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Blunt traumatic aortic injury is a rare life-threatening injury. Last few decades had witnessed a paradigm shift in the management of blunt traumatic aortic injury. This study was conducted to review the clinical spectrum of thoracic aortic injuries, the different management strategies and their associated outcomes at a level 1 trauma centre. Case series analysis of all the patients admitted with blunt thoracic aortic injuries between January 2010 and December 2020 was done. The primary endpoints were in-hospital mortality and early morbidity between the different grades of aortic injury. The overall incidence of blunt thoracic aortic injury was 0.9% (n = 55). The median age of the cohort was 30 years (IQR, 23–40 years). The predominant mode of injury was road traffic injury involving the vulnerable road users (42.3%). One-third of the patients were hemodynamically unstable on arrival with odds of mortality of 4.5 (Odds ratio 16, 95%CI 2.91–87.7). Grade III aortic injury was predominant (63.5%). Of all, 31 (59.6%) patients underwent endovascular stenting, 19 (36.5%) had NOM and 2 (3.9%) had surgical repair. In-hospital mortality was 21.1%; however, aortic injury–specific mortality was 1.92%. Mortality was highest in operative followed by NOM and endovascular stenting cohorts with 50%, 26.3% and 16.1% respectively. Endovascular stent repair is the preferred mode of treatment in hemodynamically stable patients with blunt thoracic aortic injuries with reduced risk of complications. The final outcome in patients with blunt thoracic aortic injury correlates with the hemodynamic status on arrival, severity of the concomitant injuries and the grade of the aortic injury. [ABSTRACT FROM AUTHOR]

Purpose: To study the role of prolonged prophylactic antibiotic therapy (PAT) in the prevention of Inter-costal drain (ICD) related infectious complications in patients with Blunt Trauma Chest (BTC). Methods: Patients of age 15 years and above with BTC requiring ICD were included. Patients with penetrating chest injuries, associated injuries/illnesses requiring antibiotic administration, need for mechanical ventilation, known pulmonary disease or immuno-compromised status and need for open thoracotomy were excluded. 120 patients were randomized equally to two groups; no prolonged PAT group (Group A) and prolonged PAT group (group B). Both group patients received one shot of injectable antibiotic prior to ICD insertion. Primary outcome measure was comparison of ICD related infectious complications (pneumonia, empyema and SSI) and secondary outcome measures included the duration of ICD, Length of Hospital stay (LOS) and in-hospital mortality in both the groups. Results: Infectious complications (pneumonia, empyema and SSI) were seen in only one patient in antibiotic group, and none in no antibiotic group (p value = 0.500). Other complications such as post ICD pain scores, respiratory failure requiring ventilatory support, retained hemothorax or recurrent pneumothorax, did not show any statistical difference between both groups. Also, no significant difference was seen in both the groups in terms of mean duration of ICD (p value = 0.600) and LOS (p value = 0.259).m Conclusion: Overall prevalence of ICD related infectious complications are low in BTC patients. Definitive role of prolonged prophylactic antibiotics in reducing infectious complications and other associated co morbidities in BTC patients with ICDs could not be established. Trial registry details: Clinical Trial Registry, India (Trial registered at ctri.nic.in/clinical trials/login.php, number REF/2019/021704 dated 18/10/2019). [ABSTRACT FROM AUTHOR]

Background: Yoga as alternative form of therapy has shown positive impact on pulmonary functions, exercise capacity, behavioral changes, and inflammation in non-trauma patients. However, the efficacy of Yoga has not been studied in chest trauma patients. Methods: This randomized controlled trial was conducted at level-1 Trauma Centre. Isolated chest injury patients were randomized into either standard physiotherapy or Yogatherapy groups. Patients in physiotherapy group received conventional chest physiotherapy and Yogatherapy group received a set of Yogic exercises in addition to conventional chest physiotherapy. Primary outcome measure was changes in pulmonary function tests (PFT) at 4 weeks of discharge. Secondary outcomes were changes in quality of life (QoL), respiratory muscle strength and endurance, chest wall mobility, and levels of cytokines at 4 weeks. Data were analyzed using STATA v14.0. Results: A total of 89 eligible patients were randomized to physiotherapy (n = 46) and Yoga therapy (n = 43) groups. Demographic characteristics were comparable in both the groups. There were statistically significant improvements in PFT in the Yogatherapy group compared with physiotherapy with an increase in Forced vital capacity (p = 0.02) and Forced expiratory volume (p = 0.01) at 4 weeks. In addition, there were significant improvement in physical component of QoL, respiratory muscle endurance (p = 0.003) and axillary cirtometry (p = 0.009) in the Yogatherapy group. However, no statistically significant difference in the trends of cytokine markers seen between the groups. Conclusion: Yoga was found to be effective in improving pulmonary functions and QoL in patients with chest trauma. (Trial registered at ctri.nic.in/clinicaltrials/login.php, numberREF/2016/05/011,287). [ABSTRACT FROM AUTHOR]

Background: Despite the acceptance of non-operative management (NOM), there is no consensus on the optimal length of hospital stay in patients with blunt liver and splenic injury (BLSI). Recent studies on pediatric patients have demonstrated the safety of early discharge following NOM for BLSI. We aimed at evaluating the feasibility and safety of early discharge in adult patients with BLSI following NOM in a randomized controlled trial.Materials and Methods: After initial assessment and management, patients aged 18-60 years with BLSI planned for NOM were randomized into 2 groups: Group A (test group; discharge day 3), and Group B (control group; discharge day 5). Standard NOM protocol was followed. These patients were discharged on the proposed day if they met the pre-defined discharge criteria. All patients were followed at days 7, 15, and 30 of discharge.Results: Sixty patients were recruited, 30 randomized to each arm. Most patients were males and aged less than 30 years. Road traffic injury was the most common mode of injury. Both groups were comparable in demography and injury-related parameters. 27 patients (90%) from group A and 28 patients (93%) from group B were discharged on the proposed day. Three patients had unplanned hospital visits for reasons unrelated to BLSI. All patients were asymptomatic and had a normal examination during their scheduled follow-up visits.Conclusion: Adult patients undergoing NOM for BLSI can be safely discharged after 48 h of in-hospital observation, provided other injuries precluding discharge do not exist. [ABSTRACT FROM AUTHOR]

Background: Traumatic bilateral adrenal injuries are uncommon. Adrenal injuries are overall associated with worse outcome than non-adrenal injuries. However, direct comparative evidence between unilateral and bilateral adrenal injuries is unavailable in literature. This study aims to investigate clinical significance of bilateral adrenal hematomas in terms of injury severity, morbidity and mortality. Methods: All blunt trauma abdomen patients with adrenal gland involvement on initial CECT scans of abdomen presenting to our Level 1 trauma centre over 21 months were prospectively included and followed-up. Patients were divided into unilateral and bilateral adrenal hematoma groups. For all patients, mechanism of injury, initial pulse, blood pressure, respiratory rate, Glasgow Coma Scale (GCS) scores, Injury Severity Score (ISS), New Injury Severity Score (NISS), length of ICU stay (LOI), length of hospital stay (LOS), total blood products (TBP) received were recorded. Final outcome was noted as complete recovery; discharge with poor prognosis and death. Quantitative parameters between both groups were compared using appropriate statistical tests and P < 0.05 was considered significant. Results: Forty seven patients were detected to have adrenal hematomas, 34 with unilateral (30 right and 4 left) and 13 with bilateral involvement. An oval mass replacing the gland was the most common appearance of injury (35/60) and periadrenal fat stranding was most common associated finding (47/60). Patients with bilateral adrenal hematoma had significantly lower GCS (13 vs 15, P < 0.01), ISS (38 vs 22, P < 0.01), NISS (47 vs 21, P < 0.01), LOI as proportion of LOS (91.7 % vs 10.5 %, P = 0.01) and TBP received (10 vs 4 units, P < 0.05). Outcome in bilateral group was comparatively worse with higher proportion of deaths or discharge with poor prognosis (P = 0.000). Conclusions: Patients with bilateral adrenal injury are associated with higher injury severity, morbidity and mortality compared to unilateral adrenal injury. [ABSTRACT FROM AUTHOR]

Recent literature on managing traumatic duodenal injuries suggests the superiority of primary repair. We hypothesized that duodenal trauma repair by primary closure might not be a safe strategy in an environment dealing predominantly blunt injuries with limited resources. Data analysis was done from the prospectively maintained trauma registry. The study period chosen was from January 1, 2014 to December 31, 2018. Data of 63 patients were analyzed for demographics, injuries, management, and outcome. Logistic regression was used to identify mortality predictors. The most common mechanism of injury was blunt (56/63, 88.9%). Forty (63.5%) patients had associated intraabdominal injuries. The most common American Association for the Surgery of Trauma grade of injury to the duodenum was three in 21 patients. Univariate analysis showed that mortality was associated with hypotension on presentation, higher duodenal grade, associated abdominal vascular injuries, primary closure, and duodenal leak. Logistic regression showed associated associated abdominal vascular injuries, primary closure, and leak remained significant predictors of mortality. Primary repair was found to be an independent predictor of mortality. A patient's physiology is a critical determinant of the outcome. Liberal use of tube duodenostomy over primary repair seems reasonable for blunt duodenal injury management. [ABSTRACT FROM AUTHOR]