원저 : 자연기흉의 치료에 있어 소구경 카테터 흉강삽입술의 유용성

류현욱 ( Hyun Wook Ryoo ), 서강석 ( Kang Suk Seo ), 이정호 ( Jeong Ho Lee ), 이경우 ( Kyung Woo Lee ), 김규태 ( Kyu Tae Kim ), 김종열 ( Jong Yeul Kim ) 대한응급의학회 2005 大韓應急醫學會誌 Vol.16 No.1

원저 : 국내 응급의학 분야의 학술인용 현황과 피인용 논문 특성

류현욱 ( Hyun Wook Ryoo ), 이미진 ( Mi Jin Lee ) 대한응급의학회 2013 大韓應急醫學會誌 Vol.24 No.3

Purpose: The purpose of this study was to analyze recent citation trends in an attempt to improve the impact factor (IF) of the Journal of the Korean Society of Emergency Medicine (JKEM). Data from 2001~2012 in the Korean Medical Citation Index (KoMCI) was compared with the average citation data of other Korean emergency medicinerelated journals. Methods: All citation data from all journals listed in the KoMCI and the Web of Science were obtained. The chronological changes in the annual number of published articles and reference citations, total citations and self-citations per paper, IF and impact factor excluding self-citations (ZIF) were described and compared for Korean EM-related journals and the JKEM. Results: The annual number of articles published in JKEM was significantly larger than other EM-related journals. The number of Korean journal references per article is 2.13 papers on JKEM. The mean IF of the KoMCI was 0.153 and the ZIF was 0.050 for 12 years. The annual IF (ZIF) of JKEM has gradually decreased from 0.245(0.102) in 2010 to 0.118(0.035) in 2012. However, other EM-related journals have shown increases in these factors since 2009. The IF calculated from the Web of Science was zero until 2010, but soared from 0.008 to 0.016 from 2011 to 2012, respectively. Conclusion: The citation status of JKEM has steadily decreased over the past 2 years. To make JKEM as a highly- cited journal, an awareness of the academic status of JKEM and active advertising from journal members on the importance of the IF are needed to encourage the citation of its papers.

원저 : 일개 대도시에서의 119 구급대가 자동제세동기를 사용한 병원 전 심정지 환자들에 대한 연구

이현희 ( Hyun Hee Lee ), 서강석 ( Kang Suk Seo ), 정제명 ( Jae Myung Chung ), 박정배 ( Jeong Bae Park ), 류현욱 ( Hyun Wook Ryoo ), 김종근 ( Jong Kun Kim ), 서준석 ( Jun Seok Seo ), 이삼범 ( Sam Beom Lee ), 최우익 ( Woo Ik Choi ), 이경원 () 대한응급의학회 2008 大韓應急醫學會誌 Vol.19 No.3

Purpose: To report characteristics of out-of-hospital cardiac arrest (OHCA) patients in whom 119 rescuers used an automated external defibrillator (AED) in the metropolitan area Methods: 1,689 OHCA patients were transferred to hospitals by 119 rescuers between 1 January and 31 December, 2006. Among them, 106 OHCA patients for whom 119 rescuers used an AED were enrolled retrospectively. Results: Shockable rhythm with AED use was 70.8%, witnessed arrest was 46.2%, and bystander cardiopulmonary resuscitation (CPR) was 6.6%. The most common location of cardiac arrest was in the home, at 74.5%. Response time was 7.1(±3.9) minutes. Chest compression during transport was done by 119 rescuers in 87.7% of cases, and assisted ventilations such as advanced airway management and bag valve mask ventilation were performed by 119 rescuers in 17.0%. Initial ECG findings at ED were asystole(59.4%), PEA(25.5%), VF/pulseless VT(8.5%), sinus rhythm(4.7%), and others(1.9%). The most common etiology of cardiac arrest was presumed cardiac origin in 68.9% of cases. Sustained return of spontaneous circulation (ROSC) was 26.4%. The proportion of patients discharged alive was 11.3%. Conclusion: The performance of bystander CPR and usage of AED, and appropriate CPR done by 119 rescuers were unsatisfactory in metropolitan Daegu. There is a marked need to establish basic life support education in the areas of bystander CPR, and a quantitative and qualitative development of 119 rescue capability.

원저 : 일개 3차병원 응급의료센터의 10년 전후 만족도 비교 분석

제동욱 ( Dong Wook Je ), 김창호 ( Chang Ho Kim ), 성애진 ( Ae Jin Sung ), 서준석 ( Jun Seok Seo ), 류현욱 ( Hyun Wook Ryoo ), 박정배 ( Jeong Bae Park ), 정제명 ( Jae Myung Chung ), 서강석 ( Kang Suk Seo ) 대한응급의학회 2007 大韓應急醫學會誌 Vol.18 No.6

Purpose: To compare differences in overall satisfaction with emergency department (ED) services with the results obtained 10 years previously, in order to study effects of several component factors on patients` willingness to re-visit and to give recommendations. Methods: This study was performed with questionnaires from 318 patients and proxies who were admitted to the emergency ward through the emergency medical center from February 19th, 2007 to March 18th, 2007. Evaluation of data was by frequency analysis, chi-square test, t-test, multiple regression analysis, and path analysis. Results: During a one month study period, 244 patients and proxies (77% of those eligible) completed on-site questionnaires. Sociodemographic factors had no statistically significant influence on satisfaction with ED services. In multiple regression analysis to evaluate the correlation of various factors with satisfaction, the regression coefficients were 0.435(p<0.001) for reliability, 0.248(p<0.001) for accessibility, 0.179(p<0.001) for kindness, and 0.133(p=0.004) for environmental respectively. In path analysis, the direct effect of overall satisfaction on patient willingness for re-visit was 0.582. The direct effect of overall satisfaction reliability on willingness to give recommendations were 0.594, and 0.250 respectively. Conclusion: In slight contrast to the study performed 10 years previously, the factors with the most correlation to overall satisfaction with ED services in this study were environment, kindness of hospital personnel, accessibility, and reliability of medical personnel. We confirmed that overall satisfaction is the most important factor influencing willingness for re-visit and willingness to recommend services, but found that the component factors vary as the point of survey or hospital conditions changes.

원저 : 급성 허혈성 뇌졸중 환자에서 도시-농촌 지역 간 병원 도착 지연의 차이

임창덕 ( Chang Duk Lim ), 류현욱 ( Hyun Wook Ryoo ), 황양하 ( Yang Ha Hwang ), 이미진 ( Mi Jin Lee ), 신수정 ( Su Jeong Shin ), 안재윤 ( Jae Yun Ahn ), 김종근 ( Jong Kun Kim ), 박정배 ( Jung Bae Park ), 서강석 ( Kang Suk Seo ) 대한응급의학회 2013 大韓應急醫學會誌 Vol.24 No.6

Purpose: The aim of this study was to compare the difference in acute stroke management between urban and rural areas, to investigate the factors affecting these differences, and to acquire basic information for establishing an efficient regional hub and spoke system for stroke patients. Methods: This retrospective study was based on adult patients diagnosed with acute ischemic stroke from January 2012 to December 2012 at a regional cerebrovascular center. The term “acute” was defined as 24 hours from symptom recognized. The term “urban” was defined as the region within the boundary of a metropolitan area. The distance from the symptom onset location to the stroke center was calculated using a global positioning system. Results: The rate of arriving at a stroke center within 3 hours after stroke recognition for acute ischemic stroke patients was much higher in urban areas compared to rural areas (27.5 vs. 19.2%, respectively; p-value=0.011). In stroke cases in rural areas, the distance from symptom onset location to a stroke center was determined as statistically significant through multivariate logistic regression analysis (Odds ratio (OR), 0.982; 95% Confidence interval (CI) 0.969-0.995). In contrast, the use of a public ambulance (OR, 4.258; 95% CI 2.233-8.118) and inter-hospital transfer (OR, 0.416; 95% CI 0.216-0.800) were the main prehospital delay factors in urban areas. Conclusion: For stroke cases in urban areas, it was important to directly visit a stroke center without transfer using a public ambulance. For rural areas, a new hub hospital and policies are necessary for reducing prehospital delay.

원저 : 자전거 손상 환자의 특성과 위험요인에 대한 연구

신수정 ( Su Jeong Shin ), 류현욱 ( Hyun Wook Ryoo ), 박정배 ( Jung Bae Park ), 서강석 ( Kang Suk Seo ), 정제명 ( Jae Myung Jung ), 박동찬 ( Dong Chan Park ), 문유호 ( You Ho Moon ) 대한응급의학회 2010 大韓應急醫學會誌 Vol.21 No.3

Purpose: The bicycle is a clean and future-oriented means of transportation and bicycle usage is growing. The bicycle has been in the spotlight lately with Europe and North America as the center. The purpose of this study was to establish proper prevention strategies for bicycle injuries. Methods: In this retrospective study, we analysed 148 bicycle-related injury patients who visited our hospital between Feb 1, 2008 and Jan 31, 2009. Information such as age, gender, injury severity score, injury time, injury place, and other characteristics were collected. Data were analysed using SPSS 12.0K. Results: Among the enrollees, 80.4% were male. Patients over 65 years of age accounted for only 18.2% of the group, but average injury severity score (ISS) of this group was the highest. Injuries occurred frequently between 16:00 and 22:00 in the evening, while the severity was higher between 00:00 and 08:00 in the morning. Most of the injuries developed on the roads, which included local roads, national highways, and alleyways. Injuries on the roads were more severe than those that occurred in other places. Conclusion: There have been suggestions for using bicycles safely. Legislation on bicycle helmet use already exists. Also, protective apparatus such as knee pads, wrist guards, and protection vests are recommended for use. Construction of more bike trails will be necessary. Above all, bicycle riders` safety consciousness is the most important part.

응급실에서 자의 퇴원을 요구하는 환자에 대한 최선의 진료 지침

안재윤 ( Jae Yun Ahn ), 류현욱 ( Hyun Wook Ryoo ), 최한주 ( Han Joo Choi ), 김형일 ( Hyung Il Kim ), 정진우 ( Jinwoo Jeong ), 배현아 ( Hyun A Bae ) 대한응급의학회 2021 大韓應急醫學會誌 Vol.32 No.1

Discharge against medical advice remains a problematic issue worldwide because it may not only lead to adverse medical outcomes for the patients but also medicolegal problems for emergency physicians. Recently, there have been cases in Korea in which a patient in the emergency room, who had been discharged from hospital without following medical instructions, filed a lawsuit against the hospital and emergency medical staff for their responsibility for their worsening disease since discharge. The court acknowledged the responsibility of the medical staff. To minimize the legal risk and reach the optimal ethical standard for these patients, this paper suggests the best practice guideline for the emergency physicians for patients who request discharge against medical advice from the emergency department in Korea.

흉부 외상 환자에서 늑막 천자를 위해 바늘 도관의 길이에 대한 연구

강성원 ( Sung Won Kang ), 류현욱 ( Hyun Wook Ryoo ), 박정배 ( Jung Bae Park ), 서강석 ( Kang Suk Seo ), 정제명 ( Jae Myung Chung ) 大韓外傷學會 2009 大韓外傷學會誌 Vol.22 No.1

Purpose: This study was conducted to evaluate the length of the catheter used in a needle thoracostomy for emergency decompression of a tension pneumothorax by measuring the chest wall thickness (CWT) in patients with chest trauma. Methods: A retrospective review of 201 patients with chest trauma who had been transported the emergency department in a tertiary university hospital in a metropolitan area between 1 January and 31 February 2007 was performed. The average CWT at the second intercostal space (ICS) in the midclavicular line (MCL) was measured by using a chest computed tomography scan. Results: As the left and the right mean CWTs were 3.4±1.0 cm and 3.4±1.0 cm, respectively, there was no significant statistical difference between them. The mean CWT of female patients was significantly higher than that of male patients (p=0.001). The mean CWT of patients under the age of 65 years was significantly thicker than that of the patients over the age of 65 years (p<0.001). Of the studied patients, 12 (6.0%) a CWT >5 cm. Conclusion: A 5 cm-length catheter in a needle thoracostomy may be insufficient for emergency decompression of a tension pneumothorax, so a catheter longer than 5 cm in length is needed. (J Korean Soc Traumatol 2009;22:1-4)

원저 : 두부 외상 환자의 중증도 평가 시 단순운동점수의 유용성

이상경 ( Sang Kyong Lee ), 류현욱 ( Hyun Wook Ryoo ), 박정배 ( Jung Bae Park ), 서강석 ( Kang Suk Seo ), 정제명 ( Jae Myung Chung ) 대한외상학회 2008 大韓外傷學會誌 Vol.21 No.2

Purpose: The Glasgow Coma Scale (GCS), though it is widely used for triage, has been criticized as being unnecessarily complex. Recently, a 3-point Simplified Motor Score (SMS, defined as obeys commands=2; localizes pain=1; withdrawals to pain or worse=0) was developed from the motor component of the GCS and was found to have a similar test performance for triage after traumatic brain injury when compared with the GCS as the criterion standard. The purpose of this study was to validate the SMS. Methods: We analyzed the patients who visited Kyungpook National University Hospital emergency center after traumatic brain injury from 2006 January to 2006 June. The test performance of the GCS, its motor component, and SMS relative to three clinically relevant traumatic brain injury outcomes (abnormal brain CT scans, Abbreviated Injury Scale (AIS)≥4, and mortality) were evaluated with areas under the receiver operating characteristic curves (AUCs). Results: Of 504 patients included in the analysis, 25.6% had an abnormal brain CT scans, 13.1% had AIS≥4, and 5.0% died. The AUCs for the GCS, its motor component, and SMS with respect to the abnormal CT scans were 0.776, 0.715, and 0.716, and respectively, those for AIS≥4 and mortality, were 0.969, 0.973, and 0.968, and 0.931, 0.909, and 0.909, respectively. Conclusion: The 3-point SMS demonstrated similar test performance when compared with the 15-point GCS score and its motor component for triage after traumatic brain injury in our populations. (J Korean Soc Traumatol 2008;21:71-77)

원저 : 응급실로 내원한 소아 안 손상 환자의 임상적 고찰

조재경 ( Jae Kyung Cho ), 류현욱 ( Hyun Wook Ryoo ), 신수정 ( Su Jeong Shin ), 김종근 ( Jong Kun Kim ), 박정배 ( Jeong Bae Park ), 서강석 ( Kang Suk Seo ), 정제명 ( Jae Myung Chung ) 대한응급의학회 2011 大韓應急醫學會誌 Vol.22 No.6

Purpose: Ocular injury is a significant problem in pediatric patients. The aim of this investigation was to evaluate clinical characteristics of pediatric eye injury for the purpose of offering preventive strategies. Methods: This retrospective study was carried out by evaluating the records of patients under the age of 15 years who were treated for ocular injury at the Kyungpook National University Hospital emergency medical center, from January 2003 to December 2008. A total of 477 patients were included in the study. Age, sex, date of injury, location where injury occurred, cause of injury, diagnosis, any effects on visual acuity, and any complications, were analyzed. Results: Ocular injury occurred more frequently in boys (72.3%) than in girls, and the highest incidence was seen in ages 11 to 15 years (37.3%). Ocular injury frequently occurred in the home or at school. The most common cause of injury was due to instruments (51.6%). Surgery was necessary in 71 patients (14.9%), complication developed in 48 patients (10.1%), and 40 patients (8.4%) suffered from decreased visual acuity. Conclusion: It`s important to monitor boys, in particular, who are engaged in physical activities in the home and at school. Appropriate education and application of personal protective equipment are important methods to aid in prevention of pediatric ocular trauma, especially with children in the home and with adolescents engaged in sporting activities.