Higher enhanced computed tomography attenuation value of the aorta is a predictor of massive transfusion in blunt trauma patients

OBJECTIVE: Several scoring systems have been developed to identify patients who require massive transfusion (MT) after major trauma to improve survival. The primary goal of this study was to investigate the usefulness of enhanced computed tomography attenuation values (CTAVs) of major vessels to determine the need for MT in patients with major blunt trauma.METHODS: This single-center retrospective cohort study evaluated patients aged 16 years or older who underwent contrast-enhanced computed tomography scan of the torso after major blunt trauma. The CTAVs of six major vessel points in both the arterial and portal venous phases at initial computed tomography examination were assessed and compared between the MT and the no MT group. The capability of enhanced CTAVs to predict the necessity for MT was estimated based on the area under the receiver operating characteristic curve.RESULTS: Of the 254 eligible patients, 36 (14%) were in the MT group. Patients in the MT group had significantly higher CTAVs at all sites except the inferior vena cava in both the arterial and portal venous phases than that in the no MT group. The descending aorta in the arterial phase had the highest accuracy for predicting MT, with an AUROC of 0.901 (95% confidence interval, 0.855 to 0.947; P<0.001).CONCLUSION: Initial elevation of enhanced CTAV of the aorta is a predictor for the need for MT. A higher CTAV of the aorta should alert the trauma surgeon or emergency physician to activate their MT protocol.

A patient presenting painful chest wall swelling: Tietze syndrome / 世界急诊医学杂志（英文）

@#Patients frequently visit the emergency room with acute chest pain. While some potentially life-threatening disorders may cause the pain, in approximately 80% of cases, the chest pain source is benign, and musculoskeletal chest pain accounts for nearly 20%– 50% of those cases.[1–6] Thus, pain caused by benign and pathological conditions of the chest wall encountered in the emergency department is sometimes incorrectly attributed to angina pectoris or pleuritic and other serious cardiopulmonary diseases.