Trauma Cases Research Articles

Greater distance traveled for renal trauma care is not associated with higher rates of intervention.

Trauma patients frequently may be transported significant distance to receive care at a level one trauma center. Increasing distance may cause delays in care. We sought to investigate whether distance traveled for level 1 trauma care affected rates of intervention for renal trauma. We queried our institutions reportable trauma database from the years 2015 to 2022. This data was filtered for all patients that had ICD codes pertaining to renal trauma. All renal trauma patients with zip codes where they sustained their injury were included. We then calculated the distance traveled to our hospital via Google Maps for each patient. We aggregated diagnosis codes for percutaneous angioembolism and nephrectomy. Injury severity scores (ISS) were collected. We divided patients into two groups based on distance traveled (0-30 miles and 31 + miles). We also analyzed the number of angioembolizations and open renal surgery completed for each mile distance category and analyzed for a difference between the groups. Our database yielded 307 cases of renal trauma that met inclusion criteria. We found no difference in rates of percutaneous angioembolism and open renal surgery between patients that traveled different distances for renal trauma care. Few studies have assessed distance traveled for trauma care and need for intervention. Our findings that an increased travel distance did not lead to a significantly increased risk for intervention are reassuring. Based on these findings, distance traveled for appropriate trauma care may not be a factor when deciding on transfers for renal trauma.

Primary surgery of subcondylar mandibular fracture using patient-specific implant: the Helsinki protocol

PurposePreoperative virtual planning and osteosynthesis with patient-specific implants (PSIs) have become a quotidian approach to many maxillofacial elective surgery setups. When a process is well-organized, a similar approach can be harnessed to serve the needs of exact primary reconstructions, especially in midfacial trauma cases. PSI osteosynthesis of the mandible is, however, more challenging because a mirror technique of the facial sides is often unreliable due to inherent lack of symmetry, and movement of the mandible increases the risk of loosening of the osteosynthesis. The purpose of this study was to present clinical results of the Helsinki protocol concept of utilizing PSIs in the primary surgery of unilateral mandibular subcondylar fractures as the first publication on the subject.MethodsA single-center study of a new Helsinki protocol is presented for surgical treatment of subcondylar mandibular fractures using patient-specific, titanium-milled repositator plates. Ten patients with dislocated subcondylar mandibular fractures received surgery and osteosynthesis with PSI via a retromandibular approach.ResultsClinical and radiological outcomes were excellent; none of the patients had fixation-related major complications or developed postoperative malocclusion.ConclusionsStudy results show that the Helsinki protocol, treating mandibular condylar fractures primarily with PSI plates, is a viable treatment option.

Immediate Stentless Lacrimal Sac to Conjunctiva Reconstructive Ostomy for Cancer and Trauma Defects: LACROS (Conjunctivodacryocystostomy).

To describe and evaluate the efficacy and safety of lacrimal sac to conjunctiva reconstructive ostomy for proximal lacrimal system reconstruction. This retrospective study included 41 patients (32 cancer and 9 trauma; 36 primary and 5 secondary) who underwent lacrimal sac to conjunctiva reconstructive ostomy. The technique involves creating a direct connection between a surgical opening in the lacrimal sac, which maintains its bony attachments to prevent ostomy occlusion, and the medial conjunctiva (medial fornix, bulbar, and palpebral). Interrupted 7-0 polyglactin 910 sutures were used to form a 3- to 5-mm-diameter lined conduit. Stenting was not employed. When necessary, oral mucosa or mucoperiosteal grafts and local flaps were utilized for reconstruction. Outcomes were assessed by epiphora prevention, the functional patency of the lacrimal ostomy, and the patient-reported nasolacrimal duct obstruction symptom score. On examination, all patients demonstrated canalization of the lacrimal sac to the conjunctival reconstructive ostomy, as evidenced by unobstructed tear drainage. Complications occurred in 17% of cases, including periorbital edema, chemosis, diplopia, and conjunctival granuloma. The average nasolacrimal duct obstruction symptom score for lacrimal-ocular symptoms was 3.1/10 and for nasal symptoms was 2.3/10 (0 best, 10 worst). Tearing was the least prominent complaint (0.8/10), with 1 patient reporting permanent tearing (6/10). Lacrimal sac to conjunctiva reconstructive ostomy proves to be a valuable procedure for immediate and delayed proximal lacrimal system reconstruction in cancer and trauma cases due to its straightforward and stent-free approach and its favorable 8-year outcomes.

Predicting fall parameters from infant skull fractures using machine learning.

When infants are admitted to the hospital with skull fractures, providers must distinguish between cases of accidental and abusive head trauma. Limited information about the incident is available in such cases, and witness statements are not always reliable. In this study, we introduce a novel, data-driven approach to predict fall parameters that lead to skull fractures in infants in order to aid in determinations of abusive head trauma. We utilize a state-of-the-art finite element fracture simulation framework to generate a unique dataset of skull fracture patterns from simulated falls. We then extract features from the resulting fracture patterns in this dataset to be used as input into machine learning models. We compare seven machine learning models on their abilities to predict two fall parameters: impact site and fall height. The results from our best-performing models demonstrate that while predicting the exact fall height remains challenging ( 0.27 for the ridge regression model), we can effectively identify potential impact sites ( between 0.65 and 0.76 for the random forest regression model). This work not only provides a tool to enhance the ability to assess abuse in cases of pediatric head trauma, but also advocates for advancements in computational models to simulate complex skull fractures.

Emergency medicine : what's new in 2024

Emergency medicine plays a crucial vital role as the gateway to the Swiss healthcare system. Although it has not yet been officially recognized with a specialist title, unlike most European countries - emergency medicine in Switzerland is characterized by robust research activity. This scientific article demonstrates a dynamic and rigorous evolution. In this edition, we present six articles authored by Swiss emergency physicians, each examining different aspects of our field. Topics include gender stereotypes, prehospital cardiac arrest, the unique needs of the older patients in emergency department, the administration of antifibrinolytics in trauma cases, and a predictive model for infectious endocarditis.

Midface Trauma - a Clinical Case of Complex Fracture of the Zygomatic-Alveolar Complex

Traumatic injuries of the maxillofacial region occupy one of the leading places in terms of prevalence among traumas. Injuries of this localization belong to the category of the most severe and complex injuries, posing a significant threat to the health and life of the patient, due to the fact that fractures of the bones of the facial skeleton are often accompanied by various injuries of the organs of vision, sinuses and brain. Injuries of the zygomatic bone isolated and in more than half of cases fractures of the zygomatic bone accompanied by injuries of the walls of the maxillary sinus, nasal and orbital bones, and the eyeball. Of these, 15% accompanied in combination with fractures of the maxillary sinus walls. The article presents a clinical case of transportation trauma of a patient because of a traffic accident as a passenger. Upon admission to the hospital, after a comprehensive examination, the diagnosis: Fracture with displacement of the anterior lateral wall of the right Maxillary sinus, the inferior and lateral wall of the right Orbit. Fracture of the Zygomatic arch with angular deformation. Contusion and abrasions of soft tissues of the right half of the face, right para-orbital tissue. Then successfully performed the operation - Repositioning of bone fragments in fractures Operation repositioning of the zygomatic bone fracture and Osteosynthesis of the anterior wall of the Maxillary sinus on the right side with a titanium perforated plate and isolated from the PRP membrane.

An intraoral approach to minimize morbidity in a pediatric trauma case

An intraoral approach to minimize morbidity in a pediatric trauma case

Impact of trauma center status on radiology resident performance in detecting non-accidental trauma on the WIDI SIM exam.

To evaluate whether adult and pediatric trauma center status, as well as the presence of dedicated child protection teams, influences radiology resident performance in detecting non-accidental trauma on the Emergent/Critical Care Imaging Simulation (WIDI SIM) exam. We retrospectively analyzed 639 WIDI SIM exam scores for four pediatric non-accidental trauma cases completed by radiology residents across 33 programs. Residents were stratified by level (R1-R4) and institutional factors, including adult trauma center status, pediatric trauma center status, and child protection team presence. Additionally, 2022 pediatric physical abuse counts per state were obtained from the National Child Abuse and Neglect Data System and normalized between 0 and 1. We employed a negative binomial generalized linear model (GLM). The outcome was regressed on resident level, trauma center status variables, child protection team presence, and normalized abuse counts. Higher resident training level was significantly associated with better performance (R1=3.6, R2=5, R3=6.1, R4=7.9; P<0.001). Adult trauma center accreditation was also associated with higher scores (4.6 vs. 3.3; P<0.001). In contrast, pediatric trauma center status, child protection team presence, and normalized state-level abuse counts were not significantly associated with resident performance (all P>0.05). Resident experience and adult trauma center accreditation were significantly associated with better radiology resident performance in detecting non-accidental trauma in a simulated call environment. Pediatric trauma center status, child protection team presence, and statewide abuse prevalence were not associated with detection performance. These findings suggest the need for targeted educational interventions at non-adult trauma centers and emphasize the importance of experience in developing diagnostic proficiency for non-accidental trauma.

Epidemiology of Consumer Product-Related Ocular Injuries in the Incarcerated Population

ABSTRACT Purpose To characterize the epidemiology of consumer product-related ocular injury in the United States (US) incarcerated population, and identify preventable causes. Methods The National Electronic Injury Surveillance System (NEISS) database was queried for cases of eye injury from 2014 to 2023. Incarcerated cases were identified using the keywords “prison”, “jail”, “inmate”, and “incarcerate”. Year of injury, diagnosis, product code, and demographic information were gathered and compared between the incarcerated and general US populations using SPSS version 29 (IBM Corp.). A narrative analysis categorized cases of ocular trauma in the incarcerated by common causes of injury. Results Between 2014 and 2023, there were an estimated 1,644,841 cases of consumer-product related ocular injury the US, with 2683 cases occurring in the incarcerated. A higher percentage of ocular injury cases in the incarcerated involved African American individuals (43.42% vs. 17.18%), males (92.22% vs 68.54%), alcohol use (4.11% vs. 0.64%), drug use (3.91% vs. 0.82%), and hospitalization (4.96% vs. 1.39%). Contusions were less common in the incarcerated population (27.21% vs. 41.31%), while foreign body injuries were more common (24.38% vs. 18.75%). Penal labor, including cleaning (13.74%), welding (8.25%), yardwork (5.92%), and power grinding (5.72%), accounted for 36.36% of injuries. 26.50% of injuries were sports-related, with basketball involved in 16.82%. Conclusions The epidemiology of ocular injury in the incarcerated differs from the general US population. Penal labor and sports-related ocular injury represent a majority of cases, underscoring the need for protective eyewear.

Burnout Syndrome in forensic medicine and its association with vicarious trauma, posttraumatic stress syndrome and occupational stress.

The burnout phenomenon is a subject of considerable interest due to its impact on both employee well-being and scientific inquiry. Workplace factors, both intrinsic and extrinsic, play a pivotal role in its development, often leading to job dissatisfaction and heightened burnout risk. Chronic stress and burnout induce significant dysregulation in the autonomic nervous system and hormonal pathways, alongside structural brain changes. This paper presents a preliminary review of the literature on burnout syndrome among forensic science workers, focusing on the prevalence of this phenomenon and its triggers. This review aims to consolidate existing research on burnout among forensic medicine workers, highlight significant findings, and encourage further studies. Symptoms range from demoralization to somatic complaints. The Maslach Burnout Inventory (MBI) was the main tool in assessing burnout levels alongside measures of occupational stress, vicarious trauma and posttraumatic stress syndrome. Forensic medicine workers face unique stressors, with notable impacts on burnout levels. These workers experience challenges such as workplace conflicts and exposure to traumatic cases, leading to moderate or high burnout levels, particularly, emotional exhaustion, depersonalization or low personal accomplishment. Despite the prevalence of burnout, many forensic medicine workers lack access to support networks and perceive a disregard for their well-being from supervisors. There is a pressing need for further research to understand the biological mechanisms, susceptibility factors, and discover diagnostic markers of burnout syndrome, with thegoal of its recognition as a psychiatric disorder in diagnostic manuals like the Diagnostic and Statistical Manual of Mental Disorders.

Radiology resident competency in orthopedic trauma detection in simulated on-call scenarios.

To evaluate radiology residents' ability to accurately identify three specific types of orthopedic trauma using radiographic imaging within a simulated on-call environment. We utilized the Wisdom in Diagnostic Imaging Emergent/Critical Care Radiology Simulation (WIDI SIM) to assess residents' preparedness for independent radiology call. The simulation included 65 cases, with three focusing on orthopedic trauma: sacral ala, femoral neck, and pediatric tibial/Toddler's fractures. Faculty graded residents' responses using a standardized 10-point rubric and categorized errors as observational (failing to identify key findings) or interpretive (incorrect conclusions despite correct identification of findings). 321 residents evaluated sacral ala fracture radiographs and received an average score of 1.29/10, with 8.71 points lost to observational errors. Only 6% produced effective reports (scores ≥ 7), while 80% made critical errors (scores < 2). For femoral neck fracture CT images (n = 316 residents), the average score was 2.48/10, with 6.71 points lost to observational errors. 25% produced effective reports, and 66% made critical errors. Pediatric tibial/Toddler's fracture radiographs (n = 197 residents) yielded an average score of 2.94/10, with 6.60 points lost to observational errors. 29% generated effective reports, while 71% made critical errors. Radiology residents demonstrated significant difficulty in identifying these orthopedic trauma cases, with errors primarily attributed to observational deficiencies. These findings suggest a need for targeted educational interventions in radiology residency programs to improve the identification of these fractures.

Role of laparoscopic surgery in blunt abdominal trauma; retrospective analysis in a tertiary trauma center

PurposeTrauma is a significant health concern globally and is one of the leading causes of illness and death. The laparoscopic approach has gained popularity in trauma care since its inception, becoming increasingly favored for both diagnostic and therapeutic purposes. This study aims to reduce unnecessary laparotomies and assess the effectiveness of laparoscopy in managing patients with blunt abdominal trauma.MethodsThe study is a descriptive retrospective study using the medical records of patients with blunt abdominal trauma who were managed with laparoscopy in the Department of General Surgery, King Abdulaziz Medical City in Riyadh. The study period was from 2019 to 2023 and included patients > 18 years with abdominal blunt injury, hemodynamically stable patients, and responding to resuscitation. The relationship between laparoscopic procedures according to the patient’s demographic and characteristics was conducted using the Fischer Exact test and independent sample t-test. Values were considered significant with a p-value of less than 0.05.ResultsIn this study, 74 patients were included, with 94.6% being males. The average age of the patients was 36.3 years (standard deviation of 12.5 years). The primary cause of trauma was motor vehicle accidents (MVAs), accounting for 91.9% of cases. The most common surgical approach used was laparotomy, performed in 71.6% of patients. Additionally, CT scans revealed that solid organ injuries were the most frequently detected type of injury, occurring in 41.9% of cases. Following surgery, 78.4% of the patients underwent therapeutic procedures after laparotomy, while 37.8% received therapeutic interventions post-laparoscopy.ConclusionWhile laparoscopic techniques have been used for decades in abdominal surgeries, a consensus on their effectiveness and accuracy in diagnosing blunt abdominal injuries in trauma settings is still lacking. Laparoscopy is considered safe and feasible for hemodynamically stable patients, and our findings suggest it is equally effective in trauma cases for those who can tolerate the procedure. We recommend conducting further studies with larger sample sizes and more variables to provide sufficient data to accurately assess the efficacy and safety of laparoscopy in trauma situations.

Characteristics and outcomes of out-of-hospital cardiac arrest among students under school supervision in Japan: a descriptive epidemiological study (2008-2021).

A comprehensive understanding of the epidemiology of pediatric out-of-hospital cardiac arrest (OHCA) occurring under school supervision is lacking. We aimed to comprehensively describe the characteristics and outcomes of OHCA among students in elementary schools, junior high schools, high schools, and technical colleges in Japan. OHCA data from 2008-2021 were obtained from the SPIRITS study, which provides a nationwide database of OHCAs occurring under school supervision across Japan. We included cases in which resuscitation was attempted by emergency medical service personnel or bystanders. The cases were classified into three groups based on their etiology: cardiac, non-cardiac, and traumatic origin. The primary outcome was one-month survival with favorable neurological outcomes, defined as a Glasgow-Pittsburgh cerebral performance category of 1 or 2. The demographic characteristics, event details, and outcomes were compared across the three groups by using χ2 tests for categorical variables and one-way analyses of variance for continuous variables. During the 14-year study period, 602 OHCA cases were confirmed, with 430 (71.4%) classified as cardiac, 91 (15.1%) as non-cardiac, and 81 (13.5%) as traumatic origin. Non-cardiac and traumatic cases were less likely to be witnessed at the time of arrest (46.2% and 42.0%, respectively) than cardiac cases (82.6%; p < 0.001). Initiation of cardiopulmonary resuscitation by bystanders was less common in non-cardiac and traumatic cases (62.6% and 42.0%, respectively) than that in cardiac cases (82.8%; p < 0.001). The delivery of defibrillation using public-access automated external defibrillators was also significantly less frequent in non-cardiac (3.3%) and traumatic cases (6.2%) than that in cardiac cases (59.8%; p < 0.001). Ventricular fibrillation (VF) as the first documented rhythm was observed in 77.9% of cardiac cases but was much less common in non-cardiac (5.5%) and traumatic cases (8.6%; p < 0.001). One-month survival with favorable neurological outcomes was significantly lower in non-cardiac (6.6%) and traumatic cases (0%) than that in cardiac cases (50.2%; p < 0.001). OHCAs of cardiac origin were more frequently associated with VF and had relatively good prognoses. In contrast, OHCAs of non-cardiac and traumatic origins consistently resulted in poor outcomes, highlighting the critical importance of prevention strategies to reduce the occurrence of these incidents.

Eye Trauma: Epidemiological, Clinical and Prognostic Aspects at the Garoua Regional Hospital

Introduction: Eye trauma represents a frequent reason for consultation in ophthalmology. It is a major cause of monocular blindness. Purpose: describe the epidemiological, clinical, therapeutic and prognostic aspects of ocular trauma at the Garoua Regional Hospital. Methods: This was a descriptive cross-sectional study with retrospective collection from January 1, 2019 to December 31, 2023. All patients with ocular trauma with complete files were included. The analysis was done using the SPSS26.0 software. Results: We collected 13,127 patient records including 689 cases of ocular trauma, giving a prevalence of 5.2%. The age spanned 1 to 83 years with a mean of 26.2 ± 14.8 years. The Male/Female sex ratio was 2.4. The consultation delay of 24 to 72 hours was dominant in 33.6% (n=217). Work accidents dominated in 38.2% (n=247). Metallic objects were incriminated in 13.8% (n=90). Contusion was the predominant type of trauma in 41.4% (n=275) and closed eye trauma accounted for 85.1%. Eyes with OTS (Ocular Trauma Score) 1 were the most represented in 6.9% of eyes (n=46). A poor prognosis was found in 24.6% of male patients and 5.1% of female patients, respectively a ratio (bad/good) M= 0.5 and ratio (bad/good) F= 0.2 (p value=0.004). After treatment, 14.1% (n=87) of eyes had a visual acuity of ˂1/20, with. 9.9% in males and 4.2% in females. Conclusion: The prevalence of ocular trauma is 5.2% at Garoua Regional Hospital. Raising awareness about preventive measures, especially in the workplace, can reduce the risk of blindness.

Evaluation of ultrasonography and plethysmography in detecting blood loss and volume replacement in a platelet apheresis model.

Rapid, reproducible, and noninvasive diagnostic methods like Ultrasonography (US) and plethysmographic measurements such as the perfusion index (PI) and pleth variablity index (PVI) have great potential value for emergency trauma cases in which blood loss needs to be recognized quickly and accurately. We planned this study to evaluate the utility of US, PI, and PVI in detecting early-stage hemorrhage and mimicking volume replacement using a platelet apheresis model. This prospective, observational study included 46 healthy platelet apheresis volunteers who met inclusion criteria. Both of US measurements of Vena Cava Inferior (VCImin, VCImax, and VCIcı) and plethysmographic measurements were performed in three time period (before apheresis, after whole blood was collected, and after blood components except platelets were returned to donors). Among the total 308 platelet apheresis, 46 male volunteers met inclusion criteria and consented to participate in the study. Of these 46 male volunteers, nine declined to have US measurements. After a mean blood loss of 440ml in the first phase of apheresis, IVCmax decreased significantly, while pulse increased (p=0.021 and p<0.001, respectively). After the third phase of apheresis, which simulated volume replacement, IVCmin and IVCmax increased significantly, while pulse decreased (p=0.003, p<0.001, and p<0.001, respectively). Per this platelet apheresis model, IVCmax is a diagnostic marker for both early-stage blood loss of less than 500ml and volume replacement.

The Impact of Intoxication on the Prognosis of High-Speed Motor Vehicle Accidents: A Tertiary Care Center Experience.

Several studies suggest a causal link between psychoactive agents and motor vehicle accidents (MVA). This study aimed to evaluate the impact of substance abuse and alcohol intoxication on the prognosis of high-speed MVA victims. This is a single-center retrospective cross-sectional study involving adult multiple trauma cases who were admitted to the emergency department for high-speed MVA and underwent toxicological screening. The cohort was conducted based on two main outcomes; the survival status and the neurological outcomes. 894 patients with the mean age of 27.8 ± 9.24 (range:18-37) years were studied (97.9% male). The most common indicators of severity were car rollover and ejection from the car. 296 of the patients had severe traumatic brain injury (TBI). 622 of the patients had a positive toxicological screening, with benzodiazepines (51.2%) and alcohol (26.6%) being the most commonly abused substances. The mortality rate was 5.8% and 12.1% of the patients had unfavorable neurological outcomes upon discharge. On multivariate logistic regression, predictors of mortality among high-speed MVA victims were report of a death at the scene (adjusted odds ratio (aOR): 2.529; 95% confidence interval (CI): 1.026-6.232; p = 0.044), severe TBI, the presence of dilated pupils (aOR: 11.074; 95% CI: 1.293-94.812; p = 0.028), hypotension (aOR: 0.456; 95% CI: 0.227-0.916; p = 0.027), and hypoxia (aOR: 2.95; 95% CI: 1.46-5.95; p = 0.003). Predictors of unfavorable neurological outcomes were report of a death at the scene (aOR: 3.133; 95% CI: 1.445-6.791; p = 0.004), positive toxicology screening (aOR: 3.30; 95% CI:1.68-10.204; p = 0.038), severe TBI, the presence of hypoxia (aOR: 2.96; 95% CI:1.645-5.319; p = 0.000), hypotension (aOR: 0.437; 95% CI: 0.252-0.758; p = 0.003), and bleeding (aOR: 0.287; 95% CI: 0.164-0.501; p < 0.001). A concerning proportion of high-speed MVA victims had a positive toxicology screening. Although intoxication did not increase mortality of high-speed MVAs, it was a significant predictor of unfavorable neurological outcomes of survivors.

Comparison of Ocular Trauma Score and Penetrating Ocular Trauma Score in Predicting Visual Outcome in Children

Background: Previously, no standardized system existed for naming and managing ocular trauma. The Ocular Trauma Score (OTS) was introduced to predict visual outcomes in patients with ocular injuries, proving valid in adults. However, its effectiveness in children was uncertain. To address this, the Penetrating Ocular Trauma Score (POTS) was developed specifically for pediatric cases. Despite these advancements, no consensus emerged nationally or internationally on whether OTS or POTS was the superior predictor of visual outcomes in children with ocular injuries. Objective: This study aimed to determine the more reliable scoring system for predicting visual outcomes in children after ocular trauma. A total of 34 patients aged 1 to 12 years with penetrating ocular injuries were included. Consent was obtained from the parents or guardians, and the study’s procedure was fully explained. A comprehensive eye examination, covering variables for both OTS and POTS, was conducted at the time of injury, and patients were followed for six months. Results were compared using cross-tabulation with the original OTS and POTS. Results: Of the 34 patients, 23 (67.6%) were male and 11 (32.4%) females, with a mean age of 6.7 years (range 1–15 years). Right-eye injuries occurred in 21 (61.8%) patients, and left-eye injuries in 13 (38.2%). Injuries most frequently occurred at home (61.8%) and in the street (26.5%), with stones (20.6%) and knives (17.6%) as common injury objects. An unclean wound was present in 22 (64.7%) cases, and traumatic cataract developed in 17 (50%) patients. Initial visual acuity (VA) ranged from PL to 20/20 (PL in 47%), while final VA ranged from NPL to 20/20 (PL in 26.5%). OTS results showed variable accuracy in groups 1–3 but matched predictions in groups 4 and 5. For POTS, groups 1, 2, 3, and 5 aligned with expected outcomes. Conclusion: POTS demonstrated higher reliability than OTS in predicting visual outcomes in pediatric ocular trauma cases

Changes in causes and outcomes of thoracic trauma cases during the COVID-19 pandemic: Literature review

Thoracic trauma refers to injuries affecting the chest area, which can lead to damage to the ribs, lungs, heart, and blood vessels. The most common cause of thoracic trauma is motor vehicle accidents. The COVID-19 pandemic has led to the implementation of various policies that have impacted multiple sectors, including healthcare systems and daily habits. Changes in healthcare systems are not limited to infectious cases but also extend to trauma cases. Various challenges have emerged alongside the increasing number of COVID-19 infections, such as shortages of personal protective equipment, ventilators, and hospital beds. The enforcement of pandemic-related policies has also resulted in alterations to daily routines. Lockdowns and social distancing measures have contributed to a decrease in traffic accidents due to reduced public mobility. Additionally, delays in seeking treatment for thoracic trauma due to fears of contracting COVID-19 have led to changes in outcomes. This literature review aims to identify the changes that occurred during the COVID-19 pandemic, particularly concerning the causes and outcomes of thoracic trauma cases.

NEW MORPHOLOGICAL SIGNS OF PASSENGER CAR DRIVER’ AND PASSENGERS’ BODILY INJURIES IN CASE OF MODERN SAFETY EQUIPMENT USE

The article examines the impact of modern automobile safety features on injuries sustained by drivers and passengers during traffic accidents. Cases of injuries were analyzed, and the nature of damages caused by traditional and modern safety systems was studied. It was found that modern safety features significantly reduce the risk of severe injuries, although they can themselves cause bodily harm. The study highlights the prospects for further research into the effects of advanced safety systems, such as active headrests and special pedal bracket mechanisms. The aim of the study is to increase the efficacy of forensic medical examinations of persons injured as a result of a road accident inside passenger car compartment. Materials and methods. 247 cases of trauma in the driver’s and passengers’ compartments of cars equipped with modern safety features (without fatal outcomes) were studied based on archival materials of the Odessa Regional Bureau of Forensic Medical Examination for the years 2014-2024. The morphology of bodily injuries in drivers and passengers was analyzed. Results. In a comparative study of both the traditional and new safety equipment impact on passenger car driver and passengers morphological signs of bodily injuries in a road accident it was found that current means of driver and passengers protection allow to reduce significantly the risk of severe, including fatal, bodily injuries in cases of road accidents. It was proved that safety steering column can cause serious injuries, up to the fractures occurrence. The remaining means of protection do not lead to serious injuries formation; their effect causes bruises, abrasions and superficial wounds formation. Conclusions. The current means of driver and passengers protection inside the car cabin allow to reduce significantly the risk of serious, including fatal, bodily injuries in cases of road accidents. New means of protection provide both driver and passengers greater safety inside the car cabin from injury. Prospects for furthers researches we suppose are the probable protective influence investigation of a special (breakable) pedal assembly bracket and an active headrest on driver and passenger inside the car in case of a road accident.

ANALYSIS OF PERINATAL CONSEQUENCES IN PUERPERAS WHO CHOOSE AN ALTERNATIVE APPROACH TO DELIVERY

Introduction: “Non-traditional” approaches to deliveries today are one of the main new concepts of patient orientation in modern obstetrics, aimed at improving the delivery and postpartum period course and gaining a positive delivery experience. Aim: To estimate the perinatal consequences and determine the psycho-emotional state of puerperal after the application of hydro technology during delivery. Materials and methods: 150 puerperas and their newborns were examined, who, depending on the chosen delivery tactics, were divided into: the main group (MG) – 53 women who gave birth using hydro-technology in the first and second periods of labor; comparison group (CompG) – 27 women who gave birth using hydro-technology only in the first period of labor; the control group (CG) – 70 women who gave birth according to generally accepted standards. In addition, the psycho-emotional state of all puerperas was examined on the 2nd–4th day of the postpartum period using questionnaires “Women’s Satisfaction with Deliveries” and “Edinburgh Scale of Postpartum Depression.” Results: There were no differences in the number of newborns weighing more than 4,000 g (MG – 8 (15.1 %), CompG – 4 (14.8 %), CG – 11 (15.7 %), p&gt;0.05) against the background of significantly lower number of birth canal traumatic injury cases in MG puerperas (rupture of the vagina and cervix: MG – 2 (4.0 %) and 1 (2.0 %) respectively, CompG – 3 (12.0 %) and 2 (8.0 %) respectively, CG – 12 (24.0 %) and 5 (10.0 %) respectively, p&lt;0.05). There were no significant differences in the number of newborns assessed in the first (MG – 4 (7.5 %), CompG – 4 (14.8 %), CG – 10 (14.2 %), p&gt;0.05) and in the fifth (MG – 2 (3.8 %), CompG – 6 (22.1 %), CG – 11 (15.7 %), p&gt;0.05) minutes after delivery, estimated at 8 points according to the Apgar’s scale. Noteworthy is a significantly smaller number of newborns among MG women, estimated at seven or less points (MG – 2 (3.8 %), CompG – 4 (14.8 %), CG – 9 (12.9 %), p&lt; 0.05) according to the Apgar’s scale. In the structure of pathological and transient conditions among MG newborns, a significantly lower number of mild asphyxia cases was noted (MG – 2 (3.7 %), CompG – 2 (7.4 %), CG – 10 (14.3 %), p&lt;0.05), as well as the absence of respiratory distress syndrome (MG – 0 (0.0 %), CompG – 1 (3.7 %), CG – 3 (4.3 %), p&gt;0.05) and intraventricular hemorrhages (MG – 0 (0.0 %), CompG – 1 (3.7 %), CG – 3 (4.3 %), p&gt;0.05) cases. Conclusions. The analysis of perinatal consequences shows a significantly higher number of newborns rated on the Apgar scale in the first and fifth minutes after birth in 9–10 points among newborns from women in labor of the main group and significantly higher scores for questionnaires “Women’s Satisfaction with Deliveries” and “Edinburgh Scale of Postpartum Depression” in women who gave birth using hydraulic technologies in the first and second periods of labor, which indicates a better psycho-emotional state and contributed to an earlier establishment of lactation and a shorter stay in an obstetric hospital.