Management of Severe Trauma Patients in the Emergency Intensive Care Unit

PURPOSE: The aim of this study was to evaluate the quality of the trauma care system of our hospital, in which emergency physicians care for major trauma patients in the emergency intensive care unit (ICU) in consultation with intervention radiologists and surgeons. METHODS: This was a retrospective observational study conducted in an emergency ICU of a tertiary referral hospital. We enrolled consecutive patients who had been admitted to our emergency ICU with major trauma from March 2007 to September 2010. We collected data with respect to demographic findings, mechanisms of injury, the trauma and injury severity score (TRISS), emergency surgery, angiographic intervention, and 6-month mortality. Then, we compared the observed and predicted survivals of the patients. The Hosmer-Lemeshow test and calibration plots by using 10 groups, one for each decile, of predicted mortality were used to evaluate the fitness of TRISS. P-values of greater than 0.05 represent a fair calibration. RESULTS: Among 116 patients, 12 (10.34%) were dead within 6 months after admission to the ICU, and 29 (25.00%) and 38 (32.80%) patients received emergency surgery and angiographic intervention, respectively. The mean injury severity score and revised trauma score were 36.97+/-17.73 and 7.84+/-6.75, respectively. The observed survival and the predicted survival of the TRISS were 89.66% (95% confidence interval [CI]: 84.03~95.28%) and 69.85% (95% CI: 63.80~75.91%), respectively. The calibration plots showed that the observed survival of our patients was consistently higher than the predicted survival of the TRISS (p<0.001). CONCLUSION: The observed survival for the trauma care system of our hospital, in which emergency physicians care for major trauma patients in the emergency ICU in consultation with intervention radiologists and surgeons, was higher than the predicted survival of the TRISS.

The Difference of Biochemical Status, Dietary Habits and Dietary Behaviors according to the Obesity Degree among Obese Children

This study was conducted to find biochemical status, dietary habits and dietary behaviors according to the degree of obesity among obese children, and to provide baseline data for nutrition education. The number of subjects was 64 obese children(Mildly obesed : MI 19, Moderately obese : Mo 30, Severely obese : SI 15) participated in '98 Summer Nutrition Camp'. The results of this study were as follows. 1. Weight and body fat rate was increased according to obesity degree(p<0.05). Total cholesterol and TG also was increased according to obesity degree but it was statistically significant. 2. In dietary habits, it wasn't statistically significant but MI tended to eat fast and to eat the snacks before sleeping. MO tended to skip the breakfast. SI tended to eat more snacks and dinner and they tended to overeat. 3. In cognition of self-weight, most obese children(93.7%) worried about their weight but 73.4% of obese children thought that it was possible for losing weight. There were no difference by the obesity degree. 4. In dietary behaviors, there were no statistically significant difference but MI and SI than MO tended to had worse dietary behaviors. 5. In life styles, SI than the others have tendency to have more regular exercise but they had more indoor activities than outdoor activities. 6. In foods intake frequency, SI than MI and MO ate instant foods more frequently and MI than the others ate hot and salty foods more frequently(p<0.05). With these result, MI and SI than MO tended to have undesirable dietary habits and behaviors. Many obese children worried about the weight but they had positive thought about losing weight. SI tended to do regularly exercise but they had more indoor activities than outdoor activities. Therefore, only with this study, it is difficult to say that there is the clear difference by the obesity degree. Because, in this study, we can have some difference among these groups, we should study more about these difference for effective, systemic and practical nutrition education in the future.