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Volume 33(4); December 2020
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Editorial
Keep Playing Tug-of-War Against Grim Reaper
Kun Hwang
J Trauma Inj. 2020;33(4):205-206.   Published online December 31, 2020
DOI: https://doi.org/10.20408/jti.2020.0080
  • 3,080 View
  • 73 Download
  • 1 Citations
PDF
Summary

Citations

Citations to this article as recorded by  
  • Near-death experiences in 19th century Korean tales
    Kun Hwang
    Journal of Trauma and Injury.2023; 36(2): 75.     CrossRef
Special Article
Part 4. Clinical Practice Guideline for Surveillance and Imaging Studies of Trauma Patients in the Trauma Bay from the Korean Society of Traumatology
Sung Wook Chang, Kang Kook Choi, O Hyun Kim, Maru Kim, Gil Jae Lee
J Trauma Inj. 2020;33(4):207-218.   Published online December 31, 2020
DOI: https://doi.org/10.20408/jti.2020.0084
  • 3,229 View
  • 87 Download
AbstractAbstract PDF

The following recommendations are presented herein: All trauma patients admitted to the resuscitation room should be constantly (or periodically) monitored for parameters such as blood pressure, heart rate, respiratory rate, oxygen saturation, body temperature, electrocardiography, Glasgow Coma Scale, and pupil reflex (1C). Chest AP and pelvic AP should be performed as the standard initial trauma series for severe trauma patients (1B). In patients with severe hemodynamically unstable trauma, it is recommended to perform extended focused assessment with sonography for trauma (eFAST) as an initial examination (1B). In hemodynamically stable trauma patients, eFAST can be considered as the initial examination (2B). For the diagnosis of suspected head trauma patients, brain computed tomography (CT) should be performed as an initial examination (1B). Cervical spine CT should be performed as an initial imaging test for patients with suspected cervical spine injury (1C). It is not necessary to perform chest CT as an initial examination in all patients with suspected chest injury, but in cases of suspected vascular injury in patients with thoracic or high-energy damage due to the mechanism of injury, chest CT can be considered for patients in a hemodynamically stable condition (2B). CT of the abdomen is recommended for patients suspected of abdominal trauma with stable vital signs (1B). CT of the abdomen should be considered for suspected pelvic trauma patients with stable vital signs (2B). Whole-body CT can be considered in patients with suspicion of severe trauma with stable vital signs (2B). Magnetic resonance imaging can be considered in hemodynamically stable trauma patients with suspected spinal cord injuries (2B).

Summary
Original Articles
The Effectiveness of Simulation Training in an Advanced Trauma Life Support Program for General Surgery Residents: A Pilot Study
Myoung Jun Kim, Jae Gil Lee, Seung Hwan Lee
J Trauma Inj. 2020;33(4):219-226.   Published online October 27, 2020
DOI: https://doi.org/10.20408/jti.2020.0015
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  • 141 Download
AbstractAbstract PDFSupplementary Material
Purpose

Although the Advanced Trauma Life Support (ATLS) course is now taught internationally, it has not been implemented in Korea. In recent years, interest has increased in simulation as a teaching tool in the ATLS course. We therefore hypothesized that simulation training would be a useful adjunct to the ATLS course.

Methods

We designed a 1-day curriculum that included skill development workstations, expert lectures, trauma patient simulations, and group discussion for general surgery residents. We conducted a survey to evaluate participants’ level of understanding of the initial evaluation and treatment of trauma patients, their degree of knowledge and technical improvement, their satisfaction with the learning goals, and their overall satisfaction with the curriculum. We then analyzed the effects before and after the training.

Results

Nine residents attended this course. None of the residents initially reported that they could perform a primary survey of trauma patients. The analysis revealed significant improvements after training in the questionnaire areas of “assembly of the team and preparation for resuscitation of a trauma patient” (p=0.008), “performance of a primary survey for trauma patients” (p=0.007), “resuscitative procedures for trauma patients” (p=0.008), “importance of re-evaluation” (p=0.007), “identifying the pitfalls associated with the initial assessment and management” (p=0.007), and “importance of teamwork” (p=0.007).

Conclusions

After the ATLS simulation training, all participants showed significant improvements in their understanding of how to manage multiple trauma patients. Therefore, ATLS simulation training for residents will help in the management of trauma patients.

Summary
Alcohol Intoxication and Glasgow Coma Scale Scores in Patients with Head Trauma
Jisoo Park, Taejin Park, Jung-In Ko, Woonhyung Yeo
J Trauma Inj. 2020;33(4):227-235.   Published online December 31, 2020
DOI: https://doi.org/10.20408/jti.2020.0041
  • 8,461 View
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AbstractAbstract PDF
Purpose

Alcohol intoxication is commonly associated with traumatic brain injury (TBI), but the influence of alcohol on the Glasgow Coma Scale (GCS) score remains unclear. This study investigates the effects of blood alcohol concentration (BAC) on the GCS score in head trauma patients with alcohol intoxication.

Methods

In total, 369 head trauma patients with alcohol intoxication in a 1-year period were retrospectively analyzed. The patients underwent head computed tomography and had a BAC ≥80 mg/dL. Patients were divided into TBI and non-TBI groups. Brain injury severity was further classified using the head Abbreviated Injury Score (AIS). The effects according to 5 BAC groups were examined.

Results

The TBI group consisted of 64 patients (16.2%). The mean BAC was significantly higher in the non-TBI group (293.4±87.3 mg/dL) than in the TBI group (242.8±89.9 mg/dL). The mean GCS score was significantly lower in the TBI group (10.3±4.6) than in the non-TBI group (13.0±2.5). A higher BAC showed a significant association with a lower mean GCS score in the TBI group, but not in the non-TBI group. Above ≥150 mg/dL, higher BACs showed significant odds ratios for a lower GCS score.

Conclusions

The influence of alcohol in patients with head trauma depended on the presence of a brain injury. An association between a higher BAC and a lower GCS score was only observed in patients with TBI. Therefore, if a severe brain injury is suspected based on a GCS evaluation in patients with alcohol intoxication, prompt diagnosis and intensive care should be performed without delay.

Summary
A Reappraisal of the Necessity of a Ventriculoperitoneal Shunt After Decompressive Craniectomy in Traumatic Brain Injury
Seunghan Yu, Hyuk Jin Choi, Jung Hwan Lee, Mahnjeong Ha, Byung Chul Kim
J Trauma Inj. 2020;33(4):236-241.   Published online December 31, 2020
DOI: https://doi.org/10.20408/jti.2020.0072
  • 3,220 View
  • 111 Download
  • 1 Citations
AbstractAbstract PDF
Purpose

Cranioplasty itself is believed to have therapeutic effects on hydrocephalus. The goal of this study was to evaluate the hypothesis that not every patient with hydrocephalus after decompressive craniectomy needs cerebrospinal fluid diversion, and that cranioplasty should be performed before considering cerebrospinal fluid diversion.

Methods

Data were collected from 67 individual traumatic brain injury patients who underwent cranioplasty between January 1, 2019 and December 31, 2019. Patients’ clinical and radiographic progression was reviewed retrospectively based on their medical records.

Results

Twenty-two of the 67 patients (32.8%) had ventriculomegaly on computed tomography scans before cranioplasty. Furthermore, 38 patients showed progressive ventriculomegaly after cranioplasty. Of these 38 patients, only six (15.7%) showed worsening neurologic symptoms, which were improved by the tap test; these patients eventually underwent ventriculoperitoneal shunt placement.

Conclusions

Cerebrospinal fluid diversion is not always required for radiologically diagnosed ventriculomegaly in traumatic brain injury patients after decompressive craniectomy. A careful clinical and neurologic evaluation should be conducted before placing a shunt.

Summary

Citations

Citations to this article as recorded by  
  • Post-traumatic hydrocephalus may be associated with autologous cranioplasty failure, independent of ventriculoperitoneal shunt placement: a retrospective analysis
    Carole S. L. Spake, Dardan Beqiri, Vinay Rao, Joseph W. Crozier, Konstantina A. Svokos, Albert S. Woo
    British Journal of Neurosurgery.2022; 36(6): 699.     CrossRef
Associated Injuries in Spine Trauma Patients: A Single-Center Experience
Seunghan Yu, Hyuk Jin Choi, Jung Hwan Lee, Byung Chul Kim, Mahnjeong Ha, In Ho Han
J Trauma Inj. 2020;33(4):242-247.   Published online December 31, 2020
DOI: https://doi.org/10.20408/jti.2020.0071
  • 2,573 View
  • 75 Download
AbstractAbstract PDF
Purpose

The purpose of this study was to determine the incidence and characteristics of associated injuries in patients with spine trauma.

Methods

Data of 3,920 consecutive patients admitted to a regional trauma center during a 3-year period were analyzed retrospectively.

Results

Of the 3,920 patients who were admitted to the trauma center during the 3-year study period, 389 (9.9%) had major spinal injuries. Among these 389 patients, 303 (77.9%) had associated injuries outside the spine. The most common body region of associated injuries was the extremities or pelvis (194 cases, 49.4%), followed by the chest (154 cases, 39.6%) and face (127 cases, 32.6%). Of these 303 patients, 149 (64%) had associated injuries that required surgical treatment such as laparotomy or internal fixation. Associated injuries were more common in patients with lumbar injuries (93.3%) or multiple spinal injuries (100%) than in those with lower cervical injuries (67.4%). There was a significant correlation between the location of the spinal injury and the body region of the associated injury. However, distant associated injuries were also common.

Conclusions

Associated injuries were very common in spinal injury patients. Based on demographic groups, the trauma mechanism, and the location of spinal injury, an associated injury should be suspected until proven otherwise. Using a multidisciplinary and integrated approach to treat trauma victims is of the paramount importance.

Summary
Correlations of Weather and Time Variables with Visits of Trauma Patients at a Regional Trauma Center in Korea
Hyuk Jin Choi, Jae Hoon Jang, Il Jae Wang, Mahnjeong Ha, Seunghan Yu, Jung Hwan Lee, Byung Chul Kim
J Trauma Inj. 2020;33(4):248-255.   Published online December 31, 2020
DOI: https://doi.org/10.20408/jti.2020.0062
  • 2,902 View
  • 69 Download
  • 1 Citations
AbstractAbstract PDF
Purpose

Trauma incidence and hospitalizations of trauma patients are generally believed to be affected by season and weather. The objective of this study was to explore possible associations of the hospitalization rate of trauma patients with weather and time variables at a single regional trauma center in South Korea.

Methods

Trauma hospitalization data were obtained from a regional trauma center in South Korea from January 1, 2017 to December 31, 2019. In total, from 6,788 patients with trauma, data of 3,667 patients were analyzed, excluding those from outside the city where the trauma center was located. Hourly weather service data were obtained from the Korea Meteorological Administration.

Results

The hospitalization rate showed positive correlations with temperature (r=0.635) and wind speed (r=0.501), but a negative correlation with humidity (r=−0.620). It showed no significant correlation (r=0.036) with precipitation. The hospitalization rate also showed significant correlations with time of day (p=0.033) and month (p=0.22).

Conclusions

Weather and time affected the number of hospitalizations at a trauma center. The findings of this study could be used to determine care delivery, staffing, and resource allocation plans at trauma centers and emergency departments.

Summary

Citations

Citations to this article as recorded by  
  • Climate change and mental health in Korea: A scoping review
    Jiyoung Shin, Juha Baek, Sumi Chae
    Journal of Climate Change Research.2023; 14(6-2): 989.     CrossRef
Case Reports
Traumatic Posterior Fossa Subdural Hematoma in a Neonate: A Case Report
Ki Seong Eom
J Trauma Inj. 2020;33(4):256-259.   Published online November 10, 2020
DOI: https://doi.org/10.20408/jti.2020.009
  • 3,339 View
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AbstractAbstract PDF

Although traumatic posterior fossa subdural hematoma (TPFSH) in neonates immediately after birth is extremely rare, it can pose a serious clinical problem in the neonatal period. Here, the author presents the case of a 3-day-old male infant who underwent emergency surgical treatment of TPFSH with a favorable outcome. Debate continues about surgical versus conservative treatment of TPFSH in neonates. The clinical symptoms, extent of hemorrhage, early diagnosis, and prompt and appropriate surgery are the most important factors in the treatment of TPFSH in neonates. Therefore, neurosurgeons should establish treatment strategies based on the newborn’s clinical condition, the size and location of the TPFSH, and the potential of the hematoma to cause long-term complications.

Summary
Life-Threatening Necrotizing Fasciitis of the Posterior Neck
Ji-An Choi, Jung-Ha Kwak, Chung-Min Yoon
J Trauma Inj. 2020;33(4):260-263.   Published online November 27, 2020
DOI: https://doi.org/10.20408/jti.2020.0025
  • 3,374 View
  • 60 Download
  • 1 Citations
AbstractAbstract PDF

Necrotizing fasciitis is an infection of the subcutaneous tissue that results in destruction of the fascia and is disproportionately common in patients with chronic liver disease or diabetes. Necrotizing fasciitis of the head and neck is rare, but has a high fatality rate. A 50-year-old man with a past medical history of diabetes reported a chief complaint of a wound in the posterior neck due to trauma. The wound had grown and was accompanied by pus and redness, and the patient had a fever. When the patient was referred to department of plastic & reconstructive surgery, the sternocleidomastoid muscle, semispinalis capitis muscle, splenius capitis muscle, and trapezius muscles were exposed, and the size of the defect was about 25×20 cm. Dead tissue resection was performed before negative-pressure wound therapy, followed by a split-thickness skin graft (STSG). After a 2-week course of aseptic dressing post-STSG, the patient recovered completely. No postoperative complications were observed for 1 year. Necrotizing fasciitis is a life-threatening, rapidly spreading infection, requiring early diagnosis and active surgical treatment. In addition, broad-spectrum antibiotics are required due to the variety of types of causative bacteria. Broad necrotizing fasciitis of the posterior neck is rare, but can quickly progress into a life-threatening stage.

Summary

Citations

Citations to this article as recorded by  
  • Posterior cervical necrotising fasciitis: a multidisciplinary endeavour in surgery
    Jia Hui Lee, Fung Joon Foo, Allen Wei-Jiat Wong
    Journal of Surgical Case Reports.2023;[Epub]     CrossRef
Traumatic Tricuspid Regurgitation as a Cause of Failure to Wean from Mechanical Ventilation
Yang Bin Jeon, Chul Hyun Park, Dae Sung Ma
J Trauma Inj. 2020;33(4):264-268.   Published online November 19, 2020
DOI: https://doi.org/10.20408/jti.2020.0005
  • 2,628 View
  • 55 Download
AbstractAbstract PDF

A 55-year-old man underwent emergent sternotomy due to cardiac tamponade occurring just after an accidental fall from a 10-m height. Tricuspid valve regurgitation was found on echocardiography while he was on mechanical ventilation after the operation. The patient was weaned successfully from mechanical ventilation after tricuspid valve repair under cardiopulmonary bypass. Traumatic tricuspid valve regurgitation is a rare blunt chest injury and its symptoms occur late. Tricuspid regurgitation should be considered as a reason for failure to wean from mechanical ventilation after blunt cardiac trauma.

Summary
The Management of Open Pelvic Fractures: A Report of 2 Cases
Byungchul Yu, Giljae Lee, Min A Lee, Kangkook Choi, Jihun Gwak, Youngeun Park, Yong-Cheol Yoon, Jungnam Lee
J Trauma Inj. 2020;33(4):269-274.   Published online June 2, 2020
DOI: https://doi.org/10.20408/jti.2020.008
  • 16,477 View
  • 130 Download
  • 1 Citations
AbstractAbstract PDF

Open pelvic fractures are rare, but pose challenges for trauma surgeons due to their high morbidity and mortality. Generally, early death results from uncontrolled exsanguination and late death is related to pelvic sepsis. Therefore, management of these injuries should prioritize hemostasis and contamination control starting in the initial phase of treatment. We report two cases of unstable open pelvic fractures with perineal wounds that were managed successfully.

Summary

Citations

Citations to this article as recorded by  
  • Open Pelvic Fractures with a Faringer I Zone Injury: a Set of 3 Case Reports Treated in 2020
    J POMETLOVÁ, V JEČMÍNEK, R JEČMÍNKOVÁ
    Acta chirurgiae orthopaedicae et traumatologiae Ce.2022; 89(2): 164.     CrossRef
Management of a Retained Bullet in the Corpora Cavernosa after a Civilian Gunshot Injury: A Rare Scenario
Ali Abdel Raheem, Ibrahim Alowidah, Mohamed Almousa, Mohamed Alturki
J Trauma Inj. 2020;33(4):275-278.   Published online June 2, 2020
DOI: https://doi.org/10.20408/jti.2020.007
  • 3,527 View
  • 82 Download
  • 1 Citations
AbstractAbstract PDF

A 24-year-old man presented to King Saud Medical City emergency department with a retained bullet in his penis following a civilian exchange of gunfire. After an initial assessment, the patient was taken to the operating room. Penile exploration was performed, the bullet was extracted successfully, and the corpora cavernosa were repaired properly. A 6-week follow-up showed full healing with preservation of erectile function. Immediate surgical intervention is mandatory as the primary treatment for penile gunshot injury to ensure proper anatomical and functional recovery.

Summary

Citations

Citations to this article as recorded by  
  • Retained Bullet in the Penis
    Morgan Eudy, Natalie Nowak
    Cureus.2021;[Epub]     CrossRef

J Trauma Inj : Journal of Trauma and Injury