ABSTRACT
OBJECTIVES: Early in the coronavirus 2019 (COVID-19) pandemic, a high frequency of pulmonary embolism was identified. This audit aims to assess the frequency and severity of pulmonary embolism in 2020 compared to 2019. METHODS: In this retrospective audit, we compared computed tomography pulmonary angiography (CTPA) frequency and pulmonary embolism severity in April and May 2020, compared to 2019. Pulmonary embolism severity was assessed with the Modified Miller score and the presence of right heart strain was assessed. Demographic information and 30-day mortality was identified from electronic health records. RESULTS: In April 2020, there was a 17% reduction in the number of CTPA performed and an increase in the proportion identifying pulmonary embolism (26%, n = 68/265 vs 15%, n = 47/320, p < 0.001), compared to April 2019. Patients with pulmonary embolism in 2020 had more comorbidities (p = 0.026), but similar age and sex compared to 2019. There was no difference in pulmonary embolism severity in 2020 compared to 2019, but there was an increased frequency of right heart strain in May 2020 (29 vs 12%, p = 0.029). Amongst 18 patients with COVID-19 and pulmonary embolism, there was a larger proportion of males and an increased 30 day mortality (28% vs 6%, p = 0.008). CONCLUSION: During the COVID-19 pandemic, there was a reduction in the number of CTPA scans performed and an increase in the frequency of CTPA scans positive for pulmonary embolism. Patients with both COVID-19 and pulmonary embolism had an increased risk of 30-day mortality compared to those without COVID-19. ADVANCES IN KNOWLEDGE: During the COVID-19 pandemic, the number of CTPA performed decreased and the proportion of positive CTPA increased. Patients with both pulmonary embolism and COVID-19 had worse outcomes compared to those with pulmonary embolism alone.
Subject(s)
COVID-19/complications , Computed Tomography Angiography/statistics & numerical data , Pulmonary Embolism/diagnostic imaging , Pulmonary Embolism/etiology , Aged , COVID-19/mortality , Female , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/mortality , Pneumonia, Viral/virology , Pulmonary Embolism/mortality , Retrospective Studies , SARS-CoV-2 , Severity of Illness IndexABSTRACT
PURPOSE: Paediatric cervical spine injuries are fortunately a rare entity. However, they do have the potential for devastating neurological sequelae with lifelong impact on the patient and their family. Thus, management ought to be exceptional from the initial evaluation at the scene of the injury, through to definitive management and rehabilitation. METHODS: We set out to review cervical spine injuries in children and advise on current best practice with regards to management. RESULTS: Epidemiology, initial management at the scene of injury, radiological findings and pitfalls of cervical spine trauma are outlined. Strategies for conservative and surgical management are detailed depending on the pattern of injury. The management of spinal cord injuries without radiological abnormality (SCIWORA) and cranio-cervical arterial injuries is also reviewed. CONCLUSIONS: Due to a paucity of evidence in these rare conditions, expert opinion is necessary to guide best practice management and to ensure the best chance of a good outcome for the injured child.
Subject(s)
Cervical Vertebrae/injuries , Emergency Medical Services/methods , Guideline Adherence , Immobilization/methods , Spinal Cord Injuries/therapy , Spinal Injuries/therapy , Cervical Vertebrae/diagnostic imaging , Child , Child, Preschool , Humans , Injury Severity Score , Prospective Studies , Radiography , Spinal Cord Injuries/diagnostic imaging , Spinal Cord Injuries/physiopathology , Spinal Cord Injuries/rehabilitation , Spinal Injuries/diagnostic imaging , Spinal Injuries/physiopathology , Spinal Injuries/rehabilitation , Time-to-Treatment , Transportation of Patients/methodsABSTRACT
This article reviews fractures of the cervical spine, highlighting the pertinent goals of initial management, the indications for different imaging modalities and the different fracture patterns. Basic principles of management of these different fracture patterns are outlined.
