- Necessity for a Whole-body CT Scan in Alert Blunt Multiple Trauma Patients
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You Ho Mun, Yun Jeong Kim, Soo Jeong Shin, Dong Chan Park, Sin Ryul Park, Hyun Wook Ryu, Kang Suk Seo, Jung Bae Park, Jae Myung Chung, Ji Hye Bae
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J Korean Soc Traumatol. 2010;23(2):89-95.
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 Abstract
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- PURPOSE
Whole-body CT is a very attractive diagnostic tool to clinicians, especially, in trauma. It is generally accepted that trauma patients who are not alert require whole-body CT. However, in alert trauma patients, the usefulness is questionable.
METHODS
This study was a retrospective review of the medical records of 146 patients with blunt multiple trauma who underwent whole body CT scanning for a trauma workup from March 1, 2008 to February 28, 2009. We classified the patients into two groups by patients' mental status (alert group: 110 patients, not-alert group: 36 patients). In the alert group, we compared the patients' evidence of injury (present illness, physical examination, neurological examination) with the CT findings.
RESULTS
One hundred forty six(146) patients underwent whole-body CT. The mean age was 44.6+/-18.9 years. One hundred four (104, 71.2%) were men, and the injury severity score was 14.0+/-10.38. In the not-alert group, the ratios of abnormal CT findings were relatively high: head 23/36(63.9%), neck 3/6(50.0%), chest 16/36(44.4%) and abdomen 9/36(25%). In the alert group, patients with no evidence of injury were rare (head 1, chest 6 and abdomen 2). Nine(9) patients did not need any intervention or surgery.
CONCLUSION
Whole-body CT has various disadvantages, such as radiation, contrast induced nephropathy and high medical costs. In multiple trauma patients, if they are alert and have no evidence of injury, they rarely have abnormal CT findings, and mostly do not need invasive treatment. Therefore, we should be cautious in performing whole-body CT in alert multiple trauma patients.
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Summary
- Diagnostic Usefulness of Computed Tomography Compared to Conventional Chest X-Ray for Chest Trauma Patients
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Kyu Ill Choi, Kang Suk Seo, Hyun Wook Ryoo, Jung Bae Park, Jae Myung Chung, Jae Yoon Ahn, Seong Won Kang, Jae Hyuck Yi
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J Korean Soc Traumatol. 2009;22(2):142-147.
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Abstract
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- PURPOSE
Early diagnosis and management of therapeutic interventions are very important in chest trauma. Conventional chest X-rays (CXR) and computed tomography (CT) are the diagnostic tools that can be quickly implemented for chest trauma patients in the emergency department. In this study, the usefulness of the CT as a diagnostic measurement was examined by analyzing the ability to detect thoracic injuries in trauma patients who had visited the emergency department and undergone CXR and CT.
METHODS
This study involved 84 patients who had visited the emergency department due to chest trauma and who had undergone both CXR and CT during their diagnostic process. The patients' characteristics and early vital signs were examined through a retrospective analysis of their medical records, and the CXR and the CT saved in the Picture Archiving Communication System (PACS) were examined by a radiologist and an emergency physician to verify whether or not a lesion was present.
RESULTS
Pneumothoraxes, hemothoraxes, pneumomediastina, pulmonary lacerations, rib fractures, vertebral fractures, chest wall contusions, and subcutaneous emphysema were prevalently found in a statistically meaningful way (p<0.05) on the CT. Even though their statistical significance couldn't be verified, other disorders, including aortic injury, were more prevalently found by CT than by CXR.
CONCLUSION
CT implemented for chest trauma patients visiting the emergency department allowed disorders that couldn't be found on CXR to be verified, which helped us to could accurately evaluate patients.
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Summary
- Study of the Length of Needle Thoracostomy Catheter Needed for Patients with Chest Trauma
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Sung Won Kang, Hyun Wook Ryoo, Jung Bae Park, Kang Suk Seo, Jae Myung Chung
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J Korean Soc Traumatol. 2009;22(1):1-4.
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Abstract
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- PURPOSE
This study was conducted to evaluate the length of the catheter used in a needle thoracostomy for emergency decompression of a tension pneumothorax by measuring the chest wall thickness (CWT) in patients with chest trauma METHODS: A retrospective review of 201 patients with chest trauma who had been transported the emergency department in a tertiary university hospital in a metropolitan area between 1 January and 31 February 2007 was performed. The average CWT at the second intercostal space (ICS) in the midclavicular line (MCL) was measured by using a chest computed tomography scan.
RESULTS
As the left and the right mean CWTs were 3.4+/-1.0 cm and 3.4+/-1.0 cm, respectively, there was no significant statistical difference between them. The mean CWT of female patients was significantly higher than that of male patients (p=0.001). The mean CWT of patients under the age of 65 years was significantly thicker than that of the patients over the age of 65 years (p<0.001). Of the studied patients, 12 (6.0%) a CWT > 5 cm.
CONCLUSION
A 5 cm-length catheter in a needle thoracostomy may be insufficient for emergency decompression of a tension pneumothorax, so a catheter longer than 5 cm in length is needed.
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Summary
- Validation of the Simplified Motor Score for the Triage after Traumatic Brain Injury
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Sang Kyong Lee, Hyun Wook Ryoo, Jung Bae Park, Kang Suk Seo, Jae Myung Chung
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J Korean Soc Traumatol. 2008;21(2):71-77.
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Abstract
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- PURPOSE
The Glasgow Coma Scale (GCS), though it is widely used for triage, has been criticized as being unnecessarily complex. Recently, a 3-point Simplified Motor Score (SMS, defined as obeys commands=2; localizes pain=1; withdrawals to pain or worse=0) was developed from the motor component of the GCS and was found to have a similar test performance for triage after traumatic brain injury when compared with the GCS as the criterion standard. The purpose of this study was to validate the SMS.
METHODS
We analyzed the patients who visited Kyungpook National University Hospital emergency center after traumatic brain injury from 2006 January to 2006 June. The test performance of the GCS, its motor component, and SMS relative to three clinically relevant traumatic brain injury outcomes (abnormal brain CT scans, Abbreviated Injury Scale (AIS)> or =4, and mortality) were evaluated with areas under the receiver operating characteristic curves (AUCs).
RESULTS
Of 504 patients included in the analysis, 25.6% had an abnormal brain CT scans, 13.1% had AIS> or = 4, and 5.0% died. The AUCs for the GCS, its motor component, and SMS with respect to the abnormal CT scans were 0.776, 0.715, and 0.716, and respectively, those for AIS> or =4 and mortality, were 0.969, 0.973, and 0.968, and 0.931, 0.909, and 0.909, respectively.
CONCLUSION
The 3-point SMS demonstrated similar test performance when compared with the 15-point GCS score and its motor component for triage after traumatic brain injury in our populations.
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Summary
- Relation between Location of Pelvic bone Fractures and the Injury to the Urinary bladder, Urethra or Lower gastrointestinal tract
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Chang Ho Kim, Jung Bae Park, Hyun Wook Ryoo, Kang Suk Seo, Jun Seok Seo, Jae Myung Chung, Dong Wook Je, Ae Jin Sung
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J Korean Soc Traumatol. 2007;20(2):90-95.
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Abstract
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- PURPOSE
This research was conducted to study whether the specific location of pelvic-bone fractures could increase the risk for injury to the urinary bladder, urethra, or lower gastrointestinal tract.
METHODS
We retrospectively reviewed the data of 234 patients with pelvic-bone fractures who visited the emergency department of Kyungpook National University Hospital from January 2004 to December 2006. The location of the pelvic-bone fracture was divided into 8 parts. The association of fracture location with injury to the urinary bladder, urethra, or lower gastrointestinal tract was analyzed with Fisher's-exact test and multiple logistic regression.
RESULTS
Nineteen(19) patients had urinary bladder injury, 8 had urethral injury, and 9 had lower gastrointestinal tract injury. The following fracture locations were found to be significant; urinary bladder: sacroiliac (SI) joint (p<0.001), symphysis pubis (p=0.011), and sacrum (p=0.005); urethra: SI joint (p=0.020); lower gastrointestinal tract: symphysis pubis (p=0.028). After the multiple logistic regression analysis, the primary and the independent predictors for each of the injuries were as follows; urinary bladder: sacroiliac joint (p=0.000, odds ratio [OR]=10.469); lower gastrointestinal tract: symphysis pubis (p=0.037, OR=7.009).
CONCLUSION
Consideration of further workup for injuries to the lower gastrointestinal and urinary tract is needed for some locations of pelvic-bone fractures because certain pelvic-bone fracture locations, especially the sacroiliac joint and the symphysis pubis, are associated with increased risk for injury to the lower gastrointestinal and urinary tracts.
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Summary
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