TEVAR versus open repair of blunt traumatic descending aortic injury in polytraumatic patients involved in motor vehicle accidents

Abstract Background Thoracic endovascular aortic repair (TEVAR) is the standard-of-care for treating traumatic aortic injury (TAI). Few retrospective studies compared TEVAR to open repair in blunt traumatic aortic injury (BTAI). Our objectives were to compare the early outcomes of TEVAR for blunt traumatic descending aortic injury to open repair (OR) in polytraumatic patients involved in motor vehicle accidents (MVA). Results Between February 2005 and April 2017, 71 patients with TAI due to MVA presented to our institution. All patients with descending aortic injuries were considered for open repair (n = 41) or TEVAR (n = 30) if there was no contraindication. The primary outcome was mortality, and secondary outcomes were stroke, paraplegia, intensive care unit (ICU), and hospital stay. The mean age was 28.4 ± 10.1 years in the OR group and 33.3 ± 16.6 years in TEVAR-group (P = 0.13). The injury severity scores were 41 ± 10 in the OR group and 33 ± 17 in the TEVAR group (P = 0.03). Patients in the OR group underwent emergency repair with a mean time of 0.56 ± 0.18 days from arrival. The TEVAR group had a longer time interval between arrival and procedure (2.1 ± 1.7 days, P = 0.001). The OR group had more blood transfusion (24 (58.5%) vs. 8 (27.5%), P = 0.002), renal impairment (6 (14.6%) vs. 1 (5.50%), P = 0.23), and wound infection (21 (51.2%) vs. 3 (10%), P < 0.001). Three TEVAR patients had a perioperative stroke compared to two patients in the OR group (P = 0.64). There was no difference in the mean ICU (6 ± 8.9 vs. 5.3 ± 2.9 days; P = 0.1) or hospital stay (20.1 ± 12.3 vs. 20.1 ± 18.3, P = 0.62) between the two groups. There were four deaths in the OR group and none in the TEVAR group (P = 0.13). Conclusion The results of TEVAR were comparable with the open repair for traumatic aortic injury with good early postoperative outcomes. TEVAR repair could be associated with lower mortality, blood transfusion, and infective complications. However, the complexity of the injury and technical challenges were higher in the open group.

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Childhood accidental poisoning among hospitalised children in a tertiary health care in North Central Nigeria - A two year prospective report

Nigerian Journal of Paediatrics ◽

10.4314/njp.v47i3.5 ◽

2020 ◽

Vol 47 (3) ◽

Author(s):

P.A. Ahmed ◽

V.E. Nwatah ◽

C.C. Ulonnam

Keyword(s):

Hospital Stay ◽

Clinical Features ◽

Acute Poisoning ◽

Accidental Poisoning ◽

Time Interval ◽

Fisher Exact Test ◽

Severity Scores ◽

Childhood Poisoning ◽

Home Intervention ◽

The Mean

Background: The young child can be at risk of accidental poisoning because of its being very inquisitive to mouth objects. The prevalence and typesof poisoning vary within Nigeria and different parts of the world. Aim: To describe the sociodemographics, clinical features and outcome in childhood poisoning seen at the National hospital Abuja (NHA) Nigeria. Subjects and Methods: A descriptive prospective study on children admitted for acute poisoning from September 2014 -August 2016. Consecutive children with a history of poisoning were recruited during the study period. The children were examined, and poison severity scores were recorded into a proforma, and followed up till discharge or demise. Results: Twenty-two children were admitted for acute poisoning, out of the 2336 children seen during the study period, with a prevalence rate of 0.94%. Fourteen (63.6%) were of upper social class, with 12 (54. 5%) mothers having tertiary level education. The mean time (±SD) of presentation was 11.9 ± 23.9 hours, while the mean (SD) duration of hospital stay was 4.8 ± 6.2 days; hospital stay was significant with types of poisoning (Fisher exact test 22.062, p<0.0001). The common poisoning agents were kerosene and organophosphate, 8(36.4%) each, while main clinical features were cough in 8 (36.4%), tachypnoea in 7(31.8%), fever in 6 (27.3%) and 8(36.4%) had home intervention. Two (9.1%) and 4(18.2%) had poison severity scores (PSS) of 3 and 4 respectively, which was significant for time interval of presentation and use of harmful home intervention (Fisher exact test3.697, p=0.024) and (Fisher exact test10.04, p=0.018) respectively. Fatality was 18.2%. Conclusion: kerosene and organophosphate were most common poison agents, while PSS was related to time of presentation, home intervention and types of poisoning agents. Key words: childhood, poisoning, hospitalized, outcome.

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Evaluation of Aortic Injury in Driver Fatalities Occurring in Motor Vehicle Accidents in the State of Maryland for 2003 and 2004

American Journal of Forensic Medicine & Pathology ◽

10.1097/paf.0b013e318173f067 ◽

2008 ◽

Vol 29 (2) ◽

pp. 123-127 ◽

Cited By ~ 2

Author(s):

Mary G. Ripple ◽

Jami R. Grant ◽

Joan Mealey ◽

David R. Fowler

Keyword(s):

Motor Vehicle ◽

Aortic Injury ◽

Motor Vehicle Accidents ◽

The State ◽

Vehicle Accidents

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Early Intervention Following Assaults and Motor Vehicle Accidents

PsycEXTRA Dataset ◽

10.1037/e517322011-017 ◽

2007 ◽

Author(s):

Jonathan Bisson

Keyword(s):

Early Intervention ◽

Motor Vehicle ◽

Motor Vehicle Accidents ◽

Vehicle Accidents

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Psychological Outcome of Motor Vehicle Accidents

PsycEXTRA Dataset ◽

10.1037/e517302011-066 ◽

2008 ◽

Author(s):

Yoshiharu Kim ◽

Yutaka Matsuoka ◽

Ulrich Schnyder ◽

Sara Freedman ◽

Robert Ursano

Keyword(s):

Motor Vehicle ◽

Motor Vehicle Accidents ◽

Psychological Outcome ◽

Vehicle Accidents

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A study of the relationship of time of day to motor vehicle accidents (1966-1968)

PsycEXTRA Dataset ◽

10.1037/e527422009-001 ◽

1970 ◽

Author(s):

Kersey Homi Antia

Keyword(s):

Motor Vehicle ◽

Time Of Day ◽

Motor Vehicle Accidents ◽

Vehicle Accidents ◽

Relationship Of ◽

The Relationship

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Major factors affecting the severity of motor vehicle accidents in Sri Lanka

Proceedings of The 4th International Conference on Applied Research in Science, Technology and Knowledge ◽

10.33422/4th.stk.2019.11.674 ◽

2019 ◽

Author(s):

N.A.M.R Senaviratna ◽

T.M.J.A Cooray

Keyword(s):

Sri Lanka ◽

Motor Vehicle ◽

Motor Vehicle Accidents ◽

Factors Affecting ◽

Vehicle Accidents ◽

Major Factors

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Resuscitative endovascular balloon occlusion of the aorta (REBOA) enables operative management of the peripartum trauma patient in hemorrhagic shock

Journal of Endovascular Resuscitation and Trauma Management ◽

10.26676/jevtm.v3i1.78 ◽

2019 ◽

Vol 3 (1) ◽

Author(s):

Kelvin Allenson ◽

Laura Moore

Keyword(s):

Maternal Death ◽

Motor Vehicle ◽

Operative Management ◽

Balloon Occlusion ◽

Motor Vehicle Accidents ◽

Gravid Uterus ◽

Intrauterine Pregnancy ◽

Vehicle Accidents ◽

Pelvic Hemorrhage ◽

Endovascular Balloon Occlusion

Trauma related injury is the leading cause of non-obstetric maternal death. The gravid uterus is at risk for injury, particularly during motor vehicle accidents. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a means of controlling pelvic hemorrhage in the setting of trauma. We report the use of REBOA in a hemodynamically unstable, multiply-injured young woman with viable intrauterine pregnancy.

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