Victor Kong

Background: The management of penetrating cardiac injuries (PCI) has evolved significantly. Haemodynamically stable patients with benign PCIs may be managed conservatively or with subxiphoid pericardial window (SPW). Whereas this approach has been adopted in high‐volume trauma centres, its applicability in low‐volume settings remains unclear. The aim of this study was to review the Auckland City Hospital (ACH) experience with the management of benign PCI in a high‐resource low‐volume setting. Methods: A retrospective review was conducted over a 20‐year period from 2005 to 2024 of patients who presented to ACH with a PCI using our trauma registry. Data reviewed included demographics, injury patterns, diagnostic imaging, operative interventions and outcomes. Results: During the 20‐year study period, 14 PCIs were managed by our institution. Ten (71%) were haemodynamically stable and admitted for active clinical observation. Of these, 5 (50%) deteriorated clinically or demonstrated an increased pericardial effusion size on repeat transthoracic echocardiogram (TTE). Three (75%) underwent open surgery, and one (25%) underwent an SPW. The remaining five patients remained clinically stable, with no evidence of increased pericardial effusion on serial TTE and were discharged after 48 hours of observation. There were two (20%) mortalities in the group due to expectant management and refusal of surgery. Conclusion: PCIs are rare in our locality, with approximately two‐thirds presenting haemodynamically stable. In our high‐resource low‐volume environment, open cardiac exploration appears to remain the safest approach, with favourable outcomes. Selective conservatism may be difficult to apply or justify in our environment.

Background: The optimal duration of urinary catheterisation and the necessity of routine follow‐up cystogram prior to catheter removal in non‐iatrogenic bladder injury remain controversial. International guidelines vary, and no local protocol exists. This study reviewed our institutional experience to evaluate the yield of routine cystogram prior to catheter removal. Methods: A retrospective audit was conducted of patients with non‐iatrogenic bladder injuries managed at a Level 1 trauma centre between 2005 and 2024. Patients with partial thickness or complex injuries and those who died within 7 days were excluded. Demographics, injury characteristics, management strategy, catheter duration, use of follow‐up cystogram and complications were analysed. Urinary tract infection was defined as a clinically diagnosed or microbiologically confirmed urinary infection documented during admission requiring antibiotic treatment. Intraperitoneal (IP) and extraperitoneal (EP) injuries were compared using non‐parametric and categorical statistical tests. Follow‐up cystography at our institution was performed using conventional fluoroscopic cystography. Contrast was instilled retrograde through an indwelling urethral catheter using diluted Omnipaque 350 in saline. The bladder was passively filled to approximately 300–350 mL, or until the patient reported fullness or resistance to filling was encountered. Standard anteroposterior and oblique radiographs were obtained. A positive cystogram was defined as any radiologically reported contrast extravasation consistent with a persistent urinary leak. Results: Thirty‐two patients were included (53% male; median age 35 years [IQR 26–53]). All included cases were attributable to blunt trauma. Eighteen (56%) injuries were IP and 14 (44%) EP. Twenty‐two (69%) injuries underwent operative repair. Thirty patients (94%) underwent routine follow‐up cystogram prior to catheter removal; all studies were normal. The median duration of catheterisation was 17 days (IQR 11–25). Urinary tract infection occurred in 38% of patients. Patients who developed urinary tract infection had a longer median duration of catheterisation compared with those who did not develop urinary tract infection (27 days [IQR 12–34] vs. 15 days [IQR 10–22]). There were no urinary leaks identified following catheter removal and no mortality within the available follow‐up documentation. Conclusion: Routine follow‐up cystogram prior to catheter removal demonstrated a very low diagnostic yield in uncomplicated non‐iatrogenic bladder injuries within our cohort. Prolonged catheterisation was common and associated with high rates of urinary tract infection. A selective approach to cystography and earlier catheter removal in uncomplicated injuries, particularly following IP repair, may be appropriate.

Background: The aim of this study was to review the spectrum, pattern and clinical outcome of shotgun injuries managed at a major trauma centre with limited resources. Methods: Patients presenting with shotgun injuries between January 2012 and December 2024 were retrospectively reviewed. This was accomplished using the Hybrid Electronic Medical Registry. Data included demographics, injury pattern, regions affected, diagnostic imaging, operative interventions and clinical outcomes. Results: During the 13-year study period, a total of 148 patients sustained shotgun injuries. The median age was 31 years and 93% (137/148) were male. The median Injury Severity Score was 9. Of the 148 patients, 76% (112/148) had plain films performed in the resuscitation room, and 76% (113/148) underwent computed tomography following initial assessment. Single body injuries were noted in around half (51%) of the patients, with the remaining sustaining injuries in multiple regions. The abdomen was most commonly injured (46%), followed by the chest (38%) and lower limb (34%). Operative intervention was necessary for 88 patients (59%), of whom 33 (38%) required multiple operations. The median total length of hospital stay was 5 days, with an overall mortality rate of 5% (8/148). Conclusion: Shotgun injuries are associated with a range of injuries to multiple body regions. These injuries have a high requirement for operative intervention and pose a significant morbidity and mortality risk. High-quality imaging is essential but must be integrated with clinical assessment to guide management.

Objective: This study reviews our experience with penetrating neck injury (PNI) secondary to a stab wound (SW) to clarify the incidence of cervical spinal injury (CSI) and to interrogate the role of cervical spinal motion with cervical collar in these patients. Methods: A retrospective review of a prospectively captured data set was conducted at the Pietermaritzburg Metropolitan Trauma Service in South Africa from December 2012 to December 2022. All patients who presented with a PNI due to a SW were included. Results: There were 1249 cases of PNI over the 10 year study period. 1028 were due to a SW and 90% were male. The mean age 30 years. The zonal distribution of the external wounds was were 329 (32%) in zone 1, 469 (46%) in zone 2, 164 (16%) zone 3 and 162 (16%) in the posterior triangle of the neck. In eighty two (8%) cases a CSI was sustained. In none of these cases was the CSI unstable. Twenty two (22) patients sustained a spinal cord injury and presented with a neurological deficit. Conclusions: While there is a significant incidence of spinal cord injury after a cervical SW, there is a very low incidence of cervical spine instability requiring spinal fixation. The routine application of cervical collar following a SW to the neck is unnecessary.

Purpose: Cervical spinal injury (CSI) following blunt trauma to the neck can have devastating consequences. There is a current controversy surrounding how CSIs are excluded in obtunded patients. This study aimed to evaluate the utility of CT in cervical spine clearance in a high‐volume trauma center in a developing world setting. Methods: Longitudinal 11‐year data (2012–2022) were collected from the Hybrid Electronic Medical Registry (HEMR), based at the Pietermaritzburg Metropolitan Trauma Service, to identify all obtunded patients (GCS < 15) who underwent a cervical CT scan. The accuracy of CT imaging in identifying CSI was evaluated by calculating the diagnostic sensitivity, specificity, negative predictive value, and positive predictive value against the final admission diagnosis. Results: In total, 1039 obtunded blunt trauma patients underwent CT of the C‐spine. 121 (12%) of these patients had a CSI demonstrated on CT or MRI. Six (5%) required surgery, and 115 (95%) were treated nonoperatively. In total, 113 (93%) of these patients had a positive CT, and 8 (7%) patients had a false‐negative CT but went on to have a positive MRI for CSI; none of these patients with an injury identified on MRI required surgery. CT demonstrated a sensitivity and specificity of 93.4% and 96.2%, with a negative predictive value of 99.1% for identifying CSI. Conclusion: In the obtunded trauma patient, CT correctly identifies all patients with a bony fracture of the cervical spine who will require intervention. In a small subset of patients, CT will miss non‐bony injuries. MRI may be necessary for further investigation in the context of persisting clinical concern for CSI (e.g., neurological deficit, polytrauma, unstable vital signs (especially hypotension), and intubation). Most of these non‐bony injuries do not require surgery.

This study evaluated the efficacy and safety of Foley catheter balloon tamponade (FCBT) for actively bleeding penetrating neck injuries (PNI), focusing on rates of haemostatic success, subsequent surgical exploration, morbidity and mortality associated with FCBT in PNI. A systematic search of Medline/PubMed, Embase, CINAHL and the Cochrane Library was conducted to 29 May 2025. Observational studies reporting FCBT outcomes in actively bleeding PNI were included. Pooled proportions were calculated with random effects models using Freeman-Tukey double-arcsine transformation; heterogeneity was explored with subgroup analysis and meta-regression. Study quality was assessed using the ROBINS-I tool. Nine studies (1,658 participants) were included. FCBT was deployed in 236 cases, yielding a pooled rate of use of 27.85% (95% confidence interval [CI] 2.27 to 64.60, I² = 97%, p < 0.01). Primary haemostasis was achieved in 62.50% to 100% across studies, with most series reporting success rates exceeding 80.00%. In total, 53.47% (95% CI 16.97 to 88.27, I² = 61%, p = 0.0360) underwent surgical exploration, most often for major vascular injury or rebleeding at removal. Pooled morbidity and mortality were 11.70% (95% CI 0.00 to 50.47) and 6.30% (95% CI 0.00 to 19.97), respectively. FCBT is a simple, rapid technique that achieves temporary haemorrhage control in PNI, providing a bridge to definitive surgical control, and may be effective as definitive treatment in selected venous injuries. However, pooled data are limited by heterogeneity in catheter size, balloon inflation and dwell time, restricting interpretability. Standardised multicentre prospective studies are needed to refine indications, optimise technique, and quantify complications.

Background: South Africa experiences exceptionally high levels of interpersonal violence, placing a substantial burden on both the public health and criminal justice systems. Mob assault constitutes a specific subset of interpersonal violence, characterized by blunt force trauma. This study aims to expand the existing literature by further quantifying the public health burden of mob assaults and comparing injury patterns, clinical outcomes, and healthcare resource utilization between mob‐related and non‐mob‐related assault in a large retrospective trauma cohort. Methods: This study analyzed 2,622 adult patients with blunt trauma presenting to a tertiary trauma center in South Africa between 2012 and 2022 using a retrospective review design. Patients were categorized into mob assault (MA) and non‐mob assault (NMA) groups. Data collected included demographics, injury severity, resource‐utilization, and clinical outcomes. Results: Patients in the MA group had significantly worse clinical outcomes and higher Abbreviated Injury Scale (AIS) scores. Compared with the NMA group, the MA group was associated with a statistically significant increase in complications, ICU admissions and mortality. Over the past decade, there has been a notable upward trend in rates of MA. Conclusion: Mob assault is a growing public health concern in South Africa, with victims experiencing higher rates of morbidity and mortality than other forms of interpersonal violence. Increased awareness of mob‐related injuries and clinical recognition of crush injury patterns may improve early outcomes. However, further research is required to inform targeted prevention strategies and develop effective interventions.