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Volume 17(2); December 2004
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Original Articles
The Role of Echocardiogram in Sternal Fracture
Yohan Kim, M.D., Song-Am Lee, M.D., Eun Gu Hwang, M.D., Jin-Woong Lee*, M.D.
J Korean Soc Traumatol. 2004;17(2):93-98.
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Background
Sternal fracture may be associated with myocardial contusion even in patients without associated with significant injuries. The aims of this study are to determine the role of echocardiogram(ECHO) in treatment of sternal fracture and to suggest the indication of ECHO. Material and Method: We reviewed the records of 50 consecutive patients presenting with sternal fracture after blunt chest trauma. The relationships between ECHO, creatine kinase MB isoenzyme(CK-MB), electrocardiogram(EKG) were assessed in reference to myocardial contusion. Results: Twelve patients(24%) had one or more abnormal cardiac tests but only 4(8%) had clinically symptomatic myocardial contusion. Eight(22.9%) out of 35 ECHO studies revealed pericardial effusion which was not associated with the severity of all other associated injuries. The incidence of an abnormal ECHO finding in patients of isolated sternal fracture was similar to that of the patients who suffered multiple injuries. In 4 patients with pericardial effusion, this finding was not associated with any other abnormal tests and was regarded as of no clinical cardiac significance. On the other hand, a myocardial contusion was shown by ECHO study only while EKG and CK-MB tests remained normal in that patients. Conclusion: We suggest that the ECHO should be used as a diagnostic and triage tool in every patient with sternal fracture associated with other injuries. However patients with “benign”epicardial effusion can be discharged as soon as their clinical condition improves regardless of other associate injuries.
Summary
Factors Affecting Injuries of Children at Home
Kyung Won Paek, Ph.D., Hyun Jong Song, Ph.D.*, Kook Jong Lee, M.D., Joon Pil Cho, M.D.
J Korean Soc Traumatol. 2004;17(2):99-107.
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Background
Injuries of infants and toddlers in their homes are serious public health problems. Fatal child injuries happen in our “s a f e”homes. There are many situations that can cause accidents in the house. In our study, the risk factors that have effects on the accidents at home are 1) hazards in the house that needs improving, and 2) injury preventive behaviors of the subjects. Method: In the study, we randomly selected 627 cases from Suwon area households that had children under the age of three. Survey was conducted with mothers of the children, using oneon-one interview by specially trained people. The statistical methods used the analysis were ttest, ANOVA and multiple logistic regression. Results: Children whose mother’s injury preventive behavior scores were high experienced less accident than other children(OR=1.048), and this was statistically significant. Conclusion: Home modification and mother’s injury preventive behavior have influences on prevention of home injuries among children. Based on these findings, home modification checklist and educational materials on injury preventive behaviors for parents will be developed. These materials will be used as a means of safety promotion education program to reduce home injuries.
Summary
Effect of Polymorphonuclear Neutriphil by Hypertonic Saline
In Chul Jung, M.D., Be Ahn Lee, M.D., Nak Hoon Kim, M.D., Jong Soo Park, M.D., Sung Hyuk Choi, M.D., Yun Sik Hong, M.D.
J Korean Soc Traumatol. 2004;17(2):108-116.
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Background
To investigate the effects of hypertonic saline on the generation of oxygenderived free radicals in neutrophils, this study was designed. Methods: Human PMNs were isolated from healthy volunteers’peripheral blood by the modified Boyum method. Human PMNs were incubated in 140 mM, 180 mM, 200 mM NaCl with or without fMLP, and then the production of H2O2 was measured with a flow cytometer at 5, 30, 60, 120, and 180 minutes. Isolated PMNs were incubated in 180 mM NaCl before fMLP, after fMLP and also at the same time. H2O2 production was measured by flow cytometry. Results: Hypertonic saline resulted in the suppression of fMLP-mediated H2O2 production in human PMNs. There was no statistical difference in H2O2 production according to the NaCl concentration between 180 mM and 200 mM. fMLP-mediated H2O2 production in human PMNs did not decreased at hypertonic saline infusion after fMLP. Administration of hypertonic saline decrease fMLP-mediated H2O2 production in human PMNs and concentration of 180 mM Na+is effective as well as 200 mM Na+. However, the effects of hypertonic saline is minimal when hypertonic saline was administration after PMNs were stimulated. Conclusions: It is considered that early resuscitation is required in clinically.
Summary
Case Analysis of Sexual Assault Victims
Sae Hyun Noh, M.D., Jin Ho Jung, M.D.***, Ki Chol Noh, M.D.***, Hyung Seob Won, M.D., Seong Jun Bae, M.D.*, Yeon Jung Yun, M.D.*, Dong Yub Seo, M.D.**
J Korean Soc Traumatol. 2004;17(2):117-124.
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Background
It is important for the physician and a rape counselor to understand the epidemiology which studies the incidence, prevalence, spread, prevention, and control of sexual assault in a local community or a specific group of individuals. We tried to this study in order to find the effective treatment of the sexual assault victims and to establish the data base about them. Methods: We prospectively evaluated the sexually assaulted patients who visited medical supportive center for women at national police hospital from 2003. 1. 1 to 2003. 12. 31. The data were obtained from the records of ER and OB & GY(obstetric & gynecologic) clinic; Total 334 cases of patients were evaluated. Results: The mean age was 18.4 years old. The age distribution of sexual assault victims are divided into four; 62 cases under 7 years old(18.6%), 51 cases between 7 and 13 years old(15.2%), 58 cases between 14 to 19 years old(17.3%), and 163 cases over 20 years old(48.9%). The 308 cases of patients(92.2%) were unmarried and 11 cases(3.3%) were examined within 1 hour after visiting hospital. The physical injuries were 192 vaginal injuries(37.1%), 54 ruptures of hymen(10.4%), 5 sexually transmitted disease(1.0%), 191 abnormal sensations of genital organ(36.9%), and 74 minor injuries including abrasions, contusions, lacerations(14.2%). The psychological injuries were 180 phobias(15.5%), 334 angers(28.8%), 53 guilties(4.6%), and the like. The 184 cases of patients(55.1%) were acquainted with the assailant. Conclusions: We thought that the optimal management of the sexual assault victims should be involved the continuous epidemiologic analysis and the estalishment of data base of them.
Summary
Effectivness of Operative Management and Endoscopic Placement of Transpapillary Stent in Pancreatic Trauma
Sang Bum Yoo, M.D., Min Soo Cho, M.D., Keum Seok Bae, M.D., Sung Joon Kang, M.D.
J Korean Soc Traumatol. 2004;17(2):125-130.
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Background
The presence of an injury to the pancreatic duct system is the most important determinant of the morbidity and mortality associated with blunt pancreatic trauma. Endoscopic retrograde pancreatography provides detailed images of the pancreatic duct and clearly defines the nature of pancreatic duct injury. Compared with operative intervention, we evaluate the effectiveness of endoscopic placement of transpapillary stent in pancreatic trauma.
Patients and Methods: Thirteen patient with pancreas injury from April, 1992 to December 2002 were included in this study. We classified patients according to the treatment method, such as operative intervention or endoscopic placement of transpapillary stent. And demographic information, mode of injury, imaging studies, initial serum amylase, hospital stay and complication were retrospectively reviewed. Results: Eight patients were treated by operative intervention, and another five by endoscopic placement of transpapillary stent. In operative interventional group, mean hospital days were 50.8 days, pancreas specific complication developed in 5 of the 8 were as follws: pseudocyst, intestinal obstruction and enterocutaneous fistula. In endoscopic interventional group, mean hos-pital days were 31.2 days, pancreas specific complications were 2 cases of nonsymtomatic pseudocyst. Conclusion: Endoscopic placement of transpapillary stent is an alternative treatment in pancreatic injury.
Summary
The Validity of Hepatic Arterial Embolization in Management of Traumatic Liver Injury
Sung Chul Kim, M.D., Min Soo Cho, M.D., Keum Seok Bae, M.D., Young Ju Kim M.D.*
J Korean Soc Traumatol. 2004;17(2):131-138.
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AbstractAbstract PDF
Purpose
To evaluate the effectiveness of HAE in patients with traumatic liver injury. Method: Eleven patients with traumatic liver injury who were treated with HAE from January 2000 to December 2002 were included in this study. The hepatic injuries were classified into five grades according to CT scan findings on the basis of the injury scale of the American Association for the Surgery of Trauma. All patients with grade III to V injury underwent angiography. If active hemorrhage evidence was found during angiography, hepatic artery embolization with Gelfoam or stainless coil was performed. Result: Among 129 patients with traumatic liver injury, Eleven cases of hepatic arterial embolization were performed. Two of these patients had CT scan grade III injury, 4 had grade IV injury, and 2 had grade V injury. HAE was primarily performed in eight patients, and performed after laparotomy in three patients. Five patients of eight patients who underwent HAE primaryly showed successful outcomes which were supported by shock index improvement(p=0.034) and less required packed RBC amount(p=0.028). Laparotomy was performed in HAE failed three patients, only one patient was recovered. Two of three patients who underwent post-laparotomy HAE showed successful results. Overall treatment success rate of HAE was 63.6%(7/11). Conclusion: HAE is a preferable non-surgical management in patient with traumatic liver injury.
Summary
Evaluation of Serious Injuries due to Motor Vehicle Collision
Ji Yoon Jung, M.D., Kyung Won Paek, Ph.D., Kug Jong Lee, M.D., Joon Pil Cho, M.D.
J Korean Soc Traumatol. 2004;17(2):139-148.
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AbstractAbstract PDF
Background
To provide information about serious traffic accident injuries in Suwon, Korea, during the year of 2000, we conducted an epidemiologic study of injured patients. Methods: The data were obtained by reviewing medical records of patients requiring hospital admission due to traffic injury. A retrospective study, the selection of patients was made according to ICD-10 code. Results: A total of 1389 patients were surveyed. With respect to the causes of injury, traffic accidents accounted for the highest percentage (40.2%). More men than women were injured in all age groups. The highest frequency of traffic injuries was noted in patients ranging in age from 20 to 39 years. The occurrences of accidents were distributed evenly throughout the year, with little seasonal correlation. As for the time of day, the accidents occurred more often in the afternoon and evening. Most of patients were admitted to general ward. The mean ISS of all traffic accident patients was 9.41±7.81. Factors associated with injury severity were sex, age, road user, time of day, and results of ED treatment. Conclusion: This is the first study of serious traffic accident injuries in Suwon for the year 2000. As such, our findings constitute the seminal information for future research, including collection of further data, analyses, and extensions to other cities
Summary
Significance of QTc Prolongation in Traumatic Subarachnoid Hemorrhage
Young Ju Lee, M.D., Kyoung Soo Lim, M.D., Seung Ryu, M.D., Won Kim, M.D.
J Korean Soc Traumatol. 2004;17(2):149-154.
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Background
s: Spontaneous subarachnoid hemorrhage(SAH) causes a prolonged corrected QT(QTc) interval in 20~90% of patients, but whether this occurs with traumatic SAH(tSAH) is unknown. The purpose of this study was to determine whether QTc interval prolongation occurs with tSAH and to determine the value of the QTc prolongation in predicting poor outcome. Methods: A retrospective study was performed on 63 patients with traumatic SAH. An ECG and initial computed tomography(CT) scan were the two major inclusion criteria. The primary end point was in hospital mortality. We correlated ECG changes(especially, QTc interval) with mortality and severity of hemorrhage expressed as CT grading scale. Results: Patients with QTc prolongation were more likely to have poor clinical outcome and had high in-hospital mortality(odds ratio=19.350(95% Confidence interval[CI] 2.627∼142.510, P=0.000)). Also serum potassium level of patients with QTc prolongation were lower than non-QTc prolongation. QTc interval had weak correlation with hemorrhage amount in brain CT. Conclusion: tSAH patients also showed QTc prolongation like spontaneous SAH. QTc prolongation was a good predictor of poor clinical outcome.
Summary
Value of Contrast-enhanced CT for Evaluating Mesenteric Injuries after Blunt Trauma
Ki Cheul Noh, M.D., Jin Joo Kim, M.D., Jin Ho Jung, M.D., Yong Su Lim, M.D., Hyuk Jun Yang, M.D., Keun Lee, M.D., Uk Jin, M.D.*, Cheul Hee Park, M.D.*
J Korean Soc Traumatol. 2004;17(2):155-162.
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Background
Contrast-enhanced Abdominopelvic Computed Tomography(CT) is widely used for diagnosing abdominal injuries after blunt trauma. The purpose of this retrospective study is to classify the contrast-enhanced Abdominopelvic CT finding of mesenteric injuries after blunt abdominal trauma and assess of CT finding on clinical management. Methods: Between January 2000 and December 2003, 607 consecutive spiral abdomonopelvic CT examinations were performed in the ER of Gil medical center after blunt abdominal trauma. CT represented mesenteric injuries : bowel wall thickening or hematoma, mesenteric haziness or fatty infiltration, confined fluid or hematoma within mesenteric folds. We classified patients into 5 Grade by the hematoma size on CT scans : Grade I(None, 0 mm), II(Minimal, ≤10 mm), III(Small, 11~30mm), IV(Moderate, 31~60 mm), V(Large, ≥61 mm). Results: On the basis of the CT findings, 42 of the 607 patients were selected. 18 (42.9%) of 42 patients were classified as having grade I, II, III (≤30 mm) and 24 (57.1%) of 42 patients as having grade IV, V(≥31 mm). Of the 18 patients with grade I, II, III, 16(88.9%) were managed conservatively, while 2(11.1%) underwent surgery. of the 24 patients with grade IV, V injuries, 20(83.3%) were treated surgically and 4(16.7%) patients were managed conservatively. Conclusions: It is sufficient to treat of grade I, II, III mesenteric injuries by conservative man-agement. It should be considered emergency operation to treatment of grade IV, V mesnteric injuries. (p<0.001) There were no relations between grading and initial systolic blood pressure, initial blood pressure and operation.
Summary
The Sliding Phenomenon in Men with Cervical Orthoses in the Extensive Motion
Han Sung Choi, M.D., Young Gwan Ko, M.D., Myung Chun Kim, M.D., Hoon Pyo Hong, M.D.
J Korean Soc Traumatol. 2004;17(2):163-173.
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Background
In many study reports, the cervical collar is effective in restricting 60 to 70 percent of cervical motion in 4 directions; flexion, extension, lateral bending, and rotation. But we discovered the phenomenon of “sliding”in the extensive motion of cervical vertebrae during the investigation about the effectiveness of cervical collars. Thus, the purpose of this study was to find out whether the cervical collars are effective in restricting the extensive motion of the cervical spine Methods: Fifteen volunteers, young men (23~32 years), with clinically and radiographically normal cervical spines were studied. The active cervical motion angles in flexion and extension were measured in each subject and were compared with the motion angles permitted in each of the two cervical orthoses (Philadelphia collar, Stifneck collar). We compared the restricting ability of cervical orthoses in the non-sliding state with the sliding state, especially during extension. One sample t-test, and paired t-test were used in the calculation of the statistics and the significant difference was indicated when p< 0.05. Results: With the pressure forced inferoposteriorly from the apex of the skull while extended, we created the “sliding”and compared the previously established method of measurement and the non-sliding state. The results showed significant difference among the three. The results, which the use of the previous method without considering the “sliding”was compared with the new method in consideration of the “sliding”, differed significantly. This phenomenon dimin-ished the effect of restricting the cervical motion of the cervical orthoses by 50%. Conclusion: With the pressure forced inferoposteriorly given to a person wearing cervical orthoses, we could observe the occurrence of the phenomenon that occiput was slid along the rear slope face of cervical orthoses and that reduced the restricting effect of cervical extensivemotion around 10%. Therefore, it must be considered that cervical orthoses need to be improved to reduce the motion for the direction.
Summary
Predictive Factors of Mortality in Pelvic Bone Fracture at Emergency Department
Soon Young Yun, M.D., Hyun A Bae, M.D., Hye Jin Lee, M.D.*,Young Jin Cheon, M.D.
J Korean Soc Traumatol. 2004;17(2):174-180.
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Background
The object of this retrospective study was to evaluate the clinical characteristics of the patients with pelvic fracture due to blunt trauma. We analyzed the correlation between clinical symptoms, classification of pelvic fracture, trauma score and mortality. And we aimed to establish the guideline of management in emergency departments. Methods: We performed a retrospective analysis of 133 patients with pelvic fracture during 10-year period (from January 1994 to December 2003) who were presented in our emergency department. We collected data from the medical records and made a database for analysis of following: age, sex, mechanism of injury, vital sign at admission, abbreviated injury scores (AIS), injury severity scores (ISS), anatomical grading of the fracture, clinical outcome including hospital mortality, length of hospital stay, length of intensive care unit stay, requirement of crystalloid fluid. The data were stratified into patients less than 55 years of age (young group) and 55 years or older (old group). The data were also stratified according to fracture grading and trauma scores. Results: Grade 4 fracture was the most frequent pattern(n=37, 27.8%), followed by grade 3. According to stratification by age, mortality of older age group was higher than younger group (p<0.001). But there was no significant difference between the two groups in length of hospital stay, initial systolic blood pressure, heart rate and fluid and blood product requirements. According to stratification by fracture grading system, severely fractured group (grade 4, n=37) showed higher mortality than mild group (grade 1,2 and 3). Stratification by AIS showed signif-icant difference in the hospital mortality and length of hospital stay, initial systolic blood pressure, requirement of fluid between the severely injured group (AIS≥3 in any part of head, thorax, abdomen) and mild injured group. Conclusion: The mortality of pelvic fracture is associated with age, AIS and mental status at arrival.
Summary
The Usefulness of Abdomen / Pelvis CT scan for the Diagnosis of Additional Thoracic Injuries in Multiple Trauma
Sang O Park, M.D., Hyoung Gon Song, M.D., Min Seob Sim, M,D., Yeon Kwon Jeong, M.D., Pil Cho Choi, M.D.*
J Korean Soc Traumatol. 2004;17(2):181-188.
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Background
The objective of this study is to investigate the effect of the Abdomen/Pelvis CT scan for diagnosis of additional thorax injuries in multiple trauma patients. Methods: This study was conducted with 143 multiple trauma patients who visited on the emergency department of Samsung Medical Center, from May. 1997 to Apr. 2004. We reviewed and analysed medical record, the result of their Chest AP view, abdomen/pelvis and Chest CT scan, retrospectively. Results: For 143 abdomen/pelvis injury patients, 84 patients (58.7%) were identified as having additional thorax injuries by Chest CT scans. Detection rate of rib fractures and pulmonary contusions were no difference between Chest AP view and Abdomen/Pelvis CT scan. But Abdomen/Pelvis CT scan had more effective detection rate than Chest AP view in pneumothoraces (15.9% Vs 93.6%) and hemothorace(69.2% Vs 92.3%). Conclusions: Abdomen/Pelvis CT scan provided more important information than Chest AP view for the diagnosis of the thoracic traumas that often missed on initial evaluation in multiple trauma patients. Among the thoracic injuries, pneumothoraces and hemothoraces can be highly detected in Abdomen/Pelvis CT scan.
Summary
The Diagnostic Value of Magnetic Resonance Imaging in Cervical Injury
Yong In Kim, M.D., Ki Cheul Noh, M.D., Young Joon Kang, M.D., Yong Su Lim, M.D., Hyuk Jun Yang, M.D., Gun Lee, M.D., Wook Jin, M.D.*, Seong Youn Hwang, M.D.**
J Korean Soc Traumatol. 2004;17(2):189-196.
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AbstractAbstract PDF
Background
Simple cervical X-rays often miss cervical spine injuries. Magnetic resonance imaging is valuable in these cases. The aims of this study is to determine high-risk factors of the cervical injuries, and to contribute to make indications of cervical MRI in evaluation of blunt trauma patients. Methods: We retrospectively reviewed the patients who visited our ED due to nuchal pain and examed by simple cervical X-ray and cervical MRI after blunt trauma. We analyzed the incidence of abnormal MRI findings in various patients groups. We also compared the incidence of missed cervical spine injury by level of injured spine. We thought cervical MRI to be goldstandard of this analysis. Results:The incidence of abnormality on cervical MRI is higher in male patients than female patients (p<0.01). Old (age.40) patients frequently shows abnormal cervical MRI findings than young patients (p<0.001). In patients who had neurologic abnormality, the incidence of abnormality on cervical MRI is higher than neurologically normal patients (p<0.001). But, mecha-nisms of injuries and associated injuries are not related to the incidence of abnormality on cervical MRI. Injuries of lower cervical spine (C7) are frequently missed than those of other cervical spines (p<0.01). Conclusion: When evaluate cervical injuries in male, old, and neurologically abnormal patients, we must consider cervical MRI although the simple cervical X-ray is normal. We must pay more attention to lower cervical spine injuries than other cervical spine injuries.
Summary
A Comparison of Characteristics in Pediatric
Trauma Patients under 7 Years
Ji Young You, M.D., Jae Il Lee, M.D., Ji Yeong Ryu, M.D.
J Korean Soc Traumatol. 2004;17(2):197-205.
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Background
Trauma is a leading cause of morbidity and mortality for children. This study was conducted to describe the characteristics of pediatric trauma and to compare the differences of two groups based on age. Methods: We performed a retrospective analysis of pediatric patients under 7 years of age admitted to our emergency department after a trauma from January 2003 through June 2003. The patients were divided into two groups based on age: group A (infant/toddlers, 0~3 years) and group B (preschool children, 4~6 years). Results: The most common cause of trauma was slip down in both groups. Fall down and burn were more frequent in group A, automobile and bicycle accident were more frequent in group B(p=0.000). The most common place of trauma was house in both groups, but other places were more frequent in group B(p=0.000). The most common trauma related device was furniture/electronics in group A, sporting goods in group B(p=0.002). Conclusions: From this study, we found statistically significant differences between the groups. Knowledge of age-related characteristics could result in improved diagnosis, treatment, and prevention of these injuries.
Summary
Comparison of the Prehospital Death and Emergency Department Death between 1991 and 2001
Sung Bum Oh, M.D., Kang Hyun Lee, M.D., Kyung Chul Cha, M.D., Ho Jin Ji, M.D., Ho Jung Kim, M.D., Hyun Kim, M.D., Sung Oh Hwang, M.D., Keum Suk Bae, M.D.*, and Hun-Joo Kim, M.D.**
J Korean Soc Traumatol. 2004;17(2):206-212.
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Background
Trauma-induced deaths can be prevented by implementation of trauma system during prehospital phases and in-hospital phases. To reduce the preventable death rate (PDR), it is essential to improve the treatment strategy during the prehospital phases and the in-hospital phases. This study was designed to compares the prehospital death and emergency department (ED) death in a city before and after implementation of trauma system. Method: We evaluated the prehospital and ED data of 106 trauma patients who had died in 1991 and 2001. Trauma deaths were reviewed and the preventability of those deaths was judged by three professional panels according to appropriateness of diagnosis and treatment in prehospital phases and in-hospital phases. Deaths were classified as preventable and nonpreventable. We compared the preventable death of 1991 with those of 2001. Result: Trauma patients were 993 in 1991 and 3,094 in 2001. Trauma-induced deaths were 60 in 1991 and 46 in 2001. The death rate decreased from 6% in 1991 to 1.5% in 2001 (p<0.001). Death rate by traffic accident decreased from 90% (54/60) in 1991 to 67% (31/46) in 2001 (p<0.001). The PDR decreased from 40% (24/60) in 1991 to 13% (6/46) in 2001 (p<0.001). The time elapsed from the scene of accident to ED arrival decreased from 111 minutes in 1991 to 53 minutes in 2001 (p<0.001). There was no significant difference in Injury Severity Score between Conclusion: The rate of preventable death decreased from 1991 to 2001. Implementation and improvement of the trauma system has positive effects on trauma-induced death rate, PDR and the time elapsed from the scene of accident to ED arrival.
Summary
J Trauma Inj : Journal of Trauma and Injury
© The Korean Society of Traumatology.