Articles: trauma.
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Review Meta Analysis
Bedside-focused transthoracic echocardiography in acute atraumatic thoracic aortic syndrome: a systematic review and meta-analysis of diagnostic accuracy.
The objective of this review was to assess the diagnostic accuracy of bedside-focused transthoracic echocardiography (TTE) in acute atraumatic thoracic aortic syndrome in adults. We performed a systematic review and meta-analysis of publications that described the use of bedside-focused TTE on adults presenting to emergency care settings with suspected atraumatic thoracic aortic syndrome. Studies were identified using keyword and MeSH on relevant databases as well as grey literature, followed by abstract screening and study selection by two independent reviewers. ⋯ For type B dissection, pooled sensitivity was 65% (95% CI, 45-80%) and specificity was 100% (95% CI, 0.69-100%). Regarding indirect TTE signs, pooled sensitivities and specificities were 64% (5.2-98.2%) and 94% (92-96.1%), respectively for aortic valve regurgitation, 92% (54-99.2%) and 87% (62-97%) for thoracic aortic aneurysm and 39% (33.8-45%) and 94% (92-95%) for pericardial effusion. In this systematic review and meta-analysis, bedside-focused TTE has high specificity for type A and B dissection, a moderate to high sensitivity for type A but poor for type B, and unclear diagnostic accuracy for intramural haematoma and penetrating aortic ulcer.
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Spinal injuries occur in 3% of all patients with trauma, most commonly in males, and often as a result of high-velocity impact followed by abrupt deceleration. The most affected region after spinal trauma is the thoracolumbar junction because of the anterior center of gravity at the T12-L1 vertebral level and the relatively stiff thoracic spine uniting with the mobile lumbar spine. Many classifications exist to guide the choice of operative versus nonoperative management of traumatic injuries at this site. ⋯ Ignoring this aspect of thoracolumbar management often contributes to the development of posttraumatic malalignment and other complications. This review recommends that a new or modified classification system accounts for sagittal segmental alignment factors, including the level of the injured vertebra, the number of affected adjacent levels, imaging techniques with better specificity and sensitivity, and assessment for osteoporosis. Case studies are included to show the importance of segmental sagittal alignment and the vertebral level on patient outcomes.
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The complex regional pain syndrome type 1 (CRPS-1) is one of the most discussed painful syndromes due to the variability and severity of its symptoms. CRPS-1 generally occurs after a trauma, a fracture or a sprain followed by an immobilization. Classical diagnostic criteria are not always clear; hence, the diagnosis is difficult. ⋯ Adenosine triphosphate (ATP) exerts a fundamental role in the activation of innate cutaneous immune system, in the proliferation of keratinocytes and mast cells, in the release of several proinflammatory cytokines and in the microglia activation. It is essential to intervene on this pathology as soon as possible with drugs, as clodronate, able to reduce bone marrow edema and pain through the inhibition of the primary inflammatory process and the immune reaction, limiting the activation of macrophages and the release of cytokines activating nuclear growth factor (NGF). In this review the role of ATP, bisphosphonates and rehabilitation are discussed.
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Venous thromboembolism (VTE) is a common and in some instances life-threatening complication following severe traumatic injury. Owing to a lack of high-quality evidence in VTE risk prediction and prevention in this cohort, major trauma patients receive variable VTE preventative care. The aim of this systematic review was to determine the reported rates of VTE in major trauma patients, and associated risk factors. ⋯ There exists significant variation in the reported rates of VTE in major trauma patients globally. Operative procedure, delays to prophylaxis and pelvic injury were the most consistently reported associated variables for DVT. Lower extremity injury followed by male sex and increased age were the most frequently reported associated variables for PE. Although studies indicate possible differences in risk factors for DVT and PE, heterogeneity in study characteristics and outcome reporting impedes any meaningful conclusions. Reconciliation of VTE rates in major trauma patients is necessary when comparing populations.
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Eur J Trauma Emerg Surg · Dec 2024
Review Meta AnalysisThe efficacy and safety of pre-hospital plasma in patients at risk for hemorrhagic shock: an updated systematic review and meta-analysis of randomized controlled trials.
Plasma is a critical element in hemostatic resuscitation post-injury, and its prompt administration within the prehospital setting may reduce the complications resulting from hemorrhage and shock. Our objective is to assess the efficacy and safety of prehospital plasma infusion in patients susceptible to hemorrhagic shock. ⋯ Plasma infusion in trauma patients at risk of hemorrhagic shock does not significantly affect mortality or the incidence of multiple organ failure. However, it may lead to reduced packed red blood cell transfusions and increased INR at hospital arrival.