PURPOSE: The aim of this study was to determine the relationship between the injury severity and pain intensity according to age in patients with extremity injuries. METHODS: Adult patients with an extremity injury who visited the emergency department (ED) from June 1, 2016 to November 31, 2016 were analyzed retrospectively. The major injury was defined as structural damage below the muscle layer, such as muscle, ligament, and bone. Minor injury group and major injury group were separated according to this definition. The relationship of age and pain score assessed with the numerical rating scale (NRS) with the injury severity was analyzed. RESULTS: Of a total of 1,441 patients, the number of patients with a minor and major injury was 854 (59.3%) and 587 (40.7%), respectively. The proportion of patients aged 65 and older was 6.1% and 25.7% in the minor and major injury group, respectively. Age and NRS scale showed significantly positive associations with the injury severity (p < 0.001). In all NRS scores, the overall proportion of major injuries in the older age group was higher than that in the younger age group. Regardless of the younger ( < 65 years) or older (≥65 years) age group, the NRS score was positively related to the injury severity (young age group [odds ratio, 3.944]; older age group [odds ratio, 5.754]). CONCLUSION: The pain intensity is positively related to the severity of injury regardless of age. The pain intensity is the important factor of a patient assessment and treatment in the emergency department.
Adult ; Emergency Service, Hospital ; Extremities* ; Humans ; Ligaments ; Pain Measurement ; Retrospective Studies ; Trauma Severity Indices

OBJECTIVE: The systemic inflammatory response syndrome (SIRS) criteria used in the triage scale have been implemented incompletely without laboratory data, such as the white blood cell (WBC) count, so the validity of SIRS as a triage tool has been uncertain. This study assessed the validity of the Korean Triage and Acuity Scale (KTAS) in applying SIRS with or without a WBC count. METHODS: The KTAS level was simulated by the number of SIRS criteria. This new KTAS level that did not apply the WBC count was defined as the partial-simulated KTAS (PS-KTAS), and the KTAS level including the WBC count was called the total-simulated KTAS (TS-KTAS). The authors used the intensive care unit (ICU), overall admission rate, and use of emergent interventions as the primary outcomes. RESULTS: A total of 1,077 patients with a suspected infection were triaged using the SIRS in KTAS. Multivariable logistic regression analysis showed that the odds ratio for overall admission was greater with a higher KTAS level than with KTAS level 4 in both the PS-KTAS and TS-KTAS. All areas under the curve of the PS- and TS-KTAS for ICU admission and emergent intervention rate both showed very low discriminant powers. CONCLUSION: Compared to TS-KTAS, PS-KTAS showed a similar or partially better relationship between the KTAS level and the use of critical medical resource. Future research is recommended to improve the matching between the SIRS scoring and each KTAS level to better classify the patient severity status and develop or discover new infection assessment tools that can be applied to KTAS.
Humans ; Intensive Care Units ; Leukocyte Count ; Leukocytes ; Logistic Models ; Odds Ratio ; Systemic Inflammatory Response Syndrome ; Triage

Objective: The Korean Triage and Acuity Scale (KTAS) is a triage tool for patients in the emergency department (ED). This study aimed to evaluate the ability of the KTAS to predict poor outcomes in South Korean ED patients with a suspected infection. We also compared the effectiveness of KTAS with that of the National Early Warning Score (NEWS) and Modified Early Warning Score (MEWS) in predicting poor outcomes. Methods: We conducted a single-center retrospective study that included adult patients with a suspected infection who were admitted to the ED between January 2019 and December 2019. Patients who received a prescription for antibiotics and associated culture tests in the ED were considered to have an infection. Poor outcomes were evaluated by in-hospital mortality, general ward admission, and intensive care unit (ICU) admission. A receiver operating characteristics (ROC) curve analysis was performed to evaluate and compare KTAS, NEWS, and MEWS. Results: Of the 4,127 patients in the study, in-hospital mortality was reported in 154 (3.7%) patients. The median KTAS was lower in the non-survivors than in the survivors (2.51 vs. 3.35). Multivariate logistic regression analysis showed that the KTAS was associated with in-hospital mortality, ward admission, and ICU admission. The area under the ROC curve (AUROC) values for predicting in-hospital mortality associated with the KTAS, NEWS, and MEWS were 0.776 (95% confidence interval, 0.747-0.803), 0.829 (0.759-0.811) and 0.739 (0.694-0.786), respectively. Conclusion Our results showed that the KTAS was associated with in-hospital mortality, ward admissions, and ICU admissions among ED patients with a suspected infection. Thus, KTAS may be reliable in predicting a poor outcome in ED patients with a suspected infection.

Objective: This study evaluated the usefulness of cystatin C as a prognostic predictor in heart failure patients admitted to the emergency department. Methods: This study was conducted retrospectively on patients with heart failure admitted to the emergency department between January and December 2018. Patients newly and previously diagnosed with heart failure underwent both N-terminal prohormone of brain natriuretic peptide and cystatin C tests. To assess the patients’ prognosis, a poor prognosis was defined as the occurrence of one or more of the following events: intubation, admission to an intensive care unit, coronary angiography, continuous renal replacement therapy, extracorporeal membrane oxygenation, cardiopulmonary resuscitation, and death. The patients were divided into two groups based on the occurrence of these events; the characteristics between the groups with and without events were compared. Results: Seventy-four patients were included in the study analysis: 35 and 39 in the group without and with events, respectively. The number of patients with a history of diabetes, hypertension, troponin T, and cystatin C levels were significantly higher in the group with events than in the group without events (P=0.028, P=0.041, P<0.001, and P=0.002, respectively). Multiple logistic regression analyses showed that cystatin C is a significant prognostic predictor of events. Conclusion An increased cystatin C level has been shown to clinically predict a poor prognosis of heart failure patients admitted to emergency departments.

Objective: Rapid determination of acute coronary syndrome (ACS) in the emergency department (ED) is very important for patients presenting with ischemic symptoms. The aim of this study was to determine the predictive value of HEART score for ACS and significant coronary artery stenosis (SCS). Methods: We retrospectively analyzed data of patients who visited the ED with chest discomfort and were admitted to the cardiology department. Enrolled patients were classified into ACS and non-ACS groups according to their discharge diagnosis. Patients who underwent imaging were further divided into SCS and non-SCS groups according to study results. We compared age, sex, vital signs, risk factors, electrocardiogram, troponin, and HEART score for each group. For ACS and SCS predictive performance, the test characteristics of HEART score was calculated using sensitivity, specificity, predictive value, likelihood ratio, and receiver operating characteristic (ROC) curve analysis. Results: Of 207 patients, 112 had ACS. Among enrolled patients, 155 underwent imaging workup, of whom 67 had SCS. HEART score ≤3 had 93% sensitivity for ACS and 97% for SCS. HEART score ≥7 had 82% specificity for ACS and 83% for SCS. HEART score area under ROC curve for ACS was 0.706 (95% confidence interval, 0.627–0.776) and 0.737 (95% confidence interval, 0.660–0.804) for SCS. Conclusion HEART score was a fair predictor of ACS and SCS in ED patients who presented with chest symptoms and were admitted to the cardiology department. The predictive power of HEART score was better for SCS than for ACS.

We recently reported a Philyra pisum lectin (PPL) that exerts mitogenic effects on human lymphocytes, and its molecular characterization. The present study provides a more detailed characterization of PPL based on the results from a monosaccharide analysis indicating that PPL is a glycoprotein, and circular dichroism spectra revealing its estimated alpha-helix, beta-sheet, beta-turn, and random coil contents to be 14.0%, 39.6%, 15.8%, and 30.6%, respectively. These contents are quite similar to those of deglycosylated PPL, indicating that glycans do not affect its intact structure. The binding properties to different pathogen-associated molecular patterns were investigated with hemagglutination inhibition assays using lipoteichoic acid from Gram-positive bacteria, lipopolysaccharide from Gram-negative bacteria, and both mannan and beta-1,3-glucan from fungi. PPL binds to lipoteichoic acids and mannan, but not to lipopolysaccharides or beta-1,3-glucan. PPL exerted no significant antiproliferative effects against human breast or bladder cancer cells. These results indicate that PPL is a glycoprotein with a lipoteichoic acid or mannan-binding specificity and which contains low and high proportions of alpha-helix and beta-structures, respectively. These properties are inherent to the innate immune system of P. pisum and indicate that PPL could be involved in signal transmission into Gram-positive bacteria or fungi.
beta-Glucans ; Breast ; Circular Dichroism ; Fungi ; Glycoproteins ; Gram-Negative Bacteria ; Gram-Positive Bacteria ; Hemagglutination ; Humans ; Immune System ; Lipopolysaccharides ; Lymphocytes ; Mannans ; Polysaccharides ; Sensitivity and Specificity* ; Teichoic Acids ; Urinary Bladder Neoplasms

OBJECTIVE: The quick sequential organ failure assessment (qSOFA) score, which includes mentation, systolic blood pressure, and respiratory rate, was developed to identify serious sepsis in out-of-hospital or emergency department (ED) settings. We evaluated the ability of the qSOFA score to predict poor outcome in South Korean ED patients with suspected infection.METHODS: The qSOFA score was calculated for adult ED patients with suspected infection. Patients who received intravenous or oral antibiotics in the ED were considered to have infection. In-hospital mortality rate, admission rate, intensive care unit (ICU) admission rate, length of hospital stay (LOS), and lactate levels were compared between the qSOFA score groups. Receiver operating characteristic curves and area under the receiver operating characteristic curve values for in-hospital mortality were calculated according to qSOFA cut-off points and lactate levels.RESULTS: Of 2,698 patients, in-hospital mortality occurred in 134 (5.0%). The mortality rate increased with increasing qSOFA score (2.2%, 6.4%, 17.5%, and 42.4% for qSOFA scores 0, 1, 2, and 3, respectively, P<0.001). The admission rate, ICU admission rate, LOS, and lactate level also increased with increasing qSOFA score (all P<0.001). The area under the receiver operating characteristic curve values for predicting in-hospital mortality associated with qSOFA score, lactate ≥2 mmol/L, and lactate ≥4 mmol/L were 0.719 (95% confidence interval [CI], 0.670 to 0.768), 0.657 (95% CI, 0.603 to 0.710), and 0.632 (95% CI, 0.571 to 0.693), respectively.CONCLUSION: Patients with a higher qSOFA score had higher admission, ICU admission, and in-hospital mortality rates, longer LOS, and higher lactate level. The qSOFA score showed better performance for predicting poor outcome than lactate level.
Adult ; Anti-Bacterial Agents ; Blood Pressure ; Emergencies ; Emergency Service, Hospital ; Hospital Mortality ; Humans ; Intensive Care Units ; Lactic Acid ; Length of Stay ; Mortality ; Respiratory Rate ; ROC Curve ; Sepsis

Objective: Various tools using the length-based method for weight estimation and decisions regarding equipment size have been used in pediatric resuscitation globally. The Korean Pediatric Resuscitation Tape (KPRT) is one such tool that has been developed recently. This study was performed to validate the use of KPRT in Korean children. Methods: Data on the measured weights and the endotracheal tube (ETT) sizes used for children aged 12 years or less, who received general anesthesia, were collected by reviewing medical records from June 2018 to October 2020 at two hospitals in the urban areas of Korea. We compared the weight and ETT size estimated by the KPRT to the actually measured weight and ETT size used for the study population. We also calculated the weight and ETT size using an age-based formula and compared these values to the actual values of the patients. We then analyzed the agreement between these estimated values and the actual values of the children. Results: A total of 1,237 children were included in this study. The intra-class correlation coefficient of agreement between the actual weight and estimated weight by the KPRT was 0.94 compared to 0.93 when estimated by the age-based formula. The weighted kappa coefficient of the agreement between the ETT size actually used, and the size estimated by the KPRT was 0.61 compared to 0.74 when estimated by the age-based formula. The estimated ETT sizes using the KPRT were smaller than the actual size used in children under three years old, whereas it was larger for children aged eight years or more. Conclusion Our study showed that the KPRT was a dependable tool for estimating the weight and ETT size of Korean children. Future studies would be needed to augment the reliability of the KPRT in pediatric resuscitation.

Objective: Many previous studies have reported relationships between particulate matter < 10 μm (PM10) and asthma in emergency department (ED) settings, but few have examined its effect on cerebrovascular diseases. We evaluate the “Lag effect” between PM10 and asthma, chronic obstructive pulmonary disease (COPD), myocardial infarction (MI), and ischemic and hemorrhagic stroke among patients that visited an ED. Methods: This study was retrospectively conducted on 96,077 patients that visited one of the 137 EDs in Seoul, Incheon, and Gyeonggi Province in South Korea in 2017. Medical information and 10th revision International Classification of Disease codes were obtained from the National Emergency Department Information System and PM10 levels from AirKorea. We used Poisson regression analysis to evaluate the lag effects of PM10 on diseases of interest. “Lag day 0” was defined as the day when PM10 > 80 μg/m3, and the PM10 values on the 5 following days were recorded. To assess the cumulative effects of PM10, we calculated relative risk (RR) by analyzing the cumulative effects over 6 days (lag days 0 to 5). Results: Asthma, COPD, and ischemic stroke patients (< 65 years old) showed a positive correlation between PM10 (asthma on lag day 5: RR, 2.587; 95% confidence interval [CI], 2.001-3.344; COPD on lag day 4: RR, 3.727; 95% CI, 2.988-4.650; and ischemic stroke on lag day 4: RR, 1.573; 95% CI, 1.168-2.118). MI in those≥65 showed the highest RR on lag day 1 (RR, 1.471; 95% CI, 1.042-2.077). Hemorrhagic stroke was not found to be significantly correlated with PM10 in either age group. Conclusion An increase in PM10 is associated with ED visits by patients<65 years old with asthma, COPD, or ischemic stroke, and with MI for those≥65 years.

Objective: This study aimed to compare the effects of high-flow nasal cannula (HFNC) treatment and conventional oxygen therapy (COT) in patients with heart failure (HF) admitted to the emergency department (ED). Methods: This study was a single-center, retrospective, observational study. The subjects were divided into HFNC and COT groups. The characteristics were compared, and vital signs and arterial blood gas (ABG) results were analyzed. In addition, mortality, intubation rate, intensive care unit (ICU) admission, and length of stay (LOS) were analyzed for clinical outcome. Results: Among 252 patients, 91 and 161 were treated with HFNC and COT. Two groups showed differences in vital signs, ABG results, and pulmonary edema. The HFNC group showed no difference in mortality and LOS, but more intubation and ICU admission were observed (P=0.005, P<0.001). Due to the changes in vital signs and ABG results, the HFNC group reduced blood pressure, heart rate and respiratory rate, improved SpO2, increased pH, and decreased PaCO2. Conclusion HFNC therapy effectively improved vital signs and ventilation when administered to relatively unstable patients with HF admitted to the ED.