| 1. Shyu JY, Khurana B, Soto JA, et al. ACR Appropriateness Criteria® Major Blunt Trauma. J Am Coll Radiol 2020;17:S160-S74. |
Review/Other-Dx |
N/A |
Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for major blunt trauma. |
No results stated in abstract. |
4 |
| 2. Beckmann NM, West OC, Nunez D, Jr., et al. ACR Appropriateness Criteria® Suspected Spine Trauma. J Am Coll Radiol 2019;16:S264-S85. |
Review/Other-Dx |
N/A |
Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for suspected spine trauma. |
No results stated in abstract. |
4 |
| 3. O'Dochartaigh D, Douma M. Prehospital ultrasound of the abdomen and thorax changes trauma patient management: A systematic review. [Review]. Injury. 46(11):2093-102, 2015 Nov. |
Review/Other-Dx |
925 patients |
To assess and grade the evidence that specifically examines whether prehospital ultrasound (PHUS) of the thorax and/or abdomen changes management of the trauma patient. |
992 unique citations were identified, which included eight studies that met inclusion criteria with a total of 925 patients. There are no reports of randomised controlled trials. Heterogeneity exists between the included studies which ranged from a case series to retrospective and prospective non-randomised observational studies. Three studies achieved a 2+ Scottish Intercollegiate Guidelines Networks grade for quality of evidence and the remainder demonstrated a high risk of bias. The three best studies each provided examples of prehospital ultrasound positively changing patient management. |
4 |
| 4. van der Weide L, Popal Z, Terra M, et al. Prehospital ultrasound in the management of trauma patients: Systematic review of the literature. Injury. 50(12):2167-2175, 2019 Dec. |
Review/Other-Dx |
2,889 patients |
To determine the diagnostic accuracy and the effect of prehospital ultrasound performed in (poly)trauma patients |
After screening 3343 articles, nine studies met the inclusion criteria. These included three retrospective and six prospective observational studies, with a total number of 2,889 patients. Five studies report at least one change in polytrauma management, ranging from 6% to 48,9% of the cases. The diagnostic accuracy of prehospital ultrasound was adequate in eight (out of nine) articles. High sensitivity and high specificity were found on several endpoints (pneumothorax, free abdominal fluid, haemoperitoneum, both on site and during transport). |
4 |
| 5. Murphy SP, Hawthorne N, Haase D, Chiku C, Wen J, Rodriguez RM. Low Yield of Clinically Significant Injury With Head-To-Pelvis Computed Tomography in Blunt Trauma Evaluation. Journal of Emergency Medicine. 53(6):865-870, 2017 Dec. |
Observational-Dx |
1236 patients |
To determine the yields of detecting clinically significant injuries (CSIs) with CT in >1 anatomic region. |
The median age of 1236 patients who had CT was 48 years; 69% were male; 51.2% were admitted; and hospital mortality was 4.4%. Yields of CSI with 95% confidence intervals (CIs) were: head/neck region injury 11.3% (9.6-13.3%); chest region injury only 7.9% (6.0-10.4%); abdomen/pelvis region injury only 5.1% (3.7-7.0%); both head/neck and chest CSI 2.8% (1.7-4.5%); both head/neck and abdomen/pelvis CSI 1.6% (0.9-2.9%); and both chest and abdomen/pelvis CSI 1.1% (0.5-2.4%). The yield of CSI in all 3 anatomic regions with head-to-pelvis CT was 0.6% (0.2-1.7%), and 76.7% (68.8-83.1%) of CSIs occurred in isolation. |
2 |
| 6. American College of Radiology. ACR–NASCI–SIR–SPR Practice Parameter for the Performance and Interpretation of Body Computed Tomography Angiography (CTA). Available at: https://gravitas.acr.org/PPTS/GetDocumentView?docId=164+&releaseId=2. |
Review/Other-Dx |
N/A |
Guidance document to promote the safe and effective use of diagnostic and therapeutic radiology by describing specific training, skills and techniques. |
No abstract available. |
4 |
| 7. Roberts J, Watts S, Klim S, Ritchie P, Kelly AM. Yield of serious axial injury from pan scans after blunt trauma in haemodynamically stable low-risk trauma patients. Emergency Medicine Australasia. 31(3):399-404, 2019 06. |
Review/Other-Dx |
104 patients |
To determine the rate of serious axial/truncal injury and emergency intervention in conscious, stable patients undergoing WBCT for blunt trauma in two non-trauma centre EDs in the Victorian trauma system. |
One hundred and four patients were studied. Median age was 45 years; 67% were men. Median injury severity score (ISS) was 1.5 (interquartile range 0-5); only one patient had an ISS =15. Ninety (87%, 78-92%) patients had no defined serious injury. Five (5%) patients had a defined emergency intervention - four trauma centre transfers and one transfusion. Two of these were not trauma-related. |
4 |
| 8. Hajibandeh S, Hajibandeh S, Systematic review: effect of whole-body computed tomography on mortality in trauma patients. [Review]. Journal of Injury & Violence Research. 7(2):64-74, 2015 Jul. |
Review/Other-Dx |
9 Studies |
To review studies investigating the effect of WBCT on mortality in trauma patients. |
Searching the keywords in Medline and PubMed resulted in 178 and 167 articles, respectively. Nine studies met the inclusion criteria and were reviewed. These included 8 retrospective and 1 prospective cohort studies. Mortality was measured as mortality rate or standardised mortality ratio (SMR) in the included studies. |
4 |
| 9. Lee JY, Cho DH, Lee JG, Shin H, Lee YJ, Lee SH. A nomogram predicting the need for abdominal and pelvic computed tomography in blunt trauma patients: A retrospective cohort study. International Journal Of Surgery. 47:127-134, 2017 Nov. |
Observational-Dx |
786 patients |
To develop a nomogram to predict the need for APCT scanning after the primary survey of blunt trauma patients. |
Of 786 patients, 355 (45%) patients had at least 1 injury on APCT scans. Results of multivariate logistic regression analysis showed that independent predictive factors of injuries on APCT scans were as follows: falls (=3 m high); pain (abdominal, back, flank, or pelvic); positive peritoneal signs; abnormal findings on chest radiographs; abnormal findings on pelvic radiographs; and positive findings on focused assessment with ultrasonography for trauma. The nomogram was developed using these parameters. The area under a receiver operating characteristic curve of the multivariate model for discrimination was 0.865 (95% confidence interval, 0.840-0.892). The calibration plot showed good agreement between predicted and observed outcomes. The maximal Youden index was 0.59, corresponding to a cutoff value > 59 points, which was considered the optimal cutoff value for the probability that the injury would be detected on APCT scans. |
4 |
| 10. Leede E, Cardenas TCP, Emigh BJ, et al. Chest and Pelvis X-Rays as a Screening Tool for Abdominal Injury in Geriatric Blunt Trauma Patients. American Surgeon. 88(7):1638-1643, 2022 Jul.Am Surg. 88(7):1638-1643, 2022 Jul. |
Observational-Dx |
202,553 patients |
To evaluate the utility of chest (CXR) and pelvis (PXR) X-ray, as adjuncts to the primary survey, in screening geriatric blunt trauma (GBT) patients for abdominal injury or need for laparotomy. |
A total of 202,553 patients met criteria. Overall, 9% of patients with either positive X-rays had abdominal injury and 2% laparotomy vs. 1.1% and .3% with both negative (P < .001). The specificity for any positive X-ray was 79% for abdominal injury and 78% for laparotomy. The sensitivity was 69% for abdominal injury and laparotomy. The either positive group had fewer ventilator days (.3 vs. .8, P < .0001), longer length of stay (7 vs. 5, P < .0001), and higher mortality (6% vs. 4%, P < .0001) vs both negative. |
2 |
| 11. Rodriguez RM, Canseco K, Baumann BM, et al. Pneumothorax and Hemothorax in the Era of Frequent Chest Computed Tomography for the Evaluation of Adult Patients With Blunt Trauma. Annals of Emergency Medicine. 73(1):58-65, 2019 01.Ann Emerg Med. 73(1):58-65, 2019 01. |
Observational-Dx |
21,382 patients |
To determine the incidence of pneumothorax and hemothorax observed on CT only and the incidence of isolated pneumothorax and hemothorax (pneumothorax and hemothorax occurring without other thoracic injuries), and describe the clinical implications of these injuries. |
Of 21,382 enrolled subjects, 1,064 (5%) had a pneumothorax and 384 (1.8%) had a hemothorax. Of the 8,661 patients who received both a chest radiograph and a chest CT, 910 (10.5%) had a pneumothorax, with 609 (67%) observed on CT only; 319 (3.7%) had a hemothorax, with 254 (80%) observed on CT only. Of 1,117 patients with pneumothorax, hemothorax, or both, 108 (10%) had isolated pneumothorax or hemothorax. Patients with pneumothorax observed on CT only had a lower chest tube placement rate (30% versus 65%; difference in proportions [?] -35%; 95% confidence interval [CI] -28% to 42%), admission rate (94% versus 99%; ? 5%; 95% CI 3% to 8%), and median length of stay (5 versus 6 days; difference 1 day; 95% CI 0 to 2 days) but similar mortality compared with patients with pneumothorax observed on chest radiograph and CT. Patients with hemothorax observed on CT had only a lower chest tube placement rate (49% versus 68%; ? -19%; 95% CI -31% to -5%) but similar admission rate, mortality, and median length of stay compared with patients with hemothorax observed on chest radiograph and CT. Compared with patients with other thoracic injury, those with isolated pneumothorax or hemothorax had a lower chest tube placement rate (20% versus 43%; ? -22%; 95% CI -30% to -13%), median length of stay (4 versus 5 days; difference -1 day; 95% CI -3 to 1 days), and admission rate (44% versus 97%; ? -53%; 95% CI -62% to -43%), with an admission rate comparable to that of patients without pneumothorax or hemothorax (49%). |
2 |
| 12. Rodriguez RM, Friedman B, Langdorf MI, et al. Pulmonary contusion in the pan-scan era. Injury. 47(5):1031-4, 2016 May. |
Observational-Dx |
21,382 |
To determine (1) the frequency of PC diagnosis by chest CT versus chest X-ray (CXR), (2) the frequency of PC-associated thoracic injuries, and (3) PC patient clinical outcomes (mortality, length of stay [LOS], and need for mechanical ventilation), considering patients with PC seen on chest CT only (SOCTO) and isolated PC (PC without other thoracic injury). |
Of 21,382 enrolled subjects, 8661 (40.5%) had both CXR and chest CT and 1012 (11.7%) of these had PC, making it the second most common injury after rib fracture. PC was SOCTO in 739 (73.0%). Most (73.5%) PC patients had other thoracic injury. PC patients had higher admission rates (91.9% versus 61.7%; mean difference 30.2%; 95% confidence interval [CI] 28.1–32.1%) and mortality (4.7% versus 2.0%: mean difference 2.8%; 95% CI 1.6–4.3%) than non-PC patients, but mortality was restricted to patients with other injuries (injury severity scores > 10). Patients with PC SOCTO had low rates of associated mechanical ventilation (4.6%) and patients with isolated PC SOCTO had low mortality (2.6%), comparable to that of patients without PC |
3 |
| 13. Perez MR, Rodriguez RM, Baumann BM, et al. Sternal fracture in the age of pan-scan. [Review]. Injury. 46(7):1324-7, 2015 Jul. |
Observational-Dx |
14,553 |
Widespread chest CT use in trauma evaluation may increase the diagnosis of minor sternal fracture (SF), making former teaching about SF obsolete. We sought to determine: (1) the frequency with which SF patients are diagnosed by CXR versus chest CT under current imaging protocols, (2) the frequency of surgical procedures related to SF diagnosis, (3) SF patient mortality and hospital length of stay comparing patients with isolated sternal fracture (ISF) and sternal fracture with other thoracic injury (SFOTI), and (4) the frequency and yield of cardiac contusion (CC) workups in SF patients. |
Of the 14,553 patients in the NEXUS Chest and Chest CT cohorts, 292 (2.0%) were diagnosed with SF, and 94% of SF were visible on chest CT only. Only one patient (0.4%) had a surgical procedure related to SF diagnosis. Cardiac contusion was diagnosed in 7 (2.4%) of SF patients. SF patient mortality was low (3.8%) and not significantly different than the mortality of patients without SF (3.1%) [mean difference 0.7%; 95% confidence interval (CI) -1.0 to 3.5%]. Only 2 SF patient deaths (0.7%) were attributed to a cardiac cause. SFOTI patients had longer hospital stays but similar mortality to patients with ISF (mean difference 0.8%; 95% CI -4.7% to 12.0). |
2 |
| 14. Raja AS, Mower WR, Nishijima DK, et al. Prevalence and Diagnostic Performance of Isolated and Combined NEXUS Chest CT Decision Criteria. Academic Emergency Medicine. 23(8):863-9, 2016 08. |
Observational-Dx |
11,477 patients |
To determine screening performance of both individual and combined NEXUS Chest CT criteria as predictors of thoracic injury to inform chest CT imaging decisions in "non-low-risk" patients. |
Across the 11 study sites, rates of chest CT performance ranged from 15.5% to 77.2% (median = 43.6%). We found injuries in 1,493/5,169 patients (28.9%) who had chest CT; 269 patients (5.2%) had major clinical injury (e.g., pneumothorax requiring chest tube). With sensitivity of 73.7 (95% confidence interval [CI] = 68.1 to 78.6) and specificity of 83.9 (95% CI = 83.6 to 84.2) for major clinical injury, abnormal chest-x-ray (CXR) was the single most important screening criterion. When patients had only abnormal CXR, injury and major clinical injury prevalences were 60.7% (95% CI = 52.2% to 68.6%) and 12.9% (95% CI = 8.3% to 19.4%), respectively. Injury and major clinical injury prevalences when any other single criterion alone (other than abnormal CXR) was present were 16.8% (95% CI = 15.2% to 18.6%) and 1.1% (95% CI = 0.1% to 1.8%), respectively. Injury and major clinical injury prevalences among patients when two and three criteria (not abnormal CXR) were present were 25.5% (95% CI = 23.1% to 28.0%) and 3.2% (95% CI = 2.3% to 4.4%) and 34.9% (95% CI = 31.0% to 39.0%) and 2.7% (95% CI = 1.6% to 4.5%), respectively. |
2 |
| 15. Macri F, Greffier J, Khasanova E, et al. Minor Blunt Thoracic Trauma in the Emergency Department: Sensitivity and Specificity of Chest Ultralow-Dose Computed Tomography Compared With Conventional Radiography. Annals of Emergency Medicine. 73(6):665-670, 2019 06.Ann Emerg Med. 73(6):665-670, 2019 06. |
Observational-Dx |
104 |
To evaluate the diagnostic performance of chest ultralow-dose computed tomography (CT) compared with chest radiograph for minor blunt thoracic trauma. |
Ultralow-dose CT had a sensitivity and specificity of 100% compared with reference CT in the detection of injuries (187 lesions) in 104 patients. Chest radiograph detected abnormalities in 82 patients (79% of the population), with lower sensitivity and specificity compared with ultralow-dose CT (P<.05). Despite an only fair interobserver agreement for ultralow-dose CT image quality (?=0.26), the diagnostic confidence level was certain for 95.6% of patients (chest radiograph=79.3%). Ultralow-dose CT effective dose (0.203 mSv [SD 0.029 mSv]) was similar (P=.14) to that of chest radiograph (0.175 mSv [SD 0.155 mSv]) and significantly less (P<.001) than that of reference CT (1.193 mSv [SD 0.459 mSv]). |
1 |
| 16. Hagan NE, Berdel HO, Tefft A, Bernard AC. Torso injuries after fall from standing-empiric abdominal or thoracic CT imaging is not indicated. Injury. 51(1):20-25, 2020 Jan. |
Review/Other-Dx |
1,654 |
Falls from standing (FFS) have become the most common mechanism of injury at many trauma centers. Liberal imaging of low energy trauma has questionable value. We hypothesize that torso trauma intervention is rare in the FFS population, and physical examination sufficiently screens for torso injuries needing intervention. |
1,654 patients had a FFS during our study period. 728 had an abdominal or chest CT and a GCS of 15 and comprised the evaluable population. Mean age was 56.5 years. 55.8% were female. The mortality rate was 8%. There were 179 chest injuries in 121 patients, and 54 abdominal injuries in 43 patients. 379 patients had a GCS of 15 and underwent thoracic CT, yet only 11 (3%) underwent intervention. The negative predictive value for physical exam was 100% for chest intervention. 349 patients had a GCS of 15 and abdominal CT, yet only 13 (3.7%) underwent procedural intervention. Abdominal physical exam had a negative predictive value of 99.7% for intervention, but when combined with vital signs, the value was 100%. |
4 |
| 17. Lavingia KS, Collins JN, Soult MC, Terzian WH, Weireter LJ, Britt LD. Torso Computed Tomography Can Be Bypassed after Thorough Trauma Bay Examination of Patients Who Fall from Standing. American Surgeon. 81(8):798-801, 2015 Aug. |
Review/Other-Dx |
147 patients |
To determine if torso (chest and abdomen) computed tomography (CT) could be avoided in patients with ground level falls. |
The trauma service evaluated 156 patients. Nine patients were excluded for intubation or Glasgow Coma Scale (GCS) < 13. Of the 147 remaining, mean age was 69 years, mean GCS was 14.8. A chest CT was obtained in 111 (76%). Eight (7%) had a significant thoracic injury. All patients with significant thoracic injury had positive examination findings. No patient with a normal PE was found to have a significant thoracic injury (negative predictive value of 100%). An abdominal CT was obtained in 86 (59%). Five (6%) were found to have a significant abdominal injury. All patients who had a significant radiographic injury had an abnormal PE (negative predictive value of 100%). In conclusion, thorough history and physical in the trauma bay allow the clinician to obtain selective torso CT imaging. Routine torso CT warrants re-evaluation in low-impact injury mechanisms as there appears to be little benefit compared with the resource utilization and expense. |
4 |
| 18. Parlak S, Civgin E, Besler MS, Gundogdu S. Ground level falls: computed tomography findings and clinical outcomes by age groups. Ulusal Travma ve Acil Cerrahi Dergisi = Turkish Journal of Trauma & Emergency Surgery: TJTES. 29(6):710-716, 2023 Jun. |
Observational-Dx |
1,214 patients |
To determine injury patterns in ground level falls (GLFs) and investigate the effect of age on the severity of injury. |
The mean age was 57 years, and 55.20% of the patients were female. The mortality rate was 0.50%. Injury was detected in 489 (40.30%) patients on CT. Fractures were the most common injury type. Traumatic intracranial hemorrhage was detected in 32 (2.60%) patients. Only three (0.20%) of the 63 patients with rib fractures had concomitant lung injury. The negative predictive value of the physical examination (PE) was 95.80% for chest injury. Intra-abdominal injury was not detected in any of the 116 patients who underwent abdominal CT. Hospitalization was also higher in the =65-year group (p<0.001). All mortalities (n=6) were seen in patients aged =65 years. |
3 |
| 19. Singleton JM, Bilello LA, Canham LS, et al. Chest computed tomography imaging utility for radiographically occult rib fractures in elderly fall-injured patients. The Journal of Trauma and Acute Care Surgery. 86(5):838-843, 2019 05. |
Observational-Dx |
330 emergency department patients |
To determine whether CT-diagnosed rib fractures in elderly fall patients with a normal CXR were associated with increased in-hospital resource utilization or mortality. |
We identified 330 patients, mean age was 84 years (±SD, 9.4 years); 269 (82%) of 330 were admitted. There were 96 (29%) patients with CT-diagnosed rib fracture, 56 (17%) by CT only. Compared with CT, CXR had a sensitivity of 40% (95% confidence interval, 30-50%) and specificity of 99% (95% confidence interval, 97-100%) for rib fracture. A median of two additional radiographically occult rib fractures were identified on CT. Despite an increased hospital admission rate (91% vs. 78%) p = 0.02, there was no difference between patients with and without radiographically occult (CT+ CXR-) rib fracture(s) for: median LOS (4; interquartile range (IQR) 2-7 vs 4, IQR 2-8); p = 0.92), ICU admission (28% vs. 27%) p = 0.62, median ICU LOS (2, IQR 1-8 vs 3, IQR 1-5) p = 0.54, or in-hospital mortality (10.3% vs. 7.3%) p = 0.45. |
2 |
| 20. Beaulieu-Jones BR, Zhu M, Shaikh SP, Brahmbhatt TS, Scantling D, Sanchez SE. Re-thinking the value of cross-sectional torso imaging for ground-level fall patients with altered mental status: Outcomes from a level 1 trauma center. Injury. 55(1):111239, 2024 Jan. |
Observational-Dx |
1195 patients |
To describe the value of performing omputed tomography of the torso (CTT) in patients with AMS after GLF, and hypothesized that CTT would not identify new, clinically significant injuries in patients with a normal torso physical exam (PE) and normal chest and pelvic radiographs (CXR/PXR). |
1195 patients met inclusion criteria; 344 had AMS, of which 129 (37.5 %) underwent CTT. A further 851 patients had normal mental status, of which 180 (21.2 %) underwent CTT. Patients with a normal PE with AMS (N = 79) and without AMS (N = 38) had a similar rate of new injury discovery on CTT (6.3% vs. 7.9 %, p = 1.00). Negative PE had a negative predictive value (NPV) for identification of a new, acute traumatic injury of 92.4 % (95 % CI: 0.84-0.96) in patients with AMS while normal PE, CXR, and PXR had a NPV of 96.0 % (95 % CI: 0.80-0.99). Among patients with CTT, patients with AMS had a significantly lower rate of acute traumatic injury on CTT compared to alert patients (26.4 % vs. 48.9 %, p < 0.001). On multivariate analysis, AMS was not positively associated with likelihood of identifying acute traumatic injury on CTT. |
2 |
| 21. Capelastegui A, Oca R, Iglesias G, Larena JA. MRI in suspected chest wall fractures: diagnostic value in work-related chest blunt trauma. [Review]. Skeletal Radiology. 53(2):275-283, 2024 Feb. |
Observational-Dx |
112 patients |
To describe and analyze MRI findings in suspected early fractures of the chest (ribs and sternum) and assess if this technique can add value in occupational medicine. |
100 patients (82 men, mean age 46 years, range 22-64 years) were included. MRI revealed thoracic wall injuries in 88%: rib and/or sternal fractures in 86% and muscle contusion in the remaining patients. Most patients had multiple ribs fractured, mostly at the chondrocostal junction (n=38). The interobserver agreement was excellent, with minor discrepancies in the total number of ribs fractured. The mean time to return-to-work was 41 days, with statistically significant correlation with the number of fractures. Time to return-to-work increased in displaced fractures, sternal fractures, extraosseous complications, and with age. |
2 |
| 22. Zhang T, Wu J, Chen YC, Wu X, Lu L, Mao C. Magnetic Resonance Imaging has Better Accuracy in Detecting New-Onset Rib Fractures as Compared to Computed Tomography. Medical Science Monitor. 27:e928463, 2021 Jan 11. |
Observational-Dx |
21 |
The aim of this study was to explore the magnetic resonance imaging (MRI) manifestations of new-onset rib fractures and determine the utility of MRI through a comparative study of MRI and computed tomography (CT). |
Seventy-seven rib fractures were confirmed by CT rescanning, of which 72 (93.51%) were type I fractures and 5 (6.49%) were type II. MRI identified 76 fractures, of which 3 were false positive, with the diagnostic accuracy rate of 91.25% and sensitivity rate of 94.81%. Among them, type I fractures (n=71, 3 were false positive) showed the MRI “sandwich” sign (heterogeneous high-signal shadow within bone marrow of the inner layer, low-signal bony cortex of the middle layer, and high-signal subperiosteal effusion of the outer layer) in T2-weighted fat-suppressed sequences; type II fractures (n=5) displayed intramedullary high-signal intensities and no subperiosteal effusion. Forty-four fractures (all type I) were discovered in the initial CT examination, and the corresponding diagnostic accuracy rate and sensitivity rate were 57.14%, which were lower than that of MRI. |
2 |
| 23. Hayashi D, Roemer FW, Kohler R, Guermazi A, Gebers C, De Villiers R. Thoracic injuries in professional rugby players: mechanisms of injury and imaging characteristics. [Review]. British Journal of Sports Medicine. 48(14):1097-101, 2014 Jul. |
Review/Other-Dx |
N/A |
To present data on incidence of thoracic injuries in professional rugby playersTo describe the anatomy of the joints comprising the thoracic cage and major muscles attached to the rib cageTo discuss indications and relevance for MRI and presented an optimised MRI protocol for assessment of suspected thoracic injuryTo illustrate various types of thoracic injuries seen in professional rugby players, including sternal contusion, retrosternal haematoma, manubriosternal disruption, sternoclavicular dislocation, rib fractures and injuries of the pectoralis major muscle |
No results in abstract. |
4 |
| 24. Henry TS, Donnelly EF, et al. ACR Appropriateness Criteria® Rib Fractures. J Am Coll Radiol. 2019 May;16(5S):S1546-1440(19)30160-7. |
Review/Other-Dx |
N/A |
Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for rib fractures. |
No results stated in abstract. |
4 |
| 25. Harris JH Jr, Harris WH, Jain S, Ferguson AY, Hill DA, Trahan AM. To reduce routine computed tomographic angiography for thoracic aortic injury assessment in level II blunt trauma patients using three mediastinal signs on the initial chest radiograph: a preliminary report. Emergency Radiology. 25(4):387-391, 2018 Aug. |
Observational-Dx |
197 patients |
To evaluate the role of three specifically selected mediastinal anatomic signs on the initial supine chest radiograph (CXR) of adult level II blunt thoraco-abdominally injured patients for the presence or absence of a mediastinal hematoma. |
Two or three of the selected mediastinal signs were normal in 192 (97.5%) patients. None of these patients had either a mediastinal hematoma or a major aortic injury on CTA. In each of the remaining five (2.5%) patients, two or three of the mediastinal signs were abnormal. Each of these patients had a mediastinal hematoma and a major thoracic aortic injury on CTA. |
2 |
| 26. Lewis BT, Herr KD, Hamlin SA, et al. Imaging Manifestations of Chest Trauma. Radiographics. 41(5):1321-1334, 2021 Sep-Oct.Radiographics. 41(5):1321-1334, 2021 Sep-Oct. |
Review/Other-Dx |
N/A |
In-depth exploration of the most common types of pulmonary parenchymal, pleural, and airway injuries. |
No results stated in abstract. |
4 |
| 27. Newbury A, Dorfman JD, Lo HS. Imaging and Management of Thoracic Trauma. [Review]. Seminars in Ultrasound, CT & MR. 39(4):347-354, 2018 Aug. |
Review/Other-Dx |
N/A |
Focus on the etiologies, signs and symptoms, imaging, and management of several life-threatening thoracic injuries including tracheobronchial rupture, pulmonary parenchymal injury, hemothorax, pneumothorax, diaphragmatic rupture, and axial skeleton injury. |
No results stated in abstract. |
4 |
| 28. Polireddy K, Hoff C, Kinger NP, Tran A, Maddu K. Blunt thoracic trauma: role of chest radiography and comparison with CT - findings and literature review. [Review]. Emergency Radiology. 29(4):743-755, 2022 Aug. |
Review/Other-Dx |
N/A |
Discusses demographic information, mechanism of specific injuries, common imaging findings, imaging pearls, and pitfalls and exhibits several classic imaging findings in blunt chest trauma. |
No results stated in abstract. |
4 |
| 29. Tataroglu O, Erdogan ST, Erdogan MO, et al. Diagnostic Accuracy of InitiaI Chest X-Rays in Thorax Trauma. Jcpsp, Journal of the College of Physicians & Surgeons - Pakistan. 28(7):546-548, 2018 Jul. |
Review/Other-Dx |
23 patients |
To evaluate the efficacy, sensitivity and specificity of chest x-ray as a diagnostic imaging tool in management of thorax traumas. |
Nine of 23 pneumothorax patients were diagnosed by chest X-ray. Sensitivity and specificity of PA chest X-ray in the diagnosis of pneumothorax was 39.1% and 100%, respectively. Positive predictive values of chest X-ray for diagnosis of pneumothorax was 100% and negative predictive value was 97.1%. Twenty-four patients had pleural effusions on CT scans, while only 15 could be diagnosed in chest X-rays. Chest X-rays were 62.5% sensitive and 100% specific with positive and negative predictive values of 100% and 98.1%, respectively. Twenty of 41 rib fractures were diagnosed with X-rays. Chest x rays had a 48.8% sensitivity and 100% specificity, and positive and negative predictive values were 100% and 95.6%, respectively. |
4 |
| 30. Nishimura E, Finger A, Harris M, Yoon HC. One-View Chest Radiograph for Initial Management of Most Ambulatory Patients with Rib Pain. Journal of the American Board of Family Medicine: JABFM. 34(1):144-150, 2021 Jan-Feb. |
Review/Other-Dx |
878 male, 913 female |
The objective of this study was to compare the efficacy of rib series to a single view posteroanterior chest radiograph in the clinical management of most ambulatory patients with rib pain. |
One thousand seven hundred ninety-one rib series were performed during the study period. Of these, 1168 (65.2%) rib series were performed because of trauma as reported in the clinical indication (trauma cohort). Six hundred twenty-three (34.8%) of the rib series were performed for clinical indications which did not specify acute trauma (nontrauma cohort). There were 323 (17.9%) rib series that resulted in a fracture diagnosis and 95 (5.3%) that resulted in a possible fracture diagnosis. There were 50 (2.8%) effusions, 7 (0.4%), pneumothoraces, and 1 (0.1%) hemothorax detected. Two patients, 1 each from the trauma and nontrauma cohorts, underwent subsequent intervention during the follow-up period. In both cases, the findings which led to the subsequent intervention could be seen on the initial posteroanterior chest radiograph. |
4 |
| 31. Zhang L, McMahon CJ, Shah S, Wu JS, Eisenberg RL, Kung JW. Clinical and Radiologic Predictive Factors of Rib Fractures in Outpatients With Chest Pain. [Review]. Current Problems in Diagnostic Radiology. 47(2):94-97, 2018 Mar - Apr. |
Observational-Dx |
339 patients |
To identify the clinical and radiologic predictive factors of rib fractures in stable adult outpatients presenting with chest pain and to determine the utility of dedicated rib radiographs in this population of patients. |
Of the 339 patients, 53 (15.6%) had at least 1 rib fracture. Only 20 of the 53 (37.7%) patients' fractures could be identified on the frontal chest radiograph. The frontal chest radiograph had a sensitivity of 38% and specificity of 100% when using the rib series as the reference standard. No pneumothorax, new mediastinal widening or pulmonary contusion was identified. Multiple variable logistic regression analysis of clinical factors associated with the presence of rib fractures revealed a significant association of trauma history (odds ratio 5.7 [p < 0.05]) and age =40 (odds radio 3.1 [p < 0.05]). Multiple variable logistic regression analysis of radiographic factors associated with rib fractures in this population demonstrated a significant association of pleural effusion with rib fractures (odds ratio 18.9 [p < 0.05]). Patients with rib fractures received narcotic analgesia in 47.2% of the cases, significantly more than those without rib fractures (21.3%, p < 0.05). None of the patients required hospitalization. |
2 |
| 32. Battle C, Hayward S, Eggert S, Evans PA. Comparison of the use of lung ultrasound and chest radiography in the diagnosis of rib fractures: a systematic review. Emergency Medicine Journal. 36(3):185-190, 2019 Mar. |
Review/Other-Dx |
13 studies |
The aim of this systematic review was to investigate whether the use of lung ultrasound is superior in accuracy to chest radiography, in the diagnosis of rib fractures following blunt chest wall trauma. |
13 studies were included. Overall, study results demonstrated that the use of lung ultrasound in the diagnosis of rib fractures in blunt chest wall trauma patients appears superior compared with chest radiograph. All studies were small, single centre and considered to be at risk of bias on quality assessment. Meta-analysis was not possible due to high levels of heterogeneity, lack of appropriate reference standard and poor study quality. |
4 |
| 33. Tian H, Zhang T, Zhou Y, Rastogi S, Choudhury R, Iqbal J. Role of emergency chest ultrasound in traumatic pneumothorax. An updated meta-analysis. [Review]. Medical Ultrasonography. 25(1):66-71, 2023 Mar 30. |
Meta-analysis |
12 studies |
To assess chest ultrasound (US) diagnostic accuracy in pneumothorax diagnosing. |
Twelve articles were finally chosen for quantitative analysis. The overall sensitivity of US scan in pneumothorax diagnosis was 89% (95%CI 86-91%). Specificity was 96% (95%CI 95-97%). The diagnostic odds ratio was 193.94 (59.009-637.40) at 95%CI, thus demonstrating high chest US accuracy in pneumothorax diagnosis. |
Not Assessed |
| 34. Celik A, Akoglu H, Omercikoglu S, et al. The Diagnostic Accuracy of Ultrasonography for the Diagnosis of Rib Fractures in Patients Presenting to Emergency Department With Blunt Chest Trauma. Journal of Emergency Medicine. 60(1):90-97, 2021 Jan. |
Observational-Dx |
145 adult patients who presented to the ED with thoracic pain after BCT |
To compare the diagnostic accuracy of US with CT for the detection of rib fractures in patients who presented to emergency department (ED) with blunt chest trauma (BCT). |
The final study population included 145 patients. The diagnostic accuracy of US was 80% with a sensitivity of 91.2% and specificity of 72.7% for the detection of any rib fracture (positive likelihood ratio 3.4 and negative likelihood ratio 0.12). If we considered each rib separately, the sensitivity of US decreased to 76.7% and specificity increased to 82.7% (81.3% accuracy). |
1 |
| 35. Zanobetti M, Coppa A, Nazerian P, et al. Chest Abdominal-Focused Assessment Sonography for Trauma during the primary survey in the Emergency Department: the CA-FAST protocol. European Journal of Trauma & Emergency Surgery. 44(6):805-810, 2018 Dec.Eur. j. trauma emerg. surg.. 44(6):805-810, 2018 Dec. |
Observational-Dx |
601 patients |
To evaluate the feasibility of a new protocol, Chest Abdominal-Focused Assessment Sonography for Trauma (CA-FAST), during the primary survey and to estimate its diagnostic accuracy when compared with thoracoabdominal computed tomography (CT) scan. |
Six hundred and one patients were enrolled. The mean time for protocol execution was 7 ± 3 min. Chest ultrasonography showed the following results (all p < 0.001): LCs sensitivity 59 %, specificity 98 %, positive predictive value (PPV) 92 %, negative predictive value (NPV) 86 %, accuracy 87 %; PTX sensitivity 84 %, specificity 98 %, PPV 93 %, NPV 95 %, accuracy 95 %; HTX sensitivity 82 %, specificity 97 %, PPV 87 %, NPV 95 %, accuracy 94 %. The standard 4-views FAST examination showed a diagnostic accuracy of 91 % with a sensitivity of 75 %, specificity of 96 %, PPV of 81 % and NPV of 94 %. |
2 |
| 36. Netherton S, Milenkovic V, Taylor M, Davis PJ. Diagnostic accuracy of eFAST in the trauma patient: a systematic review and meta-analysis. CJEM Canadian Journal of Emergency Medical Care. 21(6):727-738, 2019 11. |
Review/Other-Dx |
75 studies |
To search Medline and Embase from inception through October 2018, for diagnostic studies examining the sensitivity and specificity of the eFAST exam. |
Seventy-five studies representing 24,350 patients satisfied our selection criteria. Studies were published between 1989 and 2017. Pooled sensitivities and specificities were calculated for the detection of pneumothorax (69% and 99% respectively), pericardial effusion (91% and 94% respectively), and intra-abdominal free fluid (74% and 98% respectively). Sub-group analysis was completed for detection of intra-abdominal free fluid in hypotensive (sensitivity 74% and specificity 95%), adult normotensive (sensitivity 76% and specificity 98%) and pediatric patients (sensitivity 71% and specificity 95%). |
4 |
| 37. Gilbertson J, Pageau P, Ritcey B, et al. Test Characteristics of Chest Ultrasonography for Rib Fractures Following Blunt Chest Trauma: A Systematic Review and Meta-analysis. Annals of Emergency Medicine. 79(6):529-539, 2022 06. |
Meta-analysis |
6 studies (n = 663) |
To summarize the evidence comparing the test characteristics of chest ultrasonography to CT in diagnosing rib fractures. |
From 1,660 citations, we identified 7 studies for inclusion, of which 6 had available 2×2 data for meta-analysis (n = 663). Of the 6 studies, 3 involved emergency department-performed ultrasonography and 3 radiology-performed ultrasonography. Chest ultrasonography had a pooled sensitivity of 89.3% (95% confidence interval [CI], 81.1 to 94.3) and specificity of 98.4% (95% CI, 90.2 to 99.8) compared with CT imaging for the diagnosis of any rib fracture. The finding of a fracture on ultrasonography, defined as an underlying cortical irregularity, was associated with a +likelihood ratio (LR) of 55.7 (95% CI, 8.5 to 363.4) for CT diagnosed rib fracture, while the absence of ultrasonography fracture held a -LR of 0.11 (95% CI, 0.06 to 0.20). We were unable to detect a difference in test characteristics between emergency department- and radiology-performed ultrasonography (P=.11). The overall risk of bias of included studies was high, with patient selection identified as the highest risk domain. |
Good |
| 38. Alrajab S, Youssef AM, Akkus NI, Caldito G. Pleural ultrasonography versus chest radiography for the diagnosis of pneumothorax: review of the literature and meta-analysis. [Review]. Critical Care (London, England). 17(5):R208, 2013 Sep 23. |
Meta-analysis |
13 articles |
To provide a comprehensive analysis of the current literature comparing ultrasonography and chest radiography for the diagnosis of pneumothorax. |
We reviewed 601 articles and selected 25 original research articles for detailed review. Only 13 articles met all of our inclusion criteria and were included in the final analysis. One study used lung sliding sign alone, 12 studies used lung sliding and comet tail signs, and 6 studies searched for lung point in addition to the other two signs. Ultrasonography had a pooled sensitivity of 78.6% (95% CI, 68.1 to 98.1) and a specificity of 98.4% (95% CI, 97.3 to 99.5). Chest radiography had a pooled sensitivity of 39.8% (95% CI, 29.4 to 50.3) and a specificity of 99.3% (95% CI, 98.4 to 100). Our meta-regression and subgroup analyses indicate that consecutive sampling of patients compared to convenience sampling provided higher sensitivity results for both ultrasonography and chest radiography. Consecutive versus nonconsecutive sampling and trauma versus nontrauma settings were significant sources of heterogeneity. In addition, subgroup analysis showed significant variations related to operator and type of probe used. |
Good |
| 39. Chan KK, Joo DA, McRae AD, et al. Chest ultrasonography versus supine chest radiography for diagnosis of pneumothorax in trauma patients in the emergency department. Cochrane Database of Systematic Reviews. 7:CD013031, 2020 07 23. |
Meta-analysis |
13 studies |
To compare the diagnostic accuracy of chest ultrasonography (CUS) by frontline non-radiologist physicians versus chest X-ray (CXR) for diagnosis of pneumothorax in trauma patients in the emergency department (ED). To investigate the effects of potential sources of heterogeneity such as type of CUS operator (frontline non-radiologist physicians), type of trauma (blunt vs penetrating), and type of US probe on test accuracy. |
We included 13 studies of which nine (410 traumatic pneumothorax patients out of 1271 patients) used patients as the unit of analysis; we thus included them in the primary analysis. The remaining four studies used lung field as the unit of analysis and we included them in the secondary analysis. We judged all studies to be at high or unclear risk of bias in one or more domains, with most studies (11/13, 85%) being judged at high or unclear risk of bias in the patient selection domain. There was substantial heterogeneity in the sensitivity of supine CXR amongst the included studies. In the primary analysis, the summary sensitivity and specificity of CUS were 0.91 (95% confidence interval (CI) 0.85 to 0.94) and 0.99 (95% CI 0.97 to 1.00); and the summary sensitivity and specificity of supine CXR were 0.47 (95% CI 0.31 to 0.63) and 1.00 (95% CI 0.97 to 1.00). There was a significant difference in the sensitivity of CUS compared to CXR with an absolute difference in sensitivity of 0.44 (95% CI 0.27 to 0.61; P < 0.001). In contrast, CUS and CXR had similar specificities: comparing CUS to CXR, the absolute difference in specificity was -0.007 (95% CI -0.018 to 0.005, P = 0.35). The findings imply that in a hypothetical cohort of 100 patients if 30 patients have traumatic pneumothorax (i.e. prevalence of 30%), CUS would miss 3 (95% CI 2 to 4) cases (false negatives) and overdiagnose 1 (95% CI 0 to 2) of those without pneumothorax (false positives); while CXR would miss 16 (95% CI 11 to 21) cases with 0 (95% CI 0 to 2) overdiagnosis of those who do not have pneumothorax. |
Good |
| 40. Santorelli JE, Chau H, Godat L, Casola G, Doucet JJ, Costantini TW. Not so FAST-Chest ultrasound underdiagnoses traumatic pneumothorax. The Journal of Trauma and Acute Care Surgery. 92(1):44-48, 2022 01 01.J Trauma Acute Care Surg. 92(1):44-48, 2022 01 01. |
Observational-Dx |
568 patients diagnosed with pneumothorax |
To hypothesize that the sensitivity of complete ultrasonography of trauma (CUST) would be greater than initial supine chest radiograph (CXR) for detecting pneumothorax. |
There were 568 patients screened with a diagnosis of pneumothorax, identifying 362 patients with a confirmed pneumothorax in addition to CXR, CUST, and confirmatory CT imaging. The population was 83% male, had a mean age of 45 years, with 85% presenting due to blunt trauma. Sensitivity of CXR for detecting pneumothorax was 43%, while the sensitivity of CUST was 35%. After removal of occult pneumothorax (n = 171), CXR was 78% sensitive, while CUST was 65% sensitive (p < 0.01). In this subgroup, CUST had a false-negative rate of 36% (n = 62). Of those patients with a false-negative CUST, 50% (n = 31) underwent tube thoracostomy, with 85% requiring immediate placement. |
3 |
| 41. DeLoach JP, Reif RJ, Smedley WA, et al. Are Chest Radiographs or Ultrasound More Accurate in Predicting a Pneumothorax or Need for a Thoracostomy Tube in Trauma Patients?. American Surgeon. 89(9):3751-3756, 2023 Sep. |
Observational-Dx |
580 patients older than 17 years who underwent a diagnostic eFAST of the chest |
To compare compared pneumothorax (PTX) detection rates on initial chest radiographs (CXR) and chest ultrasound (CUS) to those on thoracic computed tomography (CT) scans. |
580 patients were included in the analysis after excluding patients without a chest CT scan within 2 hours of arrival. Extended Focused Assessment with Sonography in Trauma was 68.4% sensitive and 87.5% specific for detecting a moderate-to-large PTX on chest CT, while CXR was 23.5% sensitive and 86.3% specific. Extended Focused Assessment with Sonography in Trauma was 69.8% sensitive for predicting the need for tube thoracostomy, while CXR was 40.0% sensitive. |
3 |
| 42. Ackermann O, Berthold D, Fischer C, et al. Fracture sonography - Literature review and current recommendations. Ultraschall in der Medizin. 45(3):269-276, 2024 Jun.Ultraschall Med. 45(3):269-276, 2024 Jun. |
Review/Other-Dx |
N/A |
To summarize the key points regarding the individual indications on S2e guidelines for fracture sonography. |
Of the 520 primary literature sources found, 182 sources (146 clinical studies and 36 meta-analyses and systematic reviews) were evaluated after screening and content assessment. 21 indications that allow reasonable application of fracture sonography were identified. |
4 |
| 43. Riccardi A, Spinola MB, Ghiglione V, Licenziato M, Lerza R. PoCUS evaluating blunt thoracic trauma: a retrospective analysis of 18 months of emergency department activity. European journal of orthopaedic surgery & traumatologie. 29(1):31-35, 2019 Jan.Eur. j. orthop. surg. traumatol.. 29(1):31-35, 2019 Jan. |
Observational-Dx |
1672 patients with BTI |
To investigate the role of US in the detection of rib fractures and their complications compared with CXR and to evaluate its role in blunt thoracic injury (BTI). |
Between 1 June 2015 and 31 December 2016, we evaluated 1672 patients with blunt thoracic trauma. We did not apply exclusion criteria. Among these, we reported rib fractures in 689 patients (41.21%). In this group, a PoCUS was performed in 190 patients (27.58%, 101 male, 89 female), with a mean age of 59.48 years (SD 18.541). In 173 patients, a CXR followed PoCUS; among these, 33 patients also underwent a CT scan of the chest, and 16 patients, after initial PoCUS, underwent a CT scan; 1 patient underwent only PoCUS (Table 1). |
4 |
| 44. Abbasi S, Farsi D, Hafezimoghadam P, Fathi M, Zare MA. Accuracy of emergency physician-performed ultrasound in detecting traumatic pneumothorax after a 2-h training course. European Journal of Emergency Medicine. 20(3):173-7, 2013 Jun. |
Observational-Dx |
153 ED patients sustaining thoracic trauma |
To assess the accuracy of ultrasound (US) in diagnosing post-traumatic pneumothorax using a simplified diagnostic algorithm. |
From June 2009 until July 2009, a total of 153 patients were included. US had a sensitivity of 86.4%, a specificity of 100%, a positive predictor value of 100%, and a negative predictor value of 95.6%. Chest radiograph showed a sensitivity of 48.6%, a specificity of 100%, a positive predictor value of 100%, and a negative predictor value of 85.1%. The mean time to perform chest radiograph was 12 min, which was significantly higher than US, with a mean time of 2 min. All missed pneumothoraces in US evaluation were small in size. |
1 |
| 45. DeMasi S, Parker MS, Joyce M, Mulligan K, Feeser S, Balderston JR. Thoracic point-of-care ultrasound is an accurate diagnostic modality for clinically significant traumatic pneumothorax. Academic Emergency Medicine. 30(6):653-661, 2023 06. |
Observational-Dx |
846 trauma patients |
To determine the accuracy of thoracic POCUS performed by emergency physicians for the detection of clinically significant pneumothorax (PTX) in blunt and penetrating trauma patients. |
A total of 846 patients were included, with 803 (95%) sustaining blunt trauma. POCUS identified 13/15 clinically significant PTXs (defined as =35 mm of pleural separation on a blinded overread or placement of a tube thoracostomy prior to CT) with a sensitivity of 87% (95% confidence interval [CI] 58-97), specificity of 100% (95% CI 99-100), positive predictive value of 81% (95% CI 54%-95%), and negative predictive value of 100% (95% CI 99%-100%). The positive likelihood ratio was 484 and the negative likelihood ratio was 0.1. CXR identified eight (53%) clinically significant PTXs, with a sensitivity of 53% (95% CI 27%-78%) and a specificity of 100%, when correlated with the CT. The most common reason for a missed PTX identified on expert-blinded overread was failure to recognize a lung point sign that was present on US. |
3 |
| 46. Butts CC, Cline D, Pariyadath M, Avery MD, Nunn AM, Miller PR. Diagnostic Inaccuracies Using Extended Focused Assessment With Sonography in Trauma for Traumatic Pneumothorax. American Surgeon. 89(6):2272-2275, 2023 Jun. |
Observational-Dx |
94 hemodynamically stable blunt trauma patients |
To evaluate the predictive ability of ultrasound in identifying clinically significant pneumothorax . |
Ninety-four patients received evaluation by all 3 modalities. Of these, 32% were diagnosed with PTX. Sixteen patients (17%) had a clinically significant PTX. Chest X-ray and US both had a sensitivity of 75%; however, US had more than twice as many false positives, resulting in a much lower positive predictive value (63% vs 80%). |
2 |
| 47. Kithinji SM, Lule H, Acan M, Kyomukama L, Muhumuza J, Kyamanywa P. Efficacy of extended focused assessment with sonography for trauma using a portable handheld device for detecting hemothorax in a low resource setting; a multicenter longitudinal study. BMC Medical Imaging. 22(1):211, 2022 12 01. |
Observational-Dx |
104 patients |
Determining the efficacy of extended focused assessment with sonography for trauma (eFAST) in detection of haemothorax using thoracostomy findings as surrogate gold standard in a low resource setting. |
eFAST was found to be superior to chest X-ray with sensitivity of 96.1% versus 45.1% respectively. The accuracy was also higher for eFAST (96.4% versus 49.1%) but the specificity was the same at 100.0%. The area under the curve was higher for eFAST (0.980, P = 0.001 versus 0.725, P = 0.136). Combining eFAST and X-ray increased both sensitivity and accuracy. |
2 |
| 48. Yamazaki T, Hagiwara S, Kawara N, et al. Closed Fracture Diagnosed by Bedside Ultrasonography During Hemodialysis: A Report of Seven Cases and Relevant Clinical Characteristics. Journal of Nippon Medical School = Nihon Ika Daigaku Zasshi. 86(4):230-235, 2019 Sep 03. |
Review/Other-Dx |
7 patients |
Report seven of cases of closed rib or upper-limb fractures diagnosed by bedside ultrasonography during maintenance hemodialysis sessions and describe relevant clinical characteristics. |
We identified seven patients who were injured by falls in their homes. No injuries occurred on the day of dialysis. Five of the 7 patients did not visit the emergency room. All patients complained of persistent unexplained pain during a regular hemodialysis session. Ultrasonography (US) was performed during dialysis sessions, without any reports of pain. Before US evaluation, the sensitivity of radiography for diagnosis of fracture was 25%, while the sensitivity of US was 100%. Compared with other patients in our clinic, these patients were significantly older and had lower serum albumin concentrations and lower hemodialysis efficiency as determined by Kt/V. They also had a higher incidence of diabetes and a greater need for vasopressors during dialysis. These findings were consistent with the results of previous studies of the characteristics of fractures in dialysis patients. However, blood levels of creatinine, corrected calcium, phosphate, intact parathyroid hormone, and hemoglobin, as well as bone density and blood pressure, after the previous dialysis session were not different. |
4 |
| 49. Grade MM, Ehlers PF, Kornblith AE, et al. Effect of the Extended Focused Assessment With Sonography for Trauma on the Screening Performance of the National Emergency X-Radiography Utilization Study Chest Decision Instrument. Annals of Emergency Medicine. 81(4):495-500, 2023 04. |
Observational-Dx |
1,957 patients |
To assess whether eFAST improves the NEXUS Chest clinical decision instrument's diagnostic performance and may replace the chest radiograph (CXR) as a predictor variable. |
One thousand nine hundred fifty-seven patients had documented computed tomography, CXR, clinical NEXUS criteria, and adequate eFAST; 624 (31.9%) patients had blunt thoracic injuries, and 126 (6.4%) had major injuries. Compared to the NEXUS Chest clinical decision instrument, the eFAST-added clinical decision instrument demonstrated unchanged screening performance for major injury (sensitivity 0.98 [0.94 to 1.00], specificity 0.28 [0.26 to 0.30]) or any injury (sensitivity 0.97 [0.95 to 0.98], specificity 0.21 [0.19 to 0.23]). The eFAST-replaced clinical decision instrument demonstrated unchanged sensitivity for major injury (sensitivity 0.93 [0.87 to 0.97], specificity 0.31 [0.29 to 0.34]) and decreased sensitivity for any injury (0.93 [0.91 to 0.951] versus 0.97 [0.953 to 0.98]). |
3 |
| 50. Maximus S, Figueroa C, Whealon M, Pham J, Kuncir E, Barrios C. eFAST for Pneumothorax: Real-Life Application in an Urban Level 1 Center by Trauma Team Members. American Surgeon. 84(2):220-224, 2018 Feb 01. |
Observational-Dx |
369 patients with a diagnosis of PTX |
To investigate the exact sensitivity and specificity of extended FAST (eFAST) detecting traumatic pneumothorax (PTX) during practical "real-life" application. |
A total of 69 patients were excluded, as eFAST was either not performed or not documented, leaving 300 patients identified with PTX. A total of 113 patients had clinically significant PTX (37.6%), requiring immediate tube thoracostomy placement. eFAST yielded a positive diagnosis of PTX in 19 patients (16.8%), and all were clinically significant, requiring tube thoracostomy. Chest X-ray detected clinically significant PTX in 105 patients (92.9%). |
3 |
| 51. Baig A, Drabkin MJ, Khan F, Fogel J, Shah S. Patients with falls from standing height and head or neck injury may not require body CT in the absence of signs or symptoms of body injury. Emergency Radiology. 28(2):239-243, 2021 Apr.EMERG. RADIOL.. 28(2):239-243, 2021 Apr. |
Observational-Dx |
288 patients with CT evidence of acute head/neck injury that underwent body CT |
To determine the rate of clinically impactful body injury among patients who had a fall from standing height with an associated head/neck injury, but without evidence of body injury on physical exam or plain radiographs. We also examine surgical/endovascular intervention related to body injury and mortality rates for head/neck and body injury. |
There were 11.5% (n = 33) with body injury on CT (n = 33). There were 3.1% (n = 9) with clinically impactful body injury. No patient had either surgical/endovascular intervention or mortality related to body injury. Additionally, 8.7% (n = 25) had mortality from head/neck injury. Increased age (OR = 1.05, 95% CI: 1.01, 1.08, p = 0.01) and overweight BMI (25-29.99 kg/m2) (OR = 2.85, 95% CI: 1.07, 7.62, p = 0.04) were each significantly associated with increased odds for mortality from head/neck injury. |
3 |
| 52. Zhu M, O'Brien M, Shaikh SP, et al. Utilization of torso computed tomography for the evaluation of ground level falls: More imaging does not equal better care. Injury. 54(1):105-111, 2023 Jan.Injury. 54(1):105-111, 2023 Jan. |
Observational-Dx |
1,195 patients |
To characterize the use of torso CT imaging for the evaluation of ground level falls (GLF) at a single level 1 trauma center. |
Of the 1,195 patients captured during the study period, 492 patients had a positive torso physical exam (PE), and 703 had a negative torso PE. Of patients with a negative torso PE, 127 CTC and 142 CTAP were obtained, with only 5.5% CTC identifying traumatic injuries not previously diagnosed on chest radiograph (CXR), and only 0.7% CTAP identifying new injuries not identified on pelvic radiograph (PXR). Multivariable logistic regression demonstrated that only a positive PE was significantly associated with the identification of abnormal imaging findings on torso CT. A negative PE, CXR, and PXR have a negative predictive value of 98% |
3 |
| 53. Gross JA, Lehnert BE, Linnau KF, Voelzke BB, Sandstrom CK. Imaging of Urinary System Trauma. [Review]. Radiologic Clinics of North America. 53(4):773-88, ix, 2015 Jul. |
Review/Other-Dx |
N/A |
To review the imaging of blunt urinary system trauma with specific references to penetrating trauma |
No results stated in abstract |
4 |
| 54. Liu J, Yue WD, Du DY. Multi-slice computed tomography for diagnosis of combined thoracoabdominal injury. Chinese Journal of Traumatology. 18(1):27-32, 2015.Chin J Traumatol. 18(1):27-32, 2015. |
Observational-Dx |
86 cases |
To investigate the diagnostic value of multi-slice computed tomography (MSCT) for combined thoracoabdominal injury. |
Among the 86 cases, diaphragm discontinuity was found in 29 cases, segmental nonrecognition of the diaphragm in 14, diaphragmatic hernia in 21, collar sign in 14, dependent viscera sign in 18, elevated abdominal organs in 21, bowel wall thickening and/or hematoma in 6, and pneumoperitoneum in 8. CT diagnostic accuracy for diaphragm rupture was 88.4% in the right side and 90.7% in the left side. CT diagnostic accuracy for hemopneumothorax, pulmonary contusion, mediastinal hemorrhage, kidney and adrenal gland injuries was 100%, while for liver, spleen and pancreas injuries was 96.5%, 96.5%, 94.2% respectively. |
3 |
| 55. Naulet P, Wassel J, Gervaise A, Blum A. Evaluation of the value of abdominopelvic acquisition without contrast injection when performing a whole body CT scan in a patient who may have multiple trauma. Diagnostic and Interventional Imaging. 94(4):410-7, 2013 Apr. |
Observational-Dx |
84 patients |
To evaluate the diagnostic value of non-contrast-enhanced abdominopelvic acquisition when performing a whole body CT scan in a patient who may have multiple trauma. |
This study did not reveal any significant difference, particularly concerning improvement in sensitivity, between interpretation of the acquisitions with contrast injection and interpretation of all the acquisitions with or without injection. Inter-observer agreement was substantial to almost perfect. Non-contrast-enhanced thoraco-abdominopelvic acquisition represented 20% to 25% of the effective dose for the entire examination. |
4 |
| 56. Myers JB, Taylor MB, Brant WO, et al. Process improvement in trauma: traumatic bladder injuries and compliance with recommended imaging evaluation. The Journal of Trauma and Acute Care Surgery. 74(1):264-9, 2013 Jan. |
Observational-Dx |
124 patients with bladder injury |
To determine if poor compliance impacted diagnosis, management, and outcome of patients with bladder injury. |
A total of 124 patients were identified from the trauma registries with bladder injury and adequate records for review. The mean age was 35 years. Blunt trauma occurred in 110 patients (88%). Mean Injury Severity Score was 26.3. The leading concomitant injury was pelvic fracture in 98 patients (79%). Bladder injury was extraperitoneal in 75 patients (60%), intraperitoneal in 39 (31%), and both or undetermined in 10 (8%). A higher risk of death was seen in intraperitoneal with or without concomitant extraperitoneal injury compared with extraperitoneal injury only (odds ratio, 12.4; 95% confidence interval, 2.37-99.2). Management was operative in 68 (55%) patients (95% intraperitoneal, 31% extraperitoneal). Of the 124 injuries, 100 were detected with imaging: standard CT scan in 70 (56%) and cystogram or CT cystogram in 30 (24%). The remaining injuries were discovered operatively or were undocumented (n = 24, 19%). Initial imaging missed or incorrectly diagnosed bladder injury in 13 (13%) patients (nine from standard CT scan and four from CT or plain cystogram). In five cases diagnosed by standard CT scan, extraperitoneal injuries were misdiagnosed as intraperitoneal and operatively explored. |
4 |
| 57. Mahat Y, Leong JY, Chung PH. A contemporary review of adult bladder trauma. [Review]. Journal of Injury & Violence Research. 11(2):101-106, 2019 Jul. |
Review/Other-Dx |
N/A |
To present a contemporary review which encapsulates the etiology, presentation, assessment, and management of bladder injuries. |
No results stated in abstract. |
4 |
| 58. Nicola R, Menias CO, Mellnick V, Bhalla S, Raptis C, Siegel C. Sports-related genitourinary trauma in the male athlete. [Review]. Emergency Radiology. 22(2):157-68, 2015 Apr. |
Review/Other-Dx |
N/A |
To review of the spectrum of genitourinary trauma caused by sports-related injuries. |
No results stated in abstract. |
4 |
| 59. Phillips B, Holzmer S, Turco L, et al. Trauma to the bladder and ureter: a review of diagnosis, management, and prognosis. [Review]. European Journal of Trauma & Emergency Surgery. 43(6):763-773, 2017 Dec. |
Review/Other-Dx |
172 studies |
To review the literature related to the modern diagnosis, management, and prognosis for bladder and ureteral injuries is presented. |
172 potentially relevant studies were identified. Given our focus on modern diagnosis and treatment, we then narrowed the studies in each category to those published within the last 30 years, resulting in a total of 26 studies largely consisting of Level IV retrospective case series. Our review found that bladder ruptures occur from penetrating, blunt, or iatrogenic mechanisms, and most are extraperitoneal (63%). Ureteral injuries are incurred from penetrating mechanisms in 77% of cases. The overall mortality rates for bladder rupture and ureteral injury were 8 and 7%, respectively. |
4 |
| 60. Reddy D, Laher AE, Moeng M, Adam A. Bladder trauma: a guideline of the guidelines. [Review]. BJU International. 133(4):365-374, 2024 04.BJU Int. 133(4):365-374, 2024 04. |
Review/Other-Dx |
6 guidelines |
To identify and review the most up-to-date guidelines pertaining to bladder trauma in a unifying document as an updated primer in the management of all aspects relating to bladder injury. |
A total of six guidelines were included: European Association of Urology (EAU) guidelines on urological trauma (2023), EAU guidelines on paediatric urology (2022), Urotrauma: American Urological Association (AUA) (2020), Kidney and Uro-trauma: World Society of Emergency Surgery and the American Association for the Surgery of Trauma (WSES-AAST) guidelines (2019), Management of blunt force bladder injuries: A practice management guideline from the Eastern Association for the Surgery of Trauma (EAST) (2019), and EAU guidelines on iatrogenic trauma (2012). Recommendations were summarised with the associated supporting level of evidence and strength of recommendation where available. |
4 |
| 61. Bryk DJ, Zhao LC. Guideline of guidelines: a review of urological trauma guidelines. [Review]. BJU International. 117(2):226-34, 2016 Feb. |
Review/Other-Dx |
N/A |
To review the guidelines released in the last decade by several organisations for the optimal evaluation and management of genitourinary injuries (renal, ureteric, bladder, urethral and genital). |
Most recommendations are guided by the American Association for the Surgery of Trauma (AAST) organ injury severity system. Grade A evidence is rare in genitourinary trauma, and most recommendations are based on Grade B or C evidence. The findings of the most recent urological trauma guidelines are summarised. All guidelines recommend conservative management for low-grade injuries. The major difference is for haemodynamically stable patients who have high-grade renal trauma; the SIU guidelines recommend exploratory laparotomy, the EAU guidelines recommend renal exploration only if the injury is vascular, and the AUA guidelines recommend initial conservative management. |
4 |
| 62. Fouladi DF, Shayesteh S, Fishman EK, Chu LC. Imaging of urinary bladder injury: the role of CT cystography. [Review]. Emergency Radiology. 27(1):87-95, 2020 Feb.EMERG. RADIOL.. 27(1):87-95, 2020 Feb. |
Review/Other-Dx |
N/A |
To discuss the role of CT cystography in the evaluation of bladder injuries. |
No results stated in abstract. |
4 |
| 63. Dane B, Baxter AB, Bernstein MP. Imaging Genitourinary Trauma. Radiol Clin North Am. 2017 Mar;55(2):S0033-8389(16)30154-3. |
Review/Other-Dx |
N/A |
To review radiologic imaging in genitourinary trauma |
MDCT can quickly and accurately assess trauma patients for renal, ureteral, and bladder injuries. Moreover, CT guides clinical management triaging patients to those requiring discharge, observation, angioembolization, and surgery. Recognition of urinary tract trauma on initial scan acquisition should prompt delayed excretory phase imaging to identify urine leaks. Urethral and testicular trauma are imaged with retrograde urethrography and sonography, respectively. |
4 |
| 64. Chien LC, Vakil M, Nguyen J, et al. The American Association for the Surgery of Trauma Organ Injury Scale 2018 update for computed tomography-based grading of renal trauma: a primer for the emergency radiologist. [Review]. Emergency Radiology. 27(1):63-73, 2020 Feb. |
Review/Other-Dx |
N/A |
To describe CT findings of the AAST OIS for the kidney according to the 2018 revision, with an emphasis on real-world application, and highlight important differences from the prior grading scheme. |
No results stated in abstract. |
4 |
| 65. Nair AD, Kumar A, Gamanagatti S, Gupta A, Kumar S. CT findings in renovascular injuries following abdominal trauma: a pictorial review. [Review]. Emergency Radiology. 29(3):595-604, 2022 Jun. |
Review/Other-Dx |
N/A |
The revised AAST organ injury scale (OIS) for renal trauma has incorporated CT-diagnosed vascular injuries into renal injury grading which includes pseudoaneurysm and arteriovenous fistula, along with addition of some new descriptors of renovascular injury. |
No results stated in abstract. |
4 |
| 66. McCombie SP, Thyer I, Corcoran NM, et al. The conservative management of renal trauma: a literature review and practical clinical guideline from Australia and New Zealand. [Review]. BJU International. 114 Suppl 1:13-21, 2014 Nov. |
Review/Other-Dx |
n/a |
To review the literature and make practical recommendations regarding the conservative management of renal trauma. |
The literature on the conservative management of renal trauma is reviewed within the framework of the American Association for the Surgery of Trauma (AAST) kidney injury severity scale. Graded recommendations are made regarding several key topics including: imaging, inpatient management, antibiotics, return to activity, and follow-up. Grade IV injuries and intraoperative consults are examined separately in view of the difficulties these groups cause in making appropriate treatment decisions. |
4 |
| 67. Chouhan JD, Winer AG, Johnson C, Weiss JP, Hyacinthe LM. Contemporary evaluation and management of renal trauma. [Review]. Canadian Journal of Urology. 23(2):8191-7, 2016 Apr. |
Review/Other-Dx |
n/a |
In this review, we summarize the evidence and recommendations for the contemporary management of renal trauma including presentation, diagnosis, staging, management, and complications. |
Computed tomography remains a mainstay of radiological evaluation in hemodynamically stable patients. There is a growing body of literature showing that conservative, non-operative management of renal trauma is safe, even for Grade IV-V renal injuries. If surgical exploration is planned due to other injuries, a conservative approach to the kidney can often be utilized. Follow up imaging may be warranted in certain circumstances. Urinoma, delayed bleeding, and hypertension are complications that require follow up. |
4 |
| 68. Patel VA, Popat NP. Essentials of Computed Tomography Imaging of Hematuria. Saudi Journal of Kidney Diseases & Transplantation. 34(1):61-79, 2023 Jan 01.Saudi J Kidney Dis Transpl. 34(1):61-79, 2023 Jan 01. |
Review/Other-Dx |
N/A |
This article briefly reviews the common causes of gross hematuria in adults and their evaluation by CT-based urography. |
No results stated in abstract. |
4 |
| 69. Alabousi A, Patlas MN, Menias CO, et al. Multi-modality imaging of the leaking ureter: why does detection of traumatic and iatrogenic ureteral injuries remain a challenge?. [Review]. Emergency Radiology. 24(4):417-422, 2017 Aug.EMERG. RADIOL.. 24(4):417-422, 2017 Aug. |
Review/Other-Dx |
N/A |
The aim of this pictorial review is to overview the key imaging findings in blunt and penetrating traumatic and iatrogenic injuries of the ureter, as well as to discuss the advantages and disadvantages of different imaging modalities for accurately and rapidly establishing or excluding the diagnosis of ureteral injuries, with an emphasis on MDCT. The potential causes of missed ureteral injuries will also be discussed. |
No results stated in abstract. |
4 |
| 70. Haroon SA, Rahimi H, Merritt A, Baghdanian A, Baghdanian A, LeBedis CA. Computed tomography (CT) in the evaluation of bladder and ureteral trauma: indications, technique, and diagnosis. [Review]. Abdominal Radiology. 44(12):3962-3977, 2019 12. |
Review/Other-Dx |
N/A |
To review the anatomic relationships, mechanisms of injury, and clinical presentation to help physicians determine when bladder and ureteral injuries should be suspected and further imaging should be pursued. |
CT cystography and CT urography are effective tools in identifying potentially serious injuries to the genitourinary system. Timely recognition of these injuries can be crucial for the overall management and prognosis. |
4 |
| 71. Hardee MJ, Lowrance W, Stevens MH, et al. Process improvement in trauma: compliance with recommended imaging evaluation in the diagnosis of high-grade renal injuries. The Journal of Trauma and Acute Care Surgery. 74(2):558-62, 2013 Feb. |
Observational-Dx |
147 patients |
To evaluate compliance with this recommendation among adult Level I trauma centers in Utah. |
A total of 147 patients were identified with injuries of grade 3 or higher, but only 126 had available images for review at the time of the study. Of the 102 patients with a perinephric fluid collection or grade 4 to 5 injuries, delayed images were obtained in 74 (73%). In these patients, 14 (19%) had a collecting system injury. In the 28 patients without delayed images, 7 (25%) were later identified to have a collecting system injury. Of the 21 collecting system injuries, 7 (33%) had a delay in diagnosis because of lack of excretory images obtained on initial evaluation. |
2 |
| 72. Keihani S, Putbrese BE, Rogers DM, et al. Optimal timing of delayed excretory phase computed tomography scan for diagnosis of urinary extravasation after high-grade renal trauma. The Journal of Trauma and Acute Care Surgery. 86(2):274-281, 2019 02. |
Observational-Dx |
326 patients |
To hypothesize that there is an association between excretory phase timing and diagnosis of urinary extravasation and aimed to identify the optimal excretory phase timing for diagnosis of urinary extravasation. |
Overall, 326 patients were included; 245 (75%) had excretory phase CT scans for review either initially (n = 212) or only at their follow-up (n = 33). At initial CT with excretory phase, 46 (22%) of 212 patients were diagnosed with urinary extravasation. Median time between portal venous and excretory phases was 4 minutes (interquartile range, 4-7 minutes). Time of initial excretory phase was significantly greater in those diagnosed with urinary extravasation. Increased time to excretory phase was positively associated with finding urinary extravasation at the initial CT scan after controlling for multiple factors (risk ratio per minute, 1.15; 95% confidence interval, 1.09-1.22; p < 0.001). The optimal delay for detection of urinary extravasation was 9 minutes. |
1 |
| 73. Orcutt D, Lee Z, Maldonado R, Hwang C, Hagedorn JC, Skokan AJ. Ureteral Injuries Secondary to Blunt Abdominal Trauma: A 15-Year Review of Presentation, Management, and Outcomes at a Level 1 Trauma Center. Urology. 164:248-253, 2022 06. |
Review/Other-Dx |
18 patients |
To report our contemporary experience with ureteral injuries secondary to blunt trauma, with diagnostic methods and management stratified according to injury severity. |
Eighteen patients suffered 10 partial and 9 complete ureteral transections. All 16 patients who underwent initial evaluation with computed tomography were correctly graded as having partial or complete transections, and there were no missed injuries. Treatment of partial transections included observation (3/9), retrograde double-J stent placement (4/9), and Heineke-Mikulicz pyeloplasty (2/9). At a median follow-up of 9 (IQR 2-59) months, 8/9 (89%) partial transections were treated successfully. Treatment of complete transections included pyeloplasty (3/9), ureteroureterostomy (4/9), and ureteroneocystostomy (1/9). One patient who underwent attempted reconstruction 6 days after trauma required nephrectomy. At a median follow-up of 32 (IQR 4-82) months, 7/8 (89%) reconstructed complete transections were treated successfully. |
4 |
| 74. Verbeek DO, Burgess AR. Importance of Pelvic Radiography for Initial Trauma Assessment: An Orthopedic Perspective. Journal of Emergency Medicine. 50(6):852-8, 2016 Jun. |
Observational-Dx |
218 patients |
Our aim was to examine the association between selective use of pelvic radiography (PXR) and time to diagnosis of (major) pelvic fractures, as well as prioritization of key immediate interventions (including hip reduction and pelvic arterial embolization). |
Of 218 pelvic fracture patients, 79 (36%) had no initial PXR, and instead had an initial CT scan. Time to first pelvic imaging in those patients was 48 min (standard deviation [SD] = 47 min vs. 2 min [SD = 6 min] with PXR; p < 0.001). Of 40 hip dislocations, 15 (38%) were detected first on CT scan. Overall, 22 (55%) required a second CT scan after reduction in the emergency department. No initial PXR was performed in 42 of 120 (35%) pelvic ring fracture patients and in 16 of 61 (26%) unstable pelvic ring fractures. Time to pelvic arterial embolization was longer in 4 patients without initial PXR than in 14 patients with PXR (296 min [SD = 206 min] vs. 170 min [SD = 76 min], respectively, p = 0.038). |
3 |
| 75. Moura FHB, Parreira JG, Mattos T, et al. Ruling out intra-abdominal injuries in blunt trauma patients using clinical criteria and abdominal ultrasound. Revista do Colegio Brasileiro de Cirurgioes. 44(6):626-632, 2017 Nov-Dec. |
Review/Other-Dx |
5,536 patients |
To identify victims of blunt abdominal trauma in which intra-abdominal injuries can be excluded by clinical criteria and by complete abdominal ultrasonography. |
We studied 5536 victims of blunt trauma. Intra-abdominal lesions with AIS>1 were identified in 144 (2.6%); in patients with hemodynamic stability they were present in 86 (2%); in those with hemodynamic stability and normal neurological exam at admission in 50 (1.8%); in patients with hemodynamic stability and normal neurological and chest physical exam at admission, in 39 (1.5%); in those with hemodynamic stability, normal neurological, chest, abdominal and pelvic physical exam at admission, in 12 (0.5%); in patients with hemodynamic stability, normal neurological, chest, abdominal and pelvic physical exam at admission, and absence of distracting lesions, only two (0.1%) had intra-abdominal lesions. Among those with all clinical variables, 693 had normal total abdominal ultrasound, and, within this group, there were no identified intra-abdominal lesions. |
4 |
| 76. Carter JW, Falco MH, Chopko MS, Flynn WJ Jr, Wiles Iii CE, Guo WA. Do we really rely on fast for decision-making in the management of blunt abdominal trauma?. Injury. 46(5):817-21, 2015 May. |
Observational-Dx |
114 patients |
To examine our hypothesis that Focused Assessment with Sonography in Trauma examination (FAST) is not an efficacious screening tool for identifying intra-abdominal injuries. |
A total of 1671 blunt trauma patients were admitted to and evaluated in the Emergency Department during a 1½ year period and 146 patients were confirmed intra-abdominal injuries by CT and/or laparotomy. Intraoperative findings include injuries to the liver, spleen, kidneys, and bowels. In 114 hemodynamically stable patients, FAST was positive in 25 patients, with a sensitivity of 22%. In 32 hemodynamically unstable patients, FAST was positive in 9 patients, with a sensitivity of 28%. A free peritoneal fluid and splenic injury are associated with a positive FAST on univariate analysis, and are the independent predictors for a positive FAST on multiple logistic regression. |
3 |
| 77. Stengel D, Rademacher G, Ekkernkamp A, Guthoff C, Mutze S. Emergency ultrasound-based algorithms for diagnosing blunt abdominal trauma. [Review]. Cochrane Database of Systematic Reviews. (9)CD004446, 2015 Sep 14. |
Review/Other-Dx |
4 studies |
To assess the effects of diagnostic algorithms using ultrasonography including in FAST examinations in the emergency department in relation to the early, late, and overall mortality of patients with suspected blunt abdominal trauma. |
We identified four studies meeting our inclusion criteria. Overall, trials were of poor to moderate methodological quality. Few trial authors responded to our written inquiries seeking to resolve controversial issues and to obtain individual patient data. Strong heterogeneity amongst the trials prompted discussion between the review authors as to whether the data should or should not be pooled; we decided in favour of a quantitative synthesis to provide a rough impression about the effect sizes achievable with US-based triage algorithms. We pooled mortality data from three trials involving 1254 patients; the RR in favour of the FAST arm was 1.00 (95% CI 0.50 to 2.00). FAST-based pathways reduced the number of CT scans (random-effects model RD -0.52, 95% CI -0.83 to -0.21), but the meaning of this result was unclear. |
4 |
| 78. Serafetinides E, Kitrey ND, Djakovic N, et al. Review of the current management of upper urinary tract injuries by the EAU Trauma Guidelines Panel. [Review]. European Urology. 67(5):930-6, 2015 May.Eur Urol. 67(5):930-6, 2015 May. |
Review/Other-Dx |
N/A |
To present a summary of the 2014 version of the EAU guidelines on upper urinary tract injuries with the emphasis upon diagnosis and treatment. |
No results stated in abstract. |
4 |
| 79. Holmes JF, Wisner DH, McGahan JP, Mower WR, Kuppermann N. Clinical prediction rules for identifying adults at very low risk for intra-abdominal injuries after blunt trauma. Ann Emerg Med 2009;54:575-84. |
Observational-Dx |
3,435 |
To derive and validate clinical prediction rules to identify adult patients at very low risk for intra-abdominal injuries after blunt torso trauma. |
In the derivation phase, we enrolled 3,435 patients, including 311 (9.1%; 95% confidence interval [CI] 8.1% to 10.1%) with intra-abdominal injury and 109 (35.0%; 95% CI 29.7% to 40.6%) with intra-abdominal injury requiring acute intervention. In the validation study, we enrolled 1,595 patients, including 143 (9.0%; 95% CI 7.6% to 10.5%) with intra-abdominal injury. The derived rule for patients with intra-abdominal injuries who were undergoing acute intervention consisted of hypotension, Glasgow Coma Scale (GCS) score less than 14, costal margin tenderness, abdominal tenderness, hematuria level greater than or equal to 25 red blood cells/high powered field, and hematocrit level less than 30% and identified all 44 patients in the validation phase with intra-abdominal injury who were undergoing acute intervention (sensitivity 44/44, 100%; 95% CI 93.4% to 100%). The derived rule for the presence of any intra-abdominal injury consisted of GCS score less than 14, costal margin tenderness, abdominal tenderness, femur fracture, hematuria level greater than or equal to 25 red blood cells/high powered field, hematocrit level less than 30%, and abnormal chest radiograph result (pneumothorax or rib fracture). In the validation phase, the rule for any intra-abdominal injury present had the following test performance: sensitivity 137 of 143 (95.8%; 95% CI 91.1% to 98.4%), specificity 434 of 1,452 (29.9%; 95% CI 27.5% to 32.3%), and negative predictive value 434 of 440 (98.6%; 95% CI 97.1% to 99.5%). |
2 |
| 80. Corwin MT, Sheen L, Kuramoto A, Lamba R, Parthasarathy S, Holmes JF. Utilization of a clinical prediction rule for abdominal-pelvic CT scans in patients with blunt abdominal trauma. Emergency Radiology. 21(6):571-6, 2014 Dec. |
Observational-Dx |
262 patients |
To determine if a clinical prediction (CP) rule to identify patients at low risk for intra-abdominal injury (IAI) is being utilized in patients undergoing abdominal computed tomography (CT) following blunt abdominal trauma. |
The CP rule was positive if any of the following were present: systolic blood pressure <90 mmHg; urinalysis >25 red blood cells/high power field; Glasgow Coma Scale score <14; abdominal tenderness; costal margin tenderness; femur fracture; hematocrit <30 %; or pneumothorax or rib fracture on chest X-ray. The CP rule was negative if all variables were negative. Acute intervention was defined as therapeutic laparotomy or angiographic embolization. All variables in the CP rule were obtained in 218/262 (83 %; 95 % confidence interval (CI), 78, 88 %) patients. Of the 44 patients without complete CP rule assessment, 1 (2.3 %; 95 % CI, 0.1 %, 12.0 %) had an IAI but did not undergo therapeutic intervention. IAI was present in 11 (6.7 %; 95 % CI, 3.4, 11.6 %) of the 165 patients with at least one CP rule positive and 4 (36 %; 95 % CI, 11, 69 %) underwent therapeutic intervention. In the CP rule-negative patients, IAI was identified in 1/53 (1.9 %; 95 % CI, 0, 10.1 %) and no therapeutic intervention was required. |
3 |
| 81. Vasquez M, Cardarelli C, Glaser J, Murthi S, Stein D, Scalea T. The ABC's of Pancreatic Trauma: Airway, Breathing, and Computerized Tomography Scan?. Military Medicine. 182(S1):66-71, 2017 03. |
Observational-Dx |
48 patients |
Missed pancreatic injury carries significant morbidity. Computerized tomography (CT) imaging is useful, but may lack sensitivity to identify pancreatic injury. New-generation CT scanners should improve sensitivity, but this has not been studied. A previous study published in 2002 evaluating the sensitivity for identifying pancreatic injury with single-slice CT scanners yielded a 68% correlation between operative and CT findings. We aim to study the accuracy of modern CT for diagnosis and grading of pancreatic injury. |
48 patients had injuries noted on CT and in the operating room. In this group, 68.8% had CT findings discordant with operative findings. Of these, 78.8% had no injury noted on CT, of which 26.9% required surgical intervention. Seven patients with injury on CT had none identified in the operating room. Based on these results, the sensitivity for CT imaging to identify an injury is 36.4% with a positive predictive value of 68.2%. |
3 |
| 82. Hammer MM, Raptis DA, Mellnick VM, Bhalla S, Raptis CA. Traumatic injuries of the diaphragm: overview of imaging findings and diagnosis. [Review]. Abdominal Radiology. 42(4):1020-1027, 2017 04. |
Review/Other-Dx |
N/A |
To describe the findings and diagnosis of traumatic injuries such as blunt trauma and penetrating trauma. |
No results in abstract. |
4 |
| 83. Reitano E, Cioffi SPB, Airoldi C, Chiara O, La Greca G, Cimbanassi S. Current trends in the diagnosis and management of traumatic diaphragmatic injuries: A systematic review and a diagnostic accuracy meta-analysis of blunt trauma. Injury. 53(11):3586-3595, 2022 Nov.Injury. 53(11):3586-3595, 2022 Nov. |
Review/Other-Dx |
15 studies |
To assess the current diagnostic accuracy of CT-scan in the diagnosis of TDI and describe the management of this type of injury. |
Fifteen studies published between 2001 and 2019 were included. All included studies reported a contrast-enhanced computed tomography as the preferred method to obtain diagnostic imaging. Left-sided TDI was the type of injury most frequently found. False negative TDI at CT-scan were more frequent than false positive TDI (11.13 ± 23.24 vs. 2.66 ± 6.65). Six studies on blunt TDI were included in the meta-analysis, showing a high sensitivity [0.80 (95%CI 0.65-0.90)] and specificity [0.98 (95%CI 0.89-1.00)] of the CT-scan in detecting TDI. Overall, 7 articles reported laparotomy as the method of choice to repair TDI. Only 3 studies reported a laparoscopic and/or thoracoscopic approach to TDI repair. |
4 |
| 84. Sheth HS, Kumar R, DiNella J, Janov C, Kaldas H, Smith RE. Evaluation of Risk Factors for Rectus Sheath Hematoma. Clinical & Applied Thrombosis/Hemostasis. 22(3):292-6, 2016 Apr. |
Observational-Dx |
115 |
Our study aims to evaluate the risk factors for RSH, the outcomes of patients with RSH, and the management of this undesirable complication that could be serious. |
From the cohort, 53 (46.1%) patients were on chronic AC (defined as AC administered to the patient as an outpatient) and 89 (77.4%) patients received AC in the hospital. Anticoagulation therapy was therapeutic in 70 (60.9%) and prophylactic in 19 (16.5%) patients. In all, 42 patients were on warfarin, 37 patients were on UFH, 17 patients were on low-molecular-weight heparin (LMWH). Twenty (22.5%) patients were on oral and parenteral AC simultaneously. The indications for therapeutic AC were venous thromboembolism in 28 (40%), atrial fibrillation in 25 (35.7%), cardiac valve replacement in 8(11.4%), myocardial infarction or angina in 3 (4.3%), and thrombophilia in 3 (4.3%) patients. In our study, 34 (29.6%) patients were on APT (aspirin or clopidogrel). Twenty-nine (25.2%) patients received AC and APT simultaneously.Anticoagulation was the most common risk factor (77.4%) followed by CKD (58.3%), abdominal injections (51.3%), and steroids/immunosuppressant medications (41.7%). Patients who were given subcutaneous abdominal injections: anticoagulant injections were SQ UFHs 6.8%, SQ LMWHs 28.8%, and 64.4% were other medications.Risk factor differences by AC status are reported in Table 3. There were significantly more caucasian (72 of 92 [78.3%]) patients compared to African American patients (6 of 12 [50%]) who had received any form of AC (P = .03). Additionally, more patients had undergone abdominal surgeries in the no AC group and more patients received abdominal injections in the AC group.Rectus sheath hematoma treatment was observation in 44 (38.3%) patients, medical in 57 (49.6%) patients (pain management, transfusion and coagulopathy reversal, emergency team response, and ICU), and surgical in 14 (12.1%) patients.There were 17 (14.8%) deaths; however, RSH was not a direct attributable cause in any patient. Patients who died were similar in demographic characteristics to those who were discharged from the hospital. Discharged patients had more frequently received chronic AC and AC therapy in the hospital. More patients with renal failure died in the hospital. In stepwise logistic regression, mortality was significantly associated with stage 3 or higher CKD (odds ratio [OR] 6.0, P = .03, 95% confidence interval [CI] 1.18-30.4) or required transfusion for RSH treatment (OR 9.3, P = .007, 95% CI 1.83-47.5); chronic AC was less frequently prescribed in patients who died (OR 0.2, P = .02, 95% CI 0.05-0.75).In 43 (48%) patients, AC was reinitiated on average 7 days (range 0-24 days) after the event. None of these patients were readmitted with recurrence of RSH. |
4 |
| 85. Biffl WL, Ball CG, Moore EE, et al. Current use and utility of magnetic resonance cholangiopancreatography, endoscopic retrograde cholangiopancreatography, and pancreatic duct stents: A secondary analysis from the Western Trauma Association multicenter trials group on pancreatic injuries. The Journal of Trauma and Acute Care Surgery. 95(5):719-725, 2023 11 01. |
Observational-Dx |
1,243 patients |
The single most important predictor of pancreas-specific complications (PSCs) after pancreatic trauma is injury to the main pancreatic duct (MPD). Pancreatography has been recommended to evaluate the integrity of the MPD. In addition, pancreatic duct stents have been proposed to prevent or treat PSC. The primary purpose of this study was to determine the accuracy of magnetic resonance cholangiopancreatography (MRCP) in diagnosing MPD injury. We further sought to determine whether stents were effective in preventing PSC or facilitated the resolution of pancreatic leaks or fistulae. |
Thirty-three centers reported on 1,243 patients. A total of 216 underwent pancreatography-137 had MRCP and 115 ERCP, with 36 having both. The sensitivity of MRCP for MPD injury was 37%, the specificity was 94%, the positive predictive value was 77%, and the negative predictive value was 73%. When compared with ERCP, MRCP findings were discordant in 64% of cases. Pancreatic stents were placed in 77 patients; 48 (62%) were to treat PSC, with no clear benefit. Twenty-nine had prophylactic stents placed. There did not appear to be benefit in reduced PSC compared with the entire study group or among patients with high-grade pancreatic injuries. |
3 |
| 86. Debi U, Kaur R, Prasad KK, Sinha SK, Sinha A, Singh K. Pancreatic trauma: a concise review. [Review]. World Journal of Gastroenterology. 19(47):9003-11, 2013 Dec 21. |
Review/Other-Dx |
N/A |
Imaging plays an important role in diagnosis of pancreatic injuries because early recognition of the disruption of the main pancreatic duct is important. We reviewed our experience with the use of various imaging modalities for diagnosis of blunt pancreatic trauma. |
No results stated in abstract. |
4 |
| 87. Shreffler J, Smiley A, Schultz M, et al. Patients with Abrasion or Ecchymosis Seat Belt Sign Have High Risk for Abdominal Injury, but Initial Computed Tomography is 100% Sensitive. Journal of Emergency Medicine. 59(4):491-498, 2020 Oct. |
Experimental-Dx |
425 |
The purpose of this study is to 1) describe a large cohort of patients by type of ASBS and 2) determine the value of computed tomography (CT) of the abdomen and pelvis as a screening tool to rule out intra-abdominal injury (IAI) and support discharge of stable patients. |
In one of the largest described cohorts, the ASBS remained associated with IAI, most commonly, solid organ injury. Of 425 patients, 36.1% had some IAI on CT, but only 13.6% required laparotomy. Categorizing the type of skin injury in ASBS, we found that both abrasion and ecchymosis were associated with IAI. Initial CT performed with 100% sensitivity. |
2 |
| 88. Barmparas G, Patel DC, Linaval NT, et al. A negative computed tomography may be sufficient to safely discharge patients with abdominal seatbelt sign from the emergency department: A case series analysis. The Journal of Trauma and Acute Care Surgery. 84(6):900-907, 2018 06. |
Observational-Dx |
1,108 |
The presence of an abdominal seatbelt sign (ASBS) following a motor vehicle collision (MVC) is associated with a high risk for occult intra-abdominal injury, prompting imaging studies and a prolonged period of clinical observation. The aim of this study was to determine how a negative computed tomography (CT) of the abdomen/pelvis (A/P) can serve in the safe disposition of these patients. Our hypothesis was that in the setting of a negative CT, the presence of occult intra-abdominal injuries requiring a delayed intervention is extremely unlikely. |
Over the 3-year study period, 1,108 patients were admitted after an MVC. Of those, 196 (17.7%) had an ASBS upon presentation and 183 (93.4%) of 196 underwent a CT A/P. A total of 114 (62.3%) of 183 had a negative CT A/P. These patients remained hospitalized for a median of 2 (1-35) days with none (0.0%) requiring a delayed laparotomy. The sensitivity of CT A/P in identifying patients requiring an exploratory laparotomy was 100.0%, specificity was 67.9%, NPV was 100.0%, and PPV was 21.7%. The negative likelihood ratio was 0.00. |
3 |
| 89. Delaplain PT, Barrios C, Spencer D, et al. The use of computed tomography imaging for abdominal seatbelt sign: A single-center, prospective evaluation. Injury. 51(1):26-31, 2020 Jan. |
Observational-Dx |
220 patients |
To prospectively determine whether a negative CT scan is associated with the absence of hollow viscus injury (HVI), and we hypothesized that trauma patients with an abdominal SBS without CT imaging findings would not have a hollow viscus injury (HVI). |
Methods: A prospective cohort of patients with SBS was compiled over one year. Subjects were divided into those with and without HVI. Covariate distributions were summarized by group. Bivariate tests and logistic regression were used to investigate associations between covariates and HVI.Results: Of 220 patients with SBS, the incidence of HVI was 7% (n = 15). Radiographic findings were strongly associated with HVI and no patients with a negative CT scan had HVI. Free fluid was seen in 80% (12) of patients with HVI, whereas it was found in only 11% (23) without injury. A composite variable for negative CT scan was found to be associated with the absence of HVI: (Fisher's exact 1-tailed p, doubled = 0.014). |
3 |
| 90. Redmond CE, Gibney B, Nicolaou S. The abdominal seatbelt sign. [Review]. Abdominal Radiology. 45(9):2934-2936, 2020 09. |
Review/Other-Dx |
N/A |
The abdominal seatbelt sign. |
No abstract available. |
4 |
| 91. Guttmann I, Kerr HA. Blunt bladder injury. [Review]. Clinics in Sports Medicine. 32(2):239-46, 2013 Apr. |
Review/Other-Dx |
N/A |
Bladder injury should be suspected when trauma is followed by gross hematuria, suprapubic or abdominal pain, and difficulty in voiding or the inability to void. |
No results stated in abstract. |
4 |
| 92. American College of Radiology. ACR–SAR Practice Parameter for the Performance of Adult Cystography and Urethrography. Available at: https://gravitas.acr.org/PPTS/GetDocumentView?docId=78+&releaseId=2. |
Review/Other-Dx |
N/A |
Guidance document to promote the safe and effective use of diagnostic and therapeutic radiology by describing specific training, skills and techniques. |
No abstract available. |
4 |
| 93. Yeung LL, McDonald AA, Como JJ, et al. Management of blunt force bladder injuries: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2019 Feb;86(2):326-336. |
Review/Other-Dx |
N/A |
To formulate a practice management guideline using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. |
Three hundred ninety-three articles were screened, resulting in a full-text review of 64 articles. Seventeen articles were used to formulate the recommendations of this guideline. Several recommendations are made. The need for initial computed tomography cystography after trauma depends on characteristics of the trauma itself, but it is not recommended in patients without gross hematuria. In general, patients with intraperitoneal bladder ruptures should undergo operative repair. This is not routinely necessary in those with extraperitoneal ruptures unless the injury is complex. The need for follow-up cystography after bladder repair depends on the risk of urine leak. Those with low risk of urine leak do not require a follow-up study. |
4 |
| 94. Bryant WK, Shewakramani S, Zaurova M. Emergency management of renal and genitourinary trauma: best practices update [digest]. Emergency Medicine Practice. 19(8 Suppl Points & Pearls):S1-S2, 2017 Aug 22. |
Review/Other-Dx |
N/A |
To provide a best-practice approach to the diagnosis and management of renal and genitourinary injuries, with an emphasis on the systematic approach needed to identify subtle injuries and avoid long-term urinary sequelae such as hypertension, incontinence, erectile dysfunction, chronic kidney disease, and nephrectomy. |
No results stated in abstract. |
4 |
| 95. Coccolini F, Moore EE, Kluger Y, et al. Kidney and uro-trauma: WSES-AAST guidelines. World J Emerg Surg. 2019;14():54. |
Review/Other-Dx |
N/A |
To present the World Society of Emergency Surgery (WSES) and the American Association for the Surgery of Trauma (AAST) kidney and urogenital trauma management guidelines. |
No results stated in abstract. |
4 |
| 96. Malloum Boukar K, Moore L, Tardif PA, et al. Value of repeat CT for nonoperative management of patients with blunt liver and spleen injury: a systematic review. [Review]. European Journal of Trauma & Emergency Surgery. 47(6):1753-1761, 2021 Dec.Eur. j. trauma emerg. surg.. 47(6):1753-1761, 2021 Dec. |
Review/Other-Dx |
2646 patients |
To evaluate the effectiveness of routine repeat computed tomography (CT) for nonoperative management (NOM) of adults with blunt liver and/or spleen injury. |
The majority reported on liver (n = 9) or spleen injury (n = 16) or both (n = 3). No RCTs were identified. Meta-analyses were not possible because no study performed direct comparisons of study outcomes across intervention groups. Only seven of the twenty-eight studies reported whether repeat CT was routine or prompted by clinical indication. In these 7 studies, among the 254 repeat CT performed, 188 (74%) were routine and 8 (4%) of these led to a change in clinical management. Of the 66 (26%) repeated CT prompted by clinical indication, 31 (47%) led to a change in management. We found no data allowing comparison of any other outcomes across intervention groups. |
4 |
| 97. Romeo L, Andreotti D, Lacavalla D, et al. Delayed Rupture of a Normal Appearing Spleen After Trauma: Is Our Knowledge Enough? Two Case Reports. Am J Case Rep 2020;21:e919617. |
Review/Other-Dx |
2 patients |
Report 2 cases of delayed splenic rupture after blunt trauma, in which multidetector computed tomography (CT) scan at admission did not show any splenic injury. |
No results stated in abstract. |
4 |
| 98. Finnoff JT, Ray J, Corrado G, Kerkhof D, Hill J. Sports Ultrasound: Applications Beyond the Musculoskeletal System. [Review]. Sports & Health. 8(5):412-7, 2016 Sep. |
Review/Other-Dx |
N/A |
Ultrasound has been used to evaluate musculoskeletal injuries in athletes; however, ultrasound applications extend well beyond musculoskeletal conditions, many of which are pertinent to athletes. |
No results stated in abstract. |
4 |
| 99. Measuring Sex, Gender Identity, and Sexual Orientation. |
Review/Other-Dx |
N/A |
Sex and gender are often conflated under the assumptions that they are mutually determined and do not differ from each other; however, the growing visibility of transgender and intersex populations, as well as efforts to improve the measurement of sex and gender across many scientific fields, has demonstrated the need to reconsider how sex, gender, and the relationship between them are conceptualized. |
No abstract available. |
4 |
| 100. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://edge.sitecorecloud.io/americancoldf5f-acrorgf92a-productioncb02-3650/media/ACR/Files/Clinical/Appropriateness-Criteria/ACR-Appropriateness-Criteria-Radiation-Dose-Assessment-Introduction.pdf. |
Review/Other-Dx |
N/A |
To provide evidence-based guidelines on exposure of patients to ionizing radiation. |
No abstract available. |
4 |
