Conclusions: We found that the overall risk of CE with USGIVs placed by RNs to be low (4.1%), but significantly greater compared to IVs placed using standard technique (0.21%). These results are similar to a previously published study, in which USGIVs were placed by physicians. While further study is needed to delineate what, if any, operator characteristics are associated with CEs, our results suggest that USGIVs placed by RNs trained in the procedure perform as well those placed by physicians. Extravasation events are relatively rare, and the small number of CEs in the USGIV group (n¼12) did not allow for meaningful comparisons of IV characteristics between the two groups. Larger data sets, likely drawn from multiple institutions (given the relative paucity of extravasations via USGIVs) are needed to ascertain whether IV gauge, location, or catheter length have an affect on contrast extravasation.
populations. The identification and type of BCVI was correlated with several clinical variables, mortality, morbidity and hospital length-of-stay. Results: Monthly CTAn utilization increased 5.6 fold under new protocol. BCVI incidence went from 13.8/1000 blunt traumas (BT) to 34.8/1000 BT. Groups did not differ significantly with regards to age, injury severity score, or sex (p>0.05). The percentage of patients meeting Denver criteria dropped from 85.1% to 58.3% (p¼0.0001). There was a significant increase in grade 1 (518%), grade 2 (274%), and grade 3 (432%) injuries (p¼0.0001). Decreases in ischemic stroke (7.5%-2.6%, p¼0.09) and in hospital mortality (10.4%-5.1%, p¼0.15) were not significantly different. Hospital length-of-stay (p¼0.008) and intensive care unit length-of-stay (p¼0.0093) were significantly reduced between the restrictive and expanded groups. Increased contrast administration did not alter the rates of acute kidney injury (AKI) (p¼0.51) or acute respiratory distress syndrome (ARDS) (p¼0.59). Conclusions: Adherence to Denver criteria for BCVI screening in blunt trauma patients misses a significant group of injured patients at risk for stroke. These injuries are not limited to low-grade injuries. These changes also are correlated with decreased hospital length-of-stay, mortality, and rate of stroke with no change in morbidity. Expansion of Denver criteria should be considered to improve early diagnosis of BCVI in blunt injury trauma patients.
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