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심정지 후 저체온 치료를 시행한 환자군에서 혈액응고검사를 이용한 신경학적예후의 예측
이두효,오주석,김성욱,최경호,박규남 대한응급의학회 2015 대한응급의학회지 Vol.26 No.1
Purpose: The purpose of this study is to clarify the clinical significance of coagulation factor as a prognostic tool in patients with cardiac arrest treated with therapeutic hypothermia (TH). Methods: We designed a retrospective case review study in one university hospital. All adult patients who suffered cardiac arrest from December 2011 to February 2014 were considered for inclusion in the study. Patients who did not undergo TH were excluded from the analysis. Patients with any hematologic disorder were also excluded. Patients were divided into two groups, the good outcome group and the poor outcome group depending on the final cerebral performance category (CPC). Serum D-dimer, FDP, PT, aPTT, anti-thrombin III, fibrinogen, Troponin T, CK-MB, Troponin-I, DIC score, NSE, and S-100 were taken within one hour after ROSC. Logistic regression was used for multivariable analysis. Results: A total of 92 patients were included; 22 in the good outcome group, 70 in the poor outcome group. The median serum PT, aPTT, FDP, fibrinogen, and D-dimer levels were grossly elevated in the poor outcome group. Only serum PT, D-dimer level showed significant association with poor outcome (PT: OR=1.577; 95% CI=1.08-17.49, Ddimer: OR=1.577; 95% CI=1.06-2.33). The area under the receiver operating characteristic (AUC) of PT, D-dimer, and S-100 for prediction of poor outcome was 0.822 (95% CI=0.72-0.89), 0.68 (95% CI=0.57-0.77), and 0.811 (95% CI=0.70-0.89), respectively. Other factors were not associated with prognosis. Conclusion: Increased PT and D-dimer levels are significantly associated with poor outcome. PT and D-dimer values have potential for use as new prognostic predictors along with the current prognostic factor, S-100 protein.
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경부 관통상 환자에서 표재성 손상과 심부 손상을 구별할 수 있는 임상 예측 인자
정우한,최경호,오영민,최세민,오주석,박정택,이두효,김기욱,홍성엽,정현호 대한응급의학회 2022 대한응급의학회지 Vol.32 No.6
Objective: The frequency of penetrating neck injuries has gradually increased with the development of industry and the rising crime rates. There have been few studies with penetrating neck injuries reported in Korea. Thus, we analyzed clinical factors that could differentiate between superficial and deep injuries in patients with penetrating neck injuries. Methods: We investigated the medical records of 90 patients with penetrating neck injuries who visited the emergency department between January 2010 and March 2020. To identify the degree of injuries, we compared age, sex, onset and arrival time, onset-to-arrival time, initial vital signs, Glasgow Coma Scale, Revised Trauma Score, cause, mechanism, location and number of injuries, anatomical zone, alcohol intake and psychiatric history were classified as early clinical factors. Results: Among 90 patients, 51 had superficial injuries, and 39 had deep injuries. The early clinical factors showing statistically significant differences were the Glasgow Coma Scale, Revised Trauma Score, cause of injury and anatomical zones. As the Glasgow Coma Scale increased by 1 point, deep injuries decreased by 0.807 times compared to superficial injuries. Homicidal injuries were 3.233 times deeper than suicidal injuries. Conclusion: If the Glasgow Coma Scale is low or the cause of injury is homicide, the possibility of a deep penetrating injury is high. Therefore, it is important to treat the patient carefully, considering these factors.
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