PURPOSE We evaluated the efficacy of ultrasound-guided lower extremity nerve block in trauma patients. METHODS From July 2013 to April 2014, 17 patients with multiple trauma had lower extremity nerve block for immediate management of open wound in the lower extremity. We evaluated the patient satisfaction of the anesthesia and any complications related to the block. RESULTS During the lower extremity nerve block, incomplete nerve block occurred in one patient. This is the second case, the reason for this was the lack of technique. There was no anesthetic complications. CONCLUSION Ultrasound-guided lower extremity nerve block in trauma patients is an effective anesthesia technique in the immediate management of open wound in lower extremities.
PURPOSE Occult hip fracture is not evident on radiographs and the diagnosis is often missed or delayed. This study was undertaken in order to identify the clinical characteristics and complications of patients with a delayed diagnosis of an occult hip fracture. METHODS We retrospectively reviewed patients with occult hip fracture who had normal findings on initial radiographs, the diagnosis was made on additional studies between August 2006 and February 2012. Patients who were diagnosed as having occult hip fractures at the first visit were categorized as non-delayed group and those who were not diagnosed at the first visit were categorized as delayed group. RESULTS Non-delayed group included 43 patients (86%). In the remaining 7 patients (delayed group), the diagnosis was delayed by a mean of 9.6 days (range 3~19 days). Patients who were diagnosed with an occult fracture on the initial visit presented later than those with a delayed diagnosis (41/43 .vs. 3/7, p=0.002). Other clinical features were no difference between the two groups. Patients in the delayed diagnosis group were more likely to have fracture displacement (4/7 .vs. 0/43)15patients in non-delayed group (34.9%) needed operative treatment, whereas all delayed patients (100%) needed operative treatment. CONCLUSION A delayed diagnosis of occult hip fractures was associated with increased rate of displacement and operation. In patients suspected of having occult hip fractures, additional studies should be recommended.
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APPLICATION OF ARTIFICIAL INTELLIGENCE TO ASSIST HIP FRACTURE DIAGNOSIS USING PLAIN RADIOGRAPHS Phichai Udombuathong, Ruthasiri Srisawasdi, Waravut Kesornsukhon, San Ratanasanya Journal of Southeast Asian Medical Research.2022; 6: e0111. CrossRef
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PURPOSE To compare injury sustained and severity of child occupant according to the types of safety restraint systems in motor vehicle crashes. METHODS This was a retrospective observational study. The study subjects were child occupants under the age of 8 years who visited a local emergency center following a motor vehicle crash from 2010 to 2014. According to safety restraint: child restraint systems (CRS), belted, and unbelted, we compared injuries sustained and injury severity using the maximal Abbreviated Injury Scale (MAIS) and Injury Severity Score (ISS), and analyzed the characteristics of severe injuries (AIS2+). RESULTS Among 241 subjects, 9.1% were restrained in CRS, 14.5% were only belted, and 76.3% was unbelted at the time of the crashes. Fourteen had severe injuries (AIS2+), all of whom didn't be restrained by CRS. Injuries in face and neck were the highest in unbelted group, and MAIS and ISS were the lowest in CRS group. CONCLUSION Among safety restraint systems for child occupant in motor vehicle crashes, the CRS have the preventive effect of face and neck injuries, and are the most effective safety restraint systems.
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Predicting child occupant crash injury severity in the United Arab Emirates using machine learning models for imbalanced dataset Muhammad Uba Abdulazeez, Wasif Khan, Kassim Abdulrahman Abdullah IATSS Research.2023; 47(2): 134. CrossRef
Current use of safety restraint systems and front seats in Korean children based on the 2008–2015 Korea National Health and Nutrition Examination Survey Seom Gim Kong Korean Journal of Pediatrics.2018; 61(12): 381. CrossRef
PURPOSE Nitric oxide (NO) is a vasodilator and inhaled NO (iNO) is used in acute respiratory distress syndrome (ARDS) to improve alveolocapillary gas exchange. The mechanism to improve oxygenation is likely to redistribute blood flow from unventilated areas to ventilated areas. Though improvement of oxygenation, iNO therapy has not been shown to improve mortality and considered as only rescue therapy in severe hypoxemia. We conducted the study to investigate an efficacy of iNO in trauma patients with severe hypoxemia. METHODS We reviewed the trauma patients who underwent iNO therapy retrospectively from 2010 to 2014. Degree of hypoxemia was represented as PaO2/FiO2 ratio (PFR) and the severity of patient was represented with sequential organ failure assessment (SOFA) score. Patients were divided into the survivor group and non-survivor group according to the 28-day mortality. RESULTS A total of 20 patients were enrolled. The mortality of 28-day was 40%. There were no significant differences between survivor and non-survivor group in age, sex, severity of injury, PFR and SOFA score. There was significant difference in initiation time of iNO after injury (p=0.047). Maximum combinations of sensitivity and specificity for timing of iNO therapy were observed using cut-off of 3-day after injury with a sensitivity of 88% and specificity of 75%. CONCLUSION Though iNO therapy does not influence the mortality, iNO therapy may decrease the mortality caused by respiratory failure in the early phase of trauma.
PURPOSE To improve outcome of severe trauma patient, the shortening of transport time is needed. Although helicopter emergency medical services (HEMS) is still a subject of debate, it must also be considered for trauma system. The aim of this study is to assess whether transport method (HEMS versus ground EMS) is associated with outcome among inter-hospital transport. METHODS All trauma patients transported to regional emergency center by either HEMS or ground EMS from September 2011 to September 2014. We have classified patients according to two groups by transport method. Age younger than 15 years and self-discharged patients were excluded. RESULTS A total of 427 patients were available for analysis during this period. 60 patients were transported by HEMS and 367 patients were transported by ground EMS. HEMS group had higher mortality than ground EMS group (23.3% vs 3.5%; p<0.001), and included more patients with excess mortality ratio adjusted injury severity score (EMR-ISS)above 25 (91.7% vs 48.8%; p<0.001). In the multivariable regression analysis, HEMS was not associated with improved outcome compared with ground EMS, but only EMR-ISS was associated with a mortality of patients (odds ratio, 1.06; 95% confidence interval, 1.04-1.09). CONCLUSION In this study, helicopter emergency medical services transport was not associated with a decreased of mortality among the trauma patients who inter-hospital transported to the regional emergency center.
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Reduced Mortality in Severely Injured Patients Using Hospital-based Helicopter Emergency Medical Services in Interhospital Transport Oh Hyun Kim, Young-Il Roh, Hyung-Il Kim, Yong Sung Cha, Kyoung-Chul Cha, Hyun Kim, Sung Oh Hwang, Kang Hyun Lee Journal of Korean Medical Science.2017; 32(7): 1187. CrossRef
PURPOSE To calculate Preventable Trauma Death Rate (PTDR), Trauma and Injury Severity Score (TRISS) is the most utilized evaluation index of the trauma centers in South Korea. However, this method may have greater variation due to the small number of the denominator in each trauma center. Therefore, we would like to develop new indicators that can be used easily on quality improvement activities by increasing the denominator. METHODS The medical records of 1005 major trauma (ISS >15) patients who visited 2 regional trauma center (A center and B center) in 2014 were analyzed retrospectively. PTDR and PARK Index (Preventable Major Trauma Death Rate, PMTDR) were calculated in 731 patients with inclusion criteria. We invented PARK Index to minimize the variation of preventability of trauma death. In PTDR the denominator is all number of deaths, and in PARK Index the denominator is number of all patients who have survival probability (Ps) larger than 0.25. Numerator is the number of deaths from patients who have Ps larger than 0.25. RESULTS The size of denominator was 40 in A center, 49 in B center, and overall 89 in PTDR. The size of denominator was significantly increased, and 287 (7.2-fold) in A center, 422 (8.6-fold) in B center, and overall 709 (8.0-fold) in PARK Index. PARK Index was 12.9% in A center, 8.3% in B center, and overall 10.2%. CONCLUSION PARK Index is calculated as a rate of mortality from all major trauma patients who have Ps larger than 0.25. PARK Index obtain an effect that denominator is increased 8.0-fold than PTDR. Therefore PARK Index is able to compensate for greater disadvantage of PTDR. PARK Index is expected to be helpful in implementing evaluation of mortality outcome and to be a new index that can be applied to a trauma center quality improvement activity.
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Comparison of Outcomes at Trauma Centers versus Non-Trauma Centers for Severe Traumatic Brain Injury Tae Seok Jeong, Dae Han Choi, Woo Kyung Kim Journal of Korean Neurosurgical Society.2023; 66(1): 63. CrossRef
Comparison of Preventable Trauma Death Rates in Patients With Traumatic Brain Injury Before and After the Establishment of Regional Trauma Center: A Single Center Experience Dae Han Choi, Tae Seok Jeong, Myung Jin Jang Korean Journal of Neurotrauma.2023; 19(2): 227. CrossRef
PARK Index and S-score Can Be Good Quality Indicators for the Preventable Mortality in a Single Trauma Center Chan Yong Park, Kyung Hag Lee, Na Yun Lee, Su Ji Kim, Hyun Min Cho, Chan Kyu Lee Journal of Trauma and Injury.2017; 30(4): 126. CrossRef
PURPOSE Establishment of the trauma system changed quality of trauma care in many countries. As one of the first designated level 1 trauma center in Korea, we analyzed trauma registration data in 2014. METHODS Data was extracted from Korean Trauma Data Base (KTDB) that was started from august 2013. Variables related to demographics and trauma was collected through the year 2014. RESULTS There were 3269 trauma patients who admitted to our hospital and registered to KTDB in 2014. Median age was 49 years, 64.4% were men, and 90% of patients were blunt in mechanism. Median injury severity score (ISS) was 5, mean revised trauma score (RTS) was 7.65. There were 138 (4.2%) deaths and 87 (2.7%) patients of them was death after admission. CONCLUSION This is the first report using KTDB registration from our institution. Trauma volume is appropriate but it should be compared with other trauma centers in Korea. In future national analysis of KTDB is mandatory.
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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
Impact of obesity on the severity of trauma in patients injured in pedestrian traffic accidents Pillsung Oh, Jin-Seong Cho, Jae Ho Jang, Jae Yeon Choi, Woo Sung Choi, Byungchul Yu Journal of Trauma and Injury.2022; 35(4): 240. CrossRef
An analysis of missed injuries in patients with severe trauma EunGyu Ju, Sun Young Baek, Sung Soo Hong, Younghwan Kim, Seok Hwa Youn Journal of Trauma and Injury.2022; 35(4): 248. CrossRef
PURPOSE The purpose of this study is to evaluate the surgical outcome of duodenal injuries and to analyze the risk factors related to the leakage after surgical treatment. METHODS A retrospective review of 31 patients with duodenal injuries who managed by surgical treatment was conducted from December 2000 to May 2014. The demographic characteristics, injury mechanism, site of duodenal injury, association of intraabdominal organ injuries, injury severity score (ISS), abdominal abbreviated injury scale (AIS), injury-operation time lag, surgical treatment methods, complications, and mortality were reviewed. RESULTS Duodenal injury was more common in male. Twenty four (77.4%) patients were injured by blunt trauma. The most common injury site was in the second portion of the duodenum (n=19, 58.6%). Fourteen patients (45.2%) had other associated intraabdominal organ injuries. The mean ISS is 13.6+/-9.6. The mean AIS is 8.9+/-6.5. Eighteen patients (58.1%) were treated by primary closure. The remaining 13 patients underwent various operations, including exploratory laparotomy (n=4), pancreaticoduodenectomy (n=3), pyloric exclusion (n=3), Resection with end-to-end anastomosis (n=2), and duodenojejunostomy (n=1). Most common postoperative complications were intraabdominal abscess (n=9) and renal failure (n=9). Mortality rate was 9.7%. CONCLUSION ISS, AIS>10, operative time, pancreaticoduodenectomy, sepsis, and renal failure are significant predictors of a postoperative leak after duodenal injury. Careful management is needed to prevent a potential leak in patient with these findings.
PURPOSE Many patients are injured by trauma. And some of them expire due to severity of trauma. Various scoring systems have been introduced in grading severity and predicting mortality of trauma patients. This study is to evaluation the usefulness of factors for determining the severity and predicting the prognosis of the trauma victims. METHODS Data on the patients who visited our Emergency departments from January 2010 to December 2011 were retrospectively reviewed using electronic medical records. The patients were activated severe trauma team calling system. The patients were categorized as survivors and non-survivors. Univariated associations were calculated, and a multiple logistic regression analysis was used to determine variables associated with hospital mortality. RESULTS Two hundred sixty two(262) patients were enrolled, and the mortality rate was 25.6%. By multivariate analysis, lower respiration rate, lower Glasgow Coma Score, higher International Normalized Ratio and emergency transfusion within 6 hours were expected as severity and prognosis predict factors (each of odds ratio were 24.907, 14.282, 2.667 and 16.144). CONCLUSION As predict factors, respiration rate, Glasgow Coma Score, International Normalized Ratio and emergency transfusion, are useful determining the severity and predicting prognosis of trauma victims.
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Prognostic Accuracy of the Quick Sequential Organ Failure Assessment for Outcomes Among Patients with Trauma in the Emergency Department: A Comparison with the Modified Early Warning Score, Revised Trauma Score, and Injury Severity Score Min Woo Kang, Seo Young Ko, Sung Wook Song, Woo Jeong Kim, Young Joon Kang, Kyeong Won Kang, Hyun Soo Park, Chang Bae Park, Jeong Ho Kang, Ji Hwan Bu, Sung Kgun Lee Journal of Trauma and Injury.2021; 34(1): 3. CrossRef
PURPOSE Immediate identification of vascular injury requiring embolization in patients with pelvic bone fracture isn't an easy task. There have been many trials finding indicators of embolization for patients with pelvic bone fracture. Although Young and Burgess classification is useful in decision making of treatment, it is reported to have little value as indicator of embolization in major trauma patients. The aim of this study is to find out Young and burgess classification on predicting vessel injury by analzyng pelvic radiograph taken from major trauma patients with pelvic bone fracture. METHODS Among major trauma patients with injury severity scores (ISS) higher than 15 who visited our emergency room from January 2011 to June 2014, 200 patients were found with pelvic bone fracture in trauma series and thus pelvic CT angiography was taken. Setting aside patients with exclusion criteria, 153 patients were enrolled in this study for analysis of Young and Burgess classification. RESULTS The most common mechanism of injury was lateral compression in both groups. There was no statistical significant difference in Young and Burgess classification (p=0.397). The obturator artery was the most commonly injured artery in both groups. Six patients had more than one site of bleeding. CONCLUSION Prediction of transcatheter angiographic embolization using Young and Burgess classification in severe trauma patients is difficult and requires additional studies.
PURPOSE Traumatic brain injury (TBI) is the most common cause of pediatric trauma patients came to the emergency department. Without guidelines, many of these children underwent repeat brain computed tomography (CT). The purpose of this study was to evaluate the value of repeat brain CT in children with TBI. METHODS We conducted a retrospective study of TBI in children younger than 19 years of age who visited the emergency department (ED) from January 2011 to December 2012. According to the Glasgow Coma Scale (GCS) and Pediatric Glasgow Coma Scale score of the patients, study population divided in three groups. Clinical data collected included age, mechanism of injury, type of TBI, and outcome. RESULTS A Total 83 children with TBI received repeat brain CT. There were no need for neurosurgical intervention in mild TBI (GCS score 13-15) group who underwent routine repeat CT. 4 patients of mild TBI group, received repeat brain CT due to neurological deterioration, and one patient underwent neurosurgical intervention. Routine repeat CT identified 12 patients with radiographic progression. One patient underwent neurosurgical intervention based on the second brain CT finding, who belonged to the moderate TBI (GCS score 9-12) group. CONCLUSION Our study showed that children with mild TBI can be observed without repeat brain CT when there is no evidence of neurologic deterioration. Further study is needed for establish indication for repetition of CT scan in order to avoid unnecessary radiation exposure of children.
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Mortality and Epidemiology in 256 Cases of Pediatric Traumatic Brain Injury : Korean Neuro-Trauma Data Bank System (KNTDBS) 2010–2014 Hee-Won Jeong, Seung-Won Choi, Jin-Young Youm, Jeong-Wook Lim, Hyon-Jo Kwon, Shi-Hun Song Journal of Korean Neurosurgical Society.2017; 60(6): 710. CrossRef
PURPOSE Frostbite can affect still soldiers. Initial clinical manifestations are similar for superficial and deep frostbite, so early treatment is identical. It is under-estimated by physicians. We try to identify the challenges of managing these complex tissue injuries. METHODS A retrospective analysis of 84 patients hospitalized at AFCH from 2009 to 2015 was conducted. We investigated differences of epidemiological characteristics, identification of soft tissue injury, treatment and complications between superficial (SF: 43; 51.2%) and deep (DF: 41; 48.8%) frostbite. RESULTS The major (94.0%) developed frostbite in dry circumstances (89.3%). Wet circumstances (66.7%) were more susceptible to DF rather than dry (46.7%). The 38 (45.2%) arrived to specialist within 7days. Most prone sites were feet, followed by hands. Toes had more deep injuries. DF presented more increased levels of ALT, CPK, CKMB, CRP. The bone scan of W+S+ was 48.3%, 87.1% and W+S- was 20.7%, 12.9%, respectively. The treatment resulted in improved or normalized perfusion scan with matching clinical improvement. It was a good tool to assess treatment response. Eighteen normal and 8 stenotic type of PCR resulted in normal with matching clinical improvement. One continuous obstructive waveform led to minor amputation. Twelve underwent both PCR and MRA. Among 6 normal PCR, 5 showed normal and one stenosis in MRA. All 5 stenosis and one obstruction showed the same findings in MRA. It was a good tool to evaluate vascular compromise. They were treated with rapid rewarming (11.6%, 22.0%), hydrotherapy (16.3%, 29.3%), respectively. Six (14.6%) underwent STSG, 2 (4.9%) had digital amputation in DF. Berasil, Ibuprofen, Trental were commonly administered. PGE1 was administered selectively for 6.8, 10.8 days, respectively. Raynaud's syndrome (16.3%), CRPS (4.7%), LOM (14.6%) and toe deformity (4.9%) were specific sequelae. CONCLUSION We should recommend intensive foot care education, early rewarming and evacuation to specialized units. The bone scanning and PCR should allow for a more aggressive and active approach to the management of tissue viability.
PURPOSE The aims of this study were to discuss treatment and prevention under the age of 18 to identify the characteristics of the electrical burn patients. METHODS We retrospectively reviewed medical records of 97 patients with under age 18 of electric burn who were treated in emergency department of quarterly over 10,000 targets within the desired hospital for evaluation of electrical injuries between January 1, 2009 and December, 2013. We investigated age, gender, injury mechanism, season, degree of burn, surface of burn, complication, blood test, and voltage, kind of current. RESULTS Of the patients, 50 (50.5%) patients were in the first degree burn and 47 (49.5%) patients were in second degree burn. 68 (70.1%) patients had electric burn at home. 75 (85.2%) of 88 patients had normal sinus rhythm and other 13 people showed a RBBB, VPC, sinus bradycardia, sinus tachycardia. 41 (42.3) of 97 patients were in infants and 26 (26.8%) patients were in adolescence. CONCLUSION The results of this study emphasize the need for prevention of electricity at home for childhood and education of the adolescence.
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A Case of Resuscitation of an Electrocuted Child by a 119 Paramedic Jae-Min Lee, Dae-Won Kim, Hyeong-Wan Yun Fire Science and Engineering.2020; 34(4): 135. CrossRef
PURPOSE Assessment of the trauma severity associated with the prognosis of trauma patients. But we are having a lot of difficulties in assess the severity because of scarcity of current first-aid records resources. METHODS We presumed that Applying the Revised trauma score which consist of vital signs and GCS score will be helpful to assess the sevirity.This study covers the 10069 patient of Ewah womans hospital (2011.1.1.-2014.12.31) who are able to verify the GCS score from fist-aid records. RESULTS There is no distinctions between prehospital RTS and hospital RTS. And shows high level of correlation between prehospital RTS and ISS. CONCLUSION Therefore we conclude that checking the GCS and RTS at prehospital state will be help to assess the severity of trauma patients.
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Comparative Evaluation of Emergency Medical Service Trauma Patient Transportation Patterns Before and After Level 1 Regional Trauma Center Establishment: A Retrospective Single-Center Study Hyeong Seok Lee, Won Young Sung, Jang Young Lee, Won Suk Lee, Sang Won Seo Journal of Trauma and Injury.2021; 34(2): 87. CrossRef
Real-Time Monitoring Electronic Triage Tag System for Improving Survival Rate in Disaster-Induced Mass Casualty Incidents Ju Young Park Healthcare.2021; 9(7): 877. CrossRef
PURPOSE We performed a quantitative and qualitative analysis in the Journal of the Korean Society of Traumatology (JKST) by Bibliometrics to know the trends of articles. METHODS We reviewed articles in the JKST retrospectively through 1988 to 2014. Articles were classified into original articles, case reports, review articles, and also it is further classified as topics and the information related to the Department of Medicine of corresponding author. Original article was classified prospective and retrospective studies. RESULTS 753 studies and average of 27.9 studies per year were posted on JKST. 576 original articles (76.5%) were posted. Retrospective studies around 449 studies (78%) were posted and there were about 35 descript studies and 541 analytic studies. The most common themes were related to abdominal trauma, 144 pieces, 95 pieces following damage to the chest and the 84 pieces of special order of trauma. Emergency department had the highest case whereas general surgery came to the second place. CONCLUSION Recently, there has been reduced proportion of original article in JKST. It was not possible to evaluate the Korea Citation index journals due to the fact that it does not correspond to listed register Journal of National Foundation of Korea. There will be the need for the effort to improve the maintenance of the posted article number, as well as the qualitative development of the posted articles.