• Advances in pediatric surgery
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• v.19 no.2
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• pp.98-107
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• 2013

Debates exist about the appropriate treatment for pancreatic trauma in children. We intended to examine the safety of the operation of pancreatic trauma in children. This is a retrospective study of 13 patients, younger than 15, who underwent surgery for pancreatic trauma, between 1993 and 2011 in Seoul National University Children's Hospital. Medical records were reviewed for mechanism of trauma, clinical characteristics, radiological findings, operation and outcomes. Organ injury scaling from the AAST (American Association for Surgery of Trauma) was used. All injuries were caused by blunt trauma. Patients with grade III, IV, and those who were difficult to distinguish grade II from IV, underwent surgery due to severe peritonitis. Three patients with grade II were operated for reasons of mesenteric bleeding, tumor rupture of the pancreas, and progression of peritonitis. Distal pancreatectomy was performed in 10 patients and subtotal pancreatectomy and pylorus preserving pancreaticoduodenectomy in 1 patient each. The remaining one underwent surgical debridement because of severe adhesions. The location of injury, before and after operation, coincided in 83.3%. The degree of injury, before and after the operation, was identical in all the patients except for those who were difficult to tell apart grade II from grade IV, and those cannot be graded due to severe adhesion. Postoperative complications occurred in 23.1%, which improved with conservative treatment. Patients were discharged at mean postoperative 12(range 8~42) days. Even though patients with complications took longer in time from diagnosis to operation, time of trauma to operation and hospital stay, this difference was not significant. In conclusion, When pancreatic duct injury is present, or patient shows deterioration of clinical manifestation without evidence of definite duct injury, or trauma is accompanied by other organ injury or tumor rupture, operative management is advisable, and we believe it is a safe and feasible method of treatment.

• 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.

• Journal of Trauma and Injury
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• v.25 no.4
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• pp.241-246
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• 2012

Purpose: The objective of this study was to investigate the appropriateness of the cross table lateral cervical X-ray used in the emergency department for severely traumatized Korean patients. Methods: Patients visiting our institution from May 2011 to May 2012, who had injury severity score (ISS) > 15 and who received a cervical X-ray in the emergency department, were included in this study. Data including demographics, ISS score, GCS score, and place where the x-ray was taken were collected to evaluate their relationship with appropriate coverage of the cervical X-ray. The appropriateness of a cervical cross lateral view X-ray was evaluated using exposure of the basion, and the opisthion, as well as the distal level of exposure. Results: Fifty-two patients were included in this study. The identification rate of the basion was 79.2%, and the identification rate of the opisthion was 88.7%. Complete exposure of C7/T1 was accomplished in 3.8% of the patients. The ISS was higher for X-ray taken in the trauma bay, but the range of exposure showed no difference between the places where the X-rays taken. Patients who had exposure of C 5/6 or more had lower body weight and body mass index (BMI) compared with unexposed patients. Conclusion: In severely traumatized Korean patients, the adequacy of the cross table lateral cervical X-ray was inappropriate in most cases. No difference was observed in the exposure range between the places where the X-rays were taken, and patients with less exposure showed higher body weight and higher BMI.

• Journal of Korean society of Dental Hygiene
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• v.14 no.6
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• pp.915-920
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• 2014

Objectives: The aim of this study was to investigate the influencing factors on oral and maxillofacial trauma prevention education experience of students majoring in physical education. Methods: A self-reported questionnaire was filled out by 268 students majoring in physical education in Busan. All statistical analyses were performed using SPSS 21.0. The questionnaire consisted of general characteristics(4 questions), TMJ symptoms(9 questions), oral habit(8 questions), and mouth guard awareness(5 questions). The questionnaire was carried out by 5 Likert scale. Higher points of Likert scale showed the negative tendency except the mouth guard awareness. The higher points of mouth guard awareness showed the positive tendency to use the mouth guard. Results: Male students had higher scores of 2.75 points in bad oral habit than the female students(p<0.05). Female students higher score of 1.30 points in mouth guard awareness than male students(p<0.05). TMJ symptoms experience in oral and maxillofacial trauma was 3.15 points which was higher than the prevention education experience without maxillofacial trauma(p<0.001). TMJ symptoms and Mouth guard awareness showed 2.71(p<0.01) and 1.20 points(p<0.001) respectively in students with maxillofacial trauma prevention education experience. These score were higher than those without education experience of trauma prevention education experience. The influencing factors on trauma prevention education experience are mouth guard awareness(p<0.001), oral habits(p<0.01), and temporomandibular joint symptom(p<0.01). Conclusions: The necessity of mouth guards should be emphasized to prevent the serious oral trauma. It is very important to establish the rule for mouth guard use in sports activities. Therefore, oral and maxillofacial trauma prevention education program is needed.

• Journal of Trauma and Injury
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• v.34 no.3
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• pp.177-182
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• 2021

Purpose: Traumatic pancreatic injuries are rare, but their diagnosis and management are challenging. The aim of this study was to evaluate and report our experiences with the management of pancreatic injuries. Methods: We identified all adult patients (age >15) with pancreatic injuries from our trauma registry over a 7-year period. Data related to patients' demographics, diagnoses, operative information, complications, and hospital course were abstracted from the registry and medical records. Results: A total of 45 patients were evaluated. Most patients had blunt trauma (89%) and 21 patients (47%) had pancreatic injuries of grade 3 or higher. Twenty-eight patients (62%) underwent laparotomy and 17 (38%) received nonoperative management (NOM). The overall in-hospital mortality rate was 24% (n=11), and only one patient died after NOM (due to a severe traumatic brain injury). Twenty-two patients (79%) underwent emergency laparotomy and six (21%) underwent delayed laparotomy. A drainage procedure was performed in 12 patients (43%), and pancreatectomy was performed in 16 patients (57%) (distal pancreatectomy [DP], n=8; DP with spleen preservation, n=5; pancreaticoduodenectomy, n=2; total pancreatectomy, n=1). Fourteen (31%) pancreas-specific complications occurred, and all complications were successfully managed without surgery. Solid organ injuries (n=14) were the most common type of associated abdominal injury (Abbreviated Injury Scale ≥3). Conclusions: For traumatic pancreatic injuries, an appropriate treatment method should be considered after evaluation of the accompanying injury and the patient's hemodynamic status. NOM can be performed without mortality in appropriately selected cases.

• Journal of Trauma and Injury
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• v.32 no.2
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• pp.107-110
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• 2019

Bilateral chylothorax due to blunt trauma is extremely rare. We report a 74-year-old patient that developed delayed bilateral chylothorax after falling off a ladder. The patient had a simple 12th rib fracture and T12 lamina fracture. All other findings seemed normal. He was sent home and on the 5th day visited our emergency center at Halla Hospital with symptoms of dyspnea and lower back pain. Computer tomography of his chest presented massive fluid collection in his right pleural cavity and moderate amounts in his left pleural cavity with 12th rib fracture and T11-12 intervertebral space widening with bilateral facet fractures. Chest tubes were placed bilaterally and chylothorax through both chest tubes was discovered. Conservative treatment for 2 weeks failed, and thus, thoracic duct ligation was done by video assisted thoracoscopic surgery. Thoracic duct embolization was not an option. Postoperatively, the patient is now doing well and happy with the results. Early surgical treatment must be considered in the old patient, whom large amounts of chylothorax are present.

• 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 Trauma and Injury
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• v.34 no.2
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• pp.87-97
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• 2021

Purpose: This study examined emergency medical service (EMS) transportation patterns for adult trauma patients before and after establishing a level 1 regional trauma center (RTC) and to evaluate the transportation approach after prehospital severity screening. Methods: This was a retrospective observational study of trauma patients aged ≥18 years admitted via EMS to the emergency department or a level 1 RTC, 1 year before to 3 years after RTC establishment. Patients with an Injury Severity Score (ISS) in the patient registration system were selected. Analyses were performed to determine transportation pattern changes by comparing patients pre- and post-RTC establishment and by yearly comparisons over the 4-year study period using the Mann-Whitney U test and chi-square test. Results: Overall, 3,587 patients were included. The mean ISS was higher in the post-RTC group (n=2,693; 10.63±8.90, median 9.00) than in the pre-RTC group (n=894; 9.44±8.20, median 8.00; p<0.001). The mean transportation distance (9.84±13.71, median 5.80 vs. 13.12±16.15 km, median 6.00; p<0.001) was longer in the post-RTC group than in the pre-RTC group. Furthermore, proportionally fewer patients were transported from an area in the same city as the RTC after establishment (86.1% vs. 78.3%; p<0.001). Yearly comparisons revealed a gradually increasing trend in the hospital death rate (ptrend=0.031). Conclusions: After establishing a level 1 RTC, the EMS transportation of severe trauma patients increased gradually along with the long-distance transportation of minor trauma patients. Therefore, improved prehospital EMS trauma severity assessments and level 1 RTC involvement in patient classification in the prehospital phase are necessary.

• Journal of Korean Biological Nursing Science
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• v.23 no.2
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• pp.138-150
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• 2021

Purpose: This retrospective study aimed to investigate nursing interventions in patients with severe thoracic injury in trauma bay of a regional trauma center. Methods: Of the 1,780 patients admitted to the trauma bay of a regional trauma center in a university hospital in the Gyeonggi Province between January 1, 2019 and December 31, 2019, 120 adult patients with severe thoracic injury who met the inclusion criteria were enrolled. Participants' clinical characteristics and nursing interventions were collected from electronic medical records after receiving ethical approval. Nursing interventions were classified using the terminology in the Nursing Intervention Classification. Results: The mean age of participants was 52.25 years and 72.5% of participants were male. The main areas of thoracic injury included lung parenchyma and pleura (95.8%). The mean Abbreviated Injury Scale (AIS) for thoracic injury was 3.13 and the mean Injury Severity Score (ISS) was 17.81. Fluid resuscitation, invasive hemodynamic monitoring, chest tube care, respiratory monitoring, artificial airway management, gastrointestinal tube care, mechanical ventilation management: airway insertion and stabilization, blood product administration, allergy management, and surgical preparation were performed significantly more frequently in thoracic injury patients with unstable vital signs or a higher AIS score. Conclusion: This study is significant as it investigated the types of nursing interventions given to patients with severe thoracic injury in the trauma bay. These results would contribute to developing more detailed educational materials for initial nursing interventions in trauma bay.

• Journal of Trauma and Injury
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• v.19 no.2
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• pp.97-104
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• 2006

Purpose: Many factors influence the occurrence and severity of geriatric trauma, and regional weather is regarded as one factor that influences geriatric trauma. In this study, to predict the type, severity, and incidence of geriatric trauma patient, we analyzed the influence of regional weather on geriatric trauma. Methods: The subjects of our investigation were trauma patients over sixty-five years of age who visited the Emergency Department (ED) of Yeungnam University Hospital during a one-year period. We retrospectively reviewed the medical charts of 436 geriatric trauma patients, and the data were analyzed by using SPSS 12.0 for Window. The weather was based on data from the Korea Meteorological Administration. Results: The average age was 72.8 years old, and the ratio of males to females was 1:1.1. The mean spell out ISS was 10.8, and no difference was found between males and females. Slips were the most common cause of trauma. The largest numbers of aged trauma patients, 46, visited the ED in May, and the smallest number of such patients, 24, visited the ED in December. In addition to, summer saw the largest number of aged trauma patients. The type of trauma, the Injury Severity Score, and the number of patients had no relationship with season. On sunny days, the ISS was larger in patients who had hypotension and who had tachycardia. On rainy day, the ISS was larger in male patients and cultivator accident patients. The number of patients was larger on partly cloudy days. Conclusion: In spring and summer and on partly cloudy days, we must be prepared to treat aged traumatized patients in the E.D. On rainy days, visual sensation, tactual sense, and acoustic sense must be closely examined. In addition,on rainy day, aged male traumatized patients or cultivator accident patients must to be closely observation.