Jayun Cho

Background/Objectives: Traumatic bladder rupture often accompanies pelvic fracture, making it uncertain whether differences between extraperitoneal bladder rupture (EPBR) and intraperitoneal bladder rupture (IPBR) reflect the rupture site itself or overall trauma burden. Prior multi-institutional evidence has focused on EPBR. We therefore examined whether rupture site was associated with hospital length of stay after accounting for concomitant pelvic fracture and injury severity. Methods: We retrospectively reviewed 46 adults with definite traumatic bladder rupture treated at a single regional trauma center from January 2014 through December 2024. Rupture site was the primary exposure, hospital length of stay was the primary outcome, and intensive care unit (ICU) length of stay was the secondary outcome. Parsimonious exploratory log-linear models included rupture site, concomitant pelvic fracture, and Injury Severity Score (ISS). Results: Twenty-one patients had IPBR, 25 had EPBR, and 26 had concomitant pelvic fracture. In the adjusted primary-outcome analysis, rupture site was not clearly associated with hospital length of stay (EPBR versus IPBR adjusted ratio, 1.02; 95% CI, 0.59–1.76). The secondary adjusted analysis likewise showed no clear association with ICU length of stay (adjusted ratio for ICU days + 1, 1.31; 95% CI, 0.77–2.21). In unadjusted comparisons, pelvic fracture was observed more frequently with EPBR (72.0% versus 38.1%; p = 0.021; FDR q = 0.078), and EPBR was associated with longer hospital stay (median, 44.0 versus 24.0 days; p = 0.024; FDR q = 0.078) and ICU stay (8.0 versus 4.0 days; p = 0.007; FDR q = 0.037). Among 42 surgically treated patients, EPBR was associated with a longer admission-to-repair interval (adjusted ratio for days + 1, 2.21; 95% CI, 1.28–3.82). Conclusions: After adjustment for concomitant pelvic fracture and ISS, rupture site was not clearly associated with hospital or ICU length of stay. The conditional admission-to-repair finding may reflect complex trauma-care pathways rather than diagnostic delay. The frequent coexistence of bladder rupture and pelvic fracture reinforces the clinical importance of careful bladder assessment in patients with severe pelvic trauma.

Subclavian vessel injury concomitant with a closed clavicle fracture is rare, and challenges associated with exposure often make proximal control difficult. This paper presents the case of a 26-year-old man who presented to the emergency department after a fall from the sixth floor with multiple injuries, including closed clavicle fractures and a subclavian artery pseudoaneurysm. Proximal control was achieved with endovascular balloon occlusion rather than by performing cervical extension of median sternotomy. Subsequently, exposure was obtained through a subclavian incision, and the injury was treated with a bypass graft.

Background/Objectives: The Geriatric Trauma Outcome Score (GTOS) is used to predict in-hospital mortality in geriatric patients with trauma. However, its applicability to elderly patients with multiple traumas and severe traumatic brain injury (TBI) remains poorly understood. This study aimed to evaluate the predictive accuracy of the GTOS in elderly patients with multiple traumas and TBI and assess its performance in patients with mild and severe TBI. Methods: We retrospectively analyzed 1283 geriatric multiple trauma patients (aged ≥ 65 years) treated at a regional trauma center from 2019 to 2023. Patients were stratified into mild (head Abbreviated Injury Scale [AIS] ≤ 3) and severe (head AIS ≥ 4) TBI groups. GTOS values were calculated for each patient, and predicted mortality was compared with in-hospital mortality. GTOS predictive accuracy was assessed by analyzing the receiver operating characteristic curve. Results: Patients had a median Injury Severity Score of 18 (interquartile range: 10–25); 33.3% of patients received red blood cell transfusions within 24 h. The overall in-hospital mortality rate was 17.9%; GTOS predicted a mortality rate of 17.6% ± 0.17. The GTOS accurately predicted the in-hospital mortality in the entire cohort, achieving an Area Under the Curve (AUC) of 0.798. Predictive accuracy diminished for patients with severe TBI (AUC = 0.657), underestimating actual mortality (39.5% vs. 28.8% predicted). Conclusions: While the GTOS remains a useful tool for predicting in-hospital mortality in elderly patients with multiple traumas, it consistently underestimates mortality risk in those with severe TBI. Therefore, applying the GTOS in this patient subgroup warrants careful consideration.

So J, et al. J Korean Med Sci. 2025 Mar;40(25):e122. https://doi.org/10.3346/jkms.2025.40.e122

A Morel-Lavallée lesion (MLL) is a pathologic fluid collection within an abnormally formed space, resulting from an internal degloving injury between the muscle fascia and subcutaneous fat layer. Due to its resistance to conservative treatments such as drainage or compression dressing, various therapeutic methods have been developed for MLL. However, no standardized guidelines currently exist. Recently, endoscopic debridement and cutaneo-fascial suture (EDCS) has been introduced for the treatment of MLL, particularly for large lesions resistant to conservative approaches. While this procedure is known to be effective, limited reports are available on potential complications. The authors present a case of skin necrosis following EDCS for a massive MLL.

Traumatic uterine rupture is uncommon but can be fatal and life-threatening for both the mother and infant. In addition to complications caused by trauma itself, such as pelvic fracture, gestational complications such as placental abruption, abortion, premature labor, rupture of membranes, maternal death, and stillbirth can occur. In particular, fetuses have been reported to have a high mortality rate in cases of traumatic uterine rupture. A 36-year-old pregnant female patient fell from the fourth floor and was admitted to our trauma center. We observed large hemoperitoneum, pelvic fractures, and spleen laceration, and the fetus was presumed to be located outside the uterus. The pregnant woman was hemodynamically unstable. Although the fetus was stillborn, angioembolization and surgical treatment were properly performed through collaboration with an interventional radiologist, obstetrician, and trauma surgeons. After two orthopedic operations, the patient was discharged after 34 days. This case report suggests the importance of a multidisciplinary approach in the treatment of pregnant trauma patients.

Purpose: Patients with penetrating injuries are at a high risk of mortality, and many of them require emergency surgery. Proper triage and transfer of the patient to the emergency department (ED), where immediate definitive treatment is available, is key to improving survival. This study aimed to evaluate the epidemiology and outcomes of patients with penetrating torso injuries in Incheon Metropolitan City. Methods: Data from trauma patients between 2014 and 2018 (5 years) were extracted from the National Emergency Department Information System. In this study, patients with penetrating injuries to the torso (chest and abdomen) were selected, while those with superficial injuries were excluded. Results: Of 66,285 patients with penetrating trauma, 752 with injuries to the torso were enrolled in this study. In the study population, 345 patients (45.9%) were admitted to the ward or intensive care unit (ICU), 20 (2.7%) were transferred to other hospitals, and 10 (1.3%) died in the ED. Among the admitted patients, 173 (50.1%) underwent nonoperative management and 172 (49.9%) underwent operative management. There were no deaths in the nonoperative management group, but 10 patients (5.8%) died after operative management. The transferred patients showed a significantly longer time from injury to ED arrival, percentage of ICU admissions, and mortality. There were also significant differences in the percentage of operative management, ICU admissions, ED stay time, and mortality between hospitals. Conclusions: Proper triage guidelines need to be implemented so that patients with torso penetrating trauma in Incheon can be transferred directly to the regional trauma center for definitive treatment.

Traumatic iliac venous injury is rare but can be fatal. Although surgical management is considered a primary treatment method, urgent treatment is required when deep venous thrombosis and subsequent phlegmasia cerulea dolens is combined. It is difficult to treat by surgical management, and pharmaceutic thrombolysis cannot be applied due to the trauma history. Here, we describe a case of unilateral traumatic iliac venous injury and subsequent diffuse venous thrombosis in the affected iliofemoral and infrapopliteal veins, combined with phlegmasia cerulea dolens, treated with endovascular management, including bare metal stent insertion and aspiration thrombectomy.

Hyperbilirubinemia is frequently reported in trauma patients. However, few studies have investigated the effects of hyperbilirubinemia on patients’ clinical trajectories. This study aimed to evaluate the relationship between hyperbilirubinemia and patient outcomes following trauma. Our study included 387 patients who were admitted to the trauma bay with severe trauma between January 2017 and December 2021. We categorized patients into two groups based on their peak bilirubin levels: the low-bilirubin (LB) group, with levels below 3 mg/dL, and the high-bilirubin (HB) group, with levels above 3 mg/dL. We then compared the rates of complications and mortality between these two groups. The incidence of pneumonia (10.8% vs. 32.3%, p < 0.001), acute kidney injury (AKI) (2.8% vs. 19.2%, p < 0.001), sepsis (2.8% vs. 10.1%, p = 0.003), and wound infections (8.3% vs. 30.3%, p < 0.001) was significantly higher in the HB group. Additionally, the mortality rate was significantly higher (4.2% vs. 10.1%, p = 0.028) in the HB group. Multivariate analysis revealed that the higher the bilirubin level, the greater the risk of complications (pneumonia: odds ratio [OR] = 3.238; 95% confidence interval [CI] = 1.68–6.22; p < 0.001, AKI: OR = 4.718; 95% CI = 1.65–13.44; p = 0.004, sepsis: OR = 3.087; 95% CI = 1.00–9.52; p = 0.04, wound infection: OR = 3.995; 95% CI = 2.073–7.700; p < 0.001). In conclusion, hyperbilirubinemia was associated with poorer outcomes in trauma patients.

There are many reasons for solitary kidney. Congenital causes include renal agenesis and dysplasia. Acquired causes include nephrectomy performed for reasons including traumatic kidney injury, disease (e.g., renal cell carcinoma), and donation for kidney transplantation. According to the European Association of Urology, the World Society of Emergency Surgery, and the American Association for the Surgery of Trauma guidelines, it is important to preserve the remaining renal function as much as possible when a solitary kidney patient has suffered a traumatic kidney injury. The authors present a case of kidney preservation in a solitary kidney patient with a traumatic grade IV renal injury through non-operative management involving superselective renal artery angioembolization.