J E Smith1, M Midwinter, A W Lambert. 1. Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK. jasonesmith@doctors.org.uk
Abstract
INTRODUCTION: Surgical decision-making in torso trauma is complex. This paper looks at the role of the computed tomography (CT) scan in this decision-making process. PATIENTS AND METHODS: Patients with significant torso trauma (high velocity gunshot wound [HVGSW], blast, stab) admitted to a military role 2 (enhanced) hospital facility during a 7-week period of Operation HERRICK 9 (Afghanistan, October to November 2008) are reported. The management of those patients undergoing a CT scan as part of the decision-making process at the time of admission is discussed. RESULTS: Twenty eight patients with significant torso trauma were admitted to the facility during the study period; HVGSW (n = 15), blast (n = 9), stab (n = 4). Thirteen patients underwent a CT scan as part of the surgical decision-making process; HVGSW (n = 5), blast (n = 8). Imaging confirmed torso integrity in 12 patients, one of whom subsequently had a laparotomy for vascular control for on-table haemorrhage during lower limb surgery. One patient had a confirmed thoraco-abdominal injury, which was treated conservatively with tube thoracostomy and 'active observation'. CONCLUSIONS: A CT scan formed part of the surgical decision-making process in about half of the patients admitted with significant torso trauma, and helped prevent unnecessary laparotomy in this forward military environment. Those patients with a blast injury were more likely to undergo CT scanning than those where the mechanism of injury was a HVGSW.
INTRODUCTION: Surgical decision-making in torso trauma is complex. This paper looks at the role of the computed tomography (CT) scan in this decision-making process. PATIENTS AND METHODS: Patients with significant torso trauma (high velocity gunshot wound [HVGSW], blast, stab) admitted to a military role 2 (enhanced) hospital facility during a 7-week period of Operation HERRICK 9 (Afghanistan, October to November 2008) are reported. The management of those patients undergoing a CT scan as part of the decision-making process at the time of admission is discussed. RESULTS: Twenty eight patients with significant torso trauma were admitted to the facility during the study period; HVGSW (n = 15), blast (n = 9), stab (n = 4). Thirteen patients underwent a CT scan as part of the surgical decision-making process; HVGSW (n = 5), blast (n = 8). Imaging confirmed torso integrity in 12 patients, one of whom subsequently had a laparotomy for vascular control for on-table haemorrhage during lower limb surgery. One patient had a confirmed thoraco-abdominal injury, which was treated conservatively with tube thoracostomy and 'active observation'. CONCLUSIONS: A CT scan formed part of the surgical decision-making process in about half of the patients admitted with significant torso trauma, and helped prevent unnecessary laparotomy in this forward military environment. Those patients with a blast injury were more likely to undergo CT scanning than those where the mechanism of injury was a HVGSW.
Authors: J M Brody; D B Leighton; B L Murphy; G F Abbott; J P Vaccaro; L Jagminas; W G Cioffi Journal: Radiographics Date: 2000 Nov-Dec Impact factor: 5.333
Authors: F Turégano-Fuentes; D Pérez-Diaz; M Sanz-Sánchez; R Alfici; I Ashkenazi Journal: Eur J Trauma Emerg Surg Date: 2014-04-04 Impact factor: 3.693
Authors: Klemens Horst; Hagen Andruszkow; Christian D Weber; Miguel Pishnamaz; Christian Herren; Qiao Zhi; Matthias Knobe; Rolf Lefering; Frank Hildebrand; Hans-Christoph Pape Journal: PLoS One Date: 2017-10-19 Impact factor: 3.240