Journal of The Korean Society of Emergency Medicine (대한응급의학회지)

The Korean Society of Emergency Medicine (대한응급의학회)
권호 표지

The influence of the decision making time by using point-of-care creatinine in patients with acute abdomen

급성 복증 환자에서 현장검사 크레아티닌을 이용한 의사결정 시간의 단축

  • Choi, Younhyuk (Department of Emergency Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine) ;
  • Cho, Sunguk (Department of Emergency Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine) ;
  • Ahn, Hongjoon (Department of Emergency Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine) ;
  • Min, Jinhong (Department of Emergency Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine) ;
  • Jeong, Wonjoon (Department of Emergency Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine) ;
  • Ryu, Seung (Department of Emergency Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine) ;
  • Oh, Segwang (Department of Emergency Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine) ;
  • Kim, Seunghwan (Department of Emergency Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine) ;
  • You, Yeonho (Department of Emergency Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine) ;
  • Lee, Jinwoong (Department of Emergency Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine) ;
  • Park, Jungsoo (Department of Emergency Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine) ;
  • Yoo, Insool (Department of Emergency Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine) ;
  • Cho, Yongchul (Department of Emergency Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine)
  • 최윤혁 (충남대학교 의과대학 충남대학교병원 응급의학과) ;
  • 조성욱 (충남대학교 의과대학 충남대학교병원 응급의학과) ;
  • 안홍준 (충남대학교 의과대학 충남대학교병원 응급의학과) ;
  • 민진홍 (충남대학교 의과대학 충남대학교병원 응급의학과) ;
  • 정원준 (충남대학교 의과대학 충남대학교병원 응급의학과) ;
  • 유승 (충남대학교 의과대학 충남대학교병원 응급의학과) ;
  • 오세광 (충남대학교 의과대학 충남대학교병원 응급의학과) ;
  • 김승환 (충남대학교 의과대학 충남대학교병원 응급의학과) ;
  • 유연호 (충남대학교 의과대학 충남대학교병원 응급의학과) ;
  • 이진웅 (충남대학교 의과대학 충남대학교병원 응급의학과) ;
  • 박정수 (충남대학교 의과대학 충남대학교병원 응급의학과) ;
  • 유인술 (충남대학교 의과대학 충남대학교병원 응급의학과) ;
  • 조용철 (충남대학교 의과대학 충남대학교병원 응급의학과)
  • Received : 2018.05.31
  • Accepted : 2018.10.03
  • Published : 2018.12.31

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Abstract

Objective: Radio-contrast abdomino-pelvic computed tomography (APCT) is considered the gold standard diagnostic tool for an acute abdomen in the emergency department. On the other hand, APCT has a risk of contrast-induced nephropathy. Emergency physicians evaluate the creatinine (Cr) level prior to taking a APCT for the above reason but it takes time to evaluation the serum Cr level. This study hypothesized that Cr measured by a point-of-care test (POCT) can shorten the time to making clinically important decisions for patients with an acute abdomen. Methods: This prospective randomized study was conducted between March 2017 and October 2017. The subjects were divided into two groups (Cr measured by laboratory vs. Cr measured by POCT). To analyze the clinical acceptability for creatinine, agreement was demonstrated graphically by Bland-Altman plots. This study compared the time to make a clinically important decision by physicians and the length of stay at the emergency department in both groups. Results: A total of 76 patients were eligible for the study, 38 patients were assigned to each group. There was no statistically significant difference in the time to the first medical examination (P=0.222) and emergency department stay time (P=0.802). On the other hand, the time to recognition of the Cr level (P<0.001), time to performing APCT (P<0.001), time to decision making (P<0.001), and time to initiation of treatment (P<0.001) were shortened significantly in the point-of-care creatinine group. Conclusion: In this study, the POCT for creatinine can allow rapid decision making by shortening the time to performing the radio-contrast APCT than the laboratory for patients with an acute abdomen.

Keywords

References

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