Result Of Trauma Research Articles

Early use of professional interpreters improves trauma outcomes: Results of a single-center retrospective study

Patients with limited English proficiency (LEP) experience reduced pain assessment and treatment, less comprehensive physical exams, and fewer explanations of the next steps in care. These disparities persist in hospitals with staffed professional interpreters, raising questions about interpreter access and the impact on outcomes. A retrospective review of 1133 trauma activations at a single center Level 1 Trauma Center in 2021–2022 was conducted. Demographic, injury, and outcome data were drawn from the institutional trauma registry, and patient-preferred language was pulled from EMR data. Early interpreter use was defined as documentation of professional interpreter use within 24 h of arrival. LOS and ICU LOS were compared between language groups using Cox regression, and mortality was compared using Fischer's exact test. 1114 patients had data available on initial injury severity and preferred language. Of the 70 LEP patients, 62 (88.6 %) required an interpreter, and 41 of those (66.1 %) had evidence of professional interpreter use within 24 h of arrival. LEP patients who lacked early interpreter use had longer hospital stays than both English proficient (EP) patients (HR 0.59, p < 0.05) and LEP patients with early interpreter use (HR 0.51, p < 0.05) when stratified by ISS and controlling for GCS and patient age. There is no difference in LOS between LEP trauma patients who used an interpreter and EP patients, suggesting that early use of an interpreter may improve the length of stay in LEP trauma patients.

Geriatric Trauma Outcome Score in predicting mortality of Korean older adult patients with trauma: Is applicable in all cases?

This study aimed to validate the Geriatric Trauma Outcome Score (GTOS) for predicting mortality associated with trauma in older Korean adults and compare the GTOS with the Trauma and Injury Severity Score (TRISS). This study included patients aged ≥65 years who visited the Chungbuk National University Hospital Regional Trauma Center between January 2016 and December 2022. We used receiver operating characteristic (ROC) curves and calibration plots to assess the discrimination and calibration of the scoring systems. Among 3053 patients, the median age was 77 years, and the mortality rate was 5.2%. The overall GTOS-predicted mortality and 1-TRISS were 5.4% (IQR [3.7-9.5]) and 4.7% (interquartile range [IQR] [4.7-4.7]), respectively. The areas under the curves (AUCs) of 1-TRISS and GTOS for the total population were 0.763 (95% confidence interval [CI], 0.719-0.806) and 0.794 (95%CI, 0.755-0.833), respectively. In the Glasgow Coma Scale (GCS) ≤12 group, the in-hospital mortality rate was 27.5% (79 deaths). The GTOS-predicted mortality and 1-TRISS in this group were 18.6% (IQR [7.5-34.7]) and 26.9% (IQR [11.9-73.1]), respectively. The AUCs of 1-TRISS and GTOS for the total population were 0.800 (95%CI, 0.776-0.854) and 0.744 (95%CI, 0.685-0.804), respectively. The GTOS and TRISS demonstrated comparable accuracy in predicting mortality, while the GTOS offered the advantage of simpler calculations. However, the GTOS tended to underestimate mortality in patients with GCS ≤12; thus, its application requires care in such cases.

The link Between traumatic experiences and health in late life: challenges and opportunities for US-based longitudinal aging cohorts.

Trauma, defined as exposure to actual or threatened death, serious injury or sexual violence, is a pervasive, major public health challenge that disproportionately burdens socially disadvantaged groups and has known consequences for health outcomes in early and midlife. Despite plausible mechanisms by which trauma may also be a critically important risk factor for health outcomes in late life, there is presently a lack of literature evaluating the consequences of trauma on aging related health outcomes and inequities, such as dementia. In this commentary, we (a) discuss drivers of the paucity of epidemiological evidence on trauma and health outcomes in late life, namely a lack of available data, supported by detailed review of trauma measures, including interpersonal violence-a particularly common form of trauma-in seven established longitudinal aging cohort studies in the United States (US); (b) address four common concerns about the inclusion of trauma measures in cohort studies; and (c) suggest ways forward, including specific assessment tools to measure interpersonal violence after a structured review of the PhenX Toolkit, to facilitate critical research to understand the impact of trauma on outcomes in late life.

Outcomes of head trauma in children admitted to a tertiary paediatric intensive care unit in South Wales

Objective This study aimed to evaluate the demographics and outcomes of major paediatric head trauma managed in our Paediatric Intensive Care Unit (PICU) in South Wales and comparison is made with the existing published literature. Design and setting A retrospective review of medical records and imaging of patients identified from the paediatric neurosurgical trauma database at University Hospital Wales (UHW) from March 2013 to July 2021. We assessed the GCS at admission, mechanism of injury, CT scan, type of surgery required and GOS after 12 months. Patients A total of 46 children (<16 years old) who were admitted to intensive care secondary to a traumatic brain injury were identified. Mean age was 7.6 years (range 0 days–15.7 years). Results Road traffic accidents (RTA) were the predominant mechanism of injury (56.5%), followed by falls (32.6%). Neurosurgical intervention, including stand-alone ICP monitoring was required in 69.6% of patients. Post discharge outcome was defined using the Glasgow Outcome Score (GOS), with a good functional outcome (GOS ≥4) accounting for 86.4% at 12 months follow-up. Survival rate was 93.4%. Conclusion Demographics in South Wales are similar to the published literature, except falls had a higher mortality than RTA in our cohort. Head injury mechanisms, surgical interventions and outcomes show variation between patients from the pre-covid and lockdown periods. Outcomes are good for surgically and conservatively treated patients and very comparable to the published literature.

Remote Monitoring, AI, Machine Learning and Mobile Ultrasound Integration upon 5G Internet in the Prehospital Care to Support the Golden Hour Principle and Optimize Outcomes in Severe Trauma and Emergency Surgery.

Feasibility and reliability evaluation of 5G internet networks (5G IN) upon Artificial Intelligence (AI)/Machine Learning (ML), of telemonitoring and mobile ultrasound (m u/s) in an ambulance car (AC)- integrated in the pre-hospital setting (PS)- to support the Golden Hour Principle (GHP) and optimize outcomes in severe trauma (TRS). (PS) organization and care upon (5G IN) high bandwidths (10 GB/s) mobile tele-communication (mTC) experimentation by using the experimental Cobot PROMETHEUS III, pn:100016 by simulation upon six severe trauma clinical cases by ten (N1=10) experts: Four professional rescuers (n1=4), three trauma surgeons (n2=3), a radiologist (n3=1) and two information technology specialists (n4=2) to evaluate feasibility, reliability and clinical usability for instant risk, prognosis and triage computation, decision support and treatment planning by (AI)/(ML) computations in (PS) of (TRS) as well as by performing (PS) (m u/s). A. Trauma severity scales instant computations by the Cobot PROMETHEUS III, pn 100016) ) based on AI and ML complex algorithms and Cloud Computing, telemonitoring and r showed very high feasibility and reliability upon (5GIN) under specific, technological, training and ergonomic prerequisites B. Measured be-directional (m u/s) images data sharing between (AC) and (ED/TC) showed very high feasibility and reliability upon (5G IN) under specific, technological and ergonomic conditions in (TRS). Integration of (PS) tele-monitoring with (AI)/(ML) and (PS) (m u/s) upon (5GIN) via the Cobot PROMETHEUS III, (pn 100016) in severe (TRS/ES), seems feasible and under specific prerequisites reliable to support the (GHP) and optimize outcomes in adult and pediatric (TRS/ES).

Geriatric Trauma Outcome Score as a Mortality Predictor in Isolated Moderate to Severe Traumatic Brain Injury: A Single-Center Retrospective Study.

Traumatic brain injury (TBI) is a major cause of mortality and disability worldwide, with severe cases significantly increasing the risk of complications and long-term mortality. The Geriatric Trauma Outcome Score (GTOS), based on age, injury severity, and transfusion need, has been validated for predicting mortality in older trauma patients, but its utility in predicting mortality for TBI patients remains unexplored. This retrospective study included 5543 adult trauma patients with isolated moderate to severe TBI, defined by head Abbreviated Injury Scale (AIS) scores of ≥ 3, from 1998 to 2021. GTOS was calculated with the following formula: age + (Injury Severity Score × 2.5) + 22 (if transfused within 24 h). The area under the receiver operating characteristic curve (AUROC) assessed GTOS's ability to predict mortality. The optimal GTOS cutoff value was determined using Youden's index. Mortality rates were compared between high- and low-GTOS groups, separated by the optimal GTOS cutoff value, including a propensity score-matched analysis adjusting for baseline characteristics. Among 5543 patients, mortality was 8.3% (462 deaths). Higher mortality is correlated with male sex, older age, higher GTOS, and comorbidities like hypertension, coronary artery disease, and end-stage renal disease. The optimal GTOS cut-off for mortality prediction was 121.5 (AUC = 0.813). Even when the study population was matched by propensity score, patients with GTOS ≥121.5 had much higher odds of death (odds ratio 2.64, 95% confidence interval 1.93-3.61, p < 0.001) and longer hospital stays (mean 16.7 vs. 12.2 days, p < 0.001) than those with GTOS < 121.5. These findings support the idea that GTOS is a useful tool for risk stratification of in-hospital mortality in isolated moderate to severe TBI patients. However, we encourage further research to refine GTOS for better applicability in TBI patients.

High Fresh Frozen Plasma to Red Blood Cell Ratio and Survival Outcomes in Blunt Trauma

Current trauma-care protocols advocate early administration of fresh frozen plasma (FFP) in a ratio close to 1:1 with red blood cells (RBCs) to manage trauma-induced coagulopathy in patients with severe blunt trauma. However, the benefits of a higher FFP to RBC ratio have not yet been established. To investigate the effectiveness of a high FFP to RBC transfusion ratio in the treatment of severe blunt trauma and explore the nonlinear relationship between the ratio of blood products used and patient outcomes. This was a multicenter cohort study retrospectively analyzing data from the Japan Trauma Data Bank, including adult patients with severe blunt trauma without severe head injury (Injury Severity Score ≥16 and head Abbreviated Injury Scale <3) between 2019 and 2022. Patients were categorized into 2 groups based on the ratio of FFP to RBC: the high-FFP group (ratio >1) and the low-FFP group (ratio ≤1). All-cause in-hospital mortality was the primary outcome. Additionally, the occurrence of transfusion-related adverse events was evaluated. Among the 1954 patients (median [IQR] age, 61 [41-77] years; 1243 male [63.6%]) analyzed, 976 (49.9%) had a high FFP to RBC ratio. Results from logistic regression, weighted by inverse probability treatment weighting, demonstrated an association between the group with a high-FFP ratio and lower in-hospital mortality (odds ratio, 0.73; 95% CI, 0.56-0.93) compared with a low-FFP ratio. Nonlinear trends were noted, suggesting a potential ceiling effect on transfusion benefits. In this cohort study, a high FFP to RBC ratio was associated with favorable survival in patients with severe blunt trauma. These outcomes highlight the importance of revising the current transfusion protocols to incorporate a high FFP to RBC ratio, warranting further research on optimal patient treatment.

The Analysis Study of Management, Diagnosis and Outcome of Renal Trauma in Pediatrics : A Comprehensive Systematic Review

The Analysis Study of Management, Diagnosis and Outcome of Renal Trauma in Pediatrics : A Comprehensive Systematic Review

Routine Urology Consultation and Follow-up After Pediatric Blunt Renal Trauma is Likely Unnecessary

IntroductionThis study examines the outcomes of high-grade renal trauma in pediatric patients and evaluates the intervention rate. In our hospital, we routinely consult urology on all high-grade injuries. We anticipated minimal intervention, casting doubt on the need for routine urology consultation and follow-up. MethodsWe conducted a retrospective review at a single pediatric trauma center from January 2018 to June 2023, focusing on patients with severe (grade III-V) renal injuries. Data collected included demographics, trauma-related variables, hospital course, interventions, and follow-up. When the grade was not readily available in the electronic medical record, we had a board-certified pediatric radiologist review the imaging and provide the grade. Follow-up was included only if it was with a pediatric urologist. ResultsThere were 92 patients that met our inclusion criteria. Of these, 47 were grade III, 32 were grade IV, and 13 were grade V. Six (6.5%) patients required inpatient renal stent procedures. Follow-up occurred in 55/92 (60%) patients with a pediatric urologist. Follow-up by grade is as follows: 22/47 (47%) grade III, 22/32 (69%) grade IV, and 11/13 (85%) grade V. Overall 5.8% of patients required antihypertensive medications and this was more likely as injury grade increased. All stents were removed outpatient and there were 3 (3.3%) additional outpatient interventions, all in patients that were symptomatic. ConclusionGiven the low prevalence of interventions after discharge, routine consultation and follow-up with urology is likely unnecessary in the absence of an inpatient urologic procedure during the index hospitalization. Patients with high-grade injuries should instead follow up with a trauma clinic or general provider with urology follow-up based on symptoms. Type of StudyRetrospective Review. Level of EvidenceLevel III.

Prediction of Neurological Outcomes in Elderly Patients With Head Trauma Using the Geriatric Trauma Outcome Score: A Retrospective Observational Study.

Introduction Head trauma in elderly people is a problem in today's aging society. Elderly people are susceptible to head trauma because of their declining physical function; this tends to be severe. Outcome prediction is important in decision-making regarding treatment strategies; however, there is no unified method for predicting neurological outcomes in elderly patients with head trauma. Methods Elderly patients with head trauma admitted to the Japan Red Cross Narita Hospital between January 2019 and August 2023 were enrolled in this single-center, retrospective observational study. A favorable neurological outcome was defined as a cerebral performance category scale of 1 or 2. Multivariate logistic regression analysis and receiver operating characteristic curve analysis were performed to investigate the association between geriatric trauma outcome scores and outcomes and to evaluate the predictive value of geriatric trauma outcome scores. The primary outcome was a favorable neurological outcome at discharge, and the secondary outcome was in-hospital mortality. Results A total of 313 elderly patients with head trauma were eligible for analysis. Multivariate logistic regression analysis revealed that the geriatric trauma outcome score was significantly associated with a favorable neurological outcome at discharge (odds ratio 0.94, P <0.0001). In the receiver operating characteristic curve analysis, the geriatric trauma outcome score had a good predictive value for favorable neurological outcomes at discharge (area under the receiver operating characteristic curve 0.83). Conclusions The geriatric trauma outcome score had good predictive value for favorable neurological outcomes at discharge in elderly patients with head trauma and has the potential to aid in decision-making regarding treatment strategies for elderly patients with head trauma.

Greater Socioeconomic Deprivation is Associated with Increased Complication Rates and Lower Patient-Reported Outcomes Following Open Reduction and Internal Fixation of Humeral Shaft Fractures.

This study explored the hypothesis that social determinants of health (SDOH), including racial and economic differences, may impact orthopaedic trauma outcomes in patients undergoing open reduction and internal fixation (ORIF) of humeral shaft fractures. Design: Retrospective. Single, academic, tertiary Level-I trauma center. Adults with midshaft humerus fractures (AO/OTA 12) treated operatively with plate fixation from 05/2011 to 05/2021 with a minimum follow-up of nine months. Radiographic fracture healing, complication rates, and patient-reported outcomes were investigated. SDOH were assessed using the Area Deprivation Index (ADI). Demographics, complications rates, and patient-reported clinical outcomes were compared between the first and fourth ADI quartiles. 196 patients fit the study criteria. The average age of the cohort was 47 years with 50 women (51%). Comparisons of the least deprived quartile (n=49) to the most deprived quartile (n=49) yielded similar sex distribution (59% vs 43% female, p=0.15), fewer non-white patients (8% vs 51%, p<0.01), older average age (51 years vs 43 years, p=0.05), similar BMI (30.5 vs. 31.8, p=0.45), and higher Charlson Comorbidity Index (CCI) (2.2 vs.1.1, p=0.03). While nonunion rates were similar (p=0.20) between groups, the most deprived quartile had 2.3 times greater odds of post-operative complications (p=0.04). Patients in the most deprived group exhibited higher PROMIS Pain Interference (PI) scores (p<0.01) and PROMIS Depression (D) scores (p=0.01), with lower PROMIS Physical Function (PF) scores (p<0.01) at 6-month follow-up than the least depriver cohort. The most deprived cohort had three times higher odds of missing scheduled appointments within the first post-operative year (p<0.01), resulting in a significantly higher no-show rate (p<0.01) than the least deprived cohort. Regression analysis including several demographic and injury factors identified that ADI was significantly associated with the occurrence of any missed appointments (p<0.01), no-show rates (p=0.04), and experiencing one of the following post-operative complications during recovery: Nonunion, radial nerve injury, or dysfunction (p=0.03). Patients experiencing greater resource deprivation faced increased odds of complications, missed appointments, and poorer PROMIS outcomes following humeral shaft fracture fixation, emphasizing that baseline socioeconomic disparities predict unfavorable post-operative outcomes even given favorable baseline health status according to the CCI score. Level III. See Instructions for Authors for a complete description of levels of evidence.

Trauma team activation for older patients with pelvic fractures: Are current criteria adequate?

The present study aimed to identify the impact of age on current trauma team activation (TTA) processes and outcomes for patients with pelvic fractures. Adult patients with moderate and/or severe pelvic fractures (Abbreviated Injury Scale ≥ 2) between 1 January 2016 and 31 December 2021 were included utilising major trauma hospital data in Queensland. Characteristics of older (age ≥ 65) and younger patients including TTA, interventions and outcomes were examined. Multivariate analysis was used to determine factors associated with TTA in older patients. Data from 637 patients was included. Despite comparable injury severity, a TTA was activated in fewer older people (older: 65% vs. younger: 79%, P < 0.001). Older patients had more falls leading to the trauma presentation (54.4% vs. 22.6%, P < 0.001), with higher initial systolic BP (131 vs. 125 mmHg, P = 0.04). Outcomes were worse for older people, with greater rates of in-hospital complications (27.2% vs. 16.4%, P = 0.004), and longer hospital stays (12 vs. 8 days, P = 0.04). Fewer older patients could be discharged independently to home (46.3% vs. 74.5%, P < 0.001). In older patients, falls and haemodynamic parameters were strongly associated with the reduced likelihood of TTA (fall mechanism [odds ratio (OR)] 0.33; 95% confidence interval [CI] 0.15-0.74; P = 0.01; systolic BP [OR 0.98; 95% CI 0.97-0.99; P = 0.03], heart rate [OR 0.97; 95% CI 0.95-0.99; P = 0.02]). Current TTA criteria based on higher energy mechanisms and traditional vital sign thresholds are inadequate for identifying injury in older patients. Sensitive triage criteria and increased clinician awareness are required to enhance injury recognition and improve outcomes in older trauma patients.

Pattern and Outcome of Abdominal Injury Management in Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia

Background: Abdominal injury is one of the major causes of trauma admissions. Evidence based information about causes of trauma related deaths is relevant for health policy making about prevention and control. The aim of the study was to identify the mechanism of trauma, commonly injured organs, patterns and outcome of abdominal trauma in Yekatit 12 Hospital Medical College. Method: ALongitudinal study design was conducted from April 2022 to May 2023 G.C Results: During the study, 42 patients were observed, with males comprising 83.3%. Most patients fell within the 20-29 age groups. Penetrating trauma was the most common mechanism (54.8%), with stabs (38.1%), RTAs (31.0%), and gunshots (14.3%) leading the causes. Negative laparotomy rate was 4.8%. Laparotomy was performed in 88.1% of cases, with the small bowel (33.3%) being the most commonly injured organ. Postoperative complication rate was 21.6%, mainly surgical site infections (10.8%). Complication rate was higher in penetrating injuries (62.5%) compared to blunt trauma (37.5%). Mortality rate for abdominal injury was 4.78%. Conclusion: Abdominal trauma predominantly impacts younger males. Stab wounds and road traffic accidents (RTAs) are the primary causes, emphasizing the importance of public awareness for preventing RTAs and similar injuries.

Advanced Hydrogels in Breast Cancer Therapy.

Breast cancer is the most common malignancy among women and is the second leading cause of cancer-related death for women. Depending on the tumor grade and stage, breast cancer is primarily treated with surgery and antineoplastic therapy. Direct or indirect side effects, emotional trauma, and unpredictable outcomes accompany these traditional therapies, calling for therapies that could improve the overall treatment and recovery experiences of patients. Hydrogels, biomimetic materials with 3D network structures, have shown great promise for augmenting breast cancer therapy. Hydrogel implants can be made with adipogenic and angiogenic properties for tissue integration. 3D organoids of malignant breast tumors grown in hydrogels retain the physical and genetic characteristics of the native tumors, allowing for post-surgery recapitulation of the diseased tissues for precision medicine assessment of the responsiveness of patient-specific cancers to antineoplastic treatment. Hydrogels can also be used as carrier matrices for delivering chemotherapeutics and immunotherapeutics or as post-surgery prosthetic scaffolds. The hydrogel delivery systems could achieve localized and controlled medication release targeting the tumor site, enhancing efficacy and minimizing the adverse effects of therapeutic agents delivered by traditional procedures. This review aims to summarize the most recent advancements in hydrogel utilization for breast cancer post-surgery tissue reconstruction, tumor modeling, and therapy and discuss their limitations in clinical translation.

Consensus recommendations for acute trauma care & outcomes in LMICs from the transdisciplinary research, advocacy & implementation network for trauma in India.

Background & objectives Injuries profoundly impact global health, with substantial deaths and disabilities, especially in low- and middle-income countries (LMICs). This paper presents strategic consensus from the Transdisciplinary Research, Advocacy, and Implementation Network for Trauma in India (TRAIN Trauma India) symposium, advocating for enhanced, system-level trauma care to address this challenge. Methods Five working groups conducted separate literature reviews on pre-hospital trauma care, in-hospital trauma resuscitation and training, trauma systems, trauma registries, and India's Towards Improving Trauma Care Outcomes (TITCO) registry. Using a Delphi approach, the TRAIN Trauma India Symposium generated consensus statements and recommendations for interventions to streamline trauma care and reduce preventable trauma mortality in India and LMICs. Experts prioritized interventions based on cost and difficulty. Results An expert panel agreed on four pre-hospital consensus statements, eight hospital resuscitation consensus statements, six system-level consensus statements, and six trauma registry consensus statements. The expert panel recommended six pre-hospital interventions, four hospital resuscitation interventions, nine system-level interventions, and seven trauma registry interventions applicable to the Indian context. Of these, 14 interventions were ranked as low cost/low difficulty, five high cost/low difficulty, five low cost/high difficulty, and three high cost/high difficulty. Interpretation & conclusions This consensus underscores the urgent need for integrated and efficient trauma systems to reduce preventable mortality, emphasizing the importance of comprehensive care that includes community engagement and robust pre-hospital and acute hospital trauma care pathways. It highlights the critical role of inclusive, system-wide approaches, from enhancing pre-hospital care and in-hospital resuscitation to implementing effective trauma registries to improve outcomes and streamline care across contexts.

The Analysis Study of Prevalence, Management and Outcome of Renal Trauma in Pediatrics: A Comprehensive Systematic Review

Background: Acute kidney injury (AKI) in children is a critical condition influenced by diverse factors, including surgery, critical illness, and nephrotoxin exposure. It affects up to 50% of pediatric ICU admissions and has significant mortality implications, especially post-heart surgery and in the presence of inotropes or ventilation. Methods: The study adhered to PRISMA 2020 standards, examining English literature from 2014 to 2024. Result: Initially retrieving 360 articles from online databases (PubMed, SagePub, SpringerLink and Google Scholar) eight relevant papers were selected after three rounds of screening for full-text analysis. Conclusion: Pediatric renal injury, including acute kidney injury (AKI) and its long-term implications, presents a significant clinical challenge across diverse settings. Recent studies highlight varying AKI incidences and outcomes, underscoring the need for effective management strategies and long-term renal surveillance to mitigate mortality and chronic kidney disease risks.

Surgical outcome of pediatric abdominal trauma at Tertiary Hospital, Northwest Ethiopia, a 3-year retrospective study

IntroductionAbdominal trauma in children is a significant health concern that often leads to severe complications and even death. Children experience trauma more frequently than adults, with approximately one in four pediatric patients suffering from serious abdominal injuries. Falls are the leading cause of such trauma among children, which is intriguing considering that most hospital admissions for pediatric abdominal injuries result from blunt force impacts.MethodA retrospective cross-sectional analysis of medical records was conducted to examine all patients under the age of 16 who underwent exploratory laparotomy for abdominal trauma between January 1, 2020, and January 1, 2023. The clinical data were gathered using a data extraction sheet from each patient’s medical charts. Information on socio-demographic characteristics, injury mechanisms, clinical conditions at the initial presentation, intraoperative findings and complications, and patient outcomes were collected.ResultsThe study involved a total of 90 patients, consisting of 72 males (80%) and 18 females (20%). The average age of the patients was 10, with a standard deviation of 4.7, ranging from 2 to 16 years. Half of the patients were below the age of 10, accounting for 46 individuals (51%). The causes of the injuries varied among patients below and above the age of 10. However, overall, bullet injuries were the most common cause, accounting for 28 cases (31%), followed by falls in 21 cases (23.3%), horse or donkey kicks in 10 cases (11.1%), stab injuries in 10 cases (11.1%), horn injuries in 7 cases (7.8%), and road traffic accidents in 6 cases (6.7%). Physical assault, blasts, and other types of injuries, such as hen bites and metal rod injuries, were observed in 8 cases (8.9%) of the patients. Fall accidents, horse or donkey kicks, and horn injuries were particularly more common among children below the age of 10, while bullet injuries and stab injuries were most common among those above the age of 10.ConclusionFollowing abdominal trauma in children, a range of complications may arise, including immediate issues such as infections and hemorrhaging, as well as long-term consequences like impaired organ functionality and psychological distress. In our region, young children are particularly vulnerable to accidents involving falls, kicks from horses or donkeys, and injuries caused by horns. Therefore, it is crucial to educate parents about these hazards. Additionally, providing appropriate guidance on firearm safety is essential for individuals who possess such weapons.

Analysis on short-term outcomes of patients with thoracic trauma at dr. Zainoel Abidin General Hospital in Banda Aceh

Background Thoracic trauma is defined as a trauma that hits the chest wall directly or indirectly, either as a result of blunt or penetrating trauma. Thoracic trauma can occur in any age or genders, and become a life-threatening if the treatment isn’t immediate and appropriate. Methods This research was an observational study with a cohort retrospective design using secondary data in the form of thoracic trauma patients at The Zainoel Abidin General Hospital, Banda Aceh, Indonesia in the period January 2019-December 2020. The statistical analysis used were chi square for bivariate and multivariate analysis, spesifically logistic regression analysis was conducted to know which risk factor influences the most. Result There were 141 medical records used in this study, thoracic trauma was more common in men compared to women. The age group of 46-55 is the age group with the highest percentage of thoracic trauma patients, road traffic are the leading cause of thoracic trauma where the most common diagnosis is rib fractures. Significant factors that associated with the short outcome of thoracic trauma are thoracic trauma diagnosis (p=0,00), management of thoracic trauma (p=0,00), ventilator (p=0,04), duration of ventilator (p=0.01), sepsis (p=0,00), qSOFA score (p=0,00) and injury severity score (p=0,00). Conclusions Vehicle accidents contributed to a considerable number of traumatic chest injuries in this study. Diagnosis, management of trauma, days of ventilation, qSOFA score, injury severity score, and development of sepsis were associated with the short-term outcome among thoracic trauma patients. Injury severity score seems to be the most influential variable in this study, the lower the better it is. Road safety intervention is urgently needed to control the underlying problems in this study.

488 Surgical Site Infection After Hand Trauma Surgery in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

Abstract Aim In low- and middle-income countries (LMICs) surgical site infections (SSIs) are the most common post-operative complication. Associated with increased morbidity and mortality, they impose a significant financial burden on patients. A recent meta-analysis found the overall SSI risk following hand trauma surgery is 5-10%. In this study a top-up-search and re-analysis was performed to establish SSI risk in the context of countries’ income classification. Method Our PRISMA-compliant systematic review searched MEDLINE, Embase, CINAHL, CENTRAL and clinicaltrials.gov to identify studies reporting SSI rates in adults undergoing hand or wrist surgeries for trauma. Studies were grouped by country-of-origin using World Bank income classifications. Meta-analysis of proportions was performed using R and risk of bias was evaluated. Results Of 11,056 screened s, 236 studies were included. None originated from low-income countries (LICs), 40 came from LMICs (16.9%), 48 from upper middle-income countries (UMICs) (20.3%) and 148 from high-income countries (HICs) (62.7%). Of LMIC studies, 70.0% were at high risk of bias, compared to 47.7% of UMIC and 31.1% of HIC studies. Meta-analysis demonstrated SSI risk in LMIC studies as 7.9% [95%CI 6.3-9.9], UMIC studies as 6.3% [95%CI 4.4-8.8] and HIC studies as 4.5% [95%CI 3.5-5.8]. Conclusions No studies were identified from LICs, perhaps indicative of the limited hand surgery capacity. Reduced research was found from MICs compared to HICs. We concluded that SSI risk following hand trauma appears lower in HICs compared to UMICs and LMICs but may be under-reported in MIC studies. Further research into hand trauma burden and outcomes in LMICs is required.

Totally laparoscopic surgery for choledochal cysts with hand‑sewn Roux‑en‑Y reconstruction in a pediatric population.

Cyst excision and Roux-en-Y hepaticojejunostomy (RYHJ) is the standard treatment for choledochal cysts (CCs). In the present study, the results of totally laparoscopic surgery for CCs (TLCCs) in a pediatric population were evaluated. The clinical data of 28 children with CCs between June 2020 and June 2023 were retrospectively reviewed. All patients underwent TLCCs involving cyst excision and RYHJ. The jejunojejunal anastomosis was completed laparoscopically using manual sutures. Age at operation, operative time, postoperative recovery and complications were evaluated. The 28 patients comprised 8 boys and 20 girls who underwent TLCCs at a mean age of 4.2 years (range, 1 month-12.3 years) with a mean weight of 15.9 kg (range, 4.6-43 kg). All patients received ultrasound and magnetic resonance cholangiopancreatography examinations, which revealed a mean cyst diameter and length of 1.74±0.76 cm and 3.85±1.25 cm, respectively. The mean operative time was 214±43.8 min. The mean time until starting an oral diet after surgery was 2.89±1.23 days. Apart from bile leakage and wound infection, no other complications occurred during a median follow-up period of 18 months (range, 4-42 months). TLCCs can be performed safely by skilled surgeons in pediatric patients. TLCCs may be more physiologically compatible and accelerate recovery of intestinal function with reduced trauma and better esthetic outcomes than conventional laparoscopic surgery for CCs. Therefore, TLCCs with manual sutures may be considered as an option for minimally invasive surgery in pediatric patients with CCs.