scholarly journals CT-based classification systems for intra-articular calcaneal fractures: the inter- and intra-observer variations as well as integrality

2020 ◽  
Author(s):  
zhongzheng wang ◽  
Shaobo Liang ◽  
Yuchuan Wang ◽  
Ze Gao ◽  
Siyu Tian ◽  
...  
Keyword(s):  
Interobserver Reliability ◽  
Ct Scanning ◽  
Trauma Centre ◽  
Classification Systems ◽  
Ct Scans ◽  
Calcaneal Fractures ◽  
Intraobserver Reproducibility ◽  
Level I ◽  
Fracture Classification Systems ◽  
Positive Effect

Abstract Background: Several primary fracture classification systems (FCSs) have been widely used for intra-articular calcaneal fractures. The purpose of this study was to measure the inter- and intra-observer variations as well as integrality of the Zwipp, Crosby-Fitzgibbons, Sanders, and Eastwood-Atkins classification systems based on more accurate CT scans. Methods: 549 patients with intra-articular calcaneal fractures taken from a database in our level-I trauma centre (3 affiliated hospitals) were included from January 2018 to December 2019. For each case, normative CT (1 mm slices) scans were available. Four different observers reviewed all CT scans two times according to these 4 most prevalent FCSs within a 2-month interval. For these four FCSs, the kappa [κ] coefficient was used to evaluate interobserver reliability and intraobserver reproducibility, and the percentage that can be classified was used to indicate integrality. Results: The κ values were measured for Zwipp (κ= 0.38 interobserver, κ= 0.61 intraobserver), Crosby-Fitzgibbons (κ= 0.48 interobserver, κ= 0.79 intraobserver), Sanders (κ= 0.40 interobserver, κ= 0.57 intraobserver), and Eastwood-Atkins (κ= 0.44 interobserver, κ= 0.72 intraobserver). Furthermore, the integrality were calculated for Zwipp (100 %), Crosby-Fitzgibbons (100 %), Sanders (92 %) as well as Eastwood-Atkins (89.6 %). Conclusion: Compared with previous literatures, CT scanning with higher accuracy can significantly improve intraobserver reproducibility of Zwipp and Eastwood-Atkins FCSs, but it has no positive effect on variability of Sanders FCS and interobserver reliability of Crosby-Fitzgibbons FCS. While in terms of integrality, Zwipp and Crosby-Fitzgibbons FCSs appear to be superior to the other two FCSs.

scholarly journals Scoring systems for early prediction of tibial fracture non-union: an update

2021 ◽  
Author(s):  
George D. Chloros ◽  
Nikolaos K. Kanakaris ◽  
James S. H. Vun ◽  
Anthony Howard ◽  
Peter V. Giannoudis
Keyword(s):  
Tibial Fracture ◽  
Scoring Systems ◽  
Trauma Centre ◽  
Predictive Values ◽  
Non Union ◽  
Post Operative Period ◽  
Male Patients ◽  
Level I ◽  
Healing Score ◽  
Tibial Shaft Fractures

Abstract Purpose To evaluate the available tibial fracture non-union prediction scores and to analyse their strengths, weaknesses, and limitations. Methods The first part consisted of a systematic method of locating the currently available clinico-radiological non-union prediction scores. The second part of the investigation consisted of comparing the validity of the non-union prediction scores in 15 patients with tibial shaft fractures randomly selected from a Level I trauma centre prospectively collected database who were treated with intramedullary nailing. Results Four scoring systems identified: The Leeds-Genoa Non-Union Index (LEG-NUI), the Non-Union Determination Score (NURD), the FRACTING score, and the Tibial Fracture Healing Score (TFHS). Patients demographics: Non-union group: five male patients, mean age 36.4 years (18–50); Union group: ten patients (8 males) with mean age 39.8 years (20–66). The following score thresholds were used to calculate positive and negative predictive values for non-union: FRACTING score ≥ 7 at the immediate post-operative period, LEG-NUI score ≥ 5 within 12 weeks, NURD score ≥ 9 at the immediate post-operative period, and TFHS < 3 at 12 weeks. For the FRACTING, LEG-NUI and NURD scores, the positive predictive values for the development of non-union were 80, 100, 40% respectively, whereas the negative predictive values were 60, 90 and 90%. The TFHS could not be retrospectively calculated for robust accuracy. Conclusion The LEG-NUI had the best combination of positive and negative predictive values for early identification of non-union. Based on this study, all currently available scores have inherent strengths and limitations. Several recommendations to improve future score designs are outlined herein to better tackle this devastating, and yet, unsolved problem.

The management of bite wounds in children—A retrospective analysis at a level I trauma centre

Injury ◽  
2012 ◽  
Vol 43 (12) ◽  
pp. 2117-2121 ◽  
Author(s):  
Manuela Jaindl ◽  
Judith Grünauer ◽  
Patrick Platzer ◽  
Georg Endler ◽  
Christiane Thallinger ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Trauma Centre ◽  
Level I ◽  
Bite Wounds

Incidence of silent hemorrhage and delayed deterioration after stereotactic brain biopsy

1998 ◽  
Vol 89 (1) ◽  
pp. 31-35 ◽  
Author(s):  
Abhaya V. Kulkarni ◽  
Abhijit Guha ◽  
Andres Lozano ◽  
Mark Bernstein
Keyword(s):  
Ct Scan ◽  
Neurological Deficit ◽  
Stereotactic Biopsy ◽  
Brain Biopsy ◽  
Ct Scanning ◽  
Ct Scans ◽  
Stereotactic Brain Biopsy ◽  
Content Type ◽  
Fine Print

Object. Many neurosurgeons routinely obtain computerized tomography (CT) scans to rule out hemorrhage in patients after stereotactic procedures. In the present prospective study, the authors investigated the rate of silent hemorrhage and delayed deterioration after stereotactic biopsy sampling and the role of postbiopsy CT scanning. Methods. A subset of patients (the last 102 of approximately 800 patients) who underwent stereotactic brain biopsies at the Toronto Hospital prospectively underwent routine postoperative CT scanning within hours of the biopsy procedure. Their medical charts and CT scans were then reviewed. A postoperative CT scan was obtained in 102 patients (aged 17–87 years) who underwent stereotactic biopsy between June 1994 and September 1996. Sixty-one patients (59.8%) exhibited hemorrhages, mostly intracerebral (54.9%), on the immediate postoperative scan. Only six of these patients were clinically suspected to have suffered a hemorrhage based on immediate postoperative neurological deficit; in the remaining 55 (53.9%) of 102 patients, the hemorrhage was clinically silent and unsuspected. Among the clinically silent intracerebral hemorrhages, 22 measured less than 5 mm, 20 between 5 and 10 mm, five between 10 and 30 mm, and four between 30 and 40 mm. Of the 55 patients with clinically silent hemorrhages, only three demonstrated a delayed neurological deficit (one case of seizure and two cases of progressive loss of consciousness) and these all occurred within the first 2 postoperative days. Of the neurologically well patients in whom no hemorrhage was demonstrated on initial postoperative CT scan, none experienced delayed deterioration. Conclusions. Clinically silent hemorrhage after stereotactic biopsy is very common. However, the authors did not find that knowledge of its existence ultimately affected individual patient management or outcome. The authors, therefore, suggest that the most important role of postoperative CT scanning is to screen for those neurologically well patients with no hemorrhage. These patients could safely be discharged on the same day they underwent biopsy.

Is Hypaque Dangerous?

PEDIATRICS ◽  
1989 ◽  
Vol 83 (4) ◽  
pp. 650-650
Author(s):  
ROBERT SCHLECHTER ◽  
ABRAHAM BESSERMAN
Keyword(s):  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Ct Scanning ◽  
Ct Scans ◽  
Solid Organ ◽  
Abdominal Ct ◽  
Injured Child ◽  
Gastric Distention ◽  
Close Observation

Concerning the use of diatrizoate sodium (Hypaque) in abdominal CT scans described by Kane et al (Pediatrics 1988;82:11-15), we agree that there is certainly much to be gained from CT scanning in blunt abdominal trauma. We question the routine use of diatrizoate sodium in an injured child predisposed to gastric distention and vomiting. This is particularly dangerous when he or she is prone and restrained and close observation at the bedside is not possible. Solid organ injuries are well demonstrated without contrast, and injury to a viscus can be evaluated clinically and by routine roentgenographic procedures.

Etiology and Pathogenesis of Intraventricular Hemorrhage in Newborns

PEDIATRICS ◽  
1989 ◽  
Vol 84 (2) ◽  
pp. 382-385
Author(s):  
KAREN E. PAPE
Keyword(s):  
Intracranial Hemorrhage ◽  
Intraventricular Hemorrhage ◽  
Ct Scanning ◽  
Postmortem Examination ◽  
Brain Lesions ◽  
Ct Scans ◽  
Clinical Criteria ◽  
The Status

The article by Miall-Allen et al is an important contribution to the status of BP control and intracranial hemorrhage in the newborn. Until 10 years ago, there were limited methods of assessment. Hemorrhagic brain lesions were diagnosed mainly by clinical criteria and postmortem examination. In the late 1970s, CT scans provided much more in vivo information. However, CT scanning is inherently difficult in the newborn. Early machines produced a significant amount of radiation and the infants had to be transported to a radiology unit. These difficulties meant that a limited number of scans were done and children were rarely sequentially exposed.

Short Observation Period and Aggressive Discharge of Patients With Head Injury and Serial CT Scans

2021 ◽  
pp. 000313482110635
Author(s):  
Jordan Perkins ◽  
Jacob Shreffler ◽  
Danielle Kamenec ◽  
Alexandra Bequer ◽  
Corey Ziemba ◽  
...  
Keyword(s):  
Ct Scanning ◽  
Ct Scans ◽  
New Findings ◽  
Serial Ct ◽  
Radiographic Interpretation ◽  
Evidence Based Guidelines ◽  
Head Computed Tomography ◽  
Repeat Imaging ◽  
Observation Period ◽  
Negative Conversion

Background: Many patients undergo two head computed tomography (CT) scans after mild traumatic brain injury (TBI). Radiographic progression without clinical deterioration does not usually alter management. Evidence-based guidelines offer potential for limited repeat imaging and safe discharge. This study characterizes patients who had two head CTs in the Emergency Department (ED), determines the change between initial and repeat CTs, and describes timing of repeat scans. Methods: This retrospective series includes all patients with head CTs during the same ED visit at an urban trauma center between May 1st, 2016 and April 30th, 2018. Radiographic interpretation was coded as positive, negative, or equivocal. Results: Of 241 subjects, the number of positive, negative, and equivocal initial CT results were 154, 50, and 37, respectively. On repeat CT, 190 (78.8%) interpretations were congruent with the original scan. Out of the 21.2% of repeat scans that diverged from the original read, 14 (5.8%) showed positive to negative conversion, 1 (.4%) showed positive to equivocal conversion, 2 (.88%) showed negative to positive conversion, 20 (8.3%) showed equivocal to negative conversion, and 14 (5.8%) showed equivocal to positive conversion. Average time between scans was 4.4 hours, and median length of stay was 10.2 hours. Conclusions: In this retrospective review, most repeat CT scans had no new findings. A small percentage converted to positive, rarely altering clinical management. This study demonstrates the need for continued prospective research to update clinical guidelines that could reduce admission and serial CT scanning for mild TBI.

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