Journal of Trauma and Injury最新文献

Purpose: Pediatric neurotrauma (pNT) includes pediatric traumatic brain injury and spinal cord injury. The incidence and distribution of pNT by age and sex remain understudied, with several gaps in both epidemiological and clinical data. This study aimed to estimate the epidemiological parameters, clinical presentations, surgical interventions, and outcomes in our patient population with pNT.

Methods: A multicentric, ambispective study was conducted at five tertiary care pediatric neurosurgical centers in Northern India from January 2011 to December 2022. The study included children under 16 years of age admitted with a history of head injury. Data on demographics, radiological findings, management, and outcomes were recorded.

Results: A total of 2,250 children were admitted; 77.5% were male and 22.5% were female. The most common age group was 6 months to 2 years (37.3%). The primary mechanism of injury was fall from height (64.6%), followed by road traffic accidents (26.1%). Overall, 84.6% of children had mild head injury, 14.2% moderate, and 1.2% severe. The most common abnormality on computed tomography brain was contusion (9.2%). Surgical interventions were required in only 0.8% of children. A favorable outcome, as measured by Glasgow Outcome Scale, was achieved in 99.2% of patients, and the mortality rate was 0.1%.

Conclusions: Our findings indicate that pNT is most common in children aged 6 months to 2 years and predominantly affects boys. The most frequent cause was a fall from height, and the majority of patients sustained mild head injuries requiring only observation, which led to excellent outcomes. Surgical intervention was necessary in only a few cases, and mortality was rare. This study highlights the epidemiological pattern of pNT in our population and delineates various causes of such trauma.

Purpose: Dog bites pose a significant global public health challenge, with outcomes that range from minor injuries to fatalities. Despite their prevalence, no consensus has been established regarding the most effective prevention and treatment strategies. This systematic review aimed to consolidate and evaluate randomized controlled trials (RCTs) examining the effectiveness of interventions in preventing and treating dog bites.

Methods: A comprehensive search was conducted across the CINAHL, Embase, MEDLINE, Web of Science, and PubMed databases for RCTs published within the last 10 years. Studies were included if they focused on interventions to prevent or treat dog bites. Primary outcomes included the infection rate and recovery time of dog bites, the effectiveness of interventions in preventing or reducing bite severity, and associated health outcomes. The risk of bias was assessed using the Cochrane Collaboration tool.

Results: Five RCTs met the eligibility criteria, with a total of 1,148 participants. These studies examined various interventions, including medical techniques (medical glue, negative pressure wound therapy, and hyperbaric oxygen therapy), wound management strategies (primary suturing versus non-suturing), and educational interventions. A meta-analysis of four studies revealed no significant difference in infection rates between the intervention and control groups (risk ratio, 0.69; 95% confidence interval [CI], 0.27-1.77; I2=62%; P=0.44). However, the interventions examined in each study demonstrated shorter recovery times (mean difference, 11.25 days; 95% CI, 8.44-14.07 days; I2=99%; P<0.001).

Conclusions: Although the included studies suggest potential benefits of certain interventions in treating dog bites, particularly in reducing recovery time, the evidence regarding infection prevention remains inconclusive. The limited number of high-quality RCTs in this field highlights the need for further research to establish evidence-based guidelines for dog bite prevention and treatment.

Purpose: Blank cartridges are designed to produce the sound and gas flare of a gunshot without firing a bullet. However, blank cartridge shots (BCS) can still cause injuries ranging from minor to life-threatening. Within the South Korean military, most BCS-related injuries have occurred during suicide attempts. This study documents a case series of patients who sustained injuries from BCS during such attempts.

Methods: We examined the medical records of Korean soldiers at a military trauma center between April 2022 and April 2024 who had sustained injuries from BCS during suicide attempts. The analyzed data included general characteristics, injury site, surgical and psychiatric interventions, and length of hospitalization.

Results: The case series included five patients between 19 and 20 years old (mean age, 19.6±0.55 years). Four of these patients sustained self-inflicted gunshot wounds to the submandibular area, while one targeted the right temporal area. Although initial vital signs and laboratory findings were unremarkable, computed tomography scans revealed injuries from projectile gas and gunpowder, including burns, subcutaneous emphysema, and major structural damage. Cases 1 and 2 required emergency surgery for foreign body removal and debridement. The average length of hospitalization was 35.2±12.11 days. Patients were first admitted to the trauma surgery department for BCS injury management, and then transferred to the psychiatry department for emotional support. The average stay was 15.6±15.87 days in trauma surgery and 19.6±14.99 days in psychiatry.

Conclusions: This study highlights the consequences of BCS from suicide attempts in the South Korean military and provides valuable insights for medical personnel who may encounter patients with BCS injuries.

Reperfusion injury can cause tissue damage due to ischemia, with severe cases potentially resulting in multiorgan failure. Cytokine storm, a life-threatening systemic inflammatory state characterized by elevated levels of circulating cytokines and hyperactive immune cells, can also lead to tissue damage and multiorgan failure. Reperfusion injury and cytokine storm sometimes exhibit similar clinical features, necessitating specific treatment in severe cases. A 31-year-old man sustained a stab wound to his left knee. Computed tomography angiography and surgical exploration revealed a transection of the left popliteal artery and vein. Both vessels were revascularized via end-to-end anastomosis approximately 3 hours after the injury. On postoperative day 2, marked increases were observed in levels of aspartate aminotransferase (8,600 U/L), alanine transaminase (6,690 U/L), creatine phosphokinase (26,817 U/L), and lactate dehydrogenase (7,398 U/L) levels. Elevated levels of interleukin 6 (178 pg/mL) and ferritin (41,079 ng/mL) were also noted. Given the possibility of either reperfusion injury or cytokine storm, plasmapheresis was initiated. Following two rounds of plasmapheresis, the patient's condition rapidly improved, and he was discharged without complications. Reperfusion injury can arise when a target blood vessel is revascularized, particularly during severe stages of ischemia. Cytokine storm represents a life-threatening systemic inflammatory state characterized by high levels of circulating cytokines and overactive immune cells. Both reperfusion injury and cytokine storm can cause systemic inflammation and multiorgan failure. These two conditions may exhibit similar clinical features, necessitating supportive care primarily to prevent organ dysfunction. However, plasmapheresis may represent an effective treatment option in cases of severe progression.

The management of traumatic splenic injuries has evolved significantly over the past several decades, with the majority of these injuries now being treated nonoperatively. Patients who exhibit hemodynamic instability upon initial evaluation typically require surgical intervention, while the remainder are managed conservatively. Conservative treatment for traumatic splenic injuries encompasses both medical management and splenic artery angiography, followed by embolization in cases where patients exhibit clinical signs of ongoing splenic hemorrhage. Splenic artery embolization is generally divided into two categories: proximal and distal embolization. The choice of embolization technique is determined by the severity and location of the splenic injury. Patients who retain functioning splenic tissue after trauma do not routinely need immunization. This is in contrast to post-splenectomy patients, who are at increased risk for opportunistic infections.

Decompressive craniectomy is one of the most common procedures for managing severe traumatic brain injury. Cranioplasty plays a vital role in restoring the integrity of the skull and preventing complications that may arise after a decompressive craniectomy. This case report presents a 24-year-old woman who underwent cranioplasty with a cryopreserved autologous bone flap. Initially successful, the procedure was later complicated by a delayed surgical site infection and methicillin-resistant Staphylococcus aureus osteomyelitis, ultimately resulting in complete resorption of the bone flap. The report discusses the consequences of autologous bone flap resorption and surgical site infection, highlighting the critical need for effective sterilization and proper bone storage techniques. This case emphasizes the necessity of exploring alternative strategies to improve cranioplasty outcomes and minimize the risk of infection.

Purpose: The diagnosis and management of cardiac trauma and penetrating cardiac injuries pose significant challenges in emergency settings due to the rapid onset of life-threatening complications. This paper presents a narrative review to better describe the etiology, presentation, and management of penetrating cardiac trauma, offering insights and experiences related to performing emergency surgery for such cases.

Methods: We compiled cases of traumatic cardiac rupture and penetrating cardiac injuries accompanied by severe hemorrhagic shock that necessitated emergency surgery. Data were collected regarding the type of injury, causative agents, specific clinical features observed during emergency admission, intraoperative parameters, and treatment outcomes.

Results: Twenty-one patients (16 men, 5 women) with cardiac rupture or penetrating cardiac injuries were recorded. All patients presented in severe shock, and six cases (28.6%) experienced cardiac arrest upon arrival in the operating room. Cardiac rupture due to blunt chest trauma occurred in two cases (9.5%), and one case (4.8%) involved right atrial perforation due to complex open chest trauma. Penetrating injuries accounted for cardiac perforation in 18 cases (85.7%). Associated injuries were present in 11 cases (52.4%). The intraoperative mortality rate was 9.5%, and there was one postoperative death on the 11th day due to multiorgan failure.

Conclusions: Cardiac trauma and penetrating injuries are usually fatal unless promptly diagnosed and surgically treated. The timing and rapidity of emergency surgery-often foregoing ancillary tests and administrative procedures-are critical for patient survival. Emergency sternotomy, swift control of bleeding, and aggressive resuscitation are essential operative measures in saving lives. Factors that influence prognosis include the extent of blood loss, duration of cardiac arrest, acid-base imbalances, coagulopathy, multiorgan failure, and postoperative infections.

Purpose: The goal of this cross-sectional study was to investigate the prevalence of vitamin D deficiency in young orthopedic trauma patients and its impact on bone mineral density (BMD) measured through computed tomography imaging of the lumbar spine.

Methods: Conducted at a level I trauma center, this prospective cross-sectional analysis included 100 patients aged 18 to 50 years with non-fragility fractures. Vitamin D levels and Hounsfield units of the lumbar spine were recorded from computed tomography scans. Exclusion criteria included fragility fractures, lumbar surgery history, or lumbar bony/metastatic lesions. The correlation between vitamin D levels and BMD was assessed; vitamin D deficiency was defined as below 30 ng/mL.

Results: Among the participants, 75% were vitamin D-deficient, with an average vitamin D level of 25.0 ng/mL. No patients had osteoporosis based on Hounsfield units; however, 5% of patients were in the osteopenic range. In patients with normal vitamin D levels, there was an inverse correlation between vitamin D levels and BMD measured by Hounsfield units (P=0.025). Higher lumbar spine Hounsfield unit measurements correlated with lower vitamin D levels in this nondeficient population.

Conclusions: This study highlights a high prevalence of vitamin D deficiency in young orthopedic trauma patients, and it suggests a potential inverse relationship with BMD in patients with vitamin D levels >30 ng/mL. The absence of osteoporosis in our population raises questions about the influence of vitamin D on BMD in this young trauma patient demographic. Future research should explore the impact of vitamin D replacement on fracture union and investigate the interaction between vitamin D levels and bone health in the younger orthopedic trauma population.

Cardiac compression is the most crucial component of successful cardiopulmonary resuscitation (CPR). However, CPR procedure poses a risk of complications, even when CPR providers perform cardiac compressions as recommended. Reports indicate that solid organ injuries, including liver injuries, occur with an incidence of about 0.6% to 3%. In this particular case, a 25-year-old woman was found hanged in her apartment. She was transported to a nearby hospital where CPR was administered for approximately 30 minutes until she was resuscitated. Subsequently, an abdomen-pelvis computed tomography scan revealed a liver injury. The location of the liver injury, between the sternum and spine, suggested it was a compression injury caused by CPR. There was no evidence of extravasation or active bleeding; thus, conservative management was chosen for the liver injury. By hospital day 4, the patient's pupil reflex had completely disappeared. Electroencephalography showed generalized attenuation, indicating severe global brain damage. Liver injury is a relatively rare post-CPR complication, with an incidence of 0.6% according to a retrospective analysis of a cardiac arrest registry. The liver is partially situated between the sternum and spine. The end of the sternum is shaped like an inverted triangle, resembling a sword. Therefore, if the CPR provider's hands are placed too low or excessive pressure is applied, the sternum can injure the left liver. Blood loss from liver injuries could potentially hinder the successful resuscitation of patients. In this case, had there been no blood loss from the liver injury, the patient might have maintained better cerebral perfusion and function.