High Success With Nonoperative Management of Blunt Hepatic Trauma

Velmahos, George C.

doi:10.1001/archsurg.138.5.475

Cited by 196 publications

(166 citation statements)

References 24 publications

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“…2 Modern trauma care relies heavily on nonoperative, emergent percutaneous techniques in the management of injured patients with substantial hemorrhage, particularly in patients with splenic, pelvic and hepatic injuries. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Furthermore, the American College of Surgeons Committee on Trauma states that both level I and II trauma centres should have timely availability to conventional angiography and to radiology staff with the ability to oversee therapeutic procedures. 18 Unfortunately, general consensus guidelines are not currently available to define "timeliness" for percutaneous procedures aimed at hemorrhage control.…”

Section: Discussionmentioning

confidence: 99%

Timeliness in obtaining emergent percutaneous procedures in severely injured patients: How long is too long and should we create quality assurance guidelines?

Smith

Ouellet

Niven

et al. 2013

CJS

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RESEARCH • RECHERCHETimeliness in obtaining emergent percutaneous procedures in severely injured patients: How long is too long and should we create quality assurance guidelines?Background: Modern trauma care relies heavily on nonoperative, emergent percutaneous procedures, particularly in patients with splenic, pelvic and hepatic injuries. Unfortunately, specific quality measures (e.g., arrival to angiography times) have not been widely discussed. Our objective was to evaluate the time interval from arrival to initiation of emergent percutaneous procedures in severely injured patients.Methods: All severely injured trauma patients (injury severity score [ISS] > 12) presenting to a level 1 trauma centre (2007)(2008)(2009)(2010) were analyzed with standard statistical methodology.Results: Among 60 severely injured patients (mean ISS 31, hypotension 18%, mortality 12%), the median time interval to the initiation of an angiographic procedure was 270 minutes. Of the procedures performed, 85% were therapeutic embolizations and 15% were diagnostic procedures. Splenic (median time 243 min, range 32-801 min) and pelvic (median time 278 min, range 153-466 min) embolizations accounted for 43% and 25% of procedures, respectively. The median embolization procedure duration for the spleen was 28 (range 15-153) minutes compared with 59 (range 34-171) minutes for the pelvis. Nearly 22% of patients required both an emergent percutaneous and subsequent operative procedure. Percutaneous therapy typically preceded open operative explorations. Conclusion:The time interval from arrival at the trauma centre to emergent percutaneous procedures varied widely. Improved processes emphasizing patient transition from the trauma bay to the angiography suite are essential. Discussion regarding the appropriate time to angiography is needed so this marker can be used as a quality outcome measure for all level 1 trauma centres. Contexte :De nos jours, en traumatologie, les soins reposent largement sur des interventions non chirurgicales percutanées d'extrême urgence, particulièrement chez les patients blessés à la rate, au bassin et au foie. Malheureusement, les indices de qualité spé-cifiques (p. ex., temps écoulé entre l'arrivée et l'angiographie) n'ont pas fait l'objet de discussions approfondies. Notre objectif était de mesurer le temps écoulé entre l'arrivée et l'instauration des interventions percutanées d'extrême urgence chez les grands blessés. Méthodes

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Section: Discussionmentioning

confidence: 99%

Timeliness in obtaining emergent percutaneous procedures in severely injured patients: How long is too long and should we create quality assurance guidelines?

Smith

Ouellet

Niven

et al. 2013

CJS

View full text Add to dashboard Cite

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“…Approximately 30% patients are still assigned to receive laparotomy (4). At the same time, it is estimated that the percentage of non-therapeustic laparotomy lies between 5-14% in different health centers (3,4,6,(8)(9)(10)(11). Alternative treatment for these patients is use of emergency diagnostic laparoscopy.…”

Section: Discussionmentioning

confidence: 99%

Post-Traumatic Rupture of the Ovarian Cyst - Case Report

Madej¹,

Fijałkowski²,

Burdan³

2008

Polish Journal of Surgery

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“…The rate of liver-related complications in hemodynamically stable patients with blunt traumas is low (0-7%) [45][46][47][48][49]. On the other hand, liver-related complications in high-grade liver injuries are common (11-13%) [49][50][51].…”

Section: Bilomasmentioning

confidence: 99%

Traumatic Bile Duct Injuries

Molinari¹

2016

Actual Problems of Emergency Abdominal Surgery

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The vast majority of bile duct injuries is iatrogenic and occurs during abdominal surgeries or other interventions such as endoscopic or percutaneous cannulation of the biliary tree. Accidental traumas are responsible only for 1-5% of the total number of biliary injuries. The diagnosis of non-iatrogenic traumatic bile duct injuries is challenging as current cross-sectional imaging tests are not very specific. Therefore, most of the patients are diagnosed when they undergo early explorative laparotomy or when they develop late complications. Among all patients who experience traumatic bile duct injuries, 80-90% are victims of penetrating traumas from stab or gunshot wounds. On the other hand, bile duct lesions due to blunt traumas are predominantly caused by traffic accidents (compression by safety belt or airbag), falls, kicks, or work accidents. Iatrogenic bile duct injuries have been extensively covered in many other papers. In this chapter, we will focus our attention only on traumatic bile duct injuries.

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High Success With Nonoperative Management of Blunt Hepatic Trauma

Abstract: Nonoperative management of liver injuries (NOMLI) is highly successful and rarely leads to adverse events.

Cited by 196 publications

References 24 publications

Timeliness in obtaining emergent percutaneous procedures in severely injured patients: How long is too long and should we create quality assurance guidelines?

Timeliness in obtaining emergent percutaneous procedures in severely injured patients: How long is too long and should we create quality assurance guidelines?

Post-Traumatic Rupture of the Ovarian Cyst - Case Report

Traumatic Bile Duct Injuries

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