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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Paediatric trauma is a leading cause of death, with correlations between trauma outcomes and geographical locations. Certain rural regions of Norway face a higher risk of trauma-related fatalities compared to the nationwide population. Among adults, the risk of both fatal and non-fatal injuries rises with increased rurality. The study aimed to investigate whether there is an increased risk of fatal and non-fatal injuries for children in rural areas across the entire country, as well as any changes over two decades. ⋯ The mortality rate increased linearly across all levels of centrality, and the relative risk was 2.4 times higher in the most rural population compared to the most urban population. To effectively target primary prevention and enhance trauma care for paediatric patients in rural areas, a deeper epidemiological understanding and more comprehensive studies are essential.
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The focused assessment with sonography in trauma (FAST) examination plays an essential role in diagnosing hemoperitoneum in trauma patients to guide prompt operative management. The FAST examination is highly specific for hemoperitoneum in trauma patients, and has been adopted in nontrauma patients to identify intraperitoneal fluid as a cause of abdominal pain or distension. However, causes of false positive FAST examinations have been described and require prompt recognition to avoid diagnostic uncertainty and inappropriate procedures. Most causes of false positive FAST examinations are due to anatomic mimics such as perinephric fat or seminal vesicles, however, modern ultrasound machines use a variety of postprocessing image enhancement techniques that can also lead to novel false positive artifacts. ⋯ We report cases where experienced clinicians incorrectly interpreted ultrasound findings caused by a novel mimic of hemoperitoneum: the "lipliner sign." It appears most prominently at the edges of solid organs (such as the liver and the spleen), which is the same location most likely to show free fluid in FAST examination in trauma patients. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Clinicians who take care of trauma patients must be familiar with causes of false positive FAST examinations that could lead to a misdiagnosis of hemoperitoneum.
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Treatment priority in C5, C6, and C7 brachial plexus root avulsion is the recovery of shoulder function through reinnervation of shoulder muscles. The medial pectoral nerve is a potential donor for axillary nerve transfer, but outcomes are sparsely reported. This study reports the results of medial pectoral nerve transfer to the axillary nerve. ⋯ Medial pectoral nerve transfer to the axillary nerve did not yield superior results in shoulder abduction and deltoid reinnervation in our group of patients. At present, different nerve donors may also need to be considered for deltoid muscle reinnervation in patients with C5, C6, and C7 root avulsion to achieve better shoulder abduction recovery.