Internal Organ Injuries Research Articles

Distinguishing injury patterns in fatal falls from heights versus pedestrian impacts: an autopsy study for differential diagnosis in ambiguous cases.

This study investigated the injury patterns associated with fatal falls from heights compared to individuals struck by cars, aiming to enhance the differential diagnosis in ambiguous cases, where it is unclear whether the body fell from nearby building or was left on the street following a road traffic incident. A retrospective review of comprehensive forensic reports from the Institute of Legal Medicine of the University of Rome "Tor Vergata" between 2012 and 2023 was conducted. The analysis included 232 cases, gathering data on internal organ injuries, skeletal fractures, external skin injuries, as well as pleural, peritoneal, and pericardial effusions. Bilateral lung injuries were significantly more common in falls from height (33.3%) compared to pedestrians (13.6%, p < 0.001). Liver injuries also occurred more frequently in fall victims (49.6%) than in pedestrians (28.2%, p < 0.001). Skull fractures were more frequent in falls from height (68.2%) versus individuals struck by cars (55.3%, p = 0.044), while unilateral leg fractures were more common in pedestrians (28.2%) compared to fall victims (16.3%, p = 0.029). External injuries, notably to the head and legs, were more frequent in pedestrians. The "Total Injured Skin Area" analysis revealed a significant discriminative power with an optimal cut-off of 84.2cm², suggesting that injuries exceeding this threshold may be indicative of a pedestrian road fatality.

Monocyte derived large extracellular vesicles in polytrauma.

Despite significant progress in the medical field, there is still a pressing need for minimal-invasive tools to assist with decision-making, especially in cases of polytrauma. Our team explored the potential of serum-derived large extracellular vesicles, so called microparticles/microvesicles/ectosomes, to serve as a supportive tool in decision-making in polytrauma situations. We focused on whether monocyte derived large EVs may differentiate between polytrauma patients with internal organ injury (ISS>15) and those without. Thus, we compared our EV data to soluble biomarkers such as tumour necrosis factor alpha (TNF alpha) and Interleukin-8 (IL-8). From the blood of 25 healthy and 26 patients with polytrauma large EVs were isolated, purified, and characterized. TNF alpha and IL-8 levels were quantified. We found that levels of these monocyte derived large EVs were significantly higher in polytrauma patients with internal organ damage and correlated with the ISS. Interestingly, we also observed a decline in AnnV+CD14+ large EVs during normal recovery after trauma. Thus, inflammatory serological markers as TNF alpha and as IL-8 demonstrated an inability to discriminate between polytrauma patients with or without internal organ damage, such as spleen, kidney, or liver lacerations/ruptures. However, TNF and IL-8 levels were elevated in polytrauma cases overall when contrasted with healthy non-traumatic controls. These findings suggest that delving deeper into the potential of AnnV+ large EVs derived from monocytes could highly beneficial in the managment of polytrauma, potentially surpassing the efficacy of commonly used serum markers.

EXPERT-EPIDEMIOLOGICAL FEATURES OF NON-LETHAL MOTORCYCLE-RELATED TRAUMA

The forensic examination of victims of motorcycle trauma is a current issue in forensic practice. However, the forensic characteristics of contemporary nonfatal motorcycle injuries have not been adequately investigated. Aim of the work. To investigate the epidemiology of nonfatal motorcycle injuries and to determine the forensic characteristics of injuries typical of victims of motorcycle traffic accidents. Materials and methods. The study material consisted of 40 forensic medical reports on individuals affected by motorcycle injuries, performed at the Ternopil Regional Forensic Medical Bureau between 2016 and 2023. The data extraction was performed in a formalised card for each case, containing details about the injured person, circumstances, location and conditions of the injury. The types of injuries, their location and distribution by body part (head, trunk, limbs) were meticulously recorded. The data obtained were processed using variational statistical methods. Results. Research shows that the majority of nonfatal injuries to motorcyclists occur on the roads during the summer and early autumn, with peaks in June and September, typically as a result of collisions with other vehicles (usually cars). The victims are predominantly male (35 (87.5%)), young (19 (47.5%)) and mature (13 (32.5%)). Of these, 31 (77.5%) were motorcyclists, 6 (15.0%) were passengers and only 3 (7.5%) were pedestrians (p≤0.01). Different lower limb injuries were identified in 35 victims (87.5%, p≤0.01), upper limb injuries in 22 (55%) of the injured and head injuries in 20 (50%). Combined injuries involving two or more different anatomical parts of the body (head, torso and limbs) were found in 35 (87.5%) victims. Head injuries presented as abrasions, bruises or contusions, mainly to the face, often to several facial areas at the same time, typically accompanied by concussion or cerebral contusion. All victims with torso trauma were diagnosed with various soft tissue injuries, of which 18 (90%) were located on the anterior surface of the chest, in the pelvic or abdominal area (often in combination), with spinal injuries occurring in only 2 (10%) victims. Upper limb trauma was associated with various soft tissue injuries, as well as fractures and ligamentous damage in more than half of the victims with upper limb injuries. Victims with lower limb trauma had both superficial soft tissue injuries (abrasions, bruises, haematomas, contusions) and deeper injuries (lacerations or crush injuries), together with open or closed fractures of the femur, tibia and fibula, or multiple fractures. Isolated injuries involving only the trunk or upper extremities, or only the head and trunk, or only the trunk and lower extremities in nonfatal motorcycle trauma were found only in isolated cases. Conclusions. Non-fatal motorcycle trauma usually occurs on the road, in warm weather conditions, as a result of the motorcycle colliding with another vehicle. The majority of victims are motorcyclists, young and middle-aged males. Characteristic features of non-lethal motorcycle trauma are: a significant number of superficial soft tissue injuries and their predominance over fractures or internal organ injuries; the combination of head, trunk and limb injuries with a predominance of lower limb injuries; the predominant location of injuries on the frontal surface of the victims' bodies.

Analysis of anatomic location of burns inpatients in China from 2009 to 2018

BackgroundBurns cause serious physical and psychological harm to patients, placing a heavy burden on the global healthcare system. Our previous study detailed the epidemiological characteristics of burn injuries in Chinese inpatients from 2009 to 2018. Interestingly, the anatomic locations of burn injuries vary by gender, age, provinces, and outcomes among different causes. Therefore, this current study aims to analyze the characteristics of burn injuries in inpatients with various burn sites by collecting data in China from 2009 to 2018. This analysis will inform future healthcare system decisions and provide effective strategies.MethodsBurns inpatients from 196 hospitals across 31 provinces in China were included in the study, covering the period from 2009 to 2018. The data collected encompassed information on gender, age, etiology, regions, clinical outcomes, and anatomical locations of the injuries. Data analysis was conducted using Microsoft Excel 2007.ResultsFrom 2009 to 2018, a total of 333,995 burns inpatients were recorded. The most vulnerable parts to burns were multiple burn sites (230,090, 68.89%). Women were more susceptible to lower limb burns (15,608, 14%), while men were more prone to eye injuries (8,387, 3.37%) and hand burns (6,119, 2.75%). The age group of 0–10 years was the most vulnerable to burns across all body areas, including internal organs. In China, individuals aged 20–50 years were at a higher risk of head and neck burns compared to other age groups. The Han population showed increased vulnerability to eye injuries (2.12 times higher than minorities), respiratory tract issues (2.09 times higher than minorities), and trunk burns (1.83 times higher than minorities), while being less susceptible to internal organ injuries (0.23 times fewer than minorities) and lower limb burns (0.78 times fewer than minorities). The southwest region had the highest proportion of burns inpatients with burns affecting single body parts, whereas the eastern area had the highest rates of respiratory tract burns (0.85%) and multiple burn sites (80.64%). Scalding was identified as the most common cause of burns, while flame burns (769, 55.81%) and chemical burns (438, 47.35%) were the main causes of respiratory tract and internal organ injuries, respectively.ConclusionsThis study provides an initial description of characteristics of burns inpatients with various anatomic locations of burns in China over the past decade. Our findings will contribute to the most up-to-date clinical evidence database for healthcare planning and prevention initiatives in both China and other countries.

A Five-Year Overview of Bicycle Injuries in the United States Between the Years 2017 and 2021.

Introduction This study investigates the changes in bicycle-related injury rates between 2017 and 2021. We focus specifically onchanges in age demographics, and the most common diagnosesand body parts injured. Methods We queried the National Electronic Injury Surveillance System (NEISS) for injuries associated with bicycles from 2017 to 2021. Chi-square analysis was used to evaluate trends in injuries vs. time for the entire sample, age groups in five-year increments, and the proportion of injury types by diagnosis and body part. Results The highest annual injury rate (12,800 counts) occurred in 2020, coinciding with the COVID-19 safer-at-home order. Pediatric patients continue to make up the majority of injured cyclists (48% of patients are younger than 19 years), but their percentage is decreasing (zero to four years (-13%, p < 0.005), five to nine years (-17%, p < 0.005), 10-14years (-5%, p < 0.005), 20-24years (-16%, p < 0.005), 25-29 years (-2%, p < 0.005), and 50-54 years (-14%, p < 0.005)) and mirrored by an increase in the proportion of older injured cyclists (40-44years (+26%, p < 0.005), 60-64years (+44%, p< 0.005), 65-69years (+69%, p < 0.005), and 70+years (+57%, p < 0.005)). The past five years saw an increase in injuries associated with higher impact forces and the potential for more severe morbidity and mortality, such as internal organ injuries (+13%, p < 0.01). The incidence of concussions, however, has not changed significantly. The extremities are the most commonly injured body parts(upper and lower arm, elbow, wrist, hand, fingers, upper and lower leg, knee, ankle, foot, and toe = 47% total) and continue to increase in frequency (lower arm (+2%, p < 0.005), lower leg (+3%, p < 0.01), upper arm (+18%, p < 0.005), and hand (+11%, p < 0.05)), while facial injuries are becoming less common(-3%, p < 0.05), and head injuries have not experienced a significant change of incidence. Conclusion Although there was an increase in bicycle-related injuries during the COVID-19 safer-at-home order, numbers have since returned to pre-COVID-19 levels. Other changes in bicycle injury demographics and mechanisms, such as a rise in older adult cyclists and high-force mechanism injuries, however, call for a re-evaluation of preventive and treatment priorities.

Factors Associated With Head and Neck Polytrauma Presentation and Admissions at Emergency Departments of Varying Sizes.

Timely diagnosis of acute head and neck polytrauma presenting to emergency departments (EDs) optimizes outcomes. Since ED capacity influences triage and admission, the authors utilized the National Electronic Injury Surveillance System database to understand how ED size and trauma characteristics affect head and neck polytrauma presentation and admissions. Demographics and injury characteristics from the National Electronic Injury Surveillance System database from 2018 to 2021 were analyzed to delineate factors contributing to polytrauma presence and admission through multivariable logistic regressions. The authors' 207,951-patient cohort was primarily females (48.6%), non-Hispanic (62.4%), and white (51.4%) people who averaged 57.2 years old. Nonspecific head injuries were predominant (59.7%), followed by facial trauma (22.6%) with rare substance involvement (alcohol, 6.3%; drugs, 4.1%) presenting to high-volume EDs (48.5%). Of the patients, 20% were admitted, whereas 31.1% sustained polytrauma. Substance use [alcohol, odds ratio (OR) = 4.44; drugs, OR = 2.90] increased polytrauma likelihood; neck (OR = 1.35), face (OR = 1.14), and eye (OR = 1.26) associated with polytrauma more than head injuries. Burns (OR = 1.38) increased polytrauma likelihood more than internal organ injuries. Black patients sustained higher polytrauma when presented to non-small EDs (OR = 1.41-1.90) than white patients showed to small EDs. Admissions were higher for males (OR = 1.51). Relative to small EDs, large EDs demonstrated a higher increase in admissions (OR = 2.42). Neck traumas were more likely admitted than head traumas (OR = 1.71). Fractures (OR = 2.21) and burns (OR = 2.71) demonstrated an increased admission likelihood than internal organ injuries. Polytrauma presence and admissions likelihood are site, injury, and substance dependent. Understanding the impact of factors influencing polytrauma presence or admission will enhance triage to optimize outcomes.

2023 catastrophic Turkey earthquake: clinical outcomes of pediatric patients rescued under the rubble

ABSTRACT Objectives Children are the most vulnerable population affected by the earthquake. We aimed to examine the characteristics, morbidity, mortality, and the factors affecting these pediatric earthquake victims to guide the follow-up of pediatric patients who were rescued under the rubble in possible future disasters. Methods This is a retrospective observational study. The files of pediatric earthquake victims aged 0–18 years who were admitted to Adana City Training and Research Hospital between 6 February-30 April 2023 were analyzed. 318 patients were included in the study. Results Of all patients 48.7% (n = 155) were female and 51.3% (n = 163) were male. The mean age of the patients was 114.8 months. 65.4% (n = 208) of the patients were discharged from our hospital, eighteen patients (5.7%) died. Information on the hour when the patients were rescued under the rubble could be reached in 117 (36.8%) patients. The mean rescue time of these patients was 50.5 hours. 62 (53%) victims were rescued in the first 24 hours after the earthquake. There were 111 patients (34.9%) with fractures. There were 118 patients (37.1%) who underwent fasciotomy surgery. The total number of patients with amputation was 48 (15.1%). There were 36 patients (11.3%) with one limb amputated, 12 patients (%3.7) with more than one limb amputation. Internal organ injury was present in 30.5% (n = 97) of the patients. Of these patients, 85.6% (n = 83) had single organ trauma and 14.4% (n = 14) had multiple organ trauma. There were 58 patients (18.2%) with acute renal failure in follow-up. The mean rescue time for patients with amputation was 83.65 ± 62.9 hours, and for patients without amputation was 36.44 ± 50.6 hours. This difference was statistically significant (p = 0.001). No statistically significant difference was found when the ages of the patients were compared to fasciotomy, amputation, and fracture status. Conclusion While evaluating earthquake-induced trauma, pediatric patients should be approached carefully.

Isolated Transverse Process Fractures: Should We Offer Lumbar Corset or Not?

Background The aim of this study is to emphasize the need to be careful in terms of internal organ injuries in patients with isolated transverse process fracture (ITPF), and to investigate the effectiveness of corset use in controlling acute pain. Methods This is a retrospective study including 72 patients with only transverse process fractures secondary to trauma, who were admitted to the Emergency Department of Sakarya University Research and Training Hospital between January 2020 and October 2022. The radiological diagnoses were collected from spinal vertebral computed tomography images. Twelve patients were excluded from the study due to exclusion criteria. Sixty patients with ITPF were included in the comparison group. All patients were divided into two groups. The groupwith no lumbar corset (LC) included those who were discharged with analgesic and muscle relaxant treatment without a brace (n = 33). The LC+ group (n = 27) included those who received rigid lumbosacral orthosis in addition to analgesic and muscle relaxant treatment. Pain levels of all cases in both groups were evaluated with Visual Analog Scale scores on the day of trauma, the first week, the first month, and the sixth month. Results A total of 25 cases had one ITPF, 25 had two, 17 had three, and five patients had four or more ITPFs. The hospitalization rate was the highest among patients with four or more ITPFs (40%). Although the hospitalization rates according to the number of ITPFs were not statistically significant (p = 0.528), there was a clinical significance regarding increasing hospitalization rates with the increasing number of ITPFs. The hospitalization rates were 12%, 16%, 17.6%, and 40% in patients with one, two, three, and four or more ITPFs, respectively. Conclusion ITPFs should be treated conservatively. Concomitant organ injuries must be ruled out before treatment. Medical treatment without a lumbar corset could be used as a cost-effective choice.

Forensic Emergencies In The Context Of Genital Injuries: A Case Report

Introduction&#x0D; A review of gynecological emergency cases shows that traumatic injuries observed in consensual sexual relations, sexual abuse victims or following an abortion, secondary infections, internal organ injuries, and massive bleeding are gynecological forensic cases that may require an emergency approach. In this case; it is aimed to discuss the case of a child who was diagnosed as sexual abuse and reported as a forensic case.&#x0D; Case report&#x0D; In the evaluation of the case of a 15-year-old girl who applied to the emergency service with a history of the foot of a stool entering her vaginal area, it was seen that she had a complaint of active vaginal bleeding but was referred to Child Monitoring Center(ÇİM) without taking a detailed anamnesis or performing any tests. During the forensic interviews at ÇİM, on account of the fact that the patient complained of dizziness, an emergency forensic vaginal examination and operation was performed. Active vaginal bleeding, 3 cm transverse laceration, and uterine artery injury were found in the area between the upper cervix and lower uterine segment.&#x0D; Conclusion&#x0D; Our study aims to contribute to raising awareness about the importance of medical evaluation and healthy anamnesis in the emergency department regarding these issues.

Epidemiology of work-related fall injuries resulting in hospitalisation: individual and work risk factors and severity

ObjectivesInjuries at work are common and costly for individuals and employers. A common mechanism of workplace injury is through falls, but there have been few epidemiological studies of risk factors....

Pediatric thoracic injuries-experience in a tertiary care centre

Background: Isolated thoracic injury in children is not rare. Common modes of injury are blunt injury. As in children the chest wall is more compliant and the thickness of the subcutaneous and muscular layers is reduced, blunt trauma causes increased level of energy transmission leading to more chances of internal organ injuries whereas penetrating injury directly cause fatal injury to those vital organs causing significant mortality. In this study we are sharing our experience of managing isolated thoracic injuries in a tertiary trauma care centre with an encouraging outcome. Methods: This prospective study was conducted in the department of pediatric surgery in NRS medical college and hospital, Kolkata during January 2019 to December 2021. Results: Total no of cases with isolated thoracic injuries are 83 (Boys 50, girls 33). 64 children were treated conservatively and 19 required surgical intervention. 40% patients were between 2-6 years. Among the cases blunt trauma (82%), penetrating trauma (12%) and other mode of injuries (6%) have been noted which includes diaphragmatic rupture (2), bilateral hemothorax (2), unilateral hemothorax (10), pneumothorax (4), flail chest (2), isolated rib and clavicle injury (20), subcutaneous emphysema (4), tracheal injury (1), esophageal injury (1) and retained foreign body (3). Total 7 children required ventilatory support. Conclusions: Management of isolated thoracic injury is done mostly by conservative management and few require intercostal drain placement. Thoracotomy is required rarely. Postoperative ventillatory support is also an important factor for managing such patients.

Traumatic spinal injury-related hospitalizations in the United States, 2016-2019: a retrospective study.

Traumatic spinal injury (TSI) is associated with significant fatality and social burden; however, the epidemiology and treatment of patients with TSI in the US remain unclear. An adult population was selected from the National Inpatient Sample database from 2016 to 2019. TSI incidence was calculated and TSI-related hospitalizations were divided into operative and nonoperative groups according to the treatments received. TSIs were classified as fracture, dislocation, internal organ injury, nerve root injury, or sprain injuries based on their nature. The annual percentage change (APC) was calculated to identify trends. In-hospital deaths were utilized to evaluate the prognosis of different TSIs. Overall, 95047 adult patients were hospitalized with TSI in the US from 2016 to 2019, with an incidence rate of 48.4 per 100000 persons in 2019 (95% CI: 46.2-50.6). The total incidence increased with an APC of 1.5% (95% CI: 0.1-3%) from 2016 to 2019. Operative TSI treatment was more common than nonoperative (32.8 vs. 3.8; 95% CI: 32.3-33.2 vs. 3.6-4%). The number of operations increased from 37555 (95% CI: 34674-40436) to 40460 (95% CI: 37372-43548); however, the operative rate only increased for internal organ injury (i.e. spinal cord injury [SCI])-related hospitalizations (APC, 3.6%; 95% CI: 2.8-4.4%). In-hospital mortality was highest among SCI-related hospitalizations, recorded at 3.9% (95% CI: 2.9-5%) and 28% (95% CI: 17.9-38.2%) in the operative and nonoperative groups, respectively. The estimated incidence of TSI in US adults increased from 2016 to 2019. The number of operations increased; however, the proportion of operations performed on TSI-related hospitalizations did not significantly change. In 2019, SCI was the highest associated mortality TSI, regardless of operative or nonoperative treatment.

Virtual Assessment of a Representative Torso Airbag under the Fall from Height Impact Conditions

A fall from height is the main cause of serious injuries and fatalities in occupational and work-related accidents, especially construction. Falls from scaffolds, ladders, or roofs are very frequent accident scenarios. Especially for those falls from a height of 1 m to 6 m, the use of wearable smart airbags has been proposed to mitigate possible torso injuries. In this study, a virtual assessment of such an inflatable protector was conducted using numerical simulations and finite element human body models in order to determine its impact-protection performance under realistic impact conditions and identify its possible limitations. The findings obtained from the simulation study showed a significant protective effect provided by the airbag, mitigating a multiple rib fracture scenario and reducing the risk of internal organ injuries for those falling from four meters of height or less. The use case analyzed in this research demonstrates the suitability of using a virtual environment not only to evaluate current protectors but also to develop new protector devices, which could improve occupational safety.

Multiple Radiologic Findings in a Simple Blunt Thoracic Trauma

Blunt thoracic trauma is one of the main contributors to trauma-related deaths, with the broad possibility of pathological chest injury. Imaging plays an important role in detecting most of internal organ injuries. Here we presented a 56-years-old male with progressive chest pain following blunt chest trauma several days prior without any early intervention. Chest radiograph showed rib fractures, pneumothorax, atelectasis, and raised left hemidiaphragm. Further CT scan evaluation identified additional hemothorax, subcutaneous emphysema and confirming the fourth to tenth rib fractures, pneumothorax, and unilateral hemidiaphragm elevation. As seen in our case, chest radiograph is crucial in initial evaluation of chest injury, usually through identification of pathological landmark. While chest radiograph is limited to one projection, CT scan provide a global evaluation of a region with a high sensitivity and specificity in detecting and confirming most of the injuries. Thus, one must not overlook any lightly appeared blunt thoracic trauma while optimizing the use of radiography and CT scan for the evaluation of injuries.

Injuries associated with mechanical chest compressions and active decompressions after out-of-hospital cardiac arrest: A subgroup analysis of non-survivors from a randomized study

BackgroundBoth skeletal and visceral injuries are reported after cardiopulmonary resuscitation (CPR). This subgroup analysis of a randomized clinical study describes/compares autopsy documented injury patterns caused by two mechanical, piston-based chest compression devices: standard LUCAS® 2 (control) and LUCAS® 2 with active decompression (AD, intervention) in non-survivors with out-of-hospital cardiac arrest (CA). MethodWe compared injuries documented by autopsies (medical/forensic) after control and intervention CPR based on written relatives consent to use patients’ data. The pathologists were blinded for the device used. The cause of CA and injuries reported were based on a prespecified study autopsy template. We used Pearson's chi-squared testand logistic regression analysis with an alpha level of 0.05. Results221 patients were included in the main study (April 2015–April 2017) and 207 did not survive. Of these, 114 (55%, 64 control and 50 intervention) underwent medical (N = 73) or forensic (N = 41) autopsy. The cause of CA was cardiac 53%, respiratory 17%, overdose/intoxication 14%, ruptured aorta 10%, neurological 1%, and other 5%. There were no differences between control and intervention in the incidence of rib fractures (67% vs 72%; p-value = 0.58), or sternal fractures (44% vs 48%; p-value = 0.65), respectively. The most frequent non-skeletal complication was bleeding (26% of all patients) and intrathoracic was the most common location. Ten of the 114 patients had internal organ injuries, where lungs were most affected. ConclusionIn non-survivors of OHCA patients, the most frequent cause of cardiac arrest was cardiogenic. Skeletal and non-skeletal fractures/injuries were found in both control and intervention groups. Bleeding was the most common non-skeletal complication. Internal organ injuries were rare.

Thoracic injuries in trauma patients: epidemiology and its influence on mortality

BackgroundThoracic injuries are common among trauma patients. Studies on trauma patients with thoracic injuries have reported considerable differences in morbidity and mortality, and there is limited research on comparison between trauma patients with and without thoracic injuries, particularly in the Scandinavian population. Thoracic injuries in trauma patients should be identified early and need special attention since the differences in injury patterns among patient population are important as they entail different treatment regimens and influence patient outcomes. The aim of the study was to describe the epidemiology of trauma patients with and without thoracic injuries and its influence on 30-day mortality.MethodsPatients were identified through the Karolinska Trauma Register. The Abbreviated Injury Scale (AIS) system was used to find patients with thoracic injuries. Logistic regression analysis was performed to evaluate factors [age, gender, ASA class, GCS (Glasgow Coma Scale), NISS (New Injury Severity Score) and thoracic injury] associated with 30-day mortality.ResultsA total of 2397 patients were included. Of those, 768 patients (32%) had a thoracic injury. The mean (± SD, range) age of all patients (n = 2397) was 46 (20, 18–98) years, and the majority (n = 1709, 71%) of the patients were males. There was a greater proportion of patients with rib fractures among older (≥ 60 years) patients, whereas younger patients had a higher proportion of injuries to the internal thoracic organs. The 30-day mortality was 11% (n = 87) in patients with thoracic injury and 4.3% (n = 71) in patients without. After multivariable adjustment, a thoracic injury was found to be associated with an increased risk of 30-day mortality (OR 1.9, 95% CI 1.3–3.0); as was age ≥ 60 years (OR 3.7, 95% CI 2.3–6.0), ASA class 3–4 (OR 2.3, 95% CI 1.4–3.6), GCS 1–8 (OR 21, 95% CI 13–33) and NISS > 15 (OR 4.2, 2.4–7.3).ConclusionThoracic injury was an independent predictor of 30-day mortality after adjustment for relevant key variables. We also found a difference in injury patterns with older patients having a higher proportion of rib fractures, whilst younger patients suffered more internal thoracic organ injuries.

Bicycle Injuries Associated With Drug Use in the United States, 2019-2020.

The purpose of this study was to analyze the descriptive epidemiology of bicycle-related injuries associated with substances of abuse other than alcohol and to examine types of drugs involved and injury diagnoses. We used data from the 2019-2020 National Electronic Injury Surveillance System (NEISS) among persons seeking treatment in emergency departments in the United States. There were 11,314 bicycle injuries related to drug use. The most common drug reported was methamphetamine, followed by marijuana and opioids. The majority of injuries were fractures or internal organ injuries. Alcohol was involved in 22.3% of these incidents, and 32.3% of those injured were admitted to the hospital. Drug-related bicycle injuries are a significant public health issue. Prevention and control of these injuries is needed, but will likely prove to be difficult because of the variety of circumstances involved but will be aided by the expansion of quality surveillance data and further research examining the circumstances surrounding the injuries.

Plasma cell-free DNA analysis for COVID-19 and beyond.

In human, circulating cell-free DNA (cfDNA) in peripheral blood originates from various tissues/organs. In healthy subjects, cfDNA in plasma is mostly derived from the hematopoietic system; however, in various physiological and pathological conditions, the affected tissues would release DNA into circulation, thus allowing one to utilize cfDNA as a surrogate to monitor the dynamics of the inaccessible tissues in a non-invasive manner.1 Such approaches are commonly referred to as “liquid biopsies.” At present, three types of liquid biopsies are widely studied and adapted into clinical practices: non-invasive prenatal testing for genetic disorders of the fetus by sequencing and analyzing the cfDNA in maternal plasma; detecting circulating tumour-derived DNA (ctDNA) in the plasma of cancer patients makes it possible for early diagnosis, real-time tumour evolution monitoring and guidance in targeted therapy; donor-derived DNA in the plasma of transplantation recipients could be used for comprehensive monitoring of allograft rejection and injury. However, cfDNA applications in other clinical scenarios are much less explored. The COVID-19 pandemic lasted for more than 2 years. Due to the high variability in clinical symptoms of the COVID-19 patients, disease severity assessment is of clinical value in providing precision healthcare and better management for the large-number of patients. However, in most COVID-19 patients, a handful of organs is affected simultaneously, which makes the clinical assays incompetent for accurate and rapid severity assessment. To this end, in a recent work,2 Bai and colleagues developed a cfDNA-based approach for disease severity assessment of COVID-19 patients with high translational feasibility. Bai et al. performed whole-genome sequencing of plasma cfDNA and identified three types of features (including fragment length ratio, transcription start site coverage, and frequency of 4-nucleotide motifs at 5’ fragment ends3) in 399 consecutive hospitalized COVID-19 patients. They further combined these features with laboratory results and trained a model using machine learning approach, named M2Model, to distinguish critical from noncritical COVID-19 patients with a sensitivity of 85.19% at 93.33% specificity. In addition, for clinically diagnosed critical COVID-19 patients, Bai et al. successfully clustered them into three risk strata, and they showed that the M2Model was able to predict the risk of these patients towards deteriorating critical illness; moreover, survival analysis further showed that the high-risk critical COVID-19 patients predicted by the model required a significantly longer hospital stay than the other groups. Besides Bai et al. work, several studies from other groups had also explored the clinical applications of cfDNA as a biomarker for COVID-19 monitoring. For instance, Cheng et al.4 and other groups5 investigated the characteristics of cfDNA in COVID-19 patients and further developed various cfDNA-based approaches to appraise the internal organ injuries due to COVID-19. In particular, Cheng et al. reported that the concentration of cfDNA positively correlated with COVID-19 disease severity and the cfDNA profile at admission allowed one to identify patients who subsequently required intensive care or died during hospitalization. Together, these studies demonstrated the clinical potential of plasma cfDNA analysis in COVID-19, which is virtually an infectious disease. Apart from COVID-19, more and more studies have extended the significance of cfDNA in a broad spectrum of clinical scenarios in addition to its traditional applications (e.g., prenatal testing, cancer and organ transplantation). For examples, cfDNA analysis would provide precise subtyping of anaemia and effective monitoring of treatment responses6; Teo et al. showed that nucleosome signals inferred from cfDNA correlated with age-associated changes in the epigenome in vivo 7 Another recent study reported that cfDNA plays an important role in the pathogenesis of systemic lupus erythematosus and showed considerable diagnostic value.8 In the past several years, technical advances have also been developed, which allowed one to measure more types of cfDNA molecules, such as single-strand, ultralong and circular ones 9; moreover, besides concentration, genetic variation, DNA methylation profiles and copy number aberrations, the fragmentomic feature of plasma cfDNA is becoming an emerging direction in liquid biopsy, and it has been successfully implemented as novel diagnostic biomarkers for early cancer diagnosis, tumour-of-origin prediction, and tumour subtype.10 Hence, with the improvement of experimental and analytical methodologies, we believe that the next few years would witness the large expansion of the application range of plasma cfDNA in liquid biopsy, from traditional cancer fields to infectious diseases, and beyond. This work was supported by open project of BGI-Shenzhen, Shenzhen 518000, China (grant number: BGIRSZ20200007) and Shenzhen Bay Laboratory. The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

MO112: Clinical Features of Allopurinol-Induced DRESS/DIHS in 46 Patients

Abstract BACKGROUND AND AIMS Allopurinol is the first-line prescribed agent for hyperuricemia and gout. Allopurinol-induced drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare but serious and potentially life-threatening drug hypersensitivity syndrome. This study aimed to investigate the clinical features, treatment, outcome and prognostic factors of allopurinol-induced DRESS. METHOD Case reports of allopurinol-induced DRESS published by China from January 2000 to August 2021 were retrieved from CNKI, Wan Fang, Wei Pu and PubMed databases for analysis. RESULTS This study included 46 patients, consisting of 34 (73.9%) males and 12 (26.1%) females (M: F = 2.8:1). The mean of age was 56.1 ± 17.4 years (range: 23–86 years). The mean of latency periods was 24.0 ± 14.8 days (range:1–60 days). Most patients presented with fever, cutaneous eruption, eosinophilia, lymphadenopathy and facial oedema. All patients showed at least one internal organ injury. A total of 35/46 (76.1%) patients showed two or more internal organs involved. Liver and kidney injury were the most common visceral manifestations. One patient showed central nervous system involved, presenting as leukoencephalopathy. HLA*B 58:01 allele was tested in 19/46 (41.3%) patients. A total of 18/19 (94.7%) patients were positive. A total of 45/46 (97.8%) patients were treated with systemic corticosteroids. Patient outcomes were known for 45 of the 46 patients. A total of 13 (28.9%) patients were cured, 24 (53.3%) patients received partial recovery and 8 (17.8%) patients died. Septic shock and multiple organ failure were the leading causes of death. Patients with older age, underlying cardiovascular disease, chronic kidney disease, infection and internal organ involvement (including kidney, heart and lung) were associated with poorer outcomes. CONCLUSION We explored clinical features, treatment, outcome and prognostic factors of 46 allopurinol-induced DRESS cases in China. Early identification and discontinuation of the causative drug are crucial to the management of DRESS. For patients with severe disease, corticosteroids are recommended as the first-line therapy. However, further studies are needed to address diagnostic criteria of DRESS for early diagnosis, as well as to develop standardized corticosteroid treatment regimens.

Features of management of patients with fractures of the sternum

Fractures of the sternum are rare types of injuries that usually occur because of damage to the anterior chest. Due to the high frequency of combined injuries of internal organs, the mortality rate in patients with sternum fractures can reach 45 %. Despite this, the treatment of sternum fractures is a poorly understood topic. Therefore, this study was aimed at analyzing the features of managing patients with sternum fractures.