Acute Blunt Trauma Research Articles

Abstract 018: External carotid artery Pseudo aneurysm induced Internal Carotid Artery compression causing acute ischemic stroke

Introduction Here, we describe a patient in whom ischemic stroke was caused by compression of the Internal Carotid Artery (ICA) by a Pseudoaneurysm (PSA) of the External Carotid Artery (ECA) after Gun Shot injury. Eventually, the PSA of the Internal maxillary artery (IMAX) was embolized, resulting in resolution of the patient's symptoms. Methods Case Report Results A 75‐year‐old male with a history of atrial fibrillation on Eliquis presented to the emergency department after sustaining a gunshot wound to the left face. He had extensive injuries through the left masticator and submandibular space with an inferior orbital wall fracture. A Computed Tomography Angiography (CTA) neck showed injuries to the left proximal IMAX with a small PSA. As the PSA was asymptomatic it was managed with observation. On HOD day 13, CTA was done for a brief period of unresponsiveness, which showed high‐grade narrowing of left cervical ICA due to extrinsic compression from PSA which was supplied by a branch of the left ECA with distal re‐constitution (image A). The next day, patient developed right sided plegia and aphasia with NIHSS of 17. A CT head showed no acute intracranial abnormality. The patient underwent emergent Digital Subtraction Angiography (DSA), which demonstrated occlusion of the left cervical ICA from compression from a left IMAX PSA which was treated with n‐butyl‐cyanoacrylate TRUFILL embolization with resolution of flow limitation in the left cervical ICA (Image B1,B2). After embolization, the patient was oriented and able to lift right arm and leg anti‐gravity. Magnetic Resonance Imaging (MRI) was contraindicated due to retained bullet fragments. Repeat CT head did not show stroke. Conclusion A Pseudo aneurysm is characterized by a rupture of the arterial wall and the formation of an aneurysmal sac by the adjacent structures while the sustaining artery remains intact. The most prevalent causes are penetrating or acute blunt neck trauma, hyperextension injury, and injury to the base of the skull (1). Predisposing factors for PSA include carotid endarterectomy or a late complication of carotid artery dissection, infection, radiotherapy, and malignancy (1‐2). Cox et al. reported 124 patients with significant neck and head penetrating injuries. Eleven patients were found to have thirteen head and neck PSA: two in the ICA, one in the vertebral artery, and ten involving branches of the ECA. Two of seven symptomatic PSAs manifested with episodes of massive hemorrhage (3). There have been case reports describing the consequences of an elongated styloid process causing an ischemic stroke due to subsequent dissection and PSA formation (4). According to our knowledge, this case report is one of the first to describe acute ischemic symptoms resulting from ECA PSA‐induced ICA compression, with resolution of symptoms following PSA embolization. The educational value of our case lies not only in the rarity of the condition but also in the uniqueness of its presentation. This case is a fundamental addition to the existing literature on rare neuro‐vascular anomalies leading to potential catastrophic outcomes.

Pelvic ring fractures with concomitant large hematomas: diagnostic investigation with arteriography and eventual embolization in 157 trauma patients, with or without contrast extravasation at emergency CT.

This study aims to evaluate the diagnostic value of pelvic arteriography in patients with pelvic ring fractures and associated large hematomas, in both cases of positive or negative findings of contrast agent extravasation at emergency CT; in those patients with positive DSA subsequently treated with embolization, correlations with clinical-radiological parameters were investigated. In this single-center retrospective study, patients with acute blunt pelvic trauma showing at CT pelvic ring fractures with associated large (> 3cm) hematoma, with or without signs of arterial bleeding, were investigated with DSA. Technical success was considered radiographic bleeding control with disappearance of angiographic bleeding; clinical success was defined as clinical bleeding control hemodynamically stable, before applying other surgical maneuvers. Pelvic ring fractures were evaluated according to Tile classification system. One hundred and fifty-seven patients, mean age 54years, were analyzed. 70.7% had polytrauma; 14.6% patients assumed antiplatelets and/or anticoagulation therapy. False-negative and false-positive rates at CT were 29.6% and 27.1%, respectively. Polytrauma and B3/C1 Tile pattern fractures were significantly associated with bleeding signs at DSA. Seventy-two patients required embolization: 52.8% showed direct signs of DSA bleeding; among these, technical and clinical successes were 88.8% and 81.9%, respectively. In this study, patients with pelvic ring fractures and concomitant hematomas > 3cm, with or without contrast extravasation at CT, have been examined in depth with DSA focusing on both direct and indirect angiographic signs of bleeding, finding polytrauma and Tile fracture patterns B3/C1 predictive factors for arterial hemorrhage detection at DSA despite negative CT findings.

Effects of electroacupuncture on gait and proliferation and differentiation of muscle satellite cell in rats with acute blunt trauma of gastrocnemius muscle

To observe the effects of electroacupuncture on threshold of pain, gait, proliferation and differentiation of muscle satellite cell in rats with acute blunt trauma of gastrocnemius muscle, and to explore the possible mechanism of electroacupuncture in promoting the repair of acute injury of skeletal muscle. A total of 48 SD rats were randomly divided into a blank group (6 rats), a model group (24 rats) and an electroacupuncture group (18 rats). In the model group and the electroacupuncture group, the model of acute blunt trauma of gastrocnemius muscle was established by self-made impactor. In the electroacupuncture group, electroacupuncture was applied at "Chengshan" (BL 57) and "Yanglingquan" (GB 34) on the right side, with disperse-dense wave, in frequency of 2 Hz/100 Hz, once a day, 30 min each time. Electroacupuncture intervention was performed for 3, 7 and 14 days according to the sampling time. On the 1st, 3rd, 7th and 14th days after modeling, the mechanical withdrawal pain threshold of hindfoot was detected by Von Frey method; the standing time and the maximum contact area of the right hindfoot were recorded by Cat Walk XTTM animal gait analysis instrument; the morphology of the right gastrocnemius muscle and the number of inflammatory cells were observed by HE staining; the positive expression of paired box gene 7 (Pax7) and myogenic differentiation (MyoD) of the right gastrocnemius muscle was detected by immunofluorescence. After modeling, the muscle fiber rupture and massive infiltration of red blood cells and inflammatory cells were observed in the right gastrocnemius muscle; after electroacupuncture intervention, the morphology of muscle fiber was intact and the infiltration of inflammatory cells was improved. Compared with the blank group, in the model group, the differences of mechanical withdrawal pain threshold between the left and right foot were increased (P<0.05), the standing time was shortened and the maximum contact area of the right hindfoot was decreased (P<0.05), the number of inflammatory cells and the positive expression of Pax7 and MyoD of the right gastrocnemius muscle were increased (P<0.05) on the 1st, 3rd, 7th and 14th days after modeling. Compared with the model group, in the electroacupuncture group, the differences of mechanical withdrawal pain threshold were decreased (P<0.05), the standing time was prolonged (P<0.05), the number of inflammatory cells of right gastrocnemius muscle was decreased (P<0.05) on the 7th and 14th days after modeling; the maximum contact area of the right hindfoot was increased (P<0.05), the positive expression of MyoD of the right gastrocnemius muscle was increased (P<0.05) on the 3rd, 7th and 14th days after modeling; the positive expression of Pax7 of the right gastrocnemius muscle was increased (P<0.05) on the 3rd day after modeling. Electroacupuncture can effectively improve the pain threshold and gait in rats with acute blunt trauma of gastrocnemius muscle, and promote the repair of skeletal muscle injury, the mechanism may be related to the up-regulation of Pax7 and MyoD, so as to promoting the proliferation and differentiation of muscle satellite cell.

Exploring the optimal impact force for chronic skeletal muscle injury induced by drop-mass technique in rats.

Introduction: Skeletal muscle injuries are widespread in sports, traffic accidents and natural disasters and some of them with poor prognoses can lead to chronic skeletal muscle damage in the clinic. We induced a chronic skeletal muscle injury by controlling time and contusion force using an acute blunt trauma model that will help us better comprehend the pathological features of chronic skeletal muscle injury. Methods: Several levels of injury were induced by repeatedly striking in 5, 10, and 15 times the gastrocnemius muscle from the same height with 200g weights. After injury, the markers of muscle injury were assessed at 2 and 4 weeks by serum elisa. Electron microscopy, histologic and immunohistochemical staining, and mRNA analysis were used to evaluate the ultrastructure, inflammation, extracellular matrix decomposition, and anabolism of injured muscle in 2 and 4 weeks. Results: All three different kinetic energies can result in skeletal muscle injuries. However, the injured skeletal muscles of rats in each group could not recover within 2 weeks. After 4 weeks, tissue self-repair and reconstruction caused the damage induced by 5J kinetic energy to almost return to normal. In contrast, damage induced by 10J kinetic energy displayed slight improvement compared to that at 2 weeks. Despite this, collagen fibers on the surface of the tissue were disorganized, directionally ambiguous, and intertwined with each other. Myofilaments within the tissue were also arranged disorderly, with blurry and broken Z-lines. Damage caused by 15J kinetic energy was the most severe and displayed no improvements at 4 weeks compared to 2 weeks. At 4 weeks, IL-1β, IL-6, Collagen I, and Collagen III, MMP2 expressions in the 10J group were lower than those at 2 weeks, showing a tendency towards injury stabilization. Conclusion: After 4 weeks of remodeling and repair, the acute skeletal muscle injury model induced by 10J kinetic energy can stabilize pathological manifestations, inflammatory expression, and extracellular matrix synthesis and catabolism, making it an appropriate model for studying chronic skeletal muscle injuries caused by acute injury.

The value of deep learning-based computer aided diagnostic system in improving diagnostic performance of rib fractures in acute blunt trauma

BackgroundTo evaluate the value of a deep learning-based computer-aided diagnostic system (DL-CAD) in improving the diagnostic performance of acute rib fractures in patients with chest trauma.Materials and methodsCT images of 214 patients with acute blunt chest trauma were retrospectively analyzed by two interns and two attending radiologists independently firstly and then with the assistance of a DL-CAD one month later, in a blinded and randomized manner. The consensusdiagnosis of fib fracture by another two senior thoracic radiologists was regarded as reference standard. The rib fracture diagnostic sensitivity, specificity, positive predictive value, diagnostic confidence and mean reading time with and without DL-CAD were calculated and compared.ResultsThere were 680 rib fracture lesions confirmed as reference standard among all patients. The diagnostic sensitivity and positive predictive value of interns weresignificantly improved from (68.82%, 84.50%) to (91.76%, 93.17%) with the assistance of DL-CAD, respectively. Diagnostic sensitivity and positive predictive value of attendings aided by DL-CAD (94.56%, 95.67%) or not aided (86.47%, 93.83%), respectively. In addition, when radiologists were assisted by DL-CAD, the mean reading time was significantly reduced, and diagnostic confidence was significantly enhanced.ConclusionsDL-CAD improves the diagnostic performance of acute rib fracture in chest trauma patients, which increases the diagnostic confidence, sensitivity, and positive predictive value for radiologists. DL-CAD can advance the diagnostic consistency of radiologists with different experiences.

188. Adolescent idiopathic scoliosis: categorization of fracture patterns among blunt trauma patients relative to a general trauma population

BACKGROUND CONTEXT Adolescent idiopathic scoliosis (AIS) affects up to 4% of adolescents. As of yet, the characterization of traumatic injuries in AIS patients is unknown. PURPOSE To compare the risk of varying fracture locations after blunt trauma between patients with and without AIS. STUDY DESIGN/SETTING Retrospective review. PATIENT SAMPLE The Kid's Inpatient Database (KID) was queried from 2003 to 2009 to identify all patients aged 0-20 with AIS admitted for acute trauma. OUTCOME MEASURES The rates of various spinal fracture patterns as well as risk factors for vertebral fracture. METHODS KID was queried for AIS patients aged 0-20 years, from 2003 through 2009. AIS patients admitted for acute trauma were isolated. Mechanisms of injury (MOI), fracture locations and surgical procedures were assessed. Trauma AIS patients were then propensity-score matched to a general (Gen) trauma population of 323,729 KID patients, using age, sex and MOI. Fracture types were compared utilizing Chi-square and t-tests. Logistic regression analysis predicted relative odds of fracture in AIS patients. RESULTS Of 41,142 AIS cases identified, 442 patients suffered acute blunt trauma (2003: 112; 2006: 139; 2009: 186). Of those, the most prevalent MOIs were MVA (37.1%), pedestrian struck (PS) (22.9%), falls (18.3%) and assault (7.6%). Of the 442 acute blunt trauma patients, 99 (22.3%) sustained vertebral fracture. Of those, 25 patients had cervical fractures (MVA 66.52%, PS 24.14%, fall 6.9%), 23 thoracic (MVA 47.8%, PS 21.7%, fall 26.1%), 35 lumbar (MVA 57.1%, PS 20%, fall 25.7%), and 16 sacral/coccygeal (MVA 68.8%, PS 25%, fall 12.5%). Twenty-eight patients underwent spinal fusion (2-3 levels: 35.7%, 4-8 levels: 25.0%, >9 levels: 14.0%) and 14 had vertebral fracture repairs. After propensity-score matching (AIS: 432, Gen: 432), AIS patients had significantly more vertebral fractures (99 vs 52, p<0.001) and exhibited higher rates of thoracic (5.3% vs 2.5%, p=0.035) and lumbar fractures (8.1% vs 2.8%, p<0.001). Logistic regression showed AIS patients had increased odds of overall fracture (OR: 2.1 95% CI [1.4 - 3.1], p<.001), thoracic (OR: 2.2 95% CI [1.0 - 4.5], p=0.039) and lumbar fractures (OR: 3.1 95% CI [1.6 - 6.1], p<0.001). CONCLUSIONS AIS trauma patients relative to a normative trauma population were more likely to present with a vertebral fracture; specifically, thoracic and lumbar fractures. Authors acknowledge the limitations of the KID database, such as unavailability of radiographic data. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. Adolescent idiopathic scoliosis (AIS) affects up to 4% of adolescents. As of yet, the characterization of traumatic injuries in AIS patients is unknown. To compare the risk of varying fracture locations after blunt trauma between patients with and without AIS. Retrospective review. The Kid's Inpatient Database (KID) was queried from 2003 to 2009 to identify all patients aged 0-20 with AIS admitted for acute trauma. The rates of various spinal fracture patterns as well as risk factors for vertebral fracture. KID was queried for AIS patients aged 0-20 years, from 2003 through 2009. AIS patients admitted for acute trauma were isolated. Mechanisms of injury (MOI), fracture locations and surgical procedures were assessed. Trauma AIS patients were then propensity-score matched to a general (Gen) trauma population of 323,729 KID patients, using age, sex and MOI. Fracture types were compared utilizing Chi-square and t-tests. Logistic regression analysis predicted relative odds of fracture in AIS patients. Of 41,142 AIS cases identified, 442 patients suffered acute blunt trauma (2003: 112; 2006: 139; 2009: 186). Of those, the most prevalent MOIs were MVA (37.1%), pedestrian struck (PS) (22.9%), falls (18.3%) and assault (7.6%). Of the 442 acute blunt trauma patients, 99 (22.3%) sustained vertebral fracture. Of those, 25 patients had cervical fractures (MVA 66.52%, PS 24.14%, fall 6.9%), 23 thoracic (MVA 47.8%, PS 21.7%, fall 26.1%), 35 lumbar (MVA 57.1%, PS 20%, fall 25.7%), and 16 sacral/coccygeal (MVA 68.8%, PS 25%, fall 12.5%). Twenty-eight patients underwent spinal fusion (2-3 levels: 35.7%, 4-8 levels: 25.0%, >9 levels: 14.0%) and 14 had vertebral fracture repairs. After propensity-score matching (AIS: 432, Gen: 432), AIS patients had significantly more vertebral fractures (99 vs 52, p<0.001) and exhibited higher rates of thoracic (5.3% vs 2.5%, p=0.035) and lumbar fractures (8.1% vs 2.8%, p<0.001). Logistic regression showed AIS patients had increased odds of overall fracture (OR: 2.1 95% CI [1.4 - 3.1], p<.001), thoracic (OR: 2.2 95% CI [1.0 - 4.5], p=0.039) and lumbar fractures (OR: 3.1 95% CI [1.6 - 6.1], p<0.001). AIS trauma patients relative to a normative trauma population were more likely to present with a vertebral fracture; specifically, thoracic and lumbar fractures. Authors acknowledge the limitations of the KID database, such as unavailability of radiographic data.

Blunt thoracic trauma: role of chest radiography and comparison with CT - findings and literature review.

In the setting of acute trauma where identification of critical injuries is time-sensitive, a portable chest radiograph is broadly accepted as an initial diagnostic test for identifying benign and life-threatening pathologies and guiding further imaging and interventions. This article describes chest radiographic findings associated with various injuries resulting from blunt chest trauma and compares the efficacy of the chest radiograph in these settings with computed tomography (CT). Common chest radiographic findings in blunt thoracic injuries will be reviewed to improve radiologic identification, expedite management, and improve trauma morbidity and mortality. This article discusses demographic information, mechanism of specific injuries, common imaging findings, imaging pearls, and pitfalls and exhibits several classic imaging findings in blunt chest trauma. Thoracic structures commonly injured in blunt trauma that will be discussed in this article include vasculature structures (aortic trauma), the heart (cardiac contusion, pericardial effusion), the esophagus (esophageal perforation), pleural space and airways (pneumothorax, hemothorax, bronchial injury), lungs (pulmonary contusion), the diaphragm (diaphragmatic rupture), and the chest wall (flail chest). Chest radiography plays an important role in the initial evaluation of blunt chest trauma. While CT imaging has a higher sensitivity than chest radiography, it remains a valuable tool due to its ability to provide rapid diagnostic information in time-sensitive trauma situations and is ubiquitously available in the trauma bay. Familiarity with the gamut of injuries that may occur as well as identification of the associated chest radiograph findings can aid in timely diagnoses and prompt management in the setting of acute blunt chest trauma.

Evaluating the Utility of Fast in Acute Blunt Abdominal Trauma in the Emergency Department: 20 Years On

Evaluating the Utility of Fast in Acute Blunt Abdominal Trauma in the Emergency Department: 20 Years On

Comparison of diagnostic accuracy of bedside ultrasonography and radiography for calcaneal fractures in the emergency department

Objective: Ultrasonography (US) is not the method of choice for the diagnosis of calcaneal fractures. The aim of this study was to compare the diagnostic accuracy of US with plain radiography in the diagnosis of calcaneus fractures following blunt ankle and foot trauma. Methods: In this cross-sectional study, 214 patients (over 18 years) presenting to the emergency department (ED) with suspicion of traumatic calcaneus fracture following acute blunt trauma, were enrolled. Bedside ultrasonography was performed and interpreted by emergency physicians. After that, plain radiography was performed. Furthermore, all the patients were assessed by computed tomography (CT) scan as the gold standard. Results: Finally, 193 patients were enrolled with a mean age of 29.4±15.7 years (85.5% male). Fractures in the calcaneus were detected in 49 patients. The sensitivity and specificity of ultrasonography in the detection of calcaneal fractures were 83.6%, (confidence interval (CI), 69.7 –92.2) and 100% (95% CI, 96.7 –100), while the sensitivity and specificity of X-ray were 87.7% (95% CI, 74.5 –94.9) and 100% (95% CI, 96.7 –100). There was no false positive result for X-ray and US. Conclusion: Our findings suggest that bedside US with an acceptable sensitivity and specificity can be used as a promising alternative for the diagnosis of calcaneal fracture in ED.

Our 12 year experience with Montgomery T-tube in the management of acute blunt laryngotracheal trauma patients

IntroductionThe Montgomery T-tube is a device used as a combined tracheal stent and tracheostomy tube to prevent post-operative tracheal stenosis. ObjectivesThe purpose of this retrospective study is to evaluate the outcome following Montgomery T-tube stenting performed in for neck and airway injury in patients with acute blunt laryngotracheal trauma over a period of 12 years. MethodsBetween 2005 and 2017, 19 patients with acute blunt laryngotracheal trauma underwent Montgomery T-tube stenting. All 19 laryngotracheal trauma patients had undergone a preoperative tracheostomy in the emergency department by an ENT surgeon. Montgomery T-tube stenting was done later through an external approach. The follow up period ranged from 2 to 10 years. The Montgomery T-tube was removed after a period ranging from 6 months to 1½ year. ResultsThe majority of patients in the study were in the age group of 21–30 years. A preoperative tracheostomy was done in all 19 patients. All patients except 3 underwent successful decannulation, and experienced long-term satisfactory result. ConclusionManagement of acute blunt laryngotracheal trauma is a challenging problem that demands a multidisciplinary approach. The ideal treatment option should be individualized according to the patient's condition and characteristics of injury. According to our study we suggest that cases of acute blunt laryngotracheal trauma patients should be managed following the protocol as mentioned in our study, and we strongly emphasize that Montgomery T-tube should be left for at least 1 complete year in the airway as it results in negligible chances of post-traumatic stenosis of airway later.

Ottawa Knee Rule: Investigating Use and Application in a Tertiary Teaching Hospital.

BackgroundKnee injuries are encountered commonly in the emergency departments (EDs) in Ireland. Validated clinical decision rules such as Ottawa knee rule (OKR) can be used in acute knee injury settings to reduce the number of unnecessary radiography. Clinical judgment can be used to distinguish between suspected fractures and non-fractures in many cases; however, radiography is still routinely requested.ObjectivesWe evaluated the OKRs in a high-volume tertiary teaching hospital in Ireland to determine whether the rule could be safely used to decide whether patients with acute blunt knee trauma should undergo radiography.MethodsThis was an observational study conducted in the ED over a three-month period in a tertiary referral hospital. A total of 110 patients with acute knee injuries were examined using OKR. Inclusion criteria included patients with acute knee injuries due to blunt trauma or twisting injury and patients with lacerations or contusions. Open fractures and fractures due to penetrating injury were excluded from the study.ResultsFractures were seen in 12 (13.2%) of the 110 patents who met the inclusion criteria. The OKR predicted all 12 fractures. Sensitivity was 100%, and specificity was 39%.ConclusionsThe OKR is highly sensitive for fracture in this setting and can be safely used to decide whether patients with acute blunt knee trauma should undergo radiography.

Contribution of ultrasonography in evaluating traumatic lesions of the peripheral nerves

To assess the indications for and utility of diagnostic ultrasonography (US) in a series of consecutive patients with suspected traumatic peripheral nerve lesions (TPNL). We retrospectively reviewed the electronic medical records of consecutive patients referred from February 2013 to May 2018 to our US laboratory. All included patients were examined using standard US equipment, with a 4-13MHz linear array transducer. In the analyzed period, we performed US examinations in 143 patients with 149 suspected TPNL. Electrodiagnostically (EDx) complete TPNL were found in 63 (45%), partial in 59 (42%), and only demyelination (i.e., neurapraxia) in four (3%) patients. TPNL could not be confirmed in 14 (10%) patients. Nerve discontinuity was not demonstrated by US in any of the patients with EDx incomplete nerve lesions. Contact of the nerve with osteosynthetic material (OSM) was found in eight of 33 patients (24%). In five patients, the nerve could not be adequately evaluated throughout its course due to extensive changes in the surrounding tissues. In acute situations, US is most useful in EDx complete TPNL to differentiate between nerve axonotmesis and neurotmesis. High-velocity trauma, lacerations, and bone fractures are all risk factors for neurotmesis. In chronic situations, US is useful in cases of functionally inefficient reinnervation, neuropathic pain, or progressive nerve dysfunction. In such patients, the surrounding tissues and the relation of the nerve to any OSM need to be carefully examined. US examination is probably not needed in patients with TPNL following acute blunt trauma, only minor clinical deficits and/or slightly/moderately abnormal EDx findings.

Imaging of Blunt Pancreatic Trauma: A Systematic Review.

Despite several published reports on the value of imaging in acute blunt pancreatic trauma, there remains a large variability in the reported performance of ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI). The purpose of this study is to present a systematic review on the utility of these imaging modalities in the acute assessment of blunt pancreatic trauma. In addition, a brief overview of the various signs of pancreatic trauma will be presented. Keyword search was performed in MEDLINE, EMBASE, and Web of Science databases for relevant studies in the last 20 years (1999 onward). Titles and abstracts were screened, followed by full-text screening. Inclusion criteria were defined as studies reporting on the effectiveness of imaging modality (US, CT, or MRI) in detecting blunt pancreatic trauma. After initial search of 743 studies, a total of 37 studies were included in the final summary. Thirty-six studies were retrospective in nature. Pancreatic injury was the primary study objective in 21 studies. Relevant study population varied from 5 to 299. Seventeen studies compared the imaging findings against intraoperative findings. Seven studies performed separate analysis for pancreatic ductal injuries and 9 studies only investigated ductal injuries. The reported sensitivities for the detection of pancreatic injuries at CT ranged from 33% to 100% and specificity ranged from 62% to 100%. Sensitivity at US ranged from 27% to 96%. The sensitivity at MRI was only reported in 1 study and was 92%. There remains a large heterogeneity among reported studies in the accuracy of initial imaging modalities for blunt pancreatic injury. Although technological advances in imaging equipment would be expected to improve accuracy, the current body of literature remains largely divided. There is a need for future studies utilizing the most advanced imaging equipment with appropriately defined gold standards and outcome measures.

Role of multidetector computed tomography in the assessment of pancreatic injuries after blunt trauma: a multicenter experience.

Pancreatic injuries can occur from either penetrating or blunt abdominal trauma. While there are rare, especially in the setting of blunt abdominal trauma, they are associated with a mortality of up to 30%, and a morbidity of 60%. Multidetector computed tomography (MDCT) is the preferred imaging modality in patients with acute blunt abdominal trauma and for the detection of acute pancreatic injury. Magnetic resonance (MR) and magnetic resonance cholangiopancreatography (MRCP) plays an important role in the follow-up of pancreatic injury. In this brief review, we discuss the main MDCT acute imaging findings as well as the complications. Finally, we discuss the role of MR and MRCP in follow up of patients with pancreatic injuries.

Augmenting Denver criteria yields increased BCVI detection, with screening showing markedly increased risk for subsequent ischemic stroke

PurposeBCVI may lead to ischemic stroke, disability, and death, while being often initially clinically silent. Screening criteria for BCVI based on clinical findings and trauma mechanism have improved detection, with Denver criteria being most common. Up to 30% of patients do not meet BCVI screening criteria. The aim of this study was to analyze the effect of augmented Denver criteria on detection, and to determine the relative risk for ischemic stroke.MethodsDenver screening criteria were augmented by any high-energy trauma of the cervical spine, thorax, abdomen, or pelvis. All acute blunt trauma WBCT including CT angiography (CTA) over a period of 38 months were reviewed retrospectively by two Fellowship-trained radiologists, as well as any cerebral imaging after the initial trauma.Results1544 WBCT studies included 374 CTA (m/f = 271/103; mean age 41.5 years). Most common mechanisms of injury were MVA (51.5%) and fall from a height (22.3%). We found 72 BCVI in 56 patients (15.0%), with 13 (23.2%) multiple lesions. The ICA was affected in 49 (68.1%) and the vertebral artery in 23 (31.9%) of cases. The most common injury level was C2, with Biffl grades I and II most common in ICA, and II and IV in VA. Interobserver agreement was substantial (Kappa = 0.674). Of 215 patients imaged, 16.1% with BCVI and 1.9% of the remaining cases had cerebral ischemic stroke (p < .0001; OR = 9.77; 95% CI 3.3–28.7). Eleven percent of patients with BCVI would not have met standard screening criteria.ConclusionsThe increase in detection rate for BCVI justifies more liberal screening protocols.

Utility of Ultra-wide Fundus Photography in Patients with Acute Blunt Ocular Trauma

Utility of Ultra-wide Fundus Photography in Patients with Acute Blunt Ocular Trauma

Imagerie de la kératopathie bulleuse du pseudophake

A 15-year-old male patient presented with vision loss after blunt trauma to the right eye and with clinical evidence of posterior lenticonus. The posttraumatic lenticonus was eccentric (superotemporal). Irregular astigmatism with high myopia on dilated retinoscopy within the lenticonus, localized posterior convexity of peripheral capsule on ultrasound biomicroscopy, and increased higher-order aberrations (HOAs) on wavefront aberrometry compared with fellow-eye findings confirmed the diagnosis. To our knowledge, acquired peripheral posterior lenticonus representing dialysis of Weigert ligament after acute blunt trauma is a new finding. This case provides an insight into the pattern of higher HOAs associated with any type of lenticonus.

Blunt Chest Trauma: A Radiologic Approach and Review

Blunt chest trauma, a frequent component of trauma admissions, is the second leading cause of death in motor-vehicle accidents. Additionally, it may be associated with significant morbidity in those who survive. Radiography, ultrasonography, and computed tomography (CT) have a widespread role in evaluating blunt chest trauma, importantly aiding in the diagnosis and management of injury. Herein, we discuss the most common salient injuries, imaging protocol considerations and imaging findings associated with acute blunt chest trauma.

Retinal Pigment Epithelium Sequelae Caused by Blunt Ocular Trauma: Incidence, Visual Outcome, and Associated Factors

Vision loss can occur in eyes with blunt ocular trauma, but the causes have not been elucidated fully. We encountered cases of retinal pigment epithelium (RPE) sequelae following blunt ocular trauma associated with permanent vision loss in our cohort of patients with blunt ocular trauma. In this multicentre retrospective cohort study on 129 patients with retinal abnormalities caused by acute blunt ocular trauma, we investigated the incidence of RPE sequelae and evaluated associated factors and visual outcomes. RPE sequelae, which typically presented as hyperpigmentation within well-demarcated hypopigmented lesions, occurred in 29 (22.5%) patients within 1 month of trauma. Optical coherence tomography (OCT) revealed complete photoreceptor loss over the abnormal RPE. Final visual outcomes were significantly different between eyes with and without RPE sequelae. Logistic regression analysis revealed a significant association between the presence of subretinal fluid and RPE sequelae. In conclusion, RPE sequelae occurred in approximately 20% of patients with blunt ocular trauma and was associated with permanent photoreceptor defects and visual loss. Clinical evaluation using OCT may help predict RPE sequelae and visual outcomes in eyes with blunt trauma.

Acetaminophen or Nonsteroidal Anti-Inflammatory Drugs in Acute Musculoskeletal Trauma: A Multicenter, Double-Blind, Randomized, Clinical Trial

We determine whether pain treatment with acetaminophen was not inferior to nonsteroidal anti-inflammatory drugs or the combination of both in minor musculoskeletal trauma. The Paracetamol or NSAIDs in Acute Musculoskeletal Trauma Study was a double-blind, randomized, clinical trial conducted in 2 general practices and 2 emergency departments in the Netherlands. A total of 547adults, aged 18 years and older, with acute blunt minor musculoskeletal extremity trauma were randomlyassignedin a 1:1:1 ratio to acetaminophen 4,000 mg/day, diclofenac 150 mg/day, or acetaminophen 4,000 mg/day+diclofenac 150 mg/day during 3 consecutive days. Patients, health care staff, and outcome assessors were blinded for treatment allocation. Follow-up for each patient was 30 days. Primary outcome measures were between-group differences in mean numeric rating scale (NRS) pain scores in rest and with movement at 90 minutes after initial drug administration compared with baseline pain scores with a predefined noninferiority margin of 0.75 NRS points. Secondary outcomes included NRS pain scores during 3 consecutive daysand need for additional analgesia. One hundred eighty-two patients were treated with acetaminophen, 183 with diclofenac, and 182 with combination treatment. Intention-to-treat analysis revealed mean NRS reduction in rest -1.23 (95% confidence interval [CI]-1.50 to -0.95) and -1.72 (95% CI -2.01 to -1.44) with movement, both for acetaminophen at 90 minutes compared with baseline. Pairwise comparison in rest with diclofenac showed a difference of -0.027 (97.5% CI -0.45 to 0.39) and -0.052 (97.5% CI-0.46 to 0.36) for combination treatment. With movement, these numbers were -0.20 (97.5% CI -0.64 to 0.23) and-0.39 (97.5% CI -0.80 to 0.018), respectively. All differences were well below the predefined noninferiority margin. Pain treatment with acetaminophen was not inferior to that with diclofenac or the combination of acetaminophen and diclofenac in acute minor musculoskeletal extremity trauma, both in rest and with movement.