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J Korean Soc Emerg Med > Volume 29(5); 2018 > Article
Journal of The Korean Society of Emergency Medicine 2018;29(5): 465-473.
상급종합병원 및 종합병원 응급실로 전원된 패혈성 쇼크 환자의 특성과 예후: 다기관 후향적 관찰연구
김민균1, 신태건1, 조익준1, 김원영2, 유승목2, 정성필3, 범진호3, 최성혁4, 김규석5, 조유환5, 강구현6, 서길준7, 신종환8, 임태호9, 한갑수10, 황승연1 , 대한쇼크연구회
1성균관대학교 의과대학 삼성서울병원 응급의학과
2울산대학교 의과대학 서울아산병원 응급의학과
3연세대학교 의과대학 응급의학과
4고려대학교 의과대학 구로병원 응급의학과
5분당서울대학교병원 응급의학과
6한림대학교 강남성심병원 응급의학과
7서울대학교 의과대학 응급의학교실
8서울대학교 의과대학 보라매병원 응급의학과
9한양대학교 의과대학 응급의학교실
10고려대학교 의과대학 안암병원 응급의학과
Characteristics and outcomes of patients with septic shock who transferred to the emergency department in tertiary referral center: multicenter, retrospective, observational study
Min Gyun Kim1, Tae Gun Shin1, Ik Joon Jo1, Won Young Kim2, Seung Mok Ryoo2, Sung Phil Chung3, Jin Ho Beom3, Sung-Hyuk Choi4, Kyuseok Kim5, You Hwan Jo5, Gu Hyun Kang6, Gil Joon Suh7, Jonghwan Shin8, Tae Ho Lim9, Kap Su Han10, Sung Yeon Hwang1 , for the Korean Shock Society (KoSS) Investigators
1Department of Emergency Medicine, 1Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
2Department of Emergency Medicine, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
3Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
4Department of Emergency Medicine, Korea University College of Medicine, Guro Hospital, Seoul, Korea
5Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
6Department of Emergency Medicine, Hallym University College of Medicine, Seoul, Korea
7Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
8Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
9Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Korea
10Department of Emergency Medicine, Korea University College of Medicine, Anam Hospital, Seoul, Korea
Correspondence  Sung Yeon Hwang ,Tel: 02-3410-2053, Fax: 02-3410-0012, Email: sygood.hwang@samsung.com,
Received: July 11, 2018; Revised: August 14, 2018   Accepted: August 14, 2018.  Published online: October 31, 2018.
ABSTRACT
Objective:
We evaluated the clinical characteristics and prognoses of patients with septic shock who transferred to the emergency department (ED) in a tertiary referral center.
Method:
This study was performed using a prospective, multi-center registry of septic shock, with the participation of 11 tertiary referral centers in the Korean Shock Society between October 2015 and February 2017. We classified the patients as a transferred group who transferred from other hospitals after meeting the inclusion criteria upon ED arrival and a non-transferred group who presented directly to the ED. Primary outcome was hospital mortality. We conducted multiple logistic regression analysis to assess variables related to in-hospital mortality.
Results:
A total of 2,098 patients were included, and we assigned 717 patients to the transferred group and 1,381 patients to the non-transferred group. The initial Sequential Organ Failure Assessment score was higher in the transferred group than the non-transferred group (6; interquartile range [IQR], 4-9 vs. 6; IQR, 4-8; P<0.001). Mechanical ventilator (29% vs. 21%, P<0.001) and renal replacement therapy (12% vs. 9%, P=0.034) within 24 hours after ED arrival were more frequently applied in the transferred group than the non-transferred group. Overall hospital mortality was 22% and there was no significant difference between transferred and non-transferred groups (23% vs. 22%, P=0.820). Multivariable analysis showed an odds ratio for in-hospital mortality of 1.00 (95% confidence interval, 0.78-1.28; P=0.999) for the transferred group compared with the non-transferred group.
Conclusion:
The transferred group showed higher severity and needed more organ support procedures than the nontransferred group. However, inter-hospital transfer did not affect in-hospital mortality.
Key words: Sepsis; Septic shock; Mortality; Interhospital transfer
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