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Original Articles
Role of the Neutrophil-to-Lymphocyte Ratio at the Time of Arrival at the Emergency Room as a Predictor of Rhabdomyolysis in Severe Trauma Patients
Jin Chul Bae, Kyung Hoon Sun, Yong Jin Park
J Trauma Inj. 2020;33(2):96-103.   Published online June 17, 2020
DOI: https://doi.org/10.20408/jti.2020.018
  • 5,527 View
  • 95 Download
AbstractAbstract PDF
Purpose

In patients with trauma, rhabdomyolysis (RM) can lead to fatal complications resulting from muscle damage. Thus, RM must be immediately diagnosed and treated to prevent complications. Creatine kinase (CK) is the most sensitive marker for diagnosing RM. However, relying on CK tests may result in delayed treatment, as it takes approximately 1 hour to obtain CK blood test results. Hence, this study investigated whether the neutrophil-to-lymphocyte ratio (NLR) could predict RM at an earlier time point in patients with trauma, since NLR results can be obtained within 10 minutes.

Methods

This retrospective study included 130 patients with severe trauma who were admitted to the emergency room of a tertiary institution between January 2017 and April 2020. RM was defined as a CK level ≥1,000 U/L at the time of arrival. Patients with severe trauma were categorized into non-RM and RM groups, and their characteristics and blood test results were analyzed. Statistical analysis was performed using SPSS version 26.0 for Windows.

Results

Of the 130 patients with severe trauma, 50 presented with RM. In the multivariate analysis, the NLR (odds ratio [OR], 1.252; 95% confidence interval [CI], 1.130– 1.386), pH level (OR, 0.006; 95% CI, 0.000–0.198), presence of acute kidney injury (OR, 3.009; 95% CI, 1.140–7.941), and extremity Abbreviated Injury Scale score (OR, 1.819; 95% CI, 1.111–2.980) significantly differed between the non-RM and RM groups. A receiver operating characteristic analysis revealed that a cut-off NLR value of 3.64 was the best for predicting RM.

Conclusions

In patients with trauma, the NLR at the time of arrival at the hospital is a useful biochemical marker for predicting RM.

Summary
The Utility of Non-Invasive Nasal Positive Pressure Ventilation for Acute Respiratory Distress Syndrome in Near Drowning Patients
June Hyeong Kim, Kyung Hoon Sun, Yong Jin Park
J Trauma Inj. 2019;32(3):136-142.   Published online September 30, 2019
DOI: https://doi.org/10.20408/jti.2019.013
  • 7,470 View
  • 86 Download
  • 4 Citations
AbstractAbstract PDF
Purpose

Near drowning refers to immediate survival after asphyxia due to submersion or immersion in water, which is a crucial public safety problem worldwide. Acute lung injury or acute respiratory distress syndrome (ARDS) is a common complication of near drowning. The purpose of this study was to investigate the feasibility and effectiveness of noninvasive nasal positive pressure ventilation (NINPPV).

Methods

This retrospective study was conducted at a tertiary emergency department. NINPPV was administered for moderate ARDS caused by submersion or immersion in patients who were older than 18 years, from January 2015 to December 2018. We collected the demographic (age, sex, length of hospital stay, and outcome), laboratory (arterial blood gas, lactate, oxygen saturation, partial pressure of oxygen divided by the fraction of inspired oxygen, complete blood count, blood urea nitrogen, and creatinine), and clinical data (acute lung injury index and ventilator failure) of the patients. A statistical analysis was performed using Statistical Package for the Social Sciences version 20.0 for Windows.

Results

NINPPV treatment was provided to 57 patients for near drowning, 45 of whom (78.9%) were successfully treated without complications; in 12 (21.1%), treatment was changed to invasive mechanical ventilation within 48 hours due to ARDS or acute kidney injury. NINPPV treatment was successful in 31 (75.6%) out of 41 sea-water near drowning patients. They were more difficult to treat with NINPPV compared with the fresh-water near drowning patients (p<0.05).

Conclusions

NINPPV would be useful and feasible as the initial treatment of moderate ARDS caused by near drowning.

Summary

Citations

Citations to this article as recorded by  
  • Addressing gaps in our understanding of the drowning patient: a protocol for the retrospective development of an Utstein style database and multicentre collaboration
    Ogilvie Thom, Kym Roberts, Peter A Leggat, Susan Devine, Amy E Peden, Richard Charles Franklin
    BMJ Open.2023; 13(2): e068380.     CrossRef
  • Early pronation, protective lung ventilation and use of awake-prone-HFNO therapy after extubation in near-fatal drowning
    G. Misseri, P. Pierucci, D. Bellina, M. Ippolito, G. Ingoglia, C. Gregoretti
    Pulmonology.2023;[Epub]     CrossRef
  • Management for the Drowning Patient
    David Szpilman, Paddy J. Morgan
    Chest.2021; 159(4): 1473.     CrossRef
  • Treatment of the lung injury of drowning: a systematic review
    Ogilvie Thom, Kym Roberts, Susan Devine, Peter A. Leggat, Richard C. Franklin
    Critical Care.2021;[Epub]     CrossRef
Factors for Predicting the Need for an Emergency Blood Transfusion to a Multiple Trauma Patient Using Emergency Room Transfusion Score (ETS)
Hyeon Kyu Jo, Yong Jin Park, Sun Pyo Kim, Seong Jung Kim, Soo Hyung Cho, Nam Soo Cho
J Trauma Inj. 2015;28(1):1-8.   Published online March 30, 2015
DOI: https://doi.org/10.20408/jti.2015.28.1.1
  • 1,753 View
  • 14 Download
AbstractAbstract PDF
PURPOSE
The purposes of this study are finding the elements for a fast determination of the need for a transfusion to a multiple trauma patient arriving at this clinic in the initial stage establishing objective bases for a doctor in an emergency department to determine the need for a transfusion immediately after a patient has arrived at the emergency department, and providing treatment by considering various factors based on the nine criteria suggested in the emergency room transfusion score (ETS).
METHODS
This study was conducted on 375 multiple-trauma patients who visited the Chosun University Hospital Emergency Medical Center and activated the Emergency Trauma Team from January 2010 to December 2013. The patients were divided into the transfused group and the non-transfused group by retrospectively analyzing their medical records. Subsequently, the medical records were examined using the nine items suggested by the ETS and the results were analyzed.
RESULTS
Three hundred seventy-five patients with multiple traumas visited the Chosun University Hospital Emergency Medical Center and activated the Emergency Trauma Team. Among them, 258 died and 117 recovered and left the hospital. The deceased patients consisted of 182 males and 76 females with an average age 45. Of the 375, 165 were transferred from other hospitals, and 245 were blunt trauma patients. One hundred sixty-nine patients were injured in traffic accidents, and 119 of those 169 who had systolic blood pressure less than 90 mm Hg died. Two hundred twenty-six (60.3%) out of the 375 patients with multiple traumas received an emergency blood transfusion and their average age was 48. The 375 patients consisted of 156 males, 151 who had been transferred from other hospitals, 218 who presented with blunt trauma, 134 who had been injured in traffic accidents, 156 who had a systolic blood pressure less than 90 mm Hg, 134 who scored higher than 9 points on the GCS, and 162 who had a stable pelvic fracture of these 143 died.
CONCLUSION
During this study, 226 (60.3%) out of the patients with multiple traumas received an emergency blood transfusion. After analyzing the results related to emergency blood transfusion by using ETS, we found that an emergency blood transfusion had to be prepared quickly when patients were transferred from other hospitals when the systolic blood pressure was less than 90 mmHg. when abnormalities had been detected by ultrasonography and when the patient presented with a stable pelvic fracture.
Summary
The Thermal Insulation of Warm Fluid using Aluminium Foil in Trauma Care
Seo Jin Kim, Kyung Hoon Sun, Yong Jin Park, Sun Pyo Kim
J Trauma Inj. 2014;27(2):20-24.
  • 1,068 View
  • 6 Download
AbstractAbstract PDF
PURPOSE
The temperature of a warm fluid infused into a patient is lowered because the line that allows the fluid to be infused into the patient is exposed to room air. This study evaluated the effects of aluminum foil used as an insulator surrounding the fluid infusion lines when using warm crystalloid fluids to treat traumatic shock patients.
METHODS
The study measured the differences in fluid temperature between infusion lines with and without the aluminum-foil insulation. We used 1L of normal saline at 40degrees C as the infusion fluid, and the fluid infusion line was 200 cm long. The differences in temperature were measured for various fluid flow rates from 12,000 mL/min to 100 mL/min. We performed three experiments at each flow rate.
RESULTS
The results showed the differences in temperature between the groups with and without the aluminum insulation were significant for flow rates above 100 mL/min.
CONCLUSION
Hypothermia in trauma patients results in many adverse complications such as peripheral vascular constriction, tissue hypoxia, metabolic acidosis, heart dysfunction and so on. Thus, the use of warm fluids and blood components is essential to reduce the probability of hypothermia. This study showed the aluminum foil wrapped around the infusion line had an insulator effect. As a result, such a wrapping can be used to avoid the adverse effects of hypothermia.
Summary

J Trauma Inj : Journal of Trauma and Injury