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.

간호사의 수면의 질, 주간졸음 및 간호업무 중 인지한 오류 경험과의 관련성

김미성(Mi Sung Kim),김장락(Jang-Rak Kim),박기수(Ki-Soo Park),강영실(Young Sil Kang),최마이클승필(Michael Sung Pil Choe) 한국농촌의학 지역보건학회 2013 농촌의학·지역보건 Vol.38 No.4

Objectives: The objective of this study was to identify the influence of shift work on sleep quality, daytime sleepiness, and perceived errors during nursing work among hospital nurses. Methods: The study subjects were 209 hospital nurses working in two general hospitals in South Korea. The data were collected through self-administered questionnaires in May 2013. Sleep quality was measured using Korea Pittsburgh Sleep Quality Index (PSQI-K), daytime sleepiness was measured using Epworth Sleepiness Scale (ESS), and perceived errors in past 6 months during nursing duty hours with the tool developed in this study. Results: The sleep quality was significantly worse among rotating shift nurses when compared to fixed day duty nurses. However, the odds ratio (OR) of 1.92 [95% confidence interval(CI): 0.58-6.37] adjusted for sociodemographic variables, health behaviors, and working environment in logistic regression was not significant. There was no significant difference in the daytime sleepiness between rotating shift nurses and fixed day duty nurses in both simple and multivariable analyses. There were significantly more perceived errors in rotating shift nurses than fixed day duty nurses. However, the OR of 1.26 (95% CI: 0.38-4.21) adjusted for sociodemographic variables, health behaviors, working environment, sleep quality, and daytime sleepiness in logistic regression was not significant. Depression (OR=3.31, 95% CI: 1.11-9.84) and daytime sleepiness(OR=1.18, 95% CI: 1.07-1.30) were significantly associated with perceived errors in logistic regression. Conclusion: This study suggested shift work among hospital nurses had no independent influence of sleep quality, daytime sleepiness, and perceived errors. However, daytime sleepiness had independent influence of perceived errors. More studies are warranted to achieve more reliable conclusion.

일개 응급의료센터에서 분석한 불화수소산 대량 누출이 지역사회 건강에 미친 영향

김영갑 ( Young Gab Kim ),이주택 ( Ju Taek Lee ),박상현 ( Sang Hyun Park ),이찬희 ( Chan Hee Lee ),최마이클승필 ( Sung Pil Choe ),제동욱 ( Dong Wook Je ),이창재 ( Chang Jae Lee ),고대이 ( Taei Ko ),조혜정 ( Hye Jung Jo ) 대한임상독성학회 2013 대한임상독성학회지 Vol.11 No.2

Purpose: The purpose of this study is to verify the influence of a massive hydrofluoric acid spill on community health through patients who claimed to have been exposed. Methods: We analyzed 2459 patients who visited our emergency department with the claim of exposure to hydrofluoric acid, and retrospective analyses were performed. We analyzed changes in numbers of visitors per day from the day of the accidental hydrofluoric acid spill, symptoms presented by the 1924 patients, and general characteristics. Comparisons of symptoms and hematologic characteristics were made between the initially set evacuation zone(1.3 km radius parameters from the spill) and the outer zone. Results: A total of 2,459 patients who claimed exposure visited our ED from 27 September 2012 to 23 October 2012, and there was a significant increase in the number of visiting patients from day 8 of the hydrofluoric acid spill. The most common complaints were a sore throat, 729(37.9%) and no specific symptom with health concern, 547 (28.4%). Statistically significant findings were pulmonary symptoms (p=0.001), nasal symptoms (p=0.001), diarrhea (p=0.023), and skin symptoms (p=0.007). In hematologic study, a statistically significant difference was observed in white blood cell count (p=0.018), creatine phosphokinase (p<0.001), erythrocyte sediment rate (p=0.013), and phosphorus (p<0.001). Conclusion: A significant increase in the number of patients was observed one week after the accidental spill of hydrofluoric acid. The most frequent symptoms were sore throat, headache, cough, and sputum. Statistically significant increase in creatine phosphokinase level and decrease in phosphorus level were noted in patients within the evacuation zone.

급성 약물중독에 합병된 일과성 혹은 지속성 고암모니아혈증의 특성

이수형 ( Soo Hyung Lee ),박홍인 ( Hong In Park ),최마이클승필 ( Michael Sung Pil Choe ),제동욱 ( Dong Wook Je ),노우영 ( Woo Young Nho ),김성훈 ( Seong Hun Kim ),이미진 ( Mi Jin Lee ),안재윤 ( Jae Yun Ahn ),문성배 ( Sung Bae Moon 대한임상독성학회 2016 대한임상독성학회지 Vol.14 No.2

Purpose: In patients with altered mentality caused by drugs or unknown causes, ammonia is checked to facilitate differential diagnosis or diagnose hepatic coma. This helps early prevention and treatment of brain damage due to hyperammonemia. This study was conducted to evaluate clinical characteristics of intoxicated adult patients with hyperammonemia. Methods: We evaluated 95 patients with hyperammonemia among intoxicated patients above the age of 15 who visited our ED from January 2013 to December 2015. We analyzed the demographic characteristics and type of poisoning substance, reason for ingestion, toxicological characteristics such as elapsed time from ingestion to hospital visit, lab, clinical progression and complications. Data were evaluated using the student`s t test or Mann-Whitney U test for continuous variables, and Chi-square test and Fisher`s exact test for frequency analysis of categorical variables. Results: When compared to healthy individuals, patients with hyperammonemia showed statistical significance on their SOFA score (p=0.016) and poison severity score (p<0.001). Additionally, patients with hyperammonemia showed significantly different initial serum AST level (p=0.012) and maximum serum AST level during the hospital stay (p=0.026) when compared to healthy individuals. Moreover, individuals with sustained hyperammonemia compared to transient hyperammonemia showed clinically significant SOFA scores (p<0.001), poison severity scores (p=0.007), mortality rates in the ICU (p=0.021), as well as different duration of hospital stay (p=0.037), serum creatinine level (p=0.002), erythrocyte sedimentation rate (p=0.025), and serum myoglobin (p=0.015). Conclusion: Most poisoning-induced hyperammonemia cases were transient and recovered without special treatment. Therefore, hyperammonemia is almost non-specific among poisoning patients.

신뢰, 사회활동 참여와 지각된 건강수준과의 관련성

이진향(Jin Hyang Lee),박기수(Ki-Soo Park),전혜지(Hye Ji Jeon),양현수(Hyun Su Yang),김보경(Bokyoung Kim),최마이클승필(Michael Sung Pil Choe) 한국농촌의학 지역보건학회 2013 농촌의학·지역보건 Vol.38 No.4

Objectives: This study was performed to investigate the relationship between individual-level social capital and depression. And, we assessed if depressive symptom mediates the relationship between social capital and self-rated health status. Methods: Data from the 2011 Community Health Survey were analyzed for this study. We used chi-square tests and analyzed a four step approach in which several regression analyses were conducted and significance of the coefficients was examined at each step. Results: In men, the results of controlling mediating factor (depression): social participation was not significantly associated with self-rated health status(p=0.082), the finding supports that social participation was fully mediated by depression. In women, the relationship between social capital(trust, social participation) and self-rated health status was partially mediated by depression. Conclusions: In order to increase self rated health status, not only improvement in trust and social participation are needed but effort to reduce depression must be combined.

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.