Trauma Monthly
Volume:28 Issue: 4, Jul-Aug 2023

Trauma is one of the leading causes of mortality and morbidity worldwide. The mechanism of trauma is classified as either blunt or penetrating. Blunt trauma is due to motor vehicle-related injuries, falls, and assaults, whereas firearms and stabbings account for most penetrating injuries. Fifty percent of deaths occur within minutes of injury, resulting from massive bleeding or severe neurologic damage. This study aims to assess the Kampala Trauma Score and Trauma Injury Severity Score system with the outcome, i.e., mortality.
It is a prospective descriptive cohort study. A total of 285 patients were involved in the study. All patients suspected of having trauma were scored using TRISS and KAMPALA SCORES at arrival time. Clinical assessment, relevant blood investigations, and radiological investigations were done in the emergency department at the time of presentation in a tertiary care teaching hospital and repeated after 24 hours. The follow-up for mortality till the 30th post-trauma day was recorded. Physiological parameters at the time of initial assessment were recorded, including Systolic Blood Pressure (SBP), Glasgow Coma Scale (GCS) score, respiratory rate (RR), heart rate (HR), and oxygen saturation2. Chest X-ray, CT scan, USG abdomen and pelvis, and blood investigation were done when indicated.
Of the 285 patients eligible for the study, mortality was 21(13.57%). The area under the curve for TRISS and KTS were 0.951 and 0.980, respectively, at the time of admission and 0.955 and 0.989 after 24 hours. The diagnostic accuracy of KTS was higher than the TRISS, indicating that KTS was better at predicting mortality in trauma patients than the complex TRISS.
The Kampala Trauma Scoring System is better at predicting mortality than the Trauma Injury Severity Scoring System in trauma patients. It predicted early and late mortality better with better diagnostic accuracy than the TRISS.

This study aimed to determine the AKI prevalence and the contributing factors among trauma patients admitted to the ICU of the only level-one trauma center in south Iran.
The present study was a retrospective cohort of patients with post-traumatic AKI admitted to the intensive care units of Shahid Rajaee (Emtiaz) Trauma Hospital in Shiraz, Iran, between March 21, 2021, and February 20, 2022. The variables were obtained from the Iran Intensive Care Unit Registry program (IICUR). Demographic features (age, sex, height, weight), vital signs including heart rate, respiratory rate, temperature, blood pressure, outcome, and laboratory findings were gathered.
In total, 2271 trauma patients admitted to the ICUs were included in 398 cases (17.5%) developed with AKI. Most AKI patients, 249 (62.60%) were in stage 1 disease. Of 77(19.30%) individuals in stage 2, 72(18.10%) were in stage 3 of the disease. Most AKI patients were male, with a mean age of 52.92± 22.06 years. AKI patients were hospitalized in the intensive care unit for significantly more days than patients without AKI and were more severe regarding APACHE II and GCS (p-value <0.001).
Acute renal injury in ICU trauma patients is a common complication with significant mortality and length of hospital stay. Age, high APACHE II score, minimum systolic blood pressure, acute renal injury, and low GCS score are strong risk factors associated with mortality in intensive care unit patients. Patients with acute kidney injury are five times more likely to die.

Radio waves, such as cordless phones and wireless modems, have increased significantly. This study aimed to measure the effects of the 2.45 GHz wave on a mice's immune system's blood markers.
Seventy-two male mice were used. Mice’s were divided into one control group and two radiation-exposed groups (A and B). Then, there were two Wi-Fi modems, one plain and without an antenna, for group a mouse contact. The other was the type with two antennas; the mice in group B were brought into contact. After exposure, blood samples regarding white blood cells, monocytes, lymphocytes, and neutrophils were analyzed.
White blood cells, monocytes, lymphocytes, and neutrophils increased in the control group (P<0.001). However, these parameters significantly declined over time in the two intervention groups (P<0.001). The blood parameters of the mice in the two intervention groups exposed to various modems were similar (P>0.05).
The results indicated the interference of waves of this spectrum, mainly radio frequency, with the immune system of exposed mice. Blood cells are more susceptible to long-term exposure to Wi-Fi waves and have a downward trend in terms of number. Also, no significant difference was observed between the blood parameters of the two groups with different modems.

Exposure to traumatic occurrences followed by intrusive thoughts is Post-traumatic stress disorder (PTSD). Children and adolescents may experience this disease differently. This study aimed to assess trauma characteristics and risk factors related to PTSD in children and adolescents.

We searched online databases such as Web of Science, PubMed, Scopus, and Google Scholar from April 2013 to May 2023. Two authors separately screened, assessed, and included the studies, and senior reviewers resolved disagreement. This systematic review evaluated factors for PTSD in children and adolescent patients aged 6 to 18 years. Sample size, trauma type, severity, risk factors measure of PTSD, sex, age, and study location were included.

Risk factors for PTSD can be divided into pre-, peri-, and post-trauma risk factors. Pre-trauma factors include sex, race, ethnicity, socioeconomic status, and age. Per traumatic had the severity of the trauma, being trapped during the trauma, cumulative exposure to potentially traumatic experiences, dissociation, sexual abuse, being injured, witnessing injury or death, and bereavement. Post-trauma risk factors included low social support, peri-trauma fear, perceived life threats, social withdrawal, comorbid psychological problems, low-income family, distraction, PTSD at time 1, and thought suppression.

Characteristics such as the trauma severity or exposure level consistently can anticipate following PTSD levels. Risk factors can increase the likelihood of developing PTSD. There are concerns that someone with risk factors may develop PTSD, so it is essential to seek professional help. A mental health professional can assess your symptoms and provide treatment options. Classifying PTSD based on the type of trauma, the location, and the relationship with PTSD requires further studies.

Gunshot injuries to the head and neck usually result in severe trauma due to damage to major vessels and pose challenging surgical management. A penetrating neck injury places numerous organs at a significant risk.

Presentation: 

We present a 39-year-old female transferred to the level I trauma center due to multiple pellet injuries to the neck and jaw.

Diagnosis:

 Computed tomography (CT) angiography showed the presence of multiple metal densities, an intimal flap, and a local thrombus in the left common carotid artery.

Intervention: 

The patient underwent surgical exploration, which revealed neck hematoma and near-total transection of the left common carotid artery. She received a carotid interposition graft (CIP) using the greater saphenous vein to reconstruct the artery.

Outcomes:

 Following an uneventful recovery, the patient was discharged three days after the surgery without any neurological side effects or hematoma. A follow-up CT angiography six weeks after the discharge showed a successful graft.

 This case presents a rare scenario of a penetrating neck injury with foreign objects in zone 2, necessitating a specialized surgical approach. Therefore, it contributes to the current literature and aids surgeons in managing similar patients.

 Medial malleolar stress fractures are rare injuries resulting from excessive and repetitive stress loads on bone. The incidence rate of these stress fractures varies from 0.6% to 4.1% of all stress fractures and has been almost exclusively reported in athletes. Typical clinical presentation is a gradual onset of pain and tenderness at the medial malleolus site with a history of long-term physical activity. 

Presentation: 

A 60-year-old postmenopausal woman with a gradual onset of pain and point tenderness over the medial malleolus and a history of daily walking for several months.

Diagnosis:

 The initial anterior-posterior and lateral plain radiographs were normal. After the initial conservative medication therapy failed, magnetic resonance imaging (MRI) was obtained. It demonstrated a vertical linear zone of decreased signal intensity originating between the tibial plafond and the medial malleolar junction, which suggested medial malleolar stress fracture. 

Intervention: 

We started treatment with a short leg cast and non-weight bearing for six weeks that failed; open reduction and internal fixation were performed under general anesthesia. 

Outcomes:

 Six months postoperatively, the pain entirely resolved, and the patient returned to her regular daily physical activity and conducted plain radiographs demonstrating complete union, and no complications occurred.

 Medial malleolar stress fractures are rare injuries and might be misdiagnosed due to normal initial radiographs. They must be considered in those with gradual onset of pain and point tenderness of medial malleolus, especially with a history of long-term physical activity. Early diagnosis and surgical intervention lead to faster healing and a return to physical activity