Journal of Trauma and Injury

Factors for Predicting the Need for an Emergency Blood Transfusion to a Multiple Trauma Patient Using Emergency Room Transfusion Score (ETS): Hyeon Kyu Jo, Yong Jin Park, Sun Pyo Kim, Seong Jung Kim, Soo Hyung Cho, Nam Soo Cho; J Trauma Inj. 2015;28(1):1-8. Published online March 30, 2015; DOI: https://doi.org/10.20408/jti.2015.28.1.1

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Abstract PDF: PURPOSE
The purposes of this study are finding the elements for a fast determination of the need for a transfusion to a multiple trauma patient arriving at this clinic in the initial stage establishing objective bases for a doctor in an emergency department to determine the need for a transfusion immediately after a patient has arrived at the emergency department, and providing treatment by considering various factors based on the nine criteria suggested in the emergency room transfusion score (ETS).
METHODS
This study was conducted on 375 multiple-trauma patients who visited the Chosun University Hospital Emergency Medical Center and activated the Emergency Trauma Team from January 2010 to December 2013. The patients were divided into the transfused group and the non-transfused group by retrospectively analyzing their medical records. Subsequently, the medical records were examined using the nine items suggested by the ETS and the results were analyzed.
RESULTS
Three hundred seventy-five patients with multiple traumas visited the Chosun University Hospital Emergency Medical Center and activated the Emergency Trauma Team. Among them, 258 died and 117 recovered and left the hospital. The deceased patients consisted of 182 males and 76 females with an average age 45. Of the 375, 165 were transferred from other hospitals, and 245 were blunt trauma patients. One hundred sixty-nine patients were injured in traffic accidents, and 119 of those 169 who had systolic blood pressure less than 90 mm Hg died. Two hundred twenty-six (60.3%) out of the 375 patients with multiple traumas received an emergency blood transfusion and their average age was 48. The 375 patients consisted of 156 males, 151 who had been transferred from other hospitals, 218 who presented with blunt trauma, 134 who had been injured in traffic accidents, 156 who had a systolic blood pressure less than 90 mm Hg, 134 who scored higher than 9 points on the GCS, and 162 who had a stable pelvic fracture of these 143 died.
CONCLUSION
During this study, 226 (60.3%) out of the patients with multiple traumas received an emergency blood transfusion. After analyzing the results related to emergency blood transfusion by using ETS, we found that an emergency blood transfusion had to be prepared quickly when patients were transferred from other hospitals when the systolic blood pressure was less than 90 mmHg. when abnormalities had been detected by ultrasonography and when the patient presented with a stable pelvic fracture.; Summary

Seroprevalence of Viral Infection in Neurotrauma Patients Who Underwent Emergent Surgical Intervention: Kyoung Hyup Nam, Hyuk Jin Choi, Jae Il Lee, Jun Kyeung Ko, In Ho Han, Won Ho Cho; J Trauma Inj. 2015;28(1):9-14. Published online March 30, 2015; DOI: https://doi.org/10.20408/jti.2015.28.1.9

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Abstract PDF: PURPOSE
The aim of this study was to estimate the seropositive prevalence of blood-borne infection in neurotrauma patients who underwent emergent surgical intervention, especially patients with hepatitis B virus (HBV), hepatitis C virus (HCV), syphilis and human immunodefIciency virus (HIV).
METHODS
A retrospective review identified 559 patients with traumatic brain injury and spinal trauma who underwent emergent surgery between 2007 and 2014. We reviewed the medical records and extracted data, including age, sex, location of lesion, result of serologic tests, time interval of admission and surgery after presenting to emergency room. Serologic tests for HBV, HCV, syphilis and HIV were performed and analyzed to determine whether the seropositive results were confirmed by the surgeon before surgery.
RESULTS
The majority of the patients were male (74.6%), and the mean age was 55.4+/-20.2 years. Most patients underwent surgery due to traumatic brain injury (90.0%). Fifty-three patients (10.0%) showed a positive result on at least one serologic test. Seropositive rates according to pathogens were 0.5% for syphilis, 5.2% for HBV and 3.9% for HCV. No positive results were noted on the serologic tests for HIV. HBV in patients with spinal cord injury and age from 40 to 49 years were associated with high serologic positive rate, and that result was statistically significant. However, no statistically significant differences were found in the other variables. Serologic results could not confirmed before surgery in the majority of the cases (62.1%), and 10.4% of these patients showed seropositive results.
CONCLUSION
The results of this study emphasize the importance of taking precautions and conducting rapid serologic testing in preventing the occupational transmission of blood-borne viruses to health-care workers.; Summary

Management of Femoropopliteal Vascular Injuries after Trauma: Surgical Outcomes: Sung Wook Chang, Sun Han, Kyoung Min Ryu, Jae Wook Ryu; J Trauma Inj. 2015;28(1):15-20. Published online March 30, 2015; DOI: https://doi.org/10.20408/jti.2015.28.1.15

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Abstract PDF: PURPOSE
Vascular injuries caused by traffic, industrial accidents and by outside activities have increased in Korea. Especially, vascular injuries to the extremities can lead to limb loss and even mortality if they are not appropriately treated. The aim of the study was to evaluate the surgical outcomes of femoropopliteal vascular management after trauma.
METHODS
The medical records of 12 patients with femoropopliteal vascular injuries who were treated at Dankook University Hospital from 2011 to 2013 were reviewed. Iatrogenic vascular injuries were excluded. The clinical data including the causes of injury, associated injuries and surgical outcomes were analyzed retrospectively.
RESULTS
All patients were male, with a mean age of 46.8+/-16.3 years (range: 26~69 years). The causes of vascular injuries were four traffic accidents, three industrial accidents, two iron plates, one outside activity, one glass injury and one knife injury. The average transit time between the place of the accident place and the emergency department was 3.0+/-2.1 (0.5~12.5) hours, and the average preparation time for surgery was 8.0+/-6.7 (1.7~23.3) hours. The anatomic injuries included the popliteal vessel in seven cases and the femoral vessel in five cases. The average Injury Severity Score (ISS) was 12.0+/-5.0 (5~17), and the average Mangled Extremity Severity Score (MESS) was 5.7+/-2.1 (2~9). The operation methods were four interposition grafts, three end-to-end anastomoses, two direct repairs and three patch angioplasties. One case required amputation of the injured extremity.
CONCLUSION
Early recognition and revascularization of the injured vessel are mandatory to reduce limb loss and to obtain satisfactory outcomes. Therefore, careful/rapid evaluation of the vascular injuries and timely/successful surgical treatment are the keys to salvaging an injured limb.; Summary

Natural History of Spontaneous Healing of a Traumatic Radial Tear of the Lateral Meniscus: A Case Report: Jae Ang Sim, Yong Cheol Yoon, Sheen Woo Lee, Beom Koo Lee; J Trauma Inj. 2015;28(1):21-26. Published online March 30, 2015; DOI: https://doi.org/10.20408/jti.2015.28.1.21

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Abstract PDF: Complete radial tears of the lateral meniscus are relatively rare. Once torn, the injury can be debilitating due to disruption of the circumferential fibers of the meniscus. We experienced a case of a lateral meniscus with a complete radial tear at the midbody, where the two torn ends were displaced more than 1 cm and could not be approximated during arthroscopy. Thirteen months after surgery, follow-up MRI and second-look arthroscopic findings showed that the complete radial tear has healed spontaneously. However, twenty nine months after the second-look arthroscopy, the patient complained of severe knee pain during exercise. On follow-up MRI, increased sclerosis and newly developed bone marrow edema were observed in the lateral femoral condyle, compared with previous MR images. Finally, we performed meniscal allograft transplantation due to the defective properties of the completely healed lateral meniscus.; Summary

Upside-down Adipofascial Flap for the Medial Foot Soft Tissue Defect after Trauma: Case Report: Min Bom Kim, Young Ho Lee, Gil Joon Seo, Goo Hyun Baek; J Trauma Inj. 2015;28(1):27-30. Published online March 30, 2015; DOI: https://doi.org/10.20408/jti.2015.28.1.27

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Abstract PDF: A child sustained a car tire friction injury and had multiple soft tissue wounds. She had a severe soft tissue defect in the medial foot and ankle aspect which requiring flap coverage. We performed an adipoafscial flap with upside-down pattern for the treatment of the medial foot and ankle soft tissue posttraumatic defect. The flap is based on the perforator artery from the posterior tibial artery. Because it gave a thin coverage for the foot, the patient could walk with normal foot wear.; Summary

Delayed Aortic Injury Caused by a Posterior Rib Fracture: A Case Report: Chang Wan Kim, Seon Uoo Choi, Seon Hee Kim, Jae Hun Kim, Jung Joo Hwang, Hyun Min Cho, Seung Hwan Song, Jeong Su Cho; J Trauma Inj. 2015;28(1):31-33. Published online March 30, 2015; DOI: https://doi.org/10.20408/jti.2015.28.1.31

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Abstract PDF: Traumatic aortic injury is well recognized as a primary cause of instantaneous death in victims of thoracic blunt trauma presenting with an aortic rupture or dissection, particularly after a deceleration injury. However, a direct aortic injury caused by a fractured rib segment after blunt thoracic trauma is extremely rare. We report the case of a 43-year-old male patient who experienced an aortic injury caused by the sharp edge of a fractured rib after multiple rib fractures due to blunt thoracic trauma.; Summary

Application of Extracorporeal Membranous Oxygenation in Trauma Patient with Possible Transfusion Related Acute Lung Injury (TRALI): Dae Sang Lee, Chi Min Park; J Trauma Inj. 2015;28(1):34-38. Published online March 30, 2015; DOI: https://doi.org/10.20408/jti.2015.28.1.34

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Abstract PDF

The case of a patient with a transfusion-related acute lung injury (TRALI) to whom extracorporeal membrane oxygenation (ECMO) had been applied is reported. A 55-year-old male injured with liver laceration (grade 3) without chest injury after car accident. He received lots of blood transfusion and underwent damage control abdominal surgery. In the immediate postoperative period, he suffered from severe hypoxia and respiratory acidosis despite of vigorous management such as 100% oxygen with mechanical ventilation, high PEEP and muscle relaxant. Finally, ECMO was applied to the patients as a last resort. Aggressive treatment with ECMO improved the oxygenation and reduced the acidosis. Unfortunately, the patient died of liver failure and infection. TRALI is a part of acute respiratory distress syndrome (ARDS). The use of ECMO for TRALI induced severe hypoxemia might be a useful option for providing time to allow the injured lung to recover.

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A Case Report of Transfusion-Related Acute Lung Injury Induced in the Patient with HLA Antibody after Fresh Frozen Plasma Transfusion
Ki Sul Chang, Dae Won Jun, Youngil Kim, Hyunwoo Oh, Min Koo Kang, Junghoon Lee, Intae Moon
The Korean Journal of Blood Transfusion.2015; 26(3): 309. CrossRef

Successful Angiographic Embolization of Superficial Circumflex Iliac Artery Rupture Caused by Blunt Abdominal Trauma: A Case Report: Sang Bong Lee, Sung Jin Park, Kwang Hee Yeo, Ho Hyun Kim, Chan Yong Park, Jae Hun Kim, Chang Wan Kim, Seon Uoo Choi, Seon Hee Kim, Jung Joo Hwang, Hyun Min Cho; J Trauma Inj. 2015;28(1):39-42. Published online March 30, 2015; DOI: https://doi.org/10.20408/jti.2015.28.1.39

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Abstract PDF: Lat. abdominal wall hematoma with active bleeding is very rare but need prompt bleeding control. We report successful treatment by angiographic embolization of superficial circumflex iliac artery rupture caused by blunt trauma. A 60-year-old woman presented painful, enlarging, lat. abdominal wall mass with ecchymosis caused by blunt abdominal trauma. Contrast leakage of superficial circumflex iliac a. within the lt. ext. oblique m. hematoma was confirmed by abdominal computed tomography. Angiographic embolization was performed successfully. Patient was discharged at 4th day after trauma without complication. Angiographic embolization is important treatment option of lat. abdominal wall hematoma with active bleeding replacing emergency surgery.; Summary

Bilateral Spontaneous Resolution of Chronic Subdural Hematoma: A Case Report: Gyeongung Seon, Ji Min Park, Ki Seong Eom; J Trauma Inj. 2015;28(1):43-46. Published online March 30, 2015; DOI: https://doi.org/10.20408/jti.2015.28.1.43

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Abstract PDF: Although spontaneous resolution of chronic subdural hematoma (C-SDH) in the elderly has rarely been reported, spontaneous resolution of bilateral C-SDH is very rare. Here, we report the case of a 73-year-old female patient with no significant head trauma history who had a bilateral C-SDH spontaneously resolve despite receiving only conservative treatment. However, because of a lack of detailed knowledge about the mechanisms of resolution, treatment is often limited to surgical interventions that are generally successful, but invasive and prone to recurrence. We review the literature and discuss the possible relation of C-SDH's spontaneous resolution with its clinical and radiological characteristics.; Summary

Isolated Duodenal Injury following Blunt Abdominal Trauma: Young Hoon Sul, Kwang Sik Cheon, Chang Eun Jang, Kyung Ha Lee, Sang Il Lee, In Sang Song; J Trauma Inj. 2015;28(1):47-50. Published online March 30, 2015; DOI: https://doi.org/10.20408/jti.2015.28.1.47

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Abstract PDF: The isolated duodenal injury following blunt abdominal trauma is extremely rare. Because, duodenal injury is usually presented with other intra-abdominal organs injuries such as hepatic injury, pancreatic injury due to the anatomical position. So, We report a case of isolated duodenal injury following blunt abdominal trauma, and the discuss about the related article.; Summary

Colorectal Foreign Bodies: Six Cases Report and Review of the Literature: Hyoungran Kim, Seokho Choi, Jeongseok Yun; J Trauma Inj. 2015;28(1):51-54. Published online March 30, 2015; DOI: https://doi.org/10.20408/jti.2015.28.1.51

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The incidence of foreign body insertion in the anorectum is rare, however, it is increasing, especially in urban populations. Foreign objects in the anorectum can be of different sizes, shapes and materials. Frangible objects like glass or beakers, and sharp foreign bodies that may easily injure the bowel mucosa are particularly dangerous. Physicians have to consider more innovative options on how to extract these foreign bodies without inciting injury; and, if injury would occur, consider different techniques to repair it, whether transanally or transabdominally, and opt for primary repair, or resection with either anastomosis or stoma creation. Here, I introduce our cases with colorectal foreign bodies and present several literatures to help physicians decide when presented with cases like these.

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Bike handlebar grip in the rectum: minimally invasive endoscopic management
Danilo Paduano, Francesco Auriemma, Mario Bianchetti, Alessandro Repici, Benedetto Mangiavillano
Endoscopy.2022; 54(02): E42. CrossRef

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