Journal of Trauma and Injury

Case Report

Delayed diagnosis of proximal ureter injury after a blunt abdominal trauma in Korea: a case report: Soon Ki Min, Byungchul Yu, Gil Jae Lee, Min A Lee, Yang Bin Jeon, Youngeun Park, Kang Kook Choi, Hyuk Jun Yang; J Trauma Inj. 2024;37(3):243-246. Published online September 3, 2024; DOI: https://doi.org/10.20408/jti.2024.0016

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Abstract PDF: Traumatic ureteral injuries account for fewer than 1% of traumatic urologic injuries, and those caused by blunt trauma are even rarer than those caused by penetrating trauma. The symptoms associated with ureteral injury may be subtle, with or without hematuria, making it difficult to diagnose. We report the case of a 31-year-old man with a delayed diagnosis of proximal ureter injury after abdominal blunt trauma sustained in a motorcycle traffic accident. The patient underwent emergency laparotomy on admission for liver injury, mesenteric injury, and resultant hemoperitoneum. On postoperative day 6, he underwent angioembolization for suspected remnant intra-abdominal bleeding. Persistent symptoms of flank pain and leukocytosis led to follow-up imaging studies that revealed proximal ureter injury, and the patient underwent unilateral nephrectomy. This case stresses the importance of clinical suspicion for genitourinary injuries in the presence of abdominal trauma.; Summary

Original Articles

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

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

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Clinical patterns and outcomes of hospitalized patients with grinder-related neurovascular injuries: A decade of experience from a Level I Trauma center
Hassan Al-Thani, Ayman El-Menyar, Mohammad Asim, Ibrahim Afifi
Injury.2024; : 111914. CrossRef

Case Report

Successful management of a common carotid artery injury using a Pruitt-F3 Carotid Shunt: a case report: Kang Kook Choi, Jayun Cho, Min A Lee, Soo Min Eun, Yang Bin Jeon; J Trauma Inj. 2022;35(Suppl 1):S3-S7. Published online May 25, 2022; DOI: https://doi.org/10.20408/jti.2021.0032

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Abstract PDF: Penetrating neck injuries are a surgical challenge. In particular, penetrating neck injuries associated with carotid artery injuries have a high mortality rate. Overt external hemorrhage is unanimously considered as an indication for surgical exploration. The authors present a case of successful surgical management for a penetrating common carotid artery injury using a Pruitt-F3 Carotid Shunt (LeMaitre Vascular Inc., Burlington, MA, USA) in a 60-year-old male patient who was transferred to the level 1 trauma center due to a metal fragment piercing his neck while working. Active pulsatile bleeding was observed from the 3-cm-long external wound on the anterior neck in zone II. Emergent neck exploration showed near-total transection of the left common carotid artery just below the carotid bifurcation. After a Pruitt-F3 Carotid Shunt was applied to the injured carotid artery as a temporary vascular shunt, artificial graft interposition was performed for the injured common carotid artery. The patient experienced cerebral infarction as a complication caused by ischemia-reperfusion of the common carotid artery but was discharged in a suitable state for rehabilitation therapy.; Summary

Original Articles

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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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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Effects of Transport to Trauma Centers on Survival Outcomes Among Severe Trauma Patients in Korea: Nationwide Age-Stratified Analysis
Hakrim Kim, Kyoung Jun Song, Ki Jeong Hong, Jeong Ho Park, Tae Han Kim, Stephen Gyung Won Lee
Journal of Korean Medical Science.2024;[Epub] CrossRef
TiME OUT: Time-specific machine-learning evaluation to optimize ultramassive transfusion
Courtney H. Meyer, Jonathan Nguyen, Andrew ElHabr, Nethra Venkatayogi, Tyler Steed, Judy Gichoya, Jason D. Sciarretta, James Sikora, Christopher Dente, John Lyons, Craig M. Coopersmith, Crystal Nguyen, Randi N. Smith
Journal of Trauma and Acute Care Surgery.2024; 96(3): 443. CrossRef
Progressive Reduction in Preventable Mortality in a State Trauma System Using Continuous Preventable Mortality Review to Drive Provider Education: Results of Analyzing 1,979 Trauma Deaths from 2015 to 2022
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
Emergency department laparotomy for patients with severe abdominal trauma: a retrospective study at a single regional trauma center in Korea
Yu Jin Lee, Soon Tak Jeong, Joongsuck Kim, Kwanghee Yeo, Ohsang Kwon, Kyounghwan Kim, Sung Jin Park, Jihun Gwak, Wu Seong Kang
Journal of Trauma and Injury.2024; 37(1): 20. CrossRef
Angioembolization performed by trauma surgeons for trauma patients: is it feasible in Korea? A retrospective study
Soonseong Kwon, Kyounghwan Kim, Soon Tak Jeong, Joongsuck Kim, Kwanghee Yeo, Ohsang Kwon, Sung Jin Park, Jihun Gwak, Wu Seong Kang
Journal of Trauma and Injury.2024; 37(1): 28. CrossRef
Nomogram for predicting in-hospital mortality in trauma patients undergoing resuscitative endovascular balloon occlusion of the aorta: a retrospective multicenter study
Byungchul Yu, Jayun Cho, Byung Hee Kang, Kyounghwan Kim, Dong Hun Kim, Sung Wook Chang, Pil Young Jung, Yoonjung Heo, Wu Seong Kang
Scientific Reports.2024;[Epub] CrossRef
Preventable trauma deaths in the Western Cape of South Africa: A consensus-based panel review
Julia Dixon, Shaheem de Vries, Chelsie Fleischer, Smitha Bhaumik, Chelsea Dymond, Austin Jones, Madeline Ross, Julia Finn, Heike Geduld, Elmin Steyn, Hendrick Lategan, Lesley Hodsdon, Janette Verster, Suzan Mukonkole, Karlien Doubell, Navneet Baidwan, Nee
PLOS Global Public Health.2024; 4(5): e0003122. CrossRef
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
Frontiers in Medicine.2024;[Epub] CrossRef
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
Journal of Trauma and Injury.2024; 37(2): 106. CrossRef
Evaluation of Current and Future Medical Staff Knowledge on the Course of Trauma Patient Management
Anna Dąbrowska, Wiktoria Malik, Dorota Czachor, Weronika Jarych, Anna Wściślak, Zuzanna Świąder, Łucja Komisarczyk, Piotr Pałczyński
Cureus.2024;[Epub] CrossRef
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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Analysis of mortality over 7 years in a mature trauma center: evolution of preventable mortality in severe trauma patients
Sarah Guigues, Jean Cotte, Jean-Baptiste Morvan, Henry de Lesquen, Bertrand Prunet, Mathieu Boutonnet, Nicolas Libert, Pierre Pasquier, Eric Meaudre, Julien Bordes, Michael Cardinale
European Journal of Trauma and Emergency Surgery.2023; 49(3): 1425. CrossRef
Incidence and predictors of mortality among adult trauma patients admitted to the intensive care units of comprehensive specialized hospitals in Northwest Ethiopia
Mengistu Abebe Messelu, Ambaye Dejen Tilahun, Zerko Wako Beko, Hussien Endris, Asnake Gashaw Belayneh, Getayeneh Antehunegn Tesema
European Journal of Medical Research.2023;[Epub] CrossRef
Characteristics and Clinical Outcomes of Elderly Patients with Trauma Treated in a Local Trauma Center
Kwanhoon Park, Geonjae Cho, Sungho Lee, Kang Yoon Lee, Ji Young Jang
Journal of Acute Care Surgery.2023; 13(1): 13. 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
Preventable Death Rate of Trauma Patients in a Non-Regional Trauma Center
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Nine year in-hospital mortality trends in a high-flow level one trauma center in Italy
Elisa Reitano, Roberto Bini, Margherita Difino, Osvaldo Chiara, Stefania Cimbanassi
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Decision support by machine learning systems for acute management of severely injured patients: A systematic review
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Thoracic injuries in trauma patients: epidemiology and its influence on mortality
Andrea Lundin, Shahzad K. Akram, Lena Berg, Katarina E. Göransson, Anders Enocson
Scandinavian Journal of Trauma, Resuscitation and .2022;[Epub] CrossRef

Blunt Cardiac Injuries That Require Operative Management: A Single-Center 7-Year Experience: Seung Hwan Lee, Myung Jin Jang, Yang Bin Jeon; J Trauma Inj. 2021;34(4):242-247. Published online July 14, 2021; DOI: https://doi.org/10.20408/jti.2020.0069

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Abstract PDF

Purpose

Blunt cardiac injuries (BCI) have a wide clinical spectrum, ranging from asymptomatic myocardial contusion to cardiac rupture and death. BCIs rarely require surgical intervention, but can be rapidly fatal, requiring prompt evaluation and surgical treatment in some cases. The aim of this study was to identify potential factors associated with in-hospital mortality after surgery in patients with BCI.

Methods

The medical records of 15 patients who had undergone emergency cardiac surgery for BCI between January 2014 and August 2020 were retrospectively reviewed. We included trauma patients older than 18 years admitted to Regional Trauma Center, Gachon University Gil Medical Center during the study period. Clinical and laboratory variables were compared between survivors and non-survivors.

Results

Non-survivors showed a significantly higher Injury Severity Score (p=0.001) and Abbreviated Injury Scale in the chest region (p=0.001) than survivors. American Association for the Surgery of Trauma-Organ Injury Scale Grade V injuries were significantly more common in non-survivors than in survivors (p=0.031). Non-survivors had significantly more preoperative packed red blood cell (PRBC) transfusions (p=0.019) and were significantly more likely to experience preoperative cardiac arrest (p=0.001) than survivors. Initial pH (p=0.010), lactate (p=0.026), and base excess (BE; p=0.026) levels showed significant differences between the two groups.

Conclusions

Initial pH, lactate, BE, ventricular injury, the amount of preoperative PRBC transfusions, and preoperative cardiac arrest were potential predictors of in-hospital mortality.

Summary

Citations

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Treatment results of cardiac tamponade due to thoracic trauma at Jeju Regional Trauma Center, Korea: a case series
Jeong Woo Oh, Minjeong Chae
Journal of Trauma and Injury.2023; 36(3): 180. CrossRef

Single-Center Clinical Analysis of Traumatic Thoracic Aortic Injuries: A Retrospective Observational Study: Dae Sung Ma, Yang Bin Jeon; J Trauma Inj. 2021;34(2):81-86. Published online June 24, 2021; DOI: https://doi.org/10.20408/jti.2021.0019

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Abstract PDF

Purpose

This study investigated the clinical outcomes of trauma patients with blunt thoracic aortic injuries at a single institution.

Methods

During the study period, 9,501 patients with traumatic aortic injuries presented to Trauma Center of Gil Medical Center. Among them, 1,594 patients had severe trauma, with an Injury Severity Score (ISS) of >15. Demographics, physiological data, injury mechanism, hemodynamic parameters associated with the thoracic injury according to chest computed tomography (CT) findings, the timing of the intervention, and clinical outcomes were reviewed.

Results

Twenty-eight patients had blunt aortic injuries (75% male, mean age, 45.9±16.3 years). The majority (82.1%, n=23/28) of these patients were involved in traffic accidents. The median ISS was 35.0 (interquartile range 21.0–41.0). The injuries were found in the ascending aorta (n=1, 3.6%) aortic arch (n=8, 28.6%) aortic isthmus (n=18, 64.3%), and descending aorta (n=1, 3.6%). The severity of aortic injuries on chest CT was categorized as intramural hematoma (n=1, 3.6%), dissection (n=3, 10.7%), transection (n=9, 32.2%), pseudoaneurysm (n=12, 42.8%), and rupture (n=3, 10.7%). Endovascular repair was performed in 71.4% of patients (45% within 24 hours), and two patients received surgical management. The mortality rate was 25% (n=7).

Conclusions

Traumatic thoracic aortic injuries are life-threatening. In our experience, however, if there is no rupture and extravasation from an aortic injury, resuscitation and stabilization of vital signs are more important than an intervention for an aortic injury in patients with multiple traumas. Further study is required to optimize the timing of the intervention and explore management strategies for blunt thoracic aortic injuries in severe trauma patients needing resuscitation.

Summary

Citations

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Patterns, management options and outcome of blunt thoracic aortic injuries: a 20-year experience from a Tertiary Care Hospital
Hassan Al-Thani, Suhail Hakim, Mohammad Asim, Kaleem Basharat, Ayman El-Menyar
European Journal of Trauma and Emergency Surgery.2022; 48(5): 4079. CrossRef

Case Reports

Traumatic Tricuspid Regurgitation as a Cause of Failure to Wean from Mechanical Ventilation: Yang Bin Jeon, Chul Hyun Park, Dae Sung Ma; J Trauma Inj. 2020;33(4):264-268. Published online November 19, 2020; DOI: https://doi.org/10.20408/jti.2020.0005

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Abstract PDF: A 55-year-old man underwent emergent sternotomy due to cardiac tamponade occurring just after an accidental fall from a 10-m height. Tricuspid valve regurgitation was found on echocardiography while he was on mechanical ventilation after the operation. The patient was weaned successfully from mechanical ventilation after tricuspid valve repair under cardiopulmonary bypass. Traumatic tricuspid valve regurgitation is a rare blunt chest injury and its symptoms occur late. Tricuspid regurgitation should be considered as a reason for failure to wean from mechanical ventilation after blunt cardiac trauma.; Summary

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

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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The role of VATS in the removal of intrathoracic foreign bodies — a systematic review
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
Indian Journal of Thoracic and Cardiovascular Surg.2023; 39(2): 125. CrossRef

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

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

Correlation between Optic Nerve Sheath Diameter Measured by Computed Tomography and Elevated Intracranial Pressure in Patients with Traumatic Brain Injury: Tae Kyoo Lim, Byug Chul Yu, Dae Sung Ma, Gil Jae Lee, Min A Lee, Sung Yeol Hyun, Yang Bin Jeon, Kang Kook Choi; J Trauma Inj. 2017;30(4):140-144. Published online December 30, 2017; DOI: https://doi.org/10.20408/jti.2017.30.4.140

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Abstract PDF

Purpose

The optic nerve sheath diameter (ONSD) measured by ultrasonography is among the indicators of intracranial pressure (ICP) elevation. However, whether ONSD measurement is useful for initial treatment remains controversial. Thus, this study aimed to investigate the relationship between ONSD measured by computed tomography (CT) and ICP in patients with traumatic brain injury (TBI).

Methods

A total of 246 patients with severe trauma from January 1, 2015 until December 31, 2015 were included in the study. A total of 179 patients with brain damage with potential for ICP elevation were included in the TBI group. The remaining 67 patients comprised the non-TBI group. A comparison was made between the two groups. Receiver operating characteristic (ROC) curve analysis was performed to determine the accuracy of ONSD when used as a screening test for the TBI group including those with TBI with midline shift (with elevated ICP).

Results

The mean injury severity score (ISS) and glasgow coma scale (GCS) of all patients were 24.2±6.1 and 5.4±0.8, respectively. The mean ONSD of the TBI group (5.5±1.0 mm) was higher than that of the non-TBI group (4.7±0.6 mm). Some significant differences in age (55.3±18.1 vs. 49.0±14.8, p<0.001), GCS (11.7±4.1 versus 13.3±3.0, p<0.001), and ONSD (5.5±1.0 vs. 4.7±0.6, p<0.001) were observed between the TBI and the non-TBI group. An ROC analysis was used to assess the correlation between TBI and ONSD. Results showed an area under the ROC curve (AUC) value of 0.752. The same analysis was used in the TBI with midline shift group, which showed an AUC of 0.912.

Conclusions

An ONSD of >5.5 mm, measured on CT, is a good indicator of ICP elevation. However, since an ONSD is not sensitive enough to detect an increased ICP, it should only be used as one of the parameters in detecting ICP along with other screening tests.

Summary

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Characteristics of Korean Trauma Patients: A Single-center Analysis Using the Korea Trauma Database: Youngeun Park, Min Chung, Gil Jae Lee, Min A Lee, Jae Jeong Park, Kang Kook Choi, Sung Youl Hyun, Yang Bin Jeon, Dae Sung Ma, Yong Cheol Yoon, Jungnam Lee, Byungchul Yoo; J Trauma Inj. 2016;29(4):155-160. Published online December 31, 2016; DOI: https://doi.org/10.20408/jti.2016.29.4.155

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Abstract PDF

PURPOSE
Two years have passed since a level I trauma center was officially opened in the Gacheon Gil Hospital, South Korea. We analyzed 2014 and 2015 registered patient data from the Korean Trauma Data Base (KTDB) to identify trends in trauma patient care and factors that influence the quality of trauma care at the Gacheon Gil trauma center.
METHODS
Data was extracted from the KTDB included patient age, sex, systolic blood pressure at emergency room arrival, revised trauma score, injury severity score, trauma injury severity score, transfusion amount, and the cause of death was analyzed.
RESULTS
A total of 3269 trauma patients were admitted to our trauma center in 2014 and 3225 in 2015. Demographics and mechanism of injury were not significantly different between years. The severity of trauma injury was decreased in 2015 although the mortality rate was slightly increased. This requires further analysis.
CONCLUSION
The aim of this study was to determine the general status and trends in trauma incidence and management outcomes for the Incheon area. We noted no significant changes in trauma status from 2014 to 2015. We need to collect and review trauma patient data over a long period in order to elucidate trauma incidence and management trends in the trauma field. Finally, studies using trauma patient data will indicate appropriate quality control factors for trauma care and help to improve the quality of trauma management.

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