• The Journal of Internal Korean Medicine
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• v.21 no.3
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• pp.369-376
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• 2000

Purpose : Cerebrovascular disease is the most frequent cause of death in Korea and it remains severe disabilities disturbing normal life, According to the previous studies, mortality of the stroke in the first one week is up to the 20% and 95% of stroke patients in the acute stage are accompanied by more than one complications. These complications affect not only the acute stage mortality but also the late stage rehabilitations. In Korea the oriental medicine is preformed in the treatment of stroke. Therefore it is important to recognize thoroughly the complications in the acute stage of stroke and to prevent them. But studies about complications of acute stage stroke is rarely presented in the fields of oriental medicine. So this study is prepared for investigating the characteristics and frequency of complications in the acute stage of stroke. And we are to assess the importance of theses acute complications by systemic reviewing the previous studies. Methods : Fifty one patients are included who had been admitted to ICU(intensive care unit) of Chenju Hospital of Wonkwang Oriental Medicine. Twenty nine patients are diagnosed as ischemic stroke and twenty one patients are diagnosed hemorrhagic stroke. Medical and neurological complications were investigated retrospectively based on medical notes excluding primary symptoms of stroke Le. motor weakness, sensory disturbance and speech disorder. And risk factors of stroke such as D.M. or hypertension are excluded. Results : Medical complications are more frequent than neurological ones. Most frequent medical complication is dysuria(61%) and constipation(45%), fever(30%) and aspiration pneumonia(22%) are followed in order of frequency. In Neurological complication dysphagia(56%), the exacerbation of infarction due to increased intracranial pressure(24%), irritability or insomnia(21%) is most frequently complicated in order of frequency. Conclusions : These complications are mostly caused by bed rest state in acute stage stroke. It is supposed that more aggressive management can prevent theses ones. And it is possible to improve the medical and neurological conditions by sticking theses study results.

• Tuberculosis and Respiratory Diseases
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• v.73 no.4
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• pp.224-230
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• 2012

Background: We evaluated the clinical outcomes and prognostic factors of patients requiring prolonged mechanical ventilation (PMV), defined as ventilator care for ${\geq}21$ days, who were admitted to the medical intensive care unit (ICU) of a university hospital in Korea. Methods: During the study period, a total of 2,644 patients were admitted to the medical ICU, and 136 patients (5.1%) were enrolled between 2005 and 2010. Results: The mean age of the patients was $61.3{\pm}14.5$ years, and 94 (69.1%) were male. The ICU and six-month cumulative mortality rates were 45.6 and 58.8%, respectively. There were 96 patients with tracheostomy placement after admission and their mean period from admission to the day of tracheostomy was $21.3{\pm}8.4$ days. Sixty-three patients (46.3%) were successfully weaned from ventilator care. Of the ICU survivors (n=74), 34 patients (45.9%) were transferred to other hospitals (not university hospitals). Two variables (thrombocytopenia [hazard ratio (HR), 1.964; 95% confidence interval (CI), 1.225~3.148; p=0.005] and the requirement for vasopressors [HR, 1.822; 95% CI, 1.111~2.986; p=0.017] on day 21) were found to be independent factors of survival on based on the Cox proportional hazard model. Conclusion: We found that patients requiring PMV had high six-month cumulative mortality rates, and that two clinical variables (measured on day 21), thrombocytopenia and requirement for vasopressors, may be associated with prognostic indicators.

• Korean Journal of Clinical Laboratory Science
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• v.37 no.2
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• pp.96-101
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• 2005

Status epilepticus is a medical emergency, so that rapid and vigorous treatment is required to prevent neuronal damage and systemic complication. Status epilepticus is generally defined as a continuous or intermittent seizure or an unconscious condition after the onset of seizure, lasting for 30 minutes or more. We report here the outcome of status epilepticus. We retrospectively reviewed medical record of 15 patients who were diagnosed with status epilepticus at the Asan Medical Center from January 2003 to February 2004. This outcome was evaluated considering various factors such as age of patients, history of seizures, neurologic impairment, etiology, mortality, return to baseline and initial electroencephalogram (EEG) findings. The range of age was between 1 to 79 years old and the longest duration of treatment was 118 days. Most patients were treated by using pentobarbital, midazolam, phenobarbital and other antiepileptic drugs. The overall mortality was 5 (33%) out of 15 patients. The mortality was related to etiology, underlying other medical conditions and initial EEG findings. 5 (55%) out of the 9 patients with acute etiology, 5 (71%) out of the 7 patients with a multifocal or burst-suppression EEG activity, and 3 (60%) out of the 5 patients with other medical disease were related to mortality. This data demonstrate high mortality due to status epilepticus. Mortality is related to etiology, other medical conditions and abnormalities on the initial EEG.

• Journal of Korean Neurosurgical Society
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• v.48 no.2
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• pp.99-104
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• 2010

Objective : We conducted this study to evaluate the clinical impact of early enteral nutrition (EN) on in-hospital mortality and outcome in patients with critical hypertensive intracerebral hemorrhage (ICH). Methods : We retrospectively analyzed 123 ICH patients with Glasgow Coma Scale (GCS) score of 3-12. We divided the subjects into two groups : early EN group (< 48 hours, n = 89) and delayed EN group ($\geq$ 48 hours, n = 34). Body weight, total intake and output, serum albumin, Creactive protein, infectious complications, morbidity at discharge and in-hospital mortality were compared with statistical analysis. Results : The incidence of nosocomial pneumonia and length of intensive care unit stay were significantly lower in the early EN group than in the delayed EN group (p < 0.05). In-hospital mortality was less in the early EN group than in the delayed EN group (10.1% vs. 35.3%, respectively; p = 0.001). By multivariate analysis, early EN [odds ratio (OR) 0.229, 95% CI : 0.066-0.793], nosocomial pneumonia (OR = 5.381, 95% CI : 1.621-17.865) and initial GCS score (OR = 1.482 95% CI : 1.160-1.893) were independent predictors of in-hospital mortality in patients with critical hypertensive ICH. Conclusion : These findings indicate that early EN is an important predictor of outcome in patients with critical hypertensive ICH.

• Tuberculosis and Respiratory Diseases
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• v.79 no.4
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• pp.289-294
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• 2016

Background: The aim of our study was to evaluate the prognostic value of Charlson's weighted index of comorbidities (WIC) in patients with prolonged acute mechanical ventilation (PAMV, ventilator care ${\geq}96$ hours). Methods: We retrospectively enrolled 299 Korean PAMV patients who were admitted in a medical intensive care unit (ICU) of a university-affiliated tertiary care hospital between 2008 and 2013. Survivors were defined as patients who survived for 60 days after ICU admission. Results: The patients' mean age was $65.1{\pm}14.1$ years and 70.6% were male. The mean ICU and hospital length of stay was $21.9{\pm}19.7$ and $39.4{\pm}39.1$ days, respectively. In addition, the 60-day mortality rate after ICU admission was 35.5%. The mean WIC was $2.3{\pm}1.8$, with significant differences between nonsurvivors and survivors ($2.7{\pm}2.1$ vs. $2.1{\pm}1.7$, p<0.05). The area under the curve of receiver-operating-characteristics curve for WIC was 0.593 (95% confidence interval [CI], 0.523-0.661; p<0.05). Based on Kaplan-Meier curves of 60-day survival, WIC ${\geq}5$ had statistically lower survival than WIC <5 (logrank test, p<0.05). In a multivariate Cox proportional hazard model, WIC ${\geq}5$ was associated with poor prognosis (hazard ratio, 1.901; 95% CI, 1.140-3.171; p<0.05). The mortality rate of patients with WIC ${\geq}5$ was 54.2%. Conclusion: Our study showed a WIC score ${\geq}5$ might be helpful in predicting 60-day mortality in PAMV patients.

• Journal of the Korean Burn Society
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• v.23 no.1
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• pp.1-6
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• 2020

Purpose: PL, creatinine and urine output are biomarkers of the suitability and prognosis of fluid therapy in severe burn patients. The purpose of this study is to evaluate the usefulness of predicting mortality by biomarkers and its change during initial fluid therapy for severe burn patients. Methods: A retrograde review was performed on 733 patients from January 2014 to December 2018 who were admitted as severe burn patients to our burn intensive care unit (BICU). Plasma lactate, serum creatinine and urine output were measured at the time of admission to the BICU and after 48 hours. ABSI score, Hangang score, APACHEII, revised Baux index and TBSA were collected after admission. Results: 733 patients were enrolled. PL was the most useful indicators for predicting mortality in burn patients at the time of admission (AUC: 0.813) and after 48 hours (AUC: 0.698). On the other hand, mortality prediction from initial fluid therapy for 48 hours showed different results. Only creatinine showed statistical differences (P<0.05) in mortality prediction. But there were no statistical differences in mortality prediction with PL and UO (P>0.05). Conclusion: In this study, PL was most useful predictor among biomarkers for predicting mortality. Improvement in creatinine levels during the first 48 hours is associated with improved mortality. Therefore, efforts are needed to improve creatinine levels.

• Clinical and Experimental Pediatrics
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• v.51 no.11
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• pp.1158-1164
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• 2008

Purpose : To investigate the discriminative ability of pediatric index of mortality 2 (PIM2) and pediatric risk of mortality III (PRISM III) in predicting mortality in children admitted into the intensive care unit (ICU). Methods : We retrospectively analyzed variables of PIM2 and PRISM III based on medical records with children cared for in a single hospital ICU from January 2003 to December 2007. Exclusions were children who died within 2 h of admission into ICU or hopeless discharge. We used Students t test and ANOVA for general characteristics and for correlation between survivors and non-survivors for variables of PIM2 and PRISM III. In addition, we performed multiple logistic regression analysis for Hosmer-Lemeshow goodness-of-fit, receiver operating characteristic curve (ROC) for discrimination, and calculated standardized mortality ratio (SMR) for estimation of prediction. Results : We collected 193 medical records but analyzed 190 events because three children died within 2 h of ICU admission. The variables of PIM2 correlated with survival, except for the presence of post-procedure and low risk. In PRISM III, there was a significant correlation for cardiovascular/neurologic signs, arterial blood gas analysis but not for biochemical and hematologic data. Discriminatory performance by ROC showed an area under the curve 0.858 (95% confidence interval; 0.779-0.938) for PIM2, 0.798 (95% CI; 0.686-0.891) for PRISM III, respectively. Further, SMR was calculated approximately as 1 for the 2 systems, and multiple logistic regression analysis showed ${\chi}^2(13)=14.986$, P=0.308 for PIM2, ${\chi}^2(13)=12.899$, P=0.456 for PRISM III in Hosmer-Lemeshow goodness-of-fit. However, PIM2 was significant for PRISM III in the likelihood ratio test (${\chi}^2(4)=55.3$, P<0.01). Conclusion : We identified two acceptable scoring systems (PRISM III, PIM2) for the prediction of mortality in children admitted into the ICU. PIM2 was more accurate and had a better fit than PRISM III on the model tested.

• Korean Journal of Adult Nursing
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• v.19 no.1
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• pp.45-54
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• 2007

Purpose: This study was to identify the significant acute physiological predictors of mortality and of functional and cognitive recovery in hemorrhagic stroke patients. Methods: The subjects were 108 hemorrhagic stroke patients admitted to Neurological Intensive Care Unit of a university hospital. Results: The significant physiological predictors of mortality and of functional and cognitive recovery were quite different upon admission Glasgow Coma Scale scores: respiratory rate, hematocrit, serum pH, osmolality, and $PaCO_2$ were the predictors in the subjects with a high Glasgow Coma Scale scores while blood pressure, $PaO_2$, respiratory rate, and hematocrit in the subjects with a low Glasgow coma scale scores. Conclusion: The physiological derangements induced by acute stroke are undoubtedly influence clinical outcome. More study is required to determine their diverse impacts on clinical outcomes.

• Journal of Trauma and Injury
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• v.29 no.1
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• pp.8-13
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• 2016

Purpose: Specialized general trauma surgeons play an important role in the care of trauma patients. Hemoperitoneum is a severe, but representative, condition following a life-threatened trauma. The objective of this study was to compare the outcomes for polytrauma patients with hemoperitoneum between the periods during which a trauma surgeon was available and that unavailable. Methods: Thirty-one trauma patients with hemoperitoneum who were treated at Korea University Guro Hospital over a period of 4 years were included in this study, and their case records were analyzed retrospectively. The patients were divided into two groups, the 2011 and 2012 group and the 2013 and 2014 group corresponding, respectively, to the periods that a trauma surgeon was not and was working. Vital signs on admission, scores on the injury severity scale and, Glasgow coma scale, elapsed time to diagnostic, and therapeutic, and/or operative interventions were studied. The effects on intensive care unit and hospital lengths of stay, as well as mortality, were also studied. Results: The study population consisted of 16 and 15 patients in group 1 and 2, respectively. The patients in both groups had six unstable hemodynamic on admission. The time to the main procedure (intervention, operation etc.) was longer during the periods when a trauma surgeon was not working than it was during the period when working. This difference did not reached statistical significance. The mortality rates for the two groups were not statistically different either (18.75% vs 26.67%; p=0.928). Conclusion: Having at least one specialized general trauma surgeon on duty may reduce the time to intervention and surgery for severe trauma patients with hemoperitoneum, but appears to have no effect on the mortality rates. In conclusion, having only one trauma surgeon on duty does not improve the quality of care for trauma patients.

• Journal of Trauma and Injury
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• v.32 no.1
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• pp.17-25
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• 2019

Purpose: We investigated how prehospital, emergency room (ER), and delta shock indices (SI) correlate with outcomes including mortality in patients with polytrauma. Methods: We retrospectively reviewed the medical records of 1,275 patients who visited the emergency department from January 2015 to April 2018. A total of 628 patients were enrolled in the study. Patients were divided into survivor and non-survivor groups, and logistic regression analysis was used to investigate independent risk factors for death. Pearson coefficient analysis and chi-square test were used to examine the significant relationship between SI and clinical progression markers. Results: Of 628 enrolled patients, 608 survived and 27 died. Multivariate logistic regression analysis reveals "age" (p<0.001; OR, 1.068), "pre-hospital SI >0.9" (p<0.001; OR, 11.629), and "delta SI ${\geq}0.3$" (p<0.001; OR, 12.869) as independent risk factors for mortality. Prehospital and ER SIs showed a significant correlation with hospital and intensive care unit length of stay and transfusion amount. Higher prehospital and ER SIs (>0.9) were associated with poor clinical progression. Conclusions: SI and delta SI are significant predictors of mortality in patients with polytrauma. Moreover, both prehospital and ER SIs can be used as predictive markers of clinical progression in these patients.