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Aurelio Rodriguez

Publications and source records attributed to Aurelio Rodriguez.

14 recordsLinked to original sources
PubMed2006

Abdominal computed tomography and the placement of inferior vena caval filters.

BACKGROUND: Standard cavography is performed with iodinated contrast material with plain film or digital subtraction technique. However, preplacement imaging may change final inferior vena cava filter (IVC) placement in 11 to 26% of patients. This study will examine the use and reliability of incidental spiral computed abdominal tomography (CAT) scans for the placement of IVC filters. METHODS: Over a 25-month period, CAT scan data were prospectively collected on patients at high risk for pulmonary embolism (PE) or with PE that required an IVC filter. CAT scans were then evaluated specifically for vena cava anatomy and relationship to renal veins and lumbar spine. IVC filters were then placed before cavography under fluoroscopy (performed only to confirm accurate placement) based on the static relationship of the renal veins/IVC and spine. RESULTS: One hundred twenty-two patients had IVC filters placed. In the last 78 eligible patients, CAT scan placement was verified with post deployment cavography. IVC filters were deployed an average of 3.25 mm below the lowest renal vein with no veins misidentified. No strut malposition was noted on post deployment cavography. 12.1% had findings by CAT scan that altered some aspect of IVC filter placement. CONCLUSIONS: Admission or same hospital stay spiral CAT scan can provide enough anatomic detail to safely guide placement of an IVC filter. IVC filters can be deployed at bedside without contrast cavography if the preplacement CAT scan is adequate.

Adolescent↗
PubMed2006

Detection of cervical spine injuries in alert, asymptomatic geriatric blunt trauma patients: who benefits from radiologic imaging?

There are differing recommendations in the literature regarding cervical spine imaging in alert, asymptomatic geriatric patients. Previous studies also have not used computed tomography routinely. Given that cervical radiographs may miss up to 60 per cent of fractures, the incidence of cervical spine injuries in this population and its implications for clinical management are unclear. We conducted a retrospective study of blunt trauma patients 65 years and older who were alert, asymptomatic, hemodynamically stable, and had normal neurologic examinations. For inclusion, patients were required to have undergone computed tomography and plain radiographs. The presence and anatomic location of potentially distracting injuries or pain were recorded. Two hundred seventy-four patients were included, with a mean age of 76 +/- 10 years. The main mechanisms of injury were falls (51%) and motor vehicle crashes (41%). Nine of 274 (3%) patients had cervical spine injuries. The presence of potentially distracting injuries above the clavicles was associated with cervical injury when compared with patients with distracting injuries in other anatomic locations or no distracting injuries (8/115 vs 1/159, P = 0.03). There was no association of cervical spine injury with age greater or less than 75 years or with mechanism of injury. The overall incidence of cervical spine injury in the alert, asymptomatic geriatric population is low. The risk is increased with a potentially distracting injury above the clavicles. Patients with distracting injuries in other anatomic locations or no distracting injuries may not need routine cervical imaging.

Accidental Falls↗
PubMed2005

The impact of hyperglycemia on patients with severe brain injury.

BACKGROUND: This study aimed to analyze the relation of hyperglycemia to outcome in cases of severe traumatic brain injury, and to examine factors that may be responsible for the hyperglycemic state. METHODS: A retrospective analysis in an intensive care unit of a level 1 trauma center investigated 77 patients with severe traumatic brain injury. Patients with a Glasgow Coma Scale (GCS) of 8 or lower who survived more than 5 days were reviewed. Serum glucose, base deficit, GCS, use of steroids, and amounts of insulin and carbohydrates were recorded for 5 days, along with age. The Injury Severity Score (ISS) and the Abbreviated Injury Score (AIS) for the head, chest, and abdomen also were recorded. A hyperglycemia score (HS) was calculated as follows. A value of 1 was assigned each day the glucose exceeded 170 mg/dL (range, 0-5). A hyperglycemia score for days 3, 4, and 5 (HS day 3-5) also was calculated (range, 0-3). Outcomes included mortality, day 5 GCS, intensive care unit length of stay, and hospital length of stay. RESULTS: Of the 77 patients, 24 (31.2%) died. Nonsurvivors had higher glucose levels each day. The HS was higher for those who died: 2.4 +/- 1.7 versus 1.5 +/- 1.4 (p = 0.02). Univariate analysis showed that only HS and ISS correlated with all four outcome variables studied. Cox's regression analysis showed that mortality was related to age and ISS. Head AIS and HS were independent predictors of lower day 5 GCS, whereas HS 3-5 and day 4 GCS were related to prolonged hospital length of stay. Older age, diabetes, and lower day 1 GCS were associated with higher HS, whereas carbohydrate infusion rate, ISS, head AIS, and steroid administration were not. CONCLUSIONS: Early hyperglycemia is associated with poor outcomes for patients with severe traumatic brain injury. Tighter control of serum glucose without reduction of nutritional support may improve the prognosis for these critically ill patients.

Abbreviated Injury Scale↗
PubMed2005

Delayed rupture of a left ventricular aneurysm after blunt trauma.

We report a case where a 17-year-old male involved in a motor vehicle crash was admitted after seemingly minor blunt chest trauma. The patient was discharged the following day without complications. He was subsequently found dead 45 days later from a ruptured traumatic left ventricular aneurysm. We review briefly the epidemiology of patients with this complication and also suggest that the optimal method and timing of following and identifying discharged patients at risk for this rare but devastating complication is still unclear based on current literature.

Accidents, Traffic↗
PubMed2005

Ultrasonography for interval assessment in the nonoperative management of hepatic trauma.

Abdominal ultrasonography (US) is gaining widespread acceptance as a valuable diagnostic tool in the initial evaluation of trauma victims. We investigated the utility of US as a follow-up radiologic study in nonoperative hepatic trauma. Patients with liver injury designated for nonoperative management were prospectively studied over a 2-year period at our primary adult resource center for trauma. Computed tomography (CT) and radiologist-performed US were obtained at admission and at 1 week. The ability of US to detect lesions, fluid, and complications was evaluated by comparing with the corresponding CT. Twenty-five hepatic trauma patients in the study were successfully managed nonoperatively and had both initial and follow-up US and CT scans: 1 (4%) grade I, 5 (20%) grade II, 7 (28%) grade III, 7 (28%) grade IV, and 5 (20%) grade V. Four complications developed [biloma (3) and biliary fistula (1)] in 3 patients with grade IV injury and 1 with a grade II injury. Interval US appropriately detected a complication or confirmed the absence of complication in all (13/13, 100%) patients with low-grade (I-III) injury and only missed a small biloma in one patient with a grade IV injury. Interval US and CT agreement was 92 per cent for change in hemoperitoneum or parenchymal lesion. Ultrasonography is a convenient imaging modality in the evaluation of hepatic trauma. US is sufficient to detect or exclude complications in low-grade injuries. In high-grade injuries, US may be an adjunct to CT for definitive interval assessment.

Abdominal Injuries↗
PubMed2004

Falling down and falling out: management and outcome analysis.

BACKGROUND: This study compares young (< 65 years old) and elderly (> or = 65 years old) patients who fall secondary to syncope and seeks to determine whether syncope workups are being appropriately performed and whether they contribute new information that results in a change in management. METHODS: A retrospective review of patients who fell and were admitted to a Level I trauma center was performed. Data included mechanism of injury, comorbidities, and severity scores in addition to details regarding a syncope workup in patients who had unclear reasons for falling. Outcome variables were mortality, intensive care unit and hospital lengths of stay, and whether each test resulted in a change in management. RESULTS: The data set included 387 patients. Elderly patients who fell (n = 157) had significantly higher Injury Severity Scores and mortality, lower Glasgow Coma Scale scores, and longer intensive care unit and hospital lengths of stay than the younger cohort (n = 230). When a fall occurred secondary to syncope, however, there was no difference in injury severity or outcome. Patients who fell secondary to syncope (n = 61) had zero to six of the recommended tests ordered. Nineteen tests in the young group and 79 tests in the elderly patients had abnormal results. Overall, 37.8% of patients had specific interventions performed because of the abnormal test results CONCLUSION: Syncope workups were erratically performed in both young and older groups. These workups frequently resulted in abnormal findings that required intervention. Protocols are currently being developed at our institution to ensure complete assessment of trauma patients who fall for unknown reasons.

Accidental Falls↗
PubMed2003

Harbingers of poor outcome the day after severe brain injury: hypothermia, hypoxia, and hypoperfusion.

BACKGROUND: Traumatic brain injury (TBI) can be compounded by physiologic derangements that produce secondary brain injury. The purpose of this study is to elucidate the frequency with which physiologic factors that are associated with secondary brain injury occur in patients with severe closed head injuries and to determine the impact of these factors on outcome. METHODS: The records of 81 adult blunt trauma patients with Glasgow Coma Scale scores < or = 8 and transport times < 2 hours to a Level I trauma center were retrospectively reviewed searching for the following 11 secondary brain injury factors (SBIFs) in the first 24 hours postinjury: hypotension, hypoxia, hypercapnia, hypocapnia, hypothermia, hyperthermia, metabolic acidosis, seizures, coagulopathy, hyperglycemia, and intracranial hypertension. We recorded the worst SBIF during six time periods: hours 1, 2, 3, 4, 5 to 14, and 16 to 24. Occurrence of each SBIF was then correlated with outcome. RESULTS: Hypocapnia, hypotension, and acidosis occurred more frequently than other SBIFs (60-80%). Hypotension, hyperglycemia, and hypothermia were associated with increased mortality rate. Patients with episodes of hypocapnia, acidosis, and hypoxia had significantly longer intensive care unit length of stay (LOS). These three SBIFs and hyperglycemia related to longer hospital LOS as well. Hypotension and acidosis were associated with discharge to a rehabilitation facility rather than home. Finally, multivariate regression analysis revealed that hypotension, hypothermia, and Abbreviated Injury Scale score of the head were independently related to mortality, whereas other SBIFs, age, Injury Severity Score, and Glasgow Coma Scale score were not. Metabolic acidosis and hypoxia were related to longer intensive care unit and hospital LOS. CONCLUSION: Our early management of head-injured patients stresses avoidance and correction of SBIFs at all costs. Nonetheless, SBIFs occur frequently in the first 24 hours after traumatic brain injury. Six of the 11 factors studied are associated with significantly worse outcomes. Hypotension and hypothermia are independently related to mortality. Because these SBIFs are potentially preventable, protocols could be developed to decrease their frequency.

Abbreviated Injury Scale↗
PubMed2003

The need for head computed tomography in patients sustaining loss of consciousness after mild head injury.

BACKGROUND: Many management schemes have incorporated mandatory head computed tomography (HCT) to evaluate a patient sustaining blunt head trauma with a history of loss of consciousness (LOC). Commonly, this is despite physical examination findings warranting such a workup. This study is intended to better identify the significance of selective criteria, a set of constitutional signs and symptoms (CSS) for head injury, to screen patients sustaining blunt head trauma and LOC. METHODS: Over a 141/2-month period, data were prospectively collected on adults with a history of LOC and a Glasgow Coma Scale score of 14 to 15. Patients were screened for the presence of 10 typical CSS for head injury at admission before undergoing computed tomography of the head. Data collected also included mechanism of injury and alcohol intoxication. RESULTS: Three hundred thirty-one patients met criteria, of which 195 showed no CSS for head injury. Eleven (5.6%) of these patients were found to have HCT evidence of intracranial injury but resulted in no acute medical intervention. One hundred thirty-six patients had CSS, of which 29 (21.3%) had HCT evidence of injury and resulted in a lengthier hospital stay. CONCLUSION: The liberal use of HCT in patients without CSS for head injury did not influence patient care, with no increase in morbidity or mortality. These results suggest that LOC alone is not predictive of significant head injury and is not an absolute indications for HCT. More objective criteria, such as CSS, should be used before initiating a costly workup where further diagnostic and therapeutic intervention is unlikely after mild head injury.

Adult↗
PubMed2003

Operative management and outcome of iliac vessel injury: a ten-year experience.

The purpose of this study is to review demographics and examine and stratify risk factors related to the outcome of operatively treated iliac vascular injuries. We conducted a retrospective review of 78 cases of iliac vessel injury. Patients with blunt and penetrating injury had statistically similar length of hospital stay and intensive care unit stay, incidence of shock, and mortality. Shock on admission and bleeding hematoma are linked, and shock increased mortality with an odds ratio of 5.2 (P = 0.002). A review of operative technique and outcome demonstrated a low mortality of 25 per cent in arterial bypass of an isolated arterial injury versus a mortality of 83 per cent in the combined injury group. Patients treated with primary repair of venous injuries had a lower incidence of shock and mortality compared with patients treated with venous ligation. We conclude that, if matched for severity of injury and physiologic instability, the mechanism of injury does not affect mortality. Shock is the most significant prognostic factor for mortality. Operative management must be based on presence of shock.

Adolescent↗
PubMed2002

Trauma deaths in an Italian urban area: an audit of pre-hospital and in-hospital trauma care.

In Italy, a comprehensive regional study of trauma deaths has never been performed. We examined the organization and delivery of trauma care in the city area of Milan, using panel review of trauma deaths. Two panels evaluated the appropriateness of care of all trauma victims occurred during 1 year, applying predefined criteria and judging deaths as not preventable (NP), possible preventable (PP), and definitely preventable (DP). Two hundred and fifty-five deaths were reviewed. Blunt trauma were 78.04% and motor vehicle crashes accounted for over 50%. Most victims (73.72%) died during pre-hospital settings and 91.1% died within the first 6h, principally because of central nervous system injuries in blunt and hemorrhage in penetrating trauma. Panels judged 57% of deaths NP, 32% PP, 11% DP (inter-panel K-test 0.88). Preventable deaths were higher after in-hospital admission. Main failures of treatment were lack in airway control or intravenous infusions in pre-hospital and mismanagement with missed injuries in emergency department. The high rate of avoidable deaths in Milan supports the need of trained pre-hospital personnel and of well equipped referring hospitals for trauma.

Accidents↗
PubMed2002

Is helical computed tomography effective for diagnosis of blunt aortic injury?

Computed tomography has had a questionable role in diagnosing blunt aortic injury (BAI). The objective of this study was to determine the effectiveness of helical computed tomography of the thorax (HCTT) for detection of BAI. Trauma Registry data and medical records were reviewed for 2,854 patients admitted over a 32-month period. A total of 243 patients were identified at risk for BAI. Patients were evaluated for BAI because of chest radiograph, physical examination, or clinical suspicion. Eleven of 2,834 patients sustained BAI. Of 243 patients who sustained blunt torso trauma, 232 patients underwent HCTT. Eleven underwent aortography without HCTT. Sixteen patients had an abnormal HCTT, revealing 9 patients with BAI. No delayed BAI were encountered. HCTT effectively screens for BAI. Aortography can be more specifically applied as a diagnostic study when preceded by HCTT. HCTT should not be used as solitary study for BAI as some injuries identified by HCTT do not represent BAI.

Adult↗
PubMed2002

Handsewn versus stapled anastomosis in penetrating colon injuries requiring resection: a multicenter study.

BACKGROUND: Although the use of stapling devices in elective colon surgery has been shown to be as safe as handsewn techniques, there have been concerns about their safety in emergency trauma surgery. The purpose of this study was to compare stapled with handsewn colonic anastomosis following penetrating trauma. METHODS: This was a prospective multicenter study and included patients who underwent colon resection and anastomosis following penetrating trauma. Multivariate logistic regression analysis was used to identify independent risk factors for abdominal complications and compare outcomes between stapled and handsewn repairs. RESULTS: Two hundred seven patients underwent colon resection and primary anastomosis. In 128 patients (61.8%) the anastomosis was performed with handsewing and in the remaining 79 (38.2%) with stapling devices. There were no colon-related deaths and the overall incidence of colon-related abdominal complications was 22.7% (26.6% in the stapled group and 20.3% in the handsewn group, p = 0.30). The incidence of anastomotic leak was 6.3% in the stapled group and 7.8% in the handsewn group (p = 0.69). Multivariate analysis adjusting for blood transfusions, fecal contamination, and type of antibiotic prophylaxis showed that the adjusted odds ratio (OR) of complications in the stapled group was 0.83 (95% CI, 0.38-1.74, p = 0.63). In a second multivariate analysis adjusting for blood transfusions, hypotension, fecal contamination, Penetrating Abdominal Trauma Index, and preoperative delays the adjusted OR in the stapled group was 0.99 (95% CI, 0.46-2.11, p = 0.99). CONCLUSION: The results of this study suggest that the method of anastomosis following colon resection for penetrating trauma does not affect the incidence of abdominal complications and the choice should be surgeon's preference.

Adolescent↗