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

PURPOSE: We made a clinical comparison of elderly patients from home and residential aged care facilities (RACFs) who visited the emergency department and were hospitalized with acute ischemic stroke. In addition, we investigated the factors associated with prehospital delay in acute ischemic stroke. METHODS: A retrospective study was conducted in a public hospital between January 2013 and December 2016. Information regarding the patients was registered including gender, age, comorbidities, symptoms at onset, use of emergency medical services, National Institute of Health Stroke Scale (NIHSS) at the emergency department, symptom-to-door time, etc. Characteristics of the patients were analyzed and logistic regression analysis was conducted to identify factors associated with symptom-to-door time. RESULTS: A total of 402 patients were enrolled during the study period. Overall, 339 elderly patients visited from home and 63 patients from RACFs, and patients from home were divided into two groups, living with family (n=274) and living alone (n=65). Patients from RACFs were older (≤0.001) and had higher NIHSS (p=0.007) than patients from home, but there were no significant relationships between symptom-to-door time and age (p=0.525), NIHSS (p=0.428). There was no difference in symptom-to-door time between patients living with family and patients from RACFs, but patients living alone had delayed symptom-to-door time (p < 0.001). CONCLUSION: Elderly patients living alone were among the three groups that had the most delayed symptom-to-door time. Therefore, it is necessary to expand and supplement support for elderly patients living alone, as well as to improve education regarding acute ischemic stroke.
Aged ; Cerebral Infarction ; Comorbidity ; Education ; Emergency Medical Services ; Emergency Service, Hospital ; Hospitals, Public ; Housing for the Elderly ; Humans ; Logistic Models ; Nursing Homes ; Retrospective Studies ; Stroke ; Transportation of Patients

PURPOSE: This study shows the relationship between meteorological factors and the number of community acquired pneumonia (CAP) patients in the emergency room and lag effect of meteorological factors affecting CAP. METHODS: A retrospective study was conducted. Patients diagnosed with CAP in the emergency room between January 2012 and December 2014 were enrolled. The patients were over 18 years old and lived in Seoul, Korea. Meteorological factors (highest daily temperature, lowest temperature, mean temperature, diurnal temperature, rainfall, relative humidity, amount of sunshine, and powdery dust under 10 microg/m3 (PM10)) between December 2011 and December 2014 in Seoul were acquired from the Korea Meteorological Administration. Multiple Poisson regression (Generalized Linear Model) was used with daily patient's number of CAP as the response variable and meteorological factors as the explanatory variable. Variable selection was performed via Elastic net. RESULTS: A total of 568 CAP patients were checked. Highest temperature (before 6 days), rainfall (before 1 day), relative humidity (before 20, 15, 13, 6, 2, and 1 days), and PM10 (before 27, 24, 17, and 13 days) showed relationship and lag effect with the incidence of CAP. CONCLUSION: This study showed that meteorological factors (highest temperature, rainfall, relative humidity, and PM10) had relationship and lag effect with the incidence of CAP. We can make a prediction model with health weather index for prevention of CAP and redistribution of medical facilities and resources.
Dust ; Emergency Service, Hospital ; Humans ; Humidity ; Incidence ; Korea ; Meteorological Concepts ; Pneumonia* ; Regression Analysis ; Retrospective Studies ; Seoul ; Sunlight ; Weather*

PURPOSE: This study was conducted in order to evaluate the effect of a newly developed explanation handout in the emergency department (ED) between patient and guardian. METHODS: From August 24, 2013 to September 24, 2013, interviews were conducted to patient accompanying guardian, discharged from Seoul Medical Center ED. Four groups were divided according to non-handout or handout in addition to patient or guardian. Each group consisted of 50 candidates and allocated according to a random table. The explanation handout could be easily applicable automatically through the Electronic Medical Record. It contains the results of laboratory tests along with cautions by diagnosis. After discharge explanation, a survey was conducted in each group using questionnaires for evaluation of the effect on medical service satisfaction. RESULTS: A total of 97 candidates(49 patients, 48 guardians) in the non-handout group, and 99 candidates(50 patients, 49 guardians) in the handout group were enrolled. No statistical difference in epidemiology, except explanation time, was observed between the two groups. The handout group showed a higher score in all factors, however, explanation by physician (p<0.001), mean 3.61(+/-0.72) to 3.87(+/-0.73), understanding of medical status (p<0.001), mean 3.51(+/-0.75) to 4.11(+/-0.71), medical evaluation and treatment (p=0.001), mean 3.59(+/-0.72) to 3.92(+/-0.75), kindness of physician (p<0.001), mean 3.74(+/-0.81) to 4.09(+/-0.67), overall satisfaction (p<0.001), mean 3.60(+/-0.75) to 3.97(+/-0.75), willingness of revisit (p=0.023), mean 3.87(+/-0.73) to 4.09(+/-0.61), and willingness of recommendation (p<0.001), mean 3.66(+/-0.82) to 4.09(+/-0.66) showed statistically meaningful results. In a sub-analysis, statistically meaningful results were reanalyzed between patient and guardian. In the non-handout group, guardian showed higher scores in mean value in all factors, however, statistically meaningful results were observed for all factors, except understanding of medical status and medical evaluation and treatment. By application of the handout, 99 patients and 97 guardians showed higher scores in mean value in all factors. Patients showed statistically meaningful results in all factors but just in understanding of medical status in guardian. CONCLUSION: Results of this study showed that the explanation handout effectively increased medical service satisfaction. The effect of the explanation handout was more prominent in patients than guardians.
Diagnosis ; Electronic Health Records ; Emergencies* ; Emergency Medical Services ; Emergency Service, Hospital ; Epidemiology ; Humans ; Patient Satisfaction ; Surveys and Questionnaires ; Seoul

PURPOSE: This study was conducted in order to evaluate the effect of a newly developed explanation handout in the emergency department (ED) between patient and guardian. METHODS: From August 24, 2013 to September 24, 2013, interviews were conducted to patient accompanying guardian, discharged from Seoul Medical Center ED. Four groups were divided according to non-handout or handout in addition to patient or guardian. Each group consisted of 50 candidates and allocated according to a random table. The explanation handout could be easily applicable automatically through the Electronic Medical Record. It contains the results of laboratory tests along with cautions by diagnosis. After discharge explanation, a survey was conducted in each group using questionnaires for evaluation of the effect on medical service satisfaction. RESULTS: A total of 97 candidates(49 patients, 48 guardians) in the non-handout group, and 99 candidates(50 patients, 49 guardians) in the handout group were enrolled. No statistical difference in epidemiology, except explanation time, was observed between the two groups. The handout group showed a higher score in all factors, however, explanation by physician (p<0.001), mean 3.61(+/-0.72) to 3.87(+/-0.73), understanding of medical status (p<0.001), mean 3.51(+/-0.75) to 4.11(+/-0.71), medical evaluation and treatment (p=0.001), mean 3.59(+/-0.72) to 3.92(+/-0.75), kindness of physician (p<0.001), mean 3.74(+/-0.81) to 4.09(+/-0.67), overall satisfaction (p<0.001), mean 3.60(+/-0.75) to 3.97(+/-0.75), willingness of revisit (p=0.023), mean 3.87(+/-0.73) to 4.09(+/-0.61), and willingness of recommendation (p<0.001), mean 3.66(+/-0.82) to 4.09(+/-0.66) showed statistically meaningful results. In a sub-analysis, statistically meaningful results were reanalyzed between patient and guardian. In the non-handout group, guardian showed higher scores in mean value in all factors, however, statistically meaningful results were observed for all factors, except understanding of medical status and medical evaluation and treatment. By application of the handout, 99 patients and 97 guardians showed higher scores in mean value in all factors. Patients showed statistically meaningful results in all factors but just in understanding of medical status in guardian. CONCLUSION: Results of this study showed that the explanation handout effectively increased medical service satisfaction. The effect of the explanation handout was more prominent in patients than guardians.
Diagnosis ; Electronic Health Records ; Emergencies* ; Emergency Medical Services ; Emergency Service, Hospital ; Epidemiology ; Humans ; Patient Satisfaction ; Surveys and Questionnaires ; Seoul

PURPOSE: In recent years, the number of elderly patients visiting from residential aged care facilities (RACFs) has been increasing. We analyzed a comparison of characteristics between patients who visited the ER with diseases from RACFs and those who visited from home. METHODS: A retrospective study was conducted in a public hospital between January 2013 and December 2014. The subjects included patients who visited the ED from RACFs and elderly patients who visited the ED from home. Comparisons of the following parameters were made between the two groups: gender, age, mode of insurance, mode of ED visit, mobile status, Charlson comorbidity index (CCI), chief complaint, final results in the ED, and length of stay (LOS) in the ED and hospital. RESULTS: A total of 7,603 patients were enrolled during the study period. There were 6,401 elderly patients who visited from home and 1,202 patients who visited from RACFs. Patients from RACFs were older than those from home (79.90±8.01 vs. 75.78±7.26, p<0.001). More patients from RACFs were on Medicaid (56.6% vs. 27.9%, p<0.001), took more ambulance (86.3% vs. 49.4%, p<0.001), more bedridden (68.2% vs. 6.4%, p<0.001), and higher CCI (2.38±1.99 vs. 1.45±1.84, p<0.001). Compared with patients from home, those from RACFs showed a significantly higher proportion of admission (63.2% vs. 32.9%, p<0.001), ED LOS (403.03±361.77 vs. 277.07±258.82, p<0.001), and hospital LOS (19.65±18.58 vs. 15.67±15.63, p<0.001). Patients from RACFs showed especially longer ED LOS from discharged ED than those from home (388.87±422.88 vs. 221.90±215.30, p<0.001). CONCLUSION: Compared with elderly patients from home, patients from RACFs also had higher admission rate and longer ED LOS, as well as hospital LOS. Patients from RACFs had long ED LOS. The findings in this study suggest that there could be ED overcrowding in the near future.
Aged* ; Ambulances ; Comorbidity ; Emergencies* ; Emergency Service, Hospital* ; Hospitals, Public ; Humans ; Insurance ; Length of Stay ; Medicaid ; Nursing Homes ; Residential Facilities ; Retrospective Studies

Objective: This study described the effectiveness of the one-stop treat system (OTS) and the improvements characterizing the patients who come to an emergency medical center via the one-stop treat system for heavily drunken people Methods: An observational retrospective study was conducted on patients, aged 19 years or older, who visited the emergency department (ED) from January 2014 to December 2017 with alcohol intoxication (AI). The subjects were divided into two groups, that is, AI patients who come to ED directly or those who came via OTS. We compared and analyzed the characteristics of two groups including gender, age, date, mode of the ED visit, level of consciousness, diagnosis, ED length of stay (LOS), hospital LOS, and final outcomes. Results: A total of 8,144 patients were enrolled in the study. There were 2,221 AI patients who visited ED directly and 5,923 AI patients who visited ED via OTS. Patients arriving via OTS had more medical or surgical problems than the patients who came directly from the ED. Discharged patients via OTS showed a longer ED LOS (312 minutes [range, 169-520 minutes], P<0.001). Compared with patients who came directly from ED, the patients via OTS showed a higher admission rate (10.7% vs. 3.4%, respectively; P<0.001), and a higher death rate in ED (0.6% vs. 0%, respectively; P<0.001). Conclusion Compared the characteristics of the patients from ED directly in 2014-2017, the patients via OTS had higher severity and admission rate, and a longer ED LOS. Our findings suggest that we should pay attention to patients via OTS because the patients have high severity of illness.

Objective: This study evaluated the usefulness, as a risk factor of 30-day mortality, in patients residing in nursing-homes (NHs) or long-term care facilities with the diagnosis of pneumonia. Methods: We conducted a retrospective study in a public hospital between January 2017 and December 2017. The subjects included elderly patients residing in NHs and diagnosed with pneumonia in the emergency room. Data on age, gender, comorbidities, laboratory findings, pneumonia severity index score (PSI), and CURB-65 (Confusion, Urea, Respiratory rate, Blood pressure, and Age 65 or older) were entered into an electronic database. Results: A total of 439 patients were enrolled during the study period. The mean age was 82.1±8.0 years; 195 (44.4%) were men, and 30-day mortality was 21.8%. On multivariate Cox proportional hazard analysis, cerebrovascular accidents (hazard ratio [HR], 0.53; 95% confidence interval [CI], 0.33-0.87; P=0.012), chronic renal disease (HR, 2.28; 95% CI, 1.11-4.67; P=0.024), malignancy (HR, 1.69; 95% CI, 1.04-2.76; P=0.034), lactate (HR, 1.02; 95% CI, 1.01-1.03; P<0.001), albumin (HR, 0.52; 95% CI, 0.36-0.73; P<0.001), and red cell distribution width (RDW; HR, 1.11; 95% CI, 1.03- 1.19; P=0.007) were independently associated with 30-day mortality. Areas under the curve of PSI, RDW, albumin, lactate, and PSI+RDW+albumin+lactate were 0.690 (95% CI, 0.629-0.751), 0.721 (95% CI, 0.666-0.775), 0.668 (95% CI, 0.607-0.728), 0.661 (95% CI, 0.597-0.726), and 0.801 (95% CI, 0.750-0.852), respectively. Conclusion RDW, albumin, lactate and especially the combination of PSI and these factors appear to be major determinants of 30-day mortality in NH residents with pneumonia.