Management Of Injuries Research Articles

Enhancing Heat-Related Illness and Injury Management in the ICU with a Focus on Gastrointestinal Injury.

Enhancing Heat-Related Illness and Injury Management in the ICU with a Focus on Gastrointestinal Injury.

Management of Avulsion tooth within golden period in young permanent tooth

Introduction: Tooth avulsion is described as a displacement of the tooth from its socket. It may occurs due to trauma and most often involves the maxillary teeth. Numerous studies have shown that this injury is one of the most serious dental injuries, so prompt and correct emergency management is essential for attaining the best outcome after this injury. Factors that determine healing after replantation are media storage, periodontal tissue damage, extra-alveolar period and intact alveolar socket. Case History: A 11-years-old male patient was referred from Puskesmas Perak to the Department of Paediatrics Dentistry at RSKGM-P Airlangga Surabaya with complaints that his upper tooth was off from its socket. The incident occurs after his head hit the table around 30 minutes ago. The patient had no history of systemic disease and didn’t have any allergic to food and medicine. The tooth was soaked on normal saline. Discussion: The optimal treatment option following an avulsion injury is to replant avulsed tooth at the earliest. Appropriate emergency management, significant treatment plans, and prompt action influence good prognosis in the management of an avulsion injury. In the past, it was advised to perform root canal therapy extra-orally before replantation. However, the current guidelines recommend root canal therapy be performed intra-orally to minimizes the extra-oral time. After the replantation, we continue to observe the tooth every month to see the vitality, mobility, ankylosis and resorption. Conclusion: Replantation is the treatment of choice following avulsion to facilitates restorative therapy and quality of life.

Reframing acute kidney injury as a pathophysiological continuum of disrupted renal excretory function.

Surrogate measures of glomerular filtration rate (GFR) continue to serve as pivotal determinants of the incidence, severity, and management of acute kidney injury (AKI), as well as the primary reference point underpinning knowledge of its pathophysiology. However, several clinically important deficits in aspects of renal excretory function during AKI other than GFR decline, including acid-base regulation, electrolyte and water balance, and urinary concentrating capacity, can evade detection when diagnostic criteria are built around purely GFR-based assessments. The use of putative markers of tubular injury to detect "sub-clinical" AKI has been proposed to expand the definition and diagnostic criteria for AKI, but their diagnostic performance is curtailed by ambiguity with respect to their biological meaning and context specificity. Efforts to devise new holistic assessments of overall renal functional compromise in AKI would foster the capacity to better personalize patient care by replacing biomarker threshold-based diagnostic criteria with a shift to assessment of compromise along a pathophysiological continuum. The term AKI refers to a syndrome of sudden renal deterioration, the severity of which is classified by precise diagnostic criteria that have unquestionable utility in patient management as well as blatant limitations. Particularly, the absence of an explicit pathophysiological definition of AKI curtails further scientific development and clinical handling, entrapping the field within its present narrow GFR-based view. A refreshed approach based on a more holistic consideration of renal functional impairment in AKI as the basis for a new diagnostic concept that reaches beyond the boundaries imposed by the current GFR threshold-based classification of AKI, capturing broader aspects of pathogenesis, could enhance AKI prevention strategies and improve AKI patient outcome and prognosis.

Characteristics of injuries during the 2006 Lebanon conflict: a three-center retrospective study of survivors, 16 years after the conflict

BackgroundArmed conflict injury is a growing public health concern, particularly in regions like the Middle East and North Africa (MENA). The protracted conflicts and political unrest in this region have led to a substantial number of injuries. Despite this, there is still limited understanding of the specific injury patterns stemming from conflicts, such as the 2006 Lebanon conflict. This study aimed to assess the characteristics and burdens of injuries resulting from this conflict, which occurred 16 years prior to this research.MethodsThis retrospective study analyzed data of individuals affected by the 2006 Lebanon conflict, across three tertiary care centers. Demographics, injuries, complications, injury management, and hospitalization expenses were extracted from medical records and analyzed using SPSS version 29.0. Categorical variables were presented as counts and proportions, and continuous variables as mean ± standard deviation (SD). Hospital comparisons utilized chi-square or Fisher’s exact tests for categorical variables, and one-way ANOVAs for continuous variables. Analysis was conducted from September to November 2023.ResultsAcross three hospitals, 341 patients were studied, comprising 73.6% males and 26.4% females. Among them, a notable proportion (57.3% males and 34.1% females) fell within the 18–39 age range. Children and adolescents under 18 years accounted for 15.9% of males and 25.9% of females. Blast-related injuries predominated, with 24.5% resulting from direct damage caused by explosive parts and 33.3% from blast wave forces. Extremity trauma occurred in 49.0% of patients, and head/neck trauma in 24.9%. Common injuries, including penetrating, musculoskeletal, and traumatic brain injuries affected 34.9%, 31.1, and 10.0% of patients, respectively. Wound repair, fracture treatment, and debridement were the most performed procedures on 15.5, 13.5 and 9.7% of the patients, respectively. The total cost of care was USD 692,711, largely covered by the Ministry of Public Health (95.9%).ConclusionConflict-related injuries significantly contribute to the global burden of disease. Therefore, there is a pressing need to improve national guidelines to prioritize life-threatening cases and potential long-term disabilities. Furthermore, enhancing electronic registry systems to collect clinical data on injured patients is essential for conducting research and better understanding the needs of conflict casualties.

Comparative efficacy analysis of mannitol and hypertonic saline in the management of traumatic brain injury: a scientific exploration of neuroprotective strategies

Comparative efficacy analysis of mannitol and hypertonic saline in the management of traumatic brain injury: a scientific exploration of neuroprotective strategies

A Model for Causality of Pitching-related Overuse Injuries in Women's Fastpitch Softball.

Fastpitch softball is a popular women's sport, and athletes, particularly pitchers, are at high risk for overuse injury. Softball-related injury rates are low; however, the prevalence of overuse injuries is high. Injuries at the high school and collegiate levels occur early in the season, and approximately 50% of shoulder and elbow injuries in softball are attributable to overuse. Survey research showed 77% of high school pitchers pitch with pain, and 73% of collegiate pitchers reported an overuse injury in the previous season. Modifiable and non-modifiable intrinsic and extrinsic risk factors contribute to injury risk in a model that can be used in history taking, clinical examination, and management of softball-related injuries. In this manuscript, we present a scoping review of fastpitch softball injury research by competitive levels from 1990 to present. We also introduce a model for overuse injury causality in this athlete population. With this information, clinicians will be able to identify risk factors related to injury in softball pitchers. More research is needed to make evidence-based recommendations for injury prevention in this athlete population.

Challenges and strategies in the surgical management of traumatic spinal cord injuries in the Democratic Republic of the Congo

BackgroundSignificant progress has been made in the management of traumatic spinal cord injuries. However, deep disparities persist in developing countries. This work aims to describe the different challenges in the surgical management of traumatic spinal cord injuries at the Kinshasa University Teaching Hospital and some strategies implemented to overcome them. MethodsThis is a cross-sectional study of 105 patients from January 2016 to June 2023. The variables of interest included: gender, age, cause, levels of lesion, hospital admission modalities, time to admission, time to surgery, AIS score at admission and on discharge, treatment, pre, peri- and post-operative complications and outcome. ResultsWe admitted 105 patients. Only 16 % of them were taken to hospital in an ambulance. The average admission time was 49.9 ± 81.79 days. Seventy-two patients (68.6 %) were operated. The average time to surgery was 62.43 ± 85.20 days. No patient was stabilized at the trauma site. Osteosynthesis was performed with appropriate implants in 63.2 % and with improvised elements in 26.8 %. Four patients were operated without an image intensifier. Short-segmental fixation was performed in 8 patients. Twenty-one patients developed pressure ulcers. At discharge, 24 patients recovered their neurological function. Neurological status remained stationary in 43 patients. Five patients died. Seventeen patients went to rehabilitation center. There was no significant difference between the improvised strategies implemented and conventional procedures on functional recovery upon discharge from hospital or rehabilitation centre (p-value : 0.838 and 0.468 respectively). ConclusionOur establishment faces many challenges in TSCI surgery: lack of pre-hospital emergency services and mutual health insurance, delay in admission, lack of surgical implants and image intensifier, the poverty of the population. Some strategies have been implemented to overcome some of them.

Crepuscular rays - The bright side of complement after tissue injury.

Acute injuries trigger an intense activation of the body's defense mechanisms aiming to limit damage and initiate healing. Among the crucial components of the intravascular immune system, the complement system plays a significant role in traumatic injuries, albeit often negatively. It has been suggested that excessive activation of the complement system, transitioning from a localized and timed response to a systemic one, can lead to a loss of its host-protective characteristics. Complement activation products have been associated with the severity of injuries, which sometimes serve as predictors for the onset of organ dysfunctions. Animal studies utilizing complement-targeting agents have provided the basis for considering complement in the management of traumatic injuries in humans. However, numerous studies suggest that the spatial and temporal aspects of complement inhibition are crucial for its efficacy. Understanding the underlying mechanism of the injury is essential to determine where, when, and whether complement inhibition is warranted. Despite the detrimental effects of uncontrolled complement activation, its regulated activation may contribute to essential aspects of healing, such as waste removal and regeneration. This review focuses on the beneficial roles of complement activation in trauma, which are often overlooked or given less consideration but are of immense importance.

Selective nonoperative versus operative management of liver gunshot injuries: a retrospective cohort study.

Experience accumulated over the last decades suggests nonoperative management (NOM) of civilian gunshot liver injuries can be safely applied in selected cases. This study aims to compare the outcomes of selective NOM versus operative management (OM) of patients sustaining gunshot wounds (GSW) to the liver. A registry-based retrospective cohort analysis was performed for the period of 2008 to 2016 in a Brazilian trauma referral. Patients aged 16-80 years sustaining civilian GSW to right-sided abdominal quadrants and liver injury were included. Baseline data, vital signs, grade of liver injury, associated injuries, injury severity scores, blood transfusion requirements, liver- and non-liver-related complications, length-of-stay (LOS), and mortality were retrieved from individual registries. A total of 54 patients were eligible for analysis, of which 37 underwent NOM and 17 underwent OM. The median age was 25 years and all were male. No statistically significant differences were observed between groups regarding patients' demographics, injury scores, grade of liver injury and associated lesions. NOM patients tended to sustain higher-grade injuries (86.5% vs 64.7%; p = 0.08), and failure of conservative management was recorded in two (5.4%) cases. The rate of complications was 48% with no between-group statistically significant difference. Blood transfusion requirements were significantly higher in the OM group (58.8% vs 21.6%; p = 0.012). The median LOS was seven days. No deaths were recorded. Patients with liver GSW who are haemodynamically stable and without peritonitis are candidates for NOM. In this study, NOM was safe and effective even in high-grade injuries.

Management of the atrophic mandibular fractures: a ten-year prospective study of 48 injuries.

The purpose of this study was to (a) record and evaluate the epidemiological data relevant to the fractures of the atrophic mandible in the Greek population (b) present our experience in the management of these difficult injuries and (c) compare our results to the outcomes of other similar studies and discuss the postoperative complications. A prospective analysis of all the edentulous patients with fractures of the atrophic mandible treated at the Oral and Maxillofacial Surgery Department of K.A.T General Hospital of Athens in Greece was performed from November 2012 to December 2022. Age, gender and medical history of the patient, etiology and site of the fracture, classification of atrophy, type of surgical approach, type of osteosynthesis and postoperative complication. 34 patients were included in the present study and 48 fractures of the atrophic edentulous mandible were managed surgically. 22 fractures were classified as class II of atrophy, 21 fractures as class III and 5 injuries as class I. In 32 patients we used an extraoral approach and only 2 patients were treated with an intraoral access. 44 fractures were treated with a 2.0mm locking reconstruction plate and only 4 injuries of class I atrophy were treated with mini plates. Clinical practice has confirmed that for these cases an extraoral approach followed by stable fixation with a 2.0mm reconstruction locking plate can deliver excellent results. Our findings show that the routine use of primary bone grafts is not necessary and can be reserved for more complex cases.

Follow-up computed tomography and unexpected hemostasis in non-operative management of pediatric blunt liver and spleen injury.

While follow-up CT and prophylactic embolization with angiography are often conducted during non-operative management (NOM) for BLSI, particularly in a high-grade injury, the utility of early repeated CT for preventing unexpected hemorrhage remains unclear. This study aimed to elucidate whether early follow-up computerized tomography (CT) within 7 days after admission would decrease unexpected hemostatic procedures on pediatric blunt liver and spleen injury (BLSI). A post-hoc analysis of a multicenter observational cohort study on pediatric patients with BLSI (2008-2019) was conducted on those who underwent NOM, in whom the timing of follow-up CT were decided by treating physicians. The incidence of unexpected hemostatic procedure (laparotomy and/or emergency angiography for ruptured pseudoaneurysm) and complications related to BLSI were compared between patients with and without early follow-up CT within 7 days. Inverse probability weighting with propensity scores adjusted patient demographics, comorbidities, mechanism and severity of injury, initial resuscitation, and institutional characteristics. Among 1320 included patients, 552 underwent early follow-up CT. Approximately 25% of patients underwent angiography on the day of admission. The incidence of unexpected hemostasis was similar between patients with and without early repeat CT (8 [1.4%] vs. 6 [0.8%]; adjusted OR, 1.44 [0.62-3.34]; p = 0.40). Patients with repeat CT scans more frequently underwent multiple angiographies (OR, 2.79 [1.32-5.88]) and had more complications related to BLSI, particularly bile leak (OR, 1.73 [1.04-2.87]). Follow-up CT scans within 7 days was not associated with reduced unexpected hemostasis in NOM for pediatric BLSI.

#3089 Radiological assessment of suspected acute pyelonephritis in the management of urosepsis and prevention of acute kidney injury

Abstract Background and Aims Sepsis, a serious complication of infection, may result in organ dysfunction and is responsible for almost 20% of global deaths. Identification of acute pyelonephritis (pyelo), requires early clinical assessment, diagnostics and antimicrobial therapy to prevent septic shock and potential death. In 2022, the American College of Radiology (ACR) published a revised appropriateness criteria for radiological imaging in suspected acute pyelo (1). Five variant [V] categories were defined according to presence of pregnancy, stone disease, renal transplantation, complicated (i.e. recurrent pyelo, DM, immunosuppression) and uncomplicated (first) presentation. The aim of this project was to establish the proportion of patients with suspected acute pyelonephritis undergoing radiological assessment, the selected modality and radiological findings, which could contribute to the diagnosis and management. Method This observational retrospective study of 55 cases with suspected acute pyelo over 6 months. Patients who were decanted to nephrology specialist care from the acute medical take were assessed. Patients were grouped into 5 categories [Variant 1-5] as per appropriateness criteria of the ACR (Table 1a). Patient demographics, renal function and signs of sepsis were recorded. The proportion undergoing radiological assessment, the modality and outcomes are outlined in Table 1. Results Demographically, 66% of patients were female, the median age was 49 years [IQR 30] and 93.6% were Caucasian. Pre-admission baseline Creatinine (Cr) was 75 µmol/l [IQR 75]. Admission Cr was 85 µmol/l [IQR 74}, with peak inpatient Cr 94 µmol/l. Sepsis parameters (hypotensive/ tachycardia/ high CRP) on admission were observed in 38% of patients. Modality Choice 92.7% of study participants received imaging over the course of their inpatient stay. The primary modality of choice was CTKUB (36.4%), with 25.5% of patients receiving targeted ultrasound. In the setting of uncomplicated acute pyelo (V1), CTKUB was the most common diagnostic modality. Patients with a history of renal calculi (V3) were imaged equally with CTKUB and targeted ultrasound (42.9% CTKUB vs. 42.9% USS). Patients with a history of renal transplant with a native kidney in-situ were most commonly investigated with targeted ultrasound to assess for acute pyelo 92.3%. Imaging Results 52.7% of imaging had positive findings. Most frequently recorded was pyelo (23.6%), renal/ureteric calculi (16.4%) and hydronephrosis (12.7%). In presumed uncomplicated acute pyelo (Variant 1), 29% of patients had radiological evidence of pyelo. 22.2% had newly diagnosed renal/ ureteric calculus. 11.1% had hydronephrosis. One patient had both stones and hydronephrosis. In known stone disease, two presented with hydronephrosis [V3]. Two transplant cases had hydronephrosis [V5]. Conclusion Early detection of pyelonephritis and its underlying aetiology is imperative in the management of urosepsis. Results suggest 22.2% had newly diagnosed renal/ ureteric calculus in those not known to have renal disease [V1]. In total 12% had hydronephrosis, and nearly a quarter had pyelo visible on imaging. No abscesses were observed which guided duration of antibiotic therapy. Early intervention including anti-microbial therapy and management of acute kidney injury were guided by imaging outcomes. Access to specialist services and early imaging is crucial in successful outcomes in urosepsis.

Training in Endoscopic Endonasal Neurosurgical Procedures: A Systematic Review of Available Models

Abstract Background Proficiency in endoscopic endonasal neurosurgery (EEN) requires a unique skill set and is associated with a steep learning curve. Endoscopic simulation models present an opportunity for trainees to enhance their surgical skills and anatomical knowledge in a risk-free environment. To date, four main categories of training modalities have been recorded: cadaveric, synthetic, animal, and virtual reality (VR) models. Objective To analyze the features, advantages, and disadvantages of each EEN training model, describe the stages of simulation training, and propose future directions and an algorithm for EEN training. Methods A comprehensive search was performed including studies published before August 2023. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed in the search and selection of studies included. Terms for searching title and abstract were (“simulation”) AND (“endoscopic endonasal”) AND (“neurosurgery”). Articles were screened for duplicates. Results We identified 176 references, and 43 studies met the inclusion criteria. Twelve articles described cadaveric models, with 7 of them studying internal carotid artery injury management and 3 of them cerebrospinal leak management; 14 articles illustrated synthetic models, 1 article described animal models, and 16 articles outlined VR simulations. Conclusion Cadaveric models provide realistic hands-on surgical training with acceptable cost and remain the gold standard method for training. Synthetic models are most effective for preoperative surgical planning and animal models are best suited for testing of hemostatic techniques. VR simulations may become the primary training tool for novices to acquire basic anatomical knowledge as their role in advanced surgical planning is evolving.

An on-demand antibacterial hydrogel for precise and rapid elimination of bacterial infection in a murine partial thickness scald burn wound

Burn wounds trigger prolonged inflammation, impair healing, and result in a high mortality rate. The effective management of burn patients requires a targeted approach to regulate the wound microenvironment, maintaining sterility while fostering conditions conducive to healing and functionality. Here, we developed a targeted antibacterial pH/temperature-responsive silver nanoparticle (AgNP) hydrogel triggering the release of silver ions based on changes in the burn wound microenvironment. The delivery system not only exerts a strong antibacterial effect owing to the localization and interfacial interaction of ultrasmall AgNPs against the bacterial surface and deeply embedded cells within the biofilm but also downregulates the bacterial pore-forming genes, thereby overwhelmingly deactivating bacterial responses through a multifaceted mechanism of action. We demonstrate that the application of AgNP hydrogel results in pH-dependent bacterial killing and elimination of over 95 % of pathogens while being non-toxic to mammalian cell viability and migration. Furthermore, the in vivo preclinical burn infection murine model demonstrates the eradication of S. aureus infection leading to a progressive burn repair supported by increased collagen deposition, anti-inflammatory properties, and increased burn angiogenesis. Overall, this strategy provides a targeted approach to addressing drug-resistant chronic burn infections, thereby contributing to improved management of burn injuries.

Scapholunate Ligament Reconstruction With Internal Brace Augmentation Techniques for Chronic Scapholunate Dissociation: A Clinical Follow-up Study.

The scapholunate ligament is the most important stabilizer of the scapholunate articulation. The management of chronic irreversible injuries of this ligament in the absence of preexisting arthritis of the wrist joint remains controversial. Recently, surgeons introduced a novel surgical technique using an internal brace (IB). Several biomechanical studies on this technique have been conducted using cadavers; however, very few studies have discussed the results in detail in actual clinical practice. Therefore, herein, we investigated the radiological and functional results of patients who underwent IB augmentation as a treatment for chronic scapholunate dissociation. This retrospective study was conducted from April 2018 to May 2022. Twenty-two patients with chronic scapholunate dissociation were treated using the IB augmentation technique, of whom 17 were followed-up for at least 1 year. Radiological results, including scapholunate distance, scapholunate angle, and radioscaphoid angle, were collected. Furthermore, clinical parameters, such as the visual analog scale (preoperative and at final follow-up), the Disabilities of the Arm, Shoulder, and Hand scores (preoperatively and at 3, 6, and 12 months postoperatively), and Mayo wrist scores (preoperative and at final follow-up), were measured. The scapholunate distance increased significantly in the affected wrist compared to the unaffected wrist, which improved after reconstruction in all wrist positions (P < 0.05). Compared to the unaffected wrist, the scapholunate angle increased significantly in all positions (P < 0.05) except for extension (P = 0.535) and improved after reconstruction in all wrist positions. The radioscaphoid angle significantly increased compared to the angle of the unaffected wrist in all positions (P < 0.05) except for extension (P = 0.602) and clenched fist (P = 0.556). This angle improved after reconstruction in all wrist positions except for extension (P = 0.900). The visual analog scale score (7-2, preoperatively and at final follow-up) and Mayo wrist score (53-82, preoperatively and at final follow-up) improved after surgery. The Disabilities of the Arm, Shoulder, and Hand scores also improved after surgery (68, 53, 30, 7, preoperatively and at 3, 6, and 12 months postoperatively). This study revealed that scapholunate ligament reconstruction using an autologous tendon and suture tape is a good reconstruction technique that can improve clinical symptoms and radiographic parameters with a shorter operation time and fewer complications than other reconstruction methods.

Specialists' management of permanent dentition traumatic dental injuries in 7-16-year-olds: A qualitative study.

Specialist paediatric dentists are integral to dental trauma care pathways. General dentists rely on specialist input, more so in complex cases. Little is known about specialists' role in these pathways or the perceived barriers they face. The aim is to explore specialists' role in managing traumatic dental injuries in the permanent dentition in children. Face-to-face (remote video) online semi-structured interviews were undertaken. All UK specialists were invited by email. Purposeful sampling aimed to investigate representation from the devolved nations, presence/absence of working within a managed-clinical network and level of care provision. Interviews were audio-recorded and transcribed verbatim. Transcripts were thematically analysed. Data saturation was reached after nine interviews. Three main themes established were: inconsistent access to care; the need to formalise traumatic dental injuries care pathways; educationally upskilling general dentists. Geographical variation in provision of specialist and out-of-hours/emergency department care meant patients risked not receiving care by the most appropriate individual. Formalizing care pathways by clearly defining the role of each stakeholder (specialist, dentist, medical professionals and parents) and developing a method to assess complexity was perceived to be essential to improving treatment outcomes. Upskilling general dentists in trauma management appeared essential. A potential lack of engagement was raised, with a suggestion that trauma management education should become core continuing-professional development. Specialist input should be available in the management of traumatic dental injuries. Current access to specialist care is inequitable across the UK. Formalizing care pathways and upskilling general dentists could ease inconsistencies.

Development, comparison, and internal validation of prediction models to determine the visual prognosis of patients with open globe injuries using machine learning approaches

IntroductionOpen globe injuries (OGI) represent a main preventable reason for blindness and visual impairment, particularly in developing countries. The goal of this study is evaluating key variables affecting the prognosis of open globe injuries and validating internally and comparing different machine learning models to estimate final visual acuity.Materials and methodsWe reviewed three hundred patients with open globe injuries receiving treatment at Khatam-Al-Anbia Hospital in Iran from 2020 to 2022. Age, sex, type of trauma, initial VA grade, relative afferent pupillary defect (RAPD), zone of trauma, traumatic cataract, traumatic optic neuropathy (TON), intraocular foreign body (IOFB), retinal detachment (RD), endophthalmitis, and ocular trauma score (OTS) grade were the input features. We calculated univariate and multivariate regression models to assess the association of different features with visual acuity (VA) outcomes. We predicted visual acuity using ten supervised machine learning algorithms including multinomial logistic regression (MLR), support vector machines (SVM), K-nearest neighbors (KNN), naïve bayes (NB), decision tree (DT), random forest (RF), bagging (BG), adaptive boosting (ADA), artificial neural networks (ANN), and extreme gradient boosting (XGB). Accuracy, positive predictive value (PPV), recall, F-score, brier score (BS), Matthew correlation coefficient (MCC), receiver operating characteristic (AUC-ROC), and calibration plot were used to assess how well machine learning algorithms performed in predicting the final VA.ResultsThe artificial neural network (ANN) model had the best accuracy to predict the final VA. The sensitivity, F1 score, PPV, accuracy, and MCC of the ANN model were 0.81, 0.85, 0.89, 0.93, and 0.81, respectively. In addition, the estimated AUC-ROC and AUR-PRC of the ANN model for OGI patients were 0.96 and 0.91, respectively. The brier score and calibration log-loss for the ANN model was 0.201 and 0.232, respectively.ConclusionAs classic and ensemble ML models were compared, results shows that the ANN model was the best. As a result, the framework that has been presented may be regarded as a good substitute for predicting the final VA in OGI patients. Excellent predictive accuracy was shown by the open globe injury model developed in this study, which should be helpful to provide clinical advice to patients and making clinical decisions concerning the management of open globe injuries.

Pilot Validation of a 3-Dimensional Printed Pituitary Adenoma, Vascular Injury, and Cerebrospinal Fluid Leak Surgical Simulator.

Endoscopic skull base surgery is a subspecialty field which would benefit significantly from high-fidelity surgical simulators. Giving trainees the opportunity to flatten their learning curve by practicing a variety of procedures on surgical simulators will inevitably improve patient outcomes. Four neurosurgeons, 8 otolarynologists, and 6 expert course faculty agreed to participate. All participants were asked to perform a transsphenoidal exposure and resection of a pituitary adenoma, repair a cerebrospinal fluid (CSF) leak, control a carotid injury, and repair a skull base defect. The content, face, and construct validity of the 3-dimensional printed model was examined. The heart rate of the participants significantly increased from baseline when starting the carotid injury simulation (mean 90 vs 121, P = .029) and significantly decreased once the injury was controlled (mean 121 vs 110, P = .033, respectively). The participants reported a significant improvement in anxiety in facing a major vascular injury, as well as an increase in their confidence in management of major vascular injury, resecting a pituitary adenoma and repair of a CSF leak using a 5-point Likert scale (mean 4.42 vs 3.58 P = .05, 2 vs 3.25 P < .001, 2.36 vs 4.27 P < .001 and 2.45 vs 4.0 P = .001, respectively). The mean Objective Structured Assessment of Technical Skills score for experienced stations was 4.4, significantly higher than the Objective Structured Assessment of Technical Skills score for inexperienced stations (mean 3.65, P = .016). We have demonstrated for the first time a validated 3-dimensional printed surgical simulator for endoscopic pituitary surgery that allows surgeons to practice a transsphenoidal approach, surgical resection of a pituitary adenoma, repair of a CSF leak in the diaphragma sellae, control of a carotid injury, and repair of skull base defect.

Acute and Long-Term Management of Blunt Cerebrovascular Injury at a Quaternary Referral Level 1 Trauma Center: The Memphis Experience and Comparison of a New Scoring System.

The management of blunt cerebrovascular injuries (BCVIs) remains an important topic within trauma and neurosurgery today. There remains a lack of consensus within the literature and significant variation across institutions. The purpose of this study was to evaluate management of BCVI at a large, tertiary referral trauma center. Institutional Review Board approval was obtained to conduct a retrospective review of patients with BCVI at our Level 1 Trauma Center. Computed tomography angiography was used to identify BCVI for each patient. Patient information was collected, and statistical analysis was performed. With the included risk factors for ischemic complications, a novel scoring system based on ischemic risk, the "Memphis Score," was developed and evaluated to grade BCVI. Two hundred seventeen patients with BCVI from July 2020 to August 2022 were identified. The most common mechanism of injury was motor vehicle collision (141, 65.0%). Vertebral arteries were the most common vessel injured (136, 51.1%) with most injuries occurring at a high cervical location (101, 38.0%). Denver Grade 1 injuries (89, 33.5%) and a Memphis Score of 1 were most frequent (172, 64.6%), and initial anticoagulation with heparin drip was initiated 56.7% of the time (123). Endovascular treatment was required in 24 patients (11.1%) and was usually performed in the first 48 hours (15, 62.5%). While Denver Grade (P = .019) and Memphis Score (P < .00001) were significantly higher in those patients undergoing endovascular treatment, only the Memphis Score demonstrated a significant difference between those patients who had stroke or worsening on follow-up imaging and those who did not (P = .0009). Although BCVI management has improved since early investigative efforts, institutions must evaluate and share their data to help clarify outcomes. The novel "Memphis Score" presents a standardized framework to communicate ischemic risk and guide management of BCVI.

Impact of Concomitant Traumatic Pancreatic and Colon Injuries on Outcomes.

Colon and pancreatic injuries have both long been independently associated with intraabdominal infectious complications in trauma patients. The goal of this study was to evaluate the impact of concomitant pancreatic injury on outcomes in patients with traumatic colon injuries. Consecutive patients over a 3-year period who underwent operative management of colon injuries were identified. Patient characteristics, severity of injury and shock, presence and grade of pancreatic injury, and intraoperative packed red blood cell (PRBC) transfusions were recorded. Outcomes including intraabdominal abscess formation and suture line failure were collected and compared. Multivariable logistic regression analysis was then performed to determine the impact of concomitant pancreatic injury on intraabdominal abscess formation. 243 patients with traumatic colon injuries were identified. 17 of these also had pancreatic injuries. Patients with combined colon and pancreatic injuries were clinically similar to those with isolated colon injuries with respect to age, gender, penetrating mechanism of injury, admission lactate, ISS, suture line failure, and admission systolic blood pressure. Both intraabdominal abscess rates (88.2% vs 29.6%, P < .001) and intraoperative PRBC transfusions (8 vs 1 units, P = .004) were higher in the combined pancreatic and colon injury group. Multivariable logistic regression identified both intraoperative PRBC transfusions (odds ratio, 1.09; 95% confidence interval, 1.04-1.15; P < .001) and concomitant pancreatic injury (odds ratio, 14.8; 95% confidence interval, 3.92-96.87; P < .001) as independent predictors of intraabdominal abscess formation. Both intraoperative PRBC transfusions and presence of concomitant pancreatic injury are independent predictors of intraabdominal abscess formation in patients with traumatic colon injuries.