Browsing by Author "Wongwaisayawan S."

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    Abbreviated injury scale-guided assessment of traumatic deaths: postmortem CT versus autopsy
    (2025-06-01) Likkachai K.; Wongwaisayawan S.; Siriwes K.; Worasuwannarak W.; Likkachai K.; Mahidol University
    Objective: This study aimed to evaluate the diagnostic agreement between postmortem computed tomography (PMCT) and conventional autopsy in assessing injury severity and determining the cause of death using the Abbreviated Injury Scale (AIS). Materials and methods: A retrospective analysis was conducted on 65 trauma-related fatalities that underwent both PMCT and autopsy. Injuries were classified by anatomical region and scored using AIS. Severity was categorized as minor (AIS 0–3) or major (AIS 4–6). The cause of death was determined based on either expert opinion or the highest AIS score per region. Agreement between PMCT and autopsy was analyzed using kappa statistics, correlation coefficients, and chi-square tests. Results: Moderate agreement in AIS scoring was observed across most anatomical regions (36 %–52 %). Agreement improved substantially when classifying injuries as minor or major (78 %–86 %). The overall concordance for determining the cause of death was 33.85 % using expert opinion (κ = 0.23) and 55.38 % using AIS scoring (κ = 0.41). PMCT showed high sensitivity in detecting skeletal injuries but was limited in identifying soft tissue damage and vascular lesions, particularly in the abdomen and external surface regions. Conclusion: PMCT demonstrates substantial agreement with autopsy in classifying injury severity, especially when guided by AIS scoring. While PMCT alone may not replace autopsy in all cases, its utility is enhanced through standardized injury scoring. PMCT may serve as a reliable adjunct or alternative in select forensic contexts, particularly where autopsy is declined or unavailable.
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    Appendiceal wall thickness and Alvarado score are predictive of acute appendicitis in the patients with equivocal computed tomography findings
    (2023-12-01) Krisem M.; Jenjitranant P.; Thampongsa T.; Wongwaisayawan S.; Mahidol University
    Around 8–13% of the patients who underwent CT scan for diagnosis of appendicitis had equivocal CT results. About one-third of these patients had acute appendicitis and this caused diagnostic challenge to the clinicians. This study was conducted to identify clinical and imaging features that were predictive of acute appendicitis in patients who had equivocal CT findings. During January 2015 to June 2021, we retrospectively included 103 consecutive CT scans of adult patients (22 men and 81 women; mean age, 39.1 ± 17.5 years) who had equivocal CT findings of acute appendicitis. Two readers, blinded to the clinical data, independently assessed CT images for the relevant CT findings of appendicitis. Any disagreement between the readers was solved by consensus. The clinical parameters and CT findings were analyzed and compared between the patients who had appendicitis and patients who did not have appendicitis. Thirty-one (30.1%) patients had appendicitis, all of which were non-complicated. The appendiceal wall thickness of ≥ 2 mm and the Alvarado score of ≥ 7 were independent predictors of appendicitis with adjusted odds ratios (ORs) of 2.76 (95% CI, 1.09–7.02) and 1.47 (95% CI, 1.12–1.94), respectively. The maximal appendiceal diameter was higher in the appendicitis group (7.2 ± 1.2 mm vs. 6.5 ± 1.0 mm), but not predictive of appendicitis. The rest of the clinical parameters and CT findings, including mucosal hyperenhancement, periappendiceal fat reticulation, thickening of peritoneal reflection, appendicolith, focal cecal thickening, and content in appendiceal lumen showed no significant difference between two groups. The appendiceal wall thickness and the Alvarado score were able to predict appendicitis in patients who had equivocal CT findings.
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    Clinical Associated Factors of Tile B/C Type of Pelvic Ring Fractures; a Retrospective Cross-sectional study
    (2024-01-01) Tienpratarn W.; Nakpipat N.; Yuksen C.; Wongwaisayawan S.; Phootothum Y.; Jaiboon S.; Tienpratarn W.; Mahidol University
    Introduction: Pelvic ring fractures categorized under Tile Categories B and C denote partially and fully unstable fractures, respectively. This study aimed to identify the clinically associated factors of Tile B/C pelvic ring fractures. Methods: This retrospective cross-sectional study reviewed medical records from the Emergency Medicine department at Ramathibodi Hospital in Bangkok, Thailand. The study included individuals aged ≥ 15 who experienced accidents from 2012 to 2021. To investigate the associations between the clinical variables and three critical outcomes, including Tile B/C pelvic ring fractures, major vascular injuries, and the necessity for surgical or radiological interventions, multivariable logistic regression analysis was employed. Results: A total of 198 patients were included in the study, among whom 34.8% were diagnosed with Tile B/C pelvic ring fractures. The analysis revealed several significant predictors of Tile B/C fractures, including the presence of pelvic tenderness (adjusted odds ratio [aOR] = 15.25, 95% confidence interval [CI] = 5.86–39.66, p < 0.001), and a shock index (SI) ≥1 (aOR = 4.2, 95% CI = 1.24–14.22, p = 0.021). Moreover, Tile B/C pelvic ring fractures were associated with an increased incidence of major vascular events and the imperative requirement for surgical or radiological interventions. Conclusions: Clinical findings of pelvic tenderness and an SI ≥1 are strong predictive clinical factors associated with Tile B/C pelvic fractures. Early diagnosis, application of an pelvic binder, provision of initial resuscitation, and prompt transportation to a definitive care facility are crucial components of management.
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    Diagnosis and emergency surgical management of stercoral colitis-induced colonic ischemia: A case report and literature review
    (2023-10-01) Wongwaisayawan S.; Krutsri C.; Koosaksathaporn A.; Choikrua P.; Mahidol University
    Introduction and importance: Stercoral colitis is an urgent complication of fecal impaction that requires aggressive management. The rare complicated with bowel ischemia requires a high index of suspicion for early diagnosis. This case report describes the detection and management of this rare and fatal complication of stercoral colitis. Case presentation: An 80-year-old man presented after 3 days of obstipation. Abdominal plain radiography revealed several air-fluid levels in the colon with centralized small bowel gas. Computed tomography revealed fecal impaction and stercoral colitis without evidence of bowel ischemia. Clinical discussion: Fecal impaction and stercoral colitis without evidence of bowel ischemia was suspected. Owing to the development of refractory septic shock, we performed damage control surgery. Definitive surgery with end ileostomy was follow by 48 h later. The patient was discharged home safely. Conclusion: Stercoral colitis-induced ischemia is rare but potentially fatal; ischemia should be highly suspected. CT can help diagnosed of stercoral colitis but no single parameters for diagnosed of bowel ischemia. Prompt resuscitation and surgical exploration with damage control surgery are recommended.
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    Domain validation of the CRASH prognostic model for predicting 14-day mortality among patients and traumatic brain injury and intracranial hemorrhage in a Thai emergency department
    (2025-12-01) Tienpratarn W.; Phinyo P.; Yuksen C.; Wongwaisayawan S.; Khorana J.; Patumanond J.; Tienpratarn W.; Mahidol University
    Background: Traumatic brain injury (TBI) is a significant health concern, with intracranial haemorrhage (ICH) being a common complication following injury. The CRASH prediction model plays a crucial role in clinical prognostication and decision-making within this patient group. However, external validation is critical to ensure the model’s validity and applicability across different populations and settings beyond those in which it was originally developed. This study aimed to validate the CRASH prediction model for 14-day mortality among TBI patients with ICH presenting to a Thai emergency department. Methods: This retrospective study included adult TBI patients with ICH who visited the emergency department (ED) at Ramathibodi Hospital, Thailand, between 2020 and 2022. The Basic model, which incorporates age, Glasgow Coma Scale (GCS) score (3–15), pupillary reaction, and major extracranial injury, and the CT model, which extends the Basic model by including CT findings, were evaluated for their discriminative ability and calibration. Results: A total of 232 patients were included in the validation dataset. Significant differences in clinical characteristics were observed between the datasets, including older age, predominance of mild TBI, subarachnoid hemorrhage, and non-evacuated hematoma in the validation dataset. The observed 14-day mortality rate in this cohort was 9.1%, compared to 20.7% in the development dataset. The area under the receiver operating characteristics curve (AuROC) was 0.92 (95% CI: 0.84, 1.00) for the Basic model and 0.93 (95% CI: 0.86, 1.00) for the CT model. However, the calibration for both models was fair. Recalibration achieved better predictive accuracy and reduced overestimation in high-risk groups. Conclusion: The original CRASH prediction model demonstrates strong discriminative ability for predicting 14-day mortality in TBI patients; however, significant miscalibration was observed. Recalibration was therefore undertaken to improve the model’s generalisability to local populations. Nonetheless, further studies are warranted to confirm the consistency and applicability of the recalibrated models.
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    Radiologic Imaging of Traumatic Bowel and Mesenteric Injuries: A Comprehensive Up-to-Date Review
    (2023-05-01) Kaewlai R.; Chatpuwaphat J.; Maitriwong W.; Wongwaisayawan S.; Shin C.I.; Lee C.W.; Mahidol University
    Diagnosing bowel and mesenteric trauma poses a significant challenge to radiologists. Although these injuries are relatively rare, immediate laparotomy may be indicated when they occur. Delayed diagnosis and treatment are associated with increased morbidity and mortality; therefore, timely and accurate management is essential. Additionally, employing strategies to differentiate between major injuries requiring surgical intervention and minor injuries considered manageable via non-operative management is important. Bowel and mesenteric injuries are among the most frequently overlooked injuries on trauma abdominal computed tomography (CT), with up to 40% of confirmed surgical bowel and mesenteric injuries not reported prior to operative treatment. This high percentage of falsely negative preoperative diagnoses may be due to several factors, including the relative rarity of these injuries, subtle and non-specific appearances on CT, and limited awareness of the injuries among radiologists. To improve the awareness and diagnosis of bowel and mesenteric injuries, this article provides an overview of the injuries most often encountered, imaging evaluation, CT appearances, and diagnostic pearls and pitfalls. Enhanced diagnostic imaging awareness will improve the preoperative diagnostic yield, which will save time, money, and lives.
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    Usefulness and outcome of whole-body computed tomography (pan-scan) in trauma patients: A prospective study
    (2022-04-01) Harntaweesup S.; Krutsri C.; Sumritpradit P.; Singhatas P.; Thampongsa T.; Jenjitranant P.; Wongwaisayawan S.; Saksobhavivat N.; Kaewlai R.; Mahidol University
    Background: Severe trauma can cause multi-organ injuries, and the mortality rate may increase if significant organ injuries are missed. This study was performed to determine whether whole-body computed tomography scan (pan-scan) can detect significant injury and leads to proper management, including alteration the priority of management. Methods: This prospective study was conducted from January 2019 to March 2021 and involved trauma patients level 1, level 2, and dangerous mechanism of trauma. Additionally, the data of trauma patients who had selective computed tomography scan were retrospectively reviewed to compared the clinical benefits. Results: Twenty-two patients were enrolled in the prospective study. The pan-scan detected significant organ injury in 86% of the patients. Prioritization of organ injury management changed after performance of the pan-scan in 64% (major change in 64.29% and minor change in 35.71%). Skull base fracture, small bowel injury, retroperitoneal injury, kidney and bladder injury, and occult pneumothorax were the majority of injuries which was not consider before underwent pan-scan (p < 0.05). The door-to-scan time tended to be shorter in the pan-scan group than in the selective scan group without a significant difference [mean (SD), 59.5 (34) and 72.0 (86) min, respectively; p = 0.13]. Pan-scan contribute 100% confidence for trauma surgeon in diagnosis of specific organ injuries in severe injured patients. Conclusions: The pan-scan facilitates timely detection of significant unexpected organ injuries such as the skull base, occult pneumothorax, small bowel, and retroperitoneum. It also helps to prioritize management and increases the diagnostic confidence of trauma surgeons, leading to better outcomes without delay.