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Background: Despite increases in imaging guidelines for other body-regions during initial trauma assessment and the demonstrated utility of chest radiographs (CXR), guidelines for use of thoracic computed-tomography (TCT) are lacking. We hypothesized that TCT utilization had not decreased relative to other protocolized CTs, and mechanism and CXR could together predict significant injury independent of TCT.
Methods: We performed a retrospective review of blunt trauma patients ≤18 y.o. (2007-2015) at two level-1 trauma centers who received chest imaging. Baseline characteristics and incidences of body region-specific CT were compared. Injury mechanism, intrathoracic pathology, and interventions among other data were examined (significance: p<0.05).
Results: Although other body-region CT incidence decreased (p<0.05), TCT incidence did not change (p=0.65). Of the 2951 patients, 567 had both CXR and TCT, 933 received TCT-only, and 1451 had CXR-only. TCT altered management in 17 patients: 2 operations, 1 stent-placement, 1 medical management, 9 thoracostomy tube placements, and 4 negative diagnostic workups. All clinically significant changes were predicted by vehicle-related mechanism and abnormal CXR findings.
Conclusions: TCT utilization has not decreased over time. All meaningful interventions were predicted by CXR and mechanism of injury. We propose a rule, for prospective validation, reserving TCT for patients with abnormal CXR findings and severe vehicle-related trauma.
Level Of Evidence: Diagnostic study, Level III.
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http://dx.doi.org/10.1016/j.jpedsurg.2017.08.039 | DOI Listing |
JTO Clin Res Rep
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Institut de Cancérologie de l'Ouest, 44805 Saint-Herblain, France.
Introduction: In a phase 1 study, bintrafusp alfa was found to have an encouraging clinical activity in patients with previously treated advanced NSCLC. This study evaluated the safety and efficacy of bintrafusp alfa with chemotherapy in patients with stage IV NSCLC regardless of the programmed death-ligand 1 (PD-L1) expression status.
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Front Pharmacol
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Intraoperative frozen section (FS) examination of oncologic surgical specimens is frequently performed to ensure complete surgical resection. Data on the gross evaluation of surgical margins are limited. We recently published a study suggesting the use of a macroscopic 2.
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Department of Neurosurgery, University of Mississippi Medical Center, Jackson, Mississippi.
Background: The authors describe the case of a 35-year-old male who presented with back pain and painful masses on his upper extremities. He had a known sacral lesion identified 1 year prior at an outside facility, suspected to be coccidioidomycosis on biopsy, but the workup was not completed because the patient left against medical advice and was lost to follow-up. Computed tomography (CT) and magnetic resonance imaging revealed lytic destructive lesions involving the calvaria, thoracolumbar spine, and sacrum, concerning for an active and disseminated infection.
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