Journal of Trauma and Injury

Characteristics and Outcomes of Trauma Patients via Emergency Medical Services: Dae Hyun Cho, Jae Gil Lee; J Trauma Inj. 2017;30(4):120-125. Published online December 30, 2017; DOI: https://doi.org/10.20408/jti.2017.30.4.120

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Abstract PDF: Purpose
The aim of this study was to identify clinical outcome and characteristics of trauma patients via emergency medical services (EMS).
Methods
Medical records of the trauma patients visiting the emergency department were retrospectively collected and analyzed from January 2015 to June 2016 in the single institution. Of 529 registered patients, 371 patients were transported by - were enrolled. The parameters including age, gender, injury mechanism, Glasgow coma scale on arrival, presence of shock (systemic blood pressure <90 mmHg) on arrival, time to arrival from accident to emergency room (ER), need for emergency procedures such as operation or angioembolization, need for intensive care unit (ICU) admission, injury severity score (ISS), the trauma and injury severity score, revised trauma score (RTS), length of stay, and mortality rate were collected. The SAS version 9.4 (SAS Institute, Cary, NC, USA) was used for the data analysis.
Results
Arrival time from the field to the ER was significantly shorter in EMS group. However, overall outcomes including mortalities, length of stay in the ICU and hospital were same between both groups. Age, ISS, RTS, and injury mechanisms were significantly different in both groups. ISS, RTS, and age showed significant influence on mortality statistically (p<0.05).
Conclusions
The time to arrival of EMS was fast but had no effect on length of hospital stay, mortality rate. Further research that incorporates pre-hospital factors influence clinical outcomes should be conducted to evaluate the effectiveness of such a system in trauma care of Korea.; Summary

Quality Improvement in the Trauma Intensive Care Unit Using a Rounding Checklist: The Implementation Results: Ye Rim Chang, Sung Wook Chang, Dong Hun Kim, Jeongseok Yun, Jung Ho Yun, Seok Won Lee, Han Cheol Jo, Seok Ho Choi; J Trauma Inj. 2017;30(4):113-119. Published online December 30, 2017; DOI: https://doi.org/10.20408/jti.2017.30.4.113

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Abstract PDF: Purpose
Despite the numerous protocols and evidence-based guidelines that have been published, application of the therapeutics to eligible patients is limited in clinical settings. Therefore, a rounding checklist was developed to reduce errors of omission and the implementation results were evaluated.
Methods
A checklist consisting of 12 components (feeding, analgesia, sedation, thromboembolic prophylaxis, head elevation, stress ulcer prevention, glucose control, pressure sore prevention, removal of catheter, endotracheal tube and respiration, delirium monitoring, and infection control) was recorded by assigned nurses and then scored by the staff for traumatized, critically ill patients who were admitted in the trauma intensive care unit (ICU) of Dankook University Hospital for more than 2 days. A total of 170 patients (950 sheets) between April and October 2016 were divided into 3 periods (period 1, April to June; period 2, July to August; and period 3, September to October) for the analysis. Questionnaires regarding the satisfaction of the nurses were conducted twice during this implementation period.
Results
Record omission rates decreased across periods 1, 2, and 3 (19.9%, 12.7%, and 4.2%, respectively). The overall clinical application rate of the checklist increased from 90.1% in period 1 to 93.8% in period 3. Among 776 (81.7%) scored sheets, the rates of full compliance were 30.2%, 46.2%, and 45.1% for periods 1, 2, and 3, respectively. The overall mean score of the questionnaire regarding satisfaction also increased from 61.7 to 67.6 points out of 100 points from period 1 to 3.
Conclusions
An ICU rounding checklist could be an effective tool for minimizing the omission of preventative measures and evidence-based therapy for traumatized, critically-ill patients without overburdening nurses. The clinical outcomes of the ICU checklist will be evaluated and reported at an early date.; Summary

A Successful Evacuation of Vertex Epidural Hematoma; A Case Report: Jang Hun Kim, Haewon Roh, Jong Hyun Kim, Taek Hyun Kwon; J Trauma Inj. 2017;30(3):98-102. Published online October 30, 2017; DOI: https://doi.org/10.20408/jti.2017.30.3.98

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Abstract PDF: Vertex epidural hematoma (VEH) is an uncommon presentation of all epidural hematomas and presents with a wide range of symptom and signs. Diagnosis as well as treatment of VEH is also difficult because of its location adjacent to superior sagittal sinus (SSS). A 43-year-old male visited our hospital after fall down and was diagnosed with VEH. While evaluating its location and patency of SSS, he was deteriorated and urgently underwent evacuation of VEH. Bilateral craniotomies on each side, leaving a central bony island to avoid bleeding of midline structure and provide an anchor for dural tack-ups. After the operation, VEH was totally removed and the patient has restored.; Summary

Treatment Option for High Grade Spleen Injury and Predictive Factors for Non-operative Management: Joung Won Na, Jung Nam Lee, Byung Chul Yu, Min A Lee, Jae Jung Park, Gil Jae Lee; J Trauma Inj. 2017;30(3):91-97. Published online October 30, 2017; DOI: https://doi.org/10.20408/jti.2017.30.3.91

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Abstract PDF: PURPOSE
The prognostic factors of non-operative management (NOM) in high-grade spleen injuries have been extensively studied, but factors that would help treatment decisions are lacking. We compared the characteristics of the patients to identify the factors affecting treatment choices.
METHODS
This is a review of 207 blunt spleen injury patients from January 2004 to December 2013. We compared clinical features and mortality between surgery and NOM, and used multivariate regression analysis to find the factor most strongly associated with prognosis.
RESULTS
Of the 207 patients, 107 had high-grade spleen injury patents (grade III or above). Of these, 42 patients underwent surgery and 65 patients underwent NOM. The mortality was 7% following surgery, 3% with NOM. The amount of packed red blood cells transfused in the first 24 hours and spleen injury grade were associated with management type, and mortality was highly associated with activated partial thromboplastin time (aPTT) and spleen injury grade.
CONCLUSIONS
The grade of spleen injury was associated with management and mortality, so correctly assessing the spleen injury grade is important.; Summary

Experiences of Video-assisted Thoracic Surgery in Trauma: Dongsub Noh, Chan kyu Lee, Jung Joo Hwang, Hyun Min Cho; J Trauma Inj. 2017;30(3):87-90. Published online October 30, 2017; DOI: https://doi.org/10.20408/jti.2017.30.3.87

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Abstract PDF: PURPOSE
Nowadays, Video-Assisted Thoracic Surgery (VATS) is widely used for its benefits, low post-operative pain, excellent anesthetic result and complete visualization of intrathoracic organs. Despite of these advantages, VATS has not yet been widely used in trauma patients. In this study, we aimed to investigate the usefulness of VATS in the chest trauma area.
METHODS
From January 2016 to December 2016, 203 patients underwent surgical treatment for chest trauma. Their medical records were analyzed retrospectively.
RESULTS
Eleven patients underwent thoracic surgery by VATS. Six patients were unstable vital sign in the emergency room. Two patients underwent emergency surgery and the rest patients underwent planned surgery. The common surgeries were VATS hematoma evacuation and wedge resection. There was no conversion to thoracotomy. The surgery proceeded without any problems for all patients.
CONCLUSIONS
VATS would be an effective diagnostic and therapeutic modality in chest trauma patients. It can be applied to retained hemothorax, persistent pneumothorax, suspicious diaphragm injury and even coagulation of bleeder.; Summary

Analysis of Cultivator-related Trauma Cases in a Regional Trauma Center in the Rural Area of Gyeongbuk Province: Ui Kang Hwang, Seok Hwa Youn, Chan Yong Park; J Trauma Inj. 2017;30(3):80-86. Published online October 30, 2017; DOI: https://doi.org/10.20408/jti.2017.30.3.80

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Abstract PDF: PURPOSE
To analyze the data of patients who suffered trauma in a cultivator accident and visited the trauma center in rural Gyeongbuk Province.
METHODS
We retrospectively reviewed the medical records and Korean Trauma Data Bank data of 120 patients who suffered cultivator-related traumas and visited the rural regional trauma center in Gyeongbuk Province from January to December 2015.
RESULTS
The age of the patients ranged from 35 to 96 years (mean, 70 years). Ninety-one (75.8%) patients were men, and twenty-nine (24.2%) were women. Most of the patients were in their 70s (46 men [50.5%] and 13 women [44.8%]). In total, 113 patients (94.1%) arrived at the regional trauma center by ground transport and 7 (5.9%) arrived by air transport. Ninety-eight patients (81.7%) were transported to the regional trauma center directly from the scene of the accident, and twenty-two (18.3%) were transferred from another medical institute. The mean time from the accident to arrival at the emergency department was 139 minutes, and only 46 patients (38.3%) arrived within 1 hour. Twelve (10.0%) patients died, including two deaths on arrival and two post- cardiopulmonary resuscitation deaths in the emergency department. All deaths were of male cultivator operators. The causes of death were shock (hypovolemic, traumatic, or septic), subdural hematoma (open), hemothorax, rhabdomyolysis, and pneumonia.
CONCLUSIONS
As the government - led regional trauma center project is on process, it would be clinically important to summarize the initial outcome of cultivator injuries, which are characteristically found more in regional trauma centers in the rural area, and have high mortality. Based on this study, in the future, it will be necessary to follow up and analyze more number of patients and to construct accurate database about trauma cases related to cultivator in Gyeongbuk region.; Summary

Characteristics of Pediatric and Adolescent Trauma-Database Review of Single Level Trauma Center in Gangwon Province: Tae Han Lee, Pil Young Jung, Hye Youn Kwon, Hongjin Shim, Ji Young Jang, Keum Seok Bae, Seongyup Kim; J Trauma Inj. 2017;30(3):75-79. Published online October 30, 2017; DOI: https://doi.org/10.20408/jti.2017.30.3.75

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Abstract PDF

PURPOSE
Although trauma is the most common cause of death under age 18, Korean national pediatric trauma data has lack of clinical data. This study is to prepare manpower resources, equipment, and make a correct policy decision on pediatric trauma victims.
METHODS
The study enrolled 528 patients under age 16 with traumatic injury visited Wonju Severance Christian Hostpital Trauma Center, from February 12, 2015 to December 31, 2016. We analyzed the distribution of gender, age, place and time of the accident, injury mechanism, injury severity, and injured organ by medical record.
RESULTS
The major injury mechanisms were blunt injury in 485 (91.90%), penetrating injury in 27 (5.10%), burn in 13 (2.50%), near drowning in 2 (0.40%), and foreign body ingestion in 1 (0.20%). Ninety-seven (18.4%) patients were injured at home and 67 (12.7%) patients were injured at school. The overall mortality rate was 1.13% (n=6). 5 mortalities were related to automobile accident and one was fall down. Mean Injury Severity Score (ISS) was 4 (2, 8). No statistical significance was observed in the mean ISS between each age group. The peak time of accident occurrence was between 16 and 17 o'clock. The mean ISS was higher in blunt injury group than penetrating injury with statistical significance (6.50±7.60 vs. 3.00±8.10; p<0.05). The most common injury site was upper extremity. Mean ISS was highest in thorax injury. However, mean ISS of thorax injury was higher with statistical significance only compared with face, neck and upper extremity injury.
CONCLUSIONS
We reported our pediatric trauma patients data of our hospital level I trauma center, which is the only one level I trauma center of Gangwon Province. These data is useful to prevent and prepare for pediatric trauma.

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Age group characteristics of children who visited a regional trauma center and analysis of factors affecting the severe trauma
Hyung Won Lee, Jea Yeon Choi, Jae Ho Jang, Jin Seong Cho, Sung Youl Hyun, Woo Sung Choi, Jae-Hyug Woo
Pediatric Emergency Medicine Journal.2020; 7(2): 94. CrossRef

Fat Embolism Syndrome - Three Case Reports and Review of the Literature: Leonidas Grigorakos, Ioannis Nikolopoulos, Stamatina Stratouli, Anastasia Alexopoulou, Eleftherios Nikolaidis, Eleftherios Fotiou, Daria Lazarescu, Ioannis Alamanos; J Trauma Inj. 2017;30(3):107-111. Published online October 30, 2017; DOI: https://doi.org/10.20408/jti.2017.30.3.107

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Abstract PDF

The fat embolism syndrome (FES) represents a condition, usually with traumatic etiology, which may pose challenges to diagnosis while its treatment usually requires supportive measures in the intensive care units (ICUs). The clinical criteria, including respiratory and cerebral dysfunction and a petechial rash, along with imaging studies help in diagnosis. Here we present three case reports of young male who developed FES and were admitted to our ICUs after long bones fractures emerging after vehicle crashes and we briefly review FES literature. All patients' treatment was directed towards: 1) the restoration of circulating volume with fresh blood and/or plasma; 2) the correction of acidosis; and 3) immobilization of the affected part. All patients recovered and were released to the orthopedic wards. The incidence of cases of patients with FES admitted in our ICUs records a significant decrease. This may be explained in terms effective infrastructure reforms in Greece which brought about significant improvement in early prevention and management.

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Late-onset isolated cerebral fat embolism syndrome after a simple tibial plateau fracture: a rare case report
Ta-Li Hsu, Tien-Chi Li, Fei-Pi Lai, Ming Ouhyoung, Chih-Hung Chang, Cheng-Tzu Wang
Journal of International Medical Research.2021; 49(7): 030006052110284. CrossRef

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

Traumatic Abdominal Wall Hernia: A Case Report: Youngro Yang, Kwangsig Kim; J Trauma Inj. 2017;30(2):70-73. Published online June 30, 2017; DOI: https://doi.org/10.20408/jti.2017.30.2.70

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Traumatic abdominal wall hernia is a rare condition that can follow any blunt trauma to the abdomen. Generally there has been an increase in the incidence of blunt abdominal trauma, although the case of traumatic abdominal wall hernias are rare. Probably due to the elasticity of the abdominal wall for resisting the shear forces generated by a traumatic impacts. In this case, we are reporting 1 rare case, diagnosed as an abdominal wall hernia associated with herniation of bowel loops due to blunt trauma without intra-abdominal injury including peritoneum.

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Traumatic abdominal wall hernia: a rare and often missed diagnosis in blunt trauma
Sohil Pothiawala, Sunder Balasubramaniam, Mujeeb Taib, Savitha Bhagvan
World Journal of Emergency Medicine.2022; 13(6): 492. CrossRef

Bilateral Oculomotor Nerve Palsy after Head Trauma: A Case Report: Hae Won Noh, Jae Young Song, Jong Hyun Kim, Jang Hun Kim; J Trauma Inj. 2017;30(2):66-69. Published online June 30, 2017; DOI: https://doi.org/10.20408/jti.2017.30.2.66

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Abstract PDF: We introduce a patient who was suffered from isolated traumatic bilateral oculomotor nerve palsy after head trauma. The patient presented with bilateral ptosis and abnormal pupilary responses with slightly drowsy mentality at first. Performed images demonstrated some hematomas along subarachnoid, intraventricular, subdural spaces and multiple small supratentorial contusions. There was no bony abnormality or ligament injury. We assumed that small amount of interpeduncular hematoma might be the proper lesion associated with oculomotor nerve palsies, since the clinical symptom and signs presented bilaterally and the oculomotor neural fascicles run through the interpeduncular fossa.; Summary

Thoracoscopic Resection of the First Rib for Thoracic Outlet Syndrome: A Case Report: Jae Gul Kang, Soon Ho Chon, Kilsoo Yie, Min Koo Lee, Oh Sang Kwon, Song Hyun Lee, June Raphael Chon; J Trauma Inj. 2017;30(2):63-65. Published online June 30, 2017; DOI: https://doi.org/10.20408/jti.2017.30.2.63

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Abstract PDF: Standard open procedures for resection of the first rib in thoracic outlet syndrome can prove to be quite difficult with extensive incisions. A minimal invasive procedure can also be painstaking, but provides an attractive alternative to the more radical open procedures. We report the details of the technique with direct video footage of the procedure performed in a 41-year-old man with thoracic outlet syndrome done entirely by thoracoscopic methods.; Summary

The Management of Lupus Thrombocytopenia in Poly Trauma Patient: Jin Bong Ye, Young Hoon Sul, Seung Je Go, Jung Hee Choi, Joong Suck Kim; J Trauma Inj. 2017;30(2):59-62. Published online June 30, 2017; DOI: https://doi.org/10.20408/jti.2017.30.2.59

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Abstract PDF: Lupus thrombocytopenia is a common clinical manifestation in systemic lupus erythematosus (SLE). It may present to clinicians with considerable therapeutic difficulties. We experienced a 40-year-old poly trauma patient with lupus thrombocytopenia who had been treated with immunosuppressive drugs for SLE. She was treated for refractory thrombocytopenia with platelet transfusion, corticosteroid and Intravenous immunoglobulin (IVIG). Fourteen days after admission, her platelet count started to increase, 101×103/ul at 16 days after admission. Trauma patients may carry various underlying diseases and thus trauma surgeons should always be aware and ready for peculiar situations.; 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

Long-term Fistula Formation Due to Retained Bullet in Lumbar Spine after Gunshot Injury: Se Il Jeon, Soo Bin Im, Je Hoon Jeong, Jang Gyu Cha; J Trauma Inj. 2017;30(2):51-54. Published online June 30, 2017; DOI: https://doi.org/10.20408/jti.2017.30.2.51

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Abstract PDF: We here report a case of long-term fistula formation due to bullet retention for 30 years in the lumbar spine after a gunshot injury, and describe its treatment. A 62-year-old male visited our hospital due to pus-like discharge from his left flank. The discharge had been present for 30 years, since his recovery from an abdominal gunshot injury. A spine radiography showed radiopaque material in the body of the third lumbar vertebra. Foreign body was removed using an anterolateral retroperitoneal approach. The postoperative course was uneventful. The patient was discharged 7 days after the operation and was followed-up for 8 months, during which time, the fistula did not reoccur. A bullet retained long term in the vertebral body may cause obstinate osteomyelitis and fistula formation. A fistula caused by a foreign body in the spine can be effectively treated by surgical removal.; Summary

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