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Liquid biomarkers are essential in trauma cases and critical care and offer valuable insights into the extent of injury, prognostic predictions, and treatment guidance. They can help assess the severity of organ damage (OD), assist in treatment decisions and forecast patient outcomes. Notably, small extracellular vesicles, particularly those involved in splenic trauma, have been overlooked. Here, we reanalyzed our data and explored whether monocyte-derived small EVs are correlated with AAST score (American Association for the Surgery of Trauma) scoring and are sensitive enough to distinguish the severity of splenic trauma in our explorative study. There was a correlation between monocyte-derived small extracellular vesicles (EVs) and the AAST score (rSp = 0.82, p < 0.001). Specifically, we observed that blood-borne small EVs originating from monocytes (CD9+CD14+ sEVs) were directly correlated with AAST scores. These EVs were found to be significantly elevated in patients with complex spleen injuries (AAST I–IV with hemodynamic instability and need for operative management) in an incremental manner; these patients were typically classified as AAST grade II or higher, which frequently included accompanying solid organ injuries. Our initial discovery shows great promise and warrants further exploration. This could pave a novel future path for a new critical care management approach for splenic injuries. There may also be synergistic effects when combined with extended focused assessment with sonography in trauma (E-FAST) sonography, particularly in triage scenarios, where resource constraints prevent immediate access to a CT scan. [ABSTRACT FROM AUTHOR]

Background: Multi-detector contrast-enhanced abdominal computed tomography (CT) allows for the accurate detection and classification of traumatic splenic injuries, leading to improved patient management. Their effective use requires rapid study interpretation, which can be a challenge on busy emergency radiology services. A machine learning system has the potential to automate the process, potentially leading to a faster clinical response. This study aimed to create such a system. Method: Using the American Association for the Surgery of Trauma (AAST), spleen injuries were classified into 3 classes: normal, low-grade (AAST grade I-III) injuries, and high-grade (AAST grade IV and V) injuries. Employing a 2-stage machine learning strategy, spleens were initially segmented from input CT images and subsequently underwent classification via a 3D dense convolutional neural network (DenseNet). Results: This single-centre retrospective study involved trauma protocol CT scans performed between January 1, 2005, and July 31, 2021, totaling 608 scans with splenic injuries and 608 without. Five board-certified fellowship-trained abdominal radiologists utilizing the AAST injury scoring scale established ground truth labels. The model achieved AUC values of 0.84, 0.69, and 0.90 for normal, low-grade injuries, and high-grade splenic injuries, respectively. Conclusions: Our findings demonstrate the feasibility of automating spleen injury detection using our method with potential applications in improving patient care through radiologist worklist prioritization and injury stratification. Future endeavours should concentrate on further enhancing and optimizing our approach and testing its use in a real-world clinical environment. [ABSTRACT FROM AUTHOR]

The kidney is frequently injured in blunt abdominal trauma, accounting for 10 % of such cases and being the most commonly affected genitourinary organ in all traumas. Pelviureteric junction obstruction (PUJO) is typically a congenital and asymptomatic anatomical dilatation to the renal pelvis. This article reports on a 21-year-old male who ruptured a congenital PUJO following blunt abdominal trauma. He was managed with a retrograde ureteric stent and a staged pyeloplasty. This case highlights a rare case of urogenital injury due to blunt trauma and explores the impact of congenital anomalies can contribute to injury and lead to significant complications.

Copyright of Paediatrics & Family Medicine / Pediatria i Medycyna Rodzinna is the property of Medical Communications Sp. z o.o. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Pancreatic trauma is uncommon and challenging to diagnose. Contrarily, severe injuries to the kidney, spleen, and liver are frequent and typically easy to detect with imaging methods. Pancreas injuries can cause a significant amount of morbidity and mortality. Reviewing the institution's experience with this rather infrequent injury was the goal of this study. Materials and Method: The patients' records were collected from the data records at the tertiary care center for patients who had pancreatic damage and were followed up for a year. The American Association for the Surgery of Trauma pancreatic damage grade scores were assigned to each patient using the radiologic and surgical findings. Clinical examination and CT results were predominantly used to make the diagnosis in patients who underwent non-operative treatment. The data are presented as descriptive statistics. Results: Only 2.2% of the total cases that presented to the trauma center were finalized as pancreatic injuries. Trauma to the abdomen was seen in nearly half the cases brought. Most of the subjects in pancreatic injuries were in grade 3. Mortality was noted maximum for the grade 3 and 4 cases. Conclusions: While high-grade pancreatic injury almost always requires an operational intervention, low-grade pancreatic injury with an intact main pancreatic duct may be effectively handled non-operatively. When possible, distal pancreatectomy with spleen preservation is the ideal procedure for distal pancreatic trans-action. A patient who is hemodynamically stable with complex pancreaticoduodenal damage, which is related to a high death rate, should undergo Whipple resection.

Introduction: The aims of this study were to evaluate the concordance between AAST-CT appendicitis grading criteria, first published in 2014, and surgical findings and to assess the impact of CT staging on the choice of surgical approach. Methods: This was a multi-center retrospective case–control study including 232 consecutive patients undergoing surgery for acute appendicitis and who had undergone preoperative CT evaluation between 1 January 2017 and 1 January 2022. Appendicitis severity was classified in 5 grades. For each degree of severity, the surgical outcome between patients undergoing open and surgical approach was compared. Results: An almost perfect agreement (k = 0.96) was found between CT and surgery in staging acute appendicitis. The vast majority of patients with grade 1 and 2 appendicitis underwent laparoscopic surgical approach and showed low morbidity rate. In patients with grade 3 and 4 appendicitis, laparoscopic approach was adopted in 70% of cases and was associated, if compared to open, with a higher prevalence of postoperative abdominal collections (p = 0.05; fisher's exact test) and a significantly lower prevalence of surgical site infections (p = 0.0007; fisher's exact test). All the patients with grade 5 appendicitis were treated by laparotomy. Conclusions: AAST-CT appendicitis grading system seems to show a relevant prognostic value and a potential impact on the choice of surgical strategy, directing toward a laparoscopic approach in patients with grade 1 and 2, an initial laparoscopic approach, replaceable by the open one, for grade 3 and 4 and an open approach in patients with grade 5. [ABSTRACT FROM AUTHOR]

The liver is one of the most injured organs in both blunt and penetrating trauma. The aim of this study was to identify whether the AAST liver injury grade is predictive of need for intervention, risk of complications and mortality in our patient population, and whether this differs between blunt and penetrating-trauma mechanisms. Retrospective review of all liver injuries from a single high-volume metropolitan trauma centre in South Africa from December 2012 to January 2022. Inclusion criteria were all adults who had sustained traumatic liver injury. Patients were excluded if they were under 15 years of age or had died prior to operation or assessment. Statistical analysis was undertaken using both univariate and multivariate models. 709 patients were included, of which 351 sustained penetrating and 358 blunt trauma. Only 24.3 % of blunt compared to 76.4 % of penetrating trauma patients underwent laparotomy (p < 0.001). In blunt trauma, increasing AAST grade correlated directly with rates of laparotomy with an odds ratio of 1.7 (p < 0.001). In penetrating trauma, there was no statistical significance between increasing AAST grade and the rate of laparotomy. The rate of bile leak was 4.5 % (32/709) and of rebleed was 0.7 % (5/709). Five patients underwent ERCP and endoscopic sphincterotomy for bile leak, and three required angio-embolization for rebleeding. Increasing AAST grades were significantly associated with the odds of bile leak in both blunt and penetrating trauma. There was a statistically significant increase in the odds of a rebleed with increasing AAST grade in penetrating trauma. Five patients rebled, of which three died. Seven patients developed hepatic necrosis. Seventy-six patients died (10 %). There were 34/358 (9 %) deaths in the blunt cohort and 42 /351 (11 %) deaths in the penetrating trauma cohort. AAST grade in isolation is not a good predictor of the need for operation in hepatic trauma. Increasing AAST grade was not found to correlate with increased risk of mortality for both blunt and penetrating hepatic trauma. In both blunt and penetrating trauma, increasing AAST grade is significantly associated with increased bile leak. The need for ERCP and endoscopic sphincterotomy to manage bile leak in our setting is low. Similarly, the rate of rebleeding and of angioembolization was low. [ABSTRACT FROM AUTHOR]

Copyright of Cirugía y Cirujanos is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Traumatic injury of pancreas is rare and difficult to diagnose. In contrast, traumatic injuries to the liver, spleen, and kidney are common and are usually identified with ease by imaging modalities. Injuries to the pancreas may result in considerable morbidity and mortality. The purpose of this study was to review our institutional experience in regard to this relatively infrequent injury. The study design was a retrospective chart review of all adult patients with blunt pancreatic injuries treated at Department of Surgical Gastroenterology, Bangalore Medical College and Research Institute from Jan 2014–Feb 2016 with a minimum follow up period of 1 year. The radiologic and operative findings were used to ascribe the American Association for the Surgery of Trauma (AAST) pancreatic injury grade score for each patient. In patients treated non-operatively, the diagnosis was primarily based on clinical examination and CT findings. Twenty patients (18 men, 2 women) were treated during the study period. Eight patients had AAST grade 3, and 7 had AAST grade 2 pancreatic injuries. One patient with grade 4 injury treated conservatively, presented with acute intraperitoneal bleed, and required laparotomy evacuation of hematoma and ligation of gastroduodenal artery. Another patient who was posted for left nephrectomy (non-functioning kidney) underwent distal pancreatectomy following intra-op finding of pancreatic injury. Of the 20 patients, pancreas-specific complications occurred in two patients (pseudocyst). These two patients were later treated with laparoscopic cystojejunostomy. Ten patients had combined liver injury; however none of them required surgical management. The overall mortality rate in our series was zero. Pancreatic injury is uncommon and usually difficult to diagnose. Because of the subtlety of the ultrasound findings, computed tomography is the preferred method for evaluating suspected pancreatic trauma; however, pancreatic duct injury may not be detected on computed tomography scan except when there is through and through laceration. Low-grade injury in a hemodynamically stable patient can be managed conservatively. High-grade injuries can also be managed conservatively provided that they are hemodynamically stable. However, they should be under constant follow-up as they are more prone for complications. [ABSTRACT FROM AUTHOR]

The Emergency General Surgery (EGS) population is particularly at high risk for readmission. Currently, no system exists to predict which EGS patients are most at risk. We hypothesized that a subset of EGS patients could be identified with increased 30-day unplanned readmission. We also hypothesized that a majority of readmissions occur sooner than the conventional 2-week follow-up period. National Surgical Quality Improvement Program (NSQIP) nonelective general surgery patients were analyzed. Multivariable logistic regression identified factors with increased odds of unplanned readmission. AAST EGS Diagnosis Categories were used to categorize postop ICD-9 codes, and the top 10 CPT codes in each group were analyzed. Readmission rate, the reason for unplanned readmission, and time to readmission were analyzed. A total of 383,726 patients were identified with a readmission rate of 8.1% within 30 d of their primary procedure. The top 50 CPT codes accounted for 84% of EGS readmissions. Increased readmission risk was demonstrated for underweight patients (OR = 1.15, P < 0.05). High-risk hospital characteristics were LOS >2 d, any inpatient pulmonary complications, and discharge to any facility or rehab (all P < 0.05). Surgical site infections cause nearly 25% of readmissions. Intestinal procedures are most frequently readmitted (22% of EGS readmissions), with colorectal procedures having the higher odds of readmission. Most readmissions occur <10 d after discharge. A high-risk subpopulation exists within EGS, and most readmissions occur sooner than a typical 2-week follow-up. Early interventions for high-risk EGS subpopulations may allow for early intervention and reduction of unnecessary healthcare utilization. [ABSTRACT FROM AUTHOR]

The aim of this systematic review is to summarise the evidence on the use of endoscopic ductal stenting in children with grade III pancreatic injury (according to the American Association for the Surgery of Trauma - AAST). To our review we included all patients = 18 years old with endoscopic stenting due to an AAST grade III pancreatic injury from a systematic search and a retrospective chart review in our institution. In total, 34 cases of children were evaluated. In 25 cases (73.5%), the stent was placed across the duct transection site and in seven patients (20.6%) it was a transpapillary stent. Endoscopic stent insertion allowed surgery to be avoided in 79.4% of them. Pseudocysts appeared in 8/34 cases (23.5%). Endoscopic stenting appears to be a promising treatment option in the majority of children with AAST grade III pancreatic injury; more research is needed. [ABSTRACT FROM AUTHOR]

Blunt chest wall injuries are a significant cause of mortality and morbidity in trauma patients. Accurate identification and description of chest wall injuries by the radiologist can aid in guiding proper patient management. The American Association for the Surgery of Trauma (AAST) has devised a classification system based on severity. This article describes the features of each injury grade according to the AAST injury scale and discusses the implications for management. Additionally, common mechanisms of blunt chest trauma and multimodal imaging techniques are discussed. [ABSTRACT FROM AUTHOR]

Background: The World Society for Emergency Surgery determined that for appendicitis managed with appendectomy, there is a paucity of evidence evaluating costs with respect to disease severity. The American Association for the Surgery of Trauma (AAST) disease severity grading system is valid and generalizable for appendicitis. We aimed to evaluate hospitalization costs incurred by patients with increasing disease severity as defined by the AAST. We hypothesized that increasing disease severity would be associated with greater cost.Methods: Single-institution review of adults (≥ 18 years old) undergoing appendectomy for acute appendicitis during 2010-2016. Demographics, comorbidities, operative details, hospital stay, complications, and institutional cost data were collected. AAST grades were assigned by two independent reviewers based on operative findings. Total cost was ascertained from billing data and normalized to median grade I cost. Non-parametric linear regression was utilized to assess the association of several covariates and cost.Results: Evaluated patients (n = 1187) had a median [interquartile range] age of 37 [26-55] and 45% (n = 542) were female. There were 747 (63%) patients with Grade I disease, 219 (19%) with Grade II, 126 (11%) with Grade III, 50 (4%) with Grade IV, and 45 (4%) with Grade V. The median normalized cost of hospitalization was 1 [0.9-1.2]. Increasing AAST grade was associated with increasing cost (ρ = 0.39; p < 0.0001). Length of stay exhibited the strongest association with cost (ρ = 0.5; p < 0.0001), followed by AAST grade (ρ = 0.39), Clavien-Dindo Index (ρ = 0.37; p < 0.0001), age-adjusted Charlson score (ρ = 0.31; p < 0.0001), and surgical wound classification (ρ = 0.3; p < 0.0001).Conclusions: Increasing anatomic severity, as defined by AAST grade, is associated with increasing cost of hospitalization and clinical outcomes. The AAST grade compares favorably to other predictors of cost. Future analyses evaluating appendicitis reimbursement stand to benefit from utilization of the AAST grade. [ABSTRACT FROM AUTHOR]

Background The American Association for the Surgery of Trauma (AAST) developed emergency general surgery (EGS) grading systems for multiple diseases to standardize classification of disease severity. The grading system for breast infections has not been validated. We aimed to validate the AAST breast infection grading system. Methods Multi-institutional retrospective review of all adult patients with a breast infection diagnosis at Mayo Clinic Rochester 1/2015-10/2015 and Pietermaritzburg South African Hospital 1/2010-4/2016 was performed. AAST EGS grades were assigned by two independent reviewers. Inter-rater reliability was measured using the agreement statistic (kappa). Final AAST grade was correlated with patient and treatment factors using Pearson's correlation coefficient. Results Two hundred twenty-five patients were identified: grade I ( n = 152, 67.6%), II ( n = 44, 19.6%), III ( n = 25, 11.1%), IV ( n = 0, 0.0%), and V ( n = 4, 1.8%). At Mayo Clinic Rochester, AAST grades ranged from I-III. The kappa was 1.0, demonstrating 100% agreement between reviewers. Within the South African patients, grades included II, III, and V, with a kappa of 0.34, due to issues of the grading system application to this patient population. Treatment received correlated with AAST grade; less severe breast infections (grade I-II) received more oral antibiotics (correlation [−0.23, P = 0.0004]), however, higher AAST grades (III) received more intravenous antibiotics (correlation 0.29, P <0.0001). Conclusions The AAST EGS breast infection grading system demonstrates reliability and ease for disease classification, and correlates with required treatment, in patients presenting with low-to-moderate severity infections at an academic medical center; however, it needs further refinement before being applicable to patients with more severe disease presenting for treatment in low-/middle-income countries. [ABSTRACT FROM AUTHOR]

Introduction Although many radiologists invoke the surgical classification of renal injury proposed by the American Association for Surgery in Trauma (AAST), there has been only limited work on the role of the AAST system as an imaging stratification. The aim was to determine the inter-rater reliability (IRR) amongst radiologists and urologists using the AAST system. Methods: A 1-year retrospective study of consecutive patients with computed tomography (CT) evidence of renal trauma managed at a Level 1 trauma center. Three radiologists and three urologists independently stratified the presentation CT findings according to the AAST renal trauma classification. Agreement between independent raters and mutually exclusive groups was determined utilizing weighted kappa coefficients. Results: One hundred and one patients were included. Individual inter-observer agreements ranged from 54/101 (53.4%) to 62/101 (61.4%), with corresponding weighted kappa values from 0.61 to 0.69, constituting substantial agreement. Urologists achieved intra-disciplinary agreement in 49 cases (48.5%) and radiologists in 36 cases (35.6%). Six-reader agreement was achieved in 24 cases (23.7%). The AAST grade I injuries had the highest level of agreement, overall. Conclusion: The finding of substantial IRR amongst radiologists and urologists utilizing the AAST system supports continued use of the broad parameters of the AAST system, with some modification in specific categories with lower agreement. [ABSTRACT FROM AUTHOR]

Background: The AAST recently developed an emergency general surgery (EGS) disease grading system to measure anatomic severity. We aimed to validate this grading system for acute pancreatitis and compare cross sectional imaging-based AAST EGS grade and compare with several clinical prediction models. We hypothesize that increased AAST EGS grade would be associated with important physiological and clinical outcomes and is comparable to other severity grading methods.Methods: Single institution retrospective review of adult patients admitted with acute pancreatitis during 10/2014-1/2016 was performed. Patients without imaging were excluded. Imaging, operative, and pathological AAST grades were assigned by two reviewers. Summary and univariate analyses were performed. AUROC analysis was performed comparing AAST EGS grade with other severity scoring systems.Results: There were 297 patients with a mean (±SD) age of 55 ± 17 years; 60% were male. Gallstone pancreatitis was the most common etiology (28%). The overall complication, mortality, and ICU admission rates were 51, 1.3, and 25%, respectively. The AAST EGS imaging grade was comparable to other severity scoring systems that required multifactorial data for readmission, mortality, and length of stay.Conclusions: The AAST EGS grade for acute pancreatitis demonstrates initial validity; patients with increasing AAST EGS grade demonstrated longer hospital and ICU stays, and increased rates of readmission. AAST EGS grades assigned using cross sectional imaging findings were comparable to other severity scoring systems. Further studies should determine the generalizability of the AAST system.Level Of Evidence: IV Study Type: Single institutional retrospective review. [ABSTRACT FROM AUTHOR]

Splenic trauma is a common clinical entity, in diagnosis and management of which computed tomography (CT) and the radiologist play a crucial role. The radiologist must take care to choose the study protocol that provides the greatest possible quantity of information, and must be familiar with the types of splenic lesion and their varied appearances in CT. In this trial, we will review anatomic and physiological factors that influence the appearance of splenic trauma in CT, and we will also address the issue of graduating the severity of damage and its importance in clinical decisions on management of such patients. [ABSTRACT FROM AUTHOR]

OVERVIEW Traumatic liver injury can be defined as any parenchymal damage to the liver secondary to trauma, including hematoma, laceration or avulsion, as well as damage to vascular or biliary structures. The diagnosis of liver injury depends primarily on operative or radiographic findings. Historically the majority of liver injuries were diagnosed intra-operatively and this diagnosis carried a high mortality and frequent morbidity. The introduction of advanced imaging techniques combined with minimally invasive therapies like angiography, endoscopic retrograde cholangiopancreatography (ERCP), percutaneous drainage, and laparoscopy have dramatically changed management of liver injuries. This review examines the diagnosis and management of traumatic liver injury and its evolution from routine operative exploration to a more conservative nonoperative approach. A multidisciplinary approach to the diagnosis and management of the liver injuries has resulted in improved morbidity and mortality while minimizing complications. [ABSTRACT FROM AUTHOR]

Splenic trauma is a common entity of high clinical significance that may have a variety of imaging manifestations. This article reviews splenic anatomy and function, mechanisms of splenic trauma, and the classification and grading of splenic trauma, with a particular focus on contrast-enhanced CT. Heterogeneous early enhancement of the spleen and technical suggestions to minimize this artifact are discussed. Mechanisms of trauma and their classification under the American Association for the Surgery of Trauma are discussed and illustrated. The merits of an alternative classification system by Marmery et al. are also considered. We conclude that knowledge of the mechanisms, classifications, and grades of splenic trauma can assist the clinician in clinical decision making and promote improved patient outcomes. [ABSTRACT FROM AUTHOR]

Kidneys are one of the most commonly affected retroperitoneal organ in trauma cases despite its relatively well-protected location. Renal trauma occurs in 80–95% of urogenital trauma cases and 8–10% of abdominal blunt trauma. Renal trauma in hydronephrotic kidney due to ureteropelvic junction obstruction (UPJO) is a rare entity, despite of high risk of trauma urogenital due to large size and thin parenchyma. In this case we reported blunt renal injury with a congenital abnormality of the kidney. We present a case of abdominal blunt trauma due to motor-vehicle accident in a 23 year old male patient. The patient complaint of visible hematuria since 1 day after falling from motorcycle with right flank hit the road, accompanied with right flank pain. Vital signs were within normal limits. Physical examinations reveal distention of right flank with no sign of peritonitis. Supporting examination with FAST ultrasound revealed grade 4 hydronephrosis with internal echo, suspected blood accumulation inside the kidney. Abdominal CT scan revealed grade IV hydronephrosis of right kidney with thin parenchyma. We performed laparotomy and renal exploration, intraoperatively we found multiple laceration of the kidney into pelvicalyceal system (AAST grade IV) with hematoma inside the right kidney and UPJ stenosis (about 5 cm). We decided to perform right nephrectomy despite of grade IV injury with consideration of poor renal function, long stenosis segment and thin renal parenchyma will cause many complications in the future for the patient. Renal injury in UPJO kidney is a rare entity despite of high risk of injury in this population. Management of renal injury in this population might be not consistent with guideline for renal trauma, and clinical judgement from the physician plays an important role to provide the best treatment for this patient. • Renal trauma occurs in 80–95% of urogenital trauma cases and 8–10% of abdominal blunt trauma. • Renal trauma in hydronephrotic kidney due to ureteropelvic junction obstruction (UPJO) is a rare entity. • Management of renal injury in hydronephrotic kidney due to ureteropelvic junction obstruction (UPJO) might be not consistent with guideline for renal trauma. [ABSTRACT FROM AUTHOR]

Introduction: The injuries of the external male genital organs are seldom described in the written form. The aim of the study was to present of the own material with an attempt to apply the AAST scale for the evaluation of the injury degree, Material and methods: Between January 2004 and June 2006 41 patients with the injuries of their external genital organs were cured. The blunt injuries were 90.2% of all the cases and the penetrating injuries were 9.8%. All the patients were given the operational treatment. The testicles' injuries were found with 48,7% (out this figure 50% were of the 3rd degree, the 4th degree -- 35%t, the 5th degree -- 15%). The scrotum injuries caused by the blunt injuries were found with 19.5% and 4.9% were caused by the penetrating injuries. The penis blunt injuries were found with 17%, the penetrating ones with 4.9% and the mixed injuries with 4.8% of the patient. Results: All the patients were qualified for the operational treatment. The hematoma evacuation (being the result of the blunt mechanism) was necessary for the patients with the scrotum damages. For 4,9% of the patients with the penetrating scrotum damages it was necessary to revise the scrotum with its subsequent suture. Fourteen patients with the testicles' damages had the whitish sheath sutured and it was a must tote remove the testicle. Within the group of patients with the penis injuries, 2 of them had their penises totally guillotine-amputated. The group of 7 patients (17%) were treated operationally depending on the degree of their injuries. Conclusions: It is possible to use the AAST scale for diagnosing of the injuries of the external male genital organs. Every injury (even the smallest one) may cause the infertility, erection disorders, miction and mental health problems, The ultrasonography is idispensable for evaluating the damage degree and for monitoring of the post-trauma evolution. [ABSTRACT FROM AUTHOR]

Objetivo: Determinar la concordancia entre los grados de lesión de la escala AAST (American Association for the Surgery of Trauma) tomográficos y quirúrgicos en lesiones hepáticas, esplénicas y renales por trauma abdominal cerrado. Método: Estudio prospectivo, unicéntrico, observacional, comparativo y transversal, en pacientes mayores de 15 años con lesión hepática, esplénica o renal por trauma abdominal cerrado, sometidos a tomografía abdominal y posterior laparotomía exploradora, en quienes se determinó la concordancia de los grados de lesión AAST tomográficos y quirúrgicos de estos órganos, de marzo de 2017 a diciembre de 2020, en el Hospital Civil de Culiacán, Sinaloa, México., Resultados: Se incluyeron 48 pacientes, con una edad promedio de 27.9 ± 10.9 años; de ellos, 41 eran hombres (85%). La lesión esplénica fue la más frecuente, en 30 pacientes (63%), seguida de la hepática en 20 (42%) y la renal en 15 (31%). La concordancia del grado de lesión AAST entre la tomografía y la cirugía fue baja o moderada, con valores kappa de 0.234 (p < 0.001), 0.419 (p < 0.001) y 0.415 (p < 0.001) para las lesiones hepáticas, esplénicas y renales, respectivamente., Conclusiones: Los grados de lesión AAST tomográficos y quirúrgicos en el hígado, el bazo y los riñones por trauma abdominal cerrado tienen baja y moderada concordancia, y los grados tomográficos son menores que los quirúrgicos.

Background: Stress hyperglycemia is common in trauma patients. Increasing injury severity and hemorrhage trigger hepatic gluconeogenesis, glycogenolysis, peripheral and hepatic insulin resistance. Consequently, we expect glucose levels to rise with injury severity in liver, kidney and spleen injuries. In contrast, we hypothesized that in the most severe form of blunt liver injury, stress hyperglycemia may be absent despite critical injury and hemorrhage. Methods: All patients with documented liver, kidney or spleen injuries, treated at a university hospital between 2000 and 2020 were charted. Demographic, laboratory, radiological, surgical and other data were analyzed. Results: A total of 772 patients were included. In liver (n = 456), spleen (n = 375) and kidney (n = 152) trauma, an increase in injury severity past moderate to severe (according to the American Association for the Surgery of Trauma, AAST III-IV) was associated with a concomitant rise in blood glucose levels independent of the affected organ. While stress-induced hyperglycemia was even more pronounced in the most severe forms (AAST V) of spleen (median 10.7 mmol/L, p < 0.0001) and kidney injuries (median 10.6 mmol/L, p = 0.004), it was absent in AAST V liver injuries, where median blood glucose level even fell (5.6 mmol/L, p < 0.0001). Conclusions: Absence of stress hyperglycemia on hospital admission could be a sign of most severe liver injury (AAST V). Blood glucose should be considered an additional diagnostic criterion for grading liver injury. [ABSTRACT FROM AUTHOR]

Purpose: To address the disagreement about the need for splenic artery embolization (SAE) in medium grade blunt splenic trauma this retrospective study evaluates the clinical outcome of non-operative management (NOM) and the possible impact of a more liberal indication for primary SAE.Method: From 01/2010 to 12/2019 186 patients presented with splenic injury on computed tomography (CT) after blunt abdominal trauma. The extent of splenic injuries according to Marmery, vascular pathologies, active bleeding as well as clinical and laboratory parameters were recorded and analyzed with regard to the success rates of NOM and SAE. Procedural complications and clinical outcome were noted. The number needed to treat (NNT) was determined for a possible extension of the indication for SAE to grade 3 injuries.Results: Of 186 patients 126 were managed non-operatively, 47 underwent primary SAE and twelve splenectomy. NOM was successful in 119/126 (94 %) patients. Conversion rate was significantly higher in patients with active bleeding or vascular pathology. Patients with failed NOM had a significantly greater decrease in haemoglobin and haematocrit levels. Primary SAE was successful in 45/47 (96 %) cases. Major complications occurred in four cases (9%), all managed without sequela. The NNT in grade 3 splenic injuries equals 13.Conclusions: NOM of low to medium-grade blunt splenic trauma has a low failure rate. Presence of active haemorrhage is the most important predictor for failure of NOM. SAE should be reserved for high-grade injuries and visible vascular pathology or active bleeding to avoid a disproportionate increase in the NNT. [ABSTRACT FROM AUTHOR]

Background: To determine if there is an effective alternative to the current standard of computed tomography (CT) grading of pediatric pancreatic injuries. We hypothesized that the Wong grading scale, which is based on the depth and location of the pancreatic laceration, is more predictive of pseudocyst formation than the American Association for the Surgery of Trauma (AAST) scale after nonoperative management of traumatic pancreatic injury in children., Materials and Methods: A retrospective review of children admitted for pancreatic trauma to two level 1 pediatric trauma centers between 2000 and 2012 was conducted. Patients who underwent primary operation were excluded. Initial CT scans were reviewed by two radiologists blinded to clinical outcomes, and injury grades from both scales were assigned. The primary outcome was pseudocyst formation., Results: Fifty-three patients (ages 7 mo-17 y) were included. As per the Wong scale, pseudocysts occurred in 0/20 patients with grade A injuries, 2/17 (12%) with BI/CI injuries, and 9/15 (60%) with BII/CII injuries. Using the AAST scale, pseudocysts developed in 2/27 (7%) patients with grade I/II injuries, 7/20 (35%) patients with III/IV/V injuries, and 1/6 (17%) patients with a scan that was indeterminate between grades II and III. Positive Predictive value, negative predictive value, sensitivity, and specificity for pseudocyst formation were all higher using the Wong scale (AAST/Wong: Positive Predictive value 42%/50%, negative predictive value 91%/94%, sensitivity 80%/82%, and specificity 65%/77%)., Conclusions: The Wong CT grading scale may be superior to the AAST scale for early risk stratification for pseudocyst development after nonoperative management of pediatric pancreatic trauma; however, a larger study is needed for verification of these findings., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objective: Blunt traumatic aortic injury is associated with significant mortality, and increased computed tomography use identifies injuries not previously detected. This study sought to define parameters identifying patients who can benefit from medical management., Methods: We reviewed 4.5 years of blunt traumatic aortic injuries. Injury was classified as grade I (intimal flap or intramural hematoma), II (small pseudoaneurysm <50% circumference), III (large pseudoaneurysm >50% circumference), and IV (rupture/transection). Secondary signs of injury included pseudocoarctation, extensive mediastinal hematoma, and large left hemothorax. Follow-up, including computed tomography, was reviewed., Results: We identified 97 patients: 31 grade I, 35 grade II, 24 grade III, and 7 grade IV; 67(69%) male; mean age 47 ± 18.8 years, mean Injury Severity Score 38.8 ± 14.6; overall survival 76 (78.4%). Secondary signs of injury were found in 30 patients. Overall, 52 (53.6%) underwent repair, 45 undergoing thoracic endovascular aortic repair, with 2 (2.22%) procedure-related deaths, and 7 undergoing open repair. Five patients undergoing thoracic endovascular aortic repair required 7 additional procedures. In 45 medically managed patients, there were 14 deaths (31%), all secondary to associated injuries. Injury Severity Scores of survivors and nonsurvivors were 33 ± 10.8 and 48.6 ± 12.8, respectively (P < .001). Follow-up showed resolution or no change in 21 (91%) and a small increase in 2 grade I injuries., Conclusions: All blunt traumatic aortic injury does not necessitate repair. Stratification by injury grade and secondary signs of injury identifies patients appropriate for medical management. Grade IV injury necessitates emergency procedures and carries high mortality. Grade III injury with secondary signs of injury should be urgently repaired; patients without secondary signs of injury may undergo delayed repair. Grade I and II injuries are amenable to medical management., (Copyright © 2014 The American Association for Thoracic Surgery. All rights reserved.)