There have been increasing concerns about serious traffic accidents on highways. The purpose of this study was to analyze factors affecting traffic accidents on highways and the severity of the resulting injuries.

This retrospective study was conducted at a regional trauma center. We reviewed 594 patients who had been in 114 traffic accidents on highways from January 2018 to June 2020. We collected demographic data, clinical data, accident-related factors, and meteorological data (weather and temperature).

Environmental risk factors were found to be significantly associated with the incidence of traffic accidents on highways. Injury severity and the death rate were higher in sedans than in any other type of vehicle. Tunnels were the most common location of accidents, accounting for 47 accidents (41.2%) and 269 injured patients (45.3%). The injury severity of individuals riding in the driver’s seat (front seat) was high, regardless of vehicle type. Three meteorological risk factors were found to be significantly associated with traffic accidents: rainy roads (odds ratio [OR] 2.08; 95% confidence interval [CI] 1.84–3.29; p=0.01), icy or snowy roads (OR 5.12; 95% CI 2.88–7.33; p<0.01), and foggy conditions (OR 2.94; 95% CI 2.15–4.03; p<0.05).

The injury severity of patients was affected by seat position and type of vehicle, and the frequency of accident was affected by the location. The incidence of traffic accidents was strongly influenced by meteorological conditions (rain, snow/ice, and fog).

In patients with trauma, rhabdomyolysis (RM) can lead to fatal complications resulting from muscle damage. Thus, RM must be immediately diagnosed and treated to prevent complications. Creatine kinase (CK) is the most sensitive marker for diagnosing RM. However, relying on CK tests may result in delayed treatment, as it takes approximately 1 hour to obtain CK blood test results. Hence, this study investigated whether the neutrophil-to-lymphocyte ratio (NLR) could predict RM at an earlier time point in patients with trauma, since NLR results can be obtained within 10 minutes.

This retrospective study included 130 patients with severe trauma who were admitted to the emergency room of a tertiary institution between January 2017 and April 2020. RM was defined as a CK level ≥1,000 U/L at the time of arrival. Patients with severe trauma were categorized into non-RM and RM groups, and their characteristics and blood test results were analyzed. Statistical analysis was performed using SPSS version 26.0 for Windows.

Of the 130 patients with severe trauma, 50 presented with RM. In the multivariate analysis, the NLR (odds ratio [OR], 1.252; 95% confidence interval [CI], 1.130– 1.386), pH level (OR, 0.006; 95% CI, 0.000–0.198), presence of acute kidney injury (OR, 3.009; 95% CI, 1.140–7.941), and extremity Abbreviated Injury Scale score (OR, 1.819; 95% CI, 1.111–2.980) significantly differed between the non-RM and RM groups. A receiver operating characteristic analysis revealed that a cut-off NLR value of 3.64 was the best for predicting RM.

In patients with trauma, the NLR at the time of arrival at the hospital is a useful biochemical marker for predicting RM.

Near drowning refers to immediate survival after asphyxia due to submersion or immersion in water, which is a crucial public safety problem worldwide. Acute lung injury or acute respiratory distress syndrome (ARDS) is a common complication of near drowning. The purpose of this study was to investigate the feasibility and effectiveness of noninvasive nasal positive pressure ventilation (NINPPV).

This retrospective study was conducted at a tertiary emergency department. NINPPV was administered for moderate ARDS caused by submersion or immersion in patients who were older than 18 years, from January 2015 to December 2018. We collected the demographic (age, sex, length of hospital stay, and outcome), laboratory (arterial blood gas, lactate, oxygen saturation, partial pressure of oxygen divided by the fraction of inspired oxygen, complete blood count, blood urea nitrogen, and creatinine), and clinical data (acute lung injury index and ventilator failure) of the patients. A statistical analysis was performed using Statistical Package for the Social Sciences version 20.0 for Windows.

NINPPV treatment was provided to 57 patients for near drowning, 45 of whom (78.9%) were successfully treated without complications; in 12 (21.1%), treatment was changed to invasive mechanical ventilation within 48 hours due to ARDS or acute kidney injury. NINPPV treatment was successful in 31 (75.6%) out of 41 sea-water near drowning patients. They were more difficult to treat with NINPPV compared with the fresh-water near drowning patients (p<0.05).

NINPPV would be useful and feasible as the initial treatment of moderate ARDS caused by near drowning.