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J Korean Soc Emerg Med > Volume 29(6); 2018 > Article
Journal of The Korean Society of Emergency Medicine 2018;29(6): 663-670.
급성 복증 환자에서 현장검사 크레아티닌을 이용한 의사결정 시간의 단축
최윤혁, 조성욱 , 안홍준 , 민진홍 , 정원준 , 유 승 , 오세광 , 김승환 , 유연호 , 이진웅 , 박정수 , 유인술 , 조용철
충남대학교 의과대학 충남대학교병원 응급의학과
The influence of the decision making time by using point-of-care creatinine in patients with acute abdomen
Younhyuk Choi, Sunguk Cho , Hongjoon Ahn , Jinhong Min , Wonjoon Jeong , Seung Ryu , Segwang Oh , Seunghwan Kim , Yeonho You , Jinwoong Lee , Jungsoo Park , Insool Yoo , Yongchul Cho
Department of Emergency Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
Correspondence  Yongchul Cho ,Tel: 042-280-6002, Fax: 042-280-6014, Email: boxter73@naver.com,
Received: May 31, 2018; Revised: August 28, 2018   Accepted: October 3, 2018.  Published online: December 31, 2018.
ABSTRACT
Objective:
Radio-contrast abdomino-pelvic computed tomography (APCT) is considered the gold standard diagnostic tool for an acute abdomen in the emergency department. On the other hand, APCT has a risk of contrast-induced nephropathy. Emergency physicians evaluate the creatinine (Cr) level prior to taking a APCT for the above reason but it takes time to evaluation the serum Cr level. This study hypothesized that Cr measured by a point-of-care test (POCT) can shorten the time to making clinically important decisions for patients with an acute abdomen.
Method:
This prospective randomized study was conducted between March 2017 and October 2017. The subjects were divided into two groups (Cr measured by laboratory vs. Cr measured by POCT). To analyze the clinical acceptability for creatinine, agreement was demonstrated graphically by Bland-Altman plots. This study compared the time to make a clinically important decision by physicians and the length of stay at the emergency department in both groups.
Results:
A total of 76 patients were eligible for the study, 38 patients were assigned to each group. There was no statistically significant difference in the time to the first medical examination (P=0.222) and emergency department stay time (P=0.802). On the other hand, the time to recognition of the Cr level (P<0.001), time to performing APCT (P<0.001), time to decision making (P<0.001), and time to initiation of treatment (P<0.001) were shortened significantly in the point-of-care creatinine group.
Conclusion:
In this study, the POCT for creatinine can allow rapid decision making by shortening the time to performing the radio-contrast APCT than the laboratory for patients with an acute abdomen.
Key words: Creatinine; Point-of-care systems; Decision making; Tomography
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