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Volume 34(1); March 2021
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Editorial
Anatomy of the Soul, Psalm of the Anatomy
Kun Hwang
J Trauma Inj. 2021;34(1):1-2.   Published online March 31, 2021
DOI: https://doi.org/10.20408/jti.2021.0006
  • 3,002 View
  • 92 Download
PDF
Summary
Original Articles
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
J Trauma Inj. 2021;34(1):3-12.   Published online December 17, 2020
DOI: https://doi.org/10.20408/jti.2020.0048
  • 3,891 View
  • 158 Download
  • 3 Citations
AbstractAbstract PDF
Purpose

To evaluate the severity of trauma, many scoring systems and predictive models have been presented. The quick Sequential Organ Failure Assessment (qSOFA) is a simple scoring system based on vital signs, and we expect it to be easier to apply to trauma patients than other trauma assessment tools.

Methods

This study was a cross-sectional study of trauma patients who visited the emergency department of Jeju National University Hospital. We excluded patients under the age of 18 years and unknown outcomes. We calculated the qSOFA, the Modified Early Warning Score (mEWS), Revised Trauma Score (RTS), and Injury Severity Score (ISS) based on patients’ initial vital signs and assessments performed in the emergency department (ED). The primary outcome was mortality within 14 days of trauma. We analyzed qSOFA scores using multivariate logistic regression analysis and compared the predictive accuracy of these scoring systems using the area under the receiver operating characteristic curve (AUROC).

Results

In total, 27,764 patients were analyzed. In the multivariate logistic regression analysis of the qSOFA, the adjusted odds ratios with 95% confidence interval (CI) for mortality relative to a qSOFA score of 0 were 27.82 (13.63–56.79) for a qSOFA score of 1, 373.31 (183.47–759.57) for a qSOFA score of 2, and 494.07 (143.75–1698.15) for a qSOFA score of 3. In the receiver operating characteristic (ROC) curve analysis for the qSOFA, mEWS, ISS, and RTS in predicting the outcomes, for mortality, the AUROC for the qSOFA (AUROC [95% CI]; 0.912 [0.871–0.952]) was significantly greater than those for the ISS (0.700 [0.608–0.793]) and RTS (0.160 [0.108–0.211]).

Conclusions

The qSOFA was useful for predicting the prognosis of trauma patients evaluated in the ED.

Summary

Citations

Citations to this article as recorded by  
  • Clinical utility of the quick Sequential Organ Failure Assessment score in predicting life-threatening traumatic hemorrhage: An observational study
    Susumu Matsushime, Akira Kuriyama
    The American Journal of Surgery.2024; 229: 140.     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
  • Predictive value of quick sequential organ failure assessment (qSOFA) score in risk assessment and outcome prediction in blunt trauma patients: A prospective observational study
    Nidhisha Sadhwani, Vinaya Ambore, Girish Bakhshi
    Annals of Medicine & Surgery.2022;[Epub]     CrossRef
Comparison of Resting Energy Expenditure Using Indirect Calorimetry and Predictive Equations in Trauma Patients: A Pilot Study
Dae Sung Ma, Gil Jae Lee
J Trauma Inj. 2021;34(1):13-20.   Published online March 31, 2021
DOI: https://doi.org/10.20408/jti.2021.0023
  • 3,304 View
  • 122 Download
  • 1 Citations
AbstractAbstract PDF
Purpose

Nutritional therapy in the intensive care unit is an essential factor for patient progress. The purpose of this study was to compare resting energy expenditure (REE) calculated by prediction equations (PEs) to the REE measured by indirect calorimetry (IC) in trauma patients.

Methods

Patients admitted to the trauma intensive care unit who received mechanical ventilation between January and December 2015 were enrolled. REE was measured by IC (CCM Express, MGC Diagnostics) and calculated by the following PEs: Harris-Benedict, Fleisch, Robertson and Reid, Ireton-Jones, and the maximum value (25 kcal/kg/ day) of the European Society for Clinical Nutrition and Metabolism (ESPEN). All patients were ventilated at a fraction of inspired oxygen (FiO2) below 60%.

Results

Of the 31 patients included in this study, 24 (77.4%) were men and seven (22.6%) were women. The mean age of the patients was 49.7±13.2 years, their mean weight was 68.1±9.6 kg, and their mean Injury Severity Score was 26.1±11.3. The mean respiratory quotient on IC was 0.93±0.19, and their mean FiO2 was 38.72%±6.97%. The mean REE measured by IC was 2,146±444.36 kcal/day, and the mean REE values calculated by the PEs were 1,509.39±205.34 kcal/day by the Harris and Benedict equation, 1,509.39±154.33 kcal/day by the Fleisch equation, and 1,443.39±159.61 kcal/day by the Robertson and Reid equation. The Ireton-Jones equation yielded a higher value (2,278.90±202.35 kcal/ day), which was not significantly different from the value measured using IC (p=0.53). The ESPEN maximum value (1,704.03±449.36 kcal/day) was lower, but this difference was likewise not significant (p=0.127).

Conclusions

The REE measured by IC was somewhat higher than that calculated using PEs. Further studies are needed to determine the proper nutritional support for trauma patients.

Summary

Citations

Citations to this article as recorded by  
  • Determining the appropriate resting energy expenditure requirement for severe trauma patients using indirect calorimetry in Korea: a retrospective observational study
    Hak-Jae Lee, Sung-Bak Ahn, Jung Hyun Lee, Ji-Yeon Kim, Sungyeon Yoo, Suk-Kyung Hong
    Journal of Trauma and Injury.2023; 36(4): 337.     CrossRef
The Influence of Seasons and Weather on the Volume of Trauma Patients: 4 Years of Experience at a Single Regional Trauma Center
Se Heon Kim, Young Hoon Sul, Jin Young Lee, Joong Suck Kim
J Trauma Inj. 2021;34(1):21-30.   Published online March 23, 2021
DOI: https://doi.org/10.20408/jti.2020.0027
  • 3,412 View
  • 95 Download
  • 2 Citations
AbstractAbstract PDF
Purpose

The purpose of this study was to determine the influence of seasons and weather on the volume of trauma patients in central Korea.

Methods

The records of 4,665 patients treated at Chungbuk National Hospital Regional Trauma Center from January 2016 to December 2019 were retrospectively reviewed. Meteorological data including hourly temperature (°C), precipitation (mm), humidity (%), and wind speed (m/s) for each district were collected retrospectively. Statistical analysis was done using the independent <i>t</i>-test, one-way analysis of variance (ANOVA), and linear regression analysis.

Results

Patients’ average age was 53.66 years, with a significant difference between men (49.92 years) and women (60.48 years) (p<0.001). Rolling/slipping down was a prominent cause of injury in winter (28.4%, n=283), with statistical significance (p<0.001). Trauma occurred least frequently in winter (p=0.005). Linear regression analysis revealed an increasing number of patients as the temperature increased (p<0.05), the humidity increased (p<0.001), and the wind speed decreased (p<0.001). Precipitation did not affect patient volume (p=0.562). One-way ANOVA revealed a decreased incidence of trauma when the temperature exceeded 30°C (p<0.001), and when the humidity was more than 75%, compared to 25–50% and 50–75%.

Conclusions

At the regional trauma center of Chungbuk National University Hospital, in central Korea, the number of trauma patients was lowest in winter, and patient volume was affected by temperature, humidity, and wind speed.

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
  • The impact of COVID-19 on trauma patients and orthopedic trauma operations at a single focused training center for trauma in Korea
    Wonseok Choi, Hanju Kim, Whee Sung Son, Seungyeob Sakong, Jun-Min Cho, Nak-Jun Choi, Tae-Wook Noh, Namryeol Kim, Jae-Woo Cho, Jong-Keon Oh
    Journal of Trauma and Injury.2022; 35(3): 195.     CrossRef
Adult Trauma Patients with Isolated Thoracolumbar Spinous and Transverse Process Fractures May be Managed Conservatively to Improve Emergency Department Throughput
Kyrillos Awad, Dean Spencer, Divya Ramakrishnan, Marija Pejinovska, Areg Grigorian, Sebastian Schubl, Jeffry Nahmias
J Trauma Inj. 2021;34(1):31-38.   Published online February 24, 2021
DOI: https://doi.org/10.20408/jti.2020.006
  • 3,295 View
  • 123 Download
AbstractAbstract PDF
Purpose

Traumatic vertebral injuries have a prevalence of 4–5% at level I centers. Studies have demonstrated that isolated thoracolumbar transverse process fractures (iTPF) rarely require brace or surgical interventions. We hypothesized that similarly isolated thoracolumbar spinous process fractures (iSPF) would have less need for bracing and operative interventions than SPFs with associated vertebral body (VB) fractures (SPF+VB). We performed a similar analysis for iTPF compared to transverse process fractures associated with VB injury (TPF+VB).

Methods

In this single-center, retrospective study from 2012 to 2016, patients were classified into iSPF, SPF+VB, iTPF, and TPF+VB groups. Data including the fracture pattern, neurologic deficits, and operative intervention were obtained. The primary outcome studied was the need for bracing and/or surgery. A statistical analysis was conducted.

Results

Of 98 patients with spinous process fractures, 21 had iSPF and 77 had SPF+ VB. No iSPF patients underwent surgery, whereas 24 (31.17%) SPF+VB patients did undergo surgery (p=0.012). In the iSPF group, three patients (15%) received braces only for comfort, whereas 37 (48.68%) of the SPF+VB group required bracing (p=0.058). Of 474 patients with transverse process fractures, 335 had iTPF and 139 had TPF+VB. No iTPF patients underwent surgery, whereas 28 (20.14%) TPF+VB patients did (p≤ 0.001). Of the iTPF patients, six (1.86%) were recommended to receive braces only for comfort, while 68 (50.75%) of the TPF+VB patients required bracing (p<0.001).

Conclusions

No patients with iSPF or iTPF required surgical intervention, and bracing was recommended to patients in these groups for comfort only. It appears that these injures may be safely managed without interventions, calling into question the need for spine consultation.

Summary
Unplanned Reoperation Rate at a Government-Designated Regional Trauma Center in Gangwon Province
Minju Kim, Seongyup Kim
J Trauma Inj. 2021;34(1):39-43.   Published online December 10, 2020
DOI: https://doi.org/10.20408/jti.2020.0029
  • 2,852 View
  • 68 Download
AbstractAbstract PDF
Purpose

Determining appropriate ways to assess health care quality within the National Health Insurance System is of interest to both the Korean government and the medical community. However, in the trauma field, the number of indicators used to evaluate surgical quality is limited. Using data collected over 5 years at Wonju Severance Christian Hospital Trauma Center in Korea, this study aimed to determine whether the unplanned reoperation rate in the field of trauma surgery could be used to assess the quality of an institution’s surgical care.

Methods

In total, 665 general surgical procedures were performed at the Trauma Center in 453 patients with abdominopelvic injuries from January 2015 to December 2019. Data were collected from the Trauma Center’s data registry and medical records, and included information regarding patients’ demographic characteristics, the type of index operation, and the reason for unplanned reoperations.

Results

A total of 453 index operations were evaluated. The proportion of patients with an Injury Severity Score (ISS) >15 was 48–70% over the 5-year period, with an unplanned reoperation rate of 2.1–9.3%. Patients had an average ISS score of 17.5, while the average Abbreviated Injury Scale score was 2.87. Unplanned reoperations were required in about 7% of patients. The most common complications requiring reoperation were recurrent bleeding (26.9%), wound problems (26.9%), intestinal infarction (15.4%), and anastomosis site leakage (7.7%). The procedures most frequently requiring unplanned reoperations were bowel surgery (segmental resection, primary repair, enterostomy, etc.) (24.5%) and preperitoneal pelvic packing (10.6%).

Conclusions

The proportion of reoperations was confirmed to be affected by injury severity.

Summary
The Prognosis of Traumatic Small Bowel Injury Accompanied by Liver Injury
Yu Seong Noh, Sung Won Jung, Tae Gil Heo, Pyong Wha Choi, Jae Il Kim, Heung Man Jun, Yong Chan Shin, Sung Min Jung, Eun Hae Um
J Trauma Inj. 2021;34(1):44-49.   Published online December 7, 2020
DOI: https://doi.org/10.20408/jti.2020.0052
  • 8,378 View
  • 99 Download
AbstractAbstract PDF
Purpose

The aim of this study was to elucidate the prognosis, and other clinical features, such as time to surgery and the amount of transfusion, of small bowel injury (SBI) accompanied by liver injury (LI).

Methods

We investigated 221 patients with SBI who visited an emergency center from October 2000 to March 2019. We excluded patients with injuries that directly led to mortality, and the remaining 149 patients were divided into the SBI alone (SBI-A) group and the SBI accompanied by LI (SBI-LI) group. Data were collected for preoperative and surgical outcome variables, and the treatment results were compared between groups.

Results

The SBI-LI group had a higher mortality rate than the SBI-A group (22.4% vs. 14.3%), but this difference was not statistically significant (p=0.061). There were no significant differences between the SBI-A and SBI-LI groups, except for the amount of red blood cell (RBC) transfusion (SBI-A: 3.53±0.1 vs. SBI-LI: 8.38±0.7 packs, p=0.035) and the length of intensive care unit (ICU) stay (SBI-A: 6.7±0.2 vs. SBI-LI: 11.1±0.5 days, p=0.047).

Conclusions

The SBI-LI group required more RBC transfusions and longer ICU stays than the SBI-A group. SBI accompanied by LI may show higher mortality than SBI alone; however, since the difference was not statistically significant in the present study, larger-scale follow-up research is needed.

Summary
Epidemiology and Incidence of Orthopedic Fractures in the Military of the Republic of Korea
Sung Jin An, Sang Hyun Lee, Gi-Ho Moon
J Trauma Inj. 2021;34(1):50-56.   Published online November 30, 2020
DOI: https://doi.org/10.20408/jti.2020.0046
  • 3,238 View
  • 83 Download
  • 1 Citations
AbstractAbstract PDF
Purpose

Fractures are common in the military population, but limited studies have investigated the incidence of fractures among Korean military personnel. Hence, this study aimed to clarify this issue.

Methods

Eligible subjects were patients who had sustained a fracture and were registered in the N-DEMIS (the medical records system of participating hospitals) from June 2017 to May 2019. Fractures were categorized according to the fracture site, patients’ age, sex, and type of duty.

Results

In total, 23,687 patients with 23,981 fractures were included. There were 216 patients with multiple fractures, of whom 156 had fractures at two sites, 42 had fractures at three sites, and 18 had fractures at four sites. Of the 23,687 patients, 23,340 were men and 347 were women. The incidence of fractures in men and women was 12.96 per 1,000 person-years and 0.19 per 1,000 person-years, respectively. In terms of the broad location of fractures, the percentage of fractures was the highest in the hand, followed by the foot and lower leg. When the location of fractures was analyzed more specifically, the percentage of fractures was the highest in the phalanx (thumb and fingers), followed by the ankle and metacarpal bones.

Conclusions

Hand, foot, ankle, and wrist fractures were the most commonly encountered fractures in the Korean military population. To prevent the loss of combat power due to non-battle-related injuries, thorough preparation is necessary, including protective equipment and preliminary training for areas with a high frequency of fracture occurrence.

Summary

Citations

Citations to this article as recorded by  
  • Systematic Review and Meta-analysis of Exercise for the Prevention of Musculoskeletal Injuries in Soldiers
    Hoyong Sung, Geon Hui Kim, On Lee, Jaewoo Kim, Kyoung Bae Kim, Hyo Youl Moon, Yeon Soo Kim
    The Korean Journal of Sports Medicine.2024; 42(1): 1.     CrossRef
Case Reports
Severe Airway Obstruction due to Massive Retropharyngeal Hematoma in a Warfarin-Taking Patient with a Normal International Normalized Ratio
Hyun Young Cho, Hyung Il Kim
J Trauma Inj. 2021;34(1):57-60.   Published online January 14, 2021
DOI: https://doi.org/10.20408/jti.2020.0028
  • 3,175 View
  • 81 Download
AbstractAbstract PDF

Warfarin is used as part of the treatment of various diseases, and laboratory monitoring of its effects is required. Airway hematoma secondary to warfarin is rare, but can be fatal because of potential airway obstruction. Rapid definitive airway establishment is crucial if airway obstruction is suspected. This complication is more likely to occur in those with elevated coagulation laboratory values. However, we experienced a patient in whom a massive retropharyngeal hematoma caused airway obstruction after a non-severe motor vehicle collision. The patient had been taking warfarin, and had coagulation parameter values within the normal ranges. A major fracture or hemorrhage was not anticipated. Upon examination, a massive retropharyngeal hematoma was noted. Orotracheal intubation failed due to an airway obstruction. Emergency tracheostomy and an operation for hematoma removal were performed. Physicians must always consider the possibility of airway hematoma in warfarin-taking patients with normal coagulation values regardless of the severity of mechanism of injury

Summary
Hemorrhagic Shock in a Patient with a Morel-Lavallée Lesion Combined with Active Arterial Bleeding without Fracture
Eic Ju Lim, Jong-Keon Oh, Jae-Woo Cho, Seungyeob Sakong, Jun-Min Cho
J Trauma Inj. 2021;34(1):61-65.   Published online November 30, 2020
DOI: https://doi.org/10.20408/jti.2020.0013
  • 3,538 View
  • 92 Download
AbstractAbstract PDF

A Morel-Lavallée lesion is a closed degloving injury caused by traumatic separation of the skin and subcutaneous tissue from the underlying fascia. However, since physicians tend to focus on treating the bone fracture, hemodynamic instability accompanying a Morel-Lavallée lesion can sometimes be overlooked. We report the case of a hemodynamically unstable 73-year-old man who had a Morel-Lavallée lesion of the thigh, but no femur fracture. Angiography showed active bleeding from the muscular branch of the right deep femoral artery, which was then successfully embolized.

Summary
Surgically Removed Intrapulmonary Shotgun Pellet without Traumatic Hemopneumothorax
Soo Young Yoon, Young Hoon Sul
J Trauma Inj. 2021;34(1):66-69.   Published online March 23, 2021
DOI: https://doi.org/10.20408/jti.2020.0026
  • 3,075 View
  • 92 Download
AbstractAbstract PDF

When treating firearms injuries, knowledge of the proper management is important because these injuries have high morbidity and mortality. However, due to strict gun safety regulations, surgeons in Asia often have limited experiences with gunshot wound management. Recently, the authors had the experience of removing a bullet that did not cause hemopneumothorax, but remained in the lung parenchyma. Due to the risk of complications that could occur if the bullet was not removed, surgical treatment was eventually performed to remove the bullet. A literature review was needed to determine whether this treatment was appropriate. We concluded that removing the bullet could prevent incidental complications. In this regard, the authors report a case along with a review of the relevant literature to suggest appropriate treatment directions for surgeons who do not have experience with gunshot wounds.

Summary
Iatrogenic Duodenal Obstruction due to Acupuncture Therapy Trauma
Jae Hun Chung, Si-Hak Lee
J Trauma Inj. 2021;34(1):70-74.   Published online November 24, 2020
DOI: https://doi.org/10.20408/jti.2020.0011
  • 3,095 View
  • 102 Download
  • 1 Citations
AbstractAbstract PDF

There are many possible causes of duodenal obstruction, such as congenital anomalies and various acquired conditions associated with space-occupying lesions. However, hemorrhage or retroperitoneal hematoma is a rare cause of duodenal obstruction. Here, we report the case of a 55-year-old man who developed duodenal obstruction due to a large retroperitoneal hematoma after acupuncture therapy. The patient experienced abdominal discomfort along with vomiting and nausea. Considering the size of the hematoma, emergency surgery could have been performed, but conservative treatment was continued because the patient’s vital signs were stable. With spontaneous resolution of the hematoma, the symptoms of duodenal obstruction improved. The patient was eventually discharged without any complications associated with the hematoma. Our findings suggest that even when a hematoma is large, a conservative approach can be maintained until improvement of the symptoms of duodenal obstruction if the vital signs of the patient remain stable.

Summary

Citations

Citations to this article as recorded by  
  • The reporting quality of acupuncture-related traumatic adverse events: a systematic review of case studies in Korea
    Sung-A Kim, Ji-Su Lee, Tae-Hun Kim, Seunghoon Lee, Jae-Dong Lee, Jung Won Kang
    BMC Complementary Medicine and Therapies.2024;[Epub]     CrossRef
Limited Incisional Drainage and Negative-Pressure Wound Therapy in an Acute Morel-Lavallée Lesion
Eui-Sung Choi, Jae-Young Yang, Byung-Hyun Ahn
J Trauma Inj. 2021;34(1):75-78.   Published online November 10, 2020
DOI: https://doi.org/10.20408/jti.2020.0039
  • 5,443 View
  • 94 Download
AbstractAbstract PDF

A Morel-Lavallée lesion is a post-traumatic closed degloving soft tissue injury after blunt trauma. Infection and skin necrosis frequently occur if it is not treated properly in the early stages. However, there is no clearly established treatment algorithm. In the acute stage, it is mainly treated with aspiration, simple compression, and incisional drainage. In the chronic stage, sclerotherapy is usually performed. If skin necrosis develops, the necrotic tissue is resected and a skin graft is needed. We describe a case of acute Morel-Lavallée lesion in the buttock region that was treated with limited incisional drainage and negative-pressure wound therapy, and also present a review of the literature.

Summary

J Trauma Inj : Journal of Trauma and Injury