• 한국산학기술학회논문지
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• 제19권12호
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• pp.227-236
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• 2018

본 연구는 심리적 스트레스 경험과 해마 용적의 차이를 체계적이고 종합적으로 검증하기 위해 메타분석을 실시하였다. 메타분석을 위해 1990년도에서 2016년도까지 출판된 국외 문헌들 중 스트레스를 경험한 개인의 해마 용적을 측정한 연구들을 대상으로, PRISMA에 따라 스트레스 경험 집단과 정상 집단 간의 해마 용적 차이를 확인하였다. MRI를 사용하여 해마용적의 평균, 표준편차, 사례수가 제시된 연구들이 분석에 사용되었고, 13편의 연구(스트레스 경험 374명, 정상 대상자 439명)가 최종 선별되었다. 스트레스원의 유형에 따라서는, 전쟁관련 연구 8편, 개인적 외상사건 관련 연구 5편으로 나눌 수 있다. 전체 메타분석에서 효과크기는 -0.70(-1.04; -0.37)이었고, 스트레스원으로 나누어 분석하였을 때, 전쟁 관련 하위집단에서의 효과크기는 -0.47(-0.78; -0.16), 개인적 외상사건 관련 하위집단에서의 효과크기는 -0.91(-1.57; -0.26)으로 나타났다. 분석 결과, 스트레스의 경험과 해마 용적 간의 유의한 부적 상관이 확인되었다. 만성적인 스트레스 요인과 그로 인한 환자 집단들의 해마 용적은 각 연구 간 이질성이 높은 편이었지만, 3개의 연구를 제외하고 모두 해마 용적이 통제집단에 비해 작게 나타났다.

• 대한응급의학회지
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• 제29권5호
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• pp.430-436
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• 2018

Objective: The purpose of this study was to evaluate whether or not the d-dimer level indicating hyperfibrinolysis could be a predictor of early poor outcome (massive transfusion, death within 24 hours) associated with trauma-induced coagulopathy in blunt trauma without significant brain injury. Methods: This study was a retrospective observational study using 516 blunt trauma patients without significant brain injury. The poor outcome group, including patients receiving massive transfusion and those who died within 24 hours, consisted of 33 patients (6.4%). The variables were compared between the poor outcome group and good outcome group, and logistic regression analysis was performed using statistically significant variables. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the poor outcome prediction ability of the initial d-dimer level. Results: The poor outcome group showed more serious anatomical, physiological, and laboratory data than the good outcome group. In the ROC curve analysis for evaluation of the poor outcome prediction of the d-dimer level, the area under the curve value was 0.87 (95% confidence interval [CI], 0.84-0.90) while the cut-off value was 27.35 mg/L. In the logistic regression analysis, the high d-dimer level was shown to be an independent predictor of poor outcome (adjusted odds ratio, 14.87; 95% CI, 2.96-74.67). Conclusion: The high d-dimer level (>27.35 mg/L) can be used as a predictor for the poor outcome of patients with blunt trauma without significant brain injury.

• 생물치료정신의학
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• 제24권3호
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• pp.184-193
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• 2018

Objectives : This study investigated the effects of social support and chronic medical conditions on depressive symptoms in elderly people living alone in a rural community. Methods : Sociodemographic information on 173 subjects aged 65 years or older who lived alone in a rural community and were recipients of National Basic Livelihood Security was collected and analyzed. All participants completed the Korean Form of the Geriatric Depression Scale and the Lubben Social Network Scale. Additionally, the current prevalence of chronic medical conditions that interfere with the activities of daily living was examined. Multiple logistic regression analysis was conducted to analyze the associations of social support and chronic medical conditions with depressive symptoms. Results : Social support(odds ratio: OR, 0.96; 95% confidence interval: 95% CI, 0.92-0.99) and chronic medical conditions(OR, 1.59; 95% CI, 1.23-2.05) were significantly associated with depressive symptoms in all subjects. When analyzed by gender, social support served as a protective factor against depressive symptoms in elderly men only(OR, 0.91; 95% CI, 0.83-0.99), and chronic medical conditions increased the risk of depressive symptoms in elderly women only(OR, 1.74; 95% CI, 1.26-2.40). Furthermore, osteoarthritis and lumbar pain were risk factors for depressive symptoms in all subjects(OR, 2.24; 95% CI, 1.10-4.56 and OR, 2.10; 95% CI, 1.08-4.12) and in elderly women(OR, 4.07; 95% CI, 1.68-9.84 and OR, 3.34; 95% CI, 1.47-7.57), respectively. Conclusion : This study indicates that improving the social support and managing the chronic medical conditions of elderly people living alone are important for the prevention of depression in this population. Additionally, the present results suggest that it is necessary to establish different depression-prevention strategies for elderly men and women living alone.

• 대한응급의학회지
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• 제29권5호
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• pp.408-414
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• 2018

Objective: Patients with low acuity who need hospitalization may be at risk if they do not receive proper treatment in overcrowded emergency rooms. This study was conducted to investigate factors affecting the hospitalization of patients with low acuity of Korean Triage and Acuity Scale (KTAS). Methods: This study was a retrospective chart review analysis of patients aged 15 years or older who had triaged as KTAS 4 and 5 grades when visiting a local emergency medical center from January 1, 2016 to December 31, 2017. Multivariate logistic analysis was performed to analyze the effects of age, sex, reasons for visiting, visiting route, ambulance utilization, KTAS grade and major category on patient admission. Results: A total of 10,540 patients were enrolled and the odds ratio (OR) increased with age from those aged over 34 years (P<0.001). Patients that triaged as KTAS grade 5 (adjusted OR, 1.57; 95% confidence interval [CI], 1.36-1.82), had a condition caused by disease (adjusted OR, 2.31; 95% CI, 2.00-2.68), and visited by using an ambulance (public: adjusted OR, 1.05; 95% CI, 0.91-1.22; private: adjusted OR, 4.60; 95% CI, 3.85-5.49) were more likely to be hospitalized. Individuals in the "general" major category were more likely to be hospitalized than those falling into other major categories (P<0.001). Conclusion: The factors influencing the hospitalization of patients with low acuity were age, reasons for visiting, visiting route, ambulance utilization, KTAS grade and major category on patient admission.

• 대한응급의학회지
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• 제29권5호
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• pp.485-492
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• 2018

Objective: This paper reports the status of the advanced cardiac life support (ACLS) according to the guidelines by residents belonging to other departments other than the department of emergency medicine. The differences in status between the junior group and senior group was also investigated according to grades of residents. Methods: The ACLS performance for in-hospital cardiac arrest cases of one academic hospital, except for the cases occurring in intensive care unit between November 2015 and October 2017, were analyzed retrospectively. Data included the characteristics of residents, patients' outcomes, ACLS performance, and conventional treatment having discordance with the ACLS guidelines. Leaders during cardiopulmonary resuscitation (CPR) were divided into a junior group and senior group. Results: A total of 152 cases were enrolled in this study. Of these, 131 cases (86.2%) showed at least one treatment with inconsistency from the guidelines and the incidence of discordant treatment was similar in the two groups (55 [85.9%] vs. 76 [88.4%], P=0.657). Implicit use of sodium bicarbonate was more frequent in the senior residents group (odds ratio [OR], 3.04; 95% confidence interval [CI], 1.36-6.81). On the other hand, no use of a defibrillator was less frequent in the senior residents group (OR, 0.14; 95% CI, 0.03-0.81). Conclusion: In both groups, the rate of discordance with the ACLS guidelines during CPR were high. The rate of implicit use of sodium bicarbonate and no use of defibrillator were significantly different in the two groups. A customized education strategy for ACLS is needed for each group.

• 대한응급의학회지
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• 제29권6호
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• pp.568-577
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• 2018

Objective: Performing high quality cardiopulmonary resuscitation (CPR) is important for improving the survival rate with a good neurological outcome and fewer complications. The retention of accurate CPR knowledge is essential for providing high quality CPR. This study examined the effects of chest compression only CPR training on the retention of correct CPR knowledge. Methods: In December 2016, an interview survey to target the study population was conducted by trained interviewers, using a structured questionnaire. The respondents' general characteristics, status of CPR education, and knowledge and willingness regarding CPR were investigated. Pearson's chi-square tests and multivariate logistic regression analyses were used to determine which education-related factors affected the correct skill knowledge of performing CPR. Results: Among the respondents, there are 80 persons (17.4%) who answered correctly in the questions regarding the skills of performing CPR. The respondents who had a willingness to perform CPR to family and strangers were 90.2% and 44.9% respectively. Through multivariable analysis, the factors related to correct skill knowledge in performing CPR in the didactic with practice group were people who had undergone CPR training within 2 years (odds ratio [OR], 2.293; 95% confidence interval [CI], 1.311-4.009), and person who had undergone chest compression only CPR training (OR, 2.044; 95% CI, 1.033-4.042). Conclusion: Chest compression only type of CPR training and the experience of CPR education within 2 years were associated with accurate skill knowledge of performing CPR.

• 대한응급의학회지
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• 제29권5호
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• pp.493-499
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• 2018

Objective: This study aimed to identify the effects of serum potassium and lactate on neurologic outcomes in out-of-hospital post-cardiac arrest adult patients. Methods: This study was a single center, retrospective observational study. We recruited out-of-hospital post-cardiac arrest adult patients admitted to an intensive care unit from 2011 to 2017. Primary outcome was good neurologic outcome at discharge. To evaluate the prognostic impact of serum potassium and lactate, univariate and multivariate logistic regression analyses were performed. Results: A total of 57 patients were included in this study. The number of patients with good neurologic outcome was 19 (33.3%). In the univariate analysis, good neurologic outcome patients showed a higher smoking rate, shorter pre-hospital transportation time, higher rate of percutaneous coronary intervention, and lower severity score (all P<0.05). The good neurologic outcome patients also presented higher pH, lower partial pressure of carbon dioxide, and lower potassium regarding laboratory findings on the first hospital day (all P<0.05). In the multivariate analysis, the independent factors favoring good neurologic outcome were pre-hospital transportation time (adjusted odds ratio [aOR], 0.82; 95% confidence interval [CI], 0.69-0.97; P=0.019) and lower partial pressure of carbon dioxide on the first hospital day (aOR, 0.95; 95% CI, 0.91-0.99; P=0.034). Conclusion: Serum potassium and lactate were not significantly associated with good neurologic outcome in out-of-hospital post-cardiac arrest adult patients. The prognostic factors for good neurologic outcome were pre-hospital transportation time and initial partial pressure of carbon dioxide.

• 대한응급의학회지
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• 제29권5호
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• pp.500-508
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• 2018

Objective: The aim of this study was to evaluate the clinical characteristics of heat stroke in a bath facility and investigate predictive factors of multiple major complications in heat stroke patients. Methods: This was a retrospective study on heat stroke patients who visited an urban emergency center from January 2010 to March 2018. We compared clinical characteristics, complication, and outcomes of heat stroke patients in bath and non-bath facilities. Multivariate logistic regression analysis were performed to identify independent predictors of multiple major complications in heat stroke patients. Results: A total of 67 heat stroke patients with heat stroke were enrolled, of which 42 (62.6%) were in a bath facility and 25 (37.3%) were in a non-bath facility. Patients with heat stroke in the bath facility were characterized by old age, past medical history of hypertension and diabetes mellitus, and high incidence of hypotension compared with those in the non-bath facility but also low incidence of acute renal failure, seizure, and multiple major complications. In the multivariate analysis, predictive factors of multiple major complications in heat stroke patients were non-bath facility (odds ratio [OR], 5.4; 95% confidence interval [CI], 1.2-29.9), Glasgow Coma Scale (GCS)${\leq}8$ (OR, 8.2; 95% CI, 1.3-49.4), and mean arterial pressure (MAP), body temperature above $40.5^{\circ}C$ (OR, 8.1; 95% CI, 1.1-58.8) <60 mmHg (OR, 14.8; 95% CI, 1.8-122.9). Conclusion: Heat stroke in the bath facility resulted in less major complications, and high body temperature, GCS ${\leq}8$, and MAP <60 mmHg were independent predictive factors of multiple major complications in heat stroke patients.

• 대한응급의학회지
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• 제29권5호
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• pp.423-429
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• 2018

Objective: Falling is a common cause of head injury in preschool aged children. We investigated the characteristics of mild head injuries caused by falling and the association between body weight and occurrence of traumatic brain injuries (TBI). Methods: This retrospective observational study was conducted on head-injured preschool-aged children that visited the emergency department from January 2012 to December 2015. Characteristics such as age, sex, weight, free fall height, floor type, and presence of TBI, as defined as cerebral hemorrhage or skull fracture, were investigated. We calculated body weight percentiles by calibrating age and weight and categorized them into four quartile ranges. We grouped all included cases into two groups according to the presence of TBI. The characteristics of the two groups were compared by using chi-square test, and the association with TBI was investigated by using binomial logistic regression. Results: A total of 701 children were included, and TBI was observed in 95 children. Children with TBI were younger. The proportion of children with TBI was higher in the third and fourth quartiles of the body weight group as well as according to soft floor and fall from high height (${\geq}1m$). The odds of soft floor being associated with TBI was higher than the odds for hard floor (odds ratio, 2.734; 95% confidence interval [CI], 1.597-4.680). The odds of high height (${\geq}1m$) being associated with TBI was higher than that for low height (odds ratio, 2.306; 95% CI, 1.155-4.601), and the odds ratio for the weight percentile group was 1.228 (95% CI, 1.005-1.499). Conclusion: Prevalence of TBI after falling in preschool-aged children might be associated with high fall-height and body weight quartiles.

• Neonatal Medicine
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• 제25권4호
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• pp.161-169
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• 2018

Purpose: We assessed the influence of antenatal corticosteroid (ACS) on the inhospital outcomes of intrauterine growth restriction (IUGR) infants. Methods: A retrospective study was conducted with singletons born at $23^{+0}$ to $33^{+6}weeks$ of gestation at Seoul National University Hospital from 2007 to 2014. We compared clinical outcomes between infants who received ACS 2 to 7 days before birth (complete ACS), at <2 or >7 days (incomplete ACS), and those who did not receive ACS in IUGR and AGA infants. Multivariate logistic regression using Firth's penalized likelihood was performed. Results: 304 neonates with 91 IUGR neonates were eligible. Among AGA neonates, mortality (adjusted odds ratio [aOR], 0.13; 95% confidence interval [CI], 0.02 to 0.78), hypotension within 7 postnatal days (aOR, 0.20; 95% CI, 0.06 to 0.64), and severe bronchopulmonary dysplasia (BPD) or death (aOR, 0.24; 95% CI, 0.07 to 0.77) were lower in complete ACS group after adjusting for pregnancy induced hypertension and uncontrolled preterm labor. Mortality (aOR, 0.18; 95% CI, 0.04 to 0.78), hypotension (aOR, 0.26; 95% CI, 0.09 to 0.70), and severe BPD or death (aOR, 0.33; 95% CI, 0.12 to 0.92) were also lower in the incomplete ACS group. Among IUGR infants, after adjusting for birth weight and 5-minute Apgar score, inhaled nitric oxide use within 14 postnatal days was lower in both complete ACS (aOR, 0.07; 95% CI, 0.01 to 0.67) and incomplete ACS (aOR, 0.04; 95% CI, 0.01 to 0.37) groups. Conclusion: ACS was not effective in reducing morbidities in IUGR preterm infants.