

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Can We Decrease the Number of Trauma Patients ‘Missing in Action'? A Prospective Pilot Intervention to Improve Trauma Patient Compliance with Outpatient Follow-up at an Urban Level I Trauma Center

The American Surgeon ◽

10.1177/000313481408000134 ◽

2014 ◽

Vol 80 (1) ◽

pp. 96-98 ◽

Cited By ~ 5

Author(s):

Adil H. Haider ◽

Ronald H. Figura ◽

Karim Ladha ◽

Marla Johnston ◽

Kathy M. Noll ◽

...

Keyword(s):

Trauma Patient ◽

Patient Compliance ◽

Trauma Center ◽

Trauma Patients ◽

Urban Level ◽

Level I ◽

Missing In Action ◽

Pilot Intervention

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Is Whole Body CT Safe and Cost Effective in Managing MT (Major Trauma) Patients in the Emergency Department (ED)?

Journal of Emergency Medicine ◽

10.1016/j.jemermed.2012.09.119 ◽

2012 ◽

Vol 43 (5) ◽

pp. 939

Author(s):

M. Majeed ◽

D. Yeo ◽

J. Kayani

Keyword(s):

Emergency Department ◽

Major Trauma ◽

Cost Effective ◽

Whole Body ◽

Trauma Patients ◽

Whole Body Ct ◽

Body Ct

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Percutaneous Tracheostomy under Bronchoscopic Visualization Does Not Affect Short-Term or Long-Term Complications

The American Surgeon ◽

10.1177/000313481708300723 ◽

2017 ◽

Vol 83 (7) ◽

pp. 696-698 ◽

Cited By ~ 1

Author(s):

Thomas S. Easterday ◽

Joshuaw Moore ◽

Meredith H. Redden ◽

David V. Feliciano ◽

Vernon J. Henderson ◽

...

Keyword(s):

Trauma Registry ◽

Percutaneous Tracheostomy ◽

Trauma Patients ◽

Complication Rates ◽

Short Term ◽

Significant Difference ◽

Urban Level ◽

Level I ◽

Bronchoscopic Guidance

Percutaneous tracheostomy is a safe and effective bedside procedure. Some advocate the use of bronchoscopy during the procedure to reduce the rate of complications. We evaluated our complication rate in trauma patients undergoing percutaneous tracheostomy with and without bronchoscopic guidance to ascertain if there was a difference in the rate of complications. A retrospective review of all tracheostomies performed in critically ill trauma patients was performed using the trauma registry from an urban, Level I Trauma Center. Bronchoscopy assistance was used based on surgeon preference. Standard statistical methodology was used to determine if there was a difference in complication rates for procedures performed with and without the bronchoscope. From January 2007, to April 2016, 649 patients underwent modified percuteaneous tracheostomy; 289 with the aid of a bronchoscope and 360 without. There were no statistically significant differences in any type of complication regardless of utilization of a bronchoscope. The addition of bronchoscopy provides several theoretical benefits when performing percutaneous tracheostomy. Our findings, however, do not demonstrate a statistically significant difference in complications between procedures performed with and without a bronchoscope. Use of the bronchoscope should, therefore, be left to the discretion of the performing physician.

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Association of Scapular Fractures and Blunt Thoracic Aortic Injury: Fact or Fiction?

The American Surgeon ◽

10.1177/000313480507100110 ◽

2005 ◽

Vol 71 (1) ◽

pp. 54-57 ◽

Cited By ~ 2

Author(s):

Carlos V.R. Brown ◽

George Velmahos ◽

Dennis Wang ◽

Susan Kennedy ◽

Demetrios Demetriades ◽

...

Keyword(s):

Los Angeles ◽

Blunt Trauma ◽

Medical Center ◽

Aortic Injury ◽

Trauma Patients ◽

Associated Injuries ◽

Blunt Thoracic Aortic Injury ◽

Scapular Fractures ◽

Thoracic Aortic Injury ◽

Level I

It is classically taught that scapular fractures (SF) are commonly associated with blunt thoracic aortic injury (BTAI). The purpose of this study was to determine the association between SF and BTAI. A 10-year retrospective review of blunt trauma admissions from two level I trauma centers located in different geographic regions, Washington Hospital Center (WHC) and Los Angeles County Medical Center and the University of Southern California (LAC/USC), was performed. Patients with SF and BTAI were identified, and records were reviewed to determine associated injuries. We identified 35,541 blunt trauma admissions (WHC: 12,971, LAC/USC: 22,570). SF and BTAI occurred in 1.1 per cent and 0.6 per cent of patients, respectively. Most of the patients with SF had associated injuries (99%). Only four patients with SF had BTAI (4/392; 1.0%). The most common injuries associated with SF were rib (43%), lower extremity (36%), and upper extremity (33%) fractures. SF is uncommon after blunt trauma. Patients with SF almost always have significant associated injuries. Although SF indicates a high amount of energy transmitted to the upper thorax, these patients rarely have BTAI. SF should not be used as an indicator of possible BTAI.

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Prevalence and outcome of contrast-induced nephropathy in major trauma patients

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-020-01496-w ◽

2020 ◽

Author(s):

Julian Alexander Kelemen ◽

Alexander Kaserer ◽

Kai Oliver Jensen ◽

Philipp Stein ◽

Burkhardt Seifert ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Independent Risk Factor ◽

Major Trauma ◽

Whole Body ◽

Trauma Patients ◽

Contrast Induced Nephropathy ◽

Whole Body Ct ◽

Contrast Enhanced ◽

Body Ct

Abstract Background Contrast-induced nephropathy (CIN) has been well investigated in patients undergoing coronary angiography, but not in trauma patients. The main aim of this study was to determine the prevalence and to investigate independent risk factors for the development of CIN. Methods Between 2008 and 2014, all pre-hospital intubated major trauma patients with documented serum creatinine levels (SCr) undergoing a contrast-enhanced whole-body CT at admission were retrospectively analyzed. CIN was defined as a relative increase in SCr > 25% over the baseline value or an absolute SCr increase of > 44 µmol/l within 72 h. Univariate and multivariable regression analyses were performed to identify significant risk factors. A p value of < 0.01 was considered statistically significant and a p value of 0.01–0.049 suggested evidence. Results Of 284 analyzed patients, 41 (14%) met the criteria for CIN. There is suggestive evidence that age and lactate level influenced the development of CIN. Six patients (15%) had hemodialysis in the CIN-group and eight (3.3%) in the group without CIN. Complication and mortality rate was higher in patients with CIN (71% vs. 56% and 32% vs. 23%, respectively). CIN was not an independent risk factor for complications or mortality while controlling for age, gender, injury severity score, and lactate level. The length of stay was not affected by CIN. Conclusion CIN occurs frequently in trauma patients, but is not an independent risk factor for complications or mortality. Therefore, contrast enhanced whole-body CT can safely be performed in trauma patients.

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