Journal of Trauma and Injury

Original Article

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; Received July 20, 2025 Accepted January 11, 2026 Published online April 22, 2026; DOI: https://doi.org/10.20408/jti.2025.0165 [Epub ahead of print]

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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

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; Received April 13, 2025 Accepted July 31, 2025 Published online April 2, 2026; DOI: https://doi.org/10.20408/jti.2025.0086 [Epub ahead of print]

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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 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; Received July 14, 2025 Accepted August 31, 2025 Published online March 30, 2026; DOI: https://doi.org/10.20408/jti.2025.0155 [Epub ahead of print]

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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

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

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; 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

Citations

Citations to this article as recorded by

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

Case Report

Spontaneous resolution of papilledema and multilayered hemorrhages in Terson syndrome associated with subarachnoid hemorrhage: a case report: Shreyas Temkar, Hemanth Ramachandar, Astha Gupta, Amit Kumar Deb; J Trauma Inj. 2025;38(3):290-293. Published online June 25, 2025; DOI: https://doi.org/10.20408/jti.2024.0097

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Abstract PDF: Terson syndrome (TS) is a condition characterized by the association of intraocular hemorrhages with an underlying intracranial bleed. Although it is widely postulated that the condition arises from raised intracranial pressure, the occurrence of papilledema is rarely reported in TS. We present a case involving a 35 year old male patient who developed TS following a head injury. Papilledema was incidentally detected and managed with measures aimed at reducing intracranial pressure. The patient subsequently experienced spontaneous resolution of both the cerebral and ocular hemorrhages, as well as resolution of the papilledema. A dilated fundus examination is strongly recommended for any patient presenting with intracranial hemorrhage (especially subarachnoid hemorrhage) to identify intraocular hemorrhages and papilledema.; Summary

Original Article

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

Case Report

Purtscher retinopathy following isolated chest compression: a case report: Min Uk Jang, Ho Gil Jung, Youngwoong Kim; J Trauma Inj. 2024;37(4):291-294. Published online October 21, 2024; DOI: https://doi.org/10.20408/jti.2024.0032

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Abstract PDF: This case report describes the case of a 56-year-old man who developed Purtscher retinopathy following compressive chest trauma. During the tertiary survey, the patient was found to have a unilateral partial vision decline despite sustaining only mild rib fractures. The patient was diagnosed with a rare complication of Purtscher retinopathy. At a 2-week follow-up outpatient examination, improved visual acuity was observed. This case highlights the importance of conducting a tertiary survey not only on the directly impacted site, but also comprehensively across all sites, while attentively listening to and addressing the patient’s complaints.; Summary

Original Articles

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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Abstract PDF Supplementary Material

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

Citations

Citations to this article as recorded by

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
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

Prevalence of posttraumatic stress disorder in orthopedic trauma patients and a call to implement the Injured Trauma Survivor Screen as a prospective screening protocol in the United States: Victoria J. Nedder, Mary A. Breslin, Vanessa P. Ho, Heather A. Vallier; J Trauma Inj. 2024;37(1):67-73. Published online February 23, 2024; DOI: https://doi.org/10.20408/jti.2023.0068

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Abstract PDF Supplementary Material

Purpose
Posttraumatic stress disorder (PTSD) is prevalent and is associated with protracted recovery and worse outcomes after injury. This study compared PTSD prevalence using the PTSD checklist for DSM-5 (PCL-5) with the prevalence of PTSD risk using the Injured Trauma Survivor Screen (ITSS).
Methods
Adult trauma patients at a level I trauma center were screened with the PCL-5 (sample 1) at follow-up visits or using the ITSS as inpatients (sample 2).
Results
Sample 1 (n=285) had significantly fewer patients with gunshot wounds than sample 2 (n=45) (8.1% vs. 22.2%, P=0.003), nonsignificantly fewer patients with a fall from a height (17.2% vs. 28.9%, P=0.06), and similar numbers of patients with motor vehicle collision (40.7% vs. 37.8%, P=0.07). Screening was performed at a mean of 153.9 days following injury for sample 1 versus 7.1 days in sample 2. The mean age of the patients in sample 1 was 45.4 years, and the mean age of those in sample 2 was 46.1 years. The two samples had similar proportions of female patients (38.2% vs. 40.0%, P=0.80). The positive screening rate was 18.9% in sample 1 and 40.0% in sample 2 (P=0.001). For specific mechanisms, the positive rates were as follows: motor vehicle collisions, 17.2% in sample 1 and 17.6% in sample 2 (P=1.00); fall from height, 12.2% in sample 1 and 30.8% in sample 2 (P=0.20); and gunshot wounds, 39.1% in sample 1 and 80.0% in sample 2 (P=0.06).
Conclusions
The ITSS was obtained earlier than PCL-5 and may identify PTSD in more orthopedic trauma patients. Differences in the frequency of PTSD may also be related to the screening tool itself, or underlying patient risk factors, such as mechanism of injury, or mental or social health.

Summary

Citations

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Musculoskeletal Clinicians’ Perspectives on Integrated Digital Personalized Feedback Interventions to Address Risky Alcohol use and PTSD after Musculoskeletal Injury
Jafar Bakhshaie, Sina Ramtin, Jonathan Greenberg, Arun Aneja, Thuan Ly, Anka Vujanovic, David Ring, Michael Zvolensky
Journal of Clinical Psychology in Medical Settings.2026;[Epub] CrossRef
Alcohol Misuse, Posttraumatic Stress Symptoms, and Recovery After Musculoskeletal Injury: Implications for Effective Orthopaedic Care
Jafar Bakhshaie, Michael J. Zvolensky, Anka A. Vujanovic, Joseph W. Ditre, David Ring
Journal of the American Academy of Orthopaedic Sur.2026; 34(10): e1359. CrossRef
The prevalence and risk factors of posttraumatic stress disorder following road traffic accidents in China: A meta-analysis
Yanna Zhou, Juanita A Haagsma, Jan Busschbach, Rong Zeng, Zhihao Yang, Jindong Ding Petersen, Xiuquan Shi
Traffic Injury Prevention.2025; : 1. 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.

Summary

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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 Article

One year of treating patients with open fractures of the lower extremity in a new military trauma center in Korea: a case series: Ji Wool Ko, Giho Moon, Jin Geun Kwon, Kyoung Eun Kim, Hankaram Jeon, Kyungwon Lee; J Trauma Inj. 2023;36(4):376-384. Published online December 19, 2023; DOI: https://doi.org/10.20408/jti.2023.0041

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Abstract PDF

Purpose
The Armed Forces Trauma Center of Korea was established in April 2022. This study was conducted to report our 1-year experience of treating soldiers with open fractures of the lower extremity.
Methods
In this case series, we reviewed the medical records of 51 Korean soldiers with open fractures of the lower extremity between April 2022 and March 2023 at a trauma center. We analyzed patients with Gustilo-Anderson type II and III fractures and reported the duration of transportation, injury mechanisms, injured sites, and associated injuries. We also presented laboratory findings, surgery types, intensive care unit stays, hospital stays, rehabilitation results, and reasons for psychiatric consultation. Additionally, we described patients’ mode of transport.
Results
This study enrolled nine male patients who were between 21 and 26 years old. Six patients had type II and three had type III fractures. Transport from the accident scene to the emergency room ranged from 75 to 455 minutes, and from the emergency room to the operating room ranged from 35 to 200 minutes. Injury mechanisms included gunshot wounds, landmine explosions, grenade explosions, and entrapment by ship mooring ropes. One case had serious associated injuries (inhalation burn, open facial bone fractures, and hemopneumothorax). No cases with serious blood loss or coagulopathies were found, but most cases had a significant elevation of creatinine kinase. Two patients underwent vascular reconstruction, whereas four patients received flap surgery. After rehabilitation, six patients could walk, one patient could move their joints actively, and two patients performed active assistive movement. Eight patients were referred to the psychiatry department due to suicidal attempts and posttraumatic stress disorder.
Conclusions
This study provides insights into how to improve treatment for patients with military trauma, as well as medical services such as the transport system, by revising treatment protocols and systematizing treatment.

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