Journal of Trauma and Injury

Volume 22(2); December 2009

Original Articles

S-100B in Extracranial Fracture Patients Without Head Trauma: Tae Woong Park, Dong Hoon Lee, Sang Jin Lee, Sung Eun Kim, Chang Woong Kim; J Korean Soc Traumatol. 2009;22(2):123-127.

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Abstract PDF: PURPOSE
There is an increasing amount of evidence that S100B could function as a marker of brain damage. However, the cerebral specificity of S100B has been questioned, so the extracerebral sources of S100B have been paid attention. We performed this investigation to show serum S100B levels after extracranial fracture in patients without current head injury and without prior neurological disease.
METHODS
At the emergency department, we obtained the blood samples within 6 hours from trauma patients hospitalized with extracranial fractures. S100B levels were compared between one fracture and more than two fractures, and analyzed according to the presence of soft tissue damage.
RESULTS
Patients with one fracture and those with more than two fractures did not differ by age (mean, 54.70 vs. 47.03, p=0.130), and there was no significant difference in the male-to-female ratio(33:32 vs. 21:12, p=0.226). In patients with one fracture, the mean value of S-100B was 0.56 microgram/L (95% CI: 0.35-0.77) whereas in those with more than two fractures, the corresponding value was 1.09 microgram/L (95% CI: 0.46-1.7, p=0.048). The S100B level of patients with soft tissue damage(1.32+/-0.38) was higher than that of patients without soft tissue damage(0.81+/-0.21), whether one fracture or more than two fractures(p=0.049).
CONCLUSION
We present here that S100B levels were raised in 77% of patients with extracranial fractures without cerebral injury who were hospitalized from the emergency room and that the presence of soft tissue damage contributed to the increased S100B rather than the size of the fractured bone size or the number of fracturest. Thus, this study suggests that soft tissue injury may be considered as an important extracerebral source of S100B.; Summary

The Epidemiology of Bicycle Injury in Korea: Patients Who Visited 55 Emergency Rooms: Bo In Kim, Jin Hee Jung, Koo Young Jung; J Korean Soc Traumatol. 2009;22(2):128-133.

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Abstract PDF: PURPOSE
Bicycle riding is a healthy and cheap form of transportation and a popular form of recreation. This study aims to evaluate the epidemiology and the factors affecting the severity of bicycle-related injuries and to find effective methods for preventing injuries.
METHODS
This is a retrospective study of the patients' characteristics, the injury severity, the injury location, the effect of safety equipment on the bicycle injury based on information collected through the NEDIS (National Emergency Department Information System) from 1,284,429 patients who visited 55 emergency rooms nationwide.
RESULTS
During the research period throughout 55 emergency rooms 5,671 patients were seen because of bicycle injuries. The male-to-female ratio was 3.1:1, the median age 28 years old, and 42.6% of the patients were younger than 20 years old. Injury sites were mostly in the extremities(46.7%), the head(32.4%), and the face(14%), and 70.3% of severely injured patients had accompanying head trauma. Males aged 65 and older was possibly associated with severe head trauma. Of the patients who provided helmet information 4.8%(71 patients) used helmets, and 95.2%(1392 patients) did not. In this group of patients providing helmet information, none of those wearing helmets died, but 0.4% of those not wearing helmets died.
CONCLUSION
In this study, most bicycle injuries occurred in young adult men. From now, there seems to be a need for more effort on publicity activities on bicycle injuries and on the education of children and teenagers, who show a high incidence rate, and of senior citizens (over 65 years old) who show a high severity rate, about using a safety helmet to reduce the severity of injury.; Summary

The Utility of Routine Serial Brain Computed Tomography for Referred Traumatic Brain Injury Patients According to the Severity of Traumatic Brain Injury: Jeong In Hwang, Jin Seong Cho, Seung Chul Lee, Jeong Hun Lee; J Korean Soc Traumatol. 2009;22(2):134-141.

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Abstract PDF: PURPOSE
Patients with traumatic brain injury (TBI) were referred from other hospitals for further management. In addition, patients routinely underwent computed tomography examinations of the head (HCT) in the referral hospitals. The purpose of this study was to evaluate retrospectively the utility of routine HCT scans according to the severity of TBI.
METHODS
Patients with TBI referred to our hospital between December 2005 and July 2008 were included in this study. We investigated HCT findings, indications for repeat HCT examinations (routine versus a neurological change), and neurosurgical interventions. The head injury severity was divided into three categories according to the Glasgow Coma Scale (GCS) score, including mild, moderate, and severe TBI. The use of neurosurgical interventions between patients who underwent routine HCT scans and patients who underwent HCT scans for a neurological change were compared according to the severity of TBI.
RESULTS
A total of 81 patients met the entry criteria for this study. Among these patients, 67%(n=54) of the patients underwent HCT scans on a routine basis, whereas 33%(n=27) of the patients underwent HCT scans for a neurological change. A total of 21 patients showed signs of a worsening condition on the HCT scans. Neurosurgical intervention was required for 23(28.4%) patients. For patients who underwent routine HCT examinations, no patient with mild TBI underwent a neurosurgical intervention. However, one patient with moderate TBI and three(13%) patients with severe TBI underwent neurosurgical interventions. The kappa index, the level of agreement for HCT indications of intervention and referral reasons for intervention, was 0.65 for high hierarchy hospitals and 0.06 for low hierarchy hospitals.
CONCLUSION
Routine serial HCT examinations in the referred hospitals would be useful for patients with severe head injury and for patients from low hierarchy hospitals where no emergency physicians or neurosurgeons are available.; Summary

Diagnostic Usefulness of Computed Tomography Compared to Conventional Chest X-Ray for Chest Trauma Patients: Kyu Ill Choi, Kang Suk Seo, Hyun Wook Ryoo, Jung Bae Park, Jae Myung Chung, Jae Yoon Ahn, Seong Won Kang, Jae Hyuck Yi; J Korean Soc Traumatol. 2009;22(2):142-147.

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Abstract PDF: PURPOSE
Early diagnosis and management of therapeutic interventions are very important in chest trauma. Conventional chest X-rays (CXR) and computed tomography (CT) are the diagnostic tools that can be quickly implemented for chest trauma patients in the emergency department. In this study, the usefulness of the CT as a diagnostic measurement was examined by analyzing the ability to detect thoracic injuries in trauma patients who had visited the emergency department and undergone CXR and CT.
METHODS
This study involved 84 patients who had visited the emergency department due to chest trauma and who had undergone both CXR and CT during their diagnostic process. The patients' characteristics and early vital signs were examined through a retrospective analysis of their medical records, and the CXR and the CT saved in the Picture Archiving Communication System (PACS) were examined by a radiologist and an emergency physician to verify whether or not a lesion was present.
RESULTS
Pneumothoraxes, hemothoraxes, pneumomediastina, pulmonary lacerations, rib fractures, vertebral fractures, chest wall contusions, and subcutaneous emphysema were prevalently found in a statistically meaningful way (p<0.05) on the CT. Even though their statistical significance couldn't be verified, other disorders, including aortic injury, were more prevalently found by CT than by CXR.
CONCLUSION
CT implemented for chest trauma patients visiting the emergency department allowed disorders that couldn't be found on CXR to be verified, which helped us to could accurately evaluate patients.; Summary

Correlation Between the Osmolar Gap and Serum Ethanol Level and the Accuracy of Estimated Ethanol Level in Trauma Patients and Non-Trauma Patients: Hyung Woo Chang, Min Seob Sim, Sang Kuk Han, Hyoung Gon Song; J Korean Soc Traumatol. 2009;22(2):148-153.

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Abstract PDF: PURPOSE
The osmolar gap increases in proportion to the ethanol level. Some previous studies have shown that the correlation between the osmolar gap and the ethanol level is weak in trauma patient by using an indirect comparison with other patients. We conducted a direct comparison of the correlation of the osmolar gap to the ethanol level between trauma patients and non-trauma patients. We also analyzed the accuracy of the estimated ethanol level between the two groups.
METHODS
The research candidates were adult patients who had visited the emergency department of our hospital from December 2003 to November 2008. By using a retrospective chart review, we classified them into three subgroups: non-trauma without shock, trauma without shock, and trauma with shock. In each group, we compared the correlation between the osmolar gap and the measured ethanol level, and we analyzed the accuracy of the estimated ethanol level by using Lin's concordance correlation coefficient.
RESULTS
Four hundred forty-seven patients were enrolled in this study. For correlation of the osmolar gap and the measured ethanol level, Pearson's correlation coefficient was 0.916 in all patients, 0.939 in non-trauma without shock patients, 0.917 in trauma without shock patients, and 0.844 in trauma with shock patients. In the analysis of the accuracy of the estimated ethanol level by using Lin's concordance correlation coefficient, the accuracy in trauma with shock patients was lower than that in non-trauma without shock patients.
CONCLUSION
We found that the correlation between the osmolar gap and the measured ethanol level in the patient group with trauma was lower than it was in the patient group without trauma. Moreover trauma patients with shock had a lower accuracy of the estimated ethanol level than non-trauma patients.; Summary

Predictive Factors for Cervical Spine Injury in Patients with Minor Head Injury: Chul Woo Park, Ae Jin Sung, Jun Ho Lee, Seong Youn Hwang; J Korean Soc Traumatol. 2009;22(2):154-160.

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This study aimed to determine new criteria for detecting independent factors with high sensitivity in cases of cervical spine injury. We compared the sensitivity, the specificity, and the false negative predictive value (NPV) of plain radiographs with those of computed tomography for cervical spine injury in patients with minor head injury.
METHODS
We retrospectively reviewed the cases of 357 patients who underwent both cervical plain radiographs and computer tomography from January 2006, to September 2008. Patients were divided into two groups: the cervical spine injury group and the no cervical spine injury group. New criteria were organized based on variables that had significant differences in the logistic regression test.
RESULTS
Among the 357 patients, 78 patients had cervical spine injuries. The average age was 43.9+/-15.2 yrs old, and the male-to-female ratio was 1.90. The most common mechanism of injury was motor vehicle accidents. There was a significant difference in loss of consciousness, Glasgow Coma Scale (GCS)=14, neurologic deficit, posterior neck tenderness, and abnormality of the cervical plain radiographs between the two groups on the logistic regression test. New criteria included the above five variables. If a patient has at least variable, the area under the ROC curve of the new criteria was 0.850, and the sensitivity and the false NPV were 87.2% and 5.2%, respectively.
CONCLUSION
New criteria included loss of consciousness, GCS=14, neurologic deficit, posterior neck tenderness, and abnormality of the cervical plain radiographs. If the patient had at least 1 variable, he or she could have a of cervical spine injury with a sensitivity of 87.2% and a false NPV of 5.2%.; Summary

Clinical Analysis of Old-aged Chest Trauma Patient and Traumatic Hemopneumothorax: Jung Tae Kim; J Korean Soc Traumatol. 2009;22(2):161-166.

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Abstract PDF: PURPOSE
This study was conducted to analyze chest-trauma patients and the old-aged patients with a traumatic hemopneumothorax.
METHODS
We reviewed the medical records of 101 chest-trauma patients admitted to the department of cardiovascular and thoracic surgery from June 1999 to November 2008. We evaluated the general characteristics of the chest-trauma patient, especially those of old-aged patients with a traumatic hemopneumothorax.
RESULTS
Rib fracture was observed in 99 of the cases, the location distribution was right: left =261: 255, with right being dominant. Rib fractures commonly involved the 4th and the 7th rib. The average number of rib fractures was 5.1, and the average number of rib fractures in the old-aged patients was significantly higher than that in the non-old-aged patients (p=0.04). There were 17 cases of a hemopnuemothorax in old-aged patients, 52 cases in non-old-aged patients. The blood loss through the chest tube for old-aged patients was significantly more than that for the non-old-aged patients, and the initial hemoglobin level was lower in the old-aged patients.
CONCLUSION
Elderly trauma patients are more likely to die after trauma than other age groups. Even with relatively stable vital signs, invasive hemodynamic monitoring and intensive treatment are recommended.; Summary

Validity of Transfusing Group O+ Unmatched Packed Red Blood Cells in Hemorrhagic Shock Patients: Ji Hwan Lee, Minhong Choa, Junho Cho, Sung Pil Chung; J Korean Soc Traumatol. 2009;22(2):167-171.

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Abstract PDF: PURPOSE
It is important to begin a transfusion safely and appropriately as soon as possible in a hemorrhagic shock patient. A group O+ unmatched pack red blood cell (universal O+) transfusion may satisfy that requirement. We report our experiences with universal O+ to compare its usefulness for hemorrhagic shock patients with that of a matched pack red blood cell transfusion in the emergency department (ED).
METHODS
This is a retrospective study. Patients who had systolic blood pressure of less than 90 mmHg or a pulse rate of more than 120 beats per minute in the ED were included, and their medical records were reviewed. The collected data were demographic data, vital signs, blood test results, time to transfusion, the amount of transfusion, complications, and diagnoses. We calculated the emergency transfusion score (ETS) based on the patients' medical records.
RESULTS
Two hundred thirty-five patients were included. Forty-eight patients (36 trauma and 12 non-trauma patients) were transfused with a universal O+. These patients had less time to transfusion compared with the cross-matched transfusion groups (35+/-42 versus 170+/-187 minutes, p<0.001). There were no differences in complications between groups (p=0.076). Of the patients who were transfused with universal O+, 94.4% got more than 3 ETS.
CONCLUSION
The universal O+ transfusion, compared with matched pack red blood cell transfusion, should be a useful treatment for ED hemorrhagic shock patient due to its having a shorter time to transfusion without an increase in complications.; Summary

Effect of the Emergency Trauma Team's Management on the Treatment of Patients with Multiple Severe Trauma: Seong Hwa Lee, Suck Joo Cho, Seok Ran Yeom, Ji Ho Ryu, Jin Woo Jung, Sang Kyun Han, Yong In Kim, Maeng Real Park, Young Dae Kim; J Korean Soc Traumatol. 2009;22(2):172-178.

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Abstract PDF: PURPOSE
We performed this study to determine how the emergency trauma team affects the treatment of patients with multiple severe trauma and to discuss the effect and the direction of the emergency trauma team's management.
METHODS
We performed a retrospective analysis of 518 patients who visited our emergency department with severe trauma from August 2006 to July 2008. We divided the severe trauma patients into 2 groups : patients before and after trauma team management (Group 1 and Group 2). Then, we compared demographic characteristics, mechanisms of injury, and treatment outcomes (lengths of stay in the ED, admission ratio, and in-hospital mortality) between the 2 groups. In the same way, patients with multiple severe trauma were divided into 2 groups, that are patients before and after trauma team management (Group 3 and Group 4) and analyzed.
RESULTS
There was no significant difference, except mean age, between groups 1 and 2. In group 4 patients, compared to group 3 patients, the lengths of stay in the ED were lower (p value < 0.001), and the admission ratio were higher (p value = 0.017), but there was no significant difference in the in-hospital mortality between the groups 3 and 4.
CONCLUSION
When patients with multiple severe trauma visit the ED, the emergency trauma team's management can decrease the lengths of stay in the ED and increase the admission ratio, but does not produce a decrease in the in-hospital mortality rate. Further investigations of emergency trauma team management are needed to improve treatment outcomes for patients with multiple severe trauma.; Summary

Analysis of Patients Injured in Demonstraions: Kyoung Mi Lee; J Korean Soc Traumatol. 2009;22(2):179-183.

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This study was conducted to determine the level of medical care required for mass-gatherings and to describe the types of illness and injury that may occur during demonstrations.
METHODS
We conducted a retrospective review of the medical records for patients injured during demonstrations.
RESULTS
From May to August at 2008, a total of 932,000 participants attended demonstrations. Most patients were occurred from June to July, a total of 126 patients were evaluated and treated at the emergency center of our hospital. The mean patient age was 31.8+/-9.8 years, and men predominated over women. The vast majority of patients were experienced trauma (88.9%). The diagnostic categories were contusion (49.2%), laceration (20.6%), fracture (6.3%), syncope/dizziness (5.5%), ocular injuries (3.9%), dyspnea (3.9%), other trauma (3.1%), and abdominal complaints (1.5%). Two patients were admitted.
CONCLUSION
The rate and the acuity of patients seen at these demonstrations was low. Nevertheless, a full on-site physician and transportation system is recommended during similar incidents.; Summary

Treatment Strategy of Transcatheter Arterial Embolization after Pelvic CT Angiography in Traumatic Pelvic Hemorrhage: A Single Regional Emergency Center's Experience: Yu Jin Lee, Hwan Jun Jae, Won Chul Cha, Jun Seok Seo, Hyo Cheol Kim, Cheong Il Shin, Sang Do Shin; J Korean Soc Traumatol. 2009;22(2):184-192.

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This study was conducted to evaluate the effectiveness of the treatment strategy of transcatheter arterial embolization after pelvic CT angiography (CTA) in cases of traumatic pelvic hemorrhage.
METHODS
This is a retrospective analysis of pelvic hemorrhage patients who underwent transcatheter arterial embolization after pelvic CTA at our regional emergency center during a 31-month period. We reviewed the medical records and imagings of all these patients.
RESULTS
Transcatheter arterial embolization was performed in 17 patients (M:F=7:10, mean age=53.9) who underwent pelvic CTA for the evaluation of traumatic pelvic hemorrhage. Arterial bleeding was demonstrated on pelvic CTA in all patients, and the combined injury was also noted in 13 patients. The admission-to-CTA time was 84.53+/-66.92 minutes, and the CTA-to-embolization time was 147.65+/-99.97 minutes. Extravasation of contrast media or pseudoaneurysm was demonstrated on conventional angiography in all patients. Unilateral iliac artery embolization was performed in 8 patients, and bilateral iliac artery embolization was performed in 9 patients. Additional embolizations other than in the iliac arteries were performed in 7 patients. Initial hemostasis was achieved in 16 patients. One patient died of ongoing pelvic bleeding. Rebleeding occurred in only one patient and hemostasis was achieved with the second embolization. Another patient died of intracranial and facial bleeding in spite of pelvic hemostasis. The overall mortality was 11.8%, and there was no significant adverse effects in the other patients.
CONCLUSION
Transcatheter arterial embolization after pelvic CTA is an effective treatment strategy in the management of traumatic pelvic hemorrhage patients.; Summary

Multiple Intraabdominal Solid Organ Injuries after Blunt Trauma: Hyung Do Park, Sun Hyu Kim, Jong Hwa Lee, Jung Seok Hong, Eun Seog Hong; J Korean Soc Traumatol. 2009;22(2):193-198.

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Abstract PDF: PURPOSE
This study evaluated the characteristics and the prognosis of multiple intraabdominal solid organ injuries, including those to the liver, spleen, and kidney, after blunt trauma.
METHODS
From January 2001 to March 2009, 39 patients with multiple intraabdominal solid organ injuries, which had been confirmed by contrast-enhanced computed tomography after blunt trauma, were included in this retrospective study. The injury severity score (ISS), abbreviated injury scale (AIS), revised trauma score (RTS), American Association for the Surgery of Trauma (AAST) injury grade of solid organs, initial hemodynamic status, blood gas analysis, blood transfusion, and the mortality were the main outcome measurements.
RESULTS
Injured groups were classified into liver/kidney (n=17), liver/spleen (n=4), spleen/kidney (n=13), and liver/kidney/spleen (n=5) groups. Patients were older in the liver/kidney group than in the liver/kidney/spleen group (43 vs 18 years, p=0.023). The initial systolic blood pressures tended to be lower in the liver/kidney group than in the other groups (84 vs 105, 112, and 114 mmHg, p=0.087). The amounts of 24-hour packed RBC transfusion were 32 units in the liver/kidney group and 4 units in the liver/kidney/spleen group, but the difference was not statistically significant. Differences were found in neither the RTS, ISS, and AIS for head, chest, abdominal, and pelvic injuries nor the AAST injury grade for solid organ, but injuries to the chest were more severe in the liver/spleen group than in the spleen/kidney group (AIS 4.0 vs 2.8, p=0.028). Conservative treatment was the most frequent applied treatment in all groups. There were 6 mortalities : 3 due to hypovolemia, 2 to sepsis, and 1 to brain injury. Mortalities occurred only in the liver/kidney group.
CONCLUSION
Patients who had intraabdominal solid organ injuries of the liver and the kidney simultaneously, tended to be transfused more at an early time after trauma, to have lower initial systolic blood pressures, and to have a higher mortality.; Summary

Comparison of Intraperitoneal and Retroperitoneal/Pelvic Contrast Extravasation: The Characteristics and Prognosis of the Each Patient Group with Arterial Embolization according to the Abdominal Computed Tomography Scanning after Blunt Trauma: Ji Young Yoon, Sun Hyu Kim, Ryeok Ahn, Jae Cheol Hwang, Eun Seog Hong; J Korean Soc Traumatol. 2009;22(2):199-205.

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Abstract PDF: PURPOSE
This study compared the characteristics of and the prognosis for intraperitoneal and retroperitoneal/pelvic contrast extravasation, which had been confirmed by enhanced abdominal CT scan, after blunt trauma in patients who had undergone angiographic embolization.
METHODS
From January 2001 to March 2009, data were retrospectively collected regarding patients who had undergone contrast extravasation (CE) on CT scanning and arterial embolization after blunt trauma. The study patient group was divided into the intraperitoneal and the retroperitoneal/pelvic groups according to the area of contrast extravasation. We reviewed the initial demographic data, the location of injury, the solid organ injury, the embolized vessel, and the clinical outcome.
RESULTS
The mean age of the study subjects was 40.2+/-2.6 years old, and there were 24 male patients. The intraperitoneal group included 10 patients, and retroperitoneal/pelvic group was comprised of 17 patients. The amount of transfusion from presentation to intervention and during the first 24 hours was greater in the retroperitoneal/pelvic group than in the intraperitoneal group. The intraperitoneal group showed a higher frequency and severity of liver injury than the retroperitoneal/pelvic group. Angiography revealed that the hepatic artery (n=4) was the most frequently embolized vessel in the intraperitoneal group, while the internal iliac artery (n=6), followed by the renal artery (n=4), internal pudendal artery (n=3), and the gluteal artery (n=2), were the most frequently injured vessels in the retroperitoneal/pelvic group.
CONCLUSION
In patients with intra-abdominal contrast extravasation found on CT scanning and arterial embolization after blunt trauma, the need for transfusion was less in the intra-abdominal group than in the retroperitoneal/pelvic group. Liver injury was also more frequent and severe in the intraperitoneal group than in the retroperitoneal/pelvic group.; Summary

The Need for an Additional Pelvic CT in Cases of Acute Osseous Pelvic Injury that Has Already Been Diagnosed by Abdominal CT: Byoung kwon Ghim, Dong Hyuk Shin, Sang Kuk Han, Pil Cho Choi, Young Han Lee, Ha Young Park, Soo Ho Bae, Hyoung Gon Song; J Korean Soc Traumatol. 2009;22(2):206-211.

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Abstract PDF: PURPOSE
Abdominal CT (computed tomography) is a principal diagnostic imaging modality for torso trauma at the Emergency Department (ED). When acute osseous pelvic injuries are detected by abdominal CT, additional three-dimensional (3D) reconstruction pelvic CT is often performed. We compared abdominal CT with pelvic CT to provide information about acute osseous pelvic injuries.
METHODS
A retrospective investigation of patients' electronic medical records during the five year period between January 1, 2004 and December 31, 2008 among Korean soldiers who underwent pelvic CT after abdominal CT at the ED was conducted. Axial images of abdominal CT were compared with axial images and 3D reconstruction images of pelvic CT.
RESULTS
Sixteen patients underwent subsequent pelvic CT after abdominal CT. Axial images of abdominal CT showed the same results in terms of fracture detection and classification when compared to axial images and 3D reconstruction images of pelvic CT. Pelvic CT (including 3D reconstruction images) followed by abdominal CT neither detected additional fracture nor changed the fracture type.
CONCLUSION
This study has failed to show any superiority of pelvic CT (including 3D reconstruction images) over abdominal CT in detecting acute osseous pelvic injury. When 3D information is deemed be mandatory, 3D reconstructions of abdominal CT can be requested rather than obtaining an additional pelvic CT for 3D reconstruction.; Summary

Analysis of Delayed Diagnosis of Pediatric and Adolescent Patients Injured by Minor Trauma: Jee Ahn Choi, Won Bin Park, Jin Joo Kim, Jin Sung Jo, Jae Kwang Kim, Yong Su Lim, Sung Youl Hyun, Ho Seong Jeong, Hyuk Jun Yang, Gun Lee; J Korean Soc Traumatol. 2009;22(2):212-217.

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Abstract PDF: PURPOSE
To analyze delayed diagnosis, we collected date on pediatric and adolescent patients who had been admitted to the Emergency Department with injuries due to minor trauma METHODS: We retrospectively analyzed the age distribution, trauma mechanism, time interval for each affected body region at delayed diagnosis, hospital stay, and outcome for 161 pediatric and adolescent patients who had been admitted to the Emergent Department of Gachon University Gil Hospital from January 2006 to September 2008.
RESULTS
The incidence of delayed diagnosis in pediatric and adolescent trauma was 11.8% in our retrospective review of 161 pediatric and adolescent patients. Lengths of hospitalization were longer in patients with delayed diagnosis (p<0.05). Patients with delayed diagnosis were more often transferred to other hospitals than patients with non-delayed diagnosis (p<0.05). The time intervals for each different affected body regions at delayed diagnosis were significantly different, but the hospital stays were not. There were no statistical significance to age on affected body region.
CONCLUSION
From this study, we found that admission result and hospital stay were statistically significant differences between the delayed-diagnosis patient group and the non-delayed-diagnosis patient group. Finally, we must follow up pediatric and adolescent patients with minor trauma, closely considering missed injuries.; Summary

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