Noncorrelation between Thoracic Skeletal Injuries and Acute Traumatic Aortic Tear

J, Lee; Jh, Harris; Jh, Duke; Js, Williams

doi:10.1097/00005373-199709000-00002

Cited by 47 publications

(13 citation statements)

References 12 publications

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“…Vascular aortic lesions are associated with 3% of the isolated first rib fracture, but this vascular complication rate is 24% when a thoracic, abdominal or cerebral trauma, or a fracture of the long bones exists (9,16). On the other hand, Lee J and colleagues reported that there is no clinically relevant correlation between thoracic skeletal injuries and acute traumatic aortic tears (17). We detected no vascular injuries in our study.…”

Section: Discussioncontrasting

confidence: 50%

Traumatic First Rib Fractures

Yazkan¹

2012

JAEM

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Objective: Traumatic first rib fracture is associated with multisystem injuries, morbidity and mortality. We wish to report thoracic and extrathoracic injuries related with traumatic first rib fracture in this study. Material and Methods: Due to rib fractures, 162 cases were hospitalized between June 2008-April 2011, 11 (6.8%) of these cases were accompanied by first rib fracture. The first rib fracture patients were evaluated according to gender, age, etiologies of trauma, thoracic and extrathoracic injuries, diagnostic and treatment modalities, morbidity and mortality. All patients were evaluated by a multidisciplinary trauma team in the emergency department. Results: Eight cases (72.7%) were male and 3 (27.3%) were female, ages ranged from 27 to 67 age, the average was 36.7. All of the cases were blunt trauma. 10 (90.9%) cases included thoracic injuries, 3 (27.3%) cases had no extrathoracic injuries. There was no any vascular, neurological injuries and mortality. Conclusion:The first rib fracture is associated with serious thoracic and extrathoracic injuries, but not always with vascular, neurological injuries and mortality. The trauma team must know the potential severity of the first rib fracture. A multidisciplinary approach, early diagnosis, appropriate treatment and observation in the intensive care unit may be prevent morbidity and/or mortality. (JAEM 2012; 11: 27-30)

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Section: Discussioncontrasting

confidence: 50%

Traumatic First Rib Fractures

Yazkan¹

2012

JAEM

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“…Mirvis et al [21] found fractures of ribs 1 through 4 in 18% of 41 patients with traumatic aortic injury proved by angiography but with a positive predictive value of only about 21%. Lee et al [22] studied 548 patients who underwent angiography to evaluate for aortic injury and concluded that rib fractures were the only type of thoracic skeletal injury that had a higher incidence in patients with aortic injury (58%) versus those without aortic injury (43%), but the positive predictive value was only 14.8%. This has also been shown at autopsy, where Williams et al [23] retrospectively reviewed 530 motor vehicle fatalities.…”

Section: Discussion Of Procedures By Variant Variant 1: Suspected Ribmentioning

confidence: 99%

ACR Appropriateness Criteria® Rib Fractures

Imaging¹,

Henry

Donnelly

et al. 2019

Journal of the American College of Radiology

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Rib fractures are the most common thoracic injury after minor blunt trauma. Although rib fractures can produce significant morbidity, the diagnosis of injuries to underlying organs is arguably more important as these complications are likely to have the most significant clinical impact. Isolated rib fractures have a relatively low morbidity and mortality and treatment is generally conservative. As such, evaluation with standard chest radiographs is usually sufficient for the diagnosis of rib fractures, and further imaging is generally not appropriate as there is little data that undiagnosed isolated rib fractures after minor blunt trauma affect management or outcomes. Cardiopulmonary resuscitation frequently results in anterior rib fractures and chest radiographs are usually appropriate (and sufficient) as the initial imaging modality in these patients. In patients with suspected pathologic fractures, chest CT or Tc-99m bone scans are usually appropriate and complementary modalities to chest radiography based on the clinical scenario.The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.Disclaimer: The ACR Committee on Appropriateness Criteria and its expert panels have developed criteria for determining appropriate imaging examinations for diagnosis and treatment of specified medical condition(s). These criteria are intended to guide radiologists, radiation oncologists, and referring physicians in making decisions regarding radiologic imaging and treatment. Generally, the complexity and severity of a patient's clinical condition should dictate the selection of appropriate imaging procedures or treatments. Only those examinations generally used for evaluation of the patient's condition are ranked. Other imaging studies necessary to evaluate other co-existent diseases or other medical consequences of this condition are not considered in this document. The availability of equipment or personnel may influence the selection of appropriate imaging procedures or treatments. Imaging techniques classified as investigational by the FDA have not been considered in developing these criteria; however, study of new equipment and applications should be encouraged. The ultimate decision regarding the appropriateness of any specific radiologic examination or treatment must be made by the referring physician and radiologist in light of all the circumstances presented in a...

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“…Dieses Verteilungsmuster zeigt sich auch in der vorliegenden Studie: in 87,8 % resultierte das VT aus einem stumpfen Trauma, davon entfielen 75,0 % auf Verkehrsunfälle. In älteren europäischen Auswertungen stellen sich zwar Pkw-Unfälle als führende Verletzungsmechanismen bei stumpfen thorakalen Aortentraumata (AIS6; VT-2) dar [15][16][17][18], jedoch mit einem weitaus höheren Anteil als in unserer Analyse. Wir fanden einen geringeren Anteil an VT-2 im Rahmen von Pkw-Unfällen.…”

Section: Patienten Und Methodikunclassified

Bedeutung des Gefäßtraumas für die Schwerverletztenversorgung – Einfluss auf Verlauf und Mortalität

et al. 2016

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There is a lack of evidence as to the relevance of vascular trauma (VT) in patients with severe injuries. Therefore, we reviewed registry data in the present study in order to systematically objectify the effect of VT in these patients. This study aimed to provide an adequate picture of the relevance of vascular trauma and to identify adverse prognostic factors. In a retrospective analysis of records from the TraumaRegister DGU® (TR-DGU) in two subgroups with moderate and severe VT, we examined the records for differences in terms of morbidity, mortality, follow-up and prognostic parameters compared to patients without VT with the same ISS. From a total of 42,326 patients, 2,961 (7 %) had a VT, and in 2,437 cases a severe VT (AIS ≥ 3) was diagnosed (5.8 %). In addition to a higher incidence of shock and a 2 to 3-fold increase in fluid replacement and erythrocyte transfusion, patients with severe VT had a 60 % higher rate of multiple organ failure, and in-hospital mortality was twice as high (33.8 %). The massively increased early mortality (8.0 vs. 25.2 %) clearly illustrates how severely injured patients are placed at risk by the presence of a relevant VT with a comparable ISS. In our opinion, due to an unexpected poor prognosis in the TR-DGU data for vascular injuries, increased attention is required in the care of severely injured patients. Based on our comprehensive analysis of negative prognostic factors, a further adjustment to the standards of vascular medicine could be advisable. The influence of the level of care provided by the admitting hospital and the relevance of a further hospital transfer to prognosis and clinical outcome is currently being analysed.

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Noncorrelation between Thoracic Skeletal Injuries and Acute Traumatic Aortic Tear

Cited by 47 publications

References 12 publications

Traumatic First Rib Fractures

Traumatic First Rib Fractures

ACR Appropriateness Criteria® Rib Fractures

Bedeutung des Gefäßtraumas für die Schwerverletztenversorgung – Einfluss auf Verlauf und Mortalität

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