Preventable Death Rate of Trauma Patients in a Non-Regional Trauma Center

Kwanhoon Park,Wooram Choi,Sungho Lee,Kang Yoon Lee,Dongbeen Choi,Han-Gil Yoon,장지영 대한외상중환자외과학회 2023 Journal of Acute Care Surgery Vol.13 No.3

Purpose: A nationwide study (2012-2017) of preventable trauma death rates (PTDR) showed a 15.3% decrease after Regional Trauma centers were initiated. However, in non-trauma centers with an Emergency Department there is limited data of preventable mortality in trauma patients. Therefore, the purpose of this retrospective study was to investigate preventable mortality in trauma patients in a nonregional trauma center and determine the effect of initiating a Trauma Team. Methods: There were 46 deaths of trauma patients recorded in the National Health Insurance service Ilsan Hospital (NHISIH) in South Korea from January 2019 to December 2021. These patients’ preventable deaths were analyzed by an expert panel review considering the implementation of the Trauma Team in April 2020. Results: All deaths were attributable to blunt trauma with an average Injury Severity Score of 26.0 ± 19.2, Revised Trauma Score of 5.05 ± 3.20 and Trauma and Injury Score of 56.6 ± 41.3. The most frequent cause of death was traumatic brain injury followed by respiratory arrest. The most frequent error was delayed transfusion followed by delayed treatment of bleeding. Treatment errors occurred the most in the Emergency Room followed by the Intensive Care Unit. The PTDR of patients before the involvement of a Trauma Team (January 2019 to March 2020) and after the Trauma Team was initiated in April 2020 decreased from 27.27% to 4.27%, respectively (p = 0.021). Conclusion: The introduction of a dedicated Trauma Team in a non-regional trauma center significantly reduced the overall PTDR in trauma patients.

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 대한외상중환자외과학회 2023 Journal of Acute Care Surgery Vol.13 No.1

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.

The Occurrence of a Thyroid Storm in a Patient with Recurrent Refractory Peptic Ulcer: A Case Report

Park Kwanhoon,Jang Ji Young,Lee Sungho 대한외상중환자외과학회 2022 Journal of Acute Care Surgery Vol.12 No.1

A thyroid storm is a rare complication of hyperthyroidism. Although a thyroid storm rarely presents with symptoms similar to those of an acute abdomen, and in cases where emergency surgery is needed, the thyroid function test is not performed routinely. In this study, we report a case in which hyperthyroidism was diagnosed after surgery in a patient with recurrent refractory peptic ulcer disease. Although peptic ulcer disease and hyperthyroidism rarely coexist, when the patient's initial condition was reviewed in the Emergency Department, the findings were reasonable for panperitonitis due to peptic ulcer perforation, which is considered as a condition suitable for a thyroid storm. This isolated case indicates a logical leap in the correlation between peptic ulcer and thyroid storm. In recurrent refractory peptic ulcer disease, the thyroid function test may be helpful as a routine laboratory test before emergency surgery.

Characteristics and Clinical Outcomes of Elderly Trauma Patients in Local Trauma Center

GeonJae CHO,Kwanhoon Park,Sungho Lee,Kangyoon Lee,Ji Young Jang 대한외과학회 2022 대한외과학회 학술대회 초록집 Vol.2022 No.5

Risk Factors Associated with 30-day Mortality in Patients with Postoperative Acute Kidney Injury Who Underwent Continuous Renal Replacement Therapy in the Intensive Care Unit

Kang Yoon Lee,Park Kwanhoon,Lee Sungho,Ji Young Jang,배금석 대한외상중환자외과학회 2022 Journal of Acute Care Surgery Vol.12 No.2

Purpose: To evaluate the risk factors associated with 30-day mortality in patients with postoperative acute kidney injury who underwent continuous renal replacement therapy (CRRT).Methods: Retrospective analysis of the medical charts of patients with postoperative acute kidney injury who underwent CRRT in the intensive care unit between April 2012 and May 2019 was conducted.Results: There were 71 patients whose average age was 64.8 years, and average Acute Physiology and Chronic Health Evaluation 2 score was 26.2. There were 37 patients who had non-trauma emergency surgery, 16 who required trauma surgery, and 18 who had elective major surgery. In most patients, CRRT was started based on Stage 3 Acute Kidney Injury Network criteria, and the mean creatinine level at the time of CRRT initiation (3.62 mg/dL). The median period from surgery to CRRT was 3 days, and the median CRRT application was 4 days. Forty-seven patients died within 30 days of receiving CRRT. Age, elective major surgery, creatinine level on initiation of CRRT, use of norepinephrine upon the initiation of CRRT, and average daily fluid balance/body weight for 3 days following the initiation of CRRT were associated with increasing 30-day mortality in univariate analysis. In multivariate analysis, age, major elective surgery, and norepinephrine use upon initiation of CRRT were identified as independent risk factors for 30-day mortality.Conclusion: Surgical patients who underwent CRRT postoperatively had a poor prognosis. The risk of death in elderly patients who have undergone major elective surgery, or are receiving norepinephrine upon initiation of CRRT should be considered.

Clinical Outcome of Fine Needle Aspiration Cytology and Washout Thyroglobulin in Suspicious Lymph Nodes in Differentiated Thyroid Carcinoma: Discordant Results in Real-World Practice

( Jeongmin Lee ),( Hye Lim Park ),( Kwanhoon Jo ),( Min-hee Kim ),( Ja Seong Bae ),( Sohee Lee ),( Chan Kwon Jung ),( So-lyung Jung ),( Dong-jun Lim ) 대한갑상선학회 2021 International Journal of Thyroidology Vol.14 No.1

Background and Objectives: Fine needle aspiration cytology (FNAC) combined with washout thyroglobulin (Tg) measurement is the gold standard for the evaluation of metastatic lymph nodes (LNs) in thyroid cancer. However, few studies have assessed the clinical outcomes of discordant results between FNAC and washout Tg based on surgery status and follow-up imaging in real-world practice. Materials and Methods: A total of 707 LNs in 512 patients who underwent FNAC and washout Tg measurements from 2015 to 2017 were analyzed. The final LN outcomes were confirmed through postoperative histology, or through metastatic FNAC findings combined with high washout Tg level, follow-up imaging studies, or repeat FNA, if LNs were not dissected. Results: The cut-off values of washout Tg for indicating LN metastasis in preoperative and postoperative LNs were 9.6 ng/mL and 2.1 ng/mL. The diagnostic accuracy was improved by applying washout Tg according to surgery status and the results of discordant rate was reduced, Discordant between results of FNAC with washout Tg and final outcome were 9.2% (27/295) of preoperative LNs and 8.7% (36/412) of postoperative LNs. Due to inconclusive results, unnecessary neck dissection can occur in 13.9% (36/259 dissected cases). Conclusion: To improve diagnostic accuracy, cut-off values of washout Tg should be applied depending on surgery status. New biomarkers in washout fluid is necessary to resolve discordant findings.

Procalcitonin as a Predictive Factor for the Clinical Outcome of Patients with Coronavirus Disease 2019

Sungho Lee,Lee Jung Mo,Choi Taeyang,Park Kwanhoon,Lee Kang Yoon,Ji Young Jang 대한외상중환자외과학회 2022 Journal of Acute Care Surgery Vol.12 No.2

Purpose: The coronavirus disease 2019 (COVID-19) pandemic continues. It has been reported that patients with bacterial coinfection have a higher mortality rate than patients without coinfection. However, there are no clear standard guidelines for the use of antibacterial drugs. Therefore, the purpose of this study was to determine the usefulness of procalcitonin, a specific indicator of bacterial infection, as a biomarker for predicting death in COVID-19 patients.Methods: This was a retrospective study of confirmed COVID-19 patients (<i>N</i> = 283) between December 2020 and February 2021 who survived or died. Logistic regression analysis was performed to determine whether there was an association between the level of procalcitonin and death. In addition, receiver operating characteristic curve analysis was performed to determine the usefulness of procalcitonin as a predictor of death.Results: In the non-survivor group, age, the number of patients transferred from a health care center, segment neutrophil ratio, C reactive protein, ferritin, and procalcitonin were significantly higher in the survivor group. In multivariate analysis, procalcitonin was identified as an independent factor associated with death (hazard ratio 6.162, confidential interval 2.285-26.322, <i>p</i> = 0.014). In addition, the predictive power of procalcitonin level and mortality was statistically significant using receiver operating characteristic curve analysis which gave an area under the curve value of 0.823, a cut-off value of 0.05, a sensitivity of 72.2%, a specificity of 87.5% (<i>p</i> < 0.001).Conclusion: Measurement of procalcitonin and other biomarkers may be useful to determine whether to use or discontinue use of antibacterial drugs in patients with COVID-19.

[Trauma / Critical Care / Emergency Surgery] Preventable Death in Trauma Patients in Non-Regional Trauma Center: Single Center Study

Wooram Choi,Ji Young Jang,Sungho Lee,Kwanhoon Park,Kangyoon Lee 대한외과학회 2022 대한외과학회 학술대회 초록집 Vol.2022 No.11

Cytomegalovirus Induced Interstitial Nephritis and Ureteral Stenosis in Renal Transplant Recipient

Bae, Sung Ha,Chung, Byung Ha,Park, Yun Kyung,Jo, Kwanhoon,Yang, Chul Woo,Kim, Yong-Soo,Choi, Bum Soon The Korean Association of Internal Medicine 2012 The Korean Journal of Internal Medicine Vol.27 No.4

Analysis of Risk Factors for Peripherally Inserted Central Venous Catheter-Associated Bloodstream Infection

Ji Young Jang,Sungho Lee,Kwanhoon Park,Kang Yoon Lee,Dongbeen Choi 대한외상중환자외과학회 2024 Journal of Acute Care Surgery Vol.14 No.1

Purpose: Despite guidelines on the prevention of central venous line-associated bloodstream infection, itis left to the clinical judgment of the attending physician to determine the risk of infection and how longa central line should remain in place. This study aimed to identify risk factors for peripherally insertedcentral venous catheter (PICC)-associated infection. Methods: This retrospective study included 1,136 patients with a PICC who were hospitalized at theNational Health Insurance Service Ilsan Hospital (January 2015 to January 2022). Electronic medicalrecords were reviewed for patients with positive blood cultures. Patients with suspicion of infection atthe PICC insertion site or with unclear infection at other sites were defined as having a PICC-associatedinfection. Results: Thirty-five patients (3.08%) had a PICC-associated infection. There were significant differencesin hypertension (p = 0.026), lung disease (p = 0.001), PICC duration > 14 days, and antibiotic use beforePICC insertion (p = 0.016) between no PICC-associated infection, and infection in the bloodstream. Total parenteral nutrition with PICC was not significantly different between groups. Logistic regressionanalysis identified hypertension, lung disease, PICC duration > 14 days (OR 2.088, 95% CI 1.032-4.224, p = 0.041), and antibiotic use before PICC insertion (OR 0.159, 95% CI 0.049-0.515, p = 0.002) asindependent risk factors for PICC-associated infection. Conclusion: The study suggested that PICCs maintained longer than 14 days is a risk factor for PICC-associated infection. Antibiotic use prior to PICC insertion was observed as a negative factor for PICC-associated infection.