- The Impact of Trauma Center Establishment on Laparotomy Patterns and Outcomes in Severe Hemoperitoneum Patients
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Min A Lee, Jungnam Lee, Min Chung, Giljae Lee, Jaejeong Park, Kangkook Choi, Byung Chul Yoo
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J Trauma Inj. 2017;30(1):6-11. Published online March 31, 2017
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DOI: https://doi.org/10.20408/jti.2017.30.1.6
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- PURPOSE
The establishment of the trauma system has changed the quality of trauma care in many countries. As one of the first designated level I trauma centers in Korea, we hypothesized that there were changes in laparotomy patterns and subsequent survival rates after the center was established.
METHODS
This was a 5-year retrospective study of all severe hemoperitoneum patients who were transfused with more than 10 units of packed red blood cells (RBCs) within 24 h of hospitalization. Variables related to trauma were collected throughout the study period, and the patients admitted before (period 1) and after (period 2) the establishment of a trauma center were compared.
RESULTS
Forty-five patients were managed from January 2009 to March 2015. The baseline patient characteristics of the two groups, including age, Injury Severity Score, blood pressure, and hemoglobin levels, were similar. The time to the operating room (OR) was 144.3±51.5 min (period 1) and 79.9±44.1 min (period 2) (p<0.0001). Damage control surgery (DCS) was performed in 17% of patients during period 1 and in 73% during period 2. The number of actual survivors (n=10) was higher than expected (n=8) in period 2.
CONCLUSION
This is the first study analyzing the impact of a trauma center on the management of specific injuries, such as severe hemoperitoneum, in patients in Korea. During the study, the time to OR was shortened and DCS was used to a greater extent as a surgical procedure.
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Summary
- Characteristics of Korean Trauma Patients: A Single-center Analysis Using the Korea Trauma Database
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Youngeun Park, Min Chung, Gil Jae Lee, Min A Lee, Jae Jeong Park, Kang Kook Choi, Sung Youl Hyun, Yang Bin Jeon, Dae Sung Ma, Yong Cheol Yoon, Jungnam Lee, Byungchul Yoo
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J Trauma Inj. 2016;29(4):155-160. Published online December 31, 2016
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DOI: https://doi.org/10.20408/jti.2016.29.4.155
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2,370
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Abstract
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- PURPOSE
Two years have passed since a level I trauma center was officially opened in the Gacheon Gil Hospital, South Korea. We analyzed 2014 and 2015 registered patient data from the Korean Trauma Data Base (KTDB) to identify trends in trauma patient care and factors that influence the quality of trauma care at the Gacheon Gil trauma center.
METHODS
Data was extracted from the KTDB included patient age, sex, systolic blood pressure at emergency room arrival, revised trauma score, injury severity score, trauma injury severity score, transfusion amount, and the cause of death was analyzed.
RESULTS
A total of 3269 trauma patients were admitted to our trauma center in 2014 and 3225 in 2015. Demographics and mechanism of injury were not significantly different between years. The severity of trauma injury was decreased in 2015 although the mortality rate was slightly increased. This requires further analysis.
CONCLUSION
The aim of this study was to determine the general status and trends in trauma incidence and management outcomes for the Incheon area. We noted no significant changes in trauma status from 2014 to 2015. We need to collect and review trauma patient data over a long period in order to elucidate trauma incidence and management trends in the trauma field. Finally, studies using trauma patient data will indicate appropriate quality control factors for trauma care and help to improve the quality of trauma management.
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Summary
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Citations
Citations to this article as recorded by  - Associated Injuries in Spine Trauma Patients: A Single-Center Experience
Seunghan Yu, Hyuk Jin Choi, Jung Hwan Lee, Byung Chul Kim, Mahnjeong Ha, In Ho Han
Journal of Trauma and Injury.2020; 33(4): 242. CrossRef
- Analysis of KTDB Registered Trauma Patients from a Single Trauma Center in Korea
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Byungchul Yu, Min Chung, Giljae Lee, Mina Lee, Jaejeong Park, Kangkook Choi, Sungyeol Hyun, Yangbin Jeon, Daesung Ma, Young Cheol Yoon, Jungnam Lee
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J Trauma Inj. 2015;28(3):123-128. Published online September 30, 2015
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DOI: https://doi.org/10.20408/jti.2015.28.3.123
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2,576
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24
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3
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Abstract
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- PURPOSE
Establishment of the trauma system changed quality of trauma care in many countries. As one of the first designated level 1 trauma center in Korea, we analyzed trauma registration data in 2014.
METHODS
Data was extracted from Korean Trauma Data Base (KTDB) that was started from august 2013. Variables related to demographics and trauma was collected through the year 2014.
RESULTS
There were 3269 trauma patients who admitted to our hospital and registered to KTDB in 2014. Median age was 49 years, 64.4% were men, and 90% of patients were blunt in mechanism. Median injury severity score (ISS) was 5, mean revised trauma score (RTS) was 7.65. There were 138 (4.2%) deaths and 87 (2.7%) patients of them was death after admission.
CONCLUSION
This is the first report using KTDB registration from our institution. Trauma volume is appropriate but it should be compared with other trauma centers in Korea. In future national analysis of KTDB is mandatory.
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Summary
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Citations
Citations to this article as recorded by - Assessment of the Suitability of Trauma Triage According to Physiological Criteria in Korea
Gil Hwan Kim, Jae Hun Kim, Hohyun Kim, Seon Hee Kim, Sung Jin Park, Sang Bong Lee, Chan Ik Park, Dong Yeon Ryu, Kang Ho Lee, Sun Hyun Kim, Na Hyeon Lee, Il Jae Wang
Journal of Acute Care Surgery.2022; 12(3): 120. CrossRef - Impact of obesity on the severity of trauma in patients injured in pedestrian traffic accidents
Pillsung Oh, Jin-Seong Cho, Jae Ho Jang, Jae Yeon Choi, Woo Sung Choi, Byungchul Yu
Journal of Trauma and Injury.2022; 35(4): 240. CrossRef - An analysis of missed injuries in patients with severe trauma
EunGyu Ju, Sun Young Baek, Sung Soo Hong, Younghwan Kim, Seok Hwa Youn
Journal of Trauma and Injury.2022; 35(4): 248. CrossRef
- PARK Index for Preventable Major Trauma Death Rate
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Chan Yong Park, Byungchul Yu, Ho Hyun Kim, Jung Joo Hwang, Jungnam Lee, Hyun Min Cho, Han Na Park
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J Trauma Inj. 2015;28(3):115-122. Published online September 30, 2015
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DOI: https://doi.org/10.20408/jti.2015.28.3.115
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2,529
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Abstract
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- PURPOSE
To calculate Preventable Trauma Death Rate (PTDR), Trauma and Injury Severity Score (TRISS) is the most utilized evaluation index of the trauma centers in South Korea. However, this method may have greater variation due to the small number of the denominator in each trauma center. Therefore, we would like to develop new indicators that can be used easily on quality improvement activities by increasing the denominator.
METHODS
The medical records of 1005 major trauma (ISS >15) patients who visited 2 regional trauma center (A center and B center) in 2014 were analyzed retrospectively. PTDR and PARK Index (Preventable Major Trauma Death Rate, PMTDR) were calculated in 731 patients with inclusion criteria. We invented PARK Index to minimize the variation of preventability of trauma death. In PTDR the denominator is all number of deaths, and in PARK Index the denominator is number of all patients who have survival probability (Ps) larger than 0.25. Numerator is the number of deaths from patients who have Ps larger than 0.25.
RESULTS
The size of denominator was 40 in A center, 49 in B center, and overall 89 in PTDR. The size of denominator was significantly increased, and 287 (7.2-fold) in A center, 422 (8.6-fold) in B center, and overall 709 (8.0-fold) in PARK Index. PARK Index was 12.9% in A center, 8.3% in B center, and overall 10.2%.
CONCLUSION
PARK Index is calculated as a rate of mortality from all major trauma patients who have Ps larger than 0.25. PARK Index obtain an effect that denominator is increased 8.0-fold than PTDR. Therefore PARK Index is able to compensate for greater disadvantage of PTDR. PARK Index is expected to be helpful in implementing evaluation of mortality outcome and to be a new index that can be applied to a trauma center quality improvement activity.
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Summary
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Citations
Citations to this article as recorded by - Comparison of Outcomes at Trauma Centers versus Non-Trauma Centers for Severe Traumatic Brain Injury
Tae Seok Jeong, Dae Han Choi, Woo Kyung Kim
Journal of Korean Neurosurgical Society.2023; 66(1): 63. CrossRef - Comparison of Preventable Trauma Death Rates in Patients With Traumatic Brain Injury Before and After the Establishment of Regional Trauma Center: A Single Center Experience
Dae Han Choi, Tae Seok Jeong, Myung Jin Jang
Korean Journal of Neurotrauma.2023; 19(2): 227. CrossRef - PARK Index and S-score Can Be Good Quality Indicators for the Preventable Mortality in a Single Trauma Center
Chan Yong Park, Kyung Hag Lee, Na Yun Lee, Su Ji Kim, Hyun Min Cho, Chan Kyu Lee
Journal of Trauma and Injury.2017; 30(4): 126. CrossRef
- A Clinical Analysis of Abdominal Stab Wounds
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Jiyeon Park, Min Chung, Yeongdon Lee, Jungnam Lee, Woonki Lee, Yeonho Park, Jungheum Baek, Heunggyu Park, Keonkuk Kim, Jinmo Kang, Sangtae Choi, Wonsuk Lee, Seungyoun Park
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J Korean Soc Traumatol. 2010;23(2):134-141.
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Abstract
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- PURPOSE
A classic approach to abdominal stab wounds has been a routine laparotomy for the purpose of diagnosis or treatment. However, management protocols for abdominal stab wounds are still contentious in most trauma centers. We examined the relationship between the character of the stab wound and the injured intraabdominal organs by retrospectively analyzing the medical records of patients with abdominal stab wounds admitted to Gil hospital, and the findings for our patients are then confronted with a review of the literature. We aimed to propose proper management protocols to approach abdominal stab wounds.
METHODS
The medical records of all 80 patients sustaining abdominal stab wounds, admitted at the Department of Surgery, Gil Hospital, Gachon Medical School, from January 2004 to December 2008 were retrospectively reviewed. All the abdominal stab wounds were collated based on the site and the character of the injury, investigations performed on admission, results of investigations, operations performed and findings at the time of the operation.
RESULTS
The most prevalent age group was patients in their forties and the average age of the patients was 41 years for both genders. The stab wounds were most commonly located at the periumbilical area (16.9%), followed by the epigastric area (15.6%), and 18.2% of the patients had multiple wounds. The most commonly eviscerated organ was the omentum (9 out of 16 cases); 61.7% of non-eviscerated patients underwent a therapeutic laparotomy while 81.3% of eviscerated patients underwent a therapeutic laparotomy. The small bowel was the most commonly injured organ (22.7%, 17 out of 75 injuries). The review revealed a relatively common diaphragmatic injury in abdominal stab wound patients (8 cases, 10.5%). The average hospital stay was 11 days.
CONCLUSION
This review revealed commonly eviscerated and injured intraabdominal organs in abdominal stab wound patients and their relationship with a therapeutic laparotomy. Although the management is still controversial, the authors suggest indications for an immediate laparotomy and a protocol for managing abdominal stab wounds. Hemodynamic instability and peritoneal irritation signs are definite indicators for an immediate laparotomy, but the review revealed intraabdominal organ evisceration alone not to be a statistically significant factor. In addition, the authors suggest that abnormal CT findings can be valuable for making a decision on management of hemodynamically stable stab wound patients. Further study may clarify a role for a more selective approach to operative intervention and for a more extensive use of selective observation.
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