Pelvic fractures in blunt trauma patients:A comparative study

BACKGROUND Pelvic fractures(PF)with concomitant injuries are on the rise due to an increase of high-energy trauma.Increase of the elderly population with age related comorbidities further complicates the management.Abdominal organ injuries are kindred with PF due to the proximity to pelvic bones.Presence of contrast blush(CB)on computed tomography in patients with PF is considered a sign of active bleeding,however,its clinical significance and association with outcomes is debatable.AIM To analyze polytrauma patients with PF with a focus on the geriatric population,co-injuries and the value of contrast blush.METHODS This retrospective cohort study included 558 patients with PF admitted to level 1 trauma center(01/2017-01/2023).Analyzed variables included:Age,sex,mechanism of injury(MOI),injury severity score(ISS),Glasgow coma scale(GCS),abbreviated injury scale(AIS),co-injuries,transfusion requirements,pelvic angiography,embolization,laparotomy,orthopedic pelvic surgery,intensive care unit and hospital lengths of stay,discharge disposition and mortality.The study compared geriatric and non-geriatric patients,patients with and without CB and abdominal co-injuries.Propensity score matching was implemented in comparison groups.RESULTS PF comprised 4%of all trauma admissions.89 patients had CB.286(52%)patients had concomitant injuries including 93(17%)patients with abdominal co-injuries.Geriatric patients compared to non-geriatric had more falls as MOI,lower ISS and AIS pelvis,higher GCS,less abdominal co-injuries,similar CB and angio-embolization rates,less orthopedic pelvic surgeries,shorter lengths of stay and higher mortality.After propensity matching,orthopedic pelvic surgery rates remained lower(8%vs 19%,P<0.001),hospital length of stay shorter,and mortality higher(13%vs 4%,P<0.001)in geriatric patients.Out of 89 patients with CB,45(51%)were embolized.After propensity matching,patients with CB compared to without CB had more pelvic angiography(71%vs 12%,P<0.001),higher embolization rates(64%vs 22%,P=0.02)and comparable mortality.CONCLUSION Half of the patients with PF had concomitant co-injuries,including abdominal co-injuries in 17%.Similarly injured geriatric patients had higher mortality.Half of the patients with CB required an embolization.

Clinical features of multiple trauma patients combined with spine and spinal cord injuries

Objective To analyze the clinical features of the multiple trauma patients combined with spine and spinal cord injuries.Methods A retrospective study was performed in143multiple trauma patients combined with spine and spinal

The clinical characteristics and treatment of head trauma patients with skull defect

Objective To investigate the clinical characteristics and therapeutic of head trauma patients with skull defect. Methods A retrospective study of clinical data of 47 brain injury patients with skull defect in our hospital from Janary 1993 to Janary 2009 was performed. Results Compared with

BMI-Adjusted Tube Current in Chest CT and Comparison of Lifetime Attributable Risk (LAR) of Breast Cancer in Two Different BMI-Based Protocols

Possible strategies to reduce radiation dose during CT scanning have been investigated over recent decades;here the optimization of the tube current and its link with patient’s cancer incidence are being evaluated. 154 consecutive trauma patients with the need for chest CT scan were included. Two different BMI-adjusted CT protocols at a fixed voltage tube and the same scan length were applied. Dose estimation parameters like CT dose index (CTDI), dose length product (DLP) and effective breast dose were calculated. Breast surface dose was obtained by using thermoluminescence dosimeters (TLDs) and eventually, the life attributable risk (LAR) of cancer incidence was estimated. The mean effective dose was 4.87 ± 2.3 mSv and 5.12 ± 2.8 mSv for patients who were scanned with tube currents of 120 mAs and 200 mAs, respectively. There was no significant difference between organ surface doses for females but in males it was notable. The risk of cancer incidence is lower for protocol 1 in comparison with protocol 2. Optimizing tube current of 120 mAs reduced breast surface dose up to 50% in comparison with the tube current of 200 mAs. In trauma patients, using lower tube current based on BMI has notable impact on the absorbed dose in the breast and can reduce the breast cancer risk by nearly 33.6% for women.