PURPOSE: Emergency resuscitative thoracotomy (ERT) is a final salvage procedure for critically injured trauma patients. Given its low success rate and ambiguous indications, its use in blunt trauma scenarios remains highly debated. Consequently, our study seeks to ascertain the overall survival rate of ERT in blunt trauma patients and determine which patients would benefit most from this procedure. METHODS: A retrospective case-control study was conducted for this research. Blunt trauma patients who underwent ERT between January 2020 and December 2023 in our trauma center were selected for analysis, with the endpoint outcome being in-hospital survival, divided into survival and non-survival groups. Inter-group comparisons were conducted using Chi-square and Fisher's exact tests, the Kruskal-Wallis test, Student's t-test, or the Mann-Whitney U test. Univariate and multivariate logistic regression analyses were conducted to assess potential predictors of survival. Then, the efficacy of the predictors was assessed through sensitivity and specificity analysis. RESULTS: A total of 33 patients were included in the study, with 4 survivors (12.12%). Multivariate logistic regression analysis indicated a significant association between cardiac tamponade and survival, with an adjusted odds ratio of 33.4 (95% CI: 1.31 - 850.00, p = 0.034). Additionally, an analysis of sensitivity and specificity, targeting cardiac tamponade as an indicator for survivor identification, showed a sensitivity rate of 75.0% and a specificity rate of 96.6%. CONCLUSION The survival rate among blunt trauma patients undergoing ERT exceeds traditional expectations, suggesting that select individuals with blunt trauma can significantly benefit from the procedure. Notably, those presenting with cardiac tamponade are identified as the subgroup most likely to derive substantial benefits from ERT.
Adult ; Female ; Humans ; Male ; Middle Aged ; Case-Control Studies ; China ; Logistic Models ; Resuscitation/mortality* ; Retrospective Studies ; Survival Rate ; Thoracotomy/methods* ; Trauma Centers/statistics & numerical data* ; Wounds, Nonpenetrating/surgery*

PURPOSE: To evaluate the relationship between the timing of thoracic endovascular aortic repair (TEVAR) for blunt thoracic aortic injury (BTAI) and prognosis. METHODS: This is a single-center retrospective cohort study. Patients who received TEVAR for BTAI at our institution from October 2016 to September 2023 were divided into 2 categories depending on the injury severity score (ISS) (≤ 25 vs. > 25) and when the TEVAR was performed for BTAI (within 24 h vs. after 24 h), respectively. The analysis included all patients who received TEVAR treatment after being diagnosed with BTAI through whole-body CT angiography. Patients treated with open repair and non-operative management were excluded. After propensity-score matching for various factors, outcomes during hospitalization and follow-up were compared. These factors included demographics, comorbidities, concomitant injuries, cause and location of aortic injury, Glasgow coma scale score, society for vascular surgery grading, hemoglobin concentration, creatinine concentration, shock, systolic blood pressure, and heart rate at admission. The comparison was conducted using SPSS 26 software. Continuous variables were presented as either the mean ± standard deviation or median (Q₁, Q₃), and were compared using either the t-test or the Mann-Whitney U test. Categorical variables were expressed as n (%), and comparisons were made between the 2 groups using the χ² test or Fisher's exact test. Statistical significance was defined as a 2-sided p < 0.05. RESULTS: In total, 110 patients were involved in the study, with 65 (59.1%) patients having ISS scores > 25 and 32 (29.1%) receiving immediate TEVAR. The perioperative overall mortality rate in the group with ISS > 25 was significantly higher than that in the group with ISS ≤ 25 (11 (16.9%) vs. 2 (4.4%), p < 0.001). Upon admission, the elective group exhibited a notably higher Glasgow coma scale score (median (Q₁, Q₃)) compared to the immediate group (15 (12, 15) vs. 13.5 (9, 15), p = 0.039), while the creatinine concentration (median (Q₁, Q₃)) at admission was significantly higher in the immediate group (90.5 (63.8, 144.0) vs. 71.5 (58.3, 80.8), p = 0.012). The final sample included 52 matched patients. Complications occurred significantly less frequently in the elective group compared to the immediate group (16 (50.0%) vs. 3 (10.0%), p < 0.001). Single-factor analysis of variance showed that complications in hospitalized patients were significantly associated with immediate TEVAR as the sole independent risk factor (odds ratio: 9.000, 95% confidence interval: 2.266-35.752, p = 0.002). CONCLUSION In this propensity-score matched analysis of patients undergoing TEVAR for BTAI, elective TEVAR was significantly associated with a lower risk of complication rates. In this study using propensity-score matching, patients who underwent elective TEVAR for BTAI had lower complication rates than immediate TEVAR.
Humans ; Retrospective Studies ; Male ; Aorta, Thoracic/surgery* ; Female ; Endovascular Procedures/methods* ; Wounds, Nonpenetrating/mortality* ; Middle Aged ; Adult ; Aged ; Injury Severity Score ; Elective Surgical Procedures ; Time Factors ; Treatment Outcome ; Endovascular Aneurysm Repair

In Korea, which still lacks a well-established trauma care system, the inability to transport patients to adequate treatment sites in a timely manner is a cause of low trauma patient survival. As such, this study was conducted to serve as a basis for the establishment of a future trauma transport system. We performed a comparative analysis of the transport time, and treatment outcomes between trauma victims transported by ground ambulance (GAMB) and those transported via the helicopter emergency medical service (HEMS) through the National Emergency Management Agency's 119 reporting system, which is similar to the 911 system of the United States, from March 2011 to May 2014. The HEMS-transported patients received treatment instructions, by remote communication, from our trauma specialists from the time of accident reporting; in certain instances, members of the trauma medical staff provided treatment at the scene. A total of 1,626 patients were included in the study; the GAMB and HEMS groups had 1,547 and 79 patients, respectively. The median transport time was different between 2 groups (HEMS, 60 min vs. GAMB, 47 min, P<0.001) but for all patients was 49 min (less than the golden hour). Outcomes were significantly better in the HEMS compared to the GAMB, using the trauma and injury severity score (survival rate, 94.9% vs. 90.5%; Z score, 2.83 vs. -1.96; W score, 6.7 vs. -0.8). A unified 119 service transport system, which includes helicopter transport, and the adoption of a trauma care system that allows active initial involvement of trauma medical personnel, could improve the treatment outcome of trauma patients.
Air Ambulances/*utilization ; Emergency Service, Hospital/*statistics & numerical data ; Female ; Humans ; Injury Severity Score ; Male ; Prognosis ; Republic of Korea ; Survival Rate ; Time Factors ; Trauma Centers ; Treatment Outcome ; Wounds, Nonpenetrating/*mortality/therapy ; Wounds, Penetrating/*mortality/therapy

In Korea, which still lacks a well-established trauma care system, the inability to transport patients to adequate treatment sites in a timely manner is a cause of low trauma patient survival. As such, this study was conducted to serve as a basis for the establishment of a future trauma transport system. We performed a comparative analysis of the transport time, and treatment outcomes between trauma victims transported by ground ambulance (GAMB) and those transported via the helicopter emergency medical service (HEMS) through the National Emergency Management Agency's 119 reporting system, which is similar to the 911 system of the United States, from March 2011 to May 2014. The HEMS-transported patients received treatment instructions, by remote communication, from our trauma specialists from the time of accident reporting; in certain instances, members of the trauma medical staff provided treatment at the scene. A total of 1,626 patients were included in the study; the GAMB and HEMS groups had 1,547 and 79 patients, respectively. The median transport time was different between 2 groups (HEMS, 60 min vs. GAMB, 47 min, P<0.001) but for all patients was 49 min (less than the golden hour). Outcomes were significantly better in the HEMS compared to the GAMB, using the trauma and injury severity score (survival rate, 94.9% vs. 90.5%; Z score, 2.83 vs. -1.96; W score, 6.7 vs. -0.8). A unified 119 service transport system, which includes helicopter transport, and the adoption of a trauma care system that allows active initial involvement of trauma medical personnel, could improve the treatment outcome of trauma patients.
Air Ambulances/*utilization ; Emergency Service, Hospital/*statistics & numerical data ; Female ; Humans ; Injury Severity Score ; Male ; Prognosis ; Republic of Korea ; Survival Rate ; Time Factors ; Trauma Centers ; Treatment Outcome ; Wounds, Nonpenetrating/*mortality/therapy ; Wounds, Penetrating/*mortality/therapy

OBJECTIVEToday, trauma is a major public health problem in some countries. Abdominal trauma is the source of significant mortality and morbidity with both blunt and penetrating injuries. We performed an epidemiological study of abdominal trauma (AT) in Tehran, Iran. We used all our sources to describe the epidemiology and outcome of patients with AT.

METHODSThis study was done in Tehran. The study population included trauma patients admitted to the emergency department of six general hospitals in Tehran during one year. The data were collected through a questionnaire that was completed by a trained physician at the trauma center. The statistical analysis was performed using the SPSS software (version 11.5 for Windows). The statistical analysis was conducted using the chi-square and P < 0.05 was accepted as being statistically significant.

RESULTSTwo hundred and twenty-eight (2.8%) out of 8,000 patients were referred to the above mentioned centers with abdominal trauma. One hundred and twenty-five (54.9%) of the patients were in their 2nd and 3rd decades of life and 189 (83%) of our patients were male. Road traffic accidents (RTA) were the leading cause of AT with 119 (52.2%) patients. Spleen was the commonly injured organ with 51 cases. Following the analysis of injury severity, 159 (69.7%) patients had mild injuries (ISS < 16) and 69 (30.3%) patients had severe injuries (ISS equal to 16). The overall mortality rate was 46 (20.2%).

CONCLUSIONSBlunt abdominal trauma is more common than penetrating abdominal trauma. Road traffic accidents and stab wound are the most common causes of blunt and penetrating trauma, respectively. Spleen is the most commonly injured organ in these patients. The mortality rate is higher in blunt trauma than penetrating one.

Abdominal Injuries ; epidemiology ; mortality ; therapy ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Female ; Hospitals ; Humans ; Iran ; epidemiology ; Male ; Middle Aged ; Trauma Severity Indices ; Wounds, Nonpenetrating ; epidemiology ; therapy

PURPOSE: Pulmonary contusion is the most common injury in patients with blunt chest trauma, and reported as 15~20% of multiple traumatic patients. In this study, we would like to predict a prognosis for pulmonary contusion easily at ED through the chest CT scanning. METHODS: We reviewed medical records and chest CT findings of 190 pulmonary contusion patients retrospectively. Both lung were devided into 4 areas, RUL +RML, RLL, LUL, and LLL (RUL: right upper lobe, RML:right middle lobe, LUL:left upper lobe, LLL: left lower lobe). 3 point were given to each area, maximally. In each area, a ratio was measured as the longest pulmonary contusion length per the transverse axis length of lung on the largest pulmonary contusion image of chest CT scan. The score can be obtained by multiplying 3 to the ratio and raising fractions not lower than 0.5 to a unit. We classified to three groups as mild (PCS 0-2), moderate (3-5), and severe (6-12) PCS groups. RESULTS: 179 patients with pulmonary contusion were classified as 94 mild, 52 moderate, 33 severe pulmonary contusion groups by PCS. As PCS was high, PRF (Pao2/ FiO2) was decreasing, number of patients treated with mechanical ventilation was increasing, ICU stay was long, and a complication rate was increasing. CONCLUSION: For patients with blunt chest trauma at ED which classified as severe PCS group (6-12), the patients need ICU admission and active treatment for a long time to reduce the mortality and complication rate.
Axis, Cervical Vertebra ; Contusions* ; Humans ; Lung ; Medical Records ; Mortality ; Prognosis ; Respiration, Artificial ; Retrospective Studies ; Thorax* ; Tomography, X-Ray Computed* ; Wounds, Nonpenetrating

In developed countries, several trauma scoring systems are used for victims. But we do not have an optimal method in Korea for evaluating our trauma patients effectively. The purpose of this study is to assess the usefulness of various trauma scoring systems based on the physiologic and anatomic state of the patient and based on time-related variables applicable to the trauma patients and to find a practical method to evaluate the patient's health status and to predict a prognosis. A prospective analysis of 135 consecutive multiple trauma patients admitted to the intensive care unit (ICU) through the emergency center between August 1995 and March 1996 was performed with respect to various trauma scoring systems and time-related and physiological variables (e.g., Glasgow Coma Scale (GCS), Trauma Score (TS), triage-Revised Trauma Score (t-RTS), Revised Trauma Score (RTS), Injury Severity Score (ISS), Probability of Survival by Trauma Score (Revised) Injury Severity Score (TRISS), hospital stay, ICU stay, prehospital time, systolic blood pressure (SBP), and respiration rate (RR)). The range of age was from 1 to 95 years, and most of the patients (66.7%) were between 10 and 49 years of age. The male to female ratio was 2.6 : 1. Blunt injuries (129 cases, 95.6%) were frequent in motor-vehicle-related injuries (74 cases, 54.8%). The overall mortality rate was 14.1%. GCS, TS, t-RTS, RTS, ISS and the probability of survival by TRISS showed a statistical significance between the surviving and the expired groups (p<0.01) and can be used for obtaining a prognosis. In conclusion, TS, t-RTS, RTS, GCS, ISS, and the probability of survival by TRISS have a predictive value for trauma patient's health status as well as for prognosis and mortality. Those mentioned trauma scoring systems should facilitate the development of management protocols to improve future care.
Blood Pressure ; Developed Countries ; Emergencies ; Female ; Glasgow Coma Scale ; Humans ; Injury Severity Score ; Intensive Care Units ; Korea ; Length of Stay ; Male ; Mortality ; Multiple Trauma ; Prognosis* ; Prospective Studies ; Respiratory Rate ; Wounds, Nonpenetrating

INTRODUCTION: There was increase in a fall injury at the field of construction work, nowadays. There was also increase in penetrating injury by an iron reinforcing bar associated with a fall or slip injury. But this is not widely discussed in the surgical literature. The purpose of this study was to define the characteristics of injury, diagnosis, treatment and prognosis of the penetrating injury by an iron reinforcing bar associated with a fall or slip injury. METHODS AND MATERIALS: We reviewed retrospectively medical records of 17 patients who admitted and managed at Yongdong Severance hospital, Yonsei university college of medicine due to penetrating injury by an iron reinforcing bar associated with a fall or slip injury from Nov. 1987 to Dec. 1996. RESULTS: The penetrating injuries by an iron reinforcing bar associated with a fall or slip injury were 5 cases of a slip injury and 12 cases of a fall injury. The insertion site of an iron reinforcing bar was perineum in all of a slip injury. In a fall injury, insertion site was flank and back in 5 cases, perineum 4 cases, chest 2 cases and abdomen 1 case. In a fall injury, 9 patients had two or more organ injuries. CT scan was taken in 3 cases, sigmoidoscopy 3 cases and fistulogram 1 case in a slip injury. CT scan was done in 5 cases, sigmoidoscopy 1 case, cystogram 2 cases and intravenous pyelogram 1 case in a fall injury. 2 cases was cured conservatively, and operation was done in 3 cases in a slip injury in contrast to 2 cases of conservative management and operation 10 cases in a fall injury. There was no negative celiotomy. Complication was only one wound infection in a slip injury. There were wound infection 6 cases, pulmonary complication 4 cases, sepsis 1 case, necrotizing fascitis 1 case, anal sphincter injury 1 case, intraabdominal abscess 1 case and neurogenic bladder 1 case in a fall injury. There was no mortality. CONCLUSION: The penetrating injuries by an iron reinforcing bar associated with a fall or slip injury had characteristics of both penetrating and blunt injury. The chest and abdominal penetrating injuries lead to multiple organ injury. In perineal penetrating injury, we should evaluate the injury of urinary bladder, rectum and genital organ.
Abdomen ; Abscess ; Anal Canal ; Diagnosis ; Fasciitis, Necrotizing ; Genitalia ; Humans ; Iron* ; Medical Records ; Mortality ; Perineum ; Prognosis ; Rectum ; Retrospective Studies ; Sepsis ; Sigmoidoscopy ; Thorax ; Tomography, X-Ray Computed ; Urinary Bladder ; Urinary Bladder, Neurogenic ; Wound Infection ; Wounds, Nonpenetrating

Due to its anatomical position and histological characteristics of thin capsule and low abundance of connective tissue, the spleen is a prime target for damage from blunt injury or during operation. Until recently, total splenectomy has been considered as safe operation for splenic injuries. But now, splenic salvage procedure or non operative treatment have become the standard care with knowledge for immunologic function of spleen, development of radiologic examination such as ultrasonography and abdominal CT, and report about high risk of mortality after splenectomy. Authors have experienced 27 patients with splenic injury admitted to the emergency department during 5 years 4 months period from 1991 to 1996. Among them, 10 patients were received total splenectomy, 2 patients partial splenectomy, 8 patients splenorrhaphy, one patients hemostasis, and 6 patients underwent nonoperative management.
Connective Tissue ; Emergency Service, Hospital ; Hemostasis ; Humans ; Mortality ; Spleen ; Splenectomy ; Tomography, X-Ray Computed ; Ultrasonography ; Wounds, Nonpenetrating

The records of 70 patients who underwent curative operation for traumatized patients with either blunt or penetrating colorectal wounds, treated between january, 1987 and december, 1996 were retrospectively reviewed. A majority of the injuries were about to blunt injuries 50 cases(71.4%) from traffic accident 41 cases(58.6%), falling down 2 cases(2.9%). Injuries occured most commonly at the transverse colon and rectum in 22 case followed by sigmoid colon in 17 case. Associated intraabdominal injuries were frequent 51 cases(72.9%). Among the associated intra abdominal injury, small bowel was the most frequent site in 21 cases(30%) followed by spleen in 7 cases(10%), pancreas in 4 cases(5.7%) and major vessel in 4 case(5.7%). By operative procedure, primary closure of colon and rectum were 14 cases(20%), resection and anastomosis was 12 case(17.1%), primary closure with proximal diversion or end colostomy were 29 cases(41.4%). The complication rate was 59 case(84.2%) and the major complications were as follows wound infection 18 cases(30.5%), intraabdominal abscess 8 case(13.5%), pulmonary complication 7 cases(11.8%), enterocutaneous fistula 4 case(6.7%). Overall mortality were 11 case(15.7%) and mostly blunt and severe multiple trauma cases. The cause of death were MOF, sepsis and hypovolemia. This review covers the past 10 years acculmulation of colorectal injury management, morbidity and mortality.
Abdominal Injuries ; Abscess ; Accidents, Traffic ; Cause of Death ; Colon* ; Colon, Sigmoid ; Colon, Transverse ; Colostomy ; Humans ; Hypovolemia ; Intestinal Fistula ; Mortality ; Multiple Trauma ; Pancreas ; Rectum* ; Retrospective Studies ; Sepsis ; Spleen ; Surgical Procedures, Operative ; Wound Infection ; Wounds and Injuries ; Wounds, Nonpenetrating