Jornal de Trauma e Tratamento

Background: Administration of tranexamic acid (TXA) is associated with reduced mortality in civilian and military settings. The purpose of this study was to assess a TXA treatment guideline in patients with traumatic injury in a Level I trauma center. The guideline was to give TXA to patients going directly to OR, or with SBP < 90, or for whom our massive transfusion guideline was activated. The hypothesis was that TXA would confer mortality benefit without increasing thromboembolic complications (DVT/PE) or acute kidney injury (AKI).

Methods: Records of TXA recipients were reviewed. TXA recipients were compared to a random sample of historical controls that met administration criteria but did not receive TXA. Outcomes were compared for patients meeting any criteria for TXA administration and also for those going directly to the OR.

Results: From Dec 2011 through July 2012, 52 trauma patients received TXA. When compared to 74 controls (SBP < 90), TXA recipients trended towards lower mortality (5.8% vs 17.6%, p=.05), higher DVT/PE (11.5% vs 0, p=.004), and more AKI (25% vs11%, p=.02). However baseline characteristics were not well matched. When controls were selected from hypotensive patients going directly the OR, baseline matching was excellent. Among well matched direct to the OR cohorts TXA recipients had lower 24h mortality (4.3% vs 19.1%, p=.03), more DVT/PE (12% vs 0%, p=.012), a trend towards more AKI (28% vs 15%, p=.12) but no transfusion differences.

Conclusion: In civilian trauma, early TXA administration confers early survival advantage without affecting blood product usage but may increase the risk of DVT/PE and AKI.

Background: Majority of maxillofacial injuries in Port Harcourt, Nigeria is caused by road traffic accidents (57.1%), assaults (17.6%), gunshots (14.3%) and falls (9.9%). However, many reports on maxillofacial trauma have not focused specifically on assault and from our study, some of the injuries were severe based on tissue involved, tissue loss and bone involvement, the purpose of this study was to document our experience in the pattern and management of maxillofacial injuries due to assault from non projectiles in our center.

Method: Patients’ demographics, site and type of injury, tissue involved as well as presence of associated injuries. The objects that were used to inflict the injuries were documented. Soft tissue injuries were classified as either contusions alone or contusions with laceration, avulsions or degloving injuries. The investigations and treatment done, and outcome of treatment were also documented. The treatment outcome was based on esthetic appearance of the scars and patients satisfaction.

Result: Of the 31 patients, 21 had detailed information for analysis, 14(66.7%) were males and females were 7(33.3%,8(38.1%) had both soft and hard tissue injuries while 13(61.9) cases had only soft tissue injuries. Age range was between 14 years and 55 years with mean (SD) of 27.9(9.1) years. There was associated head injury in 2(9.5%) cases. Domestic violence between spouses and family members accounted for 4(19%) cases, child battering for 1(4.8%) case and the others were due conflict between neighbors or friends.

Conclusion: Intervention strategies should be targeted at the youths and adult without gainful employment in order to minimize aggression and violence

We present a case of sudden sensorineural hearing loss and paroxysmal positional vertigo following a closed head injury. A perilymphatic fistula (PLF) was suspected in the absence of any other definite diagnostic findings. The patient underwent exploratory tympanotomy. Fistula was grafted which noticeably improved his vestibular symptoms. PLF must be considered in post-traumatic sensorineural hearing loss with or without other vestibular symptoms. Surgical treatment with patching of oval and round windows remains an effective treatment, but its effect on hearing loss is less predictable.

Hypothesis : Routine repeat head Computed Tomography (CT) for patients with traumatic head injury, initially presenting with GCS of 14-15, does not change therapeutic policy in these trauma patients.

Methods : This was a retrospective cohort study of trauma patients with Glasgow Coma Scale (GCS) of 14-15 on admission, suffering from different types of intracranial bleeding who were admitted for observation in a level II trauma center. The size of hematoma on initial head CT was measured and compared to findings of repeat CT performed following 12 hours. Patients were evaluated as to changes in neurologic status and treatment.

Results: 68 patients treated over a period of 5 years were evaluated. Forty two (61.8%) were male and 24 (38.2%) were female. Mean age was 56.2 years and mean ISS score was 12 ± 5.1. Initial GCS was 15 in 51 patients and 14 in 15 other patients. CT scan revealed 7 epidural hematomas, 20 subdural hematomas, twenty eight intraparenchymal bleeding, and 13 subarchnoid hemorrhages. Repeat CT revealed an increase in size of the hematoma in 8 eight patients. None of these patients suffered from clinical deterioration. Repeat CT in 12 patients who’s GCS deteriorated, did not show any significant changes on the repeat CT scan. None of the patients underwent intervention after a routine repeat CT.

Conclusions: Routine repeat CT scan of head, performed 12 hours after the initial scan did not change the therapeutic policy in GCS 14-15 head trauma patients. The need for mandatory CT of head in mild traumatic brain injury should be questioned

Pneumorrhachis (Intraspinal air or intraspinal pneumocele) is a rare association with closed head injury. Iatrogenic causes are well known and are often secondary to diagnostic procedures. However, there are only a few case reports in the literature following trauma. We present a case of traumatic pneumorrhachis following a head injury with base of skull fracture. This was treated conservatively and patient made a full recovery.

The approach to emergency abdominal surgery has undergone a profound change primarily because of the change of types of diseases treated and the widespread use of diagnostic methods, such as ultrasound and contrast-enhanced computed tomography. In particular, these two investigative methods have allowed a more accurate preoperative diagnosis, thus avoiding many unnecessary exploratory operations, and leading to conservative treatment of many patients with abdominal trauma.

To clarify that the fluctuation of the excitability of spinal neural function after ankle sprain, we studied the alteration of H reflex from the soleus muscle in a patient with ankle sprain. A Subject was male college basketball player, whose age was twenty-one years old, and diagnosed left ankle inversed sprain (grade II). H reflex and maximal M wave from the bilateral soleus muscle were evoked at rest and amplitude ratio of H/Mmax was calculated. And, amplitude ratio of H/Mmax was compared between after and before injury. As a result of this study, amplitude ratio of H/Mmax was increased at three days after ankle sprain on both injured side and non-injured side compared with both before and one month after injury and, Long Latency Reflex (LLR) was appeared behind the H reflex consecutively on the only injured side. From results of this study, it was cleared that the excitability of spinal and supra-spinal neural function related to soleus muscle at three days after was increased due to pain, joint effusion and/or joint instability.