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Epidemiology of Patients Hospitalized for Ocular Trauma in the Chaoshan Region of China, 2001–2010  [PDF]
He Cao, Liping Li, Mingzhi Zhang
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0048377
Abstract: Background The burden and pattern of ocular trauma in China are poorly known and not well studied. We aimed at studying the epidemiological characteristics of patients hospitalized for ocular trauma at major ophthalmology departments in the largest industrial base of plastic toys in China. Methods A retrospective study of ocular trauma cases admitted to 3 tertiary hospitals in China from 1st January 2001 to 31st December 2010 was performed. Results The study included a total of 3,644 injured eyes from 3,559 patients over the 10-year period: 2,008 (55.1%) open-globe injuries, 1,580 (43.4%) closed-globe injuries, 41 (1.1%) chemical injuries, 15 (0.4%) thermal injuries and 678 (18.6%) ocular adnexal injuries. The mean age of the patients was 29.0±16.8 years with a male-to-female ratio of 5.2:1 (P = 0.007). The most frequent types of injury were work-related injuries (1,656, 46.5%) and home-related injuries (715, 20.1%). The majority of injuries in males (56.2%) and females (36.0%) occurred in the 15–44 age group and 0–14 age group, respectively. The final visual acuity correlated with the initial visual acuity (Spearman’s correlation coefficient = 0.659; P<0.001). The Ocular Trauma Score also correlated with the final visual acuity (Spearman’s correlation coefficient = 0.655; P<0.001). Conclusions This analysis provides an epidemiological study of patients who were hospitalized for ocular trauma. Preventive efforts are important for both work-related and home-related eye injuries.
Spinal cord injuries in children  [cached]
Muzumdar D,Ventureyra Enrique
Journal of Pediatric Neurosciences , 2006,
Abstract: Spinal injuries in the pediatric population are relatively rare. Hence there is not enough knowledge, experience and exposure amongst pediatric neurosurgeons about spinal injuries in children. They have to rely on general spinal or pediatric orthopedic colleagues for a comprehensive management of spine and spinal cord trauma. In addition, the advances in spinal instrumentation techniques and vast array of implantable devices for spinal stabilization add to the complexity of the problem. It is imperative that a pediatric neurosurgeon should be aware of the mechanics of spinal injury and recent advances in the management strategy of pediatric spinal injuries.
Spinal Cord Injuries without Visible Bone Lesions: Analysis of Four Consecutive Cases  [PDF]
Magatte Gaye, Sarah Ntshindj Mutomb, Amadou Ndiasse Kasse, N’famara Sylla, Sagar Diop, Alvin Nah Doe, Aboubacar Sidiki Sangharé, Mouhamadou Habib Sy, Youssoupha Sakho
Open Journal of Orthopedics (OJO) , 2018, DOI: 10.4236/ojo.2018.83012
Abstract: Objectives: Interest of this study is to report four cases of spinal cord injuries without bone lesion. Evolution of the injured patients according to the initial clinic assessment at admission and the treatment performed are discussed. Materials and Methods: From January to December 2016, we performed a retrospective study at the Neurosurgery Department of Hospital General Grand Yoff of Dakar. Four patients were followed for spinal cord injury without visible bone lesions. We analyzed the clinical, radiological, therapeutic and evolutionary data. Trauma caused by stabbing was excluded. Results: In a year, 83 cases of spinal trauma with neurological deficit were hospitalized in the department. Among them, 4 had spinal cord injuries without visible bone lesions. The average age was 31.7 years with extremes ranging from 14 to 47 years. The sex ratio of male/female was 3. We have recorded 2 cases of road traffic accidents, 1 case of fall from height and 1 case of sports accident. On the neurological level, we found 3 cases of tetraplegia, and 1 brachial monoplegia. Computed tomography in all patients was normal. All of them benefited from magnetic resonance imaging that showed spinal cord injury. All patients were under conservative treatment. One patient fully recovered, two partially and one passed away. Conclusion: In presence of any post traumatic myelopathy case, the absence of disco-vertebral lesions should bring to mind the SCIWORA as well as indicate the realization of magnetic resonance imaging.
Spinal Injuries and Associated Trauma in Children
Moslem Shakeri Bavil
Surgery Journal , 2012,
Abstract: Paediatric spinal injuries, although rare, are associated with the highest mortality rate of all orthopaedic injuries in children. A 5 years retrospective study was undertaken of all patients treated for a spinal injury at our institute. A total of 40 patients had a documented diagnosis of spinal injury. The area most commonly injured was the cervical spine (37.5%). The most common mechanism of injury was motor vehicle accident. Over 65% of the children sustained one or more associated injuries. The average Glasgow Coma Score (GCS) was 14 and the mean injury severity score was 18.95. Spinal injuries in children differ from adults due primarily to the biomechanical and anatomical features of the developing musculoskeletal system. When a spinal injury is identified on initial radiographic or clinical evaluation of an injured child, one should have a high index of suspicion that concurrent potentially life threatening injuries may be present.
MANAGEMENT OF LIVER INJURIES IN ABDOMINAL TRAUMA
Abid Rashid
The Professional Medical Journal , 2003,
Abstract: Aim & Objectives: (1): to determine the frequency of liver injuries in abdominal trauma. (2): To find out the most affected age group inabdominal trauma. (3): To describe criteria for conservative and operative management of abdominal injuries. Design: Prospectus Period:May 2001 to Oct 2002. Setting: Surgical Department of Allied Hospital, Punjab Medical College Faisalabad. Material & Methods: This studyincluded 100 patients of abdominal trauma (Blunt / penetrating) admitted through emergency. Male to female ratio was 4 to 1 (male: 40,female: 10). The age ranged from 05-45 years (mean: 19.7 years). Results: Out of the total number of hundred patients, fifty patients hadhepatic trauma. Out of fifty patients, 18(36%) patients had isolated liver injury and 32(64%) patients had associated organ injuries. Twentysix patients (52%) suffered from blunt abdominal trauma and twenty four patients (48%) penetrating injuries either due to firearm or stab.Forty two patients (84%) underwent surgery and 8(16%) patients were given conservative trial. Six patients (12%) recovered on conservativemanagement while two underwent second operation for peritonitis. Grade I & II liver injuries were found to be most common while one caseof Grade V or VI was noted. Conclusion: Blunt trauma due to toad traffic accidents is the commonest mode of abdominal injuries followedby penetrating injuries. Heamodynamically stable patients presenting within 6 hours can be treated conservatively. Haemodynamicallyunstable patients should be immediately operated.
The effect of tertiary surveys on missed injuries in trauma: a systematic review  [cached]
Keijzers Gerben B,Giannakopoulos Georgios F,Del Mar Chris,Bakker Fred C
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , 2012, DOI: 10.1186/1757-7241-20-77
Abstract: Background Trauma tertiary surveys (TTS) are advocated to reduce the rate of missed injuries in hospitalized trauma patients. Moreover, the missed injury rate can be a quality indicator of trauma care performance. Current variation of the definition of missed injury restricts interpretation of the effect of the TTS and limits the use of missed injury for benchmarking. Only a few studies have specifically assessed the effect of the TTS on missed injury. We aimed to systematically appraise these studies using outcomes of two common definitions of missed injury rates and long-term health outcomes. Methods A systematic review was performed. An electronic search (without language or publication restrictions) of the Cochrane Library, Medline and Ovid was used to identify studies assessing TTS with short-term measures of missed injuries and long-term health outcomes. ‘Missed injury’ was defined as either: Type I) any injury missed at primary and secondary survey and detected by the TTS; or Type II) any injury missed at primary and secondary survey and missed by the TTS, detected during hospital stay. Two authors independently selected studies. Risk of bias for observational studies was assessed using the Newcastle-Ottawa scale. Results Ten observational studies met our inclusion criteria. None was randomized and none reported long-term health outcomes. Their risk of bias varied considerably. Nine studies assessed Type I missed injury and found an overall rate of 4.3%. A single study reported Type II missed injury with a rate of 1.5%. Three studies reported outcome data on missed injuries for both control and intervention cohorts, with two reporting an increase in Type I missed injuries (3% vs. 7%, P<0.01), and one a decrease in Type II missed injuries (2.4% vs. 1.5%, P=0.01). Conclusions Overall Type I and Type II missed injury rates were 4.3% and 1.5%. Routine TTS performance increased Type I and reduced Type II missed injuries. However, evidence is sub-optimal: few observational studies, non-uniform outcome definitions and moderate risk of bias. Future studies should address these issues to allow for the use of missed injury rate as a quality indicator for trauma care performance and benchmarking.
Epidemiology study of facial injuries during a 13 month of trauma registry in Tehran  [cached]
Zargar Moosa,Khaji Ali,Karbakhsh Mojgan,Zarei Mohammad
Indian Journal of Medical Sciences , 2004,
Abstract: BACKGROUND: Many studies have recently noted a shift in the causative mechanism of facial injuries away from traffic accident to assaults. AIMS: Our study aimed to investigate patterns of facial injuries in trauma patients during 13 months study of trauma patients in six general hospitals in Tehran. MATERIAL AND METHODS: Trauma patients who were hospitalized for more than 24 hours and had sustained injuries within seven days from admission were included in the study. Of the 8000 trauma patients, four hundred (5%) sustained facial injuries. RESULTS: Male to female ratio was 4.5:1. Among them, 53.3% were aged 11-30 years. Traffic accidents were by the far the commonest cause of injury. Motorcyclists who wore a helmet sustained facial fractures less often during traffic accident than those patients who did not wear helmet. Soft tissue injury and facial bone fracture comprised 43.3% and 40.8% of facial injuries, respectively. The majority of Soft tissue injuries (79%) were located extra orally. The mandible and nasal bone were the most commonly fractured facial bones. Victims of assault sustained more severe injuries compared to those involved in falls and traffic accidents. CONCLUSIONS: Use of helmets by motorcyclists and the separation of pedestrians routes from motor vehicles could reduce the number of victims and consequently injuries due to road traffic accidents. For implementation of effective prevention programs for reduction of facial injuries due to assault, it seems to be necessary to conduct studies investigating causes and pattern of injuries resulting in assault.
Gastrointestinal Injuries Following Blunt Abdominal Trauma In Children
LB Chirdan, AF Uba, OO Chirdan
Nigerian Journal of Clinical Practice , 2008,
Abstract: Purpose: Gastrointestinal (GI) injuries in children following blunt abdominal trauma is rare; early diagnosis and treatment is important for good outcome. The purpose of this report is to describe the management problems encountered in children with GI injuries following blunt abdominal trauma. Patients and Methods: From January 1996 June 2006, 168 children were treated at our centre for abdominal trauma. Twenty three had GI injuries, 19 were due to blunt trauma while four were due to penetrating trauma. We retrospectively reviewed the clinical data of the 19 children that had GI injuries as a result of blunt abdominal trauma to document the presentation, clinical features, diagnosis and outcome. Results: There were 19 patients, 14 were boys, and five were girls. The median age at presentation was nine years (range 1.5 15 years). Road traffic accident was responsible for injuries in 10, fall from heights in six and assault in two children. In one child the cause of injury was not recorded. Most children presented late and at presentation over 80% had abdominal signs. Diagnosis was mainly by physical examination supported by plain abdominal x-ray in 15 children. All 19 children had laparotomy. There were a total of 23 injuries. Gastric and duodenal injuries accounted for one each. Most of the injuries were in the jejunum and ileum (10 perforations, two contusions with one mesenteric haematoma and one mesenteric tear). There was one caecal perforation and six colonic injuries , one of which was associated with intraperitoneal rectal injury. Five children had other associated injuries (three splenic injuries, one renal injury, one bladder contusion associated with long bone fractures and one severe closed head injury). Treatment included segmental resection with end to end anastomosis, wedge resection with anastomosis, exteriorizations stomas, simple excision of the perforation and closure in two layers (gastric perforation). The total mortality was four (21.1%), two of them due to associated injuries. Conclusion: Gastrointestinal injuries due to blunt abdominal trauma pose a management challenge. Management based on decisions from serial clinical examinations and simple tests without recourse to advance imaging techniques may suffice.
A review of ureteral injuries after external trauma
Bruno MT Pereira, Michael P Ogilvie, Juan Gomez-Rodriguez, Mark L Ryan, Diego Pe?a, Antonio C Marttos, Louis R Pizano, Mark G McKenney
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , 2010, DOI: 10.1186/1757-7241-18-6
Abstract: Eighty-one articles pertaining to traumatic ureteral injuries were reviewed. Data from these studies were compiled and analyzed. The majority of the study population was young males. The proximal ureter was the most frequently injured portion. Associated injuries were present in 90.4% of patients. Admission urinalysis demonstrated hematuria in only 44.4% patients. Intravenous ureterogram (IVU) failed to diagnose ureteral injuries either upon admission or in the operating room in 42.8% of cases. Ureteroureterostomy, with or without indwelling stent, was the surgical procedure of choice for both trauma surgeons and urologists (59%). Complications occurred in 36.2% of cases. The mortality rate was 17%.The mechanism for ureteral injuries in adults is more commonly penetrating than blunt. The upper third of the ureter is more often injured than the middle and lower thirds. Associated injuries are frequently present. CT scan and retrograde pyelography accurately identify ureteral injuries when performed together. Ureteroureterostomy, with or without indwelling stent, is the surgical procedure of choice of both trauma surgeons and urologists alike. Delay in diagnosis is correlated with a poor prognosis.The proper management of a trauma victim is an increasingly relevant topic of discussion due to international warfare and the growing domestic incidence of traumatic injury. According to the Center for Disease Control and Prevention (CDC), trauma is the leading cause of death in children and young adults and overall is the fifth leading cause of death in the United States [1]. The World Health Organization classifies trauma as the 9th leading cause of death worldwide [2,3].Ureteral trauma was first reported in 1868 by Alfred Poland when he described the first case of disruption from blunt trauma [4]. The patient was a 33-year-old woman who died 6 days after being pinned between a platform and a railway carriage. At autopsy, in addition to many other injuries, the right urete
Missed injuries in trauma patients: A literature review
Roman Pfeifer, Hans-Christoph Pape
Patient Safety in Surgery , 2008, DOI: 10.1186/1754-9493-2-20
Abstract: Manuscripts dealing with missed injuries after trauma were reviewed. The following search modules were selected in PubMed: Missed injuries, Delayed diagnoses, Trauma, Musculoskeletal injuires. Three time periods were differentiated: (n = 2, 1980–1990), (n = 6, 1990–2000), and (n = 9, 2000-Present).We found a wide spread distribution of missed injuries and delayed diagnoses incidence rates (1.3% to 39%). Approximately 15 to 22.3% of patients with missed injuries had clinically significant missed injuries. Furthermore, we observed a decrease of missed pelvic and hip injuries within the last decade.The lack of standardized studies using comparable definitions for missed injuries and clinically significant missed injuries call for further investigations, which are necessary to produce more reliable data. Furthermore, improvements in diagnostic techniques (e.g. the use of multi-slice CT) may lead to a decreased incidence of missed pelvic injuries. Finally, the standardized tertiary trauma survey is vitally important in the detection of clinically significant missed injuries and should be included in trauma care.Patients who have been severely injured in road accidents [1,2], especially those with head injury [1,3,4], a Glasgow Coma Scale (GCS) score of eight or lower [5,6], and a greater Injury Severity Score (ISS) [1-3,5-9], are more likely to have missed injuries or delayed diagnoses. The majority of treatment errors occur in the emergency department [10-12], the intensive care unit (ICU) [10,12] and the operating room [12]. Gruen et al. [10] analysed patterns of error contributing to trauma mortality in 64 trauma patients with recognized errors in care. Errors were found to occur in haemorrhage control (28%), airway management (16%), management of unstable patients (14%) and prophylaxis (11%). The authors suggest that strategies for error-reduction should be addressed in both the emergency department and intensive care unit. However, ongoing documentation describing t
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