- Comparison of Clinical and Anatomical Differences of Vertebral Artery Dissection between Minor Trauma and Non-trauma Causes
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Yeon Hee Chong, Ji Yun Ahn, Bum Jin Oh, Won Kim, Kyoung Soo Lim
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J Korean Soc Traumatol. 2007;20(2):101-105.
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 Abstract
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- PURPOSE
This study aimed to find any difference in the clinical or the anatomical findings of vertebral artery dissection (VAD) between the trauma and the non-trauma groups.
METHODS
We retrospectively reviewed the clinical data and radiologic images of VAD patients. We compared data on symptoms, neurologic deficit, National institutes of health stroke scale (NIHSS) at admission, Rankin score (RS) at admission and discharge, and radiological findings including anatomical features, between the trauma and the non-trauma groups.
RESULTS
From January 1997 to May 2006, 42 patients were enrolled and 13 patients (31%) had a history of earlier trauma. Focal neurologic deficit (trauma group 11/13 vs. non-trauma group 11/29), cerebral stroke (10/13 vs. 9/29), and extradural lesions of dissection (6/13 vs. 3/28) were more common in the trauma group than non-trauma group (p=0.007, p=0.017, p=0.018, respectively) and NIHSS at admission and discharge were significantly higher (p=0.012, p=0.001, respectively). Dissecting aneurysms were less frequent in the trauma group (2/13 vs. 19/29, p=0.006). Subarachnoid hemorrhage and unfavorable prognostic value (Rankin score at discharge> or =2) showed no differences between the groups (p=0.540, p=0.267, respectively).
CONCLUSION
In VAD patients after trauma, focal neurologic deficit due to ischemic stroke and a steno-occlusive pattern are more frequent than they are in non-trauma patients. The location of dissection was most frequent at the extradural vertebral artery in the trauma group. NIHSS was higher in the trauma groups but the incidence of an unfavorable prognostic value (RS> or =2) was not significantly different between the groups.
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Summary
- A Case of Tension Viscerothorax: A Rare Complication of Diaphragmatic Rupture after Blunt Abdominal Trauma
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Maeng Real Park, Jae Ho Lee, Ji Yoon Ahn, Bum Jin Oh, Won Kim, Kyoung Soo Lim
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J Korean Soc Traumatol. 2006;19(2):201-205.
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Abstract
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- Tension viscerothorax (gastrothorax) is rare life-threatening disease which is caused by air trapped in viscera.
A distended viscera in the hemi-thorax shifts the mediastinal structures and causes extra-cardiac obstructive shock. A defective diaphragm is caused by abdominal trauma or a congenital anomaly. Traumatic diaphragmatic injury can be missed until herniation develops several years after blunt trauma. In our case, a 10-year old boy developed hemodynamic compromise in the emergency department. Three years earlier, he had suffered blunt abdominal trauma during a pedestrian traffic accident, but there was no evidence of diaphragmatic injury at that time. He was successfully resuscitated by gastric decompression and an emergent thoracic operation. The operation finding revealed a traumatic diaphragmatic injury. Tension viscerothorax is a rare, but catastrophic, condition, so we suggest that addition of tension viscerothorax to the Advanced Trauma and Life Support (ATLS) guidelines may be helpful.
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Summary
- Triage Score as a Predictor of need for Tertiary care Center Transport from Scene by Helicopter
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Song Won Song, Jae Chol Yoon, Boo Soo Lee, Woo Joo Kim, Ji Yoon Ahn, Bum Jin Oh, Kyung Su Lim
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J Korean Soc Traumatol. 2006;19(2):159-163.
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Abstract
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- PURPOSE
The number of patients transported by the Helicopter Emergency Medical Service (HEMS) has increased recently. In our review of the Korean HEMS, there was no established helicopter utilization criteria or triage tool on the scene, so many patients with minor injuries were transported to tertiary care centers. The aim of this study is to evaluate the percentage of patients with minor injuries and to propose a more appropriate triage tool for predicting the need for transport to a tertiary care center.
METHODS
The subjects of this study were 59 trauma patients transported to Asan Medical Center (AMC) from the scene by Seoul HEMS from January 2004 to December 2005. The Triage score (TS), Injury Severity Score (ISS), and modified Canadian Triage and Acuity Scale (mCTAS) were calculated as severity scales.
Patients with minor injuries were defined as those with TS=9, ISS< or =15, and mCTAS> or =3. We evaluated the association of TS, ISS, and mCTAS with the appropriateness of transport.
RESULTS
Many of the patients transported to tertiary medical centers were classified as having a minor injury: TS=9 group 35 cases (72.9%), ISS< or =15 group 30 cases (62.5%) and mCTAS> or =3 group 27 cases (56.2%).
However, 56.2% (27/59) of the patients were appropriately transported according to need for admission or an operation. The more severely injured patients classified by TS, ISS, and mCTAS were more appropriately transported to a tertiary center (p<0.05).
CONCLUSION
Many patients with minor injuries were transported to a tertiary center from the scene directly.
The TS can be easily calculated by an emergency medical technician at the scene. Thus, we propose the TS as a useful triage tool for determining the necessity of transport to a tertiary center by helicopter.
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