PURPOSE: A number of studies have examined the B-type natriuretic peptide level in dialysis patients and in patients with lesser degrees of renal insufficiency. However, relationships between BNP and renal function are unknown. We sought to assess the diagnostic utility of BNP in differentiating congestive heart failure (CHF) from non-congestive heart failure (non-CHF) in patients with renal insufficiency. METHODS: BNP levels were obtained in 395 patients presenting to our emergency department with dyspnea. Of those 395 patients, 48 patients showed renal insufficiency. Patients transferred to other hospitals and those in a donot- resuscitate state were excluded. RESULTS: In patients with acute renal failure, patients with CHF (n=8) had BNP levels of 360+/-254 pg/ml whereas patients with non-CHF (n=3) had BNP levels of 114+/-103 pg/ml; however, this difference was not statistically significant. In patients with chronic renal failure, patients with CHF (n=22) had BNP levels of 1147+/-635 pg/ml, which was significantly higher than the BNP levels of 459+/-508 pg/ml for patients with non-CHF (n=7) (p=0.01). The area under the receiver operating curve, which plots sensitivity versus specificity for BNP levels in separating congestive heart failure from non-congestive heart failure in patients with chronic renal failure, was 0.805 (p=0.01). The diagnostic accuracy of BNP at a cutoff of 600 pg/ml was 76 %. CONCLUSION: The BNP cut-off value for diagnosis of CHF in patients with chronic renal failure is 600 pg/ml.
Acute Kidney Injury ; Diagnosis* ; Dialysis ; Dyspnea ; Emergency Service, Hospital ; Estrogens, Conjugated (USP)* ; Heart Failure* ; Humans ; Kidney Failure, Chronic ; Natriuretic Peptide, Brain* ; Renal Insufficiency ; Sensitivity and Specificity

PURPOSE: The purpose of this research is to evaluate the efficacy of early computed tomography in the diagnosis and treatment of bowel obstruction. METHODS: The medical records of 108 patients who underwent CT for clinically suspected bowel obstruction were reviewed retrospectively. We compared the emergency department (ED) stay time, the rate of emergent operation, and the days of hospital treatment between two groups. Group 1 have underwent CT within 3 hours, group 2 have done after 3 hours from arrival. RESULTS: After the abdominal CT, Mean ED stay time was shortened significantly. The mean ED stay time was 8.1 hours in Group 1 (n=58), and 18.0 hours in Group 2 (n=50). But We failed to reveal that the early CT is beneficial to emergent operation and total hospital time for bowel obstruction. CONCLUSION: In patients suspected bowel obstruction, Early CT is helpful for diagnosis, treatment and can shorten the ED stay time.
Diagnosis* ; Emergency Service, Hospital ; Humans ; Intestinal Obstruction ; Intestines ; Medical Records ; Retrospective Studies ; Tomography, X-Ray Computed

PURPOSE: The diagnosis of acute thoracic spinal fractures is often missed by plain radiography, alone. The purpose of this study was to compare the accuracy of radionuclide imaging with radiography, thoracic for detection of acute thoracic spinal fractures and to propose radionuclide imaging as screening tests for the diagnosis of acute thoracic spinal fractures before thoracic spine CT or MRI. METHODS: Out of the patients who were admitted to our medical center, Emergency Medicine Department for trauma from June 1, 2001, to February 28, 2003. We are retrospectively studied 67 patients who had undergone radionuclide imaging and thoracic MRI to detect acute thoracic spinal fractures. Because of their symptoms those 67 patients were suspected of having thoracic compression fractures, but those fractures had not been detected on plain thoracic spine radiographics. RESULTS: In 19 patients, 43 acute thoracic spinal fractures were detected by thoracic MRI, in 17 patients, 29 acute thoracic spinal fractures were detected by radionuclide imaging (67.4%) and in 11 patients, 14 acute thoracic spinal fractures were detected by radiography, thoracic (32.6%). The diagnostic agreement of radionuclide imaging with thoracic MRI (Kappa=0.771) was higher than that of plain radiography, thoracic with thoracic MRI (Kappa=0.439). The sensitivity, specificity, and accuracy of radionuclide imaging were 67.4%, 100%, and 93.9%, respectively, and those of plain radiography, thoracic were 32.6%, 100%, and 87.3%. The sensitivity and accuracy of radionuclide imaging for the diagnosis of acute thoracic spinal fractures were significantly higher than those of plain radiography, thoracic (p<0.05). CONCLUSION: Radionuclide imaging is more sensitive and accurate in detecting acute thoracic spinal fractures than plain thoracic spine radiography. Further study is required to prove whether radionuclide imaging is a useful screening test for acute thoracic spinal fractures instead of performing expensive thoracic spine CT or MRI.
Diagnosis* ; Emergency Medicine ; Fractures, Compression ; Humans ; Magnetic Resonance Imaging ; Mass Screening* ; Radiography ; Radiography, Thoracic ; Radionuclide Imaging* ; Retrospective Studies ; Sensitivity and Specificity ; Spinal Fractures* ; Spine

PURPOSE: This study was performed to evaluate the pediatric appendicitis score (PAS) and to propose diagnostic criteria for acute appendicitis in children. METHODS: The medical records of 194 patients who underwent appendectomies for clinically suspected acute appendicitis and the preoperative evaluations of those patients in our emergency room were, respectively, reviewed. Each of 8 clinical variables, hopping tendereness in the right lower quadrant (RLQ), anorexia, pyrexia, nausea/vomiting, RLQ tenderness, leukocytosis, neutrophilia, and migration of pain, was assigned a score of 1 or 2 to obtain a total of 10. The PAS, ultrasound (US), and combination of the PAS and US were evaluated for sensitivity, specificity, predictive value, and accuracy. RESULTS: Negative appendectomies were performed in 11.3% (22 of 194 patients) of the cases. A PAS > or = 6 was compatible with the diagnosis of appendicitis. However, in cases with a PAS< or =5, US was necessary for the diagnosis of appendicitis. Analysis of the data for the PAS and for combined PAS and US method revealed, respectively sensitivities of 73.8% and 94.6%, specificities of 86.4% and 70.6%, positive predictive values of 97.7% and 96.6%, negative predictive values of 29.7% and 60.0%, and accuracies of 75.3% and 92.1%. CONCLUSION: The PAS is a simple and good diagnostic test for assessing an acute abdomen and diagnosing acute appendicitis in children. However, a combination of the PAS and US is more accurate than the PAS alone in diagnosing acute appendicitis.
Abdomen, Acute ; Anorexia ; Appendectomy ; Appendicitis* ; Child ; Diagnosis ; Diagnostic Tests, Routine ; Emergency Service, Hospital ; Fever ; Humans ; Humulus ; Leukocytosis ; Medical Records ; Sensitivity and Specificity ; Ultrasonography

PURPOSE: Our medical institute developed an emergency department (ED) cancer unit that specialized in the management of oncologic emergencies; it was named the cancer emergency room (CER). The object of our study was to determine improvements in patient management, especially management of febrile neutropenia (FN). METHODS: This was a retrospective study of 137 febrile neutropenic episodes, including 70 episodes occurring between May 2008 and August 2008, and 67 episodes between May 2009 and August 2009. Episodes were grouped into two categories: those managed in the CER and those managed in the existing ED main treatment area of the main emergency room (MER). The time interval between presentation at the ED and first antibiotic administration, termed the door-to-needle time, clinical outcomes, and length of inpatient hospital stay were analyzed for those admitted. RESULTS: The median door-to-needle time in the CER was 2 hours (0.3-5.1), faster than the time, 3.5 hours (0.9-6.9) in the MER (p=0.000). The length of inpatient hospital stay in the CER was 4 days (1-16), shorter than that, 6 days (1-51), in the MER (p=0.034). Twelve episodes (26.1%) had adverse events in the CER and 42 (46.2%) in the MER (p=0.023). CONCLUSION: Management of FN in a unit specialized for oncologic emergencies showed faster antibiotic delivery time, more favorable outcomes and shorter duration of admission. This specialized cancer unit in the ED enables prompt and relevant management in oncologic emergencies, including events related to chemotherapy toxicity.
Anti-Bacterial Agents ; Emergencies ; Emergency Service, Hospital ; Fever ; Humans ; Inpatients ; Length of Stay ; Neutropenia ; Retrospective Studies

PURPOSE: Body fluid status of patients in an emergency room environment is a very important parameter during clinical evaluation. In this study, we wanted to know the relationship between the diameter of the inferior vena cava and the diameter of the (IVC/Ao index) and central venous pressure (CVP) in hemodynamically unstable patients. METHODS: This study was done prospectively in an emergency medical center of a hospital from January to August, 2009. We compared the diameter of the IVC, the diameter of inferior vena cava/the body surface area index (IVC/BSA index), the IVC/Ao index, and other variables. Before and after hydration of patients with a systolic blood pressure less than 90 mmHg and who had a central venous catheter in place. Then, we calculated the correlation coefficient for DeltaCVP, DeltaIVC/Ao index, and other indexes. RESULTS: Fifty-nine patients were enrolled in the study. The mean IVC diameter before hydration was 14.3+/-2.7 mm; it was 15.6+/-2.7 mm after hydration (p<0.01). The IVC/BSA index before hydration was 8.75+/-1.72 and 9.55+/-1.79 after hydration (p<0.01). The IVC/Ao index before hydration was 1.08+/-0.23; it was 1.16+/-0.25 after hydration (p<0.01). The correlation coefficient for DeltaCVP and DeltaIVC was 0.37 (p<0.01); for DeltaCVP vs. the DeltaIVC/BSA index it was 0.37 (p<0.01); for the DeltaIVC/Ao index it was 0.27 (p=0.04). CONCLUSION: CVP has a higher correlation to IVC diameter and to IVC/BSA index than to the IVC/Ao index. Hence, we should estimate the IVC/Ao index and use that estimate along with other indexes to evaluate body fluid status when dealing with hemodynamically unstable patients.
Blood Pressure ; Body Fluids ; Body Surface Area ; Central Venous Catheters ; Central Venous Pressure ; Emergencies ; Humans ; Hypogonadism ; Mitochondrial Diseases ; Ophthalmoplegia ; Prospective Studies ; Vena Cava, Inferior

PURPOSE: Hanging is a common method of suicide around the world. The prognosis after hanging injury is highly variable. Some patients die despite intensive treatment, while other patients recover without neurologic sequelae. The purpose of this study was to identify several prognostic factors affecting the outcome in patients with hanging injury. METHODS: Thirty-five patients presented at Gyeongsang National University Hospital between May 2005 and July 2009 following hanging injury. Patients, of whom 30 were unconscious, were classified as being in the initial mental status. For these patients, we investigated several factors and identified correlations between factors and prognosis. We investigated the type of hanging, mental status, presence of pupillary light reflex, glasgow coma scale (GCS), laboratory findings, presence of cardiopulmonary resuscitation (CPR) and intubation, history of psychiatric disease, alcohol use, hanging duration, brain computed tomography (CT), and injury of the spine and neck soft tissue. RESULTS: Factors suggesting a poor prognosis factors were complete hanging, poor mental status, the absence of pupillary light reflex, initial GCS, pH, bicarbonate and excess level of base, the practice of CPR and intubation. In particular, patients who showed GCS scores lower than 4.5 in the emergency room were highly likely to die. CONCLUSION: Patients after hanging injury can recover without neurologic sequelae despite altered mental status. The prognosis of patients who present with hanging injury can be established by the type of hanging, initial mental status, the presence of pupillary light reflex, initial GCS, arterial blood gas analysis (ABGA), and the practice of CPR and intubation. Therefore patients with hanging injury should be treated aggressively with consideration of prognostic factors.
Blood Gas Analysis ; Brain ; Cardiopulmonary Resuscitation ; Emergencies ; Glasgow Coma Scale ; Humans ; Hydrogen-Ion Concentration ; Intubation ; Light ; Neck ; Neck Injuries ; Prognosis ; Reflex ; Spine ; Suicide ; Unconscious (Psychology)

PURPOSE: The bicycle is a clean and future-oriented means of transportation and bicycle usage is growing. The bicycle has been in the spotlight lately with Europe and North America as the center. The purpose of this study was to establish proper prevention strategies for bicycle injuries. METHODS: In this retrospective study, we analysed 148 bicycle-related injury patients who visited our hospital between Feb 1, 2008 and Jan 31, 2009. Information such as age, gender, injury severity score, injury time, injury place, and other characteristics were collected. Data were analysed using SPSS 12.0K. RESULTS: Among the enrollees, 80.4% were male. Patients over 65 years of age accounted for only 18.2% of the group, but average injury severity score (ISS) of this group was the highest. Injuries occurred frequently between 16:00 and 22:00 in the evening, while the severity was higher between 00:00 and 08:00 in the morning. Most of the injuries developed on the roads, which included local roads, national highways, and alleyways. Injuries on the roads were more severe than those that occurred in other places. CONCLUSION: There have been suggestions for using bicycles safely. Legislation on bicycle helmet use already exists. Also, protective apparatus such as knee pads, wrist guards, and protection vests are recommended for use. Construction of more bike trails will be necessary. Above all, bicycle riders' safety consciousness is the most important part.
Accidents, Traffic ; Bicycling ; Consciousness ; Europe ; Head Protective Devices ; Humans ; Hypogonadism ; Injury Severity Score ; Knee ; Male ; Mitochondrial Diseases ; North America ; Ophthalmoplegia ; Retrospective Studies ; Risk Factors ; Transportation ; Wrist

PURPOSE: To achieve early diagnosis of hemorrhagic shock using a survival prediction model in rats. METHODS: We measured heart rate, mean arterial pressure, respiration rate and temperature in 45 Sprague-Dawley rats, and obtained an artificial neural network model for predicting survival rates. RESULTS: Area under the receiver operating characteristic (ROC) curves was 0.992. Applying the determined optimal boundary value of 0.47, the sensitivity and specificity of survival prediction were 98.4 and 96.6%, respectively. CONCLUSION: Because this artificial neural network predicts quite accurate survival rates for rats subjected to fixed-volume hemorrhagic shock, and does so with simple measurements of systolic blood pressure (SBP), mean arterial pressure (MAP), heart rate (HR), respiration rate (RR), and temperature (TEMP), it could provide early diagnosis and effective treatment for hemorrhagic shock if this artificial neural network is applicable to humans.
Animals ; Arterial Pressure ; Blood Pressure ; Early Diagnosis ; Heart Rate ; Humans ; Neural Networks (Computer) ; Rats ; Rats, Sprague-Dawley ; Respiratory Rate ; ROC Curve ; Sensitivity and Specificity ; Shock, Hemorrhagic ; Survival Rate

PURPOSE: Delayed transfer to an appropriate emergency room has been the primary reason that patients with acute ischemic stroke do not receive thrombolytic therapy. Therefore, it is crucial to develop a catchphrase system to easily recognize acute ischemic stroke. In the course of developing catchphrases for public education or campaigns, we collected and analyzed actual expressions from patients with acute ischemic stroke or their witnesses. METHODS: From January 2007 to May 2009, we enrolled 1452 patients with acute ischemic stroke who were admitted to a neurology department via an emergency room. Subjective expressions of 3 domains, which consisted of temporal characteristics at onset, body-spatial location and neurologic symptoms, were classified and the frequencies of "words" or "short phrases" were evaluated. RESULTS: In the expressions of patients with transient ischemic attack or mild stroke, "sudden" (71.1%) was the most frequent in terms of temporal characteristics at onset and was followed by "after awakening" (42.7%) and "as unusual" (7.4%). When expressing body-spatial location, "one-side arm" (51.5%), "one-side leg" (42.5%) or "onesided face" (12.5%) followed, with frequent expression of neurological symptoms of motor-parts (13.4%), speechparts (7.1%) and sensory-parts (6.7%). Patients with NIHSS > or =6 showed the same rank of expressions related to temporal and body-spatial domains. Regarding neurological symptoms, however, motor-part (74.2%), consciousness-part (50.1%) and speech-part (50.0%) were more frequent. CONCLUSION: We propose a novel Korean catchphrase, "Sudden Side Symptoms", based on a 3-dimensional system (Cubic S model) for public education so people will more easily recognize acute ischemic strokes.
Cerebral Infarction ; Emergencies ; Health Promotion ; Humans ; Ischemic Attack, Transient ; Neurologic Manifestations ; Neurology ; Stroke ; Thrombolytic Therapy ; Wit and Humor as Topic