Journal of Trauma and Injury

Volume 36(2); June 2023

Editorial

Near-death experiences in 19th century Korean tales: Kun Hwang; J Trauma Inj. 2023;36(2):75-77. Published online August 5, 2022; DOI: https://doi.org/10.20408/jti.2022.0020

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PDF: Summary

Original Articles

Quality monitoring of resuscitative endovascular balloon occlusion of the aorta using cumulative sum analysis in Korea: a case series: Hyunsik Choi, Joongsuck Kim, Kwanghee Yeo, Ohsang Kwon, Kyounghwan Kim, Wu Seong Kang; J Trauma Inj. 2023;36(2):78-86. Published online December 21, 2022; DOI: https://doi.org/10.20408/jti.2022.0069

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2 Citations

Abstract PDF

Purpose
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a state-of-the-art lifesaving procedure. However, due to its high mortality and morbidity, including ischemia and reperfusion injury, well-trained medical staff and effective systems are needed. This study was conducted to investigate the learning curve for REBOA.
Methods
To monitor this learning curve, we used cumulative sum (CUSUM) analysis and graphs of mortality and aortic occlusion time within 60, 90, and 120 minutes for consecutive patients. The procedures performed between July 2017 and June 2021 were divided into pre-trauma center (pre-TC; July 2017–February 2020) and TC (February 2020–June 2021) periods.
Results
REBOA was performed for 31 consecutive patients with trauma. The pre-TC (n=12) and TC (n=19) periods did not differ significantly with regard to Injury Severity Score, age, injury mechanism, initial systolic blood pressure, prehospital cardiopulmonary resuscitation (CPR), or CPR in the emergency department. At the 17th consecutive patient during the TC period, CUSUM failure graphs for mortality and aortic occlusion time exhibited a downward inflection, indicating an improvement in performance.
Conclusions
The mortality and aortic occlusion time of REBOA improved, and these parameters can be monitored using CUSUM analysis at the hospital level.

Summary

Citations

Citations to this article as recorded by

Emergency department laparotomy for patients with severe abdominal trauma: a retrospective study at a single regional trauma center in Korea
Yu Jin Lee, Soon Tak Jeong, Joongsuck Kim, Kwanghee Yeo, Ohsang Kwon, Kyounghwan Kim, Sung Jin Park, Jihun Gwak, Wu Seong Kang
Journal of Trauma and Injury.2024; 37(1): 20. CrossRef
Nonselective versus Selective Angioembolization for Trauma Patients with Pelvic Injuries Accompanied by Hemorrhage: A Meta-Analysis
Hyunseok Jang, Soon Tak Jeong, Yun Chul Park, Wu Seong Kang
Medicina.2023; 59(8): 1492. CrossRef

Effect of use and type of helmet on occurrence of traumatic brain injuries in motorcycle riders in Korea: a retrospective cohort study: Sowon Seo, Seok Ran Yeom, Sung-Wook Park, Il Jae Wang, Suck Ju Cho, Wook Tae Yang, Youngmo Cho; J Trauma Inj. 2023;36(2):87-97. Published online December 9, 2022; DOI: https://doi.org/10.20408/jti.2022.0029

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Abstract PDF Supplementary Material: Purpose
The purpose of this study was to investigate (1) the association among helmet wearing, incidence rate of traumatic brain injury (TBI), and in-hospital mortality; TBI was diagnosed when the head Abbreviated Injury Scale (AIS) was ≥1, and as severe TBI when head AIS was ≥3; and (2) the association between helmet type and incidence rate of TBI, severe TBI, and in-hospital mortality of motorcycle accidents based on the newly revised Emergency Department-based Injury In-depth Surveillance (EDIIS) data.
Methods
Data collected from EDIIS between January 1, 2020 and December 31, 2020 were analyzed. The final study population comprised 1,910 patients, who were divided into two groups: helmet wearing group and unhelmeted group. In addition, the correlation between helmet type and motorcycle accident was determined in 596 patients who knew the exact type of helmet they wore. A total of 710 patients who wore helmet but did not know the type were excluded from this analysis. Multivariate logistic regression was performed in both the groups to investigate the factors affecting the primary (occurrence of TBIs) and secondary outcomes (severe TBI and in-hospital mortality).
Results
The prevalence of Injury Severity Scores, TBIs, and severe TBIs as well as in-hospital mortality were the highest in the unhelmeted group. Additionally, the results from the group that wore and knew the type of helmet worn indicated that wearing a full-face helmet decreased the incidence of TBIs in comparison to a half-face helmet.
Conclusions
The wearing of a helmet in motorcycle accidents is very important as it plays a role in reducing the occurrence of TBIs and severe TBIs and in-hospital mortality. The use of a full-face helmet lowered the incidence of TBIs.; Summary

Thoracolumbar spine fracture patterns, etiologies, and treatment modalities in Jordan: Ahmad Almigdad, Sattam Alazaydeh, Mohammad Bani Mustafa, Mu'men Alshawish, Anas Al Abdallat; J Trauma Inj. 2023;36(2):98-104. Published online April 14, 2023; DOI: https://doi.org/10.20408/jti.2022.0068

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Abstract PDF: Purpose
Spine fractures are a significant cause of long-term disability and socioeconomic burden. The incidence of spine fractures tends to increase with age, decreased bone density, and fall risk. In this study, we evaluated thoracolumbar fractures at a tertiary hospital in Jordan regarding their frequency, etiology, patterns, and treatment modalities.
Methods
The clinical and radiological records of 469 patients with thoracolumbar fractures admitted to the Royal Medical Services from July 2018 to August 2022 were evaluated regarding patients’ age, sex, mechanism of injury, fracture level and pattern, and treatment modalities.
Results
The mean age of patients was 51.24±20.22 years, and men represented 52.3%. Compression injuries accounted for 97.2% of thoracolumbar fractures, and the thoracolumbar junction was the most common fracture location. Falling from the ground level was the most common mechanism and accounted for half of the injuries. Associated neurological injuries were identified in 3.8% of patients and were more common in younger patients. Pathological fractures were found in 12.4% and were more prevalent among elderly patients and women.
Conclusions
Traffic accidents and falling from height were the most common causes of spine fractures in patients younger than 40. However, 70% of spine fractures in women were caused by simple falls, reflecting the high prevalence of osteoporosis among women and the elderly. Therefore, traffic and work safety measures, as well as home safety measures and osteoporosis treatment for the elderly, should be recommended to reduce the risk of spine fractures.; Summary

Experience of surgical treatments for abdominal inferior vena cava injuries in a regional trauma center in Korea: Jin Woo Park, Dong Hun Kim; J Trauma Inj. 2023;36(2):105-113. Published online June 15, 2023; DOI: https://doi.org/10.20408/jti.2023.0001

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Abstract PDF: Purpose
Inferior vena cava (IVC) injuries are a rare type of traumatic abdominal injuries that are challenging to treat and have a very high mortality rate. This study described our experience with the surgical treatment of traumatic IVC injuries, and we investigated the demographics, clinical profiles, and surgical outcomes of cases at a regional trauma center.
Methods
Among the 16 patients who were treated for a traumatic IVC injury between January 2014 and March 2022, 14 underwent surgery. The surgical outcomes included overall mortality and 24-hour mortality, and we investigated the factors associated with these surgical outcomes. The 14 patients were divided into two groups according to the location of the IVC injury (retrohepatic IVC or higher vs. subhepatic IVC), and differences between the two groups were analyzed.
Results
A body mass index (BMI) >23.0 kg/m2 (P=0.046), an elevated serum lactate level (P=0.043), and a shorter operation time (P=0.016) were associated with overall mortality. A higher BMI (P=0.050), high serum lactate level (P=0.004), shorter operation time (P=0.005), and an injury at the retrohepatic IVC or higher level (P=0.031) were associated with 24-hour mortality. Younger age (P=0.028), higher BMI (P=0.005), an acidic pH (P=0.028), high lactatemia (P=0.012), a higher hemoglobin level (P=0.012), and shorter door-to-operating room time (P=0.028) were associated with injury at the retrohepatic IVC or higher level. Patients with subhepatic IVC injuries had a high rate of direct repair (75.0%) and a significantly lower 24-hour mortality rate (37.5%, P=0.031).
Conclusions
Subhepatic IVC injuries are easy to access and are usually treated with a direct repair method. Injuries at the retrohepatic IVC or higher level are difficult to treat surgically and require a systematic and multidisciplinary treatment strategy.; Summary

The practicality of interleukin-6 in prognosis of blunt chest trauma in Korea: a retrospective study: Jeong Woo Oh, Tae Yeon Lee, Minjeong Chae; J Trauma Inj. 2023;36(2):114-120. Published online December 8, 2022; DOI: https://doi.org/10.20408/jti.2022.0050

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Abstract PDF: Purpose
There are many studies on the practicality of interleukin-6 (IL-6) as a prognostic predictor in patients with multiple severe traumas. However, few studies focus on the practicality of IL-6 in patients with chest trauma. So, this study investigated whether IL-6 is effective as a prognostic factor in patients with blunt chest trauma.
Methods
A total of 44 blunt chest trauma patients who visited the regional trauma center from July to December 2021 were included in this retrospective study. Blood IL-6 levels were measured immediately after emergency room admittance (IL-6 E) and 24 hours after trauma (IL-6 24). To determine whether IL-6 levels can predict the clinical course and prognosis of patients with blunt chest trauma, the correlation between IL-6 (IL-6 E and IL-6 24) and the trauma score system, Injury Severity Score, Thoracic Trauma Severity Score, and Pulmonary Contusion Score, intensive care unit (ICU) stay period, and total hospitalization period were analyzed.
Results
IL-6 E showed a good correlation with Injury Severity Score (P=0.505), Thoracic Trauma Severity Score (P=0.597), Pulmonary Contusion Score (P=0.493), ICU stay period (P=0.762), and total hospitalization period (P=0.662). However, IL-6 24 had a relatively low correlation compared to IL-6 E. Therefore, IL-6 E showed useful results for predicting the prognosis of patients with blunt chest trauma.
Conclusions
Early plasma IL-6 levels (IL-6 E) can predict the injury severity of blunt chest trauma, length of ICU stay, and total hospitalization period.; Summary

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; J Trauma Inj. 2023;36(2):121-127. Published online September 19, 2022; DOI: https://doi.org/10.20408/jti.2022.0031

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Abstract PDF: Purpose
Recently, a sharp increase in the use of delivery services has led to an increase in motorcycle accidents. This study aimed to identify the characteristics of the commercial motorcycle injured patients and factors related to the severity during the past 10 years.
Methods
Patients (15–64 years old) who visited the emergency department with commercial motorcycle accidents injury registered in the Korean Emergency Department-based Injury In-depth Surveillance (2011–2020) database, were included. All included cases were categorized into two groups according to the period: group 1 (2011–2015) and group 2 (2016–2020). General characteristics and the factors associated with severity were investigated.
Results
Among 8,123 emergency department visits, patients in group 1 were 3,071, and patients in group 2 were 5,052. The odds for severity were affected by patients age (odds ratio [OR], 1.008; 95% confidence interval [CI], 1.004–1.013), and overnight/morning (00:00–12:00; OR, 1.243; 95% CI, 1.091–1.415). The odds for severity were higher in head and neck injury (OR, 8.357; 95% CI, 7.410–9.424) and torso injury (OR, 4.122; 95% CI, 3.610–4.708). The odds for the severity of accidents based on excess mortality ratio-adjusted Injury Severity Score (EMR-ISS) after 2015 were significant (OR, 1.491; 95% CI, 1.318–1.687). Hospitalization in the intensive care unit and death were associated with accidents after 2015 (OR, 2.593; 95% CI, 2.120–3.170).
Conclusions
Commercial motorcycle accidents have increased significantly over the past decade. There were statistical differences in severity based on EMR-ISS and the hospitalization in intensive care unit and death.; Summary

Case Reports

Submental intubation using laparoscopic trocar in zygomaticomaxillary complex fracture surgery in Korea: a case report: Hyejin Do, Chunui Lee, Hyeon Don Hong, Hyejin Hong, Hyun Kyo Lim, Sujin Kim; J Trauma Inj. 2023;36(2):128-132. Published online December 21, 2022; DOI: https://doi.org/10.20408/jti.2022.0036

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Abstract PDF: Submental intubation is an effective alternative technique for airway management in patients with maxillofacial trauma. Compared with tracheostomy, it is less invasive, but has risks associated with potential airway compromise such as hypoxia due to tube obstruction, collapse, and kinking. To shorten procedure time and ensure a reinforced tube lumen, we used a laparoscopic trocar as a new device for submental intubation. A 54-year-old male patient sustained a zygomaticomaxillary complex fracture and was scheduled to undergo open reduction and internal fixation. We performed intraoral intubation and made a small 1-cm incision at the submandibular midline. After dissection of the tissue from the incision site, a reinforced tube was passed using a 12-mm laparoscopic trocar. The procedure took about 5 minutes, and apnea time from disconnecting the breathing circuit and passing through the internal lumen of the trocar until it was reconnected to the ventilator was 1 minute 5 seconds. Using a laparoscopic trocar for submental intubation can reduce the time required for dissection, prevent luminal occlusion complications due to soft tissues or blood clots in the endotracheal tube, and decrease soft tissue damage.; Summary

Sphenoid sinus foreign body following airbag deployment in the United States: a case report: Birk J. Olson, Joseph B. Vella, Justin P. McCormick; J Trauma Inj. 2023;36(2):133-136. Published online August 16, 2022; DOI: https://doi.org/10.20408/jti.2022.0030

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Abstract PDF: We report a unique case of penetrating foreign bodies following a motor vehicle accident with airbag deployment. The patient presented with evidence of facial trauma and was found to have three retained foreign bodies on imaging. Notably, one foreign body was within the sphenoid sinus. This foreign body was removed uneventfully through endoscopic sinus surgery. The patient was doing well at follow-up visits. We concluded that the foreign bodies were steering wheel accessories, which detached upon airbag deployment and penetrated the patient’s face. This case report is intended to inform the public regarding the dangers of placing accessories on a steering wheel.; Summary

External iliac artery injury with posterior pelvic ring injury in Korea: a report of two cases: Joosuk Ahn, Ji Wan Kim; J Trauma Inj. 2023;36(2):137-141. Published online December 1, 2022; DOI: https://doi.org/10.20408/jti.2022.0046

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Abstract PDF: Pelvic ring injuries associated with external iliac artery injuries are rare and may be life-threatening condition. The most important factors in the managements are the immediate bleeding control and restoration of distal blood flow. We report two cases of pelvic ring injuries with external artery injuries. One case was occlusion of external iliac artery with concomitant rupture of internal iliac artery. The other case was ruptured external iliac artery. Every surgeon must understand the possibility of hidden lesions—for example, arterial rupture and thrombus—and should consider the need for embolization or thrombectomy when treating this type of injury.; Summary

Delayed diagnosis of popliteal artery injury after traumatic knee dislocation in Korea: a case report: Chung-Eun Lee, In-Seok Jang, Sang-Yoon Song, Jung-Woo Lim, Kun-Tae Kim; J Trauma Inj. 2023;36(2):142-146. Published online December 6, 2022; DOI: https://doi.org/10.20408/jti.2022.0064

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Abstract PDF: The popliteal artery damage is present to range from 1.6% to 64% of patients with knee dislocation, and it is crucial to evaluate vascular damage even if there are no prominent ischemic changes in the distal area. The injury of the popliteal artery by high-energy forces around the knee caused by a fall or traffic accident is a potentially limb-threatening complication in traumatic knee dislocation. The popliteal artery injury by blunt trauma has a high risk of limb amputation because the initial symptoms can show normal vascular circulation without urgent ischemia or obvious vascular injury signs. Since the collateral branches can delay the symptoms of decisive ischemia or pulseless extremity, the vascular damage is a major cause of limb amputation. In the present study, we describe a rare case of delayed diagnosis of popliteal artery injury after traumatic knee dislocation, requiring urgent limb revascularization surgery. After revascularization of the occluded popliteal artery, graft interposition was performed, and successful restoration was confirmed. This case illustrates that, even if ankle-brachial index >0.9 or equal pedal pulse to the uninjured extremity, serial vascular evaluation is required if there are soft signs such as diminished pulses, neurologic signs, or high-energy damage such as multiple ligament ruptures since delayed diagnosis of artery injury can be the major cause of limb amputation. The clinicians need to regard high-energy trauma such as multiple ligament rupture around the knee as a hard sign, and immediate computed tomography angiography can be helpful for accurate diagnosis and treatment.; Summary

Management of a traumatic avulsion fracture of the occipital condyle in polytrauma patient in Korea: a case report: Chang Hwa Ham, Woo-Keun Kwon, Joo Han Kim, Youn-Kwan Park, Jong Hyun Kim; J Trauma Inj. 2023;36(2):147-151. Published online December 8, 2022; DOI: https://doi.org/10.20408/jti.2022.0058

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Abstract PDF: Avulsion fracture of the occipital condyle are rare lesion at craniovertebral junction. It is often related to high-energy traumatic injuries and show diverse clinical presentations. Neurologic deficit and instabilities may justify surgical treatment. However, the integrity of neurovascular structures is undervalued in the current literatures. In this case report, we described a 26-year-old female patient with avulsion fracture of occipital condyle following a traffic accident. On initial presentation, her Glasgow Coma Scale was 8. She presented with fracture compound comminuted depressed, on the left side of her forehead with skull base fracture extending into clivus and occipital condyle. Her left occipital condyle showed avulsion injury with displacement deep into the skull base. On her computed tomography angiography, the displaced occipital condyle compressed on the sigmoid sinus resulting in its obstruction. While she was recovering her consciousness during her stay in the hospital, the lower cranial nerves showed dysfunctions corresponding to Collet-Sicard syndrome. Due to high risk of vascular injury, the patient was conservatively treated for the occipital condyle fracture. On the 4 months postdischarge follow-up, her cranial nerve symptoms practically recovered, and the occipital condyle showed signs of fusion without further displacement. Current literatures focus on neurologic deficit and stability for the surgical decisions. However, it is also important to evaluate the neurovascular integrity to assess the risk of its manipulation as it may result in fatal outcome. This case shows, an unstable avulsion occipital condyle fracture with neurologic deficit can be treated conservatively and show a favorable outcome.; Summary

Delayed open abdomen closure using a combination of acellular dermal matrix and skin graft in Korea: a case report: Yoonseob Kim, Tae Ah Kim, Hyung Min Hahn, Byung Hee Kang; J Trauma Inj. 2023;36(2):152-156. Published online November 4, 2022; DOI: https://doi.org/10.20408/jti.2022.0024

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Abstract PDF: Delayed closure of an open abdomen (OA) is a clinically challenging task despite its various modalities. It is substantially more difficult when the duration of OA treatment is prolonged due to a patient’s condition. We introduced the management of a patient who had a delayed OA treatment spanning approximately 3 months due to severe abdominal contamination. The 64-year-old male patient had an injured pelvis pressed by a road roller. After visiting a trauma center, the patient initially underwent damage control surgery and OA management; however, early primary abdominal closure failed due to severe peritonitis. After negative pressure wound therapy for several months, an acellular dermal matrix graft followed by a skin graft were successfully used as treatments. A combination of acellular dermal matrix graft, negative pressure wound therapy, and skin graft techniques is a considerable management sequence for patients subjected to delayed OA treatment.; Summary

Endovascular treatment of traumatic iliac venous injury combined with phlegmasia cerulea dolens in Korea: a case report: Suyoung Park, Jeong Ho Kim, Jung Han Hwang, Jayun Cho; J Trauma Inj. 2023;36(2):157-160. Published online December 1, 2022; DOI: https://doi.org/10.20408/jti.2022.0039

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Abstract PDF: Traumatic iliac venous injury is rare but can be fatal. Although surgical management is considered a primary treatment method, urgent treatment is required when deep venous thrombosis and subsequent phlegmasia cerulea dolens is combined. It is difficult to treat by surgical management, and pharmaceutic thrombolysis cannot be applied due to the trauma history. Here, we describe a case of unilateral traumatic iliac venous injury and subsequent diffuse venous thrombosis in the affected iliofemoral and infrapopliteal veins, combined with phlegmasia cerulea dolens, treated with endovascular management, including bare metal stent insertion and aspiration thrombectomy.; Summary

Spontaneous recanalization of complete urethral injury treated by suprapubic cystostomy alone after severe pelvic bone fracture in a young male in Korea: a case report: Han Kyul Shin, Gi Ho Moon, Sung Yub Jeong, Ho Jun Lee; J Trauma Inj. 2023;36(2):161-164. Published online December 2, 2022; DOI: https://doi.org/10.20408/jti.2022.0056

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Abstract PDF: Injury to the genitourinary tract is rare, with an incidence of less than 1%. Younger men (mean age, approximately 30 years) are predominantly affected. We introduce an unusual case of a 25-year-old male patient with complete urethral injury combined with a severe open pelvic bone fracture. During the emergency surgery, the primary realignment of the posterior urethra could not be performed due to a large defect. With suprapubic cystostomy alone, follow-up voiding cystourethrography showed spontaneous recanalization of the transected urethra after four months. Suprapubic cystostomy is an efficient treatment option when primary realignment is not possible.; Summary

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