scholarly journals Curiosity or Underdiagnosed? Injuries to Thoracolumbar Spine with Concomitant Trauma to Pancreas

2021 ◽  
Vol 10 (4) ◽  
pp. 700
Author(s):  
Jakob Hax ◽  
Sascha Halvachizadeh ◽  
Kai Oliver Jensen ◽  
Till Berk ◽  
Henrik Teuber ◽  
...  
Keyword(s):  
Injury Severity ◽  
Thoracolumbar Spine ◽  
Pancreatic Injury ◽  
Spine Injury ◽  
Control Group ◽  
Abbreviated Injury Scale ◽  
Prevalence Data ◽  
Pancreatic Injuries ◽  
Serious Injury ◽  
The Impact

The pancreas is at risk of damage as a consequence of thoracolumbar spine injury. However, there are no studies providing prevalence data to support this assumption. Data from European hospitals documented in the TraumaRegister DGU® (TR-DGU) between 2008–2017 were analyzed to estimate the prevalence of this correlation and to determine the impact on clinical outcome. A total of 44,279 patients with significant thoracolumbar trauma, defined on Abbreviated Injury Scale (AIS) as ≥2, were included. Patients transferred to another hospital within 48 h were excluded to prevent double counting. A total of 135,567 patients without thoracolumbar injuries (AIS ≤ 1) were used as control group. Four-hundred patients with thoracolumbar trauma had a pancreatic injury. Pancreatic injuries were more common after thoracolumbar trauma (0.90% versus (vs.) 0.51%, odds ratio (OR) 1.78; 95% confidence intervals (CI), 1.57–2.01). Patients with pancreatic injuries were more likely to be male (68%) and had a higher mean Injury Severity Score (ISS) than those without (35.7 ± 16.0 vs. 23.8 ± 12.4). Mean length of stay (LOS) in intensive care unit (ICU) and hospital was longer with pancreatic injury. In-hospital mortality was 17.5% with and 9.7% without pancreatic injury, respectively. Although uncommon, concurrent pancreatic injury in the setting of thoracolumbar trauma can portend a much more serious injury.

Curiosity or underdiagnosed? Thoracolumbar spinal column injuries with concomitant trauma of the pancreas

2020 ◽  
Author(s):  
Jakob Hax ◽  
Sascha Halvachizadeh ◽  
Kai Oliver Jensen ◽  
Till Berk ◽  
Henrik Teuber ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Spinal Injury ◽  
Thoracolumbar Spine ◽  
Pancreatic Injury ◽  
Spinal Injuries ◽  
Spine Injury ◽  
The Mean

Abstract Background: The pancreas is an organ which is at risk of damage as a consequence of thoracolumbar spine injury. However, to our knowledge, no studies have provided any prevalence data to support this assumption. Therefore, the coincidence of pancreatic trauma in patients with spine injury is still unknown. Data from the TraumaRegister DGU® (TR-DGU) was analysed to estimate the prevalence of this correlation and to determine its influence on clinical outcome.Methods: A retrospective investigation of cases documented in the TR-DGU between 2008 and 2017 was performed. We included data of patients admitted to participating European trauma centres who had thoracic or lumbar spine injuries and met the following criteria: i) Injury Severity Score (ISS) ≥ 9, ii) blunt trauma, and iii) no early transfer out of hospital. We investigated the coincidence of pancreas injury in patients with at least an Abbreviated Injury Scale (AIS) of 2 of the thoracic or lumbar spine. Therefore, we included all kind of relevant injuries of the thoracolumbar spine.Results: In the group with thoracolumbar injury with concomitant pancreatic injury, the mean age was 43.1 ± 18.6 years, and 68% of these patients were male. The most frequent mechanisms of trauma were car (38%) and motorbike (17%) accidents, as well as high falls (23.8%). The mean Injury Severity Score was 35.7 ± 16.0 points and the in-hospital mortality rate was 17.5%. The overall prevalence of pancreatic injury was 60.7 (0.61%; 95% confidence interval (CI), 0.58–0.65) per 10,000 patients. Patients with severe spinal injuries (AIS ≥ 2) were more likely to present with a concomitant pancreatic injury compared to patients with no or only minor spinal injury (AIS 0–1) (Odds ratio (OR) 1.78; 95%CI, 1.57–2.01).Conclusions: Concomitant pancreatic injury in patients with spinal injuries of the thoracolumbar spine is rare. However, patients with more severe spinal injuries were overall more likely (OR 1.78) to present with an accompanying pancreatic injury than those with minor thoracolumbar injuries. Therefore, trauma surgeons treating severely injured patients must be alert not to overlook this rare concomitant injury, because it does not clearly correlate with the severity of spinal injury.

Patterns and outcomes of traumatic pancreatic injuries: A retrospective review from a large multi-institutional healthcare system

Trauma ◽  
2017 ◽  
Vol 20 (1) ◽  
pp. 11-29 ◽  
Author(s):  
Toni Iurcotta ◽  
Poppy Addison ◽  
Leo I Amodu ◽  
Karina Fatakhova ◽  
Meredith Akerman ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Healthcare System ◽  
Injury Severity ◽  
Pancreatic Head ◽  
Pancreatic Injury ◽  
Pancreatic Injuries ◽  
Endocrine Insufficiency ◽  
Fluid Collections

Introduction Traumatic pancreatic injuries are rare, and morbidity and mortality information are often conflicting. To determine the frequency and outcomes of patients presenting with trauma to the pancreas, we reviewed data from a large multi-institutional healthcare system for mechanism of injury, intervention, subsequent complications, in-hospital morbidity rates, and mortality. Methods We performed a retrospective analysis of records of all pancreatic injury cases seen at four healthcare centers from 1990 to 2014. Descriptive measures are presented for continuous and categorical data. Mortality rates were obtained using the publicly accessible Social Security Death Master File. Results Of 69 patients with pancreatic injuries, median age was 24 years (range 1–88). Mechanisms of injury were blunt in 87% and penetrating in 11.8%. The median injury grade was 1. Most injuries involved the pancreatic head (24.6%). Median Injury Severity Score at presentation was 9. Thirty-seven (53.6%) patients required surgery. Twenty-five patients (36.2%) required total parenteral nutrition, 34 patients (49.3%) developed intra-abdominal fluid collections, 24 patients (34.8%) developed acute pancreatitis, and three (4.4%) developed endocrine insufficiency requiring insulin. Ten (14.5%) patients died. There were four (5.8%) readmissions and one re-operation (1.4%) within 30 days of discharge. Conclusion Traumatic pancreatic injuries occur most frequently in young healthy males with little or no comorbidities, and are generally associated with other acute injuries. Contrary to past reports, our results revealed a low mortality rate but significant morbidity, with the most common complications being intra-abdominal fluid collections, acute pancreatitis, and a need for total parenteral nutrition.

Scout Anteroposterior and Lateral CT Scans as a Screening Test for Thoracolumbar Spine Injury in Blunt Trauma

2007 ◽  
Vol 73 (8) ◽  
pp. 780-786 ◽  
Author(s):  
Nicole L. Sroka ◽  
James Combs ◽  
Rochella Mood ◽  
Vernon Henderson
Keyword(s):  
Blunt Trauma ◽  
Predictive Value ◽  
Injury Severity ◽  
Pilot Trial ◽  
Thoracolumbar Spine ◽  
Ct Images ◽  
Ct Scans ◽  
Spine Injury ◽  
Predictive Values ◽  
Ct Evaluation

Anteroposterior and lateral radiographs have traditionally been required to clear the thoracolumbar spine (TLS) after blunt trauma. The routine use of CT scans led to a pilot trial to determine if CT scout images can accurately evaluate the TLS after blunt trauma. The purpose of the study was to determine the sensitivity, specificity, positive and negative predictive values of CT scout images for the evaluation of the TLS. Patients admitted to our level II trauma center requiring CT evaluation of the chest, abdomen, and pelvis were considered for this study. Patients with blunt trauma, without neurologic deficits, or other evidence of spinal trauma on physical examination were included. Charts were reviewed for demographics, scout CT image findings, and full CT scan findings. Scout CT images were compared with reconstructed spine CT scans from chest, abdomen, and pelvis CT scans. Injuries to the TLS were defined as compression fractures, burst fractures, and subluxation. One hundred seventeen patients were included. Average Injury Severity Score was 25.1 (±9.4) and average age was 42.5 years. Twenty-three patients had diffuse back tenderness, three had ecchymosis, and 64 had distracting injuries. Twelve injuries to the TLS were present; 11 were seen on scout images. Sensitivity was 92 per cent, specificity 100 per cent, positive predictive value 100 per cent, and negative predictive value 99 per cent. Scout CT images provide an accurate assessment of the TLS after blunt trauma. We are encouraged by the results and will continue to investigate to identify the criteria that allow scout CT images to safely replace anteroposterior and lateral radiographs in the evaluation of the TLS in blunt trauma.

scholarly journals Establishing the Injury Severity of Thoracolumbar Trauma: Confirmation of the Hierarchical Structure of the AOSpine Thoracolumbar Spine Injury Classification System

2015 ◽  
Vol 5 (1_suppl) ◽  
pp. s-0035-1554158-s-0035-1554158
Author(s):  
Gregory Schroeder ◽  
Alexander Vaccaro ◽  
Christopher Kepler ◽  
John Koerner ◽  
Cumhur Oner ◽  
...  
Keyword(s):  
Hierarchical Structure ◽  
Classification System ◽  
Injury Severity ◽  
Thoracolumbar Spine ◽  
Spine Injury ◽  
The Hierarchical Structure ◽  
Injury Classification

scholarly journals Outcome of Turf Toe Injuries in NFL Players

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0033
Author(s):  
Selene G. Parekh ◽  
Tejas J. Parekh
Keyword(s):  
Injury Severity ◽  
Wide Spectrum ◽  
Average Power ◽  
Metatarsophalangeal Joint ◽  
Joint Capsule ◽  
Control Group ◽  
Post Injury ◽  
Significant Difference ◽  
Turf Toe ◽  
The Impact

Category: Midfoot/Forefoot, Sports, Trauma Introduction/Purpose: “Turf toe” is an injury to the great toe’s metatarsophalangeal joint capsule. The increase in artificial turf in the 1970’s was thought to have contributed to increased incidence of this injury in players of the National Football League (NFL). To our knowledge, there are no publications that have critically analyzed the impact of this injury on player performance. The goal of this study was to quantify the impact a turf toe injury has on NFL players, specifically in time to return to competition and their performance post-injury compared to pre-injury. Methods: This is a retrospective review of NFL players who sustained a turf toe injury between the 2011-2014 seasons. Online resources including NFL injury reports, player registries, game summary sites, NFL news articles, fantasy football sites and NFL blogs were used to identify players with this injury. Additionally, an injury database from theFantasyDoctors.com was used to further identify injured players. Recorded variables included player age, position, games missed, and type of playing surface on which the injury occurred. The performance of each offensive skill player was analyzed separately by calculating their power rating (total yards divided by 10 plus touchdowns multiplied by 6) for the 3 seasons prior to injury, the injury season (index season) and the 2 seasons immediately following. Injured offensive skill players were then compared to a control group consisting of all running backs and wide receivers without a turf toe injury who competed in the 2012 season. Results: 71 turf toe injuries in 67 players were identified. Players’ average age was 26.4 years old. Injury by playing surface: 29 grass, 29 turf and 13 unidentified. The average time missed was 3.2 games. 9 players were placed on injured reserve and 8 required surgery. 16 offensive skill players were at or above 200 total points during the 6 observed seasons. The average power rating prior to injury was 105.7 per season (7.3 per game), 87.3 (6.9 per game) during the injury season and 115.5 (8.1 per game) for post-injury seasons. The power rating per season (p=0.53) and per game (p=0.4) was not significantly different after a turf toe injury compared to before. Power ratings were not significantly different from uninjured control players (p=0.24, p=0.27). Conclusion: ”Turf toe” is a term used for an injury that has a wide spectrum of consequence depending on injury severity. A mild sprain of the great toe should respond well to conservative treatment with rest, taping and possibly an orthotic while a complete tear of the metatarsophalangeal joint capsule typically is season-ending and requires surgical repair. We were unable to show a statistically significant difference in NFL players’ performances after turf toe injury based on power ratings.

Lung Contusion in Polytrauma: An Analysis of the TraumaRegister DGU

2019 ◽  
Author(s):  
Stefan Schulz-Drost ◽  
Rebekka Finkbeiner ◽  
Rolf Lefering ◽  
Marco Grosso ◽  
Sebastian Krinner ◽  
...  
Keyword(s):  
Injury Severity ◽  
Age Groups ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Control Group ◽  
X Rays ◽  
Chest Tubes ◽  
Patient Death ◽  
Abbreviated Injury Scale ◽  
Thorax Trauma

Abstract Background Thorax trauma frequently occurs in which injuries to the bony chest, lung contusions (LCs), and others are diagnosed. The significance of this violation is described very differently and is mostly based on monocentric data. Methods A retrospective analysis of the TraumaRegister DGU® (TR-DGU) dataset (Project 2014–062) was performed between 2009 and 2014 (injury severity score [ISS] ≥ 16, primary admission to a trauma center, no isolated traumatic brain injury). Patients with LC (Abbreviated Injury Scale [AIS] 3 + 4) were compared with the control group, and an analysis of different age groups was performed. Results A total of 49,567 patients were included, thereunder 14,521 (29.3%) without relevant thoracic trauma (TT); 95.9% blunt traumas. 18,892 patients (38.1%) had LC and 14,008 (28.3%) had severe LC with AIS 3 + 4; thereunder 72.7% males. For severe LC, the average age was the lowest (44.7 ± 19.7 years) and ISS the highest (30.4 ± 12.1 points).Intubation, intensive care, (multi-) organ failure, sepsis, and extrathoracic injuries were most common in severe LC. Shock, chest tubes, further thoracic injuries, and patient death occurred most frequently in TT without LC.Younger patients showed a higher incidence of LC than the older ones; however, high patient age was a highly significant risk factor for the development of complications and poor outcome. Conclusion Since LC was present in almost 40% of the severely injured and was related to higher morbidity, LC should be detected and managed at the earliest possible time. Proper follow-ups employing chest X-rays and computed tomography (CT) scans are recommended.

Possibility of a Hyperflexion Neck Injury in a Rear Impact Accident for a Rear Middle Seat Passenger

2010 ◽  
Author(s):  
Chandrashekhar K. Thorbole ◽  
David A. Renfroe ◽  
Stan B. Andrews ◽  
Mark M. Partain ◽  
Digvijay S. Tanwar
Keyword(s):  
Injury Severity ◽  
Rear Seat ◽  
The Body ◽  
Neck Injury ◽  
Neck Extension ◽  
Acceleration Pulse ◽  
Head Restraint ◽  
Rear Impact ◽  
Serious Injury ◽  
The Impact

Rear impact accidents primarily involve neck extension injury. The sudden forward motion of the lower torso causes the head to lag the body. This results in the extension injury or whiplash injury, depending on the rate at which the struck vehicle moves forward. The front seat passengers are equipped with various technologies to help prevent the neck injuries in a rear impact scenario. A range of research has been conducted to investigate the effect of various seat design characteristics on the neck injury during a rear impact. The head restraint on the seat limits the backward movement of the head, thus preventing the serious injury. The neck injury is still a major problem for a rear seat passenger. However, very little effort has been made to improve the rear seat crashworthiness performance relating to a rear impact. Surprisingly, the middle rear seat is not required to comply with the FMVSS 202 standard. This paper demonstrates the possibility of a neck hyper-flexion during a rear impact and the mechanism of a facet dislocation injury for a rear middle seat adult passenger. A biodynamic computational model is utilized to simulate the rear impact accident of an adult male. A MADYMO standard Hybrid III 50th percentile ATD is used to simulate a real world rear impact accident. The accident reconstruction is conducted using PC CRASH to analyze the impact orientation and the change in velocity of the struck vehicle. This information along with the crush on the vehicle is used to develop an acceleration pulse to be applied on the occupant. The rear compartment of the subject vehicle was digitized using a FARO arm to recreate the exact seat structure and interior features for the simulation. This study investigates the inadequate performance of the lap belt in conjunction with roof to seat clearance for the middle seat passenger in reducing the injury severity during a rear impact.

Use of Aerosolized Antibiotics in Gram-Negative Ventilator-Associated Pneumonia in Trauma Patients

2018 ◽  
Vol 84 (12) ◽  
pp. 1906-1912
Author(s):  
Brian H. Gibson ◽  
John P. Sharpe ◽  
Richard H. Lewis ◽  
Joshua S. Newell ◽  
Joseph M. Swanson ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Injury Severity ◽  
Multidrug Resistant ◽  
Control Group ◽  
Trauma Patients ◽  
Minimal Risk ◽  
Ventilator Associated Pneumonia ◽  
Systemic Complications ◽  
Multivariable Logistic Regression ◽  
The Impact

Ventilator-associated pneumonia (VAP) is associated with significant morbidity (ventilator days, ICU days, and cost) and mortality increase in trauma patients. Multidrug-resistant strains of causative VAP pathogens are becoming increasingly common. Aerosolized antibiotics achieve high alveolar concentrations and provide valuable adjuncts in the treatment of VAP. This study examined the impact of aerosolized antibiotics in the treatment of VAP in trauma patients. Patients with either Acinetobacter baumannii or Pseudomonas aeruginosa VAP over 10 years treated with aerosolized antibiotics (cases) were stratified by age, severity of shock, and injury severity. A frequency-matched (by causative pathogen) control group treated without aerosolized antibiotics was used for comparison. Multivariable logistic regression was used to identify predictors for the use of aerosolized antibiotics. One hundred twenty VAP episodes were identified in 100 patients. Microbiologic resolution was achieved in all patients treated with aerosolized antibiotics. There was no difference in mortality (14.5% vs 15.7%, P = 0.87) and no antibiotic-related complications in either group. Multivariable logistic regression identified VAP persistence and relapse as independent predictors for the use of aerosolized antibiotics. Combined with systemic therapy, aerosolized antibiotics broaden the spectrum of therapy. They are valuable adjuncts with minimal risk of antibiotic resistance and/or systemic complications.

Anterior thoracolumbar fixation for management of thoracolumbar spine injury

2004 ◽  
Vol 1 (2) ◽  
pp. 49-54
Author(s):  
PK Sahoo ◽  
P Singh ◽  
HS Bhatoe ◽  
TVSP Murthy ◽  
K Sandhu ◽  
...  
Keyword(s):  
Thoracolumbar Spine ◽  
Spine Injury

Information and Communication Technology and Cultural Change

2012 ◽  
Vol 43 (4) ◽  
pp. 222-231 ◽  
Author(s):  
Nina Hansen ◽  
Tom Postmes ◽  
Nikita van der Vinne ◽  
Wendy van Thiel
Keyword(s):  
Cultural Values ◽  
Information And Communication Technology ◽  
Communication Technology ◽  
Cultural Change ◽  
Control Group ◽  
Self Construal ◽  
Information And Communication ◽  
The Impact ◽  
Ict For Development ◽  
Practical Implications

This paper studies whether and how information and communication technology (ICT) changes self-construal and cultural values in a developing country. Ethiopian children were given laptops in the context of an ICT for development scheme. We compared children who used laptops (n = 69) with a control group without laptops (n = 76) and a second control group of children whose laptop had broken down (n = 24). Results confirmed that after 1 year of laptop usage, the children’s self-concept had become more independent and children endorsed individualist values more strongly. Interestingly, the impact of laptop usage on cultural values was mediated by self-construal (moderated mediation). Importantly, modernization did not “crowd out” traditional culture: ICT usage was not associated with a reduction in traditional expressions (interdependent self-construal, collectivist values). Theoretical and practical implications are discussed.

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