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Analysis of incidence of traumatic brain injury in blunt trauma patients with Glasgow Coma Scale of 12 or less

Chinese Journal of Traumatology 2018年第3期21卷 152-155页

作者： Alexander Becket Kobi Peleg Oded Olsha adi givon Boris Kessel Israeli Trauma Group Department of Surgery A Emek Medical Center Afula Israel National Center for Trauma and Emergency Medicine Research Germer Institute for Epidemiology and Health Policy Research Tel Hashomer Israel Surgery Department Shaare Zedek Medical Center Jerusalem Israel Trauma Unit Hillel Yaffe Medical Center Hadera Israel Disaster Medicine Department School of Public Health Faculty of Medicine TelAviv University Israel Rappoport Medical School. Technion. Haifa Israel 不详

Purpose： Early diagnosis of traumatic brain injury （TBI） is important for improving survival and neurologic outcome in trauma victims. The purpose of this study was to assess whether Glasgow Coma Scale （GCS） of 12 or less can predict the presence of TBl and the severity of associated injuries in blunt trauma patients. Methods： A retrospective cohort study including 303,435 blunt trauma patients who were transferred from the scene to hospital from 1998 to 2013. The data was obtained from the records of the National Trauma Registry maintained by Israel＇s National Center for Trauma and Emergency Medicine Research, in the Gertner Institute for Epidemiology and Health Policy Research. All blunt trauma patients with GCS 12 or less were included in this study. Data collected in the registry include age, gender, mechanism of injury, GCS, initial blood pressure, presence of TBI and incidence of associated injuries. Patients younger than 14 years old and trauma victims with GCS 13-15 were excluded from the study. Statistical analysis was performed by using Statistical Analysis Software Version 9.2. Statistical tests performed included Chi-square tests. A p-value less than 0.05 was considered statistically significant. Results： There were 303,435 blunt trauma patients, 8731 （2.9%） of them with GCS of 3-12 that including 6351 （72%） patients with GCS of 3-8 and 2380 （28%） patient with GCS of 9--12. In these 8731 patients with GCS of 3-12, 5372 （61.5%） patients had TBI. There were total 1404 unstable patients in all the blunt trauma patients with GCS of 3-12,1256 （89%） patients with GCS 3-8, 148 （11%） patients with GCS 9-12. In the 5095 stable blunt trauma patients with GCS 3-8, 32.4% of them had no TB1. The rate in the 2232 stable blunt trauma patients with GCS 9-12 was 50.1%. In the unstable patients with GCS 3-8, 60.5% of them had TBI, and in subgroup of patients with GCS 9-12, only 37.2% suffered from TBI. Conclusion： The utility of a GCS 12 and less is limited in prediction

关键词： Multiple trauma Transfer Glasgow Coma Scale

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Evaluation of differences in injury patterns according to seat position in trauma victims survived traffic accidents

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Chinese Journal of Traumatology 2018年第5期21卷 273-276页

作者： Yaakov Daskal Ricardo Alfici adi givon Kobi Peleg Oded Olsha Boris Kessel Israel Trauma Group Surgical.Division HiUel Yaffe Medical Center. Hadera Israel National Center for Trauma and Emergency Medicine Research Gertner Institute for Epidemiology and Health Policy Research Tel Hashomer Israel Surgery Department Shaare Zedek Medical Center Jerusalem Israel Trauma Unit Hillel Yaffe Medical Center Hadera Israel Disaster Medicine Department Faculty of Medicine Tel-Aviv University Israel

Purpose： Investigation of injury patterns epidemiology among car occupants may help to develop different therapeutic approach according to the seat position. The aim of the study was to evaluate and compare differences in the incidence of serious injuries, between occupants in different locations in private cars. Methods： A retrospective study including trauma patients who were involved in motor vehicle accidents and admitted alive to 20 hospitals （6 level I trauma centers and 14 level II trauma centers）. We examined the incidence of injures with abbreviated injury score 3 and more, and compared their occurrence be- tween seat locations. Results： The study included 28,653 trauma patients, drivers account for 60.8% （17,417）. Front passenger mortality was 0.47% higher than in drivers. Rear seat passengers were at greater risk （10.26%） for trau- matic brain injuries than front seat passengers （7.48%） and drivers （7.01%）. Drivers are less likely to suffer from serious abdominal injuries （3.84%） compared to the passengers （front passengers - 5.91%, rear passengers - 5.46%）. Conclusion： Out of victims who arrived alive to the hospital, highest mortality was found in front seat passengers. The rate of serious chest injuries was higher as well. Rear seat passengers are at greater risk for serious traumatic brain injuries. All passengers have a greater incidence of abdominal injuries. These findings need to be addressed in order to develop ＂customized＂ therapeutic policy in trauma victims.

关键词： Traffic accidents Injury pattern Seat position

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Is computed tomography cystography indicated in children with pelvic fractures?

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Chinese Journal of Traumatology 2020年第3期23卷 181-184页

作者： Alexander Becker Ori Yaslowitz Joseph Dubose Kobi Peleg Yaakov Daskal adi givon Israel Trauma Group Boris Kessel Department of Surgery Emek Medical Center.AfulaIsrael The Rappoport School of Medicine TechnionHaifaIsrael Department of Surgery A Meir Medical CenterKfar-SabaIsrael R Adams Cowley Shock Trauma Center University of Maryland Medical SystemBaltimoreMDUSA National Center for Trauma and Emergency Medicine Research Gertner Institute for Epidemiology and Health Policy ResearchTel HashomerIsrael Emergency and Disaster Management Department Faculty of Medicine.School of Public Health.Tel-Aviv UniversityIsrael Trauma Unit Hillel Yaffe Medical CenterHaderaIsrael

Purpose: Pelvic fracture evaluation with abdominopelvic computed tomography (CT) and formal CT cystography for rule out of urine bladder injury have been commonly employed in pediatric trauma patients. The additional delayed imaging required to obtain optimal CT cystography is, however, associated with increased doses of ionizing radiation to pelvic organs and represent a significant risk in the pediatric population for future carcinogenic risk. We hypothesized that avoidance of routine CT cystography among pediatric pelvic fracture victims would not result in an appreciable rate of missed bladder injuries and would aid in mitigating the radiation exposure risk associated with these additional ***: A retrospective cohort study involving blunt trauma pelvic fractures among pediatric trauma patients (age<14) between the years 1997 and 2016 was conducted utilizing the Israeli National Trauma Registry. Statistical analysis was performed using SAS statistical software version 9.4 via the tests of Chisquare test and two-sided Fisher’s exact test. Ap value of less than 0.05 was considered statistically ***: A total of 1072 children were identified from the registry for inclusion. Mean age of patients was 7.7 years (range 0-14) and 713 (66.5%) were male. Overall mortality in this population was 4.1% (44/1072). Only 2.1% (23) of pediatric patients with pelvic fractures had bladder injury identified, with just 9 children having intraperitoneal bladder rupture (0.8% of all the patients).Conclusion: The vast majority of blunt pediatric trauma victims with pelvic fractures do not have urine bladder injuries. Based on our study results we do not recommend the routine utilization of CT cystography in this unique population.

关键词： Tomography,X-ray computed Cystography Bladder injury Child Pelvic fracture

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Spinal cord injury in the setting of traumatic thoracolumbar fracture is not reliably associated with increased risk of associated intra-abdominal injury following blunt trauma:An analysis of a National Trauma Registry database

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Chinese Journal of Traumatology 2021年第3期24卷 132-135页

作者： Veacheslav Zilbermints Yehuda Hershkovitz Kobi Peleg Joseph J.Dubose adi givon David Aranovich Mickey Dudkiewicz Israeli Trauma Group Boris Kessel Surgical Division Hillel Yaffe Medical Center Affiliated to Rappoport Medical SchoolTechnionHaderaIsrael Department of Surgery Shamir Medical Center Affiliated to Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael National Center for Trauma and Emergency Medicine Research Gertner Institute for Epidemiology and Health Policy ResearchTel HashomerIsrael University of Maryland School of Medicine BaltimoreMDUSA Hospital Administration Hillel Yaffe Medical CenterHaderaIsrael

Purpose:There is a common opinion that spinal fractures usually reflect the substantial impact of injuries and therefore may be used as a marker of significant associated injuries,specifically for intra-abdominal injury(IAI).The impact of concomitant spinal cord injury(SCI)with the risk of associated IAI has not been well *** aim of this study was to evaluate the incidence and severity of IAIs in patients suffering from spinal fractures with or without ***:A retrospective cohort study using the Israeli National Trauma Registry was *** with thoracic,lumbar and thoracolumbar fractures resulting from blunt mechanisms of injury from January 1,1997 to December 31,2018 were examined,comparing the incidence,severity and mortality of IAIs in patients with or without *** collected variables included age,gender,mechanism of injury,incidence and severity of the concomitant IAIs and pelvic fractures,abbreviated injury scale,injury severity score,and *** analysis was performed using GraphPad InStat?Version 3.10,with Chi-square test for independence and two sided Fisher’s exact probability ***:Review of the Israeli National Trauma Database revealed a total of 16,878 patients with spinal *** thoracic and lumbar fractures were observed in 1272 patients(7.5%),isolated thoracic fractures in 4967 patients(29.4%)and isolated lumbar fractures in 10,639 patients(63.0%).The incidence of concomitant SCI was found in 4.95%(63/1272),7.65%(380/4967)and 2.50%(266/10639)of these patients,*** overall mortality was 2.5%,proving higher among isolated thoracic fracture patient than among isolated lumbar fracture counterparts(11.3%vs.4.6%,p<0.001).Isolated thoracic fractures with SCI were significantly more likely to die than non-SCI counterparts(8.2%vs.3.1%,p<0.001).There were no differences in the incidence of IAIs between patients with or without SCI following thoracolumbar fractures overall or in isolated

关键词： Spinal fractures Blunt trauma Abdominal injuries Spinal cord injury

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