DOI QR코드

DOI QR Code

중환자실에 급성약물중독으로 입실한 자살시도 노인의 사망 관련요인

Factors Associated with Mortality in Elderly Patients Admitted to Intensive Care Unit due to Acute Drug Intoxication from Suicide Attempts

  • 김경은 (전남대학교병원) ;
  • 문선희 (전남대학교 간호대학) ;
  • 송지은 (남부대학교 간호학과) ;
  • 안민정 (전남대학교 간호대학)
  • Kim, Kyung-Eun (Chonnam National University Hospital) ;
  • Moon, Sun-Hee (College of Nursing, Chonnam National University) ;
  • Song, Chieun (Department of Nursing, Nambu University) ;
  • An, Minjeong (College of Nursing, Chonnam National University)
  • 투고 : 2024.01.05
  • 심사 : 2024.03.12
  • 발행 : 2024.06.30

초록

Purpose : This study aimed to determine the mortality rate among elderly patients admitted to the intensive care unit (ICU) for acute drug intoxication resulting from suicide attempts. It also compared the characteristics of survivors and decedents to identify factors associated with mortality. Methods : This retrospective descriptive study included 150 patients aged 65 years or older who were admitted to the ICU of a tertiary university hospital in Gwangju due to acute drug intoxication, with the period spanning January 1, 2018 to December 31, 2020. The collected data were analyzed using descriptive statistics, independent t-tests, Chi-squared tests, Fisher's exact test, and multiple logistic regression analysis. Results : The mortality rate among elderly individuals admitted to the ICU for acute drug intoxication was 19.3%. The likelihood of death was significantly higher in patients with an acute physiology and chronic health examination (APACHE) III score of 70 or above (OR=23.75, 95% CI=3.78-149.46, p<.001) and those with metabolic acidosis on initial acid-base results (OR=3.73, 95% CI=1.12-12.43, p=.032). Conclusion : These findings underscore the need for developing and implementing systematic education and targeted nursing interventions for ICU nurses caring for acutely drug-intoxicated elderly adults, particularly considering the APACHE III score and the presence of metabolic acidosis.

키워드

참고문헌

  1. Statistics Korea. Cause of death statistics 2021 [Internet]. Daejeon: Statistics Korea; 2021 [cited 2023 Nov 10]. Available from https://kosis.kr/statHtml/statHtml.do?orgId=101&tblId=DT_1B34E01&vw_cd=&list_id=&scrId=&seqNo=&lang_mode=ko&obj_var_id=&itm_id=&conn_path=K1
  2. Ministry of Health and Welfare. 2022 White paper on suicide prevention. Seoul: Ministry of Health and Welfare, Korea Foundation for Suicide Prevention; 2022 [cited 2023 Nov 10]. Available from https://www.kfsp.or.kr/web/board/15/276/?pMENU_NO=476&searchType=ALL&searchWord=2022+%EC%9E%90%EC%82%B4%EC%98%88%EB%B0%A9%EB%B0%B1%EC%84%9C
  3. Oh SY. A study on the characteristics of elderly drug addicted suicide attempters: patients requested by the department of mental health medicine at university hospital [master's thesis]. Seoul: Kyung Hee University; 2014. p. 2-3.
  4. Shin HW, Lee KJ, Kim H. The clinical characteristics of elderly suicide attempters visiting emergency room. Korean Journal of Psychosomatic Medicine. 2015;23(2):100-6. https://doi.org/10.22722/KJPM.2015.23.2.100
  5. Song SJ, Park GJ, Lee JH, Kim SC, Kim H, Lee SW. The characteristics of elderly individuals who attempted suicide by poisoning: a nationwide cross-sectional study in Korea. Journal of Korean Medical Science. 2020;35(35):e286. https://doi.org/10.3346/jkms.2020.35.e286
  6. Lee TY, Kim SR, Cho BJ, Park JH. The analysis of acute drug intoxication in emergency medical center. Journal of the Korea Academia-Industrial cooperation Society. 2010:11(2);750-7. https://doi.org/10.5762/KAIS.2010.11.2.750
  7. Korea Disease Control and Prevention Agency. Poisoning [Internet]. Cheongju: Korea Disease Control and Prevention Agency; 2023 [cited 2023 Nov 10]. Available from https://www.kdca.go.kr/contents.es?mid=a20308060100
  8. Kim JH. Analysis of characteristics of drug intoxication patients in seoul metropolitan area [master's thesis]. Busan: Inje University; 2020. p. 9-16.
  9. Kim B. Epidemiological characteristics of drug intoxication in Korea between 2005 and 2014 [master's thesis]. Daejeon: Konyang University; 2018. p. 34-42.
  10. Pillans PI, Page CB, Ilango S, Kashchuk A, Isbister GK. Self-poisoning by older Australians: a cohort study. The Medical Journal of Australia. 2017;206(4):164-9. https://doi.org/10.5694/mja16.00484
  11. Kim JH, Cho JS, Kim JJ, Lim YS, Yang HJ, Lee G. Comparison of epidemiology and outcomes of patients with intentional poisoning by age groups: single center observation study. Journal of the Korean Society of Clinical Toxicology. 2016;14(2):129-35. https://doi.org/10.22537/jksct.2016.14.2.129
  12. Liisanantti JH, Ohtonen P, Kiviniemi O, Laurila JJ, Ala-Kokko TI. Risk factors for prolonged intensive care unit stay and hospital mortality in acute drug-poisoned patients: an evaluation of the physiologic and laboratory parameters on admission. Journal of Critical Care. 2011;26(2):160-5. https://doi.org/10.1016/j.jcrc.2010.08.009
  13. Ozdemir K, Dizbay M. Nosocomial infection and risk factors in elderly patients in intensive care units. Journal of Microbiology and Infectious Diseases. 2015;5(1):38-44. https://doi.org/10.5799/ahinjs.02.2015.01.0174
  14. Barman B, Bora K, Nongpiur A. Poisoning in elderly. Indian Journal of Medical Specialities. 2018;9(3):113-7. https://doi.org/10.1016/j.injms.2018.04.008
  15. Maignan M, Pommier P, Clot S, Saviuc P, Debaty R, Briot R, et al. Deliberate drug poisoning with slight symptoms on admission: are there predictive factors for intensive care unit referral? A three-year retrospective study. Basic & Clinical Pharmacology & Toxicology. 2014;114(3):281-7. https://doi.org/10.1111/bcpt.12132
  16. Han JS, Yun SW, Choi SS. A study on the patients who attempted suicide with drug intoxication. Journal of the Korea Academia-Industrial cooperation Society. 2013;14(4):1863-70. http://dx.doi.org/10.5762/KAIS.2013.14.4.1863
  17. Lee HJ, Choa MH, Han EA, Ko DR, Ko JW, Kong TY, et al. Causative substance and time of mortality presented to emergency department following acute poisoning: 2014-2018 national emergency department information system (NEDIS). Journal of the Korean Society of Clinical Toxicology. 2021;19(2):65-71. https://doi.org/10.22537/jksct.2021.19.2.65
  18. Kim JY, Jung HM, Kim JH, Han SB, Kim JS, Paik JH. Prognostic factors of acute poisoning in elderly patient. Journal of the Korean Society of Clinical Toxicology. 2011;9(2):81-7.
  19. Lim SW, Park SM, Lee YH, Lee WW, Ahn JY, Sohn YD, et al. The features and prognoses in organophosphate intoxication according to age. Journal of the Korean Geriatrics Society. 2013;17(4):198-204. https://doi.org/10.4235/jkgs.2013.17.4.198
  20. Yixu W, Lei W, Zhang W. Analyses on relevant factors of the prognosis of elderly patients with acute poisoning. Chinese Journal of Industrial Hygiene and Occupational Diseases. 2017;35(5): 353-5. https://doi.org/10.3760/cma.j.issn.1001-9391.2017.05.008
  21. Disease Taxonomy Information Center. Korean standard classification of causes of disease [Internet]. Disease Taxonomy Information Center; 2021 [cited 2023 Nov 10]. Available from https://koicd.kr/kcd/kcd.do
  22. KTAS committee of the korean emergency medical association. What is KTAS [Internet]. Seoul: KTAS Committee of the Korean Emergency Medical Association; 2016 [cited 2023 Nov 10]. Available from http://ktas.org/about/ktas.php
  23. Anne KC, Upex A, Bateman DN. Comparison of consciousness level assessment in the poisoned patient using the alert/verbal/painful/unresponsive scale and the glasgow coma scale. Annals of Emergency Medicine. 2004;44(2):108-13. https://doi.org/10.1016/j.annemergmed.2004.03.028
  24. Lewis SN, Neal AL, Mary AH, Robert SH, Lewis RG, Neal EF. Goldfrank's toxicologic emergencies. 9th ed. New York: McGraw-Hill Education; 2011. p. 34.
  25. Knaus WA, Wagner DP, Draper EA, Zimmerman JE, Bergner M, Bastos PG, et al. The APACHE III prognostic system: risk prediction of hospital mortality for critically III hospitalized adults. Chest. 1991;100(6):1619-36. https://doi.org/10.1378/chest.100.6.1619
  26. Jeong IS, Kim MH, Kim JS. Predictive accuracy of severity scoring system: a prospective cohort study using APACHE III in a Korean intensive care unit. International Journal of Nursing Studies. 2003;40(3):219-26. https://doi.org/10.1016/S0020-7489(02)00062-7
  27. Lee JY, Seo JY, Ahn ME, Lee TH, Park SH, Kim YM, et al. A clinical review of acute poisonings in geriatric patients from rural Gangwon province. Journal of the Korean Geriatrics Society. 2011;15(4):200-6. https://doi.org/10.4235/jkgs.2011.15.4.200
  28. Kim W, Kim KH, Shin DW, Park J, Kim H, Jeon W, et al. Characteristics of Korean poisoning patients: retrospective analysis by national emergency department information system. Journal of the Korean Society of Clinical Toxicology. 2019;17(2):108-17. https://doi.org/10.22537/jksct.2019.17.2.108
  29. Yu JR, Hou YC, Fu JF, Wang IK, Chan M, Chen CY, et al. Outcomes of elderly patients with organophosphate intoxication. Scientific Reports. 2021;11(1):11615. https://doi.org/10.1038/s41598-021-91230-2
  30. Seoul Poison Control Center. Reminder yard [Internet]. Seoul: Seoul Poison Control Center; 2023 [cited 2023 Nov 10]. Available from https://www.seoulpcc.or.kr/skill/bbs/noticeList.do
  31. Lee HR, Choi CJ, Park OJ, Kim YS, Choi GO, Kim GS, et al. Adult Nursing. 6th ed. Paju: Sumunsa; 2010. p. 212-21.
  32. Lee DH, Jung JH, Jung KY, Eo EK. Different clinical outcomes by subgroups in organophosphorus poisoning. Journal of the Korean Society of Clinical Toxicology. 2007;5(1):8-14.
  33. Lee DS, Choi KH. A study of predicting the severity following glufosinate ammonium containing herbicide poisoning experienced in single emergency medical institution. Journal of the Korean Society of Clinical Toxicology. 2019;17(1):7-13. https://doi.org/10.22537/jksct.17.1.7
  34. Hamdi H, Hassanian-Moghaddam H, Hamdi A, Zahed NS. Acid-base disturbances in acute poisoning and their association with survival. Journal of Critical Care. 2016;35:84-9. https://doi.org/10.1016/j.jcrc.2016.05.003
  35. Seong JS, So HY. Comparative analysis of the accuracy of severity scoring systems for the prediction of healthcare outcomes of intensive care unit patients. Journal of Korean Critical Care Nursing. 2015;8(1):71-9.