- Effectiveness of Simple Trauma Team Activation Criteria on Prognosis of Severe Trauma Patients
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Dong Keon Lee, Kang Hyun Lee, Kyoung Chul Cha, Kyoung Hye Park, Han Joo Choi, Hyun Kim, Sung Oh Hwang
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J Korean Soc Traumatol. 2009;22(1):71-76.
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 Abstract
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- PURPOSE
The goal of this study was to compare the outcome of the after trauma team (AfterTT) group to the before trauma team (BeforeTT) group.
METHODS
All trauma patients who visited to emergency room (ER) between July 1, 2006 and February 29, 2008 based on trauma registry, with systolic blood pressure (SBP) < 90 mmHg or GCS < 9 were included in this study. We compared the amount of packed RBC transfusion, the ER stay time, the ER visit to CT evaluation time, the ER visit to operation time, the length of ICU stay, the length of hospital admission and the survival discharge rate between the AfterTT group and the BeforeTT group. Patients with brain injuries had little chance of survival. Burn patients, who visited the ER 24 hours after injury and patients who were dead on arrival (DOA) were excluded from this study.
RESULTS
Total of 93 patients were included in this study: 42 in the AfterTT group and 51 in the BeforeTT group. The AfterTT group and the Before TT group showed no differences in Revised Trauma Score (RTS) and mean age. The amount of packed RBC transfusion was lower in the AfterTT group, but no statistically significant difference was noted (AfterTT 11+/-11units, BeforeTT 16+/-15units, p=0.136). The ER visit to operation time was shorter in the AfterTT group, but there were no statistically significant difference between the groups (AfterTT 251+/-223 minutes, BeforeTT 486+/-460 minutes, p=0.082). The length of ICU stay was shorter in the AfterTT group, but the difference was not statistically significant (AfterTT 11+/-12 days, Before TT 15+/-30 days, p=0.438). The length of Hospital admission was shorter in the AfterTT group (AfterTT 43+/-37 days, BeforeTT 68+/-70 days, p=0.032), but this difference was not statistically significant.
CONCLUSION
Simple Trauma team activation criteria decreased the amount of packed RBC transfusion and the hospital admission duration. Hemodynamic instability (SBP < 90 mmHg) and decreased mental state (GCS <9) are good indices for activating the trauma team.
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Summary
- Injury Characteristics of Self-injury Patients Who Visit the Emergency Department
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Young Soo Kwak, Kang Hyun Lee, Hyung Jin Shin, Kyung Hye Park, Han Joo Choi, Hyun Kim, Sung Oh Hwang
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J Korean Soc Traumatol. 2009;22(1):65-70.
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Abstract
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Many studies have addressed a psychiatric analysis of self-injury patients who have self-injurious behavior and who have attempted suicide. Few studies on the injury characteristics of self-injury related trauma patients have been conducted. We analyzed the injury characteristics of self-injury patients.
METHODS
A retrospective review of the medical records extracted from the injury surveillance system of Wonju Christian Hospital for the period from August 2006 to February 2008 was conducted. Of the 121 cases extracted, 103 were included in this study. We analyzed the sex ratio, age group, place of injury, injury mechanism, location of injury, management results, injury severity, and relation with drinking.
RESULTS
One hundred three cases were included (sex ratio: 1.06), and the mean age was 33.9+/-14.2 years old. Fifty-six patients (54.4%) were discharged from the emergency department (ED) on the day of injury after primary care, and 9 patients (8.7%) were discharged, because they refused treatment. Seven patients (6.8%) died. Of these, 4 patients (3.9%) died after attempted cardio-pulmonary resuscitation in the ED, 1 patient (1%) was dead on arrival, and 2 patients (1.9%) died after admission. Sixteen patients (15.5%) were admitted to the hospital, including 2 patients (1.9%) needing emergency surgery. Sixteen patients (15.5%) were transferred to other hospitals. Sixty-one cases (59.2%) involved drinking, and 31 (30.1%) did not; for 11 cases (10.7%), the involvement of drinking was unknown. The mean revised trauma score (RTS) was 11.26+/-2.52, and 88 cases (85.4%) hat a RTS of 12. The mean injury severity score (ISS) was 5.80+/-14.56, and 9 (8.7%) severely injured patients had scores of more than 15.
CONCLUSION
Most self-injuries were mild traumas related to drinking and occurred at a young age. Most cases were not so severe, and the patients were discharged from the ED, but some patients needed hospitalization. Other patients had injuries so severe that they died.
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Summary
- Prognosis for Blunt Abdominal Trauma Patients with Contrast Extravasation on the Abdominopelvic CT Scan
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Hyung Jin Shin, Kang Hyun Lee, Young Soo Kwak, Sun Hyu Kim, Hyun Kim, Sung Oh Hwang
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J Korean Soc Traumatol. 2009;22(1):57-64.
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Computed tomography (CT) is an accurate test for evaluating hemodynamically stable patients with blunt abdominal trauma. Until now, there have been few studies concentrating on the diagnostic and prognostic significance of the intravenous contrast extravasation (CE) site. We investigated the site of CE on abdominopelvic CT (APCT) and its effect on treating trauma patients and predicting the clinical outcome.
METHODS
The 50 patients admitted to our emergency department with blunt abdominal trauma showing CE on APCT from January 2004 to September 2006 were included in this study. Patients were prospectively collected, and medical records were reviewed and analyzed. The patients'clinical and lab findings, Focused Assessment with Sonography for Trauma (FAST) findings, CT findings were analyzed. CE sites were classified as intraperitoneal, retroperitoneal, and pelvic cavity and were correlated with post-treatment complications, mortality, and morbidity.
RESULTS
Of the 50 patients (mean age : 45+/-18years, 29 males, 21 females) included in our study, 33 patients died (66%). There was no correlation between CE site and ICU or total hospitalization duration (p=0.553, p=0.523). During the first 24 hours of resuscitation, the pelvic cavity group required a mean of 20 units more of packed red blood cell (pRBC) transfusion compared to other groups (p=0.003). In the intraperitoneal group, more patients received operative invasive intervention - either laparotomy or embolization (p=0.025). The intraperitoneal group had the highest mortality, with 13 deaths (11/33, 39%), and the highest early mortality rate (10/13, 76%) in the first 24 hours (p=0.001).
CONCLUSION
Intraperitoneal CE on the CT scan in cases of blunt abdominal trauma is regarded as an indication of a need for invasive intervention (either angiography or laparotomy) and of a higher mortality rate in the first 24 hours. A pelvic cavity CE rquires more aggressive transfusion with pRBC. However, the CT findings themselves showed no significant correlation with overall mortality, morbidity, or hospitalization.
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Summary
- Characteristics of Wrist Injuries in Snowboarding
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Yeong Jun Kim, Kang Hyun Lee, Kyoung Chul Cha, Hyun Kim, Sung Oh Hwang, Jin Rok Oh
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J Korean Soc Traumatol. 2009;22(1):29-36.
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Abstract
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The purpose of this study was to analyze the characteristics and severity of wrist injuries in snowboarding.
METHODS
December 2005 to February 2008, Snowboarders who experienced wrist injures were included in this study. On the basis of the medical records and radiographic evaluation, the severity of distal radius fracture was classified according to the Arbeitsgemeinschaft fur Osteosynthesefragen/Association for the Study of Internal Fixation (AO/ASIF) classification.
RESULTS
Most of the injured snowboarders were a either of the beginner (35 cases, 46.1%) or the intermediate (27 cases, 35.5%) level. The most common cause of injury in snowboarding was a slip down (60 cases, 78.9%). Comminuted and articular fractures classified as AO types A3, B, and C, which required surgical reduction, made up 42.3% of the distal radial fractures in snowboarders. When we analyzed the differences in severity between the educated and the non-educated groups, an A2 type injury in the AO classification was the most common type of injury in the educated group (20 cases, 38.5%), it means less severe fractures ocurred in the educated group (p=0.045). The most frequent injury mechanism of fractures was slip down (48 cases, 63.2%), and a slip down backwards was the dominant type of slip down (36 cases, 75.0%) (p=0.031).
CONCLUSION
Among the snowboarders in this study who suffered self-down injury to the wrist, more fractures were associated with a backwards slip down than with a forward slip down due to over extension. For educated snowboarders the severity of fracture was lower than it was for uneducated snowboarders.
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Summary
- Characteristics of Head Injuries After Skiing and Snowboarding Accident
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Sung Chan Kang, Kang Hyun Lee, Han Joo Choi, Kyung Hye Park, Sang Chul Kim, Hyun Kim, Sung Oh Hwang
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J Korean Soc Traumatol. 2008;21(1):53-58.
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Skiing and snowboarding are becoming increasingly popular. Accordingly, the incidences of injuries among skiers and snowboarders are also increasing. The purpose of this study was to investigate the injury patterns of and the contributing factors to head injuries of skiers and snowboarders and to evaluate the differences in characteristics between skiing and snowboarding head injuries.
METHODS
One-hundred patients who visited the emergency department of Wonju Christian Hospital between January 2005 and March 2007 due to head injuries from skiing and snowboarding were enrolled. The mechanisms and the histories of the injuries were investigated by surveying the patients, and the degrees of head injuries were estimated by using brain CT and the Glasgow Coma Scale. The degrees and the characteristics of brain injuries were also analyzed and compared between skiers and snowboarders.
RESULTS
Out of 100 patients, 39 were injured by skiing, and 61 were injured by snowboarding. The mean age of the skiers was 26.7+/-10.0, and that of the snowboarders was 26.7+/-6.2. The percentage of male skiers was 43.6%, and that of snowboarders was 63.9%. The most frequent initial chief complaints of head-injured skiers and snowboarders were headache and mental change. The most common mechanism of injuries was a slip down. The mean Abbreviated Injury Scale Score (AIS score) of the skier group was 4.5+/-2.1 and that of the snowboarder group was 5.9+/-5.0 (p=0.222). The percentage of helmet users was 7.1% among skiers and 20.8% among snowboarders (p=0.346). Head injuries were composed of cerebral concussion (92.0%) and intracranial hemorrhage (8.0%). Intracranial hemorrhage was most frequently caused by falling down (62.5%).
CONCLUSION
The most common type of head injury to skiers and snowboarders was cerebral concussion, and severe damage was usually caused by jumping and falling down. No differences in the characteristics of the head injuries existed between skiing and snowboarding injuries.
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Summary
- Factors Affecting Hemodynamic Instability in Patients with Pelvic Bone Fracture
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Seung Min Park, Kang Hyun Lee, Han Ju Choi, Kyung Hye Park, Sang Chul Kim, Hyun Kim, Sung Oh Hwang
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J Korean Soc Traumatol. 2008;21(1):22-27.
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Treatment and prognosis in patients with pelvic bone fracture depend on the characteristics of the fracture and the stability of the pelvic ring. The purpose of this study is to analyze the characteristics of and the relationships between fracture patterns, injury mechanisms, clinical courses, and prognoses according to the hemodynamic pattern.
METHODS
Between January 2004 and September 2006, 89 patients under diagnosis of pelvic bone fracture were retrospectively analyzed on the basis of medical records and radiologic examinations. Patients with confirmed hemorragic shock with a systolic pressure of less than 90 mmHg were defined as the shock group. Young's classification was used to characterize fracture patterns. Factors relating to the clinical manifestation and to treatments such as transfusion and surgery were analytically compared.
RESULTS
The mean age of the patients was 48.8+/-18.7, among which 49 (55.1%) were male. The numbers of shock and non-shock patients were 35 (39.3%) and 54 (60.7%) respectively. Eighteen (51.4%) of the shock patient had injuries resulting from pedestrian accidents (p=0.008). According to Young's classification, lateral impact fractures amounted to 20 and 33, front-rear impact fractures to 9 and 20, and multiple fractures to 6 and 1 among the shock and non-shock patients, respectively (p=0.027). Thirty-nine (39) cases in non-shock injuries were conservatively managed while 18 cases in shock injuries were surgically treated. In the shock group, the liver and the kidney were often damaged, as well. Among the shock patients, the average admission period was 7.5+/-8.7 days in intensive care and 55.1+/-47.9 days in total, which were longer than the corresponding numbers of days for the non-shock patients (p<0.05). No deaths occurred in the non-shock group while 5 deaths (14.2%) occurred in the shock group (p=0.007).
CONCLUSION
The factors affecting hemodynamic instability in patients with pelvic bone fracture are injury mechanism, classification of fracture, and associated injuries.
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Summary
- Relation between Serum S100beta and Severity and Prognosis in Traumatic Brain Injury
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Oh Hyun Kim, Kang Hyun Lee, Kap Jun Yoon, Kyung Hye Park, Yong Su Jang, Hyun Kim, Sung Oh Hwang
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J Korean Soc Traumatol. 2007;20(2):138-143.
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S100beta, a marker of traumatic brain injury (TBI), has been increasingly focused upon during recent years. S100beta, is easily measured not only in cerebrospinal fluid (CSF) but also in serum. After TBI, serum S100beta, has been found to be increased at an early stage. The purpose of this study was to evaluate the clinical correlations between serum S100beta, and neurologic outcome, and severity in traumatic brain injury.
METHODS
From August 2006 to October 2006, we made a protocol and studied prospectively 42 patients who visited the emergency room with TBI. Venous blood samples for S100beta, protein were taken within six hours after TBI and vital signs, as well as the Glasgow Coma Scale (GCS), were recorded. The final diagnosis and the severity were evaluated using the Abbreviated Injury Score (AIS), and the prognosis of the patients was evaluated using the Glasgow Outcome Score (GOS).
RESULTS
Thirty-eight patients showed a favorable prognosis (discharge, recovery, transfer), and four showed an unfavorable prognosis. Serum S100beta, was higher in patients with an unfavorable prognosis than in patients with a favorable prognosis, and a significant difference existed between the two groups (0.74+/-50 microgram/L vs 7.62+/-6.53 microgram/L P=0.002). A negative correlation existed between serum S100beta, and the Revised Traumatic Score (R2=-0.34, P=0.03), and a positive correlation existed between serum S100beta, and the Injury Severity Score (R2=0.33, P=0.03). Furthermore, the correlations between serum S100beta, and the initial GCS and the GCS 24 hours after admission to the ER were negative (R2=-0.62, P<0.001; R2=-0.47, P=0.005). Regarding the GOS, the mean serum concentration of S100beta. was 7.62 beta partial differential/L (SD=+/-6.53) in the expired patients, 1.15 microgram/L in the mildly disable patient, and 0.727 microgram/L (SD=+/-0.73) in the recovered patients. These differences are statistically significant (p<0.001).
CONCLUSION
In traumatic brain injury, a higher level of serum concentration of S100beta, has a poor prognosis for neurologic outcome.
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Summary
- The Characteristics of Spinal Injury in Skiing and Snowboarding Injuries
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Yong Sung Cha, Kang Hyun Lee, Sun Hyu Kim, Yong Su Jang, Hyun Kim, Tae Yong Shin, Sung Oh Hwang
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J Korean Soc Traumatol. 2007;20(1):33-39.
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Few studies have been done for spinal injuries after skiing and snowboarding accidents. Assuming that the riding patterns of skiing and snowboarding were different, we analyzed the differences between the mechanisms, diagnoses and levels of spinal injuries caused by them. The purpose of this study was to gain a better understanding of spinal hazards associated with skiing and snowboarding in order to educate skiers and snowboarders.
METHODS
We conducted a prospective study of 96 patients who had sustained spinal injuries as a result of skiing and snowboarding accidents from January 2003 to March 2006. We used a questionnaire, radiological studies, history taking, and physical examinations. We analyzed the mechanism of injury, the level of spinal injury, the severity of spinal injury, and the Abbreviated Injury Scale scores (AIS score). We used the t-test and the chi-square test.
RESULTS
The skiing and the snowboarding injury group included in 96 patients. The skiing injury group included 30 patients (31.2%), and the snowboarding injury group included the remaining 66 patients (69.8%). The primary mechanism of injury in skiing was collisions and in snowboarding was slip downs (p=0.508). The primary level of spinal injury in skiing and snowboarding was at the L-spine level (p=0.547). The most common athlete ability of the injured person was at the intermediate level (p=0.954). The injured were most commonly at the beginner or the intermediate level (p=0.302). The primary diagnosis of spinal injury in skiing and snowboarding was back spain (p=0.686). The AIS scores did not differed between the two groups (p=0.986).
CONCLUSION
The most common spinal injury after skiing and snowboarding accidents was back sprain. There was no difference in the severity of spinal injury between skiing and snowboarding accidents.
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Summary
- Comparisons of Fracture Types and Pelvic Angiographic Findings in Hemodynamically Unstable Pelvic Bone Fracture
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Kwon Il Lee, Kang Hyun Lee, Sung Chan Kang, Sung Min Park, Yong Su Jang, Tae Yong Shin, Sung Oh Hwang, Hyun Kim
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J Korean Soc Traumatol. 2007;20(1):26-32.
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Hemorrhagic shock is the leading cause of death in patients with pelvic bone fractures. The majority of blood loss is due to injured pelvic arteries and retroperitoneal veins and to bleeding from the fracture site itself. Pelvic angiography and embolization of injured vessels is an effective way to control continuous bleeding. However, identifying the bleeding focus in hemodynamically unstable patients before diagnostic intervention is difficult. The purpose of this study was to determine the correlation between fracture patterns in hemodynamically unstable patients with pelvic fractures and later pelvic angiography findings.
METHODS
We performed a retrospective study of 21 hemodynamically unstable patients with pelvic fractures admitted to our emergency department between April 2001 to April 2006. All 21 patients underwent pelvic angiography. Pelvic fractures were assessed according to the Tile's classification and the degree of injury was assessed using the Injury Severity Score (ISS) and Revised Trauma Score (RTS). The hemodynamic status of the patients was defined using vital signs, base excess, and blood lactate. Fracture patterns were compared with hemodynamic status and angiography findings.
RESULTS
In the 5year study period, 21 hemodynamically unstable pelvic bone fracture patients were admitted; ten were men (47.6%), and 11 were women (52.4%). The mean age was 41.1 years (range: +/-20.1). Of the 21 embolization was performed in 6 patient (28.6%): 1 patient of the 5 unstable pelvic bone fracture patients (20%), and 5 patients of 16 the stable pelvic bone fracture patients (31.3%). There were no significant differences between the RTS (p=0.587) and embolization rate (p=0.774) for either the stable patients or the unstable patients. Patients with arterial injury on angiography had a lower RTS compared with patients without arterial injury but there was no significant difference in ISS between the two groups. The angiographic injured sites were five internal femoral arteries and one external femoral artery.
CONCLUSION
The findings in this study suggest that the pelvic fracture pattern in hemodynamically unstable patients with pelvic fractures does not correlate with pelvic angiography findings.
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Summary
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