scholarly journals Comparative analysis of the frequency and the severity of diagnosed lesions between pedestrians struck by motor vehicles and other blunt trauma mechanisms victims

2015 ◽  
Vol 42 (4) ◽  
pp. 253-258 ◽  
Author(s):  
JOSÉ GUSTAVO PARREIRA ◽  
RAFAEL KRIEGER MARTINS ◽  
JULIO SLONGO ◽  
JACQUELINE A. GIANNINI PERLINGEIRO ◽  
SILVIA CRISTINE SOLDÁ ◽  
...  
Keyword(s):  
Blunt Trauma ◽  
Motor Vehicle ◽  
Flail Chest ◽  
Vital Signs ◽  
Motor Vehicles ◽  
Trauma Patients ◽  
Arterial Blood ◽  
Group A ◽  
Extremity Injuries ◽  
Mechanism Of Trauma

ABSTRACTObjective:to compare the frequency and the severity of diagnosed injuries between pedestrians struck by motor vehicles and victims of other blunt trauma mechanisms.Methods:retrospective analysis of data from the Trauma Registry, including adult blunt trauma patients admitted from 2008 to 2010. We reviewed the mechanism of trauma, vital signs on admission and the injuries identified. Severity stratification was carried using RTS, AIS-90, ISS e TRISS. Patients were assigned into group A (pedestrians struck by motor vehicle) or B (victims of other mechanisms of blunt trauma). Variables were compared between groups. We considered p<0.05 as significant.Results:a total of 5785 cases were included, and 1217 (21,0%) of which were in group A. Pedestrians struck by vehicles presented (p<0.05) higher mean age, mean heart rate upon admission, mean ISS and mean AIS in head, thorax, abdomen and extremities, as well as lower mean Glasgow coma scale, arterial blood pressure upon admission, RTS and TRISS. They also had a higher frequency of epidural hematomas, subdural hematomas, subarachnoid hemorrhage, brain swelling, cerebral contusions, costal fractures, pneumothorax, flail chest, pulmonary contusions, as well as pelvic, superior limbs and inferior limbs fractures.Conclusion:pedestrian struck by vehicles sustained intracranial, thoracic, abdominal and extremity injuries more frequently than victims of other blunt trauma mechanism as a group. They also presented worse physiologic and anatomic severity of the trauma.

scholarly journals Predictors of Mortality and Prehospital Monitoring Limitations in Blunt Trauma Patients

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Matej Strnad ◽  
Vesna Borovnik Lesjak ◽  
Vitka Vujanović ◽  
Tine Pelcl ◽  
Miljenko Križmarić
Keyword(s):  
Hospital Mortality ◽  
Regression Model ◽  
Blunt Trauma ◽  
Injury Severity ◽  
Vital Signs ◽  
Study Groups ◽  
Multivariate Logistic Regression Model ◽  
Hospital Death ◽  
Trauma Patients ◽  
Arterial Blood

This study aimed at determining predictors of in-hospital mortality and prehospital monitoring limitations in severely injured intubated blunt trauma patients. We retrospectively reviewed patients’ charts. Prehospital vital signs, Injury Severity Score (ISS), initial Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), arterial blood gases, and lactate were compared in two study groups: survivors (n=40) and nonsurvivors (n=30). There were no significant differences in prehospital vital signs between compared groups. Nonsurvivors were older (P=0.006), with lower initial GCS (P<0.001) and higher ISS (P<0.001), along with higher lactate (P<0.001) and larger base deficit (BD;P=0.006), whereas RTS (P=0.001) was lower in nonsurvivors. For predicting mortality, area under the curve (AUC) was calculated: for lactate 0.82 (P<0.001), for ISS 0.82 (P<0.001), and for BD 0.69 (P=0.006). Lactate level of 3.4 mmol/L or more was 82% sensitive and 75% specific for predicting in-hospital death. In a multivariate logistic regression model, ISS (P=0.037), GCS (P=0.033), and age (P=0.002) were found to be independent predictors of in-hospital mortality. The AUC for regression model was 0.93 (P<0.001). Increased levels of lactate and BD on admission indicate more severe occult hypoperfusion in nonsurvivors whereas vital signs did not differ between the groups.

Trauma in pregnancy: A review of the Pennsylvania Trauma Systems Foundation database

Trauma ◽  
2017 ◽  
Vol 20 (1) ◽  
pp. 30-37 ◽  
Author(s):  
Meike Schuster ◽  
Natasha Becker ◽  
Amanda Young ◽  
Michael J Paglia ◽  
A Dhanya Mackeen
Keyword(s):  
Blunt Trauma ◽  
Motor Vehicle ◽  
Penetrating Trauma ◽  
Blunt Injury ◽  
Trauma Patients ◽  
Severely Injured ◽  
Trauma Systems ◽  
Severely Injured Patients ◽  
Vaginal Deliveries ◽  
Injured Patients

Objective The goal of this study is to determine if injury severity score (ISS) of ≥9 and systolic blood pressure (SBP) predict poor maternal/pregnancy outcomes in blunt and penetrating trauma, respectively. Methods The Pennsylvania Trauma Systems Foundation database was used to identify pregnant trauma patients. Blunt trauma patients were analyzed with regard to ISS, while penetrating trauma patients were analyzed to determine whether SBP < 90 mmHg was predictive of poor maternal outcome. Results Patients with severe blunt injury (ISS ≥ 9) due to motor vehicle accident were less likely to wear seatbelts (51% vs. 63%, p = 0.005), and delivery was required in 17% of these patients as compared to 6% of the less severely injured, and only 6% of those were vaginal deliveries. Severely injured patients were discharged home 68% of the time and 6% died compared to less severely injured patients of which 83% were discharged home and <1% died; all other patients required discharge to a rehabilitation facility. Patients with penetrating trauma and SBP < 90 mmHg on arrival were more likely to require delivery (35% vs. 5%, p < 0.001) and were 14 times more likely to die (58% vs. 4%, p < 0.001) when compared to the normotensive group. Conclusion ISS ≥ 9 and SBP < 90 mmHg are predictors for poor outcomes after trauma during pregnancy. Severely injured blunt trauma patients often require surgery and delivery. Patients who present with SBP < 90 after penetrating trauma are more likely to deliver and are 14 times more likely to die.

P207 COMPARISON OF OPIOID vs OPIOID PLUS LOCAL ANESTHETIC EPIDURAL ADMINISTRATION IN IVOR LEWIS ESOPHAGECTOMY

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
E Papaioannou ◽  
P Doka ◽  
E Koziakas ◽  
A Analyti ◽  
D Danassi ◽  
...  
Keyword(s):  
Side Effects ◽  
Vital Signs ◽  
Opioid Analgesics ◽  
Epidural Administration ◽  
Ivor Lewis ◽  
Thoracic Epidural ◽  
Ivor Lewis Esophagectomy ◽  
Arterial Blood ◽  
Group A ◽  
Group B

Abstract Aim of the study was the comparison of single morphine vs morphine plus ropivacaine epidural administration for intraoperative pain management in Ivor Lewis esophagectomy. Background & Methods In a randomized prospective clinical trial, after informed consent, 20 patients were assigned to groups A (n=10): Morphine, and B (n=10=): Morphine and ropivacaine combination, according to the medication they were administered epidurally (ed), when submitted to Ivor Lewis esophagectomy. In both groups’ patients a thoracic epidural (T5-7) was inserted preoperative, and anesthetic protocol was the same, apart from opioid analgesics, that were titrated according to patients’ requirements. In group A morphine 1.5-3mg in 10-12ml normal saline volume, while in group B morphine 1.5-3mg plus ropivacaine 0.25% in a total volume of 10-12 ml were ed administered at least 20min before surgical incision. Opioids requirement, heart rate, arterial blood pressure, increments of muscle relaxant (rocuronium bromide) repetitive doses intraoperatively, and rescue analgesics need and side effects such as nausea, vomiting, drowsiness, respiratory depression and patients’distress in case of leg movement inability were recorded postoperatively. Results Patients’ demographics were similar in both groups. Intraoperatively, group A received significantly higher (p<0.001) fentanyl doses (4-6mcg/kg initially and 2hrs repetitive increments of 1-2mcg) vs group B (2-2.5mcg/kg initially, 4 (40%) patients didn’t require any supplementary dose and the rest 2-3mcg/kg in 1-2 increment doses until the end of operation). Vital signs were stable in both groups. Rocuronium requirement was significantly lower (p<0.001) in group B (apart from initial dose 1mg/kg, which was the same in both groups, group B demanded repetitive dose only before single to two-lumen endotracheal tube replacement, while group A required 0.2-0.3mg increment doses hourly). All patients were transferred awake postoperatively in ICU. None of any group patients demonstrated any side effects, but 3 (30%) group A patients required rescue analgesic (pain score > 4). Conclusion Morphine plus ropivacaine combination administered epidurally seems to provide lower pain scores and reduces the need for extra opioids intra- and postoperatively, and reduces muscle relaxants requirement during operation. Further studies are required to support these findings.

scholarly journals P136: What happens to bypassed trauma patients meeting Field Trauma Triage standards?

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S113-S113
Author(s):  
M. Austin ◽  
J. Sinclair ◽  
S. Leduc ◽  
S. Duncan ◽  
J. Rouleau ◽  
...  
Keyword(s):  
Orthopedic Surgery ◽  
Motor Vehicle ◽  
Vital Signs ◽  
Trauma Patients ◽  
Level Of Consciousness ◽  
Control And Prevention ◽  
Ct Head ◽  
Trauma Triage ◽  
Record Review ◽  
The Impact

Introduction: Prehospital field trauma triage (FTT) standards were reviewed and revised in 2014 based on the recommendations of the Centers for Disease Control and Prevention. The FTT standard allows a hospital bypass and direct transport, within 30 min, to a lead trauma hospital (LTH). Our objectives were to assess the impact of the newly introduced prehospital FTT standard and to describe the emergency department (ED) management and outcomes of patients that had bypassed closer hospitals. Methods: We conducted a 12-month multi-centred health record review of paramedic and ED records following the implementation of the 4 step FTT standard (step 1: vital signs and level of consciousness (physiologic), step 2: anatomical injury, step 3: mechanism and step 4: special considerations) in nine paramedic services across Eastern Ontario. We included adult trauma patients transported as urgent that met FTT standard, regardless of transport time. We developed and piloted a data collection tool and obtained consensus on all definitions. The primary outcome was the rate of appropriate triage to a LTH which was defined as: ISS ≥12, admitted to intensive care unit (ICU), non-orthopedic surgery, or death. We have reported descriptive statistics. Results: 570 patients were included: mean age 48.8, male 68.9%, falls 29.6%, motor vehicle collisions 20.2%, stab wounds 10.5%, transported to a LTH 76.5% (n = 436). 72.2% (n = 315) of patients transported to a LTH had bypassed a closer hospital and 126/306 (41.2%) of those were determined to be an appropriate triage to LTH (9 patients had missing outcomes). ED management included: CT head/cervical spine 69.9%, ultrasound 53.6%, xray 51.6%, intubation 15.0%, sedation 11.1%, tranexamic acid 9.8%, blood transfusion 8.2%, fracture reduction 6.9%, tube thoracostomy 5.9%. Outcomes included: ISS ≥ 12 32.7%, admitted to ICU 15.0%, non-orthopedic surgery 11.1%, death 8.8%. Others included: admission to hospital 57.5%, mean LOS 12.8 days, orthopedic surgery 16.3% and discharged from ED 37.3%. Conclusion: Despite a high number of admissions, the majority of trauma patients bypassed to a LTH were considered over-triaged, with a low number of ED procedures and non-orthopedic surgeries. Continued work is needed to appropriately identify patients requiring transport to a LTH.

scholarly journals PL03: Implementation of the Canadian C-Spine Rule by paramedics: a safety evaluation

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S26-S27 ◽  
Author(s):  
C. Vaillancourt ◽  
M. Charette ◽  
J.E. Sinclair ◽  
J. Maloney ◽  
R. Dionne ◽  
...  
Keyword(s):  
Motor Vehicle ◽  
Eligible Patient ◽  
Vital Signs ◽  
Low Risk ◽  
Spine Injury ◽  
Trauma Patients ◽  
Risk Criteria ◽  
Radiologic Evaluation ◽  
Kappa Agreement ◽  
The Impact

Introduction: The Canadian C-Spine Rule (CCR) was validated by emergency physicians and triage nurses to determine the need for radiography in alert and stable Emergency Department trauma patients. It was modified and validated for use by paramedics in 1,949 patients. The prehospital CCR calls for evaluation of active neck rotation if patients have none of 3 high-risk criteria and at least 1 of 4 low-risk criteria. This study evaluated the impact and safety of the implementation of the CCR by paramedics. Methods: This single-centre prospective cohort implementation study took place in Ottawa, Canada. Advanced and primary care paramedics received on-line and in-person training on the CCR, allowing them to use the CCR to evaluate eligible patients and selectively transport them without immobilization. We evaluated all consecutive eligible adult patients (GCS 15, stable vital signs) at risk for neck injury. Paramedics were required to complete a standardized study data form for each eligible patient evaluated. Study staff reviewed paramedic documentation and corresponding hospital records and diagnostic imaging reports. We followed all patients without initial radiologic evaluation for 30 days for referral to our spine service, or subsequent visit with radiologic evaluation. Analyses included sensitivity, specificity, kappa coefficient, t-test, and descriptive statistics with 95% CIs. Results: The 4,034 patients enrolled between Jan. 2011 and Aug. 2015 were: mean age 43 (range 16-99), female 53.3%, motor vehicle collision 51.9%, fall 23.8%, admitted to hospital 7.0%, acute c-spine injury 0.8%, and clinically important c-spine injury (0.3%). The CCR classified patients for 11 important injuries with sensitivity 91% (95% CI 58-100%), and specificity 67% (95% CI 65-68%). Kappa agreement for interpretation of the CCR between paramedics and study investigators was 0.94 (95% CI 0.92-0.95). Paramedics were comfortable or very comfortable using the CCR in 89.8% of cases. Mean scene time was 3 min (15.6%) shorter for those not immobilized (17 min vs. 20 min; p=0.0001). A total of 2,569 (63.7%) immobilizations were safely avoided using the CCR. Conclusion: Paramedics could safely and accurately apply the CCR to low-risk trauma patients. This had a significant impact on scene times and the number of prehospital immobilizations.

Detection of Cervical Spine Injuries in Alert, Asymptomatic Geriatric Blunt Trauma Patients: Who Benefits from Radiologic Imaging?

2006 ◽  
Vol 72 (9) ◽  
pp. 773-777 ◽  
Author(s):  
Adrian W. Ong ◽  
Aurelio Rodriguez ◽  
Robert Kelly ◽  
Vicente Cortes ◽  
Jack Protetch ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cervical Spine ◽  
Blunt Trauma ◽  
Cervical Spine Injury ◽  
Motor Vehicle ◽  
Spine Injury ◽  
Trauma Patients ◽  
Cervical Spine Injuries ◽  
Spine Injuries ◽  
Anatomic Locations

There are differing recommendations in the literature regarding cervical spine imaging in alert, asymptomatic geriatric patients. Previous studies also have not used computed tomography routinely. Given that cervical radiographs may miss up to 60 per cent of fractures, the incidence of cervical spine injuries in this population and its implications for clinical management are unclear. We conducted a retrospective study of blunt trauma patients 65 years and older who were alert, asymptomatic, hemodynamically stable, and had normal neurologic examinations. For inclusion, patients were required to have undergone computed tomography and plain radiographs. The presence and anatomic location of potentially distracting injuries or pain were recorded. Two hundred seventy-four patients were included, with a mean age of 76 ± 10 years. The main mechanisms of injury were falls (51%) and motor vehicle crashes (41%). Nine of 274 (3%) patients had cervical spine injuries. The presence of potentially distracting injuries above the clavicles was associated with cervical injury when compared with patients with distracting injuries in other anatomic locations or no distracting injuries (8/115 vs 1/159, P = 0.03). There was no association of cervical spine injury with age greater or less than 75 years or with mechanism of injury. The overall incidence of cervical spine injury in the alert, asymptomatic geriatric population is low. The risk is increased with a potentially distracting injury above the clavicles. Patients with distracting injuries in other anatomic locations or no distracting injuries may not need routine cervical imaging.

MRI as an Adjunct to Cervical Spine Clearance: A Utility Analysis

2012 ◽  
Vol 78 (7) ◽  
pp. 741-744 ◽  
Author(s):  
Michael C. Soult ◽  
Leonard J. Weireter ◽  
Rebecca C. Britt ◽  
Jay N. Collins ◽  
Timothy J. Novosel ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Physical Examination ◽  
Blunt Trauma ◽  
Motor Vehicle ◽  
Retrospective Chart Review ◽  
Persistent Pain ◽  
Acute Injury ◽  
Trauma Patients ◽  
Magnetic Resonance Imaging Mri ◽  
Motorcycle Crashes

Cervical spine (CS) injury occurs in 1 to 3 per cent of blunt trauma patients. The goal of this study is to evaluate the use of magnetic resonance imaging (MRI) as an adjunct to CS computed tomography (CT) in the presence of persistent pain with a normal physical examination or obtundation. A retrospective chart review was performed on 389 blunt trauma patients undergoing both CS CT and MRI between 2007 and 2010. Abnormal CT findings were found in 199. The remaining 190 patients with normal CT scans underwent MRI for persistent pain (109), neurologic symptoms (57), or obtundation (24). Motor vehicle crashes predominated (50%) followed by falls (19%) and motorcycle crashes (12%). In the patients with persistent pain, CT showed no acute injury (89%) with subsequent MRI demonstrating ligamentous edema or injury not seen on CT in 12 per cent of patients. No patient required an operation for CS instability. All the obtunded patients demonstrated localizing motion of four extremities. MRI of these patients demonstrated ligamentous edema or injury not seen on CT in 20 per cent of patients. No obtunded patient had CS instability or needed operative intervention. A localizing physical examination in conjunction with normal CS CT safely precludes a CS injury requiring cervical fixation. MRI does not add substantially to this decision-making and the cervical collar can be safely removed.

scholarly journals Comparison of two whole-body computer tomography protocols for polytrauma patients

2021 ◽  
Vol 108 (Supplement_4) ◽  
Author(s):  
N van Veelen ◽  
S Studer ◽  
B van de Wall ◽  
R Babst ◽  
B -C Link ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Upper Extremities ◽  
Whole Body ◽  
Trauma Patients ◽  
Two Phase ◽  
Whole Body Ct ◽  
Additional Imaging ◽  
Group A ◽  
Group B ◽  
Extremity Injuries

Abstract Objective The use of whole-body computed tomography (CT) is an established standard primary diagnostic method in the work up of polytrauma patients. The protocols used for such CTs however vary between trauma centers. In our Level 1 trauma Centre the protocol was changed from a three phase to a two phase protocol with different positioning of the patient. The primary aim of this study was to compare the estimated radiation dose and scan duration of the two protocols. The secondary aim was to evaluate whether the revision of the CT protocol led to a reduction of required additional imaging of the upper extremities. Methods For this retrospective, cross-sectional study two groups of consecutive trauma patients, which were treated in a level 1 trauma center in Switzerland and received a whole-body CT were analyzed. Group A consisted of patients, who presented between January and August 2016. These patients received a three-phased CT in which a repositioning of the arms from the side of the torso to above the head between phases two and three was needed. Group B consisted of those, who presented between January and July 2017. These patients received a CT according to a revised protocol, which was performed in two phases with the arms positioned ventral on a pillow to the torso throughout the entire CT. Scan duration, estimated radiation dose, number of upper extremity injuries, number of addition imaging (xray and CT) of the upper extremities within 24 hours of initial CT. Results A total of 182 patients were included in group A and 218 in group B. Baseline characteristics didn't differ, except for there being more males in group B (p 0.006). The estimated radiation dose was lower (15.0 mSv vs 22.9 mSv, p &lt; 0.001) and the scan duration shorter (4 vs 7 minutes, p &lt; 0.001) in group B. No difference could be shown in the number of upper extremity injuries detected. Further, the number of additional images of the upper extremities needed within 24 hours of the initial CT did not differ between the groups. Conclusion Both the estimated radiation dose and the scan duration of a whole-body CT scan in trauma patients can be reduced when a two phase protocol in which the arms are positioned on a pillow ventral to the torso is used instead of a three phase protocol with repositioning of the arms. The amount of additional imaging of the upper limb could not be reduced by having the arms visible on the scan.

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