J Trauma
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Comparative Study
Blunt chest trauma victims: role of intravascular ultrasound and transesophageal echocardiography in cases of abnormal thoracic aortogram.
The objective of our study was to use transesophageal echocardiography (TEE) and intravascular ultrasonography (IVUS) to evaluate their role in interrogating abnormal or equivocal findings seen on thoracic aortography performed on blunt chest trauma patients. ⋯ When thoracic aortography yields an abnormal and especially equivocal findings, both IVUS and TEE are helpful in further sorting this out rather than subjecting the patient to a potentially unnecessary thoracotomy. In cases of aortic injury suspected at the lesser curvature of the arch-isthmic junction, TEE allowed better delineation because of multiplane imaging capability.
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Popliteal artery injuries pose a serious threat to limb survival. Blunt trauma appears to be associated with a higher amputation rate than penetrating trauma, probably because of the more extensive nature of the injuries. ⋯ Prompt resuscitation, vascularization, and proper technique appear to be the only correctable factors that improve limb salvage.
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Comparative Study
Prospective validation of computed tomographic screening of the thoracolumbar spine in trauma.
Concern for thoracolumbar spine (TLS) injuries after major trauma mandates immobilization pending radiographic evaluation. Current protocols use standard posteroanterior and lateral radiographs of the thoracolumbar spine (XR/TLS), but many patients also undergo abdominal or thoracic computed tomographic (CT) scanning. We sought to evaluate whether helical truncal CT scanning performed to evaluate visceral trauma images the spine as well as dedicated XR/TLS. ⋯ CT/CAP diagnoses TLS fractures more accurately than XR/TLS. Neither misses unstable fractures, but CT scanning finds small fractures that benefit by treatment and identifies chronic disease better. CT screening is far faster and shortens time to removal of spine precautions. CT scan-based diagnosis does not result in greater radiation exposure and improves resource use. Screening the TLS on truncal helical CT scanning performed for the evaluation of visceral injuries is more accurate than TLS imaging by standard radiography. CT/CAP should replace plain radiographs in high-risk trauma patients who require screening.
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Comparative Study
The utility of the pelvic radiograph in the assessment of pediatric pelvic fractures.
Computed tomographic (CT) scanning is sensitive in detecting pelvic fractures in the pediatric patient. Pelvic fractures in the pediatric population rarely require emergent intervention, thus providing time to obtain the optimal imaging study. The objective of this study was to compare pelvic radiographs and abdominal pelvic CT scans of all pediatric trauma patients with pelvic injury to determine the role of pelvic imaging in the immediate trauma resuscitation. ⋯ The pelvic radiograph lacked the sensitivity of the pelvic CT scan for detecting pelvic fractures in all anatomic areas evaluated. Pelvic CT scan also offers additional information regarding soft tissue injury not available on most pelvic radiographs. In the trauma patient that will undergo abdominopelvic CT scanning as part of the trauma evaluation, a pelvic radiograph may be superfluous. Screening pelvic radiography should be reserved for the rare unstable patient or the patient in whom an abdominopelvic CT scan is not otherwise indicated.