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양욱태,민문기,류지호,이대섭,이강호,신진욱,염석란,한상균 대한응급의학회 2018 대한응급의학회지 Vol.29 No.5
Objective: This study compared the prognosis of patients who visited the trauma center directly (direct visit group) with those transferred from the non-trauma center (transferred group). Methods: The patients, who were 18 or older with Injury Severity Score of 15 or more in the trauma center at Busan, were studied from October 2015 to October 2016. To compare the treatment time between the direct visit and transferred group, first treatment time, final treatment time, and time to visit the trauma center were examined. To compare the prognosis, this study compared the 48-hour, 7-day, and in-hospital mortality rate as well as the duration of intensive care unit (ICU) and total hospital stay. To analyze the factors affecting the outcome of transferred group, the physician’s level and procedures that had been performed at the non-trauma center were examined. Results: The mortality was similar in the direct visit and transferred group (48-hour 7.6% vs. 4.6%, P=0.111; 7-day 11.1% vs. 7.2%, P=0.89; and in-hospital 14.6% vs. 11.3%, P=0.214). The length of ICU and total hospital stay were similar in the two groups. The mortality was higher in the patients in the transferred group when using intubation, transfusion, and pressure intensifier. The intubated patients showed higher mortality according to logistic regression. Conclusion: The mortality, length of ICU, and hospital stay were similar but the time to visit the trauma center and the final treatment time were longer in transferred group. Stabilizing the patient at the near non-trauma center may be more helpful for some patients.
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자동차 사고에서 뒷좌석 탑승자의 손상에 영향을 주는 요인
박진영,양욱태,왕일재,조영모,염석란,조석주,여지선,박성욱 대한응급의학회 2023 대한응급의학회지 Vol.34 No.3
Objective: Previous studies focused primarily on drivers or front-seat passengers in motor vehicle accidents. Recent research has shown improvements in front-seat occupant protection. This study examined the risk factors contributing to severe injury in rear-seat occupants. Methods: This study was conducted retrospectively. The variables related to the crash data were acquired from the Emergency Department-based Injury In-depth Surveillance registry and electronic medical record of the authors’hospital between 2019 and 2020. Multivariate logistic regression analysis was used to identify the risk factors contributing to severe injury in rear-seat occupant. Results: One hundred and forty rear-seat occupants were analyzed. The occupants were categorized by the abbreviated injury scale into severe (n=39; 27.9%) and non-severe injury (n=101; 72.1%). The collision with a large-size vehicle (odds ratio [OR], 4.278; 95% confidence interval [CI], 1.617-18.000; P=0.015) and fixed objects (OR, 3.459; 95% CI, 1.347- 8.883; P=0.049) was independently associated severe injury. Seatbelt use was also an independent risk factor of severe injury (OR, 2.649; 95% CI, 1.178-5.940; P=0.018). Common severe injuries encountered in rear seats were chest (12.1%), spine (9.3%), and abdomen (5.7%). Conclusion: In contrast to the fact that seat belt use reduces the severity of injuries, seatbelt use was associated with severe injury in this study. Further research will be needed to assess the effects of seatbelt use. In addition, awareness should be raised about the relationship between the accident mechanism, seatbelt use, and the commonly injured body region.
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Is the shock index a useful tool in trauma patients with alcohol ingestion?
박시홍,왕일재,조영모,양욱태,염석란,이대섭,민문기,천모세,허업,송찬희,김예은 대한응급의학회 2023 대한응급의학회지 Vol.34 No.5
Objective: Alcohol consumption is a frequent risk factor for trauma. The shock index is widely used to predict the prognosis of trauma, and alcohol can influence the shock index in several ways. This study investigated the usefulness of the shock index in trauma patients who had ingested alcohol. Methods: This was a retrospective, observational, single-center study. We performed a logistic regression analysis to assess the association between alcohol consumption and massive transfusions. A receiver operating characteristic (ROC) curve was constructed to determine the predictive value of the shock index for patients who had ingested alcohol. Results: A total of 5,128 patients were included in the study. The alcohol-positive group had lower systolic blood pressure and higher heart rate; consequently, the shock index in this group was higher. There was no significant difference between the proportion of the alcohol-positive and alcohol-negative groups who underwent massive transfusions and suffered hospital mortality compared to the overall proportion of patients who underwent massive transfusion based on the shock index. In the logistic regression analysis, the alcohol-negative group showed higher odds ratios for massive transfusions compared to the alcohol-positive group. The area under the ROC curve for predicting massive transfusion was 0.831 for the alcohol-positive group and 0.825 for the alcohol-negative group. However, when a cutoff value of 1 was used, the false positive rate was significantly higher in the alcohol-positive group. Conclusion: The shock index is a useful tool for predicting outcomes in patients with trauma. However, in patients who have ingested alcohol, the shock index should be interpreted with caution.
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지역유형별 노인 응급환자 사망률 차이 및 영향요인-부산, 울산, 경남지역을 중심으로-
윤현준,김길훈,이명화,류지호,양욱태,염석란 사단법인 대한보건협회 2023 대한보건연구 Vol.49 No.1
연구목적: 본 연구는 지역유형을 구분하고 지역유형별 응급실에 내원한 노인환자 사망률에 영향을 미치는 요인을 파악하고자 실시되었다. 연구방법: 2017~2019년 부산, 울산, 경남 기초자치단체 시군구 43개 지역의 생태학적 특성을 수집하여 군집분석을 통해 지역유형을 구분하였다. t-검정을 통해 지역유형별 사망률 및 관련 요인 간 차이 및 다중회귀분석을 통해 영향 요인 및 영향력을 확인하였다. 연구결과: 군집은 도시군과 비도시군으로 분류되었으며 노인 응급환자 사망률은 비도시군에서 높았다. 전체, 도시군, 비도시군 모두에서 노인 응급환자 사망률에 응급실 기준시간 내 의료이용률은 유의하였다. 사망 영향 요인에 대한 영향력 순으로 전체에선 주말 및 휴일 방문 비율(-), 권역응급의료센터 기준시간 내 의료이용률(-), KTAS 1, 2등급 비율(+), 응급실 기준시간 내 의료이용률(-), 재정자립도(+), 후기고령노인(85세 이상) 비율(+), 급성심근경색 비율(+)이, 도시군에서는 KTAS 1, 2등급 비율(+), 응급실 기준시간 내 의료이용률(-), 노인여가복지시설(-), 노인의료복지시설 현원(+), 의료급여환자 비율(-), 노인주거복지시설 현원(-)이, 비도시군에서는 후기고령노인(85세 이상) 비율(+), 건강시설 면적(+), 공장 면적(+), 응급실 기준시간 내 의료이용률(-), 야간 방문 비율(+), 뇌졸중 비율(+), 지역응급의료센터급 이상 기준시간 내 의료이용률(-), 재가노인복지시설 현원(-)이 유의하게 나타났다. 결론: 노인 응급환자 사망률 개선을 위해선 지역 유형에 구분 없이 응급실 접근성 개선이 가장 시급한 과제이며 이를 위한 인프라 확충 및 신기술을 도입할 필요가 있을 것이다. 또한 지역유형별 특성을 고려한 예방 및 건강증진 활동, 노인복지시설 확충 또한 중요한 과제이다.
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