Journal of Trauma and Injury最新文献

A 47-year-old male patient who had self-inserted a rectal foreign body for anal autoerotic purposes was admitted to the emergency department. Thirty minutes after admission, he developed chest pain and profuse sweating. Electrocardiography revealed an acute inferior myocardial infarction. Initially, the patient underwent coronary angiography, and percutaneous transluminal angioplasty was performed for a 100% occlusion of the right coronary artery. Subsequently, under general anesthesia, the foreign body was removed via rectal examination in the lithotomy position. This rare clinical scenario, which has not been previously reported in the literature, highlights the potential for psychological trauma and local rectal injury to act as triggers for myocardial infarction. Respecting patient confidentiality, maintaining a nonjudgmental approach, and implementing a multidisciplinary strategy are critically important for the effective management of such uncommon cases.

Arterial-vesical injuries are rare entities, often presenting with bladder distension, bright red hematuria, and clot retention. The few cases reported in the literature typically occur following traumatic injuries to the groin or pelvis. We present a case of an arterial and vesical injury with decompression through the bladder. Our patient was a 21-year-old man who presented to a level I trauma center as a high-level activation trauma case following a single gunshot wound to the left lateral thigh. Upon arrival, the patient's systolic blood pressure was 80/50 mmHg. A pelvic x-ray revealed ballistic fragments in the pelvis. Physical examination showed a 1+ palpable left dorsalis pedis pulse. He underwent a formal trauma laparotomy, which did not identify any acute injuries. Concurrently, his Foley catheter exhibited bloody output with bladder distension. Following continuous bladder irrigation, he had profuse sanguineous output. Angiography revealed a complete disruption of the profunda femoris artery. An open exploration of the femoral canal was performed to achieve proximal control of the common femoral artery. We identified a 3-cm longitudinal injury to the profunda femoris artery and an obliterated femoral vein, both of which were ligated, resulting in decreased bladder exsanguination and hemodynamic stabilization. Consistent with the limited published cases of arterial-vesical fistula, our patient presented after a traumatic groin injury. Maintaining a high index of suspicion for communication between the thigh and extraperitoneal space due to projectile trajectory remains crucial to successfully managing these challenging injuries.

Severe hemorrhagic shock is a leading cause of death among potentially salvageable casualties. We report the case of a 24-year-old man who sustained a gunshot wound to the right hemithorax and presented with class IV hemorrhagic shock. He underwent resuscitative damage control via a right posterolateral thoracotomy. Intraoperatively, the bleeding source was identified as a lacerated posterior intercostal artery at the level of the 11th dorsal vertebra. Because access to the bleeding site remained limited even after extending the incision, right thoracic packing was performed to control the hemorrhage. On reevaluation 48 hours later, no active bleeding was observed.

Orbital trauma can result in significant complications, particularly when accompanied by foreign body entrapment. Wooden foreign bodies are rare but carry a high risk of infection and chronic inflammation. In these cases, immediate surgical intervention is critical for restoring orbital anatomy and preventing complications. A 16-year-old male patient presented with a 2-month history of persistent pus discharge from his right cheek following facial trauma sustained from a fall. Initial management involved drainage of the abscess; however, the condition persisted. On examination, the patient exhibited infraorbital nerve paresthesia and an orbital floor fracture, and his history was notable for prior foreign body retrieval involving wooden fragments. Computed tomography revealed retained foreign bodies and discontinuity of the orbital floor. Surgical management included foreign body retrieval, the Caldwell-Luc procedure, and orbital floor reconstruction with mesh and platelet-rich fibrin placement. The patient's symptoms progressively improved over 6 months, with a reduction in paresthesia and no ocular or intracranial complications despite the delayed presentation. This case highlights the challenges of diagnosing and managing penetrating wooden foreign bodies in orbital trauma. It underscores the importance of prompt surgical intervention and interdisciplinary care to prevent potentially critical complications.

This case report describes a unique instance of refractory paroxysmal sympathetic hyperactivity (PSH) in a 19-year-old woman following a traumatic brain injury sustained in a motorcycle accident. The patient presented in a semicomatose state with a Glasgow Coma Scale score of 3 (E1, VT, M2), a significant left frontotemporal subdural hematoma, and a midline shift that necessitated emergency craniectomy and hematoma evacuation. Postoperatively, she developed recurrent episodes of hyperthermia, tachycardia, hypertension, tachypnea, diaphoresis, rigidity, and eyeball deviation triggered by non-noxious stimuli. These episodes proved resistant to conventional treatments, including opioids, sedatives, and β-blockers. Based on the clinical presentation and a Paroxysmal Sympathetic Hyperactivity-Assessment Measure score of 28 (out of 29), a diagnosis of PSH was established. Bromocriptine was initiated at 0.025 mg/kg every 12 hours and later increased to every 8 hours, leading to a significant reduction in both the frequency and severity of episodes within days. Complete resolution of PSH episodes was observed by the sixth day of bromocriptine treatment, with no recurrence during the remaining treatment period. Bromocriptine was administered for a total of 1 month before being discontinued, and the patient remained symptom-free over a 10-month follow-up period. This case highlights the efficacy of bromocriptine in managing refractory PSH and underscores the importance of early recognition and targeted intervention for this rare but debilitating condition. Bromocriptine may offer a valuable therapeutic option for similar cases, particularly when conventional therapies fail.

Purpose: Previous studies have shown that early rehabilitation is associated with better long-term outcomes in patients with traumatic spinal cord injury. However, data are still limited regarding which factors are associated with discharge to a rehabilitation facility. This study aims to expand on prior research by identifying factors associated with disposition and by introducing a prediction model for these factors.

Methods: The National Trauma Data Bank was queried for patients aged 18 years or older who presented to US trauma centers from 2019 to 2021 with traumatic spinal cord injury. Multivariate logistic regression models were used to determine which patient, injury, and hospital variables were significant factors for disposition to a rehabilitation facility, compared to home and intermediate care facilities. Prediction modeling was then performed using these factors.

Results: Overall, 14,597 patients were identified, of whom 6,220 were discharged to a rehabilitation facility, 2,647 to an intermediate care facility, and 5,730 to home. Significant factors associated with discharge to a rehabilitation facility compared to home included age, injury location and severity, insurance type, estimated length of stay, systolic blood pressure at admission, and admission blood alcohol level and drug screen results. Similarly, when comparing discharge to a rehabilitation facility with discharge to an intermediate care facility, sex, age, race, estimated length of stay, systolic blood pressure at admission, drug screen results, and coexisting substance use and metabolic conditions all significantly influenced disposition. Fine tree binary classification achieved a prediction accuracy of 72.5% when comparing discharge to a rehabilitation facility and home, and a prediction accuracy of 70.0% when comparing discharge to a rehabilitation facility and an intermediate care facility.

Conclusions: This study demonstrates significant factors associated with discharge to a rehabilitation facility in patients with traumatic spinal cord injury. Further studies are needed to improve prediction accuracy.

Blunt cardiac injury is a rare but serious complication of thoracic trauma. We present the case of a 22-year-old male pedestrian involved in a road traffic accident (pedestrian vs. four‑wheeler) who was found to have ST‑segment elevation on electrocardiography during trauma evaluation. Despite being hemodynamically stable and lacking clinical signs or symptoms of cardiac injury, his electrocardiography showed ST elevations in the inferior leads. This case underscores the importance of vigilant cardiac monitoring in polytrauma patients, in whom blunt cardiac injury may be easily overlooked.

Purpose: Base deficit (BD) and age shock index have been utilized as an indicator of resuscitation adequacy and a predictor of poor outcomes in trauma cases, respectively. However, evidence regarding their correlation with in-hospital mortality among geriatric major trauma patients remains scarce in the literature.

Methods: This analytical observational study employed a retrospective cohort design involving 82 geriatric major trauma patients treated at our institution between November 2023 and November 2024. Data were collected from patients' medical records at admission (age, trauma mechanism, vital signs, Glasgow Coma Scale [GCS], Injury Severity Score, hemoglobin, BD, and comorbidities) and at discharge (survival or death).

Results: The geriatric major trauma patients who experienced in-hospital mortality were predominantly male, with an average age of 69.6 years. Traffic accidents constituted the most common trauma mechanism. Most patients presented with a GCS score between 13 and 15, and hypertension was the most frequently recorded comorbidity. BD demonstrated a significant correlation with in-hospital mortality (P<0.05). Severe BD was associated with the highest odds of in-hospital mortality (adjusted odds ratio, 40.72; 95% confidence interval, 2.90-560.86). Although age shock index did not directly correlate with mortality, it played a confounding role. Additionally, a GCS score of <9 was significantly correlated with in-hospital mortality (P<0.05).

Conclusions: The findings of this study can inform initial clinical management strategies for geriatric major trauma patients at trauma centers. Prompt resuscitation and treatment should be prioritized for patients presenting with moderate or severe BD to reduce preventable mortality in this population.

Purpose: Traumatic brain injury (TBI) represents a significant public health concern due to its high incidence, substantial prevalence of chronic neuropsychiatric sequelae, disabilities, and economic burdens. Although several primary studies have examined mortality rates among individuals with TBI in Ethiopia, no systematic reviews and meta-analyses have yet synthesized these findings to provide a comprehensive nationwide estimate.

Methods: A systematic search for Ethiopian TBI mortality studies was conducted using PubMed, MEDLINE, Hinari, ScienceDirect, Ovid, the Web of Science, the Directory of Open Access Journals, and the African Journals Online. Following the PRISMA guidelines, we screened eligible studies, assessed quality with the Joanna Briggs Institute tool, and analyzed data in Stata ver. 18. A random-effects model estimated TBI mortality and the pooled odds ratios (PORs) of predictors. Heterogeneity (I2) was assessed, and subgroup analyses, meta-regression, forest plots, and funnel plots with Egger and Begg tests addressed variability and publication bias.

Results: Of 100 records, 23 studies (n=7,866) met inclusion. The pooled incidence of mortality from TBI in Ethiopia was 15.69% (95% confidence interval [CI], 12.41-18.96). Regional incidence varied from 3.15% (95% CI, 1.23-5.08) in the Sidama Region to 39.42% (95% CI, 33.25-45.59) in the Amhara Region. Identified predictors of mortality included aspiration pneumonia (POR, 10.41; 95% CI, 3.25-33.40), penetrating injury (POR, 1.76; 95% CI, 1.07-2.90), road traffic accident injuries (POR, 1.71; 95% CI, 1.11-2.64), severe Glasgow Coma Scale (GCS) scores (POR, 18.94; 95% CI, 7.37-48.7), moderate GCS scores (POR, 2.95; 95% CI, 1.60-5.44), bilateral pupillary reaction (POR, 24.56; 95% CI, 7.72-78.19), unilateral pupillary reaction (POR, 7.75; 95% CI, 4.45-13.48), hypoxia (POR, 8.22; 95% CI, 2.42-27.98), concomitant injuries (POR, 2.15; 95% CI, 1.05-4.38), complications (POR, 4.76; 95% CI, 2.49-9.09), surgical management (POR, 0.58; 95% CI, 0.36-0.94), and mechanical ventilation (POR, 4.45; 95% CI, 2.00-9.88).

Conclusions: The high TBI mortality in Ethiopia underscores the urgent need to expand advanced trauma care centers, deploy trained personnel beyond urban areas, and strengthen road safety policies to achieve Sustainable Development Goal targets by 2030.