Journal of Trauma and Injury

Original Article

Radiologic assessment of the optimal point for tube thoracostomy using the sternum as a landmark: a computed tomography‐based analysis: Jaeik Jang, Jae-Hyug Woo, Mina Lee, Woo Sung Choi, Yong Su Lim, Jin Seong Cho, Jae Ho Jang, Jea Yeon Choi, Sung Youl Hyun; J Trauma Inj. 2024;37(1):37-47. Published online February 23, 2024; DOI: https://doi.org/10.20408/jti.2023.0058

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Abstract PDF Supplementary Material: Purpose
This study aimed at developing a novel tube thoracostomy technique using the sternum, a fixed anatomical structure, as an indicator to reduce the possibility of incorrect chest tube positioning and complications in patients with chest trauma.
Methods
This retrospective study analyzed the data of 184 patients with chest trauma who were aged ≥18 years, visited a single regional trauma center in Korea between April and June 2022, and underwent chest computed tomography (CT) with their arms down. The conventional gold standard, 5th intercostal space (ICS) method, was compared to the lower 1/2, 1/3, and 1/4 of the sternum method by analyzing CT images.
Results
When virtual tube thoracostomy routes were drawn at the mid-axillary line at the 5th ICS level, 150 patients (81.5%) on the right side and 179 patients (97.3%) on the left did not pass the diaphragm. However, at the lower 1/2 of the sternum level, 171 patients (92.9%, P<0.001) on the right and 182 patients (98.9%, P= 0.250) on the left did not pass the diaphragm. At the 5th ICS level, 129 patients (70.1%) on the right and 156 patients (84.8%) on the left were located in the safety zone and did not pass the diaphragm. Alternatively, at the lower 1/2, 1/3, and 1/4 of the sternum level, 139 (75.5%, P=0.185), 49 (26.6%, P<0.001), and 10 (5.4%, P<0.001), respectively, on the right, and 146 (79.3%, P=0.041), 69 (37.5%, P<0.001), and 16 (8.7%, P<0.001) on the left were located in the safety zone and did not pass the diaphragm. Compared to the conventional 5th ICS method, the sternum 1/2 method had a safety zone prediction sensitivity of 90.0% to 90.7%, and 97.3% to 100% sensitivity for not passing the diaphragm.
Conclusions
Using the sternum length as a tube thoracostomy indicator might be feasible.; Summary

Case Reports

Management of a traumatic avulsion fracture of the occipital condyle in polytrauma patient in Korea: a case report: Chang Hwa Ham, Woo-Keun Kwon, Joo Han Kim, Youn-Kwan Park, Jong Hyun Kim; J Trauma Inj. 2023;36(2):147-151. Published online December 8, 2022; DOI: https://doi.org/10.20408/jti.2022.0058

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Abstract PDF: Avulsion fracture of the occipital condyle are rare lesion at craniovertebral junction. It is often related to high-energy traumatic injuries and show diverse clinical presentations. Neurologic deficit and instabilities may justify surgical treatment. However, the integrity of neurovascular structures is undervalued in the current literatures. In this case report, we described a 26-year-old female patient with avulsion fracture of occipital condyle following a traffic accident. On initial presentation, her Glasgow Coma Scale was 8. She presented with fracture compound comminuted depressed, on the left side of her forehead with skull base fracture extending into clivus and occipital condyle. Her left occipital condyle showed avulsion injury with displacement deep into the skull base. On her computed tomography angiography, the displaced occipital condyle compressed on the sigmoid sinus resulting in its obstruction. While she was recovering her consciousness during her stay in the hospital, the lower cranial nerves showed dysfunctions corresponding to Collet-Sicard syndrome. Due to high risk of vascular injury, the patient was conservatively treated for the occipital condyle fracture. On the 4 months postdischarge follow-up, her cranial nerve symptoms practically recovered, and the occipital condyle showed signs of fusion without further displacement. Current literatures focus on neurologic deficit and stability for the surgical decisions. However, it is also important to evaluate the neurovascular integrity to assess the risk of its manipulation as it may result in fatal outcome. This case shows, an unstable avulsion occipital condyle fracture with neurologic deficit can be treated conservatively and show a favorable outcome.; Summary

Delayed diagnosis of popliteal artery injury after traumatic knee dislocation in Korea: a case report: Chung-Eun Lee, In-Seok Jang, Sang-Yoon Song, Jung-Woo Lim, Kun-Tae Kim; J Trauma Inj. 2023;36(2):142-146. Published online December 6, 2022; DOI: https://doi.org/10.20408/jti.2022.0064

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Abstract PDF: The popliteal artery damage is present to range from 1.6% to 64% of patients with knee dislocation, and it is crucial to evaluate vascular damage even if there are no prominent ischemic changes in the distal area. The injury of the popliteal artery by high-energy forces around the knee caused by a fall or traffic accident is a potentially limb-threatening complication in traumatic knee dislocation. The popliteal artery injury by blunt trauma has a high risk of limb amputation because the initial symptoms can show normal vascular circulation without urgent ischemia or obvious vascular injury signs. Since the collateral branches can delay the symptoms of decisive ischemia or pulseless extremity, the vascular damage is a major cause of limb amputation. In the present study, we describe a rare case of delayed diagnosis of popliteal artery injury after traumatic knee dislocation, requiring urgent limb revascularization surgery. After revascularization of the occluded popliteal artery, graft interposition was performed, and successful restoration was confirmed. This case illustrates that, even if ankle-brachial index >0.9 or equal pedal pulse to the uninjured extremity, serial vascular evaluation is required if there are soft signs such as diminished pulses, neurologic signs, or high-energy damage such as multiple ligament ruptures since delayed diagnosis of artery injury can be the major cause of limb amputation. The clinicians need to regard high-energy trauma such as multiple ligament rupture around the knee as a hard sign, and immediate computed tomography angiography can be helpful for accurate diagnosis and treatment.; Summary

Original Articles

Epidemiology and clinical characteristics of posttraumatic hospitalized patients with symptoms related to venous thromboembolism: a single-center retrospective study: Hyung Su Park, Sung Youl Hyun, Woo Sung Choi, Jin-Seong Cho, Jae Ho Jang, Jea Yeon Choi; J Trauma Inj. 2022;35(3):159-167. Published online June 10, 2022; DOI: https://doi.org/10.20408/jti.2021.0052

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Abstract PDF: Purpose
The aim of this study was to investigate the epidemiology of trauma inpatients with venous thromboembolism (VTE) symptoms diagnosed using computed tomographic angiography (CTA) in Korea
Methods
In total, 7,634 patients admitted to the emergency department of Gachon University Gil Medical Center, a tertiary hospital, and hospitalized between July 1, 2018 and December 31, 2020 were registered for this study. Of these patients, 278 patients who underwent CTA were enrolled in our study.
Results
VTE was found in 120 of the 7,634 patients (1.57%), and the positive diagnosis rate of the 278 patients who underwent CTA was 43.2% (120 of 278). The incidence of VTE was statistically significantly higher among those with severe head and neck injuries (Abbreviated Injury Scale, 3–5) than among those with nonsevere head and neck injuries (Abbreviated Injury Scale, 0–2; P=0.038). In a subgroup analysis, the severe and nonsevere head and neck injury groups showed statistically significant differences in known independent risk factors for VTE. In logistic regression analysis, the adjusted odds ratio of severe head and neck injury (Abbreviated Injury Scale, 3–5) for VTE was 1.891 (95% confidence interval, 1.043–3.430).
Conclusions
Trauma patients with severe head and neck injuries are more susceptible to VTE than those with nonsevere head and neck injuries. Thus, physicians must consider CTA as a priority for the diagnosis of VTE in trauma patients with severe head and neck injuries who show VTE-associated symptoms.; Summary

Evaluation of the accuracy of mobile cone-beam computed tomography after spinal instrumentation surgery: Ki Seong Eom, Eun Sung Park, Dae Won Kim, Jong Tae Park, Kwon-Ha Yoon; J Trauma Inj. 2022;35(1):12-18. Published online December 29, 2021; DOI: https://doi.org/10.20408/jti.2021.0010

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Abstract PDF: Purpose
Pedicle screw fixation provides 3-column stabilization, multidimensional control, and a higher rate of interbody fusion. Although computed tomography (CT) is recommended for the postoperative assessment of pedicle screw fixation, its use is limited due to the radiation exposure dose. The purpose of this preliminary retrospective study was to assess the clinical usefulness of low-dose mobile cone-beam CT (CBCT) for the postoperative evaluation of pedicle screw fixation. Methods: The author retrospectively reviewed postoperative mobile CBCT images of 15 patients who underwent posterior pedicle screw fixation for spinal disease from November 2019 to April 2020. Pedicle screw placement was assessed for breaches of the bony structures. The breaches were graded based on the Heary classification. Results: The patients included 11 men and four women, and their mean age was 66±12 years. Of the 122 pedicle screws, 34 (27.9%) were inserted in the thoracic segment (from T7 to T12), 82 (67.2%) in the lumbar segment (from L1 to L5), and six (4.9%) in the first sacral segment. Although there were metal-related artifacts, the image of the screw position (according to Heary classification) after surgery could be assessed using mobile CBCT at all levels (T7–S1). Conclusions: Mobile CBCT was accurate in determining the location and integrity of the pedicle screw and identifying the surrounding bony structures. In the postoperative setting, mobile CBCT can be used as a primary modality for assessing the accuracy of pedicle screw fixation and detecting postoperative complications.; Summary

Case Report

Pulmonary Contusion Similar to COVID-19 Pneumonia: Seung Hwan Lee, Sung Youl Hyun, Yang Bin Jeon, Jung Nam Lee, Gil Jae Lee; J Trauma Inj. 2020;33(2):119-123. Published online June 30, 2020; DOI: https://doi.org/10.20408/jti.2020.0014

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Abstract PDF

The Coronavirus disease 2019 (COVID-19) has rapidly spread across the world and caused a pandemic. It can be transmitted by an infected person or an asymptomatic carrier and is a highly contagious disease. Prevention and early identification of COVID-19 are important to minimize the transmission of COVID-19. Chest computed tomography (CT) has a high sensitivity for detecting COVID-19, but relatively low specificity. Therefore, chest CT may be difficult to distinguish COVID-19 findings from those of other infectious (notably viral types of pneumonia) or noninfectious disease. Pulmonary contusion has also a lot of similarities on chest CT with COVID-19 pneumonia. We present trauma patients with pulmonary contusion whose CT scans showed findings similar to those of COVID-19, and we report our experience in the management of trauma patients during the COVID-19 pandemic.

Summary

Citations

Citations to this article as recorded by

Comparison of chest CT scan findings between COVID-19 and pulmonary contusion in trauma patients based on RSNA criteria: Established novel criteria for trauma victims
Hossein Abdolrahimzadeh Fard, Salahaddin Mahmudi-Azer, Qusay Abdulzahraa Yaqoob, Golnar Sabetian, Pooya Iranpour, Zahra Shayan, Shahram Bolandparvaz, Hamid Reza Abbasi, Shiva Aminnia, Maryam Salimi, Mohammad Mehdi Mahmoudi, Shahram Paydar, Roham Borazjani
Chinese Journal of Traumatology.2022; 25(3): 170. CrossRef

Original Articles

Analysis of Aspiration Risk Factors in Severe Trauma Patients: Based on Findings of Aspiration Lung Disease in Chest Computed Tomography: Gyu Jin Heo, Jungnam Lee, Woo Sung Choi, Sung Youl Hyun, Jin-Seong Cho; J Trauma Inj. 2020;33(2):88-95. Published online June 30, 2020; DOI: https://doi.org/10.20408/jti.2020.0003

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Abstract PDF

Purpose

The present study will identify risk factors for aspiration in severe trauma patients by comparing patients who showed a sign of aspiration lung disease on chest computed tomography (CT) and those who did not.

Methods

We conducted a retrospective review of the Korean Trauma Data Bank between January 2014 and December 2019 in a single regional trauma center. The inclusion criteria were patients aged ≥18 years with chest CT, and who had an Injury Severity Score ≥16. Patients with Abbreviated Injury Scale (AIS)-chest score ≥1 and lack of medical records were excluded. General characteristics and patient status were analyzed.

Results

425 patients were included in the final analysis. There were 48 patients showing aspiration on CT (11.2%) and 377 patients showing no aspiration (88.7%). Aspiration group showed more endotracheal intubation in the ER (p=0.000) and a significantly higher proportion of severe Glasgow Coma Scale (GCS) (p=0.000) patients than the non-aspiration group. In AIS as well, the median AIS head score was higher in the aspiration group (p=0.046). Median oxygen saturation was significantly lower in the aspiration group (p=0.002). In a logistic regression analysis, relative to the GCS mild group, the moderate group showed an odds ratio (OR) for aspiration of 2.976 (CI, 1.024–8.647), and the severe group showed an OR of 5.073 (CI, 2.442–10.539).

Conclusions

Poor mental state and head injury increase the risk of aspiration. To confirm for aspiration, it would be useful to perform chest CT for severe trauma patients with a head injury.

Summary

Citations

Citations to this article as recorded by

Rapid Sequence Intubation Using the SEADUC Manual Suction Unit in a Contaminated Airway
Matthew Stampfl, David Tillman, Nicholas Borelli, Tikiri Bandara, Andrew Cathers
Air Medical Journal.2023; 42(4): 296. CrossRef
Incidence and Predictors of Aspiration Pneumonia Among Traumatic Brain Injury in Northwest Ethiopia
Sahlu Mitku Shiferaw, Emiru Ayalew Mengistie, Getasew Mulatu Aknaw, Abraham Tsedalu Amare, Kefyalew Amogne Azanaw
Open Access Emergency Medicine.2022; Volume 14: 85. CrossRef

Utility of Spinal Injury Diagnosis Using C-Spine Lateral X-Ray and Chest, Abdomen and Pelvis Computed Tomography in Major Trauma Patients with Impaired Consciousness: Yoon Soo Jang, Byung Hak So, Won Jung Jeong, Kyung Man Cha, Hyung Min Kim; J Trauma Inj. 2018;31(3):151-158. Published online December 31, 2018; DOI: https://doi.org/10.20408/jti.2018.042

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Abstract PDF: Purpose
The regional emergency medical centers manage the patients with major blunt trauma according to the process appropriate to each hospital rather than standardized protocol of the major trauma centers. The primary purpose of this study is to evaluate the effectiveness and influence on prognosis of additional cervical-thoracic-lumbar-spine computed tomography (CTL-spine CT) scan in diagnosis of spinal injury from the victim of major blunt trauma with impaired consciousness.
Methods
The study included patients visited the urban emergency medical center with major blunt trauma who were over 18 years of age from January 2013 to December 2016. Data were collected from retrospective review of medical records. Sensitivity, specificity, positive predictive value, and negative predictive value were measured for evaluation of the performance of diagnostic methods.
Results
One hundred patients with Glasgow coma scale ≤13 underwent additional CTL-spine CT scan. Mechanism of injury was in the following order: driver, pedestrian traffic accident, fall and passenger accident. Thirty-one patients were diagnosed of spinal injury, six of them underwent surgical management. The sensitivity of chest, abdomen and pelvis CT (CAP CT) was 72%, specificity 97%, false positive rate 3%, false negative rate 28% and diagnostic accuracy 87%. Eleven patients were not diagnosed of spinal injury with CAP CT and C-spine lateral view, but all of them were diagnosed of stable fractures.
Conclusions
C-spine CT scan be actively considered in the initial examination process. When CAP CT scan is performed in major blunt trauma patients with impaired consciousness, CTL-spine CT scan or simple spinal radiography has no significant effect on the prognosis of the patient and can be performed if necessary.; Summary

Central Venous Catheterization before Versus after Computed Tomography in Hemodynamically Unstable Patients with Major Blunt Trauma: Clinical Characteristics and Factors for Decision Making: Ji Hun Kim, Sang Ook Ha, Young Sun Park, Jeong Hyeon Yi, Sun Beom Hur, Ki Ho Lee; J Trauma Inj. 2018;31(3):135-142. Published online December 31, 2018; DOI: https://doi.org/10.20408/jti.2018.022

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Abstract PDF: Purpose
When hemodynamically unstable patients with blunt major trauma arrive at the emergency department (ED), the safety of performing early whole-body computed tomography (WBCT) is concerning. Some clinicians perform central venous catheterization (CVC) before WBCT (pre-computed tomography [CT] group) for hemodynamic stabilization. However, as no study has reported the factors affecting this decision, we compared clinical characteristics and outcomes of the pre- and post-CT groups and determined factors affecting this decision.
Methods
This retrospective study included 70 hemodynamically unstable patients with chest or/and abdominal blunt injury who underwent WBCT and CVC between March 2013 and November 2017.
Results
Univariate analysis revealed that the injury severity score, intubation, pulse pressure, focused assessment with sonography in trauma positivity score, and pH were different between the pre-CT (34 patients, 48.6%) and post-CT (all, p<0.05) groups. Multivariate analysis revealed that injury severity score (ISS) and intubation were factors affecting the decision to perform CVC before CT (p=0.003 and p=0.043). Regarding clinical outcomes, the interval from ED arrival to CT (p=0.011) and definite bleeding control (p=0.038), and hospital and intensive care unit lengths of stay (p=0.018 and p=0.053) were longer in the pre-CT group than in the post-CT group. Although not significant, the pre-CT group had lower survival rates at 24 hours and 28 days than the post-CT group (p=0.168 and p=0.226).
Conclusions
Clinicians have a tendency to perform CVC before CT in patients with blunt major trauma and high ISS and intubation.; Summary

Changes of Clinical Practice in Gastrointestinal Perforation with the Increasing Use of Computed Tomography: Ji Min Park, Young Hoon Yoon, Timothy Horeczko, Amy Hideko Kaji, Roger J Lewis; J Trauma Inj. 2017;30(2):25-32. Published online June 30, 2017; DOI: https://doi.org/10.20408/jti.2017.30.2.25

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Abstract PDF

PURPOSE
The use of computed tomography (CT) to evaluate acute abdominal complaints has increased over the past two decades. We investigated how the clinical practice of patients with intestinal perforation has changed with the increasing use of abdominal CT in the emergency department (ED).
METHODS
We compared ED arrival to CT time, ED arrival to surgical consultation time, and ED arrival to operation time according to the method of diagnosis from 2003?2004 and 2013?2014.
RESULTS
In patients with gastrointestinal perforation, time from ED arrival to CT was shorter (111.4±66.2 min vs. 199.0±97.5 min, p=0.001) but time to surgical consultation was longer (135.1±78.8 vs. 77.9±123.7, p=0.006) in 2013?2014 than in 2003?2004. There was no statistically significant difference in time to operation for perforation confirmed either by plain film or CT between the two time periods. There was no statistically significant difference in length of hospital or ICU stay or mortality between the two groups.
CONCLUSION
With the increasing use of abdominal CT in ED, ED arrival to CT time has decreased and ED arrival to surgical consultation time has increased in gastrointestinal perforation. These changes of clinical performance do not delay ED arrival to operation time or adversely influence patient outcome.

Summary

Citations

Citations to this article as recorded by

A case report of gastrointestinal perforation in patient after biliary stent insertion and the overview of gastrointestinal perforation
Ga-Young Lee, Chan-Ran Park, Jung-hyo Cho, Chang-gue Son, Nam-hun Lee
Journal of Korean Medicine.2022; 43(3): 195. CrossRef
GASTROİNTESTİNAL PERFORASYON TANISINDA KULLANILAN GÖRÜNTÜLEME YÖNTEMLERİ VE GÖRÜNTÜLEME BULGULARI
Mehtap ILGAR, Tuna ŞAHİN
Cukurova Anestezi ve Cerrahi Bilimler Dergisi.2022; 5(2): 199. CrossRef

Prevalences of Incidental Findings in Trauma Patients by Abdominal and Pelvic Computed Tomography: Jin Young Lee, Myung Jae Jung, Jae Gil Lee, Seung Hwan Lee; J Trauma Inj. 2016;29(3):61-67. Published online September 30, 2016; DOI: https://doi.org/10.20408/jti.2016.29.3.61

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2 Citations

Abstract PDF

PURPOSE
Abdominal and pelvic computed tomography (APCT) is frequently used as a diagnostic tool in trauma patients. However, trauma unrelated, incidental findings are frequently encountered. The aim of this study was to determine the prevalences of incidental findings on APCT scans in trauma patients.
METHODS
The archived records of 801 trauma patients treated from January 2013 to December 2015 were reviewed retrospectively. Six hundred and forty of these patients underwent contrast enhanced APCT in an emergency department and were included in this study, and 205 (32.1%) of these patients had incidental findings. These findings were divided into two categories: category I, meaning a radiological benign finding not requiring further evaluation or follow- up, and category II, requiring further evaluation and follow-up.
RESULTS
One hundred and sixty (24.8%) patients were allocated to category I and 45 (7.2%) to category II. The most frequent incidental findings were discovered in kidneys (34.6%), followed by liver (28.8%), and gallbladder (15.6%). The most frequent finding in category I was a benign cyst (60.1%), followed by a simple stone (15.6%), and hemangioma (11.9%). Adenomyomatosis of the gallbladder (17.8%) was the most common lesion in category II, followed by atypical mass (15.6%), complicated stone (15.6%) and cystic neoplasm (15.6%).
CONCLUSION
The prevalence of an incidental finding on APCT scans was 32.1%. Although category II lesions were not common in trauma patients, these findings should be communicated to patients, and when necessary referred to a primary care physician. Systems are required for producing appropriate discharge summaries and informing patients about the implications of incidental findings.

Summary

Citations

Citations to this article as recorded by

Incidental Cancer Diagnoses in Trauma Patients: A Case–Control Study Evaluating Long-term Outcomes
Nathaniel Bell, Amanda Arrington, Swann Arp Adams, Mark Jones, Joseph V. Sakran, Ambar Mehta, Jan M. Eberth
Journal of Surgical Research.2019; 242: 304. CrossRef
Filling the void: a low-cost, high-yield approach to addressing incidental findings in trauma patients
Nicholas Sich, Andrew Rogers, Danelle Bertozzi, Praveen Sabapathi, Waed Alswealmeen, Philip Lim, Jonathan Sternlieb, Laura Gartner, James Yuschak, Orlando Kirton, Ryan Shadis
Surgery.2018; 163(4): 657. CrossRef

Case Reports

Arteriovenous Fistula between Renal Artery and Inferior Vena Cava following Penetrating Abdominal Trauma; A Case Report: Joong Suck Kim, Seung Je Go, Ji Dae Kim, Young Hoon Sul, Jin Bong Ye, Sang Soon Park, Gwan Woo Ku, Yeong Cheol Kim; J Trauma Inj. 2015;28(4):262-265. Published online December 31, 2015; DOI: https://doi.org/10.20408/jti.2015.28.4.262

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Abstract PDF: An arteriovenous fistula (AVF) from the renal artery following a penetrating abdominal trauma is not common. We report the case of a 19-year-old male who presented with a knife stab wound in the right upper quadrant. Due to unstable vital signs and to the protrusion of the mesentery through the stab wound, providing definite evidence of peritoneal violation, an emergent exploratory laparotomy was carried out. There were injuries at the proximal transverse mesocolon and the second portion of the duodenum, with bile leakage. There was also a mild amount of retroperitoneal hematoma near the right kidney, without signs of expansion or pulsation. The mesocolon and the duodenum were repaired. After the operation, abdominal computerized tomography (CT) was performed, which revealed contrast from the right renal artery shunting directly into the vena cava. Transcatheter arterial embolization with a coil and vascular plug was performed, and the fistula was repaired. The patient recovered completely and was discharged without complication. For further and thorough evaluation of an abdominal trauma, especially one involving the retroperitoneum, a CT scan is recommended, when possible, either prior to surgery or after surgery when the patient is stabile. Furthermore, a lateral retroperitoneal hematoma and an AVF after a penetrating trauma may not always require exploration. Sometimes, it may be safely treated non-operatively or with embolization.; Summary

Unusual Brain Computed Tomography Artifact in Cerebellum Mimicking Hemorrhage: A Case Report: Jihun Lee, Ki Seong Eom, Tae Young Kim; J Trauma Inj. 2015;28(3):195-197. Published online September 30, 2015; DOI: https://doi.org/10.20408/jti.2015.28.3.195

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Abstract PDF: Artifacts can seriously degrade the quality of computed tomography (CT) images, sometimes to the point of making them diagnostically unusable. Here, we report an unusual CT artifact that could have resulted in the misdiagnosis of a hyperdense hemorrhagic lesion in a 55-year-old man. The author recommend that when hemorrhagic lesion in posterior fossa is suggested on CT, the physician should carefully consider all patient-related clinical data prior to considering surgical intervention or a biopsy. Cranial magnetic resonance imaging (MRI) can help in preventing the misdiagnosis as hemorrhage of CT scan.; Summary

Original Articles

Impact of Initial Helical Abdominal Computed Tomography on the Diagnosis of Hollow Viscus Injury and Blunt Abdominal Traumare: Young Duck Cho, Yun Sik Hong, Sung Woo Lee, Sung Hyuk Choi, Young Hoon Yoon, Sung Ik Lim, Ik Jin Jang, Seung Won Baek; J Korean Soc Traumatol. 2008;21(1):28-35.

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Abstract PDF: PURPOSE
This study was conducted to examine the clinical significance IV-contrasted helical abdomen computed tomography (CT) as a diagnostic screening tool to evaluate hollow viscus injury in blunt abdominal trauma patients.
METHODS
This is a retrospective study encompassing 108 patients, presenting to Korea University Medical Center (KUMC) Emergency Department (ED) from January 2007 to December 2007, with an initial CT finding suggestive of intra-abdominal injury. An initial non-enhanced abdomen CT was taken, followed by an enhanced CT with intravenous contrast. Patients' demographic data, as well as the mechanisms of injury, were inquired upon and obtained, initial diagnosis, as dictated by specialized radiologists, were added to post-operational (post-OP) findings and to additional CT findings acquired during their hospital stays, and all were combined to arrive at final diagnosis. Initial CT findings were further compared with the final diagnosis, yielding values for sensitivity, specificity, and accuracy, as well as positive and negative predictive values. Patients were further divided into two groups, namely, those that underwent operational intervention and those that did not. The initial CT findings of each group were subsequently compared and analyzed.
RESULTS
Initial CT scans revealed abnormal findings in a total of 212 cases - solid organ injuries being the most common finding, as was observed in 97 cases. Free fluid accumulation was evident in another 69 cases. Based on the CT findings, 77 cases (71.3%) were initially diagnosed as having a solid organ injury, 20 cases (18.5%) as having a combined (solid organ + hollow viscus) injury, and 11 cases (10.2%), as having an isolated hollow viscus injury. The final diagnosis however, were somewhat different, with only 67 cases (62.0%) attributed to solid organ injury, 31 cases (28.7%) to combined injury (solid + hollow), and 10 cases (9.3%) to hollow viscus injury. The sensitivity (CI 95%) of the initial helical CT in diagnosing hollow viscus injury was 75.6%, and its specificity was 100%. The accuracy in diagnosing hollow viscus injury was also meaningfully lower compared to that in diagnosis of solid organ injury. Among patients initially diagnosed with solid organ injuries, 10 patients (2 from follow-up CT and 8 from post-OP finding) turned out to have combined injuries. A total of 38 patients underwent an operation, and the proportion of initial CT findings suggesting free air, mesenteric hematoma or bowel wall thickening turned out to be significantly higher in the operation group.
CONCLUSION
Abdominal CT was a meaningful screening test for hollow viscus injury, but the sensitivity of abdominal CT was significantly lower in detecting hollow viscus injury as compared to solid organ injury. This calls for special consideration and careful observation by the ED physicians when dealing with cases of blunt abdominal trauma.; Summary

NEXUS and the Canadian Cervical Spine Rule as a Screening Tool for Computed Tomography Evaluation in Patients with Cervical Spine Injury: Yang Hwan Choi, Junho Cho, Minhong Choa, Yoo Seok Park, Hyun Soo Chung, Sung Pil Chung; J Korean Soc Traumatol. 2008;21(1):15-21.

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Abstract PDF: PURPOSE
National Emergency X-Radiography Utilization Study (NEXUS) criteria and the Canadian Cervical Spine rule (CCR) are commonly used in cervical trauma patients to determine whether a plain cervical X-ray should be performed. However, plain cervical X-rays are so inaccurate that cervical spine computed tomography (CT) is often considered as a screening test. We studied the usefulness of the NEXUS criteria and the CCR for determining the need for a CT evaluation in the emergency department (ED).
METHODS
This prospective observational study was conducted from January 2007 to March 2008. Plain Xray and CT scans of the cervical spine were performed on blunt trauma patients with neck pain. The relevancy of CT was examined using the NEXUS criteria and the CCR. Sensitivity, specificity, positive predicted value, and negative predicted value analyses were performed to diagnose the cervical spine injury.
RESULTS
During the study period, 284 patients were enrolled in this study. The sensitivity, specificity, positive predicted value, and negative predicted value of the NEXUS criteria were 87.5%, 1.1%, 5.0%, and 60.0% respectively, while those of the CCR were 87.5%, 8.2%, 5.3%, and 91.6%. There were two missed fracture cases when the NEXUS criteria and the CCR were applied independently, however, no cases were missed when both were applied.
CONCLUSION
This study suggests the NEXUS and the CCR in combination can be used as a guide to CT evaluation for cervical spine injury in the ED.; Summary

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