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Review Article
Biomechanics of stabbing knife attack for trauma surgeons in Korea: a narrative review
Kun Hwang, Chan Yong Park
J Trauma Inj. 2024;37(1):1-5.   Published online January 15, 2024
DOI: https://doi.org/10.20408/jti.2023.0057
  • 1,339 View
  • 29 Download
AbstractAbstract PDF
The aim of this paper was to review the biomechanics of knife injuries, including those that occur during stabbing rampages. In knife stab attacks, axial force and energy were found to be 1,885 N and 69 J, respectively. The mean velocity of a stabbing motion has been reported to range from 5 to 10 m/sec, with knife motions occurring between 0.62 and 1.07 seconds. This speed appears to surpass the defensive capabilities of unarmed, ordinarily trained law enforcement officers. Therefore, it is advisable to maintain a minimum distance of more than an arm's length from an individual visibly armed with a knife. In training for knife defense, particularly in preparation for close-quarter knife attacks, this timing should be kept in mind. Self-inflicted stab wounds exhibited a higher proportion of wounds to the neck and abdomen than assault wounds. Injuries from assault wounds presented a higher Injury Severity Score, but more procedures were performed on self-inflicted stab wounds. Wound characteristics are not different between nonsuicidal self-injury and suicidal self-wrist cutting injuries. Consequently, trauma surgeons cannot determine a patient's suicidal intent based solely on the characteristics of the wound. In Korea, percent of usage of lethal weapon is increasing. In violence as well as murders, the most frequently used weapon is knife. In the crimes using knife, 4.8% of victims are killed. Therefore, the provision of prehospital care by an emergency medical technician is crucial.
Summary
Case Reports
Successful minimally invasive management using transcatheter arterial embolization in a hemodynamically stable elderly patient with mesenteric vascular injury in a hybrid emergency room system in Korea: a case report
So Ra Ahn, Joo Hyun Lee, Sang Hyun Seo, Chan Yong Park
J Trauma Inj. 2023;36(4):435-440.   Published online July 25, 2023
DOI: https://doi.org/10.20408/jti.2023.0018
  • 2,214 View
  • 22 Download
AbstractAbstract PDF
Mesenteric injury occurs rarely in cases associated with blunt abdominal trauma. Despite its low incidence, mesenteric injury can lead to fatal outcomes such as hypovolemic shock due to hemoperitoneum or sepsis due to intestinal ischemia, or perforation-related peritonitis. For mesenteric injuries, especially those involving massive bleeding, intestinal ischemia, and perforation, the standard treatment is surgery. However, in the case of operative management, it should be borne in mind that there is a possibility of complications and mortality during and after surgery. The usefulness of transcatheter arterial embolization (TAE) is well known in solid organs but is controversial for mesenteric injury. We present a 75-year-old man with mesenteric injury due to blunt abdominal trauma. Initial abdominal computed tomography showed no hemoperitoneum, but a mesenteric contusion and pseudoaneurysm with a diameter of 17 mm were observed near the origin of the superior mesenteric artery. Since there were no findings requiring emergency surgery such as free air or intestinal ischemia, it was decided to perform nonoperative management with TAE using microcoils in hybrid emergency room system. TAE was performed successfully, and there were no complications such as bleeding, bowel ischemia, or delayed bowel perforation. He was discharged on the 23rd day after admission with percutaneous catheter drainage for drainage of mesenteric hematoma. The authors believe that treatment with TAE for highly selected elderly patients with mesenteric injuries has the positive aspect of minimally invasive management, considering the burden of general anesthesia and the various avoidable intraoperative and postoperative complications.
Summary
Pre-Hospital and In-Hospital Management of an Abdominal Impalement Injury Caused by a Tree Branch
So Ra Ahn, Joo Hyun Lee, Keun Young Kim, Chan Yong Park
J Trauma Inj. 2021;34(4):288-293.   Published online December 16, 2021
DOI: https://doi.org/10.20408/jti.2021.0051
  • 4,845 View
  • 180 Download
AbstractAbstract PDF

In South Korea, most patients who visit trauma centers with abdominal injuries have blunt trauma, and penetrating injuries are relatively rare. In extremely rare cases, some patients are admitted with a long object penetrating their abdomen, and these injuries are referred to as abdominal impalement injuries. Most cases of impalement injuries lead to fatal bleeding, and patients often die at the scene of the accident. However, patients who survive until reaching the hospital can have a good prognosis with optimal treatment. A 68-year-old female patient was admitted to the trauma center with a 4-cm-thick tree branch impaling her abdomen. The patient was transported by a medical helicopter and had stable vital signs at admission. The branch sticking out of the abdomen was quite long; thus, we carefully cut the branch with an electric saw to perform computed tomography (CT). CT revealed no signs of major blood vessel injury, but intestinal perforation was observed. During laparotomy, the tree branch was removed after confirming that there were no vascular injuries, and enterostomy was performed because of extensive intestinal injury. After treating other injuries, the patient was discharged without any complications except colostomy. Abdominal impalement injuries are treated using various approaches depending on the injury mechanism and injured region. However, the most important consideration is that the impaled object should not be removed during transportation and resuscitation. Instead, it should only be removed after checking for injuries to blood vessels during laparotomy in an environment where injury control is possible.

Summary
Non-Operative Management with Angioembolization of Grade IV and V Renal Injuries in a Hybrid Emergency Room System
So Ra Ahn, Sang Hyun Seo, Joo Hyun Lee, Chan Yong Park
J Trauma Inj. 2021;34(3):191-197.   Published online September 30, 2021
DOI: https://doi.org/10.20408/jti.2021.0034
  • 3,330 View
  • 85 Download
  • 1 Citations
AbstractAbstract PDF

Renal injuries occur in more than 10% of patients who sustain blunt abdominal injuries. Non-operative management (NOM) is the established treatment strategy for lowgrade (I–III) renal injuries. However, despite some evidence that NOM can be successfully applied to high-grade (IV, V) renal injuries, it remains unclear whether NOM is appropriate in such cases. The authors report two cases of high-grade renal injuries that underwent NOM after embolization in a hybrid emergency room (ER) system with a 24/7 in-house interventional radiology (IR) team. A 29-year-old male visited Wonkwang University Hospital Regional Trauma Center complaining of right abdominal pain after being hit by a rope. Computed tomography (CT) was performed 16 minutes after arrival, and the CT scan indicated a grade V right renal injury. Arterial embolization was initiated within 31 minutes of presentation. A 56-year-old male was transferred to Wonkwang University Hospital Regional Trauma Center with a complaint of right flank pain. He had initially presented to a nearby hospital after falling from a 3-m height. Thanks to the key CT images sent from the previous hospital prior to the patient’s arrival, angiography was performed within 8 minutes of the patient’s arrival and arterial embolization was completed within 25 minutes. Both patients were treated successfully through NOM with angioembolization and preserved kidneys. Hematoma in the first patient and urinoma in the second patient resolved with percutaneous catheter drainage. The authors believe that the hybrid ER system with an in-house IR team could contribute to NOM and kidney preservation even in high-grade renal injuries.

Summary

Citations

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  • Endovascular embolization of persistent liver injuries not responding to conservative management: a narrative review
    Simon Roh
    Journal of Trauma and Injury.2023; 36(3): 165.     CrossRef
Original Articles
Validity of the scoring system for traumatic liver injury: a generalized estimating equation analysis
Kangho Lee, Dongyeon Ryu, Hohyun Kim, Chang Ho Jeon, Jae Hun Kim, Chan Yong Park, Seok Ran Yeom
J Trauma Inj. 2022;35(1):25-33.   Published online September 7, 2021
DOI: https://doi.org/10.20408/jti.2021.0009
  • 3,549 View
  • 105 Download
  • 1 Citations
AbstractAbstract PDFSupplementary Material
Purpose
The scoring system for traumatic liver injury (SSTLI) was developed in 2015 to predict mortality in patients with polytraumatic liver injury. This study aimed to validate the SSTLI as a prognostic factor in patients with polytrauma and liver injury through a generalized estimating equation analysis. Methods: The medical records of 521 patients with traumatic liver injury from January 2015 to December 2019 were reviewed. The primary outcome variable was in-hospital mortality. All the risk factors were analyzed using multivariate logistic regression analysis. The SSTLI has five clinical measures (age, Injury Severity Score, serum total bilirubin level, prothrombin time, and creatinine level) chosen based on their predictive power. Each measure is scored as 0–1 (age and Injury Severity Score) or 0–3 (serum total bilirubin level, prothrombin time, and creatinine level). The SSTLI score corresponds to the total points for each item (0–11 points). Results: The areas under the curve of the SSTLI to predict mortality on post-traumatic days 0, 1, 3, and 5 were 0.736, 0.783, 0.830, and 0.824, respectively. A very good to excellent positive correlation was observed between the probability of mortality and the SSTLI score (γ=0.997, P<0.001). A value of 5 points was used as the threshold to distinguish low-risk (<5) from high-risk (≥5) patients. Multivariate analysis using the generalized estimating equation in the logistic regression model indicated that the SSTLI score was an independent predictor of mortality (odds ratio, 1.027; 95% confidence interval, 1.018–1.036; P<0.001). Conclusions: The SSTLI was verified to predict mortality in patients with polytrauma and liver injury. A score of ≥5 on the SSTLI indicated a high-risk of post-traumatic mortality.
Summary

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  • Liver Trauma: Management in the Emergency Setting and Medico-Legal Implications
    Angela Saviano, Veronica Ojetti, Christian Zanza, Francesco Franceschi, Yaroslava Longhitano, Ermelinda Martuscelli, Aniello Maiese, Gianpietro Volonnino, Giuseppe Bertozzi, Michela Ferrara, Raffaele La Russa
    Diagnostics.2022; 12(6): 1456.     CrossRef
Characteristics of Traffic Accidents on Highways: An Analysis Based on Patients Treated at a Regional Trauma Center
Sung Yong Lee, Kyung Hoon Sun, Chan Yong Park, Tae Hoon Kim
J Trauma Inj. 2021;34(4):263-269.   Published online June 4, 2021
DOI: https://doi.org/10.20408/jti.2020.0063
  • 8,481 View
  • 95 Download
  • 1 Citations
AbstractAbstract PDF
Purpose

There have been increasing concerns about serious traffic accidents on highways. The purpose of this study was to analyze factors affecting traffic accidents on highways and the severity of the resulting injuries.

Methods

This retrospective study was conducted at a regional trauma center. We reviewed 594 patients who had been in 114 traffic accidents on highways from January 2018 to June 2020. We collected demographic data, clinical data, accident-related factors, and meteorological data (weather and temperature).

Results

Environmental risk factors were found to be significantly associated with the incidence of traffic accidents on highways. Injury severity and the death rate were higher in sedans than in any other type of vehicle. Tunnels were the most common location of accidents, accounting for 47 accidents (41.2%) and 269 injured patients (45.3%). The injury severity of individuals riding in the driver’s seat (front seat) was high, regardless of vehicle type. Three meteorological risk factors were found to be significantly associated with traffic accidents: rainy roads (odds ratio [OR] 2.08; 95% confidence interval [CI] 1.84–3.29; p=0.01), icy or snowy roads (OR 5.12; 95% CI 2.88–7.33; p<0.01), and foggy conditions (OR 2.94; 95% CI 2.15–4.03; p<0.05).

Conclusions

The injury severity of patients was affected by seat position and type of vehicle, and the frequency of accident was affected by the location. The incidence of traffic accidents was strongly influenced by meteorological conditions (rain, snow/ice, and fog).

Summary

Citations

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  • What are the individual and joint impacts of key meteorological factors on the risk of unintentional injuries? A case-crossover study of over 147,800 cases from a sentinel-based surveillance system
    Xiao Lin, Tian Tian, Congxing Shi, Pengyu Wang, Shimin Chen, Tong Guo, Zhiqiang Li, Boheng Liang, Wangjian Zhang, Pengzhe Qin, Yuantao Hao
    Sustainable Cities and Society.2023; 91: 104413.     CrossRef
Case Reports
Splenic Artery Bleeding into the Extraperitoneal Space Mimicking Mesenteric Injury: A Rare Case of Blunt Trauma
Sang Hyun Seo, Hyun Seok Jung, Chan Yong Park
J Trauma Inj. 2021;34(2):141-145.   Published online March 15, 2021
DOI: https://doi.org/10.20408/jti.2020.0076
  • 2,938 View
  • 102 Download
AbstractAbstract PDF

Splenic injury is a common result of blunt trauma, and bleeding occurs mainly inside the splenic capsule and may leak into the peritoneal space. Herein, we report a case where active bleeding occurred in the splenic artery and only leaked into the extraperitoneal space. This is the first case of this phenomenon in a trauma patient in the English-language literature. Bleeding passed through the peritoneum, leaked into the anterior pararenal space, and continued along the extraperitoneal space to the prevesical space of the pelvis. Therefore, on the initial computed tomography (CT) scan, the bleeding appeared to be in the left paracolic gutter, so we suspected mesenteric bleeding. However, after the CT series was fully reconstructed, we accurately read the scans and confirmed splenic injury with active bleeding. If there had been a suspicion of bowel or mesenteric injury, surgery would have been required, but fortunately surgery could be avoided in this case. The patient was successfully treated with angioembolization.

Summary
Merit of Zone III Resuscitative Endovascular Occlusion of the Aorta under Real-Time Fluoroscopy in Hybrid ER: A Case of REBOA in Traumatic Cardiac Arrest
Sung Do Lee, Seungwoo Chung, Young Jun Ki, Sang Hyun Seo, Chan Yong Park
J Trauma Inj. 2020;33(3):191-194.   Published online September 30, 2020
DOI: https://doi.org/10.20408/jti.2020.0054
  • 3,898 View
  • 96 Download
AbstractAbstract PDF

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a novel technique to maintain proximal arterial pressure. It is important to locate the balloon catheter correctly in performing REBOA but it is inaccurate to check the catheter position by external measurement. Even if the position of the catheter is initially confirmed by X-ray, it is difficult to determine the location of the catheter that changes according to various situations. We performed REBOA under real-time fluoroscopy and could maintain the catheter in correct position under various situations.

Summary
Special Article
Part 3. Clinical Practice Guideline for Airway Management and Emergency Thoracotomy for Trauma Patients from the Korean Society of Traumatology
Chan Yong Park, O Hyun Kim, Sung Wook Chang, Kang Kook Choi, Kyung Hak Lee, Seong Yup Kim, Maru Kim, Gil Jae Lee
J Trauma Inj. 2020;33(3):195-203.   Published online September 30, 2020
DOI: https://doi.org/10.20408/jti.2020.0050
  • 10,350 View
  • 185 Download
AbstractAbstract PDF

The following key questions and recommendations are presented herein: when is airway intubation initiated in severe trauma? Airway intubation must be initiated in severe trauma patients with a GCS of 8 or lower (1B). Should rapid sequence intubation (RSI) be performed in trauma patients? RSI should be performed in trauma patients to secure the airway unless it is determined that securing the airway will be problematic (1B). What should be used as an induction drug for airway intubation? Ketamine or etomidate can be used as a sedative induction drug when RSI is being performed in a trauma patient (2B). If cervical spine damage is suspected, how is cervical protection achieved during airway intubation? When intubating a patient with a cervical spine injury, the extraction collar can be temporarily removed while the neck is fixed and protected manually (1C). What alternative method should be used if securing the airway fails more than three times? If three or more attempts to intubate the airway fail, other methods should be considered to secure the airway (1B). Should trauma patients maintain normal ventilation after intubation? It is recommended that trauma patients who have undergone airway intubation maintain normal ventilation rather than hyperventilation or hypoventilation (1C). When should resuscitative thoracotomy be considered for trauma patients? Resuscitative thoracotomy is recommended for trauma patients with penetrating injuries undergoing cardiac arrest or shock in the emergency room (1B).

Summary
Original Article
PARK Formula Can Replace “Guide to Medical Certificate” Published by Korean Medical Association in Deciding the Treatment Duration
Chan Yong Park, Kwang Hee Yeo, Sora Ahn
J Trauma Inj. 2018;31(2):58-65.   Published online August 31, 2018
DOI: https://doi.org/10.20408/jti.2018.31.2.58
  • 3,508 View
  • 63 Download
AbstractAbstract PDF
Purpose

Many doctors have difficulty in deciding the treatment duration in trauma patients to write in the casualty medical certificate. We tried to find a solution for this problem by using abbreviated injury scale (AIS).

Methods

A total of 39 patients treated in our regional trauma center who requested an author to write treatment duration on casualty medical certificate from January 2014 to April 2017 were included. And the treatment duration was decided based on the PARK Formula (AIS). PARK Formula (AIS)=(AIS×2) ~ ([AIS×2]+2)

Results

Among 39 patients included and 36 (92.3%) had treatment duration on casualty medical certificate within the range of treatment duration calculated by PARK Formula (AIS). Compared to the PARK Formula (AIS), the mean value was 0.13 week (0.90 day) smaller. Comparing the treatment duration between Korean Medical Association (KMA) guideline and PARK Formula (AIS), only 22 patients (56.4%) showed agreement. The mean value was 1.02 week (7.18 days) smaller in KMA guideline.

Conclusions

For the decision of the treatment duration in trauma patients, utilizing worldwide used AIS scoring system is very efficient. Using PARK Formula (AIS), doctors can document the treatment duration in the casualty medical certificate with ease. KMA should provide more practical ‘treatment duration of each diagnosis in writing casualty medial certificate’ for the doctors. We recommend PARK Formula (AIS) as a good alternative for KMA guide.

Summary
Case Report
Diagnostic Laparoscopy and Laparoscopic Diverting Sigmoid Loop Colostomy in Penetrating Extraperitoneal Rectal Injury: A Case Report
Young Goun Jo, Yun Chul Park, Wu Seong Kang, Jung Chul Kim, Chan Yong Park
J Trauma Inj. 2017;30(4):216-219.   Published online December 30, 2017
DOI: https://doi.org/10.20408/jti.2017.30.4.216
  • 5,585 View
  • 26 Download
  • 1 Citations
AbstractAbstract PDF

Laparoscopy has been one of the most effective modalities in various surgical situations, although its use in trauma patients has some limitations. The benefits of laparoscopy include cost-effectiveness, shorter length of hospital stay, and less postoperative pain. This report describes diagnostic laparoscopy and laparoscopic diverting sigmoid loop colostomy in penetrating extraperitoneal rectal injury. A 41-year-old male presented with perineal pain following penetrating trauma caused by a tree limb. Computed tomography showed air density in the perirectal space and retroperitoneum. As his vital signs were stable, we performed diagnostic laparoscopy and confirmed no intraperitoneal perforation. Therefore, laparoscopic diverting sigmoid loop colostomy was performed. He was discharged without any complications despite underlying hepatitis C-related cirrhosis. Colostomy closure was performed 3 months later.

Summary

Citations

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  • The floating rectum
    Sean Ng Kwet Chi Ng Ying Kin, William Jiang, Asiri Arachchi, Hanumant Chouhan
    ANZ Journal of Surgery.2022; 92(1-2): 264.     CrossRef
Original Articles
PARK Index and S-score Can Be Good Quality Indicators for the Preventable Mortality in a Single Trauma Center
Chan Yong Park, Kyung Hag Lee, Na Yun Lee, Su Ji Kim, Hyun Min Cho, Chan Kyu Lee
J Trauma Inj. 2017;30(4):126-130.   Published online December 30, 2017
DOI: https://doi.org/10.20408/jti.2017.30.4.126
  • 3,817 View
  • 22 Download
AbstractAbstract PDF
Purpose

Preventable Trauma Death Rate (PTDR) using Trauma and Injury Severity Score (TRISS) has been most widely used as a quality indicator in South Korea. However, this method has a small number of deaths corresponding to the denominator. Therefore, it is difficult to check the change of quality improvement for annual mortality, and there is a disadvantage that variation is severe. Therefore, we attempted to improve the quality of the mortality evaluation by reducing the variation by applying the PARK Index (preventable major trauma death rate, PMTDR) which can increase the number of denominator significantly. And the Save score (S-score) was also examined as another quality indicator.

Methods

In the PARK Index, the denominator is number of all patients who have survival probability (Ps) larger than 0.25. Numerator is the number of deaths among these. The PARK Index includes only patients with ISS >15. The S-score is calculated in the same way as the W-score, but the S-score includes only patients with ISS >15, which is a difference from the W-score.

Results

PARK Index decreased annually and was 12.9 (37/287) in 2014, 9.6 (33/343) in 2015, and 7.3 (52/709) in 2016. S-score increased annually and was ?0.29 in 2014, 4.21 in 2015, and 8.75 in 2016.

Conclusions

PARK Index and S-score improved annually. This shows that both quality indicators are improving year by year. PARK Index (PMTDR) has 9.5-fold increase in denominator overall compared to PTDR by TRISS. The S-score used only ISS >15 patients as a denominator. Therefore, there is an advantage that the numerical value change is larger than the W-score. In addition, S-score is not affected by the ratio of major trauma patients to minor trauma patients.

Summary
Analysis of Cultivator-related Trauma Cases in a Regional Trauma Center in the Rural Area of Gyeongbuk Province
Ui Kang Hwang, Seok Hwa Youn, Chan Yong Park
J Trauma Inj. 2017;30(3):80-86.   Published online October 30, 2017
DOI: https://doi.org/10.20408/jti.2017.30.3.80
  • 2,068 View
  • 17 Download
AbstractAbstract PDF
PURPOSE
To analyze the data of patients who suffered trauma in a cultivator accident and visited the trauma center in rural Gyeongbuk Province.
METHODS
We retrospectively reviewed the medical records and Korean Trauma Data Bank data of 120 patients who suffered cultivator-related traumas and visited the rural regional trauma center in Gyeongbuk Province from January to December 2015.
RESULTS
The age of the patients ranged from 35 to 96 years (mean, 70 years). Ninety-one (75.8%) patients were men, and twenty-nine (24.2%) were women. Most of the patients were in their 70s (46 men [50.5%] and 13 women [44.8%]). In total, 113 patients (94.1%) arrived at the regional trauma center by ground transport and 7 (5.9%) arrived by air transport. Ninety-eight patients (81.7%) were transported to the regional trauma center directly from the scene of the accident, and twenty-two (18.3%) were transferred from another medical institute. The mean time from the accident to arrival at the emergency department was 139 minutes, and only 46 patients (38.3%) arrived within 1 hour. Twelve (10.0%) patients died, including two deaths on arrival and two post- cardiopulmonary resuscitation deaths in the emergency department. All deaths were of male cultivator operators. The causes of death were shock (hypovolemic, traumatic, or septic), subdural hematoma (open), hemothorax, rhabdomyolysis, and pneumonia.
CONCLUSIONS
As the government - led regional trauma center project is on process, it would be clinically important to summarize the initial outcome of cultivator injuries, which are characteristically found more in regional trauma centers in the rural area, and have high mortality. Based on this study, in the future, it will be necessary to follow up and analyze more number of patients and to construct accurate database about trauma cases related to cultivator in Gyeongbuk region.
Summary
Case Report
Successful TAE after DCS for Active Arterial Bleeding from Blunt Hepatic Injury in a Child: A Case Report
Chan Ik Park, Sang Bong Lee, Kwang Hee Yeo, Seungchan Lee, Sung Jin Park, Ho Hyun Kim, Jae Hun Kim, Chang Won Kim, Chan Yong Park
J Trauma Inj. 2016;29(2):47-50.   Published online June 30, 2016
DOI: https://doi.org/10.20408/jti.2016.29.2.47
  • 1,967 View
  • 11 Download
  • 1 Citations
AbstractAbstract PDF
Transcatheter arterial embolization (TAE) for blunt hepatic injury in children is not common and is especially rare after damage control surgery (DCS). We report a successful TAE after DCS on a child for massive bleeding from the left hepatic artery due to a motor vehicle accident. The car (a sport utility vehicle) ran over the chest and abdomen of a 4-year-old boy. On arrival, initial vital signs were as follows: blood pressure, 70/40 mmHg; heart rate, 149/min; temperature, 36.7℃; respiratory rate, 38/min. After resuscitation, computed tomography was done, and a suspicious contrast leakage from a branch of the left hepatic artery and a spleen injury (grade V) were found. TAE was performed successfully after DCS for a liver injury.
Summary

Citations

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  • Damage Control Surgery for Abdominal Compartment Syndrome Caused by Delayed Rupture of Hepatic Subcapsular Hematoma
    Chan Yong Park, Kwang Hee Yeo, Ho Hyun Kim, Seon Hee Kim, Hyun Min Cho, Hoon Kwon, Chang Ho Jeon, Chang Won Kim, Seok Ran Yeom
    Trauma Image and Procedure.2017; 2(1): 17.     CrossRef
Original Article
PARK Index for Preventable Major Trauma Death Rate
Chan Yong Park, Byungchul Yu, Ho Hyun Kim, Jung Joo Hwang, Jungnam Lee, Hyun Min Cho, Han Na Park
J Trauma Inj. 2015;28(3):115-122.   Published online September 30, 2015
DOI: https://doi.org/10.20408/jti.2015.28.3.115
  • 2,555 View
  • 13 Download
  • 3 Citations
AbstractAbstract PDF
PURPOSE
To calculate Preventable Trauma Death Rate (PTDR), Trauma and Injury Severity Score (TRISS) is the most utilized evaluation index of the trauma centers in South Korea. However, this method may have greater variation due to the small number of the denominator in each trauma center. Therefore, we would like to develop new indicators that can be used easily on quality improvement activities by increasing the denominator.
METHODS
The medical records of 1005 major trauma (ISS >15) patients who visited 2 regional trauma center (A center and B center) in 2014 were analyzed retrospectively. PTDR and PARK Index (Preventable Major Trauma Death Rate, PMTDR) were calculated in 731 patients with inclusion criteria. We invented PARK Index to minimize the variation of preventability of trauma death. In PTDR the denominator is all number of deaths, and in PARK Index the denominator is number of all patients who have survival probability (Ps) larger than 0.25. Numerator is the number of deaths from patients who have Ps larger than 0.25.
RESULTS
The size of denominator was 40 in A center, 49 in B center, and overall 89 in PTDR. The size of denominator was significantly increased, and 287 (7.2-fold) in A center, 422 (8.6-fold) in B center, and overall 709 (8.0-fold) in PARK Index. PARK Index was 12.9% in A center, 8.3% in B center, and overall 10.2%.
CONCLUSION
PARK Index is calculated as a rate of mortality from all major trauma patients who have Ps larger than 0.25. PARK Index obtain an effect that denominator is increased 8.0-fold than PTDR. Therefore PARK Index is able to compensate for greater disadvantage of PTDR. PARK Index is expected to be helpful in implementing evaluation of mortality outcome and to be a new index that can be applied to a trauma center quality improvement activity.
Summary

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  • Comparison of Outcomes at Trauma Centers versus Non-Trauma Centers for Severe Traumatic Brain Injury
    Tae Seok Jeong, Dae Han Choi, Woo Kyung Kim
    Journal of Korean Neurosurgical Society.2023; 66(1): 63.     CrossRef
  • Comparison of Preventable Trauma Death Rates in Patients With Traumatic Brain Injury Before and After the Establishment of Regional Trauma Center: A Single Center Experience
    Dae Han Choi, Tae Seok Jeong, Myung Jin Jang
    Korean Journal of Neurotrauma.2023; 19(2): 227.     CrossRef
  • PARK Index and S-score Can Be Good Quality Indicators for the Preventable Mortality in a Single Trauma Center
    Chan Yong Park, Kyung Hag Lee, Na Yun Lee, Su Ji Kim, Hyun Min Cho, Chan Kyu Lee
    Journal of Trauma and Injury.2017; 30(4): 126.     CrossRef

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