• Journal of Trauma and Injury
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• 제32권3호
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• pp.127-135
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• 2019

Purpose: This study was to investigate errors of death certificate (DC) issued for patients with trauma. Methods: A retrospective review for DC issued after death related to trauma at a training hospital trauma center was conducted. Errors on DC were classified into major and minor errors depending on their influence on the process of selecting the cause of death (COD). All errors were compared depending on the place of issue of DC, medical doctors who wrote the DC, and the number of lines filled up for COD of DC. Results: Of a total 140 DCs, average numbers of major and minor errors per DC were 0.8 and 3.7, respectively. There were a total of 2.8 errors for DCs issued at the emergency department (ED) and 5.4 errors for DCs issued beyond ED. The most common major error was more than one COD on a single line for DCs issued at the ED and incompatible casual relation between CODs for DCs issued beyond ED. The number of major errors was 0.5 for emergency physician and 0.8 for trauma surgeon and neurosurgeon. Total errors by the number of lines filled up for COD were the smallest (3.1) for two lines and the largest (6.0) for four lines. Conclusions: Numbers of total errors and major errors on DCs related to trauma only were 4 and 0.8, respectively. As more CODs were written, more errors were found.

• Journal of Trauma and Injury
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• 제34권4호
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• pp.225-232
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• 2021

Purpose: Trauma is the top cause of death in people under 45 years of age. Deaths from severe trauma can have a negative economic impact due to the loss of people belonging to socio-economically active age groups. Therefore, efforts to reduce the mortality rate of trauma patients are essential. The purpose of this study was to investigate preventable mortality in trauma patients and to identify factors and healthcare-related challenges affecting mortality. Ultimately, these findings will help to improve the quality of trauma care. Methods: We analyzed the deaths of 411 severe trauma patients who presented to Gachon University Gil Hospital regional trauma center in South Korea from January 2015 to December 2017, using an expert panel review. Results: The preventable death rate of trauma patients treated at the Gachon University Gil Hospital regional trauma center was 8.0%. Of these, definitely preventable deaths comprised 0.5% and potentially preventable deaths 7.5%. The leading cause of death in trauma patients was traumatic brain injury. Treatment errors most commonly occurred in the intensive care unit (ICU). The most frequent management error was delayed treatment of bleeding. Conclusions: Most errors in the treatment of trauma patients occurred in early stages of the treatment process and in the ICU. By identifying the main causes of preventable death and errors during the course of treatment, our research will help to reduce the preventable death rate. Appropriate trauma care systems and ongoing education are also needed to reduce preventable deaths from trauma.

• Molecules and Cells
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• 제37권4호
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• pp.345-355
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• 2014

Mitigating secondary delayed neuronal injury has been a therapeutic strategy for minimizing neurological symptoms after several types of brain injury. Interestingly, secondary neuronal loss appeared to be closely related to functional loss and/or death of astrocytes. In the brain damage induced by agonists of two glutamate receptors, N-ethyl-D-aspartic acid (NMDA) and kainic acid (KA), NMDA induced neuronal death within 3 h, but did not increase further thereafter. However, in the KA-injected brain, neuronal death was not obviously detectable even at injection sites at 3 h, but extensively increased to encompass the entire hemisphere at 7 days. Brain inflammation, a possible cause of secondary neuronal damage, showed little differences between the two models. Importantly, however, astrocyte behavior was completely different. In the NMDA-injected cortex, the loss of glial fibrillary acidic protein-expressing ($GFAP^+$) astrocytes was confined to the injection site until 7 days after the injection, and astrocytes around the damage sites showed extensive gliosis and appeared to isolate the damage sites. In contrast, in the KA-injected brain, $GFAP^+$ astrocytes, like neurons, slowly, but progressively, disappeared across the entire hemisphere. Other markers of astrocytes, including $S100{\beta}$, glutamate transporter EAAT2, the potassium channel Kir4.1 and glutamine synthase, showed patterns similar to that of GFAP in both NMDA- and KA-injected cortexes. More importantly, astrocyte disappearance and/or functional loss preceded neuronal death in the KA-injected brain. Taken together, these results suggest that loss of astrocyte support to neurons may be a critical cause of delayed neuronal death in the injured brain.

• Journal of Radiation Protection and Research
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• 제47권1호
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• pp.22-29
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• 2022

Background: A comprehensive, traceable, and easy-to-understand radiation risk indicator is desired for radiological protection. The early-onset hypothesis could be used for this purpose. Materials and Methods: An indicator for early death (IED) was developed and calculated using the epidemiological dataset from the 14^th Report of the Life Span Study (LSS) of Hiroshima and Nagasaki. By clarifying the calculation process, IED for all-cause mortality was estimated. In addition, the characteristics of IED for solid cancer mortality and cardiovascular mortality as well as those of men and women, and their dependence on age at exposure were investigated for detailed analysis. Results and Discussion: The IED for all-cause mortality was estimated to be approximately 4 years for an acute radiation exposure of 1 Gy regardless of the fitting dose range. The cumulative death rate for all solid cancers also indicated the early-death tendency (approximately 7-10 years at 1 Gy). Although, there is a slight difference in the characteristics of the risk obtained from the LSS study and this study, it is considered that the IED in a unit of years can also be used to show the overall picture of risk due to radiation exposure. Conclusion: We developed and calculated the indicator for early death, IED, for the cumulative mortality rate of all causes of death, all solid cancers, and circulatory diseases. The quantitative values of IED were estimated to be 4 years for all causes of death, 7-10 years for all solid cancers. IED has an advantage for intuitively understanding the meaning of radiation risk since it can be obtained by a simple and traceable method.

• The Korean Journal of Legal Medicine
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• 제42권4호
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• pp.126-140
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• 2018

The diagnosis of cause of death (COD) or estimation of postmortem interval (PMI) is hard to perform using postmortem blood or other bodily fluids due to various biochemical changes that occur during the agonal phase or after death. To solve these problems, new paradigms and new analytical methods are needed. In this study, postmortem blood was fractionated with specific gravity 1.021, 1.029, 1.038, and 1.045, and the absorbance patterns of each sample of the 131 total cases (12 kinds of COD) were analyzed using a spectrometer. The absorbance was grouped into 9 patterns (ABS pattern 1 to 9) according to the wave length and the signal intensity. These patterns of postmortem blood were found to be distinctly different from the absorbance pattern of fresh blood. The analysis of ABS patterns is useful for the diagnosis of deaths due to acute or rapid bleeding, fire death, drowning and, in some cases, poisoning, but is not useful for the estimation of PMI.

• 대한한의학원전학회지
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• 제19권3호
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• pp.210-227
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• 2006

Many historians presume that several kings included the crown prince were killed by poison in the Jo-Soon dynasty. Above all, there is every possibility of killing the crown prince So-Hyoon(昭顯) by poison. The crown prince So-Hyeon was detained for 8 years in Sim-Yang(瀋陽). He died suddenly in two month from coming home. According to an authentic record, official death causes were malaria. But there is little possibility that a young crown prince die of malaria at the age of 34. His dead body shows change of skin color and bleeding from the ear, eye, mouth, and nose. This is the sufficient evidence that he was killed by poison. King In-Jo have a doubt that he was ousted from his post by crown prince So-Hyeon in conspiracy with cheong imperial court. Especially, after the crown prince So-Hyeon's death, owing to cold attitude that king In-Jo shows and a tragic affair that occurred to the crown prince's family, king In-Jo is under suspicion as the mastermind of the murder. Another poisoners are Jo-So Yong(趙昭容) and Lee-Hyeong Ik(李聲益). Jo-So Yong, a royal harem, intrigue against the couple of crown prince So-Hyoon. Lee-Hyeong Ik that win king In-Jo's favor take charge of the medical treatment. We supposed that toxic substance is arsenic poison.

• Asian Pacific Journal of Cancer Prevention
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• 제15권9호
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• pp.4091-4094
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• 2014

Background: This study used the receiver operating characteristic curve (ROC) to analyze Surveillance, Epidemiology and End Results (SEER) bronchioaveolar carcinoma data to identify predictive models and potential disparity in outcomes. Materials and Methods: Socio-economic, staging and treatment factors were assessed. For the risk modeling, each factor was fitted by a Generalized Linear Model to predict cause specific survival. The area under the ROC was computed. Similar strata were combined to construct the most parsimonious models. A random sampling algorithm was used to estimate modeling errors. Risk of cause specific death was computed for the predictors for comparison. Results: There were 7,309 patients included in this study. The mean follow up time (S.D.) was 24.2 (20) months. Female patients outnumbered male ones 3:2. The mean (S.D.) age was 70.1 (10.6) years. Stage was the most predictive factor of outcome (ROC area of 0.76). After optimization, several strata were fused, with a comparable ROC area of 0.75. There was a 4% additional risk of death associated with lower county family income, African American race, rural residency and lower than 25% county college graduate. Radiotherapy had not been used in 2/3 of patients with stage III disease. Conclusions: There are socio-economic disparities in cause specific survival. Under-use of radiotherapy may have contributed to poor outcome. Improving education, access and rates of radiotherapy use may improve outcome.

• Clinical and Experimental Pediatrics
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• 제45권9호
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• pp.1065-1074
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• 2002

목 적 : 영아 돌연사에 있어서 그 역학적 특성을 알아보고 사인을 밝히는데 병력에 대한 자세한 검토, 사망 당시 상황에 대한 조사, 그리고 부검 및 대사 이상 검사 등 사후 검사의 중요성에 대하여 알아보고자 하였다. 방 법 : 1987년 2월부터 2001년 12월까지 14년 8개월간 갑작스런 사망으로 응급실을 방문한 1세 미만의 영아 34례를 대상으로 하여 이들의 임상기록을 후향적으로 조사하여 이들의 역학적 특성을 조사하였다. 과거 병력에 대한 검토, 사망 당시 상황에 대한 조사 및 부검을 실시한 13례의 기록과 2000년 이후 시행한 혈액, 소변, 담즙 및 간조직에서의 사후 아실카르니틴 및 유기산 분석 검사를 통하여 사망의 원인을 분석하였다. 결 과 : 1) 성별 및 연령별 분포 : 총 34례 중 남아 18명(52.9%), 여아 16명(47.1%)으로 남아에서 많이 발생하였고 연령별 분포는 생후 6개월 이하가 31례 (88.2%)로 가장 많은 분포를 차지하였다. 2) 사망시각은 오전 6-12시에 18례(52.9%)로 가장 많은 분포를 보였다. 3) 계절적 분포는 겨울에 가장 많이 사망하였고 13례(38.2%)였다. 4) 사망 발견시 수면 자세를 알 수 있었던 15례 중 복와위가 9례, 앙와위는 6례였다. 5) 병력과 사망 당시 상황으로도 죽음의 원인을 설명할 수 없는 경우가 23례였고 이중 부검을 실시한 13례 중 특이한 병리 소견을 발견할 수 없어 SIDS로 진단을 내린 경우가 7례였고 6례는 부검을 통하여 사망의 원인을 밝힐 수 있었다. 부검을 통해 밝혀진 사인으로는 심내막 섬유 탄성증 1례, 췌도 세포증 1례, 간의 지방 변화로 지방산 대사 이상을 의심할 수 있었던 2례, 경막하 및 경막외 출혈 1례, 기관지폐렴이 1례였다. 선천성 대사 이상 질환은 부검상 총 3례에서 의심되었으나 당시에는 대사 이상 검사가 시행되지 못하였고 2000년부터 시행한 대사 이상 검사에서는 모두 정상 소견이었다. 결 론 : 자세한 병력과 사망 상황에 대한 조사와 함께 부검은 사망의 원인을 밝히고 영아 돌연사 증후군을 진단하는데 필수적이라고 할 수 있으며 앞으로 우리나라에서도 부검의 중요성을 인지하고 이를 적극적으로 시행하여야겠고 지방산 대사 이상을 포함하는 대사 이상 검사도 아울러 적극적으로 시행하여야 할 것이다.

• 복식
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• 제60권2호
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• pp.99-113
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• 2010

The corpse make-up depending on the cause of death shown in CSI is the only evidence to solve a case, and shows the characteristics of the unique make-up on the corpse, according to the causes of death. There are many types of death causes such as strangulation, manslaughter, assassination and shooting, of which the strangulation is caused by strangling the neck with the hands or using a weapon and has characteristics of showing other external wounds with purple spots appearing on the body after death. This is a presentation of the corpse with a face of white, and the purple spots bruised on the neck. Manslaughter shows deep wounds caused by a stab or laceration using a weapon, and the material feeling of the wound that makes new skin tissue, is realistically presented with make-up of gooey blood. Assassination can be thought as manslaughter in disguise as an accidental death, which the causes can be due to electrocution, suffocation from oxygen deficiency and from excessive monoxide. The make-up is presented by realistically showing the surrounding fragments of the bullet shell, the blood running down, the size of the hole in the body made from the bullet, and shows the broken skin tissues. The shape of the bullet wound can be presented differently based on the body part where the bullet penetrated into, and the part where the bullet shot out through.

• 한국인구학
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• 제9권2호
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• pp.79-92
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• 1986

Death is one of the population movement phenomena used as an important health index in most society. Especially it is regarded as group phenomenon in a specific group rather than individual one and considered important in public health field because the level and cause of death is related to health of public. The auther examined the changes of the Korean mortality pattern to evaluate the status of the Korean public health by studying mortality indicator using the population census and other materials from 1930 to 1980. The results are as follows: First, the Korean crude death rate was reduced to one third in 1980 compared to that in 1930, but the crude birth rate was constant from 1930 to 1960 causing the increase of population. So the population pattern is changing from the classic pyramic shape to bell shape and the dependency ratio was reduced from 78 in 1930 to 61 in 1980. Second, the infant mortality rate decrease rapidly. In 1980 it was one seventh of that in 1930 which was proved by the change of the age-specific death rate curve from U to J shape. Third, the male mortality reduction after the age of forty was much less than that of female, which explained the specific death pattern of high mortality in Korean middle and oldaged males. Fourth, the main cause of death was changed from infectious, parasitic, respiratory and digestive system disease to circulatory of tumorous diseases. Considering the above results, Korean health problem is now changing from the infant infection to geriatric chronic regressive disease. That naturally the direction of health service should be turned from the infant stage maternal and child health to the health problems of old people.