Study Design: Retrospective, diagnostic study. Objective: To verify if the interspinous distance is able to predict the risk for kyphotic collapse in thoracolumbar burst fractures treated conservatively without neurol...Study Design: Retrospective, diagnostic study. Objective: To verify if the interspinous distance is able to predict the risk for kyphotic collapse in thoracolumbar burst fractures treated conservatively without neurological deficit. Summary of Background Data: In patients with thoracolumbar burst fractures, the association between the amount of comminution, by using load-sharing classification (LSC), and kyphotic collapse is presented in the literature. However, LSC does not include the interspinous distance as an indirect sign to suggest biomechanical instability due to posterior ligamentous disruption in these patients in order to predict kyphotic collapse. Methods: We added the interspinous distance to the load-sharing classification (MLSC) in 50 consecutive patients with thoracolumbar burst fractures (according to Denis criteria) treated conservatively. Results: The LSC score was correlated to kyphotic collapse in the patients treated with TLSO (r = 0.312, p = 0.027;Spearman test;A = 0.668). The MLSC was similarly correlated to kyphotic collapse among TLSO-treated patients (r = 0.295, p = 0.038;Spearman test;A = 0.652). Conclusions: The interspinous distance did not contribute to the identification of worse radiographic outcomes, represented by the kyphotic collapse. This may suggest that the amount of comminution pointed out by the LSC is enough and more important than the interspinous opening in order to predict kyphotic collapse in thoracolumbar burst fractures. Possibly, the interspinous distance is much too heterogenous and multifactorial to be useful, since it reflects vertebral body height, preinjury anatomy, as well as posterior element disruption.展开更多
Objective： Detection of abdominal in- jury is a very important component in trauma management, so a precise assessment of liver and spleen injuries includ- ing their severity degree is necessary. There is a good case...Objective： Detection of abdominal in- jury is a very important component in trauma management, so a precise assessment of liver and spleen injuries includ- ing their severity degree is necessary. There is a good case to believe that in emergency situations the radiologists＇ performance may profit from a systematic approach using established scoring systems. Score systems as the organ injury scale （OIS） drawn up by the American Association for the Surgery of Trauma are a valuable guidance for objec- tive trauma assessment. Aim of this study was to evaluate retrospectively whether a structured approach using the OIS may help improve trauma assessment. Methods： Fifty-three patients, 38 male and 15 female who underwent CT and laparotomy after abdominal trauma were included in this study. The laparotomy was performed by experienced surgeons with a minimum experience of 6 years. While the original CT reports were written by differ- ent radiologists with a minimum experience of 3 years, and then a radiologist with experience of 4 years reviewed the same original CT pictures, resulting in the structured report. Both the original and structured CT results on liver and spleen injuries were transferred into OIS grades. Finally, the initial and structured CT results were compared with theintraoperative findings gathered from the surgery report. Results： Regarding the original CT report we found a mean divergence of 0.68±0.8 （r=-0.45） to the OIS finding in the surgery report for liver injuries （0.69±1.17 for spleen injuries; r=-0.69）. In comparison with the structured approach, where we detected a divergence of 0.8±0.68; r=-0.63 （0.47±0.77 for spleen injuries; r=0.91）, there was no significant difference. However we detected a lower rate of over-diag- nosis in structured approaches. Conclusion： Our study shows that a structured ap- proach to triage abdominal trauma using an imaging check- list does not lead to a significantly higher detection rate, but a nonsignificant trend to reduce the rate of over- diagnoses, thus being more precise in grading the severity grade. Concerning the bias by retrospective study design, further prospective investigations are needed to evaluate the impact of trauma scores on the workflow in emergency department procedure as structured reporting systems are a valuable guidance in other radiological disciplines.展开更多
Objective: To compare the characters and outcomes of patients injured from traffic accidents in different rank hospitals. Methods: From 8 hospitals of ranks I III, 1?915 cases were sampled and divided into 4 groups. I...Objective: To compare the characters and outcomes of patients injured from traffic accidents in different rank hospitals. Methods: From 8 hospitals of ranks I III, 1?915 cases were sampled and divided into 4 groups. Injuries of all patients were accessed by the method of RTS, AIS ISS AP and ASCOT. Results: (1) The higher rank of hospitals, the severer the patients condition were. Mean ISSs in hospital ranks II and III were greater than 16, which were recommended as a standard of severe trauma. (2) Transportation of severe patients to high level hospitals prolonged the pre hospital duration by 5 9 h. (3) Factors contributing to death were the trauma severity, complications, hospital ranks that reflect the quality of the medical care. Conclusions: (1) This sample of 1?915 cases matches the condition of most Chinese hospitals in characteristics of traffic trauma patients. (2) Most Chinese hospitals can be divided into 3 degree of trauma center by a criteria of ISS and the unexpected death. (3) Incidence of multiple injuries shows no significant difference in each rank of hospitals. (4) The relationship between the hospital rank and the quality of trauma care is significant. We suggest that a RTS=11 or ISS=9 be triaged to trauma center, and a 10% Ps (survival probability) less than the average Ps of a hospital be triage to higher level hospitals.展开更多
文摘Study Design: Retrospective, diagnostic study. Objective: To verify if the interspinous distance is able to predict the risk for kyphotic collapse in thoracolumbar burst fractures treated conservatively without neurological deficit. Summary of Background Data: In patients with thoracolumbar burst fractures, the association between the amount of comminution, by using load-sharing classification (LSC), and kyphotic collapse is presented in the literature. However, LSC does not include the interspinous distance as an indirect sign to suggest biomechanical instability due to posterior ligamentous disruption in these patients in order to predict kyphotic collapse. Methods: We added the interspinous distance to the load-sharing classification (MLSC) in 50 consecutive patients with thoracolumbar burst fractures (according to Denis criteria) treated conservatively. Results: The LSC score was correlated to kyphotic collapse in the patients treated with TLSO (r = 0.312, p = 0.027;Spearman test;A = 0.668). The MLSC was similarly correlated to kyphotic collapse among TLSO-treated patients (r = 0.295, p = 0.038;Spearman test;A = 0.652). Conclusions: The interspinous distance did not contribute to the identification of worse radiographic outcomes, represented by the kyphotic collapse. This may suggest that the amount of comminution pointed out by the LSC is enough and more important than the interspinous opening in order to predict kyphotic collapse in thoracolumbar burst fractures. Possibly, the interspinous distance is much too heterogenous and multifactorial to be useful, since it reflects vertebral body height, preinjury anatomy, as well as posterior element disruption.
文摘Objective： Detection of abdominal in- jury is a very important component in trauma management, so a precise assessment of liver and spleen injuries includ- ing their severity degree is necessary. There is a good case to believe that in emergency situations the radiologists＇ performance may profit from a systematic approach using established scoring systems. Score systems as the organ injury scale （OIS） drawn up by the American Association for the Surgery of Trauma are a valuable guidance for objec- tive trauma assessment. Aim of this study was to evaluate retrospectively whether a structured approach using the OIS may help improve trauma assessment. Methods： Fifty-three patients, 38 male and 15 female who underwent CT and laparotomy after abdominal trauma were included in this study. The laparotomy was performed by experienced surgeons with a minimum experience of 6 years. While the original CT reports were written by differ- ent radiologists with a minimum experience of 3 years, and then a radiologist with experience of 4 years reviewed the same original CT pictures, resulting in the structured report. Both the original and structured CT results on liver and spleen injuries were transferred into OIS grades. Finally, the initial and structured CT results were compared with theintraoperative findings gathered from the surgery report. Results： Regarding the original CT report we found a mean divergence of 0.68±0.8 （r=-0.45） to the OIS finding in the surgery report for liver injuries （0.69±1.17 for spleen injuries; r=-0.69）. In comparison with the structured approach, where we detected a divergence of 0.8±0.68; r=-0.63 （0.47±0.77 for spleen injuries; r=0.91）, there was no significant difference. However we detected a lower rate of over-diag- nosis in structured approaches. Conclusion： Our study shows that a structured ap- proach to triage abdominal trauma using an imaging check- list does not lead to a significantly higher detection rate, but a nonsignificant trend to reduce the rate of over- diagnoses, thus being more precise in grading the severity grade. Concerning the bias by retrospective study design, further prospective investigations are needed to evaluate the impact of trauma scores on the workflow in emergency department procedure as structured reporting systems are a valuable guidance in other radiological disciplines.
文摘Objective: To compare the characters and outcomes of patients injured from traffic accidents in different rank hospitals. Methods: From 8 hospitals of ranks I III, 1?915 cases were sampled and divided into 4 groups. Injuries of all patients were accessed by the method of RTS, AIS ISS AP and ASCOT. Results: (1) The higher rank of hospitals, the severer the patients condition were. Mean ISSs in hospital ranks II and III were greater than 16, which were recommended as a standard of severe trauma. (2) Transportation of severe patients to high level hospitals prolonged the pre hospital duration by 5 9 h. (3) Factors contributing to death were the trauma severity, complications, hospital ranks that reflect the quality of the medical care. Conclusions: (1) This sample of 1?915 cases matches the condition of most Chinese hospitals in characteristics of traffic trauma patients. (2) Most Chinese hospitals can be divided into 3 degree of trauma center by a criteria of ISS and the unexpected death. (3) Incidence of multiple injuries shows no significant difference in each rank of hospitals. (4) The relationship between the hospital rank and the quality of trauma care is significant. We suggest that a RTS=11 or ISS=9 be triaged to trauma center, and a 10% Ps (survival probability) less than the average Ps of a hospital be triage to higher level hospitals.
