Stab Wounds Research Articles

Outcomes of surgically managed adult traumatic brachial plexus injuries in an upper-middle-income country

BackgroundTraumatic brachial plexus injuries (TBPIs) are debilitating and complex to treat. The last five decades have seen advances in surgical management, and consequently improved functional outcomes in patients with these injuries. There is limited data available describing the outcomes of surgically managed TBPIs within the South African context. This study aimed to identify the common causes of injury, injury characteristics, and functional outcomes of surgically managed patients with TBPIs. MethodsWe conducted a retrospective chart review of all adult patients that underwent surgery for TBPIs over a period of ten years at a specialised hand unit in South Africa. The minimum follow-up period was one year. Patient demographic details, injury characteristics and functional outcomes were collected. Statistical analysis was performed to determine factors associated with functional outcomes. A good functional outcome for recovery was defined as a Medical Research Council (MRC) grade of three or more for the affected elements of the plexus at the most recent follow-up. ResultsForty-seven patients of median age 32 years were included in the final analysis. Most patients were male (87.2 %). The majority of patients were injured in motor vehicle accidents (MVAs) or from penetrating stab wounds (48.9 % and 38.3 % respectively). The median pre-operative MRC grade of the affected elements of the brachial plexus was 0.0, and post-operatively was 2.0. Fourteen patients (14 of 47, 29.8 %) had a good outcome and 33 had a poor outcome (33 of 47, 70.2 %). There was no difference in outcome comparing penetrating injury mechanisms to closed traction or blunt injuries, (p = 0.386, OR 1.75, 95 % CI 0.49–6.20). All patients with pan-plexal injuries had a poor outcome (15 of 33, 46 %). All patients who received intercostal (6 of 33, 18 %) or phrenic nerve transfers (3 of 33, 9 %) had a poor outcome. ConclusionAdult traumatic BPIs in this South African sample typically presented more than two months after injury and were comprised of a high proportion of penetrating injuries. Just under a third of surgically managed patients had a good outcome. Pan plexal injuries have uniformly poor outcomes. We recommend early referral for all TBPIs to a unit that manages BPI to improve outcomes.

Establishment of the morphological features of stab injuries to the ribs caused by a knife with a blade spine thickness of 0.1 cm

BACKGROUND: The identification of all possible parameters and features of the tool that caused the injuries is of high significance for resolving specific forensic questions in the study of stab injuries to the ribs. However, data on the influence of blade spine thickness on the morphological features of stab injuries to the ribs are lacking.
 AIM: To determine the morphological features of stab injuries caused by a knife with a blade spine thickness of 0.1 cm at various angles of impact relative to the lamellar structure of the rib.
 MATERIALS AND METHODS: Experimental works were performed. Injuries were inflicted perpendicularly to the plane of the rib, to a depth of 5.4 cm, with a knife having a blade spine thickness at the penetration level of 0.1 cm. The study analyzed the anterior sections of ribs IV–VI of individuals of both sexes, predominantly male, aged 18–59 years, which is based on an experimental literature review of cutting and stubbing injuries. In total, 60 experiments were conducted, with 20 injuries each inflicted longitudinally, obliquely, and transversely on the rib lamellar structure. The results of the macroscopic observations were recorded and considered for subsequent interpretation.
 RESULTS: In the macroscopic examination of injuries inflicted at various angles to the lines of the compact layer’s lamellar structure, linear-slit-shaped injuries were registered on the external compact plate. When oriented longitudinally in relation to the long axis of the bone, arcuate slit-shaped injuries were also observed. When a split crack was formed in the blade spine zone, a crack formed from one of the corners of the blunt end of the injury, extending longitudinally and obliquely along the bone’s lamellar structure, with some deviations toward the edge of the bone nearest to the injury. In transverse alignment of the injury to the long axis of the bone, the split crack morphologically corresponded to a fracture in bending deformation, gravitating toward the rib edge. The area influenced by the blade spine showed no macroscopic signs of abrasion of the compact or spongy bone. The blunt end of the injury had a round shape. On the internal compact plate, the shape of the injuries more frequently appeared slit-like, and in some cases serrated, due to the bulging of compact bone areas.
 CONCLUSION: The study identified significant specific morphological features of stab injuries to the ribs caused by a knife with a blade spine thickness of 0.1 cm, taking into account the lamellar structure of the bone tissue, which allows us to draw conclusions about the knife blade spine thickness.

Penetrating abdominal stab and gunshot injuries: 10-year experience of a secondary public hospital located in a suburban area with solo surgeons.

Trauma care systems are life-saving significant implementations of a country's healthcare systems. Trauma care requires well-established trauma settings and organizations with experienced trauma teams including experienced emergency medicine, surgery and anesthesiology staff. This study aimed to investigate the outcomes of penetrating abdominal injuries treated by solo surgeons in a suburban area. Medical records of the patients who were admitted to the emergency department with penetrating abdominal injuries between January 2012 and December 2021 were retrospectively analyzed. Patients were evaluated based on their injury sites and treatment approaches. In total, 110 patients with anterior abdominal penetrating injuries were enrolled in the study; 83 (75.4%) were stabbed and 27 (24.6%) had gunshot wounds. According to the injury site, there were 90 (81.8%) anterior; 11 (11%) right thoracoabdominal and 9 (7.2%) left thoracoabdominal injuries. Fifty-one (61.4%) stab wounds were treated with immediate laparotomy and 21 (41.1%) of these operations resulted in negative or nontherapeutic laparotomy. Also, 32 (38.6%) stab wounds were managed nonoperatively; three (9.3%) failed conservative management and received delayed laparotomy. All gunshot wounds were treated with immediate laparotomy and 14.8% resulted in either negative or nontherapeutic laparotomy. On-call surgeons were found to be more prone to perform immediate laparotomy on weekends when they were on call for 48 or 72 hours. Being a solo surgeon may increase negative laparotomy rates of penetrating abdominal injuries. This high percentage (41.1%) of negative laparotomy rates can be reduced by establishing well-organized trauma teams.

Are trauma victims with obesity lucky in penetrating trauma injuries?

We aimed to reveal the protective effect of body mass index (BMI) and subcutaneous adipose tissue thickness (SATT), together with scores covering the abdomen, in patients with penetrating abdominal trauma. The data of 234 abdominal penetrating trauma patients over the age of 16 who applied to the emergency general sur-gery unit of Istanbul Medipol Hospital between 2017 and 2021 were analyzed retrospectively. Sex, age, types of penetrating injuries, BMI, need for blood transfusion and intensive care unit (ICU), mortality, Injury Severity Score (ISS), Penetrating Abdominal Trauma Index (PATI), and Flint Colon Injury Score (FCIS) were recorded. The patients were divided into two groups: Gunshot Wound (GW) and Stab Wound (SW).While there was no significant difference in all parameters examined in all patients and GW patients in terms of BMI, a statistically significant difference was found in terms of blood transfusion need in SW patients (p=0.035). As a result of the Receiver Operating Characteristic curve analysis for the SATT variable, the cutoff value between mortality (p=0.866) and SATT (mm) values in all patients was 11 mm for all patients and 12 mm for GW patients. A significant difference was found in all patients and separately in GW and SW groups in terms of ICU and blood transfusion need, length of stay, ISS, PATI, and FCIS scores in non-operated patients (p<0.05). When all patients were examined, a statistically significant difference was found in terms of mortality (p=0.002). It is the first study to evaluate penetrating abdominal injuries with both BMI and SATT comprehensively and with all abdominal scores. A cutoff value to be determined for SATT with larger and multicenter studies can take its place as a parameter in the penetrating trauma algorithm.

Management of 52 small bowel perforations following gunshot injury: A case report

Abstract Small bowel injury is one of the most common abdominal injuries following penetrating injuries and is usually secondary to gunshot, stab, or impalement injuries to the abdomen. We report a case of shotgun injury to the abdomen in a hemodynamically stable man. He had an emergency exploratory laparotomy, during which 52 small bowel perforations and 1 transverse colon perforation were found. He was managed by damage control surgery involving a temporary nonclosure of the anterior abdominal wall with resuscitation and a second look laparotomy after 48 h.

Intracranial graft of bioresorbable polymer scaffolds loaded with human Dental Pulp Stem Cells in stab wound murine injury model.

The prevalence of central nervous system (CNS) dysfunction as a result of disease or trauma remains a clinically unsolved problem which is raising increased awareness in our aging society. Human Dental Pulp Stem Cells (hDPSCs) are excellent candidates to be used in tissue engineering and regenerative therapies of the CNS due to their neural differentiation ability and lack of tumorigenicity. Accordingly, they have been successfully used in animal models of spinal cord injury, stroke and peripheral neuropathies. The ideal therapy in brain injury should combine strategies aiming to protect the damaged lesion and, at the same time, accelerate brain tissue regeneration, thus promoting fast recovery while minimizing side or long-term effects. The use of bioresorbable nanopatterned poly(lactide-co-ɛ-caprolactone) (PLCL) polymeric scaffolds as hDPCSs carriers can represent an advantage for tissue regeneration. In this chapter, we describe the surgical procedures to implant functionalized bioresorbable scaffolds loaded with hDPSCs to improve the brain lesion microenvironment in an intracranial stab wound injury model severing the rostral migratory stream (RMS) that connects the brain subventricular zone (SVZ) and the olfactory bulb in nude mice. Additionally, we also describe the technical steps after animal sacrifice for histological tissue observation and characterization.

Traumatic damage to the diaphragm in children

To analyze treatment outcomes in children with traumatic injuries of the diaphragm. We followed-up 14 children aged 3-18 years with traumatic injuries of the diaphragm. Diagnostic measures included anamnesis, physical examination, pleural and abdominal puncture, bladder catheterization, ultrasound and X-ray examination including CT. Traumatic brain injury and thoracoabdominal trauma prevailed in children with traumatic injuries of the diaphragm. In 8 children, diaphragm injury was the result of a traffic accident. Of these, 5 ones died at the scene due to traumatic brain injury. In 3 children, diaphragm injury was associated with penetration of an iron pin through the perineum, pelvic cavity, abdominal and chest cavities when falling from a height (n=1) and sledding (n=2). Two children were littered with a pile of bricks and building materials. One girl suffered a diaphragm injury as a result of a stab wound. Combined damage to the diaphragm, TBI, chest and abdominal organs are serious injuries. Signs of shock, internal bleeding, respiratory failure and bone fractures come to the fore. Assistance to these children should be carried out in specialized hospitals.

Vascular trauma injury evaluation in Khorramabad, Iran: a cross-sectional study.

Vascular trauma injuries are associated significantly with disabilities and mortality where prompt diagnosis and management are of great importance. In this study, the authors aim to evaluate the pattern of vascular trauma injuries. This descriptive retrospective study was performed on patients with vascular injuries due to trauma referred to (Shohada Ashayer Hospital and Shahid Chamran Hospital, Khorramabad). Patients' files were evaluated for the following data: diagnostics, types of treatment and outcome, type of trauma, cause of trauma, anatomy of the injured site, duration of surgery, type of lesion, delayed complication, and requirement of revision surgery. The data obtained were descriptively evaluated using SPSSv22. Of 233 patients studied, 95.3% were males. The mean age of the patients was 29.15±11.8 years. 82.8% of patients presented with penetrating trauma whereas 32.2% of patients had stab wound trauma. The most common sign at the time of referral was a loss of sensation in 54.9% of patients. Direct diagnosis based on clinical presentation was made in 79% of patients. The upper extremity was the most common site of vascular injury in 77.3% of patients with the involvement of radial and ulnar arteries, in 63.1%. 66.9% of patients underwent primary vascular repair, 92 received revision surgery, and 69 required blood transfusion. Epidemiological studies of vascular injury can help clinicians and local healthcare centres to understand the pattern of vascular trauma based on the geographical location and train trauma surgeons and medical staff to provide effective and timely management.

Intercostal hernia secondary to penetrating trauma presenting as an abdominal swelling: A rare case

Abstract Intercostal hernia (ICH) is a type of hernia, in which the sac or contents (lung, liver, bowel, or stomach) protrude through the intercostal space. It can be categorized either into acquired or congenital types, with or without a diaphragmatic defect. We report the case of a 45-year-old man who presented to a surgical clinic with irreducible swelling in his right upper abdomen for 7 months. Patient had a history of stab injury at the same site 7 years ago. Intraoperatively, a sac containing omentum was found arising through a defect of 2 cm × 2 cm burrowing below, in the 9th intercostal space, to manifest as a subcostal bulge with complete disruption of the sternocostal joint of the 9th rib. The procedure done was an onlay mesh hernioplasty. ICH, though a rare entity, should be kept in mind as a differential diagnosis in patients with a history of thoraco-abdominal trauma. It may require modifications in the operative technique or even thoracic exploration in extreme cases.

Stab injury to the spine with retained knife blade and aortic injury: A case report and review of the literature

Abstract Nonmissile penetrating spine injuries are relatively common in developing countries. Associated injuries are most commonly pneumothoraxes or bowel injuries and rarely vascular injuries. Penetrating aortic injuries are life-threatening and require prompt workup and management. A 51-year-old male patient presented after being stabbed in the back with a blade lodged at vertebral body T10/T1l. The blade tip was in the lumen of the descending thoracic aorta. This patient was successfully managed with thoracotomy and aortic repair, followed by the removal of the blade via an open laminectomy. The patient remained neurologically intact with no complicating features. Patients with penetrating spine injuries and retained blades need adequate workup to exclude other injuries prior to the removal of the blade. A multidisciplinary approach is important in the management of these patients to prevent devastating outcomes.

Minimally invasive approach in diaphragmatic injuries due to stab wounds: 10 years of experience

Objective: We aimed to evaluate minimally invasive methods in the diagnosis and treatment of stabbing diaphragmatic injuries.&#x0D; Methods: Between January 2013 and January 2023, 66 patients with suspected diaphragmatic injury (DI) due to stab wounds, were diagnosed and treated with video assisted thoracoscopic surgery (VATS). The records of age, gender, concomitant injuries, surgical approach, morbidity and length of hospital stay were reviewed retrospectively.&#x0D; Results: The mean age of the patients was 26.39 years and they were 59 males and 7 females. Of the patients, 42 (63.4%) were on the left side and 24 (36.4%) were on the right side. According to the sites, The wounds were anterior in 32 (48.5%) of the cases and posterior in 34 (51.5%). Concomitant injuries were seen in 47 cases. DI was confirmed in 30 (45.5%) cases. Of these, 18 (60%) were on the left and 12 (40%) were on the right. The surgeries were VATS alone in 36 (54.5%), VATS via stab wounds in 22 (33.3%), and mini-thoracotomies in 8 (12.1%) of the cases, respectively. DI was confirmed in 30 (45.5%) cases. Eighteen (60%) of them were on the left, and 12 (40%) were on the right (p0.05). The mean duration of hospital stay was 4.58 days in anterior injuries and 6.11 days in posterior injuries. No patient died.&#x0D; Conclusıon: As a minimally invasive method, VATS is the method of choice for the detection and treatment of DI in thoracoabdominal injuries caused by stabbing.

Traumatic Chylothorax due to Cervical Stab Wound: A Case Report

Background: Chylothorax corresponds to the incidence of chyle in the pleural space; it was described for the first time in 1633. Its most common cause is associated with iatrogenic injuries to the thoracic duct; 80% of them take place during surgeries, such as pneumonectomy or esophagectomy. Case presentation: A case of an unusual cervical stab wound complication in a 23-year-old man who presented a late large volume chylothorax has been presented and discussed in this paper, as well as its management. Discussion: The presented case demonstrates a rare complication after a cervical stab wound. The management of chylothorax can involve non-operative management, non-operative intervention, or operative management depending on the symptoms and duration. Usually, surgical interventions are required after two weeks of clinical treatment. The differential diagnosis in a post-trauma acute onset ventilatory manifestation is mandatory to rule out pulmonary embolism. Conclusion: Traumatic chylothorax is a rare event; however, its morbidity and mortality rates can be catastrophic when it is not diagnosed early and when the treatment is not established based on a proper flowchart. Thus, dietary and drug-based clinical measures, interventional radiology, videothoracoscopy, and thoracotomy for thoracic duct ligation are valid therapeutic options for the proper management of these cases.

Breaking point? An analysis of fatal stab wounds to the torso in Ireland between 2011 and 2018, examining the extent of rib fractures.

This study examines the pattern of rib injuries occurring in cases of fatal torso stab wounds in Ireland between 2011 and 2018. It has been suggested by previous studies that rib fractures are not commonly sustained in stab wounds to the torso. We wanted to ascertain whether this was the case, as our data suggested that rib fractures were frequent, and where a rib is fractured there is a higher chance of organ injury and death, making this an important area of study. One hundred and forty seven cases of fatal stab wounds from an eight-year period were retrospectively reviewed. Fatal stab wounds to other body areas, were excluded; leaving a total of 104 cases with stab wounds to the torso. We found that 69.2% of cases had rib injuries, a figure significantly higher than previously reported. Our data suggests that stab wounds to the torso often fracture ribs, putting the underlying organs at increased risk of injury and perhaps contributing to fatality. The amount of force needed to cause a rib fracture can be difficult to quantify and indeed from the high percentage of rib fractures sustained in our data it appears that the ribs may be fractured regardless of the amount of force used; this is borne out by the finding that self-inflicted injuries also caused rib fractures. Our study shows that other factors, such as anatomical positioning and wound depth may have a greater bearing than force in terms of whether a rib fracture is sustained.

A Swedish nationwide forensic study of the manner of death in single stab injuries to the trunk

IntroductionForensic pathologists are frequently confronted with questions about whether an injury is likely to have been inflicted by an assault or be self-inflicted. However, little is known of the epidemiological variables that might be applicable to differentiate between homicides and suicides in deaths caused by single stab injuries to the trunk. MethodUsing the Swedish forensic autopsy register, we identified 94 homicides and 45 suicides between 2010 and 2021 in which death followed a single stab injury to the trunk. We extracted characteristics from the cases and performed statistical analyses using the Mann-Whitney U test, Chi-square test and logistic regression model. ResultsVictims of homicides were younger than suicide victims (median age 33 years vs. 52 years, p < 0.05), and males were in the majority in both groups (93% vs. 82%). In numerous homicide victims, stab wounds were placed in the back and in axillar regions, unlike in suicides victims in which the stabs were all placed on the medial part of the anterior trunk. Vertical entrance wounds in the skin combined with a medially running injury channel (n = 13) showed a positive predictive value of 100% (95% CI 75.3–100) for homicide, although the sensitivity was low. Homicides were conclusively associated with an outdoor death scene (OR 19.0, 95% CI 7.6–47.1), injury to thoracic bone/cartilage (OR 3.8, 95% CI 1.6–9.0), influence of alcohol (OR 7.1, 95% Cl 2.9–17.7) and illicit drugs (OR 4.3, 95% CI 1.5–11.9). Discussion and conclusionThe observed forensic characteristics of stab injuries could be used as a tool when assessing the manner of death in single stabs. Further research on variables associated with manner of death are needed and we suggest also including characteristics of surviving victims in such analyses.

Attempted Suicide with a Self-Inflicted Penetrating Stab Wound to the Medulla Oblongata Caused by a Pair of Scissors: Case Illustration

A 78-year-old male patient with a history of psychotic depression was found in the bathroom of his apartment with a pair of scissors driven deeply into the back of his neck. He presented with tetraparesis with residual control over the left lower limb movement. Immediate skull radiograph and brain computed tomography scans revealed the tip of the scissors passing into the foramen magnum. Emergent surgery with midline suboccipital craniectomy and resection of the posterior arch of C1 was performed. The scissors were spontaneously dislocated in the course of surgery. Thereafter, debridement, placement of external ventricular drain and primary closure of the dura and skin were achieved. Post-operatively, the patient was not able to follow any instructions. On the 22nd post-operative day, the patient passed away in palliation. To our knowledge, this is the first reported case of a suicide attempt involving the use of scissors reaching the medulla oblongata.

Achilles Tendon Ruptures: Limited Incision Repair

Achilles tendon ruptures are a common injury, and a steadily rising incidence has been noted since the middle of the 20th century. Conservative management is a recognized treatment method, but it bears a higher risk of tendon rerupture compared with surgical treatment. Standard open surgery, however, can lead to complications, such as wound complications and surgical site infection. Hence, efforts have been put into the development of alternative surgical techniques to lower the risk of complications. In the 1970s, Ma and Griffith introduced percutaneous tendon repair by limiting the incision to 6 stab wounds. Subsequently, the open and percutaneous approaches have been merged into limited incision procedures, which include the advantages of both: visual control as well as smaller incisions. The primary limited incision approach consisted in using twisted Kirschner wires as suture guides. They were replaced by specific guiding instruments, such as the Achillon and Percutaneous Achilles Repair System (PARS) device, which rendered the limited incision procedure safer and more standardized. The instruments consist of 4 arms: The outer arms facilitate needle introduction by predetermined holes, the inner arms allow for suture passage exclusively underneath the tendon sheath. The minimally invasive procedures may reduce complication rates, especially regarding wound healing and infection. Limited incision techniques also may reduce sural nerve injury. Level of Evidence: Diagnostic Level V—expert opinion. See Instructions for Authors for a complete description of levels of evidence.

The effect of photography training on the accurate representation of gunshot and stab wounds in autopsies: a comparative study.

Accurate representation of findings in autopsy photographs is of paramount importance. This study investigates the influence of photography training on the precision of autopsy photographs in depicting these findings. In cases of fatal gunshot and stab wounds, photographs were concurrently taken by individuals without photography training (Group A) and a trained medical photographer (Group B). Two sets of photos were then anonymously presented to forensic medicine specialists, who had no prior knowledge of the associated autopsies, along with relevant survey questions. Responses were assessed according to the autopsy findings. 63.5% of the questions were correctly answered using Group A photographs, while Group B photographs achieved an accuracy rate of 81.2%. Although the rates of incorrect answers were equal (A: 10.9%, B: 11.0%), a notable disparity was observed in the category "could not be evaluated" (A: 25.5%, B: 7.8%). Hence, a significant difference emerged in these two photo groups' ability to depict the findings accurately. Conspicuously, the length of stab wounds was unassessable in 47.3% of Group A photographs, in contrast to only 1.4% in Group B. Furthermore, the mean deviation from the gold standard in estimating stab wound length was 3.09mm for Group A and 0.77mm for Group B.Considering the extent to which autopsy photographs faithfully represent findings is vital for preserving critical evidence over time, we recommend that basic photography training and specialized autopsy photography training become integral components of forensic pathology and medicine education worldwide, complemented by the development of standardized guidelines for autopsy photography.

Use of different imaging techniques in stab wound analysis

Stab wound analysis is a relatively new field of study in forensic science, and there is currently much debate regarding the effectiveness of the analysis due to a lack of validation studies. Furthermore, the underlying viewpoints on the success of stab wound analysis vary. Examination of cut marks, for example, can reveal a variety of characteristics which can be used to determine the type of weapon that was used to inflict them. However, published studies are not consistent when identifying knife blade characteristics, instead considering a wide variety of morphological aspects and their potential value in forensic scenarios. The existing research methodology is therefore inadequate to reliably inform in such contexts, and future experimental design should be influenced by the conditional variance in stabbings in order to provide reliable findings.The research presented here takes a systematic approach to the problem, compiling the published literature (up to September 2023) on the use of different imaging methods applied to stab wound examination to create a taxonomy to examine trends in methodological approaches in both research and investigative settings. This approach identified that published studies could be classified as either morphological or morphometrical, and further sub-classified based on their degree of success and the findings reached. This emphasises the importance of prioritising research into mark data, and the need for a multi-technique, multi-disciplinary approach. A decision tree was created to illustrate which mark attributes should be studied for which purpose, and using which imaging method(s). Furthermore, the research presented identifies two key areas in stab wound research which should be the focus of standardisation efforts, namely methodological procedures and mark characteristic collection. Knife markings are difficult to interpret, but further research and standardisation of kerf mark analysis, as highlighted here, will improve the efficiency and reliability of both forensic investigations and future experimental studies.

Analysis of the results of medical care provided by emergency medical teams for injuries in the neck area

The analysis of the results of medical care at various stages of treatment of 86 people who received stab wounds in the neck area was performed. The male wounded predominated, of which there were 65 (75.6%) people, there were 21 (24.4%) women. The study shows that errors in the provision of medical care in the case of a neck injury occur in 31.4% of cases, while such errors were noted in 8.1% of cases when medical care was provided by medical teams of emergency medical care, whereas in the provision of medical care by paramedic teams of emergency medical care in 22.1% of cases. Basically, the errors were associated with incorrect performance of temporary hemostasis and underestimation of the condition of the wounded, as a result, the wounded from this localization developed or had a high risk of developing various compli[1]cations, including shock. This could not but affect the course of the nearest postoperative period with such injuries. Based on the analysis, it was found that in the group of wounded who received medical care by medical teams of emergency medical care, there was a statistically significant decrease in complications and deaths compared to the group where such assistance was provided by paramedic teams of emergency med[1]ical care. From this it can be concluded that neck injuries are the most severe injuries, higher qualifications are required to provide assistance with such injuries, while preference should be given to medical teams of emergency medical care.

Enhancing Vibrio vulnificus infection diagnosis for negative culture patients with metagenomic next-generation sequencing.

To evaluate the diagnostic value of metagenomic next-generation sequencing (mNGS) in Vibrio vulnificus (V. vulnificus) infection. A retrospective analysis of patients with V. vulnificus infection at the Fifth Affiliated Hospital of Sun Yat-Sen University from January 1, 2020 to April 23, 2023 was conducted. 14 enrolled patients were diagnosed by culture or mNGS. The corresponding medical records were reviewed, and the clinical data analyzed included demographics, epidemiology laboratory findings, physical examination, symptoms at presentation, antibiotic and surgical treatment, and outcome. In this study, 78.6% (11/14) patients had a history of marine trauma (including fish stab, shrimp stab, crab splints and fish hook wounds), 7.1% (1/14) had eaten seafood, and the remaining 14.3% (2/14) had no definite cause. Isolation of V. vulnificus from clinical samples including blood, tissue, fester and secreta. 9 cases were positive for culture, 5 cases were detected synchronously by mNGS and got positive for V. vulnificus. 85.7% (12/14) cases accepted surgical treatment, with 1 patient suffering finger amputated. 14 enrolled patients received appropriate antibiotic therapy, and all of them had recovered and discharged. 9 strains V. vulnificus isolated in this study were sensitive to most beta-lactam antibiotics, aminoglycosides, quinolones, etc. Vibrio vulnificus infection is a common water-exposed disease in Zhuhai, which requires identification of a number of pathogens. Of severe infections with unknown pathogen, mNGS can be used simultaneously, and the potential to detect multiple pathogens is of great help in guiding treatment.