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Objective: to identify victims of blunt abdominal trauma in which intra-abdominal injuries can be excluded by clinical criteria and by complete abdominal ultrasonography. Methods: retrospective analysis of victims of blunt trauma in which the following clinical variables were analyzed: hemodynamic stability, normal neurologic exam at admission, normal physical exam of the chest at admission, normal abdomen and pelvis physical exam at admission and absence of distracting lesions (Abbreviated Injury Scale >2 at skull, thorax and/or extremities). The ultrasound results were then studied in the group of patients with all clinical variables evaluated. Results: we studied 5536 victims of blunt trauma. Intra-abdominal lesions with AIS>1 were identified in 144 (2.6%); in patients with hemodynamic stability they were present in 86 (2%); in those with hemodynamic stability and normal neurological exam at admission in 50 (1.8%); in patients with hemodynamic stability and normal neurological and chest physical exam at admission, in 39 (1.5%); in those with hemodynamic stability, normal neurological, chest, abdominal and pelvic physical exam at admission, in 12 (0.5%); in patients with hemodynamic stability, normal neurological, chest, abdominal and pelvic physical exam at admission, and absence of distracting lesions, only two (0.1%) had intra-abdominal lesions. Among those with all clinical variables, 693 had normal total abdominal ultrasound, and, within this group, there were no identified intra-abdominal lesions. Conclusion: when all clinical criteria and total abdominal ultrasound are associated, it is possible to identify a group of victims of blunt trauma with low chance of significant intra-abdominal lesions.

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Objective: to identify a subgroup of blunt trauma patients with very low chance of sustaining pelvic fractures based on clinical criteria. Methods: retrospective analysis of the trauma registry data, collected in a period of 24 months. We selected adult blunt trauma patients who had a PXR on admission. The frequency of pelvic fractures was calculated for the following groups: Normal neurological examination at admission (NNE), hemodynamical stability (HS), normal pelvic examination at admission (NPE), less than 60 years old (ID<60) and absence of distracting injuries (ADI). Logistic regression analysis was carried out in order to create a probability model of negative PXR. Results: an abnormal PXR was identified in 101 (3.3%) out of the 3,055 patients who had undergone a PXR at admission. Out of these, 1,863 sustained a NNE, with 38 positive CXRs (2.0%) in this group. Considering only the 1,535 patients with NNE and HS, we found 28 positive PXRs (1.8%). Out of these, 1,506 have NPE, with 21 abnormal PXRs (1.4%). Of these, 1,202 were younger than 60 y, with 11 positive PXRs (0.9%). By adding all these criteria to the ADI, we found 2 abnormal PXRs in 502 (0.4%) cases. The probability model including all these variables had a 0,89 area under the ROC curve. Conclusions: by adding clinical criteria, it is possible to identify a group of trauma patients with very low chance of sustaining pelvic fractures. The necessity of PXR in these patients needs to be reassessed.

Antecedentes: Las lesiones penetrantes en el esófago son extremadamente raras, menos del 0.5%; se relacionan con alta morbilidad 30-66% y mortalidad ~20%; existe un desafío diagnóstico y terapéutico; dada su severidad se requiere un abordaje oportuno y un manejo agresivo para evitar secuelas y complicaciones.Diseño del estudio: Análisis descriptivo de subgrupo de una cohorte retrospectiva (2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013) de pacientes con trauma quirúrgico. La severidad del trauma fue evaluada mediante la clasificación AAST.Resultados: Del total 2390 casos de trauma quirúrgico registrados, 10 (0.4%) corresponden a trauma de esófago. Todos los casos fueron observados en hombres con una mediana de edad de 26 años . La causa de la lesión más frecuente fue la herida por arma de fuego en 6 pacientes, seguido de herida por arma corto punzante en 2 pacientes y de onda expansiva en los 2 pacientes restantes. El RTS en la mayoría de pacientes fue de 7.84 (RIC= 7.47-7.84). La severidad del trauma esofágico fue grado II en 7 pacientes y grado III en 3 pacientes. Se observaron lesiones vasculares asociadas en 2 pacientes. Todos los pacientes fueron llevados a reparo primario de la lesión. La complicación más frecuente encontrada fue la fistula traqueo esofágica en 4 pacientes. 7 pacientes requirieron re intervención, 71% por lesiones relacionadas directamente a la lesión esofagica. No se presentó mortalidad. Conclusiones:Las lesiones esofágicas en trauma de manejo quirúrgico son infrecuentes, no se observaron muertes en esta serie. Las complicaciones son habituales, la más comúnmente relacionada es la fistula traqueo esofágica, las reintervenciones presentaron adecuada evolución.Significancia Clinica: La lesión esofágica es una lesión sumamente infrecuente con complicaciones importantes e incluso fatales, con esta investigación se busca conocer la epidemiologia relacionada con dichas lesiones, conocimiento que es clave en el proceso de aprendizaje para ofrecer mejores y mas efectivos abordajes en el momento de verse enfrentado a un trauma esofágico.Palabras claves: Fistula traqueo esofágica, gastrostomía, Trauma esofágico, traqueostomía. ABSTRACTBackground: Penetrating esophageal lesions are extremely rare, less than 0.5%. They are related to high morbidity 30--66% and mortality ~20%. There is a diagnostic and therapeutic challenge, given its severity requires a timely approach and aggressive management to avoid sequelae and complications. Study design:Descriptive subgroup analysis of a retrospective cohort (2003--2013) of patients with surgical trauma. The severity of the trauma was assessed using the AAST classification.Results: Of the total 2,390 cases of registered surgical trauma, 10 (0.4%) corresponded to an esophageal trauma. All cases were observed in men with a median age of 26 years . The cause of the most frequent injury was gunshot injury in six patients, followed by blunt gun injury in two patients and blast wave in the two remaining patients. The RTS in the majority of the pat...