Comparative and retrospective evaluation of the predictive performance of optic nerve sheath thickness and optic nerve sheath diameter for traumatic brain injury using facial computed tomography

Objective@#To evaluate the predictive performance of optic nerve sheath thickness (ONST) on the outcomes of traumatic brain injury (TBI) and to compare the inter-observer agreement To evaluate the predictive performance of optic nerve sheath thickness (ONST) for traumatic brain injury (TBI) and to compare the predictive performance and inter-observer agreement between ONST and optic nerve sheath diameter (ONSD) on facial computed tomography (CT). @*Methods@#We retrospectively enrolled patients with a history of facial trauma and who underwent both facial CT and brain CT. Two reviewers independently measured ONST and ONSD of each patient using facial CT images. Final brain CT with clinical outcome was used as the reference standard for TBI. Multivariate logistic regression analyses, receiver operating characteristic (ROC) curves, and intraclass correlation coefficients were used for statistical analyses. @*Results@#Both ONST (P=0.002) and ONSD (P=0.001) on facial CT were significantly independent factors to distinguish between TBI and healthy brains; an increase in ONST and ONSD values corresponded with an increase in the risk of TBI by 8.9- and 7.6-fold, respectively. The predictive performances of the ONST (sensitivity, 96.2%; specificity, 94.3%; area under the ROC curve, 0.968) and ONSD (sensitivity, 92.6%; specificity, 90.2%; area under the ROC curve, 0.955) were excellent and exhibited similar sensitivity, specificity, and area under the curve (P=0.18–0.99). Interobserver and intraobserver intraclass correlation coefficients for ONST were significantly higher than those for ONSD (all P<0.001). @*Conclusion@#ONST on facial CT is a feasible predictor of TBI and demonstrates similar performance and superior observer agreement than ONSD. We recommend using ONST measurements to assess the need for additional brain CT scans in TBI-suspected cases.

Clinical Manifestations of Contrast Media Extravasation in the Emergency Department and the Ward

PURPOSE@#Contrast media extravasation (CME) is an adverse reaction after administration of contrast media during CT examinations. The purpose of this study was to evaluate the frequency, management, and outcomes of extravasations and to assess the risk factors for CME in the emergency department (ED) and the ward.@*MATERIALS AND METHODS@#This retrospective study was conducted at a single academic urban hospital from January 2013 to December 2015. We analyzed the medical records of all patients who experienced CME after undergoing a CT scan. We compared the patients' age, sex, underlying disease, injection site, injection flow rate, time of CT examination, type of CT examination, and severity of injury between those in the ED and the ward.@*RESULTS@#CME occurred in 41 (0.36%) of 114767 patients, which included 16 (0.34%) in the ED and 25 (0.37%) in the ward. Both groups were more frequent in those aged older than 60 years and in female. Additionally, the abdominopelvic CT type and 2–3 mL/s as the injection rate were more common in both groups. However, CME was more frequent during the nighttime (10, 62.5%) in the ER, while it was more common in the daytime (14, 56.0%) in the ward. Severe complications were more frequent in the ER (9, 56.3%) compared with the ward (8, 32.8%). There were no significant differences in CME between the ED and the ward. When comparing the clinical manifestations in the mild and severe groups, the antecubital fossa (33.3% and 0%, respectively; p = 0.013) for the injection site and abdominopelvic CT (41.7% and 82.4%, respectively; p = 0.012) and CT angiography (41.7% and 5.87%, respectively; p = 0.014) for the CT examination showed significant differences between the mild and severe groups.@*CONCLUSION@#In this study, there were no significant clinical differences in CME between the ED and ward. Thus, prevention is more important than the place of admission. Radiologists and emergency physicians should pay attention to CME in the ED because it frequently occurs at night and results in more severe complications.

Risk factors for hospital admission in revisiting patients to the emergency department with abdominal pain

OBJECTIVE: The aim of this study was to identify the clinical characteristics and risk factors associated with the admission of patients in the emergency department (ED) within 30 days after discharge. METHODS: A retrospective, observational study was conducted on adult patients presenting with abdominal pain to the ED of a single, urban, university hospital, between January 2014 and December 2015, who revisited the ED within 30 days after discharge. Data was collected on the emergency severity index level, time to contact doctors, physical examination, laboratory tests, use of computed tomography (CT), and patient disposition on revisitation. The primary outcome was hospital admission following an ED revisit in the 30-day period after the first visit. RESULTS: During the study period, 19,480 patients visited the ED with the chief complaint of abdominal pain, and 13,577 were discharged. A total of 251 patients (1.29%) revisited the ED within 30 days, of which 89 were eligible for the study. The primary outcome was associated with not performing a CT scan on the initial visit and an increased C-reactive protein (CRP) value. Receiver operating characteristic curve analysis showed that a cut-off baseline CRP value of >0.35 mg/dL can predict the primary outcome with a sensitivity and specificity of 75% and 62.1%, respectively (area under the curve, 0.701; 95% confidence interval, 0.569–0.833; P=0.007). CONCLUSION: An increased CRP value and not performing abdominal CT were associated with a higher rate of admission following ED revisits of patients with abdominal pain. Future prospective studies on the role of abdominal CT imaging in patients presenting to the ED with abdominal pain will be needed.

Neutrophil-to-lymphocyte Ratio as A Predictor of Aspiration Pneumonia in Drug Intoxication Patients

PURPOSE: To evaluate the association between neutrophil-to-lymphocyte ratio (NLR) and occurrence of aspiration pneumonia in drug intoxication (DI) patients in the emergency department (ED) and to evaluate the relationship between NLR and length of hospital admission/intensive care unit (ICU) admission. METHODS: A total of 466 patients diagnosed with DI in the ED from January 2016 to December 2017 were included in the analysis. The clinical and laboratory results, including NLR, were evaluated as variables. NLR was calculated as the absolute neutrophil count/absolute lymphocyte count. To evaluate the prognosis of DI, data on the development of aspiration pneumonia were obtained. Also, we evaluated the relationship between NLR and length of hospital admission and between NLR and length of ICU admission. Statistically, multivariate logistic regression analyses, receiver-operating characteristic (ROC) curve analysis, and Pearson's correlation (ρ) were performed. RESULTS: Among the 466 DI patients, 86 (18.5%) developed aspiration pneumonia. Multivariate logistic regression analysis revealed NLR as an independent factor in predicting aspiration pneumonia (odds ratio, 1.7; p=0.001). NLR showed excellent predictive performance for aspiration pneumonia (areas under the ROC curves, 0.815; cut-off value, 3.47; p 3.47).

Factors Related to Subarachnoid Hemorrhage as a Cause of Out-of-Hospital Cardiac Arrest

PURPOSE: Subarachnoid hemorrhage (SAH) is a common cause of out-of-hospital cardiac arrest (OHCA). Early identification of patients with SAH induced OHCA may be helpful to emergency physicians when making therapeutic decisions. We conducted an investigation of the incidence and characteristics of patients with OHCA caused by non-traumatic SAH. METHODS: We conducted a retrospective review of cases of 236 OHCA survivors who had visited the emergency department (ED) of an urban tertiary care university hospital from January 2004 to December 2010. We excluded patients for whom there was an obvious cause or trauma. Clinical characteristics of SAH induced OHCA survivors were compared with those of SAH negative OHCA survivors. RESULTS: A total of 26 patients (19.11%) had been diagnosed with SAH. Compared with SAH negative survivors, SAH positive survivors were more likely to be female (odds ratio OR, 1.262; 95% confidence interval CI, 1.300-9.605), not to have Diabetes mellitus (OR, 0.180; 95% CI, 0.037-0.879), and to have a short duration of CPR time (OR, 1.074; 95% CI, 1.003-1.150). Results of the Cardiac Troponin T assay were less likely to be positive in patients with SAH induced OHCA, compared to those with SAH negative OHCA (OR, 0.071; 95% CI, 0.008-0.526). CONCLUSION: SAH is a more frequent cause of OHCA than originally believed. Immediate brain CT scan is useful in diagnosis of SAH when patient characteristics include: female, non diabetes mellitus, short duration of CPR time, or negative TnT.

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 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.

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

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.

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.

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.

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.

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.

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.