PurposeInvestigation of injury patterns epidemiology among car occupants may help to develop different therapeutic approach according to the seat position. The aim of the study was to evaluate and compare differences in the incidence of serious injuries, between occupants in different locations in private cars.MethodsA retrospective study including trauma patients who were involved in motor vehicle accidents and admitted alive to 20 hospitals (6 level Ⅰ trauma centers and 14 level Ⅱ trauma centers). We examined the incidence of injures with abbreviated injury score 3 and more, and compared their occurrence between seat locations.ResultsThe study included 28,653 trauma patients, drivers account for 60.8% (17,417). Front passenger mortality was 0.47% higher than in drivers. Rear seat passengers were at greater risk (10.26%) for traumatic brain injuries than front seat passengers (7.48%) and drivers (7.01%). Drivers are less likely to suffer from serious abdominal injuries (3.84%) compared to the passengers (front passengers - 5.91%, rear passengers – 5.46%).ConclusionOut of victims who arrived alive to the hospital, highest mortality was found in front seat passengers. The rate of serious chest injuries was higher as well. Rear seat passengers are at greater risk for serious traumatic brain injuries. All passengers have a greater incidence of abdominal injuries. These findings need to be addressed in order to develop “customized” therapeutic policy in trauma victims.

BackgroundRecent studies have reported significant morbidity and mortality in patients with multiple rib fractures, even without flail chest. The aim of this study was to compare the clinical outcome and incidence of associated chest injuries between patients with and without flail chest, with three or more rib fractures.MethodsThis study included patients with blunt trauma with at least three rib fractures, hospitalised during 2010–2019 in the Hillel Yaffe Medical Center in central Israel (level II trauma centre). Patients with and without radiologically defined flail chest were compared with regard to demographics, Injury Severity Score (ISS), GCS, systolic blood pressure (SBP) on admission, radiological evidence of flail chest, associated chest injuries, length of stay in intensive care unit, length of hospitalisation and mortality.ResultsThe study included 407 patients, of which 79 (19.4%) had flail chest. Overall, pneumothorax and haemothorax were more common among patients with flail chest (p<0.05). When comparing patients with three to five rib fractures, there was no difference in length of intensive care and length of hospitalisation or mortality; however, there was a higher incidence of pneumothorax (24.6% vs 50.0%, p<0.05). When comparing patients with six or more rib fractures, no difference was found between patients with and without flail chest.ConclusionIn patients with three to five rib fractures, pneumothorax is more common among patients with flail chest. Clinical significance of flail chest in patients with more than six rib fractures is questionable and flail chest may not be a reliable marker for severity of chest injury in patients with more than six fractures.

The spleen is an intraperitoneal organ typically located in the left upper quadrant. Ectopic (‘wandering’) spleen refers to the displacement of the spleen from its normal anatomical location to another region in the abdominal cavity or pelvis. It’s a relatively rare condition with no clear aetiology. We present, here, a case of a wandering spleen following sleeve gastrectomy in a 23-year-old female patient, whose spleen, prior to this event, was demonstrated by imaging in a normal anatomical position. A splenectomy was performed, and after an uneventful postoperative period, the patient was discharged. No similar case description was found in the relevant medical literature. Possible causes and decision-making process are discussed. We conclude that the wandering spleen phenomenon should be considered in the differential diagnosis of patients presenting with abdominal pain and new abdominal mass following sleeve gastrectomy.

Gastrointestinal (GI) bleeding is a common surgical problem. The aim of this study was to evaluate how insertion of the nasogastric tube may enable differentiation between upper and lower GI bleeding in patients with melena. A retrospective study involving patients admitted to our surgery division with a melena was carried out between the years 2010 and 2012. A total of 386 patients were included in the study. Of these, 279 (72.2%) patients had negative nasogastric aspirate. The sensitivity of examination of nasogastric aspirate to establish the upper GI as the source of bleeding was only 28% and the negative predictive value of a negative nasogastric aspirate was less than 1%. Most patients who initially presented with melena and were found to have upper GI bleeding had a negative nasogastric aspirate. Insertion of a nasogastric tube does not affect the clinical decision to perform upper endoscopy and should not be routinely carried out.

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