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Volume 33(2); June 2020
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Special Article
Part 2. Clinical Practice Guideline for Trauma Team Composition and Trauma Cardiopulmonary Resuscitation from the Korean Society of Traumatology
Oh Hyun Kim, Seung Je Go, Oh Sang Kwon, Chan-Yong Park, Byungchul Yu, Sung Wook Chang, Pil Young Jung, Gil Jae Lee
J Trauma Inj. 2020;33(2):63-73.   Published online June 30, 2020
DOI: https://doi.org/10.20408/jti.2020.0020
  • 5,975 View
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  • 1 Citations
PDF
Summary

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  • An Artificial Intelligence Model for Predicting Trauma Mortality Among Emergency Department Patients in South Korea: Retrospective Cohort Study
    Seungseok Lee, Wu Seong Kang, Do Wan Kim, Sang Hyun Seo, Joongsuck Kim, Soon Tak Jeong, Dong Keon Yon, Jinseok Lee
    Journal of Medical Internet Research.2023; 25: e49283.     CrossRef
Original Articles
Effects of Massive Transfusion Protocol Implementation in Trauma Patients at a Level I Trauma Center
Hyun Woo Sun, Sang Bong Lee, Sung Jin Park, Chan Ik Park, Jae Hun Kim
J Trauma Inj. 2020;33(2):74-80.   Published online June 30, 2020
DOI: https://doi.org/10.20408/jti.2020.022
  • 5,803 View
  • 168 Download
  • 1 Citations
AbstractAbstract PDF
Purpose

This study was conducted to investigate whether rapid and efficient administration of blood products was achieved and whether clinical outcomes were improved by applying a massive transfusion protocol (MTP).

Methods

From January 2016 to September 2019, the medical records of trauma patients who received at least 10 units of packed red blood cells (PRBC) at Pusan National University Hospital (level I trauma center) were retrospectively reviewed. The patients treated from January 2016 to January 2018 were designated as the non-MTP group, and those treated from February 2018 to September 2019 were designated as the MTP group.

Results

During the study period, 370 patients received massive transfusions. The non-MTP and MTP groups comprised 84 and 55 patients, respectively. No significant between-group differences were found in the units of PRBC (23.2 vs. 25.3, respectively; p=0.46), fresh frozen plasma (FFP) (21.1 vs. 24.4, respectively; p=0.40), and platelets (PLT) (15.4 vs. 17.0, respectively; p=0.54) administered in the first 24 hours. No statistically significant differences between the non-MTP and MTP groups were found in the FFP-to-PRBC ratio (0.9 vs. 0.94, respectively; p=0.44) and or the PLT-to-PRBC ratio (0.72 vs. 0.72, respectively; p=0.21). However, the total number of cryoprecipitate units was significantly higher in the MTP group than in the non-MTP group (7.4 vs. 15.3 units, respectively; p=0.003) and the ratio of cryoprecipitate to PRBC in the MTP group was significantly higher than in the non-MTP group (0.31 vs. 0.62, respectively; p=0.021). The time to transfusion was significantly reduced after MTP implementation (41.0 vs. 14.9 minutes, respectively; p=0.003).

Conclusions

Although no significant differences were found in the clinical outcomes of patients who had undergone severe trauma, rapid and balanced transfusion was achieved after implementing the MTP.

Summary

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  • Acquired Factor XIII Deficiency in Patients with Multiple Trauma
    Michael Hetz, Tareq Juratli, Oliver Tiebel, Moritz Tobias Giesecke, Serafeim Tsitsilonis, Hanns-Christoph Held, Franziska Beyer, Christian Kleber
    Injury.2023; 54(5): 1257.     CrossRef
Comparison of Outcomes and Recurrence in Chronic Subdural Hematoma Patients Treated by Burr-Hole Drainage with or without Irrigation
Jongwook Choi, Kum Whang, Sungmin Cho, Jongyeon Kim
J Trauma Inj. 2020;33(2):81-87.   Published online June 5, 2020
DOI: https://doi.org/10.20408/jti.2020.003
  • 5,360 View
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  • 2 Citations
AbstractAbstract PDF
Purpose

Chronic subdural hematoma (CSDH) is a common disease in elderly patients and is usually treated by burr-hole drainage. However, the optimal surgical technique for treating CSDH has not been determined. In this study, we analyzed outcomes and recurrence rates after burr-hole drainage with or without irrigation in patients with CSDH.

Methods

Eighty-two CSDH patients treated with burr-hole drainage at Wonju Severance Christian Hospital from March 2015 to June 2016 were enrolled in this study. The subjects were divided into three groups based on the surgical technique performed as follows: single burr-hole drainage without irrigation (group A, n=47), single burr-hole drainage with irrigation (group B, n=14), or double burr-hole drainage with irrigation (group C, n=21). These three groups were compared with respect to clinical and radiological factors and the recurrence rate, and independent factors predicting recurrence were sought.

Results

After burr-hole drainage, CSDH recurred in 15 (18.3%) of the 82 patients, and six patients (7.3%) required reoperation. More specifically, recurrence was observed in 12 patients (25.5%) in group A, one (7.1%) in group B, and two (9.5%) in group C. The number of burr-holes did not significantly affect recurrence (odds ratio [OR]=0.38; 95% confidence interval [CI]: 0.60–2.38), but irrigation had a significant effect (OR=0.20; 95% CI: 0.04–0.97).

Conclusions

This study shows that irrigation during burr-hole surgery in CSDH patients significantly reduced the risk of recurrence, regardless of the number of burrholes used. We therefore recommend the use of active irrigation during burr-hole drainage surgery in CSDH patients.

Summary

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  • Factors Associated with Recurrence in Chronic Subdural Hematoma following Surgery
    Kritsada Buakate, Thara Tunthanathip
    Journal of Health and Allied Sciences NU.2024; 14(01): 085.     CrossRef
  • Factors Associated With Short-Term Outcomes of Burr-Hole Craniostomy Associated With Brain Re-Expansion and Subdural Hematoma Shrinkage for Chronic Subdural Hematoma
    Gyubin Lee, Yeongyu Jang, Kum Whang, Sungmin Cho, Jongyeon Kim, Byeongoh Kim, Jongwook Choi
    Korean Journal of Neurotrauma.2023; 19(3): 324.     CrossRef
Analysis of Aspiration Risk Factors in Severe Trauma Patients: Based on Findings of Aspiration Lung Disease in Chest Computed Tomography
Gyu Jin Heo, Jungnam Lee, Woo Sung Choi, Sung Youl Hyun, Jin-Seong Cho
J Trauma Inj. 2020;33(2):88-95.   Published online June 30, 2020
DOI: https://doi.org/10.20408/jti.2020.0003
  • 5,227 View
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  • 2 Citations
AbstractAbstract PDF
Purpose

The present study will identify risk factors for aspiration in severe trauma patients by comparing patients who showed a sign of aspiration lung disease on chest computed tomography (CT) and those who did not.

Methods

We conducted a retrospective review of the Korean Trauma Data Bank between January 2014 and December 2019 in a single regional trauma center. The inclusion criteria were patients aged ≥18 years with chest CT, and who had an Injury Severity Score ≥16. Patients with Abbreviated Injury Scale (AIS)-chest score ≥1 and lack of medical records were excluded. General characteristics and patient status were analyzed.

Results

425 patients were included in the final analysis. There were 48 patients showing aspiration on CT (11.2%) and 377 patients showing no aspiration (88.7%). Aspiration group showed more endotracheal intubation in the ER (p=0.000) and a significantly higher proportion of severe Glasgow Coma Scale (GCS) (p=0.000) patients than the non-aspiration group. In AIS as well, the median AIS head score was higher in the aspiration group (p=0.046). Median oxygen saturation was significantly lower in the aspiration group (p=0.002). In a logistic regression analysis, relative to the GCS mild group, the moderate group showed an odds ratio (OR) for aspiration of 2.976 (CI, 1.024–8.647), and the severe group showed an OR of 5.073 (CI, 2.442–10.539).

Conclusions

Poor mental state and head injury increase the risk of aspiration. To confirm for aspiration, it would be useful to perform chest CT for severe trauma patients with a head injury.

Summary

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  • Rapid Sequence Intubation Using the SEADUC Manual Suction Unit in a Contaminated Airway
    Matthew Stampfl, David Tillman, Nicholas Borelli, Tikiri Bandara, Andrew Cathers
    Air Medical Journal.2023; 42(4): 296.     CrossRef
  • Incidence and Predictors of Aspiration Pneumonia Among Traumatic Brain Injury in Northwest Ethiopia
    Sahlu Mitku Shiferaw, Emiru Ayalew Mengistie, Getasew Mulatu Aknaw, Abraham Tsedalu Amare, Kefyalew Amogne Azanaw
    Open Access Emergency Medicine.2022; Volume 14: 85.     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
J Trauma Inj. 2020;33(2):96-103.   Published online June 17, 2020
DOI: https://doi.org/10.20408/jti.2020.018
  • 5,649 View
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AbstractAbstract PDF
Purpose

In patients with trauma, rhabdomyolysis (RM) can lead to fatal complications resulting from muscle damage. Thus, RM must be immediately diagnosed and treated to prevent complications. Creatine kinase (CK) is the most sensitive marker for diagnosing RM. However, relying on CK tests may result in delayed treatment, as it takes approximately 1 hour to obtain CK blood test results. Hence, this study investigated whether the neutrophil-to-lymphocyte ratio (NLR) could predict RM at an earlier time point in patients with trauma, since NLR results can be obtained within 10 minutes.

Methods

This retrospective study included 130 patients with severe trauma who were admitted to the emergency room of a tertiary institution between January 2017 and April 2020. RM was defined as a CK level ≥1,000 U/L at the time of arrival. Patients with severe trauma were categorized into non-RM and RM groups, and their characteristics and blood test results were analyzed. Statistical analysis was performed using SPSS version 26.0 for Windows.

Results

Of the 130 patients with severe trauma, 50 presented with RM. In the multivariate analysis, the NLR (odds ratio [OR], 1.252; 95% confidence interval [CI], 1.130– 1.386), pH level (OR, 0.006; 95% CI, 0.000–0.198), presence of acute kidney injury (OR, 3.009; 95% CI, 1.140–7.941), and extremity Abbreviated Injury Scale score (OR, 1.819; 95% CI, 1.111–2.980) significantly differed between the non-RM and RM groups. A receiver operating characteristic analysis revealed that a cut-off NLR value of 3.64 was the best for predicting RM.

Conclusions

In patients with trauma, the NLR at the time of arrival at the hospital is a useful biochemical marker for predicting RM.

Summary
Exchange Nailing for Aseptic Nonunion of the Femoral Shaft after Intramedullary Nailing
Sung-Soo Ha, Chang-Wug Oh, Jae-Wook Jung, Joon-Woo Kim, Kyeong-Hyeon Park, Seong-Min Kim
J Trauma Inj. 2020;33(2):104-111.   Published online June 19, 2020
DOI: https://doi.org/10.20408/jti.2020.010
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  • 2 Citations
AbstractAbstract PDF
Purpose

Although exchange nailing is a standard method of treating femoral shaft nonunion, various rates of healing, ranging from 72% to 100%, have been reported. The purpose of this study was to evaluate the efficacy of exchange nailing in femoral shaft nonunion.

Methods

We retrospectively reviewed 30 cases of aseptic femoral shaft nonunion after intramedullary nailing. The mean postsurgical period of nonunion was 66.8 weeks. A nail at least 2 mm larger in diameter was selected to replace the previous nail after reaming. Distal fixation was performed using at least two interlocking screws. The success of the procedure was determined by the finding of union on simple radiographs. Possible reasons for failure were analyzed, including the location of nonunion, the type of nonunion, and the number of screws used for distal fixation.

Results

Of the 30 cases, 27 achieved primary healing with the technique of exchange nailing. The average time to achieve union was 23.1 weeks (range, 13.7–36.9 weeks). The three failures involved nonunion at the isthmic level (three of 15 cases), not at the infraisthmic level (zero of 15 cases). Of eight cases of oligotrophic nonunion, two (25%) failed to heal, and of 22 cases of hypertrophic nonunion, one (4.5%) failed to heal. Of 11 cases involving two screws at the distal fixation, two (18.2%) failed to heal, and of 19 cases involving three or more screws, one (5.3%) failed to heal. None of these findings was statistically significant.

Conclusions

Exchange nailing may enable successful healing in cases of aseptic nonunion of the femoral shaft. Although nonunion at the isthmic level, oligotrophic nonunion, and weaker distal fixation seemed to be associated with a higher chance of failure, further study is needed to confirm those findings.

Summary

Citations

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  • Intramedullary nailing as a treatment for non-unions of femoral shaft fractures after plating failure: A case series
    Ihsan Oesman, Dody Kurniawan, Anissa Feby Canintika
    International Journal of Surgery Case Reports.2023; 103: 107908.     CrossRef
  • Perioperative Radiographic Predictors of Non-Union in Infra-Isthmal Femoral Shaft Fractures after Antegrade Intramedullary Nailing: A Case–Control Study
    Wei-Cheng Hung, Chin-Jung Hsu, Abhishek Kumar, Chun-Hao Tsai, Hao-Wei Chang, Tsung-Li Lin
    Journal of Clinical Medicine.2022; 11(13): 3664.     CrossRef
Case Reports
Hidden Hematologic Disease in Trauma Patients: A Report of Two Cases
Sung Woo Jang, Pil Young Jung
J Trauma Inj. 2020;33(2):112-118.   Published online June 17, 2020
DOI: https://doi.org/10.20408/jti.2020.016
  • 4,580 View
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AbstractAbstract PDF

In trauma patients, coagulopathy and abnormal increases or decreases in cell counts are frequently observed, and are associated with high mortality and morbidity in the acute phase of trauma. Because major trauma is often life-threatening, and hematologic abnormalities are multi-factorial and transient, major blood loss is usually suspected to be the primary cause of these abnormalities, and much time and cost may be spent attempting to identify a focus of hemorrhage that might or might not actually exist. Persistent abnormalities in the complete blood count, however, require clinical suspicion of other hematologic diseases to minimize improper transfusions and to improve outcomes, including mortality. Physicians at trauma centers should be familiar with the clinical characteristics of hematologic diseases and should consider these diseases in trauma patients. In this report, we present cases of two hematologic disorders found in trauma patients: autoimmune hemolytic anemia induced by systemic lupus erythematosus and myelodysplastic syndrome.

Summary
Pulmonary Contusion Similar to COVID-19 Pneumonia
Seung Hwan Lee, Sung Youl Hyun, Yang Bin Jeon, Jung Nam Lee, Gil Jae Lee
J Trauma Inj. 2020;33(2):119-123.   Published online June 30, 2020
DOI: https://doi.org/10.20408/jti.2020.0014
  • 10,425 View
  • 213 Download
  • 1 Citations
AbstractAbstract PDF

The Coronavirus disease 2019 (COVID-19) has rapidly spread across the world and caused a pandemic. It can be transmitted by an infected person or an asymptomatic carrier and is a highly contagious disease. Prevention and early identification of COVID-19 are important to minimize the transmission of COVID-19. Chest computed tomography (CT) has a high sensitivity for detecting COVID-19, but relatively low specificity. Therefore, chest CT may be difficult to distinguish COVID-19 findings from those of other infectious (notably viral types of pneumonia) or noninfectious disease. Pulmonary contusion has also a lot of similarities on chest CT with COVID-19 pneumonia. We present trauma patients with pulmonary contusion whose CT scans showed findings similar to those of COVID-19, and we report our experience in the management of trauma patients during the COVID-19 pandemic.

Summary

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  • Comparison of chest CT scan findings between COVID-19 and pulmonary contusion in trauma patients based on RSNA criteria: Established novel criteria for trauma victims
    Hossein Abdolrahimzadeh Fard, Salahaddin Mahmudi-Azer, Qusay Abdulzahraa Yaqoob, Golnar Sabetian, Pooya Iranpour, Zahra Shayan, Shahram Bolandparvaz, Hamid Reza Abbasi, Shiva Aminnia, Maryam Salimi, Mohammad Mehdi Mahmoudi, Shahram Paydar, Roham Borazjani
    Chinese Journal of Traumatology.2022; 25(3): 170.     CrossRef
Spontaneously Resolved Lumbar Artery Injury after Blunt Trauma
Seung Hyuk Nam, Je Il Ryu, Jin Hwan Cheong, Ki-Chul Park, Sun Kyun Ro
J Trauma Inj. 2020;33(2):124-127.   Published online June 30, 2020
DOI: https://doi.org/10.20408/jti.2019.041
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AbstractAbstract PDF

Major bleeding caused by vascular injuries of the abdominal aorta or its branches after blunt trauma often leads to mortality or major morbidity. We report a case that lumbar artery injury following blunt trauma was spontaneously resolved without any surgical or interventional treatment. Lumbar artery injury after blunt trauma could be treated conservatively without surgical or interventional treatment in a selected case. When an aortic or its branch injury was suspicious, diagnostic angiograms in the setting of interventional treatment may be helpful to decide an appropriate treatment modality.

Summary
Blunt Transection of the Entire Anterolateral Abdominal Wall Musculature Following Seatbelt-Related Injury
Hohyun Kim, Jae Hun Kim, Gil Hwan Kim, Hyun-Woo Sun, Chan Ik Park, Sung Jin Park, Chan Kyu Lee, Suk Kim
J Trauma Inj. 2020;33(2):128-133.   Published online June 30, 2020
DOI: https://doi.org/10.20408/jti.2020.0006
  • 6,648 View
  • 103 Download
AbstractAbstract PDF

Traumatic abdominal wall hernias (TAWHs) are uncommon and the incidence of this, which is rarely encountered in clinical practice, has been estimated at 1%. Furthermore, blunt transection of the entire abdominal wall musculature caused by seatbelt is a very rare complication. We report a case of adult with a complete disruption of the entire anterolateral abdominal wall muscle following the seatbelt injury. A 32-year-old male was wearing a seat belt in a high speed motor vehicle collision. Abdominal computed tomography (CT) scan revealed the complete disruption of bilateral abdominal wall musculatures including TAWH without visceral injury. However, injuries of small bowel and sigmoid colon were observed in the intra-operative field. The patient underwent the repair by primary closure of the defect with absorbable monofilament sutures. This case suggests that especially in TAWH patients, even if a CT scan is normal, clinicians should keep the possibility of bowel injury in mind, and choose a treatment based on the clinical findings.

Summary
Exceptionally Unusual Case of a Self-Inflicted Suicidal Cut Throat Injury
Mezhuneituo Raleng, Anant Prakash Pore, Temsula Alinger
J Trauma Inj. 2020;33(2):134-137.   Published online June 5, 2020
DOI: https://doi.org/10.20408/jti.2019.043
  • 18,322 View
  • 133 Download
AbstractAbstract PDF

Here we present a 43-year-old man who was brought with a self-inflicted cut throat injury; 18 hours after the suicidal attempt. On examination a deep 12 cm cut at the level of the hyoid bone exposing the posterior pharyngeal wall was seen. Emergency surgery with primary repair, tracheostomy and feeding gastrostomy was done. Post-operative period was uneventful and patient recovered without any speech or swallowing abnormalities. Through this article we would like to stress that even in cases of frightening ghastly wounds, by maintaining simple surgical principles we can achieve good outcomes.

Summary

J Trauma Inj : Journal of Trauma and Injury