scholarly journals Risk factors for mortality in blunt abdominal trauma with surgical approach

2015 ◽  
Vol 42 (4) ◽  
pp. 259-264 ◽  
Author(s):  
SILVANIA KLUG PIMENTEL ◽  
GUILHERME VINICIUS SAWCZYN ◽  
MELISSA MELLO MAZEPA ◽  
FELIPE GUILHERME GONÇALVES DA ROSA ◽  
ADONIS NARS ◽  
...  
Keyword(s):  
Risk Factors ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Hemodynamic Instability ◽  
The Other ◽  
Organ Injury ◽  
Solid Organ ◽  
Solid Organ Injury ◽  
Serious Injury ◽  
Serious Injuries

ABSTRACTObjective:identify risk factors for mortality in patients who underwent laparotomy after blunt abdominal trauma.Methods:retrospective study, case-control, which were reviewed medical records of blunt trauma victims patients undergoing laparotomy, from March 2013 to January 2015, and compared the result of the deaths group with the group healed.Results:of 86 patients, 63% were healed, 36% died, and one patient was excluded from the study. Both groups had similar epidemiology and trauma mechanism, predominantly young adults males, automobilistic accident. Most cases that evolved to death had hemodynamic instability as laparotomy indication - 61% against 38% in the other group (p=0.02). The presence of solid organ injury was larger in the group of deaths - 80% versus 48% (p=0.001) and 61% of them had other associated abdominal injury compared to 25% in the other group (p=0.01). Of the patients who died 96% had other serious injuries associated (p=0.0003). Patients requiring damage control surgery had a higher mortality rate (p=0.0099). Only one of 18 patients with isolated hollow organ lesion evolved to death (p=0.0001). The mean injury score of TRISS of cured (91.70%) was significantly higher than that of deaths (46.3%) (p=0.002).Conclusion:the risk factors for mortality were hemodynamic instability as an indication for laparotomy, presence of solid organ injury, multiple intra-abdominal injuries, need for damage control surgery, serious injury association and low index of trauma score.

Changes in Approach to Solid Organ Injury: What the Radiologist Needs to Know

2020 ◽  
Vol 71 (3) ◽  
pp. 352-361
Author(s):  
Siobhán B. O’Neill ◽  
Saira Hamid ◽  
Savvas Nicolaou ◽  
Sadia R. Qamar
Keyword(s):  
American Association ◽  
Nonoperative Management ◽  
Damage Control ◽  
Management Strategies ◽  
Damage Control Surgery ◽  
Organ Injury ◽  
Solid Organ ◽  
Imaging Findings ◽  
Solid Organ Injury ◽  
Imaging Protocols

This review aims to examine the challenges facing radiologists interpreting trauma computed tomography (CT) images in this era of a changing approach to management of solid organ trauma. After reviewing the pearls and pitfalls of CT imaging protocols for detection of traumatic solid organ injuries, we describe the key changes in the 2018 American Association for the Surgery of Trauma Organ Injury Scales for liver, spleen, and kidney and their implications for management strategies. We then focus on the important imaging findings in observed in patients who undergo nonoperative management and patients who are imaged post damage control surgery.

scholarly journals Blunt abdominal trauma: a tertiary care experience

2018 ◽  
Vol 5 (3) ◽  
pp. 975
Author(s):  
Vikram Trehan ◽  
Sukumar S. Kumar
Keyword(s):  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Tertiary Care ◽  
Hemodynamic Instability ◽  
Morbidity And Mortality ◽  
Organ Injury ◽  
Solid Organ ◽  
Care Hospital ◽  
Management Options ◽  
Solid Organ Injury

Background: Blunt abdominal trauma (BAT) is one of the common causes of admission in surgical ward in any hospital. It requires high level of suspicion, urgent evaluation and timely management to decrease morbidity and mortality. Aim of present study was to find out demographic details, causes of injury, management options and treatment outcomes of BAT.Methods: Retrospective study of cases of BAT was carried out at a tertiary care hospital of India spanning five years, between June 2012 to June 2017. Authors analyzed the demographic profile of the trauma victims, etiological factors of BAT, the abdominal organs involved, the treatment modalities adopted and the final outcome.Results: There were 231 cases of BAT. Most common age group was 11 to 30 years which accounted for 42.42% of the total. The study had 181 (78.35%) males and 50 (21.64%) females. Road traffic accident was the most common cause of BAT and it accounted for 67.97%. Liver (34.20%) was the most commonly involved organ followed by spleen (22.51%), bowel (15.58%), mesentery (8.23%), kidney (7.36%), pancreaticoduodenal injuries (3.46%) and diaphragm (3.46%). 56.71% underwent non-operative management (NOM), 3.90% underwent angio-embolization and 39.39% eventually required operative treatment. Mortality occurred in 31 patients (13.41%) because of septicemia, renal failure, shock, acute coronary event or respiratory complications.Conclusions: NOM for BAT was found to be successful in haemodynamically stable patient with solid organ injury. Along with sophisticated infrastructure like ultrasound or CT Scan, close supervision with repeated examination by a treating surgeon were the sheet anchors of NOM. Angio-embolization is a feasible modality of treatment in solid organ injury and can avoid surgery in an appropriate patient. Definitive indications for laparotomy were hemodynamic instability and perforation-peritonitis. Initial hemodynamic instability, haemorrhagic shock, and associated injuries influenced morbidity and mortality in BAT. 

scholarly journals Intra-Abdominal Solid Organ Injury Management in Pediatrics

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
K Subrumaniam ◽  
Sakti Sakti ◽  
Nur Daliza ◽  
YW Yan
Keyword(s):  
Chest Tube ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Pediatric Population ◽  
Operative Management ◽  
Hemodynamic Instability ◽  
Organ Injury ◽  
Solid Organ ◽  
Significant Morbidity ◽  
Solid Organ Injury

Abdominal trauma is relatively uncommon in children but can leads to a significant morbidity and mortality in the pediatric population. The abdomen is the third most commonly injured anatomic region in children, after the head and the extremities. The abdomen is the most common site of initially unrecognized fatal injury in traumatized children. We are reporting a case of a child with multiple solid organ injury that was successfully treated non-operatively at our center. We presented a previously healthy 9-month-old girl, presented with fluctuating GCS secondary to motor vehicle accident with borderline hemodynamic stability. She was intubated, blood transfusion commenced and a single inotrope support started. She subsequently diagnosed with grade III liver injury, grade II splenic injury, right grade IV renal injury with large perinephric and retroperitoneal hematoma and moderate hemoperitoneum, a non-displaced left superior pubic rami fracture and cerebral edema on computed tomography (CT). She was admitted to pediatric intensive care unit (PICU). Her intra-abdominal injury injuries were successfully treated conservatively. She required a right chest tube on post trauma day 2, for right hemothorax. The chest tube was removed 3 days later following adequate drainage. She eventually was weaned off from ventilator on post trauma day 11. Feeding was commenced on day 7 of post trauma. She was discharge home well after 3 weeks post trauma with periodical follow up. Conclusion: Pediatric intra-abdominal solid organ injury is relatively uncommon, but a potential source of significant morbidity. Non-operative management is the standard of care for the majority of these injuries, which have shown successful rate more than 95%, although continued hemodynamic instability mandates operative intervention.

scholarly journals Serial hemoglobin monitoring in adult patients with blunt solid organ injury: less is more

2020 ◽  
Vol 5 (1) ◽  
pp. e000446 ◽  
Author(s):  
Firas Madbak ◽  
Dustin Price ◽  
David Skarupa ◽  
Brian Yorkgitis ◽  
David Ebler ◽  
...  
Keyword(s):  
Injury Severity ◽  
Kidney Injury ◽  
Hemodynamic Instability ◽  
Organ Injury ◽  
Solid Organ ◽  
Solid Organ Injury ◽  
Level Of Evidence ◽  
Less Is More ◽  
Urban Level ◽  
Level 1 Trauma Center

BackgroundPatients who sustain blunt solid organ injury to the liver, spleen, or kidney and are treated nonoperatively frequently undergo serial monitoring of their hemoglobin (Hb). We hypothesized that among initially hemodynamically stable patients with blunt splenic, hepatic, or renal injuries treated without an operation, scheduled monitoring of serum Hb values may be unnecessary as hemodynamic instability, not merely Hb drop, would prompt intervention.MethodsWe performed a retrospective review of patients admitted to our urban Level 1 trauma center following blunt trauma with any grade III, IV, or V liver, spleen, or kidney injury from January 1, 2016 to December 31, 2016. Patients who were hemodynamically unstable and went directly to the operating room or interventional radiology were excluded. Patients who required any urgent or unplanned operative or angiographic intervention were compared with patients who did not require an intervention. Routine demographic and outcome variables were obtained and bivariate and multivariate regression statistics were performed using Stata V.10.ResultsA total of 138 patients were included in the study. Age (39.3 vs 41.4, p=0.51), mean injury severity score (26.7 vs 22.1, p=0.12), and admission Hb (11.9 vs 12.8, p=0.06) did not differ significantly between the two groups. The number of Hb draws (9.2 vs 10, p=0.69) and the associated change in Hb (3.7 vs 3.5, p=0.71) did not differ significantly between the two groups. Only splenic grade predicted need for urgent intervention (3.5 vs 2, p<0.001). All patients who required an operative or radiologic intervention did so based on change in hemodynamics or severity of splenic grade, per our institutional protocol, and not Hb trend.DiscussionAmong patients with blunt solid organ injury, a need for emergent intervention in the form of laparotomy or angioembolization occurs within the first hours of injury. Routine scheduled Hb measurements did not change management in our cohort.Level of evidenceLevel III.

scholarly journals Damage Control in Penetrating Liver Trauma: Fear of the Unknown

2020 ◽  
Author(s):  
Carlos Alberto Ordoñez ◽  
Michael Parra ◽  
Mauricio Millan ◽  
Yaset Caicedo ◽  
Monica Guzman ◽  
...  
Keyword(s):  
Damage Control ◽  
Damage Control Surgery ◽  
Operative Management ◽  
Hemodynamic Instability ◽  
Liver Trauma ◽  
Solid Organ ◽  
Severely Injured ◽  
Management Algorithm ◽  
Liver Injuries ◽  
Non Operative Management

The liver is the most commonly affected solid organ in cases of abdominal trauma. Management of penetrating liver trauma is a challenge for surgeons but with the introduction of the concept of damage control surgery accompanied by significant technological advancements in radiologic imaging and endovascular techniques, the focus on treatment has changed significantly. The use of immediately accessible computed tomography as an integral tool for trauma evaluations for the precise staging of liver trauma has significantly increased the incidence of conservative non-operative management in hemodynamically stable trauma victims with liver injuries. However, complex liver injuries accompanied by hemodynamic instability are still associated with high mortality rates due to ongoing hemorrhage. The aim of this article is to perform an extensive review of the literature and to propose a management algorithm for hemodynamically unstable patients with penetrating liver injury, via an expert consensus. It is important to establish a multidisciplinary approach towards the management of patients with penetrating liver trauma and hemodynamic instability. The appropriate triage of these patients, the early activation of an institutional massive transfusion protocol, and the early control of hemorrhage are essential landmarks in lowering the overall mortality of these severely injured patients. To fear is to fear the unknown, and with the management algorithm proposed in this manuscript, we aim to shed light on the unknown regarding the management of the patient with a severely injured liver.

scholarly journals The critical roles of histone deacetylase 3 in the pathogenesis of solid organ injury

2021 ◽  
Vol 12 (8) ◽  
Author(s):  
Li Ning ◽  
Xiong Rui ◽  
Wang Bo ◽  
Geng Qing
Keyword(s):  
Histone Deacetylase ◽  
Chromatin Remodeling ◽  
Current Knowledge ◽  
Organ Injury ◽  
Solid Organ ◽  
Solid Organ Injury ◽  
Histone Deacetylase 3 ◽  
Physiological Conditions ◽  
Inflammatory Conditions ◽  
Therapeutic Value

AbstractHistone deacetylase 3 (HDAC3) plays a crucial role in chromatin remodeling, which, in turn, regulates gene transcription. Hence, HDAC3 has been implicated in various diseases, including ischemic injury, fibrosis, neurodegeneration, infections, and inflammatory conditions. In addition, HDAC3 plays vital roles under physiological conditions by regulating circadian rhythms, metabolism, and development. In this review, we summarize the current knowledge of the physiological functions of HDAC3 and its role in organ injury. We also discuss the therapeutic value of HDAC3 in various diseases.

scholarly journals Risk Factors for Fall-Related Serious Injury among Korean Adults: A Cross-Sectional Retrospective Analysis

2021 ◽  
Vol 18 (3) ◽  
pp. 1239
Author(s):  
Moon-Sook Kim ◽  
Hyun-Myung Jung ◽  
Hyo-Yeon Lee ◽  
Jinhyun Kim
Keyword(s):  
Risk Factors ◽  
Fall Prevention ◽  
Medical Records ◽  
Brain Injuries ◽  
Tertiary Hospital ◽  
Antiplatelet Drugs ◽  
Cross Sectional ◽  
Complete Survey ◽  
Serious Injury ◽  
Serious Injuries

The purpose of this study was to identify the risk factors of serious fall-related injuries by analyzing the differences between two fall groups: one with serious fall-related injuries and one without such injuries. Applying a retrospective, descriptive investigation study design, we analyzed the degree of fall-related injury and the risk factors related to serious falls by conducting a complete survey of the medical records of fall patients reported throughout one full year, 2017, at a tertiary hospital in Seoul, Korea. Among the patients with reported falls, 188 sustained no injury (63.1%), 72 sustained minor injury (24.2%), and 38 patients sustained serious injury (12.8%). The serious fall-related injuries included eight lacerations requiring suture (2.7%), 23 fractures (7.7%), five brain injuries (1.7%), and two deaths (0.7%). Analysis results indicated that taking anticoagulants/antiplatelet drugs (p = 0.016) and having a fall history (p = 0.038) were statistically significant in the differences between the group with serious injury related to falls and the group without serious injury. Logistic regression revealed that taking anticoagulant/antiplatelet drugs was the factor most significantly correlated with serious injuries related to falls (OR = 2.299, p = 0.022). Results show that it is necessary to develop a patient-tailored fall prevention activity program.

Embolization versus Surgery for Stabilized Patients with Solid Organ Injury

2021 ◽  
Author(s):  
Makoto Aoki ◽  
Toshikazu Abe ◽  
Shuichi Hagiwara ◽  
Daizoh Saitoh ◽  
Kiyohiro Oshima
Keyword(s):  
Organ Injury ◽  
Solid Organ ◽  
Solid Organ Injury

scholarly journals Damage control in the emergency department, a bridge to life

2021 ◽  
Vol 52 (2) ◽  
pp. e4004801
Author(s):  
Laureano Quintero ◽  
Juan Jose Melendez-Lugo ◽  
Helmer Emilio Palacios-Rodríguez ◽  
Natalia Padilla ◽  
Luis Fernando Pino ◽  
...  
Keyword(s):  
Emergency Department ◽  
Trauma Patient ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Hemodynamic Instability ◽  
Massive Hemorrhage ◽  
Severely Injured ◽  
Airway Injury ◽  
Hemostatic Resuscitation ◽  
Altered State Of Consciousness

Patients with hemodynamic instability have a sustained systolic blood pressure less or equal to 90 mmHg, a heart rate greater or equal to 120 beats per minute and an acute compromise of the ventilation/oxygenation ratio and/or an altered state of consciousness upon admission. These patients have higher mortality rates due to massive hemorrhage, airway injury and/or impaired ventilation. Damage control resuscitation is a systematic approach that aims to limit physiologic deterioration through a group of strategies that address the physiologic debt of trauma. This article aims to describe the experience earned by the Trauma and Emergency Surgery Group (CTE) of Cali, Colombia in the management of the severely injured trauma patient in the emergency department following the basic principles of damage control surgery. Since bleeding is the main cause of death, the management of the severely injured trauma patient in the emergency department requires a multidisciplinary team, which should perform damage control maneuvers aimed at rapidly control bleeding, hemostatic resuscitation and/or prompt transfer to the operating room, if required.

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