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PubMed1986

Increased lung capillary permeability after trauma: a prospective clinical study.

Pulmonary dysfunction and permeability were prospectively studied in a group of severely traumatized patients. Ventilatory parameters (i.e., PaO2/FiO2, dynamic compliance, per cent shunt, and A-a DO2) and extravascular lung water (EVLW) measurements were compared with scintigraphic determinations of pulmonary albumin extravasation. Albumin extravasation data demonstrated a pulmonary capillary permeability increase occurring shortly following trauma. The median albumin extravasation value in the patients within 24 hours of trauma was 3.6 X 10(-5)/sec, compared to a control value of -0.1 +/- 0.7 X 10(-5)/sec. Intermediate levels of albumin extravasation were found in patients studied within 48 hours of total hip replacement (1.6 +/- 0.9 X 10(-5)/sec). Eighty per cent of patients studied within the first 48 hours of their trauma had albumin extravasation values exceeding the upper limit of normal as determined by the control value + 2 S.D. In contrast to albumin extravasation values, the PaO2/FiO2, dynamic compliance, per cent shunt, A-a DO2, and EVLW did not begin to deteriorate significantly until at least 48 hours after trauma. We conclude that severe multiple trauma induces an early increase in pulmonary capillary permeability as measured by albumin extravasation scintigraphy. This change is not detectable with other commonly used measures.

Adolescent↗

PubMed2005

Use of recombinant activated factor VII to treat the acquired coagulopathy of trauma.

Recombinant activated factor VII (rFVIIa) is a drug commonly utilized in the treatment of patients with hemophilia and inhibitors. However, its use in previously normal patients with an acquired coagulopathy after trauma and surgery is increasing. Multiple trauma case reports and several case series are available, lending support for the efficacy of the drug in reversing the coagulopathy of trauma. Data from six large animal studies evaluating the efficacy in trauma models are available for evaluation. A single prospective randomized study in elective surgery has recently been published, documenting reduced blood loss and decreased transfusion after a single preoperative dose. This review describes those studies and reiterates the need for well designed prospective randomized human trauma studies.

Animals↗

PubMed2006

Posttraumatic stress disorder among female street-based sex workers in the greater Sydney area, Australia.

BACKGROUND: This paper examines rates of exposure to work-related violence and other trauma, and the prevalence of lifetime and current posttraumatic stress disorder (PTSD) among female street-based sex workers. It also investigates associations between current PTSD symptoms and: demographic characteristics, psychiatric comorbidity, injecting and sex risk behaviours, and trauma history. METHODS: Cross sectional data collected from 72 women via face to face structured interviews. The interview included structured diagnostic assessment of DSM-IV PTSD; drug dependence; depression; experience of childhood trauma; and an assessment of sex working history. RESULTS: All but one of the women interviewed reported experiencing trauma, with the majority reporting multiple traumas that typically began in early childhood. Child sexual abuse, adult sexual assault and work related violence were commonly reported. Just under half of the women met DSM-IV criteria for PTSD and approximately one-third reported current PTSD symptoms. Adult sexual assault was associated with current PTSD symptoms. Depression and drug dependence were also highly prevalent; cocaine dependence in particular was associated with elevated rates of injecting risk and sexual risk behaviours. CONCLUSION: These women reported complex trauma histories and despite ongoing opportunities for clinical intervention, they continued to experience problems, suggesting that current models of treatment may not be appropriate. More targeted interventions, and integrated mental health and drug treatment services are needed to address the problems these women are experiencing. Outreach services to these women remain a priority. Education strategies to reduce risky injecting and sexual behaviours among sex workers should also remain a priority.

Adult↗

PubMed2005

[Factors affecting the results of treatment in traumatic dislocation of the hip].

OBJECTIVES: We evaluated the long-term results of conservative and surgical treatment and the effect of prognostic factors on these results in patients with traumatic dislocation of the hip. METHODS: The study included 30 patients (27 males, 3 females; mean age 35 years; range 16 to 69 years) with traumatic hip dislocations. The most common cause was traffic accidents (80%). Fifteen patients underwent closed reduction for posterior (n=10), anterior (n=2), and central (n=3) dislocations, of which eight were isolated and seven were fracture dislocations. Open reduction was performed in 15 patients with posterior (n=14) and central (n=1) dislocations. Of these, five patients had isolated hip trauma and 10 patients had multiple trauma. Surgery was performed within the first 24 hours (n=6) or between five and 21 days (n=9). Posterior, central, and anterior dislocations were classified according to the Thompson-Epstein, Judet, and Epstein classification systems, respectively. The Pipkin classification was also used for dislocations with femoral head fractures. The results were evaluated according to the criteria proposed by Matta. The mean follow-up was 49 months (range 16 to 84 months). RESULTS: Following closed reduction, the results were satisfactory (very good or good) in 11 patients (73.3%, all isolated dislocations and three posterior fracture dislocations) and unsatisfactory (moderate or poor) in four patients (26.7%). Following open reduction, nine patients (60%) with posterior fracture dislocations had satisfactory and six patients (40%) had unsatisfactory outcome. The results were unsatisfactory in all the central dislocations. One patient developed avascular necrosis of the femur head and four patients developed degenerative arthritis following closed reduction. Degenerative arthritis was seen in six patients after surgical treatment, two of whom also had avascular necrosis. CONCLUSION: Our data may provide insight into the factors affecting the prognosis of traumatic hip dislocations treated by closed or open reduction.

Accidental Falls↗

PubMed1994

Multiple organ dysfunction syndrome in the trauma patient.

Multiple organ dysfunction syndrome (MODS) is a common complication following traumatic surgery. Aggressive volume resuscitation, restoration of perfusion, and preventive interventions may prevent or lessen the severity of MODS. The nurse, as an integral member of the multidisciplinary team, can affect the ultimate outcome of trauma by recognizing persons at risk for developing MODS and intervening in a timely manner.

Adolescent↗

PubMed1996

Commercial logging fatalities in Ontario, 1986-1991.

Despite the economic importance and hazardous nature of commercial logging in various regions, few medical studies have examined fatalities in this industry. Data derived from the files of the Ontario Chief Coroner's Office revealed 52 deaths, all men, from 1986 to 1991 in the province of Ontario. Forty-four cases were accidents (age range 20-73 years; average, 44 years), the majority involving experienced loggers. Personal error resulting in preventable unsafe work practices was a factor in most accidents (n = 35; 79.5%). Almost one half of injured workers were struck by either dead or cut trees. Although the majority of cases occurred in remote areas, delayed medical attention as a factor contributing to death was uncommon. Many of the injuries were nonsurvivable and most victims (n = 33; 75%) were dead at the scene. Most deaths were caused by either head and neck injuries (n = 20; 45.5%), multiple trauma (n = 10; 23%), chest trauma only (n = 6; 13.5%), or mechanical asphyxia (n = 5; 11%). Blood alcohol was negative in 24 accident victims tested. Eight deaths (age range 42-52 years; average, 49 years) were due to cardiac causes, mainly ischemic heart disease. Disease may have contributed to two accidents.

Abdominal Injuries↗

PubMed1993

Enterococcal infections.

An 8-year-old male suffered multiple trauma in a motor vehicle accident. He has been in intensive care and has multiple intravascular catheters and an indwelling Foley catheter. He has received 6 days of a third-generation cephalosporin antibiotic. On day 7, he develops a spiking temperature but no other evidence of infection. However, both of the two blood cultures and a urine culture grow out enterococcus.

Child↗

PubMed1996

Early and late onset bacteremia have different risk factors in trauma patients.

OBJECTIVE: The aim of this study was to identify risk factors and to describe epidemiological patterns for early-(EOB) and late-onset bacteremias (LOB) after trauma. DESIGN: A prospective study conducted on 141 consecutive trauma patients. SETTING: A general intensive care unit (ICU) of a university hospital. PATIENTS: All multiple trauma patients admitted to our general intensive care unit (ICU) from December 1990 to May 1992 were prospectively enrolled in the study. The following information was collected for each patient and recorded in a computer database: demography, severity of trauma according to the Abbreviated Injury Scale (AIS), severity of coma according to the Glasgow Coma Scale (GCS), presence of pneumothorax, pulmonary contusion, rib fractures, hemothorax, and abdominal trauma, use of mechanical ventilation, and placement of central venous catheters. Bacteremias were defined as EOB when onset occurred within 96 h after trauma, and as LOB when appearing after 96 h from trauma. RESULTS: Thirty-seven patients developed bacteremia during their ICU stay (26%): 11 (29.7%) EOB and 26 (70.3%) LOB. Gram-positive cocci were isolated more frequently in EOB than in LOB (chi 2 = 4.1, P = 0.04). The risk of EOB was significantly increased by the presence of pulmonary contusion [relative risk (RR) 15.0; confidence interval (CI) 1.99-113.25], pneumonia before the onset of bacteremia (RR 3.56; CI 1.17-10.69), AIS score greater than 32 and an abdominal injury score greater than 9 (RR 3.11; CI 1.02-9.49), while intravascular catheters and mechanical ventilation did not represent risk factors for EOB. LOB had a very different pattern and their risk was significantly increased by exposure to intravascular catheters (RR 4.96; CI 1.23-19.94) and to mechanical ventilation lasting more than 7 days (RR 3.6; CI 1.6-8.1). CONCLUSIONS: Scoring with the AIS of the abdominal and thoracic trauma at admission to the ICU appears a useful tool for identifying trauma patients at increased risk of EOB. A rigorous policy of catheter placement and maintenance as a means of reducing late bacteremias in trauma patients is essential.

Abdominal Injuries↗

PubMed1997

[Functional, neuropsychological and social outcome of polytrauma patients with severe craniocerebral trauma].

The aim of this study was to identify, in (pre-) clinically obtained data, parameters predicting the outcome of patients with multiple trauma and severe head injury. Fifty-eight patients aged 27 +/- 10 years were investigated an average of 5.8 years after the accident. The Hanover Polytrauma Score was 34 +/- 11 points, the initially assessed Glasgow Coma Scale (GCS) was 6.2 +/- 3.2 points; and the duration of coma was 15.4 +/- 14.4 days. The primary length of stay in hospital averaged 33.4 days, including 22.9 days in the intensive care unit and 20.2 days of ventilation. For a further 223 days the patients were treated at the Neurologic Clinic of Hessisch Oldendorf. Besides different neurologic deficiency symptoms, the psychometric tests showed deficits in all areas. In particular, information processing speed, concentration, recent memory and learning performance were impaired. There was free mobility of all joints in 33% of the patients. Due to injury the elbow and ankle joint developed the worst restriction. Central paralysis and heterotopic ossification also caused a restriction in joint mobility. Half of the patients were confronted with different social changes. The rate of return to work was dependent on age. Some 42% of all patients had taken up their former profession, 5% were still in training or at college, 32% were retrained to other professions, 16% were unemployed and 5% were completely retired on pension. Age, injury severity, GCS, duration of coma and duration of weaning were suitable predictors in correlation- and regression analysis. The Glasgow Outcome Scale showed good recovery and moderate disability in 53%, severe disability in 33% and persistent vegetative state in 14% of the patients.

Activities of Daily Living↗

PubMed1992

[Stabilization of pelvic fractures].

In contrast to less complicated injuries to the pelvic ring, unstable bony fractures and injuries caused to ligaments by high-energy trauma require immediate stabilization by internal fixation. Since patients with severe pelvic injuries commonly present with multiple trauma, close cooperation between different medical disciplines is necessary to provide for optimum patient management. In cases with concomitant urological injuries, a joint primary intervention is recommended. Whether anterior, posterior or combined approaches are indicated for internal fixation depends on the injury pattern. The classification of pelvic ring fractures into group A, B and C injuries is discussed in detail.

Fracture Fixation, Internal↗

PubMed1991

Trauma history in diagnostic groups of temporomandibular disorders.

Trauma history was studied for association with disease among six diagnostic subgroups of 230 patients with temporomandibular disorder (TMD) from a private practice setting with (1) disk displacement (DD) with reduction, (2) DD without reduction, (3) osteoarthrosis (OA) with prior derangement history, (4) primary OA, (5) myalgia only, and (6) subluxation only. Except for subluxation (29%), trauma history typified TMD patient groups 1 to 5 (63%, 79%, 44%, 53%, 54%) (p less than 0.001) compared with 13% and 18% of asymptomatic (n = 61) and symptomatic (n = 161) student control subjects, and 11% of general dental patients (n = 150). TMD groups 2 and 3 differed significantly (p less than 0.05). The high prevalence of trauma in the myalgia-only group complicates the concept of myofascial pain-dysfunction syndrome as solely a stress or centrally mediated disorder. DD without reduction (43%) and with reduction (38%) had the highest prevalences of motor vehicle accident trauma, myalgia and OA groups had less, and subluxation-only cases had none. On the other hand, patients with DD without reduction were also the only group to report multiple trauma (29%), suggesting that although specific traumatic events may seem to precipitate clinical symptoms, they may not always have initiated the problem. Trauma may be both an important cumulative and precipitating event in TMDs.

Accidents, Traffic↗

PubMed2003

The importance of decompressive craniectomy for the management of severe head injuries.

Neurosurgical therapy aims to minimize the secondary brain damage after a severe head injury. This includes the evacuation of an intracranial space occupying bleeding, the reduction of intracranial volumes, in hematocephalus an external ventricular drainage, and the conservative therapy in order to influence an increased intracranial pressure (ICP) and a decreased p(ti)02. When conservative treatment fails to act a decompressive craniectomy might be successful in lowering ICP. From September 1997 until August 2001 we operated on 439 patients with severe head injuries. 50 patients (11%) were treated by means of a decompressive craniectomy. The prognosis after decompression depends on the clinical signs and symptoms on admission, the patients age and the existence of major extracranial injuries. Our guidelines for an indication for decompressive craniectomy after failure of conservative interventions and evacuation of space occupying hematomas include a patients age below 50 years without multiple trauma, a patients age below 30 years in the presence of major extracranial injuries, a severe brain swelling on CT scan, the exclusion of a primary brainstem lesion or injury and the intervention before irreversible brainstem damage and secondarily while monitoring ICP and p(ti)02 in an interval up to 48 hours after the accident before irreversible brainstem damage or generalized brain damage has occurred.

Adult↗

PubMed2005

[Interdisciplinary emergency room management of trauma patients from the standpoint of coworkers].

INTRODUCTION: The purpose of this study was to examine whether staff questionnaire evaluation is useful for quality control in the emergency room (ER) setting. METHODS: Consecutive anonymous questionnaires (Likert scale 1-5) were filled out by the involved medical staff in all ER trauma cases in a university hospital from July 2002 to December 2003 (analysis of variance, P<0.05). RESULTS: In 171 ER cases, 844 staff members responded. Main criticisms concerned time management or satisfaction with personal ER training (Likert <4). Consultants rated the quality of their training significantly higher than younger doctors, two thirds of consultants vs one third of residents having passed an Advanced Trauma and Life Support course (P<0.001). Depending on responders' professional specialties and whether the situation concerned multiple trauma (Injury Severity Score >15), a significant systematic difference resulted. CONCLUSION: Our standardized staff questionnaire evaluation was revealed to be a discriminative instrument for quality management of trauma cases in the ER. To confirm these findings, correlation with clinical outcome data and further validation of the method are needed.

Attitude of Health Personnel↗

PubMedDate not supplied

Inadvertent embolization of a persistent sciatic artery in pelvis trauma.

We describe a case of unilateral persistent sciatic artery (PSA), a rare vascular anomaly, in a 43-year-old woman with severe multiple trauma. A small amount of diluted embolization particles went into this vessel during emergent endovascular therapy under fluoroscopic monitoring. The procedure was immediately stopped when the true nature of the anatomic variant was recognized. Fortunately, an ischemic event of the lower leg did not occur. The imaging findings of computed tomography and digital subtraction angiography are presented and the relevant literature is reviewed.

Adult↗

PubMed2002

Is a complete trauma series indicated for all pediatric trauma victims?

OBJECTIVE: Trauma series radiographs (ie, lateral cervical spine, anteroposterior chest, and anteroposterior pelvis) are routinely recommended for victims of multiple trauma. However, the utility of the chest and pelvic radiographs has never been adequately evaluated. The purpose of this study is to determine whether clinical findings alone predict the results of these radiographs. METHODS: The pediatric radiology department at the Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, maintains a log of all patients who have undergone a complete trauma series. From this group, we selected all patients younger than 2 years with a Glasgow Coma Scale greater than 14 points. The patients' emergency department charts were reviewed to note the presence or absence of localizing signs and symptoms referable to the chest and pelvis, including chest or pelvic pain, tenderness, ecchymoses or abrasions, shortness of breath or other respiratory symptoms, hematuria or difficulty voiding, and abdominal distention. RESULTS: Sixteen of the 91 subjects (18%) had localizing chest findings. Two of these patients had positive chest radiographs, whereas the 75 patients without localizing chest findings had no positive chest radiographs (P < 0.03). Thirty-two of 91 subjects (35%) had localizing pelvic signs. Five of these patients had positive pelvic radiographs, whereas the 56 patients without localizing pelvic signs had no positive pelvic radiographs (P < 0.01). The negative predictive value of localizing signs and symptoms was 100% for both chest and pelvic radiographs. CONCLUSION: These data suggest that if an adequate examination can be performed, trauma series radiographs can be ordered selectively, based on the patient's clinical findings.

Emergency Service, Hospital↗

PubMed2003

[Current diagnostic and therapeutic approaches in liver injuries].

PURPOSE OF THE STUDY: The recent improvements in hospital care system (centralized specialized care) and the use of new imaging methods and modern technologies in surgical treatment have greatly enhanced successful outcomes of therapy in liver injury. The aim of the study was to evaluate the contribution of procedures included in the diagnostic-therapeutic algorithms to the treatment of blunt injury to the liver in our patient population. MATERIAL: Our group consisted of 43 patients with blunt injury to the liver who were treated at the Emergency Department between 1998 and 2002. In 28 patients, blunt injury was part of polytrauma, in 7 patients it was associated with thoraco-abdominal injury and, in 8 patients, it was the only trauma sustained. METHODS: The diagnosis and therapy were based on the algorithm currently used for treating liver injury at the Emergency Department. In addition to clinical examination and assessment of the actual status of hemodynamics, spinal computed tomography was carried out to establish the therapeutic procedure. Fourteen patients were treated conservatively according to the criteria of a non-surgical approach and 29 patients underwent urgent surgery. Indications for revision surgery included, apart from signs of ongoing abdominal bleeding related to liver injury, combined spleen and kidney trauma. All patients with thoraco-abdominal involvement had laparotomy; in addition, four underwent thoracotomy including repair of the lacerated lung by suturing and three patients required suturing of a rupture of the right part of the diaphragm. RESULTS: In the patients treated conservatively, 10 showed spontaneous regression of parenchymal hematomas and four had to be treated by suction drainage. Out of 29 patients operated on, five died with signs of an irreversible hemorrhagic shock from multiple trauma and one died of multiple organ failure. DISCUSSION: The principal criterion determining therapy in blunt liver injury is the patient's hemodynamic status; laparotomy is mandatory in intra-abdominal trauma with severe hemoperitoneum or when unstable hemodynamics is due to intraperitoneal bleeding. Non-surgical treatment of blunt liver injury, on condition that the established criteria are observed, has several advantages such as less stress for the patient, fewer intra-abdominal complications and fewer blood transfusions needed. The modern technologies used in the operative procedure are related to both a transient vascular occlusion and a strategy for selective care in liver trauma. CONCLUSION: 1. The treatment strategy in a patient with blunt liver trauma is determined by the patient's hemodynamic status; in a stable patient, spinal CT examination of the thorax and abdomen is mandatory. 2. Urgent laparotomy is indicated when the patient with blunt liver trauma is hemodynamically unstable due to diagnosed hemoperitoneum or suspected intraperitoneal bleeding. 3. Conservative therapy is applied when the criteria for non-surgical treatment are fulfilled. 4. Surgical strategy for blunt liver trauma is based on the extent and localization of the injury, the patient's overall status and severity of associated injuries. Resection of the injured parenchyma is indicated when laceration of a liver lobe occurs. 5. The prognosis of blunt liver injury is influenced, apart from hemorrhagic shock reversibility, by the severity of associated injuries in multiple trauma.

Adolescent↗

PubMed2003

[Emergency ultrasound for blunt abdominal trauma--meta-analysis update 2003].

Emergency ultrasound has established itself as a key procedure of primary diagnostic work-up for blunt abdominal and multiple trauma. However, in a systematic review published in 2001 ultrasonography turned out to provide an unexpectedly low sensitivity. We conducted an update of this analysis to investigate if test characteristics will be maintained including recent studies. Prospective trials published between January 1957 and January 2003 were identified using the Medline/Oldmedline, Embase and Cochrane Controlled Trials Register databases. The searching strategy comprised a manual search as well as a search along the world-wide web. Qualitative rating was carried out by two investigators using criteria proposed by the Centre for Evidence-Based Medicine, Oxford. We investigated a composite endpoint (i. e., free fluid and/or organ laceration) as well as the single criteria organ injury and free intraabdominal fluid collections. After calculation of two-by-two-tables, Summary Receiver Operating Characteristics (SROC) and Q* values were determined together with their 95% confidence intervals. The Q* value was proposed as the point of intersection where sensitivity equals specificity. In addition, a random effects model was employed to compute common positive and negative likelihood ratios (LR). By assessing the title and/or abstract, 349 of 957 papers contained potentially valid information for the purpose of this review. A total of 67 studies were deemed eligible, nine of which had to be excluded from meta-analysis because of dual publication. This left 58 trials allocating 16,361 subjects for statistical analysis. Despite a trend towards improved study designs observed during the past decade, the included trials were of average methodological quality. Two-thirds of all investigations fulfilled two or less of the six possible quality criteria. The diagnostic reference standard was applied independently in only 40% of all protocols. With regard to the composite endpoint and the sonographic depiction of free fluid, the Q* value was estimated at 0.91, whereas Q* equaled 0.90 for the detection of organ injury. Q* values subsequently decreased with improving study quality and fell clearly below 0.80 in methodologically proper studies. Accounting for a negative LR of 0.23 (composite endpoint) and an assumed prevalence of 35% of intraabdominal injury, a post-test probability of 11% will remain in case of a negative sonogram. In pediatric trauma, ultrasound showed even worse test characteristics (negative LR = 0.43). Thus, in case of a 35% prevalence, the post-test probability has to estimated at 19%. Emergency ultrasound provides high specificity but insufficient sensitivity to reliably rule out intraabdominal injury.

Abdominal Injuries↗

PubMed2002

Diagnosis and management of bladder injury by trauma surgeons.

BACKGROUND: Bladder injuries constitute one of the most common urological injuries involving the lower urinary tract. The methods of diagnosis and management of bladder trauma have been well established and accepted. However, bladder injuries are usually associated with other major injuries, and it is our concern here how bladder injuries have been managed as part of multiple trauma. METHODS: From 1991 to 2000, a total of 51 cases of bladder injury were retrospectively reviewed. The mechanisms of trauma, types of bladder injury, time needed to diagnosis, methods of treatment, and patient outcome, were analyzed. Diagnosis time was defined as the time interval from patient arrival to the establishment of a diagnosis either by image studies or laparotomy. Management followed the general rule that bladder contusions or extraperitoneal ruptures were treated non-operatively, and that those with intraperitoneal rupture or combined rupture underwent operative repair. If bladder injury was noted after the patient left the emergency room (ER), it was defined as a delay diagnosis. The Injury Severity Score (ISS), length of hospital stay, and morbidity were used to evaluate patient outcome. RESULTS: The mean age of all the patients was 31.4 years old, and most of them had sustained an injury from a motor vehicle accident (40 of 51). All but 3 patients had gross hematuria. Ten of the patients underwent emergency laparotomy, and 2 of them underwent emergency neurosurgical procedures, therefore no image studies were performed for these 12 patients. A total of 33 patients underwent abdominal computed tomography (CT), but only 20 were correctly diagnosed, yielding an accuracy rate of 60.6%. There were 3 delay diagnoses, due to either a lack of gross hematuria on presentation or the patient leaving the ER before any bladder injury study could be performed. A retrograde cystogram was performed in 24 patients, with an accuracy rate of 95.9% (23 of 24). The mean diagnosis time of the 48 bladder injuries presented in the ER was 3.2 hours and the time needed to reach a diagnosis was not related to the severity of bladder injury. Those patients who underwent operation immediately did not seem to have a quicker diagnosis. Those patients with a higher injury score (ISS >16), and those patients who suffered from pelvic fracture, stayed in the hospital longer. However, the severity of the bladder injury was not related to the length of hospital stay. There was no bladder-related mortality in our series. CONCLUSIONS: We report our results of dealing with bladder injuries from the point of view of trauma surgeons who treat bladder injury as part of multiple injuries. Although known as a procedure of choice for diagnosis of bladder injury, the retrograde cystogram was performed in fewer than half of the patients (24 of 51), which means it is not feasible in many situations. The patient outcome was determined by the severity of injury of the patient but not by the severity of bladder injury.

Abdominal Injuries↗