This study was conducted to investigate the usefulness of a polyester urethane dural substitute (Neuro-Patch^®, B. Braun, Boulogne, France) as an anti-adhesion agent in subsequent cranioplasty by analyzing the use of Neuro-Patch^® during decompressive craniectomy in traumatic brain injury patients.

We retrospectively analyzed patients with traumatic brain injury who underwent decompressive craniectomy followed by cranioplasty from January 2015 to December 2018. Patients were analyzed according to whether they received treatment with Neuro-Patch^® or not (Neuro-Patch^® group, n=71; control group, n=55). Patients’ baseline characteristics were analyzed to identify factors that could affect cranioplasty results, including age, sex, hypertension, diabetes mellitus, use of antiplatelet agents or anticoagulant medication, the interval between craniectomy and cranioplasty, and the type of bone used in cranioplasty. The cranioplasty results were analyzed according to the following factors: operation time, blood loss, postoperative hospitalization period, surgical site infection, and revision surgery due to extra-axial hematoma.

No significant difference was found between the two groups regarding patients’ baseline characteristics. For the cranioplasty procedures, the operation time (155 vs. 190 minutes, p=0.003), intraoperative blood loss (350 vs. 450 mL, p=0.012), and number of surgical site infections (4 vs. 11 cases, p=0.024) were significantly lower in the Neuro-Patch^® group than in the control group.

The use of Neuro-Patch^® was associated with a shorter operation time, less blood loss, and a lower number of surgical site infections in subsequent cranioplasties. These results may provide a rationale for prospective studies investigating the efficacy of Neuro-Patch^®.

Mechanical ventilation (MV) is an essential life-saving modality for severely injured patients. However, the long-term use of MV is a major risk factor for late mortality. The surgical correction of long bone fractures plays a critical role not only in improving functional outcomes, but also in reducing physiological derangements, including MV duration. This study investigated the factors affecting prolonged MV (PMV) in severely injured patients with femur fractures.

We retrospectively evaluated all severely injured patients (injury severity score >15) with femur fractures who were taken to the emergency department within 12 hours of the causative accidents between January 2016 and December 2018. PMV was defined as MV lasting for ≥7 days. We analyzed the factors affecting PMV.

In total, 35 patients were enrolled and 21 (33.3%) were included in the PMV group. The PMV group required more red blood cell (RBC) transfusions within 7 days RBC (7dRBC) (12.8 vs. 6.8 units; p=0.03) and the time to femur fracture fixation (TFFF) was longer (7.9 vs. 2.7 days; p=0.018). The area under the curve (AUC) for TFFF was 0.740 (95% confidence interval [CI]: 0.572–0.908; p=0.018) and the AUC for 7dRBC was 0.718 (95% CI: 0.546–0.889; p=0.031).

This study indicates that TFFF is an independent risk factor for PMV. Early fixation of femur fractures might prevent PMV and its associated complications.

This study investigated the characteristics of adult patients who had fallen from a height and presented to an emergency room (ER) according to gender and intentionality, with the goal of reducing the harm caused by these injuries.

A retrospective analysis was conducted of fall-from-height patients aged ≥19 years from the in-depth surveillance study of injured patients visiting ERs conducted under the supervision of the Korea Centers for Disease Control and Prevention from 2011 to 2016. Patterns were analyzed according to gender and intentionality.

There were 29,838 men (68.5%) and 13,734 women (31.5%), with mean ages of 50.3±15.7 years and 57.2±19.9 years, respectively. The most common height of the fall was ≥1 m to 4 m in men (n=15,863; 53.2%) and <1 m in women (n=7,293; 53.1%). The most common location where the fall occurred was the workplace for men (n=10,500 male; 35.2%) and residential facilities for women (n=7,755; 56.5%). Most falls from height were unintentional (n=41,765; 97.1% vs. n=1,264; 2.9% for intentional falls). Suicide was the most frequent reason for intentional falls, and the age group of 19–30 years predominated in this category (n=377; 29.9%). For intentional falls, the most common interval before presentation to the ER was 0–6 hours (n=370; 29.3%) and the most common height was ≥4 m (n=872; 69.0%).

Among men, falls from height most often occurred from ≥1 m to 4 m, at the workplace, and during the course of paid work, whereas among women, they were most common from <1 m, in residential facilities, and during daily activities. Intentional falls most often occurred with the purpose of suicide, in the age group of 19–30 years, with an interval of 0–6 hours until treatment, from ≥4 m, and in residential facilities. Alcohol consumption was more common in intentional falls.

No previous study has assessed elderly pedestrian traffic accidents based on a nationwide database. This study aimed to help primary physicians who examine patients in emergency departments to determine and make prompt and accurate treatment decisions.

This study used data from the Emergency Department-based Injury In-depth Surveillance from 2013 to 2017, managed by the Korea Centers for Disease Control and Prevention. Pedestrians aged ≥65 years were included, and using multivariate logistic regression multiple factors were analyzed to determine their relationship with injury severity.

Of 227,695 subjects, 6,498 were included, of whom 2,065 (31.8%) were severely injured. There were more female than male patients in all severity groups. Most accidents occurred in the afternoon and on general roads. In the multivariate analysis, the odds ratio (OR) of injury severity for male pedestrians was 1.165 (95% confidence interval: 1.034?1.313, p=0.012). Older age of patients and the use of ambulances were associated with greater injury severity. The accident time affected the degree of injury severity; i.e., compared to dawn, injury severity increased in the morning (OR: 1.246, p=0.047) and decreased at night (OR: 0.678, p<0.001). A significant difference was noted in the correlation between the type of vehicle causing the accident and the accident severity; i.e., motorcycle accidents had lower severity than bicycle accidents (OR: 0.582, p=0.047).

Injury severity was correlated with sex, age, transportation to the ED, TA onset time, and type of vehicle. The study results suggest that injury severity may be positively reflected in initial assessments and overall integrated treatments by physicians and in the related policies.

This study was conducted to status and needs for continuing education for trauma hospital nurses in Korea.

Thirty nurses from the seven level I trauma center hospitals or trauma treatment systems were randomly selected and surveyed. The survey was conducted from March 1 to May 31, 2017. Categorical data were analyzed with Pearson chi-square tests and Continuous variables were analyzed with ANOVA.

Only 86 out of 204 nurses had received continuing education (42.1%). The current status of continuing education programs, delivering institution (p<0.001), education method (p<0.001), education period (p=0.003), number of participants (p=0.007), and instructors (p=0.014) were also significantly different from trauma center to trauma center. There were 108 (52.9%) nurses who responded that continuing education programs were “needed” 92 (45.1%) and “very much needed 16 (7.8%). According to each trauma center’s characteristics were significantly differences in the need for continuing education (p=0.089), subject selection method (p<0.001) and the number of continuing education sessions (p=0.043) depending on the hospital.

It is necessary to consider differences between the hospitals to develop continuing education programs that reflect the needs of nurses, in order to improve the efficiency of and satisfaction with the educational programs.

To determine whether a peripherally inserted central catheter (PICC) meets the goals of a low infection rate and long-term use in trauma patients.

From January 2016 to June 2018, the medical records of patients who underwent central venous catheterization at a level I trauma center were retrospectively reviewed. Data collected included age, sex, injury severity score, site of catheterization, place of catheterization (intensive care unit [ICU], emergency department, or general ward), type of catheter, length of hospital stay during catheterization, types of cultured bacteria, time to development of central line-associated bloodstream infection (CLABSI), and complications.

During the study period, 333 central vein catheters (CVC) were inserted with a total of 2,626 catheter-days and 97 PICCs were placed with a total of 2,227 catheter-days. The CLABSI rate was significantly lower in the PICC group when the analysis was limited to patients for whom the catheter was changed for the first time in the ICU after CVC insertion in the ER with similar indication and catheter insertion times (18.6 vs. 10.3/1,000 catheter-days, respectively, p<0.05). The median duration of catheter use was significantly longer in the PICC group than in the CVC group (16 vs. 6 days, respectively, p<0.05).

The study results showed that the duration of catheter use was longer and the infection rate were lower in the PICC group than in the CVC group, suggesting that PICC is a safe and reliable alternative to conventional CVC.

Near drowning refers to immediate survival after asphyxia due to submersion or immersion in water, which is a crucial public safety problem worldwide. Acute lung injury or acute respiratory distress syndrome (ARDS) is a common complication of near drowning. The purpose of this study was to investigate the feasibility and effectiveness of noninvasive nasal positive pressure ventilation (NINPPV).

This retrospective study was conducted at a tertiary emergency department. NINPPV was administered for moderate ARDS caused by submersion or immersion in patients who were older than 18 years, from January 2015 to December 2018. We collected the demographic (age, sex, length of hospital stay, and outcome), laboratory (arterial blood gas, lactate, oxygen saturation, partial pressure of oxygen divided by the fraction of inspired oxygen, complete blood count, blood urea nitrogen, and creatinine), and clinical data (acute lung injury index and ventilator failure) of the patients. A statistical analysis was performed using Statistical Package for the Social Sciences version 20.0 for Windows.

NINPPV treatment was provided to 57 patients for near drowning, 45 of whom (78.9%) were successfully treated without complications; in 12 (21.1%), treatment was changed to invasive mechanical ventilation within 48 hours due to ARDS or acute kidney injury. NINPPV treatment was successful in 31 (75.6%) out of 41 sea-water near drowning patients. They were more difficult to treat with NINPPV compared with the fresh-water near drowning patients (p<0.05).

NINPPV would be useful and feasible as the initial treatment of moderate ARDS caused by near drowning.

This study was to investigate errors of death certificate (DC) issued for patients with trauma.

A retrospective review for DC issued after death related to trauma at a training hospital trauma center was conducted. Errors on DC were classified into major and minor errors depending on their influence on the process of selecting the cause of death (COD). All errors were compared depending on the place of issue of DC, medical doctors who wrote the DC, and the number of lines filled up for COD of DC.

Of a total 140 DCs, average numbers of major and minor errors per DC were 0.8 and 3.7, respectively. There were a total of 2.8 errors for DCs issued at the emergency department (ED) and 5.4 errors for DCs issued beyond ED. The most common major error was more than one COD on a single line for DCs issued at the ED and incompatible casual relation between CODs for DCs issued beyond ED. The number of major errors was 0.5 for emergency physician and 0.8 for trauma surgeon and neurosurgeon. Total errors by the number of lines filled up for COD were the smallest (3.1) for two lines and the largest (6.0) for four lines.

Numbers of total errors and major errors on DCs related to trauma only were 4 and 0.8, respectively. As more CODs were written, more errors were found.