예측 도구를 활용한 비외상성 거미막밑출혈 환자의 병원 전 기록 분석
Analysis of pre-hospital records of patients with non-traumatic subarachnoid hemorrhage using prediction tools
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: This study aimed to develop a pre-hospital subarachnoid hemorrhage (SAH) prediction tool by analyzing the extant predictive factors of patients with non-traumatic SAH who visited the hospital through the 119 emergency medical services. Methods: We retrospectively reviewed pre-hospital care reports (PCRs) and electronic medical records (EMRs) of 103 patients with non-traumatic SAH who were transported to the emergency department of two national hospitals via the 119 emergency medical service from January 1, 2017 to December 31, 2020. Variables required to apply the Ottawa SAH Rule and EMERALD SAH Rule, which are early prediction tools for SAH, were extracted and applied. Results: The most common symptoms—which were found in 94.1% and 97.0% of all patients according to PCRs and EMRs, respectively—appeared in the following order: headache, altered state of consciousness, and nausea/vomiting. When the variables used for the EMERALD Rule, namely systolic blood pressure (SBP), diastolic blood pressure (DBP), and blood sugar test (BST), were applied, the sensitivities of EMR and PCRs were 99.9% and 92.2%, respectively. Conclusion: For the timely prediction of SAH at the pre-hospital phase, patient age and symptoms should be assessed, and SBP, DBP, and BST should be measured to transport the patient to an appropriate hospital. Keywords: Subarachnoid hemorrhage(SAH), Ottawa SAH rule, EMERALD SAH rule
Abstract
Purpose: This study aimed to develop a pre-hospital subarachnoid hemorrhage (SAH) prediction tool by analyzing the extant predictive factors of patients with non-traumatic SAH who visited the hospital through the 119 emergency medical services. Methods: We retrospectively reviewed pre-hospital care reports (PCRs) and electronic medical records (EMRs) of 103 patients with non-traumatic SAH who were transported to the emergency department of two national hospitals via the 119 emergency medical service from January 1, 2017 to December 31, 2020. Variables required to apply the Ottawa SAH Rule and EMERALD SAH Rule, which are early prediction tools for SAH, were extracted and applied. Results: The most common symptoms—which were found in 94.1% and 97.0% of all patients according to PCRs and EMRs, respectively—appeared in the following order: headache, altered state of consciousness, and nausea/vomiting. When the variables used for the EMERALD Rule, namely systolic blood pressure (SBP), diastolic blood pressure (DBP), and blood sugar test (BST), were applied, the sensitivities of EMR and PCRs were 99.9% and 92.2%, respectively. Conclusion: For the timely prediction of SAH at the pre-hospital phase, patient age and symptoms should be assessed, and SBP, DBP, and BST should be measured to transport the patient to an appropriate hospital.
참고문헌 (22)
- N K de Rooij, "Incidence of subarachnoid haemorrhage: a systematic review with emphasis on region, age, gender and time trends", Journal of Neurology, Neurosurgery & Psychiatry, 78(12), pp.1365~1372 (2007), BMJ[DOI]
- 박수정, "두통으로 한방병원에 내원하여 컴퓨터단층촬영후 지주막하출혈로 진단된 증례 보고", 대한한방내과학회지, 39(4), pp.764~771 (2018), 대한한방내과학회
- Monique H.M. Vlak, "Trigger Factors and Their Attributable Risk for Rupture of Intracranial Aneurysms", Stroke, 42(7), pp.1878~1882 (2011), Ovid Technologies (Wolters Kluwer Health)[DOI]
- 손승남, "급성 비외상성 피질부 지주막하출혈", 대한신경과학회지, 29(3), pp.252~256 (2011), 대한신경과학회
- 문준영, "119 구급요청 거절 대상 환자의 이송 현황 분석", 한국응급구조학회지, 25(3), pp.63~70 (2021), 사단법인 한국응급구조학회[DOI]
- 강경희, "응급 환자 이송서비스의 적절성: 미충족 의료와 부적절한 이용", 보건행정학회지, 24(4), pp.357~366 (2014), 한국보건행정학회[DOI]
- 안병기, "응급실 이용 횟수에 영향을 미치는 요인", 대한보건연구, 45(4), pp.23~33 (2019), 사단법인 대한보건협회[DOI]
- 이정찬, "응급실 다방문 결정 요인: 종합병원급 이상 권역응급의료센터를 중심으로", 대한보건연구, 44(3), pp.129~146 (2018), 사단법인 대한보건협회[DOI]
- 성대완, "119응급의료서비스의 비응급환자 감소방안에 관한 연구", 석사, 행정학, pp.2010
- Jeffrey J. Perry, "Clinical Decision Rules to Rule Out Subarachnoid Hemorrhage for Acute Headache", JAMA, 310(12), pp.1248~ (2013), American Medical Association (AMA)[DOI]
- Akio Kimura, "New clinical decision rule to exclude subarachnoid haemorrhage for acute headache: a prospective multicentre observational study", BMJ Open, 6(9), pp.e010999~ (2016), BMJ[DOI]
- 김경훈, "급성 두통환자의 거미막밑출혈 예측을 위한 호중구", 림프구 비율 및임상 예측 지표방법의 유용성, 2018, pp.29(4), 371~379[DOI]
- 이은하, "일개 병원의 뇌동맥류 파열의 위험요인", 한국융합학회논문지, 10(1), pp.339~351 (2019), 한국융합학회[DOI]
- Evie Marcolini, "Approach to the Diagnosis and Management of Subarachnoid Hemorrhage", Western Journal of Emergency Medicine, 20(2), pp.203~211 (2019), Western Journal of Emergency Medicine[DOI]
- 정승민, "비외상성 두통 환자에서의 거미막밑출혈 예측을 위한 임상 요인 분석", 대한응급의학회지, 25(6), pp.703~714 (2014), 대한응급의학회
- Robert W Foley, "Subarachnoid haemorrhage rules in the decision for acute CT of the head: external validation in a UK cohort", Clinical Medicine, 21(2), pp.96~100 (2021), Royal College of Physicians[DOI]
- Pathan AS, "To head CT scan or not : the clinical quandary in suspected subarachnoid hemorrhage; a validation study on Ottawa subarachnoid hemorrhage rule", Am J Emerg Med, 2(3), pp.1~8 (2018)[DOI]
- HY Cheung, "Validation and modification of the Ottawa subarachnoid haemorrhage rule in risk stratification of Asian Chinese patients with acute headache", Hong Kong Medical Journal, pp.584~592 (2018), Hong Kong Academy of Medicine Press[DOI]
- Jung JH, "Sex difference and risk factors in incidence and mortality of stroke", Doctor, pp.2019
- Jeffrey J. Perry, "Prospective Implementation of the Ottawa Subarachnoid Hemorrhage Rule and 6-Hour Computed Tomography Rule", Stroke, 51(2), pp.424~430 (2020), Ovid Technologies (Wolters Kluwer Health)[DOI]
- Tomoharu Suzuki, "External validation for sensitivity of the Ottawa subarachnoid hemorrhage rule in a Japanese tertiary teaching hospital", Scientific Reports, 11(1) (2021), Springer Science and Business Media LLC[DOI]
- Maren Ranhoff Hov, "Pre-hospital ct diagnosis of subarachnoid hemorrhage", Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 25(1), pp.21~ (2017), Springer Science and Business Media LLC[DOI]