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Original Articles
A decade of treating traumatic sternal fractures in a single-center experience in Korea: a retrospective cohort study
Na Hyeon Lee, Seon Hee Kim, Jae Hun Kim, Ho Hyun Kim, Sang Bong Lee, Chan Ik Park, Gil Hwan Kim, Dong Yeon Ryu, Sun Hyun Kim
J Trauma Inj. 2023;36(4):362-368.   Published online November 30, 2023
DOI: https://doi.org/10.20408/jti.2023.0027
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AbstractAbstract PDF
Purpose
Clinical reports on treatment outcomes of sternal fractures are lacking. This study details the clinical features, treatment approaches, and outcomes related to traumatic sternal fractures over a 10-year period at a single institution.
Methods
A retrospective cohort study was conducted of patients admitted to a regional trauma center between January 2012 and December 2021. Among 7,918 patients with chest injuries, 266 were diagnosed with traumatic sternal fractures. Patient data were collected, including demographics, injury mechanisms, severity, associated injuries, sternal fracture characteristics, hospital stay duration, mortality, respiratory complications, and surgical details. Surgical indications encompassed emergency cases involving intrathoracic injuries, unstable fractures, severe dislocations, flail chest, malunion, and persistent high-grade pain.
Results
Of 266 patients with traumatic sternal fractures, 260 were included; 98 underwent surgical treatment for sternal fractures, while 162 were managed conservatively. Surgical indications ranged from intrathoracic organ or blood vessel injuries necessitating thoracotomy to unstable fractures with severe dislocations. Factors influencing surgical treatment included flail motion and rib fracture. The median length of intensive care unit stay was 5.4 days (interquartile range [IQR], 1.5–18.0 days) for the nonsurgery group and 8.6 days (IQR, 3.3–23.6 days) for the surgery group. The median length of hospital stay was 20.9 days (IQR, 9.3–48.3 days) for the nonsurgery group and 27.5 days (IQR, 17.0 to 58.0 days) for the surgery group. The between-group differences were not statistically significant. Surgical interventions were successful, with stable bone union and minimal complications. Flail motion in the presence of rib fracture was a crucial consideration for surgical intervention.
Conclusions
Surgical treatment recommendations for sternal fractures vary based on flail chest presence, displacement degree, and rib fracture. Surgery is recommended for patients with offset-type sternal fractures with rib and segmental sternal fractures. Surgical intervention led to stable bone union and minimal complications.
Summary
Clinical characteristics of patients with the hardware failure after surgical stabilization of rib fractures in Korea: a case series
Na Hyeon Lee, Sun Hyun Kim, Seon Hee Kim, Dong Yeon Ryu, Sang Bong Lee, Chan Ik Park, Hohyun Kim, Gil Hwan Kim, Youngwoong Kim, Hyun Min Cho
J Trauma Inj. 2023;36(3):196-205.   Published online September 5, 2023
DOI: https://doi.org/10.20408/jti.2023.0026
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  • 1 Citations
AbstractAbstract PDF
Purpose
Surgical stabilization of rib fractures (SSRF) is widely used in patients with flail chests, and several studies have reported the efficacy of SSRF even in multiple rib fractures. However, few reports have discussed the hardware failure (HF) of implanted plates. We aimed to evaluate the clinical characteristics of patients with HF after SSRF and further investigate the related factors.
Methods
We retrospectively reviewed the electronic medical records of patients who underwent SSRF for multiple rib fractures at a level I trauma center in Korea between January 2014 and January 2021. We defined HF as the unintentional loosening of screws, dislocation, or breakage of the implanted plates. The baseline characteristics, surgical outcomes, and types of HF were assessed.
Results
During the study period, 728 patients underwent SSRF, of whom 80 (10.9%) were diagnosed with HF. The mean age of HF patients was 56.5±13.6 years, and 66 (82.5%) were men. There were 59 cases (73.8%) of screw loosening, 21 (26.3%) of plate breakage, 17 (21.3%) of screw migration, and seven (8.8%) of plate dislocation. Nine patients (11.3%) experienced wound infection, and 35 patients (43.8%) experienced chronic pain. A total of 21 patients (26.3%) underwent reoperation for plate removal. The patients in the reoperation group were significantly younger, had fewer fractures and plates, underwent costal fixation, and had a longer follow-up. There were no significant differences in subjective chest symptoms or lung capacity.
Conclusions
HF after SSRF occurred in 10.9% of the cases, and screw loosening was the most common. Further longitudinal studies are needed to identify risk factors for SSRF failure.
Summary

Citations

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  • Komplikationen nach operativer vs. konservativer Versorgung des schweren Thoraxtraumas
    Lars Becker, Marcel Dudda, Christof Schreyer
    Die Unfallchirurgie.2024; 127(3): 204.     CrossRef
Case Report
Management of a traumatic avulsion fracture of the occipital condyle in polytrauma patient in Korea: a case report
Chang Hwa Ham, Woo-Keun Kwon, Joo Han Kim, Youn-Kwan Park, Jong Hyun Kim
J Trauma Inj. 2023;36(2):147-151.   Published online December 8, 2022
DOI: https://doi.org/10.20408/jti.2022.0058
  • 1,682 View
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AbstractAbstract PDF
Avulsion fracture of the occipital condyle are rare lesion at craniovertebral junction. It is often related to high-energy traumatic injuries and show diverse clinical presentations. Neurologic deficit and instabilities may justify surgical treatment. However, the integrity of neurovascular structures is undervalued in the current literatures. In this case report, we described a 26-year-old female patient with avulsion fracture of occipital condyle following a traffic accident. On initial presentation, her Glasgow Coma Scale was 8. She presented with fracture compound comminuted depressed, on the left side of her forehead with skull base fracture extending into clivus and occipital condyle. Her left occipital condyle showed avulsion injury with displacement deep into the skull base. On her computed tomography angiography, the displaced occipital condyle compressed on the sigmoid sinus resulting in its obstruction. While she was recovering her consciousness during her stay in the hospital, the lower cranial nerves showed dysfunctions corresponding to Collet-Sicard syndrome. Due to high risk of vascular injury, the patient was conservatively treated for the occipital condyle fracture. On the 4 months postdischarge follow-up, her cranial nerve symptoms practically recovered, and the occipital condyle showed signs of fusion without further displacement. Current literatures focus on neurologic deficit and stability for the surgical decisions. However, it is also important to evaluate the neurovascular integrity to assess the risk of its manipulation as it may result in fatal outcome. This case shows, an unstable avulsion occipital condyle fracture with neurologic deficit can be treated conservatively and show a favorable outcome.
Summary
Original Articles
Effect of trauma center operation on emergency care and clinical outcomes in patients with traumatic brain injury
Han Kyeol Kim, Yoon Suk Lee, Woo Jin Jung, Yong Sung Cha, Kyoung-Chul Cha, Hyun Kim, Kang Hyun Lee, Sung Oh Hwang, Oh Hyun Kim
J Trauma Inj. 2023;36(1):22-31.   Published online December 6, 2022
DOI: https://doi.org/10.20408/jti.2022.0049
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AbstractAbstract PDF
Purpose
Traumatic brain injury (TBI) directly affects the survival of patients and can cause long-term sequelae. The purpose of our study was to investigate whether the operation of a trauma center in a single tertiary general hospital has improved emergency care and clinical outcomes for patients with TBI.
Methods
The participants of this study were all TBI patients, patients with isolated TBI, and patients with TBI who underwent surgery within 24 hours, who visited our level 1 trauma center from March 1, 2012 to February 28, 2020. Patients were divided into two groups: patients who visited before and after the operation of the trauma center. A comparative analysis was conducted. Differences in detailed emergency care time, hospital stay, and clinical outcomes were investigated in this study.
Results
On comparing the entire TBI patient population via dividing them into the aforementioned two groups, the following results were found in the group of patients who visited the hospital after the operation of the trauma center: an increased number of patients with a good functional prognosis (P<0.001 and P=0.002, respectively), an increased number of surviving discharges (P<0.001 and P<0.001, respectively), and a reduction in overall emergency care time (P<0.05, for all item values). However, no significant differences existed in the length of intensive care unit stay, ventilator days, and total length of stay for TBI patients who visited the hospital before and after the operation of the trauma center.
Conclusions
The findings confirmed that overall TBI patients and patients with isolated brain injury had improved treatment results and emergency care through the operation of a trauma center in a tertiary general hospital.
Summary
Factors associated with the injury severity of falls from a similar height and features of the injury site in Korea: a retrospective study
Dae Hyun Kim, Jae-Hyug Woo, Yang Bin Jeon, Jin-Seong Cho, Jae Ho Jang, Jea Yeon Choi, Woo Sung Choi
J Trauma Inj. 2023;36(3):187-195.   Published online November 16, 2022
DOI: https://doi.org/10.20408/jti.2022.0042
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AbstractAbstract PDF
Purpose
This study aimed to determine the risk factors associated with the severity of fall-related injuries among patients who suffered a fall from similar heights and analyze differences in injury sites according to intentionality and injury severity.
Methods
The Emergency Department-Based Injury In-depth Surveillance data collected between 2019 and 2020 were used in this retrospective study. Patients with fall-related injuries who fell from a height of ≥6 and <9 m were included. Patients were categorized into the severe and mild/moderate groups according to their excessive mortality ratio-adjusted Injury Severity Score (EMR-ISS) and the intention and non-intention groups. Injury-related and outcome-related factors were compared between the groups.
Results
In total, 33,046 patients sustained fall-related injuries. Among them, 543 were enrolled for analysis. A total of 256 and 287 patients were included in the severe and mild/moderate groups, respectively, and 93 and 450 patients were included in the intention and non-intention groups, respectively. The median age was 50 years (range, 39–60 years) and 45 years (range, 27–56 years) in the severe and mild/moderate groups, respectively (P<0.001). In multivariable analysis, higher height (odds ratio [OR] 1.638; 95% confidence interval [Cl], 1.279–2.098) and accompanying foot injury (OR, 0.466; 95% CI, 0.263–0.828) were independently associated with injury severity (EMR-ISS ≥25) and intentionality of fall (OR, 0.722; 95% CI, 0.418–1.248) was not associated with injury severity. The incidence of forearm injuries was four (4.3%) and 58 cases (12.9%, P=0.018) and that of foot injuries was 20 (21.5%) and 54 cases (12.0%, P=0.015) in the intention versus non-intention groups, respectively.
Conclusions
Among patients who fell from a similar height, age, and fall height were associated with severe fall-related injuries. Intentionality was not related to injury severity, and patients with foot injury were less likely to experience serious injuries. Injuries in the lower and upper extremities were more common in intentional and unintentional falls, respectively.
Summary
Validity of the scoring system for traumatic liver injury: a generalized estimating equation analysis
Kangho Lee, Dongyeon Ryu, Hohyun Kim, Chang Ho Jeon, Jae Hun Kim, Chan Yong Park, Seok Ran Yeom
J Trauma Inj. 2022;35(1):25-33.   Published online September 7, 2021
DOI: https://doi.org/10.20408/jti.2021.0009
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  • 1 Citations
AbstractAbstract PDFSupplementary Material
Purpose
The scoring system for traumatic liver injury (SSTLI) was developed in 2015 to predict mortality in patients with polytraumatic liver injury. This study aimed to validate the SSTLI as a prognostic factor in patients with polytrauma and liver injury through a generalized estimating equation analysis. Methods: The medical records of 521 patients with traumatic liver injury from January 2015 to December 2019 were reviewed. The primary outcome variable was in-hospital mortality. All the risk factors were analyzed using multivariate logistic regression analysis. The SSTLI has five clinical measures (age, Injury Severity Score, serum total bilirubin level, prothrombin time, and creatinine level) chosen based on their predictive power. Each measure is scored as 0–1 (age and Injury Severity Score) or 0–3 (serum total bilirubin level, prothrombin time, and creatinine level). The SSTLI score corresponds to the total points for each item (0–11 points). Results: The areas under the curve of the SSTLI to predict mortality on post-traumatic days 0, 1, 3, and 5 were 0.736, 0.783, 0.830, and 0.824, respectively. A very good to excellent positive correlation was observed between the probability of mortality and the SSTLI score (γ=0.997, P<0.001). A value of 5 points was used as the threshold to distinguish low-risk (<5) from high-risk (≥5) patients. Multivariate analysis using the generalized estimating equation in the logistic regression model indicated that the SSTLI score was an independent predictor of mortality (odds ratio, 1.027; 95% confidence interval, 1.018–1.036; P<0.001). Conclusions: The SSTLI was verified to predict mortality in patients with polytrauma and liver injury. A score of ≥5 on the SSTLI indicated a high-risk of post-traumatic mortality.
Summary

Citations

Citations to this article as recorded by  
  • Liver Trauma: Management in the Emergency Setting and Medico-Legal Implications
    Angela Saviano, Veronica Ojetti, Christian Zanza, Francesco Franceschi, Yaroslava Longhitano, Ermelinda Martuscelli, Aniello Maiese, Gianpietro Volonnino, Giuseppe Bertozzi, Michela Ferrara, Raffaele La Russa
    Diagnostics.2022; 12(6): 1456.     CrossRef
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
  • 3,974 View
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  • 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
Incidence and Clinical Features of Urethral Injuries with Pelvic Fractures in Males: A 6-Year Retrospective Cohort Study at a Single Institution in South Korea
Hyun Woo Sun, Hohyun Kim, Chang Ho Jeon, Jae Hoon Jang, Gil Hwan Kim, Chan Ik Park, Sung Jin Park, Jae Hun Kim, Seok Ran Yeom
J Trauma Inj. 2021;34(2):98-104.   Published online April 2, 2021
DOI: https://doi.org/10.20408/jti.2020.0034
  • 3,366 View
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AbstractAbstract PDF
Purpose

Severe pelvic fractures are associated with genitourinary injuries, but the relationship between pelvic trauma and concomitant urethral injuries has yet to be elucidated. This study evaluated the incidence, mechanism, site, and extent of urethral injuries in male patients with pelvic fractures.

Methods

A retrospective cohort study was performed involving patients with urethral injuries accompanying pelvic fractures who visited Pusan National University Hospital from January 1, 2014 to December 31, 2019. Demographics, mechanisms of injury, clinical features of the urethral injuries, concomitant bladder injuries, methods of management, and the configuration of the pelvic fractures were analyzed.

Results

The final study population included 24 patients. The overall incidence of urethral injury with pelvic fracture was 2.6%, with the most common mechanism of urethral injury being traffic accidents (62.5%). Complete urethral disruption (16/24, 66.7%) was more common than partial urethral injuries (8/24, 33.3%), and unstable pelvic fractures were the most common type of pelvic fracture observed (70.8%). There was no definitive relationship between the extent of urethral injury and pelvic ring stability.

Conclusions

The present study provides a 6-year retrospective review characterizing the incidence, mechanism, and clinical features of urethral injury-associated pelvic fractures. This study suggests that the possibility of urethral injury must be considered, especially in unstable pelvic fracture patients, and that treatment should be chosen based on the clinical findings.

Summary
Special Articles
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
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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
Part 3. Clinical Practice Guideline for Airway Management and Emergency Thoracotomy for Trauma Patients from the Korean Society of Traumatology
Chan Yong Park, O Hyun Kim, Sung Wook Chang, Kang Kook Choi, Kyung Hak Lee, Seong Yup Kim, Maru Kim, Gil Jae Lee
J Trauma Inj. 2020;33(3):195-203.   Published online September 30, 2020
DOI: https://doi.org/10.20408/jti.2020.0050
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AbstractAbstract PDF

The following key questions and recommendations are presented herein: when is airway intubation initiated in severe trauma? Airway intubation must be initiated in severe trauma patients with a GCS of 8 or lower (1B). Should rapid sequence intubation (RSI) be performed in trauma patients? RSI should be performed in trauma patients to secure the airway unless it is determined that securing the airway will be problematic (1B). What should be used as an induction drug for airway intubation? Ketamine or etomidate can be used as a sedative induction drug when RSI is being performed in a trauma patient (2B). If cervical spine damage is suspected, how is cervical protection achieved during airway intubation? When intubating a patient with a cervical spine injury, the extraction collar can be temporarily removed while the neck is fixed and protected manually (1C). What alternative method should be used if securing the airway fails more than three times? If three or more attempts to intubate the airway fail, other methods should be considered to secure the airway (1B). Should trauma patients maintain normal ventilation after intubation? It is recommended that trauma patients who have undergone airway intubation maintain normal ventilation rather than hyperventilation or hypoventilation (1C). When should resuscitative thoracotomy be considered for trauma patients? Resuscitative thoracotomy is recommended for trauma patients with penetrating injuries undergoing cardiac arrest or shock in the emergency room (1B).

Summary
Part 2. Clinical Practice Guideline for Trauma Team Composition and Trauma Cardiopulmonary Resuscitation from the Korean Society of Traumatology
Oh Hyun Kim, Seung Je Go, Oh Sang Kwon, Chan-Yong Park, Byungchul Yu, Sung Wook Chang, Pil Young Jung, Gil Jae Lee
J Trauma Inj. 2020;33(2):63-73.   Published online June 30, 2020
DOI: https://doi.org/10.20408/jti.2020.0020
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  • 1 Citations
PDF
Summary

Citations

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  • 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
Case Report
Blunt Transection of the Entire Anterolateral Abdominal Wall Musculature Following Seatbelt-Related Injury
Hohyun Kim, Jae Hun Kim, Gil Hwan Kim, Hyun-Woo Sun, Chan Ik Park, Sung Jin Park, Chan Kyu Lee, Suk Kim
J Trauma Inj. 2020;33(2):128-133.   Published online June 30, 2020
DOI: https://doi.org/10.20408/jti.2020.0006
  • 6,838 View
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AbstractAbstract PDF

Traumatic abdominal wall hernias (TAWHs) are uncommon and the incidence of this, which is rarely encountered in clinical practice, has been estimated at 1%. Furthermore, blunt transection of the entire abdominal wall musculature caused by seatbelt is a very rare complication. We report a case of adult with a complete disruption of the entire anterolateral abdominal wall muscle following the seatbelt injury. A 32-year-old male was wearing a seat belt in a high speed motor vehicle collision. Abdominal computed tomography (CT) scan revealed the complete disruption of bilateral abdominal wall musculatures including TAWH without visceral injury. However, injuries of small bowel and sigmoid colon were observed in the intra-operative field. The patient underwent the repair by primary closure of the defect with absorbable monofilament sutures. This case suggests that especially in TAWH patients, even if a CT scan is normal, clinicians should keep the possibility of bowel injury in mind, and choose a treatment based on the clinical findings.

Summary
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
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  • 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
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
  • 5,127 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
Outcomes of Cranioplasty Using Autologous Bone or 3D-Customized Titanium Mesh Following Decompressive Craniectomy for Traumatic Brain Injury: Differences in Complications
Junwon Kim, Jang Hun Kim, Jong Hyun Kim, Taek-Hyun Kwon, Haewon Roh
J Trauma Inj. 2019;32(4):202-209.   Published online December 30, 2019
DOI: https://doi.org/10.20408/jti.2019.033
  • 5,458 View
  • 99 Download
  • 6 Citations
AbstractAbstract PDF
Purpose

Cranioplasty (CP) is often required for survival after decompressive craniectomy. Several materials, including autologous bone and various artificial materials, have been introduced for CP, but it remains unclear which material is best for CP. This study aimed to explore differences in complications between patients who underwent CP using an autologous bone flap versus a three-dimensional (3D) titanium mesh and to identify significant risk factors for post-CP complications.

Methods

In total, 44 patients were enrolled in this study and divided into two groups (autologous bone vs. 3D titanium mesh). In both groups, various post-CP complications were evaluated. Through a comparative analysis, we aimed to identify differences in complications between the two groups and, using binary logistic analysis, to determine significant factors associated with complications after CP.

Results

In the autologous bone flap group, there were three cases of surgical infection (3/24, 12.5%) and 11 cases of bone flap resorption (BFR) (11/24, 45.83%). In the 3D titanium mesh group, there was only one case of surgical infection (1/20, 5%) and 11 cases of various complications, including mainly cosmetic issues (11/20, 55%). A subgroup risk factor analysis of CP with an autologous bone flap showed no risk factors that predicted BFR with statistical significance, although a marginal association was found between larger bone flaps and BFR (odds ratio [OR]=1.037, p=0.090). In patients treated with a 3D titanium mesh, multivariate analysis revealed that only the existence of a ventriculo-peritoneal shunt system was strongly associated with overall post-CP complications (OR=18.66, p=0.021).

Conclusions

Depending on which material was used, different complications could occur, and the rate of complications was relatively high in both groups. Hence, the material selected for CP should be selected based on individual patients’ conditions.

Summary

Citations

Citations to this article as recorded by  
  • Customized Additive Manufacturing in Bone Scaffolds—The Gateway to Precise Bone Defect Treatment
    Juncen Zhou, Carmine Wang See, Sai Sreenivasamurthy, Donghui Zhu
    Research.2023;[Epub]     CrossRef
  • Customized cost-effective polymethylmethacrylate cranioplasty: a cosmetic comparison with other low-cost methods of cranioplasty
    Manish Baldia, Mathew Joseph, Suryaprakash Sharma, Deva Kumar, Ashwin Retnam, Santosh Koshy, Reka Karuppusami
    Acta Neurochirurgica.2022; 164(3): 655.     CrossRef
  • Letter to the Editor: Complications following titanium cranioplasty compared with nontitanium implants cranioplasty: A systematic review and meta-analysis
    Michael Amoo, Jack Henry
    Journal of Clinical Neuroscience.2021; 87: 32.     CrossRef
  • Complications of Cranioplasty in Relation to Material: Systematic Review, Network Meta-Analysis and Meta-Regression
    Jack Henry, Michael Amoo, Joseph Taylor, David P O’Brien
    Neurosurgery.2021; 89(3): 383.     CrossRef
  • Comparison of complications in cranioplasty with various materials: a systematic review and meta-analysis
    Liming Liu, Shou-Tao Lu, Ai-Hua Liu, Wen-Bo Hou, Wen-Rui Cao, Chao Zhou, Yu-Xia Yin, Kun-Shan Yuan, Han-Jie Liu, Ming-Guang Zhang, Hai-Jun Zhang
    British Journal of Neurosurgery.2020; 34(4): 388.     CrossRef
  • 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
    Journal of Trauma and Injury.2020; 33(4): 236.     CrossRef

J Trauma Inj : Journal of Trauma and Injury