Journal of Trauma and Injury

Review Article

Predictors of massive transfusion protocols activation in patients with trauma in Korea: a systematic review: Dongmin Seo, Inhae Heo, Juhong Park, Junsik Kwon, Hye-min Sohn, Kyoungwon Jung; J Trauma Inj. 2024;37(2):97-105. Published online June 14, 2024; DOI: https://doi.org/10.20408/jti.2024.0015

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Purpose
Massive transfusion protocols (MTPs) implementation improves clinical outcomes of the patient’s resuscitation with hemorrhagic trauma. Various predictive scoring system have been used and studied worldwide to improve clinical decision. However, such research has not yet been studied in Korea. This systematic review aimed to assess the predictors of MTPs activation in patients with trauma in Korea.
Methods
The PubMed, Embase, Cochrane Library, Research Information Sharing Service databases, KoreaMed, and KMbase were searched from November 2022. All studies conducted in Korea that utilized predictors of MTPs activation in adult patients with trauma were included.
Results
Ten articles were eligible for analysis, and the predictors were assessed. Clinical assessments such as systolic and diastolic blood pressure, shock index (SI), prehospital modified SI, modified early warning system (MEWS) and reverse SI multiplied by the Glasgow Coma Scale (rSIG) were used. Laboratory values such as lactate level, fibrinogen degradation product/fibrinogen ratio, and rotational thromboelastometry (ROTEM) were used. Imaging examinations such as pelvic bleeding score were used as predictors of MTPs activation.
Conclusions
Our systematic review identified predictors of MTPs activation in patients with trauma in Korea; predictions were performed using tools that requires clinical assessments, laboratory values or imaging examinations only. Among them, ROTEM, rSIG, MEWS, SI, and lactate level showed good effects for predictions of MTPs activation. The application of predictors for MTP’s activation should be individualized based on hospital resource and skill set, also should be performed as a clinical decision supporting tools.

Summary

Citations

Citations to this article as recorded by

A Case Study on Simulation Training for Operational Improvements in the Massive Transfusion Protocol
Sooin Choi, Jongbin Wee, Haeri Jung, Young Soon Cho
The Korean Journal of Blood Transfusion.2024; 35(2): 113. CrossRef

Original Article

Clinical Practice Guideline for the Treatment of Traumatic Shock Patients from the Korean Society of Traumatology: Pil Young Jung, Byungchul Yu, Chan-Yong Park, Sung Wook Chang, O Hyun Kim, Maru Kim, Junsik Kwon, Gil Jae Lee; J Trauma Inj. 2020;33(1):1-12. Published online March 30, 2020; DOI: https://doi.org/10.20408/jti.2020.015

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Abstract PDF

Purpose

Despite recent developments in the management of trauma patients in South Korea, a standardized system and guideline for trauma treatment are absent.

Methods

Five guidelines were assessed using the Appraisal of Guidelines for Research and Evaluation II instrument.

Results

Restrictive volume replacement must be used for patients experiencing shock from trauma until hemostasis is achieved (1B). The target systolic pressure for fluid resuscitation should be 80–90 mmHg in hypovolemic shock patients (1C). For patients with head trauma, the target pressure for fluid resuscitation should be 100–110 mmHg (2C). Isotonic crystalloid fluid is recommended for initially treating traumatic hypovolemic shock patients (1A). Hypothermia should be prevented in patients with severe trauma, and if hypothermia occurs, the body temperature should be increased without delay (1B). Acidemia must be corrected with an appropriate means of treatment for hypovolemic trauma patients (1B). When a large amount of transfusion is required for trauma patients in hypovolemic shock, a massive transfusion protocol (MTP) should be used (1B). The decision to implement MTP should be made based on hemodynamic status and initial responses to fluid resuscitation, not only the patient’s initial condition (1B). The ratio of plasma to red blood cell concentration should be at least 1:2 for trauma patients requiring massive transfusion (1B). When a trauma patient is in life-threatening hypovolemic shock, vasopressors can be administered in addition to fluids and blood products (1B). Early administration of tranexamic acid is recommended in trauma patients who are actively bleeding or at high risk of hemorrhage (1B). For hypovolemic patients with coagulopathy non-responsive to primary therapy, the use of fibrinogen concentrate, cryoprecipitate, or recombinant factor VIIa can be considered (2C).

Conclusions

This research presents Korea's first clinical practice guideline for patients with traumatic shock. This guideline will be revised with updated research every 5 years.

Summary

Citations

Citations to this article as recorded by

External validation of an artificial intelligence model using clinical variables, including ICD-10 codes, for predicting in-hospital mortality among trauma patients: a multicenter retrospective cohort study
Seungseok Lee, Do Wan Kim, Na-eun Oh, Hayeon Lee, Seoyoung Park, Dong Keon Yon, Wu Seong Kang, Jinseok Lee
Scientific Reports.2025;[Epub] CrossRef
The meaning and principles of damage control surgery
Gil Jae Lee
Journal of the Korean Medical Association.2024; 67(12): 732. 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
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

Case Reports

Splenic Autotransplantation after Blunt Spleen Injury in Children: Hojun Lee, Byung Hee Kang, Junsik Kwon, John Cook-Jong Lee; J Trauma Inj. 2018;31(2):87-90. Published online August 31, 2018; DOI: https://doi.org/10.20408/jti.2018.31.2.87

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Abstract PDF

Non-operative management has been preferred in blunt spleen injury. Moreover children are more susceptible to post-splenectomy infection, spleen should be preserved if possible. However, splenectomy is inevitable to patients with severe splenic injury. Therefore splenic autotransplantation could be the last chance for preserving splenic function in these patients although efficacy has not proven. Here we reported four cases of children who were underwent splenic autotransplantation successfully after blunt trauma.

Summary

Citations

Citations to this article as recorded by

Stumpfes Bauchtrauma bei Kindern und Jugendlichen: Behandlungskonzepte in der Akutphase
M. C. Schunn, J. Schäfer, F. Neunhoeffer, J. Lieber, J. Fuchs
Die Chirurgie.2023; 94(7): 651. CrossRef

Rare Imaging of Fat Embolism Seen on Computed Tomography in the Common Iliac Vein after Polytrauma: Hojun Lee, Jonghwan Moon, Junsik Kwon, John Cook-Jong Lee; J Trauma Inj. 2018;31(2):103-106. Published online August 31, 2018; DOI: https://doi.org/10.20408/jti.2018.31.2.103

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Abstract PDF

Fat embolism refers to the presence of fat droplets within the peripheral and lung microcirculation with or without clinical sequelae. However, early diagnosis of fat embolism is very difficult because the embolism usually does not show at the computed tomography as a large fat complex within vessels. Forty-eight-year-old male with pedestrian traffic accident ransferred from a local hospital by helicopter to the regional trauma center by two flight surgeons on board. At the rendezvous point, he had suffered with dyspnea without any airway obstruction sign with 90% of oxygen saturation from pulse oximetry with giving 15 L of oxygen by a reserve bag mask. The patient was intubated at the rendezvous point. The secondary survey of the patient revealed multiple pelvic bone fracture with sacrum fracture, right femur shaft fracture and right tibia head fracture. Abdominal computed tomography was performed in 191 minutes after the injury and fat embolism with Hounsfield unit of ?86 in his right common iliac vein was identified. Here is a very rare case that mass of fat embolism was shown within common iliac vein detected in computed tomography. Early detection of the fat embolus and early stabilization of the fractures are essential to the prevention of sequelae such as cerebral fat embolism.

Summary

Citations

Citations to this article as recorded by

Fat embolism in the popliteal vein detected on CT: Case report and review of the literature
Tucker Burr, Hamza Chaudhry, Cheryl Zhang, Vasilios Vasilopoulos, Emad Allam
Radiology Case Reports.2020; 15(11): 2308. CrossRef

Original Articles

Problems with Transferring Major Trauma Patients to Emergency Medical Center of a University Hospital from Another Medical Center: Sang Soo Han, Kyoungwon Jung, Junsik Kwon, Jiyoung Kim, Sang Cheon Choi, Kug Jong Lee; J Korean Soc Traumatol. 2011;24(2):118-124.

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Abstract PDF: PURPOSE
The incidence of multiple trauma is increasing nowadays and is the leading cause of death among young adults. Initial treatment is well known to be crucial in multiple trauma victims. However, many indiscriminate transfers occur due to the lack of a well-organized trauma system in Korea. The objective of this study is to demonstrate the current serious state in which major trauma patients are transferred to the Emergency Medical Center of a university hospital from another medical center.
METHODS
From November 2009 to October 2010, we performed a retrospective study to analyze the characteristics of patients who visited the Ajou University Medical Center located in Gyeonggi-do. We evaluated the ISS (injury severity score), and a score over 15 point was identified as major trauma. The major trauma patients were separated into two groups according to the visit route, and the characteristics of each group were analyzed.
RESULTS
Among the 88,862 patients who visited to the Emergency Medical Center, trauma patients accounted for 19,950, and 343 of them were evaluated as major trauma patients. Among the 343 patients, 170 patients had been transferred from other medical centers. The proportion of males to females was 3.3:1, and the mean ISS was 22.7. The leading cause of trauma was motor vehicle accidents. Of the total 170 patients, 77.6% were admitted to the Intensive care unit and 36.3% underwent surgery. The 170 patients that had been transferred to our medical center, 78.8% were transferred from Gyeonggi-do, 15.3% were transferred from other regions, and 5.9% were miscellaneous.
CONCLUSION
Almost half of the major trauma victims treat at our medical center had been transferred from other medical centers. Establishing a traumatic system, supported by well-organized trauma centers and emergency medical services, that can reduce inappropriate transfers among medical facilities is essential.; Summary

Experience with the Treatment of Patients with Major Trauma at the Department of Trauma Surgery in One Regional Emergency Medical Center for One Year: Taeyoen Kim, Kyoungwon Jung, Junsik Kwon, Jiyoung Kim, Suk ja Baek, Seo young Song, Chan suk Gang, Kug jong Lee; J Korean Soc Traumatol. 2011;24(1):37-44.

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Abstract PDF: PURPOSE
Recently, social interest in an organized trauma system for the treatment of patients has been increasing in government and academia and the establishment of trauma center is being considered across the country. However, establishing such a system has not been easy in Korea, because enormous experiences and resources are necessary. The objectives of this study were (1) to estimate a trauma patient's demands during the course of treatment and (2) to provide appropriate direction for trauma centers to be established in Korea.
METHODS
The records of 207 patients who were admitted to the Department of Trauma Surgery in Ajou University Medical Center due to trauma were retrospectively reviewed for a 1 year period from March 2010 to February 2011. Patients were reviewed for general characteristics, number of hospital days, numbers and kinds of surgeries, numbers and kinds of consultations, ISS (Injury Severity Score) and number of patients with ISS more than 15.
RESULTS
All 207 patients were enrolled. The average number of hospital days was 36.7 days. The ICU stay was 15.9 days, and the general ward stay was 20.8 days. Admitted patients occupied 9.02 beds in ICU and 11.80 beds in the general ward per day. The average number of surgeries per patient was 1.4, and surgery at the Department of Trauma Surgery was most common. Number of consultations per patient was 14.23, and consultations with orthopedic surgeons were most common. The average ISS was 18.6. The number of patients with ISS more than 15 was 141 (61.8%) and the average number of patients treated per trauma surgeon as a major trauma patient was 94.3. The number of mortalities was 20, and the mortality rate was 9.7%.
CONCLUSION
To reduce mortality and to provide proper treatment of patients with major trauma, hospitals need some number of beds, especially in the ICU, to treat patients and to prepare them for emergent surgery. An appropriate number of trauma surgeons and various specialists for consultation are also needed.; Summary

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