Journal of Trauma and Injury最新文献

Pneumomediastinum is an uncommon complication in cases of blunt chest trauma but can signal severe underlying issues. This report discusses a 69-year-old male patient with preexisting conditions of obesity, sleep apnea, and asthma, who experienced delayed pneumomediastinum and pneumopericardium following the removal of a chest tube. This tube had been placed to address a traumatic hemopneumothorax, which had resolved. The removal of the chest tube triggered a series of events, exacerbated by the patient's chronic health conditions. The patient was managed conservatively with close monitoring and physiotherapy, which successfully resolved the condition without the need for further invasive procedures. The multifactorial nature of the Macklin effect illustrates that even routine procedures such as chest tube removal can trigger a chain reaction in susceptible patients. The choice of conservative management, rather than immediate invasive interventions, underscores the delicate balance necessary in trauma care.

Purpose: The Korean War (1950-1953) significantly advanced military medicine, with foreign military surgeons playing a pivotal role in transforming trauma care under extreme conditions.

Methods: Resources such as PubMed, JSTOR, and reports from participating nations formed the basis of this study. A thorough comparative analysis was performed to examine the similarities and differences in medical practices between the United Nations Command and North Korean forces.

Results: The United States introduced Mobile Army Surgical Hospitals, revolutionizing trauma care by enabling rapid intervention near combat zones. Innovations such as helicopter evacuation, whole blood transfusions, and antibiotic treatments reduced mortality rates among treated soldiers to as low as 3%. British surgeons excelled in managing abdominal wounds and performing orthopedic surgery, often undertaking limb-saving procedures. Field hospitals provided comprehensive care for combat injuries and infectious diseases-a major concern given the inadequate sanitation. The Indian 60th Parachute Field Ambulance treated over 20,000 casualties, demonstrating adaptability in harsh environments. The Indian Field Hospital not only treated military casualties but also provided care to Korean civilians, offering life-saving medical interventions under challenging conditions. Denmark deployed the hospital ship MS Jutlandia, equipped with advanced surgical facilities, enabling a level of medical care that was not practical on land. The Swedish Red Cross Field Hospital in Busan delivered crucial medical aid to both military personnel and civilians; its staff focused on civilian outreach and controlling epidemics, with treatments targeting diseases such as typhoid and tuberculosis. Norwegian mobile surgical teams specialized in rapid interventions near combat zones, performing life-saving operations within hours of injury and thus minimizing complications and increasing survival rates.

Conclusions: The lessons learned from these contributions continue to influence modern military and civilian healthcare systems, highlighting the importance of innovation, collaboration, and resilience in conflict settings.

Purpose: Traumatic brain injury (TBI) severity is typically assessed using the Glasgow Coma Scale (GCS). In contrast, the bispectral index (BIS) objectively evaluates a patient's level of consciousness in an intensive care unit. The primary objective of this study was to evaluate the correlation between GCS and BIS values in TBI patients. Secondary objectives included determining the range of BIS scores corresponding to different levels of consciousness and assessing the correlation among mild, moderate, and severe TBI.

Methods: Sixty patients participated in a prospective observational study conducted at a government tertiary care facility. After obtaining a detailed history and performing a physical examination, each patient's age, sex, intubation status, computed tomography brain findings, and vital signs were recorded. Subsequently, the patients' GCS and BIS values were measured at 0, 6, 12, 18, and 24 hours. Quantitative data are presented as mean±standard deviation, while qualitative data are illustrated using frequency and percentage tables. Spearman correlation analysis was employed to evaluate the association.

Results: Spearman correlation analysis demonstrated a strong positive relationship between BIS and GCS at 0 hours (r=0.655, P<0.05), 6 hours (r=0.647, P<0.05), 12 hours (r=0.652, P<0.05), 18 hours (r=0.659, P<0.05), and 24 hours (r=0.648, P<0.05). Moreover, the mean BIS value decreased significantly with increasing severity of head injury.

Conclusions: Similar to the GCS, the BIS correlates with head injury severity and may serve as a complementary tool for predicting outcomes in TBI patients.

Purpose: This study assessed patient vulnerability following traffic accidents (TAs) in Korea's border area (BA).

Methods: The BA includes cities and counties directly adjacent to the demilitarized zone with North Korea. The rear area (RA) is defined as the area immediately adjacent to the BA. TA data from 2017 to 2021 were obtained from the Traffic Accident Analysis System in Korea. Information on road length, population, number of TAs, injured patients, and fatalities was collected. The number of TAs and fatalities per 1 km of road length and per 100,000 people was calculated. Severity (number of fatalities per 100 TA cases) and lethality (number of fatalities divided by the sum of fatalities and injured patients) were used to assess the vulnerability of each area.

Results: A total of 55,463 TAs were analyzed. Although the RA exhibited higher numbers of TAs and deceased patients per 1 km of road length and per 100,000 people, the BA showed significantly higher fatalities per 100,000 people as well as increased severity and lethality.

Conclusions: The BA is more likely to be associated with death following TAs, despite a lower overall TA incidence compared to the RA. Further analysis is needed to address and mitigate this vulnerability.

Exposure to electrical current, whether through accidental contact in residential or industrial settings or via lightning strikes, represents a serious global health concern. Although numerous studies have been published on the differences between electrical and lightning injuries, they are often discussed together due to the similarities in their clinical presentations, management approaches, and outcomes. The question of whether electrical and lightning injuries should be studied together remains a matter of debate. Here, we present two cases: one of a lightning injury and another of an electrical injury. Our discussion aims to improve the understanding of lightning and electrical injuries as distinct entities. Vigorous resuscitative measures are recommended and given the complexity of electrical and lightning injuries and their long-term sequelae, patients should be managed in a multidisciplinary burn center. Furthermore, the knowledge and awareness of the general population must be improved to reduce the incidence of such injuries.

Fat emboli syndrome is a rare and potentially fatal condition that most commonly manifests after traumatic long-bone fractures. Cerebral fat emboli are one of the most feared complications leading to permanent neurologic injury, though methods for optimal monitoring in high-risk patients are lacking. We present a case of a 16-year-old female patient who presented to the emergency department following a motor vehicle collision with multiple injuries, including a comminuted femoral shaft and pelvic ring fracture, as well as an acute basilar artery occlusion due to fat embolism. Continuous transcranial Doppler ultrasound (TCD) of the bilateral middle cerebral arteries was utilized for emboli detection and evaluation of right-to-left shunt. The patient was found to have a high burden of microemboli on TCD in combination with a right-to-left shunt conferring increased risk of additional neurologic injury. Following surgical fixation of her orthopedic injuries, repeated TCD assessment demonstrated no further evidence of microemboli thus demonstrating efficacious response to definitive treatment. This report highlights the utility of TCD for early monitoring and detection of cerebral emboli in patients at risk for fat emboli syndrome as well as evaluating response to intervention.

Veno-venous (VV) extracorporeal membrane oxygenation (ECMO) is often used as a life-saving therapy for lung injuries; however, it presents challenges, including bleeding risks and potential reductions in ECMO flow. This case report details the intricate management of a 16-year-old boy who suffered severe thoracoabdominal trauma following a nine-floor fall. The patient sustained severe lung injury and damage to multiple solid organs, including liver lacerations, and was placed on VV-ECMO. When initiating ECMO, it is crucial to carefully consider anticoagulation to avoid potential bleeding complications. Therefore, despite the usual risks associated with ECMO, such as bleeding and reduced flow rates, anticoagulation was withheld due to the risk of hemorrhage from the liver injury. While on ECMO support, the patient experienced a sudden decrease in flow and blood pressure, suggesting an increase in intra-abdominal pressure. An immediate decompressive laparotomy revealed a significant hemoperitoneum, primarily caused by oozing from the liver laceration. The prompt recognition of abdominal distension and the timely decision to proceed with surgery without further imaging were key to the successful treatment. Postoperatively, the patient showed good recovery, with gradual weaning from ECMO, extubation, and eventual discharge. In conclusion, this case highlights the importance of ongoing monitoring for patients with complex trauma who are on ECMO. External factors, including elevated intra-abdominal pressure, can impair ECMO performance. Meticulous management and a multidisciplinary approach are essential in these intricate cases, which involve the nonsurgical treatment of solid organ damage accompanied by severe lung injury.

A 60-year-old man presented with total avulsion of the right globe following a penetrating injury to the right orbit from a metal bicycle handlebar. There was no light perception in the right eye on presentation. External examination revealed a full-thickness, canalicular-involving, horizontal right upper eyelid laceration through which the luxated globe and other orbital contents extruded. The globe was intact. The patient underwent urgent surgical exploration. In the operating room the optic nerve and all extraocular muscles were found to be completely transected from the globe. The globe was enucleated, and the eyelid laceration was repaired with bicanalicular stent placement.

Purpose: Traumatic brain injury is associated with adverse prognoses and significant neurological impairments that negatively affect patients' quality of life and physiological well-being. The aim of this study was to compare various computed tomography (CT) scoring systems in order to evaluate their effectiveness in predicting mortality and in risk stratification.

Methods: The evolution and trends in the use of CT scoring systems were analyzed through a bibliometric analysis of 72 Scopus-indexed documents using VOSviewer ver. 1.6.19. A systematic review was conducted following the 2020 PRISMA guidelines, with data obtained from PubMed Advance, Scopus, and Google Scholar for the period 2003-2024. A total of 198 journals were identified and subsequently filtered down to 6 that met the inclusion criteria.

Results: The bibliometric analysis revealed a progressive shift toward the use of CT scoring systems for novel diagnostic purposes and mortality prediction. The Rotterdam CT score demonstrated the highest total link strength and was most frequently published in 2017. In contrast, the Marshall CT score was more widely referenced in studies published after 2020. Despite being recognized for its sensitivity, the Helsinki CT score has not garnered equivalent research attention. Furthermore, the review suggested that the Rotterdam CT score is superior in predicting mortality among traumatic brain injury patients, with the Marshall CT score also demonstrating potential.

Conclusions: A review of the extant literature indicates that the Helsinki CT score exhibits the highest predictive accuracy, effectively estimating both mortality probability and long-term prognosis. Since 2015, research on the Helsinki CT score has steadily increased.

Trauma during pregnancy poses a potentially tragic risk to both the fetus and mother, making its management particularly challenging. Here, we present the case of a 35-year-old woman at 34 weeks and 2 days gestation who was in a motor vehicle accident and subsequently suffered placental abruption and underwent an emergency cesarean section. We also present a review of traumatic placental abruption and its epidemiology. On arrival at the trauma bay, the patient showed no significant abdominal findings other than a seat belt sign. However, 2 hours after admission, the patient developed abdominal pain and vaginal bleeding. Ultrasonography revealed no clear evidence of placental abruption. This case demonstrates the necessity of close maternal and fetal monitoring with cooperation between the trauma and obstetric teams. Even in the absence of typical symptoms such as abdominal pain on initial presentation, a high-energy mechanism of injury should be suspected.