Journal of Trauma and Injury

Original Articles

Lessons from foreign military surgeons in the Korean War: advancing trauma surgery and preparing for future conflicts: Kun Hwang, Chan Yong Park; Received February 25, 2025 Accepted March 13, 2025 Published online June 16, 2025; DOI: https://doi.org/10.20408/jti.2025.0041 [Epub ahead of print]

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Abstract PDF: Purpose
The Korean War (1950–1953) significantly advanced military medicine, with foreign military surgeons playing a pivotal role in transforming trauma care under extreme conditions.
Methods
Resources such as PubMed, JSTOR, and reports from participating nations formed the basis of this study. A thorough comparative analysis was performed to examine the similarities and differences in medical practices between the United Nations Command and North Korean forces.
Results
The United States introduced Mobile Army Surgical Hospitals, revolutionizing trauma care by enabling rapid intervention near combat zones. Innovations such as helicopter evacuation, whole blood transfusions, and antibiotic treatments reduced mortality rates among treated soldiers to as low as 3%. British surgeons excelled in managing abdominal wounds and performing orthopedic surgery, often undertaking limb-saving procedures. Field hospitals provided comprehensive care for combat injuries and infectious diseases—a major concern given the inadequate sanitation. The Indian 60th Parachute Field Ambulance treated over 20,000 casualties, demonstrating adaptability in harsh environments. The Indian Field Hospital not only treated military casualties but also provided care to Korean civilians, offering life-saving medical interventions under challenging conditions. Denmark deployed the hospital ship MS Jutlandia, equipped with advanced surgical facilities, enabling a level of medical care that was not practical on land. The Swedish Red Cross Field Hospital in Busan delivered crucial medical aid to both military personnel and civilians; its staff focused on civilian outreach and controlling epidemics, with treatments targeting diseases such as typhoid and tuberculosis. Norwegian mobile surgical teams specialized in rapid interventions near combat zones, performing life-saving operations within hours of injury and thus minimizing complications and increasing survival rates.
Conclusions
The lessons learned from these contributions continue to influence modern military and civilian healthcare systems, highlighting the importance of innovation, collaboration, and resilience in conflict settings.; Summary

Clinical profile, management, and outcome of pediatric neurotrauma: a multicentric observational study: Sanat Kumar Khanna, Anil Kumar, Anand Kumar Katiyar, Kundan Mishra; J Trauma Inj. 2025;38(1):22-31. Published online March 31, 2025; DOI: https://doi.org/10.20408/jti.2024.0080

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Abstract PDF: Purpose
Pediatric neurotrauma (pNT) includes pediatric traumatic brain injury and spinal cord injury. The incidence and distribution of pNT by age and sex remain understudied, with several gaps in both epidemiological and clinical data. This study aimed to estimate the epidemiological parameters, clinical presentations, surgical interventions, and outcomes in our patient population with pNT.
Methods
A multicentric, ambispective study was conducted at five tertiary care pediatric neurosurgical centers in Northern India from January 2011 to December 2022. The study included children under 16 years of age admitted with a history of head injury. Data on demographics, radiological findings, management, and outcomes were recorded.
Results
A total of 2,250 children were admitted; 77.5% were male and 22.5% were female. The most common age group was 6 months to 2 years (37.3%). The primary mechanism of injury was fall from height (64.6%), followed by road traffic accidents (26.1%). Overall, 84.6% of children had mild head injury, 14.2% moderate, and 1.2% severe. The most common abnormality on computed tomography brain was contusion (9.2%). Surgical interventions were required in only 0.8% of children. A favorable outcome, as measured by Glasgow Outcome Scale, was achieved in 99.2% of patients, and the mortality rate was 0.1%.
Conclusions
Our findings indicate that pNT is most common in children aged 6 months to 2 years and predominantly affects boys. The most frequent cause was a fall from height, and the majority of patients sustained mild head injuries requiring only observation, which led to excellent outcomes. Surgical intervention was necessary in only a few cases, and mortality was rare. This study highlights the epidemiological pattern of pNT in our population and delineates various causes of such trauma.; Summary

Changes in the clinical features and demographics of donors after brain death, before and after the establishment of a regional trauma center: 20 years of experience at a single center in Korea: Myung Jin Jang, Sang Tae Choi, Gil Jae Lee, Doo Jin Kim, Won Suk Lee; J Trauma Inj. 2025;38(1):14-21. Published online March 31, 2025; DOI: https://doi.org/10.20408/jti.2024.0068

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Abstract PDF: Purpose
Organ transplantation is considered the definitive treatment for end-stage organ disease. However, the scarcity of donor organs compared to the number of patients awaiting transplants is a major barrier. This study aimed to assess the impact of a regional trauma center on organ procurement and to provide a basis for future collaboration between regional trauma centers and transplant centers.
Methods
This retrospective study analyzed organ donors after brain death over a 20-year period from January 1, 2003, to December 31, 2022. It compared patients before and after the establishment of the regional trauma center, as well as trauma and nontrauma patients. The study investigated general patient characteristics and the number and types of donated organs.
Results
The average age of patients significantly increased from 37.75 years before the trauma center was established to 46.72 years after (t=–4.32, P<0.001). The organ acquisition rate significantly increased from 3.03 before to 3.47 after (t=–2.96, P=0.003). Suicide (t=6.52, P=0.011) and cardiopulmonary resuscitation cases were more common among nontrauma patients than among trauma patients (t=8.34, P=0.004). However, the organ acquisition rate was significantly higher among trauma patients than among nontrauma patients (3.53 vs. 3.21; t=2.04, P=0.004).
Conclusions
This study identified changes in the characteristics and donor organs of patients diagnosed with brain death after the establishment of a regional trauma center. Given the increase in the proportion of trauma patients and the rate of organ acquisition per capita post-establishment, efforts should be made to encourage organ donation from patients diagnosed with brain death through close collaboration between regional trauma centers and organ transplant centers.; Summary

Case Report

Successful treatment of hemophagocytic lymphohistiocytosis in a trauma patient: a case report: Young Soo Chung, Jihoon Kim; J Trauma Inj. 2025;38(1):66-70. Published online March 25, 2025; DOI: https://doi.org/10.20408/jti.2024.0093

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Abstract PDF: Hemophagocytic lymphohistiocytosis (HLH) is a rare, life-threatening hyperinflammatory syndrome characterized by excessive activation of the immune system. This case report describes an unusual presentation of HLH triggered by severe trauma from a motorcycle accident, which is a departure from traditional associations with infections, malignancies, or autoimmune conditions. A 40-year-old man with multiple traumatic injuries developed persistent fever, pancytopenia, and elevated inflammatory markers following orthopedic surgery. Despite empiric antibiotic therapy, his condition deteriorated, exhibiting high fever, skin rash, hepatic dysfunction, and marked elevation of ferritin levels (32,901 ng/mL). Bone marrow biopsy confirmed the diagnosis of HLH, and treatment was initiated according to the HLH-2004 protocol, which included methylprednisolone, intravenous immunoglobulin, and immunosuppressive therapy. The patient demonstrated significant clinical improvement and was discharged after 37 days, with no recurrence observed during the follow-up period. This case underscores the need to consider HLH in trauma patients presenting with unexplained inflammatory responses and illustrates that prompt diagnosis and aggressive treatment can lead to successful outcomes.; Summary

Original Articles

Vitamin D levels and bone mineral density: a prospective cross-sectional analysis of young orthopedic trauma patients at a rural United States trauma center: Michael Booth, Kenneth Sabacinski, Colleen Watkins, Erin Butcho, Emilie Kramer, Lukas Meadows, Michelle A. Bramer; J Trauma Inj. 2024;37(4):276-280. Published online December 26, 2024; DOI: https://doi.org/10.20408/jti.2024.0038

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Abstract PDF: Purpose
The goal of this cross-sectional study was to investigate the prevalence of vitamin D deficiency in young orthopedic trauma patients and its impact on bone mineral density (BMD) measured through computed tomography imaging of the lumbar spine.
Methods
Conducted at a level I trauma center, this prospective cross-sectional analysis included 100 patients aged 18 to 50 years with non-fragility fractures. Vitamin D levels and Hounsfield units of the lumbar spine were recorded from computed tomography scans. Exclusion criteria included fragility fractures, lumbar surgery history, or lumbar bony/metastatic lesions. The correlation between vitamin D levels and BMD was assessed; vitamin D deficiency was defined as below 30 ng/mL.
Results
Among the participants, 75% were vitamin D–deficient, with an average vitamin D level of 25.0 ng/mL. No patients had osteoporosis based on Hounsfield units; however, 5% of patients were in the osteopenic range. In patients with normal vitamin D levels, there was an inverse correlation between vitamin D levels and BMD measured by Hounsfield units (P=0.025). Higher lumbar spine Hounsfield unit measurements correlated with lower vitamin D levels in this nondeficient population.
Conclusions
This study highlights a high prevalence of vitamin D deficiency in young orthopedic trauma patients, and it suggests a potential inverse relationship with BMD in patients with vitamin D levels >30 ng/mL. The absence of osteoporosis in our population raises questions about the influence of vitamin D on BMD in this young trauma patient demographic. Future research should explore the impact of vitamin D replacement on fracture union and investigate the interaction between vitamin D levels and bone health in the younger orthopedic trauma population.; Summary

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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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

Review Article

Splenic artery embolization for trauma: a narrative review: Simon Roh; J Trauma Inj. 2024;37(4):252-261. Published online December 16, 2024; DOI: https://doi.org/10.20408/jti.2024.0056

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Abstract PDF: The management of traumatic splenic injuries has evolved significantly over the past several decades, with the majority of these injuries now being treated nonoperatively. Patients who exhibit hemodynamic instability upon initial evaluation typically require surgical intervention, while the remainder are managed conservatively. Conservative treatment for traumatic splenic injuries encompasses both medical management and splenic artery angiography, followed by embolization in cases where patients exhibit clinical signs of ongoing splenic hemorrhage. Splenic artery embolization is generally divided into two categories: proximal and distal embolization. The choice of embolization technique is determined by the severity and location of the splenic injury. Patients who retain functioning splenic tissue after trauma do not routinely need immunization. This is in contrast to post-splenectomy patients, who are at increased risk for opportunistic infections.; Summary

Case Reports

Reperfusion injury or cytokine storm? Utilizing plasmapheresis in severe trauma-induced multiorgan failure: a case report: Gun Woo Kim, Suyeong Hwang, Kyoung Hoon Lim, Sung Hoon Cho; J Trauma Inj. 2024;37(4):295-299. Published online December 4, 2024; DOI: https://doi.org/10.20408/jti.2024.0051

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Abstract PDF

Reperfusion injury can cause tissue damage due to ischemia, with severe cases potentially resulting in multiorgan failure. Cytokine storm, a life-threatening systemic inflammatory state characterized by elevated levels of circulating cytokines and hyperactive immune cells, can also lead to tissue damage and multiorgan failure. Reperfusion injury and cytokine storm sometimes exhibit similar clinical features, necessitating specific treatment in severe cases. A 31-year-old man sustained a stab wound to his left knee. Computed tomography angiography and surgical exploration revealed a transection of the left popliteal artery and vein. Both vessels were revascularized via end-to-end anastomosis approximately 3 hours after the injury. On postoperative day 2, marked increases were observed in levels of aspartate aminotransferase (8,600 U/L), alanine transaminase (6,690 U/L), creatine phosphokinase (26,817 U/L), and lactate dehydrogenase (7,398 U/L) levels. Elevated levels of interleukin 6 (178 pg/mL) and ferritin (41,079 ng/mL) were also noted. Given the possibility of either reperfusion injury or cytokine storm, plasmapheresis was initiated. Following two rounds of plasmapheresis, the patient’s condition rapidly improved, and he was discharged without complications. Reperfusion injury can arise when a target blood vessel is revascularized, particularly during severe stages of ischemia. Cytokine storm represents a life-threatening systemic inflammatory state characterized by high levels of circulating cytokines and overactive immune cells. Both reperfusion injury and cytokine storm can cause systemic inflammation and multiorgan failure. These two conditions may exhibit similar clinical features, necessitating supportive care primarily to prevent organ dysfunction. However, plasmapheresis may represent an effective treatment option in cases of severe progression.

Summary

Citations

Citations to this article as recorded by

The significance of inflammasome activation during each phase of wound healing
Carol M. Artlett
Exploration of Medicine.2025;[Epub] CrossRef

Treatment of placental abruption following blunt abdominal trauma: a case report: Jinjoo Kim, Seokyung Kim, Dongwook Kwak, Donghwan Choi; J Trauma Inj. 2025;38(1):61-65. Published online December 4, 2024; DOI: https://doi.org/10.20408/jti.2024.0050

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Abstract PDF: Trauma during pregnancy poses a potentially tragic risk to both the fetus and mother, making its management particularly challenging. Here, we present the case of a 35-year-old woman at 34 weeks and 2 days gestation who was in a motor vehicle accident and subsequently suffered placental abruption and underwent an emergency cesarean section. We also present a review of traumatic placental abruption and its epidemiology. On arrival at the trauma bay, the patient showed no significant abdominal findings other than a seat belt sign. However, 2 hours after admission, the patient developed abdominal pain and vaginal bleeding. Ultrasonography revealed no clear evidence of placental abruption. This case demonstrates the necessity of close maternal and fetal monitoring with cooperation between the trauma and obstetric teams. Even in the absence of typical symptoms such as abdominal pain on initial presentation, a high-energy mechanism of injury should be suspected.; Summary

Purtscher retinopathy following isolated chest compression: a case report: Min Uk Jang, Ho Gil Jung, Youngwoong Kim; J Trauma Inj. 2024;37(4):291-294. Published online October 21, 2024; DOI: https://doi.org/10.20408/jti.2024.0032

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Abstract PDF: This case report describes the case of a 56-year-old man who developed Purtscher retinopathy following compressive chest trauma. During the tertiary survey, the patient was found to have a unilateral partial vision decline despite sustaining only mild rib fractures. The patient was diagnosed with a rare complication of Purtscher retinopathy. At a 2-week follow-up outpatient examination, improved visual acuity was observed. This case highlights the importance of conducting a tertiary survey not only on the directly impacted site, but also comprehensively across all sites, while attentively listening to and addressing the patient’s complaints.; Summary

Endoscopic transorbital approach for the removal of a frontal lobe foreign body: a case report: Charles Gervais, Conrad Pelletier, Mathieu Laroche, Pascal Lavergne; J Trauma Inj. 2024;37(4):281-285. Published online September 25, 2024; DOI: https://doi.org/10.20408/jti.2024.0002

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Abstract PDF: Low-velocity orbital penetrating injuries may result in an intracranial retained foreign body that requires surgical removal. We describe the endoscopic transorbital removal of a retained umbrella tip in the frontal lobe, which was secondary to trauma to the orbital roof. This technique facilitated the complete removal of the foreign body without causing additional damage to the surrounding tissue. The patient had a successful postoperative recovery. We also discuss the utility of the transorbital neuroendoscopic procedure in managing these traumatic injuries.; Summary

Review Article

Renal embolization for trauma: a narrative review: Peter Lee, Simon Roh; J Trauma Inj. 2024;37(3):171-181. Published online September 24, 2024; DOI: https://doi.org/10.20408/jti.2024.0021

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1 Web of Science
2 Citations

Abstract PDF

Renal injuries commonly occur in association with blunt trauma, especially in the setting of motor vehicle accidents. Contrast-enhanced computed tomography is considered the gold-standard imaging modality to assess patients for renal injuries in the setting of blunt and penetrating trauma, and to help classify injuries based on the American Association for the Surgery of Trauma injury scoring scale. The management of renal trauma has evolved in the past several decades, with a notable shift towards a more conservative, nonoperative approach. Advancements in imaging and interventional radiological techniques have enabled diagnostic angiography with angiographic catheter-directed embolization to become a viable option, making it possible to avoid surgical interventions that pose an increased risk of nephrectomy. This review describes the current management of renal trauma, with an emphasis on renal artery embolization techniques.

Summary

Citations

Citations to this article as recorded by

Analysis of 46 Cases of Spontaneous Perirenal Hemorrhage: A Retrospective Observational Study
Seon Beom Jo, Sun Tae Ahn, Mi Mi Oh, Sung Joon Park, Young-Hoon Yoon, Jong Wook Kim, Jung-Youn Kim
Journal of Clinical Medicine.2025; 14(9): 2986. CrossRef
Normotensive trauma patients with renal injuries: Hidden candidates for massive transfusion
Xin‐Hong Lin, Pi‐Chieh Lin, Ching‐Hua Tsai, Wei‐Ti Su, Shiun‐Yuan Hsu, Ching‐Hua Hsieh
Hong Kong Journal of Emergency Medicine.2025;[Epub] CrossRef

Original Articles

Predicting 30-day mortality in severely injured elderly patients with trauma in Korea using machine learning algorithms: a retrospective study: Jonghee Han, Su Young Yoon, Junepill Seok, Jin Young Lee, Jin Suk Lee, Jin Bong Ye, Younghoon Sul, Se Heon Kim, Hong Rye Kim; J Trauma Inj. 2024;37(3):201-208. Published online August 8, 2024; DOI: https://doi.org/10.20408/jti.2024.0024

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Abstract PDF: Purpose
The number of elderly patients with trauma is increasing; therefore, precise models are necessary to estimate the mortality risk of elderly patients with trauma for informed clinical decision-making. This study aimed to develop machine learning based predictive models that predict 30-day mortality in severely injured elderly patients with trauma and to compare the predictive performance of various machine learning models. Methods: This study targeted patients aged ≥65 years with an Injury Severity Score of ≥15 who visited the regional trauma center at Chungbuk National University Hospital between 2016 and 2022. Four machine learning models—logistic regression, decision tree, random forest, and eXtreme Gradient Boosting (XGBoost)—were developed to predict 30-day mortality. The models’ performance was compared using metrics such as area under the receiver operating characteristic curve (AUC), accuracy, precision, recall, specificity, F1 score, as well as Shapley Additive Explanations (SHAP) values and learning curves. Results: The performance evaluation of the machine learning models for predicting mortality in severely injured elderly patients with trauma showed AUC values for logistic regression, decision tree, random forest, and XGBoost of 0.938, 0.863, 0.919, and 0.934, respectively. Among the four models, XGBoost demonstrated superior accuracy, precision, recall, specificity, and F1 score of 0.91, 0.72, 0.86, 0.92, and 0.78, respectively. Analysis of important features of XGBoost using SHAP revealed associations such as a high Glasgow Coma Scale negatively impacting mortality probability, while higher counts of transfused red blood cells were positively correlated with mortality probability. The learning curves indicated increased generalization and robustness as training examples increased. Conclusions: We showed that machine learning models, especially XGBoost, can be used to predict 30-day mortality in severely injured elderly patients with trauma. Prognostic tools utilizing these models are helpful for physicians to evaluate the risk of mortality in elderly patients with severe trauma.; Summary

Traumatic peripheral nerve injuries in young Korean soldiers: a recent 10-year retrospective study: Chul Jung, Jae-hyun Yun, Eun Jin Kim, Jaechan Park, Jiwoon Yeom, Kyoung-Eun Kim; J Trauma Inj. 2024;37(3):192-200. Published online August 8, 2024; DOI: https://doi.org/10.20408/jti.2024.0001

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Abstract PDF

Purpose
Traumatic peripheral nerve injury (PNI), which occurs in up to 3% of trauma patients, is a devastating condition that often leads to permanent disability. However, knowledge of traumatic PNI is limited. We describe epidemiology and clinical characteristics of traumatic PNI in Korea and identify the predictors of traumatic complete PNI. Methods: A list of enlisted soldier patients who were discharged from military service due to PNI over a 10-year period (2012–2021) was obtained, and their medical records were reviewed. Patients were classified according to the causative events (traumatic vs. nontraumatic) and injury severity (complete vs. incomplete). Of traumatic PNIs, we compared the clinical variables between the incomplete and complete PNI groups and identified predictors of complete PNI. Results: Of the 119 young male patients who were discharged from military service due to PNI, 85 (71.4%) were injured by a traumatic event; among them, 22 (25.9%) were assessed as having a complete injury. The most common PNI mechanism (n=49, 57.6%), was adjacent fractures or dislocations. Several injury-related characteristics were significantly associated with complete PNI: laceration or gunshot wound, PNI involving the median nerve, PNI involving multiple individual nerves (multiple PNI), and concomitant muscular or vascular injuries. After adjusting for other possible predictors, multiple PNI was identified as a significant predictor of a complete PNI (odds ratio, 3.583; P=0.017). Conclusions: In this study, we analyzed the characteristics of enlisted Korean soldiers discharged due to traumatic PNI and found that the most common injury mechanism was adjacent fracture or dislocation (57.6%). Patients with multiple PNI had a significantly increased risk of complete injury. The results of this study contribute to a better understanding of traumatic PNI, which directly leads to a decline in functioning in patients with trauma.

Summary

Citations

Citations to this article as recorded by

Nerve injury: the role of electroneuromyography and ultrasound in diagnostics
A. V. Klimkin, M. A. Irikova, V. B. Voitenkov, E. Yu. Skripchenko
Russian neurological journal.2025; 30(1): 51. CrossRef

Case Report

Use of helicopter emergency medical services with a physician on board in severe pediatric trauma in Korea: a case report: Yoonsuk Lee, Gunwoo Kim, Pil Young Jung; J Trauma Inj. 2024;37(3):224-227. Published online June 14, 2024; DOI: https://doi.org/10.20408/jti.2023.0080

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Abstract PDF: In Korea, helicopter emergency medical services (HEMS) with a physician on board were introduced in September 2011, funded by both central and regional governments. HEMS was integrated into the Korean emergency medical system to address the need for EMS in remote rural areas. The present report describes 16-month-old twins who fell from the fifth floor of an apartment building, located approximately 100 km from the nearest level I trauma center. Utilizing HEMS along with initial emergency management by an emergency physician, the patients were transported to the level I trauma center within the critical “golden hour.” The children had sustained multiorgan injuries. Without intervention at the scene by an emergency physician, a fatal outcome was anticipated for both children. With the use of HEMS, one patient died, but the other survived with a good prognosis. The use of HEMS flights with an emergency physician on board may improve outcomes for pediatric patients with severe trauma in medically underserved rural areas.; Summary

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