- Blunt Transection of the Entire Anterolateral Abdominal Wall Musculature Following Seatbelt-Related Injury
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Hohyun Kim, Jae Hun Kim, Gil Hwan Kim, Hyun-Woo Sun, Chan Ik Park, Sung Jin Park, Chan Kyu Lee, Suk Kim
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J Trauma Inj. 2020;33(2):128-133. Published online June 30, 2020
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DOI: https://doi.org/10.20408/jti.2020.0006
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 Abstract
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Traumatic abdominal wall hernias (TAWHs) are uncommon and the incidence of this, which is rarely encountered in clinical practice, has been estimated at 1%. Furthermore, blunt transection of the entire abdominal wall musculature caused by seatbelt is a very rare complication. We report a case of adult with a complete disruption of the entire anterolateral abdominal wall muscle following the seatbelt injury. A 32-year-old male was wearing a seat belt in a high speed motor vehicle collision. Abdominal computed tomography (CT) scan revealed the complete disruption of bilateral abdominal wall musculatures including TAWH without visceral injury. However, injuries of small bowel and sigmoid colon were observed in the intra-operative field. The patient underwent the repair by primary closure of the defect with absorbable monofilament sutures. This case suggests that especially in TAWH patients, even if a CT scan is normal, clinicians should keep the possibility of bowel injury in mind, and choose a treatment based on the clinical findings. -
Summary
- Clinical Effects of Intra-Abdominal Pressure in Critically Ill Trauma Patients
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Dong Yeon Ryu, Hohyun Kim, June Pill Seok, Chan Kyu Lee, Kwang-Hee Yeo, Seon-Uoo Choi, Jae-Hun Kim, Hyun Min Cho
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J Trauma Inj. 2019;32(2):86-92. Published online June 30, 2019
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DOI: https://doi.org/10.20408/jti.2018.052
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Abstract
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Purpose
There is increasing interest in intra-abdominal pressure (IAP) and intra-abdominal hypertension (IAH) in critically ill patients. This study investigated the effects and outcomes of elevated IAP in a trauma intensive care unit (ICU) population.
Methods
Eleven consecutive critically ill patients admitted to the trauma ICU at Pusan National University Hospital Regional Trauma Center were included in this study. IAP was measured every 8?12 hours (intermittently) for 72 hours. IAP was registered as mean and maximal values per day throughout the study period. IAH was defined as IAP ≥12 mmHg. Abdominal compartment syndrome was defined as IAP ≥20 mmHg plus ≥1 new organ failure. The main outcome measure was in-hospital mortality.
Results
According to maximal and mean IAP values, 10 (90.9%) of the patients developed IAH during the study period. The Sequential Organ Failure Assessment (SOFA) score was significantly higher in patients with IAP ≥20 mmHg than in those with IAP <20 mmHg (16 vs. 5, p=0.049). The hospital mortality rate was 27.3%. Patients with a maximum IAP ≥20 mmHg exhibited significantly higher hospital mortality rates (p=0.006). Non-survivors had higher maximum and mean IAP values.
Conclusions
Our results suggest that an elevated IAP may be associated with a poor prognosis in critically ill trauma patients.
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Summary
- PARK Index and S-score Can Be Good Quality Indicators for the Preventable Mortality in a Single Trauma Center
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Chan Yong Park, Kyung Hag Lee, Na Yun Lee, Su Ji Kim, Hyun Min Cho, Chan Kyu Lee
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J Trauma Inj. 2017;30(4):126-130. Published online December 30, 2017
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DOI: https://doi.org/10.20408/jti.2017.30.4.126
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Abstract
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Purpose
Preventable Trauma Death Rate (PTDR) using Trauma and Injury Severity Score (TRISS) has been most widely used as a quality indicator in South Korea. However, this method has a small number of deaths corresponding to the denominator. Therefore, it is difficult to check the change of quality improvement for annual mortality, and there is a disadvantage that variation is severe. Therefore, we attempted to improve the quality of the mortality evaluation by reducing the variation by applying the PARK Index (preventable major trauma death rate, PMTDR) which can increase the number of denominator significantly. And the Save score (S-score) was also examined as another quality indicator.
Methods
In the PARK Index, the denominator is number of all patients who have survival probability (Ps) larger than 0.25. Numerator is the number of deaths among these. The PARK Index includes only patients with ISS >15. The S-score is calculated in the same way as the W-score, but the S-score includes only patients with ISS >15, which is a difference from the W-score.
Results
PARK Index decreased annually and was 12.9 (37/287) in 2014, 9.6 (33/343) in 2015, and 7.3 (52/709) in 2016. S-score increased annually and was ?0.29 in 2014, 4.21 in 2015, and 8.75 in 2016.
Conclusions
PARK Index and S-score improved annually. This shows that both quality indicators are improving year by year. PARK Index (PMTDR) has 9.5-fold increase in denominator overall compared to PTDR by TRISS. The S-score used only ISS >15 patients as a denominator. Therefore, there is an advantage that the numerical value change is larger than the W-score. In addition, S-score is not affected by the ratio of major trauma patients to minor trauma patients.
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