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Volume 25(4); December 2012
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Original Articles
Development of Deep Vein Thrombosis in Severely Injured Multiple Trauma Patients
Sangnyun Kim, Dongun Lee, Bumchul Lee, Jungbae Park, Sujeong Shin
J Trauma Inj. 2012;25(4):109-114.
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AbstractAbstract PDF
PURPOSE
Deep vein thrombosis and pulmonary thromboembolism are major causes of death after severe multiple trauma. Although various means of prevention have been presented and utilized, still, there are no standard guidelines for anticoagulation of multiple trauma because of some contraindications.
METHODS
A retrospective study of adult major trauma patients whose injury severity scores (ISSs) were over 16 and who had visited one university hospital in Daegu city was performed. We compared some features of patients diagnosed DVT or PTE with those of patients without DVT by computed tomography or ultra sonography. Those features included accompanying various kinds of intracranial hemorrhages, possibility of ambulation, emergent operation, early transfusion, and suspicious symptoms.
RESULTS
The mean age of the 58 subjects included in this study was 50.9+/-17.2 years, the mean ISS was 22.7+/-6.0, and the mean hospital stay was 55.2+/-37.9 days. Ten(17.2%) patients had emergent surgery, and 44(75.9%) experienced delayed surgery. Early transfusion was needed in 34(58.6%) patients. Among the 18 patients diagnosed with DVT, accompanying intracranial hemorrhages were noted in 8(44.4%) patients; one of the 8 also had PTE. Among the same 18 patients, early transfusions were required in 11(61.1%) patients; one of the 11 also had PTE.
CONCLUSION
The risk of DVT is increased in cases of severe multiple trauma, and many difficulties in applying anticoagulants are experienced. Though we need additional studies to decide proper prophylaxis for DVT and PTE, if the patient's general condition permits, a screening test for DVT as soon as possible could be an effective method to reduce the possibility of a bad outcome.
Summary
Emergency Pancreaticoduodenectomy for Severe Pancreaticoduodenal Injury
In Kyu Park, Yoon Jin Hwang, Hyung Jun Kwon, Kyung Jin Yoon, Sang Geol Kim, Jae Min Chun, Jin Young Park, Young Kook Yun
J Trauma Inj. 2012;25(4):115-121.
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AbstractAbstract PDF
PURPOSE
Severe pancreaticoduodenal injuries are relatively uncommon, but may result in high morbidity and mortality, especially when management is not optimal, and determining the appropriate treatment is often difficult. The objective of this study was to review our experience and to evaluate the role of a pancreaticoduodenectomy (PD) in treatment of pancreaticoduodenal injuries.
METHODS
We performed a retrospective review of 16 patients who underwent an emergency PD at our hospital for severe pancreaticoduodenal injury from 1990 to 2011. Demographic data, clinical manifestations, mechanism and severity of the injury, associated injuries, postoperative complications and outcomes were reviewed.
RESULTS
The mean age of the 16 patients was 45+/-12 years (mean+/-standard deviation), and 15(93.8%) patients were male. All patients underwent an explorative laparotomy after a diagnosis using abdominal computed tomography. Almost all patients were classified as AAST grade higher than III. Thirteen(83.3%) of the 16 patients presented with blunt injuries; none presented with a penetrating injury. Only one(6.3%) patients had a combined major vascular injury. Fifteen patients underwent a standard Whipple's operation, and 1 patient underwent a pylorus-preserving pancreaticoduodenectomy. Two of the 16 patients required an initial damage-control procedure; then, a PD was performed. The most common associated injured organs were the small bowel mesentery(12, 75%) and the liver(7, 43.8%). Complications were intraabdominal abscess(50%), delayed gastric emptying(37.5%), postoperative pancreatic fistula(31.5%), and postoperative hemorrhage (12.5%). No mortalities occurred after the PD.
CONCLUSION
Although the postoperative morbidity rate is relatively higher, an emergency PD can be perform safely without mortality for severe pancreaticoduodenal injuries. Therefore, an emergency PD should be considered as a life-saving procedure applicable to patients with unreconstructable pancreaticoduodenal injuries, provided that is performed by an experienced hepatobiliary surgeon and the patient is hemodynamically stable.
Summary
Prognostic Value of Computed Tomography and Gradient-echo Magnetic Resonance Imaging in Diffuse Axonal Injury
Nam Ki Jung, Sang Chan Jin, Woo Ik Choi
J Trauma Inj. 2012;25(4):122-131.
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AbstractAbstract PDF
PURPOSE
Diffuse axonal injury (DAI) is clinically defined as a coma of over six hours in a head trauma victim without a focal mass lesion. The emergency physician usually resuscitates and stabilizes a comatose head trauma victim in the emergency Department. After assessment and treatment, the prognosis is very important to both the victim and the physician. The prognosis for DAI is based on Glasgow Coma Scale (GCS) and other imaging data. We investigated the prognostic value of computed tomography (CT) and gradient-echo magnetic resonance imaging (GRI) for head trauma victims with DAI.
METHODS
Fifty-three(53) head trauma victims of DAI were enrolled in this study from 2007 to 2012. During the study period of six years, data on trauma victims were collected retrospectively. We analyzed the differences in the Glasgow Outcome Scale (GOS) result between the CT and the GRI modalities.
RESULTS
We classified the study group by using GOS. Between the good outcome subgroup (GOS scores of 4 and 5) and the poor outcome subgroup (GOS score of 1-3), there were no statistical difference in sex, age, initial vital signs and initial GCS score. The good outcome subgroup had non-hemorrhage on CT(52%), which was correlated with good outcome and a shorter awakening time, while a larger number and a deeper location of hemorrhagic lesions on in GRI were correlated with poor outcome in DAI.
CONCLUSION
We conclude that the existence of hemorrhagic lesions on CT, and the number and location of those lesions on GRI had good prognostic value for head trauma victims with DAI.
Summary
Characteristics of Injured Pregnant Women by the Traffic Accidents
Duk Hwan Kim, Young Duck Cho, Jung Youn Kim, Young Hoon Yoon, Sung Woo Lee, Sung Woo Moon, Sung Hyuk Choi
J Trauma Inj. 2012;25(4):132-138.
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AbstractAbstract PDF
PURPOSE
Trauma is one of the major causes of maternal and fetal mortality, and the most common cause of maternal trauma is a traffic accident. In Korea, data about traffic accidents in pregnant women are not widely collected and classified so far. Hence, we studied and analyzed the characteristics of injured pregnant women by the traffic accidents.
METHODS
From January 2002 to August 2011, pregnant women who were in traffic accidents visiting Emergency Department were studied. Pregnancy out come and the degree of the damage were determined through the retrospective analysis of the medical records.
RESULTS
The pregnant women who visited after traffic accidents were total 204 patients. Among them, 176 patients had no complication related to the traffic accidents, 28 patients had complications. The incidence of the complications in the 3rd trimester pregnants was statistically significant higher than that in the other trimesters. The analysis based on the mechanism shows more complications in the pedestrian injury. In the survey by the type of the vehicles, the complications from the trauma associated with a car had lower incidence. The patients arrived at the emergency center by walking had greater numbers than who arrived by an ambulance in the groups occurred the complications. The patients suffered complications who complained pain in trunk especially in abdomen and pelvis than in extremities and complained vaginal discharge, and those showed a statistically significant greater incidence.
CONCLUSION
When pregnant women were injured by the traffic accidents, the factors related to the poor pregnant prognosis were trimester of pregnancy, means of visiting the emergency center, trauma mechanism, and complaining symptoms. Therefore, these factors may be used as a prognostic tool to predict an incidence of complications, length of hospital stay and rate of complications and can be used to plan for treatments.
Summary
Development of Simple Prediction Method for Injury Severity and Amount of Traumatic Hemorrhage via Analysis of the Correlation between Site of Pelvic Bone Fracture and Amount of Transfusion: Pelvic Bleeding Score
Sang Sik Lee, Byung Kwan Bae, Sang Kyoon Han, Sung Wook Park, Ji Ho Ryu, Jin Woo Jeong, Seok Ran Yeom
J Trauma Inj. 2012;25(4):139-144.
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AbstractAbstract PDF
PURPOSE
Hypovolemic shock is the leading cause of death in multiple trauma patients with pelvic bone fracures. The purpose of this study was to develop a simple prediction method for injury severity and amount of hemorrhage via an analysis of the correlation between the site of pelvic bone fracture and the amount of transfusion and to verify the usefulness of the such a simple scoring system.
METHODS
We analyzed retrospectively the medical records and radiologic examination of 102 patients who had been diagnosed as having a pelvic bone fracture and who had visited the Emergency Department between January 2007 and December 2011. Fracture sites in the pelvis were confirmed and re-classified anatomically as pubis, ilium or sacrum. A multiple linear regression analysis was performed on the amount of transfusion, and a simplified scoring system was developed. The predictive value of the amount of transfusion for the scoring system as verified by using the receiver operating characteristics (ROC). The area under the curve of the ROC was compared with the injury severity score (ISS).
RESULTS
From among the 102 patients, 97 patients (M:F=68:29, mean age=46.7+/-16.6 years) were enrolled for analysis. The average ISS of the patients was 16.2+/-7.9, and the average amount of packed RBC transfusion for 24 hr was 3.9+/-4.6 units. The regression equation resulting from the multiple linear regression analysis was 'packed RBC units=1.40x(sacrum fracture)+1.72x(pubis fracture)+1.67x(ilium fracture)+0.36' and was found to be suitable (p=0.005). We simplified the regression equation to 'Pelvic Bleeding Score=sacrum+pubis+ilium.' Each fractured site was scored as 0(no fracture) point, 1(right or left) point, or 2(both) points. Sacrum had only 0 or 1 point. The score ranged from 0 to 5. The area under the curve (AUC) of the ROC was 0.718 (95% CI: 0.588-0.848, p=0.009). For an upper Pelvis Bleeding Score of 3 points, the sensitivity of the prediction for a massive transfusion was 71.4%, and the specificity was 69.9%.
CONCLUSION
We developed a simplified scoring system for the anatomical fracture sites in the pelvis to predict the requirement for a transfusion (Pelvis Bleeding Score (PBS)). The PBS, compared with the ISS, is considered a useful predictor of the need for a transfusion during initial management.
Summary
Field Triage of Severely Injured Patients and Transportation by the EMS Rescue Group of Busan and Kyungnam, Korea: Is It Appropriate?
Jong Eon Lim, Seok Ran Yeom, Suck Ju Cho, Sang Kyun Han, Sung Wook Park, Sung Hwa Lee
J Trauma Inj. 2012;25(4):145-151.
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PURPOSE
The objective of this study was to determine the appropriateness of Emergency Medical Service's (EMS's) triage and transport of severely injured patients in Busan and Kyungnam, Korea.
METHODS
The medical records of the Emergency Medical Information Center were retrospectively reviewed from January 1, 2010 to December 31, 2010. We identified the number of patients that should have been transferred from a secondary to a tertiary hospital according to the EMS field triage protocol.
RESULTS
In a total of 472 cases requests to be transferred to a third hospital were made through the Emergency Medical Information Center. Of these, 207 patients(43.9%) should have been transferred to a tertiary hospital according to the EMS field triage protocol. Among them, thirty-three(15.9%) patients satisfied step 1, 15(7.0%) satisfied step 2, and 117(56.5%) satisfied step 3. Twenty-three(11.1%) patients satisfied both steps 1 and 3.
CONCLUSION
We found the triage by the EMS in the transfer of severely injured patients to a tertiary hospital to be inappropriate and re-education of EMS personnel regarding the EMS field triage protocol is needed. Because many patients are transferred from a secondary to a third hospital, we suggest changing the EMS field triage protocol to expand the severe injury criteria. A need exists to authorize secondary hospitals to transfer severely injured patients directly because there are no trauma centers in Korea.
Summary
A Nationwide Study on the Epidemiology of Head Trauma and the Utilization of Computed Tomography in Korea
So Young Park, Jae Yun Jung, Young Ho Kwak, Do Kyun Kim, Dong Bum Suh
J Trauma Inj. 2012;25(4):152-158.
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AbstractAbstract PDF
PURPOSE
To understand the epidemiology of head trauma and the utilization of brain CT in Korea, we analyzed a national sampling data set, the National Patient Sample obtained from the Health Insurance Review and Assessment Service.
METHODS
We retrospectively collected and analyzed demographic and clinical data on enrolled patients from the National Patient Sample based on medical claims data for 2009. The data included patient's age, sex, treatment date, diagnosis codes, procedure codes related with CT, holiday or night consultation fee, and fee for emergency management services.
RESULTS
In 2009, the estimated population with head trauma was 819,059(1.8%), and the rate of brain CT utilization was 22.4%. Children ages 5 to 15 were the most commonly injured group(22.8%), but had the lowest brain CT utilization(16.5%). The mean age of the estimated population with head trauma was 34.9+/-0.5 years old, and male patients accounted for 60.5% of that population. Intracranial injury was found in 8.6% of all head traumas, and the rate of intracranial injury in children was lower than it was in adults(4.1% vs. 10.9%, p<0.001). Twenty-three percent of patients with head trauma visited the emergency department (ED). More patients with head trauma visited medical facilities in the daytime on weekdays(66.5% vs. 33.5%, p<0.001), but head CT was performed more frequently at night or on weekends/holidays(16.1% vs. 34.7%, p<0.001). There is low incidence of head trauma in the winter in children (p<0.001). In the multivariate logistic regression analysis, patients who were adults, female, or ED visitors were more likely to undergo brain CT (odds ratio (OR): 1.65, 95% confidence interval (CI): 1.47-1.84; OR: 1.40, 95% CI: 1.27-1.54; OR: 7.80, 95% CI: 6.91-8.80, respectively).
CONCLUSION
In this study, we analyzed the national epidemiologic trend for head trauma, and the pattern of utilization of brain CT.
Summary
Application of Critical Pathway in Trauma Patients
Hongjin Shim, Ji Yong Jang, Jae Gil Lee, Seonghwan Kim, Min Joung Kim, You Seok Park, Inchel Park, Seung Ho Kim
J Trauma Inj. 2012;25(4):159-165.
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AbstractAbstract PDF
PURPOSE
For trauma patients, an early-transport and an organized process which are not delayed in hospital stage are necessary. Our hospital developed a procedure, the trauma Critical Pathway (CP), through which a traumatic patient has the priority over other patients, which makes the diagnostic and the therapeutic processes faster than they are for other patients.
METHODS
The records of patients to whom Trauma CP were applied from January 1, 2011 through April 15. 2012. were reviewed. We checked several time intervals from ER visiting to decision of admission-department, to performing first CT, to applying angio-embolization, to starting emergency operation and to discharging from ER. In addition, outcomes such as duration of ICU stay, hospital stay and mortality were checked and analyzed.
RESULTS
The trauma CP was applied to a total of 143 patients, of whom, 48 patients were excluded due to pre-hospital death, ER death, transferring to other hospital and not severe injury. Thus 95 patients (male 64, 67.3%) were enrolled in this study. Fifty-nine patients(62.1%) were injured by the traffic accident. The mortality rate was 10.5% and the mean Revised Trauma Score (RTS) of the patients was 6.4+/-2.0. After visiting ER, decision making for admission was completed, on average, in 3 hours 10 seconds. The mean time intervals for the first CT, angio-embolization, surgery and discharge were 1 hour 20 minutes, 5 hours 16 minutes, 7 hours 26 minutes and 6 hours 13 minutes, respectively.
CONCLUSION
The trauma CP did not show the improvement of time interval outcome, as well as mortality rate. However, this test did show that the trauma CP might be able to reduce delays in procedures for managing trauma patients at the university-based hospitals. To find out the benefit of CP protocol, a large scaled data is required.
Summary
Prognostic Factors in Patients Who Performed Angiographic Embolization for the Bleeding from Injury of the Intraabdominal Organ and Pelvic Area
Jin Ho Lee, Ji Young Jang, Hong jin Shim, Jae Gil Lee
J Trauma Inj. 2012;25(4):166-171.
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AbstractAbstract PDF
PURPOSE
In patients with traumatic hemoperitoneum or pelvic bone fracture who underwent angiography and embolization, we want to find the prognostic factors related with mortality.
METHODS
Patients(333 patients) who visited our hospital with traumatic injury from March 2008 to April 2012 were included in this study. Only 37 patients with traumatic hemoperitoneum or pelvic bone fracture underwent angiography and embolization. A retrospective review was conducted, and Glasgow coma scale (GCS), Revised trauma score (RTS), Injury severity score (ISS), initial laboratory finding and time interval, the amount of transfusion from the arrival at the ER to the start of embolization, and the vital signs before and after procedure were checked. Stastical analysis was conducted using the Chi square and Mann-Whitney U test.
RESULTS
In univariate analysis, the amount of transfusion, the base deficit before procedure, the systolic blood pressure before and after the procedure, the GCS, the RTS and the ISS were significantly associated with prognosis. In the multivariate analysis, the ISS and the base deficit had significant association with prognosis. Of the 37 patients who underwent angiography and embolization, 31 patients needed not additional procedure (Group A) while the other 6 patients needed an additional procedure (Group B). After procedure, a statistically significant higher blood pressure was observed in Group A than in Group B. As to the difference in blood pressure before and after the procedure, a statistically significant decrease in systolic blood pressure was observed in Group B, but an increase was observed in Group A.
CONCLUSION
In traumatic hemoperitoneum or pelvic bone fracture patients who underwent angiography and embolization, GCS, ISS, RTS, transfusion amount before the procedure, initial base deficit and systolic blood pressure were factors related to mortality. When patients who underwent angiography and embolization only were compared with patients who underwent re-embolization or additional procedure after the first embolization, an increase in systolic blood pressure after embolization was a prognostic factor for successful control of bleeding.
Summary
Abdominal Wall Closure Using Artificial Mesh for Patients with an Open Abdomen
Sung Whan Cha, Hong Jin Shim, Ji Young Jang, Jae Gil Lee
J Trauma Inj. 2012;25(4):172-177.
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AbstractAbstract PDF
PURPOSE
After damage control surgery, abdominal wall closure may be impossible due to increased intra-abdominal pressure (IAP), and primary closure may induce abdominal compartment syndrome. The purpose of this study was to investigate changes in the IAP and the feasibility of abdominal wall closure using artificial mesh.
METHODS
From July 2010 to July 2011, 8 patients with intra-abdominal hypertension underwent abdominal wall closure using artificial mesh. Medical data such as demographics, diagnosis, operation, IAP, postoperative complications, mortality and length of hospital stays were collected and reviewed, retrospectively. One patient was excluded because of inadequate measurement of the IAP.
RESULTS
Seven patients, 4 males and 3 females, were enrolled, and the mean age was 54.1 years old. Causes of operations were six traumatic abdominal injuries and one intra-abdominal infection. The IAP was reduced from 21.9+/-6.6 mmHg before opening the abdomen to 15.1+/-7.1 mmHg after fascial closure. Fascial closure was done on 14.9+/-17.5 days after the first operation. The mean lengths of the hospital and the intensive care unit (ICU) stays were 49.6 days and 29.7 days respectively. Operations were performed 3.1+/-1.5 times in all patients. Two patients expired, and one was transferred in a moribund state. Three patients suffered from complications, such as retroperitoneal abscesses, enterocutaneous fistulas, and bleeding that was related to the negative pressure wound therapy.
CONCLUSION
After abdominal wall closure using artificial mesh, intra-abdominal pressure was well controlled, and abdominal compartment syndrome does not occur. When the abdominal wall in patients who have intra-abdominal hypertension is closed, artificial mesh may be useful for maintaining a lower abdominal pressure. However, when negative pressure wound therapy is used, the possibility of serious complications must be kept in mind.
Summary
Medical Expenses for Trauma According to the Type of Medical Insurance
Heeseung Park, Yooun Joong Jung, Young Hwan Kim, Tae Hyun Kim, Min Ae Km, Kyu Hyouck Kyoung, Jung Jae Kim, Suk Kyung Hong
J Trauma Inj. 2012;25(4):178-187.
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AbstractAbstract PDF
PURPOSE
In Korea, the nation's medical expenses were 12 billion won in 2010. The medical costs for individuals can also be overwhelming. If a patient has sustained severe trauma, his/her insurance company responsible may pay only part of the medical bills. In Korean, there are diverse types of medical insurance, such as health insurance, automobile insurance, and industrial accident compensation insurance. And each insurance system has a different type of payment system. Our study will be essential for establishing the optimal medical expense payment system.
METHODS
From January to December 2011, we retrospectively reviewed the medical charts of 161 patients who were admitted to our hospital's emergency room after having undergone severe trauma. Of those 161 patients, 125 were retrospectively reviewed. Written permission was obtained from all of the patients. We analysed the demographic characteristics, clinical outcomes, data of the trauma, type of the patient's insurance, and the entire bill when the patient was discharged.
RESULTS
Seventy-one patients had health insurance, 48 automobile insurance, and six industrial accident compensation insurance. High-deductible insurance included health insurance and industrial accident compensation insurance, with the deductibles up to 20.6% and 19.1%, respectively. We attempted to analyze the cause of the high deductible rate. In patients with health insurance, medicines, primarily sedatives, pain killers, antibiotics, and fluids. comprised a large proportion. On the other hand, industrial accident compensation insurance deducted for a high-grade hospital room charge.
CONCLUSION
We found that medical expenses were diverse according to the type of insurance. In particular, health insurance forced patients to pay too much of the medical expenses. Therefore, in Korea we should try to identify the insurance problems and improve the wage system.
Summary
Factors Contributing to Mortality for Patients at a Newly-designated Regional Trauma Center
Ikwan Chang, Hoon Kim, Hee Jun Shin, Woo Chan Joen, Joon Min Park, Dong Wun Shin, Jun Seok Park, Kyung Hwan Kim, Je Hoon Park, Seung Woon Choi
J Trauma Inj. 2012;25(4):188-195.
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AbstractAbstract PDF
PURPOSE
An increase in the demand for specialized Trauma Centers led to a government-driven campaign, that began in 2009. Our hospital was selected as one of the Trauma Centers, and we reviewed data on trauma patients in order to correlate the mortality at a regional Trauma Center with its contributing factors, such as the severity of the injury, the means of arrival, and the time duration before arrival at our center.
METHODS
Data on the patients who visited our Trauma Center from January 2010 to November 2011 were retrospectively reviewed using electronic medical records. The patients who had revised trauma scores (RTSs) less than 7 or injury severity scores (ISSs) greater than 15 were included. The patients were categorized as survivors and non-survivors, and the means of arrival as transferred or visited directly. Time durations before arrival of less than one hour were also taken intoconsideration.
RESULTS
Two hundred(200) patients were enrolled, and the mortality rate was 36.5%. The most common cause of the accident was an automobile accident, and the most common cause of death was brain injury. The RTSs and the ISSs were significantly different in the non-survivor and the survivor groups. The mortality rate of the patients who were transferred was not statistically different from that of patients who visited directly. However, a time duration before arrival of less than one hour was statistically meaningful.
CONCLUSION
The prognosis of the trauma patients were correlated with the severity of the trauma as can be expected, but the time between the incidence of accident and the arrival at hospital and whether the presence of transfer to trauma center were not statistically significant to the prognosis.
Summary
Clinical Study of Patients with Elevated Troponin-I in Near-hanging Injury
Hyun Goo Shin, Jun Bum Park, Chang Sun Kim, Jae Hoon Oh, Young Suk Cho, Sae Hoon Park, Sang Mo Je, Hyuk Joong Choi, Bo Seung Kang, Tae Ho Lim, Hyung Goo Kang
J Trauma Inj. 2012;25(4):196-202.
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AbstractAbstract PDF
PURPOSE
This study aimed to recognize the frequency of near-hanging patients with elevated Troponin-I (Tn-I), to obtain information necessary for treatment and prediction of prognosis by analyzing the clinical feature of near-hanging patients, and to evaluate the relevance of elevated Tn-I to abnormal result of other cardiac-related examinations.
METHODS
A retrospective review for the near-hanging patients, clinical record was conducted at two urban training hospitals between April, 2001 and December, 2011. We divided included patients into two groups, which one with elevated Tn-I level (Tn-I> or =0.1 ng/dL) and one without it, and compared the differences in initial vital signs, cardiac enzyme tests, an electrocardiogram, echocardiography, chest X-ray, and the clinical outcomes.
RESULTS
A total of 39 patients were included, out of them, 14 patients showed rise in Tn-I level. The length of hospital stay and ICU hospitalization was more prolonged in the patient group with elevated Tn-I level than non-elevated group. As well as the incidence of endotracheal intubation and abnormal findings in echocardiography or chest X-ray was higher in the Tn-I elevated group, which is statistically significant.
CONCLUSION
The rising of serum Tn-I level in near-hanging patients were not uncommonly observed. We believe that the cardiac-related test including Tn-I is necessary for near-hanging patients, and those who are shown abnormal result in cardiac-related test may need close observation and intensive care.
Summary
Acalculous Cholecystitis Following Multiple Trauma with Fractures
Ki Hoon Kim, Kyu Hyouk Kyung, Jin Su Kim, Kwan U Kim, Woon Won Kim, Ji Wan Kim
J Trauma Inj. 2012;25(4):203-208.
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AbstractAbstract PDF
PURPOSE
The purpose of this study is to investigate the incidence of acalculous cholecystitis after multiple trauma with fractures and to analyze the characteristics of cholecystitis.
METHODS
We performed a retrospective study of multiple trauma patients with fractures between April 2010 and April 2012. Sixty-nine patients were identified, and the average age was 46.8(range: 15-74) years. Data were collected regarding associated injury, injury severity score (ISS), the diagnosis time after trauma, diagnostic tool, and management.
RESULTS
There were three cases(4.3%) of cholecystitis among the 69 cases, and cholecystitis was diagnosed an average of 20.7(range: 8-33) days after injury. Two patients complained of abdominal pain at diagnosis, but the other patient who had undergone surgery for small bowel perforation at the time of the injury had no abdominal pain. All three patients had abnormal liver function tests (LFTs) at diagnosis. The cholecystitis was confirmed with ultrasonography or computed tomography, and all cases were acalculous cholecystitis. At first, percutaneous transhepatic gallbladder drainage was performed; then, laparoscopic cholecystectomy (LC) was tried an average of 12(range: 11-13) days later. An laparoscopic cholecystectomy was successfully done in only one case, the other cases being converted to an open cholecystectomy due to severe inflammation.
CONCLUSION
The incidence of acaculous cholecystitis was 4.3% after multiple trauma with fractures. We should consider cholecystitis in patients with abdominal pain, fever and elevated LFTs after multiple trauma.
Summary
Evolution of Chronic Subdural Hematoma based on Brain CT findings and Appropriate Treatment Methods
Young Bae Lee
J Trauma Inj. 2012;25(4):209-216.
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AbstractAbstract PDF
PURPOSE
The objectives of this study are to classify chronic subdural hematomas based on brain computerized tomographic scan (CT scan) findings and to determine the mechanism of evolution and treatment methods.
METHODS
One hundred thirty-nine patients who were diagnosed with a chronic subdural hematoma and who available for follow up assessment 6 months post-surgery were analyzed retrospectively. The presence of trauma and past medical history were reviewed and evaluation criteria based on brain CT scan findings were examined.
RESULTS
Initial brain CT scans revealed a chronic subdural hematoma in 106 patients, a subdural hygroma in 24 patients, and an acute subdural hematoma in 9 patients. In all cases where the initial acute subdural hematoma had progressed to a chronic subdural hematoma, final was a hypo-density chronic subdural hematoma. In case where the initial subdural hygroma had progressed to a chronic subdural hematoma, the most cases of hematoma were hyper-density and mixed-density chronic subdural hematoma. In total, 173 surgeries were performed, and they consisted of 97 one burr-hole drainages, 70 two burr-hole drainages and 6 craniotomies.
CONCLUSION
This study demonstrates that rebleeding and osmotic effects are mechanisms for enlarging of a chronic subdural hematoma. In most cases, one burr-hole drainage is a sufficient for treatment. However, in cases of mixed or acute-on-chronic subdural hematomas, other appropriate treatment strategies are required.
Summary

J Trauma Inj : Journal of Trauma and Injury