1.Fever in Trauma Patients without Brain Injury
Boyoon CHOI ; Kiyoung SUNG ; Jinbeom CHO
Journal of Acute Care Surgery 2021;11(1):6-13
Purpose:
Distinguishing a fever caused by infection from the necessary febrile response in injured patients is difficult, because trauma patients often have concomitant obvious infectious origins. In traumatic brain injury, early fever might be associated with worse clinical outcomes; however, few reports on trauma patients without brain injury are available.
Methods:
In this retrospective observational study, consecutive trauma patients without brain injury who were admitted to the surgical intensive care unit during a 3 year period were included. The surgical and clinical outcomes were compared according to body temperature. Locally weighted scatterplot smoothing was used to identify the relationship between body temperature and injury severity.
Results:
A total of 111 patients were included. Body temperature increased as the injury severity score increased up to 47.717, above which it decreased. Mortality was high in hypothermic patients (72.7%; p < 0.001); however, few differences were observed between normothermic and hyperthermic patients (3.5% and 2.4%, respectively). The nonsurvivors had lower body temperatures on the 1st and 2nd days after admission (36 ˚C and 36.9 ˚C) compared with the survivors (37.3 ˚C and 37.7 ˚C; p < 0.001 and p = 0.006). In severely injured patients, low levels of inflammatory biomarkers and low body temperature were correlated with mortality.
Conclusions
Fever in trauma patients without brain injury is correlated with injury severity but not with prognosis. Hypothermia on the 1st and 2nd days after admission was significantly correlated with mortality. In severely injured patients, a decreased inflammatory response might play a certain role in promoting a high mortality rate.
2.Fever in Trauma Patients without Brain Injury
Boyoon CHOI ; Kiyoung SUNG ; Jinbeom CHO
Journal of Acute Care Surgery 2021;11(1):6-13
Purpose:
Distinguishing a fever caused by infection from the necessary febrile response in injured patients is difficult, because trauma patients often have concomitant obvious infectious origins. In traumatic brain injury, early fever might be associated with worse clinical outcomes; however, few reports on trauma patients without brain injury are available.
Methods:
In this retrospective observational study, consecutive trauma patients without brain injury who were admitted to the surgical intensive care unit during a 3 year period were included. The surgical and clinical outcomes were compared according to body temperature. Locally weighted scatterplot smoothing was used to identify the relationship between body temperature and injury severity.
Results:
A total of 111 patients were included. Body temperature increased as the injury severity score increased up to 47.717, above which it decreased. Mortality was high in hypothermic patients (72.7%; p < 0.001); however, few differences were observed between normothermic and hyperthermic patients (3.5% and 2.4%, respectively). The nonsurvivors had lower body temperatures on the 1st and 2nd days after admission (36 ˚C and 36.9 ˚C) compared with the survivors (37.3 ˚C and 37.7 ˚C; p < 0.001 and p = 0.006). In severely injured patients, low levels of inflammatory biomarkers and low body temperature were correlated with mortality.
Conclusions
Fever in trauma patients without brain injury is correlated with injury severity but not with prognosis. Hypothermia on the 1st and 2nd days after admission was significantly correlated with mortality. In severely injured patients, a decreased inflammatory response might play a certain role in promoting a high mortality rate.
3.Erratum: The Significance and Limitations of Korean Diagnosis-Related Groups in Psychiatric Inpatients' Hospital Charges.
Keun Ho JOE ; Jeong Ho SEOK ; Woon Jin JEONG ; Boung Chul LEE ; Ae Ryun KIM ; Eun kyoung CHOI ; Boyoon WON ; Chung Suk LEE
Journal of Korean Neuropsychiatric Association 2017;56(2):98-98
This correction is being published to correct the errors and to added missing contents.
4.The Significance and Limitations of Korean Diagnosis-Related Groups in Psychiatric Inpatients' Hospital Charges.
Keun Ho JOE ; Jeong Ho SEOK ; Woon Jin JEONG ; Boung Chul LEE ; Ae Ryun KIM ; Eun kyoung CHOI ; Boyoon WON ; Chung Suk LEE
Journal of Korean Neuropsychiatric Association 2017;56(1):10-19
OBJECTIVES: This study was conducted to investigate whether the charges associated with Korean Diagnosis-Related Groups for mental health inpatients adequately reflect the degree of medical resource consumption for inpatient treatment in the psychiatric ward. METHODS: This study was conducted with psychiatric inpatients data for 2014 from the National Health Insurance claim database. The main diagnoses required for admission, classification of the hospitals, and main treatment services were analyzed by examining descriptive statistics. Homogeneities of the major diagnostic criteria were assessed by calculating coefficient variances. Explanation power was determined by R2 values. RESULTS: The most frequent disorders for psychiatric inpatient treatment were alcohol-use disorder, depressive episodes, bipolar affective disorder, and dementia in Alzheimer's disease. Hospitalization and psychotherapy fees were the main medical expenses. Regardless of the homogeneity of the disease group, duration of hospital stay was the factor that most influenced medical expenses. In the psychiatric area, explanation power of Korean Diagnosis-Related Groups was 16.52% (p<0.05), which was significantly lower than that for other major diagnostic area. CONCLUSION: Most psychiatric illnesses are chronic, and the density of services can vary depending on illness severity or associated complications. The current Korean Diagnosis-Related Groups criteria did not adequately represent the amount of in-hospital medical expenditures. A novel Korean classification system that reflects the expenditures of medical resources in psychiatric hospitals should be developed in order to provide appropriate reimbursements.
Alzheimer Disease
;
Classification
;
Dementia
;
Depressive Disorder
;
Diagnosis
;
Diagnosis-Related Groups*
;
Fees and Charges
;
Health Expenditures
;
Hospital Charges*
;
Hospitalization
;
Hospitals, Psychiatric
;
Humans
;
Inpatients
;
Insurance, Health
;
Length of Stay
;
Mental Health
;
Mood Disorders
;
National Health Programs
;
Psychotherapy
5.Comparative Review of Pharmacological Treatment Guidelines for Bipolar Disorder
Seoyeon CHIN ; Hyoyoung KIM ; Jiye LEE ; Yesul KIM ; Bo-young KWON ; Boyoon CHOI ; Bobae LEE ; Chae-Eun KWON ; Yeongdo MUN ; Kaveesha FERNANDO ; Ji Hyun PARK
Korean Journal of Clinical Pharmacy 2023;33(3):153-167
Objective:
Bipolar disorder displays a spectrum of manifestations, including manic, hypomanic, depressive, mixed, psychotic, and atypical episodes, contributing to its chronic nature and association with heightened suicide risk. Creating effective pharmacotherapy guidelines is crucial for managing bipolar disorder and reducing its prevalence. Treatment algorithms grounded in science have improved symptom management, but variations in recommended medications arise from research differences, healthcare policies, and cultural nuances globally.
Methods:
This study compares Korea’s bipolar disorder treatment algorithm with guidelines from the UK, Australia, and an international association. The aim is to uncover disparities in key recommended medications and their underlying factors. Differences in CYP450 genotypes affecting drug metabolism contribute to distinct recommended medications. Variances also stem from diverse guideline development approaches—expert consensus versus metaanalysis results—forming the primary differences between Korea and other countries.
Results:
Discrepancies remain in international guidelines relying on meta-analyses due to timing and utilized studies. Drug approval speeds further impact medication selection. However, limited high-quality research results are the main cause of guideline variations, hampering consistent treatment conclusions.
Conclusion
Korea’s unique Delphi-based treatment algorithm stands out. To improve evidence-based recommendations, large-scale studies assessing bipolar disorder treatments for the Korean population are necessary. This foundation will ensure future recommendations are rooted in scientific evidence.