• Journal of Trauma and Injury
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• v.36 no.4
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• pp.337-342
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• 2023

Purpose: This study aimed to compare the resting energy expenditure (REE) measured using indirect calorimetry with that estimated using predictive equations in severe trauma patients to determine the appropriate caloric requirements. Methods: Patients admitted to the surgical intensive care unit between January 2020 and March 2023 were included in this study. Indirect calorimetry was used to measure the patients' REE values. These values were subsequently compared with those estimated using predictive equations: the weight-based equation (rule of thumb, 25 kcal/kg/day), Harris-Benedict, Ireton-Jones, and the Penn State 2003 equations. Results: A total of 27 severe trauma patients were included in this study, and 47 indirect calorimetric measurements were conducted. The weight-based equation (mean difference [MD], -28.96±303.58 kcal) and the Penn State 2003 equation (MD, - 3.56±270.39 kcal) showed the closest results to REE measured by indirect calorimetry. However, the REE values estimated using the Harris-Benedict equation (MD, 156.64±276.54 kcal) and Ireton-Jones equation (MD, 250.87±332.54 kcal) displayed significant differences from those measured using indirect calorimetry. The concordance rate, which the predictive REE differs from the measured REE value within 10%, was up to 36.2%. Conclusions: The REE values estimated using predictive equations exhibited substantial differences from those measured via indirect calorimetry. Therefore, it is necessary to measure the REE value through indirect calorimetry in severe trauma patients.

• Korean Journal of Culture and Social Issue
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• v.27 no.3
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• pp.237-258
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• 2021

The purpose of this research was to empirically explore the association between exposure to news of the nth Room Case, indirect trauma, and beliefs about the world among adults in their 20s. A total of 228 adults in their 20s participated in an online survey designed to study the association above. Analysis using SPSS 25.0 showed that participants who were exposed to more related news immediately after the nth Room case was revealed experienced a higher level of indirect trauma. Furthermore, indirect trauma fully mediated the relationship between exposure to the news of the nth Room Case and beliefs about the world. This study empirically demonstrated the impact of news exposure on beliefs about the world through indirect trauma, suggesting that, like disasters, sex crimes can cause indirect trauma to third parties through the news. However, this study was limited to adults in their 20s, and most of the participants were women; therefore, future studies using samples representing demographically more diverse groups are needed. Future research could also examine the possibility of emotional contagion mediating or moderating the relationship between news exposure and indirect trauma.

• Korean Journal of Culture and Social Issue
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• v.23 no.3
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• pp.381-407
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• 2017

The purpose of this study was to develop scale for the measurement of indirect traumatization occurred by social disaster and test their validity. To achieve this purpose, this study conduct a research through the following procedure. First, to develop the inventory, various responses of indirect traumatization occurred by social disaster were gathered from Korean adults participated in open questionnaire. 41 items were made. Second, exploratory factor analysis were performed and 21 items were selected in this step. The Indirect Trauma Scale of Social Disaster(ITSSD) consisted of 4 factors, each with 4-to-8 items, respectively. Four factors include ① private coping responses ② symptom responses ③ distrust responses of world ④ moral emotion cause of social perpetrators. Appropriate levels of reliability were established for the ITSSD. Third, Indirect Trauma Scale of Social Disaster was validated by confirmatory factor analysis, and 21 items were fixed. To 300 participants differed from development step, confirmatory factor analysis was performed. 4 factors structure derived from the exploratory analysis was appropriate. And 4 factors indicated reasonable fit index such as TLI(.913), CFI (.924) and RMSEA(.077). In addition, ITSSD identified a significant positive correlation with Posttrauma Risk Checklist, Korean Depression Scale, State-Trait Anxiety Inventory-KYZ and negative with Acceptance-action Questionnaire-2. But that was unrelated to Forgiveness Trait Scale and Life Satisfaction Scale. Also the result showed that Women experienced high level of indirect trauma of social disaster than men.

• Anxiety and mood
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• v.14 no.2
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• pp.71-79
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• 2018

Objective : Several earlier studies have reported similar symptoms in patients with posttraumatic stress disorder (PTSD) who have been repeatedly exposed to relevant media after disasters and trauma. This study aimed to examine the effects of indirect trauma experience through media rather than direct traumatic events on an individual's social life. Methods : Five hundred and fifty-four individuals participated in our online, self-reported questionnaire survey. All subjects were asked to complete a demographic questionnaire, Posttraumatic Diagnostic Scale, Beck Depression Inventory, the Impact of Event Scale-Revised, State-Trait Anxiety Inventory, Korean version of Alcohol Use Disorder Identification Test, Patient Health Questionnaire-15, Suicidal Behaviors Questionnaire-Revised. Participants were assessed in regards to their experience of violent media exposure within the past three months. Results : Data from our study indicates that the group exposed to violent media had significantly higher perceived stress, physical symptoms, insomnia, and suicide ideation in comparison to the control group. Among the major symptoms of PTSD, the proportion of intrusion symptoms was relatively high in the media exposed group. Conclusion : This suggests that indirect trauma caused by media exposure could cause post-traumatic stress symptoms. The PTSD caused by indirect trauma may have slight differences from the PTSD caused by direct trauma. Therefore, it is necessary to understand, prevent, and control the adverse effects of media.

• Journal of Trauma and Injury
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• v.34 no.1
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• pp.13-20
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• 2021

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.

• Journal of Korean Medical Science
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• v.33 no.45
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• pp.284.1-284.12
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• 2018

Background: Posttraumatic stress symptoms (PTSS) in patients with psychological trauma lead to poor health-related quality of life. Understanding of the relationships among PTSS, anxiety, depression, and illness intrusiveness will guide the development of efficient approaches to enhance subjective well-being in patients with psychological trauma. This study investigated whether anxiety and depression mediate the relationship between PTSS and illness intrusiveness in the hope of providing more comprehensive and effective trauma treatment. Methods: Psychiatric outpatients who visited the trauma clinic of a university hospital (n = 260) participated in this study. Assessments were conducted for PTSS, anxiety, depression, and illness intrusiveness. Structural equation modeling and path analysis were performed to analyze the mediating effects of anxiety and depression on the relationship between PTSS and illness intrusiveness. Results: PTSS had both direct and indirect exacerbating effects on illness intrusiveness. Anxiety exhibited the largest direct exacerbating effect on illness intrusiveness. The indirect effects of PTSS on illness intrusiveness through anxiety alone and through a depression-to-anxiety pathway were significant, but the indirect effect through depression alone was not. Conclusion: The findings demonstrate that anxiety, both independently and as part of an interrelated pathway with depression, partially mediates the relationship between PTSS and illness intrusiveness. Appropriate interventions and a comprehensive approach to alleviate anxiety and depression could mitigate the negative effects of PTSS on illness intrusiveness in patients with psychological trauma.

• Anxiety and mood
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• v.10 no.2
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• pp.95-102
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• 2014

Objective : Previous research showed that childhood trauma or domestic violence resulted in difficulties in controlling emotion and problem solving and vulnerability to psychiatric disorders. To understand the long term effect of childhood trauma, this study investigated their influences on cognitive processing of anger-evoking event and anger behavior among prisoners. Methods : All data were collected from 198 prisoners off our districts in Korea. After they consented to participate, prison officer distributed a questionnaire that included scales to demographic measure, childhood abuse (emotional abuse, physical abuse, and neglect), cognitive response of anger (attentional focus, suspicion, rumination, and hostile attitude) and behavior of anger (impulsive reaction, verbal aggression, physical confrontation, and indirect expression). For statistical analyses, SPSS 18.0 were used and path coefficients were evaluated from the structural equational modeling using LISREL 8.52. Results : Almost 50% of prisoners of our sample experienced one or more trauma during childhood. Then we tested the long term effect of childhood trauma on anger response by structural equation modeling. As expected, childhood trauma was associated with cognitive processing of anger-evoking event and anger behavior. More specifically, emotional abuse (${\beta}$=0.21, p<0.01) predicted suspicion which in turn associated with impulsive reaction (${\beta}$=0.73, p<0.001) and verbal aggression (${\beta}$=0.87, p<0.001). Emotional abuse (${\beta}$=0.24, p<0.01) also predicted hostile attitude which associated with physical confrontation (${\beta}$=0.80, p<0.001) and indirect expression (${\beta}$=0.80, p<0.001). Interestingly, physical abuse associated directly with impulsive reaction (${\beta}$=0.23, p<0.01) and indirect expression (${\beta}$=0.17, p<0.05). Neglect predicted rumination (${\beta}$=0.15, p <0.05) which associated with indirect expression marginally (${\beta}$=0.11, P<0.10). Conclusion : The results of this study, suggest longitudinal and harmful effect of childhood trauma on difficulties in controlling anger. Especially, it was revealed that childhood abuse related with processing anger evoking events more suspicious and hostile and then various anger-expressing behaviors.

• Journal of Trauma and Injury
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• v.34 no.3
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• pp.162-169
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• 2021

Purpose: For severe lung injuries or acute respiratory distress syndrome that occurs during critical care due to trauma, extracorporeal membrane oxygenation (ECMO) may be used as a salvage treatment. This study aimed to describe the experiences at a single center with the use of ECMO in trauma patients. Methods: We enrolled a total of 25 trauma patients who were treated with ECMO between January 2015 and December 2019 at a regional trauma center. We analyzed and compared patients' characteristics between survivors and non-survivors through a medical chart review. We also compared the characteristics of patients between direct and indirect lung injury groups. Results: The mean age of the 25 patients was 45.9±19.5 years, and 19 patients (76.0%) were male. The mean Injury Severity Score was 26.1±10.1. Ten patients (40.0%) had an Abbreviated Injury Scale (AIS) 3 score of 4, and six patients (24.0%) had an AIS 3 score of 5. There were 19 cases (76.6%) of direct lung injury. The mortality rate was 60.0% (n=15). Sixteen patients (64.0%) received a loading dose of heparin for the initiation of ECMO. There was no significant difference in heparin use between the survivors and non-survivors (70% in survivors vs. 60% in non-survivors, p=0.691). When comparing the direct and indirect lung injury groups, there were no significant differences in variables other than age and ECMO onset time. Conclusions: If more evidence is gathered, risk factors and indications will be identified and we expect that more trauma patients will receive appropriate treatment with ECMO.

• Journal of Trauma and Injury
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• v.30 no.4
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• pp.212-215
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• 2017

The choice of the most appropriate treatment for thoracolumbar or lumbar spine burst fracture remains controversial from conservative treatment to fusion through a posterior or anterior approach. There are many cases where ligamentotaxis is used to reduce the burst fracture. However, indirect reduction using ligamentotaxis is often limited in the magnitude of the reduction that it can achieve. In our patient with severe burst fracture, we were able to restore an almost normal level of vertebral height and secure spinal canal widening by using only ligamentotaxis by posterior instrumentation. Before the operation, the patient had more than 95% encroachment of the spinal canal. This was reduced to less than 10% after treatment.

• Anxiety and mood
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• v.6 no.1
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• pp.65-70
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• 2010

Objectives : Indirect contact with trauma may occur when a person empathically listens to detailed descriptions, exposing the person to intense emotional pain from trauma victims. Although less severe than direct trauma, indirectly traumatized persons may experience the same fear, rage, and despair as direct trauma victims. This phenomenon has been variously termed vicarious trauma, traumatic countertransference, burnout, compassion fatigue, and secondary traumatic stress. Using a psychiatric symptoms questionnaires, this study investigated the effects of indirect exposure to co-worker's trauma on the mental health of firefighters who had not directly experienced traumatic events in the previous year. Methods : We administered self-report questionnaires, such as the Impact of Event Scale-Revised (IESR) and Alcohol Use Disorder Identification Test (AUDIT), to firefighters working at two fire stations in a metropolitan city. We analyzed 188 of 232 collected surveys, after excluding falsely entered data (28 cases) and questionnaires by directly-traumatized victims (16 cases). Results : Alcohol consumption and posttraumatic stress disorder (PTSD) symptoms, as determined by the AUDIT and IES-R, were significantly higher in the indirectly-traumatized group. The ratio of high-risk members scoring higher than 23 in IES-R was larger in the indirectly traumatized group, although this was not statistically significant. Conclusion : Alcohol consumption was significantly higher in the indirectly traumatized group. This group also included more members at high risk for PTSD. Further research, with a larger group of indirectly traumatized firefighters and ongoing investigation of PTSD development and other psychiatric symptoms, is needed.