The goal of this study was to assess the reliability of color Doppler imaging in boys who presented with acute scrotal pain and borderline clinical findings. The second purpose of the study was to evaluate the potential change in diagnostic accuracy as a result of employing radiological staff with varying levels of experience. Thirty-eight consecutive patients with highly suspected testicular torsion were enrolled in this prospective study. Clinical examination was followed by color Doppler US (7.5-MHz transducer). The staff of radiologists included four residents and three experienced radiologists. All patients underwent surgical exploration. All original reports of residents were reviewed by experienced radiologists and sensitivity with specificity were determined and compared. Original interpretations of color Doppler imaging yielded sensitivity of 77.8% and specificity of 85%, which changed after review to 88.9 and 90%, respectively. Clinical assessment was accurate only in 47.4%. Agreement between original and retrospective color Doppler diagnosis was obtained in 20 of 23 (86.9%) reviewed cases. Color Doppler US may prevent unnecessary surgery in the cases with conclusive normal and increased blood flow. In all other situations scrotal exploration should be performed.
BackgroundPatients with severe pelvic fractures represent about 3% of all skeletal fractures. Hemodynamic compromise in unstable pelvic fractures is associated with arterial hemorrhage in less than 20% of patients. Angiography is an important tool in the management of severe pelvic injury, but indications and timing for its performance remain controversial.MethodsPatients with major pelvic fractures [Pelvic Abbreviated Injury Score (AIS) ≥ 3] admitted to two high volume Trauma Centers from January 2000 to June 2005 were identified and divided into two groups: Group I patients did not undergo angiography, Group II patients underwent angiography with/without embolization. Demographics, hemodynamic status on admission, concomitant injuries, Glasgow Coma Scale (GCS), Injury Severity Score (ISS), pelvic AIS, blood requirement before and after angiography, arterial blood gases and mortality were evaluated. Patients with an additional reason for hemodynamic instability were excluded.ResultsCharts of 106 patients were retrospectively reviewed. Twenty nine patients (27.4%) underwent angiography. Bleeding vessel embolization was performed in 20 (18.9%) patients. Patients who underwent angiography had a significantly higher pelvic AIS and a lower Base Excess level on admission. A blood transfusion rate of greater than 0.5 unit/hour was found to be a reliable indicator for early angiography.ConclusionA high pelvic AIS, amount of blood transfusions and decreased BE level should be considered as an indicators for early angiography in patients with severe pelvic injury.
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