Trauma

This report describes the first documented case of acute ischaemic stroke detected by continuous invasive brain tissue oxygen monitoring following traumatic brain injury.

A 27-year-old male sustained a severe traumatic brain injury following a high-speed motor vehicle accident with extensive injuries including dissection of both the right and left internal carotid arteries. In the setting of a randomised clinical trial, the patient had a continuous brain tissue oxygen monitoring device inserted into the right frontal lobe in addition to routine intracranial pressure monitoring. A subsequent ischaemic stroke was detected in real-time by continuous brain tissue oxygen monitoring.

Ischaemic stroke may complicate traumatic brain injury, due to traumatic cerebrovascular injury or other mechanisms, and could be identified by marked reductions in brain tissue oxygen (PbtO₂) with implications for acute clinical management.

Critically low PbtO₂ may alert clinicians to the possibility of evolving ischaemic stroke in patients with traumatic brain injury.

To evaluate visual outcomes and quality of life in soldiers after ocular trauma, with a focus on how vision impairment affects their daily overall well-being.

This cross-sectional observational study was conducted among soldiers who sustained ocular trauma in either or both eyes, resulting in best-corrected visual acuity (BCVA) of ≤6/36 in at least one eye and had been clinically stable for a minimum of six months. After ocular examination, the National Eye Institute 25-Item Visual-Function Questionnaire was introduced to measure vision-related quality of life. Data was analyzed using SPSS-version-23.0. T-test and one-way ANOVA tests were used to see the difference between groups. P < 0.05 was considered significant.

Thirty-eight male participants, all with monocular vision loss, were included. Mean age at presentation was 37.3 ± 8.4years (range: 23–55years). The most common cause of injury was road-traffic accidents (42.1%). Low visual quality of life was reported in VFQ25 composite score (56.47 ± 15.97) and across all 11 subscales. Specifically, participants with BCVA ≤6/36 reported substantial difficulty in terms of ‘ocular pain’ and ‘near activities’ (p < 0.05). Also, a significant difference in ‘ocular pain’ was found between those with ‘no perception of light’ and those who had undergone removal of one eye (p = 0.00). The majority reported significant challenges in ‘role difficulties’ (p = 0.01) and ‘dependency’ (p = 0.04).

Ocular trauma significantly lowers visual quality of life, with substantial deficits not only in visual acuity but also in daily functioning, emotional well-being and independence. Beyond visual acuity, factors such as role difficulties, dependency, driving and mental health should be prioritized, when assessing recovery and rehabilitation needs for those recovering from trauma.

Trauma is a leading cause of paediatric morbidity and mortality, but is often managed at non-paediatric specialist centres, where limited familiarity with paediatric patient management impacts care quality and outcomes. Telemedicine presents a unique solution to these problems, having the potential to improve patient outcomes by influencing the immediate assessment, management and disposition of injured children. This scoping review aims to detail the use of telemedicine in acute paediatric trauma: when and where it is used, what outcomes have been evaluated and any evidence gaps.

We conducted a scoping review to identify primary studies that evaluated the use of telemedicine in paediatric trauma. Five databases were searched for relevant studies published prior to June 2024.

Nine studies were included. Most papers (n = 8) reported on the effect of telehealth on patient treatment decisions and outcomes, including a decrease in mortality (n = 1), impact on patient disposition (n = 1) and change in patient care due to telehealth (n = 1). Clinician satisfaction (n = 3), parent satisfaction (n = 3) and difficulties encountered with telemedicine usage (n = 2) were also explored.

When employed to connect rural mixed emergency departments with paediatric trauma centres, telemedicine has the potential to influence initial management and improve appropriate disposition rates, with demonstrated improvement in care quality and survival rates, as well as improved stakeholder satisfaction. However, there is a need for higher-quality evidence generated through prospective studies to validate the use of telemedicine in paediatric trauma and demonstrate its impact on value-based care provided to children and their support networks.

Grade IIIB open tibial fractures are a severe form of open fractures usually accompanied by soft tissue loss and bone loss, which can be challenging to manage, and are associated with increased risk of complications, especially fracture-related infection. Popular management strategies include the induced membrane technique (Masquelet) and the distraction histogenesis technique by Ilizarov. These strategies are not, however, without their own challenges. Hence, a simple and inexpensive method of managing the bone loss usually found to accompany these fractures would revolutionize trauma care.

A 54-year-old patient presented with Gustilo-Anderson type IIIB open fracture of the left leg with approximately 14 cm bone loss. He was managed by fixing the fracture with an antibiotic cement-coated plate and by the use of a polymethylmethacrylate (PMMA) spacer to fill the bone defect with a plan for a second-stage Masquelet technique. The bone spacer was not removed due to delays in accessing theatre space, and subsequent clinical and radiological images showed evidence of fracture union without features of fracture-related infection.

This case report highlights the possibility of using PMMA as a bone substitute and also for preventing fracture-related infection in severe open fractures.

The aim of this study was to review the spectrum, pattern and clinical outcome of shotgun injuries managed at a major trauma centre with limited resources.

Patients presenting with shotgun injuries between January 2012 and December 2024 were retrospectively reviewed. This was accomplished using the Hybrid Electronic Medical Registry. Data included demographics, injury pattern, regions affected, diagnostic imaging, operative interventions and clinical outcomes.

During the 13-year study period, a total of 148 patients sustained shotgun injuries. The median age was 31 years and 93% (137/148) were male. The median Injury Severity Score was 9. Of the 148 patients, 76% (112/148) had plain films performed in the resuscitation room, and 76% (113/148) underwent computed tomography following initial assessment. Single body injuries were noted in around half (51%) of the patients, with the remaining sustaining injuries in multiple regions. The abdomen was most commonly injured (46%), followed by the chest (38%) and lower limb (34%). Operative intervention was necessary for 88 patients (59%), of whom 33 (38%) required multiple operations. The median total length of hospital stay was 5 days, with an overall mortality rate of 5% (8/148).

Shotgun injuries are associated with a range of injuries to multiple body regions. These injuries have a high requirement for operative intervention and pose a significant morbidity and mortality risk. High-quality imaging is essential but must be integrated with clinical assessment to guide management.

This study evaluates upper limb vascular injuries (ULVIs) at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH, South Africa) to describe clinical features, in-hospital outcomes, and factors associated with poor outcomes.

A retrospective cohort study analyzed 79 suspected ULVI cases from January 1, 2021 to December 31, 2023, of which 74 had confirmed arterial injuries. Data on demographics, mechanism of injury, artery involved, American Association for the Surgery of Trauma (AAST) grades, treatments, and outcomes were collected from medical records. Poor outcomes were defined as postoperative complications (infection, thrombosis, graft failure) or amputations. Adjunct procedures (fasciotomy, nerve repair) were analyzed separately as markers of injury complexity. No ischemia time or shunt use data were recorded.

Of 74 patients (91% male, mean age 33.5 years, SD 9.5), penetrating injuries (91%) included gunshot wounds (GSWs, 50%; 37/74) and stabs (41%; 30/74); nonpenetrating injuries (9%) included various mechanisms (n = 7). Brachial artery injuries predominated (72%), followed by axillary (23%) and subclavian (5%). AAST grade V injuries were most common (58%). Reverse saphenous vein graft (39%) and primary repair (34%) were frequent treatments. Outcomes included successful repairs (82%), postoperative complications (14%), and amputations (4%). GSWs were associated with poor outcomes (p = 0.01 among penetrating cases). Sensitivity analysis confirmed associations with GSWs (p = 0.015), AAST grades IV and V (p < 0.001), and reverse saphenous vein graft (p = 0.005).

CMJAH's ULVI profile, dominated by GSWs and stabs, reflects urban violence in a low- and middle-income country setting. The 4% amputation rate is comparable to high-income country benchmarks, though limited by small sample size, retrospective design, and lack of ischemia time data.

Prompt analgesia for older adults with blunt chest trauma is vital to prevent severe complications associated with pain. Pre-hospital and emergency department (ED) clinicians often have first patient contact but face limited analgesic options. Identifying the most appropriate early analgesia for this high-risk group is crucial to ensure optimal outcomes.

This systematic review aimed to describe and compare analgesic strategies used for patients aged 65 years or more in pre-hospital or ED settings, and to explore the potential application of ED findings to pre-hospital care due to a lack of pre-hospital studies.

A systematic review of online databases up to July 2025 was conducted using broad search terms and defined inclusion criteria. Narrative synthesis was used for data analysis.

Seven studies of varied study types and quality were included. No conclusive evidence identified a superior analgesic strategy or a clear impact on clinical outcomes. Nerve blocks provided comparable analgesic relief to epidural analgesia with fewer side effects and the capability of being administered at the bedside by different clinicians. This suggests potential for pre-hospital adaptation. Novel techniques, including cooling spray and percutaneous cryoneurolysis, demonstrated promising results in pain reduction, albeit based on small sample sizes. Secondary outcomes did not differ significantly across studies or analgesic strategies.

No definitive analgesic strategy was identified. Nerve blocks appear effective with fewer side effects than epidurals, supporting consideration for pre-hospital use. The absence of pre-hospital studies highlights a significant research gap, emphasising the need for future studies to guide prompt and effective analgesia in this population.

Despite the growing recognition of the interplay between diabetes and trauma outcomes, there remains a paucity of research. This study aims to describe the burden of diabetes in people with traumatic injuries, quantify its association with the occurrence of injuries and in-hospital outcomes in New Zealand (NZ), to inform the development of clinical decision support tools.

A retrospective review of Te Manawa Taki (TMT) trauma registry of all injury severities linked to the national minimum data set of NZ over 2014–2023 was conducted. Pre-existing diabetes was identified by ICD-10-AM codes E10, E11, E13 and E14 at the time of trauma admission, and complications were defined using the Australia and New Zealand Trauma Registry classification.

Over the period 2014–2023, there were 2196 cases of trauma (3.9%) with pre-existing diabetes. They faced 172% higher odds of being injured from falls compared to non-diabetics (odds ratio) = 2.7(95% CI: 2.5–3.0), p < 0.001. Diabetes, with or without complications, is strongly associated with acute kidney injury and pressure ulcers (p < 0.001). In addition, diabetes with complications was associated with other in-hospital complications, including catheter-associated urinary-tract infection, central line-associated bloodstream infection, sepsis, deep surgical site infection and stroke (p < 0.01).

The findings underscore that the presence of diabetes in trauma patients is not rare, and complications arise across injury severities. From a clinical perspective, the evidence base is strong enough to support using diabetes presence as a key variable in predictive models and as a trigger for proactive referral to diabetes services. More research is needed to improve diabetes screening and key physiologic parameters in trauma settings to guide early management decisions.

This study was conducted to determine the incidence and identify independent predictors of key postoperative events, including mortality, intensive care unit (ICU) admission, mechanical ventilation, reoperation, stoma formation, and postoperative infections among patients who underwent exploratory laparotomy for abdominal gunshot trauma in Palestine.

We conducted a multicenter retrospective cohort study across six major hospitals between January 2019 and December 2024. Medical records of patients undergoing exploratory laparotomy for abdominal bullet injuries were reviewed. Outcomes included mortality, ICU admission, mechanical ventilation, reoperation, stoma formation, and postoperative infection.

Of 830 records screened, 96 male patients (median age 22 years [IQR 18.0–26.8]) met inclusion criteria. Isolated abdominal injury occurred in 47 (49%), while 49 (51%) had additional injuries. Small bowel (52.1%), large bowel (30.2%), and liver (22.9%) were the most frequently injured organs. ICU admission was required in 69 patients (71.9%), mechanical ventilation in 31 (32.3%), and reoperation in 19 (19.8%). Stoma formation occurred in 25 (26.0%), and postoperative infections in 15 (15.9%). Overall mortality was 8 (8.3%). Independent predictors of mortality included transfusion burden (aOR 1.40 per unit, p < 0.001) and intraoperative complications (aOR 57.4, p = 0.006). ICU admission was independently associated with multiple surgical indications (aOR 3.61, p = 0.025) and transfusion volume (aOR 1.24, p = 0.040). Mechanical ventilation correlated with injury complexity, transfusion requirements, and drain placement. Reoperation was predicted by mechanical ventilation and postoperative bleeding, while stoma formation was strongly linked to large bowel injury and planned second-look surgery. Stoma formation and prolonged hospitalization independently predicted postoperative infection.

Exploratory laparotomy for abdominal gunshot injuries in Palestine was associated with high rates of ICU admission, reoperation, stoma formation, infection, and mortality. Strengthening early resuscitation, standardized transfusion protocols, infection-prevention bundles, and postoperative rehabilitation may improve survival and reduce complications in resource-limited, conflict-affected settings.

To evaluate and identify commonalities among pediatric firearm-related injuries in the diverse metropolitan and micropolitan population of Upstate South Carolina.

A retrospective chart review was conducted of 104 patients aged 0–17 years who presented to Greenville Memorial Hospital from January 1, 2017 to July 1, 2023 and were diagnosed with a firearm-related injury.

Patients were predominantly male (77.9%), Black (54.8%), with an average age of 11.9 years. Unintentional injury was the most common intent among all ages and races (44.2%). Unintentional injury was more likely among pre-teens, while assaultive/homicidal injuries were more likely among ages 13–17 (p = 0.002). Assault/homicide was more likely among Black children, and self-inflicted injuries were more likely among White children (p = 0.039). Residence was the most common location (46.2%). Of the patients eligible for psychiatric consultation, 21.5% received one. The distress level of the community impacted frequency, though it was not predictive of intent.

Though disparities based upon sex and race exist, unintentional firearm-related injury is universally problematic in the Upstate South Carolina. Efforts directed at reducing unintentional injuries, improving documentation, and championing psychiatric consults may reduce pediatric firearm-related injuries and sequelae in the Upstate.

Empirical data regarding the psychological sequelae of traumatic memories among displaced populations in the MENA region, particularly within the Syrian context, remains critically sparse. This study aims to identify the memories of war and displacement and their impact on mental health and PTSD symptoms among displaced persons and refugees.

An online questionnaire was administered to 356 internally displaced persons in Syria. They responded to the War and Displacement Memory Questionnaire (WDMQ), the PTSD Checklist for DSM-5 (PCL-5), and the Brief Symptom Inventory 18 (BSI-18). The ages ranged from 18 to 75 years (mean = 35.13, SD = 8.034). Females comprised 53.65% (n = 191), and males made up 46.34% (n = 165).

A total of 56.74% of participants scored higher on the war and displacement memory questionnaire. War events ranked highest with an average of (4.62), followed by displacement events (4.50), the emotions associated with war or displacement (4.49), the novelty of memories and their intrusive attack (4.39), feeling nostalgic for one's home (4.17), and disturbing memories (4.00). While 48.60% of participants scored above average on the PTSD scale. Whereas, 51.40% scored higher on the mental health questionnaire. While female participants and those with primary education attained marginally higher scores on the traumatic memory scale, these disparities did not reach statistical significance. Significant correlations between traumatic memories and PCL-5 and BSI-18 were found (r = 0.680, p < 0.001; 0.466, p < 0.000, respectively). Education and memories of war and displacement predict PTSD and mental health symptoms.

An integrated model of memory and mental health may provide a deeper understanding of the psychological needs and clinical features linked to memories of war and displacement. These findings may be useful in better understanding the psychological effects of traumatic memory on the mental health of refugees.

Damage control surgery (DCS) is a life-saving strategy for critically injured patients in extremis. Identifying predictors of mortality in this population may help guide clinical decision making and resource allocation in low- and middle-income countries. This study aimed to identify independent predictors of in-hospital mortality following DCS.

We conducted a retrospective analysis of 219 consecutive patients who underwent DCS at a trauma centre, over 3 years, between June 2021 and June 2024. Patient demographics, physiological parameters, laboratory values, transfusion requirements, operative details and outcomes were compared between survivors and non-survivors. Multivariable logistic regression analysis was performed to identify independent predictors of mortality.

The overall in-hospital mortality rate was 11.0% (n = 24). Patients were predominantly male (93.5%) with penetrating trauma (84.5%). Non-survivors demonstrated significantly lower Glasgow Coma Scale scores (13.0 vs. 15.0, p < 0.001), lower arterial pH (7.07 vs. 7.29, p < 0.001), higher lactate levels (13.4 vs. 6.3 mmol/L, p < 0.001) and greater transfusion requirements (p < 0.001). Multivariable analysis identified three independent predictors of mortality: elevated lactate (OR 4.33 per SD increase), lower Glasgow Coma Scale (OR 0.56 per SD increase) and lower arterial pH (OR 1.34 per SD decrease). The predictive model demonstrated excellent discrimination (AUC 0.912).

Lactate, Glasgow Coma Scale and arterial pH are independent predictors of mortality following DCS. These readily available clinical parameters may assist in prognostication and guide resuscitation efforts in this high-risk patient population.