약물중독 선별검사키트의 유용성

곽명관,김원영,이재호,오범진,김원,임경수,강희동 대한중환자의학회 2009 Acute and Critical Care Vol.24 No.2

Background: The recovery and outcome of intoxicated patients depends on the kind of drugs they took and the total time of their initial management. The purpose of this study is to evaluate the usefulness of a Triage drug kit for detecting abused drugs. Methods: From 2003 Feb. to 2003 July, we studied the patients who visited the emergency department with suspicious drug intoxication. In this case, we used a Triage drug kit for 134 patients with drug intoxication or who were clinically suspected of taking illegal drugs, with 30 of the patients initially admitting the substance they had used. The kit is an immunoassay kit for qualitative testing drug metabolites in urine. To compare with those cases of the preceding year, we studied 104 patients with drug intoxication that was detected between February 2002 and July 2002. Results: Overall, 60% of the 30 cases who did not know what substance they abused and tested positive for, and 33% of the 27 cases with suspected intoxication confirmed their substance abuse. The positive rate for benzodiazepine use was the highest (46.7%), and there were no positive results regarding amphetamine, methamphetamine or cocaine. An appropriate antidote was administered significantly more frequently in the group for which we used the kit. Conclusions: A Triage drug kit is probably useful for diagnosing acute drug intoxication and for identifying the causative substance. However, the time required to decide whether or not a patient should be admitted is not reduced. If the kit can detect the frequently abused drugs in Korea, it will be helpful for treating drug intoxicated patients.

노인 급성 뇌경색 환자의 거주 형태에 따른 내원 시간 지연 요인

김윤권,곽명관,표창해,박상현,박근홍,김한범,신승열,최한조,함은미 대한응급의학회 2018 대한응급의학회지 Vol.29 No.1

Purpose: We made a clinical comparison of elderly patients from home and residential aged care facilities (RACFs) who visited the emergency department and were hospitalized with acute ischemic stroke. In addition, we investigated the factors associated with prehospital delay in acute ischemic stroke. Methods: A retrospective study was conducted in a public hospital between January 2013 and December 2016. Information regarding the patients was registered including gender, age, comorbidities, symptoms at onset, use of emergency medical services, National Institute of Health Stroke Scale (NIHSS) at the emergency department, symptom-to-door time, etc. Characteristics of the patients were analyzed and logistic regression analysis was conducted to identify factors associated with symptom-to-door time. Results: A total of 402 patients were enrolled during the study period. Overall, 339 elderly patients visited from home and 63 patients from RACFs, and patients from home were divided into two groups, living with family (n=274) and living alone (n=65). Patients from RACFs were older (p<0.001) and had higher NIHSS (p=0.007) than patients from home, but there were no significant relationships between symptom-to-door time and age (p=0.525), NIHSS (p=0.428). There was no difference in symptom-to-door time between patients living with family and patients from RACFs, but patients living alone had delayed symptom-to-door time (p<0.001). Conclusion: Elderly patients living alone were among the three groups that had the most delayed symptom-to-door time. Therefore, it is necessary to expand and supplement support for elderly patients living alone, as well as to improve education regarding acute ischemic stroke.

응급실 내원 환자 중 지역사회획득 폐렴 발생 환자수와 기상 요소와의 연관성: 엘라스틱 넷 변수 선택 기법을 이용한 포아송 회귀분석

최한조,박상현,곽명관,표창해,박근홍,김한범,신승열 대한응급의학회 2016 大韓應急醫學會誌 Vol.27 No.1

Purpose: This study shows the relationship between meteorological factors and the number of community acquired pneumonia (CAP) patients in the emergency room and lag effect of meteorological factors affecting CAP. Methods: A retrospective study was conducted. Patients diagnosed with CAP in the emergency room between January 2012 and December 2014 were enrolled. The patients were over 18 years old and lived in Seoul, Korea. Meteorological factors (highest daily temperature, lowest temperature, mean temperature, diurnal temperature, rainfall, relative humidity, amount of sunshine, and powdery dust under 10 μg/m3 (PM10)) between December 2011 and December 2014 in Seoul were acquired from the Korea Meteorological Administration. Multiple Poisson regression (Generalized Linear Model) was used with daily patient’s number of CAP as the response variable and meteorological factors as the explanatory variable. Variable selection was performed via Elastic net. Results: A total of 568 CAP patients were checked. Highest temperature (before 6 days), rainfall (before 1 day), relative humidity (before 20, 15, 13, 6, 2, and 1 days), and PM10 (before 27, 24, 17, and 13 days) showed relationship and lag effect with the incidence of CAP. Conclusion: This study showed that meteorological factors (highest temperature, rainfall, relative humidity, and PM10) had relationship and lag effect with the incidence of CAP. We can make a prediction model with health weather index for prevention of CAP and redistribution of medical facilities and resources.

대기 중 미세먼지 농도와 응급실을 방문하는 만성 폐쇄성 폐 질환 환자와의 상관관계

오지수,박상현,곽명관,표창해,박근홍,김한범,신승열,최한조 대한응급의학회 2017 대한응급의학회지 Vol.28 No.1

Purpose: This study aimed to explore the association between increased level of ambient particulate matter and emergency room visits for chronic obstructive pulmonary disease (COPD) exacerbations. Methods: A retrospective study was conducted. We enrolled patients who lived in Seoul, Korea and were diagnosed with COPD in the emergency room between January 2012 and December 2014. Meteorological factors [daily highest temperature, lowest temperature, mean temperature, diurnal temperature, rainfall, relative humidity, amount of sunshine and particulate matter less than 10 μm (PM 10)] between December 2011 and December 2014 in Seoul were acquired from the Korea Meteorological Administration. We used a multiple Poisson regression model with daily patient’s number of COPD as a response variable and meteorological factors as explanatory variable. Variable selection was done via an Elastic net. Results: There was a total of 1,179 emergency visits for acute exacerbations of COPD patients. PM10 (before 4, 10, 11, 15, 16, 17, 22, 24, 27, 28 day), rainfall (before 1, 6, 8, 16, 18 day), relative humidity (before 2, 8), and daily temperature difference (5, 10, 15 day) had a relationship and a lag effect with COPD exacerbations. Conclusion: This study showed that an increased concentration of PM10 was associated with COPD exacerbations. A future study that reinforces the limitation of this study is necessary to get a helpful index for an adequate response of medical institution and efficient placement of medical personnel.

3차 진료기관 응급실로 내원한 심한 저나트륨혈증을 가진 노인 환자의 임상 양상 분석

김남규,이은주,곽명관,이영수,임경수,오범진 대한노인병학회 2009 Annals of geriatric medicine and research Vol.13 No.3

Background: Hyponatremia in the elderly, one of the most common disorders seen in the emergency room (ER), has been shown to have a poor prognosis if treated improperly. However, it often is a challenge to detect because of its varying symptoms. This study aimed to improve the diagnosis and management of severe hyponatremia in the ER by analyzing clinical characteristics and patterns according to patient age. Methods: Of the patients who visited the ER at Asan Medical Center in Seoul from May 1 to October 2006, 151 patients whose blood sodium concentration was 120 mEq/L or lower were examined in terms of gender, age, history, major symptoms, history of diuretic uses, and blood tests. Results: The study group included 91 males and 60 females. Of these, 81 (53.6%) were middle-aged and 70 (46.4 %) were elderly. For underlying diseases, 58 (38.4%) had liver disease and 79 (52.3%) had cancer. In the elderly group, more patients (21, 30%) visited the ER with neurological disturbances than with gastrointestinal symptoms (13, 18.6 %); and more elderly patients (14, 20%) presented with serious hyponatremia (blood sodium concentration 110 or lower) than middle-aged patients (6, 7.4%). Conclusion: In the elderly, many patients visiting the ER did not have any underlying disease but were suffering from more severe hyponatremia. The major symptoms observed included neurological disturbances such as impaired consciousness and generalized weakness. The elderly can easily develop serious hyponatremia with accompanying neurologic disturbances. The emergency physician, having a high level of suspicion, should make a quick diagnosis and manage these patients appropriately. 연구배경: 노인에서 저나트륨혈증은 응급실에서 볼 수 있는 가장 흔한 전해질 장애로 적절한 치료를 하지 않을 경우 예후에 영향을 줄 수 있으나, 응급실로 내원하는 노인 환자의 경우 증상이 다양하여 진단에 어려움이 많았다. 이에 응급실로 내원하는 심한 저나트륨혈증 환자의 연령에 따른 임상적 특성과 양상을 비교 분석하여 진단과 치료에 도움을 주고자 하였다. 방법: 2006년 5월 1일부터 10월까지 서울아산병원 응급실을 내원한 환자 중 나트륨 120 mEq/L 이하 환자 151명의 성별, 나이, 동반 기저질환, 내원 시 주 증상, 이뇨제를 포 함한 약물 복용력과 혈액 검사 결과를 전자의무기록을 이용하여 후향적으로 분석하였다. 결과: 중증 저나트륨혈증으로 응급실로 내원하는 환자의 성별은 남자가 91명, 여자가 60명으로 남자가 더 많았으며, 65세 미만의 장년군이 81명(53.6%), 65세 이상의 노인군이 70명(46.4%)이었다. 전체 환자의 58명(38.4%)이 간 질환을, 79명(52.3%)이 암을 가진 것으로 나타났으며, 상대적으로 장년군에서 간이나 암 질환을 가지고 있는 경우가 67명(82.7%)으로 많았다. 또한 내원 당시 주 증상은 연령별로 나누어 보았을 때 장년군에서는 소화기 증상 36명(44.4%)으로 가장 많았으나, 노인군에서 신경학적 이상으로 내원하는 경우가 21명(30%)으로 가장 많았다. 그리고, 노인군에서 혈중 나트륨 농도가 110 mEq/L 이하인 경우가 14명(20%)으로 65세 이하 장년군의 6명(7.4%)보다 많았다. 결론: 본 연구의 경우 다수의 환자에서 간질환이나 암과 같은 기저질환과 관련된 저나트륨혈증이 나타났고, 특히 장년군에서 이러한 기저질환에 의한 이차성 저나트륨혈증이 유의하게 많은 것으로 나타났으며, 주 증상에 있어서도 관련된 일차 질환에 의한 소화기 증상을 주소로 내원하는 경우가 더 많았다. 그러나 노인군에서는 상대적으로 기저질환없이 오는 경우가 많았으며, 보다 중증의 저나트륨혈증을 나타내는 경우가 많았고, 주 증상으로도 의식 변화와 같은 신경학적 증상이나 전신쇠약감을 호소하는 경우가 많았다.

‘서울형 시민 공감 응급실 운영사업’시행 후 행려환자의 응급의료센터 이용 행태 변화에 대한 고찰

오세윤,박상현,표창해,박근홍,곽명관,김한범,신승열,최한조,하현숙 대한응급의학회 2018 대한응급의학회지 Vol.29 No.1

Purpose: This study shows the change in emergency room use behavior by homeless patients after implementation of the ‘Seoul Type Citizen Sympathy Emergency Room Project’ in July 2015. Methods: A retrospective study was conducted in a public hospital between January 2014 and December 2014 and January 2016 and December 2016. Homeless patients who visited the emergency room in 2014 and 2016 were compared based on age, gender, mode of insurance, admission, revisit within 48 hours, length of stay (LOS) in the emergency department (ED), total cost, and major diagnostic category. Results: A total of 3,642 homeless patients were enrolled during the study period, of which 1,876 visited in 2014 and 1,766 in 2016. Fewer homeless patients in 2016 revisited within 48 hours (p=0.046). Homeless in 2016 had a shorter ED LOS (p<0.001) and lower total cost (p=0.040). More homeless patients who visited due to alcohol revisited within 48 hours in 2016 (p=0.036). Moreover, these patients did not have a different ED LOS (p=0.060) or total cost (p=0.475). Medicaid homeless patients were less connected compared health insurance by screening, brief intervention, referral to treatment program. Conclusion: Comparison of homeless patients who visited the emergency room in 2014 and 2016 revealed fewer total homeless patients in 2016, as well as less revisits within 48 hours, shorter ED LOS and lower total cost. These findings indicate that the ‘Seoul Type Citizen Sympathy Emergency Room Project’ was effective in the emergency room, but improvements for alcohol and medicaid homeless patients are needed.

응급의료센터에 질환으로 내원한 노인요양시설 환자와 일반 노인 환자의 역학적 특징 분석

함은미,김한범,표창해,박상현,박근홍,곽명관,신승열,오수빈,최한조 대한응급의학회 2017 大韓應急醫學會誌 Vol.28 No.1

Purpose: In recent years, the number of elderly patients visiting from residential aged care facilities (RACFs) has been increasing. We analyzed a comparison of characteristics between patients who visited the ER with diseases from RACFs and those who visited from home. Methods: A retrospective study was conducted in a public hospital between January 2013 and December 2014. The subjects included patients who visited the ED from RACFs and elderly patients who visited the ED from home. Comparisons of the following parameters were made between the two groups: gender, age, mode of insurance, mode of ED visit, mobile status, Charlson comorbidity index (CCI), chief complaint, final results in the ED, and length of stay (LOS) in the ED and hospital. Results: A total of 7,603 patients were enrolled during the study period. There were 6,401 elderly patients who visited from home and 1,202 patients who visited from RACFs. Patients from RACFs were older than those from home (79.90± 8.01 vs. 75.78±7.26, p<0.001). More patients from RACFs were on Medicaid (56.6% vs. 27.9%, p<0.001), took more ambulance (86.3% vs. 49.4%, p<0.001), more bedridden (68.2% vs. 6.4%, p<0.001), and higher CCI (2.38±1.99 vs. 1.45±1.84, p<0.001). Compared with patients from home, those from RACFs showed a significantly higher proportion of admission (63.2% vs. 32.9%, p<0.001), ED LOS (403.03±361.77 vs. 277.07±258.82, p<0.001), and hospital LOS (19.65±18.58 vs. 15.67±15.63, p<0.001). Patients from RACFs showed especially longer ED LOS from discharged ED than those from home (388.87±422.88 vs. 221.90±215.30, p<0.001). Conclusion: Compared with elderly patients from home, patients from RACFs also had higher admission rate and longer ED LOS, as well as hospital LOS. Patients from RACFs had long ED LOS. The findings in this study suggest that there could be ED overcrowding in the near future.

응급실에 내원한 노인 행려환자의 특성

윤철수,최한조,김한범,박상현,박근홍,곽명관 대한응급의학회 2015 대한응급의학회지 Vol.26 No.1

Purpose: The average age of the homeless is increasing as the aging society advances. We analyzed characteristics of older homeless patients who visit the emergency department (ED). Methods: A retrospective study was conducted in a public hospital between March 2011 and February 2014 from homeless patients who visited the ED. We compared their sex rates, insurance, diagnostic test, medications for discharge, admission rates, cardiopulmonary resuscitation (CPR), length of ED stay, and discharge diagnosis. Results: A total of 3237 patients were enrolled during the study period; 95.4% were male and mean age was 50.18 years, and 1734 (53.57%) were 50 years and older. The rates of health insurance coverage for these groups are similar but older homeless had more insurance of lower income (10.0% vs 12.9%; p=0.003). Older homeless were admitted to hospital more often (14.0% vs 17.9%; p=0.003) and were received medication less often (43.7% vs 40.2%; p=0.043) than younger homeless. In most cases discharge diagnosis was substance use alcohol related (36.9% vs 34.3%). Older homeless had more discharge diagnoses related to endocrine, urinary, and musculoskeletal and connective tissue, and fewer discharge diagnoses related to digestive and psychiatric. The CPR rate did not differ (1.4% vs 1.5%; p=0.906). Conclusion: This study suggested that the pattern of ED care for older homeless is different from those of younger homeless. The number of older homeless will increase and lead to admission to the hospital, thus, health care systems should be prepared by characteristics.

응급실에 있어서 세균성 뇌수막염의 초기진단적 가치로서의 혈중 프로칼시토닌과 C-반응단백질의 효용성

오민석,김원영,최상식,서동우,손창환,오범진,임경수,신주용,곽명관 대한응급의학회 2012 대한응급의학회지 Vol.23 No.3

Purpose: Immediate identification of bacterial meningitis (BM) is essential in the emergency department. However,diagnosis of BM from analysis of cerebrospinal fluid has low sensitivity. The goal of this study was to determine the ability of serum procalcitonin (PCT) and C-reactive protein (CRP) for differentiation between BM and non-BM in adult patients. Methods: This retrospective cohort study, which was conducted from Jan 1 2008 to Sep 30 2011, included patients with a diagnosis of meningitis based on compatible clinical features and cerebrospinal fluid (CSF) culture findings with a CSF leukocyte count > 5 /μL. Measurement of Serum PCT and CRP level was performed on initial admission to the emergency department. Patients were divided into two groups, according to the type of meningitis: BM or non-BM. Clinical features, laboratory results, including CSF results,serum PCT, and CRP levels were assessed. Results: A total of 63 patients (age, 49±19) with confirmed meningitis were admitted: 43 patients with non-BM and 20patients with BM. Significantly higher PCT and CRP levels,CSF white blood cell and neutrophil count, CSF glucose,and protein levels were observed in the BM group. The most highly discriminative parameters for differential diagnosis of BM proved to be serum PCT, with a sensitivity of 90%, a specificity of 100%, a positive predictive value of 100%, a negative predictive value of 96% at a diagnostic cut-off level of 1.0 ng/mL (area under the curve 0.98; 95%confidence interval 0.00-1.00) and CRP, with a sensitivity of 85%, a specificity of 88%, a positive predictive value of 77%, a negative predictive value of 93% at a diagnostic cutoff level of 6.0 mg/dL (area under the curve 0.91; 95% confidence interval 0.76-0.97). Conclusion: Serum PCT and CRP levels appear to be the most highly discriminative parameters for differential diagnosis of BM and non-BM.