Journal of Trauma and Injury

The Korean Society of Traumatology (대한외상학회)
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Management of Severe Trauma Patients in the Emergency Intensive Care Unit

응급중환자실에서의 중증외상환자 치료

  • Kim, Ji-Ju (Department of Emergency Medicine, Seoul National University Hospital) ;
  • Suh, Gil-Joon (Department of Emergency Medicine, Seoul National University Hospital) ;
  • Jeong, Ki-Young (Department of Emergency Medicine, Seoul National University Hospital) ;
  • Kwon, Woon-Yong (Department of Emergency Medicine, Seoul National University Hospital) ;
  • Kim, Kyung-Su (Department of Emergency Medicine, Seoul National University Hospital) ;
  • Lee, Hui-Jai (Department of Emergency Medicine, Seoul National University Hospital) ;
  • Kim, Yeong-Cheol (Division of Traumatology, Department of Surgery, Seoul National University Hospital) ;
  • Choi, Seok-Ho (Division of Traumatology, Department of Surgery, Seoul National University Hospital) ;
  • Lee, Young-Ho (Department of Orthopedic Surgery, Seoul National University Hospital) ;
  • Lee, Kyung-Hag (Division of Traumatology, Department of Surgery, Seoul National University Hospital) ;
  • Han, Kook-Nam (Division of Traumatology, Department of Surgery, Seoul National University Hospital) ;
  • Jae, Hwan-Jun (Department of Emergency Medicine, Seoul National University Hospital) ;
  • Kim, Hyo-Cheol (Department of Radiology, Seoul National University Hospital)
  • 김지주 (서울대학교병원 응급의학과) ;
  • 서길준 (서울대학교병원 응급의학과) ;
  • 정기영 (서울대학교병원 응급의학과) ;
  • 권운용 (서울대학교병원 응급의학과) ;
  • 김경수 (서울대학교병원 응급의학과) ;
  • 이휘재 (서울대학교병원 응급의학과) ;
  • 김영철 (서울대학교병원 외상외과) ;
  • 최석호 (서울대학교병원 외상외과) ;
  • 이영호 (서울대학교병원 정형외과) ;
  • 이경학 (서울대학교병원 외상외과) ;
  • 한국남 (서울대학교병원 외상외과) ;
  • 제환준 (서울대학교병원 응급의학과) ;
  • 김효철 (서울대학교병원 영상의학과)
  • Received : 2011.09.08
  • Accepted : 2011.11.18
  • Published : 2011.12.31
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Abstract

Purpose: The aim of this study was to evaluate the quality of the trauma care system of our hospital, in which emergency physicians care for major trauma patients in the emergency intensive care unit (ICU) in consultation with intervention radiologists and surgeons. Methods: This was a retrospective observational study conducted in an emergency ICU of a tertiary referral hospital. We enrolled consecutive patients who had been admitted to our emergency ICU with major trauma from March 2007 to September 2010. We collected data with respect to demographic findings, mechanisms of injury, the trauma and injury severity score (TRISS), emergency surgery, angiographic intervention, and 6-month mortality. Then, we compared the observed and predicted survivals of the patients. The Hosmer-Lemeshow test and calibration plots by using 10 groups, one for each decile, of predicted mortality were used to evaluate the fitness of TRISS. P-values of greater than 0.05 represent a fair calibration. Results: Among 116 patients, 12 (10.34%) were dead within 6 months after admission to the ICU, and 29 (25.00%) and 38 (32.80%) patients received emergency surgery and angiographic intervention, respectively. The mean injury severity score and revised trauma score were $36.97{\pm}17.73$ and $7.84{\pm}6.75$, respectively. The observed survival and the predicted survival of the TRISS were 89.66% (95% confidence interval [CI]: 84.03~95.28%) and 69.85% (95% CI: 63.80~75.91%), respectively. The calibration plots showed that the observed survival of our patients was consistently higher than the predicted survival of the TRISS ($p$ <0.001). Conclusion: The observed survival for the trauma care system of our hospital, in which emergency physicians care for major trauma patients in the emergency ICU in consultation with intervention radiologists and surgeons, was higher than the predicted survival of the TRISS.

Keywords

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