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Penetrating Trauma (penetrating + trauma)
Selected AbstractsThe Influence of Penetrative Trauma on the Rate of Decomposition,JOURNAL OF FORENSIC SCIENCES, Issue 2 2010Peter Cross M.Sc. Abstract:, An understanding of the factors affecting decomposition is important for the accurate estimation of postmortem interval. An experimental study on the influence of penetrating trauma on decomposition rate was carried out using the domestic pig, Sus scrofa. The results of this study were: (i) Diptera were preferentially attracted to and oviposited at natural orifices. Trauma sites were not preferentially selected for oviposition; (ii) no differences between trauma and non-trauma groups were found in time to skeletonization, weight loss (p = 0.906), total body score (p = 0.824), body temperature (p = 0.967), or changes in soil pH (p = 0.684); and (iii) the effect of investigator disturbance was significant when decomposition was measured as weight loss (p = 0.000). This study suggests that penetrating trauma of the type used in this study cannot be considered a major factor in the rate of decomposition and time to skeletonization of a gunshot trauma victim. [source] Sensitivity of Bedside Ultrasound and Supine Anteroposterior Chest Radiographs for the Identification of Pneumothorax After Blunt TraumaACADEMIC EMERGENCY MEDICINE, Issue 1 2010R. Gentry Wilkerson MD Abstract Objectives:, Supine anteroposterior (AP) chest radiographs in patients with blunt trauma have poor sensitivity for the identification of pneumothorax. Ultrasound (US) has been proposed as an alternative screening test for pneumothorax in this population. The authors conducted an evidence-based review of the medical literature to compare sensitivity of bedside US and AP chest radiographs in identifying pneumothorax after blunt trauma. Methods:, MEDLINE and EMBASE databases were searched for trials from 1965 through June 2009 using a search strategy derived from the following PICO formulation of our clinical question: patients included adult (18 + years) emergency department (ED) patients in whom pneumothorax was suspected after blunt trauma. The intervention was thoracic ultrasonography for the detection of pneumothorax. The comparator was the supine AP chest radiograph during the initial evaluation of the patient. The outcome was the diagnostic performance of US in identifying the presence of pneumothorax in the study population. The criterion standard for the presence or absence of pneumothorax was computed tomography (CT) of the chest or a rush of air during thoracostomy tube placement (in unstable patients). Prospective, observational trials of emergency physician (EP)-performed thoracic US were included. Trials in which the exams were performed by radiologists or surgeons, or trials that investigated patients suffering penetrating trauma or with spontaneous or iatrogenic pneumothoraces, were excluded. The methodologic quality of the studies was assessed. Qualitative methods were used to summarize the study results. Data analysis consisted of test performance (sensitivity and specificity, with 95% confidence intervals [CIs]) of thoracic US and supine AP chest radiography. Results:, Four prospective observational studies were identified, with a total of 606 subjects who met the inclusion and exclusion criteria. The sensitivity and specificity of US for the detection of pneumothorax ranged from 86% to 98% and 97% to 100%, respectively. The sensitivity of supine AP chest radiographs for the detection of pneumothorax ranged from 28% to 75%. The specificity of supine AP chest radiographs was 100% in all included studies. Conclusions:, This evidence-based review suggests that bedside thoracic US is a more sensitive screening test than supine AP chest radiography for the detection of pneumothorax in adult patients with blunt chest trauma. ACADEMIC EMERGENCY MEDICINE 2010; 17:11,17 © 2010 by the Society for Academic Emergency Medicine [source] Effect of Race and Insurance on Outcome of Pediatric TraumaACADEMIC EMERGENCY MEDICINE, Issue 8 2010Wael Hakmeh DO ACADEMIC EMERGENCY MEDICINE 2010; 17:809,812 © 2010 by the Society for Academic Emergency Medicine Abstract Objectives:, This study sought to determine if insurance or race status affect trauma outcomes in pediatric trauma patients. Methods:, Using the National Trauma Data Bank (NTDB; v6.2), the following variables were extracted: age (0,17 years), payment type (insured, Medicaid/Medicare, or self-pay), race (white, Black/African American, or Hispanic), Injury Severity Score (ISS > 8), type of trauma (blunt or penetrating), and discharge status (alive or dead). Data were analyzed using logistic regression. Results:, Of the 70,781 patient visits analyzed, 67% were insured, 23% were Medicaid/Medicare, and 10% were self-pay. Self-pay patients had higher mortality (11%, compared to Medicaid/Medicare at 5% and insured at 4%; p < 0.001). African Americans and Hispanics also had higher mortality (7 and 6%) compared to whites (4%; p < 0.001). Self-pay patients more likely suffered penetrating trauma than insured patients (12% vs. 4%; p < 0.001), and mortality for penetrating trauma self-pay patients was 29%, compared to only 11% for penetrating trauma insured patients (p < 0.001). The mortality rate varied from a low of 3% for insured whites, to 18% for self-pay African Americans. Logistic regression (including race, insurance status, injury type, and ISS) revealed that African Americans and Hispanics both had an increased risk of death compared to whites (African American odds ratio [OR] = 1.37, Hispanic OR = 1.20). Medicaid/Medicare patients had a slightly increased risk of death with OR = 1.14, but self-pay patients were almost three times more likely to die (adjusted OR = 2.92). Conclusions:, After controlling for ISS and type of injury, mortality disparity exists for uninsured, African American, and Hispanic pediatric trauma patients. Although the reasons for this are unclear, efforts to decrease these disparities are needed. [source] HP38P MANAGEMENT OF TRAUMATIC PANCREATIC INJURYANZ JOURNAL OF SURGERY, Issue 2007A. M. Warwick Background Trauma to the pancreas is a challenging area both in initial diagnosis and longer-term management. The retroperitoneal location makes clinical diagnosis of injury difficult and delayed diagnosis has morbid complications. Methods A review of patients with a diagnosis of traumatic pancreatic injury was performed, over a period of five years, from 2002 to 2006. We assessed the type of injury that occurred in the pancreas after both blunt and penetrating trauma; the diagnosis and timing of pancreatic injury; the need for operative/radiological intervention; and the complications of these injuries. Specifically patients with complex injuries were evaluated and these cases were critically reviewed. Results We identified 45 of cases of pancreatic trauma, aged 16,85, with a mean ISS of 27.8. Minor injury to the pancreas was found in 29 patients, and 16 patients had severe trauma to the pancreas, either major laceration or transection. Four particularly complex cases were identified, two of which required a Whipple's procedure following gunshot wounds involving the pancreatic head. Two patients with abdominal crush injuries required multiple interventions. Conclusions Patients with pancreatic trauma often have other significant injuries and one should have a high degree of suspicion of pancreatic injury in multiply injured patients. Penetrating injury to the pancreas can result in catastrophic injury requiring radical surgery. Blunt injury should be assessed by magnetic resonance cholangio-pancreatography or at laparotomy. The management of pancreatic trauma is complex and these patients should be managed in a tertiary hospital with involvement by both specialised pancreatic and trauma surgeons. [source] ROLE OF LAPAROSCOPY IN BLUNT LIVER TRAUMAANZ JOURNAL OF SURGERY, Issue 5 2006Charles H. C. Pilgrim Although much has been written about the role of laparoscopy in the acute setting for victims of blunt and penetrating trauma, little has been published on delayed laparoscopy relating specifically to complications of conservative management of liver trauma. There has been a shift towards managing liver trauma conservatively, with haemodynamic instability being the key indication for emergency laparotomy, rather than computed tomography findings. However, as a side-effect of more liver injuries being treated non-operatively, bile leak from a disrupted biliary tree presenting later in admission has appeared as a new problem to manage. We describe in this article three cases that have been managed by laparoscopy and drainage alone, outlining the advantages of this technique and defining a new role for delayed laparoscopy in blunt liver trauma. [source] SEVERE TRAUMA CAUSED BY STABBING AND FIREARMS IN METROPOLITAN SYDNEY, NEW SOUTH WALES, AUSTRALIAANZ JOURNAL OF SURGERY, Issue 4 2005Kenneth Wong Background: Stabbing and firearm trauma causing severe injuries (injury severity score (ISS) >15) and death is uncommon in Australia. The present study describes the experience with stabbings and firearm trauma causing severe injuries at a major Australian urban trauma centre. Methods: Data from a prospectively generated trauma registry regarding all patients presenting to Royal Prince Alfred Hospital (RPAH), Sydney, Australia with penetrating trauma causing severe injuries from July 1991 to June 2001 was retrospectively analysed. Results: Of all patients presenting to RPAH with stabbing and firearms wounds over the 11 year study period, 28% received an ISS >15. One hundred and forty patients were identified. 94% were male. The mean age was 34 years (15,82 years). The number of cases/year has not shown an increasing trend. Thirty per cent of patients sustained firearm related injuries, with the remainder mainly caused by knives or machetes. Fifteen per cent of injuries were self inflicted. The most common location of injury was on a public street. Fifty-two per cent of patients were injured in more than one anatomical region, with the abdomen being the most common site of injury (53%). On hundred and seventy-four operations were performed , laparotomies (43%), thoracotomies (26%), craniotomies (5%) and orthopaedic, vascular, wound explorations and other procedures (26%). Twenty-eight per cent of patients suffered at least one complication during their admission, with coagulopathy being the most common complication (20%). Mean length of stay was 10.4 days (1,107 days). The total mortality rate for the severely injured patients was 21%, with gun-related injuries having a higher mortality rate than stabbing injury (36%vs 15%). Sixty per cent of deaths were related to exsanguination. Conclusions: Stabbings and firearm trauma are associated with significant morbidity, mortality and utilization of hospital resources in metropolitan Sydney. Overall mortality rates are similar to institutions with higher volumes of penetrating trauma. 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