Correlation of computed tomographic signs of hypoperfusion and clinical hypoperfusion in adult blunt trauma patients

Smithson, Lauren; Morrell, Joseph; Kowalik, Urszula; Flynn, William J.; Guo, Weidun Alan

doi:10.1097/ta.0000000000000623

Cited by 22 publications

(19 citation statements)

References 24 publications

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“…Age above 60 years was the only special cause criteria which correlated with severe injury. The rates of elderly trauma are increasing globally and low energy mechanisms are associated with severe injury in this cohort [ 28 , 30 ]. Reasons for increased mortality in geriatric trauma are attributed to pre-existing diseases mask physiologic response to injury (e.g.…”

Section: Discussionmentioning

confidence: 99%

Evaluating the ability of a trauma team activation tool to identify severe injury: a multicentre cohort study

Vinjevoll

Uleberg

Cole

2018

Scand J Trauma Resusc Emerg Med

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BackgroundSensitive decision making tools should assist prehospital personnel in the triage of injured patients, identifying those who require immediate lifesaving interventions and safely reducing unnecessary under- and overtriage. In 2014 a new trauma team activation (TTA) tool was implemented in Central Norway. The overall objective of this study was to evaluate the ability of the new TTA tool to identify severe injury.MethodsThis was a multi-center observational cohort study with retrospective data analysis. All patients received by trauma teams at seven hospitals in Central Norway between 01.01.2015 to 31.12.2015 were included. Severe injury was defined as Injury Severity Score (ISS) > 15. Overtriage was defined as the rate of patients with TTA and ISS < 15, whilst patients with TTA and ISS > 15 were defined as correctly triaged.ResultsA total of 1141 patients were identified, of which 998 were eligible for triage criteria analysis. Median age was 35 years (IQR 20–58) and the male proportion was 67%. Mechanism of injury was predominantly blunt trauma (96%) with transport related accidents (62%) followed by falls (22%) the most common. Overall, median injury severity score (ISS) was low and severely injured patients (ISS > 15) comprised 13% of the cohort. Utility of specific TTA criteria were: physiology 20%, anatomical injury 21%, mechanism of injury (MOI) 53% and special causes 6%. Overtriage among all patients was 87%, and for those with physiologic criteria 66%, anatomical injury 82%, mechanism of injury 97% and special causes criteria 92%, respectively.ConclusionsSevere injury was infrequent and there was a substantial rate of overtriage. The ability of the TTA tool was relatively insensitive in identifying severe injury, but showed increased performance when utilizing physiologic and anatomical injury criteria. Many of the TTA mechanism of injury criteria might be considered for removal from the triage tool due to substantial rates of overtriage. This has relevance for the proposed development of national Norwegian TTA criteria.

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Section: Discussionmentioning

confidence: 99%

Evaluating the ability of a trauma team activation tool to identify severe injury: a multicentre cohort study

Vinjevoll

Uleberg

Cole

2018

Scand J Trauma Resusc Emerg Med

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“…In addition, technical progress and a new algorithm for the whole-body CT trauma protocol (with contrast) has shortened the duration of CT and made it possible to increase the number of patients examined in this manner (24,25). CT examinations in both our study and the literature can be limited, despite the signs of hypoperfusion in CT, just due to false-negatives (26). However, even in negative ultrasound examinations of cavities in a patient with unexplained life-threatening acute blood loss, CT angiography can reveal the source of bleeding despite low systemic BP and direct causal treatment in the right…”

Section: Discussionmentioning

confidence: 89%

The Occurence and Detection Of hemodynamically Significant Bleeding Into the Retroperitoneum In patients Dying Due to Blunt Traumatic-Haemorrhagic Shock

Simek¹,

Šmejkal²,

Frank³

et al. 2019

Mil. Med. Sci. Lett.

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Background: The occurrence of retroperitoneal bleeding and the manner of detection was retrospectively evaluated in patients with life-threatening traumatic bleeding. Methods: The cohort included patients who died in the Trauma Centre of the University Hospital Hradec Kralove in Czech Republic between 2008 and 2012 due to traumatic hemorrhagic shock. Findings of retroperitoneal bleeding and the findings found for life (i.e., CT, FAST, pre-operative findings) were compared. Results: During the five-year period, deaths due to the post-mortem diagnosis of traumatic hemorrhagic shock were recorded in 75 patients, 26 of which (35%) were verified by post-mortem autopsy to have hemodynamically significant bleeding into the retroperitoneum (HSBR) from 31 sources. HSBR was identified for life in 10 patients with HSBR (38.5%). Sensitivity was 55% in CT angiography and 36% in laparotomy without previous CT. The sensitivity of laparotomy with surgical exploration of the retroperitoneum was 67%. A predisposing factor for hemodynamically significant bleeding into the retroperitoneum, which may escape the surgeon's attention, is high-energy blunt trauma to the trunk. Conclusions: In the acute stage of treatment of patients with life-threatening bleeding due to high-energy blunt trauma, the surgeon has to decide whether the patient's condition allows CT and whether hematoma of the retroperitoneum should be revised surgically. However, in the present cohort few patients with HSBR underwent surgical exploration of the retroperitoneum because the hematoma was ascribed to the known injury of the pelvis and spine.

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“…4). In addition, CT angiography (CTA) renal vascular reconstruction technique not only can provide most of the detections of renal arteriography, but also can provide the accuracy information of hemodynamics stability and vascular interventional therapy [21,22].…”

Section: Discussionmentioning

confidence: 99%

Diagnosis value of multi-slice spiral CT in renal trauma

Peng

Wang

Zhang

et al. 2016

XST

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Abstract. Computed tomography (CT) is most commonly used as a noninvasive approach in diagnosis of internal organ injures. Use of multi-slice spiral CT becomes more popular in diagnosis of trauma because of its ability to generate 3D volumetric information. This study evaluated the diagnostic value of multi-slice spiral computed tomography (MSCT) with enhanced scanning in renal trauma. In total, 126 patients with kidney injury underwent MSCT scanning from a single hospital in the southern of China between January 2012 and February 2016. According to kidney injury grading standards of American Association for the Surgery of Trauma (AAST), 30 were diagnosed and classified in level I, 26 in level II, 42 in level III, 17 in level IV, 11 in level V. The outcomes of MSCT enhanced scanning achieve a 100% diagnostic accuracy rate, which was confirmed by surgical findings. We concluded that the enhanced MSCT scan permits reliable detection of renal trauma and the associated organ or tissue injuries, providing important clinical value for the diagnosis and classification of renal trauma or internal organ injures.

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Correlation of computed tomographic signs of hypoperfusion and clinical hypoperfusion in adult blunt trauma patients

Abstract: Diagnostic study, level III.

Cited by 22 publications

References 24 publications

Evaluating the ability of a trauma team activation tool to identify severe injury: a multicentre cohort study

Evaluating the ability of a trauma team activation tool to identify severe injury: a multicentre cohort study

The Occurence and Detection Of hemodynamically Significant Bleeding Into the Retroperitoneum In patients Dying Due to Blunt Traumatic-Haemorrhagic Shock

Diagnosis value of multi-slice spiral CT in renal trauma

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