Purpose: Specialized general trauma surgeons play an important role in the care of trauma patients. Hemoperitoneum is a severe, but representative, condition following a life-threatened trauma. The objective of this study was to compare the outcomes for polytrauma patients with hemoperitoneum betwee...
Purpose: Specialized general trauma surgeons play an important role in the care of trauma patients. Hemoperitoneum is a severe, but representative, condition following a life-threatened trauma. The objective of this study was to compare the outcomes for polytrauma patients with hemoperitoneum between the periods during which a trauma surgeon was available and that unavailable. Methods: Thirty-one trauma patients with hemoperitoneum who were treated at Korea University Guro Hospital over a period of 4 years were included in this study, and their case records were analyzed retrospectively. The patients were divided into two groups, the 2011 and 2012 group and the 2013 and 2014 group corresponding, respectively, to the periods that a trauma surgeon was not and was working. Vital signs on admission, scores on the injury severity scale and, Glasgow coma scale, elapsed time to diagnostic, and therapeutic, and/or operative interventions were studied. The effects on intensive care unit and hospital lengths of stay, as well as mortality, were also studied. Results: The study population consisted of 16 and 15 patients in group 1 and 2, respectively. The patients in both groups had six unstable hemodynamic on admission. The time to the main procedure (intervention, operation etc.) was longer during the periods when a trauma surgeon was not working than it was during the period when working. This difference did not reached statistical significance. The mortality rates for the two groups were not statistically different either (18.75% vs 26.67%; p=0.928). Conclusion: Having at least one specialized general trauma surgeon on duty may reduce the time to intervention and surgery for severe trauma patients with hemoperitoneum, but appears to have no effect on the mortality rates. In conclusion, having only one trauma surgeon on duty does not improve the quality of care for trauma patients.
Purpose: Specialized general trauma surgeons play an important role in the care of trauma patients. Hemoperitoneum is a severe, but representative, condition following a life-threatened trauma. The objective of this study was to compare the outcomes for polytrauma patients with hemoperitoneum between the periods during which a trauma surgeon was available and that unavailable. Methods: Thirty-one trauma patients with hemoperitoneum who were treated at Korea University Guro Hospital over a period of 4 years were included in this study, and their case records were analyzed retrospectively. The patients were divided into two groups, the 2011 and 2012 group and the 2013 and 2014 group corresponding, respectively, to the periods that a trauma surgeon was not and was working. Vital signs on admission, scores on the injury severity scale and, Glasgow coma scale, elapsed time to diagnostic, and therapeutic, and/or operative interventions were studied. The effects on intensive care unit and hospital lengths of stay, as well as mortality, were also studied. Results: The study population consisted of 16 and 15 patients in group 1 and 2, respectively. The patients in both groups had six unstable hemodynamic on admission. The time to the main procedure (intervention, operation etc.) was longer during the periods when a trauma surgeon was not working than it was during the period when working. This difference did not reached statistical significance. The mortality rates for the two groups were not statistically different either (18.75% vs 26.67%; p=0.928). Conclusion: Having at least one specialized general trauma surgeon on duty may reduce the time to intervention and surgery for severe trauma patients with hemoperitoneum, but appears to have no effect on the mortality rates. In conclusion, having only one trauma surgeon on duty does not improve the quality of care for trauma patients.
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제안 방법
This study was designed to investigate the effectiveness of a single trauma specialist by comparatively analyzing the ER retention time, ICU treatment period, and mortality rate of multiple trauma patients including those with hemoperitoneum before and after the time when the trauma specialist in our hospital began practicing.
We comparatively analyzed each group’ s general characteristics, vital signs, stability status, Injury Severity Score (ISS), Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), Trauma and Injury Severity Score (TRISS), ER retention time, ICU treatment period, and mortality rate.
대상 데이터
A total of 31 patients with trauma including hemoperitoneum were included in the study: 16 patients in Group 1 (not seen by the trauma specialist) and 15 patients in Group 2 (seen by the trauma specialist). The following results are given for Groups 1 and 2, respectively.
This study compared the 2-year period when a single trauma specialist rather than a trauma team was present in the ER of Korea University Guro Hospital with the same duration before the trauma specialist was appointed. Other studies comparing treatment results of severe trauma patients before and after a severe trauma team was introduced in other domestic or foreign hospitals have reported significantly reduced retention times in the ER and even decreased mortality rates of trauma patients.
데이터처리
* The p-values were estimated by Shapiro-Wilk normality test or Fisher’s exact test.
Fisher’ s exact test was performed for noncontinuous variables.
Statistical analysis was performed by using R: a language and environment for statistical computing, and the Shapiro-Wilk normality test was performed for continuous variables to test normality and analyze data. Data with a normal distribution are expressed as mean±SD, whereas data not distributed normally are expressed as median and interquartile range.
성능/효과
A more detailed evaluation of the ER retention time revealed that the times between patient admission to the ER and arrival of an on-duty resident or specialist were 82.5 and 75 minutes, which were not statistically significantly different (p=0.553). The times between admission to the ER and the start of a procedure such as surgery or intervention were 294.
In conclusion, rather than expecting that a single trauma specialist would be a big help in treating severe trauma, establishing a severe trauma team, constructing an appropriate system, preparing standardized guidelines, and operating it systematically would contribute to decreasing the ER retention time of severe trauma patients, making quick decisions on the treatment regime, and lowering the mortality rate.(7)
참고문헌 (9)
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Lee SH, Cho SJ, Yeom SR, Ryu JH, Jung JW, Han SK et al. Effect of the mergency trauma team's management on the treatment of patients with multiple severe trauma. J Korean Soc Traumatol; J Korean Soc Traumatol 2009: 22: 172-8.
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