Relevance of epidemiology data in trauma management

Trauma is a major cause of morbidity and mortality across the globe accounting for significant health burden.Relevance of trauma care revolves round prevention,planning and execution of safety regulations.Acquisition of the actual data regarding the type of trauma,affected age group,timings of trauma occurrence,involved part of the body constitute the initial steps in the building of the composite overview of the epidemiology of trauma.In succession,would be the measures directed towards avoidance of trauma and capacity building of trauma center.

Incorporating red blanket protocol within code crimson:Streamlining definitive trauma care amid the chaos

The care of a patient involved in major trauma with exsanguinating haemorrhage is time-critical to achieve definitive haemorrhage control,and it requires coordinated multidisciplinary care.During initial resuscitation of a patient in the emergency department(ED),Code Crimson activation facilitates rapid decisionmaking by multi-disciplinary specialists for definitive haemorrhage control in operating theatre(OT)and/or interventional radiology(IR)suite.Once this decision has been made,there may still be various factors that lead to delay in transporting the patient from ED to OT/IR.Red Blanket protocol identifies and addresses these factors and processes which cause delay,and aims to facilitate rapid and safe transport of the haemodynamically unstable patient from ED to OT,while minimizing delay in resuscitation during the transfer.The two processes,Code Crimson and Red Blanket,complement each other.It would be ideal to merge the two processes into a single protocol rather than having two separate workflows.Introducing these quality improvement strategies and coor-dinated processes within the trauma framework of the hospitals/healthcare systems will help in further improving the multi-disciplinary care for the complex trauma patients requiring rapid and definitive haemorrhage control.

Current role of extracorporeal membrane oxygenation for the management of trauma patients:Indications and results

Extracorporeal membrane oxygenation(ECMO)has emerged as a vital circulatory life support measure for patients with critical cardiac or pulmonary conditions unresponsive to conventional therapies.ECMO allows blood to be extracted from a patient and introduced to a machine that oxygenates blood and removes carbon dioxide.This blood is then reintroduced into the patient’s circulatory system.This process makes ECMO essential for treating various medical conditions,both as a standalone therapy and as adjuvant therapy.Veno-venous(VV)ECMO primarily supports respiratory function and indicates respiratory distress.Simultaneously,veno-arterial(VA)ECMO provides hemodynamic and respiratory support and is suitable for cardiac-related complications.This study reviews recent literature to elucidate the evolving role of ECMO in trauma care,considering its procedural intricacies,indications,contraindications,and associated complications.Notably,the use of ECMO in trauma patients,particularly for acute respiratory distress syndrome and cardiogenic shock,has demonstrated promising outcomes despite challenges such as anticoagulation management and complications such as acute kidney injury,bleeding,thrombosis,and hemolysis.Some studies have shown that VV ECMO was associated with significantly higher survival rates than conventional mechanical ventilation,whereas other studies have reported that VA ECMO was associated with lower survival rates than VV ECMO.ECMO plays a critical role in managing trauma patients,particularly those with acute respiratory failure.Further research is necessary to explore the full potential of ECMO in trauma care.Clinicians should have a clear understanding of the indications and contraindications for the use of ECMO to maximize its benefits in treating trauma patients.

Mechanical Eye Trauma Epidemiology, Prognostic Factors, and Management Controversies—An Update

Purpose of Review: The management of eye injuries is both difficult and argumentative. This study attempts to highlight the management of ocular trauma using currently available information in the literature and author experience. This review presents a workable framework from the first presentation, epidemiology, classification, investigations, management principles, complications, prognostic factors, final visual outcome and management debates. Review Findings: Mechanical ocular trauma is a leading cause of monocular blindness and possible handicap worldwide. Among several classification systems, the most widely accepted is Birmingham Eye Trauma Terminology (BETT). Mechanical ocular trauma is a topic of unsolved controversy. Patching for corneal abrasion, paracentesis for hyphema, the timing of cataract surgery and intraocular lens implantation are all issues in anterior segment injuries. Regarding posterior segment controversies, the timing of vitrectomy, use of prophylactic cryotherapy, the necessity of intravitreal antibiotics in the absence of infection, the use of vitrectomy vs vitreous tap in traumatic endophthalmitis is the issues. The pediatric age group needs to be approached by a different protocol due to the risk of amblyopia, intraocular inflammation, and significant vitreoretinal adhesions. The various prognostic factors have a role in the final visual outcome. B scan is used to exclude R.D, Intraocular foreign body (IOFB), and vitreous haemorrhage in hazy media. Individual surgical strategies are used for every patient according to the classification and extent of the injuries. Conclusion: This article examines relevant evidence on the management challenges and controversies of mechanical trauma of the eye and offers treatment recommendations based on published research and the authors’ own experience.

Pelvic fractures in blunt trauma patients:A comparative study

BACKGROUND Pelvic fractures(PF)with concomitant injuries are on the rise due to an increase of high-energy trauma.Increase of the elderly population with age related comorbidities further complicates the management.Abdominal organ injuries are kindred with PF due to the proximity to pelvic bones.Presence of contrast blush(CB)on computed tomography in patients with PF is considered a sign of active bleeding,however,its clinical significance and association with outcomes is debatable.AIM To analyze polytrauma patients with PF with a focus on the geriatric population,co-injuries and the value of contrast blush.METHODS This retrospective cohort study included 558 patients with PF admitted to level 1 trauma center(01/2017-01/2023).Analyzed variables included:Age,sex,mechanism of injury(MOI),injury severity score(ISS),Glasgow coma scale(GCS),abbreviated injury scale(AIS),co-injuries,transfusion requirements,pelvic angiography,embolization,laparotomy,orthopedic pelvic surgery,intensive care unit and hospital lengths of stay,discharge disposition and mortality.The study compared geriatric and non-geriatric patients,patients with and without CB and abdominal co-injuries.Propensity score matching was implemented in comparison groups.RESULTS PF comprised 4%of all trauma admissions.89 patients had CB.286(52%)patients had concomitant injuries including 93(17%)patients with abdominal co-injuries.Geriatric patients compared to non-geriatric had more falls as MOI,lower ISS and AIS pelvis,higher GCS,less abdominal co-injuries,similar CB and angio-embolization rates,less orthopedic pelvic surgeries,shorter lengths of stay and higher mortality.After propensity matching,orthopedic pelvic surgery rates remained lower(8%vs 19%,P<0.001),hospital length of stay shorter,and mortality higher(13%vs 4%,P<0.001)in geriatric patients.Out of 89 patients with CB,45(51%)were embolized.After propensity matching,patients with CB compared to without CB had more pelvic angiography(71%vs 12%,P<0.001),higher embolization rates(64%vs 22%,P=0.02)and comparable mortality.CONCLUSION Half of the patients with PF had concomitant co-injuries,including abdominal co-injuries in 17%.Similarly injured geriatric patients had higher mortality.Half of the patients with CB required an embolization.

Addressing trauma,post-traumatic stress disorder,and posttraumatic growth in breast cancer patients

BACKGROUND Breast cancer(BC)is a common cancer among females in Africa.Being infected with BC in Africa seems like a life sentence and brings devastating experiences to patients and households.As a result,BC is comorbid with trauma,post-traumatic stress disorder(PTSD),and post-traumatic growth(PTG).AIM To identify empirical evidence from peer-reviewed articles on the comorbidity trajectories between BC and trauma,BC and PTSD,and BC and PTG.METHODS This review adhered to the PRISMA guidelines of conducting a systematic review.Literature searches of the National Library of Medicine,Scopus,PubMed,Google Scholar,and Scopus databases were conducted using search terms developed for the study.The search hint yielded 769 results,which were screened based on inclusion and exclusion criteria.At the end of the screening,24 articles were included in the systematic review.RESULTS BC patients suffered trauma and PTSD during the diagnosis and treatment stages.These traumatic events include painful experiences during and after diagnosis,psychological distress,depression,and cultural stigma against BC patients.PTSD occurrence among BC patients varies across African countries,as this review disclosed:90%was reported in Kenya,80%was reported in Zimbabwe,and 46%was reported in Nigeria.The severity of PTSD among BC patients in Africa was based on the test results communicated to the patients.Furthermore,this review revealed that BC patients experience PTG,which involves losing,regaining,and surrendering final control over the body,rebuilding a personified identity,and newfound appreciation for the body.CONCLUSION Patients with BC undergo numerous traumatic experiences during their diagnosis and treatment.Psychological interventions are needed in SSA to mitigate trauma and PTSD,as well as promote PTG.

Comprehensive epidemiological assessment of trauma incidents at a level I trauma center

BACKGROUND The continuous development of social and economic progress and ongoing enhancement of infrastructure construction has led to drastic changes in the occurrence of trauma.AIM To analyze the epidemiological characteristics of trauma in Lanzhou City to provide theoretical references for improving quality of trauma care.METHODS A retrospective analysis of clinical data from 16585 trauma patients treated at the First Hospital of Lanzhou University Trauma Center from November 1,2021 to October 31,2023 was conducted.Data including age,sex,time of trauma,cause of trauma,and major injured body parts were statistically analyzed.RESULTS A total of 18235 patients were admitted,with complete data for 16585 cases.Of these,9793 were male and 6792 were female(male-to-female ratio of 1.44:1).The peak times for trauma occurrence were 10 AM-12 PM and 6-10 PM,and the peak months were from May to October.The leading causes of trauma were falls(45.32%),other trauma(15.88%),road traffic accidents(15.15%),violence(10.82%),cutting/stabbing(9.41%),mechanical injuries(2.65%),winter sports injuries(0.36%),animal bites(0.22%),burns(0.09%),and electrical injuries(0.02%).The distribution of majorly injured body parts showed statistical significance,with limbs/skin being the most affected followed by the head/neck,chest/abdomen,and back.CONCLUSION Medical institutions and government agencies can implement preventive measures and policies based on the characteristics of trauma determined in this study to enhance the quality and level of trauma care.

Predictors of visual outcome in traumatic cataract

Traumatic cataract resulting from open- or closed-globe ocular trauma is one of the most common causes of blindness. Visual outcome is unpredictable because this is not determined solely by the lens. There is a lack of a standard classification, investigations, and treatment guidelines related to the outcome, with considerable debate regarding predictive models. We review the predictors of visual outcome following surgical treatment of traumatic cataracts, which may act as a guide to clinicians.

Study on cumulative effects of biological craniocerebral trauma under repeated blast

Repeated blast impacts on personnel in explosive environments can exacerbate craniocerebral trauma.Most existing studies focus on the injury effects of a single blast,lacking in-depth analysis on the injury effects and cumulative effects of repeated blasts.Therefore,rats were used as the experimental samples to suffer from explosion blasts with different peak air overpressures(167 kPa~482 kPa)and varying number of repeated blasts.The cumulative effect of craniocerebral trauma was most pronounced for moderate repeated blast,showing approximately 95%increase of trauma severity with penta blast,and an approximately 85%increase of trauma severity with penta minor blast.The cumulative effect of craniocerebral trauma from severe,repeated blast has a smaller rate of change compared to the other two conditions.The severity of trauma from penta blast increased by approximately 69%compared to a single blast.Comprehensive physiological,pathological and biochemical analysis show that the degree of neurological trauma caused by repeated blasts is higher than that of single blasts,and the pathological trauma to brain tissue is more extensive and severe.The trauma degree remains unchanged after double blast,increases by one grade after triple or quadruple blast,and increases by two grades after penta blast.

Analysis of risk factors for trauma-induced coagulopathy in elderly major trauma patients

BACKGROUND:Trauma-induced coagulopathy(TIC)due to serious injuries significantly leads to increased mortality and morbidity among elderly patients.However,the risk factors of TIC are not well elucidated.This study aimed to explore the risk factors of TIC in elderly patients who have major trauma.METHODS:In this retrospective study,the risk factors for TIC in elderly trauma patients at a single trauma center were investigated between January 2015 and September 2020.The demographic information including gender,age,trauma parts,injury severity,use of blood products,use of vasopressors,need of emergency surgery,duration of mechanical ventilation,length of stay in the intensive care unit(ICU)and hospital,and clinical outcomes were extracted from electric medical records.Multivariate logistic regression analysis was performed to differentiate risk factors,and the performance of the model was evaluated using receiver operating characteristics(ROC)curves.RESULTS:Among the 371 elderly trauma patients,248(66.8%)were male,with the age of 72.5±6.8 years,median injury severity score(ISS)of 24(IQR:17-29),and Glasgow coma score(GCS)of 14(IQR:7-15).Of these patients,129(34.8%)were diagnosed with TIC,whereas 242(65.2%)were diagnosed with non-TIC.The severity scores such as ISS(25[20-34]vs.21[16-29],P<0.001)and shock index(SI),(0.90±0.66 vs.0.58±0.18,P<0.001)was significantly higher in the TIC group than in the non-TIC group.Serum calcium levels(1.97±0.19 mmol/L vs.2.15±0.16 mmol/L,P<0.001),fibrinogen levels(1.7±0.8 g/L vs.2.8±0.9 g/L,P<0.001),and base excess(BE,-4.9±4.6 mmol/L vs.-1.2±3.1 mmol/L,P<0.001)were significantly lower in the TIC group than in the non-TIC group.Multivariate logistic regression analysis revealed that ISS>16(OR:3.404,95%CI:1.471-7.880;P=0.004),SI>1(OR:5.641,95%CI:1.700-18.719;P=0.005),low BE(OR:0.868,95%CI:0.760-0.991;P=0.037),hypocalcemia(OR:0.060,95%CI:0.009-0.392;P=0.003),and hypofibrinogenemia(OR:0.266,95%CI:0.168-0.419;P<0.001)were independent risk factors for TIC in elderly trauma patients.The AUC of the prediction model included all these risk factors was 0.887(95%CI:0.851-0.923)with a sensitivity and specificity of 83.6%and 82.6%,respectively.CONCLUSION:Higher ISS(more than 16),higher SI(more than 1),acidosis,hypocalcemia,and hypofibrinogenemia emerged as independent risk factors for TIC in elderly trauma patients.

Severe acute pancreatitis complicated with intra-abdominal infection secondary to trauma:A case report

BACKGROUND Pancreatic trauma(PT)is rare among traumatic injuries and has a low incidence,but it can still lead to severe infectious complications,resulting in a high mortality rate.Acute pancreatitis(AP)is a common complication after PT,and when combined with organ dysfunction and sepsis,it will result in a poorer prognosis.CASE SUMMARY We report a 25-year-old patient with multiple organ injuries,including the pancreas,due to abdominal trauma,who developed necrotising pancreatitis secondary to emergency caesarean section,combined with intra-abdominal infection(IAI).The patient underwent performed percutaneous drainage,pancreatic necrotic tissue debridement,and abdominal infection foci debridement on the patient.CONCLUSION We report a case of severe AP and IAI secondary to trauma.This patient was managed by a combination of conservative treatment such as antibiotic therapy and fluid support with surgery,and a better outcome was obtained.

A finite element model of the eye matched with in vitro experiments for the prediction of traumatic retinal detachment

This study aimed to conduct finite element(FE)analysis matched with an in vitro experiment to analyze traumatic retinal detachments(TrRD)resulting from blunt trauma and provide stress and strain thresholds to predict the occurrence of TrRD.The in vitro experiment was performed on forty-eight porcine eyes using a pendulum device.We examined dynamic mechanical responses at four energy levels.A FE model,based on experimental results and published data,was used to simulate TrRD.Fifty-one additional eyes underwent immediate pathological examination following blunt impact.A dynamic variation of velocities was observed post-impact,displaying an approximate cosine oscillation-attenuation profile.Energy absorption increased as the initial energy and differed significantly at four energy levels(p<0.001).FE simulation showed a peak strain of 0.462 in the anterior vitreous body and a peak stress of 1.408 MPa at the cornea at the high-energy level.During the energy transfer,the stress was initially observed in retinal region along the impact direction at the separation.TrRD were observed in injured eyes,where a few detachments were detected in control eyes.Correlations were performed between the proportion of pathological outcomes and FE results.In conclusion,this study suggests that stress contributes to the development of retinal detachment,providing an indicator to distinguish the occurrence of TrRD.

Anesthetic Management of Neck Trauma with Traumatized Airway: A Case Report and Review

Neck trauma with a traumatized airway can be challenging for airway management, as the neck is a vital structure. Case Report: We are reporting on a 33-year-old male worker who suffered an industrial accident. A steel cord severely hit his neck. He was brought to our ER immediately. Upon arrival, he was conscious with stable vital signs. A physical examination revealed that his Adam’s apple was penetrated, and the adjacent soft tissue and structures were visible. A CT scan showed an anterior and left lateral neck penetrating injury with an open wound, exposure of the thyroid cartilage, a left thyroid cartilage fracture, and pneumoderma. He was urgently taken to the operating theater for airway stabilization and underwent six hours of exploration of the laryngopharyngeal cavity and closure of the laryngopharyngeal defect. He was then sent to the ICU. After two months in the hospital, he regularly follows up in the outpatient department. Conclusion: Effective decision-making for neck trauma with a compromised airway is crucial to ensure the patient’s safety.

Principles and Techniques of Post-Traumatic Rhinoplasty: A Review of the Literature

Post-traumatic rhinoplasty is the surgical treatment of the complex functional and aesthetic sequelae of nasal trauma. Correcting a post-traumatic nose is a challenging task, requiring the surgeon to employ a range of techniques and grafts to adequately address the deformities observed. The results of our research show that restoring pre-traumatic form and function remains complex, although many guidelines have been established to refine and optimize the management of the after-effects of nasal trauma. But it is achievable with the right techniques. The objective of our review is to highlight the various post-traumatic nasal sequelae, describe the fundamental principles in the field of post-traumatic rhinoplasty and provide the surgeon with the various existing surgical techniques and strategies so that he or she can make an appropriate choice for the patient.

Risk factors for early death in severe non-brain- injured trauma patients

Severe trauma is one of the main causes of premature death,posing a significant challenge to public health systems.[1]At present,there is a lack of universally accepted guidelines for rapid detection of life-threatening severe trauma,[2]and the accuracy of existing prognostic models in predicting early death is limited.[3,4]Severe non-brain-injured trauma(SNT)patients account for approximately 70%of all trauma-related deaths.Moreover,there is a lack of studies on early death in SNT patients.[5]This study aims to identify risk factors associated with early death(≤72 h post-admission)in SNT patients.

Pharmacological interventions targeting the microcirculation following traumatic spinal cord injury

Traumatic spinal cord injury is a devastating disorder chara cterized by sensory,motor,and autonomic dysfunction that seve rely compromises an individual's ability to perform activities of daily living.These adve rse outcomes are closely related to the complex mechanism of spinal cord injury,the limited regenerative capacity of central neurons,and the inhibitory environment fo rmed by traumatic injury.Disruption to the microcirculation is an important pathophysiological mechanism of spinal cord injury.A number of therapeutic agents have been shown to improve the injury environment,mitigate secondary damage,and/or promote regeneration and repair.Among them,the spinal cord microcirculation has become an important target for the treatment of spinal cord injury.Drug inte rventions targeting the microcirculation can improve the microenvironment and promote recovery following spinal cord injury.These drugs target the structure and function of the spinal cord microcirculation and are essential for maintaining the normal function of spinal neuro ns,axons,and glial cells.This review discusses the pathophysiological role of spinal cord microcirculation in spinal cord injury,including its structure and histopathological changes.Further,it summarizes the progress of drug therapies targeting the spinal cord mic rocirc ulation after spinal cord injury.

Shock index and its variants as predictors of mortality in severe traumatic brain injury

BACKGROUND The increase in severe traumatic brain injury(sTBI)incidence is a worldwide phenomenon,resulting in a heavy disease burden in the public health systems,specifically in emerging countries.The shock index(SI)is a physiological parameter that indicates cardiovascular status and has been used as a tool to assess the presence and severity of shock,which is increased in sTBI.Considering the high mortality of sTBI,scrutinizing the predictive potential of SI and its variants is vital.AIM To describe the predictive potential of SI and its variants in sTBI.METHODS This study included 71 patients(61 men and 10 women)divided into two groups:Survival(S;n=49)and Non-survival(NS;n=22).The responses of blood pressure and heart rate(HR)were collected at admission and 48 h after admission.The SI,reverse SI(rSI),rSI multiplied by the Glasgow Coma Score(rSIG),and Age multiplied SI(AgeSI)were calculated.Group comparisons included Shapiro-Wilk tests,and independent samples t-tests.For predictive analysis,logistic regression,receiver operator curves(ROC)curves,and area under the curve(AUC)measurements were performed.RESULTS No significant differences between groups were identified for SI,rSI,or rSIG.The AgeSI was significantly higher in NS patients at 48 h following admission(S:26.32±14.2,and NS:37.27±17.8;P=0.016).Both the logistic regression and the AUC following ROC curve analysis showed that only AgeSI at 48 h was capable of predicting sTBI outcomes.CONCLUSION Although an altered balance between HR and blood pressure can provide insights into the adequacy of oxygen delivery to tissues and the overall cardiac function,only the AgeSI was a viable outcome-predictive tool in sTBI,warranting future research in different cohorts.

Enhancing the clinical relevance of haemorrhage prediction models in trauma

We read with interest the recent systematic reviewaArtificial intelligence and machine learning for hemorrhagic trauma careoby Peng et al.[1],which evaluated literature on machine learning(ML)in the management of traumatic haemorrhage.We thank the authors for their contribution to the role of ML in trauma.

Trauma to the solid abdominal organs:The missed dark box of colonoscopy

Colonoscopy is an integral part of the lower bowel care and is generally considered a potentially safe diagnostic and therapeutic procedure performed as a daycare outpatient procedure.Colonoscopy is associated with different complications that are not limited to adverse events related to the bowel preparation solutions used,the sedatives used,but to the procedure related as well including bleeding and perforation.Injuries to the extra-luminal abdominal organs during colonoscopy are uncommon,however,serious complications related to the procedure have been reported infrequently in the literature.Life threatening injuries to the spleen,liver,pancreas,mesentery,and urinary bladder have been reported as early as in mid-1970s.These injuries should not be overlooked by clinicians and endoscopists.Steadily increasing abdominal pain,abdominal distension,and hemodynamic instability in absence of rectal bleeding should raise the possibility of severe organ injury.Splenic and hepatic injury following colonoscopy are usually serious and may be life threatening.Although conservative management may help,yet they usually need interventional radiology or surgical intervention.Acute pancreatitis following colonoscopy is usually mild and is mostly managed conservatively.The mechanism of abdominal organ injuries during colonoscopy is not fully understood,however many risk factors have been identified,which can be classified as-organ related,procedure related,and local abdominal factors.Difficult colonoscopy and prior intra-abdominal adhesions are probably the most relevant risk factors for these injuries.Left lateral position,avoidance of looping and excessive force during the procedure would probably reduce the risk of such injuries.

Laparoscopic surgery for trans-anal barotrauma: a case report

Trans-anal barotrauma resulting from the use of air guns is rare in the emergency department.Early diagnosis and timely treatment can yield a good prognosis.The first published case of trans-anal barotrauma caused by a manually operated force pump was reported in 1904.[1]Colorectal injuries have the potential to progress to high-mortality complications,such as abdominal infection,peritonitis,and septic shock.[2,3]Herein,we report a case of trans-anal barotrauma in a man who presented with pneumoperitoneum,pneumomediastinum,and pneumoscrotum.We performed laparoscopic exploration and loop ileostomy on this patient.