An evaluation of scooter injury and injury patterns following widespread adoption of E-scooters in a major metropolitan area.

OBJECTIVE: Despite the increasing use of e-scooters globally, the pattern of injuries on diagnostic imaging had not been well-documented to date. We performed a retrospective study utilizing our health system's radiology database to characterize the injury distribution and imaging features of scooter injuries. METHODS: We utilized our radiology report database searching for any imaging report containing the word "scooter", beginning September 1, 2017, when scooters were first introduced to our area through December 1, 2018. RESULTS: Our search yielded a total of 54 patients with 105 imaging studies. The injuries predominantly affected the musculoskeletal system, with a predilection to the upper extremity. We had no cases of visceral or neurotrauma. CONCLUSION: Musculoskeletal injuries were the predominant form of scooter injury. The lack of visceral injury suggests that emergency physicians should consider having a higher clinical threshold for ordering these studies in patients with scooter injuries.

Traumatic Diaphragmatic Rupture with Transthoracic Organ Herniation: A Case Report and Review of Literature.

BACKGROUND Diaphragmatic rupture is a rare pathology that reported in less than 0.5% of all trauma cases, with signs and symptoms that can easily be misdiagnosed. Clinicians must maintain a high index of suspicion to correctly diagnose and manage this pathology. We present a rare case of a large diaphragmatic rupture with transthoracic gastric and colon herniation that was successfully repaired, along with a literature review. CASE REPORT A 59-year-old woman presented to our Trauma Center after being involved in a motor vehicle collision. She complained of chest and abdominal pain, with decreased breath sounds on the left side. CT imaging revealed discontinuity of the left hemidiaphragm, with intrathoracic herniation of stomach and colon with multiple other injuries. The patient was taken for an emergent laparotomy. The diaphragmatic rupture measured 20 cm in length, with a stellate component. After ensuring complete reduction of the herniated organs, the diaphragmatic defect was primarily repaired. The patient recovered from her injuries and was doing well at last follow-up in the clinic. CONCLUSIONS This case highlights the importance of diaphragmatic rupture and its associated intra-abdominal injuries when treating trauma patients. With missed diaphragmatic injuries leading to a potential morbidity rate of 30% and mortality rate as high as 10%, the clinician must have a high index of suspicion to correctly diagnose and manage this pathology in a timely fashion. More research is needed to provide surgeons with evidence-based standardized therapies for dealing with these rare pathologies to ensure optimal patient outcomes.

"Perimortem" total body CT-scan examination in severely injured children: an informative insight into the causes of death.

OBJECTIVE: To report routine practice of "perimortem" CT-scan imaging to determine the causes of death in children dying from severe accidental injuries within the first hours following hospital admission. SETTINGS: Trauma center of a University Pediatric Hospital. METHODS: A retrospective study was conducted in children (0 to 15 years old) referred for severe trauma (GCS ≤ 8) to a regional pediatric trauma center, presenting with at least spontaneous cardiac rhythm and dying within the first 12 h after admission. "Perimortem" CT-scan consisted in high-resolution, contrast-enhanced, full-body CT-scan imaging, performed whatever child's clinical status. Lethal and associated lesions found were analyzed and classified according to validated scales. The comparison between clinical and radiological examinations and CT-scan findings evaluated the accuracy of clinical examination to predict lethal lesions. RESULTS: CT-scan performed in 73 children detected 132 potentially lethal lesions, at least 2 lesions in 63%, and 1 in 37% of the cases. More frequent lethal lesions were brain (43%), and chest injuries (33%), followed by abdominal (12%), and cervical spine injuries (12%). Clinical and minimal radiological examinations were poorly predictive for identifying abdominal/chest lesions. Clinical and imaging data provided to the medical examiner were considered sufficient to identify the cause of death, and to deliver early burial certificates in 70 children. Only three legal autopsies were commanded. CONCLUSIONS: Perimortem CT imaging could provide an insight into the causes of death in traumatized children. Performed on an emergency basis near death, it eliminates the difficulties encountered in forensic radiology. It could be a possible alternative to full-scale forensic examination, at least regarding elucidation of the potential, or highly probable causes of death.