Journal of Trauma and Injury

Original Articles

Pediatric hepatic pseudoaneurysm formation following blunt and penetrating abdominal trauma: a 5-year retrospective analysis: James Green, Christopher Bunting, Kuran Rati, Seth Cox, Mandeep Basra, Robert Hooper, Elika Kashef, Nicholas Alexander, Maryam Alfa-Wali, Neeral R. Patel; J Trauma Inj. 2026;39(2):137-143. Published online June 30, 2026; DOI: https://doi.org/10.20408/jti.2025.0219

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Abstract PDF: Purpose
Hepatic pseudoaneurysm (HPA) is a rare but potentially life-threatening sequela of liver trauma. This study aimed to evaluate the number of children diagnosed with HPAs following blunt and penetrating liver trauma at a major trauma center in London over a 5-year period.
Methods
A retrospective analysis was conducted of patients aged <18 years with liver injuries admitted to our institution between 2017 and 2022. Patients were identified through the local trauma registry. Data collected included patient demographics, imaging details (including ultrasound scanning and computed tomography [CT]), liver injury grade, and management plans.
Results
Thirty-four patients were identified (mean age, 12 years; range, 1–17 years). There were 26 men (76.5%) and 8 women (23.5%). Twenty-three patients (67.6%) sustained blunt injuries, and 11 (32.4%) sustained penetrating liver injuries. Among 30 patients (excluding 4 patients who died), 18 (60.0%) underwent repeat CT imaging. CT imaging identified four HPAs (13.3%), two of which were treated with embolization. Of the 12 patients who did not undergo repeat CT, 6 (50.0%) had follow-up ultrasound scanning.
Conclusions
Hepatic pseudoaneurysms following trauma are uncommon. Their management in the pediatric population presents challenges regarding follow-up imaging, particularly the use of CT. Although the absence of standardized protocols complicates surveillance strategies, an individualized approach informed by patient-specific factors is essential. Contrast-enhanced ultrasound may optimize HPA detection while minimizing radiation exposure.; Summary

Evaluation of diagnostic performance of PECARN clinical decision rule in children with minor head trauma presenting to the emergency department of a tertiary care center: an observational study: Salooja Sulthana N, Nikhil Paul, Archu MJ, Keerthana Manoharan K K, Linu SM, Visakh S Vinod; J Trauma Inj. 2026;39(2):144-150. Published online April 22, 2026; DOI: https://doi.org/10.20408/jti.2025.0165

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Abstract PDF: Purpose
Minor head trauma is one of the most common reasons for pediatric emergency department visits. Accurate identification of children at risk for clinically important traumatic brain injury (ciTBI) is essential to reduce unnecessary computed tomography (CT) imaging. This study evaluated the diagnostic performance of the PECARN (Pediatric Emergency Care Applied Research Network) clinical decision rule in children with minor head trauma presenting to a tertiary care hospital in South India.
Methods
In this observational study conducted between September 2022 and April 2024, 235 children aged <18 years presenting with head trauma and Glasgow Coma Scale scores of 14–15 were prospectively enrolled. Participants were stratified into age-specific PECARN risk categories. Diagnostic performance was assessed against ciTBI outcomes defined by clinical and radiological criteria.
Results
The PECARN rule demonstrated strong diagnostic performance, with a sensitivity of 82.4%, specificity of 74.1%, and an area under the receiver operating characteristic curve of 0.90 (P=0.01). No cases requiring neurosurgical intervention were missed. Children aged ≥2 years had a higher incidence of ciTBI than those aged <2 years (13.4% vs. 1.8%, P=0.048). ciTBI was significantly associated with loss of consciousness, vomiting, severe headache, and signs of basilar skull fracture (all P<0.001).
Conclusions
The PECARN rule appears to be a reliable and safe tool for evaluating pediatric minor head trauma in Indian emergency settings. Its high sensitivity and negative predictive value support its use in reducing unnecessary CT imaging while accurately identifying children at risk for ciTBI.; Summary

Case Report

Penile artery traumatic occlusion causing arteriogenic erectile dysfunction: a case report: Francesco Michele Ronza, Teresa Letizia Di Gennaro, Francesco Palmieri, Stefania Tamburrini; Received April 11, 2025 Accepted July 4, 2025 Published online April 22, 2026; DOI: https://doi.org/10.20408/jti.2025.0085 [Epub ahead of print]

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Abstract PDF Supplementary Material: We present a case of traumatic penile artery occlusion resulting in arteriogenic erectile dysfunction. A 34-year-old man was referred to the emergency department following a motorbike collision that caused pelvic trauma. Contrast-enhanced multidetector computed tomography revealed a complex pelvic fracture pattern, including pubic diastasis, fracture of the left sacral ala, and avulsion of the left ischiatic spine, along with penile artery occlusion and absence of homolateral cavernosal corpora blushes. Contrast-enhanced multidetector computed tomography is a comprehensive and precise imaging modality for evaluating pelvic trauma. Assessment of the penile artery and internal pudendal artery network is crucial in pelvic trauma cases to promptly identify arterial occlusion and facilitate timely evaluation and management of erectile dysfunction.; Summary

Review Article

The impact of ketamine on posttraumatic stress disorder (PTSD) symptomatology in trauma-exposed populations: a narrative review: Minaal Ahmed Malik, Michele Halasa, Jack Chia, Venera Derguti, Holly Hathway, Fahad Hussain, Abdel Saad; J Trauma Inj. 2026;39(2):119-127. Published online April 2, 2026; DOI: https://doi.org/10.20408/jti.2025.0086

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Abstract PDF: Ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, is widely used in trauma and emergency medicine for its rapid analgesic and sedative properties. While its efficacy in acute pain management is well established, concerns persist regarding its long-term psychological effects, particularly its potential role in the development of posttraumatic stress disorder (PTSD). Some studies indicate that ketamine may provide rapid symptom relief in PTSD, whereas others raise concerns about its contribution to dissociative states and maladaptive memory consolidation. This narrative review examines existing literature on ketamine’s influence on PTSD symptomatology in trauma-exposed populations. A comprehensive assessment of randomized controlled trials and observational studies was undertaken to explore ketamine’s effects on dissociation, memory processing, and long-term psychiatric outcomes. Relevant studies were identified from major medical databases, and findings were synthesized to present an integrated overview of ketamine’s psychological impact in trauma care settings. Clinical trials suggest that a single intravenous infusion of ketamine (0.5 mg/kg) may significantly reduce PTSD symptoms within 24 hours compared to midazolam, with improvements in overall clinical presentation and no lasting dissociative effects. Conversely, some observational studies have linked ketamine use in acute trauma care to heightened dissociation, hyperarousal, and stress symptoms during early follow-up. Research on burn patients receiving intraoperative ketamine suggests a possible reduction in PTSD incidence, although a later study reported no significant difference compared with non-ketamine controls. The relationship between ketamine and PTSD is complex, with effects appearing to depend on dose and timing of administration. While perioperative ketamine may confer protective benefits against long-term psychiatric sequelae, immediate post-trauma administration may worsen dissociative symptoms and acute stress responses. Further well-controlled clinical trials are needed to refine dosing protocols and identify patient-specific risk factors, including preexisting psychiatric conditions, to better guide its use.; Summary

Case Reports

Traumatic posterior dislocation of the sternoclavicular joint in a 12-year-old boy: a case report: Amani Azizalrahman, Altaf Ahmad Bhat, Abdulaziz Khalid Alareefy, Abdulaziz Abdullah Oalsuhaiban; Received March 10, 2025 Accepted May 22, 2025 Published online April 2, 2026; DOI: https://doi.org/10.20408/jti.2025.0057 [Epub ahead of print]

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Abstract PDF: Sternoclavicular joint (SCJ) dislocation is a rare but serious orthopedic injury, representing fewer than 1% of all fractures or dislocations. Posterior dislocations are particularly concerning due to the SCJ’s proximity to vital structures such as the trachea, esophagus, subclavian vessels, and brachial plexus. Clinical suspicion should be heightened when a patient presents with a compression-type injury to the shoulder girdle and pain around the SCJ. We report the case of a 12-year-old boy who presented to the emergency department after being punched in the right shoulder by another child, resulting in severe pain and an inability to move his right shoulder. Clinical assessment raised suspicion for a posterior SCJ dislocation, which was confirmed by computed tomography scan. The rarity of this condition in pediatric patients, coupled with the potential for severe complications, underscores the significance of this case for clinical recognition and management.; Summary

An unusual open pneumothorax due to high-voltage electrical burn injury: a case report: Norberto Navarrete, Sandra J. Bernal, Laura S. Nasiff, Federico Fernandez; Received May 29, 2025 Accepted August 11, 2025 Published online April 1, 2026; DOI: https://doi.org/10.20408/jti.2025.0122 [Epub ahead of print]

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Abstract PDF: Open intrathoracic visceral injuries are rare in electrical burns. We report the case of a 65-year-old man who sustained a high-voltage electrical burn through direct cable exposure. He arrived at the burn intensive care unit with respiratory distress secondary to an open wound on the right side of the chest wall measuring approximately 4×2 cm, with a calculated total body surface area of 2%. An immediate thoracostomy tube was placed to treat the open pneumothorax. Pneumopericardium, pneumomediastinum, and pleural infection developed later as delayed complications despite initial stabilization. After 42 days of hospitalization, the patient was discharged. This case highlights the rare occurrence of thoracic complications following electrical injury and underscores the importance of multidisciplinary, phased therapy in the management of severe electrical damage.; Summary

Blunt traumatic right-sided pericardial rupture without cardiac injury: a case report: Muhyung Heo, Hyung Won Kim, Sanghyun Sung; J Trauma Inj. 2026;39(2):178-181. Published online April 1, 2026; DOI: https://doi.org/10.20408/jti.2025.0112

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Abstract PDF: Blunt traumatic pericardial rupture is an exceptionally rare condition, often associated with high morbidity and mortality. Isolated pericardial rupture without vascular or cardiac involvement accounts for only 17% of reported cases. We describe a rare case of right-sided pericardial rupture following blunt chest trauma, an unusual presentation since most pericardial tears occur on the left side. A 23-year-old woman involved in a motor vehicle accident sustained multiple injuries, including right hemothorax, bilateral pulmonary contusions, left-sided rib fractures, and a humerus fracture. Although preoperative computed tomography showed no diagnostic findings, persistent bleeding from the right chest tube prompted exploratory thoracotomy. Intraoperative evaluation revealed a 10-cm right pericardial tear extending from the superior vena cava to the inferior vena cava, with no associated cardiac injury. Surgical management included primary closure of the pericardial tear and repair of adjacent pleural injuries. Postoperatively, the patient developed right diaphragmatic palsy due to phrenic nerve involvement. Pericardial rupture is challenging to diagnose, but in this case, persistent hemothorax facilitated early recognition and intervention. Prompt identification allowed timely surgical repair, likely preventing life-threatening complications such as cardiac herniation. This case highlights the importance of considering pericardial rupture in patients with blunt chest trauma presenting with unexplained clinical findings and underscores the value of early surgical management.; Summary

The voice of injury: a case report of isolated trauma to the larynx: Najeebuddin Mohammed, Ashima Sharma, Alekhya Machani, Sujata Patnaik; J Trauma Inj. 2026;39(1):85-89. Published online March 31, 2026; DOI: https://doi.org/10.20408/jti.2025.0065

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Abstract PDF: Although uncommon, laryngotracheal injuries carry a significant risk of mortality. This rare case of isolated laryngeal injury underscores the importance of recognizing the various potential presentations of such injuries and highlights the evidence-based management strategies that every emergency physician should consider when treating potential airway trauma. A 45-year-old male motorcyclist was involved in a road traffic accident during the night and presented to the emergency department the following morning. The patient complained of breathlessness, neck pain, hoarseness of voice, and noisy breathing. Examination revealed stridor, swelling in zones 1 and 2 of the neck, tenderness over the thyroid, and subcutaneous emphysema over the neck and anterior chest. A definitive airway was secured, and computed tomography imaging revealed a fracture of the thyroid cartilage. The patient was managed conservatively, extubated after 1 week, and discharged after 2 days of observation. Classification of the type of injury and the use of an algorithmic approach, involving consensus among the emergency department, trauma surgeons, and the critical care team, can help streamline and standardize management of these cases. Furthermore, a thorough understanding of the dos and don’ts in securing the airway in patients with laryngotracheal injuries increases the robustness of the approach to managing this patient population.; Summary

Contralateral pulmonary resection with drug-induced thrombocytopenia after previous lobectomy in chest trauma: a case report: Do Wan Kim, Kyo Seon Lee, Sang Yun Song, In-Seok Jeong; J Trauma Inj. 2026;39(2):186-190. Published online March 30, 2026; DOI: https://doi.org/10.20408/jti.2025.0157

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Abstract PDF: Secondary pulmonary resection remains challenging because of the risk of serious complications. A second thoracic surgical procedure in elective settings should prioritize the patient’s recovery potential and functional status. In thoracic oncology, clinical outcomes can be acceptable in selected patients. However, when vital signs are unstable due to traumatic lung injury, selection is not the primary consideration and emergency surgery is required. Thrombocytopenia is a condition in which a patient’s platelet count is abnormally low, diagnosed by complete blood count. In humans, the normal platelet count generally ranges from 150,000 to 450,000 platelets/μL of blood. In posttraumatic patients, thrombocytopenia is often difficult to manage because its causes are diverse. To our knowledge, survival after secondary contralateral lung resection in a patient with thrombocytopenia who previously underwent lobectomy for lung cancer is extremely rare.; Summary

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

Changes in the characteristics of civilian patients admitted to a military hospital before and during the healthcare system crisis: a retrospective cohort study: Changsin Lee, Sang Mok Lee, Kyungwon Lee; J Trauma Inj. 2026;39(1):14-24. Published online March 3, 2026; DOI: https://doi.org/10.20408/jti.2025.0096

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Abstract PDF: Purpose
In February 2024, a healthcare system crisis in Korea, triggered by the mass resignation of medical residents in protest of government medical policies, resulted in an increased influx of civilian trauma patients to a military trauma center. This study examines the scale, characteristics, and treatment outcomes of these patients before and during the crisis.
Methods
A retrospective review was conducted, comparing civilian trauma patients who visited the center from March 2023 to February 2024 (before crisis) and from March 2024 to February 2025 (during the crisis). The variables analyzed included patient demographics, injury types, methods of transportation, length of emergency room (ER) stay, hospitalization outcomes, and final treatment results. Only civilian trauma patients who required hospitalization were included; mild cases discharged from the ER were excluded.
Results
A total of 548 civilian patients visited the center during the study period, with a significant increase observed during the crisis (364 patients during the crisis vs. 81 patients before the crisis). Despite the surge, there were no significant differences in hospital arrival routes, methods of transportation, mechanisms of injury, or injury types. ER stay durations were shorter for both general and severe cases during the crisis (P=0.020 and P=0.033, respectively), although intensive care unit and overall hospital stay lengths remained unchanged. Civilian outpatient visits increased more than threefold in March 2024 compared to February 2024, and this elevated trend remained stable.
Conclusions
These findings highlight the military trauma center’s ability to maintain effective civilian trauma care despite significant healthcare system disruptions. The study underscores the resilience of the center and offers insights for optimizing trauma care operations in future crises.; Summary

Case Report

A large foreign body removal from the anterior mediastinum using a minimally invasive method after a shrapnel wound to the neck: a case report: Igor Lurin, Eduard Khoroshun, Vitaliy Makarov, Volodymyr Nehoduyko, Hannah B. Wild, Serhiy Tertishny, Yuriy Bunin; Received April 3, 2025 Accepted July 29, 2025 Published online March 3, 2026; DOI: https://doi.org/10.20408/jti.2025.0077 [Epub ahead of print]

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Abstract PDF: This case report describes the diagnosis and surgical management of a shrapnel wound to the neck with a retained foreign body (metal fragment) in the anterior mediastinum. A 44-year-old male service member was wounded in the neck during an air raid. Thirty minutes after sustaining the injury, the patient reached a forward surgical team, exhibiting hemodynamic instability responsive to resuscitation. After initial stabilization, the forward team performed primary surgical treatment of the wound, including hemostasis, irrigation and debridement, and drainage. Twelve hours later, the patient was transported by ground to the Military Medical Clinical Center of the Northern Region of the Military Medical Center of the Armed Forces of Ukraine and hospitalized in the surgical department. Diagnostic evaluation included computed tomography of the head, chest, abdomen, and pelvis along with esophagogastroduodenoscopy, which demonstrated fracture of left ribs 1 and 2, a 40×15-mm metal fragment in the anterior superior mediastinum with pneumomediastinum and hemomediastinum, and metal fragments in the soft tissues of the neck without contrast extravasation. Esophagogastroduodenoscopy revealed no evidence of esophageal injury. Surgical management included left video-assisted thoracoscopic surgery with opening of the anterior mediastinum and removal of the foreign body (metal shrapnel fragment) using a magnetic surgical instrument. The patient was discharged 2 weeks postoperatively. Gunshot wounds of the neck with a large foreign body in the anterior mediastinum are rare. The use of minimally invasive surgical techniques and modern magnetic surgical instruments can reduce surgical morbidity and may be used at tertiary care centers.; Summary

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

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