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Volume 35(4); December 2022
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Editorial
Tactical field management of penetrating arrow injuries in ancient Asia
Kun Hwang
J Trauma Inj. 2022;35(4):229-231.   Published online June 23, 2022
DOI: https://doi.org/10.20408/jti.2022.0018
  • 2,096 View
  • 43 Download
  • 1 Citations
PDF
Summary

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  • Medieval (arrow) weapon injuries in contemporary surgical practice: Impaled posterior thoracic wall arrowhead leading to haemo-thorax: Management protocols. Case report
    Ahmed Shabhay, Zarina Shabhay, Fabian Anaclet Massaga, Amri Salim Mwami, Samwel Chugulu
    International Journal of Surgery Case Reports.2023; 111: 108866.     CrossRef
Original Articles
Types of injuries caused by isolated electric scooter accidents
Kyongwon Yoo, Hyung Il Kim
J Trauma Inj. 2022;35(4):232-239.   Published online August 5, 2022
DOI: https://doi.org/10.20408/jti.2022.0010
  • 2,325 View
  • 56 Download
AbstractAbstract PDF
Purpose
The recent increase in electric scooter (e-scooter) use has been accompanied by an increase in injuries from e-scooter–related accidents. Studies have reported that most such injuries are minor, and physicians may therefore underestimate the severity of such injuries. This study investigated the types and severity of injuries caused by isolated e-scooter accidents (i.e., those that did not involve colliding with other cars or falling from heights).
Methods
This prospective observational study was conducted from May to December 2021 at our academic tertiary medical center. The demographic data of patients injured in isolated e-scooter–related accidents were collected. All injuries were categorized by body part.
Results
Fifty eligible patients visited our emergency department during the study period. Of these, 76% were categorized as nonemergency, and 62% were discharged after initial evaluation and treatment at the emergency department. Another 10% were admitted to the intensive care unit (ICU) and 18% to the ward, with nine patients receiving at least one operation. The average hospital stays were 2.4 days in the ICU and 9 days in the ward. One death occurred due to traumatic brain injury (overall mortality rate, 2%). Multiple fractures of the left third through ninth ribs combined with lung laceration and fractures of T12 and L4 were noted.
Conclusions
Various types and severities of injuries can occur in isolated e-scooter accidents. While most such injuries are minor, some will require ICU admission or surgery, and deaths can occur. Physicians should not underestimate the severity of such injuries.
Summary
Impact of obesity on the severity of trauma in patients injured in pedestrian traffic accidents
Pillsung Oh, Jin-Seong Cho, Jae Ho Jang, Jae Yeon Choi, Woo Sung Choi, Byungchul Yu
J Trauma Inj. 2022;35(4):240-247.   Published online December 8, 2021
DOI: https://doi.org/10.20408/jti.2021.0050
  • 14,511 View
  • 108 Download
  • 2 Citations
AbstractAbstract PDF
Purpose
Studies on the relationship between obesity and injuries, especially those sustained in pedestrian traffic accidents, are lacking. We aimed to assess the effects of obesity on the severity of injury at the time of admission to the emergency room in patients who experienced pedestrian traffic accidents.
Methods
This study included trauma patients registered in the Korean Trauma Database from July 1, 2018 to December 31, 2020, whose mechanism of injury was pedestrian traffic accidents and who were treated at a single institution. Those aged below 15 years were excluded. Patients were assigned to nonobese and obese groups based on a body mass index of 25 kg/m². An Injury Severity Score of 25 or greater was considered to indicate a critical injury.
Results
In total, 679 cases of pedestrian traffic accidents were registered during the study period, and 543 patients were included in the final analysis. Of them, 360 patients (66.3%) and 183 patients (33.7%) were categorized as nonobese and obese, respectively. The median age was significantly higher in the nonobese group than in the obese group (60 vs. 58 years). Multivariate analysis demonstrated that the odds ratio for critical injury in obese patients was 1.59 (95% confidence interval, 1.01–2.48) compared with nonobese patients.
Conclusions
Obesity affected the likelihood of sustaining severe injuries in pedestrian traffic accidents. Future studies should analyze the effects of body mass index on the pattern and severity of injuries in patients with more diverse injury mechanisms using large-scale data.
Summary

Citations

Citations to this article as recorded by  
  • 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
    Journal of Trauma and Injury.2023; 36(2): 121.     CrossRef
  • Pregnancy is associated with more severe injuries from motor vehicle crashes
    Ya-Hui Chang, Yu-Wen Chien, Chiung-Hsin Chang, Ping-Ling Chen, Tsung-Hsueh Lu, Chung-Yi Li
    Journal of the Formosan Medical Association.2023;[Epub]     CrossRef
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
  • 2,144 View
  • 73 Download
  • 1 Citations
AbstractAbstract 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

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  • Tertiary Trauma Survey on Emergency Department Observational Units: A Systematic Literature Review
    Tamkeen Pervez, Mehreen Malik
    Cureus.2024;[Epub]     CrossRef
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
  • 1,413 View
  • 49 Download
AbstractAbstract 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
Plastic surgery in a trauma center: a multidisciplinary approach for polytrauma patients
Kyung-Chul Moon, Yu-Kyeong Yun
J Trauma Inj. 2022;35(4):261-267.   Published online December 10, 2021
DOI: https://doi.org/10.20408/jti.2021.0086
  • 3,014 View
  • 75 Download
  • 1 Citations
AbstractAbstract PDF
Purpose
With the increasing number of polytrauma patients treated at high-level trauma centers, plastic surgery has entered the specialty of traumatology. Plastic surgeons specialize in the simultaneous surgical care of patients with facial or hand trauma and soft tissue injuries requiring microsurgery. The purpose of this study was to introduce the role of plastic surgery in a high-level trauma center.
Methods
Between January 2020 and December 2020, 5,712 patients with traumatic injuries were admitted to the emergency department of a tertiary hospital. Of these 5,712 patients, 1,578 patients were hospitalized for surgical treatment and/or critical care. Among the 1,578 hospitalized trauma patients, 551 patients (35%) required at least one plastic surgery procedure. The patient variables included age, sex, etiology, the injured area, and injury characteristics. We also retrospectively investigated surgical data such as the duration of the operation, hospital stay, length of time from injury to surgery, and collaboration with other departments.
Results
The most common injury referred to plastic surgery was facial trauma (41%), followed by hand trauma (36%), and soft tissue injuries requiring microsurgery in various parts of the body other than the hand (7%). The majority of facial and hand traumas were concomitant injuries. Sixteen percent of patients underwent collaborative surgical management for polytrauma involving both plastic surgery and another department.
Conclusions
The role of plastic surgery in multidisciplinary teams at high-level trauma centers has become increasingly important. The results of this study may help in the development of multidisciplinary trauma team strategies and future workforce planning.
Summary

Citations

Citations to this article as recorded by  
  • Interdisziplinäres Extremitäten-Board in der Behandlung von Komplexverletzungen
    T. Omar Pacha, P. Mommsen, V. Brauckmann, G. Aktas, M. Krempec, B. Wilhelmi, J.-D. Clausen, V. März, N. Krezdorn, P. M. Vogt, S. Sehmisch, J. B. Hinrichs, J. Ernst
    Die Unfallchirurgie.2023; 126(3): 175.     CrossRef
Outcomes after rib fractures: more complex than a single number
Kristin P. Colling, Tyler Goettl, Melissa L. Harry
J Trauma Inj. 2022;35(4):268-276.   Published online August 5, 2022
DOI: https://doi.org/10.20408/jti.2021.0096
  • 2,611 View
  • 77 Download
AbstractAbstract PDF
Purpose
Rib fractures are common injuries that can lead to morbidity and mortality.
Methods
Data on all patients with rib fractures admitted to a single trauma center between January 1, 2008 and December 31, 2018 were reviewed.
Results
A total of 1,671 admissions for rib fracture were examined. Patients’ median age was 57 years, the median Injury Severity Score (ISS) was 14, and the median number of fractured ribs was three. The in-hospital mortality rate was 4%. Age, the number of rib fractures, and Charlson Comorbidity Index scores were poor predictors of mortality, while the ISS was a slightly better predictor, with area under the receiver operating characteristic curve values of 0.60, 0.55, 0.58, and 0.74, respectively. Multivariate regression showed that age, ISS, and Charlson Comorbidity Index score, but not the number of rib fractures, were associated with significantly elevated adjusted odds ratios for mortality (1.03, 1.14, and 1.28, respectively).
Conclusions
Age, ISS, and comorbidities were independently associated with the risk of mortality; however, they were not accurate predictors of death. The factors associated with rib fracture mortality are complex and cannot be explained by a single variable. Interventions to improve outcomes must be multifaceted.
Summary
Case Reports
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
  • 1,864 View
  • 55 Download
AbstractAbstract 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
A case report of complete cricotracheal separation: an experience from the east coast of Malaysia
Atikah Rozhan, Adam Mohamad, Khairul Azhar M. Rajet, Mohd Zaki Ahmad, Suhaimi Bin Yusof, Wan Emelda Wan Mohamed, Bathma Devi Susibalan, Nik Mohd Syukra Nik Abd Ghani, Zamzil Amin Bin Asha’ari
J Trauma Inj. 2022;35(4):282-286.   Published online May 26, 2022
DOI: https://doi.org/10.20408/jti.2021.0071
  • 2,185 View
  • 55 Download
AbstractAbstract PDF
Complete cricotracheal separation, which is the most severe type of laryngeal trauma, is an uncommonly seen injury that clinicians have limited experience in managing. However, it is potentially fatal. Due to limited exposure to this condition, mismanagement can occur, which may further aggravate the patient’s condition. The most crucial part of managing this injury is to establish a secure airway. Tracheostomy under local anesthesia is the preferred method of airway stabilization, in order to avoid further injuries to the airway caused by endotracheal intubation. Here, we discuss the management of complete cricotracheal separation based on a case experienced in the east coast region of Malaysia, where this type of injury is rarely encountered.
Summary
Gastric necrosis after gastric artery embolization in a patient with blunt abdominal trauma: a case report
Gil Hwan Kim, Sung Jin Park, Chan Ik Park
J Trauma Inj. 2022;35(4):287-290.   Published online December 20, 2022
DOI: https://doi.org/10.20408/jti.2022.0054
  • 1,362 View
  • 34 Download
AbstractAbstract PDF
Gastric artery bleeding after blunt trauma is rare. In such cases, if vital signs are stable, angiographic embolization may be performed. Although gastric artery embolization is known to be safe due to its anatomical properties, complications may occur. We report a case of gastric necrosis after gastric artery embolization in a patient with blunt abdominal trauma. The 55-year-old male patient was found with gastric arterial bleeding after a traffic accident. His vital signs were stable, and gastric artery embolization was performed. Gastric necrosis was subsequently found, which was treated surgically.
Summary
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
  • 1,870 View
  • 39 Download
AbstractAbstract 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

J Trauma Inj : Journal of Trauma and Injury