• Journal of Trauma and Injury
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• v.23 no.2
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• pp.89-95
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• 2010

Purpose: Whole-body CT is a very attractive diagnostic tool to clinicians, especially, in trauma. It is generally accepted that trauma patients who are not alert require whole-body CT. However, in alert trauma patients, the usefulness is questionable. Methods: This study was a retrospective review of the medical records of 146 patients with blunt multiple trauma who underwent whole body CT scanning for a trauma workup from March 1, 2008 to February 28, 2009. We classified the patients into two groups by patients' mental status (alert group: 110 patients, not-alert group: 36 patients). In the alert group, we compared the patients' evidence of injury (present illness, physical examination, neurological examination) with the CT findings. Results: One hundred forty six(146) patients underwent whole-body CT. The mean age was $44.6{\pm}18.9$ years. One hundred four (104, 71.2%) were men, and the injury severity score was $14.0{\pm}10.38$. In the not-alert group, the ratios of abnormal CT findings were relatively high: head 23/36(63.9%), neck 3/6(50.0%), chest 16/36(44.4%) and abdomen 9/36(25%). In the alert group, patients with no evidence of injury were rare (head 1, chest 6 and abdomen 2). Nine(9) patients did not need any intervention or surgery. Conclusion: Whole-body CT has various disadvantages, such as radiation, contrast induced nephropathy and high medical costs. In multiple trauma patients, if they are alert and have no evidence of injury, they rarely have abnormal CT findings, and mostly do not need invasive treatment. Therefore, we should be cautious in performing whole-body CT in alert multiple trauma patients.

• Journal of Korean Academy of Nursing
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• v.12 no.2
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• pp.31-44
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• 1982

The purpose of this study was to analyze the relationship between maternal attachment and discharge against advice in high risk infants and determine the factors which affect discharge against advice. Data of this study were collected by means of reviewing the medical records of 127 in-patients who were diagnosed as high risk infants in admission and interviewing of the mothers of these patients was done by telephone. The high risk categories were neonatal hyperbilirubinemia, congenital anomaly, congenital heart disease, blood disorder, neonatal infection and birth injury. Maternal attachment was measured by deviding the subjects into 2 groups, the one the continuing treatment group and the other the discharge against advice group. Maternal attachment is determined by an interplay of maternal attitude and specific infant behaviors. Maternal attachment developes through continuous physical and psychological contact between mother and infants. Later it developes into maternal love. The results were as follows: 1. There was a significant association between maternal attachment and discharge against advice, that is, the attachment score was higher in the continuing treatment group. 2. Inspite of controlling medical insurance, severity of disease and the length of stay, it was found that there continued to be either a partially significant or fully significant relationship between maternal attachment and discharge against advice. Stepwise multiple regression revealed that maternal attachment was second in importance as a predictor of discharge against advice, which indicates that maternal attachment was a significant predictor of discharge against advice. 3. Stepwise multiple regression revealed that in 32.3％ of these cases the significant predictors of discharge against advice were length of stay, maternal attachment, delivery type, feeding type and income.

• Journal of Trauma and Injury
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• v.29 no.4
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• pp.124-128
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• 2016

Purpose: Computed tomography (CT) with intravenous (IV) contrast is an important step in the evaluation of trauma patients; however, the risk factors for contrast-induced nephropathy (CIN) in these patients remain unclear. This study determined the rate of CIN in trauma patients at a regional trauma center in Korea and identified the risk factors for developing CIN. Methods: We retrospectively reviewed the medical records of 138 patients for the patient demographics, creatinine levels, and vital signs. CIN was defined as an increase in creatinine by 0.5 mg/dL from admission after undergoing CT with IV contrast. Results: Of the patients, 7.2% developed CIN during their admission after receiving IV contrast for CT. In the multivariate analysis, only the creatinine level at presentation (Adjusted odds ratio [aOR], 5.944; 95% confidence interval [CI], 1.486-23.733; p=0.012) and an injury severity score (ISS) greater than 22 (aOR, 1.096; 95% CI, 1.021-1.176; p=0.011) were independently associated with the risk of CIN. Conclusion: CIN is uncommon in trauma patients following CT with IV contrast. The creatinine level at presentation and ISS were independent risk factors for developing CIN in trauma patients.

• Journal of Trauma and Injury
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• v.28 no.3
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• pp.108-114
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• 2015

Purpose: To improve outcome of severe trauma patient, the shortening of transport time is needed. Although helicopter emergency medical services (HEMS) is still a subject of debate, it must also be considered for trauma system. The aim of this study is to assess whether transport method (HEMS versus ground EMS) is associated with outcome among inter-hospital transport. Methods: All trauma patients transported to regional emergency center by either HEMS or ground EMS from September 2011 to September 2014. We have classified patients according to two groups by transport method. Age younger than 15 years and self-discharged patients were excluded. Results: A total of 427 patients were available for analysis during this period. 60 patients were transported by HEMS and 367 patients were transported by ground EMS. HEMS group had higher mortality than ground EMS group (23.3% vs 3.5%; p<0.001), and included more patients with excess mortality ratio adjusted injury severity score (EMR-ISS) above 25 (91.7% vs 48.8%; p<0.001). In the multivariable regression analysis, HEMS was not associated with improved outcome compared with ground EMS, but only EMR-ISS was associated with a mortality of patients (odds ratio, 1.06; 95% confidence interval, 1.04-1.09). Conclusion: In this study, helicopter emergency medical services transport was not associated with a decreased of mortality among the trauma patients who inter-hospital transported to the regional emergency center.

• Journal of Trauma and Injury
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• v.32 no.4
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• pp.220-225
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• 2019

Purpose: Mechanical ventilation (MV) is an essential life-saving modality for severely injured patients. However, the long-term use of MV is a major risk factor for late mortality. The surgical correction of long bone fractures plays a critical role not only in improving functional outcomes, but also in reducing physiological derangements, including MV duration. This study investigated the factors affecting prolonged MV (PMV) in severely injured patients with femur fractures. Methods: We retrospectively evaluated all severely injured patients (injury severity score >15) with femur fractures who were taken to the emergency department within 12 hours of the causative accidents between January 2016 and December 2018. PMV was defined as MV lasting for ≥7 days. We analyzed the factors affecting PMV. Results: In total, 35 patients were enrolled and 21 (33.3%) were included in the PMV group. The PMV group required more red blood cell (RBC) transfusions within 7 days RBC (7dRBC) (12.8 vs. 6.8 units; p=0.03) and the time to femur fracture fixation (TFFF) was longer (7.9 vs. 2.7 days; p=0.018). The area under the curve (AUC) for TFFF was 0.740 (95% confidence interval [CI]: 0.572-0.908; p=0.018) and the AUC for 7dRBC was 0.718 (95% CI: 0.546-0.889; p=0.031). Conclusions: This study indicates that TFFF is an independent risk factor for PMV. Early fixation of femur fractures might prevent PMV and its associated complications.

• Journal of Trauma and Injury
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• v.30 no.1
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• pp.6-11
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• 2017

Purpose: The establishment of the trauma system has changed the quality of trauma care in many countries. As one of the first designated level I trauma centers in Korea, we hypothesized that there were changes in laparotomy patterns and subsequent survival rates after the center was established. Methods: This was a 5-year retrospective study of all severe hemoperitoneum patients who were transfused with more than 10 units of packed red blood cells (RBCs) within 24 h of hospitalization. Variables related to trauma were collected throughout the study period, and the patients admitted before (period 1) and after (period 2) the establishment of a trauma center were compared. Results: Forty-five patients were managed from January 2009 to March 2015. The baseline patient characteristics of the two groups, including age, Injury Severity Score, blood pressure, and hemoglobin levels, were similar. The time to the operating room (OR) was $144.3{\pm}51.5$ min (period 1) and $79.9{\pm}44.1$ min (period 2) (p<0.0001). Damage control surgery (DCS) was performed in 17% of patients during period 1 and in 73% during period 2. The number of actual survivors (n=10) was higher than expected (n=8) in period 2. Conclusion: This is the first study analyzing the impact of a trauma center on the management of specific injuries, such as severe hemoperitoneum, in patients in Korea. During the study, the time to OR was shortened and DCS was used to a greater extent as a surgical procedure.

• Archives of Plastic Surgery
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• v.47 no.3
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• pp.223-227
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• 2020

Background After the laws regulating emergency medicine were amended in 2012, regional trauma centers were established in South Korea. Plastic surgeons specialize in the simultaneous surgical care of patients with facial trauma, burns, and complicated wounds. The objective of this study was to evaluate the role of the plastic surgery department in treating severe trauma patients. Methods From January 2012 to December 2018, we enrolled 366 severe trauma patients with an Injury Severity Score (ISS) over 15 who received treatment by specialists in the plastic surgery department. Of these patients, 298 (81.4%) were male, and their mean age was 51.35 years (range, 6-91 years). The average ISS was 22.01 points (range, 16-75 points). Results The most common diagnosis was facial trauma (95.1%), and facial bone fracture (65.9%) was most common injury within this subgroup. Patients were referred to 1.8 departments on average, with the neurosurgery department accounting for a high proportion of collaborations (37.0%). The most common cause of trauma was traffic accidents (62.3%), and the average length of stay in the general ward and intensive care unit was 36.90 and 8.01 days, respectively. Most patients were discharged home (62.0%) without additional transfer or readmission. Conclusions Through this study, we scoped out the role of the specialty of plastic surgery in the multidisciplinary team at regional trauma centers. These results may have implications for trauma system planning.

• Journal of Trauma and Injury
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• v.26 no.4
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• pp.291-296
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• 2013

Purpose: Prolonged ventilation leads to a higher incidence of ventilator-associated pneumonia (VAP), resulting in weaning failure and increased medical costs. The aim of this study was to analyze clinical results and prognostic factors of VAP in patients with blunt chest trauma. Methods: From 2007 to 2011, one hundred patients undergoing mechanical ventilation for more than 48 hours were divided into two groups: a VAP-negative group, (32 patients, mean age; 53 years, M:F=25:7) and a VAP- positive group, (68 patients, mean age; 60 years, M:F=56:12). VAP was diagnosed using clinical symptoms, radiologic findings and microorganisms. The injury severity score (ISS), shock, combined injuries, computerized tomographic pulmonary findings, transfusion, chronic obstructive lung disease (COPD), ventilation time, stay in intensive care unit (ICU) and hospital stays, complications such as sepsis or disseminated intravascular coagulation (DIC) and microorganisms were analyzed. Chi square, t-test, Mann-Whitney U test and logistic regression analysies were used with SPSS 18 software. Results: Age, sex, ISS, shock and combined injuries showed no differences between the VAP - negative group and - positive group (p>0.05), but ventilation time, ICU and hospital stays, blood transfusion and complications such as sepsis or DIC showed significant differencies (p<0.05). Four patients(13%) showed no clinical symptoms eventhough blood cultures were positive. Regardless of VAP, mortality-related factors were shock (p=0.036), transfusion (p=0.042), COPD (p=0.029), mechanical ventilation time (p=0.011), ICU stay (p=0.032), and sepsis (p=0.000). Microorgnisms were MRSA(43%), pseudomonas(24%), acinetobacter(16%), streptococcus(9%), klebsiela(4%), staphillococus aureus(4%). However there was no difference in mortality between the two groups. Conclusion: VAP itself was not related with mortality. Consideration of mortality-related factors for VAP and its aggressive treatment play important roles in improving patient outcomes.

• Journal of Trauma and Injury
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• v.32 no.2
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• pp.101-106
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• 2019

Purpose: The purpose of this study was to determine the essential factors for prompt arrangement of angio-embolization in patients with pelvic ring fractures. Methods: A total of 62 patients with pelvic ring fractures who underwent angio-embolization in Dankook University Hospital from March 2013 to June 2018 were retrospectively reviewed. There were 38 men and 24 women with a mean age of 59.8 years. The types of pelvic ring fractures were categorized according to the Tile classification. Patient variables included sex, initial hemoglobin concentration, initial systolic blood pressure, transfused packed red blood cells within 24 hours, Injury Severity Score (ISS), mortality rate, length of hospital stay, and time to angio-embolization. Results: The most common pelvic fracture pattern was Tile type B (n=34, 54.8%). The mean ISS was $27.3{\pm}10.9$ with 50% having an $ISS{\geq}25$. The mean time to angio-embolization from arrival was $173.6{\pm}89minutes$. Type B ($180.1{\pm}72.3minutes$) and type C fractures ($174.7{\pm}91.3minutes$) required more time to angio-embolization than type A fractures ($156.6{\pm}123minutes$). True arterial bleeding was identified in types A (35.7%), B (64.7%), and C (71.4%). Conclusions: It is important to save time to reach the angio-embolization room in treating patients with pelvic bone fractures. Trauma surgeons need to consider prompt arrangement of angio-embolization when encountering Tile type B or C pelvic fractures due to the high risk of true arterial bleeding.

• Journal of Trauma and Injury
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• v.32 no.3
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• pp.150-156
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• 2019

Purpose: To determine whether a peripherally inserted central catheter (PICC) meets the goals of a low infection rate and long-term use in trauma patients. Methods: From January 2016 to June 2018, the medical records of patients who underwent central venous catheterization at a level I trauma center were retrospectively reviewed. Data collected included age, sex, injury severity score, site of catheterization, place of catheterization (intensive care unit [ICU], emergency department, or general ward), type of catheter, length of hospital stay during catheterization, types of cultured bacteria, time to development of central line-associated bloodstream infection (CLABSI), and complications. Results: During the study period, 333 central vein catheters (CVC) were inserted with a total of 2,626 catheter-days and 97 PICCs were placed with a total of 2,227 catheter-days. The CLABSI rate was significantly lower in the PICC group when the analysis was limited to patients for whom the catheter was changed for the first time in the ICU after CVC insertion in the ER with similar indication and catheter insertion times (18.6 vs. 10.3/1,000 catheter-days, respectively, p<0.05). The median duration of catheter use was significantly longer in the PICC group than in the CVC group (16 vs. 6 days, respectively, p<0.05). Conclusions: The study results showed that the duration of catheter use was longer and the infection rate were lower in the PICC group than in the CVC group, suggesting that PICC is a safe and reliable alternative to conventional CVC.