• Journal of Trauma and Injury
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• v.34 no.1
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• pp.39-43
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• 2021

Purpose: Determining appropriate ways to assess health care quality within the National Health Insurance System is of interest to both the Korean government and the medical community. However, in the trauma field, the number of indicators used to evaluate surgical quality is limited. Using data collected over 5 years at Wonju Severance Christian Hospital Trauma Center in Korea, this study aimed to determine whether the unplanned reoperation rate in the field of trauma surgery could be used to assess the quality of an institution's surgical care. Methods: In total, 665 general surgical procedures were performed at the Trauma Center in 453 patients with abdominopelvic injuries from January 2015 to December 2019. Data were collected from the Trauma Center's data registry and medical records, and included information regarding patients' demographic characteristics, the type of index operation, and the reason for unplanned reoperations. Results: A total of 453 index operations were evaluated. The proportion of patients with an Injury Severity Score (ISS) >15 was 48-70% over the 5-year period, with an unplanned reoperation rate of 2.1-9.3%. Patients had an average ISS score of 17.5, while the average Abbreviated Injury Scale Score was 2.87. Unplanned reoperations were required in about 7% of patients. The most common complications requiring reoperation were recurrent bleeding (26.9%), wound problems (26.9%), intestinal infarction (15.4%), and anastomosis site leakage (7.7%). The procedures most frequently requiring unplanned reoperations were bowel surgery (segmental resection, primary repair, enterostomy, etc.) (24.5%) and preperitoneal pelvic packing (10.6%). Conclusions: The proportion of reoperations was confirmed to be affected by injury severity.

• Journal of Trauma and Injury
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• v.28 no.1
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• pp.15-20
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• 2015

Purpose: Vascular injuries caused by traffic, industrial accidents and by outside activities have increased in Korea. Especially, vascular injuries to the extremities can lead to limb loss and even mortality if they are not appropriately treated. The aim of the study was to evaluate the surgical outcomes of femoropopliteal vascular management after trauma. Methods: The medical records of 12 patients with femoropopliteal vascular injuries who were treated at Dankook University Hospital from 2011 to 2013 were reviewed. Iatrogenic vascular injuries were excluded. The clinical data including the causes of injury, associated injuries and surgical outcomes were analyzed retrospectively. Results: All patients were male, with a mean age of $46.8{\pm}16.3years$ (range: 26~69 years). The causes of vascular injuries were four traffic accidents, three industrial accidents, two iron plates, one outside activity, one glass injury and one knife injury. The average transit time between the place of the accident place and the emergency department was $3.0{\pm}2.1$ (0.5~12.5) hours, and the average preparation time for surgery was $8.0{\pm}6.7$ (1.7~23.3) hours. The anatomic injuries included the popliteal vessel in seven cases and the femoral vessel in five cases. The average Injury Severity Score (ISS) was $12.0{\pm}5.0$ (5~17), and the average Mangled Extremity Severity Score (MESS) was $5.7{\pm}2.1$ (2~9). The operation methods were four interposition grafts, three end-to-end anastomoses, two direct repairs and three patch angioplasties. One case required amputation of the injured extremity. Conclusion: Early recognition and revascularization of the injured vessel are mandatory to reduce limb loss and to obtain satisfactory outcomes. Therefore, careful/rapid evaluation of the vascular injuries and timely/successful surgical treatment are the keys to salvaging an injured limb.

• Journal of Auto-vehicle Safety Association
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• v.12 no.2
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• pp.40-46
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• 2020

Modern traffic accidents are a complex occurrence. Various indicators are needed to analyze traffic accidents. Countries that have been investigating traffic accidents for a long time accumulate various data to analyze traffic accidents. The Korean In-Depth Accident Study (KIDAS) database collected damaged vehicles and severity of injury caused by Collision Deformation Classification code (CDC code), Abbreviated Injury Scale (AIS), and Injury Severity Score (ISS). As a result of the investigation, data relating to the injuries of the occupants can be easily obtained, but it was difficult to analyze human severity based on the information of the damaged vehicle. This study suggests a method to measure the speed change at the time of an accident, which is one of the most important indicators in the vehicle crash database, to help advance KIDAS research.

• Journal of The Korean Society of Emergency Medicine
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• v.29 no.6
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• pp.603-615
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• 2018

Objective: We analyzed the association between regional weather and temporal changes on the daily occurrence of trauma emergencies and their severity. Methods: In this cross-sectional prospective study, we investigated daily atmospheric patterns in trauma episodes in 1,344 patients in Cheongju city, South Korea, from January 2016 to December 2016 and analyzed the association of trauma occurrence and Injury Severity Scores (ISS) with weather conditions on a daily scale. Results: The mean age of trauma patients was $53.0{\pm}23.8years$ and average ISS was $9.0{\pm}2.0$. Incidence of trauma was positively correlated with average temperature (r=0.512, P<0.001) and atmospheric pressure (r=0.332, P=0.010) and negatively correlated with air pollutants (particulate matter less than $2.5{\mu}m^3$ [PM2.5], r=-0.629, P<0.001; particulate matter less than $10{\mu}m^3$ [PM10], r=-0.679, P<0.001). ISS was not significantly correlated with climate parameters and air pollutants, and variability was observed in the frequency and severity of trauma by time of day (highest occurrence, 16-20 pm; highest ISS, 4-8 am), day of the week (highest occurrence and highest ISS, Saturday), month of the year (highest occurrence, July; highest ISS, November), and season (highest incidence, summer; highest ISS, autumn). Conclusion: The study shows a positive relationship between trauma occurrence and specific weather conditions, such as atmospheric temperature and pressure. There was a negative relationship between concentrations of PM2.5 or PM10, and trauma occurrence. However, no correlation was observed between weather conditions or the concentrations of air pollutants and ISS. In addition, seasonal, circaseptan, and circadian variations exist in trauma occurrence and severity. Thus, we suggest that evaluation of a larger, population-based data set is needed to further investigate and confirm these relationships.

• Journal of Chest Surgery
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• v.53 no.5
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• pp.291-296
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• 2020

Background: We report our 10-year experience with traumatic peripheral arterial injury repair at an urban level I trauma center. Methods: Between January 2007 and December 2016, 28 adult trauma patients presented with traumatic peripheral arterial injuries. Data were retrospectively collected on demographic characteristics, the mechanism of injury, the type of vascular injury, and physiological status on initial assessment. The analysis also included the Mangled Extremity Severity Score (MESS), Injury Severity Score, surgical procedures, and outcome variables including limb salvage, hospital stay, intensive care unit stay, and postoperative vascular complications. Results: Four (14.3%) patients required amputation due to failed revascularization. MESS significantly differed between patients with blunt and penetrating trauma (8.2±2.2 vs. 5.8±1.3, respectively; p=0.005). The amputation rate was not significantly different between patients with blunt and penetrating trauma (20% vs. 0%, respectively; p=0.295). The overall mortality rate was 3.6% (1 patient). Conclusion: Blunt trauma was associated with higher MESS than penetrating trauma, and amputation was more frequent. In particular, patients with blunt trauma had significantly higher MESS than patients with penetrating trauma (8.2±2.2 vs. 5.8±1.3, respectively; p=0.005), and amputation was performed when revascularization failed in cases of blunt trauma of the lower extremity. Therefore, particular care is needed in making treatment decisions for patients with peripheral arterial injuries caused by blunt trauma.

• Journal of Trauma and Injury
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• v.35 no.1
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• pp.3-11
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• 2022

Purpose: The increasing use of electric personal mobility devices (ePMDs) has been accompanied by an increasing incidence of associated accidents. This study aimed to investigate the characteristics of ePMD-related injuries and their associated factors. Methods: This cross-sectional study was conducted using data from the Emergency Department-based Injury In-depth Surveillance database from 2014 to 2018. All patients who were injured while operating an ePMD were eligible. The primary outcome was the rate of severe injury, defined as an excess mortality ratio-adjusted Injury Severity Score of ≥25. We calculated the adjusted odds ratios (AORs) of outcomes associated with ePMD-related injuries. Results: Of 1,391,980 injured patients, 684 (0.05%) were eligible for inclusion in this study. Their median age was 28 years old, and most injuries were sustained by men (68.0%). The rate of ePMD-related injuries increased from 3.1 injuries per 100,000 population in 2014 to 100.3 per 100,000 population in 2018. A majority of the injuries occurred on the street (32.7%). The most commonly injured area was the head and face (49.6%), and the most common diagnosis was superficial injuries or contusions (32.9%). Being aged 55 years or older (AOR, 3.88; 95% confidence interval, 1.33-11.36) and operating an ePMD while intoxicated (AOR, 2.78; 95% confidence interval, 1.52-5.08) were associated with severe injuries. Conclusions: The number of emergency room visits due to ePMD-related injuries is increasing. Old age and drunk driving are both associated with serious injuries. Active traffic enforcement and safety regulations regarding ePMDs should be implemented to prevent severe injuries caused by ePMD-related accidents.

• Journal of The Korean Society of Clinical Toxicology
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• v.13 no.2
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• pp.87-94
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• 2015

Purpose: We investigated comparison of clinical characteristics and prognosis by initial endoscopic severity in caustic injury and then discussed predisposing factors which can be helpful in predicting the prognosis and determining the treatment. Methods: This study was a retrospective review of medical records from patients over the age of 15, who underwent initial endoscopy for caustic injury from April 2007 through November 2014. Patients were classified according to two groups based on the initial endoscopic finding by Zargar's classification: patients with grade 0, I, IIa at esophagus (low risk group) and patients with grade IIb, IIIa, IIIb at esophagus (high risk group). The two groups were then compared. Results: A total of 55 patients were included (low risk group [n=44] vs. high risk group [n=11]). Old age (p<0.001), large amount of ingestion (p<0.05), oropharyngeal symptoms (p<0.01), high SOFA score (p<0.001), high WBC count (p<0.05), low base excess (p<0.01), and HCO3 (p<0.05) were statistically significant factors in the high risk group. A poor prognosis was observed for hospital stay (p<0.001), ICU admission (p<0.001), mortality (p<0.01), and stricture (p<0.001) in the high risk group. Conclusion: Clinical characteristics including age, amount of ingestion, oropharyngeal symptoms, SOFA score, WBC count, base excess, and $HCO_3$ can be helpful in the decision to undergo initial endoscopy and risk assessment by initial endoscopic severity can be helpful in predicting prognosis and determining the treatment plan.

• Journal of Trauma and Injury
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• v.32 no.4
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• pp.210-219
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• 2019

Purpose: Traumatic diaphragmatic injury (TDI) is no longer considered to be a rare condition in Korea. This study investigated differences in the prevalence of accompanying injuries and the prognosis in patients with traumatic diaphragmatic damage according to the mechanism of injury. Methods: We retrospectively reviewed the medical records of patients with TDI who were seen at a regional emergency medical center from January 2000 to December 2018. Among severe trauma patients with traumatic diaphragmatic damage, adults older than 18 years of age with a known mechanism of injury were included in this study. Surgery performed within 6 hours after the injury was sustained was defined as emergency surgery. We assessed the survival rate and likelihood of respiratory compromise according to the mechanism of injury. Results: In total, 103 patients were analyzed. The patients were categorized according to whether they had experienced a penetrating injury or a blunt injury. Thirty-five patients had sustained a penetrating injury, and traffic accidents were the most common cause of blunt injuries. The location of the injury did not show a statistically significant difference between these groups. Severity of TDI was more common in the blunt injury group than in the penetrating injury group, and was also more likely in patients with respiratory compromise. However, sex, the extent of damage, and the initial Glasgow coma scale score had no significant relationship with severity. Conclusions: Based on the findings of this study, TDI should be recognized and managed proactively in patients with blunt injury and/or respiratory compromise. Early recognition and implementation of an appropriate management strategy would improve patients' prognosis. Multi-center, prospective studies are needed in the future.

• Journal of Korean Academy of Nursing
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• v.23 no.4
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• pp.585-601
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• 1993

Data on 63 patients who had had motorcycle accidents and who were admitted to four general hospitals in the Chung Chung Nam Do area from July / 1993 to August 1993 were analyzed. The tool used for this study was a structured questionnaire which consisted of ten items on self- esteem, 18 items on health locus of control and 37 items profiling health prometion lifestyle. Injury severity scores were calculated bated based on data from the patients’ medical records. The collected data were analyzed using the SPSS, yielding descriptive statistics, t-test, ANOVA, Pearson’s Product Moment Correlation. The findings of this study are as follows. 1) Of the 63 injured motorcyclists, 35(55.6%) were helmeted and 28(44.4%) were nonhelmeted, and the nonhelmeted motorcyclists were predominantly young and male. The demographic variables for the helmeted and nonhelmeted groups were heterogeneous for age and occupation. 2) The results of the comparison between the two groups showed a statistically significant difference in the injury severity score(t=-4.70, p=0.000). The helmeted group had lower scores on injury severity score (9.00±3.93) than the nonhelmeted group(14.32土5.05). More than 60% of the nonhelmeted motorcyclists had brain injuries compared to only a third of the helmeted cyclists. 3) There .was a statistically significant difference between the two groups on self esteem(t=4.5, 000). The helmeted group had a higher mean score (31.27±2.72) than the nonhelmeted group(27.46±3.80). 4) The means for Internal health locus of control (IHLC), Powerful others health locus of control (PHLC), and Chance health locus of control (CHLC) in the two groups were similar to instrument norms reported in other literature. The mean scores on the IHLC in the two groups were higher than scores on the PHLC or the CHLC. However, there was a significant difference between the mean scores for the two groups on the PHLC (t=2.85, P=0.006). 5) The mean score for the helmeted group on the health promotion lifestyle profile was higher than the mean score for the nonhelmeted group(107.30±11.10, 96.57土 15.54 respectively), and there was a significant difference between the mean scores (t=3.64, p=0.001) . The highest score for helmeted group on the health promotion lifestyle profile was in the health care domain. However, for the nonhelmeted group the highest score was in the exercise domain and the lowest score was in the health care domain. 6) With regard to the relationship between health promotion lifestyle, health locus of control and self esteem in the two groups, the correlation coefficient between health promotion lifestyle and internal health locus of control for the helmeted group was 50(p〈0.01). For the nonhelmeted group, there was no correlation between health promotion lifestyle and internal health locus of control. However, there were significant correlation between health pro-motion lifestyle and external locus of control(r=0. 46, p〈0.01), and self esteem(r=0.495, p〈0.01). 7) Among the demographic variables, age and education had an impact on individual’s self-esteem The modifying factors of age made a contribution to explaining health - promoting lifestyle. In the present study, more than 40% rf the motorcyclists were riding without a helmet. The incidence of brain injury for patients riding without a helmet was nearly twice as high in the nonhelmeted rider as compared to the helmeted rider. The nonhelmeted motorcyclists in this study had lower self-esteem, obtained a higher score on the IHLC, and were not strongly engaged in performing health promotion activities as compared to the helmeted riders. However, some of the nonhelmeted riders who had a strong belief in PHLC were positively associated with engaging in health promotion activities. Based on the results obtained from this study, strategies to promote helmet usage for motorcyclists have to be developed.

• Journal of Trauma and Injury
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• v.29 no.4
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• pp.155-160
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• 2016

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.