Bulletin of Emergency And Trauma

Abstract Objectives: This systematic review aimed to evaluate and compare emergency hemorrhage control
interventions for hemodynamically unstable pelvic fracture trauma, assessing clinical outcomes, including
mortality, transfusion requirements, and complication rates.
Methods: A comprehensive literature search of PubMed, Scopus, Web of Science, and Google Scholar was
conducted in December 2024. Studies were selected based on predefined inclusion criteria, which considered
adult patients (≥18 years) with hemodynamically unstable pelvic fractures. Data extraction and quality
assessment were performed using standardized tools. Interventions of interest included preperitoneal pelvic
packing (PPP), angioembolization (AE), resuscitative endovascular balloon occlusion of the aorta (REBOA),
and mechanical stabilization.
Results: Ten studies were included. PPP and AE demonstrated comparable in-hospital mortality rates. However,
PPP was associated with shorter intervention times and reduced early transfusion requirements. Mechanical
stabilization was universally recommended as an initial step, while REBOA served as a temporizing measure.
The overall strength of evidence was moderate, derived primarily from retrospective studies and meta-analyses,
with no randomized controlled trials identified.
Conclusion: Both PP and AE were effective for hemorrhage control in hemodynamically unstable pelvic fractures,
with the choice of first-line intervention often dependent on logistical factors. The development of standardized
protocols and prospective studies should be prioritized in future work to optimize management strategies.

Abstract Objective: This study aimed to determine the epidemiological characteristics of elderly patients hospitalized
for spinal fractures at Mousavi Referral Hospital in Zanjan, Iran, from 2021 to 2023.
Methods: In this cross-sectional study, medical records of 261 elderly patients hospitalized with vertebral
fractures were reviewed. Data on demographic characteristics, injury mechanisms, vertebral involvement,
associated injuries, spinal cord damage, and patient outcomes were extracted and analyzed.
Results: Of the 261 patients, 138 (52.9%) were men and 123 (47.1%) were women. The mean age was 70.4±8.37
(range: 60-95). Women were significantly older than men (70±11 vs. 67±11, p=0.03). Male patients sustained
a significantly higher number of fractured vertebrae than females (p=0.02). The incidence of fractures varied
significantly across seasons (p=0.001). The most common fracture site was the thoracolumbar junction (56.2%),
and the main cause was falling (58.6%). Spinal cord injuries occurred in 7.3% of patients. The most frequent
associated fractures were pelvic (25.9%). The length of hospital stay increased significantly with the presence
of associated fractures (p=0.001), spinal cord injuries (p=0.02), and a greater number of fractured vertebrae
(p=0.04).
Conclusion: Elderly spinal fracture patients, particularly men and those with multiple vertebral fractures,
are at an increased risk of spinal cord injury, associated fractures, prolonged hospitalization, and mortality.
Falls remain the most frequent cause, and the thoracolumbar junction the most common site. These findings
highlighted the need for targeted prevention strategies, cautious clinical management, and early identification
of high-risk patients to improve outcomes. 

Abstract Objective: This study aimed to evaluate the diagnostic accuracy of a clinical scoring system, both alone
and in combination with D-dimer assay, for suspected cerebral venous thrombosis (CVT) in the emergency
department.
Methods: This prospective observational study was conducted in the Emergency Department of a tertiary care
teaching hospital in India. Patients who met the inclusion criteria were assessed using a CVT scoring system.
They underwent non-contrast computed tomogography of the brain to rule out other types of strokes and to
detect signs of CVT. D-dimer testing was also performed. The diagnosis of CVT was subsequently confirmed
by magnetic resonance venography (MRV).
Results: Among the75 study subjects, the frequency of CVT, as confirmed by MRV, was 53.33%. Elevated
D-dimer levels were observed in 32 out of 75 patients, of whom 26 (65%) patients had CVT. A low-probability
clinical score demonstrated a sensitivity of 73.33% and a pecificity of 71.1% for ruling out CVT. When a
low-probability score was combined with D-dimer values below 500 μg/L, the sensitivity for ruling out CVT
improved to 92.5%.
Conclusion: The present study indicated that moderate- and high-probability clinical scores were associated
with a higher likelihood of CVT. In this cohort, a low-probability clinical score combined with a negative
D-dimer assay had a high negative predictive value for CVT. While a moderate or high-probability score
warranted urgent imaging, it could not confirm the diagnosis on its own. This approach is particularly useful in
resource-limited settings for triaging and referring patients for the early initiation of treatment.

Abstract  Objective: This study aimed to assess the status of early warning systems (EWS) for disaster and emergency response in hospitals affiliated with Mazandaran University of Medical Sciences in 2024.
Methods: This descriptive-analytical study was conducted from April to December 2024 across all affiliated hospitals with Mazandaran University of Medical Sciences. Data were collected using a validated 55-item EWS checklist evaluating preparedness in both pre-incident and during-incident phases. Overall hospital preparedness was categorized as good (≥75%), moderate (50–74%), or poor (<50%).
Results: In the pre-incident phase, 28 out of 32 hospitals (87.5%) demonstrated good preparedness score (mean±SD: 74.8±12.1). During the incident phase, overall preparedness declined, with only 25 hospitals (78.1%) classified as good (mean±SD: 61.7±14.9). Based on total performance scores, Hospital No. 29 and 30 ranked the highest, while Hospital No. 4 demonstrated the weakest overall preparedness across both phases.
Conclusion: While most hospitals exhibited adequate preparedness in key EWS components, such as warning dissemination and response readiness, notable weaknesses were identified in hazard identification, hazard monitoring, and documentation. Strengthening targeted training programs, establishing integrated monitoring systems, and conducting regular simulation exercises are essential for enhancing operational effectiveness. 

Abstract  We present a rare case of a migratory fish bone into the thyroid gland with abscess formation and internal jugular vein (IJV) thrombosis. A 73-year-old woman was referred to our emergency department due to several syncopal attacks, a ground-level fall, drowsiness, and left-sided neck swelling, with a history of consuming fish three months ago. CT scan and ultrasound revealed abscess formation at the left side of the neck, a foreign body within the left lobe of the thyroid, and left IJV thrombosis. The fish bone was removed successfully, and a left thyroid lobectomy was performed. The postoperative course was uneventful, and the IJV reopened without further intervention. Fish bone migration into the thyroid gland is an unusual event, and its possibility should be considered, especially when the patient has persistent symptoms with negative findings on examination. In such cases, appropriate imaging and advanced interventions are essential for timely diagnosis and management 

Abstract Objective: Diaphragmatic eventration (DE) is a rare condition that can mimic a traumatic diaphragmatic hernia, particularly in trauma cases. We present a case of DE initially misdiagnosed as a diaphragmatic hernia following a road traffic accident, highlighting diagnostic challenges and surgical management.
Case Presentation: A 50-year-old man presented to the hospital after a road traffic accident with chest discomfort and decreased air entry on the left side. Chest X-ray revealed a left paracardiac opacity. Contrast-enhanced CT (CECT) of the thorax suggested a central diaphragmatic defect with herniation of the transverse colon and mesocolon. An exploratory laparotomy, however, revealed no diaphragmatic rupture but instead a central eventration measuring 10×5×7 cm containing bowel loops. The contents were reduced, and diaphragmatic plication was performed using non-absorbable polypropylene sutures. The patient’s postoperative recovery was uneventful, and he was discharged on the eighth day. At follow-up, he remained asymptomatic.
Conclusion: This case underscored the importance of considering DE as a differential diagnosis in trauma patients. Surgical exploration is crucial for definitive diagnosis, and plication could provide an effective and durable management strategy.

Abstract Objective: Anticoagulation therapy is an exceptionally effective approach for preventing thromboembolic events, including both primary and secondary occurrences that can significantly affect patient health. Among the range of anticoagulants available for clinical use, warfarin is particularly prominent, having gained extensive recognition and acceptance within the medical field for its demonstrated efficacy in treating coagulation disorders. One of the main adverse effects linked to warfarin administration is the heightened risk of bleeding, which can present in various forms. However, it is important to note that sublingual hematoma remains a relatively rare complication, though it has the potential to cause serious airway obstruction if it occurs. In situations where a patient shows symptoms of an unstable airway due to such complications, performing an urgent surgical procedure, which may involve interventions such as tracheostomy—to restore airway patency and ensure sufficient ventilation is typically recommended.
Case Presentation: This report outlines a clinical case involving a 69-year-old male patient who developed a sublingual hematoma as a direct result of warfarin therapy, which subsequently led to airway obstruction.
Conclusion: Sublingual hematoma is a rare but potentially life-threatening complication of anticoagulation therapy. Early recognition, prompt airway management, and rapid reversal of coagulopathy using available resources are critical to preventing fatal airway obstruction in the emergency setting.