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Ugeskrift For Laeger Apr 2019In this review, the recommendations for treating pancreatic traumas are summarised. A pancreatic trauma is rare but serious. Initially, the symptoms can be subtle and... (Review)
Review
In this review, the recommendations for treating pancreatic traumas are summarised. A pancreatic trauma is rare but serious. Initially, the symptoms can be subtle and may easily be overlooked by concurrent injuries such as internal bleeding. Delayed detection of pancreatic lesions is associated with increased mortality and morbidity. There is a tendency towards a more conservative approach in the treatment of pancreatic lesions, including injuries involving the pancreatic duct. In the haemodynamically instable patient damage control surgery is preferred, with closed suction drainage of the pancreas and later definitive surgery. We propose contact to a hepato-pancreato-biliary facility in case of any suspicion of a pancreatic injury.
Topics: Abdominal Injuries; Drainage; Humans; Pancreas; Thoracic Injuries; Wounds, Nonpenetrating
PubMed: 31036150
DOI: No ID Found -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Jan 2010In this study, it was aimed to assess patients who applied to our clinics with the complaints of thorax trauma, consistent thoracal wall injury, complications due to...
BACKGROUND
In this study, it was aimed to assess patients who applied to our clinics with the complaints of thorax trauma, consistent thoracal wall injury, complications due to these traumas, and the therapeutical methodology.
METHODS
Records of 668 patients, hospitalized at Süreyyapaşa Training and Research Hospital and Yüzüncü Yil University Faculty of Medicine between January 1995 and December 2007, were reviewed retrospectively. Three hundred ninety-nine (59.7%) patients had blunt trauma whereas 269 (40.2%) patients had penetrating trauma. Thoracic wall injury was detected in a total of 361 (54%) patients (303 (75.9%) with blunt trauma; 58 (21.5%) with penetrating trauma).
RESULTS
Patients were assessed according to any developed pathology related with thoracic wall injuries (contusion, hematoma, subcutaneous emphysema, bone fractures, flail chest, penetrating chest wall wounds, and traumatic asphyxia), complications and treatment modality.
CONCLUSION
Thoracal wall injuries increase morbidity and mortality due to the close proximity of the chest wall to the cardiopulmonary system. At the initial evaluation, even without any corresponding intrathoracic pathology, these patients must be monitored attentively for a probable cardiopulmonary complication for consecutive days.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Female; Humans; Male; Middle Aged; Retrospective Studies; Thoracic Injuries; Trauma Severity Indices; Wounds, Nonpenetrating; Wounds, Penetrating; Young Adult
PubMed: 20209401
DOI: No ID Found -
PloS One 2022Thoracic trauma is a major cause of death in trauma patients and road traffic accident (RTA)-related thoracic injuries have different characteristics than those with... (Observational Study)
Observational Study
BACKGROUND
Thoracic trauma is a major cause of death in trauma patients and road traffic accident (RTA)-related thoracic injuries have different characteristics than those with non-RTA related thoracic traumas, but this have been poorly described. The main objective was to investigate the epidemiology, injury pattern and outcome of patients suffering a significant RTA-related thoracic injury. Secondary objective was to investigate the influence of serious thoracic injuries on mortality, compared to other serious injuries.
METHODS
We performed a multicenter observational study including patients of the Rhône RTA registry between 1997 and 2016 sustaining a moderate to lethal (Abbreviated Injury Scale, AIS≥2) injury in any body region. A subgroup (AISThorax≥2 group) included those with one or more AIS≥2 thoracic injury. Descriptive statistics were performed for the main outcome and a multivariate logistic regression was computed for our secondary outcome.
RESULTS
A total of 176,346 patients were included in the registry and 6,382 (3.6%) sustained a thoracic injury. Among those, median age [IQR] was 41 [25-58] years, and 68.9% were male. The highest incidence of thoracic injuries in female patients was in the 70-79 years age group, while this was observed in the 20-29 years age group among males. Most patients were car occupants (52.3%). Chest wall injuries were the most frequent thoracic injuries (62.1%), 52.4% of which were multiple rib fractures. Trauma brain injuries (TBI) were the most frequent concomitant injuries (29.1%). The frequency of MAISThorax = 2 injuries increased with age while that of MAISThorax = 3 injuries decreased. A total of 16.2% patients died. Serious (AIS≥3) thoracic injuries (OR = 12.4, 95%CI [8.6;18.0]) were strongly associated with mortality but less than were TBI (OR = 27.9, 95%CI [21.3;36.7]).
CONCLUSION
Moderate to lethal RTA-related thoracic injuries were rare. Multiple ribs fractures, pulmonary contusions, and sternal fractures were the most frequent anatomical injuries. The incidence, injury pattern and mechanisms greatly vary across age groups.
Topics: Abbreviated Injury Scale; Accidents, Traffic; Adult; Brain Injuries, Traumatic; Female; Humans; Injury Severity Score; Male; Registries; Retrospective Studies; Rib Fractures; Thoracic Injuries; Young Adult
PubMed: 35522686
DOI: 10.1371/journal.pone.0268202 -
European Journal of Trauma and... Aug 2021Chest wall injuries are common in blunt trauma and associated with significant morbidity and mortality. The aim of this study was to determine the most common mechanisms...
PURPOSE
Chest wall injuries are common in blunt trauma and associated with significant morbidity and mortality. The aim of this study was to determine the most common mechanisms of injury (MOI), injury patterns, and associated injuries in patients who undergo surgery for chest wall trauma.
METHODS
This was a retrospective study of trauma patients with multiple rib fractures and unstable thoracic cage injuries who were managed surgically at Sahlgrenska University Hospital during the period September 2010-September 2017. The MOI, injury severity score (ISS), new injury severity score (NISS), thoracic and associated injuries were recorded. Patients were categorized according to age (years): groups I (15‒44), II (45‒64) and III ( > 64). Unstable thoracic cage injuries were classified as sternal, anterior, lateral and posterior flail chest.
RESULTS
Two hundred and eleven trauma patients with a mean age (years) of 58.2 ± 15.6, mean ISS 23.6 ± 11.0, and mean NISS 34.1 ± 10.6 were included in the study. Traffic accidents were the most common MOI in Group I (62%) and falls in Group III (59%). The most common flail segments were lateral and posterior. Sternal and anterior flail segments were more common with bilateral injuries and traffic accidents, particularly frontal collisions. Injuries in at least three body regions were also more associated with traffic accidents. Diaphragmatic injury was seen in 18% of patients who underwent thoracotomy.
CONCLUSIONS
The MOI associated with multiple rib fractures differs according to the age of the patient and is associated with different chest wall injury patterns and extra-thoracic injuries.
Topics: Flail Chest; Humans; Retrospective Studies; Rib Fractures; Thoracic Injuries; Thoracic Wall; Wounds, Nonpenetrating
PubMed: 30953111
DOI: 10.1007/s00068-019-01119-z -
European Journal of Orthopaedic Surgery... Aug 2023Sternal fractures (SF) are uncommon injuries usually associated with a significant mechanism of injury. Concomitant injury is likely, and a risk of mortality is... (Review)
Review
INTRODUCTION
Sternal fractures (SF) are uncommon injuries usually associated with a significant mechanism of injury. Concomitant injury is likely, and a risk of mortality is substantial.
AIM
Our aim in this study was to identify the risk factors for mortality in patients who had sustained sternal fractures.
METHODS
We conducted a single centre retrospective review of the trust's Trauma Audit and Research Network Database, from May 2014 to July 2021. Our inclusion criteria were any patients who had sustained a sternal fracture. The regions of injury were defined using the Abbreviated Injury Score. Pearson Chi-Squared, Fisher Exact tests and multivariate regression analyses were performed using IBM SPSS.
RESULTS
A total of 249 patients were identified to have sustained a SF. There were 19 patients (7.63%) who had died. The most common concomitant injuries with SF were Rib fractures (56%), Lung Contusions (31.15%) and Haemothorax (21.88%). There was a significant increase in age (59.93 vs 70.06, p = .037) and admission troponin (36.34 vs. 100.50, p = .003) in those who died. There was a significantly lower GCS in those who died (10.05 vs. 14.01, p < .001). On multi regression analysis, bilateral rib injury (p = 0.037, OR 1.104) was the only nominal variable which showed significance in mortality.
CONCLUSION
Sternal Fractures are uncommon but serious injuries. Our review has identified that bilateral rib injuries, increase in age, low GCS, and high admission troponin in the context of SF, were associated with mortality.
Topics: Humans; Trauma Centers; Sternum; Thoracic Injuries; Rib Fractures; Risk Factors; Retrospective Studies; Injury Severity Score
PubMed: 36735092
DOI: 10.1007/s00590-023-03479-0 -
Fa Yi Xue Za Zhi Aug 2022To analyze the characteristics of thoracic aorta injury in road traffic accidents, to provide data reference for forensic identification.
OBJECTIVES
To analyze the characteristics of thoracic aorta injury in road traffic accidents, to provide data reference for forensic identification.
METHODS
The data of 27 traffic accident death cases with thoracic aorta injury were analyzed according to relevant parameters including sex, age, mode of transportation, and thoracic aorta injury.
RESULTS
Aortic injury in traffic accidents was significantly more in males than females, and 74.1% cases were in the age range of 31-70 years. The most common mode of transportation was the motorcycle, followed by electric bike, most of which crashed with trucks. Most cases were accompanied by rib fractures and lung injuries. Thoracic aorta injury was the most common in ascending aorta, followed by aortic arch and thoracic aorta. Ascending aorta injury was most likely to occur in the range of 0-<1.6 cm from the aortic valve, while it was rare over 2.6 cm. Taking the aortic valve as the reference, the most common locations of injury were the anterior semilunar valve, followed by the right posterior semilunar valve and the left posterior semilunar valve. Thoracic aortic rupture occurred in 63.0% cases, and intima and media lacerations only occurred in 37.0% cases. A few deceased had aortic diseases.
CONCLUSIONS
The proximal part of the ascending aorta is prone to be injured because of the large external force of traffic accidents. The medical examiner should carefully examine the aortic injury in traffic accident deaths, and evaluate the relationship between the injury and the disease according to the condition and degree of aortic injury.
Topics: Male; Female; Humans; Adult; Middle Aged; Aged; Aorta, Thoracic; Accidents, Traffic; Thoracic Injuries; Aortic Rupture; Rib Fractures
PubMed: 36426692
DOI: 10.12116/j.issn.1004-5619.2020.410502 -
Scandinavian Journal of Trauma,... Dec 2022Thoracic injuries are common among trauma patients. Studies on trauma patients with thoracic injuries have reported considerable differences in morbidity and mortality,...
BACKGROUND
Thoracic injuries are common among trauma patients. Studies on trauma patients with thoracic injuries have reported considerable differences in morbidity and mortality, and there is limited research on comparison between trauma patients with and without thoracic injuries, particularly in the Scandinavian population. Thoracic injuries in trauma patients should be identified early and need special attention since the differences in injury patterns among patient population are important as they entail different treatment regimens and influence patient outcomes. The aim of the study was to describe the epidemiology of trauma patients with and without thoracic injuries and its influence on 30-day mortality.
METHODS
Patients were identified through the Karolinska Trauma Register. The Abbreviated Injury Scale (AIS) system was used to find patients with thoracic injuries. Logistic regression analysis was performed to evaluate factors [age, gender, ASA class, GCS (Glasgow Coma Scale), NISS (New Injury Severity Score) and thoracic injury] associated with 30-day mortality.
RESULTS
A total of 2397 patients were included. Of those, 768 patients (32%) had a thoracic injury. The mean (± SD, range) age of all patients (n = 2397) was 46 (20, 18-98) years, and the majority (n = 1709, 71%) of the patients were males. There was a greater proportion of patients with rib fractures among older (≥ 60 years) patients, whereas younger patients had a higher proportion of injuries to the internal thoracic organs. The 30-day mortality was 11% (n = 87) in patients with thoracic injury and 4.3% (n = 71) in patients without. After multivariable adjustment, a thoracic injury was found to be associated with an increased risk of 30-day mortality (OR 1.9, 95% CI 1.3-3.0); as was age ≥ 60 years (OR 3.7, 95% CI 2.3-6.0), ASA class 3-4 (OR 2.3, 95% CI 1.4-3.6), GCS 1-8 (OR 21, 95% CI 13-33) and NISS > 15 (OR 4.2, 2.4-7.3).
CONCLUSION
Thoracic injury was an independent predictor of 30-day mortality after adjustment for relevant key variables. We also found a difference in injury patterns with older patients having a higher proportion of rib fractures, whilst younger patients suffered more internal thoracic organ injuries.
Topics: Male; Humans; Middle Aged; Female; Rib Fractures; Thoracic Injuries; Injury Severity Score; Abbreviated Injury Scale; Glasgow Coma Scale
PubMed: 36503613
DOI: 10.1186/s13049-022-01058-6 -
Journal of Cardiothoracic Surgery Dec 2022Approximately 80% of patients with blunt thoracic aortic injury (BTAI) die before reaching the hospital. Most people who survive the initial injury eventually die...
BACKGROUND
Approximately 80% of patients with blunt thoracic aortic injury (BTAI) die before reaching the hospital. Most people who survive the initial injury eventually die without appropriate treatment. This study analyzed and reported the treatment strategy of a single center for BTAI in the last 10 years and the early and middle clinical results.
METHODS
This retrospective study included patients diagnosed with BTAI at Xijing Hospital from 2013 to 2022. All inpatients with BTAI aged ≥ 18 years were included in this study. The clinical data, imaging findings, and follow-up results were retrospectively collected and analyzed. The Kaplan-Meier curve and multivariate logistic regression were used to compare survivors and nonsurvivors.
RESULTS
A total of 72 patients (57% men) were diagnosed with BTAI, with a mean age of 54.2 ± 9.1 years. The injury severity score was 24.3 ± 18, with Grade I BTAI1 (1.4%), Grade II 17 (23.6%), Grade III 52 (72.2%), and Grade IV 2 (2.8%) aortic injuries. Traffic accidents were the main cause of BTAI in 32 patients (44.4%). Most patients had trauma, 37 had rib fractures (51.4%), Sixty patients (83.3%) underwent thoracic endovascular aortic repair (TEVAR) surgery, eight (11.1%) underwent conservative treatment, and only four (5.6%) underwent open surgery. The overall hospitalization mortality was 12.5%. In multivariate logistic regression, elevated creatinine levels (P = 0.041) and high Glasgow coma scale (GCS) score (P = 0.004) were the predictors of hospital mortality. The median follow-up period was 57 (28-87) months. During the follow-up period, all-cause mortality was 5.6% and no aortic-related deaths were reported. Three patients (4.2%) needed secondary surgery and two of them underwent endovascular repair.
CONCLUSION
Although TEVAR surgery may be associated with intra- or postoperative dissection rupture or serious complications in the treatment of Grade III BTAI, the incidence rate was only 8.9%. Nevertheless, TEVAR surgery remains a safe and feasible approach for the treatment of Grade II or III BTAI, and surgical treatment should be considered first,. A high GCS score and elevated creatinine levels in the emergency department were closely associated with hospital mortality. Younger patients need long-term follow-up after TEVAR.
Topics: Male; Humans; Middle Aged; Female; Retrospective Studies; Aorta, Thoracic; Creatinine; Treatment Outcome; Endovascular Procedures; Wounds, Nonpenetrating; Thoracic Injuries; Vascular System Injuries
PubMed: 36564841
DOI: 10.1186/s13019-022-02094-0 -
The American Surgeon Dec 2023Over 20% of United States adolescents are obese. A thicker layer of subcutaneous adiposity might provide a protective "armor" layer against penetrating wounds. We...
BACKGROUND
Over 20% of United States adolescents are obese. A thicker layer of subcutaneous adiposity might provide a protective "armor" layer against penetrating wounds. We hypothesized that adolescents with obesity presenting after isolated thoracic and abdominal penetrating trauma have lower rates of severe injury and mortality than adolescents without obesity.
METHODS
The 2017-2019 Trauma Quality Improvement Program database was queried for patients between 12 and 17 years old presenting with knife or gunshot wounds. Patients with body mass index (BMI) ≥30 (obese) were compared to patients with BMI <30. Sub-analyses were performed for adolescents with isolated abdominal trauma and isolated thoracic trauma. Severe injury was defined as an abbreviated injury scale grade >3. Bivariate analyses were performed.
RESULTS
12,181 patients were identified; 1603 (13.2%) had obesity. In isolated abdominal gunshot or knife wounds, rates of severe intra-abdominal injuries and mortality were similar (all > .05) between groups. In isolated thoracic gunshot wounds, adolescents with obesity had a lower rate of severe thoracic injury (5.1% vs 13.4%, = .005) but statistically similar mortality (2.2% vs 6.3%, = .053) compared to adolescents without obesity. In isolated thoracic knife wounds, rates of severe thoracic injuries and mortality were similar (all > .05) between groups.
DISCUSSION
Adolescent trauma patients with and without obesity presenting after isolated abdominal or thoracic knife wounds had similar rates of severe injury, operative intervention, and mortality. However, adolescents with obesity presenting after an isolated thoracic gunshot wound had a lower rate of severe injury. This may impact the future work-up and management of adolescents sustaining isolated thoracic gunshot wounds.
Topics: Humans; Adolescent; Child; Wounds, Gunshot; Pediatric Obesity; Wounds, Penetrating; Wounds, Stab; Thoracic Injuries; Abdominal Injuries; Retrospective Studies
PubMed: 37146266
DOI: 10.1177/00031348231174003 -
Canadian Journal of Surgery. Journal... 2022Penetrating cardiac injuries require rapid diagnosis, efficient exposure and nuanced technical approaches, within a framework of highly coordinated and integrated... (Review)
Review
Penetrating cardiac injuries require rapid diagnosis, efficient exposure and nuanced technical approaches, within a framework of highly coordinated and integrated multidisciplinary care. Acute care surgeons, with both strategic and technical expertise, are ideally positioned to address the potentially devastating consequences of these injuries. The aim of this narrative review is to offer a technical approach to the rapid evaluation, exposure, operative repair and postoperative care of penetrating cardiac injuries. A comprehensive review of the cardiac trauma literature, dating back to 1970, has provided a detailed toolbox of approaches to subxiphoid pericardial windows, resuscitative thoracotomy, median sternotomy, pericardiotomy, aortic clamping, cardiac hemorrhage control, cardiac repair, coronary artery injuries, pericardial closure, drain placement, chest wall closures, damage control thoracic procedures and immediate postoperative cardiac care, all based on fundamental physiological principles and anatomical considerations.
Topics: Humans; Thoracic Injuries; Wounds, Penetrating; Heart Injuries; Thoracotomy; Sternotomy
PubMed: 36302130
DOI: 10.1503/cjs.008521