소아 두부외상 환자에서의 반복적인 두부 CT 검사의 유용성

조호준 ( Ho Jun Jo ),임용수 ( Yong Su Lim ),김진주 ( Jin Joo Kim ),조진성 ( Jin Seong Cho ),현성열 ( Sung Youl Hyun ),양혁준 ( Hyuk Jun Yang ),이근 ( Gun Lee ) 대한외상학회 2015 大韓外傷學會誌 Vol.28 No.3

Purpose: Traumatic brain injury (TBI) is the most common cause of pediatric trauma patients came to the emergency department. Without guidelines, many of these children underwent repeat brain computed tomography (CT). The purpose of this study was to evaluate the value of repeat brain CT in children with TBI. Methods: We conducted a retrospective study of TBI in children younger than 19 years of age who visited the emergency department (ED) from January 2011 to December 2012. According to the Glasgow Coma Scale (GCS) and Pediatric Glasgow Coma Scale score of the patients, study population divided in three groups. Clinical data collected included age, mechanism of injury, type of TBI, and outcome. Results: A Total 83 children with TBI received repeat brain CT. There were no need for neurosurgical intervention in mild TBI (GCS score 13-15) group who underwent routine repeat CT. 4 patients of mild TBI group, received repeat brain CT due to neurological deterioration, and one patient underwent neurosurgical intervention. Routine repeat CT identified 12 patients with radiographic progression. One patient underwent neurosurgical intervention based on the second brain CT finding, who belonged to the moderate TBI (GCS score 9-12) group. Conclusion: Our study showed that children with mild TBI can be observed without repeat brain CT when there is no evidence of neurologic deterioration. Further study is needed for establish indication for repetition of CT scan in order to avoid unnecessary radiation exposure of children. [ J Trauma Inj 2015; 28: 149-157 ]

소아 중증 외상환자의 병원 전 요인에 따른 중증 손상의 예측과 손상의 예방

우재혁 ( Jae Hyug Woo ),양혁준 ( Hyuk Jun Yang ),임용수 ( Yong Su Lim ),조진성 ( Jin Seong Cho ),김진주 ( Jin Joo Kim ),박원빈 ( Won Bin Park ),장재호 ( Jae Ho Jang ),이근 ( Gun Lee ) 대한외상학회 2014 大韓外傷學會誌 Vol.27 No.3

Purpose: Trauma is one of the most common causes of death for children, and identifying severely injured children quickly in an overcrowded emergency room (ER) is difficult. Therefore, severe injury must be prevented, and the severity of injuries in children must be determined easily from their general characteristics and pre-hospital factors. Methods: Injured children younger than 15 years of age who visited the ER from June 2011 to May 2013 were enrolled. According to the revised trauma score (RTS) of the patients, the study population was divided in two groups, a severe group (RTS<7) and a mild group (RTS≥7). The general characteristics and the pre-hospital factors were compared between the two groups. Results: Six hundred seventy-three children were enrolled, their mean age was 8.03 (±4.45) years, and 476 (70.73%) patients were male. Of these patients, 22 patients (3.27%) were in the severe group, and 651 patients (96.73%) were in the mild group. Fewer males were in the severe group than in the mild group (50.00% vs. 71.43%, p=0.030), and children in the severe group were younger than children in the mild group (3.50 vs. 8.00 years, p=0.049). In the severe group, toddlers (54.55%, p=0.036) were the most common age group. Severe injuries occurred more often in spring (32.81%) and summer (54.56%) than in autumn (9.09%) and winter (4.55%) (p=0.026). The most common places of injury in the severe group were roads (50.00%, p=0.009), and the most common mechanisms of injury in the severe group were traffic accidents (50.00%), followed by falls (31.82%) (p=0.011). Most severely injured children were transferred by ambulance (72.73%, p=0.000). Conclusion: The results of this study may be helpful for identifying severely injured children quickly in the field and the ER. To prevent severe pediatric injuries, precautions and policies based on these results should be established. [ J Trauma Inj 2014;27:43-49 ]

두부외상 후 동반 발생한 경동맥해면정맥동루와 내경동맥박리증 1례

조진성 ( Jin Seong Cho ),양혁준 ( Hyuk Jun Yang ),이근 ( Gun Lee ),유찬종 ( Chan Jong Yoo ),진욱 ( Wook Jin ),이재관 ( Jae Gwan Lee ) 대한외상학회 2003 大韓外傷學會誌 Vol.16 No.2

A carotid-cavernous fistula (CCF) is a pathologic arteriovenous communication between the carotid artery and the cavernous sinus, and the incidence of CCF as a result of craniofacial trauma is less than 0.2%. Traumatic internal carotid artery dissection (TICAD) is a rare phenomenon, occurring in 0.02 to 0.67% of cervical blunt trauma cases. We report a rare case of CCF associated with ICAD after craniofacial trauma injury, which is very rare. A 23-year-old woman presented with left ptosis on 21 days after a car crash accident. She had suffered from headaches, diplopia, tinnitus, and dizziness. Brain MRI revealed no mass or aneurysmal sac or intracranial hemorrhage, but cerebral angiography showed CCF with ICAD. She was treated with a ICAD percutaneous transarterial stent and endovascular embolization, 1 months after cerebral angiography. clinicians treating patients with craniofacial injuries should have a complete understanding of these patients` entity, because urgent intervention may improve outcome.

만성췌장염에 의한 비장피막하혈종: 1예 보고

장경아,진욱,양달모,김형식,김학수,이훈규,양혁준,Jang, Kyung A,Jin, Wook,Yang, Dal Mo,Kim, Hyung Sik,Kim, Hak Soo,Lee, Hoon Kyu,Yang, Hyuk Jun 대한영상의학회 2001 대한영상의학회지 Vol.44 No.6

췌장과 비장은 근접한 위치로 인해 췌장염시 비장합병증이 올수 있으나, 드문 것으로 되어 있고, 췌장염에 의한 비장피막하혈종은 국내에서 아직 보고된 바 없어 저자들이 경험한 1 예를 보고하고자 한다 Since the pancreas and the spleen lie in close proximity, splenic complications during the course of pancreatitis are possible, but uncommon. No previously published report in Korean has described splenic subcapsular hematoma due to pancreatitis, and we now report one such case.

의도적 중독으로 응급센터에 내원한 환자에 대한 연령별 비교 분석

김진현 ( Jin Hyun Kim ),조진성 ( Jin Seong Cho ),김진주 ( Jin Joo Kim ),임용수 ( Yong Su Lim ),양혁준 ( Hyuk Jun Yang ),이근 ( Geun Lee ) 대한임상독성학회 2016 대한임상독성학회지 Vol.14 No.2

Purpose: This study was conducted to compare demographic and characteristic differences in self-poisoned patients by age groups using a comprehensive trauma database. Methods: This study included 1,823 patients who were admitted to the emergency room following self-poisoning. Three age groups were defined: young patients (less than 19 years), adult patients (19 to 64 years) and elderly patients (65 years and old). From January 2011 to December 2015, data were obtained from in a single emergency medical center. We investigated the materials of poisoning, ingestion time, GCS, systolic blood pressure, heart rate, and outcomes of patients. Results: A total of 1,823 self-poisoned patients visited the hospital during 5 years. Among these, 130 (7.1%) were categorized as young, 1,460 (80.1%) were adults and 233 (12.8%) were elderly. The most common drug of self-poisoning substances was antipyretics (50.0%) for those in the young group, sedative drugs (45.0%) for adults, and pesticides (41.2%) for the elderly. Mortality was 2.7% in the adult group and 14.6% in the elderly group. After adjusting for all factors related to mortality, the odds ratio (OR) of mortality was 2.63 in the elderly group (95% confidence interval [CI]: 1.44-4.81). Conclusion: There were definite differences in the characteristics of three groups. The younger patients used drugs that could be easily obtained while older patients used more lethal drugs.

일개 대학병원에서 경험한 소아의 경증 두부 외상에서 Brain CT 측정 및 효용성

김하경 ( Ha Kyung Kim ),김진주 ( Jin Joo Kim ),조진성 ( Jin Seong Cho ),장재호 ( Jae Ho Jang ),양혁준 ( Hyuk Jun Yang ),이근 ( Gun Lee ) 대한외상학회 2014 大韓外傷學會誌 Vol.27 No.3

Purpose: In children, mild traumatic brain injuries (TBI) account for 70~90% of head injuries. Without guidelines, many of these children may be exposed to excess radiation due to unnecessary imaging. The purpose of this study was to evaluate the impact of a mild TBI guideline in imaging of pediatric patients. Methods: The medical records of all children who had head computed tomography and were admitted to our hospital with a TBI with Pediatric Glasgow Coma Scale and Glasgow Coma Scale of 14 to 15 were retrospectively reviewed and compared with PECARN Rule. Results: A total of 1260 children were included and all children checked with head computed tomography. 61 pediatrics had CT positive and presented skull fracture 40, hemorrhage 8, hemorrhagic contusion 7, and diffuse axonal injury 1. Also, 4 patients diagnosed both skull fracture and brain haemorrhage and 1 patient diagnosed both haemorrhage and haemorrhagic contusion. Conclusion: There are many pediatric traumatic patients who exposed to radiation due to CT. But, the most of results were negative. So, consider to follow the CT guideline for children and many do not require brain CT. [ J Trauma Inj 2014;27:63-70 ]

응급수술을 시행한 흉부 및 경부 외상환자에 대한 임상적 고찰

현성열 ( Sung Youl Hyun ),오상우 ( Sang Woo Oh ),김재광 ( Jae Kwang Kim ),임용수 ( Yong Su Lim ),양혁준 ( Hyuk Jun Yang ),이근 ( Gun Lee ),진욱 ( Wook Jin ),류일 ( Eell Ryoo ) 대한외상학회 2003 大韓外傷學會誌 Vol.16 No.2

Background: Recently, the number of patients with the thorax or neck trauma has increased due to traffic accidents, industrial disasters, incidental accidents, and violence. Most of the thorax or neck injuries can be managed with conservative methods and simple surgical procedures, but an open thoracotomy or exploration will be necessary in emergent cases. Traumas to the thorax and the neck have an extremely poor prognosis when not diagnosed and treated early. Therefore, we analyzed the results of emergent operations in patients with thorax or neck trauma and their clinical courses. Methods: A clinical evaluation was performed on 56 patients treated with emergent operations for thorax or neck trauma from January 1997 to July 2003 according to their medical Results: There were 45 males and 11 females. The mean age was 36.1 years. The modes of injury were as follows: traffic accidents 14 cases, stab wounds 27 cases, industrial disasters 7 cases, and others 8 cases. The annual distribution of cases was as follows: 1997 year 9 cases, 1998 year 6 cases, 1999 year 7 cases, 2000 year 10 cases, 2001 10 cases, 2002 6 cases and 2003 8 cases. The injured organs were 13 cases of a ruptured diaphragm, 12 cases of a ruptured lung, 7 cases of a ruptured heart, 2 case of a ruptured aorta, 9 cases of a simple vessel ruptured and 4 cases of a ruptured esophagus and trachea. There were 9 (16%) overall deaths: 6 cases in deaths among the blunt-trauma cases and 3 deaths among the stab injury cases. Conclusion: Early diagnosis and surgical treatment is essential for thorax or neck trauma, to decrease the mortality and complications. Therefore, careful diagnostic procedure, appropriate preoperative management for hypovolemia, and early surgical treatment are essential. The setup an of emergency operation system should be considered as a reform measure.

경추부 손상에서 자기 공명 영상법의 진단적 유용성

김용인 ( Yong In Kim ),노기철 ( Ki Cheul Noh ),강영준 ( Young Joon Kang ),임용수 ( Yong Su Lim ),양혁준 ( Hyuk Jun Yang ),이근 ( Gun Lee ),진욱 ( Wook Jin ),황성연 ( Seong Youn Hwang ) 대한외상학회 2004 大韓外傷學會誌 Vol.17 No.2

Background: Simple cervical X-rays often miss cervical spine injuries. Magnetic resonance imaging is valuable in these cases. The aims of this study is to determine high-risk factors of the cervical injuries, and to contribute to make indications of cervical MRI in evaluation of blunt trauma patients. Methods: We retrospectively reviewed the patients who visited our ED due to nuchal pain and examed by simple cervical X-ray and cervical MRI after blunt trauma. We analyzed the incidence of abnormal MRI findings in various patients groups. We also compared the incidence of missed cervical spine injury by level of injured spine. We thought cervical MRI to be goldstandard of this analysis. Results: The incidence of abnormality on cervical MRI is higher in male patients than female patients (p<0.01). Old (age≥40) patients frequently shows abnormal cervical MRI findings than young patients (p<0.001). In patients who had neurologic abnormality, the incidence of abnormality on cervical MRI is higher than neurologically normal patients (p<0.001). But, mechanisms of injuries and associated injuries are not related to the incidence of abnormality on cervical MRI. Injuries of lower cervical spine (C7) are frequently missed than those of other cervical spines (p<0.01). Conclusion: When evaluate cervical injuries in male, old, and neurologically abnormal patients, we must consider cervical MRI although the simple cervical X-ray is normal. We must pay more attention to lower cervical spine injuries than other cervical spine injuries.

복부 둔상에 의한 장간막 손상 환자의 평가에서 복부단층촬영의 가치

노기철 ( Ki Cheul Noh ),김진주 ( Jin Joo Kim ),정진호 ( Jin Ho Jung ),임용수 ( Yong Su Lim ),양혁준 ( Hyuk Jun Yang ),이근 ( Keun Lee ),진욱 ( Uk Jin ),박철희 ( Cheul Hee Park ) 대한외상학회 2004 大韓外傷學會誌 Vol.17 No.2

Background: Contrast-enhanced Abdominopelvic Computed Tomography(CT) is widely used for diagnosing abdominal injuries after blunt trauma. The purpose of this retrospective study is to classify the contrast-enhanced Abdominopelvic CT finding of mesenteric injuries after blunt abdominal trauma and assess of CT finding on clinical management. Methods: Between January 2000 and December 2003, 607 consecutive spiral abdomonopelvic CT examinations were performed in the ER of Gil medical center after blunt abdominal trauma. CT represented mesenteric injuries : bowel wall thickening or hematoma, mesenteric haziness or fatty infiltration, confined fluid or hematoma within mesenteric folds. We classified patients into 5 Grade by the hematoma size on CT scans : Grade I(None, 0 mm), II(Minimal, ≤10 mm), III(Small, 11~30mm), IV(Moderate, 31~60 mm), V(Large, ≥61 mm). Results: On the basis of the CT findings, 42 of the 607 patients were selected. 18 (42.9%) of 42 patients were classified as having grade I, II, III (≤30 mm) and 24 (57.1%) of 42 patients as having grade IV, V(≥31 mm). Of the 18 patients with grade I, II, III, 16(88.9%) were managed conservatively, while 2(11.1%) underwent surgery. of the 24 patients with grade IV, V injuries, 20(83.3%) were treated surgically and 4(16.7%) patients were managed conservatively. Conclusions: It is sufficient to treat of grade I, II, III mesenteric injuries by conservative management. It should be considered emergency operation to treatment of grade IV, V mesenteric injuries. (p<0.001) There were no relations between grading and initial systolic blood pressure, initial blood pressure and operation.

응급의료 전용헬기와 지상 앰뷸런스를 이용한 병원 간 이송에서 외상 환자의 예후 비교

강경국 ( Kyeong Guk Kang ),조진성 ( Jin Seong Cho ),김진주 ( Jin Ju Kim ),임용수 ( Yong Su Lim ),박원빈 ( Won Bin Park ),양혁준 ( Hyuk Jun Yang ),이근 ( Geun Lee ) 대한외상학회 2015 大韓外傷學會誌 Vol.28 No.3

Purpose: To improve outcome of severe trauma patient, the shortening of transport time is needed. Although helicopter emergency medical services (HEMS) is still a subject of debate, it must also be considered for trauma system. The aim of this study is to assess whether transport method (HEMS versus ground EMS) is associated with outcome among inter-hospital transport. Methods: All trauma patients transported to regional emergency center by either HEMS or ground EMS from September 2011 to September 2014. We have classified patients according to two groups by transport method. Age younger than 15 years and self-discharged patients were excluded. Results: A total of 427 patients were available for analysis during this period. 60 patients were transported by HEMS and 367 patients were transported by ground EMS. HEMS group had higher mortality than ground EMS group (23.3% vs 3.5%; p<0.001), and included more patients with excess mortality ratio adjusted injury severity score (EMR-ISS) above 25 (91.7% vs 48.8%; p<0.001). In the multivariable regression analysis, HEMS was not associated with improved outcome compared with ground EMS, but only EMR-ISS was associated with a mortality of patients (odds ratio, 1.06; 95% confidence interval, 1.04-1.09). Conclusion: In this study, helicopter emergency medical services transport was not associated with a decreased of mortality among the trauma patients who inter-hospital transported to the regional emergency center. [ J Trauma Inj 2015; 28: 108-114 ]