• Journal of Trauma and Injury
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• 제25권3호
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• pp.79-86
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• 2012

Purpose: The most common cuase of transfusion for trauma victims in an emergency department is hypovolemic shock due to injury. After an injury to an internal organ of the chest or the abdomen, transfusion is needed to supply blood products and to compensate tissue oxygen transport and bleeding. From the 1990's, there have been some reports that transfusion is one of the major factors causing multiple-organ failure. Thus, as much as possible, tranfusion has been minimized in the clinical setting. This study aims to analyze the prognostic factors for mortality among trauma victims transfused with blood products in an emergency department. Methods: We conducted this study for the year of 2010 retrospectively. The study group included adult trauma victims tranfused with blood products in our ED. The exclusion criteria were discharge against medical advice, and missing follow-up due to transfer to another facility. During the study period, 34 adult trauma victims were enrolled. We compared the clinical variables between survivors and non-survivors. Results: the mean age of the 34 victims was 58.06 years, and males account for 58.5% of the study group. The most-frequently used form transportation was ambulance(119, 55.9%), and the most common injury mechanism was mobile vehicle accidents(67.6%). The mean revised trauma score (RTS) was 5.9, and the mean injury severity score (ISS) was 47.76. The mortality rate in the ED was 58.5%, Comparison of survivors with non-survivors showed statistical differences in injury mechanism, initial SBP, DBP, RTS, ISS, and some laboratory data such as AST, ALT, pH, PO2, HCO3, glucose (p<0.05). Regression analyses showed that mortality among adult trauma victims transfused in the ED correlated with RTS. Conclusion: When an adult trauma victim is transported to the ED and needs a tranfusion, the emergency physician carefully assess the victim by using physiologic data.

• Journal of Korean Neurosurgical Society
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• 제58권2호
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• pp.131-136
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• 2015

Objective : To investigate the incidence of corpus callosum injury (CCI) in patients with mild traumatic brain injury (TBI) using brain MRI. We also performed a review of the clinical characteristics associated with this injury. Methods : A total of 356 patients in the study were diagnosed with TBI, with 94 patients classified as having mild TBI. We included patients with mild TBI for further evaluation if they had normal findings via brain computed tomography (CT) scans and also underwent brain MRI in the acute phase following trauma. As assessed by brain MRI, CCI was defined as a high-signal lesion in T2 sagittal images and a corresponding low-signal lesion as determined by axial gradient echo (GRE) imaging. Based on these criteria, we divided patients into two groups for further analysis : Group I (TBI patients with CCI) and Group II (TBI patients without CCI). Results : A total of 56 patients were enrolled in this study (including 16 patients in Group I and 40 patients in Group II). Analysis of clinical symptoms revealed a significant difference in headache severity between groups. Over 50% of patients in Group I experienced prolonged neurological symptoms including dizziness and gait disturbance and were more common in Group I than Group II (dizziness : 37 and 12% in Groups I and II, respectively; gait disturbance : 12 and 0% in Groups I and II, respectively). Conclusion : The incidence of CCI in patients with mild TBI was approximately 29%. We suggest that brain MRI is a useful method to reveal the cause of persistent symptoms and predict clinical prognosis.

• Journal of Korean Neurosurgical Society
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• 제47권3호
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• pp.199-202
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• 2010

Objective : Balloon kyphoplasty is a minimally invasive procedure that is mainly performed for refractory pain due to osteoporotic compression fractures. The purpose of this study was to evaluate the results of balloon kyphoplasty performed at different times after an injury. Methods : In this retrospective study, the records of 99 patients who underwent one level of balloon kyphoplasty between January 2005 and December 2007 were reviewed. The patients were divided into three groups : 21 patients treated within 3 weeks of an injury (the acute group), 49 treated within 3 weeks to 2 months of an injury (the subacute group), and 29 patients treated at more than 2 months after an injury (the chronic group). Clinical outcomes were assessed using a visual analogue scale (VAS). In addition, modified MacNab's grading criteria was used to assess the subjective patient outcome. The radiology findings, including vertebral height restoration and procedure related complications, were analyzed based on the different time intervals after the injury. Results : Patients in all three groups achieved marked pain relief in terms of the VAS within 7 days of the procedure. Good or excellent results were achieved by most patients in all three groups. However, the height restoration, the main advantage to performing a balloon kyphoplasty, was not achieved in the chronic group. Moreover, evidence of complications including cement leakage was observed significantly less frequently in the subacute group compared to the other two groups. Conclusion : Although balloon kyphoplasty is an effective treatment for osteoporotic compression fractures, with regard to pain relief, the subacute stage appears to be optimal for treating patients with a balloon kyphoplasty in terms of achieving the best outcomes with minimal complications.

• Journal of Trauma and Injury
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• 제35권3호
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• pp.189-194
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• 2022

Purpose: The purpose of this study was to determine whether a higher Injury Severity Score (ISS) could serve as an indicator of splenectomy in patients with traumatic splenic lacerations. Methods: A total of 256 cases of splenic laceration were collected from January 1, 2005 to December 31, 2018. After the application of exclusion criteria, 105 were eligible for this study. Charts were reviewed for demographic characteristics, initial vital signs upon presentation to the emergency room, Glasgow Coma Scale, computed tomography findings, ISS, and treatment strategies. The cases were then divided into nonsplenectomy and splenectomy groups for analysis. Results: When analyzed with the chi-square test and t-test, splenectomy was associated with a systolic blood pressure lower than 90 mmHg, a Glasgow Coma Scale score lower than 13, active bleeding found on computed tomography, a splenic laceration grade greater than or equal to 4, and an ISS greater than 15 at presentation. However, in multivariate logistic regression analysis, only active bleeding on computed tomography showed a statistically significant relationship (P=0.014). Conclusions: Although ISS failed to show a statistically significant independent relationship with splenectomy, it may still play a supplementary role in traumatic splenic injury management.

• Journal of Korean Neurosurgical Society
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• 제61권5호
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• pp.574-581
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• 2018

Objective : The zero-profile implant (Zero-P) is accepted for use in anterior cervical fusion for the treatment of degenerative cervical disease. However, evidence pertaining to its efficiency and safety in traumatic cervical injury is largely insufficient. This study aimed to compare the overall outcomes of patients who underwent Zero-P for traumatic cervical disc injury. Methods : Data from a total of 53 consecutive patients who underwent surgery for traumatic or degenerative cervical disc disease using the Zero-P were reviewed. Seventeen patients (group A) had traumatic cervical disc injury and the remaining 36 (group B) had degenerative cervical disc herniation. The fusion and subsidence rates and Cobb angle were measured retrospectively from plain radiographs. The patients' clinical outcomes were evaluated using the Japanese Orthopedic Association (JOA) score and Odom's criteria. Results : The C2-7 Cobb and operative segmental angles increased by $3.45{\pm}7.61$ and $2.94{\pm}4.59$ in group A; and $2.46{\pm}7.31$ and $2.88{\pm}5.49$ in group B over 12 postoperative months, respectively. The subsidence and fusion rate was 35.0% and 95.0% in group A; and 36.6% and 95.1% in group B, respectively. None of the parameters differed significantly between groups. The clinical outcomes were similar in both groups in terms of increasing the JOA score and producing a grade higher than "good" using Odom's criteria. Conclusion : The application of Zero-P in patients with traumatic cervical disc injury was found to be acceptable when compared with the clinical and radiological outcomes of degenerative cervical spondylosis.

• Composites Research
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• 제36권4호
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• pp.253-258
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• 2023

교통수단의 발전은 이동이 불편한 장애인들의 이동권 보장을 실현하였지만 차량사고시 발생할 수 있는 장애인 탑승객의 안전 향상은 일반 승객좌석에 비해 낮다고 할 수 있다. 특히 갑자기 발생할 수 있는 후방 추돌 사고의 경우 장애인 탑승객의 머리와 목 부상에 취약한 것이 현실이다. 이에 본 연구에서는 휠체어 운송 차량의 후방 추돌 시 차량내 장애인 탑승객의 머리와 목 상해지수 개선을 위해 headrest를 관상면으로 3등분한 multi-layer headrest foam이 제안되었다. 간이 모델을 통한 저속 후방 추돌 해석을 통해 foam의 다양한 압축 특성을 부여하기 위한 stress scale factor의 범위가 선정되었으며, 해당 범위를 parameter로 지정하여 GA최적화가 수행되었다. 최적화결과를 통해 layer의 압축 특성에 따른 HIC와 NIC간의 상간관계 분석이 이뤄졌으며, HIC는 Front layer, NIC는 Mid layer의 압축 특성에 가장 민감하게 반응하였고 Rear layer의 압축 특성은 가장 낮게 나타났다. Validation model에 일반headrest와 최적화된 multi-layer headrest를 각각 배치하여 저속 후방 추돌 sled test 해석을 수행하였으며, 일반headrest대비 multi-layer headrest에서의 HIC와 NIC가 낮게 도출되었다. multi-layer headrest에서의 압축 거동 역시 명확하게 나타나 multi-layer headrest가 일반headrest대비 머리와 목의 상해지수 개선에 효과적인 것이 검증되었다.

• Journal of Trauma and Injury
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• 제36권3호
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• pp.231-241
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• 2023

Purpose: Overtriage and undertriage rates are critical metrics in trauma, influenced by both trauma team activation (TTA) criteria and compliance with these criteria. Analysis of undertriaged patients at a level I trauma center revealed suboptimal compliance with existing criteria. This study assessed triage patterns after implementing compliance-focused process interventions. Methods: A physician-driven, free-text alert system was modified to a nonphysician, hospital dispatcher-guided system. The latter employed dropdown menus to maximize compliance with criteria. The preintervention period included patients who presented between May 12, 2020, and December 31, 2020. The postintervention period incorporated patients who presented from May 12, 2021, through December 31, 2021. We evaluated appropriate triage, overtriage, and undertriage using the Standardized Trauma Assessment Tool. Statistical analyses were conducted with an α level of 0.05. Results: The new system was associated with improved compliance with existing TTA criteria (from 70.3% to 79.3%, P=0.023) and decreased undertriage (from 6.0% to 3.2%, P=0.002) at the expense of increasing overtriage (from 46.6% to 57.4%, P<0.001), ultimately decreasing the appropriate triage rate (from 78.4% to 74.6%, P=0.007). Conclusions: This study assessed a workflow change designed to improve compliance with TTA criteria. Improved compliance decreased undertriage to below the target threshold of 5%, albeit at the expense of increased overtriage. The decrease in appropriate triage despite compliance improvements suggests that the current criteria at this institution are not adequately tailored to optimally balance the minimization of undertriage and overtriage. This finding underscores the importance of improved compliance in evaluating the efficacy of TTA criteria.

• Journal of Trauma and Injury
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• 제18권1호
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• pp.17-25
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• 2005

Background: Traumatic rupture of the aorta is a life-threatening injury that must be diagnosed as rapidly as possible and treated immediately. The chest X-ray is a valuable tool for screening traumatic rupture of the aorta in blunt chest trauma. And various chest radiologic parameters are being used as diagnostic tools for aortic injury. The purpose of this study is to identify chest radiographic parameters that may assist in the detection of traumatic rupture of the aorta and to compare these findings with those of other reports. Methods: This study involved 30 adult patients with traumatic rupture of the aorta seen at the emergency department of the Asan Medical Center from 1997 to 2004. The control subjects were 30 healthy patients with neither lung nor cardiovascular disease. We retrospectively assessed over 14 parameters on chest X-rays. Results: In 11 of the 14 parameters, there were significant differences between the study group and the control group. There was no significant difference in the M/C ratio (mediastinumto-chest width ratio) between the two groups, and neither the left nor the right paraspinal interface was statistically significant (p value>0.05). Our study indicates that new criteria for the MC ratio and for the paraspinal interfaces are needed for screening traumatic aorta injury. The other radiographic parameters for traumatic rupture of the aorta need to be further assessed through a prospective study.

• Journal of Trauma and Injury
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• 제33권2호
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• pp.88-95
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• 2020

Purpose: The present study will identify risk factors for aspiration in severe trauma patients by comparing patients who showed a sign of aspiration lung disease on chest computed tomography (CT) and those who did not. Methods: We conducted a retrospective review of the Korean Trauma Data Bank between January 2014 and December 2019 in a single regional trauma center. The inclusion criteria were patients aged ≥18 years with chest CT, and who had an Injury Severity Score ≥16. Patients with Abbreviated Injury Scale (AIS)-chest score ≥1 and lack of medical records were excluded. General characteristics and patient status were analyzed. Results: 425 patients were included in the final analysis. There were 48 patients showing aspiration on CT (11.2%) and 377 patients showing no aspiration (88.7%). Aspiration group showed more endotracheal intubation in the ER (p=0.000) and a significantly higher proportion of severe Glasgow Coma Scale (GCS) (p=0.000) patients than the non-aspiration group. In AIS as well, the median AIS head score was higher in the aspiration group (p=0.046). Median oxygen saturation was significantly lower in the aspiration group (p=0.002). In a logistic regression analysis, relative to the GCS mild group, the moderate group showed an odds ratio (OR) for aspiration of 2.976 (CI, 1.024-8.647), and the severe group showed an OR of 5.073 (CI, 2.442-10.539). Conclusions: Poor mental state and head injury increase the risk of aspiration. To confirm for aspiration, it would be useful to perform chest CT for severe trauma patients with a head injury.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제21권4호
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• pp.289-296
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• 2018

Purpose: We aimed to study the pattern of liver-injury in children with dengue fever (DF) and validate serum aminotransferase ${\geq}1,000IU/L$ as a marker of severe DF. Methods: Children admitted with DF were included. DF was defined by presence of clinical criteria and positive serological or antigen tests in absence of other etiology. DF severity was graded as dengue without or with warning signs and severe dengue. Liver-injury was defined as alanine aminotransferase (ALT) more than twice the upper limit of normal (boys, 30 IU/L; girls, 21 IU/L). Results: Of 372 children with DF, 144 (38.7%) had liver-injury. Risk of liver-injury and aminotransferase levels increased with DF severity (p<0.001). Recommended ALT and aspartate aminotransferase (AST) cut-off at ${\geq}1,000IU/L$ had sensitivity 4.8% (5/105), specificity 99.3% (265/267) for detection of severe DF. In children with ALT and AST <1,000 IU/L (n=365), the area under receiver operating curves for prediction for severe DF, were 0.651 (95% confidence interval [CI], 0.588-0.714; p<0.001) for ALT and 0.647 (95% CI, 0.582-0.712; p<0.001) for AST. Serum ALT at 376 IU/L and AST at 635 IU/L had sensitivity and specificity comparable to ${\geq}1,000IU/L$ for defining severe DF. Conclusion: Liver-injury is common in DF. The ALT and AST levels increase with DF severity. ALT and AST levels of ${\geq}1,000IU/L$ could be lowered to 376 IU/L and 635 IU/L respectively for defining severe DF.