PURPOSE: Upper gastrointestinal bleeding (UGIB) is a common medical emergency condition in the emergency department (ED). Patients with UGIB show a wide range of clinical severity, from mild bleeding to death. The objective of this study was to evaluate methods for risk stratification of active UGIB in the ED. METHODS: We retrospectively reviewed patients with UGIB who were admitted to the ED of a tertiary care, university-affiliated hospital center from January 2011 to December 2011. Our study subjects were patients over 20 years old who complained of symptoms and signs of gastrointestinal tract bleeding and underwent endoscopic gastroduodenoscopy (EGD) evaluation. However, patients diagnosed with variceal gastrointestinal bleeding, disseminated malignancy, coagulopathy, and lower gastrointestinal bleeding and patients who did not undergo EGD within 6 hours were excluded. The Blatchford score and the clinical Rockall score were calculated for the enrolled patients. In cases where the value of each score was greater than 0, the scores were considered high risk. Active UGIB was defined as a symptom of patients who underwent emergency endoscopic intervention such as ligation or sclerotherapy. We compared the proportions of patients identified as high risk using chi tests. The areas under the receiver operating characteristic (AUROC) curve for detection of patients requiring emergency endoscopic intervention were calculated for both the Blatchford score and the clinical Rockall score. RESULTS: The numbers of patients with high risk according to the Blatchford score and the clinical Rockall were 220 (93.6%) and 192 (81.7%) of 235 patients, respectively. The number of patients with active UGIB was 96 (40.9%) of 235 patients. The sensitivity and specificity of risk stratification based on the Blatchford score was 100% (96/96) and 10.8% (15/139) (p=0.001), respectively, while those based on the clinical Rockall score were 80.2% (77/96) and 17.3% (24/139) (p>0.05). The AUROC curves of the Blatchford score and the clinical Rockall score were 0.617 (95% CI; 0.546-0.688) and 0.495 (95% CI; 0.420-0.571), respectively. CONCLUSION: The Blatchford score could be more useful as a risk stratification tool than the clinical Rockall score for active UGIB patients in the ED. The Blatchford score would be preferable as a clinical tool that can discriminate patients who need emergency endoscopic intervention for control of UGIB.
Emergencies ; Emergency Service, Hospital* ; Endoscopy ; Gastrointestinal Hemorrhage ; Gastrointestinal Tract ; Hemorrhage* ; Humans ; Ligation ; Retrospective Studies ; ROC Curve ; Sclerotherapy ; Sensitivity and Specificity ; Tertiary Healthcare

In this study, we investigated playground equipment related injuries in preschool-aged children. This was a retrospective observational study using Emergency Department based Injury In-depth Surveillance, (2011–2014). We included the preschool-aged children with playground equipment related injuries. We surveyed the mechanism and incidence of injuries, and estimated the odds ratio (OR) of traumatic brain injury (TBI) and upper/lower extremities fracture. There were 6,110 patients, mean age was 4.14 ± 1.95 years old. Slide and swing related injuries were 2,475 (40.5%) and 1,102 (18.0%). Fall down (48.5%) was the most common mechanism. The OR of TBI in children 0–2 years old was 1.88 times higher than children 3–7 years old, and in swing was 4.72 (OR, 4.72; 95% confidence interval [CI], 2.37–9.40) times higher than seesaw. The OR of upper extremity fracture in children 3–7 years old was 3.07 times higher than children 0–2 years old, and in climbing was 2.03 (OR, 2.03; 95% CI, 1.63–2.52) times higher than swing. The OR of lower extremity fractures in horizontal bars, tightropes, and trampolines was 2.95 (OR, 2.95; 95% CI, 1.55–5.61) times higher than swing. The most common mechanism and playground equipment were fall down and slide. TBI was associated to younger children (0–2 years old) and swing. Fracture of upper extremities was associated to older children (3–7 years old) and climbing. Fracture of lower extremities was associated to others such as horizontal bars, tightropes, and trampolines.
Brain Injuries ; Child* ; Child, Preschool ; Emergencies* ; Emergency Service, Hospital ; Extremities ; Fractures, Bone ; Humans ; Incidence ; Lower Extremity ; Observational Study ; Odds Ratio ; Play and Playthings ; Retrospective Studies ; Upper Extremity ; Wounds and Injuries

PURPOSE: Falling is one of the most common causes of injury for preschool children. Here, we aim to identify the characteristics and risk factors of injuries by falling-down in preschool children. METHODS: Between January 2010 and December 2011, we enrolled patients under the age of 7 years, who were injured by falling down and visited an urban regional emergency center. We retrospectively surveyed the medical record of these patients, including age, sex, place and height of fall, type of floor, guardian's witness, traumatic brain injury (TBI), and fracture of extremities. RESULTS: The odds ratios sex (male), age (under 2 years old), height of fall, type of floor (hard), and guardian's witness (presence) that resulted in TBI were 1.35 (95% confidence interval [Cl], 0.72?2.55; p=0.352), 3.83 (95% Cl, 1.78?8.65; p<0.05), 6.38 (95% Cl, 3.27–12.44;p<0.05), 3.58 (95% Cl, 0.47–27.30; p=0.218), and 1.47 (95% Cl, 0.63–3.43; p=0.377), respectively. The odds ratios sex (male), age (over 2 years old), height of fall, type of floor (soft), and guardian's witness (absence) that resulted in fractures were 1.19 (95% Cl, 0.78–1.81; p=0.433), 3.10 (95%Cl, 1.99–4.84; p<0.05), 1.98 (95%Cl, 1.19–3.29; p<0.05), 2.41 (95% Cl, 1.29–4.54; p<0.05), and 1.15 (95%Cl, 0.72–1.85, p=0.554), respectively. CONCLUSION: In preschool children who experienced an injury from falling down, TBI was increased with younger patients and higher height of fall, but it was not related with patient's sex, type of floor, and guardian's witness; conversely, fractures were increased with older patients, higher height of fall, and soft floor, but not related with patient's sex and guardian's witness.
Accidental Falls ; Brain Injuries ; Child* ; Child, Preschool ; Emergencies ; Extremities ; Humans ; Medical Records ; Odds Ratio ; Retrospective Studies ; Risk Factors*

PURPOSE: This study reports the clinical features of infant, child, school aged and adolescent patients treated for acute poisoning in nationwide emergency departments (EDs). METHODS: We retrospectively analyzed clinical data pertaining to patients under 19 years of age who were treated for acute poisoning in nationwide EDs from 2013 to 2015. The data were collected by the National Emergency Department Information System (NEDIS). All patients were divided into three groups: ‘Infant and child group’ (0 to 5 years), ‘school age group’ (6 to 12 years) and ‘adolescent group’ (13 to 18 years). General characteristics, Korea Standard Classification of Disease 7(th) (KCD-7) codes and results of care were collected. RESULTS: There were 14,500 pediatric poisoning cases during the study period. The distribution of patient age was bimodal with two peaks among infant, child and adolescent group. The proportion of alert mentality at the ED visit of the infant and child group was 99.3%, while that of the adolescent group was 86.4%. The proportion of intentional intoxication was higher in the adolescent group (40.7%) than other age groups. Among children less than 13 years of age, various poisonous substances and therapeutic drugs were common. CONCLUSION: There were some clinical differences in acute poisoning patients between age groups. It is necessary to establish a preventive plan considering characteristics by age. Since the KCD-7 code has limitations in analyzing the characteristics of poisoning patients, it is necessary to consider the registration system of poisoning patients.
Adolescent ; Child ; Classification ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Infant ; Information Systems* ; Korea ; Pediatrics ; Poisoning* ; Retrospective Studies*

PURPOSE: We evaluated the power of the Rapid Emergency Medicine Score (REMS) for predicting hospital mortality in trauma patients. Then, we compared the REMS with two other scoring systems, the Emergency Trauma Score (EMTRAS) and the Injury Severity Score (ISS) for predicting prognosis. METHODS: We examined data from a prospectively collected registry in a single trauma center from January 2010 to November 2011. Patients enrolled in the registry were trauma patients who were predicted to have an ISS>15 or who required urgent multiple surgical consultations as soon as possible. Pediatric patients (<18-years-old) who were referred after initial care or death on arrival, and those with injuries due to burns, asphyxia, or drowning were excluded. The study population was divided into two subgroups according to hospital mortality, and the differences in clinical characteristics and calculated scores were examined. The odds ratio (OR) of REMS for predicting In-hospital mortality was calculated and the prognostic power of the three scoring systems for predicting hospital mortality by drawing receiver operating characteristic (ROC) curves was compared. RESULTS: A total of 103 patients were included in the analysis. Of these, 44 died during hospitalization. All three prognostic scores were significantly higher in the hospital mortality subgroup. The OR of the REMS for predicting hospital mortality was 1.35 (p<0.001). The areas under the ROC curves of the REMS, EMTRAS, and ISS were 0.815 (95% confidence interval [CI], 0.727-0.884), 0.872 (95% CI, 0.793-0.930), and 0.693 (95% CI, 0.595-0.780), respectively. The area under the ROC curve of the REMS was not different from that of the EMTRAS or ISS. CONCLUSION: The REMS showed good prognostic power for predicting hospital mortality in severely injured patients. Consecutive prospective studies are warranted to determine the utility of this scoring system for trauma patients.
Asphyxia ; Burns ; Drowning ; Emergencies* ; Emergency Medicine* ; Hospital Mortality* ; Hospitalization ; Humans ; Injury Severity Score ; Mortality ; Odds Ratio ; Prognosis ; Prospective Studies ; Referral and Consultation ; ROC Curve ; Trauma Centers ; Trauma Severity Indices ; Triage ; Wounds and Injuries

PURPOSE: Inflation of an endotracheal tube cuff with adequate pressure is an important procedure. Passive release technique (PRT) is a useful and convenient method for inflating the cuff. To date, no study comparing this method with minimal occlusive volume technique (MOVT), one of the most commonly used methods for inflating the cuff, has been reported. We conducted this study for comparison of effectiveness, difficulty, and preference between the two methods. METHODS: We conducted a prospective, crossover, randomized study in which participants used each technique, one at a time. Participants inflated the cuff of an endotracheal tube inserted into a manikin after receiving brief education on use of the two methods. After inflating the cuff using each method, pressure and volume of the inflated cuff were measured using a portable manometer and syringes, respectively. Then, difficulty of each method was investigated using the visual analogue scale (VAS) and preference for each method was investigated. RESULTS: A total of 47 participants were enrolled in the study. The mean pressure between the two methods was not statistically different (p=0.27). However, adequate pressure was achieved in 37 (78.7%) and 16 (34.0%) of participants in PRT and MOVT, respectively (p<0.01). The mean volume was 6.0+/-0.4 ml in PRT and 5.7+/-0.6 ml in MOVT (p<0.01). The VAS score for diffculty was 17.7+/-15.8 in PRT and 76.0+/-15.8 in MOVT (p<0.01). Preference for PRT was 46(97.9%) and that for MOVT was 1 (2.1%). CONCLUSION: PRT is an easier, more preferred, and more effective method for cuff inflation than MOVT.
Inflation, Economic ; Intubation ; Manikins ; Prospective Studies ; Syringes

A 77-year-old woman was admitted to a local clinic for altered consciousness and presented with a suspected basal ganglion hemorrhage detected on brain computed tomography. The patient was stuporous, but her vital signs were stable. Her initial blood glucose was 607 mg/dL, and a hyperdense lesion was found in the right basal ganglion on brain computed tomography. T1-weighted magnetic resonance imaging revealed high signal intensity in the right basal ganglion. Electroencephalography showed no seizure activity. The patient was treated with a fluid infusion, and serum glucose level was controlled with insulin. The patient gradually recovered consciousness and was alert within 24 hours as serum glucose level normalized. The basal ganglion lesion caused by hyperglycemia was not accompanied by involuntary limb movement. This is the first report of a patient presenting with decreased consciousness and typical neural radiographic changes associated with nonketotic hyperglycemia but without movement abnormalities.
Aged ; Basal Ganglia* ; Blood Glucose ; Brain ; Consciousness ; Electroencephalography ; Extremities ; Female ; Ganglion Cysts ; Hemorrhage ; Humans ; Hyperglycemia* ; Insulin ; Magnetic Resonance Imaging ; Seizures ; Stupor ; Tomography, X-Ray Computed ; Vital Signs

PURPOSE: In addition to chemical burn of the alimentary tract, caustic ingestion can cause severe complications including esophageal perforation, airway edema, esophageal stricture, and death. Hematological parameters have been reported to be useful inflammatory markers predicting prognoses in various clinical situations where oxidative stress is increased. We hypothesized that hematological parameters might be useful for prediction of complications after caustic ingestion. METHODS: We performed a retrospective analysis of patients admitted to our Emergency Department after caustic ingestion. The numbers of leukocytes, neutrophils, lymphocytes, and monocytes, and the neutrophil-lymphocyte ratio were compared between uncomplicated and complicated patient groups. Receiver operating characteristic curve analysis was performed for parameters that differed between the two groups. Subgroup analysis was performed according to the substance ingested, thus acid or alkali. RESULTS: Thirty-seven patients were included in our study and eight had complications. Leukocyte, neutrophil counts, and the neutrophil-lymphocyte ratio of the complicated group were higher than those of the uncomplicated group. The areas under the receiver operating characteristic curves of leukocyte counts, neutrophil counts, and the neutrophil- lymphocyte ratio, were 0.819, 0.832, and 0.750, respectively. The cut-off values of these parameters for prediction of complications were 12 060/uL, 9607/uL, and 2.72, respectively. In subgroup analysis, the leukocyte and neutrophil counts, and the neutrophil-lymphocyte ratio of complicated patients who had ingested alkali were higher than those of the uncomplicated group. CONCLUSION: Leukocyte counts, neutrophil counts, and the neutrophil-lymphocyte ratio might serve as useful predictors of complications after ingestion of caustic substances.
Alkalies ; Blood Cell Count ; Burns, Chemical ; Caustics ; Eating* ; Edema ; Emergency Service, Hospital ; Esophageal Perforation ; Esophageal Stenosis ; Esophagus ; Humans ; Leukocyte Count ; Leukocytes ; Lymphocytes ; Monocytes ; Neutrophils ; Oxidative Stress ; Prognosis ; Retrospective Studies* ; ROC Curve ; Wounds and Injuries

OBJECTIVE: International emergency medicine (IEM) is a rapidly growing field in emergency medicine (EM). However, there are few studies of the interest and attitude of EM residents on this subject in Korea. The aim of this study was to assess the awareness of IEM and determine feasibility of adoption as an EM residency program. METHODS: A structured on/off-line survey was distributed to all current first to third grade EM residents in Korea (year 2016–2017). Ninety-two hospitals with residency programs and 463 residents were identified as potential survey candidates. The survey consisted of 20 questionnaires including binary yes/no and multiple choice questions. RESULTS: The response rate was 37.1% (172/463). The proportion of residents who have interest in IEM was 62.8% (108/172); 76.2% (131/172) respondents answered that they wanted to participate in IEM/global health activities during their residency. Approximately two thirds (68.6%, 118/172) reported that they plan to participate in any IEM activity even after graduation. More than half (56.4%, 97/172) agreed that the inclusion of IEM/global health training in their residency might be necessary and it may help them to guide their future careers after their training (68.6%, 118/172). A total of 144 respondents (83.7%) indicated lack of time during their residency mostly, absence of an IEM program (47.1%, 81/172), and lack of information on IEM (31.4%, 54/172). CONCLUSION: IEM is of interest to Korean EM residents. On the other hand, formal education and training offered to residents is limited in Korea. Korean Society of Emergency Medicine should start discussions on how to adopt a global IEM agenda, and reflect on a resident training program.
Education ; Emergencies* ; Emergency Medicine* ; Global Health ; Hand ; Internship and Residency ; Korea ; Surveys and Questionnaires

OBJECTIVE: We aimed to investigate the factors related to satisfaction with the pediatric emergency department service in Korea. METHODS: This study examined data from the Korea Health Panel Data from 2010 to 2012. Pediatric patients who visited the emergency department at least once between 2010 and 2012 in Korea were included. Data were collected on patient satisfaction with the emergency department service, and factors related to the patient characteristics, emergency department service process, and medical institution. We compared the dissatisfied and satisfied groups, and calculated the odds ratios for satisfaction according to each variable. RESULTS: A total of 1,505 emergency department visits from 947 pediatric patients during the 3-year period were analyzed. We estimated that about 79.5% of patients in the population were satisfied. The odds of expressing satisfaction were higher among males than in females, and among patients who were hospitalized after emergency department treatment compared to those who were transferred to another hospital. Conversely, the odds of expressing satisfaction were lower among patients who had a chronic disease, a financial source other than National Health Insurance, experienced hospitalization within 1 year. CONCLUSION: Our study results might be helpful for establishing a satisfactory pediatric emergency medical service system. In the future, further prospective studies evaluating the causal relationships between the relevant factors and patient satisfaction are warranted.
Chronic Disease ; Emergencies* ; Emergency Medical Services ; Emergency Service, Hospital* ; Female ; Hospitalization ; Humans ; Korea* ; Male ; National Health Programs ; Odds Ratio ; Parents ; Patient Satisfaction ; Pediatrics ; Prospective Studies