Panamerican Journal of Trauma, Critical Care & Emergency Surgery

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2023 | May-August | Volume 12 | Issue 2

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SPECIAL ISSUE INVITATION

Violence – Prevention and Interventions

[Year:2023] [Month:May-August] [Volume:12] [Number:2] [Pages:2] [Pages No:vii - viii]

   DOI: 10.5005/pajt-12-2-vii  |  Open Access | 

253

EDITORIAL

Sandro Rizoli

Welcome New Executive Director, New President, and Thanks to so Many for the Joint PTS/CBC/SBAIT 2023 Congress

[Year:2023] [Month:May-August] [Volume:12] [Number:2] [Pages:2] [Pages No:61 - 62]

   DOI: 10.5005/jp-journals-10030-1426  |  Open Access |  How to cite  | 

250

Perspectives

Pablo Ottolino

In Memoriam Professor Fernando Rodríguez Montalvo

[Year:2023] [Month:May-August] [Volume:12] [Number:2] [Pages:2] [Pages No:63 - 64]

   DOI: 10.5005/jp-journals-10030-1419  |  Open Access |  How to cite  | 

989

ORIGINAL RESEARCH

Tanya E Thomas, Tizeta Wolde, Jennifer Lobb, Brandon Parker, Christian Gozzo, Avinash Gogineni, Nicholas Namias, Patricia Byers

ILBME-80: Analysis of Injury and Resource Utilization Trends in Motorcycle Collisions: A Retrospective Study

[Year:2023] [Month:May-August] [Volume:12] [Number:2] [Pages:5] [Pages No:65 - 69]

Keywords: Blunt trauma, Cost, Helmet, Motorcycle, Public health, Scooter, Trauma

   DOI: 10.5005/jp-journals-10030-1415  |  Open Access |  How to cite  | 

Abstract

Introduction: Florida law Title XXII 316.211 3b allows motorcycle and motor scooter riders to ride without a helmet if they are over the age of 21 or carry an insurance policy providing at least $10,000 in medical benefits for crash injuries. We evaluated the specific injury patterns and associated costs of 150 consecutive patients treated at a level I trauma center in Florida for a motorcycle crash to show clinical trends, evaluate hospital resource utilization, and quantify the financial burden of care. Materials and methods: We reviewed 150 consecutive adult motorcycle and scooter collision patients treated at a safety-net level I trauma center in Florida between 28th February 2017 and 19th July 2017. We recorded the abbreviated injury scale (AIS) and injury severity scores (ISS) and classified injuries with an Injury Severity Score (ISS) >15 as severe. We assessed the use of computed tomography (CT) scans, magnetic resonance imaging (MRI), and hours spent in the operating room (OR) and converted these services to monetary value to calculate the financial burden of care. The first hour in the OR carried a cost of $6,381 and each subsequent hour had a cost of $4,157. The average cost of a CT was $1,565 and the average cost of an MRI was $2,048. Results: The most common severely injured area in our patients was the extremities, followed by the head and chest. Patients wearing helmets had fewer severe head and face injuries. The proportion of patients discharged to a skilled nursing facility or experienced inhospital mortality was significantly higher in those with ISS scores classified as severe or highly severe. Similarly, patients with an ISS score classification of severe had higher average use of OR time, CT scans, number of surgeries, and consultations. Conclusion: Severe injuries were the costliest due to greater OR use, CT scans, and consultations. Legislation that would require proper helmets, gear, and personal injury insurance coverage would help decrease the burden of injury and reduce the financial burden on hospitals.

366

ORIGINAL RESEARCH

Orlando Favio Arevalo Guerra, Adriana M Zuñiga, Mario A Herrera, Henry Giraldo, Christian Muñoz, Wilmer Perez, Michael Zapata, Adolfo G Hadad

Novel Classification and Proposal Guide for the Management of Hypopharynx Trauma

[Year:2023] [Month:May-August] [Volume:12] [Number:2] [Pages:6] [Pages No:70 - 75]

Keywords: Conservative treatment, Hypopharynx, Penetrating neck trauma, Severity scales, Trauma surgery

   DOI: 10.5005/jp-journals-10030-1422  |  Open Access |  How to cite  | 

Abstract

Introduction: The management of noniatrogenic penetrating trauma to the hypopharynx remains controversial due to its uncommonness and limited evidence to support management protocols. The present study's primary goal is to describe the management of noniatrogenic penetrating hypopharyngeal trauma (THF) in a tertiary hospital in Colombia. The secondary goal is to present a novel classification and management guide for such injuries. Study design: Case series collected retrospectively from the hospital trauma registry between January 2021 and April 2022. THF was categorized as grade I–IV according to a new classification (described below) and correlated with the clinical outcome at hospital discharge. The data collection and analysis were done using the Epi InfoTM software. Quantitative variables were presented as mean and/or mean according to the distribution. Qualitative variables were presented as frequency and percentages. The outcomes of each patient are described. Results: Over the study period, 31 patients were admitted to the emergency department with penetrating neck trauma in zone II and III. Fourteen of the 31 had a hypopharyngeal injury, one required surgical management, and 13 were managed conservatively. The male/female gender ratio was 13/1, the mean injury severity score (ISS) was 8, revised trauma scores (RTS) was 7, the mean age was 31 years, and zone II (8/14, 58%) was the most affected area. Retrospectively analyzing the injuries and applying the proposed classification, we found that: Nine patients (64%) had a grade I injury, three (21%) had a grade II, one had a grade III, and one had a grade IV. The use of the AREVALO Hypopharynx University Valle (HUV) classification and management guide reduced the average hospital stay from 4 to 1 day mostly by allowing immediate oral feeding, thus reducing the need for enteral nutrition. Only one patient underwent surgical repair. All other 13 patients were successfully managed nonoperatively, of whom 10 were followed up after discharge, and none developed any complications. Conclusion: The proposed novel classification may optimize the care of patients with a penetrating injury of the hypopharynx by standardizing the management of this uncommon entity and preventing the trauma care team from unnecessary overtreatment of patients with low-grade lesions.

606

ORIGINAL RESEARCH

Doris Sarmiento, Antonella Gallegos, Mateo Pacurucu, Rafael Valdivieso, Catherine Cabrera, Amber N Himmler

Choledocholithiasis: Easy and Early Diagnosis

[Year:2023] [Month:May-August] [Volume:12] [Number:2] [Pages:4] [Pages No:76 - 79]

Keywords: Cholangiopancreatography endoscopic retrograde, Choledocholithiasis, Common bile duct, Liver function tests

   DOI: 10.5005/jp-journals-10030-1418  |  Open Access |  How to cite  | 

Abstract

Aims and objectives: Choledocholithiasis is prevalent in Western countries, representing 10–15% of symptomatic gallstones, and is associated with a high-risk of complications (1–2%). The primary objective of the study is to determine the validity of liver function tests (LFTs) early, as well as establish LFT cutoff values. In this way, there will be greater accuracy in diagnosing this condition, and a reduced need for subsequent endoscopic retrograde cholangiopancreatography (ERCP), which is particularly beneficial for hospitals with limited resources. Materials and methods: This is an analytical study for the validation of diagnostic tests for choledocholithiasis. The inclusion criteria were patients over the age of 16 with a suspected diagnosis of choledocholithiasis who underwent ERCP (gold standard). Demographic data and LFTs were analyzed, including total bilirubin (TB), direct bilirubin (DB), alanine aminotransferase (ALT), aspartate aminotransferase (AST), γ-glutamyltransferase (GGT), and alkaline phosphatase (ALP). LFTs were compared between patients with ERCP-confirmed choledocholithiasis vs patients with negative findings on ERCP, thus obtaining sensitivity, specificity, and predictive values. Results: A total of 262 patients who underwent ERCP were included in the study, of which 167 patients (63.7%) had confirmed choledocholithiasis. The most sensitive LFTs were ALT (87.43%) and GGT (87.43%), while those with the highest specificity were AST (82.11%), and GGT (80%). All the tests obtained an area under the curve greater than 0.83, and specific LFT cutoffs were established. Conclusion: All LFTs had high sensitivity for a successful diagnosis of choledocholithiasis, most notably AST and GGT. Our findings demonstrated that a raised AST and GGT served as valid markers in raising an early suspicion of choledocholithiasis, thus expediting the diagnostic process and preventing unnecessary ERCP. As ERCP is not widely available in hospitals in low to middle-income countries, these findings have strong implications for hospitals with limited resources.

747

ORIGINAL RESEARCH

Edward Delgado, Daiana López, Manuela Arocena, Nicolás A Consolandich, Nicolás Sagasti, Fernando Machado

Diagnostic Accuracy of the Extended FAST Protocol Performed by Students and Surgical Residents in the Emergency Department in 2022

[Year:2023] [Month:May-August] [Volume:12] [Number:2] [Pages:6] [Pages No:80 - 85]

Keywords: Emergency, Extended Focused Assessment with Sonography in Trauma, Injured, Polytraumatized

   DOI: 10.5005/jp-journals-10030-1423  |  Open Access |  How to cite  | 

Abstract

Introduction: The Extended Focused Assessment with Sonography in Trauma (eFAST) protocol is an evaluation system that consists of ultrasonographic determination of intraabdominal free fluid, hemothorax, and pneumothorax. So far, there is no national research on this subject; in this context, the present study is proposed. Objectives: The general objective was to establish the diagnostic accuracy of the eFAST protocol performed by previously trained students and surgical residents in an emergency department. The obtained diagnosis was then compared to the intraoperative diagnosis, computed tomography (CT), or ultrasound. Methodology: A prospective, descriptive, observational study of diagnostic tests was performed. This study included patients who suffered a traumatic event involving kinetic energy transmission between January and September of 2022 and who were also submitted to an eFAST protocol in the Emergency Department of the Hospital de Clínicas in Montevideo, Uruguay. Results: Out of 100 eFAST protocols, 28 were performed by students and 72 by residents. No significant differences (p = 0.59) were found between operators. Of the 100 eFAST protocols, 69 were negative and 31 were positive (pneumothorax being the main diagnosis). CT was the most common comparison method (87%). This study met 70% sensitivity, 95% specificity, and 90% positive predictive value. The most frequent etiology was polytrauma (56%). Conclusion: The eFAST protocol performed by surgical residents and undergraduate students presented high specificity and high positive predictive value, with no significant differences between both groups. Clinical significance: This protocol has proven to be a valuable tool in the emergency department to improve patient prognosis. This is the first research to determine the diagnostic accuracy of said protocol at the national level, and the first to compare its precision between general surgery residents and previously trained advanced medical students.

670

CASE REPORT

Bárbara J Ortiz, Daniel I Gutierrez, Marcelo Parra, Francisco Moraga

Bronchial Rupture in Blind Thoracic Trauma: Report of 2 Cases and Review of the Literature

[Year:2023] [Month:May-August] [Volume:12] [Number:2] [Pages:4] [Pages No:86 - 89]

Keywords: Case report, Conservative treatment, Torax trauma, Windpipe

   DOI: 10.5005/jp-journals-10030-1425  |  Open Access |  How to cite  | 

Abstract

Aim: To present two cases of bronchial rupture in the context of blunt chest trauma treated in our institution and to conduct a narrative review of the literature. Background: Bronchial rupture following blunt chest trauma is uncommon (1–3%) but associated with high mortality. About 70–80% do not reach the emergency service; however, most of those diagnosed in the hospital are treated with conservative management. Case description: Case 1; male 18 years old, traffic accident, and left massive hemothorax in recuperator; thoracotomy and left inferior lobectomy are performed. Case 2; female 20 years old, traffic accident; on admission, an exploratory laparotomy was performed due to hepatic trauma; progresses unstable in the intensive care unit (ICU); computed tomography (CT) scan of the chest shows right source bronchial injury; thoracotomy and bronchial repair are performed. Conclusion: Bronchial injury is an infrequent pathology, but it could have a lethal evolution. The emergency surgeon must have a high rate of suspicion of high-energy bruises. Clinical significance: The duration and type of surgical intervention varies according to the patient's conditions and characteristics of the lesions; in both cases, in their study, diagnosis and treatment are in accordance with what has been reviewed in the literature.

431

Perspectives

Beneath the White Coats: A Speech on the Togetherness (or Separation) of Life and Work for a Physician

[Year:2023] [Month:May-August] [Volume:12] [Number:2] [Pages:2] [Pages No:90 - 91]

   DOI: 10.5005/jp-journals-10030-1424  |  Open Access |  How to cite  | 

302

LETTER TO EDITOR

Neeraj Kumar, Gayatri Sagdeo

Termination of the Ventricular Premature Complex by Etomidate

[Year:2023] [Month:May-August] [Volume:12] [Number:2] [Pages:2] [Pages No:92 - 93]

   DOI: 10.5005/jp-journals-10030-1420  |  Open Access |  How to cite  | 

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