The American journal of emergency medicine
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It is a common practice to routinely obtain x-rays before clinical evaluation and cleaning of glass-caused wounds to assess for possible retained foreign bodies (FBs). [Am J Surg 1982;144(July):63-5; Ann Emerg Med 1983;12(July):434-7; Emerg Med Clin NorthAm 1985;3(2):383-91; Emerg Med Clin North Am 1992;10:163-77; Ann Emerg Med 1988 17(12):125-34; Emerg Med Clin North Am 1992;10(4):757-79] This prospective study was designed to question whether routine x-rays are necessary for all patients with glass-caused wounds. Plain films were taken before clinical exam but not reviewed until after the exam was completed. Wounds were categorized according to depth, whether or not the clinician was able to adequately explore the wound, and whether or not an FB was found clinically. ⋯ Almost all of these superficial wounds (99.2%, 133/134) could be adequately explored. There were clinically undetected FBs (ie, wounds that benefited from x-ray) in 2 (1.5%) of 134 superficial wounds and 10 (7.7%) of 130 deeper wounds. In light of the benign nature of the 2 superficial wounds in which an FB was missed clinically, we conclude that there exists a subset of glass-caused wounds that are superficial and adequately explorable, and, therefore, do not need routine x-rays.
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National estimates of the number of lacerations are based on the number of wounds cared for in the emergency department (ED). However, this number includes wounds other than lacerations. We estimated the number and characteristics of lacerations treated in the United States between 1992 and 2002. ⋯ Despite an increase in the total number of ED visits over the last decade, the number of lacerations has declined, as is less than previously estimated.
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Currently, nonoperative management is the procedure of choice for solid organ injury in patients with a blunt abdominal trauma. Missed blunt bowel and mesenteric injuries (BBMIs) are possible because diagnosis is difficult. The aim of our study was to test a new algorithm for BBMI diagnosis using abdominal ultrasonography (AUS), computed tomography (CT), and diagnostic peritoneal lavage (DPL). ⋯ The proposed algorithm (based on AUS, CT, and DPL) had a high accuracy to diagnose BBMI while requiring the performance of DPL in only a few (2%) patients.