Journal of Trauma and Injury

Case Reports

Bridging the gap: a successful interhospital transfer of a bleeding pelvic fracture patient using REBOA and the “doctor car” system: a case report: Hanbyol Song, Gil Jae Lee, Byungchul Yu, Seung Hwan Lee, Min A Lee, Myung Jin Jang, Jeong Ho Kim, Kang Kook Choi; Received March 11, 2025 Accepted May 22, 2025 Published online November 20, 2025; DOI: https://doi.org/10.20408/jti.2025.0059 [Epub ahead of print]

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Abstract PDF: Severe traumatic injuries, particularly unstable pelvic fractures, frequently result in life-threatening hemorrhagic shock, necessitating urgent transfer to specialized trauma centers. However, interhospital transport of hemodynamically unstable patients poses a significant risk of clinical deterioration. Resuscitative endovascular balloon occlusion of the aorta (REBOA) offers effective temporary hemodynamic stabilization before definitive care. Here, we describe the successful use of zone III REBOA by a surgeon-staffed emergency medical service (“doctor car”) to rapidly stabilize and safely transfer a 62-year-old man with a severe bleeding pelvic fracture. Upon arrival at the trauma center, the patient underwent immediate definitive treatments, including preperitoneal pelvic packing and transarterial embolization. This case highlights the potential for integrating REBOA with physician-staffed emergency transport systems as a strategy to bridge critical gaps in regional trauma care networks and improve patient outcomes.; Summary

Damage control thoracotomy with chest packing for hemorrhage control in massive hemothorax and shock: a case report: Shivinder Singh, Jitendra Kumar Singh, Shalendra Singh, Aishwainee VG, Umesh Kumar, Venkat Narayanan; Received March 10, 2025 Accepted May 15, 2025 Published online September 29, 2025; DOI: https://doi.org/10.20408/jti.2025.0066 [Epub ahead of print]

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Abstract PDF: Severe hemorrhagic shock is a leading cause of death among potentially salvageable casualties. We report the case of a 24-year-old man who sustained a gunshot wound to the right hemithorax and presented with class IV hemorrhagic shock. He underwent resuscitative damage control via a right posterolateral thoracotomy. Intraoperatively, the bleeding source was identified as a lacerated posterior intercostal artery at the level of the 11th dorsal vertebra. Because access to the bleeding site remained limited even after extending the incision, right thoracic packing was performed to control the hemorrhage. On reevaluation 48 hours later, no active bleeding was observed.; Summary

Original Articles

Blunt abdominal trauma: a retrospective study on clinical insights and treatment outcomes: Anurag Kumar, Rachith Sridhar, Harendra Kumar, Abdul Hakeem S., Abdul Vakil Khan, Majid Anwer; J Trauma Inj. 2025;38(3):221-231. Published online September 29, 2025; DOI: https://doi.org/10.20408/jti.2025.0045

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Abstract PDF: Purpose
Blunt abdominal trauma is a significant cause of morbidity and mortality, predominantly affecting younger male patients. Therefore, a study examining the mechanisms of injury, injury patterns, and outcomes in these cases is essential. The aim of this study was to evaluate demographics, injury mechanisms, treatments provided, and outcomes in cases of blunt abdominal trauma at a level I trauma center in Eastern India.
Methods
A descriptive retrospective study was conducted at a level I trauma center using departmental audit data spanning 18 months (July 2022–December 2023). Data from 118 patients diagnosed with blunt abdominal trauma were analyzed.
Results
The study revealed a pronounced male predominance (6.35:1), with a mean age of 30.2 years. Road traffic accidents were the most frequent cause of injury (56.8%). Only six patients (5.1%) presented within the "golden hour," resulting in delayed interventions. Surgical intervention was necessary in 78 cases (66.1%), with hollow viscus perforation being the most common indication. The mean hospital stay was 10.6 days, and the overall mortality rate was 12.7%. The presence of shock upon admission significantly correlated with mortality (P<0.001).
Conclusions
Blunt abdominal trauma continues to represent a critical healthcare challenge, particularly affecting younger males. Improved healthcare accessibility, adherence to Advanced Trauma Life Support protocols, and timely interventions could improve survival rates.; Summary

Correlation of base deficit and age shock index with in-hospital mortality in geriatric major trauma patients: a 1-year retrospective study at a single level I trauma center in Indonesia: Miftahul Khairat Musmar Elbama, M. Iqbal Rivai, Irwan , Avit Suchitra, Aulia Rahman, Rose Dinda Martini; J Trauma Inj. 2025;38(3):204-210. Published online September 3, 2025; DOI: https://doi.org/10.20408/jti.2025.0021

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Abstract PDF: Purpose
Base deficit (BD) and age shock index have been utilized as an indicator of resuscitation adequacy and a predictor of poor outcomes in trauma cases, respectively. However, evidence regarding their correlation with in-hospital mortality among geriatric major trauma patients remains scarce in the literature.
Methods
This analytical observational study employed a retrospective cohort design involving 82 geriatric major trauma patients treated at our institution between November 2023 and November 2024. Data were collected from patients’ medical records at admission (age, trauma mechanism, vital signs, Glasgow Coma Scale [GCS], Injury Severity Score, hemoglobin, BD, and comorbidities) and at discharge (survival or death).
Results
The geriatric major trauma patients who experienced in-hospital mortality were predominantly male, with an average age of 69.6 years. Traffic accidents constituted the most common trauma mechanism. Most patients presented with a GCS score between 13 and 15, and hypertension was the most frequently recorded comorbidity. BD demonstrated a significant correlation with in-hospital mortality (P<0.05). Severe BD was associated with the highest odds of in-hospital mortality (adjusted odds ratio, 40.72; 95% confidence interval, 2.90–560.86). Although age shock index did not directly correlate with mortality, it played a confounding role. Additionally, a GCS score of <9 was significantly correlated with in-hospital mortality (P<0.05).
Conclusions
The findings of this study can inform initial clinical management strategies for geriatric major trauma patients at trauma centers. Prompt resuscitation and treatment should be prioritized for patients presenting with moderate or severe BD to reduce preventable mortality in this population.; Summary

Case Report

Preperitoneal pelvic packing as a salvage operation for postoperative retroperitoneal bleeding with hemodynamic instability after the Kocher-Langenbeck approach to the acetabulum: a case report: Doo-Hun Kim, Maru Kim, Dae-Sang Lee, Tae Hwa Hong, Hangjoo Cho; J Trauma Inj. 2025;38(3):285-289. Published online June 25, 2025; DOI: https://doi.org/10.20408/jti.2024.0087

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Abstract PDF: Pelvic fractures result from high-energy trauma, and when accompanied by hemorrhagic shock, the mortality rate increases to 40%. Pelvic fractures are anatomically categorized as pelvic ring disruptions and acetabular fractures, each requiring different treatment methods and approaches. Acetabular fractures, which also result from high-energy injuries, may be accompanied by hemorrhagic shock. Treatment options for pelvic fractures with hemorrhagic shock include angioembolization, preperitoneal pelvic packing (PPP), and emergency laparotomy. In hemodynamically stable patients, early total care may be attempted, and for acetabular fractures (posterior column), the Kocher-Langenbeck approach is the treatment of choice. This case report describes the use of PPP as a salvage operation for postoperative retroperitoneal bleeding with hemodynamic instability following a Kocher-Langenbeck approach for an acetabular fracture with pelvic ring injury. The patient was discharged without postoperative complications such as bone displacement or surgical site infection. While PPP is commonly employed as an initial treatment modality for pelvic fractures with hemorrhagic shock, it may also be valuable in managing postoperative retroperitoneal bleeding with hemorrhagic shock.; Summary

Original Articles

Management of cardiac trauma and penetrating cardiac injuries with severe hemorrhagic shock: a 5-year experience: Tran Thuc Khang; J Trauma Inj. 2024;37(4):268-275. Published online December 16, 2024; DOI: https://doi.org/10.20408/jti.2024.0063

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2 Web of Science
3 Citations

Abstract PDF

Purpose
The diagnosis and management of cardiac trauma and penetrating cardiac injuries pose significant challenges in emergency settings due to the rapid onset of life-threatening complications. This paper presents a narrative review to better describe the etiology, presentation, and management of penetrating cardiac trauma, offering insights and experiences related to performing emergency surgery for such cases.
Methods
We compiled cases of traumatic cardiac rupture and penetrating cardiac injuries accompanied by severe hemorrhagic shock that necessitated emergency surgery. Data were collected regarding the type of injury, causative agents, specific clinical features observed during emergency admission, intraoperative parameters, and treatment outcomes.
Results
Twenty-one patients (16 men, 5 women) with cardiac rupture or penetrating cardiac injuries were recorded. All patients presented in severe shock, and six cases (28.6%) experienced cardiac arrest upon arrival in the operating room. Cardiac rupture due to blunt chest trauma occurred in two cases (9.5%), and one case (4.8%) involved right atrial perforation due to complex open chest trauma. Penetrating injuries accounted for cardiac perforation in 18 cases (85.7%). Associated injuries were present in 11 cases (52.4%). The intraoperative mortality rate was 9.5%, and there was one postoperative death on the 11th day due to multiorgan failure.
Conclusions
Cardiac trauma and penetrating injuries are usually fatal unless promptly diagnosed and surgically treated. The timing and rapidity of emergency surgery—often foregoing ancillary tests and administrative procedures—are critical for patient survival. Emergency sternotomy, swift control of bleeding, and aggressive resuscitation are essential operative measures in saving lives. Factors that influence prognosis include the extent of blood loss, duration of cardiac arrest, acid-base imbalances, coagulopathy, multiorgan failure, and postoperative infections.

Summary

Citations

Citations to this article as recorded by

Fifteen-year surgical experience with penetrating cardiac injury in Vietnam: A retrospective observational study of management and outcomes
The-May Nguyen, Cong-Huy Nguyen, Minh-Tung Do
Medicine.2025; 104(45): e45759. CrossRef
Penetrating Cardiac Injuries: “Damage Control” and ERAS Ways of Thinking
Vasyl V. Tkalich, Valentyna I. Borysova, Sergii I. Savoliuk, Yurii V. Nedilia, Oleksandr V. Galiiev
Ukrainian Journal of Cardiovascular Surgery.2025; 33(4): 56. CrossRef
Comprehensive management of multidrug-resistant bacterial infections and fungal infections after penetrating chest injury: a case of complex infection in a patient treated for a postinjury wound
Mingwei Gong, Zeping Yang, Juan Han
BMC Infectious Diseases.2025;[Epub] CrossRef

Effects of Trauma-Related Shock on Myocardial Function in the Early Period Using Transthoracic Echocardiography: Dae Sung Ma; J Trauma Inj. 2021;34(2):119-125. Published online June 30, 2021; DOI: https://doi.org/10.20408/jti.2021.0041

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Abstract PDF

Purpose

The present study aimed to analyze the effect of trauma-related shock on myocardial function in the early stages of trauma through transthoracic echocardiography (TTE) findings.

Methods

We performed a retrospective review and analysis of the medical records of patients aged ≥18 years who were evaluated by TTE within 2 days of admission for trauma-related shock (n=72). Patients were selected from a group of 739 patients admitted with trauma-related shock between January 2014 and December 2016.

Results

The incidence rate of myocardial dysfunction in the left ventricle (LV) was 6.8% (5/72), with rates of 7.7% (4/52) in the thoracic injury group and 5.0% (1/20) in the non-thoracic injury group. In the diastolic function of LV, relaxation abnormality was present in 55.8% (29/52) of patients in the thoracic injury group and 50% (10/20) of patients in the non-thoracic injury group.

Conclusions

This study may suggest that traumatic shock without thoracic injury may influence myocardial function in the early stages after trauma. Therefore, evaluation of myocardial function may be needed for patients experiencing shock after trauma, regardless of the presence of thoracic injury.

Summary

Citations

Citations to this article as recorded by

Longitudinal Myocardial Deformation as an Emerging Biomarker for Post-Traumatic Cardiac Dysfunction
Makhabbat Bekbossynova, Timur Saliev, Murat Mukarov, Madina Sugralimova, Arman Batpen, Anar Kozhakhmetova, Zhumagul Sholdanova
Life.2025; 15(7): 1052. CrossRef

Case Series of Zone III Resuscitative Endovascular Balloon Occlusion of the Aorta in Traumatic Shock Patients: Byungchul Yu, Gil Jae Lee, Kang Kook Choi, Min A Lee, Jihun Gwak, Youngeun Park, Jung Nam Lee; J Trauma Inj. 2020;33(3):162-169. Published online September 30, 2020; DOI: https://doi.org/10.20408/jti.2020.0031

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1 Citations

Abstract PDF

Purpose

There is increasing evidence in the literature regarding resuscitative endovascular balloon occlusion of the aorta (REBOA) globally, but few cases have been reported in Korea. We aimed to describe our experience of successful Zone III REBOA and to discuss its algorithm, techniques, and related complications.

Methods

We reviewed consecutive cases who survived from hypovolemic shock after Zone III REBOA placement for 4 years. We reviewed patients’ baseline characteristics, physiological status, procedural data, and outcomes.

Results

REBOA was performed in 44 patients during the study period, including 10 patients (22.7%) who underwent Zone III REBOA, of whom seven (70%) survived. Only one patient was injured by a penetrating mechanism and survived after cardiopulmonary resuscitation. All patients underwent interventions to stop bleeding immediately after REBOA placement.

Conclusions

This case series suggests that Zone III REBOA is a safe and feasible procedure that could be applied to traumatic shock patients with normal FAST findings who receive a chest X-ray examination at the initial resuscitation.

Summary

Citations

Citations to this article as recorded by

On the Feasibility of Using REBOA Technology for the Treatment of Patients with Polytrauma
A. I. Zhukov, N. N. Zadneprovsky, P. A. Ivanov, L. S. Kokov
Russian Sklifosovsky Journal "Emergency Medical Ca.2024; 13(1): 14. CrossRef

Case Report

Successful Damage Control Resuscitation with Resuscitative Endovascular Balloon Occlusion of the Aorta in a Pediatric Patient: Yoonjung Heo, Sung Wook Chang, Dong Hun Kim; J Trauma Inj. 2020;33(3):170-174. Published online September 30, 2020; DOI: https://doi.org/10.20408/jti.2020.0012

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1 Citations

Abstract PDF

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is considered an emerging adjunct therapy for profound hemorrhagic shock, as it can maintain temporary stability until definitive repair of the injury. However, there is limited information about the use of this procedure in children. Herein, we report a case of REBOA in a pediatric patient with blunt trauma, wherein the preoperative deployment of REBOA played a pivotal role in damage control resuscitation. A 7-year-old male patient experienced cardiac arrest after a motor vehicle accident. After 30 minutes of cardiopulmonary resuscitation, spontaneous circulation was achieved. The patient was diagnosed with massive hemoperitoneum. REBOA was then performed under ongoing resuscitative measures. An intra-aortic balloon catheter was deployed above the supraceliac aorta, which helped achieved permissive hypotension while the patient was undergoing surgery. After successful bleeding control with small bowel resection for mesenteric avulsion, thorough radiologic evaluations revealed hypoxic brain injury. The patient died from deterioration of disseminated intravascular coagulation. Although the patient did not survive, a postoperative computed tomography scan revealed neither remaining intraperitoneal injury nor peripheral ischemia correlated with the insertion of a 7-Fr sheath. Hence, REBOA can be a successful bridge therapy, and this result may facilitate the further usage of REBOA to save pediatric patients with non-compressible torso hemorrhage.

Summary

Citations

Citations to this article as recorded by

Dynamic response of the aortic hemodynamic status to endovascular occlusion: A computational fluid dynamics study
Zhongyou Li, Anyu Hou, Jiyang Zhang, Fei Gao, Feng Yan, Lingjun Liu, Taoping Bai, Ming Zhang, Wentao Jiang
Journal of Biomechanics.2025; 184: 112680. CrossRef

Original Articles

Clinical Practice Guideline for the Treatment of Traumatic Shock Patients from the Korean Society of Traumatology: Pil Young Jung, Byungchul Yu, Chan-Yong Park, Sung Wook Chang, O Hyun Kim, Maru Kim, Junsik Kwon, Gil Jae Lee; J Trauma Inj. 2020;33(1):1-12. Published online March 30, 2020; DOI: https://doi.org/10.20408/jti.2020.015

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4 Citations

Abstract PDF

Purpose

Despite recent developments in the management of trauma patients in South Korea, a standardized system and guideline for trauma treatment are absent.

Methods

Five guidelines were assessed using the Appraisal of Guidelines for Research and Evaluation II instrument.

Results

Restrictive volume replacement must be used for patients experiencing shock from trauma until hemostasis is achieved (1B). The target systolic pressure for fluid resuscitation should be 80–90 mmHg in hypovolemic shock patients (1C). For patients with head trauma, the target pressure for fluid resuscitation should be 100–110 mmHg (2C). Isotonic crystalloid fluid is recommended for initially treating traumatic hypovolemic shock patients (1A). Hypothermia should be prevented in patients with severe trauma, and if hypothermia occurs, the body temperature should be increased without delay (1B). Acidemia must be corrected with an appropriate means of treatment for hypovolemic trauma patients (1B). When a large amount of transfusion is required for trauma patients in hypovolemic shock, a massive transfusion protocol (MTP) should be used (1B). The decision to implement MTP should be made based on hemodynamic status and initial responses to fluid resuscitation, not only the patient’s initial condition (1B). The ratio of plasma to red blood cell concentration should be at least 1:2 for trauma patients requiring massive transfusion (1B). When a trauma patient is in life-threatening hypovolemic shock, vasopressors can be administered in addition to fluids and blood products (1B). Early administration of tranexamic acid is recommended in trauma patients who are actively bleeding or at high risk of hemorrhage (1B). For hypovolemic patients with coagulopathy non-responsive to primary therapy, the use of fibrinogen concentrate, cryoprecipitate, or recombinant factor VIIa can be considered (2C).

Conclusions

This research presents Korea's first clinical practice guideline for patients with traumatic shock. This guideline will be revised with updated research every 5 years.

Summary

Citations

Citations to this article as recorded by

External validation of an artificial intelligence model using clinical variables, including ICD-10 codes, for predicting in-hospital mortality among trauma patients: a multicenter retrospective cohort study
Seungseok Lee, Do Wan Kim, Na-eun Oh, Hayeon Lee, Seoyoung Park, Dong Keon Yon, Wu Seong Kang, Jinseok Lee
Scientific Reports.2025;[Epub] CrossRef
The meaning and principles of damage control surgery
Gil Jae Lee
Journal of the Korean Medical Association.2024; 67(12): 732. CrossRef
An Artificial Intelligence Model for Predicting Trauma Mortality Among Emergency Department Patients in South Korea: Retrospective Cohort Study
Seungseok Lee, Wu Seong Kang, Do Wan Kim, Sang Hyun Seo, Joongsuck Kim, Soon Tak Jeong, Dong Keon Yon, Jinseok Lee
Journal of Medical Internet Research.2023; 25: e49283. CrossRef
Nonselective versus Selective Angioembolization for Trauma Patients with Pelvic Injuries Accompanied by Hemorrhage: A Meta-Analysis
Hyunseok Jang, Soon Tak Jeong, Yun Chul Park, Wu Seong Kang
Medicina.2023; 59(8): 1492. CrossRef

Immediate Post-laparotomy Hypotension in Patients with Severe Traumatic Hemoperitoneum: Gil Jae Lee, Min A Lee, Byungchul Yoo, Youngeun Park, Myung Jin Jang, Kang Kook Choi; J Trauma Inj. 2020;33(1):38-42. Published online March 30, 2020; DOI: https://doi.org/10.20408/jti.2020.014

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Abstract PDF: Purpose
Immediate post-laparotomy hypotension (PLH) is a precipitous drop in blood pressure caused by a sudden release of abdominal tamponade after laparotomy in cases of severe hemoperitoneum. The effect of laparotomy on blood pressure in patients with significant hemoperitoneum is unknown.
Methods
In total, 163 patients underwent laparotomy for trauma from January 1, 2013 to December 31, 2015. Exclusion criteria included the following: negative laparotomy, only a hollow viscous injury, and hemoperitoneum <1,000 mL. After applying those criteria, 62 patients were enrolled in this retrospective review. PLH was defined as a decrease in the mean arterial pressure (MAP) ≥10 mmHg within 10 minutes after laparotomy.
Results
The mean estimated hemoperitoneum was 3,516 mL. The incidence of PLH was 23% (14 of 62 patients). The MAP did not show significant differences before and after laparotomy (5 minutes post-laparotomy, 67.5±16.5 vs. 68.3±18.8 mmHg; p=0.7; 10 minutes post-laparotomy, 67.5±16.5 vs. 70.4±18.8 mmHg; p=0.193). The overall in-hospital mortality was 24% (15 of 62 patients). Mortality was not significantly higher in the PLH group (two of 14 [14.3%] vs. 13 of 48 [27.1%]; p=0.33). No statistically significant between-group differences were observed in the intensive care unit and hospital stay.
Conclusions
PLH may be less frequent and less devastating than it is often considered. Surgical hemostasis during laparotomy is important. Laparotomy with adequate resuscitation may explain the equivalent outcomes in the two groups.; Summary

Resuscitative Endovascular Balloon occlusion of the aorta in Impending Traumatic arrest: Is It Effective?: Jae Sik Chung, Oh Hyun Kim, Seongyup Kim, Ji Young Jang, Gyo Jin An, Pil Young Jung; J Trauma Inj. 2020;33(1):23-30. Published online March 30, 2020; DOI: https://doi.org/10.20408/jti.2020.001

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2 Citations

Abstract PDF

Purpose

Hemorrhagic shock is the leading cause of death in trauma patients worldwide. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a technique used to improve the hemodynamic stability of patients with traumatic shock and to temporarily control arterial hemorrhage. However, further research is required to determine whether REBOA with cardiopulmonary resuscitation (CPR) in near-arrest or arrest trauma patients can help resuscitation. We analyzed trauma patients who underwent REBOA according to their CPR status and evaluated the effects of REBOA in arrest situations.

Methods

This study was a retrospective single-regional trauma center study conducted at a tertiary medical institution from February 2017 to November 2019. We evaluated the mortality of severely injured patients who underwent REBOA and analyzed the factors that influenced the outcome. Patients were divided into CPR and non-CPR groups.

Results

We reviewed 1,596 trauma patients with shock, of whom 23 patients underwent REBOA (1.4%). Two patients were excluded due to failure and a repeated attempt of REBOA. The Glasgow Coma Scale score was lower in the CPR group than in the non-CPR group (p=0.009). Blood pressure readings at the emergency room were lower in the CPR group than in the non-CPR group, including systolic blood pressure (p=0.012), diastolic blood pressure (p=0.002), and mean arterial pressure (p=0.008). In addition, the mortality rate was higher in the CPR group (100%) than in the non-CPR group (50%) (p=0.012). The overall mortality rate was 76.2%.

Conclusions

Our study suggests that if REBOA is deemed necessary in a timely manner, it is better to perform REBOA before an arrest occurs. Therefore, appropriate protocols, including pre-hospital REBOA, should be constructed to demonstrate the effectiveness of REBOA in reducing mortality in arrest or impending arrest patients.

Summary

Citations

Citations to this article as recorded by

An Early Experience of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in the Republic of Korea: A Retrospective Multicenter Study
Joonhyeon Park, Sung Woo Jang, Byungchul Yu, Gil Jae Lee, Sung Wook Chang, Dong Hun Kim, Ye Rim Chang, Pil Young Jung
Journal of Trauma and Injury.2020; 33(3): 144. CrossRef
Pitfalls, Complications, and Necessity of Education about REBOA: A Single Regional Trauma Center Study
Sol Kim, Jae Sik Chung, Sung Woo Jang, Pil Young Jung
Journal of Trauma and Injury.2020; 33(3): 153. CrossRef

Case Report

Resuscitation from a pH of 6.5: A Case Report and Review of Pathophysiology and Management of Extreme Acidosis from Hypovolemic Shock after Trauma: Alexander Balmaceda, Sona Arora, Ilan Sondheimer, McKenzie M. Hollon; J Trauma Inj. 2019;32(4):238-242. Published online December 30, 2019; DOI: https://doi.org/10.20408/jti.2019.029

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6 Citations

Abstract PDF

Extreme acidosis is a life-threatening physiological state that causes disturbances in the cardiovascular, pulmonary, immune, and hematological systems. Trauma patients commonly present to the operating room (OR) in hypovolemic shock, leading to tissue hypoperfusion and the development of acute metabolic acidosis with or without a respiratory component. It is often believed that trauma patients presenting to the OR in severe metabolic acidosis (pH <7.0) will have a nearly universal mortality rate despite aggressive resuscitation and damage control. The current literature does not include reports of successful resuscitations from a lower pH, which may lead providers to assume that a good outcome is not possible. However, here we describe a case of successful resuscitation from an initial pH of 6.5 with survival to discharge home 95 days after admission with almost full recovery. We describe the effects of acute acidosis on the respiratory and cardiovascular systems and hemostasis. Finally, we discuss the pillars of management in patients with extreme acute acidosis due to hemorrhage: transfusion, treatment of hyperkalemia, and consideration of buffering acidosis with bicarbonate and hyperventilation.

Summary

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A Case Report of a Patient Surviving Severe Acidemia With Arterial pH Less Than 6.5
Karthik V Iyer, Justin A Jebackumar, Sarah Sundet, Moye Mathew, Vikram Oke
Cureus.2025;[Epub] CrossRef
Design, fabrication, and in vitro evaluation of a 3D printed, bio-absorbable PLA tibia bone implant with a novel lattice structure
Devika Banothu, Pankaj Kumar, Syed Gazanfar Mustafa Ali, Rajasri Reddy, Ravindran Gobinath, Sukumar Dhanapalan
Biomedical Physics & Engineering Express.2025; 11(5): 055015. CrossRef
Outcome of Cardiac Arrest and Non-Cardiac Arrest Patients with Severe Acidosis in the Emergency Department: A Retrospective Cohort Study
Zeynep Saral Öztürk, Emine Emektar, Handan Özen Olcay, Sedat Akkan, Yunsur Çevik
Eurasian Journal of Emergency Medicine.2025;[Epub] CrossRef
Prognosis of patients with extreme acidosis on admission to the emergency department: A retrospective cohort study
Amichai Gutgold, Shaden Salameh, Jeries Nashashibi, Yonatan Gershinsky
The American Journal of Emergency Medicine.2024; 76: 36. CrossRef
Thoracotomy Resuscitation of a Patient Who Sustained Blunt Force Trauma with a pH of 6.7 on Admission and Ultra Massive Transfusion of 42 Units of Blood
John T. Meghreblian, A. J. Bethurum, Lou M. Smith
The American Surgeon™.2024; 90(8): 2066. CrossRef
Successful Outcomes of Critically Ill Patients with Extreme Metabolic Acidosis Treated with Structured Approach: Case Series
Sasa Dragic, Danica Momcicevic, Biljana Zlojutro, Milka Jandric, Tijana Kovacevic, Vlado Djajic, Ognjen Gajic, Pedja Kovacevic
Clinical Medicine Insights: Case Reports.2021;[Epub] CrossRef

Original Articles

Usefulness of Shock Index to Predict Outcomes of Trauma Patient: A Retrospective Cohort Study: Myoung Jun Kim, Jung Yun Park, Mi Kyoung Kim, Jae Gil Lee; J Trauma Inj. 2019;32(1):17-25. Published online March 31, 2019; DOI: https://doi.org/10.20408/jti.2018.034

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14 Citations

Abstract PDF

Purpose

We investigated how prehospital, emergency room (ER), and delta shock indices (SI) correlate with outcomes including mortality in patients with polytrauma.

Methods

We retrospectively reviewed the medical records of 1,275 patients who visited the emergency department from January 2015 to April 2018. A total of 628 patients were enrolled in the study. Patients were divided into survivor and non-survivor groups, and logistic regression analysis was used to investigate independent risk factors for death. Pearson coefficient analysis and chi-square test were used to examine the significant relationship between SI and clinical progression markers.

Results

Of 628 enrolled patients, 608 survived and 27 died. Multivariate logistic regression analysis reveals “age” (p<0.001; OR, 1.068), “pre-hospital SI >0.9” (p<0.001; OR, 11.629), and “delta SI ≥0.3” (p<0.001; OR, 12.869) as independent risk factors for mortality. Prehospital and ER SIs showed a significant correlation with hospital and intensive care unit length of stay and transfusion amount. Higher prehospital and ER SIs (>0.9) were associated with poor clinical progression.

Conclusions

SI and delta SI are significant predictors of mortality in patients with polytrauma. Moreover, both prehospital and ER SIs can be used as predictive markers of clinical progression in these patients.

Summary

Citations

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Prehospital Delta Shock Index Predicts Mortality and Need for Life Saving Interventions in Trauma Patients
Philip W. Walker, James F. Luther, Stephen R. Wisniewski, Joshua B. Brown, Ernest E. Moore, Martin Schreiber, Bellal Joseph, Chad T. Wilson, Brian G. Harbrecht, Daniel G. Ostermayer, Bryan Cotton, Richard Miller, Mayur Patel, Christian Martin-Gill, Jason
Prehospital Emergency Care.2025; 29(7): 902. CrossRef
Clinical predictors of unplanned reoperations in trauma patients with damage control surgeries for truncal injuries
Michael Semanco, Jennifer Montero, Nancy Russell, Ashley Diaz, Andrew C. Gaugler
Trauma.2025; 27(3): 225. CrossRef
Association of Age Shock Index with Mortality among Trauma Patients in the Emergency Department
Areej Zehra, Inayat Ali Khan, Muhammad Khan, Shahid Pervez Shaikh, Padma Rathore, Ghazal Irfan
Pakistan Journal of Health Sciences.2025; : 209. CrossRef
The Unrecognized Burden of Patient-Level Social Determinants of Health on Health Outcomes Following Traumatic Injury
Pawan J. Mathew, Joshua A. Sznol, Sarah J. Ullrich, Robert D. Becher, Kimberly A. Davis, Kevin M. Schuster
Injury.2025; : 112882. CrossRef
Evaluation of the role of repeated inferior vena cava sonography in estimating first 24 h fluid requirement in resuscitation of major blunt trauma patients in emergency department Suez Canal University Hospital
Rasha Mahmoud Ahmed, Bassant Sayed Moussa, Mohamed Amin Ali, Aml Ibrahiem Sayed Ahmed Abo El Sood, Gouda Mohamed El Labban
BMC Emergency Medicine.2024;[Epub] CrossRef
Association of Shock Index and Modified Shock Index with Mortality Rate in Emergency Department Trauma Patient
Areej Zehra, Farah Ahmed, Yasmeen Fatima Zaidi, Umaima Khan, Rabia Rauf, Samina Mohyuddin
Pakistan Journal of Health Sciences.2024; : 134. CrossRef
Delta shock index predicts injury severity, interventions, and outcomes in trauma patients: A 10-year retrospective observational study
Mohammad Asim, Ayman El-Menyar, Khalid Ahmed, Mushreq Al-Ani, Saji Mathradikkal, Abubaker Alaieb, Abdel Aziz Hammo, Ibrahim Taha, Ahmad Kloub, Hassan Al-Thani
World Journal of Critical Care Medicine.2024;[Epub] CrossRef
Shock Index for the Prediction of Interventions and Mortality in Patients With Blunt Thoracic Trauma
Mohammad Asim, Ayman El-Menyar, Talat Chughtai, Ammar Al-Hassani, Husham Abdelrahman, Sandro Rizoli, Hassan Al-Thani
Journal of Surgical Research.2023; 283: 438. CrossRef
Emergency Department Shock Index Outperforms Prehospital and Delta Shock Indices in Predicting Outcomes of Trauma Patients
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Analysis of the Importance of Sacroiliac Joint Fractures as a Prognostic Factor of the Patients with Pelvic Fractures: Yeon-Uk Ju, Jun-Min Cho, Nam-Ryeol Kim, Kyung-Bum Lee, Jin-Kak Kim, Jong-Keon Oh; J Trauma Inj. 2018;31(1):6-11. Published online April 30, 2018; DOI: https://doi.org/10.20408/jti.2018.31.1.6

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Abstract PDF: Purpose
The diagnosis of pelvic fractures pattern has become to be essential in the decision making of treatment modality and reducing morbidity and mortality in multiple trauma patients. Sacroiliac joint (SIJ) disruption can cause life-threatening massive arterial bleeding. This study aimed to determine a method of predicting the prognosis and treatment direction with pelvis X-ray alone in the emergency room. We investigated whether SIJ disruption can be used alone as a poor prognostic factor.
Methods
We analyzed the medical records and radiologic examination results of 167 patients with pelvic fractures from January 1, 2015 to December 31, 2016 retrospectively. Patients with pathologic fractures, thoraco-abdominal bleeding, and acetabulum fractures and pediatric patients (n=63) were excluded. Factors related to the clinical manifestations and treatments, such as transfusion and surgery, were statistically compared.
Results
The cross-sectional analysis showed that there was no correlation between SIJ injury and sex; there were statistically significant relationships between occurrences of shock, conjoined fractures, transfusion, and surgeries. The hospitalization period and partial thromboplastin time and prothrombin time values increased. The logistic regression analysis showed that when an SIJ injury occurred, blood transfusion and hypotension possibilities increased.
Conclusions
When pelvic fractures occur near the SIJ, blood transfusion and shock possibilities increase. Physicians must be aware of the high severity and poor prognosis of such fractures when these are diagnosed in the emergency room. And furthermore, the physician has to predict and prepare the intensive care and multidisciplinary approaches.; Summary

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