Early Characteristics and Progression of Blunt Traumatic Aortic Injuries at a Single Level I Trauma Center

2020 ◽  
pp. 153857442096645
Author(s):  
Daniel Cheng ◽  
Allison G. McNickle ◽  
Douglas R. Fraser ◽  
Joseph T. Carroll ◽  
Jorge A. Vega ◽  
...  
Keyword(s):  
Motor Vehicle ◽  
Traumatic Injury ◽  
Operative Management ◽  
Aortic Injury ◽  
Low Grade ◽  
High Grade ◽  
Aortic Pathology ◽  
Non Operative Management ◽  
Delayed Intervention ◽  
Repeat Imaging

Objectives: The most widely accepted grading system for blunt traumatic aortic injury (BTAI) by the Society of Vascular Surgery (SVS) recommends endovascular repair for grade 2 and greater. Non-operative management in grade 2 injuries has been shown to be reasonable in certain circumstances. The natural history of low-grade injuries (1, 2) when managed non-operatively is not well defined. Methods: Utilizing our trauma registry, patients from 2013 to 2016 with blunt traumatic injury who underwent initial computed tomography were identified. Aortic pathology was graded and grouped by SVS classification. Clinical courses were reviewed for timing of interventions, repeat imaging, concurrent injuries, and outcomes. Analysis of variance and Chi-square tests of significance were utilized to compare between groups. Results: Out of 10,178 patients, we identified 32 with BTAI (grade: 1 (n = 13), 2 (n = 5), 3 (n = 3), 4 (n = 11)). High-grade injuries (3, 4) resulted only from motor vehicle, motorcycle, and pedestrian mechanisms. Initially, 9 patients (28%) required intervention, 5 (16%) were treated non-operatively, and 18 (56%) underwent repeat imaging. On repeat imaging, injuries that did not resolve remained stable and no injuries were found to progress. Of these patients, 9 (50%) required delayed intervention and 9 (50%) successfully underwent non-operative management. Patients with low-grade injuries were more likely to have successful non-operative management than those with high-grade injuries (72% vs 7%; p < 0.01). Conclusions: While low-grade injuries generally have good outcomes, some ultimately do require delayed intervention, and short-term imaging is not reliable in identifying these cases.

scholarly journals The management and outcome of paediatric splenic injuries in the Netherlands

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Maike Grootenhaar ◽  
Dominique Lamers ◽  
Karin Kamphuis-van Ulzen ◽  
Ivo de Blaauw ◽  
Edward C. Tan
Keyword(s):  
The Netherlands ◽  
Hospital Stay ◽  
Operative Management ◽  
Trauma Centre ◽  
Management Approach ◽  
Haemodynamic Instability ◽  
Low Grade ◽  
High Grade ◽  
Level 1 ◽  
Non Operative Management

Abstract Background Non-operative management (NOM) is generally accepted as a treatment method of traumatic paediatric splenic rupture. However, considerable variations in management exist. This study analyses local trends in aetiology and management of paediatric splenic injuries and evaluates the implementation of the guidelines proposed by the American Paediatric Surgical Association (APSA) in a level 1 trauma centre. Methods The charts of paediatric patients with blunt splenic injury (BSI) who were admitted or transferred to a level 1 trauma centre between 2003 and 2020 were retrospectively assessed. Information pertaining to demographics, mechanism of injury, injury description, associated injuries, intervention and outcomes were analysed and compared to international literature. Results There were 130 patients with BSI identified (63.1% male), with a mean age of 11.3 ± 4.0 and a mean Injury Severity Score (ISS) of 21.6 ± 13.7. Bicycle accidents were the most common trauma mechanism (23.1%). Sixty-four percent were multi-trauma patients, 25% received blood transfusions, and 31% were haemodynamically unstable. Mean injury grade was 3.0, with 30% of patients having a high-grade injury. In total, 75% of patients underwent NOM with a 100% efficacy rate. Total splenectomy rate was 6.2%. Four patients died due to brain damage. Patients with a high-grade BSI (grades IV–V) had a significantly higher ISS and longer bedrest and more often presented with an active blush on computed tomography (CT) scans than patients with a low-grade BSI (grades I–III). Non-operative management was mainly the choice of treatment in both groups (76.6% and 79.5%, respectively). Haemodynamic instability was a predictor for operative management (OM) (p = 0.001). Predictors for a longer length of stay (LOS) included concomitant injuries, haemodynamic instability and OM (all p < 0.02). Interobserver agreement in the grading of BSI is moderate, with a Cohens Kappa coefficient of 0.493. Conclusion Non-operative management has proven to be a realistic management approach in both low- and high-grade splenic injuries. Consideration for operative management should be based on haemodynamic instability. Compared to the anticipated length of bedrest and hospital stay outlined in the APSA guidelines, the Netherlands can reduce the length of bedrest and hospital stay through their non-operative management. Level of evidence Therapeutic study, level III

scholarly journals The management and outcome of paediatric splenic injuries in the Netherlands

2021 ◽  
Author(s):  
Maike Grootenhaar ◽  
Dominique Lamers ◽  
Karin Kamphuis-van Ulzen ◽  
Ivo de Blaauw ◽  
Edward C Tan
Keyword(s):  
The Netherlands ◽  
Hospital Stay ◽  
Operative Management ◽  
Hemodynamic Instability ◽  
Trauma Centre ◽  
Management Approach ◽  
Low Grade ◽  
High Grade ◽  
Level 1 ◽  
Non Operative Management

Abstract Background: Non-operative management (NOM) is generally accepted as a treatment method of traumatic paediatric splenic rupture. However, considerable variations in management exist. This study analyses local trends in aetiology and management of paediatric splenic injuries and evaluates the implementation of the guidelines proposed by the American Paediatric Surgical Association (APSA) in a level 1 trauma centre. Methods: The charts of paediatric patients with blunt splenic injury (BSI) who were admitted or transferred to a level 1 trauma centre between 2003 and 2020 were retrospectively assessed. Information pertaining to demographics, mechanism of injury, injury description, associated injuries, intervention and outcomes were analysed and compared to international literature.Results: There were 130 patients with BSI identified (63.1% male), with a mean age of 11.3 ± 4.0 and a mean injury severity score (ISS) of 21.6 ± 13.7. Bicycle accidents were the most common trauma mechanism (23.1%). Sixty-four percent were multi-trauma patients, 25% received blood transfusions, and 31% were hemodynamically unstable. Mean injury grade was 3.0, with 30% of patients having a high-grade injury. In total, 75% of patients underwent NOM with a 100% efficacy rate. Total splenectomy rate was 6.2%. Four patients died due to brain damage. Patients with a high-grade BSI (grade IV-V) had a significantly higher ISS and longer bedrest and more often presented with an active blush on computed tomography (CT) scans than patients with a low-grade BSI (grade I-III). Non-operative management was mainly the choice of treatment in both groups (76.6% and 79.5%, respectively). Hemodynamic instability was a predictor for operative management (OM) (p=0.001). Predictors for a longer length of stay (LOS) included concomitant injuries, hemodynamic instability and OM (all p < 0.02). Interobserver agreement in the grading of BSI is moderate, with a Cohens Kappa coefficient of 0.493.Conclusion: Non-operative management has proven to be a realistic management approach in both low- and high-grade splenic injuries. Consideration for operative management should be based on hemodynamic instability. Compared to the anticipated length of bedrest and hospital stay outlined in the APSA guidelines, the Netherlands can reduce the length of bedrest and hospital stay through their non-operative management.Level of evidence: Therapeutic study, level III

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.

scholarly journals Non-Operative Management with Angioembolization of Grade IV and V Renal Injuries in a Hybrid Emergency Room System

2021 ◽  
Vol 34 (3) ◽  
pp. 191-197
Author(s):  
So Ra Ahn ◽  
Sang Hyun Seo ◽  
Joo Hyun Lee ◽  
Chan Yong Park
Keyword(s):  
Emergency Room ◽  
Trauma Center ◽  
Arterial Embolization ◽  
Operative Management ◽  
University Hospital ◽  
Percutaneous Catheter Drainage ◽  
High Grade ◽  
Kidney Preservation ◽  
Non Operative Management ◽  
Renal Injuries

Renal injuries occur in more than 10% of patients who sustain blunt abdominal injuries. Non-operative management (NOM) is the established treatment strategy for lowgrade (I–III) renal injuries. However, despite some evidence that NOM can be successfully applied to high-grade (IV, V) renal injuries, it remains unclear whether NOM is appropriate in such cases. The authors report two cases of high-grade renal injuries that underwent NOM after embolization in a hybrid emergency room (ER) system with a 24/7 in-house interventional radiology (IR) team. A 29-year-old male visited Wonkwang University Hospital Regional Trauma Center complaining of right abdominal pain after being hit by a rope. Computed tomography (CT) was performed 16 minutes after arrival, and the CT scan indicated a grade V right renal injury. Arterial embolization was initiated within 31 minutes of presentation. A 56-year-old male was transferred to Wonkwang University Hospital Regional Trauma Center with a complaint of right flank pain. He had initially presented to a nearby hospital after falling from a 3-m height. Thanks to the key CT images sent from the previous hospital prior to the patient’s arrival, angiography was performed within 8 minutes of the patient’s arrival and arterial embolization was completed within 25 minutes. Both patients were treated successfully through NOM with angioembolization and preserved kidneys. Hematoma in the first patient and urinoma in the second patient resolved with percutaneous catheter drainage. The authors believe that the hybrid ER system with an in-house IR team could contribute to NOM and kidney preservation even in high-grade renal injuries.

E-scooter accidents: A rising cause of kidney injury

2021 ◽  
pp. 039156032110376
Author(s):  
Alberto Bianchi ◽  
Sebastian Gallina ◽  
Francesco Cianflone ◽  
Alessandro Tafuri ◽  
Maria Angela Cerruto ◽  
...  
Keyword(s):  
Fluid Layer ◽  
Kidney Injury ◽  
Operative Management ◽  
High Grade ◽  
Abdominal Ct ◽  
Perirenal Hematoma ◽  
First Case ◽  
Kidney Trauma ◽  
Kidney Involvement ◽  
Non Operative Management

Introduction: E-scooters recently gained mass expansion, leading to increased use-related injuries, most commonly head trauma, facial, and extremity fractures, while abdominal trauma with kidney involvement is less frequent. Here we present two cases of e-scooter-related high-grade blunt kidney trauma. Case reports: The first case was a 24-year-old male presenting with right abdominal pain after e-scooter autonomous right fall. Focused assessment with sonography for trauma (FAST) was negative, while abdominal CT showed a 3 cm middle-renal laceration. Six-day CT showed minimal urinary extravasation. Neither anemization nor impaired kidney function was observed; the patient was discharged after 9 days. The second case was a 42-year-old male presenting with right flank pain and ipsilateral chest pain after autonomous right fall. Thoracic X-ray revealed multiple rib fractures, while abdominal echography showed a non-homogeneous right kidney with a 1.5 cm perirenal fluid layer. Abdominal CT revealed 2.5 × 4 × 3.5 cm full-thickness middle-upper renal parenchyma laceration and confirmed the perirenal hematoma, while demonstrating two hepatic lesions. A series of CT and ultrasounds confirmed the stability of the aforementioned lesions and reduction of the perirenal hematoma; laboratory findings didn’t show anemization nor impaired renal function. The patient was discharged after 10 days. Discussion: Widespread usage of e-scooter is accompanied by an uptick in traumatic events. The chance of renal trauma increases when lateral fall occurs. In our cases patients were hemodynamically stable, the kidney injury severity was high-grade, and non-operative management was effective. Conclusion: E-scooter accidents could lead to high-grade renal injuries, amenable of non-operative management; these events are expected to raise.

scholarly journals Predictors of splenic artery embolization as an adjunct to non-operative management of stable blunt splenic injury: a multi-institutional study

2019 ◽  
Vol 4 (1) ◽  
pp. e000323 ◽  
Author(s):  
Kristin Salottolo ◽  
Matthew M Carrick ◽  
Robert M Madayag ◽  
James Yon ◽  
Allen Tanner ◽  
...  
Keyword(s):  
Splenic Artery ◽  
Splenic Injury ◽  
Motor Vehicle ◽  
Multivariate Logistic Regression Analysis ◽  
Operative Management ◽  
Artery Embolization ◽  
Splenic Artery Embolization ◽  
Radiographic Findings ◽  
Blunt Splenic Injury ◽  
Non Operative Management

BackgroundWe sought to identify predictors of splenic artery embolization (SAE) over observation for hemodynamically stable patients with blunt splenic injury (BSI), by Organ Injury Scale (OIS) grade.MethodsThis was a multi-institutional retrospective study of all adults (≥18) with BSI who were initially managed non-operatively between 2014 and 2016. Multivariate logistic regression analysis was used to identify predictors of SAE by OIS grade. Covariates included radiographic characteristics (presence/quantity of hemoperitoneum, blush, vascular injury), demographics (age, sex, cause), Injury Severity Score, vital signs, and hemoglobin values. We also examined outcomes of death, length of stay (LOS), intensive care unit (ICU) admission, blood products, and failed non-operative management (NOM).ResultsAmong 422 patients with stable BSI, 93 (22%) had SAE and 329 (78%) were observed. The rate of SAE increased by grade (p<0.001). In grade I and II BSI, 7% had SAE; significant predictors of SAE were blush (OR: 5.9, p=0.02), moderate or large hemoperitoneum (OR: 3.0, p=0.01), and male sex (OR: 6.3, p=0.05). In grade III BSI, 26% had SAE; significant predictors included moderate or large hemoperitoneum (OR: 3.9, p=0.04), motor vehicle crash (OR: 6.1, p=0.005), and age (OR=1.4, 40% with each decade increase in age, p=0.02). The rate of SAE was 52% for grade IV and 85% for grade V BSI; there were no independent predictors of SAE in either grade. Clinical outcomes were comparable by NOM strategy and grade, except longer LOS with SAE in grades I–III (p<0.05) and longer ICU LOS with SAE in grades I–IV (p<0.05). Only 5 (1.2%) patients failed NOM (4 observation, 1 SAE).ConclusionThese results strongly support SAE consideration for patients with stable grade IV and V BSI even if there are no other high-risk clinical or radiographic findings. For grades I–III, the identified predictors may help refine consideration for SAE.Level of evidenceLevel III, retrospective epidemiological study.

Persistent symptoms following non operative management in low grade MCL injury of the knee — The role of the deep MCL

The Knee ◽  
2009 ◽  
Vol 16 (1) ◽  
pp. 64-68 ◽  
Author(s):  
Luke Jones ◽  
Quamar Bismil ◽  
Faisal Alyas ◽  
David Connell ◽  
Jonathan Bell
Keyword(s):  
Operative Management ◽  
Low Grade ◽  
Persistent Symptoms ◽  
Non Operative Management

scholarly journals Massive inguinoscrotal herniation of the bladder: challenges in non-operative management

2020 ◽  
Vol 2020 (12) ◽  
Author(s):  
Kelvin Adasonla ◽  
Joseph Gabriel ◽  
Mohammed Kamil Quraishi ◽  
Graham Watson
Keyword(s):  
Obstructive Uropathy ◽  
Kidney Injury ◽  
Operative Management ◽  
Bilateral Hydronephrosis ◽  
Non Operative Management ◽  
Term Management ◽  
Repeat Imaging ◽  
Urinary Sepsis

Abstract Massive inguinoscrotal hernias containing the bladder are rare but can present with significant complications such as obstructive uropathy and urinary sepsis. A comorbid 71-year-old gentleman presented with an enlarging inguinoscrotal mass and an acute kidney injury (AKI). Imaging revealed a large inguinoscrotal hernia containing the bladder, and bilateral hydronephrosis. Renal function improved on urethral catheterization. Admitted under general surgery originally, the patient declined any surgical intervention and had his catheter removed as an outpatient, without urological follow up. He represented 6 months later with urinary sepsis and a new AKI. Repeat imaging revealed a progression of the bilateral hydronephrosis. Subsequently admitted under urology, bilateral nephrostomies as well as a catheter were inserted. Once stable, he was discharged with both as part of his long-term management. Non-operative management of this condition may occasionally be necessary, and so requires effective multidisciplinary decision making. Real-world organizational and geographical factors contributed to the challenges in this case.

scholarly journals Trauma Audit for Intra-Abdominal Injury in Hospital Pulau Pinang

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Choon Hui Gan ◽  
Viknesh S ◽  
Wai Pheng Wong ◽  
Sahul Hamid
Keyword(s):  
Ct Scan ◽  
Chinese Population ◽  
Splenic Injury ◽  
Motor Vehicle ◽  
Operative Management ◽  
Skewed Distribution ◽  
Abdominal Injury ◽  
Negative Laparotomy ◽  
Chinese Ethnicity ◽  
Non Operative Management

Introduction: Intra-abdominal injury is one of the leading causes of morbidity and mortality in all age groups in the world. Our aim is to review the demography, incidence rates and prevalence of intra-abdominal injury in Hospital Pulau Pinang in a tertiary hospital in Northern region of Malaysia. Materials and Methods: We retrospectively reviewed medical records of patients diagnosed with intra-abdominal injury from January 2016 until December 2017 using an in-house electronic database. Traumatic renal injury was excluded. Diagnosis was confirmed via contrast-enhanced CT scan or exploratory laparotomy. Results: A total of 82 patients were diagnosed with intraabdominal injury over a period of 2 years. There is a male (75.61%) and of Chinese ethnicity (43.90%) predominance. Median age at presentation was 20 years old. The oldest patient was 94 years old and the youngest patient was 9 months old. Commonest etiology was motor vehicle accident (78.04%) followed by traumatic fall (12.19%). The commonest injury was splenic injury (50%) followed by liver injury (39.28%). The majority of patient (59.52%) was treated non-surgically, in which a grade 2 splenic injury patient underwent operation after failing a non-operative management. There were only 2 mortalities among the 34 patients in the operative group. There is a higher incidence among Chinese ethnicity due to skewed distribution of Chinese population in our studied area in relation to total Chinese population in Malaysia. We showed a reduction in negative laparotomy in stable patients with suspected intra-abdominal injury with the utilization of a CT scan. Decision for non-operative management should be tailored to individualized approach accompanied by serial assessment for optimal care. Conclusion: Blunt trauma was the most common type of intra-abdominal injury and the spleen was found to be the most common organ injured.

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