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Nathan Kuppermann – One of the best experts on this subject based on the ideXlab platform.

  • validation of a prediction rule for the identification of children with intra Abdominal injuries after blunt torso trauma
    Annals of Emergency Medicine, 2009
    Co-Authors: James F. Holmes, Amy Mao, Smita Awasthi, John P. Mcgahan, David H. Wisner, Nathan Kuppermann
    Abstract:

    Study objective We validate the accuracy of a previously derived clinical prediction rule for the identification of children with intra-Abdominal injuries after blunt torso trauma. Methods We conducted a prospective observational study of children with blunt torso trauma who were evaluated for intra-Abdominal Injury with Abdominal computed tomography (CT), diagnostic laparoscopy, or laparotomy at a Level I trauma center during a 3-year period to validate a previously derived prediction rule. The emergency physician providing care documented history and physical examination findings on a standardized data collection form before knowledge of the results of diagnostic imaging. The clinical prediction rule being evaluated included 6 “high-risk” variables, the presence of any of which indicated that the child was not at low risk for intra-Abdominal Injury: low age-adjusted systolic blood pressure, Abdominal tenderness, femur fracture, increased liver enzyme levels (serum aspartate aminotransferase concentration >200 U/L or serum alanine aminaminotransferase concentration >125 U/L), microscopic hematuria (urinalysis >5 RBCs/high powered field), or an initial hematocrit level less than 30%. Results One thousand three hundred twenty-four children with blunt torso trauma were enrolled, and 1,119 (85%) patients had the variables in the decision rule documented by the emergency physician and therefore made up the study sample. The prediction rule had the following test characteristics: sensitivity=149 of 157, 94.9% (95% confidence interval [CI] 90.2% to 97.7%) and specificity=357 of 962, 37.1% (95% CI 34.0 to 40.3%). Three hundred sixty-five patients tested negative for the rule; thus, strict application would have resulted in a 33% reduction in Abdominal CT scanning. Of the 8 patients with intra-Abdominal Injury not identified by the prediction rule, 1 underwent a laparotomy. This patient had a serosal tear and a mesenteric hematoma at laparotomy, neither of which required specific surgical intervention. Conclusion A clinical prediction rule consisting of 6 variables, easily available to clinicians in the ED, identifies most but not all children with intra-Abdominal Injury. Application of the prediction rule to this sample would have reduced the number of unnecessary Abdominal CT scans performed but would have failed to identify 1 child undergoing (a nontherapeutic) laparotomy. Thus, further refinement of this prediction rule in a large, multicenter cohort is necessary before widespread implementation.

  • Validation of a prediction rule for the identification of children with intra-Abdominal injuries after blunt torso trauma.
    Annals of emergency medicine, 2009
    Co-Authors: James F. Holmes, Amy Mao, Smita Awasthi, John P. Mcgahan, David H. Wisner, Nathan Kuppermann
    Abstract:

    We validate the accuracy of a previously derived clinical prediction rule for the identification of children with intra-Abdominal injuries after blunt torso trauma. We conducted a prospective observational study of children with blunt torso trauma who were evaluated for intra-Abdominal Injury with Abdominal computed tomography (CT), diagnostic laparoscopy, or laparotomy at a Level I trauma center during a 3-year period to validate a previously derived prediction rule. The emergency physician providing care documented history and physical examination findings on a standardized data collection form before knowledge of the results of diagnostic imaging. The clinical prediction rule being evaluated included 6 “high-risk” variables, the presence of any of which indicated that the child was not at low risk for intra-Abdominal Injury: low age-adjusted systolic blood pressure, Abdominal tenderness, femur fracture, increased liver enzyme levels (serum aspartate aminotransferase concentration >200 U/L or serum alanine aminaminotransferase concentration >125 U/L), microscopic hematuria (urinalysis >5 RBCs/high powered field), or an initial hematocrit level less than 30%. One thousand three hundred twenty-four children with blunt torso trauma were enrolled, and 1,119 (85%) patients had the variables in the decision rule documented by the emergency physician and therefore made up the study sample. The prediction rule had the following test characteristics: sensitivity=149 of 157, 94.9% (95% confidence interval [CI] 90.2% to 97.7%) and specificity=357 of 962, 37.1% (95% CI 34.0 to 40.3%). Three hundred sixty-five patients tested negative for the rule; thus, strict application would have resulted in a 33% reduction in Abdominal CT scanning. Of the 8 patients with intra-Abdominal Injury not identified by the prediction rule, 1 underwent a laparotomy. This patient had a serosal tear and a mesenteric hematoma at laparotomy, neither of which required specific surgical intervention. A clinical prediction rule consisting of 6 variables, easily available to clinicians in the ED, identifies most but not all children with intra-Abdominal Injury. Application of the prediction rule to this sample would have reduced the number of unnecessary Abdominal CT scans performed but would have failed to identify 1 child undergoing (a nontherapeutic) laparotomy. Thus, further refinement of this prediction rule in a large, multicenter cohort is necessary before widespread implementation.

  • association between the seat belt sign and intra Abdominal Injury in children with blunt torso trauma
    Academic Emergency Medicine, 2005
    Co-Authors: Peter E Sokolove, Nathan Kuppermann, James F. Holmes
    Abstract:

    Objectives: To determine the association between an Abdominal ‘‘seat belt sign’’ (SBS) and intra-Abdominal Injury (IAI) in children presenting to the emergency department (ED) after blunt trauma. Methods: The authors performed a prospective, observational study of children at risk for IAI who presented to a Level 1 trauma center following a motor vehicle collision (MVC) during a two-year period. Physical examination findings were recorded prior to Abdominal imaging or surgery. The SBS was defined as an area of erythema, ecchymoses, and/or abrasions across the patient’s Abdominal wall resulting from a seat belt restraint. Patients were divided into two cohorts based on the presence or absence of an SBS, then further subdivided based on Abdominal tenderness or pain. The authors compared patients with and without SBS, and those with and without Abdominal pain or tenderness for the presence of IAI. Results: Three hundred ninety children, of whom 46 (12%, 95% CI = 9% to 15%) had an SBS, were enrolled. IAIs were more common in patients with, versus without, an SBS (14/46 vs. 36/344, relative risk 2.9; 95% CI = 1.7 to 5.0; p , 0.001). Patients with an SBS were more likely to have gastrointestinal injuries than those without an SBS (12/46 vs. 7/344, relative risk 12.8; 95% CI = 5.3 to 31; p = 0.001). Pancreatic injuries were also more common among patients with an SBS (3/46 vs. 1/344, relative risk 22; 95% CI = 2.4 to 211; p = 0.006). There was no difference in the prevalence of solid organ injuries between those with and without an SBS (4/46 vs. 34/344, relative risk 0.9, 95% CI = 0.3 to 2.4; p = 1.00). None of the six patients (0%, 95% CI = 0 to 39%) with an SBS, but without Abdominal pain or tenderness, had IAIs. Conclusions: Patients with an SBS after an MVC are more likely to have IAIs than patients without an SBS, predominately due to a higher rate of gastrointestinal injuries. Patients with an SBS but without Abdominal pain or tenderness appear to be at low risk for IAI. Key words: blunt Abdominal trauma; seat belt sign; restraint; pediatric; motor vehicle collisions. ACADEMIC EMERGENCY MEDICINE 2005; 12:808–813.

James F. Holmes – One of the best experts on this subject based on the ideXlab platform.

  • rate of intra Abdominal Injury after a normal Abdominal computed tomographic scan in adults with blunt trauma
    American Journal of Emergency Medicine, 2012
    Co-Authors: James F. Holmes, John P. Mcgahan, David H. Wisner
    Abstract:

    Abstract Objective The objective of this study is to determine the rate of intra-Abdominal Injury (IAI) in adults with blunt Abdominal trauma after a normal Abdominal computed tomographic (CT) scan. We hypothesize that the risk of subsequent IAI is so low that hospital admission and observation for possible IAI are unnecessary. Methods We conducted a prospective, observational cohort study of adults (>18 years) with blunt trauma who underwent Abdominal CT scanning in the emergency department. Computed tomographic scans were obtained with intravenous contrast but no oral contrast. Abnormalities on Abdominal CT included all visualized IAIs or any finding suggestive of possible IAI. Patients were followed up to determine the presence or absence of IAI and the need for therapeutic intervention if IAI was identified. Results Of the 3103 patients undergoing Abdominal CT, 2734 (88%) had normal CT scans. The median age was 39 years (interquartile range, 26-51 years); and 2141 (78%) were admitted to the hospital. Eight (0.3%; 95% confidence interval, 0.1%-0.6%) were identified with IAIs after normal Abdominal CT scans including the following injuries: pancreas (5), liver (4), gastrointestinal (2), and spleen (2). Five underwent therapy at laparotomy. Abdominal CT had a likelihood ratio (+) of 20.9 (95% confidence interval, 17.7-24.8) and likelihood ratio (−) of 0.034 (0.017-0.068). Conclusion Adult patients with blunt torso trauma and normal Abdominal CT scans are at low risk for subsequently identified IAI. Thus, hospitalization for evaluation of possible IAI after a normal Abdominal CT scan is unnecessary in most cases.

  • Does This Adult Patient Have a Blunt Intra-Abdominal Injury?
    JAMA, 2012
    Co-Authors: Daniel K. Nishijima, David H. Wisner, David L. Simel, James F. Holmes
    Abstract:

    Context Blunt Abdominal trauma often presents a substantial diagnostic challenge. Well-informed clinical examination can identify patients who require further diagnostic evaluation for intra-Abdominal injuries after blunt Abdominal trauma. Objective To systematically assess the precision and accuracy of symptoms, signs, laboratory tests, and bedside imaging studies to identify intra-Abdominal injuries in patients with blunt Abdominal trauma. Data Sources We conducted a structured search of MEDLINE (1950–January 2012) and EMBASE (1980–January 2012) to identify English-language studies examining the identification of intra-Abdominal injuries. A separate, structured search was conducted for studies evaluating bedside ultrasonography. Study Selection We included studies of diagnostic accuracy for intra-Abdominal Injury that compared at least 1 finding with a reference standard of Abdominal computed tomography, diagnostic peritoneal lavage, laparotomy, autopsy, and/or clinical course for intra-Abdominal Injury. Twelve studies on clinical findings and 22 studies on bedside ultrasonography met inclusion criteria for data extraction. Data Extraction Critical appraisal and data extraction were independently performed by 2 authors. Data Synthesis The prevalence of intra-Abdominal Injury in adult emergency department patients with blunt Abdominal trauma among all evidence level 1 and 2 studies was 13% (95% CI, 10%-17%), with 4.7% (95% CI, 2.5%-8.6%) requiring therapeutic surgery or angiographic embolization of injuries. The presence of a seat belt sign (likelihood ratio [LR] range, 5.6-9.9), rebound tenderness (LR, 6.5; 95% CI, 1.8-24), hypotension (LR, 5.2; 95% CI, 3.5-7.5), Abdominal distention (LR, 3.8; 95% CI, 1.9-7.6), or guarding (LR, 3.7; 95% CI, 2.3-5.9) suggest an intra-Abdominal Injury. The absence of Abdominal tenderness to palpation does not rule out an intra-Abdominal Injury (summary LR, 0.61; 95% CI, 0.46-0.80). The presence of intraperitoneal fluid or organ Injury on bedside ultrasound assessment is more accurate than any history and physical examination findings (adjusted summary LR, 30; 95% CI, 20-46); conversely, a normal ultrasound result decreases the chance of Injury detection (adjusted summary LR, 0.26; 95% CI, 0.19-0.34). Test results increasing the likelihood of intra-Abdominal Injury include a base deficit less than −6 mEq/L (LR, 18; 95% CI, 11-30), elevated liver transaminases (LR range, 2.5-5.2), hematuria (LR range, 3.7-4.1), anemia (LR range, 2.2-3.3), and abnormal chest radiograph (LR range, 2.5-3.8). Symptoms and signs may be most useful in combination, particularly in identification of patients who do not need further diagnostic workup. Conclusions Bedside ultrasonography has the highest accuracy of all individual findings, but a normal result does not rule out an intra-Abdominal Injury. Combinations of clinical findings may be most useful to determine which patients do not require further evaluation, but the ideal combination of variables for identifying patients without intra-Abdominal Injury requires further study.

  • validation of a prediction rule for the identification of children with intra Abdominal injuries after blunt torso trauma
    Annals of Emergency Medicine, 2009
    Co-Authors: James F. Holmes, Amy Mao, Smita Awasthi, John P. Mcgahan, David H. Wisner, Nathan Kuppermann
    Abstract:

    Study objective We validate the accuracy of a previously derived clinical prediction rule for the identification of children with intra-Abdominal injuries after blunt torso trauma. Methods We conducted a prospective observational study of children with blunt torso trauma who were evaluated for intra-Abdominal Injury with Abdominal computed tomography (CT), diagnostic laparoscopy, or laparotomy at a Level I trauma center during a 3-year period to validate a previously derived prediction rule. The emergency physician providing care documented history and physical examination findings on a standardized data collection form before knowledge of the results of diagnostic imaging. The clinical prediction rule being evaluated included 6 “high-risk” variables, the presence of any of which indicated that the child was not at low risk for intra-Abdominal Injury: low age-adjusted systolic blood pressure, Abdominal tenderness, femur fracture, increased liver enzyme levels (serum aspartate aminotransferase concentration >200 U/L or serum alanine aminotransferase concentration >125 U/L), microscopic hematuria (urinalysis >5 RBCs/high powered field), or an initial hematocrit level less than 30%. Results One thousand three hundred twenty-four children with blunt torso trauma were enrolled, and 1,119 (85%) patients had the variables in the decision rule documented by the emergency physician and therefore made up the study sample. The prediction rule had the following test characteristics: sensitivity=149 of 157, 94.9% (95% confidence interval [CI] 90.2% to 97.7%) and specificity=357 of 962, 37.1% (95% CI 34.0 to 40.3%). Three hundred sixty-five patients tested negative for the rule; thus, strict application would have resulted in a 33% reduction in Abdominal CT scanning. Of the 8 patients with intra-Abdominal Injury not identified by the prediction rule, 1 underwent a laparotomy. This patient had a serosal tear and a mesenteric hematoma at laparotomy, neither of which required specific surgical intervention. Conclusion A clinical prediction rule consisting of 6 variables, easily available to clinicians in the ED, identifies most but not all children with intra-Abdominal Injury. Application of the prediction rule to this sample would have reduced the number of unnecessary Abdominal CT scans performed but would have failed to identify 1 child undergoing (a nontherapeutic) laparotomy. Thus, further refinement of this prediction rule in a large, multicenter cohort is necessary before widespread implementation.

David H. Wisner – One of the best experts on this subject based on the ideXlab platform.

  • a multicenter study of the risk of intra Abdominal Injury in children after normal Abdominal computed tomography scan results in the emergency department
    Annals of Emergency Medicine, 2013
    Co-Authors: Benjamin T Kerrey, David H. Wisner, Alexander J Rogers, Lois K Lee, Kathleen Adelgais, Michael G Tunik, Stephen Blumberg, Kimberly S Quayle, Peter E Sokolove, Michelle Miskin
    Abstract:

    Study objective We determine whether intra-Abdominal Injury is rarely diagnosed after a normal Abdominal computed tomography (CT) scan result in a large, generalizable sample of children evaluated in the emergency department (ED) after blunt torso trauma. Methods This was a planned analysis of data collected during a prospective study of children evaluated in one of 20 EDs in the Pediatric Emergency Care Applied Research Network. The study sample consisted of patients with normal results for Abdominal CT scans performed in the ED. The principal outcome measure was the negative predictive value of CT for any intra-Abdominal Injury and those undergoing acute intervention. Results Of 12,044 enrolled children, 5,380 (45%) underwent CT scanning in the ED; for 3,819 of these scan the results were normal. Abdominal CT had a sensitivity of 97.8% (717/733; 95% confidence interval [CI] 96.5% to 98.7%) and specificity of 81.8% (3,803/4,647; 95% CI 80.7% to 82.9%) for any intra-Abdominal Injury. Sixteen (0.4%; 95% CI 0.2% to 0.7%) of the 3,819 patients with normal CT scan results later received a diagnosis of an intra-Abdominal Injury, and 6 of these underwent acute intervention for an intra-Abdominal Injury (0.2% of total sample; 95% CI 0.06% to 0.3%). The negative predictive value of CT for any intra-Abdominal Injury was 99.6% (3,803/3,819; 95% CI 99.3% to 99.8%); and for Injury undergoing acute intervention, 99.8% (3,813/3,819; 95% CI 99.7% to 99.9%). Conclusion In a multicenter study of children evaluated in EDs after blunt torso trauma, intra-Abdominal injuries were rarely diagnosed after a normal Abdominal CT scan result, suggesting that safe discharge is possible for the children when there are no other reasons for admission.

  • rate of intra Abdominal Injury after a normal Abdominal computed tomographic scan in adults with blunt trauma
    American Journal of Emergency Medicine, 2012
    Co-Authors: James F. Holmes, John P. Mcgahan, David H. Wisner
    Abstract:

    Abstract Objective The objective of this study is to determine the rate of intra-Abdominal Injury (IAI) in adults with blunt Abdominal trauma after a normal Abdominal computed tomographic (CT) scan. We hypothesize that the risk of subsequent IAI is so low that hospital admission and observation for possible IAI are unnecessary. Methods We conducted a prospective, observational cohort study of adults (>18 years) with blunt trauma who underwent Abdominal CT scanning in the emergency department. Computed tomographic scans were obtained with intravenous contrast but no oral contrast. Abnormalities on Abdominal CT included all visualized IAIs or any finding suggestive of possible IAI. Patients were followed up to determine the presence or absence of IAI and the need for therapeutic intervention if IAI was identified. Results Of the 3103 patients undergoing Abdominal CT, 2734 (88%) had normal CT scans. The median age was 39 years (interquartile range, 26-51 years); and 2141 (78%) were admitted to the hospital. Eight (0.3%; 95% confidence interval, 0.1%-0.6%) were identified with IAIs after normal Abdominal CT scans including the following injuries: pancreas (5), liver (4), gastrointestinal (2), and spleen (2). Five underwent therapy at laparotomy. Abdominal CT had a likelihood ratio (+) of 20.9 (95% confidence interval, 17.7-24.8) and likelihood ratio (−) of 0.034 (0.017-0.068). Conclusion Adult patients with blunt torso trauma and normal Abdominal CT scans are at low risk for subsequently identified IAI. Thus, hospitalization for evaluation of possible IAI after a normal Abdominal CT scan is unnecessary in most cases.

  • Does This Adult Patient Have a Blunt Intra-Abdominal Injury?
    JAMA, 2012
    Co-Authors: Daniel K. Nishijima, David H. Wisner, David L. Simel, James F. Holmes
    Abstract:

    Context Blunt Abdominal trauma often presents a substantial diagnostic challenge. Well-informed clinical examination can identify patients who require further diagnostic evaluation for intra-Abdominal injuries after blunt Abdominal trauma. Objective To systematically assess the precision and accuracy of symptoms, signs, laboratory tests, and bedside imaging studies to identify intra-Abdominal injuries in patients with blunt Abdominal trauma. Data Sources We conducted a structured search of MEDLINE (1950–January 2012) and EMBASE (1980–January 2012) to identify English-language studies examining the identification of intra-Abdominal injuries. A separate, structured search was conducted for studies evaluating bedside ultrasonography. Study Selection We included studies of diagnostic accuracy for intra-Abdominal Injury that compared at least 1 finding with a reference standard of Abdominal computed tomography, diagnostic peritoneal lavage, laparotomy, autopsy, and/or clinical course for intra-Abdominal Injury. Twelve studies on clinical findings and 22 studies on bedside ultrasonography met inclusion criteria for data extraction. Data Extraction Critical appraisal and data extraction were independently performed by 2 authors. Data Synthesis The prevalence of intra-Abdominal Injury in adult emergency department patients with blunt Abdominal trauma among all evidence level 1 and 2 studies was 13% (95% CI, 10%-17%), with 4.7% (95% CI, 2.5%-8.6%) requiring therapeutic surgery or angiographic embolization of injuries. The presence of a seat belt sign (likelihood ratio [LR] range, 5.6-9.9), rebound tenderness (LR, 6.5; 95% CI, 1.8-24), hypotension (LR, 5.2; 95% CI, 3.5-7.5), Abdominal distention (LR, 3.8; 95% CI, 1.9-7.6), or guarding (LR, 3.7; 95% CI, 2.3-5.9) suggest an intra-Abdominal Injury. The absence of Abdominal tenderness to palpation does not rule out an intra-Abdominal Injury (summary LR, 0.61; 95% CI, 0.46-0.80). The presence of intraperitoneal fluid or organ Injury on bedside ultrasound assessment is more accurate than any history and physical examination findings (adjusted summary LR, 30; 95% CI, 20-46); conversely, a normal ultrasound result decreases the chance of Injury detection (adjusted summary LR, 0.26; 95% CI, 0.19-0.34). Test results increasing the likelihood of intra-Abdominal Injury include a base deficit less than −6 mEq/L (LR, 18; 95% CI, 11-30), elevated liver transaminases (LR range, 2.5-5.2), hematuria (LR range, 3.7-4.1), anemia (LR range, 2.2-3.3), and abnormal chest radiograph (LR range, 2.5-3.8). Symptoms and signs may be most useful in combination, particularly in identification of patients who do not need further diagnostic workup. Conclusions Bedside ultrasonography has the highest accuracy of all individual findings, but a normal result does not rule out an intra-Abdominal Injury. Combinations of clinical findings may be most useful to determine which patients do not require further evaluation, but the ideal combination of variables for identifying patients without intra-Abdominal Injury requires further study.

Miklosh Bala – One of the best experts on this subject based on the ideXlab platform.

  • Microhematuria as an Indicator of Significant Abdominal Injury.
    Pediatric Emergency Care, 2019
    Co-Authors: Lea Ohana-sarna-cahan, Yonatan Levin, Itai Gross, Ayal Hassidim, Jonathan B. Yuval, Amit Hess, Miklosh Bala, Saar Hashavya
    Abstract:

    BACKGROUND AND OBJECTIVES Trauma is one of the leading causes of morbidity and mortality in the pediatric population. In many centers, microhematuria is used as a screening tool for the presence of significant Abdominal Injury and as an indication for further imaging. Our objective was to evaluate the role of microhematuria by dipstick as an indicator of significant Abdominal Injury in children. METHODS A retrospective review of children aged 0 to 16 years admitted for a motor vehicle accident or a fall from 2007 to 2017 who had urinalyses performed. RESULTS The charts of 655 children were reviewed. Microhematuria was found in 100 children, of whom 49 (49%), 28 (28%), and 23 (23%) had small, moderate, and large amounts of hematuria, respectively. Of the children who had microhematuria, 41 underwent a computed tomography scan. Positive findings were recorded in 16 (39%) of these patients. There was a clear association between microhematuria as detected by the urine dipstick and a significant finding on the computed tomography scan (P = 0.002). The sensitivity of microhematuria for significant Abdominal pathology on imaging was 66.6% and the specificity was 68.3% (positive predictive value, 39%; negative predictive value, 87.1%). Microhematuria was associated with increased length of stay in the hospital (P < 0.001), surgical interventions (P = 0.036), and admission to the pediatric intensive care unit (P < 0.001). CONCLUSIONS The diagnostic role of dipstick urine analysis in the assessment of intra-Abdominal Injury has low sensitivity and specificity. Nevertheless, it is still a valuable screening tool for the evaluation of the severity of Injury.

  • Abdominal Injury patterns in patients with seatbelt signs requiring laparotomy
    Journal of Emergencies Trauma and Shock, 2014
    Co-Authors: Seema Biswas, Mohamed Adileh, Gidon Almogy, Miklosh Bala
    Abstract:

    Aims: We analyzed our series of patients with seatbelt signs (bruising) that underwent laparotomy in order to correlate Injury pattern with clinical course and outcome. Materials and Methods: Retrospective analysis of patients with seatbelt signs presenting to the level 1 Trauma Unit between 2005 and 2010 was performed. We evaluated the nature of injuries during laparotomy associated with seatbelt signs and their treatment and complications. Results: There were 41 patients, 25 (61%) male, with a median age of 26 years. Median Injury severity score (ISS) was 25 (range 6-66) and overall mortality was 10% (four patients). Patients were classified into three groups according to time from Injury to surgery. Median time to surgery for the immediate group ( n = 12) was 1.05 h, early group ( n = 22) was 2.7 h, and delayed group ( n = 7) was 19.5 h. Patients in the immediate group tended to have solid organ injuries; whereas, patients in the delayed group had bowel Injury. Patients with solid organ injuries were found to be more seriously injured and had higher mortality ( P Conclusion: Our data suggest that there is a cohort of patients with seatbelt Injury who have solid organ Injury requiring urgent intervention. Solid organ injuries associated with malpositioned seatbelts lying higher on the abdomen tend to result in hemodynamic instability necessitating immediate surgery. They have more postoperative complications and a greater mortality. Seatbelt signs should be accurately documented after any car crash.

  • Abdominal trauma after terrorist bombing attacks exhibits a unique pattern of Injury
    Annals of Surgery, 2008
    Co-Authors: Miklosh Bala, Avraham I Rivkind, Gideon Zamir, Tal Hadar, Iryna Gertsenshtein, Yoav Mintz, Alon J Pikarsky, Dalit Amar, Noam Shussman, Mahmoud Abu Gazala
    Abstract:

    Background: The recent growth in the volume of civilian blast trauma caused by terrorist bombings warrants special attention to the specific pattern of Injury associated with such attacks. Objective: To characterize the Abdominal injuries inflicted by terrorist-related explosions and to compare the pattern of Injury with civilian, penetrating and blunt, Abdominal trauma. Methods: Retrospective analysis of prospectively collected data from 181 patients with Abdominal trauma requiring laparotomy, who were admitted to the Hadassah Hospital, Jerusalem, Israel, from October 2000 to December 2005. Patients were divided into 3 groups according to mechanism of Injury: terror-related blast Injury (n = 21), gunshot wounds (GSW) (n = 73) and blunt trauma (n = 87). Results: Median Injury severity score in the blast group was significantly higher compared with GSW and blunt groups (34, 18, and 29, respectively, P < 0.0001). Injury to multiple body regions (≥3) occurred in 85.7% of blast group, 28.8% of GSW group, and 59.7% of blunt group (P < 0.001). The pattern of intra-Abdominal Injury was different between the groups. Bowel Injury was found in 71.4% of blast victims, 64.4% of GSW, and 25.3% of blunt group (P < 0.001). Parenchymal Injury was found in one third of patients in blast and GSW groups versus 60.9% of patients in blunt group (P = 0.001). Penetrating shrapnel was the cause of bowel Injury in all but 1 patient in the blast group (94.4%). Conclusions: Terrorist attacks generate more severe injuries to more body regions than other types of trauma. Abdominal Injury inflicted by terrorist bombings causes a unique pattern of wounds, mainly Injury to hollow organs. Shrapnel is the leading cause of Abdominal Injury following terrorist bombings.

Peter E Sokolove – One of the best experts on this subject based on the ideXlab platform.

  • a multicenter study of the risk of intra Abdominal Injury in children after normal Abdominal computed tomography scan results in the emergency department
    Annals of Emergency Medicine, 2013
    Co-Authors: Benjamin T Kerrey, David H. Wisner, Alexander J Rogers, Lois K Lee, Kathleen Adelgais, Michael G Tunik, Stephen Blumberg, Kimberly S Quayle, Peter E Sokolove, Michelle Miskin
    Abstract:

    Study objective We determine whether intra-Abdominal Injury is rarely diagnosed after a normal Abdominal computed tomography (CT) scan result in a large, generalizable sample of children evaluated in the emergency department (ED) after blunt torso trauma. Methods This was a planned analysis of data collected during a prospective study of children evaluated in one of 20 EDs in the Pediatric Emergency Care Applied Research Network. The study sample consisted of patients with normal results for Abdominal CT scans performed in the ED. The principal outcome measure was the negative predictive value of CT for any intra-Abdominal Injury and those undergoing acute intervention. Results Of 12,044 enrolled children, 5,380 (45%) underwent CT scanning in the ED; for 3,819 of these scan the results were normal. Abdominal CT had a sensitivity of 97.8% (717/733; 95% confidence interval [CI] 96.5% to 98.7%) and specificity of 81.8% (3,803/4,647; 95% CI 80.7% to 82.9%) for any intra-Abdominal Injury. Sixteen (0.4%; 95% CI 0.2% to 0.7%) of the 3,819 patients with normal CT scan results later received a diagnosis of an intra-Abdominal Injury, and 6 of these underwent acute intervention for an intra-Abdominal Injury (0.2% of total sample; 95% CI 0.06% to 0.3%). The negative predictive value of CT for any intra-Abdominal Injury was 99.6% (3,803/3,819; 95% CI 99.3% to 99.8%); and for Injury undergoing acute intervention, 99.8% (3,813/3,819; 95% CI 99.7% to 99.9%). Conclusion In a multicenter study of children evaluated in EDs after blunt torso trauma, intra-Abdominal injuries were rarely diagnosed after a normal Abdominal CT scan result, suggesting that safe discharge is possible for the children when there are no other reasons for admission.

  • association between the seat belt sign and intra Abdominal Injury in children with blunt torso trauma
    Academic Emergency Medicine, 2005
    Co-Authors: Peter E Sokolove, Nathan Kuppermann, James F. Holmes
    Abstract:

    Objectives: To determine the association between an Abdominal ‘‘seat belt sign’’ (SBS) and intra-Abdominal Injury (IAI) in children presenting to the emergency department (ED) after blunt trauma. Methods: The authors performed a prospective, observational study of children at risk for IAI who presented to a Level 1 trauma center following a motor vehicle collision (MVC) during a two-year period. Physical examination findings were recorded prior to Abdominal imaging or surgery. The SBS was defined as an area of erythema, ecchymoses, and/or abrasions across the patient’s Abdominal wall resulting from a seat belt restraint. Patients were divided into two cohorts based on the presence or absence of an SBS, then further subdivided based on Abdominal tenderness or pain. The authors compared patients with and without SBS, and those with and without Abdominal pain or tenderness for the presence of IAI. Results: Three hundred ninety children, of whom 46 (12%, 95% CI = 9% to 15%) had an SBS, were enrolled. IAIs were more common in patients with, versus without, an SBS (14/46 vs. 36/344, relative risk 2.9; 95% CI = 1.7 to 5.0; p , 0.001). Patients with an SBS were more likely to have gastrointestinal injuries than those without an SBS (12/46 vs. 7/344, relative risk 12.8; 95% CI = 5.3 to 31; p = 0.001). Pancreatic injuries were also more common among patients with an SBS (3/46 vs. 1/344, relative risk 22; 95% CI = 2.4 to 211; p = 0.006). There was no difference in the prevalence of solid organ injuries between those with and without an SBS (4/46 vs. 34/344, relative risk 0.9, 95% CI = 0.3 to 2.4; p = 1.00). None of the six patients (0%, 95% CI = 0 to 39%) with an SBS, but without Abdominal pain or tenderness, had IAIs. Conclusions: Patients with an SBS after an MVC are more likely to have IAIs than patients without an SBS, predominately due to a higher rate of gastrointestinal injuries. Patients with an SBS but without Abdominal pain or tenderness appear to be at low risk for IAI. Key words: blunt Abdominal trauma; seat belt sign; restraint; pediatric; motor vehicle collisions. ACADEMIC EMERGENCY MEDICINE 2005; 12:808–813.

  • Identification of children with intra-Abdominal injuries after blunt trauma.
    Annals of emergency medicine, 2002
    Co-Authors: James F. Holmes, Peter E Sokolove, William E. Brant, Michael J. Palchak, Cheryl Vance, John T. Owings, Nathan Kuppermann
    Abstract:

    Abstract Study Objective: We sought to determine the utility of laboratory testing after adjusting for physical examination findings in the identification of children with intra-Abdominal injuries after blunt trauma. Methods: The study was a prospective observational series of children younger than 16 years old who sustained blunt trauma and were at risk for intra-Abdominal injuries during a 2½-year period at an urban Level I trauma center. Patients were examined by faculty emergency physicians and underwent standardized laboratory testing. Clinical and laboratory findings were recorded on a standardized data sheet. Intra-Abdominal Injury was considered present if an Injury was documented to the spleen, liver, pancreas, kidney, adrenal glands, or gastrointestinal tract. We performed multiple logistic regression and binary recursive partitioning analyses to identify which physical examination findings and laboratory variables were independently associated with intra-Abdominal Injury. Results: Of 1,095 enrolled patients, 107 (10%, 95% confidence interval [CI] 8% to 12%) had intra-Abdominal injuries. The mean age was 8.4±4.8 years. From both analyses, we identified 6 findings associated with intra-Abdominal Injury: low systolic blood pressure (adjusted odds ratio [OR] 4.1; 95% CI 1.1 to 15.2), Abdominal tenderness (adjusted OR 5.8; 95% CI 3.2 to 10.4), femur fracture (adjusted OR 1.3; 95% CI 0.5 to 3.7), serum aspartate aminotransferase concentration more than 200 U/L or serum alanine aminaminotransferase concentration more than 125 U/L (adjusted OR 17.4; 95% CI 9.4 to 32.1), urinalysis with more than 5 RBCs per high-powered field (adjusted OR 4.8; 95% CI 2.7 to 8.4), and an initial hematocrit of less than 30% (adjusted OR 2.6; 95% CI 0.9 to 7.5). Conclusion: After adjusting for physical examination findings, laboratory testing contributes significantly to the identification of children with intra-Abdominal injuries after blunt trauma. [Holmes JF, Sokolove PE, Brant WE, Palchak MJ, Vance CW, Owings JT, Kuppermann N. Identification of children with intra-Abdominal injuries after blunt trauma. Ann Emerg Med. May 2002;39:500-509.]