Comparison of ultrasonography and computed tomography in the determination of traumatic thoracic injuries

Kozacı, Nalan; Avcı, Mustafa; Ararat, Ertan; Pinarbaşili, Tansu; Özkaya, Muharrem; Etli, Ibrahim; Dönertaş, Eda; Karakoyun, Ömer Faruk

doi:10.1016/j.ajem.2018.08.002

Cited by 27 publications

(13 citation statements)

References 21 publications

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“…Our results agree with those in a study performed by Kozaci et al, which was conducted at the Antalya Education and Research Hospital in Turkey between June 2015 and March 2018, in which the mean age of the study population was 38 ± 20 years (13).…”

Section: Discussionsupporting

confidence: 93%

Impact of Implementation of Sequential Trauma Education Programs (STEPs) Course on Missed Injuries in Emergency Polytrauma Patients, Ismailia, Egypt

Elbaih

Hirshon

El-Hariri

et al. 2020

Preprint

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Introduction: Trauma deaths account for 8% of all deaths in Egypt. Patients with multiple injuries are at high risk but may be saved with a good triage system and a well-trained trauma team in dedicated institutions. The incidence of missed injuries in the Emergency Department (ED) of Suez Canal University Hospital (SCUH) was found to be 9.0% after applying Advanced Trauma Life Support (ATLS) guidelines. However, this rate is still high compared with many trauma centers.Aim: Improve the quality of management of polytrauma patients by decreasing the incidence of missed injuries by implementing the Sequential Trauma Education Programs (STEPs) course in the ED at SCUH.Methods: This interventional training study was conducted in the SCUH ED. The study was conducted during the 1-month precourse and for 6 months after the implementation of the STEPs course for ED physicians. Overall, 458 polytrauma patients were randomly selected, of which 45 were found to have missed injuries after applying the inclusion and exclusion criteria. We assessed the clinical relevance of these cases for missed injuries before and after the STEPs course.Results: Overall, 45 patients were found to have missed injuries, of which 15 (12%) were pre-STEPs and 30 (9%) were post-STEPs course. The STEPs course significantly increased adherence to vital data recording, but the reduction of missed injuries (3.0%) was not statistically significant in relation to demographic and trauma findings. However, the decrease in missed injuries in the post-STEPs course group was an essential clinically significant finding.Conclusion: STEPs course implementation decreased the incidence of missed injuries in polytrauma patients. Thus, the STEPs course can be considered at the same level of other advanced trauma courses as a training skills program or possibly better in dealing with trauma patients. Repetition of this course by physicians should be mandatory to prevent more missed injuries. Therefore, the validation of STEPs course certification should be completed at least every 2 years to help decrease the number of missed injuries, especially in low-income countries and low-resource settings.

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Section: Discussionsupporting

confidence: 93%

Impact of Implementation of Sequential Trauma Education Programs (STEPs) Course on Missed Injuries in Emergency Polytrauma Patients, Ismailia, Egypt

Elbaih

Hirshon

El-Hariri

et al. 2020

Preprint

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“…Ultrasound has been shown to be a valuable adjunct in the initial assessment of trauma patients [ 30 ] and is more sensitive than chest radiographs in diagnosing rib fractures [ 14 ], although the examination may be more time-consuming, be difficult in the presence of subcutaneous emphysema, be inaccessible to subscapular rib fractures and painful [ 31 ]. However, ultrasound can serve as a complement to CT with the added advantage of possible repetition without radiation, but it is still less sensitive than CT, despite having a high specificity concerning diagnosing intra-thoracic injuries [ 32 ]. At our hospital, ultrasound was used as a bedside tool in the resuscitation of our patients but we had not implemented a standardized protocol for assessing fractures in the sternum, cartilage or ribs, and therefore this modality was not used in our study.…”

Section: Discussionmentioning

confidence: 99%

Mechanism of injury, injury patterns and associated injuries in patients operated for chest wall trauma

Caragounis

Xiao

Granhed

2019

Eur J Trauma Emerg Surg

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Purpose Chest wall injuries are common in blunt trauma and associated with significant morbidity and mortality. The aim of this study was to determine the most common mechanisms of injury (MOI), injury patterns, and associated injuries in patients who undergo surgery for chest wall trauma. Methods This was a retrospective study of trauma patients with multiple rib fractures and unstable thoracic cage injuries who were managed surgically at Sahlgrenska University Hospital during the period September 2010–September 2017. The MOI, injury severity score (ISS), new injury severity score (NISS), thoracic and associated injuries were recorded. Patients were categorized according to age (years): groups I (15‒44), II (45‒64) and III ( > 64). Unstable thoracic cage injuries were classified as sternal, anterior, lateral and posterior flail chest. Results Two hundred and eleven trauma patients with a mean age (years) of 58.2 ± 15.6, mean ISS 23.6 ± 11.0, and mean NISS 34.1 ± 10.6 were included in the study. Traffic accidents were the most common MOI in Group I (62%) and falls in Group III (59%). The most common flail segments were lateral and posterior. Sternal and anterior flail segments were more common with bilateral injuries and traffic accidents, particularly frontal collisions. Injuries in at least three body regions were also more associated with traffic accidents. Diaphragmatic injury was seen in 18% of patients who underwent thoracotomy. Conclusions The MOI associated with multiple rib fractures differs according to the age of the patient and is associated with different chest wall injury patterns and extra-thoracic injuries.

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“…They found US highly specific and moderately sensitive in detecting thoracic injuries. While pneumothorax was identified with the highest sensitivity, the lowest sensitivity was observed for detecting haemothorax and subcutaneous emphysema [28]. The presence of subcutaneous emphysema is suggested by the presence of the E lines using the linear probe.…”

Section: Types Of Effusionmentioning

confidence: 93%

“…Haemothorax shows a variety of morphological changes depending on the stage [28]. Kozaci et al com- 1.…”

Section: Types Of Effusionmentioning

confidence: 99%

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Ultrasound of the pleura in children, WFUMB review paper

Jaworska¹,

Buda

Ciucă

et al. 2021

Med Ultrason

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Ultrasound (US) is an ideal diagnostic tool for paediatric patients owning to its high spatial and temporal resolution, real-time imaging, and lack of ionizing radiation and bedside availability. The lack of superficial adipose tissue and favorable acoustic windows in children makes US the first line of investigation for the evaluation of pleural and chest wall abnormali-ties. Lung parenchyma was previously thought to be inaccessible to ultrasound due to the presence of the air and bony thorax. The change in attitude and growing awareness of the diagnostic possibilities has led to lung ultrasound (LUS) being accepted as a valuable point of care method. In addition, the application of LUS has widened with improvements in technology such as higher resolution transducers, harmonic imaging and contrast-enhanced ultrasound. In the current World Federation of Societies for Ultrasound in Medicine and Biology (WFUMB) paper series the topic will be introduced, the technical requirements explained and the use of ultrasound in the lung and pleura in pediatric patients are discussed.

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Comparison of ultrasonography and computed tomography in the determination of traumatic thoracic injuries

Cited by 27 publications

References 21 publications

Impact of Implementation of Sequential Trauma Education Programs (STEPs) Course on Missed Injuries in Emergency Polytrauma Patients, Ismailia, Egypt

Impact of Implementation of Sequential Trauma Education Programs (STEPs) Course on Missed Injuries in Emergency Polytrauma Patients, Ismailia, Egypt

Mechanism of injury, injury patterns and associated injuries in patients operated for chest wall trauma

Ultrasound of the pleura in children, WFUMB review paper

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