Periorbital and Globe Injuries in Pediatric Orbital Fractures: A Retrospective Review of 116 Patients at a Level 1 Trauma Center

2020 ◽  
pp. 194338752093369
Author(s):  
Jordan Halsey ◽  
Marvin Argüello-Angarita ◽  
Osward Y. Carrasquillo ◽  
Ian C. Hoppe ◽  
Edward S. Lee ◽  
...  
Keyword(s):  
Retrospective Review ◽  
Trauma Center ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Orbital Floor ◽  
Orbital Fracture ◽  
Orbital Fractures ◽  
Orbital Floor Fractures ◽  
Level 1 ◽  
Level 1 Trauma Center

Study Design: Retrospective chart review of pediatric and globe injuries associated with orbital fractures.ObjectiveOur study seeks to examine these injuries and their association with orbital fractures at our trauma center to gain a better understanding of how to approach pediatric patients with orbital fractures. Methods: A retrospective review of all facial fractures in pediatric patients at an urban level 1 trauma center was performed for the years 2002 to 2014. Patient demographics were collected, as well as orbital fracture location, mechanism of injury, concomitant injuries, ophthalmologic documentation, imaging, and perioperative records. Results: One hundred sixteen pediatric patients over a 12-year period sustained an orbital fracture. The orbital floor was the most commonly fractured orbital bone in our series (60%). Thirty-four (30%) of the pediatric patients with orbital fractures had documented periorbital and/or globe injuries at the time of presentation. The most common periorbital injury was entrapment related to orbital floor fractures. Significant eyelid lacerations were present in seven patients, with five of these patients had canalicular injuries and two had canthal malposition. Five pediatric patients presented with traumatic optic neuropathy. Two patients had ruptured globes requiring enucleation. Conclusions: Periorbital soft tissue and globe injuries associated with orbital fractures occurs in a substantial number of pediatric patients. There are no guidelines for treatment of these type of injuries in the pediatric population. Further research should be performed to better understand the appropriate management of periorbital injuries in conjunction with surgical management of the orbital fractures

scholarly journals A Protocol to Reduce Interobserver Variability in the Computed Tomography Measurement of Orbital Floor Fractures

2015 ◽  
Vol 8 (4) ◽  
pp. 289-298 ◽  
Author(s):  
ChuanHan Ang ◽  
JinRong Low ◽  
JiaYi Shen ◽  
Elijah Zheng Yang Cai ◽  
Eileen Chor Hoong Hing ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Surface Area ◽  
Interobserver Variability ◽  
Intraclass Correlation ◽  
Orbital Floor ◽  
Orbital Fracture ◽  
Orbital Fractures ◽  
Fracture Detection ◽  
Orbital Floor Fractures

Orbital fracture detection and size determination from computed tomography (CT) scans affect the decision to operate, the type of surgical implant used, and postoperative outcomes. However, the lack of standardization of radiological signs often leads to the false-positive detection of orbital fractures, while nonstandardized landmarks lead to inaccurate defect measurements. We aim to design a novel protocol for CT measurement of orbital floor fractures and evaluate the interobserver variability on CT scan images. Qualitative aspects of this protocol include identifying direct and indirect signs of orbital fractures on CT scan images. Quantitative aspects of this protocol include measuring the surface area of pure orbital floor fractures using computer software. In this study, 15 independent observers without clinical experience in orbital fracture detection and measurement measured the orbital floor fractures of three randomly selected patients following the protocol. The time required for each measurement was recorded. The intraclass correlation coefficient of the surface area measurements is 0.999 (0.997–1.000) with p-value < 0.001. This suggests that any observer measuring the surface area will obtain a similar estimation of the fractured surface area. The maximum error limit was 0.901 cm2 which is less than the margin of error of 1 cm2 in mesh trimming for orbital reconstruction. The average duration required for each measurement was 3 minutes 19 seconds (ranging from 1 minute 35 seconds to 5 minutes). Measurements performed with our novel protocol resulted in minimal interobserver variability. This protocol is effective and generated reproducible results, is easy to teach and utilize, and its findings can be interpreted easily.

Renal trauma: a 6-year retrospective review from a level 1 trauma center in Denmark

2019 ◽  
Vol 53 (6) ◽  
pp. 398-402 ◽  
Author(s):  
Sophia Liff Maibom ◽  
Mette Lind Holm ◽  
Niklas Kahr Rasmussen ◽  
Ulla Germer ◽  
Ulla Nordström Joensen
Keyword(s):  
Retrospective Review ◽  
Trauma Center ◽  
Renal Trauma ◽  
Level 1 ◽  
Level 1 Trauma Center

scholarly journals Retrospective Review of Air Transportation Use for Upper Extremity Amputations at a Level-1 Trauma Center

2016 ◽  
Vol 08 (02) ◽  
pp. 086-090 ◽  
Author(s):  
W. Grantham ◽  
Philip To ◽  
Jeffry Watson ◽  
Jeremy Brywczynski ◽  
Donald Lee
Keyword(s):  
Upper Extremity ◽  
Retrospective Review ◽  
Trauma Center ◽  
Air Transportation ◽  
Level 1 ◽  
Level 1 Trauma Center

The cervical spine can be cleared without MRI after blunt trauma:A retrospective review of a single level 1 trauma center experience over 8 years

2018 ◽  
Vol 216 (3) ◽  
pp. 427-430
Author(s):  
Daniel Novick ◽  
Raina Wallace ◽  
Jody C. DiGiacomo ◽  
Anand Kumar ◽  
Steven Lev ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Retrospective Review ◽  
Trauma Center ◽  
Single Level ◽  
Level 1 ◽  
Level 1 Trauma Center

scholarly journals PEDIATRIC ORTHOPAEDIC TRAUMA AND ASSOCIATED INJURIES AT AN INNER-CITY LEVEL 1 TRAUMA CENTER

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0011
Author(s):  
Michael Levidy ◽  
Rahul Rai ◽  
Alice Chu ◽  
Neil Kaushal ◽  
O. Folorunsho Edobor-Osula
Keyword(s):  
Lower Extremity ◽  
Inner City ◽  
Trauma Center ◽  
Pediatric Patients ◽  
Orthopaedic Trauma ◽  
Associated Injuries ◽  
Tibia Fractures ◽  
Pediatric Orthopaedic ◽  
Level 1 ◽  
Level 1 Trauma Center

Background/Purpose: Pediatric orthopaedic trauma in inner city communities often present with unique and modifiable risk factors. The purpose of this study was to characterize and evaluate the pattern and nature of orthopaedic and associated injuries in pediatric patients involved in motor vehicle accidents (MVA), falls, sports related injuries and pedestrian struck either on foot or on bicycle at an inner-city level 1 trauma center. Methods: 260 pediatric patients who presented to the emergency department after a fall, a sports related injury, MVA, pedestrian struck on foot (PSoF), or pedestrians struck on bicycle (PSoB) with orthopaedic injuries at our institution between 2013 and 2020 were retrospectively reviewed. Results: The mean age of our cohort was 9.1 years (SD ±4.60). 36.5% (95/260) were girls, 63.5% (165/260) were boys. There were a total of 260 patients with a total of 331 fractures. 96.3% (319/331) of the fractures were appendicular while 3.6% (12/331) were axial. 43.8% (114/260) of patients had lower extremity fractures and 49.2% (128/260) had upper extremity fractures. Of all mechanisms, MVAs were most commonly associated with axial fractures (p<0.01). Falls were associated most commonly with upper extremity fractures (p<0.01), lower patient age (p<0.01) and negatively correlated with lower extremity fractures (p<0.01). Sports related injuries were most commonly correlated with tibia fractures (p<0.01). Sports etiologies were subdivided into Basketball (29%), Football (27%), Soccer (11%), and other physical activities like Rollerblading (11%) and Skateboarding (9%). PSoF was associated with tibia fractures (p<0.05) and open fractures (p<0.01). PSoB was the most likely mechanism to lead to lower extremity fractures (p=0.01) and head trauma (p<0.01). 75% (6/8) of PSoB were not wearing a helmet at the time of injury. Conclusion: Not surprisingly, falls represent the most common mechanism of pediatric orthopaedic injury. Other mechanism of injuries included MVAs, pedestrian struck on foot or bicycle were associated with more significant trauma including vertebral fractures, open fractures, head trauma and compartment syndrome. Preventative measures including education on car seat and seat belt use, helmet use and bicycle safety in children may reduce the incidence of these serious injuries. [Figure: see text]

scholarly journals Identifying trauma patients with benefit from direct transportation to Level-1 trauma centers

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Charlie A. Sewalt ◽  
Benjamin Y. Gravesteijn ◽  
Daan Nieboer ◽  
Ewout W. Steyerberg ◽  
Dennis Den Hartog ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Trauma Center ◽  
Trauma Patients ◽  
Trauma Centers ◽  
Absolute Benefit ◽  
Predicted Probability ◽  
Prehospital Triage ◽  
Level 1 ◽  
Level 1 Trauma Center ◽  
Level 2

Abstract Background Prehospital triage protocols typically try to select patients with Injury Severity Score (ISS) above 15 for direct transportation to a Level-1 trauma center. However, ISS does not necessarily discriminate between patients who benefit from immediate care at Level-1 trauma centers. The aim of this study was to assess which patients benefit from direct transportation to Level-1 trauma centers. Methods We used the American National Trauma Data Bank (NTDB), a retrospective observational cohort. All adult patients (ISS > 3) between 2015 and 2016 were included. Patients who were self-presenting or had isolated limb injury were excluded. We used logistic regression to assess the association of direct transportation to Level-1 trauma centers with in-hospital mortality adjusted for clinically relevant confounders. We used this model to define benefit as predicted probability of mortality associated with transportation to a non-Level-1 trauma center minus predicted probability associated with transportation to a Level-1 trauma center. We used a threshold of 1% as absolute benefit. Potential interaction terms with transportation to Level-1 trauma centers were included in a penalized logistic regression model to study which patients benefit. Results We included 388,845 trauma patients from 232 Level-1 centers and 429 Level-2/3 centers. A small beneficial effect was found for direct transportation to Level-1 trauma centers (adjusted Odds Ratio: 0.96, 95% Confidence Interval: 0.92–0.99) which disappeared when comparing Level-1 and 2 versus Level-3 trauma centers. In the risk approach, predicted benefit ranged between 0 and 1%. When allowing for interactions, 7% of the patients (n = 27,753) had more than 1% absolute benefit from direct transportation to Level-1 trauma centers. These patients had higher AIS Head and Thorax scores, lower GCS and lower SBP. A quarter of the patients with ISS > 15 were predicted to benefit from transportation to Level-1 centers (n = 26,522, 22%). Conclusions Benefit of transportation to a Level-1 trauma centers is quite heterogeneous across patients and the difference between Level-1 and Level-2 trauma centers is small. In particular, patients with head injury and signs of shock may benefit from care in a Level-1 trauma center. Future prehospital triage models should incorporate more complete risk profiles.

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