14 results on '"Luchette, Fred A."'
Search Results
2. Utility of an oral examination in a surgical clerkship
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Hassett, James, Luchette, Fred, Doerr, Ralph, Bernstein, George, Ricotta, John, Petrelli, Nicholas, Stulc, Jaroslaw, Curl, G. Richard, Booth, Crank Mcl., and Hoover, Eddie
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Surgery -- Study and teaching ,Medicine -- Tests, problems and exercises ,Health - Published
- 1992
3. A randomized, double-blind, placebo-controlled study to assess the effect of recombinant human erythropoietin on functional outcomes in anemic, critically ill, trauma subjects: the Long Term Trauma Outcomes Study
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Luchette, Fred A., Pasquale, Michael D., Fabian, Timothy C., Langholff, Wayne K., and Wolfson, Marsha
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ANEMIA treatment , *CRITICALLY ill patient care , *ERYTHROPOIETIN , *MEDICAL rehabilitation , *TREATMENT effectiveness , *RECOMBINANT proteins , *LONG-term health care , *PLACEBOS , *RANDOMIZED controlled trials , *BLIND experiment - Abstract
Abstract: Background: Achieving a higher hemoglobin (Hb) level might allow the anemic, critically ill, trauma patient to have an improved outcome during rehabilitation therapy. Methods: Patients with major blunt trauma orthopedic injuries were administered epoetin alfa or placebo weekly both in hospital and for up to 12 weeks after discharge or until the Hb level was >12.0 g/dL, whichever occurred first. The 36-question Short Form Health Assessment questionnaire (SF-36) was used to evaluate physical function (PF) outcomes at baseline, at hospital discharge, and at several time points posthospital discharge. Results: One hundred ninety-two patients were enrolled (epoetin alfa [n = 97], placebo [n = 95]). Hb increased from baseline to hospital discharge in both groups (epoetin alfa: 1.2 g/dL vs placebo: 0.9 g/dL), and transfusion requirements were similar between groups. Both groups showed improvements in SF-36 PF; there were no significant differences in the average of all posthospital discharge scores (epoetin alfa: 27.3 vs placebo 30.9; P = 0.38). Thromboembolic events were similar between groups. Conclusions: No differences were observed in physical function outcomes or safety in anemic, critically ill, trauma patients treated with epoetin alfa compared with placebo. [Copyright &y& Elsevier]
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- 2012
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4. The ribs or not the ribs: which influences mortality?
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Jones, Keith M., Reed, R. Lawrence, and Luchette, Fred A.
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MORTALITY , *BONE fractures , *RIB cage , *AGE factors in disease , *ARTERIAL injuries , *LOGISTIC regression analysis - Abstract
Abstract: Background: The relative impact of rib fractures on mortality risk is unclear. This study examined the respective relationships between mortality and the number of fractured ribs, patient age, and severity of intrathoracic and extrathoracic injuries. Methods: The National Trauma Data Bank was queried, abstracting mortality, age, number of ribs fractured, associated intrathoracic and extrathoracic injury, and Abbreviated Injury Score codes. Results: Multivariate logistic regression indicated the strongest influence on mortality was severity of intrathoracic injury, followed by severity of extrathoracic injury, age 65 years or older, more than 5 ribs fractured, and age 46 to 65 years. The mortality rate for isolated rib fractures ranged from 1.8% to 3.2%. Conclusions: Mortality related to rib fractures is affected independently by severe intrathoracic injury, presence of extrathoracic injury, advanced age, and more than 5 fractured ribs. Patients with these conditions may benefit from a higher level of care. [Copyright &y& Elsevier]
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- 2011
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5. A practical cost-effective management strategy for gallstone pancreatitis.
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Tabone, Lawrence E., Conlon, Molly, Fernando, Emil, Yi, Sophia, Sarker, Sharfi, Fisichella, P. Marco, and Luchette, Fred A.
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COST effectiveness , *PANCREATITIS treatment , *GALLSTONES , *ENDOSCOPIC retrograde cholangiopancreatography , *CHOLECYSTECTOMY , *SURGICAL complications , *HOSPITAL charges - Abstract
BACKGROUND: The purpose of this study was to evaluate the outcomes of various surgeon strategies used to evaluate and treat common duct stones (CDSs) in patients presenting with mild to moderate gallstone pancreatitis (GP). METHODS: We performed a retrospective review of patients admitted for mild to moderate GP. Data variables included laboratory values and radiology images, indications for and findings of intraoperative cholangiogram (IOC) and endoscopic retrograde cholangiopancreatography (ERCP), length of stay (LOS), and hospital charges. Data were stratified by 2 different management strategies: preoperative ERCP and then laparoscopic cholecystectomy (LC) or LC with IOC followed by selective postoperative ERCP. RESULTS: During this time period, 80 patients met the study criteria, 56 were treated by LC with IOC, and 24 had a preoperative ERCP performed. The incidence of CDS was 33% (n 5 26). The presence of CDSs correlated with an elevated total bilirubin at admission (CDSs 3.5 mg/dL vs 2.1 mg/dL no CDSs, P ,.01) and 24 hours after admission (CDS 3.2 mg/dL vs 1.5 mg/dL no CDS, P ,.01). Patients who had an IOC compared with those who had preoperative ERCP had a shorter LOS (4.6 vs 5.9 days, P 5 .04) and lower hospital charges (US $28,510 vs US $38,620; P , .01). CONCLUSIONS: Elevated total bilirubin at admission and 24 hours after admission may predict a patient's risk for CDS. We found that the management of uncomplicated GP with early LC and IOC results in decreased LOS and total hospital charges when compared with preoperative ERCP. [ABSTRACT FROM AUTHOR]
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- 2013
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6. Association between COVID-19 diagnosis and postoperative outcomes in sleeve gastrectomy and Roux-en-Y gastric bypass: A national cohort study.
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Swanson J, Baker MS, Fernando M, Luchette FA, and Cohn T
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- Humans, Cohort Studies, COVID-19 Testing, Treatment Outcome, Anastomotic Leak diagnosis, Anastomotic Leak epidemiology, Anastomotic Leak etiology, Retrospective Studies, Gastrectomy methods, Postoperative Complications diagnosis, Postoperative Complications epidemiology, Postoperative Complications etiology, Gastric Bypass adverse effects, Gastric Bypass methods, Obesity, Morbid complications, Obesity, Morbid diagnosis, Obesity, Morbid surgery, COVID-19 diagnosis, COVID-19 epidemiology, COVID-19 complications, Bariatric Surgery adverse effects, Laparoscopy methods
- Abstract
Background: We seek to determine the association between COVID-19 diagnosis and postoperative outcomes following bariatric surgery., Methods: Using the Metabolic and Bariatric Surgery Accreditation Quality Improvement Project (MBSAQIP) database, patients undergoing sleeve gastrectomy and gastric bypass without a COVID-19 diagnosis were 2:1 propensity-score matched to those with COVID-19 infection pre or postoperatively., Results: 1369 (0.74 %) and 1331 (0.72 %) patients had a COVID-19 diagnosis within 14 days prior to or 30 days after their operation, respectively. Patients with preoperative COVID-19 infection had equivalent outcomes to COVID-19 negative patients (all p > 0.05). Postoperative COVID-19 diagnosis was associated with worse outcomes including increased risk of anastomotic/staple line leak (1.1 % vs 0.1 %, p < 0.001), postoperative pneumonia (2.9 % vs 0.1 %, p < 0.001), and 30-day reoperation (2.1 % vs 0.9 %, p = 0.002)., Conclusions: Postoperative diagnosis of COVID-19 after bariatric surgery is associated with worse outcomes; however, it is safe to perform these procedures on patients recently convalesced from COVID-19 infection., Competing Interests: Declaration of competing interest All authors have no conflicts of interest to disclose for this research paper., (Copyright © 2023. Published by Elsevier Inc.)
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- 2024
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7. Locally advanced pancreatic cancer: Is surgical palliation associated with improved clinical outcome relative to medical palliation?
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Kramer SP, Tonelli C, Luchette FA, Swanson J, Abdelsattar Z, Cohn T, and Baker MS
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- Humans, Palliative Care methods, Retrospective Studies, Pancreas, Pancreatic Neoplasms surgery
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Background: The value of palliative surgery in pancreatic cancer is not well-defined., Methods: We queried the National Cancer Database for patients undergoing curative-intent resection, palliative surgery or medical palliation for clinical stage cT4N0-2M0 pancreatic cancer. Cohorts were 1:1:1 propensity-score-matched for comorbidities and stage. Kaplan-Meier method was used to compare overall survival for matched cohorts., Results: 9,107 patients met inclusion criteria: 3,567 (39 %) underwent curative intent surgery, 1608 (18 %) surgical palliation, 3932 (43 %) medical palliation. Patients undergoing resection and surgical palliation had significant hospitalizations (11.0 ± 0.4 vs. 10.0 ± 0.3 days; p = 0.821) and rates of readmission (8.1 % vs. 2.0 %; p < 0.001). Patients undergoing surgical palliation demonstrated marginal increases in survival relative to those undergoing medical palliation (8.54 vs. 7.36 months; p < 0.0001)., Conclusion: In patients undergoing care for locally advanced pancreatic cancer, palliative surgery is associated with marginal improvement in survival but significant lengths of hospitalization and risk of readmission., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)
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- 2024
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8. Laparoscopic and robotic paraesophageal hernia repair in United States veterans: Clinical outcomes and risk factors associated with reoperation recurrence.
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Tonelli CM, Baker MS, Luchette FA, and Cohn T
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- Humans, United States epidemiology, Reoperation, Risk Factors, Herniorrhaphy adverse effects, Recurrence, Hernia, Hiatal surgery, Robotic Surgical Procedures, Veterans, Laparoscopy
- Abstract
Background: Despite surgical advances, rates of paraesophageal hernia recurrence remain high. We evaluate outcomes of paraesophageal hernia repair in United States veterans, safety of robotic technology, and risk factors for reoperation for recurrence., Methods: The Veterans Affairs Surgical Quality Improvement Program database was queried for patients undergoing laparoscopic or robotic paraesophageal hernia repair from 2010 to 2021. The effect of patient and operative characteristics on outcomes was evaluated., Results: 2,444 patients underwent paraesophageal hernia repair. 62 (2.5%) had a reoperation for recurrence. Emergent priority (aOR 18.3 [5.9-56.2]) and younger age (aOR 0.7 [0.5-0.9]) were associated with increased risk of reoperation. On comparison of propensity matched cohorts, repairs done robotically took longer (4.17 vs. 3.57 h, p < 0.001) but had 30-day outcomes and rates of reoperation for recurrence equivalent to laparoscopic repairs (p > 0.05)., Conclusion: Emergent priority and younger age are associated with increased risk of reoperation for recurrent paraesophageal hernia. Robotic approaches take longer but are safe., Competing Interests: Declaration of competing interest The authors have no financial or other conflicts of interest to disclose. This study was not funded., (Copyright © 2022. Published by Elsevier Inc.)
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- 2023
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9. A matched cohort comparison of endoscopic resection, chemoradiation and esophagectomy in the treatment of early-stage esophageal squamous cell carcinoma.
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Swanson J, Littau M, Tonelli C, Cohn T, Luchette FA, Abdelsattar Z, and Baker MS
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- Humans, Esophagectomy methods, Treatment Outcome, Retrospective Studies, Chemoradiotherapy methods, Neoplasm Staging, Esophageal Squamous Cell Carcinoma surgery, Esophageal Neoplasms
- Abstract
Background: The efficacy of endoscopic resection in early-stage esophageal squamous cell carcinoma has not been defined., Methods: We queried the National Cancer Database to identify patients presenting with cT1N0M0 esophageal squamous cell cancer between 2004 and 2017. Transitive match methods were used to 1:1:1 propensity match patients undergoing endoscopic resection to patients undergoing esophagectomy and those undergoing definitive chemoradiotherapy. Kaplan Meier method was used to compare 5-year overall survival profiles for matched cohorts., Results: 301 patients (19%) underwent endoscopic resection; 497 (32%) esophagectomy; 767 (49%) chemoradiation. On comparison of matched cohorts, patients undergoing chemoradiation demonstrated lower rates of survival than those undergoing esophagectomy (32% vs. 59%, p < 0.0001) while those undergoing endoscopic resection demonstrated rates comparable to patients undergoing esophagectomy (53% vs. 59%, p = 0.77)., Conclusions: For cT1N0M0 esophageal squamous cell cancer, endoscopic resection is associated with rates of survival similar to those following esophagectomy and better than those following definitive chemoradiation., Competing Interests: Declaration of competing interest The authors of this paper have no conflicts of interest to disclose., (Copyright © 2022 Elsevier Inc. All rights reserved.)
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- 2023
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10. Use of a national registry to define a composite quality metric for rectal cancer.
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Tonelli CM, Kulshrestha S, Singer M, Pawlik TM, Luchette FA, Abdelsattar ZM, and Baker MS
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- Humans, Neoadjuvant Therapy, Benchmarking, Registries, Neoplasm Staging, Retrospective Studies, Rectal Neoplasms surgery, Proctectomy
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Background: Quality assessment in oncologic surgery has traditionally involved reporting discrete metrics that may be difficult for patients and referring providers to interpret. We define a composite quality metric (CQM) for resection in rectal cancer., Methods: We queried the National Cancer Database to identify patients undergoing low anterior resection for clinical stage II-III rectal adenocarcinoma between 2010 and 2017. CQM was defined as appropriate neoadjuvant therapy, margin-negative resection, appropriate lymph node assessment, postoperative length of stay (LOS) < 75th percentile, and no 30-day readmission or mortality., Results: 19,721 patients met inclusion criteria; 8,083 (41%) had a CQM. The most common reasons for failure to achieve CQM: inadequate node assessment (27%), prolonged LOS (26%). On Cox modeling, CQM (aHR 0.70, 95% CI [0.66, 0.75]) was associated with improved overall survival., Conclusion: CQM is independently associated with improved survival in rectal cancer and may be an effective measure of quality., Competing Interests: Declaration of competing interest Dr. Singer has associations with Ethicon Inc., Intuitive Surgical Inc., Merck & Co. Inc., and Nestle. The remaining authors have no financial disclosures., (Copyright © 2022 Elsevier Inc. All rights reserved.)
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- 2023
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11. Low and moderate grade retroperitoneal liposarcoma: Is adjuvant radiotherapy associated with improved survival in patients undergoing R1 resection?
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Littau MJ, Bunn C, Kim P, Kulshrestha S, Tonelli C, Abdelsattar ZM, Luchette FA, and Baker MS
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- Humans, Radiotherapy, Adjuvant, Retrospective Studies, Liposarcoma radiotherapy, Liposarcoma surgery, Retroperitoneal Neoplasms radiotherapy, Retroperitoneal Neoplasms surgery
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Background: Few studies evaluate the efficacy of adjuvant radiotherapy (aXRT) in patients with retroperitoneal liposarcoma undergoing resection to histologically positive (R1) margins., Methods: We queried the National Cancer Database to identify patients undergoing R1 resection for localized, large (>5 cm) low and moderate grade retroperitoneal liposarcoma between 2004 and 2016. Kaplan Meier method was used to compare overall survival (OS) for patients receiving aXRT to a 1:2 propensity-matched cohort of patients undergoing resection alone., Results: A total of 322 (76.5%) patients underwent R1 resection alone, while 99 (23.5%) underwent resection followed by aXRT. The 99 receiving aXRT were successfully 1:2 propensity-score matched to 198 undergoing resection alone. There was no difference in 5-year OS between matched cohorts (69.7% vs 76.2%, p = 0.40)., Conclusions: In patients undergoing R1 resection of moderate- and well-differentiated retroperitoneal liposarcoma, use of aXRT is not associated with an improvement in OS., (Published by Elsevier Inc.)
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- 2022
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12. The importance of the margin of resection and radiotherapy in retroperitoneal liposarcoma.
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Littau MJ, Kulshrestha S, Bunn C, Agnew S, Sweigert P, Luchette FA, and Baker MS
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- Aged, Databases, Factual, Female, Humans, Liposarcoma mortality, Male, Middle Aged, Neoadjuvant Therapy, Proportional Hazards Models, Radiotherapy, Adjuvant, Retroperitoneal Neoplasms mortality, Retrospective Studies, Survival Rate, Treatment Outcome, Liposarcoma radiotherapy, Liposarcoma surgery, Margins of Excision, Retroperitoneal Neoplasms radiotherapy, Retroperitoneal Neoplasms surgery
- Abstract
Background: Prior studies evaluating the impact of adjuvant or neoadjuvant radiotherapy on clinical outcomes in retroperitoneal liposarcoma have been underpowered., Methods: We queried the National Cancer Database for patients undergoing resection of retroperitoneal liposarcoma from 2004 to 2016. Cox proportional hazards modeling stratified by tumor size was used to identify factors associated with overall survival., Results: 4018 patients met inclusion criteria. 251 had small (<5 cm), 574 intermediate (5-10 cm), and 3193 large (>10 cm) tumors. Positive surgical margins were correlated with risk of death across all tumor size categories (<5 cm HR 2.33, CI [1.20, 4.55]; 5-10 cm HR 1.49, CI [1.03, 2.14]; >10 cm HR 1.30, CI [1.12, 1.51]). Adjuvant radiotherapy was associated with improved survival for patients with large tumors only (HR 0.75, CI [0.64, 0.89])., Conclusions: In retroperitoneal liposarcoma, adjuvant radiation is associated with improved survival only for patients with tumors larger than 10 cm. Radiation should be used sparingly in patients with smaller tumors., Summary: The use of radiotherapy in the management of retroperitoneal sarcoma remains controversial. We isolated retroperitoneal liposarcomas only and identified a survival benefit from radiotherapy treatment only in tumors larger than 10 cm and only in the adjuvant setting., (Published by Elsevier Inc.)
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- 2021
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13. The importance of the margin of resection and external radiation in non-lipomatous retroperitoneal sarcoma.
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Littau MJ, Kulshrestha S, Bunn C, Agnew S, Sweigert P, Luchette FA, and Baker MS
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- Adult, Aged, Databases, Factual, Female, Humans, Male, Middle Aged, Neoadjuvant Therapy, Radiotherapy, Adjuvant, Retroperitoneal Neoplasms pathology, Retrospective Studies, Sarcoma pathology, Treatment Outcome, Margins of Excision, Retroperitoneal Neoplasms radiotherapy, Retroperitoneal Neoplasms surgery, Sarcoma radiotherapy, Sarcoma surgery
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Background: Prior studies evaluating the impact of adjuvant or neoadjuvant radiation on clinical outcomes of patients with non-lipomatous retroperitoneal sarcoma have been underpowered., Methods: We queried the National Cancer Database to identify patients undergoing surgical resection of retroperitoneal sarcoma with non-lipomatous histology from 2004 to 2016. Multivariable logistic regression and Cox proportional hazards modelling with patients stratified by tumor size were used to identify factors associated with overall survival., Results: 3,394 patients met inclusion criteria. 592 had small (<5 cm), 1,186 had intermediate (5-10 cm), and 1,616 had large (>10 cm) tumors. Use of either neoadjuvant or adjuvant radiotherapy was associated with improved survival for patients with intermediate (neoadjuvant HR 0.67, CI [0.46, 0.98]; adjuvant HR 0.61, CI [0.50, 0.76]) and large (neoadjuvant HR 0.50, CI [0.37, 0.68]; adjuvant HR 0.56, CI [0.47, 0.69]) tumors, while adjuvant radiation therapy was associated with a survival benefit for small-sized tumors (HR 0.67, CI [0.46, 0.99])., Conclusions: Radiation therapy is associated with an overall survival benefit in patients presenting undergoing resection of non-lipomatous retroperitoneal sarcoma., (Copyright © 2020 Elsevier Inc. All rights reserved.)
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- 2021
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14. Cervical spine clearance when unable to be cleared clinically: a pooled analysis of combined computed tomography and magnetic resonance imaging.
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Plackett TP, Wright F, Baldea AJ, Mosier MJ, Thomas C, Luchette FA, Ton-That HH, and Esposito TJ
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- Cervical Vertebrae diagnostic imaging, Humans, Cervical Vertebrae injuries, Magnetic Resonance Imaging, Neck Injuries diagnosis, Tomography, X-Ray Computed, Wounds, Nonpenetrating diagnosis
- Abstract
Background: The role of cervical spine magnetic resonance imaging (MRI) in the evaluation of clinically unevaluable blunt trauma patients has been called into question by several recent studies., Methods: A PubMed search was performed for all studies comparing computed tomography and MRI in the assessment of the cervical spine in patients who cannot be evaluated clinically. The radiologic findings and clinical outcomes from each study were collated for analysis., Results: Data for 1,714 patients were available. All patients had a negative computed tomography scan and then underwent an MRI. There were 271 (15.8%) patients who had a previously undocumented finding on MRI with the majority (98.2%) being a ligamentous injury. Only 5 injuries (1.8%) resulted in surgical intervention., Conclusions: MRI identifies additional injuries; however, the vast majority are of minor clinical significance. Routine MRI after a negative computed tomography of the cervical spine is not supported by the current literature., (Published by Elsevier Inc.)
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- 2016
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