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A Study on the Performance Evaluation of G2B Procurement Process Innovation by Using MAS: Korea G2B KONEPS Case (멀티에이전트시스템(MAS)을 이용한 G2B 조달 프로세스 혁신의 효과평가에 관한 연구 : 나라장터 G2B사례)

  • Seo, Won-Jun;Lee, Dae-Cheor;Lim, Gyoo-Gun
    • Journal of Intelligence and Information Systems
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    • v.18 no.2
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    • pp.157-175
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    • 2012
  • It is difficult to evaluate the performance of process innovation of e-procurement which has large scale and complex processes. The existing evaluation methods for measuring the effects of process innovation have been mainly done with statistically quantitative methods by analyzing operational data or with qualitative methods by conducting surveys and interviews. However, these methods have some limitations to evaluate the effects because the performance evaluation of e-procurement process innovation should consider the interactions among participants who are active either directly or indirectly through the processes. This study considers the e-procurement process as a complex system and develops a simulation model based on MAS(Multi-Agent System) to evaluate the effects of e-procurement process innovation. Multi-agent based simulation allows observing interaction patterns of objects in virtual world through relationship among objects and their behavioral mechanism. Agent-based simulation is suitable especially for complex business problems. In this study, we used Netlogo Version 4.1.3 as a MAS simulation tool which was developed in Northwestern University. To do this, we developed a interaction model of agents in MAS environment. We defined process agents and task agents, and assigned their behavioral characteristics. The developed simulation model was applied to G2B system (KONEPS: Korea ON-line E-Procurement System) of Public Procurement Service (PPS) in Korea and used to evaluate the innovation effects of the G2B system. KONEPS is a successfully established e-procurement system started in the year 2002. KONEPS is a representative e-Procurement system which integrates characteristics of e-commerce into government for business procurement activities. KONEPS deserves the international recognition considering the annual transaction volume of 56 billion dollars, daily exchanges of electronic documents, users consisted of 121,000 suppliers and 37,000 public organizations, and the 4.5 billion dollars of cost saving. For the simulation, we analyzed the e-procurement of process of KONEPS into eight sub processes such as 'process 1: search products and acquisition of proposal', 'process 2 : review the methods of contracts and item features', 'process 3 : a notice of bid', 'process 4 : registration and confirmation of qualification', 'process 5 : bidding', 'process 6 : a screening test', 'process 7 : contracts', and 'process 8 : invoice and payment'. For the parameter settings of the agents behavior, we collected some data from the transactional database of PPS and some information by conducting a survey. The used data for the simulation are 'participants (government organizations, local government organizations and public institutions)', 'the number of bidding per year', 'the number of total contracts', 'the number of shopping mall transactions', 'the rate of contracts between bidding and shopping mall', 'the successful bidding ratio', and the estimated time for each process. The comparison was done for the difference of time consumption between 'before the innovation (As-was)' and 'after the innovation (As-is).' The results showed that there were productivity improvements in every eight sub processes. The decrease ratio of 'average number of task processing' was 92.7% and the decrease ratio of 'average time of task processing' was 95.4% in entire processes when we use G2B system comparing to the conventional method. Also, this study found that the process innovation effect will be enhanced if the task process related to the 'contract' can be improved. This study shows the usability and possibility of using MAS in process innovation evaluation and its modeling.

Effects of University Students' Entrepreneurial Passion on Performance through Exploration Capability and Connection Capability (대학생의 기업가 열정이 정보 탐색 및 연계 역량을 통해 창업의지에 미치는 영향에 관한 연구)

  • Yoon, Byeong seon;Kim, Chun Kyu
    • Asia-Pacific Journal of Business Venturing and Entrepreneurship
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    • v.14 no.3
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    • pp.97-110
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    • 2019
  • This study analyzed various factors of influence affecting the will to start a business and established and empirically analyzed a research model to see which factors significantly affect the will to start a business. To this end, we investigated the general characteristics and experiences of individuals, conducted a study on the will to start a business, and analyzed the entrepreneurship passion for startups, the ability to find business opportunities, and the ability to connect with partner companies. The intent to start a business survey was investigated in a recertive style with a 7 point scale, and the reliability and feasibility review were analyzed through the PLS analysis method, which enables the implementation of a measurement model and a structural model. To collect valid data, the survey was conducted using an entrepreneurial curriculum class hours to collect and analyze 421 data. In summary, the results are as follows: First, college students have many opportunities to develop their capabilities through competitions held by universities and support institutions, and by utilizing them, they have no fear of starting a business. Second, the ability of students to discover product clients themselves has been improved by fostering entrepreneurship in the special lectures on startup in universities. Third, it can be seen that it has received various information on startups from support agencies to enhance its commitment to startups. The implications are as follows. First, they should foster entrepreneurship among college students by offering practical oriented courses that can broaden their understanding of startups. Second, it needs to be improved from entrepreneurial enthusiasm to a program that can grow into a company that can collaborate with partner companies and confirm its commitment to corporate establishment and product development and determine market opportunities. Third, it is necessary to establish an ecosystem of start-ups that can carry out systematic planning and performance management as it is weak to carry out projects with will to startups.

A Study on Risk Assessment Method for Earthquake-Induced Landslides (지진에 의한 산사태 위험도 평가방안에 관한 연구)

  • Seo, Junpyo;Eu, Song;Lee, Kihwan;Lee, Changwoo;Woo, Choongshik
    • Journal of the Society of Disaster Information
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    • v.17 no.4
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    • pp.694-709
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    • 2021
  • Purpose: In this study, earthquake-induced landslide risk assessment was conducted to provide basic data for efficient and preemptive damage prevention by selecting the erosion control work before the earthquake and the prediction and restoration priorities of the damaged area after the earthquake. Method: The study analyzed the previous studies abroad to examine the evaluation methodology and to derive the evaluation factors, and examine the utilization of the landslide hazard map currently used in Korea. In addition, the earthquake-induced landslide hazard map was also established on a pilot basis based on the fault zone and epicenter of Pohang using seismic attenuation. Result: The earthquake-induced landslide risk assessment study showed that China ranked 44%, Italy 16%, the U.S. 15%, Japan 10%, and Taiwan 8%. As for the evaluation method, the statistical model was the most common at 59%, and the physical model was found at 23%. The factors frequently used in the statistical model were altitude, distance from the fault, gradient, slope aspect, country rock, and topographic curvature. Since Korea's landslide hazard map reflects topography, geology, and forest floor conditions, it has been shown that it is reasonable to evaluate the risk of earthquake-induced landslides using it. As a result of evaluating the risk of landslides based on the fault zone and epicenter in the Pohang area, the risk grade was changed to reflect the impact of the earthquake. Conclusion: It is effective to use the landslide hazard map to evaluate the risk of earthquake-induced landslides at the regional scale. The risk map based on the fault zone is effective when used in the selection of a target site for preventive erosion control work to prevent damage from earthquake-induced landslides. In addition, the risk map based on the epicenter can be used for efficient follow-up management in order to prioritize damage prevention measures, such as to investigate the current status of landslide damage after an earthquake, or to restore the damaged area.

Minimizing Estimation Errors of a Wind Velocity Forecasting Technique That Functions as an Early Warning System in the Agricultural Sector (농업기상재해 조기경보시스템의 풍속 예측 기법 개선 연구)

  • Kim, Soo-ock;Park, Joo-Hyeon;Hwang, Kyu-Hong
    • Korean Journal of Agricultural and Forest Meteorology
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    • v.24 no.2
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    • pp.63-77
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    • 2022
  • Our aim was to reduce estimation errors of a wind velocity model used as an early warning system for weather risk management in the agricultural sector. The Rural Development Administration (RDA) agricultural weather observation network's wind velocity data and its corresponding estimated data from January to December 2020 were used to calculate linear regression equations (Y = aX + b). In each linear regression, the wind estimation error at 87 points and eight time slots per day (00:00, 03:00, 06:00, 09.00, 12.00, 15.00, 18.00, and 21:00) is the dependent variable (Y), while the estimated wind velocity is the independent variable (X). When the correlation coefficient exceeded 0.5, the regression equation was used as the wind velocity correction equation. In contrast, when the correlation coefficient was less than 0.5, the mean error (ME) at the corresponding points and time slots was substituted as the correction value instead of the regression equation. To enable the use of wind velocity model at a national scale, a distribution map with a grid resolution of 250 m was created. This objective was achieved b y performing a spatial interpolation with an inverse distance weighted (IDW) technique using the regression coefficients (a and b), the correlation coefficient (R), and the ME values for the 87 points and eight time slots. Interpolated grid values for 13 weather observation points in rural areas were then extracted. The wind velocity estimation errors for 13 points from January to December 2019 were corrected and compared with the system's values. After correction, the mean ME of the wind velocities reduced from 0.68 m/s to 0.45 m/s, while the mean RMSE reduced from 1.30 m/s to 1.05 m/s. In conclusion, the system's wind velocities were overestimated across all time slots; however, after the correction model was applied, the overestimation reduced in all time slots, except for 15:00. The ME and RMSE improved b y 33% and 19.2%, respectively. In our system, the warning for wind damage risk to crops is driven by the daily maximum wind speed derived from the daily mean wind speed obtained eight times per day. This approach is expected to reduce false alarms within the context of strong wind risk, by reducing the overestimation of wind velocities.

The Hybrid Organization's Response to Conflicting Institutional Demands: A Case Study about Social Ventures (하이브리드 조직의 모순 대응 전략 변화: 소셜벤처 노을과 에누마 사례를 중심으로)

  • Jin, Wooseok;Seong, Jieun
    • Asia-Pacific Journal of Business Venturing and Entrepreneurship
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    • v.17 no.5
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    • pp.151-168
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    • 2022
  • Nowadays companies are required to achieve social goals beyond maximizing shareholder profits. Accordingly, it is important to pursue both the economic and social goals of a company at the same time. Thus the importance of hybrid organizations is increasing theoretically and practically. In particular, since hybrid organizations essentially have the complexity of pursuing both economic and social purposes, the institutional demands of various stakeholders surrounding hybrid organizations are also conflicting. Several previous studies have considered how hybrid organizations respond to these conflicting institutional demands, but most studies are limited to studying at a specific point in time. As a result, there was a limit to analyzing the dynamics in response to conflicting institutional demands as the hybrid organization expanded its business. This study predicted that the hybrid organization would take selective coupling with conflicting institutional demands and that the process of responding to institutional demands would change according to the organization's growth. In this study, we had a case study about Noul and Enuma, social ventures that operate relatively advanced business models with outstanding results in innovation and technology. As a result, social ventures show a selective coupling for conflicting institutional demands, and the selective coupling process changes as their business model are advanced. Specifically, in the early stages of the business, it appears to respond to economic and social demands at the same time with a single business model. When the business is advanced, two or more business models are operated, some of which respond to economic needs and some of which respond to social needs. In the early stages of business, social ventures respond to economic and social demands with a single business model to gain legitimacy and survive in the institutional demands. But when they enter the business growth period, they try to separate business models which respond to economic and social values because they pursue sustainable growth and challenge large-scale missions. Overall, this study attempted to contribute to an in-depth understanding of hybrid organizations by identifying that the method of responding to conflicting institutional demands varies depending on the growth process of social ventures.

The Effect of Structured Information on the Sleep Amount of Patients Undergoing Open Heart Surgery (계획된 간호 정보가 수면량에 미치는 영향에 관한 연구 -개심술 환자를 중심으로-)

  • 이소우
    • Journal of Korean Academy of Nursing
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    • v.12 no.2
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    • pp.1-26
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    • 1982
  • The main purpose of this study was to test the effect of the structured information on the sleep amount of the patients undergoing open heart surgery. This study has specifically addressed to the Following two basic research questions: (1) Would the structed in formation influence in the reduction of sleep disturbance related to anxiety and Physical stress before and after the operation? and (2) that would be the effects of the structured information on the level of preoperative state anxiety, the hormonal change, and the degree of behavioral change in the patients undergoing an open heart surgery? A Quasi-experimental research was designed to answer these questions with one experimental group and one control group. Subjects in both groups were matched as closely as possible to avoid the effect of the differences inherent to the group characteristics, Baseline data were also. collected on both groups for 7 days prior to the experiment and found that subjects in both groups had comparable sleep patterns, trait anxiety, hormonal levels and behavioral level. A structured information as an experimental input was given to the subjects in the experimental group only. Data were collected and compared between the experimental group and the control group on the sleep amount of the consecutive pre and post operative days, on preoperative state anxiety level, and on hormonal and behavioral changes. To test the effectiveness of the structured information, two main hypotheses and three sub-hypotheses were formulated as follows; Main hypothesis 1: Experimental group which received structured information will have more sleep amount than control group without structured information in the night before the open heart surgery. Main hypothesis 2: Experimental group with structured information will have more sleep, amount than control group without structured information during the week following the open heart surgery Sub-hypothesis 1: Experimental group with structured information will be lower in the level of State anxiety than control group without structured information in the night before the open heart surgery. Sub-hypothesis 2 : Experimental group with structured information will have lower hormonal level than control group without stuctured information on the 5th day after the open heart surgery Sub-hypothesis 3: Experimental group with structured information will be lower in the behavioral change level than control group without structured information during the week after the open heart surgery. The research was conducted in a national university hospital in Seoul, Korea. The 53 Subjects who participated in the study were systematically divided into experimental group and control group which was decided by random sampling method. Among 53 subjects, 26 were placed in the experimental group and 27 in the control group. Instruments; (1) Structed information: Structured information as an independent variable was constructed by the researcher on the basis of Roy's adaptation model consisting of physiologic needs, self-concept, role function and interdependence needs as related to the sleep and of operational procedures. (2) Sleep amount measure: Sleep amount as main dependent variable was measured by trained nurses through observation on the basis of the established criteria, such as closed or open eyes, regular or irregular respiration, body movement, posture, responses to the light and question, facial expressions and self report after sleep. (3) State anxiety measure: State Anxiety as a sub-dependent variable was measured by Spi-elberger's STAI Anxiety scale, (4) Hormornal change measure: Hormone as a sub-dependent variable was measured by the cortisol level in plasma. (5) Behavior change measure: Behavior as a sub-dependent variable was measured by the Behavior and Mood Rating Scale by Wyatt. The data were collected over a period of four months, from June to October 1981, after the pretest period of two months. For the analysis of the data and test for the hypotheses, the t-test with mean differences and analysis of covariance was used. The result of the test for instruments show as follows: (1) STAI measurement for trait and state anxiety as analyzed by Cronbachs alpha coefficient analysis for item analysis and reliability showed the reliability level at r= .90 r= .91 respectively. (2) Behavior and Mood Rating Scale measurement was analyzed by means of Principal Component Analysis technique. Seven factors retained were anger, anxiety, hyperactivity, depression, bizarre behavior, suspicious behavior and emotional withdrawal. Cumulative percentage of each factor was 71.3%. The result of the test for hypotheses show as follows; (1) Main hypothesis, was not supported. The experimental group has 282 minutes of sleep as compared to the 255 minutes of sleep by the control group. Thus the sleep amount was higher in experimental group than in control group, however, the difference was not statistically significant at .05 level. (2) Main hypothesis 2 was not supported. The mean sleep amount of the experimental group and control group were 297 minutes and 278 minutes respectively Therefore, the experimental group had more sleep amount as compared to the control group, however, the difference was not statistically significant at .05 level. Thus, the main hypothesis 2 was not supported. (3) Sub-hypothesis 1 was not supported. The mean state anxiety of the experimental group and control group were 42.3, 43.9 in scores. Thus, the experimental group had slightly lower state anxiety level than control group, howe-ver, the difference was not statistically significant at .05 level. (4) Sub-hypothesis 2 was not supported. . The mean hormonal level of the experimental group and control group were 338 ㎍ and 440 ㎍ respectively. Thus, the experimental group showed decreased hormonal level than the control group, however, the difference was not statistically significant at .05 level. (5) Sub-hypothesis 3 was supported. The mean behavioral level of the experimental group and control group were 29.60 and 32.00 respectively in score. Thus, the experimental group showed lower behavioral change level than the control group. The difference was statistically significant at .05 level. In summary, the structured information did not influence the sleep amount, state anxiety or hormonal level of the subjects undergoing an open heart surgery at a statistically significant level, however, it showed a definite trends in their relationships, not least to mention its significant effect shown on behavioral change level. It can further be speculated that a great degree of individual differences in the variables such as sleep amount, state anxiety and fluctuation in hormonal level may partly be responsible for the statistical insensitivity to the experimentation.

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Construction and Application of Intelligent Decision Support System through Defense Ontology - Application example of Air Force Logistics Situation Management System (국방 온톨로지를 통한 지능형 의사결정지원시스템 구축 및 활용 - 공군 군수상황관리체계 적용 사례)

  • Jo, Wongi;Kim, Hak-Jin
    • Journal of Intelligence and Information Systems
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    • v.25 no.2
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    • pp.77-97
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    • 2019
  • The large amount of data that emerges from the initial connection environment of the Fourth Industrial Revolution is a major factor that distinguishes the Fourth Industrial Revolution from the existing production environment. This environment has two-sided features that allow it to produce data while using it. And the data produced so produces another value. Due to the massive scale of data, future information systems need to process more data in terms of quantities than existing information systems. In addition, in terms of quality, only a large amount of data, Ability is required. In a small-scale information system, it is possible for a person to accurately understand the system and obtain the necessary information, but in a variety of complex systems where it is difficult to understand the system accurately, it becomes increasingly difficult to acquire the desired information. In other words, more accurate processing of large amounts of data has become a basic condition for future information systems. This problem related to the efficient performance of the information system can be solved by building a semantic web which enables various information processing by expressing the collected data as an ontology that can be understood by not only people but also computers. For example, as in most other organizations, IT has been introduced in the military, and most of the work has been done through information systems. Currently, most of the work is done through information systems. As existing systems contain increasingly large amounts of data, efforts are needed to make the system easier to use through its data utilization. An ontology-based system has a large data semantic network through connection with other systems, and has a wide range of databases that can be utilized, and has the advantage of searching more precisely and quickly through relationships between predefined concepts. In this paper, we propose a defense ontology as a method for effective data management and decision support. In order to judge the applicability and effectiveness of the actual system, we reconstructed the existing air force munitions situation management system as an ontology based system. It is a system constructed to strengthen management and control of logistics situation of commanders and practitioners by providing real - time information on maintenance and distribution situation as it becomes difficult to use complicated logistics information system with large amount of data. Although it is a method to take pre-specified necessary information from the existing logistics system and display it as a web page, it is also difficult to confirm this system except for a few specified items in advance, and it is also time-consuming to extend the additional function if necessary And it is a system composed of category type without search function. Therefore, it has a disadvantage that it can be easily utilized only when the system is well known as in the existing system. The ontology-based logistics situation management system is designed to provide the intuitive visualization of the complex information of the existing logistics information system through the ontology. In order to construct the logistics situation management system through the ontology, And the useful functions such as performance - based logistics support contract management and component dictionary are further identified and included in the ontology. In order to confirm whether the constructed ontology can be used for decision support, it is necessary to implement a meaningful analysis function such as calculation of the utilization rate of the aircraft, inquiry about performance-based military contract. Especially, in contrast to building ontology database in ontology study in the past, in this study, time series data which change value according to time such as the state of aircraft by date are constructed by ontology, and through the constructed ontology, It is confirmed that it is possible to calculate the utilization rate based on various criteria as well as the computable utilization rate. In addition, the data related to performance-based logistics contracts introduced as a new maintenance method of aircraft and other munitions can be inquired into various contents, and it is easy to calculate performance indexes used in performance-based logistics contract through reasoning and functions. Of course, we propose a new performance index that complements the limitations of the currently applied performance indicators, and calculate it through the ontology, confirming the possibility of using the constructed ontology. Finally, it is possible to calculate the failure rate or reliability of each component, including MTBF data of the selected fault-tolerant item based on the actual part consumption performance. The reliability of the mission and the reliability of the system are calculated. In order to confirm the usability of the constructed ontology-based logistics situation management system, the proposed system through the Technology Acceptance Model (TAM), which is a representative model for measuring the acceptability of the technology, is more useful and convenient than the existing system.

Discriminatory Attitudes towards IV/AIDS (PWHAs) Patents by Middle and High School Students (HIV/AIDS 감염인에 대한 차별의식에 미치는 영향의 중고등학생 간 비교: 에이즈 낙인의 매개효과)

  • Chun, Sung-Soo;Kim, Ju-Ri;Shin, Seung-Bae;Sohn, Ae-Ree
    • The Journal of Korean Society for School & Community Health Education
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    • v.9 no.1
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    • pp.63-83
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    • 2008
  • Objectives: This study was to examine HIV/AIDS knowledge of transmission, attitudes toward homosexuals on stigma of HIV/AIDS and discriminatory attitudes towards person with HIV/AIDS (PWHAs) by middle and high school students in Seoul, Korea. Methods: The population of this study is middle and high school students in Seoul, Korea. Eight junior high schools and eight senior high schools were selected randomly. Three thousand and one hundred thirty-one students (1704 males and 1397 males) from 16 schools participated in the survey, and 2.977 cases were analyzed. A self-administered questionnaire measuring socio-demographic variables, HIV/AIDS knowledge of transmission, sigma of HIV/AIDS (3 items, 5-point Likert-type scale) and discriminatory attitudes PWHAs (5 items, 5-point Likert-type scale) was utilized. The Structural Equation Modeling was employed to investigate the research Model. Results: The empirical study shows that a number of statistical hypotheses are significant. The stigma and discriminatory attitudes PWHAs were significantly different by middle and high school students. The attitudes toward homosexuals and HIV/AIDS knowledge of transmission were important factors on stigma and discriminatory attitudes PWHAs. Socio-demographical variables such as sex was related to the stigma and discriminatory attitudes PWHAs. Conclusion: Therefore, it is important to design HIV prevention strategies that increase in positive attitudes towards PWHAs.

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Identification and Measurement of Hospital-Related Fears in Hospitalized School-Aged Children (학령기 입원아동의 병원관련 공포에 관한 탐색연구)

  • 문영임
    • Journal of Korean Academy of Nursing
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    • v.25 no.1
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    • pp.61-79
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    • 1995
  • When children are admitted to hospital, they have to adapt to new and unfamiliar stimuli. Children may respond with fear to stimuli such as pain or unfamiliar experiences. One goal of nursing is to help hospitalized children to adapt effectively to their hospital experience. Accordingly, nurses need to assess childrens' fears of their hospital experience to contribute to the planning of care to alleviate these fears. The problem addressed by this study was to identify and measure hospital-related fears(hereafter called HRF) in hospitalized school-aged children. The study was conceptualized with Roy's model. A descriptive qualitative approach was used first, followed by a quantitative approach. This study was conducted from November 30, 1989 to January 12, 1991. The sample consisted of 395 hospitalized school-aged children selected through an allocated sampling technique in nine general hospitals. The HRF questionnaire (three point likert scale ) was developed by a delphi technique. The data were analyzed by an SAS program. Factor analysis was used for the examination of component factors. Differences in the HRF related to demographic variables were examined by t-test, analysis of variance and the Scheffe test. The crude scores of the HRF scale were transformed into T- scores to calculate the standard scores. The results included the following : 1. Forty-four items were derived from 188 statements identifying the childrens' hospital-re-lated fears. These items clustered into 14 factors, fear of injections, operations, bodily harm others' pain, medical rounds, physical examinations, medical staff, disease process, blood and X-rays, drugs and cockroaches, tests, harsh discipline from parents or staff, being absent from school, and separation from family. The 14 factors was classified into four categories,'pain','the unfamiliar','the un-known' and 'separation'. 2. The reliability of the HRF instruments was .92(Cronbach's alpha). In the factor analysis, Cronbach's alpha coefficients for the 14 factors ranged from .84 to .86 and Cronbach's alpha coefficients for the four categories ranged from .70 to .84. Pearson correlation coefficient scores for relationships among the 14 factors ranged from ,11 to .50, and among the four categories, from ,44 to ,63, indicating their relative independence. 3. The total group HRF score ranged from 45 to 130 in a possible range of H to 132, with a mean of 74.51. The fears identified by the children were, in order, injections, harsh discipline by parents or staff, bodily harm, operations, medical staff, disease process, and medical rounds ; the least feared was others' pain. The fear item with the highest mean score was surgery and the lowest was examination by a doctor. HRF scores were higher for girls than for boys, and for grade 1 students than for grade 6 students. HRF scores were lower for children whose fathers were over 40 than for those whose fathers were in the 30 to 39 age group, and whose mothers were over 35 than for those whose mothers were in the 20 to 34 age group. HRF scores were lower when the mother rather than any other person stayed with the child. The expressed fear of pain, the unfamiliar, the un-known and of separation directs nurses' concern to the threat felt by hospitalized children to their concept of self. This study contributes to the assessment of fears of hospitalized children and of stimuli impinging on those fears. Accordingly, nursing practice will be directed to the alleviation of pain, pre-admission orientation to the hospital setting and routines, initiation of information about procedures and experiences and arrangments for mothers to stay with their children. Recommendations were made for further research in different settings and for development and testing of the instrument.

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Multivariate Analysis of Predictive Factors for the Severity in Stable Patients with Severe Injury Mechanism (중증 손상 기전의 안정된 환자에서 중증도 예측 인자들에 대한 다변량 분석)

  • Lee, Jae Young;Lee, Chang Jae;Lee, Hyoung Ju;Chung, Tae Nyoung;Kim, Eui Chung;Choi, Sung Wook;Kim, Ok Jun;Cho, Yun Kyung
    • Journal of Trauma and Injury
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    • v.25 no.2
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    • pp.49-56
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    • 2012
  • Purpose: For determining the prognosis of critically injured patients, transporting patients to medical facilities capable of providing proper assessment and management, running rapid assessment and making rapid decisions, and providing aggressive resuscitation is vital. Considering the high mortality and morbidity rates in critically injured patients, various studies have been conducted in efforts to reduce those rates. However, studies related to diagnostic factors for predicting severity in critically injured patients are still lacking. Furthermore, patients showing stable vital signs and alert mental status, who are injured via a severe trauma mechanism, may be at a risk of not receiving rapid assessment and management. Thus, this study investigates diagnostic factors, including physical examination and laboratory results, that may help predict severity in trauma patients injured via a severe trauma mechanism, but showing stable vital signs. Methods: From March 2010 to December 2011, all trauma patients who fit into a diagnostic category that activated a major trauma team in CHA Bundang Medical Center were analyzed retrospectively. The retrospective analysis was based on prospective medical records completed at the time of arrival in the emergency department and on sequential laboratory test results. PASW statistics 18(SPSS Inc., Chicago, IL, USA) was used for the statistical analysis. Patients with relatively stable vital signs and alert mental status were selected based on a revised trauma score of more than 7 points. The final diagnosis of major trauma was made based on an injury severity score of greater than 16 points. Diagnostic variables include systolic blood pressure and respiratory rate, glasgow coma scale, initial result from focused abdominal sonography for trauma, and laboratory results from blood tests and urine analyses. To confirm the true significance of the measured values, we applied the Kolmogorov-Smirnov one sample test and the Shapiro-Wilk test. When significance was confirmed, the Student's t-test was used for comparison; when significance was not confirmed, the Mann-Whitney u-test was used. The results of focused abdominal sonography for trauma (FAST) and factors of urine analysis were analyzed using the Chi-square test or Fisher's exact test. Variables with statistical significance were selected as prognostics factors, and they were analyzed using a multivariate logistics regression model. Results: A total of 269 patients activated the major trauma team. Excluding 91 patients who scored a revised trauma score of less than 7 points, 178 patients were subdivided by injury severity score to determine the final major trauma patients. Twenty-one(21) patients from 106 major trauma patients and 9 patients from 72 minor trauma patients were also excluded due to missing medical records or untested blood and urine analysis. The investigated variables with p-values less than 0.05 include the glasgow coma scale, respiratory rate, white blood cell count (WBC), serum AST and ALT, serum creatinine, blood in spot urine, and protein in spot urine. These variables could, thus, be prognostic factors in major trauma patients. A multivariate logistics regression analysis on those 8 variables showed the respiratory rate (p=0.034), WBC (p=0.005) and blood in spot urine (p=0.041) to be independent prognostic factors for predicting the clinical course of major trauma patients. Conclusion: In trauma patients injured via a severe trauma mechanism, but showing stable vital signs and alert mental status, the respiratory rate, WBC count and blood in the urine can be used as predictable factors for severity. Using those laboratory results, rapid assessment of major trauma patients may shorten the time to diagnosis and the time for management.