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

2016 ◽  
Vol 82 (1) ◽  
pp. 41-45 ◽  
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.

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

2015 ◽  
Vol 81 (10) ◽  
pp. 1080-1083
Author(s):  
Andrea A. Zaw ◽  
Donovan Stewart ◽  
Jason S. Murry ◽  
David M. Hoang ◽  
Beatrice Sun ◽  
...  
Keyword(s):  
Chest Trauma ◽  
Aortic Injury ◽  
Whole Body ◽  
Initial Assessment ◽  
Trauma Patients ◽  
Inclusion Criteria ◽  
Whole Body Ct ◽  
Appropriate Treatment ◽  
Urban Level ◽  
Level I

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.

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

2005 ◽  
Vol 71 (1) ◽  
pp. 54-57 ◽  
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.

Repairing the injured bronchus in blunt chest trauma – A case series

Trauma ◽  
2021 ◽  
pp. 146040862098811
Author(s):  
Anith Nadzira Riduan ◽  
Narasimman Sathiamurthy ◽  
Benedict Dharmaraj ◽  
Diong Nguk Chai ◽  
Narendran Balasubbiah
Keyword(s):  
Blunt Trauma ◽  
Chest Trauma ◽  
Surgical Intervention ◽  
Case Series ◽  
Trauma Patients ◽  
Lung Collapse ◽  
Comprehensive Management ◽  
Lung Capacity ◽  
Management Algorithm ◽  
Operative Outcomes

Introduction Traumatic bronchial injury (TBI) is uncommon, difficult to diagnose and often missed. The incidence of TBI among blunt trauma patients is estimated to be around 0.5–2%. Bronchoplastic surgery is indicated in most cases to repair the tracheobronchial airway and preserve lung capacity. There is limited existing literature addressing the management of this condition in view of its rarity. The comprehensive management and outcomes of these patients are discussed. Methods The case notes of all patients who presented with persistent lung collapse due to trauma since July 2017 were reviewed retrospectively. Those patients requiring surgical intervention were included in the review. The mode of injury, clinical, radiological and bronchoscopy findings, concurrent injuries, type of surgery, length of stay (LOS) and operative outcomes were reviewed. Results Out of 11 patients who presented with persistent lung collapse post-blunt trauma, four (36%) were found to have structural bronchial disruption. All of them underwent successful repair of the injured bronchus, without the need of a pneumonectomy. The other seven patients were successfully treated conservatively. Conclusion The repair of the injured bronchus is essential in improving respiratory function and to prevent a pneumonectomy. Routine bronchoscopic evaluation should be performed for all suspected airway injuries as recommended in our management algorithm. Delayed presentations should not hinder urgent referral to thoracic centers for tracheobronchial reconstruction.

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

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
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.

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

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.

scholarly journals Whole-body CT-based imaging algorithm for multiple trauma patients: radiation dose and time to diagnosis

2015 ◽  
Vol 88 (1047) ◽  
pp. 20140616 ◽  
Author(s):  
S Gordic ◽  
H Alkadhi ◽  
S Hodel ◽  
H-P Simmen ◽  
M Brueesch ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Multiple Trauma ◽  
Whole Body ◽  
Trauma Patients ◽  
Imaging Algorithm ◽  
Whole Body Ct ◽  
Time To Diagnosis ◽  
Multiple Trauma Patients ◽  
Body Ct
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