Epidemiology of Trauma Patients and Analysis of 268 Mortality Cases: Trends of a Single Center in Korea

변천성,박일환,오중환,배금석,이강현,이은비 연세대학교의과대학 2015 Yonsei medical journal Vol.56 No.1

Purpose: There is an increasing incidence of mortality among trauma patients; therefore, it is important to analyze the trauma epidemiology in order to prevent trauma death. The authors reviewed the trauma epidemiology retrospectively at a regional emergency center of Korea and evaluated the main factors that led to trauma-related deaths. Materials and Methods: A total of 17007 trauma patients were registered to the trauma registry of the regional emergency center at Wonju SeveranceChristian Hospital in Korea from January 2010 to December 2012. Results: The mean age of patients was 35.2 years old. The most frequent trauma mechanism was blunt injury (90.8%), as well as slip-and-fall down injury, motor vehicle accidents,and others. Aside from 142 early trauma deaths, a total of 4673 patients were admitted for further treatment. The most common major trauma sites of admitted patients were on the extremities (38.4%), followed by craniocerebral, abdominopelvis,and thorax. With deaths of 126 patients during in-hospital treatment, the overall mortality (142 early and 126 late deaths) was 5.6% for admitted patients. Ages ≥55, injury severity score ≥16, major craniocerebral injury, cardiopulmonary resuscitationat arrival, probability of survival <25% calculated from the trauma and injury severity score were independent predictors of trauma mortality in multivariate analysis. Conclusion: The epidemiology of the trauma patients studied was found to be mainly blunt trauma. This finding is similar to previous papers in terms of demographicsand mechanism. Trauma patients who have risk factors of mortality requirecareful management in order to prevent trauma-related deaths.

트라우마 이론 연구의 새 지평 열기: 탈식민주의 트라우마 연구와 신디고 마고나의 『어머니가 어머니에게』를 통해서

서길완 ( Gilwan Seoh ) 영미문학연구회 2018 영미문학연구 Vol.34 No.-

The present study begins with a recognition of the urgent need to resolve the problem of challenges to the value and effectiveness of trauma theory as the limitations of trauma theory research have become a point of contention in recent years. A new trauma model developed by post-colonial trauma studies researchers provides one such possible problem-solving measure. This essay will perform two tasks that measure its efficacy. First, this essay will examine how this new trauma concept and model (“insidious trauma”), presented as an alternative measure by post-colonialism researchers, contributes to the expansion of the focus and scope of existing trauma theory research. Second, this essay will add the new concepts of “slow violence,” “boomerang effect,” and “implicated subject” to those aspects of post-colonial trauma theory that must be supplemented and improved to explain the sustainability of the trauma theory. Using this background, this essay will thoroughly analyze Mother to Mother, a post-colonial novel. We will explain how new concepts in postcolonial trauma studies explain the decolonization of the traumatic history experienced by the ethnic minorities and non-Western characters in this novel. At the same time, this essay will examine how applying an improved model of postcolonial trauma to this discussion expands the horizon of trauma research by revealing the association between conflicts and trauma in a disparate world, meaning the First World (the West) and the Third World (post-Apartheid Africa).

바람직한 한국형 외상진료시스템

이강현 대한의사협회 2013 대한의사협회지 Vol.56 No.9

Trauma is the leading cause of mortality and disability for Koreans under age 44. In Korea,35.2% of trauma deaths are preventable. Currently, a trauma care system is just beginning to be established in Korea. Optimal trauma care systems have the potential to significantly reduce trauma-related mortality. For patients with severe injuries, getting care at a trauma center lowers the risk of mortality by 15-25%. An optimal trauma care system provides care with a wellfunctioning,comprehensive system from pre-hospital trauma care through the rehabilitation stages. A trauma care system should also include disaster preparedness and education and training to the public, and to paramedics and trauma-related medical personnel. An optimal trauma care system will give the right treatment to the right patients at the right place and time. The components of optimal trauma systems include trauma center designation; the existence of trauma advisory groups; trauma registry use for quality control; current field triage guidelines;trauma system involvement in emergency preparedness planning; and national funding sources.

Epidemiology and Clinical Patterns of Ocular Trauma at a Level 1 Trauma Center in Korea

Park Jungyul,Yang Sang Cheol,최희영 대한의학회 2021 Journal of Korean medical science Vol.36 No.1

Background: To evaluate the patterns of distribution and clinical manifestations of ocular injuries referred to the level 1 trauma center of Pusan National University Hospital (PNUH) in Korea. Methods: We analyzed 254 of 4,287 patients who were referred to the Department of Ophthalmology at the level 1 trauma center of the PNUH, from January 2016 through December 2018. Data on the incidence of ocular injuries, sex, age, monthly and seasonal distribution, day and time of injury, side of injury, cause, residence of patients, referral time to an ophthalmologist and subsequent examination time, final visual acuity (VA), and complications were obtained from medical records and retrospectively reviewed. The patients were grouped according to their main diagnosis using the Birmingham Eye Trauma Terminology System (BETTS) and Ocular Trauma Score (OTS). Results: The incidence of ocular injuries with major trauma was higher in men (n = 207, 81.5%), the median age at time of injury was 54 years, and Pusan recorded the most cases. The incidences of ocular injury were 1.47/100,000, 1.57/100,000, 1.48/100,000 in 2016, 2017 and 2018, respectively. The most common cause was by a motorbike accident, followed by a pedestrian traffic accident and falls. According to the BETTS classification, open-globe injuries represented 4% of cases, closed-globe injuries represented 12.6%, and other injuries represented 83.1%. Open-globe injuries were significantly associated with low final VA (P = 0.01). In the OTS, 79.4% of patients received 4 or 5 points and 13.7% of patients received 1 or 2 points. The patients who received 1 or 2 points in the OTS score showed final VA below hand movement (P < 0.001), except for two patients. Lid laceration and low initial VA were highly correlated with poor final VA (P < 0.001).Conclusion: This is the first study on the epidemiology and clinical manifestations in trauma patients with ocular injuries at a level 1 trauma center. The incidences of ocular injuries with major trauma were about 1.47–1.57/100,000. BETTS, OTS, lid laceration and initial VA were associated with final VA. We expect our study to provide a basis of data for the evaluation, prevention, and management of ocular injuries in patients with systemic trauma.

Trauma and Healing in The Kitchen God’s Wife

원하남 충남대학교 인문과학연구소 2019 인문학연구 Vol.58 No.1

The purpose of this paper is to analyze trauma and its healing process in the representative writer of Asian American literature, Amy Tan’s The Kitchen God’s Wife. In the novel, Tan exquisitely and vividly delineates the protagonist Winnie’s traumatic experiences. In China, Winnie experiences a series of traumatic events from childhood before emigrating to America. Winnie successively suffers from traumas of parents’ abandonment, neglect, sexual abuse, domestic violence, and rape. After migrating to the new continent, Winnie suffers from the destructive aftermath of trauma, and manifests trauma’s symptoms of hyper-arousal and disconnection. At her friend Helen’s urging, Winnie begins to confide her traumas to her daughter, Pearl. Through trauma narrative talk-story, the protagonist Winnie not only breaks the disconnection caused by trauma, but also builds up an intimate and close mother-daughter relationship with her daughter. At the same time, Pearl also understands her mother’s love, and gets to know her mother’s traumatic past. In the end, Winnie’s long concealed traumas are healed. This novel has strong autobiographical colors, as Tan puts her family traumas into The Kitchen God’s Wife. In reality, Tan’s mother Daisy is the archetype for Winnie in the novel. Through rewriting her mother’s traumatic experiences, Tan assimilates and integrates these traumas into a life story of her family. As a result, because Tan becomes to get a clear understanding of her mother’s traumatic past, the traumas of Tan’s mother can be healed. Despite the prevailed skeptical thought towards the complete healing of trauma, Tan has a positive stance to trauma and its healing. Through this novel, Amy Tan provides insightful ideas and notions about trauma, the healing of trauma, and trauma in literature.

사라 캐인(Sarah Kane)의 텍스트와 트라우마 -<갈망(Crave)>, <4.48 사이코시스(4.48 Psychosis)>를 중심으로

남지수 ( Ji Soo Nam ) 한국연극학회 2009 한국연극학 Vol.0 No.39

This study analyzed Sarah Kane`s dramaturgical reception of trauma focused on her late texts Crave and 4.48 Psychosis. Although she left only six texts during the short time as a professional playwright, she has steadily showed interests about the trauma in all of the texts, and, in fact, treated it as one of the key themes. Considering that Kane suffered from deep depression and melancholia, it is possible to assume that fragmented and split personality of Kane is reflected on the writing in unconscious way. The study starts from this premise. The thesis is to research the dramaturgical aspects in terms of how the invisible unsubstantial trauma appears on the texts Crave and 4.48 Psychosis: traumatic aspects of Kane`s works make itself more recognizable given that the subjects of enunciation in Crave and 4.48 Psychosis seems to suffer, and may show most extreme and unstable inner status in the last texts being written just before her tragic end. Traces and evidences of Kane`s trauma found in Crave and 4.48 Psychosis can be looked under the three subcategories: structure, character, and language. First, the structure has characteristics of repetition and cycle, and it produces the image of horror and repressed feeling. Fractured dialogues repeated in Crave and dramatic compositions cycled in 4.48 Psychosis-as if turning around at 4:48-remind us of endless pain of trauma. It shows that trauma has the high possibility and enormous power to attack you anytime and ruin your life without any expectation. Also even not realizing when on earth you are hooked off from the trauma, the horror and repressed feeling are intensified. Second, characters show deconstructed aspects having only alphabet-name or disembodied voice, and it emphasizes the isolated self in the world. Because trauma makes lose sense of the self and destabilize the construction of the identity and others, characters seem to confine the self in own world. On the other hand, they are eager to be protected and loved in a way of overcoming the trauma. From the unstable and pressed feeling, they try to make relationship with others at hard edge. This sort of double edges of sword that end up denying and craving others at the same time show trauma`s dialectic characteristic, also Kane`s coherent love theme. Third, language creates uneasy and empty status of mind. Because unconscious trauma exists in eidetic image and senses, it is impossible to explain the trauma`s entity and the very source of the pain. In this sense, language does not carry the meaning, but deliver the image to audience as a signifier. Particularly, in 4.48 Psychosis, unique line-disposition like poem and sporadic number arrangement are noticeable. The gap which derived from the imperfect meaningful structure and blank or space is to be placed by human sense, so language becomes the language with image. As language bears intense aspiration to leave its traces, we need to look into the emotion and sentiment embedded in the language and its gap. Kane`s trauma unconsciously infiltrates and leaves its traces sporadically in the texts. The cruelty of trauma in the Crave and 4.48 Psychosis does not explain cruel reality, but the real cruelty embodied in structure, character and language that can be only recognized by the human sense. That is, real threat is that the represented world will fail to cohere, and thereby indict the very notion of a coherent reality.

Implications of Human and Psychological Trauma in the Era of the Pandemic

Yeojin Lim,Jeumnam Kim J-INSTITUTE 2022 International Journal of Human & Disaster Vol.7 No.2

Purpose: In the name of fear and prevention of corona infection, human society is branded as an infected individual or group. In serious infectious disease situations, the scapegoat of transferring tension and fear to some members of the community can cause dissociation and cultural trauma. The scapegoat violence, which is blamed for the expectation of collective psychological purification, lives in an era of confusion that requires a healthy alternative. Therefore, in this situation, this study aims to examine the implications of human and psy-chological trauma to us from a historical point of view. Method: Modern times, violence that eludes and condemns some members because of the expectation of collective psychological cleanup is living in an era of confusion that requires healthy alternatives. This study is to examine previous studies and data related to trauma and to suggest the implications of trauma phenomenon in the pandemic era. Results: We are part of a post-trauma society, as is society, where individuals and societies who have experi-enced violence and trauma are overwhelmed by fear. It is undoubtedly true that the Pandemic era increases the frequency and intensity of depression and anxiety in humans, as it causes “group trauma” in many people. Per-sonal trauma is an emotional wound that begins with a shocking event that occurred to one person or a small number of people. On the other hand, collective trauma is a trauma that occurs because of the shock of society as a whole, not an individual or a small number. Trauma is widely understood as a variety of psychological and spiritual wounds in large and small forms experienced in everyday life. If this concept of broadness is premised, trauma can happen to anyone, anytime, anywhere, in various contexts of life. After the fall of mankind, constant war, natural disas-ters and talent, terrorism, and social oppression have left untouchable scars on many people. The core of trauma relief(therapy) is to restore the relationship through the recovery of broken communication, and it is necessary to provide in-depth support with interest at the national level. In addition, it is necessary to approach trauma from a phenomenological point of view and to make it possible to understand the victim more generally considering the sociocultural context intertwined with the complex life and experience of the victim experiencing trauma as a de-evidence paradigm. Conclusion: This study suggests implications for the meaning of social human and psychological trauma to us in the current Pandemic situation and also it is expected to be a basic foundation for in-depth papers that can lead to follow-up studies.

Trauma and Healing in The Kitchen God’s Wife

( Yuan Henan ) 충남대학교 인문과학연구소 2019 인문학연구 Vol.58 No.1

본 연구의 목적은 아시아계 미국문학의 대표적인 작가인 에이미 탄(Amy Tan)의 『부엌신의 아내』(The Kitchen God’s Wife)에 나타난 트라우마와 치유 과정을 분석하는 것이다. 작가 탄은 작품 속에서 주인공 위니(Winnie)의 과거 트라우마의 경험을 절묘한 필치로 생생하게 묘사한다. 중국에서 위니는 어릴 때부터 연속적으로 부모님의 버림, 무시, 성적 학대, 가정 폭력과 성폭행을 당한다. 그리고 신대륙으로 이민을 온 후에도 위니는 트라우마를 계속 경험하며 트라우마의 주요증상인 과다각성의 증세를 보인다. 그러나 친구인 헬렌(Helen)의 강요로 인하여 위니는 딸 펄(Pearl) 한테 자기의 과거 트라우마를 털어놓음으로써 딸과 소통을 하게 되며 딸과 친밀하고 가까운 모녀 관계를 회복한다. 따라서 펄은 어머니의 사랑과 과거 트라우마를 이해하게 되고 어머니와 딸의 갈등이 해소됨으로써 위니의 오랫동안 숨겨졌던 트라우마도 치유된다. 이 소설은 작가의 강한 자전적인 요소가 결합된 자전적인 소설이며 탄은 자기의 가족 트라우마를 작품 속에 암시적으로 투영한다. 탄의 어머니 데이지(Daisy)가 위니의 원형이며 탄은 어머니의 트라우마 경험을 다시 쓰기를 통하여 자기 가정에 존재했던 트라우마가 치유되는 과정을 보여준다. 탄은 어머니의 과거 트라우마를 통하여 어머니의 과거를 분명하게 이해하게 된다. 작가인 탄은 트라우마의 완전한 치유에 대한 회의적인 시각에도 불구하고 트라우마의 치유에 대해 긍정적인 입장을 제기한다. 결국 작가인 탄은 트라우마와 치유의 과정을 통하여 인간에 대한 이해와 사랑에 대해 통찰적인 견해를 보여주고 있다. The purpose of this paper is to analyze trauma and its healing process in the representative writer of Asian American literature, Amy Tan’s The Kitchen God’s Wife. In the novel, Tan exquisitely and vividly delineates the protagonist Winnie’s traumatic experiences. In China, Winnie experiences a series of traumatic events from childhood before emigrating to America. Winnie successively suffers from traumas of parents’ abandonment, neglect, sexual abuse, domestic violence, and rape. After migrating to the new continent, Winnie suffers from the destructive aftermath of trauma, and manifests trauma’s symptoms of hyper-arousal and disconnection. At her friend Helen’s urging, Winnie begins to confide her traumas to her daughter, Pearl. Through trauma narrative talk-story, the protagonist Winnie not only breaks the disconnection caused by trauma, but also builds up an intimate and close mother-daughter relationship with her daughter. At the same time, Pearl also understands her mother’s love, and gets to know her mother’s traumatic past. In the end, Winnie’s long concealed traumas are healed. This novel has strong autobiographical colors, as Tan puts her family traumas into The Kitchen God’s Wife. In reality, Tan’s mother Daisy is the archetype for Winnie in the novel. Through rewriting her mother’s traumatic experiences, Tan assimilates and integrates these traumas into a life story of her family. As a result, because Tan becomes to get a clear understanding of her mother’s traumatic past, the traumas of Tan’s mother can be healed. Despite the prevailed skeptical thought towards the complete healing of trauma, Tan has a positive stance to trauma and its healing. Through this novel, Amy Tan provides insightful ideas and notions about trauma, the healing of trauma, and trauma in literature.

Epidemiology and Management Trend of Renal Trauma: Results of a Nationwide Population-Based Study

Tae Bum Sik,Jang Hoon Ah,Yu Jihyeong,Oh Kyung-Jin,Moon Kyung Hyun,Park Jae Young 대한의학회 2022 Journal of Korean medical science Vol.37 No.47

Background: To analyze the incidence of renal trauma using the National Health Insurance Service Database (NHISD). Methods: Using the NHISD, representative of all upper urinary tract injuries in Korea, data regarding renal trauma were analyzed. The International Classification of Diseases, Tenth Revision Clinical Modification codes were used to identify the diagnoses. The incidence estimates of renal traumas were analyzed using Poisson regression analysis. Risk factors for high-grade renal trauma were estimated using multivariable logistic regression analyses. Results: Patients with renal trauma were identified from a nationwide database collected by the National Health Insurance Service of Korea between 2012 and 2016. Among 37,683 individuals with renal trauma, 1,293 (3.4%) were diagnosed with high-grade renal trauma. Surgical therapy was performed in 995 (2.6%) patients with renal trauma and 184 (14.2%) patients with high-grade renal trauma. Renal trauma occurred in all age groups, and the ratio between men and women was approximately 3:1. Men and women experienced 8,000 (31.82/100,000) and 2,365 (9.52/100,000) renal trauma in 2013 (total 10,365, 20.73/100,000) and 5,243 (20.56/100.000) and 2,168 (8.58/100,000) in 2016 (total 7,411, 14.60/100,000), respectively. In multivariable analysis, female sex, age (age; 41–60 and 61–80 years), and comorbidity of peripheral vascular disease, renal disease, and malignancy were revealed as risk factors for high-grade renal trauma. Conclusion: Annual incidence of renal trauma is 17.33 per 100,000 population from 2012 to 2016. The incidence of kidney damage decreased gradually from 2013 to 2016, and the majority of renal trauma cases were low-grade. Conservative management was the preferred treatment modality in most patients with renal trauma, including those with high-grade renal trauma.

공공보건 문제로서 아동기 부정적 경험(ACEs)의 현황과 트라우마 -기반 접근의 법적 도입에 대한 검토

민윤영 경희대학교 법학연구소 2018 경희법학 Vol.53 No.4

This paper aims to introduce the concept of trauma-informed approaches into the field of law in Korea. To do so, it tackles the issue in three parts: theoretical, empirical, and comparative legal research. Trauma is an expansive topic, so this study specifically focused on childhood trauma, also known as Adverse Childhood Experiences(ACEs). The concept of the Trauma-Informed Approach is now widely embraced by various fields of human services, including, but not limited to, mental health, education, corrections, public safety, child welfare. Although application of this approach to law is in its infancy, the necessity of trauma-informed law is being recognized in Western legal culture, as the law regularly deals with people affected by traumatic events. This paper argues that this approach could be relevant for the Korean legal system, too. The reason for this is Korea's unique history which is full of traumatic events. Korea has undergone several massively traumatic events in a relatively short period of time such as colonization, division of the peninsula into South and North, Korean War and several dictatorships. As a legal system that has to deal with people who have undergone traumatic events at the national level, it is therefore necessary for the country to have a trauma-informed legal system. After exploring the usefulness of the concept of ACEs and trauma-informed approach in the field of law in Korea, this project observed the adverse experiences of the Korean people during childhood. The questionnaire developed by WHO which is called “ACE-IQ” was used. More than 1,000 people were surveyed and analyzed during this process. The results successfully showed that ACEs should be taken seriously as public health issue in Korea because childhood trauma is more prevalent than was previously understood. Lastly, it introduces how the trauma-informed approach is accepted in the United States legal system. This part of the paper aimed to focus on trauma-informed courts and ACEs related legislations to provide more practical information which can be helpful for Korea's legal system as it transforms into a trauma-informed one. 이 글은 트라우마-기반 접근(trauma-informed approach)을 한국의 법체계에 소개하고자 하며, 트라우마-기반 법학의 필요성과 가능성을 이론적, 실증적, 비교법적 차원으로 나누어 살펴보았다. 트라우마라는 개념은 매우 폭 넓은 개념이기 때문에, 이 연구는 특히 아동기 트라우마를 중심으로 연구하였다. 아동기 트라우마는 아동기 부정적 경험(Adverse Childhood Experiences, ACEs)이라는 새로운 개념을 통해 서구권에서 활발히 연구되고 있다. 서구권에서 트라우마-기반 접근은 정신의학, 교육, 교정, 공공안전, 아동복지 등 다양한 분야에 널리 수용되고 있으며, 법학에의 도입도 다방면으로 시도되고 있다. 법은 트라우마적인 사건을 겪은 사람들의 문제를 다루기 때문에, 특히 트라우마에 대한 인식과 감수성을 가지는 것이 필요하다. 이 연구는 이러한 트라우마-기반 접근을 한국의 법체계에도 도입해야 한다고 주장하는데, 특히 한국의 현대사가 트라우마적 사건들로 얼룩져 있다는 역사적 맥락을 고려할 때 더욱 그러하다. 한국은 100년 남짓의 짧은 시간 동안 식민지, 분단, 6.25전쟁, 독재정권, 그리고 최근의 세월호 등 국가적으로 심각한 트라우마를 유발할 수 있는 사건들을 지속적으로 겪어왔다. 치유되지 않은 트라우마는 세대를 건너 전달되어 또 다른 트라우마를 낳는다. 한국의 법체계가 트라우마에 대해 특히 인식과 감수성을 가져야할 중요한 이유 중 하나이다. 특히 이 글이 주목하는 아동기 부정적 경험(ACEs, 아동기 트라우마)는 아동의 뇌 발달에 영향을 미쳐서 아동기 이후 성인기에도 전방위적 영향을 미치는데, 이러한 근본적 영향력 때문에 서구권에서는 아동기 트라우마를 공공보건(public health)의 문제로서 다룬다. 아동기 트라우마의 영향력은 범죄 성향을 포함한 성인기의 법 관련 활동에도 영향을 미치기 때문에 공공보건 문제이자 법의 문제이기도 하다. 이러한 이론적 차원을 제II장에서 다룬다. 제III장에서는 WHO에서 개발한 아동기 부정적 경험 국제설문문항(ACE-IQ)을 활용하여 한국의 만19세 이상 성인 1037명을 대상으로 실시한 한국인의 아동기 부정적 경험 실태조사 결과를 소개한다. 조사 결과 한국에서도 아동기 트라우마가 중요한 공공보건적 이슈임을 확인하는 결과를 얻을 수 있었다. 마지막으로는 미국의 법체계에 트라우마-기반 접근이 어떻게 수용되고 있는지를 살펴보았는데, 이 부분에서는 특히 트라우마-기반 법원과 ACEs 관련 입법들을 중심으로 고찰하였다.