- Comparison of Penetrating and Blunt Traumatic Diaphragmatic Injuries
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Sang Su Lee, Sung Youl Hyun, Hyuk Jun Yang, Yong Su Lim, Jin Seong Cho, Jae Hyug Woo
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J Trauma Inj. 2019;32(4):210-219. Published online December 30, 2019
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DOI: https://doi.org/10.20408/jti.2019.034
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Abstract
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Purpose
Traumatic diaphragmatic injury (TDI) is no longer considered to be a rare condition in Korea. This study investigated differences in the prevalence of accompanying injuries and the prognosis in patients with traumatic diaphragmatic damage according to the mechanism of injury.
Methods
We retrospectively reviewed the medical records of patients with TDI who were seen at a regional emergency medical center from January 2000 to December 2018. Among severe trauma patients with traumatic diaphragmatic damage, adults older than 18 years of age with a known mechanism of injury were included in this study. Surgery performed within 6 hours after the injury was sustained was defined as emergency surgery. We assessed the survival rate and likelihood of respiratory compromise according to the mechanism of injury.
Results
In total, 103 patients were analyzed. The patients were categorized according to whether they had experienced a penetrating injury or a blunt injury. Thirty-five patients had sustained a penetrating injury, and traffic accidents were the most common cause of blunt injuries. The location of the injury did not show a statistically significant difference between these groups. Severity of TDI was more common in the blunt injury group than in the penetrating injury group, and was also more likely in patients with respiratory compromise. However, sex, the extent of damage, and the initial Glasgow coma scale score had no significant relationship with severity.
Conclusions
Based on the findings of this study, TDI should be recognized and managed proactively in patients with blunt injury and/or respiratory compromise. Early recognition and implementation of an appropriate management strategy would improve patients’ prognosis. Multi-center, prospective studies are needed in the future.
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Summary
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Citations
Citations to this article as recorded by
- An audit of traumatic haemothoraces in a regional hospital in KwaZulu-Natal, South Africa
CM Kithuka, VC Ntola, W Sibanda South African Journal of Surgery.2023; 61(3): 12. CrossRef - Factors Associated with Successful Video-Assisted Thoracoscopic Surgery and Thoracotomy in the Management of Traumatic Hemothorax
Heather M. Grant, Alexander Knee, Michael V. Tirabassi Journal of Surgical Research.2022; 269: 83. CrossRef
- The Value of X-ray Compared with Magnetic Resonance Imaging in the Diagnosis of Traumatic Vertebral Fractures
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Yang Woo Lee, Jae Ho Jang, Jin Joo Kim, Yong Su Lim, Sung Youl Hyun, Hyuk Jun Yang
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J Trauma Inj. 2017;30(4):158-165. Published online December 30, 2017
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DOI: https://doi.org/10.20408/jti.2017.30.4.158
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7,797
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Abstract
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Purpose
The purpose of this study was to evaluate the diagnostic accuracy of X-rays in patients with acute traumatic vertebral fractures visiting the emergency department and to analyze the diagnostic value of X-rays for each spine level.
Methods
We retrospectively analyzed basal characteristics by reviewing medical records of 363 patients with adult traumatic vertebral fractures, admitted to the emergency center from March 1, 2014 to February 28, 2017. We analyzed spine X-rays and magnetic resonance imaging (MRI) scans to determine distribution according to the vertebral level, and we evaluated the efficacy of X-rays by comparing discrepancies between X-rays and MRI scans.
Results
For a total of 363 patients, the mean age was 56.65 (20?93) and 214 (59%) were males. On the basis of X-rays, 67 cases (15.1%) were of the cervical spine, 133 cases (30.0%) were of the thoracic spine, and 243 cases (54.9%) were of the lumbar spine. In particular, the thoracolumbar region (T11-L2) was the most common, with 260 cases (58.7%). In X-rays, fractures were the least in the upper thoracic region (T1-T3), whereas MRI scans revealed fairly uniform distribution across the thoracic spine. Sensitivity of X-rays was lowest in the upper thoracic spine and specificity was almost always greater than 98%, except for 94.7% in L1. Positive predictive value was lower in the mid-thoracic region (T4-T9) and negative predictive value was slightly lower in C6, T2, and T3 than at other sites. Diagnostic accuracy of X-rays by vertebral body, transverse process, and spinous process according to fractured vertebral structures was significantly different according to vertebral level.
Conclusions
Diagnostic accuracy of X-rays was lower in the upper thoracic region than in other parts. Further studies are needed to identify better methods for diagnosis considering cost and neurological prognosis.
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Summary
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Citations
Citations to this article as recorded by
- A novel radiological assessment to identify acute vertebral compression fractures: A pilot observational study
Keisuke Tsuruta, Toru Ueyama, Tomoo Watanabe, Yasunori Kobata, Kenichi Nakano, Hidetada Fukushima Acute Medicine & Surgery.2023;[Epub] CrossRef - Forward Bending in Supine Test: Diagnostic Accuracy for Acute Vertebral Fragility Fracture
Chan-Woo Jung, Jeongik Lee, Dae-Woong Ham, Hyun Kang, Dong-Gune Chang, Youngbae B. Kim, Young-Joon Ahn, Joo Hyun Shim, Kwang-Sup Song Healthcare.2022; 10(7): 1215. CrossRef
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