Embolization in Trauma Patients: What Trauma Radiologists Should Know

Abstract Objectives Limited information exists on embolization for trauma patients regarding arteries embolized, embolic materials used, and embolization duration. We clarified the clinical application of embolization in trauma patients and factors associated with a prolonged procedure time. Methods Medical records of 162 trauma patients who underwent embolization between January 2007 and December 2020 at a regional trauma care center were reviewed retrospectively. Patients were divided into six embolized body regions: cerebrovascular, chest, abdomen, pelvis, peripheral, and other. Patient demographics, trauma mechanism, physiology, trauma severity, embolization procedures, and 30-day mortality were examined. The primary outcome was identifying an embolized body region and arteries, and secondary outcome was procedure time. Results Embolization was mainly performed in pelvic fractures (n = 96, 59%) and abdominal organ injuries (n = 57, 35%) and extended to the chest (n = 17, 10%), cerebrovascular (n = 8, 4.9%), peripheral (n = 5, 3.1%), and other (n = 7, 4.3%) regions. Approximately 13% (n = 21) of patients underwent embolization in ≥2 regions. Embolization was more strictly performed in minor artery injuries, e.g. external iliac (n = 15, 16%) and lumbar artery (n = 22, 23%) branches in pelvic fractures, and inferior phrenic artery (n = 2, 3.5%) branches in liver injuries. Non-selective embolization for a pelvic fracture tended to show a shorter procedure time despite no statistically significant difference (p = 0.056). For a longer procedure time, the number of embolized arteries (R = 0.357) and embolized body regions (R = 0.428) correlated. Conclusions Embolizations for trauma patients extended to various trauma regions. In time-sensitive embolization, emergency interventional radiologists showed superior knowledge of expected embolizing arteries and factors associated with procedure time.

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LO89: Factors associated with delay in trauma team activation and impact on patient outcomes

CJEM ◽

10.1017/cem.2017.151 ◽

2017 ◽

Vol 19 (S1) ◽

pp. S58-S59

Author(s):

R. Connolly ◽

M. Woo ◽

J. Lampron ◽

J.J. Perry

Keyword(s):

Length Of Stay ◽

Trauma Team ◽

Operative Management ◽

Trauma Patients ◽

Early Group ◽

Emergency Physicians ◽

Trauma Team Activation ◽

Factors Associated ◽

Significant Difference ◽

Delayed Group

Introduction: Trauma code activation is initiated by emergency physicians using physiologic and anatomic criteria, mechanism of injury and patient demographic factors in conjunction with data obtained from emergency medical service personnel. This enables rapid definitive treatment of trauma patients. Our objective was to identify factors associated with delayed trauma team activation. Methods: We conducted a health records review to supplement data from a regional trauma center database. We assessed consecutive cases from the trauma database from January 2008 to March 2014 including all cases in which a trauma code was activated by an emergency physician. We defined a delay in trauma code activation as a time greater than 30 minutes from time to arrival to trauma team activation. Data were collected in Microsoft Excel and analyzed in Statistical Analysis System (SAS). We conducted univariate analysis for factors potentially influencing trauma team activation and we subsequently used multiple logistic regression analysis models for delayed activation in relation to mortality, length of stay and time to operative management. Results: 1020 patients were screened from which 174 patients were excluded, as they were seen directly by the trauma team. 846 patients were included for our analysis. 4.1% (35/846) of trauma codes were activated after 30 minutes. Mean age was 40.8 years in the early group versus 49.2 in the delayed group p=0.01. There was no significant difference in type of injury, injury severity or time from injury between the two groups. Patients were over 70 years in 7.6% in the early activation group vs 17.1% in the delayed group (p=0.04). 77.7% of the early group were male vs 71.4% in the delayed group (p=0.39). There was no significant difference in mortality (15.2% vs 11.4% p=0.10), median length of stay (10 days in both groups p=0.94) or median time to operative management (331 minutes vs 277 minutes p=0.52). Conclusion: Delayed activation is linked with increasing age with no clear link with increased mortality. Given the severe injuries in the delayed cohort which required activation of the trauma team further emphasis on the older trauma patient and interventions to recognize this vulnerable population should be made. When assessing elderly trauma patients emergency physicians should have a low threshold to activate trauma teams.

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Reports of Regional Body Discomfort during Carpenter Apprentice Training

Proceedings of the Human Factors and Ergonomics Society Annual Meeting ◽

10.1177/154193129604001323 ◽

1996 ◽

Vol 40 (13) ◽

pp. 688-692

Author(s):

Peregrin Spielholz ◽

Steven F. Wiker

Keyword(s):

Body Region ◽

Training Effects ◽

Awareness Training ◽

Musculoskeletal Discomfort ◽

Body Regions ◽

Lower Back ◽

Significant Difference ◽

Body Discomfort

Regional discomfort questionnaires were administered to apprentice carpenters at three month intervals for a duration of six months following an ergonomics awareness training as part of apprenticeship school. Reports of frequent musculoskeletal discomfort were reported by between 20 and 29 percent of carpenters for each of the nine body regions with the exception of higher levels for the lower back. Severity ratings and frequency of discomfort were highest for the lower back and hands/wrists. There was no significant difference in reports of musculoskeletal discomfort among the baseline and follow-up questionniares (p > 0.05). The lower back was the only body region showing a decrease in the ratings of discomfort severity during follow-up. Further study of training effects on work methods and discomfort are recommended.

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Outcomes of Monochorionic, Diamniotic Twin Pregnancies with Prenatally Diagnosed Intertwin Weight Discordance

American Journal of Perinatology ◽

10.1055/s-0040-1721697 ◽

2020 ◽

Author(s):

Nasim C. Sobhani ◽

Teresa N. Sparks ◽

Kristen A. Gosnell ◽

Larry Rand ◽

Juan M. Gonzalez ◽

...

Keyword(s):

Risk Factors ◽

Pregnancy Outcome ◽

Care Center ◽

Tertiary Care ◽

Subsequent Development ◽

The United States ◽

Secondary Outcome ◽

Fetal Ultrasound ◽

Factors Associated ◽

Twin Pregnancies

Objective Monochorionic, diamniotic (MCDA) twin pairs are predisposed to various pregnancy complications due to the unique placental angioarchitecture of monochorionicity. Few studies have evaluated the outcomes of weight-discordant MCDA pairs without selective fetal growth restriction (SFGR) or the risk factors for development of SFGR. This study aims to describe the natural history of expectant, noninvasive management of weight-discordant MCDA twins and to evaluate risk factors associated with progression to SFGR. Study Design This was a retrospective cohort study at a single, tertiary care center in the United States. All MCDA twins with isolated intertwin weight discordance (ITWD) ≥ 20% diagnosed before 26 weeks' gestational age (GA) were included. The primary outcome of descriptive analyses was overall pregnancy outcome, incorporating both survival to delivery and GA at delivery, as defined by the North American Fetal Therapy Network. The secondary outcome was SFGR in one twin (defined as estimated fetal weight < 10% for GA) and factors associated with this progression. Only those with fetal ultrasound (US) within 4 weeks of delivery were included in this secondary analysis. Results Among 73 MCDA pairs with ITWD, 73% had a good pregnancy outcome, with dual live delivery at a median GA of 33 weeks. Among the 34 pairs with adequate US follow-up, 56% developed SFGR. There were no differences in GA at delivery or discordance at birth between those who did and those who did not develop SFGR. There was a nonsignificant association between increasing ITWD at diagnosis and subsequent development of SFGR. Conclusion Expectant, noninvasive management can be considered in MCDA twin pregnancies with ITWD ≥ 20% diagnosed before 26 weeks. This approach is associated with a good pregnancy outcome in the majority of cases, even after the development of SFGR in the smaller twin. Key Points

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Does Time to Pelvic Fixation Influence Outcomes in Trauma Patients?

The American Surgeon ◽

10.1177/00031348211056266 ◽

2021 ◽

pp. 000313482110562

Author(s):

Nicholas A. Taylor ◽

Alison A. Smith ◽

Alan Marr ◽

Lance Stuke ◽

Patrick Greiffenstein ◽

...

Keyword(s):

Linear Regression ◽

Multiple Linear Regression ◽

Univariate Analysis ◽

Pelvic Fractures ◽

Trauma Patients ◽

Pelvic Fixation ◽

Trauma Population ◽

Life Saving ◽

Significant Difference ◽

Late Group

Background Pelvic fractures cause significant morbidity in the trauma population. Many factors influence time to fracture fixation. No previous study has determined the optimal time window for pelvic fixation. Methods A retrospective review of trauma patients with pelvic fractures from 2016 to 2020 was performed. Patients were stratified into EARLY and LATE groups, by time to fixation within 3 days or greater than 3 days whether from admission or from completion of a life-saving procedure. Unpaired Student’s t-test and Fisher’s exact test were performed with multiple linear regression for variables with P < .2 on univariate analysis. Results 287 patients were identified with a median fixation time of 3 days. There was no significant difference in demographics, incidence of preceding life-saving procedure, angioembolization, or mechanism of injury in the 2 groups ( P > .05). Length of stay in the EARLY group was significantly reduced at 11.9 +/− .7 days compared to 18.0 +/−1.2 days in the LATE group ( P < .001). There was no significant difference in rates of ventilator-associated pneumonia, deep vein thrombosis, pulmonary embolism (PE), acute kidney injury (AKI), pressure ulcer, or acute respiratory distress syndrome (ARDS) ( P > .05). There were significantly more SSIs (surgical site infections) in the LATE group. After multiple linear regression adjusting for covariates of age and ISS, the difference in hospital LOS was 5.5 days (95% CI −8.0 to −3.1, P < .001). Discussion Fixation of traumatic pelvic fractures within 3 days reduced LOS. Prospective multi-center studies will help identify additional factors to decrease time to surgery and improve patient outcomes.

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Musculoskeletal Disorders among Italian Dentists and Dental Hygienists

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18052705 ◽

2021 ◽

Vol 18 (5) ◽

pp. 2705

Author(s):

Maria Giovanna Gandolfi ◽

Fausto Zamparini ◽

Andrea Spinelli ◽

Alessandro Risi ◽

Carlo Prati

Keyword(s):

Physical Activity ◽

Musculoskeletal Disorders ◽

Working Hours ◽

Physical Activities ◽

University Education ◽

Lumbar Region ◽

Factors Associated ◽

Body Regions ◽

Significant Difference ◽

Dental Professionals

Dental professionals often perform physically and mentally demanding therapeutical procedures. They work maintaining muscular imbalance and asymmetrical positions for a long time. The aim of the study was to describe the prevalence and the factors associated to work-related musculoskeletal disorders (WMSD) among Italian dental professionals and the most affected body regions. A cross-sectional observational study was conducted between March 2019 and February 2020. The Nordic Musculoskeletal questionnaire (NMQ) was implemented with questions related to working habits (dental occupation, working hours per week and per days, years of work) and lifestyle (practiced physical activity, including frequency and duration, mobilization activities, and knowledge of ergonomic guidelines) was used. The-chi square test was carried out to detect any statistically significant difference (p < 0.05). Logistic regression was carried out to detect the most significant factors associated to WMSD occurrence. A total of 284 questionnaires have been used for the analysis. A high proportion of dental professionals (84.6%) were affected by WMSD in the last 12 months. A higher prevalence was found in females (87%) when compared to males (80%). The prevalence of WMSD was correlated to the working hours/day and hour/week, with a higher risk for operators working >5 h/day and >30 h/week. In addition, a high prevalence was found in operators working for 2–5 years after graduation. Most of the surveyed dental professionals practiced physical activity (70.1%) but only a few had satisfactorily knowledge of ergonomic guidelines (12.7%). Interestingly, participants who practiced yoga or stretching as physical activities demonstrated lower WMSD (77%) when compared to other physical activities (84%). We can highlight that generic physical activities have no functional effect on WMSD for dental professionals. The most affected body areas were neck (59.9%), shoulders (43.3%), lumbar region (52.1%), dorsal region (37.7%) and wrists (30.6%). Considering the magnitude of the problem, there is an urgent need to implement the education in ergonomics among dental professionals, that may be achieved by teaching biomechanics, posturology and integrative functional therapies (such as yoga) during the university education and by promoting holistic health of dental operators.

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Should registrars be reporting after-hours CT scans? A calculation of error rate and the influencing factors in South Africa

Acta Radiologica ◽

10.1258/ar.2011.110103 ◽

2012 ◽

Vol 53 (1) ◽

pp. 61-68 ◽

Cited By ~ 9

Author(s):

Owen D Terreblanche ◽

Savvas Andronikou ◽

Linda T Hlabangana ◽

Taryn Brown ◽

Pieter E Boshoff

Keyword(s):

South Africa ◽

Influencing Factors ◽

Error Rate ◽

The Body ◽

Ct Scans ◽

Body Region ◽

Body Regions ◽

Significant Difference ◽

After Hours ◽

The Difference

Background There is a heavy reliance on registrars for after-hours CT reporting with a resultant unavoidable error rate. Purpose To determine the after-hours CT reporting error rate by radiology registrars and influencing factors on this error rate. Material and Methods A 2-month prospective study was undertaken at two tertiary, level 1 trauma centers in Johannesburg, South Africa. Provisional CT reports issued by the registrar on call were reviewed by a qualified radiologist the following morning and information relating to the number, time and type of reporting errors made as well as the body region scanned, indication for the scan, year of training of the registrar, and workload during the call were recorded and analyzed. Results A total of 1477 CT scans were performed with an overall error rate of 17.1% and a major error rate of 7.7%. The error rate for 2nd, 3rd, and 4th year registrars was 19.4%, 15.1%, and 14.5%, respectively. A significant difference was found between the error rate in reporting trauma scans (15.8%) compared to non-trauma scans (19.2%) although the difference between emergency scans (16.9%) and elective scans (22.6%) was found to be not significant, a finding likely due to the low number of elective scans performed. Abdominopelvic scans elicited the highest number of errors (33.9%) compared to the other body regions such as head (16.5%) and cervical, thoracic, or lumbar spine (11.7%). Increasing workload resulted in a significant increase in error rate when analyzed with a generalized linear model. There was also a significant difference noted in the time of scan groups which we attributed to a workload effect. Missed findings were the most frequent errors seen (57.3%). Conclusion We found an increasing error rate associated with increasing workload and marked increase in errors with the reporting of abdominopelvic scans. There was a decrease in the error rate when looking an increasing year of training although this there was only found to be significant difference between the 2nd and 3rd year registrars.

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Novel transcatheter arterial embolization method for hemodynamically unstable pelvic fractures to prevent complications of gluteal necrosis

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-018-01066-1 ◽

2019 ◽

Vol 46 (5) ◽

pp. 1129-1136 ◽

Cited By ~ 1

Author(s):

Takaaki Maruhashi ◽

Fumie Kashimi ◽

Rika Kotoh ◽

Shun Kasahara ◽

Hiroaki Minehara ◽

...

Keyword(s):

Overall Survival ◽

Transcatheter Arterial Embolization ◽

Arterial Embolization ◽

Pelvic Fractures ◽

Embolic Agent ◽

Gelatin Sponge ◽

Procedure Time ◽

Iliac Arteries ◽

Significant Difference ◽

Embolization Procedure

Abstract Purpose To validate our previously designed transcatheter arterial embolization (TAE) technique for bilateral iliac arteries in unstable pelvic fractures, which is designed to also prevent gluteal necrosis and avoid vasopressors. Methods We retrospectively analyzed the data of patients with pelvic fractures who underwent our new TAE procedure to determine the incidence of subsequent gluteal necrosis. We also compared certain variables between patients who underwent TAE before 2005 using a different technique and developed gluteal necrosis and patients who underwent TAE in 2005 and onward using our technique. Gluteal necrosis was confirmed by a radiologist based on imaging findings. Results Seventy patients with pelvic fractures who underwent our TAE technique met the inclusion criteria (bilateral iliac arterial embolization and no embolic agent other than a gelatin sponge). Patients’ median age was 47.5 years, 33 were male, and 92.9% (65/70) had unstable fractures. Sixty-eight patients had severe multiple trauma. No patients developed gluteal necrosis following our TAE procedure and the overall survival rate was 82.9% (58/70). We found no statistically significant difference in procedure time between the previous and new technique, although the new procedure tended to be shorter. Furthermore, overall survival did not significantly differ between the groups. Multiple regression analysis revealed that TAE procedure time and external pelvic fracture fixation were independently related to gluteal necrosis. Conclusions Our non-selective bilateral iliac arterial embolization procedure involves arresting shock quickly, resulting in no post-procedure gluteal necrosis. The procedure involves cutting the gelatin sponge rather than “pumping” and avoids the use of vasopressors.

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Outpatient versus inpatient superficial parotidectomy: clinical and pathological characteristics

Journal of Otolaryngology - Head and Neck Surgery ◽

10.1186/s40463-020-00484-9 ◽

2021 ◽

Vol 50 (1) ◽

Cited By ~ 1

Author(s):

Daniel J. Lee ◽

David Forner ◽

Christopher End ◽

Christopher M. K. L. Yao ◽

Shireen Samargandy ◽

...

Keyword(s):

Care Center ◽

Tertiary Care ◽

Fistula Formation ◽

Secondary Outcome ◽

Complication Rates ◽

Superficial Parotidectomy ◽

Outpatient Procedure ◽

Tumor Pathology ◽

Outpatient Group ◽

Significant Difference

Abstract Background Superficial parotidectomy has a potential to be performed as an outpatient procedure. The objective of the study is to evaluate the safety and selection profile of outpatient superficial parotidectomy compared to inpatient parotidectomy. Methods A retrospective review of individuals who underwent superficial parotidectomy between 2006 and 2016 at a tertiary care center was conducted. Primary outcomes included surgical complications, including transient/permanent facial nerve palsy, wound infection, hematoma, seroma, and fistula formation, as well as medical complications in the postoperative period. Secondary outcome measures included unplanned emergency room visits and readmissions within 30 days of operation due to postoperative complications. Results There were 238 patients included (124 in outpatient and 114 in inpatient group). There was no significant difference between the groups in terms of gender, co-morbidities, tumor pathology or tumor size. There was a trend towards longer distance to the hospital from home address (111 Km in inpatient vs. 27 in outpatient, mean difference 83 km [95% CI,- 1 to 162 km], p = 0.053). The overall complication rates were comparable between the groups (24.2% in outpatient group vs. 21.1% in inpatient, p = 0.56). There was no difference in the rate of return to the emergency department (3.5% vs 5.6%, p = 0.433) or readmission within 30 days (0.9% vs 0.8%, p = 0.952). Conclusion Superficial parotidectomy can be performed safely as an outpatient procedure without elevated risk of complications. Graphical abstract

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Factors Associated with Meeting Obstetric Care Consensus Guidelines for Nulliparous, Term, Singleton, Vertex Cesarean Births

American Journal of Perinatology Reports ◽

10.1055/s-0041-1740563 ◽

2021 ◽

Vol 11 (04) ◽

pp. e142-e146

Author(s):

Tiffany Wang ◽

Inga Brown ◽

Jim Huang ◽

Tetsuya Kawakita ◽

Michael Moxley

Keyword(s):

Care Center ◽

Tertiary Care ◽

Obstetric Care ◽

Confounding Factors ◽

Multivariable Logistic Regression Model ◽

Retrospective Case ◽

Factors Associated ◽

Key Points ◽

Significant Difference ◽

Cesarean Births

Objective This study aimed to identify factors associated with meeting the Obstetric Care Consensus (OCC) guidelines for nulliparous, term, singleton, and vertex (NTSV) cesarean births. Materials and methods This was a retrospective case control study of women with NTSV cesarean births between January 2014 and December 2017 at single tertiary care center. Demographics and clinical characteristics were compared between women with NTSV cesarean births which did or did not meet OCC guidelines. A multivariable logistic regression model was used to evaluate the effect of each variable on the odds of meeting OCC guidelines. Results There were 1,834 women with NTSV cesarean births of which 744 (40.6%) met OCC guidelines for delivery and 1,090 (59.4%) did not. After controlling for confounding factors, the odds of meeting OCC guidelines were increased for in-house providers managing with residents (adjusted odds ratio [aOR] = 2.03, 95% confidence interval [CI]: 1.44–2.87) and without residents (aOR = 1.66, 95% CI: 1.30–2.12), compared with non-in-house providers managing without residents. There was no significant difference in the odds of meeting OCC guidelines for in-house providers managing with or without residents (aOR = 1.23, 95% CI: 0.84–1.79). Conclusion After adjusting for confounding factors, in-house provider coverage, regardless of resident involvement, is associated with increased odds of NTSV cesarean births meeting OCC guidelines. Key Points

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Is Blush on CT Scan in Patients With Pelvic Fracture Associated With Embolization Rates and Outcomes?

The American Surgeon ◽

10.1177/0003134820940246 ◽

2020 ◽

pp. 000313482094024

Author(s):

Deepika Koganti ◽

Zachary J. Grady ◽

Jonathan Nguyen ◽

Caroline C. Butler ◽

S. Robb Todd ◽

...

Keyword(s):

Ct Scan ◽

Pelvic Fracture ◽

Predictive Value ◽

High Specificity ◽

Pelvic Fractures ◽

Hospital Length Of Stay ◽

Trauma Patients ◽

Contrast Extravasation ◽

Significant Difference ◽

Active Extravasation

Introduction In trauma patients with pelvic fractures, computed tomography (CT) scans are a critical tool to evaluate life-threatening hemorrhage. Contrast extravasation, or “blush”, on CT may be a sign of bleeding, prompting a consult for angiography and possible embolization. However, the utility of blush on CT is controversial. We sought to evaluate our experience with patients who sustained pelvic fractures and had blush on CT. Method A retrospective review was performed for all patients with blunt pelvic fractures between January 1, 2017 and December 31, 2018. Demographic, clinical, radiographic, and injury data were obtained. Comparison of mortality, hospital length of stay (LOS), and intensive care unit (ICU) LOS was performed for 3 subgroups: angio versus no angio; embo versus no embo; prophylactic embo versus therapeutic embo. We also calculated the sensitivity, specify, positive predictive value (PPV), and negative predictive value (NPV) of CT blush to predict the need for embolization. Results 889 patients were found to have a blunt pelvic fracture. 51 patients had blush on CT scan. 29 (56.9%) underwent angiography. 17 (58.6%) of these 29 patients were found to have extravasation and were embolized. 12 patients had an angio with no extravasation, and 6 of these patients (50%) underwent prophylactic embolization. No significant difference was found for hospital LOS, ICU LOS, or mortality in our 3 groups. Sensitivity, specificity, PPV, and NPV for CT blush were 74%, 96%, 33%, 99%, respectively. Conclusion Patients with active extravasation undergoing embolization had similar outcomes to patients without active extravasation. Blush on CT scan had low sensitivity and low PPV but high specificity and high NPV. Future studies need to include careful attention to the CT protocol utilized as well as patient selection.

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