• Journal of Trauma and Injury
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• 제31권2호
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• pp.87-90
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• 2018

Non-operative management has been preferred in blunt spleen injury. Moreover children are more susceptible to post-splenectomy infection, spleen should be preserved if possible. However, splenectomy is inevitable to patients with severe splenic injury. Therefore splenic autotransplantation could be the last chance for preserving splenic function in these patients although efficacy has not proven. Here we reported four cases of children who were underwent splenic autotransplantation successfully after blunt trauma.

• Journal of Trauma and Injury
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• 제37권1호
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• pp.86-88
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• 2024

Misinterpreting radiographic findings can lead to unnecessary interventions and potential patient harm. The urgency required when responding to the compromised health of trauma patients can increase the likelihood of misinterpreting chest x-rays in critical situations. We present the case report of a trauma patient whose skin fold artifacts were mistaken for pneumothorax on a follow-up chest x-ray, resulting in unnecessary chest tube insertion. We hope to help others differentiate between skin folds and pneumothorax on the chest x-rays of trauma patients by considering factors such as location, shape, sharpness, and vascular markings.

• Journal of Trauma and Injury
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• 제28권4호
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• pp.284-291
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• 2015

The aim of this study is to present a nonoperative treatment for abdominal injuries in patients with multiple traumas and to discuss the role of metropolitan tertiary hospital, non-regional trauma centers. We collected data from patients with multiple traumas including abdominal injuries from 2009 to 2014. Patient characteristics, associated injuries, short-term outcomes and departments that managed the patients overall were analyzed. Based on treatment modalities for abdominal injury, patients were divided into two groups: the operative treatment group and the nonoperative treatment group. We compared differences in patient characteristics, injury mechanisms, initial vital signs, detailed injury types, lengths of hospital and ICU stays. Of the 167 patients with multiple traumas, abdominal injuries were found in 57 patients. The injury mechanism for 44 patients (77.2%) was traffic accidents, and associated extra-abdominal injuries were shown in 45 patients (78.9%). The mean lengths of hospital and ICU stays for the 57 patients were 36.4 days and 8.3 days, respectively. The in-hospital mortality rate was 8.8%. Ten patients (17.5%) were treated operatively, and 47 patients (82.5%) were treated nonoperatively. Among the 47 patients in the nonoperative treatment group, 17 patients received embolization, and 3 patients underwent a percutaneous drainage procedure. Operative treatments were used more in patients with injuries to the pancreas and bowel. No patient required additional surgery or died due to the failure of nonoperative treatment. No differences in the clinical characteristics except for the detailed injury type were observed between the two groups. In appropriately selected patients with multiple traumas including abdominal injuries, nonoperative treatment is a safe and feasible. For rapid and accurate managements of these patients, well-trained trauma surgeons who can manage problems with the various systems in the human body and who can decide whether nonoperative treatment is appropriate or not are required.

• Journal of Trauma and Injury
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• 제28권3호
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• pp.177-181
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• 2015

Purpose: Assessment of the trauma severity associated with the prognosis of trauma patients. But we are having a lot of difficulties in assess the severity because of scarcity of current first-aid records resources. Methods: We presumed that Applying the Revised trauma score which consist of vital signs and GCS score will be helpful to assess the sevirity.This study covers the 10069 patient of Ewah womans hospital (2011.1.1.-2014.12.31) who are able to verify the GCS score from fist-aid records. Results: There is no distinctions between prehospital RTS and hospital RTS. And shows high level of correlation between prehospital RTS and ISS. Conclusion: Therefore we conclude that checking the GCS and RTS at prehospital state will be help to assess the severity of trauma patients.

• 한국응급구조학회지
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• 제27권1호
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• pp.113-125
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• 2023

Purpose: This descriptive research study aimed to identify and strengthen the knowledge, attitudes, and performances related to first aid for patients with oral and maxillofacial trauma among 119 EMTs working at 119 safety centers and local stations in Jeollanam-do, South Korea. Methods: An online questionnaire was distributed among 144 119 EMTs working at fire stations in Jeollanam-do from August 1 to August 15, 2022. Results: The factors that influenced the knowledge of oral and maxillofacial trauma among the 119 EMTs included qualification (β=.113, p=.005) and performance (β=.837, p=.005), and those influential to attitudes were qualification (β=0.194, p=.005), ordinary interest (β=0.242, p=.005), and the need for education (β=.285, p=.005). The only factor that influenced the performance of first aid for patients with oral and maxillofacial trauma was knowledge (β=.900, p=.005). Conclusion: Considering the nature of first aid for patients with oral and maxillofacial trauma, it is necessary to organize practical knowledge and educational content tailored to the characteristics of each task. This should be simultaneously conducted with practice-oriented simulation education.

• Journal of Trauma and Injury
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• 제26권3호
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• pp.157-162
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• 2013

Purpose: Abdominal trauma rarely causes injuries involving duodenum. But, it is associated with higher rate of the complication and mortality than other abdominal injuries. There are many options for the management of duodenal injuries. Herein we are to review our experiences and find out the risk factors related to the morbidity and the mortality in traumatic duodenal injuries. Methods: The medical records of total 25 patients who managed by surgical managements and survive more than 48 hours were conducted from January 2006 to December 2012. The clinical characteristics, treatments, and outcomes are reviewed. Results: Among 25 patients, most of them (n=17, 68.0%) were managed by the pyloric exclusion and the gastrojejunostomy. The $3^{rd}$ portion is the most injured site (n=15, 60.0%), and the majority exhibited grade 2 severity (n=14, 56.0%). Most of patients had blunt abdominal traumas (n=23, 92.0%) so that many of them (n=14, 56.0%) had other combined abdominal injuries. The mean ISS is $11.5{\pm}6.2$. The surgery related mortality rate was 28.0%. There was no statistical significance between each factors and the mortality except leakage (p=0.012). But, we could find some trends about traumatic duodenal injuries in this study. The mortality rates of them who older than 55 years were higher than others. And, all 3 patients who delayed the operation more than 24 hours after the trauma had some complications or died. Also, the patients who had the $2^{nd}$ portion injury, grade 3 injury, or combined abdominal injury were less survived. Conclusion: Duodenal injury is related to high rate of morbidity(47.8%) and mortality(28.0%). Age, portion of injury, OIS grade, ISS>15, combined intra-abdominal operation, and trauma to operation time over 24 hrs have some trend with attribution to mortality. Especially leakage of duodenal injury is related to mortality.

• Journal of Trauma and Injury
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• 제22권1호
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• pp.37-43
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• 2009

Purpose: A missed fracture is a very common occurrence in the Emergency Department (ED) and can have serious results because of delays in treatment, resulting in long-term disability. It is also one of the most common causes leading to medical legal issues. We analyzed the causes of missed fractures by using a bone scan which is known to be an effective tool for diagnosing bony lesions. Methods: We reviewed the medical records of trauma patients who underwent a bone scan after being discharged the ED from September 2006 to March 2008. Cases of missed fractures were identified by using electronic medical records to review each diagnosis. Definition of missed fracture was read after bone scan by radiologist. We decided that there was no fracture if we read 'trauma-related lesion' or 'cannot rule out fracture' on a bone scan read by a radiologist. Enrolled patients were analyzed by age, sex, time until bone scan and Injury Severity Score (ISS). Patients were divided into two groups, alert mentality and not-alert mentality, so there were split between a diagnosis group and a missed fracture group. ISS was also used in determining the severity of the patient's injury upon discharge from the ED. Results: A total of 532 patients were enrolled in this study. Of those, 487 patients were in the diagnosis group, and 45 patients (8.4%) were discovered to have had a fracture. Of the 45 missed fracture patients, 34 patients (6.4%) had one-site fractures, 8 patients (1.5%) had two-site fractures, and 3 patients (0.6%) had three-site fractures. The most commonly missed fracture was multiple rib fractures (18 patients, 30.5%), followed by lumbosacral (LS) spine fractures (10 patients, 16.9%), thoracic spine fractures (8 patients, 13.6%), and clavicle fractures (6 patients, 10.2%). Mean age was $50.12{\pm}18.54$ years in the diagnosis group and $57.38{\pm}16.88$ years in the missed fracture group. For the diagnosis group, the mean ISS was $9.03{\pm}8.26$, but in the missed fracture group it was $17.53{\pm}9.69$. Missed fractures were much more frequent in the not-alert mentality (p<0.01) and in the high (ISS$ ISS{\geq}16$) group (p<0.01). Conclusion: Missed fractures occur most frequent in patients of old age, not-alert mentality, and high ISS. Multiple rib and spine fractures were found to be the most frequent missed fractures, regardless of trauma severity. This study also shows a high possibility of clavicle and scapula fractures in patients with severe trauma.

• Journal of Trauma and Injury
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• 제19권2호
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• pp.135-142
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• 2006

Purpose: We planned to determine the diagnostic capability of focused assessment with sonography for trauma (FAST) in cases of blunt abdominal injury (BAI). Methods: A retrospective analysis of FAST sheets was performed from April 2002 to December 2004. During the study period, 135 BAI patients were evaluated with FAST at the Emergency Department of Bundang CHA Hospital. Of this group, twenty-eight patients were excluded, leaving 107 patients for analysis. Abdomen CT (computerized tomography) or exploratory laparotomy confirmed the presence of hemoperitoneum. At the secondary survey, patients underwent a three-view FAST examination (LogicQ; General Electric, Waukesha, USA) by an emergency physician, followed within 2 hours by an abdomen CT or exploratory laparotomy. The FAST examination was considered positive if it demonstrated evidence of free intra-abdominal fluid. Results: There were 45 true-positive FAST examination, 57 true-negatives, 1 false-positive, and 4 false negatives (sensitivity 91.8%, specificity 98.3%, positive predictive value 97.8%, negative predictive value 93.4%). The area under the ROC curve was 0.951 for the FAST examination. Conclusion: FAST is a highly reliable method for screening patients suspected of having BAI for the presence or absence of hemoperitoneum.

• Journal of Chest Surgery
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• 제31권11호
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• pp.1085-1088
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• 1998

연구배경 : 많은 외상 환자에서 흉곽골이 손상에 노출되지만 흉곽골 외상 환자에서 단순 흉부 사진으로 흉곽부위 손상정도를 최종진단 하기는 어려운 경우가 많다. 특별히 흉곽골의 경미한 손상의 경우는 골주사 검사를 사용하여 명확한 진단을 할 수 있겠는데 감수성은 매우 높은 결과를 나타내었다. 재료 및 방법 : 680명의 흉곽 외상환자 중 골스캔을 환자를 대상으로 조사하였다. 결과 : 680례에서 감수성은 97.4%이고 위음성은 2.6%였다. 감수성에 있어서 검사 실시 시기가 가장 중요한 요소로 생각되며 손상 부위별로 늑골이나 흉골 골절의 경우는 1주 이후, 늑연골 접합부골절의 경우와 상기 부위골절들이 동반된 경우는 3일 이후면 언제나 우수한 결과를 보였다. 결론 : 흉부외상환자에서 골절에 대한 정확한 진단을 위하여는 적절한 시기의 골스캔이 필요하다.

• Journal of Chest Surgery
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• 제28권12호
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• pp.1160-1166
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• 1995

From 1980 through 1993, sixty one patients having traumatic flail chest were analysised retrospectively at the Department of Thoracic and Cardivascular Surgery, Chonbuk National University Hospital. There were 47 men and 14 women, mean age, 49.3 years, age range 4 to 82 years. The most common mode of trauma was automobile accident, common combined other organ injuries were skeletal injury [ 36 patients and neurologic injury [ 20 patients . In the mode of treatment, ventilator therapy was done in 34 cases and operative stabilization was done in 18 cases [ Kirschner or steel wire: 9 cases, Judet`s strut: 9 cases . Sixteen patients died [26 % . The main factors associated with fatal outcome were shock [ p < 0.002 , head injury [ p < 0.005 , and more than 50 years of age [ p < 0.05 . In fatal cases, 14 patients died during in ventilator therapy [ 14/34, 41 % and 2 patients died following operative stabilization of chest wall [ 2/18, 11 % .The overall cause of death was septicemia, ARDS, ARF, hypovolemic shock and hypoxic brain damage.