• Physical Therapy Korea
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• v.3 no.1
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• pp.57-64
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• 1996

Spinal cord injury in child often occurs without evidence of fracture or dislocation. The mechanisms of neural damage in this syndrome of spinal cord injury without radiographic abnormality(SCIWORA) include flexion, hyperextension, longitudinal distraction, and ischemia. Inherent elasticity of the vertebral column in infants and young children, among other age-related anatomical peculiarities, render the pediatric spine exceedingly vulnerable to deforming forces. The neurological lesions encountered in this syndrome include a high incidence of complete and severe partial cord lesions. Children younger than 8years old sustain more serious neurological damage and suffer a larger number of upper cervical cord lesions than children aged over 8 years. Of the children with SCIWORA. 52% have delayed onset of paralysis up to 4 days after injury, and most of these children recall transient paresthesia, numbness, or subjective paralysis. The long-term prognosis in cases of SCIWORA is grim. Most children with complete and severe lesions do not recover; only those with initially mild neural injuries make satisfactory neurological recovery.

• Journal of The Korean Society of Clinical Toxicology
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• v.2 no.1
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• pp.58-62
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• 2004

Acid ingestion can cause not only caustic injury on esophagus and stomach but also fatal outcome through systemic complications. We report the case of a patient who died early after severe caustic injury with strong acid. A 38-year-old man who ingested about 400ml of hydrochloric acid of unknown concentration was transferred to our hospital from a private clinic, in which he was managed with gastric irrigation through a nasogastric tube. He was complaining dyspnea and abdominal pain. Physical examination demonstrated tenderness and rebound tenderness on epigastric region. Severe metabolic acidosis and leukocytosis were noted. Radiological findings suggested perforation of gastrointestinal tract, although the physical signs were not typical. Endoscopy revealed caustic injuries of grade I on esophagus and of grade Ⅲ on stomach, which indicate more severe injury on the stomach than on the esophagus. Exploratory surgery was recommended but unfortunately not permitted by his family. Despite intensive measures, his vital signs deteriorated rapidly and he died 50 hours after the ingestion.

• Journal of Veterinary Clinics
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• v.37 no.1
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• pp.53-56
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• 2020

A wild juvenile bean goose (Anser fabalis serrirostris) was rescued after sustaining an extensive degloving injury around the neck and chin region. Except for the degloving injury, physical and radiographic examination detected no other trauma-induced abnormality. On the day of presentation to the hospital, the patient underwent extensive debridement and suturing. A twice-daily force feeding with diluted parrot weaning food was required during the hospitalization due to severe anorexia. On day 18, the bean goose was moved to the aviary to undergo rehabilitation and feeding by itself. Management of the severe degloving injury of the cervical region with medical intervention and nutritional assistance was successful in this case, and the results of this case shows the proper management can be implemented to produce satisfactory outcomes.

• Journal of Korean Neurosurgical Society
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• v.39 no.4
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• pp.271-276
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• 2006

Objective : Despite the recent progress that has been made in intracerebral monitoring, it is still difficult to quantify the exact extent of primary brain damage after severe head injury. In this work, we investigate the role of S-100B protein as a serum marker of brain damage after severe head injury. Methods : 21 patients with severe head injury [GCS score <9] were selected for this prospective study. A venous blood sample was taken as soon as possible after head injury and the serum concentration of S-100B protein was measured daily for five consecutive days. The serum level of S-100B protein was compared with the patients' outcome. The outcome was measured twice, at hospital discharge and after 6 months of follow-up using the Glasgow Outcome Scale[GOS]. Results : Those patients who died within two weeks [after head injury] had a significantly higher serum S-100B value than those who survived [median, 9.64ug/L versus 2.91ug/L]. Seven [78%] of the nine patients who died had a maximum S-100B value of 2ug/L or higher, while three [25%] of the twelve surviving patients showed a maximum S-100B protein value of more than 2ug/L [P<005]. Conclusion : These results indicate that S-100B protein appears to be the most reliable index for estimating the extent of brain damage.

• The Journal of Internal Korean Medicine
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• v.25 no.2
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• pp.361-367
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• 2004

The following case study suggests strongly the efficacy of Danggwisusan and acupuncture therapy in the treatment of patients with severe contusion and tissue injury of the liver and kidney. The chief symptoms of this case were severe pain in the right side, purpura hemorrhagica, insomnia and third degree bums at the shoulder and face. Analysis of blood chemistry indicated high AST, high ALT, high BUN, high creatine, high creatine kinase and high LDH. Fallowing medication of the patient with Danggwisusan, the symptoms and indexes for tissue injury decreased rapidily within the first week. This results support a potential role for Danggwisusan in the treatment of severe contusion with tissue injury of the liver and kidney.

• Journal of Trauma and Injury
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• v.25 no.3
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• pp.72-78
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• 2012

Purpose: Clinical observation and research findings show that acute traumatic coagulopathy (ATC) is a major factor that must be addressed in the early care of severe trauma patients. ATC is associated with increased transfusion requirements and poor clinical outcomes. This study aimed to correlate the early predictable factors of ATC with the outcomes in severe trauma patients. Methods: Retrospective data from the trauma registry on severe trauma patients (Injury Severity Score (ISS) ${\geq}16$) were used to identify variables independently associated with coagulopathy. Univariate associations were calculated, and a multivariable logistic regression analysis was used to determine variables independently associated with ATC. Results: Patients were mostly male, aged $51.9{\pm}17.8$ years, with an injury severity score of $24.1{\pm}12.4$. ATC, as diagnosed in the emergency department (ED), occurred in 17% of the severe trauma patients. Using a multivariable logistic regression analysis, early predictable variables independently associated with ATC were base deficit (odds ratio (OR): 13.03; 95% confidence interval (CI): 3.47-48.93), acute liver injury (OR: 4.24; 95% CI: 1.06-17.00), and transfer from another hospital (OR: 21.00; 95% CI: 3.23-136.60). Conclusion: ATC is associated with mortality in severe trauma patients, and some variables associated with trauma and shock are an independent predictors of ATC. These variables contribute to the early recognition and management of coagulopathy, which may improve the outcome from trauma resuscitation.

• Journal of Korean Neurosurgical Society
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• v.29 no.2
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• pp.196-202
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• 2000

Objective : This study was designed to evaluate the relationship between the initial neurosurgical or psychosocial factors and the psychosocial outcome. Patients and Methods : We analyzed 123 head-injured patients who were referred to the department of psychiatry for the evaluation of psychosocial function. We analyzed initial neurosurgical variables such as Glasgow Coma scale(GCS) score, skull fracture, CT finding, and psychosocial outcomes with regards to psychosis, personality change, depression, anxiety and IQ on Intelligence Scale. Results : Patients with mild head injury(GCS score 13-15, N＝94, 76.4%) had better recovery rate on Glasgow Outcome Scale(GOS), less personality change than those with moderate or severe head injury. However, depression, anxiety and intelligence were not significantly different between two groups. The skull fracture(N＝37, 30.1%) did not influence on the psychosocial outcome with reference to personality change, depression, anxiety and intelligence. The patients with abnormal CT findings(N＝64, 52%) had lower recovery rate on GOS, more frequent tendency in psychosis, personality change and severe depression, less frequent in anxiety and mild depression, than patients with normal CT finding. However, levels of intelligence were not different between two groups. The patients with industrial accidents(IA) had lower educational level, milder head injury, more delay for the psychiatric evaluation (longer treatment period) than those with motor vehicular accidents(MVA). The psychosocial outcome with reference to personality change, depression, anxiety, intelligence were not different between two groups. Conclusion : These findings indicate that the more severe initial trauma, the poorer psychosocial outcome. However, it was frequently observed that patients with mild head injury suffered from mild anxiety and depression. Therefore mild head injury appeared to be more complicated by psychosocial stressors. The patients with IA, despite the fact that initial head injury was mild, required longer treatment period than MVA.

• Journal of Auto-vehicle Safety Association
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• v.6 no.1
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• pp.22-26
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• 2014

Fatality of accidents on curved roads where rollover accidents are likely to take place was higher than that on straight roads. We ought to investigate factors affecting injury severity of occupant in a vehicle rollover accident. From January 2011 to December 2013, we collected data about rollover motor vehicle crash accident. We surveyed occupant's injury, vehicle type, safety devices, type of rollover accident and the number of turn in accident. Of the 132 subjects, 56.1% were males, 50.8% were drivers, 48.5% fastened seat belt, and air bag deployed in 12.1%. Among injuries sustained head, chest and abdomen were major sites of severe injury(Abbreviated injury scale>2). Seat belt use, rollover type, and the number of 1/4 turn were found to have significant positive correlations with Injury Severity Score. The regression analysis herein found significance in safety belt use and the number of 1/4 turn. Seat belt use was a significant factor affecting injury severe of occupant in rollover accident.

• Journal of Korean Academy of Nursing
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• v.36 no.4
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• pp.621-629
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• 2006

Purpose. The purpose of this study was to identify the clinical variables that predict functional and cognitive recovery at 1- and 6-month in both severe and moderate/mild traumatic brain injury patients. Methods. The subjects of this study were 82 traumatically brain-injured patients who were admitted to a Neurological Intensive Care Unit at a university hospital. Potential prognostic factors included were age, motor and pupillary response, systolic blood pressure, heart rate, and the presence of intracranial hematoma at admission. Results. The significant predictors of functional disability in severe traumatic brain injury subjects were, age, systolic blood pressure, the presence of intracranial hematoma, motor response, and heart rate at admission. In moderate/mild traumatic brain injury patients, motor response, abnormal pupil reflex, and heart rate at admission were identified as significant predictors of functional disability. On the other hand, the significant predictors of cognitive ability for severe traumatic brain injury patients were motor response and the presence of intracranial hematoma at admission, whereas those for moderate/mild patients were motor response, pupil reflex, systolic blood pressure at admission, and age. Conclusions. The results of the present study indicate that the significant predictors of TBI differ according to TBI severity on admission, outcome type, and outcome measurement time. This can be meaningful to critical care nurses for a better understanding on the prediction of brain injury patients. On the other hand, the model used in the present study appeared to produce relatively low explicabilities for functional and cognitive recovery although a direct comparison of our results with those of others is difficult due to differences in outcome definition and validation methods. This implies that other clinical variables should be added to the model used in the present study to increase its predicting power for determining functional and cognitive outcomes.

• Journal of Trauma and Injury
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• v.22 no.2
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• pp.134-141
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• 2009

Purpose: Patients with traumatic brain injury (TBI) were referred from other hospitals for further management. In addition, patients routinely underwent computed tomography examinations of the head (HCT) in the referral hospitals. The purpose of this study was to evaluate retrospectively the utility of routine HCT scans according to the severity of TBI. Methods: Patients with TBI referred to our hospital between December 2005 and July 2008 were included in this study. We investigated HCT findings, indications for repeat HCT examinations (routine versus a neurological change), and neurosurgical interventions. The head injury severity was divided into three categories according to the Glasgow Coma Scale (GCS) score, including mild, moderate, and severe TBI. The use of neurosurgical interventions between patients who underwent routine HCT scans and patients who underwent HCT scans for a neurological change were compared according to the severity of TBI. Results: A total of 81 patients met the entry criteria for this study. Among these patients, 67%(n=54) of the patients underwent HCT scans on a routine basis, whereas 33%(n=27) of the patients underwent HCT scans for a neurological change. A total of 21 patients showed signs of a worsening condition on the HCT scans. Neurosurgical intervention was required for 23(28.4%) patients. For patients who underwent routine HCT examinations, no patient with mild TBI underwent a neurosurgical intervention. However, one patient with moderate TBI and three(13%) patients with severe TBI underwent neurosurgical interventions. The kappa index, the level of agreement for HCT indications of intervention and referral reasons for intervention, was 0.65 for high hierarchy hospitals and 0.06 for low hierarchy hospitals. Conclusion: Routine serial HCT examinations in the referred hospitals would be useful for patients with severe head injury and for patients from low hierarchy hospitals where no emergency physicians or neurosurgeons are available.