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Original Articles
Quality monitoring of resuscitative endovascular balloon occlusion of the aorta using cumulative sum analysis in Korea: a case series
Hyunsik Choi, Joongsuck Kim, Kwanghee Yeo, Ohsang Kwon, Kyounghwan Kim, Wu Seong Kang
J Trauma Inj. 2023;36(2):78-86.   Published online December 21, 2022
DOI: https://doi.org/10.20408/jti.2022.0069
  • 2,143 View
  • 46 Download
  • 2 Citations
AbstractAbstract PDF
Purpose
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a state-of-the-art lifesaving procedure. However, due to its high mortality and morbidity, including ischemia and reperfusion injury, well-trained medical staff and effective systems are needed. This study was conducted to investigate the learning curve for REBOA.
Methods
To monitor this learning curve, we used cumulative sum (CUSUM) analysis and graphs of mortality and aortic occlusion time within 60, 90, and 120 minutes for consecutive patients. The procedures performed between July 2017 and June 2021 were divided into pre-trauma center (pre-TC; July 2017–February 2020) and TC (February 2020–June 2021) periods.
Results
REBOA was performed for 31 consecutive patients with trauma. The pre-TC (n=12) and TC (n=19) periods did not differ significantly with regard to Injury Severity Score, age, injury mechanism, initial systolic blood pressure, prehospital cardiopulmonary resuscitation (CPR), or CPR in the emergency department. At the 17th consecutive patient during the TC period, CUSUM failure graphs for mortality and aortic occlusion time exhibited a downward inflection, indicating an improvement in performance.
Conclusions
The mortality and aortic occlusion time of REBOA improved, and these parameters can be monitored using CUSUM analysis at the hospital level.
Summary

Citations

Citations to this article as recorded by  
  • 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
    Journal of Trauma and Injury.2024; 37(1): 20.     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
Effect of use and type of helmet on occurrence of traumatic brain injuries in motorcycle riders in Korea: a retrospective cohort study
Sowon Seo, Seok Ran Yeom, Sung-Wook Park, Il Jae Wang, Suck Ju Cho, Wook Tae Yang, Youngmo Cho
J Trauma Inj. 2023;36(2):87-97.   Published online December 9, 2022
DOI: https://doi.org/10.20408/jti.2022.0029
  • 1,904 View
  • 61 Download
AbstractAbstract PDFSupplementary Material
Purpose
The purpose of this study was to investigate (1) the association among helmet wearing, incidence rate of traumatic brain injury (TBI), and in-hospital mortality; TBI was diagnosed when the head Abbreviated Injury Scale (AIS) was ≥1, and as severe TBI when head AIS was ≥3; and (2) the association between helmet type and incidence rate of TBI, severe TBI, and in-hospital mortality of motorcycle accidents based on the newly revised Emergency Department-based Injury In-depth Surveillance (EDIIS) data.
Methods
Data collected from EDIIS between January 1, 2020 and December 31, 2020 were analyzed. The final study population comprised 1,910 patients, who were divided into two groups: helmet wearing group and unhelmeted group. In addition, the correlation between helmet type and motorcycle accident was determined in 596 patients who knew the exact type of helmet they wore. A total of 710 patients who wore helmet but did not know the type were excluded from this analysis. Multivariate logistic regression was performed in both the groups to investigate the factors affecting the primary (occurrence of TBIs) and secondary outcomes (severe TBI and in-hospital mortality).
Results
The prevalence of Injury Severity Scores, TBIs, and severe TBIs as well as in-hospital mortality were the highest in the unhelmeted group. Additionally, the results from the group that wore and knew the type of helmet worn indicated that wearing a full-face helmet decreased the incidence of TBIs in comparison to a half-face helmet.
Conclusions
The wearing of a helmet in motorcycle accidents is very important as it plays a role in reducing the occurrence of TBIs and severe TBIs and in-hospital mortality. The use of a full-face helmet lowered the incidence of TBIs.
Summary
Outcomes after rib fractures: more complex than a single number
Kristin P. Colling, Tyler Goettl, Melissa L. Harry
J Trauma Inj. 2022;35(4):268-276.   Published online August 5, 2022
DOI: https://doi.org/10.20408/jti.2021.0096
  • 2,472 View
  • 75 Download
AbstractAbstract PDF
Purpose
Rib fractures are common injuries that can lead to morbidity and mortality.
Methods
Data on all patients with rib fractures admitted to a single trauma center between January 1, 2008 and December 31, 2018 were reviewed.
Results
A total of 1,671 admissions for rib fracture were examined. Patients’ median age was 57 years, the median Injury Severity Score (ISS) was 14, and the median number of fractured ribs was three. The in-hospital mortality rate was 4%. Age, the number of rib fractures, and Charlson Comorbidity Index scores were poor predictors of mortality, while the ISS was a slightly better predictor, with area under the receiver operating characteristic curve values of 0.60, 0.55, 0.58, and 0.74, respectively. Multivariate regression showed that age, ISS, and Charlson Comorbidity Index score, but not the number of rib fractures, were associated with significantly elevated adjusted odds ratios for mortality (1.03, 1.14, and 1.28, respectively).
Conclusions
Age, ISS, and comorbidities were independently associated with the risk of mortality; however, they were not accurate predictors of death. The factors associated with rib fracture mortality are complex and cannot be explained by a single variable. Interventions to improve outcomes must be multifaceted.
Summary
Review Article
Evolution of trauma care and the trauma registry in the West Australian health system
Mayura Thilanka Iddagoda, Maxine Burrell, Sudhakar Rao, Leon Flicker
J Trauma Inj. 2022;35(2):71-75.   Published online May 31, 2022
DOI: https://doi.org/10.20408/jti.2021.0060
  • 2,383 View
  • 69 Download
  • 1 Citations
AbstractAbstract PDF
Trauma care is evolving throughout the world to meet the demand resulting from rapidly increasing rates of mortality and morbidity related to external injuries. The State Major Trauma Service was designated to Royal Perth Hospital in 2004 to provide comprehensive care for trauma patients in Western Australia (WA), which is the largest state by area in the country. The State Major Trauma Unit, which was established in 2008, functions as a level I center and admits over 1,000 major trauma patients per year, making it the second busiest trauma center in Australia. The importance of recording data related to trauma was identified by the trauma service in WA to inspire higher standards of patient care and injury prevention. In 1994, the service established a trauma registry, which has undergone significant changes over the last two decades. The current State Trauma Registry is linked to a statewide database called the Data Linkage System. The linked data are available for policy development, quality assurance, and research. This article discusses the evolution of the trauma service and the registry database in the WA health system. The State Trauma Registry has enormous potential to contribute to research and quality improvement studies along with its ability to link with other databases.
Summary

Citations

Citations to this article as recorded by  
  • Development of a standardized minimum dataset for including low‐severity trauma patients in trauma registry collections in Australia and Aotearoa New Zealand
    Grant Christey, Jacelle Warren, Cameron S. Palmer, Maxine Burrell, Kirsten Vallmuur
    ANZ Journal of Surgery.2023; 93(3): 572.     CrossRef
Original Articles
Clinical implications of the newly defined concept of ventilator-associated events in trauma patients
Tae Yeon Lee, Jeong Woo Oh, Min Koo Lee, Joong Suck Kim, Jeong Eun Sohn, Jeong Hwan Wi
J Trauma Inj. 2022;35(2):76-83.   Published online December 24, 2021
DOI: https://doi.org/10.20408/jti.2021.0064
  • 2,226 View
  • 77 Download
AbstractAbstract PDF
Purpose
Ventilator-associated pneumonia is the most common nosocomial infection in patients with mechanical ventilation. In 2013, the new concept of ventilator- associated events (VAEs) replaced the traditional concept of ventilator-associated pneumonia. We analyzed risk factors for VAE occurrence and in-hospital mortality in trauma patients who received mechanical ventilatory support.
Methods
In this retrospective review, the study population comprised patients admitted to the Jeju Regional Trauma Center from January 2020 to January 2021. Data on demographics, injury characteristics, and clinical findings were collected from medical records. The subjects were categorized into VAE and no-VAE groups according to the Centers for Disease Control and Prevention/National Healthcare Safety Network VAE criteria. We identified risk factors for VAE occurrence and in-hospital mortality.
Results
Among 491 trauma patients admitted to the trauma center, 73 patients who received ventilator care were analyzed. Patients with a chest Abbreviated Injury Scale (AIS) score ≥3 had a 4.7-fold higher VAE rate (odds ratio [OR], 4.73; 95% confidence interval [CI], 1.46–17.9), and those with a glomerular filtration rate (GFR) <75 mL/min/1.73 m2 had 4.1-fold higher odds of VAE occurrence (OR, 4.15; 95% CI, 1.32–14.1) and a nearly 4.2-fold higher risk for in-hospital mortality (OR, 4.19; 95% CI, 1.30–14.3). The median VAE-free duration of patients with chest AIS ≥3 was significantly shorter than that of patients with chest AIS <3 (P=0.013).
Conclusions
Trauma patients with chest AIS ≥3 or GFR <75 mL/min/1.73 m2 on admission should be intensively monitored to detect at-risk patients for VAEs and modify the care plan accordingly. VAEs should be closely monitored to identify infections early and to achieve desirable results. We should also actively consider modalities to shorten mechanical ventilation in patients with chest AIS ≥3 to reduce VAE occurrence.
Summary
Prognostic Accuracy of the Quick Sequential Organ Failure Assessment for Outcomes Among Patients with Trauma in the Emergency Department: A Comparison with the Modified Early Warning Score, Revised Trauma Score, and Injury Severity Score
Min Woo Kang, Seo Young Ko, Sung Wook Song, Woo Jeong Kim, Young Joon Kang, Kyeong Won Kang, Hyun Soo Park, Chang Bae Park, Jeong Ho Kang, Ji Hwan Bu, Sung Kgun Lee
J Trauma Inj. 2021;34(1):3-12.   Published online December 17, 2020
DOI: https://doi.org/10.20408/jti.2020.0048
  • 3,901 View
  • 158 Download
  • 3 Citations
AbstractAbstract PDF
Purpose

To evaluate the severity of trauma, many scoring systems and predictive models have been presented. The quick Sequential Organ Failure Assessment (qSOFA) is a simple scoring system based on vital signs, and we expect it to be easier to apply to trauma patients than other trauma assessment tools.

Methods

This study was a cross-sectional study of trauma patients who visited the emergency department of Jeju National University Hospital. We excluded patients under the age of 18 years and unknown outcomes. We calculated the qSOFA, the Modified Early Warning Score (mEWS), Revised Trauma Score (RTS), and Injury Severity Score (ISS) based on patients’ initial vital signs and assessments performed in the emergency department (ED). The primary outcome was mortality within 14 days of trauma. We analyzed qSOFA scores using multivariate logistic regression analysis and compared the predictive accuracy of these scoring systems using the area under the receiver operating characteristic curve (AUROC).

Results

In total, 27,764 patients were analyzed. In the multivariate logistic regression analysis of the qSOFA, the adjusted odds ratios with 95% confidence interval (CI) for mortality relative to a qSOFA score of 0 were 27.82 (13.63–56.79) for a qSOFA score of 1, 373.31 (183.47–759.57) for a qSOFA score of 2, and 494.07 (143.75–1698.15) for a qSOFA score of 3. In the receiver operating characteristic (ROC) curve analysis for the qSOFA, mEWS, ISS, and RTS in predicting the outcomes, for mortality, the AUROC for the qSOFA (AUROC [95% CI]; 0.912 [0.871–0.952]) was significantly greater than those for the ISS (0.700 [0.608–0.793]) and RTS (0.160 [0.108–0.211]).

Conclusions

The qSOFA was useful for predicting the prognosis of trauma patients evaluated in the ED.

Summary

Citations

Citations to this article as recorded by  
  • Clinical utility of the quick Sequential Organ Failure Assessment score in predicting life-threatening traumatic hemorrhage: An observational study
    Susumu Matsushime, Akira Kuriyama
    The American Journal of Surgery.2024; 229: 140.     CrossRef
  • Multifaceted Analysis of the Environmental Factors in Severely Injured Trauma: A 30-Day Survival Analysis
    Sung Woo Jang, Hae Rim Kim, Pil Young Jung, Jae Sik Chung
    Healthcare.2023; 11(9): 1333.     CrossRef
  • Predictive value of quick sequential organ failure assessment (qSOFA) score in risk assessment and outcome prediction in blunt trauma patients: A prospective observational study
    Nidhisha Sadhwani, Vinaya Ambore, Girish Bakhshi
    Annals of Medicine & Surgery.2022;[Epub]     CrossRef
Essential Factors in Predicting the Need for Angio-Embolization in the Acute Treatment of Pelvic Fracture with Hemorrhage
Seok-Won Yang, Hee-Gon Park, Sung-Hyun Kim, Sung-Hyun Yoon, Seung-Gwan Park
J Trauma Inj. 2019;32(2):101-106.   Published online June 30, 2019
DOI: https://doi.org/10.20408/jti.2019.008
  • 3,200 View
  • 51 Download
AbstractAbstract PDF
Purpose

The purpose of this study was to determine the essential factors for prompt arrangement of angio-embolization in patients with pelvic ring fractures.

Methods

A total of 62 patients with pelvic ring fractures who underwent angio-embolization in Dankook University Hospital from March 2013 to June 2018 were retrospectively reviewed. There were 38 men and 24 women with a mean age of 59.8 years. The types of pelvic ring fractures were categorized according to the Tile classification. Patient variables included sex, initial hemoglobin concentration, initial systolic blood pressure, transfused packed red blood cells within 24 hours, Injury Severity Score (ISS), mortality rate, length of hospital stay, and time to angio-embolization.

Results

The most common pelvic fracture pattern was Tile type B (n=34, 54.8%). The mean ISS was 27.3±10.9 with 50% having an ISS ≥25. The mean time to angio-embolization from arrival was 173.6±89 minutes. Type B (180.1±72.3 minutes) and type C fractures (174.7±91.3 minutes) required more time to angio-embolization than type A fractures (156.6±123 minutes). True arterial bleeding was identified in types A (35.7%), B (64.7%), and C (71.4%).

Conclusions

It is important to save time to reach the angio-embolization room in treating patients with pelvic bone fractures. Trauma surgeons need to consider prompt arrangement of angio-embolization when encountering Tile type B or C pelvic fractures due to the high risk of true arterial bleeding.

Summary
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
  • 3,160 View
  • 36 Download
AbstractAbstract 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
Usefulness of Shock Index to Predict Outcomes of Trauma Patient: A Retrospective Cohort Study
Myoung Jun Kim, Jung Yun Park, Mi Kyoung Kim, Jae Gil Lee
J Trauma Inj. 2019;32(1):17-25.   Published online March 31, 2019
DOI: https://doi.org/10.20408/jti.2018.034
  • 5,367 View
  • 177 Download
  • 6 Citations
AbstractAbstract PDF
Purpose

We investigated how prehospital, emergency room (ER), and delta shock indices (SI) correlate with outcomes including mortality in patients with polytrauma.

Methods

We retrospectively reviewed the medical records of 1,275 patients who visited the emergency department from January 2015 to April 2018. A total of 628 patients were enrolled in the study. Patients were divided into survivor and non-survivor groups, and logistic regression analysis was used to investigate independent risk factors for death. Pearson coefficient analysis and chi-square test were used to examine the significant relationship between SI and clinical progression markers.

Results

Of 628 enrolled patients, 608 survived and 27 died. Multivariate logistic regression analysis reveals “age” (p<0.001; OR, 1.068), “pre-hospital SI >0.9” (p<0.001; OR, 11.629), and “delta SI ≥0.3” (p<0.001; OR, 12.869) as independent risk factors for mortality. Prehospital and ER SIs showed a significant correlation with hospital and intensive care unit length of stay and transfusion amount. Higher prehospital and ER SIs (>0.9) were associated with poor clinical progression.

Conclusions

SI and delta SI are significant predictors of mortality in patients with polytrauma. Moreover, both prehospital and ER SIs can be used as predictive markers of clinical progression in these patients.

Summary

Citations

Citations to this article as recorded by  
  • Shock Index for the Prediction of Interventions and Mortality in Patients With Blunt Thoracic Trauma
    Mohammad Asim, Ayman El-Menyar, Talat Chughtai, Ammar Al-Hassani, Husham Abdelrahman, Sandro Rizoli, Hassan Al-Thani
    Journal of Surgical Research.2023; 283: 438.     CrossRef
  • Emergency Department Shock Index Outperforms Prehospital and Delta Shock Indices in Predicting Outcomes of Trauma Patients
    Hamidreza Hosseinpour, Tanya Anand, Sai Krishna Bhogadi, Christina Colosimo, Khaled El-Qawaqzeh, Audrey L. Spencer, Lourdes Castanon, Michael Ditillo, Louis J. Magnotti, Bellal Joseph
    Journal of Surgical Research.2023; 291: 204.     CrossRef
  • Shock index as a predictor for mortality in trauma patients: a systematic review and meta-analysis
    Malene Vang, Maria Østberg, Jacob Steinmetz, Lars S. Rasmussen
    European Journal of Trauma and Emergency Surgery.2022; 48(4): 2559.     CrossRef
  • Delta Shock Index Predicts Outcomes in Pediatric Trauma Patients Regardless of Age
    Samer Asmar, Muhammad Zeeshan, Muhammad Khurrum, Jorge Con, Mohamad Chehab, Letitia Bible, Rifat Latifi, Bellal Joseph
    Journal of Surgical Research.2021; 259: 182.     CrossRef
  • Shock index as a predictor for short‐term mortality in helicopter emergency medical services: A registry study
    Johannes Björkman, Lasse Raatiniemi, Piritta Setälä, Jouni Nurmi
    Acta Anaesthesiologica Scandinavica.2021; 65(6): 816.     CrossRef
  • Association between prehospital field to emergency department delta shock index and in-hospital mortality in patients with torso and extremity trauma: A multinational, observational study
    Dae Kon Kim, Joo Jeong, Sang Do Shin, Kyoung Jun Song, Ki Jeong Hong, Young Sun Ro, Tae Han Kim, Sabariah Faizah Jamaluddin, Zsolt J. Balogh
    PLOS ONE.2021; 16(10): e0258811.     CrossRef
Mortality Reduction in Major Trauma Patients after Establishment of a Level I Trauma Center in Korea: A Single-Center Experience
Young Il Roh, Hyung Il Kim, Yong Sung Cha, Kyoung-Chul Cha, Hyun Kim, Kang Hyun Lee, Sung Oh Hwang, Oh Hyun Kim
J Trauma Inj. 2017;30(4):131-139.   Published online December 30, 2017
DOI: https://doi.org/10.20408/jti.2017.30.4.131
  • 3,803 View
  • 63 Download
  • 4 Citations
AbstractAbstract PDFSupplementary Material
Purpose

Trauma systems have been shown to decrease injury-related mortality. The present study aimed to compare the mortality rates of patients with major trauma (injury severity score >15) treated before and after the establishment of a level I trauma center.

Methods

During this 20-month study, participants were divided into pre-trauma center and trauma center groups, and trauma and injury severity score (TRISS) method was used to compare mortality rates during 10-month periods before and after the establishment of the trauma center (October 2013 to July 2014 vs. October 2014 to July 2015).

Results

Of the 541 total participants, 278 (51.5%) visited after the establishment of the trauma center. The Z and W statistics indicated better outcomes in the trauma center group than in the pre-trauma center group (Z statistic, 2.635 vs. ?0.700; W statistic, 4.640). The trauma center group also exhibited meaningful reductions in the time interval from the emergency department (ED) visit to emergency surgery (118.0 minutes vs. 142.5 minutes, p=0.020) and the interval from the ED visit to intensive care unit admission (202.0 minutes vs. 259.0 minutes, p=0.035) relative to the pre-trauma center group.

Conclusions

The TRISS and multivariate analysis revealed significant improvements in survival rates in the trauma center group, compared to the pre-trauma center group.

Summary

Citations

Citations to this article as recorded by  
  • Mortality Trends in Chest-Abdominal Trauma Patients Before and After the Establishment of Trauma Centers in South Korea
    Dae Ryong Kang, Hye Sim Kim, Ji Young Jang, Ou-Hyen Kim, Kiyoung Kim, Un Young Choi, Jiwool Ko, Keum Seok Bae, Hongjin Shim
    Journal of Acute Care Surgery.2024; 14(1): 1.     CrossRef
  • The Feedback Form and Its Role in Improving the Quality of Trauma Care
    Hany Bahouth, Roi Abramov, Moran Bodas, Michael Halberthal, Shaul Lin
    International Journal of Environmental Research an.2022; 19(3): 1866.     CrossRef
  • Survival benefit of direct transport to trauma centers among patients with unintentional injuries in Korea: a propensity score-matched analysis
    Dong Jun Lee, Seok Hoon Ko, Jongkyeong Kang, Myung Chun Kim, Han Zo Choi
    Clinical and Experimental Emergency Medicine.2022; 10(1): 37.     CrossRef
  • Machine Learning Model to Predict Ventilator Associated Pneumonia in patients with Traumatic Brain Injury: The C.5 Decision Tree Approach
    Ahmad Abujaber, Adam Fadlalla, Diala Gammoh, Hassan Al-Thani, Ayman El-Menyar
    Brain Injury.2021; 35(9): 1095.     CrossRef
Case Report
Temporary Closure for Sternotomy in Patient with Massive Transfusion Might Be Lethal
Maru Kim, Joongsuck Kim, Sung Jeep Kim, Hang Joo Cho
J Trauma Inj. 2017;30(1):12-15.   Published online March 31, 2017
DOI: https://doi.org/10.20408/jti.2017.30.1.12
  • 2,015 View
  • 10 Download
AbstractAbstract PDF
A 58-year-old male visited our emergency room for multiple traumas from explosion. On initial evaluation, hemopneumoperitoneum with liver laceration (grade 4) and colon perforation was identified. Hemopericardium with cardiac tamponade was also identified. Shrapnel was detected in the right ventricle. Damage control surgery was planned due to condition of hypotension. In operation room, control over bleeding was achieved after sternotomy, pericardiotomy, and laparotomy. Massive transfusion was done during operation. After gauze packing, operation was terminated with temporary closure (TC). Sanguineous fluid was drained profusely. Disseminated intravascular coagulopathy was confirmed through laboratory findings. No extravasation was discovered at hepatic angiogram. On re-operation, there was no active bleeding but oozing from sternotomy site was identified. Bone bleeding was impossible to control. Finally, reoperation was ended after gauze packing and TC all over again. The patient could survive for only a day after re-operation.
Summary
Original Articles
A Comparison of the Effectiveness of Before and After the Regional Trauma Center's Establishment
Bo Hyung Song, Sung Youl Hyun, Jin Joo Kim, Jin Seong Cho, Dae Sung Ma, Ha Kyung Kim, Geun Lee
J Trauma Inj. 2016;29(3):68-75.   Published online September 30, 2016
DOI: https://doi.org/10.20408/jti.2016.29.3.68
  • 2,100 View
  • 10 Download
  • 1 Citations
AbstractAbstract PDF
PURPOSE
The purpose of this study was to analyze the effectiveness of regional trauma center's management.
METHODS
Data collected between January 2013 and December 2015 from a regional trauma center registry was retrospectively reviewed. The patients who had injury severity score (ISS) greater than 15 and over the age of 18 were included. We compared annual general characteristics, the injury mechanism, the pathway of transportation, the injury severity score, the length of stay in emergency department (ED) and hospital, the in-hospital mortality.
RESULTS
The annual numbers of enrolled patients were 337, 334 and 278, respectively. No significant differences were found in the annual patient's median ages, injury mechanism, ISS and in-hospital mortality. The annual proportions of coming from other hospital and the median length of stay in hospital were increased after establishment of regional trauma center. The annual median lengths of stay in ED were decreased remarkably.
CONCLUSION
Through the establishment of regional trauma center, the length of stay in ED can be reduced but not in-hospital mortality. More multidisciplinary cooperation and well-organized study is needed to reduce mortality of major trauma patients and maximize effect of regional trauma center.
Summary

Citations

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  • The Effects of a Trauma Team Approach on the Management of Open Extremity Fractures in Polytrauma Patients: A Retrospective Comparative Study
    Seungyeob Sakong, Eic Ju Lim, Jun-Min Cho, Nak-Jun Choi, Jae-Woo Cho, Jong-Keon Oh
    Journal of Trauma and Injury.2021; 34(2): 105.     CrossRef
Effect on Trauma Patients of Having Even One General Trauma Surgeon on Duty
Jang Whan Jo, Jun Min Cho, Nam Ryeol Kim
J Trauma Inj. 2016;29(1):8-13.   Published online March 31, 2016
DOI: https://doi.org/10.20408/jti.2016.29.1.8
  • 2,048 View
  • 13 Download
  • 1 Citations
AbstractAbstract PDF
PURPOSE
Specialized general trauma surgeons play an important role in the care of trauma patients. Hemoperitoneum is a severe, but representative, condition following a life-threatened trauma. The objective of this study was to compare the outcomes for polytrauma patients with hemoperitoneum between the periods during which a trauma surgeon was available and that unavailable.
METHODS
Thirty-one trauma patients with hemoperitoneum who were treated at Korea University Guro Hospital over a period of 4 years were included in this study, and their case records were analyzed retrospectively. The patients were divided into two groups, the 2011 and 2012 group and the 2013 and 2014 group corresponding, respectively, to the periods that a trauma surgeon was not and was working. Vital signs on admission, scores on the injury severity scale and, Glasgow coma scale, elapsed time to diagnostic, and therapeutic, and/or operative interventions were studied. The effects on intensive care unit and hospital lengths of stay, as well as mortality, were also studied.
RESULTS
The study population consisted of 16 and 15 patients in group 1 and 2, respectively. The patients in both groups had six unstable hemodynamic on admission. The time to the main procedure (intervention, operation etc.) was longer during the periods when a trauma surgeon was not working than it was during the period when working. This difference did not reached statistical significance. The mortality rates for the two groups were not statistically different either (18.75% vs 26.67%; p=0.928).
CONCLUSION
Having at least one specialized general trauma surgeon on duty may reduce the time to intervention and surgery for severe trauma patients with hemoperitoneum, but appears to have no effect on the mortality rates. In conclusion, having only one trauma surgeon on duty does not improve the quality of care for trauma patients.
Summary

Citations

Citations to this article as recorded by  
  • Significance of orthopedic trauma specialists in trauma centers in Korea
    Yong-Cheol Yoon, Chang-Wug Oh, Jong-Keon Oh
    Archives of Orthopaedic and Trauma Surgery.2019; 139(10): 1379.     CrossRef
Evaluation the Usefulness of Individual factors for Determining the Severity and Predicting Prognosis of Trauma Victims
Sung Yoon Kim, Byung Hak So, Hyung Min Kim, Won Jung Jeong, Kyung Man Cha, Seung Pill Choi
J Trauma Inj. 2015;28(3):134-143.   Published online September 30, 2015
DOI: https://doi.org/10.20408/jti.2015.28.3.134
  • 1,728 View
  • 5 Download
  • 1 Citations
AbstractAbstract PDF
PURPOSE
Many patients are injured by trauma. And some of them expire due to severity of trauma. Various scoring systems have been introduced in grading severity and predicting mortality of trauma patients. This study is to evaluation the usefulness of factors for determining the severity and predicting the prognosis of the trauma victims.
METHODS
Data on the patients who visited our Emergency departments from January 2010 to December 2011 were retrospectively reviewed using electronic medical records. The patients were activated severe trauma team calling system. The patients were categorized as survivors and non-survivors. Univariated associations were calculated, and a multiple logistic regression analysis was used to determine variables associated with hospital mortality.
RESULTS
Two hundred sixty two(262) patients were enrolled, and the mortality rate was 25.6%. By multivariate analysis, lower respiration rate, lower Glasgow Coma Score, higher International Normalized Ratio and emergency transfusion within 6 hours were expected as severity and prognosis predict factors (each of odds ratio were 24.907, 14.282, 2.667 and 16.144).
CONCLUSION
As predict factors, respiration rate, Glasgow Coma Score, International Normalized Ratio and emergency transfusion, are useful determining the severity and predicting prognosis of trauma victims.
Summary

Citations

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  • Prognostic Accuracy of the Quick Sequential Organ Failure Assessment for Outcomes Among Patients with Trauma in the Emergency Department: A Comparison with the Modified Early Warning Score, Revised Trauma Score, and Injury Severity Score
    Min Woo Kang, Seo Young Ko, Sung Wook Song, Woo Jeong Kim, Young Joon Kang, Kyeong Won Kang, Hyun Soo Park, Chang Bae Park, Jeong Ho Kang, Ji Hwan Bu, Sung Kgun Lee
    Journal of Trauma and Injury.2021; 34(1): 3.     CrossRef
Prognosis and Clinical Outcome of Alcohol Withdrawal Syndrome in Trauma Patients
Dong Gil Oh, Min Soo Cho, Keum Seok Bae, Sung Joon Kang
J Korean Soc Traumatol. 2008;21(2):115-119.
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AbstractAbstract PDF
PURPOSE
Abrupt abstinence from alcohol in cause of chronic alcohol addiction can trigger alcohol withdrawal syndrome. The authors studied the effect of post-operative alcohol withdrawal syndrome in patients who require intensive care due to trauma.
METHODS
For the study group, we selected 70 patients who had undergone emergency surgery from May 2003 to March 2007 due to trauma and who had been treated with prophylactic thiamine. Data was collected retrospectively. We excluded those who extended their hospital stay for other than traumatic causes, those who died within 3 days of surgery after trauma, those who transferred to other institutions, and those who received a psychiatric diagnosis. Patient groups were determined by the existence or the non-existence of withdrawal syndrome. Age, sex, injury mechanism, mortality, complications, durations of hospital stay and intensive care, use of mechanical ventilator, and sedative use were investigated. A Chi-square test and The Mann-Whitney method were used for statistical analysis in this study.
RESULTS
Twenty-four (24) patients from the 58 who had an ISS of 16 or more showed alcohol withdrawal syndrome, and men were shown to be affected with the syndrome significantly more than women. Although ISS was higher in the group with alcohol withdrawal syndrome, statistically, the difference was not significant (p<0.08). The total hospital stay in the patient group with alcohol withdrawal syndrome was on average 10 days longer. However, the difference was not significant (p<0.054). The duration of intensive care in the patient group with alcohol withdrawal syndrome was significantly longer (p<0.029). The patients with alcohol withdrawal syndrome showed no significant difference in the duration of mechanical ventilator use (p<0.783), or in the duration of sedative use (p<0.284). Respiratory distress, pneumonia, upper airway infection, sepsis, acute renal failure, and mortality in the alcohol withdrawal syndrome group were investigated, but no statistically significant difference were noted.
CONCLUSION
We found that the duration of intensive care in chronic alcohol abusers was longer due to the development of alcohol withdrawal syndrome. We also discovered that, when the patients overcame the symptoms of alcohol withdrawal syndrome after intensive care, no difference was found in the frequency of developing complications, the morbidity, and the mortality. Therefore, we conclude that intensive care in trauma patients who are chronic alcohol abusers decreases the incidence of complications found in patients with postoperative alcohol withdrawal syndrome and does not adversely impact the prognoses for those patients.
Summary

J Trauma Inj : Journal of Trauma and Injury