Journal of the Korea Academia-Industrial cooperation Society (한국산학기술학회논문지)

The Korea Academia-Industrial cooperation Society (한국산학기술학회)
권호 표지
DOI QR코드

DOI QR Code

Characteristics of patients with decreased mental status while staying in an emergency department: Comparative study with alert patients

응급실 체류 중에 의식이 저하된 환자의 특성: 의식명료 환자와의 비교연구

  • Received : 2018.06.26
  • Accepted : 2018.10.05
  • Published : 2018.10.31
Download PDF
⟨ Previous Next ⟩

Abstract

This was a retrospective study that compared the characteristics of patients with decreased mental status (DMS) during their stays in an emergency department (ED) with that of patients with alert mental status (AMS). The participants in this study consisted of 90 patients with DMS who were staying in an ED along with 100 randomly selected patients with AMS. The DMS group contained more instances of cerebrovascular disease, liver disease, diabetes, and hypertension compared to the AMS group (p=0.001, p=0.003, p<0.001, and p=0.002, respectively). With regard to triage, the DMS group had higher severity than the AMS group (p<.001). The final diagnosis for the DMS group was as follows: 64.9% neurological and 63.3% related to the digestive system, which differed from that of the AMS group (p<.001). Fifty-six (62.2%) patients with DMS had their statuses discovered by nurses, while nine patients in the DMS group had received cardiopulmonary resuscitation. These results suggest that ED nurses frequently assess the consciousness of patients who they suspect may have neurologic or digestive diseases and are classified as high severity, even when the patients are alert.

본 연구는 내원 당시에는 의식이 명료했으나 응급실 체류 중에 의식이 저하된 환자의 특성을 의식이 명료한 환자와 비교하여 파악하기 위한 후향적 조사연구이다. 연구대상은 일개 응급실에 방문한 응급환자 중 내원 당시에는 의식이 명료했으나 내원 후 의식저하를 보인 환자 90명과 내원당시 의식이 명료했으며 응급실 체류 중에도 의식저하가 없는 환자 중 무작위 추출한 100명이었다. 연구결과 의식저하 군은 의식명료 군에 비해 뇌혈관 질환, 간질환, 당뇨, 고혈압의 기저질환이 많았다(p=.001, p=.003, p<.001, and p=.002, respectively). 중증도 분류 결과 의식저하 군은 의식명료 군에 비해 중증도가 높았다(p<.001). 의식저하 군의 최종 진단명은 신경계 질환 64.9%, 소화기계 질환 63.3%로 의식명료 군과 차이가 있었다(p<.001). 의식저하 군 중 56명(62.2%)은 응급실 간호사에 의해 의식저하 상태가 발견되었다. 의식저하 군 중 9명은 심정지가 발생하여 심폐소생술을 받았다. 본 연구결과 응급실 간호사는 응급실 내원 당시 의식이 명료하더라도 중증도가 높고, 신경계 질환이나 소화기계 질환이 의심되는 환자는 의식수준을 자주 사정해야 함을 시사한다.

Keywords

References

  1. H. C. Jin, J. Y. No, S. J. Jo, S. L. Lee, S. J. Kim, S. Y. Lyu, H. Y. Kim, "The Clinical Analysis on the Altered Mental Status in the ED", Journal of The Korean Society of Emergency Medicine, Vol.14, No5, pp.615-623, 2003.
  2. W. Kanich, W. J. Brady, J. S. Huff, A. D. Perron, C. Holstege, G. Lindbeck, C. T. Carter, "Altered mental status: Evaluation and etiology in the ED", The American Journal of Emergency Medicine, Vol.20, No7, pp.613-617, 2002. DOI: https://dx.doi.org/10.1053/ajem.2002.35464
  3. National Emergency Medical Center, 2016 Annual report of Korean emergency medicine [Internet]. Seoul: Korean Statistical Information Service, [cited 2017 Oct 10], Avaliable from: http://www.e-gen.or.kr/nemc/statistics_annual_report.do. (accessed April, 10, 2018)
  4. Emergency Nurses Association. Emergency nursing core curriculum, pp.23-30, Elsevier Health Sciences, 2017.
  5. S. H. Moon, Y. H. Park, "Concept Analysis of Triage Competency in Emergency Nursing", Journal of Korean Critical Care Nursing, Vol.10, No3, pp.41-52, 2017.
  6. B. J. Kim, U. N. Lee, K. H. Kang, S. S. Kim, S. A. Kim, Y. H. Sung, D. S. Shin, K. O. Yi, H. J. Lee, "A Study of Job Analysis of the Emergency Room Nurse", Journal of Korean Clinical Nursing Research, Vol.12, No1, pp.81-95, 2006.
  7. TA Edwards, Art of triage, pp.7-49, Nova Science Publishers, 2014.
  8. H. J. Song, Emergency Medical Service System and Policy Implications in Korea, Health and welfare policy forum, Vol.90, pp.63-73, 2004.
  9. S. M. Mun, S G. Jeong, Y. M. Oh, S. M. Choe, G. H. Cheo. K. N. Park, J. S. Oh, "Effect of Issuing of Hospitalization Sheets by Emergency Department on Shortening Length of Stay", The Korean Society of Emergency Medicine, Vol.20, No.1, pp.10-19, 2009.
  10. Z. Kekec, V. Senol, F. Koc, G. Seydaoglu, "Analysis of Altered Mental Status in Turkey", International Journal of Neuroscience, Vol.118, No.5, pp.609-617, 2008. DOI: https://dx.doi.org/10.1080/00207450701849133
  11. J. P. Choi, Altered Mental Status in Emergency Department Patients : Etiologies and Outcomes, Konyang University, Master Thesis, 2007.
  12. S. I. Yoo, H. S. Won, J. H. Jung, S. H. Jang, "Clinical Analysis on Patients with Altered Mental Status in the Emergency Department: Elderly versus Adult Patients", Annals of geriatric medicine and research, Vol.12, No2, pp.82-88, 2008.
  13. S. Y. Youk, "Nursing Competency and Indicator Development by Emergency Nurse's Clinical Ladder", Journal of Korean Academy of Nursing Administration, Vol.9, No3, pp.481-494, 2003.
  14. World Health Organization, ICD-10 Version: 2010 [Internet]. World Health Organization, Avaliable from: http://apps.who.int/classifications/icd10/browse/2010/en. (accessed April, 15, 2018)
  15. J. E. Tintinalli, J. S. Stapczynski, O. J. Ma, D. M. Cline, G. D. Meckler, "Altered Mental Status and Coma. Tintinalli's Emergency Medicine: A Comprehensive Study Guide", 8e edition, McGraw Hill Professional, 2016.
  16. J. H. Lee, J. S. Seo, D. H. Seol, M. S. P. Choe, K. S. Seo, J. B. Park, J. M. Chung, "Clinical Review of Elderly Patients Who Visited the Emergency Department with Altered Mental Status", The Korean Society of Emergency Medicine, Vol.15, No.1, pp.24-29, 2004.
  17. S.Y. Park, J. M. Woo, "Delirium of Elderly Patients in Emergency Room", The Korean Society of Biological Therapies in Psychiatry, Vol.18, No.2, pp.104-110, 2012.
  18. K. H. Kang, "Predictors of Emergency Medical Transports Use Based on 2009", Korea Health Panel, Vol.28, No.3, pp.80-86, 2014.
  19. C. O'Keeffe, S. Mason, R. Jacques, J. Nicholl, "Characterising non-urgent users of the emergency department (ED): A retrospective analysis of routine ED data", PLOS ONE, Vol.13, No.2, Article ID e0192855, 2018. DOI: https://dx.doi.org/10.1371/journal.pone.0192855
  20. H. Xiao, Y. Wang, T. Xu, H. Zhu, S. Guo, Z. Wang, X. Yu, "Evaluation and treatment of altered mental status patients in the emergency department: life in the fast lane", World Journal of Emergency Medicine, Vol.3, No.4, pp.270-77, 2012. DOI: https://dx.doi.org/10.5847/wjem.j.issn.1920-8642. 2012.04.006
  21. M. A. Aslaner, M. Boz, A. Celik, A. Ahmedali, S. Eroglu, N. M. Aksu, S. E. Eroglu, "Etiologies and delirium rates of elderly ED patients with acutely altered mental status: a multicenter prospective study", The American Journal of Emergency Medicine, Vol.35, No.1, pp.71-76, 2017. DOI: https://dx.doi.org/10.1016/j.ajem.2016.10.004