Comparison of chest CT scan findings between COVID-19 and pulmonary contusion in trauma patients based on RSNA criteria: Established novel criteria for trauma victims / 中华创伤杂志(英文版)

PROPOSE@#In this study, we re-assessed the criteria defined by the radiological society of North America (RSNA) to determine novel radiological findings helping the physicians differentiating COVID-19 from pulmonary contusion.@*METHODS@#All trauma patients with blunt chest wall trauma and subsequent pulmonary contusion, COVID-19-related signs and symptoms before the trauma were enrolled in this retrospective study from February to May 2020. Included patients (Group P) were then classified into two groups based on polymerase chain reaction tests (Group Pa for positive patients and Pb for negative ones). Moreover, 44 patients from the pre-pandemic period (Group PP) were enrolled. They were matched to Group P regarding age, sex, and trauma-related scores. Two radiologists blindly reviewed the CT images of all enrolled patients according to criteria defined by the RSNA criteria. The radiological findings were compared between Group P and Group PP; statistically significant ones were re-evaluated between Group Pa and Group Pb thereafter. Finally, the sensitivity and specificity of each significant findings were calculated. The Chi-square test was used to compare the radiological findings between Group P and Group PP.@*RESULTS@#In the Group PP, 73.7% of all ground-glass opacities (GGOs) and 80% of all multiple bilateral GGOs were detected (p < 0.001 and p = 0.25, respectively). Single bilateral GGOs were only seen among the Group PP. The Chi-square tests showed that the prevalence of diffused GGOs, multiple unilateral GGOs, multiple consolidations, and multiple bilateral consolidations were significantly higher in the Group P (p = 0.001, 0.01, 0.003, and 0.003, respectively). However, GGOs with irregular borders and single consolidations were more significant among the Group PP (p = 0.01 and 0.003, respectively). Of note, reticular distortions and subpleural spares were exclusively detected in the Group PP.@*CONCLUSION@#We concluded that the criteria set by RSNA for the diagnosis of COVID-19 are not appropriate in trauma patients. The clinical signs and symptoms are not always useful either. The presence of multiple unilateral GGOs, diffused GGOs, and multiple bilateral consolidations favor COVID-19 with 88%, 97.62%, and 77.7% diagnostic accuracy.

Should we change our approach to resuscitating victims of femoral fracture? A clinical experience in a busy trauma hospital in Shiraz, Iran / 中华创伤杂志(英文版)

PURPOSE@#Traumatic hemorrhagic shock is a life-threatening event worldwide. Severe brain trauma accompanying femoral fractures can trigger inflammatory responses in the body and increase pre-inflammatory cytokines such as TNF-α, IL-1. The primary treatment in these cases is hydration with crystalloids, which has both benefits and complications. The purpose of this study was to investigate the effects of fluid therapy on the hemodynamics, coagulation profiles, and blood gases in such patients.@*METHODS@#In this cross-sectional study, patients were divided into two groups: femoral fracture group and non-femoral group. The hemodynamic status, coagulation profile, and blood gases of patients in both groups were evaluated upon arrival at the hospital and again 2 h later. Data were analyzed by t-test and ANOVA with repeated data and paired samples t-test.@*RESULTS@#A total of 681 trauma patients (605 men and 76 women) participated in this study, including 69 (86.3%) men and 11 (13.8%) women in femoral fracture group and 536 men (89.2%) and 65 women (10.8%) in non-femoral group. The laboratory parameters were evaluated in response to the equal amount of crystalloid fluid given upon arrival and 2 h later. Blood gases decreased in the fracture group despite fluid therapy (p < 0.003), and the coagulation profile worsened although the change was not statistically significant.@*CONCLUSION@#The treatment of multiple-trauma patients with femoral bone fractures should be more concerned with the need for the infusion of vasopressors such as norepinephrine. If there is evidence of clinical shock, excessive crystalloid infusion (limited to 1 L) should be avoided, and blood and blood products should be started as soon as possible.

Management of deep vein thrombosis [DVT] prophylaxis in trauma patients

Deep vein thrombosis [DVT] and pulmonary embolism [PTE] are known as venous thromboembolism [VTE]. DVT occurs when a thrombus [a blood clot] forms in deep veins of the body, usually in the lower extremities. It can cause swelling or leg pain, but sometimes may occur with no symptoms. Awareness of DVT is the best way to prevent the VTE. Patients with trauma are at increased risk of DVT and subsequent PE because of coagulopathy in patients with multiple trauma, DVT prophylaxis is essential but the VTE prophylaxis strategy is controversial for the trauma patients. The risk factors for VTE includes pelvic and lower extremity fractures, and head injury

Objective structured clinical examination [OSCE]-based assessment of the advanced trauma life Support [ATLS] course in Iran

Objective: to evaluate the effect of advance trauma life support [ATLS[registered sign]] training on general surgery residents clinical reasoning skills using the national boards-style objective structured clinical examination [OSCE]

Methods: this cross-sectional single-center study was conducted in Shiraz University of Medical Sciences including 51 surgery residents that participated in a mandatory national board style OSCE between May 2014 and May 2015. OSCE scores of two groups of general surgery residents including 23 ATLS[registered sign] trained and 28 non-ATLS[registered sign] trained were compared using Mann-Whitney U test. The exam was graded out of 20 points and the passing score was >/=14 including 40% trauma cases

Results: there were 8[15.7%] women and 43[84.3%] men among the participants with mean age of 31.12 +/- 2.69 and 33.67 +/- 4.39 years in women and men respectively. Overall 7 [87.5%] women and 34 [79.07%] men passed the OSCE. The trauma section OSCE score was significantly higher in the ATLS[registered sign] trained participants when compared to non-ATLS[registered sign] [7.79 +/- 0.81vs.6.90 +/- 1.00; p=0.001]. In addition, the total score was also significantly higher in ATLS[registered sign] trained residents [16.07 +/- 1.41 vs. 14.60 +/- 1.40; p=0.001]. There was no association between gender and ATLS[registered sign] score [p=0.245] or passing the OSCE [p=0.503]

Conclusion: ATLS[registered sign] training is associated with improved overall OSCE scores of general surgery residents completing the board examinations suggesting a positive transfer of ATLS learned skills to management of simulated surgical patients including trauma cases

Tube thoracostomy [chest tube] removal in traumatic patients: what do we know? What can we do?

Chest tube [CT] or tube thoracostomy placement is often indicated following traumatic injuries. Premature movement of the chest tube leads to increased hospital complications and costs for patients. Placement of a chest tube is indicated in drainage of blood, bile, pus, drain air, and other fluids. Although there is a general agreement for the placement of a chest tube, there is little consensus on the subsequent management. Chest tube removal in trauma patients increases morbidity and hospital expense if not done at the right time. A review of relevant literature showed that the best answers to some questions about time and decision-making have been long sought. Issues discussed in this manuscript include chest tube removal conditions, the need for chest radiography before and after chest tuberemoval, the need to clamp the chest tube prior to removal, and drainage rate and acceptability prior to removal

spatiotemporal pattern of trauma in victims of violence visited in emergency room of Rajaei hospital, Shiraz, Iran

Objective: To explain an important aspect of violence, the Spatiotemporal pattern of trauma in victims of violence visited in emergency room of Rajaei hospital, Shiraz, Iran

Methods: This cross-sectional prospective study comprised 109 randomly selected victims of violence visited in emergency room of Rajaei hospital, a tertiary referral hospital affiliated to Shiraz University of Medical Sciences in winter 2013. We recorded the demographic information as well as data regarding the type and time of the injuries. The data collected for each victim was then entered in a data gathering form

Results: The study included 88% males with mean age 27.8 +/- 8.8 years, which encompassed more tharf| 60% young adults. Our study showed a temporal pattern with triple peaks. Moreover, 64% of assault trauma occurred at night. Furthermore, our study showed the majority of our patients suffered from stab wounds and about 57% of patients studied lacked high school diploma. Moreover it was revealed that violence was more common in downtown Shiraz, especially in the Fifth city district with simultaneous presence of many riskr factors for violence

Conclusion: The result of this study showed that age, gender, educational status and temporal peak of violence were shown to be similar to other investigations conducted in other countries. Despite these similarities, stabbing were more prevalent in our study. Additionally, the Fifth city district of Shiraz seems to be the main city district where preventive intervention is needed to reduce violence- related injuries

Short-term outcome of open appendectomy in southern iran: a single center experience

Objectives: To evaluate the short-term outcome of open appendectomy, the rate of negative appendectomy as well as pathology reports after surgery in patients with suspected acute appendicitis

Methods: This was a retrospective cross-sectional study being performed in Nemazee hospital affiliated with Shiraz University of Medical Science during a 2-year period between 2008 and 2010. The medical records of all consecutive patients who underwent open appendectomy in our center due to acute appendicitis were included in the study. The elective and laparoscopic appendectomies were excluded. The demographic information, clinical findings, laboratory investigations and the histopathological examination of the appendix were recorded and reported

Results: A total of 337 patient including 137[36.4%] females, and 240[63.6%] males with the mean ageof 16.26 +/- 9.81 [range 3 to 76] years were stduied. Anorexia [64.7%]and fever [20.7%] were more prevalent symptoms. The mean duration between pain initiation and operation ranged from 0 to 14 days with mean 1.88 +/- 1.63 days. Right lower quadrant [RLQ], periumbilical, epigastria, left lower quadrant [LLQ], and Right upper quadrant [RUQ], pain were manifest in 78.8%, 41.6%, 12.2%, 3.2%, and 1.3% of patients, respectively Pathological evaluation of the appendix showed appendicitis in 70.4% of patients

Conclusion: The higher rate of negative appendectomy accounts for wasteful tapping of medical resources and causing further complication in patients. Therefore it is essential to conduct more accurate studies to detect the root cause of the disease. This would help improve the management of appendicitis which is an emergency condition with high incidence

Chest tube removal time in trauma patients on positive ventilation pressure: a randomized clinical trial

To determine the removal time of the chest tube in ICU trauma patients under positive ventilation pressure [PVP]. This was randomized clinical trial being performed in ICU department of Rajaei trauma hospital from March to December 2011. A total number of 92 trauma patients who were admitted in ICU and were under ventilation and had chest tube were randomly assigned into two groups. In case group, chest tube was clamped after 5-7 days. In the control group, chest tube was retained until the patients were under PVP The chest tube was removed if there was no air leak or the drainage was less than 300 mL. Complications observed in the case and control groups were 4.4% of 4.3% respectively [p=0.862]. Among case group with hemothorax, 6.7% developed complication while this ratio for pneumothorax was 7.1% and zero in those with hemopneumothorax [p=0.561], whereas respective values for the control group were 11.1%, 8.3% and zero [p=0.262]. Complications were noticed in 10.5% of those with more than 300 ml of pulmonary drainage. There were no complications in patients without air leak. In mild leak, 4.8% of subjects experienced complication, in moderate leak, no complication occurred and in severe ones, complication was visible in 7.7% of patients [p=0.842]. The present study showed that the removal of chest tube in patients under ventilation within 5-7 days after its insertion is safe without any complications

Modified perihepatic packing; a creative and beneficial method for management of high grade liver injury

To evaluate the efficacy of modified perihepatic packing [MPHP] in reducing the rate of re-bleeding rate after packing removal. This was an experimental study being performed in Shiraz animal laboratory. High grade liver parenchymal injury was induced in 30 transgenic Australian rabbits which were then divided into two groups. Group A [control] included 14 and group B [experimental] comprised 16 rabbits. The animals in group A underwent standard perihepatic packing [SPHP] and those in group B were subjected to MPHP. Re-bleeding was assessed and compared between the two groups, after removal of perihepatic packings. There was no significant difference between two study groups regarding baseline and perioperative characteristics. Rabbits in group A had significantly lower rate of postoperative re-bleeding compared to those in group A [57.1% vs. 12.5%; p=0.019]. The mean bleeding volume was also significantly lower in group B compared to group A [76.88 +/- 22.12 vs. 98.93 +/- 33.8 mL; p<001]. Although the survival rate was higher in group A compared to group B [93.8% vs. 78.6%] but the difference was not statistically significant [p=0.315]. MPHP is a simple and safe procedure for surgical management of high grade liver parenchymal injury concomitant with severe loss of glisson's capsule. This procedure significantly decreases re-bleeding after packing removal in comparison with SPHP

Predictive value of biochemical markers for extremity vascular trauma outcome

To evaluate the predictive value of some biochemical markers in the outcome of extremity vascular trauma. This study comprised 30 patients with traumatic arterial injury and acute limb ischemia referred to Namazi hospital affiliated with Shiraz University of Medical Sciences, over a period of 8 months, from Sep 2009 to Jul 2010. Venous blood samples were drawn from distal ischemic limb to determine pH, HCO[3][-], PCO[2], PO[2], Na[+] and K[+] before definitive surgical intervention. Comparable samples were also obtained from veins of non-ischemic upper extremities. The biochemical assays were compared after monitoring the revasculurized limbs and evaluation of viability during a period of 7 days. The mean age of the patients was 28.3 +/- 7.8 [range: 18-56] years. Two [6.6%] patients underwent amputation because of developing irreversible limb ischemia after vascular reconstruction. Both patients had blunt traumatic knee injury accompanied by nerve, vein and soft tissue damage. The statistical analysis showed correlations between parameters, except for Na[+] of local [ischemic limb] and systemic samples. In this context, the highest correlation was observed in regard to HCO[3][-]. The correlation was most pronounced with respect to HCO[3][-]. Ischemic limbs exhibited reduction in pH and PO[2] but, PCO[2] and K increased after ischemia of injured limbs. PO[2] reflects tissue perfusion and is of value in predicting the outcome. We believe that blunt trauma and associated nerve, vein and soft tissue injuries pose negative prognostic effects on limb survival postoperatively

Emergency operating room workload pattern: a single center experience from southern Iran

To determine the epidemiology and pattern of emergency operating room workload in Nemazee hospital affiliated with Shiraz University of Medical Sciences, Shiraz, Iran. All surgical emergency operations which were performed in Nemazee hospital, Shiraz, Iran were collected over twelve months [September 2007 to September 2008]. The data obtained included indications, presenting symptoms the services provided and the demographic information of the patients. Overall number of recorded emergency operations in this cross sectional descriptive study was 3946, with males constituting 72% of the patients. The highest male/female ratio reported in trauma patients was 6.4:1 with the median age of 23 years, and the mean age of the operated patients was 27.8 years. Second to neurosurgery [19.64%] the general surgery was the busiest discipline in emergency operations [59.14%]. Appendectomy [11.77%], double/triple lumen/central venous catheter insertion [9.4%], and fiber optic/rigid bronchoscopy [3.27%] were the commonest general surgical operations. Among trauma patients, neurotrauma was the commonest reason for operation [10%]. Based on a new approach toward emergency operating room workload, in our country and centre, we showed that it is necessary to devote particular and individualized attention to the fields of agenda and hospital management of emergency operations. This is due to a high emergency operating room workload and its unique characteristics in our centre in contrast to other hospitals and departments. Although a decision making and operational strategy is recently seen to improve the quality and quantity of emergency services available to our patients, there is still a gap between present and optimal emergency healthcare which should be provided for our residents