Portal vein thrombosis (PVT) secondary to blunt abdominal trauma associated with liver injury is extremely rare in healthy individuals as well as in minor liver injury, and it carries a high rate of morbidity and mortality. Moreover, acute asymptomatic PVT is difficult to diagnose. We present a young trauma patient with isolated minor liver injury associated with acute PVT. A 27-year-old man presented to the emergency department after a motor vehicle collision. His primary survey findings were unremarkable. His secondary survey showed a large contusion (7 × 7 cm²) at the epigastrium with marked tenderness and localized guarding. The CT angiography of the whole abdomen revealed liver injury grade 3 in hepatic segments 2/3 and 4b (according to the American Association for the Surgery of Trauma classification) extending near the porta hepatis with patent hepatic and portal veins and without other solid organ injury. The follow-up CT of the whole abdomen on post-injury day 7 showed a 1.8-cm thrombus in the left portal vein with patent right portal and hepatic veins, and a decreased size of the hepatic lacerations. A liver function test was repeated on post-injury day 4, and it revealed improved transaminitis. The patient received intravenous anticoagulant therapy with low-molecular-weight heparin according to weight-based dosing for treatment. The CT of the whole abdomen performed 2 weeks after anticoagulant therapy showed small residual thrombosis in the left portal vein. The patient received intravenous anticoagulant therapy for a total of 3 months. On the follow-up visits at 1 month, 2 months, 6 months, and 1 year after the injury, the patients did not have any detectable abnormal symptoms. PVT post-blunt minor liver injury is an extremely rare complication. If the thrombosis is left untreated, serious morbidity and mortality can ensue. However, its diagnosis in asymptomatic patients is still challenging. Periodic imaging is necessary for highly suspected PVT, especially in liver injury with lacerations close to the porta hepatis, even in cases of a minor injury.
Humans ; Portal Vein ; Male ; Adult ; Wounds, Nonpenetrating/complications* ; Venous Thrombosis/diagnostic imaging* ; Liver/injuries* ; Acute Disease ; Accidents, Traffic

PURPOSEExsanguination is the most common leading cause of death in trauma patients. The massive transfusion (MT) protocol may influence therapeutic strategies and help provide blood components in timely manner. The assessment of blood consumption (ABC) score is a popular MT protocol but has low predictability. The lactate level is a good parameter to reflect poor tissue perfusion or shock states that can guide the management. This study aimed to modify the ABC scoring system by adding the lactate level for better prediction of MT.

METHODSThe data were retrospectively collected from 165 trauma patients following the trauma activated criteria at Songklanagarind Hospital from January 2014 to December 2014. The ABC scoring system was applied in all patients. The patients who had an ABC score ≥2 as the cut point for MT were defined as the ABC group. All patients who had a score ≥2 with a lactate level >4 mmol/dL were defined as the ABC plus lactate level (ABC + L) group. The prediction for the requirement of massive blood transfusion was compared between the ABC and ABC + L groups. The ability of ABC and ABC + L groups to predict MT was estimated by the area under the receiver operating characteristic curve (AUROC).

RESULTSAmong 165 patients, 15 patients (9%) required massive blood transfusion. There were no significant differences in age, gender, mechanism of injury or initial vital signs between the MT group and the non-MT group. The group that required MT had a higher Injury Severity Score and mortality. The sensitivity and specificity of the ABC scoring system in our institution were low (81%, 34%, AUC 0.573). The sensitivity and specificity were significantly better in the ABC + L group (92%, 42%, AUC = 0.745).

CONCLUSIONThe ABC scoring system plus lactate increased the sensitivity and specificity compared with the ABC scoring system alone.

Adult ; Blood Transfusion ; Female ; Humans ; Lactic Acid ; blood ; Male ; Predictive Value of Tests ; Trauma Severity Indices

OBJECTIVEThe association of scapular fractures with other life-threatening injuries including blunt thoracic aortic injury is widely recognized. Few studies have investigated this presumed association. In this study, we investigated the incidence of significant associated injuries with scapular fracture and their outcomes.

METHODSA retrospective study was conducted from 2005 to 2009 in a level I trauma center in Thailand. All blunt trauma patients were identified. Patients?demographics, injury mechanism, associated injuries, Injury Severity Score (ISS), and survival outcomes were recorded. The management of associated injuries with scapular fracture was reviewed, and the risk factors for mortality were identified.

RESULTSAmong the 7 345 trauma patients admitted, scapular fractures occurred in 84 cases (1.1%). The mean age was (37.98+/-15.21) years. Motorcycle crash was the most frequent mechanism of injury, occurring in 51 cases (60.7%). Seventy-four patients (88.1%) suffering from scapular fractures had associated injuries: 5 (6.0%) had significant chest injuries, but none of them had blunt thoracic aortic injury. Two patients (2.4%) with scapular fractures died. Factors determining the likelihood of mortality were: (1) ISS larger than 25 (LR equal to 8.5, P less than 0.05); (2) significant associated chest injury (AIS larger than 3, LR equal to 5.3, P less than 0.05) and (3) significant associated abdominal injury (AIS larger than 3, LR equal to 5.3, P larger than 0.05).

CONCLUSIONA blunt scapular fracture may not accompany a blunt thoracic aortic injury but it is strongly related to other injuries like chest injury, extremity injury, head injury, etc. If a scapular fracture is found with a high ISS score, high chest or abdomen AIS score, the patient would have a high risk of mortality.

Fractures, Bone ; Humans ; Injury Severity Score ; Retrospective Studies ; Thoracic Injuries ; Wounds, Nonpenetrating ; epidemiology

Objective: The association of scapular fractures with other life-threatening injuries including blunt thoracic aortic injury is widely recognized.Few studies have investigated this presumed association.In this study,wc investigated the incidence of significant associated injuries with scapular fracture and their outcomes.Methods: A retrospective study was conducted from 2005 to 2009 in a level I trauma center in Thailand.All blunt trauma patients were identified.Patients' demographics,injury mechanism,associated injuries,Injury Severity Score (ISS),and survival outcomes were recorded.The management of associated injuries with scapular fracture was reviewed,and the risk factors for mortality were identified.Results: Among the 7 345 trauma patients admitted,scapular fractures occurred in 84 cases (1.1％).The mean age was (37.98±15.21) years.Motorcycle crash was the most frequent mechanism of injury,occurring in 51 cases (60.7％).Seventy-four patients (88.1％) suffering from scapular fractures had associated injuries:5 (6.0％) had significant chest injuries,but none of them had blunt thoracic aortic injury.Two patients (2.4％) with scapular fractures died.Factors determining the likelihood of mortality were:(1) ISS＞25(LR=8.5,P＜0.05); (2) significant associated chest injury (AIS＞3,LR=5.3,P＜0.05) and (3) significant associated abdominal injury (AIS＞3,LR=5.3,P＜0.05).Conclusion: A blunt scapular fracture may not accompany a blunt thoracic aortic injury but it is strongly related to other injuries like chest injury,extremity injury,head injury,etc.If a scapular fracture is found with a high ISS score,high chest or abdomen AIS score,the patient would have a high risk of mortality.