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

Background: This study aims to evaluate the predictive value of the blood urea nitrogen (BUN)/albumin ratio for in-hospital mortality in pediatric burn patients with a total body surface area (TBSA) of 20% or greater and to compare its performance with established scoring systems, namely the Abbreviated Burn Severity Index (ABSI) and the Pediatric Baux Score (P-Baux).

Methods: Patients hospitalized with burns involving 20% or greater TBSA in our pediatric burn unit between 2018 and 2023 were reviewed retrospectively. Patients were analyzed for demographic information, basic clinical data, cause of burn, operative interventions, ABSI and P-Baux scores and the follow-up period. The BUN/albumin ratio was calculated using BUN and albumin values measured at the time of index hospital admission. Data were evaluated for in-hospital mortality.

Results: A total of 212 patients were included in the study. Patients were divided into two groups: survivors and non-survivors. The non-survivor group had significantly higher TBSA involvement, full-thickness burns, inhalation injuries, and operative requirements (p<0.001). The overall mortality rate was 4.5%. Receiver operating characteristic (ROC) analysis demonstrated that the BUN/albumin ratio is a strong predictor of in-hospital mortality, with predictive power similar to that of the ABSI and P-Baux scores. The cut-off value for mortality prediction using the BUN/albumin ratio was >5.24.

Conclusion: The BUN/albumin ratio is a simple and easily accessible marker that demonstrates strong statistical value in predicting in-hospital mortality in pediatric patients with burns covering 20% or more of the body. Given its availability from routine blood tests, we believe it may serve as a practical and helpful tool for clinicians caring for pediatric burn patients.

Background: To assess the diagnostic value of the C-reactive protein to lymphocyte ratio (CLR) and other inflammatory markers in distinguishing complicated from uncomplicated acute appendicitis (AA) to support timely surgical intervention.

Methods: This retrospective study included 682 patients who underwent appendectomy between January 2018 and January 2021. Based on the histopathological American Association for the Surgery of Trauma (AAST) AA grading system, patients were classified as complicated AA (grades 3-5; n=144) or uncomplicated AA (grades 1-2; n=538). Preoperative laboratory values-white blood cell (WBC) count, neutrophil count, C-reactive protein (CRP), sodium (Na), CLR, neutrophil-to-lymphocyte ratio (NLR), and CRP/Na-were analyzed. Diagnostic performance was assessed using receiver operating characteristic (ROC) analysis.

Results: Complicated AA cases were significantly older (37.5+-17.6 vs. 30.0+-12.8 years; p<0.001). CRP (7.17+-6.78 vs. 2.98+-4.52 mg/dL), WBC, neutrophils, and CLR (5.66+-9.13 vs. 1.89+-3.94) were significantly elevated in the complicated group (p<0.001). CLR showed moderate diagnostic accuracy (AUC=0.712), with a cutoff of ≥2.82 yielding 53.5% sensitivity and 82.7% specificity (OR=5.49, 95% CI: 3.69-8.16). Hyponatremia and elevated NLR/PLR also correlated with complications.

Conclusion: CLR is a moderately accurate, highly specific, and accessible biomarker for identifying complicated AA. Its integration with clinical evaluation may enhance preoperative risk stratification, especially in resource-limited settings.

Background: Acute appendicitis is the most common diagnosis considered in patients presenting to the emergency department with right lower quadrant pain. However, atypical presentations often lead to unnecessary surgeries and increased healthcare costs. This study aimed to improve diagnostic accuracy in acute appendicitis using a hybrid machine learning (ML) model.

Methods: A retrospective analysis was performed on 395 patients who underwent appendectomy for suspected acute appendicitis between 2020 and 2024 at Ankara University Faculty of Medicine, Department of General Surgery. Demographic, clinical, laboratory, and radiological variables were collected. ML algorithms, including NaiveBayes, MultilayerPerceptron, IBk, AdaBoost, RandomForest, and a hybrid model combining NaiveBayes, AdaBoost, and RandomForest, were applied. The dataset was evaluated using 10-fold cross-validation, repeated 1,000 times. Accuracy, F-measure, Matthews Correlation Coefficient (MCC), receiver operating characteristic (ROC) area, and precision-recall curve (PRC) area were used as performance criteria.

Results: Among the 395 patients, 52.9% were male, with a mean age of 37.3+-15.6 years. Histopathological examination confirmed acute appendicitis in 341 (86.3%) patients and negative appendectomy in 54 (13.7%) patients. The diagnostic accuracy of the Alvarado score at a cut-off value of ≥6 was 79.0%. Among the ML algorithms, the hybrid model achieved the best performance, with 92.9% accuracy, 93% F-measure, 70.4% MCC, 90.8% ROC area, and 93.4% PRC area. This model correctly predicted 95.6% of acute appendicitis cases and 75.9% of negative appendectomy cases.

Conclusion: The hybrid ML model demonstrated superior diagnostic accuracy compared to the Alvarado score for acute appendicitis. Integration of such models into clinical practice could reduce negative appendectomy rates and enhance patient management by enabling faster and more reliable diagnosis.

Background: This study aimed to evaluate the neuroprotective potential of pregabalin (PB) and methylprednisolone (MP) in a rat model of spinal cord injury (SCI) by assessing serum and spinal cord levels of superoxide dismutase (SOD) and glutathione peroxidase (GPx), markers of oxidative stress, and neurological recovery outcomes.

Methods: Forty-four rats were randomized into six groups: sham, PB control (40 mg/kg), SCI alone, MP-treated SCI (30 mg/kg), and PB-treated SCI (40 and 80 mg/kg). SCI was induced at the T10 level using the Allen weight-drop method. PB and MP were administered intraperitoneally for three days post-injury. Neurological recovery was assessed using the Tarlov scale and inclined plane test. Although 44 rats were initially allocated, mortality and technical loss resulted in a final cohort of 35 animals; however, post hoc power remained >90% for key biochemical outcomes.

Results: SOD levels were significantly reduced in the MP+SCI group compared with the sham (p=0.006), SCI (p=0.015), 40 PB (p=0.004), and 80 PB+SCI (p=0.028) groups. Additionally, the SCI group exhibited lower SOD activity than the 40 PB group (p=0.007). Serum glutathione peroxidase levels were significantly lower in both the SCI (p=0.018) and 80 PB+SCI (p=0.009) groups compared with the sham group, whereas the 40 PB group showed higher GPx activity than the SCI (p=0.010) and 80 PB+SCI (p=0.006) groups. In spinal cord tissue, SOD activity in the 40 PB+SCI group was significantly lower than in the SCI group (p=0.007). Additionally, SOD activity in the SCI group was significantly higher than in the 40 PB group (p=0.007). Spinal cord GPx levels were significantly elevated in the SCI group compared with the sham (p=0.007), MP+SCI (p=0.010), 40 PB (p=0.003), 40 PB+SCI (p=0.003), and 80 PB+SCI (p=0.028) groups. Furthermore, the MP+SCI group demonstrated higher GPx activity than the sham group (p=0.045). Pregabalin improved inclined-plane performance but did not produce significant changes in Tarlov motor scores, indicating selective enhancement of postural stability rather than full locomotor recovery. Histopathological analysis revealed no significant differences between the trauma groups.

Conclusion: Pregabalin mitigated oxidative stress and partially improved functional stability in experimental spinal cord injury, suggesting possible clinical applicability pending further validation.

Background: Childhood forensic traumatic injuries represent one of the foremost preventable public health concerns. This study aims to evaluate the sociodemographic characteristics, types of trauma, and the legal nature of traumatic injuries in pediatric cases subjected to forensic evaluation.

Methods: Data from 275 pediatric cases who presented to Çankırı State Hospital between January 1, 2024 and December 31, 2024, with traumatic injuries requiring forensic notification were retrospectively analyzed.

Results: Of the cases, 72.4% were male and 27.6% were female, with a mean age of 13.01+-4.22 years. The most common causes of injury were physical assault (43.3%), in-vehicle traffic accidents (19.6%), and out-of-vehicle traffic accidents (17.8%). The distribution of injuries varied significantly by age and sex; physical violence (73.9%), injuries from sharp or stabbing objects (95%), and firearm injuries (100%) were more frequent among males, whereas blunt trauma was more commonly observed in females (42.9%). Soft tissue trauma was present in 92.4% of the cases, and multiple body region injuries were identified in 39.3%, with the head and neck region being particularly affected in physical assault cases (53.8%). Traffic accidents were associated with multi-region injuries and moderate to severe bone fractures.

Conclusion: This study demonstrates that childhood traumatic injuries vary significantly by age and gender. Enhancements in socioeconomic, environmental, and educational interventions are essential for the prevention of pediatric trauma. The findings are considered to offer valuable guidance for improving clinical and legal processes.

Cardiopulmonary resuscitation (CPR) is a vital life-saving intervention but may result in various traumatic injuries, particularly with vigorous or prolonged efforts. Although visceral injuries are uncommon, they can be fatal. In this report, we present a rare postmortem case demonstrating multiple internal injuries-including pericardial and myocardial lacerations, liver laceration, and renal pelvis and renal vein injury-following CPR. A 70-year-old male was found unresponsive on the roadside and transported to the emergency department, where CPR was initiated due to cardiac arrest. Despite all medical interventions, resuscitation efforts were unsuccessful. Laboratory tests showed elevated cardiac and liver enzymes. A forensic autopsy was performed due to the suspicious nature of the death. External examination revealed no signs of assault; a burn over the sternum was consistent with defibrillator pad contact. CPR-related rib and sternal fractures were observed. A non-transmural myocardial laceration with pericardial injury was noted. Minor intraperitoneal hemorrhage, small hepatic and renal lacerations, and a millimetric tear in the left renal vein were identified. Histopathology revealed severe coronary atherosclerosis with ~80% luminal narrowing. Toxicology detected only therapeutic drug levels. The patient had a history of hypertension without recent cardiac follow-up. Surveillance footage showed the individual clutching his chest before collapsing. In conclusion, this case underscores that multiple internal organ injuries, although uncommon, may arise as complications of CPR. In elderly individuals, reduced tissue resilience may predispose to pericardial, myocardial, hepatic, and renal venous injuries, which should be considered in both clinical management and forensic evaluations.

Background: The objective of this study was to evaluate the diagnostic value of serum pro-adrenomedullin (pro-ADM) levels in diagnosing acute appendicitis (AA) in patients presenting to the emergency department (ED) with abdominal pain.

Methods: This prospective clinical study included patients over the age of 18 who presented to the ED with abdominal pain and were initially suspected of having appendicitis. A venous blood sample was collected from each patient upon presentation, and serum pro-ADM levels were measured. Based on laboratory and radiological evaluations, patients were categorized into two groups: those diagnosed with AA and those without AA. The AA group was further subdivided into simple and complicated AA. All statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS) for Windows, version 21.0 (SPSS Inc., Chicago, IL, USA). A p-value of <0.05 was considered statistically significant.

Results: This study included 83 adult patients with abdominal pain, of whom 44 were male (53.0%) and 39 were female (47.0%). The mean age of the patients was 32.28+-16.10 years. Serum pro-ADM levels were higher in patients with appendicitis than in those without. Setting the cut-off value for pro-ADM at 3.375 pg/mL to identify patients with appendicitis revealed a statistically significant difference between patients with and without appendicitis (p=0.002). Additionally, there was a statistically significant difference in serum pro-ADM levels when comparing the duration of ED presentation among patients with appendicitis (p<0.001).

Conclusion: Serum pro-ADM levels are elevated in patients with appendicitis; however, pro-ADM is less effective in distinguishing between simple and complicated appendicitis. Serum pro-ADM levels in patients who present to the ED within the first 24 hours of abdominal pain onset may be useful for early diagnosis.

Background: This study aims to compare the radiological and functional outcomes of long arm casting versus splinting in the nonsurgical treatment of pediatric supracondylar humerus fractures classified as Modified Gartland type I and IIa.

Methods: Between January 2021 and January 2024, 112 pediatric type I and IIa supracondylar humerus fractures (SCHFs) treated nonoperatively with long arm splinting or casting were evaluated. Baumann angle and lateral capitellohumeral angle (LCHA) were measured pre-reduction, post-reduction, and at weeks 1 and 4. Outcomes were compared using Flynn's criteria.

Results: Of the 112 patients, 55 had type I (49%) and 57 had type IIa (51%) fractures (mean age: 7.51 years; 69 males, 43 females). Fractures were equally distributed between the right and left sides (n=56 each). Fifty-eight patients were treated with long arm splinting and 54 with long arm casting. Follow-up durations were similar between groups. In the splint group, the mean Baumann angle was 72.1° pre-reduction and 73.2° at week 4; in the cast group, it was 70.7° and 73.4°, respectively. Mean LCHA increased from 43.9° to 50.8° with splinting and from 42.4° to 50.1° with casting. A statistically significant difference was not observed for loss of reduction between the splinting and casting groups (p=0.475). No statistically significant differences were observed in LCHA (p=0.175), Baumann angle values (p=0.485), or Flynn scores (p=0.768) pre- and post-reduction in type I and type IIa SCHFs.

Conclusion: Splinting and casting yielded comparable clinical and radiological outcomes in nonsurgically managed Modified Gartland type I and IIa supracondylar humerus fractures. However, splinting stands out as a strong alternative due to its ease of application and lower complication rates.

Background: Ischemia-reperfusion (I/R) injury of the lower limbs is a significant clinical challenge that can arise due to surgical procedures, thrombotic events, embolism, or traumatic vascular damage. This study aimed to evaluate the antioxidative and histo-pathological protective effects of quercetin, a potent flavonoid antioxidant, on skeletal muscle subjected to I/R injury.

Methods: Eighteen Wistar Albino rats were randomly assigned into three groups: Control (sham laparotomy), Ischemia-Reperfusion (IR) group (2 hours of ischemia followed by 2 hours of reperfusion), and Ischemia-Reperfusion plus quercetin treatment (IR-Q) group, receiving 20 mg/kg quercetin intraperitoneally 30 minutes before ischemia induction. After the experimental protocols, skeletal muscle samples were collected for biochemical assays measuring malondialdehyde (MDA) levels and superoxide dismutase (SOD) activity, as well as for histopathological examination.

Results: The IR group demonstrated a significant increase in MDA concentration compared to controls (p<0.0001), whereas administration of quercetin in the IR-Q group significantly attenuated MDA levels relative to the untreated IR group (p=0.012). SOD activity was markedly diminished in the IR group (p<0.0001) but was significantly restored in the IR-Q group compared to IR alone (p=0.012). Histological analyses revealed pronounced muscle atrophy, degeneration, leukocyte infiltration, and fiber fragmentation/hyalinization in the IR group, which were significantly alleviated by quercetin treatment (p<0.05).

Conclusion: These findings indicate that quercetin exerts a protective effect against oxidative stress and structural damage induced by ischemia-reperfusion in skeletal muscle, potentially through enhancement of endogenous antioxidant defenses. Quercetin thus holds promise as a therapeutic agent in mitigating I/R injury; however, further studies are needed to elucidate its precise mechanisms and clinical applicability.

Purpose: To compare the clinical, cosmetic, and surgical outcomes of medial-first and lateral-first open reduction approaches in the treatment of unstable pediatric supracondylar humerus fractures when closed reduction fails.

Methods: In this retrospective comparative study, 68 pediatric patients (aged 2-10 years) with Gartland Type III and IV supracondylar humerus fractures requiring open reduction were evaluated. Patients were divided into two groups based on the initial surgical approach: medial-first (n = 31) and lateral-first (n = 37). Demographic characteristics, surgical time, pin configuration, range of motion, Flynn's functional and cosmetic outcomes, and postoperative complications were compared between groups.

Results: The medial-first group demonstrated significantly shorter surgical time (55.5 +- 16.0 vs. 72.0 +- 20.2 minutes, p < 0.001) and superior cosmetic outcomes (excellent cosmetic Flynn's scores in 83.9% vs. 62.2%, p = 0.0408). The need for an additional incision was markedly higher in the lateral-first group (0 vs. 18 patients, p < 0.00001). Functional outcomes and complication rates were comparable between groups.

Conclusion: The medial-first approach in unstable pediatric supracondylar humerus fractures provides advantages in surgical efficiency and cosmetic outcomes, while minimizing the need for secondary incisions. It represents a safe and effective option for achieving stable fixation when closed reduction is unsuccessful.