어떤 다발성 외상환자가 중환자실에 오래 있게 되는가?; Injury severity score와 손상부위 수의 비교

Why do Multiple-trauma Patients Stay Longer in the Intensive Care Unit?; - A Comparison of Injury Severity Score and The Number of Injured Regions -

  • 조무진 (부산대학교병원 응급의학과) ;
  • 이성화 (부산대학교병원 응급의학과) ;
  • 조석주 (부산대학교병원 응급의학과) ;
  • 염석란 (부산대학교병원 응급의학과) ;
  • 한상균 (부산대학교병원 응급의학과) ;
  • 박성욱 (부산대학교병원 응급의학과) ;
  • 이대섭 (부산대학교병원 응급의학과)
  • Jo, Mu Jin (Department of Emergency Medicine, Pusan National University Hospital) ;
  • Lee, Seong Hwa (Department of Emergency Medicine, Pusan National University Hospital) ;
  • Cho, Seok Ju (Department of Emergency Medicine, Pusan National University Hospital) ;
  • Yeom, Seok Ran (Department of Emergency Medicine, Pusan National University Hospital) ;
  • Han, Sang Kyoon (Department of Emergency Medicine, Pusan National University Hospital) ;
  • Park, Sung Wook (Department of Emergency Medicine, Pusan National University Hospital) ;
  • Lee, Dae Seop (Department of Emergency Medicine, Pusan National University Hospital)
  • 투고 : 2013.01.10
  • 심사 : 2013.04.17
  • 발행 : 2013.06.30

초록

Purpose: Injury severity score (ISS), a widely used scoring system, is used to define the severity of trauma in multiple-trauma patients. Nevertheless, ISS cut-off value for predicting the outcome of multiple-trauma patients has not been confirmed. Thus, this study was performed to determine the more useful method for predicting the outcome for multiple-trauma patients: the ISS or the number of anatomical Abbreviated injury scale (AIS) injury regions. Methods: for 195 consecutive patients who a regional emergency medical center, we analyzed the ISS and the number of anatomical AIS injury region. The patients were divided into four groups based on the ISS and the number of anatomical AIS regions. We compared intensive-care-unit (ICU) admission days and hospitalization days and ICU stay ratio (ICU admission days/hospitalization days) between the four groups. Results: In the groups with an ISS more than 17, the results were not significantly different statistically the group with 2 anatomical AIS injury regions and more than 3 anatomical AIS injury regions. Also, in the group with an ISS of 17 or less, the results were the same as those for patients with an ISS more than 17 (p>0.05). Among the patients with 2 anatomical AIS injury regions, patients with an ISS more than 17 patients had more ICU admission days and a higher ICU stay ratio than patients with an ISS 17 or less. Also, Among the patients with 3 anatomical AIS injury regions, the results were the same as those for patients with 2 anatomical AIS injury regions. Conclusion: Patients with high ISS, regardless of the number of anatomical AIS injury regions had significantly longer ICU stays and higher ICU admission ratio. Thus, the ISS may be a better method than the number of anatomical AIS injury regions for predicting the outcomes for multiple-trauma patients.

키워드

참고문헌

  1. Butcher N, Balogh ZJ. The definition of polytrauma: the need for international consensus. Injury 2009;40 Suppl.4: S12-S22.
  2. Butcher N, Balogh ZJ. AIS>2 in at least two body regions: A potential new anatomical definition of polytrauma. Injury 2012; 43: 196-9. https://doi.org/10.1016/j.injury.2011.06.029
  3. Chawda MN, Hildebrand F, Pape HC, Giannoudis PV. Predicting outcome after multiple trauma: which scoring system? Injury 2004; 35: 347-58. https://doi.org/10.1016/S0020-1383(03)00140-2
  4. Sikand M, Williams K, White C, Morgan CG. The financial cost of treating polytrauma: implications for tertiary referral centres in the United Kingdom. Injury 2005; 36: 733-7. https://doi.org/10.1016/j.injury.2004.12.026
  5. Biewener A, Aschenbrenner U, Rammelt S, Grass R, Zwipp H. Impact of helicopter transport and hospital level on mortali-ty of polytrauma patients. J Trauma 2004; 56: 94-8. https://doi.org/10.1097/01.TA.0000061883.92194.50
  6. Hildebrand F, Giannoudis P, Kretteck C, Pape H. Damage control: extremities. Injury 2004; 35: 678-9. https://doi.org/10.1016/j.injury.2004.03.004
  7. Pape HC, Remmers D, Rice J, Ebisch M, Krettek C, Tscherne H. Appraisal of early evaluation of blunt chest trauma: development of a standardized scoring system for initial clinical decision making. J Trauma 2000; 49: 496-504. https://doi.org/10.1097/00005373-200009000-00018
  8. Bone LB, Babikian G, Stegemann PM. Femoral canal reaming in the polytrauma patient with chest injury. A clnical perspective. Clin Orthop Relat Res. 1995; 318: 91-4.
  9. McLain RF. Functional outcomes after surgery for spinal fractures: return to work and activity. Spine. 2004; 29: 470-7. https://doi.org/10.1097/01.BRS.0000092373.57039.FC
  10. Asehnoune K, Edouard A. Inflammatory response and polytrauma: an update. Reanimation. 2006; 15: 568-75. https://doi.org/10.1016/j.reaurg.2006.10.011
  11. Andre L, Lynne M, Natalie L, Moishe L, John SS. The injury severity score or the new injury severity score for predicting intensive care unit admission and hospital length of stay? Injury 2004; 36: 477-83.
  12. Hala T, Adina ZH, Ziad M, Maria A, Souheil EC. The injury severity score or the new injury severity score for predicting intensive care unit admission and hospital length of stay: Experience from a university hospital in a developing country. Injury 2008; 39: 115-20. https://doi.org/10.1016/j.injury.2007.06.007
  13. Hayashi Y, Morisawa K, Klompas M, Jones M, Bandeshe H, Boots R, et al. Toward Improved Surveillance: The Impact of Ventilator-Associated Complications on Length of Stay and Antibiotic Use in Patients in Intensive Care Units. Clin Infect Dis 2013; 56: 471-7. https://doi.org/10.1093/cid/cis926
  14. Sharma A, Malhotra S, Grover S, Jindal SK. Incidence, prevalence, risk factor and outcome of delirium in intensive care unit: a study from India. Gen Hosp Psychiatry 2012; 34: 639- 46. https://doi.org/10.1016/j.genhosppsych.2012.06.009
  15. Pan SC, Wang JT, Chen YC, Chang YY, Chen ML, Chang SC. Incidence of and risk factors for infection or colonization of vancomycin-resistant enterococci in patients in the intensive care unit. PLoS One 2012; 7: e47297. https://doi.org/10.1371/journal.pone.0047297
  16. Hadfield RJ, Parr MJ, Manara AR. Late deaths in multiple trauma patients receiving intensive care. Resuscitation 2001; 49: 279-81. https://doi.org/10.1016/S0300-9572(00)00364-6
  17. Pfeifer R, Tarkin IS, Rocos B, Pape HC. Patterns of mortality and cause of death in polytrauma patients-Has anything changed? Injury 2009; 40: 907-10. https://doi.org/10.1016/j.injury.2009.05.006
  18. Hwang JY, Lee KH, Shin HJ, Cha KC, Kim H, Hwang SO. Correlation analysis of trauma scoring system in predictive validity in motor vehicle accident. J Kor Soc Emerg Med 2011; 4: 329-34.