Successful modeling and/or design of engineering systems often requires one to address the impact of multiple ＂design variables＂ on the prescribed outcome.There are often multiple,competing objectives based on which...Successful modeling and/or design of engineering systems often requires one to address the impact of multiple ＂design variables＂ on the prescribed outcome.There are often multiple,competing objectives based on which we assess the outcome of optimization.Since accurate,high fidelity models are typically time consuming and computationally expensive,comprehensive evaluations can be conducted only if an efficient framework is available.Furthermore,informed decisions of the model/hardware＇s overall performance rely on an adequate understanding of the global,not local,sensitivity of the individual design variables on the objectives.The surrogate-based approach,which involves approximating the objectives as continuous functions of design variables from limited data,offers a rational framework to reduce the number of important input variables,i.e.,the dimension of a design or modeling space.In this paper,we review the fundamental issues that arise in surrogate-based analysis and optimization,highlighting concepts,methods,techniques,as well as modeling implications for mechanics problems.To aid the discussions of the issues involved,we summarize recent efforts in investigating cryogenic cavitating flows,active flow control based on dielectric barrier discharge concepts,and lithium（Li）-ion batteries.It is also stressed that many multi-scale mechanics problems can naturally benefit from the surrogate approach for ＂scale bridging.＂展开更多
In this study, the effects of discharge rate and LiMn2O4 cathode properties （thickness, porosity, particle size, and solid-state diffusivity and conductivity） on the gravimetric energy and power density of a lithium...In this study, the effects of discharge rate and LiMn2O4 cathode properties （thickness, porosity, particle size, and solid-state diffusivity and conductivity） on the gravimetric energy and power density of a lithium-ion battery cell are analyzed simultaneously using a cell-level model. Surrogate-based analysis tools are applied to simulation data to construct educed-order models, which are in turn used to perform global sensitivity analysis to compare the relative importance of cathode properties. Based on these results, the cell is then optimized for several distinct physical scenarios using gradient-based methods. The comple-mentary nature of the gradient-and surrogate-based tools is demonstrated by establishing proper bounds and constraints with the surrogate model, and then obtaining accurate optimized solutions with the gradient-based optimizer. These optimal solutions enable the quantification of the tradeoffs between energy and power density, and the effect of optimizing the electrode thickness and porosity. In conjunction with known guidelines, the numerical optimization frame-work developed herein can be applied directly to cell and pack design.展开更多
Influenza viruses were responsible for most adult viral pneumonia.Presently,coronavirus disease 2019(COVID-19)has evolved into serious global pandemic.COVID-19 outbreak is expected to persist in months to come that wi...Influenza viruses were responsible for most adult viral pneumonia.Presently,coronavirus disease 2019(COVID-19)has evolved into serious global pandemic.COVID-19 outbreak is expected to persist in months to come that will be synchronous with the influenza season.The management,prognosis,and protection for these two viral pneumonias differ considerably and differentiating between them has a high impact on the patient outcome.Reverse transcriptase polymerase chain reaction is highly specific but has suboptimal sensitivity.Chest computed tomography(CT)has a high sensitivity for detection of pulmonary disease manifestations and can play a key-role in diagnosing COVID-19.We reviewed 47 studies and delineated CT findings of COVID-19 and influenza pneumonia.The differences observed in the chest CT scan can be helpful in differentiation.For instance,ground glass opacities(GGOs),as the most frequent imaging finding in both diseases,can differ in the pattern of distribution.Peripheral and posterior distribution,multilobular distribution,pure or clear margin GGOs were more commonly reported in COVID-19,whereas central or peri-bronchovascular GGOs and pure consolidations were more seen in influenza A(H1N1).In review of other imaging findings,further differences were noticed.Subpleural curvilinear lines,sugar melted sign,intra-lesional vascular enlargement,reverse halo sign,and fibrotic bands were more reported in COVID-19 than H1N1,while air space nodule,tree-in-bud,bronchiectasia,pleural effusion,and cavitation were more seen in H1N1.This delineation,when combined with clinical manifestations and laboratory results may help to differentiate these two viral infections.展开更多
Protein energy wasting (PEW) is a major challenge in CKD. Objective: To assess PEW in predialysis patients on their first visit to a nephrologist. Methods: Three day dietary intake of 484 CKD stage 3 patients was take...Protein energy wasting (PEW) is a major challenge in CKD. Objective: To assess PEW in predialysis patients on their first visit to a nephrologist. Methods: Three day dietary intake of 484 CKD stage 3 patients was taken. Appetite was assessed with ADAT. Patients were divided into groups based on appetite and BMI. Results: Male and female parameters are serum albumin 3.7 ± 0.84/3.68.8 ± 0.81 g/dL, total protein 7.02 ± 1.27/6.94 ± 1.26 g/dL, creatinine 4.68 ± 4.19/3.74 ± 3.36 mg% creatinine clearance 33.22 ± 30.48/37.55 ± 33.87 ml/minute, BMI 22.60 ± 4.29/23.43 ± 4.77kg/m2 energy/kg 16.97 ± 0.65/16.8 ± 0.64, protein g/kg 0.65 ± 0.28/0.64 ± 0.30, carbohydrate g/kg 2.98 ± 1.54/2.98 ± 0.1.36, fat g/kg 2.98 ± 0.23/2.79 ± 0.22, respectively. As appetite decreased, dietary protein and energy intake decreased significantly. Appetite in males and females: Average 14.46%, 4.13%, poor 9.7%, 18.18%, anorexic 13.2%, 7.4%. Income had strong correlation with BMI (p 0.000), dietary protein (p 0.000), energy (p 0.000) and carbohydrate (p 0.000). Appetite correlated with creatinine (p 0.019), dietary energy, protein, carbohydrate and fat (p 0.000) intake. BMI correlated (p 0.000) with fat, carbohydrate, energy and creatinine clearance. ANOVA showed significant difference within and between appetite groups in energy, protein, fat, carbohydrate, creatinine clearance (p 0.000) and serum albumin (p 0.025). There was significant difference in protein (p 0.026), energy intake (p 0.000) and creatinine clearance (p 0.038) within and between BMI groups. Based on income, there was significant difference among groups in BMI (p 0.000), energy (p 0.019), protein (p 0.031) and albumin (0.001).展开更多
Purpose:Non-operative management(NOM)has been validated for blunt liver and splenic injuries.Literature on continuous intra-abdominal pressure(IAP)monitoring as a part of NOM remains to be equivocal.The study aimed to...Purpose:Non-operative management(NOM)has been validated for blunt liver and splenic injuries.Literature on continuous intra-abdominal pressure(IAP)monitoring as a part of NOM remains to be equivocal.The study aimed to find any correlation between clinical parameters and IAP,and their effect on the NOM of patients with blunt liver and splenic injury.Method:A prospective cross-sectional study conducted at a level I trauma center from October 2018 to January 2020 including 174 patients who underwent NOM following blunt liver and splenic injuries.Hemodynamically unstable patients or those on ventilators were excluded,as well as patients who suffered significant head,spinal cord,and/or bladder injuries.The study predominantly included males(83.9%)with a mean age of 32.5 years.IAP was monitored continuously and the relation of IAP with various parameters,interventions,and outcomes were measured.Data were summarized as frequency(percentage)or mean±SD or median(Q1,Q3)as indicated.χ2 or Fisher's exact test was used for categorical variables,while for continuous variables parametric(independent t-test)or nonparametric tests(Wilcoxon rank sum test)were used as appropriate.Clinical and laboratory correlates of IAP<12 with p<0.200 in the univariable logistic regression analysis were included in the multivariable analysis.A p<0.05 was used to indicate statistical significance.Results:Intra-abdominal hypertension(IAH)was seen in 19.0%of the study population.IAH was strongly associated with a high injury severity score(p<0.001),and other physiological parameters like respiratory rate(p<0.001),change in abdominal girth(AG)(p<0.001),and serum creatinine(p<0.001).IAH along with the number of solid organs involved,respiratory rate,change in AG,and serum creatinine was associated with the intervention,either operative or non-operative(p=0.001,p=0.002,p<0.001,p<0.001,p=0.013,respectively).On multivariable analysis,IAP(p=0.006)and the mean change of AG(p=0.004)were significantly associated with the need for intervention.Conclusion:As a part of NOM,IAP should be monitored as a continuous vital.However,the decision for any intervention,either operative or non-operative cannot be guided by IAP values alone.展开更多
Purpose:Outcomes of peripheral arterial injury(PAI)depend on various factors,such as warm ischemia time and concomitant injuries.Suboptimal prehospital care may lead to delayed presentation,and a lack of dedicated tra...Purpose:Outcomes of peripheral arterial injury(PAI)depend on various factors,such as warm ischemia time and concomitant injuries.Suboptimal prehospital care may lead to delayed presentation,and a lack of dedicated trauma system may lead to poorer outcome.Also,there are few reports of these outcomes.The study aims to review our experience of PAI management for more than a decade,and identify the predictors of limb loss in these patients.Methods:This is a retrospective analysis of prospectively maintained database of trauma admissions at a level I trauma center from January 2008 to December 2019.Patients with acute upper limb arterial injuries or lower limb arterial injuries at or above the level of popliteal artery were included.Association of limb loss with ischemia time,mechanism of injury,and concomitant injuries was studied using multiple logistic regressions.Statistical analysis was performed using STATA version 15.0(Stata Corp LLC,Texas).Results:Out of 716 patients with PAI,the majority(91.9%)were young males.Blunt trauma was the most common mechanism of injury.Median ischemia time was 4 h(interquartile range 2-7 h).Brachial artery(28.5%)was the most common injured vessel followed by popliteal artery(17.5%)and femoral artery(17.3%).Limb salvage rate was 78%.Out of them,158(22.1%)patients needed amputation,and 53(7.4%)had undergone primary amputation.The majority(88.6%)of patients who required primary or secondary amputations had blunt trauma.On multivariate analysis,blunt trauma,ischemia time more than 6 h and concomitant venous,skeletal,and soft tissue injuries were associated with higher odds of amputation.Conclusion:Over all limb salvage rates was 77.9%in our series.Blunt mechanism of injury and associated skeletal and soft tissue injury,ischemia time more than 6 h portend a poor prognosis.Injury prevention,robust prehospital care,and rapid referral to specialized trauma center are few efficient measures,which can decrease the morbidity associated with vascular injury.展开更多
Purpose:Renal trauma constitutes 0.5%-5% of all trauma patients,and 10%-20% of abdominal trauma.It is the most commonly injured organ in the genitourinary tract.Road traffic crash(RTC)is the most common cause.In recen...Purpose:Renal trauma constitutes 0.5%-5% of all trauma patients,and 10%-20% of abdominal trauma.It is the most commonly injured organ in the genitourinary tract.Road traffic crash(RTC)is the most common cause.In recent years due to the advances in radiological imaging and endovascular techniques,there has been an increase in the nonoperative management of renal trauma.We investigated a large trauma cohort at a level I trauma centre to evaluate patients'demographics with renal trauma,their management,and the outcomes.Methods:This was a retrospective analysis of the prospectively collected data of renal trauma patients managed from January 2016 to December 2020.Patients who visited the level I trauma centre in north India with renal trauma were included in this study.Patients who were dead on arrival in the emergency department were excluded.Demographics,mechanism of injury,presence of hemorrhagic shock,associated injuries,complications,length of hospital stay(LOS),discharge,and mortality were recorded.The data were entered in Microsoft Excel 365 and analysed using SPSS version 21.Results:This study collected data from 303 renal trauma patients.Males constituted 86.5%of the patients.Most patients were young,aged from 20-40 years.Blunt renal trauma was the predominant mode of injury(n=270,89.1%).RTCs(n=190,62.7%)and falls from height(n=65,21.4%)were the 2 most common mechanisms of injury.Focused assessment with sonography in trauma was positive in 68.4% of patients.Grade Ⅲ(grading by the American Association for the Surgery of Trauma)renal trauma(30.4%)was the most common grade in our study.The liver(n=104,34.3%)and splenic trauma(n=96,31.7%)were the most commonly associated injuries.Of the 303 patients,260(85.8%)were managed nonoperatively.The mean(SD)of the patients’LOS was 12.5(6.5)days.There were 25(8.3%)mortalities during the study period and all of them had associated other injuries.The comparison of LOS of isolated renal trauma group and renal trauma with associated injuries group was not statistically significant(p=0.322).All the patients who died during the study period had renal trauma with associated other organ injuries.None of the patients with isolated renal trauma died during the study.The outcome comparison between both groups was not statistically significant(p=0.110).Conclusion:Renal trauma predominantly occurs in young males,especially due to RTCs followed by fall from height.Focused assessment with sonography in trauma is not reliable in detecting renal injuries,other diagnostic tools such as contrast enhanced computed tomography torso should be considered in diagnosing and grading these injuries.Renal trauma usually does not occur in isolation.Majority are associated with other abdominal and extra abdominal injuries.Most of the times these injuries can be managed nonoperatively,which can achieve a low mortality.The patients who required surgery had high mortality as compared to patients who managed nonoperatively.These patients who required surgery had either severe renal or extra renal trauma and were in hemorrhagic shock.Renal trauma from this large cohort may contribute to improving the quality of care for patients with renal trauma by obtaining knowledge about the patient's characteristics,management,and outcomes.展开更多
Blunt traumatic injuries to the superior gluteal artery are rare in clinic. A majority of injuries present as aneurysms following penetrating trauma, fracture pelvis or posterior dislocation of the hip joint. We repor...Blunt traumatic injuries to the superior gluteal artery are rare in clinic. A majority of injuries present as aneurysms following penetrating trauma, fracture pelvis or posterior dislocation of the hip joint. We reported a rare case of superior gluteal artery pseudoaneurysm following blunt trauma presenting as large expanding right gluteal hematoma without any bony injury. The gluteal hematoma was suspected clinically, confirmed by ultrasound and the arterial injury was diagnosed by CT angiography that revealed a large right gluteal hematoma with a focal contrast leakage forming a pseudoaneurysm within the hematoma. Pseudoaneurysm arose from the superior gluteal branch of right internal iliac artery, which was successfully angioembolized. The patient was discharged on day 4 of hospitalization with resolving gluteal hematoma. This report highlighted the importance of considering an arterial injury following blunt trauma to the buttocks with subsequent painful swelling. Acknowledgment of this rare injury pattern was necessary to facilitate rapid diagnosis and appropriate treatment.展开更多
Purpose： Traumatic cardiac injury （TCI） is a challenge for trauma surgeons as it provides a short thera- peutic window and the management is often dictated by the underlying mechanism and hemodynamic status, The cu...Purpose： Traumatic cardiac injury （TCI） is a challenge for trauma surgeons as it provides a short thera- peutic window and the management is often dictated by the underlying mechanism and hemodynamic status, The current study is to evaluate the factors influencing the outcome of TCI. Methods： Prospectively maintained database of TCI cases admitted at a Level-I trauma center from July 2008 to June 2013 was retrospectively analyzed. Hospital records were reviewed and statistical analysis was performed using the SPSS version 15. Results： Out of 21 cases of TCI, 6 （28.6%） had isolated and 15 （71.4%） had associated injuries. Ratio be- tween blunt and penetrating injuries was 2：1 with male preponderance. Mean ISS was 31.95. Thirteen patients （62%） presented with features suggestive of shock. Cardiac tamponade was present in 12 （57%） cases and pericardiocentesis was done in only 6 cases of them. Overall 19 patients underwent surgery, Perioperatively 8 （38,1%） patients developed cardiac arrest and 7 developed cardiac arrhythmia. Overall survival rate was 71.4%. Mortality was related to cardiac arrest （p = 0.014）, arrhythmia （p = 0.014）, and hemorrhagic shock （p = 0.04）. The diagnostic accuracy of focused assessment by sonography in trauma （FAST） was 95.24%. Conclusion： High index of clinical suspicion based on the mechanism of injury, meticulous examination by FAST and early intervention could improve the overall outcome.展开更多
A two-dimensional lattice Boltzmann model has been employed to simulate the impingement of a liquid drop on a dry surface.For a range of Weber number,Reynolds number and low density ratios,multiple phases leading to b...A two-dimensional lattice Boltzmann model has been employed to simulate the impingement of a liquid drop on a dry surface.For a range of Weber number,Reynolds number and low density ratios,multiple phases leading to breakup have been obtained.An analytical solution for breakup as function of Reynolds and Weber number based on the conservation of energy is shown to match well with the simulations.At the moment breakup occurs,the spread diameter is maximum;it increases with Weber number and reaches an asymptotic value at a density ratio of 10.Droplet breakup is found to be more viable for the case when the wall is non-wetting or neutral as compared to a wetting surface.Upon breakup,the distance between the daughter droplets is much higher for the case with a non-wetting wall,which illustrates the role of the surface interactions in the outcome of the impact.展开更多
Background:Studies to identify an ideal trauma score tool representing prediction of outcomes of the pediatric fall patient remains elusive. Our study was undertaken to identify better predictor of mortality in the pe...Background:Studies to identify an ideal trauma score tool representing prediction of outcomes of the pediatric fall patient remains elusive. Our study was undertaken to identify better predictor of mortality in the pediatric fall patients. Methods:Data was retrieved from prospectively maintained trauma registry project at level 1 trauma center developed as part of Multicentric Project—Towards Improving Trauma Care Outcomes (TITCO) in India. Single center data retrieved from a prospectively maintained trauma registry at a level 1 trauma center, New Delhi, for a period ranging from 1 October 2013 to 17 February 2015 was evaluated. Standard anatomic scores Injury Severity Score (ISS) and New Injury Severity Score (NISS) were compared with physiologic score Revised Trauma Score (RTS) using receiver operating curve (ROC). Results:Heart rate and RTS had a statistical difference among the survivors to nonsurvivors. ISS, NISS, and RTS were having 50, 50, and 86% of area under the curve on ROCs, and RTS was statistically significant among them. Conclusions: Physiologically based trauma score systems (RTS) are much better predictors of inhospital mortality in comparison to anatomical based scoring systems (ISS and NISS) for unintentional pediatric falls.展开更多
Purpose： The epidemiology of pediatric trauma is different in different parts of the world. Some researchers suggest falls as the most common mechanism, whereas others report road traffic accidents （RTAs） as the mo...Purpose： The epidemiology of pediatric trauma is different in different parts of the world. Some researchers suggest falls as the most common mechanism, whereas others report road traffic accidents （RTAs） as the most common cause. The aim of this study is to find out the leading cause of pediatric admissions in Trauma Surgery in New Delhi, India. Methods： Inpatient data from January 2012 to September 2014 was searched retrospectively in Jai Prakash Narayan Apex Trauma Centre Trauma Registry. All patients aged 18 years or less on index presentation admitted to surgical ward/ICU or later taken transfer by the Department of Trauma Surgery were included. Data were retrieved in predesigned proformas. Information thus compiled was coded in unique alphanumeric codes for each variable and subjected to statistical analysis using SPSS version 21. Results： We had 300 patients over a 33 month period. Among them, 236 （78.6%） were males and 64 （21.3%） females. Overall the predominant cause was RTAs in 132 （43%） patients. On subgroup analysis of up to 12 years age group （n - 147）, the most common cause was found to be RTAs again. However, falls showed an incremental upward trend （36.05% in up to 12 age group versus 27% overall）, catching up with RTAs （44.89%）. Pediatric Trauma Score （PTS） ranged from 0 to 12 with a mean of 8.12 _＋ 2.022. 223 （74.33%） patients experienced trauma limited to one anatomic region only, whereas 77 （25.66%） patients suffered polytrauma. 288 patients were discharged to home care. Overall, 12 patients expired in the cohort. Median hospital stay was 6 days （range 1-182）. Conclusion： Pediatric trauma is becoming a cause of increasing concern, especially in the developing countries. The leading cause of admissions in Trauma Surgery is RTAs （43%） as compared to falls from height （27%）; however, falls from height are showing an increasing trend as we move to younger age groups. Enhancing road safety alone may not be a lasting solution for prevention of pediatric trauma and local injury patterns must be taken into account when formulating policies to address this unique challenge.展开更多
The management of hemodynamically normal patients with retained intra-pericardial foreign body re- mains a matter of conjecture. The available literature supports non-operative management of such innocuous foreign bod...The management of hemodynamically normal patients with retained intra-pericardial foreign body re- mains a matter of conjecture. The available literature supports non-operative management of such innocuous foreign bodies. We report our experience of a hemodynamically normal patient with a retained intra-pericardial pellet from a firearm injury. He initially received successful non-operative management but developed fatal hemopericardium 21 days after injury. In this paper, we discussed the pitfalls in the management of such injuries in light of the available literature and summarized the clinical experience.展开更多
Neck, being not protected by skeleton, is vulnerable to external trauma and injury which involves blood vessels, trachea, esophagus and other endocrine and nervous system organs. Vascular injuries can not only cause p...Neck, being not protected by skeleton, is vulnerable to external trauma and injury which involves blood vessels, trachea, esophagus and other endocrine and nervous system organs. Vascular injuries can not only cause potentially, life-threatening hemorrhage but also need profound surgical expertise in man- agement. Development of collateral circulation in neck is well known： however, there is scarcity of literature on the role of collateral formation in neck trauma. Here, we present a unique case of pene- trating gunshot injury to neck with right common carotid and right subclavian artery injury with hemorrhagic shock managed with ligation of these vessels as a life-saving procedure. The patient pre- sented ~ith no neurological or motor de~,cits in immediate postoperative period owing to the collateral circulation between right vertebral artery and right common carotid and right subclavian artery.展开更多
Aneurysm of gastroduodenal artery （CDA） is rare. Most reported cases are due to pancreatitis and atherosclerosis; however, those following pancreatic trauma have not been reported. We encountered GDA aneurysm in a p...Aneurysm of gastroduodenal artery （CDA） is rare. Most reported cases are due to pancreatitis and atherosclerosis; however, those following pancreatic trauma have not been reported. We encountered GDA aneurysm in a patient of blunt abdominal trauma, who had pancreatic contusion and retroduodenal air on contrast enhanced computed tomography of abdomen. Emergency laparotomy for suspected duodenal injury revealed duodenal wall and pancreatic head contusion, mild hemoperitoneum and no evidence of duodenal perforation. In the postoperative period, the patient developed upper gastrointestinal hemorrhage on day 5. Repeat imaging revealed GDA aneurysm, which was managed successfully by angioembolization. This case highlights, one, delayed presen- tation of GDA aneurysm after blunt pancreatic trauma and two, its successful management using endovascular technique.展开更多
Introduction:Hemorrhage control is the essence of trauma care.Conventional teaching is 1 on the floor(ie,external bleeding)and 4 more(thoracic cavity,abdomen,retroperitoneum,and long bones).In this case report,we pres...Introduction:Hemorrhage control is the essence of trauma care.Conventional teaching is 1 on the floor(ie,external bleeding)and 4 more(thoracic cavity,abdomen,retroperitoneum,and long bones).In this case report,we present a unique case with concealed bleeding into the soft tissue compartment leading to shock.This case triggered to consider the soft tissue compartment as the sixth potential bleeding site in trauma patients in hemorrhagic shock.Case presentation:We present the case with concealed bleeding into the soft tissue compartment posing a challenge in management.On presentation,he had a pulse rate of 117 beats/min,a blood pressure of 90/60mmHg,and a Glasgow Coma Scale(GCS)score of 9.During resuscitation,the patient's blood pressure dropped to 70/46 mmHg with a GCS of 7 of 15.He was then intubated and reevaluated.Contrast-enhanced computed tomography of the torso revealed a right scapular fracture with a large soft tissue hematoma along the right side of the neck and chest wall,extending up to the right lumbar region.Conclusion:We suggest that the soft tissue compartment is the sixth potential site of internal bleeding in trauma patients,which should not be overlooked after having ruled out the other 5 sites.展开更多
Introduction:Traumatic neck injuries(TNIs)constitute 5%–10%of all trauma cases.These injuries can be caused by either penetrating or blunt trauma.Patients can have a varied presentation like cut injury over the neck,...Introduction:Traumatic neck injuries(TNIs)constitute 5%–10%of all trauma cases.These injuries can be caused by either penetrating or blunt trauma.Patients can have a varied presentation like cut injury over the neck,bleeding,neck swelling,breathing difficulty,dysphagia,etc.Methods:This was a retrospective observational study conducted at a level I trauma center in India from January 2016 to March 2020.One hundred thirty patients who required admission and intervention due to TNIs were included in this study.Results:One hundred thirty patients with neck injuries were included in this study.Males were predominant(91.5%)with the age ranging from 10 to 70years.The most common mechanism of injury was physical assault(40.7%),followed by road traffic injury(23.8%)and self-inflicted injuries(18.4%).Penetrating trauma was predominant.Open neck wound with bleeding was the most common presenting symptom.Zone II injuries were more common(83.8%)followed by zone I(12.3%)and zone III(3.8%).Soft tissue injury including skin,platysma breach,and strap muscle injury was present in 46.9% of patients.Laryngopharyngeal injury was present in 13.8%,tracheal injury in 28.5%,vascular injury in 13.8%,and esophageal injury in 4.6% of patients.Conclusion:Penetrating neck trauma is more common than blunt in developing countries like India.Advanced Trauma Life Support(ATLS)protocol guides the initial management.The definitive management depends on the type and mechanism of injury,anatomical level,severity,and the organ injured.展开更多
Background: Pancreatic trauma (PT) accounts for less than 1% of all trauma admissions. Occasionally, PT is undetected during theprimary survey and becomes apparent only when complications arise. It occurs in up to 5% ...Background: Pancreatic trauma (PT) accounts for less than 1% of all trauma admissions. Occasionally, PT is undetected during theprimary survey and becomes apparent only when complications arise. It occurs in up to 5% of blunt abdominal trauma cases and 12%of individuals with penetrating abdominal injuries. Management is determined by the status of the main pancreatic duct and associatedinjuries.Methods: This was an ambispective study conducted at the Jai Prakash Narayan Apex Trauma Center, All India Institute ofMedical Sciences,New Delhi, from January 2015 to December 2017 (retrospective), and January 2019 to December 2020 (prospective). In total, 113patients with PT were included in this study.Results:We analyzed the data of 113 patients with PT included in this study, of whichmales predominated (93.7%). Blunt PT was presentin 101 patients (89.4%) and penetrating PT in 12 patients (10.6%). Half of the patients (51.3%) had the American Association for theSurgery of Trauma grade III PT, followed by grade II (18.6%), and grade I (15%). Of the total 113 patients, 68 (60.2%) were treated withoperative management, and 45 (39.8%) with nonoperative management. Distal pancreatectomy, with or without splenectomy, was themost common procedure performed in our study, followed by drainage. There were 27 mortalities (23.8%) during the study period, ofwhich 7 were directly related to PT and 20 were due to other organ-related sepsis and hemorrhagic shock.Conclusion: Pancreatic trauma is rare but challenging for trauma surgeons, with persistent management controversies. Early diagnosisis important for favorable results;however, a delay in diagnosis has been associated with higher morbidity and mortality. Low-grade pancreaticinjuries can be successfully managed nonoperatively, whereas high-grade pancreatic injuries require surgical intervention.展开更多
Pancreatic trauma remains a challenge to a trauma surgeon even with extensive advancement in medicine.The mortality and morbidity associated with this injury remain high.A high index of suspicion,mechanism of injury,a...Pancreatic trauma remains a challenge to a trauma surgeon even with extensive advancement in medicine.The mortality and morbidity associated with this injury remain high.A high index of suspicion,mechanism of injury,and early identification hold key in the final outcome.The management of pancreatic injury should involve a multidisciplinary team comprising of trauma surgeons,radiologists,and gastroenterologists.This review highlights the burden of the pancreatic injury and its management.展开更多
文摘Successful modeling and/or design of engineering systems often requires one to address the impact of multiple ＂design variables＂ on the prescribed outcome.There are often multiple,competing objectives based on which we assess the outcome of optimization.Since accurate,high fidelity models are typically time consuming and computationally expensive,comprehensive evaluations can be conducted only if an efficient framework is available.Furthermore,informed decisions of the model/hardware＇s overall performance rely on an adequate understanding of the global,not local,sensitivity of the individual design variables on the objectives.The surrogate-based approach,which involves approximating the objectives as continuous functions of design variables from limited data,offers a rational framework to reduce the number of important input variables,i.e.,the dimension of a design or modeling space.In this paper,we review the fundamental issues that arise in surrogate-based analysis and optimization,highlighting concepts,methods,techniques,as well as modeling implications for mechanics problems.To aid the discussions of the issues involved,we summarize recent efforts in investigating cryogenic cavitating flows,active flow control based on dielectric barrier discharge concepts,and lithium（Li）-ion batteries.It is also stressed that many multi-scale mechanics problems can naturally benefit from the surrogate approach for ＂scale bridging.＂
基金supported by the General Motors and University of Michigan Advanced Battery Coalition for Drivetrains (ABCD)
文摘In this study, the effects of discharge rate and LiMn2O4 cathode properties （thickness, porosity, particle size, and solid-state diffusivity and conductivity） on the gravimetric energy and power density of a lithium-ion battery cell are analyzed simultaneously using a cell-level model. Surrogate-based analysis tools are applied to simulation data to construct educed-order models, which are in turn used to perform global sensitivity analysis to compare the relative importance of cathode properties. Based on these results, the cell is then optimized for several distinct physical scenarios using gradient-based methods. The comple-mentary nature of the gradient-and surrogate-based tools is demonstrated by establishing proper bounds and constraints with the surrogate model, and then obtaining accurate optimized solutions with the gradient-based optimizer. These optimal solutions enable the quantification of the tradeoffs between energy and power density, and the effect of optimizing the electrode thickness and porosity. In conjunction with known guidelines, the numerical optimization frame-work developed herein can be applied directly to cell and pack design.
文摘Influenza viruses were responsible for most adult viral pneumonia.Presently,coronavirus disease 2019(COVID-19)has evolved into serious global pandemic.COVID-19 outbreak is expected to persist in months to come that will be synchronous with the influenza season.The management,prognosis,and protection for these two viral pneumonias differ considerably and differentiating between them has a high impact on the patient outcome.Reverse transcriptase polymerase chain reaction is highly specific but has suboptimal sensitivity.Chest computed tomography(CT)has a high sensitivity for detection of pulmonary disease manifestations and can play a key-role in diagnosing COVID-19.We reviewed 47 studies and delineated CT findings of COVID-19 and influenza pneumonia.The differences observed in the chest CT scan can be helpful in differentiation.For instance,ground glass opacities(GGOs),as the most frequent imaging finding in both diseases,can differ in the pattern of distribution.Peripheral and posterior distribution,multilobular distribution,pure or clear margin GGOs were more commonly reported in COVID-19,whereas central or peri-bronchovascular GGOs and pure consolidations were more seen in influenza A(H1N1).In review of other imaging findings,further differences were noticed.Subpleural curvilinear lines,sugar melted sign,intra-lesional vascular enlargement,reverse halo sign,and fibrotic bands were more reported in COVID-19 than H1N1,while air space nodule,tree-in-bud,bronchiectasia,pleural effusion,and cavitation were more seen in H1N1.This delineation,when combined with clinical manifestations and laboratory results may help to differentiate these two viral infections.
文摘Protein energy wasting (PEW) is a major challenge in CKD. Objective: To assess PEW in predialysis patients on their first visit to a nephrologist. Methods: Three day dietary intake of 484 CKD stage 3 patients was taken. Appetite was assessed with ADAT. Patients were divided into groups based on appetite and BMI. Results: Male and female parameters are serum albumin 3.7 ± 0.84/3.68.8 ± 0.81 g/dL, total protein 7.02 ± 1.27/6.94 ± 1.26 g/dL, creatinine 4.68 ± 4.19/3.74 ± 3.36 mg% creatinine clearance 33.22 ± 30.48/37.55 ± 33.87 ml/minute, BMI 22.60 ± 4.29/23.43 ± 4.77kg/m2 energy/kg 16.97 ± 0.65/16.8 ± 0.64, protein g/kg 0.65 ± 0.28/0.64 ± 0.30, carbohydrate g/kg 2.98 ± 1.54/2.98 ± 0.1.36, fat g/kg 2.98 ± 0.23/2.79 ± 0.22, respectively. As appetite decreased, dietary protein and energy intake decreased significantly. Appetite in males and females: Average 14.46%, 4.13%, poor 9.7%, 18.18%, anorexic 13.2%, 7.4%. Income had strong correlation with BMI (p 0.000), dietary protein (p 0.000), energy (p 0.000) and carbohydrate (p 0.000). Appetite correlated with creatinine (p 0.019), dietary energy, protein, carbohydrate and fat (p 0.000) intake. BMI correlated (p 0.000) with fat, carbohydrate, energy and creatinine clearance. ANOVA showed significant difference within and between appetite groups in energy, protein, fat, carbohydrate, creatinine clearance (p 0.000) and serum albumin (p 0.025). There was significant difference in protein (p 0.026), energy intake (p 0.000) and creatinine clearance (p 0.038) within and between BMI groups. Based on income, there was significant difference among groups in BMI (p 0.000), energy (p 0.019), protein (p 0.031) and albumin (0.001).
文摘Purpose:Non-operative management(NOM)has been validated for blunt liver and splenic injuries.Literature on continuous intra-abdominal pressure(IAP)monitoring as a part of NOM remains to be equivocal.The study aimed to find any correlation between clinical parameters and IAP,and their effect on the NOM of patients with blunt liver and splenic injury.Method:A prospective cross-sectional study conducted at a level I trauma center from October 2018 to January 2020 including 174 patients who underwent NOM following blunt liver and splenic injuries.Hemodynamically unstable patients or those on ventilators were excluded,as well as patients who suffered significant head,spinal cord,and/or bladder injuries.The study predominantly included males(83.9%)with a mean age of 32.5 years.IAP was monitored continuously and the relation of IAP with various parameters,interventions,and outcomes were measured.Data were summarized as frequency(percentage)or mean±SD or median(Q1,Q3)as indicated.χ2 or Fisher's exact test was used for categorical variables,while for continuous variables parametric(independent t-test)or nonparametric tests(Wilcoxon rank sum test)were used as appropriate.Clinical and laboratory correlates of IAP<12 with p<0.200 in the univariable logistic regression analysis were included in the multivariable analysis.A p<0.05 was used to indicate statistical significance.Results:Intra-abdominal hypertension(IAH)was seen in 19.0%of the study population.IAH was strongly associated with a high injury severity score(p<0.001),and other physiological parameters like respiratory rate(p<0.001),change in abdominal girth(AG)(p<0.001),and serum creatinine(p<0.001).IAH along with the number of solid organs involved,respiratory rate,change in AG,and serum creatinine was associated with the intervention,either operative or non-operative(p=0.001,p=0.002,p<0.001,p<0.001,p=0.013,respectively).On multivariable analysis,IAP(p=0.006)and the mean change of AG(p=0.004)were significantly associated with the need for intervention.Conclusion:As a part of NOM,IAP should be monitored as a continuous vital.However,the decision for any intervention,either operative or non-operative cannot be guided by IAP values alone.
文摘Purpose:Outcomes of peripheral arterial injury(PAI)depend on various factors,such as warm ischemia time and concomitant injuries.Suboptimal prehospital care may lead to delayed presentation,and a lack of dedicated trauma system may lead to poorer outcome.Also,there are few reports of these outcomes.The study aims to review our experience of PAI management for more than a decade,and identify the predictors of limb loss in these patients.Methods:This is a retrospective analysis of prospectively maintained database of trauma admissions at a level I trauma center from January 2008 to December 2019.Patients with acute upper limb arterial injuries or lower limb arterial injuries at or above the level of popliteal artery were included.Association of limb loss with ischemia time,mechanism of injury,and concomitant injuries was studied using multiple logistic regressions.Statistical analysis was performed using STATA version 15.0(Stata Corp LLC,Texas).Results:Out of 716 patients with PAI,the majority(91.9%)were young males.Blunt trauma was the most common mechanism of injury.Median ischemia time was 4 h(interquartile range 2-7 h).Brachial artery(28.5%)was the most common injured vessel followed by popliteal artery(17.5%)and femoral artery(17.3%).Limb salvage rate was 78%.Out of them,158(22.1%)patients needed amputation,and 53(7.4%)had undergone primary amputation.The majority(88.6%)of patients who required primary or secondary amputations had blunt trauma.On multivariate analysis,blunt trauma,ischemia time more than 6 h and concomitant venous,skeletal,and soft tissue injuries were associated with higher odds of amputation.Conclusion:Over all limb salvage rates was 77.9%in our series.Blunt mechanism of injury and associated skeletal and soft tissue injury,ischemia time more than 6 h portend a poor prognosis.Injury prevention,robust prehospital care,and rapid referral to specialized trauma center are few efficient measures,which can decrease the morbidity associated with vascular injury.
文摘Purpose:Renal trauma constitutes 0.5%-5% of all trauma patients,and 10%-20% of abdominal trauma.It is the most commonly injured organ in the genitourinary tract.Road traffic crash(RTC)is the most common cause.In recent years due to the advances in radiological imaging and endovascular techniques,there has been an increase in the nonoperative management of renal trauma.We investigated a large trauma cohort at a level I trauma centre to evaluate patients'demographics with renal trauma,their management,and the outcomes.Methods:This was a retrospective analysis of the prospectively collected data of renal trauma patients managed from January 2016 to December 2020.Patients who visited the level I trauma centre in north India with renal trauma were included in this study.Patients who were dead on arrival in the emergency department were excluded.Demographics,mechanism of injury,presence of hemorrhagic shock,associated injuries,complications,length of hospital stay(LOS),discharge,and mortality were recorded.The data were entered in Microsoft Excel 365 and analysed using SPSS version 21.Results:This study collected data from 303 renal trauma patients.Males constituted 86.5%of the patients.Most patients were young,aged from 20-40 years.Blunt renal trauma was the predominant mode of injury(n=270,89.1%).RTCs(n=190,62.7%)and falls from height(n=65,21.4%)were the 2 most common mechanisms of injury.Focused assessment with sonography in trauma was positive in 68.4% of patients.Grade Ⅲ(grading by the American Association for the Surgery of Trauma)renal trauma(30.4%)was the most common grade in our study.The liver(n=104,34.3%)and splenic trauma(n=96,31.7%)were the most commonly associated injuries.Of the 303 patients,260(85.8%)were managed nonoperatively.The mean(SD)of the patients’LOS was 12.5(6.5)days.There were 25(8.3%)mortalities during the study period and all of them had associated other injuries.The comparison of LOS of isolated renal trauma group and renal trauma with associated injuries group was not statistically significant(p=0.322).All the patients who died during the study period had renal trauma with associated other organ injuries.None of the patients with isolated renal trauma died during the study.The outcome comparison between both groups was not statistically significant(p=0.110).Conclusion:Renal trauma predominantly occurs in young males,especially due to RTCs followed by fall from height.Focused assessment with sonography in trauma is not reliable in detecting renal injuries,other diagnostic tools such as contrast enhanced computed tomography torso should be considered in diagnosing and grading these injuries.Renal trauma usually does not occur in isolation.Majority are associated with other abdominal and extra abdominal injuries.Most of the times these injuries can be managed nonoperatively,which can achieve a low mortality.The patients who required surgery had high mortality as compared to patients who managed nonoperatively.These patients who required surgery had either severe renal or extra renal trauma and were in hemorrhagic shock.Renal trauma from this large cohort may contribute to improving the quality of care for patients with renal trauma by obtaining knowledge about the patient's characteristics,management,and outcomes.
文摘Blunt traumatic injuries to the superior gluteal artery are rare in clinic. A majority of injuries present as aneurysms following penetrating trauma, fracture pelvis or posterior dislocation of the hip joint. We reported a rare case of superior gluteal artery pseudoaneurysm following blunt trauma presenting as large expanding right gluteal hematoma without any bony injury. The gluteal hematoma was suspected clinically, confirmed by ultrasound and the arterial injury was diagnosed by CT angiography that revealed a large right gluteal hematoma with a focal contrast leakage forming a pseudoaneurysm within the hematoma. Pseudoaneurysm arose from the superior gluteal branch of right internal iliac artery, which was successfully angioembolized. The patient was discharged on day 4 of hospitalization with resolving gluteal hematoma. This report highlighted the importance of considering an arterial injury following blunt trauma to the buttocks with subsequent painful swelling. Acknowledgment of this rare injury pattern was necessary to facilitate rapid diagnosis and appropriate treatment.
文摘Purpose： Traumatic cardiac injury （TCI） is a challenge for trauma surgeons as it provides a short thera- peutic window and the management is often dictated by the underlying mechanism and hemodynamic status, The current study is to evaluate the factors influencing the outcome of TCI. Methods： Prospectively maintained database of TCI cases admitted at a Level-I trauma center from July 2008 to June 2013 was retrospectively analyzed. Hospital records were reviewed and statistical analysis was performed using the SPSS version 15. Results： Out of 21 cases of TCI, 6 （28.6%） had isolated and 15 （71.4%） had associated injuries. Ratio be- tween blunt and penetrating injuries was 2：1 with male preponderance. Mean ISS was 31.95. Thirteen patients （62%） presented with features suggestive of shock. Cardiac tamponade was present in 12 （57%） cases and pericardiocentesis was done in only 6 cases of them. Overall 19 patients underwent surgery, Perioperatively 8 （38,1%） patients developed cardiac arrest and 7 developed cardiac arrhythmia. Overall survival rate was 71.4%. Mortality was related to cardiac arrest （p = 0.014）, arrhythmia （p = 0.014）, and hemorrhagic shock （p = 0.04）. The diagnostic accuracy of focused assessment by sonography in trauma （FAST） was 95.24%. Conclusion： High index of clinical suspicion based on the mechanism of injury, meticulous examination by FAST and early intervention could improve the overall outcome.
文摘A two-dimensional lattice Boltzmann model has been employed to simulate the impingement of a liquid drop on a dry surface.For a range of Weber number,Reynolds number and low density ratios,multiple phases leading to breakup have been obtained.An analytical solution for breakup as function of Reynolds and Weber number based on the conservation of energy is shown to match well with the simulations.At the moment breakup occurs,the spread diameter is maximum;it increases with Weber number and reaches an asymptotic value at a density ratio of 10.Droplet breakup is found to be more viable for the case when the wall is non-wetting or neutral as compared to a wetting surface.Upon breakup,the distance between the daughter droplets is much higher for the case with a non-wetting wall,which illustrates the role of the surface interactions in the outcome of the impact.
文摘Background:Studies to identify an ideal trauma score tool representing prediction of outcomes of the pediatric fall patient remains elusive. Our study was undertaken to identify better predictor of mortality in the pediatric fall patients. Methods:Data was retrieved from prospectively maintained trauma registry project at level 1 trauma center developed as part of Multicentric Project—Towards Improving Trauma Care Outcomes (TITCO) in India. Single center data retrieved from a prospectively maintained trauma registry at a level 1 trauma center, New Delhi, for a period ranging from 1 October 2013 to 17 February 2015 was evaluated. Standard anatomic scores Injury Severity Score (ISS) and New Injury Severity Score (NISS) were compared with physiologic score Revised Trauma Score (RTS) using receiver operating curve (ROC). Results:Heart rate and RTS had a statistical difference among the survivors to nonsurvivors. ISS, NISS, and RTS were having 50, 50, and 86% of area under the curve on ROCs, and RTS was statistically significant among them. Conclusions: Physiologically based trauma score systems (RTS) are much better predictors of inhospital mortality in comparison to anatomical based scoring systems (ISS and NISS) for unintentional pediatric falls.
文摘Purpose： The epidemiology of pediatric trauma is different in different parts of the world. Some researchers suggest falls as the most common mechanism, whereas others report road traffic accidents （RTAs） as the most common cause. The aim of this study is to find out the leading cause of pediatric admissions in Trauma Surgery in New Delhi, India. Methods： Inpatient data from January 2012 to September 2014 was searched retrospectively in Jai Prakash Narayan Apex Trauma Centre Trauma Registry. All patients aged 18 years or less on index presentation admitted to surgical ward/ICU or later taken transfer by the Department of Trauma Surgery were included. Data were retrieved in predesigned proformas. Information thus compiled was coded in unique alphanumeric codes for each variable and subjected to statistical analysis using SPSS version 21. Results： We had 300 patients over a 33 month period. Among them, 236 （78.6%） were males and 64 （21.3%） females. Overall the predominant cause was RTAs in 132 （43%） patients. On subgroup analysis of up to 12 years age group （n - 147）, the most common cause was found to be RTAs again. However, falls showed an incremental upward trend （36.05% in up to 12 age group versus 27% overall）, catching up with RTAs （44.89%）. Pediatric Trauma Score （PTS） ranged from 0 to 12 with a mean of 8.12 _＋ 2.022. 223 （74.33%） patients experienced trauma limited to one anatomic region only, whereas 77 （25.66%） patients suffered polytrauma. 288 patients were discharged to home care. Overall, 12 patients expired in the cohort. Median hospital stay was 6 days （range 1-182）. Conclusion： Pediatric trauma is becoming a cause of increasing concern, especially in the developing countries. The leading cause of admissions in Trauma Surgery is RTAs （43%） as compared to falls from height （27%）; however, falls from height are showing an increasing trend as we move to younger age groups. Enhancing road safety alone may not be a lasting solution for prevention of pediatric trauma and local injury patterns must be taken into account when formulating policies to address this unique challenge.
文摘The management of hemodynamically normal patients with retained intra-pericardial foreign body re- mains a matter of conjecture. The available literature supports non-operative management of such innocuous foreign bodies. We report our experience of a hemodynamically normal patient with a retained intra-pericardial pellet from a firearm injury. He initially received successful non-operative management but developed fatal hemopericardium 21 days after injury. In this paper, we discussed the pitfalls in the management of such injuries in light of the available literature and summarized the clinical experience.
文摘Neck, being not protected by skeleton, is vulnerable to external trauma and injury which involves blood vessels, trachea, esophagus and other endocrine and nervous system organs. Vascular injuries can not only cause potentially, life-threatening hemorrhage but also need profound surgical expertise in man- agement. Development of collateral circulation in neck is well known： however, there is scarcity of literature on the role of collateral formation in neck trauma. Here, we present a unique case of pene- trating gunshot injury to neck with right common carotid and right subclavian artery injury with hemorrhagic shock managed with ligation of these vessels as a life-saving procedure. The patient pre- sented ~ith no neurological or motor de~,cits in immediate postoperative period owing to the collateral circulation between right vertebral artery and right common carotid and right subclavian artery.
文摘Aneurysm of gastroduodenal artery （CDA） is rare. Most reported cases are due to pancreatitis and atherosclerosis; however, those following pancreatic trauma have not been reported. We encountered GDA aneurysm in a patient of blunt abdominal trauma, who had pancreatic contusion and retroduodenal air on contrast enhanced computed tomography of abdomen. Emergency laparotomy for suspected duodenal injury revealed duodenal wall and pancreatic head contusion, mild hemoperitoneum and no evidence of duodenal perforation. In the postoperative period, the patient developed upper gastrointestinal hemorrhage on day 5. Repeat imaging revealed GDA aneurysm, which was managed successfully by angioembolization. This case highlights, one, delayed presen- tation of GDA aneurysm after blunt pancreatic trauma and two, its successful management using endovascular technique.
文摘Introduction:Hemorrhage control is the essence of trauma care.Conventional teaching is 1 on the floor(ie,external bleeding)and 4 more(thoracic cavity,abdomen,retroperitoneum,and long bones).In this case report,we present a unique case with concealed bleeding into the soft tissue compartment leading to shock.This case triggered to consider the soft tissue compartment as the sixth potential bleeding site in trauma patients in hemorrhagic shock.Case presentation:We present the case with concealed bleeding into the soft tissue compartment posing a challenge in management.On presentation,he had a pulse rate of 117 beats/min,a blood pressure of 90/60mmHg,and a Glasgow Coma Scale(GCS)score of 9.During resuscitation,the patient's blood pressure dropped to 70/46 mmHg with a GCS of 7 of 15.He was then intubated and reevaluated.Contrast-enhanced computed tomography of the torso revealed a right scapular fracture with a large soft tissue hematoma along the right side of the neck and chest wall,extending up to the right lumbar region.Conclusion:We suggest that the soft tissue compartment is the sixth potential site of internal bleeding in trauma patients,which should not be overlooked after having ruled out the other 5 sites.
文摘Introduction:Traumatic neck injuries(TNIs)constitute 5%–10%of all trauma cases.These injuries can be caused by either penetrating or blunt trauma.Patients can have a varied presentation like cut injury over the neck,bleeding,neck swelling,breathing difficulty,dysphagia,etc.Methods:This was a retrospective observational study conducted at a level I trauma center in India from January 2016 to March 2020.One hundred thirty patients who required admission and intervention due to TNIs were included in this study.Results:One hundred thirty patients with neck injuries were included in this study.Males were predominant(91.5%)with the age ranging from 10 to 70years.The most common mechanism of injury was physical assault(40.7%),followed by road traffic injury(23.8%)and self-inflicted injuries(18.4%).Penetrating trauma was predominant.Open neck wound with bleeding was the most common presenting symptom.Zone II injuries were more common(83.8%)followed by zone I(12.3%)and zone III(3.8%).Soft tissue injury including skin,platysma breach,and strap muscle injury was present in 46.9% of patients.Laryngopharyngeal injury was present in 13.8%,tracheal injury in 28.5%,vascular injury in 13.8%,and esophageal injury in 4.6% of patients.Conclusion:Penetrating neck trauma is more common than blunt in developing countries like India.Advanced Trauma Life Support(ATLS)protocol guides the initial management.The definitive management depends on the type and mechanism of injury,anatomical level,severity,and the organ injured.
文摘Background: Pancreatic trauma (PT) accounts for less than 1% of all trauma admissions. Occasionally, PT is undetected during theprimary survey and becomes apparent only when complications arise. It occurs in up to 5% of blunt abdominal trauma cases and 12%of individuals with penetrating abdominal injuries. Management is determined by the status of the main pancreatic duct and associatedinjuries.Methods: This was an ambispective study conducted at the Jai Prakash Narayan Apex Trauma Center, All India Institute ofMedical Sciences,New Delhi, from January 2015 to December 2017 (retrospective), and January 2019 to December 2020 (prospective). In total, 113patients with PT were included in this study.Results:We analyzed the data of 113 patients with PT included in this study, of whichmales predominated (93.7%). Blunt PT was presentin 101 patients (89.4%) and penetrating PT in 12 patients (10.6%). Half of the patients (51.3%) had the American Association for theSurgery of Trauma grade III PT, followed by grade II (18.6%), and grade I (15%). Of the total 113 patients, 68 (60.2%) were treated withoperative management, and 45 (39.8%) with nonoperative management. Distal pancreatectomy, with or without splenectomy, was themost common procedure performed in our study, followed by drainage. There were 27 mortalities (23.8%) during the study period, ofwhich 7 were directly related to PT and 20 were due to other organ-related sepsis and hemorrhagic shock.Conclusion: Pancreatic trauma is rare but challenging for trauma surgeons, with persistent management controversies. Early diagnosisis important for favorable results;however, a delay in diagnosis has been associated with higher morbidity and mortality. Low-grade pancreaticinjuries can be successfully managed nonoperatively, whereas high-grade pancreatic injuries require surgical intervention.
文摘Pancreatic trauma remains a challenge to a trauma surgeon even with extensive advancement in medicine.The mortality and morbidity associated with this injury remain high.A high index of suspicion,mechanism of injury,and early identification hold key in the final outcome.The management of pancreatic injury should involve a multidisciplinary team comprising of trauma surgeons,radiologists,and gastroenterologists.This review highlights the burden of the pancreatic injury and its management.
