Thoracoabdominal Trauma Research Articles

The role of repeated extended FAST in patients with stable blunt thoracoabdominal trauma.

Thoracic and abdominal computed tomography scans are widely used modalities for trauma patients in emergency department (ED). However, alternative diagnostic and follow-up tools are also needed, due to limitations such as high cost and exces-sive radiation exposure. This study aimed to investigate the utility of repeated extended focused abdominal sonography for trauma (rE-FAST) performed by the emergency physician in patients with stable blunt thoracoabdominal trauma. This was a prospective, single-center diagnostic accuracy study. Patients with blunt thoracoabdominal trauma admitted to the ED were included in the study. The E-FAST was performed on the patients included in the study at the 0th h, the 3rd h, and the 6th h during their follow-up. Then, the diagnostic accuracy metrics of E-FAST and rE-FAST were calculated. The sensitivity and specificity of E-FAST in determining thoracoabdominal pathologies were found to be 75% and 98.7%, respectively. The sensitivity and specificity for specific pathologies were 66.7% and 100% for pneumothorax, 66.7% and 98.8% for hemothorax, and 66.7% and 100% for hemoperitoneum, respectively. The sensitivity and specificity of rE-FAST in determining thoracal and/or abdominal hemorrhage in stable patients were found to be 100% and 98.7%, respectively. E-FAST successfully rules in thoracoabdominal pathologies in patients with blunt trauma, with its high specificity. However, only a rE-FAST might be sensitive enough to exclude traumatic pathologies in these stable patients.

Right Post-Traumatic Diaphragmatic Hernia with Liver Dislocation

Diaphragmatic hernia is a rare consequence of thoraco-abdominal trauma. It may be associated with high morbidity and mortality, particularly if surgical intervention is delayed. We report a case of a right diaphragmatic hernia in a 75-year-old woman. The patient was referred to our hospital with mild dyspnea. Chest radiograph showed an overtly elevated right hemi-diaphragm. Thoracic and abdominal computed tomographic scan was requested and showed a defect of the right diaphragmatic muscle wall with intrathoracic ascension of the liver. During the postoperative course, the patient was still on mechanical ventilation, hemodynamically unstable. She developped urinary peritonitis and an extensive bowel ischemia worsening. We report this case to show that the prognosis is related to associated injuries and possible complications. The possibility of a diaphragmatic rupture should be kept in mind and surgery is mandatory in order to avoid complications.

Right diaphragmatic rupture associated with aortic dissection after blunt thoracoabdominal trauma

Right diaphragmatic rupture associated with aortic dissection after blunt thoracoabdominal trauma

Diaphragmatic Injuries among Severely Injured Patients (ISS ≥ 16)-An Indicator of Injury Pattern and Severity of Abdominal Trauma.

Background and Objectives: Abdominal trauma among severely injured patients with an injury severity score (ISS) of 16 and above can lead to potentially life-threatening injuries that might need immediate surgical intervention. Traumatic injuries to the diaphragm (TID) are a challenging condition often accompanied by other injuries in the thoracoabdominal region. Materials and Methods: We retrospectively analyzed the occurrence and clinical course of TID among severely injured patients treated at our center between 2008 and 2019 and compared them to other groups of severely injured patients without TID. Results: Thirty-five patients with TID and a median ISS of 41 were treated in the period mentioned above. They were predominantly middle-aged men and mostly victims of blunt trauma as a consequence of motor vehicle accidents. A total of 70.6% had left-sided TID, and in 69.6%, the size of defect was larger than 10 cm. The diagnosis was made with computed tomography (CT) in 68.6% of the cases, while in 25.8%, it was made intraoperatively or delayed by a false-negative initial CT scan, and in 5.7%, an intraoperative diagnosis was made without preoperative CT imaging. Surgical repair was mostly conducted via laparotomy, performing a direct closure with continuous suture. A comparison to 191 patients that required laparotomy for abdominal injuries other than TID revealed significantly higher rates of concomitant injuries to several abdominal organs among patients suffering from TID. Compared to all other severely injured patients treated in the same period (n = 1377), patients suffering from TID had a significantly higher median ISS and a longer mean duration of hospital stay. Conclusions: Our findings show that TID can be seen as an indicator of particularly severe thoracoabdominal trauma that requires increased attention from the treatment team so as not to miss relevant concomitant injuries that require immediate intervention.

Association between Elevated De Ritis Ratio and Mortality Outcome in Adult Patients with Thoracoabdominal Trauma.

The De Ritis ratio is widely used to differentiate various causes of liver disease and serves as an independent prognostic predictor for different malignancies and non-malignant illnesses. This retrospective study aimed to identify the association between the De Ritis ratio on admission and mortality outcomes in adult thoracoabdominal trauma patients. A total of 2248 hospitalized adult trauma patients with thoracoabdominal injury, defined as an abbreviated injury scale (AIS) score ≥ 1 in the thoracic and abdominal regions, between 1 January 2009, and 31 December 2019, were included. They were categorized into three tertile groups according to the De Ritis ratio. A 1:1 propensity score-matched study group was established to attenuate the confounding effect of patient characteristics on the mortality outcome assessment. The AST levels of the tertile 1, 2, and 3 groups were 115.8 ± 174.9, 115.7 ± 262.0, and 140.5 ± 209.7 U/L, respectively. Patients in the tertile 3 group had a significantly higher level of AST than those in the tertile 1 group (p = 0.032). In addition, patients in the tertile 1 group had a significantly higher level of ALT than those in the tertile 2 and 3 groups (115.9 ± 158.1 U/L vs. 74.5 ± 107.0 U/L and 61.9 ± 86.0 U/L, p < 0.001). The increased De Ritis ratio in trauma patients with thoracoabdominal injuries was mainly attributed to elevated AST levels. The propensity score-matched patient cohorts revealed that the patients in the tertile 3 group presented a 3.89-fold higher risk of mortality than the patients in the tertile 2 group. In contrast, the patients in the tertile 1 group did not have a significantly different mortality rate than those in the tertile 2 group. This study suggests that a De Ritis ratio > 1.64 may be a useful biomarker to identify patients with a higher risk for mortality.

Preoperative CT Scanning in Hemodynamically Stable Thoracoabdominal Gunshot Wounds: Outcomes from a Long-Term Single-Institution Pilot Study

INTRODUCTION: Emergent operative exploration is the standard of care for penetrating thoracoabdominal trauma. With advanced CT imaging, preoperative scans may be obtained efficiently for operative planning. This study aims to determine if CT imaging before operative exploration for hemodynamically stable thoracoabdominal gunshot wound injuries adversely affects patient outcomes. METHODS: This was a retrospective chart review was performed between 2014 and 2019 at an urban trauma center to identify hemodynamically stable patients who suffered penetrating thoracoabdominal gunshot wound and had operative intervention. Patients were then stratified into 2 groups: (1) those who received CT imaging before operative intervention, and (2) those who went straight to the operating room (OR). RESULTS: A total of 113 patients were identified. A total of 64 (56.6%) received CT imaging, and 49 (43.4%) went straight to the OR (Table). There were no differences in mortality (p = 0.25), hospital length of stay (p = 0.17), ICU length of stay (p = 0.14), ventilator days (p = 0.37), and postoperative complications (p > 0.05). Time spent in the OR and time from emergency department to end of operation were similar between groups (p = 0.051). Multivariable analysis demonstrated risk factors for time greater than 150 minutes includes Injury Severity Score, age, sex, and blood product administration. Multivariate regression displayed that for each unit of PRBC given, OR time were more likely to increase (p < 0.001). Table. - Patient Demographics and Outcome Data Demographics Overall Sample (N = 113) Group A: CT Scan before Going to the Operating Room (N = 64) Group B: Straight to the Operating Room (N = 49) p Value Age, y, mean (SD) 25.57 (7.60) 24.30 (6.74) 27.22 (8.38) 0.042 Race, % (White, Black, other, unknown) 8.0, 86.7, 1.8, 3.5 3.1, 92.2, 1.6, 3.1 14.3, 79.6, 2.0, 4.1 0.175 Sex, % (male, female) 92, 8 90.6, 9.4 93.9, 6.1 0.530 Injury Severity Score, mean (SD) 16.95 (9.42) 16.34 (8.76) 17.73 (10.26) 0.220 Hospital days, mean (SD) 11.06 (8.12) 10.42 (7.87) 11.90 (8.44) 0.142 Ventilator days, mean (SD) 2.07 (4.15) 1.95 (4.65) 2.22 (3.43) 0.370 MTP activation, n (%) 31.9% 17.2% 51% <0.0001 Total number of blood products, mean (SD) 4.00 (6.24) 2.09 (3.26) 6.49 (8.11) <0.0001 Mortality, n (%) 0.9% 0% 2.0% 0.251 CONCLUSION: Obtaining a CT scan before operative intervention in hemodynamically stable patients with thoracoabdominal gunshot wound did not affect mortality, hospital length of stay, or ventilator days, indicating that obtaining CT scans before operative intervention may be safe in select patients. This pilot serves as the basis for an ongoing regional multi-institutional study.

P-129 TRAUMATIC HERNIA, URGENT REPAIR?

Abstract Aim We present our clinical experience in the urgent repair of traumatic hernias through two clinical cases. Material and Methods Case 1: A 45-year-old man suffering thoraco-abdominal trauma due to running over. Thoracoabdominal CT scan and surgical examination shows a meso tear of terminal ileum and traumatic section of the right lateral musculature. Case 2: A 19-year-old man suffering abdominal trauma due to a traffic accident. CT abdomen is performed which reports large traumatic hernia of the left anterior abdominal wall including intestinal loops, with pneumo and retroneumoperitoneum. Results Case 1: We close the mesenteric gap and repair musculature by associating a polypropylene mesh in the preperitoneal space. The patient is discharged after 13 days. During the two-year follow-up, no hernia recurrence was detected. Case 2: A reconstruction of the wall is performed associating posterior separation of left components, in addition to ileocecal and sigma resection with anastomosis. As a complication presents seroma and chronic sinus, without hernia recurrence during follow-up for 5 years. Conclusions The tendency in traumatic hernias is their repair in a second time attending first to injuries that compromise the survival of the patient, but larger defect can lead to irreversible sequelae since enlargement of hernia, atrophy and muscle retraction, resulting in a more complex repair. If the patient requires urgent surgical intervention for visceral injury, some authors defend the simultaneous repair of the hernia in stable patients. Our group thinks that patients requires individualized management and its urgent repair will depend on the clinical situation.

A rare case report of perforated viscerothorax in a traumatic diaphragmatic rupture

IntroductionDiaphragmatic injuries are a consequence of penetrating or blunt thoracoabdominal trauma. Minor injuries are often masked. However, they are easily picked in the presence of diaphragmatic herniations. Delayed presentation is associated with the influx of visceral contents into the thoracic cavity, which may cause strangulation and obstruction. Viscerothorax is a rare complication of diaphragmatic injuries.Presentation of caseA case report of a 25-year-old male patient with a history of penetrating chest injury. He presented to our setting with a sharp abdominal pain and episodes of vomiting that were later accompanied by chest pains and difficulty breathing. A CT scan revealed the presence of a left hemidiaphragmatic injury with a viscerothorax and mediastinal shift to the right side. Surgery was immediately done and with a good postoperative outcome.DiscussionDiaphragmatic injuries are still uncommon and are often overlooked in initial presentations. The presence of herniation through the defect prompts early diagnosis. Delayed presentations of these injuries are often affiliated with herniations that may be strangulating or obstructing with more severe complications such as viscerothorax causing tension into the thoracic cavity.ConclusionThe approach to diaphragmatic injuries at their initial presentation must be handled with an excellent index of suspicion in the evaluation of trauma victims to reduce management delay and avoid detrimental complications in contrast to the involvement of other associated injuries such as haemothorax, rib fractures, and visceral injuries. Early defect diagnosis followed by definitive surgical repair is the most favoured approach.

Factors Associated with Traumatic Diaphragmatic Rupture among Patients with Chest or Abdominal Injury: A Nationwide Study from Japan.

Background: Blunt traumatic diaphragmatic rupture (TDR) is a rare condition that is seen in patients with blunt thoracoabdominal trauma. However, factors that are associated with blunt TDR have not been fully revealed. The purpose of this study was to evaluate the factors that are associated with blunt TDR in trauma patients with a chest or abdominal injury using nationwide trauma registry data in Japan. Method: This study was a retrospective observational study with a 15-year study period from 2004 to 2018. We included trauma patients with a chest or abdominal Abbreviated Injury Score of two or more. We evaluated the relationship between confounding factors such as mechanism of injury and blunt TDR with multivariable logistic regression analysis. Results: This study included 65,110 patients, of whom 496 patients (0.8%) suffered blunt TDR. Factors that were associated with blunt TDR were disturbance of consciousness (adjusted OR [AOR]: 1.639, 95% CI: 1.326–2.026), FAST positive (AOR: 2.120, 95% CI: 1.751–2.567), front seat passenger (AOR: 1.748, 95% CI: 1.129–2.706), and compression injury by heavy object (AOR: 1.677, 95% CI: 1.017–2.765). Conclusion: This study revealed several factors that are associated with blunt TDR. The results of this study may be useful for clinicians when estimating blunt TDR.

Chylous ascites and pancreatic pseudocyst on a child following blunt abdominal trauma; a case report.

IntroductionChylous ascites is the collection of milky-like fluid rich in triglycerides within the peritoneal cavity. It results from disruption of normal intestinal lymphatic flow. It is caused mainly by congenital anomalies, trauma, and malignancy. Chylous ascites following blunt abdominal injury is uncommon in pediatrics. Chyle duct and pancreatic injuries present a rare clinical sequela yet to be reported in the literature. Conservative management is the mainstay of treating chyle duct injuries, reserving invasive measures for unique circumstances.Case presentationA case of an eleven-year-old female who suffered blunt thoracoabdominal trauma and sustained injuries to the chest, pancreas, and chyle duct. She had clinical signs of peritonism and decreased air entry on the right hemithorax. While she underwent abdominal exploration, the chylous ascites eventually resolved on conservative management, and the pancreatic pseudocyst was later drained percutaneously.DiscussionChylous ascites and pancreatic pseudocyst is uncommon in pediatrics. While surgery is indicated in selected cases, a conservative approach is advocated in managing lymphatic leaks. Diet with low triglycerides and high protein is advocated to decrease lymph production. Treatment of pancreatic pseudocyst varies from conservative (watchful waiting) to drainage measures.ConclusionAlthough chylous ascites is not expected following trauma, has to be considered among differential free peritoneal fluid. Pancreatic injuries are common but difficult to diagnose. CT and MRCP are preferred modalities for diagnosing pancreatic injuries. While dietary modification and drainage of the chylous ascites were the mainstays in managing chyle duct injury, pancreatic pseudocyst resolved after percutaneous drainage.

Pattern and In-Hospital Mortality of Thoracoabdominal Injuries Associated with Motor Vehicle Accident-Related Head Injury: a Single-Center Retrospective Study.

Aim To determine the pattern and in-hospital mortality of thoracoabdominal injuries associated with head injuries (HI) due to motor vehicle accidents. Settings and Design. A single-center retrospective study in a tertiary care hospital, level 1 trauma center in the southern region of Saudi Arabia. Methods and Materials Descriptive analysis was conducted to evaluate sex, age, types of head injury, associated thoracoabdominal injuries, particular admission day, duration of hospital stay, and discharge category, and associations between different variables and outcomes were analyzed. Results The cohort had a mean age of 26.9 ± 15.8 years, with a predominance of men (86.9%). Thoracoabdominal injuries were present in 6.8% of MVA-related HI, and 14.3% of victims expired during their hospital stay, mostly within the first 10 days. All expired patients had posttraumatic brain lesions. Moreover, there was a significant association between intensive care unit (ICU) admission and poor prognosis. Conclusions Existence of posttraumatic brain lesions and requirement of ICU admission are significant variables affecting outcomes in patients with motor vehicle-associated HI with concomitant thoracoabdominal trauma in this study. Patients who survived the first 10 days after trauma seemed to have a better prognosis. More efforts are needed to reduce the health burden of this lethal injury.

Diagnostic Accuracy of Extended Focused Assessment with Sonography For Trauma (E-FAST) Keeping Contrast Enhanced CT Chest And Abdomen As Gold Standard

Objective: To determine the diagnostic accuracy of extended focused assessment with sonography for trauma (E-FAST) for detecting thoraco-abdominal trauma, keeping contrast-enhanced CT chest and abdomen as the gold standard.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Department of Radiology, Combined Military Hospital, Quetta, from Jan 2020 to Aug 2021.&#x0D; Methodology: A total of (n=196) patients, of age 18-60 years, of both genders, who sustained thoraco-abdominal injuries and were referred for contrast-enhanced Computed tomography of the chest and abdomen were enrolled in the study. Patients were subjected to the thorax and abdomen ultrasonographic examination first and then underwent a contrast-enhanced CT scan of the thorax and abdomen. The findings of both modalities were recorded and subjected to statistical analysis to confirm the accuracy of ultrasound, considering CT-scan as a gold standard procedure.&#x0D; Results: The mean age of the patients was 35 10.6. There were 164 (83.7%) males and 32 (16.3%) females. Blunt trauma was seen in 131 (66.8%) and penetrating trauma in 65 (32.2%) patients. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of E-FAST for chest trauma was 79.4%, 94.7%, 87.6%, 90.7% and 89.8% respectively, for abdominal trauma was 68.6%, 95.2%, 88.8%, 84.5% and 85.7% respectively and for combined chest and abdominal trauma was 77.1%, 95.9%, 85.9%, 92.8% and 91.3% respectively.&#x0D; Conclusion: E-FAST has good diagnostic accuracy for the chest, abdominal and both thoraco-abdominal trauma and can be incorporated into the routine assessment of patients presenting with trauma.

Nature and structure of thoracoabdominal injuries

This article presents the incidence, nature and structure of thoracoabdominal injuries in two major districts of the Andijan region. The results of diagnostics, tactics of treatment, and also an estimation of severity of a condition of patients with thoracoabdominal traumas are resulted. An analysis of mortality is presented.

Pediatric Blast Trauma: A Systematic Review and Meta-Analysis of Factors Associated with Mortality and Description of Injury Profiles.

Blast polytrauma is among the most serious mechanisms of injury confronted by medical providers. There are currently no specific studies or guidelines that define risk factors for mortality in the context of pediatric blast injuries or describe pediatric blast injury profiles. The objectives of this study were to evaluate risk factors for pediatric mortality and to describe differences in injury profiles between explosions related to terrorism versus unrelated to terrorism within the pediatric population. A PRISMA systematic review and meta-analysis was performed where articles published from the years 2000-2021 were extracted from PubMed. Mortality and injury profile data were extracted from articles that met inclusion criteria. A bivariant unadjusted odds ratio (OR) analysis was performed to establish protective and harmful factors associated with mortality and to describe the injury profiles of blasts related to terrorism. Statistical significance was established at P < .05. Thirty-eight articles were included and described a total of 222,638 unique injuries. Factors associated with increased mortality included if the explosion was related to terrorism (OR = 32.73; 95% CI, 28.80-37.21; P < .05) and if the explosion involved high-grade explosives utilized in the Global War on Terror ([GWOT] OR = 1.28; 95% CI, 1.04-1.44; P < .05). Factors associated with decreased mortality included if the patient was resuscitated in a North Atlantic Treaty Organization (NATO)-affiliated combat trauma hospital (OR = 0.48; 95% CI, 0.37-0.62; P < .05); if the explosive was fireworks (OR = 3.20×10-5; 95% CI, 2.00×10-6-5.16×10-4; P < .05); and if the explosion occurred in the United States (OR = 2.40×10-5; 95% CI, 1.51×10-6-3.87×10-4; P < .05). On average, victims of explosions related to terrorism were 10.30 years old (SD = 2.73) with 68.96% (SD = 17.58%) of victims reported as male. Comparison of victims of explosions related to terrorism revealed a higher incidence of thoracoabdominal trauma (30.2% versus 8.6%), similar incidence of craniocerebral trauma (39.5% versus 43.1%), and lower incidence of extremity trauma (31.8% versus 48.3%) compared to victims of explosions unrelated to terrorism. Explosions related to terrorism are associated with increased mortality and unique injury profiles compared to explosions unrelated to terrorism in the pediatric population. Such findings are important for optimizing disaster medical education of pediatric providers in preparation for and management of acute sequelae of blast injuries-terror-related and otherwise.

Prevalence of thoracic and abdominal injuries in patients with penetrating thoracoabdominal trauma

Establecer la prevalencia de lesiones diafragmáticas, torácicas y abdominales asociadas con traumatismos toracoabdominales penetrantes. Método: En un período de 12 meses se recopilaron los pacientes que ingresaron a un hospital de tercer nivel de complejidad con traumatismo toracoabdominal penetrante y que requirieron manejo quirúrgico. Se realizó un análisis descriptivo de los hallazgos empleando medidas de tendencia central y dispersión para las variables cuantitativas y proporciones con intervalos de confianza para las variables cualitativas. Se incluyeron 112 pacientes, de los cuales el 91.3% ingresó con heridas por arma blanca, el 60% de las heridas se encontraban del lado izquierdo y en el 66% de los casos debajo del octavo espacio intercostal. El 34% de los pacientes presentaban algún tipo de lesión orgánica y el 27,6% lesión diafragmática. El órgano intraabdominal con más frecuencia lesionado fue el hígado (9,8%), seguido del bazo (6,25%) y el colon (6,25%). Discusión y conclusiones: La zona toracoabdominal más a menudo afectada fue la posterior izquierda, pero la de mayor prevalencia de lesión diafragmática fue la anterior izquierda, siendo el riesgo de lesión diafragmática en esta zona 10 veces mayor en comparación con la zona posterior derecha y casi el doble con respecto a la región posterior izquierda; no se encontró diferencia estadísticamente significativa al compararlo con la región anterior derecha. Las lesiones de víscera sólida son las más frecuentes en la cavidad abdominal.

Delayed renal and liver laceration in patient with low velocity fall in setting of anticoagulation and renal mass: A case report

In this case report, we present a patient with a low velocity fall resulting in thoracoabdominal blunt trauma made occult by the absence of reported history or external physical signs and symptoms. Delayed grade 3 renal laceration and concomitant grade 2 hepatic laceration was the result in this patient that was being treated for septicemia in the setting of urinary tract infection, aspiration pneumonia, and anticoagulation for new-onset atrial fibrillation. This mismatch in initial presentation and severity of the delayed hemorrhagic process of multiple visceral organs after low-velocity blunt injury appears to be rare or significantly underreported. The acute decompensation and insidious course seen in this case highlights the importance of considering a more global assessment of hemorrhagic risk factors, rather than history, hematuria, and initial hemodynamic parameters alone.

Laparoscopic repair of acute traumatic diaphragmatic hernia with mesh reinforcement: A case report.

Introduction and importanceTraumatic diaphragmatic injuries are rare and usually occur after thoracoabdominal trauma. Most patients will have other potentially life-threatening injuries. High index of suspicion is the most important attribute. Unfortunately, it is incorrectly diagnosed in up to 33% of cases. If left untreated, the onset of complications carries mortality rates between 25 and 80%.Case presentationWe report a case of an acute diaphragmatic laceration in a 29-year-old male with thoracoabdominal trauma due to a road traffic accident. Physical examination revealed an absence of normal breath sounds in the left hemithorax. CT-scan confirmed a voluminous left diaphragmatic hernia with omental, gastric, and transverse colon content, so surgical intervention was advised. During laparoscopy, a 15 cm long and 5 cm wide diaphragmatic defect was identified. The hernia was reduced laparoscopically, and the defect repaired with interrupted non-absorbable sutures. As a reinforcement, a visceral contact prosthesis was placed. The patient had an uneventful recovery and after 12-month follow-up he has no evidence of recurrence.Clinical discussionDiaphragmatic injuries do not close spontaneously. An abdominal approach is recommended as it allows for evaluation of the entire abdomen and treatment of any associated injury. Watertight closure with nonabsorbable suture and in case of large defects, the placement of a mesh on the peritoneal side of the diaphragm is recommended to reinforce the primary repair.ConclusionLaparoscopic emergency surgery has proved to be effective and safe in selected patients with hemodynamic stability. Patients can expect the benefits of minimal invasive surgery with recurrence rate like the open approach.

Posttraumatic Adrenal Hematoma a Case Report and Literature Review

Post-traumatic adrenal hematoma is a difficult to diagnose condition with rare but severe complications. Post-traumatic adrenal hematoma occurs in up to 2% of patients with abdominal trauma. Only CT scans performed during lesion assessments of violent thoracoabdominal trauma can confirm the diagnosis. Symptomatology is often masked by associated visceral or parietal injuries. Standard biological examinations are generally of little help. We describe a case of a 12-year-old child who presented with a right adrenal hematoma after a road traffic accident (MVA), associated with a peritoneal effusion and a fracture of the right sacral fin as well as a fracture of the right pubic ischium.

Diagnostic methods and surgical treatment of patients with thoracoabdominal traumas (review of the literature).

Thoracoabdominal traumatism is a topical problem of modern medicine due to its wide prevalence, severe course and unfavorable outcome. This article presents an overview of the epidemiology, diagnosis, and surgical treatment of patients with thoracoabdominal injuries. It showed that the current incidence of thoracoabdominal injuries reaches 13.7-16.4% of all chest and abdominal injuries. Lethality in thoracoabdominal injuries ranges from 3.13% to 20%. In most cases these are patients of working age, with an average age of 27.5-34.8 years, men comprising 71.2%. Nowadays, the number of patients with thoracoabdominal injuries tends to increase in Uzbekistan and other economically developing countries of the world because of increasing transportation, construction and crime. Video-thoracoscopy and video-laparoscopy are among the widespread methods of diagnosis and treatment of thoracoabdominal traumas. According to many authors, the specificity of video-laparoscopy and video-thoracoscopy is 100%, and the sensitivity is 87.5-99.3%.

Role of glucose/potassium ratio and shock index in predicting mortality in patients with isolated thoracoabdominal blunt trauma.

The aim of this study, investigate the prognostic value of shock index (SI), which has been accepted for a long time, and glucose-potassium ratio (GPR), which has limited data in patients with trauma and those with isolated blunt thoracoabdominal trauma. This retrospective observational study was conducted at the tertiary reference hospital. Consecutive patients aged 18 years and older treated for blunt thoracoabdominal trauma in the emergency department between August 2020 and February 2022 were included in the study. The ability of GPRs obtained from arterial blood gases and SI levels on admission to predict mortality and indication for surgery was evaluated by calculating areas under receiver operating characteristic curves Area under the curve (AUCs). A total of 102 patients, of which 91 in the survivor group and 11 in the non-survivor group, were analyzed. The AUCs for estimating mortality with GPR and SI were 0.854 (95% confidence interval [CI], 0.742-0.967) and 0.809 (95%, 0.666-0.952), respectively. The AUCs of GPR and SI to estimate the indication for surgery were 0.761 (95% CI, 0.657-0.864) and 0.582 (95% CI, 0.416-0.747), respectively. This study reported the efficacy of SI and GPR in predicting surgical indication and mortality in patients with isolated blunt thoracoabdominal trauma and the superior predictive role of GPR over SI.