- The Utility of Ultrasonography in the Emergency Department for the Diagnosis of Finger Tendon Injury
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Jung Woo Park, Jang Young Lee, Won Suck Lee, Won Young Sung, Sang Won Seo, Jung Il Yang
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J Trauma Inj. 2014;27(4):139-144.
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 Abstract
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- PURPOSE
Detection and determination of tendon injury in the finger or hand is not easy. Therefore, we aimed to study and evaluate the accuracy and the effectiveness of ultrasonography for the diagnosis of finger tendon injury.
METHODS
In this study, we enrolled patients, regardless of age and sex, with lacerations on their fingers. Patients with invisible wounds were excluded. We evaluated the accuracy and the effectiveness of ultrasonography and compared the results obtained from ultrasonography and with those obtained by visual observation of the injuries.
RESULTS
The sensitivity, the specificity and the accuracy of ultrasonography were found to be 66.7%, 100% and 91.3%, respectively (p<0.001) while those of physical examination were 71.4%, 98.3% and 91.3%, respectively. Small differences were observed between the sensitivities and specificities of the two examinations; however, the accuracies were the same (p<0.001). The area under the receiver operating characteristic (ROC) curve, which was used for diagnosis of tendon rupture using ultrasonography, was found to be 0.985 (95% confidence interval CI: 0.929-0.999),while that of physical examination was 0.938 (95% CI: 0.861-0.980).
CONCLUSION
Ultrasonography can be used an effective diagnostic tool for patients with finger tendon injury.
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Summary
- Experience with Operating a Trauma Team at a Local Private University Hospital
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Yong Hwan Kim, Young Mo Yang, Jang Young Lee, Won Suk Lee, Won Young Sung, Koung Nam Bark
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J Trauma Inj. 2013;26(3):99-103.
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Abstract
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- PURPOSE
This hospital has operated a trauma system of the inclusive trauma system under the sponsorship of this hospital and with financial support from the government from 2011, and it has been designated as a specialized trauma center (candidate) since November 2008. Therefore, this emergency medical center evaluated the influence of the inclusive trauma system on the course of healing and on the results for trauma patients within the region.
METHODS
The medical records of all patients who were registered as trauma patients from among those who visited the emergency medical center of this hospital from April 2009 to May 2012 were retrospectively reviewed. The monthly and the annual averages of important indices, such as the time in the emergency room and preventable mortalities, were calculated, and patterns of change were sought. The preventable mortality rate was calculated by using the Trauma Injury Severity Score (TRISS) for each patient.
RESULTS
The total number of patients registered from April 2009 to May 2012 was 601, and male patients accounted for a larger proportion(432 males(71.88%) vs. 169 females(28.12%)). Their average age was 46.2 years, the average Revised Trauma Score (RTS) was 5.74 points, and the average Injury Severity Score (ISS) was 26.99 points. The preventable mortality rate during the entire period, which was calculated using the TRISS, appeared lower than the preventable mortality rates reported in past studies in the Republic of Korea.
CONCLUSION
These results for the operation of a new trauma system are limited in that they are only for a local private university hospital. However, results show greater changes and developments in and out of the hospital due to multilateral endeavors by the trauma team and the hospital. These endeavors include increased communications among the departments and development of a complementary patient registration system.
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Summary
- Successful Treatment of a Traumatic Hepatic Arterioportal Fistula: A Case Report
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Yun Su Mun, Oh Sang Kwon, Jang Young Lee, Gyeong Nam Park, Hyun Young Han, Min Koo Lee
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J Trauma Inj. 2013;26(1):22-25.
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Abstract
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- Severe blunt abdominal trauma frequently involves the liver. The development of nonsurgical treatment of liver trauma has led to more frequent appearance of unusual complications. A hepatic arterioportal fistula (APF) is a rare complication of liver trauma. We present a case of traumatic APF in a patient with liver trauma. A 31-year-old male visited our emergency department with pain in the right upper abdomen following a traffic accident. Initial physical exam and abdominal computed tomography (CT) revealed liver laceration with hemoperitoneum. An abdominal CT obtained on day 11 revealed early opacification of the right portal vein on the arterial phase. After we had come to suspect an APF of the liver, its presence was confirmed on angiography. It was subsequently managed by using transcatheter coil embolization. In patients with portal hypertension and no evidence or history of cirrhosis, one should consider an APF as a potential etiology if history of liver biopsy or penetrating trauma exists. In a patient with liver trauma, serial abdominal CT is important for early detection and treatment of an APF.
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Summary
- Ureteral Injury Caused By Blunt Trauma: A Case Report
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Oh Sang Kwon, Yun Su Mun, Seung Hwo Woo, Hyun Young Han, Jung Joo Hwang, Jang Young Lee, Min Koo Lee
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J Trauma Inj. 2012;25(4):291-295.
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Abstract
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- Ureteral trauma is rare, accounting for less than 1% of all urologic traumas. However, a missed ureteral injury can result in significant morbidity and mortality. The purpose of this case presentation is to suggest another method for early detection of ureteral injury in blunt traumatic patient.
A 47-years-old man was injured in pedestrian traffic accident. He undergone 3-phase abdominal CT initially and had had a short-term follow-up simple. We suspected ureteral injury. Our final diagnosis of a ureteral injury was based on follow-up and antegrade pyeloureterography, he underwent emergency surgery.
We detected the ureteral injury early and took a definitive action within 24 hours.
In blunt trauma, if abnormal fluid collection in the perirenal retroperitoneal space is detect, the presence of a ureteral injury should be suspected, so a short-term simple X-ray or abdominal CT, within a few hours after initial abdominal CT, may be useful.
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Summary
- Comparison between Tissue Adhesive and Suture by Using Modified Hollander Score for Facial Wounds Treated in the Emergency Department
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Suk Ho Hong, Young Mo Yang, Jang Young Lee, Won Suk Lee, Koung Nam Bark, Hee Bum Yang
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J Korean Soc Traumatol. 2011;24(2):143-150.
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Abstract
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- 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.
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Summary
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