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The Clinical Usefulness of Halo Sign on CT Image of Trauma Patients.

Seung Yong LEE ; You Dong SOHN ; Hee Cheol AHN ; Gu Hyun KANG ; Jung Tae CHOI ; Moo Eob AHN ; Jeong Youl SEO

Journal of the Korean Society of Traumatology.2007;20(2):144-148.

PURPOSE: The management of hemorrhagic shock is critical for trauma patients. To assess hemorrhagic shock, the clinician commonly uses a change in positional blood pressure, the shock index, an estimate of the diameter of inferior vena cava based on sonography, and an evaluation of hypoperfusion complex shown on a CT scan. To add the finding for the hypoperfusion complex, the 'halo sign' was introduced recently. To our knowledge, this 'halo sign' has not been evaluated for its clinical usefulness, so we designed this study to evaluate its usefulness and to find the useful CT signs for hypoperfusion complex. METHODS: The study was done from January 2007 to May 2007. All medical records and CT images of 124 patients with trauma were reviewed, of which 103 patients were included. Exclusion criteria was as follows: 1) age < 15 year old and 2) head trauma score of AIS > or = 5. RESULTS: The value of kappa, to assess the inter-observer agreement, was 0.51 (p < 0.001). The variables of the halo-sign-positive group were statistically different from those of the halo-sign-negative group. The rate of transfusion for the halo-sign-positive group was about 10 times higher than that of the halo-sign-negative group and the rate of mortality was about 6 times higher. CONCLUSION: In the setting of trauma, early abdominal CT can show diffuse abnormalities due to hypoperfusion complex. Recognition of these signs is important in order to prevent an unwanted outcome in hemorrhagic shock. We conclude that the halo sign is a useful one for hypoperfusion complex and that it is useful for assessing the degree of hemorrhagic shock.
Adolescent ; Blood Pressure ; Craniocerebral Trauma ; Humans ; Medical Records ; Mortality ; Shock ; Shock, Hemorrhagic ; Tomography, X-Ray Computed ; Vena Cava, Inferior

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Dental Prosthesis Causing Pneumonia in a Delirious Elderly Patient after Hip Fracture Surgery.

Young Kyun LEE ; Yong Chan HA ; Kyung Hoi KOO

Journal of the Korean Society of Traumatology.2012;25(3):97-100.

We report a case of delayed diagnosed pneumonia due to an aspirated metallic crown, which had been detached from a molar tooth. Dental prosthesis should be checked and a careful review of the chest radiograph is mandatory when an elderly patient with delirium after hip fracture surgery develops pneumonia postoperatively.
Aged ; Crowns ; Delayed Diagnosis ; Delirium ; Dental Prosthesis ; Hip ; Humans ; Molar ; Pneumonia ; Thorax ; Tooth

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Duodenal Injury after Blunt Abdominal Trauma: Report of Two Cases.

Ki Hoon KIM

Journal of the Korean Society of Traumatology.2012;25(3):94-96.

Duodenal injuries following a blunt or penetrating trauma are uncommon and account for just 3% to 5% of all abdominal injuries. About 22% of all duodenal injuries are caused by blunt trauma. An overlooked injury or delayed diagnosis of duodenal injury may lead to increased mortality and morbidity. We report two cases of a duodenal injury following blunt abdominal trauma.
Abdominal Injuries ; Delayed Diagnosis

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Closed Digital Reduction of Posttraumatic Lung Hernia.

Ki Sung PARK

Journal of the Korean Society of Traumatology.2012;25(3):91-93.

Postraumatic lung hernia is a rare occurrence. A number of cases reported in the literature have been treated with early thoracotomy to repair partial protruded lung and pleura to prevent strangulation and incarceration. We present a case of a 45-year-old patient of left posttrumatic lung hernia, in which closed digital reduction was successful. The strategy of the management approach could be established by further accumulated experience.
Hernia ; Humans ; Lung ; Middle Aged ; Pleura ; Thoracotomy

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Right Diaphragmatic Rupture after Blunt Trauma: Case Report.

Ki Hoon KIM ; Jin Su KIM ; Sung Jin PARK ; Woon Won KIM ; Do Kyun KANG ; Ho Gi MIN ; Yong Han KIM ; Cheol Gyu O

Journal of the Korean Society of Traumatology.2012;25(3):87-90.

Blunt diaphragmatic rupture (BDR) is a relatively rare injury and occurs in 0.8% to 7% of all thorocoabdominal blunt trauma. Especially right diaphragmatic rupture after blunt abdominal trauma is a rarer than left. The diagnosis of BDR can be missed while evaluating the multiple trauma patient. Other severe injuries may mask BDR during the primary resuscitation and survey. We experienced two cases of traumatic rupture of right diaphragm, one diagnosed immediately and the other diagnosed delayed. In this paper we present two cases of traumatic diaphragmatic rupture.
Diaphragm ; Humans ; Masks ; Multiple Trauma ; Resuscitation ; Rupture

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Predictive Factors for Mortality among Adult Trauma Victims Transfused in an Emergency Department.

Kyung Won LEE

Journal of the Korean Society of Traumatology.2012;25(3):79-86.

PURPOSE: The most common cuase of transfusion for trauma victims in an emergency department is hypovolemic shock due to injury. After an injury to an internal organ of the chest or the abdomen, transfusion is needed to supply blood products and to compensate tissue oxygen transport and bleeding. From the 1990's, there have been some reports that transfusion is one of the major factors causing multiple-organ failure. Thus, as much as possible, tranfusion has been minimized in the clinical setting. This study aims to analyze the prognostic factors for mortality among trauma victims transfused with blood products in an emergency department. METHODS: We conducted this study for the year of 2010 retrospectively. The study group included adult trauma victims tranfused with blood products in our ED. The exclusion criteria were discharge against medical advice, and missing follow-up due to transfer to another facility. During the study period, 34 adult trauma victims were enrolled. We compared the clinical variables between survivors and non-survivors. RESULTS: The mean age of the 34 victims was 58.06 years, and males account for 58.5% of the study group. The most-frequently used form transportation was ambulance(119, 55.9%), and the most common injury mechanism was mobile vehicle accidents(67.6%). The mean revised trauma score (RTS) was 5.9, and the mean injury severity score (ISS) was 47.76. The mortality rate in the ED was 58.5%, Comparison of survivors with non-survivors showed statistical differences in injury mechanism, initial SBP, DBP, RTS, ISS, and some laboratory data such as AST, ALT, pH, PO2, HCO3, glucose (p<0.05). Regression analyses showed that mortality among adult trauma victims transfused in the ED correlated with RTS. CONCLUSION: When an adult trauma victim is transported to the ED and needs a tranfusion, the emergency physician carefully assess the victim by using physiologic data.
Abdomen ; Adult ; Emergencies ; Follow-Up Studies ; Glucose ; Hemorrhage ; Humans ; Hydrogen-Ion Concentration ; Injury Severity Score ; Male ; Oxygen ; Retrospective Studies ; Shock ; Survivors ; Thorax ; Transportation

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Acute Traumatic Coagulopathy in Severe Trauma Patients.

Dong Eun LEE ; Kang Suk SEO ; Mi Jin LEE ; Su Jeong SHIN ; Hyun Wook RYOO ; Jong Kun KIM ; Jung Bae PARK

Journal of the Korean Society of Traumatology.2012;25(3):72-78.

PURPOSE: Clinical observation and research findings show that acute traumatic coagulopathy (ATC) is a major factor that must be addressed in the early care of severe trauma patients. ATC is associated with increased transfusion requirements and poor clinical outcomes. This study aimed to correlate the early predictable factors of ATC with the outcomes in severe trauma patients. METHODS: Retrospective data from the trauma registry on severe trauma patients (Injury Severity Score (ISS)> or =16) were used to identify variables independently associated with coagulopathy. Univariate associations were calculated, and a multivariable logistic regression analysis was used to determine variables independently associated with ATC. RESULTS: Patients were mostly male, aged 51.9+/-17.8 years, with an injury severity score of 24.1+/-12.4. ATC, as diagnosed in the emergency department (ED), occurred in 17% of the severe trauma patients. Using a multivariable logistic regression analysis, early predictable variables independently associated with ATC were base deficit (odds ratio (OR): 13.03; 95% confidence interval (CI): 3.47-48.93), acute liver injury (OR: 4.24; 95% CI: 1.06-17.00), and transfer from another hospital (OR: 21.00; 95% CI: 3.23-136.60). CONCLUSION: ATC is associated with mortality in severe trauma patients, and some variables associated with trauma and shock are an independent predictors of ATC. These variables contribute to the early recognition and management of coagulopathy, which may improve the outcome from trauma resuscitation.
Aged ; Emergencies ; Humans ; Injury Severity Score ; Liver ; Logistic Models ; Male ; Resuscitation ; Retrospective Studies ; Shock

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FAST Reappraisal: Cross-sectional Study.

Sang Hyun HA ; Chong Kun HONG ; Jun Ho LEE ; Seong Youn HWANG ; Seong Hee CHOI

Journal of the Korean Society of Traumatology.2012;25(3):67-71.

PURPOSE: Focused Assessment with Sonography for Trauma (FAST) provides an important initial screening examination in adult trauma patients. However, due to its low sensitivity, FAST is not a replacement for computed tomography (CT) in hemodynamically stable trauma patients. The aim of this study was to determine the test characteristics of FAST in adult, hemodynamically stable, blunt abdominal trauma patients by using a critical action as a reference standard. METHODS: The medical records for FAST examination at a single hospital from January 2009 to February 2011 were retrospectively reviewed. The inclusion criterion was isolated, hemodynamically stable, blunt abdominal trauma. Hemodynamically unstable patients or patients with penetrating injuries were excluded. The reference standard was the presence of a critical action, which was defined as one of the following: 1) operative intervention for a finding discovered on CT, 2) interventional radiology for bleeding, 3) transfusion of 2 or more packed RBCs, or 4) death at the emergency department. RESULTS: There were 230 patients who met the inclusion criterion. There were 20 true positive, 206 true negative, 0 false positive, and 4 false negative results. The sensitivity and the specificity were 83% and 100%, respectively. CONCLUSION: Despite its low sensitivity for detecting any abnormal finding discovered on CT, negative FAST could aid to exclude critical action in hemodynamically stable, blunt abdominal trauma patients.
Abdominal Injuries ; Adult ; Cross-Sectional Studies ; Emergencies ; Hemorrhage ; Humans ; Mass Screening ; Medical Records ; Radiology, Interventional ; Retrospective Studies ; Sensitivity and Specificity ; Wounds, Nonpenetrating

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The Result of Open Reduction and Fixation in Sternal Fracture with Displacement.

Young Jin KIM ; Hyun Min CHO

Journal of the Korean Society of Traumatology.2010;23(2):175-179.

PURPOSE: Sternal fractures after blunt thoracic trauma can cause significant pain and disability. They are relatively uncommon as a result of direct trauma to the sternum and open reduction is reserved for those with debilitating pain and fracture displacement. We reviewed consecutive 11 cases of open reduction and fixation of sternum and tried to find standard approach to the traumatic sternal fractures with severe displacement. METHODS: From December 2008 to August 2010, the medical records of 11 patients who underwent surgical reduction and fixation of sternum for sternal fractures with severe displacement were reviewed. We investigated patients' characteristics, chest trauma, associated other injuries, type of open reduction and fixation, combined operations, preoerative ventilator support and postoperative complications. RESULTS: The mean patient age was 59.3years (range, 41~79). The group comprised 6 male and 5 female subjects. Among 11 patients who underwent open reduction and fixation for sternal fracture with severe displacement, 6 cases had isolated sternal fractures and the other 5 patients had associated other injuries. Sternal fractures were caused by car accidents (9/11, 81.8%), falling down (1/11, 9.1%) and direct blunt trauma to the sternum (1/11, 9.1%), respectively. 3 of the 7 patients (42.9%) who underwent sternal plating with longitudinal plates showed loosening of fixation. Otherwise, none of the 4 patients who underwent surgical fixation using T-shaped plate had stable alignment of the fracture. CONCLUSION: Sternal fractures with severe displacement need to be repaired to prevent chronic pain, instability of the anterior chest wall, deformity of the sternum, and even kyphosis. In the present study, a T-shaped plate with a compression-tension mechanism constitutes the treatment of choice for displaced sternal fractures.
Chronic Pain ; Congenital Abnormalities ; Displacement (Psychology) ; Female ; Humans ; Kyphosis ; Male ; Medical Records ; Sternum ; Thoracic Wall ; Thorax ; Ventilators, Mechanical

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Clinical Feasibility of Video-assisted Thoracic Surgery for Thoracic Trauma.

Do Kyun KANG ; Hyeong Ryul KIM ; Yong Hee KIM ; Dong Kwan KIM ; Seung Il PARK

Journal of the Korean Society of Traumatology.2010;23(2):170-174.

PURPOSE: As techniques and instruments for video-assisted thoracic surgery (VATS) have been evolving, attempts to perform VATS for chest trauma have been increasing. Several studies have demonstrated the feasibility and safety of VATS for thoracic trauma. We reviewed our experience to evaluate the clinical feasibility and safety of VATS for thoracic trauma. METHODS: Fifty-two patients underwent thoracic surgery for chest trauma in Asan Medical Center from January 1990 to December 2009. VATS was performed in 21 patients who showed stable vital signs. We reviewed retrospectively the medical records of those patients to investigate the results of VATS for thoracic trauma. RESULTS: Thoracic exploration for chest trauma was performed in 52 patients. There were 46 males (88.5%) and 6 females (11.5%). The median age was 46.0 years (range: 11~81 years). There were 39 blunt and 13 penetrating traumas. A standard posterolateral thoracotomy was performed in 31 patients, and VATS was tried in 21 patients. We performed successful VATS in 13 patients; 11 males (84.5%) and 2 females (15.5%) with a median age of 46.0 years (range: 24~75 years). The indication of VATS was persistent intrathoracic hemorrhage in 10 patients and clotted hemothorax in 3 patients. There were no complications, but there were two mortalities due to multiple organ failure after massive transfusion. In 8 patients, VATS was converted to a standard posterolateral thoracotomy for several reasons. The reason was inadequate visualization for bleeding control or evacuation of the hematoma in 5 patients. In 3 patients, VATS was performed to evaluate diaphragmatic injury. After the diaphragmatic injury had been confirmed, a standard posterolateral thoracotomy was performed to repair the diaphragm. CONCLUSION: VATS should be safe and efficient method for diagnostic evaluation and surgical management of stable patients with thoracic trauma.
Female ; Hematoma ; Hemorrhage ; Hemothorax ; Humans ; Male ; Medical Records ; Multiple Organ Failure ; Retrospective Studies ; Thoracic Surgery ; Thoracic Surgery, Video-Assisted ; Thoracotomy ; Thorax ; Vital Signs

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