Blunt Abdominal Trauma Patients Research Articles

Immediate versus expedient emergent laparotomy in unstable isolated abdominal trauma patients.

Unstable abdominal trauma patients should be treated with emergent laparotomy. However, few studies have evaluated the association between time to surgery and survival in these patients. We aimed to assess the influence of time to laparotomy on outcomes in blunt and penetrating unstable abdominal trauma patients. This retrospective study includes patients with abdominal injuries, systolic blood pressure <90mmHg on arrival, admitted in Israel during 2000-2018. Data regarding patients' characteristics, Injury Severity Score (ISS), Glasgow Coma Scale (GCS), time to surgery, length of hospital stay and mortality were collected via The Israeli National Trauma Registry. Overall, 69 blunt and 127 penetrating injury patients were included in the study. For blunt and penetrating trauma patients with ISS ≤14, no differences in outcome were found between patients who underwent laparotomy within 60min of admission and those who underwent laparotomy within 60-120min of admission. In patients with blunt trauma, ISS ≥16, and GCS <15, mortality was higher in the immediate laparotomy group (p = 0.004 and 0.049, respectively). In patients with a penetrating injury, no differences in mortality between immediate and expedient laparotomy were demonstrated. In patients with a blunt injury, with ISS ≥16 and GCS <15, mortality was higher among the immediate laparotomy group.

Peritoneo-Cutaneous Fistula Secondary to Pigtail Catheter Insertion in a Blunt Abdominal Trauma Patient: A Case Report

We hereby present the first case of iatrogenic peritoneal-cutaneous fistula (PCF) formed at the site of removal of the pigtail catheter. The patient was admitted and underwent local site fistulous tract excision under general anaesthesia. Patient was discharged after an uneventful post-op period. Our intervention led to closure of the fistula leading to improved quality of life of the patient. Our case demonstrates that PCF can be created due to epithelialization secondary to chronic inflammation in a previous pigtail catheter tract.

The role of prothrombin complex concentrate to control critical bleeding after splenectomy for blunt abdominal trauma; A case report

Blunt abdominal trauma is an event that can cause massive internal bleeding and can be life-threatening. Splenectomy is often performed to treat organ injuries in patients with blunt abdominal trauma. However, splenectomy can cause hemostasis problems, which can cause more bleeding and risk complications such as Acute Kidney Injury (AKI).&#x0D; This case report aims to discuss the role of prothrombin complex concentrate (PCC) in treating bleeding and preventing AKI in blunt abdominal trauma patients after splenectomy at Fatmawati Hospital, Jakarta, Indonesia.&#x0D; A 15-year-old woman experienced blunt abdominal trauma due to a sports accident and sustained internal bleeding. After a thorough evaluation, she underwent an emergency splenectomy to stop the bleeding. However, patients developed hemostasis problem which made the control of postoperative bleeding difficult. To overcome this problem, patient was administered PCC intravenously, which resulted in significant improvement in controlling postoperative bleeding. The hematocrit level and red blood cell count steadily increased, indicating the effectiveness of PCC in improving the patient's hemostasis.&#x0D; PCC can play an important role in treating post-splenectomy bleeding in patients with blunt abdominal trauma. Apart from that, the use of PCC can also help prevent AKI, which is a serious and life-threatening complication. Further research and clinical trials are needed to confirm the benefits of using PCC in a broader patient population with similar conditions.&#x0D; Abbreviations: AKI- Acute Kidney Injury; PCC- Prothrombin Complex Concentrate&#x0D; Keywords: Acute Kidney Injury; Bleeding; Blunt Abdominal Trauma; Prothrombin Complex Concentrate; Splenectomy&#x0D; Citation: Laksana AP, Manggala SK, Irawany V. The role of prothrombin complex concentrate to control critical bleeding after splenectomy for blunt abdominal trauma; A case report. Anaesth. pain intensive care 2024;28(1):177−181; DOI: 10.35975/apic.v28i1.2289&#x0D; Received: September 13, 2023; Reviewed: October 29, 2023; Accepted: December 19, 2023

Development and validation of a nomogram to predict postsurgical intra-abdominal infection in blunt abdominal trauma patients: A multicenter retrospective study

BackgroundIntra-abdominal infection is a common complication of blunt abdominal trauma. Early detection and intervention can reduce the incidence of intra-abdominal infection and improve patients’ prognoses. This study aims to construct a clinical model predicting postsurgical intra-abdominal infection after blunt abdominal trauma. MethodsThis study is a retrospective analysis of 553 patients with blunt abdominal trauma from the Department of General Surgery of 7 medical centers (2011–2021). A 7:3 ratio was used to assign patients to the derivation and validation cohorts. Patients were divided into 2 groups based on whether intra-abdominal infection occurred after blunt abdominal trauma. Multivariate logistic regression and least absolute shrinkage and selection operator regression were used to select variables to establish a nomogram. The nomogram was evaluated, and the validity of the model was further evaluated by the validation cohort. ResultsA total of 113 were diagnosed with intra-abdominal infection (20.4%). Age, prehospital time, C-reactive protein, injury severity score, operation duration, intestinal injury, neutrophils, and antibiotic use were independent risk factors for intra-abdominal infection in blunt abdominal trauma patients (P < .05). The area under the receiver operating curve (area under the curve) of derivation cohort and validation cohort was 0.852 (95% confidence interval, 0.784–0.912) and 0.814 (95% confidence interval, 0.751–0.902). The P value for the Hosmer-Lemeshow test was .135 and .891 in the 2 cohorts. The calibration curve demonstrated that the nomogram had a high consistency between prediction and practical observation. The decision curve analysis also showed that the nomogram had a better potential for clinical application. To facilitate clinical application, we have developed an online at https://nomogramcgz.shinyapps.io/IAIrisk/. ConclusionThe nomogram is helpful in predicting the risk of postoperative intra-abdominal infection in patients with blunt abdominal trauma and provides guidance for clinical decision-making and treatment.

Determinants of adverse management outcomes of blunt abdominal trauma patients operated at a referral hospital in southern Ethiopia: a retrospective record review

BackgroundAbdominal trauma is one of the common reasons for emergency visits yet there is paucity of data about the subject in the horn of Africa. This study was aimed at determining the determinants of adverse management outcomes of blunt abdominal trauma among operated patients at Wolaita Sodo University Teaching and Referral Hospital, Ethiopia.MethodsThis was a three-year retrospective review conducted among 128 patient records selected using purposive sampling in which all records for the patients operated for a diagnosis of blunt abdominal trauma during the study period were included. A pretested checklist was used to extract the data relating to adverse outcomes and characteristics of the patients. A descriptive analysis followed by logistic regression was done.ResultsOf the 128 patients, adverse management outcomes related to blunt abdominal trauma occurred in 52%. Patients residing in rural areas (adjusted odds ratio 3.23, 95% confidence interval: 1.13–9.24) and those with tachycardia, (adjusted odds ratio = 3.25, 95% confidence interval: 1.19–8.83) or tachypnea (adjusted odds ratio 3.25, 95% confidence interval: 1.19–8.83) were more likely to have adverse management outcomes.ConclusionAdverse management outcomes are relatively high and associated with rural residence and deranged vital signs (tachycardia and tachypnea). Close monitoring targeting patients from rural residence and those presenting with tachycardia and tachypnea is recommended.

Survival Secrets: Unmasking the Factors Predicting Failure of Non-operative Management (NOM) in Splenic Injuries.

Splenic injuries are common solid organ injuries resulting from blunt abdominal trauma in road traffic accidents. Very often, splenic injuries can be life-threatening. Earlier, splenic injuries were often dealt with surgical intervention, such as splenectomy. With the recognition of the immunological function of the spleen and possible complications of splenectomy surgery, such as overwhelming post-splenectomy infections (OPSI), there has been a recent trend for non-operative management (NOM). To study the variables predicting failure of NOM in blunt abdominal trauma patients with splenic injury. This is a retrospective study that includes 235 patients who presented to the Safdarjung Hospital emergency room (New Delhi, India) with blunt trauma abdomen and splenic injuries with or without associated injuries between January 2019 and December 2021. The data was entered in a Microsoft Excel spreadsheet (Microsoft Corp., Redmond, WA, USA). Categorical variables were expressed as frequencies and percentages. Pearson's chi-square test of association was used to determine if there is a relationship between two variables. A p-value of <0.05 was considered statistically significant. Out of 235 patients with blunt abdominal trauma and splenic injuries, 82 were hemodynamically unstable despite resuscitation and were taken up for emergency laparotomy. The remaining 153 patients, who were either hemodynamically stable or stabilized after adequate resuscitation, were managed on the lines of NOM. The number of patients with splenic injury in AAST grades 1, 2, 3, 4, and 5 was 36, 50, 40, 24, and three, respectively. Out of 153 patients, 130 (85%) were successfully managed by NOM, while eight (5%) had to discontinue NOM as they required surgical intervention. The failure of NOM (fNOM) is seen mostly with grade 5 injuries (2/2, 100%, p<0.01), followed by grade 4 (4/20, 20%) and grade 3 (2/37, 5.7%). The mean age in fNOM was 58.3 years, as compared to 42.2 years in the success of NOM (sNOM). All eight patients had multiple concomitant injuries, with femur fracture being the most common association in up to six patients (p<0.01), followed by liver injury in four patients. There were 15 mortalities, irrespective of AAST severity grade. All of these patients had associated concomitant injuries, with intracranial bleeding (n = 10, 32%, p<0.01) being the most common association, followed by femur fracture (n = 6, 20%) and liver injury (n = 5, 16%). Also, the cause of death was unrelated to splenic trauma (p = 0.67), with pulmonary embolism (n = 6, 40%, p<0.01) being the most common cause, followed by brain stem herniation (n = 5, 34%). Non-operative management is a safe and efficient method for treating patients with splenic injuries who are hemodynamically stable or stabilized. The factors associated with fNOM include elderly age, a higher American Association for the Surgery of Trauma(AAST) grade of splenic injury, and associated concomitant injuries. Femur fracture was the most common concomitant injury present in cases where NOM failed, followed by liver injury. The presence of intracranial bleeds in these patients was a common association with mortality, irrespective of the grade of splenic injury.

CASS – A cost-effective strategy in the management of blunt trauma abdomen

Background: Abdominal trauma is one of the leading causes of morbidity and mortality in both developing and developed countries. Management of blunt trauma abdomen (BTA) relies on most importantly, the clinical presentation of the patient. Aims and Objectives: This study aims at determining the accuracy of the clinical abdominal scoring system (CASS) in predicting the need for operative management of blunt abdominal trauma patients and also comparing the CASS score with the American association for the surgery of trauma – computed tomography (AAST CT) score. Materials and Methods: A total of 50 patients with BTA presenting to the Government tertiary care center Mysore were evaluated for age, sex, type of trauma, systolic blood pressure, Glasgow coma scale, pulse rate, time of presentation after trauma, abdominal clinical findings, respiratory rate, and hemoglobin concentration. Radiological investigations were done as indicated. CASS score was calculated and a comparison of the same with CT findings, in determining the need for laparotomy, was studied. Patients with co-existing head injuries and comorbidities were excluded from the study. Results: Among 50 cases, 44 were male accounting for 88% of the study population and 6 were female. The majority belonged to 18–30 years of age, accounting for 46%. In 42% of cases, a road trafficaccident was the mode of injury, followed by a fall from height in 4%. Latent period 52% of cases presented to the hospital between 0 and 6 h of the incident. 10% associated chest injuries. 42% showed splenic injury, thereby making it the most commonly injured organ. 28% had the liver injury. 28% had hemoperitoneum with source of bleed being unknown. Conclusion: CASS is a reliable and promising scoring system with sensitivity comparable to AAST CT grading in determining the need for surgical intervention in BTA patients. CASS provides an effective means of saving time and resources and gives the added advantage of avoiding expenses to underprivileged patients in our country.

Clinico-Epidemiological Profile of Blunt Trauma Abdomen Patients in a Tertiary Care Hospital: An Observational Study

Background: Trauma is the leading cause of death in the population under the age of 45 year sold.1 Among trauma cases, Abdominal trauma accounts for the third most commonly injured part of the body. With the rising trend of road traffic accidents, the clinical patterns and profile of blunt abdominal trauma patients is also changing. Aim: To access the incidence, mode of injury and clinical presentation of blunt abdominal trauma patients in order to access the problem size in the study area. Material and Method: A prospective descriptive type of study was conducted in a tertiary care hospital including 100 study participants. All the patients with the diagnosis of the blunt abdominal trauma were assessed clinically at the time of presentation. After obtaining written informed consent, the detailed information regarding the mode of injury, clinical presentation was collected and recorded. Data Analysis: The data collected were then entered in MS Excel sheet and was analysed using SPSS v 20.0. the data was presented in the form of numbers and proportions. Results and conclusion: 85% of participants were male, majority (55%) belong to 21-40 years age group. The most common mode of injury was Road traffic accidents (75%) and most common clinical presentation was pain abdomen (98%). Spleen was the most common solid organ involved.

A RETROSPECTIVE STUDY BETWEEN CLINICAL EXAMINATION, FOCUSSED ABDOMINAL SONOGRAM IN TRAUMA AND CT SCAN IN BLUNT INJURY ABDOMEN IN A TERTIARY CARE CENTRE

Aims and Objectives: Blunt abdominal trauma (BAT) accounts for the majority (80 percent) of abdominal injuries seen in the Emergency Department and is responsible for substantial morbidity and mortality in developing countries. It requires high degree of suspicion, investigation and management. The most commonly injured abdominal organs are liver and spleen. The aim of this study was to nd etiology, early diagnosis and management of patients with blunt abdominal trauma based on clinical examination, FAST and CT scan. A retrospective study of 60 cases of blunt Abdominal trauma patients Methods: presenting to emergency and outpatient department of Surgery of Silchar Medical College and Hospital from September 2020 to September 2021 was done. Amongst the studied cases most Results: common age group involved was (21–30) years (28 cases). Liver was found to be the most common injured organ (22 cases) followed by bowel and spleen. FAST was the most commonly used investigation after blunt abdominal trauma. CT was used only in hemodynamically stable patients (19 cases). The most common intra-operative nding was Intestinal perforation and the most common surgery performed was the repair or resection and anastomosis of intestinal perforation. Most common mode of injury wa Conclusions: s road trafc accidents and predominantly, men were affected. Clinical examination alone is inadequate because patients may have altered mental status. Initial resuscitation followed by physical examination and monitoring of clinical parameters and FAST and computed tomography (CT) abdomen are very important to detect patients with minimal and clinically untraceable sign of abdominal injury. Rapid diagnosis, early timed referral, adequate and trained staff, careful monitoring, early decision to go for operative or nonoperative management can help save many lives.

Accuracy of Focused Assessment with Sonography for Trauma Performed by Emergency Medicine Residents

Aim: To evaluate the accuracy of focused assessment with sonography for trauma (FAST) performed by emergency medicine residents to detect intra-peritoneal free fluid in blunt trauma patients. Design: Randomized control trial. Place and duration of study: Accident &amp; Emergency Department, Mayo Hospital Lahore from 6th April 2022 to 5th November 2022. Methodology: One hundred and twenty one patients were included. FAST scan was performed in each patient by emergency resident as well as radiology resident. FAST was performed under direct supervision of radiology consultant. Furthermore, FAST reports were confirmed by patient follow up in first 24 hours by checking final outcome of patient based on results of abdominal computed tomography (CT), exploratory laparotomy or conservative management by admitting in surgical ward for observation and hemodynamic status change. Results: Focused assessment with sonography for trauma scan done by emergency residents showed free fluid in 20 patients (16.5%) while FAST done by radiology residents was positive in 21 (17.4%). Sensitivity of FAST performed by EM residents was 85.7% and specificity was 98%, while FAST done by radiology residents had sensitivity of 95.25 and specificity of 99%. Accuracy of FAST done by EM residents was 95.8% as final outcome. Conclusion: After training, emergency residents can perform FAST with high accuracy, similar to radiology residents in blunt abdominal trauma patients. Keywords: Focused assessment with sonography for trauma (FAST), Trauma, Blunt abdominal trauma

A STUDY OF CORRELATION OF PREOPERATIVE RADIOLOGICAL DIAGNOSIS WITH OPERATIVE FINDINGS IN BLUNT INJURY ABDOMEN

Introduction: Trauma has been called the neglected disease of modern society, despite its close companionship with man1. Abdominal trauma caused by blunt force is a common presentation in the emergency room seen in adults and children. They are usually an outcome of road trafc accidents, fall from heights or fall on any blunt objects or due to assaults2. They are associated with a high morbidity and mortality which can be avoided with early diagnosis and management. To study the correlation Objective: of preoperative diagnosis made by radiological evaluation with the intraoperative ndings in cases of blunt abdominal trauma. Materials and methods: The present study was conducted on 60 clinically suspected patients of blunt abdominal trauma presenting to the Emergency Department, King George Hospital, Visakhapatnam. The study was conducted after prior approval by the Institutional Ethics Committee and informed and written consent from the patient. 60 patients with clinical suspicion of blunt abdominal trauma were selected. After thorough clinical examination, the patients were subjected to X-ray chest and abdomen, Ultrasonography (USG) and Computed Tomography (CT) imaging. After arriving at a pre-operative diagnosis, these patients were followed up and correlation of this diagnosis was done with the intraoperative ndings and the results were evaluated. The data entry was done using M.S.Excel and statistical analysis was done using Statistical package for social sciences (SPSS version 16) for M.S.Windows. Fischers exact test was used. p-value less than 0.05 was considered to be statistically signicant. It was observed that preoperative diagnosis ma Results: de with CT had a higher degree of correlation with the intraoperative ndings when compared to Ultrasonography. It can be concluded that CT i Conclusion: s a better tool for preoperative evaluation when compared to USG in cases of blunt abdominal trauma

Indicative factors for surgical or angiographic intervention in hemodynamically stable patients with blunt abdominal trauma: A retrospective cohort study.

The standard of care for intraperitoneal injury in hemodynamically stable patients after blunt abdominal trauma has been replaced by non-operative management (NOM). However, selective NOM, depending on the situation, seems necessary in determining the treatment plan. In this study, we attempted to identify risk factors for surgical or angiographic intervention (SAI) in hemodynamically stable blunt abdominal trauma patients. This retrospective study which included adult patients who were brought to a regional trauma center was conducted from March 2015 to October 2019. We evaluated the characteristics of blunt abdominal trauma patients and analyzed factors that were related to the requirement of SAI in these patients. Patients were divided into SAI and conservative management (CM) groups. We reviewed 1,176 patients, and after exclusions, of whom 248 blunt abdominal trauma and free fluid observed on CT were identified. The mean pulse rate was higher in the SAI than in the CM (P=0.025). Laboratory findings showed that lactate and delta neutrophil index (DNI) levels were higher in the SAI than in the CM (P=0.002 and 0.026 respectively). Additionally, the mean free fluid size in the SAI (85.69mm) was significantly larger than that in the CM (68.12mm; P=0.001), and blush was more frequently observed in the SAI (P<0.001). In multivariate analysis, only blush was an independent prognostic factor for SAI (OR 11.7, 95% CI, 5.1-30.8, P<0.001). In hemodynamically stable patients with blunt abdominal trauma, blush but also high lactate and DNI are associated with the requirement of interventional radiology and/or surgery.

Relationship Between Degree of Solid Organ Trauma to Intra-Abdominal Pressure (IAP) In Blunt Abdomen Trauma at Prof. Dr. I G.N.G. Ngoerah General Hospital, Bali, Indonesia

Background: Blunt abdominal trauma is a common trauma case with a high mortality rate. Increased Intra-Abdominal Pressure (IAP) is one of the factors that affect the morbidity and mortality rates of blunt abdominal trauma. In this condition the authors are interested in examining the relationship between the Degree of Solid Organ Trauma and Intra-Abdominal Pressure (IAP) in Blunt Abdominal Trauma. Objective: To determine the relationship between the degree of hepatic, spleen and multi-organ trauma to intra-abdominal pressure (IAP) in patients with blunt abdominal trauma. Methods: This study used a prospective observational design, with an analytic cross-sectional design to assess the relationship between the degree of solid organ trauma and intra-abdominal pressure (IAP) in blunt abdominal trauma involving 45 samples of patients with blunt abdominal trauma at Prof. Dr. I.G.N.G. Ngoerah Denpasar Hospital in the period November 2021 – November 2022. Results: Intra-abdominal pressure (IAP) was significantly correlated with the degree of spleen trauma with an r value of 0.403 (p: 0.046) which indicated that intra-abdominal pressure (IAP) increased with increasing degree of splenic trauma. Conclusion: Splenic trauma is associated and significantly correlated with increased intra-abdominal pressure (IAP) and its degree in blunt abdominal trauma patients.

Clinical utility of performing FAST scan in hemodynamically stable patients presenting with blunt abdominal trauma in level one trauma center

Background: Focused assessment with sonography for trauma (FAST) has a role in the rapid screening of hemodynamically unstable patients to decide on management, however, its role in hemodynamically stable patients remains equivocal. Objectives: This study aimed to determine the sensitivity and specificity rate of FAST for intra-abdominal injury (IAI) in hemodynamically stable blunt abdominal trauma patients. Secondary outcomes like Glasgow coma score, length of hospital stays (LOS), head injury, and mortality were also examined for their association with FAST scan results. Settings and Design: A retrospective cross-sectional study was conducted in level-one trauma center in Bahrain. Methods: This study was conducted from January 2019 to October 2020. A total of 191 trauma codes were activated during this period, however, only 112 patients were included based on the inclusion criteria. Results: FAST scan in hemodynamically stable patients was found to have a higher specificity (96.7%) than sensitivity (30%) in this study. A higher negative predictive value (NPV) (86.4%) compared to a positive predictive value (66.6%) and a high accuracy rate (84.8%) was observed. LOS showed significant association only with FAST diagnostic accuracy. Conclusion: In hemodynamically stable patients; FAST is better at ruling in intra IAI when compared to ruling out and its high NPV supports it being a good screening tool. The results do not support the use of FAST as the sole diagnostic tool without performing computed tomography scan.

DIAGNOSTIC ACCURACY OF FOCUSED ASSESSMENT WITH SONOGRAPHY IN TRAUMA FOR VISCERAL INJURIES IN BLUNT ABDOMINAL TRAUMA PATIENTS KEEPING CT AS GOLD STANDARD

Background: Blunt abdominal trauma is common and is associated with intra-abdominal injury. Focused assessment with sonography in trauma (FAST) is extremely sensitive and specific test for the diagnosis of visceral injury in such patients with added benefit of quick scan and bedside availability. This study was conducted with an aim to establish the diagnostic accuracy of FAST for diagnosing visceral injuries in blunt abdominal trauma patients. Methods: This study involved 247 patients of both genders aged 18–60 years, referred to Department of Diagnostic Radiology with history of blunt abdominal trauma. All these 247 patients underwent FAST and CT abdomen. The results of CT scan were taken as gold standard and those of FAST were judged accordingly as true/false positive/negative. Results: Visceral injury was diagnosed in 167 (67.6%) patients on FAST while CT scan confirmed visceral injury in 165 (66.8%) patients. There were 155 true positive, 12 false positive, 10 false negative and 70 true negative cases which yielded 93.94% sensitivity, 85.37% specificity, 91.09% accuracy, 92.81% positive predictive value and 87.50% negative predictive value for FAST in detecting visceral injury. Conclusion: FAST is fairly sensitive, specific, and accurate in diagnosing visceral injury among blunt abdominal trauma. Its non-invasive, radiation-free nature, and widespread bedside availability advocate its preferred use in place of CT in diagnosis of visceral injury in blunt abdominal trauma cases. Pak J Physiol 2022;18(3):7?10

Blunt abdominal trauma patients presenting to a tertiary care facility of Pakistan: A three years' experience.

Blunt abdominal trauma (BAT) refers to injuries without wounds entering the peritoneal cavity due to road traffic accidents (RTA) and falls, as a result of collision or counter collision. The objective of the present study was to determine the frequency of patients with visceral injuries in blunt abdominal trauma. This study was carried out in the Department of Surgery, including ward-3 of Jinnah Post Graduate Medical Centre, Karachi, from November 2017 till November 2020. The study design was descriptive case series. During the study period, the data of 112 patients was collected, which comprised of 102 males and 10 females. All the patients between 12 to 65 years of age (mean age:31.84±13.14 years) presenting to the emergency with < 24 hours of abdominal trauma, were included in the study. Organs involved during blunt abdominal trauma were observed and frequency was recorded. Liver injuries were found in 48(42.28%) patients, intestinal injuries in 40(35.7%), splenic injuries in 32(28.5%), kidney injuries in 24(21.4%), pancreatic injuries in 8(7.1%) and stomach injuries in 4(3.5%) patients. Grade 4 liver injury was found in 80(71%) patients, Grade 2 and 3 splenic injuries in 56(50%) patients whereas 47(42%) patients had grade 1 kidney injury. Liver was found to be the most frequent organ involved, followed by intestine and spleen.

Comparing Outcomes in Transcatheter Embolization for the Management of Penetrating versus Blunt Trauma

Abstract Objectives This article assesses potential factors associated with successful embolization and/or mortality benefit among patients with penetrating (PT) compared to those with blunt abdominal trauma (BT) undergoing emergent angiography. Materials and Methods A retrospective study of arterial embolization for BT and PT at a tertiary care academic center in an urban setting between 2018 and 2020 was conducted. Fischer's exact and Student's t-tests were used to assess differences between PT and BT, regarding technical success, in-hospital mortality, number of vessels embolized, and requirement of Operating Room (OR) for bleeding control after embolization. Results Forty-three patients underwent embolization. Twenty-three presented with BT versus 20 with PT. There was no difference in the rate of success between the two groups (91.3% vs. 100%; p = 0.49). No difference was observed in mean days of survival among BT and PT patients treated by embolization (mean [standard deviation]: 13.7 [2.6] vs. 19.1 [2.79] days; p = 0.160). There was no difference in mortality between the two groups (13.0% vs. 10.5%; p = 1.00). Mean number of vessels embolized was higher in the BT group compared to PT (2.26 [1.32] vs. 1.44 [1.03], p = 0.044). The rate of BT patients who required subsequent OR intervention for hemorrhage control after embolization was similar to those with PT (8.7% vs. 10.5%; p = 0.84). Conclusion The rate of mortality, technical success, and requirement of subsequent OR intervention for hemorrhage control was comparable between BT and PT. BT was associated with a higher mean number of vessels embolized compared to PT. Our case series may provide insight in the use of embolization for PT, but further investigation is needed with larger cohorts.

Do signs of abdominal wall injury on computed tomography predict intra-abdominal injury in trauma patients with a seatbelt sign?

BackgroundA seatbelt sign in patients with blunt abdominal injury is associated with both abdominal wall and intra-abdominal injuries. This study aimed to assess the association between signs of abdominal wall injury on computed tomography (CT) and rates of intra-abdominal injury in patients with a blunt abdominal injury and a clinical seatbelt sign. MethodsThis study includes hemodynamically stable trauma patients with blunt abdominal injury and a clinical seatbelt sign who were hospitalized in two regional trauma centers in Israel, during 2014–2019. All data were collected via the medical center's trauma registry in both centers. ResultsWe identified 123 stable blunt abdominal trauma patients with a seatbelt sign, of which 101 (82.1%) and 22 (17.9%) had a low-grade and high-grade abdominal wall injury according to CT findings, respectively. Laparotomy rates were significantly higher in patients with signs of high-grade abdominal wall injury (p<0.0001). No differences in the timing of laparotomy between low and high-grade injuries were found. ConclusionsIn stable patients with blunt abdominal trauma and a clinical seatbelt sign, the severity of abdominal wall injury, as represented by CT findings, may predict a need for surgical treatment.

Study of Spleen and Liver Injuries in Patients of Blunt Trauma Abdomen

Objective: To study the spleen and liver injuries in patients of blunt trauma abdomen. Material and methods: This was a cross sectional study which conducted at Department of Surgery Loralai Medical College Loralai from May 2021 to November 2021 over the period of 6 months. Total 130 patients aged 18-50 years either gender with blunt trauma abdomen were recruited for this study. Spleen and liver injuries and their grading was studied. Results: Total 130 patients of blunt abdominal trauma were recruited. Age range was 18-50 years with mean age 30.85 ± 8.84 years. Out of 130 patients, liver injury was found in 67 (52%) patients. Total 84 (65%) patients had spleen injury. Total 20 (15%) patients had both liver and spleen injury. Conclusion: Results of this study concluded that spleen was the most common injured organ. Grade-I liver and spleen injury was commonly seen. Age group 18-33 years was common age group and males were prominent than females. Keywords: trauma, abdomen, liver, spleen

A Novel Machine Learning-Assisted Clinical Diagnosis Support Model for Early Identification of Pancreatic Injury in Blunt Abdominal Trauma Patients at the Bedside: A Cross-National Study

A Novel Machine Learning-Assisted Clinical Diagnosis Support Model for Early Identification of Pancreatic Injury in Blunt Abdominal Trauma Patients at the Bedside: A Cross-National Study