• Journal of Trauma and Injury
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• v.25 no.4
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• pp.109-114
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• 2012

Purpose: Deep vein thrombosis and pulmonary thromboembolism are major causes of death after severe multiple trauma. Although various means of prevention have been presented and utilized, still, there are no standard guidelines for anticoagulation of multiple trauma because of some contraindications. Methods: A retrospective study of adult major trauma patients whose injury severity scores (ISSs) were over 16 and who had visited one university hospital in Daegu city was performed. We compared some features of patients diagnosed DVT or PTE with those of patients without DVT by computed tomography or ultra sonography. Those features included accompanying various kinds of intracranial hemorrhages, possibility of ambulation, emergent operation, early transfusion, and suspicious symptoms. Results: The mean age of the 58 subjects included in this study was $50.9{\pm}17.2years$, the mean ISS was $22.7{\pm}6.0$, and the mean hospital stay was $55.2{\pm}37.9days$. Ten(17.2%) patients had emergent surgery, and 44(75.9%) experienced delayed surgery. Early transfusion was needed in 34(58.6%) patients. Among the 18 patients diagnosed with DVT, accompanying intracranial hemorrhages were noted in 8(44.4%) patients; one of the 8 also had PTE. Among the same 18 patients, early transfusions were required in 11(61.1%) patients; one of the 11 also had PTE. Conclusion: The risk of DVT is increased in cases of severe multiple trauma, and many difficulties in applying anticoagulants are experienced. Though we need additional studies to decide proper prophylaxis for DVT and PTE, if the patient's general condition permits, a screening test for DVT as soon as possible could be an effective method to reduce the possibility of a bad outcome.

• Journal of Trauma and Injury
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• v.25 no.4
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• pp.241-246
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• 2012

Purpose: The objective of this study was to investigate the appropriateness of the cross table lateral cervical X-ray used in the emergency department for severely traumatized Korean patients. Methods: Patients visiting our institution from May 2011 to May 2012, who had injury severity score (ISS) > 15 and who received a cervical X-ray in the emergency department, were included in this study. Data including demographics, ISS score, GCS score, and place where the x-ray was taken were collected to evaluate their relationship with appropriate coverage of the cervical X-ray. The appropriateness of a cervical cross lateral view X-ray was evaluated using exposure of the basion, and the opisthion, as well as the distal level of exposure. Results: Fifty-two patients were included in this study. The identification rate of the basion was 79.2%, and the identification rate of the opisthion was 88.7%. Complete exposure of C7/T1 was accomplished in 3.8% of the patients. The ISS was higher for X-ray taken in the trauma bay, but the range of exposure showed no difference between the places where the X-rays taken. Patients who had exposure of C 5/6 or more had lower body weight and body mass index (BMI) compared with unexposed patients. Conclusion: In severely traumatized Korean patients, the adequacy of the cross table lateral cervical X-ray was inappropriate in most cases. No difference was observed in the exposure range between the places where the X-rays were taken, and patients with less exposure showed higher body weight and higher BMI.

• Journal of Trauma and Injury
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• v.25 no.4
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• pp.122-131
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• 2012

Purpose: Diffuse axonal injury (DAI) is clinically defined as a coma of over six hours in a head trauma victim without a focal mass lesion. The emergency physician usually resuscitates and stabilizes a comatose head trauma victim in the emergency Department. After assessment and treatment, the prognosis is very important to both the victim and the physician. The prognosis for DAI is based on Glasgow Coma Scale (GCS) and other imaging data. We investigated the prognostic value of computed tomography (CT) and gradient-echo magnetic resonance imaging (GRI) for head trauma victims with DAI. Methods: Fifty-three(53) head trauma victims of DAI were enrolled in this study from 2007 to 2012. During the study period of six years, data on trauma victims were collected retrospectively. We analyzed the differences in the Glasgow Outcome Scale (GOS) result between the CT and the GRI modalities. Results: We classified the study group by using GOS. Between the good outcome subgroup (GOS scores of 4 and 5) and the poor outcome subgroup (GOS score of 1-3), there were no statistical difference in sex, age, initial vital signs and initial GCS score. The good outcome subgroup had non-hemorrhage on CT(52%), which was correlated with good outcome and a shorter awakening time, while a larger number and a deeper location of hemorrhagic lesions on in GRI were correlated with poor outcome in DAI. Conclusion: We conclude that the existence of hemorrhagic lesions on CT, and the number and location of those lesions on GRI had good prognostic value for head trauma victims with DAI.

• Journal of Trauma and Injury
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• v.25 no.4
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• pp.203-208
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• 2012

Purpose: The purpose of this study is to investigate the incidence of acalculous cholecystitis after multiple trauma with fractures and to analyze the characteristics of cholecystitis. Methods: We performed a retrospective study of multiple trauma patients with fractures between April 2010 and April 2012. Sixty- nine patients were identified, and the average age was 46.8(range: 15-74) years. Data were collected regarding associated injury, injury severity score (ISS), the diagnosis time after trauma, diagnostic tool, and management Results: There were three cases(4.3%) of cholecystitis among the 69 cases, and cholecystitis was diagnosed an average of 20.7(range: 8-33) days after injury. Two patients complained of abdominal pain at diagnosis, but the other patient who had undergone surgery for small bowel perforation at the time of the injury had no abdominal pain. All three patients had abnormal liver function tests (LFTs) at diagnosis. The cholecystitis was confirmed with ultrasonography or computed tomography, and all cases were acalculous cholecystitis. At first, percutaneous transhepatic gallbladder drainage was performed; then, laparoscopic cholecystectomy (LC) was tried an average of 12(range: 11-13) days later. An laparoscopic cholecystectomy was successfully done in only one case, the other cases being converted to an open cholecystectomy due to severe inflammation. Conclusion: The incidence of acaculous cholecystitis was 4.3% after multiple trauma with fractures. We should consider cholecystitis in patients with abdominal pain, fever and elevated LFTs after multiple trauma.

• Journal of Trauma and Injury
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• v.22 no.1
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• pp.1-4
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• 2009

Purpose: This study was conducted to evaluate the length of the catheter used in a needle thoracostomy for emergency decompression of a tension pneumothorax by measuring the chest wall thickness (CWT) in patients with chest trauma Methods: A retrospective review of 201 patients with chest trauma who had been transported the emergency department in a tertiary university hospital in a metropolitan area between 1 January and 31 February 2007 was performed. The average CWT at the second intercostal space (ICS) in the midclavicular line (MCL) was measured by using a chest computed tomography scan. Results: As the left and the right mean CWTs were $3.4{\pm}1.0cm$ and $3.4{\pm}1.0cm$, respectively, there was no significant statistical difference between them. The mean CWT of female patients was significantly higher than that of male patients (p=0.001). The mean CWT of patients under the age of 65 years was significantly thicker than that of the patients over the age of 65 years (p<0.001). Of the studied patients, 12 (6.0%) a CWT > 5 cm. Conclusion: A 5 cm-length catheter in a needle thoracostomy may be insufficient for emergency decompression of a tension pneumothorax, so a catheter longer than 5 cm in length is needed.

• Journal of Trauma and Injury
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• v.22 no.2
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• pp.248-253
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• 2009

Purpose: Hemodynamically unstable pelvic fractures represent therapeutic challenges for the trauma team. The authors of this article have studied the clinical profiles of the angiographic intervention population at the emergency department during four years (2005~2009) to develop clinical guidelines for preventing deaths due to multiple trauma and for predicting the prognosis during initial evaluation. Methods: We performed a retrospective review of 34 patients who had undergone angiographic interventions at the emergency department and compared the differences in clinical variables between survivors and non-survivors. Results: Representative values were compared between survivors and non-survivors : RTS (revised trauma score) 7.006 (6.376~7.841) vs. 6.128 (4.298~6.494), PRC (packed red cell) units 5.5 (2.0~11.0) vs. 15 (8.0~18.5), and lactate (mmol/L) 3.0 (1.0~7.0) vs. 8.5 (3.5~10.5). RTS (p<0.01) and PRC units before angiographic interventions (p=0.01) and lactate (p=0.02) had correlations to the final outcomes. Conclusion: The availability of an angiographic suite and persistent hypotension after adequate fluid resuscitation for pelvic trauma are good indications of angiographic intervention for pelvic hemorrhage.

• Journal of Trauma and Injury
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• v.22 no.1
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• pp.29-36
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• 2009

Purpose: The purpose of this study was to analyze the characteristics and severity of wrist injuries in snowboarding. Methods: December 2005 to February 2008, Snowboarders who experienced wrist injures were included in this study. On the basis of the medical records and radiographic evaluation, the severity of distal radius fracture was classified according to the Arbeitsgemeinschaft fur Osteosynthesefragen/Association for the Study of Internal Fixation (AO/ASIF) classification. Results: Most of the injured snowboarders were a either of the beginner (35 cases, 46.1%) or the intermediate (27 cases, 35.5%) level. The most common cause of injury in snowboarding was a slip down (60 cases, 78.9%). Comminuted and articular fractures classified as AO types A3, B, and C, which required surgical reduction, made up 42.3% of the distal radial fractures in snowboarders. When we analyzed the differences in severity between the educated and the non-educated groups, an A2 type injury in the AO classification was the most common type of injury in the educated group (20 cases, 38.5%), it means less severe fractures ocurred in the educated group (p=0.045). The most frequent injury mechanism of fractures was slip down (48 cases, 63.2%), and a slip down backwards was the dominant type of slip down (36 cases, 75.0%) (p=0.031). Conclusion: Among the snowboarders in this study who suffered self-down injury to the wrist, more fractures were associated with a backwards slip down than with a forward slip down due to over extension. For educated snowboarders the severity of fracture was lower than it was for uneducated snowboarders.

• Journal of Trauma and Injury
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• v.22 no.1
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• pp.18-23
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• 2009

Purpose: In this study, we retrospectively investigated the medical records of patients with facial fractures and suspected cranial injuries in order to determine if there was any relationship between various facial fracture patterns and cranial injuries. Methods: Medical records were reviewed to identify patients diagnosed with facial fractures who underwent cranial computed tomography (CT) scans. Records were reviewed for gender, age, injury mechanism, facial fracture pattern, and presence or absence of cranial injuries. Facial fracture patterns were classified as isolated fractures (tripod, zygomatic arch, maxilla, orbit, and mandible), combined fractures, or total fractures. Cranial injuries included skull fractures, traumatic subarachnoid hemorrhages, subdural hemorrhages, epidural hemorrhages, and contusional hemorrhages. All cranial injuries were established by using cranial CT scans, and these kinds of cranial injuries were defined radiologically-proven cranial injuries (RPCIs). We evaluated the relationship between each pattern of facial fractures and the incidence of RPCIs. Results: Of 132 eligible patients with facial fractures who underwent cranial CT scans, a total of 27 (20.5%) patients had RPCIs associated with facial fractures. Falls and slips were the most common causes of the fractures (31.8%), followed by assaults and motor vehicle accidents (MVAs). One hundred one (76.5%) patients had isolated facial fractures, and 31 (23.5%) patients had combined facial fractures. Fractures were found most commonly in the orbital and maxillary bones. Patients with isolated maxillary fractures had a lower incidence of RPCIs than those with total mandibular fractures. RPCIs frequently accompanied combined facial fractures. Conclusion: Combined facial fractures had a significant positive correlation with RPCIs. This means that facial fractures caused by stronger or multidirectional external force are likely to be accompanied by cranial injuries.

• Journal of Trauma and Injury
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• v.22 no.2
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• pp.128-133
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• 2009

Purpose: Bicycle riding is a healthy and cheap form of transportation and a popular form of recreation. This study aims to evaluate the epidemiology and the factors affecting the severity of bicycle-related injuries and to find effective methods for preventing injuries. Methods: This is a retrospective study of the patients'characteristics, the injury severity, the injury location, the effect of safety equipment on the bicycle injury based on information collected through the NEDIS (National Emergency Department Information System) from 1,284,429 patients who visited 55 emergency rooms nationwide. Results: During the research period throughout 55 emergency rooms 5,671 patients were seen because of bicycle injuries. The male-to-female ratio was 3.1:1, the median age 28 years old, and 42.6% of the patients were younger than 20 years old. Injury sites were mostly in the extremities(46.7%), the head(32.4%), and the face(14%), and 70.3% of severely injured patients had accompanying head trauma. Males aged 65 and older was possibly associated with severe head trauma. Of the patients who provided helmet information 4.8%(71patients) used helmets, and 95.2%(1392 patients) did not. In this group of patients providing helmet information, none of those wearing helmets died, but 0.4% of those not wearing helmets died. Conclusion: In this study, most bicycle injuries occurred in young adult men. From now, there seems to be a need for more effort on publicity activities on bicycle injuries and on the education of children and teenagers, who show a high incidence rate, and of senior citizens (over 65 years old) who show a high severity rate, about using a safety helmet to reduce the severity of injury.

• Journal of Trauma and Injury
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• v.22 no.2
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• pp.254-259
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• 2009

Purpose: Pelvic trauma is a serious skeletal injury with high mortality. Especially in cases of severe injury trauma, treatment outcomes depend on early diagnosis and intervention. We expect trauma surgeon to play an important role in the management of severe multiple trauma patients. Methods: A retrospective study was performed on pelvic trauma patients with hemodynamic instability between March 2005 and September 2009. We divided the time period into period I (March 2005~Feburary 2009) and period II (March 2009~September 2009). The trauma surgeon and team started to work from period II. Data were collected regarding demographic characteristics, mechanism of injury, type of pelvic fracture, ISS(injury severity score), treatment modality, transfusion requirement, time to definitive treatment, and mortality. Results: During period I, among 7 hemodynamically unstable patients, 4(57.1%) patients died. However during Period II, only one of 6(16.6%) patients died. The demographic data and injury scores showed no differences between the two time periods, but the time to definitive treatment was very short with trauma team intervention(14.4 hrs vs. 3.9 hrs). Also, the amount of transfusion was less(41.1 U vs. 13.9 U). With arterial embolization, early pelvic external fixation led to less transfusion and made patients more stable. Conclusion: This study demonstrated the importance of the trauma surgeon and the trauma team in cases of hemodynamically unstable pelvic trauma. Even with the same facility and resources, an active trauma team approach can increase the survival of severely injured multiple trauma patients.