외상성 두부 손상환자의 상급병원 전원을 위한 이차 중증도 분류 개발 = Development of Secondary Triage Rules for Interfacility Transfer of Patients with Traumatic Brain Injury

다국어 초록 (Multilingual Abstract)

Purpose: This study was aimed to develop secondary
triage rule for decision of interfacility transfer to higher level
of trauma center for patients with traumatic brain injury
(TBI).
Methods: In a prospective observational study from August
2006 to December 2007 conducted in an urban tertiary
emergency department, data were obtained from patients
more than 15 years old and with TBI. Primary outcome was
defined as meaningful positive CT findings. Secondary outcome
was defined as meaningful intervention. Non-adjusted
univariated logistic regression model was derived from
result of chi-square test and adjusted model was derived
using stepwise selection manner. Hosman-Lemeshow test
for the goodness of fit was used.
Results: Total number of eligible patients with traumatic
brain injury was 653. Primary outcome was positive in 103
patients and secondary outcome was positive in 42
patients. In univariate logistic regression, risk factors were
age over 65(OR: 2.40), history of cerebrovascular disease(
OR: 7.08), fall over two meter(OR: 6.28), pedestrian
struck(OR: 18.5), headache(OR: 2.18), vomiting(OR: 3.03),
disorientation(OR: 5.37), any evidence of open fracture(OR:
24.03), Glasgow coma sacle less than 13(OR: 4.97),
Racoon’s eye sign (OR: 2.50). These 10 risk factors were
statistically significant in adjusted model which was derived
using stepwise selected manner. Hosman-Lemeshow test
for the goodness of fit was used and chi-square was
1.307(p=0.86). This decision rule had a sensitivity of
93.48%, a specificity of 41.13%, and a negative predictive
value of 97.32%.
Conclusion: A sensitive clinical decision rule with high negative
predictive value for detection of abnormal CT lesions
which need transfer to higher level of trauma center was
developed.

참고문헌 (Reference)

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