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At least 289 records · Page 16Linked to original sources
PubMed1977

Abdominal injuries due to blank cartridges.

Blank cartridges may produce serious injury and the recognition of this hazard must be borne in mind when treating these wounds. This paper reports two cases of complicated abdominal injury inflicted by a blank cartridge.

Abdominal Injuries↗
PubMed1999

Identification of intra-abdominal injuries in children hospitalized following blunt torso trauma.

OBJECTIVE: To determine the utility of the ED physical examination and laboratory analysis in screening hospitalized pediatric blunt trauma patients for intra-abdominal injuries (IAIs). METHODS: The authors reviewed the records of all patients aged <15 years who sustained blunt traumatic injury and were admitted to a Level 1 trauma center over a four-year period. Patients were considered high-risk for IAI if they had any of the following at ED presentation: decreased level of consciousness (GCS < 15), abdominal pain, tenderness on abdominal examination, or gross hematuria. Patients without any of these findings were considered moderate risk for LAI. The authors compared moderate-risk patients with and without IAIs with regard to physical examination and laboratory findings obtained in the ED. RESULTS: Of 1,040 children with blunt trauma, 559 (54%) were high-risk and 481 (46%) were moderate-risk for IAI. 126 (23%) of the high-risk and 22 (4.6%) of the moderate-risk patients had IAIs. Among moderate-risk patients with and without IAIs, those with IAIs were more likely to have abdominal abrasions (5/22 vs 34/459, p = 0.008), an abnormal chest examination (11/22 vs 86/457, p = 0.01), higher mean serum concentrations of aspartate aminotransferase (AST) (604 U/L vs 77 U/L, p < 0.001) and alanine aminotransferase (ALT) (276 U/L vs 39 U/L, p = 0.002), higher mean white blood cell (WBC) counts (16.3 K/mm3 vs 12.8 K/mm3, p < 0.001), and a higher prevalence of >5 RBCs/hpf on urinalysis (7/22 vs 54/427, p = 0.02). There was no significant difference (p > 0.05) between moderate-risk patients with and without IAIs in initial serum concentrations of amylase, initial hematocrit, drop in hematocrit >5 percentage points in the ED, or initial serum bicarbonate concentrations. CONCLUSION: In children hospitalized for blunt torso trauma who are at moderate risk for IAI, ED findings of abdominal abrasions, an abnormal chest examination, and microscopic hematuria as well as elevated levels of AST and ALT, and elevated WBC count are associated with IAI.

Abdominal Injuries↗
PubMed1991

Predictors of abdominal injury in children with pelvic fracture.

During a 48-month period, 2,248 children (aged less than 15 years) were consecutively admitted to a regional pediatric trauma center with blunt trauma (ICD-9-CM code greater than or equal to 800). Fifty-four children (2.4%) had injury to the pelvic circle, as diagnosed by radiographic examination; 13 of these children had concomitant abdominal or genitourinary (GU) injury. Contingency table analysis and stepwise logistic regression were used to determine the best predictors of abdominal injury. The mean age of the children was 8.6 years. Eighty-nine percent of the injuries were motor-vehicle related (59% pedestrian; 30% crash occupant). Nine children (17%) required transfusions of packed red blood cells; 9 children (17%) required surgery. There were 6 deaths in this group, a mortality rate of 11.1%. The most common fracture sites in the pelvis were the pubic rami (59%), ilium or pelvic rim (17%), and the sacrum (6%). Ten children (19%) had multiple pelvic fractures. Location of fracture was strongly associated with the probability of abdominal injury: 80% of children with multiple pelvic fractures had concomitant abdominal or GU injury, compared with 33% with fracture of the ilium or pelvic rim, and 6% with isolated pubic fractures (p less than 0.001). The variables that best predicted abdominal or GU injury using a backward-elimination, stepwise logistic model were the presence of multiple pelvic fractures (p less than 0.002) and unweighted Revised Trauma Score (p less than 0.05); age of child, systolic blood pressure, respiration rate, Glasgow Coma Scale score, and mechanism of injury were not predictive.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Injuries↗
PubMed1975

Penetrating abdominal injuries in children and adolescents.

A total of 107 children and adolescents underwent laparotomies for penetrating trauma. There were 64 patients with stab wounds and 43 with gunshot wounds. Only 8 per cent of the patients were under 12 years of age. Three patients died--two from gunshot wounds of major vessels and one from a gunshot wound of the colon. Most of the injuries were related to crimes of violence or were self-inflicted. Multiple organ injuries and postoperative complications were significantly more common among patients with gunshot wounds than in those with stab wounds. Associated extra-abdominal injuries appeared to be more common among patients with gunshot wounds but the difference was not statistically significant. Unnecessary laparotomies were twice as frequent in victims of stab wounds.

Abdominal Injuries↗
PubMed1991

[Comparative evaluation of laparoscopy and laparocentesis in the diagnosis of abdominal injuries].

The article presents a comparative estimation of laparoscopy and laparocentesis in diagnostics of abdominal traumas. Based on an analysis of results of 20 laparoscopies and 861 laparocenteses the author makes a conclusion that both laparoscopy and laparocentesis have high informative value in diagnostics of abdominal traumas, their diagnostic reliability having no substantial distinctions. Laparocentesis takes 5-6 times less time than laparoscopy.

Abdominal Injuries↗
PubMed2001

Operative management of abdominal injuries in children.

Operative repair of visceral injuries in children is infrequent enough so that an individual surgeon's experience may decay as time goes by. This report recommends incisions, a plan for thorough exploration, and the best surgical strategies for abdominal injuries, Simplicity and organ conservation are emphasized.

Abdominal Injuries↗
PubMedDate not supplied

[Isolated lesions of the gallbladder, in closed abdominal injuries. Apropos of 7 cases].

The authors report 7 cases of isolated injuries of the gallbladder, in closed abdominal trauma. The literature indicates the frequency to lie between one and five percent. The postprandial period and fasting alcohol levels, responsible for the distention of the gallbladder, are mostly the cause of such lesions. Four groups of injuries are described: 1) laceration 2) avulsion 3) simple contusion 4) traumatic cholecystitis Early diagnosis of such injuries is difficult as abdominal signs are poor and little specific; the authors note the value of peritoneal puncture and lavage. The treatment of gallbladder trauma is always surgical, cholecystectomy giving the best results; raphy and cholecystostomy are second choice treatments. The prognosis is usually favorable, even if surgery is delayed, and depends essentially on the nature of associated extra-abdominal injuries.

Adult↗
PubMed2001

Evolution in damage control for exsanguinating penetrating abdominal injury.

OBJECTIVE: Damage control (DC) has proven valuable in exsanguinated patients. The purpose of this study was to quantify and qualify the impact of current damage control principles applied in a penetrating abdominal injury (PAI) population. METHODS: Over a 3-year period (June 1997-May 2000), of 271 laparotomies for PAI, 24 patients underwent DC (8.9%). Demographics, injury grade, resuscitative and operative parameters, acid-base status, coagulation profiles, fluid/transfusion requirements, definitive repairs, abdominal closure, complications, and outcomes were reviewed. Data were compared with our DC experience a decade earlier. Fisher's exact test was used for comparisons. RESULTS: Overall survival improved for equivalent Injury Severity Score, Revised Trauma Score, TRISS, admission systolic blood pressure, operating room systolic blood pressure, and Penetrating Abdominal Trauma Index score. Solids (1.2 vs. 1.3), hollow organ (1.5 vs. 1.7), and major vascular injuries (0.5 vs. 0.8) per patient remain unchanged. Currently, there was less hypothermia with equivalent operating room times. In intensive care unit survivors, acid-base status was similar but coagulopathy and hypothermia were less severe. Definitive colon management has shifted from ostomies to anastomoses. Eventual fascial closure occurred in 14 of 19 (74%) compared with 12 of 14 (86%) in the historical group. There were three gastrointestinal fistulae (one pancreatic), one anastomotic leak, and three intra-abdominal abscesses. CONCLUSION: Continued application of DC principles has led to improved survival with PAI. Better control of temperature, experience with the open abdomen, and intensive care unit care may be causative.

Abdominal Injuries↗
PubMed2005

Distinguishing inflicted versus accidental abdominal injuries in young children.

OBJECTIVES: To compare the presentation of young children with abdominal trauma caused by high-velocity accidental (HVA), low-velocity accidental (LVA), and inflicted injury, and to test the hypothesis that a delay in care is highly predictive of an inflicted injury. METHODS: We performed a retrospective chart review at an urban Level I pediatric trauma center between 1991 and 2001 of children younger than 6 years who were admitted with abdominal injuries and an Abbreviated Injury Scale (AIS) score > or = 2. Charts were abstracted for demographic information, history of presentation, mechanism of injury, and diagnoses. Accidental injuries were defined as high velocity (motor vehicle crash or a fall from > 10 feet) or low velocity (household trauma, bicycle crash, or a fall from < 10 feet). Inflicted trauma was defined as a constellation of unexplained injuries, confessions by a perpetrator, or disclosure by the victim. RESULTS: Of the 121 children in the study, 77 (64%) had HVA injuries, 31 (26%) had LVA injuries, and 13 (11%) had inflicted injuries. Solid organ injuries (e.g., liver, spleen, and kidney) were most common in all groups, and abused children were significantly more likely to have suffered a hollow viscus injury (p = 0.03). Abused children were also significantly more likely to have suffered injuries with an AIS score >3 and combined hollow viscus and solid organ injuries than the HVA group or the LVA group (p < 0.001). Presentation for medical care occurred within 12 hours for 100% of the HVA group but only 65% of the LVA group, and 46% of the abuse group (p < 0.001). Presentation to care at greater than 12 hours was neither specific nor highly predictive of abuse, as some children with LVA injuries presented for care late despite developing symptoms shortly after their injury occurred (specificity, 65% [95% confidence interval, 45-81%]; positive predictive value, 39% [95% confidence interval, 17-64%]). CONCLUSION: Young children with inflicted abdominal injuries are more likely to have more severe injuries, multiple injuries, and a delay in seeking care than young children with accidental abdominal trauma. However, delay in seeking care is not specific for inflicted injury and occurs in some children with LVA abdominal trauma.

Abbreviated Injury Scale↗
PubMed1977

[Surgical management of thoracic and thoraco-abdominal injuries].

From 1970 to 1974 407 patients with thoracic injuries have been treated by the authors in the 2nd Surgical and Thoracic Surgical Department of the "János" Hospital, Budapest--out of them 190 patients were classified as severely injured. The material and the operative technique in isolated thoracal and combined thoracal-abdominal injuries are discussed. The importance of the operative stabilization of the thoracic wall is emphasized and fixation of the thoracic wall by means of pericostal sutures is advocated, if because of the intrathoracal injury--just the same--thoracotomy is to be performed. On the basis of their experiences and because of the risk of late complications and of residues impairing the function in certain types of the thoracal injuries surgical treatment is advocated by the authors.

Abdominal Injuries↗
PubMed1993

Utility of routine laboratory testing for detecting intra-abdominal injury in the pediatric trauma patient.

OBJECTIVE: To assess the prevalence of laboratory abnormalities (complete blood cell count, electrolytes, blood urea nitrogen, creatinine, glucose, aspartate aminotransferase, alanine aminotransferase, amylase, lipase, urinalysis [U/A]) and the sensitivity and specificity of the physical examination (PE) and screening laboratory tests for identifying intra-abdominal injury (IAI) in moderately injured pediatric patients. DESIGN, PARTICIPANTS, AND SETTING: Phase I: Retrospective chart review of 285 consecutive level II (moderately injured) trauma patients seen at a children's hospital emergency department/pediatric trauma center. All patients were received directly from the scene and had the following data recorded: mechanism of injury, Glasgow coma score, trauma score, pediatric trauma score, systematically recorded PE findings, laboratory results, and injuries detected during hospitalization. Phase II: To confirm the sensitivity of the PE and U/A found in phase I, the model was applied to 91 additional trauma patients identified by International Classification of Diseases, 9th revision (ICD-9) codes as having IAI. INTERVENTION: None. RESULTS: Phase I: A total of 3939 tests were ordered for the 285 patients entered in phase I. Aspartate aminotransferase and alanine aminotransferase values were obtained in 59% of patients; glucose level was obtained in 78% of patients; complete blood cell count, U/A, and levels of electrolytes, blood urea nitrogen, creatinine, amylase, and lipase were obtained in more than 85% of patients. The overall prevalence of laboratory abnormalities was 5.7%. Fourteen patients (4.8%) were identified who had a total of 23 significant IAIs (9 pancreatic, 6 splenic, 5 renal, 3 hepatic). The PE combined with U/A showing more than five red blood cells per high-power field had a sensitivity of 100%, specificity of 64%, positive predictive value of 13%, and negative predictive value of 100% for the detection of IAI. The presence of laboratory abnormalities suggesting injury did not increase the sensitivity of the model and significantly decreased both specificity and positive predictive value. Phase II: The PE combined with U/A identified an abnormality in 89 (97.8%) of 91 cases (95% confidence interval = 94.8% to 100%). CONCLUSIONS: In the moderately injured pediatric trauma patient, (1) there is a low prevalence of laboratory abnormalities; (2) the PE combined with U/A is a highly sensitive screen for IAI; and (3) in patients with a normal PE of the abdomen and a normal U/A, laboratory testing seldom identifies unsuspected IAI.

Abdominal Injuries↗