The Value of Abdominal and Pelvic CT Scan in Trauma Patients With Low Injury Severity Score and High Glasgow Coma Scale

2021 ◽  
pp. 000313482110474
Author(s):  
Tarik Wasfie ◽  
Daniel Rivera ◽  
Mursal Naisan ◽  
Shelby Zaremba ◽  
Mikayla Depuydt ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Glasgow Coma Scale ◽  
Physical Examination ◽  
Injury Severity ◽  
Surgical Intervention ◽  
Trauma Patients ◽  
Ct Findings ◽  
Group A ◽  
Fast Exam ◽  
Group B

Introduction Computed tomography scans became the mainstay of emergency department (ED) evaluation of trauma patients including those with a high Glasgow Coma Scale (GCS) and a low Injury Severity Score (ISS). We elected to find the value of abdominal and pelvic CT in patients with negative physical examination and Focused Assessment of Sonography for Trauma (FAST) on arrival to the ED. Methods This study is a retrospective analysis of 901 consecutive patients from 2017 to 2019 who presented to the ED with level 2 and 3 activation criteria. Each patient received a physical examination, CT abdomen and pelvis, and FAST exam. Data were collected on external factor including GCS, ISS, age, sex, comorbidities, anticoagulation use, and surgical intervention. The patients were divided into 2 groups, Group A and B. Group A consisted of patients with a negative physical exam, FAST, and CT result. Group B included patients with a negative physical exam and FAST exam with positive CT findings. Statistical analysis was done using a Student’s t-test and chi-square test for significance value of P < .05. Institutional Review Board approval was obtained for this study. Results A total of 901 patients were analyzed which included 489 (54.3%) male and 412 (45.7%) female with a mean age of 56.2 (SD = 22.62) years. Out of the 901 patients, 461 patients received a physical, FAST, and CT exam. Group A consisted of 442 (95.9%) patients and Group B had 19 (4.1%) patients. Both groups were similar in GCS and ISS scoring with no significance difference in age, sex, comorbidities, and anticoagulation use. There was a significant difference in the ICU and hospital mean length of stay when CT scan was positive [2 (SD = 4.23) days vs. .6 (SD = 1.33) days with P < .0001 and 4.57 (SD ± 4.17) days vs. 2.5 (SD = 2.00) days with P < .0001, respectively]. The CT findings of the 19 patients in group B consisted of 6 incidentalomas, 5 vertebral compression fractures, 4 pelvic bone fractures, 1 minor liver contusion, 1 non-specific bowel thickening, 1 non-displaced rib fracture, and 1 case of small amount of free fluid in the pelvis. None of the CT findings required surgical intervention. Conclusion Computed tomography of the abdomen and pelvis in trauma patients with high GCS and low ISS with initial negative physical and FAST examination did not provide additional critical information.

Non-Selective Thoracic Computed Tomography in Trauma Patients Results in Injury Severity Score Inflation

2021 ◽  
pp. 000313482110249
Author(s):  
Leonardo Alaniz ◽  
Omaer Muttalib ◽  
Juan Hoyos ◽  
Cesar Figueroa ◽  
Cristobal Barrios
Keyword(s):  
Computed Tomography ◽  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Treatment Plan ◽  
Mortality Prediction ◽  
Trauma Patients ◽  
Mortality Benefit ◽  
Severity Scores ◽  
Score Inflation

Introduction Extensive research relying on Injury Severity Scores (ISS) reports a mortality benefit from routine non-selective thoracic CTs (an integral part of pan-computed tomography (pan-CT)s). Recent research suggests this mortality benefit may be artifact. We hypothesized that the use of pan-CTs inflates ISS categorization in patients, artificially affecting admission rates and apparent mortality benefit. Methods Eight hundred and eleven patients were identified with an ISS >15 with significant findings in the chest area. Patient charts were reviewed and scores were adjusted to exclude only occult injuries that did not affect treatment plan. Pearson chi-square tests and multivariable logistic regression were used to compare adjusted cases vs non-adjusted cases. Results After adjusting for inflation, 388 (47.8%) patients remained in the same ISS category, 378 (46.6%) were reclassified into 1 lower ISS category, and 45 (5.6%) patients were reclassified into 2 lower ISS categories. Patients reclassified by 1 category had a lower rate of mortality ( P < 0.001), lower median total hospital LOS ( P < .001), ICU days ( P < .001), and ventilator days ( P = 0.008), compared to those that remained in the same ISS category. Conclusion Injury Severity Score inflation artificially increases survival rate, perpetuating the increased use of pan-CTs. This artifact has been propagated by outdated mortality prediction calculation methods. Thus, prospective evaluations of algorithms for more selective CT scanning are warranted.

Advantages and limitations of the use of tractography and fMRI in the treatment of anaplastic glioma

2021 ◽  
pp. 32-42
Author(s):  
Igor Aleksandrovich Medyanik ◽  
Simon Quarteng Badu
Keyword(s):  
Neurological Disorders ◽  
Preoperative Diagnosis ◽  
Surgical Intervention ◽  
Complete Resection ◽  
Anaplastic Glioma ◽  
Neurological Deficits ◽  
Neural Pathways ◽  
Histological Subtype ◽  
Group A ◽  
Group B

The possibility of using only tractography as a preoperative diagnosis of anaplastic glioma is limited due to its inability to show the exact functional location of the tumor; therefore, the combination of tractography and fMRI seems to be a more promising complex diagnostic method. In neurooncology, complete resection without or with minimal neurological deficit is the goal of surgical intervention. The aim of the study was to investigate the advantages and limitations of the use of tractography and fMRI in the treatment of anaplastic glioma compared to standard CT or MRI. The study involved 48 patients who were divided into two groups based on the use of fMRI and tractography: group A (24 patients) and without it — group B (24 patients). The groups were compared in terms of age, sex, histological subtype of anaplastic glioma, degree of resection, postoperative complications, and dynamics of neurological disorders. The combination of fMRI and tractography is the best preoperative diagnosis, it is safe and allows localizing neural pathways, preserve them during surgery, and reduce postoperative neurological deficits.

scholarly journals Magnetic resonance imaging and computed tomography of equine cheek teeth and adjacent structures: comparative study of image quality in horses in vivo, post-mortem and frozen-thawed

2019 ◽  
Vol 61 (1) ◽  
Author(s):  
Christin Röttiger ◽  
Maren Hellige ◽  
Bernhard Ohnesorge ◽  
Astrid Bienert-Zeit
Keyword(s):  
Computed Tomography ◽  
Image Quality ◽  
Post Mortem ◽  
Mr Images ◽  
Adjacent Structures ◽  
Group A ◽  
Group B ◽  
The Impact ◽  
Ct And Mri

Abstract Background The use of cadavers for radiology research methodologies involving subjective image quality evaluation of anatomical criteria is well-documented. The purpose of this method comparison study was to evaluate the image quality of dental and adjacent structures in computed tomography (CT) and high-field (3 T) magnetic resonance (MR) images in cadaveric heads, based on an objective four-point rating scale. Whilst CT is a well-established technique, MR imaging (MRI) is rarely used for equine dental diagnostics. The use of a grading system in this study allowed an objective assessment of CT and MRI advantages in portraying equine cheek teeth. As imaging is commonly performed with cadaveric or frozen and thawed heads for dental research investigations, the second objective was to quantify the impact of the specimens’ conditions (in vivo, post-mortem, frozen-thawed) on the image quality in CT and MRI. Results The CT and MR images of nine horses, focused on the maxillary premolar 08s and molar 09s, were acquired post-mortem (Group A). Three observers scored the dental and adjacent tissues. Results showed that MR sequences gave an excellent depiction of endo- and periodontal structures, whereas CT produced high-quality images of the hard tooth and bony tissues. Additional CT and MRI was performed in vivo (Group B) and frozen-thawed (Group C) in three of these nine horses to specify the condition of the best specimens for further research. Assessing the impact of the specimens’ conditions on image quality, specific soft tissues of the maxillary 08s and 09s including adjacent structures (pulps, mucosa of the maxillary sinuses, periodontal ligament, soft tissue inside the infraorbital canal) were graded in group B and C and analysed for significant differences within CT and MR modalities in comparison to group A. Results showed that MRI scores in vivo were superior to the post-mortem and frozen-thawed condition. Conclusions On comparing the imaging performance of CT and MRI, both techniques show a huge potential for application in equine dentistry. Further studies are needed to assess the clinical suitability of MRI. For further research investigations it must be considered, that the best MR image quality is provided in live horses.

Early versus Late Tracheostomy: Is There an Outcome Difference?

2019 ◽  
Vol 85 (4) ◽  
pp. 370-375 ◽  
Author(s):  
Adel Elkbuli ◽  
Raed Ismail Narvel ◽  
Paul J. Spano ◽  
Valerie Polcz ◽  
Astrid Casin ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Glasgow Coma Scale ◽  
Primary Outcome ◽  
Injury Severity ◽  
Future Research ◽  
Trauma Patients ◽  
Early Tracheostomy ◽  
Outcome Difference ◽  
The Impact

The effect of timing in patients requiring tracheostomy varies in the literature. The purpose of this study was to evaluate the impact of early tracheostomy on outcomes in trauma patients with and without traumatic brain injury (TBI). This study is a four-year review of trauma patients undergoing tracheostomy. Patients were divided into two groups based on TBI/non-TBI. Each group was divided into three subgroups based on tracheostomy timing: zero to three days, four to seven days, and greater than seven days postadmission. TBI patients were stratified by the Glasgow Coma Scale (GCS), and non-TBI patients were stratified by the Injury Severity Score (ISS). The primary outcome was ventilator-free days (VFDs). Significance was defined as P < 0.05. Two hundred eighty-nine trauma patients met the study criteria: 151 had TBI (55.2%) versus 138 (47.8%) non-TBI. There were no significant differences in demographics within and between groups. In TBI patients, statistically significant increases in VFDs were observed with GCS 13 to 15 for tracheostomies performed in four to seven versus greater than seven days ( P = 0.005). For GCS <8 and 8 to 12, there were significant increases in VFDs for tracheostomies performed at days 1 to 3 and 4 to 7 versus greater than seven days (P << 0.05 for both). For non-TBI tracheostomies, only ISS ≥ 25 with tracheostomies performed at zero to three days versus greater than seven days was associated with improved VFDs. Early tracheostomies in TBI patients were associated with improved VFDs. In trauma patients with no TBI, early tracheostomy was associated with improved VFDs only in patients with ISS ≥ 25. Future research studies should investigate reasons TBI and non-TBI patients may differ.

scholarly journals A direct correlation between commissural orientation and annular shape in bicuspid aortic valves: a new anatomical and computed tomography classification

2020 ◽  
Vol 30 (5) ◽  
pp. 666-670
Author(s):  
Ilaria Chirichilli ◽  
Francesco Giosuè Irace ◽  
Luca Paolo Weltert ◽  
Andrea Salica ◽  
Lorenzo Guerrieri Wolf ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Aortic Annulus ◽  
Aortic Valves ◽  
Elliptical Shape ◽  
Anatomical Classification ◽  
Bicuspid Aortic Valves ◽  
Group A ◽  
Group B ◽  
Symmetrical Type

Abstract OBJECTIVES The shape of the aortic annulus is still under debate. Recent findings suggest a possible gradual spectrum of circularity from tricuspid aortic valves (TAVs), to type 1 bicuspid aortic valves (BAVs) to type 0 BAVs. BAVs have been recently classified in a symmetrical (type A), asymmetrical (type B) or very asymmetrical (type C) phenotype according to the commissural orientation (CO) (160°–180°, 140°–159° and 120°–139°, respectively). The aim of this study is to verify in BAVs the correlation between the aortic annular shape and the CO of valve cusps and to suggest a new anatomical and geometric classification of BAVs based on CO and annular shape. METHODS We retrospectively selected 191 consecutive patients who underwent both electrocardiography-gated computed tomography scan of the aortic root and transthoracic echocardiography between January 2016 and June 2019. The population was divided into 2 groups: 54 BAVs and 137 TAVs. We analysed the subgroup of BAV patients and divided them into group A, group B and group C depending on the CO. The shape of the aortic annulus was considered ‘circular’ or ‘elliptic’ according to the ellipticity index (EI).We studied the possible correlation between CO and annular shape in BAVs. We also analysed the subgroup of TAV patients studying their annular shape and EI. RESULTS After univariate linear regression, BAV patients showed a significant correlation between the CO and the EI (R = −0, 445, R2 = 0, 198, P = 0.001). As the CO decreases, the EI increases and approaches an elliptical shape. After grouping BAVs according to the CO, a mean EI of 1.10 ± 0.07 was found in group A, 1.13 ± 0.08 in group B, 1.18 ± 0.07 in group C, P = 0.0097 indicating a gradual spectrum of ellipticity with the decrease of CO. TAVs subgroup showed a mean EI of 1.27 ± 0.09, suggesting that the more the CO is reduced in BAVs, the more the annulus probably tends towards the very elliptical shape of TAVs. CONCLUSIONS This study shows a linear correlation between CO and annular shape in BAVs. In particular, the aortic annulus follows a continuous spectrum of ellipticity depending on the CO. These findings lay the groundwork for a new anatomical classification of BAVs based on CO and annular shape.

scholarly journals Readjustment of abdominal computed tomography protocols in a university hospital: impact on radiation dose

2015 ◽  
Vol 48 (5) ◽  
pp. 292-297 ◽  
Author(s):  
Ricardo Francisco Tavares Romano ◽  
Priscila Silveira Salvadori ◽  
Lucas Rios Torres ◽  
Elisa Almeida Sathler Bretas ◽  
Daniel Bekhor ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Radiation Dose ◽  
Clinical Suspicion ◽  
University Hospital ◽  
Abdominal Ct ◽  
Abdominal Computed Tomography ◽  
Computed Tomography Scans ◽  
Group A ◽  
Group B ◽  
Tomography Scan

AbstractObjective:To assess the reduction of estimated radiation dose in abdominal computed tomography following the implementation of new scan protocols on the basis of clinical suspicion and of adjusted images acquisition parameters.Materials and Methods:Retrospective and prospective review of reports on radiation dose from abdominal CT scans performed three months before (group A – 551 studies) and three months after (group B – 788 studies) implementation of new scan protocols proposed as a function of clinical indications. Also, the images acquisition parameters were adjusted to reduce the radiation dose at each scan phase. The groups were compared for mean number of acquisition phases, mean CTDIvol per phase, mean DLP per phase, and mean DLP per scan.Results:A significant reduction was observed for group B as regards all the analyzed aspects, as follows: 33.9%, 25.0%, 27.0% and 52.5%, respectively for number of acquisition phases, CTDIvol per phase, DLP per phase and DLP per scan (p < 0.001).Conclusion:The rational use of abdominal computed tomography scan phases based on the clinical suspicion in conjunction with the adjusted images acquisition parameters allows for a 50% reduction in the radiation dose from abdominal computed tomography scans.

Blunt Cardiac Injury: A Single-Center 15-Year Experience

2020 ◽  
Vol 86 (4) ◽  
pp. 354-361
Author(s):  
Jin-Mou Gao ◽  
Hui Li ◽  
Gong-Bin Wei ◽  
Chao-Pu Liu ◽  
Ding-Yuan Du ◽  
...  
Keyword(s):  
Traffic Accidents ◽  
Early Recognition ◽  
Cardiac Injury ◽  
Shock Rate ◽  
Thoracic Injury ◽  
Trauma Patients ◽  
Myocardial Contusion ◽  
Blunt Cardiac Injury ◽  
Group A ◽  
Group B

In recent years, the incidence of blunt cardiac injury (BCI) has increased rapidly and is an important cause of death in trauma patients. This study aimed to explore early diagnosis and therapy to increase survival. All patients with BCI during the past 15 years were analyzed retrospectively regarding the mechanism of injury, diagnostic and therapeutic methods, and outcome. The patients were divided into two groups according to the needs of their condition—nonoperative (Group A) and operative (Group B). Comparisons of the groups were performed. A total of 348 patients with BCI accounted for 18.3 per cent of 1903 patients with blunt thoracic injury. The main cause of injury was traffic accidents, with an incidence of 48.3 per cent. In Group A (n = 305), most patients sustained myocardial contusion, and the mortality was 6.9 per cent. In Group B (n = 43), including those with cardiac rupture and pericardial hernia, the mortality was 32.6 per cent. Comparisons of the groups regarding the shock rate and mortality were significant ( P < 0.01). Deaths directly resulting from BCI in Group B were greater than those in Group A ( P < 0.05). In all 348 patients, the mortality rate was 10.1 per cent. When facing a patient with blunt thoracic injury, a high index of suspicion for BCI must be maintained. To manage myocardial contusion, it is necessary to protect the heart, alleviate edema of the myocardium, and control arrhythmia with drugs. To deal with those requiring operation, early recognition and expeditious thoracotomy are essential.

COMPARATIVE STUDY OF DECOMPRESSIVE CRANIECTOMY AFTER MASS LESION EVACUATION IN SEVERE HEAD INJURY

Neurosurgery ◽  
2009 ◽  
Vol 64 (5) ◽  
pp. 927-940 ◽  
Author(s):  
Bizhan Aarabi ◽  
Dale C. Hesdorffer ◽  
J. Marc Simard ◽  
Edward S. Ahn ◽  
Carla Aresco ◽  
...  
Keyword(s):  
Head Injury ◽  
Glasgow Coma Scale ◽  
Decompressive Craniectomy ◽  
Mass Lesion ◽  
Icp Monitoring ◽  
Computed Tomographic ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Mass Evacuation

Abstract OBJECTIVE This study was conducted to evaluate outcome after decompressive craniectomy (DC) in the setting of mass evacuation with or without intracranial pressure (ICP) monitoring. METHODS Over a 48-month period (March 2000 to March 2004), 54 of 967 consecutive head injury patients underwent DC for evacuation of a mass lesion. DC was performed without ICP monitoring in 27 patients who required urgent decompression (group A) and in 27 patients who did not require urgent surgery and who had their ICP monitored for 1 to 14 days before surgery (group B). RESULTS In group A, the mean Glasgow Coma Scale score was 6.0; 80% had computed tomographic evidence of a shift greater than 5 mm; and 25 patients underwent DC immediately after resuscitation. In group B, the mean Glasgow Coma Scale score was 7.3; 40% had computed tomographic evidence of shift; and 75% underwent DC 24 hours or longer after presentation. Overall, 22 patients died (12 in group A and 10 in group B), 11 remained vegetative or severely disabled (3 in group A and 8 in group B), and 19 had good recovery (11 in group A and 8 in group B). Two patients were lost to follow-up. In 18 group B patients with ICP greater than 20 mm Hg before mass evacuation, ICP dropped an average of 13 mm Hg (P &lt; 0.001). A mass lesion greater than 50 mL (odds ratio [OR], 2.86; 95% confidence interval [CI], 1.04–7.89) and evidence of low attenuation on computed tomography before (OR, 3.3; 95% CI, 1.1–10.3) or after (OR, 2.92; 95% CI, 1.02–8.34) DC were predictors of death. A good outcome occurred in 42% of patients with and in 63% of patients without delayed traumatic injury (OR, 0.3; 95% CI, 0.1–1.1). Outcome was favorable in 78.6% of patients who had no ICP monitoring before DC versus 47.1% of patients with ICP monitoring (OR, 0.2; 95% CI, 0.1–1.2). CONCLUSION In this study, mortality after DC for mass lesion was greater than expected, and outcome did not differ between patients with or without ICP monitoring.

scholarly journals A Experiência duma Norma de Atuação no Traumatismo Crânio-Encefálico Ligeiro em Idade Pediátrica: Estudo Longitudinal de Três Anos

2017 ◽  
Vol 30 (10) ◽  
pp. 704
Author(s):  
Joana Matias ◽  
Sofia Almeida ◽  
Sofia Ferrito ◽  
Ana Margarida Queiroz ◽  
Ana Dias Alves ◽  
...  
Keyword(s):  
Head Injury ◽  
Physical Examination ◽  
Computerized Tomography ◽  
Study Groups ◽  
Minor Head Injury ◽  
Red Flags ◽  
Intracranial Injury ◽  
Group A ◽  
Group B ◽  
Methods Analytical

Introduction: Head injury is common in children, with mostly being minor and not resulting in intracranial injury. Computerized tomography head scan is the preferred exam, but implies exposure to radiation; the indications for computerized tomography head scan in minor injuries are not consensual. An expectant approach is a good option in most cases. The aim was to compare the patients hospitalized and subjected to computerized tomography head scan with patients hospitalized but not subjected to computerized tomography head scan in order to assess the safety of our institution’s practice protocol.Material and Methods: Analytical longitudinal retrospective study, during three years, including patients younger than 15 years of age with minor head injury, admitted for in hospital surveillance through a paediatric emergency room. We defined two study groups: group A (hospitalized with computerized tomography head scan) and group B (hospitalized without computerized tomography head scan).Results: Study sample consisting of 206 patients: 81 (39%) group A and 125 (61%) group B. Symptoms, including vomiting, were more frequent in group B (91% and 61% vs 75% and 35%, p < 0.05); large scalp hematoma and palpable fracture in group A (11% and 12% vs 0%, p < 0.05). We performed computerized tomography head scan in 39% of the study patients (children with red flags in the physical examination or unfavourable course during hospitalization); 43% had traumatic brain injury (29 patients had fracture, 18 patients had intracranial injury). Three patients underwent neurosurgery. We did not register deaths, readmissions or neurologic sequelae.Discussion: Significant intracranial injury was infrequent. The hospitalization and surveillance of children and adolescents with symptomatic minor head injury, without red flags in the physical examination, did not seem to result in additional risks.Conclusion: The careful selection of patients for computerized tomography head scan enabled a decrease in the number of these exams and the exposure to ionizing radiation.

Central venous catheterization for acute trauma resuscitation: Tip position analysis using routine emergency computed tomography

2018 ◽  
Vol 19 (5) ◽  
pp. 461-466 ◽  
Author(s):  
Manuel F Struck ◽  
Sebastian Ewens ◽  
Wolfram Schummer ◽  
Thilo Busch ◽  
Michael Bernhard ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Central Venous Catheter ◽  
Injury Severity ◽  
Venous Catheter ◽  
Trauma Patients ◽  
Trauma Resuscitation ◽  
Central Venous ◽  
Catheter Tip ◽  
Tip Position ◽  
Multiple Trauma Patients

Purpose: Central venous catheter insertion for acute trauma resuscitation may be associated with mechanical complications, but studies on the exact central venous catheter tip positions are not available. The goal of the study was to analyze central venous catheter tip positions using routine emergency computed tomography. Methods: Consecutive acute multiple trauma patients requiring large-bore thoracocervical central venous catheters in the resuscitation room of a university hospital were enrolled retrospectively from 2010 to 2015. Patients who received a routine emergency chest computed tomography were analyzed regarding central venous catheter tip position. The central venous catheter tip position was defined as correct if the catheter tip was placed less than 1 cm inside the right atrium relative to the cavoatrial junction, and the simultaneous angle of the central venous catheter tip compared with the lateral border of the superior vena cava was below 40°. Results: During the 6-year study period, 97 patients were analyzed for the central venous catheter tip position in computed tomography. Malpositions were observed in 29 patients (29.9%). Patients with malpositioned central venous catheters presented with a higher rate of shock (systolic blood pressure <90 mmHg) at admission (58.6% vs 33.8%, p = 0.023) and a higher mean injury severity score (38.5 ± 15.7 vs 31.6 ± 11.8, p = 0.041) compared with patients with correctly positioned central venous catheter tips. Logistic regression revealed injury severity score as a significant predictor for central venous catheter malposition (odds ratio = 1.039, 95% confidence interval = 1.005–1.074, p = 0.024). Conclusion: Multiple trauma patients who underwent emergency central venous catheter placement by experienced anesthetists presented with considerable tip malposition in computed tomography, which was significantly associated with a higher injury severity.

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