Computed tomography in hemodynamically unstable severely injured blunt and penetrating trauma patients

Ordóñez, Carlos A.; Herrera-Escobar, Juan P.; Parra, Michael W.; Rodriguez-Ossa, Paola A.; Mejia, David; Sánchez, Á.; Badiel, Marisol; Morales, Monica; Rojas-Mirquez, Johanna Carolina; Garcia-Garcia, Maria P.; Pino, Luis Fernando; Puyana, Juan Carlos

doi:10.1097/ta.0000000000000975

Cited by 41 publications

(27 citation statements)

References 13 publications

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“…However, CT in unstable trauma patients has not been absolutely unacceptable in recent years. Ordonez et al reported that CT in unstable patients did not decrease mortality compared to immediate DCS, and they instead avoided surgery in approximately half of the cases [6]. In addition, the CT findings can help in deciding a specific surgical or IR management.…”

Section: Discussionmentioning

confidence: 99%

Complete Traumatic Transection of the Renal Vein with Renal Venous Hemostasis via Arterial Embolization before Nephrectomy: A Case Report

Mitani

Ishikawa

Kono

et al. 2018

Interventional Radiology

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A 44-year-old man fell off a cliff and was taken to a community hospital. He was a non-responder and was transferred to our tertiary care hospital. Contrast-enhanced computed tomography images revealed a right renal vein injury and a massive retroperitoneal hemorrhage. Angiography of the right renal artery showed extravasation during the venous phase; therefore, the artery was immediately embolized with N-butyl cyanoacrylate and coils. Subsequently, nephrectomy was performed. Arterial embolization of the renal artery for a renal vein injury in a patient with hemodynamic instability may be effective as a damage-control interventional radiology bridge to emergency nephrectomy.

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Section: Discussionmentioning

confidence: 99%

Complete Traumatic Transection of the Renal Vein with Renal Venous Hemostasis via Arterial Embolization before Nephrectomy: A Case Report

Mitani

Ishikawa

Kono

et al. 2018

Interventional Radiology

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“…Among preoperative abdominal trauma patients, one previous study reported harmful effect of CT [10]. Another previous study reported that there was no significant difference of mortality between patients underwent CT and those not underwent CT in different population of unstable trauma patients including abdominal and non-abdominal trauma patients [13]. Those previous studies have critical limitations to examine the effect of CT in observational studies, due to unmeasured confounders.…”

Section: Discussionmentioning

confidence: 99%

“…Since 2010, one large-scale observational study has revealed the benefits of Whole-body CT (WBCT) for unstable patients [9]. In contrast, another study showed that CT was associated with a negative outcome among preoperative abdominal trauma patients [10], while other studies showed no significant association between CT and mortality [11–13]. Therefore, whether CT is really harmful for hemodynamically unstable patients remains in question.…”

Section: Introductionmentioning

confidence: 99%

Computed tomography during initial management and mortality among hemodynamically unstable blunt trauma patients: a nationwide retrospective cohort study

Tsutsumi

Fukuma

Tsuchiya

et al. 2017

Scand J Trauma Resusc Emerg Med

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BackgroundAlthough many hemodynamically unstable trauma patients undergo computed tomography (CT) to identify a source of bleeding, this practice is currently only recommended by a few guidelines. To clarify whether CT has harmful effects among these patients, we examined the association between CT during initial management and mortality among unstable blunt trauma patients.MethodsThis was a retrospective cohort study based on Japan Trauma Data Bank 2004–2014 registry data. Study population was adult blunt trauma patients with hypotension on arrival. The primary outcome was the in-hospital mortality. Two types of analyses were performed to adjust for confounding factors including propensity score inverse probability of treatment weighted (IPTW) and instrumental variable (IV) analysis.ResultsAmong 5,809 patients who met inclusion criteria, 5,352 (92.1%) underwent CT. The No CT group was more likely to have severe physiological conditions and lower probability of survival than those of the CT group. In IPTW analysis adjusting for measured confounders, we found a significant protective effect of undergoing CT on in-hospital mortality (excess deaths: −20.6 per 100 patients, 95% CI −26.2 to −14.9). In IV analysis adjusting both for measured and unmeasured confounders, the association between CT and mortality was not statistically significant (excess deaths: −4.1 per 100 patients, 95% CI −23.1 to 14.8).DiscussionWe did not find clinically meaningful harmful effect of CT on survival for unstable blunt trauma patients even after adjusting both for measured and unmeasured confounders.Conclusions Our results did not support the recommendation of current guideline. We suggest physicians should consider CT as one of the diagnostic options even when patients are unstable.Electronic supplementary materialThe online version of this article (doi:10.1186/s13049-017-0396-7) contains supplementary material, which is available to authorized users.

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“…CT is also being done in hemodynamically unstable patients by maintaining aggressive resuscitation schemes and Ordonez et al reported that CT scan was attainable in 47% of these patients and avoided surgery in 54% with no added mortality. 12 Solid organs are injured the most in BAT. Liver was injured in 34.2% cases while spleen in 22.51% of the present BAT series.…”

Section: Discussionmentioning

confidence: 99%

Blunt abdominal trauma: a tertiary care experience

Trehan¹,

Kumar²

2018

Int Surg J

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Background: Blunt abdominal trauma (BAT) is one of the common causes of admission in surgical ward in any hospital. It requires high level of suspicion, urgent evaluation and timely management to decrease morbidity and mortality. Aim of present study was to find out demographic details, causes of injury, management options and treatment outcomes of BAT.Methods: Retrospective study of cases of BAT was carried out at a tertiary care hospital of India spanning five years, between June 2012 to June 2017. Authors analyzed the demographic profile of the trauma victims, etiological factors of BAT, the abdominal organs involved, the treatment modalities adopted and the final outcome.Results: There were 231 cases of BAT. Most common age group was 11 to 30 years which accounted for 42.42% of the total. The study had 181 (78.35%) males and 50 (21.64%) females. Road traffic accident was the most common cause of BAT and it accounted for 67.97%. Liver (34.20%) was the most commonly involved organ followed by spleen (22.51%), bowel (15.58%), mesentery (8.23%), kidney (7.36%), pancreaticoduodenal injuries (3.46%) and diaphragm (3.46%). 56.71% underwent non-operative management (NOM), 3.90% underwent angio-embolization and 39.39% eventually required operative treatment. Mortality occurred in 31 patients (13.41%) because of septicemia, renal failure, shock, acute coronary event or respiratory complications.Conclusions: NOM for BAT was found to be successful in haemodynamically stable patient with solid organ injury. Along with sophisticated infrastructure like ultrasound or CT Scan, close supervision with repeated examination by a treating surgeon were the sheet anchors of NOM. Angio-embolization is a feasible modality of treatment in solid organ injury and can avoid surgery in an appropriate patient. Definitive indications for laparotomy were hemodynamic instability and perforation-peritonitis. Initial hemodynamic instability, haemorrhagic shock, and associated injuries influenced morbidity and mortality in BAT.

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Computed tomography in hemodynamically unstable severely injured blunt and penetrating trauma patients

Abstract: Therapy/care management study, level IV.

Cited by 41 publications

References 13 publications

Complete Traumatic Transection of the Renal Vein with Renal Venous Hemostasis via Arterial Embolization before Nephrectomy: A Case Report

Complete Traumatic Transection of the Renal Vein with Renal Venous Hemostasis via Arterial Embolization before Nephrectomy: A Case Report

Computed tomography during initial management and mortality among hemodynamically unstable blunt trauma patients: a nationwide retrospective cohort study

Blunt abdominal trauma: a tertiary care experience

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