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외상성 급성 뇌경막하출혈에서 수술시간이 예후에 미치는 영향
김갑득 대한응급의학회 2000 대한응급의학회지 Vol.11 No.4
Background: Traumatic acute subdural hematoma remains one of the most lethal of all head injuries. It has been strongly held that the critical factor in the overall outcome from acute subdural hematoma is the timing of operative intervention for clot removal; those operated on within 4 hours of injury may have a marked decrease in mortality and morbidity. Methods: Data were reviewed for 79 patients with a traumatic acute subdural hematoma during 2 years between January 1997 and December 1998. Treatment protocol included rapid operative intervention and aggressive postoperative control of intracranial pressure. Results: The overall mortality rate was 63.3%, and 21.5% had functional recovery. The following variables statistically correlated(p<0.05) with the outcome: admission GCS score, pupil changes, and compression of basal cisterns on computerized tomography. Earlier surgical removal of the hematoma had a better prognosis according to a statistical analysis using the multiple linear regression method(p<0.05). However, there was no difference in mortality between patients operated on within 4 hours of injury and those undergoing surgery 4 hours or longer after the injury. Conclusion: Earlier surgical removal of the hematoma has a better prognosis, but the operative timing-within the first 4 hours-may not be critical to the outcome.
급성 외상성 두개강내출혈에서 수술시간이 사망에 미치는 영향
김갑득 大韓應急醫學會 1998 대한응급의학회지 Vol.9 No.4
To discover the effects of the time from injury to operative evacuation of the acute intracranial hematoma in the regard to improve outcome mortality, we reviewed the records 90 traumatic patients with acute intracrainal hematoma treated at our hospital between 1996 and 1997. The overall mortality rate was 50%. The important prognostic variables included Glasgow coma scale(GCS), age, degree of midline shift in computerized tomography(CT), and lesional type of hematoma. Outcome was not significantly improved by rapid surgical decompression and no benefit revealed when surgery was performed within first 4 hours. The mean interval from injury to surgery was 411 minutes for patients who died and 404 minutes for patients with functional recovery, but it was statistically insignificant. The mortality rate for those patients operated on within 4 hours of injury was 44% versus 52.3% for those operated on after 4 hours, and it was also statistically insignificant. In our opinion impact brain damage may be substantial and will affect recovery from intracranial hematoma and the operative timing - within the first 4 hours - may not be critical as has been commonly held.
경도 외상성뇌손상에서 뇌진탕후증후군을 예측할 수 있는 임상소견
김갑득 대한응급의학회 2013 대한응급의학회지 Vol.24 No.1
Purpose: Mild traumatic brain injury (mTBI) is defined as head injury resulting from blunt trauma with one or more of the following conditions: 1) any period of transient confusion,disorientation, or impaired consciousness; 2) any period of dysfunction of memory (amnesia) around the time of injury; 3) observed signs of other neurological or neuropsychological dysfunction; 4) any period of loss of consciousness lasting 30 minutes or less. As a result of its subtle computed tomography (CT) findings, patients with mTBI were almost ordered discharged in the emergency setting. However, postconcussion syndrome (PCS) could develop in approximately 10 to 20% of these patients. This study was conducted in order to investigate the prognostic factors of PCS, and the role of magnetic resonance imaging (MRI)for diagnosis of PCS in mTBI patients. Methods: This retrospective study was conducted in 397patients who were admitted with mTBI (GCS=15, age≥6years old) for analysis of the prognostic factors of PCS, and 187 patients who underwent both CT scan and MRI for comparison of the sensitivity of CT to that of MRI from January 2009 to December 2010. PCS was defined as a disorder with somatic, cognitive, or affective symptoms. Results: Of the mTBI patients, 44.2% had PCS. The independent prognostic factors were loss of consciousness (LOC)/posttraumatic amnesia (PTA), headache, and intracranial hemorrhage on CT scans. Strong suggestive CT findings of PCS were lesions located in intra-axial and white matter, subdural hematoma, and intraprenchymal contusion of the frontal or temporal lobe. A decision model for prediction of PCS in mTBI consisted of three risk factors:LOC/PTA, headache, facial fracture, and intracranial hemorrhage on CT scans. The sensitivity of MRI was superior to that of CT in detection of PCS (72.4.4% vs 60.9%,p=0.021). Conclusion: The possibility of developing PCS was high in mTBI patients with LOC/PTA, headache, and abnormal CT findings. These patients may require MRI evaluation.
김갑득 대한응급의학회 2011 大韓應急醫學會誌 Vol.22 No.3
Purpose: Facial fractures are highly associated with cervical spine or spinal cord injuries. Nevertheless, disagreement exists as to the actual incidence of cervical spinal trauma in conjunction with various facial fracture patterns. The purpose of this study was to evaluate the incidence of cervical spine injuries associated with various types of facial fractures. Methods: A retrospective review from 2003 to 2009 was performed on 4440 patients with facial fractures who presented to the emergency room of our hospital. Facial fractures were grouped into thirds. Cervical spine injuries were divided into one of two groups including upper cervical injuries (C0-C2)and lower cervical injuries (C3-C7) and included fractures,dislocation, and disc herniation with or without neurological deficits. The chi-square test and multivariate logistic regression analyses were used to identify associations between facial fractures and cervical spine injuries. Results: Among all patients with facial fractures, 80(1.85%)also had cervical spine injuries. Independent risk factors for cervical spine injury in patients with facial fracture were male gender (odds ratio [OR]=2.0), high velocity mechanism of injury (OR=4.0), and upper-third (OR=2.8) or combined facial fractures (OR=1.8). Cervical spine injuries increased in patients with high-force facial fractures. Fractures of the upper face were associated with an increased likelihood of lower cervical spine injuries and lower-third facial fractures were associated with an increased likelihood of having an upper cervical spine injury. Conclusion: Facial fractures were commonly associated with cervical spine injuries. The cervical spine must be examined carefully whenever facial injuries are present.