Journal of Trauma and Injury

Volume 24(2); December 2011

Original Articles

Clinical Analysis of Ocular Trauma Induced by Lawn Trimmers: In Gu Kang, Cheol Sang Park, Hyun Sik Ryu, Sok Jin Heo, Youn Sok Chae, Hyun Jin Kim, Seong Soo Park, Mi Jin Lee, Won Joon Jeong; J Korean Soc Traumatol. 2011;24(2):61-67.

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Abstract PDF: PURPOSE
Lawn trimmers are widely used to cut the weeds around graves in South Korea, but they can cause ocular injury. We investigate at the emergency room the incidence and the clinical features of ocular trauma induced by lawn trimmers.
METHODS
The authors analyzed 106 patients who visited Konyang University Hospital's emergency room from March 1, 2007, to October 31, 2011, because of ocular trauma caused by a lawn trimmer. Patients were sorted into two groups, severe ocular injury and mild ocular injury.
RESULTS
Over a 5-year period, 106 patients with ocular trauma caused by a lawn trimmer underwent clinical study. Most of the patient (103 patients) were males, and the average age of the patients was 51.75+/-11.66 years. The incidence of ocular trauma peaked in the sixth decade of life. Most injuries occurred between July and September. Severe ocular injury developed in 46.2% of all patients. As age increased, so did the severity of the ocular injury. The impacting object was a small stone in 43.4% of all patients. Nobody wore protective gear. The most common diagnosis were corneal abrasion, followed by intraocular foreign body, corneal laceration, and sclera laceration. Fifty-four patients were followed up, and thirty-six patients of them had severe injury. The most common complication was a traumatic cataract.
CONCLUSION
Ocular trauma induced by a lawn trimmer is more severe than general ocular trauma. We suggest that everyone using a lawn trimmer should wear protective gear and follow safety guidelines.; Summary

Clinical Analysis of Traumatic Pancreatic Injury: Seon Mi Hwangbo, Young Bong Kwon, Kyung Jin Yun, Hyung Jun Kwon, Jae min Chun, Sang Geol Kim, Jin Young Park, Yun Jin Hwang, Young Gook Yun; J Korean Soc Traumatol. 2011;24(2):68-74.

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Abstract PDF: PURPOSE
Althoughpancreas injury is rare in abdominal trauma,it posesa challengeto the surgeon because its clinicalfeaturesare not prominentand the presence of main duct injurycannot be easily identified by imaging studies. Furthermore, severe pancreas injuries require a distal pancreatectomy or a pancreaticoduodnectomy which are associated considerable morbidity and mortality. We reviewed the clinical features of and outcomes for patients with pancreas injury.
METHODS
For 10 years from Jan. 2001 to Dec. 2010, thirty-four patients were diagnosedas having pancreas injury by using an explo-laparotomy. Patients successfully treated bynon-operative management were excluded. Patients were divided into early (n=18) and delayed surgery groups (n=11) based on an interval of 24hours between injury and surgery. The clinical features of and the outcomes for the patients in both groups were compared.
RESULTS
Males were more commonly injured (82.4% vs.17.6%). The mean age was 37.2 years. The injury mechanisms included vehicle accidents (62.9%, 22/34), assaults (20%, 7/34), and falls (11.4%, 3/34)). The head and neck of the pancreas was most commonly injured, followed by the body and the tail (16, 12, and 6 cases). Of the 34 patients, 26 (76.5%) patients had accompanying injuries. Grade 1 and 2 occurred in 14 (5 and 9) patients, and grade 3, 4, and 5 occurred in 20 (16, 3, and 1) patients. The early and delayed surgery groups showed no difference in surgical outcomes. Two patients with grade 3 in the early surgery group died after surgery,one due tomassive hemorrhage and the other due to septic shock. Of the five patients initially managed non-operatively,three developed peripancreatic necrosis and two developed pseudocyst. All five patients were successfully cured by surgery.
CONCLUSION
All cases of pancreas injury in this study involved blunt injury, and accompanying injury to major vessels or the bowel was the major cause of mortality. Surgery delayed for longer than 24 hours after was not associated with adverseoutcomes.; Summary

A Comparison of the Effectiveness of Before and After the Trauma Team's Establishment: Treatment Outcomes and Lengths of Stay in the Emergency Department: Cheong Hoon Kwon, Chang Min Park, Young Tae Park; J Korean Soc Traumatol. 2011;24(2):75-81.

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Abstract PDF: PURPOSE
The aim of this study was to analyze the influence of a trauma team's management.
METHODS
A total of 181 patients with severe trauma were retrospectively divided into two groups. Of these 181 patients, 81 patients without a trauma team admitted between April and October 2008 were assigned to Group 1, and 100 patients with a Trauma team admitted between April and October 2009 were assigned to Group II. We compared general characteristics, the length of stay in the emergency department (ED) and treatment outcomes (24-h packed RBC transfusion, length of intensive care unit (ICU) stay, length of hospital stay, in-hospital mortality, 24-h mortality) between these two groups.
RESULTS
The length of stay in the ED was significantly reduced in Group II compared to Group I (p=0.025). No significant differences were found in mean arterial pressure, Glasgow Coma Scale, Revised Trauma Score, Injury Severity Score, in-hospital mortality and 24-h mortality between the two groups. However, Group II had a lower amount of 24-h packed RBC transfusion and a shorter length of ICU and hospital stay than Group I, although these differences were not statistically significant.
CONCLUSION
Through the establishment of a trauma team, the length of stay in the ED can be reduced remarkably. Furthermore, the need for 24-h packed RBC transfusions and the length of stay in the ICU and hospital were found to be decreased in patients managed by a trauma team.; Summary

Clinical Aspects and Prognostic Factors Of Small Bowel Perforation After Blunt Abdominal Trauma: Ji Won Kim, Seung Su Kwak, Mun Ki Park, Yong Pyeong Koo; J Korean Soc Traumatol. 2011;24(2):82-88.

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Abstract PDF: PURPOSE
The incidence of abdominal trauma with intra-abdominal organ injury or bowel rupture is increasing. Articles on the diagnosis, symptoms and treatment of small bowel perforation due to blunt trauma have been reported, but reports on the relationship of mortality and morbidity to clinical factors for prognosis are minimal. The purposes of this study are to evaluate the morbidity and mortality of patients with small bowel perforation after blunt abdominal trauma on the basis of clinical examinationand to analyze factors associated with the prognosisfor blunt abdominal trauma with small bowel perforation.
METHODS
The clinical data on patients with small bowel perforation due to blunt trauma who underwent emergency surgery from January 1994 to December 2009 were retrospectively analyzed. The correlation of each prognostic factor to morbidity and mortality, and the relationship among prognostic factors were analyzed.
RESULTS
A total of 83 patients met the inclusion criteria: The malewas 81.9% .The mean age was 45.6 years.The mean APACHE II score was 5.75.The mean time interval between injury and surgery was 395.9 minutes.The mean surgery time was 111.1 minutes. Forty seven patients had surgery for ileal perforations, and primary closure was done for 51patients. The mean admission period was 15.3 days, and the mean fasting time was 4.5 days. There were 6 deaths (7.2%), and 25 patientssuffered from complications.
CONCLUSION
The patient's age and the APACHE II score on admission were important prognostic factors that effecteda patient's progress. Especially, this study shows that the APACHE II score had effect on the operation time, admission period, the treatment period, the fasting time, the mortality rate, and the complication rate.; Summary

Prognostic Factor, for Major Trauma Patients in the Emergency Medical Service System: Duko Lim, Tae Nyoung Chung, Chang Jae Lee, Su Guun Jin, Eui Chung Kim, Sung Wook Choi, Ok Jun Kim; J Korean Soc Traumatol. 2011;24(2):89-94.

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Abstract PDF: PURPOSE
A few studies have assessed the factors affecting the prognoses for major trauma patients and those improving the circumstances when dealing with the trauma system. In that light, we analyzed factors, such as pre-hospital factors, the time to admission, the length of stay in the emergency department (ED) and emergency operation, influencing the outcomes for trauma patients.
METHODS
The patients who visited our emergency department from April 1, 2009, to February 29, 2011, due to major trauma were enrolled in the study. The inclusion criterion was a revised trauma score (RTS) < 7 or injury severity score (ISS) > or = 16. We used reviews of medical records, to analyze each step of emergency medical care with respect to patients' sex, age, visit time and visit date. Continuous variables were described as a median with an interquartile range, and we compared the variables between the survival and the mortality groups by using the Mann-Whitney U test. Fisher's exact test was used for nominal variables. Using the variables that showed statistical significance in univariate comparisons, we performed a logistic regression analysis, and we tested the model's adequacy by the using the Hosmer-Lemeshow method.
RESULTS
A total of 261 patients with major trauma satisfied either the RTS score criterion or the ISS score criterion. Excluding 12 patients with missing data, 249 patients were included in this study. The overall mortality rate was 16.9%. Time to ED arrival, time to admission, time of ED stay, RTS, ISS, and visit date being a holiday showed statistically significant differences between the survival and the mortality groups in the univariate analysis. RTS, ISS, length of ED stay, and visit date being a holiday showed statistical significance in the multivariate analysis.
CONCLUSION
The mortality rate did not show a significant relationship with the time to ED arrival, use of 119, on time to admission. Rather, it elicited a quite significant correlation with the trauma scoring system (RTS and ISS), the time of ED stay, and the visit date being a holiday.; Summary

Analysis of Medical Costs for Trauma Patients: Yeong Cheol Kim, Suk Ho Choi, Kuk Nam Han, Kyung Hak Lee, Soo Eun Lee, Gil Joon Suh, Yeo Kyou Yoon; J Korean Soc Traumatol. 2011;24(2):95-97.

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Abstract PDF: PURPOSE
We analyzed the medical costs for severely traumatized patients according to the severity and medical performance so that we couldimprove the financial balance of the trauma center.
METHODS
Retrospective analysis was performed on patients visitingSNUH Trauma Center from May 2011 to August 2011. Among a total of 55 severely traumatized patients, 31 patients whose medical bills were available and categorized were included in this study. The injury severity score (ISS) was calculated from the abbreviated injury score (AIS), which was updated in 2008,for each patient to assess the severity of injury. Major trauma was defined as an ISS above 15.
RESULTS
The 31 patients in this study included 20 males and 11 females. The average ISS was 33.23+/-16.65 points.We categorize the patients into three groups according to ISS, 16-24: group 1, 25-40: group 2, and above 41: group 3. Total incomes, admission fees, surgery fees, and imaging test fees are shown in table 1. The costs seem to be higher costs in group 2, but this result has no statistical significance. Statistical significantly data are as follows: high radiologic test fees in group 1, short hospital stay in groups 1 and 2, and short ICU stay in group 1. The averagehospital stay was 17 days, and the average emergency intensive care unit (EICU) stay was 7.5 days. Although the EICU stay was only 44% of the total hospital stay, the income from the EICU covers 79.4% of the total hospital income.
CONCLUSION
From this study, we found several items that show relatively high medical income from severely traumatized patients visiting the SNUH Trauma Center. Most of the medical fees arise in the early phase of acute medicine usually in the ICU. Efforts to identify the items with high income and to minimize expenses will improve the financial structure of the Trauma Center,which is facing a budget crisis.; 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

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 Traumatic Pancreas Injury in Multiple Trauma: Single Center Experience: Hyuna Jang, Hong Jin Shim, Sung Whan Cha, Jae Gil Lee; J Korean Soc Traumatol. 2011;24(2):111-117.

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Abstract PDF: PURPOSE
Pancreatic injury is rare in abdominal trauma patients (3%~12%). but it could result in significant morbidity and even mortality. Early and adequate decision making are very important in the management of patients with traumatic pancreatic injury. The purpose of this study was to assess the kinds of management and outcome through the review of our experience of pancreatic injury with multiple trauma.
METHODS
We reviewed 17 patients with traumatic pancreas injury via electronic medical records from Jan. 2002 and April. 2011. We collected demographic findings; the type, location and grade of pancreas injury, the treatment modality, and patient's outcomes, such as complications, length of hospital stay (LOS), and mortality.
RESULTS
Total 17 patients were reviewed, and man was 13 (88%). Traffic accident was the most common cause of injury. Pancreas neck was the most common injured site, and occured in 5 patients. Ductal injury was detected in 7 cases. Eleven patients were treated by surgical procedure, and in this group, 3 patients underwent the endoscopic retrograde pancreas drainage procedure coincidently. ERPD was tried in 8 patients, and failed in 2 patients. The major complications were post-traumatic fluid collection and abscess which accounted for 70% of all patients. The hospital stay was 35.9 days, and it was longer in patient with ductal injury (38.0+/-18.56 vs. 34.5+/-33.68 days). Only one patient was died due to septic shock associated with an uncontrolled retroperitoneal abscess.
CONCLUSION
Early diagnosis is the most important factor to apply the adequate treatment option and to manage the traumatic pancreas injury. Aggressive treatment should be considered in patients with a post-operative abscess.; Summary

Problems with Transferring Major Trauma Patients to Emergency Medical Center of a University Hospital from Another Medical Center: Sang Soo Han, Kyoungwon Jung, Junsik Kwon, Jiyoung Kim, Sang Cheon Choi, Kug Jong Lee; J Korean Soc Traumatol. 2011;24(2):118-124.

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Abstract PDF: PURPOSE
The incidence of multiple trauma is increasing nowadays and is the leading cause of death among young adults. Initial treatment is well known to be crucial in multiple trauma victims. However, many indiscriminate transfers occur due to the lack of a well-organized trauma system in Korea. The objective of this study is to demonstrate the current serious state in which major trauma patients are transferred to the Emergency Medical Center of a university hospital from another medical center.
METHODS
From November 2009 to October 2010, we performed a retrospective study to analyze the characteristics of patients who visited the Ajou University Medical Center located in Gyeonggi-do. We evaluated the ISS (injury severity score), and a score over 15 point was identified as major trauma. The major trauma patients were separated into two groups according to the visit route, and the characteristics of each group were analyzed.
RESULTS
Among the 88,862 patients who visited to the Emergency Medical Center, trauma patients accounted for 19,950, and 343 of them were evaluated as major trauma patients. Among the 343 patients, 170 patients had been transferred from other medical centers. The proportion of males to females was 3.3:1, and the mean ISS was 22.7. The leading cause of trauma was motor vehicle accidents. Of the total 170 patients, 77.6% were admitted to the Intensive care unit and 36.3% underwent surgery. The 170 patients that had been transferred to our medical center, 78.8% were transferred from Gyeonggi-do, 15.3% were transferred from other regions, and 5.9% were miscellaneous.
CONCLUSION
Almost half of the major trauma victims treat at our medical center had been transferred from other medical centers. Establishing a traumatic system, supported by well-organized trauma centers and emergency medical services, that can reduce inappropriate transfers among medical facilities is essential.; Summary

Original article

Clinical Characteristics of Small Bowel Perforation due to Blunt Abdominal Trauma: Jung Min Bae; J Korean Soc Traumatol. 2011;24(2):125-128.

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Abstract PDF: PURPOSE
Blunt small bowel injury (SBI) is frequently combined other organ injury. So, clinical outcome and characteristics of SBI are influenced by other combined injuries. Thus, we analyzed isolated SBI patients and studied clinical outcome and characteristics.
METHODS
Between 2005 and 2010, 36 consecutive patients undergoing laparotomy due to isolated SBI were identified in a retrospectively collected. Database. Clinical outcome and characteristics were analyzed.
RESULTS
Laparotomy was performed in 36 patients. Primary repair was performed 17 patients. Segmental resection of small bowel was performed 19 patients. Median time gap from trauma to operation was 9 hours. In 24 hours from trauma, operation was performed 31 patients. Post operative death was 5 patients. Mean hospital stay was 18 days and median hospital stay was 12 days. There were significant differences between operation type and minor complication and hospital stay. And there were significant differences between time gap in 24 hours and minor complication. But, there were no significant between time gap and mortality.
CONCLUSION
Although this study had many limitations, some valuable information was produced. When operation above 24 hours was delayed in SBI, minor complications were significantly increased. Segmental resection of small bowel in SBI were significantly increased minor complications and hospital stay. So, preventive measures for surgical site infection was important to reduce wound complication and hospital stay. Further continuous study and multi-center study were should be performed to improve clinical outcome in SBI.; Summary

Original Articles

Accidental Injuries from Explosion of a Compressed Natural Gas Bus: Seok Hee Jang, Bo Seung Kang, Hyuk Joong Choi, Hyung Goo Kang, Tae Ho Lim; J Korean Soc Traumatol. 2011;24(2):129-135.

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Abstract PDF: PURPOSE
During August 2010, a natural gas fuel cylinder on a bus exploded in downtown Seoul, injuring 20 citizens. This kind of blast injury has never been reported in Korea before. Thus, the goal of this study was to review the clinical features of these victims to help physicians manage similar cases and to understand the risk factors associated with blast injuries in everyday life.
METHODS
Twenty (20) victims who visited nearby emergency departments, and 3 peoples left hospital without care. Seventeen (17) victims were included in this study, and the following factors were investigated: age, sex, type of hospital, diagnosis of injury, injury mechanism, position of victim (in-bus/out of bus), classification of injury severity with START (simple triage and rapid treatment), and classification of injury according to the mechanism of the blast injury.
RESULTS
The victims included 8 males (47%), 9 females (53%). The mean age was 37.5+/-12. Thirteen (13) victims were transferred to two tertiary hospitals, and 4 were transferred to two secondary hospitals. The types of injury were 3 fractures, 2 ligaments injuries, 6 contusions, 4 abrasions, and 3 open wounds (one of them was combined fracture). According to START classification, 17 victims were 1 immediate, 11 minor, 5 delayed, and no death. Classifications according to the mechanism of the blast injury were 1 primary injury, 6 secondary injuries (2 of them combined other mechanism), 3 tertiary injuries and 9 quaternary injuries.
CONCLUSION
Trauma care physicians should be familiar with not only the specific types of injuries from blast accidents, but also the potential accidents that may occur in public facilities.; Summary

The Role of Endoscopic Retrograde Cholangiopancreatography (ERCP) in the Treatment of Traumatic Pancreas Injury: Min young Jeong, Young hwan Kim, Kyu hyouck Kyoung, Sung Koo Lee, Suk kyung Hong; J Korean Soc Traumatol. 2011;24(2):136-142.

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Abstract PDF: PURPOSE
Blunt pancreatic injury has a high mortality rate, especially if adequate management is delayed. Although many guidelines exist for diagnosis and treatment, there is no consensus to date. Therefore, we analyzed the role of endoscopic retrograde cholangiopancreatography (ERCP) as a diagnostic and therapeutic tool for the treatment of traumatic pancreatic injury.
METHODS
We retrospectively reviewed the electronic medical records (EMR) database at Asan Medical Center (Seoul, South Korea) to identify all patients diagnosed with trauma to the pancreas between June 2003 and December 2010. Clinical and operative findings, CT (computed tomography) images, and ERCP findings were assessed.
RESULTS
A total of 40 patients were evaluated in this study. Of these, 14 patients underwent diagnostic ERCP, and 26 did not. Of the 14 patients who underwent diagnostic ERCP, 5 were found to have normal pancreatic ducts, thereby preventing a needless laparotomy in these patients. Of the patients diagnosed with ductal injury, four were treated with endoscopic intervention, and four underwent an exploratory laparotomy. The remaining patient was treated with radiologic intervention (percutaneous drainage) to manage pancreatic pseudocyst formation.
CONCLUSION
Our findings suggest that ERCP is a beneficial diagnostic and therapeutic modality for the treatment of traumatic pancreatic injury.; Summary

Comparison between Tissue Adhesive and Suture by Using Modified Hollander Score for Facial Wounds Treated in the Emergency Department: Suk Ho Hong, Young Mo Yang, Jang Young Lee, Won Suk Lee, Koung Nam Bark, Hee Bum Yang; J Korean Soc Traumatol. 2011;24(2):143-150.

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Abstract PDF: PURPOSE
The object of this study is to compare the patient satisfaction in the view of scarring, cost, and hospital stay between the conventional suture method and a method using Histoacryl(R) (2-N-butylcyanoacrylate) adhesive for treating facial lacerations in the emergency department.
METHODS
This study is a randomized prospective trial, which was conducted from December 2009 to January 2010. The participants include 109 patients who visited the emergency room in Deajon Eulji Medical Center. The ages ranged from 1 to 59 (mean age of 18.7), and all had facial lacerations of less than 3 cm. In order to treat the facial lacerations, an emergency medicine doctor used tissue adhesive (2-N-butylcyanoacrylate, Histoacryl(R)) for 41 patients in the experimental group, and a plastic surgeon performed conventional suturing for 68 patients in the control group. The ER-stay and the primary treatment fee were compared in the two groups, and the scarring was evaluated 10 to 11 months from suturing by using the Modified Hollander Method and the 10-cm scaled VAS (visual analogue scale: score 0=no scar, score 10=very severe scar).
RESULTS
The ER stay was 76 minutes for the experimental group and 107 minutes for the control group, showing that statistically significantly less time of 31 minutes was taken in the experimental group. The cost of the experimental group was 40000 won (50.1%) more expensive than the control group, with an average cost of 121900 won for the experimental group and 81200 won for the control group. As for scar evaluation, 10.56 months after suturing, the experimental group showed a better result with a score of 2.6 compared to a score of 3.4 in the control group; however, this difference was not statistically significant (p<0.05). As to a detailed evaluation of scar characteristics, the experimental group had a statistically significantly better result in scar elevation, with a score of 0.6 compared to a score of 1.65 for the control group.
CONCLUSION
If appropriate patients are selected, the method using tissue adhesive directly applied by an EM doctor not only decreases ER stay but also creates similar patients satisfaction, with statistically better result in scar elevation, compared to the conventional suture method; thus, ultimately general patient satisfaction is increased.; Summary

Case Report

Unusual Cause of Cognitive Impairment after a Traffic Accident: Chi Min Park; J Korean Soc Traumatol. 2011;24(2):151-154.

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Abstract PDF: In trauma patients, cognitive impairment may develop due to several causes: traumatic brain injury such as intracranial hemorrhage, diffuse axonal injury, hypoxic brain injury or reperfusion injury, the psychologic disorder, such as acute stress disorder, post-traumatic disorder or delirium. We describe a 62-year-old male with post-trauma cognitive impairment due to a primary central nervous system lymphoma.; Summary

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