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Volume 32(1); March 2019
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Original Articles
Effectiveness after Designation of a Trauma Center: Experience with Operating a Trauma Team at a Private Hospital
Kyoung Hwan Kim, Sung Ho Han, Soon-Ho Chon, Joongsuck Kim, Oh Sang Kwon, Min Koo Lee, Hohyoung Lee
J Trauma Inj. 2019;32(1):1-7.   Published online March 31, 2019
DOI: https://doi.org/10.20408/jti.2018.054
  • 3,215 View
  • 36 Download
AbstractAbstract PDF
Purpose

The present study aimed to evaluate the influence of how the trauma care system applied on the management of trauma patient within the region.

Methods

We divided the patients in a pre-trauma system group and a post-trauma system group according to the time when we began to apply the trauma care system in the Halla Hospital after designation of a trauma center. We compared annual general characteristics, injury severity score, the average numbers of the major trauma patients, clinical outcomes of the emergency department, and mortality rates between the two groups.

Results

No significant differences were found in the annual patients’ average age (54.1±20.0 vs. 52.8±18.2, p=0.201), transportation pathways (p=0.462), injury mechanism (p=0.486), injury severity score (22.93 vs. 23.96, p=0.877), emergency room (ER) stay in minutes (199.17 vs. 194.29, p=0.935), time to operation or procedure in minutes (154.07 vs. 142.1, p=0.767), time interval to intensive care unit (ICU) in minutes (219.54 vs. 237.13, p=0.662). The W score and Z score indicated better outcomes in post-trauma system group than in pre-trauma system group (W scores, 2.186 vs. 2.027; Z scores, 2.189 vs. 1.928). However, when analyzing survival rates for each department, in the neurosurgery department, in comparison with W score and Z score, both W score were positive and Z core was higher than +1.96. (pre-trauma group: 3.426, 2.335 vs. post-trauma group: 4.17, 1.967). In other than the neurosurgery department, W score was positive after selection, but Z score was less than +1.96, which is not a meaningful outcome of treatment (pre-trauma group: ?0.358, ?0.271 vs. post-trauma group: 1.071, 0.958).

Conclusions

There were significant increases in patient numbers and improvement in survival rate after the introduction of the trauma system. However, there were no remarkable change in ER stay, time to ICU admission, time interval to emergent procedure or operation, and survival rates except neurosurgery. To achieve meaningful survival rates and the result of the rise of the trauma index, we will need to secure sufficient manpower, including specialists in various surgical area as well as rapid establishment of the trauma center.

Summary
Development of Korean Teaching Model for Surgical Procedures in Trauma -Essential Surgical Procedures in Trauma Course-
Hohyun Kim, Chan-Yong Park, Hyun-Min Cho, Kwang-Hee Yeo, Jae Hun Kim, Byungchul Yu, Seung-Je Go, Oh Sang Kwon
J Trauma Inj. 2019;32(1):8-16.   Published online March 31, 2019
DOI: https://doi.org/10.20408/jti.2018.051
  • 4,023 View
  • 68 Download
AbstractAbstract PDFSupplementary Material
Purpose

The Essential Surgical Procedures in Trauma (ESPIT) course was developed as a model to teach necessary surgical procedures to trauma physicians. Its goals are to improve knowledge, self-confidence, and technical competence.

Methods

The ESPIT course consisted of five lectures and a porcine lab operative experience. The ESPIT course has been run seven times between February 2014 and April 2016. ESPIT participants completed a questionnaire to assess self-efficacy regarding essential surgical procedures in trauma before and immediately after taking the ESPIT course. Sixty-three participants who completed both pre- and post-course questionnaires on self-efficacy were enrolled in this study.

Results

The overall post-ESPIT mean self-efficacy score was higher than the pre-ESPIT mean self-efficacy score (8.3±1.30 and 4.5±2.13, respectively) (p<0.001). Self-efficacy was significantly improved after the ESPIT course in general surgeons (p<0.001), thoracic and cardiovascular surgeons (p<0.001), emergency medicine doctors, and others (neurosurgeons, orthopedic surgeons) (p<0.001). The differences in self-efficacy score according to career stage (<1 year, 1?3 years, 3?5 years, and >5 years) were also statistically significant (p<0.001).

Conclusions

The data of the ESPIT participants indicated that they felt that the ESPIT course improved their self-efficacy with regard to essential surgical procedures in trauma. The ESPIT course may be an effective strategy for teaching surgical procedures, thus promoting better management of traumatic injuries.

Summary
Usefulness of Shock Index to Predict Outcomes of Trauma Patient: A Retrospective Cohort Study
Myoung Jun Kim, Jung Yun Park, Mi Kyoung Kim, Jae Gil Lee
J Trauma Inj. 2019;32(1):17-25.   Published online March 31, 2019
DOI: https://doi.org/10.20408/jti.2018.034
  • 5,455 View
  • 178 Download
  • 6 Citations
AbstractAbstract PDF
Purpose

We investigated how prehospital, emergency room (ER), and delta shock indices (SI) correlate with outcomes including mortality in patients with polytrauma.

Methods

We retrospectively reviewed the medical records of 1,275 patients who visited the emergency department from January 2015 to April 2018. A total of 628 patients were enrolled in the study. Patients were divided into survivor and non-survivor groups, and logistic regression analysis was used to investigate independent risk factors for death. Pearson coefficient analysis and chi-square test were used to examine the significant relationship between SI and clinical progression markers.

Results

Of 628 enrolled patients, 608 survived and 27 died. Multivariate logistic regression analysis reveals “age” (p<0.001; OR, 1.068), “pre-hospital SI >0.9” (p<0.001; OR, 11.629), and “delta SI ≥0.3” (p<0.001; OR, 12.869) as independent risk factors for mortality. Prehospital and ER SIs showed a significant correlation with hospital and intensive care unit length of stay and transfusion amount. Higher prehospital and ER SIs (>0.9) were associated with poor clinical progression.

Conclusions

SI and delta SI are significant predictors of mortality in patients with polytrauma. Moreover, both prehospital and ER SIs can be used as predictive markers of clinical progression in these patients.

Summary

Citations

Citations to this article as recorded by  
  • Shock Index for the Prediction of Interventions and Mortality in Patients With Blunt Thoracic Trauma
    Mohammad Asim, Ayman El-Menyar, Talat Chughtai, Ammar Al-Hassani, Husham Abdelrahman, Sandro Rizoli, Hassan Al-Thani
    Journal of Surgical Research.2023; 283: 438.     CrossRef
  • Emergency Department Shock Index Outperforms Prehospital and Delta Shock Indices in Predicting Outcomes of Trauma Patients
    Hamidreza Hosseinpour, Tanya Anand, Sai Krishna Bhogadi, Christina Colosimo, Khaled El-Qawaqzeh, Audrey L. Spencer, Lourdes Castanon, Michael Ditillo, Louis J. Magnotti, Bellal Joseph
    Journal of Surgical Research.2023; 291: 204.     CrossRef
  • Shock index as a predictor for mortality in trauma patients: a systematic review and meta-analysis
    Malene Vang, Maria Østberg, Jacob Steinmetz, Lars S. Rasmussen
    European Journal of Trauma and Emergency Surgery.2022; 48(4): 2559.     CrossRef
  • Delta Shock Index Predicts Outcomes in Pediatric Trauma Patients Regardless of Age
    Samer Asmar, Muhammad Zeeshan, Muhammad Khurrum, Jorge Con, Mohamad Chehab, Letitia Bible, Rifat Latifi, Bellal Joseph
    Journal of Surgical Research.2021; 259: 182.     CrossRef
  • Shock index as a predictor for short‐term mortality in helicopter emergency medical services: A registry study
    Johannes Björkman, Lasse Raatiniemi, Piritta Setälä, Jouni Nurmi
    Acta Anaesthesiologica Scandinavica.2021; 65(6): 816.     CrossRef
  • Association between prehospital field to emergency department delta shock index and in-hospital mortality in patients with torso and extremity trauma: A multinational, observational study
    Dae Kon Kim, Joo Jeong, Sang Do Shin, Kyoung Jun Song, Ki Jeong Hong, Young Sun Ro, Tae Han Kim, Sabariah Faizah Jamaluddin, Zsolt J. Balogh
    PLOS ONE.2021; 16(10): e0258811.     CrossRef
Early Predictive Values for Severe Rhabdomyolysis in Blunt Trauma
Jung Yun Park, Myoung Jun Kim, Jae Gil Lee
J Trauma Inj. 2019;32(1):26-31.   Published online March 31, 2019
DOI: https://doi.org/10.20408/jti.2018.029
  • 4,796 View
  • 129 Download
  • 2 Citations
AbstractAbstract PDF
Purpose

Rhabdomyolysis (RB) is a syndrome characterized by the decomposition of striated muscles and leakage of their contents into the bloodstream. Acute kidney injury (AKI) is the most significant and serious complication of RB and is a major cause of mortality in patients with RB. Severe RB (creatine kinase [CK] ≥5,000) has been associated with AKI. However, early prediction is difficult because CK can reach peak levels 1?3 days after the trauma. Hence, the aim of our study was to identify predictors of severe RB using initial patient information and parameters.

Methods

We retrospectively analyzed 1,023 blunt trauma patients admitted to a single tertiary hospital between August 2011 and March 2018. Patients with previously diagnosed chronic kidney disease were excluded from the study. RB and severe RB were defined as a CK level ≥1,000 U/L and ≥5,000 U/L, respectively. The diagnosis of AKI was based on RIFLE criteria.

Results

The overall incidence of RB and severe RB was 31.3% (n=320) and 6.2% (n=63), respectively. On multivariable analysis, male sex (odds ratio [OR] 3.78, 95% confidence interval [CI] 1.43 to 10.00), initial base excess (OR 0.85, 95% CI 0.80 to 0.90), initial CK (OR 2.07, 95% CI 1.67 to 2.57), and extremity abbreviated injury scale score (OR 1.78, 95% CI 1.39 to 2.29) were found to predict severe RB. The results of receiver operating characteristic analysis showed that the best cutoff value for the initial serum CK level predictive of severe RB was 1,494 U/L.

Conclusions

Male patients with severe extremity injuries, low base excess, and initial CK level >1,500 U/L should receive vigorous fluid resuscitation.

Summary

Citations

Citations to this article as recorded by  
  • Factors Associated with Acute Kidney Injury Occurrence and Prognosis in Rhabdomyolysis at the Emergency Department
    Jun Seok Seo, Inhwan Yeo, Changho Kim, Daeun Kim, Jeong-Hoon Lim, Kyoungtae Park, Jiwoo Jeong, Hojin Kwon, Yuna Cho, Sungyeon Park
    Medicina.2024; 60(1): 105.     CrossRef
  • Role of the Neutrophil-to-Lymphocyte Ratio at the Time of Arrival at the Emergency Room as a Predictor of Rhabdomyolysis in Severe Trauma Patients
    Jin Chul Bae, Kyung Hoon Sun, Yong Jin Park
    Journal of Trauma and Injury.2020; 33(2): 96.     CrossRef
Management and Outcome of Patients with Acetabular Fractures: Associated Injuries and Prognostic Factors
Do-Hyun Yeo, Jong-Keon Oh, Jae-Woo Cho, Beom-Soo Kim
J Trauma Inj. 2019;32(1):32-39.   Published online March 31, 2019
DOI: https://doi.org/10.20408/jti.2018.016
  • 3,839 View
  • 72 Download
  • 2 Citations
AbstractAbstract PDF
Purpose

The aim of this study was to determine which factors contribute to the surgical treatment outcomes of acetabular fractures. Simultaneously, we aim to report on the treatment results after our hospital was designated as the focused training center for trauma.

Methods

We conducted a retrospective review of all patients who experienced acetabular fractures from January 1, 2014 to May 1, 2017 and visited our hospital. Patients who had associated pelvic ring fractures or were lost to the one-year follow-up were excluded; a total of 37 fractures were evaluated. We evaluated the clinical results using the scoring system of Merle d’Aubign? (MDA) and grade of Brooker for heterotopic ossification.

Results

Thirty-seven patients (31 men and 6 women) were identified. The mean injury severity score (ISS) was 8.7, with 32.4% of patients having a score >15. The average blood transfusion in the first 24 hours was 0.54 pints. Falling was the most common injury mechanism (32.4%). Chest injury was the most common associated injury (16.2%), followed by head injury (13.5%). The posterior wall and both column fracture were the most common (37.8%) fracture patterns. Excellent and good clinical grades of MDA included 28 patients (75.6%) and fair and poor grades included nine (24.3%), respectively. Four patients were diagnosed with a post-operative infection (10.8%); one out of four patients who had co-morbidity died (2.7%), and another patient underwent a replacement surgery (2.7%). Multivariate analysis showed that age and operation time were associated with MDA. In addition, operation time and ISS were significant co-factors of the Brooker grade.

Conclusions

Korea University Guro Hospital showed similar treatment results of acetabular fractures compared to other publications. The age and operation time were co-factors of the clinical outcome of this fracture. Additionally, increased operation time and injury severity score were suggested to increase the Brooker grade.

Summary

Citations

Citations to this article as recorded by  
  • Outcome of acetabulum fractures treated with open reduction and internal fixation through Kocher-Langenbeck Approach: A retrospective study
    Dharmendra Kumar, Narendra Singh Kushwaha, Prakash Gaurav Tiwari, Yashvardhan Sharma, R.N. Srivastava, Vineet Sharma
    Journal of Clinical Orthopaedics and Trauma.2021; 23: 101599.     CrossRef
  • FUNCTIONAL AND RADIOLOGICAL OUTCOMES OF ACETABULAR FRACTURES
    Sangam Jain, Dishit Vaghasia, Tanay Nahatkar, Spandan Koshire, Amol Salve, Vinod Kumar Yadav
    INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH.2021; : 1.     CrossRef
Analysis of Risk Factors for Infection in Orthopedic Trauma Patients
Gi Ho Moon, Jae-Woo Cho, Beom Soo Kim, Do Hyun Yeo, Jong-Keon Oh
J Trauma Inj. 2019;32(1):40-46.   Published online March 31, 2019
DOI: https://doi.org/10.20408/jti.2018.023
  • 4,588 View
  • 124 Download
  • 3 Citations
AbstractAbstract PDF
Purpose

We perform an analysis of infection risk factors for fracture patients and confirm that the risk factors reported in previous studies increase the risk of actual infection among fractured patients. In addition, injury severity score (ISS) which is used as an evaluation tool for morbidity of trauma patients, confirms whether there is a relationship with infection after orthopedic fracture surgery.

Methods

We retrospectively reviewed 1,818 patients who underwent fixation surgery at orthopedic trauma team, focused trauma center from January 1, 2015 to December 31, 2017. Thirty-five patients were infected after fracture surgery. We analyzed age, sex, open fracture criteria based on Gustilo-Aderson classification 3b, anatomical location (upper extremity or lower extremity) of fracture, diabetes, smoking, ISS.

Results

Of 1,818 patients, 35 (1.9%) were diagnosed with postoperative infection. Of the 35 infected patients, nine (25.7%) were female and five (14.0%) were upper extremity fractures. Three (8.6%) were diagnosed with diabetes and eight (22.8%) were smokers. Thirteen (37.1%) had ISS less than nine points and six (17.1%) had ISS 15 points or more. Of 1,818 patients, 80 had open fractures. Surgical site infection were diagnosed in 12 (15.0%) of 80. And nine of 12 were checked with Gustilo-Aderson classification 3b or more. Linear logistic regression analysis was performed using statistical analysis program Stata 15 (Stata Corporation, College Station, TX, USA). In addition, independent variables were logistic regression analyzed individually after Propensity scores matching. In all statistical analyzes, only open fracture was identified as a risk factor.

Conclusions

The risk factors for infection in fracture patients were found to be significantly influenced by open fracture rather than the underlying disease or anatomical feature of the patient. In the case of ISS, it is considered that there is a limitation. It is necessary to develop a new scoring system that can appropriately approach the morbidity of fracture trauma patients.

Summary

Citations

Citations to this article as recorded by  
  • Analysis of Risk Factors and Association of Cluster of Differentiation (CD) Markers With Conventional Markers in Delayed Fracture Related Infection for Closed Fracture
    Archana Raikwar, Ajai Singh, Vikas Verma , Abbas Ali Mehdi, Narendra Singh Kushwaha, Rashmi Kushwaha
    Cureus.2021;[Epub]     CrossRef
  • Feasibility of Early Definitive Internal Fixation of Pelvic Bone Fractures in Therapeutic Open Abdomen
    Kyunghak Choi, Kwang-Hwan Jung, Min Ae Keum, Sungjeep Kim, Jihoon T Kim, Kyu-Hyouck Kyoung
    Journal of Trauma and Injury.2020; 33(1): 18.     CrossRef
  • Characterization and Antibiofilm Activity of Mannitol–Chitosan-Blended Paste for Local Antibiotic Delivery System
    Leslie R. Pace, Zoe L. Harrison, Madison N. Brown, Warren O. Haggard, J. Amber Jennings
    Marine Drugs.2019; 17(9): 517.     CrossRef
Case Reports
Chronic Dislocation of the Distal Interphalangeal Joints
Junki Shiota, Daisuke Kawamura, Norimasa Iwasaki
J Trauma Inj. 2019;32(1):47-50.   Published online March 31, 2019
DOI: https://doi.org/10.20408/jti.2018.030
  • 9,462 View
  • 99 Download
AbstractAbstract PDF

Irreducible dislocation of the distal interphalangeal (DIP) joint is a rare traumatic condition commonly seen in sports injuries. Herein, we present a case with chronic dislocation of the DIP joint caused by high energy trauma accompanied by a fracture of the ipsilateral clavicle. The local deformity resulting from the dislocation can be trivial. Therefore, obtaining radiographs of all the interphalangeal joint injuries, regardless of the findings on inspection, is crucial for accurate diagnosis in the case of high energy trauma. The good functional improvement was obtained by open reduction and temporary wire fixation for 4 weeks.

Summary
Combination of Anterior and Posterior Subcutaneous Internal Fixation for Unstable Pelvic Ring Injuries: The “Hula Hoop Technique”
Daniel Balbachevsky, Robinson Esteves Pires, Rodrigo Guerra Sabongi, The?philo Asfora Lins, Geiser de Souza Carvalho, H?lio Jorge Alvachian Fernandes, Fernando Baldy dos Reis
J Trauma Inj. 2019;32(1):51-59.   Published online March 31, 2019
DOI: https://doi.org/10.20408/jti.2018.003
  • 5,350 View
  • 104 Download
AbstractAbstract PDF

Unstable pelvic ring lesions are usually treated with internal fixation. In patients presenting clinical instability or soft tissue complication risk, external fixation is a safe treatment option. However, pin tract infection, insufficient biomechanical properties, difficulty sitting and changing decubitus are important drawbacks related to the treatment. The present study reports the association of anterior and posterior subcutaneous internal fixation by applying spine-designed implants on the pelvic ring disruption: supra-acetabular pedicle screws with an interconnecting rod (Infix), plus posterior transiliac fixation with the same system, which the authors have named the “Hula Hoop Technique”.

Summary
Minimally Invasive Stabilization with Percutaneous Screws Fixation of APC-3 Pelvic Ring Injury
Beom-Soo Kim, Jong-Keon Oh, Jae-Woo Cho, Do-Hyun Yeo, Jun-Min Cho
J Trauma Inj. 2019;32(1):60-65.   Published online March 31, 2019
DOI: https://doi.org/10.20408/jti.2018.015
  • 6,026 View
  • 123 Download
AbstractAbstract PDF

Pelvic fractures are associated with life-threatening injuries and high rates of morbidity and mortality. Management of internal blood loss associated with unstable pelvic ring injuries is paramount during the initial period. The reconstruction of the pelvic ring is of importance because it is a major contributor to the stability of the pelvic ring. We report the case of a 25-year-old man who had an unstable pelvic ring fracture combined with rupture of an obturator artery and had a successful and satisfactory treatment using minimally invasive surgery with percutaneous antegrade screw fixation.

Summary
Acute Pancreatitis after Additional Trauma in Chronic Traumatic Pancreatic Diaphragmatic Hernia
You Ho Mun, Sin Youl Park
J Trauma Inj. 2019;32(1):66-70.   Published online March 31, 2019
DOI: https://doi.org/10.20408/jti.2019.007
  • 3,326 View
  • 52 Download
AbstractAbstract PDF

Traumatic diaphragmatic injuries (TDIs) are a rare complication in thoraco-abdominal trauma. The diagnosis is difficult and if left untreated, TDI can cause traumatic diaphragmatic hernia (TDH). Through an injured diaphragm, the liver, spleen, stomach, small intestine, and large intestine can be herniated to the thoracic cavity, but pancreatic herniation and pancreatitis are quite rare in TDH. This paper reports a case of pancreatitis developed by additional trauma in a patient with asymptomatic chronic TDH. A 58-year-old male visited the emergency department with a left abdominal injury after a fall 6 hours earlier. The vital signs were stable, but the amylase and lipase levels were elevated to 558 U/L and 1,664 U/L, respectively. Abdominal computed tomography (CT) revealed a left diaphragmatic hernia and an incarceration of the stomach, pancreatic ductal dilatation, and peripancreatic fatty infiltration. Additional history taking showed that he had suffered a fall approximately 20 years ago and had an accidentally diaphragmatic hernia through a chest CT 6 months earlier. A comparison with the previous CT revealed the pancreatitis to be caused by secondary pancreatic ductal obstruction due to the incarcerated stomach. For pancreatitis, gastrointestinal decompression was performed, and after 3 days, the pancreatic enzyme was normalized; hence, a thoracotomy was performed. A small ruptured diaphragm was found and reposition of the organs was performed. This paper reports the experience of successfully treating pancreatitis and pancreatic hernia developed after trauma without complications through a thoracotomy following gastrointestinal decompression.

Summary

J Trauma Inj : Journal of Trauma and Injury