2017-18 HSC Section 3 Green Book

J Trauma Acute Care Surg Volume 82, Number 6

Tessler et al.

TABLE 1. Characteristics, N = 44 Variables Injury Severity Score, median (IQR)

TABLE 3. Physical Examination at Presentation

No. (%) **

2 (1 – 11.5) 7.3 (5.3 – 11)

Hard Signs (N = 10)* Active hemorrhage Airway compromise Air bubbling wound

Age: median (IQR), y

6 (13.6) 7 (15.9)

Age range, y

No (%)

0 to <1 1 to <5 5 to <10 10 to <16 16 to 18

2 (4.5) 7 (15.9) 19 (43.2) 14 (31.8)

0 0 0

Expanding/pulsatile hematoma

Hematemesis Hemiparesis

1 (2.3) 2 (4.5)

2 (4.5)

Massive subcutaneous emphysema

Male

24 (54.5)

Pulse deficit

0

Mechanism Gunshot wound

Respiratory distress

1 (2.3) 1 (2.3)

11 (25.0) 10 (22.7) 9 (20.5) 9 (20.5)

Shock

Fall/collision onto sharp object

Soft signs (N = 16) † Bruit

Dog bite

0 0 0 0

Stab

Chest tube air leak Dysphagia, dyspnea

MVC with penetrating shrapnel

2 (4.5) 3 (6.8)

Other

Hemoptysis Lac > 2 cm

Trauma phase before BCHO* Field

15 (34.1)

33 (75)

Minor hematemesis

0

Referral hospital

10 (22.7)

Nonpulsatile, nonexpanding hematoma

1 (2.3)

Not available

1 (2.3)

Paresthesias

0

Stridor

1 (2.3) 2 (4.5)

*UCSF Benioff Children's Hospital Oakland.

Venous oozing Voice change

angiography among 18 total patients. Proportions of the total number of patients seen in each respective period that underwent cross-sectional imaging and/or neck exploration are shown in Figure 1. Comparisons between the proportions of standard CT, CTA, and neck exploration between the first and last de- fined periods demonstrated a 27.7% increase in CTA, 20.9% 1 (2.3) *Number of patients with any hard sign of injury. The numbers listed in the column are the number of patients with that hard sign where any single patient can have multiple hard or soft signs. **Percent of total 44 patients. † Number of patients with only soft signs. The numbers listed in the column are the num- ber of patients with that soft sign where any patient can have multiple hard or soft signs.

either noncontrast or intravenous contrast. Between the years 2005 and 2009, six patients had standard CT scans and one had CT angiography of the neck among 18 total patients in that period. Between the years 2010 and 2014, three patients had CT scans of the head/neck/face, and five patients underwent CT

TABLE 2. Vital Signs and Zone of Injury Vital Signs

No. (%)

MAP*, mm Hg <50

2 (4.7)

50 – 90

19 (44.1) 22 (51.1.)

>90

Heart rate*, bpm**, range <60

1 (2.3)

60 – 110

20 (46.5) 22 (51.1) 6 (13.9)

>110

Abnormal breath sounds

Hypoxia (<90%)

2 (4.6)

Glasgow Coma Score 13 – 15

37 (84.1) 1 (2.3) 6 (13.6)

8 – 12

3 – 7

Zone of injury* Zone I

1 (2.3)

Zone II

32 (72.7) 6 (13.6)

Zones II and III

Zone III

4 (9.1)

*N = 43. **Beats per minute.

Figure 1. Imaging and neck exploration over time.

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