Comparison of the diagnostic accuracy of CT scan with oral and intravenous contrast versus CT scan with intravenous contrast alone in the diagnosis of blunt abdominal trauma / 中华创伤杂志(英文版)

PURPOSE@#Abdominal CT scan using oral and intravenous (IV) contrast is helpful in the diagnosis of intra-abdominal injuries. However, the use of oral and IV contrast delays the process of diagnosis and increases the risk of aspiration. It has also been shown that CT scan with IV contrast alone is as helpful as CT scan with oral and IV contrast and rectal CT scan in detecting abdominal injuries. Therefore, the present study aims to prospectively compare the diagnostic value of CT scan with oral and IV contrast versus CT scan with IV contrast alone in the diagnosis of blunt abdominal trauma (BAT).@*METHODS@#Altogether 123 BAT patients, 60 (48.8%) women and 63 (51.2%) men with the mean age of (40.4 ± 18.7) years who referred to the emergency department of Imam Khomeini Educational and Medical Center in Sari, Iran (a tertiary trauma center in north of Iran) from November 2014 to March 2017 and underwent abdominal CT scans + laparotomy were investigated. Those with penetrating trauma or hemodynamically unstable patients were excluded. The participants were randomly allocated to two groups: abdominal CT scan with oral and IV contrast (n = 63) and CT scan with IV contrast alone (n = 60). No statistically significant difference was found between two groups regarding the hemodynamic parameters, age, gender, injury mechanisms (all p > 0.05). The results of CT scan were compared with that of laparotomy results. The collected data were recorded in SPSS version 22.0 for Windows. Quantitative data were presented as mean and SD.@*RESULTS@#The sensitivity and specificity of CT scan using oral and IV contrast in the diagnosis of BAT were estimated at 96.48 (95% CI: 90.73 - 99.92) and 92.67 (95% CI: 89.65 - 94.88), respectively; while CT scan with IV contrast alone achieved a comparable sensitivity and specificity of 96.6 (95% CI: 87.45 - 99,42 and 92.84 (95% CI: 89.88 - 95.00), respectively.@*CONCLUSION@#CT scan with IV contrast alone can be used to assess visceral injuries in BAT patients with normal hemodynamics to avoid diagnostic delay.

Efficacy and safety of morphine and low dose ketamine for pain control of patients with long bone fractures: a randomized, double-blind, clinical trial

Objective: To compare the effects of intravenous morphine and a low dose of ketamine on pain intensity of patients with traumatic fractures of the long bones

Methods: This randomized, controlled, double-blinded, clinical trial was conducted in the adult emergency department [ED] of Emam Khomeini hospital, a tertiary general hospital affiliated with Mazandaran University of Medical Sciences, in Northern Iran, during a 6-month period. Patients were randomly assigned to receive intravenous morphine [0.1 mg/kg] or low dose ketamine [0.5 mg/kg] for control of the pain in the emergency room. The pain intensity was checked by a nurse using the visual analogue scale [VAS] at 30, 60, 90, 120, 180 and 240, minutes after the intervention

Results: Overall we included a total number of 156 patients with mean age of 35.87 +/- 3.38 years. There were 111 [71.2%] men and 4 [28.8%] women among the patients. Patients were randomly assigned to receive intravenous morphine [n=78] or low dose ketamine [n=78]. The pain intensity decreased significantly in both study groups after 240 minutes of intervention. However, there was no significant difference between the two study groups regarding the pain intensity at 30 [p=0.378], 60 [p=0.927], 90 [p=0.434], 120 [p=0.557], 180 [p=0.991] and 240 [p=0.829] minutes. The side effects were comparable while low dose ketamine was associated with higher need for rescue analgesic [p=0.036]

Conclusion: The results of the current study demonstrates that the intravenous low dose ketamine leads to successful pain control in patients with long bone fractures and the effects are comparable with intravenous morphine

Efficacy and safety of combination therapy with ketorolac and morphine in patient with acute renal colic; A triple-blind randomized controlled clinical trial

Objective: To compare the efficacy of combination therapy with ketorolac and morphine with monotherapy with each in patients with acute renal colic

Methods: This triple-blind, randomized clinical trial was conducted during a 6-month period from March to September 2014 in Northern Iran. We included 300 patients with clinical diagnosis of acute renal colic and pain score greater than 4 on 10 cm visual analogue scale [VAS] score. Patients were randomly assigned to three study groups to receive 0.1 mg/kg morphine in combination with 30 mg ketorolac [n=100], or only 0.1 mg/kg morphine [n=100] or only 30mg ketorolac [n=100]. All the patients were evaluated at 0, 20 minute,40 minute later. Our outcomes were pain reduction and need for additive morphine in 20 and 40 minutes. We also recorded and compared the adverse effects between the study groups

Results: There was no significant difference between the study groups. The pain intensity was comparable between three study groups after 20-min of intervention. However, we found that the pain intensity was significantly lower in balanced analgesia group when compared to morphine [3.01+/-0.98 vs. 3.66+/-1.02; p=0.012] or ketorolac alone [3.01+/-0.98 vs. 3.68+/-0.88; p=0.018]. However, those receiving the balanced analgesia, required significantly less rescue analgesia when compared to morphine [16% vs. 20%; p=0.041] or ketorolac [16% vs. 24%; p=0.012] alone

Conclusion: Balanced analgesia with morphine and ketorolac is more effective compared to morphine or ketorolac alone determine by lower pain scores after 40-min of injection and lower need for rescue analgesia