trauma

Trauma is the leading cause of death in developing countries. Head and neck trauma is one of the most common causes of referral to the emergency department following injuries resulting from motor vehicle accidents, sports, fights, and falls from heights. Cervical spine injuries account for 2-3% of trauma patients. This study was conducted to compare the accuracy of plain radiography and CT scan in diagnosing cervical spine injuries in trauma patients in Shahroud city.

This descriptive-analytical study was conducted using a cross-sectional method and convenient sampling on 115 cervical spine trauma victims referred to the emergency department of Imam Hossein (AS) Hospital in Shahroud in 2018-2019. Data were collected using a demographic information checklist. After collection, the data were entered into SPSS version 23, WinPepi version 11.65, and MEDCALC statistical software and analyzed using descriptive-analytical statistics.

In this study, the results showed that out of 115 patients with cervical spine injury, 59.1% were male and 40.9% were female. The mean age of the patients was 39.8 ± 15.3 years. Car accident, rollover and motorcycle accident were the most frequent mechanisms of injury to the patients with 39.1, 24.3 and 20.9% respectively. The sensitivity, specificity, positive and negative predictive value, positive and negative likelihood ratio and area under the Ruck curve for simple radiographs read by an emergency medicine specialist were 55.56, 97.17, 26.5, 96.62, 19.63, 0.46 and 76% respectively. Also, the sensitivity, specificity, positive and negative predictive value, positive and negative likelihood ratio, and area under the Rock curve for plain radiographs read by a radiologist were 0, 0.33, 66.67, 100, 100, 97.25, and 83 percent, respectively.

According to the results of the study, it can be stated that plain radiography cannot be considered an appropriate tool to rule out cervical vertebrae injuries caused by trauma. Also, taking radiography may be a waste of time for faster and better diagnosis, as well as a waste of money without achieving appropriate results, given the higher accuracy of CT scanning. Therefore, it is recommended to use CT scanning in case of clinical suspicion or if the radiography images do not meet the standards.

Abdominal trauma, including blunt abdominal trauma (BAT) and penetrating abdominal trauma (PAT), leads to various complications in patients. For this reason, this study aimed to compare patterns and outcomes of patients with BAT and PAT.

In this retrospective study, patients who were referred to the emergency room were included. Initially, the researchers designed a researcher-made checklist and entered the patients' information into this checklist. In this study, the records of patients who were admitted to the hospital emergency department as temporary or permanent hospitalizations with a diagnosis of abdominal trauma were included, and information related to the patients' records was extracted. The researchers extracted the patients' information and entered it into SPSS software version 18, and then the data were analyzed.

In the BAT group, 70.2% of the patients were male, 68.8% were in the 21-40 years age group, 63.5% of the patients were in the Improve health status, 35.1% were hospitalized due to traffic accident, 81.7% had multiple traumas, and 51.9% had Glasgow Coma Scale (GCS)  between 3-6. Also, in the PAT group, 78.2% of the patients were male, 82.1% were in the 21-40 years age group, 46.2% of the patients were in the Improve health status, 32.1% were hospitalized due to traffic accident, 92.3% had multiple traumas, and 35.9% had GCS between 3-6. Also, according to the findings, there was a significant difference between the patients of the two groups in terms of time of injury, health status, and multiple traumas.

Given that the presence of multiple traumas and GCS scores have been associated with patient mortality, it is recommended that these two criteria be examined more carefully when providing clinical care to patients.

Traumatic aortic injuries are predominantly caused by high-impact motor vehicle collisions, often due to sudden deceleration. This report presents a rare case of localized dissection and partial aortic arch rupture resulting from a fire suppressant explosion.

A 36-year-old male was transferred following a fire suppressant explosion at a copper smelter. He presented with central chest pain and stable hemodynamics, with no signs of external chest trauma. Computed tomography (CT) imaging revealed a localized dissection of the ascending aorta and a partial rupture of the aortic arch, in addition to fractures in the hand and foot caused by suppressant debris. The patient subsequently became hemodynamically unstable and required urgent surgical intervention. He underwent ascending aortic and aortic arch repairs. Postoperatively, his course was complicated by a pulmonary embolism, which was managed medically. He was eventually discharged after recovering from his injuries.

Aortic injuries resulting from small-scale blasts can occur. Successful management relies on a high index of suspicion and timely surgical intervention.

Previous studies have shown a reduction in pediatric trauma volume during COVID19, but many have looked at a limited number of facilities, analyzed a narrow timeframe, or both. The objective of this analysis was to assess the impact of COVID-19 on pediatric trauma volume for a statewide sample during 2020. Based on previous literature, researchers hypothesized a reduction in volume during the implementation of these policies.

Retrospective cross-sectional analysis of five years (2016 – 2020) of Indiana’s statewide trauma patient registry. Patients under age 15 were included. Those who were transfer patients or missing key data were excluded. In total, 10,926 patients were included in analysis. Baseline years (2016 – 2019) were compared to 2020 to estimate the impact of COVID-19 on pediatric trauma volume.

Overall monthly volume of pediatric traumas were lower than baseline in March and April 2020 (though not significantly), but rebounded quickly and were above trend in the latter half of the year. Injury patterns differed in both mechanism and location from previous years. Gunshot wounds were more prevalent than previous years, while the volume of non-accidental traumas fell slightly. Injuries that occurred in private residences rose significantly, while fewer took place in schools.

Results indicated an initial drop in injury volume consistent with previous findings, but these were offset by increased volume in the second half of 2020. The growth in gun violence is concerning and warrants additional research. Changes in behavior in response to the pandemic such as reduced participation in sports and use of playgrounds, reduced driving, and increased time at home help explain the changes observed in injury patterns. These findings emphasize the continued need for pediatric trauma care during the pandemic.

To describe the epidemiological profile, clinical characteristics, and visual outcome of pediatric ocular trauma in Tunisia.

In this retrospective cohort study, we reviewed the charts of 398 children younger than 16 years of age, presenting to the Emergency Department “B” of Hedi Rais Institute of Ophthalmology, for ocular trauma. The study period was between January 1, 2013, and January 1, 2019. The final best‑corrected visual acuity (BCVA) was measured at the end of the follow‑up period, which was 6 months. We used the Chi‑squared test to compare the two groups of final visual acuities (good vs. poor visual outcome) for different prognostic factors. The ocular trauma score (OTS) and the pediatric OTS (POTS) were calculated for each child. We used the Cohen’s kappa coefficient to evaluate the agreement between our final visual acuities using OTS and POTS.

The mean age was 7.95 years with a sex ratio (males to females) of 5.32. Closed‑globe injury (CGI) was found in 321 eyes, while 101 eyes had open‑globe injury (OGI). Injuries were bilateral in 24 children. The majority of injuries occurred at home. The predominant mechanism of injury was fall in CGI and tree branch in OGI. Initial and final BCVA were predominantly ≤0.3 logMAR in both CGI and OGI. OTS category 3 and POTS category 2 were the most common. Factors associated with poor prognosis included delay to consultation >24 h (P = 0.0001); initial BCVA >1 logMAR (P = 0.0001); OGI (P = 0.001); size of injury ≥5 mm (P = 0.01); zone III in OGI (P = 0.032); endophthalmitis (P = 0.001); OTS 1 and 2 (P = 0.01); POTS 1 (P = 0.0001); and the following associated lesions: cataract (P = 0.006), retinal detachment (P = 0.03), and intraocular foreign body (P = 0.03). We found that both OTS (P = 0.001) and POTS (P = 0.003) were predictive of the final BCVA, with a moderate agreement between them (Cohen’s kappa = 0.56).

Studying the epidemiological profile and identifying the risk factors for poor visual outcome of pediatric ocular trauma are necessary to implement preventive measures. A thorough clinical evaluation and close patient follow‑up are crucial for identifying these risk factors. Both OTS and POTS were predictive of the final visual outcome. POTS has the advantage of bypassing the initial visual acuity which may be difficult to assess in children.

Urinary bladder injuries present in emergencies in the set up of road traffic accidents with blunt trauma to the abdomen. Bladder injury can be extraperitoneal, intraperitoneal, or mixed. Intraperitoneal bladder ruptures comprise 15% of all bladder injuries. The most common feature of bladder rupture is hematuria, which can be either microscopic or gross. We hereby present a case of isolated urinary bladder intraperitoneal rupture following a roadside accident due to its rarity.

The 29-year-old male was brought to emergency with an alleged history of Roadside accidents with a distended abdomen. Hematuria is present on Foley’s catheterization. X-ray of the pelvis was normal. Contrast-enhanced computerized tomography whole abdomen showed bladder rupture. The patient was taken up for exploratory laparotomy and bladder repair. The postoperative period was uneventful.

In blunt abdominal trauma, up to 90% of bladder injuries are often associated with pelvic fractures. Isolated traumatic bladder rupture is rare. In intraperitoneal bladder rupture, urine gets collected in the peritoneal cavity. Intraperitoneal bladder rupture requires exploratory laparotomy and the site of rupture is treated by suturing the bladder in two layers with absorbable sutures. Postoperative care is focused on preventing urinary catheter-associated infections.

This case report highlights the rare occurrence of isolated bladder rupture in cases of Road traffic accidents. Our patient recovered uneventfully after exploratory laparotomy and surgical repair.

Acromion, lateral projection of scapular spine, fracture is an uncommon injury which is often diagnosed late. Though, usually managed conservatively, the indications for surgery in these fractures are very specific. We are reporting on a 56-year-old active woman with an isolated displaced base of acromion fracture by tension- band wire fixation which resulted into uneventful union, and obtained good shoulder Constant Score and UCLA shoulder score . (( Acromion, lateral projection of scapular spine, fracture is an uncommon injury which is often diagnosed late. Though, usually managed conservatively, the indications for surgery in these fractures are very specific. We are reporting on a 56-year-old active woman with an isolated displaced base of acromion fracture by tension- band wire fixation which resulted into uneventful union, and obtained good shoulder Constant Score and UCLA shoulder score Acromion, lateral projection of scapular spine, fracture is an uncommon injury which is often diagnosed late. Though, usually managed conservatively, the indications for surgery in these fractures are very specific. We are reporting on a 56-year-old active woman with an isolated displaced base of acromion fracture by tension- band wire fixation which resulted into uneventful union, and obtained good shoulder Constant Score and UCLA shoulder score . . ))

Traumatic injuries are among the leading causes of visits to the pediatric emergency department (PED).

This study aims to evaluate the pediatric approach to musculoskeletal trauma in children to determine whether the routine use of X-rays can be reduced by encouraging the use of ultrasound.

This retrospective observational study included children aged 0 - 18 years admitted to the PED of the Policlinico A. Gemelli with a diagnosis of musculoskeletal trauma from January 2017 to December 2021. Patients were divided into two groups based on the presence of fractures identified through radiological examinations: "Fracture Yes" and "Fracture No." Data on X-rays performed were categorized according to the site of trauma.

A total of 5,972 children were enrolled. The most notable findings concern the regions of trauma. Among 1,273 patients who underwent X-rays of the hand region, 617 (48%) showed fractures, and 656 (51%) did not. Of the 744 X-rays performed for the foot region, 235 (31%) revealed fractures, while 509 (68%) were negative for fractures. In the upper limbs region, 1,334 X-rays were performed, with 1,079 (80%) identifying fractures and 255 (20%) showing no fractures. For the lower limbs region, 479 X-rays were conducted, 204 (42%) of which revealed fractures, while 275 (58%) were negative for fractures. All these results demonstrated statistically significant differences (P < 0.05).

Despite the limitations of the study's retrospective design and its single-center setting, the findings highlight a high prevalence of X-rays in the hand and upper limb regions, often with positive results. In contrast, radiography of the lower limbs and feet frequently yielded negative findings, suggesting potential overuse. Future research should investigate the clinical utility of musculoskeletal ultrasound as an alternative imaging modality to minimize unnecessary radiation exposure in pediatric patients.

Hand injuries from firecrackers require precise repair, especially when the thumb is involved due to its crucial role in grasping, pinching, and daily activities. In this study, we evaluate the outcomes of selective soft tissue pollicization in a patient who sustained fireworks injuries, including multiple wounds, amputations with bone exposure, digital nerve transections, and extensive soft tissue damage across several fingers. Numerous methods exist to achieve optimal results, each with benefits and downsides. Through comprehensive assessment and meticulous surgical technique, we present the therapeutic management of a case that necessitated a selective approach to reconstruction, with focusing on preserving neurovascular bundles and tendons. Post-surgery, the patient regained full sensation and functional movement in the first metacarpophalangeal and interphalangeal joints, closely mirroring a normal thumb, enabling effective grasping, pinching, and opposition movements for daily tasks.

Spinal cord trauma (SCT) is one of the types of traumas that causes many complications. In order to identify these complications, it is necessary to check the results of laboratory tests and radiology tests.

This study was conducted with the aim of determining the relationship between serum lactate of patients and the severity of injury caused in trauma patients. The study included 190 hospitalized patients with SCT. The researchers’ enrolled patients with SCT injuries who met the inclusion criteria by visiting the hospital daily.

Results showed that out of 190 examined patients, 32 (16.8%) patients died and 158 (83.2%) were discharged from the hospital. Also, 160 (84.2%) of the patients were male, and 30 (15.8%) of them were female. Regarding the injury mechanism, it was shown that 98 (51.6%) of the patients were due to road traffic accidents, 33 (17.4%) of the patients were due to falls, and only 8 (4.2%) were due to sports accidents. Also, the result showed the amount of lactate in the survivors group was 1.2 (0.8-2.6), and in the non-survivors group it was 3.9 (2.8-6.6).

Considering that there were laboratory changes in patients with TSCI, it is recommended to use the results of this study as a clinical guide for doctors.

This study aimed to evaluate pulpal responses to sensibility tests after traumatic dental injuries and determine the sensitivity and specificity of these tests over time. Twenty-one patients with 51 traumatized teeth were included. After excluding 12 teeth during follow-ups, 39 teeth remained for final assessment. Pulp sensibility responses (electric pulp test (EPT), cold test, and heat test) were recorded at the initial visit and two weeks, one month, two months, and 12 months post-injury. The sensitivity and specificity of the tests were calculated using the response of traumatized teeth in the 12-month follow-up as the reference standard. Lateral luxation was the most common injury. Among the 25 teeth with an initial negative response to sensibility tests, 4 concussions, 8 subluxations, 3 lateral luxation, 1 root fracture, and 1 uncomplicated crown fracture cases regained pulpal sensibility within one year. None of the immature teeth developed pulpal necrosis, whereas 7 out of 26 mature teeth did, primarily in lateral luxation cases. The specificity of the EPT increased from 0.47 on the first visit to 0.77 at two months and 0.83 at one year, with cold and heat tests showing similar trends. The sensitivity of cold and heat tests reached 1.0 at two months. Sensibility tests improved over time in traumatized teeth, with 17 out of 25 initially non-responsive teeth recovering within a year. No immature teeth developed necrosis. The specificity of all sensibility tests reached 0.83 in 12 months, and cold/heat test sensitivity reached 1.0 at two months.

Although massive transfusion protocol (MTP) has been used extensively in the treatment of patients with bleeding trauma, its actual efficacy remains unknown. This umbrella review of systematic reviews and meta-analyses aims to update the evidence and assess the impact of implementing MTP/ whole blood transfusion on the mortality of trauma patients.

Data sources: This umbrella review searched Medline (via Ovid), Embase, PubMed, Cochrane Library, CINAHL databases, JBISRIR, Epistemonikos, EPPI-Centre, CRD, and PROSPERO for possible systematic reviews from inception until October 2023.  Study eligibility criteria, participants, and interventions: Reviews that reported data comparing different types of massive blood perfusion were included. The quality of studies was evaluated using the Joanna Briggs Institute (JBI) critical appraisal tool. Our study outcomes, 30-day mortality, and 24-hour mortality, were re-analyzed using Comprehensive Meta-Analysis Software (CMA 3.0).

Thirty studies met the eligibility criteria. Eventually, we included eight studies in the current meta-analysis. The calculated odds ratio (OR) and 95% confidence interval (CI) for 30-day mortality in MTP and non-MTP comparison was OR = 0.654, 95% CI: 0.576, 0.741, P-value <0.001, and similarly, when comparing the whole blood group and blood component group, significant differences were found between the groups in terms of 24h-mortality 0.763, (95% CI: 0.608, 0.957), and P-value = 0.020. The results showed low heterogeneity among the studies.

Our results support that MTP decreases 30-day mortality compared to non-MTP. Furthermore, our analysis showed that whole blood transfusion decreases the odds of 24-hour mortality compared to blood components.

This report highlights the critical position of ML and DL in revolutionizing the treatment of spinal injuries. These cutting-edge technologies are improving diagnostic approaches for evaluating vertebral fractures and significantly broadening the capability to predict fractures in both the short and long term. Their impact is particularly profound in enabling precise diagnoses and effectively distinguishing between non-cancerous and cancerous fractures. While less frequently explored, predictive studies deliver essential comprehension into the development of vertebral collapse and the treatment-related risk influences. With their advanced computational capabilities, these approaches perfectly address the intricate challenges associated with spinal injuries, paving the way for genuinely personalized care strategies. As these technologies evolve, they promise to substantially contribute to the medical administration and scientific acceptance of spinal injuries. Future studies in spinal fracture care must order developing and refining prognostic algorithms through ML to elevate pre-operative and post-operative patient care.

Traumatic brain injury represents a significant public health concern that can manifest at any age. It also stands as one of the primary causes of disability and mortality in the ensuing years of a patient's life. The present study aims to discern predictors of mortality stemming from traumatic brain injury among individuals aged 18 to 45 in Isfahan City.
This retrospective cross-sectional study included all TBI adult cases (18-45 years) presented to the trauma registry (Kashani and Al-Zahra Hospitals) in Esfahan City - from September 2020 to February 2023. The data was exported into SPSS (version 16) for analysis.
A total of 1942 individuals with TBI aged 18 to 45 years were enrolled in the study. The frequency of mortality from traumatic brain injury was 482 (24.8 %) of patients During the study period (30 months). 191 (39.63%) patients with severe trauma died. When these variables were tested at multivariate logistic regression, being low GCS level, having concomitant injury, patients' condition at presentation SBP, hyperthermia during hospital stay, and high ISS Score were found to be statistically significant with p-value < 0.05 at 95% CI.
Most studies, spanning all age groups, identified the GCS, followed closely by the Injury Severity Score and accompanying injuries, as principal indicators of mortality risks. Moreover, there is a pressing need to routinely monitor adults for variations in systolic blood pressure and episodes of hyperthermia during their hospital stay.

The Kocher approach is the most commonly used technique for treating fractures in the posterior wall and column of the acetabulum. This approach requires cutting the short external rotator muscles. In many cases, it becomes impossible to repair these muscles due to inadequate tissue quality, as the pressure from the fractured bone fragments may damage them. This study aims to assess the limitations in internal and external hip rotation compared to the intact side and to evaluate changes in clinical symptoms using the Harris Hip Score (HHS).

The study involved 30 patients with acetabular fractures who underwent surgery at Taleghani Hospital between March 2021 and September 2022. Only the Kocher approach was utilized for the surgeries. The assessment tools included a goniometer to measure the internal and external rotation of the hip and the Harris Hip Score questionnaire. Patients were evaluated six months after their surgery.

All patients in the study were men, with an average age of 36 ± 2 years. The most common type of fracture observed was the posterior wall fracture, which accounted for 60% of the cases. The results revealed no statistically significant difference in the external rotation between the operated and intact hip. However, there was a significant difference in the internal rotation of the operated hip compared to the intact hip. The average score on the HHS questionnaire was 89.56, indicating a satisfactory outcome.

The degree of external rotation in the hip is not solely reliant on the short external rotator muscles; other muscles, such as the gluteus maximus, sartorius, and psoas, also influence it. However, damage to the external rotator muscles, if not repaired, can reduce hip internal rotation. The HHS was also recorded at 89/56, which falls within the acceptable range and did not indicate a statistically significant decrease.