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The Journal of Trauma and Acute Care... Feb 2023Thromboelastography (TEG)-derived maximum amplitude-reaction time (MA-R) ratio that accounts for both hypocoagulable and hypercoagulable changes in coagulation is...
INTRODUCTION
Thromboelastography (TEG)-derived maximum amplitude-reaction time (MA-R) ratio that accounts for both hypocoagulable and hypercoagulable changes in coagulation is associated with poor outcomes in adults. The relationship between these TEG values and outcomes has not been studied in children.
METHODS
In a retrospective cohort study, a level I pediatric trauma center database was queried for children younger than 18 years who had a TEG assay on admission between 2016 and 2020. Demographics, injury characteristics, and admission TEG values were recorded. The MA-R ratio was calculated and divided into quartiles. Main outcomes included mortality, transfusion within 24 hours of admission, and thromboembolism. A logistic regression model was generated adjusting for age, Injury Severity Score, injury mechanism, admission shock, and Glasgow Coma Scale.
RESULTS
In total, 657 children were included, of which 70% were male and 75% had blunt mechanism injury. The median (interquartile range) age was 11 (4-14) years, the median (interquartile range) Injury Severity Score was10 (5-22), and in-hospital mortality was 7% (n = 45). Of these patients, 17% (n = 112) required transfusion. Most R and MA values were within normal limits. On unadjusted analysis, the lowest MA-R ratio quartile was associated with increased mortality (15% vs. 4%, 5%, and 4%, respectively; p < 0.001) and increased transfusion need (26% vs. 12%, 16%, and 13%, respectively; p = 0.002) compared with higher quartiles. In the logistic regression models, a low MA-R ratio was independently associated with increased in-hospital mortality (odds ratio [95% confidence interval], 4.4 [1.9-10.2]) and increased need for transfusion within 24 hours of admission (odds ratio [95% confidence interval], 2.0 [1.2-3.4]) compared with higher MA-R ratio. There was no association between MA-R ratio and venous thromboembolic events (venous thromboembolic event rate by quartile: 4%, 2%, 1%, and 3%).
CONCLUSION
Although individual admission TEG values are not commonly substantially deranged in injured children, the MA-R ratio is an independent predictor of poor outcome. Maximum amplitude-reaction time ratio may be a useful prognostic tool in pediatric trauma; validation is necessary.
LEVEL OF EVIDENCE
Therapeutic/Care Management; Level III.
Topics: Adult; Humans; Male; Child; Adolescent; Female; Thrombelastography; Retrospective Studies; Reaction Time; Thrombophilia; Venous Thromboembolism; Injury Severity Score; Wounds and Injuries; Blood Coagulation Disorders
PubMed: 36694332
DOI: 10.1097/TA.0000000000003834 -
Acta Bio-medica : Atenei Parmensis Apr 2021Muscle in vein (MIV ) conduits have gradually been employed in the last 20 years as a valuable technique in bridging peripheral nerve gaps after nerve lesions who cannot...
Muscle in vein (MIV ) conduits have gradually been employed in the last 20 years as a valuable technique in bridging peripheral nerve gaps after nerve lesions who cannot undergo a direct tension-free coaptation. The advantages of this procedure comparing to the actual benchmark (autograft) is the sparing of the donor site, and the huge availability of both components (i.e. muscle and veins). Here we present a case serie of four MIV performed at our hospital from 2018 to 2019. The results we obtained in our experi-ence confirmed its effectiveness both in nerve regeneration (as sensibility recovery) and in neuropathic pain eradication. Our positive outcomes encourage its use in selected cases of residual nerve gaps up to 30 mm.
Topics: Humans; Muscles; Nerve Regeneration; Peripheral Nerve Injuries; Peripheral Nerves; Veins
PubMed: 33944845
DOI: 10.23750/abm.v92iS1.9202 -
Radiographics : a Review Publication of... Feb 2023The range of intracranial venous anomalies in children differs from that in adults. As a commonly encountered highly morbid disease, sinovenous thrombosis has been...
The range of intracranial venous anomalies in children differs from that in adults. As a commonly encountered highly morbid disease, sinovenous thrombosis has been discussed extensively in the literature, and the associated imaging considerations are similar in pediatric and adult patients. The authors shift the focus to less frequently discussed cerebral venous diseases in pediatric patients. First, the practical embryology pertinent to malformations, syndromes, and variants such as vein of Galen aneurysmal malformation, Sturge-Weber syndrome, and developmental venous anomalies are discussed. Second, anatomic considerations that are applicable to neuroimaging in pediatric patients with cerebral venous anomalies are reviewed. In the discussion of anatomy, special attention is given to the medullary venous system that serves the cerebral white matter, superficial cortical veins (tributaries of the dural venous sinuses), and bridging veins, which carry blood from the superficial cortical veins through the potential subdural space into the dural venous sinuses. Third, the selection of imaging modalities (US, CT and CT venography, and MRI) is addressed, and various MR venographic pulse sequences (time-of-flight, phase-contrast, and contrast-enhanced sequences) are compared. Finally, a broad variety of congenital and acquired superficial and deep venous diseases in children are reviewed, with emphasis on less frequently discussed entities involving the medullary (eg, deep medullary venous engorgement and thrombosis, periventricular hemorrhagic venous infarction due to germinal matrix hemorrhage), cortical (eg, cortical venous thrombosis), and bridging (eg, acute and chronic manifestations of injury in abusive head trauma) veins, as well as the deep veins and dural venous sinuses (eg, varix). RSNA, 2023 Quiz questions for this article are available through the Online Learning Center. and
Topics: Adult; Humans; Child; Cerebral Veins; Magnetic Resonance Imaging; Sinus Thrombosis, Intracranial; Cranial Sinuses; Craniocerebral Trauma; Varicose Veins
PubMed: 36656758
DOI: 10.1148/rg.220129 -
European Review For Medical and... Jun 2021Timely intervention is the key to the successful management of penetrating injuries to jugular veins; however, the optimal clinical management of these perforations and...
OBJECTIVE
Timely intervention is the key to the successful management of penetrating injuries to jugular veins; however, the optimal clinical management of these perforations and associated risk factors for mortality are not fully established. This study examined the trauma characteristics, vital signs, and in-hospital mortality in penetrating external and internal jugular vein injuries (PEJVI and PIJVI, respectively).
PATIENTS AND METHODS
In this National Trauma Data Bank database study on patients with penetrating jugular vein injuries (PJVIs), details pertaining to demographics, comorbidities, type of injury, mechanism and intent of injury, Injury Severity Score (ISS), vital signs, treatment, and outcome, were abstracted. Multivariate logistic regression was used to identify the risk factors of in-hospital mortality.
RESULTS
A total of 548 patients with PJVIs were included in the final analysis. Patients with PEJVI were more likely to have a self-inflicted injury (p<.001) than those with PIJVI. In both groups, hemorrhage control surgery was performed in almost 60% of the patients within 24 hrs. of the injury (p=.767). Systolic blood pressure (OR 0.99, 95% CI: 0.98-1.00, p=.043), Glasgow coma scale (OR 0.88, 95% CI: 0.81-0.95, p<.001), ISS (OR 1.10, 95% CI: 1.06-1.14, p<.001), and the firearm as a mechanism of injury (OR 2.85, 95% CI: 1.19-6.79, p=.018) were found to be independently associated with the risk of in-hospital mortality.
CONCLUSIONS
The injury severity, hemodynamic stability, comma scale, intent, and mechanism of injury differed significantly in PEJVI and PIJVI; however, the type of PJVI did not have an independent association with in-hospital mortality.
Topics: Adult; Databases, Factual; Female; Glasgow Coma Scale; Hospital Mortality; Humans; Injury Severity Score; Jugular Veins; Logistic Models; Male; Middle Aged; Risk Factors; Wounds and Injuries; Wounds, Penetrating
PubMed: 34227070
DOI: 10.26355/eurrev_202106_26144 -
The Journal of Trauma and Acute Care... Feb 2018Following venous injury, venorrhaphy can restore outflow, although it risks thrombosis and venous thromboembolism (VTE). Vein ligation is a faster option, although it...
BACKGROUND
Following venous injury, venorrhaphy can restore outflow, although it risks thrombosis and venous thromboembolism (VTE). Vein ligation is a faster option, although it potentially risks extremity edema. The purpose of this study was to evaluate the management of venous injury on VTE and extremity edema in patients with isolated lower-extremity venous injuries.
METHODS
Patients with common iliac, external iliac, and femoral venous injuries over a 10-year period were stratified by age, shock, management of venous injury, injury severity, and timing and type of anticoagulation. Outcomes included development of extremity edema and VTE (pulmonary embolism, deep venous thrombosis). Outcomes were then evaluated to determine risk factors for symptomatic lower-extremity edema and VTE by the management of venous injuries.
RESULTS
Eighty-four patients were identified: 20 common iliac, 27 external iliac, 37 femoral. Forty-nine underwent vein repair and 35 underwent vein ligation. Ninety-three percent were male with a mean Injury Severity Score and Glasgow Coma Scale score of 17 and 14, respectively. Venous thromboembolism occurred in 18 (21%), 15 (18%) deep venous thrombosis, and 4 (5%) pulmonary embolisms. Thirty-two (38%) patients developed lower-extremity edema. Those who underwent vein ligation had a greater degree of shock on presentation (RBC transfusions, 14 vs. 8 units; p = 0.03) and were more likely to receive prophylactic fasciotomies (60% vs. 33%, p = 0.01). There was no difference in time to or type of chemoprophylaxis between patients who underwent vein repair and those who received vein ligation. However, patients with vein ligation had fewer episodes of VTE (9% vs. 31%, p = 0.02) with no difference in symptomatic lower-extremity edema (37% vs. 39%, p = 0.88) or amputation rates (0% vs. 2%, p = 0.99).
CONCLUSION
Vein repair had a higher incidence of VTE while providing no additional benefit in reducing symptomatic extremity edema compared to ligation in patients suffering venous injury. Ligation of most extremity venous injuries can be performed without increasing patient morbidity.
LEVEL OF EVIDENCE
Therapeutic study, level IV.
Topics: Adolescent; Adult; Aged; Edema; Female; Femoral Vein; Humans; Iliac Vein; Leg; Ligation; Male; Middle Aged; Phlebography; Retrospective Studies; Risk Factors; Vascular Surgical Procedures; Vascular System Injuries; Venous Thromboembolism; Young Adult
PubMed: 29370050
DOI: 10.1097/TA.0000000000001746 -
The American Surgeon Jul 2024Iliac and femoral venous injuries represent a challenging dilemma in trauma surgery with mixed results. Venous restoration of outflow (via repair or bypass) has been...
BACKGROUND
Iliac and femoral venous injuries represent a challenging dilemma in trauma surgery with mixed results. Venous restoration of outflow (via repair or bypass) has been previously identified as having higher rates of VTE (venous thromboembolism) compared to ligation. We hypothesized that rates of VTE and eventual amputation were similar whether restoration of venous outflow vs ligation was performed at initial operation.
METHODS
Patients in the 2019-2021 National Trauma Data Bank with iliac and femoral vein injuries were abstracted and analyzed. The primary outcomes of interest were in-hospital lower extremity amputation and VTE.
RESULTS
A total of 2642 patients with operatively managed iliac and femoral vein injuries were identified VTE was found in 10.8% of patients. Multivariable logistic regression was performed and identified bowel injury, higher ISS, older age, open repair, and longer time to VTE prophylaxis initiation as independent predictors of VTE. Amputation was required in 4.2% of patients. Multivariable logistic regression identified arterial or nerve injury, femur or tibia fracture, venous ligation, percutaneous intervention, fasciotomy, bowel injury, and higher ISS as independent factors of amputation.
CONCLUSION
Venous restoration was not an independent predictor of VTE. Venous ligation on index operation was the only modifiable independent predictor of amputation identified on regression analysis.
Topics: Humans; Female; Male; Venous Thromboembolism; Adult; Femoral Vein; Middle Aged; Risk Factors; Amputation, Surgical; Quality Improvement; Iliac Vein; Vascular System Injuries; Retrospective Studies; Ligation
PubMed: 38527489
DOI: 10.1177/00031348241241645 -
Biochemical and Biophysical Research... May 2020Smoke inhalation injury (SII) affects more than 50,000 people annually causing carbon monoxide (CO) poisoning. Although the increased blood level of carboxyhemoglobin...
Blood carboxyhemoglobin elimination curve, half-lifetime, and arterial-venous differences in acute phase of carbon monoxide poisoning in ovine smoke inhalation injury model.
Smoke inhalation injury (SII) affects more than 50,000 people annually causing carbon monoxide (CO) poisoning. Although the increased blood level of carboxyhemoglobin (CO-Hb) is frequently used to confirm the diagnosis of SII, knowledge of its elimination in the acute phase is still limited. The aim of this study is to determine CO-Hb elimination rates and their differences in arterial (aCO-Hb) and mixed-venous (vCO-Hb) blood following severe SII in a clinically relevant ovine model. Forty-three chronically instrumented female sheep were subjected to SII (12 breaths, 4 sets) through tracheostomy tube under anesthesia and analgesia. After the SII, sheep were awakened and placed on a mechanical ventilator (FiO = 1.0, tidal volume 12 mL/kg, and PEEP = 5cmHO) and monitored. Arterial and mixed-venous blood samples were withdrawn simultaneously for blood gas analysis at various time points to determine CO-HB half-lifetime and an elimination curve. The mean of highest aCO-Hb level during SII was 70.8 ± 13.9%. The aCO-Hb elimination curve showed an approximated exponential decay during the first 60 min. Per mixed linear regression model analysis, aCO-Hb significantly (p < 0.001) declined (4.3%/minute) with a decay constant lambda of 0.044. With this lambda, mean lifetime and half-lifetime of aCO-Hb were 22.7 and 15.7 min, respectively. The aCO-Hb was significantly lower compared to vCO-Hb at all-time points (0-180 min). To our knowledge, this is the first report describing CO-Hb elimination curve in the acute phase after severe SII in the clinically relevant ovine model. Our data shows that CO-Hb is decreasing in linear manner with supportive mechanical ventilation (0-60 min). The results may help to understand CO-Hb elimination curve in the acute phase and improvement of pre-hospital and initial clinical care in patients with CO poisoning.
Topics: Acute Disease; Animals; Arteries; Carbon Monoxide Poisoning; Carboxyhemoglobin; Disease Models, Animal; Female; Half-Life; Hemodynamics; Sheep; Smoke Inhalation Injury; Veins
PubMed: 32199614
DOI: 10.1016/j.bbrc.2020.03.048 -
Journal of Orthopaedic Surgery (Hong... 2020Venous anastomosis is the key procedure for Ishikawa zone Ⅱ fingertip replantation. Both palmar and lateral veins provide efficient venous drainage. This study... (Comparative Study)
Comparative Study
PURPOSE
Venous anastomosis is the key procedure for Ishikawa zone Ⅱ fingertip replantation. Both palmar and lateral veins provide efficient venous drainage. This study compared the clinical effects between these venous anastomoses for fingertip replantation.
METHODS
In 2016-2018, 61 patients underwent Ishikawa zone Ⅱ fingertip replantation with venous anastomosis (28 and 33 cases with palmar and lateral anastomoses, respectively). Retrospective comparative analyses evaluated surgical technique and function, including operative time; rates of finger survival, venous congestion, and infection; sensation; joint motion; cold intolerance symptom severity (CISS), Disabilities of the Arm, Shoulder, and Hand (DASH), and Vancouver scar scores; and chronic regional pain syndrome (CRPS) rates.
RESULTS
There were 33 patients with lateral vein anastomosis and 28 patients with palmar vein anastomosis. The average patient follow-up was 18.2 months. The survival rates did not differ significantly between groups (87.8% (29/33) vs. 85.7% (24/28), > 0.05); however, the operative time was shorter in the lateral vein group than in the palmar vein group (78.57 ± 7.08 min vs. 67.88 ± 5.77 min, < 0.05). Venous congestion and infection rates did not differ significantly between groups ( > 0.05). The replanted finger function, including joint motion, sensation, DASH scores, Vancouver scar scores, and CRPS rates, did not differ significantly between groups ( > 0.05). However, the CISS score was higher in the palmar vein group than in the lateral vein group (44.39 ± 5.16 vs. 38.09 ± 4.49, < 0.05).
CONCLUSIONS
Venous anastomosis with either palmar or lateral veins showed high survival rates and good function in fingertip replantation. The lateral vein had a shorter operative time and benefit to arterial revision and was especially suitable for patients with finger pulp damage.
Topics: Adult; Amputation, Traumatic; Anastomosis, Surgical; Female; Finger Injuries; Fingers; Humans; Male; Middle Aged; Operative Time; Replantation; Retrospective Studies; Veins; Young Adult
PubMed: 33034253
DOI: 10.1177/2309499020962861 -
Canadian Journal of Surgery. Journal... Jun 2018Intra-abdominal vascular injury (IAVI) is uncommon but continues to be associated with high mortality rates despite technological advances in the past decades. In light...
BACKGROUND
Intra-abdominal vascular injury (IAVI) is uncommon but continues to be associated with high mortality rates despite technological advances in the past decades. In light of these ongoing developments, we reviewed our contemporary experience with IAVI in an attempt to clarify and refine our management strategies and the outcome of these patients.
METHODS
We retrospectively reviewed the charts of all patients admitted between January 2011 and December 2014 at a major trauma centre in South Africa who were found to have an IAVI during laparotomy for trauma. We collected demographic and clinical data including mechanism of injury, location and severity of the injury, concurrent injuries, physiologic parameters and clinical outcome.
RESULTS
We identified 110 patients with IAVIs, of whom 98 had sustained penetrating injuries (55 gunshot wounds and 43 stab wounds). There were 84 arterial injuries (including 21 renal and 17 mesenteric) and 74 venous injuries (including 21 renal and 17 inferior vena caval). Combined venous and arterial injuries were found in almost one-third of patients (34 [30.9%]). Fifty-seven patients (51.8%) required intensive care admission. The overall mortality rate was 28.2% (31 patients); the rate was 62% for aortic injuries and 47% for inferior vena cava injuries. Liver injury, large bowel injury, splenic injury and elevated lactate level were all associated with a statistically significantly higher mortality rate.
CONCLUSION
The mortality rate for IAVI remains high despite decades of operative experience in high-volume centres. Open operative techniques alone are unlikely to achieve further reduction in mortality rates. Integration of endovascular techniques may provide an alternative strategy to improve outcomes.
Topics: Abdominal Injuries; Adult; Aorta; Female; Humans; Laparotomy; Male; Retrospective Studies; South Africa; Surgical Procedures, Operative; Trauma Centers; Vascular System Injuries; Vena Cava, Inferior; Wounds, Gunshot; Wounds, Stab; Young Adult
PubMed: 29806813
DOI: 10.1503/cjs.009717 -
Emergencias : Revista de La Sociedad... Jun 2016
Topics: Adult; Embolism; Foreign-Body Migration; Humans; Male; Renal Veins; Thoracic Injuries; Wounds, Gunshot
PubMed: 29105458
DOI: No ID Found