Journal of Trauma and Injury

Original Articles

The characteristics and clinical outcomes of trauma patients transferred by a physician-staffed helicopter emergency medical service in Korea: a retrospective study: Myung Jin Jang, Woo Sung Choi, Jung Nam Lee, Won Bin Park; Received October 9, 2023 Accepted November 30, 2023 Published online February 23, 2024; DOI: https://doi.org/10.20408/jti.2023.0074 [Epub ahead of print]

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Abstract PDF: Purpose
Helicopter transport with medical teams has been proven to be effective, with improvements in patient survival rates. This study compared and analyzed the clinical characteristics and treatment outcomes of trauma patients transported by doctor helicopters according to whether patients were transferred after a clinical evaluation or without a clinical evaluation.
Methods
This study retrospectively reviewed data from the Korean Trauma Data Bank of trauma patients who arrived at a regional trauma center through doctor helicopters from January 1, 2014, to December 31, 2022. The patients were divided into two groups: doctor helicopter transport before evaluation (DHTBE) and doctor helicopter transport after evaluation (DHTAE). These groups were compared.
Results
The study population included 351 cases. At the time of arrival at the trauma center, the systolic blood pressure was significantly lower in the DHTAE group than in the DHTBE group (P=0.018). The Injury Severity Score was significantly higher in the DHTAE group (P<0.001), and the accident to trauma center arrival time was significantly shorter in the DHTBE group (P<0.001). Mortality did not show a statistically significant between-group difference (P=0.094). Surgical cases in the DHTAE group had a longer time from the accident scene to trauma center arrival (P=0.002). The time from the accident to the operation room or from the accident to angioembolization showed no statistically significant differences.
Conclusions
DHTAE was associated with significantly longer transport times to the trauma center, as well as non-statistically significant trends for delays in receiving surgery and procedures, as well as higher mortality. If severe trauma is suspected, air transport to a trauma center should be requested immediately after a simple screening test (e.g., mechanism of injury, Glasgow Coma Scale, or Focused Assessment with Sonography in Trauma), which may help reduce the time to definitive treatment.; Summary

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

Comparison of pediatric injury patterns before and during the COVID-19 pandemic in Korea: a retrospective study: Geom Pil Nam, Woo Sung Choi, Jin-Seong Cho, Yong Su Lim, Jae-Hyug Woo, Jae Ho Jang, Jea Yeon Choi; J Trauma Inj. 2023;36(4):343-353. Published online December 22, 2023; DOI: https://doi.org/10.20408/jti.2023.0053

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Abstract PDF Supplementary Material: Purpose
The COVID-19 pandemic led to significant changes in the lifestyle patterns of children and affected the patterns of pediatric injuries. This study analyzed the changing patterns of pediatric injury overall and by age groups, based on the datasets before and during the COVID-19 pandemic.
Methods
This study is based on the data of patients who presented with injuries at 24 hospital emergency departments participating in the Emergency Department-based Injury In-depth Surveillance (EDIIS) conducted by the Korea Disease Control and Prevention Agency. The surveillance data was categorized by injury mechanism, location, activity, and severity. We analyzed the injury patterns of pediatric patients aged 0 to 15 years. Subgroup analysis was conducted by age group in children aged 7 to 15 years, 1 to 6 years, and <1 year.
Results
The study periods were March 12, 2018, to December 31, 2019 (pre–COVID-19 period) and March 12, 2020, to December 31, 2021 (COVID-19 pandemic period). A total of 222,304 patients aged ≤15 years were included in the study. When comparing the COVID-19 pandemic period to the pre–COVID-19 period, the total number of pediatric patients with injuries decreased by 38.7%, while the proportions of in-home injuries (57.9% vs. 67.9%), and minor injuries (39.3% vs. 49.2%) increased. In the 7 to 15 years group, bicycle riding injuries (50.9% vs. 65.6%) and personal mobility device injuries (2.4% vs. 4.6%) increased. The 1 to 6 years group also showed an increase in bicycle accident injuries (15.8% vs. 22.4%). In the <1 year group, injuries from falls increased (44.5% vs. 49.9%). Self-harm injuries in the 7 to 15 years group also increased (1.6% vs. 2.8%).
Conclusions
During the COVID-19 pandemic period, the overall number of pediatric injuries decreased, while injuries occurring at home and during indoor activities increased. Traffic accidents involving bicycles and personal mobility devices and self-harm injuries increased in the 7 to 15 years group. In the <1 year group, the incidence of falls increased. Medical and societal preparedness is needed so that we might anticipate these changes in the patterns of pediatric injuries during future infectious disease pandemics.; Summary

Factors associated with the injury severity of falls from a similar height and features of the injury site in Korea: a retrospective study: Dae Hyun Kim, Jae-Hyug Woo, Yang Bin Jeon, Jin-Seong Cho, Jae Ho Jang, Jea Yeon Choi, Woo Sung Choi; J Trauma Inj. 2023;36(3):187-195. Published online November 16, 2022; DOI: https://doi.org/10.20408/jti.2022.0042

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Abstract PDF: Purpose
This study aimed to determine the risk factors associated with the severity of fall-related injuries among patients who suffered a fall from similar heights and analyze differences in injury sites according to intentionality and injury severity.
Methods
The Emergency Department-Based Injury In-depth Surveillance data collected between 2019 and 2020 were used in this retrospective study. Patients with fall-related injuries who fell from a height of ≥6 and <9 m were included. Patients were categorized into the severe and mild/moderate groups according to their excessive mortality ratio-adjusted Injury Severity Score (EMR-ISS) and the intention and non-intention groups. Injury-related and outcome-related factors were compared between the groups.
Results
In total, 33,046 patients sustained fall-related injuries. Among them, 543 were enrolled for analysis. A total of 256 and 287 patients were included in the severe and mild/moderate groups, respectively, and 93 and 450 patients were included in the intention and non-intention groups, respectively. The median age was 50 years (range, 39–60 years) and 45 years (range, 27–56 years) in the severe and mild/moderate groups, respectively (P<0.001). In multivariable analysis, higher height (odds ratio [OR] 1.638; 95% confidence interval [Cl], 1.279–2.098) and accompanying foot injury (OR, 0.466; 95% CI, 0.263–0.828) were independently associated with injury severity (EMR-ISS ≥25) and intentionality of fall (OR, 0.722; 95% CI, 0.418–1.248) was not associated with injury severity. The incidence of forearm injuries was four (4.3%) and 58 cases (12.9%, P=0.018) and that of foot injuries was 20 (21.5%) and 54 cases (12.0%, P=0.015) in the intention versus non-intention groups, respectively.
Conclusions
Among patients who fell from a similar height, age, and fall height were associated with severe fall-related injuries. Intentionality was not related to injury severity, and patients with foot injury were less likely to experience serious injuries. Injuries in the lower and upper extremities were more common in intentional and unintentional falls, respectively.; Summary

Changes in incidence and severity of commercial motorcycle accidents due to the use of delivery service platforms in Korea: a retrospective cohort study: Dam Moon, Jae Ho Jang, Jin Seong Cho, Jae Yeon Choi, Jae-hyug Woo, Woo Sung Choi, Sung Yeol Hyun, Seung Hwan Lee; J Trauma Inj. 2023;36(2):121-127. Published online September 19, 2022; DOI: https://doi.org/10.20408/jti.2022.0031

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Abstract PDF: Purpose
Recently, a sharp increase in the use of delivery services has led to an increase in motorcycle accidents. This study aimed to identify the characteristics of the commercial motorcycle injured patients and factors related to the severity during the past 10 years.
Methods
Patients (15–64 years old) who visited the emergency department with commercial motorcycle accidents injury registered in the Korean Emergency Department-based Injury In-depth Surveillance (2011–2020) database, were included. All included cases were categorized into two groups according to the period: group 1 (2011–2015) and group 2 (2016–2020). General characteristics and the factors associated with severity were investigated.
Results
Among 8,123 emergency department visits, patients in group 1 were 3,071, and patients in group 2 were 5,052. The odds for severity were affected by patients age (odds ratio [OR], 1.008; 95% confidence interval [CI], 1.004–1.013), and overnight/morning (00:00–12:00; OR, 1.243; 95% CI, 1.091–1.415). The odds for severity were higher in head and neck injury (OR, 8.357; 95% CI, 7.410–9.424) and torso injury (OR, 4.122; 95% CI, 3.610–4.708). The odds for the severity of accidents based on excess mortality ratio-adjusted Injury Severity Score (EMR-ISS) after 2015 were significant (OR, 1.491; 95% CI, 1.318–1.687). Hospitalization in the intensive care unit and death were associated with accidents after 2015 (OR, 2.593; 95% CI, 2.120–3.170).
Conclusions
Commercial motorcycle accidents have increased significantly over the past decade. There were statistical differences in severity based on EMR-ISS and the hospitalization in intensive care unit and death.; 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

Severity of grinder injuries and related factors compared with other high-rotation cutting tool injuries: a multicenter retrospective study from 2011 to 2018: Juni Song, Yang Bin Jeon, Jae Ho Jang, Jin Seong Cho, Jae Yeon Choi, Woo Sung Choi; J Trauma Inj. 2023;36(1):32-38. Published online May 25, 2022; DOI: https://doi.org/10.20408/jti.2021.0057

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Abstract PDF: Purpose
This study aimed to identify the characteristics of patients injured by high-rotation cutting tools and the factors related to the severity of their injuries.
Methods
Adult patients (≥18 years), who presented to the emergency department (ED) after a high-rotation cutting tool injury and who were registered in the Korean Emergency Department-based Injury In-Depth Surveillance (2011–2018) database, were included. Patients’ demographic characteristics, injury-related factors, and Injury Severity Scores were collected. All included cases were categorized into two groups according to the tool that caused the injury: grinder versus nongrinder. The characteristics of the two groups were compared, and the factors associated with the severity of injuries were investigated.
Results
Among 8,697 ED visits, 4,603 patients had been using a grinder and 4,094 had been using a nongrinder tool. The most frequently injured body part while using a grinder was the hand (46.4%), followed by the head (23.0%). While using a nongrinder tool, the most frequently injured body part was also the hand (64.0%), followed by the lower leg (11.4%). The odds of a severe injury were affected by patient age (odds ratio [OR], 1.024; 95% confidence interval [CI], 1.020–1.028) and using a grinder (OR, 2.073; 95% CI, 1.877–2.290). The odds of a severe injury using a grinder were higher in arm injuries (OR, 1.60; 95% CI, 1.40–1.83) and multiple-part injuries (OR, 1.998; 95% CI, 1.639–2.437). The odds of a severe injury using a grinder were lower for head injuries (OR, 0.481; 95% CI, 0.297–0.781).
Conclusions
Injuries from grinders were more likely to affect the head and neck than nongrinder injuries, despite the lower severity. The current lack of regulations on grinders in occupational safety and health standards warrants relevant legislation and the development of applicable safety equipment.; 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

Impact of obesity on the severity of trauma in patients injured in pedestrian traffic accidents: Pillsung Oh, Jin-Seong Cho, Jae Ho Jang, Jae Yeon Choi, Woo Sung Choi, Byungchul Yu; J Trauma Inj. 2022;35(4):240-247. Published online December 8, 2021; DOI: https://doi.org/10.20408/jti.2021.0050

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Abstract PDF

Purpose
Studies on the relationship between obesity and injuries, especially those sustained in pedestrian traffic accidents, are lacking. We aimed to assess the effects of obesity on the severity of injury at the time of admission to the emergency room in patients who experienced pedestrian traffic accidents.
Methods
This study included trauma patients registered in the Korean Trauma Database from July 1, 2018 to December 31, 2020, whose mechanism of injury was pedestrian traffic accidents and who were treated at a single institution. Those aged below 15 years were excluded. Patients were assigned to nonobese and obese groups based on a body mass index of 25 kg/m². An Injury Severity Score of 25 or greater was considered to indicate a critical injury.
Results
In total, 679 cases of pedestrian traffic accidents were registered during the study period, and 543 patients were included in the final analysis. Of them, 360 patients (66.3%) and 183 patients (33.7%) were categorized as nonobese and obese, respectively. The median age was significantly higher in the nonobese group than in the obese group (60 vs. 58 years). Multivariate analysis demonstrated that the odds ratio for critical injury in obese patients was 1.59 (95% confidence interval, 1.01–2.48) compared with nonobese patients.
Conclusions
Obesity affected the likelihood of sustaining severe injuries in pedestrian traffic accidents. Future studies should analyze the effects of body mass index on the pattern and severity of injuries in patients with more diverse injury mechanisms using large-scale data.

Summary

Citations

Citations to this article as recorded by

Changes in incidence and severity of commercial motorcycle accidents due to the use of delivery service platforms in Korea: a retrospective cohort study
Dam Moon, Jae Ho Jang, Jin Seong Cho, Jae Yeon Choi, Jae-hyug Woo, Woo Sung Choi, Sung Yeol Hyun, Seung Hwan Lee
Journal of Trauma and Injury.2023; 36(2): 121. CrossRef
Pregnancy is associated with more severe injuries from motor vehicle crashes
Ya-Hui Chang, Yu-Wen Chien, Chiung-Hsin Chang, Ping-Ling Chen, Tsung-Hsueh Lu, Chung-Yi Li
Journal of the Formosan Medical Association.2023;[Epub] CrossRef

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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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

Citations

Citations to this article as recorded by

Rapid Sequence Intubation Using the SEADUC Manual Suction Unit in a Contaminated Airway
Matthew Stampfl, David Tillman, Nicholas Borelli, Tikiri Bandara, Andrew Cathers
Air Medical Journal.2023; 42(4): 296. CrossRef
Incidence and Predictors of Aspiration Pneumonia Among Traumatic Brain Injury in Northwest Ethiopia
Sahlu Mitku Shiferaw, Emiru Ayalew Mengistie, Getasew Mulatu Aknaw, Abraham Tsedalu Amare, Kefyalew Amogne Azanaw
Open Access Emergency Medicine.2022; Volume 14: 85. CrossRef

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