Journal of Trauma and Injury

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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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

Large Focal Extrapleural Hematoma of Chest Wall: A Case Report: Hohyoung Lee, Sung Ho Han, Min Koo Lee, Oh Sang Kwon, Kyoung Hwan Kim, Jung Suk Kim, Soon-Ho Chon, Sung Ho Shinn; J Trauma Inj. 2019;32(2):115-117. Published online June 30, 2019; DOI: https://doi.org/10.20408/jti.2019.001

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Abstract PDF: Although hemothorax and pneumothorax are common complications seen in rib fractures, focal extrapleural hematoma is quite rare. We report a 63-year-old female patient that developed large focal extrapleural hematoma after falling off a second floor veranda. The patient had sustained 3, 4, 5th costal cartilage rib fractures and a sternum fracture. She had developed suspected empyema with loculations with small amount of hemothorax. She underwent a planned early decortication/adhesiolysis by video assisted thoracoscopic surgery at the 12th post-trauma day due to failed drainage. Unexpectedly, she had no adhesions or any significant retained hematoma mimicking a mass, but was found with the focal extrapleural chest wall hematoma. She was discharged on postoperative 46th day for other reasons and is doing fine today.; Summary

Bilateral Chylothorax Due to Blunt Spine Hyperextension Injury: A Case Report: Hohyoung Lee, Sung Ho Han, Min Koo Lee, Oh Sang Kwon, Kyoung Hwan Kim, Jung Suk Kim, Soon-Ho Chon, Sung Ho Shinn; J Trauma Inj. 2019;32(2):107-110. Published online June 30, 2019; DOI: https://doi.org/10.20408/jti.2018.050

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Bilateral chylothorax due to blunt trauma is extremely rare. We report a 74-year-old patient that developed delayed bilateral chylothorax after falling off a ladder. The patient had a simple 12th rib fracture and T12 lamina fracture. All other findings seemed normal. He was sent home and on the 5th day visited our emergency center at Halla Hospital with symptoms of dyspnea and lower back pain. Computer tomography of his chest presented massive fluid collection in his right pleural cavity and moderate amounts in his left pleural cavity with 12th rib fracture and T11-12 intervertebral space widening with bilateral facet fractures. Chest tubes were placed bilaterally and chylothorax through both chest tubes was discovered. Conservative treatment for 2 weeks failed, and thus, thoracic duct ligation was done by video assisted thoracoscopic surgery. Thoracic duct embolization was not an option. Postoperatively, the patient is now doing well and happy with the results. Early surgical treatment must be considered in the old patient, whom large amounts of chylothorax are present.

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Thoracic duct injury: An up to date
JoséLuis Ruiz Pier, MohebA Rashid
The Journal of Cardiothoracic Trauma.2021; 6(1): 15. CrossRef

Effectiveness after Designation of a Trauma Center: Experience with Operating a Trauma Team at a Private Hospital: Kyoung Hwan Kim, Sung Ho Han, Soon-Ho Chon, Joongsuck Kim, Oh Sang Kwon, Min Koo Lee, Hohyoung Lee; J Trauma Inj. 2019;32(1):1-7. Published online March 31, 2019; DOI: https://doi.org/10.20408/jti.2018.054

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Abstract PDF: Purpose
The present study aimed to evaluate the influence of how the trauma care system applied on the management of trauma patient within the region.
Methods
We divided the patients in a pre-trauma system group and a post-trauma system group according to the time when we began to apply the trauma care system in the Halla Hospital after designation of a trauma center. We compared annual general characteristics, injury severity score, the average numbers of the major trauma patients, clinical outcomes of the emergency department, and mortality rates between the two groups.
Results
No significant differences were found in the annual patients’ average age (54.1±20.0 vs. 52.8±18.2, p=0.201), transportation pathways (p=0.462), injury mechanism (p=0.486), injury severity score (22.93 vs. 23.96, p=0.877), emergency room (ER) stay in minutes (199.17 vs. 194.29, p=0.935), time to operation or procedure in minutes (154.07 vs. 142.1, p=0.767), time interval to intensive care unit (ICU) in minutes (219.54 vs. 237.13, p=0.662). The W score and Z score indicated better outcomes in post-trauma system group than in pre-trauma system group (W scores, 2.186 vs. 2.027; Z scores, 2.189 vs. 1.928). However, when analyzing survival rates for each department, in the neurosurgery department, in comparison with W score and Z score, both W score were positive and Z core was higher than +1.96. (pre-trauma group: 3.426, 2.335 vs. post-trauma group: 4.17, 1.967). In other than the neurosurgery department, W score was positive after selection, but Z score was less than +1.96, which is not a meaningful outcome of treatment (pre-trauma group: ?0.358, ?0.271 vs. post-trauma group: 1.071, 0.958).
Conclusions
There were significant increases in patient numbers and improvement in survival rate after the introduction of the trauma system. However, there were no remarkable change in ER stay, time to ICU admission, time interval to emergent procedure or operation, and survival rates except neurosurgery. To achieve meaningful survival rates and the result of the rise of the trauma index, we will need to secure sufficient manpower, including specialists in various surgical area as well as rapid establishment of the trauma center.; Summary

Development of Korean Teaching Model for Surgical Procedures in Trauma -Essential Surgical Procedures in Trauma Course-: Hohyun Kim, Chan-Yong Park, Hyun-Min Cho, Kwang-Hee Yeo, Jae Hun Kim, Byungchul Yu, Seung-Je Go, Oh Sang Kwon; J Trauma Inj. 2019;32(1):8-16. Published online March 31, 2019; DOI: https://doi.org/10.20408/jti.2018.051

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Abstract PDF Supplementary Material: Purpose
The Essential Surgical Procedures in Trauma (ESPIT) course was developed as a model to teach necessary surgical procedures to trauma physicians. Its goals are to improve knowledge, self-confidence, and technical competence.
Methods
The ESPIT course consisted of five lectures and a porcine lab operative experience. The ESPIT course has been run seven times between February 2014 and April 2016. ESPIT participants completed a questionnaire to assess self-efficacy regarding essential surgical procedures in trauma before and immediately after taking the ESPIT course. Sixty-three participants who completed both pre- and post-course questionnaires on self-efficacy were enrolled in this study.
Results
The overall post-ESPIT mean self-efficacy score was higher than the pre-ESPIT mean self-efficacy score (8.3±1.30 and 4.5±2.13, respectively) (p<0.001). Self-efficacy was significantly improved after the ESPIT course in general surgeons (p<0.001), thoracic and cardiovascular surgeons (p<0.001), emergency medicine doctors, and others (neurosurgeons, orthopedic surgeons) (p<0.001). The differences in self-efficacy score according to career stage (<1 year, 1?3 years, 3?5 years, and >5 years) were also statistically significant (p<0.001).
Conclusions
The data of the ESPIT participants indicated that they felt that the ESPIT course improved their self-efficacy with regard to essential surgical procedures in trauma. The ESPIT course may be an effective strategy for teaching surgical procedures, thus promoting better management of traumatic injuries.; Summary

Esophageal Rupture Due to Diving in Shallow Waters: Sung Ho Han, Soon-Ho Chon, Jong Hyun Lee, Min Koo Lee, Oh Sang Kwon, Kyoung Hwan Kim, Jung Suk Kim, Ho hyoung Lee, June Raphael Chon; J Trauma Inj. 2018;31(1):16-18. Published online April 30, 2018; DOI: https://doi.org/10.20408/jti.2018.31.1.16

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Abstract PDF: Delayed esophageal rupture due to blunt injury is not new. However, rupture due to suspected barotrauma is very rare. We describe a case of esophageal rupture in a male 24-year-old patient after diving in shallow waters. The patient was quadriplegic and could not experience the typical chest pain related to rupture and resulting mediastinitis. The rupture was discovered 4 days after emergency decompressive laminectomy and fusion for his cervical spine. The rupture was evidently caused by barotrauma and was discovered four days after admission. He underwent primary closure and pericardial flap as a life-saving procedure.; Summary

Rib Fixation for a Patient with Severely Displaced and Overlapped Costal Cartilage Fractures: Sung Ho Han, Soon-Ho Chon, Jong Hyun Lee, Min Koo Lee, Oh Sang Kwon, Kyoung Hwan Kim, Jung Suk Kim, Ho hyoung Lee; J Trauma Inj. 2018;31(1):12-15. Published online April 30, 2018; DOI: https://doi.org/10.20408/jti.2018.31.1.12

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Abstract PDF: Rib fixations for flail chest or displaced rib fractures are not a new technique. However, reports on rib fixations involving costal cartilage fractures are very few and surprisingly there are no reports of internal fixations involving only the costal cartilage in the English literature. The diagnosis is difficult and the necessity of the procedure may be quite controversial. Placing plates in screws into the costal cartilage alone may seem unstable and easily dislodged or stripped through the cartilage. We report a 31-year-old male scuba diver instructor who underwent rib fixations over his 7th and 8th costal cartilage ribs for severe pain. The procedure was done with conventional plates and screws. He had the plates and screws removed 2 months later due to lingering pain, but with them removed he is now quite happy with the results without pain. The procedure for fixation of painful overlapped costal cartilage is quite simple and can be done with the usual conventional methods, fixating plate and screws directly over the cartilage alone without fixation over the bony rib.; Summary

Thoracoscopic Resection of the First Rib for Thoracic Outlet Syndrome: A Case Report: Jae Gul Kang, Soon Ho Chon, Kilsoo Yie, Min Koo Lee, Oh Sang Kwon, Song Hyun Lee, June Raphael Chon; J Trauma Inj. 2017;30(2):63-65. Published online June 30, 2017; DOI: https://doi.org/10.20408/jti.2017.30.2.63

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Abstract PDF: Standard open procedures for resection of the first rib in thoracic outlet syndrome can prove to be quite difficult with extensive incisions. A minimal invasive procedure can also be painstaking, but provides an attractive alternative to the more radical open procedures. We report the details of the technique with direct video footage of the procedure performed in a 41-year-old man with thoracic outlet syndrome done entirely by thoracoscopic methods.; Summary

Thoracoscopy in Management of Chest Trauma: Our Three-year Jeju Experience: Sung Hyun Lee, Kilsoo Yie, Jong Hyun Lee, Jae Gul Kang, Min Koo Lee, Oh Sang Kwon, Soon Ho Chon; J Trauma Inj. 2017;30(2):33-40. Published online June 30, 2017; DOI: https://doi.org/10.20408/jti.2017.30.2.33

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PURPOSE
The role for minimally invasive surgery in chest trauma is vague, one that recently is more frequently performed, and one attractive option to be considered. Thoracoscopic surgery may improve morbidity, mortality, hasten recovery and shorten hospital stay.
METHODS
A total of 31 patients underwent video assisted thoracoscopic surgery for the treatment of blunt and penetrating chest trauma from June 9th, 2013 to March 21st, 2016 in Jeju, South Korea.
RESULTS
Twenty-three patients were males and eight patients were females. Their ages ranged from 23 to 81 years. The cause of injury was due to traffic accident in 17 patients, fall down in 5 patients, bicycle accident in 2 patients, battery in 2 patients, crushing injury in 2 patients, and slip down, kicked by horse, and stab wound in one patient each. Video assisted thoracoscopic exploration was performed in the 18 patients with flail chest or greater than 3 displaced ribs. The thoracoscopic procedures done were hematoma evacuation in 13 patients, partial rib fragment excision in 9 patients, lung suture in 5 patients, bleeding control (ligation or electrocautery) in 3 patients with massive hemothorax, diaphragmatic repair in two patients, wedge resection in two patients and decortication in 1 patient. There was only one patient with conversion to open thoracotomy.
CONCLUSION
There is a broad range of procedures that can be done by thoracoscopic surgery and a painful thoracotomy incision can be avoided. Thoracoscopic surgery can be done safely and swiftly in the trauma patient.

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Video assisted thoracoscopic surgery vs thoracotomy in management of post traumatic retained hemothorax: a randomized study
Abd Elrahman Mohammed Khalaf, Ahmed Emadeldeen Ghoneim, Alaa Basiouni Mahmoud, Amr Abdelmonem Abdelwahab
The Cardiothoracic Surgeon.2023;[Epub] CrossRef

Pericardial Tamponade following Perihepatic Gauze Packing for Blunt Hepatic Injury: Jin Bong Ye, Young Hoon Sul, Seung Je Go, Oh Sang Kwon, Joong Suck Kim, Sang Soon Park, Gwan Woo Ku, Min Koo Lee, Yeong Cheol Kim; J Trauma Inj. 2015;28(3):211-214. Published online September 30, 2015; DOI: https://doi.org/10.20408/jti.2015.28.3.211

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Abstract PDF: The primary and secondary survey was designed to identify all of a patient's injuries and prioritize their management. However 15 to 22.3% of patient with missed injuries had clinically significant missed injuries. To reduce missed injury, special attention should be focused on patients with severe anatomical injury or obtunded. Victims of blunt trauma commonly had multiple system involvement. Some reports indicate that inexperience, breakdown of estalished protocol, clinical error, and restriction of imaging studies may be responsible for presence of missed injury. The best way of reducing clinical significant of missed injuries was repeated clinical assessment. Here we report a case of severe blunt hepatic injury patient and pericardial injury that was missed in primary and secondary survey. After damage control surgery of hepatic injury, she remained hemodynamically unstable. Further investigation found cardiac tamponade during intensive care. This was managed by pericardial window operation through previous abdominal incision and abdominal wound closure was performed.; Summary

Wound Probing in Neck Trauma Patients: Jin Bong Ye, Young Hoon Sul, Yun Su Mun, Seung Je Go, Oh Sang Kwon, Gwan Woo Ku, Min Koo Lee; J Trauma Inj. 2015;28(3):198-201. Published online September 30, 2015; DOI: https://doi.org/10.20408/jti.2015.28.3.198

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Abstract PDF: Neck trauma is a relatively uncommon but can be a life-threatening injury. Several guidelines for neck trauma is established to recommend a proper management such as no clamping of bleeding vessels, no probing of wounds, Trendelenberg position for preventing venous air embolism. Here, we present a regretful case of 49-year-old man with neck trauma presenting undesired bleeding after probing of wound, and then discuss about treatment guildeline for neck trauma with a review.; Summary

Ureteral Injury Caused By Blunt Trauma: A Case Report: Oh Sang Kwon, Yun Su Mun, Seung Hwo Woo, Hyun Young Han, Jung Joo Hwang, Jang Young Lee, Min Koo Lee; J Trauma Inj. 2012;25(4):291-295.

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Abstract PDF: Ureteral trauma is rare, accounting for less than 1% of all urologic traumas. However, a missed ureteral injury can result in significant morbidity and mortality. The purpose of this case presentation is to suggest another method for early detection of ureteral injury in blunt traumatic patient. A 47-years-old man was injured in pedestrian traffic accident. He undergone 3-phase abdominal CT initially and had had a short-term follow-up simple. We suspected ureteral injury. Our final diagnosis of a ureteral injury was based on follow-up and antegrade pyeloureterography, he underwent emergency surgery. We detected the ureteral injury early and took a definitive action within 24 hours. In blunt trauma, if abnormal fluid collection in the perirenal retroperitoneal space is detect, the presence of a ureteral injury should be suspected, so a short-term simple X-ray or abdominal CT, within a few hours after initial abdominal CT, may be useful.; Summary

Experience with Blunt Pancreatic Trauma at Eulji University Hospital: Seung Hyun Yang, Yun Su Mun, Oh Sang Kwon, Min Koo Lee; J Trauma Inj. 2012;25(4):261-266.

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Abstract PDF: PURPOSE
Traumatic pancreatic injury is not common in abdominal trauma injury. However, the morbidity and the mortality rates of patients with pancreatic injury, which are related with difficulties of initial assessment, establishment of diagnosis, and treatment are relatively high. The aim of this study is to review our institution's experience and suggest a diagnosis and therapeutic algorithm for use in cases involving traumatic pancreatic injury.
METHODS
Eighteen(18) patients with blunt pancreatic injury from January, 2004 to October 2012 were included in this study. We analyzed treatment and diagnosis method, other organ injury, treatment interval, hospital stay and complications retrospectively.
RESULTS
Nine patients were treated with conservative medication and another nine patients were treated surgically. Complications occurred in nine patients, and one patient died due to intraventricular hemorrhage and subdural hemorrhage with multiple organ failure. Delayed surgery was performed in three cases. The early and delayed surgery groups showed difference in hospital stay and intensive care unit stay. Delayed surgery was associated with a longer hospital stay (p=0.007) than immediate surgery.
CONCLUSION
In blunt pancreatic trauma, proper early diagnosis and prompt treatment are recommended necessity. Based on this review of our experience, we also suggest the adoption of our institution's algorithm for cases involving traumatic pancreatic injury.; Summary

Successful Treatment of a Traumatic Hepatic Arterioportal Fistula: A Case Report: Yun Su Mun, Oh Sang Kwon, Jang Young Lee, Gyeong Nam Park, Hyun Young Han, Min Koo Lee; J Trauma Inj. 2013;26(1):22-25.

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Abstract PDF: Severe blunt abdominal trauma frequently involves the liver. The development of nonsurgical treatment of liver trauma has led to more frequent appearance of unusual complications. A hepatic arterioportal fistula (APF) is a rare complication of liver trauma. We present a case of traumatic APF in a patient with liver trauma. A 31-year-old male visited our emergency department with pain in the right upper abdomen following a traffic accident. Initial physical exam and abdominal computed tomography (CT) revealed liver laceration with hemoperitoneum. An abdominal CT obtained on day 11 revealed early opacification of the right portal vein on the arterial phase. After we had come to suspect an APF of the liver, its presence was confirmed on angiography. It was subsequently managed by using transcatheter coil embolization. In patients with portal hypertension and no evidence or history of cirrhosis, one should consider an APF as a potential etiology if history of liver biopsy or penetrating trauma exists. In a patient with liver trauma, serial abdominal CT is important for early detection and treatment of an APF.; Summary

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