Journal of Trauma and Injury最新文献

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.

Trauma eponyms reflect historical advancements in trauma medicine across various organ systems, often honoring pioneering physicians. These terms trace the evolution of medical understanding, particularly during wartime, though some have been replaced by more precise terminology. A comprehensive literature review was performed using the PubMed database to identify trauma-related eponyms described from 1837 to 1950. Supplementary biographical sources were also consulted. Eponyms were analyzed regarding their geographic distribution, affected organ systems, and ongoing clinical relevance, emphasizing connections to advancements in imaging, surgical procedures, and trauma care. A total of 30 trauma-related eponyms were identified, predominantly originating from France and Germany, highlighting the European leadership in medical research during the 19th and early 20th centuries. The pre-World War I period (1837-1914) emphasized anatomical and pathological observations, exemplified by eponyms such as Ollivier syndrome (1837), Curling ulcer (1842), and Klumpke paralysis (1885). The World Wars and subsequent postwar era (1914-1950) prompted significant innovations in battlefield medicine and surgical techniques, resulting in eponyms such as Tinel sign (1915), Bywaters syndrome (1941), and Fegeler syndrome (1949). While some eponyms have become obsolete, others remain clinically relevant due to clearly defined pathophysiological characteristics. Developments in imaging modalities (x-rays, magnetic resonance imaging, and computed tomography) and surgical methods have reinforced the contemporary relevance of these terms. Trauma-related eponyms provide a historical framework for understanding the evolution of trauma care. Their continued use highlights their diagnostic value and the enduring influence of historical medical discoveries on contemporary clinical practice.

Terson syndrome (TS) is a condition characterized by the association of intraocular hemorrhages with an underlying intracranial bleed. Although it is widely postulated that the condition arises from raised intracranial pressure, the occurrence of papilledema is rarely reported in TS. We present a case involving a 35 year old male patient who developed TS following a head injury. Papilledema was incidentally detected and managed with measures aimed at reducing intracranial pressure. The patient subsequently experienced spontaneous resolution of both the cerebral and ocular hemorrhages, as well as resolution of the papilledema. A dilated fundus examination is strongly recommended for any patient presenting with intracranial hemorrhage (especially subarachnoid hemorrhage) to identify intraocular hemorrhages and papilledema.

Purpose: Pedestrian traffic injuries pose a significant public health issue worldwide and remain prevalent in Korea despite ongoing efforts to improve traffic safety. To inform future initiatives aimed at addressing this problem, this study compared pedestrian injuries between preschoolers (aged 4-5 years) and early school-aged children (aged 6-7 years), using national data on pedestrian injuries in these groups.

Methods: This study analyzed secondary data from the 2020 Community-Based Severe Trauma Surveillance (2016-2020). Injury-related characteristics and outcome variables were compared between the two age groups. Additionally, the distribution of pedestrian injuries was analyzed by month, day, and time.

Results: Of 413 pedestrian injuries, 173 (41.9%) occurred in preschoolers and 240 (58.1%) occurred in early school-aged children. Injuries most frequently occurred in July for preschoolers (18.5%) and in June for early school-aged children (13.3%). Preschoolers experienced more injuries on Saturdays (22.0%), whereas early school-aged children had higher injury rates on Tuesdays and Thursday both (17.9%). Peak injury times were around 5 PM for preschoolers (16.2%) with a secondary peak at 9 AM (15.6%). For early school-aged children, 5 and 6 PM were peak injury times (both 14.6%), with a secondary peak at 3 PM (14.2%). The severe injury group (Injury Severity Score, 16-75) had a significantly higher mortality rate than the mild/moderate injury group (Injury Severity Score, 1-15; odds ratio, 5.65; P=0.006). Furthermore, the mortality rate was significantly higher at local emergency centers than at regional trauma centers (odds ratio, 4.00; P=0.011).

Conclusions: Understanding the distinct characteristics of pedestrian injuries among young children can inform targeted interventions and policies, ultimately mitigating this problem and improving traffic safety for children in Korea and globally.

Talar extrusion is an extremely rare injury, with few cases described in the literature. Treatment options vary and are primarily determined by the degree of soft tissue involvement and the surgeon's experience. Good or acceptable outcomes have been reported with talar reimplantation, even in cases of open dislocations with severe contamination. However, a high complication rate has been observed, with infections and avascular necrosis of the talus representing the most frequent complications. The aim of this study is to present a case of open talar dislocation that was successfully treated. An 18-year-old male patient with an open talar extrusion and severe soft tissue damage was treated with reimplantation of the talus, yielding favorable results. Soft tissues were simultaneously reconstructed using a reverse adipofascial sural flap. The patient remained infection-free, and no signs of avascular necrosis were observed 1 year after the trauma.

Purpose: Pulmonary complications, including pneumonia and respiratory failure, continue to be major contributors to morbidity and mortality in patients with chest trauma. Although several artificial intelligence (AI) models have been developed to predict trauma mortality, there remains a lack of AI-based prediction models specifically targeting pulmonary complications in chest trauma. To address this gap, we developed and validated an explainable AI model for predicting pulmonary complications.

Methods: This retrospective analysis included 1,040 patients with blunt chest trauma who were treated at a single regional trauma center between January 2019 and March 2023. Pulmonary complications were defined as pneumonia, prolonged mechanical ventilation (>48 hours), or other major thoracic complications necessitating surgical intervention. Machine learning algorithms, including extreme gradient boosting (XGBoost), random forest, adaptive boosting (AdaBoost), light gradient boosting machine (LightGBM), and a deep neural network, were trained using hyperparameter tuning and threefold cross-validation. Model performance was evaluated by sensitivity, specificity, accuracy, balanced accuracy, F1 score, and the area under the receiver operating characteristic curve (AUC). Model interpretability was assessed using Shapley Additive Explanations (SHAP) values.

Results: Among the total cohort, 188 patients (18.1%) developed pulmonary complications. In the independent testing dataset (n=208), XGBoost achieved the highest AUC (0.856), while AdaBoost demonstrated the highest balanced accuracy (0.779). All machine learning models outperformed conventional scoring systems. SHAP analysis identified key predictors of pulmonary complications, including age, Injury Severity Score, Glasgow Coma Scale score, Abbreviated Injury Scale of the extremity or head, initial PaO2 to fraction of inspired oxygen ratio, location of the primary rib fracture, and presence of flail motion.

Conclusions: The developed AI model accurately predicts pulmonary complications in patients with chest trauma and outperforms traditional prognostic tools. The model's explainability offers actionable clinical insights, supporting early risk stratification and evidence-based decision-making in trauma care.

A 5-year-old female pediatric patient with head trauma was transferred to our regional trauma center. A depressed skull fracture measuring 45 mm in diameter and 6 mm in depth was diagnosed using a 3-dimensional (3D) computed tomography (CT) scan. Despite the absence of significant neurological symptoms, the extent of the depression necessitated surgical intervention on the third day of hospitalization. Using a 2 mm micro burr, two holes were drilled at strategically selected points of the fracture identified by 3D CT. Adson blunt dissecting hooks were inserted through the burr holes to elevate and reduce the fracture. Postoperative CT scans, including a follow-up scan on the 36th day, demonstrated stable reduction. The minimally invasive technique applied for pediatric depressed skull fracture reduction may significantly reduce pain, shorten recovery time, and decrease hospitalization duration, yielding favorable outcomes.

Purpose: The adapted Clavien-Dindo in trauma (ACDiT) scoring system modifies the original Clavien-Dindo system to grade complications in both operatively and nonoperatively managed trauma patients. This study aimed to validate the ACDiT tool as a novel outcome measure in abdominal trauma patients, correlating ACDiT scores with hospital length of stay (LOS), intensive care unit (ICU) LOS, and mortality. We also described injury patterns and identified factors associated with morbidity and mortality.

Methods: A prospective observational study was conducted over 18 months at a tertiary hospital in Western Rajasthan, India. A total of 154 patients with an Abbreviated Injury Scale (AIS) ≥2 were included, while pregnant and lactating mothers were excluded. Complications were graded using ACDiT, and outcomes such as LOS and ICU LOS were analyzed.

Results: Among 154 patients, 90.3% sustained blunt trauma and 9.7% had penetrating injuries. Significant extra-abdominal injuries (AIS >2) were noted in 46.1%. Complications occurred in 38.3% of patients, with grade II complications being the most common (20.3%). Higher ACDiT grades were significantly associated with prolonged LOS (P<0.001) and ICU LOS (P=0.001). The ACDiT scale demonstrated a strong predictive value for morbidity and mortality (adjusted R2=0.11, P<0.001).

Conclusions: The ACDiT is a reliable and objective tool for assessing complications and outcomes in abdominal trauma patients, effectively correlating with LOS and ICU LOS.