Journal of Trauma and Injury

Original Article

Association between craniofacial trauma and traumatic brain injury in patients admitted to a tertiary care hospital: a prospective cross-sectional study: Peer Asad Aziz, Abdul Wajid, Etizaz Ahmed, Arslan Mehmood, Babar Ali Qureshi, Hameedullah Khan, Zeeshan Nasir Bhatti; J Trauma Inj. 2026;39(3):249-255. Published online September 30, 2026; DOI: https://doi.org/10.20408/jti.2025.0068

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Abstract PDF: Purpose
Craniofacial trauma and traumatic brain injuries (TBIs) frequently coexist due to their close anatomical proximity, making it essential to understand their correlation for optimal patient management. This study examines the association between specific types of craniofacial fractures and corresponding brain injuries in patients admitted to a tertiary care hospital.
Methods
A prospective cross-sectional study was carried out in the Department of Neurosurgery, Liaquat University of Medical and Health Sciences, from October 2024 to February 2025. Fifty-six patients with both craniofacial and brain injuries were included. Data collection involved systematic clinical evaluation, imaging studies, and statistical analyses using Pearson correlation coefficients, Spearman correlation coefficients, and ordinal logistic regression.
Results
The most common mechanism of injury was road traffic accidents (87.5%), and the most frequent craniofacial injuries were midface fractures (82.1%), with zygomaticomaxillary complex and naso-orbito-ethmoid fractures showing a significant association with pneumocephalus (P<0.05). Le Fort type I fractures were associated with subarachnoid hemorrhage. Patients with more than two midface fractures were 4.16 times more likely to sustain brain injuries (B=1.069; 95% confidence interval [CI], 0.301–1.837; P=0.006). Frontal air sinus fractures, especially with bilateral and both-table involvement, were strongly correlated with contusions and pneumocephalus (B=1.627; 95% CI, 0.569–2.684; P=0.003). Palatal fractures demonstrated a significant association with diffuse axonal injury (P=0.032).
Conclusions
The study highlights a significant correlation between craniofacial fractures and TBI severity, highlighting the importance of early detection and multidisciplinary management. Further large-scale studies are warranted to refine predictive models and improve clinical outcomes.; Summary

Case Report

Pneumatosis cystoides intestinalis misdiagnosed as pneumoperitoneum due to colon perforation in a patient with blunt trauma injuries: a case report: So Ra Ahn, Joo Hyun Lee, Chan Yong Park; J Trauma Inj. 2026;39(2):182-185. Published online March 30, 2026; DOI: https://doi.org/10.20408/jti.2025.0155

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Abstract PDF: A laparotomy is usually performed when pneumoperitoneum is identified on abdominal computed tomography (CT) in patients with trauma-related injuries. However, in rare cases, pneumatosis cystoides intestinalis (PCI) may be misinterpreted as free air due to bowel perforation. PCI typically follows a benign course and can be managed with physical examinations and imaging studies. In this case, however, the patient was comatose from a severe traumatic brain injury, rendering the physical examination unreliable. Abdominal CT revealed multiple extraluminal air foci in the retroperitoneal space surrounding the ascending colon, consistent with pneumoperitoneum. No evidence of intraoperative peritonitis was found. Nevertheless, because bowel perforation could not be definitively excluded, a right hemicolectomy was performed, and histopathological examination confirmed PCI.; Summary

Original Article

Comparing the Full Outline of Unresponsiveness (FOUR) score and the Glasgow Coma Scale (GCS) for predicting outcomes in traumatic brain injury: a comparative study: Harsh Jain, Jishnu N. Nair, Davuluri Venkata Shashank, Visvanathan Krishnaswamy, Krishnamurthy Ganesh; J Trauma Inj. 2025;38(4):327-334. Published online December 31, 2025; DOI: https://doi.org/10.20408/jti.2025.0125

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Abstract PDF

Purpose
Traumatic brain injuries (TBIs) are a leading cause of morbidity, mortality, socioeconomic loss, and diminished quality of life among survivors of all injury types. The Glasgow Coma Scale (GCS), though commonly used in the intensive care unit (ICU), has limitations that may be addressed by the Full Outline of Unresponsiveness (FOUR) score. We compared the ability of the FOUR and GCS scores to predict outcomes in patients with TBI.
Methods
This prospective observational study included all patients presenting with head injury who survived beyond 24 hours between 2020 and 2022. Basic demographic data, prehospital care details, and neurological findings were collected. TBI severity was assessed using both the GCS and FOUR scores, and outcomes were graded using the Glasgow Outcome Score (GOS).
Results
Among 225 patients (mean age, 42.4±19.7 years; male sex, 77.8%) with TBIs, the mortality rate was 4.4%, and 15.1% experienced a poor outcome (GOS ≤2). Receiver operating characteristic curve analysis showed good predictive ability for both the FOUR score (area under the curve [AUC], 0.85) and GCS (AUC, 0.88). FOUR score ≤12 and GCS ≤10 were identified as optimal cutoff values for predicting poor outcomes (P<0.001), with the FOUR score demonstrating sensitivity and specificity of 79.4% and 77.5%, respectively. A FOUR score ≤12 at admission was significantly associated with intubation (odds ratio [OR], 8.2; 95% confidence interval [CI], 4.6–14.4; P<0.001), tracheostomy (OR, 21.8; 95% CI. 6.9–68.8; P<0.001), and neurological complications, including mental function deficits (OR, 7.5; 95% CI, 3.2–17.7; P<0.001), cranial nerve palsy (OR, 4.1; 95% CI, 1.6–10.4; P=0.002), and motor deficits (OR, 9.4; 95% CI, 4.6–19.2; P<0.001). A strong correlation was observed between the FOUR score and GOS (r=0.7).
Conclusions
The FOUR score is a reliable tool for assessing TBI severity and predicting outcomes, with performance comparable to the GCS. An admission FOUR score ≤12 was associated with poor neurological outcomes, increased need for advanced airway management, and long-term disability. By capturing additional neurological parameters beyond the GCS, the FOUR score may offer clinical advantages in ICU settings for early prognostication and management of patients with TBI.

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NEUROLOGICAL AND HEMODYNAMIC PROFILES OF POST CRANIOTOMY PATIENTS BASED ON SURVIVAL STATUS IN THE INTENSIVE CARE UNIT
Rudi Hariyono Hariyono
International Journal of Nursing and Midwifery Sc.2026; 10(2): 341. CrossRef

Review Article

Incidence and predictors of mortality among traumatic brain injury patients in Ethiopia: a systematic review and meta-analysis: Addisu Waleligne Tadesse, Derara Girma Tufa, Hiwot Dejene Dissassa, Melese Wagaye; J Trauma Inj. 2025;38(3):181-194. Published online September 29, 2025; DOI: https://doi.org/10.20408/jti.2024.0104

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Abstract PDF

Purpose
Traumatic brain injury (TBI) represents a significant public health concern due to its high incidence, substantial prevalence of chronic neuropsychiatric sequelae, disabilities, and economic burdens. Although several primary studies have examined mortality rates among individuals with TBI in Ethiopia, no systematic reviews and meta-analyses have yet synthesized these findings to provide a comprehensive nationwide estimate.
Methods
A systematic search for Ethiopian TBI mortality studies was conducted using PubMed, MEDLINE, Hinari, ScienceDirect, Ovid, the Web of Science, the Directory of Open Access Journals, and the African Journals Online. Following the PRISMA guidelines, we screened eligible studies, assessed quality with the Joanna Briggs Institute tool, and analyzed data in Stata ver. 18. A random-effects model estimated TBI mortality and the pooled odds ratios (PORs) of predictors. Heterogeneity (I2) was assessed, and subgroup analyses, meta-regression, forest plots, and funnel plots with Egger and Begg tests addressed variability and publication bias.
Results
Of 100 records, 23 studies (n=7,866) met inclusion. The pooled incidence of mortality from TBI in Ethiopia was 15.69% (95% confidence interval [CI], 12.41–18.96). Regional incidence varied from 3.15% (95% CI, 1.23–5.08) in the Sidama Region to 39.42% (95% CI, 33.25–45.59) in the Amhara Region. Identified predictors of mortality included aspiration pneumonia (POR, 10.41; 95% CI, 3.25–33.40), penetrating injury (POR, 1.76; 95% CI, 1.07–2.90), road traffic accident injuries (POR, 1.71; 95% CI, 1.11–2.64), severe Glasgow Coma Scale (GCS) scores (POR, 18.94; 95% CI, 7.37–48.7), moderate GCS scores (POR, 2.95; 95% CI, 1.60–5.44), bilateral pupillary reaction (POR, 24.56; 95% CI, 7.72–78.19), unilateral pupillary reaction (POR, 7.75; 95% CI, 4.45–13.48), hypoxia (POR, 8.22; 95% CI, 2.42–27.98), concomitant injuries (POR, 2.15; 95% CI, 1.05–4.38), complications (POR, 4.76; 95% CI, 2.49–9.09), surgical management (POR, 0.58; 95% CI, 0.36–0.94), and mechanical ventilation (POR, 4.45; 95% CI, 2.00–9.88).
Conclusions
The high TBI mortality in Ethiopia underscores the urgent need to expand advanced trauma care centers, deploy trained personnel beyond urban areas, and strengthen road safety policies to achieve Sustainable Development Goal targets by 2030.

Summary

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Time to mortality and its predictors among traumatic brain injury patients admitted to Hiwot Fana Comprehensive Specialized University Hospital, Harari Region, Eastern Ethiopia: a hospital based, retrospective follow-up study
Fekadu Yadessa, Fitsum Berhane, Mohammednur Abdulahi, Samrawit Abebaw, Waritu Abas, Betelhem Worku, Roba Banjaw, Bati Benti
BMC Neurology.2026;[Epub] CrossRef
Predictors of 30-day mortality among patients with head trauma: a prospective cohort study
Ehab Hamed Abdelsalam, Ayman Mahmoud Mahmoud Alsayes, Shereif Wadie Nashed, Khaled Mohammed Maghawry, Khaled Abdou
The Egyptian Journal of Critical Care Medicine.2026;[Epub] CrossRef

Case Report

Management of posttraumatic refractory paroxysmal sympathetic hyperactivity with bromocriptine: a case report: Min-Seok Woo, Seong-Hyun Park, Jeong-Hyun Hwang, Chaejin Lee; J Trauma Inj. 2026;39(1):68-74. Published online September 3, 2025; DOI: https://doi.org/10.20408/jti.2025.0016

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Abstract PDF: This case report describes a unique instance of refractory paroxysmal sympathetic hyperactivity (PSH) in a 19-year-old woman following a traumatic brain injury sustained in a motorcycle accident. The patient presented in a semicomatose state with a Glasgow Coma Scale score of 3 (E1, VT, M2), a significant left frontotemporal subdural hematoma, and a midline shift that necessitated emergency craniectomy and hematoma evacuation. Postoperatively, she developed recurrent episodes of hyperthermia, tachycardia, hypertension, tachypnea, diaphoresis, rigidity, and eyeball deviation triggered by non-noxious stimuli. These episodes proved resistant to conventional treatments, including opioids, sedatives, and β-blockers. Based on the clinical presentation and a Paroxysmal Sympathetic Hyperactivity-Assessment Measure score of 28 (out of 29), a diagnosis of PSH was established. Bromocriptine was initiated at 0.025 mg/kg every 12 hours and later increased to every 8 hours, leading to a significant reduction in both the frequency and severity of episodes within days. Complete resolution of PSH episodes was observed by the sixth day of bromocriptine treatment, with no recurrence during the remaining treatment period. Bromocriptine was administered for a total of 1 month before being discontinued, and the patient remained symptom-free over a 10-month follow-up period. This case highlights the efficacy of bromocriptine in managing refractory PSH and underscores the importance of early recognition and targeted intervention for this rare but debilitating condition. Bromocriptine may offer a valuable therapeutic option for similar cases, particularly when conventional therapies fail.; Summary

Original Article

Correlation between bispectral index values and the Glasgow Coma Scale in traumatic brain injury patients: a prospective observational study: Anjum H. Mujawar, Pradnya M. Bhalerao, Sujit J. Kshirsagar; J Trauma Inj. 2025;38(2):97-102. Published online June 30, 2025; DOI: https://doi.org/10.20408/jti.2025.0026

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Abstract PDF: Purpose
Traumatic brain injury (TBI) severity is typically assessed using the Glasgow Coma Scale (GCS). In contrast, the bispectral index (BIS) objectively evaluates a patient’s level of consciousness in an intensive care unit. The primary objective of this study was to evaluate the correlation between GCS and BIS values in TBI patients. Secondary objectives included determining the range of BIS scores corresponding to different levels of consciousness and assessing the correlation among mild, moderate, and severe TBI.
Methods
Sixty patients participated in a prospective observational study conducted at a government tertiary care facility. After obtaining a detailed history and performing a physical examination, each patient’s age, sex, intubation status, computed tomography brain findings, and vital signs were recorded. Subsequently, the patients’ GCS and BIS values were measured at 0, 6, 12, 18, and 24 hours. Quantitative data are presented as mean±standard deviation, while qualitative data are illustrated using frequency and percentage tables. Spearman correlation analysis was employed to evaluate the association.
Results
Spearman correlation analysis demonstrated a strong positive relationship between BIS and GCS at 0 hours (r=0.655, P<0.05), 6 hours (r=0.647, P<0.05), 12 hours (r=0.652, P<0.05), 18 hours (r=0.659, P<0.05), and 24 hours (r=0.648, P<0.05). Moreover, the mean BIS value decreased significantly with increasing severity of head injury.
Conclusions
Similar to the GCS, the BIS correlates with head injury severity and may serve as a complementary tool for predicting outcomes in TBI patients.; Summary

Review Article

Deciphering the effectiveness of computed tomography scoring systems in improving mortality prediction for traumatic brain injury: a systematic review and bibliometric analysis: Astrid Ekklesia Saputri, Eunike Priscila, Rian Ka Praja, Ysrafil Ysrafil; J Trauma Inj. 2025;38(2):82-90. Published online June 25, 2025; DOI: https://doi.org/10.20408/jti.2025.0009

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Abstract PDF

Purpose
Traumatic brain injury is associated with adverse prognoses and significant neurological impairments that negatively affect patients' quality of life and physiological well-being. The aim of this study was to compare various computed tomography (CT) scoring systems in order to evaluate their effectiveness in predicting mortality and in risk stratification.
Methods
The evolution and trends in the use of CT scoring systems were analyzed through a bibliometric analysis of 72 Scopus-indexed documents using VOSviewer ver. 1.6.19. A systematic review was conducted following the 2020 PRISMA guidelines, with data obtained from PubMed Advance, Scopus, and Google Scholar for the period 2003–2024. A total of 198 journals were identified and subsequently filtered down to 6 that met the inclusion criteria.
Results
The bibliometric analysis revealed a progressive shift toward the use of CT scoring systems for novel diagnostic purposes and mortality prediction. The Rotterdam CT score demonstrated the highest total link strength and was most frequently published in 2017. In contrast, the Marshall CT score was more widely referenced in studies published after 2020. Despite being recognized for its sensitivity, the Helsinki CT score has not garnered equivalent research attention. Furthermore, the review suggested that the Rotterdam CT score is superior in predicting mortality among traumatic brain injury patients, with the Marshall CT score also demonstrating potential.
Conclusions
A review of the extant literature indicates that the Helsinki CT score exhibits the highest predictive accuracy, effectively estimating both mortality probability and long-term prognosis. Since 2015, research on the Helsinki CT score has steadily increased.

Summary

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Comparative predictive performance of computed tomography scoring systems in traumatic brain injury: a systematic review, Bayesian comparison, and meta-analysis
Armin Khavandegar, Zahra Ramezani, Elaheh Khodadoust, Mahgol Sadat Hassan Zadeh Tabatabaei, Tahereh Maleki, Negin Safari Dehnavi, Mario Ganau, Lara Prisco, Ghazaleh Kheiri, Nasim Ramzi, Maral Moafi, Roberto Parisi, Sadra Kheiri, Soroush Mozaffari, Mustafa
Neurosurgical Review.2026;[Epub] CrossRef

Original Articles

Clinical profile, management, and outcome of pediatric neurotrauma: a multicentric observational study: Sanat Kumar Khanna, Anil Kumar, Anand Kumar Katiyar, Kundan Mishra; J Trauma Inj. 2025;38(1):22-31. Published online March 31, 2025; DOI: https://doi.org/10.20408/jti.2024.0080

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Abstract PDF

Purpose
Pediatric neurotrauma (pNT) includes pediatric traumatic brain injury and spinal cord injury. The incidence and distribution of pNT by age and sex remain understudied, with several gaps in both epidemiological and clinical data. This study aimed to estimate the epidemiological parameters, clinical presentations, surgical interventions, and outcomes in our patient population with pNT.
Methods
A multicentric, ambispective study was conducted at five tertiary care pediatric neurosurgical centers in Northern India from January 2011 to December 2022. The study included children under 16 years of age admitted with a history of head injury. Data on demographics, radiological findings, management, and outcomes were recorded.
Results
A total of 2,250 children were admitted; 77.5% were male and 22.5% were female. The most common age group was 6 months to 2 years (37.3%). The primary mechanism of injury was fall from height (64.6%), followed by road traffic accidents (26.1%). Overall, 84.6% of children had mild head injury, 14.2% moderate, and 1.2% severe. The most common abnormality on computed tomography brain was contusion (9.2%). Surgical interventions were required in only 0.8% of children. A favorable outcome, as measured by Glasgow Outcome Scale, was achieved in 99.2% of patients, and the mortality rate was 0.1%.
Conclusions
Our findings indicate that pNT is most common in children aged 6 months to 2 years and predominantly affects boys. The most frequent cause was a fall from height, and the majority of patients sustained mild head injuries requiring only observation, which led to excellent outcomes. Surgical intervention was necessary in only a few cases, and mortality was rare. This study highlights the epidemiological pattern of pNT in our population and delineates various causes of such trauma.

Summary

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Development of a paediatric model of diffuse traumatic brain injury in ferrets
Justin L. Krieg, Carl Hooper, Hasini Kapuwelle, Rebecca P. George, Rebecca J. Hood, William T. O’Brien, Stuart J. McDonald, Anna V. Leonard, Renée J. Turner, Frances Corrigan
Scientific Reports.2026;[Epub] CrossRef

Validation of chest trauma scoring systems in polytrauma: a retrospective study with 1,038 patients in Korea: Hongrye Kim, Mou Seop Lee, Su Young Yoon, Jonghee Han, Jin Young Lee, Junepill Seok; J Trauma Inj. 2024;37(2):114-123. Published online May 9, 2024; DOI: https://doi.org/10.20408/jti.2023.0087

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Purpose
Appropriate scoring systems can help classify and treat polytrauma patients. This study aimed to validate chest trauma scoring systems in polytrauma patients.
Methods
Data from 1,038 polytrauma patients were analyzed. The primary outcomes were one or more complications: pneumonia, chest complications requiring surgery, and mortality. The Thoracic Trauma Severity Score (TTSS), Chest Trauma Score, Rib Fracture Score, and RibScore were compared using receiver operating characteristic (ROC) analysis in patients with or without head trauma.
Results
In total, 1,038 patients were divided into two groups: those with complications (822 patients, 79.2%) and those with no complications (216 patients, 20.8%). Sex and body mass index did not significantly differ between the groups. However, age was higher in the complications group (64.1±17.5 years vs. 54.9±17.6 years, P<0.001). The proportion of head trauma patients was higher (58.3% vs. 24.6%, P<0.001) and the Glasgow Coma Scale score was worse (median [interquartile range], 12 [6.5–15] vs. 15 [14–15]; P<0.001) in the complications group. The number of rib fractures, the degree of rib fracture displacement, and the severity of pulmonary contusions were also higher in the complications group. In the area under the ROC curve analysis, the TTSS showed the highest predictive value for the entire group (0.731), head trauma group (0.715), and no head trauma group (0.730), while RibScore had the poorest performance (0.643, 0.622, and 0.622, respectively)
Conclusions
Early injury severity detection and grading are crucial for patients with blunt chest trauma. The chest trauma scoring systems introduced to date, including the TTSS, are not acceptable for clinical use, especially in polytrauma patients with traumatic brain injury. Therefore, further revisions and analyses of chest trauma scoring systems are recommended.

Summary

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Evaluation and Proposed Refinement of the Thoracic Trauma Severity Score: Improving Prognostic Accuracy in Blunt Chest Trauma Including Polytrauma Patients
Noha Mohamed Ashraf Fouda, Nour El-Din Noaman Gwely, Gehad Ibrahim Awad, Mohammed Abdelfattah Sanad
European Journal of Cardio-Thoracic Surgery.2026;[Epub] CrossRef
Accurate, fair, and generalisable scaling of injury severity score-based AI with demographics in terms of mortality in patients with trauma: multi-centre, multi-national retrospective cohort study
Yunjeong Choi, Junepill Seok, Thomas Young-Chul Oh, Jeremy Hsu, Do Wan Kim, Byungchul Yu, Jayun Cho, Woocheol Jang, Jina Kim, Na-eun Oh, Jehyeuk Ahn, Robert J. Femia, Paul A. Testa, Dong Keon Yon, Daniel K. Sodickson, Wu Seong Kang, Jinseok Lee
eBioMedicine.2026; 126: 106206. CrossRef
Development and validation of a prediction model for respiratory complications and in-hospital mortality in trauma patients
Do Wan Kim, Dongjin Yeo, Juyeong Kim, Yerin Hwang, Hyunjee Kim, Seung Ha Hwang, Jaeyu Park, Jinseok Lee, Jaehyeong Cho, Selin Woo, Junepill Seok, Byungchul Yu, Youngmin Kim, Sebeom Jeon, Dong Keon Yon, Wu Seong Kang
Scientific Reports.2026;[Epub] CrossRef
Role of the Chest Trauma Scoring System as a Predictor of Mortality and Morbidity and as a Prognostic Tool in Thoracic Trauma Patients: A Prospective Observational Study
Sruthi R. Pillai, Ramu Remanan, Vigy Georgekutty Vazhakalayalil
Amrita Journal of Medicine.2026;[Epub] CrossRef
Lateral implosion injuries: Epidemiology, outcomes and evaluation of the Ch-Sh classification
Joseph E. Hughes-Gooding, Liam Alcock, Peter T.M. Clarke, William J. Hunt, John G. Edwards
Journal of Trauma and Acute Care Surgery.2026;[Epub] CrossRef
Clinical and instrumental diagnosis of combined fractures of the clavicle and ribs
O.A. Burianov, V.Р. Kvasha, M.V. Кrаvchuk, D.V. Miasnikov
EMERGENCY MEDICINE.2025; 21(8): 800. CrossRef
Clinical prediction models for the management of blunt chest trauma in the emergency department: a systematic review
Ceri Battle, Elaine Cole, Kym Carter, Edward Baker
BMC Emergency Medicine.2024;[Epub] CrossRef

Case Report

Conservative treatment of corpus callosum hemorrhage due to a falling coconut in Indonesia: a case report: Hanan Anwar Rusidi, Ferry Wijanarko; J Trauma Inj. 2024;37(1):79-82. Published online January 12, 2024; DOI: https://doi.org/10.20408/jti.2023.0052

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Abstract PDF

The potential for traumatic brain injury resulting from falling coconuts is frequently overlooked. These incidents can cause focal lesions in the form of brain hemorrhage. Corpus callosum hemorrhage due to blunt trauma from a falling object is rare and typically associated with poor prognosis. The purpose of this report is to detail a case of corpus callosum hemorrhage caused by a coconut fall and to discuss the conservative management approach employed. We report the case of a 54-year-old woman who was admitted to the hospital with symptoms of unconsciousness, headache, and expressive aphasia after being struck by a falling coconut. Notably, hemorrhage was detected within the body of the corpus callosum, as revealed by imaging findings. The patient received intensive monitoring and treatment in the intensive care unit, including oxygen therapy, saline infusion, an osmotic diuretic, analgesics, and medication to prevent stress ulcers. The patient demonstrated marked clinical improvement while undergoing conservative treatment. Despite the typically unfavorable prognosis of these rare injuries, our patient exhibited meaningful clinical improvement with conservative treatment. Timely diagnosis and appropriate interventions were crucial in managing the patient’s condition. This report emphasizes the importance of considering traumatic brain injury caused by falling coconuts and highlights the need for further research and awareness in this area.

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Under the coconut palm – a retrospective analysis of trauma incidents caused by falling coconuts presenting to emergency department at a tertiary care centre in coastal India
A. Sai Deepak, Aaditya Katyal, Neeraja A Nair, Tanvee Walia, Rachana Bhat
International Journal of Emergency Medicine.2025;[Epub] CrossRef

Original Articles

Outcomes and physiologic responses associated with ketamine administration after traumatic brain injury in the United States and Canada: a retrospective analysis: Austin J. Peters, Saad A. Khan, Seiji Koike, Susan Rowell, Martin Schreiber; J Trauma Inj. 2023;36(4):354-361. Published online November 7, 2023; DOI: https://doi.org/10.20408/jti.2023.0034

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Purpose
Ketamine has historically been contraindicated in traumatic brain injury (TBI) due to concern for raising intracranial pressure. However, it is increasingly being used in TBI due to the favorable respiratory and hemodynamic properties. To date, no studies have evaluated whether ketamine administered in subjects with TBI is associated with patient survival or disability.
Methods
We performed a retrospective analysis of data from the multicenter Prehospital Tranexamic Acid Use for Traumatic Brain Injury trial, comparing ketamine-exposed and ketamine-unexposed TBI subjects to determine whether an association exists between ketamine administration and mortality, as well as secondary outcome measures.
Results
We analyzed 841 eligible subjects from the original study, of which 131 (15.5%) received ketamine. Ketamine-exposed subjects were younger (37.3±16.9 years vs. 42.0±18.6 years, P=0.037), had a worse initial Glasgow Coma Scale score (7±3 vs. 8±4, P=0.003), and were more likely to be intubated than ketamine-unexposed subjects (88.5% vs. 44.2%, P<0.001). Overall, there was no difference in mortality (12.2% vs. 15.5%, P=0.391) or disability measures between groups. Ketamine-exposed subjects had significantly fewer instances of elevated intracranial pressure (ICP) compared to ketamine-unexposed subjects (56.3% vs. 82.3%, P=0.048). In the very rare outcomes of cardiac events and seizure activity, seizure activity was statistically more likely in ketamine-exposed subjects (3.1% vs. 1.0%, P=0.010). In the intracranial hemorrhage subgroup, cardiac events were more likely in ketamine-exposed subjects (2.3% vs. 0.2%, P=0.025). Ketamine exposure was associated with a smaller increase in TBI protein biomarker concentrations.
Conclusions
Ketamine administration was not associated with worse survival or disability despite being administered to more severely injured subjects. Ketamine exposure was associated with reduced elevations of ICP, more instances of seizure activity, and lower concentrations of TBI protein biomarkers.

Summary

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Is ketamine safe for traumatic brain injury? A systematic review and meta-analysis
João Vitor Sciorilli, Yohanna Idsabella Rossi, Rodrigo dos Reis Schevz, Davi Barbosa, Josué Lee, Flávio Gallani, Marc Maegele
Journal of Critical Care.2026; 91: 155347. CrossRef
Analgesic and Physiologic Effects of Ketamine Compared with Opioids in Prehospital Trauma Care: A Systematic Review and Meta-Analysis
Anna C. Meyer, Maryrose Kuo, David M. Duriancik
The Journal of Emergency Medicine.2026; 85: 28. CrossRef
Outcomes associated with ketamine administration following traumatic brain injury
Jonathan Dallas, Hyoungjin Park, Robert G. Briggs, David J. Cote, Frank J. Attenello, Gabriel Zada
Journal of Clinical Neuroscience.2026; 148: 111968. CrossRef
Ketamine is Associated with Increased 24-Hour Mortality Following Traumatic Brain Injury Compared with Other Induction Medications, a Retrospective Study
Austin Peters, Riley Mitchell, Stephen R. Wisniewski, Eva V. Zadorozny, Bryan A. Cotton, Jeremy W. Cannon, Martin A. Schreiber, Ernest E. Moore, Nicholas Namias, Joseph P. Minei, Jason L. Sperry, Bedda L. Rosario-Rivera, Francis X. Guyette
Neurotrauma Reports.2026;[Epub] CrossRef
Exploring Ketamine in Traumatic Brain Injury: A Narrative Review of Its Current Emerging Perspectives from Clinical and Preclinical Studies
Thamer Alaifan, Abdulrahman M. Khojah, Abdulrazak Sakhakhni, Ali Alkhaibary, Eman A. Alraddad, Elaf Alqurashi, Shadell Alghamdi, Sereen Kazim, Ahmed Attar, Ahmed Alkhani
Journal of Neurotrauma.2026;[Epub] CrossRef
Current Management and Future Challenges in the Management of Severe Traumatic Brain Injury
Larissa Russo, Aasim Kazmi, Nasim Ahmed
Medicina.2025; 61(4): 738. CrossRef
Analgesia, Sedation, and Neuromuscular Blockade in Pediatric Severe Traumatic Brain Injury: Secondary Analysis of the “Approaches and Decisions in Acute Pediatric TBI Trial” (ADAPT)
Jennifer Clancy Laws, Jaskaran Rakkar, Sandra D. W. Buttram, Michael Seth Wolf
Neurocritical Care.2025; 43(3): 745. CrossRef
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ASN Neuro.2025;[Epub] CrossRef
Study on the predictive role of bile acid and lymphocyte count in the prognosis of patients with traumatic brain injury: a retrospective analysis
Jie Xu, Yinghua Song, Xiancheng Chen, Ming Chen, Yun Zhao, Zhi Li, Songyang Li, Liang Zhang, Wenkui Yu
Frontiers in Neurology.2025;[Epub] CrossRef

Effect of use and type of helmet on occurrence of traumatic brain injuries in motorcycle riders in Korea: a retrospective cohort study: Sowon Seo, Seok Ran Yeom, Sung-Wook Park, Il Jae Wang, Suck Ju Cho, Wook Tae Yang, Youngmo Cho; J Trauma Inj. 2023;36(2):87-97. Published online December 9, 2022; DOI: https://doi.org/10.20408/jti.2022.0029

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Purpose
The purpose of this study was to investigate (1) the association among helmet wearing, incidence rate of traumatic brain injury (TBI), and in-hospital mortality; TBI was diagnosed when the head Abbreviated Injury Scale (AIS) was ≥1, and as severe TBI when head AIS was ≥3; and (2) the association between helmet type and incidence rate of TBI, severe TBI, and in-hospital mortality of motorcycle accidents based on the newly revised Emergency Department-based Injury In-depth Surveillance (EDIIS) data.
Methods
Data collected from EDIIS between January 1, 2020 and December 31, 2020 were analyzed. The final study population comprised 1,910 patients, who were divided into two groups: helmet wearing group and unhelmeted group. In addition, the correlation between helmet type and motorcycle accident was determined in 596 patients who knew the exact type of helmet they wore. A total of 710 patients who wore helmet but did not know the type were excluded from this analysis. Multivariate logistic regression was performed in both the groups to investigate the factors affecting the primary (occurrence of TBIs) and secondary outcomes (severe TBI and in-hospital mortality).
Results
The prevalence of Injury Severity Scores, TBIs, and severe TBIs as well as in-hospital mortality were the highest in the unhelmeted group. Additionally, the results from the group that wore and knew the type of helmet worn indicated that wearing a full-face helmet decreased the incidence of TBIs in comparison to a half-face helmet.
Conclusions
The wearing of a helmet in motorcycle accidents is very important as it plays a role in reducing the occurrence of TBIs and severe TBIs and in-hospital mortality. The use of a full-face helmet lowered the incidence of TBIs.

Summary

Citations

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Helmet use in patients with severe traumatic brain injury: associations with Rotterdam CT score components, skull fractures, and cervical fractures
Christopher Ryalino, Joukje van der Naalt, Sebastiaan M. Bossers, Frank W. Bloemers, Dennis Den Hartog, Esther M.M. Van Lieshout, Nico Hoogerwerf, Stephan A. Loer, Lothar A. Schwarte, Patrick Schober, Anthony R. Absalom
Brain Injury.2026; 40(2): 107. CrossRef
Systematic review and meta-analysis of efficacy of helmet use and helmet laws to reduce mortality and cervical spine injury in adult motorcycle riders: A practice management guideline from the Eastern Association for the Surgery of Trauma
Asanthi M. Ratnasekera, Sirivan S. Seng, Stuart K. Gardiner, Caroline Butler, Anna Goldenberg-Sandau, Ning Lu, Hiba Abdel Aziz, Rachel D. Appelbaum, Hassan Mashbari, Shabnam Hafiz, Sharfuddin Chowdhury, Hahn Soe-Lin, John M. Reynolds, Amanda L. Teichman,
Journal of Trauma and Acute Care Surgery.2025; 99(4): 650. CrossRef

Effect of trauma center operation on emergency care and clinical outcomes in patients with traumatic brain injury: Han Kyeol Kim, Yoon Suk Lee, Woo Jin Jung, Yong Sung Cha, Kyoung-Chul Cha, Hyun Kim, Kang Hyun Lee, Sung Oh Hwang, Oh Hyun Kim; J Trauma Inj. 2023;36(1):22-31. Published online December 6, 2022; DOI: https://doi.org/10.20408/jti.2022.0049

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Abstract PDF

Purpose
Traumatic brain injury (TBI) directly affects the survival of patients and can cause long-term sequelae. The purpose of our study was to investigate whether the operation of a trauma center in a single tertiary general hospital has improved emergency care and clinical outcomes for patients with TBI.
Methods
The participants of this study were all TBI patients, patients with isolated TBI, and patients with TBI who underwent surgery within 24 hours, who visited our level 1 trauma center from March 1, 2012 to February 28, 2020. Patients were divided into two groups: patients who visited before and after the operation of the trauma center. A comparative analysis was conducted. Differences in detailed emergency care time, hospital stay, and clinical outcomes were investigated in this study.
Results
On comparing the entire TBI patient population via dividing them into the aforementioned two groups, the following results were found in the group of patients who visited the hospital after the operation of the trauma center: an increased number of patients with a good functional prognosis (P<0.001 and P=0.002, respectively), an increased number of surviving discharges (P<0.001 and P<0.001, respectively), and a reduction in overall emergency care time (P<0.05, for all item values). However, no significant differences existed in the length of intensive care unit stay, ventilator days, and total length of stay for TBI patients who visited the hospital before and after the operation of the trauma center.
Conclusions
The findings confirmed that overall TBI patients and patients with isolated brain injury had improved treatment results and emergency care through the operation of a trauma center in a tertiary general hospital.

Summary

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Early operative management in trauma: A nationwide comparison of time to surgery and survival at trauma centers and non-trauma centers
Jesper Eriksson, Anna Mattsson, Emma Larsson, Anders Oldner, Erik von Oelreich
Injury.2026; 57(9): 113350. CrossRef

Postoperative infection after cranioplasty in traumatic brain injury: a single center experience: Mahnjeong Ha, Jung Hwan Lee, Hyuk Jin Choi, Byung Chul Kim, Seunghan Yu; J Trauma Inj. 2022;35(4):255-260. Published online November 16, 2022; DOI: https://doi.org/10.20408/jti.2022.0043

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6 Citations

Abstract PDF

Purpose
To determine the incidence and risk factors of postoperative infection after cranioplasty in patients with traumatic brain injury (TBI).
Methods
Data of 289 adult patients who underwent cranioplasty after TBI at a single regional trauma center between year 2018 and 2021 were reviewed retrospectively. Patient characteristics and various procedural variables, such as interval between craniectomy and cranioplasty, estimated blood loss, laterality and materials of the bone flap, and duration and classification of perioperative antibiotics usage were analyzed.
Results
Postoperative infection occurred in 17 patients (5.9%). Onset time of infectious symptom ranged from 9 days to 174 days (median, 24 days) after cranioplasty. The most common cultured organism was Staphylococcus aureus (47.1%), followed by Klebsiella pneumoniae (17.6%) and Enterococcus faecalis (17.6%). Patients with postoperative infection were more likely to have diabetes (odds ratio [OR], 6.96; 95% confidence interval [CI], 1.92–25.21; P=0.003), lower body mass index (OR, 0.81; 95% CI, 0.66–0.98; P=0.029), and shorter duration of perioperative antibiotics (OR, 0.83; 95% CI, 0.71–0.98; P=0.026).
Conclusions
For TBI patients with diabetes, poor nutritional status should be managed cautiously for increased risk of infection after cranioplasty. Further studies and discussions are needed to determine an appropriate antibiotics protocol in cranioplasty.

Summary

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Risk factors for periosteal fluid collection and surgical site infection based on cranioplasty material: Analysis of 434 cases
Chung Mo Koo, In-Ho Jung, Sang Koo Lee
Clinical Neurology and Neurosurgery.2026; 262: 109308. CrossRef
The Overlooked Role of Nutrition in Recovery after Cranioplasty Surgery: Where We Are and Where We Must Go? A Critical Narrative Review
Marcio Yuri Ferreira, Louisa Nicola, Gabriel de Almeida Monteiro, Leonardo Januário Campos Cardoso, Eli Berglas, Felix Schumacher, Jennifer Rath, Netanel Ben-Shalom
Journal of Craniofacial Surgery.2026; 37(6): 1642. CrossRef
PEEK implants for cranioplasty: a mapping review of 3D printing, surface functionalisation, and clinical performance gaps
Zoltán Márk Horváth, Roman Viter, Oskars Radziņš, Andreas Thor, Tetiana Kolisnyk, Valentyn Mohylyuk
Materials Advances.2026; 7(8): 3935. CrossRef
Предиктори пізніх ускладнень після декомпресивної краніектомії
М. Ю. Глухенький, М. В. Каджая
Likarska sprava.2026;[Epub] CrossRef
Cranioplasty during the intermediate postoperative period after gunshot wounds to the brain: clinical and organizational aspects of timely intervention
Mark Y. Hlukhenky, Nikolay V. Kadzhaya, Alexander S. Gotin, Andriy P. Huk
Ukrainian Neurosurgical Journal.2026; 32(3): 69. CrossRef
Navigating the Role of Surgery in Optimizing Patient Outcomes in Traumatic Brain Injuries (TBIs): A Comprehensive Review
Meenakshi Reddy Yathindra, Nagma Sabu, Seetha Lakshmy, Celine A Gibson, Alexander T Morris, Sumaiya Farah Fatima, Aarushi Gupta, Lilit Ghazaryan, Jean C Daher, Grace Tello Seminario, Tanvi Mahajan, Humza F Siddiqui
Cureus.2024;[Epub] CrossRef

Usefulness of intraoperative transcranial sonography in patients with traumatic brain injuries: a comparison with postoperative computed tomography: Mahn Jeong Ha, Seung Han Yu, Jung Hwan Lee, Hyuk Jin Choi, Byung Chul Kim; J Trauma Inj. 2023;36(1):8-14. Published online June 20, 2022; DOI: https://doi.org/10.20408/jti.2021.0093

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Abstract PDF

Purpose
The aim of this study was to assess the agreement between intraoperative transcranial sonography (TCS) and postoperative computed tomog¬raphy (CT) in patients with traumatic brain injuries.
Methods
We performed a retrospective cross-sectional study of 35 patients who underwent TCS during surgery, among those who presented to a regional trauma center and underwent decompressive craniectomy between January 1, 2017 and April 30, 2020.
Results
The mean difference between TCS and CT in measuring the midline shift was –1.33 mm (95% confidence inter¬val, –2.00 to –0.65; intraclass correlation coefficient [ICC], 0.96; P<0.001). An excellent correlation was found between TCS and CT in assessing contralateral subdural hematomas (ICC, 0.96; P<0.001) and focal hematoma lesions (ICC, 0.99; P<0.001). A very good correlation between TCS and CT was found for measurements of ventricle width (ICC, 0.92; P<0.001).
Conclusions
TCS during surgery is considered an effective diagnostic tool for the detection of intraoperative parenchymal changes in patients with traumatic brain injuries.

Summary

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Comparison of Transcranial Sonography with Computed Tomography of the Brain in Post-craniectomy Patients for Acquired Brain Injury
Bernice Thamarai Selvi, Goldwin Helancecil, Priyadharshini Muthiah, Judy Ann John, Naveen Cherian Thomas
International Journal of Health Sciences and Resea.2026; : 266. CrossRef
Intraoperative ultrasonography after dural closure for early detection of bleeding in cranial surgery
Abdurrahim Tekin
Surgical Neurology International.2026; 17: 566. CrossRef

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