• Title/Summary/Keyword: Injury Severity Score

Search Result 246, Processing Time 0.039 seconds

Comparison of Survival in Pelvic Bone Fractures with Arterial Embolization (골반골 골절로 인한 동맥 파열로 동맥 색전술을 시행받은 환자에서의 생존 비교)

  • Kim, Woo Youn;Hong, Eun Seok;Hong, Jung Seok;Ahn, Ryeok;Hwang, Jae Cheol;Kim, Sun Hyu
    • Journal of Trauma and Injury
    • /
    • v.21 no.1
    • /
    • pp.46-52
    • /
    • 2008
  • Purpose: This study was to evaluate the effect of arterial embolization on survival in patients with pelvic bone fractures and arterial bleeding. Methods: From January 2001 to December 2007, in all, 18 patients with pelvic bone fractures that had been treated with interventional arterial embolization were included in this retrospective study. The Injury Severity Score (ISS), the Revised Trauma Score (RTS), the initial hemodynamic status, the blood gas analysis, blood transfusion data, and mortality were the main outcome measurements. Results: Pelvic bone fractures were classified into lateral compression (LC), antero-posterior compression (APC), vertical shear (VS), and combined (CM) type according to the Young-Burgess classification. The Survivor group included 11 patients (61.1%), and the non-survivor group included 7 patients (38.9%). The mean ages for the survivor and the non-survivor groups were 40.0 and 45.6 years (p=0.517). The types of pelvic bone fractures were LC 11 (61.1%), APC 6 (33.3%), and VS 1 (5.6%): LC 7 (63.6%), and APC 4 (36.4%) in the survivor group and LC 4 (57.1%), APC 2 (28.6%), and VS 1 (14.3%) in the non-survivor group. The internal iliac artery was the predominant injured vessel among both the survivors (n = 5, 45.5%) and the non-survivors (n = 4, 57.1%). No differences in initial blood pressures, ISS, and RTS existed between the two groups, but the arterial pH was lower in the non-survivor group (pH 7.09 (${\pm}0.20$) vs 7.30 (${\pm}0.08$), p=0.018). The number of transfused 24-hour units of packed RBC was greater in the non-survivor group ($24.1{\pm}12.5$ vs $14.4{\pm}6.8$, p=0.046). Conclusion: No differences in initial blood pressure and trauma scores existed between survivors and non-survivors with pelvic bone fractures, who had been treated with arterial embolization, but arterial pH was lower the in non-survivors.

The Predcitors of the Development of Acute Respiratory Distress Syndrome in the Patients with Acute Pancreatitis (급성 췌장염으로 내과계 중환자실에 입원한 환자들의 급성호흡곤란 증후군 발생에 연관된 인자에 관한 연구)

  • Yoo, Mi-Ran;Koh, Youn-Suck;Lim, Chae-Man;Lee, Moon-Gyu;Lee, Hong-Jae;Lee, Moo-Song;An, Jong-Jun;Lee, Sung-Koo;Kim, Myung-Hwan;Lee, Sang-Do;Kim, Woo-Sung;Kim, Dong-Soon;Kim, Won-Dong
    • Tuberculosis and Respiratory Diseases
    • /
    • v.44 no.4
    • /
    • pp.861-870
    • /
    • 1997
  • Background : Though acute respiratory distress(ARDS) often occurs in the early stage of severe acute pancreatitis and significantly contributed to the mortality of the condition, the characteristics of the group who develops ARDS in the patients with acute pancreatitis have not been fully found. The objective of this investigation was to identify predictable factors which distinguish a group who would develop ARDS in the patients with acute pancreatitis. Method : A retrospective analysis of 94 cases in 86 patients who were admitted the Medical Intensive Care Unit with acute pancreatitis was done. ARDS were developed in 13 cases among them (13.8%). The possible clinical factors related to the development were analyzed using univariate analysis and $x^2$-test. Results : The risk of ARDS development was increased in the patients with abonormal findings of chest X-ray at admission compared to the patients with normal chest X-ray (p<0.05). The risk was also increased according to the sevecrity index score in abdominal computed tomography at the time of admission (p<0.05). The higher APACHE III score of the first day of admission, the more risk increment of ARDS development was observed (p<0.01). Patients with more than one points of Murray's lung injury score showed higher risk of ARDS compared to the patients with 0 points of that. The patients with sepsis and the patients with more than three organ dysfunction at admission had 3.5 times and 23.3 times higher risk of the development of ARDS compared to the patients without sepsis and without organ failure in each (p<0.05, p<0.01). Conclusion : The risk of ARDS development would be higher in the acute pancreatitis patients with abnormal chest X-ray, higher CT severity index, higher APACHE III or Murray's lung injury score, accompanying sepsis, and more than three organ failure at admission.

  • PDF

The Effect of Trauma Team Approach on the Management of Hemodynamically Unstable Pelvic Bone Fracture: Retrospective Comparative study

  • Cho, Won-Tae;Cho, Jae-Woo;Kim, Jinil;Kim, Jin-Kak;Oh, Jong-Keon;Kim, Hak Jun;Kim, Namryeol;Cho, Jun-Min
    • Journal of Trauma and Injury
    • /
    • v.29 no.4
    • /
    • pp.139-145
    • /
    • 2016
  • Purpose: The major pelvic trauma results in high mortality with associated fatal other injuries. During early stage of resuscitation, multidisciplinary approach is essential to improve the survival and outcomes. This study aims to report the effect and positive outcome of the trauma team approach on the management of hemodynamically unstable pelvic bone fracture. Methods: This retrospective review included all patients with hemodynamically unstable pelvic bone fracture admitted between March 2007 and December 2015. Patients were divided into group A, which comprised those admitted before the trauma team approach was started, and group B, which comprised those admitted after the approach was started. The advanced trauma life support protocol was followed for all patient. The comparisons between the two groups were based on medical records. Study variables included demographics, initial vital sign, injury severity score, fracture type, and injury mechanism. We analyzed the outcomes in each group with respect to the time interval for doctors' arrival, total length of stay in the emergency department (ED), time interval for computed tomography evaluation, 24-hour mortality, time interval for definitive fixation, and definitive fixation in the time-window of opportunity. Results: Fifty-three patients met the inclusion criteria. No statistically significant differences in demographic data existed between the two groups. The time interval for doctors' arrival (min, $63.09{\pm}50.48$ vs $21.48{\pm}17.75$; p=0.038) and total length of stay in the ED (min, $269.33{\pm}105.96$ vs $115.49{\pm}56.24$; p=0.023) were significantly improved. The 24-hour mortality was not significantly different between the two groups.(%, 14.3 vs 12.0; p=1.000) However, the time interval for definitive fixation and definitive fixation in the time-window of opportunity showed better results. Conclusion: The trauma team approach has positive effects, which include initial resuscitation through multidisciplinary approach and shortening the time interval to definitive fixation, on the management of hemodynamically unstable pelvic bone fracture.

Comparison of Rib Fracture Location for Morbidity and Mortality in Flail Chest (늑골 골절의 위치가 동요흉의 이환율 및 사망률에 미치는 요인)

  • Byun, Chun Sung;Park, Il Hwan;Bae, Geum Suk;Jeong, Pil Yeong;Oh, Joong Hwan
    • Journal of Trauma and Injury
    • /
    • v.26 no.3
    • /
    • pp.170-174
    • /
    • 2013
  • Purpose: A flail chest is one of most challenging problems for trauma surgeons. It is usually accompanied by significant underlying pulmonary parenchymal injuries and mayled to a life-threatening thoracic injury. In this study, we evaluated the treatment result for a flail chest to determine the effect of trauma localization on morbidity and mortality. Methods: Between 2004 and 2011, 46 patients(29 males/17 females) were treated for a flail chest. The patients were divided into two group based on the location of the trauma in the chest wall; Group I contained patients with an anterior flail chest due to a bilateral costochondral separation (n=27) and Group II contained patients with a single-side posterolateral flail chest due to a segmental rib fracture (n=19). The location of the trauma in the chest wall, other injuries, mechanical ventilation support, prognosis and ISS (injury severity score) were retrospectively examined in the two groups. Results: Mechanical ventilation support was given in 38 patients(82.6%), and 7 of these 38 patients required a subsequent tracheostomy. The mean ISS for all 46 patients was $19.08{\pm}10.57$. Between the two groups, there was a significant difference in mean ventilator time (p<0.048), but no significant difference in either trauma-related morbidity (p=0.369) or mortality (p=0.189). Conclusion: An anterior flail chest frequently affects the two underlying lung parenchyma and can cause a bilateral lung contusion, a hemopneumothorax and lung hemorrhage. Thus, it needs longer ventilator care than a lateral flail chest does and is more frequently associated with pulmonary complications with poor outcome than a lateral flail chest is. In a severe trauma patient with a flail chest, especially an anterior flail chest, we must pay more attention to the pulmonary care strategy and the bronchial toilet.

Prognosis and Clinical Outcome of Alcohol Withdrawal Syndrome in Trauma Patients (외상 환자에서 알코올 금단 증후군의 발생이 예후에 미치는 영향)

  • Oh, Dong Gil;Cho, Min Soo;Bae, Keum Seok;Kang, Sung Joon
    • Journal of Trauma and Injury
    • /
    • v.21 no.2
    • /
    • pp.115-119
    • /
    • 2008
  • Purpose: Abrupt abstinence from alcohol in cause of chronic alcohol addiction can trigger alcohol withdrawal syndrome. The authors studied the effect of post-operative alcohol withdrawal syndrome in patients who require intensive care due to trauma. Methods: For the study group, we selected 70 patients who had undergone emergency surgery from May 2003 to March 2007 due to trauma and who had been treated with prophylactic thiamine. Data was collected retrospectively. We excluded those who extended their hospital stay for other than traumatic causes, those who died within 3 days of surgery after trauma, those who transferred to other institutions, and those who received a psychiatric diagnosis. Patient groups were determined by the existence or the non-existence of withdrawal syndrome. Age, sex, injury mechanism, mortality, complications, durations of hospital stay and intensive care, use of mechanical ventilator, and sedative use were investigated. A Chi-square test and The Mann-Whitney method were used for statistical analysis in this study. Results: Twenty-four (24) patients from the 58 who had an ISS of 16 or more showed alcohol withdrawal syndrome, and men were shown to be affected with the syndrome significantly more than women. Although ISS was higher in the group with alcohol withdrawal syndrome, statistically, the difference was not significant (P<0.08). The total hospital stay in the patient group with alcohol withdrawal syndrome was on average 10 days longer. However, the difference was not significant (P<0.054). The duration of intensive care in the patient group with alcohol withdrawal syndrome was significantly longer (P<0.029). The patients with alcohol withdrawal syndrome showed no significant difference in the duration of mechanical ventilator use (P<0.783), or in the duration of sedative use (P<0.284). Respiratory distress, pneumonia, upper airway infection, sepsis, acute renal failure, and mortality in the alcohol withdrawal syndrome group were investigated, but no statistically significant difference were noted. Conclusion: We found that the duration of intensive care in chronic alcohol abusers was longer due to the development of alcohol withdrawal syndrome. We also discovered that, when the patients overcame the symptoms of alcohol withdrawal syndrome after intensive care, no difference was found in the frequency of developing complications, the morbidity, and the mortality. Therefore, we conclude that intensive care in trauma patients who are chronic alcohol abusers decreases the incidence of complications found in patients with post-operative alcohol withdrawal syndrome and does not adversely impact the prognoses for those patients.

Clinical Characteristics and Risk Factors of Acute Kidney Injury in Patients with Glyphosate Poisoning (글리포세이트 중독 환자에서 급성 신손상 발생의 임상 양상과 위험 인자)

  • Park, Hyung Hun;Choi, Kyu Ill;Lee, Je Won;Park, Jung Min;Park, Jinwook;Noh, Sang Moon;Cho, Jaekyung;Lee, Daero;Cho, Jae Chul;Park, Dong Chan;Kim, Yang Hun;Lee, Joo Hwan
    • Journal of The Korean Society of Clinical Toxicology
    • /
    • v.18 no.2
    • /
    • pp.110-115
    • /
    • 2020
  • Purpose: Acute kidney injury (AKI) in patients with glyphosate poisoning has a poor prognosis. This study aimed to predict the risk factors for AKI in patients with glyphosate poisoning at the emergency department (ED). Methods: Clinical data on glyphosate poisoning patients at ED who were older than 18 years were collected retrospectively between January 2013 and December 2019. The clinical characteristics and clinical outcomes of the AKI group in patients with glyphosate poisoning were compared with the non-AKI (NAKI) group. Results: Of 63 glyphosate poisoning patients, AKI was observed in 15 (23.8%). The AKI patients group showed the following: old age (p=0.038), low systolic blood pressure (p=0.021), large amount of ingestion (p=0.026), delayed hospital visits (p=0.009), high white blood cells (WBC) (p<0.001), high neutrophil counts (p<0.001), high neutrophil-lymphocyte (LN) ratios (p<0.001), high serum potassium (p=0.005), low arterial blood pH (p=0.015), and low pO2 (p=0.021), low bicarbonate (p=0.009), and high Poisoning Severity Score (PSS) (p<0.001). AKI patients required hemodialysis, ventilator care (p<0.001, p=0.002), and inotropics (p<0.001). They also showed more intensive care unit admission (p<0.001), longer hospitalization (p<0.001), and high mortality (p<0.001). Logistic multivariate regression analysis showed that high WBCs (OR, 1.223) and increased LN ratios (OR, 1.414) were independently associated with the occurrence of AKI. Conclusion: In patients with glyphosate poisoning at ED, high WBCs and increased LN ratios can help predict the occurrence of AKI.

A Study on the Purpose-in-Life Level in Patients with Traumatic Brain Injury (외상성 뇌 손상 환자의 삶의 목적 수준에 관한 연구)

  • Rho, Seung-Ho;Kim, Sung-Woo
    • Korean Journal of Psychosomatic Medicine
    • /
    • v.7 no.2
    • /
    • pp.184-195
    • /
    • 1999
  • Objectives : As traumatic brain injury(TBI) leaves chronic sequelae in mind and body, the injured patients should rectify the meaning and object that they have pursued in their lives and set up a new purpose in life that they may make the rest of their lives meaningful. This study was designed to investigate the purpose and quality of life levels and the influence of demographic and clinical variables on the levels in the patients with TBI, and to be of some help to their rehabilitation. Methods : In order to assess the purpose in life(PIL) and the quality of life(QOL) levels, Purpose-in-Life Test, Sickness Impact Profile, Quality of Life Index, Head Injury Symptom Ckecklist, and Neurobehavioral Rating Scale were administered to the subjects. The subjects were thirty-two patients with TBI and the same numbered normal controls. The TBI group was composed of 16 to 65 year-aged patients who had received mild or severe TBI at least 12 months before, and the controls were siblings or friends of the patients whose age, sex, and educational level were similar to them. Results : 1) The PIL and QOL levels of the patients with TBI remained significantly lower than that of control group after their symptoms of injury were stabilized(p<.01, p<.01). 2) The mean PIL score of TBI group was $58.8{\pm}23.2$, which was to be regarded as the level of existential vacuum. 3) The PIL level of TBI group was significantly correlated with the QOL level(p <.01). 4) The subgroup with lower PIL level in patients with TBI has significantly higher rate of female than that with higher PIL(p<.05), the PIL level of female patients was significantly lower than that of male patients(p <.05). 5) The significant differences in PIL levels were not found, in which comparison was performed between each pair of subgroups of patients with TBI divided by severity of injury(mild vs severe), marital status(married vs unmarried), and occupational status prior to injury(employed vs unemployed). Conclusion : The PIL of patients with TBI still remained the level of existential vacuum after symptoms of sequelae had been stabilized, The QOL level was also extremely low, and as the PIL level was low the QOL was also low. The demographic and clinical variables except sex did not have influence on the PIL level in brain-injured patients. It is suggested that every patient should admit their mental and physical limitations caused by brain injury and revise their purpose in life for successful rehabilitation.

  • PDF

Lung Injury Indices Depending on Tumor Necrosis Factor-$\alpha$ Level and Novel 35 kDa Protein Synthesis in Lipopolysaccharide-Treated Rat (내독소처치 흰쥐에서 Tumor Necrosis Factor-$\alpha$치 상승에 따른 폐손상 악화 및 35 kDa 단백질 합성)

  • Choi, Young-Mee;Kim, Young-Kyoon;Kwon, Soon-Seog;Kim, Kwan-Hyoung;Moon, Hwa-Sik;Song, Jeong-Sup;Park, Sung-Hak
    • Tuberculosis and Respiratory Diseases
    • /
    • v.45 no.6
    • /
    • pp.1236-1251
    • /
    • 1998
  • Background : TNF-$\alpha$ appears to be a central mediator of the host response to sepsis. While TNF-$\alpha$ is mainly considered a proinflammatory cytokine, it can also act as a direct cytotoxic cytokine. However, there are not so many studies about the relationship bet ween TNF-$\alpha$ level and lung injury severity in ALI, particularly regarding the case of ALI caused by direct lung injury such as diffuse pulmonary infection. Recently, a natural defense mechanism, known as the stress response or the heat shock response, has been reported in cellular or tissue injury reaction. There are a number of reports examining the protective role of pre-induced heat stress proteins on subsequent LPS-induced TNF-$\alpha$ release from monocyte or macrophage and also on subsequent LPS-induced ALI in animals. However it is not well established whether the stress protein synthesis such as HSP can be induced from rat alveolar macrophages by in vitro or in vivo LPS stimulation. Methods : We measured the level of TNF-$\alpha$, the percentage of inflammatory cells in bronchoalveolar lavage fluid, protein synthesis in alveolar macrophages isolated from rats at 1, 2, 3, 4, 6, 12, and 24 hours after intratracheal LPS instillation. We performed histologic examination and also obtained histologic lung injury index score in lungs from other rats at 1, 2, 3, 4, 6, 12, 24 h after intratracheal LPS instillation. Isolated non-stimulated macrophages were incubated for 2 h with different concentration of LPS (0, 1, 10, 100 ng/ml, 1, or 10 ${\mu}g/ml$). Other non-stimulated macrophages were exposed at $43^{\circ}C$ for 15 min, then returned to at $37^{\circ}C$ in 5% CO2-95% for 1 hour, and then incubated for 2 h with LPS (0, 1, 10, 100ng/ml, 1, or 10 ${\mu}g/ml$). Results : TNF-$\alpha$ levels began to increase significantly at 1 h, reached a peak at 3 h (P<0.0001), began to decrease at 6 h, and returned to control level at 12 h after LPS instillation. The percentage of inflammatory cells (neutrophils and alveolar macrophages) began to change significantly at 2 h, reached a peak at 6 h, began to recover but still showed significant change at 12 h, and showed insignificant change at 24 h after LPS instillation compared with the normal control. After LPS instillation, the score of histologic lung injury index reached a maximum value at 6 h and remained steady for 24 hours. 35 kDa protein band was newly synthesized in alveolar macrophage from 1 hour on for 24 hours after LPS instillation. Inducible heat stress protein 72 was not found in any alveolar macrophages obtained from rats after LPS instillation. TNF-$\alpha$ levels in supernatants of LPS-stimulated macro phages were significantly higher than those of non-stimulated macrophages(p<0.05). Following LPS stimulation, TNF-$\alpha$ levels in supernatants were significantly lower after heat treatment than in those without heat treatment (p<0.05). The inducible heat stress protein 72 was not found at any concentrations of LPS stimulation. Whereas the 35 kDa protein band was exclusively found at dose of LPS of 10 ${\mu}g/ml$. Conclusion : TNF-$\alpha$ has a direct or indirect close relationship with lung injury severity in acute lung injury or acute respiratory distress syndrome. In vivo and in vitro LPS stimulation dose not induce heat stress protein 72 in alveolar macrophages. It is likely that 35 kDa protein, synthesized by alveolar macrophage after LPS instillation, does not have a defense role in acute lung injury.

  • PDF

Balloon Kyphoplasty through Extrapedicular Approach in the Treatment of Middle Thoracic Osteoporotic Compression Fracture : T5-T8 Level

  • Kim, Hyeun-Sung;Kim, Seok-Won;Ju, Chang-Il
    • Journal of Korean Neurosurgical Society
    • /
    • v.42 no.5
    • /
    • pp.363-366
    • /
    • 2007
  • Objective : Kyphoplasty performed in the middle thoracic spine presents technical challenges that differ from those in the lower thoracic or lumbar region due to small pedicle size and angular severity for thoracic kyphosis. The purpose of this study was to evaluate the efficacy of balloon kyphoplasty through extrapedicular approach for the treatment of intractable osteoporotic compression fractures in the middle thoracic spine. Methods : The patients who were performed with one level balloon kyphoplasty through extrapedicular approach due to painful osteoporotic compression fractures at T5-T8 from June 2003 to July 2005 were retrospectively analyzed. Imaging and clinical features were analyzed including involved vertebrae level, vertebral height, Injected cement volume, clinical outcome and complications. Results : Eighteen female patients (age ranged from 60 to 77 years old) were included in this study. The average amount of the implanted cement was $4.2{\pm}1.5\;cc$. The mean cobb angle and compression rate were improved from $12.1{\pm}6.5^{\circ}$ to $8.5{\pm}7.2^{\circ}$ and from 30% to 15%, respectively. The mean pain score (visual analogue scale) prior to kyphoplasty was 7.9 and it decreased to 3.0 after the procedure. Cement leakage to the adjacent disc (2 cases) and paravertebral soft tissues (1 case) were seen but there were no major complications such as pneumothorax, segmental arte 이 Injury, pulmonary embolism, or epidural leakage. Conclusion : Balloon kyphoplasty through extrapedicular approach is considered as a safe and effective in treating the middle thoracic regions with low complication rate.

Clinical Study of Old-aged Patients in Traffic Accidents and Admitted For Emergency Treatment (도심 지역에 위치한 일개병원의 고 연령 교통사고 환자에 대한 임상적 연구)

  • Lee, Young Hwan;Song, Hyoung Gon
    • Journal of Trauma and Injury
    • /
    • v.19 no.1
    • /
    • pp.74-80
    • /
    • 2006
  • Purpose: For prevention and suitable administration, the effect of age on the severity of injuries in traffic accidents should be considered when evaluating a patient, but there have not been enough epidemiological studies that evaluate the age factor in traffic accidents. For that reason, we investigated old-aged patients who were involved in traffic accidents (65 years old or more) and who were admitted to the emergency department of a college hospital in an urban city of Korea. Methods: We collected data from traffic-accident patients who came to the emergency room of a university hospital in Seoul from Jan.1, 2004 to Dec.31, 2005. We compared their abilities to ambulate and the RTSs (Revised trauma scores) by using a LSD (least significant difference), linear regression. Results: A total of 1460 patients were included. The mean RTS of all traffic-accident patients was $7.77{\pm}0.280$. The scores for drivers and passengers, motor-cycle drivers and passengers, bicycle drivers and passengers, and pedestrians were $7.79{\pm}0.21$, $7.78{\pm}0.22$, $7.54{\pm}0.25$, $7.77{\pm}0.20$, and $7.80{\pm}0.21$ respectively (p=0.000). There was no statistically significant difference between the RTS of patients over 65 years and that of other patients. In a regression analysis, the number of patients over 45 ages who were able to ambulate was lower than that of younger people, independently of other influencing factors (B=-0.330, R-square = 0.243, p=0.000). Conclusion: We expected that RTS of old age group more than 65 years old will significantly lower than that of others, but there was no statistically significant difference.