Cervical Spine Epidural Hematoma Disguised as Acute Ischemic Stroke: A Case Report

Cervical spine epidural hematoma is a rare disease, which can sometimes be misdiagnosed as acute ischemic stroke when a patient shows hemiparesis. A 68-year-old woman visited the emergency department with right side motor weakness without signs of facial palsy or cranial nerve deficit. She also complained of accompanying neck pain. Acute ischemic stroke was suspected initially and a non-contrast computed tomography of the brain was taken, which showed no cerebral hemorrhage. Brain and cervical spine magnetic resonance imaging (MRI) was performed for further evaluation. No evidence of cerebral infarction. However, an epidural hematoma was detected on cervical spine MRI. The patient was consulted to the neurosurgery department and decompressive laminectomy and hematoma evacuation was performed. Emergency physicians should consider cervical spine epidural hematoma in cases of sudden onset hemiparesis with accompanying neck pain.

Cervical Spine Epidural Hematoma Disguised as Acute Ischemic Stroke: A Case Report

Cervical spine epidural hematoma is a rare disease, which can sometimes be misdiagnosed as acute ischemic stroke when a patient shows hemiparesis. A 68-year-old woman visited the emergency department with right side motor weakness without signs of facial palsy or cranial nerve deficit. She also complained of accompanying neck pain. Acute ischemic stroke was suspected initially and a non-contrast computed tomography of the brain was taken, which showed no cerebral hemorrhage. Brain and cervical spine magnetic resonance imaging (MRI) was performed for further evaluation. No evidence of cerebral infarction. However, an epidural hematoma was detected on cervical spine MRI. The patient was consulted to the neurosurgery department and decompressive laminectomy and hematoma evacuation was performed. Emergency physicians should consider cervical spine epidural hematoma in cases of sudden onset hemiparesis with accompanying neck pain.

Spontaneous Uterine Perforation from Pyometra: A Case Report

Pyometra is the accumulation of pus in the uterine cavity. The incidence of pyometra in elderly patients is approximately 13.6%. Abdominal pain, fever, and vaginal discharge are the usual symptoms, but about half of the cases of uncomplicated pyometra have no specific symptoms. Spontaneous uterine rupture, resulting from complications of pyometra, is extremely rare. We report a case of spontaneous uterine rupture due to pyometra. A 77-year-old female patient who complained of nausea, abdominal pain, and poor oral intake (which started the day before) was transferred from the local hospital after having taken an abdominal CT. She had been bedridden for a year and had a history of hypertension, cerebral infarction, and colon cancer (for which she had a successful operation 12 years prior). Upon arrival, the patient was alert and her vital signs were: blood pressure of 113/78 mmHg, temperature of 36.9degrees C, respiratory rate of 22/min, and a pulse rate of 99/min. Her bowel sound was normal and physical examinations indicated a rigid abdomen with tenderness and rebound tenderness. Free air was observed in the abdominal CT and panperitonitis, due to uterine perforation resulting from pyometra, was also suggested. Hence, an emergency operation was undertaken. During the operation, the fundus of the uterus was found to be perforated with a 1 cmx1 cm-sized passage and a purulent discharge was apparent. Both the adnexa and bowel showed adhesion, but there was no bowel perforation or evident cancerous lesion. Entercoccus faecalis was cultured from both the cervical discharge and tissue obtained during operation. In summary, emergency physicians may consider uterine perforation due to pyometra in elderly woman with peritonitis.

Leg Weakness After An Automobile Accident Due To Spinal Cord Ischemia: A Case Report

Anterior spinal artery syndrome, also known as Beck's syndrome, is defined as ischemia or infarction of the spinal cord. Beck's syndrome occurs from aortic thrombus, embolism, or dissection blocking the blood flow to the great radicular artery (GRA) of Adamkiewicz. Abdominal artery embolism due to trauma is relatively rare and urgent detection of vascular injury is substantial to fair clinical outcome of the patient, therefore, we report on a case of traumatic artery dissection presenting as lower leg weakness.

The Influence of Wearing a Helmet on Facial Fractures Patterns in Injured Motorcycle Riders

PURPOSE: This study was undertaken in order to identify the influence of wearing a head protective device (helmet) on facial fracture patterns in injured motorcycle riders. METHODS: We retrospectively reviewed the medical records of patients who underwent facial bone computed tomography (CT) resulting from motorcycle riding injuries between May 2009 and July 2011. Data collected included age, gender, Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), status of helmet use, alcohol intake, time of accident, seating position of the rider, traumatic head injury (THI) measure and facial fracture patterns. Facial fracture patterns were grouped as fracture of the upper-face (orbits), mid-face (maxilla, zygoma, nose) and lower-face (mandible). We assessed the association between facial fracture patterns and helmet use. RESULTS: Of the 180 patients included in this study, 163 (90.6%) were male, 60 (33.3%) suffered facial fracture, 85 (47.2%) wore a helmet and 30 (16.7%) suffered THI. Their mean age was 28.7+/-14.6 years. Between the helmeted and unhelmeted groups, there was statistically significant difference in age, GCS, RTS and THI. There was no significant association between wearing a helmet and type of facial fracture. Multivariate logistic regression analysis demonstrated that age was the only factor influencing helmet use. CONCLUSION: Wearing a helmet prevented traumatic head injury but did not prevent any particular type of facial fractures in the injured motorcycle riders assessed in this study.

Retrospective Validation of the San Francisco Syncope Rule for Predicting Serious Outcomes in a Korean Emergency Department

PURPOSE: Syncope in a common condition that is typically benign but is occasionally associated with mortality. We conducted a retrospective validation of the San Francisco Syncope Rule (SFSR) for use in identifying emergency department (ED) syncope patients with short-term serious outcomes. METHODS: We studied 131 syncope patients who were admitted to or visited the out-patient department within 1 month of an ED visit related to syncope from January to December 2010. Patients meeting the inclusion criteria as defined in the SFSR derivation were evaluated for 5 previously derived predictor variables: abnormal electrocardiography (ECG), shortness of breath, hematocrit <30%, triage systolic blood pressure <90 mm Hg, and a history of congestive heart failure. Predetermined outcome measures as defined by the SFSR included death, myocardial infarction, arrhythmia, pulmonary embolism, stroke, subarachnoid hemorrhage, significant hemorrhage, or any condition causing or likely to cause a return ED visit and hospitalization, or related event. RESULTS: The patient group consisted of 63 males and 68 females with an average age of 56 years. 35(26.7%) patients met the predetermined criteria for serious outcome. 10 of 35(28.6%) patients with a serious outcome were not identified as high risk using the rule. The rule performance for predicting serious outcomes included a sensitivity of 71.4% (95% confidence interval (CI), 56% to 86%), specificity of 69.8% (95% confidence interval (CI), 69% to 70%) and positive predictive value of 47.3%. CONCLUSION: In this retrospective validation study in Korea, the SFSR performed with comparable specificity but with significantly lower sensitivity than reported in the original study. Implementing the rule would significantly increase admission rates.

Bronchial Ruptures after Blunt Trauma in Two Patients: Different Time of Diagnosis and Different Prognosis

Bronchial injury due to blunt trauma is often associated with other significant injuries; as a result, making a rapid diagnosis can be difficult. Delay of early diagnosis and surgical treatment can result in a fatal course, including persistent pneumothorax, soft tissue emphysema, lung collapse, recurrent infection, or death. Bronchoscopy remains a reliable diagnostic method; however, it is difficult to perform in the emergency department. In some cases, suspicion of emergency physicians, depending on findings observed on computed tomography scan, can be more helpful than bronchoscopy. In this article, we present two cases of bronchial injury after blunt chest trauma; differences in prognosis were dependent on the time taken to make a decision.

Decision Factors in Performance of Intravenous Contrast-enhanced Computed Tomography for Patients with Acute Flank Pain in an Emergency Department

PURPOSE: The aim of this study is to determine decision factors for performance of intravenous (IV) contrast-enhanced computed tomography (CT) for patients with acute flank pain in an emergency department. METHODS: We evaluated patients who presented with acute flank pain and underwent IV contrast-enhanced CT from January 2010 to June 2011. The IV contrast-enhanced CT useful group was defined as patients whose CT findings were equal to the final diagnosis. But urolithiasis was an exception, because enhanced CT is not useful in making the final diagnosis. We conducted a comparison of clinical characteristics and laboratory findings between the IV contrast-enhanced CT useful group and the not useful group. We then performed logistic regression analysis for analysis of independent predictors. RESULTS: A total of 166 patients were enrolled in this study. The IV contrast-enhanced CT useful group included 41 (24.7%) patients. Results of logistic regression analysis demonstrated that right upper quadrant tenderness (p=0.023), right lower quadrant tenderness (p=0.037), and negative hematuria (p=0.007) were independent predictors for the IV contrast-enhanced CT useful group. CONCLUSION: In patients with acute flank pain, performance of IV contrast-enhanced CT is useful for detection of alternative findings in the presence of right upper quadrant tenderness, right lower quadrant tenderness, and negative hematuria.

Spontaneous Intramural Intestinal Hematoma: A Rare Complication of Anticoagulation

Spontaneous intramural intestinal hematoma is a rare complication resulting from over-anticoagulation. We report on three uncommon cases of spontaneous intramural small bowel hematoma due to oral anticoagulation. The patients received conservative treatment with bowel rest, hydration and vitamin K infusion, and transfusion of fresh frozen plasma (FFP). Computed tomography (CT) scan was performed for diagnostic confirmation. Patients recovered within a few days. Because there are no specific symptoms or clinical signs, diagnosis of this condition is difficult. Therefore, clinical suspicion and experience are important. This case report represents an attempt to share information on this rare condition by presentation of the case and literature review.

The Usefulness of Computed Tomography for Clinical Diagnosis of Pelvic Inflammatory Disease in an Emergency Department

PURPOSE: Early detection and appropriate treatment of pelvic inflammatory disease (PID) are important to prevent adverse sequelae. The purpose of this study was to evaluate the usefulness of computed tomography (CT) for diagnosis of PID in an emergency department (ED). METHODS: We undertook a retrospective review of patients with acute low abdominal pain who were checked by abdominal CT in the ED at a tertiary hospital between June 2009 and December 2009. Inclusion criteria were PID on CT or non specific findings on CT and a consultation to the gynecology department. Exclusion criteria were age less than 15 years, age greater than 60 years, definite other causes for the acute low abdominal pain seen on CT, intact virginity, and transfer to another hospital. We compared clinical characteristics and laboratory findings between group A (clinically diagnosed PID patients) and group B (non-PID patients). We calculated sensitivity and specificity of CT findings to predict clinical diagnosis of PID. RESULTS: A total of 68 patients were enrolled in this study. Median age was 31 years (24-39). Group A consisted of 51 patients; group B of 17 patients. Cervical motion tenderness (p=0.001) and WBC count (p=0.013) were significantly different between the two groups. The accuracy of PID findings on CT for predicting the clinical diagnosis of PID was 85.29%. The sensitivity and specificity were 92.16% and 64.71%, respectively. Leukorrhea had a sensitivity of 76.47% and a specificity of 47.06%. Cervical motion tenderness had a sensitivity of 87.18% and a specificity of 75%. CONCLUSION: Abdominal CT performed in the ED is a useful method for the clinical diagnosis of PID.

The Utility of Liver Transaminase as a Predictor of Liver Injury in Blunt Abdominal Trauma

PURPOSE: The liver is the second most common organ injured by blunt abdominal trauma. The purpose of this study was to determine the utility of liver transaminase in screening blunt abdominal trauma patients for traumatic liver injury. METHODS: We retrospectively reviewed the medical records of 231 patients who sustained blunt trauma and were at risk for traumatic liver injury between June 2009 and August 2010. All of them underwent a focused assessment with sonography for trauma (FAST) and abdominal computed tomography (CT). Based on the diagnosis of abdominal CT, patients were divided into two groups: group I with liver injury and group II without liver injury. We compared the two groups and calculated the sensitivity, the specificity and the predictive values of serum aspartate aminotransferase (AST) and serum alanine aminotransferase (ALT) by using multiple cutoff values. RESULTS: Of 231 patients with no abdominal free fluid in the FAST, 33 had traumatic liver injury on abdominal CT. The mean AST and ALT levels in group I (311.6 IU/L and 228.1 IU/L, respectively) were significantly higher than the values in group II (48.4 IU/L and 35.6 IU/L, respectively). The cutoff to distinguish liver injury is 60 IU/L for AST and 58 IU/L for ALT, with 93.8% sensitivity and 79.8% specificity for AST, and 90.6% sensitivity and 87.4% specificity for ALT. CONCLUSION: We recommend that all patient with suspected blunt abdominal trauma be evaluated using serum liver transaminase as a screening test for liver injury even though no abdominal free fluid is shown on the FAST. If AST > 60 IU/L and/or ALT > 58 IU/L, abdominal CT was useful to confirm liver injury in this study

Indications for Computed Tomography (CT) to Detect Renal Injury in Pediatric Blunt Abdominal Trauma Patients with Microscopic Hematuria

PURPOSE: Controversy exists regarding whether pediatric blunt abdominal trauma patients with microscopic hematuria should undergo radiographic evaluation. Adult patients have indications such as shock and deceleration injury. This study was conducted to suggest indications for the use of CT to detect significant renal injury in pediatric blunt abdominal trauma patients with microscopic hematuria. METHODS: From January 2005 to December 2009, patients less than 18 years of age with blunt abdominal trauma and microscopic hematuria who had undergone CT were included in this retrospective study. We analyzed the correlation between microscopic hematuria, shock, deceleration injury, and American Association for the Surgery of Trauma (AAST) renal injury grade. Patients were divided into two groups: the insignificant renal injury group (AAST grade 1) and the significant renal injury group (AAST grades 2-5). We compared age, gender, mechanism of injury, degree of microscopic hematuria, evidence of shock, presence of deceleration injury, and associated injuries between the two groups. We analyzed the effect of each of the above each factors on renal injury by using a logistic regression analysis. RESULTS: Forty-three children were included, and the median age was 15 years. Five children had a significant renal injury. No significant differences, except age and microscopic hematuria (more than 30 red blood cells per high power field (RBC/HPF), p = 0.005) existed between the insignificant and the significant injury groups. A positive correlation existed between renal injury and microscopic hematuria (rho = 0.406, p = 0.007), but renal injury was not correlated with shock and deceleration injury. In the multivariate regression analysis, microscopic hematuria was the only factor correlated with renal injury (p = 0.042). CONCLUSION: If a microscopic hematuria of more than 30 RBC/HPF exists, the use of CT should be considerd, regardless of shock and deceleration injury to detect significant renal injury in pediatric blunt abdominal trauma patients.

The Effect of the Body Mass Index and the Abdominal Circumference in the Diagnosis of Appendicitis using Ultrasonography

PURPOSE: This study was conducted to investigate the effect of body mass index (BMI) and abdominal circumference (AC) on the diagnosis of appendicitis using ultrasonography (US). METHODS: Between January 1, 2007, and June 30, 2007, we recruited 170 patients who complained about right lower-quadrant pain and who had an Alvarado score greater than 7 points. We recorded the height, weight, and AC for each patient and calculated a BMI. All patients received US investigation by emergency department residents. The cases were categorized according to whether the appendicitis was visible or non-visible. The sensitivity, specificity, and accuracy for each group were assessed and compared. RESULTS: A total of 170 patients was enrolled. Of those 94 patients had visible signs of appendicitis, and 76 patients had non-visible appendicitis. The mean BMI and AC of visible group were 22.09+/-3.12 and 77.47+/-9.32, as compared with 22.43+/-4.05 and 83.83+/-9.48 for the non-visible group, and the groups had significant differences in BMI and AC (p<0.001). The sensitivity, specificity and accuracy of US in patients with BMI under 25 were 58%, 60%, and 58%, respectively, and for those with BMI over 25 were 35%, 50%, and 36%. The sensitivity, specificity, and accuracy of US for male patients with AC under 90 cm were 55%, 75%, and 56%, and for those with AC over 90 cm the numbers were 35%, 50%, and 33%. The sensitivity, specificity, and accuracy of US in females with AC under 80 cm were 75%, 75%, and 74% and for those with AC over 80 cm, 45%, 50%, and 47%. CONCLUSION: Increasing BMI and AC negatively affect the US sensitivity, specificity, and accuracy in an appendicitis diagnosis.

Comparison of CPR Outcomes between Autopulse TM and Manual Compression in Adult Out-of-hospital Cardiac Arrest

PURPOSE: Our goal was to compare resuscitation outcomes, 24 hour survival, and survival discharge between patients resuscitated with an AutoPulse compression device vs. those resuscitated using manual compression in adult, out-of-hospital non-traumatic cardiac arrest patients. METHODS:We retrospectively reviewed cases of out-of-hospital cardiac arrest that occurred between July 2005 and June 2008. We included, 267 non-traumatic patients who had. We compared characteristics between 93 patients who had AutoPulse compression and 174 patients who had manual compression. Characteristics included resuscitation outcomes (return of spontaneous circulation [ROSC], 24 hour survival and resuscitation outcomes according to the initial ECG. RESULTS: The rate of ROSC was 43.1% for AutoPulse compression and 50.57% for manual compression; the difference was not significant (p=0.294). Survival rates at 24 hours were, respectively, 33.3% and 31.6% (p=0.88). Survival discharge proportions were, 8.6% and 11.5%, respectively (p=0.599). CONCLUSION: There are no statistically significant differences in resuscitation outcomes between AutoPulse and manual compression in adult, out-of-hospital, non-traumatic, cardiac arrest patients.

Factors that Influence Selecting the Imaging Modality for Diagnosing Acute Appendicitis

PURPOSE: The aim of this study is to evaluate the advanced radiographic imaging that's used for making the diagnosis of an acute appendicitis, and also the factors that influence selecting the imaging modality. METHODS: We retrospectively reviewed the data of 420 patients who underwent an appendectomy as an emergency procedure in our hospital from January 1, 2005, to December 31, 2006. All the cases were categorized into three groups by the radiologic imaging tests. One was the ultrasonography (US) only group, another was the computed tomography (CT) only group and the third was both the US and CT scan group. Age, gender, height, weight, the Alvarado score (AS) and the body mass index (BMI) were compared between the 3 groups. I assessed the reason for choosing computed tomography (CT) to assist in making the diagnosis. RESULTS: Four hundred twenty patients underwent operative exploration under the presumed diagnosis of appendicitis. Of those, 348 patients underwent US, 48 underwent CT scanning and 24 underwent both US and CT scanning. The mean age and BMI were significantly higher in the CT only group (P<0.001 and P=0.008, respectively). The most common reason for choosing CT scanning was that the physician suspected other diseases other than appendicitis due to an atypical presentation on the physical examination. CONCLUSION: US was the most commonly used radiologic imaging study for making the diagnosis of appendicitis. CT was more frequently used for the old or obese patients for making the differential diagnosis.

The Effect of S-100B Protein and Risk Factors on Indication of Cranial Computed Tomography in Patients with Minor Head Injury

PURPOSE: S-100B protein is a reliable biomarker of brain injury. The clinical decision rules for screening of a cranial computed tomography (CCT) in minor head injury patients remain controversial. The purpose of this study was to determine whether S-100B protein and risk factors for minor head injury patients can provide meaningful insights to improve initial CCT scanning of patients with MHI. METHODS: Fifty patients with MHI were enrolled in this prospective study from July 2007 to September 2007. All patients who fulfilled the following inclusion criteria were enrolled: history of head trauma, initial GCS score of 14 to 15, and one or more clinical findings. Risk factors of patients presented in this study included age younger than 2 years or above sixty years, focal neurologic deficit (FND), post-traumatic seizure, skull fracture, extra-cranial injury, coagulopathy, previous neurologic deficit and ingestion of toxicants (drugs or alcohol). A venous blood sample for assessment of S-100B protein was drawn and a CCT scan was undergone. The reference value of S-100B protein was 0.105 microgram/L. All CCT findings were confirmed by radiologists. RESULTS: Of the 50 patients studied, 15 patients exhibited trauma-relevant intracranial lesions on the CCT scan (CCTpositive). The subgroups of CCT-positive and -negative showed no statistically difference in S-100B level (p=0.068). Of the fifty patients, thirteen had no risk factors (RF). However, statistically significant differences were observed in S-100B level when the subgroups were classified into RF-positive and RF-negative groups (p=0.016). The CCTpositive findings of 13 patients with no RF were identified with 100% sensitivity, 54.6% specificity, 28.6% positive predictive value and 100% negative predictive value through assessment of S-100B protein level. CONCLUSION: In patients with MHI, S-100B protein level and risk factors may give us reliable predictive information prior to CCT screening in emergency department.

Effect of Alcohol on Base Deficit in Trauma

PURPOSE: Alcohol intake is commonly found in injured patients, and alcohol affects base deficit independently with trauma. The purpose of this study was to evaluate the effect of alcohol on base deficit in trauma patients. METHODS: Data was retrospectively collected from trauma patients over 18 years of age who were admitted at the emergency center between October 2005 and July 2006. Blood sampling for alcohol level, base deficit evaluation were done within first hour for all patients. Patients were divided according to the serum alcohol level into an alcohol group(serum alcohol level> or =10 mg/dl) and a non-alcohol group. The patients were also stratified into minor (ISS or =16) injury groups according to their injury severity score (ISS). RESULTS: The study enrolled 63 patients of whom 37 fell into the alcohol group and 26 into the non-alcohol group. The mean alcohol level within the alcohol group was 210+/-85 mg/dl. Base deficit and serum lactate were not found to be significantly different in minor and major injuries, and ISS, base deficit were not significantly different with serum alcohol level. Base deficit was somewhat higher on average but not statistically significant in the non-alcohol group than in the alcohol group (-3.0+/-4.5 vs. -1.8+/-6.7 mmol/L, p=0.444). The base deficit was higher for the major injury-alcohol group than for the major injury-non-alcohol group, but this difference also did not achieve statistical significance (-4.6 +/-5.8 vs -2.4+/-8.1 mmol/L, p=0.117) CONCLUSION: In the severely injured patients, base deficit appears to be increased with alcohol but we found no statistically significant differences in base deficit and ISS between alcohol group and non-alcohol group of injured patients.

Clinical Analysis of Facial Bone Fractures

PURPOSE: As modern civilization and transportation systems have developed, the incidence of facial bone fractures has increased. The purpose of this study was to develop a criteria for proper use of computed tomography in cases of facial bone fracture, so that an accurate diagnoses can be made and proper treatment can be given. METHODS: This study included patients who visited the emergency center from March 2005 to December 2005. A total of 513 patients received facial bone computed tomography. The patients were divided into 2 groups: 242 patients who were diagnosed with facial fractures, and 271 patients without facial fractures. General, physical, and neurological examinations were analyzed to determine the degree of correlations with facial fractures. RESULTS: In facial fractures group, the sex ratio was 2.7:1 (M:F=177:65). The patients were mainly younger. There were two common causes of injuries; 117 cases (48.3%) were caused by fisticuffs, and 54 cases (22.3%) resulted from traffic accidents. Orbital fractures were the most common injury, comprising 156 cases (64.5%). The average injury severity score (ISS) of the patients was 6.5+/-4.0. As determined by multiple logistic regression analysis based on controlled physical examination and neurologic examination, significant risk factors related to facial fracture are abrasion, swelling, bruise, laceration, conjunctival hemorrhage, epistaxis, enophthalmos, extraoccular muscle limitation, temporo-mandible malocclusion and paresthesia. CONCLUSIONS: Facial bone fractures mostly occurred among active males between the ages of 20 to 40, and the most common causes are fisticuffs and traffic accidents. When facial injuries are associated with physical symptoms, such as swelling, laceration, conjunctival hemorrhage, epistaxis, enophthalmos, extraoccular muscle limitaion, temporo-mandible malocclusion and paresthesia, facial bone computed tomography is essential to proper diagnosis.

Utility of Radiologic Imaging for Patients who underwent Appendectomy

PURPOSE: The primary aim of this study was to evaluate the rate of advanced radiographic imaging for patients who underwent appendectomy. The secondary aim was to investigate the effect of ultrasonography (US) and computed tomography (CT) on the outcome of an appendectomy. METHODS: We retrospectively reviewed the data of 585 patients who underwent an appendectomy as an emergency procedure in our hospital within a 2-year period. Cases were categorized by the presence or absence of advanced radiographic imaging. We evaluated the negative appendectomy rate, the occurrence of perforation, and the preoperative emergency department length of stay (ED LOS). RESULTS: Five hundred eighty-five (585) patients underwent operative exploration for presumed appendicitis. Of those 165 patients had no advanced imaging, 347 had a US, 49 had a CT scan, 24 had both US and a CT scan. Acute appendicitis was pathologically proven in 567 patients, corresponding to negative appendectomy rate of 3.1%. Ninetythree appendices (15.9%) were perforated. The mean preoperative ED LOS was 15.8 hours. CONCLUSION: Advanced radiographic imaging prior to operative exploration did not lower the negative appendectomy rate. Diagnostic imaging significantly increased the perforation rate and the preoperative ED LOS.

Correlation Between Facial Fracture and Cranial Injury

PURPOSE: There are two theories about the relationships between facial fractures and cranial injuries. One is that facial bones act as a protective cushion for the brain, and the other is that facial fractures are the marker for increased risk of cranial injury. They have been debated on for many years. The purpose of this study is to identify the relationship between facial fractures and cranial injuries. METHODS: A retrospective study was performed on 242 patients with facial fractures. The data were analyzed based on the medical records of the patients: age, gender, cause of injury, Injury Severity Score (ISS), alcohol intake, type of facial fractures, and type of cranial injury. The patients were divided into two groups: facial fractures with cranial injury and facial fractures without cranial injury. We compared the general characteristics between the two groups and evaluated the relationship between each type of facial fracture and each type of cranial injury. RESULTS: Among the 242 patients with facial bone fractures, 96 (39.7%) patients had a combination of facial fractures and cranial injuries. Gender predilection was demonstrated to favor males: the ratio was 3:1. The mean age was 36.51+/-19.63. As to the injury mechanism, traffic accidents (in car, out of car, motorcycle) were statistically significant in the group of facial fractures with cranial injury (p=0.038, p=0.000, p=0.003). The ISS was significant, but alcohol intake was not significant. No significant relationship between facial fractures and skull fractures was found. Only maxilla fractures, zygoma fractures, and cerebral concussion had a significant difference in cranial injury (p=0.039, p=0.025). CONCLUSION: There is a no correlation between facial fractures and skull fractures, which suggests that the cushion effect is the predominent relationship between facial fractures and cranial injuries.