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The aim of this study is to determine if the introduction of a pan-scan protocol during the initial assessment for blunt trauma activations would affect missed injuries, incidental findings, treatment times, radiation exposure, and cost. A 6-month prospective study was performed on patients with blunt trauma at a level 1 trauma center. During the last 3 months of the study, a pan-scan protocol was introduced to the trauma assessment. Categorical data were analyzed by Fisher exact test and continuous data were analyzed by Mann-Whitney nonparametric test. There were a total of 220 patients in the pre–pan-scan period and 206 patients during the pan-scan period. There was no significant difference in injury severity or mortality between the groups. Introduction of the pan-scan protocol substantially reduced the incidence of missed injuries from 3.2% to 0.5%, the length of stay in the emergency department by 68.2 minutes (95% confidence interval [CI], −134.4 to −2.1), and the mean time to the first operating room visit by 1465 minutes (95% CI, −2519 to −411). In contrast, fixed computed tomographic scan cost increased by $48.1 (95% CI, 32-64.1) per patient; however, total radiology cost per patient decreased by $50 (95% CI, −271.1 to 171.4). In addition, the rate of incidental findings increased by 14.4% and the average radiation exposure per patient was 8.2 mSv (95% CI, 5.0-11.3) greater during the pan-scan period. Although there are advantages to whole-body computed tomography, elucidation of the appropriate blunt trauma patient population is warranted when implementing a pan-scan protocol.

PurposeTube thoracostomy (TT) is a simple and a life-saving procedure; nevertheless, it carries morbidity, even after its removal. Currently, TT is managed and removed by chest X-ray (CXR) evaluation. There are limitations and these are directly linked to complications. The use of thoracic ultrasound (US) has already been established in the diagnosis of pneumothorax (PTX) and hemothorax (HTX); its use, in substitution of CXR can lead to improvement in care. Our aim is to evaluate the efficiency and safety of US in the management of TT.MethodsProspective and randomized study with patients requiring TT. They were divided in groups according to their thoracic injuries (PTX and HTX) and randomized into two groups according to TT management: US and CXR. Data collected included gender, age, mechanism of injury, days to TT removal, complications after TT removal and presence of mechanical ventilation.ResultsSixty-one patients were randomized, of which 68.8% were male. The most frequent diagnosis was PTX, present in 37 cases. Median time for TT removal was 2.5 days in the US group and 4.9 in the control group (p = 0.009). The complication rate was 6.6%, with no morbidity in the US group. TT removal in patients with mechanical ventilation did not increase the incidence of complications.ConclusionsThe use of US in the management is efficient and safe. It allows early TT removal regardless the cause of the thoracic injury.

To assess whether inverted grayscale rib series, used alone or as an additional imaging modality, improves diagnostic accuracy of rib fractures of emergency medicine (EM) residents in minor chest trauma. Twenty readers, including 5 junior and 5 senior EM residents and 10 fourth-year medical students, independently reviewed 110 patients' radiographs during 3 sessions. Session 1 used conventional grayscale rib series, session 2 used inverted grayscale rib series, and session 3 used both conventional and inverted grayscale images. The McNemar test was used to compare the sensitivities and specificities of the diagnostic methods, and to compare their sensitivities and specificities for detecting more than 3 rib fractures. Interobserver agreement was assessed using Cohen κ analysis. For senior EM residents, there was no difference in sensitivity (P = .283) and accuracy (P = .888) between conventional rib series and the double-modality method. For junior EM residents and medical students, the double modality offered higher diagnostic sensitivity (P < .001, P = .001) and accuracy (P = .006, P = .002) than did conventional radiography. In cases with more than 3 rib fractures, who required specialist trauma care, the double modality provided greater sensitivity and accuracy among junior EM residents (P = .035 and P = .035, respectively) and medical students (P = .010, P = .010) than did conventional radiography. In the diagnosis of rib fractures, the combined use of conventional and inverted grayscale rib series increases the diagnostic accuracy of less biased readers by conventional grayscale image like junior EM residents and medical students.

Background: The purpose of this study was to determine whether patients with left-sided thoracoabdominal (TA) stab wounds can be safely treated with clinical and chest X-ray follow up. Method: A prospective, randomized control study was conducted at Groote Schuur Hospital from September 2009 through to November 2014. Patients with asymptomatic left TA stab wounds included in the trial were randomized into two groups. Group A underwent diagnostic laparoscopy and Group B underwent clinical and radiological follow-up. Results: Twenty-seven patients were randomized to Group A (N=27) and thirty-one to Group B (N=31). All patients were young males with a median age of 26 years (range 18 to 48). The incidence of occult diaphragm injury in Group A was 29%. All diaphragm injuries found at laparoscopy were repaired. The mean hospital stay for the patients in Group A was 5 days (SD 1.3), compared to a mean hospital stay of 2.9 days (SD, 1.5), in Group B (p<0.001). All patients in Group B had normal chest X-rays at their last visit. The mean follow-up time was 24 months (median: 24; interquartile range: 1–40). There was no morbidity or mortality in Group B. Conclusions: Clinical and radiological follow-up are feasible and appear to be safe, in the short term, in patients who harbour occult diaphragm injuries after left TA stab wounds. Until studies showing the natural history of diaphragm injury in humans are available, laparoscopy should remain the gold standard in treatment.

PurposeCT-scan is increasingly used in blunt trauma, but the real impact on patient outcome is still unclear. This study was conducted to assess the effect of performing routine (versus selective) chest and abdominopelvic CT-scan on patient admission time and outcome in blunt trauma.MethodsConscious and hemodynamically stable high-energy trauma patients were included (n = 140). Routine chest and abdominopelvic CT-scan was requested in addition to the conventional radiography and ultrasound for the intervention group and selective CT-scan according to clinical presentation was done for the control group. Patient admission times in the emergency room and surgery ward, complications, and performed surgical procedures were assessed. “Unsuspected injuries” defined as additional findings on CT-scan, which were not expected before CT-scan, were evaluated.ResultsAdmission time in the emergency ward and admission time in hospital were significantly shorter in the intervention group. Complications were similar in both groups. Abdominopelvic CT-scan in the intervention group revealed nine (7.8%) unsuspected injuries. All of these nine patients had also a positive clinical examination and injuries in other body regions. Chest CT-scan in the intervention group led to additional diagnoses in 17 patients (24.28%) leading to tube thoracostomy in 13 patients (18.57%).ConclusionRoutine chest and abdominopelvic CT-scan in conscious blunt trauma patients decreases the hospitalization time, but has no impact on patient outcome and probably might lead to overtreatment of occult injuries. The option of using a selective approach should be further evaluated to decrease radiation exposure and facility overuse.

Introduction Bombings, accounting for approximately 50% of global terrorist incidents, frequently cause high-morbidity thoracic trauma, including blast lung injury. This retrospective radiological review characterizes injury patterns in bomb blast victims to guide mass casualty response and improve patient outcomes. Methods This retrospective observational review, conducted at Aga Khan University Hospital (January 2004–October 2024), included 130 patients with bomb blast injuries. Demographics, injury mechanisms, and imaging findings were categorized by blast type and summarized using frequencies, percentages, medians, and interquartile ranges. Results Among 130 victims (94.6% males; median (interquartile range) age, 32 (26.0–43.5) years), initial chest X-ray was performed in 85.4% of cases, detecting foreign bodies (22.8%), emphysema (10.4%), and atelectasis (10.4%). Computed tomography was performed in 28.5% of the patients on the second imaging assessment; however, foreign bodies and atelectasis persisted at 14.4%–15.9% on follow-up. Primary blast injuries predominated (68.4%–78.8%), followed by secondary (15.0%–23.3%), tertiary (0%–4.7%), and quaternary (1.8%–4.4%) injuries; additionally, 48.5% of patients did not undergo a third study. Conclusions Primary blast injuries predominate, with frequent foreign bodies, emphysema, and atelectasis. Initial chest X-ray facilitates rapid assessment, while computed tomography is reserved for complex cases. Tailored imaging protocols may enhance timely care and outcomes in resource-limited settings.

Management of penetrating thoracoabdominal (PTA) injuries with signs of hemorrhage have warranted operative intervention but improved imaging capabilities have redefined interventions required. We examined outcomes of hemodynamically stable patients undergoing preoperative CT imaging with the hypothesis that CT imaging would decrease OR time without delaying OR arrival. A retrospective multicenter study was performed amongst four urban trauma centers examining hemodynamically stable patients with PTA injuries requiring operative intervention from January 2017–December 2021. The primary outcome was OR time. Secondary outcomes included length of stay (LOS), ICU LOS, and mortality. A multivariable logistic regression with random intercept for trauma center was fit to assess whether preoperative CT affected time in the OR. Of 534 hemodynamically stable patients with penetrating injuries, 322 (60.3 ​%) received preoperative CT. The median time in OR were 130 (IQR: 84,180) and 140 (IQR: 100, 180) minutes for patients with and without preoperative CT, respectively. Median time to OR was 68 (IQR: 47, 110) and 26 (IQR 17,38) minutes in patients with and without preop CT, respectively. Median ICU LOS were 0 vs 1 day, the median hospital LOS were 7 vs 8 days for patients with and without pre-op imaging respectively. The multivariable model showed that obtaining a pre-op CT scanning was not independently associated with time spent in OR. (Adjusted OR:0.94; 95 ​% CI: 0.85, 1.04). In patients with PTA injuries and hemodynamic stability, preoperative CT scanning was not associated with decreased OR time, postoperative complications, or mortality. •CT has significantly changed the paradigm in management of penetrating injuries.•Preoperative CT appears safe & useful in stable patients with penetrating injuries.•Median OR was similar amongst patients who did and did not receive preoperative CT.•CT lends to thoughtful operative planning and thorough postoperative workups.

Objective To assess a radiologist’s detection rate of rib fractures in trauma CT when reading curved planar reformats (CPRs) of the ribs compared to reading standard MPRs. Methods Two hundred and twenty trauma CTs (146 males, 74 females) were retrospectively subjected to a software algorithm to generate CPRs of the ribs. Patients were split into two equal groups. Sixteen patients were excluded due to insufficient segmentation, leaving 107 patients in group A and 97 patients in group B. Two radiologists independently evaluated group A using CPRs and group B using standard MPRs. Two different radiologists reviewed both groups with the inverse methods setting. Results were compared to a standard of reference created by two senior radiologists. Results The reference standard identified 361 rib fractures in 61 patients. Reading CPRs showed a significantly higher overall sensitivity ( P  < 0.001) for fracture detection than reading standard MPRs, with 80.9 % (584/722) and 71.5 % (516/722), respectively. Mean reading time was significantly shorter for CPRs (31.3 s) compared to standard MPRs (60.7 s; P  < 0.001). Conclusion Using CPRs for the detection of rib fractures accelerates the reading of trauma patient chest CTs, while offering an increased overall sensitivity compared to conventional standard MPRs. Key Points • In major blunt trauma, rib fractures are diagnosed with Computed Tomography . • Image processing can unfold all ribs into a single plane . • Unfolded ribs can be read twice as fast as axial images . • Unfolding the ribs allows a more accurate diagnosis of rib fractures .

Point of care ultrasound has long been used in the trauma setting for rapid assessment and diagnosis of critically ill patients. Its utility for diagnosis of pericardial effusion in the setting of penetrating thoracic trauma has more recently been a topic of consideration, given the rapid decompensation that these patients can experience. This study aims to identify the diagnostic accuracy of point of care ultrasound in the diagnosis of pericardial effusion among patients with penetrating thoracic trauma. Retrospective review of 2099 patients brought to the trauma bay between the years 2016 and 2021 were analyzed for diagnosis of pericardial effusion. Patients who were diagnosed with a pericardial effusion were investigated for point of care ultrasound findings. Descriptive statistics were performed to identify sensitivity, specificity, positive predictive value, and negative predictive value. Prevalence was calculated to be 26.7 cases of pericardial effusion per 1000 patients presenting with penetrating thoracic trauma. Incidence was estimated to be 3.8 cases of pericardial effusion per 1000 person-years. Calculation of diagnostic capabilities of ED POCUS revealed a sensitivity of 96.36 ​%, a specificity of 100 ​%, PPV of 100 ​%, and NPV of 99.90 ​%. Point of Care cardiac ultrasonography is a reliable tool for the rapid diagnosis of pericardial effusion in penetrating thoracic trauma patients. Patients with ultrasound suggestive of this condition should receive rapid surgical management to prevent decompensation. •Point-of-care ultrasonography is widely utilized in the trauma bay.•Patients with cardiac injury are susceptible to rapid decompensation and swift diagnosis can be life-saving.•Cardiac ultrasonography can be reliably used to assess for cardiac injury in penetrating thoracic trauma.•Improvements in technology and training on sonographic technology may be improving the diagnostic accuracy of this tool.