Kim, Sung Yoon;So, Byung Hak;Kim, Hyung Min;Jeong, Won Jung;Cha, Kyung Man;Choi, Seung Pill
Journal of Trauma and Injury
/
v.28
no.3
/
pp.134-143
/
2015
Purpose: Many patients are injured by trauma. And some of them expire due to severity of trauma. Various scoring systems have been introduced in grading severity and predicting mortality of trauma patients. This study is to evaluation the usefulness of factors for determining the severity and predicting the prognosis of the trauma victims. Methods: Data on the patients who visited our Emergency departments from January 2010 to December 2011 were retrospectively reviewed using electronic medical records. The patients were activated severe trauma team calling system. The patients were categorized as survivors and non-survivors. Univariated associations were calculated, and a multiple logistic regression analysis was used to determine variables associated with hospital mortality. Results: Two hundred sixty two(262) patients were enrolled, and the mortality rate was 25.6%. By multivariate analysis, lower respiration rate, lower Glasgow Coma Score, higher International Normalized Ratio and emergency transfusion within 6 hours were expected as severity and prognosis predict factors (each of odds ratio were 24.907, 14.282, 2.667 and 16.144). Conclusion: As predict factors, respiration rate, Glasgow Coma Score, International Normalized Ratio and emergency transfusion, are useful determining the severity and predicting prognosis of trauma victims.
Park, Hyun Oh;Choi, Jun Young;Jang, In Seok;Kim, Jong Duk;Choi, Jae Won;Lee, Chung Eun
Journal of Chest Surgery
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v.52
no.6
/
pp.400-408
/
2019
Background: For decades, trauma has been recognized globally as a major cause of death. Reducing the mortality of patients with trauma is an extremely pressing issue, particularly for those with severe trauma. An early and accurate assessment of the risk of mortality among patients with severe trauma is important for improving patient outcomes. Methods: We performed a retrospective medical record review of 582 patients with severe trauma admitted to the emergency department between July 2011 and June 2016. We analyzed the associations of in-hospital mortality with the baseline characteristics and initial biochemical markers of patients with severe trauma on admission. Results: The overall in-hospital mortality rate was 14.9%. Multivariate logistic regression analysis showed that the patient's Rapid Emergency Medicine Score (REMS; odds ratio [OR], 1.186; 95% confidence interval [CI], 1.018-1.383; p=0.029), Emergency Trauma Score (EMTRAS; OR, 2.168; 95% CI, 1.570-2.994; p<0.001), serum lactate levels (SLL; OR, 1.298; 95% CI, 1.118-1.507; p<0.001), and Injury Severity Score (ISS; OR, 1.038; 95% CI, 1.010-1.130; p=0.021) were significantly associated with in-hospital mortality. Conclusion: The REMS, EMTRAS, and SLL can easily and rapidly be used as alternatives to the injury severity score to predict in-hospital mortality for patients who present to the emergency department with severe trauma.
Kim, Yong-Kwan;Jang, Yong-Soo;Kang, Gu-Hyun;Choi, Jung-Tae;Jeon, Hoo;Kim, Jin-Ho
Journal of Trauma and Injury
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v.23
no.2
/
pp.102-106
/
2010
Purpose: With the increasing numbers of foreign residents in Korea, the need for an emergency medical care system for foreign patients seems to be growing. Sometimes, a foreigner admitted to an emergency room is not treated sufficiently due to the absence of insurance, facility in the Korean language, and a guardian. The management of a foreigner with trauma in the ER is difficult due to various problems such as social and economic status. The purpose of this study was to investigate the current management status of foreigners with penetrating wounds in the emergency room. Methods: This study is an analysis of 580 patients that were diagnosed with penetrating wounds in one teaching Hospital from Jan. 1, 2008 to Dec. 31, 2008. We analyzed results according to nationality, alcohol ingestion, intentional or accidental trauma, trauma mechanism, injury severity, management time in the ER, and outcome in the ER. Results: Of the total 580 patients, 486 patients (83.8%) were native Koreans and 94 patients (16.2%) were foreigners. According to the Revised Trauma Score, the average score of native Korean patients was 7.808, and the average score of foreign patients was 7.638. Of native Korean patients, 22.6% had knife wounds while 38.3% of foreign patients did. Of native Korean patients, 17.3% experienced intentional trauma while 33.0% of the foreign patients did. Of native Korean patients, 22.5% had ingested alcohol while 49.4% of the foreigners had. Of native Korean patients, 10.5% were admitted while 7.6% of the foreign patients were. Of native Korean patients, 14.2% were discharged against medical advice (DAMA), while 18.5% of foreign patients were. Of native Korean patients, 1.2% ran away while 8.7% of the foreign patients did. Conclusion: Stabbing was the most common cause of penetrating wounds in foreigner patients in this study. Intentional trauma was more common in foreigners with penetrating wounds than in native Koreans. The severity was higher in foreigners with penetrating wounds than it was in native Koreans, and patients who ran away or were discharged against medical advice were more commonly foreigners with penetrating wounds. Social insurance or policy is needed for the management of foreigners with penetrating wounds.
Purpose: The purpose of this study was to identify the characteristics and nursing activities of severe trauma patients regarding damaged body parts in Busan Regional Emergency Medical Center. Methods: A survey using a 'trauma patient information questionnaire and a list of nurse activities' was conducted with 133 patients over 15 points ISS on EMR from June 1, 2011 to May 31, 2012. The collected data were analyzed by the SPSS/WIN 12.0 program. Results: Almost all of the subjects were men, and the mean age was 48.8. The amount of road traffic accidents was 60.4%, and the mean RTS and ISS were 6.08, and 23.14 points. Nursing activities in common were airway management, assessment of LOC & GCS, and EKG monitoring. Most of head and neck trauma patients were cared for manasing using intracranial pressure: each patience had the following assessed: pupil size and light reflex, they were checked the leak of CSF, kept $30^{\circ}$ head elevation, and administered medications. Some of chest trauma patients were treated for chest tube and central venous catheter insertion. Partial abdominal trauma patients were administered analgesic and cared for using arterial pressure measurement. Part of the limbs and pelvis trauma patients were given a blood transfusion. Conclusion: Based on the results, the characteristics and nursing activities were specific according to the specific damaged body parts.
Purpose: Nutritional therapy in the intensive care unit is an essential factor for patient progress. The purpose of this study was to compare resting energy expenditure (REE) calculated by prediction equations (PEs) to the REE measured by indirect calorimetry (IC) in trauma patients. Methods: Patients admitted to the trauma intensive care unit who received mechanical ventilation between January and December 2015 were enrolled. REE was measured by IC (CCM Express, MGC Diagnostics) and calculated by the following PEs: Harris-Benedict, Fleisch, Robertson and Reid, Ireton-Jones, and the maximum value (25 kcal/kg/day) of the European Society for Clinical Nutrition and Metabolism (ESPEN). All patients were ventilated at a fraction of inspired oxygen (FiO2) below 60%. Results: Of the 31 patients included in this study, 24 (77.4%) were men and seven (22.6%) were women. The mean age of the patients was 49.7±13.2 years, their mean weight was 68.1±9.6 kg, and their mean Injury Severity Score was 26.1±11.3. The mean respiratory quotient on IC was 0.93±0.19, and their mean FiO2 was 38.72%±6.97%. The mean REE measured by IC was 2,146±444.36 kcal/day, and the mean REE values calculated by the PEs were 1,509.39±205.34 kcal/day by the Harris and Benedict equation, 1,509.39±154.33 kcal/day by the Fleisch equation, and 1,443.39±159.61 kcal/day by the Robertson and Reid equation. The Ireton-Jones equation yielded a higher value (2,278.90±202.35 kcal/day), which was not significantly different from the value measured using IC (p=0.53). The ESPEN maximum value (1,704.03±449.36 kcal/day) was lower, but this difference was likewise not significant (p=0.127). Conclusions: The REE measured by IC was somewhat higher than that calculated using PEs. Further studies are needed to determine the proper nutritional support for trauma patients.
Purpose: Using a propensity analysis, a recent study reported that blood transfusion might not be an independent predictor of mortality in critically ill patients, which contradicted the results of earlier studies. This study aims to reveal whether or not blood transfusion is an independent predictor of mortality in trauma patients. Methods: A total of three hundred fifty consecutive trauma patients who were admitted to our emergency center from January 2004 to October 2005 and who underwent an arterial blood gas analysis and a venous blood analysis were included in this study. Their medical records were collected prospectively and retrospectively. Using a multivariate logistic analysis, data on the total population and on the propensity-score -matched population were retrospectively analyzed for association with mortality. Results: Of the three hundred fifty patients, one hundred twenty-nine (36.9%) received a blood transfusion. These patients were older (mean age: 48 vs. 44 years; p=0.019) and had a higher mortality rate (27.9% vs. 7.7%; p<0.001). In the total population, the multivariate analysis revealed that the Glasgow coma scale score, the systolic blood pressure, bicarbonate, the need for respiratory support, past medical history of heart disease, the amount of blood transfusion for 24 hours, and hemoglobin were associated with mortality. In thirty-seven pairs of patients matched with a propensity score, potassium, new injury severity score, amount of blood transfusion for 24 hours, and pulse rate were associated with mortality in the multivariate analysis. Therefore, blood transfusion was a significant independent predictor of mortality in trauma patients. Conclusion: Blood transfusion was revealed to be a significant independent predictor of mortality in the total population of trauma patients and in the propensity-score-matched population.
Kim, Whan Sik;Cho, Min Su;Bae, Keum Seok;Kang, Seong Joon;Lee, Kang Hyun;Hwang, Keum;Oh, Jin Rok;Park, Il Hwan
Journal of Trauma and Injury
/
v.20
no.2
/
pp.96-100
/
2007
Purpose: Trauma is the 5th most common leading cause of death in Korea, but there has been no appropriate management system for patients until now. We analyzed the main causes of death in trauma patients by comparing the characteristics of those patients with the characteristics of patients who survived. We feel this analysis should have a positive effect on the development of an appropriate trauma management system in Korea. Methods: We retrospectively reviewed trauma patients who had been admitted to the Department of General Surgery from February 2002 to February 2007. We compared several expected risk factors between the mortality and the survival group. Data on the transportation, arrival time at the emergency center, amount of transfusion, initial shock index, cause of death, and initial physical condition according to RTS (Revised trauma score), ISS (Injury severity score) and TRISS (Trauma and Injury Severity Score) were collected. Patients with ISS lower than 12 were excluded. Results: Three hundred sixty-six(366) patients with multiple injuries were included. There were 40 patients in the mortality group and 326 patients in the survival group. The mean arrival time (minutes) to emergency center was longer in the mortality group (137.6 vs 93.6 p 0.04). The total amount of transfusion (ml) was larger in the mortality group (7139 vs 2470 p 0.01). The initial shock index was higher in the mortality group (1.45 vs 1.17 p<0.01). The RTS, ISS, and TRISS were not statistically different between the groups. In the multivariate analysis, mean arrival time and initial shock index were important factors for survival. Conclusion: If the mortality rate of trauma patients is to be reduced, the arrival time at the emergency center should be minimized. Improvement of the emergency medical transfer service system is very important for achieving that.
Purpose: This study was conducted to gather descriptive data on trauma victims and to observe the general demographic characteristics and clinical profile of trauma victims who were admitted to a regional emergency medical center in the west southern Kyungsangnam-do area. Objects & Method: The study population consisted of 1,909 trauma patients who visited the emergency department of Gyeongsang National University Hospital between January 2003 and December 2004. The medical records were reviewed in a retrospective manner. Demographic data, the mechanism of injury, and clinical information were collected by three professional medical affairs recorders and an emergency physician and a Revised Trauma Score (RTS) and an Injury Severity Score (ISS) were calculated for each patient. Collected data were analyzed with SPSS software version 12.0. Results: Male patients outmembered female patients (M:F=2.54:1), and the mean age of the population was $40.5{\pm}21.4$ years. The mean RTS and ISS were $7.45{\pm}1.11$ and $8.40{\pm}7.44$, respectively. The seventies showed the highest ISS($10.94{\pm}8.66$). The most common mechanism of injury was motor-vehicle accidents (45.57%), followed by falls or slips(28.26%), and other blunt injuries(12.68%). The most frequent causes of death was cerebral herniation due to head injury(68.4%) and irreversible shock(26.3%). Conclusion: The present study clarified the demographic and clinical characteristics of trauma patients in the Kyungsangnam-do area. In the future, prospective clinical data collection is needed for a more sophisticated trauma study.
Purpose: The aim of this study was to analyze the influence of a trauma team's management. Methods: A total of 181 patients with severe trauma were retrospectively divided into two groups. Of these 181 patients, 81 patients without a trauma team admitted between April and October 2008 were assigned to Group 1, and 100 patients with a Trauma team admitted between April and October 2009 were assigned to Group II. We compared general characteristics, the length of stay in the emergency department (ED) and treatment outcomes (24-h packed RBC transfusion, length of intensive care unit (ICU) stay, length of hospital stay, in-hospital mortality, 24-h mortality) between these two groups. Results: The length of stay in the ED was significantly reduced in Group II compared to Group I ($p$=0.025). No significant differences were found in mean arterial pressure, Glasgow Coma Scale, Revised Trauma Score, Injury Severity Score, in-hospital mortality and 24-h mortality between the two groups. However, Group II had a lower amount of 24-h packed RBC transfusion and a shorter length of ICU and hospital stay than Group I, although these differences were not statistically significant. Conclusion: Through the establishment of a trauma team, the length of stay in the ED can be reduced remarkably. Furthermore, the need for 24-h packed RBC transfusions and the length of stay in the ICU and hospital were found to be decreased in patients managed by a trauma team.
Purpose: Pediatric hand trauma is common and sometimes causes deformity or disability. The incidence and etiologies of hand trauma in children are different from those in adults. This study analyzed the characteristics of pediatric hand trauma cases and patients over a 15-year period. Methods: We conducted a retrospective medical record review of 3,432 children (2,265 boys, 1,167 girls, under 18 years of age) with hand injuries from January 2005 to December 2019. We evaluated the sex distribution and injury etiologies. Injuries were classified by type as burns, amputations, crushing injuries, lacerations, extensor and flexor tendon injuries, open and closed fractures, and nerve injuries. Results: Among the pediatric hand injury patients, males were predominant (1.94:1). Simple lacerations (58.4%) were the most common injury type, followed by fractures (22.8%). Lacerations and burns tended to be common in younger age groups, while tendon injuries, nerve injuries, and crushing injuries were more frequently encountered in older age groups. Conclusions: Hand trauma prevention strategies should be established considering the frequent trauma etiologies in specific age groups. An awareness of age-specific characteristics of pediatric hand trauma patients will be helpful to prevent hand trauma.
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