Search

Objective: To review the contemporary bladder trauma epidemiology, diagnosis and management over a 12-year period at a level 1 trauma centre in Australia. Patients and Methods: From July 2001 through June 2013, 97 multi-trauma patients at a level 1 trauma centre in Australia were identified to have sustained bladder rupture. Data on demographics, clinical presentation, diagnosis, management and complications were extracted from the TraumaNET database, medical records and health-coding database. Results: Of the 97 patients, 98% of bladder ruptures resulted from blunt trauma mostly from road accidents. There was a male preponderance of 64%. Intra-peritoneal bladder rupture (51%) was the most common type of injury followed by extra-peritoneal bladder ruptures (42%) and combined intra- and extra-peritoneal bladder ruptures (7%). Concomitant pelvic fractures occurred in 78% of patients and concurrent intra-abdominal injuries in 68%. Initial imaging missed 28% of bladder ruptures, with computed tomography with intravenous contrast missing 65% of bladder ruptures. The majority of intra-peritoneal bladder ruptures and 56% of extra-peritoneal bladder ruptures were repaired surgically, with 83% of repairs performed in conjunction with another surgical procedure. The in-hospital mortality rate was 9%, and all deaths were due to concomitant injuries. Conclusion: Traumatic bladder rupture is associated with a 9% mortality rate due to the frequently associated significant concurrent injuries. Computed tomography cystogram or plain cystogram is the imaging modality of choice in diagnosing bladder rupture. Intra-peritoneal bladder ruptures should be repaired surgically, while extra-peritoneal bladder ruptures can be treated conservatively in selected patients. The timing of surgical repair should be coordinated with other specialties. Level of evidence: 4 [ABSTRACT FROM AUTHOR]

Trauma effects the lives of many people around the world; cases may include people involved in a car crash right through to military personnel injured on the battle field. Each situation requires different levels of care and the diagnosis and treatments administered play a large role in the recovery of the trauma victims. In such events it is vital to provide the correct level of care with high efficiency and with minimal errors. However these fast paced situations lead to stressful environments contributing to errors in patient care leading to detrimental consequences of morbidity. Computerized decision support systems have been introduced into the medical industry which have greatly improved patient recovery in trauma care, however such systems are primarily targeted for use in well-established medical facilities. The time it takes to transport an injured victim at the scene to a medical facility also plays an important role in the recovery process; by introducing optical head mounted display systems, remote off site field support can be provided which can enhance effective medical advice offered to both inexperienced through to properly trained medical staff prior, during transport and upon reception at a medical facility. This device is expected to greatly improve the recovery phase of trauma victims and reduce errors in patient treatment and diagnosis both in and out of hospital care. [ABSTRACT FROM AUTHOR]