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Article ; Online: Clinical parameters for the early detection of complications in patients with blunt hepatic and/or splenic injury undergoing non-operative management.

Wongweerakit, Onchuda / Akaraborworn, Osaree / Sangthong, Burapat / Thongkhao, Komet

European journal of trauma and emergency surgery : official publication of the European Trauma Society

2024

Abstract: Background: Complications arising during non-operative management (NOM) of blunt hepatic and/or splenic trauma, particularly in cases of severe injury, are associated with significant morbidity and mortality. Abdominal computed tomography (CT) is the ... ...

Abstract	Background: Complications arising during non-operative management (NOM) of blunt hepatic and/or splenic trauma, particularly in cases of severe injury, are associated with significant morbidity and mortality. Abdominal computed tomography (CT) is the gold standard for the initial detection of complications during NOM. Although many institutions advocate routine in-hospital follow-up scans to improve success rates, others recommend a more selective approach. The use of follow-up CT remains a subject of ongoing debate, with no validated guidelines available regarding the timing, effectiveness, or intervals of follow-up imaging. Objective: We aimed to identify the clinical parameters for the early detection of complications in patients with blunt hepatic and/or splenic injury undergoing NOM. Materials and methods: This retrospective cohort study included patients with blunt hepatic and/or splenic trauma treated at Songklanagarind Hospital, a level 1 trauma center, from 2013 to 2022. We assessed all patients indicated for non-operative management and examined their clinical parameters and complications. Results: Of 542 patients with blunt hepatic and/or splenic injuries, 315 (58%) were managed non-operatively. High-grade hepatic injuries were significantly associated with complications, as determined through a multivariate logistic regression analysis after adjusting for factors such as contrast blush findings, age, sex, and injury severity score (ISS) (adjusted OR = 7.69, 95% CI 1.59-37.13; p = 0.011). Among the patients with complications (n = 27), 17 (63%) successfully underwent non-operative management. Notably, eight patients presented with clinical symptoms prior to the diagnosis of complications, while only two patients had no clinical symptoms before the diagnosis. Tachycardia, abdominal pain, decreased hematocrit levels, and fever were significant indicators of complications (p < 0.05). Conclusion: Routine CT to detect complications may not be necessary in patients with asymptomatic low-grade blunt hepatic injuries. By contrast, in those with isolated blunt hepatic injuries that are managed non-operatively, high-grade injuries, the presence of a contrast blush on initial imaging, and the patient's age may warrant consideration for routine follow-up CT scans. Clinical symptoms and laboratory observations during NOM, such as tachycardia, abdominal pain, decreased hematocrit levels, and fever, are significantly associated with complications. These symptoms necessitate further management, regardless of the initial injury severity, in patients with blunt hepatic and/or splenic injuries undergoing NOM.
Language	English
Publishing date	2024-01-31
Publishing country	Germany
Document type	Journal Article
ZDB-ID	2275480-5
ISSN	1863-9941 ; 1863-9933
ISSN (online)	1863-9941
ISSN	1863-9933
DOI	10.1007/s00068-024-02460-8
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Article: Acute portal vein thrombosis in an isolated, blunt, minor liver injury near the porta hepatis.

Wongweerakit, Onchuda / Akaraborworn, Osaree / Sangthong, Burapat / Thongkhao, Komet

Chinese journal of traumatology = Zhonghua chuang shang za zhi

2023

Abstract: 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 ... ...

Abstract	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 cm × 7 cm) 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 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.
Language	English
Publishing date	2023-09-20
Publishing country	China
Document type	Case Reports
ZDB-ID	2276839-7
ISSN	1008-1275
ISSN	1008-1275
DOI	10.1016/j.cjtee.2023.09.003
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Article: A review in emergency central venous catheterization.

Akaraborworn, Osaree

Chinese journal of traumatology = Zhonghua chuang shang za zhi

2017 Volume 20, Issue 3, Page(s) 137–140

Abstract: Central venous catheterization is widely used in the emergency setting. This review aims to assess central venous catheterization from the perspectives of types of catheters, sites of insertion, and techniques. In emergency conditions, non-tunneled ... ...

Abstract	Central venous catheterization is widely used in the emergency setting. This review aims to assess central venous catheterization from the perspectives of types of catheters, sites of insertion, and techniques. In emergency conditions, non-tunneled catheters are preferred because the technique for its insertion is not complicated and less time-consuming. The size of catheter depends on the purpose of catheterization. For example, a large bore catheter is needed for rapid infusion. The ideal catheterization site should bear fewer thromboses, lower infectious rate, and fewer mechanical complications. Thus the femoral vein should be avoided due to a high rate of colonization and thrombosis while the subclavian vein seems to exhibit fewer infectious complications compared with other sites. The ultrasound-guided technique increases the success rate of insertion while decreases the mechanical complications rate.
Language	English
Publishing date	2017-06
Publishing country	China
Document type	Journal Article ; Review
ZDB-ID	2276839-7
ISSN	1008-1275
ISSN	1008-1275
DOI	10.1016/j.cjtee.2017.03.003
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Article ; Online: A review in emergency central venous catheterization

Osaree Akaraborworn

Chinese Journal of Traumatology, Vol 20, Iss 3, Pp 137-

2017 Volume 140

Abstract	Central venous catheterization is widely used in the emergency setting. This review aims to assess central venous catheterization from the perspectives of types of catheters, sites of insertion, and techniques. In emergency conditions, non-tunneled catheters are preferred because the technique for its insertion is not complicated and less time-consuming. The size of catheter depends on the purpose of catheterization. For example, a large bore catheter is needed for rapid infusion. The ideal catheterization site should bear fewer thromboses, lower infectious rate, and fewer mechanical complications. Thus the femoral vein should be avoided due to a high rate of colonization and thrombosis while the subclavian vein seems to exhibit fewer infectious complications compared with other sites. The ultrasound-guided technique increases the success rate of insertion while decreases the mechanical complications rate.
Keywords	Central venous catheters ; Central catheterization ; Vascular access devices ; Medicine (General) ; R5-920
Language	English
Publishing date	2017-06-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Age as the Impact on Mortality Rate in Trauma Patients.

Wongweerakit, Onchuda / Akaraborworn, Osaree / Sangthong, Burapat / Thongkhao, Komet

Critical care research and practice

2022 Volume 2022, Page(s) 2860888

Abstract: Background: Globally, the fastest-growing population is that of older adults. Geriatric trauma patients pose a unique challenge to trauma teams because the aging process reduces their physiologic reserve. To date, no agreed-upon definition exists for ... ...

Abstract	Background: Globally, the fastest-growing population is that of older adults. Geriatric trauma patients pose a unique challenge to trauma teams because the aging process reduces their physiologic reserve. To date, no agreed-upon definition exists for the geriatric trauma patients, and the appropriate age cut point to consider patients at increased risk of mortality is unclear. Objectives: To determine the age cut point at which age impacts the mortality rate in trauma patients in Thailand. Materials and methods: This was a retrospective cohort and prognostic analysis study conducted in trauma patients ≥40 years. Patient data were retrieved from the trauma registry database and hospital information system in Songklanagarind Hospital. The estimated sample size of 1,509 patients was calculated based on the trauma registry data. The age with the maximum mortality rate was used as the cut point to define the elderly population. Hospital cost, intensive care unit (ICU) length of stay, gender, precomorbidity, mechanism of injury, injury severity score (ISS), and trauma and injury severity score were analyzed for any correlation with mortality, and whether or not they were associated with elderly trauma patients. Results: A total of 1,523 trauma patients ≥40 years were included in the study. The median age in both the survival and death groups was 61 years, with gender in both groups being similar ( Conclusion: Age is a significant risk factor for mortality in trauma patients. The mortality significantly increased at the age of 70 and higher.
Language	English
Publishing date	2022-10-26
Publishing country	Egypt
Document type	Journal Article
ZDB-ID	2573849-5
ISSN	2090-1313 ; 2090-1305
ISSN (online)	2090-1313
ISSN	2090-1305
DOI	10.1155/2022/2860888
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Article: Intravenous Fluid of Choice in Major Abdominal Surgery: A Systematic Review.

Noonpradej, Seechad / Akaraborworn, Osaree

Critical care research and practice

2020 Volume 2020, Page(s) 2170828

Abstract: Background: Intravenous fluid therapy plays a role in maintaining the hemodynamic status for tissue perfusion and electrolyte hemostasis during surgery. Recent trials in critically ill patients reported serious side effects of some types of fluids. ... ...

Abstract	Background: Intravenous fluid therapy plays a role in maintaining the hemodynamic status for tissue perfusion and electrolyte hemostasis during surgery. Recent trials in critically ill patients reported serious side effects of some types of fluids. Since the most suitable type of fluid is debatable, a consensus in perioperative patients has not been reached. Method: We performed a systematic review of randomized control trials (RCTs) that compared two or more types of fluids in major abdominal surgery. The outcomes were related to bleeding, hemodynamic status, length of hospital stay, and complications, such as kidney injury, electrolyte abnormality, major cardiac adverse event, nausea, vomiting, and mortality. A literature search was performed using Medline and EMBASE up to December 2019. The data were pooled to investigate the effect of fluid on macrocirculation and intravascular volume effect. Results: Forty-three RCTs were included. Eighteen fluids were compared: nine were crystalloids and nine were colloids. The results were categorized into macrocirculation and intravascular volume effect, microcirculation, anti-inflammatory parameters, vascular permeability, renal function (colloids), renal function and electrolytes (crystalloids), coagulation and bleeding, return of bowel function, and postoperative nausea vomiting (PONV). We found that no specific type of fluid led to mortality and every type of colloid was equivalent in volume expansion and did not cause kidney injury. However, hydroxyethyl starch and dextran may lead to increased bleeding. Normal saline can cause kidney injury which can lead to renal replacement therapy, and dextrose fluid can decrease PONV. Conclusion: In our opinion, it is safe to give a balanced crystalloid as the maintenance fluid and give a colloid, such as HES130/0.4, 4% gelatin, or human albumin, as a volume expander.
Language	English
Publishing date	2020-08-03
Publishing country	Egypt
Document type	Journal Article ; Review
ZDB-ID	2573849-5
ISSN	2090-1313 ; 2090-1305
ISSN (online)	2090-1313
ISSN	2090-1305
DOI	10.1155/2020/2170828
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Article ; Online: Damage control resuscitation for massive hemorrhage

Akaraborworn Osaree

Chinese Journal of Traumatology, Vol 17, Iss 2, Pp 108-

2014 Volume 111

Abstract: Hemorrhage is the second most common cause of death among trauma patients and almost half of the deaths occur within 24 hours after arrival. Damage control resuscitation is a new paradigm for patients with massive bleeding. It consists of permissive ... ...

Abstract	Hemorrhage is the second most common cause of death among trauma patients and almost half of the deaths occur within 24 hours after arrival. Damage control resuscitation is a new paradigm for patients with massive bleeding. It consists of permissive hypotension, hemostatic resuscitation and transfusion strategies, and damage control surgery. Permissive hypotension seems to have better results before the bleeding is controlled. The strategy of fluid resuscitation is minimizing crystalloid infusion and increasing early transfusion Chin J Traumatol 2014;17(2):108-111 Damage control resuscitation for massive hemorrhage with a high ratio of fresh frozen plasma to packed red cells. Damage control surgery is done when the patient’s condition is unfit for definitive surgery. Hemorrhage and contamination control with temporary abdominal closure is performed before transferring the patients to intensive care unit and the operating room for a permanent laparotomy. Key words: Shock; Hemorrhage; Resuscitation
Keywords	Medicine (General) ; R5-920
Language	English
Publishing date	2014-04-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Damage control resuscitation for massive hemorrhage.

Akaraborworn, Osaree

Chinese journal of traumatology = Zhonghua chuang shang za zhi

2014 Volume 17, Issue 2, Page(s) 108–111

Abstract	Hemorrhage is the second most common cause of death among trauma patients and almost half of the deaths occur within 24 hours after arrival. Damage control resuscitation is a new paradigm for patients with massive bleeding. It consists of permissive hypotension, hemostatic resuscitation and transfusion strategies, and damage control surgery. Permissive hypotension seems to have better results before the bleeding is controlled. The strategy of fluid resuscitation is minimizing crystalloid infusion and increasing early transfusion with a high ratio of fresh frozen plasma to packed red cells. Damage control surgery is done when the patient's condition is unfit for definitive surgery. Hemorrhage and contamination control with temporary abdominal closure is performed before transferring the patients to intensive care unit and the operating room for a permanent laparotomy.
MeSH term(s)	Blood Transfusion ; Fluid Therapy/methods ; Hemorrhage/therapy ; Humans ; Isotonic Solutions
Chemical Substances	Isotonic Solutions ; crystalloid solutions
Language	English
Publishing date	2014-04-01
Publishing country	China
Document type	Journal Article ; Review
ZDB-ID	2276839-7
ISSN	1008-1275
ISSN	1008-1275
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Article: Massive Blood Transfusion for Trauma Score to Predict Massive Blood Transfusion in Trauma.

Akaraborworn, Osaree / Siribumrungwong, Boonying / Sangthong, Burapat / Thongkhao, Komet

Critical care research and practice

2021 Volume 2021, Page(s) 3165390

Abstract: Background: Massive blood loss is the most common cause of immediate death in trauma. A massive blood transfusion (MBT) score is a prediction tool to activate blood banks to prepare blood products. The previously published scoring systems were mostly ... ...

Abstract	Background: Massive blood loss is the most common cause of immediate death in trauma. A massive blood transfusion (MBT) score is a prediction tool to activate blood banks to prepare blood products. The previously published scoring systems were mostly developed from settings that had mature prehospital systems which may lead to a failure to validate in settings with immature prehospital systems. This research aimed to develop a massive blood transfusion for trauma (MBTT) score that is able to predict MBT in settings that have immature prehospital care. Methods: This study was a retrospective cohort that collected data from trauma patients who met the trauma team activation criteria. The predicting parameters included in the analysis were retrieved from the history, physical examination, and initial laboratory results. The significant parameters from a multivariable analysis were used to develop a clinical scoring system. The discrimination was evaluated by the area under a receiver operating characteristic (AuROC) curve. The calibration was demonstrated with Hosmer-Lemeshow goodness of fit, and an internal validation was done. Results: Among 867 patients, 102 (11.8%) patients received MBT. Four factors were associated with MBT: a score of 3 for age ≥60 years; 2.5 for base excess ≤-10 mEq/L; 2 for lactate >4 mmol/L; and 1 for heart rate ≥105 /min. The AuROC was 0.85 (95% CI: 0.78-0.91). At the cut point of ≥4, the positive likelihood ratio of the score was 6.72 (95% CI: 4.7-9.6, Conclusions: The MBTT score has good discrimination to predict MBT with simple and rapidly obtainable parameters.
Language	English
Publishing date	2021-02-24
Publishing country	Egypt
Document type	Journal Article
ZDB-ID	2573849-5
ISSN	2090-1313 ; 2090-1305
ISSN (online)	2090-1313
ISSN	2090-1305
DOI	10.1155/2021/3165390
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Article: Phlegmasia Cerulea Dolens with Compartment Syndrome.

Chaochankit, Wongsakorn / Akaraborworn, Osaree

Annals of vascular diseases

2018 Volume 11, Issue 3, Page(s) 355–357

Abstract: Venous thromboembolism (VTE) is a major healthcare problem that results in significant mortality, morbidity, and expenditure of resources. It compounds with pulmonary embolism (PE) and deep vein thrombosis (DVT). Phlegmasia cerulea dolens (PCD) is an ... ...

Abstract	Venous thromboembolism (VTE) is a major healthcare problem that results in significant mortality, morbidity, and expenditure of resources. It compounds with pulmonary embolism (PE) and deep vein thrombosis (DVT). Phlegmasia cerulea dolens (PCD) is an uncommon but potentially life-threatening complication of acute DVT characterized by marked swelling of the extremities with pain and cyanosis, which in turn may lead to arterial ischemia and ultimately gangrene with high amputation and mortality rates. The key in treating such patients is to provide quick and effective treatment to save the limbs and the patient.
Language	English
Publishing date	2018-09-11
Publishing country	Japan
Document type	Journal Article
ZDB-ID	2394256-3
ISSN	1881-6428 ; 1881-641X
ISSN (online)	1881-6428
ISSN	1881-641X
DOI	10.3400/avd.cr.18-00030
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