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J Korean Soc Emerg Med > Volume 27(6); 2016 > Article
Journal of The Korean Society of Emergency Medicine 2016;27(6): 497-504.
성인 중증 외상환자에서 사망 예측을 위한 신개념 polytrauma의 유용성
김인혁1, 서강석1, 이미진1, 박정배1, 김종근1, 류현욱1, 안재윤1, 문성배1, 이동언1, 박용석1, 최마이클승필2
1경북대학교 의과대학 응급의학교실
2차의과학대학교 구미차병원 응급의학과
Usefulness of New Berlin Definition of Polytrauma for Mortality Prediction in Adult Patients with Major Trauma
In Hyuk Kim1, Kang Suk Seo1, Mi Jin Lee1, Jung Bae Park1, Jong Kun Kim1, Hyun Wook Ryoo1, Jae Yun Ahn1, Sungbae Moon1, Dong Eun Lee1, Yong Seok Park1, Michael Sung Pil Choe2
1Department of Emergency Medicine, Kyungpook National University School of Medicine, Daegu, Korea
2Gumi CHA Medical Center, CHA University, Gumi, Korea
Correspondence  Kang Suk Seo ,Tel: 053-420-6400, Fax: 053-428-2820, Email: kssuh@knu.ac.kr,
Received: June 15, 2016; Revised: June 16, 2016   Accepted: August 24, 2016.  Published online: December 31, 2016.
ABSTRACT
Purpose:
The terminology that represented major trauma was vague, inconsistent, and lacked validation. The objective of this study is to investigate the new definition of polytrauma in adult patients of major trauma.
Method:
A retrospective data of adult major trauma patients [Age≥15, 16≤Injury Severity Score (ISS)<75] from a regional trauma center were collected in period between July 2011 and December 2013 and divided into two groups: polytrauma and non-polytrauma. We compared the demographic, laboratory characteristics, and outcomes in patients with major trauma, polytrauma and non-polytrauma. Univariate associations were calculated, and a multiple logistic regression analysis was used to determine the parameters associated with in-hospital mortality and early death.
Results:
A total of 662 patients met the inclusion criteria for major trauma. Of these, 150 (22.7%) met the new polytrauma definition. In the major trauma group, the mean ISS was 22, in-hospital mortality rate was 23.4%, and early death rate was 20.7%. In the polytrauma group, ISS was 27, in-hospital mortality rate was 44.7%, and early death rate was 38.7%. In the non-polytrauma group, ISS was 20, in-hospital mortality rate was 17.2%, and early death rate was 15.4%. Of the five physiologic parameters (systolic blood pressure≤90 mmHg, Glasgow Coma Scale≤8, base deficit≥6, international normalized ratio≥1.4/activated partial thromboplastin time≥40 seconds, age≥70 years), the lowest in-hospital mortality was found when one parameter was involved (2.5%), and the highest mortality was found when all parameters were involved (100%).
Conclusion:
Based on “The new Berlin definition”, polytrauma was associated more with in-hospital mortality and early death than non-polytrauma in adults. The five physiologic parameters were correlated with in-hospital mortality.
Key words: Injury severity score, Patient outcome assessment, Polytrauma
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