RESUMO
BACKGROUND: Cervical spine clearance requires clinicians to assess the reliability of physical examination based on a patient's mental status and distracting injuries. Distracting injuries have never been clearly defined in military casualties. METHODS: Retrospective review was conducted of patients entered into Department of Defense Trauma Registry January 2008 to August 2013, identifying blunt trauma patients with cervical spine injury and Glasgow Coma Score ≥ 14. Physical examination and radiology results were abstracted from medical records and injury diagnoses were obtained from Department of Defense Trauma Registry. Groups were compared, p-value of < 0.05 was considered significant. RESULTS: A total of 149 patients met study criteria; 20 patients (13%) had a negative clinical examination of the cervical spine. Coexisting injuries identified in patients with negative physical examination included injuries in proximity to the neck (head, thoracic spine, chest, or humerus) in 17 (85%) patients. In 3 patients (15%), coexisting injuries were not in proximity to the neck and included pelvic, femur, and tibia fractures. All patients without coexisting injury (n = 37) had a positive physical examination. CONCLUSION: Physical examination of multitrauma casualties with neck injury may be unreliable when distracting injuries are present. When no distracting injuries were present, the physical examination was accurate in all patients.
Assuntos
Vértebras Cervicais/lesões , Traumatismo Múltiplo , Traumatismos da Coluna Vertebral/epidemiologia , Ferimentos não Penetrantes/epidemiologia , Adulto , Feminino , Escala de Coma de Glasgow , Humanos , Incidência , Masculino , Estudos Retrospectivos , Traumatismos da Coluna Vertebral/diagnóstico , Tomografia Computadorizada por Raios X , Estados Unidos/epidemiologia , Guerra , Ferimentos não Penetrantes/diagnósticoRESUMO
United States Armed Forces radiologists deployed to Afghanistan and Iraq in modern military conflicts may encounter pediatric patients as a casualty of war or when providing humanitarian assistance to the indigenous population. Pediatric patients account for 4-7% of admissions at U.S. military hospitals during the Iraq and Afghanistan conflicts. It is pertinent for radiologists in the humanitarian care team to be familiar with imaging pediatric trauma patients, the pathology endemic to the local population, and delayed presentations of congenital and developmental disorders to adequately care for these patients. The radiological manifestations of various pediatric disorders seen in the setting of the Iraq and Afghanistan conflicts will be explored.
Assuntos
Campanha Afegã de 2001- , Diagnóstico por Imagem/métodos , Hospitais Militares , Guerra do Iraque 2003-2011 , Militares , Pediatria/métodos , Adolescente , Altruísmo , Criança , Pré-Escolar , Feminino , Humanos , Infecções/diagnóstico , Masculino , Medicina Militar , Tomografia Computadorizada por Raios X , Estados Unidos , Ferimentos e Lesões/diagnósticoRESUMO
Imaging in a patient suspected of having suffered an acute stroke is used primarily to clear the patient for thrombolytic therapy, by excluding intracranial hemorrhage and nonstroke causes of the patient's symptoms, within a critical 3-hour window. Noncontrast CT of the brain is the imaging test of choice for the initial evaluation of a patient with suspected acute ischemic stroke. It is rapid and readily available and has a high sensitivity for intracranial hemorrhage. Contrast-enhanced CT angiography and perfusion imaging may provide additional information with only a minimal increase in scanning time. Finally, diffusion-weighted magnetic resonance sequences have a high sensitivity for acute stroke and, with magnetic resonance perfusion imaging, may play an increasing role in the future treatment of stroke.
