Trauma Monthly
Volume:27 Issue: 5, Sep-Oct 2022

Injuries, as one of the three broad causes, the groups in the global burden of diseases cause the hierarchy and impose a significant burden on public health. This study aimed to determine the Mechanism and severity of injuries in the trauma patients admitted to Peymaniyeh Jahrom Trauma hospital in 2021.  This cross-sectional study was performed on 622 trauma patients based on the census method registered in National Trauma Registry System for 12 months from March 2021 to March 2022 in Peymaniyeh Jahrom Trauma hospital. Age, gender, marital status, level of education, Mechanism of injury, Severity of Injury Severity Score (ISS), and GCS (Glasgow Coma Scale), as well as GCS (Glasgow Coma Scale), Abbreviated Injury Scale, were included in a checklist developed following the aims of the research (AIS). The data were examined using the SPSS software (version 23). The most common types of trauma were road accidents 283(45.5%), falls191(30.7%), stabbings or cuts89(14.3%), and blunt injuries 4(6.6%), respectively. The mean age of those who had fallen (53.69±24.95) was significantly higher in road accident patients (32.47±18.94) and other injuries(p<0.0001). The mean ISS in the patients with road accident trauma (6.24±8.44) and falls (5.48±3.07) was significantly higher compared to other mechanisms of trauma (p < 0.0001). The mean AIS in upper and lower extremity trauma in the patients who had fallen (2.00±0.35 vs. 2.41±0.70) and in road accidents (1.91±0.48 vs. 2.20±0.64) was higher compared to other mechanisms of trauma (p < 0.0001). Furthermore, the frequency of severe multiple trauma (AIS ≥3) was higher in the patients with road accidents(p=0.021). The people with falls were older than other trauma patients with more severe lower extremity injuries. On the other hand, road accident patients had more multiple trauma than patients with falls and other mechanisms of injury.

Identifying significant contributors to an extended stay in the hospital and readmission rate is of great importance in military settings.

The present study investigated the factors associated with multiple readmissions and total readmission days among patients with traumatic combat injuries. The data were collected from military personnel (N=775) with combat-related injuries sustained between 2014 and 2019. The data included the pattern and mechanism of injury, Abbreviated Injury Scale (AIS), injury severity score (ISS), primary and subsequent treatments and procedures, experienced side effects, source of admission, hospital care unit, and the length of stay in the hospital. The association of the variables of interest with multiple readmissions and total readmission days was examined by logistic regression.

There was a significant relationship between multiple readmissions and total readmission days and LOS, max AIS, ISS, side effects, and blood transfusion. Among the variables influencing multiple readmissions, ISS>24 led to the highest risk.

A longer LOS within the index admission and its associated factors put patients at risk of multiple and more extended readmission events in the future. The outcomes imply that patients with more severe injuries may require high-quality care for longer durations as part of the initial hospital inpatient stay. This may motivate more effective management of combat-related injuries and the associated medical costs.

Length of stay is necessary when discussing health care and cost reduction. There is a complex relationship between hospitalization in the emergency department and the outcomes of patients transferred to the ICU. This study aimed to determine the relationship between the length of stay in the emergency department and the results in head trauma patients. This retrospective analytical cross-sectional study was conducted on 257 patient files selected from 3810 cases from a medical center in Iran over five years. The data included personal and clinical information of the patients. The primary outcomes indicated that cardiopulmonary resuscitation (31.77%, n=88) and mortality (31.41%, n=87) had occurred the most. The mean, standard deviation, and median of the duration of intubation were 10.6±8.2 and 8.4 days. The three mentioned values were 10.4±8.5 and 7.8 days for the length of stay in the ICU and 16.1±11.5 and 12.4 days for the length of hospital stay. Moreover, results indicated that the patients who stayed a shorter time in the trauma emergency department had a shorter duration of intubation and hospital stay. Length of stay in the emergency department is related to the primary and secondary clinical outcomes. Treatment time for patients with trauma in the emergency department should be minimal.

Keratopathy is a common complication following exposure to chemical warfare, namely mustard gas. In recent years, a quest was undertaken to seek an effective and uncomplicated corneal transplantation method by ophthalmologists nationwide. In our study, we report our results following lamellar keratoplasty (LK) without limbal stem cell transplantation in patients with delayed-onset mustard gas keratopathy (DMGK).  Thirty-one eyes of 22 veterans with DMGK who underwent conventional LK were assessed. The presence of limbal stem cell deficiency (LSCD) was proven clinically as well as by impression cytology. The results were evaluated based on best spectacle-corrected visual acuity (BSCVA), refractive error (RE), corneal clarity, and corneal graft survival rate. The mean age of patients at the surgery was 52.93±5.8 years, and the mean follow-up was 36.25±20.65 months. The mean preoperative BSCVA was 1.67±0.32 logarithm of the minimal angle of resolution unit (Log MAR), significantly improved, reaching 0.32±0.22 Log MAR after surgery (p = 0.001). The mean preoperative spherical equivalent (SE) was 2.47±1.17 diopters, significantly increasing to 3.5±1.08 diopters after suture removal was complete (p = 0.001). Epithelial graft rejection occurred in 9.67% of eyes (3/31) and was treated successfully with topical eye drops. At the end of the follow-up period, no signs of graft rejection were found, but three eyes had mild central corneal opacity. According to the results of our study, LK without LSC transplantation can be successful in patients with DMGK because of partial rather than complete LSCD.

 Stress fractures develop when a bone cannot remodel in response to a repetitive force. They are less frequent in the upper extremities, and the coronoid process is an infrequent site for stress fractures. Coronoid stress fractures present with pain and tenderness of the elbow, which is exacerbated by full extension of the elbow.

A 24-year-old boxer man was admitted to the hospital after complaining of pain in the anterior part of his elbow for seven months. Physical examination revealed exacerbation of the pain during hyper-extension positions and training, tenderness of the elbow at the anterior region, and decreased range of motion. Coronoid stress fractures should be considered in athletes, especially gymnasts with chronic elbow pain. Initial treatment is conservative management of the pain. If the conventional treatment fails, fixation of the fragment with a surgical approach and subsequent rehabilitation must be performed.

Traumatic sacral spondylosis is a sporadic injury pattern, and frequently, it is accompanied by injury to the cauda equina with perineal numbness, paralysis of sphincters, and sacral root weakness.

A 35-year-old male complained of low back pain, left-sided dropped foot, and sphincter dysfunction after 9 meters fall. On imaging, he had S1-S2 spondylosis. We operated on the patient with a single posterior approach. The L3-S3 instrumented fusion after stepwise distraction to reduce deformity concomitant with L5-S2 laminectomy and foraminotomy. After two years of follow-up, the sphincter disturbance was relieved, but the limb deficit had no change. On follow-up images, the fusion between S1 and S2 was confirmed.

We recommend surgical treatment of this injury to allow some neurological improvement and stabilize the spine on the pelvis. Also, the operation must be delayed for days to rule out any intra-pelvic life-threatening, primarily vascular injury. A stepwise intraoperative distraction on not curved rods could be helpful in the reduction of this deformity.

The superior mesenteric and celiac arteries separately originate from the aorta. Developmental changes can lead to the formation of a united celicaomesenteric trunk.

  An 83-year-old male with epigastric shooting pain radiating to the back was admitted to the hospital. Computed tomography angiography of the abdomen was performed to rule out dissection. Incidentally, a united celiacomesenteric trunk was observed. A long right renal artery directly originated from the aorta with a corkscrew appearance, and the left suprarenal and the left gastric arteries arose from the aorta with a common trunk.

A united celiacomesenteric trunk can put the individual at risk of surgical complications and ischemia due to the lack of dual supply.