RT Journal Article
SR Electronic
T1 Penetrating gluteal injuries in North West London: a retrospective cohort study and initial management guideline
JF Trauma Surgery & Acute Care Open
JO Trauma Surg Acute Care Open
FD BMJ Publishing Group Ltd
SP e000727
DO 10.1136/tsaco-2021-000727
VO 6
IS 1
A1 Gerard Hywel Owen McKnight
A1 Seema Yalamanchili
A1 Natalia Sanchez-Thompson
A1 Nadia Guidozzi
A1 Natasha Dunhill-Turner
A1 Alex Holborow
A1 Nicola Batrick
A1 Shehan Hettiaratchy
A1 Mansoor Khan
A1 Elika Kashef
A1 Chris Aylwin
A1 Dan Frith
YR 2021
UL http://tsaco.bmj.com/content/6/1/e000727.abstract
AB Background Penetrating gluteal injuries (PGIs) are an increasingly common presentation to major trauma centers (MTCs) in the UK and especially in London. PGIs can be associated with mortality and significant morbidity. There is a paucity of consistent guidance on how best to investigate and manage these patients.Methods A retrospective cohort study was performed by interrogating prospectively collected patient records for PGI presenting to a level 1 MTC in London between 2017 and 2019.Results There were 125 presentations with PGI, accounting for 6.86% of all penetrating injuries. Of these, 95.2% (119) were male, with a median age of 21 (IQR 18–29), and 20.80% (26) were under 18. Compared with the 3 years prior to this study, the number of PGI increased by 87%. The absolute risk (AR) of injury to a significant structure was 27.20%; the most frequently injured structure was a blood vessel (17.60%), followed by the rectum (4.80%) and the urethra (1.60%). The AR by anatomic quadrant of injury was highest in the lower inner quadrant (56%) and lowest in the upper outer quadrant (14%). CT scanning had an overall sensitivity of 50% and specificity of 92.38% in identifying rectal injury.Discussion The anatomic quadrant of injury can be helpful in stratifying risk of rectal and urethral injuries when assessing a patient in the emergency department. Given the low sensitivity in identifying rectal injury on initial CT, this data supports assesing any patients considered at high risk of rectal injury with an examination under general anesthetic with or without rigid sigmoidoscopy . The pathway has created a clear tool that optimizes investigation and treatment, minimizing the likelihood of missed injury or unnecessary use of resources. It therefore represents a potential pathway other centers receiving a similar trauma burden could consider adopting.Level of evidence 2b.