Journal of Trauma and Injury

Original Articles

Radiologic assessment of the optimal point for tube thoracostomy using the sternum as a landmark: a computed tomography‐based analysis: Jaeik Jang, Jae-Hyug Woo, Mina Lee, Woo Sung Choi, Yong Su Lim, Jin Seong Cho, Jae Ho Jang, Jea Yeon Choi, Sung Youl Hyun; J Trauma Inj. 2024;37(1):37-47. Published online February 23, 2024; DOI: https://doi.org/10.20408/jti.2023.0058

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Abstract PDF Supplementary Material: Purpose
This study aimed at developing a novel tube thoracostomy technique using the sternum, a fixed anatomical structure, as an indicator to reduce the possibility of incorrect chest tube positioning and complications in patients with chest trauma.
Methods
This retrospective study analyzed the data of 184 patients with chest trauma who were aged ≥18 years, visited a single regional trauma center in Korea between April and June 2022, and underwent chest computed tomography (CT) with their arms down. The conventional gold standard, 5th intercostal space (ICS) method, was compared to the lower 1/2, 1/3, and 1/4 of the sternum method by analyzing CT images.
Results
When virtual tube thoracostomy routes were drawn at the mid-axillary line at the 5th ICS level, 150 patients (81.5%) on the right side and 179 patients (97.3%) on the left did not pass the diaphragm. However, at the lower 1/2 of the sternum level, 171 patients (92.9%, P<0.001) on the right and 182 patients (98.9%, P= 0.250) on the left did not pass the diaphragm. At the 5th ICS level, 129 patients (70.1%) on the right and 156 patients (84.8%) on the left were located in the safety zone and did not pass the diaphragm. Alternatively, at the lower 1/2, 1/3, and 1/4 of the sternum level, 139 (75.5%, P=0.185), 49 (26.6%, P<0.001), and 10 (5.4%, P<0.001), respectively, on the right, and 146 (79.3%, P=0.041), 69 (37.5%, P<0.001), and 16 (8.7%, P<0.001) on the left were located in the safety zone and did not pass the diaphragm. Compared to the conventional 5th ICS method, the sternum 1/2 method had a safety zone prediction sensitivity of 90.0% to 90.7%, and 97.3% to 100% sensitivity for not passing the diaphragm.
Conclusions
Using the sternum length as a tube thoracostomy indicator might be feasible.; Summary

Epidemiology and clinical characteristics of posttraumatic hospitalized patients with symptoms related to venous thromboembolism: a single-center retrospective study: Hyung Su Park, Sung Youl Hyun, Woo Sung Choi, Jin-Seong Cho, Jae Ho Jang, Jea Yeon Choi; J Trauma Inj. 2022;35(3):159-167. Published online June 10, 2022; DOI: https://doi.org/10.20408/jti.2021.0052

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Abstract PDF: Purpose
The aim of this study was to investigate the epidemiology of trauma inpatients with venous thromboembolism (VTE) symptoms diagnosed using computed tomographic angiography (CTA) in Korea
Methods
In total, 7,634 patients admitted to the emergency department of Gachon University Gil Medical Center, a tertiary hospital, and hospitalized between July 1, 2018 and December 31, 2020 were registered for this study. Of these patients, 278 patients who underwent CTA were enrolled in our study.
Results
VTE was found in 120 of the 7,634 patients (1.57%), and the positive diagnosis rate of the 278 patients who underwent CTA was 43.2% (120 of 278). The incidence of VTE was statistically significantly higher among those with severe head and neck injuries (Abbreviated Injury Scale, 3–5) than among those with nonsevere head and neck injuries (Abbreviated Injury Scale, 0–2; P=0.038). In a subgroup analysis, the severe and nonsevere head and neck injury groups showed statistically significant differences in known independent risk factors for VTE. In logistic regression analysis, the adjusted odds ratio of severe head and neck injury (Abbreviated Injury Scale, 3–5) for VTE was 1.891 (95% confidence interval, 1.043–3.430).
Conclusions
Trauma patients with severe head and neck injuries are more susceptible to VTE than those with nonsevere head and neck injuries. Thus, physicians must consider CTA as a priority for the diagnosis of VTE in trauma patients with severe head and neck injuries who show VTE-associated symptoms.; Summary

Age group analysis of patients with dog bite injuries who visited a single regional emergency medical center and factors affecting wound infections: Dong Ho Kang, Jea Yeon Choi, Woo Sung Choi, Jae Ho Jang, Jin-Seong Cho, Sung Youl Hyun; J Trauma Inj. 2022;35(2):84-91. Published online May 17, 2022; DOI: https://doi.org/10.20408/jti.2021.0046

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Abstract PDF: Purpose
The aim of this study was to analyze by age group the characteristics of patients with dog bite injuries, as well as determine which factors were associated with wound infections in those patients.
Methods
We reviewed patients with dog bite injuries who presented to Gachon University Gil Medical Center in Incheon, Korea from January 1, 2014 to December 31, 2018. They were classified by age group: children (0–18 years), adults (19–59 years), or elderly (≥60 years). Event profiles, wound characteristics, and infections were compared across these age groups. Multivariable logistic regression was used to identify factors associated with wound infections.
Results
Of the total 972 dog bite injuries, 272 (28.0%) were in children, 606 (62.3%) were in adults, and 94 (9.7%) were in the elderly. The median age was 30 years (interquartile range, 16–48 years) and the majority of patients (60.5%) were female. The most common place of injury was at home (73.8%) and indoors (77.0%). In children, the head and neck were the most frequent sites of injury (43%), while the most frequent site in adults and the elderly (50.8% and 59.6%, respectively) was the upper extremity. The odds ratio (OR) for wound infection was 3.997 (95% confidence interval [CI], 1.279–12.491; P=0.017) for head and neck injuries and 3.881 (95% CI, 1.488–10.122; P=0.006) for lower extremity injuries. The OR for wound infection was 4.769 (95% CI, 2.167–10.494; P<0.001) for significant injuries. Elderly patients had a higher risk for wound infection than other age groups (OR, 2.586; 95% CI, 1.221–5.475; P=0.013).
Conclusions
When analyzing patients with dog bite injuries, differences across age groups were found, with the elderly at the highest risk for significant injury and wound infection. It is recommended that age-specific approaches and strategies be used to prevent dog bite wound infections.; Summary

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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21 Citations

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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Hakrim Kim, Kyoung Jun Song, Ki Jeong Hong, Jeong Ho Park, Tae Han Kim, Stephen Gyung Won Lee
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Charles D Mabry, Benjamin Davis, Michael Sutherland, Ronald Robertson, Jennifer Carger, Deidre Wyrick, Terry Collins, Austin Porter, Kyle Kalkwarf
Journal of the American College of Surgeons.2024; 238(4): 426. CrossRef
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Prolonged time to recovery and its predictors among trauma patients admitted to the intensive care units in comprehensive specialized hospitals in Northwest Ethiopia: a multicenter retrospective follow-up study, 2022
Mengistu Abebe Messelu, Temesgen Ayenew, Tesfa Sewunet Alamneh, Tiruye Azene Demile, Aster Tadesse Shibabaw, Asnake Gashaw Belayneh
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Myung Jin Jang, Woo Sung Choi, Jung Nam Lee, Won Bin Park
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Anna Dąbrowska, Wiktoria Malik, Dorota Czachor, Weronika Jarych, Anna Wściślak, Zuzanna Świąder, Łucja Komisarczyk, Piotr Pałczyński
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A Deployable Viscoelastic Coagulation Monitor Enables Point-of-Care Assessment of Coagulopathy in Swine With Polytrauma
Teryn R Roberts, Isabella Garcia, Ivan Slychko, Heidi J Dalton, Andriy I Batchinsky
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Sarah Guigues, Jean Cotte, Jean-Baptiste Morvan, Henry de Lesquen, Bertrand Prunet, Mathieu Boutonnet, Nicolas Libert, Pierre Pasquier, Eric Meaudre, Julien Bordes, Michael Cardinale
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Case Report

Pulmonary Contusion Similar to COVID-19 Pneumonia: Seung Hwan Lee, Sung Youl Hyun, Yang Bin Jeon, Jung Nam Lee, Gil Jae Lee; J Trauma Inj. 2020;33(2):119-123. Published online June 30, 2020; DOI: https://doi.org/10.20408/jti.2020.0014

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Abstract PDF

The Coronavirus disease 2019 (COVID-19) has rapidly spread across the world and caused a pandemic. It can be transmitted by an infected person or an asymptomatic carrier and is a highly contagious disease. Prevention and early identification of COVID-19 are important to minimize the transmission of COVID-19. Chest computed tomography (CT) has a high sensitivity for detecting COVID-19, but relatively low specificity. Therefore, chest CT may be difficult to distinguish COVID-19 findings from those of other infectious (notably viral types of pneumonia) or noninfectious disease. Pulmonary contusion has also a lot of similarities on chest CT with COVID-19 pneumonia. We present trauma patients with pulmonary contusion whose CT scans showed findings similar to those of COVID-19, and we report our experience in the management of trauma patients during the COVID-19 pandemic.

Summary

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Comparison of chest CT scan findings between COVID-19 and pulmonary contusion in trauma patients based on RSNA criteria: Established novel criteria for trauma victims
Hossein Abdolrahimzadeh Fard, Salahaddin Mahmudi-Azer, Qusay Abdulzahraa Yaqoob, Golnar Sabetian, Pooya Iranpour, Zahra Shayan, Shahram Bolandparvaz, Hamid Reza Abbasi, Shiva Aminnia, Maryam Salimi, Mohammad Mehdi Mahmoudi, Shahram Paydar, Roham Borazjani
Chinese Journal of Traumatology.2022; 25(3): 170. CrossRef

Original Articles

Analysis of Aspiration Risk Factors in Severe Trauma Patients: Based on Findings of Aspiration Lung Disease in Chest Computed Tomography: Gyu Jin Heo, Jungnam Lee, Woo Sung Choi, Sung Youl Hyun, Jin-Seong Cho; J Trauma Inj. 2020;33(2):88-95. Published online June 30, 2020; DOI: https://doi.org/10.20408/jti.2020.0003

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2 Citations

Abstract PDF

Purpose

The present study will identify risk factors for aspiration in severe trauma patients by comparing patients who showed a sign of aspiration lung disease on chest computed tomography (CT) and those who did not.

Methods

We conducted a retrospective review of the Korean Trauma Data Bank between January 2014 and December 2019 in a single regional trauma center. The inclusion criteria were patients aged ≥18 years with chest CT, and who had an Injury Severity Score ≥16. Patients with Abbreviated Injury Scale (AIS)-chest score ≥1 and lack of medical records were excluded. General characteristics and patient status were analyzed.

Results

425 patients were included in the final analysis. There were 48 patients showing aspiration on CT (11.2%) and 377 patients showing no aspiration (88.7%). Aspiration group showed more endotracheal intubation in the ER (p=0.000) and a significantly higher proportion of severe Glasgow Coma Scale (GCS) (p=0.000) patients than the non-aspiration group. In AIS as well, the median AIS head score was higher in the aspiration group (p=0.046). Median oxygen saturation was significantly lower in the aspiration group (p=0.002). In a logistic regression analysis, relative to the GCS mild group, the moderate group showed an odds ratio (OR) for aspiration of 2.976 (CI, 1.024–8.647), and the severe group showed an OR of 5.073 (CI, 2.442–10.539).

Conclusions

Poor mental state and head injury increase the risk of aspiration. To confirm for aspiration, it would be useful to perform chest CT for severe trauma patients with a head injury.

Summary

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Comparison of Penetrating and Blunt Traumatic Diaphragmatic Injuries: Sang Su Lee, Sung Youl Hyun, Hyuk Jun Yang, Yong Su Lim, Jin Seong Cho, Jae Hyug Woo; J Trauma Inj. 2019;32(4):210-219. Published online December 30, 2019; DOI: https://doi.org/10.20408/jti.2019.034

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2 Citations

Abstract PDF

Purpose

Traumatic diaphragmatic injury (TDI) is no longer considered to be a rare condition in Korea. This study investigated differences in the prevalence of accompanying injuries and the prognosis in patients with traumatic diaphragmatic damage according to the mechanism of injury.

Methods

We retrospectively reviewed the medical records of patients with TDI who were seen at a regional emergency medical center from January 2000 to December 2018. Among severe trauma patients with traumatic diaphragmatic damage, adults older than 18 years of age with a known mechanism of injury were included in this study. Surgery performed within 6 hours after the injury was sustained was defined as emergency surgery. We assessed the survival rate and likelihood of respiratory compromise according to the mechanism of injury.

Results

In total, 103 patients were analyzed. The patients were categorized according to whether they had experienced a penetrating injury or a blunt injury. Thirty-five patients had sustained a penetrating injury, and traffic accidents were the most common cause of blunt injuries. The location of the injury did not show a statistically significant difference between these groups. Severity of TDI was more common in the blunt injury group than in the penetrating injury group, and was also more likely in patients with respiratory compromise. However, sex, the extent of damage, and the initial Glasgow coma scale score had no significant relationship with severity.

Conclusions

Based on the findings of this study, TDI should be recognized and managed proactively in patients with blunt injury and/or respiratory compromise. Early recognition and implementation of an appropriate management strategy would improve patients’ prognosis. Multi-center, prospective studies are needed in the future.

Summary

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An audit of traumatic haemothoraces in a regional hospital in KwaZulu-Natal, South Africa
CM Kithuka, VC Ntola, W Sibanda
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Case Report

The Successful Removal of a Foreign Body in the Spleen via Diaphragm Laceration Site by Video-Assisted Thoracoscopic Surgery: Yang Bin Jeon, Sung Youl Hyun, Dae Sung Ma; J Trauma Inj. 2019;32(2):122-125. Published online June 30, 2019; DOI: https://doi.org/10.20408/jti.2018.055

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Abstract PDF

A 73-year-old man, who, in an inebriated state, had slipped in a flowerbed and was wounded on the left flank, was transferred to Trauma Center, Gil Medical Center, Gachon University College of Medicine. Based on the chest and abdominopelvic computed tomography, he was diagnosed with multiple rib fractures and hemopneumothorax on the left hemithorax and was found to have a bony fragment in the spleen. He had not presented peritonitis and exsanguinous symptoms during the observation period. Seven days later, computed tomography of the abdomen showed suspected diaphragmatic injury and a retained foreign body in the spleen. On exploration by video assisted thoracoc surgery (VATS), a herniated omentum through the lacerated site of the diaphragm was observed. After omentectomy using Endo Gia, the foreign body in the spleen was observed through the lacerated site of the diaphragm. Traumatic diaphragm rupture with a foreign body, in the spleen, was successfully managed by video assisted thoracic surgery via the lacerated site of the diaphragm.

Summary

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Fahmi Hussein Kakamad, Razhan Kawa Ali, Bnar Jamal Hama Amin, Shvan Hussein Mohammed, Diyar Adnan Omar, Karukh Khalid Mohammed, Sanaa Othman Karim, Suhaib Hussein Kakamad, Rawezh Qadir Mohammed Salih, Diyar Abubaker Mohammed, Abdulwahid Mohammed Salih, Mo
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Original Articles

The New Recreational Transportation on the Street: Personal Mobility, Is It Safe?: Young Woo Kim, Won Bin Park, Jin Seong Cho, Sung Youl Hyun, Geun Lee; J Trauma Inj. 2018;31(3):125-134. Published online December 31, 2018; DOI: https://doi.org/10.20408/jti.2018.040

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13 Citations

Abstract PDF

Purpose

The interest in the personal mobility started to grow and as the interest increases, there are growing concerns about the safety of it. The purpose of the study is to look at the types and dynamics of patients injured by the personal mobilities.

Methods

This was a retrospective 2-year observational study, from January 2016 to December 2017, on the patients who visited the emergency center and the trauma center, with an injury related to driving the personal mobility. Cases of the personal mobility-related accident were collected based on electronic medical records and hospital emergency department-based injury in-depth surveillance data.

Results

A total of 65 patients visited the emergency center and the trauma center, during this study period. Six patients of 50 adults admitted the alcohol consumption (12%) and two adult patients wore the helmet as the protection gear (3.1%). The number of the patients in 2017 rises three times more than the number of patients in 2016 (51 vs. 14). Injuries to the head and neck region (67.7%) was the most common, followed by the upper extremity (46.2%). Eleven patients (16.9%) were admitted to the hospital, of whom three were admitted to the intensive care unit due to intracranial hemorrhage. Nine patients underwent surgery.

Conclusions

The use of the personal mobility will continue to grow and the accidents, caused by the vehicle, will increase along with it. The study showed the damage is worse than expected. Personal mobility currently has a limited safety laws and the riders are not yet fully aware of its danger. The improvement of the regulation of the personal mobility, safety education is needed.

Summary

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Reuben Tamakloe, Kaihan Zhang, Ahmed Hossain, Inhi Kim, Shin Hyoung Park
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Comparative Analysis between Spinning and Other Causes in Exercise-Induced Rhabdomyolysis: Do Won Shim, Sung Youl Hyun, Jae Hyug Woo, Jae Ho Jang, Jae Yeon Choi; J Trauma Inj. 2018;31(3):159-165. Published online December 31, 2018; DOI: https://doi.org/10.20408/jti.2018.038

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Abstract PDF

Purpose

Spinning-induced rhabdomyolysis (SIR) has been increasing in recent years and accounts for a large proportion of exercise-induced rhabdomyolysis (EIR). The purpose of this study was to compare the clinical features between SIR and non-spinning exercise-induced rhabdomyolysis (NSIR), and to analyze each of these clinical features.

Methods

A retrospective chart review was conducted on patients treated due to EIR from January 2006 to March 2018. Patients were divided into the SIR and NSIR groups, and their clinical factors, outcome, and blood chemistries were compared and analyzed.

Results

Sixty-two patients were enrolled in this study, with 23 (37.1%) and 39 (62.9%) patients categorized in the SIR and NSIR groups, respectively. The SIR group were mostly women (78.3% vs. 38.5%, p=0.002), more f requent EIR occurrence in the first exercise class (60.9% vs. 15.4%, p=0.001), and had most complaints of thigh pain (91.3% vs. 43.6%, p=0.001). The SIR group had a higher incidence rate despite its shorter exercise duration (90.5% vs. 62.9%, p=0.024), longer hospital stay (6.0 [4.5?7.0] vs. 5.0 [3.5?6.0] days, p=0.080), and higher rate of peak CPK (15,000 U/L or higher) (91.3% vs. 74.4%, p=0.182) compared to the NSIR group.

Conclusions

SIR occurs at a higher rate during the first exercise class in women compared to NSIR, and the incidence rate is higher in SIR than in NSIR despite its shorter exercise duration (less than 60 minutes). It is necessary to recognize these risks during spinning exercises and to perform these exercises sequentially and systematically.

Summary

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Yoshio Masuda, Rachel Wam, Benjamin Paik, Clara Ngoh, Andrew MTL Choong, Jun Jie Ng
The Physician and Sportsmedicine.2023; 51(4): 294. CrossRef
Tackling the rhabdomyolysis outbreak before it spins out of control
Si Oon Cheah, Bernard Chee Siang Lee
Singapore Medical Journal.2022; 63(10): 564. CrossRef

Case Reports

Upper Extremity Deep Vein Thrombosis after Clavicle Fracture and Immobilization: Sung Jin Kim, Dae Sung Ma, Sung Youl Hyun, Yang Bin Jeon, Seok Joo, Ahram Han; J Trauma Inj. 2018;31(1):34-37. Published online April 30, 2018; DOI: https://doi.org/10.20408/jti.2018.31.1.34

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Abstract PDF: Upper extremity deep vein thrombosis (DVT) is an unusual condition compared to lower extremity DVT, and it represents about 10% of all DVTs. We report a case of upper extremity DVT after clavicle fracture and immobilization.; Summary

Delayed Surgical Management of Traumatic Pseudoaneurysm of the Ascending Aorta in Multiple Trauma: Dae Sung Ma, Sung Jin Kim, Seok Joo, Sung Youl Hyun, Yang Bin Jeon; J Trauma Inj. 2018;31(1):29-33. Published online April 30, 2018; DOI: https://doi.org/10.20408/jti.2018.31.1.29

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Abstract PDF: Traumatic blunt aortic injury especially on proximal ascending aorta is a rare injury with a few reports. Generally emergency surgical management was performed. In this case, however, in multiple trauma with brain injury, emergency surgical management of aortic injury might result in unexpected secondary injury of the brain. Herein, we report a case of a 33-year-old man who was driving a truck was injured in a head-on collision. Evaluation revealed a pseudoaneurysm on his ascending aorta concomitant with epidural hemorrhage. He was treated by surgical management of his ascending aorta after 3 days from accident. There were no postoperative and neurologic complications and the patient was discharged after 18 days.; Summary

Original Articles

Prognosis of Pulmonary Function in Patients with Multiple Rib Fractures: Hee Beom Park, Sung Youl Hyun, Jin Joo Kim, Yeon Sik Jang; J Trauma Inj. 2017;30(4):179-185. Published online December 30, 2017; DOI: https://doi.org/10.20408/jti.2017.30.4.179

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Abstract PDF

Purpose

Rib fracture is the most common complication of blunt thoracic trauma. We investigated the effect of rib fracture on pulmonary function in the conservatively treated patients.

Methods

From January 2000 to February 2017, we reviewed the records of 72 patients with rib fracture and pulmonary function tests were performed. According to the number of rib fractures, patients were classified into two groups: less than six fractured ribs (group A) and more than six fractured ribs (group B). The groups were compared concerning demographics, underlying diseases, associated thoracic injuries, surgery, mechanical ventilator times, days spent in the intensive care unit and pulmonary function test.

Results

There were no statistically significant differences in the demographic data between the two groups. Mean hospitalization was 13.5 days in group A and 27.0 days in group B (p<0.001). There was no statistically significant difference between the two groups in the pulmonary function test.

Conclusions

We conclude that pulmonary function is restored by conservative treatment in patients with rib fractures even if the number of rib fractures increases. In patients with multiple rib fractures, studies comparing open rib fixation and conservative treatment of long term pulmonary function are required.

Summary

Citations

Citations to this article as recorded by

Prevalence of chronic post-thoracotomy pain in patients with traumatic multiple rib fractures in South Korea: a cross-sectional study
Kun Hyung Kim, Chan Kyu Lee, Seon Hee Kim, Youngwoong Kim, Jung Eun Kim, Yu Kyung Shin, Junepill Seok, Hyun Min Cho
Scientific Reports.2021;[Epub] CrossRef
Yoga—An Alternative Form of Therapy in Patients with Blunt Chest Trauma: A Randomized Controlled Trial
Mallikarjun Gunjiganvi, Purva Mathur, Minu Kumari, Karan Madan, Atin Kumar, Rajesh Sagar, Sushma Sagar, Amit Gupta, Biplab Mishra, Altaf Hussain Mir, Mohini Meti, Subodh Kumar
World Journal of Surgery.2021; 45(7): 2015. CrossRef
Medicolegal Evaluation of Long-Term Respiratory Functions in Patients Injured Due to Traffic Accidents
Esra Dugral, Aydin Sanli, İsmail Ozgur Can
Cureus.2021;[Epub] CrossRef

Emergency Surgical Management of Traumatic Cardiac Injury in Single Institution for Three Years: Seok Joo, Dae Sung Ma, Yang Bin Jeon, Sung Youl Hyun; J Trauma Inj. 2017;30(4):166-172. Published online December 30, 2017; DOI: https://doi.org/10.20408/jti.2017.30.4.166

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Abstract PDF: Purpose
Thoracic traumas represent 10?15% of all traumas and are responsible for 25% of all trauma mortalities. Traumatic cardiac injury (TCI) is one of the major causes of death in trauma patients, rarely present in living patients who are transferred to the hospital. TCI is a challenge for trauma surgeons as it provides a short therapeutic window and the management is often dictated by the underlying mechanism and hemodynamic status. This study is to describe our experiences about emergency cardiac surgery in TCI.
Methods
This is a retrospective clinical analysis of patients who had undergone emergency cardiac surgery in our trauma center from January 2014 to December 2016. Demographics, physiologic data, mechanism of injuries, the timing of surgical interventions, surgical approaches and outcomes were reviewed.
Results
The number of trauma patients who arrived at our hospital during the study period was 9,501. Among them, 884 had chest injuries, 434 patients were evaluated to have over 3 abbreviated injury scale (AIS) about the chest. Cardiac surgeries were performed in 18 patients, and 13 (72.2%) of them were male. The median age was 47.0 years (quartiles 35.0, 55.3). Eleven patients (61.1%) had penetrating traumas. Prehospital cardiopulmonary resuscitations (CPR) were performed in 4 patients (22.2%). All of them had undergone emergency department thoracotomy (EDT), and they were transferred to the operating room for definitive repair of the cardiac injury, but all of them expired in the intensive care unit. Most commonly performed surgical incision was median sternotomy (n=13, 72.2%). The majority site of injury was right ventricle (n=11, 61.1%). The mortality rate was 22.2% (n=4).
Conclusions
This study suggests that penetrating cardiac injuries are more often than blunt cardiac injury in TCI, and the majority site of injury is right ventricle. Also, it suggests prehospital CPR and EDT are significantly responsible for high mortality in TCI.; Summary

The Value of X-ray Compared with Magnetic Resonance Imaging in the Diagnosis of Traumatic Vertebral Fractures: Yang Woo Lee, Jae Ho Jang, Jin Joo Kim, Yong Su Lim, Sung Youl Hyun, Hyuk Jun Yang; J Trauma Inj. 2017;30(4):158-165. Published online December 30, 2017; DOI: https://doi.org/10.20408/jti.2017.30.4.158

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2 Citations

Abstract PDF

Purpose

The purpose of this study was to evaluate the diagnostic accuracy of X-rays in patients with acute traumatic vertebral fractures visiting the emergency department and to analyze the diagnostic value of X-rays for each spine level.

Methods

We retrospectively analyzed basal characteristics by reviewing medical records of 363 patients with adult traumatic vertebral fractures, admitted to the emergency center from March 1, 2014 to February 28, 2017. We analyzed spine X-rays and magnetic resonance imaging (MRI) scans to determine distribution according to the vertebral level, and we evaluated the efficacy of X-rays by comparing discrepancies between X-rays and MRI scans.

Results

For a total of 363 patients, the mean age was 56.65 (20?93) and 214 (59%) were males. On the basis of X-rays, 67 cases (15.1%) were of the cervical spine, 133 cases (30.0%) were of the thoracic spine, and 243 cases (54.9%) were of the lumbar spine. In particular, the thoracolumbar region (T11-L2) was the most common, with 260 cases (58.7%). In X-rays, fractures were the least in the upper thoracic region (T1-T3), whereas MRI scans revealed fairly uniform distribution across the thoracic spine. Sensitivity of X-rays was lowest in the upper thoracic spine and specificity was almost always greater than 98%, except for 94.7% in L1. Positive predictive value was lower in the mid-thoracic region (T4-T9) and negative predictive value was slightly lower in C6, T2, and T3 than at other sites. Diagnostic accuracy of X-rays by vertebral body, transverse process, and spinous process according to fractured vertebral structures was significantly different according to vertebral level.

Conclusions

Diagnostic accuracy of X-rays was lower in the upper thoracic region than in other parts. Further studies are needed to identify better methods for diagnosis considering cost and neurological prognosis.

Summary

Citations

Citations to this article as recorded by

A novel radiological assessment to identify acute vertebral compression fractures: A pilot observational study
Keisuke Tsuruta, Toru Ueyama, Tomoo Watanabe, Yasunori Kobata, Kenichi Nakano, Hidetada Fukushima
Acute Medicine & Surgery.2023;[Epub] CrossRef
Forward Bending in Supine Test: Diagnostic Accuracy for Acute Vertebral Fragility Fracture
Chan-Woo Jung, Jeongik Lee, Dae-Woong Ham, Hyun Kang, Dong-Gune Chang, Youngbae B. Kim, Young-Joon Ahn, Joo Hyun Shim, Kwang-Sup Song
Healthcare.2022; 10(7): 1215. CrossRef

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