• Journal of Korean Neurosurgical Society
• /
• v.30 no.1
• /
• pp.54-59
• /
• 2001

Objectives : With the advancement of a social life, the pediatric head injuries(PHI) occur greater than ever. Since the PHI differs from adult head injury with regards to mechanism of trauma, prognosis, and mortality, it is important to identify the characteristics of the PHI for its proper treatments and prognosis. Methods : For this study, a series of 365 PHI patients under 15 years of age who were admitted to our hospital, were evaluated from January 1991 to December 1996. The clinical variable studied were age, sex, Glasgow coma score(GCS), causes of trauma, diagnosis, symptoms, associated injuries and Glasgow outcome score (GOS). The characteristics of PHI were evaluated according to presentations of skull fractures, intracranial hemorrhages, associated injuries, GCS at admission and GOS. Results : Mean age of the studied patients was 6.51 years of age. The majority of PHI patients were under the 7 years of age(66.7%). The ratio of male to female was 2.2:1. Seasonally, PHI occurred more frequently during March to August(61.6%). The main causes of the injuries were accidental falls and traffic accidents(47.1% and 46.3%). One hundred ninety seven(54%) patients suffered from skull fractures and 110(30.1%) patients were developed intracranial hemorrhages and acute epidural hematomas(17.8%) which were the most common intracranial hemorrhages. There was statistical significance between skull fractures and intracranial hemorrhage (p=0.032) and between GCS and GOS(p=0.001). However, there was no statistical significance between skull fractures and intracranial hemorrhage(epidural hematomas, subdural hematomas, and intracerebral, intraventricular and subarachnoid hemorrhage)(p=0.061, 0.251 and 0.880). Also there were no significance of prognosis between under the seven and over the 8 years of age(p=0.349). Conclusions : The core management for PHI is prevention from its occurrences. However, when unexpected accident occurs, early diagnosis and treatment for PHI by through examination for associated injuries and other damages even if there is no skull fracture are essential in managing patient's outcome.

• Journal of Medicine and Life Science
• /
• v.17 no.1
• /
• pp.7-15
• /
• 2020

The field triage guidelines have been widely implemented in the Korean trauma system. This study aimed to evaluate and validate whether it is reliable to use the field triage guidelines for predicting severe traumatic brain injury (TBI) and traumatic spinal injury (TSI) patients. This study retrospectively analyzed in-hospital cohort registries of all TBI and TSI patients, who visited the emergency department (ED) of the Jeju National University Hospital from 1 January 2013 to 31 December 2015. The primary outcome was defined as TBI and TSI patients with an injury severity score (ISS)>15. Secondary outcomes were defined as cases in which one or more of the following conditions: in-hospital death, ISS>15, admission to the intensive care unit, emergency surgery. We enrolled 14,889 TBI and TSI patients who visited ED, of which 7,966 (53.5%) were triage positive. The overall sensitivity, specificity and area under the curve (AUC) of the full cumulative field triage guidelines step's model (Step 1+3+4 criteria) for primary outcome were 82.8%, 47.0%, and 0.646, respectively. In the results for secondary outcomes, the specificity did not show a significant difference, but the sensitivity decreased to 66.5% and AUC to 0.568. The results of this study suggest that further optimization of the field triage guidelines is needed to identify high-risk TBI and TSI patients.

• Journal of Trauma and Injury
• /
• v.32 no.1
• /
• pp.32-39
• /
• 2019

Purpose: The aim of this study was to determine which factors contribute to the surgical treatment outcomes of acetabular fractures. Simultaneously, we aim to report on the treatment results after our hospital was designated as the focused training center for trauma. Methods: We conducted a retrospective review of all patients who experienced acetabular fractures from January 1, 2014 to May 1, 2017 and visited our hospital. Patients who had associated pelvic ring fractures or were lost to the one-year follow-up were excluded; a total of 37 fractures were evaluated. We evaluated the clinical results using the scoring system of Merle $d^{\prime}Aubign\acute{e}$ (MDA) and grade of Brooker for heterotopic ossification. Results: Thirty-seven patients (31 men and 6 women) were identified. The mean injury severity score (ISS) was 8.7, with 32.4% of patients having a score >15. The average blood transfusion in the first 24 hours was 0.54 pints. Falling was the most common injury mechanism (32.4%). Chest injury was the most common associated injury (16.2%), followed by head injury (13.5%). The posterior wall and both column fracture were the most common (37.8%) fracture patterns. Excellent and good clinical grades of MDA included 28 patients (75.6%) and fair and poor grades included nine (24.3%), respectively. Four patients were diagnosed with a post-operative infection (10.8%); one out of four patients who had co-morbidity died (2.7%), and another patient underwent a replacement surgery (2.7%). Multivariate analysis showed that age and operation time were associated with MDA. In addition, operation time and ISS were significant co-factors of the Brooker grade. Conclusions: Korea University Guro Hospital showed similar treatment results of acetabular fractures compared to other publications. The age and operation time were co-factors of the clinical outcome of this fracture. Additionally, increased operation time and injury severity score were suggested to increase the Brooker grade.

• Journal of Korean Neurosurgical Society
• /
• v.65 no.1
• /
• pp.123-129
• /
• 2022

Objective : Chronic subdural hematoma (CSDH) is one of the most common pathology in daily neurosurgical practice and incidence increases with age. The aim of this study was to evaluate the prognostic factors and surgical outcome of CSDH in patients aging over 90 years compared with a control group of patients aging under 90 years. Methods : This study reviewed 25 patients with CSDH aged over 90 years of age treated in our department. This group was compared with a younger group of 25 patients aged below their eighties. At admission past medical history was recorded concerning comorbidities (hypertension, dementia, ictus cerebri, diabetes, and heart failure or attack). History of alcohol abuse, anticoagulant and antiplatelet therapy, head trauma and seizures were analyzed. Standard neurological examination and Markwalder score at admission, 48 hours after surgery and 1-6 months follow-up, radiologic data including location and CSDH maximum thickness were also evaluated. Results : Their mean age was 92.8 years and the median was 92.4 years (range, 90-100 years). In older group, the Markwalder evaluation at one month documented the complete recovery of 24 patients out of 25 without statistical difference with the younger group. This data was confirmed at 6-month follow-up. One patient died from cardiovascular failure 20 days after surgery. The presence of comorbidities, risk factors (antiplatelet therapy, anticoagulant therapy, history of alcohol abuse, and head trauma), preoperative symptoms, mono or bilateral CSDH, maximum thickness of hematoma, surgical time and recurrence were similar and statistically not significant in both groups. Conclusion : In this study, we demonstrate that surgery for very old patients above 90 years of age affected by CSDH is safe and allows complete recovery. Comparing two groups of patients above and under 90 years old we found that complication rate and recovery were similar in both groups.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
• /
• v.13 no.1
• /
• pp.15-23
• /
• 2002

Knowledge regarding the resilience factors and risk factors of the childhood trauma on the developental trajectory is in its infancy due to the lack of prospective follow-up studies in the childhood trauma and limited understanding of the complex reciprocal interactions between childhood trauma, develop-ent and various aspects of children's environment. These difficulties in the conceptual framework and research methods in the childhood trauma are partly reflected in the inconsistencies, even controversies, of the results in the childhood trauma researches. Despite these difficulties, common aspects of the risk factors and resilience of the childhood trauma on the development can be identified from the previous studies. The resilience to the negative outcome on the development by childhood trauma includes：sex female before puberty, male after puberty or infancy), high socioeconomic status, no organic problem, easy temperament, no previous experience with early loss or separation, younger age at the trauma, better problem solving capacity, high self-esteem, internal locus of control, high coping skills, ability to identify interpersonal relationships, ability to play, sense of humor, having capable parents, having a warm relaionship with at least one of the parents, high education and participating in the organized religious activities. These commonalities of the results suggest that risk and resilient factors of the childhood trauma are interdependent, each factor has multiplicity in the impacts on the children's development according to the developmental stage of the child, family and children's other environment, trauma and stressor have diverse effects according to their intensity and risk and resilience factors could have synergistic or antagonistic effects to each other. To develop comprehensive understanding on the relationship between childhood trauma and developmental psychopathology, risk and resilience factors and to develop effective and efficient prevention and intervention, research on the effect of the stress on the neurodevelopment, on the individual differences of the response to the trauma including genetic factors and constitution, and on the brain plasticity should be accompanied in the future.

• Journal of Trauma and Injury
• /
• v.20 no.2
• /
• pp.144-148
• /
• 2007

Purpose: The management of hemorrhagic shock is critical for trauma patients. To assess hemorrhagic shock, the clinician commonly uses a change in positional blood pressure, the shock index, an estimate of the diameter of inferior vena cava based on sonography, and an evaluation of hypoperfusion complex shown on a CT scan. To add the finding for the hypoperfusion complex, the 'halo sign' was introduced recently. To our knowledge, this 'halo sign' has not been evaluated for its clinical usefulness, so we designed this study to evaluate its usefulness and to find the useful CT signs for hypoperfusion complex. Methods: The study was done from January 2007 to May 2007. All medical records and CT images of 124 patients with trauma were reviewed, of which 103 patients were included. Exclusion criteria was as follows: 1) age < 15 year old and 2) head trauma score of AIS ${\geq}$ 5. Results: The value of kappa, to assess the inter-observer agreement, was 0.51 (p < 0.001). The variables of the halo-sign-positive group were statistically different from those of the halo-sign-negative group. The rate of transfusion for the halo-sign-positive group was about 10 times higher than that of the halo-sign-negative group and the rate of mortality was about 6 times higher. Conclusion: In the setting of trauma, early abdominal CT can show diffuse abnormalities due to hypoperfusion complex. Recognition of these signs is important in order to prevent an unwanted outcome in hemorrhagic shock. We conclude that the halo sign is a useful one for hypoperfusion complex and that it is useful for assessing the degree of hemorrhagic shock.

• Journal of Trauma and Injury
• /
• v.22 no.2
• /
• pp.199-205
• /
• 2009

Purpose: This study compared the characteristics of and the prognosis for intraperitoneal and retroperitoneal/pelvic contrast extravasation, which had been confirmed by enhanced abdominal CT scan, after blunt trauma in patients who had undergone angiographic embolization. Methods: From January 2001 to March 2009, data were retrospectively collected regarding patients who had undergone contrast extravasation (CE) on CT scanning and arterial embolization after blunt trauma. The study patient group was divided into the intraperitoneal and the retroperitoneal/pelvic groups according to the area of contrast extravasation. We reviewed the initial demographic data, the location of injury, the solid organ injury, the embolized vessel, and the clinical outcome. Results: The mean age of the study subjects was $40.2{\pm}2.6$ years old, and there were 24 male patients. The intraperitoneal group included 10 patients, and retroperitoneal/pelvic group was comprised of 17 patients. The amount of transfusion from presentation to intervention and during the first 24 hours was greater in the retroperitoneal/pelvic group than in the intraperitoneal group. The intraperitoneal group showed a higher frequency and severity of liver injury than the retroperitoneal/pelvic group. Angiography revealed that the hepatic artery (n=4) was the most frequently embolized vessel in the intraperitoneal group, while the internal iliac artery (n=6), followed by the renal artery (n=4), internal pudendal artery (n=3), and the gluteal artery (n=2), were the most frequently injured vessels in the retroperitoneal/pelvic group. Conclusion: In patients with intra-abdominal contrast extravasation found on CT scanning and arterial embolization after blunt trauma, the need for transfusion was less in the intra-abdominal group than in the retroperitoneal/pelvic group. Liver injury was also more frequent and severe in the intraperitoneal group than in the retroperitoneal/pelvic group.

• Korean Journal of Community Nutrition
• /
• v.11 no.1
• /
• pp.124-132
• /
• 2006

The aim of this study is to evaluate the clinical outcome. Between January 1,2002 to September 30, 2002, we prospectively and retrospectively recruited III hospitalized patients who received Enteral Nutrition (EN group n = 52) and Total Parenteral Nutrition (TPNgroup n = 59) for more than seven days. The factors of clinical outcomes are costs, incidences of infection, lengths of hospital stay, and changes in weight. The characteristics of patients were investigated, which included nutritional status, disease severity CAP ACHE III score) and hypermetabolic severity Chypermetabolic score). Hypermeta-bolic scores were determined by high fever (> $38^{\circ}C$), rapid breathing (> 30 breaths/min) , rapid pulse rate (> 100 beats/min), leukocytosis (WBC > 12000 $mm^{3}$), leukocytopenia (WBC > 3000 $mm^{3}$), status of infection, inflammatory bowel disease, surgery and trauma. There was a positive correlation between hypermetabolic score and length of hospital stay (ICU), medical cost, weight loss, antibiotics adjusted by age while APACHEIII score did not show correlation to clinical outcome. Medical cost was higher by $18.2\%$ in the TPN group than the EN group. In conclusion, there was a strong negative correlation between the clinical outcome (cost, incidence of infection, hospital stay) and hypermetabolic score. Higher metabolic stress caused more malnutrition and complications. For nutritional management of patients with malnutrition, multiple factors, including nutritional assessment, and evaluation of hypermetabolic severity are needed to provide nutritional support for critically ill patients.

• Journal of Korean Neurosurgical Society
• /
• v.30 no.2
• /
• pp.144-149
• /
• 2001

Objective : Spinal nerve root compression occurs commonly in conditions, such as herniated nucleus pulposus, spinal stenosis, intervertebral foraminal stenosis, and trauma. However, the pathophysiolosy of the symptoms and signs related to spinal nerve root compression is poorly understood. The purpose of the present study was to assess and compare the changes of various pressures of intervertebral foraminal pressure before and after decompression. Method : After laminetomy without foraminotomy was performed, pressure sensor tip of Camino parenchymal type was located at the middle-central portion of the intervertebral foramen and anterior portion of nerve root for the foraminal pressure before decompression of the intervertebral foramen. After laminectomy with foraminotomy, the same method was used for the foraminal pressure after decompression. The authors studied 40 consecutive patients (57 disc spaces) with severe constant root pain to the lower leg, pain unrelived by bed rest, and minimal tension signs, diagnosed by MRI. Results : In patients with intervertebral foraminal stenosis, the intraforaminal pressure was decreased from $86{\pm}2.23mmHg$ to $17.1{\pm}1.51mmHg$ and in patients without stenosis, from $55.9{\pm}1.08mmHg$ to $11.9{\pm}1.25mmHg$. All patients below 20mmHg after decompression showed good outcome, but 4 cases who showed poor outcome had foraminal stenosis, posterolateral type of the herniated disc, and above 30mmHg of foraminal pressure after decompression. Conclusion : These findings suggest that if the foraminal pressure falls below 20mmHg after decompression, good outcome can be anticipated. Central type of the herniated disc shows better outcome compared to the posterolateral type.

• Archives of Craniofacial Surgery
• /
• v.16 no.3
• /
• pp.147-150
• /
• 2015

Impalement injury is the subset of penetrating trauma, defined as fixed, elongated objects penetrate and remain in the human body cavity or region by relatively low velocity. We report an unusual case of facial and neck impalement where two dirty rusted iron bars penetrated forehead bilaterally and exited neck and ear respectively without causing major organ injuries. After thorough radiologic and physical evaluation, the patient got medical and surgical treatment. The patient was discharged without complication after four day of delayed wound closure. There have been no complications and sequelaes related with trauma, wound infection and scar contracture at 3-year follow-up. According to affected organs and pattern of impalement, individualized and multidisciplinary surgical approach should be considered. Following these guidelines as in this case, it was possible to achieve excellent clinical outcome in impalement injury.