Journal of Trauma and Injury

Volume 27(3); September 2014

Original Articles

Predictive Indicators for the Severity of Pediatric Trauma and the Prevention of Injuries According to the General Characteristics and Pre-hospital Factors of Severe Pediatric Trauma Patients: Jae Hyug Woo, Hyuk Jun Yang, Yong Su Lim, Jin Seong Cho, Jin Joo Kim, Won Bin Park, Jae Ho Jang, Gun Lee; J Trauma Inj. 2014;27(3):43-49.

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Abstract PDF: PURPOSE
Trauma is one of the most common causes of death for children, and identifying severely injured children quickly in an overcrowded emergency room (ER) is difficult. Therefore, severe injury must be prevented, and the severity of injuries in children must be determined easily from their general characteristics and pre-hospital factors.
METHODS
Injured children younger than 15 years of age who visited the ER from June 2011 to May 2013 were enrolled. According to the revised trauma score (RTS) of the patients, the study population was divided in two groups, a severe group (RTS<7) and a mild group (RTS> or =7). The general characteristics and the pre-hospital factors were compared between the two groups.
RESULTS
Six hundred seventy-three children were enrolled, their mean age was 8.03 (+/-4.45) years, and 476 (70.73%) patients were male. Of these patients, 22 patients (3.27%) were in the severe group, and 651 patients (96.73%) were in the mild group. Fewer males were in the severe group than in the mild group (50.00% vs. 71.43%, p=0.030), and children in the severe group were younger than children in the mild group (3.50 vs. 8.00 years, p=0.049). In the severe group, toddlers (54.55%, p=0.036) were the most common age group. Severe injuries occurred more often in spring (32.81%) and summer (54.56%) than in autumn (9.09%) and winter (4.55%) (p=0.026). The most common places of injury in the severe group were roads (50.00%, p=0.009), and the most common mechanisms of injury in the severe group were traffic accidents (50.00%), followed by falls (31.82%) (p=0.011). Most severely injured children were transferred by ambulance (72.73%, p=0.000).
CONCLUSION
The results of this study may be helpful for identifying severely injured children quickly in the field and the ER. To prevent severe pediatric injuries, precautions and policies based on these results should be established.; Summary

Injury Analysis of a 25-passenger Bus Left-quarter Turn Rollover Accident: Sang Min Park, Sang Chul Kim, Kang Hyun Lee, Jae Wan Lee, Hyuk Jin Jeon, Ho Jung Kim, Jin Yong Kim, Young Soo Kwak, Woo Sung Lee; J Trauma Inj. 2014;27(3):50-56.

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Abstract PDF: PURPOSE
Rollover motor vehicle crashes have a higher injury severity and fatality than other motor vehicle crash types. From a left-quarter turn rollover accident of 25-passenger bus, we intend to assess the injury of the occupant and the injury severities according to the occupants' position.
METHODS
We carried out the 3 steps investigation of occupants' interview, visiting the repair shop and using the police report. We analyzed injuries sustained by occupants, and compared injury severities considering column, row in occupant's position and passenger interaction.
RESULTS
The rollover involved 14 passengers in the bus who were all old women except a man driver. The most common injury was in the upper extremity, with six occurrences being a left clavicle fracture. Major injuries including hemothorax and pneumothorax were diagnosed at left side of the occupant. In the comparison of injury severity among driver's column (left side), mid column and passengercolumn, ISS of passenger column was the highest (9.9+/-7.4, 8.8+/-5.5, and 10.3+/-4.0, respectively, p>0.05). The injury severity of multiple occupants by row was higher than that of single occupant (10.8 vs. 3, p<0.05).
CONCLUSION
An occupant must fasten their seat belt to prevent an injury by passenger interaction in the left-quarter turn rollover accident of a bus.; Summary

Treatment of Hamate Body Coronal Fracture: Sang Hyun Lee, Nu Ri Kim, Jae Hoon Jang, Tae Young Ahn; J Trauma Inj. 2014;27(3):57-62.

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Abstract PDF: PURPOSE
A hamate body coronal fracture is well known as a very rare fracture in the carpal bones and is also hard to diagnose in initial stage due to the bone's architecture. We report our experience in treatment of such a fracture, and we present a review of the relevant literatures.
METHODS
Four patients who experienced hamate body coronal fractures from October 2006 to October 2013 were enrolled in this study. One patient also had an associated Capitate fracture, and two patients had associated dislocations of the 4th metacarpal joint. We performed open reduction and mini-screw fixation on the four patients. In addition, a K-wire was fixed for the two patients with dislocations.
RESULTS
The average follow-up period was 24.5 months after surgery, and bone union was observed at the 8th week after surgery. We confirmed that bone union had been completed for all the patients, and functional tests showed that joint motion was in the normal range without complications.
CONCLUSION
When a patient has consistent pain on the ulnar side of the wrist, a hamate fracture should be suspected. Computer tomography is better than a simple X-ray scan for confirming the diagnosis of a hamate body coronal fracture. An open reduction and mini-screw fixation led to a good result.; Summary

The Use of Brain Computer Tomography Examination with Mild Traumatic Brain Injury in Pediatrics: Ha Kyung Kim, Jin Joo Kim, Jin Seong Cho, Jae Ho Jang, Hyuk Jun Yang, Gun Lee; J Trauma Inj. 2014;27(3):63-70.

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Abstract PDF: PURPOSE
In children, mild traumatic brain injuries (TBI) account for 70~90% of head injuries. Without guidelines, many of these children may be exposed to excess radiation due to unnecessary imaging. The purpose of this study was to evaluate the impact of a mild TBI guideline in imaging of pediatric patients.
METHODS
The medical records of all children who had head computed tomography and were admitted to our hospital with a TBI with Pediatric Glasgow Coma Scale and Glasgow Coma Scale of 14 to 15 were retrospectively reviewed and compared with PECARN Rule.
RESULTS
A total of 1260 children were included and all children checked with head computed tomography. 61 pediatrics had CT positive and presented skull fracture 40, hemorrhage 8, hemorrhagic contusion 7, and diffuse axonal injury 1. Also, 4 patients diagnosed both skull fracture and brain haemorrhage and 1 patient diagnosed both haemorrhage and haemorrhagic contusion.
CONCLUSION
There are many pediatric traumatic patients who exposed to radiation due to CT. But, the most of results were negative. So, consider to follow the CT guideline for children and many do not require brain CT.; Summary

Case Reports

A Case of Cardiac Laceration due to Anterior Thoracic Stab Injury: Won Gi Woo, Ji Young Jang, Seung Hwan Lee, Chang Young Lee, Jae Gil Lee; J Trauma Inj. 2014;27(3):71-74.

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Abstract PDF: Among chest trauma patients, cardiac laceration is a rare, but severe, condition requiring prompt management. Depending on the patient's hemodynamic status, early detection rate of a cardiac laceration may or may not be occur. If a possibility of cardiac laceration exists, an emergent thoracotomy should be performed. Furthermore, patients who experience a cardiac laceration also experience different kinds of complications. Therefore, close follow-up and monitoring are required. Herein, we report a 41-year-old man with a left atrium and a left ventricle laceration caused by a thoracic stab injury.; Summary

A Case of Hypopharyngeal Perforation in a Trauma Patient on Ventilatory Support: Kwon Jae Park, Chang Min Park, Sang Seok Jung, Jung Hee Bang; J Trauma Inj. 2014;27(3):75-78.

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Abstract PDF: Hypopharyngeal perforation is a rare, but fatal, complication. Clinical signs and symptoms of this condition are neck pain, odynophagia, dysphagia, fever, vomiting, cervical swelling and subcutaneous emphysema. However, these signs are obscured in patient suffering from severe trauma who has had an endotracheal tube inserted, which delay proper evaluation and treatment. Here, we report a case of hypopharyngeal perforation in a trauma patient who had an endotracheal tube inserted for mechanical ventilation.; Summary

Bilateral Brachial Plexopathy Following an Attempted Hanging: A Case Report: Byung Nam Yoon, Seong Hye Choi, Joung Ho Rha, Jung Joon Sung, Eun Ju Ma, Kwang Woo Lee; J Trauma Inj. 2014;27(3):79-83.

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Abstract PDF: The brachial plexus is a network of nerves that provides movement and feeling to the shoulder, arm and hand. The majority of acute brachial plexus injuries occur when the plexus is stretched violently or torn. This happens as result of the shoulder being pressed down forcefully while the head is pushed up and away from that shoulder. Such injuries frequently result from automobile or motor-cycle accidents or from falls and usually affect one side. Nerve injuries vary in severity from a mild stretching of the nerve to a tearing of the nerve root away from the spinal cord. We experienced a 50-year-old woman with weakness in both upper extremities after an attempted hanging. A consecutive workup revealed bilateral brachial plexus injuries. Six months after the incident, she had fully recovered. This is a very rare case of bilateral brachial plexus injuries after an attempted hanging.; Summary

Extensive Blunt Hepatic Injury due to Cross-over Traffic Accident: A Case Report of Conservative Management: In Seok Jang, Sung Hwan Kim, Jung Eun Lee, Jong Woo Kim, Jun Young Choi, Il Woo Shin, Hyun Ok Kim; J Trauma Inj. 2014;27(3):84-88.

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Abstract PDF: The severity of blunt hepatic injury correlates with internal organ damage. We experienced a patient, who had an extensive crushed liver injury. The patient was a 28-year-old man, who was involved in a traffic accident in which a wheel ran over his right upper abdomen. A grade V severe hepatic laceration was diagnosed with computed tomography. His vital signs were stable, so we could wait for times with conservative management. Bile leakage led to biloma and bile spillage into the peritoneal space. Selective percutaneous drainage was needed to control the several biloma. After four months of conservative management, could the patient was discharged in good condition.; Summary

Management of Bile Leaks from Bilateral Intrahepatic Ducts after Blunt Trauma: Dong Hun Kim, Seokho Choi, Seung Je Go; J Trauma Inj. 2014;27(3):89-93.

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Abstract PDF: Bile leaks are complications that are much more frequent after a high-grade liver injury than after a low-grade liver injury. In this report, we describe the management of bile leaks that were encountered after angiographic embolization in a 27-year-old man with a high-grade blunt liver injury. He had undergone an abdominal irrigation and drainage with a laparotomy on post-injury day (PID) 16 due to bile peritonitis and continuous bile leaks from percutaneous abdominal drainage. He required three percutaneous drainage procedures for a biloma and liver abscesses in hepatic segments 4, 5 and 8, as well as endoscopic retrograde cholangiopancreatography with biliary stent placement into the intrahepatic biloma via the common bile duct. We detected communication between the biloma and the bilateral intrahepatic duct by using a tubogram. Follow-up abdominal computed tomography on PID 47 showed partial thrombosis of the inferior vena cava at the suprahepatic level, and the patient received anticoagulation therapy with low molecular weight heparin and rivaroxaban. As symptomatic improvement was achieved by using conservative management, the percutaneous drains were removed and the patient was discharged on PID 82.; Summary

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