Journal of Trauma and Injury

  • 제28권3호
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  • Pages.134-143
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  • 2015
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  • 2799-4317(pISSN)
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  • 2287-1683(eISSN)
대한외상학회 (The Korean Society of Traumatology)
권호 표지

외상 환자의 중증도 판단과 예후 예측을 위한 개별 인자들의 유용성 평가

Evaluation the Usefulness of Individual factors for Determining the Severity and Predicting Prognosis of Trauma Victims

  • 김성윤 (가톨릭대학교 의과대학 응급의학교실) ;
  • 소병학 (가톨릭대학교 의과대학 응급의학교실) ;
  • 김형민 (가톨릭대학교 의과대학 응급의학교실) ;
  • 정원중 (가톨릭대학교 의과대학 응급의학교실) ;
  • 차경만 (가톨릭대학교 의과대학 응급의학교실) ;
  • 최승필 (가톨릭대학교 의과대학 응급의학교실)
  • Kim, Sung Yoon (Department of Emergency Medicine, College of Medicine, The Catholic University of Korea) ;
  • So, Byung Hak (Department of Emergency Medicine, College of Medicine, The Catholic University of Korea) ;
  • Kim, Hyung Min (Department of Emergency Medicine, College of Medicine, The Catholic University of Korea) ;
  • Jeong, Won Jung (Department of Emergency Medicine, College of Medicine, The Catholic University of Korea) ;
  • Cha, Kyung Man (Department of Emergency Medicine, College of Medicine, The Catholic University of Korea) ;
  • Choi, Seung Pill (Department of Emergency Medicine, College of Medicine, The Catholic University of Korea)
  • 투고 : 2015.07.30
  • 심사 : 2015.10.04
  • 발행 : 2015.09.30
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초록

Purpose: Many patients are injured by trauma. And some of them expire due to severity of trauma. Various scoring systems have been introduced in grading severity and predicting mortality of trauma patients. This study is to evaluation the usefulness of factors for determining the severity and predicting the prognosis of the trauma victims. Methods: Data on the patients who visited our Emergency departments from January 2010 to December 2011 were retrospectively reviewed using electronic medical records. The patients were activated severe trauma team calling system. The patients were categorized as survivors and non-survivors. Univariated associations were calculated, and a multiple logistic regression analysis was used to determine variables associated with hospital mortality. Results: Two hundred sixty two(262) patients were enrolled, and the mortality rate was 25.6%. By multivariate analysis, lower respiration rate, lower Glasgow Coma Score, higher International Normalized Ratio and emergency transfusion within 6 hours were expected as severity and prognosis predict factors (each of odds ratio were 24.907, 14.282, 2.667 and 16.144). Conclusion: As predict factors, respiration rate, Glasgow Coma Score, International Normalized Ratio and emergency transfusion, are useful determining the severity and predicting prognosis of trauma victims.

키워드

참고문헌

  1. Death rates for the cause of death: Staticstics Korea. Available at: http://kostat.go.kr/ ;cited 2014.10.01.
  2. Hwang JY, Lee KH, Shin HJ, Cha KC, Kim H, Hwang SO. Correlation analysis of trauma scoring system in predictive validity in motor vehicle accident. J Korean SocEmerg Med 2011; 22: 329-34.
  3. Mattox KL, Moore EE, Feliciano DV. Trauma. Injury severity scoring and outcomes research. 7thed. New York: McGraw-Hill; 2013: 77-88.
  4. Osler T, Baker SP, Long W: A modification of the injury severity score that both improves accuracy and simplifies scoring. J Trauma 1997; 43: 922-5. https://doi.org/10.1097/00005373-199712000-00009
  5. Staff T, Eken T, Wik L, Roislien J, Sovik S. Physiologic, demographic and mechanistic factors predicting New Injury Severity Score (NISS) in motor vehicle accident victims. Injury 2014; 45: 9-15. https://doi.org/10.1016/j.injury.2012.11.010
  6. Borgman MA, Maegele M, Wade CE, Blackbourne LH, Spinella PC. Pediatric trauma BIG score: predicting mortality in children after military and civilian trauma. Pediatrics 2011; 127: 2010-439.
  7. Brockamp T, Maegele M, Gaarder C, Goslings JC, Cohen MJ, Lefering R, et al. Comparison of the predictive performance of the BIG, TRISS, and PS09 score in an adult trauma population derived from multiple international trauma registries. Crit Care 2013; 17: R134. https://doi.org/10.1186/cc12813
  8. Raum MR, Nijsten MW, Vogelzang M, Schuring F, Lefering R, Bouillon B, et al. Emergency trauma score: an instrument for early estimation of trauma severity. Crit Care Med 2009; 37: 1972-7. https://doi.org/10.1097/CCM.0b013e31819fe96a
  9. The Trauma Audit and Research Network. Available at: https://www.tarn.ac.uk/Contest.aspx?ca=4
  10. Bouamra O, Wrotchford A, Hollis S, Vail A, Woodford M, Lecky F. A new approach to outcome prediction in trauma: A comparison with the TRISS model. J Trauma 2006; 61: 701-10. https://doi.org/10.1097/01.ta.0000197175.91116.10
  11. Sartorius D, Le Manach Y, David JS, Rancurel E, Smail N, Thicolpe M, et al. Mechanism, glasgow coma scale, age, and arterial pressure (MGAP): a new simple prehospital triage score to predict mortality in trauma patients. Crit Care Med 2010; 38: 831-7. https://doi.org/10.1097/CCM.0b013e3181cc4a67
  12. Kim YH, Seo KS, Lee MJ, Park JB, Kim JK, Ahn JY, et al. Application of new trauma scoring systems for mortality prediction in patients with adult major trauma. J Korean Soc Emerg Med 2014; 25: 447-55.
  13. Healthcare-associated Infections: Centers for Disease Control and Prevention. USA. Available at: http://www.cdc.gov/HAI/
  14. Sasser SM, Hunt RC, Faul M, Sugerman D, Pearson SW, Dulski T, et al. Guidelines for field triage of injured patients: Recommendations of the National Expert Panel on Field Triage. 2011. MMWR Recomm Rep 2012; 61: 1-20.
  15. Demetrios D, Jack S, Kathleen A, Newton E, Velmahos GC, Murray JA, et al. Old age as a criterion for trauma team activation. J Trauma 2001; 51: 754-57. https://doi.org/10.1097/00005373-200110000-00022
  16. Rogers A, Rogers F, Bradburn E, Krasne M, Lee J, Wu D, et al. Old and undertriaged: a lethal combination. Am Surg 2012; 78: 711-5.
  17. Champion HR, Copes WS, Buyer D, Flanagan ME, Bain L, Sacco WJ. Major trauma in geriatric patients. Am J Public Health 1989; 79: 1278-82. https://doi.org/10.2105/AJPH.79.9.1278
  18. Diamond IR, Parkin PC, Wales PW, Bohn D, Kreller MA, Dykes EH, et al. Pediatric blunt and penetrating trauma deaths in Ontario: a population-based study. J Pediatr Surg 2009; 44: 981-6. https://doi.org/10.1016/j.jpedsurg.2009.01.039
  19. Dutton RP, Stansbury LG, Leone S, Kramer E, Hess JR, Scalea TM. Trauma mortality in mature trauma systems: are we doing better? An analysis of trauma mortality patterns, 1997-2008. J Trauma 2010; 69: 620-6. https://doi.org/10.1097/TA.0b013e3181bbfe2a
  20. Chang IW, Kim H, Shin HJ, Joen WC, Park JM, Shin DW, et al. Factors contributing to mortality for patients at a newlydesignated regional trauma center. J Korean Soc Trauma 2012; 25: 188-95.
  21. Hess JR, Brohi K, Dutton RP, Hauser CJ, Holcomb JB, Kluger Y, et al. The coagulopathy of trauma: a review of mechanisms. J Trauma 2008; 65: 748-54. https://doi.org/10.1097/TA.0b013e3181877a9c
  22. Lee DE, Seo KS, Lee MJ, Shin SJ, Ryoo HW, Kim JK, et al. Acute traumatic coagulopathy in severe trauma patients. J Korean Soc Trauma 2012; 25: 72-8.
  23. Noh MS, Yang SS, Kyoung KH. The effect of acute coagulopathy in profoundly traumatic patients on acute and early deaths. J Korean Soc Trauma 2014; 27: 158-64.
  24. Kim SJ, Lee SW, Han GS, Moon SW, Choi SH, Hong YS. Acute traumatic coagulopathy decreased actual survival rate when compared with predicted survival rate in severe trauma. Emerg Med J 2012; 29: 906-10. https://doi.org/10.1136/emermed-2011-200630
  25. Narayan M, Tesoriero R, Bruns BR, Klyushnenkova EN, Chen H, Diaz JJ. Acute care surgery: Defining mortality in emergency general surgery in the state of maryland. J Am Coll Surg 2015; 220: 762-70. https://doi.org/10.1016/j.jamcollsurg.2014.12.051