Organ Injury Scale Research Articles

The American Association for the Surgery of Trauma Organ Injury Scale for Spleen Does Not Equally Predict Interventions in Penetrating and Blunt Trauma.

The American Association for the Surgery of Trauma (AAST) Organ Injury Scale (OIS) for the spleen (and other organs) was created in 1989. It has been validated to predict mortality, need for operation, length of stay (LOS), and intensive care unit (ICU) LOS. We aimed to determine if the Spleen OIS is applied equally to blunt and penetrating trauma. We analyzed the Trauma Quality Improvement Program (TQIP) database from 2017-2019, including patients with spleen injuries. Outcomes included the rates of mortality, operation, spleen-specific operation, splenectomy, and splenic embolization. 60900 patients had a spleen injury with an OIS grade. Mortality rates increased in Grades IV and V for both blunt and penetrating trauma. In blunt trauma, the odds for any operation, spleen-specific operation, and splenectomy increased, for each increase in grade. Penetrating trauma showed similar trends in grades up to grade IV, but were statistically similar between grade IV and V. Splenectomy was higher in penetrating trauma for all grades. Splenic embolization peaked at 25% of grade IV trauma before decreasing in grade V. Rates in penetrating trauma were significantly lower in all grades, peaking at 2.5% of Grade III injuries. The mechanism of trauma is a significant factor for all outcomes, independent of AAST-OIS. Hemostasis is predominantly surgical in penetrating trauma, achieved with angioembolization more frequently in blunt trauma. Penetrating trauma management is influenced by the potential for injury to peri-splenic organs.

Factors associated with enteral nutrition tolerance after trauma laparotomy of the small bowel and mesenteric injuries by blunt trauma

BackgroundIn patients with blunt injury due to abdominal trauma, the common cause for laparotomy is damage to the small bowel and mesentery. Recently, postoperative early enteral nutrition (EEN) has been recommended for abdominal surgery. However, EEN in patients with blunt bowel and/or mesenteric injury (BBMI) has not been established. Therefore, this study aimed to identify the factors that affect early postoperative small bowel obstruction (EPSBO) and the date of tolerance to solid food and defecation (SF + D) after surgery in patients with BBMI.MethodsWe retrospectively reviewed patients who underwent laparotomy for BBMI at a single regional trauma center between January 2013 and July 2021. A total of 257 patients were included to analyze the factors associated with enteral nutrition tolerance in patients with EPSBO and the postoperative day of tolerance to SF + D.ResultsThe incidence of EPSBO in patients with BBMI was affected by male sex, small bowel organ injury scale (OIS) score, mesentery OIS score, amount of crystalloid, blood transfusion, and postoperative drain removal date. The higher the mesentery OIS score, the higher was the EPSBO incidence, whereas the small bowel OIS did not increase the incidence of EPSBO. The amount of crystalloid infused within 24 h; the amount of packed red blood cells, fresh frozen plasma, and platelet concentrate transfused; the time of drain removal; Injury Severity Score; and extremity abbreviated injury scale (AIS) score were correlated with the day of tolerance to SF + D. Multivariate analysis between the EPSBO and non-EPSBO groups identified mesentery and small bowel OIS scores as the factors related to EPSBO.ConclusionMesenteric injury has a greater impact on EPSBO than small bowel injury. Further research is needed to determine whether the mesentery OIS score should be considered during EEN in patients with BBMI. The amount of crystalloid infused and transfused blood components within 24 h, time of drain removal, injury severity score, and extremity AIS score are related to the postoperative day on which patients can tolerate SF + D.

Validating the American Association for the Surgery of Trauma Pancreas Injury Grade Using Trauma Quality Improvement Program Data.

The American Association for the Surgery of Trauma (AAST) Organ Injury Scale (OIS) for the pancreas was created in 1990. Our aim was to validate the ability of the AAST-OIS pancreas grade to predict adjuncts to operative management, including endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous drain placement. We analyzed the Trauma Quality Improvement Program (TQIP) database from 2017 to 2019, including all patients with a pancreas injury. Outcomes included the rates of mortality, laparotomy, ERCP, and peri-pancreatic or hepatobiliary percutaneous drain placement. Outcomes were analyzed by AAST-OIS, and odds ratios (ORs) and 95 confidence intervals (CIs) were calculated for each. 3571 patients were included in the analysis. The AAST grade was associated with increased rates of mortality and laparotomy at every level (P < .05). Endoscopic retrograde cholangiopancreatography rates increased from grade 2 to 3 (OR 4.685, 95% CI 3.254-6.745), were similar between grades 3 and 4 (P > .05), and decreased from grades 4 to 5 (OR .443, CI .250-.788). Likewise, rates of percutaneous drain placement increased from grade 2 to 3 (OR 1.999, CI 1.192-3.353), were similar between grades 3 and 4 (P > .05), and decreased from grades 4 to 5 (OR .266, .076-.934). Increasing pancreatic injury grade is associated with increased mortality and laparotomy rates at all levels. Endoscopic retrograde cholangiopancreatography and percutaneous drainage procedures are used most in mid-grade (3-4) pancreatic trauma. The decrease in nonsurgical procedures in grade 5 pancreatic trauma is likely secondary to increased rates of surgical management (resection and/or wide drainage). The AAST-OIS for pancreatic injury is associated with mortality and interventions.

The American Association for the Surgery of Trauma Organ Injury Scale is Associated With Cystoscopic and Percutaneous Urologic Procedures in Renal Injuries.

The American Association for the Surgery of Trauma Organ Injury Scale for the kidney was created in 1989. It has been validated to various outcomes including operations. It was updated in 2018 to better predict endourologic interventions, but this change has not been validated. In addition, the AAST-OIS does not consider mechanism of trauma in its interpretation. We analyzed 3years of the Trauma Quality Improvement Program database including all patients with a kidney injury. We recorded rates of mortality, operation, renal operation, nephrectomy, renal embolization, cystoscopic intervention, and percutaneous urologic procedures. 26294 patients were included. In penetrating trauma, mortality, operation, renal-specific operation, and nephrectomy rates increased at every grade. Renal embolization and cystoscopy rates peaked in grade IV. Percutaneous interventions were rare across all grades. In blunt trauma, mortality and nephrectomy rates increased only in grades IV and V. Operation, renal operation, and renal embolization rates increased at every grade level. Cystoscopy rates peaked in grade IV. Percutaneous procedure rates only increased between grades III and IV. Penetrating injuries are more likely to require nephrectomy in grades III-V, cystoscopic procedures in grade III, and percutaneous procedures in grades I-III. Endourologic procedures are most utilized in grade IV injuries, which are in part defined by injuries with damage to the central collecting system. Despite penetrating injuries more frequently requiring nephrectomy, they also more frequently require nonsurgical procedures. Mechanism of trauma should be considered when interpreting the AAST-OIS for kidney injuries.

ROLE OF 128 SLICE MDCT IN PANCREATIC TRAUMA DIAGNOSIS AND MANAGEMENT

Aims and Objectives:This study aimed to detail how multi-detector computed tomography (MDCT) can be utilised to the study diagnosis of pancreatic trauma and its management. Material and Methods:This Hospital-based prospective study was carried out over 10 months from December 2020 to SEP 2021 at the Department of Radiodiagnosis, Narayana medical college, Nellore. 30 patients with pancreatic injury were included in study. All patients underwent Contrast enhanced computed tomography abdomen on128 slice CT(GE OPTIMA 660).Grading of pancreatic injury done using American Association for the surgery of trauma organ injury scale .One patient underwent MRI abdomen and MRCP. 20 patients are treated conservatively. 10 out of 30 patients underwentsurgery.Intraoperative findings noted. Results: 1. According to American Association for the surgery of trauma organ injury scale 19/30 patients are of grade I &amp;grade II injury. 6/30 in grade III and 5/30 were grade IV injuries. 2. Grade I &amp;II patients were managed conservatively and improved remarkably on followup. 3. Grade III&amp;IV patients underwent surgery and CT findings are confirmed intraoperatively. 4. 6 patients with grade III injury undergone Distal pancreatectomy + Splenectomy and 4 patients undergone Spleen preserving Distal Pancreatectomy. 5. Grade IV patients initially managed conservatively in which 4 patients developed pseudocyst they were treated with cystogastrostomy and one patient developed fistula .This fistula was initially controlled with Percutaneous catheter drainage followed by roux -en- y fistulojejunostomy. Conclusion: 1. CT represents an accurate tool for diagnosing pancreatic trauma, it provides useful information to plan therapeutic approach .

Management Strategies and Outcomes of Paediatric Blunt Abdominal Trauma at a Tertiary Care Centre in South Kerala: A Retrospective Observational Study

Introduction: Blunt abdominal trauma is a leading cause of injury in paediatric population. The management of paediatric abdominal injury has shifted from Operative Management (OM) to Non Operative Management (NOM) over years. NOM is the standard treatment for clinically stable patients with blunt trauma abdomen. Aim: To describe retrospectively the management strategies and outcomes of paediatric patients with blunt abdominal trauma in a tertiary care centre. Materials and Methods: This was a retrospective observational record-based study that included 96 medical records of children admitted in Government Medical College, Thiruvananthapuram, Kerala, India, with blunt trauma abdomen from January 2018 to December 2022. Patients were characterised according to the treatment they received as- NOM and OM. Ultrasound Focused Assessment with Sonography in Trauma (USG FAST) and Contrast Enhanced Computed Tomography (CECT) abdomen were done in all the patients. The factors recorded were- age, gender, mechanism of injury, concomitant injury, tachycardia, hypotension, respiratory rate, blood transfusion requirement, injuries (American Association of Surgery of Trauma (AAST) organ injury scale), length of Intensive Care Unit (ICU) and hospital stay and mortality. Univariate analysis of the clinical features were done using Chi-square test using Statistical Package for the Social Sciences (SPSS) 27.0 statistical software. The p-value &lt;0.05 was considered statistically significant. Result: About 83 patients (86.46%) were in NOM group while 13 patients (13.54%) were in OM group. The most common age group involved was 6-12 years with male predominance. Median age was 9.2 years. The most common mechanism of injury was road traffic accident 31 (32.29%). Among 84 patients with isolated solid organ injury, only 5 (5.9%) required surgical intervention. Among nine patients with isolated hollow viscous injury, 5 (55.5%) required surgical intervention. All 3 (100%) patients with both hollow viscous and solid organ injury required surgery. Hypotension and blood transfusion requirement were statistically significant factors in the OM group p&lt;0.05. Complications, length of hospital and ICU stay were more in operatively managed group with mortality rate of 1.04%. Conclusion: The success of NOM of blunt trauma abdomen depends on proper selection of the patient. Patients who are haemodynamically stable can be safely managed non operatively with adequate monitoring in a tertiary care centre.

Solid Organ Injury Grading in the Abdomen: A Primer for Emergency Radiology

The American Association for the Surgery of Trauma (AAST) established the Organ Injury Scale (OIS) in 1984, making an initial revision in 1994, and the most recent revision in 2018. This recent revision was made to better predict the need for operative or angiointervention management, considering active hemorrhage or other vascular complications. Diagnosis of hemodynamically stable patients is made by CT; however, hemodynamically unstable patients may be diagnosed via focused assessment with sonography in trauma (FAST) ultrasound or emergency laparotomy.1–3 In this article, we discuss in depth the different OIS gradings for renal, hepatic, and splenic trauma and demonstrate the necessary information that an emergency radiologist must know through a series of cases. This knowledge will allow radiologists to concisely communicate with referring teams and help them make the appropriate management decisions for each patient case.1 , 4

Toward automated interpretable AAST grading for blunt splenic injury.

The American Association for the Surgery of Trauma (AAST) splenic organ injury scale (OIS) is the most frequently used CT-based grading system for blunt splenic trauma. However, reported inter-rater agreement is modest, and an algorithm that objectively automates grading based on transparent and verifiable criteria could serve as a high-trust diagnostic aid. To pilot the development of an automated interpretable multi-stage deep learning-based system to predict AAST grade from admission trauma CT. Our pipeline includes 4 parts: (1) automated splenic localization, (2) Faster R-CNN-based detection of pseudoaneurysms (PSA) and active bleeds (AB), (3) nnU-Net segmentation and quantification of splenic parenchymal disruption (SPD), and (4) a directed graph that infers AAST grades from detection and segmentation results. Training and validation is performed on a dataset of adult patients (age ≥ 18) with voxelwise labeling, consensus AAST grading, and hemorrhage-related outcome data (n = 174). AAST classification agreement (weighted κ) between automated and consensus AAST grades was substantial (0.79). High-grade (IV and V) injuries were predicted with accuracy, positive predictive value, and negative predictive value of 92%, 95%, and 89%. The area under the curve for predicting hemorrhage control intervention was comparable between expert consensus and automated AAST grading (0.83 vs 0.88). The mean combined inference time for the pipeline was 96.9s. The results of our method were rapid and verifiable, with high agreement between automated and expert consensus grades. Diagnosis of high-grade lesions and prediction of hemorrhage control intervention produced accurate results in adult patients.

Operative Management of Penetrating Colon Injury: Gone Are the Days of the Diverting Colostomy

INTRODUCTION: There is continued controversy regarding the optimal operative management of penetrating colon injury (PCI). The aim of our study is to compare outcomes of initial diverting operation (DO) vs primary repair and anastomosis (PRA) for PCI. METHODS: A 2017-2018 American College of Surgeons TQIP analysis. All adult trauma patients with operatively managed PCI were included. Transferred, dead ≤24 hours, or burn patients were excluded. Patients were stratified into DO or PRA. Outcomes measures were superficial and deep operative site infection (SSI) rate, intraabdominal abscess, sepsis, infectious complication, and failure of operative management (FOM; unplanned operating room return or subsequent diversion), hospital and ICU length of stay (LOS), and mortality. Multivariate regression was performed to identify predictors of infectious complication. RESULTS: A total of 4,504 patients were identified, of whom 357 (8%) underwent DO and 4,147 (92%) PRA. Mean age was 34 ± 13 years, 4,029(90%) were men, median Injury Severity Score was 16 [9-25]. The most common mechanism of injury was firearm (82%). Left-sided colon was most commonly affected (38%), and 56% had an American Association for the Surgery of Trauma Organ Injury Scale (AAST-OIS) grade III PCI or higher. A total of 599b(13%) patients had an infectious complication. DO group had higher superficial SSI rate (5.0% vs 2.4%; p = 0.003) and infectious complication (19.0% v s12.8%; p < 0.001), but no difference in deep SSI rate, intra-abdominal abscess, sepsis, FOM, mortality, hospital and ICU LOS between both groups (p > 0.05). Independent predictors of infectious complication are described in the Table. CONCLUSION: One in 7 patients with PCI developed an infectious complication, most commonly an intra-abdominal abscess. DO is independently associated with increased risk of infectious complication, along with left-sided PCI, concomitant gastric or small intestinal injuries, firearm injury, and AAST-OIS grade of PCI. PRA should be the preferred operative management for PCI.Table

Role of multi detector computed tomography (MDCT) in evaluation and management of blunt abdominal trauma

Background: The majority of all blunt and penetrating body injuries are abdominal injuries. Computed tomography is a significant and quick technology that provides information on the kind of abdominal damage quickly and aids in patient care in accordance with that information. The current study's objectives were to assess the value of Multidetector Computed Tomography (MDCT) in identifying intra-abdominal injuries in patients with acute abdominal trauma and to give knowledge that might precisely guide therapy decisions (non- operative versus operative). and to compare the computed tomography (CT) results to either clinical observation, a further CT scan (if necessary), or the results of surgery (wherever applicable). Objectives: To examine the utility of multidetector computed tomography (MDCT) in detecting intra-abdominal injuries in patients with blunt abdominal trauma and providing information to define the role of therapy (operative versus conservative). Materials and Methods: This two-year prospective study looked at 50 patients who had suffered blunt abdominal trauma. The MDCT findings were compared to clinical outcomes, follow-up CT scans (if needed), and surgical outcomes (whichever applicable). Results: Motor vehicular accidents were the commonest cause of abdomen blunt injury (68%). Abdominal injury was present in 38 (76%) patients and hemoperitoneum was seen on CT scan in 33 patients (85.8%). In 27 patients, hemoperitoneum was associated with solid organ injury. The commonest injury was splenic injury. In 6 patients (15.8%) who underwent surgery, CT findings of hemoperitoneum and solid organ injury were verified, and bowel injury was shown to be the origin of isolated hemoperitoneum in two cases. The CT scan was 100% accurate in detecting hemoperitoneum. During the follow-up period, all conservatively handled cases recovered without incident. As a result, OIS grading appeared to predict care methods in the majority of patients in this study's overall analysis of solid organ injuries, with the exception of those with bowel and mesenteric injuries. Conclusion: In the diagnosis and management of blunt abdominal trauma, CT is the imaging modality of choice. Keywords: Computed tomography; Blunt Abdominal Trauma; Organ Injury Scaling (OIS); splenic injury; liver injury, road traffic accidents.

Comparison between level 1 and level 2 trauma centers for the management of splenic blunt trauma

IntroductionThe management of blunt splenic trauma has evolved in the last years, from mainly operative approach to the non-operative management (NOM). The aim of this study is to investigate whether trauma center (TC) designation (level 1 and level 2) affects blunt splenic trauma management. MethodsA retrospective analysis of blunt trauma patients with splenic injury admitted to 2 Italian TCs, Niguarda (level 1) and San Carlo Borromeo (level 2), was performed, receiving either NOM or emergency surgical treatment, from January 1, 2015 to December 31, 2020. Univariate comparison was performed between the two centers, and multivariate analysis was carried out to find predictive factors associated with NOM and splenectomy. Results181 patients were included in the study, 134 from level 1 and 47 from level 2 TCs. The splenectomy/emergency laparotomy ratio was inferior at level 1 TC for high-grade splenic injuries (30.8% for level 1 and 100% for level 2), whose patients presented higher incidence of other injuries. Splenic NOM failure was registered in only one case (3.3%). At multivariate analysis, systolic pressure, spleen organ injury scale (OIS) and injury severity score (ISS) resulted significant predictive factors for NOM, and only spleen OIS was predictive factor for splenectomy (Odds Ratio 0.14, 0.04–0.49 CI 95%, P < .01). ConclusionBoth level 1 and 2 trauma centers demonstrated application of NOM with a high rate of success with some management difference in the treatment and outcome of patients with splenic injuries between the two types of TCs.

Indications for the surgical management of pancreatic trauma: An update.

Pancreatic trauma is rare compared to other abdominal solid organ injuries, accounting for 0.2%-0.3% of all trauma patients. Moreover, this type of injury may frequently be overlooked or not readily appreciated on initial clinical examinations and investigations. The organ injury scale determines the severity of the trauma. Nonetheless, there are conflicting recommendations for the best strategy in severe cases. Overall, conservative management of induced severe traumatic pancreatitis is adequate. Modern imaging modalities such as ultrasound scanning and computed tomography scanning can detect injuries in fewer than 60% of patients. However, magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography (ERCP) have diagnostic accuracies approaching 90%-100%. Thus, management options include ERCP and stent placement or distal pancreatectomy in cases of complete gland transection and wide drainage only for damage control surgery, which can prevent mortality but increases the risk of morbidity. In the majority of cases, surgical intervention is not required and should be reserved for only severe grade III to grade V injuries.

Blunt splenic injury in adults: Association between volumetric quantitative CT parameters and intervention.

Computed tomography volumetry of blunt splenic injury-related features predicts splenectomy and angioembolization in adults and identifies clinically important target features for computer vision and automation research. BACKGROUND Several ordinal grading systems are used in deciding whether to perform angioembolization (AE) or splenectomy following blunt splenic injury (BSI). The 2018 American Association for the Surgery of Trauma (AAST) Organ Injury Scale incorporates vascular lesions but not hemoperitoneum, which is considered in the Thompson classifier. Granular and verifiable quantitative measurements of these features may have a future role in facilitating objective decision making. PURPOSE The purpose of this study is to compare performance of computed tomography (CT) volumetry-based quantitative modeling to the 1994 and 2018 AAST Organ Injury Scale and Thompson classifier for the following endpoints: decision to perform splenectomy (SPY), and the composite of SPY or AE. MATERIALS AND METHODS Adult BSI patients (age ≥18 years) scanned with dual-phase CT prior to intervention at a single Level I trauma center from 2017 to 2019 were included in this retrospective study (n = 174). Scoring using 2018 AAST, 1994 AAST, and Thompson systems was performed retrospectively by two radiologists and arbitrated by a third. Endpoints included (1) SPY and (2) the composite of SPY or AE. Logistic regression models were developed from segmented active bleed, contained vascular lesion, splenic parenchymal disruption, and hemoperitoneum volumes. Area under the receiver operating characteristic curve (AUC) for ordinal systems and volumetric models were compared. RESULTS Forty-seven BSI patients (27%) underwent SPY, and 87 patients (50%) underwent SPY or AE. Quantitative model AUCs (0.85—SPY, 0.82—composite) were not significantly different from 2018 AAST AUCs (0.81, 0.88, p = 0.66, 0.14) for both endpoints and were significantly improved over Thompson scoring (0.76, p = 0.02; 0.77, p = 0.04). CONCLUSION Quantitative CT volumetry can be used to model intervention for BSI with accuracy comparable to 2018 AAST scoring and significantly higher than Thompson scoring. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level IV.

Efficacy of Minimal Invasive Methods in Management of Traumatic Pancreatic Injury

Introduction Isolated pancreatic injury is relatively uncommon due to its mostly retroperitoneal location. However, if present, it is associated with other visceral injuries and causes serious complications if expected management is delayed. Cases In this report we have discussed about the different minimal invasive management approaches in two cases of pancreatic injury. The first case had American Association for the Surgery of Trauma Organ Injury Scale (AAST-OIS) grade IV pancreatic injury with late presentation who underwent ultrasound-guided percutaneous drainage of pseudocyst with video assisted lavage of cavity, followed by endoscopic retrograde cholangiopancreatography (ERCP) guided pancreatic duct stenting. Second case had AAST-OIS grade II pancreatic injury which was managed with serial percutaneous drainage. Conclusion Management of pancreatic injury is complex. Evolving trend of minimal invasive techniques of management for selected patients with higher grade pancreatic injury is associated with better outcomes.

Validation of the American Association for the Surgery of Trauma Organ Injury Scale for Penetrating Colon Injuries.

In 2020, the American Association for the Surgery of Trauma (AAST) published a revision of the organ injury scale (OIS) for bowel injuries. The update included for the first time a separate OIS for penetrating colon injuries as well as imaging criteria. To validate the new OIS and its correlation with outcomes, we performed a retrospective review of patients with penetrating colon injuries (AIS<3 in other body regions) between 2016 and 2020 at a single institution. Sixty-six patients met inclusion criteria. Most were young (29years median) and male (90%). All underwent operative intervention and 23 (34%) had pre-operative imaging. Imaging grade was higher than operative grade in 11 patients (48%). Higher AAST operative grade was associated with a higher likelihood of resection and anastomosis or colostomy, need for damage control laparotomy, and development of intra-abdominal abscess and acute kidney injury. A multicenter study is underway to confirm these findings.

Improvement of mortality in severe liver injury after trauma center implementation: a propensity score matched study.

To evaluate changes in the management and outcome of severe liver injury after trauma center implementation. Trauma patients with severe liver injury (organ injury scale score ≥ 4) treated between January 2011 and December 2020 were retrospectively reviewed. A trauma center was built in 2016 at our institution, and patients were dichotomized into two groups: before trauma center (BTC) and after trauma center (ATC) group. Treatment methods and outcomes were compared between the groups with 1:1 propensity score matching. We included 50 patients in the BTC group and 104 patients in the ATC group. Patients in the ATC group had frequent utilization of angiography (16% vs 47.1%, p < 0.001), faster transfusion [84 (37-152) min vs 17 (10-79) min, p < 0.001], and less fluid administration within 24h [8.3 (5.7-13.7) L vs 5.7 (3.1-10.1) L, p = 0.002]. However, mortality rate was not significantly different between the groups (26.0% vs 20.2%, p = 0.416). 1:1 propensity score matching was performed using the variables of age, injury severity score, systolic blood pressure, Glasgow Coma Scale, and initial base excess level. After matching, the mortality rate (26.0% vs 10.0%, p = 0.037) and ventilator application (74.0% vs 54.0%, p = 0.037) significantly improved. Severe liver injury management improved after trauma center implementation.

CT findings in renovascular injuries following abdominal trauma: a pictorial review.

Renal vascular injuries are more devastating than parenchymal injuries alone, thus account for higher injury grade and require prompt recognition. Revised AAST organ injury scale (OIS) for renal trauma has incorporated CT-diagnosed vascular injuries into renal injury grading which includes pseudoaneurysm and arteriovenous fistula, along with addition of some new descriptors of renovascular injury. Dual-phase contrast-enhanced CT (with both arterial and venous phase) can easily pick up renovascular injuries and is the modality of choice for imaging renovascular trauma. Radiologist should be well versed with the imaging findings of renovascular injuries so that accurate injury grading can be done and further management can be planned at the earliest.

ROLE OF COMPUTED TOMOGRAPHY IN EVALUATION OF BLUNT INJURY ABDOMEN

Objectives: The purpose of our study was to assess the role of multi slice computed tomography (CT) in the evaluation of patients with blunt injury abdomen and describe the frequency, type of injury to visceral organs and aid in accurate management of the patients. Subjects And Methods: The study included 31 patients suspected of blunt abdominal injury referred from emergency unit of PESIMSR, Kuppam. All the patients subjected to contrast enhanced multi slice (CT) in axial cuts and images are transferred to workstation then coronal and sagittal reconstruction obtained . Data included were age, sex, mode of injury and scan results. Organs injures were graded according to AAST organ injury scale guidelines. Results: There were 26 male and 6 female patients having blunt injury abdomen. Majority of the patients between the age group of 18 to 40. Most common mode of injury was road trafc accident (RT). Most commonly injured organ was spleen (18) followed by liver (17) followed by kidney injury (10). Hemoperitoneum is seen in most of the individuals (27). Pelvic bone fracture was seen in 6 patients,rib fracture seen in 5 patients and spinal fracture seen in 3 patients. Pancreatic body contusion was seen in one individual. Paralytic ileus and pneumoperitoneum seen in one each. Vascular injury was seen in 7 patients with IVC thrombus (1 patient) and portal vein thrombus (1 patient). Adrenal hematoma was seen in 4 patients. Conclusion: Contrast enhanced multi slice CT is a useful modality in identifying organ injury in blunt injury abdomen. Most commonly involved organ being spleen, liver and kidney. Majority of the trauma is due to RTA.

Organ Injury Scaling 2020 update: Bowel and mesentery.

The 1990 Small Bowel and Colon Organ Injury Scales (OIS) were revised to incorporate the imaging (CT), operative and pathologic findings to better describe the level of injury. The new revised OIS separates blunt bowel injuries from penetrating bowel injuries due to differences in imaging findings. A new OIS was created for bowel mesenteric injuries.

Resection versus drainage in the management of patients with AAST-OIS grade IV blunt pancreatic injury: A single trauma centre experience

IntroductionWe aimed to compare outcomes of pancreatic resection with that of peripancreatic drainage for American Association for the Surgery of Trauma–Organ Injury Scale (AAST-OIS) grade IV blunt pancreatic injury in order to determine the optimal treatment method. Materials and methodsNineteen surgical patients with AAST-OIS grade IV blunt pancreatic injury between 1994 and 2016 were retrospectively studied. ResultsAmong the 19 patients, 14 were men and 5 were women (median age: 33 years). Twelve patients underwent pancreatic resection (spleen-sacrificing distal pancreatectomy, n = 6; spleen-preserving distal pancreatectomy, n = 3; and central pancreatectomy with Roux-en-Y anastomosis, n = 3), and seven underwent peripancreatic drainage. After comparing these two groups, no significant differences were found in terms of gender, shock at triage, laboratory data, injury severity score, associated injury, length of hospital stay, and complication. The only significant difference was that in the drainage group, the duration from injury to surgery was longer than that from injury to resection (median, 48 hours vs. 24 hours; P = 0.036). In the drainage group, three patients required reoperation, and another three required further pancreatic duct stent therapy. ConclusionsIn the surgery of the grade IV blunt pancreatic injury, pancreatic resection is warranted in early, conclusive MPD injury; if surgery is delayed or MPD injury has not been clearly assessed, peripancreatic drainage is an alternative method. However, peripancreatic drainage alone is not adequate and further pancreatic duct stent or reoperation is required. Further studies should be conducted to confirm our conclusions.