简介：AbstractPurpose:This study aimed at exploring the application of trauma time axis management in the treatment of severe trauma patients by using the Medicalsystem trauma system.Methods:We performed a retrospective cohort study involving patients with severe trauma. Patients who were admitted before the application of the Medicalsystem trauma system were divided into before system group; patients who were admitted after the application of the system were divided into after system group. Comparison was made between the two groups. For normally distributed data, means were reported along with standard deviation, and comparisons were made using the independent samples t test. Categorical data were compared using the Chi-square test. The Mann-Whitney U test was used to compare nonparametric variables.Results:There were 528 patients admitted to the study during the study period. There was no significant statistical difference in the time from the start of trauma team to arrive at the resuscitation room between the two groups. The time from arrival at hospital to endotracheal intubation, to ventilator therapy, to blood transfusion, to completion of CT scan, to completion of closed thoracic drainage, to the start of operation, as well as the length of stay in resuscitation room and hospital were significantly lower after the application of the Medicalsystem trauma system. The mortality was decreased by 8.6% in the after system group compared with that in the before system group, but there was no statistical difference.Conclusion:The Medicalsystem trauma system can optimize diagnosis and treatment process for trauma patients, and accordingly improve the treatment efficiency and shorten the treatment time. Therefore, the Medicalsystem trauma system deserves further popularization and promotion.

简介：The20thcenturyisacenturyinwhichhumanmaterialcivilizationandmedicinedevelopedthemostrapidly,manycausesofdiseasesunknownbeforewerefoundmolecularly,manydiseasesorterminaldiseasesuncurablebeforewerecuredwithnewtherapeuticmethods,manyfatalcontagiousdiseasesthathadcausedcorpsoverthewildernesswerecontrolledeffectively,cathetertechniquesandoperationscouldbeusedanywhereinthehumanbodysolongastheywereneeded,andnewdiagnosticandtherapeutictechniquesemergedoneafteranother;medicalprogressmadeanever-lastingcontributiontohumanhealth.

简介：十二指肠的损伤由于增加的汽车事故和强烈事件经常越来越不平常却现在看见。十二指肠的损伤的管理能是复杂的，特别当对pancreatic-duodenal-biliary建筑群的巨大的损害同时发生时。甚至病人及时收到手术，多重手术后的复杂并发症和高死亡是普通的。更好知道并且设法十二指肠的损伤，我们由十二指肠的损伤，治疗，诊断和腹部的关键词在PubMed寻找了最近的相关文学。它证明因为诊断和管理是复杂的，死亡高，十二指肠的损伤应该及时并且机智地被对待。并且新技术的申请能帮助改进管理。在这评论，我们讨论了十二指肠的损伤的发生，诊断，管理，和复杂并发症以及死亡。

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简介：与多重损伤在病人为错误诊断探索特征，治疗结果和原因的目的，以便减少错误诊断的发生。从1997年8月被同意进入我们的部门到2008年8月的有多重损伤的3163个病人全部的方法A，回顾地被学习比较诊断和治疗的特征。有2117男性(66.93%)，有平均数的1046女性(33.07%)36.46年变老(范围，14-80年)。象一般地位，创伤的条件，诊断和治疗状况，预后和死亡那样的参数被分析。错误诊断组和正确诊断组之间的差别以阐明的损害，复杂并发症和治疗结果的严厉被比较错误诊断的原因和预防。结果在这研究的多重损伤的错误诊断率是16.19%。误诊的主要解剖地点是手足和骨盆(299个位置，39.50%)，腹的区域和骨盆的机关(148个位置，19.55%)，并且胸的区域(109个位置，14.40%)。在错误诊断组，ISS，一些医院停留，知觉的骚乱的率，批评盒子和吃惊，盒子是33.78吗？

简介：AbstractThroughout the past 2020, the pandemic COVID-19 has caused a big global shock, meanwhile it brought a great impact on the public health network. Trauma emergency system faced a giant challenge and how to manage trauma under the pandemic of COVID-19 was widely discussed. However, the trauma treatment of special population (geriatric patients and patients taking anticoagulant drugs) has received inadequate attention. Due to the high mortality following severe traumatic hemorrhage, hemostasis and trauma-induced coagulopathy are the important concerns in trauma treatment. Sepsis is another topic should not be ignored when we talking about trauma. COVID-19 itself is a special kind of sepsis, and it may even be called as serious systemic infection syndrome. Sepsis has been become a serious problem waiting to be solved urgently no matter in the fields of trauma, or in intensive care and infection, etc. This article reviewed the research progress in areas including trauma emergency care, trauma bleeding and coagulation, geriatric trauma and basic research of trauma within 2020.

简介：Objective:Toprobeintoeffectivesurgicalproceduresandimprovetheoutcomeoftreatmentforpatientswithseverehepaticinjury.Methods:Aretrospectivestudyinvolving113patientswithseverehepatictrauma(AASTgradeIVandV)duringthepast12yearswascarriedout.Ninety-eightpatientsunderwentsurgicaltreatment.SurgicalinterventionsincludinghepatectomyordirectcontrolofbleedingvesselsbyfingerfracturetechniquewithPringlemaneuver,selectiveligationofhepaticartery,retrohepaticcavalrepairwithtotalhepaticvascularocclusion,andperihepaticpackingweremainlyused.Results:Inthe98patientstreatedoperatively,thesurvivalratewas69.4%(68/98).Among40patientswithjuxtahepaticvenousinjury(JHVI),15werecuredwiththemaximumbloodtransfusionof12000ml.EightcasesofGradeIVinjurytreatednonoperativelywerecured.Thepercentageoffailureofnonoperativemanagementwas42.9%(6/14).Theoverallmortalityratewas32.7%(37/113),and57%ofthedeathswereduetoexsanguination.Conclusions:Reasonablesurgicalproceduresbasedonclassificationofhepaticinjuriescanincreasethesurvivalrateofseverelivertrauma.AccurateperihepaticpackingiseffectiveindealingwithJHVI.

简介：Thebrainishighlyplasticafterstrokeorepilepsy;however,thereisapaucityofbrainplasticityinvestigationaftertraumaticbraininjury(TBI).ThisminireviewsummarizesthemostrecentevidenceofbrainplasticityinhumanTBIpatientsfromtheperspectiveofadvancedmagneticresonanceimaging.Similartootherformsofacquiredbraininjury,TBIpatientsalsodemonstratedbothstructuralreorganizationaswellasfunctionalcompensationbytherecruitmentofotherbrainregions.However,thelargescalebrainnetworkalterationsafterTBIarestillunknown,andthefieldisstillshortofpropermeansonhowtoguidethechoiceofTBIrehabilitationortreatmentplantopromotebrainplasticity.Theauthorsalsopointoutthenewdirectionofbrainplasticityinvestigation.

简介：AbstractPurpose:Injuries are one of the leading causes of death and lead to a high social and financial burden. Injury patterns can vary significantly among different age groups and body regions. This study aimed to evaluate the relationship between mechanism of injury, patient comorbidities and severity of injuries. Methods: The study included trauma patients from July 2016 to June 2018, who were admitted to Sina Hospital, Tehran, Iran. The inclusion criteria were all injured patients who had at least one of the following: hospital length of stay more than 24 h, death in hospital, and transfer from the intensive care unit of another hospital. Data collection was performed using the National Trauma Registry of Iran minimum dataset.Results:The most common injury mechanism was road traffic injuries (49.0%), followed by falls (25.5%). The mean age of those who fell was significantly higher in comparison with other mechanisms (p < 0.001). Severe extremity injuries occurred more often in the fall group than in the vehicle collision group (69.0% vs. 43.5%, p < 0.001). Moreover, cases of severe multiple trauma were higher amongst vehicle collisions than injuries caused by falls (27.8% vs. 12.9%, p = 0.003).Conclusion:Comparing falls with motor vehicle collisions, patients who fell were older and sustained more extremity injuries. Patients injured by motor vehicle collision were more likely to have sustained multiple trauma than those presenting with falls. Recognition of the relationship between mechanisms and consequences of injuries may lead to more effective interventions.

简介：AbstractPurpose:Alcohol has been associated with 10%—35% trauma admissions and 40% trauma-related deaths globally. In response to the COVID-19 pandemic, the United Kingdom entered a state of "lockdown" on March 23, 2020. Restrictions were most significantly eased on June 1, 2020, when shops and schools re-opened. The purpose of this study was to quantify the effect of lockdown on alcohol-related trauma admissions.Methods:All adult patients admitted as "trauma calls" to a London major trauma centre during April 2018 and April 2019 (pre-lockdown, n = 316), and 1st April—31st May 2020 (lockdown, n = 191) had electronic patient records analysed retrospectively. Patients’ blood alcohol level and records of intoxication were used to identify alcohol-related trauma. Trauma admissions from pre-lockdown and lockdown cohorts were compared using multiple regression analyses.Results:Alcohol-related trauma was present in a significantly higher proportion of adult trauma calls during lockdown (lockdown 60/191 (31.4%), vs. pre-lockdown 62/316 (19.6%); (odds ratio (OR): 0.83, 95% CI: 0.38—1.28, p < 0.001). Lockdown was also associated with increased weekend admissions of trauma (lockdown 125/191 weekend (65.5%) vs. pre-lockdown 179/316 (56.7%); OR: 0.40, 95% CI: 0.79 to -0.02, p = 0.041). No significant difference existed in the age, gender, or mechanism between pre-lockdown and lockdown cohorts (p > 0.05).Conclusions:The United Kingdom lockdown was independently associated with an increased proportion of alcohol-related trauma. Trauma admissions were increased during the weekend when staffing levels are reduced. With the possibility of further global "waves" of COVID-19, the long-term repercussions of dangerous alcohol-related behaviour to public health must be addressed.

简介：Objective:Toevaluatethetreatmentforpatientswithmajorvascularinjuriesassociatedwithtraumaticorthopedicinjuries.Methods:Atotalof196patients,agedfrom4-67yearswiththemeanageof29.88years,hadmajorvascularinjuriesassociatedwithtraumaticorthopedicinjuriesandweretreatedinourhospitalinaperiodof44years.Themostcommonmechanismoftraumawasblunttrauma(67.3%),openinjuriesaccountedfor32.4%and54.5%oftheinjurieswerelocatedinthelowerextremities.Thevascularinjuryfrequentlyhappenedinthefemoralartery(26.7%)andpoplitealartery(20.3%).Thetreatmentprincipleconsistedofaggressiveresuscitation,Dopplerimagingandstableboneinternalfixationwithsubsequentvascularrepairanddebridement.Thevascularrepairforinjuriesincludedend-to-endanastomosis(80cases,39.6%),interpositionalveingraft(94,46.5%),vasculardecompressionthroughfracturedistraction(18,8.9%),arterialligation(6,3.0%),veinpatch(2,1.0%),bypassgraft(2,1.0%),venousrepairincludingautogenousveingraft(9,24.3%)andligation(28,75.7%)andprophylacticalfasciotomy(15,7.4%).Postoperativeamputationwasperformedin16cases(16.3%).Results:Nointraoperativedeathwasobservedandallfracturesunitedwithin6months.Limbsweresalvagedin180patients(91.8%).Amongthesepatients,earlycomplicationswerefoundin19patients(9.7%)andlatecomplicationswereobservedin8patients(4.1%).Conclusions:Awell-organizedapproach,basedonaspecifictreatmentprinciple,notonlyimprovesclinicaloutcomebutalsodoesgoodtoexcellentfunctionalrecoveryforpatientswithsevereorthopedicinjuriesandconcomitantvascularlesion.

简介：AbstractPurpose:The reliability of trauma coding is essential in establishing the reliable trauma data and adopting efficient control and monitoring policies. The present study aimed to determine the reliability of trauma coding in educational hospitals affiliated to Shahid Beheshti University of Medical Sciences, Iran.Methods:In this descriptive cross-sectional study, 591 coded medical records with a trauma diagnosis in 2018 were selected and recoded by two coders. The reliability of trauma coding was calculated using Cohen's kappa. The data were recorded in a checklist, in which the validity of the content had been confirmed by experts.Results:The reliability of the coding related to the nature of trauma in research units was 0.75—0.77, indicating moderate reliability. Also, the reliability of the coding of external causes of trauma was 0.57—0.58, suggesting poor reliability.Conclusion:The reliability of trauma coding both in terms of the nature of trauma and the external causes of trauma does not have a good status in the research units. This can be due to the complex coding of trauma, poor documentation of the cases, and not studying the entire case. Therefore, holding training courses for coders, offering training on the accurate documentation to other service providers, and periodically auditing the medical coding are recommended.

简介：Objective:Toinvestigatethecorrelationbetweentraumaandpulmonarythromboembolism.Methods:Comminutedfracturesandextensivesoft-tissuecontusionatbothhindlimbsweremadebyafallingweightfromaheightin16rabbits.Lungperfusionscanningwasperformedtoobtaintheradioactivitycountsbeforetrauma,at1h,48hand96haftertrauma.Allthedataweredividedinto4groupsbasedontheabove4timepoints.Therabbitsweresacrificedwhenpositivefindingsonthepulmonaryperfnsionscanningappeared.Theirlungswereharvestedtobeparaffin-embeddedandstainedwithhematoxylin-erosinmethodforhistologicalexaminationofthromboembolism.TherandomizedblockdesignANOVAandthemethodofleastsignificantdifference(LSD)wereusedforstatisticalanalysisoftheradioactivitycounts.Results:Thehistologicalfindingsshowedthatpulmonaryembolismdevelopedin6ofthe16rabbits(37.5%).Fiveofthe6pulmonaryembolismrabbitspresentedneitherclinicalsymptomsnorpositivepulmonaryembolismmanifestationsinthelungperfusionscanning.Asignificantdifferencewasfoundinlungperfusionradioactivitybetweenthepre-traumatic,post-traumatic1hgroupsandpost-traumatic48hand96hgroups(P<0.05).Conclusions:Fracturesofthehindlimbsaccompaniedwithextensivesoft-tissuecontusionmaycausepulmonarymicro-embolismthatisnotsensitivetolungperfusionscanningandtendstohavenoclinicalsymptoms.Pulmonaryembolismdevelopmentmaytakemorethantwodaysaftertrauma.

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简介：Objective:Toevaluatetheepidemiologiccharacteristicsofexpresswaytraffictraumain2040casesinZhejiangProvince.Methods:Thedataof2040casesofexpresswaytraffictraumatakenfromZhejiangProvincialExpresswayTrafficBureauwereanalyzedwithcomputertechniques.Results:Atotalof2040personswereinjuredin7963expresswaytrafficaccidentsinZhejiangProvincefromJanuary1999toDecember2001.Amongthem,435personsdied(mortality,21.3%)and1605wereinjured.Theeconomiclosseswereover170millionyuanRMB.Theaccidentscausedbyhumanfactorsaccountedfor84.9%(vehicledriversaccountingfor79.2%),whichmainlyincludedimpropermeasures(20.4%),steeringfailure(17.7%),insufficientlongitudinalspace(15.9%),overspeeddrive(12.5%),fatiguedrive(6.4%),loadingviolation(5.9%)andcarelessdrive(6.3%).Mechanicaltroublesandotherfactorstookup15.1%.Thereexistedobviousunevendistributionamongvariousregions.JiaxingandShaoxingwerethesectionswithhighincidenceofaccidents.Theaccidentsmostlyhappenedat12:00-18:00,butthecausing-deadonesmostconcentratedat0:00-6:00.Themainvictimswereyoungandmiddle-agedpeople(accountingfor72.3%),butaccident-strickenchildrenandelderlypersons(over70yearsold)tookuphighermortalities(30.2%and40.7%,respectively).Conclusions:Thenumberofexpresswaytrafficaccidentsandtheeconomiclossesareincreasingyearbyyear,withobviousunevendistributionatdifferentplaces,differenttimeandunderdifferentweatherconditions.Toreducetheaccidentfrequency,itisimportanttostrengthentheenforcementoftrafficregulation,tobalancethesystemof'person-vehicle-road',andtoimprovethesafetyconsciousnessofpeople.

简介：Objective:Toexploretheriskfactorsofnosocomialinfectioninseverecraniocerebraltraumaandthewayofprevention.Methods:Theclinicaldataof387patientswithseverecraniocerebraltraumawerereviewed.Results:Thetotalnosocomialinfectionrateofthisstudywas22.99%.Pulmonarynosocomialinfectionpresentedmostfrequently.TheG-bacilliwerethemostcommoninfectiousbacteria.Themortalityrateoftheinfectiongroupwas38.20%.Conclusions:Complicationsofnosocomialinfectionaffecttheprognosisofcraniocerebraltraumapatients.Nosocomialinfectionisrelatedtotheageofthepatients,craniocerebraltraumaseverity,unreasonableutilizationofantibioticsandinvasiveoperations,suchastrachealcannula,mechanicalventilation,urethralcatheterizationanddeepvenouscatheterization.Patientswithseverecraniocerebraltraumashouldbecarefullytreatedandnursedtoavoidnosocomialinfection.Inordertoreducetherateofnosocomialinfection,intensivemeasurementshouldbeadopted.

简介：AbstractBlunt traumatic aortic injury is the second leading cause of death after motor vehicle accidents. The most frequent localisation of aortic lesion is the isthmus, especially in those who survived the accident. Here we report a case of blunt traumatic aortic injury with unusual localisation and modality. A 31 years old man sustained a motorcycle accident, being run over by a car. Computed tomography scan showed an atypical ascending aorta lesion, confirmed by intraoperative finding. The patient underwent emergency ascending aorta replacement with Dacron tubular graft. The patient was discharged uneventfully on 35th postoperative day, after multiple maxillofacial surgeries for concomitant injuries.

简介：AbstractPurpose:There are currently no clear guidelines for use of pan- or selective CT in elderly trauma patients and this subject matter remains controversial. The aim of this study is to compare the outcome of elderly trauma patients in a level 1 trauma centre who required a pan- or selective CT scan on admission.Methods:The Trauma Audit Research Network database was reviewed to identify eligible patients (≥65 years) over a one-year period, from January 2018 to January 2019. Patients’ demographics, mechanism of injury, injury severity score, length of hospital stay (LOS), mortality and type of CT scans done were recorded. The inclusion criteria were elderly patients ≥65 years involved in acute trauma setting (less than one day between incident and emergency department presentation and blunt mechanism of injury). Exclusion criteria were patients <65 years, perforating mechanism of injury and patients with delayed presentation more than one day after the incident, and patients who have not got any CT scan at presentation. Statistical analyses were undertaken on SPSS (version 25.0; IBM, New York, USA).Results:In total, 481 patients with the mean age of 80.8 years were evaluated (48.6% male). Among them 232 cases were multiple injuries while 249 were single system injuries. And 235 patients (48.8%) underwent pan-CT in whom 66.8% were multiple injuries; 246 (51.1%) did selective CT scan in whom 69.5% were single system injuries. In multiple injury patients, performing a pan-CT scan on presentation was associated with shorter LOS compared to those who had a selective CT, in which 76.4% patients spent < 21 days in the pan-CT group compared to 16.0% for those investigated by selective CT scan (p < 0.001); and 2.5% spent > 60 days in pan-CT group compared to 64% in selective CT group (p < 0.0001). Performing pan-CT was also associated with lower need to repeat CT (p < 0.01). In patients with a single system injury, no differences were found in LOS or the need to repeat CT if either pan-CT or selective CT were requested.Conclusion:We recommend doing pan-CT scan in all elderly patients with multiple system injuries as it decreases the LOS and the need for another CT during hospital stay. No difference in LOS or the need to repeat another CT if pan-CT or selective CT were requested initially in single system injuries. Although age and injury severity score are poor predictors for the need to do pan-CT, the mechanism of injury may be helpful.

简介：AbstractPurpose:The mortality rate for severely injured patients with the injury severity score (ISS) ≥16 has decreased in Germany. There is robust evidence that mortality is influenced not only by the acute trauma itself but also by physical health, age and sex. The aim of this study was to identify other possible influences on the mortality of severely injured patients.Methods:In a matched-pair analysis of data from Trauma Register DGU®, non-surviving patients from Germany between 2009 and 2014 with an ISS≥16 were compared with surviving matching partners. Matching was performed on the basis of age, sex, physical health, injury pattern, trauma mechanism, conscious state at the scene of the accident based on the Glasgow coma scale, and the presence of shock on arrival at the emergency room.Results:We matched two homogeneous groups, each of which consisted of 657 patients (535 male, average age 37 years). There was no significant difference in the vital parameters at the scene of the accident, the length of the pre-hospital phase, the type of transport (ground or air), pre-hospital fluid management and amounts, ISS, initial care level, the length of the emergency room stay, the care received at night or from on-call personnel during the weekend, the use of abdominal sonographic imaging, the type of X-ray imaging used, and the percentage of patients who developed sepsis. We found a significant difference in the new injury severity score, the frequency of multi-organ failure, hemoglobine at admission, base excess and international normalized ratio in the emergency room, the type of accident (fall or road traffic accident), the pre-hospital intubation rate, reanimation, in-hospital fluid management, the frequency of transfusion, tomography (whole-body computed tomography), and the necessity of emergency intervention.Conclusion:Previously postulated factors such as the level of care and the length of the emergency room stay did not appear to have a significant influence in this study. Further studies should be conducted to analyse the identified factors with a view to optimising the treatment of severely injured patients. Our study shows that there are significant factors that can predict or influence the mortality of severely injured patients.

简介：AbstractTrauma-induced pulmonary thromboembolism is the second leading cause of death in severe trauma patients. Primary fibrinolytic hyperactivity combined with hemorrhage and consequential hypercoagulability in severe trauma patients create a huge challenge for clinicians. It is crucial to ensure a safe anticoagulant therapy for trauma patients, but a series of clinical issues need to be answered first, for example, what are the risk factors for traumatic venous thromboembolism? How to assess and determine the status of coagulation dysfunction of patients? When is the optimal timing to initiate pharmacologic prophylaxis for venous thromboembolism? What types of prophylactic agents should be used? How to manage the anticoagulation-related hemorrhage and to determine the optimal timing of restarting chemoprophylaxis? The present review attempts to answer the above questions.