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Ji Wool Ko,김명준,최영운,Shim Hongjin,정회정,Jang Ji Young,배금석,김광민 대한외상중환자외과학회 2022 Journal of Acute Care Surgery Vol.12 No.2
Purpose: Pelvis fractures are associated with bladder and urethral injury (BUI). The purpose of this study was to identify risk factors associated with BUI in patients with pelvic fracture.Methods: Patients (> 18 years) with pelvic injury (<i>N</i> = 314) at our hospital between January 2015 and June 2020 were retrospectively analyzed for age, sex, cause of injury, initial vital signs, urine red blood cell (RBC) count, Glasgow Coma Scale and Abbreviated Injury Scale score, Injury Severity Score, preperitoneal pelvic packing, and femur, lumbar spine, and pelvic fractures.Results: Compared with the BUI-absent group, the BUI-present group had a greater percentage of patients who were male (79.2% vs. 55.9%; <i>p</i> = 0.026), had a urine RBC count/high power field (HPF) ≥ 30 (94.4% vs. 38.8%; <i>p</i> < 0.001), underwent preperitoneal pelvic packing (37.5% vs. 18.6%; <i>p</i> = 0.035), had symphysis pubis diastasis (33.3% vs. 11.7%; <i>p</i> = 0.008), and had sacroiliac joint dislocation (54.2% vs. 23.4%; <i>p</i> = 0.001). Independent risk factors associated with BUI were symphysis pubis diastasis [odds ratio (OR) was 3.958 (95% confidence interval: 1.191–13.154); <i>p</i> = 0.025] and a urine RBC count/HPF ≥ 30 [OR = 25.415 (95% confidence interval: 3.252–198.637); <i>p</i> = 0.006]. Of those with BUI, 15 patients were diagnosed at the trauma bay, and 9 had a delayed diagnosis.Conclusion: Patients with pelvic injury who display symphysis pubis diastasis or have a urine RBC count/ HPF ≥ 30 are at higher risk of BUI, therefore, further BUI investigations should be considered.
( Ji Wool Ko ),( Il Hwan Park ),( Chun Sung Byun ),( Sung Woo Jang ),( Pil Young Jung ) 대한외상학회 2021 大韓外傷學會誌 Vol.34 No.3
Purpose: For severe lung injuries or acute respiratory distress syndrome that occurs during critical care due to trauma, extracorporeal membrane oxygenation (ECMO) may be used as a salvage treatment. This study aimed to describe the experiences at a single center with the use of ECMO in trauma patients. Methods: We enrolled a total of 25 trauma patients who were treated with ECMO between January 2015 and December 2019 at a regional trauma center. We analyzed and compared patients’ characteristics between survivors and non-survivors through a medical chart review. We also compared the characteristics of patients between direct and indirect lung injury groups. Results: The mean age of the 25 patients was 45.9±19.5 years, and 19 patients (76.0%) were male. The mean Injury Severity Score was 26.1±10.1. Ten patients (40.0%) had an Abbreviated Injury Scale (AIS) 3 score of 4, and six patients (24.0%) had an AIS 3 score of 5. There were 19 cases (76.6%) of direct lung injury. The mortality rate was 60.0% (n=15). Sixteen patients (64.0%) received a loading dose of heparin for the initiation of ECMO. There was no significant difference in heparin use between the survivors and non-survivors (70% in survivors vs. 60% in non-survivors, p=0.691). When comparing the direct and indirect lung injury groups, there were no significant differences in variables other than age and ECMO onset time. Conclusions: If more evidence is gathered, risk factors and indications will be identified and we expect that more trauma patients will receive appropriate treatment with ECMO.
( Ji Wool Ko ),( Giho Moon ),( Jin Geun Kwon ),( Kyoung Eun Kim ),( Hankaram Jeon ),( Kyungwon Lee ) 대한외상학회 2023 大韓外傷學會誌 Vol.36 No.4
Purpose: The Armed Forces Trauma Center of Korea was established in April 2022. This study was conducted to report our 1-year experience of treating soldiers with open fractures of the lower extremity. Methods: In this case series, we reviewed the medical records of 51 Korean soldiers with open fractures of the lower extremity between April 2022 and March 2023 at a trauma center. We analyzed patients with Gustilo-Anderson type II and III fractures and reported the duration of transportation, injury mechanisms, injured sites, and associated injuries. We also presented laboratory findings, surgery types, intensive care unit stays, hospital stays, rehabilitation results, and reasons for psychiatric consultation. Additionally, we described patients’ mode of transport. Results: This study enrolled nine male patients who were between 21 and 26 years old. Six patients had type II and three had type III fractures. Transport from the accident scene to the emergency room ranged from 75 to 455 minutes, and from the emergency room to the operating room ranged from 35 to 200 minutes. Injury mechanisms included gunshot wounds, landmine explosions, grenade explosions, and entrapment by ship mooring ropes. One case had serious associated injuries (inhalation burn, open facial bone fractures, and hemopneumothorax). No cases with serious blood loss or coagulopathies were found, but most cases had a significant elevation of creatinine kinase. Two patients underwent vascular reconstruction, whereas four patients received flap surgery. After rehabilitation, six patients could walk, one patient could move their joints actively, and two patients performed active assistive movement. Eight patients were referred to the psychiatry department due to suicidal attempts and posttraumatic stress disorder. Conclusions: This study provides insights into how to improve treatment for patients with military trauma, as well as medical services such as the transport system, by revising treatment protocols and systematizing treatment.
Ji Wool Ko,Seong Chan Gong,Myung Jun Kim,Jae Sik Chung,Young Un Choi,Jun Hyuk Lee,Pil Young Jung 대한외과학회 2020 Annals of Surgical Treatment and Research(ASRT) Vol.99 No.6
Purpose: Recently, several studies have demonstrated symptom-based, non-zonal algorithms for approaching penetrating neck injuries. The purpose of this study was to confirm the effectiveness of the “no zone” approach in traumatic neck injuries. Methods: Medical charts of patients with traumatic neck injuries who presented at the Regional Trauma Center in South Korea between January 2014 and December 2018 were retrospectively reviewed. Negative final neck findings (FNFs) were compared with positive FNFs (which include major vascular, aerodigestive, nerve, endocrine gland, cartilage, or hyoid bone injuries) using multivariate logistic regression analysis including values of the “zone” and/or no zone approach. Results: Out of 168 trauma patients, 70 patients with a minor injury and 7 patients under the age of 18 years were excluded. Of the remaining 91 patients, 74 (81.3%) had penetrating neck injuries and 17 (18.7%) had blunt neck injuries. Initial diagnosis most frequently revealed external wounds in zone II (84.6%). Twenty (22.0%) and 36 (39.5%) patients had hard and soft signs, respectively, using the no zone approach. Further, there was a significant difference between the negative and positive FNFs in patients with hard signs (11.6% vs. 54.5%; P < 0.01, respectively). According to the multivariate logistic regression analysis, the hard signs were associated with an odds ratio (OR) for FNFs (OR, 18.92; 95% confidence interval, 3.55–157.60). Conclusion: Traumatic neck injuries classified as having hard signs based on the no zone approach may be correlated with internal organ injuries of the neck.
Hongjin Shim,Dae Ryong Kang,Hye Sim Kim,Ji Young Jang,Ou-Hyen Kim,Kiyoung Kim,Un Young Choi,Ko Ji Wool,Keum Seok Bae 대한외상중환자외과학회 2024 Journal of Acute Care Surgery Vol.14 No.1
Purpose: We sought to assess mortality trends in chest-abdominal trauma patients, before and after theimplementation of the Project Supporting Establishment of Trauma Centers (PSETC) in the Republic ofKorea. Methods: Data from the National Health Insurance Service claims database between 2009 to 2017 wereanalyzed. Patients with chest-abdominal trauma were defined as those with relevant main diagnosiscodes and claims for emergency medical management fees. Mortality and cumulative data were analyzedfor each year to compare mortality before and after the establishment of regional trauma centers acrossKorea (2014). Results: In total, 29,127 patients were included in the analysis. While the annual incidence of trauma-related chest-abdominal injuries increased, mortalities decreased. In particular, the trauma incidencerate among patients over 50 years increased during the study period. Mortalities at trauma centers didnot change year by year after the PSETC. Before and after 2014, when trauma centers operated underthe PSETC, mortalities decreased [trauma cases before the PSETC; n = 14,321 (mortality 5.61), after thePSETC; n = 14,806 (mortality 4.96)]. Conclusion: The number of patients treated for chest-abdominal injuries increased from 2009 to 2017 inKorea, whereas mortalities decreased over the same period.