J Trauma
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Comparative Study
Hand-held thoracic sonography for detecting post-traumatic pneumothoraces: the Extended Focused Assessment with Sonography for Trauma (EFAST).
Thoracic ultrasound (EFAST) has shown promise in inferring the presence of post-traumatic pneumothoraces (PTXs) and may have a particular value in identifying occult pneumothoraces (OPTXs) missed by the AP supine chest radiograph (CXR). However, the diagnostic utility of hand-held US has not been previously evaluated in this role. ⋯ EFAST has comparable specificity to CXR but is more sensitive for the detection of OPTXs after trauma. Positive EFAST findings should be addressed either clinically or with CT depending on hemodynamic stability. CT should be used if detection of all PTXs is desired.
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To facilitate the identification of ED patients at risk for intimate partner violence (IPV), we assessed the relationship of acute violence-related injury and history of IPV victimization or perpetration. ⋯ Screening for IPV among individuals presenting with a violence-related injury may be helpful in identifying individuals at risk of partner violence.
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CT scans are often used in the evaluation of blunt trauma patients. Many scans are negative. Clinical predictors of positive abdominal CT scans would be beneficial in patient care. ⋯ Our data suggest that an abnormal pelvis x-ray and intubation are significant risk factors for a positive CT scan. Alcohol intoxication, mechanism of injury, and unreliable examination, without other associated indication for a scan, may warrant further study.
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This study aimed to determine predictive factors of mortality after posttraumatic brain injury. ⋯ In Tunisia, head injury is a frequent cause of hospitalization, comprising 14.4% of all adult admissions. It is observed most often among young patients involved in traffic accidents. The short-term prognosis is poor, with a high (29%) mortality rate, and determined by demographic, clinical, radiologic, and biologic factors. Prevention is highly advised.
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Free abdominal fluid on ultrasound in unstable pelvic ring fracture: is laparotomy always necessary?
In unstable pelvic ring fractures free abdominal fluid on ultrasound (US) may be caused by retroperitoneal hematoma that passes into the abdominal cavity or by an additional intraabdominal lesion. In this study a clinical pathway for the therapy of potentially combined lesions was analyzed. ⋯ The finding of intraperitoneal fluid on US in the emergency department strongly correlates with significant intraabdominal lesions requiring surgical intervention. Early laparotomy appears indicated in these cases. Shock control in pelvic bleeding can be sufficiently achieved by internal tamponade and external fixation.