Journal of Trauma and Injury最新文献

Purpose: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a state-of-the-art lifesaving procedure. However, due to its high mortality and morbidity, including ischemia and reperfusion injury, well-trained medical staff and effective systems are needed. This study was conducted to investigate the learning curve for REBOA in Korea.

Methods: To monitor this learning curve, we used cumulative sum (CUSUM) analysis and graphs of mortality and aortic occlusion time within 60, 90, and 120 minutes for consecutive patients. The procedures performed between July 2017 and June 2021 were divided into pre-trauma center (pre-TC; July 2017-February 2020) and TC (February 2020-June 2021) periods.

Results: REBOA was performed for 31 consecutive patients with trauma. The pre-TC (n=12) and TC (n=19) periods did not differ significantly with regard to Injury Severity Score, age, injury mechanism, initial systolic blood pressure, prehospital cardiopulmonary resuscitation (CPR), or CPR in the emergency department. At the 17th consecutive patient during the TC period, CUSUM failure graphs for mortality and aortic occlusion time exhibited a downward inflection, indicating an improvement in performance.

Conclusions: The mortality and aortic occlusion time of REBOA improved, and these parameters can be monitored using CUSUM analysis at the hospital level.

Purpose: Inferior vena cava (IVC) injuries are a rare type of traumatic abdominal injuries that are challenging to treat and have a very high mortality rate. This study described our experience with the surgical treatment of traumatic IVC injuries, and we investigated the demographics, clinical profiles, and surgical outcomes of cases at a regional trauma center.

Methods: Among the 16 patients who were treated for a traumatic IVC injury between January 2014 and March 2022, 14 underwent surgery. The surgical outcomes included overall mortality and 24-hour mortality, and we investigated the factors associated with these surgical outcomes. The 14 patients were divided into two groups according to the location of the IVC injury (retrohepatic IVC or higher vs. subhepatic IVC), and differences between the two groups were analyzed.

Results: A body mass index (BMI) >23.0 kg/m² (P=0.046), an elevated serum lactate level (P=0.043), and a shorter operation time (P=0.016) were associated with overall mortality. A higher BMI (P=0.050), higher serum lactate level (P=0.004), shorter operation time (P=0.005), and an injury at the retrohepatic IVC or higher level (P=0.031) were associated with 24-hour mortality. Younger age (P=0.028), higher BMI (P=0.005), more acidic pH, higher lactatemia (P=0.012), a higher hemoglobin level (P=0.012), and shorter door-to-operating room time (P=0.028) were associated with injury at the retrohepatic IVC or higher level. Patients with subhepatic IVC injuries had a high rate of direct repair (75.0%) and a significantly lower 24-hour mortality rate (37.5%, P=0.031).

Conclusions: Subhepatic IVC injuries are easy to access and are usually expected to treat with a direct repair method. Injuries at the retrohepatic IVC or higher level are difficult to treat surgically and require a systematic and multidisciplinary treatment strategy.

Traumatic iliac venous injury is rare but can be fatal. Although surgical management is considered a primary treatment method, urgent treatment is required when deep venous thrombosis and subsequent phlegmasia cerulea dolens is combined. It is difficult to treat by surgical management, and pharmaceutic thrombolysis cannot be applied due to the trauma history. Here, we describe a case of unilateral traumatic iliac venous injury and subsequent diffuse venous thrombosis in the affected iliofemoral and infrapopliteal veins, combined with phlegmasia cerulea dolens, treated with endovascular management, including bare metal stent insertion and aspiration thrombectomy.

Avulsion fracture of the occipital condyle are rare lesion at craniovertebral junction. It is often related to high-energy traumatic injuries and show diverse clinical presentations. Neurologic deficit and instabilities may justify surgical treatment. However, the integrity of neurovascular structures is undervalued in the current literatures. In this case report, we described a 26-year-old female patient with avulsion fracture of occipital condyle following a traffic accident. On initial presentation, her Glasgow Coma Scale was 8. She presented with fracture compound comminuted depressed, on the left side of her forehead with skull base fracture extending into clivus and occipital condyle. Her left occipital condyle showed avulsion injury with displacement deep into the skull base. On her computed tomography angiography, the displaced occipital condyle compressed on the sigmoid sinus resulting in its obstruction. While she was recovering her consciousness during her stay in the hospital, the lower cranial nerves showed dysfunctions corresponding to Collet-Sicard syndrome. Due to high risk of vascular injury, the patient was conservatively treated for the occipital condyle fracture. On the 4 months postdischarge follow-up, her cranial nerve symptoms practically recovered, and the occipital condyle showed signs of fusion without further displacement. Current literatures focus on neurologic deficit and stability for the surgical decisions. However, it is also important to evaluate the neurovascular integrity to assess the risk of its manipulation as it may result in fatal outcome. This case shows, an unstable avulsion occipital condyle fracture with neurologic deficit can be treated conservatively and show a favorable outcome.

Injury to the genitourinary tract is rare, with an incidence of less than 1%. Younger men (mean age, approximately 30 years) are predominantly affected. We introduce an unusual case of a 25-year-old male patient with complete urethral injury combined with a severe open pelvic bone fracture. During the emergency surgery, the primary realignment of the posterior urethra could not be performed due to a large defect. With suprapubic cystostomy alone, follow-up voiding cystourethrography showed spontaneous recanalization of the transected urethra after four months. Suprapubic cystostomy is an efficient treatment option when primary realignment is not possible.

Purpose: The purpose of this study was to investigate (1) the association among helmet wearing, incidence rate of traumatic brain injury (TBI), and in-hospital mortality; TBI was diagnosed when the head Abbreviated Injury Scale (AIS) was ≥1, and as severe TBI when head AIS was ≥3; and (2) the association between helmet type and incidence rate of TBI, severe TBI, and in-hospital mortality of motorcycle accidents based on the newly revised Emergency Department-based Injury In-depth Surveillance (EDIIS) data.

Methods: Data collected from EDIIS between January 1, 2020 and December 31, 2020 were analyzed. The final study population comprised 1,910 patients, who were divided into two groups: helmet wearing group and unhelmeted group. In addition, the correlation between helmet type and motorcycle accident was determined in 596 patients who knew the exact type of helmet they wore. A total of 710 patients who wore helmet but did not know the type were excluded from this analysis. Multivariate logistic regression was performed in both the groups to investigate the factors affecting the primary (occurrence of TBIs) and secondary outcomes (severe TBI and in-hospital mortality).

Results: The prevalence of Injury Severity Scores, TBIs, and severe TBIs as well as in-hospital mortality were the highest in the unhelmeted group. Additionally, the results from the group that wore and knew the type of helmet worn indicated that wearing a full-face helmet decreased the incidence of TBIs in comparison to a half-face helmet.

Conclusions: The wearing of a helmet in motorcycle accidents is very important as it plays a role in reducing the occurrence of TBIs and severe TBIs and in-hospital mortality. The use of a full-face helmet lowered the incidence of TBIs.

Delayed closure of an open abdomen (OA) is a clinically challenging task despite its various modalities. It is substantially more difficult when the duration of OA treatment is prolonged due to a patient's condition. We introduced the management of a patient who had a delayed OA treatment spanning approximately 3 months due to severe abdominal contamination. The 64-year-old male patient had an injured pelvis pressed by a road roller. After visiting a trauma center, the patient initially underwent damage control surgery and OA management; however, early primary abdominal closure failed due to severe peritonitis. After negative pressure wound therapy for several months, an acellular dermal matrix graft followed by a skin graft were successfully used as treatments. A combination of acellular dermal matrix graft, negative pressure wound therapy, and skin graft techniques is a considerable management sequence for patients subjected to delayed OA treatment.

Pelvic ring injuries associated with external iliac artery injuries are rare and may be life-threatening condition. The most important factors in the managements are the immediate bleeding control and restoration of distal blood flow. We report two cases of pelvic ring injuries with external artery injuries. One case was occlusion of external iliac artery with concomitant rupture of internal iliac artery. The other case was ruptured external iliac artery. Every surgeon must understand the possibility of hidden lesions-for example, arterial rupture and thrombus-and should consider the need for embolization or thrombectomy when treating this type of injury.

Submental intubation is an effective alternative technique for airway management in patients with maxillofacial trauma. Compared with tracheostomy, it is less invasive, but has risks associated with potential airway compromise such as hypoxia due to tube obstruction, collapse, and kinking. To shorten procedure time and ensure a reinforced tube lumen, we used a laparoscopic trocar as a new device for submental intubation. A 54-year-old male patient sustained a zygomaticomaxillary complex fracture and was scheduled to undergo open reduction and internal fixation. We performed intraoral intubation and made a small 1-cm incision at the submandibular midline. After dissection of the tissue from the incision site, a reinforced tube was passed using a 12-mm laparoscopic trocar. The procedure took about 5 minutes, and apnea time from disconnecting the breathing circuit and passing through the internal lumen of the trocar until it was reconnected to the ventilator was 1 minute 5 seconds. Using a laparoscopic trocar for submental intubation can reduce the time required for dissection, prevent luminal occlusion complications due to soft tissues or blood clots in the endotracheal tube, and decrease soft tissue damage.