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Kang Kook Choi 13 Articles
Epidemiology and outcomes of patients with penetrating trauma in Incheon Metropolitan City, Korea based on National Emergency Department Information System data: a retrsopective cohort study
Youngmin Kim, Byungchul Yu, Se-Beom Jeon, Seung Hwan Lee, Jayun Cho, Jihun Gwak, Youngeun Park, Kang Kook Choi, Min A Lee, Gil Jae Lee, Jungnam Lee
J Trauma Inj. 2023;36(3):224-230.   Published online December 21, 2022
DOI: https://doi.org/10.20408/jti.2022.0055
  • 1,408 View
  • 46 Download
AbstractAbstract PDF
Purpose
Patients with penetrating injuries are at a high risk of mortality, and many of them require emergency surgery. Proper triage and transfer of the patient to the emergency department (ED), where immediate definitive treatment is available, is key to improving survival. This study aimed to evaluate the epidemiology and outcomes of patients with penetrating torso injuries in Incheon Metropolitan City.
Methods
Data from trauma patients between 2014 and 2018 (5 years) were extracted from the National Emergency Department Information System. In this study, patients with penetrating injuries to the torso (chest and abdomen) were selected, while those with superficial injuries were excluded.
Results
Of 66,285 patients with penetrating trauma, 752 with injuries to the torso were enrolled in this study. In the study population, 345 patients (45.9%) were admitted to the ward or intensive care unit (ICU), 20 (2.7%) were transferred to other hospitals, and 10 (1.3%) died in the ED. Among the admitted patients, 173 (50.1%) underwent nonoperative management and 172 (49.9%) underwent operative management. There were no deaths in the nonoperative management group, but 10 patients (5.8%) died after operative management. The transferred patients showed a significantly longer time from injury to ED arrival, percentage of ICU admissions, and mortality. There were also significant differences in the percentage of operative management, ICU admissions, ED stay time, and mortality between hospitals.
Conclusions
Proper triage guidelines need to be implemented so that patients with torso penetrating trauma in Incheon can be transferred directly to the regional trauma center for definitive treatment.
Summary
Rare complication of skin necrosis after endoscopic debridement and cutaneo-fascial suture for a massive Morel-Lavallée lesion in Korea: a case report
Youngmin Kim, Jayun Cho, Myung Jin Jang, Kang Kook Choi
J Trauma Inj. 2023;36(3):304-309.   Published online August 25, 2023
DOI: https://doi.org/10.20408/jti.2023.0007
  • 552 View
  • 18 Download
AbstractAbstract PDF
A Morel-Lavallée lesion (MLL) is a pathologic fluid collection within an abnormally formed space, resulting from an internal degloving injury between the muscle fascia and subcutaneous fat layer. Due to its resistance to conservative treatments such as drainage or compression dressing, various therapeutic methods have been developed for MLL. However, no standardized guidelines currently exist. Recently, endoscopic debridement and cutaneo-fascial suture (EDCS) has been introduced for the treatment of MLL, particularly for large lesions resistant to conservative approaches. While this procedure is known to be effective, limited reports are available on potential complications. The authors present a case of skin necrosis following EDCS for a massive MLL.
Summary
Successful management of a common carotid artery injury using a Pruitt-F3 Carotid Shunt: a case report
Kang Kook Choi, Jayun Cho, Min A Lee, Soo Min Eun, Yang Bin Jeon
J Trauma Inj. 2022;35(Suppl 1):S3-S7.   Published online May 25, 2022
DOI: https://doi.org/10.20408/jti.2021.0032
  • 1,797 View
  • 74 Download
AbstractAbstract PDF
Penetrating neck injuries are a surgical challenge. In particular, penetrating neck injuries associated with carotid artery injuries have a high mortality rate. Overt external hemorrhage is unanimously considered as an indication for surgical exploration. The authors present a case of successful surgical management for a penetrating common carotid artery injury using a Pruitt-F3 Carotid Shunt (LeMaitre Vascular Inc., Burlington, MA, USA) in a 60-year-old male patient who was transferred to the level 1 trauma center due to a metal fragment piercing his neck while working. Active pulsatile bleeding was observed from the 3-cm-long external wound on the anterior neck in zone II. Emergent neck exploration showed near-total transection of the left common carotid artery just below the carotid bifurcation. After a Pruitt-F3 Carotid Shunt was applied to the injured carotid artery as a temporary vascular shunt, artificial graft interposition was performed for the injured common carotid artery. The patient experienced cerebral infarction as a complication caused by ischemia-reperfusion of the common carotid artery but was discharged in a suitable state for rehabilitation therapy.
Summary
A case report of field amputation: the rescue of an entrapped patient through the "doctor car" system
Byungchul Yu, Gil Jae Lee, Min A Lee, Kang Kook Choi, Jihun Gwak, Youngeun Park, Yong-Cheol Yoon, Jayun Cho, Seung Hwan Lee, Jungnam Lee
J Trauma Inj. 2022;35(Suppl 1):S27-S30.   Published online June 15, 2022
DOI: https://doi.org/10.20408/jti.2022.0012
  • 2,103 View
  • 73 Download
AbstractAbstract PDF
In certain circumstances, invasive procedures such as creation of a surgical airway, insertion of a chest drain, intraosseous puncture, or amputation in the field are necessary. These invasive procedures can save lives. However, emergency medical service teams cannot perform such procedures according to the law in Korea. The upper arm of a 29-year-old male patient was stuck in a huge machine and the emergency medical service team could not rescue the patient. A doctor-car team was dispatched to the scene and the team performed the filed amputation to extricate the patient. He was brought to the trauma center immediately and underwent formal above-elbow amputation. Here we describe a case of field amputation to rescue a patient through a “doctor car” system, along with a literature review.
Summary
Salvation of a solitary kidney in a patient with grade IV renal trauma: a case report
Hyuntack Shin, Ae Jin Sung, Min A Lee, Jayun Cho, Gil Jae Lee, Byungchul Yu, Kang Kook Choi
J Trauma Inj. 2022;35(Suppl 1):S18-S22.   Published online June 17, 2022
DOI: https://doi.org/10.20408/jti.2021.0091
  • 1,594 View
  • 48 Download
AbstractAbstract PDF
There are many reasons for solitary kidney. Congenital causes include renal agenesis and dysplasia. Acquired causes include nephrectomy performed for reasons including traumatic kidney injury, disease (e.g., renal cell carcinoma), and donation for kidney transplantation. According to the European Association of Urology, the World Society of Emergency Surgery, and the American Association for the Surgery of Trauma guidelines, it is important to preserve the remaining renal function as much as possible when a solitary kidney patient has suffered a traumatic kidney injury. The authors present a case of kidney preservation in a solitary kidney patient with a traumatic grade IV renal injury through non-operative management involving superselective renal artery angioembolization.
Summary
Major Causes of Preventable Death in Trauma Patients
Youngeun Park, Gil Jae Lee, Min A Lee, Kang Kook Choi, Jihun Gwak, Sung Youl Hyun, Yang Bin Jeon, Yong-Cheol Yoon, Jungnam Lee, Byungchul Yu
J Trauma Inj. 2021;34(4):225-232.   Published online July 29, 2021
DOI: https://doi.org/10.20408/jti.2020.0074
  • 7,843 View
  • 207 Download
  • 12 Citations
AbstractAbstract PDF
Purpose

Trauma is the top cause of death in people under 45 years of age. Deaths from severe trauma can have a negative economic impact due to the loss of people belonging to socio-economically active age groups. Therefore, efforts to reduce the mortality rate of trauma patients are essential. The purpose of this study was to investigate preventable mortality in trauma patients and to identify factors and healthcare-related challenges affecting mortality. Ultimately, these findings will help to improve the quality of trauma care.

Methods

We analyzed the deaths of 411 severe trauma patients who presented to Gachon University Gil Hospital regional trauma center in South Korea from January 2015 to December 2017, using an expert panel review.

Results

The preventable death rate of trauma patients treated at the Gachon University Gil Hospital regional trauma center was 8.0%. Of these, definitely preventable deaths comprised 0.5% and potentially preventable deaths 7.5%. The leading cause of death in trauma patients was traumatic brain injury. Treatment errors most commonly occurred in the intensive care unit (ICU). The most frequent management error was delayed treatment of bleeding.

Conclusions

Most errors in the treatment of trauma patients occurred in early stages of the treatment process and in the ICU. By identifying the main causes of preventable death and errors during the course of treatment, our research will help to reduce the preventable death rate. Appropriate trauma care systems and ongoing education are also needed to reduce preventable deaths from trauma.

Summary

Citations

Citations to this article as recorded by  
  • Effects of Transport to Trauma Centers on Survival Outcomes Among Severe Trauma Patients in Korea: Nationwide Age-Stratified Analysis
    Hakrim Kim, Kyoung Jun Song, Ki Jeong Hong, Jeong Ho Park, Tae Han Kim, Stephen Gyung Won Lee
    Journal of Korean Medical Science.2024;[Epub]     CrossRef
  • TiME OUT: Time-specific machine-learning evaluation to optimize ultramassive transfusion
    Courtney H. Meyer, Jonathan Nguyen, Andrew ElHabr, Nethra Venkatayogi, Tyler Steed, Judy Gichoya, Jason D. Sciarretta, James Sikora, Christopher Dente, John Lyons, Craig M. Coopersmith, Crystal Nguyen, Randi N. Smith
    Journal of Trauma and Acute Care Surgery.2024; 96(3): 443.     CrossRef
  • Analysis of mortality over 7 years in a mature trauma center: evolution of preventable mortality in severe trauma patients
    Sarah Guigues, Jean Cotte, Jean-Baptiste Morvan, Henry de Lesquen, Bertrand Prunet, Mathieu Boutonnet, Nicolas Libert, Pierre Pasquier, Eric Meaudre, Julien Bordes, Michael Cardinale
    European Journal of Trauma and Emergency Surgery.2023; 49(3): 1425.     CrossRef
  • Incidence and predictors of mortality among adult trauma patients admitted to the intensive care units of comprehensive specialized hospitals in Northwest Ethiopia
    Mengistu Abebe Messelu, Ambaye Dejen Tilahun, Zerko Wako Beko, Hussien Endris, Asnake Gashaw Belayneh, Getayeneh Antehunegn Tesema
    European Journal of Medical Research.2023;[Epub]     CrossRef
  • Characteristics and Clinical Outcomes of Elderly Patients with Trauma Treated in a Local Trauma Center
    Kwanhoon Park, Geonjae Cho, Sungho Lee, Kang Yoon Lee, Ji Young Jang
    Journal of Acute Care Surgery.2023; 13(1): 13.     CrossRef
  • An Artificial Intelligence Model for Predicting Trauma Mortality Among Emergency Department Patients in South Korea: Retrospective Cohort Study
    Seungseok Lee, Wu Seong Kang, Do Wan Kim, Sang Hyun Seo, Joongsuck Kim, Soon Tak Jeong, Dong Keon Yon, Jinseok Lee
    Journal of Medical Internet Research.2023; 25: e49283.     CrossRef
  • Preventable Death Rate of Trauma Patients in a Non-Regional Trauma Center
    Kwanhoon Park, Wooram Choi, Sungho Lee, Kang Yoon Lee, Dongbeen Choi, Han-Gil Yoon, Ji Young Jang
    Journal of Acute Care Surgery.2023; 13(3): 118.     CrossRef
  • Nine year in-hospital mortality trends in a high-flow level one trauma center in Italy
    Elisa Reitano, Roberto Bini, Margherita Difino, Osvaldo Chiara, Stefania Cimbanassi
    Updates in Surgery.2022; 74(4): 1445.     CrossRef
  • Decision support by machine learning systems for acute management of severely injured patients: A systematic review
    David Baur, Tobias Gehlen, Julian Scherer, David Alexander Back, Serafeim Tsitsilonis, Koroush Kabir, Georg Osterhoff
    Frontiers in Surgery.2022;[Epub]     CrossRef
  • Flat Inferior Vena Cava on Computed Tomography for Predicting Shock and Mortality in Trauma: A Meta-Analysis
    Do Wan Kim, Hee Seon Yoo, Wu Seong Kang
    Diagnostics.2022; 12(12): 2972.     CrossRef
  • Model for Predicting In-Hospital Mortality of Physical Trauma Patients Using Artificial Intelligence Techniques: Nationwide Population-Based Study in Korea
    Seungseok Lee, Wu Seong Kang, Sanghyun Seo, Do Wan Kim, Hoon Ko, Joongsuck Kim, Seonghwa Lee, Jinseok Lee
    Journal of Medical Internet Research.2022; 24(12): e43757.     CrossRef
  • Thoracic injuries in trauma patients: epidemiology and its influence on mortality
    Andrea Lundin, Shahzad K. Akram, Lena Berg, Katarina E. Göransson, Anders Enocson
    Scandinavian Journal of Trauma, Resuscitation and .2022;[Epub]     CrossRef
Management of Traumatic Pancreatic Injuries: Evaluation of 7 Years of Experience at a Single Regional Trauma Center
Min A Lee, Seung Hwan Lee, Kang Kook Choi, Youngeun Park, Gil Jae Lee, Byungchul Yu
J Trauma Inj. 2021;34(3):177-182.   Published online September 30, 2021
DOI: https://doi.org/10.20408/jti.2021.0070
  • 2,606 View
  • 86 Download
AbstractAbstract PDF
Purpose

Traumatic pancreatic injuries are rare, but their diagnosis and management are challenging. The aim of this study was to evaluate and report our experiences with the management of pancreatic injuries.

Methods

We identified all adult patients (age >15) with pancreatic injuries from our trauma registry over a 7-year period. Data related to patients’ demographics, diagnoses, operative information, complications, and hospital course were abstracted from the registry and medical records.

Results

A total of 45 patients were evaluated. Most patients had blunt trauma (89%) and 21 patients (47%) had pancreatic injuries of grade 3 or higher. Twenty-eight patients (62%) underwent laparotomy and 17 (38%) received nonoperative management (NOM). The overall in-hospital mortality rate was 24% (n=11), and only one patient died after NOM (due to a severe traumatic brain injury). Twenty-two patients (79%) underwent emergency laparotomy and six (21%) underwent delayed laparotomy. A drainage procedure was performed in 12 patients (43%), and pancreatectomy was performed in 16 patients (57%) (distal pancreatectomy [DP], n=8; DP with spleen preservation, n=5; pancreaticoduodenectomy, n=2; total pancreatectomy, n=1). Fourteen (31%) pancreas-specific complications occurred, and all complications were successfully managed without surgery. Solid organ injuries (n=14) were the most common type of associated abdominal injury (Abbreviated Injury Scale ≥3).

Conclusions

For traumatic pancreatic injuries, an appropriate treatment method should be considered after evaluation of the accompanying injury and the patient’s hemodynamic status. NOM can be performed without mortality in appropriately selected cases.

Summary
Part 4. Clinical Practice Guideline for Surveillance and Imaging Studies of Trauma Patients in the Trauma Bay from the Korean Society of Traumatology
Sung Wook Chang, Kang Kook Choi, O Hyun Kim, Maru Kim, Gil Jae Lee
J Trauma Inj. 2020;33(4):207-218.   Published online December 31, 2020
DOI: https://doi.org/10.20408/jti.2020.0084
  • 3,233 View
  • 87 Download
AbstractAbstract PDF

The following recommendations are presented herein: All trauma patients admitted to the resuscitation room should be constantly (or periodically) monitored for parameters such as blood pressure, heart rate, respiratory rate, oxygen saturation, body temperature, electrocardiography, Glasgow Coma Scale, and pupil reflex (1C). Chest AP and pelvic AP should be performed as the standard initial trauma series for severe trauma patients (1B). In patients with severe hemodynamically unstable trauma, it is recommended to perform extended focused assessment with sonography for trauma (eFAST) as an initial examination (1B). In hemodynamically stable trauma patients, eFAST can be considered as the initial examination (2B). For the diagnosis of suspected head trauma patients, brain computed tomography (CT) should be performed as an initial examination (1B). Cervical spine CT should be performed as an initial imaging test for patients with suspected cervical spine injury (1C). It is not necessary to perform chest CT as an initial examination in all patients with suspected chest injury, but in cases of suspected vascular injury in patients with thoracic or high-energy damage due to the mechanism of injury, chest CT can be considered for patients in a hemodynamically stable condition (2B). CT of the abdomen is recommended for patients suspected of abdominal trauma with stable vital signs (1B). CT of the abdomen should be considered for suspected pelvic trauma patients with stable vital signs (2B). Whole-body CT can be considered in patients with suspicion of severe trauma with stable vital signs (2B). Magnetic resonance imaging can be considered in hemodynamically stable trauma patients with suspected spinal cord injuries (2B).

Summary
Part 3. Clinical Practice Guideline for Airway Management and Emergency Thoracotomy for Trauma Patients from the Korean Society of Traumatology
Chan Yong Park, O Hyun Kim, Sung Wook Chang, Kang Kook Choi, Kyung Hak Lee, Seong Yup Kim, Maru Kim, Gil Jae Lee
J Trauma Inj. 2020;33(3):195-203.   Published online September 30, 2020
DOI: https://doi.org/10.20408/jti.2020.0050
  • 10,081 View
  • 180 Download
AbstractAbstract PDF

The following key questions and recommendations are presented herein: when is airway intubation initiated in severe trauma? Airway intubation must be initiated in severe trauma patients with a GCS of 8 or lower (1B). Should rapid sequence intubation (RSI) be performed in trauma patients? RSI should be performed in trauma patients to secure the airway unless it is determined that securing the airway will be problematic (1B). What should be used as an induction drug for airway intubation? Ketamine or etomidate can be used as a sedative induction drug when RSI is being performed in a trauma patient (2B). If cervical spine damage is suspected, how is cervical protection achieved during airway intubation? When intubating a patient with a cervical spine injury, the extraction collar can be temporarily removed while the neck is fixed and protected manually (1C). What alternative method should be used if securing the airway fails more than three times? If three or more attempts to intubate the airway fail, other methods should be considered to secure the airway (1B). Should trauma patients maintain normal ventilation after intubation? It is recommended that trauma patients who have undergone airway intubation maintain normal ventilation rather than hyperventilation or hypoventilation (1C). When should resuscitative thoracotomy be considered for trauma patients? Resuscitative thoracotomy is recommended for trauma patients with penetrating injuries undergoing cardiac arrest or shock in the emergency room (1B).

Summary
Case Series of Zone III Resuscitative Endovascular Balloon Occlusion of the Aorta in Traumatic Shock Patients
Byungchul Yu, Gil Jae Lee, Kang Kook Choi, Min A Lee, Jihun Gwak, Youngeun Park, Jung Nam Lee
J Trauma Inj. 2020;33(3):162-169.   Published online September 30, 2020
DOI: https://doi.org/10.20408/jti.2020.0031
  • 3,546 View
  • 67 Download
AbstractAbstract PDF
Purpose

There is increasing evidence in the literature regarding resuscitative endovascular balloon occlusion of the aorta (REBOA) globally, but few cases have been reported in Korea. We aimed to describe our experience of successful Zone III REBOA and to discuss its algorithm, techniques, and related complications.

Methods

We reviewed consecutive cases who survived from hypovolemic shock after Zone III REBOA placement for 4 years. We reviewed patients’ baseline characteristics, physiological status, procedural data, and outcomes.

Results

REBOA was performed in 44 patients during the study period, including 10 patients (22.7%) who underwent Zone III REBOA, of whom seven (70%) survived. Only one patient was injured by a penetrating mechanism and survived after cardiopulmonary resuscitation. All patients underwent interventions to stop bleeding immediately after REBOA placement.

Conclusions

This case series suggests that Zone III REBOA is a safe and feasible procedure that could be applied to traumatic shock patients with normal FAST findings who receive a chest X-ray examination at the initial resuscitation.

Summary
The Suitability of the CdC field Triage for Korean Trauma Care
Kang Kook Choi, Myung Jin Jang, Min A Lee, Gil Jae Lee, Byungchul Yoo, Youngeun Park, Jung Nam Lee
J Trauma Inj. 2020;33(1):13-17.   Published online March 30, 2020
DOI: https://doi.org/10.20408/jti.2020.013
  • 5,063 View
  • 117 Download
  • 3 Citations
AbstractAbstract PDF
Purpose

Accurate and appropriate prehospital field triage is essential for a trauma system. The Korean trauma system (established in 2014) uses the trauma field triage algorithm of the United States Centers for Disease Control and Prevention (CDC). This study evaluated the suitability of the CDC field triage criteria for major trauma cases (injury severity score >15) in Korea.

Methods

This retrospective cohort study evaluated trauma patients who presented at the authors’ regional trauma center from January 1 to May 7, 2017. The undertriage and overtriage rates of each CDC field triage step were calculated. Receiver operating characteristic curves were constructed, and the area under the curve (AUC) was evaluated for each step.

Results

Among the 1,009 enrolled patients, 168 (16.7%) had major trauma. The undertriage/overtriage rates of each step (steps I, II, III, and IV) of CDC field triage were 9.2%/47.4%, 6.3%/50.8%, 4.5%/59.4%, and 5.3%/78.9%, respectively. The AUC values of each CDC triage step were 0.722, 0.783, 0.791, and 0.615, respectively. The AUC values of the separate components of each step (physiologic criteria, anatomic criteria, mechanism-of-injury criteria, and special considerations) were 0.722, 0.648, 0.647, and 0.456, respectively.

Conclusions

The CDC field triage system is acceptable, but not ideal, for Korean trauma care. If we follow the protocol, it would be preferable to omit step IV. The Korean Triage and Acuity Scale may be a good indicator for in-hospital triage. However, a new triage protocol that is simple to estimate on-scene while having good performance should be developed.

Summary

Citations

Citations to this article as recorded by  
  • Effects of Transport to Trauma Centers on Survival Outcomes Among Severe Trauma Patients in Korea: Nationwide Age-Stratified Analysis
    Hakrim Kim, Kyoung Jun Song, Ki Jeong Hong, Jeong Ho Park, Tae Han Kim, Stephen Gyung Won Lee
    Journal of Korean Medical Science.2024;[Epub]     CrossRef
  • Prehospital triage in emergency medical services system: A scoping review
    Kisook Kim, Booyoung Oh
    International Emergency Nursing.2023; 69: 101293.     CrossRef
  • 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
Immediate Post-laparotomy Hypotension in Patients with Severe Traumatic Hemoperitoneum
Gil Jae Lee, Min A Lee, Byungchul Yoo, Youngeun Park, Myung Jin Jang, Kang Kook Choi
J Trauma Inj. 2020;33(1):38-42.   Published online March 30, 2020
DOI: https://doi.org/10.20408/jti.2020.014
  • 6,714 View
  • 122 Download
AbstractAbstract PDF
Purpose

Immediate post-laparotomy hypotension (PLH) is a precipitous drop in blood pressure caused by a sudden release of abdominal tamponade after laparotomy in cases of severe hemoperitoneum. The effect of laparotomy on blood pressure in patients with significant hemoperitoneum is unknown.

Methods

In total, 163 patients underwent laparotomy for trauma from January 1, 2013 to December 31, 2015. Exclusion criteria included the following: negative laparotomy, only a hollow viscous injury, and hemoperitoneum <1,000 mL. After applying those criteria, 62 patients were enrolled in this retrospective review. PLH was defined as a decrease in the mean arterial pressure (MAP) ≥10 mmHg within 10 minutes after laparotomy.

Results

The mean estimated hemoperitoneum was 3,516 mL. The incidence of PLH was 23% (14 of 62 patients). The MAP did not show significant differences before and after laparotomy (5 minutes post-laparotomy, 67.5±16.5 vs. 68.3±18.8 mmHg; p=0.7; 10 minutes post-laparotomy, 67.5±16.5 vs. 70.4±18.8 mmHg; p=0.193). The overall in-hospital mortality was 24% (15 of 62 patients). Mortality was not significantly higher in the PLH group (two of 14 [14.3%] vs. 13 of 48 [27.1%]; p=0.33). No statistically significant between-group differences were observed in the intensive care unit and hospital stay.

Conclusions

PLH may be less frequent and less devastating than it is often considered. Surgical hemostasis during laparotomy is important. Laparotomy with adequate resuscitation may explain the equivalent outcomes in the two groups.

Summary
Correlation between Optic Nerve Sheath Diameter Measured by Computed Tomography and Elevated Intracranial Pressure in Patients with Traumatic Brain Injury
Tae Kyoo Lim, Byug Chul Yu, Dae Sung Ma, Gil Jae Lee, Min A Lee, Sung Yeol Hyun, Yang Bin Jeon, Kang Kook Choi
J Trauma Inj. 2017;30(4):140-144.   Published online December 30, 2017
DOI: https://doi.org/10.20408/jti.2017.30.4.140
  • 5,009 View
  • 119 Download
  • 6 Citations
AbstractAbstract PDF
Purpose

The optic nerve sheath diameter (ONSD) measured by ultrasonography is among the indicators of intracranial pressure (ICP) elevation. However, whether ONSD measurement is useful for initial treatment remains controversial. Thus, this study aimed to investigate the relationship between ONSD measured by computed tomography (CT) and ICP in patients with traumatic brain injury (TBI).

Methods

A total of 246 patients with severe trauma from January 1, 2015 until December 31, 2015 were included in the study. A total of 179 patients with brain damage with potential for ICP elevation were included in the TBI group. The remaining 67 patients comprised the non-TBI group. A comparison was made between the two groups. Receiver operating characteristic (ROC) curve analysis was performed to determine the accuracy of ONSD when used as a screening test for the TBI group including those with TBI with midline shift (with elevated ICP).

Results

The mean injury severity score (ISS) and glasgow coma scale (GCS) of all patients were 24.2±6.1 and 5.4±0.8, respectively. The mean ONSD of the TBI group (5.5±1.0 mm) was higher than that of the non-TBI group (4.7±0.6 mm). Some significant differences in age (55.3±18.1 vs. 49.0±14.8, p<0.001), GCS (11.7±4.1 versus 13.3±3.0, p<0.001), and ONSD (5.5±1.0 vs. 4.7±0.6, p<0.001) were observed between the TBI and the non-TBI group. An ROC analysis was used to assess the correlation between TBI and ONSD. Results showed an area under the ROC curve (AUC) value of 0.752. The same analysis was used in the TBI with midline shift group, which showed an AUC of 0.912.

Conclusions

An ONSD of >5.5 mm, measured on CT, is a good indicator of ICP elevation. However, since an ONSD is not sensitive enough to detect an increased ICP, it should only be used as one of the parameters in detecting ICP along with other screening tests.

Summary

Citations

Citations to this article as recorded by  
  • Correlation Between Optic Nerve Sheath Diameter at Initial Head CT and the Rotterdam CT Score
    Aletor O Amakhian, Elohor B Obi-Egbedi-Ejakpovi, Eghosa Morgan, Ademola A Adeyekun, Munir M Abubakar
    Cureus.2023;[Epub]     CrossRef
  • Sono-clinical decision rule for repeat head computed tomography scan in traumatic brain injury in emergency settings
    Priyanka Modi, Sanjeev Bhoi, Savan Pandey
    WFUMB Ultrasound Open.2023; 1(2): 100026.     CrossRef
  • Sonographic Measurement of the Optic Nerve Sheath Diameter to Improve Detection of Elevated Intracranial Pressure
    Faten Farid Awdallah, Islam Hassan Abulnaga, Suzy Fawzy Michael, Hassan Khaled Nagi, Mohamed Hosny Abdallah
    Biomedical and Pharmacology Journal.2022; 15(3): 1677.     CrossRef
  • Serial Optic Nerve Sheath Diameter via Radiographic Imaging
    Diane McLaughlin, Lisa Anderson, Jinhong Guo, Molly McNett
    Neurology Clinical Practice.2021;[Epub]     CrossRef
  • The association between intracranial pressure and optic nerve sheath diameter on patients with head trauma
    Kaan Çelik, Bekir Enes Demiryurek
    Arquivos de Neuro-Psiquiatria.2021; 79(10): 879.     CrossRef
  • MRI measurement of optic nerve sheath diameter using 3D driven equilibrium sequence as a non-invasive tool for the diagnosis of idiopathic intracranial hypertension
    Ahmed S. Abdelrahman, Mai M. K. Barakat
    Egyptian Journal of Radiology and Nuclear Medicine.2020;[Epub]     CrossRef

J Trauma Inj : Journal of Trauma and Injury