PURPOSE: With the advances in diagnostic and interventional radiology, emergency physicians have been frequently confronted with radiocontrast media (RCM)-induced anaphylaxis. However, few studies have addresses RCMinduced anaphylaxis in Korea. The aim of this study was to describe the clinical features and treatment patterns of RCM-induced anaphylaxis patients who visited an emergency department (ED) in a tertiary referral hospital. METHODS: All patients who visited the ED and were diagnosed with "anaphylaxis" during a 3-year period were evaluated and cases of RCM-induced anaphylaxis were selected based on medical records. RESULTS: Twenty patients with RCM-induced anaphylaxis were retrospectively analyzed. Nine patients (45.0%) were male and the mean age was 59.5+/-14.9 years. Eighteen patients were referred following computed tomography (CT) examination and 2 patients from home. The most common manifestations were systolic blood pressure (SBP) < 90 mmHg (75.0%), followed by dizziness (55.0%), syncope (40.0%), angioedema (35.0%), and dyspnea (35.0%). Epinephrine was administered in 16 patients (80.0%), corticosteroids in 18 (90.0%), and antihistamine in 18 (90.0%). Only 4 patients (22.2%) were managed by epinephrine in the CT room. Seventeen patients were discharged directly from the ED after some observation period (7.3+/-5.0 hours) and 3 were admitted to the ICU. Corticosteroids were prescribed at discharge only in 9 patients (45.0%). CONCLUSION: The clinical features of RCM-induced anaphylaxis were similar to those of other causative agents. The underuse of epinephrine in the CT room and the under-prescription of corticosteroids at discharge indicate a need for anaphylaxis management education and treatment plan.
Adrenal Cortex Hormones ; Anaphylaxis ; Angioedema ; Blood Pressure ; Contrast Media ; Dizziness ; Dyspnea ; Emergencies ; Epinephrine ; Humans ; Korea ; Male ; Medical Records ; Radiology, Interventional ; Referral and Consultation ; Retrospective Studies ; Syncope

BACKGROUND: Almost every study of rib fractures in the elderly show associated injuries resulting in admission to thoracic or cardiovascular surgery. In Korea, no studies have compared these elderly patients with younger patients. METHODS: This study is based on patients who were diagnosed as having rib fracture at the Emergency Department of the Seoul Medical Center from March 2013 to April 2011. The medical records and radiological examinations of 192 cases were reviewed. Two groups were created-older than 65 years and younger than 64 years. Comparisons were made between the two groups including place of injury, time of injury, associated injuries, and the final result in the Emergency Department. RESULTS: The final patient sample size was 192. The elderly group had 142 patients with the average age being 48.77+/-9.70 years and 75.4% males. The young group had 50 patients with the average age at 75.90+/-7.21 years and 25% males. The most common place of injury was road (p=0.007) in the young group and home (p=0.002) in the elderly group. The most common mechanisms of injury were slipping (47.4%), traffic accidents (18.2%), falling (14.1%), and assault (9.4%). Falling was more prevalent in the young group than in the elderly group (p=0.011). Rib fractures occurred at night (p<0.001), on Saturdays, on Sundays, and in the winter in the young group and in the morning(p=0.002), on Mondays, on Fridays, and in the winter in the elderly group. Associated injuries, in descending order, were chest, limb, head, and spine. CONCLUSION: This study found that several selected factors of an injury-place, mechanism, time, and associated injuries, differ by age.
Accidents, Traffic ; Aged ; Emergency Service, Hospital* ; Extremities ; Head ; Humans ; Korea ; Male ; Medical Records ; Rib Fractures* ; Sample Size ; Seoul ; Spine ; Thorax

OBJECTIVE: The purposes of this study were to examine overall quality of life (QOL) in long term stroke survivals and to identify variables that predict QOL after stroke. METHOD: Subjects were 51 stroke patients (male; 28, female; 23) with stroke onset at least 6 months previously. Interview, measurement of depression and QOL were performed at outpatient clinic after discharge. Review of medical records included characteristics of stroke and communication disorders. Interview questionnare included caregiver, religion, education level, occupation and income. Depression and functional status was measured by the Beck depression inventory (BDI) and modified Barthel index (MBI), respectively. QOL was measured with the use of 5-item (activity, daily living, health, support, outlook) version of the Quality of Life Index (QLI) and its range of scores is 0~10. We compared QLI scores according to various factors obtained from medical records and questionnaire. RESULTS: Mean duration after onset of stroke was 33.6 months (range, 6~216 months). The mean score of QLI were 7.0+/-2.1. Low MBI score, communication disorder and depression had a negative effect on QOL (p<0.05). Sex, age, occupation, caregivers, religion, education level, income, duration after stroke onset and side of hemiplegia had no effect on QOL (p>0.05). CONCLUSION: Low MBI score, depression and communication disorders would be negative predictors of QOL and identification of these factor may assist stroke patients in coping their personal and social life.
Ambulatory Care Facilities ; Caregivers ; Communication Disorders ; Depression ; Education ; Female ; Hemiplegia ; Humans ; Medical Records ; Occupations ; Quality of Life* ; Surveys and Questionnaires ; Stroke*

The aim of this study was to elucidate the epidemiology of traumatic head injury (THI) among Korean children. A prospective, in-depth trauma survey was conducted in five teaching hospitals. Data from all of the children who attended the emergency department (ED) were analyzed. From June 2008 to May 2009, 2,856 children with THI visited the 5 EDs. The average age of the subjects was 5.6 (SD +/- 4.9) yr old, and 1,585 (55.5%) were 0-4 yr old. The male-to-female ratio was 2.3 to 1 (1,979 vs 877). Consciousness levels of the subjects were classified according to the Glasgow Coma Scale (GCS), and 99.1%, 0.6%, and 0.4% were determined as mild, moderate, or severe injury, respectively, according to the GCS categorization. Most injuries occurred at home (51.3%), and the most common mechanism of injury was collision (43.2%). With regard to outcome, 2,682 (93.9%) patients were sent home, and 35 (1.2%) were transferred to another hospital. A total of 133 (4.7%) patients were hospitalized, and 38 (1.3%) underwent surgery. The incidence and characteristics of pediatric THI in Korea are affected by sex, location and injury mechanism.
Adolescent ; Child ; Child, Preschool ; Craniocerebral Trauma/*epidemiology/radiography ; Female ; Glasgow Coma Scale ; Humans ; Infant ; Infant, Newborn ; Male ; Prospective Studies ; Republic of Korea/epidemiology ; Severity of Illness Index ; Sex Factors

PURPOSE: Appendicitis is one of the most common causes of acute abdominal pain presenting to the emergency department (ED). Emergency physicians are responsible for correct diagnosis and management of pain associated with appendicitis before surgery. We analyzed the comparison of management and pain control for appendicitis between adults and children in the ED. METHODS: This study was a retrospective case control study, conducted in two EDs of a teaching hospital from 2011 to 2012. Patients who were diagnosed as appendicitis based on the radiologic modality were enrolled. We analyzed the clinical characteristics of the patients, who were adults and children diagnosed with appendicitis, respectively. We also analyzed the predictors of pain control for the appendicitis patients by multiple logistic regression. RESULTS: A total of 2,130 patients were enrolled during a two-year period. The median age of the patients was 33 years (IQR 19~47) and 22.8% of patients were under 18 years of age; 54.6% were men. Ultrasonography was performed on 10.8% of patients and computed tomography (CT) on 89.4%. Significant difference in overall pain management was observed between children and adults (adult 29.5% vs children 20.6%, p=0.001). Adult patients younger than 65 years old, male, and those who underwent CT scan received more analgesics than others. Significant difference of the type of analgesics was observed between adults patients and pediatric patients. The use of analgesics did not affect the outcome, such as complication, unplanned revisit. CONCLUSION: Both adults and children with acute appendicitis still did not receive enough pain medication in the ED, even after being diagnosed.
Abdominal Pain ; Adult* ; Analgesics ; Appendicitis* ; Case-Control Studies ; Child* ; Diagnosis ; Emergencies ; Emergency Service, Hospital* ; Hospitals, Teaching ; Humans ; Logistic Models ; Male ; Pain Management ; Retrospective Studies ; Tomography, X-Ray Computed ; Ultrasonography

PURPOSE: To report long term treatment outcomes of osteofibrous dysplasia and association with adamantinoma. PATIENTS AND METHODS: From January 1984 to July 2001, 14 patients with osteofibrous dysplasia were followed for an average of 108 months (78 to 260 months). Our patient group consisted of 6 men and 8 women, with a mean age of 13.9 years (2 to 65 years). We reviewed the clinical and pathological features of all 14 patients. RESULTS: Thirteen patients had a lesion in the tibia, while one patient had lesions in both the tibia and the fibula. Initial treatments were observation after biopsy (6 patients), curettage with or without a bone graft (3 patients), resection followed by a free vascularized fibular bone graft (4 patients), or resection and regeneration with the Ilizarov external fixation (1 patient). Curettage was performed on 6 patients due to recurrence or progression after the initial treatment. Among these patients, one was diagnosed with AD from the biopsy of the recurrent lesion. This patient was further treated by segmental resection and pasteurization. After the initial pathology slides of the 13 patients were reviewed with immunohistochemical cytokeratin staining, one patient diagnosis was changed from osteofibrous dysplasia to osteofibrous dysplasia-like adamantinoma. CONCLUSION: Some patients with osteofibrous dysplasia require close observation because of the high association risk between osteofibrous dysplasia and adamantinoma, Immunohistochemical staining may be helpful in differentiating these two diagnoses.
Adamantinoma/metabolism/pathology/*surgery ; Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Female ; Fibrous Dysplasia of Bone/metabolism/pathology/*surgery ; Fibula/chemistry/radiography/surgery ; Humans ; Immunohistochemistry ; Keratins/analysis ; Male ; Middle Aged ; Tibia/chemistry/radiography/surgery

PURPOSE: The aim of the study was to investigate the frequency of adverse events and the appropriate observational duration after successful air reduction of childhood intussusception. METHODS: This was a retrospective, observational study of children, aged 0 to 14 years, who underwent successful air reduction after diagnosis of intussusception in two tertiary referral hospitals. The demographic data, onset time and type of intussusception, observational duration and frequency of adverse events after air reduction were collected. We categorized the adverse events as grade 1 to 5. Grade 1 is severe abdominal pain which requires analgesia; grade 2 is nausea and vomiting which require intravenous (IV) hydration; grade 3 is symptoms and signs requiring re-evaluation of ultrasonography (US), confirmed as no recurrence; grade 4 is symptoms and signs requiring re-evaluation of US, confirmed as recurrence; and grade 5 is failed second air reduction and consequent operation. RESULTS: A total of 547 patients (369 boys and 178 girls) were enrolled. Mean age of the subjects was 24.1 months (SD: +/-19.3, range 1-144). The mean time duration from symptom onset to emergency department (ED) visit was 18.4 hours (SD: +/-18.5), and the average observational duration after the successful air reduction was 32.8 hours (SD: +/-29.1, range: 1-216). The number of children who suffered from the grade 1 to 5 of adverse events were 13 (2.4%), 2 (0.4%), 38 (6.9%), 33 (6%), and 2 (0.4%), respectively. A total of 17 (3.1%) children recurred after 24 hours of air reduction, 7 (1.3%) in the hospital and 10 (1.8%) after discharge. Among these patients, only one (0.2%) child under in-hospital observation underwent an operation. CONCLUSION: A 24-hour long observation at ED after the successful air reduction allows the safe and feasible management of childhood intussusception.
Abdominal Pain ; Aged ; Child ; Emergencies ; Humans ; Intussusception ; Nausea ; Recurrence ; Retrospective Studies ; Tertiary Care Centers ; Vomiting

PURPOSE: The objective of this study was to understand and compare the general attitude of medical staff and guardians toward family presence (FP) in the pediatric emergency department (PED). METHODS: A cross-sectional study was conducted in PEDs in Korea. Doctors and nurses who worked in PEDs and guardians who brought children(< or =15 years old) to the PED were asked to complete a structured questionnaire. A 5-point Likert scale was used as the scoring method. The influence of invasiveness of procedures and socio-demographic factors associated with favorable attitude toward FP were assessed. RESULTS: A total of 206 medical staff and 194 guardians were enrolled. The proportion of guardians with a favorable attitude toward FP was higher than that of the medical staff (99.5% vs. 51.4%). Healthcare providers believed that FP could be "helpful to calm down children and/or guardian (s)", and expressed concern that FP could cause "breakage of rapport when procedure fails". Most guardians believed that FP could be "helpful to support the child emotionally". The invasiveness of procedures was negatively related to the proportion of favorable medical staff toward FP, but did not influence that of the guardians. Previous experience with FP (odds ratio=2.04, 95% confidence interval 1.19-4.22) and occupation (OR=0.17, 95% CI 0.07-0.38) of the medical staff showed a negative association with a favorable attitude toward FP. CONCLUSION: We found discrepancies in general attitude toward FP between guardians and medical staff. Previous experience with FP and occupation of medical staff showed an association with a favorable attitude toward FP.
Child ; Cross-Sectional Studies ; Emergencies* ; Emergency Service, Hospital* ; Health Personnel ; Humans ; Korea ; Medical Staff* ; Occupations ; Surveys and Questionnaires ; Research Design

PURPOSE: The objective of this study was to understand and compare the general attitude of medical staff and guardians toward family presence (FP) in the pediatric emergency department (PED). METHODS: A cross-sectional study was conducted in PEDs in Korea. Doctors and nurses who worked in PEDs and guardians who brought children(< or =15 years old) to the PED were asked to complete a structured questionnaire. A 5-point Likert scale was used as the scoring method. The influence of invasiveness of procedures and socio-demographic factors associated with favorable attitude toward FP were assessed. RESULTS: A total of 206 medical staff and 194 guardians were enrolled. The proportion of guardians with a favorable attitude toward FP was higher than that of the medical staff (99.5% vs. 51.4%). Healthcare providers believed that FP could be "helpful to calm down children and/or guardian (s)", and expressed concern that FP could cause "breakage of rapport when procedure fails". Most guardians believed that FP could be "helpful to support the child emotionally". The invasiveness of procedures was negatively related to the proportion of favorable medical staff toward FP, but did not influence that of the guardians. Previous experience with FP (odds ratio=2.04, 95% confidence interval 1.19-4.22) and occupation (OR=0.17, 95% CI 0.07-0.38) of the medical staff showed a negative association with a favorable attitude toward FP. CONCLUSION: We found discrepancies in general attitude toward FP between guardians and medical staff. Previous experience with FP and occupation of medical staff showed an association with a favorable attitude toward FP.
Child ; Cross-Sectional Studies ; Emergencies* ; Emergency Service, Hospital* ; Health Personnel ; Humans ; Korea ; Medical Staff* ; Occupations ; Surveys and Questionnaires ; Research Design

PURPOSE: This study was conducted in order to identify the clinical characteristics of fish bone impaction among children in three tertiary hospitals and to investigate the usefulness of plain radiographs. METHODS: Children with suspected fish bone impaction in their aerodigestive tract were enrolled in this study. Data on patient's sex and age, characteristics of the allegedly ingested fish bone, utilization rate and result of neck radiographs, and removal procedures were collected retrospectively from three university-affiliated hospitals. RESULTS: A total of 270 children, from Seoul National University College of Medicine (n=113), Seoul National University Bundang Hospital (n=114), and Seoul National University Boramae Hospital (n=43) were enrolled consecutively. A total of 162 patients (60.0%) were male; the mean age of subjects was 6.9+/-4.1 years. The most commonly suspected source of fish bones was mackerel (n=58, 21.5%), followed by yellow corbina (n=57, 21.1%), and cutlass fish (n=22, 8.2%). Results of initial oropharyngeal inspections by emergency physicians (EP) were negative in 213 patients (78.9%). Among these patients, 173(64.1%) underwent simple neck radiography (radiograph group) and 40(14.8%) patients did not (non-radiograph group). In the radiograph group, no fish bone (0.0%) was observed on plain radiographs. Additional throat examinations were consulted to otolaryngologists (OL), and fish bones were detected in 62(35.8%) and 15(37.5%) patients, from the radiograph group and non-radio group, respectively. Among oropharyngeal inspections performed by EP or OL (130 patients), the most common impacted site of fish bones was the paratonsillar area (n=92, 71.5%). CONCLUSION: Mackerel and corbina are common sources of fish bone impaction in Korean children. Due to poor visualization and no additional information for use in management, the usefulness of plain radiographs is questionable.
Child ; Emergencies ; Gastrointestinal Tract ; Humans ; Neck ; Perciformes ; Pharynx ; Retrospective Studies ; Tertiary Care Centers