scholarly journals Contemporary management of renal trauma in Canada: A 10-year experience at a level 1 trauma centre

2018 ◽  
Vol 13 (6) ◽  
Author(s):  
Uday Mann ◽  
Logan Zemp ◽  
Keith F. Rourke
Keyword(s):  
Penetrating Trauma ◽  
Injured Patient ◽  
Trauma Centre ◽  
Renal Trauma ◽  
Trauma Patients ◽  
High Grade ◽  
Mechanism Of Injury ◽  
Level 1 ◽  
Grade 3 ◽  
Urological Intervention

Introduction: Contemporary Canadian renal trauma data is lacking. Our objective is to describe 10-year outcomes of renal trauma at a Canadian level 1 trauma centre using a conservative approach. Methods: The Alberta Trauma Registry at the University of Alberta was used to identify renal trauma patients from October 2004 to December 2014. Hospital records and imaging were reviewed to identify clinic-radiographical factors, including patient age, gender, Injury Severity Score (ISS), American Association of the Surgery for Trauma (AAST) grade, computerized tomography (CT) findings, urological interventions, length of stay, transfusion and death rates. Descriptive statistics, Chi-square, and t-tests were used when appropriate. Results: A total of 368 renal trauma patients were identified. Mechanism of injury was blunt trauma in 89.1% of cases, mean age was 36.2 years, and mean ISS was 30.8 (±13.6). AAST grade distribution was 16.6% (Grade 1), 22.8% (Grade 2), 36.4% (Grade 3), 20.9% (Grade 4), and 3.3% (Grade 5). Overall, 9.5% (35) of patients required urological intervention for a total of 40 treatments, including ureteral stenting (3.0%), angioembolization (3.3%), percutaneous drainage (0.3%), or open intervention including nephrectomy (2.4%) and renorrhaphy (0.5%). No Grade 1 or 2 injuries required intervention, while 1.5%, 31.2%, and 75.0% of Grade 3, 4, and 5 injuries did, respectively. The overall renal salvage rate was 97.6%, which did not differ by mechanism of injury (p=0.25). Patients with penetrating trauma were more likely to require urological intervention (20.0% vs. 8.2%; p=0.04). Of the high-grade (III–V) renal injuries identified, 15.7% (35/223) required urological intervention, 4.9% (11) required open surgical intervention, and only 4.0% (9) of patients with high-grade renal injury required nephrectomy. Conclusions: The trend towards conservative treatment of renal trauma in Canada appears well-supported even in a severely injured patient population, as over 90% of patients avoid urological intervention and only 3% require operative intervention resulting in renal salvage rates of 97.6%.

Contemporary management of pediatric high grade renal trauma: 10 year experience at a level 1 trauma centre

2020 ◽  
Vol 16 (5) ◽  
pp. 656.e1-656.e5
Author(s):  
Elaine J. Redmond ◽  
Darcie A. Kiddoo ◽  
Peter D. Metcalfe
Keyword(s):  
Trauma Centre ◽  
Renal Trauma ◽  
High Grade ◽  
Level 1 ◽  
Contemporary Management

scholarly journals The management and outcome of paediatric splenic injuries in the Netherlands

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Maike Grootenhaar ◽  
Dominique Lamers ◽  
Karin Kamphuis-van Ulzen ◽  
Ivo de Blaauw ◽  
Edward C. Tan
Keyword(s):  
The Netherlands ◽  
Hospital Stay ◽  
Operative Management ◽  
Trauma Centre ◽  
Management Approach ◽  
Haemodynamic Instability ◽  
Low Grade ◽  
High Grade ◽  
Level 1 ◽  
Non Operative Management

Abstract Background Non-operative management (NOM) is generally accepted as a treatment method of traumatic paediatric splenic rupture. However, considerable variations in management exist. This study analyses local trends in aetiology and management of paediatric splenic injuries and evaluates the implementation of the guidelines proposed by the American Paediatric Surgical Association (APSA) in a level 1 trauma centre. Methods The charts of paediatric patients with blunt splenic injury (BSI) who were admitted or transferred to a level 1 trauma centre between 2003 and 2020 were retrospectively assessed. Information pertaining to demographics, mechanism of injury, injury description, associated injuries, intervention and outcomes were analysed and compared to international literature. Results There were 130 patients with BSI identified (63.1% male), with a mean age of 11.3 ± 4.0 and a mean Injury Severity Score (ISS) of 21.6 ± 13.7. Bicycle accidents were the most common trauma mechanism (23.1%). Sixty-four percent were multi-trauma patients, 25% received blood transfusions, and 31% were haemodynamically unstable. Mean injury grade was 3.0, with 30% of patients having a high-grade injury. In total, 75% of patients underwent NOM with a 100% efficacy rate. Total splenectomy rate was 6.2%. Four patients died due to brain damage. Patients with a high-grade BSI (grades IV–V) had a significantly higher ISS and longer bedrest and more often presented with an active blush on computed tomography (CT) scans than patients with a low-grade BSI (grades I–III). Non-operative management was mainly the choice of treatment in both groups (76.6% and 79.5%, respectively). Haemodynamic instability was a predictor for operative management (OM) (p = 0.001). Predictors for a longer length of stay (LOS) included concomitant injuries, haemodynamic instability and OM (all p < 0.02). Interobserver agreement in the grading of BSI is moderate, with a Cohens Kappa coefficient of 0.493. Conclusion Non-operative management has proven to be a realistic management approach in both low- and high-grade splenic injuries. Consideration for operative management should be based on haemodynamic instability. Compared to the anticipated length of bedrest and hospital stay outlined in the APSA guidelines, the Netherlands can reduce the length of bedrest and hospital stay through their non-operative management. Level of evidence Therapeutic study, level III

Clinical and economic effects of selective radiological evaluation of high-energy trauma patients: a prospective experience of a level 1 busy trauma centre

2014 ◽  
Vol 32 (7) ◽  
pp. 535-538 ◽  
Author(s):  
Shahram Paydar ◽  
Armin Ahmadi ◽  
Behnam Dalfardi ◽  
Alireza Shakibafard ◽  
Hamidreza Abbasi ◽  
...  
Keyword(s):  
High Energy ◽  
Trauma Centre ◽  
Economic Effects ◽  
Trauma Patients ◽  
Radiological Evaluation ◽  
High Energy Trauma ◽  
Level 1

Patient Contact Time and Prehospital Interventions in Hypotensive Trauma Patients: Should We Reconsider the “ABC” Algorithm When Time Is of the Essence?

2020 ◽  
Vol 86 (8) ◽  
pp. 937-943
Author(s):  
Scott Ninokawa ◽  
Jessica Friedman ◽  
Danielle Tatum ◽  
Alison Smith ◽  
Sharven Taghavi ◽  
...  
Keyword(s):  
Injury Severity ◽  
Wound Care ◽  
Penetrating Trauma ◽  
Trauma Patients ◽  
Abc Algorithm ◽  
New Injury Severity Score ◽  
Urban Level ◽  
Level 1 ◽  
Needle Decompression ◽  
Level 1 Trauma Center

Introduction There is disagreement in the trauma community concerning the extent to which emergency medical services (EMS) should perform on-scene interventions. Additionally, in recent years the “ABC” algorithm has been questioned in hypotensive patients. The objective of this study was to quantify the delay introduced by different on-scene interventions. Methods A retrospective analysis of hypotensive trauma patients brought to an urban level 1 trauma center by EMS from 2007 to 2018 was performed, and patients were stratified by mechanism of injury and new injury severity score (NISS). Independent samples median tests were used to compare median on-scene times. Results Among 982 trauma patients, median on-scene time was 5 minutes (interquartile range 3-8). In penetrating trauma patients ( n = 488) with NISS of 16-25, intubation significantly increased scene time from 4 to 6 minutes ( P < .05). In penetrating trauma patients with NISS of 10-15, wound care significantly increased scene time from 3 to 6 minutes ( P < .05). Tourniquet use, interosseous (IO) access, intravenous (IV) access, and needle decompression did not significantly increase scene time. Conclusion Understanding that intubation increases scene time in penetrating trauma, while IV and IO access do not, alterations to the traditional “ABC” algorithm may be warranted. Further investigation of prehospital interventions is needed to determine which are appropriate on-scene.

Helicopter Transport of Trauma Patients Improves Survival Irrespective of Transport Time

2020 ◽  
pp. 000313482094356
Author(s):  
Andrew M. Schneider ◽  
Joseph A. Ewing ◽  
John D. Cull
Keyword(s):  
Injury Severity ◽  
Survival Rates ◽  
Trauma Patients ◽  
Mechanism Of Injury ◽  
Transport Time ◽  
Level 1 ◽  
Student’S T ◽  
Level 1 Trauma Center ◽  
Student’S T Test ◽  
Transportation Type

Objectives Helicopter transport of trauma patients remains controversial. We examined the survival rates of patients undergoing helicopter versus ground transport to a Level 1 trauma center. Methods Retrospective analysis was performed on trauma patients treated between 2014 and 2017. Student’s t-test was used to compare air versus ground transport times. A logistic regression was then used to examine the association of transportation type on survival controlling for demographics, mechanism of injury, transport time, field intubation, and injury severity. Results Of 3967 patients identified, 69.6% (2762) were male, and the average age was 40 years. Most patients suffered blunt injuries (86.8%, 3445), while the remaining had penetrating injuries (11.6%, 459) or burns (1.6%, 63). The majority of patients were transferred by ground (3449) with only 13% (518) transferred by air. Patients transported by air had increased Injury Severity Score (ISS) with a median of 17 (IQR 9-24) versus 9 (IQR 5-14), increased length of stay (LOS) at 6 days versus 3 ( P < .001), and increased mortality at 12.6% vs 6.5% ( P < .001). Patients transported by air arrived 16.6 ± 6.7 minutes faster compared with ground for the zip codes examined. When adjusting for the mechanism of injury, ISS, age, gender, intubation status, and transport time, air transport was associated with an increased likelihood of survival (odds ratio [OR] = 1.57, 95% CI = 1.06-2.40). Conclusion In our analysis of 3967 patients, those transported by air had a significant improvement in the likelihood of survival compared with those transported by ground even when adjusting for both ISS and time.

scholarly journals Renal trauma: the current best practice

2018 ◽  
Vol 10 (10) ◽  
pp. 295-303 ◽  
Author(s):  
Tomer Erlich ◽  
Noam D. Kitrey
Keyword(s):  
Renal Injury ◽  
Best Practice ◽  
Motor Vehicle ◽  
Penetrating Trauma ◽  
High Energy ◽  
Renal Trauma ◽  
Common Mechanism ◽  
Trauma Patients ◽  
Vehicle Accidents ◽  
Enhanced Computed Tomography

The kidneys are the most vulnerable genitourinary organ in trauma, as they are involved in up to 3.25% of trauma patients. The most common mechanism for renal injury is blunt trauma (predominantly by motor vehicle accidents and falls), while penetrating trauma (mainly caused by firearms and stab wound) comprise the rest. High-velocity weapons impose specifically problematic damage because of the high energy and collateral effect. The mainstay of renal trauma diagnosis is based on contrast-enhanced computed tomography (CT), which is indicated in all stable patients with gross hematuria and in patients presenting with microscopic hematuria and hypotension. Additionally, CT should be performed when the mechanism of injury or physical examination findings are suggestive of renal injury (e.g. rapid deceleration, rib fractures, flank ecchymosis, and every penetrating injury of the abdomen, flank or lower chest). Renal trauma management has evolved during the last decades, with a distinct evolution toward a nonoperative approach. The lion’s share of renal trauma patients are managed nonoperatively with careful monitoring, reimaging when there is any deterioration, and the use of minimally invasive procedures. These procedures include angioembolization in cases of active bleeding and endourological stenting in cases of urine extravasation.

scholarly journals Management of high-grade renal traumas with collecting system injuries

2021 ◽  
Vol 15 (11) ◽  
Author(s):  
Jennifer A. Locke ◽  
Sarah Neu ◽  
Roshan Navaratnam ◽  
Andrea Phillips ◽  
Avery B. Nathens ◽  
...  
Keyword(s):  
Trauma Center ◽  
American Association ◽  
Trauma Patients ◽  
High Grade ◽  
Asymptomatic Patients ◽  
Urinary Extravasation ◽  
Prospective Trials ◽  
Level 1 ◽  
Level 1 Trauma Center ◽  
Collecting System

Introduction: Approximately 50% of all high-grade renal traumas (HGRT, American Association for the Surgery of Trauma [AAST] grade 4/5) have associated collecting system injuries. Although most of these collecting system injuries will heal spontaneously, approximately 20–30% of these injuries are managed with ureteric stents. The objective of the study was to review the management of HGRT with collecting system injuries in a level 1 trauma center. Methods: This was a single-center, retrospective cohort study of trauma patients with HGRT and collecting system injuries from 1998–2019. Results: We identified 147 patients with HGRT. Of the 105 patients who had trauma computed tomography (CT) imaging within 24 hours, 46 were found to have collecting system injuries. Seven of these patients underwent intervention based on initial CT findings; the remaining 39 patients with urinary extravasation were conservatively managed. Of the 37 patients who underwent reimaging, 22 (59%) demonstrated a stable or resolving collection and 15 (41%) demonstrated continued urinary extravasation. Resolution of extravasation on subsequent imaging was observed in 10 of those patients, while five patients (14%) required intervention (four stents, one percutaneous drain) for symptoms/signs of urinary extravasation. Conclusions: In this study, most patients with HGRT and collecting system injuries did not require intervention unless the patient became symptomatic. The majority of collecting system injuries resolved with no intervention. This study underscores the need for future prospective trials to investigate the necessity of intervening in HGRT collecting system injuries and, secondarily, the need for routine reimaging in these asymptomatic patients.

scholarly journals Trauma 2021Perceptions of a trauma team regarding in situ simulationEpidemiology of submersion injuries in Canadian children and adolescents: 1990–2018A survey of medical and administrative directors on REBOA use in Canadian trauma centresCut to the chase: comparing cutting tools in the exposure of simulated trauma patientsPediatric major trauma. Anaesthesia education: airway, breathing, coffee and cases 2020–2021Geriatric trauma care at a level 1 trauma centre: Are we following best practice?Was the introduction of a provincially standardized consensus statement for postintubation analgesia and sedation associated with increased use of associated pharmacological therapies in New Brunswick?Are there important variations in the care of adult trauma patients with isolated, nonoperative subdural hematomas between those admitted to a neurosurgical centre and those admitted to a non-neurosurgical centre for their entire inpatient stay?Flattening the curve on the negative psychosocial impact of trauma on the family of acute care trauma survivors: a quantitative studyDoes ACLS belong in ATLS? Seeking evidence during resuscitative thoracotomyAutologous omental harvest for microvascular free flap reconstruction of a severe traumatic scalp degloving injury: a case reportDerivation and validation of actionable quality indicators targeting reductions in complications for injury admissionsASA dosing practices in the management of blunt cerebrovascular injury: a retrospective reviewA retrospective analysis of bicycle lane collisions in Vancouver, British Columbia, from 2012 to 2017Evaluating the Screening, Brief Intervention and Referral to Treatment (SBIRT) process at Vancouver General HospitalAlcohol use and trauma in Alberta after COVID-19 lockdown: overrepresentation and undertreatment are opportunities for improvementMental health and addiction diagnoses are linked to increased violent injuries and gaps in provision of resources during the COVID-19 pandemicPain management strategies after orthopedic trauma in a level 1 trauma centre: a descriptive study with a view of optimizing practicesStudy to Actively Warm Trauma Patients (STAY WARM): a feasibility pilot evaluationPrehospital trauma care in civilian and military settings including cold environments: a systematic review and knowledge gap analysisAntibiotic administration in open fractures: adherence to guidelines at a Canadian trauma centreAre we meeting massive transfusion protocol activation and blood product delivery times in trauma patients? A retrospective review from 2014 to 2018Unplanned returns to the operating room: a quality improvement initiative at a level 1 trauma centreStopping the bleed: the history and rebirth of Canadian freeze-dried plasmaThe state of the evidence for emergency medical services (EMS) care of prehospital severe traumatic brain injury: an analysis of appraised research from the Prehospital Evidence-based Practice programA mixed methods study of a paramedic falls referral program in Nova ScotiaFirst presentations of psychiatric illness at a level 1 trauma centreAlcohol and substance abuse screening in pediatric trauma patients: examining rates of screening and implementing a screen for the pediatric populationMeasuring behavioural quality and quantity of team leaders during simulated interprofessional trauma careImproving rural trauma outcomes: a structured trauma-training program for rural family physicians with enhanced surgical skills — a pilot projectTrauma treatment: evidence-based response to psychological needs after a natural disasterHow prepared are Canadian trauma centres for mass casualty incidents?The catalytic effect of multisource feedback for trauma teams: a pilot studyRetrievable inferior vena cava filter for primary prophylaxis of pulmonary embolism in at-risk trauma patients: a feasibility trialValue of data collected by the medical examiner service on the quality of alcohol and toxicology testing in fatal motor vehicle collisionsPrehospital narrow pulse pressure predicts need for resuscitative thoracotomy and emergent surgical intervention after traumaImpact of a geriatric consultation service on outcomes in older trauma patients: a retrospective pre–post studyExploring physical literacy as a condition of fall mechanism in older adultsIs the use of business intelligence software helpful in planning injury prevention campaigns?Exposure to endotracheal intubation among trauma patients in level 5 trauma centres in New Brunswick — a retrospective reviewAre early specialist consultations helpful predictors of those who require care in level 1 or 2 designated trauma centres?Neurologic outcomes after traumatic cardiac arrest: a systematic reviewClosed-loop communication in the trauma bay: identifying opportunities for team performance improvement through a video review analysisEmbolization in nonsplenic trauma: outcomes at a Canadian trauma hospitalThe matrix: grouping ICD-10-CA injury codes by body region and nature of injury for reporting purposesEvaluation of low-value clinical practices in acute trauma care: a multicentre retrospective studyTrauma 101: a virtual case-based trauma conference as an adjunct to medical educationPhysiologic considerations, indications and techniques for ECLS in trauma: experience of a level 1 trauma centreEngaging patients in the selection of trauma quality indicatorsStrategies aimed at preventing chronic opioid use in trauma and acute care surgery: a scoping reviewAugmented reality surgical telementoring for leg fasciotomyIdentification of high-risk trauma patients requiring major interventions for traumatic hemorrhage: a prospective study of clinical gestaltEvaluating best practices in trauma care of older adultsBetween paradigms: comparing patient and parent experiences of injured adolescents treated at pediatric or adult trauma centresEarly outcomes after implementation of chest trauma management protocol in Vancouver General HospitalUtility of diagnostic peritoneal lavage versus focused abdominal sonography for trauma in penetrating abdominal injuryTime to definitive surgery and survival in pediatric patients younger than 18 years with gunshot woundsThe effect of chronic obstructive lung disease on post-traumatic acute respiratory distress syndrome: predictors of morbidity and mortalityThe association between injury type and clinical outcomes in patients with traumatic renal injury after nephrectomyWhen low complication rates are a bad sign: the negative impact of introducing an electronic medical record on TQIP data completenessClinical handover from paramedic services to the trauma team: a video review analysis of the IMIST-AMBO protocol implementationGeriatric Recovery and Enhancement Alliance in Trauma (GREAT) multidisciplinary quality improvement initiative: improving process and outcome measures for geriatric trauma patientsIncreasing the safety of inadvertent iliac artery device deployment with the COBRA-OS, a novel low-profile REBOA deviceIs it better to watch before or listen while doing? A randomized trial of video-modelling versus telementoring for out-of-scope tube thoracostomy insertion performed by search and rescue medicsIndications for prehospital civilian tourniquet application by first responders: an expert consensus opinion of military physicians by the Delphi method

2021 ◽  
Vol 64 (5 Suppl 1) ◽  
pp. S37-S64
Author(s):  
Olga Bednarek ◽  
Mike O’Leary ◽  
Sean Hurley ◽  
Caleb Cummings ◽  
Ruth Bird ◽  
...  
Keyword(s):  
New Brunswick ◽  
Trauma Care ◽  
Trauma Team ◽  
Trauma Centre ◽  
Quality Improvement Initiative ◽  
Evidence Based ◽  
Trauma Patients ◽  
Trauma Outcomes ◽  
Trauma Centres ◽  
Level 1

How Did the COVID-19 Pandemic Affect Trauma Volume at an Urban Level I Trauma Center?

2022 ◽  
pp. 000313482110540
Author(s):  
Alexandra Hahn ◽  
Tommy Brown ◽  
Brett Chapman ◽  
Alan Marr ◽  
Lance Stuke ◽  
...  
Keyword(s):  
Health Care ◽  
Trauma Center ◽  
Penetrating Trauma ◽  
Retrospective Chart Review ◽  
Trauma Patients ◽  
Minor Trauma ◽  
Significant Difference ◽  
Urban Level ◽  
Level 1 ◽  
Level 1 Trauma Center

Introduction The COVID-19 pandemic changed the face of health care worldwide. While the impacts from this catastrophe are still being measured, it is important to understand how this pandemic impacted existing health care systems. As such, the objective of this study was to quantify its effects on trauma volume at an urban Level 1 trauma center in one of the earliest and most significantly affected US cities. Methods A retrospective chart review of consecutive trauma patients admitted to a Level 1 trauma center from January 1, 2017 to December 31, 2020 was completed. The total trauma volume in the years prior to the pandemic (2017-2019) was compared to the volume in 2020. These data were then further stratified to compare quarterly volume across all 4 years. Results A total of 4138 trauma patients were treated in the emergency room throughout 2020 with 4124 seen during 2019, 3774 during 2018, and 3505 during 2017 in the pre-COVID-19 time period. No significant difference in the volume of minor trauma or trauma transfers was observed ( P < .05). However, there was a significant increase in the number of major traumas in 2020 as compared to prior years (38.5% vs 35.6%, P < .01) and in the volume of penetrating trauma (29.1% vs 24.0%, P < .01). Discussion During the COVID-19 outbreak, trauma remained a significant health care concern. This study found an increase in volume of penetrating trauma, specifically gunshot wounds throughout 2020. It remains important to continue to devote resources to trauma patients during the ongoing COVID-19 pandemic.

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