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Case Report
Treatment of a penetrating inferior vena cava injury using doctor-helicopter emergency medical service and direct-to-operating room resuscitation in Korea: a case report
Dongmin Seo, Jieun Kim, Jiwon Kim, Inhae Heo, Jonghwan Moon, Kyoungwon Jung, Hohyung Jung
J Trauma Inj. 2024;37(1):74-78.   Published online January 12, 2024
DOI: https://doi.org/10.20408/jti.2023.0055
  • 583 View
  • 15 Download
AbstractAbstract PDF
Inferior vena cava (IVC) injuries can have fatal outcomes and are associated with high mortality rates. Patients with IVC injuries require multiple procedures, including prehospital care, surgical techniques, and postoperative care. We present the case of a 67-year-old woman who stabbed herself in the abdomen with a knife, resulting in an infrarenal IVC injury. We shortened the transfer time by transporting the patient using a helicopter and decided to perform direct-to-operating room resuscitation by a trauma physician in the helicopter. The patient underwent laparotomy with IVC ligation for damage control during the first operation. The second- and third-look operations, including previous suture removal, IVC reconstruction, and IVC thrombectomy, were performed by a trauma surgeon specializing in cardiovascular diseases. The patient was discharged without major complications on the 19th postoperative day with rivaroxaban as an anticoagulant medication. Computed tomography angiography at the outpatient clinic showed that thrombi in the IVC and both iliac veins had been completely removed. Patients with IVC injuries can be effectively treated using a trauma system that includes fast transportation by helicopter, damage control for rapid hemostasis, and expert treatment of IVC injuries.
Summary
Original Article
A decade of treating traumatic sternal fractures in a single-center experience in Korea: a retrospective cohort study
Na Hyeon Lee, Seon Hee Kim, Jae Hun Kim, Ho Hyun Kim, Sang Bong Lee, Chan Ik Park, Gil Hwan Kim, Dong Yeon Ryu, Sun Hyun Kim
J Trauma Inj. 2023;36(4):362-368.   Published online November 30, 2023
DOI: https://doi.org/10.20408/jti.2023.0027
  • 602 View
  • 30 Download
AbstractAbstract PDF
Purpose
Clinical reports on treatment outcomes of sternal fractures are lacking. This study details the clinical features, treatment approaches, and outcomes related to traumatic sternal fractures over a 10-year period at a single institution.
Methods
A retrospective cohort study was conducted of patients admitted to a regional trauma center between January 2012 and December 2021. Among 7,918 patients with chest injuries, 266 were diagnosed with traumatic sternal fractures. Patient data were collected, including demographics, injury mechanisms, severity, associated injuries, sternal fracture characteristics, hospital stay duration, mortality, respiratory complications, and surgical details. Surgical indications encompassed emergency cases involving intrathoracic injuries, unstable fractures, severe dislocations, flail chest, malunion, and persistent high-grade pain.
Results
Of 266 patients with traumatic sternal fractures, 260 were included; 98 underwent surgical treatment for sternal fractures, while 162 were managed conservatively. Surgical indications ranged from intrathoracic organ or blood vessel injuries necessitating thoracotomy to unstable fractures with severe dislocations. Factors influencing surgical treatment included flail motion and rib fracture. The median length of intensive care unit stay was 5.4 days (interquartile range [IQR], 1.5–18.0 days) for the nonsurgery group and 8.6 days (IQR, 3.3–23.6 days) for the surgery group. The median length of hospital stay was 20.9 days (IQR, 9.3–48.3 days) for the nonsurgery group and 27.5 days (IQR, 17.0 to 58.0 days) for the surgery group. The between-group differences were not statistically significant. Surgical interventions were successful, with stable bone union and minimal complications. Flail motion in the presence of rib fracture was a crucial consideration for surgical intervention.
Conclusions
Surgical treatment recommendations for sternal fractures vary based on flail chest presence, displacement degree, and rib fracture. Surgery is recommended for patients with offset-type sternal fractures with rib and segmental sternal fractures. Surgical intervention led to stable bone union and minimal complications.
Summary
Case Reports
Rare complication of skin necrosis after endoscopic debridement and cutaneo-fascial suture for a massive Morel-Lavallée lesion in Korea: a case report
Youngmin Kim, Jayun Cho, Myung Jin Jang, Kang Kook Choi
J Trauma Inj. 2023;36(3):304-309.   Published online August 25, 2023
DOI: https://doi.org/10.20408/jti.2023.0007
  • 614 View
  • 19 Download
AbstractAbstract PDF
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.
Summary
Sphenoid sinus foreign body following airbag deployment in the United States: a case report
Birk J. Olson, Joseph B. Vella, Justin P. McCormick
J Trauma Inj. 2023;36(2):133-136.   Published online August 16, 2022
DOI: https://doi.org/10.20408/jti.2022.0030
  • 2,200 View
  • 41 Download
AbstractAbstract PDF
We report a unique case of penetrating foreign bodies following a motor vehicle accident with airbag deployment. The patient presented with evidence of facial trauma and was found to have three retained foreign bodies on imaging. Notably, one foreign body was within the sphenoid sinus. This foreign body was removed uneventfully through endoscopic sinus surgery. The patient was doing well at follow-up visits. We concluded that the foreign bodies were steering wheel accessories, which detached upon airbag deployment and penetrated the patient’s face. This case report is intended to inform the public regarding the dangers of placing accessories on a steering wheel.
Summary
Humeral intramedullary nail bending following trauma: a case report
Siem A. Willems, Alexander P. A. Greeven
J Trauma Inj. 2023;36(1):65-69.   Published online June 17, 2022
DOI: https://doi.org/10.20408/jti.2022.0002
  • 2,267 View
  • 36 Download
AbstractAbstract PDF
The surgical approach for humeral implant failure can be challenging due to neurovascular anatomy and the possible necessity of osteosynthesis removal. We present a rare case of humeral nail bending after secondary trauma in a patient with preexistent nonunion of the humerus after intramedullary nailing. During revision surgery, the nail was sawed in half and the distal part was removed, followed by plate osteosynthesis with cable fixation to achieve absolute stability. The patient regained a full range of motion 1 year after surgery, and complete healing of the fracture was seen on imaging.
Summary
Management of a traumatic anorectal full-thickness laceration: a case report
Laura Fortuna, Andrea Bottari, Riccardo Somigli, Sandro Giannessi
J Trauma Inj. 2022;35(3):215-218.   Published online May 19, 2022
DOI: https://doi.org/10.20408/jti.2021.0049
  • 2,357 View
  • 124 Download
AbstractAbstract PDF
The rectum is the least frequently injured organ in trauma, with an incidence of about 1% to 3% in trauma cases involving civilians. Most rectal injuries are caused by gunshot wounds, blunt force trauma, and stab wounds. A 46-year-old male patient was crushed between two vehicles while he was working. He was hemodynamically unstable, and the Focused Assessment with Sonography for Trauma showed hemoperitoneum and hemoretroperitoneum; therefore, damage control surgery with pelvic packing was performed. A subsequent whole-body computed tomography scan showed a displaced pelvic bone and sacrum fracture. There was evidence of an anorectal full-thickness laceration and urethral laceration. In second-look surgery performed 48 hours later, the pelvis was stabilized with external fixators, and it was decided to proceed with loop sigmoid colostomy. A tractioned rectal probe with an internal balloon was positioned in order to approach the flaps of the rectal wall laceration. On postoperative day 13, a radiological examination with endoluminal contrast injected from the stoma after removal of the balloon was performed and showed no evidence of extraluminal leak. Rectosigmoidoscopy, rectal manometry, anal sphincter electromyography, and trans-stomic transit examinations showed normal findings, indicating that it was appropriate to proceed with the closure of the colostomy. The postoperative course was uneventful. The optimal management for extraperitoneal penetrating rectal injuries continues to evolve. Primary repair with fecal diversion is the mainstay of treatment, and a conservative approach to rectal lacerations with an internal balloon in a rectal probe could provide a possibility for healing with a lower risk of complications.
Summary
Original Articles
Changes in patterns of plastic surgery emergencies at a level I trauma center in India during the COVID-19 pandemic
Veena Singh, Ansarul Haq, Sarsij Sharma, Sanjeev Kumar, Aditya Kumar, Amarjeet Kumar, Neeraj Kumar, Anil Kumar
J Trauma Inj. 2022;35(2):108-114.   Published online May 11, 2022
DOI: https://doi.org/10.20408/jti.2021.0015
  • 1,679 View
  • 40 Download
AbstractAbstract PDF
Purpose
The coronavirus disease 2019 (COVID-19) pandemic has had major effects worldwide, including sudden and forceful setbacks to the healthcare system. The COVID-19 pandemic has also led to changes in the plastic and reconstructive management of emergency cases, including those due to road traffic accidents. This study analyzed changes in patterns of plastic surgery emergencies and modifications in consultation policies to minimize the exposure of healthcare workers.
Methods
Data on plastic surgery emergency calls received from the trauma and emergency department were collected for a period of 2 months before and during lockdown. The data were then analyzed with respect to the cause, mechanism, and site of the injury, as well as other variables.
Results
During lockdown, there was a 40.4% overall decrease in the plastic surgery emergency case volume (168 vs. 100). The average daily number of consultations before lockdown was 2.8 as compared to 1.6 during lockdown. Road traffic accidents remained the most common mechanism of injury in both groups (45.8% vs. 39.0%) but decreased in number during the lockdown (77 vs. 39). Household accidents, including burns, were the second most common cause of injury in both phases (7.7% vs. 20.0%), but their proportion increased significantly from 7.7.% to 20.0% in the lockdown phase (P=0.003). The percentage of minor procedures done in the emergency department increased from 53.5% to 72.0% during lockdown (P=0.002). Procedures in the operating room decreased by 73.1% during lockdown (67 vs. 18, P=0.001).
Conclusions
The COVID-19 pandemic and lockdown orders in India greatly influenced trends in traumatic emergencies as observed by the plastic surgery team at our tertiary care center. Amidst all the chaos and limitations of the pandemic period, providing safe and prompt care to the patients presenting to the emergency room was our foremost priority.
Summary
Plastic surgery in a trauma center: a multidisciplinary approach for polytrauma patients
Kyung-Chul Moon, Yu-Kyeong Yun
J Trauma Inj. 2022;35(4):261-267.   Published online December 10, 2021
DOI: https://doi.org/10.20408/jti.2021.0086
  • 2,830 View
  • 74 Download
  • 1 Citations
AbstractAbstract PDF
Purpose
With the increasing number of polytrauma patients treated at high-level trauma centers, plastic surgery has entered the specialty of traumatology. Plastic surgeons specialize in the simultaneous surgical care of patients with facial or hand trauma and soft tissue injuries requiring microsurgery. The purpose of this study was to introduce the role of plastic surgery in a high-level trauma center.
Methods
Between January 2020 and December 2020, 5,712 patients with traumatic injuries were admitted to the emergency department of a tertiary hospital. Of these 5,712 patients, 1,578 patients were hospitalized for surgical treatment and/or critical care. Among the 1,578 hospitalized trauma patients, 551 patients (35%) required at least one plastic surgery procedure. The patient variables included age, sex, etiology, the injured area, and injury characteristics. We also retrospectively investigated surgical data such as the duration of the operation, hospital stay, length of time from injury to surgery, and collaboration with other departments.
Results
The most common injury referred to plastic surgery was facial trauma (41%), followed by hand trauma (36%), and soft tissue injuries requiring microsurgery in various parts of the body other than the hand (7%). The majority of facial and hand traumas were concomitant injuries. Sixteen percent of patients underwent collaborative surgical management for polytrauma involving both plastic surgery and another department.
Conclusions
The role of plastic surgery in multidisciplinary teams at high-level trauma centers has become increasingly important. The results of this study may help in the development of multidisciplinary trauma team strategies and future workforce planning.
Summary

Citations

Citations to this article as recorded by  
  • Interdisziplinäres Extremitäten-Board in der Behandlung von Komplexverletzungen
    T. Omar Pacha, P. Mommsen, V. Brauckmann, G. Aktas, M. Krempec, B. Wilhelmi, J.-D. Clausen, V. März, N. Krezdorn, P. M. Vogt, S. Sehmisch, J. B. Hinrichs, J. Ernst
    Die Unfallchirurgie.2023; 126(3): 175.     CrossRef
Adult Trauma Patients with Isolated Thoracolumbar Spinous and Transverse Process Fractures May be Managed Conservatively to Improve Emergency Department Throughput
Kyrillos Awad, Dean Spencer, Divya Ramakrishnan, Marija Pejinovska, Areg Grigorian, Sebastian Schubl, Jeffry Nahmias
J Trauma Inj. 2021;34(1):31-38.   Published online February 24, 2021
DOI: https://doi.org/10.20408/jti.2020.006
  • 3,272 View
  • 123 Download
AbstractAbstract PDF
Purpose

Traumatic vertebral injuries have a prevalence of 4–5% at level I centers. Studies have demonstrated that isolated thoracolumbar transverse process fractures (iTPF) rarely require brace or surgical interventions. We hypothesized that similarly isolated thoracolumbar spinous process fractures (iSPF) would have less need for bracing and operative interventions than SPFs with associated vertebral body (VB) fractures (SPF+VB). We performed a similar analysis for iTPF compared to transverse process fractures associated with VB injury (TPF+VB).

Methods

In this single-center, retrospective study from 2012 to 2016, patients were classified into iSPF, SPF+VB, iTPF, and TPF+VB groups. Data including the fracture pattern, neurologic deficits, and operative intervention were obtained. The primary outcome studied was the need for bracing and/or surgery. A statistical analysis was conducted.

Results

Of 98 patients with spinous process fractures, 21 had iSPF and 77 had SPF+ VB. No iSPF patients underwent surgery, whereas 24 (31.17%) SPF+VB patients did undergo surgery (p=0.012). In the iSPF group, three patients (15%) received braces only for comfort, whereas 37 (48.68%) of the SPF+VB group required bracing (p=0.058). Of 474 patients with transverse process fractures, 335 had iTPF and 139 had TPF+VB. No iTPF patients underwent surgery, whereas 28 (20.14%) TPF+VB patients did (p≤ 0.001). Of the iTPF patients, six (1.86%) were recommended to receive braces only for comfort, while 68 (50.75%) of the TPF+VB patients required bracing (p<0.001).

Conclusions

No patients with iSPF or iTPF required surgical intervention, and bracing was recommended to patients in these groups for comfort only. It appears that these injures may be safely managed without interventions, calling into question the need for spine consultation.

Summary
Case Reports
Large Focal Extrapleural Hematoma of Chest Wall: A Case Report
Hohyoung Lee, Sung Ho Han, Min Koo Lee, Oh Sang Kwon, Kyoung Hwan Kim, Jung Suk Kim, Soon-Ho Chon, Sung Ho Shinn
J Trauma Inj. 2019;32(2):115-117.   Published online June 30, 2019
DOI: https://doi.org/10.20408/jti.2019.001
  • 4,884 View
  • 46 Download
AbstractAbstract PDF

Although hemothorax and pneumothorax are common complications seen in rib fractures, focal extrapleural hematoma is quite rare. We report a 63-year-old female patient that developed large focal extrapleural hematoma after falling off a second floor veranda. The patient had sustained 3, 4, 5th costal cartilage rib fractures and a sternum fracture. She had developed suspected empyema with loculations with small amount of hemothorax. She underwent a planned early decortication/adhesiolysis by video assisted thoracoscopic surgery at the 12th post-trauma day due to failed drainage. Unexpectedly, she had no adhesions or any significant retained hematoma mimicking a mass, but was found with the focal extrapleural chest wall hematoma. She was discharged on postoperative 46th day for other reasons and is doing fine today.

Summary
Bilateral Chylothorax Due to Blunt Spine Hyperextension Injury: A Case Report
Hohyoung Lee, Sung Ho Han, Min Koo Lee, Oh Sang Kwon, Kyoung Hwan Kim, Jung Suk Kim, Soon-Ho Chon, Sung Ho Shinn
J Trauma Inj. 2019;32(2):107-110.   Published online June 30, 2019
DOI: https://doi.org/10.20408/jti.2018.050
  • 3,247 View
  • 55 Download
  • 1 Citations
AbstractAbstract PDF

Bilateral chylothorax due to blunt trauma is extremely rare. We report a 74-year-old patient that developed delayed bilateral chylothorax after falling off a ladder. The patient had a simple 12th rib fracture and T12 lamina fracture. All other findings seemed normal. He was sent home and on the 5th day visited our emergency center at Halla Hospital with symptoms of dyspnea and lower back pain. Computer tomography of his chest presented massive fluid collection in his right pleural cavity and moderate amounts in his left pleural cavity with 12th rib fracture and T11-12 intervertebral space widening with bilateral facet fractures. Chest tubes were placed bilaterally and chylothorax through both chest tubes was discovered. Conservative treatment for 2 weeks failed, and thus, thoracic duct ligation was done by video assisted thoracoscopic surgery. Thoracic duct embolization was not an option. Postoperatively, the patient is now doing well and happy with the results. Early surgical treatment must be considered in the old patient, whom large amounts of chylothorax are present.

Summary

Citations

Citations to this article as recorded by  
  • Thoracic duct injury: An up to date
    JoséLuis Ruiz Pier, MohebA Rashid
    The Journal of Cardiothoracic Trauma.2021; 6(1): 15.     CrossRef
Original Articles
A Prospective, Randomized, Controlled Trial to Assess the Efficacy of a Multi-Disciplinary Screening, Brief Intervention and Referral to Treatment Program for Patients with Fractures of the Oral and Maxillofacial Region Because of Alcohol-Related Injuries in the Emergency Department
Ja Heon Koo, Hyung Jun Song, Jun Hee Lee, Jae Hyun Kim, Jung Woo Nam, Jae Eun Im
J Trauma Inj. 2018;31(3):143-150.   Published online December 31, 2018
DOI: https://doi.org/10.20408/jti.2018.045
  • 10,349 View
  • 40 Download
  • 1 Citations
AbstractAbstract PDF
Purpose

We have implemented a multi-disciplinary Screening, Brief Intervention and Referral to Treatment (SBIRT) protocol to prevent individuals who sustained alcohol-related traumatic injuries. We therefore conducted this single-center, prospective, randomized, controlled trial (RCT) to assess its efficacy.

Methods

All the enrolled patients (n=30) were randomized to either the SBIRT group or the control group. In the current RCT, the proportion of the patients who reduced the amount of alcohol consumption and those who received a specialized treatment served as primary outcome measures. Moreover, changes in a 3-item version of the Alcohol Use Disorders Identification Test Consumption (AUDIT-C), Severity of Dependence Scale (SDS) and Kessler Psychological Distress Scale (K-6) scores at 3 months from baseline served as secondary outcome measures.

Results

At 3 months, the proportion of the patients who reduced the amount of alcohol consumption was significantly higher in the SBIRT group as compared with the control group (86.7% vs. 57.1%, p=0.02). Moreover, the proportion of the patients who received a specialized treatment was also significantly higher as compared with the control group (26.7% vs. 1.4%, p=0.01). Furthermore, there were significant differences in changes in the AUDIT, SDS and K-6 scores at 3 months from baseline between the two groups (p<0.05).

Conclusions

In conclusion, our results indicate that the SBIRT is effective in reducing hazardous and harmful levels of drinking, the degree of alcohol dependence and that of psychological distress in at-risk drinkers.

Summary

Citations

Citations to this article as recorded by  
  • Effectiveness of Brief Alcohol Intervention in Reducing Alcohol Consumption Among Patients With Alcohol-Related Facial Trauma in the Emergency Department: A Systematic Review and Meta-Analysis
    Ismail Azzam, Kai Lee
    Journal of Oral and Maxillofacial Surgery.2023; 81(9): 1102.     CrossRef
Emergency Surgical Management of Traumatic Cardiac Injury in Single Institution for Three Years
Seok Joo, Dae Sung Ma, Yang Bin Jeon, Sung Youl Hyun
J Trauma Inj. 2017;30(4):166-172.   Published online December 30, 2017
DOI: https://doi.org/10.20408/jti.2017.30.4.166
  • 3,242 View
  • 61 Download
AbstractAbstract PDF
Purpose

Thoracic traumas represent 10?15% of all traumas and are responsible for 25% of all trauma mortalities. Traumatic cardiac injury (TCI) is one of the major causes of death in trauma patients, rarely present in living patients who are transferred to the hospital. TCI is a challenge for trauma surgeons as it provides a short therapeutic window and the management is often dictated by the underlying mechanism and hemodynamic status. This study is to describe our experiences about emergency cardiac surgery in TCI.

Methods

This is a retrospective clinical analysis of patients who had undergone emergency cardiac surgery in our trauma center from January 2014 to December 2016. Demographics, physiologic data, mechanism of injuries, the timing of surgical interventions, surgical approaches and outcomes were reviewed.

Results

The number of trauma patients who arrived at our hospital during the study period was 9,501. Among them, 884 had chest injuries, 434 patients were evaluated to have over 3 abbreviated injury scale (AIS) about the chest. Cardiac surgeries were performed in 18 patients, and 13 (72.2%) of them were male. The median age was 47.0 years (quartiles 35.0, 55.3). Eleven patients (61.1%) had penetrating traumas. Prehospital cardiopulmonary resuscitations (CPR) were performed in 4 patients (22.2%). All of them had undergone emergency department thoracotomy (EDT), and they were transferred to the operating room for definitive repair of the cardiac injury, but all of them expired in the intensive care unit. Most commonly performed surgical incision was median sternotomy (n=13, 72.2%). The majority site of injury was right ventricle (n=11, 61.1%). The mortality rate was 22.2% (n=4).

Conclusions

This study suggests that penetrating cardiac injuries are more often than blunt cardiac injury in TCI, and the majority site of injury is right ventricle. Also, it suggests prehospital CPR and EDT are significantly responsible for high mortality in TCI.

Summary
Experiences of Video-assisted Thoracic Surgery in Trauma
Dongsub Noh, Chan kyu Lee, Jung Joo Hwang, Hyun Min Cho
J Trauma Inj. 2017;30(3):87-90.   Published online October 30, 2017
DOI: https://doi.org/10.20408/jti.2017.30.3.87
  • 1,990 View
  • 11 Download
AbstractAbstract PDF
PURPOSE
Nowadays, Video-Assisted Thoracic Surgery (VATS) is widely used for its benefits, low post-operative pain, excellent anesthetic result and complete visualization of intrathoracic organs. Despite of these advantages, VATS has not yet been widely used in trauma patients. In this study, we aimed to investigate the usefulness of VATS in the chest trauma area.
METHODS
From January 2016 to December 2016, 203 patients underwent surgical treatment for chest trauma. Their medical records were analyzed retrospectively.
RESULTS
Eleven patients underwent thoracic surgery by VATS. Six patients were unstable vital sign in the emergency room. Two patients underwent emergency surgery and the rest patients underwent planned surgery. The common surgeries were VATS hematoma evacuation and wedge resection. There was no conversion to thoracotomy. The surgery proceeded without any problems for all patients.
CONCLUSIONS
VATS would be an effective diagnostic and therapeutic modality in chest trauma patients. It can be applied to retained hemothorax, persistent pneumothorax, suspicious diaphragm injury and even coagulation of bleeder.
Summary
Case Report
Thoracoscopic Resection of the First Rib for Thoracic Outlet Syndrome: A Case Report
Jae Gul Kang, Soon Ho Chon, Kilsoo Yie, Min Koo Lee, Oh Sang Kwon, Song Hyun Lee, June Raphael Chon
J Trauma Inj. 2017;30(2):63-65.   Published online June 30, 2017
DOI: https://doi.org/10.20408/jti.2017.30.2.63
  • 1,904 View
  • 19 Download
AbstractAbstract PDF
Standard open procedures for resection of the first rib in thoracic outlet syndrome can prove to be quite difficult with extensive incisions. A minimal invasive procedure can also be painstaking, but provides an attractive alternative to the more radical open procedures. We report the details of the technique with direct video footage of the procedure performed in a 41-year-old man with thoracic outlet syndrome done entirely by thoracoscopic methods.
Summary

J Trauma Inj : Journal of Trauma and Injury