Hemoperitoneum Score Helps Determine Need for Therapeutic Laparotomy

McKenney, Kimberley L.; McKenney, Mark; Cohn, Stephen M.; Compton, Raymond P.; Nuñez, Diego; Dolich, Matthew; Namias, Nicholas

doi:10.1097/00005373-200104000-00009

Cited by 98 publications

(71 citation statements)

References 19 publications

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“…It is more difficult to recognize when the patient has not been operated on, or when the drains or the chest tube become occluded by clots. In these cases the reexamination of the patient, aided by a chest radiograph, an ultrasound directed to detect liquid in the cavities [103][104][105], and a high suspicion index will help to diagnose the complication. The treatment should not be delayed, and will consist of surgical exploration with the strong consideration of performing damage control procedures.…”

Section: The Hypotense or Hypoperfused Trauma Patient In The Icumentioning

confidence: 99%

Critical Care Issues in the Early Management of Severe Trauma

García

2006

Surgical Clinics of North America

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Violent trauma and road traffic injuries kill more than 2.5 million people in the world every year. It has been calculated by the World Health Organization that in 2002 there occurred 1.6 million violent deaths [1] and 1.2 million deaths from traffic injury [2], for a combined mortality of 48 deaths per 100,000 population per year.Most trauma deaths occur at the scene or in the first hour after trauma, with a proportion from 34% to 50% occurring in hospitals [3]. These deaths could be prevented by optimization of trauma care. Preventability of trauma deaths has been reported as high as 76% [4] and as low as 1% in mature trauma systems [5,6].Prehospitalization procedures, elapsed time to hospital arrival are, of course, vital to the whole trauma scenario, but errors made in the in-hospital phase of care are responsible for one third to two thirds of the reported by different authors [7,8]. Of these, intensive care unit (ICU) errors are among the most frequent and significant. Errors in the ICU management of trauma patients were studied by Duke and colleagues [9]. They reported 165 ICU trauma deaths. Two hundred fifty-eight errors occurred in 81 patients (52%), and 134 of them contributed to death in 52 patients (34%). ICU errors were classified as management errors (82%), diagnostic (9%), technique (5%), and system inadequacies (4%). Davis and colleagues [10] identified critical care errors in 30% of 125 trauma deaths with errors. These errors contributed to 48% of all preventable deaths.The most common critical care errors are related to airway and respiratory management, fluid resuscitation, neurotrauma diagnosis and support, and delayed diagnosis of critical lesions [9,10].It is imperative for the general surgeon who takes care of trauma patients to know how to deal with these critical aspects, to reduce preventable morbidity and mortality. In the next segment, the situations in which the participation of the surgeon is crucial, during the initial phases of reanimation and stabilization of the critically traumatized patient will be discussed. Airway and ventilation managementAirway and respiratory management errors are the most common of those identified by several authors [9][10][11] The cardinal manifestation is a sudden or a rapidly progressing desaturation, frequently accompanied by tachycardia and arrhytmias, and occasionally by agitation. Hypertension announces the cardiovascular collapse, and bradicardia appears immediately after the total collapse [12]. The symptoms should not be attributed to agitation when it is present, and other possible causes must be ruled out before. Diagnosing the complication involves a directed physical examination, the analysis of the airway pressures and ventilator volumes, chest radiographs, and sometimes the measurement of arterial blood gases (ABG), and the urinary bladder pressure ( Table 1).The emergency conditions in which the access to the airways must be gained, the displacement to diagnosis areas or operating room and the agitation, often present, make the critical...

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Section: The Hypotense or Hypoperfused Trauma Patient In The Icumentioning

confidence: 99%

Critical Care Issues in the Early Management of Severe Trauma

García

2006

Surgical Clinics of North America

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“…McKenney et al [35,36] developed and prospectively evaluated a scoring system that measured the depth of fluid in the deepest pocket, and 1 point was added for fluid in each of the other areas (four areas maximum.) In this study, 85% of patients with a score [3 required a therapeutic laparotomy, whereas 15% of patients with a score of 2 required surgery.…”

Section: Fluid Volume and Scoring Systemsmentioning

confidence: 99%

Ultrasound in abdominal trauma

Rose

2004

Emergency Medicine Clinics of North America

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Ultrasound in the evaluation of abdominal trauma has evolved over the past 30 years. The use of ultrasound for abdominal trauma was described initially by Kristensen and colleagues [1] in 1971. In 1976, Ascher and colleagues [2] first reported the accuracy of ultrasound in Radiology, with 80% sensitivity for the detection of splenic injury. In a study of 808 patients, Tiling and colleagues [3] in 1990 reported a sensitivity of 89%, a specificity of 100%, and an accuracy of 98%. This same group also was first to comment on the effect of training and experience and reported that surgeons with extensive ultrasound experience could diagnose intra-abdominal fluid with a sensitivity of 96% and an accuracy of 99%. Interest and experience with ultrasound for trauma grew steadily around the world among surgeons and emergency physicians during the early 1990s [4][5][6][7]. During this period, ultrasound technology was improving with regard to price, portability, and resolution, allowing its use during resuscitation. At the same time, in the United States, there was continuing reliance on diagnostic peritoneal lavage (DPL) and CT and much less interest in sonography for abdominal trauma. This all changed when emergency physicians and surgeons in the United States began to publish their experience with ultrasound [4,8,9]. The term Focused Assessment with Sonography for Trauma (FAST) was coined by Rozycki et al [10] in 1996 and has persisted as the accepted acronym for the trauma ultrasound evaluation. The basic four-view examination (perihepatic, perisplenic, pelvic, and pericardial views) has become the foundation of the FAST examination. The rapid, noninvasive, and practical nature of ultrasound for bedside evaluation of critically injured patients has changed the evaluation of blunt abdominal trauma.

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“…Произведен сравнительный анализ прогности-ческой ценности различных критериев отбора пациентов для NOM, описанных в литературе: 1) ультразвуковых шкал количественной оценки гемоперитонеума Huang [10] (табл. 1) и McKenney [11], 2) гемодинамических показателей, 3) уров-ня гемоглобина, 4) различных вариантов соче-тания вышеуказанных факторов, 5) ультразву-ковой шкалы отбора пациентов на операцию при травме -SSORTT (Sonographic Scoring for Operating Room Triage in Trauma) [8].…”

Section: материал и методыunclassified

Non-Operative Management of Blunt Abdominal Trauma: Positive Predictors

et al. 2017

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Актуальность. В последние годы в ведущих мировых специализированных центрах избира-тельное консервативное ведение (NOM -nonoperative management) входит в стандартные протоколы лечения закрытой травмы. В основе успеха применения данной тактики лежит тща-тельный отбор пострадавших. Критерии селек-ции до настоящего времени четко не опреде-лены. Целью исследования стало определение прогностических критериев успешного NOM и разработка лечебно-диагностического алго-ритма его применения. Материал и методы. В исследование включены 209 пострадавших с травмой живота, в лечении которых в период с января 2006 по сентябрь 2015 г. применена лапароскопия либо консервативное ведение. Анализировались объем гемоперитонеума и степень повреждения органов по данным уль-тразвукового исследования и компьютерной томографии, уровень гемоглобина, уровень артериального давления и пульс. Произведен сравнительный анализ прогностической цен-ности различных критериев отбора пациентов для NOM, описанных в литературе: 1) ультра-звуковых шкал количественной оценки гемо-перитонеума Huang и McKenney, 2) гемодина-мических показателей, 3) уровня гемоглобина, 4) различных вариантов сочетания вышеука-занных факторов, 5) ультразвуковой шкалы от-бора пациентов на операцию при травме -шка-лы SSORTT. Результаты. Положительная прогностическая ценность использованных в исследовании показателей по отдельности, их комбинаций, а также различных вариантов балльной оценки каждого из факторов варьи-ровала от 88 до 91,7%. При этом не выявлено статистически значимых различий между по-ложительной прогностической ценностью всех вариантов сочетания факторов и оценкой толь-ко ультразвуковых данных по шкале McKenney. Заключение. Предложенные нами прогности-ческие критерии и выработанный лечебно-диа-гностический алгоритм просты и доступны для применения в клинической практике. В последние годы в ведущих мировых специализированных центрах консер-вативное ведение (англ. non-operative management -NOM) вошло в стандарт-ные протоколы лечения закрытой травмы живо-та [1][2][3][4][5]. Суть тактики заключается в проведении динамического клинико-инструментального мо-ниторинга состояния пострадавшего в расчете на спонтанный гемостаз при повреждении па-ренхиматозных органов либо в выполнении эн-доваскулярного гемостаза при продолжающемся крово течении у гемодинамически стабильного па-циента. Эффективность консервативного ведения абдоминальной травмы по различным данным варьирует от 61,5 до 97% [1][2][3][4][5][6][7]. Ключевым усло-вием для успешного применения консервативной тактики служит тщательный отбор пострадавших. Среди прогностических критериев успешности NOM фигурируют: стабильность гемодинамики, объем гемоперитонеума и тяжесть повреждений паренхиматозных органов по данным ультразву-кового исследования (УЗИ) и компьютерной то-мографии (КТ), отсутствие подозрения на травму полых органов по данным КТ, объем гемотранс-фузии, необходимый для поддержания гемогло-бина на уровне 80-90 г/л, возраст пострадавшего [1][2][3][4][5][6][7][8]. Несмотря на достаточно широкое распро-странени...

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Hemoperitoneum Score Helps Determine Need for Therapeutic Laparotomy

Abstract: We conclude that the majority of patients with a score > or = 3 will need surgery. The US hemoperitoneum scoring system was a better predictor of a therapeutic laparotomy than initial blood pressure and/or base deficit.

Cited by 98 publications

References 19 publications

Critical Care Issues in the Early Management of Severe Trauma

Critical Care Issues in the Early Management of Severe Trauma

Ultrasound in abdominal trauma

Non-Operative Management of Blunt Abdominal Trauma: Positive Predictors

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