ORIGINAL ARTICLE J Trauma Inj 2017;30(3):80-86 http://doi.org/10.20408/jti.2017.30.3.80 JOURNAL OF TRAUMA AND INJURY Analysis of Cultivator-related Trauma Cases in a Regional Trauma Center in the Rural Area of Gyeongbuk Province Ui Kang Hwang, M.D., Ph.D.1, Seok Hwa Youn, M.D.1, Chan Yong Park, M.D., Ph.D.2 1Department of Trauma Surgery, Andong Medical Group Hospital, Andong, Korea 2Department of Trauma Surgery, Pusan National University Hospital, Busan, Korea Received: May 10, 2017 Purpose: To analyze the data of patients who suffered trauma in a cultivator accident Revised: July 4, 2017 and visited the trauma center in rural Gyeongbuk Province. Accepted: July 8, 2017 Methods: We retrospectively reviewed the medical records and Korean Trauma Data Bank data of 120 patients who suffered cultivator-related traumas and visited the rural regional trauma center in Gyeongbuk Province from January to December 2015. Results: The age of the patients ranged from 35 to 96 years (mean, 70 years). Ninety-one (75.8%) patients were men, and twenty-nine (24.2%) were women. Most of the patients were in their 70s (46 men [50.5%] and 13 women [44.8%]). In total, 113 patients (94.1%) arrived at the regional trauma center by ground transport and 7 (5.9%) arrived by air transport. Ninety-eight patients (81.7%) were transported to the regional trauma center directly from the scene of the accident, and twenty-two (18.3%) were transferred from Correspondence to another medical institute. The mean time from the accident to arrival at the emergen- Chan Yong Park, M.D., Ph.D. Department of Trauma Surgery, Pusan cy department was 139 minutes, and only 46 patients (38.3%) arrived within 1 hour. National University Hospital, 179 Gudeok- Twelve (10.0%) patients died, including two deaths on arrival and two post- cardiopul- ro, Seo-gu, Busan 49241, Korea Tel: +82-51-240-7369 monary resuscitation deaths in the emergency department. All deaths were of male cul- Fax: +82-51-240-7719 tivator operators. The causes of death were shock (hypovolemic, traumatic, or septic), E-mail: [email protected] subdural hematoma (open), hemothorax, rhabdomyolysis, and pneumonia. Conclusions: As the government - led regional trauma center project is on process, it would be clinically important to summarize the initial outcome of cultivator injuries, which are characteristically found more in regional trauma centers in the rural area, and have high mortality. Based on this study, in the future, it will be necessary to fol- low up and analyze more number of patients and to construct accurate database about trauma cases related to cultivator in Gyeongbuk region. Keywords: Trauma; Agriculture; Transportation; Treatment http://www.jtraumainj.org Copyright © 2017 The Korean Society of Trauma This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License eISSN 2287-1683 (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted noncommercial use, distribution, and pISSN 1738-8767 reproduction in any medium, provided the original work is properly cited. Ui Kang Hwang, et al. Cultivator-related Trauma in Gyeongbuk Province INTRODUCTION patients). Patients who suffered from cultivator trauma presented to the emergency department most often in In the 1970s, the Korean government expanded its distri- spring (47 cases [39.2%]), followed by summer (41 cases Analysis of Cultivator-related Trauma bution of agricultural machinery, including cultivators, [34.2%]), autumn (29 cases [24.2%]), and winter (3 cases across the nation to accelerate economic growth and pro- [2.5%]). Regarding the injury mechanism (in order of Cases in a Regional Trauma Center in mote their food policy [1]. According to the National Sta- prevalence), the cultivator overturned in 41 (34.2%) cases, tistical Office, 1,089,000 farm households existed in South followed by fall in 37 (30.8%), collision in 32 (26.7%) and the Rural Area of Gyeongbuk Province Korea as of December 1, 2015. Gyeongbuk had 185,000 unknown in 10 (8.3%). In order of frequency, the injured farm households (17.0%), which is the most in the coun- persons were as follows: cultivator operator, 92 cases Ui Kang Hwang, M.D., Ph.D.1, Seok Hwa Youn, M.D.1, Chan Yong Park, M.D., Ph.D.2 try [2]. Cultivator accidents are generally severe and can (76.7%); cultivator passenger, 20 cases (16.7%); pedestri- 1Department of Trauma Surgery, Andong Medical Group Hospital, Andong, Korea lead to substantial physical damage and economic losses. an, 5 cases (4.1%); and unknown, three cases (2.5%). The 2Department of Trauma Surgery, Pusan National University Hospital, Busan, Korea Although there have been cultivator accidents in Gyeong- accidents occurred on a public road in 56 cases (46.7%) buk, systematic data and reports are lacking. The regional cases, on farmland in 26 cases (21.7%), on a farm road in trauma center project implemented by the government 18 cases (15.0%), in a residential area in 14 cases (11.6%), has made it possible to construct a more accurate trau- and in another or unknown location in six cases (5.0%). Purpose: To analyze the data of patients who suffered trauma in a cultivator accident ma database. The purpose of this study was to analyze and visited the trauma center in rural Gyeongbuk Province. the data of patients who suffered cultivator trauma and Status on arrival in the emergency department (Table 2) Methods: We retrospectively reviewed the medical records and Korean Trauma Data visited the trauma center in the rural area of Gyeongbuk In total, 113 patients (94.1%) arrived at the regional trau- Bank data of 120 patients who suffered cultivator-related traumas and visited the rural Province. ma center by ground transport and seven arrived (5.9%) regional trauma center in Gyeongbuk Province from January to December 2015. by air transport. Ninety-eight patients (81.7%) were Results: The age of the patients ranged from 35 to 96 years (mean, 70 years). Ninety-one transported to the center directly from the scene of the (75.8%) patients were men, and twenty-nine (24.2%) were women. Most of the patients METHODS accident, and twenty-two (18.3%) were transferred from were in their 70s (46 men [50.5%] and 13 women [44.8%]). In total, 113 patients (94.1%) another medical institute. The mean time from accident arrived at the regional trauma center by ground transport and 7 (5.9%) arrived by air We retrospectively reviewed the parameters(clinical char- to arrival at the emergency department was 139 min, and transport. Ninety-eight patients (81.7%) were transported to the regional trauma center acteristics, pre-hospital arrival patient information, trau- only 46 patients (38.3%) arrived within 1 hour. Accord- directly from the scene of the accident, and twenty-two (18.3%) were transferred from ma center medical information, treatment and outcomes) ing to the Abbreviated Injury Scale, the injured body area another medical institute. The mean time from the accident to arrival at the emergen- based on the medical records and Korean Trauma Data were the head in 29 cases (13.8%), the face in 9 (4.3%), cy department was 139 minutes, and only 46 patients (38.3%) arrived within 1 hour. Bank data of 120 patients who suffered cultivator trau- the neck in 0 cases, the thorax in 40 cases (19.0%), the Twelve (10.0%) patients died, including two deaths on arrival and two post- cardiopul- ma and visited the regional trauma center in Gyeongbuk abdomen in 14 cases (6.7%), the spine in 44 cases (20.9%), monary resuscitation deaths in the emergency department. All deaths were of male cul- Province from January to December 2015. Statistical anal- the upper extremities in 31 cases (14.8%), the pelvis and tivator operators. The causes of death were shock (hypovolemic, traumatic, or septic), ysis was done by frequency analysis using Microsoft Excel lower extremities in 34 cases (16.2%), and external, ther- subdural hematoma (open), hemothorax, rhabdomyolysis, and pneumonia. pivot table. mal, and other trauma in 9 cases (4.3%). There were 20 Conclusions: As the government - led regional trauma center project is on process, it major trauma patients (16.7%) with an Injury Severity would be clinically important to summarize the initial outcome of cultivator injuries, Score (ISS) ≥16, 98 (81.6%) with an ISS <16, and 2 (1.7%) which are characteristically found more in regional trauma centers in the rural area, RESULTS in whom the ISS was unknown. The mean value of the and have high mortality. Based on this study, in the future, it will be necessary to fol- ISS was 8.538 and the median was 5. There were 108 pa- low up and analyze more number of patients and to construct accurate database about Clinical characteristics (Table 1) tients (90.0%) with a Revised Trauma Score (RTS) ≥7.0, trauma cases related to cultivator in Gyeongbuk region. The age of the patients was 35–96 years (mean, 70 years). 8 (6.7%) with a score <7.0, and 4 (3.3%) in whom the Ninety-one (75.8%) patients were men and twenty-nine RTS was unknown. The mean value of RTS was 7.7668 Keywords: Trauma; Agriculture; Transportation; Treatment (24.2%) were women. Most of the patients were in their and the median was 7.8408. Twenty-four patients (20.0%) 70s (46 men and 13 women). In addition, there were 14 were transported to the trauma center from Andong city men and 1 woman >80 years of age (Fig. 1). There were and 90 (75%) were transported from six counties adjacent 73 patients (60.8%) with comorbidities, including hyper- to Andong city (Bonghwa, Yeongyang, Cheongsong, Uis- tension (35 patients), diabetes (23 patients), and cancer (11 eong, Yecheon, and Yeongju).