Journal of Trauma and Injury

Case Reports

Successful Damage Control Resuscitation with Resuscitative Endovascular Balloon Occlusion of the Aorta in a Pediatric Patient: Yoonjung Heo, Sung Wook Chang, Dong Hun Kim; J Trauma Inj. 2020;33(3):170-174. Published online September 30, 2020; DOI: https://doi.org/10.20408/jti.2020.0012

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Resuscitative endovascular balloon occlusion of the aorta (REBOA) is considered an emerging adjunct therapy for profound hemorrhagic shock, as it can maintain temporary stability until definitive repair of the injury. However, there is limited information about the use of this procedure in children. Herein, we report a case of REBOA in a pediatric patient with blunt trauma, wherein the preoperative deployment of REBOA played a pivotal role in damage control resuscitation. A 7-year-old male patient experienced cardiac arrest after a motor vehicle accident. After 30 minutes of cardiopulmonary resuscitation, spontaneous circulation was achieved. The patient was diagnosed with massive hemoperitoneum. REBOA was then performed under ongoing resuscitative measures. An intra-aortic balloon catheter was deployed above the supraceliac aorta, which helped achieved permissive hypotension while the patient was undergoing surgery. After successful bleeding control with small bowel resection for mesenteric avulsion, thorough radiologic evaluations revealed hypoxic brain injury. The patient died from deterioration of disseminated intravascular coagulation. Although the patient did not survive, a postoperative computed tomography scan revealed neither remaining intraperitoneal injury nor peripheral ischemia correlated with the insertion of a 7-Fr sheath. Hence, REBOA can be a successful bridge therapy, and this result may facilitate the further usage of REBOA to save pediatric patients with non-compressible torso hemorrhage.

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Dynamic response of the aortic hemodynamic status to endovascular occlusion: A computational fluid dynamics study
Zhongyou Li, Anyu Hou, Jiyang Zhang, Fei Gao, Feng Yan, Lingjun Liu, Taoping Bai, Ming Zhang, Wentao Jiang
Journal of Biomechanics.2025; 184: 112680. CrossRef

Successful TAE after DCS for Active Arterial Bleeding from Blunt Hepatic Injury in a Child: A Case Report: Chan Ik Park, Sang Bong Lee, Kwang Hee Yeo, Seungchan Lee, Sung Jin Park, Ho Hyun Kim, Jae Hun Kim, Chang Won Kim, Chan Yong Park; J Trauma Inj. 2016;29(2):47-50. Published online June 30, 2016; DOI: https://doi.org/10.20408/jti.2016.29.2.47

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Transcatheter arterial embolization (TAE) for blunt hepatic injury in children is not common and is especially rare after damage control surgery (DCS). We report a successful TAE after DCS on a child for massive bleeding from the left hepatic artery due to a motor vehicle accident. The car (a sport utility vehicle) ran over the chest and abdomen of a 4-year-old boy. On arrival, initial vital signs were as follows: blood pressure, 70/40 mmHg; heart rate, 149/min; temperature, 36.7℃; respiratory rate, 38/min. After resuscitation, computed tomography was done, and a suspicious contrast leakage from a branch of the left hepatic artery and a spleen injury (grade V) were found. TAE was performed successfully after DCS for a liver injury.

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Damage Control Surgery for Abdominal Compartment Syndrome Caused by Delayed Rupture of Hepatic Subcapsular Hematoma
Chan Yong Park, Kwang Hee Yeo, Ho Hyun Kim, Seon Hee Kim, Hyun Min Cho, Hoon Kwon, Chang Ho Jeon, Chang Won Kim, Seok Ran Yeom
Trauma Image and Procedure.2017; 2(1): 17. CrossRef

Original Articles

Injury Analysis of Child Passenger According to the Types of Safety Restraint Systems in Motor Vehicle Crashes: Kang Min Sung, Sang Chul Kim, Hyuk Jin Jeon, Yeong Soo Kwak, Young Han Youn, Kang Hyun Lee, Jong Chan Park, Ji Hun Choi; J Trauma Inj. 2015;28(3):98-103. Published online September 30, 2015; DOI: https://doi.org/10.20408/jti.2015.28.3.98

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PURPOSE
To compare injury sustained and severity of child occupant according to the types of safety restraint systems in motor vehicle crashes.
METHODS
This was a retrospective observational study. The study subjects were child occupants under the age of 8 years who visited a local emergency center following a motor vehicle crash from 2010 to 2014. According to safety restraint: child restraint systems (CRS), belted, and unbelted, we compared injuries sustained and injury severity using the maximal Abbreviated Injury Scale (MAIS) and Injury Severity Score (ISS), and analyzed the characteristics of severe injuries (AIS2+).
RESULTS
Among 241 subjects, 9.1% were restrained in CRS, 14.5% were only belted, and 76.3% was unbelted at the time of the crashes. Fourteen had severe injuries (AIS2+), all of whom didn't be restrained by CRS. Injuries in face and neck were the highest in unbelted group, and MAIS and ISS were the lowest in CRS group.
CONCLUSION
Among safety restraint systems for child occupant in motor vehicle crashes, the CRS have the preventive effect of face and neck injuries, and are the most effective safety restraint systems.

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Predicting child occupant crash injury severity in the United Arab Emirates using machine learning models for imbalanced dataset
Muhammad Uba Abdulazeez, Wasif Khan, Kassim Abdulrahman Abdullah
IATSS Research.2023; 47(2): 134. CrossRef
Current use of safety restraint systems and front seats in Korean children based on the 2008–2015 Korea National Health and Nutrition Examination Survey
Seom Gim Kong
Korean Journal of Pediatrics.2018; 61(12): 381. CrossRef

The Clinical Usefulness of Halo Sign on CT Image of Trauma Patients: Jong Il Jeong, Ah Jin Kim, Dong Wun Shin, Jun Young Rho, Kyung Hwan Kim, Hong Yong Kim, Jun Seok Park; J Korean Soc Traumatol. 2007;20(2):83-89.

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Abstract PDF: PURPOSE
This research was performed to determine which clinical signs and symptoms of brain injury are sensitive indicators of skull fracture (SF) and intracranial injury (ICI) in head injured children.
METHODS
We conducted a prospective study of minor head trauma in children younger than 2 years of age for a 1-year period. Skull radiographs, brain computed tomography (CT), and data forms, including mechanism of injury, symptoms, physical findings, and hospital course, were completed for each child.
RESULTS
Of 137 study subjects, 17 (12.4%) had SF/ICI. Falls were the most common mechanism of injury, and heights of fall above 1 meter were associated with incidence of SF/ICI (p<0.05). Scalp abnormalities were not associated with incidence of SF/ICI. As for clinical symptoms, lethargy and a grouping of features (irritability & vomiting) were associated with incidence of SF/ICI (p<0.05). The incidence of seizure, loss of consciousness, vomiting, irritability, and scalp abnormality did not differ significantly between those with normal radiologic findings and those with SF/ICI. Among asymptomatic patients, 11 (14.5%) patients had SF/ICI, and among patients with normal scalp findings, 9 (12.7%) patients had SF/ICI.
CONCLUSION
Clinical signs and symptoms, except for lethargy and a grouping of features (irritability & vomiting), were not sensitive predictors of SF/ICI. Nevertheless, SF/ICI occurred among normal children. In such a case, a liberal policy of CT scanning is warranted.; Summary

Current Status of Intraosseous Infusion Technique Use at Emergency Departments in Korea: Sang Cheon Choi, Hyun Soo Park, Jae Woo Kim; J Korean Soc Traumatol. 2007;20(1):6-11.

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Abstract PDF: PURPOSE
Gaining vascular access is difficult and time-consuming in critically ill children, so nowdays, in many countries, intraosseous vascular access is frequently used for rapid vascular access in critically ill children. Its pharmacokinetics is close to that of the peripheral intravenous route, but its infusion flow rate is faster. The purpose of this study was to determine how widely the intraosseous infusion technique was being used in Korean emergency departments.
METHODS
We telephoned forty-two (42) randomly selected university-affiliated hospitals. We asked physicians if they use the intraosseous infusion technique. Responders were emergency and pediatric residents and emergency faculty. If they responded that they were not using the intraosseous infusion technique, we asked the reason. Also, we asked about their experiences with the intraosseous infusion technique.
RESULTS
Forty-two (42) hospitals were enrolled in this study. No hospital used the intraosseous infusion technique on a regular basis. However, 8 hospitals used the intraosseous infusion technique occasionally. None of the responders had experience with the intraosseous infusion technique.
CONCLUSION
The intraosseous infusion technique is currently underrepresented at emergency departments in Korea.; Summary

ICECI Based External Causes Analysis of Severe Pediatric Injury: Ki Ok Ahn, Jae Eun Kim, Hye Young Jang, Koo Young Jung; J Korean Soc Traumatol. 2006;19(1):1-7.

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Abstract PDF: PURPOSE
Injury is a leading cause of morbidity and mortality for children. As an injury prevention measure, the differences in external causes of severe pediatric injuries based on ICECI were analyzed according to age groups.
METHODS
A retrospective study was performed for pediatric patients under 15 years of age, who had been admitted to the emergency department with severe injuries from January 1998 to December 2004. The external causes of injury were investigated according to the ICECI: intent, mechanisms, places of occurrence, objects/substances producing injury, and related activities. The patients were divided into four groups based on age: infant (< 0 year), toddler (1~4 years), preschool age (5~8 years), and school age (9~15 years).
RESULTS
The injury mechanisms, the places of occurrence and the related objects/substances vary with the age groups. The most common subtype of traffic accidents was pedestrian injury in pre-school age group. Falls most frequently occurred in the toddler group. But falls from a height of less than l meter height (6 patients) occurred only in the infant group. The most common place of occurrence in the infant group was the home, and that of other groups was the road. The related objects/substances for falls, for example, household furnitures and playground equipment depended on the age group.
CONCLUSION
The age-group specific characteristics of severe pediatric injury were analyzed successfully through the ICECI. Therefore, when establishing a plan for the prevention of pediatric injury, consideration must be given to the differences in the external causes of injuries according to age group.; Summary

Case Report

Penetrating Orbitocranial Injury of a Pencil in a Pediatric Patient: Sun Chul Hwang; J Korean Soc Traumatol. 2012;25(1):28-31.

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Abstract PDF: Pencils are common instruments for children to use and play with. This report describes an unusual penetrating orbitocranial injury in a 5-year-old girl who was struck in her facewith a pencil. She was holding it at a desk, and her friend pushed her back. The pencil penetrated the left lower eyelid and went deep into the right frontal lobe through the base of the skull. It was removed at the emergency room, after which brain CT was performed to detect the development of an intracranial hematoma. No complications occurred after conservative management with antibiotics and an antiepileptic drug. Pencils can be hazardous to children, and a penetrating head injury with a pencil may be managed without cranial surgery.; Summary

Original Articles

Indications for Computed Tomography (CT) to Detect Renal Injury in Pediatric Blunt Abdominal Trauma Patients with Microscopic Hematuria: Cheolgon Go, Hye Jin Kim, Sukjin Cho, Sung Chan Oh, Sang Lae Lee, Seok Yong Ryu; J Korean Soc Traumatol. 2010;23(1):29-37.

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Abstract PDF: PURPOSE
Controversy exists regarding whether pediatric blunt abdominal trauma patients with microscopic hematuria should undergo radiographic evaluation. Adult patients have indications such as shock and deceleration injury. This study was conducted to suggest indications for the use of CT to detect significant renal injury in pediatric blunt abdominal trauma patients with microscopic hematuria.
METHODS
From January 2005 to December 2009, patients less than 18 years of age with blunt abdominal trauma and microscopic hematuria who had undergone CT were included in this retrospective study. We analyzed the correlation between microscopic hematuria, shock, deceleration injury, and American Association for the Surgery of Trauma (AAST) renal injury grade. Patients were divided into two groups: the insignificant renal injury group (AAST grade 1) and the significant renal injury group (AAST grades 2-5). We compared age, gender, mechanism of injury, degree of microscopic hematuria, evidence of shock, presence of deceleration injury, and associated injuries between the two groups. We analyzed the effect of each of the above each factors on renal injury by using a logistic regression analysis.
RESULTS
Forty-three children were included, and the median age was 15 years. Five children had a significant renal injury. No significant differences, except age and microscopic hematuria (more than 30 red blood cells per high power field (RBC/HPF), p = 0.005) existed between the insignificant and the significant injury groups. A positive correlation existed between renal injury and microscopic hematuria (rho = 0.406, p = 0.007), but renal injury was not correlated with shock and deceleration injury. In the multivariate regression analysis, microscopic hematuria was the only factor correlated with renal injury (p = 0.042).
CONCLUSION
If a microscopic hematuria of more than 30 RBC/HPF exists, the use of CT should be considerd, regardless of shock and deceleration injury to detect significant renal injury in pediatric blunt abdominal trauma patients.; Summary

Age-related Injury Profile in Childhood: Kyung A Ahn, Eun Sook Kim, Kyung Soo Lim; J Korean Soc Traumatol. 2009;22(1):87-96.

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Abstract PDF: PURPOSE
Injuries are the most important cause of morbidity and mortality in the childhood population worldwide. Thus, this study was down to investigate the type and the severity of injuries according to the age group in childhood.
METHODS
A survey of injury information and a chart review were done on 378 children (257 boys, 121 girls) who visited the Emergency Departments of Asan Medical Center from March 1, 2009, to March 31, 2009. To determine differences in injury mechanism, accident place, injury site, New Injury Severity Score (NISS) and Pediatric Trauma Score (PTS), we divided the 378 patients into 4 group: under 1 year, 1 to 4 years, 5 to 9 years, and 10 to 15 years.
RESULTS
The mean (+/-SD) age of the study group was 5.1 (+/-4.4) years. Two year olds formed the largest group of injured children, with 77 cases (20.4% of the total). The most common cause of injury in childhood was being hit by an object (26.2%). Falls were frequent in the under-1-year group (22.2%) and slip downs (30.1%) were more frequent in 1-to-4-year group. More than half (53.4%) of the injuries occurred in the home, and the most common places of home-related injuries were the living room (41.1%) and the bedroom (31.2%). The mean (+/-SD) NISS was 1.5 (+/-1.8), and traffic accidents had the highest NISS (2.8+/-5.1). Injuries occurred most frequently during the evening. The peak period was 4:00 PM to 8:00 PM (33.7%).
CONCLUSION
Patterns of childhood injury by age group were considerably different, and less severe and nonhospitalized injuries were common. Thus, need to improve surveillance of a variety of injuries, promote intersectional collaboration, build institutional capacities and mobilize community support and policy as an investment in prevention.; Summary

A Pilot Study on Environmental Factors Contributing to Childhood Home Slip-Down Injuries: Jeong Min Ryu, Min Hoo Seo, Won Young Kim, Won Kim, Kyoung Soo Lim; J Korean Soc Traumatol. 2009;22(1):51-56.

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Abstract PDF: PURPOSE
The purpose of this study was to investigate environmental factors contributing to childhood home slip-down injuries.
METHODS
Among a total of 2,812 injured children in our Customer Injury Surveillance System (CISS), we performed a prospective study on 262 children with home slip-down injuries who visited the pediatric emergency department of Asan Medical Center between March 2008 and February 2009. We made a frequency analysis on parameters such as activities just before the accident, the presence of any obstacles or lubricant materials, specific home place in the home where the injuries occurred, flooring materials on which the slipdown happened, additional objects hit after slip down, the site and kind of injury, the duration of therapy, and the disposition.
RESULTS
Walking was the most common activity just before the injury. Because rooms and bathrooms were most common places in the home for slip down injuries, laminated papers/ vinyl floor coverings and tiles were the most common flooring materials used in the places where the injuries occured. Most commonly, no obstacles caused the children to slip down, but the furniture, stairs, doorsills, wetness, or soapy fluid followed after that. Over half of the children who slipped (58%) also collided with other than the floor itself after the slipdown, most common objects hit were the edges of the furniture, and doorsills, followed by stairways. The head and neck were the most commonly injured sites, and a laceration was the most common kind of injury. Most children needed less than 1 week of therapy, only 4 children (1.53%) admitted. There were no mortalities.
CONCLUSION
The environmental factors contributing to slip-down injuries were the bathroom, laminated papers/vinyl floors, the furniture, stairs, doorsills, and wetness or soapy fluid. Especially, the furniture, stairs, and doorsills can be both primary obstacles and secondary collision objects. For the safety of our children, we must consider these factors on housing, when decorating or remodeling our house.; Summary

Case Report

The Reality of Child Abuse in Korea: Kyuwhan Jung, Ho Seong Han, Do Joong Park, Seok Chan Eun; J Trauma Inj. 2012;25(4):283-286.

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Abstract PDF: A trauma surgeon is always concerned about child abuse when he or she meets injured children. Abused children will be neglected if trauma surgeons only concentrate on the injured site or physical dynamics. Lately, violence on children has increased in Korea. Therefore, in this study, we considered child abuse through a review of the literatures. An eleven-year-old boy visited the emergency room vomiting with abdominal distension. He had been kicked in the abdomen by his step-mother 10 days earlier. The computed tomography revealed a transected pancreas tail and neck with a large pesudocyst (Fig. 1) and laboratory findings showed an elevated amylase level of more than 6,500 IU/L. Because he complained of severe pain with rebound tenderness on the whole abdomen, he underwent an emergent laparotomy, a distal pancreatectomy of the tail portion with an anti-leakage procedure on the cut surface of the pancreas. However, he underwent a distal pancreatectomy again on the neck portion of the pancreas because of a continuing pseudocyst with severe pain that could not be controlled with conservative managements. After that, his symptoms were improved and he returned to his daily life.; Summary

Original article

Is Local Anesthesia Necessary in Ketamine Sedation for Pediatric Facial Laceration Repair?: A Double-Blind, Randomized, Controlled Study: Min Jung Ko, Jae Hyung Choi, Young Soon Cho, Jung Won Lee, Hoon Lim, Hyung Jun Moon; J Trauma Inj. 2014;27(4):178-185.

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Abstract PDF: PURPOSE
The aim of this study was to assess the clinical efficacy of combined treatment with local anesthesia and ketamine procedural sedation for pediatric facial laceration repair in the Emergency Department (ED).
METHODS
Patients aged 1 to 5 years receiving ketamine for facial laceration repair were prospectively enrolled in a double-blind, randomized, and controlled study at an ED. All patients were to receive intravenous ketamine (2 mg/kg). The local anesthesia group (LA group) received a local anesthetic along with ketamine, whereas the no local anesthesia group (NLA group) received only ketamine. The total time of sedation, the patients' movements and groans, adverse events, and the satisfaction ratings of physicians, nurses, and parents were recorded.
RESULTS
A total of 186 patients were randomized (NLA group: 90, LA group: 96). The total time of sedation (30.5 minutes for the NLA group, 32.6 minutes for the LA group; p=0.660), patients' groans (26 (28.9%) versus 23 (24.0%); 0.446) and movements (27 (30%) versus 35 (36.5%); p=0.350) was not affected by the addition of local anesthesia. Other adverse events were similar between the two groups. Also, the satisfaction ratings of physicians (median 4 for the NLA group versus 4 for the LA group (p=0.796)), nurses (2 versus 2.5 (p=0.400)), and parents (4 versus 4 (p=0.199)) were equivalent between the two groups.
CONCLUSION
In this study, we found that local anesthesia was not required along with ketamine sedation for pediatric facial laceration repair.; Summary

Original Articles

Predictive Indicators for the Severity of Pediatric Trauma and the Prevention of Injuries According to the General Characteristics and Pre-hospital Factors of Severe Pediatric Trauma Patients: Jae Hyug Woo, Hyuk Jun Yang, Yong Su Lim, Jin Seong Cho, Jin Joo Kim, Won Bin Park, Jae Ho Jang, Gun Lee; J Trauma Inj. 2014;27(3):43-49.

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Abstract PDF: PURPOSE
Trauma is one of the most common causes of death for children, and identifying severely injured children quickly in an overcrowded emergency room (ER) is difficult. Therefore, severe injury must be prevented, and the severity of injuries in children must be determined easily from their general characteristics and pre-hospital factors.
METHODS
Injured children younger than 15 years of age who visited the ER from June 2011 to May 2013 were enrolled. According to the revised trauma score (RTS) of the patients, the study population was divided in two groups, a severe group (RTS<7) and a mild group (RTS> or =7). The general characteristics and the pre-hospital factors were compared between the two groups.
RESULTS
Six hundred seventy-three children were enrolled, their mean age was 8.03 (+/-4.45) years, and 476 (70.73%) patients were male. Of these patients, 22 patients (3.27%) were in the severe group, and 651 patients (96.73%) were in the mild group. Fewer males were in the severe group than in the mild group (50.00% vs. 71.43%, p=0.030), and children in the severe group were younger than children in the mild group (3.50 vs. 8.00 years, p=0.049). In the severe group, toddlers (54.55%, p=0.036) were the most common age group. Severe injuries occurred more often in spring (32.81%) and summer (54.56%) than in autumn (9.09%) and winter (4.55%) (p=0.026). The most common places of injury in the severe group were roads (50.00%, p=0.009), and the most common mechanisms of injury in the severe group were traffic accidents (50.00%), followed by falls (31.82%) (p=0.011). Most severely injured children were transferred by ambulance (72.73%, p=0.000).
CONCLUSION
The results of this study may be helpful for identifying severely injured children quickly in the field and the ER. To prevent severe pediatric injuries, precautions and policies based on these results should be established.; Summary

Factors Associated with Radiologic Tests in Patients with Radial Head Subluxation: Ikwan Chang, Do Kyun Kim, So Young Park, Dongbum Suh, Jae Yun Jung, Young Ho Kwak; J Trauma Inj. 2014;27(2):13-19.

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Abstract PDF: PURPOSE
In general, X-ray examinations are not recommended for radial head subluxation (pulled elbow) patients. The purpose of this study was to determine the frequency of X-ray examinations and to investigate the factors associated with the decision to perform an X-ray examination on a patient with a pulled elbow.
METHODS
Patients who visited the pediatric emergency department (ED) of one tertiary hospital from January 1, 2011, to December 31, 2012, with a diagnosis of radial head subluxation at discharge were enrolled in this study. Through retrospective chart reviews, factors that could have influenced the decision to perform an X-ray examination and their statistical relevance were analyzed.
RESULTS
A total 308 patients were enrolled, and 101 patients (32.8%) underwent X-ray examinations. Among the 252 patients with a typical pulled elbow, 65 underwent X-ray examination. This result showed statistical significance compared to atypical pull-elbow group (25.8% vs. 64.3%, p<0.001). Factors associated with the decision to perform an X-ray examination were analyzed using the Chi-square test and the Fisher's exact test. The mechanism of injury and consultation with an orthopedic surgeon (p=0.001) showed statistical significance. In the multivariable logistic regression, the odds ratio (OR) for the injury mechanism was 4.7 (95% CI: 1.8~8.8, p<0.001) and that for consultation with an orthopedic surgeon was 8.0 (95% CI: 1.6~40.7, p=0.004).
CONCLUSION
One third of patients with a pulled elbow underwent X-ray examination, and patients with an atypical mechanism of injury underwent more frequent X-ray examinations than did patients with a typical mechanism of injury. The factors that could have influenced the decision to perform an X-ray examination were mechanism of injury and consultation with an orthopedic surgeon.; Summary

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