Journal of Trauma and Injury最新文献

Polytrauma triggers a complex systemic inflammatory response, and early identification of high-risk patients is essential for guiding timely interventions and improving outcomes. Interleukin-6 (IL-6), a rapidly induced proinflammatory cytokine, has emerged as a potential biomarker for prognosis in the trauma setting. This narrative review summarizes current evidence on the prognostic role of IL-6 in polytrauma patients, addressing its biological functions, kinetics after injury, and associations with clinical outcomes such as acute respiratory distress syndrome, multiple organ dysfunction syndrome, intensive care unit admission, and mortality. IL-6 levels have been shown to correlate with injury severity scores and to predict complications more reliably than many other inflammatory markers, largely due to its early elevation and sustained presence in circulation. Furthermore, IL-6 measurement may inform surgical decision-making, particularly in selecting candidates for damage control strategies versus definitive care. Compared to other cytokines and acute-phase reactants, IL-6 demonstrates superior temporal responsiveness and prognostic accuracy in the early postinjury phase. Despite variability in measurement methods and the influence of external confounding factors, IL-6 holds significant promise as a clinical tool for early triage, risk stratification, and potentially therapeutic targeting in trauma care. Standardized protocols and larger multicenter studies are needed to facilitate broader adoption and integration of IL-6 into clinical algorithms.

Purpose: Traumatic injuries during pregnancy present significant challenges for emergency providers, necessitating rapid assessment to ensure the safety of both mother and fetus. Scoring systems that can be applied immediately upon presentation may facilitate early triage and inform disposition decisions. This study evaluated the predictive performance of the Obstetric Early Warning Score (OEWS), Injury Severity Score (ISS), and Revised Trauma Score (RTS) in determining hospitalization needs among pregnant trauma patients admitted to the emergency department (ED).

Methods: This retrospective cross-sectional study included pregnant trauma patients aged 18 years or older who were admitted to a tertiary care ED between January 2019 and December 2022. Demographic, clinical, laboratory, and trauma-related data were collected. OEWS, ISS, and RTS were calculated at admission. The primary outcome was the requirement for hospitalization. Binary logistic regression and receiver operating characteristic (ROC) curve analyses were performed to assess predictive performance.

Results: A total of 316 pregnant trauma patients were included. Hospitalization was required in 14.9% of cases. Higher OEWS (mean, 2.63 vs. 0.33; P=0.001) and ISS (mean, 18.02 vs. 5.04; P<0.001) were significantly associated with hospitalization. In multivariate analysis, OEWS (odds ratio [OR], 1.553; 95% confidence interval [CI], 1.087-2.219; P=0.016) and ISS (OR, 1.170; 95% CI, 1.083-1.264; P<0.001) were independent predictors of hospitalization. ROC analysis demonstrated that ISS had the highest predictive value (area under the curve, 0.783; 95% CI, 0.695-0.870; P<0.001).

Conclusions: Both ISS and OEWS are effective tools for predicting hospitalization needs in pregnant trauma patients. Incorporating these scoring systems into ED triage protocols may enhance early identification of high-risk patients and improve outcomes for both mothers and fetuses.

A 41-year-old man presented with discomfort in the medial arch of his foot, which worsened with weight-bearing. The condition had initially been misdiagnosed as plantar fasciitis, and he had received conservative treatment without imaging, with no relief of symptoms. Plain radiography and computed tomography later revealed a 2.5-cm radiopaque, needle-like foreign body in the superficial midfoot. Further history-taking revealed that the patient had stepped on a sewing needle during childhood, approximately 35 years earlier. The foreign body was surgically removed through an extended incision, as it was encased in granulomatous tissue and was not easily accessible via a minimally invasive approach. Histopathological examination confirmed a fibrous reaction with granuloma formation surrounding the retained metallic object. The patient remained asymptomatic postoperatively and returned to normal activity. To the author's knowledge, this is the first reported case of a sewing needle retained in the foot for over 30 years without an allergic reaction or infection. Although many foreign bodies are detected shortly after injury, this case highlights the importance of thorough history-taking and appropriate imaging, especially when symptoms mimic common conditions such as plantar fasciitis. Additionally, in long-standing cases, complete encapsulation by reactive tissue may necessitate more extensive surgical exposure for successful removal.

Isolated orbital roof fractures are rare, accounting for less than 0.2% of all facial fractures. They usually result from high-velocity impacts and are frequently associated with additional facial, ocular, and neurological trauma, necessitating a multidisciplinary team approach. In this report, we present a case of an isolated orbital roof fracture complicated by orbital compartment syndrome, severe proptosis, vision loss, corneal abrasion, subdural hemorrhage, and a dural tear. Surgical intervention was initially delayed due to logistical constraints. Ultimately, fracture reduction and orbital roof reconstruction were successfully performed using a split calvarial bone graft. Postoperatively, there was marked improvement in proptosis and visual function; however, the patient continued to experience residual visual impairment due to corneal laceration. Although less common, orbital roof fractures represent a potentially serious form of craniofacial trauma. Standardized treatment protocols remain difficult to establish, given the rarity of such injuries. Repair methods are primarily directed at separating intracranial from intraorbital contents. A coordinated interdisciplinary approach involving plastic surgery, ophthalmology, and neurosurgery is essential for comprehensive patient management.

Purpose: This study aimed to analyze changes in injury severity among child pedestrians following the implementation of the revised Road Traffic Act (the "Minsik Law") in Korea's child protection zones on March 25, 2020.

Methods: We conducted a retrospective analysis using the nationwide Emergency Department-based Injury In-depth Surveillance (EDIIS) database. The pre-amendment period (January 2018 to February 2020; n=1,480) was compared with the post-amendment period (March 2021 to December 2023; n=1,085) for pedestrian accident patients under 13 years of age, applying a 1-year washout period to mitigate the effects of the COVID-19 pandemic. The primary outcome was severe injury, defined as an Injury Severity Score (ISS) of ≥15. Multivariate logistic regression was used for the assessment.

Results: A total of 2,565 patients were included. The proportion of severe injuries (ISS ≥15) decreased from 63.1% to 53.6% after the amendment, although this trend did not reach statistical significance (P=0.085). However, after adjustment for age, sex, and other variables, multivariate analysis showed that the post-amendment period was independently associated with a significant 38.4% reduction in the odds of severe injury (adjusted odds ratio, 0.616; P<0.001). A significant shift in the distribution of injury sites was also noted (P<0.005).

Conclusions: The revision of the Road Traffic Act was significantly associated with reduced injury severity among child pedestrians in Korea. These findings provide strong evidence supporting the policy's effectiveness in improving clinical outcomes and strengthening child safety.

Purpose: Ventilator-associated pneumonia (VAP) remains a leading cause of morbidity and mortality in intensive care units (ICUs). The effectiveness of prophylactic inhaled amikacin in preventing VAP remains uncertain. This study compared VAP incidence between patients with trauma who received prophylactic inhaled amikacin and those who did not.

Methods: We conducted a retrospective, single-center analysis of 66 mechanically ventilated trauma patients admitted to the ICU between May and December 2024. Primary outcomes were infection-related ventilator-associated conditions (IVAC) and microbiologically confirmed VAP. Secondary outcomes included mechanical ventilation duration, ICU and hospital length of stay, and 30-day mortality. Statistical analyses comprised chi-square tests, multivariate logistic regression, and Cox proportional hazards regression with propensity score matching.

Results: A total of 66 patients were included: 28 in the prophylaxis group and 38 in the control group. The prophylaxis group demonstrated a higher unadjusted incidence of IVAC (85.71% vs. 55.26%, P=0.02) and VAP (82.14% vs. 44.74%, P<0.01) compared with the control group. However, after adjustment, logistic regression revealed no significant association between inhaled amikacin and increased risk of VAP (odds ratio [OR], 3.00; 95% confidence interval [CI], 0.80-12.81; P=0.11) or IVAC (OR, 3.10; 95% CI, 0.71-16.43; P=0.15). Similarly, Cox regression analysis showed no significant effect on VAP (hazard ratio [HR], 1.10; 95% CI, 0.47-2.58; P=0.82) or IVAC (HR, 1.68; 95% CI, 0.78-3.59; P=0.18). Secondary outcomes did not differ significantly between groups.

Conclusions: Prophylactic inhaled amikacin neither prevented nor increased IVAC and VAP risk in mechanically ventilated trauma patients, suggesting no meaningful impact on VAP outcomes in this population.

Purpose: Traumatic abdominal wall hernia, a rare condition resulting from blunt trauma, is characterized by disruption of the abdominal wall musculature and fascia without skin penetration. Given its rarity, standardized treatment guidelines are lacking, and the necessity for immediate surgery remains debated. This study examines high-energy posterolateral abdominal wall injuries (AWI), which pose significant management challenges due to their anatomical complexity and high recurrence risk.

Methods: We retrospectively reviewed records of 44 adults with grade III-VI AWI treated between 2013 and 2023 at a level I trauma center. Patients were categorized into emergency repair or delayed management groups based on the initial treatment strategy, with injuries anatomically classified as anterior, lateral, or posterolateral. Nonoperative management (NOM) was limited to patients without herniation on index imaging and entailed close observation with regular follow-up imaging.

Results: AWI was identified in 44 of 83,532 patients (0.05%) with blunt trauma. Anatomically, 4 cases (9.1%) were anterior, 17 (38.6%) were lateral, and 23 (52.3%) were posterolateral. Three patients (6.8%) were classified as grade III injury, 16 (36.4%) as grade IV, 24 (54.6%) as grade V, and 1 (2.3%) as grade VI. Emergency repair was performed in 26 patients (59.1%), whereas 18 (40.9%) initially received delayed management. In the latter group, 8 of 18 patients (44.4%) were judged to require delayed repair, of whom six proceeded to surgery. Among 10 NOM patients with indeterminate muscle-layer integrity on initial imaging due to hematoma or tissue injury, follow-up revealed delayed hernia development in three, while seven had resolved hematoma, confirming wall integrity.

Conclusions: In hemodynamically stable patients with traumatic posterolateral AWI without herniation, NOM with close monitoring and delayed repair for subsequent hernia appears safe and effective as an alternative to immediate surgery. Management should be tailored to injury location and patient condition. These findings inform the management timing and approach for this rare, challenging injury pattern.

Purpose: Managing hemodynamically unstable patients with pelvic fractures is highly challenging, particularly when vascular injuries are present, as these can significantly worsen prognosis. This study evaluated outcomes in patients with pelvic trauma and vascular injuries prior to the introduction of preperitoneal pelvic packing.

Methods: We retrospectively reviewed the medical records of 195 patients with pelvic injuries who presented to the emergency room of our hospital between May 2003 and August 2013.

Results: Among the 195 patients, 34 had vascular injuries and 161 had nonvascular injuries. The vascular injury group had significantly higher transfusion rates (82.4% vs. 11.8%, P<0.001) and required a greater mean number of packed red blood cell units than the nonvascular group (5.2±5.5 vs. 0.4±1.4, P<0.001). Subgroup analysis within the vascular injury cohort revealed significant differences between patients with venous phase extravasation (n=5) and those with isolated arterial phase extravasation (n=29) in median packed red blood cell units transfused (12.5 units vs. 3 units; P=0.014), cardiac arrest rate (80.0% vs. 10.3%, P=0.003), and mortality rate (60.0% vs. 10.3%, P=0.029). Notably, patients with isolated venous extravasation showed a significantly higher mortality rate compared to those with isolated arterial extravasation (100% vs. 10.3%, P=0.004).

Conclusions: Venous phase extravasation was associated with higher transfusion requirements, cardiac arrest incidence, and mortality compared to arterial extravasation.

We present the case of a 55-year-old man with an AO/OTA 43-C3 pilon fracture in whom initial uniplanar external fixation failed to relieve persistent medial skin tenting, resulting in focal ischemic necrosis. Within 72 hours, the patient developed bullae and violaceous discoloration, which progressed to full-thickness skin breakdown. Despite staged open reduction and internal fixation and fasciocutaneous flap coverage, the patient developed chronic osteomyelitis, ultimately requiring segmental bone resection to control the infection. The patient underwent serial debridement procedures and placement of antibiotic-loaded cement spacers. Definitive reconstruction was achieved with salvage tibiotalocalcaneal arthrodesis using the Expert Tibial Nail system on postoperative day 319. Twelve months after fusion and bone grafting, radiographs confirmed solid union, and the patient was ambulating independently, albeit with considerable long-term functional limitations. This case underscores the importance of early and meticulous soft tissue evaluation in high-energy pilon fractures. Prompt repositioning of fracture fragments or the use of adjunctive decompression is essential. Delayed or inadequate decompression can lead to a cascade of complications, beginning with soft tissue necrosis and progressing to deep infection and limb salvage fusion, even when standard fixation protocols are followed.

Purpose: Traumatic brain injuries (TBIs) are a leading cause of morbidity, mortality, socioeconomic loss, and diminished quality of life among survivors of all injury types. The Glasgow Coma Scale (GCS), though commonly used in the intensive care unit (ICU), has limitations that may be addressed by the Full Outline of Unresponsiveness (FOUR) score. We compared the ability of the FOUR and GCS scores to predict outcomes in patients with TBI.

Methods: This prospective observational study included all patients presenting with head injury who survived beyond 24 hours between 2020 and 2022. Basic demographic data, prehospital care details, and neurological findings were collected. TBI severity was assessed using both the GCS and FOUR scores, and outcomes were graded using the Glasgow Outcome Score (GOS).

Results: Among 225 patients (mean age, 42.4±19.7 years; male sex, 77.8%) with TBIs, the mortality rate was 4.4%, and 15.1% experienced a poor outcome (GOS ≤2). Receiver operating characteristic curve analysis showed good predictive ability for both the FOUR score (area under the curve [AUC], 0.85) and GCS (AUC, 0.88). FOUR score ≤12 and GCS ≤10 were identified as optimal cutoff values for predicting poor outcomes (P<0.001), with the FOUR score demonstrating sensitivity and specificity of 79.4% and 77.5%, respectively. A FOUR score ≤12 at admission was significantly associated with intubation (odds ratio [OR], 8.2; 95% confidence interval [CI], 4.6-14.4; P<0.001), tracheostomy (OR, 21.8; 95% CI. 6.9-68.8; P<0.001), and neurological complications, including mental function deficits (OR, 7.5; 95% CI, 3.2-17.7; P<0.001), cranial nerve palsy (OR, 4.1; 95% CI, 1.6-10.4; P=0.002), and motor deficits (OR, 9.4; 95% CI, 4.6-19.2; P<0.001). A strong correlation was observed between the FOUR score and GOS (r=0.7).

Conclusions: The FOUR score is a reliable tool for assessing TBI severity and predicting outcomes, with performance comparable to the GCS. An admission FOUR score ≤12 was associated with poor neurological outcomes, increased need for advanced airway management, and long-term disability. By capturing additional neurological parameters beyond the GCS, the FOUR score may offer clinical advantages in ICU settings for early prognostication and management of patients with TBI.