Journal of Trauma and Injury

Original Articles

Emergency department laparotomy for patients with severe abdominal trauma: a retrospective study at a single regional trauma center in Korea: Yu Jin Lee, Soon Tak Jeong, Joongsuck Kim, Kwanghee Yeo, Ohsang Kwon, Kyounghwan Kim, Sung Jin Park, Jihun Gwak, Wu Seong Kang; J Trauma Inj. 2024;37(1):20-27. Published online January 12, 2024; DOI: https://doi.org/10.20408/jti.2023.0072

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Abstract PDF: Purpose
Severe abdominal injuries often require immediate clinical assessment and surgical intervention to prevent life-threatening complications. In Jeju Regional Trauma Center, we have instituted a protocol for emergency department (ED) laparotomy at the trauma bay. We investigated the mortality and time taken from admission to ED laparotomy.
Methods
We reviewed the data recorded in our center’s trauma database between January 2020 and December 2022 and identified patients who underwent laparotomy because of abdominal trauma. Laparotomies that were performed at the trauma bay or the ED were classified as ED laparotomy, whereas those performed in the operating room (OR) were referred to as OR laparotomy. In cases that required expeditious hemostasis, ED laparotomy was performed appropriately.
Results
From January 2020 to December 2022, 105 trauma patients admitted to our hospital underwent emergency laparotomy. Of these patients, six (5.7%) underwent ED laparotomy. ED laparotomy was associated with a mortality rate of 66.7% (four of six patients), which was significantly higher than that of OR laparotomy (17.1%, 18 of 99 patients, P=0.006). All the patients who received ED laparotomy also underwent damage control laparotomy. The time between admission to the first laparotomy was significantly shorter in the ED laparotomy group (28.5 minutes; interquartile range [IQR], 14–59 minutes) when compared with the OR laparotomy group (104 minutes; IQR, 88–151 minutes; P <0.001). The two patients who survived after ED laparotomy had massive mesenteric bleeding, which was successfully ligated. The other four patients, who had liver laceration, kidney rupture, spleen injury, and pancreas avulsion, succumbed to the injuries.
Conclusions
Although ED laparotomy was associated with a higher mortality rate, the time between admission and ED laparotomy was markedly shorter than for OR laparotomy. Notably, major mesenteric hemorrhages were effectively controlled through ED laparotomy.; Summary

Treatment Strategy of Transcatheter Arterial Embolization after Pelvic CT Angiography in Traumatic Pelvic Hemorrhage: A Single Regional Emergency Center's Experience: Yu Jin Lee, Hwan Jun Jae, Won Chul Cha, Jun Seok Seo, Hyo Cheol Kim, Cheong Il Shin, Sang Do Shin; J Korean Soc Traumatol. 2009;22(2):184-192.

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Abstract PDF: PURPOSE
This study was conducted to evaluate the effectiveness of the treatment strategy of transcatheter arterial embolization after pelvic CT angiography (CTA) in cases of traumatic pelvic hemorrhage.
METHODS
This is a retrospective analysis of pelvic hemorrhage patients who underwent transcatheter arterial embolization after pelvic CTA at our regional emergency center during a 31-month period. We reviewed the medical records and imagings of all these patients.
RESULTS
Transcatheter arterial embolization was performed in 17 patients (M:F=7:10, mean age=53.9) who underwent pelvic CTA for the evaluation of traumatic pelvic hemorrhage. Arterial bleeding was demonstrated on pelvic CTA in all patients, and the combined injury was also noted in 13 patients. The admission-to-CTA time was 84.53+/-66.92 minutes, and the CTA-to-embolization time was 147.65+/-99.97 minutes. Extravasation of contrast media or pseudoaneurysm was demonstrated on conventional angiography in all patients. Unilateral iliac artery embolization was performed in 8 patients, and bilateral iliac artery embolization was performed in 9 patients. Additional embolizations other than in the iliac arteries were performed in 7 patients. Initial hemostasis was achieved in 16 patients. One patient died of ongoing pelvic bleeding. Rebleeding occurred in only one patient and hemostasis was achieved with the second embolization. Another patient died of intracranial and facial bleeding in spite of pelvic hemostasis. The overall mortality was 11.8%, and there was no significant adverse effects in the other patients.
CONCLUSION
Transcatheter arterial embolization after pelvic CTA is an effective treatment strategy in the management of traumatic pelvic hemorrhage patients.; Summary

Physician-staffed Helicopter Transport for Mountain-rescued Emergency Patients: a Pilot Trial: Jeong Ho Park, Sang Do Shin, Eui Jung Lee, Chang Bae Park, Yu Jin Lee, Kyoung Soo Kim, Myoung Hee Park, Han Bum Kim, Do Kyun Kim, Woon Yong Kwon, Young Ho Kwak, Gil Joon Suh; J Trauma Inj. 2012;25(4):230-240.

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Abstract PDF: PURPOSE
We aimed to compare the transport time, the proportion of direct hospital visit and the emergency procedures between the current mountain rescue helicopter emergency medical service (HEMS) and physician-staffed mountain-rescue HEMS.
METHODS
During weekends from October 2, to November 21, 2010, 9 emergency physicians participated as HEMS staff in the mountain-rescue HEMS program of the Seoul fire department. Patient demographic data, transport time, proportion of direct hospital visits, and emergency procedures were recorded. We also collected data on HEMS mountain-rescued patients from June 1, to September 1, 2010, and we compared them to those for the study patients. After an eight-week trial of the HEMS, we performed a delphi survey to determine the attitude of the physician staff, as well as the feasibility of using a physician staff.
RESULTS
Twenty-four(24) patients were rescued from mountains by physician-staffed HEMS during the study period, and 35 patients were rescued during the pre-study period. Patient demographic findings were not statistically different between the two groups, but the transport time and the emergency procedures were. During the study period, the time from call to take-off was 6.1+/-4.1 min (vs. 12.1+/-8.9 min during the pre-study period, p-value=0.001), and the time from call to arrival at the scene was 15.0+/-4.8 min (vs. 22.3+/-8.1 min during the pre-study period, p-value=0.0001). The proportions of direct hospital visit were not different between the two groups, but more aggressive emergency procedures were implemented in the study group. The delphi survey showed positive agreement on indications for HEMS, rapidity of transport and overall satisfaction.
CONCLUSION
A pilot trial of physician-staffed HEMS for mountain rescue showed rapid response and more aggressive performance of emergency procedures with high satisfaction among the attending physicians.; Summary

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