, Dalia Koujah, Clare Zipf-Sigler, Eric Peterson, Jimmy Chim 
, Amrutha JS, Devi Prakash Mohapatra, Rajesh , Rahul Bhargava 
, Kyungwon Lee 
, Adel Elkbuli, Sarah E. Johnson, David L. McClure, Antonio Pepe , Younghoon Sul 
, Chan Ik Park, Jae Hun Kim, Chang Won Kim 
, Arun Kumar M, Kshitij Jyoti, A Saravana Santhosh, Vitesh Popli 
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, Hojong Park, Kyu Hyouck Kyoung, Sang Jun Park 
, Byung Hee Kang Citations
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, Yun Cheol Park, Young Goun Jo, Jung Chul Kim Citations
, Giljae Lee, Jungnam Lee, Byungchul Yu Citations
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The author’s trauma center implemented Mobile Trauma Units (MTU), which are ground transportation automobiles constructed with advanced medical equipment, in an attempt to improve the survival rate of severe trauma patients. The purpose of this study was to examine the efficacy of MTU as a means of inter-hospital transfer of patients in urban environments.
Patients with an injury severity score (ISS) of 16 or more were enrolled in this study. The participants must also be patients who were transferred with the MTU in the 18 months between January 2017 and June 2018. To assess the survival probability, the revised trauma score (RTS), trauma and injury severity score (TRISS), and w-score were used as the outcome indices.
Forty-four (86.3%) of the severe trauma patients with an ISS of 16 or more were male and 7 (13.7%) were female. The number of patients from the territory were 32 (62.7%), and patients from the others were 19 (37.3%). All the patients received their injury from blunt force trauma. The average time of from the scene of the accident to the trauma center was 176 minutes. In 13 deaths, 10 (76.9%) of the RTS values were below 4 points. Among the 51 patients, TRISS was more than 0.5 in 32 patients (62.7%). The w-score was 13.25 and the actual survival rate of a patient was 74.50%.
Ground transportation automobiles that use MTU for severe trauma patients in urban areas are more economically beneficial and more efficient. The survival rate while using MTU was also shown to be higher than that of medical helicopter transfers.
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An isolated pancreatic transection due to blunt trauma is a rare occurrence that usually requires surgical treatment. Non-surgical treatment for a pancreatic transection remains controversial because of its associated complications. On the other hand, non-surgical treatment has been used increasingly as a treatment option with promising results in recent years. A patient presented with a suspected pancreatic injury caused by a motorcycle accident. The computed tomography findings revealed an isolated pancreatic neck transection with a small amount of fluid collection. He was hemodynamically stable without signs of peritoneal irritation. Endoscopic retrograde pancreatography and stent insertion were performed. The patient had no significant complications and was discharged on day 18. The stent was removed on day 103 and the patient showed good recovery. For an isolated pancreatic transection, endoscopic intervention can be considered as an alternative with a good outcome in selected patients.
Trauma is a leading cause of death, even in previously healthy and disease-free individuals, and the mortality rate is very high in neck trauma patients. On the other hand, there have been few studies related to neck injuries. This study examined the characteristics and treatment results of trauma-related neck injuries using the data from Korean National Emergency Department Information System.
Neck trauma patients were classified using the 6th Korean Standard Disease Classification system. The patients’ demographic factors, number of surgeries, and clinical results were investigated. Statistical analysis was conductedusing SPSS to evaluate the annual differences in the demographic factors; mortality according to the site of injury andtype of surgery; and mechanisms of injury.
From 2011 to 2014, 2,458 neck trauma patients were treated in hospitals in South Korea. The number of patients admitted to regional and local emergency medical centers was 883 (35.9%) and 1,502 (61.1%), respectively. No significant annual differences were observed in age, sex ratio, location of treatment center, mortality, and injury site (vascular, tracheal, or esophageal). In addition, no significant differences in the cause of injury, performed surgery (%), and mortality according to the injured organ were observed.
This study revealed no annual changes in neck injury patients or differences in mortality according to injured organs. This study can be used as a basis for national research on organ-specific injuries, and may help predict the demand for future support projects for the establishment of regional trauma centers.
, Im-kyung Kim, Seo Hee Choi, Changro Lee, Man Ki Ju Patients with multiple traumas often experience multiple fractures that are missed or overlooked, despite the use of imaging, careful history taking, and physical examinations. This study aimed to evaluate the usefulness of whole body bone scan (WBBS) for detecting missed bone injuries in patients with multiple traumas.
We evaluated 30 patients with multiple traumas who underwent WBBS at single tertiary referral center between March 2008 and February 2016. We assessed the association of patient demographics with WBBS uptake as a binomial outcome variable.
There were no significant differences in patient demographics by WBBS. The mean injury severity score did not differ by WBBS (18.1 in the WBBS-negative group vs. 18.4 in the WBBS-positive group), and duration from admission to the evaluation of the WBBS was similar (5.4 days in both groups). The most common uptake site in the WBBS was the ribs (n=7), followed by the tibia (n=3), skull (n=2), ankle (n=1), and sternum (n=1). None of the missed injuries required further treatment, such as manual reduction or surgery.
WBBS was useful for detecting missed bone injuries in patients with multiple trauma.
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A new unmatched type-O packed red blood cell (UORBC) storage system was established in Ajou University Hospital Trauma Center. This system was expected to deliver faster and more efficient transfusion.
On March 2016, a new blood storage bank was installed in the trauma bay. Sixty patients who received UORBC from March 2016 to August 2016 were compared with 50 traumatic shock patients who received transfusions at the trauma bay in 2015. Time of transfusion, mortality, adverse transfusion reaction and change of systolic blood pressure were reviewed.
Transfusion time from arrival at the hospital was significantly shorter in 2016 (14.07±11.14 min vs. 34.72±15.17 min, p<0.001), but 24-hour mortality was not significantly different (13.3% vs. 20.8%, p=0.292). Systolic blood pressure significantly increased after UORBC transfusion (92.49 mmHg to 107.15 mmHg, p=0.002). Of the 60 patients who received UORBC in trauma bay, 47 (78.3%) patients had an incompatible ABO type, but no adverse transfusion reaction was notated.
UORBC allows early blood transfusion and improved systolic blood pressure without significant adverse reactions.
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Traumatic bronchial injury (TBI) is rare and often fatal, usually a result of blunt or penetrating chest trauma. Clinical manifestations of TBI include pneumothorax, pneumomediastinum, subcutaneous emphysema and continuous air leakage despite thoracostomy with negative pressure. However, TBI is initially difficult to diagnose because its signs are similar to other chest traumas. Delayed diagnosis of TBI can result in sepsis, bronchial stenosis, hypoxic injury, and eventually can cause death. We experienced two patients with TBI, possibly a result of blunt chest trauma. We did not diagnose TBI in the emergency room because we did not suspect it. During surgery, we discovered right bronchial rupture, so performed end to end anastomosis of bronchus in two patients. This report discusses the rare occurrence of TBIs due to chest trauma; our aim is to increase awareness of this diagnosis in the trauma center.
, Jonghwan Moon, Sang Hyun Lim, Yeo Jin Kim, Hyoeun Ahn, Sung Yong Park In the critically injuried and hemodynamically unstable patient, extended focused assessment with sonography for trauma (E-FAST) examination can be performed for a rapid assessment of peritoneal and/or pericardial fluid. We report a case of traumatic tricuspid regurgitation that was missed in the emergency department by E-FAST and identified by intraoperative transesophageal echocardiography.
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, Kyoung Mi Lee, In Byung Kim, Heon-Kyun Ha, Wan Sung Kim, Hyoun Jong Moon, Jin Ho Jeong, Kang Kook Choi Acute care surgery (ACS) models have evolved worldwide over the last decade. However, South Korea has an established trauma system and does not consider the ACS model. This study compares the management and outcome of emergency cholecystectomy in the ACS model to those of traditional on-call attending surgeon model for emergency surgery.
Retrospectively collected data for patients who underwent emergency cholecystectomy from May 2013 to January 2015 was analyzed to compare data from a traditional on-call system (OCS) and ACS.
One hundred and twenty-four patients were enrolled in the study (62 patients ACS vs. 62 patients OCS). Hospital stay (days) (ACS=4.29±2.49 vs. OCS=4.82±4.48, p=0.46) and stay in emergency room (minutes) (ACS=213.10±113.99 vs. OCS=241.10±150.73, p=0.20) did not differ significantly between groups. Operation time (minutes) was significantly shorter in the ACS than OCS group (389.97±215.21 vs. 566.35±290.14, p<0.001). Other clinical variables (sex, open-conversion rate, whether the operation was performed at night/holiday, intensive care unit admission rate) did not differ between groups. There was no mortality and readmission.
The implementation of the ACS led to shorter operation time and no increase of postoperative mortality and complication.
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To improve trauma outcomes, a solid logistic support system is obviously crucial. An important national trauma outcome indicator is preventable trauma death rate, 35% in Korea. The Korean government is aware of this figure and is making efforts to reduce the preventable trauma death rate by 20%. One of the main components was establishing regional trauma centers covering the Korean peninsula, and a trauma care system. Seventeen regional trauma centers will be verified by the year of 2020. To achieve this goal, trauma specialist medical staff’s role is essential. A trauma system is very complicated. It involves a broad range of health care fields from the prehospital setting to rehabilitation. In addition, a number of professionals, institutions and authorities are involved. Thus, very sophisticated systemic approaches are needed. An essential initial component is surveillance, which can start with collecting data and analyzing them thoroughly with a suitable trauma scoring system to describe the characteristics of injured patients in Korea. Several trauma scoring systems are available in Korea. However, these systems need validation to decide which is pertinent for a records- based Korean trauma system. Although the Korean Trauma Data Bank (KTDB) is recently established, it can be used for a predictive model in Korea.
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The aim of this study is to investigate the clinical characteristics and epidemiology of stab wound in a single center for 5 years.
Eighty-seven patients visited the emergency room with stab wounds between March 2008 and October 2013. Patient demographics, location of the wound, injured internal organ, and clinical parameters were reviewed.
Among eighty seven patients, 59 were male, and the mean age was 45.6 years old (range, 18∼85 years old). The most common age group was fifth and sixth decades. The most common cause of stab injury was self-infliction (32 cases), followed by violence (31 cases) and accident (23 cases). Self-infliction injuries were associated with underlying psychological problems in 20 patients. The most common injured sites were abdomen (48 cases), followed by thorax (20 cases) and neck (12 cases). Emergent exploration was required in 37 patients. Four patients (4.6%) were dead due to hypovolemic shock after injury of the thorax (lung) or neck (transection of carotid artery and transection of trachea). The length of hospital stay was 3 days (0∼6.5 days) and the injury severity score (ISS) was 4 points (1∼9 points). ISS was associated with the length of hospital stay (p<0.001) and emergency exploration (p=0.001).
Self-inflicted injury was the most common cause of stab injury and it was related to psychologic problems. The most common injured site was abdomen.
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Early diagnosis and prompt treatment of acute acalculous cholecystitis is important, because it is associated with high mortality. In major trauma patients, besides the direct damage the trauma itself causes, many complications can occur due to trauma. The purpose of this study was to evaluate the prevalence and risk factors for development of acute acalculous cholecystitis in patients with severe traumatic injuries.
In this retrospective study, we reviewed the trauma registry data of 629 major trauma patients (injury severity score>15) of Eulji University Hospital seen between May 2012 and March 2015. Of the 629 patients, twelve were diagnosed with acute acalculous cholecystitis. Information collected from the medical record review included demographic data, clinical characteristics, laboratory findings, and diagnostic and therapeutic outcomes.
Twelve patients of 629 patients (1.9%) were diagnosed with acute acalculous cholecystitis, and while nine patients survived, three patients died. The clinical and laboratory findings at the initial emergency room visit and at diagnosis of acute acalculous cholecystitis were compared, and there were significant differences in the body temperature (p=0.002), C-reactive protein (CRP) (p=0.002), alkaline phosphatase (ALP) (p=0.008), total bilirubin (p=0.015), and lactate (p=0.046).
Early diagnosis and proper treatment is important in acute acalculous cholecystitis after major trauma. If the patients after major trauma have elevated body temperature, lactate, CRP, ALP, and total bilirubin, one should keep in mind of the possibility of acute acalculous cholecystitis.
Traumatic bleeding is a prime cause of mortality after trauma, responsible for 40% of trauma- related early death. Traumatic bleeding often occurs as direct bleeding from injured site and is frequently complicated by trauma-induced coagulopathy (TIC). Traditionally, TIC was related to hemodilution, coagulation factor consumption, acidosis and hypothermia. However, TIC is now considered shock-associated hypoperfusion, a combination that activates the protein C pathway. While this adds to the understanding of this condition, the pathophysiology of TIC is not fully understood. Because TIC is composed of multiple factors, point-of-care testing (POCT) of coagulopathy that can rapidly provide information on an individual patient’s coagulation status is important. Among POCT tests are viscoelastic tests (VET), of which the most commonly used are thromboelastography and thromboelastometry. These provide rapid and dynamic bedside assessment of TIC. Treatment algorithms using VET results reduce mortality, morbidity and amount of transfusion. Although VET offers several advantages, there are limitations. VET cannot reduce mortality and morbidity, cannot fully assess the entire coagulation process, need ongoing quality control protocols, and require trained personnel. In conclusion, despite its limitations, VET has many advantages in assessment of TIC, POCT and treatment of TIC. Efforts to overcome the limitations are needed.
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