- The Study of the Severity and Prognosis in Severe Traumatic Patients according to Alcohol Ingestion
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Ho Hyung Jung, Sang Kyoon Han, Sung Wha Lee, Sung Wook Park, Soon Chang Park, Seok Ran Yeom, Moon Gi Min, Yong In Kim, Ji Ho Ryu
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J Trauma Inj. 2014;27(4):108-114.
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 Abstract
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- PURPOSE
Alcohol ingestion is a significant risk factor for injuries. However, the influence of high blood alcohol concentration about the severe traumatic injury is controversial. The aim of study was to analyze the injury severity, prognosis in severe traumatic patients according to alcohol ingestion.
METHODS
This study was performed retrospectively with severe traumatic patients (Injury Severity Score> or =16) who visited the emergency department at Pusan National University Hospital from January 2013 to December 2013.
RESULTS
In total 98 severe traumatic patients, blood alcohol concentration (BAC) positive group (BAC>30 mg/dl) is 42 (42.90%) patients and BAC negative group (BAC< or =30 mg/dl) is 56 (57.10%)patients. Head and neck injury is significantly high in BAC positive group (35 patients, 83.3%) compared to BAC negative group (33 patients, 58.9%). Comparison of injury severity, outcome and mortality is not significantly different between two groups.
CONCLUSION
In severe traumatic patients, head and neck injury occurred high in BAC positive group. Alcohol ingestion did not influence injury severity, outcome in severe traumatic patients. However, effort to decreasing injury related to alcohol ingestion and prospective multi-center study is needed.
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Summary
- Why do Multiple-trauma Patients Stay Longer in the Intensive Care Unit?; A Comparison of Injury Severity Score and The Number of Injured Regions
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Mu Jin Jo, Seong Hwa Lee, Seok Ju Cho, Seok Ran Yeom, Sang Kyoon Han, Sung Wook Park, Dae Seop Lee
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J Trauma Inj. 2013;26(2):47-52.
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Abstract
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- PURPOSE
Injury severity score (ISS), a widely used scoring system, is used to define the severity of trauma in multiple-trauma patients. Nevertheless, ISS cut-off value for predicting the outcome of multiple-trauma patients has not been confirmed. Thus, this study was performed to determine the more useful method for predicting the outcome for multiple-trauma patients: the ISS or the number of anatomical Abbreviated injury scale (AIS) injury regions.
METHODS
For 195 consecutive patients who a regional emergency medical center, we analyzed the ISS and the number of anatomical AIS injury region. The patients were divided into four groups based on the ISS and the number of anatomical AIS regions. We compared intensive-care-unit (ICU) admission days and hospitalization days and ICU stay ratio (ICU admission days/hospitalization days) between the four groups.
RESULTS
In the groups with an ISS more than 17, the results were not significantly different statistically the group with 2 anatomical AIS injury regions and more than 3 anatomical AIS injury regions. Also, in the group with an ISS of 17 or less, the results were the same as those for patients with an ISS more than 17 (p>0.05). Among the patients with 2 anatomical AIS injury regions, patients with an ISS more than 17 patients had more ICU admission days and a higher ICU stay ratio than patients with an ISS 17 or less. Also, Among the patients with 3 anatomical AIS injury regions, the results were the same as those for patients with 2 anatomical AIS injury regions.
CONCLUSION
Patients with high ISS, regardless of the number of anatomical AIS injury regions had significantly longer ICU stays and higher ICU admission ratio. Thus, the ISS may be a better method than the number of anatomical AIS injury regions for predicting the outcomes for multiple-trauma patients.
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Summary
- Development of Simple Prediction Method for Injury Severity and Amount of Traumatic Hemorrhage via Analysis of the Correlation between Site of Pelvic Bone Fracture and Amount of Transfusion: Pelvic Bleeding Score
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Sang Sik Lee, Byung Kwan Bae, Sang Kyoon Han, Sung Wook Park, Ji Ho Ryu, Jin Woo Jeong, Seok Ran Yeom
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J Trauma Inj. 2012;25(4):139-144.
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Abstract
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- PURPOSE
Hypovolemic shock is the leading cause of death in multiple trauma patients with pelvic bone fracures. The purpose of this study was to develop a simple prediction method for injury severity and amount of hemorrhage via an analysis of the correlation between the site of pelvic bone fracture and the amount of transfusion and to verify the usefulness of the such a simple scoring system.
METHODS
We analyzed retrospectively the medical records and radiologic examination of 102 patients who had been diagnosed as having a pelvic bone fracture and who had visited the Emergency Department between January 2007 and December 2011. Fracture sites in the pelvis were confirmed and re-classified anatomically as pubis, ilium or sacrum. A multiple linear regression analysis was performed on the amount of transfusion, and a simplified scoring system was developed. The predictive value of the amount of transfusion for the scoring system as verified by using the receiver operating characteristics (ROC). The area under the curve of the ROC was compared with the injury severity score (ISS).
RESULTS
From among the 102 patients, 97 patients (M:F=68:29, mean age=46.7+/-16.6 years) were enrolled for analysis. The average ISS of the patients was 16.2+/-7.9, and the average amount of packed RBC transfusion for 24 hr was 3.9+/-4.6 units. The regression equation resulting from the multiple linear regression analysis was 'packed RBC units=1.40x(sacrum fracture)+1.72x(pubis fracture)+1.67x(ilium fracture)+0.36' and was found to be suitable (p=0.005). We simplified the regression equation to 'Pelvic Bleeding Score=sacrum+pubis+ilium.' Each fractured site was scored as 0(no fracture) point, 1(right or left) point, or 2(both) points. Sacrum had only 0 or 1 point. The score ranged from 0 to 5. The area under the curve (AUC) of the ROC was 0.718 (95% CI: 0.588-0.848, p=0.009). For an upper Pelvis Bleeding Score of 3 points, the sensitivity of the prediction for a massive transfusion was 71.4%, and the specificity was 69.9%.
CONCLUSION
We developed a simplified scoring system for the anatomical fracture sites in the pelvis to predict the requirement for a transfusion (Pelvis Bleeding Score (PBS)). The PBS, compared with the ISS, is considered a useful predictor of the need for a transfusion during initial management.
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Summary
- Needle Decompression for Trauma Patients: Chest Wall Thickness and Size of the Needle
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Jeewan Kim, Jinwoo Jeong, Suck Ju Cho, Seokran Yeom, Sang Kyoon Han, Sungwook Park
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J Korean Soc Traumatol. 2010;23(2):63-67.
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Abstract
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- PURPOSE
A tension pneumothorax is a fatal condition that requires immediate intervention. Although a definitive treatment for a tension pneumothorax is a tube thoracostomy, needle decompression can provide temporary relief, that is lifesaving. The traditional procedure for needle decompression involves inserting a needle or catheter at the second intercostal space, the midclavicular line. Recent evidence suggests that the commonly used catheters do not have sufficiently penetrate the chest wall. There are also claims that a lateral approach to needle decompression is easier and safer than the traditional anterior approach. The purpose of this study is to evaluate the optimal approach for needle decompression for the Korean population by measuring chest wall thicknesses at the points used for both the anterior and the lateral approaches.
METHODS
The chest wall thickness (CWT) of trauma victims who visited the Emergency Center of Pusan National University Hospital was measured by computed tomography (CT) images. The CWT was measured at the points used for the anterior and the lateral methods and was compared with the length of commonly used catheters, which is 45 mm.
RESULTS
The mean CWT at the second intercostal space, the midclavicular line, was shorter than the CWT at the 5th intercostal space, the anterior axillary line. However, the percentage of patients whose CWT was greater than 45 mm was larger when measured anteriorly (8.2%) that when measure laterally (5.7%). Female patients and those older than 60 were more likely to have an anterior CWT greater than 45 mm (28.2% for females and 15.5% for those older than 60).
CONCLUSION
The percentage of trauma victims in Korea whose CWT is greater than 45 mm is lower than the values previously reported by other countries. However, females and older patients tend to have thicker chest walls, so the lateral approach would be suggested when performing needle decompression for such patients with suspected tension pneumothoraces.
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Summary
- Evaluation of the Educational Efficacy of a Cadaver-based Model for Teaching a Simple Suture Technique to Medical Students
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Hyun Soo Do, Jin Hong Min, Seung Woo Hong, Sang Kyoon Han, In Soo Kim, Seung Ryu, Jin Woong Lee, Seung Whan Kim, In Sool Yoo
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J Korean Soc Traumatol. 2006;19(2):121-125.
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Abstract
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- PURPOSE
There is ongoing demand to deliver better procedural training to medical students in the emergency department. Thus, we studied the efficacy of a cadaver-based training model for teaching simple suture techniques to medical students.
METHODS
We investigated ten fourth-year medical students, who were rounding and being trained in the Emergency Department of Chungnam National University Hospital. They were educated with slides about a simple suture technique for 30 minutes to evaluate the efficacy of the cadaver-based training model. We prospectively measured their skill by administering a test on the cadaver-based simple suture technique in 3cm sized linar wound separately to each of them.
RESULTS
A total of ten fourth-year medical students completed the investigation. The tension, the direction of suture, the degree of cleanness, the number of sutures, the adequacy of the cutting thread length, and the suturing time in the first attempt were compared with those in the second one. The second results were compared with those in the third one, and the third results were compared with those in the fourth one. All the results had statistical significance.
CONCLUSION
These findings support the value of the cadaver-based simple suture technique training model as a medical student teaching model. The cadaver-based simple suture technique teaching model is a good way of teaching several medical skills to medical students.
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