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      Characteristics of Traumatic Urogenital Injuries in Emergency Department; a 10-year Cross-sectional Study

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          Abstract

          Introduction:

          Urogenital system injuries (UGIs) are seen in 10% of adult cases with multiple trauma. Although UGIs are rarely life threatening, they can cause major long-term morbidities. This study aimed to evaluate the characteristics of traumatic UGIs in patients who were referred to emergency department following multiple traumas.

          Methods:

          This retrospective cross-sectional study was conducted on multiple trauma patients who were presented to emergency department during a 10-year period (2008-2017). All patients with kidney, ureter, bladder, urethra, or external genitalia injuries were studied. The patients’ data were extracted from their clinical profiles.

          Results:

          Out of the 13598 admitted patients in our trauma center, UGIs were seen in 267 (1.9%) cases. The mean age of patients with UGIs was 27.3 ± 6.1 years (74.15% male). The highest incidence of UGI was seen in those aged between 21 and 30 years (39.7%) and motorcycle accidents (49%) was the most frequent cause of trauma. 221 patients had an unstable situation and were emergently transferred to operation room (13.57% with traumatic kidney injury). The most common injured sites of urogenital system were kidney with 155 (58%) cases, followed by external genitalia with 91 (34.1%) cases. 77.5% of cases were managed conservatively and the rest (22.5%) underwent surgical procedures.

          Conclusion:

          UGIs comprise a low percentage (2%) of traumatic injuries, which are mostly caused by blunt trauma due to road traffic accidents. Kidney is the most common injured organ and UGIs mostly happen in young ages.

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          Most cited references39

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          Comparison of the Canadian CT Head Rule and the New Orleans Criteria in patients with minor head injury.

          Current use of cranial computed tomography (CT) for minor head injury is increasing rapidly, highly variable, and inefficient. The Canadian CT Head Rule (CCHR) and New Orleans Criteria (NOC) are previously developed clinical decision rules to guide CT use for patients with minor head injury and with Glasgow Coma Scale (GCS) scores of 13 to 15 for the CCHR and a score of 15 for the NOC. However, uncertainty about the clinical performance of these rules exists. To compare the clinical performance of these 2 decision rules for detecting the need for neurosurgical intervention and clinically important brain injury. In a prospective cohort study (June 2000-December 2002) that included 9 emergency departments in large Canadian community and university hospitals, the CCHR was evaluated in a convenience sample of 2707 adults who presented to the emergency department with blunt head trauma resulting in witnessed loss of consciousness, disorientation, or definite amnesia and a GCS score of 13 to 15. The CCHR and NOC were compared in a subgroup of 1822 adults with minor head injury and GCS score of 15. Neurosurgical intervention and clinically important brain injury evaluated by CT and a structured follow-up telephone interview. Among 1822 patients with GCS score of 15, 8 (0.4%) required neurosurgical intervention and 97 (5.3%) had clinically important brain injury. The NOC and the CCHR both had 100% sensitivity but the CCHR was more specific (76.3% vs 12.1%, P<.001) for predicting need for neurosurgical intervention. For clinically important brain injury, the CCHR and the NOC had similar sensitivity (100% vs 100%; 95% confidence interval [CI], 96%-100%) but the CCHR was more specific (50.6% vs 12.7%, P<.001), and would result in lower CT rates (52.1% vs 88.0%, P<.001). The kappa values for physician interpretation of the rules, CCHR vs NOC, were 0.85 vs 0.47. Physicians misinterpreted the rules as not requiring imaging for 4.0% of patients according to CCHR and 5.5% according to NOC (P = .04). Among all 2707 patients with a GCS score of 13 to 15, the CCHR had sensitivities of 100% (95% CI, 91%-100%) for 41 patients requiring neurosurgical intervention and 100% (95% CI, 98%-100%) for 231 patients with clinically important brain injury. For patients with minor head injury and GCS score of 15, the CCHR and the NOC have equivalent high sensitivities for need for neurosurgical intervention and clinically important brain injury, but the CCHR has higher specificity for important clinical outcomes than does the NOC, and its use may result in reduced imaging rates.
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            Evaluation and management of renal injuries: consensus statement of the renal trauma subcommittee.

            To determine the optimal evaluation and management of renal injuries by review of the world's English-language literature on the subject. A consensus conference convened by the World Health Organization and the Societé Internationale d'Urologie met to critically review reports of the diagnosis and treatment of renal trauma. The English-language literature about renal trauma was identified using Medline, and additional cited works not detected in the initial search obtained. Evidence-based recommendations for the diagnosis and management of renal trauma were made with reference to a five-point scale. There were many Level 3 and 4 citations, few Level 2, and one Level 1 which supported clinical practice patterns. Findings of nearly 200 reviewed citations are summarized. Published reports on renal trauma still rely heavily on expert opinion and single-institution retrospective case series. Prospective trials of the most significant issues, when possible, might improve the quality of evidence that dictates the behaviour of practitioners.
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              Consensus statement on urethral trauma.

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                Author and article information

                Journal
                Arch Acad Emerg Med
                Arch Acad Emerg Med
                AAEM
                Archives of Academic Emergency Medicine
                Shahid Beheshti University of Medical Sciences (Tehran, Iran )
                2645-4904
                2019
                9 November 2019
                : 7
                : 1
                : e63
                Affiliations
                [1 ]Urology Department, Shohada e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
                [2 ]Laser Application in Medical Science Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
                [3 ]Proteomics Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
                Author notes
                [* ]Correspondence author: Mohammadreza Razzaghi; Laser Application in Medical Science Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Tel: +98 9121482592, Fax: +98 2122712234, Email: M-razaghi@sbmu.ac.ir.
                Article
                emerg-7-e63
                6905419
                31875217
                992b1bbd-dd13-4e59-aa71-3555a79bd163

                This open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0) ( http://creativecommons.org/licenses/by/3.0/)

                History
                : July 2019
                : September 2019
                Categories
                Original Research

                urogenital system,acute kidney injury,wounds and injuries,multiple trauma,epidemiology,mortality

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