{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T17:08:27Z","timestamp":1777136907353,"version":"3.51.4"},"reference-count":11,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2023,6,26]],"date-time":"2023-06-26T00:00:00Z","timestamp":1687737600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,6,26]],"date-time":"2023-06-26T00:00:00Z","timestamp":1687737600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100006034","name":"University of Southern California","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100006034","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Trauma Emerg Surg"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Aim<\/jats:title>\n                <jats:p>The aim of this study is to evaluate utility and reliability of chest CT as a standalone screening modality for stable patients with thoracic GSWs and potential transmediastinal trajectories.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>All patients with thoracic GSWs over a 5-year period were identified. Unstable patients requiring immediate surgery were excluded and the remaining underwent chest CT with intravenous contrast. Sensitivity and specificity for clinically significant injuries were tested against an aggregate gold standard of discharge diagnosis including imaging, operative and clinical findings.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>A total of 216 patients met inclusion criteria and underwent chest CT. After imaging, 65 (30.1%) had indication for immediate surgery, of which 10 (4.6%) underwent a thoracic procedure for chest injuries while 151 (69.9%) were selected for nonoperative management (NOM). 11 (5.1%) required a delayed thoracic operation, none due to injuries missed on CT. The remaining 140 (64.8%) underwent successful NOM. Up to 195 (90.3%) patients had successful NOM of thoracic injuries. Only 9.2% required additional imaging, all negative. CT identified a cardiac injury in one case and a vascular injury in two cases, all confirmed by surgery, while one thoracic IVC injury missed on CT was found intraoperatively. 2 patients had CT suspicious for esophageal injury, ruled out by following investigations. There was one death in the total cohort, none in the NOM group.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Modern high-quality CT provides highly accurate and reliable screening modality for penetrating chest and mediastinal injuries and can be used as a standalone study in most patients or to guide further tests. Chest CT facilitated successful NOM.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00068-023-02315-8","type":"journal-article","created":{"date-parts":[[2023,6,26]],"date-time":"2023-06-26T08:07:50Z","timestamp":1687766870000},"page":"2439-2445","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Dangerous passage: the utility and accuracy of modern chest computed tomography in penetrating thoracic injuries with potential transmediastinal trajectory"],"prefix":"10.1007","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1153-123X","authenticated-orcid":false,"given":"Marco","family":"Sozzi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5191-596X","authenticated-orcid":false,"given":"Kenji","family":"Inaba","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5743-596X","authenticated-orcid":false,"given":"Morgan A.","family":"Schellenberg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9625-5363","authenticated-orcid":false,"given":"Kazuhide","family":"Matsushima","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9169-9069","authenticated-orcid":false,"given":"Matthew J.","family":"Martin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2023,6,26]]},"reference":[{"issue":"1","key":"2315_CR1","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1067\/msy.2000.106463","volume":"128","author":"E Degiannis","year":"2000","unstructured":"Degiannis E, Benn CA, Leandros E, Goosen J, Boffard K, Saadia R. Transmediastinal gunshot injuries. Surgery. 2000;128(1):54\u20138. https:\/\/doi.org\/10.1067\/msy.2000.106463.","journal-title":"Surgery"},{"issue":"9","key":"2315_CR2","doi-asserted-by":"publisher","first-page":"949","DOI":"10.1001\/archsurg.1996.01430210047009","volume":"131","author":"EE Cornwell 3rd","year":"1996","unstructured":"Cornwell EE 3rd, Kennedy F, Ayad IA, Berne TV, Velmahos G, Asensio J, Demetriades D. Transmediastinal gunshot wounds. A reconsideration of the role of aortography. Arch Surg. 1996;131(9):949\u201352. https:\/\/doi.org\/10.1001\/archsurg.1996.01430210047009. (discussion 952-3).","journal-title":"Arch Surg"},{"issue":"3","key":"2315_CR3","doi-asserted-by":"publisher","first-page":"416","DOI":"10.1097\/00005373-200003000-00008","volume":"48","author":"BM Renz","year":"2000","unstructured":"Renz BM, Cava RA, Feliciano DV, Rozycki GS. Transmediastinal gunshot wounds: a prospective study. J Trauma. 2000;48(3):416\u201321. https:\/\/doi.org\/10.1097\/00005373-200003000-00008.","journal-title":"J Trauma"},{"issue":"2","key":"2315_CR4","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1016\/j.athoracsur.2006.05.107","volume":"83","author":"JH Burack","year":"2007","unstructured":"Burack JH, Kandil E, Sawas A, O\u2019Neill PA, Sclafani SJ, Lowery RC, Zenilman ME. Triage and outcome of patients with mediastinal penetrating trauma. Ann Thorac Surg. 2007;83(2):377\u201382. https:\/\/doi.org\/10.1016\/j.athoracsur.2006.05.107. (discussion 382).","journal-title":"Ann Thorac Surg"},{"issue":"9","key":"2315_CR5","doi-asserted-by":"publisher","first-page":"1198","DOI":"10.1016\/j.injury.2012.12.014","volume":"44","author":"OT Okoye","year":"2013","unstructured":"Okoye OT, Talving P, Teixeira PG, Chervonski M, Smith JA, Inaba K, Noguchi TT, Demetriades D. Transmediastinal gunshot wounds in a mature trauma centre: changing perspectives. Injury. 2013;44(9):1198\u2013203. https:\/\/doi.org\/10.1016\/j.injury.2012.12.014.","journal-title":"Injury"},{"issue":"1","key":"2315_CR6","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1177\/145749690209100107","volume":"91","author":"D Demetrios","year":"2002","unstructured":"Demetrios D, Velmahos GC. Penetrating injuries of the chest: indication for operation. Scand J Surg. 2002;91(1):41\u20135. https:\/\/doi.org\/10.1177\/145749690209100107.","journal-title":"Scand J Surg"},{"issue":"10","key":"2315_CR7","doi-asserted-by":"publisher","first-page":"1247","DOI":"10.1007\/s00268-002-6522-2","volume":"26","author":"KK Nagy","year":"2002","unstructured":"Nagy KK, Roberts RR, Smith RF, Joseph KT, An GC, Bokhari F, Barrett J. Trans-mediastinal gunshot wounds: are \u201cstable\u201d patients really stable? 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We consulted extensively with the IRB of University of Southern California (USC) who determined that our study did not need ethical approval. An IRB official waiver of ethical approval was granted from the IRB of USC (HS-22-00241).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}