Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES最新文献

Background: In this study, we aimed to present the management and treatment processes of patients with splenic trauma, discuss nonoperative treatment approaches, and share our institutional experience.

Methods: A total of 244 patients hospitalized for splenic trauma between January 2010 and January 2020 were retrospectively analyzed.

Results: Splenic injury was present in 22% of trauma patients who presented to the emergency department and were consulted by pediatric surgery. The most common cause of splenic injury was falls (60%). Forty-three percent of patients were of school age. Ninety percent of patients had Grade I-III splenic injuries. The mean age at presentation was 7.90 years. The mean hematocrit level was 32% and the mean hemoglobin level was 10.90. Blood transfusion was administered to 29% of patients. Additional injuries were present in 45.9% of cases, with the lung being the most frequently affected organ. The mean length of hospital stay was 6.03 days. Mortality occurred in five patients, and morbidity was observed in five patients. There was a statistically significant correlation between blood pressure, urine output, and mortality. A statistically significant association was also found between platelet-to-lymphocyte ratio, blood transfusion, hemoglobin level, Glasgow Coma Scale (GCS) score, and mortality (p<0.001). Furthermore, significant correlations were identified between GCS score, length of hospital stay, neutrophil count, and the presence of additional injuries (p<0.001). A strong negative correlation was observed between lactate levels and blood transfusion (r=-0.610), as well as between lactate levels and GCS score (r=-0.645). In the ROC analysis evaluating lactate as a predictor of additional injury, a sensitivity of 58% and specificity of 83% were identified at a cutoff value of 1.9.

Conclusion: We recommend nonoperative management for patients with splenic injury, as it reduces mortality, morbidity, and healthcare costs. Treatment protocols for these patients should be scientifically standardized.

Background: Upper gastrointestinal bleeding (UGIB) is a significant cause of morbidity and mortality. While endoscopy is the primary treatment modality, transcatheter arterial embolization (TAE) can be an effective alternative when endoscopic treatment fails. This study aims to evaluate the safety and efficacy of empiric TAE for acute UGIB.

Methods: This retrospective, single-center study reviewed 20 consecutive patients referred to interventional radiology for embolization due to UGIB between August 2021 and November 2024. The mean patient age was 62.3±16.2 years. Clinical success was defined as devascularization of the target area resulting in clinical cessation of bleeding and stabilization of hemoglobin levels. Technical success was defined as occlusion of the feeding vessel and/or absence of extravasation following angiography.

Results: Thirteen patients (65%) had duodenal bleeding and underwent gastroduodenal artery embolization. Seven patients (35%) had gastric bleeding and underwent left gastric artery embolization. Both the technical and clinical success rates of the procedure were 100%. Rebleeding occurred in one patient (5%) and was managed surgically. There was no procedure-related mortality. One major complication (5%), coil migration, was managed conservatively. One minor complication (5%), a groin hematoma, occurred and did not require transfusion.

Conclusion: Empiric transcatheter embolization is an effective and safe treatment option for acute upper gastrointestinal bleeding, demonstrating high technical and clinical success rates. The procedure shows favorable outcomes in terms of hemostasis, rebleeding rates, and complication profiles compared to surgical intervention.

Background: In the evaluation of forensic cases, misinterpretations of radiological imaging can directly affect not only patients' diagnostic and therapeutic processes but also judicial proceedings. This retrospective study aimed to investigate the impact of radiological re-evaluations on forensic report outcomes.

Methods: Between July 2023 and March 2025, a total of 365 forensic cases that underwent radiological evaluation were retrospectively reviewed. For radiological examinations performed in the emergency department (plain radiography or computed tomography), interpretations made by our radiology specialist and the corresponding forensic reports were reviewed retrospectively. X-ray images requested in the emergency department that lacked a radiologist report and were evaluated by emergency physicians were subsequently interpreted by our radiology specialist; this cohort was defined as an "X-ray interpretation" group. Computed tomography (CT) images requested in the emergency department that were initially reported via teleradiology were subsequently reinterpreted by our radiology specialist; this cohort was defined as the "CT interpretation" group.

Results: Following interpretations performed by our radiologist, changes in the conclusion section of forensic reports were observed in 35.3% of cases. The rate of changes in forensic report conclusions was statistically significantly higher in the "CT interpretation" group (47.8%) than in the "X-ray interpretation" group (34.2%). The likelihood of modifications in forensic report outcomes was significantly greater in cases involving three or more injury sites. The most frequent cause of error was the misinterpretation of bone fractures (84.5%), predominantly affecting the craniofacial and upper extremity regions. In fracture assessment, false-positive findings were more commonly identified on plain radiographs (73.8%), whereas false-negative findings were more frequently encountered on computed tomography scans (59.5%).

Conclusion: These findings demonstrate that radiological misinterpretations, particularly in the assessment of bone fractures, can significantly influence forensic report outcomes and, consequently, judicial processes. This study underscores the necessity of involving trauma-experienced radiologists in forensic imaging and highlights the importance of effective interdisciplinary collaboration between radiology and forensic medicine.

Background: Traumatic brain injury (TBI) is a major cause of trauma-related morbidity and mortality worldwide. Early identification of patients at risk of clinical deterioration is essential for optimizing emergency management. The Modified Early Warning Score (MEWS) and the reverse Shock Index multiplied by the Glasgow Coma Scale (rSIG) are simple, rapidly calculable tools that may assist clinicians in early prognostic assessment. This study aimed to evaluate the prognostic performance of MEWS and rSIG in predicting poor outcomes among patients with isolated head trauma.

Methods: This retrospective observational study included patients presenting to the emergency department of Manisa Celal Bayar University Hospital between June 2021 and June 2024 with isolated head trauma. Demographic, clinical, and laboratory data were retrieved from the hospital information system. MEWS, Shock Index (SI), reverse Shock Index (rSI), and rSIG values were calculated for each patient. Group comparisons were performed using nonparametric tests. Correlations were analyzed using Spearman coefficients. Receiver operating characteristic (ROC) curves were constructed to assess discriminative power, and binary logistic regression was used to identify independent predictors of poor outcomes, defined as intensive care unit admission and/or in-hospital mortality.

Results: A total of 705 patients (65.7% male; mean age 37.2+-27.0 years) were analyzed. Pathological cranial CT findings were present in 24.7%, and the overall mortality rate was 2.7%. Patients with poor outcomes exhibited significantly higher MEWS and SI values, whereas GCS, rSI, and rSIG were markedly lower (all p <0.001). ROC analysis showed moderate predictive ability for rSIG (AUC=0.701) and limited discriminative power for MEWS (AUC=0.610), with optimal cut-offs of ≤21.35 and ≥0.5, respectively. In multivariate analyses, MEWS and rSIG demonstrated independent prognostic significance for poor outcomes in separate models, with rSIG remaining significant in models excluding GCS. MEWS correlated positively with hospital stay (r=0.385, p<0.001), while rSIG showed a negative correlation (r=-0.252, p<0.001).

Conclusion: MEWS and rSIG are practical bedside tools that may support early risk stratification in patients with isolated head trauma. MEWS reflects early physiological deterioration, while rSIG provides complementary hemodynamic-neurological information and should be interpreted as an adjunct rather than a standalone triage instrument. Routine use of these scores may support early clinical decision-making and patient monitoring in the emergency setting when interpreted as adjuncts to standard clinical assessment.

Background: Motorcycle accidents represent a significant public health and forensic medicine issue due to their high morbidity and mortality rates. This study aimed to evaluate the demographic, clinical, and forensic characteristics of motorcycle accidents.

Methods: A retrospective analysis was conducted on 2,445 motorcycle accident cases referred to the Department of Forensic Medicine at Eskişehir Osmangazi University Faculty of Medicine for forensic evaluation between 2020 and 2024. Demographic data, accident characteristics, helmet and alcohol use, injury patterns, Injury Severity Score (ISS) values, and forensic report classifications according to Turkish Penal Code (TCK) No. 5237 were analyzed.

Results: Of these cases, 91.7% were male, with an average age of 31.8 years; the most commonly affected age group was 20-29 years. Most accidents occurred within city limits (68.1%), and the most frequent accident mechanism was collision with another vehicle (59.8%). Helmet use was reported in 36.0% of cases, while 47.0% were not wearing a helmet at the time of the accident. The most common injuries involved the lower (44.4%) and upper extremities (38.7%). Fractures most frequently affected the tibia/fibula, wrist-hand bones, and ribs. The average ISS was 9.1+-4.8; injuries were classified as mild in 59.3% of cases, moderate in 30.0%, and severe in 10.7%. According to the TCK, 66.0% of injuries were classified as 'treatable with simple medical intervention.'

Conclusion: Motorcycle accidents are particularly common among young men, and helmet use remains low. Injuries predominantly affect the extremities, and forensic classification based on the TCK provides a distinctive contribution to forensic medicine practice. Increasing the use of protective equipment, preventing driving under the influence of alcohol, and strengthening traffic safety measures are essential.

Uncontrolled hemorrhagic shock due to trauma is a life-threatening condition requiring rapid intervention. Every minute in the man-agement of these patients is valuable. In recent years, resuscitative endovascular aortic balloon occlusion (REBOA) has emerged as a valuable tool in emergency and trauma practice, providing additional time for the patient, particularly in cases where surgical hemosta-sis is delayed. A 62-year-old male patient with no known comorbidities was transported to our tertiary trauma center after receiving five minutes of cardiopulmonary resuscitation (CPR) and intubation at an external facility following a high-energy traffic accident. Upon presentation, the patient's blood pressure was 50/20 mmHg and pulse rate was 128 beats/min. He had extensive pelvic trauma, lower extremity trauma, major soft tissue loss, and vascular and bone injuries. He underwent hemostatic resuscitation along with whole-body computed tomography (CT) imaging; however, cardiac arrest recurred after imaging. During CPR, simultaneous imaging studies revealed no trauma or bleeding in the brain or thorax. REBOA was planned for the patient. Temporary return of spontaneous circula-tion (ROSC) was achieved 38 minutes after REBOA. During this period, the patient received a total of six units of packed red blood cells, three units of fresh frozen plasma, two units of cryoprecipitate, and calcium replacement. The REBOA procedure was performed by emergency physicians and cardiovascular surgeons who had received hands-on training using a REBOA simulation model developed by our team. However, despite achieving a temporary hemodynamic response, the patient could not be stabilized for surgical interven-tion and was pronounced deceased. In this case, we share the first REBOA experience of emergency department physicians trained with a locally produced simulation model. We believe that simulation-based training will contribute to physician experience and direct field application in rare or rapidly evolving emergencies.

Background: Ischemia-reperfusion (IR) injury significantly reduces erythrocyte deformability, leading to increased oxidative stress, inflammation, and impaired microvascular perfusion. This study aimed to examine the protective effects of hydroxytyrosol (HT), a powerful antioxidant derived from olives, on erythrocyte deformability and related oxidative stress markers in a rat model of hind limb ischemia-reperfusion injury.

Methods: Twenty-four rats were randomly divided into four groups: Sham, HT-Sham, ischemia-reperfusion (IR), and IR treated with HT (IR-HT). HT was administered intraperitoneally at a dose of 10 mg/kg prior to ischemia induction. Following reperfusion, biochemical parameters, including malondialdehyde (MDA), superoxide dismutase (SOD), endothelial nitric oxide synthase (eNOS), erythrocyte deformability, and morphology, were evaluated.

Results: HT administration significantly improved erythrocyte deformability, decreased MDA levels, increased SOD activity, and moderated eNOS expression in the IR-HT group compared to the untreated IR group (p<0.001). Morphological analysis demonstrated substantial preservation of erythrocyte integrity, with fewer pathological changes such as echinocytes and dacrocytes.

Conclusion: This study provides preliminary insights into the protective mechanisms of HT, highlighting its therapeutic potential in reducing erythrocyte dysfunction and oxidative damage during ischemia-reperfusion events. Further research exploring comprehensive signaling pathways and long-term clinical outcomes is advisable..

Background: The aim of this study was to present our institutional experience with periprocedural management of emergency cesarean section (CS) operations and maternal and fetal cardiac complications in pregnant women with pulmonary hypertension (PH).

Methods: Thirteen patients who were diagnosed with PH during pregnancy and/or prior to pregnancy according to European Society of Cardiology (ESC) criteria, and who were referred to our hospital with a decision for emergency CS from an external center, were included in the study. For patients who underwent urgent surgery, the following data were recorded: demographic characteristics, time of diagnosis, treatments for pulmonary hypertension used before pregnancy, during pregnancy, and/or after CS, arterial blood gas values, pulmonary and systemic pressure values after induction and at the 12th postoperative hour, extracorporeal membrane oxygenation (ECMO) requirements, time to extubation, length of intensive care stay, and mortality rates.

Results: Eight of the 13 patients were diagnosed with idiopathic pulmonary arterial hypertension (IPAH). The mean systolic systemic arterial pressure (BPs), systolic pulmonary arterial pressure (PAPs), and mean pulmonary arterial pressure were 130+-14.2 mmHg, 93+-28 mmHg, and 52+-17 mmHg, respectively. Six of the 13 patients required ECMO support. The one-month mortality rate was 46%.

Conclusion: Pregnancy in women with PH is associated with significant maternal morbidity and mortality. If the underlying etiology is IPAH, the risk of mortality is higher than in other forms of PH. Mechanical circulatory support devices, including ECMO, may serve as a temporary bridge to lung transplantation in selected cases. Therefore, early diagnosis of IPAH, timely referral of patients to specialized centers, and planning of these operations by a multidisciplinary team consisting of cardiologists, gynecologists, and cardiac anesthesiologists are necessary.

Background: Acute calculous cholecystitis (ACC) is one of the most common conditions encountered in emergency medicine and surgical practice. Delayed recognition of severe cases can lead to complications such as empyema, gangrene, or perforation, resulting in high morbidity and mortality. While the Tokyo Guidelines provide standardized diagnostic and severity grading criteria, the availability and reliability of imaging may be limited in certain settings. Therefore, there is growing interest in simple and cost-effective biomarkers. This study aimed to evaluate the diagnostic and prognostic value of complete blood count-derived (CBC-derived) systemic inflammatory indices, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte × platelet ratio (NLPR), systemic immune-inflammation index (SII), and multiple inflammatory index (MII), in predicting disease severity in patients with ACC.

Methods: A total of 160 patients diagnosed with ACC in the emergency department between January 2020 and May 2024 were retrospectively analyzed. Patients with acalculous cholecystitis, cholangitis, choledocholithiasis, incomplete data, or age younger than 18 years were excluded. Demographic, clinical, and laboratory findings were reviewed. Receiver operating characteristic (ROC) curve analysis was used to determine optimal cut-off values.

Results: The strongest predictive performance was observed for MII (cut-off=250,011; sensitivity 76.9%; specificity 78.9%; area under the curve [AUC]=0.770). NLR (cut-off=8.45) showed 76.9% sensitivity and 68.0% specificity (AUC=0.755). NLPR (cut-off=0.027) had 76.9% sensitivity and 54.4% specificity, while SII (cut-off=2414) achieved 69.2% sensitivity and 72.1% specificity (all p<0.05). All indices were significant predictors of severe ACC.

Conclusion: CBC-derived systemic inflammatory indices, particularly MII and NLR, are effective, accessible, and inexpensive markers for predicting the severity of ACC. These parameters may complement clinical assessment and assist in decision-making, especially in situations where imaging is unavailable or inconclusive.

Background: To evaluate the anatomical and functional outcomes of pars plana vitrectomy (PPV) combined with prophylactic chorioretinectomy (CR) in patients with deadly weapon-related open globe injuries (DWOGIs).

Methods: Medical records of patients who underwent PPV and prophylactic CR for open globe injuries (OGIs) caused by deadly weapons between November 2016 and October 2024 were retrospectively reviewed. Demographic characteristics, injury type, cause of injury, zone of injury, intraocular foreign body (IOFB) exit/impact site, best-corrected visual acuity (BCVA), proliferative vitreoretinopathy (PVR) rates, anatomical success, and globe survival were evaluated.

Results: Of a total of 283 OGIs, 41 eyes from 35 patients who underwent PPV with prophylactic CR for deadly weapon-related trauma were included in the analysis. The mean age was 30.9+-9.4 years, and 88.6% of the patients were male. Perforating injuries were observed in 38 eyes (92.7%), and penetrating injuries associated with an IOFB in 3 eyes (7.3%). The causes of injury included improvised explosive devices in 20 eyes (48.8%), hand grenades in 11 eyes (26.8%), landmines in 8 eyes (19.5%), and rocket-propelled grenades in 2 eyes (4.9%). The IOFB exit/impact site was located in the posterior pole in 38 eyes (92.7%), of which 22 (53.6%) were outside the vascular arcades, 12 (29.3%) within the vascular arcades, and 4 (9.7%) adjacent to the optic disc. The mean initial BCVA was 2.62+-0.98 logMAR, with 90.2% of eyes presenting between light perception and counting fingers. PPV was performed at a mean of 5.9+-2.7 days after primary repair. Of these eyes, 43.9% had retinal detachment. The mean number of PPV procedures was 2.6+-1.1. C3F8 gas endotamponade was used in 51.2% of cases. At a mean follow-up of 32.8+-16.6 months, the final BCVA improved significantly to 1.18+-1.20 logMAR (p<0.001), with 68.3% achieving ≥20/200 vision. At final follow-up, the rates of PVR, anatomical success, and globe survival were 14.6% (6/41), 85.4% (35/41), and 87.8% (36/41), respectively.

Conclusion: Pars plana vitrectomy combined with prophylactic CR appears to be an effective treatment option for DWOGIs, offering prevention of PVR development and achieving high anatomical success, favorable globe survival, and meaningful visual improvement despite severe ocular trauma.