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Purpose@#This study aimed to investigate the characteristics of elderly patients who visited a non-regional trauma center to examine the effects of old age on the clinical outcomes of patients. @*Methods@#The medical charts of 159 patients with trauma who visited the National Health Insurance Service Ilsan Hospital between March 2020 and February 2022 were retrospectively analyzed. @*Results@#Of the 159 patients, 41 were assigned to the elderly patient group (EPG) and 118 were assigned to the non-elderly patient group (NEPG). The average age of patients in each group was 75.5 and 38.2 years in the EPG and the NEPG, respectively. Comparing the injury mechanism between the two groups, pedestrian traffic accidents (TA) were the most common (24.4%), followed by slipping (19.5%), motorcycle TA, and bicycle TA (14.6%) in EPG. In the NEPG, motorcycle TA (28.0%) was the most common, followed by car TA (27.1%), and fall injury (16.9%), with a significant difference between the two groups (p < 0.001). The significant differences between the two groups were the injury severity score (ISS; p = 0.004), severe trauma (p = 0.045), intensive care unit admission (p = 0.028), emergency operation (p = 0.034), and mortality (p = 0.013). The statistically significant risk factors for mortality were old age (p = 0.024) and chest injury (p = 0.013). @*Conclusion@#Patients in the EPG compared with the NEPG group showed different injury mechanisms. The EPG has a higher severity and mortality rate than the NEPG.
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Purpose@#A nationwide study (2012-2017) of preventable trauma death rates (PTDR) showed a 15.3% decrease after Regional Trauma centers were initiated. However, in non-trauma centers with an Emergency Department there is limited data of preventable mortality in trauma patients. Therefore, the purpose of this retrospective study was to investigate preventable mortality in trauma patients in a nonregional trauma center and determine the effect of initiating a Trauma Team. @*Methods@#There were 46 deaths of trauma patients recorded in the National Health Insurance service Ilsan Hospital (NHISIH) in South Korea from January 2019 to December 2021. These patients’ preventable deaths were analyzed by an expert panel review considering the implementation of the Trauma Team in April 2020. @*Results@#All deaths were attributable to blunt trauma with an average Injury Severity Score of 26.0 ± 19.2, Revised Trauma Score of 5.05 ± 3.20 and Trauma and Injury Score of 56.6 ± 41.3. The most frequent cause of death was traumatic brain injury followed by respiratory arrest. The most frequent error was delayed transfusion followed by delayed treatment of bleeding. Treatment errors occurred the most in the Emergency Room followed by the Intensive Care Unit. The PTDR of patients before the involvement of a Trauma Team (January 2019 to March 2020) and after the Trauma Team was initiated in April 2020 decreased from 27.27% to 4.27%, respectively (p = 0.021). @*Conclusion@#The introduction of a dedicated Trauma Team in a non-regional trauma center significantly reduced the overall PTDR in trauma patients.
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Purpose@#In 2018, the Act to Improve Training Conditions and the Status of Medical Residents (AITR) was fully implemented in South Korea. This study aimed to investigate the effects of AITR implementation on the clinical outcomes of patients who underwent emergency abdominal surgery. @*Materials and Methods@#A total of 2571 patients who underwent emergency abdominal surgery after visiting the emergency room (ER) between 2015 and 2019 was included. Electronic medical records were retrospectively reviewed. In addition, a comparative analysis was performed for patient groups treated before and after AITR implementation. @*Results@#The median patient age was 48.0 years, and 49.2% of them were male. Appendicitis was the most common diagnosis (82.6%), followed by major abdominal emergencies (9.9%) and cholecystitis (7.5%). The median time from arrival to surgery was 439 min, and 52 (2.0%) patients died. A comparison of patients who underwent surgery before (pre-AITR; 1453, 56.5%) and after (post-AITR; 1118, 43.5%) AITR implementation revealed a significant difference in age, number of residents on a 24-h shift, and diagnosis. The time from ER arrival to surgery was not significantly longer after AITR implementation than before AITR implementation (434 min vs. 443 min, p=0.230). AITR was not a significant risk factor for mortality (p=0.225). @*Conclusion@#The time from ER arrival to emergency surgery did not increase significantly after AITR implementation, and there was no difference in the patients’ clinical outcomes.
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Objective@#The objective of this study was to compare and evaluate the diagnostic value of serum carbohydrate antigen 125 (CA125) and/or human epididymis protein 4 (HE4) and a panel of novel multiple biomarkers in patients with ovarian tumors to identify more accurate and effective markers for screening ovarian cancer. @*Methods@#Candidate ovarian cancer biomarkers were selected based on a literature search. Dozens of candidate biomarkers were examined using 143 serum samples from patients with ovarian cancer and 157 healthy serum samples as noncancer controls. To select the optimal marker panel for an ovarian cancer classification model, a set of biomarker panels was created with the number of possible combinations of eight biomarkers. Using the set of biomarkers as an input variable, the optimal biomarker panel was selected by examining the performance of the biomarker panel set using the Random Forest algorithm as a non-linear classification method and a 10-fold cross-validation technique. @*Results@#The final selected optimal combination of five biomarkers (CA125, HE4, cancer antigen 15-3, apolipoprotein [Apo] A1, and ApoA2) exhibited a sensitivity of 93.71% and specificity of 93.63% for ovarian cancer detection during validation. @*Conclusion@#Combining multiple biomarkers is a valid strategy for ovarian cancer diagnosis and can be used as a minimally invasive screening method for early ovarian cancer. A panel of five optimal biomarkers, including CA125 and HE4, was verified in this study. These can potentially be used as clinical biomarkers for early detection of ovarian cancer.
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Purpose@#To evaluate the risk factors associated with 30-day mortality in patients with postoperative acute kidney injury who underwent continuous renal replacement therapy (CRRT). @*Methods@#Retrospective analysis of the medical charts of patients with postoperative acute kidney injury who underwent CRRT in the intensive care unit between April 2012 and May 2019 was conducted. @*Results@#There were 71 patients whose average age was 64.8 years, and average Acute Physiology and Chronic Health Evaluation 2 score was 26.2. There were 37 patients who had non-trauma emergency surgery, 16 who required trauma surgery, and 18 who had elective major surgery. In most patients, CRRT was started based on Stage 3 Acute Kidney Injury Network criteria, and the mean creatinine level at the time of CRRT initiation (3.62 mg/dL). The median period from surgery to CRRT was 3 days, and the median CRRT application was 4 days. Forty-seven patients died within 30 days of receiving CRRT. Age, elective major surgery, creatinine level on initiation of CRRT, use of norepinephrine upon the initiation of CRRT, and average daily fluid balance/body weight for 3 days following the initiation of CRRT were associated with increasing 30-day mortality in univariate analysis. In multivariate analysis, age, major elective surgery, and norepinephrine use upon initiation of CRRT were identified as independent risk factors for 30-day mortality. @*Conclusion@#Surgical patients who underwent CRRT postoperatively had a poor prognosis. The risk of death in elderly patients who have undergone major elective surgery, or are receiving norepinephrine upon initiation of CRRT should be considered.
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Purpose@#The coronavirus disease 2019 (COVID-19) pandemic continues. It has been reported that patients with bacterial coinfection have a higher mortality rate than patients without coinfection. However, there are no clear standard guidelines for the use of antibacterial drugs. Therefore, the purpose of this study was to determine the usefulness of procalcitonin, a specific indicator of bacterial infection, as a biomarker for predicting death in COVID-19 patients. @*Methods@#This was a retrospective study of confirmed COVID-19 patients (N = 283) between December 2020 and February 2021 who survived or died. Logistic regression analysis was performed to determine whether there was an association between the level of procalcitonin and death. In addition, receiver operating characteristic curve analysis was performed to determine the usefulness of procalcitonin as a predictor of death. @*Results@#In the non-survivor group, age, the number of patients transferred from a health care center, segment neutrophil ratio, C reactive protein, ferritin, and procalcitonin were significantly higher in the survivor group. In multivariate analysis, procalcitonin was identified as an independent factor associated with death (hazard ratio 6.162, confidential interval 2.285-26.322, p = 0.014). In addition, the predictive power of procalcitonin level and mortality was statistically significant using receiver operating characteristic curve analysis which gave an area under the curve value of 0.823, a cut-off value of 0.05, a sensitivity of 72.2%, a specificity of 87.5% (p < 0.001). @*Conclusion@#Measurement of procalcitonin and other biomarkers may be useful to determine whether to use or discontinue use of antibacterial drugs in patients with COVID-19.
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Purpose@#Pelvis fractures are associated with bladder and urethral injury (BUI). The purpose of this study was to identify risk factors associated with BUI in patients with pelvic fracture. @*Methods@#Patients (> 18 years) with pelvic injury (N = 314) at our hospital between January 2015 and June 2020 were retrospectively analyzed for age, sex, cause of injury, initial vital signs, urine red blood cell (RBC) count, Glasgow Coma Scale and Abbreviated Injury Scale score, Injury Severity Score, preperitoneal pelvic packing, and femur, lumbar spine, and pelvic fractures. @*Results@#Compared with the BUI-absent group, the BUI-present group had a greater percentage of patients who were male (79.2% vs. 55.9%; p = 0.026), had a urine RBC count/high power field (HPF) ≥ 30 (94.4% vs. 38.8%; p < 0.001), underwent preperitoneal pelvic packing (37.5% vs. 18.6%; p = 0.035), had symphysis pubis diastasis (33.3% vs. 11.7%; p = 0.008), and had sacroiliac joint dislocation (54.2% vs. 23.4%; p = 0.001). Independent risk factors associated with BUI were symphysis pubis diastasis [odds ratio (OR) was 3.958 (95% confidence interval: 1.191–13.154); p = 0.025] and a urine RBC count/HPF ≥ 30 [OR = 25.415 (95% confidence interval: 3.252–198.637); p = 0.006]. Of those with BUI, 15 patients were diagnosed at the trauma bay, and 9 had a delayed diagnosis. @*Conclusion@#Patients with pelvic injury who display symphysis pubis diastasis or have a urine RBC count/ HPF ≥ 30 are at higher risk of BUI, therefore, further BUI investigations should be considered.
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Purpose@#Attending physicians in Korea are aware of the existence of the Nutrition Support Team (NST), but even when the NST are consulted, compliance with their recommendations may be low. This study was performed to identify physicians’ compliance with the NST advice and how this affected the outcome of treatment for critically ill patients. @*Methods@#This study was a retrospective observational study. Critically ill patients who were older than 18 years, younger than 90 years, and had been admitted and managed in the intensive care unit were selected for this study. Patients were assigned to either the compliance group or the non-compliance group according to physician compliance with the NST advice. Each group were compared using variables such as calorie supply, protein supply, laboratory findings, hospital stay, 30-day mortality, and survival rate. @*Results@#The compliance group (81% of cases) was supplied with a significantly higher energy (1,146.36 ± 473.45 kcal vs. 832.45 ± 364.28 kcal, p < 0.01) and a significantly higher protein (55.00 ± 22.30 g/day vs. 42.98 ± 24.46 g/day, p = 0.04) compared with the non-compliance group. There was no significant difference in the basic demographics between groups, although the compliance group had a better outcome in the 30-day mortality rate (8% vs. 26%, p = 0.02), and in survival beyond 1 year (Crude model, hazard ratio: 2.42, CI: 1.11-5.29). @*Conclusion@#Critically ill patients whose attending physician complied with the NST advice, received an increased energy intake and supply of protein which was positively associated with survival.
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A thyroid storm is a rare complication of hyperthyroidism. Although a thyroid storm rarely presents with symptoms similar to those of an acute abdomen, and in cases where emergency surgery is needed, the thyroid function test is not performed routinely. In this study, we report a case in which hyperthyroidism was diagnosed after surgery in a patient with recurrent refractory peptic ulcer disease. Although peptic ulcer disease and hyperthyroidism rarely coexist, when the patient's initial condition was reviewed in the Emergency Department, the findings were reasonable for panperitonitis due to peptic ulcer perforation, which is considered as a condition suitable for a thyroid storm. This isolated case indicates a logical leap in the correlation between peptic ulcer and thyroid storm. In recurrent refractory peptic ulcer disease, the thyroid function test may be helpful as a routine laboratory test before emergency surgery.
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This study was conducted to confirm the performance of the microRNA (miRNA) biomarker combination as a new breast cancer screening method in Korean women under the age of 50 with a high percentage of dense breasts. To determine the classification performance of a set of miRNA biomarkers (miR-1246, 202, 21, and 219B) useful for breast cancer screening, we determined whether there was a significant difference between the breast cancer and healthy control groups through box plots and the Mann– Whitney U-test, which was further examined in detail by age group. To verify the classification performance of the 4 miRNA biomarker set, 4 classification methods (logistic regression, random forest, XGBoost, and generalized linear model plus random forest) were applied, and 10-fold cross-validation was used as a validation method to improve performance stability. We confirmed that the best breast cancer detection performance was achievable in patients under 50 years of age when the set of 4 miRNAs were used. Under the age of 50, the 4 miRNA biomarkers showed the highest performance with a sensitivity of 85.29%, specificity of 93.33%, and area under the curve (AUC) of 0.961. Examining the results of 4 miRNA biomarkers was found to be an effective strategy for diagnosing breast cancer in Korean women under 50 years of age with dense breasts, and hence has the potential as a new breast cancer screening tool. Further validation in an appropriate screening population with large-scale clinical trials is required.
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Intra-abdominal infection is a common, serious complication in patients undergoing emergency abdominal surgery following blunt abdominal trauma. Infectious conditions increase the incidence of autoimmune hemolytic anemia (AIHA), but reports of AIHA occurring after abdominal trauma surgery are rare. Therefore, we report a case of sepsis due to fasciitis and AIHA after abdominal trauma surgery which was successfully managed following the appropriate treatment of both conditions.
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Purpose@#Traumatic kidney injury can be treated surgically or nonsurgically. Nonsurgical treatment options include angiography, embolization, and conservative treatment. We aimed to identify factors that help in making clinical decisions on treatment plans for patients with traumatic kidney injury caused by blunt trauma. @*Methods@#The study included 377 patients aged ≥18 years with traumatic kidney injury caused by blunt abdominal trauma admitted to the emergency room of Wonju Severance Christian Hospital between January 2008 and July 2020. Medical records, laboratory test results, and computed tomography results were retrospectively reviewed. @*Results@#Multivariable logistic analysis showed diastolic blood pressure at admission and disruption of Gerota's fascia were significantly associated with surgical treatment, and that perinephric hematoma rim distance was the only significant indicator favoring embolization. Receiver operating characteristic curve analysis showed that angiography and embolization should be considered when hematoma size exceeds 2.97 cm. @*Conclusion@#When a patient with traumatic kidney injury due to blunt trauma visits an emergency room, even when vital signs are stable, Gerota’s fascia should be checked by computed tomography prior to deciding on surgical treatment, and angiographic embolization should be considered if perinephric hematoma rim distance exceeds 2.97 cm.
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Intra-abdominal infection is a common, serious complication in patients undergoing emergency abdominal surgery following blunt abdominal trauma. Infectious conditions increase the incidence of autoimmune hemolytic anemia (AIHA), but reports of AIHA occurring after abdominal trauma surgery are rare. Therefore, we report a case of sepsis due to fasciitis and AIHA after abdominal trauma surgery which was successfully managed following the appropriate treatment of both conditions.
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Purpose@#Traumatic kidney injury can be treated surgically or nonsurgically. Nonsurgical treatment options include angiography, embolization, and conservative treatment. We aimed to identify factors that help in making clinical decisions on treatment plans for patients with traumatic kidney injury caused by blunt trauma. @*Methods@#The study included 377 patients aged ≥18 years with traumatic kidney injury caused by blunt abdominal trauma admitted to the emergency room of Wonju Severance Christian Hospital between January 2008 and July 2020. Medical records, laboratory test results, and computed tomography results were retrospectively reviewed. @*Results@#Multivariable logistic analysis showed diastolic blood pressure at admission and disruption of Gerota's fascia were significantly associated with surgical treatment, and that perinephric hematoma rim distance was the only significant indicator favoring embolization. Receiver operating characteristic curve analysis showed that angiography and embolization should be considered when hematoma size exceeds 2.97 cm. @*Conclusion@#When a patient with traumatic kidney injury due to blunt trauma visits an emergency room, even when vital signs are stable, Gerota’s fascia should be checked by computed tomography prior to deciding on surgical treatment, and angiographic embolization should be considered if perinephric hematoma rim distance exceeds 2.97 cm.
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PURPOSE: A task force appointed by the Korean Society of Acute Care Surgery reviewed previously published guidelines on antibiotic use in patients with abdominal injuries and adapted guidelines for Korea. METHODS: Four guidelines were assessed using the Appraisal of Guidelines for Research and Evaluation II instrument. Five topics were considered: indication for antibiotics, time until first antibiotic use, antibiotic therapy duration, appropriate antibiotics, and antibiotic use in abdominal trauma patients with hemorrhagic shock. RESULTS: Patients requiring surgery need preoperative prophylactic antibiotics. Patients who do not require surgery do not need antibiotics. Antibiotics should be administered as soon as possible after injury. In the absence of hollow viscus injury, no additional antibiotic doses are needed. If hollow viscus injury is repaired within 12 hours, antibiotics should be continued for ≤ 24 hours. If hollow viscus injury is repaired after 12 hours, antibiotics should be limited to 7 days. Antibiotics can be administered for ≥7 days if hollow viscus injury is incompletely repaired or clinical signs persist. Broad-spectrum aerobic and anaerobic coverage antibiotics are preferred as the initial antibiotics. Second-generation cephalosporins are the recommended initial antibiotics. Third-generation cephalosporins are alternative choices. For hemorrhagic shock, the antibiotic dose may be increased twofold or threefold and repeated after transfusion of every 10 units of blood until there is no further blood loss. CONCLUSION: Although this guideline was drafted through adaptation of other guidelines, it may be meaningful in that it provides a consensus on the use of antibiotics in abdominal trauma patients in Korea.
Subject(s)
Humans , Abdominal Injuries , Advisory Committees , Anti-Bacterial Agents , Antibiotic Prophylaxis , Cephalosporins , Consensus , Korea , Shock, HemorrhagicABSTRACT
Abdominal sepsis is mainly caused by intra-abdominal or retroperitoneal infection; therefore, early detection of the source of infection and adequate, prompt treatment are the most important contributors to patient outcomes. Because patients with sepsis often receive emergency abdominal surgery after regular hours, and most patients need critical care postoperatively, the need for personnel to specialize in these areas has emerged. The concept of acute care surgery (ACS), which includes trauma care, emergency general surgery, and surgical critical care, has been discussed since the early 2000s, and ACS fellowships were launched in the United States in 2008. ACS teams have been found to reduce mortality and complication rates, to decrease the time to surgery, and to lower financial costs in comparison to the traditional surgical model. In Korea, a regional trauma center project was started in 2012, and the government provided funding for each trauma center as part of this project. In the ACS field, the system for non-trauma emergency surgery is currently in the early stages of discussion. The need for such a system has been accelerated by the reduction of working hours per week of residents, as well as the shortage of manpower for emergency general surgery and surgical critical care on the night shift. In this review, we discuss the manpower problems that impact the treatment of abdominal emergency patients, and consider ways in which the Korean ACS system can treat these patients professionally.
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Abdominal sepsis is mainly caused by intra-abdominal or retroperitoneal infection; therefore, early detection of the source of infection and adequate, prompt treatment are the most important contributors to patient outcomes. Because patients with sepsis often receive emergency abdominal surgery after regular hours, and most patients need critical care postoperatively, the need for personnel to specialize in these areas has emerged. The concept of acute care surgery (ACS), which includes trauma care, emergency general surgery, and surgical critical care, has been discussed since the early 2000s, and ACS fellowships were launched in the United States in 2008. ACS teams have been found to reduce mortality and complication rates, to decrease the time to surgery, and to lower financial costs in comparison to the traditional surgical model. In Korea, a regional trauma center project was started in 2012, and the government provided funding for each trauma center as part of this project. In the ACS field, the system for non-trauma emergency surgery is currently in the early stages of discussion. The need for such a system has been accelerated by the reduction of working hours per week of residents, as well as the shortage of manpower for emergency general surgery and surgical critical care on the night shift. In this review, we discuss the manpower problems that impact the treatment of abdominal emergency patients, and consider ways in which the Korean ACS system can treat these patients professionally.
Subject(s)
Humans , Abdomen, Acute , Abdominal Injuries , Critical Care , Emergencies , Fellowships and Scholarships , Financial Management , Korea , Models, Anatomic , Mortality , Sepsis , Trauma Centers , United StatesABSTRACT
PURPOSE: The 2018 PyeongChang Winter Olympic Games involved 2925 elite athletes, and providing proper health care services for these elite athletes was a critical priority. We established an emergency department (ED) in the Pyeongchang Mountain Polyclinic during the Olympics, which served staff and athletes from many countries. This experience, as well as a description of illnesses and injuries encountered during the games, may provide useful information for planning medical care at similar events in the future. MATERIALS AND METHODS: The polyclinic ED operated from January 25 to February 27, 2018. All cases were enrolled in this study, and their data were analyzed by date and category. In addition, the number of injuries by body part, number of illnesses by organ system, and illness symptoms and causes were analyzed. RESULTS: In total, 288 patients were encountered in the ED. These included 113 injuries and 175 illnesses. We consulted with 153 staff members and 75 athletes, and reported that the fingers were the most commonly injured body part, followed by the knee. The respiratory system was the most commonly involved organ system, and the most common cause of illness was infection. Thirty-eight influenza tests were performed, among which the results of seven were positive. We performed 17 norovirus tests, among which the results of four were positive. CONCLUSION: Our analysis of our ED experience will aid arrangements for medical services in future Winter Games. Additionally, given our new experience, we will now be able to provide better medical services for future winter sports events.
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Humans , Athletes , Delivery of Health Care , Emergencies , Emergency Service, Hospital , Fingers , Influenza, Human , Knee , Norovirus , Respiratory System , SportsABSTRACT
PURPOSE: The aim of this study is to evaluate treatment outcomes and mortality risks associated with hemodynamic instability caused by severe pelvic fracture in a regional trauma center. METHODS: The medical charts of 44 patients with hemodynamic instability due to pelvic fractures who were admitted to a regional trauma center from January 2014 to May 2017 were analyzed retrospectively. RESULTS: The mean age was 61.8 years, and the mean injury severity score was 39.1. Twenty-six patients (59.1%) were transferred from other hospitals, and the median time from injury to emergency room arrival was 115.5 minutes. Preperitoneal pelvic packing, pelvic angiography, and external pelvic fixation were performed in 38 patients (86.4%) for hemostasis. The mortality rate was 52.3%, and 15 patients (34.1%) died from hemorrhage. Logistic regression analysis showed that initial low systolic blood pressure and packed red blood cell (PRBC) requirement were independent risk factors associated with mortality. PRBC requirement for four hours and application of emergent hemostatic procedures were independent factors associated with hemorrhage-induced mortality. CONCLUSION: Emergency procedures for hemostasis should be performed immediately for patients with hemodynamic instability due to pelvic fracture, and they should be transferred to a regional trauma center as soon as possible.
Subject(s)
Humans , Angiography , Blood Pressure , Emergencies , Emergency Service, Hospital , Erythrocytes , Hemodynamics , Hemorrhage , Hemostasis , Injury Severity Score , Logistic Models , Mortality , Pelvis , Retrospective Studies , Risk Factors , Shock , Trauma CentersABSTRACT
Hemodynamic monitoring continuously checks hemodynamic variables for problems so that the clinician can treat them when a patient's vital signs are unstable. There are many different monitoring systems, and many new technologies were developed over the past three decades. It is challenging to understand the many monitoring system in the intensive care units, for example. However, all such monitoring systems are based on the general principle of monitoring oxygen transport to a peripheral organ. In this review, from conventional to recent principles, general concepts and paradigm shifts of hemodynamic monitoring will be discussed.