Traumatic diaphragmatic injuries: a retrospective review of a 12-year experience at a tertiary trauma centre

<p><b>INTRODUCTION</b>Traumatic diaphragmatic injuries (TDIs) are clinically challenging. We aimed to review TDIs treated at a tertiary trauma centre over a 12-year period.</p><p><b>METHODS</b>This was a single-centre retrospective review of adult patients with TDIs treated between 1 January 2003 and 31 December 2014. Primary outcomes were mortality rates and Injury Severity Scores (ISS) associated with each TDI subtype. Secondary outcomes included proportions of TDIs diagnosed radiologically, operatively or during autopsy. We compared the TDI subtypes with respect to mechanism of injury, mortality rates and median ISS. Data was analysed using descriptive statistics.</p><p><b>RESULTS</b>Among 46 patients studied, the TDI subtypes noted were acute diaphragmatic herniation (n = 14, 30.4%), tears (n = 22, 47.8%) and contusions (n = 10, 21.7%). Patients with these TDI subtypes had a mortality rate of 35.7%-100%, while the ISS ranges for survivors and deaths were 22.0-34.0 (interquartile range [IQR] 6.5-23.0) and 53.5-66.0 (IQR 16.0-28.5), respectively. TDIs were identified via chest radiography (n = 2/33, 6.1%) and computed tomography (n = 6/13, 46.2%). All survivors (n = 21) and deaths (n = 25) underwent open surgery or autopsy, respectively, which confirmed TDIs. Blunt traumas and penetrating traumas were more frequently associated with acute herniation/contusions and tears, respectively. There were statistically significant differences among the TDI subtypes in their mechanism of injury, mortality rate and median ISS of survivors.</p><p><b>CONCLUSION</b>TDIs showed varying injury patterns with blunt versus penetrating mechanisms of injury, and were associated with significant mortality rates. Preoperative imaging had limited diagnostic use.</p>

A review of stab wound injuries at a tertiary trauma centre in Singapore: are self-inflicted ones less severe?

<p><b>INTRODUCTION</b>In Singapore, as strict laws are a strong deterrent against armed violence, little is known about the epidemiology of penetrating stab wound injuries. Our study aimed to investigate the epidemiology of stab wound injuries at a major trauma centre in Singapore and determine if there was a difference in severity between self-inflicted stab wound (SI) injuries and those inflicted by others (IO).</p><p><b>METHODS</b>We retrospectively reviewed all penetrating injuries at Tan Tock Seng Hospital, and identified and categorised all stab wound injuries as SI or IO. Basic demographic information, injury severity characteristics and outcome data were compared between these two groups. A review of all mortalities was performed, including recording the causes of death.</p><p><b>RESULTS</b>Between 2005 and 2010, there were a total of 149 stab wound injuries, of which 24 (16.1%) were SI and 125 (83.9%) were IO injuries. Patients tended to be young (mean age 34.1 ± 14.2 years). The mean Injury Severity Score was significantly different between the SI and IO groups (8.8 ± 6.5 vs. 12.3 ± 8.1; p = 0.03). In both groups, the majority underwent an operative procedure (83.3% vs. 85.6%) and had an average hospital stay of four days.</p><p><b>CONCLUSION</b>The study confirms our hypothesis that SI injuries tend to be less severe than IO injuries and are more likely to occur at home rather than at a public area. This finding may be useful in the triage of patients with stab wound injuries.</p>

Adult rectosigmoid junction intussusception presenting with rectal prolapse

Most cases of intussusception in adults present with chronic and nonspecific symptoms, and can sometimes be challenging to diagnose. We herein report on a patient with the rare symptom of colonic intussusceptions presenting with rectal prolapse and review the existing literature of similar case reports to discuss how to reach an accurate diagnosis. A 75-year-old woman with dementia presented with per rectal bleeding, rectal prolapse and lower abdominal pain. An operation was scheduled and a large sigmoid intussusception with a polyp as a leading point was found intraoperatively. She subsequently recovered well and was discharged. As large sigmoid intussusceptions may present as rectal prolapse, intussusception should be considered as a differential diagnosis for immobile patients, especially when the leading point is a lesion.

Multimodality imaging of splenic sclerosing angiomatoid nodular transformation

Sclerosing angiomatoid nodular transformation (SANT) is an exceedingly rare, benign and proliferative vascular lesion that arises from the splenic red pulp. It is often an incidental finding on imaging. The diagnosis of SANT is confirmed via histopathological examination of the resected spleen. Herein, we present a case of SANT and describe its typical imaging characteristics. An asymptomatic 39-year-old man was found to have a 3.1 cm × 2.7 cm × 2.3 cm hypoechoic splenic lesion during abdominal ultrasonography, which was performed to investigate his elevated gamma-glutamyl transpeptidase and alanine transaminase levels. Contrast-enhanced computed tomography suggested a vascular splenic lesion, while magnetic resonance imaging demonstrated features consistent with SANT. In view of the increasing size of the lesion on follow-up imaging, the patient elected for splenectomy. Histopathological examination confirmed SANT, and the lesion was completely resected by laparoscopic splenectomy.

A 10-Year Profile of Trauma Admissions Caused by Interpersonal Violence: A Major Trauma Centre's Experience

<p><b>INTRODUCTION</b>This study aimed to characterise interpersonal violence victims admitted to a major trauma centre.</p><p><b>MATERIALS AND METHODS</b>A retrospective cohort study of interpersonal violence victims who were admitted to our centre from 1 January 2001 to 31 December 2010 was conducted. Data were obtained from our trauma registry.</p><p><b>RESULTS</b>Interpersonal violence victims constituted 444 (90.1% males and 9.9% females) out of a total of 8561 trauma admissions in the same time period. The average age was 36.6 years (range, 14 to 83 years). Majority were Chinese (53.4%) and Singaporeans (77.3%). The number of cases increased from 10 per year to 96 per year in the first 8 years, then decreased in the last 2 years (55 in year 2010). Time of injury was predominantly 0000 to 0559 hours (72.3%). Interpersonal violence mostly occurred in public spaces for both genders (88.7%). However, the number of females who were injured at home was significantly higher than males (P = 0.000). Blunt trauma (58.3%) was more common than penetrating trauma (41.7%). The average injury severity score (ISS) was 13.5 (range, 1 to 75); 34.9% of patients had major trauma (ISS >15). The average Glasgow coma scale (GCS) score was 13.5 (range, 3 to 15); 16.4% of patients had moderate-to-severe brain injury (GCS 3-8). Blunt trauma was significantly more likely to cause major trauma than penetrating trauma (P = 0.003). The sole case of firearm assault caused most morbi-mortality. Overall mortality was 4.5%. Major trauma (OR: 25.856; P = 0.002) and moderate-to-severe brain injury (OR: 7.495; P = 0.000) were independent risk factors of mortality.</p><p><b>CONCLUSION</b>There has been no prior published data on interpersonal violence locally. This study is thus useful as preliminary data for future population-based studies. It also provides data for authorities to formulate preventive and intervention strategies.</p>

Major workplace related accidents in Singapore: A major trauma centre's experience

<p><b>INTRODUCTION</b>Major workplace related accidents pose a significant healthcare resource challenge in Singapore.</p><p><b>MATERIALS AND METHODS</b>Our study looks at the epidemiology of patients who were admitted for workplace related accidents, in a single institution, with an Injury Severity Score of >9.</p><p><b>RESULTS</b>There were 196 cases of major workplace related accidents admitted between January 2006 and December 2007. The median age of patients admitted was 37 years with a large percentage being males (95.4%) and non-residents (57.1%). The most common ethnic group was Chinese (53.1%) followed by Indians (23.5%). The most common mechanism of injury was fall from height (66.3%) followed by injuries as a result of falling objects at work (21.9%). The percentage of patients who required surgical intervention was 69.9%. Patients admitted for major workplace related accidents had a median length of stay of 5 days in the hospital, a median length of 24 days of medical leave (ML), certifying them unfit for duty and the average cost of stay for each patient was S$11,000.</p><p><b>CONCLUSIONS</b>We have a better understanding of the epidemiology and socio-economic impact of workplace related accidents through this study. Workplace related accidents result in significant number of man-days lost from work and monetary cost to employers, medical insurance and the hospital. With an improved understanding, we propose methods to prevent and reduce such accidents in future. A direct consequence of which will be the possible reduction of hospitalisation costs and better allocation of healthcare resources in the future.</p>