응급의료전달체계의 각 요인이 중증외상환자의 예후에 미치는 영향 분석

임득호 ( Du Ko Lim ),정태녕 ( Tae Nyoung Chung ),이창재 ( Chang Jae Lee ),진수근 ( Su Guun Jin ),김의중 ( Eui Chung Kim ),최성욱 ( Sung Wook Choi ),김옥준 ( Ok Jun Kim ) 대한외상학회 2011 大韓外傷學會誌 Vol.24 No.2

Purpose: A few studies have assessed the factors affecting the prognoses for major trauma patients and those improving the circumstances when dealing with the trauma system. In that light, we analyzed factors, such as pre-hospital factors, the time to admission, the length of stay in the emergency department (ED) and emergency operation, influencing the outcomes for trauma patients. Methods: The patients who visited our emergency department from April 1, 2009, to February 29, 2011, due to major trauma were enrolled in the study. The inclusion criterion was a revised trauma score (RTS) < 7 or injury severity score (ISS) ≥ 16. We used reviews of medical records, to analyze each step of emergency medical care with respect to patients` sex, age, visit time and visit date. Continuous variables were described as a median with an interquartile range, and we compared the variables between the survival and the mortality groups by using the Mann-Whitney U test. Fisher`s exact test was used for nominal variables. Using the variables that showed statistical significance in univariate comparisons, we performed a logistic regression analysis, and we tested the model`s adequacy by the using the Hosmer-Lemeshow method. Results: A total of 261 patients with major trauma satisfied either the RTS score criterion or the ISS score criterion. Excluding 12 patients with missing data, 249 patients were included in this study. The overall mortality rate was 16.9%. Time to ED arrival, time to admission, time of ED stay, RTS, ISS, and visit date being a holiday showed statistically significant differences between the survival and the mortality groups in the univariate analysis. RTS, ISS, length of ED stay, and visit date being a holiday showed statistical significance in the multivariate analysis. Conclusion: The mortality rate did not show a significant relationship with the time to ED arrival, use of 119, on time to admission. Rather, it elicited a quite significant correlation with the trauma scoring system (RTS and ISS), the time of ED stay, and the visit date being a holiday.

중심정맥도관의 우심방 내 위치 분류 및 예측

이창재 ( Chang Jae Lee ),이태림 ( Tae Rim Lee ),정태녕 ( Tae Nyoung Chung ),배진건 ( Jinkun Bae ) 한국보건정보통계학회 2015 보건정보통계학회지 Vol.40 No.3

Objectives: Central venous catheter (CVC) insertion is one of the most frequently performed procedures during critical care. Confirming proper placement of catheter tip is very important during the procedure because right atrial placement of CVC may increase the risk of fatal complications as perforation and cardiac tamponade. This study was performed to check the usefulness of tip-to-carina (TC) distance and to compare the accuracy among various classification models for predicting RA positioning of a CVC. Methods: This study reviewed retrospectively medical records and picture archiving communication system of patients who were given chest computed tomography within 12 hours after CVC insertion between May 2002 and April 2012. Bivariate analyses were conducted relating physical and radiologic methods to predict RA placement of a CVC tip. A multiple logistic regression model was then derived, with all variables in the final model significant at p<0.05. Full and TC distance based models including linear discriminant analysis, classification and regression tree, bagging, random forest and support vector machine were developed and compared the area under ROC curve (AUROC), sensitivity and specificity using training and test data. Each modeling was conducted ten times. Results: Among 120 cases, 24 tips were placed in RA. Significant predictable factors were rib level, age and TC distance (all p-value <0.001). TC distance (p=0.001) was independently valid in multiple logistic regression. Both full and reducted models using TC distance in five classification methods showed high values of accuracy (above 88%) and AUROC (above 0.89). There were no statistically significant difference between full and reducted model in AUROC. The cut-off value for TC distance for detecting RA positioning of a CVC was 43.65 mm (sensitivity=83.3%, specificity=95.8%). Conclusions: TC distance is a useful marker for detecting RA positioning of a CVC.

중증 손상 기전의 안정된 환자에서 중증도 예측 인자들에 대한 다변량 분석

이재영 ( Jae Young Lee ),이창재 ( Chang Jae Lee ),이형주 ( Hyoung Ju Lee ),정태녕 ( Tae Nyoung Chung ),김의중 ( Eui Chung Kim ),최성욱 ( Sung Wook Choi ),김옥준 ( Ok Jun Kim ),조윤경 ( Yun Kyung Cho ) 대한외상학회 2012 大韓外傷學會誌 Vol.25 No.2

Purpose: For determining the prognosis of critically injured patients, transporting patients to medical facilities capable of providing proper assessment and management, running rapid assessment and making rapid decisions, and providing aggressive resuscitation is vital. Considering the high mortality and morbidity rates in critically injured patients, various studies have been conducted in efforts to reduce those rates. However, studies related to diagnostic factors for predicting severity in critically injured patients are still lacking. Furthermore, patients showing stable vital signs and alert mental status, who are injured via a severe trauma mechanism, may be at a risk of not receiving rapid assessment and management. Thus, this study investigates diagnostic factors, including physical examination and laboratory results, that may help predict severity in trauma patients injured via a severe trauma mechanism, but showing stable vital signs. Methods: From March 2010 to December 2011, all trauma patients who fit into a diagnostic category that activated a major trauma team in CHA Bundang Medical Center were analyzed retrospectively. The retrospective analysis was based on prospective medical records completed at the time of arrival in the emergency department and on sequential laboratory test results. PASW statistics 18(SPSS Inc., Chicago, IL, USA) was used for the statistical analysis. Patients with relatively stable vital signs and alert mental status were selected based on a revised trauma score of more than 7 points. The final diagnosis of major trauma was made based on an injury severity score of greater than 16 points. Diagnostic variables include systolic blood pressure and res-piratory rate, glasgow coma scale, initial result from focused abdominal sonography for trauma, and laboratory results from blood tests and urine analyses. To confirm the true significance of the measured values, we applied the Kolmogorov-Smirnov one sample test and the Shapiro-Wilk test. When significance was confirmed, the Student``s t-test was used for comparison; when significance was not confirmed, the Mann-Whitney u-test was used. The results of focused abdominal sonography for trauma (FAST) and factors of urine analysis were analyzed using the Chi-square test or Fisher`s exact test. Variables with statistical significance were selected as prognostics factors, and they were analyzed using a multivariate logistics regression model. Results: A total of 269 patients activated the major trauma team. Excluding 91 patients who scored a revised trauma score of less than 7 points, 178 patients were subdivided by injury severity score to determine the final major trauma patients. Twenty-one(21) patients from 106 major trauma patients and 9 patients from 72 minor trauma patients were also excluded due to missing medical records or untested blood and urine analysis. The investigated variables with p-values less than 0.05 include the glasgow coma scale, respiratory rate, white blood cell count (WBC), serum AST and ALT, serum creatinine, blood in spot urine, and protein in spot urine. These variables could, thus, be prognostic factors in major trauma patients. A multivariate logistics regression analysis on those 8 variables showed the respiratory rate (p=0.034), WBC (p=0.005) and blood in spot urine (p=0.041) to be independent prognostic factors for predicting the clinical course of major trauma patients. Conclusion: In trauma patients injured via a severe trauma mechanism, but showing stable vital signs and alert mental status, the respiratory rate, WBC count and blood in the urine can be used as predictable factors for severity. Using those laboratory results, rapid assessment of major trauma patients may shorten the time to diagnosis and the time for management. (J Korean Soc Traumatol 2012;25:49-56)

애완용 햄스터에 의한 교상 후 발생한 아나필락시스 1례

정태녕,윤유상,박준석,박인철,조광현,김승호 대한응급의학회 2004 대한응급의학회지 Vol.15 No.1

응급 전산화단층촬영에서 조영제 사용에 따른 신독성

조영순,정태녕,손대곤,김승호 대한응급의학회 2003 대한응급의학회지 Vol.14 No.2

Purpose: In the last 30 years, there has been a markedly increased use of iodinated contrast agents in diagnostic and interventional radiological procedures. Due to the possible side effect of nephrotoxicity of these radiocontrast agents, we investigated the incidence of nephrotoxicity and attempted to identify the patient groups at higher risk for contrast nephrotoxicity among the patients who underwent emergency computerized tomography. Methods: We reviewed the medical records of 1,572 patients who had undergone contrast computerized tomography at the Emergency Center, Yonsei Medical Center, from January to May 2002. We defined contrast nephrotoxicity as any increase in the creatinine value of more than 0.5mg/dL (44㎛ol/L) or 25% compared to the baseline value. Results: We found 21 patients (1.3%) who met the criterion for contrast nephrotoxicity: 13 patients with normal renal function, and 8 patients with a higher than normal creatinine value before contrast-enhanced computerized tomography. The incidence of contrast nephrotoxicity in the patient group with normal renal function was 0.8% (13/1551), compared to 38.1% (8/21) in the pre-existing renal insufficiency group. There were no statistical differences on the amounts of dye used and the frequencies of risk factors for contrast nephrotoxicity between the patients in pre-existing renal insufficiency group who developed nephrotoxicity and who did not. The renal function of all patients returned to the baseline value without dialysis or renal replacement therapy. Conclusion: Pre-existing renal insufficiency is the most important risk factor for contrast nephrotoxicity. We need to take precautions and to have a proper protocol for the prevention of contrast nephrotoxicity in emergency care.