Comparison of Injury Patterns and Severity between Younger and Older Rider in the Motorcycle Accident

PURPOSE: The mortality of motorcycle accidents in old age is very high in Korea compared with other countries. The aim of this study is to compare the differences in injury patterns and severity between younger and older riders in motorcycle accidents. METHODS: Cross sectional data from Konkuk University Chung-ju Hospital were used to evaluate patients who visited the emergency department as a result of a motorcycle accident from June 2012 to May 2014. We separated the patients into younger rider group from 16 to 64 and older rider group over 65 years of age. Injury sustained, the types of severe injuries and injury severity between two groups were compared using Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS). RESULTS: The younger and older rider group included 310 and 111 patients, respectively. Injuries in head, face, chest, and lumbar spine were higher in the older rider group (p<0.05). In the comparison of severe injury sustained over AIS 2, the older rider group had a four-fold odds increased rate of head injury (OR 3.718, 95% CI: 2.317-5.965, p<0.001) and a two-fold odds increased rate of chest injury (OR 2.306, 95% CI: 1.199-4.437, p=0.016) compared with the younger rider group. In addition, the older rider group had a nearly seven fold increased odds of severe injury over ISS 15 (OR 7.108, 95% CI: 3.579-14.119, p<0.001). CONCLUSION: In a motorcycle accident, the frequency of head, facial, chest, and lumbar injuries was higher in the older rider group. In addition, the older rider group had a higher injury severity, particularly a higher risk of head and chest injury.

Sigmoid Colon Perforation after Laparoscopic Gynecologic Surgery: A Case Report

Bowel injury after laparoscopic gynecologic surgery is a rare but serious complication. In particular, diagnosis of a patient with bowel injury is difficult because of the unusual patient presentation and remaining intraabdominal gas. We report on a case of a sigmoid colon perforation after laparoscopic gynecologic surgery. A 42-year-old woman with abdominal pain and distention underwent exploratory laparotomy. She had undergone laparoscopic gynecologic surgery 6 days ago. During the procedure, a sigmoid colon perforation was found as well as severe inflammation at the pelvic cavity. The patient underwent segmental resection of the sigmoid colon with loop ileostomy. Postoperative acute abdomen did not show classic signs on physical examination and diagnostic imaging. Thus, a more careful approach and interpretation of diagnosis was needed.

Prognosis for Blunt Abdominal Trauma Patients with Contrast Extravasation on the Abdominopelvic CT Scan

PURPOSE: Computed tomography (CT) is an accurate test for evaluating hemodynamically stable patients with blunt abdominal trauma. Until now, there have been few studies concentrating on the diagnostic and prognostic significance of the intravenous contrast extravasation (CE) site. We investigated the site of CE on abdominopelvic CT (APCT) and its effect on treating trauma patients and predicting the clinical outcome. METHODS: The 50 patients admitted to our emergency department with blunt abdominal trauma showing CE on APCT from January 2004 to September 2006 were included in this study. Patients were prospectively collected, and medical records were reviewed and analyzed. The patients'clinical and lab findings, Focused Assessment with Sonography for Trauma (FAST) findings, CT findings were analyzed. CE sites were classified as intraperitoneal, retroperitoneal, and pelvic cavity and were correlated with post-treatment complications, mortality, and morbidity. RESULTS: Of the 50 patients (mean age : 45+/-18years, 29 males, 21 females) included in our study, 33 patients died (66%). There was no correlation between CE site and ICU or total hospitalization duration (p=0.553, p=0.523). During the first 24 hours of resuscitation, the pelvic cavity group required a mean of 20 units more of packed red blood cell (pRBC) transfusion compared to other groups (p=0.003). In the intraperitoneal group, more patients received operative invasive intervention - either laparotomy or embolization (p=0.025). The intraperitoneal group had the highest mortality, with 13 deaths (11/33, 39%), and the highest early mortality rate (10/13, 76%) in the first 24 hours (p=0.001). CONCLUSION: Intraperitoneal CE on the CT scan in cases of blunt abdominal trauma is regarded as an indication of a need for invasive intervention (either angiography or laparotomy) and of a higher mortality rate in the first 24 hours. A pelvic cavity CE rquires more aggressive transfusion with pRBC. However, the CT findings themselves showed no significant correlation with overall mortality, morbidity, or hospitalization.

Injury Characteristics of Self-injury Patients Who Visit the Emergency Department

PURPOSE: Many studies have addressed a psychiatric analysis of self-injury patients who have self-injurious behavior and who have attempted suicide. Few studies on the injury characteristics of self-injury related trauma patients have been conducted. We analyzed the injury characteristics of self-injury patients. METHODS: A retrospective review of the medical records extracted from the injury surveillance system of Wonju Christian Hospital for the period from August 2006 to February 2008 was conducted. Of the 121 cases extracted, 103 were included in this study. We analyzed the sex ratio, age group, place of injury, injury mechanism, location of injury, management results, injury severity, and relation with drinking. RESULTS: One hundred three cases were included (sex ratio: 1.06), and the mean age was 33.9+/-14.2 years old. Fifty-six patients (54.4%) were discharged from the emergency department (ED) on the day of injury after primary care, and 9 patients (8.7%) were discharged, because they refused treatment. Seven patients (6.8%) died. Of these, 4 patients (3.9%) died after attempted cardio-pulmonary resuscitation in the ED, 1 patient (1%) was dead on arrival, and 2 patients (1.9%) died after admission. Sixteen patients (15.5%) were admitted to the hospital, including 2 patients (1.9%) needing emergency surgery. Sixteen patients (15.5%) were transferred to other hospitals. Sixty-one cases (59.2%) involved drinking, and 31 (30.1%) did not; for 11 cases (10.7%), the involvement of drinking was unknown. The mean revised trauma score (RTS) was 11.26+/-2.52, and 88 cases (85.4%) hat a RTS of 12. The mean injury severity score (ISS) was 5.80+/-14.56, and 9 (8.7%) severely injured patients had scores of more than 15. CONCLUSION: Most self-injuries were mild traumas related to drinking and occurred at a young age. Most cases were not so severe, and the patients were discharged from the ED, but some patients needed hospitalization. Other patients had injuries so severe that they died.