scholarly journals The Role of Nonophthalmologists in the Primary Evaluation of Head Injury Patients with Ocular Injuries

2021 ◽  
Vol 11 (11) ◽  
pp. 1220
Author(s):  
Chen-Hua Lin ◽  
Xiao Chun Ling ◽  
Wei-Chi Wu ◽  
Kuan-Jen Chen ◽  
Chi-Hsun Hsieh ◽  
...  
Keyword(s):  
Head Injuries ◽  
Ct Scans ◽  
Trauma Patients ◽  
Penetrating Injuries ◽  
Ocular Lesions ◽  
Ocular Injuries ◽  
Primary Evaluation ◽  
Primary Trauma ◽  
Trauma Surgeons ◽  
Visual Complaints

Purpose—Visual complaints are common in trauma cases. However, not every institution provides immediate ophthalmic consultations 24 h per day. Some patients may receive an ophthalmic consultation but without positive findings. We tried to evaluate risk factors for ocular emergencies in trauma patients. Then, the ophthalmologists could be selectively consulted. Methods—From January 2019 to December 2019, head injuries patients concurrent with suspected ocular injuries were retrospectively reviewed. All of the patients received comprehensive ophthalmic examinations by ophthalmologists. Patients with and without ocular injuries were compared. Specific ophthalmic evaluations that could be primarily performed by primary trauma surgeons were also analyzed in detail. Results—One hundred forty cases were studied. Eighty-nine (63.6%) patients had ocular lesions on computed tomography (CT) scans or needed ophthalmic medical/surgical intervention. Near 70% (69.7%, 62/89) of patients with ocular injuries were diagnosed by CT scans. There was a significantly higher proportion of penetrating injuries in patients with ocular injuries than in patients without ocular injuries (22.5% vs. 3.9%, p = 0.004). Among the patients with blunt injuries (N = 118), 69 (58.5%) patients had ocular injuries. These patients had significantly higher proportions of periorbital swelling (89.9% vs. 67.3%, p = 0.002) and diplopia (26.1% vs. 8.2%, p = 0.014) than patients without ocular injuries. Conclusions—In patients with head injuries, concomitant ocular injuries with indications for referral should always be considered. CT serves as a rapid and essential diagnostic tool for the evaluation of concomitant ocular injuries. Ophthalmologists could be selectively consulted for patients with penetrating injuries or specific ocular presentations, thus reducing the burden of ophthalmologists.

scholarly journals FREE PERITONEAL FLUID IN TRAUMA PATIENTS: THE PARADIGM SHIFT

2015 ◽  
Vol 2 (1) ◽  
pp. 3-8
Author(s):  
I. Negoi ◽  
S. Păun ◽  
S. Hostiuc ◽  
B. Stoica ◽  
I. Tănase ◽  
...  
Keyword(s):  
Peritoneal Fluid ◽  
Head Injuries ◽  
Univariate Analysis ◽  
Traumatic Injury ◽  
Preoperative Imaging ◽  
Trauma Patients ◽  
Conversion To Open Surgery ◽  
Associated Lesions ◽  
Trauma Surgeons ◽  
Free Peritoneal Fluid

Trauma surgeons are confronted nowadays with various abdominal injuries, with a more and more increased severity, secondary to urban violence and traffic related accidents. We aim to better define the prognostic value of post-traumatic hemoperitoneum (PTH) in the nowadays era of nonoperative management of abdominal lesions, and to correlate it with the current pattern of traumatic injuries. Retrospective study of patients admitted during 24 months. Selections criteria: (1) Traumatic injury; (2) Free peritoneal fluid on preoperative imaging; (3) Surgical exploration of the abdomen. Setting: A level I trauma center. Results: There were 64 patients, with two peak frequencies between 18-35 and 50-70 years old. Abdominal wall ecchymoses were found in 36 (55%) of cases. Out of 64 cases 37 (58.7%) were transportation related, 12 (19%) caused by human aggression and 10 (16.9%) by falls. According to the Trauma Score (TS) there were 50 (78.2%) cases with TS between 14-16, 9 (17.2%) between 10 –13 and 3 (4.8%) with TS <9. More frequent extraabdominal associated lesions were: head injuries – 38 (58.5%), thoracic trauma – 34 (52.3%), orthopedic injuries – 24 (36.9%). Diagnostic peritoneal lavage was performed in 5 (7.8%) cases. FAST has a sensibility of 70.21% and CT scan a sensibility of 100%. Most frequent injured abdominal organs were the spleen – 36 (56.25%), liver 17 (26.56%) and mesentery 14 (21.87%). Laparotomy was performed in 59 (92.2%) of cases, laparoscopy in 2 (3.1%) of cases and conversion to open surgery in 3 (4.7%) cases. Mortality was 23.43%. We observed several predictive factors for mortality on univariate analysis: haemoglobin < 8g/dl (p=0.02), haematocrits < 25% (p=0.01), hemoperitoneum > 1500 ml (p=0.04), colonic trauma (p=0.001), head (p=0.01) and thoracic injuries (p=0.04). Dedicated trauma surgeons should balance between trauma kinetics details, patients’ clinical examination, and diagnostic workup, in an effort to decrease morbidity and mortality secondary to missed injuries or unnecessary laparotomies.

Managing Craniomaxillofacial Injury Without Inpatient Consult: Outcomes and Patient Cost Savings

2020 ◽  
pp. 000313482092332
Author(s):  
Patrick Melmer ◽  
Ryan Taylor ◽  
Keely Muertos ◽  
Jason D. Sciarretta
Keyword(s):  
Glasgow Coma Scale ◽  
Injury Severity ◽  
Cost Savings ◽  
Ct Scans ◽  
Skull Fractures ◽  
Cost Burden ◽  
Penetrating Injuries ◽  
Readmission Rates ◽  
Total Patient ◽  
Trauma Surgeons

Background We hypothesized that trauma surgeons can safely selectively manage traumatic craniomaxillofacial injuries (CMF) without specialist consult, thereby decreasing the overall cost burden to patients. Methods A 4-year retrospective analysis of all CMF fractures diagnosed on facial CT scans. CMF consultation was compared with no-CMF consultation. Demographics, injury severity, and specialty consultation charges were recorded. Penetrating injuries, skull fractures, or patients completing inpatient craniofacial surgery were excluded. Results 303 patients were studied (124 CMF consultation vs 179 no-CMF consultation), mean age was 47.8 years, with 70% males. Mean Glasgow Coma Scale and Injury Severity Score (ISS) was 14 ± 3.4 and 10 ± 9, respectively. Patients with CMF consults had higher ISS ( P < .001) and needed surgery on admission ( P < .001), while no-CMF consults had shorter length of stay ( P < .002). No in-hospital mortality or 30-day readmission rates were related to no-CMF consult. Total patient charges saved with no-CMF consultation was $26 539.96. Discussion Trauma surgeons can selectively manage acute CMF injuries without inpatient specialist consultation. Additional guidelines can be established to avoid tertiary transfers for specialty consultation and decrease patient charges.

scholarly journals Blunt Traumatic Extracranial Cerebrovascular Injury and Ischemic Stroke

2017 ◽  
Vol 7 (1) ◽  
pp. 72-83 ◽  
Author(s):  
Paul M. Foreman ◽  
Mark R. Harrigan
Keyword(s):  
Ischemic Stroke ◽  
Motor Vehicle ◽  
Head Injuries ◽  
High Energy ◽  
Trauma Patients ◽  
Cerebrovascular Injury ◽  
Vertebral Arteries ◽  
Number Of Patients ◽  
High Energy Collisions ◽  
Trauma Surgeons

Background: Ischemic stroke occurs in a significant subset of patients with blunt traumatic cerebrovascular injury (TCVI). The patients are victims of motor vehicle crashes, assaults or other high-energy collisions, and suffer ischemic stroke due to injury to the extracranial carotid or vertebral arteries. Summary: An increasing number of patients with TCVI are being identified, largely because of the expanding use of computed tomography angiography for screening patients with blunt trauma. Patients with TCVI are particularly challenging to manage because they often suffer polytrauma, that is, numerous additional injuries including orthopedic, chest, abdominal, and head injuries. Presently, there is no consensus about optimal management. Key Messages: Most literature about TCVI and stroke has been published in trauma, general surgery, and neurosurgery journals; because of this, and because these patients are managed primarily by trauma surgeons, patients with stroke due to TCVI have been essentially hidden from view of neurologists. This review is intended to bring this clinical entity to the attention of clinicians and investigators with specific expertise in neurology and stroke.

Pediatric Trauma Patients with Temporal Bone Fractures Are at Risk for Multiple Cranial CT Scans

2020 ◽  
Author(s):  
Joshua Ewy ◽  
Martin Piazza ◽  
Brian Thorp ◽  
Michael Phillips ◽  
Carolyn Quinsey
Keyword(s):  
At Risk ◽  
Temporal Bone ◽  
Bone Fractures ◽  
Pediatric Trauma ◽  
Ct Scans ◽  
Trauma Patients ◽  
Cranial Ct

Experienced trauma team leaders save the lives of multiple-trauma patients with severe head injuries

Surgery Today ◽  
2018 ◽  
Vol 49 (3) ◽  
pp. 261-267
Author(s):  
Zhi-Jie Hong ◽  
Cheng-Jueng Chen ◽  
De-Chuan Chan ◽  
Teng-Wei Chen ◽  
Jyh-Cherng Yu ◽  
...  
Keyword(s):  
Multiple Trauma ◽  
Head Injuries ◽  
Trauma Team ◽  
Trauma Patients ◽  
Team Leaders ◽  
Multiple Trauma Patients

Diagnostic value of emergency medical services provider judgement in the identification of head injuries among trauma patients

2018 ◽  
Vol 26 (2) ◽  
pp. 274-280
Author(s):  
E. A. J. van Rein ◽  
D. Jochems ◽  
R. D. Lokerman ◽  
R. van der Sluijs ◽  
R. M. Houwert ◽  
...  
Keyword(s):  
Emergency Medical Services ◽  
Head Injuries ◽  
Diagnostic Value ◽  
Medical Services ◽  
Trauma Patients ◽  
Emergency Medical

Hazard Ratio of 90-Day Mortality in ICU Patients with Abdominal Injuries Compared with Head Injuries

2021 ◽  
Vol 24 (12) ◽  
pp. 897-902
Author(s):  
Farshid Rahimi-Bashar ◽  
Sara Ashtari ◽  
Ali Fathi Jouzdani ◽  
Seyed Jalal Madani ◽  
Keivan Gohari-Moghadam
Keyword(s):  
Head Trauma ◽  
Abdominal Trauma ◽  
Head Injuries ◽  
Public Health Problem ◽  
Hazard Ratio ◽  
Major Public Health Problem ◽  
Trauma Patients ◽  
Abdominal Injuries ◽  
Icu Patients ◽  
Surgical Icu

Background: Despite advances in the treatment of abdominal injuries in patients with trauma, it remains a major public health problem worldwide. Evaluation of hazard ratio (HR) of 90-day mortality in intensive care unit (ICU) patients with abdominal injuries compare with head injuries in trauma patients and non-trauma surgical ICU patients. Methods: This single-center, prospective cohort study was conducted on 400 patients admitted to the ICU between 2018 and 2019 due to trauma or surgery in Hamadan, Iran. The main outcome was mortality at 90-day after ICU admission. Cox proportional hazards models were used to determine the HR and 95% confidence interval (CI) for 90-day mortality. Results: The 90-day mortality was 21.9% in abdominal injuries patients. According to multivariate Cox regression, the expected hazard mortality was 2.758 times higher in patients with abdominal injuries compared to non-trauma patients (HR: 2.758, 95% CI: 1.077–7.063, P=0.034). About more than 50% of all deaths in the abdominal and head trauma groups occurred within 20 days after admission. Mean time to death was 27.85±20.1, 30.27±18.22 and 31.43±26.24 days for abdominal-trauma, surgical-ICU, and head-trauma groups, respectively. Conclusion: Difficulty in accurate diagnosis due to the complex physiological variability of abdominal trauma, less obvious clinical symptoms in blunt abdominal injuries, multi-organ dysfunction in abdominal injuries, failure to provide timely acute care, as well as different treatment methods all account for the high 90-day mortality rate in abdominal-trauma patients. Therefore, these patients need a multidisciplinary team to care for them both in the ICU and afterwards in the general ward.

Through Thick or Thin: Disparities in Perioperative Anticoagulant Use in Trauma Patients

2019 ◽  
Vol 85 (9) ◽  
pp. 1040-1043 ◽  
Author(s):  
Anna Romagnoli ◽  
Joseph Dubose ◽  
David Feliciano
Keyword(s):  
Practice Patterns ◽  
Meta Analysis ◽  
Traumatic Injury ◽  
Consensus Conference ◽  
Trauma Patients ◽  
Peripheral Artery ◽  
Perioperative Anticoagulation ◽  
Peripheral Arterial ◽  
Contemporary Practice ◽  
Trauma Surgeons

Although vascular surgery guidelines recommend immediate anticoagulation for acute occlusion of a peripheral artery, it is unclear whether trauma surgeons follow this practice. A survey regarding the use of perioperative anticoagulation was sent to surgeons who perform their own peripheral arterial repairs after traumatic injury to define contemporary practice patterns. This survey demonstrated minimal consensus opinion regarding the management of extremity vascular injuries, strongly suggesting the need for a consensus conference, meta-analysis, and prospective studies to guide further care.

scholarly journals Is computed tomography of the brain necessary in patients with clinically suspected depressed skull fracture and no focal neurological deficit?

2010 ◽  
Vol 14 (2) ◽  
pp. 28
Author(s):  
J A Rabie ◽  
S Otto ◽  
A J Le Roux
Keyword(s):  
Computed Tomography ◽  
Neurological Deficit ◽  
Descriptive Analysis ◽  
Skull Fracture ◽  
Neurological Deficits ◽  
Ct Scans ◽  
Trauma Patients ◽  
Focal Neurological Deficit ◽  
Depressed Skull Fracture ◽  
The Brain

Objective. The objective of the study was to determine whether computed tomography (CT) of the brain is necessary in all head trauma patients with clinically suspected depressed skull fractures, Glasgow Coma Scale (GCS) scores of 13 and above, and no focal neurological deficits. Design. A retrospective descriptive analysis was undertaken of patients of all ages who presented at the trauma unit of the Pelonomi Hospital Complex in Bloemfontein with GCS of 13 to 15, depressed skull fracture, no clinical focal neurological deficit, and who also underwent CT of the brain. Data were obtained from patients' files, and radiological reports and were analysed by the Department of Statistics, University of the Free State. Results. One hundred and thirty-one patients were included in the study, of whom 56 (42.7%) were found to have substantial intracranial pathology as determined by CT. Twenty-four (18.3%) of these patients had a GCS of 13, of whom 6 (25%) had normal CT scans and 18 (75%) intracranial pathology. Twenty-eight (21.37%) of the 56 patients with intracranial pathology had a GCS of 14, of whom 11 (39.3%) had normal CT scans and 17 (60.7%) intracranial pathology. A GCS of 15 was determined in 79 (60.3%) of the 131 patients, of whom 58 (73.4%) had normal CT scans and 21 (26.6%) intracranial pathology. Conclusion. Based on our findings, CT imaging of the brain in patients with a clinically suspected depressed skull fracture despite any clinical neurological deficit and a GCS of 13 or more is warranted in our setting. The likelihood of injury on CT correlated inversely with the GCS.

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