European journal of trauma and emergency surgery : official publication of the European Trauma Society
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Eur J Trauma Emerg Surg · Feb 2018
ReviewTraumatic inferior shoulder dislocation: a review of management and outcome.
Traumatic inferior shoulder dislocation (ISD) is rare, estimated to occur in 0.5% of all shoulder dislocations. We describe the demographics, natural history and outcome of this injury. ⋯ Clinical and radiographic assessment of ISD is key to diagnosis and successful reduction. Patients can be treated with shoulder immobilisation for 2-3 weeks. In the setting of ongoing pain or instability, further imaging should be performed. The outcome of ISD is generally favourable.
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Eur J Trauma Emerg Surg · Feb 2018
Predictors of outcome in 101 patients requiring emergent thoracotomy for penetrating pulmonary injuries.
Operative interventions are uncommonly required for penetrating pulmonary injuries. Similarly, because their incidence is low, few series appear sporadically in the literature. Objectives of this study are to identify predictors of outcome for patients requiring emergent thoracotomy for penetrating pulmonary injuries and evaluate the use of tissue sparing versus resective techniques for their management. ⋯ Predictors of outcome for penetrating pulmonary injuries requiring thoracotomy are identified and must be taken into account in their operative management. Tissue sparing techniques-stapled pulmonary tractotomy is once again validated, and it remains effective as the mainstay for their management; however, only pneumonectomy predicts outcome. AAST-OIS injury grades IV-VI predict outcome with higher injury grades requiring resective procedures.
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Eur J Trauma Emerg Surg · Feb 2018
Improved outcomes for hepatic trauma in England and Wales over a decade of trauma and hepatobiliary surgery centralisation.
Over the last decade trauma services have undergone a reconfiguration in England and Wales. The objective is to describe the epidemiology, management and outcomes for liver trauma over this period and examine factors predicting survival. ⋯ Our study has shown that being treated in a unit with an on-site HPB service increased the odds of survival. Further evaluation of the benefits of trauma and HPB surgery centralisation is warranted.
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The rise of computed tomography (CT) use in trauma has become the subject of concern given the harms of CT including radiation, cost, over diagnosis and identification of incidental lesions. We developed a novel metric, the Negative CT Score, (∑CT-) which quantifies how often CT imaging identifies important injuries. Our objective was to describe the pattern of CT utilization in trauma at an urban academic level one trauma center using this novel metric. ⋯ In a consecutive series of 552 intermediate trauma patients at our urban trauma center, 2.36 body regions were scanned per patient; of these, 2.10 regions revealed no important CT findings. We hope that these results and the Negative CT Score can be used to identify trends, variations in practice, and outliers within and across departments so that CT utilization can be optimized.
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Eur J Trauma Emerg Surg · Feb 2018
Cumulative radiation exposure and estimated lifetime cancer risk in multiple-injury adult patients undergoing repeated or multiple CTs.
To estimate the cumulative radiation exposure and lifetime attributable risk (LAR) of radiation-induced cancer from computed tomographic (CT) scanning of adult patients with multiple-injury traumas. ⋯ More than half of the multiple-injury trauma patients were classified as low risk cumulative effective dose (≤20 mSv) and almost all patients had a low LAR risk of cancer incidence from CT studies. Patients who were at the highest risk of cancer from CT scans were those aged under 30 years who had multiple or repeated scans, particularly in the trunk.