Journal of Trauma and Injury最新文献

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.

Purpose: Blunt abdominal trauma is a significant cause of morbidity and mortality, predominantly affecting younger male patients. Therefore, a study examining the mechanisms of injury, injury patterns, and outcomes in these cases is essential. The aim of this study was to evaluate demographics, injury mechanisms, treatments provided, and outcomes in cases of blunt abdominal trauma at a level I trauma center in Eastern India.

Methods: A descriptive retrospective study was conducted at a level I trauma center using departmental audit data spanning 18 months (July 2022-December 2023). Data from 118 patients diagnosed with blunt abdominal trauma were analyzed.

Results: The study revealed a pronounced male predominance (6.35:1), with a mean age of 30.2 years. Road traffic accidents were the most frequent cause of injury (56.8%). Only six patients (5.1%) presented within the "golden hour," resulting in delayed interventions. Surgical intervention was necessary in 78 cases (66.1%), with hollow viscus perforation being the most common indication. The mean hospital stay was 10.6 days, and the overall mortality rate was 12.7%. The presence of shock upon admission significantly correlated with mortality (P<0.001).

Conclusions: Blunt abdominal trauma continues to represent a critical healthcare challenge, particularly affecting younger males. Improved healthcare accessibility, adherence to Advanced Trauma Life Support protocols, and timely interventions could improve survival rates.

Purpose: Hemorrhage is the leading cause of preventable battlefield deaths, and up to 30% of casualties could survive with timely transfusions. In a potential North Korea-South Korea conflict, ensuring adequate blood supply would be crucial for military medical readiness. This study estimated the 2-week blood demand in such a conflict and evaluated South Korea's preparedness to meet it.

Methods: A multifaceted approach was employed, incorporating historical casualty data, medical literature on battlefield transfusions, South Korean blood supply reports, and military blood logistics models. Projections indicate 80,000 to 150,000 casualties within the first 2 weeks, with 30% of military and 15% of civilian casualties requiring transfusions. The estimated total blood demand ranges from 360,000 to 600,000 L, surpassing current South Korean reserves.

Results: Despite a 100,000-L prewar storage goal, weekly replenishment needs could reach 150,000 to 300,000 L, placing immense strain on collection, storage, and distribution systems. Key shortages include packed red blood cells, fresh frozen plasma, and platelets, with projected deficits of up to 120,000, 70,000, and 30,000 units, respectively. The logistical challenges of storing and transporting platelets, given their 5-day shelf life, make them particularly vulnerable to depletion. To address these shortages, a multipronged strategy is required, including pre-war stockpiling, mobile blood banks, rapid military-civilian coordination, international cooperation with US and other allies, and prioritization of whole blood over component therapy.

Conclusions: South Korea's current blood reserves are insufficient for a large-scale war. A combination of strategic stockpiling, military-civilian coordination, and alternative blood sources (synthetic oxygen carriers, prewar autologous donation programs) is essential to sustaining medical operations and improving survival rates.

Pelvic fractures result from high-energy trauma, and when accompanied by hemorrhagic shock, the mortality rate increases to 40%. Pelvic fractures are anatomically categorized as pelvic ring disruptions and acetabular fractures, each requiring different treatment methods and approaches. Acetabular fractures, which also result from high-energy injuries, may be accompanied by hemorrhagic shock. Treatment options for pelvic fractures with hemorrhagic shock include angioembolization, preperitoneal pelvic packing (PPP), and emergency laparotomy. In hemodynamically stable patients, early total care may be attempted, and for acetabular fractures (posterior column), the Kocher-Langenbeck approach is the treatment of choice. This case report describes the use of PPP as a salvage operation for postoperative retroperitoneal bleeding with hemodynamic instability following a Kocher-Langenbeck approach for an acetabular fracture with pelvic ring injury. The patient was discharged without postoperative complications such as bone displacement or surgical site infection. While PPP is commonly employed as an initial treatment modality for pelvic fractures with hemorrhagic shock, it may also be valuable in managing postoperative retroperitoneal bleeding with hemorrhagic shock.

Fat embolism syndrome (FES) is a rare but serious complication most commonly associated with trauma, particularly long bone fractures. However, symptomatic FES remains a significant diagnostic and therapeutic challenge. We present the case of a 20-year-old man who, after sustaining multiple long bone fractures in a motorcycle accident and initially appearing stable, experienced a rapid and fatal progression of FES. This case underscores the unpredictable course of FES even in young, previously healthy individuals and highlights the critical need for early recognition and intervention. It also emphasizes the importance of identifying risk factors that may predict severe outcomes and mortality.

Femoral neck fractures commonly occur in older patients and typically require surgical intervention to promptly restore mobility and minimize complications. While the anterior, lateral, and posterior approaches are frequently employed for hemiarthroplasty, each has its own benefits and drawbacks. Notably, the posterior approach has been linked to a higher risk of dislocation in some studies. The SPAIRE (saving piriformis and internus, repair of externus) technique is a modern adaptation of the traditional posterolateral approach. This less invasive, anatomically considerate method preserves the piriformis muscle tendon and the conjoint tendon of the superior gemellus, obturator internus, and inferior gemellus muscles. However, it involves sectioning the tendon of the obturator externus muscle. The technique is designed to maintain stabilizing muscular structures, decrease dislocation risk, and hasten functional recovery, including in patients with neurological conditions. This case report describes the treatment of a 79-year-old woman with a transcervical fracture of the right femoral neck. A bipolar hemiarthroplasty was performed using the SPAIRE technique. The procedure effectively preserved the functional synergistic unit of the piriformis-conjoint tendon (quadriceps coxa) and included meticulous capsular and tendinous repair. The patient's postoperative recovery was characterized by an excellent functional outcome at the 3-month follow-up. This case highlights the advantages of the SPAIRE technique in enhancing joint stability and facilitating rapid recovery, especially in geriatric patients.

Inferior vena cava (IVC) injuries are rare but deadly. Depending on the mechanism of injury, patient status, and type of injury, intervention may be surgical or endovascular. These injuries typically pose challenges in identification and treatment. During surgical intervention, rapid access and timely control of the bleeding site may be difficult. In this series, we aim to describe various IVC injuries presented at our center, detailing challenges and outcomes in their management. The study aims to characterize the presentation, interventions, and outcomes of IVC injury cases at a level I trauma center over a period of 30 months. In this report, a total of six cases of IVC injury were treated at our center. All patients underwent surgical intervention. Each patient experienced a high-energy trauma mechanism, with three patients sustaining blunt trauma and three sustaining penetrating trauma. Of the six patients, three survived while three died. Mortality was attributed to delayed presentation, complexity of injuries, and technical difficulties. Adherence to Advanced Trauma Life Support (ATLS) protocols, timely diagnosis and resuscitation, and rapid decision-making can reduce mortality associated with IVC injuries. Nonetheless, surgeons must remain cognizant of the inherent challenges and pitfalls in managing these injuries.