Penetrating Trauma Research Articles

Identification of gunshot entry wounds using hyperdense rim sign on post-mortem computed tomography.

Post-mortem computed tomography (PMCT) is an increasingly utilized tool in forensic medicine for evaluating head gunshot injuries. Vault bevelling sign, when present, provides information regarding entry and exit wounds; when absent, identifying wound type on PMCT remains challenging. A cutaneous hyperdense ring, described in an animal study by Junno et al. (2022), may be indicative of contact shots. We hypothesized that it could also be observed in human gunshot injuries. Our study evaluates the reliability of the cutaneous hyperdense rim sign for identifying entry gunshot wounds in PMCT. After excluding complex and mucosal wounds, two operators retrospectively evaluated 64 gunshot wounds (30 entry and 34 exit wounds) in 34 head PMCT cases (2018-2022). Gold standard for wound type determination was the autopsy report. The hyperdense rim sign was defined as at least two-thirds of a continuous cutaneous hyperdense circle on a multiplanar reconstruction of cutaneous tissue tangent to the wound. The hyperdense rim sign demonstrated a specificity of 97% (95% CI: 85-100%) and a sensitivity of 63% (95% CI: 44-80%) for identifying entry wounds. Moreover, in 16 external examination reports where the presence of powder residues or bullet wipe at entry wound was explicitly mentioned, a positive association was observed between hyperdense rim sign and the presence of these elements (p = 0.018). These findings suggest that the hyperdense rim sign, when present, may be a valuable tool for entry wound determination in gunshot injuries, interpreted in conjunction with other CT and autopsy features.

<i>Ochrobactrum anthropi</i>: a rare case of endocarditis

Ochrobactrum anthropi is an aerobic Gram-negative bacillus, formerly known as “Achromobacter group Vd”. It is increasingly recognized as a potentially problematic, opportunistic, and nosocomial pathogen. Most cases of human diseases due to O. anthropi are associated with central venous catheter line infection; few case reports about infective endocarditis, pancreatic abscess, puncture wound osteochondritis, endophthalmitis, urinary tract infection, meningitis, pelvic abscess, and osteomyelitis are present in the literature. Among the previously stated infections it can cause, infective endocarditis is very rare; only four cases have been described in the literature. Here, we report the case of an immunocompromised man who developed native valve endocarditis with septic cerebral embolization due to O. anthropi.

Evaluation of an anthropometric head surrogate exposed to chisel-nosed fragment simulating projectile impact

Fragment-induced penetrating injuries pose a significant threat in modern combat. Explosions from explosive devices generate metallic fragments that can lethally penetrate various body regions, with the head being particularly most vulnerable to fatality in terms of penetration. Hence, understanding the head’s response to fragment impact is crucial. To this end, this study investigated the ballistic response of an anatomically accurate anthropometric head surrogate to fragment impact. The head surrogate comprised simulants for the three major layers of the head (skin, skull, and brain). Using a pneumatic gas gun, we impacted chisel-nosed fragment simulating projectiles (FSPs) of 1.10-g and 2.79-g on the head surrogate. We analyzed the ballistic response of the head surrogate in terms of ballistic limit velocities (V50), energy densities (E50/A), and failure mechanisms in each layer. The results indicated sensitivity to the FSP size. The 1.10-g FSP had a ∼41% higher V50 and a ∼63% higher E50/A compared to the 2.79-g FSP. Additionally, each head surrogate layer exhibited distinct failure mechanisms. The skin simulant failed due to a combination of shearing and elastic hole enlargement, forming a cavity smaller than the size of the FSP. The skull simulant fractured, creating a cavity at the entry point matching the FSP size. The brain simulant failure involved shearing of the cavity and penetration of fractured skull fragments. We also observed no significant difference in response when introducing a flexible neck attachment on which the head surrogate was mounted. Furthermore, comparisons of an anthropometric (close-shape) head surrogate with a simplified open-shaped head surrogate revealed the minimal influence of the head curvature on the response due to the localized nature of fragment penetration. These findings provide a comprehensive understanding of the head surrogate’s mechanical response to fragment impact. The insights from this work hold significant value in the assessment of penetrating head injury, especially against small fragments. The results can be applied in modern warhead design and forensic investigations.

Early Surgery and High Dose Steroids in Treating Patients with Indirect Traumatic Optic Neuropathy: A Meta-Analysis and Systematic Review

Introduction: Optic nerve injury is a devastating cause of permanent visual loss after blunt or penetrating injury occurring in up to 7% of head trauma cases. No single treatment strategy and timing of intervention has proved optimal. Timely and appropriate management is key to improving visual outcomes. We compared whether immediate surgical decompression or steroids would lead to improvement of visual outcomes in individuals with indirect traumatic optic neuropathy. Methods: We searched from several online databases and included studies of patients with direct Optic nerve injury, those who received combined treatment with surgery and steroids, and those with delayed initiation of treatment were excluded. Results: The final search yielded eleven eligible studies. Both interventions showed similar results in improvement of visual function (RR 2.35, 95% CI 0.87 to 6.34, p=0.09, I2 0%). Both early and late intervention also showed similar results in improvement of visual function (RR 1.72, 95% CI 0.89 to 3.35, p=0.11, I2 61%). Among patients who underwent early surgical decompression, the rate of visual acuity improvement was 73% with those who underwent transcranial surgery and 69% with those who underwent endoscopic surgery. Conclusion: This study shows that immediate surgical decompression and early high dose steroid administration are equally effective in improving visual function. Patients with no light perception (NLP) and light perception (LP) pre treatment resulted to better visual improvement with steroids while those with counting fingers (CF) and more than CF pre treatment, resulted to better visual improvement with surgical decompression.

Rescuing the knee: arthroscopic extraction of a long-neglected glass fragment: a case report

The knee joint frequently encounters penetrating injuries and has ample space to harbor foreign objects. While foreign bodies in the knee joint are unusual, especially those not originating from surgical procedures, extensive literature exists on the extraction of loose bodies and metallic objects from this articulation. However, documentation on uncommon intruders remains scarce. This case study delves into the experience of a 22-year-old male who suffered persistent pain due to a neglected foreign object in his knee joint. After its removal, a complete resolution of symptoms was achieved. It highlights the importance of prompt arthroscopic intervention for optimal outcomes. Here we present a unique case involving a 22-year-old male who underwent arthroscopic retrieval of a neglected glass fragment from his knee joint. The patient sought medical attention five months after the initial injury due to sudden and severe pain onset. Arthroscopy stands as the favored minimally invasive method for extracting foreign bodies from the knee joint, especially from its deeper and less accessible regions. Utilizing pre-operative radiological imaging enhances understanding of the anatomical placement, facilitates surgical orientation, and reduces operation time. A keen sense of suspicion and thorough history-taking are crucial in achieving an accurate diagnosis.

Determination of the Perpetrator-Victim Position in a Case of Severe Traumatic Brain Injury due to a Less-Lethal Weapon Projectile, Based on Brain Injuries

Less-lethal (or non-lethal) weapons cause lethal and non-lethal injuries; this depends on many factors, including the shot distance and the modifications made to the operation of the weapon and the projectiles. This type of weapon has a similar shape to a firearm, shares the same physical and chemical operating principle and uses the combustion of a chemical substance to eject the projectile. In technical terms, the only difference is the projectile. Currently with the changes in weapons and projectiles, it is difficult to make a correlation. Just like lethal firearm projectiles and due to their operation, they leave macroscopic gunshot residues such as powder tattooing or soot deposition, only occasionally a contusion ring. In addition, there is a variety in the appearance of the entrance wounds. Therefore, it is very important to process the scene and carefully dissect the external wound and the surrounding area and, if possible, the recovery of the projectile. We present a case where a non-penetrating superficial injury to the skull produced trauma consistent with a coup contrecoup brain injury, which allows us to identify the perpetrator-victim position.

Surgical Management of Penetrating Carotid Artery Injury: Preoperative Level of Consciousness Does Matter.

The optimal surgical management of penetrating carotid artery injuries (PCAI) remains controversial. This study aimed to examine the association between operative techniques for PCAI and the incidence of stroke. This retrospective cohort study used the American College of Surgeons Trauma Quality Improvement Program (2016-2021) database. We included patients (≥16 years old) with severe penetrating injuries to the common or internal carotid arteries (CCA/ICA) who underwent one of the following operative procedures: primary suture repair, ligation, and arterial reconstruction with a graft. Multivariate logistic regression analysis with cluster-adjusted robust standard errors was performed to estimate the adjusted odds ratio (AOR) for postoperative stroke stratified by the initial Glasgow Coma Scale (GCS). A total of 429 patients were included (329 underwent primary suture repair, 82 underwent ligation, and 81 underwent arterial reconstruction with a graft). The median age was 31 years (interquartile range [IQR]: 24-43) and median GCS on arrival was 11 (IQR: 3-15). On multivariate analysis after adjusting for potential confounders, ligation of CCA/ICA was significantly associated with increased odds of stroke in patients with initial GCS ≥9 (AOR: 4.40, 95% confidence interval [CI]: 1.16-16.58, p=0.029), whereas there was no significant association in patients with GCS <9 (AOR: 0.77, 95% CI: 0.28-2.11, p=0.37). No significant association was identified between arterial reconstruction with a graft and stroke, irrespective of the initial GCS. The study findings suggest that the preoperative level of consciousness may help in planning operative strategies for PCAI. In patients with an initial GCS ≥ 9, definitive repair of the CCA/ICA, including arterial reconstruction with a graft, should be pursued instead of ligation.

Management of penetrating arrow injury of the maxillofacial region, case report

An arrow maxillofacial penetrating injury is an unusual traumatic injury sometimes encountered in developing countries. This rare injury has the potential to be dangerous because the arrow is deeply lodged in maxillofacial region crossed by major vessels, and because damage to one of these vessels should always be suspected. Furthermore, removal of a foreign body may result in complications such as massive bleeding or iatrogenic injury to adjacent structure and complications should always be considered in maxillofacial region. We describe a case of a patient who presented with maxillofacial penetrating arrow injury and analyze the problems faced in its management with emphasis on diagnostic imaging, on surgical planning and on careful surgery management.

Open Trauma to the Larynx by a Stab Wound: A Case Report

&amp;lt;i&amp;gt;Introduction&amp;lt;/i&amp;gt;: Open laryngeal trauma is rare. Only early and appropriate diagnosis and treatment can preserve or restore the respiratory and phonatory functions of the larynx and prevent the appearance of disabling functional sequelae. &amp;lt;i&amp;gt;Material and method&amp;lt;/i&amp;gt;: This was a 50-year-old patient with a history of psychiatric illness, admitted for treatment of a penetrating wound to the neck following an attempted self-lysis with a bladed weapon (knife). On examination, we objectified a conscious patient with a makeshift bandage soiled with blood at the neck. A respiratory murmur was also perceived. Given this picture, the patient was immediately taken in a lying position to the operating room for surgical management. The postoperative course was marked on D13 by a decannulation process and a complete decanution on D15 postoperatively. We proceeded to remove the nasogastric tube on D21. A cure without respiratory or vocal sequelae was obtained on D28 postoperatively. &amp;lt;i&amp;gt;Conclusion&amp;lt;/i&amp;gt;: Open trauma is a diagnostic and therapeutic emergency. If unrecognized or poorly managed, it can be life-threatening in the immediate term or cause serious long-term after-effects.

High-energy blunt pelvic ring injuries and pre-hospital pelvic binder applications – A retrospective assessment based on a prospective registry

IntroductionApplication of a pelvic binder in the pre-hospital settings is a crucial step of high-energy blunt pelvic ring injury (PRI) management protocols. The aim of this retrospective cohort study was to evaluate the percentage of pre-hospital pelvic binder's applications in high-energy blunt type B or C PRI patients managed at a single level I trauma center, and to assess its impact on the medical resource requirements and patients' outcomes. MethodsThe institutional Severely Injured Patients’ Registry was screened for patients meeting the following inclusion criteria: (1) high-energy blunt PRI; (2) admission between 2014.01.01 and 2022.12.31; (3) age ≥16 years; and (4) available computed tomography of the pelvis. Exclusion criteria were: (1) death before admission; (2) low-energy injury; (3) penetrating, blast and electrical injuries; and (4) secondary transfers. Study variables, including pre-hospital application of a pelvic binder and demographic, clinical, management and outcome data were extracted from the registry. Additionally, AO/OTA classifications were determined. ResultsA consecutive series of 262 patients was included into the final analysis. Of these, 58.8 % received a pre-hospital pelvic binder (PPB), increasing from type A (45.1 %) to type B (57.8 %) and type C (73.7 %). Pre-hospital hemodynamic instability was a major factor triggering the use of PPB in high-energy blunt type B PRI patients with PPB in 76.9 % of the cases with hemodynamic instability vs. 51.3 % of the cases without hemodynamic instability (p = 0.009). This difference was not statistically significant for high-energy blunt type C PRI patients (82.8 % vs. 64.3 %, p = 0.200). The presence of a physician on the trauma site contributed to the increased percentage of PRI managed with PPB from 43.5 % to 67.3 % in type B PRI (p = 0.011), and from 50 % to 77.1 % in type C PRI (p = 0.257).This study showed an increased need for packed red blood cells (PRBC) transfusions in subgroups treated with PPB and no statistically significant differences in term of intensive care unit (ICU) and total hospital length of stay and complications between high-energy blunt type B or C PRI patients with or without PPB.Comparison of mortality rates in patients with and without PPB showed a trend towards lower mortality rates with PPB in patients with AIS extremity participating in at least 50 % of the total ISS. ConclusionIn the ideal pre-hospital scenario, every high-energy blunt type B or C PRI patient should be managed with a PPB. Continuous pre-hospital team training and information is crucial to achieve this goal. The preparation of Emergency Department and ICU who admit a patient with PPB should include a sufficient number of PRBC ready for transfusion. Mortality rates did not seem to be affected by PPB, except for a trend towards lower mortality rates in patients in whom their PRI was the major component of the global severity of their injury. This might point out the critical and positive effect of PPB in high-energy blunt PRI patients.

Gunshot Residue Deposition With and Without Firearm Suppressors (Silencers).

Forensic pathologists recognize the importance of estimating the range of fire for gunshot entrance wounds. Classically described ranges of fire include contact, close range, medium (or intermediate) range, and indeterminate (or distant) range. The presence or absence of gunshot residue (smoke/soot and/or gunpowder) and the characteristics of the gunshot residue are evaluated in order to estimate the range of fire. It is well known that interposed targets can block or otherwise alter gunshot residue deposition. In this preliminary study, a comparison is made between gunshot defects produced on targets using firearms with and without an attached suppressor device (so-called "silencer"). Comparisons are made at various distances from the targets, using multiple weapon/ammunition calibers.

Racial-ethnicity group distributions of blood product use in acute trauma care transfusion.

Recent studies suggest Black patients are transfused less often and at lower hemoglobin levels than White patients. In elective surgery, Black and Non-White patients have greater estimated blood loss and transfusion frequency. We asked whether similar transfusion disparities are observable in acute trauma resuscitation. In a single-center retrospective analysis of trauma registry/blood-bank-linked data from a large US trauma center, we identified all acute trauma patients 2011-2022. Our data sources permitted distinction of Race and Ethnicity and therefor binning as Non-White-race/not Hispanic plus any-race/Hispanic or White/not Hispanic. We tallied Injury Severity Scores mild through profound (ISS 1-9, 9-15, 16-25, >25), type (blunt vs. penetrating) and mechanism (firearms, etc.), and associated blood use overall and in the first, first four, and first 24 h, comparing results with chi square, p < .01. Overall, 50,394 (68.41%) acute trauma patients were classified as White and 23,251 (31.7%) as Other than White. White patients were more likely to receive any blood products (17.8% vs. 11.9%), but, for all measures of urgency/quantity, Non-White patients were transfused more often (respectively, first 4 h, 51.9% vs. 42.1%; ≥3u/first hour, 18.5% vs. 11.0%; ≥10u/24 h, 8.1% vs. 3.8%) (all p < .001). White patients were far more likely to have blunt injury than Non-White patients, (77.2% vs. 42.6%), less likely to have penetrating injury (10.1% vs. 14%) and far less likely to be injured by firearms (30.6% vs. 56.9%) (all p < .001). At our center, blood use in acute trauma resuscitation was associated with injury severity and mechanism, not race/ethnicity.

Intraoral gunshot injury associated with soot in the deep airways

In suicidal gunshots to the head, the oral cavity ranks among the preferred entrance sites. If the weapon’s muzzle end is located within the mouth, it is to be expected that the cartridge discharge residues are deposited on the buccal and palatal mucosa, the tongue and the pharynx, often in combination with tears of the lips due to the expanding combustion gases. Ensuing from the bullet entrance wound and any concomitant injuries, blood is released into the upper airways and subsequently aspirated into the lung periphery provided that respiration continues for at least a short time. Evidently, this impedes the detection of additional soot deposits in the trachea, bronchi and alveoli. Using the example of an intraoral gunshot with a revolver cal. 357 Magnum, the paper points out that in individual cases it may be possible to prove the presence of gunshot residues in the deep airways.

Iatrogenic needle penetrating injury of cervical spinal cord: a case of fatal therapeutic complication.

A 52-year-old woman with of neck pain underwent percutaneous neck injection of local anesthetic and a corticosteroid without image guidance. She collapsed asystolic during the procedure was resuscitated and then died after 2 weeks in the intensive care unit with hypoxic encephalopathy. Complete postmortem examination included additional posterior neck dissection and cervical spinal cord removal with intact dura mater. The entire cervical spinal cord with the dura and leptomeninges was embedded in an oriented sequence of several paraffin blocks. Serial sections of each selected blocks were then studied to locate a putative puncture site. Serial sections from the third and fourth cervical levels (C3-C4) were stained with luxol fast blue-hematoxylin-eosin, iron stain, trichrome stain, and immunostained for b-amyloid precursor protein, and CD68. Histological examination revealed a linear needle track with a subacute healing reaction. The path included the dorsal spinal dura, arachnoid, and the left dorsal column. Clinicopathological correlation and the cause of death are discussed. Careful planning, dissection, sampling, and oriented serial sectioning with immunostaining were key points to document the injuries and understand this case.

Lethal Self-Administration of Atracurium: A Rarely Reported Case with Review of Literature.

Atracurium besylate is a nondepolarizing skeletal muscle relaxant first introduced in 1980. It is used during endotracheal intubation. It causes muscle relaxation during surgery or mechanical ventilation. When people consider suicide, they employ drugs found in their surroundings but not usually injectable muscle relaxants, which are not widely available. Studies on their use in suicide are rarely reported worldwide. This was a case of a 34-year-old male nursing staff, working in the general surgery department's operation theater complex, who was found unconscious in bed in his room in the morning with an empty syringe by the bedside. He was declared dead when brought to the emergency department. Forensic autopsy was conducted, and during the external examination, a needle puncture wound was found over the left cubital fossa. No other external other injuries were observed throughout the body. The toxicological analysis report indicated the presence of laudanosine in the vitreous humor, blood, urine, and skin from the puncture site and underneath vein. Also, the toxicological analysis of the empty syringe found at the crime scene revealed the presence of atracurium, confirming that the victim had administered a lethal dose of atracurium.

Role of preoperative CT imaging in penetrating thoraco-abdominal injuries: A multicenter study of urban trauma centers

IntroductionManagement of penetrating thoracoabdominal (PTA) injuries with signs of hemorrhage have warranted operative intervention but improved imaging capabilities have redefined interventions required. We examined outcomes of hemodynamically stable patients undergoing preoperative CT imaging with the hypothesis that CT imaging would decrease OR time without delaying OR arrival. MethodsA retrospective multicenter study was performed amongst four urban trauma centers examining hemodynamically stable patients with PTA injuries requiring operative intervention from January 2017–December 2021. The primary outcome was OR time. Secondary outcomes included length of stay (LOS), ICU LOS, and mortality. A multivariable logistic regression with random intercept for trauma center was fit to assess whether preoperative CT affected time in the OR. ResultsOf 534 hemodynamically stable patients with penetrating injuries, 322 (60.3 ​%) received preoperative CT. The median time in OR were 130 (IQR: 84,180) and 140 (IQR: 100, 180) minutes for patients with and without preoperative CT, respectively. Median time to OR was 68 (IQR: 47, 110) and 26 (IQR 17,38) minutes in patients with and without preop CT, respectively. Median ICU LOS were 0 vs 1 day, the median hospital LOS were 7 vs 8 days for patients with and without pre-op imaging respectively. The multivariable model showed that obtaining a pre-op CT scanning was not independently associated with time spent in OR. (Adjusted OR:0.94; 95 ​% CI: 0.85, 1.04). ConclusionIn patients with PTA injuries and hemodynamic stability, preoperative CT scanning was not associated with decreased OR time, postoperative complications, or mortality.

Surface-engineered caterpillar-like silica nanocomposites for enhanced interparticle friction and interlock in shear thickening suspension

This study presents a novel method for fabricating surface-engineered caterpillar-like silica nanocomposites by combining rod-like nanorods with spherical nanoparticles to control aspect ratios and surface functionalization. This unique design facilitates functional assembly at the nanoscale. Additionally, we developed an innovative composite by encapsulating polyurethane elastomers within shear thickening fluid (STF)-impregnated Kevlar, significantly enhancing the flexibility and durability of the resulting STF/Kevlar/PU composite. Microstructural and chemical modifications were characterized, and detailed rheological analysis revealed a 165 % increase in viscosity and a substantial rise in storage modulus from 91.56 to 18,640 Pa, indicating improved surface morphology and roughness. These enhancements promoted stronger interparticle friction and rotational motion during flow. Impact resistance tests further demonstrated a 314 % increase in peak impact force, driven by frictional interactions between the dispersed caterpillar-like particles. The results confirmed that surface roughness and adhesive forces play a critical role in activating stress-dependent frictional contacts, a key mechanism behind the improved performance. These findings highlight the potential of these composites for mitigating penetration injuries and offer precise control over the shear-thickening transition in engineering applications, making them promising candidates for lightweight protective materials.

Mesenchymal stem cells suppress inflammation by downregulating interleukin-6 expression in intestinal perforation animal model

Introduction: Intestinal perforation has significant fatality due to sepsis contamination and prolonged inflammation. Studies showed that mesenchymal stem cells (MSCs) secreted cytokines and growth factors to reduce inflammation. This study aims to reveal the role of MSCs in controlling inflammation in intestinal perforation wound healing by measuring interleukin-6 (IL-6) and leukocytes in injured tissue. Materials and methods: A total of 48 rat models with a 10-mm longitudinal incision at the small intestine were divided into four groups: sham, control, Treatment group 1 (T1) injected with MSC doses of 1.5×106 cells and Treatment group 2 (T2) with 3×106 cells. IL-6 expressions were determined using western blot analysis, whereas the leukocyte infiltrations were assessed using the histopathological examination. All variables were evaluated on day 3 and 7. Results: Leukocyte infiltration is significantly lower in T1 and T2 compared to control group in day 3 and 7 (P&lt;0.05), while there were no differences between the two treatment groups. The expression of IL-6 was found to be significantly lower in the T1 and T2 groups compared to the control group on days 3 and 7 (P&lt;0.05), with no significant differences observed between the two treatment groups. Conclusion: MSCs administration in rats with intestinal perforation reduced inflammation by controlling leukocyte infiltration and IL-6 expression.

Stop the Bleed-Wait for the Ambulance or Get in the Car and Drive? A Post Hoc Analysis of an EAST Multicenter Trial.

Background: The Stop the Bleed campaign gives bystanders an active role in prehospital hemorrhage control. Whether extending bystanders' role to private vehicle transport (PVT) for urban penetrating trauma improves survival is unknown, but past research has found benefit to police and PVT. We hypothesized that for penetrating trauma in an urban environment, where prehospital procedures have been proven harmful, PVT improves outcomes compared to any EMS or advanced life support (ALS) transport.Methods: Post-hoc analysis of an EAST multicenter trial was performed on adult patients with penetrating torso/proximal extremity trauma at 25 urban trauma centers from 5/2019-5/2020. Patients were allocated to PVT and any EMS or ALS transport using nearest neighbor propensity score matching. Univariate analyses included Wilcoxon signed rank or McNemar's Test and logistic regression.Results: Of 1999 penetrating trauma patients in urban settings, 397 (19.9%) had PVT, 1433 (71.7%) ALS transport, and 169 (8.5%) basic life support (BLS) transport. Propensity matching yielded 778 patients, distributed equally into balanced groups. PVT patients were primarily male (90.5%), Black (71.2%), and sustained gunshot wounds (68.9%). ALS transport had significantly higher ED mortality (3.9% vs 1.9%, P = 0.03). There was no difference in in-hospital mortality rate, hospital LOS, or complications for all EMS or ALS only transport patients.Conclusion: Compared to PVT, ALS, which provides more prehospital procedures than BLS, provided no survival benefit for penetrating trauma patients in urban settings. Bystander education incorporating PVT for early arrival of penetrating trauma patients in urban settings to definitive care merits further investigation.

The role of video-assisted thoracoscopy in chest trauma: a retrospective monocentric experience.

Video-assisted thoracoscopy (VAT) plays an essential role in the exploration of pleural cavity after thoracic trauma, although some doubts about the precise and specific indications persist. This study examines the eligibility criteria for videothoracoscopy and establishes the ideal timing for VAT. Between January 2011 and November 2022, we observed 923 polytraumatized patients. All patients underwent computed tomography (CT) scan total body with and without contrast enhancement. Two hundred and nine patients carried out VAT within 10 ± 2h of injury while 8 patients after 20 ± 1h. The Injury Severity Score (ISS) was 31 ± 1 and the Glasgow Coma Scale was 14.1 ± 0.3 upon arrival at the hospital. One hundred and nineteen patients displayed hemothorax (55%), 62 hemopneumothorax (28.5%), 21 penetrating wound (9.6%), 10 pneumothorax (4.6%) and 5 chylothorax (2.3%). In 18 patients (8.3%) without vascular, diaphragmatic, or parenchymal lesion the treatment consisted in chest tube placement. VAT was converted to video-assisted thoracoscopic surgery (VATS) in 190 patients (87.5%), to open surgery in 8 (3.7%) and to laparoscopy in 1 (0.5%). Twelve patients (5.5%) with diaphragm ruptures < 5cm in diameter were treated by separate stitches suture in VATS. Only eight postoperative complications (4 pneumonia, three atelectasis and one pulmonary embolism) out of 217 VAT, positively resolved with medical treatment, were noted exclusively in patients undergoing minimally invasive approach 20 ± 1h after trauma. Early VAT in selected patients is a safe and easy procedure that ensure a quick diagnosis of lesions and an accurate management of the most thoracic injuries among trauma patients. The prompt identification of injuries, to avoid life-threatening conditions requiring rapid intervention, responds to medico-legal needs to which VAT fulfills.