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Penetrating cardiac injury resulting in a bullet embolus: a case report. 子弹栓塞导致的穿透性心脏损伤:病例报告。
Pub Date : 2024-09-01 Epub Date: 2024-09-03 DOI: 10.20408/jti.2024.0018
Sammy Shihadeh, Anwar Khan, Kristen Walker, Ali Al-Rawi, Alfredo Cordova

Bullet embolism is a potential complication of a gunshot wound, especially with a low-velocity missile. This is because the trajectory of the low-velocity bullet can be significantly slowed as it passes through tissue. An unusual form of travel can occur in which the bullet enters the vasculature but does not have enough kinetic energy to create a through-and-through wound, leading it to remain inside the vasculature. Once inside the vasculature, the bullet could migrate to different parts of the body, potentially causing complications such as ischemia, becoming a source of thromboembolism, or functioning as a nidus for infection. The management of a bullet embolism varies from case to case, as each patient with this issue has a unique body habitus that can result in infinite possibilities of the trajectory and destination of the bullet embolus. Additional damage to surrounding vasculature or tissue can occur, as well as embolization of the bullet to critical areas of the body. Here we present the case of a 72-year-old man who had a self-inflicted gunshot wound to the chest with a low-velocity bullet, which penetrated the right atrium of the heart. It traveled into the venous vasculature through the right atrium, into the inferior vena cava, and eventually settled in the right internal iliac vein. He refused further intervention and management after initial workup and resuscitation.

子弹栓塞是枪伤的一种潜在并发症,尤其是在使用低速导弹时。这是因为低速子弹穿过组织时,弹道会明显变慢。可能会出现一种不寻常的飞行形式,即子弹进入血管,但没有足够的动能造成贯穿伤,导致子弹留在血管内。一旦进入血管,子弹就会转移到身体的不同部位,可能会引起缺血、血栓栓塞或感染等并发症。子弹栓塞的处理方法因病例而异,因为每位患者都有独特的身体习惯,这可能导致子弹栓塞的轨迹和目的地出现无限可能。周围血管或组织可能受到额外损伤,子弹也可能栓塞到身体的关键部位。我们在此介绍一名 72 岁男性的病例,他的胸部被一颗低速子弹自残,子弹穿透了心脏右心房。子弹穿过右心房进入静脉血管,进入下腔静脉,最终落在右髂内静脉。经过初步检查和抢救,他拒绝接受进一步的干预和治疗。
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引用次数: 0
Predicting 30-day mortality in severely injured elderly patients with trauma in Korea using machine learning algorithms: a retrospective study. 利用机器学习算法预测韩国重创老年患者的 30 天死亡率:一项回顾性研究。
Pub Date : 2024-09-01 Epub Date: 2024-08-08 DOI: 10.20408/jti.2024.0024
Jonghee Han, Su Young Yoon, Junepill Seok, Jin Young Lee, Jin Suk Lee, Jin Bong Ye, Younghoon Sul, Se Heon Kim, Hong Rye Kim

Purpose: The number of elderly patients with trauma is increasing; therefore, precise models are necessary to estimate the mortality risk of elderly patients with trauma for informed clinical decision-making. This study aimed to develop machine learning based predictive models that predict 30-day mortality in severely injured elderly patients with trauma and to compare the predictive performance of various machine learning models.

Methods: This study targeted patients aged ≥65 years with an Injury Severity Score of ≥15 who visited the regional trauma center at Chungbuk National University Hospital between 2016 and 2022. Four machine learning models-logistic regression, decision tree, random forest, and eXtreme Gradient Boosting (XGBoost)-were developed to predict 30-day mortality. The models' performance was compared using metrics such as area under the receiver operating characteristic curve (AUC), accuracy, precision, recall, specificity, F1 score, as well as Shapley Additive Explanations (SHAP) values and learning curves.

Results: The performance evaluation of the machine learning models for predicting mortality in severely injured elderly patients with trauma showed AUC values for logistic regression, decision tree, random forest, and XGBoost of 0.938, 0.863, 0.919, and 0.934, respectively. Among the four models, XGBoost demonstrated superior accuracy, precision, recall, specificity, and F1 score of 0.91, 0.72, 0.86, 0.92, and 0.78, respectively. Analysis of important features of XGBoost using SHAP revealed associations such as a high Glasgow Coma Scale negatively impacting mortality probability, while higher counts of transfused red blood cells were positively correlated with mortality probability. The learning curves indicated increased generalization and robustness as training examples increased.

Conclusions: We showed that machine learning models, especially XGBoost, can be used to predict 30-day mortality in severely injured elderly patients with trauma. Prognostic tools utilizing these models are helpful for physicians to evaluate the risk of mortality in elderly patients with severe trauma.

目的:老年创伤患者的数量正在不断增加;因此,有必要建立精确的模型来估计老年创伤患者的死亡风险,以便做出明智的临床决策。本研究旨在开发基于机器学习的预测模型,以预测重伤老年创伤患者的 30 天死亡率,并比较各种机器学习模型的预测性能:本研究的对象是年龄≥65 岁、受伤严重程度评分≥15 分、2016 年至 2022 年期间在忠北国立大学医院地区创伤中心就诊的患者。研究人员开发了四种机器学习模型--逻辑回归模型、决策树模型、随机森林模型和极梯度提升模型(XGBoost)--用于预测 30 天死亡率。使用接收者操作特征曲线下面积(AUC)、准确度、精确度、召回率、特异性、F1得分以及夏普利加性解释(SHAP)值和学习曲线等指标对这些模型的性能进行了比较:对机器学习模型预测重创老年患者死亡率的性能评估显示,逻辑回归、决策树、随机森林和 XGBoost 的 AUC 值分别为 0.938、0.863、0.919 和 0.934。在这四种模型中,XGBoost 的准确度、精确度、召回率、特异性和 F1 分数分别为 0.91、0.72、0.86、0.92 和 0.78,均表现优异。使用 SHAP 对 XGBoost 的重要特征进行分析后发现,格拉斯哥昏迷量表高会对死亡概率产生负面影响,而输血红细胞计数越高则与死亡概率呈正相关。学习曲线表明,随着训练实例的增加,泛化程度和稳健性也在提高:我们的研究表明,机器学习模型(尤其是 XGBoost)可用于预测严重创伤老年患者的 30 天死亡率。利用这些模型的预后工具有助于医生评估严重创伤老年患者的死亡风险。
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引用次数: 0
Spontaneous intracranial hypotension in young and middle-aged patients with chronic subdual hematoma in Korea: three case reports. 韩国慢性低度血肿中青年患者自发性颅内低血压:三份病例报告。
Pub Date : 2024-09-01 Epub Date: 2024-08-08 DOI: 10.20408/jti.2024.0008
Ae Ryoung Lee, Yun Suk Choi

This case series highlights chronic subdural hematoma in previously healthy young and middle-aged patients, where symptoms persisted despite initial surgical intervention. Subsequent diagnosis revealed spontaneous intracranial hypotension through computed tomography myelography. All patients experienced symptom relief after undergoing epidural blood patch. In conclusion, spontaneous intracranial hypotension should be considered in chronic subdural hematoma cases without trauma or underlying disease, with epidural blood patch recommended before surgical intervention if spontaneous intracranial hypotension is suspected.

本系列病例重点介绍了先前健康的中青年患者的慢性硬膜下血肿,尽管最初进行了手术干预,但症状依然存在。通过计算机断层扫描脊髓造影术,随后的诊断发现了自发性颅内低血压。所有患者在接受硬膜外血液补片治疗后症状均得到缓解。总之,在没有外伤或潜在疾病的慢性硬膜下血肿病例中,应考虑自发性颅内低血压,如果怀疑有自发性颅内低血压,建议在手术干预前进行硬膜外血补片治疗。
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引用次数: 0
The causes and numbers of hospital admissions and deaths during the Korean War. 朝鲜战争期间入院和死亡的原因和人数。
Pub Date : 2024-09-01 Epub Date: 2024-09-30 DOI: 10.20408/jti.2023.0067
Kun Hwang, Hun Kim, Chan Yong Park
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引用次数: 0
Use of helicopter emergency medical services with a physician on board in severe pediatric trauma in Korea: a case report. 在韩国严重儿科创伤中使用直升机紧急医疗服务并在机上配备一名医生:病例报告。
Pub Date : 2024-09-01 Epub Date: 2024-06-14 DOI: 10.20408/jti.2023.0080
Yoonsuk Lee, Gunwoo Kim, Pil Young Jung

In Korea, helicopter emergency medical services (HEMS) with a physician on board were introduced in September 2011, funded by both central and regional governments. HEMS was integrated into the Korean emergency medical system to address the need for EMS in remote rural areas. The present report describes 16-month-old twins who fell from the fifth floor of an apartment building, located approximately 100 km from the nearest level I trauma center. Utilizing HEMS along with initial emergency management by an emergency physician, the patients were transported to the level I trauma center within the critical "golden hour." The children had sustained multiorgan injuries. Without intervention at the scene by an emergency physician, a fatal outcome was anticipated for both children. With the use of HEMS, one patient died, but the other survived with a good prognosis. The use of HEMS flights with an emergency physician on board may improve outcomes for pediatric patients with severe trauma in medically underserved rural areas.

韩国于 2011 年 9 月引入了直升机紧急医疗服务 (HEMS),机上配有一名医生,由中央政府和地区政府共同出资。直升机紧急医疗服务被纳入韩国紧急医疗系统,以满足偏远农村地区对紧急医疗服务的需求。本报告描述了一对 16 个月大的双胞胎从一栋公寓楼的五楼坠落,该公寓楼距离最近的一级创伤中心约 100 公里。在一名急诊医生的初步急救处理下,患者在关键的 "黄金一小时 "内被送往一级创伤中心。这些儿童受到了多器官损伤。如果没有急诊医生在现场进行干预,预计两名儿童都将面临死亡。由于使用了直升机急救服务,一名患者死亡,但另一名幸存下来,预后良好。在医疗服务不足的农村地区,使用配备急诊医生的直升机急救服务可改善严重创伤儿科患者的预后。
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引用次数: 0
Renal embolization for trauma: a narrative review. 肾脏栓塞治疗创伤:叙述性综述。
Pub Date : 2024-09-01 Epub Date: 2024-09-24 DOI: 10.20408/jti.2024.0021
Peter Lee, Simon Roh

Renal injuries commonly occur in association with blunt trauma, especially in the setting of motor vehicle accidents. Contrast-enhanced computed tomography is considered the gold-standard imaging modality to assess patients for renal injuries in the setting of blunt and penetrating trauma, and to help classify injuries based on the American Association for the Surgery of Trauma injury scoring scale. The management of renal trauma has evolved in the past several decades, with a notable shift towards a more conservative, nonoperative approach. Advancements in imaging and interventional radiological techniques have enabled diagnostic angiography with angiographic catheter-directed embolization to become a viable option, making it possible to avoid surgical interventions that pose an increased risk of nephrectomy. This review describes the current management of renal trauma, with an emphasis on renal artery embolization techniques.

肾损伤通常与钝性创伤有关,尤其是在机动车事故中。对比增强计算机断层扫描被认为是评估钝性创伤和穿透性创伤患者肾脏损伤的黄金标准成像模式,并有助于根据美国创伤外科协会损伤评分标准对损伤进行分类。在过去的几十年中,肾创伤的治疗方法不断发展,并明显转向更为保守的非手术治疗方法。影像学和介入放射学技术的进步使诊断性血管造影和血管造影导管引导栓塞成为一种可行的选择,从而避免了增加肾切除风险的手术干预。这篇综述介绍了目前肾创伤的治疗方法,重点是肾动脉栓塞技术。
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引用次数: 0
Traumatic arterial thoracic outlet syndrome after multiple rib fractures not including the first rib in Korea: a case report 韩国不包括第一肋骨在内的多发性肋骨骨折后的创伤性动脉胸廓出口综合征:病例报告
Pub Date : 2024-06-05 DOI: 10.20408/jti.2023.0081
Seock Yeol Lee
Arterial thoracic outlet syndrome (TOS) resulting from thoracic trauma is an exceedingly rare condition, typically caused by a fracture of the first rib or clavicle. In this report, the author presents a case of traumatic arterial TOS precipitated by multiple left rib fractures, notably excluding the first rib, following a fall from a 2-m high stepladder. The patient was treated successfully with first rib resection via a transaxillary approach, and the postoperative course was uneventful. The literature includes no known reports of traumatic arterial TOS in patients with multiple fractures that spare the first rib, making this the first documented case of its kind. In this instance, the patient sustained fractures to the fourth and fifth ribs. The TOS was likely not a direct result of the multiple rib fractures, which were located some distance from the thoracic outlet. Rather, it is hypothesized that the trauma from these fractures caused a soft tissue injury within the thoracic outlet, which ultimately led to the development of TOS.
胸部创伤导致的动脉胸廓出口综合征(TOS)是一种极为罕见的疾病,通常由第一肋骨或锁骨骨折引起。在本报告中,作者介绍了一例外伤性动脉胸廓出口综合征病例,患者从 2 米高的阶梯上跌落,造成左侧多处肋骨骨折,尤其是第一肋骨骨折。患者通过经腋窝入路成功接受了第一根肋骨切除术,术后恢复顺利。文献中没有关于多发性骨折患者发生创伤性动脉TOS而第一肋骨未受损伤的报道,因此这是第一例有文献记载的此类病例。在这个病例中,患者的第四和第五根肋骨骨折。TOS很可能不是多发性肋骨骨折的直接结果,因为多发性肋骨骨折的位置离胸廓出口有一定距离。相反,据推测,这些骨折造成的创伤导致胸廓出口处软组织损伤,最终导致 TOS 的发生。
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引用次数: 0
Relevance of the Watson-Jones anterolateral approach in the management of Pipkin type II fracture-dislocation: a case report and literature review. Watson-Jones 前外侧入路在治疗皮普金 II 型骨折脱位中的相关性:病例报告和文献综述。
Pub Date : 2024-06-01 Epub Date: 2024-06-17 DOI: 10.20408/jti.2024.0004
Nazim Sifi, Ryad Bouguenna

Femoral head fractures with associated hip dislocations substantially impact the functional prognosis of the hip joint and present a surgical challenge. The surgeon must select a safe approach that enables osteosynthesis of the fracture while also preserving the vascularization of the femoral head. The optimal surgical approach for these injuries remains a topic of debate. A 44-year-old woman was involved in a road traffic accident, which resulted in a posterior iliac dislocation of the hip associated with a Pipkin type II fracture of the femoral head. Given the size of the detached fragment and the risk of incarceration preventing reduction, we opted against attempting external orthopedic reduction maneuvers. Instead, we chose to perform open reduction and internal fixation using the Watson-Jones anterolateral approach. This involved navigating between the retracted tensor fascia lata muscle, positioned medially, and the gluteus medius and minimus muscles, situated laterally. During radiological and clinical follow-up visits extending to postoperative month 15, the patient showed no signs of avascular necrosis of the femoral head, progression toward coxarthrosis, or heterotopic ossification. The Watson-Jones anterolateral approach is a straightforward intermuscular and internervous surgical procedure. This method provides excellent exposure of the femoral head, preserves its primary vascularization, allows for anterior dislocation, and facilitates the anatomical reduction and fixation of the fracture.

股骨头骨折伴有髋关节脱位会严重影响髋关节的功能预后,是一项外科手术挑战。外科医生必须选择一种安全的方法,既能对骨折进行骨合成,又能保留股骨头的血管。此类损伤的最佳手术方法仍是一个争论不休的话题。一名 44 岁的女性在一次道路交通事故中导致髋关节髂后脱位,并伴有股骨头皮普金 II 型骨折。考虑到脱出碎片的大小以及嵌顿阻碍复位的风险,我们决定不尝试外部矫形复位手法。相反,我们选择使用沃森-琼斯(Watson-Jones)前外侧入路进行切开复位和内固定。这需要在位于内侧的牵张筋膜肌和位于外侧的臀中肌和臀小肌之间穿梭。在术后第15个月的放射学和临床随访中,患者没有出现股骨头血管性坏死、髋关节病变或异位骨化的迹象。Watson-Jones 前外侧入路是一种直接的肌间和颈内手术方法。这种方法能很好地暴露股骨头,保留其主要血管,允许股骨头前脱位,有利于骨折的解剖复位和固定。
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引用次数: 0
Clinical predictors of therapeutic laparotomy in anterior abdominal stab injuries: a multicenter study from low-income institutions in Ethiopia. 前腹部刀刺伤进行治疗性开腹手术的临床预测因素:一项来自埃塞俄比亚低收入机构的多中心研究。
Pub Date : 2024-06-01 Epub Date: 2024-06-19 DOI: 10.20408/jti.2024.0009
Segni Kejela, Abel Hedato, Yeabsera Mekonnen Duguma, Meklit Solomon Gebremariam

Purpose: Despite the high incidence of abdominal stab injuries, the rate of nontherapeutic laparotomies and the predictors of therapeutic laparotomies have rarely been studied in low-income settings.

Methods: This multicenter retrospective study involved three of the largest academic medical centers in central Ethiopia. All patients who sustained an anterior abdominal stab injury and underwent exploratory laparotomy, regardless of the intraoperative findings, were included over the 3-year course of the study.

Results: Of the 117 patients who underwent exploratory laparotomy, 35 patients (29.9%) underwent nontherapeutic laparotomies. Three factors predicted therapeutic laparotomy: hollow viscus evisceration (adjusted odds ratio [AOR], 5.77; 95% confidence interval [CI], 1.16-28.64; P=0.032), localized and generalized peritonitis (AOR, 4.77; 95% CI, 1.90-11.93; P=0.001), and white blood cell count ≥11,500/mm3 (AOR, 2.77; 95% CI, 1.002-7.650; P=0.049). The overall positive predictive value of the therapeutic predictors was 80.2%, while the negative predictive value of all predictor-negative patients was 58.1%. The predictors would have prevented 51.4% of the nontherapeutic laparotomies.

Conclusions: Close to one-third of the patients had a nontherapeutic laparotomy. The clinical predictors of therapeutic laparotomy were shown to have a high positive predictive value despite a lower negative predictive value. Further prospective studies that involve all patients who sustain anterior abdominal stab injuries are needed to potentially improve on the negative predictive value of the predictors suggested by our study.

目的:尽管腹部刀刺伤的发生率很高,但在低收入环境中,非治疗性开腹手术的发生率和治疗性开腹手术的预测因素却很少被研究:这项多中心回顾性研究涉及埃塞俄比亚中部三个最大的学术医疗中心。这项多中心回顾性研究涉及埃塞俄比亚中部三个最大的学术医疗中心,在为期三年的研究过程中,所有腹部前部刺伤并接受探查性开腹手术的患者,无论术中结果如何,均被纳入研究范围:结果:在接受探查性开腹手术的117名患者中,有35名患者(29.9%)接受了非治疗性开腹手术。预测治疗性开腹手术的因素有三个:空腔脏器裂开(调整后的几率比 [AOR],5.77;95% 置信区间 [CI],1.16-28.64;P=0.032)、局部和全身腹膜炎(AOR,4.77;95% CI,1.90-11.93;P=0.001)和白细胞计数≥11,500/mm3(AOR,2.77;95% CI,1.002-7.650;P=0.049)。治疗预测因子的总体阳性预测值为 80.2%,而所有预测因子阴性患者的阴性预测值为 58.1%。这些预测值可避免 51.4% 的非治疗性开腹手术:结论:近三分之一的患者接受了非治疗性开腹手术。尽管阴性预测值较低,但治疗性开腹手术的临床预测值却很高。需要对所有前腹部刀刺伤患者进行进一步的前瞻性研究,以提高我们研究中提出的预测指标的阴性预测值。
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引用次数: 0
Experiencing cardiac arrest during surgical exploration in hemodynamically stable patients with multiple stab wounds, including lower extremity in Korea: a case report. 在韩国,血流动力学稳定的多处刀伤(包括下肢)患者在手术探查过程中心脏骤停:病例报告。
Pub Date : 2024-06-01 Epub Date: 2024-06-14 DOI: 10.20408/jti.2024.0025
Jung Rae Cho, Dae Sung Ma

Stab wounds, particularly those affecting multiple body regions, present considerable challenges in trauma care. This report describes a case of sustained self-inflicted stab injuries to the abdomen and thighs of a 23-year-old male patient. Although the patient's vital signs were stable and bleeding was minimal from thigh wounds without overt signs of vascular injury, the patient experienced a sudden, profound hemorrhage from the right thigh, leading to cardiac arrest. Successful resuscitation was followed by surgical repair of a right superficial femoral arterial injury accompanying a resuscitative endovascular balloon of the aorta. Subsequent lower extremity computed tomography angiography revealed no additional vascular abnormalities. The patient was discharged in stable condition on the 12th postoperative day. This case underscores the unpredictability of stab wound trajectories and the potential for hidden vascular injuries, even in the absence of immediate life-threatening signs. It also emphasizes the critical role of advanced imaging modalities, such as computed tomography angiography, in identifying concealed injuries, and the importance of strategic intraoperative techniques, including resuscitative endovascular balloon occlusion of the aorta, in achieving favorable patient outcomes.

刺伤,尤其是那些影响身体多个区域的刺伤,给创伤护理带来了相当大的挑战。本报告描述了一例 23 岁男性患者腹部和大腿持续性自伤刺伤的病例。虽然患者生命体征稳定,大腿伤口出血量极少,没有明显的血管损伤迹象,但患者右大腿突然大出血,导致心脏骤停。抢救成功后,对右侧股浅动脉损伤进行了手术修复,同时对主动脉进行了血管内球囊抢救。随后进行的下肢计算机断层扫描血管造影术未发现其他血管异常。术后第 12 天,患者病情稳定出院。本病例强调了刺伤轨迹的不可预测性以及潜在的隐性血管损伤,即使没有立即出现危及生命的体征。该病例还强调了计算机断层扫描血管造影术等先进成像模式在识别隐匿性损伤方面的关键作用,以及术中策略性技术(包括主动脉血管内球囊闭塞复苏术)在实现患者良好预后方面的重要性。
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引用次数: 0
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Journal of Trauma and Injury
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