Traumatic Hematoma Research Articles

169 Point-of-Care Ultrasound Diagnosis of Retrobulbar Hematoma in Cadaveric Models

Traumatic retrobulbar hematoma is an emergent condition which requires rapid diagnosis and immediate decompression to prevent vision loss. Ultrasound has been used in animal models, and numerous case reports have highlighted its use in the emergency medicine patient population. The objective of this study is to assess the ability of emergency medicine providers to diagnosis retrobulbar hematomas using point-of-care ultrasound. 20 cadaveric eyeballs were randomly selected to simulate a retrobulbar hematoma. 2-3cc of normal saline solution was injected through the medial aspect of the orbit directly into the retrobulbar space. Thirteen emergency medicine residents (each with <15 prior ocular scans), 1 Emergency Ultrasound fellow (>25 prior ocular scans) and 1 Emergency Ultrasound faculty (>25 prior ocular scans) participated in the study. The 4-12 MHz linear transducer on the GE logiq E was utilized. 4 of the 20 eyeballs had a retrobulbar hematoma. Point-of-care ultrasound had a sensitivity of 85% (95% CI 72.9 - 92.4), specificity of 89.1% (95% CI 84.3 - 92.6), positive predictive value of 66% (95% CI 54.4 - 76.3), and a negative predictive value of 95.9% (95% CI 92.2 - 98.0). Overall accuracy was 88.3%. The positive LR was 7.8 with a negative LR of 0.16. The Fisher's exact method calculated a 2-tailed P value of <0.0001. The average kappa measurement was 0.67 (95% 0.57 - 0.77). Individuals with >10 prior ocular scans had a sensitivity of 95% (95% CI 73.0 - 99.7). Emergency Ultrasound fellowship trained faculty had a sensitivity of 100%. Point-of-care ultrasound is a rapid, accurate imaging modality to diagnose retrobulbar hematomas. With additional ocular ultrasound experience, accuracy improves to near 100%.

Repeat Head CT for Expectant Management of Traumatic Epidural Hematoma.

Guidelines regarding the role of repeated head computed tomography (CT) imaging in the nonoperative management of traumatic epidural hematomas (EDHs) do not exist. Consequently, some children may be exposed to unnecessary additional ionizing radiation. We describe the frequency, timing, and utility of reimaging of EDHs to identify patients who might avoid reimaging. A retrospective cohort study of subjects aged 0 to 18 years with a traumatic EDH treated at a level I pediatric trauma center from 2003 to 2014. Radiographic and clinical findings, the frequency and timing of reimaging, and changes in neurologic status were compared between subjects whose management changed because of a meaningful CT scan and those whose did not. Of the 184 subjects who were analyzed, 19 (10%) had a meaningful CT. There was no difference in the frequency of CT scans between the meaningful CT scan and no meaningful CT groups (median 1 [interquartile range 1-2] in no meaningful CT and median 1 [interquartile range 1-2] in meaningful CT scans; P = .7). Only 7% of repeated CTs changed management. Neurologic status immediately before the repeat scan (odds ratio 45; 95% confidence interval 10-200) and mass effect on the initial CT (odds ratio 4; 95% confidence interval 1.5-13) were associated with a meaningful CT. Reimaging only subjects with concerning pre-CT neurologic findings or mass effect on initial CT would have decreased imaging by 54%. Reimaging is common, but rarely changes management. Limiting reimaging to patients with concerning neurologic findings or mass effect on initial evaluation could reduce imaging by >50%.

Influence of Admission Blood Glucose in Predicting Outcome in Patients With Spontaneous Intracerebral Hematoma.

Background and Aims: Hyperglycemia or elevated blood glucose levels have been associated with poor outcomes in patients with ischemic stroke yet control of hyperglycemia has not resulted in good outcomes. High admission blood glucose (ABG) values have been mitigated by other poor prognosticators like large hematoma volume, intraventricular extension (IVE) of hematoma and poor GCS. The aim of this study was to evaluate the effects of blood glucose levels at admission, on mortality and functional outcomes at discharge and 3 months follow up.Methods: This was a retrospective observational study conducted at a tertiary care. Patients with spontaneous SICH were enrolled from a prospective SICH register maintained at our hospital. Blood glucose values were recorded on admission. Patients with traumatic hematomas, vascular malformations, aneurysms, and coagulation abnormalities were excluded from our study.Results: A total of 510 patients were included in the study. We dichotomised our cohort into two groups, group A with ABG>160 mg/dl and group B with ABG<160 mg/dl. Mean blood glucose levels in these two groups were 220.73 mg/dl and 124.37 mg/dl respectively, with group A having twice the mortality. mRS at discharge and 3 months was better in Group B (p ≤ 0.001) as compared to Group A. Age, GCS, volume of hematoma, ABG, IVE and Hydrocephalus were significant predictors of mortality and poor outcome on univariate analysis with a p < 0.05. The relationship between ABG and mortality (P = 0.249, 95% CI 0.948–1.006) and outcome (P = 0.538, 95% CI 0.997–1.005) failed to reach statistical significance on multivariate logistic regression. Age, Volume of hematoma and GCS were stronger predictors of mortality and morbidity.Conclusion: Admission blood glucose levels was not an independent predictor of mortality in our study when adjusted with age, GCS, and hematoma volume. The effect of high ABG on SICH outcome is probably multifactorial and warrants further research.

Hematoma Intracerebelar Traumático

O hematoma intracerebelar traumático é considerado uma lesão rara. Encontra-se associado com lesão direta na região occipital ou por mecanismo de contragolpe. Tomografia computadorizada (TC) tem sido o exame de escolha no diagnóstico e conduta. Geralmente cursa com péssimo prognóstico. Os autores apresentam um caso de hemorragia intracerebelar traumática e faz uma revisão da literatura.

Delayed presenting traumatic Extradural Haematoma- whether surgery always necessary? – An experience in a tertiary care hospital.

Background: Extradural haematoma (EDH), considered being the most serious preventable complication of head injury, requiring immediate diagnosis and surgical intervention. Though surgical evacuation constitutes the definitive treatment of this condition but many patients who presented late to emergency can be saved from craniotomy with watchful repeated neurological assessments.Aims and Objectives: To evaluate the role of surgical and non surgical management of delayed presenting traumatic EDH at a tertiary care Hospital.Materials and Methods: This study was conducted from December 2015 to February 2017 at Nil Ratan Sircar medical College, Kolkata. A total 100 cases of traumatic Extradural Haematoma were admitted with history of prior head injury of greater than 8 hours duration. All the patients were assessed clinically on admission and by NECT brain either prior to or immediately after admission. All patients with traumatic EDH were evaluated by dedicated trauma team and by Neurosurgeons, patients who came to hospital facility with more than 8 hours history of incident with haematoma &lt;30 cm3, no associated midline shift and no signs of focal neurodeficits or papillary asymmetry with GCS 13-15, were initially managed conservatively, those who failed any of the chosen criteria treated by operative interventions.Results: Of all patients more 50% cases were associated with vehicular accident. Eighty percent cases were referred from primary or secondary care level hospitals and the remaining directly from accident site or scene of injury. Fifteen patients had post injury seizures, most of the cases were associated with additional intradural lesions like contusions or intracerebral haematoma. Approximately one forth patients presented with GCS &gt;13, all these patients experiences positive outcomes. In this series of EDH location was temporoparietal region constitute 45% of the total, in 36 % of cases there were associated skull fracture. 55% of the patients in this series underwent operative intervention and 45% treated non operatively. Overall, 78% patients had good recovery, whereas 12% patients remained moderate to severe disabled at 6 weeks follow up period.Conclusion: Although surgical management is the treatment of choice in EDH, in selected delayed presenting EDH patients can be managed non-operatively with good outcome.Asian Journal of Medical Sciences Vol.9(4) 2018 41-45

Liquid Posterior Fossa Epidural Hematoma in Pediatric Trauma: A Single-Center Case Series.

Liquid posterior fossa epidural hematoma (LPFEH) following head trauma is uncommon, and very few such cases have been described in the literature. Eight patients with this entity and their treatments are presented here. We performed a single-institution retrospective analysis of all patients with diagnosed LPFEH over a 3-year period. Collected data included clinical history, laboratory results, treatment, and review of all imaging studies performed. Eight pediatric cases were identified with imaging findings consistent with LPFEH; no adult case was identified. Enlargement of ventricles appeared on computed tomography (CT) in six cases, and secondary epilepsy onset occurred in three cases with severe dilated ventricles. Routine hematologic and coagulation tests failed to disclose anemia or abnormal coagulation in each case. Five patients underwent burr-hole drainage of the hematoma and recovered completely. Conservative therapy was adopted in three patients for small hematomas, and hematoma enlargement was not observed in the follow-up CT scans. LPFEH is a rare subtype of traumatic epidural hematoma specifically recognized in the pediatric population. Minimally invasive burr-hole drainage is a feasible procedure for the patient with evident space-occupying effect. Coagulation dysfunction or low hemoglobin as a possible contributing factor and its role in formation of LPFEH was excluded.

Endoscopically assisted supratentorial evacuation of infratentorial epidural hematomas crossing the transverse sinus

Abstract Objective Traumatic posterior fossa extradural hematoma (TPFEDH) is a serious complication of cranial injury and the orthodox technique for removal of TPFEDH encompasses a suboccipital craniectomy or craniotomy. However, in some cases, the TPFEDH might extend to the supratentorial space, thus appearing to be crossing the transverse sinus. Contrary to the standard way, a modified supratentorial transoccipital approach may be better suitable in the management of this subtype of TPFEDH. Methods The clinical data of 34 consecutive patients in which the TPFEDH was crossing the transverse sinus were prospectively assessed. We operated all the parents using the supratentorial transoccipital approach via supratentorial liner incision. The supratentorial extradural hematoma (EDH) was evacuated and the endoscope was used to fully evacuate the infratentorial compartment. Glasgow Coma Scale at discharge (dGCS) was documented and Glasgow Outcome Scale score (GOS) was measured at 3–15 months (mean = 5.4 months) follow-up subsequently. Results The average operation time was 44 min (30–60 min). The blood loss was so minimal that the intraoperative blood transfusion was unnecessary for all the patients. Complete hematoma removal was achieved on all the patients. The average dGCS and GOS were 14 and 4.9 respectively. One case suffered from primary brain stem injury whose GOS scored only 3 on follow up. There was no surgery related mortality at discharge and during the follow-up. Conclusion This is the first case series to demonstrate the removal of TPFEDH crossing the transverse sinus via the modified supratentorial transoccipital craniotomy. This approach was proven to be more effective in managing such cases.

A Rare Case of Lumbar Traumatic Intradiscal Hematoma Followed by Repeatative Occupation Related Minor Trauma

A Rare Case of Lumbar Traumatic Intradiscal Hematoma Followed by Repeatative Occupation Related Minor Trauma

Traumatic spinal epidural hematoma: an alarming and diagnostic challenge in the ED

Traumatic spinal epidural hematoma (TSEH) is a neurosurgical emergency which is considered as one of the rare causes of back pain. The onset of symptoms presentation can vary especially following a trauma. Here, we report a case where a young girl had a trivial fall and presented symptoms of back pain three days later. She developed abrupt onset of lower limb weakness during her stay in the emergency department (ED). X-ray and computed tomography (CT) imaging of the spine did not show any obvious abnormality whereas, Magnetic resonance imaging (MRI) imaging revealed hyper-intense lesions in the thoracic spinal segment which led to the diagnosis of TSEH. Our case highlights the importance of the atypical and varied nature of presentation and the choice of investigation which would help in the early diagnosis of this entity. Keywords: Traumatic spinal epidural hematoma, Back pain, Paraperesis, Emergency department

Delayed Posterior Urethroplasty Following Pelvic Fracture Urethral Injury: Do We Have to Wait 3 Months?

To compare outcomes with early vs delayed reconstruction following pelvic fracture urethral injury (PFUI) to determine if a traditional 3-month delay is necessary. This delay has been advocated to allow resolution of traumatic inflammation and hematoma but has never been validated. We proceed to reconstruction at 3-6 weeks if the associated injuries are stable, the perineum is soft on rectal palpation, and the fracture is stable for lithotomy positioning. PFUI patients treated with a suprapubic tube and delayed urethroplasty from October 1991 to August 2016 were included. Patients with initial catheter realignment were excluded. We compared reconstruction failure, incontinence, and erectile dysfunction rates in patients reconstructed within 6 weeks after injury with those reconstructed after the traditional ≥12 weeks. Thirty-nine patients were identified with a median age of 32 years (17 to 69). Overall, the median urethral gap was 2 cm (1-4.5) and median follow-up was 64 months (12-277). Stricture failure occurrence was 5.1%, incontinence rate was 7.7%, and erectile dysfunction rate was 56.4%. The 22 patients with urethroplasty ≤6 weeks post-injury were no more likely to experience erectile dysfunction (13 vs 9, P = .70), urinary incontinence (1 vs 2, P = .40) or reconstruction failure (2 vs 0, P = .20) than the 17 patients delayed ≥12 weeks. We report similar outcomes following urethral reconstruction for PFUI patients repaired ≤6 weeks after injury compared with those delayed ≥12 weeks. This suggests that in selected cases reconstruction at 3-6 weeks is feasible, minimizing the morbidity of a suprapubic tube.

Qualitative and quantitative analysis of furofuran lignans, iridoid glycosides, and phenolic acids in Radix Dipsaci by UHPLC-Q-TOF/MS and UHPLC-PDA

Radix Dipsaci (RD), the dried root of Dipsacus asper, is used in traditional Chinese medicine as a remedy for bone fractures, traumatic hematoma, threatened abortion, and uterine bleeding. A novel ultra high-performance liquid chromatography coupled with quadrupole-time-of-flight tanderm mass spectrometry (UHPLC-Q-TOF/MS) approach was performed to rapidly characterize the chemical constituents of RD. Consequently, 21 compounds, including 12 iridoid glycosides (IGs), 4 furofuran lignans (FLs), and 5 phenolic acids (PAs) were discovered and identified from RD. Among these compounds, 3 IGs were previously unreported. Furthermore, a rapid and reliable UHPLC-DAD-based method was developed. The linearity (R2 > 0.999), repeatability (RSDs < 3.0%), intra-day and inter-day precision (RSDs < 1.6%), recovery (98.9%–102.5%), limits of detection (0.2–2.75 ng), and limits of quantification (0.75–8.5 ng) of the method was validated. The method was successfully applied for the simultaneous determination of 11 compounds in 20 batches of RD collected from various geographical regions in China. Different RD samples exhibited significantly varied contents of 11 analytes, among which IGs and PAs are abundant compounds that could be used as suitable quality markers for RD. The present study provided a useful approach for comprehensively evaluating the chemical composition and quality of RD.

Incidence, hospital costs and in-hospital mortality rates of surgically treated patients with traumatic cranial epidural hematoma

Abstract Background: In this study, the patients who were operated in two clinics due to traumatic cranial epidural hematoma (EDH) were assessed retrospectively and the factors that increase the costs were tried to be revealed through conducting cost analyses. Methods: The patients who were operated between 2010 and 2016 with the diagnosis of EDH were assessed in terms of age, sex, trauma etiology, Glasgow coma scale (GCS) at admission, the period from trauma to hospital arrival, trauma-related injury in other organs, the localization of hematoma, the size of hematoma, length of stay in the intensive care unit (ICU), length of antibiotherapy administration, number of consultations conducted, total cost of in-hospital treatments of the patients and prognosis. Results: Distribution of GCS were, between 13-15 in 18 (36%) patients, 9-13 in 23 (46%) patients and 3-8 in 9 (18%) patients. The reasons for emergency department admissions were fall from high in 29 (58%) patients, assault in 11 (22%) patients and motor vehicle accident in 10 (20%) patients. The average cost per ICU stay was 2838 $ (range=343-20571 $). The average cost per surgical treatment was 314 $. ICU care was approximately 9 times more expensive than surgical treatment costs. The mortality rate of the study cohort was 14% (7 patients). Conclusion: The prolonged period of stay in the ICU, antibiotherapy and repeat head CTs increase the costs for patients who are surgically treated for EDH.

Hematoma extradural intracraniano

O hematoma extradural representa 1% a 5,5% das lesões intracranianas em pacientes com trauma cranioencefálico. Os objetivos desta pesquisa foram estudar descritivamente 162 casos de hematoma extradural e analisar o volume do hematoma em relação à sua localização, à idade do paciente e à presença de lesões intracranianas associadas. Foram estudados 162 casos de hematoma extradural traumáticos por tomografia computadorizada atendidos no Hospital Governador “João Alves Filho” (Aracaju-SE) entre 1994 e 2004. Para analise estatística, foram utilizados testes t-student, ANOVA com pós-teste de Tukey e curva de regressão linear. Os resultados foram significativos quando p &lt; 0,05. Vinte e nove vírgula seis porcento dos pacientes, tinham menos de 20 anos de idade, 67,3% tinham entre 20 e 59 anos e 3,1% tinham acima de 60 anos de idade. A relação masculino–feminino foi de 5.48:1. Na curva de regressão linear, não houve significância entre o volume do hematoma extradural e a idade de pacientes com 15 anos ou mais. Não houve diferença entre o volume do hematoma em pacientes com e sem lesão intracraniana associada. O volume do hematoma foi significativamente menor na região temporal em comparação às regiões frontotemporoparietal e temporoparietal, assim como na região frontal em relação à temporoparietal. Diante disso, conclui-se que: 1) A incidência de hematoma extradural foi maior em adultos jovens do sexo masculino; 2) Não há relação entre o volume do hematoma e a idade do paciente; 3) O volume do hematoma independe da presença de lesão intracraniana associada; 4) Há relação entre o volume do hematoma e sua localização, sendo o menor volume em região temporal

Hematoma duodenal traumático.

&#x0D; &#x0D; Antecedentes: Las lesiones del duodeno se producen en alrededor del 3 al 5 % de las lesiones traumáticas abdominales. El diagnóstico es un desafío, especialmente en el traumatismo cerrado, porque la signosintomatología es inespecífica. La valoración inicial se centra en la identificación temprana de lesiones de alto grado asociadas con altas tasas de mortalidad. La mayoría de las lesiones del duodeno son de bajo grado y pueden ser de manejo conservador, pero lesiones más complejas pueden requerir cirugía. El objetivo es mostrar el caso de un paciente que presentó un hematoma duodenal traumático y su tratamiento.&#x0D; Caso clínico: Paciente sexo masculino 27 años de edad ingresa por trauma abdominal contuso. Se presentó con dolor centroabdominal, náuseas y vómitos. Hemodinamia estable; exámenes de laboratorio normales. Tomografía computada (TC) abdominal mostró una obstrucción intestinal causada por un hematoma en la pared duodenal. Se realizó tratamiento conservador en base a descompresión gástrica, inhibidores de la bomba de protones intravenosa, nutrición parenteral y controles clínicos seriados, cursando una buena evolución.&#x0D; Discusión: Se trata de una entidad infrecuente en los pacientes adultos. El manejo no operatorio en caso de hematoma duodenal traumático es efectivo y evita la morbimortalidad de procedimientos más complejos.&#x0D;

Traumatic Epidural Hematoma Crop up Following Decompressive Craniectomy for contrecoup Acute Subdural Hematoma

Traumatic Epidural Hematoma Crop up Following Decompressive Craniectomy for contrecoup Acute Subdural Hematoma

Rapid Redistribution of an Acute Traumatic Epidural Hematoma in a Patient with Invasive Skull Cancer

The rapid spontaneous resolution of an acute epidural hematoma (EDH) has rarely been reported. A possible mechanism of spontaneous resolution is egress of the hematoma into the subgaleal space through a skull fracture. We report a case of rapid redistribution of an acute EDH in a 37-year-old man who had a malignant peripheral nerve sheath tumor of the skull and who slipped and fell when going to the bathroom. A huge EDH without a skull fracture developed in the left parieto-occipital area. The acute EDH was completely alleviated and a newly developed intracerebral hematoma was found on a brain computed tomography scan that was acquired the day after the trauma. Given these findings, a fractured skull and increased pressure in the intradural area may have been the mechanisms underlying the redistribution of the hematoma.

A case of duodenal stenosis due to traumatic intramural hematoma of duodenum improved by conservative treatment

A case of duodenal stenosis due to traumatic intramural hematoma of duodenum improved by conservative treatment

Conservative Plan for Post Traumatic Extradural Hematoma: Risk Factors Favouring Conversion to Surgery

Introduction: Extradural hematoma (EDH) is considered one of the most serious and recognized secondary insults of traumatic brain injury (TBI). We will analyse the data of cases required conversion from a conservative to a surgical management and identify the possible patient and disease related risk factors in such cases. Patients and Methods: This prospective study included 90 patients with traumatic EDH, admitted to the Neurotrauma department in Cairo University hospitals from March 2014 to August 2016. Their CT scans reveal EDH alone or with associated cerebral lesions initially fitting the criteria of conservative management. Results: The commonest site is frontal in 21 patients (23.3%), followed by parietotemporal in 18 patients (20%). While Posterior fossa hematomas occurred in 3 cases, which was the least common site (3.3%). The mean size of the EDH was 17.02 ml, with a standard deviation of 6.29 ml. The minimum size was 2 ml and a maximum of 28 ml. The cut off value of the size of the hematoma requiring conversion to a surgical management was 19 ml. Conclusion: Clear indications of EDH evacuation have been well known, however studying which risk factors are more liable to convert conservative management plan to evacuation is important. Increased caution and closer monitoring are required when the size of the hematoma is >19 ml or the hematoma is overlying a venous sinus. Unlike coagulopathy which was found to be a potential risk factor, but larger number study is needed.

Cervical spine traumatic epidural haematomas: Incidence and characteristics.

Cervical spine traumatic epidural haematomas (CSTEH) can cause potentially devastating neurological deficits if not promptly identified. Study aims were to determine the incidence, characteristics and outcomes for patients with CSTEH. A retrospective study was performed at a tertiary hospital with an adult Level 1 Trauma Centre on all consecutive patients diagnosed with CSTEH over a 4 year period. Medical record review was undertaken for all patients with the diagnoses of CSTEH to identify patient characteristics including age, mechanism of injury and co-morbid conditions. Additional data was extracted regarding radiology interpretation, surgical interventions, thromboembolic chemoprophylaxis use, discharge disposition and neurological outcomes. A total of 27 888 patients were admitted with traumatic injuries between 1 July 2010 and 30 June 2014, of which 1916 patients sustained cervical spine injuries. The incidence of CSTEH was 0.6% among all trauma patients and 9.1% among patients with any cervical spine injury. Of those with CSTEH, 89 patients (50.9%) had neurological deficits consistent with the anatomical location of the epidural haematoma. Magnetic resonance imaging diagnosed CSTEH in 132 patients (75.4%), of whom 23 patients (13.1%) had normal computed tomography cervical spine imaging. Among the patients diagnosed with CSTEH, 13 (7.4%) died and 78 (44.6%) required cervical spine surgical decompressions. This study shows a high incidence of CSTEH among trauma patients. CSTEH is associated with significant morbidity and mortality. High clinical vigilance is required to allow the request and acquisition of urgent magnetic resonance imaging to diagnose CSTEH as the entity is often not evident on initial cervical spine computed tomography investigations.

Incidence, hospital costs and in-hospital mortality rates of surgically treated patients with traumatic cranial epidural hematoma

Abstract Background: In this study, the patients who were operated in two clinics due to traumatic cranial epidural hematoma (EDH) were assessed retrospectively and the factors that increase the costs were tried to be revealed through conducting cost analyses. Methods: The patients who were operated between 2010 and 2016 with the diagnosis of EDH were assessed in terms of age, sex, trauma etiology, Glasgow coma scale (GCS) at admission, the period from trauma to hospital arrival, trauma-related injury in other organs, the localization of hematoma, the size of hematoma, length of stay in the intensive care unit (ICU), length of antibiotherapy administration, number of consultations conducted, total cost of in-hospital treatments of the patients and prognosis. Results: Distribution of GCS were, between 13-15 in 18 (36%) patients, 9-13 in 23 (46%) patients and 3-8 in 9 (18%) patients. The reasons for emergency department admissions were fall from high in 29 (58%) patients, assault in 11 (22%) patients and motor vehicle accident in 10 (20%) patients. The average cost per ICU stay was 2838 $ (range=343-20571 $). The average cost per surgical treatment was 314 $. ICU care was approximately 9 times more expensive than surgical treatment costs. The mortality rate of the study cohort was 14% (7 patients). Conclusion: The prolonged period of stay in the ICU, antibiotherapy and repeat head CTs increase the costs for patients who are surgically treated for EDH.