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Individualized Trauma Management and Care Strategy

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A special issue of Journal of Personalized Medicine (ISSN 2075-4426). This special issue belongs to the section "Clinical Medicine, Cell, and Organism Physiology".

Deadline for manuscript submissions: closed (5 January 2023) | Viewed by 20633

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Dr. Chi-Tung Cheng

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Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33328, Taiwan
Interests: trauma; acute care surgery; critical care; artificial intelligence; machine learning; medical image analysis; database research

Special Issue Information

Dear Colleagues,

Trauma remains the leading cause of death for individuals below the age of 45 and results in loss of productivity. Trauma management requires a multidisciplinary team with experience. Recent advances in trauma and critical care, including new concepts of trauma-induced coagulopathy, transfusion medicine, vascular interventions, imaging technology, and novel devices, may decrease the mortality and morbidity of trauma victims and avoid tragedy.

Rapid and accurate diagnosis with early treatment is the cornerstone of dealing with trauma patients. However, the complexity of patients with multiple traumas and the anarchy of the emergency room make this a challenge. Therefore, the guidelines and algorithms need to be personalized considering age, gender, race, mechanism, the extent and severity of injuries, comorbidities, culture, and other individual factors. Only personalized management will lead to the most favorable outcome.

This Special Issue embraces, but is not limited to the following topics of trauma and acute care surgery, including the diagnosis and treatment algorithm of any specific injured organs, novel technology and the intervention of trauma management, rehabilitation and recovery management of trauma patients, innovation of trauma and critical care, and personalized trauma care.

Dr. Chi-Tung Cheng
Guest Editor

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Personalized Medicine is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

trauma
emergency surgery
interventional radiology
critical care
personalized treatment
precision diagnosis

Published Papers (11 papers)

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11 pages, 3751 KiB

Open AccessArticle

Comparing the Clinical Efficacy of Coil Embolization in GDA Stump versus Common Hepatic Artery in Postoperative Hemorrhage after Pancreatoduodenectomy

by Chia-Chien Wu, Huan-Wu Chen, Ker-En Lee, Yon-Cheong Wong and Yi-Kang Ku

J. Pers. Med. 2023, 13(2), 264; https://doi.org/10.3390/jpm13020264 - 31 Jan 2023

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Abstract

Background: Hemorrhage after pancreaticoduodenectomy is an uncommon but fatal complication. In this retrospective study, the different treatment modalities and outcomes for treating post-pancreaticoduodenectomy hemorrhage are analyzed. Methods: Our hospital imaging database was queried to identify patients who had undergone pancreaticoduodenectomy during the period of 2004–2019. The patients were retrospectively split into three groups, according to their treatment: conservative treatment without embolization (group A: A1, negative angiography; A2, positive angiography), hepatic artery sacrifice/embolization (group B: B1, complete; B2, incomplete), and gastroduodenal artery (GDA) stump embolization (group C). Results: There were 24 patients who received angiography or transarterial embolization (TAE) treatment 37 times (cases). In group A, high re-bleeding rates (60%, 6/10 cases) were observed, with 50% (4/8 cases) for subgroup A1 and 100% (2/2 cases) for subgroup A2. In group B, the re-bleeding rates were lowest (21.1%, 4/19 cases) with 0% (0/16 cases) for subgroup B1 and 100% (4/4 cases) for subgroup B2. The rate of post-TAE complications (such as hepatic failure, infarct, and/or abscess) in group B was not low (35.3%, 6/16 patients), especially in patients with underlying liver disease, such as liver cirrhosis and post-hepatectomy (100% (3/3 patients), vs. 23.1% (3/13 patients); p = 0.036, p < 0.05). The highest rate of re-bleeding (62.5%, 5/8 cases) was observed for group C. There was a significant difference in the re-bleeding rates of subgroup B1 and group C (p = 0.00017). The more iterations of angiography, the higher the mortality rate (18.2% (2/11 patients), <3 times vs. 60% (3/5 patients), ≥3 times; p = 0.245). Conclusions: The complete sacrifice of the hepatic artery is an effective first-line treatment for pseudoaneurysm or for the rupture of the GDA stump after pancreaticoduodenectomy. Hepatic complications are not uncommon and are highly associated with underlying liver disease. Conservative treatment, the selective embolization of the GDA stump, and incomplete hepatic artery embolization do not provide enduring treatment effects. Full article

(This article belongs to the Special Issue Individualized Trauma Management and Care Strategy)

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16 pages, 2286 KiB

Open AccessArticle

Emergency Care for Burn Patients—A Single-Center Report

by Andrei Niculae, Ileana Peride, Mirela Tiglis, Ana Maria Nechita, Lucian Cristian Petcu and Tiberiu Paul Neagu

J. Pers. Med. 2023, 13(2), 238; https://doi.org/10.3390/jpm13020238 - 28 Jan 2023

Cited by 2 | Viewed by 1944

Abstract

Burns, one of the main public health problems, lead to significant mortality and morbidity. Epidemiological studies regarding burn patients in Romania are scarce. The aim of this study is to identify the burn etiology, demographics, clinical characteristics, and outcomes in patients requiring treatment in a regional burn unit. Design. We performed a retrospective observational study of 2021. Patients. All patients admitted to our six-bed intensive care unit (ICU) were included. Interventions. The following data were collected for further analysis: demographics, burn pattern (etiology, size, depth, affected body region), type of ventilation, ABSI (Abbreviated Burn Severity Index) score, comorbidities, bioumoral parameters, and hospitalization days. Results. There were 93 burned patients included in our study that were divided into two groups: alive patients’ group (63.4%) and deceased patients’ group (36.6%). The mean age was 55.80 ± 17.16 (SD). There were 65.6% male patients, and 39.8% of the patients were admitted by transfer from another hospital. Further, 59 patients presented third-degree burns, from which 32.3% died. Burns affecting >37% of the total body surface area (TBSA) were noticed in 30 patients. The most vulnerable regions of the body were the trunk (p = 0.003), the legs (p = 0.004), the neck (p = 0.011), and the arms (p = 0.020). Inhalation injury was found in 60.2% of the patients. The risk of death in a patient with an ABSI score > 9 points was 72 times higher. Comorbidities were present in 44.1% of the patients. We observed a median LOS (length of stay) of 23 days and an ICU-LOS of 11 days. Logistic regression analysis showed that admission protein, creatinkinase, and leukocytes were independent risk factors for mortality. The general mortality rate was 36.6%. Conclusion. A thermal factor was responsible for the vast majority of burns, 94.6% of cases being accidents. Extensive and full-thickness burns, burns affecting the arms, inhalation injuries, the need for mechanical ventilation, and a high ABSI score represent important risk factors for mortality. Considering the results, it appears that prompt correction of protein, creatinkinase, and leukocytes levels may contribute to improvement in severe burn patients’ outcomes. Full article

(This article belongs to the Special Issue Individualized Trauma Management and Care Strategy)

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10 pages, 1353 KiB

Open AccessFeature PaperArticle

The Clinical Application of Machine Learning-Based Models for Early Prediction of Hemorrhage in Trauma Intensive Care Units

by Shih-Wei Lee, His-Chun Kung, Jen-Fu Huang, Chih-Po Hsu, Chia-Cheng Wang, Yu-Tung Wu, Ming-Shien Wen, Chi-Tung Cheng and Chien-Hung Liao

J. Pers. Med. 2022, 12(11), 1901; https://doi.org/10.3390/jpm12111901 - 14 Nov 2022

Cited by 2 | Viewed by 1450

Abstract

Uncontrolled post-traumatic hemorrhage is an important cause of traumatic mortality that can be avoided. This study intends to use machine learning (ML) to build an algorithm based on data collected from an electronic health record (EHR) system to predict the risk of delayed bleeding in trauma patients in the ICU. We enrolled patients with torso trauma in the surgical ICU. Demographic features, clinical presentations, and laboratory data were collected from EHR. The algorithm was designed to predict hemoglobin dropping 6 h before it happened and evaluated the performance with 10-fold cross-validation. We collected 2218 cases from 2008 to 2018 in a trauma center. There were 1036 (46.7%) patients with positive hemorrhage events during their ICU stay. Two machine learning algorithms were used to predict ongoing hemorrhage events. The logistic model tree (LMT) and the random forest algorithm achieved an area under the curve (AUC) of 0.816 and 0.809, respectively. In this study, we presented the ML model using demographics, vital signs, and lab data, promising results in predicting delayed bleeding risk in torso trauma patients. Our study also showed the possibility of an early warning system alerting ICU staff that trauma patients need re-evaluation or further survey. Full article

(This article belongs to the Special Issue Individualized Trauma Management and Care Strategy)

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14 pages, 1232 KiB

Open AccessArticle

Tailored Surgical Stabilization of Rib Fractures Matters More Than the Number of Fractured Ribs

by Wen-Ruei Tang, Chao-Chun Chang, Chih-Jung Wang, Tsung-Han Yang, Kuo-Shu Hung, Chun-Hsien Wu, Yi-Ting Yen, Yau-Lin Tseng and Yan-Shen Shan

J. Pers. Med. 2022, 12(11), 1844; https://doi.org/10.3390/jpm12111844 - 4 Nov 2022

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Abstract

Background: Patients sustaining multiple rib fractures have a significant risk of developing morbidity and mortality. More evidence is emerging that the indication of surgical stabilization of rib fractures (SSRF) should expand beyond flail chest. Nevertheless, little is known about factors associated with poor outcomes after surgical fixation. We reviewed patients with rib fractures to further explore the role of SSRF; we matched two groups by propensity score (PS). Method: A comparison of patients with blunt thoracic trauma treated with SSRF between 2010 and 2020 was compared with those who received conservative treatment for rib fractures. Risk factors for poor outcomes were analyzed by multivariate regression analysis. Results: After tailored SSRF, the number of fractured ribs was not associated with longer ventilator days (p = 0.617), ICU stay (p = 0.478), hospital stay (p = 0.706), and increased nonprocedure-related pulmonary complications (NPRCs) (p = 0.226) despite having experienced much more severe trauma. In the multivariate regression models, lower GCS, delayed surgery, thoracotomy, and flail chest requiring mechanical ventilation were factors associated with prolonged ventilator days. Lower GCS, higher ISS, delayed surgery, and flail chest requiring mechanical ventilation were factors associated with longer ICU stays. Lower GCS and older age were factors associated with increased NPRCs. In the PS model, NPRCs risk was reduced by SSRF. Conclusions: The risk of NPRCs was reduced once ribs were surgically fixed through an algorithmic approach, and poor consciousness and aging were independent risk factors for NPRCs. Full article

(This article belongs to the Special Issue Individualized Trauma Management and Care Strategy)

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8 pages, 815 KiB

Open AccessArticle

The Surgical Timing and Complications of Rib Fixation for Rib Fractures in Geriatric Patients

by Szu-An Chen, Chien-An Liao, Ling-Wei Kuo, Chih-Po Hsu, Chun-Hsiang Ouyang and Chi-Tung Cheng

J. Pers. Med. 2022, 12(10), 1567; https://doi.org/10.3390/jpm12101567 - 23 Sep 2022

Cited by 2 | Viewed by 2232

Abstract

Rib fractures (RF) are a common injury that cause significant morbidity and mortality, especially in geriatric patients. RF fixation could shorten hospital stay and improve survival. The aim of this retrospective study was to evaluate the clinical impact and proper surgical timing of RF fixation in geriatric patients. We reviewed all the medical data of patients older than 16 years old with RF from the trauma registry database between January 2017 and December 2019 in Chang Gung Memorial Hospital. A total of 1078 patients with RF were enrolled, and 87 patients received RF fixation. The geriatric patients had a higher chest abbreviated injury scale than the non-geriatric group (p = 0.037). Univariate analysis showed that the RF fixation complication rates were significantly related to the injury severity scores (Odds ratio 1.10, 95% CI 1.03–1.20, p = 0.009) but not associated with age (OR 0.99, 95% CI 0.25–3.33, p = 0.988) or the surgical timing (OR 2.94, 95% CI 0.77–12.68, p = 0.122). Multivariate analysis proved that only bilateral RF was an independent risk factor of complications (OR 6.60, 95% CI 1.38–35.54, p = 0.02). RF fixation can be postponed for geriatric patients after they are stabilized and other lethal traumatic injuries are managed as a priority. Full article

(This article belongs to the Special Issue Individualized Trauma Management and Care Strategy)

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11 pages, 3362 KiB

Open AccessArticle

Development and Characterization of an Ex Vivo Testing Platform for Evaluating Automated Central Vascular Access Device Performance

by Emily N. Boice, David Berard, Sofia I. Hernandez Torres, Guy Avital and Eric J. Snider

J. Pers. Med. 2022, 12(8), 1287; https://doi.org/10.3390/jpm12081287 - 5 Aug 2022

Cited by 1 | Viewed by 1294

Abstract

Access to the central vasculature is critical for hemodynamic monitoring and for delivery of life-saving therapeutics during emergency medicine and battlefield trauma situations but requires skill often unavailable in austere environments. Automated central vascular access devices (ACVADs) using ultrasound and robotics are being developed. Here, we present an ex vivo lower-body porcine model as a testing platform for evaluation of vascular devices and compare its features to commercially available platforms. While the commercially available trainers were simpler to set-up and use, the scope of their utility was limited as they were unable to provide realistic anatomic, physiologic, and sonographic properties that were provided by the ex vivo model. However, the ex vivo model was more cumbersome to set-up and use. Overall, both have a place in the development and evaluation pipeline for ACVADs before testing on live animals, thus accelerating product development and translation. Full article

(This article belongs to the Special Issue Individualized Trauma Management and Care Strategy)

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10 pages, 840 KiB

Open AccessArticle

The Influence of Serious Extracranial Injury on In-Hospital Mortality in Children with Severe Traumatic Brain Injury

by Min Chao, Chia-Cheng Wang, Carl P. C. Chen, Chia-Ying Chung, Chun-Hsiang Ouyang and Chih-Chi Chen

J. Pers. Med. 2022, 12(7), 1075; https://doi.org/10.3390/jpm12071075 - 30 Jun 2022

Cited by 2 | Viewed by 1506

Abstract

(1) Background: Severe traumatic brain injury (sTBI) is the leading cause of death in children. Serious extracranial injury (SEI) commonly coexists with sTBI after the high impact of trauma. Limited studies evaluate the influence of SEI on the prognosis of pediatric sTBI. We aimed to analyze SEI’s clinical characteristics and initial presentations and evaluate if SEI is predictive of higher in-hospital mortality in these sTBI children. (2) Methods: In this 11-year-observational cohort study, a total of 148 severe sTBI children were enrolled. We collected patients’ initial data in the emergency department, including gender, age, mechanism of injury, coexisting SEI, motor components of the Glasgow Coma Scale (mGCS) score, body temperature, blood pressure, blood glucose level, initial prothrombin time, and intracranial Rotterdam computed tomography (CT) score of the first brain CT scan, as potential mortality predictors. (3) Results: Compared to sTBI children without SEI, children with SEI were older and more presented with initial hypotension and hypothermia; the initial lab showed more prolonged prothrombin time and a higher in-hospital mortality rate. Multivariate analysis showed that motor components of mGCS, fixed pupil reaction, prolonged prothrombin time, and higher Rotterdam CT score were independent predictors of in-hospital mortality in sTBI children. SEI was not an independent predictor of mortality. (4) Conclusions: sTBI children with SEI had significantly higher in-hospital mortality than those without. SEI was not an independent predictor of mortality in our study. Brain injury intensity and its presentations, including lower mGCS, fixed pupil reaction, higher Rotterdam CT score, and severe injury-induced systemic response, presented as initial prolonged prothrombin time, were independent predictors of in-hospital mortality in these sTBI children. Full article

(This article belongs to the Special Issue Individualized Trauma Management and Care Strategy)

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8 pages, 2261 KiB

Open AccessArticle

Treatment of Mechanical Corneal Wounds Emergencies during the COVID-19 Pandemic: Absorbable 10-0 Vicryl (Polyglactin 910) Sutures as a Suitable Strategy

by Nicolas Abihaidar, Gilles Thuret, Philippe Gain and Thibaud Garcin

J. Pers. Med. 2022, 12(6), 866; https://doi.org/10.3390/jpm12060866 - 25 May 2022

Viewed by 1922

Abstract

Background—The COVID-19 pandemic has changed our standard practices: operating rooms were only available for functional emergencies and outpatient visits were drastically reduced in favor of telemedicine. Aim: To report the personalized “one-shot” surgery using absorbable 10-0 Vicryl (V10-0) or polyglactin 910 monofilament in mechanical corneal injuries from February 2020 to December 2021. Methods—Prospective case series with at least 12-months’ follow-up, in a French university hospital. Among the overall population of open or closed-globe emergencies (n = 40), non-penetrating corneal lamellar lacerations (long axis > 2 mm) in zone 1 (OTC group) were treated with V10-0 suture(s) (n = 10), replacing traditional non-absorbable 10-0 nylon suture(s) or medical options in first line. The outpatient visits were performed on day (D)10, month (M)2, M6 then every six months. One interim visit by phone teleconsultation was scheduled between D10 and M2, and other(s) as needed. The main outcome was best-corrected visual acuity (BCVA) at M6. Secondary outcomes included mainly corneal astigmatism (CA) at M6 complications. Results—Among the ten corneal wounds, there were three children (30%), eight domestic accidents (80%), three eyes with metallic foreign bodies (30%), four open-globe injuries (40%), and nine eyes that received high-speed projectiles or sharp objects (90%). The complete V10-0 suture(s) absorption occurred in all eyes between D10 and M2. At M6, mean far and near BCVA decreased from 0.680 ± 0.753 and 0.490 ± 0.338 preoperatively to 0.050 ± 0.071 and 0.220 ± 0.063 logMAR (p = 0.019 and p = 0.025 respectively), mean CA decreased from 4.82 ± 3.86 preoperatively to 1.15 ± 0.66 diopters (p = 0.008). BCVA and CA were unchanged thereafter. No serious adverse event nor repeated surgery occurred. The mean number of teleconsultations was 1.20 ± 0.63 without an additional nonscheduled outpatient visit. Conclusions—The absorbable V10-0 sutures might be a safe and effective alternative for eligible corneal wounds, while reducing the number of outpatient visits, especially for children (no suture removal). The COVID-19 pandemic highlighted that they are ideally suited to logistical challenges. Full article

(This article belongs to the Special Issue Individualized Trauma Management and Care Strategy)

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14 pages, 637 KiB

Open AccessArticle

Failure to Rescue (FTR) and Pitfalls in the Management of Complex Enteric Fistulas (CEF): From Rescue Surgery to Rescue Strategy

by Stefano Piero Bernardo Cioffi, Osvaldo Chiara, Luca Del Prete, Alessandro Bonomi, Michele Altomare, Andrea Spota, Roberto Bini and Stefania Cimbanassi

J. Pers. Med. 2022, 12(2), 292; https://doi.org/10.3390/jpm12020292 - 16 Feb 2022

Viewed by 1777

Abstract

Purpose: Complex enteric fistulas (CEF) represent general surgeons’ nightmare. This paper aims to explore the impact on failure-to-rescue (FTR) rate of a standardised and integrated surgical and critical care step-up approach. Methods: This was a retrospective observational cohort study. Patients treated for CEF from 2009 to 2019 at Niguarda Hospital were included. Each patient was approached following a three-step approach: study phase, sepsis control and strategy definition phase, and surgical rescue phase. Results: Sixteen patients were treated for CEF. Seven fistulas were classified as complex entero-cutaneous (ECF) and nine as entero-atmospheric fistula (EAF). Median number of surgical procedures for fistula control before definitive surgical attempt was 11 (IQR 2–33.5). The median time from culprit surgery and the first access at Niguarda Hospital to definitive surgical attempt were 279 days (IQR 231–409) and 120 days (IQR 34–231), respectively. Median ICU LOS was 71 days (IQR 28–101), and effective hospital LOS was 117 days, (IQR 69.5–188.8). Three patients (18.75%) experienced spontaneous fistula closure after conversion to simple ECF, whereas 13 (81.25%) underwent definitive surgery for fistula takedown. Surgical rescue was possible in nine patients. Nine patients underwent multiple postoperative revision for surgical complications. Four patients failed to be rescued. Conclusion: An integrated step-up rescue strategy is crucial to standardise the approach to CEF and go beyond the basic surgical rescue procedure. The definition of FTR is dependent from the examined population. CEF patients are a unique cluster of emergency general surgery patients who may need a tailored definition of FTR considering the burden of postoperative events influencing their outcome. Full article

(This article belongs to the Special Issue Individualized Trauma Management and Care Strategy)

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12 pages, 1980 KiB

Open AccessArticle

Diagnostic Accuracy of Computed Tomography for the Prediction of the Need for Laparotomy for Traumatic Hollow Viscus Injury: Systematic Review and Meta-Analysis

by Cheng-Chieh Hsia, Chen-Yu Wang, Jen-Fu Huang, Chih-Po Hsu, Ling-Wei Kuo, Chun-Hsiung Ouyang, Chien-Hung Liao and Huan-Wu Chen

J. Pers. Med. 2021, 11(12), 1269; https://doi.org/10.3390/jpm11121269 - 1 Dec 2021

Cited by 1 | Viewed by 1557

Abstract

Background: Traumatic hollow viscus injury (THVI) is one of the most difficult challenges in the trauma setting. Computed tomography (CT) is the most common modality used to diagnose THVI; however, various performance outcomes of CT have been reported. We conducted a systematic review and meta-analysis to analyze how precise and reliable CT is as a tool for the assessment of THVI. Method: A systematic review and meta-analysis were conducted on studies on the use of CT to diagnose THVI. Publications were retrieved by performing structured searches in databases, review articles and major textbooks. For the statistical analysis, summary receiver operating characteristic (SROC) curves were constructed using hierarchical models. Results: Sixteen studies enrolling 12,514 patients were eligible for the final analysis. The summary sensitivity and specificity of CT for the diagnosis of THVI were 0.678 (95% CI: 0.501–0.809) and 0.969 (95% CI: 0.920–0.989), respectively. The summary false positive rate was 0.031 (95% CI 0.011–0.071). Conclusion: In this meta-analysis, we found that CT had indeterminate sensitivity and excellent specificity for the diagnosis of THVI. Full article

(This article belongs to the Special Issue Individualized Trauma Management and Care Strategy)

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8 pages, 763 KiB

Open AccessArticle

The Role of Nonophthalmologists in the Primary Evaluation of Head Injury Patients with Ocular Injuries

by Chen-Hua Lin, Xiao Chun Ling, Wei-Chi Wu, Kuan-Jen Chen, Chi-Hsun Hsieh, Chien-Hung Liao and Chih-Yuan Fu

J. Pers. Med. 2021, 11(11), 1220; https://doi.org/10.3390/jpm11111220 - 18 Nov 2021

Cited by 1 | Viewed by 1533

Abstract

Purpose—Visual complaints are common in trauma cases. However, not every institution provides immediate ophthalmic consultations 24 h per day. Some patients may receive an ophthalmic consultation but without positive findings. We tried to evaluate risk factors for ocular emergencies in trauma patients. Then, the ophthalmologists could be selectively consulted. Methods—From January 2019 to December 2019, head injuries patients concurrent with suspected ocular injuries were retrospectively reviewed. All of the patients received comprehensive ophthalmic examinations by ophthalmologists. Patients with and without ocular injuries were compared. Specific ophthalmic evaluations that could be primarily performed by primary trauma surgeons were also analyzed in detail. Results—One hundred forty cases were studied. Eighty-nine (63.6%) patients had ocular lesions on computed tomography (CT) scans or needed ophthalmic medical/surgical intervention. Near 70% (69.7%, 62/89) of patients with ocular injuries were diagnosed by CT scans. There was a significantly higher proportion of penetrating injuries in patients with ocular injuries than in patients without ocular injuries (22.5% vs. 3.9%, p = 0.004). Among the patients with blunt injuries (N = 118), 69 (58.5%) patients had ocular injuries. These patients had significantly higher proportions of periorbital swelling (89.9% vs. 67.3%, p = 0.002) and diplopia (26.1% vs. 8.2%, p = 0.014) than patients without ocular injuries. Conclusions—In patients with head injuries, concomitant ocular injuries with indications for referral should always be considered. CT serves as a rapid and essential diagnostic tool for the evaluation of concomitant ocular injuries. Ophthalmologists could be selectively consulted for patients with penetrating injuries or specific ocular presentations, thus reducing the burden of ophthalmologists. Full article

(This article belongs to the Special Issue Individualized Trauma Management and Care Strategy)

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