Journal of Trauma and Injury

Original Article

Effect of trauma center operation on emergency care and clinical outcomes in patients with traumatic brain injury: Han Kyeol Kim, Yoon Suk Lee, Woo Jin Jung, Yong Sung Cha, Kyoung-Chul Cha, Hyun Kim, Kang Hyun Lee, Sung Oh Hwang, Oh Hyun Kim; J Trauma Inj. 2023;36(1):22-31. Published online December 6, 2022; DOI: https://doi.org/10.20408/jti.2022.0049

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Abstract PDF: Purpose
Traumatic brain injury (TBI) directly affects the survival of patients and can cause long-term sequelae. The purpose of our study was to investigate whether the operation of a trauma center in a single tertiary general hospital has improved emergency care and clinical outcomes for patients with TBI.
Methods
The participants of this study were all TBI patients, patients with isolated TBI, and patients with TBI who underwent surgery within 24 hours, who visited our level 1 trauma center from March 1, 2012 to February 28, 2020. Patients were divided into two groups: patients who visited before and after the operation of the trauma center. A comparative analysis was conducted. Differences in detailed emergency care time, hospital stay, and clinical outcomes were investigated in this study.
Results
On comparing the entire TBI patient population via dividing them into the aforementioned two groups, the following results were found in the group of patients who visited the hospital after the operation of the trauma center: an increased number of patients with a good functional prognosis (P<0.001 and P=0.002, respectively), an increased number of surviving discharges (P<0.001 and P<0.001, respectively), and a reduction in overall emergency care time (P<0.05, for all item values). However, no significant differences existed in the length of intensive care unit stay, ventilator days, and total length of stay for TBI patients who visited the hospital before and after the operation of the trauma center.
Conclusions
The findings confirmed that overall TBI patients and patients with isolated brain injury had improved treatment results and emergency care through the operation of a trauma center in a tertiary general hospital.; Summary

Case Reports

Spontaneous recanalization of complete urethral injury treated by suprapubic cystostomy alone after severe pelvic bone fracture in a young male in Korea: a case report: Han Kyul Shin, Gi Ho Moon, Sung Yub Jeong, Ho Jun Lee; J Trauma Inj. 2023;36(2):161-164. Published online December 2, 2022; DOI: https://doi.org/10.20408/jti.2022.0056

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Abstract PDF: Injury to the genitourinary tract is rare, with an incidence of less than 1%. Younger men (mean age, approximately 30 years) are predominantly affected. We introduce an unusual case of a 25-year-old male patient with complete urethral injury combined with a severe open pelvic bone fracture. During the emergency surgery, the primary realignment of the posterior urethra could not be performed due to a large defect. With suprapubic cystostomy alone, follow-up voiding cystourethrography showed spontaneous recanalization of the transected urethra after four months. Suprapubic cystostomy is an efficient treatment option when primary realignment is not possible.; Summary

External iliac artery injury with posterior pelvic ring injury in Korea: a report of two cases: Joosuk Ahn, Ji Wan Kim; J Trauma Inj. 2023;36(2):137-141. Published online December 1, 2022; DOI: https://doi.org/10.20408/jti.2022.0046

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Abstract PDF: Pelvic ring injuries associated with external iliac artery injuries are rare and may be life-threatening condition. The most important factors in the managements are the immediate bleeding control and restoration of distal blood flow. We report two cases of pelvic ring injuries with external artery injuries. One case was occlusion of external iliac artery with concomitant rupture of internal iliac artery. The other case was ruptured external iliac artery. Every surgeon must understand the possibility of hidden lesions—for example, arterial rupture and thrombus—and should consider the need for embolization or thrombectomy when treating this type of injury.; Summary

Endovascular treatment of traumatic iliac venous injury combined with phlegmasia cerulea dolens in Korea: a case report: Suyoung Park, Jeong Ho Kim, Jung Han Hwang, Jayun Cho; J Trauma Inj. 2023;36(2):157-160. Published online December 1, 2022; DOI: https://doi.org/10.20408/jti.2022.0039

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Abstract PDF: Traumatic iliac venous injury is rare but can be fatal. Although surgical management is considered a primary treatment method, urgent treatment is required when deep venous thrombosis and subsequent phlegmasia cerulea dolens is combined. It is difficult to treat by surgical management, and pharmaceutic thrombolysis cannot be applied due to the trauma history. Here, we describe a case of unilateral traumatic iliac venous injury and subsequent diffuse venous thrombosis in the affected iliofemoral and infrapopliteal veins, combined with phlegmasia cerulea dolens, treated with endovascular management, including bare metal stent insertion and aspiration thrombectomy.; Summary

Experience and successful treatment of craniocerebral gunshot injury at a regional trauma center in Korea: a case report and literature review: Mahnjeong Ha, Seunghan Yu, Jung Hwan Lee, Byung Chul Kim, Hyuk Jin Choi; J Trauma Inj. 2022;35(4):277-281. Published online November 22, 2022; DOI: https://doi.org/10.20408/jti.2022.0057

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Abstract PDF: Craniocerebral gunshot injuries is gradually increasing in the civilian population with a worse prognosis than closed head trauma. We experienced a case of craniocerebral gunshot injury which a bullet penetrating from the submandibular area into the clivus of a patient. The patient did not show any symptom. However, serial laboratory findings showed an increase in blood lead level. We removed foreign bodies without any problems using an endoscopic transnasal transclival approach. Due to the extremely low frequency, guidelines for definitive management of gunshot injuries have not been presented in Korea yet. We introduce our surgical experience of a craniocerebral gunshot injury with an unusual approach for removing intracranial foreign bodies.; Summary

Original Articles

Postoperative infection after cranioplasty in traumatic brain injury: a single center experience: Mahnjeong Ha, Jung Hwan Lee, Hyuk Jin Choi, Byung Chul Kim, Seunghan Yu; J Trauma Inj. 2022;35(4):255-260. Published online November 16, 2022; DOI: https://doi.org/10.20408/jti.2022.0043

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Abstract PDF: Purpose
To determine the incidence and risk factors of postoperative infection after cranioplasty in patients with traumatic brain injury (TBI).
Methods
Data of 289 adult patients who underwent cranioplasty after TBI at a single regional trauma center between year 2018 and 2021 were reviewed retrospectively. Patient characteristics and various procedural variables, such as interval between craniectomy and cranioplasty, estimated blood loss, laterality and materials of the bone flap, and duration and classification of perioperative antibiotics usage were analyzed.
Results
Postoperative infection occurred in 17 patients (5.9%). Onset time of infectious symptom ranged from 9 days to 174 days (median, 24 days) after cranioplasty. The most common cultured organism was Staphylococcus aureus (47.1%), followed by Klebsiella pneumoniae (17.6%) and Enterococcus faecalis (17.6%). Patients with postoperative infection were more likely to have diabetes (odds ratio [OR], 6.96; 95% confidence interval [CI], 1.92–25.21; P=0.003), lower body mass index (OR, 0.81; 95% CI, 0.66–0.98; P=0.029), and shorter duration of perioperative antibiotics (OR, 0.83; 95% CI, 0.71–0.98; P=0.026).
Conclusions
For TBI patients with diabetes, poor nutritional status should be managed cautiously for increased risk of infection after cranioplasty. Further studies and discussions are needed to determine an appropriate antibiotics protocol in cranioplasty.; Summary

Factors associated with the injury severity of falls from a similar height and features of the injury site in Korea: a retrospective study: Dae Hyun Kim, Jae-Hyug Woo, Yang Bin Jeon, Jin-Seong Cho, Jae Ho Jang, Jea Yeon Choi, Woo Sung Choi; J Trauma Inj. 2023;36(3):187-195. Published online November 16, 2022; DOI: https://doi.org/10.20408/jti.2022.0042

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Abstract PDF: Purpose
This study aimed to determine the risk factors associated with the severity of fall-related injuries among patients who suffered a fall from similar heights and analyze differences in injury sites according to intentionality and injury severity.
Methods
The Emergency Department-Based Injury In-depth Surveillance data collected between 2019 and 2020 were used in this retrospective study. Patients with fall-related injuries who fell from a height of ≥6 and <9 m were included. Patients were categorized into the severe and mild/moderate groups according to their excessive mortality ratio-adjusted Injury Severity Score (EMR-ISS) and the intention and non-intention groups. Injury-related and outcome-related factors were compared between the groups.
Results
In total, 33,046 patients sustained fall-related injuries. Among them, 543 were enrolled for analysis. A total of 256 and 287 patients were included in the severe and mild/moderate groups, respectively, and 93 and 450 patients were included in the intention and non-intention groups, respectively. The median age was 50 years (range, 39–60 years) and 45 years (range, 27–56 years) in the severe and mild/moderate groups, respectively (P<0.001). In multivariable analysis, higher height (odds ratio [OR] 1.638; 95% confidence interval [Cl], 1.279–2.098) and accompanying foot injury (OR, 0.466; 95% CI, 0.263–0.828) were independently associated with injury severity (EMR-ISS ≥25) and intentionality of fall (OR, 0.722; 95% CI, 0.418–1.248) was not associated with injury severity. The incidence of forearm injuries was four (4.3%) and 58 cases (12.9%, P=0.018) and that of foot injuries was 20 (21.5%) and 54 cases (12.0%, P=0.015) in the intention versus non-intention groups, respectively.
Conclusions
Among patients who fell from a similar height, age, and fall height were associated with severe fall-related injuries. Intentionality was not related to injury severity, and patients with foot injury were less likely to experience serious injuries. Injuries in the lower and upper extremities were more common in intentional and unintentional falls, respectively.; Summary

Editorial

Penetrating trauma and “The Wound Man”: Kun Hwang; J Trauma Inj. 2023;36(1):1-2. Published online November 4, 2022; DOI: https://doi.org/10.20408/jti.2022.0035

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PDF: Summary

Case Report

Delayed open abdomen closure using a combination of acellular dermal matrix and skin graft in Korea: a case report: Yoonseob Kim, Tae Ah Kim, Hyung Min Hahn, Byung Hee Kang; J Trauma Inj. 2023;36(2):152-156. Published online November 4, 2022; DOI: https://doi.org/10.20408/jti.2022.0024

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Abstract PDF: Delayed closure of an open abdomen (OA) is a clinically challenging task despite its various modalities. It is substantially more difficult when the duration of OA treatment is prolonged due to a patient’s condition. We introduced the management of a patient who had a delayed OA treatment spanning approximately 3 months due to severe abdominal contamination. The 64-year-old male patient had an injured pelvis pressed by a road roller. After visiting a trauma center, the patient initially underwent damage control surgery and OA management; however, early primary abdominal closure failed due to severe peritonitis. After negative pressure wound therapy for several months, an acellular dermal matrix graft followed by a skin graft were successfully used as treatments. A combination of acellular dermal matrix graft, negative pressure wound therapy, and skin graft techniques is a considerable management sequence for patients subjected to delayed OA treatment.; Summary

Editorial

Development of variolation and its introduction to Joseon-era Korea: Kun Hwang; Received August 19, 2022 Accepted August 29, 2022 Published online October 26, 2022; DOI: https://doi.org/10.20408/jti.2022.0044 [Epub ahead of print]

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PDF: Summary

Case Report

Exercise-induced traumatic muscle injuries with active bleeding successfully treated by embolization: three case reports: Yoonjung Heo, Hye Lim Kang, Dong Hun Kim; J Trauma Inj. 2022;35(3):219-222. Published online September 28, 2022; DOI: https://doi.org/10.20408/jti.2022.0028

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Abstract PDF

Muscle injuries caused by indirect trauma during exercise are common. Most of these injuries can be managed conservatively; however, further treatment is required in extreme cases. Although transcatheter arterial embolization is a possible treatment modality, its role in traumatic muscle injuries remains unclear. In this case series, we present three cases of exercise-induced muscle hemorrhage treated by transcatheter arterial embolization with successful outcomes. The damaged muscles were the rectus abdominis, adductor longus, and iliopsoas, and the vascular injuries were accessed via the femoral artery during the procedures.

Summary

Citations

Citations to this article as recorded by

Thermal and Magnetic Dual-Responsive Catheter-Assisted Shape Memory Microrobots for Multistage Vascular Embolization
Qianbi Peng, Shu Wang, Jianguo Han, Chenyang Huang, Hengyuan Yu, Dong Li, Ming Qiu, Si Cheng, Chong Wu, Mingxue Cai, Shixiong Fu, Binghan Chen, Xinyu Wu, Shiwei Du, Tiantian Xu
Research.2024;[Epub] CrossRef

Original Articles

Analysis of procedural performance after a pilot course on endovascular training for resuscitative endovascular balloon occlusion of the aorta: Sung Wook Chang, Dong Hun Kim, Dae Sung Ma, Ye Rim Chang; J Trauma Inj. 2023;36(1):3-7. Published online September 22, 2022; DOI: https://doi.org/10.20408/jti.2022.0022

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Abstract PDF: Purpose
As resuscitative endovascular balloon occlusion of the aorta (REBOA) is performed in an extremely emergent situation, achieving competent clinical practice is mandatory. Although there are several educational courses that teach the REBOA procedure, there have been no reports evaluating the impact of training on clinical practice. Therefore, this study is aimed to evaluate the effects of the course on procedural performance during resuscitation and on clinical outcomes.
Methods
Patients who were managed at a regional trauma center in Dankook University Hospital from August 2016 to February 2018 were included and were grouped as precourse (August 2016–August 2017, n=9) and postcourse (September 2017–February 2018, n=9). Variables regarding injury, parameters regarding REBOA procedure, morbidity, and mortality were prospectively collected and reviewed for comparison between the groups.
Results
Demographics and REBOA variables did not differ between groups. The time required from arterial puncture to balloon inflation was significantly shortened from 9.0 to 5.0 minutes (P=0.003). There were no complications associated with REBOA after the course. Mortality did not show any statistical difference before and after the course.
Conclusions
The endovascular training for REBOA pilot course, which uses a modified form of flipped learning, realistic simulation of ultrasound-guided catheter insertion and balloon manipulation, and competence assessment, significantly improved procedural performance during resuscitation of trauma patients.; Summary

Changes in incidence and severity of commercial motorcycle accidents due to the use of delivery service platforms in Korea: a retrospective cohort study: Dam Moon, Jae Ho Jang, Jin Seong Cho, Jae Yeon Choi, Jae-hyug Woo, Woo Sung Choi, Sung Yeol Hyun, Seung Hwan Lee; J Trauma Inj. 2023;36(2):121-127. Published online September 19, 2022; DOI: https://doi.org/10.20408/jti.2022.0031

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Abstract PDF: Purpose
Recently, a sharp increase in the use of delivery services has led to an increase in motorcycle accidents. This study aimed to identify the characteristics of the commercial motorcycle injured patients and factors related to the severity during the past 10 years.
Methods
Patients (15–64 years old) who visited the emergency department with commercial motorcycle accidents injury registered in the Korean Emergency Department-based Injury In-depth Surveillance (2011–2020) database, were included. All included cases were categorized into two groups according to the period: group 1 (2011–2015) and group 2 (2016–2020). General characteristics and the factors associated with severity were investigated.
Results
Among 8,123 emergency department visits, patients in group 1 were 3,071, and patients in group 2 were 5,052. The odds for severity were affected by patients age (odds ratio [OR], 1.008; 95% confidence interval [CI], 1.004–1.013), and overnight/morning (00:00–12:00; OR, 1.243; 95% CI, 1.091–1.415). The odds for severity were higher in head and neck injury (OR, 8.357; 95% CI, 7.410–9.424) and torso injury (OR, 4.122; 95% CI, 3.610–4.708). The odds for the severity of accidents based on excess mortality ratio-adjusted Injury Severity Score (EMR-ISS) after 2015 were significant (OR, 1.491; 95% CI, 1.318–1.687). Hospitalization in the intensive care unit and death were associated with accidents after 2015 (OR, 2.593; 95% CI, 2.120–3.170).
Conclusions
Commercial motorcycle accidents have increased significantly over the past decade. There were statistical differences in severity based on EMR-ISS and the hospitalization in intensive care unit and death.; Summary

Case Report

Nonoperative management of colon and mesocolon injuries caused by blunt trauma: three case reports: Naa Lee, Euisung Jeong, Hyunseok Jang, Yunchul Park, Younggoun Jo, Jungchul Kim; J Trauma Inj. 2022;35(4):291-296. Published online September 19, 2022; DOI: https://doi.org/10.20408/jti.2022.0009

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Abstract PDF: The therapeutic approach for colon injury has changed continuously with the evolution of management strategies for trauma patients. In general, immediate laparotomy can be considered in hemodynamically unstable patients with positive findings on extended focused assessment with sonography for trauma. However, in the case of hemodynamically stable patients, an additional evaluation like computed tomography (CT) is required. Surgical treatment is often required if prominent mesenteric extravasation, free fluid, bowel infarction, and/or colon wall perforation are observed. However, immediate intervention in hemodynamically stable patients without indications for surgical treatment remains questionable. Three patients with colon and mesocolon injuries caused by blunt trauma were treated by nonoperative management. At the time of admission, they were alert and their vital signs were stable. Colon and mesocolon injuries, large hematoma, colon wall edema, and/or ischemia were revealed on CT. However, no prominent mesenteric extravasation, free fluid, bowel infarction, and/or colon wall perforation were observed. In two cases, conservative treatment was performed without worsening abdominal pain or laboratory tests. Follow-up CT showed improvement without additional treatment. In the third case, follow-up CT and percutaneous drainage were performed in considering the persistent left abdominal discomfort, fever, and elevated inflammatory markers of the patient. After that, outpatient CT showed improvement of the hematoma. In conclusion, nonoperative management can be considered as a therapeutic option for mesocolon and colon injuries caused by blunt trauma of selected cases, despite the presence of large hematoma and ischemia, if there are no clear indications for immediate intervention.; Summary

Original Article

An analysis of missed injuries in patients with severe trauma: EunGyu Ju, Sun Young Baek, Sung Soo Hong, Younghwan Kim, Seok Hwa Youn; J Trauma Inj. 2022;35(4):248-254. Published online September 14, 2022; DOI: https://doi.org/10.20408/jti.2022.0017

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Abstract PDF

Purpose
To analyze the data of trauma patients with undetected injuries at the time of initial resuscitation during the primary and secondary surveys.
Methods
We retrospectively reviewed the medical records of 807 patients who were hospitalized at the National Trauma Center, Seoul, Korea from June 1, 2019 to June 30, 2021.
Results
In trauma patients with an Injury Severity Score ≥16 accounted for 38.0% in the non-missed injury group (non-MIG), but this rate was considerably higher at 71.2% in MIG. The mean hospitalization longer in MIG (50.90±39.56) than in non-MIG (24.74±26.11). The proportion of patients with missed injuries detected through tertiary trauma survey (TTS) was 28 patients (23.5%) within 24 hours, 90 patients (75.6%) after 24 hours to before discharge. The majority of missed injuries were fractures (82.4%) and ligament tears (8.4%), which required consultation with the orthopedic department. The final diagnoses of missed injuries were confirmed by computed tomography (44.5%), magnetic resonance imaging (19.3%), X-ray (19.3%), bone scan (11.8%), and physical examination (5.0%).
Conclusions
TTS is considered a useful process for detecting missed injuries that were not identified at the time of initial resuscitation in the primary and secondary surveys. In the future, to detect missed injuries quickly, it is necessary to develop a suitable TTS program for each trauma center. In addition, further research is needed to verify the effectiveness of the protocolized TTS and survey chart to improve the effectiveness of TTS.

Summary

Citations

Citations to this article as recorded by

Tertiary Trauma Survey on Emergency Department Observational Units: A Systematic Literature Review
Tamkeen Pervez, Mehreen Malik
Cureus.2024;[Epub] CrossRef

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