Journal of Trauma and Injury

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Original Articles

Major Causes of Preventable Death in Trauma Patients: Youngeun Park, Gil Jae Lee, Min A Lee, Kang Kook Choi, Jihun Gwak, Sung Youl Hyun, Yang Bin Jeon, Yong-Cheol Yoon, Jungnam Lee, Byungchul Yu; J Trauma Inj. 2021;34(4):225-232. Published online July 29, 2021; DOI: https://doi.org/10.20408/jti.2020.0074

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Abstract PDF

Purpose

Trauma is the top cause of death in people under 45 years of age. Deaths from severe trauma can have a negative economic impact due to the loss of people belonging to socio-economically active age groups. Therefore, efforts to reduce the mortality rate of trauma patients are essential. The purpose of this study was to investigate preventable mortality in trauma patients and to identify factors and healthcare-related challenges affecting mortality. Ultimately, these findings will help to improve the quality of trauma care.

Methods

We analyzed the deaths of 411 severe trauma patients who presented to Gachon University Gil Hospital regional trauma center in South Korea from January 2015 to December 2017, using an expert panel review.

Results

The preventable death rate of trauma patients treated at the Gachon University Gil Hospital regional trauma center was 8.0%. Of these, definitely preventable deaths comprised 0.5% and potentially preventable deaths 7.5%. The leading cause of death in trauma patients was traumatic brain injury. Treatment errors most commonly occurred in the intensive care unit (ICU). The most frequent management error was delayed treatment of bleeding.

Conclusions

Most errors in the treatment of trauma patients occurred in early stages of the treatment process and in the ICU. By identifying the main causes of preventable death and errors during the course of treatment, our research will help to reduce the preventable death rate. Appropriate trauma care systems and ongoing education are also needed to reduce preventable deaths from trauma.

Summary

Citations

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Analysis of mortality over 7 years in a mature trauma center: evolution of preventable mortality in severe trauma patients
Sarah Guigues, Jean Cotte, Jean-Baptiste Morvan, Henry de Lesquen, Bertrand Prunet, Mathieu Boutonnet, Nicolas Libert, Pierre Pasquier, Eric Meaudre, Julien Bordes, Michael Cardinale
European Journal of Trauma and Emergency Surgery.2023; 49(3): 1425. CrossRef
Incidence and predictors of mortality among adult trauma patients admitted to the intensive care units of comprehensive specialized hospitals in Northwest Ethiopia
Mengistu Abebe Messelu, Ambaye Dejen Tilahun, Zerko Wako Beko, Hussien Endris, Asnake Gashaw Belayneh, Getayeneh Antehunegn Tesema
European Journal of Medical Research.2023;[Epub] CrossRef
Characteristics and Clinical Outcomes of Elderly Patients with Trauma Treated in a Local Trauma Center
Kwanhoon Park, Geonjae Cho, Sungho Lee, Kang Yoon Lee, Ji Young Jang
Journal of Acute Care Surgery.2023; 13(1): 13. CrossRef
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
Preventable Death Rate of Trauma Patients in a Non-Regional Trauma Center
Kwanhoon Park, Wooram Choi, Sungho Lee, Kang Yoon Lee, Dongbeen Choi, Han-Gil Yoon, Ji Young Jang
Journal of Acute Care Surgery.2023; 13(3): 118. CrossRef
Nine year in-hospital mortality trends in a high-flow level one trauma center in Italy
Elisa Reitano, Roberto Bini, Margherita Difino, Osvaldo Chiara, Stefania Cimbanassi
Updates in Surgery.2022; 74(4): 1445. CrossRef
Decision support by machine learning systems for acute management of severely injured patients: A systematic review
David Baur, Tobias Gehlen, Julian Scherer, David Alexander Back, Serafeim Tsitsilonis, Koroush Kabir, Georg Osterhoff
Frontiers in Surgery.2022;[Epub] CrossRef
Flat Inferior Vena Cava on Computed Tomography for Predicting Shock and Mortality in Trauma: A Meta-Analysis
Do Wan Kim, Hee Seon Yoo, Wu Seong Kang
Diagnostics.2022; 12(12): 2972. CrossRef
Model for Predicting In-Hospital Mortality of Physical Trauma Patients Using Artificial Intelligence Techniques: Nationwide Population-Based Study in Korea
Seungseok Lee, Wu Seong Kang, Sanghyun Seo, Do Wan Kim, Hoon Ko, Joongsuck Kim, Seonghwa Lee, Jinseok Lee
Journal of Medical Internet Research.2022; 24(12): e43757. CrossRef
Thoracic injuries in trauma patients: epidemiology and its influence on mortality
Andrea Lundin, Shahzad K. Akram, Lena Berg, Katarina E. Göransson, Anders Enocson
Scandinavian Journal of Trauma, Resuscitation and .2022;[Epub] CrossRef

Effects of the Coronavirus Disease 2019 (COVID-19) Pandemic on Outcomes among Patients with Polytrauma at a Single Regional Trauma Center in South Korea: Sun Hyun Kim, Dongyeon Ryu, Hohyun Kim, Kangho Lee, Chang Ho Jeon, Hyuk Jin Choi, Jae Hoon Jang, Jae Hun Kim, Seok Ran Yeom; J Trauma Inj. 2021;34(3):155-161. Published online June 4, 2021; DOI: https://doi.org/10.20408/jti.2020.0064

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Abstract PDF

Purpose

The coronavirus disease 2019 (COVID-19) pandemic has necessitated a redistribution of resources to meet hospitals’ service needs. This study investigated the impact of COVID-19 on a regional trauma center in South Korea.

Methods

We retrospectively reviewed cases of polytrauma at a single regional trauma center in South Korea between January 20 and September 30, 2020 (the COVID-19 period) and compared them to cases reported during the same time frame (January 20 to September 30) between 2016 and 2019 (the pre-COVID-19 period). The primary outcome was in-hospital mortality, and secondary outcomes included the number of daily admissions, hospital length of stay (LOS), and intensive care unit (ICU) LOS.

Results

The mean number of daily admissions decreased by 15% during the COVID-19 period (4.0±2.0 vs. 4.7±2.2, p=0.010). There was no difference in mechanisms of injury between the two periods. For patients admitted during the COVID-19 period, the hospital LOS was significantly shorter (10 days [interquartile range (IQR) 4–19 days] vs. 16 days [IQR 8–28 days], p<0.001); however, no significant differences in ICU LOS and mortality were found.

Conclusions

The observations at Regional Trauma Center, Pusan National University Hospital corroborate anecdotal reports that there has been a decline in the number of patients admitted to hospitals during the COVID-19 period. In addition, patients admitted during the COVID-19 pandemic had a significantly shorter hospital LOS than those admitted before the COVID-19 pandemic. These preliminary data warrant validation in larger, multi-center studies.

Summary

Citations

Citations to this article as recorded by

Patientensicherheit bei differenzierter (innerklinischer) Schockraumaktivierung für Schwerverletzte
S. Hagel, K. R. Liedtke, S. Bax, S. Wailke, T. Klüter, P. Behrendt, G. M. Franke, A. Seekamp, P. Langguth, A. Balandin, M. Grünewald, D. Schunk
Die Unfallchirurgie.2023; 126(6): 441. CrossRef
Characteristics of Patients With Traumatic Brain Injury in a Regional Trauma Center: A Single-Center Study
Mahnjeong Ha, Seunghan Yu, Byung Chul Kim, Jung Hwan Lee, Hyuk Jin Choi, Won Ho Cho
Korean Journal of Neurotrauma.2023; 19(1): 6. CrossRef
Changes in Injury Pattern and Outcomes of Trauma Patients after COVID-19 Pandemic: A Retrospective Cohort Study
Myungjin Jang, Mina Lee, Giljae Lee, Jungnam Lee, Kangkook Choi, Byungchul Yu
Healthcare.2023; 11(8): 1074. CrossRef
Análise do atendimento primário de pacientes vítimas de violência interpessoal e autodirigida durante a pandemia da COVID-19
HELOÍSA MORO TEIXEIRA, ANGEL ADRIANY DA-SILVA, ANNE KAROLINE CARDOZO DA-ROCHA, MARIANA ROTHERMEL VALDERRAMA, RAFAELLA STRADIOTTO BERNARDELLI, VITÓRIA WISNIEVSKI MARUCCO SILVA, LUIZ CARLOS VON BAHTEN
Revista do Colégio Brasileiro de Cirurgiões.2023;[Epub] CrossRef
Analysis of primary care of victims of interpersonal and self inflicted violence during the COVID-19 pandemic
HELOÍSA MORO TEIXEIRA, ANGEL ADRIANY DA-SILVA, ANNE KAROLINE CARDOZO DA-ROCHA, MARIANA ROTHERMEL VALDERRAMA, RAFAELLA STRADIOTTO BERNARDELLI, VITÓRIA WISNIEVSKI MARUCCO SILVA, LUIZ CARLOS VON BAHTEN
Revista do Colégio Brasileiro de Cirurgiões.2023;[Epub] CrossRef
Comparison of Clinical Characteristics of Traumatic Brain Injury Patients According to the Mechanism Before and After COVID-19
Jonghyun Sung, Jongwook Choi, Kum Whang, Sung Min Cho, Jongyeon Kim, Seung Jin Lee, Yeon gyu Jang
Korean Journal of Neurotrauma.2023; 19(3): 307. CrossRef
Outcomes improvement despite continuous visits of severely injured patients during the COVID-19 outbreak: experience at a regional trauma centre in South Korea
Sooyeon Kang, Ji Eun Park, Ji Wool Ko, Myoung Jun Kim, Young Un Choi, Hongjin Shim, Keum Seok Bae, Kwangmin Kim
BMC Emergency Medicine.2022;[Epub] CrossRef
Impact of the COVID-19 pandemic on the epidemiology of traffic accidents: a cross-sectional study
ANGEL ADRIANY DA SILVA, GABRIELA REDIVO STRÖHER, HELOÍSA MORO TEIXEIRA, MARIA VICTÓRIA GUTIERREZ CORDEIRO, MARCIA OLANDOSKI, LUIZ CARLOS VON-BAHTEN
Revista do Colégio Brasileiro de Cirurgiões.2022;[Epub] CrossRef
Impacto da pandemia da COVID-19 na epidemiologia dos acidentes de trânsito: um estudo transversal
ANGEL ADRIANY DA SILVA, GABRIELA REDIVO STRÖHER, HELOÍSA MORO TEIXEIRA, MARIA VICTÓRIA GUTIERREZ CORDEIRO, MARCIA OLANDOSKI, LUIZ CARLOS VON-BAHTEN
Revista do Colégio Brasileiro de Cirurgiões.2022;[Epub] CrossRef

Epidemiology of Facial Bone Fractures During the Coronavirus Disease 2019 Pandemic: A Single Korean Level I Trauma Center Study: Min Ji Kim, Kyung Min Yang, Hyoseob Lim; J Trauma Inj. 2021;34(4):233-241. Published online December 24, 2021; DOI: https://doi.org/10.20408/jti.2021.0098

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Abstract PDF

Purpose

The medical community has been heavily impacted by the coronavirus disease 2019 pandemic. The management of facial trauma patients has been affected by the patient capacity of emergency rooms. In this study, we share our experiences of facial trauma management during the social lockdown period and investigate the epidemiological changes in facial bone fractures.

Methods

A total of 997 patients who presented to Ajou University Hospital Emergency Center and were evaluated by plastic or maxillofacial surgeons for facial trauma were included in this retrospective study. Our study design was a comparative study of two groups: the 2019 group (control) and the 2020 group (the experimental group that experienced social lockdown).

Results

The total number of emergency room inpatients reflected the national pandemic trends with three peaks in patient numbers. According to these trends, facial bone fractures had two different low points in August 2020 and December 2020. A comparison of the 2019 and 2020 facial bone fractures did not show a statistically significant difference in the total number of patients. An analysis of the causes of trauma showed that domestic accidents increased in 2020 (30.92%; p<0.001). Among the anatomical sites of facial injury in surgical patients, the frontozygomatic complex fracture increased the most in 2020 (p=0.018). Facial injuries with two separate sites of injury or with three or more involved sites also showed a significant increase in 2020 (p<0.001).

Conclusions

We demonstrated that the incidence of facial trauma patients correlated with the incidence of patients presenting to the emergency department and that facial trauma is inextricably related to multi-trauma cases. Domestic accidents and facial trauma with multiple anatomically involved sites are increasing trends that need more attention.

Summary

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Changes in Injury Pattern and Outcomes of Trauma Patients after COVID-19 Pandemic: A Retrospective Cohort Study
Myungjin Jang, Mina Lee, Giljae Lee, Jungnam Lee, Kangkook Choi, Byungchul Yu
Healthcare.2023; 11(8): 1074. CrossRef
The Trend of Change in Oral and Maxillofacial Injuries of Pediatric Patients in the COVID-19 Pandemic: a Regional Emergency Medical Center and Dental Hospital Study
Suebin Choi, Chankue Park, Jonghyun Shin, Taesung Kim, Eungyung Lee
THE JOURNAL OF THE KOREAN ACADEMY OF PEDTATRIC DEN.2023; 50(3): 318. CrossRef

Case Report

Non-Permanent Transcatheter Proximal Renal Artery Embolization for a Grade 5 Renal Injury with Delayed Recanalization and Preserved Renal Parenchymal Enhancement: Abhishek Jairam, Bradley King, Zachary Berman, Gerant Rivera-Sanfeliz; J Trauma Inj. 2021;34(3):198-202. Published online September 30, 2021; DOI: https://doi.org/10.20408/jti.2020.0075

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Abstract PDF

Super-selective renal artery embolization is an increasingly popular technique for the management of traumatic, low-grade renal trauma. When performed in distal arterial branches, this intervention enables tissue preservation and arrest of hemorrhage, but it may not be practical in cases of multifocal, high-grade renal injuries. In such cases, surgical nephrectomy remains the more common treatment modality to ensure hemodynamic control. We present the unique case of a patient who presented in hemorrhagic shock following a major trauma that resulted in a grade 5 renal injury treated with complete renal artery embolization using Gelfoam, resulting in hemodynamic stabilization. Interestingly, imaging 1 month after embolization revealed residual enhancement of the inferior pole of the kidney, suggesting reconstitution of flow and partial renal salvage. Ultimately, transcatheter “nephrectomy” with careful selection of a temporary embolic agent may serve as a safe and efficient alternative to surgical nephrectomy with the added possibility of preserving partial renal perfusion and function in the emergent setting.

Summary

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Salvation of a solitary kidney in a patient with grade IV renal trauma: a case report
Hyuntack Shin, Ae Jin Sung, Min A Lee, Jayun Cho, Gil Jae Lee, Byungchul Yu, Kang Kook Choi
Journal of Trauma and Injury.2022; 35(Suppl 1): S18. CrossRef
The Role of Renal Artery Embolisation in the Management of Blunt Renal Injuries: A Review
Rosemary Denning Ho, Vivek Shrivastava, Amir Mokhtari, Raghuram Lakshminarayan
Vascular and Endovascular Review.2022;[Epub] CrossRef

Original Articles

Comparative Evaluation of Emergency Medical Service Trauma Patient Transportation Patterns Before and After Level 1 Regional Trauma Center Establishment: A Retrospective Single-Center Study: Hyeong Seok Lee, Won Young Sung, Jang Young Lee, Won Suk Lee, Sang Won Seo; J Trauma Inj. 2021;34(2):87-97. Published online March 24, 2021; DOI: https://doi.org/10.20408/jti.2020.0021

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Abstract PDF

Purpose

This study examined emergency medical service (EMS) transportation patterns for adult trauma patients before and after establishing a level 1 regional trauma center (RTC) and to evaluate the transportation approach after prehospital severity screening.

Methods

This was a retrospective observational study of trauma patients aged ≥18 years admitted via EMS to the emergency department or a level 1 RTC, 1 year before to 3 years after RTC establishment. Patients with an Injury Severity Score (ISS) in the patient registration system were selected. Analyses were performed to determine transportation pattern changes by comparing patients pre- and post-RTC establishment and by yearly comparisons over the 4-year study period using the Mann-Whitney U test and chi-square test.

Results

Overall, 3,587 patients were included. The mean ISS was higher in the post-RTC group (n=2,693; 10.63±8.90, median 9.00) than in the pre-RTC group (n=894; 9.44±8.20, median 8.00; p<0.001). The mean transportation distance (9.84±13.71, median 5.80 vs. 13.12±16.15 km, median 6.00; p<0.001) was longer in the post-RTC group than in the pre-RTC group. Furthermore, proportionally fewer patients were transported from an area in the same city as the RTC after establishment (86.1% vs. 78.3%; p<0.001). Yearly comparisons revealed a gradually increasing trend in the hospital death rate (p_trend=0.031).

Conclusions

After establishing a level 1 RTC, the EMS transportation of severe trauma patients increased gradually along with the long-distance transportation of minor trauma patients. Therefore, improved prehospital EMS trauma severity assessments and level 1 RTC involvement in patient classification in the prehospital phase are necessary.

Summary

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Establishment of Emergency Teaching Model and Optimization of Discrete Dynamic Calculation in Complex Virtual Simulation Environment
He Li, Yuansong Sun, Kai Song, Chunlin Yin, Gengxin Sun
Mathematical Problems in Engineering.2022; 2022: 1. CrossRef
Model for Predicting In-Hospital Mortality of Physical Trauma Patients Using Artificial Intelligence Techniques: Nationwide Population-Based Study in Korea
Seungseok Lee, Wu Seong Kang, Sanghyun Seo, Do Wan Kim, Hoon Ko, Joongsuck Kim, Seonghwa Lee, Jinseok Lee
Journal of Medical Internet Research.2022; 24(12): e43757. CrossRef

Prognostic Accuracy of the Quick Sequential Organ Failure Assessment for Outcomes Among Patients with Trauma in the Emergency Department: A Comparison with the Modified Early Warning Score, Revised Trauma Score, and Injury Severity Score: Min Woo Kang, Seo Young Ko, Sung Wook Song, Woo Jeong Kim, Young Joon Kang, Kyeong Won Kang, Hyun Soo Park, Chang Bae Park, Jeong Ho Kang, Ji Hwan Bu, Sung Kgun Lee; J Trauma Inj. 2021;34(1):3-12. Published online December 17, 2020; DOI: https://doi.org/10.20408/jti.2020.0048

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Abstract PDF

Purpose

To evaluate the severity of trauma, many scoring systems and predictive models have been presented. The quick Sequential Organ Failure Assessment (qSOFA) is a simple scoring system based on vital signs, and we expect it to be easier to apply to trauma patients than other trauma assessment tools.

Methods

This study was a cross-sectional study of trauma patients who visited the emergency department of Jeju National University Hospital. We excluded patients under the age of 18 years and unknown outcomes. We calculated the qSOFA, the Modified Early Warning Score (mEWS), Revised Trauma Score (RTS), and Injury Severity Score (ISS) based on patients’ initial vital signs and assessments performed in the emergency department (ED). The primary outcome was mortality within 14 days of trauma. We analyzed qSOFA scores using multivariate logistic regression analysis and compared the predictive accuracy of these scoring systems using the area under the receiver operating characteristic curve (AUROC).

Results

In total, 27,764 patients were analyzed. In the multivariate logistic regression analysis of the qSOFA, the adjusted odds ratios with 95% confidence interval (CI) for mortality relative to a qSOFA score of 0 were 27.82 (13.63–56.79) for a qSOFA score of 1, 373.31 (183.47–759.57) for a qSOFA score of 2, and 494.07 (143.75–1698.15) for a qSOFA score of 3. In the receiver operating characteristic (ROC) curve analysis for the qSOFA, mEWS, ISS, and RTS in predicting the outcomes, for mortality, the AUROC for the qSOFA (AUROC [95% CI]; 0.912 [0.871–0.952]) was significantly greater than those for the ISS (0.700 [0.608–0.793]) and RTS (0.160 [0.108–0.211]).

Conclusions

The qSOFA was useful for predicting the prognosis of trauma patients evaluated in the ED.

Summary

Citations

Citations to this article as recorded by

Multifaceted Analysis of the Environmental Factors in Severely Injured Trauma: A 30-Day Survival Analysis
Sung Woo Jang, Hae Rim Kim, Pil Young Jung, Jae Sik Chung
Healthcare.2023; 11(9): 1333. CrossRef
Predictive value of quick sequential organ failure assessment (qSOFA) score in risk assessment and outcome prediction in blunt trauma patients: A prospective observational study
Nidhisha Sadhwani, Vinaya Ambore, Girish Bakhshi
Annals of Medicine & Surgery.2022;[Epub] CrossRef

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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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

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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

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

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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

Review Article

Evolution of trauma care and the trauma registry in the West Australian health system: Mayura Thilanka Iddagoda, Maxine Burrell, Sudhakar Rao, Leon Flicker; J Trauma Inj. 2022;35(2):71-75. Published online May 31, 2022; DOI: https://doi.org/10.20408/jti.2021.0060

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Trauma care is evolving throughout the world to meet the demand resulting from rapidly increasing rates of mortality and morbidity related to external injuries. The State Major Trauma Service was designated to Royal Perth Hospital in 2004 to provide comprehensive care for trauma patients in Western Australia (WA), which is the largest state by area in the country. The State Major Trauma Unit, which was established in 2008, functions as a level I center and admits over 1,000 major trauma patients per year, making it the second busiest trauma center in Australia. The importance of recording data related to trauma was identified by the trauma service in WA to inspire higher standards of patient care and injury prevention. In 1994, the service established a trauma registry, which has undergone significant changes over the last two decades. The current State Trauma Registry is linked to a statewide database called the Data Linkage System. The linked data are available for policy development, quality assurance, and research. This article discusses the evolution of the trauma service and the registry database in the WA health system. The State Trauma Registry has enormous potential to contribute to research and quality improvement studies along with its ability to link with other databases.

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Development of a standardized minimum dataset for including low‐severity trauma patients in trauma registry collections in Australia and Aotearoa New Zealand
Grant Christey, Jacelle Warren, Cameron S. Palmer, Maxine Burrell, Kirsten Vallmuur
ANZ Journal of Surgery.2023; 93(3): 572. CrossRef

Case Reports

Bilateral foot drop caused by T12 infectious spondylitis after vertebroplasty: a case report: Dong Hwan Kim, Yong Beom Shin, Mahnjeong Ha, Byung Chul Kim, In Ho Han, Kyoung Hyup Nam; J Trauma Inj. 2022;35(1):56-60. Published online March 21, 2022; DOI: https://doi.org/10.20408/jti.2021.0083

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The most common cause of foot drop is lumbar degenerative disc herniation, particularly at L4/5. We present a rare case of spinal cord injury accompanied by a thoracolumbar lesion that presented with bilateral foot drop. A 69-year-old male patient presented with sudden-onset severe bilateral leg pain and bilateral foot drop. Radiologic findings revealed T12 spondylitis compressing the conus medullaris. He had undergone vertebroplasty for a T12 compression fracture after a fall 6 months before. A physical examination showed bilateral foot drop, paresthesia of both L5 dermatomes, increased deep tendon reflex, and a positive Babinski sign. An acute bilateral L5 root lesion and a conus medullaris lesion were suspected based on electromyography. A surgical procedure was done for decompression and reconstruction. After the operation, bilateral lower extremity muscle strength recovered to a good grade from the trace grade, and the patient could walk without a cane. The current case is a very rare report of bilateral foot drop associated with T12 infectious spondylitis after vertebroplasty. It is essential to keep in mind that lesions of the thoracolumbar junction can cause atypical neurological symptoms. Furthermore, understanding the conus medullaris and nerve root anatomy at the T12–L1 level will be helpful for treating patients with atypical neurological symptoms.

Summary

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Evaluating Acute Bilateral Foot Drop: A Case Report
Arsh N Patel, Colby Kihara, Carter Gay, Katie Oakley, P.J. Reddy
Cureus.2022;[Epub] CrossRef

Chronic epidural hematoma evacuated through surgical treatment: a case report: Eui Gyu Sin; J Trauma Inj. 2022;35(1):43-45. Published online March 21, 2022; DOI: https://doi.org/10.20408/jti.2021.0036

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Epidural hematoma (EDH) can sometimes be life-threatening, although small-volume EDHs can resolve spontaneously like other intracranial hematomas. However, in rare cases, EDH can transform into a chronic form instead of disappearing. In contrast to subdural hematoma, there is no agreed-upon definition or treatment of chronic EDH. A 41-year-old male patient with acute EDH in the bilateral paravertical area due to partial rupture of the sagittal sinus was operated first, and then remnant contralateral hematoma was treated conservatively. One month after surgery, he showed hemiparesis, and brain imaging revealed chronic EDH at the location of the remnant acute hematoma. We performed surgery again to treat chronic EDH through a large craniotomy. Although many cases of EDH are self-limited, clinicians must keep in mind that some cases of EDH, especially those of venous origin and arising in young people, can become chronic and require surgical treatment.

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Chronic epidural hematoma: a systematic review and meta-analysis
Nicaise Kpègnon Agada, Nourou Dine Adeniran Bankole, Mèhomè Wilfried Dossou, Omar Boladji Adébayo Badirou, Emeka Alfred Clement, Fresnel Lutèce Ontsi Obame, Laté Dzidoula Lawson, Romeo Bujiriri Murhega, Arsène Daniel Nyalundja, Nukunté David Lionel Togben
Egyptian Journal of Neurosurgery.2023;[Epub] CrossRef

Complete Transection of the Cystic Duct and Artery after Blunt Trauma: A Case Report: Sung Hoon Cho, Kyoung Hoon Lim; J Trauma Inj. 2021;34(4):294-298. Published online December 16, 2021; DOI: https://doi.org/10.20408/jti.2021.0097

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Extrahepatic biliary tract and gallbladder injuries following blunt abdominal trauma are uncommon. Traumatic cystic duct transection is even rarer, which has frequently caused missed diagnosis and delayed treatment. An 18-year-old female patient with no past medical history was transferred to the Trauma Center of Kyungpook National University Hospital after falling from a height of approximately 20 meters. She became hemodynamically stable after initial resuscitation, and initial contrast-enhanced abdominal computed tomography (CT) showed right kidney traumatic infarction and multiple intrahepatic contusions with minimal fluid collection but no extravasation of the contrast. She was admitted to the intensive care unit. On the second day of hospitalization, her abdomen became distended, with follow-up CT showing a large collection of intra-abdominal fluid. Laparoscopic exploration was then performed, which revealed devascularization of the gallbladder with complete transection of the cystic duct and artery. Laparoscopic cholecystectomy was performed, as well as primary closure of the cystic duct orifice on the common bile duct using a 4-0 Prolene suture. After surgery, no clinical evidence of biliary leakage or common bile duct stricture was observed.

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A Rare Complication of Percutaneous Transhepatic Gallbladder Drainage
Yang-Yuan Chen, Chih-Hsuan Chen, Yung-Fang Chen
Gastroenterology.2022; 163(5): e29. CrossRef

Original Articles

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

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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.

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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

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

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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.

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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

Perioperative complications of the modified Stoppa approach for the treatment of pelvic bone fractures: a single-institution review of 48 cases: Hyeonjoon Lee, Suenghwan Jo, Gwangchul Lee, Yongjin Cho; J Trauma Inj. 2022;35(1):19-24. Published online November 23, 2021; DOI: https://doi.org/10.20408/jti.2021.0061

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Purpose
The current study aimed to report the perioperative complications of the modified Stoppa approach for the treatment of pelvic bone fractures. Methods: We analyzed 48 consecutive operations in 45 patients who were treated with internal fixation using the modified Stoppa approach between March 2016 and July 2018. This included three revision operations. The mean age of the patients was 54.5 years, and the patients included 35 male patients and 10 female patients. All fractures occurred as a consequence of high-energy trauma and 70.3% had associated injuries at the time of the fracture. The mean Injury Severity Score was 9.03±5.60. The perioperative complications found during and immediately after surgery were recorded and were classified into three categories: vascular injuries, nerve injuries, and other complications. Results: Overall, 14 perioperative complications (29.2%) in 14 cases were identified. The most common complications were nerve injuries, which occurred in seven cases, all involving the obturator nerve. Uncontrollable vascular injuries occurred in six cases, which required additional incisions and support of vascular surgeons or postoperative interventions. Additionally, one case of peritoneal tearing occurred, which required help from an abdominal surgeon. Conclusions: While the modified Stoppa approach seems to be a viable method to treat pelvic fractures, significant perioperative complications may occur, suggesting that surgeons should pay careful attention to minimize the damage to other structures and that appropriate support from other surgical departments is paramount.

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Severe intraoperative vascular bleeding as main complication of acetabular fractures treated with plate osteosynthesis via the modified Stoppa approach
Julia Riemenschneider, Maren Janko, Tilmann Vollrath, Christoph Nau, Ingo Marzi
Injury.2023; 54(7): 110773. CrossRef

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