While Joint Commission on Accreditation of Healthcare Organizations(JCAHO) and American College of Surgeon(ACS) have identified certain audit filters in trauma care, there are few studies to substantiate the value of these audit filters. Some researchers found that audit filters qualifiers were significantly associated with adverse outcomes, however, others were unable to reproduce such association. It is also necessary to test their validity and applicability in Korea. The purpose of this present study was to validate two trauma audit filters proposed by the JCAHO and the ACS, through the analysis of the relationship between timeliness of operation and risk-adjusted mortality. Among trauma audit filters, timeliness of operation in epidural or subdural hematoma(EDH/SDH) and intraabdominal injury were selected. By stratified random cluster sampling, 19 emergency medical centers (EMCs) were selected from 30 EMCs and all patients who received craniotomy or laparotomy in 1996 were evaluated in each hospital. Six medical records administrators reviewed medical records of 463 patients with EDH/SDH and of 508 patients with intraabdominal injury retrospectively. In other to adjust risk of mortality, timeliness of operation, age, Revised Trauma Score(RTS), ICD-9CM based ICISS, and experiences of transfer were included in logistic regression model. In the logistic regression models of all EDH/SDH or intraabdominal injury patients, timeliness of operation was not significant predictor of mortality. However, if patients who have been operated later than 12 hours were excluded from the statistical model, timeliness of operation showed significant or marginally significant relationship with mortality in the following situations; craniotomy > 4 hours in EDH(OR=30.46, p=0.032), craniotomy > 8 hours in SDH(OR=6.50, p=0.020), laparotomy > 2 hours in shock patients(OR=9.26, p=0.055). In addition to timeliness of operation, RTS and ICISS were significant variables in every logistic regression model, and experience of transfer and types of EMC were significant or marginally significant only in EDH. Timeliness of operation as audit filters for trauma care could not be applied to all cases. Early operations seem to improve clinical outcome only in the patients for whom emergent craniotomy or laparotomy were indicated. It could be interpreted as a phenomenon of 'confounding by indication'. Additional studies to establish more objective eligibility criteria for these audit filiters are needed.
Accreditation ; Administrative Personnel ; Craniotomy ; Delivery of Health Care ; Emergencies ; Humans ; Joint Commission on Accreditation of Healthcare Organizations ; Joints ; Korea ; Laparotomy ; Logistic Models ; Medical Records ; Models, Statistical ; Mortality ; Retrospective Studies ; Shock

BACKGROUND: Emergency Medical Technicians can do emergency care only under the control of the physicians. Emergency medical services system(EMSS) in Korea is now extended from the level of basic life support(BLS) to advanced life support(ALS). Unfortunately we don't have any official medical control system yet. We and regional EMSS, 119 rescue team(BLS), have had monthly joint meeting to validate and improve the prehospital care since August, 1998. METHODS: From August, 1998 to February, 1999, 1,708 patients were transported to Ewha Mokdong Hospital by regional 119 rescue team. Eight hundred and six(47.2%) run record were collected and analyzed. The appropriateness of the prehospital care were evaluated based on the comparison of assessment data and treatment data in each run record. The run record were divided into 5 groups; 1) necessary-adequate, 2) necessary-inadequate, 3) necessary-undo, 4) unnecessary-done, and 5) unnecessary-undo. 1) and 5) were judged as acceptable, and 2), 3), and 4) as unacceptable. RESULTS: Among 806 transported patients, 60.8% required one or more emergency care. 21.0% of required care were not provided, and 20.7% of provided care were not adequate. 78.8% of unprovided and 75.9% of inadequate care were 'airway and oxygen supply'. Overall unacceptable rate was decreased from 31.7% to 17.0% during first 5 months, but it rose up again to 24.7% after 2 months. Cardiopulmonary resuscitation(CPR) was performed in 29 prehospital cardiac arrest victims and admitted to ICU in 5 cases. CPR was not provided in 8 necessary situations, and unnecessary CPR was done in 3 cases. CONCLUSION: EMSS in Korea also need a kind of medical control system, even for BLS level. Major portion of the quality assurance program could be 'airway and oxygen supply', but attention should be focused in cardiac arrest victims and CPR. Record keeping and reliance of run record data are now pending problems. Fire department should develop a formal medical control system and the referring hospital should have an organization for maintaining the quality of prehospital care.
Cardiopulmonary Resuscitation ; Emergency Medical Services* ; Emergency Medical Technicians ; Fires ; Heart Arrest ; Humans ; Joints ; Korea ; Oxygen ; Retrospective Studies*

No abstract available.
Aminolevulinic Acid*

BACKGROUND: It is difficult to evaluate the effectiveness of ongoing cardiopulmonary resuscitation(CPR). Recent studies suggest that continuous end-tidal carbon dioxide(ETC02) monitoring may be useful non-invasive indicator of CPR. The purpose of this study is to determine whether ETC02 monitoring during CPR could be used as a prognostic indicator of resuscitation and survival. METHOD: A prospective, clinical study was performed from May 1997 to April 1998 at the department of emergency medicine, Ewha Womans University Mokdong hospital. All patients were immediately connected to mainstream capnometer sensor between the tube and the bag after endotracheal intubation using infrared capnometer. RESULT: The study included 70 patients (39 were men) with a mean age of 55+/-16 years. 37 patients with return of spontaneous circulation(ROSC) had higher maximal ETCO2 during CPR than 33 Patients without ROSC (26.9+/-19.4 vs 10.2+/- 9.0mmHg, p=0.0001). The ETCO2 was not significantly different in relation to age, gender, initial rhythm, and survival time after ROSC. But there was significant difference in immediate cause of arrest in ROSC group (P=0.0016). When maximal ETC02 was less than 10mmHg, we observed sensitivity of 83.8%, specificity of 54.5% in predicting ROSC. There were 6 patients with ROSC in spite of maximal ETCO2 was less than 10mmHg. CONCLUSION: Continuous ETCOB monitoring during CPR may be useful, noninvasive, and valuable predictor of successful resuscitation and survival from cardiac arrest. But ETCO2 should lot be used as a single indicator for the withdrawal of CPR.
Carbon Dioxide* ; Carbon* ; Cardiopulmonary Resuscitation* ; Emergency Medicine ; Female ; Heart Arrest ; Humans ; Intubation, Intratracheal ; Prospective Studies ; Resuscitation ; Sensitivity and Specificity

Acrokeratosis verruciformis is a familial disease characterized by indolent papules resembIing flat warts on the backs of the hands and feet with lesser involvement of volar surfaces, wrists, and ankles. A cas of 42 years old female with acrokeratosis verruciformis is reported. The skin lesions of this patient showed numerous rice to pea sized, flat-topped, round or polygonal, warty papules on the dorsal aspects of the hands and feet and also, pitted keratolysis on both volar surface of the hands. The hitologic findings were those of features of acrokeratosis verruciformis, i.e. the epidermis shows marked hyperkeratosis with slight acanthosis and papillomatosis and circumscribed elevations of the epidermis resembling church spires characteristically.
Adult ; Ankle ; Darier Disease* ; Epidermis ; Female ; Foot ; Hand ; Humans ; Papilloma ; Peas ; Skin ; Warts ; Wrist

No abstract available.
Gastrointestinal Stromal Tumors*

No abstract available.
Cardiology*

Sixteen cases under the age of 19 were underwent surgical treatment for hernlated lumbar intervertebral disc over 10 years of period in the Department of Orthopaedic Surgery,Catholic Medical College. The results were obtained as follows: 1. The incidence was 5.2% of all herniated lumbar intervertebral disc patients who treated surgically, but no sexual predilection. 2. Nine cases (56.3%) had a definite previous history of injuries. 3. Average intervals between the onset of clinical symptoms and the operation were 9.2 months. 4. Neurologic deficits are less severe and frequent (8 cases, 50%) but the clinical symptoms do not differ from than that of the adult. 5. 7 cases (43.8%) revealed definite reptured lumbar intervertebral discs and 5 cases (31.3%) are diffuse buldging of annular fibers in operative findings. 6. According to histopathological study, 8 cases show degenerative fibrocartilagenous changes in surgical specimen. 7. The radiological abnormalities of lumbar spine are less common than that of the adult. 8. Excellent or good results were found in 12 cases (75%) but two cases required a further surgical procedure. 9. In generally, hernlated Iumbar intervertebral disc in teenagers show better results and more rapid recovery of clinical symptoms by surgical treatment, and less residual symptoms than that of the adult.
Adolescent ; Adult ; Clinical Study ; Humans ; Incidence ; Intervertebral Disc ; Neurologic Manifestations ; Spine

We present two cases of cerebral paragonimiasis in a 23-year-old Korean army soldier and in a 18-year-old Korean girl, respectively. The diagnosis was made on the basis of clinical, laboratory and x-ray findings, and was confirmed by the histopathological examination of the excised cyst. P.W. skin test showed positive reaction, whereas C.S. test negative. X-ray study on skull revealed multiple globulated round cystic formations in occipital region. Two months after surgical removal of cysts, visual field were not improved. Pertinent literatures are reviewed.
Adolescent ; Adult ; Blindness* ; Choroid* ; Coloboma* ; Diagnosis ; Female ; Hemianopsia* ; Heredity ; Humans ; Iris* ; Membranes ; Military Personnel ; Optic Nerve* ; Paragonimiasis* ; Skin Tests ; Skull ; Visual Fields ; Young Adult