Journal of Trauma and Injury

Original Article

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; J Trauma Inj. 2024;37(3):201-208. Published online August 8, 2024; DOI: https://doi.org/10.20408/jti.2024.0024

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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

Case Report

Surgical management of supratentorial and infratentorial epidural hematoma in Korea: three case reports: Su Young Yoon, Junepill Seok, Yook Kim, Jin Suk Lee, Jin Young Lee, Mou Seop Lee, Hong Rye Kim; J Trauma Inj. 2023;36(4):399-403. Published online December 26, 2023; DOI: https://doi.org/10.20408/jti.2023.0073

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Abstract PDF: Supratentorial and infratentorial epidural hematoma (SIEDH) is a rare but life-threatening complication following traumatic brain injury. However, the literature on SIEDH is sparse, consisting only of a few small series. Prompt diagnosis and the application of appropriate surgical techniques are crucial for the rapid and safe management of SIEDH. Herein, we present three cases of SIEDH treated at our institution, employing a range of surgical approaches.; Summary

Original Article

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

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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1 Citations

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

Original Article

Analysis of Abdominal Trauma Patients Using National Emergency Department Information System: In Gyu Song, Jin Suk Lee, Sung Won Jung, Jong Min Park, Han Deok Yoon, Jung Tak Rhee, Sun Worl Kim, Borami Lim, So Ra Kim, Il Young Jung; J Trauma Inj. 2016;29(4):116-123. Published online December 31, 2016; DOI: https://doi.org/10.20408/jti.2016.29.4.116

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Abstract PDF

PURPOSE
To develop an inclusive and sustainable trauma system as the assessment of burden of injuries is very much important. The purpose of this study was to evaluate the estimates and characteristics of abdominal traumatic injuries.
METHODS
The data were extracted from the National Emergency Department Information System. Based on Korean Standard Classification for Disease 6th version, which is the Korean version of International Classification of Disease 10th revision, abdominal injuries were identified and abdominal surgeries were evaluated with electronic data interchange codes. Demographic factors, numbers of surgeries and clinical outcomes were also investigated.
RESULTS
From 2011 to 2014, about 24,696 patients with abdominal trauma were admitted to the hospitals annually in South Korea. The number of patients who were admitted to regional and local emergency medical centers was 8,622 (34.91%) and 15,564(63.02%), respectively. Based on National Emergency Department Information System, liver was identified as the most commonly injured abdominal solid organ (39.50%, 9,754/24,696, followed by spleen (17.57%, 4,338/24,696) and kidney (12.94%, 3,195/24,696).
CONCLUSION
This study shows that the demand for abdominal trauma care is considerable in South Korea and most of the patients with abdominal trauma were admitted to regional or local emergency centers. The results of this study can be used as good source of information for staffs to ensure proper delivery of abdominal trauma care in trauma centers nationally.

Summary

Citations

Citations to this article as recorded by

Abdominal stab wound in A Pregnant woman resulting in Evisceration, Uterine Perforation and Fetal Chest Injury: A Case Report and Literature Review
Oumarou O, Landry TW, Joe NC, Wirwah FT, Ulrich BS, Jean-Paul EN
Journal of Surgery and Surgical Research.2019; : 010. CrossRef

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