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 < or = 90 mmHg (OR, 2.570; P < 0.001), GCS score < or = 8 (OR, 6.229; P < 0.001), head or neck AIS score > or = 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.
Abbreviated Injury Scale ; Blood Pressure ; Glasgow Coma Scale ; Head ; Humans ; Injury Severity Score ; Korea ; Logistic Models ; Medical Records ; Mortality* ; Neck ; Risk Factors* ; Trauma Centers ; Wounds and Injuries

PURPOSE: Pedestrian traffic accident (TA) deaths account for 40% of Korea's annual TA fatalities. With that in mind, we reviewed the cases of traumatic pedestrian TA patients admitted to emergency medical centers in Korea. We analysed factors affecting the severity of injury in order to investigate risk factors for subsequent traumatic threats. METHODS: Prospective methods were applied using a prepared trauma recording format. Trauma records included patient factors (age, gender, occupation, underlying disease), accident factors (time of accident, weather conditions, transportation time, vehicle type causing the accident, influence of alcoholic on both drivers and victims, accident location), and other factors (means of initial hospital admittance transportation). We reviewed medical records to obtain data for vital signs, Glasgow coma scale (GCS), abbreviated injury scale (AIS), injury severity score (ISS), and trauma and injury severity score (TRISS). We divided subjects into 3 groups according to their ISS scores: mild (1-8 points), moderate (9-15 points), severe (>==16 points). These groups were compared with each other regarding degree of severity? RESULTS: We analyzed data for 23,392 traumatized patients that presented at an EMC. Of the 23,392, 252 (3.1%) were pedestrian TA patients. Among this pedestrian cohort, males 156 patients (male 61.9% and female 38.1%; p=0.332). Mean age was 43.1 (+/-19.9). Severity was greater in those over 40 years of age compared those under 40 (p=0.000). Farmer's had the greatest severity than patients in other occupations (p=0.004). Those with an underlying disease showed a higher degree of severity (p=0.028). The most common accident site was city roads (85.7%) but the degree of severity at such sites did not was not significantly greater (p=0.052). Sports utility vehicle (SUV) had the highest rate of accident severity (p=0.004). Cases involving drunken drivers had victims with higher severity (p=0.005). CONCLUSION: Factors that increase the rate of fatalities pedestrian TAs are: older age, underlying illness, working in the agricultural sector, driving an SUV, the patient being in a drunken state.
Abbreviated Injury Scale ; Accidents, Traffic ; Alcoholics ; Cohort Studies ; Emergencies ; Female ; Glasgow Coma Scale ; Humans ; Injury Severity Score ; Korea ; Male ; Medical Records ; Occupations ; Prospective Studies ; Risk Factors ; Sports ; Transportation ; Vital Signs ; Weather

PURPOSE: Even though traumatic pancreatic injuries occur in only 0.2% to 4% of all abdominal injuries, the morbidity and the mortality rates associated with pancreatic injuries remain high. The aim of this study was to evaluate the clinical outcomes of traumatic pancreatic injuries and to identify predictors of mortality and morbidity. METHODS: We retrospectively reviewed the medical records of 26 consecutive patients with a pancreatic injury who underwent a laparotomy from January 2000 to December 2010. The data collected included demographic data, the mechanism of injury, the initial vital signs, the grade of pancreatic injury, the injury severity score (ISS), the revised trauma score (RTS), the Glasgow Coma Scale (GCS), the number of abbreviated injury scales (AIS), the number of associated injuries, the initial laboratory findings, the amount of blood transfusion, the type of operation, the mortality, the morbidity, and others. RESULTS: The overall mortality rate in our series was 23.0%, and the morbidity rate was 76.9%. Twenty patients (76.9%) had associated injuries to either intra-abdominal organs or extra-abdominal organs. Two patients (7.7%) underwent external drainage, and 18 patients (69.3%) underwent a distal pancreatectomy. Pancreaticoduodenectomies were performed in 6 patients (23.0%). Three patients underwent a re-laparotomy due to anastomosis leakage or postoperative bleeding, and all patients died. The univariate analysis revealed 11 factors (amount of transfusion, AAST grade, re-laparotomy, associated duodenal injury, base excess, APACHE II score, type of operation, operation time, RTS, associated colon injury, GCS) to be significantly associated with mortality (p<0.05). CONCLUSION: Whenever a surgeon manages a patient with traumatic pancreatic injury, the surgeon needs to consider the predictive risk factors. And, if possible, the patient should undergo a proper and meticulous, less invasive surgical procedure.
Abbreviated Injury Scale ; Abdominal Injuries ; APACHE ; Blood Transfusion ; Colon ; Drainage ; Glasgow Coma Scale ; Hemorrhage ; Humans ; Injury Severity Score ; Laparotomy ; Medical Records ; Pancreatectomy ; Pancreaticoduodenectomy ; Retrospective Studies ; Risk Factors ; Vital Signs

PURPOSE: Various scoring systems have been introduced in grading severity and predicting mortality of trauma patients. The objective of this study is to apply novel trauma scoring systems; BIG score (Base deficit (B), International normalized ratio (I), Glasgow Coma Scale (G)), Emergency Trauma Score (EMTRAS), Probability of Survival score version 12 (PS12), and MGAP (Mechanism, GCS, Age, Arterial pressure) to adults with major trauma, and to compare their performance with traditional systems; Injury Severity System (ISS), Revised Trauma Score (RTS), and Trauma and Injury Severity Score (TRISS). METHODS: Retrospective data collected between January 2011 and June 2012 from a regional trauma center registry on adult major trauma patients (Age> or =18, ISS> or =16) were used to identify factors associated with death. Univariate associations were calculated, and a multiple logistic regression analysis was used to determine variables associated with hospital mortality. RESULTS: A total of 298 adult major trauma patients were retrieved in order to validate new trauma scoring systems. The median ISS was 22 [interquartile range (IQR) 17~25], and the hospital mortality rate was 30.9%. Traditional trauma scoring systems were each calculated to have an area under the curve of ISS 0.72 [95% confidence interval (CI): 0.67-0.77], TRISS 0.91 (95% CI: 0.88-0.94), and RTS 0.90 (95% CI: 0.86-0.93). New trauma scoring systems were calculated to have an area under the curve of EMTRAS 0.91 (95% CI: 0.87-0.94), BIG score 0.90 (95% CI: 0.86-0.93), PS12 0.91 (95% CI: 0.87-0.94), and MGAP 0.89 (95% CI: 0.85-0.93). CONCLUSION: The new trauma scoring systems (EMTRAS, BIG, MGAP) were good predictors of mortality in adult major trauma patients on admission. They performed well compared to traditional trauma scoring systems (ISS, RTS, TRISS).
Adult* ; Emergencies ; Fatal Outcome ; Glasgow Coma Scale ; Hospital Mortality ; Humans ; Injury Severity Score ; International Normalized Ratio ; Logistic Models ; Mortality* ; Retrospective Studies ; Trauma Centers ; Trauma Severity Indices ; Triage

A new algorithm to generate the medical record report based on XML and linked list is proposed in this paper. It decomposes and abstracts the content of report. Reporter can search and reuse the resources quickly, when writing or modifying the report. The experiment results prove that the algorithm reduces the reporting time and standardizes the content of report.
Algorithms ; Humans ; Medical Record Linkage ; Medical Records Systems, Computerized ; Programming Languages

PURPOSE: The purpose of this study is, first, to analyze the risk factors that influence the severity of injury in pediatric multiple trauma patients and, second, to present solutions for the problems related to the treatment of such patients. Our living situations are so complicated that the danger of accidents is truly open to children who are not prepared. We need to draw attention to the increased numbers of various accidents involving children. METHODS: We studied patients who visited the Emergency Medical Center at Chosun University Hospital from January 1, 2006, to December 31, 2008. Using medical records, we evaluated the general characteristics: the mechanism of injury, the vital signs, the revised trauma score (RTS), the injury severity score (ISS), and the hemoglibin value, which was checked at the time of visit, and the presence or the absence of emergent on regular surgery. We divided the level of injury as follows: light level (1-8 points), mid level (9-15 points), and serious level (above 16 points). We analyzed the medical data by using SPSS 17.0 for windows. RESULTS: The average age of the patients examined was 8.6 years. The number of 6- to 11-year-old patients was 96, which was the largest, but the degree of injury severity was the highest among infant (0-2 years), according to ISS 7.95(+/-6.85). The frequency of accidents was highest on sunny days, and most accidents occurred from 16:00 to 20:00. The cause of multiple trauma for children was the greatest in the traffic accident, (95 patients, 49.0%). In addition, the trauma caused by traffic accidents showed the highest ISS value (9.02+/-6.42) and the most serious degree (P=0.004). The ISS level of injury (8.40+/-6.64) for patients moved from a secondary hospital was higher than that (6.49+/-5.57) for patients who visited the medical center directly. The severity of injury was highest for patients who used a 119 ambulance (8.84+/-5.80). According to the injured parts of body, Injuries to the arms and the feet most frequent (79 patients, 40.7%), but the level of injury was the highest for internal organs and chest, 16.42+/-8.56 and 11.23+/-6.97, respectively. CONCLUSION: We used Abbreviated Injury Scale (AIS) in order to examine the characteristics by injured body part for pediatric multiple trauma patients. Because the degree of injury was the highest for internal organs or the chest, we need to more seriously examine and provide for patients who are suspected of having injuries to the internal organs or the chest. We need to quickly determine the need for surgery in patients with serious injuries to the arms and the feet, which is the greatest in frequency. In particular, we need to consider the surgical care of patients who are not very high in the severity of injury to their brains.
Abbreviated Injury Scale ; Accidents, Traffic ; Ambulances ; Arm ; Brain ; Child ; Emergencies ; Foot ; Humans ; Infant ; Injury Severity Score ; Light ; Medical Records ; Multiple Trauma ; Risk Factors ; Thorax ; Vital Signs

PURPOSE: The aim of this study was to analyze the characteristics and prognosis of intraperitoneal and retroperitoneal solid organ injuries after trauma. METHODS: We analyzed computed tomography (CT) data for 232 patients who had injury to solid abdominal organs between January 2002 and June 2009. The patients who had solid organ injury on CT were categorized into intraperitoneal, retroperitoneal and intra/retroperitoneal injury groups. Medical records were reviewed retrospectively, and data regarding the sex and age of patients, mechanism of injury, initial hemodynamic status, Revised Trauma Score (RTS), Abbreviated Injury Scale (AIS), Injury Severity Score (ISS), amount of transfusion, admission rate to intensive care unit (ICU), and mortality were collected and analyzed. Injury severity of solid organs was classified according to the American Association for the Surgery of Trauma (AAST) grading system. RESULTS: The intraperitoneal injury group had 131 patients, the retroperitoneal injury group 49 patients, and the intra/retroperitoneal injury group 52 patients. The intra/retroperitoneal injury group exhibited low blood pressure, a large number of packed red blood cells that were transfused, and high ISS and abdominal AIS. They tended to stay longer in the ICU and showed a higher mortality. Conservative management was the most common therapeutic modality for all 3 groups. CONCLUSION: The intra/retroperitoneal injury group showed higher fall for the mecahnism of injury, a lower initial blood pressure and a larger number of packed red blood cells that were transfused compared with the other groups. Therefore, physicians should rapidly identify those with a poor prognosis at initial presentation and make a decision quickly when they are caring for intra/retroperitoneal injury patients.
Abbreviated Injury Scale ; Abdominal Injuries ; Blood Pressure ; Erythrocytes ; Hemodynamics ; Humans ; Hypotension ; Injury Severity Score ; Intensive Care Units ; Medical Records ; Multiple Trauma ; Peritoneal Cavity ; Prognosis ; Retroperitoneal Space ; Retrospective Studies

PURPOSE: To estimate the reporting rate of tuberculosis in one medium-sized city in Korea. METHODS: Data claimed by national health insurance corporationand notification data of KTBS (Korea Tuberculosis Surveillance System) were compared through medical record-linkage method. Regarding the cases that were claimed medical care fee as tuberculosis but not notified to KTBS, we reviewed medical charts of the patients and investigated the reasons of failure to notify. RESULTS: Number of cases claimed health insurance fee as tuberculosis occurrences in Cheonan was 2,331 in 2007, while 956 cases were matched as notified cases to KTBS after electronic record-linkage by personal identifier. Among remaining 1,375 cases that were not matched, real missed cases through medical record review survey were found to be 104. The reasons of failure to notify were because of 'not tuberculosis patients' (500, 36.4%), 'notified in 2006' (421, 30.6%), 'diseases coding error' (341, 24.8%) and 'notified as other diseases' (9, 0.7%). Therefore, the corrected reporting rate was calculated at 93% (95% CI: 91.6% - 94.2%). Notably, reporting rate of clinics (58.1%) was significantly lower than those of hospitals (93.4%) or general hospitals (96.6%). CONCLUSIONS: All cases of tuberculosis diagnosis, which were claimed and not notified, were verified, the reporting rate was not as low as that of the data known through media. However, to reach the goal of tuberculosis elimination (reporting rate over 95%), more effort into improvement of the reporting system is necessary.
Clinical Coding ; Disease Notification ; Electronics ; Electrons ; Fees and Charges ; Hospitals, General ; Humans ; Insurance, Health ; Mandatory Reporting ; Medical Record Linkage ; Medical Records ; National Health Programs ; Private Sector ; Tuberculosis

OBJECTIVE: Intracranial pressure (ICP) is one of the critical parameter for the patients of severe traumatic brain injury (TBI) to determine the treatment modalities and predict clinical outcomes. Hence, the ICP monitoring with accuracy and safety is essential for the TBI patients. The purpose of this study is to compare its safety and clinical usefulness of intraventricular ICP monitoring method to the parenchymal type. METHODS: We retrospectively reviewed the medical records and imaging data of 18 severe TBI patients. We used intraventricular ICP monitoring in 10 patients and parenchymal 8 patients. We compared the clinical findings of the two type ICP monitoring methods including procedure time, neurological status, outcome, complications and mortality. RESULTS: The initial Glasgow Coma Scale of intraventricular ICP monitoring and parenchymal ICP monitoring patients were 5.8 (range: 4-7) and 6.5 (range: 3-7) respectively. The Glasgow Outcome Scale after 6 months was a little higher in intraventricular monitoring patients than parenchymal monitoring patients (2.8 vs. 2.0, p=0.25). We could not find any intraventricular catheter related complication in intraventricular ICP monitoring patients. There was no difference in mortality in both groups (p=0.56). CONCLUSION: Our results suggest that intraventricular catheter insertion for ICP monitoring is relatively a safe procedure in the severe TBI patients. We could not demonstrate the significant benefit of intraventricular type ICP monitoring compared with parenchymal type ICP monitoring. Considering intraventricular type ICP monitoring have advantages of the accuracy and extraventricular drainage, intraventricular type ICP monitoring could be considered for severe TBI patients, regardless of hydrocephalus.
Brain Injuries ; Catheters ; Drainage ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Humans ; Hydrocephalus ; Intracranial Pressure ; Medical Records ; Retrospective Studies

BACKGROUND: The purpose of this study was to compare clinical aspects of pelvic fractures in an aged group with a non-aged group and to delineate its characteristics to improve prevention and treatment. METHODS: Medical records and radiological examinations of 100 cases were reviewed. Two groups were created, older than 65 years and younger than 65 years. In addition, the following were carefully examined and recorded-gender distribution, cause and types of fractures, associated injuries, Injury Severity Score (ISS), Glasgow Coma Scale, need for intensive care unit admission, duration of hospitalization, and mortality rate. RESULTS: A difference in gender distribution was seen with 12 males and 26 females in the aged group and 35 males and 27 females in the non-aged group (p<0.05). The mechanism of injury for the aged group in decreasing order was pedstrian accidents, falls, and passenger accidents while it was passenger accidents, pedestrian accidents, and falls for the non-aged group (p<0.05). Level of severity was higher in the non-aged group for fracture type, ISS, Glasgow Coma Scale, intensive care unit admission, and hospitalization duration. However, when ISS was greater than 15, this was seen in the aged group with also a higher mortality rate in the same group. CONCLUSION: Education and prevention, particularly about gender distribution and mechanism of injury, of pelvic fractures in the aged population are needed, and because of the potential seriousness of fractures in the elderly, active assessment and treatment are also necessary.
Aged ; Female ; Glasgow Coma Scale ; Hospitalization ; Humans ; Injury Severity Score ; Intensive Care Units ; Male ; Medical Records ; Pelvic Bones