Chest and Pelvis X-Rays as a Screening Tool for Abdominal Injury in Geriatric Blunt Trauma Patients

2021 ◽  
pp. 000313482199866
Author(s):  
Emily Leede ◽  
Tatiana C. P. Cardenas ◽  
Brent J. Emigh ◽  
Lawrence H. Brown ◽  
Pedro G. Teixeira ◽  
...  
Keyword(s):  
Blunt Trauma ◽  
High Specificity ◽  
Data Bank ◽  
Abdominal Injury ◽  
Trauma Patients ◽  
X Rays ◽  
X Ray ◽  
National Trauma ◽  
National Trauma Data Bank ◽  
Hospital Days

Background This study evaluates the utility of chest (CXR) and pelvis (PXR) X-ray, as adjuncts to the primary survey, in screening geriatric blunt trauma (GBT) patients for abdominal injury or need for laparotomy. Methods We performed a retrospective analysis of patients 65-89 years in the 2014 National Trauma Data Bank. X-ray injuries were identified by ICD9 codes and defined as any injury felt to be readily detectable by a non-radiologist. X-ray findings were dichotomized as “both negative” (no injury presumptively apparent on CXR or PXR) or “either positive” (any injury presumptively apparent on CXR or PXR). Rates of abdominal injuries and laparotomy were compared and used to calculate sensitivity and specificity. The primary outcomes were abdominal injury and laparotomy. The secondary outcomes included mortality, ventilator days, and hospital days. Results A total of 202 553 patients met criteria. Overall, 9% of patients with either positive X-rays had abdominal injury and 2% laparotomy vs. 1.1% and .3% with both negative ( P < .001). The specificity for any positive X-ray was 79% for abdominal injury and 78% for laparotomy. The sensitivity was 69% for abdominal injury and laparotomy. The either positive group had fewer ventilator days (.3 vs. .8, P < .0001), longer length of stay (7 vs. 5, P < .0001), and higher mortality (6% vs. 4%, P < .0001) vs both negative. Conclusion CXR and PXR can be used to assess for intra-abdominal injury and need for laparotomy. GBT patients with either positive X-rays should continue workup regardless of mechanism due to the high specificity of this tool for abdominal injury and need for laparotomy.

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.

Racial Disparities in Adult Blunt Trauma Patients With Acute Respiratory Distress Syndrome

2020 ◽  
pp. 088506662091617
Author(s):  
Raymond L. Chou ◽  
Areg Grigorian ◽  
Jeffry Nahmias ◽  
Sebastian D. Schubl ◽  
Patrick T. Delaplain ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Blunt Trauma ◽  
Distress Syndrome ◽  
Private Insurance ◽  
Data Bank ◽  
Trauma Patients ◽  
Risk Of Death ◽  
National Trauma ◽  
Incidence And Mortality ◽  
National Trauma Data Bank

Objective: Study incidence and mortality for blunt trauma patients developing acute respiratory distress syndrome (ARDS) across race and insurance. Design: The National Trauma Data Bank (2007-2015) was queried for blunt trauma patients age >16. Covariates (age >65, injury severity score [ISS] >25, traumatic brain injury, lung injury, pneumonia, severe sepsis, hypotension on admission, and blood transfusion) were included in a multivariable logistic regression analysis. Setting: Despite progress in the treatment for ARDS, it remains a significant concern. Racial differences in response to trauma and ARDS have been inconsistently demonstrated. Since these prior studies, ARDS has been redefined by the Berlin Criteria, advances in care have been made, and health-care accessibility has changed. Patients: Adult blunt trauma patients with ISS > 15 and length of stay ≥ 3 days to examine patients at high risk of ARDS. Measurements and Main Results: There were 28 727 patients with ARDS. Most were white (76.2%), followed by blacks (11.5%), Hispanics (11.3%), and Asians (1.8%). Overall mortality was 20.5%. Compared to whites, blacks (odds ratio [OR]: 1.15, confidence interval [CI]: 1.10-1.20, P < .001) had higher risk of ARDS, being Hispanic was protective (OR: 0.80, CI: 0.76-0.83, P < .001). Asians with ARDS were at greater risk of death (OR: 1.31, CI: 1.07-1.61, P < .05) while being black was not associated with risk of death. Patients with private insurance had less diagnosed ARDS and those with ARDS had lower mortality than other insurances (OR: 0.86, CI: 0.79-0.92, P < .001). Conclusions: Data from the National Trauma Data Bank (2007-2015) demonstrates racial and insurance disparities in the development of ARDS in blunt trauma patients. When compared to whites, blacks are at higher risk of developing ARDS while being Hispanic is protective. Likewise, Asians are at greatest risk of death and blacks have no difference in mortality when compared to whites. Patients with private insurance have lower risk of incidence and mortality.

Helicopter Transport Use for Trauma Patients Is Decreasing Significantly Nationwide but Remains Overutilized

2018 ◽  
Vol 84 (10) ◽  
pp. 1630-1634 ◽  
Author(s):  
Navpreet K. Dhillon ◽  
Nikhil T. Linaval ◽  
Kavita A. Patel ◽  
Christos Colovos ◽  
Ara Ko ◽  
...  
Keyword(s):  
Injury Severity ◽  
Data Bank ◽  
The United States ◽  
Trauma Patients ◽  
Effective Utilization ◽  
National Trauma ◽  
National Trauma Data Bank ◽  
Minor Injuries ◽  
Helicopter Transportation ◽  
Rapid Transfer

Rapid transfer of trauma patients to a trauma center for definitive management is essential to increase survival. The utilization of helicopter transportation for this purpose remains heavily debated. The purpose of this study was to characterize the trends in helicopter transportations of trauma patients in the United States over the last decade. Subjects with a primary mode of either ground or helicopter transportation were selected from the National Trauma Data Bank datasets 2007 to 2015. Over this period, the proportion of patients transported by a helicopter decreased significantly in a linear fashion from 17 per cent in 2007 to 10.2 per cent in 2015 ( P < 0.001). The overall mortality of this population was 7.6 per cent and remained unchanged over the study period ( P = 0.545). Almost 3 of 10 subjects (29.4%) transported by a helicopter had an Injury Severity Score <9. The proportion of elderly (>65 years) patients requiring helicopter transportation increased by 69.1 per cent, whereas their associated mortality decreased by 21.5 per cent. The use of a helicopter for the transportation of trauma patients has significantly decreased over the last decade without any significant change in mortality, possibly indicating more effective utilization of available resources. Overtriage of patients with minor injuries remained relatively unchanged.

Farm Injuries: Animal Most Common, Machinery Most Lethal: An NTDB Study

2019 ◽  
Vol 85 (7) ◽  
pp. 752-756
Author(s):  
Karl Damroth ◽  
Rachel Damroth ◽  
Asad Chaudhary ◽  
Anfin Erickson ◽  
Liam Heneghan ◽  
...  
Keyword(s):  
Injury Severity ◽  
Data Bank ◽  
Trauma Patients ◽  
Age Group ◽  
Fatality Rate ◽  
P Values ◽  
Injury Type ◽  
National Trauma ◽  
National Trauma Data Bank ◽  
Farm Injuries

To characterize both emergency room (ER) and hospital discharge dispositions of patients presenting with farm-related injuries. The 2012 National Trauma Data Bank was queried in August 2017 for injuries occurring on a farm. Patients were stratified by gender, age group, race, Injury Severity Score (ISS), and injury type. We performed logistic regression analysis to correlate parameters with likelihood of discharge home or death. P values < 0.05 were considered significant. Five thousand six hundred thirty-one patients were identified, the majority of whom were male (72%) and white (85%). The most common mechanisms of injury included animal-related (29%), followed by falls, vehicles, and other causes. The highest ISSs were seen in vehicular injuries (11% ISS of 251) and the greatest fatality rate was seen in machinery injuries (4%). Four thousand seven hundred fifty-three (84%) patients were admitted to the hospital, and 4056 (72%) were discharged home from the ER or after hospitalization. One hundred thirty patients (2%) died of their farm-related injury. Most patients presenting to the ER with farm-related injuries survive, are admitted to the hospital, and are ultimately discharged home. Few patients die of their injuries. Animal injury is most common and machinery injury most lethal of farm trauma patients presenting to the ER.

scholarly journals Survival prediction of trauma patients: a study on US National Trauma Data Bank

2017 ◽  
Vol 43 (6) ◽  
pp. 805-822 ◽  
Author(s):  
I. Sefrioui ◽  
R. Amadini ◽  
J. Mauro ◽  
A. El Fallahi ◽  
M. Gabbrielli
Keyword(s):  
Data Bank ◽  
Survival Prediction ◽  
Trauma Patients ◽  
National Trauma ◽  
National Trauma Data Bank

Epidemiology of Traumatic Esophageal Injury: An Analysis of the National Trauma Data Bank

2019 ◽  
Vol 85 (4) ◽  
pp. 342-349 ◽  
Author(s):  
Alexander A. Xu ◽  
Janis L. Breeze ◽  
Jessica K. Paulus ◽  
Nikolay Bugaev
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Traumatic Injury ◽  
Data Bank ◽  
Esophageal Injury ◽  
Trauma Patients ◽  
Adult Age ◽  
National Trauma ◽  
National Trauma Data Bank

Existing literature on traumatic injury of the esophagus (TIE) is limited. We aimed to describe the clinical characteristics and outcomes of TIE. We reviewed the National Trauma Data Bank for the years 2010–2015. We described the demographics, characteristics, and outcomes of adult (age ≥16 years) TIE patients and also compared those factors in blunt versus penetrating TIE. The association between TIE and mortality was analyzed using multivariable logistic regression. Thousand four hundred eleven adult TIE patients were identified (37 per 100,000 trauma patients, 95% confidence intervals (CI): 35, 39). TIE patients were younger (38 vs 52 years), more likely to be male (81% vs 62%), and more severely injured (Injury Severity Score ≥ 25: 45% vs 7%) than patients without TIE (all P < 0.001). TIE was observed 16 times more frequently with penetrating injuries (257 per 100,000, 95% CI: 240, 270) than with blunt injuries (16 per 100,000, 95% CI: 15, 18). Inhospital TIE mortality was 19 per cent. TIE patients had greater risk of mortality than other trauma patients, after adjusting for age, gender, and Injury Severity Score (odds ratio = 1.4, 95% CI: 1.1, 1.7). Mortality in blunt and penetrating TIE did not differ. Although extremely rare, TIE is independently associated with a marked increase in mortality, even after adjusting for other risk factors.

scholarly journals Optimizing Chest X-ray Indication in Blunt Trauma Patients using Clinical Criteria

2017 ◽  
Vol 6 (1) ◽  
pp. 30-34
Author(s):  
Luca GA Pivetta ◽  
Cristiano Below ◽  
Giovanna Z Rondini ◽  
Jacqueline AG Perlingero ◽  
José C Assef ◽  
...  
Keyword(s):  
Blunt Trauma ◽  
Thoracic Injury ◽  
Trauma Patients ◽  
X Rays ◽  
Chest Drainage ◽  
X Ray ◽  
Clinical Criteria ◽  
Chest X Ray ◽  
Low Probability ◽  
Excessive Number

ABSTRACT Background There is an excessive number of unnecessary chest X-rays (CXRs) in minor blunt trauma patients. Objective To identify, using routine clinical criteria, a subgroup of blunt trauma patients that do not require CXR for assessment. Materials and methods This was a retrospective analysis of trauma registry data collected over a 24-month period. Adult blunt trauma patients undergoing CXR on admission were analyzed. The following clinical criteria were assessed: Normal neurologic examination on admission (NNEx), hemodynamic stability (HS), normal physical examination of the chest on admission (NCEx), age ≤ 60 years, and absence of distracting injuries (Abbreviated Injury Scale >2 in head, abdomen, and extremities). These clinical criteria were progressively merged to select a group with lowest risk of exhibiting abnormal CXR on admission. Results Out of 4,647 patients submitted to CXR on admission, 268 (5.7%) had abnormal findings on scans. Of 2,897 patients admitted with NNEx, 116 (4.0%) had abnormal CXR. Of 2,426 patients with NNEx and HS, 74 (3.0%) had abnormal CXR. Of 1,698 patients with NNEx, HS, and NCEx, 24 (1.4%) had abnormal CXR. Of 1,347 patients with NNEx, HS, NCEx, and age < 60 years, 12 had thoracic injury (0.9% of total individuals receiving CXR). A total of 4 patients underwent chest drainage. Among 1,140 cases with all clinical criteria, 8 had confirmed thoracic injuries and 2 underwent chest drainage. Conclusion A subgroup of blunt trauma patients with low probability of exhibiting abnormalities on CXR at admission was identified. The need for CXR in this subgroup should be reviewed. How to cite this article Pivetta LGA, Parreira JG, Below C, Rondini GZ, Perlingero JAG, Assef JC. Optimizing Chest X-ray Indication in Blunt Trauma Patients using Clinical Criteria. Panam J Trauma Crit Care Emerg Surg 2017;6(1):30-34.

Comparing Urban Maxillofacial Trauma Patterns to the National Trauma Data Bank©

2019 ◽  
Vol 129 (2) ◽  
pp. 149-156 ◽  
Author(s):  
Jason E. Cohn ◽  
Kiara C. Smith ◽  
Jordan J. Licata ◽  
Alex Michael ◽  
Seth Zwillenberg ◽  
...  
Keyword(s):  
Urban Environment ◽  
Data Bank ◽  
Urban Setting ◽  
Maxillofacial Trauma ◽  
Trauma Patients ◽  
National Trauma ◽  
Fracture Patterns ◽  
Injury Mechanisms ◽  
National Trauma Data Bank ◽  
Chi Square Analysis

Objectives: We aimed to determine whether certain maxillofacial fracture patterns and injury mechanisms were more prevalent in an urban environment. In addition, we aimed to determine if maxillofacial trauma incidence correlated with income. Methods: Data was collected from Einstein Healthcare Network and Temple University Health System. These data were compared to the 2016 National Trauma Data Bank© (NTDB©) using chi-square analysis. Multivariate analysis was used to identify correlations between demographic variables and fracture patterns. Sociodemographic data was further characterized utilizing neighborhood mapping. Results: A total of 252 patients from our urban campuses and 14 447 patients from the NTDB© were identified with facial fractures. Maxillofacial trauma patients in the urban population were more likely to be minorities and less likely to be Caucasian compared to the NTDB© ( P < .001). Patients in the urban setting were more likely to sustain mandibular and orbital fractures, and less likely to sustain maxillary fractures and multiple fractures ( P < .001). Urban maxillofacial trauma patients were more likely to sustain assault and sporting injuries, and less likely to sustain injuries from motor vehicle accidents and self-harm ( P < .001). Conclusions: Maxillofacial trauma patterns and injury mechanisms were shown to be significantly different in an urban environment as compared to national data.

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