Journal of Acute Care Surgery

Trauma, System

Role of Trauma Surgeons at a Regional Trauma Center in South Korea: Dongmin Seo, Inhae Heo, Hohyung Jung, Kyoungwon Jung; J Acute Care Surg 2024;14(3):94-101. Published online November 21, 2024; DOI: https://doi.org/10.17479/jacs.2024.14.3.94

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Purpose
Treatment at a dedicated trauma center significantly reduces the mortality rate after trauma. High-quality trauma care requires well-established systems. Moreover, the presence of an on-site trauma surgeon during resuscitation improves outcomes. Although the trauma system history, including trauma centers in South Korea, is relatively short, it has developed rapidly, and trauma surgeons’ roles have also been established. This study aimed to show clinical performance, particularly in trauma surgery, and the outcomes of a regional trauma center serving as a Level 1 trauma center in South Korea.
Methods
Using the Korean Trauma Data Bank, data collected at Ajou University Hospital Trauma Center between January 2020 and December 2022 was retrospectively analyzed. Patients’ demographic characteristics, mechanisms of injuries, trauma surgery types, and outcomes were evaluated.
Results
There were 9,205 patients admitted with trauma, of whom 1,149 underwent trauma surgery (including laparotomy, thoracotomy, pelvic packing, neck surgery, and peripheral vascular surgery). A total of 1,787 trauma surgeries were performed, and the mean time to surgery for hypotensive patients with hemorrhagic shock from arrival was approximately 50 minutes. Damage control surgery including laparotomy, thoracotomy, and pelvic packing accounted for 12% of cases. It was determined that the mortality rate (excluding death on arrival) was less than 5%, and the length of hospital stay decreased over the study period.
Conclusion
Clinical performance, particularly in trauma surgery, conducted by dedicated trauma surgeons, has led to favorable clinical outcomes at a regional trauma center in South Korea.

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Trauma, Basic

Tranexamic Acid in Trauma Management: A Review of Evidence: Namryeol Kim; J Acute Care Surg 2023;13(3):85-94. Published online November 23, 2023; DOI: https://doi.org/10.17479/jacs.2023.13.3.85

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Hemorrhage is the leading cause of death in trauma patients and trauma induced coagulopathy (TIC) is a major contributor to bleeding mortality. TIC has a diverse pathophysiology triggered by injury and hypoperfusion, including platelet dysfunction, endotheliopathy, fibrinogen or thrombin abnormalities, and dysregulated fibrinolysis. Early fluid resuscitation, appropriate blood transfusion, and definitive control of bleeding are essential components of initial management for TIC. Additionally, tranexamic acid (TXA), an antifibrinolytic agent, has emerged as a potential adjunctive therapy following the 2010 landmark trial that demonstrated the benefit of early administration of TXA in reducing trauma patient mortality (CRASH-2). This review provides an analysis of the current literature on the use of TXA in trauma patients. It critically evaluates the evidence on the effect of TXA on TIC and other clinical outcomes, emphasizing the time-sensitive nature of TXA administration and the variation of its effect depending on the severity and location of injury. It also discusses the optimal dosage, timing, and safety of TXA, as well as the challenges and limitations of existing studies. Furthermore, it highlights the importance of individualized treatment approaches based on the fibrinolysis status of TIC and the value of goal-directed therapy guided by viscoelastic hemostatic assays for the appropriate use of TXA.

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Pharmacokinetics of Tranexamic Acid (TXA) Delivered by Expeditious Routes in a Swine Model of Polytrauma and Hemorrhagic Shock
Mallori Wilson, Sean Stuart, Brittany Lassiter, Timothy Parker, Clyde Martin, Robert Healy, Christopher Treager, Eric Sulava, Lorie Gower, Pravina Fernandez, Emily Friedrich
Prehospital Emergency Care.2024; 28(5): 680. CrossRef

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Trauma, Organ(liver, bowel, kideny etc.)

Small Hepatic Hemangioma Leading to Life-Threatening Bleeding Following Blunt Abdominal Trauma: A Case Report: Rumi Nakabayashi, Yosuke Miyachi, Minami Torai, Koichiro Mitsuoka, Gen Shimada, Toshimi Kaido; J Acute Care Surg 2023;13(3):134-137. Published online November 23, 2023; DOI: https://doi.org/10.17479/jacs.2023.13.3.134

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A male pedestrian in his 30’s was hit by a car and immediately taken to hospital by ambulance. On arrival, his blood pressure was 83/64 mmHg and his heart rate was 140 beats/min. Computed tomography showed extravasation of contrast medium from the lateral segment of the liver. Given the exacerbation caused by hypotension, an emergency laparotomy was performed. Temporary hemostasis was achieved by packing with gauze and a subsequent transcatheter arterial embolization. At the 2^nd laparotomy, a small amount of active bleeding from the injury site was noted; therefore, an emergency lateral segmentectomy was performed. The postoperative course was uneventful and he was discharged home 8 days later. The pathology of the liver specimen revealed that a 2.5 cm hepatic hemangioma was the cause of bleeding. Traumatic rupture of hepatic hemangiomas is rare, and most reported cases are of giant hemangiomas. Our case demonstrated that even a small hemangioma can elicit life-threatening bleeding in blunt abdominal trauma.

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Critical care

Tissue Perfusion and the Braden Scale as Predictors of Pressure Injury Risk in the Intensive Care Unit Patient: Eileen Wong, Shirley Visperas, So Yung Choi, Mahealani Suapaia; J Acute Care Surg 2023;13(3):112-117. Published online November 23, 2023; DOI: https://doi.org/10.17479/jacs.2023.13.3.112

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Purpose
The national rate of pressure injury (PI) in the intensive care unit (ICU) 2016-2018 was 5.97%, while at one hospital in Honolulu, Hawaii it averaged 13%. The Braden scale is the gold standard PI risk assessment tool. Researchers have reported the Braden scale has limited value in the ICU setting and consider tissue perfusion to be the better indicator. The aim was to determine if tissue perfusion, as measured by noninvasive transcutaneous tissue oxygen levels, was a predictor of PI risk development.
Methods
Electronic medical records of 161 patients admitted from January 1, 2017 to June 30, 2019 were retrospectively reviewed. Patients’ characteristics were summarized using descriptive statistics. Bivariate associations with the development of PI were examined using Fisher’s exact test for the categorical variables, and Wilcoxon rank-sum test for the continuous variables. A multivariable logistic model was fitted for the development of PI with adjustments for potential confounders.
Results
Of 161 patients, 125 met the inclusion criteria. Length of stay, Acute Physiology and Chronic Health Evaluation II score, use of vasopressors, and the Braden score were statistically significant predictors of PI risk development; tissue perfusion was not significant.
Conclusion
ICU patients have a higher mortality and severity of illness. The Braden score guides implementation of PI preventative measures. The relationship between tissue perfusion and PI development may warrant further research. A broader clinical picture to incorporate the Braden scale and other risk factors in PI development such as Acute Physiology and Chronic Health Evaluation II score and use of vasopressors should be considered.

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Trauma

Submandibular Injury Caused by the Close-Range Firing of a Military Blank Cartridge Shot: Hyo Jin Kim, Donghyoun Lee, Kyungwon Lee; J Acute Care Surg 2023;13(1):35-38. Published online March 21, 2023; DOI: https://doi.org/10.17479/jacs.2023.13.1.35

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Few studies have reported injuries caused by a blank cartridge shot (BCS) into the head and neck. We experienced a case of minor injury resulting from BCS (despite the close proximity). The patient was a 20-year-old male soldier who attempted suicide by firing a BCS from a K2 rifle into his mouth. He suffered from skin and soft tissue defect in the submandibular area with burns and minimal bleeding. A computed tomography scan showed subcutaneous emphysema which was suspected to be related to the projectile gas released during the firing of the BCS, and a tiny fragment without hematoma or structure injuries. We closely observed the clinical features including the occurrence of infection and functional abnormalities. The subcutaneous emphysema faded away along with the soft tissue defect. After wound management was completed on the 13^th hospital day, the patient was transferred to the Department of Psychiatry without any problems.

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Injuries from blank cartridge shots in suicide attempts within the South Korean military: a case series of five patients
Jeong Il Joo, Changsin Lee, Kyungwon Lee
Journal of Trauma and Injury.2024; 37(4): 262. CrossRef
One year of treating patients with open fractures of the lower extremity in a new military trauma center in Korea: a case series
Ji Wool Ko, Giho Moon, Jin Geun Kwon, Kyoung Eun Kim, Hankaram Jeon, Kyungwon Lee
Journal of Trauma and Injury.2023; 36(4): 376. CrossRef

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Trauma

Uncommon Mechanism of Mangled Extremity; Three Cases of Rope Entanglement Injury of the Lower Leg: Minsu Noh, Kyu-Hyouck Kyoung, Sungjeep Kim, Min Ae Keum, Seongho Choi, Kyounghak Choi, Jihoon Kim; J Acute Care Surg 2023;13(1):27-31. Published online March 21, 2023; DOI: https://doi.org/10.17479/jacs.2023.13.1.27

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Rope entanglement injury is a rare entity. Previous reported studies mainly consisted of finger-related injuries. We describe three cases of rope entanglement injury of the lower leg. In the first patient, a belowthe- knee amputation was performed as the primary treatment for unilateral amputated lower limb. In the second patient, a below-the-knee amputation and perineal wound management were simultaneously performed. The third patient had vascular injury combined with internal soft tissue injury without related bone fracture. He suffered serious sequelae from a delay in transfer from a local hospital. Rope entanglement injuries of the lower leg do not present in a consistent manner, and the treatment of accompanying injuries should be considered from an early stage. Care should be taken to ensure that there are no internal injuries missed because the exterior appears to be stable.

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Trauma, Organ(liver, bowel, kideny etc.)

Management of Adult Blunt Renal Injury: A 10-Year Retrospective Review at a Single Institution: Jin Soo Kim, Ki Hoon Kim, Se Hun Kim; J Acute Care Surg 2023;13(1):21-26. Published online March 21, 2023; DOI: https://doi.org/10.17479/jacs.2023.13.1.21

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Purpose
Renal injury occurs in up to 5% of trauma cases and the kidney is the third most wounded abdominal organ. The study objective was to analyze clinical characteristics of patients with blunt renal trauma and review the treatment of high-grade blunt renal injuries.
Methods
The medical charts of trauma patients who visited Haeundae Paik Hospital between March 2010 and February 2020 were retrospectively analyzed. Data on demographics, injury patterns, clinical presentation, management, and outcomes were analyzed.
Results
A total of 68 patients with renal trauma were included in this study. The most common renal injury was Grade III (n = 27, 39.7%). Falling was the predominant mechanism of injury (n = 33, 48.5%), and 23.5% (n = 16) of patients sustained isolated renal trauma. Organ damage related to kidney injury included chest injury (57.4%, n = 39) and abdominal or pelvic content injury (48.5%, n = 33). The overall mortality rate was 2.9% (n = 2). There were 45 cases of high-grade renal trauma (AAST Kidney injury scale Grade Ш-V). There was no statistical difference in the outcomes of high-grade (n = 44, 97.8%) and low-grade (n = 23, 100%) renal trauma patients who received nonoperative treatment (p = 0.511). Variables did not differ significantly, except for the injury severity score which was statistically significantly different between low-grade and high-grade renal trauma patients (p = 0.001).
Conclusion
Most patients with traumatic renal injury, even those with high-grade injury, can be managed by nonoperative treatment, and have a good prognosis.

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Management and Outcomes of Blunt Renal Trauma: A Retrospective Analysis from a High-Volume Urban Emergency Department
Bruno Cirillo, Giulia Duranti, Roberto Cirocchi, Francesca Comotti, Martina Zambon, Paolo Sapienza, Matteo Matteucci, Andrea Mingoli, Sara Giovampietro, Gioia Brachini
Journal of Clinical Medicine.2025; 14(15): 5288. CrossRef

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Trauma

Characteristics and Clinical Outcomes of Elderly Patients with Trauma Treated in a Local Trauma Center: Kwanhoon Park, Geonjae Cho, Sungho Lee, Kang Yoon Lee, Ji Young Jang; J Acute Care Surg 2023;13(1):13-20. Published online March 21, 2023; DOI: https://doi.org/10.17479/jacs.2023.13.1.13

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Purpose
This study aimed to investigate the characteristics of elderly patients who visited a non-regional trauma center to examine the effects of old age on the clinical outcomes of patients.
Methods
The medical charts of 159 patients with trauma who visited the National Health Insurance Service Ilsan Hospital between March 2020 and February 2022 were retrospectively analyzed.
Results
Of the 159 patients, 41 were assigned to the elderly patient group (EPG) and 118 were assigned to the non-elderly patient group (NEPG). The average age of patients in each group was 75.5 and 38.2 years in the EPG and the NEPG, respectively. Comparing the injury mechanism between the two groups, pedestrian traffic accidents (TA) were the most common (24.4%), followed by slipping (19.5%), motorcycle TA, and bicycle TA (14.6%) in EPG. In the NEPG, motorcycle TA (28.0%) was the most common, followed by car TA (27.1%), and fall injury (16.9%), with a significant difference between the two groups (p < 0.001). The significant differences between the two groups were the injury severity score (ISS; p = 0.004), severe trauma (p = 0.045), intensive care unit admission (p = 0.028), emergency operation (p = 0.034), and mortality (p = 0.013). The statistically significant risk factors for mortality were old age (p = 0.024) and chest injury (p = 0.013).
Conclusion
Patients in the EPG compared with the NEPG group showed different injury mechanisms. The EPG has a higher severity and mortality rate than the NEPG.

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The road less recovered: Examining the effect of trauma on frailty trajectories in older patients
Jessica Falon, Priyadharshani Samarasinghe, James Elhindi, Urna Rahman, Aswin Shanmugalingam, Isabella Zappala, Jeremy Hsu
Journal of Trauma and Acute Care Surgery.2025;[Epub] CrossRef

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Basic, Organ(liver, bowel, kideny etc.)

Rouviere’s Sulcus: A Guide to Safe Laparoscopic Cholecystectomy: Reetesh Pathak, Lakshya Mittal, Ghaus Mohd Chouhan, Apoorva Tripathi; J Acute Care Surg 2023;13(1):10-12. Published online March 21, 2023; DOI: https://doi.org/10.17479/jacs.2023.13.1.10

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Purpose
Rouviere’s sulcus (RS) serves as an important anatomical landmark to avoid bile duct injuries during a laparoscopic cholecystectomy. However, there is significant paucity in literature regarding its surgical importance during laparoscopic surgeries. The aim of this study was to identify cases where RS was identified before dissection of the Calot’s triangle.
Methods
For this retrospective observational study, 500 patients who underwent a laparoscopic cholecystectomy at our hospital and who were operated on between September 2017 to August 2022 were reviewed. Identification of RS and its types were analyzed.
Results
Among all 500 cases, RS was present in 465 (93%) cases whereas it was absent in only 35 (7%) cases. RS was present in different forms of cholelithiasis. Open, closed, slit like, and scar type of RS was found in 75.29%, 12.90%, 3.21%, and 8.20%, respectively. Identification of RS along with achieving a critical view of safety in antero-superior direction to RS resulted in no injury to the bile duct in all 465 cases.
Conclusion
Identification of RS along with achieving a critical view of safety should be the aim in all laparoscopic cholecystectomy procedures. The RS is as an important landmark to reduce biliary tract injuries.

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Trauma, Organ(liver, bowel, kideny etc.)

Spleen-Preserving Distal Pancreatectomy for Blunt Pancreatic Trauma in a Pediatric Patient: Gil Hwan Kim, Jae Hun Kim, Sun Hyun Kim; J Acute Care Surg 2022;12(3):142-144. Published online November 23, 2022; DOI: https://doi.org/10.17479/jacs.2022.12.3.142; Correction in: J Acute Care Surg 2023;13(2):83

Abstract
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Pancreatic injury is rare in pediatric cases of blunt abdominal trauma and nonoperative management is preferred in pediatric patients. There are more concerns about operative treatment observed in pediatric patients compared with adult patients. However, some pediatric cases require surgical treatment. If distal pancreatectomy is performed, the necessity of splenectomy should be considered, especially in pediatric patients. This study reports the case of a 17-month-old patient with a Grade 3 pancreatic injury following blunt abdominal trauma. The patient was successfully managed by spleen-preserving distal pancreatectomy. In conclusion, this surgical technique can be performed safely, and complications caused by splenectomy can be prevented using this technique.

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Trauma, Organ(liver, bowel, kideny etc.)

Determination of Risk Factors for Predicting Bladder-Urethra Injury in Cases of Pelvic Bone Fracture: A Retrospective Single Center Study: Ji Wool Ko, Myoung Jun Kim, Young Un Choi, Hongjin Shim, Hoejeong Chung, Ji Young Jang, Keum Seok Bae, Kwangmin Kim; J Acute Care Surg 2022;12(2):63-69. Published online July 22, 2022; DOI: https://doi.org/10.17479/jacs.2022.12.2.63

Abstract
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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 (N = 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%; p = 0.026), had a urine RBC count/high power field (HPF) ≥ 30 (94.4% vs. 38.8%; p < 0.001), underwent preperitoneal pelvic packing (37.5% vs. 18.6%; p = 0.035), had symphysis pubis diastasis (33.3% vs. 11.7%; p = 0.008), and had sacroiliac joint dislocation (54.2% vs. 23.4%; p = 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); p = 0.025] and a urine RBC count/HPF ≥ 30 [OR = 25.415 (95% confidence interval: 3.252–198.637); p = 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.

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Nutrition

Visualizing Frailty: Exploring Radiographical Measures of Frailty in Trauma Patients: Omolola Fakunle, Meet Patel, Victoria G. Kravets, Adam Singer, Robert Hernandez-Irizarry, Mara L. Schenker; J Acute Care Surg 2021;11(3):121-128. Published online November 23, 2021; DOI: https://doi.org/10.17479/jacs.2021.11.3.121

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Purpose
This study assessed the relationship of core muscle sarcopenia, myosteatosis, and L1 attenuation to the 5-factor modified frailty index (mFI-5), discharge disposition, and post-admission complications in orthopedic and general trauma patients. It was hypothesized that reduced sarcopenia, L1 attenuation, and increased myosteatosis is associated with higher mFI-5 scores (≥ 0.3), discharge into care, and increased post-admission complications.
Methods
This prospective cohort study was performed at a Level 1 trauma center. Patients were surveyed and metrics of the mFI-5 were used. Frail was categorized as a mFI-5 score ≥ 0.3. Recent abdominal computed tomography (CT) scans were used to extract radiographical information of total psoas cross-sectional area, psoas myosteatosis, and L1 vertebrae attenuation.
Results
There were 140 patients who consented to the study, of which 83 had available abdomen and pelvis CT scans. The mean age was 43.19 (± 17.36), and 65% were male (n = 52). When comparing the frail (16%, n = 13) and not frail (84%, n = 70) patients, there was a significant difference in mean psoas myosteatosis (p < 0.0001) and the attenuation of the L1 vertebrae (p < 0.001). On multivariate analysis when accounting for age, myosteatosis of the psoas muscles was predictive of an mFI-5 score ≥ 0.3.
Conclusion
The findings suggest that myosteatosis and L1 attenuation are associated with frailty indices (mFI-5) after traumatic injury. Future studies are needed to prospectively assess the validity of both radiographical and index-based markers of frailty in predicting post-traumatic complications, mortality, and hospital utilization.

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Trauma, Emergency surgery

Case Report of a Laparoscopic Primary Diaphragmatic Repair in Acute Penetrating Trauma: Is It Within the Realm of an Acute Care Surgeon?: Yagan Pillay, Cheyenne Vetter; J Acute Care Surg 2021;11(2):78-81. Published online July 7, 2021; DOI: https://doi.org/10.17479/jacs.2021.11.2.78

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The laparoscopic repair of traumatic diaphragmatic injuries in the acute phase has not been well established. The current consensus view is an elective repair by a surgeon with an advanced laparoscopic skill set. This case report illustrates the position that with judicious patient selection an acute repair is not only possible but well within the realm of an acute care surgeon. Anterior diaphragmatic injuries with penetrating trauma can even be repaired primarily without the need for prosthetic reinforcement. It is hoped that this case report will add to the surgical armamentarium of the acute care surgeon.

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Trauma, Critical care

Fever in Trauma Patients without Brain Injury: Boyoon Choi, Kiyoung Sung, Jinbeom Cho; J Acute Care Surg 2021;11(1):6-13. Published online March 24, 2021; DOI: https://doi.org/10.17479/jacs.2021.1.6

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Purpose
Distinguishing a fever caused by infection from the necessary febrile response in injured patients is difficult, because trauma patients often have concomitant obvious infectious origins. In traumatic brain injury, early fever might be associated with worse clinical outcomes; however, few reports on trauma patients without brain injury are available.

Methods
In this retrospective observational study, consecutive trauma patients without brain injury who were admitted to the surgical intensive care unit during a 3 year period were included. The surgical and clinical outcomes were compared according to body temperature. Locally weighted scatterplot smoothing was used to identify the relationship between body temperature and injury severity.

Results
A total of 111 patients were included. Body temperature increased as the injury severity score increased up to 47.717, above which it decreased. Mortality was high in hypothermic patients (72.7%; p < 0.001); however, few differences were observed between normothermic and hyperthermic patients (3.5% and 2.4%, respectively). The nonsurvivors had lower body temperatures on the 1st and 2nd days after admission (36 ˚C and 36.9 ˚C) compared with the survivors (37.3 ˚C and 37.7 ˚C; p < 0.001 and p = 0.006). In severely injured patients, low levels of inflammatory biomarkers and low body temperature were correlated with mortality.

Conclusions
Fever in trauma patients without brain injury is correlated with injury severity but not with prognosis. Hypothermia on the 1st and 2nd days after admission was significantly correlated with mortality. In severely injured patients, a decreased inflammatory response might play a certain role in promoting a high mortality rate.

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Fever in the Trauma Bay: A Marker for Greater Risk of Adverse Outcomes
Samir M. Fakhry, Yan Shen, Gina M. Berg, James R. Dunne, Parker Hu, Darrell L. Hunt, Mark G. McKenney, Nicholas W. Sheets, R. Joseph Sliter, Matthew M. Carrick, Jeneva M. Garland, Alessandro Orlando
Surgical Infections.2025; 26(4): 255. CrossRef
Prognostic factors in patients with gastrointestinal perforation under the acute care surgery model : a retrospective cohort study
Kiyoung Sung, Sanguk Hwang, Jaeheon Lee, Jinbeom Cho
BMC Surgery.2024;[Epub] CrossRef

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2 Crossref

Trauma, AKI

Acute Kidney Injury After Trauma: Risk Factors and Clinical Outcomes: Jin-Ho Jheong, Suk-Kyung Hong, Tae-Hyun Kim; J Acute Care Surg 2020;10(3):90-95. Published online November 20, 2020; DOI: https://doi.org/10.17479/jacs.2020.10.3.90

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Purpose
Acute kidney injury (AKI) is an uncommon but serious complication after trauma. The objective of this study was to evaluate the clinical characteristics, risk factors, and outcomes of AKI after trauma.
Methods
A retrospective cohort study of 386 trauma patients who visited the emergency department at the Asan Medical Center between January 2012 and December 2013 was performed. There were 322 patients included in this study. Patients were assigned into the AKI group and no AKI group. Regression analysis was performed to identify the factors associated with development of AKI following trauma.
Results
The overall incidence of AKI following trauma was 6%. There was no difference in patients`age, sex, and body weight between groups. Whereas there was a significant difference in Injury Severity Score, Glasgow Coma Scale, presence of shock, need for a transfusion, lactic acid levels, and severe rhabdomyolysis. In multivariate analysis, the independent risk factors associated with AKI after trauma included the Injury Severity Score [odds ratio (OR) = 1.065, p < 0.01], presence of shock (OR = 3.949, p = 0.012), and severe rhabdomyolysis (OR = 4.475, p < 0.01). Patients in the AKI group were classified (according to the RIFLE criteria) as at Risk in 9 cases (43%), Injury present in 3 (14%), Failure in 7 (33%), Loss in 0 (0%) and End-stage in 2 (10%). Renal replacement therapy was required for 10 patients (47%) in the AKI group and 4 of them (40%) underwent successful weaning. Hospital mortality rate was higher in the AKI group (5/21, 23%) than the no AKI group (3/301, 1% ; p < 0.01).
Conclusion
The development of AKI was associated with the severity of trauma, and trauma increased mortality rates.

Citations

Citations to this article as recorded by

Predisposing Factors and Outcome of Acute Kidney Injury After Blunt Trauma: A 10-Year Study
Hassan Al-Thani, Ahmed Faidh Ramzee, Mohammad Asim, Ayman El-Menyar
Journal of Surgical Research.2023; 284: 193. CrossRef
Still finding ways to augment the existing management of acute and chronic kidney diseases with targeted gene and cell therapies: Opportunities and hurdles
Peter R. Corridon
Frontiers in Medicine.2023;[Epub] CrossRef

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Trauma, Organ(liver, bowel, kideny etc.)

Lessons Learnt in The Management of Acute Complications following Liver Injury in Children: Raghunath B. Vasudeva, Bahubali D. Gadgade, Praveena D. Lakshmi; J Acute Care Surg 2020;10(3):106-111. Published online November 20, 2020; DOI: https://doi.org/10.17479/jacs.2020.10.3.106

Abstract
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Purpose
Liver injuries constitute an important cause of hospital admissions, pediatric morbidity, and sometimes mortality. This study was undertaken to assess the spectrum of pediatric liver injuries with special emphasis on the management of acute complications.
Methods
This retrospective study used data from the Department of Pediatric Surgery, Bangalore Medical College, Bengaluru, India, between March 2013 and March 2019. All children between 1-18 years were included in the study (n = 33). Children were assessed with relevance to age, sex, mode of injury, hemodynamic stability at admission, need for blood transfusions, surgery, radiological investigations, complications, total number of days of stay in hospital, and mortality.
Results
There were 27 (81.8%) males and 6 (18.18%) were females. The most common cause for injury was a road traffic accident (60.6%). The majority (nearly 65%) of pediatric liver injuries were Grade II and III. There were 4 children who had post traumatic complications including 2 pseudoaneurysms, 1 inferior vena cava thrombus, and 1 bile leak with a biloma formation which were managed appropriately.
Conclusion
Timely and appropriate radiological evaluation is required for assessments of complications. The majority of complications can be managed conservatively, and minimally invasive techniques like endoscopic retrograde cholangiopancreatography is helpful in the management of complications.

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Critical care, Trauma

Veno-Veno Extracorporeal Membrane Oxygenation in Post-Traumatic Acute Lung Injury: Se Heon Kim, Young Hoon Sul, Jin Young Lee, Jin Bong Ye, Jin Suk Lee, Soo Young Yoon, Joong Suck Kim; J Acute Care Surg 2020;10(2):68-71. Published online July 24, 2020; DOI: https://doi.org/10.17479/jacs.2020.10.2.68

Abstract
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Patients with severe lung injury and hemorrhagic shock, may develop acute respiratory failure syndrome during resuscitation, and may require extracorporeal membrane oxygenation (ECMO) support to ensure adequate oxygenation to sustain life. In this case study, a 69 year-old female was hit by a motor vehicle whilst riding her bicycle. She was in a state of hemorrhagic shock due to polytrauma and was resuscitated with massive fluid transfusion during the initial management. After admission to the intensive care unit, she suffered from hypoxia which required mechanical ventilation using 100% oxygen. However, hypoxia did not improve, so she was placed on venoveno ECMO support after 4 days of intensive care treatment. Although trauma and bleeding are considered as relative contraindications for ECMO support, veno-veno ECMO allows for lung rest, and improvement of pulmonary function.

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Trauma

Clinical Analysis of Trauma Characteristics Among Preschool-Aged Children: Dohoe Ku, Ki Hoon Kim; J Acute Care Surg 2020;10(2):37-41. Published online July 24, 2020; DOI: https://doi.org/10.17479/jacs.2020.10.2.37

Abstract
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Purpose
This study aimed to independently analyze pediatric trauma characteristics from a single institution in Korea to gain a better understanding of pediatric injury.
Methods
A retrospective review was conducted at a single, non-regional trauma center using data from 303 children (< 8 years) who presented at the emergency department (March 2010 to December 2018), to determine the frequency and details of admissions. Demographic variables [sex, age, mechanism of injury, regions of trauma on the body, score of the injury (abbreviated injury scale)] location where the trauma occurred, injury severity score, history of surgery, mortality, and cumulative length of hospital stay], were used to evaluate the severity of the trauma.
Results
The frequency of admissions was typically high for all seasons except winter. The most common mechanism of injury was due to falls; however, this was not the case for 1-, 2-, and 4-yearolds. The most common location where trauma occurred was at home for the age group 1-3 years, and outside the home for children aged 4 years or older. The most common area of injury was the extremities (65.7%). The median injury severity score was 4 (range, 4-4), and the median hospital stay was 4 days (range, 2-6). The overall mortality rate was 0.3%.
Conclusion
Although mortality from trauma is low among pediatric patients, we must continue to improve treatment outcomes. Hospitals lack sufficient resources for pediatric trauma specialists, however to improve patient outcome, it is necessary to recognize age-specific trauma characteristics.

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Trauma

Maternal Fetal Trauma: When One Patient Becomes Two: A Case Study: Bonnie McCracken; J Acute Care Surg 2020;10(1):25-29. Published online March 30, 2020; DOI: https://doi.org/10.17479/jacs.2020.10.1.25

Abstract
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Trauma is a complication in an estimated 6-7% of pregnancies, and is the most frequent cause of obstetric death. Trauma has been shown to result in maternal or fetal death, and in cases of extensive trauma, both may die. Management of pregnant patients has multiple challenges. It requires coordination of the trauma and obstetrics teams, as well as other specialties specific to the injuries of the patient. Management of the pregnant female has been described in trauma literature, but there are few reports on the management of both mother and fetus, when both have sustained trauma injuries. This case study discusses the series of events when a mother and fetus have injuries, and the considerations required in the post-resuscitative period when both patients survive.

Citations

Citations to this article as recorded by

Recognition and management of traumatic fetal injuries
Sarah C. Stokes, Nathan S. Rubalcava, Christina M. Theodorou, Manisha B. Bhatia, Brian W. Gray, Payam Saadai, Rachel M. Russo, Amelia McLennan, Dana C. Bichianu, Mary T. Austin, Ahmed I. Marwan, Fuad Alkhoury
Injury.2022; 53(4): 1329. CrossRef

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Trauma, Organ(liver, bowel, kideny etc.)

Review of the Clinical Characteristics of Adrenal Gland Injury Following Blunt Trauma in a Single Institution: Sung Yong Hong, Ki Hoon Kim; J Acute Care Surg 2019;9(1):7-11. Published online April 30, 2019; DOI: https://doi.org/10.17479/jacs.2019.9.1.7

Abstract
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Purpose:

Adrenal gland injuries in trauma are rare and usually misdiagnosed or undere-stimated in an emergency setting because they are asymptomatic and associated with severe abdominal injuries. This paper reviews the clinical characteristics of adrenal injuries.

Methods:

A retrospective analysis of trauma patients who visited the authors’ emergency center was performed from March, 2010 to December, 2017. The patient demographic data, injury mechanism & associated injuries, injury severity score, hospital stay, and mortality were retrieved and analyzed.

Results:

Adrenal gland injuries were found in 52 patients: 73.1% (n=38) were males and the mean age was 43.6 years. Of the patients, 84.6% (n=44) had ISS =15. Right adrenal gland injuries occurred in 82.7% (n=43). The mechanism of injury was falls in 30.8% (n=16), motor vehicle accidents in 25.0% (n=13), and pedestrian accidents in 23.1% (n=12). Associated injures were liver injury (58.5%), rib fracture (52.8%), kidney injury (24.5%), pelvic bone fracture (20.8%), spine fracture (28.3%), and spleen injury (13.2%). The mean hospital stay was 34.2 days, and the intensive care unit stay was 9 days. The mortality rate was 3.8% (n=2).

Conclusion:

Adrenal gland injuries are common in males and frequent in the right side. Falls are the leading cause of injury. Most injuries have an associated injury at the abdominal or thoracic region. Adrenal injury is accompanied by high injury severity but showed a good prognosis.

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Adrenal gland laceration in adult trauma patients without severe concomitant abdominal organ injuries: Incidence, associated factors, and outcomes from a national trauma database study
Musaed Rayzah
Medicine.2025; 104(10): e41756. CrossRef

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Emergency surgery, Trauma

Abdominal Tuberculosis Combined with Abdominal Trauma: Young Ik Kim, Ji Young Jang, Hongjin Shim, Keum Seok Bae; J Acute Care Surg 2017;7(2):75-77. Published online October 30, 2017; DOI: https://doi.org/10.17479/jacs.2017.7.2.75

Abstract
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Abdominal tuberculosis is a rare disease, about 5% of extra-pulmonary tuberculosis. However, the diagnosis of abdominal tuberculosis is difficult, because of its atypical symptoms and signs, and ambiguous results upon physical examination. When abdominal tuberculosis is combined with abdominal injury, the diagnosis will be especially complex. We present our experience of abdominal tuberculosis associated with abdominal trauma.

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Procedure, Trauma

The Role of Whole-Body Computed Tomography in Severely Injured Patients Retrospective Single Center Cohort Study: Hyun-Woo Sun, Suk-Kyung Hong, Min-Ae Keum, Jong-Kwan Baek, Jung-Sun Lee, Choong-Wook Lee; J Acute Care Surg 2016;6(1):18-22. Published online April 30, 2016; DOI: https://doi.org/10.17479/jacs.2016.6.1.18

Abstract
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Purpose:

To assess the effects of whole-body computed tomography (WBCT) on severely injured trauma patients.

Methods:

After the installation of a WBCT scanner, we compared 48 patients who underwent the WBCT (WBCT cohort) with 40 patients prior to the WBCT (pre-WBCT cohort). We evaluated the number of CT, radiation exposure, time interval to decision and clinical outcomes such as length of intensive care unit stay, ventilation period, and acute kidney injury rates.

Results:

In the WBCT cohort, the number of CT scans was significantly less (3.5 times) than in the pre-WBCT cohort (5.5 times; p<0.001). The radiation exposure was significantly lower in the WBCT cohort (24.5 mSv) than in the pre-WBCT cohort (31.3 mSv; p=0.040). The amount of radio-contrast used differed between the groups, but not significantly. Although there were fewer acute kidney injuries in the WBCT cohort (27.1%) than in pre-WBCT cohort (37.5%; p=0.296), especially severe injuries (stage 3 Acute Kidney Injury [AKI] Network: 17.5% in pre-WBCT vs. 6.3% in WBCT; p=0.059), the difference did not reach statistical significance. The hospital length of stay was significantly shorter in the WBCT cohort (21.42 days) than in the pre-WBCT cohort (32.38 days, p=0.019). However, there were no significant differences in the time interval to decision, intensive care unit stay, ventilation days, and mortality.

ConclusionL

The WBCT decreased the number of CT scans and subsequent less use of radio-contrast amount. It also tended to reduce severe AKI.

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System

Injury Severity Scoring System for Trauma Patients and Trauma Outcomes Research in Korea: Kyounwon Jung, John Cook-Jong Lee, Jiyoung Kim; J Acute Care Surg 2016;6(1):11-17. Published online April 30, 2016; DOI: https://doi.org/10.17479/jacs.2016.6.1.11

Abstract
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To improve trauma outcomes, a solid logistic support system is obviously crucial. An important national trauma outcome indicator is preventable trauma death rate, 35% in Korea. The Korean government is aware of this figure and is making efforts to reduce the preventable trauma death rate by 20%. One of the main components was establishing regional trauma centers covering the Korean peninsula, and a trauma care system. Seventeen regional trauma centers will be verified by the year of 2020. To achieve this goal, trauma specialist medical staff’s role is essential. A trauma system is very complicated. It involves a broad range of health care fields from the prehospital setting to rehabilitation. In addition, a number of professionals, institutions and authorities are involved. Thus, very sophisticated systemic approaches are needed. An essential initial component is surveillance, which can start with collecting data and analyzing them thoroughly with a suitable trauma scoring system to describe the characteristics of injured patients in Korea. Several trauma scoring systems are available in Korea. However, these systems need validation to decide which is pertinent for a records- based Korean trauma system. Although the Korean Trauma Data Bank (KTDB) is recently established, it can be used for a predictive model in Korea.

Citations

Citations to this article as recorded by

Predictive factors for size change of aorta in patients with acute blunt traumatic aortic injury
Soojin Lee, Seunghwan Song, Seon Hee Kim, Chang Won Kim, Hoon Kwon, Dongman Ryu, Na Hyeon Lee, Eunji Kim
General Thoracic and Cardiovascular Surgery.2025; 73(4): 209. CrossRef
Development and Validation of a Korean Trauma and Injury Severity Score (K-TRISS) Model for Predicting Trauma Outcomes
Jungsub So, Kyoungwon Jung, Junsik Kwon, Byung Hee Kang, Yo Han Lee, Eun Hae Lee, Chan Ik Park, Jayun Cho, Hoonsung Park, Seoyoung Song, Jayoung Yoo, Inhae Heo
Journal of Korean Medical Science.2025;[Epub] CrossRef
Comprehensive analysis of cytokines as predictors of multi-organ dysfunction syndrome in patients with trauma: a prospective observational study
In Sik Shin, Myoung Jun Kim, Md Habibur Rahman, Cheol-Su Kim, Kwangmin Kim
Molecular & Cellular Toxicology.2025;[Epub] CrossRef
State of orthopaedic trauma registries in South Korea, Japan, and Australia
James Otieno, Richard De Steiger, Keisuke Ishii, Ji Wan Kim, Narutaka Katoh, Jun Young Lee, Hiroaki Minehara, Takashi Miyamoto, Richard Page, Yong-Cheol Yoon, Zsolt J. Balogh
OTA International.2025;[Epub] CrossRef
Prevalence of and factors associated with trauma surgeons' referral and patients' willingness to acupuncture treatment after traumatic rib fractures: A single-center cross-sectional study
Min Ha Kim, Hyun Min Cho, Seon Hee Kim, Youngwoong Kim, Yu Kyung Shin, Kun Hyung Kim
Integrative Medicine Research.2024; 13(4): 101096. CrossRef
Understanding Regional Trauma Centers and managing a trauma care system in South Korea: a systematic review
Jeehye Im, Eun Won Seo, Kyoungwon Jung, Junsik Kwon
Annals of Surgical Treatment and Research.2023; 104(2): 61. CrossRef
Feasibility and Clinical Outcomes of Resuscitative Endovascular Balloon Occlusion of the Aorta in Patients with Traumatic Shock: A Single-Center 5-Year Experience
Gyeongho Lee, Dong Hun Kim, Dae Sung Ma, Seok Won Lee, Yoonjung Heo, Hancheol Jo, Sung Wook Chang
Journal of Chest Surgery.2023; 56(2): 108. CrossRef
Severity of grinder injuries and related factors compared with other high-rotation cutting tool injuries: a multicenter retrospective study from 2011 to 2018
Juni Song, Yang Bin Jeon, Jae Ho Jang, Jin Seong Cho, Jae Yeon Choi, Woo Sung Choi
Journal of Trauma and Injury.2023; 36(1): 32. CrossRef
Relationship Between Facial Bone Fractures and the Risk of Posttraumatic Complications: A Hypothesis on the Cushion Effect of the Facial Skeletons in Temporal Bone Fractures
Hantai Kim, Jang Gyu Han, Hun Yi Park, Yun-Hoon Choung, Jeong Hun Jang
Journal of Korean Medical Science.2023;[Epub] CrossRef
Characteristics and Risk Factors for Pressure Ulcers in Severe Trauma Patients Admitted to the Trauma Intensive Care Unit
Seung-yeon Lim, Young-min Jeong, So-young Jeong
Journal of Acute Care Surgery.2023; 13(2): 47. CrossRef
Does the Probability of Survival Calculated by the Trauma and Injury Severity Score Method Accurately Reflect the Severity of Neurotrauma Patients Admitted to Regional Trauma Centers in Korea?
Mahnjeong Ha, Seunghan Yu, Jung Hwan Lee, Byung Chul Kim, Hyuk Jin Choi
Journal of Korean Medical Science.2023;[Epub] CrossRef
Characteristics and clinical outcomes of older patients with trauma visiting the emergency department before and during the COVID-19 Pandemic: A level 1 trauma center cohort study
Ok-Hee Cho, Jeongeun Yoon
Journal of Korean Gerontological Nursing.2023; 25(4): 400. CrossRef
The Relationship between Hospital Selection by Employer and Disabilities in Occupational Accidents in Korea
Joonho Ahn, Min Jang, Hyoungseob Yoo, Hyoung-Ryoul Kim
Safety and Health at Work.2022; 13(3): 279. CrossRef
Electric Scooter-Related Trauma in Korea
Jun Ho Choi, Sang Seong Oh, Kwang Seog Kim, Jae Ha Hwang, Sam Yong Lee
Journal of Korean Medical Science.2022;[Epub] CrossRef
A quantitative analysis of trauma patients having undergone plastic surgery
Nam Kyu Lim, Jae Hee Yoon, Alen Palackic
PLOS ONE.2022; 17(8): e0272054. CrossRef
Epidemiology and clinical characteristics of posttraumatic hospitalized patients with symptoms related to venous thromboembolism: a single-center retrospective study
Hyung Su Park, Sung Youl Hyun, Woo Sung Choi, Jin-Seong Cho, Jae Ho Jang, Jea Yeon Choi
Journal of Trauma and Injury.2022; 35(3): 159. CrossRef
The use of machine learning for investigating the role of plastic surgeons in anatomical injuries: A retrospective observational study
Nam Kyu Lim, Jong Hyun Park
Medicine.2022; 101(40): e30943. CrossRef
The Relationship Between Trauma Scoring Systems and Outcomes in Patients With Severe Traumatic Brain Injury
Tae Seok Jeong, Dae Han Choi, Woo Kyung Kim
Korean Journal of Neurotrauma.2022; 18(2): 161. CrossRef
Association between the participation of the plastic surgery department and qualitative prognoses in severe trauma patients: A retrospective observational study
Nam Kyu Lim, Sungyeon Kim, Jae Hee Yoon, Kyung-Hwa Choi
Medicine.2022; 101(51): e32387. CrossRef
Prognostic Accuracy of the Quick Sequential Organ Failure Assessment for Outcomes Among Patients with Trauma in the Emergency Department: A Comparison with the Modified Early Warning Score, Revised Trauma Score, and Injury Severity Score
Min Woo Kang, Seo Young Ko, Sung Wook Song, Woo Jeong Kim, Young Joon Kang, Kyeong Won Kang, Hyun Soo Park, Chang Bae Park, Jeong Ho Kang, Ji Hwan Bu, Sung Kgun Lee
Journal of Trauma and Injury.2021; 34(1): 3. CrossRef
Educational needs of severe trauma treatment simulation based on mixed reality: Applying focus group interviews to military hospital nurses
Seon Mi Jang, Sinwoo Hwang, Yoomi Jung, Eunyoung Jung
The Journal of Korean Academic Society of Nursing Education.2021; 27(4): 423. CrossRef
Inclusion of lactate level measured upon emergency room arrival in trauma outcome prediction models improves mortality prediction: a retrospective, single-center study
Jonghwan Moon, Kyungjin Hwang, Dukyong Yoon, Kyoungwon Jung
Acute and Critical Care.2020; 35(2): 102. CrossRef
Trauma severity and mandibular fracture patterns in a regional trauma center
Hyeok Lee, Kwang Seog Kim, Jun Ho Choi, Jae Ha Hwang, Sam Yong Lee
Archives of Craniofacial Surgery.2020; 21(5): 294. CrossRef
Characteristics of children with trauma compared to those with disease in the emergency department: a Korean single regional emergency medical center study
Yosub Hwang, Ha Young Jo, Hye Won Yoo, Young Mi Kim, Hye-Young Kim
Pediatric Emergency Medicine Journal.2020; 7(2): 108. CrossRef
Age group characteristics of children who visited a regional trauma center and analysis of factors affecting the severe trauma
Hyung Won Lee, Jea Yeon Choi, Jae Ho Jang, Jin Seong Cho, Sung Youl Hyun, Woo Sung Choi, Jae-Hyug Woo
Pediatric Emergency Medicine Journal.2020; 7(2): 94. CrossRef
Effectiveness after Designation of a Trauma Center: Experience with Operating a Trauma Team at a Private Hospital
Kyoung Hwan Kim, Sung Ho Han, Soon-Ho Chon, Joongsuck Kim, Oh Sang Kwon, Min Koo Lee, Hohyoung Lee
Journal of Trauma and Injury.2019; 32(1): 1. CrossRef
Comparison of outcomes in severely injured patients between a South Korean trauma center and matched patients treated in the United States
Kyoungwon Jung, Shokei Matsumoto, Alan Smith, Kyungjin Hwang, John Cook-Jong Lee, Raul Coimbra
Surgery.2018; 164(3): 482. CrossRef

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