Journal of Trauma and Injury最新文献

{"title":"Neuroleptic malignant syndrome in a cervical spinal injury patient: a case report.","authors":"Binayak Deb, Yudhyavir Singh, Shuchi Smita, Sreehari N","doi":"10.20408/jti.2025.0159","DOIUrl":"10.20408/jti.2025.0159","url":null,"abstract":"<p><p>Neuroleptic malignant syndrome (NMS) is a rare, idiosyncratic, and potentially fatal complication associated with the abrupt withdrawal of dopaminergic agents or the use of antidopaminergic medications that affect the hypothalamus and basal ganglia. Its hallmark features include severe hyperthermia, altered consciousness, skeletal muscle rigidity, and autonomic instability. We present the case of a young patient with a cervical spine injury who was admitted to the trauma intensive care unit (ICU). The patient developed a persistent high-grade fever that did not respond to standard interventions, which was ultimately attributed to NMS resulting from the administration of neuroleptic medications. Because of a high degree of clinical suspicion and the implementation of prompt therapeutic measures, the patient achieved a favorable clinical outcome. Early diagnosis and timely intervention are crucial in NMS due to its rapid clinical progression, particularly as the use of dopaminergic antagonists becomes more prevalent in ICU settings. This case highlights the diagnostic challenges of managing NMS alongside spinal trauma in the ICU, as NMS often mimics common postoperative and ICU-related complications, necessitating heightened clinical vigilance.</p>","PeriodicalId":52698,"journal":{"name":"Journal of Trauma and Injury","volume":" ","pages":"191-194"},"PeriodicalIF":0.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13328901/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148310342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric hepatic pseudoaneurysm formation following blunt and penetrating abdominal trauma: a 5-year retrospective analysis.","authors":"James Green, Christopher Bunting, Kuran Rati, Seth Cox, Mandeep Basra, Robert Hooper, Elika Kashef, Nicholas Alexander, Maryam Alfa-Wali, Neeral R Patel","doi":"10.20408/jti.2025.0219","DOIUrl":"10.20408/jti.2025.0219","url":null,"abstract":"<p><strong>Purpose: </strong>Hepatic pseudoaneurysm (HPA) is a rare but potentially life-threatening sequela of liver trauma. This study aimed to evaluate the number of children diagnosed with HPAs following blunt and penetrating liver trauma at a major trauma center in London over a 5-year period.</p><p><strong>Methods: </strong>A retrospective analysis was conducted of patients aged <18 years with liver injuries admitted to our institution between 2017 and 2022. Patients were identified through the local trauma registry. Data collected included patient demographics, imaging details (including ultrasound scanning and computed tomography [CT]), liver injury grade, and management plans.</p><p><strong>Results: </strong>Thirty-four patients were identified (mean age, 12 years; range, 1-17 years). There were 26 men (76.5%) and 8 women (23.5%). Twenty-three patients (67.6%) sustained blunt injuries, and 11 (32.4%) sustained penetrating liver injuries. Among 30 patients (excluding 4 patients who died), 18 (60.0%) underwent repeat CT imaging. CT imaging identified four HPAs (13.3%), two of which were treated with embolization. Of the 12 patients who did not undergo repeat CT, 6 (50.0%) had follow-up ultrasound scanning.</p><p><strong>Conclusions: </strong>Hepatic pseudoaneurysms following trauma are uncommon. Their management in the pediatric population presents challenges regarding follow-up imaging, particularly the use of CT. Although the absence of standardized protocols complicates surveillance strategies, an individualized approach informed by patient-specific factors is essential. Contrast-enhanced ultrasound may optimize HPA detection while minimizing radiation exposure.</p>","PeriodicalId":52698,"journal":{"name":"Journal of Trauma and Injury","volume":"39 2","pages":"137-143"},"PeriodicalIF":0.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13328891/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148354761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Selective urethral catheterization in trauma: balancing risk, need, and clinical judgment.","authors":"Christos Bartsokas, Mohammad Alsenani","doi":"10.20408/jti.2025.0268","DOIUrl":"10.20408/jti.2025.0268","url":null,"abstract":"","PeriodicalId":52698,"journal":{"name":"Journal of Trauma and Injury","volume":" ","pages":"107-109"},"PeriodicalIF":0.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13328900/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147788380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical practice guideline recommendations for orthopedic surgical management of traumatic hip fractures: a systematic review.","authors":"Tia Kalise Shutes, Kaylan Nicole Johnson, Emily Wayent Blevins, Madeline Grace Shipley, Saurabh P Mehta","doi":"10.20408/jti.2025.0105","DOIUrl":"10.20408/jti.2025.0105","url":null,"abstract":"<p><strong>Purpose: </strong>Hip fractures pose a critical orthopedic challenge, disproportionately affecting older adults and significantly compromising mobility and independence. The complexity of both the injury and the patient profile necessitates adopting best practices grounded in research evidence to optimize surgical management and recovery. This study comprehensively evaluated the quality and clinical applicability of existing clinical practice guidelines (CPGs) for the orthopedic surgical management of traumatic hip fractures and summarized key practice recommendations.</p><p><strong>Methods: </strong>A systematic literature search was performed across five databases (PubMed, CINAHL, Scopus, Embase, and PEDro) for CPGs published since January 2000. Two reviewers independently identified eligible CPGs using predefined criteria. The methodological quality of eligible CPGs was assessed using the AGREE II tool, which examines quality across the domains of scope, stakeholder involvement, rigor of development, clarity of presentation, applicability, and editorial independence. The complementary AGREE-REX tool was used to assess the guidelines' clinical relevance and applicability.</p><p><strong>Results: </strong>Six CPGs were critically appraised, and two demonstrated high methodological quality scores (2009 SIGN and 2023 NICE CPGs). Across all CPGs, there was consensus emphasizing surgical timing within 24 to 48 hours after a hip fracture. In addition, most CPGs recommended against the use of preoperative traction. Recommendations for diagnostic imaging were supported by limited high-quality evidence. Domains addressing target users' values and resource feasibility scored lowest across CPGs, diminishing implementability.</p><p><strong>Conclusions: </strong>Fewer than half of the appraised CPGs were rated high quality, and important clinical practice domains were insufficiently addressed. Orthopedic surgeons should follow recommendations to perform operative intervention within 24 to 48 hours after injury and avoid preoperative traction. The findings also underscore the need to develop CPGs with higher methodological rigor and more actionable practice recommendations.</p>","PeriodicalId":52698,"journal":{"name":"Journal of Trauma and Injury","volume":" ","pages":"110-118"},"PeriodicalIF":0.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13328903/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147823394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of diagnostic performance of PECARN clinical decision rule in children with minor head trauma presenting to the emergency department of a tertiary care center: an observational study.","authors":"Salooja Sulthana N, Nikhil Paul, Archu Mj, Keerthana Manoharan K K, Linu Sm, Visakh S Vinod","doi":"10.20408/jti.2025.0165","DOIUrl":"10.20408/jti.2025.0165","url":null,"abstract":"<p><strong>Purpose: </strong>Minor head trauma is one of the most common reasons for pediatric emergency department visits. Accurate identification of children at risk for clinically important traumatic brain injury (ciTBI) is essential to reduce unnecessary computed tomography (CT) imaging. This study evaluated the diagnostic performance of the PECARN (Pediatric Emergency Care Applied Research Network) clinical decision rule in children with minor head trauma presenting to a tertiary care hospital in South India.</p><p><strong>Methods: </strong>In this observational study conducted between September 2022 and April 2024, 235 children aged <18 years presenting with head trauma and Glasgow Coma Scale scores of 14-15 were prospectively enrolled. Participants were stratified into age-specific PECARN risk categories. Diagnostic performance was assessed against ciTBI outcomes defined by clinical and radiological criteria.</p><p><strong>Results: </strong>The PECARN rule demonstrated strong diagnostic performance, with a sensitivity of 82.4%, specificity of 74.1%, and an area under the receiver operating characteristic curve of 0.90 (P=0.01). No cases requiring neurosurgical intervention were missed. Children aged ≥2 years had a higher incidence of ciTBI than those aged <2 years (13.4% vs. 1.8%, P=0.048). ciTBI was significantly associated with loss of consciousness, vomiting, severe headache, and signs of basilar skull fracture (all P<0.001).</p><p><strong>Conclusions: </strong>The PECARN rule appears to be a reliable and safe tool for evaluating pediatric minor head trauma in Indian emergency settings. Its high sensitivity and negative predictive value support its use in reducing unnecessary CT imaging while accurately identifying children at risk for ciTBI.</p>","PeriodicalId":52698,"journal":{"name":"Journal of Trauma and Injury","volume":" ","pages":"144-150"},"PeriodicalIF":0.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13328899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147789084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of the simulation-based Airway and Catheter Cannulation Education-from Starters to Specialists (ACCESS) program for critical care procedures.","authors":"Jung Rae Cho, Hancheol Jo, Yoonjung Heo, Dong Hun Kim","doi":"10.20408/jti.2026.0034","DOIUrl":"10.20408/jti.2026.0034","url":null,"abstract":"<p><strong>Purpose: </strong>Central venous catheterization and endotracheal intubation are critical lifesaving procedures, yet structured training opportunities remain limited and often rely on informal apprenticeships. This study evaluates the effectiveness of the Airway and Catheter Cannulation Education-from Starters to Specialists (ACCESS) program in improving procedural knowledge, confidence, and ultrasound proficiency.</p><p><strong>Methods: </strong>Data from 70 healthcare professionals (38 residents, 28 specialists, and 4 others) who completed the ACCESS program between 2022 and 2025 were analyzed. Participants were divided into two cohorts: a retrospective cohort (n=46) from 2022 to 2023, who completed the post-training questionnaire only, and a prospective cohort (n=24) from 2024 to 2025, who underwent pre- and post-training assessments. The questionnaire used a self-reported 10-point Likert scale.</p><p><strong>Results: </strong>Overall, 67 valid post-training responses were analyzed, excluding 3 incomplete surveys from the prospective group. Participants reported exceptional satisfaction, with clinicians (>6 years of experience) reporting higher satisfaction with equipment (P=0.020). In the prospective cohort (pre-training, n=24; post-training, n=21), significant improvements were observed across all domains (P<0.001). Ultrasound proficiency showed the most dramatic increase (from 4.67 to 8.81), accompanied by marked improvements in procedural confidence.</p><p><strong>Conclusions: </strong>The ACCESS program effectively enhanced procedural competence, especially ultrasound-guided skills. The significant improvement observed in the cohort with a high percentage of specialists underscores the limitations of traditional models and highlights the critical value of standardized high-fidelity simulation training programs for physicians at all career stages.</p>","PeriodicalId":52698,"journal":{"name":"Journal of Trauma and Injury","volume":"39 2","pages":"160-166"},"PeriodicalIF":0.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13328892/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148354409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blunt traumatic right-sided pericardial rupture without cardiac injury: a case report.","authors":"Muhyung Heo, Hyung Won Kim, Sanghyun Sung","doi":"10.20408/jti.2025.0112","DOIUrl":"10.20408/jti.2025.0112","url":null,"abstract":"<p><p>Blunt traumatic pericardial rupture is an exceptionally rare condition, often associated with high morbidity and mortality. Isolated pericardial rupture without vascular or cardiac involvement accounts for only 17% of reported cases. We describe a rare case of right-sided pericardial rupture following blunt chest trauma, an unusual presentation since most pericardial tears occur on the left side. A 23-year-old woman involved in a motor vehicle accident sustained multiple injuries, including right hemothorax, bilateral pulmonary contusions, left-sided rib fractures, and a humerus fracture. Although preoperative computed tomography showed no diagnostic findings, persistent bleeding from the right chest tube prompted exploratory thoracotomy. Intraoperative evaluation revealed a 10-cm right pericardial tear extending from the superior vena cava to the inferior vena cava, with no associated cardiac injury. Surgical management included primary closure of the pericardial tear and repair of adjacent pleural injuries. Postoperatively, the patient developed right diaphragmatic palsy due to phrenic nerve involvement. Pericardial rupture is challenging to diagnose, but in this case, persistent hemothorax facilitated early recognition and intervention. Prompt identification allowed timely surgical repair, likely preventing life-threatening complications such as cardiac herniation. This case highlights the importance of considering pericardial rupture in patients with blunt chest trauma presenting with unexplained clinical findings and underscores the value of early surgical management.</p>","PeriodicalId":52698,"journal":{"name":"Journal of Trauma and Injury","volume":" ","pages":"178-181"},"PeriodicalIF":0.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13328890/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147596275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vertebral artery dissection and homonymous hemianopsia after a cervical spine fracture in a polytrauma patient with hypoplastic contralateral vertebral artery: a case report.","authors":"Josip Lovaković, Dino Bobovec, Ivan Dobrić, Anko Antabak, Goran Milašin, Dino Papeš","doi":"10.20408/jti.2025.0014","DOIUrl":"10.20408/jti.2025.0014","url":null,"abstract":"<p><p>Despite the increasing incidence of vertebral artery injury (VAI), it can often be overlooked during the management of polytrauma patients. Due to its specific anatomical location, the VA is particularly susceptible to both traumatic and spontaneous injuries. Traumatic VAI can result from blunt or penetrating trauma and is frequently associated with cervical spine injuries. An 18-year-old male patient was brought to the emergency department after being struck by a motor vehicle. The patient exhibited altered mental status while remaining normotensive and tachypneic. Notably, there were no visible injuries to the head or neck, though multiple contusions were present on the chest and abdomen. Radiographic imaging revealed a fracture of the transverse process of the seventh cervical vertebra, which caused dissection, thrombosis, and occlusion of the V1 segment of the left VA. Additionally, hypoplasia of the contralateral VA was observed. Given the presence of ultrasonographically confirmed free intra-abdominal fluid and the patient's newly developed hemodynamic instability, he was urgently transferred to the operating theatre. A grade 3 liver laceration was discovered, and hemostasis was successfully achieved using direct sutures. After regaining consciousness, the patient reported right-sided homonymous hemianopsia accompanied by signs of cerebral ischemia. Following stabilization, he was started on anticoagulant and antiplatelet therapy. Upon discharge and during follow-up, the visual deficit persisted. This case emphasizes the importance of recognizing and managing VAI in polytraumatized patients. Furthermore, the rare combination of contralateral VA hypoplasia and VAI significantly influenced the development of neurological deficits.</p>","PeriodicalId":52698,"journal":{"name":"Journal of Trauma and Injury","volume":" ","pages":"173-177"},"PeriodicalIF":0.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13328888/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144978333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Resuscitative endovascular balloon occlusion of the aorta (REBOA) as a potential facilitator of definitive fascial closure in the open abdomen: a retrospective study in massive traumatic hemorrhage.","authors":"Yoonjung Heo, Dong Hun Kim","doi":"10.20408/jti.2025.0310","DOIUrl":"10.20408/jti.2025.0310","url":null,"abstract":"<p><strong>Purpose: </strong>Resuscitative endovascular balloon occlusion of the aorta (REBOA) effectively reduces uncontrollable torso hemorrhage in trauma. An open abdomen (OA) with temporary abdominal closure commonly follows damage control surgery in such cases. Early definitive fascial closure (DFC) is crucial to prevent complications such as enteric fistula, peritoneal abscess, or chronic ventral hernia. This study aimed to evaluate the effect of REBOA on DFC after massive traumatic hemorrhage.</p><p><strong>Methods: </strong>This retrospective study analyzed 839 patients requiring massive transfusion at a level I trauma center between 2015 and 2022. Subgroup analyses were conducted among patients who underwent OA and DFC. Primary outcomes were DFC achievement and timing (≤48 hours vs. >48 hours). Secondary outcomes included various clinical outcomes.</p><p><strong>Results: </strong>Of 229 patients meeting inclusion criteria, 76 (33.2%) required OA management, of whom 33 (43.4%) achieved DFC. The OA+ group demonstrated more severe injury (median Injury Severity Score, 34.0 vs. 22.0; P<0.001) and higher REBOA utilization (47.4% vs. 15.0%, P<0.001). Multivariate analysis showed that bowel perforation (adjusted odds ratio [OR], 6.75; 95% confidence interval [CI], 1.56-29.23; P=0.011) and Sequential Organ Failure Assessment (SOFA) score (adjusted OR, 0.58; 95% CI, 0.43-0.79; P<0.001) were independently associated with DFC achievement; REBOA use was not. Among patients achieving DFC, univariate analysis identified OA indication (OR, 0.11), number of laparotomies (OR, 0.16), and crystalloid volume (OR, 1.00) as factors associated with early closure (≤48 hours), though none remained significant in multivariate analysis.</p><p><strong>Conclusions: </strong>Zone I REBOA did not significantly influence the achievement or timing of DFC following OA in trauma patients with massive hemorrhage. The deteriorating condition in REBOA recipients and the limited sample size may have affected these findings. Nevertheless, several clinical indicators were associated with DFC, suggesting potential utility in trauma care decisions.</p>","PeriodicalId":52698,"journal":{"name":"Journal of Trauma and Injury","volume":"39 2","pages":"151-159"},"PeriodicalIF":0.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13328893/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148354718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contralateral pulmonary resection with drug-induced thrombocytopenia after previous lobectomy in chest trauma: a case report.","authors":"Do Wan Kim, Kyo Seon Lee, Sang Yun Song, In-Seok Jeong","doi":"10.20408/jti.2025.0157","DOIUrl":"10.20408/jti.2025.0157","url":null,"abstract":"<p><p>Secondary pulmonary resection remains challenging because of the risk of serious complications. A second thoracic surgical procedure in elective settings should prioritize the patient's recovery potential and functional status. In thoracic oncology, clinical outcomes can be acceptable in selected patients. However, when vital signs are unstable due to traumatic lung injury, selection is not the primary consideration and emergency surgery is required. Thrombocytopenia is a condition in which a patient's platelet count is abnormally low, diagnosed by complete blood count. In humans, the normal platelet count generally ranges from 150,000 to 450,000 platelets/μL of blood. In posttraumatic patients, thrombocytopenia is often difficult to manage because its causes are diverse. To our knowledge, survival after secondary contralateral lung resection in a patient with thrombocytopenia who previously underwent lobectomy for lung cancer is extremely rare.</p>","PeriodicalId":52698,"journal":{"name":"Journal of Trauma and Injury","volume":" ","pages":"186-190"},"PeriodicalIF":0.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13328898/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147576559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}