2차와 3차 병원에서 외상 치료의 적정성 비교

홍석현 ( Suk Hyun Hong ),한갑수 ( Gap Su Han ),정상헌 ( Sang Hun Jung ),전정민 ( Chung Min Chun ),최성혁 ( Sung Hyuk Choi ),이성우 ( Sung Woo Lee ),홍윤식 ( Yun Sik Hong ) 대한외상학회 2005 大韓外傷學會誌 Vol.18 No.1

본 연구에서는 응급처치 및 중환자 처치 능력의 확충이 중증 외상환자 치료에 미치는 영향을 알아보고자 두 기간 동안 대도시의 3차 병원과 중소도시의 2차 병원에서 외상치료의 적정성을 비교하였다. 응급 및 중환자 처치 능력의 확충 이후, 2차 병원은 타 병원으로의 전원 없이도 중증 외상 환자를 치료할 수 있게 되었으며, 생리학적 외상 치료 능력이 향상되어 보다 정확한 외상 치료가 가능해 졌다. 비록 특별하게 고안된 외상 센터가 아니라 하더라도, 잘 구축된 응급 의료 체계하에서 지역별로 응급 및 중 환자 처치 능력을 강화하면 외상 환자 치료 성적을 향상 시킬 수 있을 것이다. Background: This study compared the performance of trauma care in an urban and a suburban hospital before and after the enhancement of emergency and intensive care. Method: The medical records of patients who were admitted to the intensive care unit following trauma from 1994 to 1995 and from 2002 to 2003 were examined. The standardized W (Ws), the 95% confidence interval (CI) of the Ws, and the predicted survival rate (Ps) were calculated. During each period, each hospital`s actual survival rate was compared with the 95% CI of the Ps according to the revised trauma score (RTS) and injury severity score (ISS). Spell out RTS and ISS. Result: From 1994 to 1995, 225 and 121 records from the urban and the suburban hospitals were reviewed, respectively. The 95% CI`s of the Ws were -2.30 to 2.73 and -11.40 to -5.90, respectively. The actual survival rate of the suburban hospital was significantly lower than the predicted survival rate at all RTS. From 2002 to 2003, 315 and 268 records from the urban and the suburban hospitals were reviewed, respectively. The 95% CI`s of the Ws was -3.56 to 0.24 and -3.73 to 0.26, respectively. There was no difference between the actual survival rate and the predicted survival rate. Conclusion: An enlargement of the capacities of emergency and intensive care may improve the performance of trauma care at a small suburban hospital.

노인외상환자의 예후 인자

문철규,전정민,최성혁,문준동,이성우,홍윤식 大韓應急醫學會 1999 대한응급의학회지 Vol.10 No.2

Background: It has been documented that certain prognostic factors may affect the outcomes of the old aged victims by trauma. Considering that trauma is the sixth most common cause of death in people over the age of 65 years and there is a rapid growth of elderly population, it is paramount to understand the prognostic factors when dealing with geriatric trauma patients. Hypothesis and Goals: It can be hypothesized that the prognostic factors should be determined independently between populations being consisted of different races, countries, socio-economic states, cultures, or so on. Thus, the study was designed to evaluate the factors affecting the outcomes of elderly Korean trauma patients. Methods: One hundred forty six patients aged over 65 years were retrospectively reviewed, who visited the Emergency Center of Korea University from January, 1997 to June, 1998. Of 146 patients, 7 were excluded due to discharge against advice or transfer to the other hospitals. Parameters analyzed were age, sex, mechanism of injuries, body region injured, Injury Severity Score (ISS), previous medical illness, hospital morbidity, duration of hospital stay, and cost. Each patient was classified into improved or not-improved group depending on the outcomes, and young-old or old-old group depending on the age. The factors affecting the hospital stay in improved patients were analyzed in the parameters of previous medical illness, hospital morbidity, multiple injuries, ISS, and age. All statistical tests were conducted with two-tailed levels of 0.05. Results: Of 139 patients, the mean age was 74±7.1 years, mean ISS 9.3±7.26, mean hospital stay 27±27.1 days. Most commonly injured body region was the extremities due to fall from a level surface. Rate of previous illness showed 0.94 medical diseases per person and were aggravated after trauma in 39 patients (60.9%). Hospital morbidity rate was 0.46 incidents per person. There were no differences in age and duration of hospital stay between the improved and the not-improved group. Substantial differences were noted in affected body region, incidence of previous illness, and hospital morbidity between the groups (p=NS). Not-improved group had higher ISS(p<0.05). ISS, previous illness and hospital morbidity affected the duration of hospital stay in the improved group. Hospital stay was 40±25.1 days in patients with ISS over 6 while 6±8.6 days in those with ISS 5(p<0.05). Hospital stay in the improved was 26±26.9 days while 31±24.8 days in the improved old-old group (p=NS). Hospital stay in the young-old minor trauma (ISS5) patients with previous illness and hospital morbidity was 26±10.1 days while 4±7.3 days in those without previous illness and hospital morbidity (p<0.05). Conclusion: Previous medical illness and hospital morbidity, not age, are predictive of outcomes of geriatric trauma patients with respect to hospital stay. As most of the hospital morbidity was a trauma-induced aggravation of previous medical illness and hospital morbidity contributing poor outcomes can be potentially avoidable, routine aggressive care for the geriatric trauma patients with previous medical illnesses is needed.

Zipeprol dihydrochloride(RESPILENE??) 중독에 의한 근 긴장 이상증(Dystonia) -증례 보고-

전정민,이성우,홍윤식 대한응급의학회 1996 대한응급의학회지 Vol.7 No.3

Zipeprol dihydrochloride is a non-essential but widely used antitussive, which is not considered as being capable of creating dependence or abuse liability. But some experimental study (Morreti-V, 1989) resulted indicate zipeprol as moderate opioid agonist. And zipeprol abuse and it's side-effect have been rarely reported. It included seizure, cerebral edema, abnormalities of posture and gait. We have experienced a case of parkinsonic dystonic movement disorder induced by zipeprol abuse. A 21-year-old male was admitted in August, 1995, with a symptom of abnormalities of posture and gait. He had ingested 3000mg zipeprol per day for 3 years. He recovered after anticholinergics therapy. His Brain MRI, EEG showed no abnormality. High doses of zipeprol, therefore, exert a generalized irritating cortical effect together with a localized, neurotoxic effect which proved to be transient. Zipeprol should be much more strictly controlled and more through follow-up in respect of side-effects of therapeutic use and abuse are recommended.

외상성 기흉에 동반된 후복막기종 : 증례보고 Case Report

홍윤식,이성우,최성혁,전정민,문철규,문준동 대한외상학회 1998 大韓外傷學會誌 Vol.11 No.1

We describe a 23-year-old patient from blunt injury after motor vehicle accident. The cardiorespiratory and mental status were sufficient. He had pneumoretroperitoneum, left pneumothorax, complex zygoma fracture and left clavicle frature. Close drainage of left hemithorax and the diagnostic workups were done for evaluation of retroperitoneal free air. As free retroperitoneal gas has its source in a ruptured retroperitoneal viscus in common case, close attention was paid to possible abdominal symptoms. Abdominal computed tomography failed to demonstrate any pathology except free air in retroperitoneum. Surgical exploration of intraperitoneun and retroperitoneum wasn't revealed any injury. The patient was discharged after fixation of zygomatic fracture. The underlying pathophysiology of free retroperitoneal air in the absence of viscus and diaphragm lesions are discussed and the literatures are reviewed.

상지의 운동제한을 보이는 소아에서 방사선 검사의 필요성

이성우,문성우,윤영훈,이베안,정상헌,전정민,홍윤식 대한응급의학회 2002 대한응급의학회지 Vol.13 No.3

Purpose: The study was designed to identify the necessity of radiographs and to decrease overutilization of radiographs in uncommunicable children who do not move their arms. This study provides clinical guidelines on radiographic evaluation and treatment of children with limited motion in the upper extremity. Methods: The cases of one hundred thirteen pediatric patients under 36 months of age, who had visited the Emergency Center of Korea University Ansan Hospital from January 2000 to December 2001, were retrospectively reviewed. Pediatric patients with upper extremity injuries due to multiple trauma, laceration or motor vehicle accident were excluded. Parameters analyzed were age, sex, mechanism of injury, physical findings, radiographic finding, and injuried upper extremity region. We described focal tenderness and regional edema as physical finding. Each patient without regional edema was classified into an improved or a not-improved group depending on the outcomes after manual reduction. All statistical tests were conducted with two-tailed levels of 0.05. Results: Of the 113 patients, the mean age was 18.6±0.89 months. The most common injury mechanisms were unknown and traction. Minimal edema in the elbow joint was seen in 5 cases, and supracondylar fractures due to short falls were seen in 4 (80%) of those cases (p<0.05). The improved group was finally confined to radial head subluxation in 88 patients. Although all the not-improved-group patients had received radiographs, no abnormal findings were seen in the elbow. However, clavicle fracture due to fall above or from a level surface were seen in 4 cases (20%) of the not-improved group (p<0.05). No difference of injury mechanism existed between the improved and the not-improved groups. Conclusion: Recommand Radiographic evaluations in Children not-used arm with regional edema before manual reduction. But without regional edema, manual reduction of elbow is first. If children without regional edema do not improve after manual reduction of elbow and they are injuried due to fall, children should be assessed for fractures of clavicle.