Journal of Trauma and Injury

FAST Reappraisal: Cross-sectional Study: Sang Hyun Ha, Chong Kun Hong, Jun Ho Lee, Seong Youn Hwang, Seong Hee Choi; J Korean Soc Traumatol. 2012;25(3):67-71.

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Abstract PDF: PURPOSE
Focused Assessment with Sonography for Trauma (FAST) provides an important initial screening examination in adult trauma patients. However, due to its low sensitivity, FAST is not a replacement for computed tomography (CT) in hemodynamically stable trauma patients. The aim of this study was to determine the test characteristics of FAST in adult, hemodynamically stable, blunt abdominal trauma patients by using a critical action as a reference standard.
METHODS
The medical records for FAST examination at a single hospital from January 2009 to February 2011 were retrospectively reviewed. The inclusion criterion was isolated, hemodynamically stable, blunt abdominal trauma. Hemodynamically unstable patients or patients with penetrating injuries were excluded. The reference standard was the presence of a critical action, which was defined as one of the following: 1) operative intervention for a finding discovered on CT, 2) interventional radiology for bleeding, 3) transfusion of 2 or more packed RBCs, or 4) death at the emergency department.
RESULTS
There were 230 patients who met the inclusion criterion. There were 20 true positive, 206 true negative, 0 false positive, and 4 false negative results. The sensitivity and the specificity were 83% and 100%, respectively.
CONCLUSION
Despite its low sensitivity for detecting any abnormal finding discovered on CT, negative FAST could aid to exclude critical action in hemodynamically stable, blunt abdominal trauma patients.; Summary

Acute Traumatic Coagulopathy in Severe Trauma Patients: Dong Eun Lee, Kang Suk Seo, Mi Jin Lee, Su Jeong Shin, Hyun Wook Ryoo, Jong Kun Kim, Jung Bae Park; J Korean Soc Traumatol. 2012;25(3):72-78.

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Abstract PDF: PURPOSE
Clinical observation and research findings show that acute traumatic coagulopathy (ATC) is a major factor that must be addressed in the early care of severe trauma patients. ATC is associated with increased transfusion requirements and poor clinical outcomes. This study aimed to correlate the early predictable factors of ATC with the outcomes in severe trauma patients.
METHODS
Retrospective data from the trauma registry on severe trauma patients (Injury Severity Score (ISS)> or =16) were used to identify variables independently associated with coagulopathy. Univariate associations were calculated, and a multivariable logistic regression analysis was used to determine variables independently associated with ATC.
RESULTS
Patients were mostly male, aged 51.9+/-17.8 years, with an injury severity score of 24.1+/-12.4. ATC, as diagnosed in the emergency department (ED), occurred in 17% of the severe trauma patients. Using a multivariable logistic regression analysis, early predictable variables independently associated with ATC were base deficit (odds ratio (OR): 13.03; 95% confidence interval (CI): 3.47-48.93), acute liver injury (OR: 4.24; 95% CI: 1.06-17.00), and transfer from another hospital (OR: 21.00; 95% CI: 3.23-136.60).
CONCLUSION
ATC is associated with mortality in severe trauma patients, and some variables associated with trauma and shock are an independent predictors of ATC. These variables contribute to the early recognition and management of coagulopathy, which may improve the outcome from trauma resuscitation.; Summary

Predictive Factors for Mortality among Adult Trauma Victims Transfused in an Emergency Department: Kyung Won Lee; J Korean Soc Traumatol. 2012;25(3):79-86.

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Abstract PDF: PURPOSE
The most common cuase of transfusion for trauma victims in an emergency department is hypovolemic shock due to injury. After an injury to an internal organ of the chest or the abdomen, transfusion is needed to supply blood products and to compensate tissue oxygen transport and bleeding. From the 1990's, there have been some reports that transfusion is one of the major factors causing multiple-organ failure. Thus, as much as possible, tranfusion has been minimized in the clinical setting. This study aims to analyze the prognostic factors for mortality among trauma victims transfused with blood products in an emergency department.
METHODS
We conducted this study for the year of 2010 retrospectively. The study group included adult trauma victims tranfused with blood products in our ED. The exclusion criteria were discharge against medical advice, and missing follow-up due to transfer to another facility. During the study period, 34 adult trauma victims were enrolled. We compared the clinical variables between survivors and non-survivors.
RESULTS
The mean age of the 34 victims was 58.06 years, and males account for 58.5% of the study group. The most-frequently used form transportation was ambulance(119, 55.9%), and the most common injury mechanism was mobile vehicle accidents(67.6%). The mean revised trauma score (RTS) was 5.9, and the mean injury severity score (ISS) was 47.76. The mortality rate in the ED was 58.5%, Comparison of survivors with non-survivors showed statistical differences in injury mechanism, initial SBP, DBP, RTS, ISS, and some laboratory data such as AST, ALT, pH, PO2, HCO3, glucose (p<0.05). Regression analyses showed that mortality among adult trauma victims transfused in the ED correlated with RTS.
CONCLUSION
When an adult trauma victim is transported to the ED and needs a tranfusion, the emergency physician carefully assess the victim by using physiologic data.; Summary

Right Diaphragmatic Rupture after Blunt Trauma: Case Report: Ki Hoon Kim, Jin Su Kim, Sung Jin Park, Woon Won Kim, Do Kyun Kang, Ho Gi Min, Yong Han Kim, Cheol Gyu O; J Korean Soc Traumatol. 2012;25(3):87-90.

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Abstract PDF: Blunt diaphragmatic rupture (BDR) is a relatively rare injury and occurs in 0.8% to 7% of all thorocoabdominal blunt trauma. Especially right diaphragmatic rupture after blunt abdominal trauma is a rarer than left. The diagnosis of BDR can be missed while evaluating the multiple trauma patient. Other severe injuries may mask BDR during the primary resuscitation and survey. We experienced two cases of traumatic rupture of right diaphragm, one diagnosed immediately and the other diagnosed delayed. In this paper we present two cases of traumatic diaphragmatic rupture.; Summary

Closed Digital Reduction of Posttraumatic Lung Hernia: Ki Sung Park; J Korean Soc Traumatol. 2012;25(3):91-93.

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Abstract PDF: Postraumatic lung hernia is a rare occurrence. A number of cases reported in the literature have been treated with early thoracotomy to repair partial protruded lung and pleura to prevent strangulation and incarceration. We present a case of a 45-year-old patient of left posttrumatic lung hernia, in which closed digital reduction was successful. The strategy of the management approach could be established by further accumulated experience.; Summary

Duodenal Injury after Blunt Abdominal Trauma: Report of Two Cases: Ki Hoon Kim; J Korean Soc Traumatol. 2012;25(3):94-96.

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Abstract PDF: Duodenal injuries following a blunt or penetrating trauma are uncommon and account for just 3% to 5% of all abdominal injuries. About 22% of all duodenal injuries are caused by blunt trauma. An overlooked injury or delayed diagnosis of duodenal injury may lead to increased mortality and morbidity. We report two cases of a duodenal injury following blunt abdominal trauma.; Summary

Dental Prosthesis Causing Pneumonia in a Delirious Elderly Patient after Hip Fracture Surgery: Young Kyun Lee, Yong Chan Ha, Kyung Hoi Koo; J Korean Soc Traumatol. 2012;25(3):97-100.

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Abstract PDF: We report a case of delayed diagnosed pneumonia due to an aspirated metallic crown, which had been detached from a molar tooth. Dental prosthesis should be checked and a careful review of the chest radiograph is mandatory when an elderly patient with delirium after hip fracture surgery develops pneumonia postoperatively.; Summary

A Case of Neobladder Rupture Following Blunt Trauma: Young Hoon Sul, Moon Haeng Lee, Sang Il Lee, Kwang Sik Cheon, In Sang Song; J Korean Soc Traumatol. 2012;25(3):101-104.

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Abstract PDF: Bladder rupture following blunt trauma is rare, and no neobladder rupture following blunt trauma has yet been reported. We present a case of neobladder rupture following blunt trauma. The patient was a 65-year-old male patient who had been treated for bladder cancer via a radical cystectomy with an orthotopic ileal neobladder four years prior to this admission, and who was admitted to our emergency department due to multiple trauma after a 1.5 m fall. Primary repair was performed for the neobladder rupture.; Summary

Abdominal Organ Injuries with Chyloperitoneum after Blunt Tauma: A Case Report: Young Hwan Kim, Yooun Joong Jung, Suk Kyung Hong; J Korean Soc Traumatol. 2012;25(3):105-108.

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Abstract PDF: Chyloperitoneum or chylous ascite after trauma is a rare condition. It can develop after direct injuries of lymphatic vessels or cisterna chyli. Though isolated chyle duct injury has sometimes been reported, chyloperitoneum is generally accompanied by various kinds of damage to other intraabdominal organs. There's still no established therapeutic protocol regarding the treatment of chyloperitoneum when it is accompanied by the serious injuries of intraabdominal organs. We describe a 66-year-old male with serious intraabdominal organ injuries after blunt trauma. In our case, chyloperitoneum developed due to the injuries to the mesenteric lymph vessels and compression of cisterna chyli by hematoma around aorta.; Summary

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