Maeyane Stephens Moeng

Background: Occult diaphragmatic injury occurs in 17%–54% of patients with left thoracoabdominal penetrating trauma and carries a substantial risk of delayed herniation, bowel strangulation, and mortality if missed. The comparative diagnostic performance of multidetector computed tomography (CT) and diagnostic laparoscopy (DL) in this specific population remains incompletely defined. Methods: A systematic review was conducted according to the PRISMA‐DTA statement. PubMed/MEDLINE, Scopus, Cochrane Library, and Google Scholar were searched from inception to August 2026. Diagnostic accuracy studies reporting CT findings against a surgical reference standard in adult patients with left thoracoabdominal penetrating trauma were included. The methodological quality was assessed with QUADAS‐2. A bivariate random‐effects model was used for pooled estimates. Results: Four primary diagnostic accuracy studies (222 patients with extractable 2 × 2 data) were included. Individual sensitivities of CT ranged from 50% to 82% and specificities from 88% to 100%. The pooled sensitivity of CT was 0.70 (95% CI 0.56–0.80; I ² = 36%) and the pooled specificity was 0.94 (95% CI 0.89–0.97; I ² = 0%). Qualitative evidence from seven additional studies demonstrated diaphragmatic injury rates of 23%–54% and high feasibility of therapeutic laparoscopy. Conclusions: CT has high specificity but insufficient sensitivity to reliably exclude diaphragmatic injury after left thoracoabdominal penetrating trauma. Diagnostic laparoscopy remains the reference standard for definitive exclusion and permits immediate repair. Trial Registration: CRD420261458138

Background: Non-operative management (NOM) is the standard of care for haemodynamically stable patients with blunt splenic injury; however, failure of NOM remains clinically significant, particularly in settings where adjunctive interventions such as splenic artery embolisation are not routinely utilised. This study aimed to evaluate NOM outcomes and identify predictors of failure at a South African Level I trauma centre. Methods: A retrospective cohort study of adult patients with blunt splenic injury over a 5-year period (2020–2025) was conducted. Patients were stratified according to their initial management strategy into operative and non-operative groups. Categorical variables were compared using Fisher’s exact test, and continuous variables using the Mann–Whitney U test. Multivariable logistic regression analysis was performed to identify independent predictors of NOM failure. Results: A total of 136 patients were included. Twelve patients (8.8%) underwent immediate operative management, while 124 (91.2%) were initially managed non-operatively. NOM was successful in 112 patients (90.3%), with 12 patients (9.7%) requiring delayed operative intervention. Overall mortality was 4.4% (6/136), with all deaths attributable to associated injuries rather than isolated splenic trauma. Increased admission heart rate was independently associated with NOM failure (OR 1.04 per beat increase; 95% CI 1.01–1.08; p = 0.009). Higher Injury Severity Scores and severe traumatic brain injury were more frequent in patients with NOM failure but were not independently predictive. Splenic artery embolisation was not utilised in this cohort. Conclusions: Non-operative management is safe and effective for blunt splenic injury, with high rates of splenic preservation. Admission tachycardia predicts NOM failure and may guide early clinical decision-making. These findings support the use of NOM in low- and middle-income settings where interventional radiology is not routinely available.

Background: Renal trauma is a major cause of morbidity and mortality among trauma patients, especially in low- and middle-income countries (LMICs) where penetrating injuries are common. Although international evidence increasingly supports selective non-operative management (SNOM) for haemodynamically stable patients, data from resource-limited settings remain scarce. This study sought to assess the management outcomes of patients with traumatic renal injury at a South African tertiary trauma centre, describing management patterns and outcomes and identifying predictors of in-hospital death. Methods: A retrospective audit was carried out on all consecutive trauma patients presenting with renal injuries at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) between July 2021 and June 2024. Patient demographics, injury mechanism and grade, admission physiological parameters, management strategies, complications, and outcomes were documented. Associations with in-hospital mortality were analysed using bivariate methods and Cox proportional hazards regression. Results: Of 161 patients included, 91.3% were male, with a median age of 32 years (interquartile range [IQR] 26–38). Penetrating trauma accounted for 80.1% of cases, predominantly gunshot wounds (GSWs; 49.7%). Most injuries were classified as American Association for the Surgery of Trauma (AAST) grades III–V (74.5%), and 68.3% required surgical intervention, although direct renal procedures were necessary in only 42.7% of operated patients. Nephrectomy accounted for 80.9% of renal-specific surgical interventions (38 of 47 patients who underwent a direct renal procedure). The overall in-hospital mortality rate was 17.4%. On multivariable analysis, admission lactate (hazard ratio [HR] 1.09; 95% confidence interval [CI] 1.00–1.18; p = 0.049), admission creatinine (HR 1.56; 95% CI 1.29–1.89; p < 0.001), and blood product transfusion within 24 h (HR 3.27; 95% CI 1.14–9.41; p = 0.028) were independently associated with mortality in the adjusted model. Conclusions: Admission lactate, creatinine, and early blood transfusion requirements were independently associated with in-hospital mortality in the adjusted model in this high-acuity cohort. These readily available physiological markers may facilitate early identification of high-risk patients in resource-limited settings; however, in the absence of ISS data, these variables may partly reflect the global burden of physiological insult from polytrauma rather than renal-specific predictors of death. A proportion of patients were managed non-operatively; however, given the inherent selection bias in management allocation and the absence of SNOM-specific outcome data stratified by AAST grade, no conclusions regarding the efficacy or safety of non-operative management can be drawn from this descriptive audit.

Background: Penetrating abdominal trauma with bowel or omental evisceration has traditionally mandated exploratory laparotomy due to perceived high risk of intra‐abdominal injury. Selective nonoperative management (SNOM) has gained acceptance in stable patients, but evidence specific to evisceration remains limited and controversial. Objective: To compare outcomes of operative management versus SNOM in adults with penetrating abdominal trauma and documented evisceration. Methods: Systematic review conducted per PRISMA 2020 guidelines. Databases searched were as follows: PubMed, Scopus, Wits Summon, and Google Scholar (1980–2025). Inclusion were as follows: adults ≥ 18 years, penetrating (stab/gunshot) trauma, documented bowel/omental evisceration, operative versus SNOM comparison, and outcomes (mortality, missed injuries, delayed therapeutic laparotomy, complications, and length of stay). Risk of bias via Newcastle–Ottawa Scale; evidence certainty via GRADE. Random‐effects meta‐analysis performed where feasible PROSPERO registration number: (CRD420261345559). Results: From 292 records, 152 remained after deduplication; 47 full texts assessed; 20 studies included in qualitative synthesis; and 13 in meta‐analysis. SNOM significantly reduced nontherapeutic laparotomy (pooled OR 0.61, 95% CI 0.46–0.80; I ² = 26%; and p < 0.001) without increased mortality or morbidity. Subgroup analysis showed SNOM particularly safe in isolated omental evisceration (failure < 15%), with higher therapeutic rates in bowel/organ cases. Evidence certainty was moderate (downgraded for observational design and heterogeneity). Conclusions: In hemodynamically stable patients with penetrating abdominal trauma and evisceration, SNOM appears safe and preferable in selected cases reducing unnecessary laparotomies without compromising outcomes. Prospective trials are needed to refine indications.

Background: Laparoscopy is a valuable surgical modality in trauma, yet its application remains underexplored. This study evaluates the feasibility and short-term outcomes of laparoscopy for abdominal trauma at a high-volume Level 1 trauma centre in Johannesburg. Methods: A retrospective cohort study of adult patients who underwent laparoscopy for abdominal trauma at Charlotte Maxeke Johannesburg Academic Hospital from January 2021 to June 2025 was conducted. Demographics, mechanism of injury, injury severity score, intraoperative findings, conversion rates, complications and length of stay were analysed. Results: Of 69 patients who underwent laparoscopy, 60 met the inclusion criteria. Median age was 30.5 years (IQR 27–38), with 95% male patients (95% CI: 86.3%–98.3%). Penetrating trauma accounted for 98.3% of cases. Negative laparoscopy occurred in 28.3% (95% CI: 18.5%–40.8%), potentially avoiding non-therapeutic laparotomy. Diaphragmatic injuries were the most common positive finding (15%). Conversion occurred in 23.3% (95% CI: 14.4%–35.4%), most commonly for definitive repair (15%). Complications occurred in 6.7% (95% CI: 2.6%–15.9%), with no in-hospital mortalities. Median length of stay was 4 days (IQR 3–7). Conclusion: Laparoscopy is feasible in carefully selected haemodynamically stable trauma patients, even in resource-constrained, high-volume settings. These findings support further investigation of laparoscopy in low- and middle-income countries, with investment in training infrastructure a key priority. Contribution: This study provides contemporary South African evidence on the feasibility and short-term outcomes of laparoscopy in selected trauma patients and supports further evaluation of its potential to avoid non-therapeutic laparotomy.

Background: Trauma remains a leading cause of morbidity and mortality in low- and middle-income countries (LMICs), with South Africa experiencing a high burden of intentional and high-energy injuries. Disparities in critical care resources between the public and private healthcare sectors have been reported, but comparative trauma intensive care unit (ICU) outcomes remain incompletely described. Methods: This retrospective cohort study compared adult trauma patients admitted to public and private healthcare sector ICUs in Johannesburg between July 2022 and June 2023. The primary outcome was 30-day in-hospital mortality. Secondary outcomes included injury characteristics, severity of illness and factors associated with mortality. Descriptive statistics and multivariate logistic regression were used for data analysis. Results: A total of 453 trauma patients were included (private ICU n = 209; public ICU n = 244), with male predominance in both cohorts. Private ICU patients were older, more frequently sustained blunt trauma, and had longer ICU stays. Public ICU patients were younger and more likely to sustain penetrating trauma (68.4% vs 14.4%; p < 0.001). Thirty-day mortality did not differ significantly (private 8.6% vs public 11.9%; p = 0.255), despite greater illness and injury severity among private ICU patients. Greater severity of illness and injury independently predicted mortality, while public ICU admission was associated with increased adjusted odds of mortality. Conclusion: Despite differences in injury profiles, patient mortality was similar in both healthcare sectors. Illness severity remains the prevailing determinant of outcome, underscoring the importance of severity scoring systems and potential system-level factors in LMICs’ trauma care. Level of evidence: Level III; prognostic and epidemiological study. Contribution: This study provides comparative trauma ICU outcomes data from the public and private healthcare sectors in Johannesburg, highlighting the role of illness severity and healthcare sector infrastructure on patient mortality and informing trauma critical care in LMICs.

Background: Non-operative management (NOM) has become the standard of care for haemodynamically stable patients with liver trauma, yet robust data from low- and middle-income countries (LMICs) remain scarce, particularly in settings with a high burden of penetrating trauma. Methods: This single-centre retrospective cohort study analysed 251 adult patients with liver injuries managed non-operatively at a major trauma centre in Johannesburg, South Africa, between January 2017 and December 2023. The primary outcome was in-hospital mortality. Secondary outcomes included 30-day survival and associated injury patterns. Results: Overall mortality was 1.20% (3/251; Wilson 95% confidence interval [CI]: 0.41–3.45). All deaths occurred within 30 days. Admission lactate was the only variable significantly associated with mortality in the univariate analysis (odds ratio [OR]: 1.53 per 1 mmol/L increase, 95% CI: 1.11–2.10, p = 0.009). Sensitivity analysis using Firth’s penalised logistic regression yielded consistent results (penalised OR: 1.48, 95% CI: 1.08–2.03, p = 0.015). The American Association for the Surgery of Trauma (AAST) liver injury grade showed no association with mortality. Chest injuries were the most common associated injury (42.6%). Associated injury patterns were consistent across Grades III–V. Conclusion: In appropriately selected haemodynamically stable patients, NOM achieved excellent outcomes despite a substantial polytrauma burden. Physiology, rather than anatomic grade or associated injury pattern, determined survival. These findings support physiology-led selection in resource-constrained environments. Contribution: This study provides key insights into the real-world outcomes of non-operative management (NOM) of liver trauma in a high-volume, resource-constrained South African trauma centre. It demonstrates exceptionally low mortality (1.20%) with physiology-led patient selection despite a high burden of penetrating trauma and polytrauma. The primary contribution is evidence that admission lactate is a strong predictor of mortality, while anatomic injury grade (AAST) is not. These findings reinforce physiology-guided decision-making in LMIC settings and align directly with the journal’s focus on clinical practice and surgical outcomes in Southern Africa.

Background: Penetrating chest trauma is a leading cause of mortality in South Africa. In haemodynamically stable patients with injuries within the cardiac box, occult cardiac injury remains difficult to detect, particularly in resource-limited settings. The diagnostic utility of troponin T in this population is poorly defined. Methods: A retrospective cohort study was conducted on haemodynamically stable patients presenting with penetrating anterior chest injuries to Charlotte Maxeke Johannesburg Academic Hospital between May 2022 and June 2024. Sensitivity, specificity, positive predictive value, and negative predictive value (NPV) of serum troponin T were calculated against subxiphoid pericardial window, surgical findings, ultrasound and electrocardiography. Results: Among 256 patients (96% male; median age 31 years), 65% sustained stab wounds and 35% gunshot wounds. Serum Troponin T demonstrated high sensitivity (90.5% pooled against definitive modalities) and an NPV of up to 88.8% in concordance analysis with commonly used screening modalities (non-reference comparators); NPV against definitive reference standards ranged from 50.0% to 66.7%, but had low specificity (37.5% pooled). Overall mortality was 3.9% and was significantly associated with haemopericardium (p = 0.020) and pleural injury (p = 0.029). Conclusion: Serum Troponin T offered high sensitivity and NPV for excluding occult cardiac injury in haemodynamically stable patients, supporting its role as an accessible screening adjunct in resource-constrained emergency departments. Contribution: This study represents the largest cohort evaluating serum troponin T in haemodynamically stable penetrating chest trauma, addressing a critical evidence gap. The findings are directly relevant to South African clinical practice and align with the journal’s focus on improving patient care in resource-limited settings.