To investigate the relationship between hospital length of stay and initial clinical information in patients with rib fractures due to blunt chest trauma.
This study included 92 eligible patients. We analyzed hospital length of stay (HLS) by multiple linear regression analysis. The gender, age, heart rate (HR), systolic blood pressure (SBP), and number of rib fractures (FxNo) were assumed as independent variables. We also assessed the following : presence of pneumo-hemothoraces, chest drainage tube requirements, and epidural anesthesia or intercostal block requirements.
In conclusion, HLS was estimated using the following formula ; HLS=4.9+0,9×FxNo±15.6 (days). When patients were older than 60, the estimated length of stay increased by 3.3 days. Also, when patients required chest tube drainage, the estimated length of stay increased by 3.6 days.
Using this formula, we are able to estimate the length of hospital stay at the initial clinical presentation. We also suggest the importance of prevention of pneumonia to avoid extension of hospital stay.
We encountered a rare case of neck impalement injury extending to the oral cavity, requiring cricothyroidotomy and total submandibular gland excision. A 48-year-old man who was working on a construction site, had his right neck penetrated by an iron pipe of about 10 mm in diameter when he fell. We examined his neck and head by plain CT. We recognized a neck hematoma compressing the trachea, and were soon aware of stridor. We conducted a cricothyroidotomy as soon as possible. We then immediately explored the injury site, and observed wounds reaching the oral cavity through the soft palate and injury to the submandibular gland. We perfomed a total right submandibular gland excision. In neck impalement injuries, it is important to carefully confirm whether or not airway obstruction exists and if other tissues are injured, and we must treat patients while controlling infection.
Transection of the common bile duct due to blunt abdominal trauma is very rarely experienced. Consequently, a choice of reconstruction depends on the extent, shape and length of the injury. In this case, transection of the common bile duct and extensive rupture of the second portion of the duodenal lateral wall were observed. However, parenchyma of the pancreas and papilla of Vater were not injured. We performed reconstruction with duodenojejunal side to side anastomosis using the same loop of the choledochojejunostomy. This method is applicable to extended rupture of the duodenum forming a double tract reconstruction that enables sufficient decompression of the duodenum.
[Background] It is difficult to diagnose cervical spinal cord injury (CSCI) in blunt trauma patients with severe disturbance of consciousness (DOC) because of the lack of sufficient neurological findings during initial trauma care.
[Patients] Of the 1313 blunt trauma patients examined between 2003 and 2008, 5 who developed CSCI secondary to severe DOC with a Glasgow Coma Scale score of < 8 points were included in this study.
[Results] At admission, 4 of the 5 patients had hypotension (systolic arterial pressure, <100 mmHg), and none of them had tachycardia (heart rate, <100 bpm). To diagnose CSCI, we performed cervical radiography in 3 patients. In each of the 2 other patients, computed tomography (CT) and magnetic resonance imaging (MRI) use were required. Three of the patients developed both respiratory paralysis and quadriplegia.
[Discussion] It is extremely difficult to predict the onset of paralysis in blunt trauma patient with severe DOC. Therefore, it is necessary to detect CSCI on the basis of cervical radiography and CT findings. In blunt trauma patients who have hypotension but no tachycardia, neurogenic shock should be strongly suspected. In this study, we showed that the probability of CSCI is high when CSCI patients are complicated by severe DOC.
A previously healthy 49-year-old male builder was injured by a 1.5 ton steel plate that accidentally fell on this patient. He was immediately transferred to our facility in a state of shock. With the diagnosis of unstable pelvic fracture and extra-peritoneal rectal perforation, the former was managed by massive transfusion, TAE, and external pelvic fixation and the latter by rectal transection, rectal washout, and presacral drainage. After the initial stabilization in the ICU, a diverting colostomy was created on the following day. After 20 days of intensive care with rigorous local wound irrigation and debridement, the patient recovered from sepsis. Due to the severe peripelvic infection, the external fixator failed to maintain the stability of the fractured pelvis ; however, with daily wound care under the adequate provision of analgesics, the pelvis became gradually stabilized over the next 4 months. Rehabilitation enabled the patient to be discharged home 10 months after the injury.
In this case, the management of unstable pelvic fracture became even more complicated with concomitant rectal injury. We herein report our successful treatment of this case, and we review the literature regarding methods to stabilize a fractured pelvis in the face of peripelvic soft tissue infection.
We changed treatment indications and modalities for severe hepatic injuries during the past 29 years. Hepatectomy was mainly undertaken during the early stage (1979-1984), the death rate of which was 64.3%. In the middle stage (1985-1994), the criteria for hepatectomy and use of adjunctive procedures were applied. The death rate of hepatectomy decreased, but outcomes for DCS and IIIb+JHV were poor. We considered that the circulatory state was more important than anatomical features of hepatic injuries and selected several treatment modalities such as hepatectomy, DCS and NOM during the late stage (1995-2007). The death rate in the late stage was decreased to 11.4%. Treatment modalities and outcomes for severe hepatic injuries have changed dramatically in the past 29 years. Multiple modes of therapy are available for hemorrhage control, which has improved outcomes. It is important to improve the death rate of DCS and IIIb+JHV in the future.