Testicular rupture: Simplifying the diagnosis

2019 ◽  
Vol 13 (3) ◽  
pp. 217-220
Author(s):  
Lap Yan Leung ◽  
Jai Seth ◽  
Michael Gonsalves ◽  
Nick Watkin ◽  
Davendra Sharma
Keyword(s):  
Ultrasound Imaging ◽  
Road Traffic ◽  
Tunica Albuginea ◽  
Case Series ◽  
Trauma Centre ◽  
Level Of Evidence ◽  
Difficult Condition ◽  
Major Trauma Centre ◽  
Testicular Rupture ◽  
Mechanism Of Trauma

Objective: To review the use of ultrasound imaging in the diagnosis of testicular rupture and in relation to current guidelines. Methods: Data was retrospectively collected for all patients diagnosed with testicular rupture at a major trauma centre between 2011 and 2018. Data included patient demographics, mechanism of trauma, specific findings on ultrasound and outcomes. On review of ultrasound imaging, specific findings identified include a breach in the tunica albuginea (currently advised in guidelines), heterogenicity and contour loss. Results: Eight patients were identified with average age 37 years old, mechanism of trauma was 50%, 37.5% and 12.5% for motorcycle road traffic collision, sporting injury and workplace injury respectively. A breach of tunica albuginea was identified on ultrasound in 65% of cases, compared with 100% of cases showing contour loss and heterogenicity. Of the 87.5% patients who were managed surgically one needed orchidectomy (and later testosterone replacement). Conclusion: Guidelines have varied on how to use ultrasound imaging in diagnosing a clinically difficult condition. Our case series demonstrates that diagnosing testicular rupture by looking for more easily identifiable characteristics (heterogenicity and contour loss) than currently recommended in the guidelines (breech in the tunica albuginea) will aid diagnosis and patient pathway and improve outcomes. Level of evidence: 5

scholarly journals Vascular injuries and Their Management in Major Trauma from Road Traffic Collisions at a Major Trauma Centre

2019 ◽  
Vol 58 (6) ◽  
pp. e536-e537
Author(s):  
Rachael Bygate ◽  
Laurence Orchard ◽  
Michelle Wilkinson ◽  
Raghvinder Gambhir
Keyword(s):  
Major Trauma ◽  
Road Traffic ◽  
Trauma Centre ◽  
Vascular Injuries ◽  
Major Trauma Centre

scholarly journals 40 days and 40 nights: Clinical characteristics of major trauma and orthopaedic injury comparing the incubation and lockdown phases of COVID-19 infection

2020 ◽  
Vol 1 (7) ◽  
pp. 330-338 ◽  
Author(s):  
Bisola Ajayi ◽  
Alex Trompeter ◽  
Magnus Arnander ◽  
Philip Sedgwick ◽  
Darren F. Lui
Keyword(s):  
Clinical Characteristics ◽  
Traffic Accidents ◽  
Major Trauma ◽  
Road Traffic ◽  
Trauma Centre ◽  
Orthopaedic Patients ◽  
Major Trauma Centre ◽  
Group A ◽  
Group B ◽  
The Uk

Aims The first death in the UK caused by COVID-19 occurred on 5 March 2020. We aim to describe the clinical characteristics and outcomes of major trauma and orthopaedic patients admitted in the early COVID-19 era. Methods A prospective trauma registry was reviewed at a Level 1 Major Trauma Centre. We divided patients into Group A, 40 days prior to 5 March 2020, and into Group B, 40 days after. Results A total of 657 consecutive trauma and orthopaedic patients were identified with a mean age of 55 years (8 to 98; standard deviation (SD) 22.52) and 393 (59.8%) were males. In all, 344 (approximately 50%) of admissions were major trauma. Group A had 421 patients, decreasing to 236 patients in Group B (36%). Mechanism of injury (MOI) was commonly a fall in 351 (52.4%) patients, but road traffic accidents (RTAs) increased from 56 (13.3%) in group A to 51 (21.6%) in group B (p = 0.030). ICU admissions decreased from 26 (6.2%) in group A to 5 (2.1%) in group B. Overall, 39 patients tested positive for COVID-19 with mean age of 73 years (28 to 98; SD 17.99) and 22 (56.4%) males. Common symptoms were dyspnoea, dry cough, and pyrexia. Of these patients, 27 (69.2%) were nosocomial infections and two (5.1%) of these patients required intensive care unit (ICU) admission with 8/39 mortality (20.5%). Of the patients who died, 50% were older and had underlying comorbidities (hypertension and cardiovascular disease, dementia, arthritis). Conclusion Trauma admissions decreased in the lockdown phase with an increased incidence of RTAs. Nosocomial infection was common in 27 (69.2%) of those with COVID-19. Symptoms and comorbidities were consistent with previous reports with noted inclusion of dementia and arthritis. The mortality rate of trauma and COVID-19 was 20.5%, mainly in octogenarians, and COVID-19 surgical mortality was 15.4%. Cite this article: Bone Joint Open 2020;1-7:330–338.

scholarly journals 40 days and 40 nights: Clinical characteristics of major trauma and orthopaedic injury comparing the incubation and lockdown phases of COVID-19 infection

2020 ◽  
Vol 1 (7) ◽  
pp. 330-338 ◽  
Author(s):  
Bisola Ajayi ◽  
Alex Trompeter ◽  
Magnus Arnander ◽  
Philip Sedgwick ◽  
Darren F. Lui
Keyword(s):  
Clinical Characteristics ◽  
Traffic Accidents ◽  
Major Trauma ◽  
Road Traffic ◽  
Trauma Centre ◽  
Orthopaedic Patients ◽  
Major Trauma Centre ◽  
Group A ◽  
Group B ◽  
The Uk

Aims The first death in the UK caused by COVID-19 occurred on 5 March 2020. We aim to describe the clinical characteristics and outcomes of major trauma and orthopaedic patients admitted in the early COVID-19 era. Methods A prospective trauma registry was reviewed at a Level 1 Major Trauma Centre. We divided patients into Group A, 40 days prior to 5 March 2020, and into Group B, 40 days after. Results A total of 657 consecutive trauma and orthopaedic patients were identified with a mean age of 55 years (8 to 98; standard deviation (SD) 22.52) and 393 (59.8%) were males. In all, 344 (approximately 50%) of admissions were major trauma. Group A had 421 patients, decreasing to 236 patients in Group B (36%). Mechanism of injury (MOI) was commonly a fall in 351 (52.4%) patients, but road traffic accidents (RTAs) increased from 56 (13.3%) in group A to 51 (21.6%) in group B (p = 0.030). ICU admissions decreased from 26 (6.2%) in group A to 5 (2.1%) in group B. Overall, 39 patients tested positive for COVID-19 with mean age of 73 years (28 to 98; SD 17.99) and 22 (56.4%) males. Common symptoms were dyspnoea, dry cough, and pyrexia. Of these patients, 27 (69.2%) were nosocomial infections and two (5.1%) of these patients required intensive care unit (ICU) admission with 8/39 mortality (20.5%). Of the patients who died, 50% were older and had underlying comorbidities (hypertension and cardiovascular disease, dementia, arthritis). Conclusion Trauma admissions decreased in the lockdown phase with an increased incidence of RTAs. Nosocomial infection was common in 27 (69.2%) of those with COVID-19. Symptoms and comorbidities were consistent with previous reports with noted inclusion of dementia and arthritis. The mortality rate of trauma and COVID-19 was 20.5%, mainly in octogenarians, and COVID-19 surgical mortality was 15.4%. Cite this article: Bone Joint Open 2020;1-7:330–338.

Traumatic aortic injury presenting to an adult major trauma centre

Trauma ◽  
2018 ◽  
Vol 21 (4) ◽  
pp. 272-279
Author(s):  
Jordan Bade-Boon ◽  
Joseph K Mathew ◽  
Mark C Fitzgerald ◽  
Biswadev Mitra
Keyword(s):  
Clinical Characteristics ◽  
Road Traffic ◽  
Clinical Signs ◽  
Vital Signs ◽  
High Energy ◽  
Aortic Injury ◽  
Trauma Centre ◽  
Road Traffic Crashes ◽  
Major Trauma Centre ◽  
Rule Out

Introduction Traumatic aortic injury is an uncommon condition. Timely diagnosis may enable early haemostatic resuscitation, essential to prevent worsening of the injury prior to definitive management. The aim of this study was to assess the utility of initial vital signs and presenting clinical characteristics to confirm or rule out aortic injury. Methods A retrospective review of patients from The Alfred Trauma Registry was conducted. Patients presenting between January 2006 and July 2014 and diagnosed with aortic injury were identified. Demographics and presenting clinical characteristics were extracted. Sensitivity of individual clinical variables for the detection of aortic injury was calculated. Results There were 77 patients identified with aortic injury, with an in-hospital mortality rate of 19.5% (95% CI: 10.6–28.3%). Of these, 68 (88.3%) patients presented after high-energy blunt mechanisms. Clinical signs and early chest X-ray findings were poorly sensitive to detect aortic injury. Patients who presented with hypotension had a greater severity of aortic injury, more commonly had associated abnormal investigation findings and were more likely to require blood products and inotropic agents (p < 0.05). However, sensitivity of initial hypotension to rule out aortic injury was 39.0% (95% CI: 28.1–49.9%). Conclusions The diagnosis of aortic injury was uncommon in hospital. Most injuries were secondary to high-velocity road traffic crashes or high falls. Clinical signs were not adequately sensitive to be used for the exclusion of aortic injury. We recommend a high degree of clinical suspicion and liberal imaging among cases where aortic injury is possible.

Epidemiology and aetiology of paediatric traumatic cardiac arrest in England and Wales

2018 ◽  
Vol 104 (5) ◽  
pp. 437-443 ◽  
Author(s):  
James Vassallo ◽  
Melanie Webster ◽  
Edward B G Barnard ◽  
Mark D Lyttle ◽  
Jason E Smith
Keyword(s):  
Cardiac Arrest ◽  
Injury Severity ◽  
Road Traffic ◽  
Population Based ◽  
Trauma Centre ◽  
Research Network ◽  
Common Mechanism ◽  
England And Wales ◽  
Traumatic Cardiac Arrest ◽  
Major Trauma Centre

ObjectiveTo describe the epidemiology and aetiology of paediatric traumatic cardiac arrest (TCA) in England and Wales.DesignPopulation-based analysis of the UK Trauma Audit and Research Network (TARN) database.Patients and settingAll paediatric and adolescent patients with TCA recorded on the TARN database for a 10-year period (2006–2015).MeasuresPatient demographics, Injury Severity Score (ISS), location of TCA (‘prehospital only’, ‘in-hospital only’ or ‘both’), interventions performed and outcome.Results21 710 paediatric patients were included in the database; 129 (0.6%) sustained TCA meeting study inclusion criteria. The majority, 103 (79.8%), had a prehospital TCA. 62.8% were male, with a median age of 11.7 (3.4–16.6) years, and a median ISS of 34 (25–45). 110 (85.3%) had blunt injuries, with road-traffic collision the most common mechanism (n=73, 56.6%). 123 (95.3%) had severe haemorrhage and/or traumatic brain injury. Overall 30-day survival was 5.4% ((95% CI 2.6 to 10.8), n=7). ‘Pre-hospital only’ TCA was associated with significantly higher survival (n=6) than those with TCA in both ‘pre-hospital and in-hospital’ (n=1)—13.0% (95% CI 6.1% to 25.7%) and 1.2% (95% CI 0.1% to 6.4%), respectively, p<0.05. The greatest survival (n=6, 10.3% (95% CI 4.8% to 20.8%)) was observed in those transported to a paediatric major trauma centre (MTC) (defined as either a paediatric-only MTC or combined adult-paediatric MTC).ConclusionsSurvival is possible from the resuscitation of children in TCA, with overall survival comparable to that reported in adults. The highest survival was observed in those with a pre-hospital only TCA, and those who were transported to an MTC. Early identification and aggressive management of paediatric TCA is advocated.

scholarly journals A profile of a major trauma centre of North West England between 2011 and 2018

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Raimundas Lunevicius ◽  
Mina Mesri
Keyword(s):  
Traffic Accidents ◽  
Major Trauma ◽  
Road Traffic ◽  
Survival Rates ◽  
Trauma Team ◽  
Trauma Centre ◽  
North West ◽  
Major Trauma Centre ◽  
Mortality Ratio ◽  
Expected Mortality

AbstractThis study examined the trends and patterns of major trauma (MT) activities, causes, mortality and survival at the Aintree Major Trauma Centre (MTC), Liverpool, between 2011 and 2018. The number of trauma team activations (TTAs) rose sharply over time (n = 699 in 2013; n = 1522 in 2018). The proportion of TTAs that involved MT patients decreased from 75.1% in 2013 to 67.4% in 2018. The leading cause of MT was a fall from less than 2 m (36%). There has been a fivefold increase in the overall number of trauma procedures between 2011 and 2018. Orthopaedic surgeons have performed 80% of operations (n = 7732), followed by neurosurgeons, oral and maxillofacial surgeons, and general trauma surgeons. Both types of fall (> 2 m and < 2 m) and road traffic accidents were the three leading causes of death during the study period. The observed mortality rates exceeded that of expected rates in years 2012, 2014, 2016 and 2017. The all-cause observed to expected mortality ratio was 1.08 between 2012 and 2018. A change in care for MT patients was not directly associated with improved survival, although the marginally ascending trend line in survival rates between 2012 and 2018 reflects a gradual positive change.

scholarly journals 1665 Characterising the Escalation in Hospital Trauma Admission During the Easing of the COVID-19 Level 4 Lockdown Restrictions

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
L Holt ◽  
A Sud ◽  
G Dixon ◽  
O Rutka ◽  
J Taylor
Keyword(s):  
Service Provision ◽  
Major Trauma ◽  
Road Traffic ◽  
Trauma Centre ◽  
Major Trauma Centre ◽  
Severity Scores ◽  
Tier System ◽  
Societal Level ◽  
Level 1 ◽  
Trauma Admission

Abstract Introduction Major trauma reduced by over a third during the institution of UK level-4 national lockdown (Rajput K. et al; 2020). Easing of lockdown on a societal level posed unprecedented uncertainties. With the easing of restrictions, it is expected that the quantity of trauma would increase. In the absence of ‘normality’ it remains uncertain about the extent of the quantity, severity and aetiology of the trauma. The effect of lockdown easing on patterns of traumatic admissions has not been studied and it has important implications upon service provision. Method A retrospective cohort study using the data from 2017-2019 were used as a 3-year control to compare each month of 2020. Regional trauma data (TARN data) from Aintree level-1 Major Trauma Centre, the regional tertiary Specialist Units. Easing of restrictions to the regional tier system began in May-July. This index 3months was compared to the control data. Results Following easing of restrictions there was a significant increase in the Incident Severity Scores from trauma admissions. The %mortality during the level-4 lockdown decreases but as restrictions are eased there is an increase in the % mortality. The number of stabbings and road traffic collisions are also seen to increase following the ease of restrictions. Conclusions There is a decrease in the number of trauma calls seen following the easing of restrictions, yet the severity of the incident and the mortality rate has increased. Therefore, is the trauma more severe of does COVID-19 influence this?

scholarly journals The impact of ‘unofficial trauma’ on a Major Trauma Centre: A service evaluation of accident and emergency department trauma team activations

Trauma ◽  
2020 ◽  
Vol 22 (4) ◽  
pp. 278-284
Author(s):  
Alex Wright ◽  
Simon J Mercer ◽  
Ben Morton
Keyword(s):  
Road Traffic ◽  
Statistical Tests ◽  
Penetrating Trauma ◽  
Trauma Centre ◽  
Research Network ◽  
Shop Floor ◽  
Trauma Patients ◽  
Healthcare Provision ◽  
Major Trauma Centre ◽  
The Impact

Introduction Trauma remains a leading cause of death worldwide. In the UK, data for trauma patients are prospectively collected locally and collated by the Trauma Audit and Research Network. This study assesses and describes the subgroup of patients who triggered a trauma call but who subsequently did not meet criteria for Trauma Audit and Research Network. Methods A single centre, retrospective observational study of trauma calls between 1 June 2012 and 31 August 2018 was performed, determining which trauma calls had been submitted to Trauma Audit and Research Network by cross referencing with the submission database. Data were tested for normality (Shapiro–Wilk test) and appropriate statistical tests employed to determine differences between inclusion and non-inclusion groups. For categorical data, we used Chi-squared tests to examine for differences. Results There were 6529 trauma calls and over half (3837 (58.8%)) were not registered on Trauma Audit and Research Network. Patients excluded were significantly younger (mean 42.4 years SD 19.2) than those who met inclusion criteria (mean 50.3 years, SD 21.8), p < 0.001 and were significantly more likely to suffer from penetrating trauma (18.6% versus 8.2%, p < 0.001), the majority (77.8%, 553/713) caused by stabbings. Patients excluded were less likely to be involved in a road traffic accident (31.1% versus 35.3%, p < 0.001), less likely to have fallen downstairs (15.2% versus 18.7%, p < 0.001) and less likely to have fallen from a height > 2 m (8.1% versus 12.7%, p < 0.001). Discussion Patients who trigger a trauma call but who subsequently do not meet the criteria for Trauma Audit and Research Network inclusion place a significant burden on healthcare provision. To our knowledge this is the first investigation to specifically explore this group of at-risk patients. To enable medical planners a more accurate view of activity on the ‘shop floor’, particularly in reference to knife crime injuries we ask the question as to whether a separate database should now be held of trauma calls?

Primary total hip replacement using Burch-Schneider cages for acetabular fractures

2020 ◽  
pp. 112070002095764 ◽  
Author(s):  
Frank Liaw ◽  
Siddharth Govilkar ◽  
Daniel Banks ◽  
Pradeep Kankanalu ◽  
Bishoy Youssef ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Weight Bearing ◽  
Case Series ◽  
Trauma Centre ◽  
Acetabular Fractures ◽  
Leg Length ◽  
Superior Gluteal Artery ◽  
Total Hip ◽  
Major Trauma Centre

Introduction: Osteoporotic acetabular fractures are common and pose a difficult technical challenge for the trauma surgeon. Acute total hip arthroplasty (THA) using a Burch-Schneider antiprotrusio cage with immediate postoperative weight-bearing is a method to approach these injuries. This case series reports our outcomes of acute THA using Burch-Schneider cages for acetabular fractures from a UK major trauma centre based on length of stay, radiological outcome, complications and outcome scores. Methods: Data were collected from all patients who underwent acute THA with a Burch-Schneider cage for acetabular fractures between June 2006 and August 2015. Patients were followed up clinically, radiologically, and using Oxford Hip Scores (OHS). Results: 20 patients with a median age of 73 (range 60–90 years) were identified. All patients were independent walkers at follow-up, and had achieved radiological union. There were no dislocations, subsidence, revision or deep infections. Significant complications include 1 perioperative death as a result of complications arising from pre-existing pulmonary fibrosis; 1 deep vein thrombosis; 1 intraoperative arterial injury to the superior gluteal artery; and 1 leg-length discrepancy. Mean length of stay was 10 days. The mean OHS was 37/48 at a mean follow-up of 26 months. Conclusions: This case series further validates the use of Burch-Schneider cages with primary THA in acute acetabular fractures.

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