Near Disappearance of Splenorrhaphy as an Operative Strategy for Splenic Preservation After Trauma

2021 ◽  
pp. 000313482110505
Author(s):  
Ara Ko ◽  
Sydney Radding ◽  
David V. Feliciano ◽  
Joseph J. DuBose ◽  
Rosemary A. Kozar ◽  
...  
Keyword(s):  
Operative Therapy ◽  
Organ Injury ◽  
Suture Repair ◽  
Low Grade ◽  
Trauma Patients ◽  
Splenic Preservation ◽  
Historical Cohort ◽  
Operative Strategy ◽  
Urban Level ◽  
Level I

Background Splenorrhaphy was once used to achieve splenic preservation in up to 40% of splenic injuries. With increasing use of nonoperative management and angioembolization, operative therapy is less common and splenic injuries treated operatively are usually high grade. Patients are often unstable, making splenic salvage unwise. Modern surgeons may no longer possess the knowledge to perform splenorrhaphy. Methods The records of adult trauma patients with splenic injuries from September 2014 to November 2018 at an urban level I trauma center were reviewed retrospectively. Data including American Association for the Surgery of Trauma splenic organ injury scale, type of intervention, splenorrhaphy technique, and need for delayed splenectomy were collected. This contemporary cohort (CC) was compared to a historical cohort (HC) of splenic injuries at a single center from 1980 to 1989 (Ann Surg 1990; 211: 369). Results From 2014 to 2018, 717 adult patients had splenic injuries. Initial management included 157 (21.9%) emergent splenectomy, 158 (22.0%) angiogram ± embolization, 371 (51.7%) observation, and only 10 (1.4%) splenorrhaphy. The HC included a total of 553 splenic injuries, of which 313 (56.6%) underwent splenectomy, while splenorrhaphy was performed in 240 (43.4%). Those who underwent splenorrhaphy in each cohort (CC vs HC) were compared. Conclusion The success rate of splenorrhaphy has not changed. However, splenorrhaphy now involves only electrocautery with topical hemostatic agents and is used primarily in low-grade injuries. Suture repair and partial splenectomy seem to be “lost arts” in modern trauma care.

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

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
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.

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.

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

2017 ◽  
Vol 83 (7) ◽  
pp. 696-698 ◽  
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.

scholarly journals 90 Penetrating Abdominal Trauma: Comperative Study Between Operative and Conservative Management

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Shalaby ◽  
M Ibrahim ◽  
T El Faioumy ◽  
M Elmessiry
Keyword(s):  
Abdominal Trauma ◽  
Operative Management ◽  
The Other ◽  
University Hospital ◽  
Organ Injury ◽  
Low Grade ◽  
Trauma Patients ◽  
Solid Organ ◽  
Penetrating Abdominal Trauma ◽  
Non Operative Management

Abstract Aim to Assess the feasibility and safety of selective non-operative management in penetrating abdominal injuries and to identify a protocol for selection of patient’s candidates for non-operative management. Method In this comparative study 40 abdominal stab victims (admitted to Emergency Department of Alexandria Main University Hospital) were selected during 6 months period where 20 patients were suitable for non-operative management according to strict selection criteria whereas the other 20 patients were operated according to clinical and/or radiological indications or on basis of department protocol, the results were compared in view of final outcome. Results In our study, 15 patients were assigned for operative management according to selected clinical and/or radiological indications only 3 of them (20%) had non-therapeutic laparotomies, On the other hand, five patients were explored on basis of department protocol in violation of our indications for exploration; four of them (80%) were non-therapeutic. So, the rate of non-therapeutic laparotomies was significantly higher when done mandatory without selected clinical and radiological indications. Conclusions Assessment of vital signs together with abdominal examination are the most important and dependable tools in decision making in penetrating abdominal trauma patients. Patients with shock on admission (but responding to resuscitation), proved low grade solid organ injury (by CT), and proved intraperitoneal collection (by US or CT) could be managed conservatively regarding that they remain vitally and clinically stable. If failure of conservation occurs, it is usually during the 1st 24 hours after admission.

Mortality Risk Stratification in Elderly Trauma Patients Based on Initial Arterial Lactate and Base Deficit Levels

2011 ◽  
Vol 77 (10) ◽  
pp. 1337-1341 ◽  
Author(s):  
Angela L. Neville ◽  
Denis Nemtsev ◽  
Raed Manasrah ◽  
Scott D. Bricker ◽  
Brant A. Putnam
Keyword(s):  
Blood Pressure ◽  
Risk Stratification ◽  
Systolic Blood Pressure ◽  
Vital Signs ◽  
Base Deficit ◽  
Trauma Patients ◽  
Arterial Lactate ◽  
Urban Level ◽  
Level I ◽  
Elderly Trauma Patients

Elderly trauma patients have worse outcomes than their younger counterparts. Early risk stratification remains difficult, particularly because traditional vital signs are less reliable. We hypothesized that arrival lactate and base deficit (BD) could be used to predict mortality in elderly trauma patients with a normal admission blood pressure. We retrospectively evaluated the prospectively collected trauma registry at our urban Level I trauma center between 2003 and 2009. Patients sustaining blunt trauma, age 55 years or older, with a systolic blood pressure 90 mmHg or higher, and who had arterial lactate and/or BD measured within 4 hours of arrival comprised the study group. Primary outcomes were in-hospital and 24-hour mortality. There were 364 patients with a lactate and 324 with a BD drawn. Patients with a lactate 2.5 mmol or greater were 3.7 times more likely to die than those with a lactate less than 2.5 mmol (95% CI, 1.6 to 8.2; P = 0.0018). The OR for mortality was 5.2 (95% CI, 2.5 to 11.2; P < 0.0001) in patients with a BD -4 or less. Elevated lactate and BD were even stronger predictors of early mortality (within first 24 hours). After increasing the hypotension threshold to a systolic blood pressure 110 mmHg or greater, lactate and BD remained highly predictive of in-hospital and 24-hour mortality.

scholarly journals A mixed psychiatric and somatic care unit for trauma patients: 10 years of experience in an urban level I trauma center in the Netherlands

2019 ◽  
Vol 46 (5) ◽  
pp. 1159-1165
Author(s):  
Lisette Dekker ◽  
Hansje M. Heller ◽  
Jessica E. van der Meij ◽  
Annelies E. J. Toor ◽  
Leo M. G. Geeraedts
Keyword(s):  
The Netherlands ◽  
Trauma Center ◽  
Trauma Patients ◽  
Years Of Experience ◽  
Urban Level ◽  
Level I

Isolated Blunt Duodenal Trauma: Simple Repair, Low Mortality

2015 ◽  
Vol 81 (10) ◽  
pp. 961-964 ◽  
Author(s):  
Stefano Siboni ◽  
Elizabeth Benjamin ◽  
Tobias Haltmeier ◽  
Kenji Inaba ◽  
Demetrios Demetriades
Keyword(s):  
Blunt Trauma ◽  
Abdominal Trauma ◽  
Primary Repair ◽  
Data Bank ◽  
Hospital Length Of Stay ◽  
Organ Injury ◽  
Low Grade ◽  
Trauma Patients ◽  
National Trauma ◽  
National Trauma Data Bank

Optimal surgical management of traumatic duodenal injury (DI) remains controversial. The National Trauma Data Bank was queried for all blunt trauma patients with DI. Patients with isolated injury were identified by excluding chest and head Abbreviated Injury Score > 3 and non-duodenal intra-abdominal Organ Injury Scale ≥ 3. Demographics, OIS, and operative intervention were collected. Outcomes included mortality and hospital length of stay (HLOS). During the study period, 3,456,098 blunt trauma patients were entered into the National Trauma Data Bank, 388,137 of which had abdominal trauma. Overall, 1.0 per cent patients with abdominal trauma had DI with isolated DI in only 0.6 per cent (n = 2220). The majority of isolated DI was low grade with only 158 patients sustaining severe injury and overall mortality was 5.2 per cent. Overall 743 patients were operated, of which 353 (47.5%) patients underwent duodenal operation, 280 (37.7%) had primary repair (PR), and 68 (9.2%) had gastroenterostomy (GE). Patients with PR had similar mortality to those with GE (6.6% vs 4.5%, P = 0.777); however, HLOS was shorter (median 11 days, vs 18 days, P < 0.001). In only OIS 4 and 5 injuries, PR was also associated with shorter HLOS ( P = 0.004) and similar mortality ( P = 1.000) when compared with GE. Isolated DI after blunt abdominal trauma is rare. In severe injuries, PR is associated with a shorter HLOS without effecting mortality when compared with GE.

Effects of a More Restrictive Transfusion Trigger in Trauma Patients

2019 ◽  
Vol 85 (4) ◽  
pp. 409-413 ◽  
Author(s):  
Mary Garland-Kledzik ◽  
Michaela Gaffley ◽  
David Crouse ◽  
Collin Conrad ◽  
Preston Miller ◽  
...  
Keyword(s):  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Trauma Patients ◽  
Transfusion Trigger ◽  
Transfusion Threshold ◽  
Trauma Service ◽  
Transfusion Requirements ◽  
Organ System Failure ◽  
Urban Level ◽  
Level I

Since the Transfusion Requirements in Critical Care trial, studies have shown that acutely ill patients can drift as a low as 5 g/dL. This study reviews a transfusion trigger change to 6.5 g/dL, which we hypothesize will conserve resources and improve quality of care. This is a retrospective chart review at an urban Level I trauma center from January through December 2015 after our trauma service changed the transfusion trigger from 7 to 6.5 g/dL. Outcomes in patients before (TT7) and after (TT6.5) the change in transfusion threshold were then compared. One hundred thirty-one discrete patients were included in this trial, with 285 instances of a hemoglobin of 7 g/dL or less and 178 transfusions. Seventy-two patients were before the change in threshold and 59 after. There was no change in length of hospital stay, ICU stay, ventilator days, mortality, and organ system failure after change in the transfusion threshold. After initiation of a more conservative threshold, 72 units of blood were saved. Decreased transfusion threshold was associated with no worse outcomes associated with decreased resource utilization.

Sign in / Sign up

Export Citation Format

Share Document