Pub Date : 2022-08-10DOI: 10.1097/EC9.0000000000000036
Qing Zhao, Jian-guo Xiao, Huiyong Liu
Abstract Background Supplementation of corticosteroid, ascorbic acid and thiamine in adult septic patients remains controversial. We aimed to evaluate the efficacy and safety of hydrocortisone, ascorbic acid and thiamine (HAT) in adult septic patients. Methods Data search included Pumbed, EMBASE, and the Cochrane Library from inception to Sep, 2021. Only studies with classifications of sepsis and intravenous HAT treatment were included. Adult patients with sepsis (aged ≥18 years) were divided into 2 groups. The treatment group received HAT therapy, whereas the control group received standard care and/or intravenous hydrocortisone. The primary outcome was hospital mortality. Results Eleven studies including 4579 patients who fulfilled the predefined criteria were analyzed (6 randomized controlled trials [RCTs] and 5 clinical cohort studies). No hospital mortality reduction was demonstrated in patients treated with HAT when compared to the reference (OR: 0.99; 95% CI: 0.77 to 1.27; I2 = 39%) group. Sequential organ failure assessment (SOFA) score decrement at 72hours was more significant in HAT-treated patients (mean difference [MD]: –1.23; 95% CI: –1.94 to –0.53; I2 = 81%). There was no difference in the duration of vasopressor use between HAT-treated patients and controls (MD: –4.92; 95% CI: –24.38 to 14.53; I2 = 97%). Statistical heterogeneity was noted with no sign of significant publication bias. Conclusion In adult sepsis and septic shock patients, HAT treatment failed to reduce mortality or shorten vasopressor duration, but reduced SOFA scores.
{"title":"No benefit of hydrocortisone, ascorbic acid, and thiamine in reducing mortality in adult sepsis patients: a systematic review and meta-analysis","authors":"Qing Zhao, Jian-guo Xiao, Huiyong Liu","doi":"10.1097/EC9.0000000000000036","DOIUrl":"https://doi.org/10.1097/EC9.0000000000000036","url":null,"abstract":"Abstract Background Supplementation of corticosteroid, ascorbic acid and thiamine in adult septic patients remains controversial. We aimed to evaluate the efficacy and safety of hydrocortisone, ascorbic acid and thiamine (HAT) in adult septic patients. Methods Data search included Pumbed, EMBASE, and the Cochrane Library from inception to Sep, 2021. Only studies with classifications of sepsis and intravenous HAT treatment were included. Adult patients with sepsis (aged ≥18 years) were divided into 2 groups. The treatment group received HAT therapy, whereas the control group received standard care and/or intravenous hydrocortisone. The primary outcome was hospital mortality. Results Eleven studies including 4579 patients who fulfilled the predefined criteria were analyzed (6 randomized controlled trials [RCTs] and 5 clinical cohort studies). No hospital mortality reduction was demonstrated in patients treated with HAT when compared to the reference (OR: 0.99; 95% CI: 0.77 to 1.27; I2 = 39%) group. Sequential organ failure assessment (SOFA) score decrement at 72hours was more significant in HAT-treated patients (mean difference [MD]: –1.23; 95% CI: –1.94 to –0.53; I2 = 81%). There was no difference in the duration of vasopressor use between HAT-treated patients and controls (MD: –4.92; 95% CI: –24.38 to 14.53; I2 = 97%). Statistical heterogeneity was noted with no sign of significant publication bias. Conclusion In adult sepsis and septic shock patients, HAT treatment failed to reduce mortality or shorten vasopressor duration, but reduced SOFA scores.","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":"2 1","pages":"167 - 174"},"PeriodicalIF":0.0,"publicationDate":"2022-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46041111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-22DOI: 10.1097/EC9.0000000000000055
Nurcan Kutluer Karaca
Abstract Dexmedetomidine is an α2 agonist that is frequently used for sedation in intensive care units (ICUs). Hypotension and bradycardia are common adverse effects observed in clinical practice. In perioperative conditions, polyuria is a rare adverse effect with limited case reports after dexmedetomidine infusion. Similar to this situation, in ICU, there are rare cases. We present the case of a 59-year-old man who developed polyuria secondary to high-dose intravenous dexmedetomidine infusion in the medical ICU.
{"title":"Dexmedetomidine-induced polyuria in the intensive care unit: a case report","authors":"Nurcan Kutluer Karaca","doi":"10.1097/EC9.0000000000000055","DOIUrl":"https://doi.org/10.1097/EC9.0000000000000055","url":null,"abstract":"Abstract Dexmedetomidine is an α2 agonist that is frequently used for sedation in intensive care units (ICUs). Hypotension and bradycardia are common adverse effects observed in clinical practice. In perioperative conditions, polyuria is a rare adverse effect with limited case reports after dexmedetomidine infusion. Similar to this situation, in ICU, there are rare cases. We present the case of a 59-year-old man who developed polyuria secondary to high-dose intravenous dexmedetomidine infusion in the medical ICU.","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":"3 1","pages":"81 - 83"},"PeriodicalIF":0.0,"publicationDate":"2022-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44582355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-10DOI: 10.1097/EC9.0000000000000033
Alexandra Skovran, Mason B Hinke, S. N. Sloan, Greg Stahl, Kerry Johnson, S. Goade, R. Arnce
Abstract Background Sepsis is the leading cause of death in hospitalized patients and significant effort has been made to facilitate early diagnosis and management. However, aggressive treatment can have negative effects, especially in patients with unstable volume status, such as those with congestive heart failure. Methods We used electronic medical records to perform a retrospective study looking at hospital outcomes in patients from Southwest Missouri who were admitted with sepsis and had a comorbid diagnosis of hypertensive heart failure. Our primary outcome was in-hospital mortality. Results We studied a total of 184 patients with the diagnosis of hypertensive heart failure with sepsis, and 348 patients with the diagnosis of sepsis that served as the baseline group. There was a total of 37 (20%) deaths in the hypertensive heart failure group and a total of 94 (27%) deaths in the baseline group. Conclusion Our study showed no significant difference between the baseline group and those with hypertensive heart disease with heart failure.
{"title":"Congestive heart failure and sepsis: a retrospective study of hospitalization outcomes from a rural hospital in Southwest Missouri","authors":"Alexandra Skovran, Mason B Hinke, S. N. Sloan, Greg Stahl, Kerry Johnson, S. Goade, R. Arnce","doi":"10.1097/EC9.0000000000000033","DOIUrl":"https://doi.org/10.1097/EC9.0000000000000033","url":null,"abstract":"Abstract Background Sepsis is the leading cause of death in hospitalized patients and significant effort has been made to facilitate early diagnosis and management. However, aggressive treatment can have negative effects, especially in patients with unstable volume status, such as those with congestive heart failure. Methods We used electronic medical records to perform a retrospective study looking at hospital outcomes in patients from Southwest Missouri who were admitted with sepsis and had a comorbid diagnosis of hypertensive heart failure. Our primary outcome was in-hospital mortality. Results We studied a total of 184 patients with the diagnosis of hypertensive heart failure with sepsis, and 348 patients with the diagnosis of sepsis that served as the baseline group. There was a total of 37 (20%) deaths in the hypertensive heart failure group and a total of 94 (27%) deaths in the baseline group. Conclusion Our study showed no significant difference between the baseline group and those with hypertensive heart disease with heart failure.","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":"2 1","pages":"105 - 108"},"PeriodicalIF":0.0,"publicationDate":"2022-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42972235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-01DOI: 10.1097/ec9.0000000000000041
A. Ratnayake, Yonggang Li, A. Kushner
{"title":"The true global burden of trauma: a call for a comprehensive trauma research platform","authors":"A. Ratnayake, Yonggang Li, A. Kushner","doi":"10.1097/ec9.0000000000000041","DOIUrl":"https://doi.org/10.1097/ec9.0000000000000041","url":null,"abstract":"","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44014973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-01DOI: 10.1097/EC9.0000000000000043
P. Dar, Jogendra Boddeda, Supreet Kaur, Pratyusha Priyadarshini, Abhinav Kumar, D. Bagaria, Narendra Choudhary, J. Alam, S. Sagar, Subodh Kumar, Amit Gupta, Biplab Mishra
Abstract Introduction: Traumatic neck injuries (TNIs) constitute 5%–10% of all trauma cases. These injuries can be caused by either penetrating or blunt trauma. Patients can have a varied presentation like cut injury over the neck, bleeding, neck swelling, breathing difficulty, dysphagia, etc. Methods: This was a retrospective observational study conducted at a level I trauma center in India from January 2016 to March 2020. One hundred thirty patients who required admission and intervention due to TNIs were included in this study. Results: One hundred thirty patients with neck injuries were included in this study. Males were predominant (91.5%) with the age ranging from 10 to 70 years. The most common mechanism of injury was physical assault (40.7%), followed by road traffic injury (23.8%) and self-inflicted injuries (18.4%). Penetrating trauma was predominant. Open neck wound with bleeding was the most common presenting symptom. Zone II injuries were more common (83.8%) followed by zone I (12.3%) and zone III (3.8%). Soft tissue injury including skin, platysma breach, and strap muscle injury was present in 46.9% of patients. Laryngopharyngeal injury was present in 13.8%, tracheal injury in 28.5%, vascular injury in 13.8%, and esophageal injury in 4.6% of patients. Conclusion: Penetrating neck trauma is more common than blunt in developing countries like India. Advanced Trauma Life Support (ATLS) protocol guides the initial management. The definitive management depends on the type and mechanism of injury, anatomical level, severity, and the organ injured.
{"title":"Varied presentations, magnitude, and outcome of traumatic neck injuries at a level I trauma center","authors":"P. Dar, Jogendra Boddeda, Supreet Kaur, Pratyusha Priyadarshini, Abhinav Kumar, D. Bagaria, Narendra Choudhary, J. Alam, S. Sagar, Subodh Kumar, Amit Gupta, Biplab Mishra","doi":"10.1097/EC9.0000000000000043","DOIUrl":"https://doi.org/10.1097/EC9.0000000000000043","url":null,"abstract":"Abstract Introduction: Traumatic neck injuries (TNIs) constitute 5%–10% of all trauma cases. These injuries can be caused by either penetrating or blunt trauma. Patients can have a varied presentation like cut injury over the neck, bleeding, neck swelling, breathing difficulty, dysphagia, etc. Methods: This was a retrospective observational study conducted at a level I trauma center in India from January 2016 to March 2020. One hundred thirty patients who required admission and intervention due to TNIs were included in this study. Results: One hundred thirty patients with neck injuries were included in this study. Males were predominant (91.5%) with the age ranging from 10 to 70 years. The most common mechanism of injury was physical assault (40.7%), followed by road traffic injury (23.8%) and self-inflicted injuries (18.4%). Penetrating trauma was predominant. Open neck wound with bleeding was the most common presenting symptom. Zone II injuries were more common (83.8%) followed by zone I (12.3%) and zone III (3.8%). Soft tissue injury including skin, platysma breach, and strap muscle injury was present in 46.9% of patients. Laryngopharyngeal injury was present in 13.8%, tracheal injury in 28.5%, vascular injury in 13.8%, and esophageal injury in 4.6% of patients. Conclusion: Penetrating neck trauma is more common than blunt in developing countries like India. Advanced Trauma Life Support (ATLS) protocol guides the initial management. The definitive management depends on the type and mechanism of injury, anatomical level, severity, and the organ injured.","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":"2 1","pages":"45 - 49"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47489220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-01DOI: 10.1097/EC9.0000000000000042
A. Ratnayake, S. Nakahara, D. Bagaria, Sohan De Silva, Sri Lal De Silva, April Llaneta, Ratrawee Pattanarattanamolee, Yonggang Li, Bui Hai Hoang
Abstract Since trauma is a growing health problem worldwide, emergency trauma care including emergency medical services (EMS) is becoming an integral part of the healthcare system. The optimal EMS which will improve access to trauma care, will be different in each country because of different healthcare systems, trauma etiology, and economic situations. To adopt models that have succeeded in developed countries is not always appropriate. In order to identify the optimal EMS model in developing countries, comparing the systems among many countries in detail and examining their advantages and disadvantages would be necessary. Therefore, this article tries to identify important elements of EMS to achieve mature EMS systems based on comparisons of 7 Asian countries, and discusses the need to conduct more detailed and extensive comparisons.
{"title":"Focused research in emergency medical systems in Asia: a necessity for trauma system advancement","authors":"A. Ratnayake, S. Nakahara, D. Bagaria, Sohan De Silva, Sri Lal De Silva, April Llaneta, Ratrawee Pattanarattanamolee, Yonggang Li, Bui Hai Hoang","doi":"10.1097/EC9.0000000000000042","DOIUrl":"https://doi.org/10.1097/EC9.0000000000000042","url":null,"abstract":"Abstract Since trauma is a growing health problem worldwide, emergency trauma care including emergency medical services (EMS) is becoming an integral part of the healthcare system. The optimal EMS which will improve access to trauma care, will be different in each country because of different healthcare systems, trauma etiology, and economic situations. To adopt models that have succeeded in developed countries is not always appropriate. In order to identify the optimal EMS model in developing countries, comparing the systems among many countries in detail and examining their advantages and disadvantages would be necessary. Therefore, this article tries to identify important elements of EMS to achieve mature EMS systems based on comparisons of 7 Asian countries, and discusses the need to conduct more detailed and extensive comparisons.","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":"2 1","pages":"87 - 93"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46404106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-01DOI: 10.1097/ec9.0000000000000047
Shailvi Gupta, A. Tannous, Thomas Scalea
{"title":"United States trauma system: Maryland focus","authors":"Shailvi Gupta, A. Tannous, Thomas Scalea","doi":"10.1097/ec9.0000000000000047","DOIUrl":"https://doi.org/10.1097/ec9.0000000000000047","url":null,"abstract":"","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42768595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-01DOI: 10.1097/EC9.0000000000000037
M. Moussa, M. Chakra, A. Dellis, A. Papatsoris
ABSTRACT Background: Percutaneous nephrolithotomy (PNL) is the gold standard to treat large or complex renal stones. Intrarenal pseudoaneurysm is a rare, yet clinically significant, complication of PNL. Case summary: A 58-year-old man with a 3 cm calculus in the lower calyx of the left kidney was operated on by PNL 3 days before presentation to the emergency department. The patient presented with massive hematuria and dizziness. Upon presentation, the patient appeared uncomfortable and in distress. He was in hemorrhagic shock. The patient was resuscitated with intravenous fluids and blood transfusion. An urgent computed tomography scan showed multiple clots in the left renal pelvis and bladder with a retroperitoneal hematoma. The patient underwent angiography which revealed an inferior pole branch pseudoaneurysm. The pseudoaneurysm was treated by endovascular embolization with N-butyl-2-cyanoacrylate. No postoperative complications were seen. Conclusion: Selective renal artery embolization is an effective treatment for pseudoaneurysm post PNL with excellent outcomes.
{"title":"Intrarenal pseudoaneurysm after percutaneous nephrolithotomy: a case report","authors":"M. Moussa, M. Chakra, A. Dellis, A. Papatsoris","doi":"10.1097/EC9.0000000000000037","DOIUrl":"https://doi.org/10.1097/EC9.0000000000000037","url":null,"abstract":"ABSTRACT Background: Percutaneous nephrolithotomy (PNL) is the gold standard to treat large or complex renal stones. Intrarenal pseudoaneurysm is a rare, yet clinically significant, complication of PNL. Case summary: A 58-year-old man with a 3 cm calculus in the lower calyx of the left kidney was operated on by PNL 3 days before presentation to the emergency department. The patient presented with massive hematuria and dizziness. Upon presentation, the patient appeared uncomfortable and in distress. He was in hemorrhagic shock. The patient was resuscitated with intravenous fluids and blood transfusion. An urgent computed tomography scan showed multiple clots in the left renal pelvis and bladder with a retroperitoneal hematoma. The patient underwent angiography which revealed an inferior pole branch pseudoaneurysm. The pseudoaneurysm was treated by endovascular embolization with N-butyl-2-cyanoacrylate. No postoperative complications were seen. Conclusion: Selective renal artery embolization is an effective treatment for pseudoaneurysm post PNL with excellent outcomes.","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":"2 1","pages":"101 - 103"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44459251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-01DOI: 10.1097/EC9.0000000000000046
K. Gianaris, B. Stewart, S. Wren, A. Kushner
Abstract Armed conflicts are increasing globally due to political unrest and the broader effects of climate change. Without resources to provide quality surgical care, it becomes nearly impossible to provide quality emergency surgery and trauma care similar to that in high-income countries. To understand and help aid organizations provide resources and address the surgical needs of populations facing armed conflict, a matrix to identify variables and help with interventions was envisioned. A previously published global surgery matrix based on the PIPES (Personnel, Infrastructure, Procedures, Equipment and Supplies) surgical capacity tool was adapted to this context. The novel matrix incorporates 108 variables. These variables are grossly divided into local and international agency components to address the issue of who is providing care. Using a time continuum of pre-conflict, conflict, and post-conflict allows organizations to concentrate on when during the conflict to target their intervention. In addition to the previously used personnel, infrastructure, procedures, equipment, and supplies categories, a sixth category called standards was included that addresses the issues such as information technology, data systems, quality improvement programs, and patient safety. Pilot testing of this matrix to obtain feedback from end users is the next step in development. Ultimately, peri-conflict preparedness should increase and improve surgical outcomes and reduce in death and disabilities around the world.
{"title":"The complexity of providing humanitarian surgical care in armed conflict: a framework to help categorize needs","authors":"K. Gianaris, B. Stewart, S. Wren, A. Kushner","doi":"10.1097/EC9.0000000000000046","DOIUrl":"https://doi.org/10.1097/EC9.0000000000000046","url":null,"abstract":"Abstract Armed conflicts are increasing globally due to political unrest and the broader effects of climate change. Without resources to provide quality surgical care, it becomes nearly impossible to provide quality emergency surgery and trauma care similar to that in high-income countries. To understand and help aid organizations provide resources and address the surgical needs of populations facing armed conflict, a matrix to identify variables and help with interventions was envisioned. A previously published global surgery matrix based on the PIPES (Personnel, Infrastructure, Procedures, Equipment and Supplies) surgical capacity tool was adapted to this context. The novel matrix incorporates 108 variables. These variables are grossly divided into local and international agency components to address the issue of who is providing care. Using a time continuum of pre-conflict, conflict, and post-conflict allows organizations to concentrate on when during the conflict to target their intervention. In addition to the previously used personnel, infrastructure, procedures, equipment, and supplies categories, a sixth category called standards was included that addresses the issues such as information technology, data systems, quality improvement programs, and patient safety. Pilot testing of this matrix to obtain feedback from end users is the next step in development. Ultimately, peri-conflict preparedness should increase and improve surgical outcomes and reduce in death and disabilities around the world.","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":"2 1","pages":"41 - 44"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41698012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-15DOI: 10.1097/EC9.0000000000000061
A. Anand, P. Dar, Preksha Rani, Supreet Kaur, J. James, J. Alam, Pratyusha Priyadarshini, Abhinav Kumar, D. Bagaria, Narendra Choudhary, Subodh Kumar, Amit Gupta, S. Sagar, Biplab Mishra
Abstract Background Pancreatic trauma (PT) accounts for less than 1% of all trauma admissions. Occasionally, PT is undetected during the primary survey and becomes apparent only when complications arise. It occurs in up to 5% of blunt abdominal trauma cases and 12% of individuals with penetrating abdominal injuries. Management is determined by the status of the main pancreatic duct and associated injuries. Methods This was an ambispective study conducted at the Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, from January 2015 to December 2017 (retrospective), and January 2019 to December 2020 (prospective). In total, 113 patients with PT were included in this study. Results We analyzed the data of 113 patients with PT included in this study, of which males predominated (93.7%). Blunt PT was present in 101 patients (89.4%) and penetrating PT in 12 patients (10.6%). Half of the patients (51.3%) had the American Association for the Surgery of Trauma grade III PT, followed by grade II (18.6%), and grade I (15%). Of the total 113 patients, 68 (60.2%) were treated with operative management, and 45 (39.8%) with nonoperative management. Distal pancreatectomy, with or without splenectomy, was the most common procedure performed in our study, followed by drainage. There were 27 mortalities (23.8%) during the study period, of which 7 were directly related to PT and 20 were due to other organ-related sepsis and hemorrhagic shock. Conclusion Pancreatic trauma is rare but challenging for trauma surgeons, with persistent management controversies. Early diagnosis is important for favorable results; however, a delay in diagnosis has been associated with higher morbidity and mortality. Low-grade pancreatic injuries can be successfully managed nonoperatively, whereas high-grade pancreatic injuries require surgical intervention.
{"title":"Management and outcome of pancreatic trauma: a 6-year experience at a level I trauma center","authors":"A. Anand, P. Dar, Preksha Rani, Supreet Kaur, J. James, J. Alam, Pratyusha Priyadarshini, Abhinav Kumar, D. Bagaria, Narendra Choudhary, Subodh Kumar, Amit Gupta, S. Sagar, Biplab Mishra","doi":"10.1097/EC9.0000000000000061","DOIUrl":"https://doi.org/10.1097/EC9.0000000000000061","url":null,"abstract":"Abstract Background Pancreatic trauma (PT) accounts for less than 1% of all trauma admissions. Occasionally, PT is undetected during the primary survey and becomes apparent only when complications arise. It occurs in up to 5% of blunt abdominal trauma cases and 12% of individuals with penetrating abdominal injuries. Management is determined by the status of the main pancreatic duct and associated injuries. Methods This was an ambispective study conducted at the Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, from January 2015 to December 2017 (retrospective), and January 2019 to December 2020 (prospective). In total, 113 patients with PT were included in this study. Results We analyzed the data of 113 patients with PT included in this study, of which males predominated (93.7%). Blunt PT was present in 101 patients (89.4%) and penetrating PT in 12 patients (10.6%). Half of the patients (51.3%) had the American Association for the Surgery of Trauma grade III PT, followed by grade II (18.6%), and grade I (15%). Of the total 113 patients, 68 (60.2%) were treated with operative management, and 45 (39.8%) with nonoperative management. Distal pancreatectomy, with or without splenectomy, was the most common procedure performed in our study, followed by drainage. There were 27 mortalities (23.8%) during the study period, of which 7 were directly related to PT and 20 were due to other organ-related sepsis and hemorrhagic shock. Conclusion Pancreatic trauma is rare but challenging for trauma surgeons, with persistent management controversies. Early diagnosis is important for favorable results; however, a delay in diagnosis has been associated with higher morbidity and mortality. Low-grade pancreatic injuries can be successfully managed nonoperatively, whereas high-grade pancreatic injuries require surgical intervention.","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":"3 1","pages":"6 - 11"},"PeriodicalIF":0.0,"publicationDate":"2022-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42271288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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