Blunt

Abstract: Blunt vertebral arterial injury (BVI) has historically been considered an uncommon event of relative insignificance. There have been many case reports describing BVI-associated cerebrovascular accidents, both ischemic and hemorrhagic, but clinical series of vertebral artery injuries have been composed primarily of penetrating injuries. In the seven largest reports, only 8 (4%) of 195 total reported patients had sustained blunt mechanisms; these 8 patients as a group had reasonably good outcomes, leading to the belief that BVI is relatively innocuous. 1–7 This concept was further supported in small series dealing specifically with blunt injuries. 8–14 In 1996 we adopted an aggressive screening protocol for blunt carotid arterial injuries. 15 Using four-vessel cerebral arteriography, we began identifying a significant number of BVIs in addition to blunt carotid injury. Fabian et al 16 previously demonstrated the benefits of systemic heparin therapy in treating patients with blunt carotid injury; our experience with asymptomatic patients affirmed the Memphis data. 15 Extrapolation of blunt carotid injury treatment principles to BVI, however, has not been supported. Collectively, the consensus in the literature to date is that asymptomatic patients with narrowing, irregularity, or occlusion of the vertebral artery do not require treatment. 1–7,11,12 The purpose of this study was to analyze our experience and formulate a rational diagnostic and therapeutic approach to BVI.

Abstract: Background:Blunt injury to the carotid or vertebral vessels (blunt cerebrovascular injury [BCVI]) is diagnosed in approximately 1 of 1,000 (0.1%) patients hospitalized for trauma in the United States with the majority of these injuries diagnosed after the development of symptoms secondary to central

Abstract: Background Blunt hollow viscus injury (HVI) is uncommon. No sufficiently large series has studied the prevalence of these injuries in blunt trauma patients. This study defines the prevalence of blunt HVI, in addition to the associated morbidity and mortality rates for this diagnosis on the basis of

Abstract: BACKGROUND: During the last century, the management of blunt force trauma to the liver has changed from observation and expectant management in the early part of the 1900s to mainly operative intervention, to the current practice of selective operative and nonoperative management. These issues were first addressed by the Eastern Association for the Surgery of Trauma in the Practice Management Guidelines for Nonoperative Management of Blunt Injury to the Liver and Spleen published online in 2003. Since that time, a large volume of literature on these topics has been published requiring a reevaluation of the previous Eastern Association for the Surgery of Trauma guideline. METHODS: The National Library of Medicine and the National Institutes of Health MEDLINE database were searched using PubMed (www.pubmed.gov). The search was designed to identify English-language citations published after 1996 (the last year included in the previous guideline) using the keywords liver injury and blunt abdominal trauma. RESULTS: One hundred seventy-six articles were reviewed, of which 94 were used to create the current practice management guideline for the selective nonoperative management of blunt hepatic injury. CONCLUSION: Most original hepatic guidelines remained valid and were incorporated into the greatly expanded current guidelines as appropriate. Nonoperative management of blunt hepatic injuries currently is the treatment modality of choice in hemodynamically stable patients, irrespective of the grade of injury or patient age. Nonoperative management of blunt hepatic injuries should only be considered in an environment that provides capabilities for monitoring, serial clinical evaluations, and an operating room available for urgent laparotomy. Patients presenting with hemodynamic instability and peritonitis still warrant emergent operative intervention. Intravenous contrast enhanced computed tomographic scan is the diagnostic modality of choice for evaluating blunt hepatic injuries. Repeated imaging should be guided by a patient’s clinical status. Adjunctive therapies like angiography, percutaneous drainage, endoscopy/endoscopic retrograde cholangiopancreatography and laparoscopy remain important adjuncts to nonoperative management of hepatic injuries. Despite the explosion of literature on this topic, many questions regarding nonoperative management of blunt hepatic injuries remain without conclusive answers in the literature. (J Trauma Acute Care Surg. 2012;73: S288YS293.