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OBJECTIVES: There is little evidence guiding the management of grade I-II traumatic splenic injuries with contrast blush (CB). We aimed to analyze the failure rate of nonoperative management (NOM) of grade I-II splenic injuries with CB in hemodynamically stable patients. METHODS: A multicenter, retrospective cohort study examining all grade I-II splenic injuries with CB was performed at 21 institutions from January 1, 2014, to October 31, 2019. Patients >18 years old with grade I or II splenic injury due to blunt trauma with CB on CT were included. The primary outcome was the failure of NOM requiring angioembolization/operation. We determined the failure rate of NOM for grade I versus grade II splenic injuries. We then performed bivariate comparisons of patients who failed NOM with those who did not. RESULTS: A total of 145 patients were included. Median Injury Severity Score was 17. The combined rate of failure for grade I-II injuries was 20.0%. There was no statistical difference in failure of NOM between grade I and II injuries with CB (18.2% vs 21.1%, p>0.05). Patients who failed NOM had an increased median hospital length of stay (p=0.024) and increased need for blood transfusion (p=0.004) and massive transfusion (p=0.030). Five patients (3.4%) died and 96 (66.2%) were discharged home, with no differences between those who failed and those who did not fail NOM (both p>0.05). CONCLUSION: NOM of grade I-II splenic injuries with CB fails in 20% of patients. LEVEL OF EVIDENCE: IV.

This study systematically evaluates therapeutic approaches for abdominal traumatic injuries, encompassing surgical and nonsurgical interventions. It aims to contribute valuable insights for clinicians by examining the effectiveness and outcomes associated with various modalities. Methods: Conducted over one year at Government Medical College Jammu, a prospective observational study involved patients with a history of abdominal trauma. Inclusion criteria covered all ages, admission to surgical units, and clinical/radiological indications of hollow viscus injuries within the gastrointestinal tract. Exclusion criteria were established, emphasizing precise anatomical definitions for trauma management. Results: Data analysis revealed a predominance of male patients (82%) from rural areas (71%). Blunt trauma constituted 92% of cases. Various management strategies were employed based on factors such as clinical condition, injury severity, and anatomical location. Primary closure of perforation was the most prevalent approach (39%), with other strategies including omental patch closure, resection and anastomosis, loop ileostomy, and colostomy. Complications occurred in a minority of cases, including wound infection (12%), sepsis (9%), burst abdomen (3%), stoma retraction (2%), and atelectasis (2%). Conclusion: This study provides valuable insights into the diverse therapeutic approaches for abdominal trauma, emphasizing the need for individualized management. The findings contribute to guiding clinicians in decision-making and optimizing patient outcomes. [ABSTRACT FROM AUTHOR]

Blunt traumatic dissection of the celiac artery without aortic dissection is a rare event. There is paucity of data on the appropriate management of such injuries. In this brief report, we present a patient with isolated celiac artery dissection after blunt abdominal trauma. The patient was managed non-operatively with anticoagulation and developed splenic infarct. Due to its rarity, no grading criteria and management guidelines exist for the spectrum of isolated blunt CA injuries. Furthermore, it remains unlikely that injury volume will increase to create robust management guidelines. We therefore suggest that isolated celiac artery injury be graded based on the Biffl grading criteria for blunt cerebrovascular injury and managed accordingly. [ABSTRACT FROM AUTHOR]

Background: Blunt bowel and mesenteric injuries (BBMI) are frequently missed despite the widespread use of computed tomography (CT). Early diagnosis for timely management of surgically significant blunt bowel and mesenteric injuries (sBBMI) can be challenging. Several tools predictive for sBBMI have been proposed such as the "Bowel Injury Prediction Score" (BIPS) that is based on presence of abdominal tenderness, white blood cell count ≥17,000/mm3 and CT grade. The utility of this scoring system for early diagnosis of sBBMI has neither been studied in an Indian population nor prospectively validated. Methods: A single-centre prospective cohort study was conducted at a Trauma Centre in India. After screening of 1793 patients with blunt trauma abdomen who presented between 1st January 2022 and 31st August 2022 and underwent CT scan, eventually, 80 patients of age >18 years, hemodynamically stable and CT finding suspicious of BBMI were included. BIPS score was calculated. Patients were followed to evaluate the outcome. Results: The incidence of sBBMI was 3.06%. Mean age of study patients was 36.2 ± 16.5 years with male predominance (92.5%) and road traffic accidents the commonest mode of injury. Patients with BBMI were more likely to require operative intervention in the presence of abdominal tenderness at presentation (p < 0.01) and CT grade ≥4 (p < 0.01). For patients with WBC counts of ≥17,000/mm3, no statistically significant difference was noted in the need for operative intervention. BIPS ≥2 had 94.5% sensitivity, 72% specificity, 88% PPV, and 86% NPV for identifying patients with sBBMI. Conclusion: Calculation of BIPS at the time of presentation can avoid unnecessary delays in surgical management and thereby reduce overall morbidity and mortality even in an Indian setup. However, WBC counts > 17,000/mm3 were not found to be predictive of sBBMI. [ABSTRACT FROM AUTHOR]

Background: Combat casualties are frequently injured in austere settings where modern imaging modalities are unavailable. Exploratory laparotomies are often performed in these settings when there is suspicion for intra-abdominal injury. Prior studies of combat casualties reported non-therapeutic laparotomy (NTL) rates as high as 32%. Given improvements in combat casualty care over time, we evaluated NTLs performed during later years of the wars in Iraq and Afghanistan. Methods: Military personnel with combat-related injuries (6/1/2009–12/31/2014) who underwent exploratory laparotomy based on concern for abdominal injury (i.e. not performed for proximal vascular control or fecal diversion) and were evacuated to Landstuhl Regional Medical Center (Germany) before being transferred to participating U.S. military hospitals were assessed. An NTL was defined as a negative laparotomy without substantial intra-abdominal injuries requiring repair. Characteristics, indications for laparotomy, operative findings, and outcomes were examined. Results: Among 244 patients who underwent laparotomies, 41 (16.8%) had NTLs and 203 (83.2%) had therapeutic laparotomies (i.e. positive findings). Patients with NTLs had more computed tomography scans concerning for injury (48.8% vs 27.1%; p = 0.006), less penetrating injury mechanisms (43.9% vs 71.9%; p < 0.001), and lower Injury Severity Scores (26 vs 33; p = 0.003) compared to patients with therapeutic laparotomies. Patients with NTLs were also less likely to be admitted to the intensive care unit (70.7 vs 89.2% for patients with therapeutic laparotomies; p = 0.007). No patients with NTLs developed abdominal surgical site infections (SSI) compared to 16.7% of patients with therapeutic laparotomies (p = 0.002). There was no significant difference in mortality between the groups (p = 0.198). Conclusions: Our proportion of NTLs was lower than reported from earlier years during the wars in Iraq and Afghanistan. No infectious complications from NTLs (i.e. abdominal SSIs) were identified. Nevertheless, surgeons should continue to have a low threshold for exploratory laparotomy in military patients in austere settings with concern for intra-abdominal injury. [ABSTRACT FROM AUTHOR]

Objectives: To assess needle placement accuracy in the rectus abdominis (RA) muscle during dry needling (DN) without entering the peritoneum. Methods: Two physical therapists performed DN on a cadaver, making 10 attempts each to needle the RA without entering the peritoneum. Techniques followed two common DN approaches. Ultrasound verified needle depth and safety. Results: Seventy percent of attempts were recorded as safe needle placement, while 30% were unsafe. Accurate RA needle placement without peritoneal entry occurred in 55% of attempts. Discussion/Conclusion: Inadvertent peritoneal needle placement during RA DN poses risks regardless of experience. Ultrasound guidance may enhance safety and precision in clinical practice. [ABSTRACT FROM AUTHOR]

Background: Previous studies suggest increased abdominal girth in obese individuals provides a "cushion effect," against severe abdominal trauma. In comparison, the unique anatomic/physiological condition of pregnancy, such as the upward displacement of organs by an expanding uterus, may decrease risk of abdominal injury. However, increased overall blood volume and vascularity of organs during pregnancy raise concerns for increased bleeding and potentially more severe injuries. Therefore, this study aimed to elucidate whether the "cushion effect" observed in obese patients extends to pregnant trauma patients (PTPs). We hypothesized a lower risk of blunt solid organ injury (BSOI) (liver, spleen, and kidney) in pregnant vs non-pregnant blunt trauma patients. Methods: The 2020-2021 Trauma Quality Improvement Program was queried for all female blunt trauma patients (age<50 years) involved in motor vehicle collisions (MVCs). We compared pregnant vs non-pregnant patients. The primary outcomes were incidence of BSOI, and severity of abdominal trauma defined by abbreviated injury scale (AIS). Results: From 94,831 female patients, 2598 (2.7%) were pregnant. When compared to non-pregnant patients, PTPs had lower rates of liver (5.5% vs 7.6%, P < .001) and kidney (1.8% vs 2.6%, P = .013) injury. However, PTPs had higher rates of serious (13.4% vs 9.0%, P < .001) and severe abdominal injury (7.5% vs 4.3%, P < .001). Discussion: BSOI occurred at a lower rate in PTPs compared to non-PTPs; however, contrary to the "cushion effect" observed in obese populations, pregnant women had a higher rate of severe abdominal injuries. These data support comprehensive evaluations for PTPs presenting after a MVC. Level of Evidence: IV (therapeutic). [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion Paediatric traumatic duodenal hematoma is a rare type of blunt abdominal injury for which treatment strategies are controversial. This study aimed to evaluate the application value of nonoperative management of paediatric duodenal hematoma caused by trauma.A retrospective analysis was conducted on patients with duodenal hematoma with a confirmed history of abdominal trauma admitted to our hospital between January 2010 and December 2022. General patient information, including age, sex, cause of injury, clinical manifestations, and treatment outcomes, was recorded.A total of 11 cases were included in this study, with 6 males and 5 females. School‐age children (≥6 years) accounted for 72.7% (8/11) of the cases. Bicycle handlebar injuries accounted for 63.6% (7/11) of cases. Among these cases, 5 (45.5%) were classified as American Association for the Surgery of Trauma grade I, while the remaining were classified as grade II. The median history time was 1 day (range: 2 h–12 days). All patients were successfully treated using non‐operative methods. The median time to oral feeding after injury was 17 days (range: 9–32 days). Oral feeding was initiated within 2 weeks in 2 patients (18.2%), within 3 weeks in 6 patients (54.5%), and within 4 weeks in 10 patients (90.9%).Paediatric traumatic duodenal hematoma is more common in school‐aged children, mainly due to bicycle handlebar injuries. Nonoperative treatment is proven to be safe and effective, with duodenal obstruction symptoms typically resolving within 4 weeks. [ABSTRACT FROM AUTHOR]

Background: Traumatic pancreaticobiliary injuries are challenging to diagnose and manage. Endoscopic retrograde cholangiopancreatography (ERCP) has potential diagnostic and therapeutic utility in cases of traumatic pancreaticobiliary injuries. Methods: In this single-center retrospective study, we assessed 25 cases of abdominal trauma in which the patients underwent ERCP for management of suspected pancreaticobiliary injuries. We analyzed basic patient demographics, mechanism of trauma, method of diagnosis, ERCP results, surgical treatments, and outcomes. Results: Of the 25 assessed patients, 12 (48%) had pancreatic injuries, 12 (48%) had biliary injuries, and 1 (4%) patient had both. The median age was 28 years [IQR 25-35], and 84% of patients were males. Fifty-six percent of injuries were from blunt trauma, while 44% were from penetrating trauma. In cases of ERCP-confirmed biliary leaks (n=11), 100% of leaks were resolved in the 8 patients who underwent repeat ERCP after initial ERCP with stenting. In cases of ERCP-conirmed pancreatic duct leaks (n=10), 57% of duct leaks were resolved in the 7 patients who underwent repeat ERCP after initial ERCP with stenting. One patient in the biliary trauma cohort developed post-ERCP pancreatitis and sepsis. Conclusion: ERCP was a useful diagnostic and therapeutic intervention in this population of patients with pancreaticobiliary trauma. [ABSTRACT FROM AUTHOR]

Background: Abdominal wall injuries are commonly encountered in veterinary medicine and may lead to significant complications if not appropriately treated. Different types of grafts, including autologous, xenogeneic, biologic or non-biologic and composite grafts, are widely used to ensure adequate tissue repair and prevent recurrence in cases of hernia. However, identifying the most suitable graft for each case is particularly challenging. Methods: In the present study, a commercial graft derived from bovine small intestinal submucosa (bSIS) was compared with the polypropylene mesh (PPM) in terms of their repair efficacy and tissue compatibility. These grafts were used to repair artificially induced abdominal wall defects in 24 rats categorised into two groups. The morphologic and histologic analyses were used to compare and assess the grafts. Result: The results showed that bSIS has several merits over PPM in terms of biological activity and tissue compatibility. [ABSTRACT FROM AUTHOR]

BACKGROUND: Laparoscopy is widely adopted across nearly all surgical subspecialties in the elective setting. Initially finding indication in minor abdominal emergencies, it has gradually become the standard approach in the majority of elective general surgery procedures. Despite many technological advances and increasing acceptance, the laparoscopic approach remains underutilized in emergency general surgery and in abdominal trauma. Emergency laparotomy continues to carry a high morbidity and mortality. In recent years, there has been a growing interest from emergency and trauma surgeons in adopting minimally invasive surgery approaches in the acute surgical setting. The present position paper, supported by the World Society of Emergency Surgery (WSES), aims to provide a review of the literature to reach a consensus on the indications and benefits of a laparoscopic-first approach in patients requiring emergency abdominal surgery for general surgery emergencies or abdominal trauma. METHODS: This position paper was developed according to the WSES methodology. A steering committee performed the literature review and drafted the position paper. An international panel of 54 experts then critically revised the manuscript and discussed it in detail, to develop a consensus on a position statement. RESULTS: A total of 323 studies (systematic review and meta-analysis, randomized clinical trial, retrospective comparative cohort studies, case series) have been selected from an initial pool of 7409 studies. Evidence demonstrates several benefits of the laparoscopic approach in stable patients undergoing emergency abdominal surgery for general surgical emergencies or abdominal trauma. The selection of a stable patient seems to be of paramount importance for a safe adoption of a laparoscopic approach. In hemodynamically stable patients, the laparoscopic approach was found to be safe, feasible and effective as a therapeutic tool or helpful to identify further management steps and needs, resulting in improved outcomes, regardless of conversion. Appropriate patient selection, surgeon experience and rigorous minimally invasive surgical training, remain crucial factors to increase the adoption of laparoscopy in emergency general surgery and abdominal trauma. CONCLUSIONS: The WSES expert panel suggests laparoscopy as the first approach for stable patients undergoing emergency abdominal surgery for general surgery emergencies and abdominal trauma.

INTRODUCTION: Noncompressible torso hemorrhage is the leading cause of exsanguination on the battlefield. A self-expanding, intraperitoneal deployed, thermoreversible foam has been developed that can be easily administered by a medic in austere settings to temporarily tamponade noncompressible torso hemorrhage. The purpose of this study was to assess the long-term safety and physical characteristics of using Fast Onset Abdominal Management (FOAM; Critical Innovations LLC) in swine. MATERIALS AND METHODS: Yorkshire swine (40-60 kg) were sedated, intubated, and placed on ventilatory support. An external jugular catheter was placed for sampling of blood. Continuous heart rate, temperature, saturation of peripheral oxygen, end-tidal carbon dioxide, and peak airway pressures were monitored for a 4-hour period after intervention (i.e., FOAM agent injection or a sham introducer without agent delivery). The FOAM agent was injected to obtain an intra-abdominal pressure of 60 mmHg for at least 10 minutes. After 4 hours, the animals were removed from ventilatory support and returned to their housing for a period of 7-14 days. Group size analysis was not performed, as this was a descriptive safety study. Blood samples were obtained at baseline and at 1-hour post-intervention and then on days 1, 3, 7, and 14. Euthanasia, necropsy, and harvesting of samples for histologic analysis (from kidneys, terminal ilium, liver, pancreas, stomach, spleen, and lungs) were performed upon expiration. Histologic scoring for evidence of ischemia, necrosis, and abdominal compartment sequela was blinded and reported by semi-quantitative scale (range 0-4; 0 = no change, 1 = minimal, 2 = mild, 3 = moderate, and 4 = marked). Oregon Health & Science Universitys Institutional Animal Care and Use Committee, as well as the U.S. Army Animal Care and Use Review Office, approved this protocol before the initiation of experiments (respectively, protocol numbers IP00003591 and MT180006.e002). RESULTS: Five animals met a priori inclusion criteria, and all of these survived to their scheduled endpoints. Two animals received sham injections of the FOAM agent (one euthanized on day 7 and one on day 14), and three animals received FOAM agent injections (one euthanized on day 7 and two on day 14). A transitory increase in creatinine and lactate was detected during the first day in the FOAM injected swine but resolved by day 3. No FOAM agent was observed in the peritoneal cavity upon necropsy at day 7 or 14. Histologic data revealed no clinically relevant differences in any organ system between intervention and control animals upon sacrifice at day 7 or 14. CONCLUSIONS: This study describes the characteristics, survival, and histological analysis of using FOAM in a porcine model. In our study, FOAM reached the desired intra-abdominal pressure endpoint while not significantly altering basic hematologic parameters, except for transient elevations of creatinine and lactate on day 1. Furthermore, there was no clinical or histological relevant evidence of ischemia, necrosis, or intra-abdominal compartment syndrome. These results provide strong support for the safety of the FOAM device and will support the design of further regulatory studies in swine and humans.

Copyright of Retos: Nuevas Perspectivas de Educación Física, Deporte y Recreación is the property of Federacion Espanola de Asociaciones de Docentes de Educacion Fisica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Injury related death is a leading cause of death globally. Abdominal injuries may occur in up to one third of patients with trauma. Road traffic accidents have become the commonest mechanism of trauma. Materials and Methods: This was a hospital based retrospective descriptive study conducted at Dhulikhel Hospital-Kathmandu University Hospital. Patients admitted with abdominal trauma from July 2021 to December 2023 were included in this study. Results: This study included 60 patients with abdominal trauma. Mean age of patients was 35.60 ± 15.81 (10-76) years. Majority of patients belonged to age group 21-40 years (n=32, 53.3%) with male predominance (Male:female ratio=3.6:1). Blunt abdominal trauma (n=58, 96.7%) was more common than penetrating abdominal trauma (n=2, 3.3%). Road traffic accident (n=31, 51.7%), fall from height (n=22, 36.7%) and physical assaults (n=7, 11.7%) were the mechanisms of injury. In our study, commonly injured organs were spleen(n=19, 30.64%), liver(n=15, 24.19%) and small bowel(n=14, 22.58%). Among the patients with penetrating abdominal trauma, one patient had rectal injury and next patient had stab injury with protruding omentum through the wound. Thirty four patients (56.7%) were managed conservatively and 26 patients (43.3%) underwent operative management. The mortality rate was 8.33% (n=5) of which 4 (80%) had undergone operative management and 1 (20%) was being managed conservatively. Conclusion: Majority of patients with solid organ injury can be managed conservatively while hollow viscus injury undergoes operative treatment. Physically active male population is the most affected group. Road traffic accidents are the leading cause of abdominal trauma followed by fall from height and physical assaults.

Introduction: The global estimate reflects 4.4 million injury-related deaths every year and the thoracoabdominal region is frequently injured since it is a wide area. Methods: An autopsy-based cross-sectional study was conducted using a convenient sampling technique for three years. A Chi-square test was conducted for categorical variables. A P value of less than 0.01 was considered statistically significant. Results: Out of 80 cadavers, the male:female ratio was 1:0.31. The commonest age group was 20–29 years. Victims of road traffic accidents were 54 (67.5%) followed by falls from height 10 (12.5%). External thoracic injuries were commoner than internal and vice versa in abdominal injuries. Liver injuries were major in number. Combined thoracic-abdominal and associated injuries were observed in 67 (83.75%) victims. The commonest cause of death was craniocerebral injury combined with hemorrhagic shock (36.25%). Eighteen (22.5%) victims died on the spot having an Injury Severity Score (ISS) of 73.37 followed by a survival time of 1–7 days in 17 (21.25%) cases. A significant correlation was found between ISS and survival period. Conclusion: All thoracic and abdominal injuries represent a possible increase in morbidity and mortality; hence, working toward their prevention and timely intervention is necessary.

Background: The indocyanine green (ICG) fluorescence test has become a standard test in surgical procedures, facilitating the assessment of blood perfusion in real-time. While its utility in emergency surgeries for evaluating anastomotic blood supply is well-established, its application in trauma cases, especially those involving mesenteric hematoma, remains underexplored. Herein, we present a case to illustrate the efficacy of the ICG fluorescence test in such scenarios. Case presentation: A 51-year-old man with uncontrolled hypertension suffered blunt abdominal trauma following a motor vehicle accident. We used the intra-operative ICG fluorescence test to chart the surgical plan for the patient. A combination of diagnostic laparoscopy with ICG fluorescence testing effectively excluded bowel ischemia, leading to the avoidance of intestinal resection and the need for a temporary ostomy. The patient resumed enteral nutrition. Conclusions: Our case underscores the efficacy of ICG fluorescence testing in assessing bowel viability and guiding surgical strategies in trauma patients with mesenteric hematoma. By facilitating real-time visualization of blood perfusion, ICG testing enables the adoption of conservative treatments in patients who would traditionally require more invasive surgical interventions, with minimal effect on operation time and cost. [ABSTRACT FROM AUTHOR]

Background: The growing geriatric population has specific medical characteristics that should be taken into account especially in trauma setting. There is little evidence on management of abdominal trauma in the elderly and this article compares the management and outcomes of younger and older patients in order to highlight fields of improvement. Method: We conducted a retrospective database analysis from two European university hospitals selecting patients admitted for abdominal injury and extracted the following data: epidemiological data, mechanisms of the trauma, vital signs, blood tests, injuries, applied treatments, trauma scores and outcomes. We compared to different age group (16–64 and 65+ years old) using uni- and multivariable analysis. Results: 1181 patients were included for statistical analysis. The main mechanisms of injury in both group were traffic accidents and in the elderly group, falls were more frequent. Both had similar Abbreviated Injury Score except for the thoracic injuries, which was higher in the elderly group. We reported a death rate of 13% in the elderly group and 7% in the younger group. However, multivariable analysis did not report age as an independent predictor of mortality. The management including surgery, blood transfusion and need for intensive care were similar in both groups. Conclusion: Although elderly patients suffering abdominal trauma have an almost two fold higher mortality, their management is quite similar leading to an important point of improvement in regards to triage and lower threshold for more aggressive management and surveillance. Age itself does not seem to be a reliable predictor of mortality. Introducing a frailty score when taking care of elderly trauma patients could improve the outcomes. [ABSTRACT FROM AUTHOR]

Background Abdominal trauma is a significant cause of morbidity and mortality, necessitating accurate and timely diagnosis for effective management. Contrast-enhanced CT (CECT) is widely utilized for evaluating abdominal injuries, but its diagnostic efficacy compared to other modalities like ultrasonography (FAST) and clinical examination warrants further investigation.This prospective study evaluates the role of contrast-enhanced CT (CECT) in the assessment of abdominal trauma, comparing its diagnostic accuracy with ultrasonography (FAST) and clinical examination Methods A total of 100 patients with abdominal trauma were included in this study. Patient demographics, injury mechanisms, organ injuries detected by CECT, severity of injuries (based on the AAST Organ Injury Scale), presence of hemoperitoneum, diagnostic accuracy of CECT, interventions based on CECT findings, complications, mortality rates, length of hospital stay, and follow-up outcomes were analyzed. Results The study comprised 65 males and 35 females, with the majority aged between 18-30 years. Road Traffic Accidents (50%) were the most common injury mechanism. CECT detected liver injuries in 30%, spleen in 25%, kidney in 20%, pancreas and intestines in 10% each, and multiple organs in 5%. Severity distribution was as follows: Grade I (20%), Grade II (25%), Grade III (30%), Grade IV (15%), and Grade V (10%). Hemoperitoneum was present in 40% of patients. CECT showed high diagnostic accuracy with 95% sensitivity, 90% specificity, 92% PPV, and 93% NPV. In comparison, FAST had 70% sensitivity and 75% specificity, while clinical examination had 65% sensitivity and 80% specificity. Interventions based on CECT findings included non-operative management (70%), surgical intervention (25%), and endovascular procedures (5%). Complications included infections (5%), re-bleeding (3%), and organ failure (2%). Mortality was 4%, predominantly due to severe multi-organ injury. The mean hospital stay was 10 days. At 3-month follow-up, 80% of patients had fully recovered, 15% had partial recovery, and 5% had long-term complications. Conclusion CECT is a highly sensitive and specific imaging modality for evaluating abdominal trauma, providing critical information for clinical management and significantly influencing patient outcomes. [ABSTRACT FROM AUTHOR]

Background: This systematic review investigates the diagnostic value of ultrasound in the evaluation of torso injuries following a penetrating trauma. Methods: We searched PubMed, Scopus, and WOS databases for related original articles until May 7, 2023, and extracted data related to diagnostic performance. The bivariate model and hierarchic summary receiver operating characteristic (HSROC) approach were used to calculate pooled diagnostic values. Cochrane Q test and I-squared were performed to evaluate heterogeneity. We assessed heterogeneity with meta-regression. Results: Seventeen studies were included, which involved a total number of 1866 patients. According to meta-analysis, sonography demonstrated a pooled sensitivity of 56% (45–67%) and specificity of 96% (94–97%), positive likelihood ratio (LR +) of 13.66 (8.03–23.23), and negative likelihood ratio (LR-) of 0.45 (0.35–0.59) for detecting abdominal injuries. In pericardial penetrating trauma, pooled sensitivity was 100% (45–100%), pooled specificity was 99% (96–100%), LR + was 136.7 (24.8–752.3), and LR- was 0.00 (0.00–1.22). For thoracic penetrating trauma, pooled sensitivity was 99% (93–100%) and specificity was 100% (98–100%). Conclusions: Sonography demonstrated promising diagnostic value in the initial assessment of torso penetrating trauma, particularly in the thoracic and pericardial regions. However, the sensitivity of sonography is limited in abdominal penetrating trauma and a combination with other imaging modalities should be considered in these cases. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to ascertain the prevalence of rib fractures and other injuries resulting from CPR and to compare manual with mechanically assisted CPR. An additional aim was to summarize the literature on surgical treatment for rib fractures following CPR. Design: Systematic review and meta-analysis. Data sources: Embase, Medline Ovid, Cochrane Central, Web of Science, and Google Scholar. Review methods: The databases were searched to identify studies reporting on CPR-related injuries in patients who underwent chest compressions for a non-traumatic cardiopulmonary arrest. Subgroup analysis was conducted to compare the prevalence of CPR-related injuries in manual versus mechanically assisted chest compressions. Studies reporting on surgery for CPR-related rib fractures were also reviewed and summarized. Results: Seventy-four studies reporting CPR-related injuries were included encompassing a total of 16,629 patients. Any CPR-related injury was documented in 60% (95% confidence interval [95% CI] 49–71) patients. Rib fractures emerged as the most common injury, with a pooled prevalence of 55% (95% CI 48–62). Mechanically assisted CPR, when compared to manual CPR, was associated with a higher risk ratio for CPR-related injuries of 1.36 (95% CI 1.17–1.59). Eight studies provided information on surgical stabilization of CPR-related rib fractures. The primary indication for surgery was the inability to wean from mechanical ventilation in the presence of multiple rib fractures. Conclusion: Rib fractures and other injuries frequently occur in patients who undergo CPR after a non-traumatic cardiopulmonary arrest, especially when mechanical CPR is administered. Surgical stabilization of CPR-related rib fractures remains relatively uncommon. Level of evidence: Level III, systematic review and meta-analysis. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Point of Care Ultrasound (POCUS) has seen increasing use in the prehospital environment over the last decade, primarily with the extended focused assessment with sonography in trauma (eFAST) exam. Previous studies have shown prehospital eFAST exams are feasible in the helicopter transport environment but have yet to demonstrate effects on clinical care. This retrospective case series identified 655 patients with blunt thoraco-abdominal trauma or concern for pneumothorax due to penetrating injury transported by a single helicopter EMS (HEMS) program over a two-year period after introducing POCUS. Of those patients, 258 received prehospital ultrasound which was reported to change clinical care in seven cases (2.7%, 95%-CI [1.1–5.5]). This was primarily through preventing unnecessary needle thoracostomy and initiating blood transfusion for treatment of hemorrhagic shock in cases where the degree of shock was unclear due to inconsistent vital signs. This study highlights the improvements in clinical care that may result from the introduction of eFAST exams in the prehospital environment. [ABSTRACT FROM AUTHOR]

Diagnosis of relevant organ injury after blunt abdominal injury (AI) in multiple-injury/polytraumatised patients is challenging. AI can be distinguished between injuries of parenchymatous organs (POI) of the upper abdomen (liver, spleen) and bowel and mesenteric injuries (BMI). Still, such injuries may be associated with delays in diagnosis and treatment. The present study aimed to verify laboratory parameters, imaging diagnostics, physical examination and related injuries to predict intraabdominal injuries. This retrospective, single-centre study includes data from multiple-injury/polytraumatised patients between 2005 and 2017. Two main groups were defined with relevant abdominal injury (AI+) and without abdominal injury (AI−). The AI+ group was divided into three subgroups: BMI+, BMI+/POI+, and POI+. Groups were compared in a univariate analysis for significant differences. Logistic regression analysis was used to determine predictors for AI+, BMI+ and POI+. 26.3% (271 of 1032) of the included patients had an abdominal injury. Subgroups were composed of 4.7% (49 of 1032) BMI+, 4.7% (48 of 1032) BMI+/POI+ and 16.8% (174 of 1032) POI+. Pathological abdominal signs had a sensitivity of 48.7% and a specificity of 92.4% for AI+. Transaminases were significantly higher in cases of AI+. Pathological computed tomography (CT) (free fluid, parenchymal damage, Bowel Injury Prediction Score (BIPS), CT Grade > 4) was summarised and had a sensitivity of 94.8%, a specificity of 98%, positive predictive value (PPV) of 94.5% and, negative predictive value (NPV) of 98.2% for AI+. The detected predictors for AI+ were pathological abdominal findings (odds ratio (OR) 3.93), pathological multi-slice computed tomography (MSCT) (OR 668.9), alanine (ALAT) ≥ 1.23 µmol/ls (OR 2.35) and associated long bone fractures (OR 3.82). Pathological abdominal signs, pathological MSCT and lactate (LAC) levels ≥ 1.94 mmol/l could be calculated as significant risk factors for BMI+. For POI+ pathological abdominal MSCT, ASAT ≥ 1.73 µmol/ls and concomitant thoracic injuries had significant relevance. The study presents reliable risk factors for abdominal injury and its sub-entities. The predictors can be explained by the anatomy of the trunk and existing studies. Elevated transaminases predicted abdominal injury (AI+) and, specifically, the POI+. The pathological MSCT was the most reliable predictive parameter. However, it was essential to include further relevant parameters. [ABSTRACT FROM AUTHOR]

Trauma is a serious public health problem, and abdominal injuries are among the leading causes of hospitalization after trauma. Therefore, this study aimed to determine the outcome of abdominal trauma and its predictors in patients who underwent laparotomy at Asella Referral and Teaching Hospital (ARTH), South Central Ethiopia. We conducted a retrospective institutional based cross‐sectional study of patients who underwent laparotomy for abdominal trauma at ARTH from October 1, 2015, to September 30, 2020. Bivariate and multivariate logistic regressions were used to determine associations between independent factors and mortality due to abdominal trauma, and a P value of <0.05 indicated statistical significance. Out of 139 patients, 110 (79.1%) were males and 88 (63.3%) aged <30 years old, with a mean age of 29 ± 15.73 years. The most common mechanism of injury was penetrating trauma, which accounted for 94 (67.6%) patients. The mortality rate was 21 (15.1%). Factors such as blunt mechanism of injury (95% CI: AOR: 3.36, 1.24–9.09), SBP < 90 mmHg at presentation (95% CI: AOR = 9.37, 3.28–26.80), time >6 hours from trauma to admission (95% CI: AOR: 5.44, 1.78–16.63), unstable intraoperative patient condition (95% CI: AOR = 8.82, 3.05–25.52), and patients who need blood transfusion (95% CI: AOR: 6.63, 1.92–22.91) were significantly associated with mortality. The mortality rate of abdominal trauma patients who underwent laparotomy was high. Therefore, healthcare providers should provide priority for traumatic patients as prolonged waiting time to get healthcare results in poor outcomes for the patients. [ABSTRACT FROM AUTHOR]

Introduction: Abdominal trauma in children is a significant health concern that often leads to severe complications and even death. Children experience trauma more frequently than adults, with approximately one in four pediatric patients suffering from serious abdominal injuries. Falls are the leading cause of such trauma among children, which is intriguing considering that most hospital admissions for pediatric abdominal injuries result from blunt force impacts. Method: A retrospective cross-sectional analysis of medical records was conducted to examine all patients under the age of 16 who underwent exploratory laparotomy for abdominal trauma between January 1, 2020, and January 1, 2023. The clinical data were gathered using a data extraction sheet from each patient's medical charts. Information on socio-demographic characteristics, injury mechanisms, clinical conditions at the initial presentation, intraoperative findings and complications, and patient outcomes were collected. Results: The study involved a total of 90 patients, consisting of 72 males (80%) and 18 females (20%). The average age of the patients was 10, with a standard deviation of 4.7, ranging from 2 to 16 years. Half of the patients were below the age of 10, accounting for 46 individuals (51%). The causes of the injuries varied among patients below and above the age of 10. However, overall, bullet injuries were the most common cause, accounting for 28 cases (31%), followed by falls in 21 cases (23.3%), horse or donkey kicks in 10 cases (11.1%), stab injuries in 10 cases (11.1%), horn injuries in 7 cases (7.8%), and road traffic accidents in 6 cases (6.7%). Physical assault, blasts, and other types of injuries, such as hen bites and metal rod injuries, were observed in 8 cases (8.9%) of the patients. Fall accidents, horse or donkey kicks, and horn injuries were particularly more common among children below the age of 10, while bullet injuries and stab injuries were most common among those above the age of 10. Conclusion: Following abdominal trauma in children, a range of complications may arise, including immediate issues such as infections and hemorrhaging, as well as long-term consequences like impaired organ functionality and psychological distress. In our region, young children are particularly vulnerable to accidents involving falls, kicks from horses or donkeys, and injuries caused by horns. Therefore, it is crucial to educate parents about these hazards. Additionally, providing appropriate guidance on firearm safety is essential for individuals who possess such weapons. [ABSTRACT FROM AUTHOR]

Purpose Methods Results Conclusions It is well established that hollow viscus perforation leads to sepsis and acute kidney injury (AKI) in non‐trauma patients. However, the relationship between traumatic hollow viscus injury (HVI) and AKI is not well understood. Utilizing data from the National Trauma Data Bank, we investigated whether HVI serves as a risk factor for AKI. Additionally, we examined the characteristics of AKI in stable patients who underwent conservative treatment.We reviewed blunt abdominal trauma (BAT) cases from 2012 to 2015, comparing patients with and without AKI. Significant factors from univariate analysis were tested in a multivariate logistic regression (MLR) to identify independent AKI determinants. We also analyzed subsets: patients without HVI and stable patients given conservative management.Out of the 563,040 BAT patients analyzed, 9073 (1.6%) developed AKI. While a greater proportion of AKI patients had HVI than those without AKI (13.3% vs. 5.2%, p < 0.001), this difference wasn't statistically significant in the MLR (p = 0.125). Notably, the need for laparotomy (odds = 3.108, p < 0.001) and sepsis (odds = 13.220, p < 0.001) were identified as independent risk factors for AKI. For BAT patients managed conservatively (systolic blood pressure >90 mmHg, without HVI or laparotomy; N = 497,066), the presence of sepsis was a significant predictor for the development of AKI (odds = 16.914, p < 0.001).While HVI wasn't a significant risk factor for AKI in BAT patients, the need for laparotomy was. Stable BAT patients managed conservatively are still at risk for AKI due to non‐peritonitis related sepsis. [ABSTRACT FROM AUTHOR]

Background: Blunt trauma Abdomen (BTA) due to RTA is the sixth leading cause of death in India. Conservative management of most blunt abdominal injuries developed from the observation that most of these injuries would 'heal themselves' and that operative intervention could interfere with this process. Aim: To evaluate the outcome of conservative management of solid visceral injuries in BTA.Design: Prospective observational study. Methods:Study conducted in the Postgraduate Deptt. of Surgery, Govt. Medical College Jammu entailing 72 patients of BTA admitted from October 2018 to November 2019. Results: Out of 72 patients, 56 males were & 16 females. 69.44% had RTA. Most common age group was 21-30 years (30.56%).56.94% patients reported to hospital within 2 to 6 hours.FAST was positive in 95.83% patients. Liver was most commonly affected solid organ. 77.77% were managed conservatively and average hospital stay was 9.78 days. 4.16% patients of BTA expired in the study. Conclusion: In almost all the solitary solid visceral injuries with mild to moderate hemodynamic changes, Non Operative Management (NOM) is highly successful. It is concluded that all the isolated solid visceral injuries must be given fair chance of NOM where facilities of medical care or surgical ICUs are available for continuous monitoring. [ABSTRACT FROM AUTHOR]

Background: Penetrating abdominal trauma in patients is associated with severe morbidity and sometimes death. The incidence of penetrating trauma varies widely over the world. Similarly, the global experience with laparoscopy in trauma patients varied. Many recent investigations have indicated that laparoscopy plays a useful function in such cases. Objective: This study aimed to assess the diagnostic and therapeutic utility of laparoscopy in penetrating abdominal trauma (PAT) patients with respect to the precision and effectiveness of care and the avoidance of needless laparotomy. Patients and methods: This prospective study was conducted at Sohag University Hospitals, Sohag, Egypt. We included all patients with penetrating anterior abdominal wall injuries who were vitally stable. Results: We involved 60 patients who were admitted to the Emergency Room after suffering from penetrating abdominal injuries. The patients' mean age was 37.4 years and the percentage of male patients was higher (81.67%). Stab wounds accounted for 60% of injuries while gunshot wounds accounted for 40%. Hospital stay in laparoscopy was longer due to gastric, small intestinal, and colonic injuries. The average operation time in laparoscopy was 2.5 hours and about 2.25 hours in laparotomy. There were no post-operative complications in the form of postoperative leakage or wound infection found in the studied patients. Conclusion: Stab wounds were more common than gunshot wounds and the laparoscopic approach proved to be accurate and effective in the management of PAT and led to successful avoidance of unnecessary laparotomy. The patients experienced an uncomplicated course, with no postoperative complications and relatively short hospitalization. Further research and studies should be conducted to evaluate the long-term outcomes and potential benefits of laparoscopy in PAT cases, including larger sample sizes and comparative analyses. [ABSTRACT FROM AUTHOR]

Objective: To explore the application and effect of team‐based learning (TBL) based on network platform in teaching surgical abdominal emergency. Methods: A total of 80 fourth‐year medical students from our university's 5‐year clinical medicine program were enrolled. They were randomly assigned to two groups: the control group (n = 40) used the online large class teaching method and the experimental group (n = 40) used the online TBL. The teaching effect of web‐based TBL was evaluated by collecting the subjective evaluation of the experimental group and the objective test results of both groups through a questionnaire. Results: Online TBL was well‐received by most students. More than 80% of them found the teaching method interesting, and more than 90% of them gave a high rating to the improvement of their learning ability with online TBL. The experimental group scored significantly higher than the control group in the objective tests (p < 0.05). Conclusion: The network‐based TBL is preferred by most students. TBL curricula are more conducive to medical student learning and engagement and have better learning outcomes. [ABSTRACT FROM AUTHOR]

Abdominal trauma is an important cause of mortality in young people. The objectives of the review were to identify risk factors associated with mortality in abdominal trauma and to determine the incidence of mortality. A systematic review and meta-analysis was performed including ten observational studies that provided information on 188,400 participants. The risk factors were as follows: advanced age SMD 0.27 [95% CI: 0.15; 0.38], firearm injury OR 1.71 [95% CI: 1.52; 1.93], associated injuries OR 2.94 [95% CI: 1.98; 4.37], vascular injury OR 4.83 [95% CI: 3.09; 7.55]), increased number of red blood cell transfusions SMD 1.07 [95% CI: 0.96; 1.19], and solid organ injury OR 2.13 [95% CI: 1.51; 3.00]. The mortality ranged between 5 and 25.8% and the risk factors described were predictors of mortality in abdominal trauma. [ABSTRACT FROM AUTHOR]