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박용석 ( Yong Seok Park ),서강석 ( Kang Suk Seo ),박정배 ( Jung Bae Park ),이미진 ( Mi Jin Lee ),류현욱 ( Hyun Wook Ryoo ),문성배 ( Sungbae Moon ),김종근 ( Jong Kun Kim ),이동언 ( Dong Eun Lee ),안재윤 ( Jae Yun Ahn ) 대한응급의학회 2016 大韓應急醫學會誌 Vol.27 No.6
Purpose: This study investigated the association between the initial red cell distribution width (RDW) and mortality in patients with severe trauma. Methods: We conducted a retrospective analysis between January and December 2014. Severe adult trauma patients (age ≥18, Injury Severity Score≥16), who were treated in our emergency department, were included in this study. We classified patients into four groups in accordance with their RDW (group 1: RDW≤12.3%, group 2: 12.4%≤RDW≤12.6%, group 3: 12.7%≤RDW≤13.2%, group 4: 13.3%≤RDW). They were compared based on the characteristics of their groups. We also compared the baseline characteristics of patients who survived and did not survive. Univariate and multivariate Cox proportional hazard analyses were performed to determine the association between mortality and each variable. Results: We enrolled 364 severe trauma adult patients. The mortality rate was 8.9%, 16.2%, 12.6%, and 20.4% for RDW groups 1, 2, 3, and 4, respectively; there was no statistical significance. The RDW of patients who survived (n=311) and did not survive (n=53) were 12.7% (12.4-13.3%) and 12.9% (12.5-13.6%), respectively, but this was also not statistically significant (p=0.075). Univariate Cox proportional hazard analysis showed a significant difference between the mortality and initial RDW, but a multivariate analysis did not show an independent association between initial RDW and mortality (hazard ratio, 0.729; confidence interval, 0.508-1.047; p=0.087). Moreover, multivariate analysis did not also show a significant difference between RDW quartile groups according to route of hospital visit. Conclusion: There was no independent association between the initial RDW and mortality in patients with severe trauma.
조재완 ( Jae Wan Cho ),서강석 ( Kang Suk Seo ),이미진 ( Mi Jin Lee ),박정배 ( Jung Bae Park ),김종근 ( Jong Kun Kim ),류현욱 ( Hyun Wook Ryoo ),안재윤 ( Jae Yun Ahn ),문성배 ( Sungbae Moon ),이동언 ( Dong Eun Lee ),김윤정 ( Yun Je 대한응급의학회 2018 大韓應急醫學會誌 Vol.29 No.4
Objective: A massive transfusion (MT) of 10 or more units of packed red blood cells (PRCs) focuses on the summation volumes over 24 hours. This traditional concept promotes survivor bias and fails to identify the “massively” transfused patient. The critical administration threshold (≥3 units of PRCs per hour, CAT+) has been proposed as a new definition of MT that includes the volume and rate of blood transfusion. This study examined the CAT in predicting mortality in adult patients with severe trauma, compared to MT. Methods: Retrospective data of adult major trauma patients (age≥15 years, Injury Severity Score [ISS]≥16) from a regional trauma center collected between May 2016 and June 2017 were used to identify the factors associated with trauma-related death. Univariate associations were calculated, and multiple logistic regression analysis was performed to determine the parameters associated with in-hospital mortality. Results: A total of 540 patients were analyzed. The median ISS was 22, and the hospital mortality rate was 30.9% (n=92). Fortytwo (7.8%) and 23 (4.3%) patients were CAT+ and traditional MT+, respectively. Severe brain injury, CAT+, acidosis, and elderly age were significant variables in multivariate analysis. CAT+ was associated with a fourfold increased risk of death (odds ratio, 4.427; 95% confidence interval, 1.040-18.849), but MT+ was not associated (odds, 1.837; 95% confidence interval, 0.376-8.979). Conclusion: The new concept of CAT for transfusion was a more useful validation concept of mortality in adult severe trauma patients on admission than traditional MT. Encompassing both the rate and volume of transfusion, CAT is a more sensitive tool than common MT definitions.
김인혁 ( In Hyuk Kim ),서강석 ( Kang Suk Seo ),이미진 ( Mi Jin Lee ),박정배 ( Jung Bae Park ),김종근 ( Jong Kun Kim ),류현욱 ( Hyun Wook Ryoo ),안재윤 ( Jae Yun Ahn ),문성배 ( Sungbae Moon ),이동언 ( Dong Eun Lee ),박용석 ( Yong S 대한응급의학회 2016 大韓應急醫學會誌 Vol.27 No.6
Purpose: The terminology that represented major trauma was vague, inconsistent, and lacked validation. The objective of this study is to investigate the new definition of polytrauma in adult patients of major trauma. Methods: A retrospective data of adult major trauma patients [Age≥15, 16≤Injury Severity Score (ISS)<75] from a regional trauma center were collected in period between July 2011 and December 2013 and divided into two groups: polytrauma and non-polytrauma. We compared the demographic, laboratory characteristics, and outcomes in patients with major trauma, polytrauma and non-polytrauma. Univariate associations were calculated, and a multiple logistic regression analysis was used to determine the parameters associated with in-hospital mortality and early death. Results: A total of 662 patients met the inclusion criteria for major trauma. Of these, 150 (22.7%) met the new polytrauma definition. In the major trauma group, the mean ISS was 22, in-hospital mortality rate was 23.4%, and early death rate was 20.7%. In the polytrauma group, ISS was 27, in-hospital mortality rate was 44.7%, and early death rate was 38.7%. In the non-polytrauma group, ISS was 20, in-hospital mortality rate was 17.2%, and early death rate was 15.4%. Of the five physiologic parameters (systolic blood pressure≥90 mmHg, Glasgow Coma Scale≥8, base deficit≥6, international normalized ratio≥1.4/activated partial thromboplastin time≥40 seconds, age≥70 years), the lowest in-hospital mortality was found when one parameter was involved (2.5%), and the highest mortality was found when all parameters were involved (100%). Conclusion: Based on “The new Berlin definition”, polytrauma was associated more with in-hospital mortality and early death than non-polytrauma in adults. The five physiologic parameters were correlated with in-hospital mortality.
서현일 ( Hyun Il Seo ),박용석 ( Yong Seok Park ),이미진 ( Mi Jin Lee ),안재윤 ( Jae Yun Ahn ),김종근 ( Jong Kun Kim ),문성배 ( Sungbae Moon ),이동언 ( Dong Eun Lee ),손유동 ( You Dong Sohn ),이숙희 ( Suk Hee Lee ),최재영 ( Jae You 대한응급의학회 2017 大韓應急醫學會誌 Vol.28 No.4
Purpose: This study aims to investigate how variability of bystander cardiopulmonary resuscitation (CPR) willingness may change depending on special situations and to find out factors that enhance CPR willingness in each situation and ways to increase the ratio of bystander CPR. Methods: A population-based, nationwide study using a structured questionnaire via telephone survey regarding CPR was done in 2015 (n=1,000). A stratified cluster sampling was conducted to assess the impact of age and gender on CPR willingness. The contents of the questionnaire consisted of basic characteristics, CPR training experience, and status. Additionally, respondents were presented with five hypothetical scenarios of cardiopulmonary arrest; family member, stranger, elderly person, preschool child, and pregnant woman. Results: Willingness to perform CPR was low for pregnant women (52.1%) or elders (59.3%), moderate for strangers (73.3%) or children (71.3%), but high for a family members (90.4%). Age, awareness of CPR, training experience of CPR, CPR training by manikin practice, recent CPR training (≤2 years), experience of bystander CPR, family history of severe illness, and awareness of Good Samaritan law all influenced the willingness to perform CPR on bystander in each scenario. Conclusion: The willingness of bystander CPR decreased in special situations, especially for elderly and pregnant woman. However, recent CPR training group were more willing in the elderly, and CPR experienced group also showed increased tendency in pregnant woman. It is expected that the rate of bystander CPR can be increased by emphasizing that performing bystander CPR for children, pregnant women, and elders is not different from the general population.
이 연구는 현재 학교에서 실시되고 있는 수행평가가 중학생들의 과학성취도와 정의적 영역에 어떠한 영향을 미치는지를 알아보는데 목적이 있다. 수행평가의 다양한 방법 중에서도 과학과에서 가장 많이 실시되고 있는 실험실습법에 의한 수행평가의 방법이 중학교 과학학습에 미치는 영향을 알아보았다. 연구 결과로부터 볼 때, 과학성취도의 평균이 동질한 두 집단에서 수행평가를 적용한 실험집단의 과학 성취도 점수가 유의미하게 향상되었으며, 특히 사전 과학성취도가 중, 하위권인 학생들의 과학성취도에 통계적으로 유의미하게 영향을 미쳤다. 상위권 학생은 비록 통계적으로 유의미하지는 않지만 성적이 약간 향상되었다. 정의적 영역에서는 실험집단의 사전·사후 검사에서 유의미한 차이는 없었다. 그러나 실험집단은 통계적으로 유의미하지는 않지만 긍정적으로 변화를 보인 반면, 비교집단은 통계적으로 유의미하게 부정적인 방향으로 변화하였다. 정의적 영역에 대한 실험집단의 사전·사후검사 비교에서 정의적 영역의 하위요소 중 자아개념과 학습습관의 변화는 유의미하게 상승하였으며, 학습에 대한 태도의 변화에는 효과가 없었다. 실험집단의 과학성취도가 상·중·하인 집단별 정의적 영역점수의 향상정도에서 모두 유의미한 차이는 없었고, 실험집단과 비교집단의 비교분석에서는 정의적 영역의 하위요소 중 학습에 대한 태도에서 중, 하위권 학생들에게 긍정적인 효과가 나타났으며, 학습습관에 있어서는 하위권 학생들에게 긍정적인 효과를 보였다. 따라서 과학과에서 실험실습법에 의한 수행평가의 실시가 중학생들의 과학성취도와 정의적 영역의 향상에 영향을 미치고 있는 것으로 나타났으며 특히 성적이 중, 하위권인 학생들에게 미치는 영향이 더 크게 나타났다. The purpose of this study was to examine the effects of and application of the experimental practice which is one of the performance assessments on student's science achievements and affective domain in the middle school science. For this study, two classes were chosen from a co-ed middled school in Gimhae, and assigned to the experimental and the control groups. Prior to the instructions, a science achievements test and a affective domain test were administered. After the instructions, post-tests which were similar to the pretest were also administered. The results showed that the performance assessment based on an experimental practice was more effective of enhancing students' science achievement. However, there was no significant difference in an affective domain test between the two groups. For the control group, there was a significant difference between the pretest and post test in affective domain. It means that there was a negative change in affective domain of the control group.