Journal of Trauma and Injury

Original Articles

Postextubation management in head injury patients at high risk of reintubation in the trauma intensive care unit: a retrospective study: Saeed Mahmood, Temur Baykuziyev, Mohammad Asim, Naushad Ahmad Khan, Ayman El-Menyar, Gustav Strandvik, Sandro Rizoli, Hassan Al-Thani; J Trauma Inj. 2025;38(4):320-326. Published online December 29, 2025; DOI: https://doi.org/10.20408/jti.2025.0050

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Abstract PDF: Purpose
Careful clinical assessment is essential for extubation in patients with acute respiratory failure, and decisions must weigh the potential benefits and risks related to the timing of extubation. This study aimed to characterize the population at high risk for extubation failure and to assess the interventions employed to prevent reintubation in head injury patients admitted to the trauma intensive care unit.
Methods
We retrospectively obtained data from the trauma registry database of traumatic brain injury patients who were intubated and admitted to a trauma intensive care unit in Qatar from January 2013 to December 2015. Regression analysis was performed to examine the association between successful extubation and in-hospital complications.
Results
In total, 297 head injury patients (279 male and 26 female patients) at high risk of reintubation were included in the analysis. The prevalence of agitation and pneumonia in postextubated head injury patients were 10.8% and 4.7%, respectively. After adjusting for confounding variables, successful extubation with the use of a nasal cannula and continuous positive airway pressure was significantly associated with reduced agitation (P=0.001) and a lower incidence of in-hospital complications, including pneumonia (P=0.001) and sepsis (P=0.02).
Conclusions
This study suggests an association between successful extubation, reduced agitation, and a decreased incidence of in-hospital complications such as pneumonia and sepsis. Particular attention and further research should focus on optimizing extubation management for head injury patients.; Summary

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

Case Reports

Pancreaticoduodenectomy as an option for treating a hemodynamically unstable traumatic pancreatic head injury with a pelvic bone fracture in Korea: a case report: Sung Yub Jeong, Yoonhyun Lee, Hojun Lee; J Trauma Inj. 2023;36(3):261-264. Published online December 7, 2022; DOI: https://doi.org/10.20408/jti.2022.0059

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Abstract PDF

Pancreatic trauma occurs in 0.2% of patients with blunt trauma and 5% of severe abdominal injuries, which are associated with high mortality rates (up to 60%). Traumatic pancreatoduodenectomy (PD) has significant morbidity and appreciable mortality owing to complicating factors, associated injuries, and shock. The initial reconstruction in patients with severe pancreatic injuries aggravates their status by causing hypothermia, coagulopathy, and acidosis, which increase the risk for early mortality. A staging operation in which PD follows damage control surgery is a good option for hemodynamically unstable patients. We report the case of a patient who was treated by staging PD for an injured pancreatic head.

Summary

Citations

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A Case of Pancreaticoduodenectomy for Grade V Traumatic Pancreatic Injury in an Elderly Patient
Tsuyoshi Terada, Susumu Matushime, Keisuke Kamo, Kazuki Hashida, Nobuichiro Tamura
Cureus.2025;[Epub] CrossRef

Successful management of a Comatose Patient with Traumatic Brain Exposure with a fronto-Parieto-occipital flap: Charles Chidiebele Maduba, Ugochukwu Uzodimma Nnadozie; J Trauma Inj. 2020;33(1):48-52. Published online March 30, 2020; DOI: https://doi.org/10.20408/jti.2019.037

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Abstract PDF

Composite skull defects in patients with severe head injuries are very challenging to manage. The dilemma when deciding whether to perform a definitive reconstruction is how long to wait for physiological recovery before an intervention complicates the situation. The inability of such patients to tolerate prolonged anesthetic exposure is a driving factor for performing the minimal intervention necessary to facilitate recovery. Herein, we present a case involving the successful immediate reconstructive treatment of a severely head-injured adolescent with a composite scalp defect secondary to trauma. A 14-year-old boy sustained a severe head injury from a motor vehicle accident with a composite scalp defect in the right fronto-parietal region. The frontal lobe was exposed, and the right eye was crushed and devitalized. The patient was deeply unconscious for 3 days, without any significant improvements before reconstructive surgery was proposed due to fear of possible meningitis resulting from the exposure of brain structures. We successfully managed the patient with a fronto-parieto-occipital flap, after which the patient promptly recovered consciousness.

Summary

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Citations to this article as recorded by

Reconstruction of Half of the Forehead Traumatic Defect with Single Rotation Flap and Hemi-Brow Transposition in a Resource Constrained Setting: A Case Report
Charles Chidiebele Maduba, Ugochukwu Uzodimma Nnadozie
Journal of Medical and Surgical Research.2022;[Epub] CrossRef

Penetrating Orbitocranial Injury of a Pencil in a Pediatric Patient: Sun Chul Hwang; J Korean Soc Traumatol. 2012;25(1):28-31.

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Abstract PDF: Pencils are common instruments for children to use and play with. This report describes an unusual penetrating orbitocranial injury in a 5-year-old girl who was struck in her facewith a pencil. She was holding it at a desk, and her friend pushed her back. The pencil penetrated the left lower eyelid and went deep into the right frontal lobe through the base of the skull. It was removed at the emergency room, after which brain CT was performed to detect the development of an intracranial hematoma. No complications occurred after conservative management with antibiotics and an antiepileptic drug. Pencils can be hazardous to children, and a penetrating head injury with a pencil may be managed without cranial surgery.; Summary

Original Article

Prognostic Value of Computed Tomography and Gradient-echo Magnetic Resonance Imaging in Diffuse Axonal Injury: Nam Ki Jung, Sang Chan Jin, Woo Ik Choi; J Trauma Inj. 2012;25(4):122-131.

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Abstract PDF: PURPOSE
Diffuse axonal injury (DAI) is clinically defined as a coma of over six hours in a head trauma victim without a focal mass lesion. The emergency physician usually resuscitates and stabilizes a comatose head trauma victim in the emergency Department. After assessment and treatment, the prognosis is very important to both the victim and the physician. The prognosis for DAI is based on Glasgow Coma Scale (GCS) and other imaging data. We investigated the prognostic value of computed tomography (CT) and gradient-echo magnetic resonance imaging (GRI) for head trauma victims with DAI.
METHODS
Fifty-three(53) head trauma victims of DAI were enrolled in this study from 2007 to 2012. During the study period of six years, data on trauma victims were collected retrospectively. We analyzed the differences in the Glasgow Outcome Scale (GOS) result between the CT and the GRI modalities.
RESULTS
We classified the study group by using GOS. Between the good outcome subgroup (GOS scores of 4 and 5) and the poor outcome subgroup (GOS score of 1-3), there were no statistical difference in sex, age, initial vital signs and initial GCS score. The good outcome subgroup had non-hemorrhage on CT(52%), which was correlated with good outcome and a shorter awakening time, while a larger number and a deeper location of hemorrhagic lesions on in GRI were correlated with poor outcome in DAI.
CONCLUSION
We conclude that the existence of hemorrhagic lesions on CT, and the number and location of those lesions on GRI had good prognostic value for head trauma victims with DAI.; Summary

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