Problems of Trauma Care and Rate of Preventable Trauma Death in Jeju, South Korea

PURPOSE: This study was undertaken to investigate preventable trauma death and trauma care errors contributing to death on Jeju Island. METHODS: A retrospective study was conducted on all trauma deaths between January 2008 and May 2010 at five emergency departments (ED) in Jeju. Of the 165 deaths, 101 patients included for study after excluding death within one hour or after one week. Injury severity was scored according to the Injury Severity Score (ISS) and survival probability (Ps) was calculated. Trauma care errors were coded to six categories: pre-hospital, ED, operating room, intensive care unit, general ward, and inter-hospital transfer. In addition, system inadequacy, problems in treatment, diagnosis, and procedures were analyzed. Patient records were reviewed independently and preventability was determined by agreement. RESULTS: The preventable death rate was 35.6%, and the mean ISS was 25.25+/-10.78. Of all 149 inappropriate cares, 66.4% contributed to death. Of the 121 treatment-related problems, 88 problems occurred in the ED. Of the 18 system-related problems, 12 were in the pre-hospital phase. Seventy of the 96 problems associated with deaths occurred in the ED, and 12 of 29 problems in the pre-hospital phase. CONCLUSION: The preventable death rate was high. Inappropriate care rendered in the treatment process in the ED and system-related errors in the pre-hospital phase were major contributors to preventable trauma deaths. To reduce preventable deaths, more efforts are required on organizing trauma team management and improving care errors during the pre-hospital and inter-hospital transfer.

Availability of Multimarker IndexTM in Prediction of Ischemic Stroke Severity

PURPOSE: The Multimarker IndexTM (MMX) is derived from 4 biochemical markers (S100 beta, MMP-9, D-dimer, BNP) and is known to be useful in the early detection of stroke. Assessment of severity in the early stages of stroke is as important as early detection of stroke itself, so that early intensive management can be applied. We evaluated wheather MMX is correlated with stroke severity as measured by NIHSS. METHODS: MRI-confirmed stroke patients were prospectively enrolled for analysis of MMX from their serum, and initial NIHSS was recorded. Patients were divided into three convenient groups according to the time from symptom onset. In each group, correlation of MMX and NIHSS was studied. RESULTS: Fifty-one patients were enrolled, and MMX was found to be positively correlated with NIHSS (p<0.01). In subgroup analysis, group A (presented to ED within 6 hours of symptom onset), and group B (presented to ED from 6-12 hours after symptom onset) showed the same positive correlation between MMX and NIHSS (p=0.017, p<0.001), but in group C (presented to ED after more than 12 hours after symptom onset), there was no correlation (p=0.840). CONCLUSION: MMX positively correlated with stroke severity measured by NIHSS for patients presenting to ED within 12 hours of symptom onset.

A Case of Penetrating Facial Wound by a Grinder

Penetrating facial wounds are uncommon and are usually life threatening because of the possibility of brain damage. There are three possible pathways for penetrating the cranium through the orbit: via the orbital roof, via the superior orbital fissure, or between the optic canal and lateral wall of the orbit. Brain injuries resulting from the penetrating wounds show extensive parenchymal damage, hemorrhage, and brain edema. Transorbital penetrating wounds can lead to diverse lesions of the optical apparatus, including the eye globe, the optical nerve, and the chiasm. Moreover, intracerebral structures may be hurt, and bleeding and infection may occur. Early diagnosis and prompt debridement are the fundamental factors affecting the outcome of a penetrating facial wound. An 87-year-old man was admitted to the emergency department with a grinder impacted into the medial aspect of the right eye. On presentation, the man was fully conscious with a Glasgow Coma Scale score of 15 and complained of a visual disturbance of the right eye. Computed tomography demonstrated a right orbital medial and inferior wall fracture, a frontal bone fracture, and a contusional hemorrhage in frontal lobe of the brain. A craniotomy with hematoma removal and repair of the orbital floor was done. He showed no neurological deficits except right visual loss. This appears to be the first report of a man with a penetrating facial wound caused by a grinder, who presented with a potentially disastrous craniocerebral injury that did not lead to any serious neurological seguelae.