Journal of Trauma and Injury

Volume 36(1); March 2023

Editorial

Penetrating trauma and “The Wound Man”: Kun Hwang; J Trauma Inj. 2023;36(1):1-2. Published online November 4, 2022; DOI: https://doi.org/10.20408/jti.2022.0035

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Original Articles

Analysis of procedural performance after a pilot course on endovascular training for resuscitative endovascular balloon occlusion of the aorta: Sung Wook Chang, Dong Hun Kim, Dae Sung Ma, Ye Rim Chang; J Trauma Inj. 2023;36(1):3-7. Published online September 22, 2022; DOI: https://doi.org/10.20408/jti.2022.0022

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1 Citations

Abstract PDF

Purpose
As resuscitative endovascular balloon occlusion of the aorta (REBOA) is performed in an extremely emergent situation, achieving competent clinical practice is mandatory. Although there are several educational courses that teach the REBOA procedure, there have been no reports evaluating the impact of training on clinical practice. Therefore, this study is aimed to evaluate the effects of the course on procedural performance during resuscitation and on clinical outcomes.
Methods
Patients who were managed at a regional trauma center in Dankook University Hospital from August 2016 to February 2018 were included and were grouped as precourse (August 2016–August 2017, n=9) and postcourse (September 2017–February 2018, n=9). Variables regarding injury, parameters regarding REBOA procedure, morbidity, and mortality were prospectively collected and reviewed for comparison between the groups.
Results
Demographics and REBOA variables did not differ between groups. The time required from arterial puncture to balloon inflation was significantly shortened from 9.0 to 5.0 minutes (P=0.003). There were no complications associated with REBOA after the course. Mortality did not show any statistical difference before and after the course.
Conclusions
The endovascular training for REBOA pilot course, which uses a modified form of flipped learning, realistic simulation of ultrasound-guided catheter insertion and balloon manipulation, and competence assessment, significantly improved procedural performance during resuscitation of trauma patients.

Summary

Citations

Citations to this article as recorded by

Nomogram for predicting in-hospital mortality in trauma patients undergoing resuscitative endovascular balloon occlusion of the aorta: a retrospective multicenter study
Byungchul Yu, Jayun Cho, Byung Hee Kang, Kyounghwan Kim, Dong Hun Kim, Sung Wook Chang, Pil Young Jung, Yoonjung Heo, Wu Seong Kang
Scientific Reports.2024;[Epub] CrossRef

Usefulness of intraoperative transcranial sonography in patients with traumatic brain injuries: a comparison with postoperative computed tomography: Mahn Jeong Ha, Seung Han Yu, Jung Hwan Lee, Hyuk Jin Choi, Byung Chul Kim; J Trauma Inj. 2023;36(1):8-14. Published online June 20, 2022; DOI: https://doi.org/10.20408/jti.2021.0093

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Abstract PDF: Purpose
The aim of this study was to assess the agreement between intraoperative transcranial sonography (TCS) and postoperative computed tomog¬raphy (CT) in patients with traumatic brain injuries.
Methods
We performed a retrospective cross-sectional study of 35 patients who underwent TCS during surgery, among those who presented to a regional trauma center and underwent decompressive craniectomy between January 1, 2017 and April 30, 2020.
Results
The mean difference between TCS and CT in measuring the midline shift was –1.33 mm (95% confidence inter¬val, –2.00 to –0.65; intraclass correlation coefficient [ICC], 0.96; P<0.001). An excellent correlation was found between TCS and CT in assessing contralateral subdural hematomas (ICC, 0.96; P<0.001) and focal hematoma lesions (ICC, 0.99; P<0.001). A very good correlation between TCS and CT was found for measurements of ventricle width (ICC, 0.92; P<0.001).
Conclusions
TCS during surgery is considered an effective diagnostic tool for the detection of intraoperative parenchymal changes in patients with traumatic brain injuries.; Summary

Can parents prevent tooth loss related to dental avulsion? An assessment of knowledge related to permanent teeth: Gowri Sivaramakrishnan, Deena Abawi, Fatima Mohammad Shoaib, Fatema Bucheery, Ahmed Ali Salman, Majeed Jasim Kadhem, Fatema AlSulaiti, Muneera Alsobaiei, Leena AlSalihi; J Trauma Inj. 2023;36(1):15-21. Published online June 29, 2022; DOI: https://doi.org/10.20408/jti.2021.0094

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Abstract PDF: Purpose
Dental avulsion injuries have a poor prognosis that largely depends on the immediate steps taken to manage the avulsed tooth. A lack of knowledge about the initial management can lead to tooth loss, with further adverse implications for esthetics, phonetics, and overall growth and function. Hence, the present study aimed to assess parents’ knowledge regarding dental avulsion and the variables associated with their knowledge of avulsion injuries.
Methods
A series of closed-ended questions on parents’ knowledge regarding avulsion, such as immediate management, storage media, handling, and urgency of visiting the dentist, was asked. Univariate associations between the outcomes were assessed using the Pearson chi-square test. The chi-square goodness-of-fit test was used to check whether the sample data were representative of the population.
Results
In total, 211 mothers and 149 fathers were included, of whom 46.7% had experienced dental trauma during their own childhood. Sixty-one percent of mothers believed that they knew everything necessary about tooth avulsion and its management. A significant number of participants who thought that they had a good level of knowledge about avulsion chose water, tissue, or paper wrap to transport the tooth, and preferred tap water, alcohol, or antiseptic to clean the avulsed tooth.
Conclusions
Both mothers and fathers had poor knowledge about tooth avulsion, indicating that there is an immediate need for educational programs focusing on this issue. Since a substantial proportion of participants believed incorrect information, it is vital to disseminate accurate information.; Summary

Effect of trauma center operation on emergency care and clinical outcomes in patients with traumatic brain injury: Han Kyeol Kim, Yoon Suk Lee, Woo Jin Jung, Yong Sung Cha, Kyoung-Chul Cha, Hyun Kim, Kang Hyun Lee, Sung Oh Hwang, Oh Hyun Kim; J Trauma Inj. 2023;36(1):22-31. Published online December 6, 2022; DOI: https://doi.org/10.20408/jti.2022.0049

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Abstract PDF: Purpose
Traumatic brain injury (TBI) directly affects the survival of patients and can cause long-term sequelae. The purpose of our study was to investigate whether the operation of a trauma center in a single tertiary general hospital has improved emergency care and clinical outcomes for patients with TBI.
Methods
The participants of this study were all TBI patients, patients with isolated TBI, and patients with TBI who underwent surgery within 24 hours, who visited our level 1 trauma center from March 1, 2012 to February 28, 2020. Patients were divided into two groups: patients who visited before and after the operation of the trauma center. A comparative analysis was conducted. Differences in detailed emergency care time, hospital stay, and clinical outcomes were investigated in this study.
Results
On comparing the entire TBI patient population via dividing them into the aforementioned two groups, the following results were found in the group of patients who visited the hospital after the operation of the trauma center: an increased number of patients with a good functional prognosis (P<0.001 and P=0.002, respectively), an increased number of surviving discharges (P<0.001 and P<0.001, respectively), and a reduction in overall emergency care time (P<0.05, for all item values). However, no significant differences existed in the length of intensive care unit stay, ventilator days, and total length of stay for TBI patients who visited the hospital before and after the operation of the trauma center.
Conclusions
The findings confirmed that overall TBI patients and patients with isolated brain injury had improved treatment results and emergency care through the operation of a trauma center in a tertiary general hospital.; Summary

Severity of grinder injuries and related factors compared with other high-rotation cutting tool injuries: a multicenter retrospective study from 2011 to 2018: Juni Song, Yang Bin Jeon, Jae Ho Jang, Jin Seong Cho, Jae Yeon Choi, Woo Sung Choi; J Trauma Inj. 2023;36(1):32-38. Published online May 25, 2022; DOI: https://doi.org/10.20408/jti.2021.0057

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Abstract PDF: Purpose
This study aimed to identify the characteristics of patients injured by high-rotation cutting tools and the factors related to the severity of their injuries.
Methods
Adult patients (≥18 years), who presented to the emergency department (ED) after a high-rotation cutting tool injury and who were registered in the Korean Emergency Department-based Injury In-Depth Surveillance (2011–2018) database, were included. Patients’ demographic characteristics, injury-related factors, and Injury Severity Scores were collected. All included cases were categorized into two groups according to the tool that caused the injury: grinder versus nongrinder. The characteristics of the two groups were compared, and the factors associated with the severity of injuries were investigated.
Results
Among 8,697 ED visits, 4,603 patients had been using a grinder and 4,094 had been using a nongrinder tool. The most frequently injured body part while using a grinder was the hand (46.4%), followed by the head (23.0%). While using a nongrinder tool, the most frequently injured body part was also the hand (64.0%), followed by the lower leg (11.4%). The odds of a severe injury were affected by patient age (odds ratio [OR], 1.024; 95% confidence interval [CI], 1.020–1.028) and using a grinder (OR, 2.073; 95% CI, 1.877–2.290). The odds of a severe injury using a grinder were higher in arm injuries (OR, 1.60; 95% CI, 1.40–1.83) and multiple-part injuries (OR, 1.998; 95% CI, 1.639–2.437). The odds of a severe injury using a grinder were lower for head injuries (OR, 0.481; 95% CI, 0.297–0.781).
Conclusions
Injuries from grinders were more likely to affect the head and neck than nongrinder injuries, despite the lower severity. The current lack of regulations on grinders in occupational safety and health standards warrants relevant legislation and the development of applicable safety equipment.; Summary

Sports injuries: a 5-year review of admissions at a major trauma center in the United Kingdom: Ahmad Hammad Hassan, Aref-Ali Gharooni, Harry Mee, James Geffner, Fahim Anwar; J Trauma Inj. 2023;36(1):39-48. Published online July 14, 2022; DOI: https://doi.org/10.20408/jti.2021.0084

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Abstract PDF: Purpose
Sports offer several health benefits but are not free of injury risk. Activity dynamics vary across sports, impacting the injury profile and thereby influencing healthcare resource utilization and health outcomes. The purpose of this study was to investigate sports-related major trauma cases and compare differences across sports and activity groups.
Methods
A retrospective case notes review of sports-related major traumas over a 5-year period was conducted. Demographic, hospital episode-related, and health outcome-related data were analyzed, and differences were compared across sports and activity groups. The Glasgow Outcome Scale (GOS) at discharge was used as the primary outcome measure and the length of hospital stay as the secondary outcome measure.
Results
In total, 74.6% of cases had good recovery at discharge (GOS, 5), 18.9% had moderate disability (GOS, 4), and 3.7% had severe disability (GOS, 3). The mean length of hospital stay was 11.2 days (range, 1–121 days). The most severely injured body region was the limbs (29.1%) and vertebral/spinal injuries were most common in terms of location (51.8%). A significant difference (P<0.05) existed in GOS across sports groups, with motor sports having the lowest GOS. However, no significant differences (P>0.05) were found in other health-outcome variables or injury patterns across sports or activity groups, although more competitive sports cases (67.08%) required admission than recreational sports cases (32.9%).
Conclusions
Spinal injuries are the most frequent sports injuries, bear the worst health outcomes, and warrant better preventive measures. Head injuries previously dominated the worst outcomes; this change is likely due to better preventive and management modalities. Competitive sports had a higher injury frequency than recreational sports, but no difference in health outcomes or injury patterns.; Summary

Case Reports

Successful surgical intervention in traumatic carotid artery thrombosis after a motor vehicle accident: a case report: Görkem Yiğit; J Trauma Inj. 2023;36(1):49-52. Published online June 29, 2022; DOI: https://doi.org/10.20408/jti.2021.0095

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Abstract PDF: Blunt carotid artery injury can lead to impaired brain perfusion due to ischemic stroke and thromboembolic events. To reduce the risk of potential neurological complications, it is critical to determine the diagnosis and management protocol as quickly as possible after a detailed clinical examination. This report presents successful surgical treatment of a young male patient who developed a traumatic left common carotid artery thrombosis after a motor vehicle accident.; Summary

Azygos and right superior intercostal vein injury secondary to blunt trauma: a case report: Nima Yaftian, Benjamin Dunne, Phillip Antippa; J Trauma Inj. 2023;36(1):53-55. Published online July 21, 2022; DOI: https://doi.org/10.20408/jti.2022.0001

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Abstract PDF: Azygos vein injuries are rare consequences of blunt trauma. When there is high drainage output from a right-sided intercostal catheter, an azygos injury must be considered in the differential diagnosis. We report the case of a 38-year-old male patient involved in a fall from a height during a motorcycle accident. Computed tomography demonstrated a large right-sided hemothorax and left-sided pneumothorax. The patient was transferred to the operating theatre and underwent a clamshell thoracotomy. A laceration in the azygos vein at the confluence of the arch of the azygos and the right superior intercostal vein was identified. Bleeding was controlled at the trifurcation. The patient survived and was discharged home on postoperative day 15.; Summary

Incidental traumatic right diaphragmatic rupture: a missed case after trauma: Fatima Alharmoodi, Shadin Ghabra, Salem Alharthi; J Trauma Inj. 2023;36(1):56-59. Published online June 23, 2022; DOI: https://doi.org/10.20408/jti.2022.0008

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Abstract PDF: Traumatic diaphragmatic hernia is among the most uncommon conditions after severe trauma, and it is associated with high morbidity and mortality. The diagnosis is difficult and might be missed, but a multimodal investigation might help in terms of diagnostic yield. In this case report, we present a missed right diaphragmatic rupture 14 years after the trauma.; Summary

Experience with the emergency vascular repair of upper limb arterial transection with concurrent acute compartment syndrome: two case reports: Charles Chidiebele Maduba, Ugochukwu Uzodimma Nnadozie, Victor Ifeanyichukwu Modekwe; J Trauma Inj. 2023;36(1):60-64. Published online September 7, 2022; DOI: https://doi.org/10.20408/jti.2022.0007

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Abstract PDF: Upper extremity vascular injuries occurring with acute compartment syndrome are very challenging to manage in an emergency context in resource-poor settings. The need to always recognize the likelihood of coexisting compartment syndrome guides surgeons to perform concomitant fasciotomy to ensure a better outcome. We managed three vascular injuries in the upper extremities in two patients with concomitant imminent compartment syndrome observed intraoperatively. The first injury was complete brachial artery disruption following blunt trauma, while the second and third injuries were radial and ulnar artery transection caused by sharp glass cuts. Both patients were treated with vascular repair and fasciotomy. Secondary wound coverage was applied with split-thickness skin grafting, and the outcomes were satisfactory. Concomitant fasciotomy potentially improves the outcomes of vascular repair in emergency vascular surgery and should be considered for all injuries with the potential for acute compartment syndrome.; Summary

Humeral intramedullary nail bending following trauma: a case report: Siem A. Willems, Alexander P. A. Greeven; J Trauma Inj. 2023;36(1):65-69. Published online June 17, 2022; DOI: https://doi.org/10.20408/jti.2022.0002

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Abstract PDF: The surgical approach for humeral implant failure can be challenging due to neurovascular anatomy and the possible necessity of osteosynthesis removal. We present a rare case of humeral nail bending after secondary trauma in a patient with preexistent nonunion of the humerus after intramedullary nailing. During revision surgery, the nail was sawed in half and the distal part was removed, followed by plate osteosynthesis with cable fixation to achieve absolute stability. The patient regained a full range of motion 1 year after surgery, and complete healing of the fracture was seen on imaging.; Summary

Bilateral anterior dislocation in the hips: a case report: Dheeraj Makkar, Ravi Sauhta; J Trauma Inj. 2023;36(1):70-73. Published online August 5, 2022; DOI: https://doi.org/10.20408/jti.2022.0023

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Abstract PDF: The hip is a stable ball-and-socket joint. Bilateral anterior dislocations of the native hip joints account for fewer than 1% of all dislocations. We present a unique case of a bilateral anterior dislocation in a patient who presented to our institution within 6 hours of trauma. The dislocations were promptly reduced under propofol anesthesia in the operating room. The patient did not suffer a concurrent fracture. After the procedure, we performed regular X-ray examinations for 2 years to rule out the development of avascular necrosis of the head of the femur. The course of the patient was unremarkable.; Summary

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