Bulletin of Emergency And Trauma

Abstract Objectives: This study aimed to systematically review and quantify the association between D-dimer levels and injury outcomes in trauma patients through a meta-analysis.
Methods: A systematic literature search of PubMed, MEDLINE/PubMed, and Web of Science was conducted from 2011 to 2023, supplemented by manual reference list searches. Two independent reviewers assessed the risk of bias using the Newcastle-Ottawa Scale. The primary outcomes were mortality and deep vein thrombosis (DVT).
Results: Of 84 identified articles, 17 were eligible for full-text assessment, and 12 were included in the final analysis. A random-effects model was used to pool the study results. The analysis revealed a statistically significant difference in mean D-dimer levels between patients with poor outcomes and those without poor outcomes (p=0.0003). The standardized mean difference (SMD) was 0.51 (95% confidence interval [CI]:0.24 to 0.79). Furthermore, a significant difference in mean D-dimer levels was observed between survivors and non-survivors (p=0.03, SMD:0.42, 95% CI:0.04-0.79) and between patients with DVT and those without DVT (p=0.0008, SMD:0.79, 95% CI:0.32-1.25).
Conclusion: This meta-analysis indicated that elevated D-dimer levels upon admission could be a valuable prognostic marker in trauma patients and might help predict poor outcomes.

Abstract Objective: This systematic review and meta-analysis aimed to evaluate the efficacy of urine alkalinization in preventing acute kidney injury (AKI) and the need for dialysis in patients with rhabdomyolysis.
Methods: This study was conducted in accordance with the PRISMA guideline. A systematic literature search of MEDLINE/ PubMed, Scopus, Web of Science, and Embase databases was conducted. No time or language restrictions were applied to maximize the scope of the results. After removing duplicates, the remaining articles were screened by title, abstract, and study criteria. Two researchers independently assessed the full texts of the remaining studies, with any discrepancies resolved through discussion. The risk of bias was assessed using the ROBINS-I tool, and studies with a critical risk of bias were excluded from the final analysis.
Results: Out of 9,230 initially identified articles, five studies met the inclusion criteria for the meta-analysis. The analysis revealed that urine alkalinization was not significantly effective in preventing AKI (OR: 2.11; 95% CI: 0.09-47.72; p=0.3), preventing acute renal failure (OR: 1.26; 95% CI: 0.86-1.84; p=0.36), or reducing the need for dialysis (OR: 4.25; 95% CI: 0-3.8e+07; p=0.25).
Conclusion: The addition of sodium bicarbonate to fluid therapy solution did not appear to provide significant protection against AKI, acute renal failure, or the need for dialysis in patients with rhabdomyolysis. Further insight should be sought through controlled randomized clinical trials with larger sample sizes.

Abstract Objective: This systematic review and meta-analysis aimed to evaluate the impact of albumin administration on mortality and total resuscitation volume in burn patients.
Methods: We systematically searched ScienceDirect, Cochrane, PubMed, MEDLINE, Scopus, and ProQuest in June 2025 using the terms “Burns,” “Resuscitation,” and “Albumin.” Studies were included if they investigated albumin as part of burn resuscitation in adult patients and reported on mortality and total resuscitation volume. Pediatric studies, studies using albumin for other purposes, and those using other colloids were excluded. Reviewers independently extracted data on study characteristics, patient demographics, and outcomes. The risk of bias was assessed using RoB 2 for RCTs and ROBINS-I for non-randomized studies (NRCTs). Pooled analyses were performed using Review Manager 9.3.0, applying random-effects models.
Results: Eleven of the 7,365 identified articles were included. Albumin administration did not significantly affect mortality (OR=1.19 [0.62–2.28], p=0.57) or total resuscitation volume (OR=0.69 [-0.93–2.31], p=0.34). However, albumin use was associated with a reduced incidence of sepsis (OR=1.18 [1.02–1.38], p=0.03) and ARDS (OR=2.64 [1.43–4.86], p=0.02).
Conclusion: The administration of albumin did not significantly impact mortality or resuscitation volume in burn patients. While there is some evidence of potential benefits in reducing complications, this is limited by heterogeneity, underscoring the need for further high-quality RCTs.

Abstract Objective: The primary outcome was the management of acute agitation, as measured by the Richmond
Agitation-Sedation Scale (RASS). Secondary outcomes included the incidence of adverse effects and the time
to onset of the therapeutic effect.
Methods: This randomized clinical trial was conducted between March 2021 and March 2022. Participants
were recruited from patients presenting with acute agitation who required pharmacological intervention at
Emam Reza and Shahid Hasheminejad hospitals (Mashhad, Iran). Eligible participants were adults aged 18 to
65 years. Using a block randomization method with a block size of four, patients were assigned to receive either
5 mg of intravenous (IV) haloperidol or 2 mg/Kg of IV ketamine. Data were analyzed using SPSS software
(version 22).
Results: A total of 120 participants were randomized. The majority were male, comprising 43 (73%) in the
haloperidol group and 45 (75%) in the ketamine group. The mean age was 45.42±16.65 in the ketamine group
and 48.28±16.75 years in the haloperidol group (p=0.34). In the haloperidol group, the mean admission RASS
score was 1.73±0.75, which decreased to 0.07±1.25 post-intervention. In the ketamine group, the mean admission
RASS score was 1.58±0.61, which improved to -0.92±1.19 following treatment.
Conclusion: Ketamine demonstrated a faster onset of action in managing acute agitation than haloperidol.
These findings suggested that ketamine might represent a viable first-line therapeutic

Abstract Objective: This study aimed to assess the potential of the Systemic Inflammatory Response Index (SIRI) for
diagnosing AA, its possible advantages over current methods, and its utility in distinguishing uncomplicated
from complicated appendicitis.
Methods: In this cross-sectional study, 240 patients scheduled for appendectomy with a diagnosis of AA were
enrolled. Demographic information, clinical and paraclinical findings, including complete blood count (CBC),
Alvarado score, SIRI, sonography findings, and pathology results, were documented. Data were analyzed using
SPSS software version 26.
Results: Of the 240 patients, 106 (44.2%) were men, and 134 (55.8%) were women, with a mean age of 37.49±15.55
years. Final pathology reports identified 26 (10.8%) cases of a normal appendix, 176 (73.3%) with uncomplicated
appendicitis, 23 (9.6%) with complicated appendicitis, and 15 (6.3%) with reactive lymphoid hyperplasia. SIRI
demonstrated significant differences across the pathology groups (P<0.0001). It showed notable discrimination
between normal and complicated appendicitis (P=0.005), normal and combined appendicitis (P=0.008), and
suggestive differences for normal versus uncomplicated (P=0.021) and uncomplicated versus complicated
cases (P=0.044). Similarly, Alvarado scores showed significant differences, particularly between the normal
and complicated appendicitis groups.
Conclusion: The SIRI and Alvarado scoring systems showed significant potential for diagnosing appendicitis
with acceptable sensitivity and specificity. They might also assist in differentiating between uncomplicated and
complicated appendicitis.

Abstract Marin-Amat syndrome is a rare form of facial synkinesis resulting from aberrant connections between the
trigeminal and facial nerves. This condition manifests as involuntary eyelid closure upon voluntary jaw
movement. It is distinct from the more common Marcus Gunn jaw-winking syndrome (MGJWS), which
involves upper eyelid elevation during mastication. Here, we reported a case of a 64-year-old woman who
developed this syndrome following combat-related maxillofacial trauma to the lateral mandible, which resulted
in a left facial nerve injury. After her mandibular fractures were stabilized using 2 mm plates, her medical
history was notable only for hypothyroidism. Six months post-injury, and following an attempted free fibula flap
procedure, the patient began experiencing involuntary facial movements. These symptoms caused significant
social discomfort and difficulty with eating. Treatment options, including botulinum toxin and surgery, were
discussed; however, the patient opted for a conservative management approach.

Abstract We evaluated the recent prospective study by Hamidnezhad et al. comparing Trauma and Injury Severity Score (TRISS) and Madras Head Injury Prognostic Scale (MHIPS) in traumatic brain injury. The authors showed that both tools are good predictors of mortality and ICU admission, with higher specificity for TRISS and higher sensitivity for MHIPS. Their two-endpoint methodology, sound approach, and robust statistical methodology greatly enhance confidence in the result. However, several areas for future improvement still exist. Calibration, necessary to evaluate agreement between predicted and observed outcomes, was not assessed, although it is key to prognostic modelling. Further, Decision Curve Analysis might illuminate net clinical benefit over threshold probabilities. Wider issues in trauma prognostic models, like small sample sizes, sparse external validation, unsatisfactory treatment of missing data, and dichotomizing of continuous predictors, also need to be improved. Lastly, stability of models deserves more consideration to permit transportability to other settings. We praise the authors' contribution and issue these improvements as recommendations for future prognostic studies in head injury.