• 대한임상독성학회지
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• 제12권1호
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• pp.14-21
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• 2014

Purpose: The objective of this study was to develop a new scoring tool that is comprehensively applicable and predicts fatality within 24 h of intoxication. Methods: This was a cohort study conducted in two emergency medical centers from 2011 to 2012. We identified factors associated with severe/fatality. Through a discriminant analysis, we devised the aBIG (age, Base deficit, Infection, and Glasgow coma scale) score. To compare the ability of aBIG to predict intoxication severity with that of previous scoring systems such as APACHE II, MODS, SAPS IIe, and SOFA, we determined the receiver operating characteristic curves of each variable in predicting severe-to-fatal toxicity. Results: Compared with the mild/moderate toxicity group (n=211), the severe/fatal group (n=143) had higher incidences of metabolic acidosis, infection, serious mental change, QTc prolongation and hepato-renal failure. Age, base deficit, infection-WBC count, and Glasgow Coma Scale were independently associated with severe/fatal poisoning. These variables were combined into the poisoning "aBIG" score [$0.28{\times}$Age group+$0.38{\times}WBC$ count/$10^3+0.52{\times}$Base deficit+$0.64{\times}$(15-GCS)], which were each calculated to have an area under the curve of 0.904 (95% confidence interval: 0.868-0.933). The aBIG poisoning score had an equivalent level of severity predictability as APACHE II and a superior than MODS, SOFA, and SAPS IIe. Conclusion: We developed a simplified scoring system using the four variables of age, base deficit, infected leukocytosis, and GCS. The poisoning aBIG score was a simple method that could be performed rapidly on admission to evaluate severity of illness and predict fatal severity in patients with acute intoxications.

• Journal of Trauma and Injury
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• 제35권3호
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• pp.189-194
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• 2022

Purpose: The purpose of this study was to determine whether a higher Injury Severity Score (ISS) could serve as an indicator of splenectomy in patients with traumatic splenic lacerations. Methods: A total of 256 cases of splenic laceration were collected from January 1, 2005 to December 31, 2018. After the application of exclusion criteria, 105 were eligible for this study. Charts were reviewed for demographic characteristics, initial vital signs upon presentation to the emergency room, Glasgow Coma Scale, computed tomography findings, ISS, and treatment strategies. The cases were then divided into nonsplenectomy and splenectomy groups for analysis. Results: When analyzed with the chi-square test and t-test, splenectomy was associated with a systolic blood pressure lower than 90 mmHg, a Glasgow Coma Scale score lower than 13, active bleeding found on computed tomography, a splenic laceration grade greater than or equal to 4, and an ISS greater than 15 at presentation. However, in multivariate logistic regression analysis, only active bleeding on computed tomography showed a statistically significant relationship (P=0.014). Conclusions: Although ISS failed to show a statistically significant independent relationship with splenectomy, it may still play a supplementary role in traumatic splenic injury management.

• Journal of Korean Neurosurgical Society
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• 제44권1호
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• pp.1-7
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• 2008

Objective : The purpose of this study was to investigate the factors affecting the surgical outcome and to compare the surgical results between transsylvian and transcortical approaches in patients with putaminal hematomas. Methods : Retrospective review of charts and CT scan images was conducted in 45 patients (20 transsylvian and 25 transcortical approaches) who underwent open surgical evacuation of putaminal hematomas. Mean Glasgow coma scale (GCS) score and hematoma volume were $7.5{\pm}3.2$ and $78.1{\pm}29.3\;cc$, respectively. The factors affecting the functional mortality were investigated using a multivariate logistic regression analysis. In addition, surgical results between transsylvian and transcortical approaches were compared. Results : None of the patients had a good recovery after the surgery. Overall functional survival rate and mortality were 37.7% and 31%, respectively. The only risk factor for functional mortality was GCS motor score after controlling age, history of hypertension, side of hematoma, hematoma amount midline shift, presence of intraventricular hemorrhage and surgical approach (p=0.005). Even though a transcortical approach was shorter in operative time (4.4 versus 5.1 hour) and showed a higher mortality rate (40% versus 20%) and lower functional survival (45% versus 35%) compared to the transsylvian approach, the differences were not statistically significant between the two groups. Conclusion : In patients who have large amounts of hematoma and require open surgical evacuation, the only significant risk factor for functional survival is the preoperative GCS score. Cortical incision methods such as transsylvian and transcortical approaches have no influence on the surgical outcome. To decompress the swollen brain rapidly, transcortical approach seems to be more suitable than transsylvian approach.

• Journal of Korean Neurosurgical Society
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• 제41권1호
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• pp.16-21
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• 2007

Objective : Civilian gunshot injuries to the brain are relatively rare and study of these injuries has been neglected in South Korea. We present our experience with penetrating gunshot injuries to the brain and review the outcome of surgical management, as well as other clinical predictors influencing the prognosis. Methods : We present a retrospective analysis of 13 patients with penetrating gunshot injuries to the brain who were treated at our hospital over a period of 22 years. Results : The Glasgow Coma Scale[GCS] score on admission was recorded to be : 3-5 in 1 patient, 6-8 in 3 patients, 9-12 in 2 patients and 13-15 in 7 patients. There were 11 patients who underwent surgical treatment, and the surgical mortality rate was 0%. The admission GCS score was the most valuable prognostic factor. The best results were found to be in patients admitted with an initial GCS higher than 13. There were no favorable outcomes in patients admitted with a GCS of 8 or lower. There was a correlation between the presence of a transventricular or bihemispheric trajectory and poor outcome. The patients admitted with unilobar wounds resulted in better outcome than those with bilobar or multilobar wounds. Retained deep intracranial bone or metal fragments were the most common postoperative complication. However, retained fragments did not increase the risk of infection or seizure. Conclusion : Our results suggest that a less aggressive approach, consisting of minimal local debridement and removal of the bone and metal fragments that are easily accessible, can be successfully used in civilian gunshot wounds to the brain.

• 대한임상독성학회지
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• 제9권2호
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• pp.81-87
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• 2011

Purpose: Incidents of suicide attempt and acute poisoning in the elderly population is rising. This study investigated the clinical nature of acute poisoning and differences between the survival and mortality groups in the elderly. Methods: We retrospectively investigated 325 patients with acute poisoning who visited the emergency department. Patients were divided into two groups, one survival and one death group. Information regarding patient sex, age, root cause of poisoning, time of year of poisoning, type of intoxicant, duration of time between intoxicant ingestion and arrival at the emergency department, total length of hospital stay, and any previous suicide attempts and subsequent hospitalization were collected. An initial Glasgow Coma Scale (GCS) and an initial and final Poison Severity Score (PSS) for each patient was calculated. Results: The survival rate for men was higher than for women in this study. The most common reason of drug intoxication was suicide, with accidental ingestion and substance abuse occurring in descending frequency. Seasonal factors were reflected in the data with the highest number of incidents occurring in spring and the lowest number in winter. Compared with the mortality group, the survival group had a lower initial PSS with a higher GCS. Conclusion: We conclude that being female, having suicide as a root cause, agrochemicals as an intoxicant, low initial Glasgow Coma Scale and high initial Poisoning Severity Score, are all associated with poor prognosis.

• Journal of Korean Neurosurgical Society
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• 제46권2호
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• pp.123-129
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• 2009

Objective: This study was aimed to identify the incidence and risk factors of vancomycin-resistant enterococcus (VRE) colonization in neurosurgical practice of field, with particular attention to intensive care unit (ICU). Methods: This retrospective study was carried out on the Neurosurgical ICU (NICU), during the period from January. 2005 to December. 2007, in 414 consecutive patients who had been admitted to the NICU. Demographics and known risk factors were retrieved and assessed by statistical methods. Results: A total of 52 patients had VRE colonization among 414 patients enrolled, with an overall prevalence rate of 6.1%. E. faecium was the most frequently isolated pathogen, and 92.3% of all VRE were isolated from urine specimen. Active infection was noticed only in 2 patients with bacteremia and meningitis. Relative antibiotic agents were third-generation cephalosporin in 40%, and vancomycin in 23%, and multiple antibiotic usages were also identified in 13% of all cases. Multivariate analyses showed Glasgow coma scale (GCS) score less than 8, placement of Foley catheter longer than 2 weeks, ICU stay over 2 weeks and presence of nearby VRE-positive patients had a significantly independent association with VRE infection. Conclusion: When managing the high-risk patients being prone to be infected VRE in the NICU, extreme caution should be paid upon. Because prevention and outbreak control is of ultimate importance, clinicians should be alert the possibility of impending colonization and infection by all means available. The most crucial interventions are careful hand washing, strict glove handling, meticulous and active screening, and complete segregation.

• Journal of Korean Neurosurgical Society
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• 제60권2호
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• pp.239-249
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• 2017

Objective : The purpose of this study is to evaluate the associations between 30-day mortality and various radiological and clinical factors in patients with traumatic acute subdural hematoma (SDH). During the 11-year study period, young patients who underwent surgery for SDH were followed for 30 days. Patients who died due to other medical comorbidities or other organ problems were not included in the study population. Methods : From January 1, 2004 to December 31, 2014, 318 consecutive surgically-treated traumatic acute SDH patients were registered for the study. The Kaplan-Meier method was used to analyze 30-day survival rates. We also estimated the hazard ratios of various variables in order to identify the independent predictors of 30-day mortality. Results : We observed a negative correlation between 30-day mortality and Glasgow coma scale score (per 1-point score increase) (hazard ratio [HR], 0.60; 95% confidence interval [CI], 0.52-0.70; p<0.001). In addition, use of antithrombotics (HR, 2.34; 95% CI, 1.27-4.33; p=0.008), history of diabetes mellitus (HR, 2.28; 95% CI, 1.20-4.32; p=0.015), and accompanying traumatic subarachnoid hemorrhage (hazard ratio, 2.13; 95% CI, 1.27-3.58; p=0.005) were positively associated with 30-day mortality. Conclusion : We found significant associations between short-term mortality after surgery for traumatic acute SDH and lower Glasgow Coma Scale scores, use of antithrombotics, history of diabetes mellitus, and accompanying traumatic subarachnoid hemorrhage at admission. We expect these findings to be helpful for selecting patients for surgical treatment of traumatic acute SDH, and for making accurate prognoses.

• Journal of Trauma and Injury
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• 제25권4호
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• pp.122-131
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• 2012

Purpose: Diffuse axonal injury (DAI) is clinically defined as a coma of over six hours in a head trauma victim without a focal mass lesion. The emergency physician usually resuscitates and stabilizes a comatose head trauma victim in the emergency Department. After assessment and treatment, the prognosis is very important to both the victim and the physician. The prognosis for DAI is based on Glasgow Coma Scale (GCS) and other imaging data. We investigated the prognostic value of computed tomography (CT) and gradient-echo magnetic resonance imaging (GRI) for head trauma victims with DAI. Methods: Fifty-three(53) head trauma victims of DAI were enrolled in this study from 2007 to 2012. During the study period of six years, data on trauma victims were collected retrospectively. We analyzed the differences in the Glasgow Outcome Scale (GOS) result between the CT and the GRI modalities. Results: We classified the study group by using GOS. Between the good outcome subgroup (GOS scores of 4 and 5) and the poor outcome subgroup (GOS score of 1-3), there were no statistical difference in sex, age, initial vital signs and initial GCS score. The good outcome subgroup had non-hemorrhage on CT(52%), which was correlated with good outcome and a shorter awakening time, while a larger number and a deeper location of hemorrhagic lesions on in GRI were correlated with poor outcome in DAI. Conclusion: We conclude that the existence of hemorrhagic lesions on CT, and the number and location of those lesions on GRI had good prognostic value for head trauma victims with DAI.

• 대한임상독성학회지
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• 제7권2호
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• pp.77-82
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• 2009

Purpose: In highly doses, endosulfan lowers the seizure threshold and elicits central nervous system stimulation, which can result in seizures, respiratory failure, and death. Management of seizure control is essential for survival and prognosis of intoxicated patients. This study assessed whether seizure time was an independent predictor mortality in patients with endosulfan poisoning. Methods: This retrospective study enrolled patients with endosulfan poisoning presenting to Masan Samsung Hospital and Gyeongsang National University Hospital from January 2003 to December 2008. The data were collected from clinical records and laboratory files. Using a multivariate logistic analysis, data on the total population was retrospectively analyzed for association with mortality. Results: Of the 24 patients with endosulfan poisoning, nineteen (79.1%) experienced seizure. The patients in the seizure group showed significantly lower Glasgow coma scale score, base excess, bicarbonate, and significant existence of mechanical ventilation, as compared to the non seizure group (n=5). Seizure, Glasgow coma scale score, systolic blood pressure, bicarbonate level, need for respiratory support, pulse rate, respiratory rate, pH, base excess, and seizure time were associated with mortality. The fatality rate of endosulfan poisoning was 54.1% with higher mortality among patients experiencing. Longer seizure time was associated with higher mortality. Conclusion: Seizure time can be a significant independent predictor of mortality in patients with acute endosulfan poisoning. Physicians should aggressively treat for seizure control in patients with acute endosulfan poisoning.

• Journal of Korean Neurosurgical Society
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• 제58권3호
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• pp.262-270
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• 2015

Objective : Long-term oral anticoagulation or antiplatelet therapy has been used with increasing frequency in the elderly. These patients are at increased risk of morbidity and mortality from expansion of intracranial hemorrhage. We conducted a single-center retrospective case control study to evaluate risk factors associated with outcomes and to identify the differences in outcome in traumatic brain injury between preinjury anticoagulation use and without anticoagulation. Methods : A retrospective study of patients who underwent craniotomy or craniectomy for acute traumatic cerebral hemorrhage, between January 2005 and December 2014 was performed. Results : A consecutive series of 50 patients were evaluated. The factors significantly differed between the two groups were initial Prothrombin Time-International Normalized Ratio, initial platelet count, initial Glasgow Coma Scale score, and postoperative intracranial bleeding. Mean Glasgow Outcome Scale (GOS) score were similar between the two groups. In the patient with low-energy trauma only, no significant differences in GOS score, postoperative bleeding and many other factors were observed. The contributing factors to postoperative bleeding was preinjury anticoagulation and its adjusted odds ratio was 12 [adjusted odds ratio (OR), 12.242; p=0.0070]. The contributing factors to low GOS scores, which mean unfavorable neurological outcomes, were age (adjusted OR, 1.073; p=0.039) and Rotterdam scale score for CT scans (adjusted OR, 3.123; p=0.0020). Conclusion : Preinjury anticoagulation therapy contributed significantly to the occurrence of postoperative bleeding. However, preinjury anticoagulation therapy in the patients with low-energy trauma did not contribute to the poor clinical outcomes or total hospital stay. Careful attention should be given to older patients and severity of hemorrhage on initial brain CT.