Choi YU, et al. J Korean Soc Coloproctol. 2011 Jun;27(3):114-121. http://dx.doi.org/10.3393/jksc.2011.27.3.114

Kim K, et al. Yonsei Med J. 2019 May;60(5):474-480. https://doi.org/10.3349/ymj.2019.60.5.474

Delta neutrophil index (DNI) can be used as a biomarker for infection to predict patient outcomes. We aimed to investigate the relationship between DNI and clinical outcomes in trauma patients who underwent abdominal surgery. We retrospectively analyzed injured patients who underwent emergent abdominal surgery in the regional trauma center of Wonju Severance Christian Hospital between March 2016 and May 2018. Patient characteristics, operation type, preoperative and postoperative laboratory findings, and clinical outcomes were evaluated. Logistic regression analysis was performed for risk factors associated with mortality. Overall, 169 patients (mean age, 53.8 years; 66.3% male) were enrolled in this study, of which 19 (11.2%) died. The median injury severity score (ISS) was 12. The non-survivors had a significantly higher ISS [25(9–50) vs. 10(1–50), p<0.001] and serum lactate level (9.00±4.10 vs. 3.04±2.23, p<0.001) and more frequent shock (63.2% vs 23.3%, p<0.001) and solid organ injury (52.6% vs. 25.3%, p = 0.013) than the survivors. There were significant differences in postoperative DNI between the two groups (p<0.009 immediate post-operation, p = 0.001 on postoperative day 1 [POD1], and p = 0.013 on POD2). Logistic regression analysis showed that the independent factors associated with mortality were postoperative lactate level (odds ratio [OR] 1.926, 95% confidence interval [CI] 1.101–3.089, p = 0.007), postoperative sequential organ failure assessment score (OR 1.593, 95% CI 1.160–2.187, p = 0.004), and DNI on POD1 (OR 1.118, 95% CI 1.028–1.215, p = 0.009). The receiver operating characteristics curve demonstrated that the area under the curve of DNI on POD1 was 0.887 (cut-off level: 7.1%, sensitivity 85.7%, and specificity 84.4%). Postoperative DNI may be a useful biomarker to predict mortality in trauma patients who underwent emergent abdominal surgery.

Background: Several recent studies have shown that preperitoneal pelvic packing (PPP) effectively produces hemostasis in patients with unstable pelvic fractures. However, few studies have examined the rate of surgical site infections (SSIs) in patients undergoing PPP following an unstable pelvic fracture. The purpose of the present study was to evaluate factors associated with SSI in such patients.Methods: We retrospectively reviewed the medical charts of 188 patients who developed hemorrhagic shock due to pelvic fracture between April 2012 and May 2021. Forty-four patients were enrolled in this study.Results: SSI occurred in 15 of 44 patients (34.1%). The SSIs occurred more frequently in cases of repacking during the second-look surgery (0 vs. 4 [26.7%], P=0.010) and combined bladder-urethra injury (1 [3.4%] vs. 4 [26.7%], P=0.039). The incidence of SSIs was not significantly different between patients undergoing depacking within or after 48 hours (12 [41.4%] vs. 5 [33.3%], P=0.603). The mean time to diagnosis of SSI was 8.1±3.9 days from PPP. The most isolated organism was Staphylococcus epidermidis.Conclusions: Repacking and combined bladder-urethra injury are potential risk factors for SSI in patients with unstable pelvic fracture. Close observation is recommended for up to 8 days in patients with these risk factors. Further, 48 hours after PPP, removing the packed gauze on cessation of bleeding and not performing repacking can help prevent SSI. Additional analyses are necessary with a larger number of patients with the potential risk factors identified in this study.

Ko JW, et al. Ann Surg Treat Res. 2020 Dec;99(6):352-361. https://doi.org/10.4174/astr.2020.99.6.352

Background. Although blunt abdominal trauma is sometimes readily identified in patients with trauma, its diagnosis and treatment can be delayed due to various limitations including unconsciousness or unstable vital functions, which may cause shock due to blood loss and sepsis. Confirming the correlation between the specific damage of the abdominal organ and the recommended surgical intervention will allow for predicting abdominal damage based on the specific underlying trauma mechanisms. Objectives. This study aimed to assess the proportion of patients with blunt trauma resulting from intraabdominal injury who received surgical intervention (surgery and angioembolization [A/E]), stratified by trauma mechanism and to examine which organs were damaged per different trauma incident. Methods. We retrospectively analyzed the clinical characteristics of 2,291 patients in a tertiary trauma center. Clinical characteristics included age, sex, injury severity score, trauma mechanism (car, motorcycle, pedestrian, bicycle, ship or train accident, fall, slipping or rolling down, bumping, crush injury, explosion burn, and others), abdominal surgical intervention, damaged organ, and A/E site. Results. One-fourth of the patients with blunt trauma required surgical intervention in the abdomen. In particular, the mesentery or bowel was the main injured area for abdominal surgery in all mechanisms, and the spleen or liver was the main damaged organ subjected to A/E. Therefore, we should consider that a substantial proportion of patients with trauma do require abdominal surgery. In particular, repeated physical examination and imaging tests are necessary when the patients are unconscious or their vital functions are unstable for accurate confirmation of injury.