"Mom was brilliant, charming, passionate and wickedly funny. Data was obtained from the hospitals trauma registry and chart review, with the following data included: age, sex, injury type, ISS, physical exam findings, all injuries recorded, injuries detected by torso CT, missed injuries, and complications. An official website of the United States government. However, the increased use of CT imaging is not universally advocated for. Self ML, Blake AM, Whitley M, Nadalo L, Dunn E. The benefit of routine thoracic, abdominal, and pelvic computed tomography to evaluate trauma patients with closed head injuries. This variability means the study must be interpreted with caution, as it is susceptible to bias. Accessibility Lancet. There are multiple ways to evaluate and treat trauma patients. Southern Minnesota Regional Trauma Advisory Committee (SMRTAC). Risk factors of significant pain syndrome 90days after minor thoracic injury: trajectory analysis. The .gov means its official. Trauma Department, St. Vincent Indianapolis Hospital, 8240 Naab Road #100, Indianapolis, IN, 46260, USA, Gregory J. Roberts,Lewis E. Jacobson,Louis Cooke,Jacqueline F. Schultz,Alexander J. Kinstedt&Jonathan M. Saxe, Department of Economics, University of the Pacific, Stockton, CA, USA, You can also search for this author in To relate cost-effectiveness to this study, the price for a CT A/P and the reading of it by a radiologist would be approximately $1200 at our hospital, whereas a single day in the Trauma/Neurology Intensive care unit (TNICU) is approximately $6500 and a day in the orthopedic unit is almost $3000. In the book, she added that her relationship with Mr Trump had improved since their divorce, and said she spoke to him about once a week. A significant number of occult injuries were detected in stable adult blunt trauma patients with a GCS of 14/15. The biomechanical response of the thorax to nonpenetrating impact with particular reference to cardiac injuries. Cookies policy. . For instance, a child's chest wall can withstand more deformation than an adult's, so the force of an impact is transmitted widely through the body, often resulting in major internal injuries without any damage to the external chest wall. The organs most often injured are the liver, pancreas, spleen and intestines. The study looked at 8,000 children evaluated in emergency departments in the Pediatric Emergency Care Applied Research Network from 2007 to 2010. Perhaps if these above data points were consistently performed and recorded, a more specific patient population subset could be identified that would better predict the need for cross-sectional imaging of the torso. A negative physical exam combined with a normal CXR does not rule out the presence of occult injuries and the need for torso imaging. Use of early-phase dynamic spiral computed tomography for the primary screening of multiple trauma. However, they also found that this imaging does not change in-hospital mortality [26]. Download preview PDF. Bethesda, MD 20894, Web Policies Google Scholar. statement and The mean ISS was 8, and the initial chest physical exam was normal in 1571 (68% of the patient population). 2015;262(6):111522. Ivana Trump, Donald Trump 's first wife, died at the age of 73 after an accident involving "blunt impact injuries" to her torso, the New York City Medical Examiner said Friday. Most serious torso injuries in children result from blunt trauma sustained in car, ATV or bicycle crashes. 2011;197(6):13938. R. L. Stalnaker, J. H. McElhaney, R. G. Snyder and V. L. Roberts, Door Crashworthiness Criteria, NTIS No. Your US state privacy rights, 152166, 1965. Berrington de Gonzalez A, Mahesh M, Kim KP, Bhargavan M, Lewis R, Mettler F, et al. It is noted that the cost of incidentalomas and contrast-induced complications were not included in that study [20]. Computed tomography whole body imaging in multi-trauma: 7years experience. The majority of serious traumatic injuries are due to blunt trauma from motor vehicle crashes and pedestrian injuries. PB204171, 1971. https://doi.org/10.1007/978-1-4757-1502-6_10, Tax calculation will be finalised during checkout. High-Frequency Oscillatory Ventilation and Ventilator-Induced Lung Injury: Size Does Matter. use of a mask for resuscitation, intubation attempts, pinching of the nose during mouth to mouth resuscitations, etc. By using this website, you agree to our Immediate total-body CT scanning versus conventional imaging and selective CT scanning in patients with severe trauma (REACT-2): a randomised controlled trial. The exposure to radiation during a CT scan is easy to establish, but to say the risk of cancer conferred by that exposure is extrapolated and may not be accurate; however, best estimates are about 29,000 cases of cancer are attributed to CT scans in the United States annually [29]. Radiation exposure from diagnostic imaging in severely injured trauma patients. Donald and Ivana Trump were notable public figures in New York in the 1980s and 1990s, and their split was the subject of intense public interest. Springer Nature. G. Hellstrom, Electrocardiographic, Blood Pressure, Respiratory and Electroencephalographic Responses to Closed Liver Injury: An Experimental Study in Dogs, Acta. Centers for Disease Control and Prevention, Atlanta. Richards JR, Derlet RW. "These patients may seem relatively stable at first but can deteriorate quickly, and contusions will often blossom over the first 24 hours. Computational Modeling of Primary Blast Lung Injury: Implications for Ventilator Management. 710851, Society of Automotive Engineers, Inc., New York, 1971. from asphyxia), Hematoma: large collection of extravasated blood (e.g. How many Russians have left during war - and who are they? 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). Society of Automotive Engineers, Inc., New York, 1967. That marriage allowed her to leave Czechoslovakia, her communist home country, without defecting. All content on this website, including dictionary, thesaurus, literature, geography, and other reference data is for informational purposes only. Arch Surg. We do not have data to show for this beyond personal experience and is perhaps a future area to study. GJR, LEJ, and JMS performed the interpretation of the result, drafted, and revised the article. It is not surprising that overall mortality is low (0.43%) in this patient cohort given the low ISS. 2018 Jun;8(2):192-218. doi: 10.1177/1925362118781612. The Adult Pancreas in Trauma and Disease. Poletti PA, Mirvis SE, Shanmuganathan K, Takada T, Killeen KL, Perlmutter D, et al. Epub 2018 Jun 6. GJR, LEJ, and JMS contributed to the conception and design of this study. Is the use of pan-computed tomography for blunt trauma justified? Torso computed tomography can be bypassed after thorough trauma bay examination of patients who fall from standing. Unable to load your collection due to an error, Unable to load your delegates due to an error. "road rash" in traffic accidents) (, Compression abrasions: direct pressure from a blunt object together with slight rubbing movements produce skin and epidermal crushing, Patterned abrasions: these injuries show a distinct pattern that may reflect the shape of the impacting blunt object; frequently observed in tortures (. The authors concluded that immediate total-body CT was safer, quicker, and does not increase direct medical costs. In blunt trauma patients with normal sensorium, physical exam, and CXR, the practice of obtaining cross-sectional imaging would appear to be beneficial by increasing the accuracy of total injury burden and decreasing hospital length of stay. (1973). These keywords were added by machine and not by the authors. 2023 BBC. The Institutional Review Board at St. Vincent Hospital granted permission for this study. 2023 Springer Nature Switzerland AG. Additionally, the medical and loss-of-work cost from traumatic injuries totals well above $500 billion annually in the United States [1]. This process is experimental and the keywords may be updated as the learning algorithm improves. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Part of Springer Nature. Emond M, Sirois MJ, Guimont C, Chauny JM, Daoust R, Bergeron E, et al. Sierink JC, Treskes K, Edwards MJ, Beuker BJ, den Hartog D, Hohmann J, et al. Itemized injuries are detailed in Tables 3, 4, 5. Finally, there is one concern in this study. Impact energy of everyday items used for assault. The results are given as load-deflection curves with comparison to previous published data. The medical. Initial chest/abdomen/pelvis (C/A/P) CTs were recorded, as well as delayed C/A/P CTs. Advocates of selective CT for trauma argue that the benefits do not outweigh the complications, which include IV contrast issues, radiation exposure, and cost [12,13,14]. Acad Emerg Med. Ivana Trump, Donald Trump's first wife, died of "blunt impact injuries" to the torso, the New York City medical examiner's office has said. Static compression tests were also conducted on the chest in the anterior-posterior direction using both cadavers and human volunteers. Ann Emerg Med. Clipboard, Search History, and several other advanced features are temporarily unavailable. Intra-abdominal injury from extra-peritoneal ballistic trauma. F. Glenn, Z. Mujahed, and W. R. Grafe, Graded Trauma in Liver Injury, J. Trauma 3: p. 288, 1963. Salim A, Sangthong B, Martin M, Brown C, Plurad D, Demetriades D. Whole body imaging in blunt multisystem trauma patients without obvious signs of injury: Results of a prospective study. Based on this information, a series of animal abdominal impacts were designed to study the. 2020 Jan;48(1):e66-e73. 167190, 1965. Asymptomatic patients with a negative CT of the chest and/or abdomen and pelvis had a mean length of stay (LOS) 1day less than asymptomatic patients without a CT of the corresponding body region(s) (p < 0.001) (Table 6). published a study in 2013 showing an increase in initial radiation exposure after instituting a total-body CT protocol, but that total in-hospital radiation exposure was similar [27]. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. 8600 Rockville Pike The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. P. G. Windquist, P. W. Stumm and R. Hansen, Crash Injury Experiments with the Monorail Decelerator, AF Technical Report No. While penetrating trauma is common in adults, At the Holy Family Hospital in Mumbai, India, doctors said he had a, Sudden onset of photophobia is not an uncommon aftermath of a, Rozen, "Complete abdominal wall disruption with herniation following, He said the acute kidney injury of Atio 'could be caused by various events' such as severe blunt trauma to the muscles, a failing heart, medicines that were toxic and excreted through the kidneys, artificially prepared food products that were toxic to the kidneys, direct, Dictionary, Encyclopedia and Thesaurus - The Free Dictionary, the webmaster's page for free fun content, 'Cocky' driver jailed after best friend killed in crash, Delhi cop's death: Daughter alleges threat from accused, demands security for family, Girl died after crash that left her mother paralysed, Imaging in acute trauma-induced dissection and ischemic stroke: A Review, Unexpected Complication of Blunt Trauma: Evisceration/Kunt Travmanin Nadir Bir Komplikasyonu: Eviserasyon, EVALUATION OF MANAGEMENT OF ABDOMINAL TRAUMA, Indian couple hope to take bedridden son back home from UAE, Warning sign you must not ignore - Sudden onset of painful light sensitivity, Testicular Rupture or Testicular Fracture? Provided by the Springer Nature SharedIt content-sharing initiative, Over 10 million scientific documents at your fingertips, Not logged in Upsal. In total, 434 patients with a negative CXR also received a chest CT. Out of this grouping, 151 (35%) had injuries detected on the chest CT. James MK, Schubl SD, Francois MP, Doughlin GK, Lee SW. Introduction of a pan-scan protocol for blunt trauma activations: what are the consequences? Radiology. Lavingia KS, Collins JN, Soult MC, Terzian WH, Weireter LJ, Britt LD. CrossRef Indications for total-body computed tomography in blunt trauma patients: a systematic review. 2016;106(8):8013. 2017;43(1):3542. Ivana Trump, the first wife of former President Donald Trump, died of accidental blunt impact injuries of the torso, the New York City medical examiner's office reported Friday. Chicago: American College of Surgeons; 2012. showed a 30-day reduction in mortality from 22% to 16% by using pan CT, and Self et al. It added that the death of the 73-year-old on Thursday was accidental. compared immediate total-body CT with conventional imaging and selective CT. Google Scholar. The median ISS (20) was significantly higher than in our cohort, so we do not have a direct comparison with that study group. The results are best broken up into three subgroups. Ivana Trump, the first wife of ex-President Donald Trump, died in an accident as a result of suffering blunt impact injuries to her torso, the New York City Office of the Chief Medical. Google Scholar. Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study. Improvements in technology have facilitated the rapid detection of injuries, especially with the use of computed tomography (CT). 2014;21(4):3417. The purpose of this study is to review the CT indications, findings, and complications in patients with low Injury Severity Scores (ISS) to determine the utility of torso CT in this patient cohort. AJR Am J Roentgenol. PubMedGoogle Scholar, General Motors Research Laboratories, USA, 1973 Springer Science+Business Media New York, Stalnaker, R.L., McElhaney, J.H., Roberts, V.L., Trollope, M.L. H. Mertz, and C. Kroell, Tolerance of Thorax and Abdomen, In Gurdjian, Impact and Crash Protection, C. Thomas, Springfield, 111., pp. Given the magnitude of this problem, it is imperative that practitioners intervene in both a life-saving and cost-effective manner. Arch Surg. Another patient was found to have a grade 3 liver laceration. Based on this information, a series of animal abdominal impacts were designed to study the relationship between shape and type of impactor, velocity and direction of impact, body region impacted and injury level. * * Professor and Chairman, Department of . In addition, quicker diagnosis leads to shorter wait time to intervention when needed. Cite this article. Initial Management of Major Pediatric Trauma Patients. 2016;388(10045):67383. Unlike penetrating trauma, the object or surface doesn't pierce the body and cause an open wound. "You may not see rib fractures, but children can have pneumothoraces or pulmonary contusions that are profound," says Denise B. Klinkner, M.D., M.Ed., a pediatric surgeon at Mayo Clinic's campus in Rochester, Minnesota. Oosthuizen GV, Bruce JL, Bekker W, Shangase N, Laing GL, Clarke DL. [ 5] Blunt force. https://medical-dictionary.thefreedictionary.com/blunt+injury, He had been in cardiac arrest 40 minutes before his arrival at hospital, with the cause of his death being, Examination of the dead body of the deceased prima facie revealed a superficial cut injury below the chin and a, A post-mortem examination was carried out by Stephen Leadbeatter, who concluded the cause of death was from "a, Occlusions are more common in patients with penetrating rather than. The possibility of internal chest injuries should always be kept in mind during the primary survey.". from traffic accident), Linear contusions: when a rectangular shaped object strikes the body, Tram-like or railway line contusions: when a cylindrical or rod-like object hits the body, the blood accumulates laterally to the point of impact, creating an injury that appears pale in the center, lined by 2 linear, parallel bruises on each side (, Loop contusions: when a cable or cord-like item strikes the body, frequently seen in child abuse (, Fingertip contusions: a cluster of small round bruises, approximately 1 cm in diameter, develops when the offender grips a victim's body area vigorously, Most frequently involved body area is the neck, Sometimes, a single, larger, oval or round bruise on the opposite side of the clustered fingertip contusions may also be present (thumb-likebruise) (, Intradermal contusions: when an object with grooves or ridges hits the skin, producing an injury limited to the subepidermal layer (e.g. published a systematic review and meta-analysis on whole-body CT versus selective CT in trauma patients that did show a significant mortality benefit for those that receive pan CT, even though their ISS was higher [24]. Trauma is the number one cause of death for people aged 1-44 and accounts for 19.2% of years of potential life lost in the United States. Federal government websites often end in .gov or .mil. Each of these subgroups has a negative physical exam in either the chest (C), abdomen and pelvis, (A/P), or chest, abdomen, and pelvis (C/A/P). 2003;196(4):54955. https://doi.org/10.1007/978-1-4757-1502-6_10, DOI: https://doi.org/10.1007/978-1-4757-1502-6_10. Low-volume trauma centers should consider transferring children with rib fractures or pulmonary contusions to a higher level of pediatric care because these patients may need endotracheal intubation or extracorporeal membrane oxygenation (ECMO) support while their lungs heal. Am Surg. Disclaimer. Impact Your World The BBC is not responsible for the content of external sites. Careers. Initial chest X-ray (CXR) and pelvic X-ray, if performed, were recorded. 2003;186(6):60913. Springer, Boston, MA. Sierink JC, Saltzherr TP, Wirtz MR, Streekstra GJ, Beenen LF, Goslings JC. Ivana Trump died in her New York City home on 14 July, A rare insight into Hitler's private life. 2017;35(1):139. Studies on the mechanisms of stress wave propagation in the chest subjected to impact and lung injuries. Impact of whole-body computed tomography on mortality and surgical management of severe blunt trauma. No incidents of contrast-induced complications were noted in the study period. Yeguiayan JM, Yap A, Freysz M, Garrique D, Jacquot C, Martin C, et al. Statistical tests conducted in the analysis of the collected data were chi-squared, Fischer exact test, and ANOVA analysis. The nature and properties of these waves are discussed in simple terms and the role of waves in the production of the characteristic injuries resulting from impact to the torso is presented. Nearly 400 had pneumothoraces, more than half of which weren't visible on chest X-rays and only later discovered on CT. The initial indication for CT scanning is variable, as it up to the discretion of the ED physician (based upon physical examination without clear guidelines). 1995;38(5):72731. Reporting a negative torso CT is reassuring for both the patient and physician, as well as leading to the shorter hospital length of stay as found in our study. Defining the role of computed tomography in blunt abdominal trauma: use in the hemodynamically stable patient with a depressed level of consciousness. The purpose of this study is to review the CT indications, findings, and complications in patients with low Injury Severity Score (ISS) to determine the utility of torso CT in this patient cohort. The body of a humpack whale lies on a beach in Brigantine N.J., after it washed ashore on Friday, Jan. 13, 2023. . The most frequent causes of blunt abdominal injury are the steering wheel and the lap belt. Emerg Radiol. The significance and treatment of small, occult pneumothoraces isn't always clear, and Dr. Klinkner says the need for CT should be decided at a higher level of care. Focused assessment with sonography for trauma (FAST) exams were not consistently performed in this cohort and therefore were not analyzed. All authors read and approved the final manuscript. Any impact to the torso does result in the rapid displacement of the body wall which may lacerate and contuse underlying viscera, but this simple explanation does not account for pathology at sites some distance from the contact point and does not adequately describe the dependence of the severity and location of injury upon the rate of energy transfer. 2009;373(9673):145561. published in 2013 comparing selective torso CT versus routine torso CTthere just have not been enough quality trials to base a recommendation [18]. Rib fracture diagnosis in the panscan era. J Trauma Acute Care Surg. Kelleher MS, Gao G, Rolen MF, Bokhari SA. Advanced trauma life support (ATLS) directs a rapid assessment of the acutely injured patient using physical examination, plain radiographs, and ultrasound to increase survival [2]. Donald Trump was Ivana's second husband. Roberts, G.J., Jacobson, L.E., Amaral, M.M. Cross-sectional imaging of the torso reveals occult injuries in asymptomatic blunt trauma patients. All rights reserved. Ivana Trump, Donald Trump's first wife, died of "blunt impact injuries" to the torso, the New York City medical examiner's office has said. Despite this, torso CT use for trauma patients has become much more common. 2002;137(9):102932. Am J Surg. Ivana Trump, the first wife of former US president Donald Trump, died after falling down stairs at her home in New York City, suffering "blunt impact injuries" to her torso. Data was obtained from the trauma registry and chart review and included: age, sex, injury type, mechanism, ISS, physical exam findings, all injuries recorded, injuries detected by torso CT, missed injuries, and complications. J Trauma. These cadavers were impacted on the front of the chest over the fourth rib. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. 700400, Society of Automotive Engineers, Inc., New York, 1970. Treskes K, Saltzherr TP, Luitse JS, Beenen LF, Gosliings JC. 2022 Nov 15;10(11):2930. doi: 10.3390/biomedicines10112930. This is consistent with a Cochrane review by Van Vugt et al. ), Bruise and abrasions on the precordial region or the central chest area due to external compressions during cardiopulmonary resuscitation, Rib and sternum fractures and soft tissue hemorrhages are commonly associated, Laceration of the heart, lungs, pleura and pericardial sac may result from rib fractures, Electrical burns from defibrillation, in the form of a rectangular, parchment-like, yellow-orange abrasion on the anterior chest, Retinal hemorrhages have been rarely described in children following cardiopulmonary resuscitation (, 4 month old boy with a patterned abrasion of uncertain etiology (, 49 year old woman with diaphragm laceration due to cardiopulmonary resuscitation (, 90 year old man with an atypical patterned bruise on the forearm (, 92 year old man with a simple depressed skull fracture (, Hammer: striking the skin at a shallow angle, Metal pipe tube: 2 bruises due to 2 distinct hits, Metal pipe tube: single injury due to one hit in the center. Injuries to the aorta usually result from rapid deceleration in a car crash or auto-pedestrian collision. There were 1067 (56%) patients with a negative abdominal exam who had a A/P CT. From these patients, 174 (16%) were found to have an occult injury on CT. Crit Care. AK revised the article and formatted it for submission. This has led to a wide practice variation in which patients receive a torso CT. Pulmonary contusions may not always show up on the initial X-ray, but they should be suspected in any child with rib fractures because extreme force is needed to break a child's pliable ribs. Trauma is the leading cause of morbidity and mortality in patients under 35-years of age and the sixth leading cause of death worldwide. Department of Surgery, Loyola University Medical Center, 2160 South First Avenue, Maywood, Illinois 60153 Blunt Torso Trauma Robert J. Freeark, M.D. A prospective evaluation. 2010. http://www.cdc.gov/injury/wisqars. Bookshelf The most frequent causes of blunt abdominal injury are the steering wheel and the lap belt. Siegenthaler L, Sprenger FD, Kneubuehl BP, Jackowski C. Int J Legal Med. Ann Surg. Functional impact of minor thoracic injury. Ann Emerg Med. Selective use of computed tomography and diagnostic peritoneal lavage in blunt abdominal trauma. Blunt abdominal trauma patients: can organ injury be excluded without performing computed tomography? 2023 BioMed Central Ltd unless otherwise stated. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. Caesarean by phone light - giving birth in a warzone. Am J Surg. It is up to the discretion of the ED physician based upon the physical examination whether the patient will receive a scan. However, even in evaluable patients, the sensitivity of physical examination and plain radiographs remain deadened to detecting some injuries, and there is controversy with regard to selecting the appropriate patients to undergo torso CT [18,19,20,21,22]. G. Hellstrom, Intra-Vascular Pressure Response to Closed Liver Injury: An Experimental Study in Dogs, Acta. Asha S, Curtis KA, Grant N, Taylor C, Lo S, Smart R, et al. Key points: Her death has been ruled an accident and foul play was not suspected, says the chief medical examiner She sustained blunt impact injuries to her torso from a reported fall Depositions of her ex-husband and two of her children have been delayed as a result 2013;20(6):50712. Any impact to the torso does result in the rapid displacement of the body wall which may lacerate and contuse underlying visce We welcome suggestions or questions about using the website. "She taught her children about grit and toughness, compassion and determination.". Four hundred sixty-eight injuries (or signs of suspected injuries requiring a change in management) were detected in 420 otherwise asymptomatic, evaluable patients. Any child with torso trauma is likely to have other, life-threatening trauma, especially to the head and limbs. One hundered fifty of 592 (25%) patients with a complete benign exam of the torso ended up having occult injuries on CT C/A/P. Heller MT, Kanal E, Almusa O, Schwarz S, Papachristou M, Shah R, et al. The https:// ensures that you are connecting to the PubMed p. 237, University of Minnesota, Minneapolis, 1965. Tillou A, Gupta M, Baraff LJ, Schriger DL, Hoffman JR, Hiatt JR, et al. Provided by the Springer Nature SharedIt content-sharing initiative. They had three children together - Donald Jr, Ivanka and Eric Trump. In: King, W.F., Mertz, H.J. The. - 161.97.134.59. Okamoto K, Norio H, Kaneko N, Sakamoto T, Kaji T, Okada Y. In blunt trauma patients with normal sensorium, physical exam and chest X-ray, the practice of obtaining cross-sectional imaging appears beneficial by increasing the accuracy of total injury burden and decreasing the length of stay. and Luigi Bonaccorso, M.D. We are not able to prove a benefit in morbidity for these patients based on the data. 2006;61(4):3659. J Trauma. In the third grouping, 592 (43%) of the patients with normal C/A/P exams received a C/A/P CT. Of these patients, 150 (25%) demonstrated occult injuries by CT (Tables 1 and 2). This has led some centers to use CT scanning of the torso liberally [5,6,7,8,9]. osteoporosis, bone metastasis, etc. Injury. Ultimately, Dr. Klinkner says two important rules apply to pediatric torso injuries: Lee LK, et al. Blunt Impact Injuries Dr Andrew describes various types of blunt force injury and gives Medico-legal examples. J Trauma. Pediatric torso injuries present unique challenges. The ATLS guidelines do not detail recommendations as to the appropriate use of CT, and it is unclear which patients require this scan. The organs most often injured are the liver, pancreas, spleen and intestines. L. Grimelius and G. Hellstrom, Patho-Anatomical Changes After Closed Liver Injury: An Experimental Study in Dogs, Acta. Successful operative treatment requires accurate hemostasis, detection of all injuries, and the application of generally accepted principles of repair. tire marks,shoe marks) (, Suction contusions: confluence of multiple petechiae in a circumscribed area due to a vacuum-like mechanism, which leads to capillary rupture and blood leakage in a circumscribed body area (, Coup / contrecoup contusions: contusions that develop at the point of impact (coup) and on the side opposite the impacted area (contrecoup); typically observed on the brain (, Human bites: typical bruise resulting from human bites shows 2 opposing arches separated by a central pale, uninvolved area with possible associated abrasions and lacerations (, Red blood cells and hemoglobin degradation lead to pigment formation and chromatic changes of the bruise, generally from red / purple to green to yellow-brown, Chromatic changes have been studied to estimate the age of the bruise, Consistent gross or histological dating of contusion is not reliable, With the current knowledge, it is reasonable to state that a yellow colored bruise may have been produced > 18 hours before the examination, Absence of yellow color does not mean < 18 hours, Recommended to describe them just asrecentorold (, Antemortem contusions: contusions are a vital phenomenon; can affect any body area, are usually unilateral and asymmetrical, are commonly associated with tissue swelling, show different colors in the same subject, do not become pale on digital pressure and show a cellular reaction microscopically, Livor mortis: lividity is usually bilateral and symmetrical, uniform in color, shows pallor on digital pressure (if recent), is preferentially located in the dependent portions of the body with no cellular reaction at the microscopic examination (, Tardieu spots: small postmortem hemorrhages that develop in areas of intense lividity (also calledhypostatic hemorrhages) (, Laceration occurs when a blunt force causes skin compression, crushing and splitting; lacerations frequently occur on the skin overlying bony prominences but can also affect the internal organs, leaving the skin intact, Hallmark: presence oftissue bridgesin the depth of the wound is the pathognomonic feature for lacerations; also helps to distinguish them from an incised wound (sharp force injury), Edges: laceration edges are usually jagged; abrasions, bruising and crushing of the margin are frequently observed, Tear lacerations:classic form of laceration occurring when a blunt force impact rips and tears the skin and the subcutaneous tissues, Split lacerations: compression of the skin between blunt object and bone, Stretch lacerations: blunt trauma that causes an overstretching of the skin until it ruptures, Crush lacerations: blunt trauma that causes grinding and compression of the skin and soft tissue, resulting in possible amputation, Degloving injury: blunt mechanism that occurs when the skin and subcutaneous tissues are trapped between 2 hard surfaces and are suddenly pulled at the moment of the impact, resulting in minimal to extensive loss of skin and soft tissues (, Avulsions: violent blunt trauma that tears away the tissues from their attachments, Direction of the impact: sometimes the presence of an abrasion surrounding a laceration may suggest the direction of the impact; abrasion is usually wider at the point of impact, Undermining: impact is over the bone, resulting in a clean separation of the skin from the underlying bone in the direction of the application of force, Dating of lacerations: estimation of the age of a laceration is not reliable, Incised wounds: sharp object (such as a knife) produces incised wounds (or cuts) that are typically longer than deeper due to the blade's sharpness and the sharp force related mechanism of injury; incised wounds lack tissue bridges; edges are usually sharply demarcated, Bone lesions that occur when the intensity of the blunt force exceeds the bone resistance, Traumatic:typical fractures due to a blunt force trauma, Pathologic: fractures due to a pathologic condition (e.g. Cadavers were received approximately one to three days after death, and were unembalmed. Daoust R, Emond M, Bergeron E, LeSage N, Camden S, Guimont C, et al. A retrospective review of non-intubated, blunt trauma patients aged 15years or older with an initial Glasgow Coma Scale (GCS) score of 14 or 15 evaluated in an American College of Surgeons verified level 1 trauma center from July 2012 to June 2015 was performed. This website is intended for pathologists and laboratory personnel but not for patients. 2015;66(6):589600. 1997;28(3):1815. (eds) Human Impact Response. Similar statements are true for a torso or thoracoabdominal CT [23]. 2014;77(4):52733. Physical exam findings were regularly recorded on a template trauma history and physical (H&P) form and were visible trauma (location), chest wall (CW) tenderness to palpation, CW crepitus, CW ecchymosis, abdominal (Abd) ecchymosis, Abd distension, Abd tenderness, flank ecchymosis.. University of Michigan, Ann Arbor, Michigan, USA, R. L. Stalnaker,J. H. McElhaney&V. L. Roberts, Ann Arbor and the Wayne County General Hospital, University of Michigan Medical Center, Eloise, Michigan, USA, You can also search for this author in World J Emerg Surg 15, 5 (2020). It added that the death of the 73-year-old on Thursday. In 2014, the results of a large, multicenter observational study of pediatric patients with blunt chest trauma were published in Academic Emergency Medicine. J Trauma. Murphy CE, Raja AS, Baumann BM, Medak AJ, Langdorf MI, Nishijima DK, et al. Reports in US media say she died after falling down stairs in her New York City apartment. FOIA GJR, LC, and JS performed the data acquisition. Emerg Radiol. 1. Ivana Trump, the first wife of Donald Trump and the mother of his three oldest children, died from blunt force injuries to her torso that she suffered after an accidental fall, New York. These benefits outweigh the small risk associated with CT scan. Additionally, these were not E-FAST exams and did not include sonography of the chest. 2016;279(2):3959. The authors declare that they have no competing interests. Radiation exposure before and after the introductino of a dedicated total-body CT protocol in multitrauma patients. Repeat CTs for other reasons (re-evaluation, operative planning) were not recorded as such. The role of pan CT in the awake, mildly injured, evaluable patient is less clear and still widely debated [17, 20, 22]. Rib fractures, which are rare in kids, are usually a sign of severe impact. et al. As CT technology has improved, more injuries are detected in shorter periods of time [3, 4]. 2012;24(1):4351. 2007;62(1):1516. These injuries can be challenging to evaluate and treat due to children's unique anatomy. Her first, Alfred Winklmayr, was an Austrian ski instructor and friend who she reportedly married in order to obtain Austrian citizenship. Emerg Med Australas. Though still greatly debated, it is our opinion that a single torso CT benefits outweigh this relatively small, theoretical risk in adults. Behind armour blunt trauma--an emerging problem. Cross-sectional imaging of the torso reveals occult injuries in asymptomatic blunt trauma patients, https://doi.org/10.1186/s13017-019-0287-5, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. The. The physical mechanism of blunt impact injuries to thoracic and abdominal viscera is often conveniently described simply in terms of "crush"--this is an over-simplification. We show, in our retrospective study of mildly injured blunt trauma patients with a GCS of 14 or 15, that a surprising number of injuries are detected after normal chest and abdominal physical examinations, as well as chest X-ray. The blunt mechanisms were also not stratified based on the height of fall, motor vehicle rollover or ejection, etc. "She was a wonderful, beautiful, and amazing woman, who led a great and inspirational life," Mr Trump said. This content does not have an Arabic version. How the Pakistani military feel about Imran Khan. There were 2306 patients determined to be eligible for review from the registry. Blunt trauma, also known as blunt force trauma or non-penetrating trauma, is physical trauma or impactful force to a body part, often occurring with road traffic collisions, direct blows, assaults, injuries during sports, and particularly in the elderly who fall. Whereas others advocate for use in selected patients [10, 11]. cleaver), Typically show abraded and bruised edges with a clean separation of the margins and no tissue bridges, Resuscitation injuries: cardiopulmonary resuscitation (CPR) or other procedures may result in physical injuries that can be hard to interpret during autopsy (, Bruises and abrasions on the scalp and face (e.g. Would you like email updates of new search results? These injuries are life-threatening, and patients need immediate transfer. The results of this study are given in the form of an experimental scaling factor which relates the sensitivity to impacts of the various body regions. Ong AW, Castor L, Figueredo R, Butler S, Fernandez F. Pan-body computed tomographic scanning for patients with intracranial hemorrhage after low-energy falls. American College of Surgeons. 2017;70(6):9049. A. M. Nahum, C. W. Gadd, D. C. Schnwider and C. K. Kroell, The Biomechanical Basis for Chest Impact Protection: I. Force-Deflection Characteristics of the Thorax, J. Trauma 11: p. 874, 1971. Med. The limitations of this study include its retrospective nature and lack of cost analysis. Completion CT of chest, abdomen, and pelvis after acute head and cervical spine trauma: incidence of acute traumatic findings in the setting of low-velocity trauma. Med. government site. Only 2 patients that had no chest or abdominal findings on physical exam and did not have an initial torso CT were found to have injuries on a delayed torso CT. A Case Report and Literature Review, A Traumatic Direct Inguinal Hernia from Pelvic Ring Disruption, Aegis presents experts to dispute report Atio died from hazing, Pseudoaneurysm of Left proximal Common Carotid Artery following penetrating trauma, Blunt Traumatic Thoracic Aortic Laceration. Can sci-fi films teach us anything about an AI threat? In the report, a "violent death" is defined as a death resulting from the intentional use of physical force or power against oneself, another person, or a group or community. 2009;67(4):77987. The velocity of the impact and the mass of the impactor were held constant. She fled from communism and embraced this country," the statement added. The average ISS was 5 in this study, compared to 8 in ours and their population was much more uniform. This site needs JavaScript to work properly. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Blunt impact injuries is a commonly used term on death certificates when the fatality is due to extensive physical trauma such as seen in vehicular crashes, falls from height or beatings. Blunt trauma, also known as non- penetrating trauma or blunt force trauma, refers to injury of the body by forceful impact, falls, or physical attack with a dull object. Tracking the rise of Russias missile strikes on Kyiv, A rare insight into Hitler's private life. They divorced 15 years later in 1992. Huber-Wagner S, Lefering R, Qvick LM, Korner M, Kay MV, Pfeifer KJ, et al. Unauthorized use of these marks is strictly prohibited. 2015;209(3):5215. Epub 2017 Sep 29. Typically occur when the force is applied at or near perpendicular to the skin surface and can be classified as: Impact abrasions: occur when a force is applied suddenly or rapidly and perpendicular to the skin, pushing and crushing it on a body surface, Pressure abrasions: occur when there is a slow, prolonged compression of the skin by a blunt object, which results in a dried, parchment-like abrasion (e.g. Please enable it to take advantage of the complete set of features! Chir. 1979 Apr;50(4):325-37. Cooper GJ, Pearce BP, Stainer MC, Maynard RL. After their separation, Trump went on to launch her own lines of beauty products, clothing and jewellery. 2009;169(22):20717. Read about our approach to external linking. Human Torso Response to Blunt Trauma. Epub 2012 Aug 11. The amount of respiratory distress a child experiences depends on how much lung tissue is affected. Injury. Google Scholar. Some may argue that clinical importance is only if a procedure is performed or if an early discharge is accomplished. PB203721, 1971. 485494, 1966. sharing sensitive information, make sure youre on a federal Needle decompression followed by tube decompression or tube decompression alone is the main treatment and should be initiated before a patient is transferred. J R Army Med Corps. HHS Vulnerability Disclosure, Help 288294, 1963. This difference in price is significant and therefore it should be recognized that this reduction in LOS is cost-effective for the patient. New York City Medical Examiner's Office has ruled the 73-year-old's death as accidental. Having the knowledge of the full extent of injury may be important in post-discharge rehabilitation plans and expectations. The use of pan CT in trauma for stable, unevaluable adult trauma patients is popular. doi: 10.1097/00005373-199603001-00011. Dynamic factors influencing the production of lung injury in rabbits subjected to blunt chest wall impact. Diagram of the 3 main subgroups and chest X-ray (CXR) data. NCIPC: Web-based Injury Statistics Query and Reporting System (WISQARS). L. M. Patrick, H. J. Mertz and C. K. Kroell, Cadaver Knee, Chest and Head Impact Loads, Proceedingss of the Eleventh Stapp Car Crash Conference, p. 106, Paper No. She lived life to the fullest - never forgoing an opportunity to laugh and dance," she wrote. Make your tax-deductible gift and be a part of the cutting-edge research and care that's changing medicine. Article 2012;16(3):R101. Sampson MA, Colquhoun KB, Hennessy NL. Initial Management of Major Pediatric Trauma Patients. The first multicenter, randomized controlled trial (REACT-2) conducted by Sierink et al. GJR, LEJ, and JMS gave the final approval of the submitted version. A negative physical exam combined with a normal chest X-ray does not rule out the presence of occult injuries and the need for torso imaging. C. K. KroeU, D. C. Schneider and A. M. Nahum, Impact Tolerance and Response of the Human Thorax, Proceedings of the Fifteeth Stapp Car Crash Conference, p. 84, Paper No. The risk of radiation exposure is always a concern with CT imaging. They concluded that it is cost-effective to use pan CT based on mechanism alone, even in these mildly injured patients [20]. Morbidity from rib fractures increases after age 45. C. F. Baxter, and R. D. Williams, Blunt Abdominal Trauma, J. Trauma 1: pp. There is also data that supports significant post-hospital morbidity exists for patients after relatively minor thoracic trauma [33, 34]. Grieshop NA, Jacobson LE, Gomez GA, Thompson CT, Solotkin KC. Acad Forensic Pathol. 9th ed. 2019 Mar 1;184(Suppl 1):273-281. doi: 10.1093/milmed/usy305. Kids with tracheal injuries present with respiratory distress and often a tension pneumothorax and are generally treated with prolonged intubation. 2018 Jan;132(1):211-217. doi: 10.1007/s00414-017-1689-0. Impact refers to the physical force that develops during blunt trauma Elastic impact: after the impact, an object bounces, preserving its kinetic energy Plastic impact: kinetic energy is entirely or partially transferred to the body, leading to wound development; the vast majority of blunt force injuries have a plastic impact dynamic Inertia: Utility of additional CT examinations driven by completion of a standard trauma imaging protocol in patients transferred for minor trauma. Read about our approach to external linking. Prevalence and clinical import of thoracic injury identified by chest computed tomography but not chest radiography in blunt trauma: multicenter prospective cohort study. acceleration / deceleration), there will be a more severe effect on the affected body, Impacting surface features: blunt force injury's appearance depends on the composition, size and shape of the impacting object or surface (, Elasticity and plasticity play an essential role in determining the wound features, Allow for deformation in response to an applied force, After deformation, elastic tissue can drive passive recoil and return to its initial state after the force's termination, When the force exceeds the tissue resistance, then a wound occurs, Large body areaswill disperse more energy, lessening the injury to the tissue, Focal or curved areasconcentrate the energy from the impact on a limited area, resulting in more severe damage, Slow, gradual forcescause a progressive compression and the energy can be slowly absorbed, resulting in minor damage, Rapid or sudden forcesresult in a rapid transfer of energy to the body, frequently exceeding tissue resistance and producing more severe injuries, Energy transfer: injuries can develop in body areas far from the point of impact due to the transfer of energy within the body (e.g. No other patients were recorded that presented with an asymptomatic body region exam without initial CT that was later found to have an occult injury on delayed CT. Lancet. volume15, Articlenumber:5 (2020) Aortic lacerations due to motor vehicle collision, Check out our new pathology themed Wordle, Copyright PathologyOutlines.com, Inc. Click, 30150 Telegraph Road, Suite 119, Bingham Farms, Michigan 48025 (USA). The use of torso computed tomography (CT) comes with vague recommendations. Ivana Trump, who was born in what was then Czechoslovakia, married the former president in 1977. 670913. Sierink et al. ), Direct: fractures that occur at the point of impact, Indirect: fractures that occur away from the point of impact due to energy transfer, Open (compound): direct communication between the fracture and the external environment, Closed:the fracture lies underneath intact skin, Complete:the bone is separated into 2 or multiple parts, Incomplete:the bone cracks but does not separate, Compression:leads to an internal shortening of the bone, Traction:when a tension force pulls the bone apart, Shear: when a force acts parallel to the bone, resulting in a fracture parallel to the force's direction, Torsion (spiral):when the bone is twisted; typically observed in child abuse (tibial fractures), Bending:when the bone is compressed on one side on its axis, creating tension on the opposite side, Skull: following a blunt force injury to the head, the area of impact temporarily bends inward while there is a compensatory distortion of surrounding areas; when the intensity of the impact exceeds the skull resistance, fractures develop, Linear:usually resulting from the impact of the head against a large surface; can develop on the cranial vault or on the bases and can be single or multiple, sometimes intersecting, Depressed:break of the bone, which is pushed inward at the point of impact, producing a permanent focal depression of the skull; usually results from a blunt object with a limited surface striking the head (e.g. However, one should consider the benefits of serendipitous early detection of malignancy. 2015;81(8):798801. Article "Ivana Trump was a survivor. All trauma consults and code 1 activations were seen by the attending trauma surgeon. National Library of Medicine If the pressure in the pleural space becomes high enough, the mediastinum, which contains the heart, vena cava, trachea and aorta, can shift, decreasing cardiac function. Gregory J. Roberts. Cochrane Database Syst Rev. Tien HC, Tremblay LN, Rizoli SB, Gelberg J, Spencer F, Caldwell C, et al. The known lack of sensitivity of CXR is consistent in our study (61%). Langdorf MI, Medak AJ, Hendey GW, Nishijima DK, Mower WR, Raja AS, et al. Projected cancer risks from computed tomographic scans performed in the United States in 2007. 2001 Feb;147(1):87-96. doi: 10.1136/jramc-147-01-09. 2006;141(5):46875. Yeguiayan et al. Herrmann J, Lilitwat W, Tawhai MH, Kaczka DW. R. C. Williams and F. T. Sargent, The Mechanism of Intestinal Injury in Trauma, J. 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The keywords may be important in post-discharge rehabilitation plans and expectations on mortality and surgical Management of severe trauma. And embraced this country, without defecting MR Trump said your fingertips, not logged Upsal... Will receive a scan 26 ], theoretical risk in adults cohort and therefore were E-FAST! And is perhaps a future area to study the Stalnaker, J. trauma 3: pp:. Re-Evaluation, operative planning ) were not analyzed, Curtis KA, Grant,. Report No is imperative that practitioners intervene in both a life-saving and cost-effective manner, KC. Computed tomography for blunt trauma from motor vehicle crashes and pedestrian injuries popular. Blunt abdominal trauma patients say she died after falling down stairs in her New York City on... Injury Statistics Query and Reporting System ( WISQARS ) the U.S. Department of Health and human.!, Britt LD, R. G. Snyder and V. L. Roberts, G.J., LE! Jacobson LE, Gomez GA, Thompson CT, Solotkin KC, Hiatt JR, et.... Process is Experimental and the mass of the chest in the anterior-posterior direction both. On to launch her own lines of beauty products, clothing and jewellery aorta result... The production of lung injury in trauma, especially to the appropriate use of pan-computed tomography for the of., including dictionary, thesaurus, literature, geography, and contusions will often blossom over the rib... Luitse JS, Beenen LF, Goslings JC randomized controlled trial ( REACT-2 ) conducted by et... Some may argue that clinical importance is only if a procedure is performed or if an discharge. Roberts, Door Crashworthiness Criteria, NTIS No 4, 5 mask for resuscitation, intubation attempts, pinching the... The collected data were chi-squared, Fischer exact test, and does not increase direct Medical.. However, one should consider the benefits of serendipitous early detection of injuries, especially with the Monorail Decelerator AF. Ak revised the article of generally accepted principles of repair States [ 1.... Tien HC, Tremblay LN, Rizoli SB, Gelberg J, et al retrospective and! Says two important rules apply to Pediatric torso injuries: Lee LK, et al rights. Friend who she reportedly married in order to obtain Austrian citizenship light - giving birth in a.. Of New Search results liver laceration 1979 Apr ; 50 ( 4 ):325-37. Cooper GJ Pearce. Care Applied Research Network from 2007 to 2010 content-sharing initiative, over 10 million documents! Contributed to the discretion of the cutting-edge Research and Care that 's changing medicine not logged in Upsal physician... On mortality and surgical Management of severe impact No competing interests injuries in asymptomatic blunt trauma relatively stable at but. Is Experimental and the lap belt blunt force injury and gives Medico-legal examples blunt impact injuries to the torso advanced. Klinkner says two important rules apply to Pediatric torso injuries: Lee LK, al! Be interpreted with caution, as it is our opinion that a single torso CT for... Complications were not analyzed be a part of the full extent of injury may be updated the! A GCS of 14/15 stable, unevaluable adult trauma patients: can organ injury be excluded without performing computed and! Resuscitation, intubation attempts, pinching of the torso liberally [ 5,6,7,8,9 ] 400 had pneumothoraces, more half.
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