Journal of Trauma and Injury

Original Articles

From trauma surgery to acute care surgery: a 4-year observational study at a single trauma center in Korea: Jung-Woo Woo, Jae Yool Jang, Yo Seok Cho, Hongkyung Shin, Chan Yong Park; J Trauma Inj. 2025;38(4):382-388. Published online December 31, 2025; DOI: https://doi.org/10.20408/jti.2025.0248

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Abstract PDF: Purpose
The acute care surgery (ACS) model establishes the capacity to immediately accommodate nontraumatic emergency surgery requiring urgent treatment while simultaneously elevating the existing trauma care system to the highest level. This study aims to evaluate the 4-year experience of operating after expanding the trauma surgery domain to ACS at this institution, which was designated as a lower-level trauma center by the local government in 2020.
Methods
A retrospective study was conducted using clinical records for patients who underwent surgery in the Division of Trauma and Acute Care Surgery over a 54-month period, from March 2021 to August 2025.
Results
Trauma volumes remained stable (10–20 cases semiannually) after ACS implementation, with surgical case numbers similar to those recorded before its introduction. Nontrauma volumes increased from 3 cases in March–August 2023 to 163 in March–August 2025.
Conclusions
The transition from the trauma surgery model to the ACS model successfully increased the efficiency of trauma and emergency general surgery within the level II low-volume environment, accomplishing without reducing the existing trauma caseload. These findings support the adoption of ACS in similar emergency medical institutions and offer insights relevant for national policy development concerning emergency general surgery in Korea.; Summary

Treatment strategy for acute blunt traumatic abdominal wall injury: a single-center retrospective study in Korea: Gun Woo Kim, Chang-Yeon Jung, Sung Hoon Cho, Suyeong Hwang, Kyoung Hoon Lim; J Trauma Inj. 2025;38(4):373-381. Published online December 31, 2025; DOI: https://doi.org/10.20408/jti.2025.0234

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Abstract PDF: Purpose
Traumatic abdominal wall hernia, a rare condition resulting from blunt trauma, is characterized by disruption of the abdominal wall musculature and fascia without skin penetration. Given its rarity, standardized treatment guidelines are lacking, and the necessity for immediate surgery remains debated. This study examines high-energy posterolateral abdominal wall injuries (AWI), which pose significant management challenges due to their anatomical complexity and high recurrence risk.
Methods
We retrospectively reviewed records of 44 adults with grade III–VI AWI treated between 2013 and 2023 at a level I trauma center. Patients were categorized into emergency repair or delayed management groups based on the initial treatment strategy, with injuries anatomically classified as anterior, lateral, or posterolateral. Nonoperative management (NOM) was limited to patients without herniation on index imaging and entailed close observation with regular follow-up imaging.
Results
AWI was identified in 44 of 83,532 patients (0.05%) with blunt trauma. Anatomically, 4 cases (9.1%) were anterior, 17 (38.6%) were lateral, and 23 (52.3%) were posterolateral. Three patients (6.8%) were classified as grade III injury, 16 (36.4%) as grade IV, 24 (54.6%) as grade V, and 1 (2.3%) as grade VI. Emergency repair was performed in 26 patients (59.1%), whereas 18 (40.9%) initially received delayed management. In the latter group, 8 of 18 patients (44.4%) were judged to require delayed repair, of whom six proceeded to surgery. Among 10 NOM patients with indeterminate muscle-layer integrity on initial imaging due to hematoma or tissue injury, follow-up revealed delayed hernia development in three, while seven had resolved hematoma, confirming wall integrity.
Conclusions
In hemodynamically stable patients with traumatic posterolateral AWI without herniation, NOM with close monitoring and delayed repair for subsequent hernia appears safe and effective as an alternative to immediate surgery. Management should be tailored to injury location and patient condition. These findings inform the management timing and approach for this rare, challenging injury pattern.; Summary

Venous phase extravasation on computed tomography is a red flag sign in critical/severe pelvic injuries: Hong Kyung Shin, Chami Im, Hye Rim Shin, Mi Jeong Choi, Jung-Woo Woo; J Trauma Inj. 2025;38(4):360-365. Published online December 31, 2025; DOI: https://doi.org/10.20408/jti.2025.0198

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Abstract PDF: Purpose
Managing hemodynamically unstable patients with pelvic fractures is highly challenging, particularly when vascular injuries are present, as these can significantly worsen prognosis. This study evaluated outcomes in patients with pelvic trauma and vascular injuries prior to the introduction of preperitoneal pelvic packing.
Methods
We retrospectively reviewed the medical records of 195 patients with pelvic injuries who presented to the emergency room of our hospital between May 2003 and August 2013.
Results
Among the 195 patients, 34 had vascular injuries and 161 had nonvascular injuries. The vascular injury group had significantly higher transfusion rates (82.4% vs. 11.8%, P<0.001) and required a greater mean number of packed red blood cell units than the nonvascular group (5.2±5.5 vs. 0.4±1.4, P<0.001). Subgroup analysis within the vascular injury cohort revealed significant differences between patients with venous phase extravasation (n=5) and those with isolated arterial phase extravasation (n=29) in median packed red blood cell units transfused (12.5 units vs. 3 units; P=0.014), cardiac arrest rate (80.0% vs. 10.3%, P=0.003), and mortality rate (60.0% vs. 10.3%, P=0.029). Notably, patients with isolated venous extravasation showed a significantly higher mortality rate compared to those with isolated arterial extravasation (100% vs. 10.3%, P=0.004).
Conclusions
Venous phase extravasation was associated with higher transfusion requirements, cardiac arrest incidence, and mortality compared to arterial extravasation.; Summary

Thirteen-year trend analysis of orbital blowout fractures: shifts in mechanisms and ocular sequelae across two Korean trauma centers (2011–2023): Minhee Hwang, Youngjun Kim, Changryul Claud Yi; J Trauma Inj. 2025;38(4):353-359. Published online December 31, 2025; DOI: https://doi.org/10.20408/jti.2025.0164

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Abstract PDF: Purpose
This study aimed to examine 13-year changes in the injury mechanisms of orbital blowout fractures (OBFs) in Korea and to determine how those changes influenced preoperative ocular motility deficits, while also assessing whether apparent intercenter differences persisted after covariate adjustment.
Methods
A retrospective cohort was assembled from two level I trauma centers: a historical 2011 series from Inje University Sanggye Paik Hospital (n=150) and a pooled 2019–2023 series from Pusan National University Hospital (n=50). Eligibility required computed tomography–confirmed medial and/or inferior wall fracture with an intact orbital rim; patients with rim involvement or penetrating ocular trauma were excluded. Injury mechanism, fracture site, and diplopia and/or extraocular movement (EOM) limitation at presentation were abstracted from electronic medical records. Categorical comparisons used the chi-square test, and trends across calendar years were assessed using logistic regression (with year as a continuous predictor). Multivariable logistic modeling estimated adjusted odds ratios (aORs) for preoperative ocular motility deficit according to age, sex, mechanism, fracture site, calendar year, and center, with robust clustering.
Results
Interpersonal violence decreased from 34.7% of OBFs in 2011 to 14.0% in 2019–2023, representing an 11% annual decline (OR, 0.89; 95% confidence interval [CI], 0.81–0.97, P=0.007). Preoperative diplopia or EOM limitation was observed in 23 of 200 patients (11.5%): 14% in 2011 versus 4% in 2019–2023. Independent predictors of EOM limitation were interpersonal violence (aOR 3.84; 95% CI, 1.38–10.65; P=0.010) and male sex (aOR, 4.78; 95% CI, 1.49–15.49; P=0.009). Age showed a protective trend (aOR, 0.75 per decade; P=0.064); fracture extent and center were not significant after adjustment. Calendar year showed a borderline inverse association (aOR, 0.86; P=0.061), indicating a 14% annual reduction in presentation-time deficit.
Conclusions
Between 2011 and 2023, the Korean OBF landscape shifted from violent assault to accidental mechanisms, accompanied by a marked decline in preoperative ocular motility impairment. Assault mechanism and male sex remain strong risk indicators, while center-based differences appear largely explained by temporal composition. Public health efforts that reduce violence may therefore translate directly into better functional status at initial presentation.; Summary

Inhaled amikacin as a preventive strategy against ventilator-associated pneumonia in a trauma intensive care unit: early evidence from a single-center retrospective cohort study: Ohchul Kwon, Nahyeon Lee, Seok Hwa Youn, Younghwan Kim, Mina Kim, Jinho Jheong, Gaesung Ha, Youngwoong Kim; J Trauma Inj. 2025;38(4):343-352. Published online December 31, 2025; DOI: https://doi.org/10.20408/jti.2025.0145

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Abstract PDF Supplementary Material: Purpose
Ventilator-associated pneumonia (VAP) remains a leading cause of morbidity and mortality in intensive care units (ICUs). The effectiveness of prophylactic inhaled amikacin in preventing VAP remains uncertain. This study compared VAP incidence between patients with trauma who received prophylactic inhaled amikacin and those who did not.
Methods
We conducted a retrospective, single-center analysis of 66 mechanically ventilated trauma patients admitted to the ICU between May and December 2024. Primary outcomes were infection-related ventilator-associated conditions (IVAC) and microbiologically confirmed VAP. Secondary outcomes included mechanical ventilation duration, ICU and hospital length of stay, and 30-day mortality. Statistical analyses comprised chi-square tests, multivariate logistic regression, and Cox proportional hazards regression with propensity score matching.
Results
A total of 66 patients were included: 28 in the prophylaxis group and 38 in the control group. The prophylaxis group demonstrated a higher unadjusted incidence of IVAC (85.71% vs. 55.26%, P=0.02) and VAP (82.14% vs. 44.74%, P<0.01) compared with the control group. However, after adjustment, logistic regression revealed no significant association between inhaled amikacin and increased risk of VAP (odds ratio [OR], 3.00; 95% confidence interval [CI], 0.80–12.81; P=0.11) or IVAC (OR, 3.10; 95% CI, 0.71–16.43; P=0.15). Similarly, Cox regression analysis showed no significant effect on VAP (hazard ratio [HR], 1.10; 95% CI, 0.47–2.58; P=0.82) or IVAC (HR, 1.68; 95% CI, 0.78–3.59; P=0.18). Secondary outcomes did not differ significantly between groups.
Conclusions
Prophylactic inhaled amikacin neither prevented nor increased IVAC and VAP risk in mechanically ventilated trauma patients, suggesting no meaningful impact on VAP outcomes in this population.; Summary

Effects of the medical professional shortage caused by a resident walkout on scene-to-door time: a retrospective cohort study at a trauma center: Yo-Seok Cho, Jae Yool Jang, Jung-Woo Woo, Do Joong Park, Chan Yong Park; J Trauma Inj. 2025;38(4):335-342. Published online December 29, 2025; DOI: https://doi.org/10.20408/jti.2025.0128

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Abstract PDF Supplementary Material: Purpose
In February 2024, a nationwide resident walkout in Korea caused a temporary shortage of medical professionals. This study investigated whether the walkout influenced trauma care, with a particular focus on scene-to-door time and patients’ in-hospital course.
Methods
Trauma patients transported by emergency medical services between June 1, 2022, and March 31, 2025, were included if trauma team activation occurred upon emergency department arrival. Patients were divided into two groups: group 1 (post–COVID-19 normalization period) and group 2 (post–resident walkout period). The primary outcome was scene-to-door time.
Results
A total of 271 patients were analyzed: 117 in group 1 and 154 in group 2. The proportion of patients originating outside the primary service area increased from 16.7% to 31.3%. Intensive care unit admission rates decreased (65.0% vs. 22.1%), while interhospital transfers directly from the emergency department increased (7.7% vs. 18.8%). The median scene-to-door time rose from 28 to 44.5 minutes. Spline regression and locally estimated scatterplot smoothing analyses revealed no consistent temporal trend but showed greater variability during the walkout period. According to the generalized linear model, scene-to-door time was 42% longer during this period.
Conclusions
The resident walkout was associated with marked delays in scene-to-door time and shifts in in-hospital patient flow. These findings suggest that even temporary workforce shortages can disrupt both prehospital and in-hospital trauma care, underscoring the importance of response planning and adaptable system operations during workforce disruptions.; Summary

Review Articles

Prognostic role of serum interleukin-6 levels in polytrauma patients: a comprehensive narrative review: Nicola Madani, Sereen Halayqeh, Hebah Almahariq, Ahmad Al-Badawi, Mohammad Alomari, Bassem Haddad; Received April 9, 2025 Accepted June 25, 2025 Published online December 29, 2025; DOI: https://doi.org/10.20408/jti.2025.0081 [Epub ahead of print]

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Abstract PDF: Polytrauma triggers a complex systemic inflammatory response, and early identification of high-risk patients is essential for guiding timely interventions and improving outcomes. Interleukin-6 (IL-6), a rapidly induced proinflammatory cytokine, has emerged as a potential biomarker for prognosis in the trauma setting. This narrative review summarizes current evidence on the prognostic role of IL-6 in polytrauma patients, addressing its biological functions, kinetics after injury, and associations with clinical outcomes such as acute respiratory distress syndrome, multiple organ dysfunction syndrome, intensive care unit admission, and mortality. IL-6 levels have been shown to correlate with injury severity scores and to predict complications more reliably than many other inflammatory markers, largely due to its early elevation and sustained presence in circulation. Furthermore, IL-6 measurement may inform surgical decision-making, particularly in selecting candidates for damage control strategies versus definitive care. Compared to other cytokines and acute-phase reactants, IL-6 demonstrates superior temporal responsiveness and prognostic accuracy in the early postinjury phase. Despite variability in measurement methods and the influence of external confounding factors, IL-6 holds significant promise as a clinical tool for early triage, risk stratification, and potentially therapeutic targeting in trauma care. Standardized protocols and larger multicenter studies are needed to facilitate broader adoption and integration of IL-6 into clinical algorithms.; Summary

Autologous transfusion of hemothoraces in resuscitation after thoracic trauma: a narrative review: Nicholas George Chapman, Devorah Leah Wineberg; J Trauma Inj. 2025;38(4):313-319. Published online November 20, 2025; DOI: https://doi.org/10.20408/jti.2025.0053

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Abstract PDF: Traumatic hemothoraces represent a readily available, normothermic, and ABO-compatible source of blood. As a resuscitation fluid, pleural blood presents a reduced risk of transmissible disease and hemolytic transfusion reactions, and it minimizes patient exposure to the storage lesion that affects allogeneic blood products. Pleural blood therefore retains more physiological concentrations of electrolytes and 2,3-diphosphoglycerate when compared to packed red blood cells. However, pleural blood also has a lower oxygen-carrying capacity than packed red blood cells and is largely depleted of coagulation factors. Yet, due to the presence of tissue factor and other proinflammatory mediators, it may paradoxically increase clot formation once transfused. Uncertainty remains regarding the clinical relevance of the supranormal levels of proinflammatory mediators and the effects of autotransfusion on coagulation in vivo. There is now a body of evidence suggesting that autotransfusion reduces the requirement for donor blood products, and small studies have not identified any signals of harm; however, any positive or negative effects on patient outcomes are yet to be conclusively demonstrated. Centers with access to a robust supply of allogeneic donor blood should continue with standard care until more comprehensive research is conducted to clarify both the clinical benefits and risks of autotransfusion. Nonetheless, autotransfusion retains a role in cases where there is a contraindication to allogeneic transfusion, and in low-resource centers where safe and reliable access to donor blood products is limited.; Summary

Case Report

Damage control thoracotomy with chest packing for hemorrhage control in massive hemothorax and shock: a case report: Shivinder Singh, Jitendra Kumar Singh, Shalendra Singh, Aishwainee VG, Umesh Kumar, Venkat Narayanan; Received March 10, 2025 Accepted May 15, 2025 Published online September 29, 2025; DOI: https://doi.org/10.20408/jti.2025.0066 [Epub ahead of print]

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Abstract PDF: Severe hemorrhagic shock is a leading cause of death among potentially salvageable casualties. We report the case of a 24-year-old man who sustained a gunshot wound to the right hemithorax and presented with class IV hemorrhagic shock. He underwent resuscitative damage control via a right posterolateral thoracotomy. Intraoperatively, the bleeding source was identified as a lacerated posterior intercostal artery at the level of the 11th dorsal vertebra. Because access to the bleeding site remained limited even after extending the incision, right thoracic packing was performed to control the hemorrhage. On reevaluation 48 hours later, no active bleeding was observed.; Summary

Original Articles

Identification of predictive factors and development of a prediction model for rehabilitation facility discharge in patients with traumatic spinal cord injury: a retrospective analysis of the National Trauma Data Bank: James Bridges, Norris C. Talbot, Michael Folse, Stephen Whipple, Bharat Guthikonda, Navdeep Samra, Deepak Kumbhare; J Trauma Inj. 2025;38(3):255-267. Published online September 29, 2025; DOI: https://doi.org/10.20408/jti.2025.0049

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Abstract PDF Supplementary Material: Purpose
Previous studies have shown that early rehabilitation is associated with better long-term outcomes in patients with traumatic spinal cord injury. However, data are still limited regarding which factors are associated with discharge to a rehabilitation facility. This study aims to expand on prior research by identifying factors associated with disposition and by introducing a prediction model for these factors.
Methods
The National Trauma Data Bank was queried for patients aged 18 years or older who presented to US trauma centers from 2019 to 2021 with traumatic spinal cord injury. Multivariate logistic regression models were used to determine which patient, injury, and hospital variables were significant factors for disposition to a rehabilitation facility, compared to home and intermediate care facilities. Prediction modeling was then performed using these factors.
Results
Overall, 14,597 patients were identified, of whom 6,220 were discharged to a rehabilitation facility, 2,647 to an intermediate care facility, and 5,730 to home. Significant factors associated with discharge to a rehabilitation facility compared to home included age, injury location and severity, insurance type, estimated length of stay, systolic blood pressure at admission, and admission blood alcohol level and drug screen results. Similarly, when comparing discharge to a rehabilitation facility with discharge to an intermediate care facility, sex, age, race, estimated length of stay, systolic blood pressure at admission, drug screen results, and coexisting substance use and metabolic conditions all significantly influenced disposition. Fine tree binary classification achieved a prediction accuracy of 72.5% when comparing discharge to a rehabilitation facility and home, and a prediction accuracy of 70.0% when comparing discharge to a rehabilitation facility and an intermediate care facility.
Conclusions
This study demonstrates significant factors associated with discharge to a rehabilitation facility in patients with traumatic spinal cord injury. Further studies are needed to improve prediction accuracy.; Summary

Blunt abdominal trauma: a retrospective study on clinical insights and treatment outcomes: Anurag Kumar, Rachith Sridhar, Harendra Kumar, Abdul Hakeem S., Abdul Vakil Khan, Majid Anwer; J Trauma Inj. 2025;38(3):221-231. Published online September 29, 2025; DOI: https://doi.org/10.20408/jti.2025.0045

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Abstract PDF: Purpose
Blunt abdominal trauma is a significant cause of morbidity and mortality, predominantly affecting younger male patients. Therefore, a study examining the mechanisms of injury, injury patterns, and outcomes in these cases is essential. The aim of this study was to evaluate demographics, injury mechanisms, treatments provided, and outcomes in cases of blunt abdominal trauma at a level I trauma center in Eastern India.
Methods
A descriptive retrospective study was conducted at a level I trauma center using departmental audit data spanning 18 months (July 2022–December 2023). Data from 118 patients diagnosed with blunt abdominal trauma were analyzed.
Results
The study revealed a pronounced male predominance (6.35:1), with a mean age of 30.2 years. Road traffic accidents were the most frequent cause of injury (56.8%). Only six patients (5.1%) presented within the "golden hour," resulting in delayed interventions. Surgical intervention was necessary in 78 cases (66.1%), with hollow viscus perforation being the most common indication. The mean hospital stay was 10.6 days, and the overall mortality rate was 12.7%. The presence of shock upon admission significantly correlated with mortality (P<0.001).
Conclusions
Blunt abdominal trauma continues to represent a critical healthcare challenge, particularly affecting younger males. Improved healthcare accessibility, adherence to Advanced Trauma Life Support protocols, and timely interventions could improve survival rates.; Summary

Review Article

Trauma eponyms (1837–1950): a comprehensive historical review: Halil Tekiner, Eileen S. Yale, Jacob Draves, Steven H. Yale; J Trauma Inj. 2025;38(3):168-180. Published online September 29, 2025; DOI: https://doi.org/10.20408/jti.2025.0037

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Abstract PDF: Trauma eponyms reflect historical advancements in trauma medicine across various organ systems, often honoring pioneering physicians. These terms trace the evolution of medical understanding, particularly during wartime, though some have been replaced by more precise terminology. A comprehensive literature review was performed using the PubMed database to identify trauma-related eponyms described from 1837 to 1950. Supplementary biographical sources were also consulted. Eponyms were analyzed regarding their geographic distribution, affected organ systems, and ongoing clinical relevance, emphasizing connections to advancements in imaging, surgical procedures, and trauma care. A total of 30 trauma-related eponyms were identified, predominantly originating from France and Germany, highlighting the European leadership in medical research during the 19th and early 20th centuries. The pre–World War I period (1837–1914) emphasized anatomical and pathological observations, exemplified by eponyms such as Ollivier syndrome (1837), Curling ulcer (1842), and Klumpke paralysis (1885). The World Wars and subsequent postwar era (1914–1950) prompted significant innovations in battlefield medicine and surgical techniques, resulting in eponyms such as Tinel sign (1915), Bywaters syndrome (1941), and Fegeler syndrome (1949). While some eponyms have become obsolete, others remain clinically relevant due to clearly defined pathophysiological characteristics. Developments in imaging modalities (x-rays, magnetic resonance imaging, and computed tomography) and surgical methods have reinforced the contemporary relevance of these terms. Trauma-related eponyms provide a historical framework for understanding the evolution of trauma care. Their continued use highlights their diagnostic value and the enduring influence of historical medical discoveries on contemporary clinical practice.; Summary

Original Article

Assessing the outcomes and complications of abdominal trauma using the adapted Clavien-Dindo in trauma scoring system in a tertiary hospital: an observational study: Kollanur Charan, Naveen Sharma, Mahaveer Singh Rodha, Ramkaran Chaudhary, Arvind Sinha, Siddhi Chawla; J Trauma Inj. 2025;38(3):195-203. Published online September 29, 2025; DOI: https://doi.org/10.20408/jti.2025.0032

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Abstract PDF: Purpose
The adapted Clavien-Dindo in trauma (ACDiT) scoring system modifies the original Clavien-Dindo system to grade complications in both operatively and nonoperatively managed trauma patients. This study aimed to validate the ACDiT tool as a novel outcome measure in abdominal trauma patients, correlating ACDiT scores with hospital length of stay (LOS), intensive care unit (ICU) LOS, and mortality. We also described injury patterns and identified factors associated with morbidity and mortality.
Methods
A prospective observational study was conducted over 18 months at a tertiary hospital in Western Rajasthan, India. A total of 154 patients with an Abbreviated Injury Scale (AIS) ≥2 were included, while pregnant and lactating mothers were excluded. Complications were graded using ACDiT, and outcomes such as LOS and ICU LOS were analyzed.
Results
Among 154 patients, 90.3% sustained blunt trauma and 9.7% had penetrating injuries. Significant extra-abdominal injuries (AIS >2) were noted in 46.1%. Complications occurred in 38.3% of patients, with grade II complications being the most common (20.3%). Higher ACDiT grades were significantly associated with prolonged LOS (P<0.001) and ICU LOS (P=0.001). The ACDiT scale demonstrated a strong predictive value for morbidity and mortality (adjusted R2=0.11, P<0.001).
Conclusions
The ACDiT is a reliable and objective tool for assessing complications and outcomes in abdominal trauma patients, effectively correlating with LOS and ICU LOS.; Summary

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

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; Received January 22, 2025 Accepted February 23, 2025 Published online September 3, 2025; DOI: https://doi.org/10.20408/jti.2025.0016 [Epub ahead of print]

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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

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