Evaluation Of Trauma Research Articles

Trauma Program Value Assessment at an Academic Health Network System Over 12 Years.

Trauma is a leading cause of global death, with 200000 deaths and over 3 million non-fatal injuries/year in the United States. We aim to assess trauma care value for patients who underwent urgent laparotomies (LAP) and thoracotomies (THO) in our Health Network System. Clinical variables (v = 84) from trauma patients (>18 yo) were retrieved retrospectively (Jan-2010 to July-2016) and prospectively (Aug-2016 to Sept-2021) from a Health System warehouse under IRB-approved protocols. Patients were divided according to their Injury Severity Score (ISS) into mild/moderate cases (ISS <15) and severe cases (ISS >15). Value was assessed using quality and cost domains. Quality surrogates included graded postoperative complications (PCs), length of stay (LOS), 30-day readmission (RA), patient satisfaction (PS), and textbook (TB) cases. Total charges (TCs) and reimbursement index (RI) were included as surrogates for cost. Value domains were displayed in scorecards comparing Observed (O) with Expected (E) (using the ACS risk calculator) outcomes. Uni-/multivariate analyses were performed using SPSS. 41,927 trauma evaluations were performed, leading to 16044 admissions, with 528 (3.2%) patients requiring urgent surgical procedures (LAP = 413 and THO = 115). Although the M:F ratio (7:3) was similar in LAP vs THO groups, age and BMI were significantly different (41.8 ± 19.1 vs 51.8 ± 19.9 years, 28.6 ± 9.9 vs 27.4 ± 7Kg/m2, respectively, P < .05). Blunt trauma was involved in 68.8/77.3% of the LAP/THO procedures, respectively (P < .05). Multivariate analyses showed ISS, age, ASA class, and medical center as factors significantly predicting PC (P < .05). Postoperative complication grades from the LAP/THO groups showed above-average outcomes; nonetheless, LOS was higher than the national averages. The Trauma Program holds high value in our Health Network System. Protocols for decreasing LOS are being implemented.

The role of 3D cinematic rendering in the evaluation of upper extremity trauma.

Traumatic upper extremity injuries are a common cause of emergency department visits, comprising between 10-30% of traumatic injury visits. Timely and accurate evaluation is important to prevent severe complications such as permanent deformities, ischemia, or even death. Computed tomography (CT) and CT angiography (CTA) are the favored non-invasive imaging techniques for assessing upper extremity trauma, playing a crucial role in both the treatment planning and decision-making processes for such injuries. In CT postprocessing, a novel 3D rendering method, cinematic rendering (CR), employs sophisticated lighting models that simulate the interaction of multiple photons with the volumetric dataset. This technique produces images with realistic shadows and improved surface detail, surpassing the capabilities of volume rendering (VR) or maximal intensity projection (MIP). Considering the benefits of CR, we demonstrate its use and ability to achieve photorealistic anatomic visualization in a series of 11 cases where patients presented with traumatic upper extremity injuries, including bone, vascular, and skin/soft tissue injuries, adding to diagnostic confidence and intervention planning.

Utilizing Un-enhanced Chest Computed Tomography Screening for Blunt Trauma Surgery Decisions.

Background Blunt chest trauma is a common and potentially life-threatening condition that requires prompt assessment for potential surgical intervention. Computed tomography (CT) of the chest has emerged as a valuable tool due to its heightened sensitivity and specificity in detecting thoracic injuries compared to conventional chest radiography. Objective This study aims to assess the impact of non-contrast CT chest findings on surgical decision-making and compare these findings with those from chest radiographs. Methods The study was conducted at the Accident and Emergency Department of Medical Teaching Institute, Lady Reading Hospital, Peshawar, Khyber Pakhtunkhwa, Pakistan. Patients of all ages and genders who presented with blunt chest trauma were included. Non-contrast CT chest scans were used as an initial screening tool and compared with traditional chest radiographs. Data collected included patient demographics, mechanism of injury, diagnostic findings, and treatment decisions. Imaging was performed using a GE Optima 16-slice scanner (Medsystems Sp. z o.o., Lublin, Poland). Results The study included 246 patients, of whom 210 (85.4%) were males. The most common age group was 50 years or older, comprising 71 (28.9%) of the sample. The predominant mechanism of trauma was road traffic accidents, reported by 188 (76.4%) patients. Hemopneumothorax was detected in 121 (49.2%) patients on CT scans compared to 34 (13.8%) patients on chest radiographs. On chest radiograph, the pneumothorax component was missed in 43 (17.5%) patients, and the hemothorax component was not detected in 21 (8.5%) patients. Patient management included conservative management in 30 (12.2%) cases and surgical intervention in the form of unilateral tube thoracostomy in 173 (70.3%) patients or bilateral tube thoracostomy in 43 (17.5%) patients. Conclusion Our study supports the use of non-contrast CT scans as a reliable diagnostic tool for blunt chest trauma, consistent with current literature. This approach facilitates prompt management decisions, particularly for initiating tube thoracostomy based on findings of pneumothorax and hemothorax. The rarity of mediastinal great vessel trauma further justifies minimizing routine contrast use, thereby enhancing the efficiency of trauma evaluations.

The technical consultancy office in the evaluation of dental trauma from a road accident

The technical consultancy office in the evaluation of dental trauma from a road accident

Evaluation of a Slim Modiolar Electrode Array: A Temporal Bone Study.

Evaluation of the Slim Modiolar (SM) electrode in temporal bones (TB) will elucidate the electrode's insertion outcomes. The SM electrode was designed for atraumatic insertion into the scala tympani, for ideal perimodiolar positioning and with a smaller caliber to minimize interference with cochlear biological processes. The SM electrode was inserted into TBs via a cochleostomy. First, the axial force of insertion was measured. Next, TBs were inserted under fluoroscopy to study insertion dynamics, followed by histologic evaluation of electrode placement and cochlear trauma. A subset of TBs were inserted with the Contour Advance (CA) electrode for comparison. Sixteen of 22 insertions performed to measure the axial force of insertion had flat or near zero insertion force profiles. Six insertions had increased insertion forces, which were attributed to improper sheath depth before electrode insertion. Under real-time fluoroscopy, 23 of 25 TBs had uneventful insertion and good perimodiolar placement. There was 1 scala vestibuli insertion due to suboptimal cochleostomy position and 1 tip roll over related to premature electrode deployment. When compared with the CA electrode, 14 of 15 insertions with the SM electrode resulted in a more perimodiolar electrode position. No evidence of trauma was found in histologic evaluation of the 24 TBs with scala tympani insertions. TB evaluation revealed that the SM electrode exerts minimal insertion forces on cochlear structures, produces no histologic evidence of trauma, and reliably assumes the perimodiolar position. Nonstandard cochleostomy location, improper sheath insertion depth, or premature deployment of the electrode may lead to suboptimal outcomes.

Lung ultrasonography underdiagnoses clinically significant pneumothorax

BackgroundUltrasonography for trauma is an integral part of the Advanced Trauma Life Support algorithm and supported extensively in the literature. The reliability of chest ultrasonography as a screening examination for pneumothorax during initial trauma evaluation is unclear. We performed a prospective study where we hypothesized that chest ultrasonography would have low sensitivity for detecting clinically significant pneumothorax. MethodsA prospective observational analysis of patients with blunt chest trauma at a level 1 trauma center was performed. Patients included had supine chest radiography and chest ultrasonography performed prior to intervention as well as confirmatory computed tomographic imaging. All chest ultrasonography was performed in the trauma bay by a registered sonographer. All imaging was evaluated by an attending trauma surgeon and radiologist in real time. ResultsOf 2,185 patients screened with a diagnosis of blunt thoracic trauma, 1,489 patients had chest radiography, chest ultrasonography, and confirmatory computed tomography and were included for analysis. Patients were 71% male, with median age of 42 years, and mean Injury Severity Score of 6. The sensitivity of chest ultrasonography to detect pneumothorax was low. Chest ultrasonography had a false negative rate of 72% (n = 58), with 22% (n = 13) undergoing tube thoracostomy. Patients with false negative examinations had lower initial O2 saturation and systolic blood pressure and were more likely to have rib fractures compared with true negative chest ultrasonography examinations. ConclusionChest ultrasonography performed on initial trauma evaluation has low sensitivity with a high rate of false negative examinations. Because many of these false negative results are clinically significant requiring thoracostomy, using chest ultrasonography alone to screen for pneumothorax should be done with caution.

Role of Laparoscopy in Evaluation of Various Blunt Abdominal Trauma

Introduction with Objective: The aim of the present study was to assess the role of laparoscopy in evaluation of various Blunt abdominal trauma (BTA) in tertiary care teaching hospital. Materials and Methods: A prospective observational study was conducted from 21st June 2016 to 21st December 2017 among 50 abdominal blunt trauma patients attending at Casualty Block, Dhaka Medical College Hospital, Dhaka, after obtaining requisite consent from the patients attendant. Data were collected through the assessment and investigation report of abdominal blunt trauma patients in the Casualty Department. The collected data were entered into the computer and analyzed by using SPSS (version 20.1) to assess the role of laparoscopy in evaluation of various blunt abdominal trauma. Results: Most of the patients were from 21-30 years (36%) of age group followed by 11-20 years (32%). The median age of this study population is 27 years. Of the study population, 84% (n=42) were male and 16% (n=8) were female. Male-female ratio was 84:16. In this study, 62% (n=31) of patients underwent only laparoscopy and 38% of patients (n=19%) underwent laparoscopy followed by laparotomy. Perforation of gas containing hollow viscus (94.73%) is responsible for conversion of laparoscopy into laparotomy in patients with blunt abdominal trauma. Among 50 patients 14 patients (28%) developed post operative complications. Rate of wound infection was higher laparoscopy followed by laparotomy (n=11). One patient developed post operative collection following laparoscopy. The accuracy rate is 100% in laparoscopic evaluation of BTA in this study. Conclusion: laparoscopy is a useful modality for evaluating and managing hemodynamically stable blunt abdominal trauma patients. Medicine Today 2024, Vol.36 (2): 95-98

Enhancing trauma evaluation: Comparative analysis of post-mortem computed tomography and autopsy findings in abdominal stab wounds.

In cases of traumatic deaths, accurate assessment of injuries is essential for both legal and medical purposes. This case report compares the findings of post-mortem computed tomography with conventional autopsy methods in assessing abdominal stab wounds. A 34-year-old woman with multiple stab wounds in the abdomen underwent post-mortem examination, including computed tomography imaging. Computed tomography revealed specific breaches in the skin's continuity and internal injuries, including perforation of the stomach. A conventional autopsy confirmed the presence of multiple stab wounds and associated injuries to internal structures. However, additional injuries to major blood vessels, such as the abdominal aorta and inferior vena cava, were only detected during manual exploration of the peritoneal cavity. This case highlights the complementary roles of post-mortem computed tomography and conventional autopsy in evaluating traumatic injuries. While computed tomography imaging offers non-invasive visualisation of injuries, manual examination remains essential for identifying certain injuries, particularly those affecting major blood vessels. The integration of computed tomography imaging with traditional autopsy methods enhances the accuracy and reliability of forensic assessments in cases of traumatic deaths, particularly in complex cases involving multiple injuries. Understanding the strengths and limitations of these techniques is crucial for improving forensic investigations and ultimately enhancing medico-legal outcomes.

MR Cranial Bone Imaging: Evaluation of Both Motion-Corrected and Automated Deep Learning Pseudo-CT Estimated MR Images.

CT imaging exposes patients to ionizing radiation. MR imaging is radiation free but previously has not been able to produce diagnostic-quality images of bone on a timeline suitable for clinical use. We developed automated motion correction and use deep learning to generate pseudo-CT images from MR images. We aim to evaluate whether motion-corrected pseudo-CT produces cranial images that have potential to be acceptable for clinical use. Patients younger than age 18 who underwent CT imaging of the head for either trauma or evaluation of cranial suture patency were recruited. Subjects underwent a 5-minute golden-angle stack-of-stars radial volumetric interpolated breath-hold MR image. Motion correction was applied to the MR imaging followed by a deep learning-based method to generate pseudo-CT images. CT and pseudo-CT images were evaluated and, based on indication for imaging, either presence of skull fracture or cranial suture patency was first recorded while viewing the MR imaging-based pseudo-CT and then recorded while viewing the clinical CT. A total of 12 patients underwent CT and MR imaging to evaluate suture patency, and 60 patients underwent CT and MR imaging for evaluation of head trauma. For cranial suture patency, pseudo-CT had 100% specificity and 100% sensitivity for the identification of suture closure. For identification of skull fractures, pseudo-CT had 100% specificity and 90% sensitivity. Our early results show that automated motion-corrected and deep learning-generated pseudo-CT images of the pediatric skull have potential for clinical use and offer a high level of diagnostic accuracy when compared with standard CT scans.

Ocular findings in the evaluation of abusive head trauma in children.

Abusive head trauma (AHT) is a form of child physical abuse that can result in major ocular injuries. This study describes the clinical presentation and ocular manifestations of infants diagnosed with AHT in a tertiary care center in Saudi Arabia. This is an observational, retrospective, cross-sectional study from 2015 to 2022 conducted at King Abdullah Specialized Children's Hospital (KASCH) in Riyadh, Saudi Arabia. Inclusion criteria include infants <2 years of age, diagnosed with AHT that had an eye examination as part of the evaluation. A total of 25 (50 eyes) cases of AHT had an eye examination documented in the electronic patients' records. The majority were males 19 (76%), and <6 months of age 10 (40%). About half of the children were healthy 13 (52%), and 12 (48%) had underlying physical illness. All patients had computed tomography scans. Subdural bleeding was noted in 22 (88%), 1 (4%) had epidural, and 4 (16%) had subarachnoid bleed. External ocular signs were noted in 8 (32%) patients only, including raccoon eyes, periorbital bruises, subconjunctival hemorrhage, and nonfixating eyes. Fundus findings were bilateral in 18 (72%), unilateral in 2 (8%), and normal in 5 (20%). In those with findings, the majority of 34 (68%) eyes had multiple retinal hemorrhages, 4 (8%) had vitreous hemorrhages, 2 (4%) retinal detachments, and 1 (2%) retinoschisis. Fundus examination is an important part of the comprehensive examination of children with suspected AHT; the majority of patients had an abnormal fundus examination with the tendency of bilateral findings.

Are there patients with an intracapsular fracture of the hip who may benefit from an uncemented hemiarthroplasty?

Cemented hemiarthroplasty is an effective form of treatment for most patients with an intracapsular fracture of the hip. However, it remains unclear whether there are subgroups of patients who may benefit from the alternative operation of a modern uncemented hemiarthroplasty - the aim of this study was to investigate this issue. Knowledge about the heterogeneity of treatment effects is important for surgeons in order to target operations towards specific subgroups who would benefit the most. We used causal forest analysis to compare subgroup- and individual-level treatment effects between cemented and modern uncemented hemiarthroplasty in patients aged > 60 years with an intracapsular fracture of the hip, using data from the World Hip Trauma Evaluation 5 (WHiTE 5) multicentre randomized clinical trial. EuroQol five-dimension index scores were used to measure health-related quality of life at one, four, and 12 months postoperatively. Our analysis revealed a complex landscape of responses to the use of a cemented hemiarthroplasty in the 12 months after surgery. There was heterogeneity of effects with regard to baseline characteristics, including age, pre-injury health status, and lifestyle factors such as alcohol consumption. This heterogeneity was greater at the one-month mark than at subsequent follow-up timepoints, with particular regard to subgroups based on age. However, for all subgroups, the effect estimates for quality of life lay within the confidence intervals derived from the analysis of all patients. The use of a cemented hemiarthroplasty is expected to increase health-related quality of life compared with modern uncemented hemiarthroplasty for all subgroups of patients aged > 60 years with a displaced intracapsular fracture of the hip.

Advances in Evaluation of Electrode Insertion Trauma Induced Residual Hearing loss in Cochlear Implant Recipients and its significance- A Narrative Review.

Cochlear implant surgery has revolutionized the management of profound hearing loss, with a growing focus on preserving residual hearing, particularly low-frequency hearing. This review synthesizes existing literature on cochlear implantation techniques, surgical principles, and emerging therapies aimed at reducing post-implantation hearing loss. Methodologically, a comprehensive narrative literature review was conducted, encompassing various study designs and participant demographics. The search strategy involved major biomedical databases, focusing on articles in English. Surgical techniques such as "soft surgery" emphasize minimizing mechanical stress on the cochlea, while advancements in pharmacological agents explore the use of corticosteroids, neurotrophins, and growth factors to enhance hearing preservation. Electrode design and insertion strategies are evolving to minimize trauma and optimize hearing outcomes, including consideration of insertion forces and electrode array designs. Evaluating residual hearing loss involves sophisticated techniques like electrocochleography and radiological imaging. The impact of residual hearing on auditory verbal outcomes is variable, with studies indicating positive correlations with language development, particularly in speech production. Emerging strategies in electrode design, surgical techniques, and drug delivery hold promise for improving outcomes in cochlear implantation. However, challenges such as the lack of standardized guidelines and the need for further clinical trials remain. Future directions include the exploration of nanotechnologies, gene therapies, and stem cells for constructing bionic ears, although ethical and technical hurdles persist. This review underscores the ongoing efforts to enhance cochlear implant functionality and the need for continued research to optimize outcomes for patients with hearing loss.

Coronal Plane Assessment for Levator Trauma.

Levator avulsion is a major etiological factor of pelvic organ prolapse (POP) and is primarily diagnosed on tomographic axial plane imaging. Two-dimensional imagingcan also image the levator. The objective was to test reproducibility and validity of coronal plane assessment for diagnosis of levator trauma by assessing the coronal plane obtained on tomographic ultrasound imaging. A retrospective study of women who had undergone an interview, POPQ and four-dimensional translabial ultrasound at a tertiary urogynecological unit. Post-processing of archived volume data was performed for assessment; and levator muscle area and estimate of remnant muscle mass in the coronal plane. Interobserver reproducibility of the latter two measures and associations between various measures of levator trauma and POP were tested. Interobserver agreement was good for percentage estimates (ICC 0.743), but fair for area measurements (ICC 0.482). Six hundred and twenty four women were seen, 468 (75%) had significant clinical prolapse. Full levator avulsions were diagnosed in 137 (22%). Mean TTS was 2.7 (range 0-12). On coronal plane assessment average muscle area was 1.47 (SD 0.76) cm2 and 1.55 (SD 0.74) cm2 on the right and left, respectively (P = .005). It was 76% and 79% for average estimates of muscle mass (P = .021). Both measures were strongly associated with POP; however, they were not superior to TTS in predicting POP. Coronal plane assessment in volume data is reproducible and valid for evaluation of levator trauma. Muscle mass estimate may be a better measure than muscle area.

Current Approaches in Forensic Pathology Evaluation of Abusive Head Trauma

Current Approaches in Forensic Pathology Evaluation of Abusive Head Trauma

Incidental pulmonary embolism in abdominal CT: detection rate and characteristics with artificial intelligence

Abstract Background Abdominal CT is a mainstay in the evaluation of abdominal infections, trauma, oncology, and postoperative complications. Pulmonary embolism is a common complication, but there is a risk that these ancillary findings are overlooked. In addition, data on detection rate and characteristics of incidental pulmonary embolism (iPE) on abdominal CT are lacking. Purpose The current study compared the period before and after implementing an artificial intelligence (AI) algorithm for iPE detection regarding detection rate and characteristics. Material and Methods A retrospective cross-sectional study was performed on abdominal CTs between August 1, 2019, and January 31, 2021 (before AI implementation, 8026 studies) and August 1, 2021, and January 31, 2023 (after AI implementation, 8765 studies). iPE cases were identified through text search and manually confirmed. Study indication and urgency were recorded for iPE patients, and the most proximal iPE level was assessed. A total of 1000 cases after AI implementation were randomly selected and manually reviewed for AI accuracy analysis. Results A total of 5876 patients with a mean age of 63.6 ± 17.7 years were included before AI implementation, and 6310 patients with a mean age of 63.2 ± 18.3 years after AI implementation. The iPE detection rate was higher after AI implementation, 0.57% (50/8765 studies) vs 0.12% (10/8026), P &amp;lt; .001. The most common study indications were abdominal pain (25%, 15/60 cases) and infection (30%, 18/60 cases). There were no differences in CT pulmonary angiography usage or the most proximal extent of the iPE between the periods before or after AI implementation, P &amp;gt; .05. AI identified 46/50 of the reported iPE with 7 AI false-positive cases for a positive predictive value of 87% (95% confidence interval: 75-93%). In the manually reviewed randomly selected subset, iPE prevalence was 1.7% (15/874, 95% confidence interval: 1.0-2.8%) with AI having 40% sensitivity (95% CI, 16-68) and 100% specificity (95% CI, 99.5-100). Conclusion Implementing AI for iPE detection and triage increased the iPE detection rate in abdominal CT. The AI sensitivity was moderate, with very few AI false positives.

Prospective with historical control, case-matched cohort study of the tertiary survey beneficial in critically severe trauma patients

Background The tertiary survey is an evaluation process conducted after the primary and secondary surveys. It aims to identify missed injuries. This research aims to study the benefits of tertiary surveys in severely traumatized patients. Methods This prospective with historical control, case-matched cohort was conducted on critically-ill trauma patients who were admitted to the surgical intensive care unit (SICU) of Thammasat University Hospital. The study compared the period before and after the implementation of the tertiary survey. Tertiary survey record form was used in all severely traumatized patients with Injury Severity Score (ISS) &gt; 15 within the first 24 hours and before discharge from SICU between August 2022 and February 2023. The comparison data were retrieved from electronic medical records of patients admitted to SICU with ISS &gt; 15 between April 2020 and July 2022. Results We identified 55 type II missed injuries in 39 of 100 cases prior to implementation and 1 type II missed injury after implementation. Type II missed injury decreased from 31% to 4%, and the missed injury detection rate was 56% after implementing the tertiary survey. However, there is no statistically significant difference in morbidity and mortality rates from missed injuries before and after implementation. Conclusions Using tertiary surveys can reduce missed injury rates and increase missed injury detection rates. This research highlights the importance of implementing tertiary surveys as a routine part of trauma evaluation to improve patient care. However, there is no effect on the outcomes, which may require more sample size. Clinical Trials Registry (reference number TCTR20230625001).

Predicting the complexity and mortality of polytrauma patients with machine learning models

We aim to develop machine learning (ML) models for predicting the complexity and mortality of polytrauma patients using clinical features, including physician diagnoses and physiological data. We conducted a retrospective analysis of a cohort comprising 756 polytrauma patients admitted to the intensive care unit (ICU) at Pizhou People’s Hospital Trauma Center, Jiangsu, China between 2020 and 2022. Clinical parameters encompassed demographics, vital signs, laboratory values, clinical scores and physician diagnoses. The two primary outcomes considered were mortality and complexity. We developed ML models to predict polytrauma mortality or complexity using four ML algorithms, including Support Vector Machine (SVM), Random Forest (RF), Artificial Neural Network (ANN) and eXtreme Gradient Boosting (XGBoost). We assessed the models’ performance and compared the optimal ML model against three existing trauma evaluation scores, including Injury Severity Score (ISS), Trauma Index (TI) and Glasgow Coma Scale (GCS). In addition, we identified several important clinical predictors that made contributions to the prognostic models. The XGBoost-based polytrauma mortality prediction model demonstrated a predictive ability with an accuracy of 90% and an F-score of 88%, outperforming SVM, RF and ANN models. In comparison to conventional scoring systems, the XGBoost model had substantial improvements in predicting the mortality of polytrauma patients. External validation yielded strong stability and generalization with an accuracy of up to 91% and an AUC of 82%. To predict polytrauma complexity, the XGBoost model maintained its performance over other models and scoring systems with good calibration and discrimination abilities. Feature importance analysis highlighted several clinical predictors of polytrauma complexity and mortality, such as Intracranial hematoma (ICH). Leveraging ML algorithms in polytrauma care can enhance the prognostic estimation of polytrauma patients. This approach may have potential value in the management of polytrauma patients.

Serial Trauma Abdominal Ultrasound in Children (STAUNCH): A Pilot Study.

Ultrasound has established utility within pediatric emergency medicine and has an added benefit of avoiding excessive radiation exposure. The serial focused assessment with sonography in trauma (sFAST) examination is a potential alternative to improve pediatric trauma evaluation. We sought to evaluate the accuracy of sFAST in pediatric patients with blunt abdominal trauma. We performed a multicenter, retrospective observational study of electronic medical records, trauma registry data, and image archiving records of previous sFAST examinations. Examinations from pediatric patients (18 years or younger) who presented to an emergency department with blunt abdominal trauma were eligible for inclusion as long as the period between the first and second FAST was at least 30 minutes but no more than 24 hours. Demographic data and patient and outcomes were collected. Data collected from 3 institutions found a total of 38 sFAST performed between July 2017 and September 2021 on eligible patients. Of these, there were 6 (15.4%) FAST examinations that were positive after an initial negative or indeterminate interpretation. The overall sensitivity and specificity of sFAST were 66.7% (95% confidence interval 22.3-95.7%) and 93.8% (79.2-99.3%), respectively. This pilot study found that sFAST can enhance blunt trauma evaluation and improve sensitivity and diagnostic accuracy. More data are needed to determine how sFAST can be utilized in pediatric patients with blunt abdominal trauma.

Assessment of head trauma in children: Current guidelines and challenges

The objective of this research is to analyze and synthesize current guidelines for the assessment of head trauma in children, identifying challenges faced in implementing these guidelines in clinical practice. To search for eligible responses, a systematic literature review was carried out, the aim of which was to gather, analyze and synthesize all available evidence on the research topic. Searches in scientific literature were carried out in the following databases: Latin American and Caribbean Literature in Health Sciences - LILACS and National Library of Medicine - PUBMED. Analysis and synthesis of current guidelines for the evaluation of head trauma in children reveal a series of fundamental recommendations to ensure an effective and safe approach to the management of these complex cases. However, its implementation in clinical practice faces significant challenges that can impact the quality of care offered to children suffering from head trauma. One of the main challenges is the variability in interpretation and application of guidelines by healthcare professionals, due to the complexity and multifaceted nature of pediatric head trauma. Additionally, a lack of adequate resources, such as neuroimaging equipment and trained personnel, may limit the ability of healthcare facilities to follow all guideline recommendations.

Contrast-enhanced point of care ultrasound for the evaluation of stable blunt abdominal trauma by the emergency physician: A prospective diagnostic study.

Clinical examination alone cannot reliably rule out significant traumatic abdominal injury. Computed tomography (CT) has become the primary method for evaluating blunt abdominal trauma and clinicians rely heavily on it to rule out abdominal injury. Ultrasound examination may miss significant abdominal injury particularly in stable patients. The use of a contrast agent improves ultrasound sensitivity to visceral abdominal injuries. The objective of this diagnostic study is to compare bedside contrast enhanced ultrasound (CEUS) performed by emergency physicians to CT in hemodynamically stable adults for the assessment of blunt abdominal trauma and evaluate CEUS accuracy outcomes. Hemodynamically stable patients with blunt trauma were prospectively enrolled in the trauma bay. After initial evaluation, we included patients at risk of abdominal injury and for whom an abdominal CT was planned by the trauma leader. Ultrasonography was performed prospectively and at the bedside by the emergency physician followed by abdominal CT used as a reference standard. Thirty-three patients were enrolled in the study; among them, 52% showed positive traumatic findings in abdominal CT scans, and 42% were diagnosed with solid organ lesions. Compared to CT, a focused abdominal sonography (FOCUS) examination, looking for free fluid or perirenal hematoma, showed limited performance for traumatic findings with a sensitivity of 65% (95% confidence interval [CI]: 38%-86%), a specificity of 75% (95% CI: 48%-93%), a negative likelihood ratio (NLR) of 0.47 (95% CI: 0.23-0.95), and a positive likelihood ratio (PLR) of 2.59 (95% CI: 1.03-6.48). When combining FOCUS with CEUS, the sensitivity of the sonography increased to 94% (95% CI: 71%-100%) with a specificity of 75% (95% CI: 48%-93%). The PLR was 3.76 (95% CI: 1.6-8.87) and the NLR was 0.08 (95% CI: 0.01-0.54). In our population, abdominal sonography with contrast failed to identify a single positive abdominal CT with a grade 1 kidney injury. A FOCUS examination shows limited sensitivity and specificity to detect positive abdominal CT in stable adults with abdominal trauma. With the addition of contrast and careful inspection of solid organs, abdominal sonography with contrast performed by the emergency physician improves the ability to rule out traumatic findings on abdominal CT. CEUS performed by emergency physicians may miss injuries, especially in the absence of free fluid, in cases of low-grade injuries, simultaneous injuries, or poor-quality examinations.