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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.
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비외상성 복통을 주소로 응급의료센터에 내원한 젊은 여성 환자의 급성 복증 감별에 있어서 이학적 및 검사실 인자들에 대한 다변량 분석
이창재,정태녕,임득호,진수근,김옥준,최성욱,김의중,조윤경 대한응급의학회 2011 大韓應急醫學會誌 Vol.22 No.6
Purpose: One of the most challenging groups of patients to diagnose that visit an emergency department (ED) is the female with acute abdominal pain. The causes of acute abdominal pain range from minor, self-limiting conditions to life-threatening disorders. Differential diagnosis for these patients is extensive and frequently requires multiple examinations and tests. This study analyzed the effectiveness of surgical abdomen detection using various physical examination and clinical laboratory methods, for young women reporting non-traumatic abdominal pain. Methods: This study reviewed computed tomography (CT)reports for 232 women, aged 21~35 years old, who visited our ED for nontraumatic abdominal pain from July 2009 to June 2010. Bivariate analyses relating physical and laboratory methods used to detect surgical abdomen were conducted. A multivariate logistic regression model was then derived,with all variables in the final model significant at p<0.05. Results: The number of patients who required surgical intervention was 88, while the number who did not require surgery was 144. Significant predictive methods for identifying surgical abdomen were maximal tenderness site (p=0.019), rebound tenderness (p=0.037), white blood cell count (p=0.012) and urine blood (p=0.037). The bootstrap result was identical in 1000 samples with a 95% confidence interval. Conclusion: Maximal tenderness site, rebound tenderness,and results indicating leukocytosis and hematuria were found to be independently valid factors for detection of surgical abdomen in young women evaluated in our ED due for nontraumatic abdominal pain.
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중증 외상 환자의 재원기간에 관련된 응급의료전달 체계 내 요인 분석
진수근,정태녕,임득호,이창재,김의중,최성욱,김옥준 대한응급의학회 2011 대한응급의학회지 Vol.22 No.6
Purpose: Severe trauma is indicative of poor patient prognosis and higher mortality rates. Moreover, severe trauma may be related with higher hospital costs. Our recent study showed that severe trauma costs significantly more per patient than general trauma. Length of hospital stay was shown to be an independent factor contributing to higher cost in the study. We assessed factors affecting length of hospital stay in severe trauma patients. Methods: Data from the severe trauma registry was collected prospectively and retrospectively reviewed. Time of emergency department (ED) registration, mechanism of injury, initial vital signs, revised trauma score (RTS), injury severity scale (ISS), specialty consultation time, time to admission decision, ED length of stay, and overall hospital length of stay (LOS) were evaluated. All factors listed above were put into a univariate, Cox proportional hazard analysis. LOS and other factors resulting in p-values under 0.20were included in the multivariate analysis. Results: A total of 249 patients were enrolled to the study. There were significant univariate analysis results for RTS and ISS (p=0.001, 0.006, respectively). The only significant multivariate analysis result was for RTS (p=0.025, hazard ratio=1.167). Conclusion: Higher RTS score is an independent factor leading to earlier discharge from the hospital in severe trauma patients.
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