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Journal of Trauma and Injury

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수록범위 : 1권1호(1988)~34권2호(2021) |수록논문 수 : 1,033
대한외상학회지
34권2호(2021년 06월) 수록논문
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1Trauma Surgeons: Heroes of a Moment

저자 : Kun Hwang

발행기관 : 대한외상학회 간행물 : 대한외상학회지 34권 2호 발행 연도 : 2021 페이지 : pp. 79-80 (2 pages)

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2Single-Center Clinical Analysis of Traumatic Thoracic Aortic Injuries: A Retrospective Observational Study

저자 : Dae Sung Ma , Yang Bin Jeon

발행기관 : 대한외상학회 간행물 : 대한외상학회지 34권 2호 발행 연도 : 2021 페이지 : pp. 81-86 (6 pages)

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Purpose: This study investigated the clinical outcomes of trauma patients with blunt thoracic aortic injuries at a single institution.
Methods: During the study period, 9,501 patients with traumatic aortic injuries presented to Trauma Center of Gil Medical Center. Among them, 1,594 patients had severe trauma, with an Injury Severity Score (ISS) of >15. Demographics, physiological data, injury mechanism, hemodynamic parameters associated with the thoracic injury according to chest computed tomography (CT) findings, the timing of the intervention, and clinical outcomes were reviewed.
Results: Twenty-eight patients had blunt aortic injuries (75% male, mean age, 45.9±16.3 years). The majority (82.1%, n=23/28) of these patients were involved in traffic accidents. The median ISS was 35.0 (interquartile range 21.0-41.0). The injuries were found in the ascending aorta (n=1, 3.6%) aortic arch (n=8, 28.6%) aortic isthmus (n=18, 64.3%), and descending aorta (n=1, 3.6%). The severity of aortic injuries on chest CT was categorized as intramural hematoma (n=1, 3.6%), dissection (n=3, 10.7%), transection (n=9, 32.2%), pseudoaneurysm (n=12, 42.8%), and rupture (n=3, 10.7%). Endovascular repair was performed in 71.4% of patients (45% within 24 hours), and two patients received surgical management. The mortality rate was 25% (n=7).
Conclusions: Traumatic thoracic aortic injuries are life-threatening. In our experience, however, if there is no rupture and extravasation from an aortic injury, resuscitation and stabilization of vital signs are more important than an intervention for an aortic injury in patients with multiple traumas. Further study is required to optimize the timing of the intervention and explore management strategies for blunt thoracic aortic injuries in severe trauma patients needing resuscitation.

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3Comparative Evaluation of Emergency Medical Service Trauma Patient Transportation Patterns Before and After Level 1 Regional Trauma Center Establishment: A Retrospective Single-Center Study

저자 : Hyeong Seok Lee , Won Young Sung , Jang Young Lee , Won Suk Lee , Sang Won Seo

발행기관 : 대한외상학회 간행물 : 대한외상학회지 34권 2호 발행 연도 : 2021 페이지 : pp. 87-97 (11 pages)

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Purpose: This study examined emergency medical service (EMS) transportation patterns for adult trauma patients before and after establishing a level 1 regional trauma center (RTC) and to evaluate the transportation approach after prehospital severity screening.
Methods: This was a retrospective observational study of trauma patients aged ≥18 years admitted via EMS to the emergency department or a level 1 RTC, 1 year before to 3 years after RTC establishment. Patients with an Injury Severity Score (ISS) in the patient registration system were selected. Analyses were performed to determine transportation pattern changes by comparing patients pre- and post-RTC establishment and by yearly comparisons over the 4-year study period using the Mann-Whitney U test and chi-square test.
Results: Overall, 3,587 patients were included. The mean ISS was higher in the post-RTC group (n=2,693; 10.63±8.90, median 9.00) than in the pre-RTC group (n=894; 9.44±8.20, median 8.00; p<0.001). The mean transportation distance (9.84±13.71, median 5.80 vs. 13.12±16.15 km, median 6.00; p<0.001) was longer in the post-RTC group than in the pre-RTC group. Furthermore, proportionally fewer patients were transported from an area in the same city as the RTC after establishment (86.1% vs. 78.3%; p<0.001). Yearly comparisons revealed a gradually increasing trend in the hospital death rate (ptrend=0.031).
Conclusions: After establishing a level 1 RTC, the EMS transportation of severe trauma patients increased gradually along with the long-distance transportation of minor trauma patients. Therefore, improved prehospital EMS trauma severity assessments and level 1 RTC involvement in patient classification in the prehospital phase are necessary.

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4Incidence and Clinical Features of Urethral Injuries with Pelvic Fractures in Males: A 6-Year Retrospective Cohort Study at a Single Institution in South Korea

저자 : Hyun Woo Sun , Hohyun Kim , Chang Ho Jeon , Jae Hoon Jang , Gil Hwan Kim , Chan Ik Park , Sung Jin Park , Jae Hun Kim , Seok Ran Yeom

발행기관 : 대한외상학회 간행물 : 대한외상학회지 34권 2호 발행 연도 : 2021 페이지 : pp. 98-104 (7 pages)

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Purpose: Severe pelvic fractures are associated with genitourinary injuries, but the relationship between pelvic trauma and concomitant urethral injuries has yet to be elucidated. This study evaluated the incidence, mechanism, site, and extent of urethral injuries in male patients with pelvic fractures.
Methods: A retrospective cohort study was performed involving patients with urethral injuries accompanying pelvic fractures who visited Pusan National University Hospital from January 1, 2014 to December 31, 2019. Demographics, mechanisms of injury, clinical features of the urethral injuries, concomitant bladder injuries, methods of management, and the configuration of the pelvic fractures were analyzed.
Results: The final study population included 24 patients. The overall incidence of urethral injury with pelvic fracture was 2.6%, with the most common mechanism of urethral injury being traffic accidents (62.5%). Complete urethral disruption (16/24, 66.7%) was more common than partial urethral injuries (8/24, 33.3%), and unstable pelvic fractures were the most common type of pelvic fracture observed (70.8%). There was no definitive relationship between the extent of urethral injury and pelvic ring stability.
Conclusions: The present study provides a 6-year retrospective review characterizing the incidence, mechanism, and clinical features of urethral injury-associated pelvic fractures. This study suggests that the possibility of urethral injury must be considered, especially in unstable pelvic fracture patients, and that treatment should be chosen based on the clinical findings.

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5The Effects of a Trauma Team Approach on the Management of Open Extremity Fractures in Polytrauma Patients: A Retrospective Comparative Study

저자 : Seungyeob Sakong , Eic Ju Lim , Jun-min Cho , Nak-jun Choi , Jae-woo Cho , Jong-keon Oh

발행기관 : 대한외상학회 간행물 : 대한외상학회지 34권 2호 발행 연도 : 2021 페이지 : pp. 105-111 (7 pages)

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Purpose: Open extremity fractures require prompt antibiotic medication and initial debridement surgery to reduce the infection rate and restore functional stabilization. We aimed to report the effects and positive outcomes of a trauma team approach on the management of open extremity fractures in polytrauma patients.
Methods: This retrospective review included all polytrauma patients with open extremity fractures admitted between March 2009 and December 2019. Patients were divided into two groups according to whether they were treated before or after the implementation of the trauma team approach (March 2014). We analyzed the outcomes in each group with respect to the time interval until the doctor's arrival, total length of stay in the emergency department, the time interval until initial antibiotic treatment and operation, whether the initial operation was performed within 24 hours, and the rate of deep infections.
Results: A total of 123 patients met the inclusion criteria. There were no statistically significant differences in demographic characteristics. The time interval until the doctor's arrival (64.12±49.2 minutes vs. 19.82±15.23 minutes; p=0.035) and initial antibiotic treatment (115.47±72.12 minutes vs. 48.78±30.12 minutes; p=0.023) significantly improved after implementing the trauma team approach. The union rate was not significantly different. However, the time interval until initial debridement, opportunity for initial debridement within 24 hours, and the rate of deep infections demonstrated better results.
Conclusions: The reduced time interval until initial antibiotic treatment and debridement could be attributed to the positive effect of the trauma team approach on the management of open extremity fractures in polytrauma patients.

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6Indications for Laparotomy in Patients with Abdominal Penetrating Injuries Presenting with Ambiguous Computed Tomography Findings

저자 : Eun Ji Choi , Sanghee Choi , Byung Hee Kang

발행기관 : 대한외상학회 간행물 : 대한외상학회지 34권 2호 발행 연도 : 2021 페이지 : pp. 112-118 (7 pages)

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Purpose: Negative laparotomy in patients with abdominal penetrating injuries (APIs) is associated with deleterious outcomes and unnecessary expense; however, the indications for laparotomy in hemodynamically stable patients with ambiguous computed tomography (CT) findings remain unclear. This study aimed to identify the factors associated with negative laparotomy. findings
Methods: Data of patients who underwent laparotomy for APIs between 2011 and 2019 were retrospectively reviewed. Patients who presented with definite indications for laparotomy were excluded. The patients were dichotomized into negative and positive laparotomy groups, and the baseline characteristics, laboratory test results, and CT findings were compared between the groups.
Results: Of 55 patients with ambiguous CT findings, 38 and 17 patients were assigned to the negative and positive laparotomy groups, respectively. There was no significant difference between the groups with respect to the baseline characteristics or the nature of the ambiguous CT findings. However, the laboratory test results showed that there was a difference in the percentage of neutrophils between the groups (negative: 55.6% [range 47.4-66.1%] vs. positive: 79.8% [range 77.6-88.2%], p<0.001), although the total white blood cell count was not significantly different. The mean duration of hospital stay for the negative laparotomy group was 13.1 days, and seven patients (18.4%) experienced complications.
Conclusions: Diagnostic factors definitively indicative of laparotomy were not identified, although the percentage of neutrophils might be helpful. However, routine laparotomy in patients with peritoneal injuries could result in instances of negative laparotomy.

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7Effects of Trauma-Related Shock on Myocardial Function in the Early Period Using Transthoracic Echocardiography

저자 : Dae Sung Ma

발행기관 : 대한외상학회 간행물 : 대한외상학회지 34권 2호 발행 연도 : 2021 페이지 : pp. 119-125 (7 pages)

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Purpose: The present study aimed to analyze the effect of trauma-related shock on myocardial function in the early stages of trauma through transthoracic echocardiography (TTE) findings.
Methods: We performed a retrospective review and analysis of the medical records of patients aged ≥18 years who were evaluated by TTE within 2 days of admission for trauma-related shock (n=72). Patients were selected from a group of 739 patients admitted with trauma-related shock between January 2014 and December 2016.
Results: The incidence rate of myocardial dysfunction in the left ventricle (LV) was 6.8% (5/72), with rates of 7.7% (4/52) in the thoracic injury group and 5.0% (1/20) in the non-thoracic injury group. In the diastolic function of LV, relaxation abnormality was present in 55.8% (29/52) of patients in the thoracic injury group and 50% (10/20) of patients in the non-thoracic injury group.
Conclusions: This study may suggest that traumatic shock without thoracic injury may influence myocardial function in the early stages after trauma. Therefore, evaluation of myocardial function may be needed for patients experiencing shock after trauma, regardless of the presence of thoracic injury.

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8Cerebral Fat Embolism That Was Initially Negative on Diffusion-Weighted Magnetic Resonance Imaging

저자 : Seung Je Go , Yun Su Mun , Seung Ho Bang , Yong Han Cha , Young Hoon Sul , Jin Bong Ye , Jae Guk Kim

발행기관 : 대한외상학회 간행물 : 대한외상학회지 34권 2호 발행 연도 : 2021 페이지 : pp. 126-129 (4 pages)

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Fat embolism syndrome is a rare, but serious condition that occurs in patients with fractures of the long bones or who undergo orthopedic surgery. The main clinical features of fat embolism syndrome are an altered mental status, hypoxia, and petechial rash. Cerebral fat embolism is the most severe manifestation of fat embolism syndrome because it can lead to an altered mental status. The diagnosis of cerebral fat embolism is clinical, but brain magnetic resonance image (MRI) is helpful. There is usually an interval until symptoms, such as an altered mental status, develop after trauma. We report a case of cerebral fat embolism in which the patient's mental status deteriorated several hours after trauma and the initial findings were negative on diffusion-weighted MRI.

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9Celiac Artery Compression After a Spine Fracture, and Pericardium Rupture After Blunt Trauma: A Case Report from a Single Injury

저자 : Joongsuck Kim , Hyun Min Cho , Sung Hwan Kim , Seong Hoon Jung , Jeong Eun Sohn , Kwangmin Lee

발행기관 : 대한외상학회 간행물 : 대한외상학회지 34권 2호 발행 연도 : 2021 페이지 : pp. 130-135 (6 pages)

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Celiac artery compression is a rare condition in which the celiac artery is compressed by the median arcuate ligament. Case reports of compression after trauma are hard to find. Blunt traumatic pericardium rupture is also a rare condition. We report a single patient who experienced both rare conditions from a single blunt injury. An 18-year-old woman was brought to the trauma center after a fatal motorcycle accident, in which she was a passenger. The driver was found dead. Her vital signs were stable, but she complained of mild abdominal pain, chest wall pain, and severe back pain. There were no definite neurologic deficits. Her initial computed tomography (CT) scan revealed multiple rib fractures, moderate lung contusions with hemothorax, moderate liver injury, and severe lumbar spine fracture and dislocation. She was brought to the angiography room to check for active bleeding in the liver, which was not apparent. However, the guide wire was not able to pass through the celiac trunk. A review of the initial CT revealed kinking of the celiac trunk, which was assumed to be due to altered anatomy of the median arcuate ligament caused by spine fractures. Immediate fixation of the vertebrae was performed. During recovery, her hemothorax remained loculated. Suspecting empyema, thoracotomy was performed at 3 weeks after admission, revealing organized hematoma without pus formation, as well as rupture of the pericardium, which was immediately sutured, and decortication was carried out. Five weeks after admission, she had recovered without complications and was discharged home.

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10Delayed Diagnosis of Traumatic Rupture of Anterior Papillary Muscle of Tricuspid Valve; Importance of Trans-Esophageal Echocardiogram in the Evaluation of Major Blunt Chest Trauma

저자 : Ryan Bylsma , Mustafa Baldawi , Bruce Toporoff , Matthew Shin , Meghan Cochran-yu , Davinder Ramsingh , Purvi Parwani , David G. Rabkin

발행기관 : 대한외상학회 간행물 : 대한외상학회지 34권 2호 발행 연도 : 2021 페이지 : pp. 136-140 (5 pages)

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We present a case of delayed diagnosis of traumatic tricuspid valve rupture in a patient who was emergently brought to the operating room for repair of lacerations to the heart and liver without intraoperative transesophageal echocardiography (TEE). Initial post-operative transthoracic echocardiography (TTE) did not show structural pathology. One week later, TTE with better image quality showed severe tricuspid regurgitation. Subsequently, TEE clearly demonstrated rupture of the anterior papillary muscle and flail anterior tricuspid leaflet. The case description is followed by a brief discussion of the utility of TEE in the setting of blunt thoracic trauma.

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