- Acute Traumatic Coagulopathy in Severe Trauma Patients
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Dong Eun Lee, Kang Suk Seo, Mi Jin Lee, Su Jeong Shin, Hyun Wook Ryoo, Jong Kun Kim, Jung Bae Park
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J Korean Soc Traumatol. 2012;25(3):72-78.
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 Abstract
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- PURPOSE
Clinical observation and research findings show that acute traumatic coagulopathy (ATC) is a major factor that must be addressed in the early care of severe trauma patients. ATC is associated with increased transfusion requirements and poor clinical outcomes. This study aimed to correlate the early predictable factors of ATC with the outcomes in severe trauma patients.
METHODS
Retrospective data from the trauma registry on severe trauma patients (Injury Severity Score (ISS)> or =16) were used to identify variables independently associated with coagulopathy. Univariate associations were calculated, and a multivariable logistic regression analysis was used to determine variables independently associated with ATC.
RESULTS
Patients were mostly male, aged 51.9+/-17.8 years, with an injury severity score of 24.1+/-12.4. ATC, as diagnosed in the emergency department (ED), occurred in 17% of the severe trauma patients. Using a multivariable logistic regression analysis, early predictable variables independently associated with ATC were base deficit (odds ratio (OR): 13.03; 95% confidence interval (CI): 3.47-48.93), acute liver injury (OR: 4.24; 95% CI: 1.06-17.00), and transfer from another hospital (OR: 21.00; 95% CI: 3.23-136.60).
CONCLUSION
ATC is associated with mortality in severe trauma patients, and some variables associated with trauma and shock are an independent predictors of ATC. These variables contribute to the early recognition and management of coagulopathy, which may improve the outcome from trauma resuscitation.
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Summary
- Diagnostic Usefulness of Computed Tomography Compared to Conventional Chest X-Ray for Chest Trauma Patients
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Kyu Ill Choi, Kang Suk Seo, Hyun Wook Ryoo, Jung Bae Park, Jae Myung Chung, Jae Yoon Ahn, Seong Won Kang, Jae Hyuck Yi
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J Korean Soc Traumatol. 2009;22(2):142-147.
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Abstract
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Early diagnosis and management of therapeutic interventions are very important in chest trauma. Conventional chest X-rays (CXR) and computed tomography (CT) are the diagnostic tools that can be quickly implemented for chest trauma patients in the emergency department. In this study, the usefulness of the CT as a diagnostic measurement was examined by analyzing the ability to detect thoracic injuries in trauma patients who had visited the emergency department and undergone CXR and CT.
METHODS
This study involved 84 patients who had visited the emergency department due to chest trauma and who had undergone both CXR and CT during their diagnostic process. The patients' characteristics and early vital signs were examined through a retrospective analysis of their medical records, and the CXR and the CT saved in the Picture Archiving Communication System (PACS) were examined by a radiologist and an emergency physician to verify whether or not a lesion was present.
RESULTS
Pneumothoraxes, hemothoraxes, pneumomediastina, pulmonary lacerations, rib fractures, vertebral fractures, chest wall contusions, and subcutaneous emphysema were prevalently found in a statistically meaningful way (p<0.05) on the CT. Even though their statistical significance couldn't be verified, other disorders, including aortic injury, were more prevalently found by CT than by CXR.
CONCLUSION
CT implemented for chest trauma patients visiting the emergency department allowed disorders that couldn't be found on CXR to be verified, which helped us to could accurately evaluate patients.
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Summary
- Study of the Length of Needle Thoracostomy Catheter Needed for Patients with Chest Trauma
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Sung Won Kang, Hyun Wook Ryoo, Jung Bae Park, Kang Suk Seo, Jae Myung Chung
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J Korean Soc Traumatol. 2009;22(1):1-4.
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Abstract
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This study was conducted to evaluate the length of the catheter used in a needle thoracostomy for emergency decompression of a tension pneumothorax by measuring the chest wall thickness (CWT) in patients with chest trauma METHODS: A retrospective review of 201 patients with chest trauma who had been transported the emergency department in a tertiary university hospital in a metropolitan area between 1 January and 31 February 2007 was performed. The average CWT at the second intercostal space (ICS) in the midclavicular line (MCL) was measured by using a chest computed tomography scan.
RESULTS
As the left and the right mean CWTs were 3.4+/-1.0 cm and 3.4+/-1.0 cm, respectively, there was no significant statistical difference between them. The mean CWT of female patients was significantly higher than that of male patients (p=0.001). The mean CWT of patients under the age of 65 years was significantly thicker than that of the patients over the age of 65 years (p<0.001). Of the studied patients, 12 (6.0%) a CWT > 5 cm.
CONCLUSION
A 5 cm-length catheter in a needle thoracostomy may be insufficient for emergency decompression of a tension pneumothorax, so a catheter longer than 5 cm in length is needed.
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Summary
- Validation of the Simplified Motor Score for the Triage after Traumatic Brain Injury
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Sang Kyong Lee, Hyun Wook Ryoo, Jung Bae Park, Kang Suk Seo, Jae Myung Chung
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J Korean Soc Traumatol. 2008;21(2):71-77.
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Abstract
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The Glasgow Coma Scale (GCS), though it is widely used for triage, has been criticized as being unnecessarily complex. Recently, a 3-point Simplified Motor Score (SMS, defined as obeys commands=2; localizes pain=1; withdrawals to pain or worse=0) was developed from the motor component of the GCS and was found to have a similar test performance for triage after traumatic brain injury when compared with the GCS as the criterion standard. The purpose of this study was to validate the SMS.
METHODS
We analyzed the patients who visited Kyungpook National University Hospital emergency center after traumatic brain injury from 2006 January to 2006 June. The test performance of the GCS, its motor component, and SMS relative to three clinically relevant traumatic brain injury outcomes (abnormal brain CT scans, Abbreviated Injury Scale (AIS)> or =4, and mortality) were evaluated with areas under the receiver operating characteristic curves (AUCs).
RESULTS
Of 504 patients included in the analysis, 25.6% had an abnormal brain CT scans, 13.1% had AIS> or = 4, and 5.0% died. The AUCs for the GCS, its motor component, and SMS with respect to the abnormal CT scans were 0.776, 0.715, and 0.716, and respectively, those for AIS> or =4 and mortality, were 0.969, 0.973, and 0.968, and 0.931, 0.909, and 0.909, respectively.
CONCLUSION
The 3-point SMS demonstrated similar test performance when compared with the 15-point GCS score and its motor component for triage after traumatic brain injury in our populations.
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Summary
- Relation between Location of Pelvic bone Fractures and the Injury to the Urinary bladder, Urethra or Lower gastrointestinal tract
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Chang Ho Kim, Jung Bae Park, Hyun Wook Ryoo, Kang Suk Seo, Jun Seok Seo, Jae Myung Chung, Dong Wook Je, Ae Jin Sung
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J Korean Soc Traumatol. 2007;20(2):90-95.
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Abstract
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This research was conducted to study whether the specific location of pelvic-bone fractures could increase the risk for injury to the urinary bladder, urethra, or lower gastrointestinal tract.
METHODS
We retrospectively reviewed the data of 234 patients with pelvic-bone fractures who visited the emergency department of Kyungpook National University Hospital from January 2004 to December 2006. The location of the pelvic-bone fracture was divided into 8 parts. The association of fracture location with injury to the urinary bladder, urethra, or lower gastrointestinal tract was analyzed with Fisher's-exact test and multiple logistic regression.
RESULTS
Nineteen(19) patients had urinary bladder injury, 8 had urethral injury, and 9 had lower gastrointestinal tract injury. The following fracture locations were found to be significant; urinary bladder: sacroiliac (SI) joint (p<0.001), symphysis pubis (p=0.011), and sacrum (p=0.005); urethra: SI joint (p=0.020); lower gastrointestinal tract: symphysis pubis (p=0.028). After the multiple logistic regression analysis, the primary and the independent predictors for each of the injuries were as follows; urinary bladder: sacroiliac joint (p=0.000, odds ratio [OR]=10.469); lower gastrointestinal tract: symphysis pubis (p=0.037, OR=7.009).
CONCLUSION
Consideration of further workup for injuries to the lower gastrointestinal and urinary tract is needed for some locations of pelvic-bone fractures because certain pelvic-bone fracture locations, especially the sacroiliac joint and the symphysis pubis, are associated with increased risk for injury to the lower gastrointestinal and urinary tracts.
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Summary
- Clinical Characteristics and Prognosis of Heat Stroke
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Noh Han Park, Hyun Wook Ryoo, Kang Suk Seo, Jung Bae Park, Jae Mung Chung
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J Korean Soc Traumatol. 2006;19(2):113-120.
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Abstract
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The aim of this study was to evaluate the clinical characteristics of classic heat stroke in Korea and to identify factors of prognosis for heat stroke by comparing a survival group with a non-survival group.
METHODS
We retrospectively analyzed 27 patients with heat stroke who visited the Emergency Department of Kyungpook National University Hospital from March 2001 to February 2005. First, we divided the patients into two groups, the classic heat stroke group and the exertional heat stroke group, and compared them.
Second, we compared the survival group with the non-survival group. Age, sex, cause, place where patients were found, underlying diseases, cooling time, performance of endotracheal intubation, initial Glasgow Coma Scale, initial vital sign, and laboratory findings were reviewed.
RESULTS
Five of 27 patients in heat stroke died. The classic heat stroke group had 20 patients. They were old and had more patients in the bathroom than the exertional heat stroke group had. The non-survival group showed lower blood pressure, lower initial GCS score, and higher respiratory rate than the survival group. In laboratory findings, the non-survival group also showed lower HCO3-level, lower albumin level, lower glucose level, more prolonged PT, and higher CK-MB level than the survival group. Delay in recognition of heat stroke and cooling were poor prognostic factors in heat stroke.
CONCLUSION
The classic heat stroke group had patients who were old and found in the bathroom. Early recognition and treatment of heat stroke is important to reduce mortality. Cooling time, initial GCS score, mean arterial pressure, resipratory rate, HCO3-, PT, CK-MB, and albumin seem to be meaningful when forming a prognosis for heat stroke patients.
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