Background. In patients with severe injury, predicting the injury site without using advanced diagnostic modalities can help formulate a diagnosis and treatment plan based on the suspected injury site. Objectives. This study aimed to determine the correlation between the injury site and trauma mechanism in severely injured patients with blunt trauma. Methods. We retrospectively analyzed the clinical characteristics—including age, sex, date of emergency room (ER) visit, time of injury, trauma mechanism (car accident, motorcycle accident, bicycle accident, pedestrian accident, fall, slipping and rolling down, crush injury, assault, and others), final diagnosis, injury severity score, abbreviated injury scale (AIS) score, and injury site—of 1,245 patients in a tertiary trauma center. Results. There was a strong correlation between certain injury sites and specific trauma mechanisms. In particular, most trauma mechanisms were associated with injury to the head and neck, as well as the chest, with a combined frequency of >40.0%. Moreover, when using one-way analysis of variance and Bonferroni’s post hoc tests, there were significant differences in AIS scores 1, 3, 4, and 5 for each trauma mechanism. Conclusion. Generally, when patients with severe injury present to the ER, the injury site can be predicted upon initial assessment based on the trauma mechanism. Based on our study, the injury site predicted by a specific mechanism should be checked repeatedly and additionally through physical examination and imaging tools. This can reduce misdiagnosis and help with accurate diagnosis and treatment.

Background. In cases of chest trauma, computed tomography (CT) can be used alongside chest anteroposterior (AP) radiography and physical examination during initial evaluation. Performing a CT scan may be difficult if a patient has unstable vital signs. In contrast, radiography may not always reliably diagnose nonmarked pneumothorax or extensive subcutaneous emphysema. Objectives. This study aimed to determine the agreement between chest radiography and CT findings in patients with blunt chest trauma. The study also aimed to determine the occurrence of occult pneumothorax and clarify the proportion of subcutaneous emphysema and pneumothorax detected through radiography and CT, respectively. Methods. We included patients (n = 1284) with chest trauma who were admitted to the emergency room of a tertiary hospital between January 2015 and June 2022. We excluded patients aged <18 years, those with stab injury, those without radiography and CT findings, and patients who required iatrogenic intervention, such as chest tube insertion, before imaging. We recorded age, sex, trauma mechanism, and Abbreviated Injury Scale score for each patient. From radiography and CT scans, we recorded the presence of rib fracture, subcutaneous emphysema, lung contusion, pneumothorax, and pneumomediastinum. The accuracy, sensitivity, specificity, and positive and negative predictive values were calculated to assess the reliability of radiography as a predictor of CT-based diagnosis. Results. Radiography exhibited a specificity of nearly 100% for all items. In most cases, findings that could not be confirmed by CT were not evident on radiographs. The incidence of occult pneumothorax was 87.3%. When subcutaneous emphysema was observed on radiography, CT findings indicated pneumothorax in 96.7% of cases. Conclusions. In situations where the patient’s vital signs are unstable and performing a CT scan is not feasible, the presence of subcutaneous emphysema on radiography may indicate the need for chest decompression, even if pneumothorax is not observed.

Background. Although blunt abdominal trauma is sometimes readily identified in patients with trauma, its diagnosis and treatment can be delayed due to various limitations including unconsciousness or unstable vital functions, which may cause shock due to blood loss and sepsis. Confirming the correlation between the specific damage of the abdominal organ and the recommended surgical intervention will allow for predicting abdominal damage based on the specific underlying trauma mechanisms. Objectives. This study aimed to assess the proportion of patients with blunt trauma resulting from intraabdominal injury who received surgical intervention (surgery and angioembolization [A/E]), stratified by trauma mechanism and to examine which organs were damaged per different trauma incident. Methods. We retrospectively analyzed the clinical characteristics of 2,291 patients in a tertiary trauma center. Clinical characteristics included age, sex, injury severity score, trauma mechanism (car, motorcycle, pedestrian, bicycle, ship or train accident, fall, slipping or rolling down, bumping, crush injury, explosion burn, and others), abdominal surgical intervention, damaged organ, and A/E site. Results. One-fourth of the patients with blunt trauma required surgical intervention in the abdomen. In particular, the mesentery or bowel was the main injured area for abdominal surgery in all mechanisms, and the spleen or liver was the main damaged organ subjected to A/E. Therefore, we should consider that a substantial proportion of patients with trauma do require abdominal surgery. In particular, repeated physical examination and imaging tests are necessary when the patients are unconscious or their vital functions are unstable for accurate confirmation of injury.