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PubMed1975

Use of chloroquine in shock.

One group of dogs received single doses of intramuscular chloroquine and another group served as a control. The dogs were subjected to haemorrhagic shock and then retransfused with their own blood after two hours of shock. The chloroquine-treated dogs had normal PA pressures after correction of acidosis and significantly smaller increases in the pulmonary vascular resistance. The results are similar but less marked than those obtained with aspirin. Chloroquine inhibited in vitro platelet aggregation by 50% and was not associated with any increased bleeding. This may be an advantage when used in patients with multiple trauma or increased bleeding tendency.

Animals↗
PubMed2006

[Tolerance to perioperative anemia. Mechanisms, influencing factors and limits].

The expected cost explosion in transfusion medicine (increasing imbalance between donors and potential recipients, treatment of transfusion-associated complications) increases the socio-economic significance of specific institutional transfusion programs. In this context the estimated use of the patient's physiologic tolerance to anemia enables 1) the tolerance of larger blood losses (loss of "diluted blood"), 2) the onset of transfusion to the time after surgical control of bleeding to be delayed and 3) the perioperative collection of autologous red blood cells. The present review article summarizes the mechanisms, influencing factors and limits of this natural tolerance to anemia and deduces the indication for perioperative red blood cell transfusion. Under strictly controlled conditions (anesthesia, normovolemia, complete muscular relaxation, hyperoxemia, mild hypothermia) extremely low hemoglobin concentrations [Hb <3 g/dl (<1.86 mmol/l)] are tolerated without transfusion by individuals with no cardiopulmonary disease. In the clinical routine these situations are limited to borderline situations e.g. unexpected massive blood losses in Jehovah's Witnesses or unexpected shortcomings in blood supply. The current recommendations coincide to the effect that perioperative red blood cell transfusion 1) is unnecessary up to a Hb concentration of 10 g/dl (6.21 mmol/l) even in older patients with cardiopulmonary comorbidity and 2) is only recommended in cases of Hb <6 g/dl (<3.72 mmol/l) in otherwise healthy subjects including pregnant women and children. Critically ill patients with multiple trauma and sepsis do not seem to benefit from transfusions up to Hb concentrations >9 g/dl (>5.59 mmol/l). In cases of massive hemorrhaging and diffuse bleeding disorders the maintenance of a Hb concentration of 10 g/dl (6.21 mmol/l) seems to contribute to stabilization of coagulation.

Anemia↗
PubMed1995

[The application of n-acetylcysteine as an antioxidant and mucolytic in mechanical ventilation in intensive care patients. A prospective, randomized, placebo-controlled, double-blind study].

Oxygen radicals and oxygen radial mediators are thought to be important components in the development of acute lung injury, sepsis, and multiple organ failure. Injured patients, patients with pulmonary diseases, and multiple trauma patients also showed an elevated lipid peroxidation, indicating increased oxidant stress. N-Acetylcysteine (NAC) has been used as an antioxidant in a wide variety of experiments. NAC has been suggested to act by raising concentrations of cysteine, and hence glutathione, and by scavenging of oxidant species [1, 11, 17, 29]. The present study was designed to investigate whether the application of NAC in intubated patients has an effect on concentrations of reduced glutathione in plasma and bronchoalveolar lavage fluid (BAL) and on the lipid peroxidation products malondialdehyde and conjugated dienes. Because NAC has been widely used as a mucolytic drug for the treatment of lung diseases, the influence on tracheobronchial mucus was studied, too. METHODS. In a randomized, double-blind, placebo-controlled study, a total of 38 long-term ventilated patients of a surgical intensive care unit were investigated. Patients were treated for 5 days with either 3 g NAC/day or placebo. The plasma concentration of reduced glutathione, malondialdehyde, and conjugated dienes were measured on admission and on the 3rd and 5th days of treatment [8, 34, 48]. Additionally, the numbers of tracheobronchial suctionings were registered and chest radiographs were evaluated. A fibre-bronchoscopy was performed on admission and on the 3rd day of treatment. The amount and viscidity of tracheobronchial secretions were examined semiquantitatively, and glutathione levels were measured in the unconcentrated BAL. The study was approved by the ethics committee of the University of Ulm. RESULTS. The two groups were comparable with respect to age, sex, APACHE II score and diagnosis (Table 1). We found no significant differences in reduced glutathione levels in the plasma or in the BAL (Figs. 1, 2). Plasma concentrations of malondialdehyde were similar (Fig. 3). Only the levels of conjugated dienes were significantly higher on the 5th treatment day in the placebo group (Fig. 4). The organ function of the lung (FiO2, PEEP, PaO2), liver (SGOT, bilirubin), and kidney (creatinine) and coagulation parameters (PTT, prothrombin time, platelet count) were similar in the two groups during the time of investigation. We observed no clinically relevant differences in the tracheobronchial mucus (Table 2). CONCLUSION. The present data do not support routine use of NAC in ventilated patients, either as an antioxidant or as a mucolytic agent. Intravenous administration of 3 g NAC/day had no clinically relevant effect on glutathione levels, lipid peroxidation products, tracheobronchial mucus, and clinical condition.

APACHE↗
PubMed2000

[Quality of life after long-term surgical intensive care treatment].

INTRODUCTION: Long-term treatment in surgical intensive care units (SICU) subjects the patient to a high degree of somatic, psychological, and social stress. The aim of this study was to determine their outcome in terms of quality of life and health status. METHODS: All patients from a 4-year period in a SICU with a length of stay (LOS) of 30 days or more were included. All survivors were interviewed and examined after 35 +/- 14 months; they also completed several questionnaires (Munich Inventory for Quality of Life and Health Status, POMS, and Spitzer Quality of Life Index). RESULTS: One hundred one patients fulfilled the inclusion criteria, and 46 survived until follow-up. Forty-one (89%) could be traced and examined. Male:female ratio was 31:10, age 42 +/- 17 years, and LOS 51 +/- 19 days, Diagnoses on admittance were multiple trauma (n = 32) and other (n = 9). When classifying patients according to physical impairment, one third each showed no, mediocre, or severe limitations. Subjective appraisal of quality of life and well-being was sufficient for about half the patients in every test. Trauma victims experienced more severe impairment of quality of life. There were no differences between sex, age, or time until follow-up. CONCLUSION: After prolonged SICU treatment, about half of the patients report limitations in their quality of life as a result of their illness and the subsequent treatment. Some patients, in particular after trauma, exhibit striking psychosocial problems despite satisfactory somatic treatment results. These problems can be positively addressed in rehabilitative efforts.

Adult↗
PubMed2002

[Extracorporeal lung support and endovascular stent in traumatic aortic rupture and severe lung failure].

Blunt thoracic injury in association with aortic rupture represents a life-threatening situation. Surgical repair used to be the preferred method of treatment. Because most patients are multiple trauma patients including head injuries, bone fractures and respiratory failure, urgent surgical procedures portend excessively high morbidity and mortality rates. Delay in operative management bears the risk of exsanguinating hemorrhage, secondary complications, prolonged hospital stay with increased costs. We present here an alternative treatment protocol including pumpless extracorporal lung assist and endovascular aortic stent graft placement in a 20-year old traffic accident victim. This procedure may be an especially useful treatment option in managing patients with complex lung and aortic pathology primarily not suitable for transportation or surgery.

Adult↗
PubMed2002

Relationship between ventilatory settings and barotrauma in the acute respiratory distress syndrome.

OBJECTIVE: High pressures or volumes may increase the risk of barotrauma in the acute respiratory distress syndrome (ARDS). METHODS: The first part of the study analyzed data from a prospective trial of two ventilation strategies in 116 patients with ARDS retrospectively, and ventilatory pressures and volumes were compared in patients with or without pneumothorax. The second part consisted of a literature analysis of prospective trials (14 clinical studies, 2270 patients) describing incidence and risk factors for barotrauma in ARDS patients, and mean values of ventilatory parameters were plotted against incidence of barotrauma. RESULTS: In our clinical trial comparing two tidal volumes, 15 patients (12.3%) developed pneumothorax. There was no significant difference in any pressure or volume between these patients and the rest of the population, including end-inspiratory plateau pressure (P(plat)), driving pressure (P(plat)-PEEP), respiratory rate and compliance. Multiple trauma was more frequent among patients with pneumothorax (27%) than in those without (7%). Duration of mechanical ventilation tended to be longer with pneumothorax. In the literature review, the incidence of barotrauma varied between 0% and 49%, and correlated strongly with P(plat), with a high incidence above 35 cmH(2)O, and with compliance, with a high incidence below 30 ml/cmH(2)O. CONCLUSION: Clinical studies maintaining P(plat) lower than 35 cmH(2)O found no apparent relationship between ventilatory parameters and pneumothorax. Analysis of the literature suggests a correlation when patients receive mechanical ventilation with P(plat) levels exceeding 35 cmH(2)O.

Barotrauma↗
PubMed2006

Prehospital withholding and withdrawal of life-sustaining treatments. The French LATASAMU survey.

OBJECTIVE: To investigate the end-of-life decision process in patients managed by emergency physicians in the prehospital setting. DESIGN: A 40-item retrospective study about most recent end-of-life decision in the prehospital setting. PATIENTS AND PARTICIPANTS: 1069 physicians (44.9%) from 192 French emergency mobile units. MEASUREMENTS AND RESULTS: A total of 816 (76.3%) physicians reported at least one prehospital end-of-life decision. Conscious patients were involved in 30.7% (54/176) and families in 63.6% of cases. The physician discussed the end-of-life decision with at least one other physician in 56.5% of cases. Perceived imminent death was the most frequently reported criterion (90.1%). Nearly four fifths of patients died before arrival at the hospital (78.8%). Factors independently associated with prehospital withdrawal decision included multiple trauma [odds ratio (OR) 5.7, 95% confidence interval (CI) 1.6-19.7], intubation (OR 3.9, 95% CI 2.3-6.5), chronic disease with severe heart failure (OR 2.8, 95% CI 1.5-5.2), acute event with postanoxic coma (OR 2.2, 95% CI 1.3-4.0), emergency physician from a teaching hospital (OR 2.1, 95% CI, 1.3-3.5), male patient (OR 1.9, 95% CI 1.1-3.3), and no sedation (OR 1.9, 95% CI 1.2-3.1). Prehospital withholding decisions were taken for 684 (88%) patients and withdrawing decisions for 12%. CONCLUSIONS: Treatment withholding and withdrawal is common in the prehospital setting in France. These decisions remain highly questionable in this emergency context, in the absence of knowledge of the patient's medical history and of patients' and relatives' clear wishes concerning end-of-life decisions.

Cross-Sectional Studies↗
PubMed1998

Increased microvascular water permeability in patients with septic shock, assessed with venous congestion plethysmography (VCP).

OBJECTIVES: To investigate microvascular water permeability (filtration capacity, Kf) in patients with septic and non-septic shock using a new non-invasive method for studying microvascular parameters in man. SETTING: Intensive Care Unit of a university hospital. PATIENTS AND METHODS: We investigated 28 patients, presenting with cardio-vascular instability due to either septic shock, or non-septic shock (haemorrhage, multiple trauma, respiratory and/or cardiac failure). INTERVENTIONS: We used standard invasive methods of monitoring (in-dwelling arterial lines and pulmonary artery flotation catheters) in combination with computer assisted venous congestion plethysmography (VCP) measurements, for a parallel assessment of peripheral microcirculatory parameters. RESULTS: On admission to the ICU, patients with septic shock revealed a significantly higher mean value of filtration capacity Kf = 6.1 +/- 0.4 x 10(-3) (mean value +/- standard error of the mean, ml.min-1.100 ml tissue-1.mmHg-1 = KfU) than non-septic patients Kf = 3.5 +/- 0.3 KfU (p < 0.02). The Kf values of the septic patients were significantly higher than those from age-matched patients with peripheral vascular disease (4.1 +/- 0.2 KfU, p < 0.001) and those of healthy controls (4.3 +/- 0.2 KfU, p < 0.001); the Kf values of the non-septic patients, however, were not significantly different. The highest mean Kf value observed during the stay on ICU was Kfmax 11.6 +/- 0.2 KfU in the septic group and 5.7 +/- 0.1 KfU in the non-septic group (p < 0.001). Pvi, a value reflecting the balance of hydrostatic and oncotic forces in the microcirculation, was elevated in both patient groups. On admission, in septic patients Pvi was 39.2 +/- 3.3 mmHg and in non-septic patients 35.1 +/- 2.7 mmHg, these values were not significantly different, but significantly higher than the Pvi value of healthy controls (Pvi 21.5 +/- 0.8) (p < 0.001). A weak, however significant, positive correlation was found between Kf and Pvi in both patient groups. No correlations were found between Kf, as well as Pvi, and cardiac index (CI), oxygen delivery index (DO2I), oxygen consumption index (VO2I) and systemic vascular resistance index (SVRI). CONCLUSIONS: An increase in permeability of microvessels will cause a loss of intravascular fluid and may therefore partially explain the large fluid requirements of patients in shock. It will also favour the development of oedema, which is often found in septic patients. We propose that changes in Kf are useful indices of microvascular malfunction and that VCP allows the non-invasive assessment of these parameters.

Adult↗
PubMed2001

Non-occlusive small bowel necrosis during gastric tube feeding: a case report.

Small bowel necrosis is known as a rare, but serious complication of jejunal tube feeding. We report a case of non-occlusive small bowel necrosis with gastric tube feeding. The patient had a moderate multiple trauma with head injury. Abdominal distension developed after several days of uneventful nasogastric tube feeding. At laparotomy patchy necrosis of the small bowel was found without signs of bowel obstruction or impaired mesenteric perfusion. The patient recovered after a prolonged ICU stay. In this case the large doses of clonidine, given due to an alcohol withdrawal syndrome, were suspected to be a major contributing factor to the development of the small bowel necrosis by impairing gut motility and mucosal perfusion. We conclude that, first, small bowel necrosis can occur after primarily uneventful enteral feeding, even with gastric feeding; second, clonidine can dramatically impair gastrointestinal function in critically ill patients by impairing gut motility and mucosal perfusion.

Adrenergic alpha-Agonists↗
PubMed1999

Etiological aspects in osteochondritis dissecans patellae.

In a retrospective study probable etiological factors of rare cases of osteochondritis dissecans of the patella were analyzed. Anamnestic data and data obtained from standardized roentgenography in the anterior-posterior, axial, and lateral views of the patella were evaluated. Anamnestic data provided no evidence of the etiology in addition to the fact that several patients mentioned a single or multiple trauma. In contrast to this, evaluation of the roentgenograms showed that most of the patients with osteochondritis patellae exhibited a flat articular surface of the patella (types I and V in Hertel's classification) and a distinct accumulation of the patellae with greater lateral than medial facet (types II and III in Wiberg's classification). Furthermore, the axial shape of the patellar groove exhibited a distinct accumulation of type III trochleae, representing a hypoplasia of the medial and hyperplasia of the lateral part of the trochlea. Evaluation of the lateromedial patellar alignment revealed in a distinct accumulation of grade II dislocation medially and laterally. Although the data were obtained from a rather small number of patients, in our opinion these results support the theory of biomechanical induction of osteochondritis dissecans patellae. Further dynamic analyses are needed to clarify biodynamic effects on the patella and the patellofemoral joint.

Adult↗
PubMed2005

Humeral shaft fractures treated by dynamic compression plates, Ender nails and interlocking nails.

Between January 1991 and December 2002, we treated 92 acute, displaced, closed humeral shaft fractures (AO classification type A). We used three fixation methods: dynamic compression plates (DCP) in 36 patients, Ender nails (EN) in 32 patients and interlocking nails (ILN) in 24 patients. The patients were followed for a minimum of 24 months. At one year, all fractures except two (one DCP/one ILN) had united. Patients treated with EN had shorter mean operation time, 51 (35-110) min; less mean blood loss, 70 (30-170) ml and shorter mean hospital stay, 5.8 (3-12) days. There were three iatrogenic radial nerve palsies: two in the DCP group and one in the ILN group. There was one wound infection. There were three cases with impingement of the shoulder but range of motion was restored after nail removal. For patients with multiple trauma or high operative risk, EN fixation served as a safer and faster procedure. ILN fixation offered a stable fixation via a smaller incision but more fracture comminution might happen.

Adult↗
PubMed2005

Eleven years of liver trauma: the Scottish experience.

The aim of this population based study was to assess the incidence, mechanisms, management, and outcome of patients who sustained hepatic trauma in Scotland (population 5 million) over the period 1992-2002. The Scottish Trauma Audit Group database was searched for details of any patient with liver trauma. Data on identified patients were analyzed for demographic information, mechanisms of injury, associated injuries, hemodynamic stability on presentation, management, and outcome. A total of 783 patients were identified as having sustained liver trauma. The male-to-female ratio was 3:1 with a median age of 31 years. Blunt trauma (especially road traffic accidents) accounted for 69% of injuries. Liver trauma was associated with injuries to the chest, head, and abdominal injuries other than liver injury; most commonly spleen and kidneys. In all, 166 patients died in the emergency department, and a further 164 died in hospital. The mortality rate was higher in patients with increasing age (p < 0.001), hemodynamic instability (p < 0.001), blunt trauma (p < 0.001), and increasing severity of liver injury (p < 0.001). The incidence of liver trauma in Scotland is low, but it accounts for significant mortality. Associated injuries were common. Outcome was worse in patients with advanced age, blunt trauma, multiple injuries and those requiring an immediate laparotomy.

Adolescent↗
PubMed2002

The significance of the percentage of the defect size in spina bifida cystica in determination of the surgical technique.

AIM: Our aim was to classify meningoceles and meningomyeloceles in terms of defect area as a percentage of the thoracolumbar region to make it possible to select the surgical technique accordingly. MATERIALS AND METHODS: Thirty-two cases were included in the study program. Any defect smaller than 8% of the thoracolumbar region was primarily sutured and classed as grade 1. RESULTS: The defects that it was not possible to handle with primary suture because of the broad base and thereby closed with muscle-skin flaps were those occupying more than 8% of the thoracolumbar region and these were classed as grade 2. It was not possible to perform primary repair of any defect occupying more than 8% of the thoracolumbar area. CONCLUSION: The use of combined latissimus dorsi+gluteus maximus muscle-skin flaps was found to be safe in broad-based meningomyelocele defects, as they provide wider closures and permanent bolstering of the meningomyelocele defect, thus protecting the region against multiple trauma.

Female↗
PubMedDate not supplied

Severe head injury in children--analyzing the better outcome over a decade and the role of major improvements in intensive care.

We suggest a few possible explanations, including improvement of intensive care, as the main cause, for the improved outcome after severe head injury in children and present the predictors of outcome observed in a contemporary series. From January 1984 to June 1988 we saw 117 children (ages 0-14) with postresuscitation GCS (Glasgow Come Scale) scores of 3-8. The more recent cohort of children seen in 1994-1996 was made up of 152 patients. Apart from standard statistics we used a segmentation method called CHAID (SSPS software). Previously known predictors of outcome are found still to apply in our series. Although in the recent period there was a lower proportion of patients with GCS 3-4 (11% versus 32%), a higher percentage had suffered multiple trauma (56% versus 33%). The rates of craniotomy and of ICP monitoring were similar (66% and 61%). Comparison of the two cohorts for outcome at discharge and through 1 year shows that mortality fell from 33% to 10% and the proportion achieving improvement of neurological status increased from 24% to 56%. CHAID analysis showed that the mortality rates of patients within specific groups declined significantly over the two periods: (1) a significant reduction in mortality was seen in patients with GCS 5-7, especially those with diffuse axonal injury (DAI) (17.3% to 0%); (2) no child admitted in shock survived in the earlier period, whereas 7 with GCS 4-6 survived during the recent period. The best model for mortality prediction includes GCS, and in the GCS 4-7 subgroup, the presence of subdural hematoma. It seems that the trend toward better immediate outcome is continuous, and this is the more striking when the severity of injury is taken into consideration. Our belief is that the modern medical and surgical techniques, although incurring higher costs and necessitating ongoing intensity, are well worth the effort.

Adolescent↗
PubMed2005

Use of the less invasive stabilization system (LISS) in patients with distal femoral (AO33) fractures: a prospective multicenter study.

INTRODUCTION: The Less Invasive Stabilization System (LISS) is an internal fixator that can be inserted percutaneously by means of a minimally invasive surgical approach. This paper presents the use of this system exclusively in patients with AO33 distal femoral fractures, a group in which fracture management is often complicated by multiple trauma and soft-tissue damage. MATERIALS AND METHODS: A series of 62 patients (mean age 52 years) with 66 AO33A or C fractures received the LISS implant and were followed prospectively for 12 months. Assessments included the radiographic evaluation of implant placement and healing, measurement of valgus/varus and sagittal joint malalignment, and the assessment of weight-bearing capacity and range of motion. RESULTS: The mean duration of surgery was 85 min (range 40-135 min) for 33A fractures and 149 min (range 50-300 min) for 33C fractures. Postoperative radiographic assessments showed that the LISS implant was positioned correctly in 59 cases (89%). Assessment of valgus/varus alignment showed correct axial alignment in 49 cases (74%), a deviation of 5-10 degrees in 13 cases, and a 10-20 degrees deviation in 1 case. Correct sagittal alignment was observed in 56 cases (85%), 5-10 degrees malalignment in 5 cases, and 10-20 degrees in 2 cases. During the course of the 1-year follow-up, 8 patients (9 fractures) died; 2 other patients were not available for follow-up. Complete fracture healing was achieved in 85% of the followed-up patients. Forty-eight patients were capable of full weight-bearing. After fracture healing, maximum flexion of the injured limb was on average 80% of the range of the uninjured limb. An extension deficit of more than 5 degrees was measured in 3 cases. Of the 62 patients, 14 underwent further operations during the course of follow-up. Of these, 6 required bone grafting and 3 refixation of the implant due to implant loosening. Deep infections requiring several debridements occurred in 2 patients. No complications relating solely to the implant were observed. CONCLUSION: The LISS showed good overall results in the treatment of these difficult fractures. It is a good alternative to conventional extramedullary and intramedullary stabilizing techniques, especially in more complex fracture situations.

Adult↗
PubMed2005

Studies on the time frame for ossification of the medial epiphysis of the clavicle as revealed by CT scans.

The authors retrospectively analyzed 629 CT images of patients aged between 15 and 30 years produced during multiple trauma diagnostics at the Unfallkrankenhaus Berlin. For the purposes of this study, the authors reliably determined the ossification status of the medial epiphysis of the clavicle in 556 cases, using the classification of stages by Schmeling et al. In both sexes, stage 2 was first noted at age 15. In male patients, the earliest occurrence of stage 3 was noted at age 17, in female patients at age 16. Stage 4 was first achieved by both sexes at age 21. Stage 5 was first noted in female patients at age 21 and in male patients at age 22, which is 4 or 5 years earlier than was observed by a comparable study using conventional radiographs. The partial-volume effect in computed tomography using the thick slice scanning mode was discussed as a possible explanation for this early visualization. The question of how slice thickness affects the age intervals between ossification stages identified by CT examinations should be examined in additional studies.

Adolescent↗
PubMed2005

Temporary stenting of acquired benign tracheoesophageal fistulas in critically ill ventilated patients.

BACKGROUND: To evaluate the use of esophageal stents for temporary sealing of acquired benign tracheoesophageal fistulas developed in critically ill, ventilated patients. METHODS: This is a retrospective analysis (1992-2003) of the data of 12 mechanically ventilated patients - six of them after major or multiple trauma - being intubated for a median of 30 days before they develop an acquired benign tracheoesophageal fistula. Five of them were in sepsis. Two types of stents were used: the Wilson-Cook esophageal balloon plastic stent in the first four cases and the Ultraflex covered self-expandable stent in the remaining eight. The total procedure was performed at bedside in the intensive care unit, with no special need for supplementary anesthesia or fluoroscopic control. RESULTS: Stent implantation was technically successful in all patients and fistula occlusion was achieved in every case. There was no stent migration and fistulas remained sealed until death or upon decision for removal. Nine patients died between 5 days and 2 months after stent placement, as a result of their diseases. Three patients were referred for fistula surgical repair 33, 36, and 43 days after stent placement. Before surgery the stents were easily removed under direct vision. CONCLUSION: Temporary closure of an acquired tracheoesophageal fistula developed in critically ill ventilated patients is an easy, bedside-applicable, safe, and effective palliative procedure, with no complications or mortality.

Adult↗
PubMed2002

Serious horse-riding accidents: imaging findings and evaluation with multi-slice CT.

PURPOSE: To assess acute phase multi-slice CT findings in horse-riding accidents in patients referred to a level one trauma center. METHODS: Using PACS, we retrieved all CT requests during a time period of 19 months. Patients who had a horse-riding accident and were examined with multi-slice CT were included. The imaging findings of multi-slice CT were retrospectively evaluated by location and injury mechanism. RESULTS: Forty-six patients (3 male, 43 female, age 16-55 years, mean age 30) were assessed. The injuries we found were five head, three facial, 13 spine, five body, two pelvic, and three lower extremity trauma. Multiple injuries were seen in five (11%) patients. In 21 patients (46%) the initial multi-slice CT examination(s) was normal. Three main injury mechanisms were established; falling off a horse (72%), a horse kick (11%), and crushing injury caused by a falling horse (13%). Fifteen (33%) patients had serious injuries, one lethal and they were associated more frequently with falling off a horse. CONCLUSION: Serious injuries with horse riding accidents are not uncommon. In two thirds of patients, the injury mechanism was falling off a horse. Multiple injuries were seen in 11% of cases. In the acute phase, multi-slice CT provided fast and valuable information in assessing these injuries.

Journal Article↗