Single Versus Multiple Solid Organ Injuries Following Blunt Abdominal Trauma

El‐Menyar, Ayman; Abdelrahman, Husham; Al-Hassani, Ammar; Peralta, Rubén; Abdel-Aziz, Hiba; Latifi, Rifat; Al-Thani, Hassan

doi:10.1007/s00268-017-4087-3

Cited by 28 publications

(23 citation statements)

References 33 publications

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“…Other injuries, such as splenic injuries, kidney injuries and pelvic fractures, might be associated with devastating haemorrhagic events. However, due to the advancement of angioembolisation, a substantial proportion of these patients can be managed in a non-operative manner, with dramatically improved survival 51–53. Pneumohemothoraces could be present in a wide variety of chest injuries.…”

Section: Discussionmentioning

confidence: 99%

Inequality of trauma care under a single-payer universal coverage system in Taiwan: a nationwide cohort study from the National Health Insurance Research Database

Kuo

Liao

et al. 2019

BMJ Open

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ObjectivesTo assess the impact of lower socioeconomic status on the outcome of major torso trauma patients under the single-payer system by the National Health Insurance (NHI) in Taiwan.DesignA nationwide, retrospective cohort study.SettingAn observational study from the NHI Research Database (NHIRD), involving all the insurees in the NHI.ParticipantsPatients with major torso trauma (injury severity score ≥16) from 2003 to 2013 in Taiwan were included. International Classification of Disease, Ninth Revision, Clinical Modification codes were used to identify trauma patients. A total of 64 721 patients were initially identified in the NHIRD. After applying the exclusion criteria, 20 009 patients were included in our statistical analysis.Primary and secondary outcome measuresThe primary outcome measure was in-hospital mortality, and we analysed patients with different income levels and geographic regions. Multiple logistic regression was used to control for confounding variables.ResultsIn univariate analysis, geographic disparities and low-income level were both risk factors for in-hospital mortality for patients with major torso trauma (p=0.002 and <0.001, respectively). However, in multivariate analysis, only a low-income level remained an independent risk factor for increased in-hospital mortality (p<0.001).ConclusionEven with the NHI, wealth inequity still led to different outcomes for major torso trauma in Taiwan. Health policies must focus on this vulnerable group to eliminate inequality in trauma care.

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Section: Discussionmentioning

confidence: 99%

Inequality of trauma care under a single-payer universal coverage system in Taiwan: a nationwide cohort study from the National Health Insurance Research Database

Kuo

Liao

et al. 2019

BMJ Open

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“…This study comprised of mainly blunt trauma (95%) cases; the cardiovascular responses in patients with blunt trauma may differ from those with penetrating injuries. Although SI is also a useful tool for triaging patients for improved outcomes and effective utilization of resources (El-Menyar et al 2017; Khan et al 2013; Heidar et al 2014), we do believe that further prospective studies comparing utility of SI with the other scoring tools are needed in patients with potential SOI.…”

Section: Limitationsmentioning

confidence: 96%

“…Polytrauma patients are frequently diagnosed to have abdominal injuries with an estimated frequency of 15–17/100,000 in Qatar (Arumugam et al 2015). In particular, abdominal solid organ injury (SOI) secondary to high-impact trauma results in considerable bleeding, morbidity and mortality (El-Menyar et al 2017). SOI includes any grade of injury to the liver, spleen, kidneys or pancreas in isolation or combination.…”

Section: Introductionmentioning

confidence: 99%

“…Rapid diagnosis of SOIs, mainly liver and spleen, is important to minimize the risk of hemorrhagic shock, the need for surgery and post-operative complications (Sawhney et al 2014). Abdominal trauma patients who are found to have lower grade SOI with normal physiological status are usually treated non-operatively (El-Menyar et al 2017). On the other hand, hemodynamic instability despite resuscitation is an indication to consider immediate exploratory laparotomy and definitive surgery (Stawicki 2017).…”

Section: Introductionmentioning

confidence: 99%

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Shock index in patients with traumatic solid organ injury as a predictor of massive blood transfusion protocol activation

et al. 2019

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PurposeWe aimed to assess the utility of shock index (SI) to predict the need for massive transfusion protocol (MTP) in patients with solid organ injury (SOI) in a Level 1 Trauma center.MethodsWe conducted a retrospective analysis for patients with SOI between 2011 and 2014. Patients were categorized according to on-admission SI into low (< 0.8) and high SI (≥0.8) group.ResultsA total of 4500 patients were admitted with trauma, of them 572 sustained SOIs (289 patients had SI ≥0.8). In comparison to low SI, patients with high SI were younger, had higher injury severity scores (ISS) and lower Trauma and Injury Severity Score (TRISS); (p < 0.001). The proportion of exploratory laparotomy (EXLap), blood transfusion (BT), MTP activation, sepsis and hospital mortality were significantly higher in patients with high SI. Serum lactate (r = 0.34), hematocrit (r = − 0.34), ABC score (r = 0.62), ISS (r = 0.35), and amount of transfused blood (r = 0.22) were significantly correlated with SI. On multivariable regression analysis using 9 relevant variables (age, sex, ISS, ED GCS, serum lactate, hematocrit, Abdomen AIS and Focused assessment with sonography in trauma (FAST) and SI), SI ≥ 0.8 was an independent predictor of BT (OR 2.80; 95%CI 1.56–4.95) and MTP (OR 2.81;95% CI 1.09–7.21) .ConclusionsIn patients with SOI, SI is a simple bedside predictor for BT and MTP activation. Further prospective studies are needed to support our findings.

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“…After the liver the spleen is the second most commonly injured organ during blunt abdominal trauma [1]. When a trauma patient who is hemodinamically unstable or with diffuse peritoneal signs and free fluid is detected at Focused Assessment with Sonography for Trauma (FAST) examination, a laparotomy is usually performed.…”

Section: Introductionmentioning

confidence: 99%

Contrast-enhanced ultrasound performance in predicting blunt splenic injuries requiring only observation and monitoring

2019

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Aims: To assess contrast enhanced ultrasound (CEUS) performance in the prediction of non-operatively managed blunt spleen injuries requiring only observation and monitoring during follow-up and to evaluate if CEUS accuracy was higher than conventional ultrasound (US) in this field.Material and methods: In 112 hemodynamic stable blunt spleen trauma patients, CEUS was performed for follow-up after computed tomography evaluation in the emergency department. CEUS and US performance were assessed considering as true negative cases patients that had not underwent interventional or surgical treatment during follow-up and were assessed as negative for splenic complications respectively by CEUS or US examinations.Results: CEUS showed sensitivity of 100%, specificity of 96.1%, positive predictive value of 69.2%, negative predictive value of 100.0% and accuracy of 96.4%. CEUS showed a significantly higher accuracy than conventional US (p=0.013).Conclusions: CEUS is a very useful imaging modality during follow-up of blunt splenic trauma non-operatively managed, allowing an efficientprediction of splenic injuries requiring only observation and monitoring during follow-up.

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Single Versus Multiple Solid Organ Injuries Following Blunt Abdominal Trauma

Cited by 28 publications

References 33 publications

Inequality of trauma care under a single-payer universal coverage system in Taiwan: a nationwide cohort study from the National Health Insurance Research Database

Inequality of trauma care under a single-payer universal coverage system in Taiwan: a nationwide cohort study from the National Health Insurance Research Database

Shock index in patients with traumatic solid organ injury as a predictor of massive blood transfusion protocol activation

Contrast-enhanced ultrasound performance in predicting blunt splenic injuries requiring only observation and monitoring

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