Jean Cotte1, Fredrik Courjon2, Sébastien Beaume3, Bertrand Prunet4, Julien Bordes5, Cédric N'Guyen6, Claire Contargyris7, Guillaume Lacroix8, Ambroise Montcriol9, Eric Kaiser10, Eric Meaudre11. 1. Anaesthesia and Intensive Care Department, Sainte-Anne Military Hospital, BP 20545, 83041 Toulon cedex 9, France. Electronic address: jean.cotte@gmail.com. 2. Emergency Department, Sainte-Anne Military Hospital, BP 20545, 83041 Toulon cedex 9, France. Electronic address: fredrik.courjon@yahoo.fr. 3. Emergency Department, Sainte-Anne Military Hospital, BP 20545, 83041 Toulon cedex 9, France. Electronic address: docteur.beaume@gmail.com. 4. Anaesthesia and Intensive Care Department, Sainte-Anne Military Hospital, BP 20545, 83041 Toulon cedex 9, France. Electronic address: prunet.bertrand@orange.fr. 5. Anaesthesia and Intensive Care Department, Sainte-Anne Military Hospital, BP 20545, 83041 Toulon cedex 9, France. Electronic address: bordes.julien@neuf.fr. 6. Anaesthesia and Intensive Care Department, Sainte-Anne Military Hospital, BP 20545, 83041 Toulon cedex 9, France. Electronic address: ced040@hotmail.fr. 7. Anaesthesia and Intensive Care Department, Sainte-Anne Military Hospital, BP 20545, 83041 Toulon cedex 9, France. Electronic address: contargyris@hotmail.com. 8. Anaesthesia and Intensive Care Department, Sainte-Anne Military Hospital, BP 20545, 83041 Toulon cedex 9, France. Electronic address: gllacroix@aol.com. 9. Anaesthesia and Intensive Care Department, Sainte-Anne Military Hospital, BP 20545, 83041 Toulon cedex 9, France. Electronic address: ambroise.montcriol@free.fr. 10. Anaesthesia and Intensive Care Department, Sainte-Anne Military Hospital, BP 20545, 83041 Toulon cedex 9, France. Electronic address: kaiserenmission@gmail.com. 11. Anaesthesia and Intensive Care Department, Sainte-Anne Military Hospital, BP 20545, 83041 Toulon cedex 9, France. Electronic address: eric.meaudre@club-internet.fr.
Abstract
AIM: Over-triage rates related to the use of Vittel criteria are unknown. We compared severe stable trauma patients with and without significant visceral injuries. STUDY DESIGN: A single-centre retrospective analysis of a single-centre prospective cohort. PATIENTS AND METHODS: Trauma patients with at least one positive Vittel criterion from June 2010 to January 2012 in a level-1 trauma centre. Initial management included a systematic whole-body scanner. All significant lesions in stable trauma patients were recorded. RESULTS: A total of 252 trauma patients were admitted. One hundred and twenty were stable. In this group without vital distress, 72 (60%) had at least one occult lesion, 21 (17.5%) had an isolated orthopaedic injury and 27 (22.5%) had no injury. Thoracic injuries accounted for 44% of visceral injuries, abdominal for 17%, spinal for 16% and cerebral for 15%. Overall, the over-triage rate was 19%. Surgery for significant visceral injury was performed in 13 patients (18%) and arteriography in 4 patients (5.5%). Admission in an intensive care unit was required for 13 patients with occult injuries and for one patient without such a lesion (18% versus 2%, P=0.008). Hospital stays were longer in the group with visceral injuries (4±7 versus 9±8days; P=0.006). CONCLUSION: Vittel criteria use in trauma patients induces an acceptable over-triage rate. A large proportion of stable trauma patients have occult lesions. These visceral injuries frequently require special care. These data highlight the imperative need to transport major trauma patients immediately to a dedicated trauma centre and supports whole-body scanner use.
AIM: Over-triage rates related to the use of Vittel criteria are unknown. We compared severe stable traumapatients with and without significant visceral injuries. STUDY DESIGN: A single-centre retrospective analysis of a single-centre prospective cohort. PATIENTS AND METHODS: Traumapatients with at least one positive Vittel criterion from June 2010 to January 2012 in a level-1 trauma centre. Initial management included a systematic whole-body scanner. All significant lesions in stable traumapatients were recorded. RESULTS: A total of 252 traumapatients were admitted. One hundred and twenty were stable. In this group without vital distress, 72 (60%) had at least one occult lesion, 21 (17.5%) had an isolated orthopaedic injury and 27 (22.5%) had no injury. Thoracic injuries accounted for 44% of visceral injuries, abdominal for 17%, spinal for 16% and cerebral for 15%. Overall, the over-triage rate was 19%. Surgery for significant visceral injury was performed in 13 patients (18%) and arteriography in 4 patients (5.5%). Admission in an intensive care unit was required for 13 patients with occult injuries and for one patient without such a lesion (18% versus 2%, P=0.008). Hospital stays were longer in the group with visceral injuries (4±7 versus 9±8days; P=0.006). CONCLUSION: Vittel criteria use in traumapatients induces an acceptable over-triage rate. A large proportion of stable traumapatients have occult lesions. These visceral injuries frequently require special care. These data highlight the imperative need to transport major traumapatients immediately to a dedicated trauma centre and supports whole-body scanner use.
Authors: Stefan Wirth; Julian Hebebrand; Raffaella Basilico; Ferco H Berger; Ana Blanco; Cem Calli; Maureen Dumba; Ulrich Linsenmaier; Fabian Mück; Konraad H Nieboer; Mariano Scaglione; Marc-André Weber; Elizabeth Dick Journal: Insights Imaging Date: 2020-12-10