Journal of Trauma and Injury

Volume 29(3); September 2016

Original Articles

Prevalences of Incidental Findings in Trauma Patients by Abdominal and Pelvic Computed Tomography: Jin Young Lee, Myung Jae Jung, Jae Gil Lee, Seung Hwan Lee; J Trauma Inj. 2016;29(3):61-67. Published online September 30, 2016; DOI: https://doi.org/10.20408/jti.2016.29.3.61

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PURPOSE
Abdominal and pelvic computed tomography (APCT) is frequently used as a diagnostic tool in trauma patients. However, trauma unrelated, incidental findings are frequently encountered. The aim of this study was to determine the prevalences of incidental findings on APCT scans in trauma patients.
METHODS
The archived records of 801 trauma patients treated from January 2013 to December 2015 were reviewed retrospectively. Six hundred and forty of these patients underwent contrast enhanced APCT in an emergency department and were included in this study, and 205 (32.1%) of these patients had incidental findings. These findings were divided into two categories: category I, meaning a radiological benign finding not requiring further evaluation or follow- up, and category II, requiring further evaluation and follow-up.
RESULTS
One hundred and sixty (24.8%) patients were allocated to category I and 45 (7.2%) to category II. The most frequent incidental findings were discovered in kidneys (34.6%), followed by liver (28.8%), and gallbladder (15.6%). The most frequent finding in category I was a benign cyst (60.1%), followed by a simple stone (15.6%), and hemangioma (11.9%). Adenomyomatosis of the gallbladder (17.8%) was the most common lesion in category II, followed by atypical mass (15.6%), complicated stone (15.6%) and cystic neoplasm (15.6%).
CONCLUSION
The prevalence of an incidental finding on APCT scans was 32.1%. Although category II lesions were not common in trauma patients, these findings should be communicated to patients, and when necessary referred to a primary care physician. Systems are required for producing appropriate discharge summaries and informing patients about the implications of incidental findings.

Summary

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Incidental Cancer Diagnoses in Trauma Patients: A Case–Control Study Evaluating Long-term Outcomes
Nathaniel Bell, Amanda Arrington, Swann Arp Adams, Mark Jones, Joseph V. Sakran, Ambar Mehta, Jan M. Eberth
Journal of Surgical Research.2019; 242: 304. CrossRef
Filling the void: a low-cost, high-yield approach to addressing incidental findings in trauma patients
Nicholas Sich, Andrew Rogers, Danelle Bertozzi, Praveen Sabapathi, Waed Alswealmeen, Philip Lim, Jonathan Sternlieb, Laura Gartner, James Yuschak, Orlando Kirton, Ryan Shadis
Surgery.2018; 163(4): 657. CrossRef

A Comparison of the Effectiveness of Before and After the Regional Trauma Center's Establishment: Bo Hyung Song, Sung Youl Hyun, Jin Joo Kim, Jin Seong Cho, Dae Sung Ma, Ha Kyung Kim, Geun Lee; J Trauma Inj. 2016;29(3):68-75. Published online September 30, 2016; DOI: https://doi.org/10.20408/jti.2016.29.3.68

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PURPOSE
The purpose of this study was to analyze the effectiveness of regional trauma center's management.
METHODS
Data collected between January 2013 and December 2015 from a regional trauma center registry was retrospectively reviewed. The patients who had injury severity score (ISS) greater than 15 and over the age of 18 were included. We compared annual general characteristics, the injury mechanism, the pathway of transportation, the injury severity score, the length of stay in emergency department (ED) and hospital, the in-hospital mortality.
RESULTS
The annual numbers of enrolled patients were 337, 334 and 278, respectively. No significant differences were found in the annual patient's median ages, injury mechanism, ISS and in-hospital mortality. The annual proportions of coming from other hospital and the median length of stay in hospital were increased after establishment of regional trauma center. The annual median lengths of stay in ED were decreased remarkably.
CONCLUSION
Through the establishment of regional trauma center, the length of stay in ED can be reduced but not in-hospital mortality. More multidisciplinary cooperation and well-organized study is needed to reduce mortality of major trauma patients and maximize effect of regional trauma center.

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The Effects of a Trauma Team Approach on the Management of Open Extremity Fractures in Polytrauma Patients: A Retrospective Comparative Study
Seungyeob Sakong, Eic Ju Lim, Jun-Min Cho, Nak-Jun Choi, Jae-Woo Cho, Jong-Keon Oh
Journal of Trauma and Injury.2021; 34(2): 105. CrossRef

Analysis of Radiological and Clinical Results in Treatment of Open Segmented Tibia Fractures: A Comparison between Intramedullary Nailing and Minimal Invasive Plate Osteosynthesis: Ji Wan Kim, Hyung Keun Song; J Trauma Inj. 2016;29(3):76-81. Published online September 30, 2016; DOI: https://doi.org/10.20408/jti.2016.29.3.76

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Abstract PDF: PURPOSE
The purpose of this study was to compare the data comprehensively including not only the clinical and radiographic outcomes but some parameters related to operation between the minimally invasive plate osteosynthesis (MIPO) technique and intramedullary nailing (IMN) for treatment of segmental tibia shaft fractures.
METHODS
We conducted a retrospective study of 31 patients (mean age, 49.3 years, range, 27-74 years), with a mean follow-up of 14.1 months (range, 12-19 months) with acute segmental tibial fractures (AO 42-C2) who underwent either surgical treatment of MIPO or IMN. In accordance with the Gustilo-Anderson classification, 11 were type I, 5 were type II, and 15 were type III. Initial compartment syndrome was confirmed in 2 cases.
RESULTS
There were no statistically significant differences in terms of the patient demographic data between the two groups. The time to definitive fixation was longer in the MIPO group (mean 13.7±10.9 days; range, 2-27) than in the intramedullary group (mean 5.4±9.6 days; range, 0-35) with statistically significant difference (p=0.002). Bony union was observed in most of cases but except 5 cases of nonunion were diagnosed (3 in the MIPO vs 2 in IMN, p=0.188). The average bone healing time was 27.1 weeks (10 to 56 weeks) in MIPO group and 23.2 weeks (13 to 66 weeks) in IMN group, respectively (p=0.056). Overall complications were 5 cases in MIPO group and 2 cases in the IMN group. Difference in LEFS was not statistically significant between both groups (p=0.824).
CONCLUSION
This study showed that segmental tibia shaft fractures treated with both MIPO and intramadullary nailing was challenging with relatively high complication rate. A well planned sequential strategy with keeping the soft tissue and personality of fracture in mind is utmost significant as much as the choice of surgical modalities.; Summary

The Effectiveness of Extended Focused Assessment with Sonography for Trauma Education Conducted on the Medical College Students: Kyu Ho Oh, Han Ho Do, Hee Young Kim, Jun Seok Seo; J Trauma Inj. 2016;29(3):82-88. Published online September 30, 2016; DOI: https://doi.org/10.20408/jti.2016.29.3.82

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Abstract PDF

PURPOSE
Sonongraphic examinations such as extended Focused Assessment with Sonography in Trauma (eFAST) are widely used in Emergency Departments. This study is designed to determine student achievement by teaching medical college students through short training.
METHODS
38 participants in their 3rd year of medical school were enrolled in this study. An Emergency Medicine physician trained the students to 2 hours of theoretical training followed by 2 hours of hands on training.
RESULTS
The average age of students was 28.1±3.4, with 21 male students. The average of pre-educational test results were 60.4±8.9 and post-educational exam results were 80.1±14.5 (p<0.001). The average success rate of eFAST was 87.5%. But success rate of each items were lowest in checking the hepatorenal recess and the splenorenal recess, each success rate, 65.8% and 68.4%, consecutively. The questionnaires filled out after the study showed that the students were highly interested in this education and that they found the education easy to understand. They also answered that eFAST education is necessary in the medical college curriculum.
CONCLUSION
This study shows that eFAST can be effectively taught to students through short training.

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Diagnostic performance of the extended focused assessment with sonography for trauma (EFAST) patients in a tertiary care hospital of Nepal
Samjhana Basnet, Sanu Krishna Shrestha, Alok Pradhan, Roshana Shrestha, Anmol Purna Shrestha, Grishma Sharma, Sahil Bade, Latika Giri
Trauma Surgery & Acute Care Open.2020; 5(1): e000438. CrossRef

Case Reports

Video-Assisted Thoracoscopic Ligation of the Thoracic Duct in a Patient with Traumatic Chylothorax: Deok Heon Lee, Joon Yong Cho, Tak Hyuk Oh; J Trauma Inj. 2016;29(3):89-92. Published online September 30, 2016; DOI: https://doi.org/10.20408/jti.2016.29.3.89

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Abstract PDF: Non-surgical traumatic chylothorax following blunt chest trauma is rare, with only a few cases having been reported. In general, conservative treatment measures are recommended as initial management of traumatic chylothorax; these include closed thoracostomy, dietary restriction, and parenteral nutrition. There are few reports of surgery for traumatic chylothorax. We report our experience with thoracic duct ligation using video-assisted thoracoscopic surgery in a patient with chylothorax following blunt chest injury with associated fractures of the thoracic spine.; Summary

Successful Endoscopic Treatment of Hepatic Duct Confluence Injury after Blunt Abdominal Trauma: Case Report: Chan Ik Park, Sung Jin Park, Sang Bong Lee, Kwang Hee Yeo, Seon Uoo Choi, Seon Hee Kim, Jae Hun Kim, Dong Hoon Baek; J Trauma Inj. 2016;29(3):93-97. Published online September 30, 2016; DOI: https://doi.org/10.20408/jti.2016.29.3.93

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Abstract PDF: Hepatic duct confluence injury, which is developed by blunt abdominal trauma, is rare. Conventionally, bile duct injury was treated by surgical intervention. In recent decades, however, there had been an increase in radiologic or endoscopic intervention to treat bile duct injury. In a hemodynamically stable patient, endoscopic intervention is considered as the first-line treatment for bile duct injury. A 40 year-old man was transferred to the emergency department of OO trauma center after multiple blunt injuries. Contrast-enhanced abdominal computed tomography performed in another hospital showed a liver laceration with active arterial bleeding, fracture of the sacrum and left inferior pubic ramus, and intraperitoneal bladder rupture. The patient presented with hemorrhagic shock because of intra-peritoneal hemorrhage. After resuscitation, angiographic intervention was performed. After angiographic embolization of the liver laceration, emergency laparotomy was performed to repair the bladder injury. However, there was no evidence of bile duct injury on initial laparotomy. On post-trauma day (PTD) 4, the color of intra-abdominal drainage of the patient changed to a greenish hue; bile leakage was revealed on magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography (ERCP). Bile leakage was detected near the hepatic duct confluence; therefore, a biliary stent was placed into the left hepatic duct. On PTD 37, contrast leakage was still detected but both hepatic ducts were delineated on the second ERCP. Stents were placed into the right and left hepatic ducts. On PTD 71, a third ERCP revealed no contrast leakage; therefore, all stents were removed after 2 weeks (PTD 85). ERCP and biliary stenting could be effective treatment options for hemodynamically stable patients after blunt trauma.; Summary

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