Multiple Soft Tissue Injuries Research Articles

Фактори ризику та прогнозування печінкової дисфункції у військовослужбовців з вогнепальними пораненнями

The purpose of the study was to improve the results of treatment of post-traumatic reactive hepatitis in victims of gunshot wounds by improving the prognosis, early diagnosis and treatment. Materials and methods. A retrospective analysis of 233 medical records of inpatients of wounded military persons of 2014-2020 hospitalized in medical institutions of the Ministry of Defense of Ukraine for more than 14 days. All victims were examined in the laboratory using unified methods of laboratory tests. The value of relative risk was calculated. The probability of liver dysfunction was assessed using binary logistic regression with a comprehensive analysis of the values of individual indicators (risk factors). The informativeness of the forecast was determined by sensitivity and specificity, which were calculated on the basis of true and false (positive and negative) forecasts. Additionally, the quality of the binary logistics model was tested by ROC analysis to determine the area under the ROC-curve (AUC). Results and discussion. There was a significant difference in the frequency of detection of most of the analyzed indicators: mine-explosive type of injury; presence of abdominal trauma, including liver trauma, multiple soft tissue trauma, traumatic shock and anemia (p <0.05 according to Fisher's exact test). Skeletal trauma occurred in both subgroups with almost the same frequency, thoracic trauma more often, but not significantly (p >0.05 according to Fisher's exact test). All studied indicators had a significant risk of developing reactive hepatitis (upper and lower limits of 95 % confidence interval greater than 1.0). Anaemia had the greatest impact (relative risk greater than 5.6 with a specificity of 0.951), followed by multiple soft tissue injuries (more than 3.8 with a specificity of 0.833), traumatic shock (more than 3.7 with a specificity of 0.747). Relative risk values of the mine-explosive nature of injuries, abdominal trauma and liver trauma were in the range of 2.0-2.7. Using the method of Wald's exclusion, a model of reactive hepatitis prognosis was created with a prognostic value of a positive result of 78.9 %, a prognostic value of a negative result of 95.1 %, specificity of 87.5 %, and sensitivity of 91.1 %. The results of the ROC analysis were evaluated based on the area under the ROC-curve (AUC), which was 0.879 (95 % CI 0.810-0.929) at a significance level of <0.001. The cut-off value is 0.5. For the convenience of usage of the described model, the mobile application was created. Conclusion. The most significant risk factors for reactive hepatitis after gunshot wounds are anaemia, multiple soft tissue injuries, and traumatic shock. The model for predicting the development of reactive hepatitis after a gunshot wound, made in the form of a mobile application, in which the presence of abdominal trauma, multiple soft tissue trauma, traumatic shock and anaemia are used as predictors, has a specificity of 87.5 % and sensitivity of 91.1 %

Nursing care of a case of multiple organ dysfunction syndrome caused by child abuse combined with severe soft tissue injury

Objective To explore the nursing experience of a child with multiple organ dysfunction syndrome caused by physical abuse and severe soft tissue injury. Methods In this case, multiple soft tissue injuries and multiple organ dysfunction syndrome were caused by domestic violence abuse. Nursing included strengthening artificial airway nursing, continuous blood purification nursing, skin injury nursing, sedation and analgesia management, nutritional support nursing, psychological nursing and family education. Results After careful treatment and nursing, the child′s condition improved and was transferred to the general ward for further treatment and discharged. Conclusions The nursing of multiple soft tissue injuries and multiple organ dysfunction syndrome includes strengthening artificial airway nursing, continuous blood purification nursing, skin injury nursing, sedation and analgesia management, nutritional support nursing, psychological nursing and family education. Key words: Nursing care; Child abuse; Soft tissue injury; Multiple organ dysfunction syndrome

Impact of e‐scooter injuries on Emergency Department imaging

Since the introduction of a shared e-scooter service to Auckland in October there have been multiple media reports of associated injuries, but no quantitation of the number or severity of these injuries, or the impact on hospital emergency department services in Auckland. We performed a retrospective chart review on all patients referred to Auckland hospital ED radiology with the indication containing 'e-scooter' between 15 August 2018 and 15 December 2018. All requests were screened to ensure that the injury was caused by an e-scooter. Recorded data included patient demographics, type of imaging utilised, injury type, and whether admission or surgery was required. Sixty-four patients met the inclusion criteria, only one of these was prior to introduction of shared e-scooters on 15 October 2018. Of these, there were 27 limb fractures, 3 dislocations, a fractured spine, 12 patients with concussion, 1 extra-dural bleed, 9 facial/skull fractures and multiple soft tissue injuries. Almost 40% of the patients required admission to a specialty service following imaging, and 25.4% required surgery. A total of 221 plain films and 47 CT scans were performed for e-scooter injuries in the 2-month period after their introduction. Introduction of shared e-scooters has resulted in a large number of serious related injuries that have required urgent radiology imaging. Many of these patients required further specialist consultation or surgery, and place an increased burden on overstretched emergency department services.

Value of quantitative assessment using Multidetector CT in predicting ligamentous and meniscal injuries in acute tibial plateau fractures

PurposeTo assess the ability of MDCT to predict ligamentous and meniscal injuries in acute tibial plateau fractures compared to MR images. Patients and methodsForty patients with acute tibial plateau fracture and 15 control subjects were subjected to MDCT and MR images. Lateral plateau depression (LPD) and lateral plateau widening (LPW) were measured in coronal MDCT images. Meniscal, cruciate, and collateral ligaments injuries were evaluated in MR images. ResultsSoft tissue injuries incidence was not related to Schatzker type (P > 0.05). LBD and LBW were different significantly between patients and control subjects ((P value < 0.001∗). LPD was correlated to meniscal, cruciate, and collateral ligaments injuries (P < 0.05). LPW was correlated to cruciate and collateral ligaments tears (P < 0.05) but not meniscal lesions (P > 0.05). LPD > 6 mm or LPW > 7 mm increased possibility of Soft tissue injuries. Multiple soft tissue injuries were not related to Schatzker types (P > 0.05). LPD and LPW were correlated with number of soft tissue injuries. ConclusionMDCT measurements of LPD and LPW are correlated with incidence and number of ligamentous and meniscal injuries. MDCT can predict ligamentous and meniscal injuries without waiting for MRI in acute tibial plateau fractures.

A Life-Threatening Presentation of Child Physical Abuse

Intra-abdominal injuries from impacts are the second most common cause of death in battered children. However, it may be difficult to distinguish between accidental abdominal injury and abuse, especially in the absence of other clinical findings. Published reports are also limited about the diagnosis of abuse in children with intra-abdominal injury. We report a case with jejunal perforation, multiple soft tissue injuries, and occipital fracture secondary to child abuse who was initially admitted to our hospital with complaint of fever, cough, and vomiting. An exploratory laparotomy revealed perforation of the jejunum, and an end-to-end anastomosis was performed. The patient was evaluated by the hospital's child protective team to implement appropriate diagnostic and child-protective interventions, and the child was discharged home in 10 days.

Inflicted esophageal perforation

Esophageal perforation in children is uncommon. A 2 1 2 - year-old girl presented with multiple soft tissue injuries of various chronological ages. Initial lateral cervical spine films showed the presence of a prevertebral air collection with soft tissue swelling. Enhanced computerized tomography confirmed the presence of proximal esophageal rupture and a retropharyngeal abscess. External drainage of the abscess and intravenous antibiotics led to resolution of the perforation in 13 days. Discrepancies in the history and the constellation of injuries pointed to an inflicted etiology (through child abuse). Since 1984, 21 case studies have described inflicted esophageal perforation. Common mechanisms of injury include foreign body ingestion and blunt or penetrating external trauma. Early diagnosis of these injuries reduces both acute and long-term morbidity and mortality. Pediatric surgeons must be aware of inflicted injury as an etiology of esophageal and hypopharyngeal perforation.