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Penetrating gluteal injuries in North West London: a retrospective cohort study and initial management guideline
BACKGROUND: Penetrating gluteal injuries (PGIs) are an increasingly common presentation to major trauma centers (MTCs) in the UK and especially in London. PGIs can be associated with mortality and significant morbidity. There is a paucity of consistent guidance on how best to investigate and manage...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8311336/ https://www.ncbi.nlm.nih.gov/pubmed/34395917 http://dx.doi.org/10.1136/tsaco-2021-000727 |
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author | McKnight, Gerard Hywel Owen Yalamanchili, Seema Sanchez-Thompson, Natalia Guidozzi, Nadia Dunhill-Turner, Natasha Holborow, Alex Batrick, Nicola Hettiaratchy, Shehan Khan, Mansoor Kashef, Elika Aylwin, Chris Frith, Dan |
author_facet | McKnight, Gerard Hywel Owen Yalamanchili, Seema Sanchez-Thompson, Natalia Guidozzi, Nadia Dunhill-Turner, Natasha Holborow, Alex Batrick, Nicola Hettiaratchy, Shehan Khan, Mansoor Kashef, Elika Aylwin, Chris Frith, Dan |
author_sort | McKnight, Gerard Hywel Owen |
collection | PubMed |
description | BACKGROUND: Penetrating gluteal injuries (PGIs) are an increasingly common presentation to major trauma centers (MTCs) in the UK and especially in London. PGIs can be associated with mortality and significant morbidity. There is a paucity of consistent guidance on how best to investigate and manage these patients. METHODS: A retrospective cohort study was performed by interrogating prospectively collected patient records for PGI presenting to a level 1 MTC in London between 2017 and 2019. RESULTS: There were 125 presentations with PGI, accounting for 6.86% of all penetrating injuries. Of these, 95.2% (119) were male, with a median age of 21 (IQR 18–29), and 20.80% (26) were under 18. Compared with the 3 years prior to this study, the number of PGI increased by 87%. The absolute risk (AR) of injury to a significant structure was 27.20%; the most frequently injured structure was a blood vessel (17.60%), followed by the rectum (4.80%) and the urethra (1.60%). The AR by anatomic quadrant of injury was highest in the lower inner quadrant (56%) and lowest in the upper outer quadrant (14%). CT scanning had an overall sensitivity of 50% and specificity of 92.38% in identifying rectal injury. DISCUSSION: The anatomic quadrant of injury can be helpful in stratifying risk of rectal and urethral injuries when assessing a patient in the emergency department. Given the low sensitivity in identifying rectal injury on initial CT, this data supports assesing any patients considered at high risk of rectal injury with an examination under general anesthetic with or without rigid sigmoidoscopy. The pathway has created a clear tool that optimizes investigation and treatment, minimizing the likelihood of missed injury or unnecessary use of resources. It therefore represents a potential pathway other centers receiving a similar trauma burden could consider adopting. LEVEL OF EVIDENCE: 2b. |
format | Online Article Text |
id | pubmed-8311336 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-83113362021-08-13 Penetrating gluteal injuries in North West London: a retrospective cohort study and initial management guideline McKnight, Gerard Hywel Owen Yalamanchili, Seema Sanchez-Thompson, Natalia Guidozzi, Nadia Dunhill-Turner, Natasha Holborow, Alex Batrick, Nicola Hettiaratchy, Shehan Khan, Mansoor Kashef, Elika Aylwin, Chris Frith, Dan Trauma Surg Acute Care Open Guidelines/Algorithms BACKGROUND: Penetrating gluteal injuries (PGIs) are an increasingly common presentation to major trauma centers (MTCs) in the UK and especially in London. PGIs can be associated with mortality and significant morbidity. There is a paucity of consistent guidance on how best to investigate and manage these patients. METHODS: A retrospective cohort study was performed by interrogating prospectively collected patient records for PGI presenting to a level 1 MTC in London between 2017 and 2019. RESULTS: There were 125 presentations with PGI, accounting for 6.86% of all penetrating injuries. Of these, 95.2% (119) were male, with a median age of 21 (IQR 18–29), and 20.80% (26) were under 18. Compared with the 3 years prior to this study, the number of PGI increased by 87%. The absolute risk (AR) of injury to a significant structure was 27.20%; the most frequently injured structure was a blood vessel (17.60%), followed by the rectum (4.80%) and the urethra (1.60%). The AR by anatomic quadrant of injury was highest in the lower inner quadrant (56%) and lowest in the upper outer quadrant (14%). CT scanning had an overall sensitivity of 50% and specificity of 92.38% in identifying rectal injury. DISCUSSION: The anatomic quadrant of injury can be helpful in stratifying risk of rectal and urethral injuries when assessing a patient in the emergency department. Given the low sensitivity in identifying rectal injury on initial CT, this data supports assesing any patients considered at high risk of rectal injury with an examination under general anesthetic with or without rigid sigmoidoscopy. The pathway has created a clear tool that optimizes investigation and treatment, minimizing the likelihood of missed injury or unnecessary use of resources. It therefore represents a potential pathway other centers receiving a similar trauma burden could consider adopting. LEVEL OF EVIDENCE: 2b. BMJ Publishing Group 2021-07-23 /pmc/articles/PMC8311336/ /pubmed/34395917 http://dx.doi.org/10.1136/tsaco-2021-000727 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) . |
spellingShingle | Guidelines/Algorithms McKnight, Gerard Hywel Owen Yalamanchili, Seema Sanchez-Thompson, Natalia Guidozzi, Nadia Dunhill-Turner, Natasha Holborow, Alex Batrick, Nicola Hettiaratchy, Shehan Khan, Mansoor Kashef, Elika Aylwin, Chris Frith, Dan Penetrating gluteal injuries in North West London: a retrospective cohort study and initial management guideline |
title | Penetrating gluteal injuries in North West London: a retrospective cohort study and initial management guideline |
title_full | Penetrating gluteal injuries in North West London: a retrospective cohort study and initial management guideline |
title_fullStr | Penetrating gluteal injuries in North West London: a retrospective cohort study and initial management guideline |
title_full_unstemmed | Penetrating gluteal injuries in North West London: a retrospective cohort study and initial management guideline |
title_short | Penetrating gluteal injuries in North West London: a retrospective cohort study and initial management guideline |
title_sort | penetrating gluteal injuries in north west london: a retrospective cohort study and initial management guideline |
topic | Guidelines/Algorithms |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8311336/ https://www.ncbi.nlm.nih.gov/pubmed/34395917 http://dx.doi.org/10.1136/tsaco-2021-000727 |
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