Wertigkeit der k�rperlichen und radiologischen Basisdiagnostik des Beckens in der Schockraumbehandlung

Pehle, B.; Nast-Kolb, D.; Oberbeck, Reiner; Waydhas, Christian; Ruchholtz, Steffen

doi:10.1007/s00113-003-0629-2

Cited by 59 publications

(11 citation statements)

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“…While it is easier to make the correct diagnosis in clinically alert patients, the examiner should be aware of missed injuries in unconscious and intubated patients. Here further diagnostic tools would be beneficial [26-28]. Some studies have revealed a lack of admission radiographs of the injured area as one reason for overlooked injuries and others have reported misinterpreted x-rays [29,30].…”

Section: Discussionmentioning

confidence: 99%

Risk stratification by injury distribution in polytrauma patients -- does the clavicular fracture play a role?

et al. 2013

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BackgroundThoracic and extremity injuries are common in polytraumatized patients. The clavicle limits the upper thoracic cage and connects the body and upper extremities. It is easy to examine and is visible on standard emergency room radiographs. We hypothesize that clavicular fracture in polytrauma patients indicates the presence of further injuries of the upper extremities, head, neck and thorax.Material and methodsRetrospective study including patients admitted between 2008 and 2012 to a level-I trauma center. Inclusion criteria: ISS > 16, two or more injured body regions, clavicular fracture. Control group: patients admitted in 2011, ISS > 16, two or more injured body regions, no clavicular fracture. Patient information was obtained from the patients’ charts; evaluation of radiographic findings was performed; scoring was based on the Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS) AIS/ISS; data were analyzed using Pearson’s correlation and the Mann–Whitney U-test in SPSS (version 11.5.1); graphs were drawn using EXCEL®.ResultsThirty-four patients with clavicular fracture (C+) and 40 without (C-) were included; the mean ISS was 25 (range 16–57), m = 70%, f = 30%; age 43.3 years (range 9–88); clavicular fractures were positively correlated with severe thoracic (p = 0.011, OR 4.5: KI 1.3–15.3), external (p < 0.001, OR 9.2: KI 2.7–30.9) and upper extremity injuries (p < 0.001, OR 33.2: KI 6.9–16.04 resp. p = 0.004, OR 12.5: KI 1.5–102.9). C + showed a lower head/neck AIS (p = 0.033), higher thorax AIS (p = 0.04), arm/shoulder AIS (p = 0.001) and external AIS (0.003) than C-. Mean hospital stay and ICU treatment time were longer in the C + group (p = 0.001 and p = 0.025 respectively).ConclusionA clavicular fracture can be diagnosed easily and may be used as a pointer for further thoracic and upper extremity injuries in polytrauma patients that might have been otherwise missed. Special attention should be paid on second and tertiary survey.

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Section: Discussionmentioning

confidence: 99%

Risk stratification by injury distribution in polytrauma patients -- does the clavicular fracture play a role?

et al. 2013

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“…Meanwhile, fractures of pelvis and long bones are commonly observed in middle aged people due to osteoporosis and falls and in young people usually due to severe hits [ 4 , 5 ]. Patients with severe pelvic fractures account for 3% of total fractures [ 6 ]. The complications of bone fracture include infection, avascular necrosis, large blood vessel damage, damage to the nerves, damage to the muscles, damage to the tendons, osteoarthritis and in certain cases, shock, fat embolism, compartment syndrome, lower extremity deep vein thrombosis (DVT) and lung embolism [ 7 - 9 ].…”

Section: Introductionmentioning

confidence: 99%

Prognostic Value of Arterial Blood Gas Indices Regarding the Severity of Traumatic Injury and Fractures of the Femur and Pelvis

Mohsenian

Khoramian

Mazloom

2018

BEAT

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Objective:To evaluate the prognostic value of arterial blood gas (ABG) indices, especially base excess (BE), regarding the severity of traumatic injury.Methods:A total number of 96 trauma patients with fractures of femur and pelvis were included in this study. Demographic characteristics and clinical information of samples were recorded. The results of ABG test and hemoglobin (Hb) were evaluated at two time intervals (on admission and 6 hours later). The outcome of the patients was evaluated at the end of the study (dead or alive). The ABG indices included O2 saturation (O2Sat), PH, PO2, PCO2, bicarbonate (HCO3) and base excess (BE). The mean of the hemodynamic and ABG indices were compared between those who were discharged and mortality cases. The confounders were compensated using a multivariate logistic regression model. Results:Overall 94 trauma patients with long and pelvic fractures were included. There were 69 (73.4%) men and 25 (26.6%) women among the patients with mean age of 37.43 ± 20.07 years. The mortality rate was 10 (10.6%). The most common mechanism of injury was motorcycle accident in 41 (43.6%) and car collision in 43 (45.7%) patients. We found that mortality was significantly associated with amount of FFP transfusion (p=0.005), but was not associated with amount of transfused packed cells (p=0.113). We also found that mortality was associated with lower BP after 6 hours of admission (p=0.001), higher HR on admission (p=0.036), lower HR after 6 hours (p=0.017), lower O2Sat on admission (p<0.001), higher PCO2 after 6 hours and lower BE on admission (p=0.025). Conclusion: The ABG indices including O2Sat, BE and PCO2 are considered prognostic determinants of outcome in trauma patients with long and pelvic fractures. These findings can be considered as fundamental studies to achieve new diagnostic methods.

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“…A total of 2644 studies were screened. Twenty studies met the eligibility criteria and were included [10][11][12][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] in the quality assessment and meta-analysis ( Fig. 1 and S- Table 1 in supplementary file).…”

Section: Resultsmentioning

confidence: 99%

“…The reference standards were x-ray [ 33 – 36 , 38 , 40 , 44 , 46 , 49 ], unclear [ 11 ], or x-ray or CT [ 10 , 12 , 37 , 39 , 41 – 43 , 45 , 47 , 48 ]. Findings were interpreted by a radiologist [ 33 – 35 , 39 , 41 , 43 , 45 , 46 , 49 ], surgeon [ 12 , 33 , 35 , 36 , 42 ], or an unreported specialist [ 10 , 11 , 37 , 38 , 40 , 44 , 47 , 48 ]. One study [ 48 ] focused on an unstable pelvic fracture.…”

Section: Resultsmentioning

confidence: 99%

“… ? Gonzalez et al [ 41 ] 2002 > 14 ≥14 In-hos + + − + + Xp or CT + + Pehle et al [ 42 ] 2003 – – In-hos − + + + + Xp or CT − ? Waydhas et al [ 12 ] 2007 – ≤13 In-hos − − − + − Xp or CT − + Duane et al [ 43 ] 2008 > 16 – In-hos + + − + − Xp or CT + ?…”

Section: Resultsmentioning

confidence: 99%

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Diagnostic accuracy of physical examination for detecting pelvic fractures among blunt trauma patients: a systematic review and meta-analysis

et al. 2020

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Background Pelvic fractures are common among blunt trauma patients, and timely and accurate diagnosis can improve patient outcomes. However, it remains unclear whether physical examinations are sufficient in this context. This study aims to perform a systematic review and meta-analysis of studies on the diagnostic accuracy and clinical utility of physical examination for pelvic fracture among blunt trauma patients. Methods Studies were identified using the MEDLINE, EMBASE, and CENTRAL databases starting from the creation of the database to January 2020. A total of 20 studies (49,043 patients with 8300 cases [16.9%] of pelvic fracture) were included in the quality assessment and meta-analysis. Two investigators extracted the data and evaluated the risk of bias in each study. The meta-analysis involved a hierarchical summary receiver operating curve (ROC) model to calculate the diagnostic accuracy of the physical exam. Subgroup analysis assessed the extent of between-study heterogeneity. Clinical utility was assessed using decision curve analysis. Results The median prevalence of pelvic fracture was 10.5% (interquartile range, 5.1–16.5). The pooled sensitivity (and corresponding 95% confidence interval) of the hierarchical summary ROC parameters was 0.859 (0.761–0.952) at a given specificity of 0.920, which was the median value among the included studies. Subgroup analysis revealed that the pooled sensitivity among patients with a Glasgow Coma Scale score ≥ 13 was 0.933 (0.847–0.998) at a given specificity of 0.920. The corresponding value for patients with scores ≤ 13 was 0.761 (0.560–0.932). For threshold probability < 0.01 with 10–15% prevalence, the net benefit of imaging tests was higher than that of physical examination. Conclusion Imaging tests should be performed in all trauma patients regardless of findings from physical examination or patients’ levels of consciousness. However, the clinical role of physical examination should be considered given the prevalence and threshold probability in each setting.

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Wertigkeit der k�rperlichen und radiologischen Basisdiagnostik des Beckens in der Schockraumbehandlung

Cited by 59 publications

References 0 publications

Risk stratification by injury distribution in polytrauma patients -- does the clavicular fracture play a role?

Risk stratification by injury distribution in polytrauma patients -- does the clavicular fracture play a role?

Prognostic Value of Arterial Blood Gas Indices Regarding the Severity of Traumatic Injury and Fractures of the Femur and Pelvis

Diagnostic accuracy of physical examination for detecting pelvic fractures among blunt trauma patients: a systematic review and meta-analysis

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