Journal of Trauma and Injury

Min A Lee

9 Articles

Treatment Option for High Grade Spleen Injury and Predictive Factors for Non-operative Management: Joung Won Na, Jung Nam Lee, Byung Chul Yu, Min A Lee, Jae Jung Park, Gil Jae Lee; J Trauma Inj. 2017;30(3):91-97. Published online October 30, 2017; DOI: https://doi.org/10.20408/jti.2017.30.3.91

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Abstract PDF: PURPOSE
The prognostic factors of non-operative management (NOM) in high-grade spleen injuries have been extensively studied, but factors that would help treatment decisions are lacking. We compared the characteristics of the patients to identify the factors affecting treatment choices.
METHODS
This is a review of 207 blunt spleen injury patients from January 2004 to December 2013. We compared clinical features and mortality between surgery and NOM, and used multivariate regression analysis to find the factor most strongly associated with prognosis.
RESULTS
Of the 207 patients, 107 had high-grade spleen injury patents (grade III or above). Of these, 42 patients underwent surgery and 65 patients underwent NOM. The mortality was 7% following surgery, 3% with NOM. The amount of packed red blood cells transfused in the first 24 hours and spleen injury grade were associated with management type, and mortality was highly associated with activated partial thromboplastin time (aPTT) and spleen injury grade.
CONCLUSIONS
The grade of spleen injury was associated with management and mortality, so correctly assessing the spleen injury grade is important.; Summary

The Impact of Trauma Center Establishment on Laparotomy Patterns and Outcomes in Severe Hemoperitoneum Patients: Min A Lee, Jungnam Lee, Min Chung, Giljae Lee, Jaejeong Park, Kangkook Choi, Byung Chul Yoo; J Trauma Inj. 2017;30(1):6-11. Published online March 31, 2017; DOI: https://doi.org/10.20408/jti.2017.30.1.6

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Abstract PDF: PURPOSE
The establishment of the trauma system has changed the quality of trauma care in many countries. As one of the first designated level I trauma centers in Korea, we hypothesized that there were changes in laparotomy patterns and subsequent survival rates after the center was established.
METHODS
This was a 5-year retrospective study of all severe hemoperitoneum patients who were transfused with more than 10 units of packed red blood cells (RBCs) within 24 h of hospitalization. Variables related to trauma were collected throughout the study period, and the patients admitted before (period 1) and after (period 2) the establishment of a trauma center were compared.
RESULTS
Forty-five patients were managed from January 2009 to March 2015. The baseline patient characteristics of the two groups, including age, Injury Severity Score, blood pressure, and hemoglobin levels, were similar. The time to the operating room (OR) was 144.3±51.5 min (period 1) and 79.9±44.1 min (period 2) (p<0.0001). Damage control surgery (DCS) was performed in 17% of patients during period 1 and in 73% during period 2. The number of actual survivors (n=10) was higher than expected (n=8) in period 2.
CONCLUSION
This is the first study analyzing the impact of a trauma center on the management of specific injuries, such as severe hemoperitoneum, in patients in Korea. During the study, the time to OR was shortened and DCS was used to a greater extent as a surgical procedure.; Summary

Rectal Injury Associated with Pelvic Fracture: Jihun Gwak, Min A Lee, Byungchul Yu, Kang Kook Choi; J Trauma Inj. 2016;29(4):201-203. Published online December 31, 2016; DOI: https://doi.org/10.20408/jti.2016.29.4.201

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Rectal injury is seen in 1-2% of all pelvic fractures, and lower urinary tract injury occurs in up to 7%. These injuries are rare, but if missed, can lead to a severe septic response. Rectal injury may be suspected by the presence of gross blood on digital rectal examination. However, this classic sign is not always present on physical examination. If an Antero-Posterior Compression type pelvic fracture is seen, we should consider the possibility of rectal and lower urinary tract injury. It is important to define the anatomic location of the rectal injury as it relates to the peritoneal reflection. Trauma to the intraperitoneal rectum should be managed as a colonic injury. Extraperitoneal rectal injury should be managed with fecal diversion regardless of primary repair. We present the case of a 46-year-old man who was referred to our hospital following a major trauma to the pelvis in a pedestrian accident.

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Rectal Perforation Associated with a Pelvic Fracture Managed with Lateral Caudal Axial Pattern Flap Surgery Using the Tail to Skin Defect in a Mixed-Breed Dog
Jongjin Lee, Jinsu Kang, Namsoo Kim, Suyoung Heo
Journal of Veterinary Clinics.2021; 38(5): 240. CrossRef

Enteroatmospheric Fistula Associated with Open Abdomen: Jihun Gwak, Min A Lee, Dae Sung Ma, Kang Kook Choi; J Trauma Inj. 2016;29(4):195-200. Published online December 31, 2016; DOI: https://doi.org/10.20408/jti.2016.29.4.195

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Abstract PDF: Enteroatmospheric fistula (EAF) is one of the most devastating complications in patients with an open abdomen and has associated morbidity and mortality rates. No gold standard therapy has been established for the treatment of EAF, and thus, treatment decision making is dependent on the experience of medical staff. Nevertheless, treatment involves the following; 1) sepsis must be managed, 2) sufficient nutritional support must be provided, and 3) effluent must be isolated from skin and open viscera. Here the authors present the case of a 29-year-old man who developed enteroatmospheric fistula after damage control laparotomy.; Summary

Blush on Computed Tomography and Transcatheter Arterial Embolization in Pelvic Fracture: Jihun Gwak, Yong Cheol Yoon, Min A Lee, Byungchul Yu, Myung Jin Jang, Kang Kook Choi; J Trauma Inj. 2016;29(4):161-166. Published online December 31, 2016; DOI: https://doi.org/10.20408/jti.2016.29.4.161

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Abstract PDF: PURPOSE
Bleeding is the primary cause of death after severe pelvic fracture. Transcatheter arterial embolization (TAE) is the mainstay of treatment for arterial bleeding. This study aimed to determine the frequency of bleeding by angiography of blush-positive pelvic fractures on computed tomography (CT) images. The bleeding arteries that were involved were investigated by pelvic angiography.
METHODS
This retrospective cohort study evaluated 83 pelvic fracture patients who were treated in the intensive care unit of the author's trauma center between January 01, 2013 and April 30, 2015.
RESULTS
Overall mortality was 9 of 83 patients (10.8%). Blush was observed in 37 patients; blush-positive patients had significantly higher mortality (24.3%) than blush-negative patients (0%). Twenty-four of the 83 patients (28.9%) underwent pelvic angiography. Bleeding was showed in 22 of 24 patients in pelvic angiography. TAE was successfully performed in 21 (95.5%) of the bleeding 22 patients. Angiography was performed in 23 of 37 blush-positive patients, and arterial bleeding was identified in 21 (91.3%). A total 33 bleeding arteries were identified in 22 angiography-positive patients. The most frequent origin of bleeding was internal iliac artery (69.7%) followed by the external iliac artery (18.2%) and lumbar arteries (12.1%).
CONCLUSION
The vascular blush observed in CT scans indicates sites of ongoing bleeding in pelvic angiography. TAE is an excellent therapeutic option for arterial bleeding and has a high success rate with few complications.; Summary

Characteristics of Korean Trauma Patients: A Single-center Analysis Using the Korea Trauma Database: Youngeun Park, Min Chung, Gil Jae Lee, Min A Lee, Jae Jeong Park, Kang Kook Choi, Sung Youl Hyun, Yang Bin Jeon, Dae Sung Ma, Yong Cheol Yoon, Jungnam Lee, Byungchul Yoo; J Trauma Inj. 2016;29(4):155-160. Published online December 31, 2016; DOI: https://doi.org/10.20408/jti.2016.29.4.155

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PURPOSE
Two years have passed since a level I trauma center was officially opened in the Gacheon Gil Hospital, South Korea. We analyzed 2014 and 2015 registered patient data from the Korean Trauma Data Base (KTDB) to identify trends in trauma patient care and factors that influence the quality of trauma care at the Gacheon Gil trauma center.
METHODS
Data was extracted from the KTDB included patient age, sex, systolic blood pressure at emergency room arrival, revised trauma score, injury severity score, trauma injury severity score, transfusion amount, and the cause of death was analyzed.
RESULTS
A total of 3269 trauma patients were admitted to our trauma center in 2014 and 3225 in 2015. Demographics and mechanism of injury were not significantly different between years. The severity of trauma injury was decreased in 2015 although the mortality rate was slightly increased. This requires further analysis.
CONCLUSION
The aim of this study was to determine the general status and trends in trauma incidence and management outcomes for the Incheon area. We noted no significant changes in trauma status from 2014 to 2015. We need to collect and review trauma patient data over a long period in order to elucidate trauma incidence and management trends in the trauma field. Finally, studies using trauma patient data will indicate appropriate quality control factors for trauma care and help to improve the quality of trauma management.

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Associated Injuries in Spine Trauma Patients: A Single-Center Experience
Seunghan Yu, Hyuk Jin Choi, Jung Hwan Lee, Byung Chul Kim, Mahnjeong Ha, In Ho Han
Journal of Trauma and Injury.2020; 33(4): 242. CrossRef

Right Diaphragmatic Injury Accompanied by Herniation of the Liver: A Case Report: Min A Lee, Kang Kook Choi, Gil Jae Lee, Byung Chul Yu, Dae Sung Ma, Yang Bin Jeon, Jung Nam Lee, Min Chung; J Trauma Inj. 2016;29(2):43-46. Published online June 30, 2016; DOI: https://doi.org/10.20408/jti.2016.29.2.43

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Abstract PDF: Traumatic diaphragmatic injury (TDI) occurs in 1% of patients of blunt abdominal trauma. Most TDIs involve the left diaphragm, however the authors experienced TDI accompanied by a liver laceration of the right diaphragm. When detected early, TDI can be easily treated, however serious complications can occur if not. When diaphragmatic injury is suspected due to clinical manifestation, comprehensive analysis of the patient data including radiologic findings is important.; Summary

A Blunt Traumatic Vertebral Artery Injury: A Case Report: Min A Lee, Kang Kook Choi, Gil Jae Lee, Byung Chul Yu, Dae Sung Ma, Yang Bin Jeon, Min Chung, Jung Nam Lee; J Trauma Inj. 2016;29(1):28-32. Published online March 31, 2016; DOI: https://doi.org/10.20408/jti.2016.29.1.28

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Blunt traumatic vertebral artery injury (TVAI) is relatively rare, but it may frequently be associated with head and neck trauma. TVAI is difficult to diagnose with diverse outcomes, thus it is a clinical challenge. There are no widely accepted guidelines for treatment and diagnosis, so that the diagnosis of TVAI can be easily delayed. Therefore, any clinical suspicion from clues on the initial imaging is important for diagnosis of TVAI. The authors report on the case of a patient diagnosed as having a TVAI with a transverse foramen fracture.

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Airway management in a displaced comminuted fracture of the mandible and atlas with a vertebral artery injury: A case report
Rathna Paramaswamy
Journal of Dental Anesthesia and Pain Medicine.2018; 18(3): 183. CrossRef

Three-year Analysis of Patients and Treatment Experiences in the Regional Trauma Center of Gachon University Gil Hospital between 2011 and 2013: Yong Cheol Yoon, Jung Nam Lee, Min Chung, Yang Bin Jeon, Jae Jeong Park, Byung Chul Yu, Gil Jae Lee, Hyun Jin Cho, Dae Sung Ma, Min A Lee, Jung Ju Choi, Seong Son; J Trauma Inj. 2014;27(4):170-177.

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Abstract PDF: PURPOSE
The first regional trauma center selected in Korea was the Gachon University Gil hospital regional trauma center; expectation on its role has been high because of its location in the Seoul metropolitan region. To determine if those expectations are being met, we analyzed the patients visiting the center and their treatment experiences for the past 3 years in order to propose a standard for the operation of a trauma center.
METHODS
The visiting route, visiting methods, performance of emergency surgery, the ward and the length of stay, the injury mechanism, the injury severity score (ISS), the department that managed the surgery, and the cause of death were analyzed for 367 patients visiting the center from its establishment in June 2011 through December 2013.
RESULTS
The mean age of the patients was 47 years (285 male and 82 female patients). A total of 187 patients directly visited the center whereas 180 were transferred to the center. Traffic accidents comprised the majority of injury mechanisms, and 178 patients underwent emergency surgery. The mean length of stay per patient was 11 days for those in the ICU and 27 days for those in a general ward. These patients occupied 4 beds in the ICU and 10 beds in the general ward per day. A total of 1.21 surgeries were performed per patient, and the mean number of surgeries performed per day was 0.49. The mean ISS was 15.91, and 183 patients (50%) had an ISS of > or =16. Thirty-one patients died; they had a mean ISS of 28.42. The most frequent cause of death was multi-organ failure. The mean number of treatment consultations during a patient's stay was 6.32. Forty-five patients (13%) were discharged from the center, and 291 (79%) were transferred to another hospital.
CONCLUSION
A systematic approach to establishing a treatment model for trauma patients, including injury mechanism, multidisciplinary treatment, and trauma surgeon intervention, is required for treating trauma patients.; Summary

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