AIM To produce a radiological grading of gastric traumatic injuries. METHODS In our study, we retrospectively analyzed 32 cases of blunt gastric traumatic injuries and compared computed tomography(CT) data with patien...AIM To produce a radiological grading of gastric traumatic injuries. METHODS In our study, we retrospectively analyzed 32 cases of blunt gastric traumatic injuries and compared computed tomography(CT) data with patients' surgical or medical development. In all cases, a basal phase was acquired, and an intravenous contrast material was administered via an antecubital venous catheter with acquisition in the venous phase(70-90 s). In addition, a further set of delayed scans was performed 4-5 min after the first scanning session, without supplementary intravenous contrast material, to identify or better define areas of active bleeding. All CT examinations were retrospectively reviewed by two radiologists, with more than 5 years of experience in emergency radiology, to detect signs of gastric injuries and/or associated abdominal lesions according to literature data. Specific CT findings for gastric rupture include luminal content extravasation and discontinuity of the gastric wall, while CT findings suggestive of injury consisted of free peritoneal fluid, extraluminal air, pneumatosis, and thickening and hematoma of gastric wall.RESULTS We found 32 gastric traumatic injuries. In 22 patients(68.8%), the diagnosis was based on the surgical findings; in the other 10 patients(31.2%), the diagnosis was based on the clinical and CT radiological data. We observed discontinuity of the gastric wall and luminal content extravasation in 1 patient(3.1%); in 10 patients(31.2%), there was extra-luminal air in the peritoneum. In 28 patients(87.5%), there was peritoneal fluid, which was blood in 14 patients(hematoma in 11 patients and contrast material extravasation from active bleeding in 3 patients). In 15 patients(46.9%), there was gastric wall thickening. In 3 patients, it was possible to identify a prevalent involvement of the external layer of the gastric wall, whereas, in 2 patients, the inner side of the gastric wall presented with major involvement. In 3 patients(9.4%), pneumatosis of the gastric wall was detected. In 19(59.展开更多
Renal injuries are classified,based on the American Association for the Surgery of Trauma classification,in to five grades of injury.Several imaging modalities have been available for assessing the grade of renal inju...Renal injuries are classified,based on the American Association for the Surgery of Trauma classification,in to five grades of injury.Several imaging modalities have been available for assessing the grade of renal injury,each with their usefulness and limitations.Currently,plain radiographs and intravenous urography have no role in the evaluation of patients with suspected renal injury.Ultrasonography(USG) has a limited role in evaluating patients with suspected retroperitoneal injury;however,it plays an important role during follow up in patients with urinoma formation.USG helps to monitor the size of a urinoma and also for the drainage procedure.The role of selective renal arteriography is mainly limited to an interventional purpose rather than for diagnostic utility.Retrograde pyelography is useful in assessing ureteral and renal pelvis integrity in suspected ureteropelvic junction injury and for an interventional purpose,like placing a stent across the site of ureteric injury.Magnetic resonance imaging has no role in acute renal injuries.Multidetector computed tomography is the modality of choice in the evaluation of renal injuries.It is also useful in evaluating traumatic injuries to kidneys with preexisting abnormalities and can help to define the extent of penetrating injuries in patients with stab wounds in the flank region.The combination of imaging findings along with clinical information is important in the management of the individual patient.This article will describe a spectrum of renal injuries encountered in a trauma setting.展开更多
Background:Well-known trauma mortality prediction scores such as New Injury Severity Score (NISS), Revised Trauma Score (RTS), and Trauma and Injury Severity Score (TRISS) have been externally validated from high-inco...Background:Well-known trauma mortality prediction scores such as New Injury Severity Score (NISS), Revised Trauma Score (RTS), and Trauma and Injury Severity Score (TRISS) have been externally validated from high-income countries with established trauma databases. However, these scores were never used in Malaysian population. In this current study, we attempted to validate these scoring systems using our regional trauma surgery database. Methods:A retrospective analysis of the regional Malaysian Trauma Surgery Database was performed over a period of 3 years from May 2011 to April 2014. NISS, RTS, Major Trauma Outcome Study (MTOS)-TRISS, and National Trauma Database (NTrD)-TRISS scores were recorded and calculated. Individual scoring system's performance in predicting trauma mortality was compared by calculating the area under the receiver operating characteristic (AUC) curve. Youden index and associated optimal cutoff values for each scoring system was calculated to predict mortality. The corresponding positive predictive value, negative predictive value, and accuracy of the cutoff values were calculated. Results:A total of 2208 trauma patients (2004 blunt and 204 penetrating injuries) with mean age of 36 (SD=16) years were included. There were 239 deaths with a corresponding mortality rate of 10.8%. The AUC calculated for the NISS, RTS, MTOS-TRISS, and NTrD-TRISS were 0.878, 0.802, 0.812, and 0.848, respectively. The NISS score with a cutoff value of 24, sensitivity of 86.6%and specificity of 74.3%, outperformed the rest (p<0.001). Mortality was predicted by NISS with an overall accuracy of 75.6%;its positive predictive value was at 29.02%and negative predictive value at 97.86%. Conclusion:Amongst the four scores, the NISS score is the best trauma mortality prediction model suited for a local Malaysian trauma population. Further validation with multicentre data in the country may require to ascertain the finding.展开更多
文摘AIM To produce a radiological grading of gastric traumatic injuries. METHODS In our study, we retrospectively analyzed 32 cases of blunt gastric traumatic injuries and compared computed tomography(CT) data with patients' surgical or medical development. In all cases, a basal phase was acquired, and an intravenous contrast material was administered via an antecubital venous catheter with acquisition in the venous phase(70-90 s). In addition, a further set of delayed scans was performed 4-5 min after the first scanning session, without supplementary intravenous contrast material, to identify or better define areas of active bleeding. All CT examinations were retrospectively reviewed by two radiologists, with more than 5 years of experience in emergency radiology, to detect signs of gastric injuries and/or associated abdominal lesions according to literature data. Specific CT findings for gastric rupture include luminal content extravasation and discontinuity of the gastric wall, while CT findings suggestive of injury consisted of free peritoneal fluid, extraluminal air, pneumatosis, and thickening and hematoma of gastric wall.RESULTS We found 32 gastric traumatic injuries. In 22 patients(68.8%), the diagnosis was based on the surgical findings; in the other 10 patients(31.2%), the diagnosis was based on the clinical and CT radiological data. We observed discontinuity of the gastric wall and luminal content extravasation in 1 patient(3.1%); in 10 patients(31.2%), there was extra-luminal air in the peritoneum. In 28 patients(87.5%), there was peritoneal fluid, which was blood in 14 patients(hematoma in 11 patients and contrast material extravasation from active bleeding in 3 patients). In 15 patients(46.9%), there was gastric wall thickening. In 3 patients, it was possible to identify a prevalent involvement of the external layer of the gastric wall, whereas, in 2 patients, the inner side of the gastric wall presented with major involvement. In 3 patients(9.4%), pneumatosis of the gastric wall was detected. In 19(59.
文摘Renal injuries are classified,based on the American Association for the Surgery of Trauma classification,in to five grades of injury.Several imaging modalities have been available for assessing the grade of renal injury,each with their usefulness and limitations.Currently,plain radiographs and intravenous urography have no role in the evaluation of patients with suspected renal injury.Ultrasonography(USG) has a limited role in evaluating patients with suspected retroperitoneal injury;however,it plays an important role during follow up in patients with urinoma formation.USG helps to monitor the size of a urinoma and also for the drainage procedure.The role of selective renal arteriography is mainly limited to an interventional purpose rather than for diagnostic utility.Retrograde pyelography is useful in assessing ureteral and renal pelvis integrity in suspected ureteropelvic junction injury and for an interventional purpose,like placing a stent across the site of ureteric injury.Magnetic resonance imaging has no role in acute renal injuries.Multidetector computed tomography is the modality of choice in the evaluation of renal injuries.It is also useful in evaluating traumatic injuries to kidneys with preexisting abnormalities and can help to define the extent of penetrating injuries in patients with stab wounds in the flank region.The combination of imaging findings along with clinical information is important in the management of the individual patient.This article will describe a spectrum of renal injuries encountered in a trauma setting.
文摘Background:Well-known trauma mortality prediction scores such as New Injury Severity Score (NISS), Revised Trauma Score (RTS), and Trauma and Injury Severity Score (TRISS) have been externally validated from high-income countries with established trauma databases. However, these scores were never used in Malaysian population. In this current study, we attempted to validate these scoring systems using our regional trauma surgery database. Methods:A retrospective analysis of the regional Malaysian Trauma Surgery Database was performed over a period of 3 years from May 2011 to April 2014. NISS, RTS, Major Trauma Outcome Study (MTOS)-TRISS, and National Trauma Database (NTrD)-TRISS scores were recorded and calculated. Individual scoring system's performance in predicting trauma mortality was compared by calculating the area under the receiver operating characteristic (AUC) curve. Youden index and associated optimal cutoff values for each scoring system was calculated to predict mortality. The corresponding positive predictive value, negative predictive value, and accuracy of the cutoff values were calculated. Results:A total of 2208 trauma patients (2004 blunt and 204 penetrating injuries) with mean age of 36 (SD=16) years were included. There were 239 deaths with a corresponding mortality rate of 10.8%. The AUC calculated for the NISS, RTS, MTOS-TRISS, and NTrD-TRISS were 0.878, 0.802, 0.812, and 0.848, respectively. The NISS score with a cutoff value of 24, sensitivity of 86.6%and specificity of 74.3%, outperformed the rest (p<0.001). Mortality was predicted by NISS with an overall accuracy of 75.6%;its positive predictive value was at 29.02%and negative predictive value at 97.86%. Conclusion:Amongst the four scores, the NISS score is the best trauma mortality prediction model suited for a local Malaysian trauma population. Further validation with multicentre data in the country may require to ascertain the finding.
