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Original Articles
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
  • 6,917 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
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
  • 5,320 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
Characteristics of Korean Trauma Patients: A Single-center Analysis Using the Korea Trauma Database
Youngeun Park, Min Chung, Gil Jae Lee, Min A Lee, Jae Jeong Park, Kang Kook Choi, Sung Youl Hyun, Yang Bin Jeon, Dae Sung Ma, Yong Cheol Yoon, Jungnam Lee, Byungchul Yoo
J Trauma Inj. 2016;29(4):155-160.   Published online December 31, 2016
DOI: https://doi.org/10.20408/jti.2016.29.4.155
  • 2,397 View
  • 28 Download
  • 1 Citations
AbstractAbstract PDF
PURPOSE
Two years have passed since a level I trauma center was officially opened in the Gacheon Gil Hospital, South Korea. We analyzed 2014 and 2015 registered patient data from the Korean Trauma Data Base (KTDB) to identify trends in trauma patient care and factors that influence the quality of trauma care at the Gacheon Gil trauma center.
METHODS
Data was extracted from the KTDB included patient age, sex, systolic blood pressure at emergency room arrival, revised trauma score, injury severity score, trauma injury severity score, transfusion amount, and the cause of death was analyzed.
RESULTS
A total of 3269 trauma patients were admitted to our trauma center in 2014 and 3225 in 2015. Demographics and mechanism of injury were not significantly different between years. The severity of trauma injury was decreased in 2015 although the mortality rate was slightly increased. This requires further analysis.
CONCLUSION
The aim of this study was to determine the general status and trends in trauma incidence and management outcomes for the Incheon area. We noted no significant changes in trauma status from 2014 to 2015. We need to collect and review trauma patient data over a long period in order to elucidate trauma incidence and management trends in the trauma field. Finally, studies using trauma patient data will indicate appropriate quality control factors for trauma care and help to improve the quality of trauma management.
Summary

Citations

Citations to this article as recorded by  
  • 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
    Journal of Trauma and Injury.2020; 33(4): 242.     CrossRef

J Trauma Inj : Journal of Trauma and Injury