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Volume 34(3); September 2021
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Original Articles
Characteristics and Outcomes of Patients with Bicycle-Related Injuries at a Regional Trauma Center in Korea
Yoonhyun Lee, Min Ho Lee, Dae Sang Lee, Maru Kim, Dae Hyun Jo, Hyosun Park, Hangjoo Cho
J Trauma Inj. 2021;34(3):147-154.   Published online June 4, 2021
DOI: https://doi.org/10.20408/jti.2020.0066
  • 4,021 View
  • 109 Download
AbstractAbstract PDF
Purpose

We analyzed the characteristics and outcomes of patients with bicycle-related injuries at a regional trauma center in northern Gyeonggi Province as a first step toward the development of improved prevention measures and treatments.

Methods

The records of 239 patients who were injured in different types of bicycle-related accidents and transported to a single regional trauma center between January 2017 and December 2018 were examined. This retrospective single-center study used data from the Korea Trauma Database.

Results

In total, 239 patients experienced bicycle-related accidents, most of whom were males (204, 85.4%), and 46.9% of the accidents were on roads for automobiles. Forty patients (16.7%) had an Injury Severity Score (ISS) of 16 or more. There were 125 patients (52.3%) with head/neck/face injuries, 97 patients (40.6%) with injuries to the extremities, 59 patients (24.7%) with chest injuries, and 21 patients (8.8%) with abdominal injuries. Patients who had head/neck/face injuries and an Abbreviated Injury Score (AIS) ≥3 were more likely to experience severe trauma (ISS ≥16). In addition, only 13 of 125 patients (10.4%) with head/neck/face injuries were wearing helmets, and patients with injuries in this region who were not wearing helmets had a 3.9-fold increased odds ratio of severe injury (AIS ≥2).

Conclusions

We suggest that comprehensive accident prevention measures, including safety training and expansion of safety facilities, should be implemented at the governmental level, and that helmet wearing should be more strictly enforced to prevent injuries to the head, neck, and face.

Summary
Effects of the Coronavirus Disease 2019 (COVID-19) Pandemic on Outcomes among Patients with Polytrauma at a Single Regional Trauma Center in South Korea
Sun Hyun Kim, Dongyeon Ryu, Hohyun Kim, Kangho Lee, Chang Ho Jeon, Hyuk Jin Choi, Jae Hoon Jang, Jae Hun Kim, Seok Ran Yeom
J Trauma Inj. 2021;34(3):155-161.   Published online June 4, 2021
DOI: https://doi.org/10.20408/jti.2020.0064
  • 3,969 View
  • 120 Download
  • 9 Citations
AbstractAbstract PDF
Purpose

The coronavirus disease 2019 (COVID-19) pandemic has necessitated a redistribution of resources to meet hospitals’ service needs. This study investigated the impact of COVID-19 on a regional trauma center in South Korea.

Methods

We retrospectively reviewed cases of polytrauma at a single regional trauma center in South Korea between January 20 and September 30, 2020 (the COVID-19 period) and compared them to cases reported during the same time frame (January 20 to September 30) between 2016 and 2019 (the pre-COVID-19 period). The primary outcome was in-hospital mortality, and secondary outcomes included the number of daily admissions, hospital length of stay (LOS), and intensive care unit (ICU) LOS.

Results

The mean number of daily admissions decreased by 15% during the COVID-19 period (4.0±2.0 vs. 4.7±2.2, p=0.010). There was no difference in mechanisms of injury between the two periods. For patients admitted during the COVID-19 period, the hospital LOS was significantly shorter (10 days [interquartile range (IQR) 4–19 days] vs. 16 days [IQR 8–28 days], p<0.001); however, no significant differences in ICU LOS and mortality were found.

Conclusions

The observations at Regional Trauma Center, Pusan National University Hospital corroborate anecdotal reports that there has been a decline in the number of patients admitted to hospitals during the COVID-19 period. In addition, patients admitted during the COVID-19 pandemic had a significantly shorter hospital LOS than those admitted before the COVID-19 pandemic. These preliminary data warrant validation in larger, multi-center studies.

Summary

Citations

Citations to this article as recorded by  
  • Patientensicherheit bei differenzierter (innerklinischer) Schockraumaktivierung für Schwerverletzte
    S. Hagel, K. R. Liedtke, S. Bax, S. Wailke, T. Klüter, P. Behrendt, G. M. Franke, A. Seekamp, P. Langguth, A. Balandin, M. Grünewald, D. Schunk
    Die Unfallchirurgie.2023; 126(6): 441.     CrossRef
  • Characteristics of Patients With Traumatic Brain Injury in a Regional Trauma Center: A Single-Center Study
    Mahnjeong Ha, Seunghan Yu, Byung Chul Kim, Jung Hwan Lee, Hyuk Jin Choi, Won Ho Cho
    Korean Journal of Neurotrauma.2023; 19(1): 6.     CrossRef
  • Changes in Injury Pattern and Outcomes of Trauma Patients after COVID-19 Pandemic: A Retrospective Cohort Study
    Myungjin Jang, Mina Lee, Giljae Lee, Jungnam Lee, Kangkook Choi, Byungchul Yu
    Healthcare.2023; 11(8): 1074.     CrossRef
  • Análise do atendimento primário de pacientes vítimas de violência interpessoal e autodirigida durante a pandemia da COVID-19
    HELOÍSA MORO TEIXEIRA, ANGEL ADRIANY DA-SILVA, ANNE KAROLINE CARDOZO DA-ROCHA, MARIANA ROTHERMEL VALDERRAMA, RAFAELLA STRADIOTTO BERNARDELLI, VITÓRIA WISNIEVSKI MARUCCO SILVA, LUIZ CARLOS VON BAHTEN
    Revista do Colégio Brasileiro de Cirurgiões.2023;[Epub]     CrossRef
  • Analysis of primary care of victims of interpersonal and self inflicted violence during the COVID-19 pandemic
    HELOÍSA MORO TEIXEIRA, ANGEL ADRIANY DA-SILVA, ANNE KAROLINE CARDOZO DA-ROCHA, MARIANA ROTHERMEL VALDERRAMA, RAFAELLA STRADIOTTO BERNARDELLI, VITÓRIA WISNIEVSKI MARUCCO SILVA, LUIZ CARLOS VON BAHTEN
    Revista do Colégio Brasileiro de Cirurgiões.2023;[Epub]     CrossRef
  • Comparison of Clinical Characteristics of Traumatic Brain Injury Patients According to the Mechanism Before and After COVID-19
    Jonghyun Sung, Jongwook Choi, Kum Whang, Sung Min Cho, Jongyeon Kim, Seung Jin Lee, Yeon gyu Jang
    Korean Journal of Neurotrauma.2023; 19(3): 307.     CrossRef
  • Outcomes improvement despite continuous visits of severely injured patients during the COVID-19 outbreak: experience at a regional trauma centre in South Korea
    Sooyeon Kang, Ji Eun Park, Ji Wool Ko, Myoung Jun Kim, Young Un Choi, Hongjin Shim, Keum Seok Bae, Kwangmin Kim
    BMC Emergency Medicine.2022;[Epub]     CrossRef
  • Impact of the COVID-19 pandemic on the epidemiology of traffic accidents: a cross-sectional study
    ANGEL ADRIANY DA SILVA, GABRIELA REDIVO STRÖHER, HELOÍSA MORO TEIXEIRA, MARIA VICTÓRIA GUTIERREZ CORDEIRO, MARCIA OLANDOSKI, LUIZ CARLOS VON-BAHTEN
    Revista do Colégio Brasileiro de Cirurgiões.2022;[Epub]     CrossRef
  • Impacto da pandemia da COVID-19 na epidemiologia dos acidentes de trânsito: um estudo transversal
    ANGEL ADRIANY DA SILVA, GABRIELA REDIVO STRÖHER, HELOÍSA MORO TEIXEIRA, MARIA VICTÓRIA GUTIERREZ CORDEIRO, MARCIA OLANDOSKI, LUIZ CARLOS VON-BAHTEN
    Revista do Colégio Brasileiro de Cirurgiões.2022;[Epub]     CrossRef
Initial Experiences of Extracorporeal Membrane Oxygenation for Trauma Patients at a Single Regional Trauma Center in South Korea
Ji Wool Ko, Il Hwan Park, Chun Sung Byun, Sung Woo Jang, Pil Young Jung
J Trauma Inj. 2021;34(3):162-169.   Published online July 28, 2021
DOI: https://doi.org/10.20408/jti.2020.0073
  • 2,952 View
  • 72 Download
AbstractAbstract PDF
Purpose

For severe lung injuries or acute respiratory distress syndrome that occurs during critical care due to trauma, extracorporeal membrane oxygenation (ECMO) may be used as a salvage treatment. This study aimed to describe the experiences at a single center with the use of ECMO in trauma patients.

Methods

We enrolled a total of 25 trauma patients who were treated with ECMO between January 2015 and December 2019 at a regional trauma center. We analyzed and compared patients’ characteristics between survivors and non-survivors through a medical chart review. We also compared the characteristics of patients between direct and indirect lung injury groups.

Results

The mean age of the 25 patients was 45.9±19.5 years, and 19 patients (76.0%) were male. The mean Injury Severity Score was 26.1±10.1. Ten patients (40.0%) had an Abbreviated Injury Scale (AIS) 3 score of 4, and six patients (24.0%) had an AIS 3 score of 5. There were 19 cases (76.6%) of direct lung injury. The mortality rate was 60.0% (n=15). Sixteen patients (64.0%) received a loading dose of heparin for the initiation of ECMO. There was no significant difference in heparin use between the survivors and non-survivors (70% in survivors vs. 60% in non-survivors, p=0.691). When comparing the direct and indirect lung injury groups, there were no significant differences in variables other than age and ECMO onset time.

Conclusions

If more evidence is gathered, risk factors and indications will be identified and we expect that more trauma patients will receive appropriate treatment with ECMO.

Summary
Sternal Fracture Fixation with a Steel Wire: The New “Timala” Technique
Rabindra Bhakta Timala, Nirmal Panthee
J Trauma Inj. 2021;34(3):170-176.   Published online September 30, 2021
DOI: https://doi.org/10.20408/jti.2021.0014
  • 3,286 View
  • 81 Download
  • 1 Citations
AbstractAbstract PDF
Purpose

Traumatic sternal fractures are rare but quite disabling injuries. Timely fixation of sternal fractures reduces pain and prevents respiratory complications. However, the fixation technique should be simple, effective, and readily available in local circumstances.

Methods

From January 2014 to March 2020, seven patients with sternal fracture/ dislocation underwent steel wire fixation with the new “Timala” technique. In this technique, adjacent ribs are anchored with two steel wires to form an “X” in front of the fractured segment of the sternum. Patients were followed up clinically and radiologically.

Results

Six of the patients were men and one was a female. Five of them had injuries due to falls and two were injured in road traffic accidents. Their age ranged from 18 years to 76 years, with a median age of 41 years. All seven patients experienced immediate recovery from pain and showed evidence of fracture healing on postoperative chest X-rays and clinical examinations.

Conclusions

Anchoring ribs to fix the sternum with steel wire is a safe, effective, easily available, and reproducible method to fix sternal fractures or dislocations.

Summary

Citations

Citations to this article as recorded by  
  • Features of management of patients with fractures of the sternum
    Aslan Alekseevich Teuvov, Arthur Mukharbievich Baziev, Zarema Nuriyidinovna Lovpache , Inna Salodinovna Abazova, Alina Aslanovna Teuvova
    Hirurg (Surgeon).2022; (2): 40.     CrossRef
Management of Traumatic Pancreatic Injuries: Evaluation of 7 Years of Experience at a Single Regional Trauma Center
Min A Lee, Seung Hwan Lee, Kang Kook Choi, Youngeun Park, Gil Jae Lee, Byungchul Yu
J Trauma Inj. 2021;34(3):177-182.   Published online September 30, 2021
DOI: https://doi.org/10.20408/jti.2021.0070
  • 2,769 View
  • 89 Download
AbstractAbstract PDF
Purpose

Traumatic pancreatic injuries are rare, but their diagnosis and management are challenging. The aim of this study was to evaluate and report our experiences with the management of pancreatic injuries.

Methods

We identified all adult patients (age >15) with pancreatic injuries from our trauma registry over a 7-year period. Data related to patients’ demographics, diagnoses, operative information, complications, and hospital course were abstracted from the registry and medical records.

Results

A total of 45 patients were evaluated. Most patients had blunt trauma (89%) and 21 patients (47%) had pancreatic injuries of grade 3 or higher. Twenty-eight patients (62%) underwent laparotomy and 17 (38%) received nonoperative management (NOM). The overall in-hospital mortality rate was 24% (n=11), and only one patient died after NOM (due to a severe traumatic brain injury). Twenty-two patients (79%) underwent emergency laparotomy and six (21%) underwent delayed laparotomy. A drainage procedure was performed in 12 patients (43%), and pancreatectomy was performed in 16 patients (57%) (distal pancreatectomy [DP], n=8; DP with spleen preservation, n=5; pancreaticoduodenectomy, n=2; total pancreatectomy, n=1). Fourteen (31%) pancreas-specific complications occurred, and all complications were successfully managed without surgery. Solid organ injuries (n=14) were the most common type of associated abdominal injury (Abbreviated Injury Scale ≥3).

Conclusions

For traumatic pancreatic injuries, an appropriate treatment method should be considered after evaluation of the accompanying injury and the patient’s hemodynamic status. NOM can be performed without mortality in appropriately selected cases.

Summary
Case Reports
Extra-Pericardial Tamponade due to Internal Thoracic Artery Rupture after Blunt Trauma: A Case Report
Dongsub Noh, Sung Wook Chang, Dae Sung Ma
J Trauma Inj. 2021;34(3):183-186.   Published online September 30, 2021
DOI: https://doi.org/10.20408/jti.2021.0045
  • 3,174 View
  • 106 Download
  • 1 Citations
AbstractAbstract PDF

Cardiac tamponade is an acute life-threatening condition that predominantly involves the intra-pericardial space; however, an expanding mediastinal hematoma can also sometimes cause cardiac tamponade. Here we describe the case of a 45-year-old male driver in whom a traffic accident resulted in rupture of the left internal thoracic artery (ITA), extra-pericardial hematoma, and sternal fracture. After resuscitation, he was scheduled to undergo angio-embolization to repair the ruptured left ITA, but he suddenly developed cardiac tamponade that required a decompressive sternotomy. Nevertheless, the patient had an uncomplicated recovery, and this case suggests that extra-pericardial cardiac tamponade should be considered as a possible consequence of retro-sternal hematoma due to traumatic ITA rupture.

Summary

Citations

Citations to this article as recorded by  
  • Traumatic Pseudoaneurysms of the Internal Mammary Artery: Two Cases and Percutaneous Intervention
    Kayla A. Aikins, Zoé N. Anderson, Timothy M. Koci
    Diagnostics.2023; 14(1): 63.     CrossRef
Small Bowel Hernia due to a Blunt Pelvic Injury
Min Jae Gal, Jung Chul Kim
J Trauma Inj. 2021;34(3):187-190.   Published online September 30, 2021
DOI: https://doi.org/10.20408/jti.2020.0022
  • 2,488 View
  • 63 Download
AbstractAbstract PDF

A 91-year-old female presented to Chonnam National University Hospital Regional Trauma Center with a lateral compression type III fracture of the pelvis. She was managed non-operatively for a week in the intensive care unit under close observation and had an emergency operation due to delayed onset of an acute obstructed direct inguinal hernia. Traumatic abdominal wall hernias are rare. However, trauma surgeons should always be aware of the possibility of such injuries because of their critical consequences.

Summary
Non-Operative Management with Angioembolization of Grade IV and V Renal Injuries in a Hybrid Emergency Room System
So Ra Ahn, Sang Hyun Seo, Joo Hyun Lee, Chan Yong Park
J Trauma Inj. 2021;34(3):191-197.   Published online September 30, 2021
DOI: https://doi.org/10.20408/jti.2021.0034
  • 3,327 View
  • 85 Download
  • 1 Citations
AbstractAbstract PDF

Renal injuries occur in more than 10% of patients who sustain blunt abdominal injuries. Non-operative management (NOM) is the established treatment strategy for lowgrade (I–III) renal injuries. However, despite some evidence that NOM can be successfully applied to high-grade (IV, V) renal injuries, it remains unclear whether NOM is appropriate in such cases. The authors report two cases of high-grade renal injuries that underwent NOM after embolization in a hybrid emergency room (ER) system with a 24/7 in-house interventional radiology (IR) team. A 29-year-old male visited Wonkwang University Hospital Regional Trauma Center complaining of right abdominal pain after being hit by a rope. Computed tomography (CT) was performed 16 minutes after arrival, and the CT scan indicated a grade V right renal injury. Arterial embolization was initiated within 31 minutes of presentation. A 56-year-old male was transferred to Wonkwang University Hospital Regional Trauma Center with a complaint of right flank pain. He had initially presented to a nearby hospital after falling from a 3-m height. Thanks to the key CT images sent from the previous hospital prior to the patient’s arrival, angiography was performed within 8 minutes of the patient’s arrival and arterial embolization was completed within 25 minutes. Both patients were treated successfully through NOM with angioembolization and preserved kidneys. Hematoma in the first patient and urinoma in the second patient resolved with percutaneous catheter drainage. The authors believe that the hybrid ER system with an in-house IR team could contribute to NOM and kidney preservation even in high-grade renal injuries.

Summary

Citations

Citations to this article as recorded by  
  • Endovascular embolization of persistent liver injuries not responding to conservative management: a narrative review
    Simon Roh
    Journal of Trauma and Injury.2023; 36(3): 165.     CrossRef
Non-Permanent Transcatheter Proximal Renal Artery Embolization for a Grade 5 Renal Injury with Delayed Recanalization and Preserved Renal Parenchymal Enhancement
Abhishek Jairam, Bradley King, Zachary Berman, Gerant Rivera-Sanfeliz
J Trauma Inj. 2021;34(3):198-202.   Published online September 30, 2021
DOI: https://doi.org/10.20408/jti.2020.0075
  • 2,898 View
  • 66 Download
  • 2 Citations
AbstractAbstract PDF

Super-selective renal artery embolization is an increasingly popular technique for the management of traumatic, low-grade renal trauma. When performed in distal arterial branches, this intervention enables tissue preservation and arrest of hemorrhage, but it may not be practical in cases of multifocal, high-grade renal injuries. In such cases, surgical nephrectomy remains the more common treatment modality to ensure hemodynamic control. We present the unique case of a patient who presented in hemorrhagic shock following a major trauma that resulted in a grade 5 renal injury treated with complete renal artery embolization using Gelfoam, resulting in hemodynamic stabilization. Interestingly, imaging 1 month after embolization revealed residual enhancement of the inferior pole of the kidney, suggesting reconstitution of flow and partial renal salvage. Ultimately, transcatheter “nephrectomy” with careful selection of a temporary embolic agent may serve as a safe and efficient alternative to surgical nephrectomy with the added possibility of preserving partial renal perfusion and function in the emergent setting.

Summary

Citations

Citations to this article as recorded by  
  • Salvation of a solitary kidney in a patient with grade IV renal trauma: a case report
    Hyuntack Shin, Ae Jin Sung, Min A Lee, Jayun Cho, Gil Jae Lee, Byungchul Yu, Kang Kook Choi
    Journal of Trauma and Injury.2022; 35(Suppl 1): S18.     CrossRef
  • The Role of Renal Artery Embolisation in the Management of Blunt Renal Injuries: A Review
    Rosemary Denning Ho, Vivek Shrivastava, Amir Mokhtari, Raghuram Lakshminarayan
    Vascular and Endovascular Review.2022;[Epub]     CrossRef
Visual Disturbance Caused by a Nail Gun-Induced Penetrating Brain Injury
Jin Bong Ye, Young Hoon Sul, Se Heon Kim, Jin Young Lee, Jin Suk Lee, Hong Rye Kim, Soo Young Yoon, Jung Hee Choi
J Trauma Inj. 2021;34(3):203-207.   Published online September 30, 2021
DOI: https://doi.org/10.20408/jti.2021.0030
  • 2,437 View
  • 65 Download
AbstractAbstract PDF

Penetrating brain injury caused by a nail gun is an uncommon clinical scenario reported in the literature. A 36-year-old male presented with a nail that had penetrated through the occipital bone. He was alert and neurologically intact except for visual disturbance. Computed tomography (CT) of the brain showed the nail lodged at the occipital lobe and the parietal lobe, with minimal intracerebral hemorrhage. The nail was placed in the occipital lobe close to the superior sagittal sinus. We removed the nail with craniotomy since the entrance of the nail was close to the superior sagittal sinus. There were no newly developed neurological deficits postoperatively. Immediate postoperative CT showed no newly developed lesions. The patient recovered well without any significant complications. Two weeks postoperatively, magnetic resonance imaging showed no remarkable lesions. The visual disturbance was followed up at the outpatient department. To summarize, we report a rare case of penetrating head injury by a nail gun and discuss relevant aspects of the clinical management.

Summary
Non-Operative Management of Traumatic Gallbladder Bleeding with Cystic Artery Injury: A Case Report
Tae Hoon Kim
J Trauma Inj. 2021;34(3):208-211.   Published online August 19, 2021
DOI: https://doi.org/10.20408/jti.2021.0003
  • 2,787 View
  • 67 Download
AbstractAbstract PDF

Gallbladder injuries are rare in cases of blunt abdominal trauma and are usually associated with damage to other internal organs. If the physician does not suspect gallbladder injury and check imaging studies carefully, it may be difficult to distinguish a gallbladder injury from gallbladder stone, hematoma, or bleeding. Therefore, in order not to miss the diagnosis, the clinical findings and correlation should be confirmed. In the present case, a 60-year-old male presented to a local trauma center complaining of pain in the upper right quadrant and chest wall following a motor vehicle collision. Abdominal computed tomography (CT) showed a hepatic laceration and hematoma in the parenchyma in segments 4, 5, and 6 and active bleeding in the lumen of the gallbladder. Traumatic gallbladder injuries generally require surgery, but in this case, non-operative management was possible with cautious follow-up consisting of abdominal CT and angiography with repeated physical examinations and hemodynamic monitoring in the intensive care unit.

Summary
Experiences of Emergency Surgical Treatment for a COVID-19 Patient with Severe Traumatic Brain Injury at a Regional Trauma Center: A Case Report
Jung-Ho Yun
J Trauma Inj. 2021;34(3):212-217.   Published online September 30, 2021
DOI: https://doi.org/10.20408/jti.2021.0073
  • 3,281 View
  • 72 Download
AbstractAbstract PDF

Various medical scenarios have arisen with the prolonged coronavirus disease 2019 (COVID-19) pandemic. In particular, the increasing number of asymptomatic COVID-19 patients has prompted reports of emergency surgical experiences with these patients at regional trauma centers. In this report, we describe an example. A 25-year-old male was admitted to the emergency room after a traffic accident. The patient presented with stuporous mentality, and his vital signs were in the normal range. Lacerations were observed in the left eyebrow area and preauricular area, with hemotympanum in the right ear. Brain computed tomography showed a contusional hemorrhage in the right frontal area and an epidural hematoma in the right temporal area with a compound, comminuted fracture and depressed skull bone. Surgical treatment was planned, and the patient was intubated to prepare for surgery. A blood transfusion was prepared, and a central venous catheter was secured. The initial COVID-19 test administered upon presentation to the emergency room had a positive result, and a confirmatory polymerase chain reaction (PCR) test was administered. The PCR test confirmed a positive result. Emergency surgical treatment was performed because the patient’s consciousness gradually deteriorated. The risk of infection was high due to the open and unclean wounds in the skull and brain. We prepared and divided the COVID-19 surgical team, including the patient’s transportation team, anesthesia team, and surgical preparation team, for successful surgery without any transmission or morbidity. The patient recovered consciousness after the operation, received close monitoring, and did not show any deterioration due to COVID-19.

Summary

J Trauma Inj : Journal of Trauma and Injury