Journal of Trauma and Injury

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

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Abstract 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

The Influence of Seasons and Weather on the Volume of Trauma Patients: 4 Years of Experience at a Single Regional Trauma Center: Se Heon Kim, Young Hoon Sul, Jin Young Lee, Joong Suck Kim; J Trauma Inj. 2021;34(1):21-30. Published online March 23, 2021; DOI: https://doi.org/10.20408/jti.2020.0027

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Purpose

The purpose of this study was to determine the influence of seasons and weather on the volume of trauma patients in central Korea.

Methods

The records of 4,665 patients treated at Chungbuk National Hospital Regional Trauma Center from January 2016 to December 2019 were retrospectively reviewed. Meteorological data including hourly temperature (°C), precipitation (mm), humidity (%), and wind speed (m/s) for each district were collected retrospectively. Statistical analysis was done using the independent <i>t</i>-test, one-way analysis of variance (ANOVA), and linear regression analysis.

Results

Patients’ average age was 53.66 years, with a significant difference between men (49.92 years) and women (60.48 years) (p<0.001). Rolling/slipping down was a prominent cause of injury in winter (28.4%, n=283), with statistical significance (p<0.001). Trauma occurred least frequently in winter (p=0.005). Linear regression analysis revealed an increasing number of patients as the temperature increased (p<0.05), the humidity increased (p<0.001), and the wind speed decreased (p<0.001). Precipitation did not affect patient volume (p=0.562). One-way ANOVA revealed a decreased incidence of trauma when the temperature exceeded 30°C (p<0.001), and when the humidity was more than 75%, compared to 25–50% and 50–75%.

Conclusions

At the regional trauma center of Chungbuk National University Hospital, in central Korea, the number of trauma patients was lowest in winter, and patient volume was affected by temperature, humidity, and wind speed.

Summary

Citations

Citations to this article as recorded by

Climate change and mental health in Korea: A scoping review
Jiyoung Shin, Juha Baek, Sumi Chae
Journal of Climate Change Research.2023; 14(6-2): 989. CrossRef
The impact of COVID-19 on trauma patients and orthopedic trauma operations at a single focused training center for trauma in Korea
Wonseok Choi, Hanju Kim, Whee Sung Son, Seungyeob Sakong, Jun-Min Cho, Nak-Jun Choi, Tae-Wook Noh, Namryeol Kim, Jae-Woo Cho, Jong-Keon Oh
Journal of Trauma and Injury.2022; 35(3): 195. CrossRef

Case Reports

The Management of Lupus Thrombocytopenia in Poly Trauma Patient: Jin Bong Ye, Young Hoon Sul, Seung Je Go, Jung Hee Choi, Joong Suck Kim; J Trauma Inj. 2017;30(2):59-62. Published online June 30, 2017; DOI: https://doi.org/10.20408/jti.2017.30.2.59

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Abstract PDF: Lupus thrombocytopenia is a common clinical manifestation in systemic lupus erythematosus (SLE). It may present to clinicians with considerable therapeutic difficulties. We experienced a 40-year-old poly trauma patient with lupus thrombocytopenia who had been treated with immunosuppressive drugs for SLE. She was treated for refractory thrombocytopenia with platelet transfusion, corticosteroid and Intravenous immunoglobulin (IVIG). Fourteen days after admission, her platelet count started to increase, 101×103/ul at 16 days after admission. Trauma patients may carry various underlying diseases and thus trauma surgeons should always be aware and ready for peculiar situations.; Summary

Pelvic Bone Fracture with Preperitoneal Hemorrhage: Joong Suck Kim, Young Hoon Sul, Seung Je Go, Jin Bong Ye, Sang Soon Park, Gwan Woo Ku, Yeong Cheol Kim; J Trauma Inj. 2015;28(4):272-275. Published online December 31, 2015; DOI: https://doi.org/10.20408/jti.2015.28.4.272

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Abstract PDF: Pelvic bone fracture with unstable vital signs is a life-threatening condition demanding proper diagnosis and immediate treatment. Unlike long bones, the pelvic bone is a three dimensional structure with complex holes and grooves for vessels and nerves. Because of this complexity, a pelvic bone fracture can lead to complicated and serious bleeding. We report a case of a fifty-year-old male suffering from a pelvic bone fracture due to a fall. An imaging study showed fractures of both the superior and the inferior ramus of the pubic bone, with contrast extravasation underneath them, resulting in a large preperitoneal hematoma. He was sent for angiography, which revealed a hemorrhage from a branch of the left obturator artery. Embolization was done with a glue and lipiodol mixture. The patient recovered without complication, and was discharged at four weeks after admission.; Summary

Arteriovenous Fistula between Renal Artery and Inferior Vena Cava following Penetrating Abdominal Trauma; A Case Report: Joong Suck Kim, Seung Je Go, Ji Dae Kim, Young Hoon Sul, Jin Bong Ye, Sang Soon Park, Gwan Woo Ku, Yeong Cheol Kim; J Trauma Inj. 2015;28(4):262-265. Published online December 31, 2015; DOI: https://doi.org/10.20408/jti.2015.28.4.262

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Abstract PDF: An arteriovenous fistula (AVF) from the renal artery following a penetrating abdominal trauma is not common. We report the case of a 19-year-old male who presented with a knife stab wound in the right upper quadrant. Due to unstable vital signs and to the protrusion of the mesentery through the stab wound, providing definite evidence of peritoneal violation, an emergent exploratory laparotomy was carried out. There were injuries at the proximal transverse mesocolon and the second portion of the duodenum, with bile leakage. There was also a mild amount of retroperitoneal hematoma near the right kidney, without signs of expansion or pulsation. The mesocolon and the duodenum were repaired. After the operation, abdominal computerized tomography (CT) was performed, which revealed contrast from the right renal artery shunting directly into the vena cava. Transcatheter arterial embolization with a coil and vascular plug was performed, and the fistula was repaired. The patient recovered completely and was discharged without complication. For further and thorough evaluation of an abdominal trauma, especially one involving the retroperitoneum, a CT scan is recommended, when possible, either prior to surgery or after surgery when the patient is stabile. Furthermore, a lateral retroperitoneal hematoma and an AVF after a penetrating trauma may not always require exploration. Sometimes, it may be safely treated non-operatively or with embolization.; Summary

Original Article

Clinical Analysis of TEVAR in Blunt Thoracic Aortic Injury: Gwan Woo Ku, Jin Ho Choi, Min Suk Choi, Sang Soon Park, Young Hoon Sul, Seung Je Go, Jin Bong Ye, Joong Suck Kim, Yeong Cheol Kim, Jung Joo Hwang; J Trauma Inj. 2015;28(4):232-240. Published online December 31, 2015; DOI: https://doi.org/10.20408/jti.2015.28.4.232

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Abstract PDF: PURPOSE
Thoracic aortic injury is a life-threatening injury that has been traditionally treated by using surgical management. Recently, thoracic endovascular aortic repair (TEVAR) has been conducted pervasively as a better alternative treatment method. Therefore, this study will focus on analyzing the outcome of TEVAR in patients suffering from a blunt thoracic aortic injury.
METHODS
Of the blunt thoracic aortic injury patients admitted to Eulji University Hospital, this research focused on the 11 patients who had received TEVAR during the period from January 2008 to April 2014.
RESULTS
Seven of the 11 patients were male. At the time of admission, the mean systolic pressure was 105.64+/-24.60 mm Hg, and the mean heart rate was 103.64+/-20.02 per minute. The median interval from arrival to repair was 7 (4, 47) hours. The mean stay in the ICU was 21.82+/-16.37 hours. In three patients, a chimney graft technique was also performed to save the left subclavian artery. In one patient, a debranching of the aortic arch vessels was performed. In two patients, the left subclavian artery was totally covered. In one patient whose proximal aortic neck length was insufficient, the landing zone was extended by using a prophylactic left subclavian artery to left common carotid artery bypass before TEVAR. There were no operative mortalities, but a patient who was covered of left subclavian artery died from ischemic brain injury. Complications such as migration, endovascular leakage, collapse, infection and thrombus did not occur.
CONCLUSION
Our short-term outcomes of TEVAR for blunt thoracic aorta injury was feasible. Left subclavian artery may be sacrificed if the proximal landing zone is short, but several methods to continue the perfusion should be considered.; Summary

Case Reports

Pericardial Tamponade following Perihepatic Gauze Packing for Blunt Hepatic Injury: Jin Bong Ye, Young Hoon Sul, Seung Je Go, Oh Sang Kwon, Joong Suck Kim, Sang Soon Park, Gwan Woo Ku, Min Koo Lee, Yeong Cheol Kim; J Trauma Inj. 2015;28(3):211-214. Published online September 30, 2015; DOI: https://doi.org/10.20408/jti.2015.28.3.211

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Abstract PDF: The primary and secondary survey was designed to identify all of a patient's injuries and prioritize their management. However 15 to 22.3% of patient with missed injuries had clinically significant missed injuries. To reduce missed injury, special attention should be focused on patients with severe anatomical injury or obtunded. Victims of blunt trauma commonly had multiple system involvement. Some reports indicate that inexperience, breakdown of estalished protocol, clinical error, and restriction of imaging studies may be responsible for presence of missed injury. The best way of reducing clinical significant of missed injuries was repeated clinical assessment. Here we report a case of severe blunt hepatic injury patient and pericardial injury that was missed in primary and secondary survey. After damage control surgery of hepatic injury, she remained hemodynamically unstable. Further investigation found cardiac tamponade during intensive care. This was managed by pericardial window operation through previous abdominal incision and abdominal wound closure was performed.; Summary

Delayed Diaphragmatic Injury with Massive Hemothorax Due to Lower Rib Fracture: Woo Shik Kim, Joong Suck Kim; J Trauma Inj. 2015;28(2):79-82. Published online June 30, 2015; DOI: https://doi.org/10.20408/jti.2015.28.2.79

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Abstract PDF

Simple rib fracture is one of most common injury after blunt thoracic trauma found in approximately 7% to 40% of cases. Delayed traumatic diaphragmatic injury with massive hemothorax after rib fracture is rare but a potentially life-threatening condition. We present a rare case of a 79-year-old male with delayed diaphragmatic injury with massive hemothorax due to fracture of the lower ribs. Under thoracoscopy, hemothorax was evacuated, diaphragmatic rupture was identified and repaired, and the lower ribs were fixed with metal plate (s). Although simple lower rib fractures may be the only clinical finding, close observation and monitoring are required because of the possibility of diaphragmatic and/or intraabdominal organ injury.

Summary

Citations

Citations to this article as recorded by

Fatal Delayed Hemothorax after Simple Rib Fracture
Minju Lee, Sang Bum Lim, Hye Jeong Kim, Sohyung Park, Hongil Ha
Korean Journal of Legal Medicine.2017; 41(2): 56. CrossRef

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