Radiographic Reread Protocols to Identify Clinically Relevant Errors in Initial Trauma Evaluations

Introduction Diagnostic radiology interpretive errors in trauma patients can lead to missed diagnoses, compromising patient care. Due to this, our level II trauma center implemented a reread protocol of all radiographic imaging within 24 hours on our highest trauma activation level (Code T). We sought to determine the efficacy of this reread protocol in identifying missed diagnoses in Code T patients. We hypothesized that a few, but clinically relevant errors, would be identified upon reread. Methods All radiographic study findings (initial read and reread) performed for Code T admissions from July 2015 to May 2016 were queried. The reviewed radiological imaging was given one of four designations: agree with interpretation, minor (non-life threatening) nonclinically relevant error(s)—addendum/correction required or clinically relevant error(s) (major [life threatening] and minor)—addendum/correction required, and trauma surgeon notified. The results were compiled, and the number of each type of error was calculated. Results Of the 752 radiological imaging studies reviewed on the 121 Code T patients during this period, 3 (0.40%) contained minor clinically relevant errors, 11 (1.46%) contained errors that were not clinically relevant, and 738 (98.1%) agreed with the original interpretation. The three clinically relevant errors included a right mandibular fracture found on X-ray and a temporal bone fracture that crossed the clivus and bilateral rib fractures found on computerized tomography. Discussion Clinically relevant errors, although minimal, were discovered during rereads for Code T patients. Although the clinical errors were significant, none affected patient outcomes. We propose that the implementation of reread protocols should be based upon institution-specific practices.

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Lung ultrasound in blunt chest trauma: A clinical review

Ultrasound ◽

10.1177/1742271x21994604 ◽

2021 ◽

pp. 1742271X2199460

Author(s):

Serena Rovida ◽

Daniele Orso ◽

Salman Naeem ◽

Luigi Vetrugno ◽

Giovanni Volpicelli

Keyword(s):

Blunt Chest Trauma ◽

Chest Trauma ◽

Lung Ultrasound ◽

Lung Parenchyma ◽

Trauma Patients ◽

Minor Trauma ◽

Major Life ◽

Diagnostic Modality ◽

Life Threatening ◽

Sternal Fractures

Introduction Bedside lung sonography is recognized as a reliable diagnostic modality in trauma settings due to its ability to detect alterations both in lung parenchyma and in pleural cavities. In severe blunt chest trauma, lung ultrasound can identify promptly life-threatening conditions which may need direct intervention, whereas in minor trauma, lung ultrasound contributes to detection of acute pathologies which are often initially radio-occult and helps in the selection of those patients that might need further investigation. Topic Description We did a literature search on databases EMBASE, PubMed, SCOPUS and Google Scholar using the terms ‘trauma’, ‘lung contusion’, ‘pneumothorax’, ‘hemothorax’ and ‘lung ultrasound’. The latest articles were reviewed and this article was written using the most current and validated information. Discussion Lung ultrasound is quite accurate in diagnosing pneumothorax by using a combination of four sonographic signs; absence of lung sliding, B-lines, lung pulse and presence of lung point. It provides a rapid diagnosis in hemodynamically unstable patients. Lung contusions and hemothorax can be diagnosed and assessed with lung ultrasound. Ultrasound is also very useful for evaluating rib and sternal fractures and for imaging the pericardium for effusion and tamponade. Conclusion Bedside lung ultrasound can lead to rapid and accurate diagnosis of major life-threatening pathologies in blunt chest trauma patients.

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Pre-Hospital Criteria Identifies Trauma Patients More Likely to be Under-Triaged to a Lower Trauma Activation Level

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2018.08.649 ◽

2018 ◽

Vol 227 (4) ◽

pp. e240

Author(s):

Sawyer G. Smith ◽

Elizabeth N. Dewey ◽

Lynn S. Eastes ◽

Martin A. Schreiber

Keyword(s):

Trauma Patients ◽

Activation Level ◽

Trauma Activation

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JDP2, a Novel Molecular Key in Heart Failure and Atrial Fibrillation?

International Journal of Molecular Sciences ◽

10.3390/ijms22084110 ◽

2021 ◽

Vol 22 (8) ◽

pp. 4110

Author(s):

Gerhild Euler ◽

Jens Kockskämper ◽

Rainer Schulz ◽

Mariana S. Parahuleva

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Atrial Fibrillation ◽

Cardiac Dysfunction ◽

Therapeutic Target ◽

Close Correlation ◽

Disease Development ◽

Major Life ◽

Life Threatening ◽

Current Therapies

Heart failure (HF) and atrial fibrillation (AF) are two major life-threatening diseases worldwide. Causes and mechanisms are incompletely understood, yet current therapies are unable to stop disease progression. In this review, we focus on the contribution of the transcriptional modulator, Jun dimerization protein 2 (JDP2), and on HF and AF development. In recent years, JDP2 has been identified as a potential prognostic marker for HF development after myocardial infarction. This close correlation to the disease development suggests that JDP2 may be involved in initiation and progression of HF as well as in cardiac dysfunction. Although no studies have been done in humans yet, studies on genetically modified mice impressively show involvement of JDP2 in HF and AF, making it an interesting therapeutic target.

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Efforts to Improve Appropriate Trauma Activation for Patients Transferred to a Level 1 Trauma Center From Outside Hospitals

The American Surgeon ◽

10.1177/0003134820919732 ◽

2020 ◽

Vol 86 (5) ◽

pp. 467-475

Author(s):

Sara Seegert ◽

Roberta E. Redfern ◽

Bethany Chapman ◽

Daniel Benson

Keyword(s):

Injury Severity ◽

Trauma Centers ◽

Activation Level ◽

American College Of Surgeons ◽

Before And After ◽

Trauma Response ◽

Level 1 ◽

Transferred Patients ◽

Trauma Activation ◽

Level 1 Trauma Center

Trauma centers monitor under- and overtriage rates to comply with American College of Surgeons Committee on Trauma verification requirements. Efforts to maintain acceptable rates are often undertaken as part of quality assurance. The purpose of this project was to improve the institutional undertriage rate by focusing on appropriately triaging patients transferred from outside hospitals (OSHs). Trauma physicians received education and pocket cards outlining injury severity score (ISS) calculation to aid in prospectively estimating ISS for patients transferred from OSHs, and activate the trauma response expected for that score. Under- and overtriage rates before and after the intervention were compared. The postintervention period saw a significant decrease in overall overtriage rate, with simultaneous trend toward lower overall undertriage rate, attributable to the significant reduction in undertriage rate of patients transferred from OSHs. Prospectively estimating ISS to assist in determining trauma activation level shows promise in managing appropriate patient triage. However, questions arose regarding the necessity for full trauma activation for transferred patients, regardless of ISS. It may be necessary to reconsider how patients transferred from OSHs are evaluated. Full trauma activation can be a financial and resource burden, and should not be taken lightly.

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"To evaluate efficacy of Gruta in Grabhashaymukhgata Vrana with special reference to Cervical Erosion."

National Journal of Research in Ayurved Science ◽

10.52482/ayurlog.v8i06.771 ◽

2020 ◽

Vol 8 (06) ◽

Author(s):

Pravin Ashok Mali

Keyword(s):

Vaginal Discharge ◽

Benign Lesion ◽

Modern Science ◽

Routine Activity ◽

Major Life ◽

Causative Factors ◽

Threatening Condition ◽

Life Threatening ◽

The Individual ◽

Gynaecological Disease

Cervical erosion is one of the causative factors for vaginal discharge. Cervical erosion, a benign lesion is sometimes much troublesome due to its chronic nature and recurrence. Cauterization and cryosurgery are most common treatment for cervical erosion in modern science. Certain diseases may not be life threatening but may be troublesome and irritating to the individual in her routine activity. When neglected may lead to serious complications or turn into major life threatening condition. Cervical erosion is one among them, increasingly prevalent nowadays, demanding great concern over it. Cervical erosion is a common gynaecological disease and seen in about 80-85% of women. As per Ayurveda classics Garbhashaya grivamukhagatavrana can be correlated with cervical erosion. Various research has been done in ayurveda on its treatment. One such compound Ghrut can be used incorporation with other treatment. This article is to enlighten on the same.

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Treatment of Pulmonary Embolism: a Decade of Experience

Ukrainian journal of cardiovascular surgery ◽

10.30702/ujcvs/19.3505/038046-049 ◽

2019 ◽

pp. 46-49

Author(s):

A. Nikonenko ◽

S. Matvieiev ◽

V. Osaulenko ◽

S. Nakonechniy

Keyword(s):

Pulmonary Embolism ◽

Outpatient Treatment ◽

Acute Pulmonary Embolism ◽

High Efficiency ◽

Oral Anticoagulants ◽

Fibrinolytic Therapy ◽

Major Life ◽

Life Threatening Illness ◽

The World ◽

Life Threatening

Pulmonary embolism (PE) is a major life-threatening illness which remains one of the main causes of sudden death throughout the world. The analysis of diagnosis and treatment of 472 patients with acute pulmonary embolism for a period of 10 years was performed. High efficiency of diagnosis using multispiral computer angiopulmonography (MSCT APG) has been established, thus this method completely supersedes the traditional selective angiopulmonography. Seventeen (3.6 %) patients died due to PE recurrence, another 8 (1.7 %) patients died due to the bleeding after using fibrinolytics and anticoagulants, and 14 (2.9 %) died due to progression of organs failure. This emphasizes the need to improve measures aimed to prevent PE recurrence and identify sources of possible bleeding and refrain from aggressive fibrinolytic therapy. The use of differentiated approach to the treatment with thrombolytic therapy and anticoagulants enabled to achieve recovery in 433 (91.7 %) patients who were discharged for outpatient treatment. New oral anticoagulants were prescribed to 94 (21.7 %) patients after discharge.

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Epidemiology of Blood Stream Infections at a Level-1 Trauma Care Center of India

Journal of Laboratory Physicians ◽

10.4103/0974-2727.129086 ◽

2014 ◽

Vol 6 (01) ◽

pp. 022-027 ◽

Cited By ~ 6

Author(s):

Purva Mathur ◽

Prince Varghese ◽

Vibhor Tak ◽

Jacinta Gunjiyal ◽

Sanjeev Lalwani ◽

...

Keyword(s):

Pathogenic Bacteria ◽

Care Center ◽

Subsequent Development ◽

Bloodstream Infections ◽

Blood Stream ◽

Common Source ◽

Trauma Patients ◽

Major Life ◽

High Prevalence ◽

Level 1

ABSTRACT Purpose: Bloodstream infections (BSIs) are one of the major life-threatening infections in hospitals. They are responsible for prolonged hospital stays, high healthcare costs, and significant mortality. The epidemiology of BSIs varies between hospitals necessitating analysis of local trends. Few studies are available on trauma patients, who are predisposed due to the presence of multiple invasive devices. Materials and Methods: A prospective surveillance of all BSIs was done at a level 1 trauma center from April, 2011 to March, 2012. All patients admitted to the different trauma intensive care units (ICUs) were monitored daily by attending physicians for subsequent development of nosocomial BSI. An episode of BSI was identified when patients presented with one or more of the following signs/symptoms, that is, fever, hypothermia, chills, or hypotension and at least one or more blood culture samples demonstrated growth of pathogenic bacteria. BSIs were further divided into primary and secondary BSIs as per the definitions of Center for Disease Control and Prevention. All patients developing nosocomial BSIs were followed till their final outcome. Results: A total of 296 episodes of nosocomial BSIs were observed in 240 patients. A source of BSI was identified in 155 (52%) episodes. Ventilator-associated pneumonia was the most common source of secondary BSI. The most common organism was Acinetobacter sp. (21.5%). Candida sp. accounted for 12% of all blood stream organisms. A high prevalence of antimicrobial resistance was observed in Gram-negative and-positive pathogens. Conclusions: Trauma patients had a high prevalence of BSIs. Since secondary bacteremia was more common, a targeted approach to prevention of individual infections would help in reducing the burden of BSIs.

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Fractures Involving the Orbit

Surgery of the Eyelid, Lacrimal System, and Orbit ◽

10.1093/oso/9780195340211.003.0023 ◽

2011 ◽

Author(s):

Don O. Kikkawa ◽

Christine C. Annunziata

Keyword(s):

Lateral Wall ◽

Medial Wall ◽

Orbital Floor ◽

Trauma Patients ◽

Posterior Aspect ◽

Orbital Roof ◽

Life Threatening ◽

Interior Walls ◽

Anterior Support ◽

Orbital Rim

Orbital and periorbital injury can occur with localized trauma to the eye or in the setting of multiple trauma associated with injury to other vital organs. A reported 16% of major trauma patients have ocular or orbital injury, and 55% of patients with facial injury have associated ocular or orbital injury. In general, the amount of ocular, soft tissue, and bony damage is related to the amount, duration, and direction of force applied to the orbit and face. Nevertheless, orbital injury is common and can be a subtle finding in the context of other facial or life-threatening injuries. Geometrically, the bony orbit most closely resembles a four-sided pyramid consisting of an apex, a base, and four sides: roof, floor, medial wall, and lateral wall. The absence of the orbital floor posteriorly and the inclination of the lateral wall toward the medial wall changes the geometric shape from a four-sided pyramid to a three-sided pyramid at the orbital apex. The bony margin circumscribes the orbital entrance and provides anterior support for the thin bones of the interior walls of the orbit. Rounding of the orbital walls blends demarcation of the superior, medial, inferior, and lateral walls. The entrance measures 40 mm horizontally and 32 mm vertically. The widest portion of the orbital margin lies about 1 cm behind the anterior orbital rim. In adults, the depth from orbital rim to apex varies from 40 to 45 mm. Safe subperiosteal dissection may be accomplished along the lateral wall and orbital floor for 22 mm and along the medial wall and orbital roof for 30 mm. The volume of the orbit is approximately 30 cc. The triangular floor of the orbit serves as the roof of the maxillary sinus. Several areas of thin bone create weak points in the orbital floor that are susceptible to fracture. The thinnest portion is medial to the infraorbital groove and canal, particularly posteriorly, where the medial wall has no bony support. In the posterior aspect of the floor, the infraorbital fissure extends as the infraorbital canal.

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