응급실 다방문환자의 임상적 고찰

최마이클승필,서강석,감신,서준석,이정호,설동환,정제명,박정배,김종근 대한응급의학회 2003 大韓應急醫學會誌 Vol.14 No.5

성인 중증 중독환자 예측을 위한 새로운 지표 개발: aBIG score for poisoning

최마이클승필 ( Michael Sung Pil Choe ),안재윤 ( Jae Yun Ahn ),강인구 ( In Gu Kang ),이미진 ( Mi Jin Lee ) 대한임상독성학회 2014 대한임상독성학회지 Vol.12 No.1

Purpose: The objective of this study was to develop a new scoring tool that is comprehensively applicable and predicts fatality within 24 h of intoxication. Methods: This was a cohort study conducted in two emergency medical centers from 2011 to 2012. We identified factors associated with severe/fatality. Through a discriminant analysis, we devised the aBIG (age, Base deficit, Infection, and Glasgow coma scale) score. To compare the ability of aBIG to predict intoxication severity with that of previous scoring systems such as APACHE II, MODS, SAPS IIe, and SOFA, we determined the receiver operating characteristic curves of each variable in predicting severe-to-fatal toxicity. Results: Compared with the mild/moderate toxicity group (n=211), the severe/fatal group (n=143) had higher incidences of metabolic acidosis, infection, serious mental change, QTc prolongation and hepato-renal failure. Age, base deficit, infection-WBC count, and Glasgow Coma Scale were independently associated with severe/fatal poisoning. These variables were combined into the poisoning “aBIG” score [0.28×Age group+0.38×WBC count/103+0.52×Base deficit+0.64×(15-GCS)], which were each calculated to have an area under the curve of 0.904 (95% confidence interval: 0.868-0.933). The aBIG poisoning score had an equivalent level of severity predictability as APACHE II and a superior than MODS, SOFA, and SAPS IIe. Conclusion: We developed a simplified scoring system using the four variables of age, base deficit, infected leukocytosis, and GCS. The poisoning aBIG score was a simple method that could be performed rapidly on admission to evaluate severity of illness and predict fatal severity in patients with acute intoxications.

노인외상환자의 사망률에 영향을 미치는 인자

김종근,최마이클승필,이정헌,박정배,서강석,윤영국 大韓應急醫學會 1999 대한응급의학회지 Vol.10 No.3

Background : The goal of this study is to identify the factors that predict mortality in elderly trauma patients. Methods : We reviewed retrospectively the medical record of 144 cases of geriatric trauma admitted to Kyungpook National University Hospital from January 1998 to December 1998. We evaluated the general characteristics, mechanisms of injury, Revised Trauma Score(RTS), Injury Severity Score(ISS), Probability of survival(Ps) by TRISS(Trauma and Injury Severity Score) method, amount of blood transfused, preexisting disease, complications, length of stay, and mortality. Results : 1. The mean age was 75.39 ±7.89 years old, and male to female ratio was 0.89:1. 2. The mechanisms of injury were primarily falls(56.3%) followed by bicycle or motorcycle(13.9%), and pedestrian injuries(13.2%) and motor vehicle accidents(6.9%). 3. The mean Glasgow Coma Scale(GCS), RTS and ISS are 13.3 ±3.5, 7.2 ±1.4 and 14.2 ±11.6 respectively. 4. The actual mortality rate was 18.1% (26/144명). But by TRISS method, predicted mortality rate was 9.3%(12.5/144명), excess mortality rate was 108% and Z score was 3.99 indicating that actual number of death exceed predicted number of death. 5. Between the survivors and nonsurvivors, the results were significantly different as follows ; systolic blood pressure(141.9 ±28.3 vs. 116.8 ±48.7 mmHg), GCS(14.3 ±2.0 vs. 9.0 ±5.1), RTS(7.8 ±0.7 vs 5.4 ±2.3), ISS(11.3 ±5.6 vs 27.2 ±20.2), Ps by TRISS(0.97 ±0.06 vs 0.65 ±0.37), preexisting diseases(50.8 vs 69.8%). Conclusion : Geriatric patients are more likely to die after trauma than other age groups. The cause of higher actual mortality rate compared to predicted mortality rate was considered as the higher incidence of delayed death due to sepsis or multiple organ failure. In order to reduce the mortality, even with relatively stable initial vital sign, invasive hemodynamic monitoring and intensive treatment are recommended and also, prevention and treatment of nosocomial infection are very important.

병원 전 심정지 환자의 심폐소생술의 분석

김종근,최마이클승필,서강석,설동환,박정배,정제명 대한응급의학회 2002 대한응급의학회지 Vol.13 No.1

Purpose: The purpose of this research is to estimate the overall survival rate and to understand the factors influencing hospital discharge when cardiopulmonary resuscitaion is attempted on out-of hospital cardiac arrest victims. Methods: From March 2000 to February 2001, we studied prospectively 71 consecutive victims with out-of-hospital cardiac arrest. We used the same record based on the "Utstein Style". Results: Fifty-three of the 71 patients were transported by 119 ambulance; the remainder were transported by non-119 ambulance. An initial rhythm of pulseless electrical activity(PEA) was present in 66.2% of the patients, ventricular fibrillation (VF)/ventricular tachycardia in 22.5%, and asystole in 11.3%. Fifty-five of the 71 (77.5%) were cardiac arrest cases witnessed by a layman. The number of cardiac etiologies was 24 (33.8%), non-cardiac etiologies 36 (50.7%), and unknown causes 11 (15.5%). There were no statistical differences in return of spontaneous circulation (ROSC) and survival rate related to the causes of cardiac arrest, initial EKG rhythm, and method of transportation. Of the 71 patients, 29 patients,(40.2%) experienced ROSC; seven patients survived. Conclusion: With the increase in cardiovascular disease and traffic accidents, the number of out-of hospital cardiac arrests has risen accordingly. However, the survival rate has not changes much compared to the past. Major factors contributing to the unchanged survival rate are lack of bystander CPR, defibrillation in the prehospital stage, inappropriate CPR by EMT, early pronouncement of death, and unskilled CPR by the physician, and improvement in these areas are necessary in order to bring about a change.

대한응급의학회지에 게재된 연구의 부적절한 사후‐검정력 분석

류현욱,이미진,최마이클승필,김종근 대한응급의학회 2013 대한응급의학회지 Vol.24 No.4

Purpose: Negative studies provide valuable information. However, conducting studies with inadequate power is unethical and an inefficient use of resources. Moreover,inaccurate interpretations from underpowered studies result in false conclusions that alter clinical interventions and deter further research. The purpose of this study was to determine the prevalence of negative studies with inadequate power in the Journal of the Korean Society of Emergency Medicine (JKEM). Methods: We assessed all papers in JKEM from 2009 to 2012. We sought published evidence that a post-hoc power analysis had been performed in association with the main hypothesis of the paper. All clinical research studies containing the phrase “no difference” were identified. Data necessary for power calculation were extracted from applicable studies. Results: There were a total of 351 papers in which a statistical comparison was undertaken. Out of 351 original articles,170(48.4%) were negative studies that contained enough information for analysis. Out of 126 negative studies in JKEM, only 21(16.7%) had performed a power analysis demonstrating adequate sample size. In addition, only 6.3% of dichotomous variable articles and 10.3% of continuous variable articles had adequate power. Levels of adequate power in negative studies did not improve over time (p=0.148). Conclusion: Many negative studies in JKEM are inconclusive because they lack the adequate power to detect even large differences between groups. Therefore, it is imperative to consider power when interpreting the literature. When designing future research, power calculations should be performed to ensure sufficient patient recruitment to attain clinically meaningful results.

일개 병원에서의 응급실을 방문한 패혈성 폐쇄성 요로감염 환자에 대한 고찰

박재형,김성훈,최마이클승필,제동욱,노우영,박홍인,신수정,박용석,박창원,이미진,안재윤,이동언,문성배,김창호,이숙희 대한응급의학회 2020 대한응급의학회지 Vol.31 No.3

Objective: Unlike common acute urinary tract infections, obstructive urinary tract infections caused by urinary calculus can be fatal because they can progress to sepsis and cause shock or disseminated intravascular coagulation. The evidence of patients with obstructive urinary tract infections caused by urinary tract stones visiting the emergency center is still lacking. Methods: Seventy-seven patients who visited the emergency room with obstructive urinary tract infections caused by urinary calculus from January 2016 to December 2018 were enrolled in this study and divided into two groups: sepsis group and non-sepsis group. Results: The lymphocyte count, platelet count, neutrophil-lymphocyte ratio, serum creatinine, and C-reactive protein were significantly different in the sepsis-positive and negative groups. Percutaneous nephrostomy was also significantly higher in the sepsis-positive group. The area under the receiver operating characteristic curve was calculated to evaluate the ability of the neutrophil-lymphocyte ratio and platelet-lymphocyte ratio to predict a septic urinary tract infection. The neutrophil-lymphocyte ratio and platelet-lymphocyte ratio were 0.659 and 0.550, respectively. Multivariate logistic regression analysis showed that diabetic patients, percutaneous nephrostomy, and serum creatinine were associated with septic obstructive urinary tract infection. Conclusion: In patients with an obstructive urinary tract infection who were referred to the emergency center, diabetic patients and those with high blood urea nitrogen and creatinine levels are at high risk of sepsis. In such cases, rapid diagnosis and treatment, such as percutaneous nephrostomy, are necessary.

응급실로 내원한 비외상성 복막염 환자의 위험 예측 모델로서 P-POSSUM 및 맨하임 복막염 지수(Mannheim Peritonitis Index) 평가를 위한 단일 응급센터 연구

김보람,김성훈,최마이클승필,최대해,제동욱,노우영,이수형,조선호,김신우,김형욱,이정식 대한응급의학회 2022 대한응급의학회지 Vol.33 No.2

Objective: Peritonitis is a life-threatening, emergent surgical disease with very high mortality and morbidity. Currently, there are insufficient Korean studies using the P-POSSUM (Portsmouth-Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity) and the Mannheim Peritonitis Index (MPI) as risk prediction models for nontraumatic peritonitis patients who visit the emergency room. Methods: This retrospective study was carried out on 196 cases of non-traumatic peritonitis in a single emergency center from January 2015 to December 2019. Receiver operating characteristic (ROC) curves were obtained and the area under the ROC curve (AUC) was compared using both P-POSSUM and MPI. The observed mortality and expected mortality for P-POSSUM were compared using the goodness of fit assessed using the Hosmer-Lemeshow equation. Results: Diastolic blood pressure, blood urea nitrogen, potassium, length of stay, and intensive care unit admissions were significantly different between survivors and non-survivors. The AUC was 0.812 for P-POSSUM and 0.646 for MPI. The observed-to-expected mortality ratio for P-POSSUM indicated fewer than expected deaths in all quintiles of risk and this was more pronounced, especially when the expected mortality was over 60%. Conclusion: In non-traumatic peritonitis patients, P-POSSUM was more useful in predicting risk than the MPI score. However, P-POSSUM overestimated the risk in high-risk patients. Although the MPI score is only somewhat useful for predicting mortality in patients with non-traumatic peritonitis, it is useful as an adjuvant.

일개 병원에서 실신으로 응급실을 내원한 환자에게 적용한Canadian Syncope Risk Score에 대한 고찰

박용석,이경화,최마이클승필,제동욱,김성훈,노우영,박홍인,신수정,이미진,안재윤,이동언,문성배,이숙희 대한응급의학회 2018 大韓應急醫學會誌 Vol.29 No.2

Objective: Syncope is mostly benign, but it can also be caused by a life-threatening situation. In Korea, no studies have investigated application of the Canadian Syncope Risk Score (CSRS) to patients with syncope; therefore, this study was started to evaluate the usefulness of CSRS. Methods: A total of 222 patients who visited the emergency room with syncope for one year from January 2016 to December 2016 were enrolled in this study. Patients were divided into two groups, a serious adverse events (SAE) group and a non-serious adverse events group. The scores of the nine CSRS variables were added and the CSRS was then calculated after the addition. Results: The CSRS score for patients with SAE ranged from 0 to 8. The CSRS score was 18.6%, 31.7%, 55.6%, and 58.8% for 0, 1, 2, and 3, respectively. In the case of CSRS 0 and 1, 17 patients (81.0%) and 11 patients (84.6%) were non-cardiac. In the case of CSRS 2, 7 were non-cardiac (70.0%). In the case of CSRS 3, 6 cases (60.0%) were cardiogenic and 4 cases (40.0%) were non-cardiogenic. The area under the receiver operating characteristic curve of CSRS to predict SAE was 0.71. Setting the CSRS cutoff value to 0, we found that sensitivity and specificity of predicting SAE was 67.19% and 67.09%, respectively. Conclusion: CSRS may be difficult to predict for acute intracranial disease or acute hemorrhagic disease requiring transfusion; therefore, it is necessary to supplement it further.

119 구급대의 간접의료지도 프로그램 만족도 조사

이창재,제동욱,고대이,최마이클승필 대한응급의학회 2014 대한응급의학회지 Vol.25 No.1

Purpose: The purpose of this study was to identify thedegree of satisfaction with indirect medical oversight programsand its determinants. Methods: Gumi 119 rescuers participated in indirect medicaloversight programs, including Emergency MedicalServices (EMS) record review, weekly visiting education,and monthly EMS conference from March 2012 to February2013. Data were collected using a mail survey with a selfadministeredquestionnaire. The degree of satisfaction withthe programs was categorized according to two groups(1=satisfied, 2=unsatisfied). Then the Mann-Whitney U testand Fisher’s exact test were performed in order to find statisticallysignificant factors influencing satisfaction. Results: Cronbach αof questionnaires was 0.869. Amongthe 59 questionnaires, 55(93.2%) were returned. No differencesin sex, age, career, EMS record review, monthly conference,linkage with direct medical direction, and improvementof confidence in ER medical team were observedbetween the two groups. Qualification, weekly visiting program,and improvement in reliability to hospital showed statisticalsignificance (p=0.017, 0.040 and 0.001, respectively). Conclusion: The level of qualification of 119 rescuers andweekly visiting education at the fire department by doctorshas had a significant influence on satisfaction with indirectmedical oversight.

의식변화를 주 증상으로 내원한 응급실 노인환자의 임상적 고찰

이정호,서준석,설동환,최마이클승필,서강석,박정배,정제명 대한응급의학회 2004 대한응급의학회지 Vol.15 No.1

P u r p o s e: The number of geriatric patients admitted to the emergency department (ED) is growing as the elderly population grows. The altered mental status of the elderly is more difficult to evaluate and manage than others. The purpose of this study was to determine the etiologies of altered mental status in elderly patients visiting the ED. M e t h o d s: A retrospective study was made of 119 patients who visited the ED of Kyungpook National University Hospital for altered mental status from January 2001 to June 2002. R e s u l t s: The results of this study showed that extracranial causes (67.8%) were more than intracranial causes (31.9%): metabolic (35.3%), cerebrovascular (29.4%), extracranial infection (16.0%), cardiovascular (8.4%), drugs/toxins (8.4%), and intracranial infection (2.5%). The group with underlying disease or with brain imaging done showed more intracranial causes than extracranial causes. The results showed that the age, the initial Glasgow coma scale (GCS) score, a new positive finding on a brain image, and the causes of the mental change had significant influence on improvement of the mental status and on the survival rate (p < 0.05). C o n c l u s i o n: Initial evaluation of the underlying disease, the GCS score, an early study of brain imaging, and a search for possible metabolic causes, as well as others should be done simultaneously to deliver high quality care to elderly patient. Knowledge of the most frequent causes of altered mental status in elderly patients may assist the emergency physician in the approaching these potentially ill patients and managing their care.