Through Thick or Thin: Disparities in Perioperative Anticoagulant Use in Trauma Patients

2019 ◽  
Vol 85 (9) ◽  
pp. 1040-1043 ◽  
Author(s):  
Anna Romagnoli ◽  
Joseph Dubose ◽  
David Feliciano
Keyword(s):  
Practice Patterns ◽  
Meta Analysis ◽  
Traumatic Injury ◽  
Consensus Conference ◽  
Trauma Patients ◽  
Peripheral Artery ◽  
Perioperative Anticoagulation ◽  
Peripheral Arterial ◽  
Contemporary Practice ◽  
Trauma Surgeons

Although vascular surgery guidelines recommend immediate anticoagulation for acute occlusion of a peripheral artery, it is unclear whether trauma surgeons follow this practice. A survey regarding the use of perioperative anticoagulation was sent to surgeons who perform their own peripheral arterial repairs after traumatic injury to define contemporary practice patterns. This survey demonstrated minimal consensus opinion regarding the management of extremity vascular injuries, strongly suggesting the need for a consensus conference, meta-analysis, and prospective studies to guide further care.

scholarly journals FREE PERITONEAL FLUID IN TRAUMA PATIENTS: THE PARADIGM SHIFT

2015 ◽  
Vol 2 (1) ◽  
pp. 3-8
Author(s):  
I. Negoi ◽  
S. Păun ◽  
S. Hostiuc ◽  
B. Stoica ◽  
I. Tănase ◽  
...  
Keyword(s):  
Peritoneal Fluid ◽  
Head Injuries ◽  
Univariate Analysis ◽  
Traumatic Injury ◽  
Preoperative Imaging ◽  
Trauma Patients ◽  
Conversion To Open Surgery ◽  
Associated Lesions ◽  
Trauma Surgeons ◽  
Free Peritoneal Fluid

Trauma surgeons are confronted nowadays with various abdominal injuries, with a more and more increased severity, secondary to urban violence and traffic related accidents. We aim to better define the prognostic value of post-traumatic hemoperitoneum (PTH) in the nowadays era of nonoperative management of abdominal lesions, and to correlate it with the current pattern of traumatic injuries. Retrospective study of patients admitted during 24 months. Selections criteria: (1) Traumatic injury; (2) Free peritoneal fluid on preoperative imaging; (3) Surgical exploration of the abdomen. Setting: A level I trauma center. Results: There were 64 patients, with two peak frequencies between 18-35 and 50-70 years old. Abdominal wall ecchymoses were found in 36 (55%) of cases. Out of 64 cases 37 (58.7%) were transportation related, 12 (19%) caused by human aggression and 10 (16.9%) by falls. According to the Trauma Score (TS) there were 50 (78.2%) cases with TS between 14-16, 9 (17.2%) between 10 –13 and 3 (4.8%) with TS <9. More frequent extraabdominal associated lesions were: head injuries – 38 (58.5%), thoracic trauma – 34 (52.3%), orthopedic injuries – 24 (36.9%). Diagnostic peritoneal lavage was performed in 5 (7.8%) cases. FAST has a sensibility of 70.21% and CT scan a sensibility of 100%. Most frequent injured abdominal organs were the spleen – 36 (56.25%), liver 17 (26.56%) and mesentery 14 (21.87%). Laparotomy was performed in 59 (92.2%) of cases, laparoscopy in 2 (3.1%) of cases and conversion to open surgery in 3 (4.7%) cases. Mortality was 23.43%. We observed several predictive factors for mortality on univariate analysis: haemoglobin < 8g/dl (p=0.02), haematocrits < 25% (p=0.01), hemoperitoneum > 1500 ml (p=0.04), colonic trauma (p=0.001), head (p=0.01) and thoracic injuries (p=0.04). Dedicated trauma surgeons should balance between trauma kinetics details, patients’ clinical examination, and diagnostic workup, in an effort to decrease morbidity and mortality secondary to missed injuries or unnecessary laparotomies.

scholarly journals SAFETY AND EFFICACY OF DRUG COATED BALLOON ANGIOPLASTY FOR PERIPHERAL ARTERY REVASCULARIZATION. A META-ANALYSIS

2021 ◽  
Vol 77 (18) ◽  
pp. 1150
Author(s):  
Waqas Ullah ◽  
Mohamed Zghouzi ◽  
Bachar Ahmad ◽  
Yasar Sattar ◽  
Zeeshan Sattar ◽  
...  
Keyword(s):  
Balloon Angioplasty ◽  
Meta Analysis ◽  
Peripheral Artery ◽  
Safety And Efficacy ◽  
Drug Coated Balloon

scholarly journals Effectiveness of trauma care systems at different stages of development in reducing mortality: a systematic review and meta-analysis protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e047439
Author(s):  
Rayan Jafnan Alharbi ◽  
Virginia Lewis ◽  
Sumina Shrestha ◽  
Charne Miller
Keyword(s):  
Systematic Review ◽  
Trauma Care ◽  
Data Extraction ◽  
Meta Analysis ◽  
Trauma System ◽  
Secondary Data ◽  
Trauma Centre ◽  
Trauma Patients ◽  
Trauma Systems ◽  
Stages Of Development

IntroductionThe introduction of trauma systems that began in the 1970s resulted in improved trauma care and a decreased rate of morbidity and mortality of trauma patients. Worldwide, little is known about the effectiveness of trauma care system at different stages of development, from establishing a trauma centre, to implementing a trauma system and as trauma systems mature. The objective of this study is to extract and analyse data from research that evaluates mortality rates according to different stages of trauma system development globally.Methods and analysisThe proposed review will comply with the checklist of the ‘Preferred reporting items for systematic review and meta-analysis’. In this review, only peer-reviewed articles written in English, human-related studies and published between January 2000 and December 2020 will be included. Articles will be retrieved from MEDLINE, EMBASE and CINAHL. Additional articles will be identified from other sources such as references of included articles and author lists. Two independent authors will assess the eligibility of studies as well as critically appraise and assess the methodological quality of all included studies using the Cochrane Risk of Bias for Non-randomised Studies of Interventions tool. Two independent authors will extract the data to minimise errors and bias during the process of data extraction using an extraction tool developed by the authors. For analysis calculation, effect sizes will be expressed as risk ratios or ORs for dichotomous data or weighted (or standardised) mean differences and 95% CIs for continuous data in this systematic review.Ethics and disseminationThis systematic review will use secondary data only, therefore, research ethics approval is not required. The results from this study will be submitted to a peer-review journal for publication and we will present our findings at national and international conferences.PROSPERO registration numberCRD42019142842.

scholarly journals How Can a Deep Learning Algorithm Improve Fracture Detection on X-rays in the Emergency Room?

2021 ◽  
Vol 7 (7) ◽  
pp. 105
Author(s):  
Guillaume Reichert ◽  
Ali Bellamine ◽  
Matthieu Fontaine ◽  
Beatrice Naipeanu ◽  
Adrien Altar ◽  
...  
Keyword(s):  
Deep Learning ◽  
Emergency Room ◽  
Learning Algorithm ◽  
Traumatic Injury ◽  
Diagnostic Tools ◽  
Appendicular Skeleton ◽  
Trauma Patients ◽  
X Rays ◽  
Fracture Detection ◽  
Local Data

The growing need for emergency imaging has greatly increased the number of conventional X-rays, particularly for traumatic injury. Deep learning (DL) algorithms could improve fracture screening by radiologists and emergency room (ER) physicians. We used an algorithm developed for the detection of appendicular skeleton fractures and evaluated its performance for detecting traumatic fractures on conventional X-rays in the ER, without the need for training on local data. This algorithm was tested on all patients (N = 125) consulting at the Louis Mourier ER in May 2019 for limb trauma. Patients were selected by two emergency physicians from the clinical database used in the ER. Their X-rays were exported and analyzed by a radiologist. The prediction made by the algorithm and the annotation made by the radiologist were compared. For the 125 patients included, 25 patients with a fracture were identified by the clinicians, 24 of whom were identified by the algorithm (sensitivity of 96%). The algorithm incorrectly predicted a fracture in 14 of the 100 patients without fractures (specificity of 86%). The negative predictive value was 98.85%. This study shows that DL algorithms are potentially valuable diagnostic tools for detecting fractures in the ER and could be used in the training of junior radiologists.

scholarly journals Accuracy of Contrast Extravasation on Computed Tomography for Diagnosing Severe Pelvic Hemorrhage in Pelvic Trauma Patients: A Meta-Analysis

Medicina ◽  
2021 ◽  
Vol 57 (1) ◽  
pp. 63
Author(s):  
Sung Nam Moon ◽  
Jung-Soo Pyo ◽  
Wu Seong Kang
Keyword(s):  
Computed Tomography ◽  
Meta Analysis ◽  
Characteristic Curve ◽  
Pelvic Trauma ◽  
Test Accuracy ◽  
Trauma Patients ◽  
Positive Finding ◽  
Summary Receiver Operating Characteristic ◽  
Contrast Extravasation ◽  
Pelvic Hemorrhage

Background and objective: The early detection of underlying hemorrhage of pelvic trauma has been a critical issue. The aim of this study was to systematically determine the diagnostic accuracy of computed tomography (CT) for detecting severe pelvic hemorrhage. Materials and Methods: Relevant articles were obtained by searching PubMed, EMBASE, and Cochrane databases through 28 November 2020. Diagnostic test accuracy results were reviewed to obtain the sensitivity, specificity, diagnostic odds ratio, and summary receiver operating characteristic curve of CT for the diagnosis in pelvic trauma patients. The positive finding on CT was defined as the contrast extravasation. As the reference standard, severe pelvic hemorrhage was defined as an identification of bleeding at angiography or by direct inspection using laparotomy that required hemostasis by angioembolization or surgery. A subgroup analysis was performed according to the CT modality that is divided by the number of detector rows. Result: Thirteen eligible studies (29 subsets) were included in the present meta-analysis. Pooled sensitivity of CT was 0.786 [95% confidence interval (CI), 0.574–0.909], and pooled specificity was 0.944 (95% CI, 0.900–0.970). Pooled sensitivity of the 1–4 detector row group and 16–64 detector row group was 0.487 (95% CI, 0.215–0.767) and 0.915 (95% CI, 0.848–0.953), respectively. Pooled specificity of the 1–4 and 16–64 detector row groups was 0.956 (95% CI, 0.876–0.985) and 0.906 (95% CI, 0.828–0.951), respectively. Conclusion: Multi-detector CT with 16 or more detector rows has acceptable high sensitivity and specificity. Extravasation on CT indicates severe hemorrhage in patients with pelvic trauma.

Impact of lipoprotein(a) levels on angiographic severity of femoropopliteal lesions

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Yanaka ◽  
H Akahori ◽  
T Imanaka ◽  
K Miki ◽  
N Yoshihara ◽  
...  
Keyword(s):  
De Novo ◽  
Independent Predictor ◽  
Lesion Length ◽  
Peripheral Artery ◽  
Lipoprotein A ◽  
Class D ◽  
Artery Disease ◽  
Peripheral Arterial ◽  
The Impact ◽  
Severe Calcification

Abstract Background High lipoprotein(a) [Lp(a)] levels are a risk factor for peripheral artery disease (PAD). However, the association between Lp(a) levels and angiographic severity of PAD has not been systematically studied. Purpose The aim of this study was to assess the impact of Lp(a) levels on angiographic severity of femoropopliteal lesions in patients with PAD. Methods We retrospectively analyzed a single-center database including 108 patients (74±8 years, 69% male) who underwent endovascular therapy for de novo femoropopliteal lesions and measured Lp(a) levels before therapy between June 2016 and September 2019. Patients were divided into low Lp(a) [LP(a) &lt;30 mg/dL; 77 patients] and high Lp(a) [LP(a) ≥30 mg/dL; 31 patients] groups. Trans-Atlantic Inter-Society Consensus (TASC) II classification, calcification [referring to peripheral arterial calcium scoring system (PACSS) classification] and lesion length were compared between the groups. Results Median Lp(a) was 16 (7–31) mg/dL.The prevalence of TASC II class D (13% vs 38%, P&lt;0.01) and severe calcification (PACSS 4) (6% vs 23%, P=0.02) was significantly higher and lesion length was longer (123±88 mm vs 175±102 mm, P&lt;0.01) in the high Lp(a) group than in the low Lp(a) group.(Table and Figure) In multivariate analysis, Lp(a)≥30 was an independent predictor for TASC II class D (HR=3.67, P=0.02) and PACSS 4 (HR=4.97, P=0.02) prevalence. Conclusion Lp(a) was associated with angiographic severity of femoropopliteal lesions in patients with PAD. Comparison of angiographic severity Funding Acknowledgement Type of funding source: None

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