ABSTRACT
RESUMEN Objetivo: evaluar el rendimiento diagnóstico de la tomografía abdominal sin medio de contraste oral en pacientes con dolor abdominal. Materiales y métodos: se incluyeron tomografías de pacientes con dolor abdominal entre el 1 de septiembre y 31 de diciembre del 2015 en el Hospital Universitario San Vicente Fundación. Se analizó el desempeño de las tomografías con o sin contraste oral y se consideró como prueba de referencia el resultado diagnóstico definitivo en la intervención quirúrgica o por diagnóstico clínico. Se calculó la sensibilidad, especificidad y los valores predictivos positivos y negativos con intervalos de confianza del 95 %. Resultados: fueron evaluadas un total de 128 tomografías de abdomen, 91 con contraste oral y 37 sin él. La tomografía sin contraste oral tuvo una sensibilidad y especificidad muy similar a la que sí lo tenía, con valores de 84 % y 91,6 %, respectivamente. Conclusión: el rendimiento global de la tomografía con contraste oral fue similar a la que no lo tenía, con valores cercanos al 90 %. La adquisición de la tomografía con contraste oral tomó casi 3 veces más tiempo que el requerido en los estudios sin contraste oral.
SUMMARY Objective: Evaluate the diagnostic performance of abdominal tomography without oral contrast medium in patients with abdominal pain. Materials and methods: Abdominal tomographies of patients with abdominal pain were included, between September 1 and December 31, 2015 at the Hospital Universitario San Vicente Fundación. For the analysis of the tomographies with or without oral contrast, the definitive diagnostic result in the surgical intervention or by clinical diagnosis was considered as a reference test. We calculated the sensitivity, specificity and positive and negative predictive values with their respective 95% confidence intervals for tomography with and without oral contrast. Results: 128 abdominal tomographies, 91 with oral contrast and 37 without this type of contrast were evaluated. The tomography without oral contrast had a sensitivity and specificity very similar to the tomography with contrast, with values of 84% and 91.6%, respectively. Conclusion: The performance of the tomography with oral contrast was similar to the tomography without oral contrast, with values close to 90%. The acquisition of tomography with oral contrast took almost 3 times longer than that required in the studies without oral contrast.
Subject(s)
Humans , Abdominal Pain , Contrast Media , TomographyABSTRACT
BACKGROUND: The study aimed to establish the benefits of using chest tubes with negative pleural suction against trapped water in patients with penetrating or blunt chest trauma who underwent tube thoracostomy, in terms of the incidence of complications, such as persistent air leak, clotted hemothorax, empyema, and duration of stay. METHODS: Patients who underwent tube thoracostomy because of traumatic pneumothorax, hemothorax, or hemopneumothorax were randomly assigned into one of two groups: in Group 1, the three-bottle drainage system was connected to a negative suction; in Group 2, no suction was given. Patients who required mechanical ventilation or emergency surgery (thoracotomy or thoracoscopy) either at the time of admission to the institution or immediately after the tube thoracostomy, patients who had histories of thoracic procedures or chronic pulmonary diseases (chronic obstructive pulmonary disease, diffuse interstitial lung disease), and patients with multiple injuries with severe traumatic brain injury and a Glasgow Coma Scale (GCS) score less than 8 of 15 were excluded from the study. Hospital stay, duration of tube thoracostomy, prolonged fistula, and other clinical variables were compared. RESULTS: One hundred ten patients were included, 56 in the group with suction and 54 in the group without suction. There were no differences in the demographic characteristics of each group. There were no differences between the groups in terms of hospital stay (p = 0.22), duration of tube thoracostomy (p = 0.35) (3 days in each group), or complications. However, the probability of air leak presence in time was greater for the Group 1 patients with negative suction versus the Group 2 patients (p = 0.023). CONCLUSION: The use of negative pleural suction did not demonstrate advantages over the three-bottle chest drainage system without suction in patients with uncomplicated traumatic pneumothorax, hemothorax, or hemopneumothorax. LEVEL OF EVIDENCE: Therapeutic study, level II.
Subject(s)
Chest Tubes , Suction/methods , Thoracic Injuries/therapy , Adult , Chest Tubes/adverse effects , Female , Hemopneumothorax/therapy , Hemothorax/therapy , Humans , Length of Stay , Male , Pneumothorax/therapy , Suction/adverse effects , Thoracoscopy , Thoracotomy , Treatment Outcome , Wounds, Nonpenetrating/therapy , Wounds, Penetrating/therapyABSTRACT
INTRODUCTION: The liver is the most frequently injured organ in blunt abdominal trauma. Patients that are hemodynamically unstable must undergo inmmediate surgical treatment. There are 2 surgical approaches for these patients; Anatomical Liver resection or non-anatomic liver resection. Around 80-90% of patients are candidates for non-operative management. -Several risk factors have been studied to select the patients most suited for a non operative management. MATERIALS AND METHODS: We performed a retrospective study based on a prospective database. We searched for risk factors related to immediate surgical management and failed non-operative management. We also described the surgical procedures that were undertaken in this cohort of patients and their outcomes and complications. RESULTS: During the study period 117 patients presented with blunt liver trauma. 19 patients (16.2%) required a laparotomy during the initial 24h after their admission. There were 11 deaths (58%) amongst these patients. Peri-hepatic packing and suturing were the most common procedures performed. A RTS Score<7.8 (RR: 7.3; IC 95%: 1.8-30.1), and ISS Score >20 (RR 2,5 IC 95%: 1.0-6.7), and associated intra-abdominal injuries (RR: 2.95; IC 95%: 1.25-6.92) were risk factors for immediate surgery. In 98 (83.7%) patients a non-operative management was performed. 7 patients had a failed non-operative management. CONCLUSION: The need for immediate surgical management is related to the presence of associated intra-abdominal injuries, and the ISS and RTS scores. In this series the most frequently performed procedure for blunt liver trauma was peri-hepatic packing.
