Journal of Trauma and Injury

Original Articles

Quality Improvement in the Trauma Intensive Care Unit Using a Rounding Checklist: The Implementation Results: Ye Rim Chang, Sung Wook Chang, Dong Hun Kim, Jeongseok Yun, Jung Ho Yun, Seok Won Lee, Han Cheol Jo, Seok Ho Choi; J Trauma Inj. 2017;30(4):113-119. Published online December 30, 2017; DOI: https://doi.org/10.20408/jti.2017.30.4.113

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Abstract PDF: Purpose
Despite the numerous protocols and evidence-based guidelines that have been published, application of the therapeutics to eligible patients is limited in clinical settings. Therefore, a rounding checklist was developed to reduce errors of omission and the implementation results were evaluated.
Methods
A checklist consisting of 12 components (feeding, analgesia, sedation, thromboembolic prophylaxis, head elevation, stress ulcer prevention, glucose control, pressure sore prevention, removal of catheter, endotracheal tube and respiration, delirium monitoring, and infection control) was recorded by assigned nurses and then scored by the staff for traumatized, critically ill patients who were admitted in the trauma intensive care unit (ICU) of Dankook University Hospital for more than 2 days. A total of 170 patients (950 sheets) between April and October 2016 were divided into 3 periods (period 1, April to June; period 2, July to August; and period 3, September to October) for the analysis. Questionnaires regarding the satisfaction of the nurses were conducted twice during this implementation period.
Results
Record omission rates decreased across periods 1, 2, and 3 (19.9%, 12.7%, and 4.2%, respectively). The overall clinical application rate of the checklist increased from 90.1% in period 1 to 93.8% in period 3. Among 776 (81.7%) scored sheets, the rates of full compliance were 30.2%, 46.2%, and 45.1% for periods 1, 2, and 3, respectively. The overall mean score of the questionnaire regarding satisfaction also increased from 61.7 to 67.6 points out of 100 points from period 1 to 3.
Conclusions
An ICU rounding checklist could be an effective tool for minimizing the omission of preventative measures and evidence-based therapy for traumatized, critically-ill patients without overburdening nurses. The clinical outcomes of the ICU checklist will be evaluated and reported at an early date.; Summary

Evaluation of Lung Injury Score as a Prognostic Factor of Critical Care Management in Multiple Trauma Patients with Chest Injury: Kook Nam Han, Seok Ho Choi, Yeong Cheol Kim, Kyoung Hak Lee, Soo Eon Lee, Ki Young Jeong, Gil Joon Suh; J Korean Soc Traumatol. 2011;24(2):105-110.

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Abstract PDF: PURPOSE
Chest injuries in multiple trauma patients are major predisposing factor for increased length of stay in intensive care unit, prolonged mechanical ventilator, and respiratory complications such as pneumonia. The aim of this study is the evaluation of lung injury score as a risk factor for prolonged management in intensive care unit (ICU).
METHODS
Between June to August in 2011, 46 patients admitted to shock and trauma center in our hospital and 24 patients had associated chest damage without traumatic brain injury. Retrospectively, we calculated injury severity score (ISS), lung injury score, and the number of fractured ribs and performed nonparametric correlation analysis with length of stay in ICU and mechanical ventilator support.
RESULTS
Calculated lung injury score(<48 hours) was median 1(0-3) and ISS was median 30(8-38) in study population. They had median 2(0-14) fractured ribs. There were 2 bilateral fractures and 2 flail chest. Ventilator support was needed in 11(45.8%) of them for median 39 hours(6-166). The ISS of ventilator support group was median 34(24-34) and lung injury score was median 1.7(1.3-2.5). Tracheostomy was performed in one patient and it was only complicated case and ICU stay days was median 9(4-16). In correlation analysis, Lung injury score and ISS were significant with the length of stay in ICU but the number of fractured ribs and lung injury score were predicting factors for prolonged mechanical ventilator support.
CONCLUSION
Lung injury score could be a possible prognostic factor for the prediction of increased length of stay in ICU and need for mechanical ventilator support.; Summary

Management of Severe Trauma Patients in the Emergency Intensive Care Unit: Ji Ju Kim, Gil Joon Suh, Ki Young Jeong, Woon Yong Kwon, Kyung Su Kim, Hui Jai Lee, Yeong Cheol Kim, Seok Ho Choi, Young Ho Lee, Kyung Hag Lee, Kook Nam Han, Hwan Jun Jae, Hyo Cheol Kim; J Korean Soc Traumatol. 2011;24(2):98-104.

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Abstract PDF: PURPOSE
The aim of this study was to evaluate the quality of the trauma care system of our hospital, in which emergency physicians care for major trauma patients in the emergency intensive care unit (ICU) in consultation with intervention radiologists and surgeons.
METHODS
This was a retrospective observational study conducted in an emergency ICU of a tertiary referral hospital. We enrolled consecutive patients who had been admitted to our emergency ICU with major trauma from March 2007 to September 2010. We collected data with respect to demographic findings, mechanisms of injury, the trauma and injury severity score (TRISS), emergency surgery, angiographic intervention, and 6-month mortality. Then, we compared the observed and predicted survivals of the patients. The Hosmer-Lemeshow test and calibration plots by using 10 groups, one for each decile, of predicted mortality were used to evaluate the fitness of TRISS. P-values of greater than 0.05 represent a fair calibration.
RESULTS
Among 116 patients, 12 (10.34%) were dead within 6 months after admission to the ICU, and 29 (25.00%) and 38 (32.80%) patients received emergency surgery and angiographic intervention, respectively. The mean injury severity score and revised trauma score were 36.97+/-17.73 and 7.84+/-6.75, respectively. The observed survival and the predicted survival of the TRISS were 89.66% (95% confidence interval [CI]: 84.03~95.28%) and 69.85% (95% CI: 63.80~75.91%), respectively. The calibration plots showed that the observed survival of our patients was consistently higher than the predicted survival of the TRISS (p<0.001).
CONCLUSION
The observed survival for the trauma care system of our hospital, in which emergency physicians care for major trauma patients in the emergency ICU in consultation with intervention radiologists and surgeons, was higher than the predicted survival of the TRISS.; Summary

Analysis of the Prognostic Factors in Trauma Patients with Massive Bleeding: Seok Ho Choi, Gil Joon Suh, Yeong Cheol Kim, Woon Yong Kwon, Kook Nam Han, Kyoung Hak Lee, Soo Eon Lee, Seung Je Go; J Trauma Inj. 2012;25(4):247-253.

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Abstract PDF: PURPOSE
Hemorrhage is a main cause of death in trauma patients. The goal of this study is to describe the characteristics of trauma patients with massive bleeding and to evaluate the prognostic factors concerning their survival.
METHODS
This study was performed retrospectively and included trauma patients with massive bleeding who had been treated from March 2007 to August 2012. The inclusion criterion was patients who received more than 10 U of packed red blood cells within the first 24 hours after visiting the emergency department. Based on their medical records, we collected data in terms of demographic findings, mechanisms of injury, initial clinical and laboratory findings, methods for hemostasis (emergency surgery and/or angioembolization), transfusion, injury severity score (ISS), revised trauma score (RTS) and trauma and injury severity score (TRISS). We used the Mann-Whitney U test and Fisher's exact test to compare the variables between the patients that survived and those that did not. We performed a logistic regression analysis with the significant variables from the univariate test.
RESULTS
Thirty-two(32) patients were enrolled. The main mechanisms of injury were falls and motor vehicle accidents. The mean transfusion amount of packed red blood cells (PRBC) was 17.4 U. The mean elapsed time for the first hemostasis (surgery or embolization) was 3.5 hours. The initial technical success rates were 83.3%(15/18) in angioembolization and 66.7%(8/12) in surgery. The overall mortality rate was 34.4%(11/32). The causes of death were bleeding, brain swelling and multiple organ failure. The ISS(25.5 vs 46.3, p=0.000), TRISS(73.6 vs 45.1, p=0.034) and base excess(<-12 mmol/L, p=0.020) were significantly different between the patients who survived and those who did not.
CONCLUSION
The ISS was a prognostic factor for trauma patients with massive bleeding.; Summary

The Adequacy of a Cross Table Lateral Cervical X-ray in Severely Traumatized Korean Patients: Kyung Hag Lee, Yeong Cheol Kim, Seok Ho Choi, Gook Nam Han, Soo Un Lee, Jung Eun Lee, Gil Joon Suh, Yeo Kyu Yoon; J Trauma Inj. 2012;25(4):241-246.

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Abstract PDF: PURPOSE
The objective of this study was to investigate the appropriateness of the cross table lateral cervical X-ray used in the emergency department for severely traumatized Korean patients.
METHODS
Patients visiting our institution from May 2011 to May 2012, who had injury severity score (ISS) > 15 and who received a cervical X-ray in the emergency department, were included in this study. Data including demographics, ISS score, GCS score, and place where the x-ray was taken were collected to evaluate their relationship with appropriate coverage of the cervical X-ray. The appropriateness of a cervical cross lateral view X-ray was evaluated using exposure of the basion, and the opisthion, as well as the distal level of exposure.
RESULTS
Fifty-two patients were included in this study. The identification rate of the basion was 79.2%, and the identification rate of the opisthion was 88.7%. Complete exposure of C7/T1 was accomplished in 3.8% of the patients. The ISS was higher for X-ray taken in the trauma bay, but the range of exposure showed no difference between the places where the X-rays taken. Patients who had exposure of C 5/6 or more had lower body weight and body mass index (BMI) compared with unexposed patients.
CONCLUSION
In severely traumatized Korean patients, the adequacy of the cross table lateral cervical X-ray was inappropriate in most cases. No difference was observed in the exposure range between the places where the X-rays were taken, and patients with less exposure showed higher body weight and higher BMI.; Summary

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