The role of hepatobiliary surgeon beyond the hepatobiliary traum

John Cook-Jong Lee 대한외과학회 2016 대한외과학회 학술대회 초록집 Vol.2016 No.11

Splenic Autotransplantation after Blunt Spleen Injury in Children

( Hojun Lee ),( Byung Hee Kang ),( Junsik Kwon ),( John Cook-jong Lee ) 대한외상학회 2018 大韓外傷學會誌 Vol.31 No.2

Non-operative management has been preferred in blunt spleen injury. Moreover children are more susceptible to post-splenectomy infection, spleen should be preserved if possible. However, splenectomy is inevitable to patients with severe splenic injury. Therefore splenic autotransplantation could be the last chance for preserving splenic function in these patients although efficacy has not proven. Here we reported four cases of children who were underwent splenic autotransplantation successfully after blunt trauma.

Rare Imaging of Fat Embolism Seen on Computed Tomography in the Common Iliac Vein after Polytrauma

( Hojun Lee ),( Jonghwan Moon ),( Junsik Kwon ),( John Cook-jong Lee ) 대한외상학회 2018 大韓外傷學會誌 Vol.31 No.2

Fat embolism refers to the presence of fat droplets within the peripheral and lung microcirculation with or without clinical sequelae. However, early diagnosis of fat embolism is very difficult because the embolism usually does not show at the computed tomography as a large fat complex within vessels. Forty-eight-year-old male with pedestrian traffic accident ransferred from a local hospital by helicopter to the regional trauma center by two flight surgeons on board. At the rendezvous point, he had suffered with dyspnea without any airway obstruction sign with 90% of oxygen saturation from pulse oximetry with giving 15 L of oxygen by a reserve bag mask. The patient was intubated at the rendezvous point. The secondary survey of the patient revealed multiple pelvic bone fracture with sacrum fracture, right femur shaft fracture and right tibia head fracture. Abdominal computed tomography was performed in 191 minutes after the injury and fat embolism with Hounsfield unit of -86 in his right common iliac vein was identified. Here is a very rare case that mass of fat embolism was shown within common iliac vein detected in computed tomography. Early detection of the fat embolus and early stabilization of the fractures are essential to the prevention of sequelae such as cerebral fat embolism.

Diagnostic significance of diaphragmatic height index in traumatic diaphragmatic rupture

Junsik Kwon,John Cook-Jong Lee,Jonghwan Moon 대한외과학회 2019 Annals of Surgical Treatment and Research(ASRT) Vol.97 No.1

Purpose: Traumatic diaphragmatic rupture resulting from blunt trauma is usually severe. However, it is often overlooked during initial evaluation because there are no characteristic signs and symptoms. Thus, this study aimed to determine the clinical characteristics of diaphragmatic rupture caused by blunt trauma and investigate the diagnostic usefulness of diaphragmatic height index (DHI) measured using chest radiographs. Methods: The cohort comprised patients who were admitted due to diaphragmatic rupture from blunt trauma. Patients were divided into 2 groups; the control group comprised patients with blunt trauma who were matched for age, sex, and Injury Severity Score, while the DHI group comprised patients with diaphragmatic rupture from blunt trauma. Receiver operating characteristic curve was used to determine the cutoff value of DHI for diaphragmatic injury. The sensitivity, specificity, predictability, accuracy, and likelihood ratio of the cutoff were then determined. Results: A total of 60 patients were confirmed to have diaphragmatic rupture. The mean DHI in patients with diaphragmatic rupture on the right and left side were both significantly different compared to that in the control group. A DHI cutoff value of >1.31 showed 71% sensitivity and 87% specificity for diagnosing right diaphragmatic rupture, while a cutoff value of <0.43 showed 87% sensitivity and 76% specificity for diagnosing left diaphragmatic rupture. Conclusion: DHI can be useful in the diagnosis of diaphragmatic rupture. DHI as determined using chest radiographs in patients with blunt abdominal trauma, particularly in those ineligible for diagnostic work-up, may help in the diagnosis of diaphragmatic rupture.

The Applicability of Trauma and Injury Severity Score for a Blunt Trauma Population in Korea and a Proposal of New Models Using Score Predictors

정경원,허요,John Cook-Jong Lee,김영환,문종환,윤석화,김지영,김주양,김효주 연세대학교의과대학 2016 Yonsei medical journal Vol.57 No.3

Purpose: The purpose of this study was to verify the utility of existing Trauma and Injury Severity Score (TRISS) coefficients and to propose a new prediction model with a new set of TRISS coefficients or predictors. Materials and Methods: Of the blunt adult trauma patients who were admitted to our hospital in 2014, those eligible for Korea Trauma Data Bank entry were selected to collect the TRISS predictors. The study data were input into the TRISS formula to obtain “probability of survival” values, which were examined for consistency with actual patient survival status. For TRISS coefficients, Major Trauma Outcome Study-derived values revised in 1995 and National Trauma Data Bank-derived and National Sample Project-derived coefficients revised in 2009 were used. Additionally, using a logistic regression method, a new set of coefficients was derived from our medical center’s database. Areas under the receiver operating characteristic (ROC) curve (AUC) for each predictionability were obtained, and a pairwise comparison of ROC curves was performed. Results: In the statistical analysis, the AUCs (0.879–0.899) for predicting outcomes were lower than those of other countries. However,by adjusting the TRISS score using a continuous variable rather than a code for age, we were able to achieve higher AUCs [0.913 (95% confidence interval, 0.899 to 0.926)]. Conclusion: These results support further studies that will allow a more accurate prediction of prognosis for trauma patients. Furthermore,Korean TRISS coefficients or a new prediction model suited for Korea needs to be developed using a sufficiently sized sample.

The Best Prediction Model for Trauma Outcomes of the Current Korean Population: a Comparative Study of Three Injury Severity Scoring Systems

Kyoungwon Jung,John Cook-Jong Lee,Rae Woong Park,Dukyong Yoon,Sungjae Jung,Younghwan Kim,Jonghwan Moon,Yo Huh,Junsik Kwon 대한중환자의학회 2016 Acute and Critical Care Vol.31 No.3

Background: Injury severity scoring systems that quantify and predict trauma outcomes have not been established in Korea. This study was designed to determine the best system for use in the Korean trauma population. Methods: We collected and analyzed the data from trauma patients admitted to our institution from January 2010 to December 2014. Injury Severity Score (ISS), Revised Trauma Score (RTS), and Trauma and Injury Severity Score (TRISS) were calculated based on the data from the enrolled patients. Area under the receiver operating characteristic (ROC) curve (AUC) for the prediction ability of each scoring system was obtained, and a pairwise comparison of ROC curves was performed. Additionally, the cut-off values were estimated to predict mortality, and the corresponding accuracy, positive predictive value, and negative predictive value were obtained. Results: A total of 7,120 trauma patients (6,668 blunt and 452 penetrating injuries) were enrolled in this study. The AUCs of ISS, RTS, and TRISS were 0.866, 0.894, and 0.942, respectively, and the prediction ability of the TRISS was significantly better than the others (p < 0.001, respectively). The cut-off value of the TRISS was 0.9082, with a sensitivity of 81.9% and specificity of 92.0%; mortality was predicted with an accuracy of 91.2%; its positive predictive value was the highest at 46.8%. Conclusions: The results of our study were based on the data from one institution and suggest that the TRISS is the best prediction model of trauma outcomes in the current Korean population. Further study is needed with more data from multiple centers in Korea.

Risk factors for mortality of severe trauma based on 3 years` data at a single Korean institution

Joohyun Sim,Jaeheon Lee,John Cook-Jong Lee,Yunjung Heo,Heejung Wang,Kyoungwon Jung 대한외과학회 2015 Annals of Surgical Treatment and Research(ASRT) Vol.89 No.4

Purpose: This study aimed to determine the mortality rate in patients with severe trauma and the risk factors for trauma mortality based on 3 years’ data in a regional trauma center in Korea. Methods: We reviewed the medical records of severe trauma patients admitted to Ajou University Hospital with an Injury Severity Score (ISS) > 15 between January 2010 and December 2012. Pearson chi-square tests and Student t-tests were conducted to examine the differences between the survived and deceased groups. To identify factors associated with mortality after severe trauma, multivariate logistic regression was performed. Results: There were 915 (743 survived and 172 deceased) enrolled patients with overall mortality of 18.8%. Age, blunt trauma, systolic blood pressure (SBP) at admission, Glasgow Coma Scale (GCS) at admission, head or neck Abbreviated Injury Scale (AIS) score, and ISS were significantly different between the groups. Age by point increase (odds ratio [OR], 1.016; P = 0.001), SBP ≤ 90 mmHg (OR, 2.570; P < 0.001), GCS score ≤ 8 (OR, 6.229; P < 0.001), head or neck AIS score ≥ 4 (OR, 1.912; P = 0.003), and ISS by point increase (OR, 1.042; P < 0.001) were significant risk factors. Conclusion: In severe trauma patients, age, initial SBP, GCS score, head or neck AIS score, and ISS were associated with mortality.

Secondary Abdominal Compartment Syndrome Recognized in Operating Room in Severely Injured Patients

Seok Hwa Youn,John Cook-Jong Lee,Kyoungwon Jung,Jonghwan Moon,Yo Huh,Younghwan Kim 대한중환자의학회 2016 Acute and Critical Care Vol.31 No.1

For trauma patients with severe shock, massive fluid resuscitation is necessary. However, shock and a large amount of fluid can cause bowel and retroperitoneal edema, which sometimes leads to abdominal compartment syndrome in patients without abdomino-pelvic injury. If other emergent operations except intraabdomen are needed, a distended abdomen is likely to be recognized late, leading to multiple organ dysfunction. Herein, we report two cases of a 23-year-old woman who was in a car accident and a 53-year old man who was pressed on his leg by a pressing machine; severe brain swelling and popliteal vessel injury were diagnosed, respectively. They were both in severe shock and massive fluid resuscitation was required in the emergency department. Distended abdomen was recognized in both the female and male patients immediately after neurosurgical operation and immediately before orthopaedic operation in the operating room, respectively. Decompressive laparotomy revealed massive ascites with retroperitoneal edema.

Trauma surgery without proper compensation under the current Korean National Health Insurance System

Kyoungwon Jung,Yunjung Heo,John Cook-Jong Lee,Mijin Lee,Suni Son,Hee Suk Park,Joo-Ok Kim,Jeong Hee Lee 대한외과학회 2017 Annals of Surgical Treatment and Research(ASRT) Vol.92 No.5

Purpose: This study aimed to evaluate the situations and problems of the current health insurance fees for trauma surgeries. Methods: We reviewed the medical records and billing data from trauma surgeries performed in the hospital from August 2012 to July 2014. The name and number of surgeries were investigated and the code and number of operations prescribed by surgeons were compared with the number of cases actually billed to insurance. In addition, the results returned by the Health Insurance Review & Assessment Services (HIRA) after deduction were investigated and compared to verify the insurance review findings. Results: During the study period, total 1,534 trauma surgical procedures were performed for a total of 253 trauma patients. Based on names, 1,092 procedures were performed; however, 442 cases (28.8%) could not be prescribed because of lack of proper insurance codes for the procedures. A total of 1,046.5 surgical procedures were prescribed by surgeons, adjusted by the insurance team, and finally billed to the HIRA; 162 bills were returned from the HIRA after rate reductions, corresponding to a reduction rate of 15.5%. The major reason for reduction was “fee criteria and limited number”. The compensation rate for billed surgical procedures was 84.5%. Conclusion: The high reduction and low compensation rate for trauma surgery under the current Korean National Health Insurance System need to be reviewed and improved. Furthermore, it is necessary to establish new criteria for surgical procedures fees for latest ones such as damage control surgery performed on severe trauma patients.

Current management for patients with hemodynamic instability due to pelvic fracture in Korean regional trauma centers: multi-institutional trial

Ji Young JANG,Kyungwon JUNG,Keum Seok BAE,Seokho CHOI,John Cook-Jong LEE,Dong Hun KIM,Byung Hee KANG 대한외과학회 2019 대한외과학회 학술대회 초록집 Vol.2019 No.10