Heo, Gyu Jin
(Department of Emergency Medicine, Gil Medical Center)
,
Lee, Jungnam
(Department of Traumatology, Gil Medical Center, Gachon University College of Medicine)
,
Choi, Woo Sung
(Department of Emergency Medicine, Gil Medical Center)
,
Hyun, Sung Youl
(Department of Traumatology, Gil Medical Center, Gachon University College of Medicine)
,
Cho, Jin-Seong
(Department of Emergency Medicine, Gil Medical Center, Gachon University College of Medicine)
Purpose: The present study will identify risk factors for aspiration in severe trauma patients by comparing patients who showed a sign of aspiration lung disease on chest computed tomography (CT) and those who did not. Methods: We conducted a retrospective review of the Korean Trauma Data Bank betwe...
Purpose: The present study will identify risk factors for aspiration in severe trauma patients by comparing patients who showed a sign of aspiration lung disease on chest computed tomography (CT) and those who did not. Methods: We conducted a retrospective review of the Korean Trauma Data Bank between January 2014 and December 2019 in a single regional trauma center. The inclusion criteria were patients aged ≥18 years with chest CT, and who had an Injury Severity Score ≥16. Patients with Abbreviated Injury Scale (AIS)-chest score ≥1 and lack of medical records were excluded. General characteristics and patient status were analyzed. Results: 425 patients were included in the final analysis. There were 48 patients showing aspiration on CT (11.2%) and 377 patients showing no aspiration (88.7%). Aspiration group showed more endotracheal intubation in the ER (p=0.000) and a significantly higher proportion of severe Glasgow Coma Scale (GCS) (p=0.000) patients than the non-aspiration group. In AIS as well, the median AIS head score was higher in the aspiration group (p=0.046). Median oxygen saturation was significantly lower in the aspiration group (p=0.002). In a logistic regression analysis, relative to the GCS mild group, the moderate group showed an odds ratio (OR) for aspiration of 2.976 (CI, 1.024-8.647), and the severe group showed an OR of 5.073 (CI, 2.442-10.539). Conclusions: Poor mental state and head injury increase the risk of aspiration. To confirm for aspiration, it would be useful to perform chest CT for severe trauma patients with a head injury.
Purpose: The present study will identify risk factors for aspiration in severe trauma patients by comparing patients who showed a sign of aspiration lung disease on chest computed tomography (CT) and those who did not. Methods: We conducted a retrospective review of the Korean Trauma Data Bank between January 2014 and December 2019 in a single regional trauma center. The inclusion criteria were patients aged ≥18 years with chest CT, and who had an Injury Severity Score ≥16. Patients with Abbreviated Injury Scale (AIS)-chest score ≥1 and lack of medical records were excluded. General characteristics and patient status were analyzed. Results: 425 patients were included in the final analysis. There were 48 patients showing aspiration on CT (11.2%) and 377 patients showing no aspiration (88.7%). Aspiration group showed more endotracheal intubation in the ER (p=0.000) and a significantly higher proportion of severe Glasgow Coma Scale (GCS) (p=0.000) patients than the non-aspiration group. In AIS as well, the median AIS head score was higher in the aspiration group (p=0.046). Median oxygen saturation was significantly lower in the aspiration group (p=0.002). In a logistic regression analysis, relative to the GCS mild group, the moderate group showed an odds ratio (OR) for aspiration of 2.976 (CI, 1.024-8.647), and the severe group showed an OR of 5.073 (CI, 2.442-10.539). Conclusions: Poor mental state and head injury increase the risk of aspiration. To confirm for aspiration, it would be useful to perform chest CT for severe trauma patients with a head injury.
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제안 방법
For discrete variables, univariate analysis was performed using the chi-square test, and for continuous variables with a non-normal distribution, the Mann-Whitney U test was used. A logistic regression analysis was performed to investigate the risk factors associated with aspiration. Results with a p-value <0.
This study had several limitations. First, this was a retrospective study conducted at a single regional trauma center. The number of patients enrolled in the study was insufficient for a more thorough statistical comparison of relevant factors between the aspiration group and the non-aspiration group.
Mechanism of accident was categorized as motor vehicle traffic accident (TA), pedestrian TA, motorcycle TA, fall down/slip down or unknown, and time of accident was categorized as 00:00–08:00, 08:00–16:00, or 16:00–24:00.
First, this was a retrospective study conducted at a single regional trauma center. The number of patients enrolled in the study was insufficient for a more thorough statistical comparison of relevant factors between the aspiration group and the non-aspiration group. Second, because it is difficult to differentiate between aspiration lung disease and traumatic lung injury from radiologic findings, patients with an AIS-chest score of ≥1 point were excluded from this study.
대상 데이터
Of these, 1,333 patients without chest CT scans were excluded, and 1,326 patients with AIS-chest ≥1 were excluded. A further 75 patients were excluded due to mis-recorded or duplicate chart numbers, transfer from the ER to another hospital, being under 18 years of age, or due to trauma affecting the interpretation of CT scans, and the remaining 425 patients were included in the final analysis. Of these 425 patients, there were 48 patients showing aspiration on chest CT (11.
The present study focused on patients registered in the KTDB who had visited a single regional trauma center between January 1st 2014 and December 31st 2019. The inclusion criteria were patients aged ≥18 years who had undergone chest CT, and who had an Injury Severity Score (ISS) ≥16.
데이터처리
, Chicago, IL, USA). For discrete variables, univariate analysis was performed using the chi-square test, and for continuous variables with a non-normal distribution, the Mann-Whitney U test was used. A logistic regression analysis was performed to investigate the risk factors associated with aspiration.
성능/효과
As general characteristics, the patients’ sex, age, mechanism of accident, time of accident, past medical history, status at discharge from the ER, and intubation in the ER were compared between the aspiration and the non-aspiration group.
후속연구
In order to test for aspiration, it would be useful to perform chest CT for severe trauma patients with head injury to check for accompanying aspiration lung disease. Therefore, in severe trauma patients with head injury or poor mental state, various measures should be considered to reduce the risk of aspiration, and this will need to be investigated further in studies with a larger sample size of patients.
참고문헌 (24)
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