노인 외상 환자에 대한 분석 및 외상성 혈기흉의 임상양상

김정태 ( Jung Tae Kim ) 대한외상학회 2009 대한외상학회지 Vol.22 No.2

Purpose: This study was conducted to analyze chest-trauma patients and the old-aged patients with a traumatic hemopneumothorax. Methods: We reviewed the medical records of 101 chest-trauma patients admitted to the department of cardiovascular and thoracic surgery from June 1999 to November 2008. We evaluated the general characteristics of the chest-trauma patient, especially those of old-aged patients with a traumatic hemopneumothorax. Results: Rib fracture was observed in 99 of the cases, the location distribution was right: left =261: 255, with right being dominant. Rib fractures commonly involved the 4th and the 7th rib. The average number of rib fractures was 5.1, and the average number of rib fractures in the old-aged patients was significantly higher than that in the non-old-aged patients (p=0.04). There were 17 cases of a hemopnuemothorax in old-aged patients, 52 cases in non-old-aged patients. The blood loss through the chest tube for old-aged patients was significantly more than that for the non-old-aged patients, and the initial hemoglobin level was lower in the old-aged patients. Conclusion: Elderly trauma patients are more likely to die after trauma than other age groups. Even with relatively stable vital signs, invasive hemodynamic monitoring and intensive treatment are recommended. (J Korean Soc Traumatol 2009;22:161-66)

다발성 중증 외상 환자들의 치료에 대한 응급 외상팀 운영의 효과

이성화 ( Seong Hwa Lee ),조석주 ( Suck Joo Cho ),염석란 ( Seok Ran Yeom ),류지호 ( Ji Ho Ryu ),정진우 ( Jin Woo Jung ),한상균 ( Sang Kyun Han ),김용인 ( Yong In Kim ),박맹렬 ( Maeng Real Park ),김영대 ( Young Dae Kim ) 대한외상학회 2009 대한외상학회지 Vol.22 No.2

Purpose: We performed this study to determine how the emergency trauma team affects the treatment of patients with multiple severe trauma and to discuss the effect and the direction of the emergency trauma team`s management. Methods: We performed a retrospective analysis of 518 patients who visited our emergency department with severe trauma from August 2006 to July 2008. We divided the severe trauma patients into 2 groups: patients before and after trauma team management (Group 1 and Group 2). Then, we compared demographic characteristics, mechanisms of injury, and treatment outcomes (lengths of stay in the ED, admission ratio, and in-hospital mortality) between the 2 groups. In the same way, patients with multiple severe trauma were divided into 2 groups, that are patients before and after trauma team management (Group 3 and Group 4) and analyzed. Results: There was no significant difference, except mean age, between groups 1 and 2. In group 4 patients, compared to group 3 patients, the lengths of stay in the ED were lower (p value<0.001), and the admission ratio were higher (p value=0.017), but there was no significant difference in the in-hospital mortality between the groups 3 and 4. Conclusion: When patients with multiple severe trauma visit the ED, the emergency trauma team`s management can decrease the lengths of stay in the ED and increase the admission ratio, but does not produce a decrease in the in-hospital mortality rate. Further investigations of emergency trauma team management are needed to improve treatment outcomes for patients with multiple severe trauma. (J Korean Soc Traumatol 2009;22:172-78)

교통사고 예방 및 대책에 대한 워크샵

대한외상학회 대한외상학회 1989 大韓外傷學會誌 Vol.2 No.1

응급수술을 시행한 응급의료센터 내원 외상 환자 분석; 응급의학과 진료는 외상환자에 대한 외과의 수술과 같은 전문적인 진료를 오히려 지연시키는가?

이경원 ( Kyung Won Lee ) 대한외상학회 2007 대한외상학회지 Vol.20 No.1

Purpose: Trauma surgery is not an official medical specialty in the Republic of Korea (South Korea). Thus, a trauma victim transported to an emergency room (ER) is resuscitated and surveyed by an intern, a resident, or an emergency physician (EP) at first. Currently an operative management is decreasing because of multiple factors. Nevertheless, trauma surgery is the key for some patients. Does the EP`s treatment in the ER delay the surgeon`s emergency operation? Methods: A retrospective study was performed for trauma victims who underwent trauma surgery from March 2004 to February 2005 in a local emergency center of Daegu-city. We reviewed the medical records and analyzed the trauma victim`s age, sex, cause of injury, method of transport, time from the trauma to the operation, EP`s treatment, surgical department, mortality, and injury severity score (ISS). Results: Of the 223 trauma victims included in this study, males were predominant (83.4%). The mean age was 37.98 years of age. The main Causes of trauma were trauma NOS (not otherwise specified) and motor vehicle accidents (MVA). The main methods of transport was privately owned automobile. The mean time from trauma to operation was 617.46 min. The mean ISS was 7.67. Trauma surgery with the EP`s treatment group included 40 trauma victims with higher ISS, and the time from trauma to operation was shorter than it was for the 183 trauma victims not in that group. Conclusion: The EP`s treatment of high-ISS multiple-injury trauma victims can shorten the time from trauma to trauma surgery and will help the surgical department treatment. In the trauma care system of the Republic of Korea, and increased role should be encouraged for emergency physician. (J Korean Soc Traumatol 2007;20:19-25)

2차와 3차 병원에서 외상 치료의 적정성 비교

홍석현 ( Suk Hyun Hong ),한갑수 ( Gap Su Han ),정상헌 ( Sang Hun Jung ),전정민 ( Chung Min Chun ),최성혁 ( Sung Hyuk Choi ),이성우 ( Sung Woo Lee ),홍윤식 ( Yun Sik Hong ) 대한외상학회 2005 대한외상학회지 Vol.18 No.1

본 연구에서는 응급처치 및 중환자 처치 능력의 확충이 중증 외상환자 치료에 미치는 영향을 알아보고자 두 기간 동안 대도시의 3차 병원과 중소도시의 2차 병원에서 외상치료의 적정성을 비교하였다. 응급 및 중환자 처치 능력의 확충 이후, 2차 병원은 타 병원으로의 전원 없이도 중증 외상 환자를 치료할 수 있게 되었으며, 생리학적 외상 치료 능력이 향상되어 보다 정확한 외상 치료가 가능해 졌다. 비록 특별하게 고안된 외상 센터가 아니라 하더라도, 잘 구축된 응급 의료 체계하에서 지역별로 응급 및 중 환자 처치 능력을 강화하면 외상 환자 치료 성적을 향상 시킬 수 있을 것이다. Background: This study compared the performance of trauma care in an urban and a suburban hospital before and after the enhancement of emergency and intensive care. Method: The medical records of patients who were admitted to the intensive care unit following trauma from 1994 to 1995 and from 2002 to 2003 were examined. The standardized W (Ws), the 95% confidence interval (CI) of the Ws, and the predicted survival rate (Ps) were calculated. During each period, each hospital`s actual survival rate was compared with the 95% CI of the Ps according to the revised trauma score (RTS) and injury severity score (ISS). Spell out RTS and ISS. Result: From 1994 to 1995, 225 and 121 records from the urban and the suburban hospitals were reviewed, respectively. The 95% CI`s of the Ws were -2.30 to 2.73 and -11.40 to -5.90, respectively. The actual survival rate of the suburban hospital was significantly lower than the predicted survival rate at all RTS. From 2002 to 2003, 315 and 268 records from the urban and the suburban hospitals were reviewed, respectively. The 95% CI`s of the Ws was -3.56 to 0.24 and -3.73 to 0.26, respectively. There was no difference between the actual survival rate and the predicted survival rate. Conclusion: An enlargement of the capacities of emergency and intensive care may improve the performance of trauma care at a small suburban hospital.

TRISS method 를 통한 복부외상환자의 예후 비교

정기훈,조용걸,이문섭,엄준원,김남렬,홍윤식 대한외상학회 2000 大韓外傷學會誌 Vol.13 No.1

Purpose: Currently, trauma patients in Korea are treated in general hospitals instead of trauma centers. We performed this study to determine the prognosis for trauma patients through scoring systems and to identify was any difference in outcome between patients treated at two hospitals. Methods: We retrospectively reviewed the medical records of abdominal trauma patients admitted to the ICU in two hospitals. Hospital A is located in Seoul (800 beds), and Hospital B is located in Kyungju (400 beds). There were 48 abdominal trauma patients in Hospital A from January 1, 1997, to December 31, 1998, and 50 patients in Hospital B from January 1, 1995 through December 31, 1998. The abdominal trauma index (ATI), revised trauma score (RTS), and injury severity score (ISS) of each patient were obtained. TRISS scores and W, Z statistics were then calculated. Results: There were no significant statistical scoring system between survivors and nonsurvivors in either hospital. W score was -0.182 in Hospital A and -9.700 in Hospital B. Z score was -0.193 in Hospital A and -2.011 in Hospital B. Misclassifications of predicted survival and death rates was 16.7% (Hospital A) and 18% (Hospital B) Conclusion : There was not statistic significance to the ATI, RTS, or ISS between survivors and nonsurvivors at either hospital. The TRISS methodology has some limitations for determining differences in outcomes of treatment at the two hospitals.

혈역학적으로 불안정한 골반외상 환자의 치료를 통해 본 외상전문의의 필요성

신성 ( Sung Shin ),경규혁 ( Kyu Hyuk Kyung ),김지완 ( Ji Wan Kim ),김정재 ( Jung Jae Kim ),홍석경 ( Suk Kyung Hong ) 대한외상학회 2009 대한외상학회지 Vol.22 No.2

Purpose: Pelvic trauma is a serious skeletal injury with high mortality. Especially in cases of severe injury trauma, treatment outcomes depend on early diagnosis and intervention. We expect trauma surgeon to play an important role in the management of severe multiple trauma patients. Methods: A retrospective study was performed on pelvic trauma patients with hemodynamic instability between March 2005 and September 2009. We divided the time period into period I (March 2005~Feburary 2009) and period II (March 2009~September 2009). The trauma surgeon and team started to work from period II. Data were collected regarding demographic characteristics, mechanism of injury, type of pelvic fracture, ISS (injury severity score), treatment modality, transfusion requirement, time to definitive treatment, and mortality. Results: During period I, among 7 hemodynamically unstable patients, 4(57.1%) patients died. However during Period II, only one of 6(16.6%) patients died. The demographic data and injury scores showed no differences between the two time periods, but the time to definitive treatment was very short with trauma team intervention(14.4 hrs vs. 3.9 hrs). Also, the amount of transfusion was less(41.1 U vs. 13.9 U). With arterial embolization, early pelvic external fixation led to less transfusion and made patients more stable. Conclusion: This study demonstrated the importance of the trauma surgeon and the trauma team in cases of hemodynamically unstable pelvic trauma. Even with the same facility and resources, an active trauma team approach can increase the survival of severely injured multiple trauma patients. (J Korean Soc Traumatol 2009;22:254-259)

응급실에 내원한 둔상환자의 수혈 필요성 예측인자

오지선 ( Ji Sun Oh ),김형민 ( Hyung Min Kim ),최세민 ( Se Min Choi ),최경호 ( Kyoung Ho Choi ),홍태용 ( Tai Yong Hong ),박규남 ( Kyu Nam Park ),소병학 ( Byung Hak So ) 대한외상학회 2009 대한외상학회지 Vol.22 No.2

Purpose: In multiple blunt trauma patients, transfusion may be a significant therapeutic adjunct to non-operative management. The blood products must be expedited and efficiently to patients in impending shock caused by hemorrhage or traumatic coagulopathy, but the decision to perform blood transfusion has been made empirically, based on the clinician`s and has not been guided by objective parameters, but own opinion, that may result in an underestimate of or a failure to detect bleeding, in delayed transfusion, and in a reduced outcome. This article presents quickly assessable predictive factors for determining if a blood transfusion is required to improve outcomes in multiple blunt trauma patients admitted to the emergency room. Methods: In a retrospective review of 282 multiple blunt trauma patients who visited our emergency center by emergency rescuer during a 1-year period, possible factors predictive of the need for a blood transfusion were subjected to univariate and multivariate logistic regression analysis. Results: Of blunt trauma patients, 9.2% (26/282), received red blood cells in the first 24 hours of care. Univariate analysis revealed significant associations between blood transfused and heart rate (HR)>100 beats/min, respiratory rate (RR)>20 breaths/min, Glasgow Coma Scale (GCS)<14, Revised Trauma Score (RTS)<11, white blood cell count (WBC)<4000 or >10000, and initial abnormal portable trauma series (C-spine lateral, chest AP, pelvis AP). A multiple regression analysis, with a correction for diagnosis, identified HR>100 beats/min (EXP 3.2), GCS<14 (EXP 4.1), and abnormal trauma series (EXP 2.9), as independent predictors. Conclusion: In our study, systolic blood pressure (SBP)<90 mmHg, old age>65 years, hemoglobin <13g/dL, mechanism of injury were poor predictors of early blood transfusion. Initial abnormal portable trauma series, HR>100 beats/min, and GCS<14 were quickly assessable useful factors for predicting a need for early blood transfusion in blunt trauma patients visiting the emergency room. (J Korean Soc Traumatol 2009;22:218-26)

혈관 색전술을 시행한 외상 환자에 대한 임상적 고찰

선종효 ( Jong Hyo Sun ),김재광 ( Jae Kwang Kim ),임용수 ( Yong Su Lim ),김진주 ( Jin Joo Kim ),조진성 ( Jin Sung Jo ),현성열 ( Sung Youl Hyun ),정호성 ( Ho Sung Jeong ),양혁준 ( Hyuk Jun Yang ),이근 ( Gun Lee ),김정호 ( Jeong Ho 대한외상학회 2009 대한외상학회지 Vol.22 No.2

Purpose: Hemodynamically unstable pelvic fractures represent therapeutic challenges for the trauma team. The authors of this article have studied the clinical profiles of the angiographic intervention population at the emergency department during four years (2005~2009) to develop clinical guidelines for preventing deaths due to multiple trauma and for predicting the prognosis during initial evaluation. Methods: We performed a retrospective review of 34 patients who had undergone angiographic interventions at the emergency department and compared the differences in clinical variables between survivors and non-survivors. Results: Representative values were compared between survivors and non-survivors: RTS (revised trauma score) 7.006 (6.376~7.841) vs. 6.128 (4.298~6.494), PRC (packed red cell) units 5.5 (2.0~11.0) vs. 15 (8.0~18.5), and lactate (mmol/L) 3.0 (1.0~7.0) vs. 8.5 (3.5~10.5). RTS (p<0.01) and PRC units before angiographic interventions (p=0.01) and lactate (p=0.02) had correlations to the final outcomes. Conclusion: The availability of an angiographic suite and persistent hypotension after adequate fluid resuscitation for pelvic trauma are good indications of angiographic intervention for pelvic hemorrhage. (J Korean Soc Traumatol 2009;22:248-53)

두부 손상이 없는 골절 환자에서 혈중 S100B 단백질의 분석

박태웅 ( Tae Woong Park ),이동훈 ( Dong Hoon Lee ),이상진 ( Sang Jin Lee ),김성은 ( Sung Eun Kim ),김찬웅 ( Chang Woong Kim ) 대한외상학회 2009 대한외상학회지 Vol.22 No.2

Purpose: There is an increasing amount of evidence that S100B could function as a marker of brain damage. However, the cerebral specificity of S100B has been questioned, so the extracerebral sources of S100B have been paid attention. We performed this investigation to show serum S100B levels after extracranial fracture in patients without current head injury and without prior neurological disease. Methods: At the emergency department, we obtained the blood samples within 6 hours from trauma patients hospitalized with extracranial fractures. S100B levels were compared between one fracture and more than two fractures, and analyzed according to the presence of soft tissue damage. Results: Patients with one fracture and those with more than two fractures did not differ by age (mean, 54.70 vs. 47.03, p=0.130), and there was no significant difference in the male-to-female ratio(33:32 vs. 21:12, p=0.226). In patients with one fracture, the mean value of S-100B was 0.56 μg/L (95% CI: 0.35-0.77) whereas in those with more than two fractures, the corresponding value was 1.09 μg/L (95% CI: 0.46-1.7, p=0.048). The S100B level of patients with soft tissue damage(1.32±0.38) was higher than that of patients without soft tissue damage(0.81±0.21), whether one fracture or more than two fractures(p=0.049). Conclusion: We present here that S100B levels were raised in 77% of patients with extracranial fractures without cerebral injury who were hospitalized from the emergency room and that the presence of soft tissue damage contributed to the increased S100B rather than the size of the fractured bone size or the number of fracturest. Thus, this study suggests that soft tissue injury may be considered as an important extracerebral source of S100B. (J Korean Soc Traumatol 2009;22:123-7)