PURPOSE: To compare the clinical results of hemodynamically unstable patients diagnosed with pelvic ring injury according to the presence of a trauma team. MATERIALS AND METHODS: Patients with hemodynamically unstable pelvic fracture were enrolled in the study and were divided into two groups: Group I, patients who were managed before March 2009, when there was no trauma team; and Group II, patients who were managed after March 2009, when emergent trauma team began to work. Data were collected regarding the time the trauma team began patient management, the treatment modality used to control bleeding, transfusion requirement, and patient mortality. RESULTS: The time when the trauma team began patient management was five hours and 48 minutes in Group I and 57 minutes in Group II. The time to definitive treatment in order to control bleeding in Group I and Group II was 14.4 hours and 4.2 hours, respectively. The amount of the transfusion was 41.1 unit in Group I and 13.2 unit in Group II patients. In Group I, four patients (57.1%) died, although only one of the seven patients in Group II (14.3%) died. CONCLUSION: Using a multidisciplinary approach, the trauma team has only a short amount of time to determine their treatment strategy and to achieve prompt management of bleeding, with the final objective to decrease the mortality rate in patients with hemodynamically unstable pelvic fractures.
Hemorrhage ; Humans

PURPOSE: Triage is the initial clinical evaluation process in a hospital emergency department (ED). The Korean Triage and Acuity Scale-based triage system (KTAS) has been developed and used in Korean EDs as a triage tool. However, there has been limited evidence of its reliability and validation in KTAS. The aim of this study was to validate KTAS by comparing the Emergency Severity Index (ESI). METHODS: This was a prospective study. All adult patients over the age of 18 years who visited our ED during the study period were included. Patients were independently triaged by a primary triage nurse using KTAS and emergency physician by ESI. The total admission rate (TAR) and length of stay (LOS) were analyzed by comparing KTAS and ESI according to acuity levels. RESULTS: A total of 2919 patients were enrolled in our study. With KTAS, 0.8%, 9.3%, 41.6%, 39.7%, and 8.6% were assigned to the levels 1, 2, 3, 4, and 5, respectively. With ESI, 1.8%, 15.7%, 38.4%, 42.5%, and 1.6% were assigned to levels 1, 2, 3, 4, and 5, respectively. The percentage of each level using KTAS was similar to using ESI. Significant consistency existed in TAR and LOS compared with KTAS and ESI. CONCLUSION: KTAS seems preferable to triaged patients according to severity. It is helpful to order of priority in utilization for ED.
Adult* ; Emergencies* ; Emergency Service, Hospital ; Humans ; Length of Stay ; Prospective Studies ; Tertiary Care Centers* ; Triage*

BACKGROUDN: In end-stage renal disease (ESRD) patients, cardiovascular disease (CVD) is a major cause of morbidity and mortality. These patients frequently have hyperhomocysteinemia, a putative risk factor for cardiovascular disease. Several studies suggest that lowering plasma homocysteine may improve endothelial dysfunction, a marker of atherothrombotic risk. Pulse wave velocity (PWV) is a useful diagnostic tool to access endothelial dysfunction, and is widely used screening test for atherosclerosis. METHODS: We measured fasting total plasma homocysteine (tHcy) in 84 hemodialysis patients and 21 peritoneal dialysis patients. Subjects were assigned to two groups. Group I (tHcy <20 umol/L) consisted of 74 ESRD patients who have taken continual usual dose folate (1 mg/day). Group II (tHcy> or =20 umol/L) consisted of 26 ESRD patients who have taken high dose folate (5 mg/day). For 15 Group I patients and 5 Group II patients, pulse wave doppler velocity (PWV) measurements were taken before and after 3 months of folate treatment. RESULTS: The mean tHcy concentration was higher in the ESRD patients (82 HD: 16.9+/-6.4 mol/L, 20 PD: 18.0+/-16.7 mol/L). The pulse wave velocity (PWV) was faster in ESRD patients-19 HD: Aorta (Ao)-PWV 8.98+/-1.4, lower extremities (LE)-PWV 10.15+/-1.3, upper extremities (UE)-PWV 8.80+/-0.8 (m/s); 8 PD: Ao-PWV 9.32+/-1.8, LE-PWV 10.64+/-1.4, UE-PWV 9.24+/-0.7 (m/s). The PWV increased in ESRD patients with coronary heart disease and who had a history of angioplasty because of thrombosis or stenosis of vascular access. There was a significant reduction in hyperhomocysteinemia after 3 months in the high dose folate supplement group as compared to the usual dose folate supplement group with a significant statistical difference between the two groups. (15 Group I patients: 13.9+/-4.9 mol/L->13.5+/-6.1 for 5 Group II patients: 34.3+/-27.5 mol/L->23.0+/-5.9 mol/L (p<0.05, paired t-test). No difference in the PWV was found before and after folic acid supplementation for the two groups (p>0.05, paired t-test). CONCLUSIONS: We assume that PWV and homocysteine concentration have some correlation and both studies are available as part of screening tests for atherosclerosis in ESRD. Although no significant interval change was detected for the PWV, this finding suggests that high-dose folate supplementation was helpful to minimize the risk of cardiovascular disease associated with hyperhomocysteinemia in ESRD patients.
Angioplasty ; Aorta ; Atherosclerosis ; Blood Flow Velocity ; Cardiovascular Diseases ; Constriction, Pathologic ; Coronary Disease ; Fasting ; Folic Acid* ; Homocysteine* ; Humans ; Hyperhomocysteinemia ; Kidney Failure, Chronic* ; Lower Extremity ; Mass Screening ; Mortality ; Peritoneal Dialysis ; Plasma ; Pulse Wave Analysis* ; Renal Dialysis ; Risk Factors ; Thrombosis ; Upper Extremity