Journal of Trauma and Injury

Jae Gil Lee

17 Articles

A Case of Traumatic Cervical Braun-Sequard Syndrome: Dae Hyun Cho, Seung Hwan Lee, Jae Gil Lee, Myung Jae Jung; J Trauma Inj. 2017;30(3):103-106. Published online October 30, 2017; DOI: https://doi.org/10.20408/jti.2017.30.3.103

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Abstract PDF: A traumatic Braun-Sequard syndrome of the cervical spine is reported in a 53-year-old male. The patient recovered spontaneously over several days with surgical intervention. The diagnosis was made on magnetic resonance imaging with physical examination, which also demonstrated subsequent resolution of bone marrow intensity. The etiological factors of spinal Braun-Sequard syndrome are reviewed.; Summary

Management of Perirectal Laceration without Fecal Diversion: A Case Report: Dae Hyun Cho, Seung Hwan Lee, Myung Jae Jung, Jae Gil Lee; J Trauma Inj. 2017;30(2):55-58. Published online June 30, 2017; DOI: https://doi.org/10.20408/jti.2017.30.2.55

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Abstract PDF: Clinical research on multiple lacerations of perineum or buttock is sparse and rare so limited to case reports. But a missed rectal injury combined bladder or vessel can have devastating consequence. Although it is generally known that it should be treated accompanying with diverting ileostomy or colostomy, the aim of this case is announce the possibility of management of perectal injury without diversion.; Summary

Time to Surgery and Injury Severity Score: Chang Seon Oh, Jae Gil Lee, Seung Hyun Kim; J Trauma Inj. 2016;29(4):151-154. Published online December 31, 2016; DOI: https://doi.org/10.20408/jti.2016.29.4.151

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Abstract PDF: PURPOSE
To evaluate the association between time to surgery and injury severity score (ISS).
METHODS
Medical charts and records were reviewed for polytrauma patients who underwent trauma surgery from November 2014 to March 2016. The patients were divided into two groups based on the ISS.
RESULTS
Among the 217 operated patients, 22 patients underwent first and second surgery. The patients with an ISS over 17 (mean 13.0 days) had a longer interval between surgeries than patients with an ISS of 17 or less (mean 7.5 days) (p=0.031). One hundred and twenty-one patients only underwent elective surgery and there is a positive correlation between ISS and time to elective surgery (p<0.028, Pearson's correlation coefficient=0.224). Seventy-four patients underwent emergent surgery only. Among these, the patients with an ISS of 17 or less underwent general surgery (86%) but the patients with an ISS more than 17 underwent neurological surgery (47%).
CONCLUSION
Patients with high ISS need critical care during the preoperative and postoperative period.; Summary

Management of Thoracic Aortic Injury after Blunt Trauma: Nine Cases at a Single Medical Center: Kyungwon Lee, Jae Gil Lee; J Trauma Inj. 2016;29(4):146-150. Published online December 31, 2016; DOI: https://doi.org/10.20408/jti.2016.29.4.146

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Abstract PDF: PURPOSE
Traumatic aortic injuries are rare, but life threatening condition. They usually occur after high velocity impact on the chest or abdomen such as traffic accident or fall. We report the experiences of the traumatic aortic injuries at a single center.
METHODS
We retrospectively reviewed the medical records of nine patients with aortic injury resulting from the blunt trauma from Jan. 2010 to May. 2016.
RESULTS
The mean age was 51.1±20.8 years old, and ten (90.9%) were men. The mechanisms of injury were traffic accidents in seven patients (motorcycle accidents; 3, car accidents; 4), and four in fall injury. Most common injured sites were thoracic aorta (9, 81.8%). Aortic injuries were repaired by endovascular approach in four patients, and by open graft surgery in four. Two patients were managed conservatively. Nine patients survived without any complications.
CONCLUSION
We had experienced different approaches for management of aortic injuries after blunt trauma according to locations and severity of lesions.; Summary

Prevalences of Incidental Findings in Trauma Patients by Abdominal and Pelvic Computed Tomography: Jin Young Lee, Myung Jae Jung, Jae Gil Lee, Seung Hwan Lee; J Trauma Inj. 2016;29(3):61-67. Published online September 30, 2016; DOI: https://doi.org/10.20408/jti.2016.29.3.61

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Abstract PDF

PURPOSE
Abdominal and pelvic computed tomography (APCT) is frequently used as a diagnostic tool in trauma patients. However, trauma unrelated, incidental findings are frequently encountered. The aim of this study was to determine the prevalences of incidental findings on APCT scans in trauma patients.
METHODS
The archived records of 801 trauma patients treated from January 2013 to December 2015 were reviewed retrospectively. Six hundred and forty of these patients underwent contrast enhanced APCT in an emergency department and were included in this study, and 205 (32.1%) of these patients had incidental findings. These findings were divided into two categories: category I, meaning a radiological benign finding not requiring further evaluation or follow- up, and category II, requiring further evaluation and follow-up.
RESULTS
One hundred and sixty (24.8%) patients were allocated to category I and 45 (7.2%) to category II. The most frequent incidental findings were discovered in kidneys (34.6%), followed by liver (28.8%), and gallbladder (15.6%). The most frequent finding in category I was a benign cyst (60.1%), followed by a simple stone (15.6%), and hemangioma (11.9%). Adenomyomatosis of the gallbladder (17.8%) was the most common lesion in category II, followed by atypical mass (15.6%), complicated stone (15.6%) and cystic neoplasm (15.6%).
CONCLUSION
The prevalence of an incidental finding on APCT scans was 32.1%. Although category II lesions were not common in trauma patients, these findings should be communicated to patients, and when necessary referred to a primary care physician. Systems are required for producing appropriate discharge summaries and informing patients about the implications of incidental findings.

Summary

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Incidental Cancer Diagnoses in Trauma Patients: A Case–Control Study Evaluating Long-term Outcomes
Nathaniel Bell, Amanda Arrington, Swann Arp Adams, Mark Jones, Joseph V. Sakran, Ambar Mehta, Jan M. Eberth
Journal of Surgical Research.2019; 242: 304. CrossRef
Filling the void: a low-cost, high-yield approach to addressing incidental findings in trauma patients
Nicholas Sich, Andrew Rogers, Danelle Bertozzi, Praveen Sabapathi, Waed Alswealmeen, Philip Lim, Jonathan Sternlieb, Laura Gartner, James Yuschak, Orlando Kirton, Ryan Shadis
Surgery.2018; 163(4): 657. CrossRef

Relation between Blood Alcohol Concentration and Clinical Parameters in Trauma Patients: Tae Hwa Hong, Ji Young Jang, Seung Hwan Lee, Hyung Won Kim, Hong Jin Shim, Jae Gil Lee; J Trauma Inj. 2015;28(4):256-261. Published online December 31, 2015; DOI: https://doi.org/10.20408/jti.2015.28.4.256

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Abstract PDF: PURPOSE
The aim of this study was to evaluate the effects of blood alcohol concentration (BAC) on the clinical parameters in trauma patients.
METHODS
From January 2011 to March 2013, the records of a total of 102 trauma patients with BAC data were analyzed retrospectively. The revised trauma score (RTS), injury severity score (ISS), presence of shock, use of mechanical ventilation and blood transfusion, length of hospital stay, and mortality were collected. Patients were divided into four groups in accordance with the level of BAC: group A (<100 mg/dL), B (100~200 mg/dL), C (200~250 mg/dL), and D (>250 mg/dL). Patients were also divided into two groups depending on the presence of the shock, and gender, ISS, BAC, and presence of active bleeding were compared between these two groups.
RESULTS
No statistically significant differences in the ISS, RTS, presence of active bleeding, use of mechanical ventilation, and mortality were noted between groups A to D. However, the presence of shock was significantly higher in group D. After patients with severe chest injuries had been excluded, mechanical ventilation was found to have been applied more frequently in the higher BAC groups (C and D). A logistic regression analysis of these factors showed that extremely high BAC (>250 mg/dL) was an independent indicator of shock.
CONCLUSION
High BAC is a predicator of shock and the need for mechanical ventilation in patients with trauma, regardless of injury severity. Alcohol intoxication leads to an overestimate of the clinical condition and aggressive management for trauma patients. Thus, a guideline for the diagnosis and treatment of patients intoxicated with alcohol is necessary.; Summary

The Influence of How the Trauma Care System Is Applied at the Trauma Center: The Initial Experience at Single Trauma Center: Hyung Won Kim, Tae Hwa Hong, Seung Hwan Lee, Myung Jae Jung, Jae Gil Lee; J Trauma Inj. 2015;28(4):241-247. Published online December 31, 2015; DOI: https://doi.org/10.20408/jti.2015.28.4.241

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Abstract PDF

PURPOSE
To evaluate the influence of how the trauma care system is applied on the management of trauma patients.
METHODS
We divided the patients into a pre-trauma system group and a post-trauma system group according to the time when we began to apply the trauma care system in our institution. We compared the general characteristics, injury severity score, initial response time to the trauma patients, number of preventable deaths, and clinical outcomes between the two groups.
RESULTS
The numbers of patients in the pre-trauma system group and the post-trauma system group were 188 and 257, respectively. No differences in the patient's median ages, trauma scores (ISS, RTS, TRISS) and proportions of severe trauma patients (ISS>15) were observed between the two groups. The number and the proportion of patients who were admitted to our hospital were increased in the post-trauma system group. The time interval from trauma CP activation to emergency surgery or angio-embolization, and the patient's time spent in emergency room were shortened in the posttrauma system group. However, the lengths of the ICU stay and the hospital stay, and the number of in-hospital mortalities were not improved in the post-trauma system group. In severe trauma patients (ISS>15), there were no differences between the two groups in the number and the proportion of admitted patients, and the time interval from trauma CP activation to performing a diagnostic and therapeutic procedure was not shortened in the post-trauma system group.
CONCLUSION
Application of the trauma care system has shortened the time between the initial response and patient management. However, this improvement was not enough to result in better clinical outcomes. More trauma physicians, multidisciplinary cooperation, and a well-organized trauma management process will be needed if the maximum efficacy of the trauma system is to be achieved.

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Effectiveness after Designation of a Trauma Center: Experience with Operating a Trauma Team at a Private Hospital
Kyoung Hwan Kim, Sung Ho Han, Soon-Ho Chon, Joongsuck Kim, Oh Sang Kwon, Min Koo Lee, Hohyoung Lee
Journal of Trauma and Injury.2019; 32(1): 1. CrossRef
Characteristics and Outcomes of Trauma Patients via Emergency Medical Services
Dae Hyun Cho, Jae Gil Lee
Journal of Trauma and Injury.2017; 30(4): 120. CrossRef
Analysis of Abdominal Trauma Patients Using National Emergency Department Information System
In-Gyu Song, Jin Suk Lee, Sung Won Jung, Jong-Min Park, Han Deok Yoon, Jung Tak Rhee, Sun Worl Kim, Borami Lim, So Ra Kim, Il-Young Jung
Journal of Trauma and Injury.2016; 29(4): 116. CrossRef

Usefulness of End-tidal Carbon Dioxide as a Predictor of Emergency Intervention in Major Trauma Patients: Sung Ho Kim, Seunghwan Kim, Jae Gil Lee, Sung Phil Chung, Seung Ho Kim; J Trauma Inj. 2014;27(4):133-138.

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Abstract PDF: PURPOSE
If the survival of patients suffering from severe blunt trauma is to be improved, appropriate interventions should be taken immediately. The purpose of this study is to evaluate the clinical utility of end-tidal carbon dioxide (ETCO2) as a surrogate marker for predicting both the need for intervention and the prognosis.
METHODS
This is a prospective observational study. Nasal cannula was applied to measure ETCO2, and the following parameters, which are known to be related to the prognosis for a patient, were recorded: injury severity score (ISS), revised trauma score (RTS), arterial blood gas (ABG), lactate, and hemoglobin (Hb). To evaluate the outcome, we investigated the details of emergent interventions and expired patients.
RESULTS
A total of 93 patients were enrolled in this study. Emergent intervention was significantly associated with systolic blood pressure (sBP, p-value=0.001), ETCO2 (p-value<0.001), serum lactate level (p-value<0.001), pH (p-value< 0.003), HCO3 (p-value=0.004), base excess (p-value<0.002), ISS (p-value<0.001) and RTS (p-value=0.005). In the multivariate logistic regression, only ETCO2 (odds ratio (OR): 0.897, 95% confidence interval (CI): 0.792-0.975, pvalue= 0.048) and ISS (OR: 1.132, 95% CI: 1.053-1.233, p-value=0.002) were associated with emergent intervention whereas ETCO2 (p-value=0.973) and ISS (p-value=0.511) were not statistically significant in predicting the survival of patients in the univariate analysis. An optimal ETCO cut-off of 29 mmHg on the ROC curve was determined, with the area under the ROC curve (AUC) being 0.824 (0.732-0.917)].
CONCLUSION
This study has revealed that ETCO2, which can be rapid and easily measured through a nasal cannula, and the ISS may be prognostic indicators of emergent interventions in Emergency Departments.; Summary

A Case of Cardiac Laceration due to Anterior Thoracic Stab Injury: Won Gi Woo, Ji Young Jang, Seung Hwan Lee, Chang Young Lee, Jae Gil Lee; J Trauma Inj. 2014;27(3):71-74.

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Abstract PDF: Among chest trauma patients, cardiac laceration is a rare, but severe, condition requiring prompt management. Depending on the patient's hemodynamic status, early detection rate of a cardiac laceration may or may not be occur. If a possibility of cardiac laceration exists, an emergent thoracotomy should be performed. Furthermore, patients who experience a cardiac laceration also experience different kinds of complications. Therefore, close follow-up and monitoring are required. Herein, we report a 41-year-old man with a left atrium and a left ventricle laceration caused by a thoracic stab injury.; Summary

The Choice of Management in Patients with Splenic Blunt Trauma: A Single Center Study: Ji Young Jang, Seung Hwan Lee, Jae Gil Lee; J Trauma Inj. 2013;26(4):280-285.

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Abstract PDF: PURPOSE
Nowadays, non-operative management increases in patients with blunt splenic injury due to development of diagnostic and interventional technique. The purpose of this study is to evaluate the management in patients with blunt splenic injury and effect of clinical state such as shock on the choice of management.
METHODS
From April 2007 to July 2013, we retrospectively reviewed the medical charts of fifty patients who had splenic injury after blunt trauma. The demographic characteristics, American Association for the Surgery of Trauma (AAST) grade of splenic injury, management method (emergency operation, angiographic embolization or observation) and clinical outcome were analyzed.
RESULTS
The mean age was 41.5+/-21.4 years and male was 44(88%). Twenty patients(40%) were in shock condition initially and five patients(10%) underwent emergency operation due to hemodynamic instability. Emergency angiographic embolization was performed in 20 patients(40%) and 25 patients were managed conservatively. When patients were divided into shock group (SG) and non-shock group (NSG), Patients in SG had significantly higher serum lactate level and base deficit than NSG (lactate; 4.5+/-3.4 mmol/L, base deficit; 5.8+/-4.4 mmol/L vs 1.9+/-1.4 mmol/L, 2.8+/-2.5 mmol/L, p=0.007, p=0.013). There was no significant difference of AAST grade and contrast blush rate in abdomen CT between two groups. Among 45 patients with non-operative management, four patients(8.9%) got delayed angiographic embolization and 3 patient died from companied organ injury.
CONCLUSION
Non-operative management can be acceptable management option in patients with splenic blunt trauma under intensive hemodynamic monitoring.; Summary

Transfer Patterns of Multiple Trauma Patients in University Hospital after Acute Phase Management: Jong Min Lee, Ji Young Jang, Seung Hwan Lee, Jae Gil Lee; J Trauma Inj. 2013;26(4):261-265.

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Abstract PDF: PURPOSE
The aim of this study is to evaluate the transfer pattern of multiple trauma patients after acute phase management and to determine whether the time between the surgeon's decision and the actual transfer correlates with the patient's insurance type.
METHODS
Three hundred ninety-two(392) multiple trauma patients visited the emergency room from January 2011 to April 2013. Among the 143 patients who were admitted by a trauma surgeon, 47 were transferred to another hospital after acute phase management. The age, gender, trauma mechanism, Revised trauma score (RTS), Injury severity score (ISS), insurance type, length of ICU stay and hospital stay were analyzed through a retrospective chart review.
RESULTS
The mean age was 47.7 years, and traffic accident was the most common mechanism(26, 55.3%). The mean RTS and ISS were 6.93 and 22.7, respectively. Twenty-five patients(53%) were covered by National health insurance, and 20 patients(42.6%) were covered by automobile insurance. Patients were transferred to primary (4.3%), secondary(80.9%), tertiary(4.3%) and care(10.6%) hospitals. The mean time from transfer decision to actual transfer was significantly longer for patients who were covered by automobile insurance than it was for patients who were covered by national health insurance (p=0.038).
CONCLUSION
An appropriate transfer system at the end of acute phase care is essential for managing trauma centers with limited staffing and facilities. In addition, the mean time from transfer decision to actual transfer seemed to be definitely related to the type of insurance covering the patient.; Summary

Management of Traumatic Pancreas Injury in Korea: Literature Review: Seung Hwan Lee, Ji Young Jang, Hongjin Shim, Jae Gil Lee; J Trauma Inj. 2013;26(3):207-213.

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Abstract PDF: PURPOSE
Traumatic pancreas injuries are rare conditions that result in high morbidity and mortality. Thus, early diagnosis and intervention are very important to manage pancreatic injuries. The purpose of this study is to review the management and outcomes of the pancreatic injuries in the Korean population.
METHODS
Original articles published from January 2001 to December 2012 and addressing the Korean population were selected by using indices such as 'pancreas injury', 'traumatic pancreas injury', and 'pancreatic trauma' to search KoreaMed and PubMed. Nine reports were selected to review the management options for surgery or endoscopic retrograde cholangio-pancreatography. We assessed the injury mechanisms, injury severities, associated injuries, types of operation, and outcomes.
RESULTS
Two hundred fifty of the 332 patients included in the 9 selected reports were men, and the mean age of all patients was 36.4 years. The main injury mechanism was traffic accidents(65.6%). Most patients had grade II or III injuries(68.9%). The most common extra-pancreatic injury site was the liver, followed by the chest and spleen. Operative management, including distal pancreatectomies(129), drainage procedures(64), pancreaticoduodenectomies( 23), and others(60), was used for 276 patients. The reported mortality rate was 10.2%, and the morbidity rate ranged from 38% to 76.9%. The average length of hospital stay was 39.5 days. Risk factors for mortality were amount of transfusion, injury severity, base deficit, age, and presence of shock.
CONCLUSION
In this study, we found neither significant data nor a consensus. If national guidelines are to be developed and established, a national data bank or registry, and nationwide data collection are required.; Summary

Effective Radiologic Doses and Lifetime Attributable Risks in Patients with Trauma Critical Pathway Activation: Wonhyo Lee, Taeyoung Kong, Seunghwan Kim, Je Sung You, Yoo Seok Park, Jae Gil Lee, Sung Phil Chung; J Trauma Inj. 2013;26(3):198-206.

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Abstract PDF: PURPOSE
This study was performed to calculate and analyze the effective radiation doses from computed tomography (CT) and radiologic intervention in patients in the emergency department (ED) with trauma critical pathway (CP) activation and further to estimate the lifetime attributable risks (LARs) for the incidence of and mortality from cancers induced by the radiation dose.
METHODS
Through a retrospective electrical chart review of 104 injured patients who trauma critical pathway were activated from November 2012 to March 2013, we calculated effective radiologic doses by taking the product of the dose-linear product of the scan and the conversion coefficient. After a determination of the image results, we divided the patients into two groups, negative or positive, and calculated the effective dose for each group. With these results, we estimated the LARs for the incidence of and the mortality from cancers by using the table in the Biologic Effects of Ionizing Radiation (BEIR)-VII report.
RESULTS
A total of 76 patients were enrolled. The mean age was 49.0+/-8.5 years. The mean injury severity score (ISS) was 12.7+/-8.4. The cumulative effective dose (CED) for individual patients varied from 2.8 mSv to 238.8 mSv, and the mean was 47.6+/-39.9 mSv. The CED in patients with an ISS> or =16(63.2+/-26.6 mSv) was higher than that of patients whose ISS<16(33.5+/-23.1 mSv) (p<0.001). The CED in patients who were treated with surgery or intervention(69.0+/-45.2 mSv) was higher than that of patients who were treated conservatively(33.6+/-22.4 mSv) (p<0.001). The LARs for cancer incidence and mortality were 328.5+/-308.6 and 189.0+/-159.3 per 100,000 people, respectively.
CONCLUSION
The CED and the LAR for trauma CP-activated patients in the ED were significant, so efforts should be made to decrease the effective dose received by severely injured patients.; Summary

Abdominal Wall Closure Using Artificial Mesh for Patients with an Open Abdomen: Sung Whan Cha, Hong Jin Shim, Ji Young Jang, Jae Gil Lee; J Trauma Inj. 2012;25(4):172-177.

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Abstract PDF: PURPOSE
After damage control surgery, abdominal wall closure may be impossible due to increased intra-abdominal pressure (IAP), and primary closure may induce abdominal compartment syndrome. The purpose of this study was to investigate changes in the IAP and the feasibility of abdominal wall closure using artificial mesh.
METHODS
From July 2010 to July 2011, 8 patients with intra-abdominal hypertension underwent abdominal wall closure using artificial mesh. Medical data such as demographics, diagnosis, operation, IAP, postoperative complications, mortality and length of hospital stays were collected and reviewed, retrospectively. One patient was excluded because of inadequate measurement of the IAP.
RESULTS
Seven patients, 4 males and 3 females, were enrolled, and the mean age was 54.1 years old. Causes of operations were six traumatic abdominal injuries and one intra-abdominal infection. The IAP was reduced from 21.9+/-6.6 mmHg before opening the abdomen to 15.1+/-7.1 mmHg after fascial closure. Fascial closure was done on 14.9+/-17.5 days after the first operation. The mean lengths of the hospital and the intensive care unit (ICU) stays were 49.6 days and 29.7 days respectively. Operations were performed 3.1+/-1.5 times in all patients. Two patients expired, and one was transferred in a moribund state. Three patients suffered from complications, such as retroperitoneal abscesses, enterocutaneous fistulas, and bleeding that was related to the negative pressure wound therapy.
CONCLUSION
After abdominal wall closure using artificial mesh, intra-abdominal pressure was well controlled, and abdominal compartment syndrome does not occur. When the abdominal wall in patients who have intra-abdominal hypertension is closed, artificial mesh may be useful for maintaining a lower abdominal pressure. However, when negative pressure wound therapy is used, the possibility of serious complications must be kept in mind.; Summary

Prognostic Factors in Patients Who Performed Angiographic Embolization for the Bleeding from Injury of the Intraabdominal Organ and Pelvic Area: Jin Ho Lee, Ji Young Jang, Hong jin Shim, Jae Gil Lee; J Trauma Inj. 2012;25(4):166-171.

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Abstract PDF: PURPOSE
In patients with traumatic hemoperitoneum or pelvic bone fracture who underwent angiography and embolization, we want to find the prognostic factors related with mortality.
METHODS
Patients(333 patients) who visited our hospital with traumatic injury from March 2008 to April 2012 were included in this study. Only 37 patients with traumatic hemoperitoneum or pelvic bone fracture underwent angiography and embolization. A retrospective review was conducted, and Glasgow coma scale (GCS), Revised trauma score (RTS), Injury severity score (ISS), initial laboratory finding and time interval, the amount of transfusion from the arrival at the ER to the start of embolization, and the vital signs before and after procedure were checked. Stastical analysis was conducted using the Chi square and Mann-Whitney U test.
RESULTS
In univariate analysis, the amount of transfusion, the base deficit before procedure, the systolic blood pressure before and after the procedure, the GCS, the RTS and the ISS were significantly associated with prognosis. In the multivariate analysis, the ISS and the base deficit had significant association with prognosis. Of the 37 patients who underwent angiography and embolization, 31 patients needed not additional procedure (Group A) while the other 6 patients needed an additional procedure (Group B). After procedure, a statistically significant higher blood pressure was observed in Group A than in Group B. As to the difference in blood pressure before and after the procedure, a statistically significant decrease in systolic blood pressure was observed in Group B, but an increase was observed in Group A.
CONCLUSION
In traumatic hemoperitoneum or pelvic bone fracture patients who underwent angiography and embolization, GCS, ISS, RTS, transfusion amount before the procedure, initial base deficit and systolic blood pressure were factors related to mortality. When patients who underwent angiography and embolization only were compared with patients who underwent re-embolization or additional procedure after the first embolization, an increase in systolic blood pressure after embolization was a prognostic factor for successful control of bleeding.; Summary

Application of Critical Pathway in Trauma Patients: Hongjin Shim, Ji Yong Jang, Jae Gil Lee, Seonghwan Kim, Min Joung Kim, You Seok Park, Inchel Park, Seung Ho Kim; J Trauma Inj. 2012;25(4):159-165.

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Abstract PDF: PURPOSE
For trauma patients, an early-transport and an organized process which are not delayed in hospital stage are necessary. Our hospital developed a procedure, the trauma Critical Pathway (CP), through which a traumatic patient has the priority over other patients, which makes the diagnostic and the therapeutic processes faster than they are for other patients.
METHODS
The records of patients to whom Trauma CP were applied from January 1, 2011 through April 15. 2012. were reviewed. We checked several time intervals from ER visiting to decision of admission-department, to performing first CT, to applying angio-embolization, to starting emergency operation and to discharging from ER. In addition, outcomes such as duration of ICU stay, hospital stay and mortality were checked and analyzed.
RESULTS
The trauma CP was applied to a total of 143 patients, of whom, 48 patients were excluded due to pre-hospital death, ER death, transferring to other hospital and not severe injury. Thus 95 patients (male 64, 67.3%) were enrolled in this study. Fifty-nine patients(62.1%) were injured by the traffic accident. The mortality rate was 10.5% and the mean Revised Trauma Score (RTS) of the patients was 6.4+/-2.0. After visiting ER, decision making for admission was completed, on average, in 3 hours 10 seconds. The mean time intervals for the first CT, angio-embolization, surgery and discharge were 1 hour 20 minutes, 5 hours 16 minutes, 7 hours 26 minutes and 6 hours 13 minutes, respectively.
CONCLUSION
The trauma CP did not show the improvement of time interval outcome, as well as mortality rate. However, this test did show that the trauma CP might be able to reduce delays in procedures for managing trauma patients at the university-based hospitals. To find out the benefit of CP protocol, a large scaled data is required.; Summary

Management of Traumatic Pancreas Injury in Multiple Trauma: Single Center Experience: Hyuna Jang, Hong Jin Shim, Sung Whan Cha, Jae Gil Lee; J Korean Soc Traumatol. 2011;24(2):111-117.

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Abstract PDF: PURPOSE
Pancreatic injury is rare in abdominal trauma patients (3%~12%). but it could result in significant morbidity and even mortality. Early and adequate decision making are very important in the management of patients with traumatic pancreatic injury. The purpose of this study was to assess the kinds of management and outcome through the review of our experience of pancreatic injury with multiple trauma.
METHODS
We reviewed 17 patients with traumatic pancreas injury via electronic medical records from Jan. 2002 and April. 2011. We collected demographic findings; the type, location and grade of pancreas injury, the treatment modality, and patient's outcomes, such as complications, length of hospital stay (LOS), and mortality.
RESULTS
Total 17 patients were reviewed, and man was 13 (88%). Traffic accident was the most common cause of injury. Pancreas neck was the most common injured site, and occured in 5 patients. Ductal injury was detected in 7 cases. Eleven patients were treated by surgical procedure, and in this group, 3 patients underwent the endoscopic retrograde pancreas drainage procedure coincidently. ERPD was tried in 8 patients, and failed in 2 patients. The major complications were post-traumatic fluid collection and abscess which accounted for 70% of all patients. The hospital stay was 35.9 days, and it was longer in patient with ductal injury (38.0+/-18.56 vs. 34.5+/-33.68 days). Only one patient was died due to septic shock associated with an uncontrolled retroperitoneal abscess.
CONCLUSION
Early diagnosis is the most important factor to apply the adequate treatment option and to manage the traumatic pancreas injury. Aggressive treatment should be considered in patients with a post-operative abscess.; Summary

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