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Volume 33(1); March 2020
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Original Articles
Clinical Practice Guideline for the Treatment of Traumatic Shock Patients from the Korean Society of Traumatology
Pil Young Jung, Byungchul Yu, Chan-Yong Park, Sung Wook Chang, O Hyun Kim, Maru Kim, Junsik Kwon, Gil Jae Lee
J Trauma Inj. 2020;33(1):1-12.   Published online March 30, 2020
DOI: https://doi.org/10.20408/jti.2020.015
  • 17,818 View
  • 1,012 Download
  • 2 Citations
AbstractAbstract PDF
Purpose

Despite recent developments in the management of trauma patients in South Korea, a standardized system and guideline for trauma treatment are absent.

Methods

Five guidelines were assessed using the Appraisal of Guidelines for Research and Evaluation II instrument.

Results

Restrictive volume replacement must be used for patients experiencing shock from trauma until hemostasis is achieved (1B). The target systolic pressure for fluid resuscitation should be 80–90 mmHg in hypovolemic shock patients (1C). For patients with head trauma, the target pressure for fluid resuscitation should be 100–110 mmHg (2C). Isotonic crystalloid fluid is recommended for initially treating traumatic hypovolemic shock patients (1A). Hypothermia should be prevented in patients with severe trauma, and if hypothermia occurs, the body temperature should be increased without delay (1B). Acidemia must be corrected with an appropriate means of treatment for hypovolemic trauma patients (1B). When a large amount of transfusion is required for trauma patients in hypovolemic shock, a massive transfusion protocol (MTP) should be used (1B). The decision to implement MTP should be made based on hemodynamic status and initial responses to fluid resuscitation, not only the patient’s initial condition (1B). The ratio of plasma to red blood cell concentration should be at least 1:2 for trauma patients requiring massive transfusion (1B). When a trauma patient is in life-threatening hypovolemic shock, vasopressors can be administered in addition to fluids and blood products (1B). Early administration of tranexamic acid is recommended in trauma patients who are actively bleeding or at high risk of hemorrhage (1B). For hypovolemic patients with coagulopathy non-responsive to primary therapy, the use of fibrinogen concentrate, cryoprecipitate, or recombinant factor VIIa can be considered (2C).

Conclusions

This research presents Korea's first clinical practice guideline for patients with traumatic shock. This guideline will be revised with updated research every 5 years.

Summary

Citations

Citations to this article as recorded by  
  • An Artificial Intelligence Model for Predicting Trauma Mortality Among Emergency Department Patients in South Korea: Retrospective Cohort Study
    Seungseok Lee, Wu Seong Kang, Do Wan Kim, Sang Hyun Seo, Joongsuck Kim, Soon Tak Jeong, Dong Keon Yon, Jinseok Lee
    Journal of Medical Internet Research.2023; 25: e49283.     CrossRef
  • Nonselective versus Selective Angioembolization for Trauma Patients with Pelvic Injuries Accompanied by Hemorrhage: A Meta-Analysis
    Hyunseok Jang, Soon Tak Jeong, Yun Chul Park, Wu Seong Kang
    Medicina.2023; 59(8): 1492.     CrossRef
The Suitability of the CdC field Triage for Korean Trauma Care
Kang Kook Choi, Myung Jin Jang, Min A Lee, Gil Jae Lee, Byungchul Yoo, Youngeun Park, Jung Nam Lee
J Trauma Inj. 2020;33(1):13-17.   Published online March 30, 2020
DOI: https://doi.org/10.20408/jti.2020.013
  • 5,053 View
  • 117 Download
  • 3 Citations
AbstractAbstract PDF
Purpose

Accurate and appropriate prehospital field triage is essential for a trauma system. The Korean trauma system (established in 2014) uses the trauma field triage algorithm of the United States Centers for Disease Control and Prevention (CDC). This study evaluated the suitability of the CDC field triage criteria for major trauma cases (injury severity score >15) in Korea.

Methods

This retrospective cohort study evaluated trauma patients who presented at the authors’ regional trauma center from January 1 to May 7, 2017. The undertriage and overtriage rates of each CDC field triage step were calculated. Receiver operating characteristic curves were constructed, and the area under the curve (AUC) was evaluated for each step.

Results

Among the 1,009 enrolled patients, 168 (16.7%) had major trauma. The undertriage/overtriage rates of each step (steps I, II, III, and IV) of CDC field triage were 9.2%/47.4%, 6.3%/50.8%, 4.5%/59.4%, and 5.3%/78.9%, respectively. The AUC values of each CDC triage step were 0.722, 0.783, 0.791, and 0.615, respectively. The AUC values of the separate components of each step (physiologic criteria, anatomic criteria, mechanism-of-injury criteria, and special considerations) were 0.722, 0.648, 0.647, and 0.456, respectively.

Conclusions

The CDC field triage system is acceptable, but not ideal, for Korean trauma care. If we follow the protocol, it would be preferable to omit step IV. The Korean Triage and Acuity Scale may be a good indicator for in-hospital triage. However, a new triage protocol that is simple to estimate on-scene while having good performance should be developed.

Summary

Citations

Citations to this article as recorded by  
  • Effects of Transport to Trauma Centers on Survival Outcomes Among Severe Trauma Patients in Korea: Nationwide Age-Stratified Analysis
    Hakrim Kim, Kyoung Jun Song, Ki Jeong Hong, Jeong Ho Park, Tae Han Kim, Stephen Gyung Won Lee
    Journal of Korean Medical Science.2024;[Epub]     CrossRef
  • Prehospital triage in emergency medical services system: A scoping review
    Kisook Kim, Booyoung Oh
    International Emergency Nursing.2023; 69: 101293.     CrossRef
  • 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
Feasibility of Early Definitive Internal Fixation of Pelvic Bone Fractures in Therapeutic Open Abdomen
Kyunghak Choi, Kwang-Hwan Jung, Min Ae Keum, Sungjeep Kim, Jihoon T Kim, Kyu-Hyouck Kyoung
J Trauma Inj. 2020;33(1):18-22.   Published online March 30, 2020
DOI: https://doi.org/10.20408/jti.2019.044
  • 4,447 View
  • 99 Download
AbstractAbstract PDF
Purpose

Damage control laparotomy has contributed to improved survival rates for severe abdominal injuries. A large part of severe abdominal injury occurs with a concomitant pelvic bone fracture. The safety and effectiveness of internal fixation of pelvic bone fracture(s) has not been established. The aim of the present study was to evaluate infection risk in the pelvic surgical site in patients who underwent emergent abdominal surgery.

Methods

This single-center retrospective observational study was based on data collected from a prospectively maintained registry between January 2015 and June 2019. Patients who underwent laparotomy and pelvic internal fixation were included. Individuals <18 and ≥80 years of age, those with no microbiological investigations, and those who underwent one-stage abdominal surgery were excluded. Comprehensive statistical comparative analysis was not performed due to the small number of enrolled patients.

Results

A total of six patients met the inclusion criteria, and the most common injury mechanism was anterior-posterior compression (67%). The average duration of open abdomen was 98 hours (range, 44–198), and the time interval between abdominal closure and pelvic surgery was 98 hours. One patient (16.7%) died due to multi-organ dysfunction syndrome. Micro-organisms were identified in the abdominal surgical site in five patients (83%), with no micro-organisms in pelvic surgical sites. There was no unplanned implant removal.

Conclusions

Internal fixation of pelvic bone fracture(s) could be performed in the state of open abdomen, and the advantages of early fixation may countervail the risks for cross contamination.

Summary
Resuscitative Endovascular Balloon occlusion of the aorta in Impending Traumatic arrest: Is It Effective?
Jae Sik Chung, Oh Hyun Kim, Seongyup Kim, Ji Young Jang, Gyo Jin An, Pil Young Jung
J Trauma Inj. 2020;33(1):23-30.   Published online March 30, 2020
DOI: https://doi.org/10.20408/jti.2020.001
  • 4,795 View
  • 140 Download
  • 2 Citations
AbstractAbstract PDF
Purpose

Hemorrhagic shock is the leading cause of death in trauma patients worldwide. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a technique used to improve the hemodynamic stability of patients with traumatic shock and to temporarily control arterial hemorrhage. However, further research is required to determine whether REBOA with cardiopulmonary resuscitation (CPR) in near-arrest or arrest trauma patients can help resuscitation. We analyzed trauma patients who underwent REBOA according to their CPR status and evaluated the effects of REBOA in arrest situations.

Methods

This study was a retrospective single-regional trauma center study conducted at a tertiary medical institution from February 2017 to November 2019. We evaluated the mortality of severely injured patients who underwent REBOA and analyzed the factors that influenced the outcome. Patients were divided into CPR and non-CPR groups.

Results

We reviewed 1,596 trauma patients with shock, of whom 23 patients underwent REBOA (1.4%). Two patients were excluded due to failure and a repeated attempt of REBOA. The Glasgow Coma Scale score was lower in the CPR group than in the non-CPR group (p=0.009). Blood pressure readings at the emergency room were lower in the CPR group than in the non-CPR group, including systolic blood pressure (p=0.012), diastolic blood pressure (p=0.002), and mean arterial pressure (p=0.008). In addition, the mortality rate was higher in the CPR group (100%) than in the non-CPR group (50%) (p=0.012). The overall mortality rate was 76.2%.

Conclusions

Our study suggests that if REBOA is deemed necessary in a timely manner, it is better to perform REBOA before an arrest occurs. Therefore, appropriate protocols, including pre-hospital REBOA, should be constructed to demonstrate the effectiveness of REBOA in reducing mortality in arrest or impending arrest patients.

Summary

Citations

Citations to this article as recorded by  
  • An Early Experience of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in the Republic of Korea: A Retrospective Multicenter Study
    Joonhyeon Park, Sung Woo Jang, Byungchul Yu, Gil Jae Lee, Sung Wook Chang, Dong Hun Kim, Ye Rim Chang, Pil Young Jung
    Journal of Trauma and Injury.2020; 33(3): 144.     CrossRef
  • Pitfalls, Complications, and Necessity of Education about REBOA: A Single Regional Trauma Center Study
    Sol Kim, Jae Sik Chung, Sung Woo Jang, Pil Young Jung
    Journal of Trauma and Injury.2020; 33(3): 153.     CrossRef
Trauma Volume and Performance of a regional Trauma Center in Korea: Initial 5-year analysis
Byungchul Yu, Giljae Lee, Min A Lee, Kangkook Choi, Sungyoul Hyun, Yangbin Jeon, Yong-Cheol Yoon, Jungnam Lee
J Trauma Inj. 2020;33(1):31-37.   Published online March 30, 2020
DOI: https://doi.org/10.20408/jti.2020.004
  • 5,562 View
  • 141 Download
  • 7 Citations
AbstractAbstract PDF
Purpose

We aimed to evaluate the trauma volume and performance indicators during the first 5-year period of operation in a single regional trauma center.

Methods

We analyzed prospectively collected data from the Korean Trauma Data Bank for a single regional trauma center between January 2014 and December 2018. More than 250 variables were analyzed. We calculated the predicted survival rates using the trauma and injury severity score (TRISS) method.

Results

In total, there were 16,103 trauma admissions during the first 5 years; trauma activation was performed in 5,105 of these cases. Over 70% of the patients were men, and most of the admitted patients were within the age groups of 55–59 years for men and 75–79 years for women. Analyses were performed considering two patient groups: the total patient group and the group of those with severe trauma (injury severity score [ISS] >15). The median ISS, revised trauma score, and TRISS of the two groups were 5 (interquartile range [IQR] 4–10), 22 (IQR 17–27), and 7.6±0.99 and 6.74±1.9, 0.95±0.13, 0.81±2.67, respectively. Of the total patient group, 801 patients (5%) died in the hospital, whereas of the group of patients with ISS >15, 526 (19.5%) died. The direct transportation of patients to the regional trauma center increased year by year. The emergency room stay time and time to entering the operating room showed a decrease until 2017; however, these parameters increased again in 2018.

Conclusions

The trauma volume in the regional trauma center is appropriate, and some improvements could be observed after its establishment. However, performance indicators reveal the prematurity of the trauma center and its potential for further improvements. Moreover, the development of a national trauma system, beyond regional trauma centers, is required.

Summary

Citations

Citations to this article as recorded by  
  • Prioritization of Injury Prevention and Management Programs and Research and Development (R&D) Projects: Survey Using the Delphi Technique and Analytic Hierarchy Process
    Won Kyung Lee, Minsu Ock, Ju Ok Park, Changsoo Kim, Beom Sok Seo, Jeehee Pyo, Hyun Jin Park, Ui Jeong Kim, Eun Jeong Choi, Shinyoung Woo, Hyesook Park
    Asia Pacific Journal of Public Health.2024; 36(1): 78.     CrossRef
  • Positive impact of trauma center to exsanguinating pelvic bone fracture patient survival: A Korean trauma center study
    Mina Lee, Byungchul Yu, Giljae Lee, Jungnam Lee, Kangkook Choi, Youngeun Park, Jihun Gwak, Myung Jin Jang
    Hong Kong Journal of Emergency Medicine.2023; 30(4): 225.     CrossRef
  • Understanding Regional Trauma Centers and managing a trauma care system in South Korea: a systematic review
    Jeehye Im, Eun Won Seo, Kyoungwon Jung, Junsik Kwon
    Annals of Surgical Treatment and Research.2023; 104(2): 61.     CrossRef
  • Multifaceted Analysis of the Environmental Factors in Severely Injured Trauma: A 30-Day Survival Analysis
    Sung Woo Jang, Hae Rim Kim, Pil Young Jung, Jae Sik Chung
    Healthcare.2023; 11(9): 1333.     CrossRef
  • Changes in the Deceased-Donor Trend in Korea: Establishment of Regional Trauma Centers and KODA
    Jeong-Moo Lee
    Journal of Clinical Medicine.2022; 11(5): 1239.     CrossRef
  • An Evaluation of the Effect of Performance Improvement and Patient Safety Program Implemented in a New Regional Trauma Center of Korea
    Yo Huh, Junsik Kwon, Jonghwan Moon, Byung Hee Kang, Sora Kim, Jayoung Yoo, Seoyoung Song, Kyoungwon Jung
    Journal of Korean Medical Science.2021;[Epub]     CrossRef
  • Artificial intelligence to predict in-hospital mortality using novel anatomical injury score
    Wu Seong Kang, Heewon Chung, Hoon Ko, Nan Yeol Kim, Do Wan Kim, Jayun Cho, Hongjin Shim, Jin Goo Kim, Ji Young Jang, Kyung Won Kim, Jinseok Lee
    Scientific Reports.2021;[Epub]     CrossRef
Immediate Post-laparotomy Hypotension in Patients with Severe Traumatic Hemoperitoneum
Gil Jae Lee, Min A Lee, Byungchul Yoo, Youngeun Park, Myung Jin Jang, Kang Kook Choi
J Trauma Inj. 2020;33(1):38-42.   Published online March 30, 2020
DOI: https://doi.org/10.20408/jti.2020.014
  • 6,709 View
  • 122 Download
AbstractAbstract PDF
Purpose

Immediate post-laparotomy hypotension (PLH) is a precipitous drop in blood pressure caused by a sudden release of abdominal tamponade after laparotomy in cases of severe hemoperitoneum. The effect of laparotomy on blood pressure in patients with significant hemoperitoneum is unknown.

Methods

In total, 163 patients underwent laparotomy for trauma from January 1, 2013 to December 31, 2015. Exclusion criteria included the following: negative laparotomy, only a hollow viscous injury, and hemoperitoneum <1,000 mL. After applying those criteria, 62 patients were enrolled in this retrospective review. PLH was defined as a decrease in the mean arterial pressure (MAP) ≥10 mmHg within 10 minutes after laparotomy.

Results

The mean estimated hemoperitoneum was 3,516 mL. The incidence of PLH was 23% (14 of 62 patients). The MAP did not show significant differences before and after laparotomy (5 minutes post-laparotomy, 67.5±16.5 vs. 68.3±18.8 mmHg; p=0.7; 10 minutes post-laparotomy, 67.5±16.5 vs. 70.4±18.8 mmHg; p=0.193). The overall in-hospital mortality was 24% (15 of 62 patients). Mortality was not significantly higher in the PLH group (two of 14 [14.3%] vs. 13 of 48 [27.1%]; p=0.33). No statistically significant between-group differences were observed in the intensive care unit and hospital stay.

Conclusions

PLH may be less frequent and less devastating than it is often considered. Surgical hemostasis during laparotomy is important. Laparotomy with adequate resuscitation may explain the equivalent outcomes in the two groups.

Summary
Case Reports
The management of Pancreatic fistula Complicated by Gastric fistulation following Emergency Splenectomy
Tan Jih Huei, Henry Tan Chor Lip, Chow Sing Thou, Yuzaidi Mohamad, Rizal Imran Alwi
J Trauma Inj. 2020;33(1):43-47.   Published online March 30, 2020
DOI: https://doi.org/10.20408/jti.2019.036
  • 5,812 View
  • 159 Download
  • 1 Citations
AbstractAbstract PDF

Pancreatic and gastric fistulas are rare complications of emergency splenectomy, and it is extremely rare for a pancreatic fistula to be further complicated by a fistulation into the stomach. Here, we present a case of pancreatogastric fistula in a 60-year-old man who experienced polytrauma due to a blunt mechanism. He underwent emergency splenectomy for splenic injury and developed a pancreatic fistula as a complication. A percutaneous endoscopic procedure was performed to drain the fistula, after which he developed a pancreatogastric fistula as a further complication. A double-pigtail stent was inserted via gastroscopy into the fistula tract to allow internal drainage of the pancreatic collection into the stomach cavity. When a pancreatic fistula is complicated by gastric fistulation, endoscopic stenting of the pancreatogastric fistula tract for internal drainage is an effective treatment option.

Summary

Citations

Citations to this article as recorded by  
  • Successful percutaneous transgastric diversion of a chronic post-operative combined pancreaticocutaneous and gastrocutaneous fistula using a snare-target technique: A case report
    Katherine J. Li, Ken Leslie, Derek W. Cool
    International Journal of Surgery Case Reports.2021; 80: 105685.     CrossRef
Successful management of a Comatose Patient with Traumatic Brain Exposure with a fronto-Parieto-occipital flap
Charles Chidiebele Maduba, Ugochukwu Uzodimma Nnadozie
J Trauma Inj. 2020;33(1):48-52.   Published online March 30, 2020
DOI: https://doi.org/10.20408/jti.2019.037
  • 16,694 View
  • 194 Download
AbstractAbstract PDF

Composite skull defects in patients with severe head injuries are very challenging to manage. The dilemma when deciding whether to perform a definitive reconstruction is how long to wait for physiological recovery before an intervention complicates the situation. The inability of such patients to tolerate prolonged anesthetic exposure is a driving factor for performing the minimal intervention necessary to facilitate recovery. Herein, we present a case involving the successful immediate reconstructive treatment of a severely head-injured adolescent with a composite scalp defect secondary to trauma. A 14-year-old boy sustained a severe head injury from a motor vehicle accident with a composite scalp defect in the right fronto-parietal region. The frontal lobe was exposed, and the right eye was crushed and devitalized. The patient was deeply unconscious for 3 days, without any significant improvements before reconstructive surgery was proposed due to fear of possible meningitis resulting from the exposure of brain structures. We successfully managed the patient with a fronto-parieto-occipital flap, after which the patient promptly recovered consciousness.

Summary
Delayed manifestation of Isolated Intramural Hematoma of the duodenum resulting from Blunt abdominal Trauma
Tae Sun Ha, Jun Chul Chung
J Trauma Inj. 2020;33(1):53-58.   Published online March 30, 2020
DOI: https://doi.org/10.20408/jti.2019.042
  • 6,964 View
  • 147 Download
  • 2 Citations
AbstractAbstract PDF

Duodenal injury following blunt abdominal trauma is a relatively unusual complication, and it may sometimes be difficult to distinguish a duodenal hematoma from duodenal perforation. According to recent reports, intramural hematomas typically resolve spontaneously with conservative treatment. Surgery, however, is occasionally necessary in some cases if the diagnosis is delayed, conservative therapy fails, or a high degree of suspicion of duodenal injury persists. We experienced a case of delayed manifestation of a duodenal intramural hematoma that was surgically treated.

Summary

Citations

Citations to this article as recorded by  
  • Intramural duodenal hematoma: diagnosis and management of a rare entity
    Álvaro Pérez-Rubio, Juan Carlos Sebastián-Tomás, Sergio Navarro-Martínez, Marta Córcoles Córcoles, Carlos Domingo del Pozo
    Cirugía Española (English Edition).2023; 101(7): 515.     CrossRef
  • Hematoma intramural duodenal: diagnóstico y manejo de una entidad infrecuente
    Álvaro Pérez-Rubio, Juan Carlos Sebastián-Tomás, Sergio Navarro-Martínez, Marta Córcoles Córcoles, Carlos Domingo del Pozo
    Cirugía Española.2023; 101(7): 515.     CrossRef
Editorials
Re: Comparison of the Surgical Approaches for frontal Traumatic Intracerebral Hemorrhage
Luis Rafael Moscote-Salazar, Ezequiel Garcia-Ballestas, Pradeep Chouksey, Amit Agrawal
J Trauma Inj. 2020;33(1):59-60.   Published online March 30, 2020
DOI: https://doi.org/10.20408/jti.2020.005
  • 4,248 View
  • 69 Download
PDF
Summary
Reply to the Comments on “Case Series: Successful resuscitation of Severe facial Injuries Caused by a Chainsaw”
Han Joo Choi
J Trauma Inj. 2020;33(1):61-62.   Published online March 30, 2020
DOI: https://doi.org/10.20408/jti.2020.011
  • 4,610 View
  • 85 Download
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Summary

J Trauma Inj : Journal of Trauma and Injury