Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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The Effects of Chest Injury in the Early Deaths of Trauma Patients

외상에 의한 초기 사망에서 흉부손상에 대한 고찰

  • Lee Dong Hoon (Department of Emergency Medicine, College of Medicine, Ewha Womans University) ;
  • Cho Dai Yun (Department of Thoracic and Cardiovascular Surgery, College of Medicine, Chung Ang University) ;
  • Kim Chan Woong (Department of Emergency Medicine, Chung Ang University Yongsan Hospital) ;
  • Sohn Dong Suep (Department of Thoracic and Cardiovascular Surgery, College of Medicine, Chung Ang University)
  • 이동훈 (이화여자대학교 의과대학 부속 목동병원 응급의학과) ;
  • 조대윤 (중앙대학교 의과대학 흉부외과학교실) ;
  • 김찬웅 (중앙대학교 의과대학 부속 용산병원 응급의학과) ;
  • 손동섭 (중앙대학교 의과대학 흉부외과학교실)
  • Published : 2006.02.01
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Abstract

Background: In the studies of the distribution of time to death in trauma patients, the early deaths within several hours after injury were a large component of total trauma deaths. Due to the development of trauma system, overall mortality of trauma was decreased, but trauma is still the major cause of deaths. Material and Method: From January 1994 to December 2003, trauma patients who had been admitted and had expired at tertiary hospital were enrolled. There was a total of 400 cases, a retrospective study was done to determine the distribution of trauma mortality according to the part of the body that were severely injured part and compared the difference between early deaths within 6 hours and late deaths after 6 hours. We also analysed the risk factors of early deaths due to trauma. Result: In severe injury to the head and abdomen, the distribution of mortality was bimodal. But, in severe chest injuries, the distribution was log-shape and most early deaths were almost of trauma related. The average of GCS were 5.86$\pm$4.15 for the early deaths and 8.24$\pm$5.02 for the late deaths (p < 0.05). The AIS of thorax were 2.66$\pm$1.87 for the early deaths and 1.55$\pm$1.76 for late deaths. The risk factors for early mortality were non-EMS transportation (odds ratio 3.474), high AIS (odds ratio 1.491) and GCS (odds ratio 0.859). Conclusion: In trauma patients, the causes of early mortality were severe brain injury and massive hemorrhage. Also severe chest injuries were the major cause of the early deaths in truama. Early diagnosis of chest injury can frequently be missed in the acute trauma setting. Therefore, high index of suspicion, a careful examination, and aggressive surgical treatment are important in multiple trauma patients.

배경: 외상에 의한 사망의 시간적 분포에 대한 연구에 의하면 외상 후 수 시간 이내의 초기 사망이 높은 비율을 차지하고 있다. 외상체계의 발달로 전체적인 외상 사망은 감소하였으나 아직까지도 외상은 주요한 사망 원인 중 하나이다. 저자들은 외상 사망의 분포에서 과반수 이상을 차지하는 초기사망의 위험 요인을 알아보고자 하였다 대상 및 방법: 1994년 1월부터 2003년 12월까지 3차 의료기관 응급의료센터에 내원한 외상환자 중 사망한 환자 400예를 후향적으로 분석하여 사망의 시간적 분포와 손상의 부위에 따른 사망의 시간적 분포를 분석하였다. 외상 사망에 있어서 초기 6시간 이내에 사망한 환자와 6시간 이후에 사망한 환자를 비교하여 초기 사망의 위험요소를 분석하였다. 결과: 손상의 종류에 따른 외상 사망의 분포는 두부와 복부 손상은 2상 분포를 보였으나 흥부 손상의 경우는 초기 사망이 대부분을 차지하였다. 초기 사망군에서 GCS가 5.86$\pm$4.15로 후기 사망군 8.24$\pm$5.02로 유의한 차이를 보였으며(p<0.05), 흉부 AIS에서도 초기 사망군 2.66$\pm$1.87로 후기 사망군 1.55$\pm$1.76 으로 초기 사망군에서 손상이 더 심한 것을 나타났다(p<0.05). 초기 사망군의 위험요소 분석에서는 119 구급대에 의해 이송되지 않은 경우(교차비 3.474),높은 흉부 AIS (교차비 1.491), 낮은 GCS (교차비 0.859)가 각 주요 위험요소로 나타났다. 걸론. 외상에 의한 사망에서 지금까지 외상체계의 초점이 되었던 초기 사망의 원인 중 뇌신경계 손상과 출혈뿐만 아니라, 흥부 손상 역시 초기 외상사망의 중요한 요인이다. 따라서 외상환자의 초기 처치에서 흥부손상에 대한 적극적인 검사와 외과적 처치가 필요할 것이다.

Keywords

References

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