Journal of Trauma and Injury

Original Articles

Predicting 30-day mortality in severely injured elderly patients with trauma in Korea using machine learning algorithms: a retrospective study: Jonghee Han, Su Young Yoon, Junepill Seok, Jin Young Lee, Jin Suk Lee, Jin Bong Ye, Younghoon Sul, Se Heon Kim, Hong Rye Kim; Received April 22, 2024 Accepted May 29, 2024 Published online August 8, 2024; DOI: https://doi.org/10.20408/jti.2024.0024 [Epub ahead of print]

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Abstract PDF: Purpose
The number of elderly patients with trauma is increasing; therefore, precise models are necessary to estimate the mortality risk of elderly patients with trauma for informed clinical decision-making. This study aimed to develop machine learning based predictive models that predict 30-day mortality in severely injured elderly patients with trauma and to compare the predictive performance of various machine learning models.
Methods
This study targeted patients aged ≥65 years with an Injury Severity Score of ≥15 who visited the regional trauma center at Chungbuk National University Hospital between 2016 and 2022. Four machine learning models—logistic regression, decision tree, random forest, and eXtreme Gradient Boosting (XGBoost)—were developed to predict 30-day mortality. The models’ performance was compared using metrics such as area under the receiver operating characteristic curve (AUC), accuracy, precision, recall, specificity, F1 score, as well as Shapley Additive Explanations (SHAP) values and learning curves.
Results
The performance evaluation of the machine learning models for predicting mortality in severely injured elderly patients with trauma showed AUC values for logistic regression, decision tree, random forest, and XGBoost of 0.938, 0.863, 0.919, and 0.934, respectively. Among the four models, XGBoost demonstrated superior accuracy, precision, recall, specificity, and F1 score of 0.91, 0.72, 0.86, 0.92, and 0.78, respectively. Analysis of important features of XGBoost using SHAP revealed associations such as a high Glasgow Coma Scale negatively impacting mortality probability, while higher counts of transfused red blood cells were positively correlated with mortality probability. The learning curves indicated increased generalization and robustness as training examples increased.
Conclusions
We showed that machine learning models, especially XGBoost, can be used to predict 30-day mortality in severely injured elderly patients with trauma. Prognostic tools utilizing these models are helpful for physicians to evaluate the risk of mortality in elderly patients with severe trauma.; Summary

Clinical characteristics and mortality risk factors among trauma patients by age groups at a single center in Korea over 7 years: a retrospective study: Jonghee Han, Su Young Yoon, Junepill Seok, Jin Young Lee, Jin Suk Lee, Jin Bong Ye, Younghoon Sul, Seheon Kim, Hong Rye Kim; J Trauma Inj. 2023;36(4):329-336. Published online November 7, 2023; DOI: https://doi.org/10.20408/jti.2023.0035

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Abstract PDF: Purpose
In this study, we aimed to compare the characteristics of patients with trauma by age group in a single center in Korea to identify the clinical characteristics and analyze the risk factors affecting mortality.
Methods
Patients aged ≥18 years who visited the Chungbuk National University Hospital Regional Trauma Center between January 2016 and December 2022 were included. The accident mechanism, severity of the injury, and outcomes were compared by classifying the patients into group A (18–64 years), group B (65–79 years), and group C (≥80 years). In addition, logistic regression analysis was performed to identify factors affecting death.
Results
The most common injury mechanism was traffic accidents in group A (40.9%) and slipping in group B (37.0%) and group C (56.2%). Although group A had the highest intensive care unit admission rate (38.0%), group C had the highest mortality rate (9.5%). In the regression analysis, 3 to 8 points on the Glasgow Coma Scale had the highest odds ratio for mortality, and red blood cell transfusion within 24 hours, intensive care unit admission, age, and Injury Severity Score were the predictors of death.
Conclusions
For patients with trauma, the mechanism, injured body region, and severity of injury differed among the age groups. The high mortality rate of elderly patients suggests the need for different treatment approaches for trauma patients according to age. Identifying factors affecting clinical patterns and mortality according to age groups can help improve the prognosis of trauma patients in the future.; Summary

Case Reports

Visual Disturbance Caused by a Nail Gun-Induced Penetrating Brain Injury: Jin Bong Ye, Young Hoon Sul, Se Heon Kim, Jin Young Lee, Jin Suk Lee, Hong Rye Kim, Soo Young Yoon, Jung Hee Choi; J Trauma Inj. 2021;34(3):203-207. Published online September 30, 2021; DOI: https://doi.org/10.20408/jti.2021.0030

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Abstract PDF: Penetrating brain injury caused by a nail gun is an uncommon clinical scenario reported in the literature. A 36-year-old male presented with a nail that had penetrated through the occipital bone. He was alert and neurologically intact except for visual disturbance. Computed tomography (CT) of the brain showed the nail lodged at the occipital lobe and the parietal lobe, with minimal intracerebral hemorrhage. The nail was placed in the occipital lobe close to the superior sagittal sinus. We removed the nail with craniotomy since the entrance of the nail was close to the superior sagittal sinus. There were no newly developed neurological deficits postoperatively. Immediate postoperative CT showed no newly developed lesions. The patient recovered well without any significant complications. Two weeks postoperatively, magnetic resonance imaging showed no remarkable lesions. The visual disturbance was followed up at the outpatient department. To summarize, we report a rare case of penetrating head injury by a nail gun and discuss relevant aspects of the clinical management.; Summary

Cerebral Fat Embolism That Was Initially Negative on DiffusionWeighted Magnetic Resonance Imaging: Seung Je Go, Yun Su Mun, Seung Ho Bang, Yong Han Cha, Young Hoon Sul, Jin Bong Ye, Jae Guk Kim; J Trauma Inj. 2021;34(2):126-129. Published online March 22, 2021; DOI: https://doi.org/10.20408/jti.2020.0007

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Abstract PDF: Fat embolism syndrome is a rare, but serious condition that occurs in patients with fractures of the long bones or who undergo orthopedic surgery. The main clinical features of fat embolism syndrome are an altered mental status, hypoxia, and petechial rash. Cerebral fat embolism is the most severe manifestation of fat embolism syndrome because it can lead to an altered mental status. The diagnosis of cerebral fat embolism is clinical, but brain magnetic resonance image (MRI) is helpful. There is usually an interval until symptoms, such as an altered mental status, develop after trauma. We report a case of cerebral fat embolism in which the patient’s mental status deteriorated several hours after trauma and the initial findings were negative on diffusion-weighted MRI.; Summary

Chronic Traumatic Glass Foreign Body Removal from the Lung through a Direct Parenchymal Incision: Su Young Yoon, Si Wook Kim, Jin Suk Lee, Jin Young Lee, Jin Bong Ye, Se Heon Kim, Young Hoon Sul; J Trauma Inj. 2019;32(4):248-251. Published online December 30, 2019; DOI: https://doi.org/10.20408/jti.2019.031

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Abstract PDF

Traumatic intrapulmonary glass foreign bodies that are missed on an initial examination can migrate and lead to severe complications. Here, we present a rare case of a traumatic intrapulmonary glass foreign body surgically removed by a direct pulmonary incision, which preserved the pulmonary parenchyma and avoided severe complications caused by migration.

Summary

Citations

Citations to this article as recorded by

Thoracoscopic retrieval of an intrapulmonary sewing needle: A case report
Houssem Messaoudi, Imen Ben Ismail, Wafa Ragmoun, Hatem Lahdhili, Saber Hachicha, Slim Chenik
Clinical Case Reports.2020; 8(12): 2494. CrossRef

Experience of Penetrating Gunshot Wound on Head in Korea: Hong Rye Kim, Seung Je Go, Young Hoon Sul, Jin Bong Ye, Jin Young Lee, Jung Hee Choi, Seoung Myoung Choi, Yook Kim, Su Young Yoon; J Trauma Inj. 2018;31(2):82-86. Published online August 31, 2018; DOI: https://doi.org/10.20408/jti.2018.31.2.82

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Abstract PDF

Craniocerebral gunshot injuries (CGIs) are extremely seldom happened in Korea because possession of individual firearm is illegal. So, CGIs are rarely encountered by Korean neurosurgeons or Korean trauma surgeons, though in other developing countries or Unites states of America their cases are indefatigably increasing. Management goal should focus on early aggressive, vigorous resuscitation. The treatments consist of immediate life salvage through correction of coagulopathy, intracranial decompression, prevention of infection and preservation of nervous tissue. There have been few studies involving penetrating CGIs in Korea. Here we present a case of penetrating gunshot wound in Korea. We present a 58-year-old man who was unintentionally shot by his colleague with a shotgun. The patients underwent computed tomography (CT) for assessment of intracranial injury. The bullet passed through the left parietal bone and right lateral ventricle and exited through the posterior auricular right temporal bone. After CT scan, he arrested and the cardiopulmonary resuscitation was conducted immediately. But we were unable to resuscitate him. This case report underscores the importance of the initial clinical exam and CT studies along with adequate resuscitation to make the appropriate management decision. Physicians should be familiar with the various injury patterns and imaging findings which are poor prognostic indicators.

Summary

Citations

Citations to this article as recorded by

Civilian penetrating traumatic brain injury: A 5-year single-center experience
Omid Yousefi, Pouria Azami, Roham Borazjani, Amin Niakan, Mahnaz Yadollahi, Hosseinali Khalili
Surgical Neurology International.2023; 14: 28. CrossRef

The Management of Lupus Thrombocytopenia in Poly Trauma Patient: Jin Bong Ye, Young Hoon Sul, Seung Je Go, Jung Hee Choi, Joong Suck Kim; J Trauma Inj. 2017;30(2):59-62. Published online June 30, 2017; DOI: https://doi.org/10.20408/jti.2017.30.2.59

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Abstract PDF: Lupus thrombocytopenia is a common clinical manifestation in systemic lupus erythematosus (SLE). It may present to clinicians with considerable therapeutic difficulties. We experienced a 40-year-old poly trauma patient with lupus thrombocytopenia who had been treated with immunosuppressive drugs for SLE. She was treated for refractory thrombocytopenia with platelet transfusion, corticosteroid and Intravenous immunoglobulin (IVIG). Fourteen days after admission, her platelet count started to increase, 101×103/ul at 16 days after admission. Trauma patients may carry various underlying diseases and thus trauma surgeons should always be aware and ready for peculiar situations.; Summary

Pelvic Bone Fracture with Preperitoneal Hemorrhage: Joong Suck Kim, Young Hoon Sul, Seung Je Go, Jin Bong Ye, Sang Soon Park, Gwan Woo Ku, Yeong Cheol Kim; J Trauma Inj. 2015;28(4):272-275. Published online December 31, 2015; DOI: https://doi.org/10.20408/jti.2015.28.4.272

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Abstract PDF: Pelvic bone fracture with unstable vital signs is a life-threatening condition demanding proper diagnosis and immediate treatment. Unlike long bones, the pelvic bone is a three dimensional structure with complex holes and grooves for vessels and nerves. Because of this complexity, a pelvic bone fracture can lead to complicated and serious bleeding. We report a case of a fifty-year-old male suffering from a pelvic bone fracture due to a fall. An imaging study showed fractures of both the superior and the inferior ramus of the pubic bone, with contrast extravasation underneath them, resulting in a large preperitoneal hematoma. He was sent for angiography, which revealed a hemorrhage from a branch of the left obturator artery. Embolization was done with a glue and lipiodol mixture. The patient recovered without complication, and was discharged at four weeks after admission.; Summary

Arteriovenous Fistula between Renal Artery and Inferior Vena Cava following Penetrating Abdominal Trauma; A Case Report: Joong Suck Kim, Seung Je Go, Ji Dae Kim, Young Hoon Sul, Jin Bong Ye, Sang Soon Park, Gwan Woo Ku, Yeong Cheol Kim; J Trauma Inj. 2015;28(4):262-265. Published online December 31, 2015; DOI: https://doi.org/10.20408/jti.2015.28.4.262

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Abstract PDF: An arteriovenous fistula (AVF) from the renal artery following a penetrating abdominal trauma is not common. We report the case of a 19-year-old male who presented with a knife stab wound in the right upper quadrant. Due to unstable vital signs and to the protrusion of the mesentery through the stab wound, providing definite evidence of peritoneal violation, an emergent exploratory laparotomy was carried out. There were injuries at the proximal transverse mesocolon and the second portion of the duodenum, with bile leakage. There was also a mild amount of retroperitoneal hematoma near the right kidney, without signs of expansion or pulsation. The mesocolon and the duodenum were repaired. After the operation, abdominal computerized tomography (CT) was performed, which revealed contrast from the right renal artery shunting directly into the vena cava. Transcatheter arterial embolization with a coil and vascular plug was performed, and the fistula was repaired. The patient recovered completely and was discharged without complication. For further and thorough evaluation of an abdominal trauma, especially one involving the retroperitoneum, a CT scan is recommended, when possible, either prior to surgery or after surgery when the patient is stabile. Furthermore, a lateral retroperitoneal hematoma and an AVF after a penetrating trauma may not always require exploration. Sometimes, it may be safely treated non-operatively or with embolization.; Summary

Original Article

Clinical Analysis of TEVAR in Blunt Thoracic Aortic Injury: Gwan Woo Ku, Jin Ho Choi, Min Suk Choi, Sang Soon Park, Young Hoon Sul, Seung Je Go, Jin Bong Ye, Joong Suck Kim, Yeong Cheol Kim, Jung Joo Hwang; J Trauma Inj. 2015;28(4):232-240. Published online December 31, 2015; DOI: https://doi.org/10.20408/jti.2015.28.4.232

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Abstract PDF: PURPOSE
Thoracic aortic injury is a life-threatening injury that has been traditionally treated by using surgical management. Recently, thoracic endovascular aortic repair (TEVAR) has been conducted pervasively as a better alternative treatment method. Therefore, this study will focus on analyzing the outcome of TEVAR in patients suffering from a blunt thoracic aortic injury.
METHODS
Of the blunt thoracic aortic injury patients admitted to Eulji University Hospital, this research focused on the 11 patients who had received TEVAR during the period from January 2008 to April 2014.
RESULTS
Seven of the 11 patients were male. At the time of admission, the mean systolic pressure was 105.64+/-24.60 mm Hg, and the mean heart rate was 103.64+/-20.02 per minute. The median interval from arrival to repair was 7 (4, 47) hours. The mean stay in the ICU was 21.82+/-16.37 hours. In three patients, a chimney graft technique was also performed to save the left subclavian artery. In one patient, a debranching of the aortic arch vessels was performed. In two patients, the left subclavian artery was totally covered. In one patient whose proximal aortic neck length was insufficient, the landing zone was extended by using a prophylactic left subclavian artery to left common carotid artery bypass before TEVAR. There were no operative mortalities, but a patient who was covered of left subclavian artery died from ischemic brain injury. Complications such as migration, endovascular leakage, collapse, infection and thrombus did not occur.
CONCLUSION
Our short-term outcomes of TEVAR for blunt thoracic aorta injury was feasible. Left subclavian artery may be sacrificed if the proximal landing zone is short, but several methods to continue the perfusion should be considered.; Summary

Case Reports

Pericardial Tamponade following Perihepatic Gauze Packing for Blunt Hepatic Injury: Jin Bong Ye, Young Hoon Sul, Seung Je Go, Oh Sang Kwon, Joong Suck Kim, Sang Soon Park, Gwan Woo Ku, Min Koo Lee, Yeong Cheol Kim; J Trauma Inj. 2015;28(3):211-214. Published online September 30, 2015; DOI: https://doi.org/10.20408/jti.2015.28.3.211

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Abstract PDF: The primary and secondary survey was designed to identify all of a patient's injuries and prioritize their management. However 15 to 22.3% of patient with missed injuries had clinically significant missed injuries. To reduce missed injury, special attention should be focused on patients with severe anatomical injury or obtunded. Victims of blunt trauma commonly had multiple system involvement. Some reports indicate that inexperience, breakdown of estalished protocol, clinical error, and restriction of imaging studies may be responsible for presence of missed injury. The best way of reducing clinical significant of missed injuries was repeated clinical assessment. Here we report a case of severe blunt hepatic injury patient and pericardial injury that was missed in primary and secondary survey. After damage control surgery of hepatic injury, she remained hemodynamically unstable. Further investigation found cardiac tamponade during intensive care. This was managed by pericardial window operation through previous abdominal incision and abdominal wound closure was performed.; Summary

Wound Probing in Neck Trauma Patients: Jin Bong Ye, Young Hoon Sul, Yun Su Mun, Seung Je Go, Oh Sang Kwon, Gwan Woo Ku, Min Koo Lee; J Trauma Inj. 2015;28(3):198-201. Published online September 30, 2015; DOI: https://doi.org/10.20408/jti.2015.28.3.198

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Abstract PDF: Neck trauma is a relatively uncommon but can be a life-threatening injury. Several guidelines for neck trauma is established to recommend a proper management such as no clamping of bleeding vessels, no probing of wounds, Trendelenberg position for preventing venous air embolism. Here, we present a regretful case of 49-year-old man with neck trauma presenting undesired bleeding after probing of wound, and then discuss about treatment guildeline for neck trauma with a review.; Summary

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