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Original Articles
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
  • 3,413 View
  • 105 Download
  • 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
The Prognosis of Traumatic Small Bowel Injury Accompanied by Liver Injury
Yu Seong Noh, Sung Won Jung, Tae Gil Heo, Pyong Wha Choi, Jae Il Kim, Heung Man Jun, Yong Chan Shin, Sung Min Jung, Eun Hae Um
J Trauma Inj. 2021;34(1):44-49.   Published online December 7, 2020
DOI: https://doi.org/10.20408/jti.2020.0052
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  • 99 Download
AbstractAbstract PDF
Purpose

The aim of this study was to elucidate the prognosis, and other clinical features, such as time to surgery and the amount of transfusion, of small bowel injury (SBI) accompanied by liver injury (LI).

Methods

We investigated 221 patients with SBI who visited an emergency center from October 2000 to March 2019. We excluded patients with injuries that directly led to mortality, and the remaining 149 patients were divided into the SBI alone (SBI-A) group and the SBI accompanied by LI (SBI-LI) group. Data were collected for preoperative and surgical outcome variables, and the treatment results were compared between groups.

Results

The SBI-LI group had a higher mortality rate than the SBI-A group (22.4% vs. 14.3%), but this difference was not statistically significant (p=0.061). There were no significant differences between the SBI-A and SBI-LI groups, except for the amount of red blood cell (RBC) transfusion (SBI-A: 3.53±0.1 vs. SBI-LI: 8.38±0.7 packs, p=0.035) and the length of intensive care unit (ICU) stay (SBI-A: 6.7±0.2 vs. SBI-LI: 11.1±0.5 days, p=0.047).

Conclusions

The SBI-LI group required more RBC transfusions and longer ICU stays than the SBI-A group. SBI accompanied by LI may show higher mortality than SBI alone; however, since the difference was not statistically significant in the present study, larger-scale follow-up research is needed.

Summary
Comparison of Penetrating and Blunt Traumatic Diaphragmatic Injuries
Sang Su Lee, Sung Youl Hyun, Hyuk Jun Yang, Yong Su Lim, Jin Seong Cho, Jae Hyug Woo
J Trauma Inj. 2019;32(4):210-219.   Published online December 30, 2019
DOI: https://doi.org/10.20408/jti.2019.034
  • 4,048 View
  • 94 Download
  • 2 Citations
AbstractAbstract PDF
Purpose

Traumatic diaphragmatic injury (TDI) is no longer considered to be a rare condition in Korea. This study investigated differences in the prevalence of accompanying injuries and the prognosis in patients with traumatic diaphragmatic damage according to the mechanism of injury.

Methods

We retrospectively reviewed the medical records of patients with TDI who were seen at a regional emergency medical center from January 2000 to December 2018. Among severe trauma patients with traumatic diaphragmatic damage, adults older than 18 years of age with a known mechanism of injury were included in this study. Surgery performed within 6 hours after the injury was sustained was defined as emergency surgery. We assessed the survival rate and likelihood of respiratory compromise according to the mechanism of injury.

Results

In total, 103 patients were analyzed. The patients were categorized according to whether they had experienced a penetrating injury or a blunt injury. Thirty-five patients had sustained a penetrating injury, and traffic accidents were the most common cause of blunt injuries. The location of the injury did not show a statistically significant difference between these groups. Severity of TDI was more common in the blunt injury group than in the penetrating injury group, and was also more likely in patients with respiratory compromise. However, sex, the extent of damage, and the initial Glasgow coma scale score had no significant relationship with severity.

Conclusions

Based on the findings of this study, TDI should be recognized and managed proactively in patients with blunt injury and/or respiratory compromise. Early recognition and implementation of an appropriate management strategy would improve patients’ prognosis. Multi-center, prospective studies are needed in the future.

Summary

Citations

Citations to this article as recorded by  
  • An audit of traumatic haemothoraces in a regional hospital in KwaZulu-Natal, South Africa
    CM Kithuka, VC Ntola, W Sibanda
    South African Journal of Surgery.2023; 61(3): 12.     CrossRef
  • Factors Associated with Successful Video-Assisted Thoracoscopic Surgery and Thoracotomy in the Management of Traumatic Hemothorax
    Heather M. Grant, Alexander Knee, Michael V. Tirabassi
    Journal of Surgical Research.2022; 269: 83.     CrossRef
Clinical Outcomes of Diffuse Axonal Injury According to Radiological Grade
Hak-Jae Lee, Hyun-Woo Sun, Jae-Seok Lee, Nak-Joon Choi, Yoon-Joong Jung, Suk-Kyung Hong
J Trauma Inj. 2018;31(2):51-57.   Published online August 31, 2018
DOI: https://doi.org/10.20408/jti.2018.31.2.51
  • 17,308 View
  • 282 Download
  • 5 Citations
AbstractAbstract PDF
Purpose

Patients with diffuse axonal injury experience various disabilities and have a high cost of treatment. Recent researches have revealed the underlying mechanism and pathogenesis of diffuse axonal injury. This study aimed to investigate the correlation between the radiological grading of diffuse axonal injury and the clinical outcomes of patients.

Methods

From January 2011 to December 2016, among 294 patients with traumatic brain injury, 44 patients underwent magnetic resonance imaging (MRI). A total of 18 patients were enrolled in this study except for other cerebral injuries, such as cerebral hemorrhage or hypoxic brain damage. Demographic data, clinical data, and radiological findings were retrospectively reviewed. The grading of diffuse axonal injury was analyzed based on patient’s MRI findings.

Results

For the most severe diffuse axonal injury patients, prolonged intensive care unit (ICU) stay (p=0.035), hospital stay (p=0.012), and prolonged mechanical ventilation (p=0.030) were observed. However, there was no significant difference in healthcare-associated infection rates between MRI grading (p=0.123). Massive transfusion, initial hemoglobin and lactate levels, and MRI gradings were found to be highly significant in predicting the duration of unconsciousness.

Conclusions

This study showed that patients with high grade diffuse axonal injury have prolonged ICU stays and significantly longer hospital stays. Deteriorated mental patients with high energy injuries should be evaluated to identify diffuse axonal injuries by using an appropriate imaging tool, such as MRI. It will be important to predict the duration of consciousness recovery using MRI scans.

Summary

Citations

Citations to this article as recorded by  
  • Prediction for the prognosis of diffuse axonal injury using automated pupillometry
    Makoto Murase, Shinichi Yasuda, Makoto Sawano
    Clinical Neurology and Neurosurgery.2024; 240: 108244.     CrossRef
  • Head CT for the intensivist: 10 tips and pearls
    Sajeev A. MAHENDRAN, Oliver FLOWER, J. Claude HEMPHILL III rd
    Minerva Anestesiologica.2022;[Epub]     CrossRef
  • Evaluation of Laboratory Variables Related to Diffuse Axonal Injury: A Cross-sectional Study
    Masoud Hatefi, Khalil Komlakh
    Archives of Neuroscience.2022;[Epub]     CrossRef
  • Clinical outcomes of diffuse axonal injury after traumatic brain injury according to magnetic resonance grading
    Insu Lee, Kawngwoo Park, Tae Seok Jeong, Woo-Seok Kim, Woo Kyung Kim, Do Yeon Rhee, Cheol Wan Park
    Journal of Korean Society of Geriatric Neurosurger.2021; 16(2): 71.     CrossRef
  • Use of Magnetic Resonance Imaging in Acute Traumatic Brain Injury Patients is Associated with Lower Inpatient Mortality
    Hwan Lee, Yifeng Yang, Jiehui Xu, Jeffrey B. Ware, Baogiong Liu
    Journal of Clinical Imaging Science.2021; 11: 53.     CrossRef
Clinical Characteristics and Prognostic Factors of Pulmonary Contusion with Traumatic Lung Cyst
Yong Hwan Kim, Sung Youl Hyun, Jin Joo Kim, Chung Kwon Kim, Yong Su Lim, Hyuk Jun Yang, Mi Jin Lee
J Korean Soc Traumatol. 2008;21(2):100-107.
  • 1,272 View
  • 4 Download
AbstractAbstract PDF
PURPOSE
A traumatic lung cyst (TLC) is a rare complication and is usually detected with a pulmonary contusion. This study attempted to identify the prognostic factors and the clinical characteristics for pulmonary contusion with TLCs.
METHODS
We retrospectively reviewed the medical records and chest CT findings of 71 TLC patients who visited our hospital from January 2006 to December 2007. Patients were assessed for any clinical characteristics. We evaluated significant differences between the survival and the death groups for patients with a traumatic lung cyst.
RESULTS
The male-to-female ratio of patients with TLCs was 54:17, and the mean age of the patients was 37.70 +/- 19.78 years with 36.6% of the patients being under 30 years fo age. The cause of blunt thoracic trauma was mainly pedestrian traffic accidents (26.8%) and falls (25.4%). Associated conditions included pulmonary contusion in 68 patients (95.7%), hemopneumothorax in 63 patients (88.7%), and rib fracture in 52 patitents (73.2%). There was no consistent relationship between the number of TLCs and the pulmonary contusion score. The overall mortality rate of TLC patients was 26.8%. Death correlated with a need for ventilatory assistance, mean arterial pressure, worst mean arterial pressure in 24 hours, initial pH and base excess, worst pH and base excess in 24 hours, refractory shock, initial GCS score, and pulmonary contusion score.
CONCLUSION
The presence of the aforementioned predictors indicate serious injury, which is the main determinant of the outcome for thoracic injuries with TLCs.
Summary
Clinical Characteristics and Prognosis of Heat Stroke
Noh Han Park, Hyun Wook Ryoo, Kang Suk Seo, Jung Bae Park, Jae Mung Chung
J Korean Soc Traumatol. 2006;19(2):113-120.
  • 1,195 View
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AbstractAbstract PDF
PURPOSE
The aim of this study was to evaluate the clinical characteristics of classic heat stroke in Korea and to identify factors of prognosis for heat stroke by comparing a survival group with a non-survival group.
METHODS
We retrospectively analyzed 27 patients with heat stroke who visited the Emergency Department of Kyungpook National University Hospital from March 2001 to February 2005. First, we divided the patients into two groups, the classic heat stroke group and the exertional heat stroke group, and compared them. Second, we compared the survival group with the non-survival group. Age, sex, cause, place where patients were found, underlying diseases, cooling time, performance of endotracheal intubation, initial Glasgow Coma Scale, initial vital sign, and laboratory findings were reviewed.
RESULTS
Five of 27 patients in heat stroke died. The classic heat stroke group had 20 patients. They were old and had more patients in the bathroom than the exertional heat stroke group had. The non-survival group showed lower blood pressure, lower initial GCS score, and higher respiratory rate than the survival group. In laboratory findings, the non-survival group also showed lower HCO3-level, lower albumin level, lower glucose level, more prolonged PT, and higher CK-MB level than the survival group. Delay in recognition of heat stroke and cooling were poor prognostic factors in heat stroke.
CONCLUSION
The classic heat stroke group had patients who were old and found in the bathroom. Early recognition and treatment of heat stroke is important to reduce mortality. Cooling time, initial GCS score, mean arterial pressure, resipratory rate, HCO3-, PT, CK-MB, and albumin seem to be meaningful when forming a prognosis for heat stroke patients.
Summary
Effectiveness of Simple Trauma Team Activation Criteria on Prognosis of Severe Trauma Patients
Dong Keon Lee, Kang Hyun Lee, Kyoung Chul Cha, Kyoung Hye Park, Han Joo Choi, Hyun Kim, Sung Oh Hwang
J Korean Soc Traumatol. 2009;22(1):71-76.
  • 1,284 View
  • 7 Download
AbstractAbstract PDF
PURPOSE
The goal of this study was to compare the outcome of the after trauma team (AfterTT) group to the before trauma team (BeforeTT) group.
METHODS
All trauma patients who visited to emergency room (ER) between July 1, 2006 and February 29, 2008 based on trauma registry, with systolic blood pressure (SBP) < 90 mmHg or GCS < 9 were included in this study. We compared the amount of packed RBC transfusion, the ER stay time, the ER visit to CT evaluation time, the ER visit to operation time, the length of ICU stay, the length of hospital admission and the survival discharge rate between the AfterTT group and the BeforeTT group. Patients with brain injuries had little chance of survival. Burn patients, who visited the ER 24 hours after injury and patients who were dead on arrival (DOA) were excluded from this study.
RESULTS
Total of 93 patients were included in this study: 42 in the AfterTT group and 51 in the BeforeTT group. The AfterTT group and the Before TT group showed no differences in Revised Trauma Score (RTS) and mean age. The amount of packed RBC transfusion was lower in the AfterTT group, but no statistically significant difference was noted (AfterTT 11+/-11units, BeforeTT 16+/-15units, p=0.136). The ER visit to operation time was shorter in the AfterTT group, but there were no statistically significant difference between the groups (AfterTT 251+/-223 minutes, BeforeTT 486+/-460 minutes, p=0.082). The length of ICU stay was shorter in the AfterTT group, but the difference was not statistically significant (AfterTT 11+/-12 days, Before TT 15+/-30 days, p=0.438). The length of Hospital admission was shorter in the AfterTT group (AfterTT 43+/-37 days, BeforeTT 68+/-70 days, p=0.032), but this difference was not statistically significant.
CONCLUSION
Simple Trauma team activation criteria decreased the amount of packed RBC transfusion and the hospital admission duration. Hemodynamic instability (SBP < 90 mmHg) and decreased mental state (GCS <9) are good indices for activating the trauma team.
Summary
Prognostic Factors in Patients Who Performed Angiographic Embolization for the Bleeding from Injury of the Intraabdominal Organ and Pelvic Area
Jin Ho Lee, Ji Young Jang, Hong jin Shim, Jae Gil Lee
J Trauma Inj. 2012;25(4):166-171.
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AbstractAbstract PDF
PURPOSE
In patients with traumatic hemoperitoneum or pelvic bone fracture who underwent angiography and embolization, we want to find the prognostic factors related with mortality.
METHODS
Patients(333 patients) who visited our hospital with traumatic injury from March 2008 to April 2012 were included in this study. Only 37 patients with traumatic hemoperitoneum or pelvic bone fracture underwent angiography and embolization. A retrospective review was conducted, and Glasgow coma scale (GCS), Revised trauma score (RTS), Injury severity score (ISS), initial laboratory finding and time interval, the amount of transfusion from the arrival at the ER to the start of embolization, and the vital signs before and after procedure were checked. Stastical analysis was conducted using the Chi square and Mann-Whitney U test.
RESULTS
In univariate analysis, the amount of transfusion, the base deficit before procedure, the systolic blood pressure before and after the procedure, the GCS, the RTS and the ISS were significantly associated with prognosis. In the multivariate analysis, the ISS and the base deficit had significant association with prognosis. Of the 37 patients who underwent angiography and embolization, 31 patients needed not additional procedure (Group A) while the other 6 patients needed an additional procedure (Group B). After procedure, a statistically significant higher blood pressure was observed in Group A than in Group B. As to the difference in blood pressure before and after the procedure, a statistically significant decrease in systolic blood pressure was observed in Group B, but an increase was observed in Group A.
CONCLUSION
In traumatic hemoperitoneum or pelvic bone fracture patients who underwent angiography and embolization, GCS, ISS, RTS, transfusion amount before the procedure, initial base deficit and systolic blood pressure were factors related to mortality. When patients who underwent angiography and embolization only were compared with patients who underwent re-embolization or additional procedure after the first embolization, an increase in systolic blood pressure after embolization was a prognostic factor for successful control of bleeding.
Summary
Original articles
The Study of the Severity and Prognosis in Severe Traumatic Patients according to Alcohol Ingestion
Ho Hyung Jung, Sang Kyoon Han, Sung Wha Lee, Sung Wook Park, Soon Chang Park, Seok Ran Yeom, Moon Gi Min, Yong In Kim, Ji Ho Ryu
J Trauma Inj. 2014;27(4):108-114.
  • 1,245 View
  • 8 Download
AbstractAbstract PDF
PURPOSE
Alcohol ingestion is a significant risk factor for injuries. However, the influence of high blood alcohol concentration about the severe traumatic injury is controversial. The aim of study was to analyze the injury severity, prognosis in severe traumatic patients according to alcohol ingestion.
METHODS
This study was performed retrospectively with severe traumatic patients (Injury Severity Score> or =16) who visited the emergency department at Pusan National University Hospital from January 2013 to December 2013.
RESULTS
In total 98 severe traumatic patients, blood alcohol concentration (BAC) positive group (BAC>30 mg/dl) is 42 (42.90%) patients and BAC negative group (BAC< or =30 mg/dl) is 56 (57.10%)patients. Head and neck injury is significantly high in BAC positive group (35 patients, 83.3%) compared to BAC negative group (33 patients, 58.9%). Comparison of injury severity, outcome and mortality is not significantly different between two groups.
CONCLUSION
In severe traumatic patients, head and neck injury occurred high in BAC positive group. Alcohol ingestion did not influence injury severity, outcome in severe traumatic patients. However, effort to decreasing injury related to alcohol ingestion and prospective multi-center study is needed.
Summary
Survival Rate and Neurologic Outcome for Patients after Traumatic Cardiac Arrest
Shin Woong Park, Sung Youl Hyun, Jin Joo Kim, Yong Su Lim, Jin Sung Cho, Hyuk Jun Yang, Won Bin Park, Jae Hyug Woo, Jae Ho Jang
J Trauma Inj. 2013;26(3):190-197.
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AbstractAbstract PDF
PURPOSE
Trauma is one of the major cause of death in Korea. This study focused on the survival rate and the neurologic outcome for patients with traumatic cardiac arrest (CA) at one emergency center.
METHODS
We retrospectively reviewed the medical records of patients with traumatic CA who were seen at a regional emergency medical center from January 2010 to December 2011. From among major trauma patients at that medical center, adults older than 18 years of age who had CA were included in this study. CA included out-of-hospital CA with arrival at the Emergency Department (ED) within three hours and in-hospital CA. We checked the survival rate and the neurologic outcome.
RESULTS
A total of 61 patients were analyzed: 32 patients had return of spontaneous circulation (ROSC), 6 patients survived to discharge (survival rate: 9.84%), and 4 were still alive 90 days after discharge. The Cerebral performance category (CPC) scores at 6 months after discharge showed 1 good and 5 poor in neurologic outcomes. Factors such as initial rhythm of CA, part with major injury, Revised Trauma Score (RTS) and pH, were significant for ROSC, survival, and neurologic outcome in patients with traumatic CA.
CONCLUSION
In this study, patients who had traumatic CA showed a 9.84% survival rate and a 1.64% good neurologic outcome. The results are poorer than those for CA caused by disease. Multi-center, prospective studies are needed.
Summary

J Trauma Inj : Journal of Trauma and Injury