Journal of Trauma and Injury

Volume 28(4); December 2015

Original Articles

Assessment of the Clinical and the Radiological Prognostic Factors that Determine the Management of a Delayed, Traumatic, Intraparenchymal Hemorrhage (DTIPH): Je Il Ryu, Choong Hyun Kim, Jae Min Kim, Jin Hwan Cheong; J Trauma Inj. 2015;28(4):223-231. Published online December 31, 2015; DOI: https://doi.org/10.20408/jti.2015.28.4.223

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Abstract PDF: PURPOSE
Delayed, traumatic, intraparenchymal hemorrhage (DTIPH) is a well-known contributing factor to secondary brain damage that evokes severe brain edema and intracranial hypertension. Once it has occurred, it adversely affects the patient's outcome. The aim of this study was to evaluate the prognosis factors for DTIPH by comparing clinical, radiological and hematologic results between two groups of patients according to whether surgical treatment was given or not.
METHODS
The author investigated 26 patients who suffered DTIPH during the recent consecutive five-year period. The 26 patients were divided according to their having undergone either a decompressive craniectomy (n=20) or continuous conservative treatment (n=6). A retrospective investigation was done by reviewing their admission records and radiological findings.
RESULTS
This incidence of DTIPH was 6.6% among the total number of patients admitted with head injuries. The clinical outcome of DTIPH was favorable in 9 of the 26 patients (34.6%) whereas it was unfavorable in 17 patients (65.4%). The patients with coagulopathy had an unexceptionally high rate of mortality. Among the variables, whether the patient had undergone a decompressive craniectomy, the patient's preoperative clinical status, and the degree of midline shift had significant correlations with the ultimate outcome.
CONCLUSION
In patients with DTIPH, proper evaluation of preoperative clinical grading and radiological findings can hamper deleterious secondary events because it can lead to a swift and proper decompressive craniectomy to reduce the intracranial pressure. Surgical decompression should be carefully selected, paying attention to the patient's accompanying injury and hematology results, especially thrombocytopenia, in order to improve the patient's neurologic outcomes.; Summary

Clinical Analysis of TEVAR in Blunt Thoracic Aortic Injury: Gwan Woo Ku, Jin Ho Choi, Min Suk Choi, Sang Soon Park, Young Hoon Sul, Seung Je Go, Jin Bong Ye, Joong Suck Kim, Yeong Cheol Kim, Jung Joo Hwang; J Trauma Inj. 2015;28(4):232-240. Published online December 31, 2015; DOI: https://doi.org/10.20408/jti.2015.28.4.232

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Abstract PDF: PURPOSE
Thoracic aortic injury is a life-threatening injury that has been traditionally treated by using surgical management. Recently, thoracic endovascular aortic repair (TEVAR) has been conducted pervasively as a better alternative treatment method. Therefore, this study will focus on analyzing the outcome of TEVAR in patients suffering from a blunt thoracic aortic injury.
METHODS
Of the blunt thoracic aortic injury patients admitted to Eulji University Hospital, this research focused on the 11 patients who had received TEVAR during the period from January 2008 to April 2014.
RESULTS
Seven of the 11 patients were male. At the time of admission, the mean systolic pressure was 105.64+/-24.60 mm Hg, and the mean heart rate was 103.64+/-20.02 per minute. The median interval from arrival to repair was 7 (4, 47) hours. The mean stay in the ICU was 21.82+/-16.37 hours. In three patients, a chimney graft technique was also performed to save the left subclavian artery. In one patient, a debranching of the aortic arch vessels was performed. In two patients, the left subclavian artery was totally covered. In one patient whose proximal aortic neck length was insufficient, the landing zone was extended by using a prophylactic left subclavian artery to left common carotid artery bypass before TEVAR. There were no operative mortalities, but a patient who was covered of left subclavian artery died from ischemic brain injury. Complications such as migration, endovascular leakage, collapse, infection and thrombus did not occur.
CONCLUSION
Our short-term outcomes of TEVAR for blunt thoracic aorta injury was feasible. Left subclavian artery may be sacrificed if the proximal landing zone is short, but several methods to continue the perfusion should be considered.; Summary

The Influence of How the Trauma Care System Is Applied at the Trauma Center: The Initial Experience at Single Trauma Center: Hyung Won Kim, Tae Hwa Hong, Seung Hwan Lee, Myung Jae Jung, Jae Gil Lee; J Trauma Inj. 2015;28(4):241-247. Published online December 31, 2015; DOI: https://doi.org/10.20408/jti.2015.28.4.241

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Abstract PDF

PURPOSE
To evaluate the influence of how the trauma care system is applied on the management of trauma patients.
METHODS
We divided the patients into a pre-trauma system group and a post-trauma system group according to the time when we began to apply the trauma care system in our institution. We compared the general characteristics, injury severity score, initial response time to the trauma patients, number of preventable deaths, and clinical outcomes between the two groups.
RESULTS
The numbers of patients in the pre-trauma system group and the post-trauma system group were 188 and 257, respectively. No differences in the patient's median ages, trauma scores (ISS, RTS, TRISS) and proportions of severe trauma patients (ISS>15) were observed between the two groups. The number and the proportion of patients who were admitted to our hospital were increased in the post-trauma system group. The time interval from trauma CP activation to emergency surgery or angio-embolization, and the patient's time spent in emergency room were shortened in the posttrauma system group. However, the lengths of the ICU stay and the hospital stay, and the number of in-hospital mortalities were not improved in the post-trauma system group. In severe trauma patients (ISS>15), there were no differences between the two groups in the number and the proportion of admitted patients, and the time interval from trauma CP activation to performing a diagnostic and therapeutic procedure was not shortened in the post-trauma system group.
CONCLUSION
Application of the trauma care system has shortened the time between the initial response and patient management. However, this improvement was not enough to result in better clinical outcomes. More trauma physicians, multidisciplinary cooperation, and a well-organized trauma management process will be needed if the maximum efficacy of the trauma system is to be achieved.

Summary

Citations

Citations to this article as recorded by

Effectiveness after Designation of a Trauma Center: Experience with Operating a Trauma Team at a Private Hospital
Kyoung Hwan Kim, Sung Ho Han, Soon-Ho Chon, Joongsuck Kim, Oh Sang Kwon, Min Koo Lee, Hohyoung Lee
Journal of Trauma and Injury.2019; 32(1): 1. CrossRef
Characteristics and Outcomes of Trauma Patients via Emergency Medical Services
Dae Hyun Cho, Jae Gil Lee
Journal of Trauma and Injury.2017; 30(4): 120. CrossRef
Analysis of Abdominal Trauma Patients Using National Emergency Department Information System
In-Gyu Song, Jin Suk Lee, Sung Won Jung, Jong-Min Park, Han Deok Yoon, Jung Tak Rhee, Sun Worl Kim, Borami Lim, So Ra Kim, Il-Young Jung
Journal of Trauma and Injury.2016; 29(4): 116. CrossRef

Features of Patients Associated with Falls from Heights Admitted to Republican Research Center of Emergency Medicine: Abdukhakim Muminovich Khadjibaev, Pulat Karimovich Sultanov, Hoon Kim; J Trauma Inj. 2015;28(4):248-255. Published online December 31, 2015; DOI: https://doi.org/10.20408/jti.2015.28.4.248

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Abstract PDF

PURPOSE
study of the mutual influence of the individual anatomical regions damage in patients associated with falls from heights.
METHODS
561 medical reports of patients associated with falls from heights admitted to Republican Research Center of Emergency Medicine (RRCEM), in period of 2010-2013 yy, were analyzed retrospectively. Patient's age range was from 15 to 89. Treatment of these patients held in three stages: period of acute disorders of vital functions; relative stabilization period; stabilization of vital functions. The scope and content of medical diagnostic procedures performed on pre-hospital and intensive care stages. The severity of each injury was scored according to the AIS scale, the total severity of lesions was scored by points due to ISS. Digital material is treated by methods of mathematical statistics.
RESULTS
Falls from heights leads to associated injuries for 4 times more than isolated trauma, and increases according to height of fall and falling surface. Patients with TBIdaggerchest trauma, are most serious contingent that has highest mortality and complications (36.8%). TBIdaggermusculoskeletal system trauma are characterized by high blood loss, traumatic shock and fat embolism, forming a vicious circle.
CONCLUSION
in patients associated with falls from heights clinical manifestations of injuries mutual aggravation syndrome will be seen. TBI leads to complication of chest trauma, delayed diagnostics of abdominal and chest trauma, aggravation of coma condition. Developing of high blood loss and fat embolism in musculoskeletal system trauma leads to shock and pulmonary embolism, which increases probability of death in the presence of abdominal or chest trauma, but abdominal trauma or chest trauma has no significant effect on the severity of the musculoskeletal system trauma.

Summary

Citations

Citations to this article as recorded by

Organ Donation in Uzbekistan: Achievements and Prospects for Further Development
Abduhakim Khadjibaev, Farhod Khadjibaev, Khikmat Anvarov, Pulat Sultanov
Experimental and Clinical Transplantation.2020; 18(Suppl2): 54. CrossRef

Relation between Blood Alcohol Concentration and Clinical Parameters in Trauma Patients: Tae Hwa Hong, Ji Young Jang, Seung Hwan Lee, Hyung Won Kim, Hong Jin Shim, Jae Gil Lee; J Trauma Inj. 2015;28(4):256-261. Published online December 31, 2015; DOI: https://doi.org/10.20408/jti.2015.28.4.256

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Abstract PDF: PURPOSE
The aim of this study was to evaluate the effects of blood alcohol concentration (BAC) on the clinical parameters in trauma patients.
METHODS
From January 2011 to March 2013, the records of a total of 102 trauma patients with BAC data were analyzed retrospectively. The revised trauma score (RTS), injury severity score (ISS), presence of shock, use of mechanical ventilation and blood transfusion, length of hospital stay, and mortality were collected. Patients were divided into four groups in accordance with the level of BAC: group A (<100 mg/dL), B (100~200 mg/dL), C (200~250 mg/dL), and D (>250 mg/dL). Patients were also divided into two groups depending on the presence of the shock, and gender, ISS, BAC, and presence of active bleeding were compared between these two groups.
RESULTS
No statistically significant differences in the ISS, RTS, presence of active bleeding, use of mechanical ventilation, and mortality were noted between groups A to D. However, the presence of shock was significantly higher in group D. After patients with severe chest injuries had been excluded, mechanical ventilation was found to have been applied more frequently in the higher BAC groups (C and D). A logistic regression analysis of these factors showed that extremely high BAC (>250 mg/dL) was an independent indicator of shock.
CONCLUSION
High BAC is a predicator of shock and the need for mechanical ventilation in patients with trauma, regardless of injury severity. Alcohol intoxication leads to an overestimate of the clinical condition and aggressive management for trauma patients. Thus, a guideline for the diagnosis and treatment of patients intoxicated with alcohol is necessary.; Summary

Case Reports

Arteriovenous Fistula between Renal Artery and Inferior Vena Cava following Penetrating Abdominal Trauma; A Case Report: Joong Suck Kim, Seung Je Go, Ji Dae Kim, Young Hoon Sul, Jin Bong Ye, Sang Soon Park, Gwan Woo Ku, Yeong Cheol Kim; J Trauma Inj. 2015;28(4):262-265. Published online December 31, 2015; DOI: https://doi.org/10.20408/jti.2015.28.4.262

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Abstract PDF: An arteriovenous fistula (AVF) from the renal artery following a penetrating abdominal trauma is not common. We report the case of a 19-year-old male who presented with a knife stab wound in the right upper quadrant. Due to unstable vital signs and to the protrusion of the mesentery through the stab wound, providing definite evidence of peritoneal violation, an emergent exploratory laparotomy was carried out. There were injuries at the proximal transverse mesocolon and the second portion of the duodenum, with bile leakage. There was also a mild amount of retroperitoneal hematoma near the right kidney, without signs of expansion or pulsation. The mesocolon and the duodenum were repaired. After the operation, abdominal computerized tomography (CT) was performed, which revealed contrast from the right renal artery shunting directly into the vena cava. Transcatheter arterial embolization with a coil and vascular plug was performed, and the fistula was repaired. The patient recovered completely and was discharged without complication. For further and thorough evaluation of an abdominal trauma, especially one involving the retroperitoneum, a CT scan is recommended, when possible, either prior to surgery or after surgery when the patient is stabile. Furthermore, a lateral retroperitoneal hematoma and an AVF after a penetrating trauma may not always require exploration. Sometimes, it may be safely treated non-operatively or with embolization.; Summary

Endovascular Stent Placement in a Patient with a Posttraumatic Isolated Superior Mesenteric Artery Dissection with Focally Progressing Dissecting Aneurysms and a Severely Compressed True Lumen: Young Kyu Kim, Kyu Hee Her, Seung Hyoung Kim, Kwangsik Kim; J Trauma Inj. 2015;28(4):266-271. Published online December 31, 2015; DOI: https://doi.org/10.20408/jti.2015.28.4.266

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Abstract PDF: Reports on a posttraumatic isolated superior mesenteric artery (SMA) dissection are rare. Recently, endovascular stent placement via percutaneous access, instead of vascular surgery, has been widely accepted as the initial treatment for a patient with an isolated SMA dissection or its complications. A 60-year-old female patient was transferred to our hospital due to an isolated SMA dissection after a car accident. The SMA dissection was 8.5 cm in length, and it involved the true lumen, which was severely compressed by the thrombosed false lumen. The patient was closely observed because she did not complain of any specific visceral pain. On the seventh hospital day, she underwent computed tomography (CT) to decide on a further treatment plan, irrespective of the presence of the abdominal symptom. The findings of the follow-up CT showed no difference compared to those of the previous CT. She was discharged with anticoagulants. One month later, the follow-up CT revealed focally progressing dissecting aneurysms in the false lumen of the dissected SMA and a more severely compressed true lumen. Two self-expandable metallic stents were successfully placed in the true lumen of the dissected SMA, covering two aneurysmal lesions. Herein, we report a successful endovascular treatment with stent placement for treating focally progressing dissecting aneurysms and a severely compressed true lumen in a patient with a posttraumatic isolated SMA dissection.; Summary

Pelvic Bone Fracture with Preperitoneal Hemorrhage: Joong Suck Kim, Young Hoon Sul, Seung Je Go, Jin Bong Ye, Sang Soon Park, Gwan Woo Ku, Yeong Cheol Kim; J Trauma Inj. 2015;28(4):272-275. Published online December 31, 2015; DOI: https://doi.org/10.20408/jti.2015.28.4.272

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Abstract PDF: Pelvic bone fracture with unstable vital signs is a life-threatening condition demanding proper diagnosis and immediate treatment. Unlike long bones, the pelvic bone is a three dimensional structure with complex holes and grooves for vessels and nerves. Because of this complexity, a pelvic bone fracture can lead to complicated and serious bleeding. We report a case of a fifty-year-old male suffering from a pelvic bone fracture due to a fall. An imaging study showed fractures of both the superior and the inferior ramus of the pubic bone, with contrast extravasation underneath them, resulting in a large preperitoneal hematoma. He was sent for angiography, which revealed a hemorrhage from a branch of the left obturator artery. Embolization was done with a glue and lipiodol mixture. The patient recovered without complication, and was discharged at four weeks after admission.; Summary

Vacuum-assisted Closure Therapy for Treating Patients with Severe Subcutaneous Emphysema: Tak Hyuk Oh, Sang Cjeol Lee, Deok Heon Lee, Joon Yong Cho; J Trauma Inj. 2015;28(4):276-279. Published online December 31, 2015; DOI: https://doi.org/10.20408/jti.2015.28.4.276

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Abstract PDF: Subcutaneous emphysema is a benign condition following trauma (pneumothorax and oropharyngeal), cervical or thoracic procedures, and mediastinal infection. However, severe subcutaneous emphysema may be related to serious complications such as respiratory failure, airway compromise, and tension- related phenomena. Many alternative therapies have been tried to treat patients with this condition. We report our experience with vacuum-assisted closure therapy for treating patients with severe subcutaneous emphysema.; Summary

Tillaux Fracture in an Adolescent with a Trimalleolar Ankle Fracture: Seok Kyun Park, Soo Uk Chae; J Trauma Inj. 2015;28(4):280-283. Published online December 31, 2015; DOI: https://doi.org/10.20408/jti.2015.28.4.280

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Abstract PDF: The adolescent Tillaux fracture is an avulsion fracture of the anterolateral corner of the distal tibial epiphysis caused by external rotation of the foot. This type of fracture occurs during epiphyseal fusion in adolescence. A difficult to detect Tillaux fracture was discovered on a preoperative radiograph, such fractures have rarely been reported to accompany a predominantly adult-type ankle fracture. Especially, to the best of our knowledge, no case of a trimalleolar ankle fracture in an adolescent with a Tillaux fracture has been reported. Thus, we present a case of a trimalleolar ankle fracture in a 15-year-old adolescent with a Tillaux fracture who was successfully treated surgically.; Summary

Nonoperative Treatment for Abdominal Injury in Multiple Trauma Patients: Experience in the Metropolitan Tertiary Hospital in Korea (2009~2014): Seung Young Oh, Gil Joon Suh; J Trauma Inj. 2015;28(4):284-291. Published online December 31, 2015; DOI: https://doi.org/10.20408/jti.2015.28.4.284

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Abstract PDF: The aim of this study is to present a nonoperative treatment for abdominal injuries in patients with multiple traumas and to discuss the role of metropolitan tertiary hospital, non-regional trauma centers. We collected data from patients with multiple traumas including abdominal injuries from 2009 to 2014. Patient characteristics, associated injuries, short-term outcomes and departments that managed the patients overall were analyzed. Based on treatment modalities for abdominal injury, patients were divided into two groups: the operative treatment group and the nonoperative treatment group. We compared differences in patient characteristics, injury mechanisms, initial vital signs, detailed injury types, lengths of hospital and ICU stays. Of the 167 patients with multiple traumas, abdominal injuries were found in 57 patients. The injury mechanism for 44 patients (77.2%) was traffic accidents, and associated extra-abdominal injuries were shown in 45 patients (78.9%). The mean lengths of hospital and ICU stays for the 57 patients were 36.4 days and 8.3 days, respectively. The in-hospital mortality rate was 8.8%. Ten patients (17.5%) were treated operatively, and 47 patients (82.5%) were treated nonoperatively. Among the 47 patients in the nonoperative treatment group, 17 patients received embolization, and 3 patients underwent a percutaneous drainage procedure. Operative treatments were used more in patients with injuries to the pancreas and bowel. No patient required additional surgery or died due to the failure of nonoperative treatment. No differences in the clinical characteristics except for the detailed injury type were observed between the two groups. In appropriately selected patients with multiple traumas including abdominal injuries, nonoperative treatment is a safe and feasible. For rapid and accurate managements of these patients, well-trained trauma surgeons who can manage problems with the various systems in the human body and who can decide whether nonoperative treatment is appropriate or not are required.; Summary

Inadvertent Arterial Catheterization of Central Venous Catheter: A Case Report: Seung Young Oh; J Trauma Inj. 2015;28(4):292-294. Published online December 31, 2015; DOI: https://doi.org/10.20408/jti.2015.28.4.292

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Abstract PDF: Central venous catheterization is one of the most important procedures for initial resuscitation of hemodynamically unstable patients including multiple trauma patients. Inadvertent arterial placement of the large caliber central venous catheter can results in resuscitation failure as well as unnecessary invasive treatment. Here, we report an arterial puncture during central venous catheterization which may lead to inadvertent arterial catheterization. We recommend that arterial catheterization should be evaluated before dilator insertion during Seldinger's method. Ultrasound can help in preventing the inadvertent arterial catheterization of central venous catheter.; Summary

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