BACKGROUND: This study aimed to estimate risk adjusted mortality rate in the ICUs (Intensive care units) by APACHE (Acute Physiology And Chronic Health Evaluation) III for revealing the performance variation in ICUs. METHODS: This study focused on 1,090 patients in the ICUs of 18 hospitals. For establishing risk adjusted mortality predictive model, logistic regression analysis was performed. APACHE III, surgery experience, admission route, and major disease categories were used as independent variables. The performance of each model was evaluated by c-statistic and goodness-of-fit test of Hosmer-Lemeshow. Using this predictive model, the performance of each ICU was tested as ratio of predictive mortality rate and observed mortality rate. RESULTS: The average observed mortality rate was 24.1%. The model including APACHE III score, admission route, and major disease categories was signified as the fittest one. After risk adjustment, the ratio of predictive mortality rate and observed mortality rate was distributed from 0.49 to 1.55. CONCLUSIONS: The variation in risk adjusted mortality among ICUs was wide. The effort to reduce this quality difference is needed.
APACHE ; Humans ; Critical Care ; Intensive Care Units ; Logistic Models ; Risk Adjustment

OBJECTIVES: This study was conducted to estimate the socioeconomic cost of injuries in South Korea. METHODS: We matched claims data from national health insurance, automobile insurance and industrial accident compensation insurance (IACI), and mortality data obtained from the national statistical office from 2001 to 2003 by patients' unique identifier. Socioeconomic cost included both direct cost and indirect cost: the direct cost was injury-related medical expenditure and the indirect cost included loss of productivity due to healthcare utilization and premature death. RESULTS: The socioeconomic cost of injuries in Korea was approximately 1.9% of the GDP from 2001 to 2003. That is, 12.1 trillion KRW (Korean Won) in 2001, 12.3 trillion KRW in 2002, and 13.7 trillion KRW in 2003. In 2003, direct medical costs were 24.6% (3.4 trillion KRW), the costs for loss of productivity by healthcare utilization were 13.0% (1.8 trillion KRW), and the costs for loss of productivity by premature death were 62.4% (8.6 trillion KRW). CONCLUSIONS: In this study, the socioeconomic cost of injuries in Korea between 2001 and 2003 was estimated by using not only health insurance claims data, but also automobile insurance, IACI claims and mortality data. We conclude that social efforts are required to reduce the socioeconomic cost of injuries in Korea, which represented approximately 1.9% of the GDP for the time period specified.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; *Cost of Illness ; Efficiency ; Female ; *Health Care Costs ; Humans ; Infant ; Infant, Newborn ; Inpatients ; Korea ; Length of Stay ; Male ; Middle Aged ; Outpatients ; Socioeconomic Factors ; Wounds and Injuries/*economics/mortality

OBJECTIVES: This study was conducted to estimate the cumulative incidence rate (CIR) of unintentional injuries in Korean daily life and to describe the pattern of unintentional injuries. METHODS: The study population was the people who used the National Health Insurance because of injuries (ICD code: S00~T98) during 2006. The stratified sample according to gender, age and the severity of injury (NISS, New Injury Severity Score) was randomly selected. The questions on the questionnaire were developed as a reference for an international classification tool (ICECI, International Classification of External Causes of Injury). The questions included the locations of injury, the mechanisms of injury and the results of injury. Moreover, we used age, gender, region and income variables for analysis. RESULTS: The CIR of unintentional injuries that occurred in daily life for 1 year per 100,000 persons was 17,606, and the CIR of severe injuries was 286. Many injuries were occurred at home (29.6%), public places (19.0%), school (13.7%) and near home (12.0%). The major mechanisms of injuries were slipping (48.8%), contact (14.0%), physical over-exertion (13.8%), and fall (6.6%). Infants and old aged people were vulnerable to injuries, and those who lived rural area and who were in a low income level were vulnerable too. CONCLUSIONS: We signified the risk groups and risk settings of unintentional injuries in Korean daily life. These results could contribute to establishing strategies for injury prevention and implementing these strategies.
Accidents/*statistics & numerical data ; Adolescent ; Adult ; Age Factors ; Aged ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Infant, Newborn ; Korea/epidemiology ; Male ; Middle Aged ; Residence Characteristics ; Sex Factors ; Socioeconomic Factors ; Trauma Severity Indices ; Wounds and Injuries/classification/*epidemiology

OBJECTIVES: To investigate the patterns of unintentional home injuries in Korea. METHODS: The study population was 12,382,088 people who utilized National Health Insurance services due to injuries (main diagnosis codes S00 to T28) during 2006. Stratified samples(n=459,501) were randomly selected by sex, age group and severity of injury. A questionnaire was developed based on the International Classification of External Causes of Injury and 18,000 cases surveyed by telephone were analyzed after being projected into population proportionately according to the response rates of their strata. Domestic injury cases were finally included. RESULTS: Domestic injuries (n=3,804) comprised 21.1% of total daily life injuries during 2006. Women were vulnerable to home injuries, with the elderly and those of lower income (medical-aid users) tending to suffer more severe injuries. Injury occurred most often due to a slipping fall (33.9%), overexertion (15.3%), falling (9.5%) and stumbling (9.4%), with severe injury most often resulting from slipping falls, falls and stumbles. Increasing age correlated with domestic injury-related disability. CONCLUSIONS: The present findings provide basic information for development of home injury prevention strategies, with focus on the elderly.

PURPOSE: The purpose of this study was to evaluate the experiences of patients who used emergency department services and to analyze the factors which influenced their willingness to use them again. METHODS: The survey was carried out at 17 emergency medical centers for one days, and 509 patients and caregivers answered the questions. The questionnaire was developed through literature review and consultation with professionals. The survey questions addressed the following: duration of residence in ED (emergency department), waiting times, fairness of waiting times, respectfulness from medical staff, explanation of treatment plan, explanation of medical test, explanation of drug prescription, explanation of discharge, ease of asking about treatment, response times to requests for help, respect for privacy, existence of threatening situations and cleanliness of ED. RESULTS: The major factors which influenced patients' willingness to return were duration of residence in ED, fairness of waiting times, respectfulness from medical staff, explanation of drug prescription, ease of asking about treatment, existence of threatening situations and cleanliness of ED. Only education among all demographic and socio-economic factors and clinical outcomes had a bearing on willingness to return. CONCLUSION: The evaluation of patients' experiences is a useful method for gauging the quality of emergency department services. Moreover, specifically focused questions about patients' experiences can greatly contribute to improving the quality of emergency department services.
Caregivers ; Drug Prescriptions ; Emergencies ; Emergency Medical Services ; Humans ; Medical Staff ; Morphinans ; Privacy ; Surveys and Questionnaires ; Reaction Time ; Ursidae

Background/Aims: To investigate a reported outbreak of presumed hepatitis E virus (HEV) infection in a Korean food manufacturing facility and to explore the association between anti-HEV immunoglobulin M (IgM) positivity and coronavirus disease 2019 (COVID-19) infection or vaccination. Methods: Twenty-four cases of anti-HEV IgM positivity were reported among 646 workers at the facility in 2022. An epidemiological investigation was conducted, comprising HEV-RNA testing of blood and environmental samples, analysis of group meal records, and an association between anti-HEV IgM positivity and confirmed COVID-19 infection or vaccination. Results: All 24 patients were asymptomatic, with cases spread sporadically across the facility. HEV RNA was not detected in the serum or environmental samples. Four out of 340 meals (1.2%) showed a significantly higher proportion of anti-HEV positivity in each meal intake group than in the non-intake group on certain days. Although the cumulative rate of COVID-19 infection showed no difference, the anti-HEV IgM positive group showed significantly higher proportions of >2 doses of COVID-19 vaccination (83.3% vs 48.7%, p=0.021), vaccination within 90 days (45.8% vs 19.7%, p=0.008), and having the Moderna vaccine administered as the last vaccine (75.0% vs 14.5%, p<0.001) than those of the anti-HEV negative group. In four multivariable models, three or more COVID-19 vaccinations and the Moderna vaccine as the last vaccine were consistently associated with anti-HEV IgM positivity, while the specific day group meal intake was also a significant factor. Conclusions This epidemiological investigation showed that anti-HEV IgM positivity may occur as a false-positive result related to COVID-vaccination over three times and use of the Moderna vaccine, although a portion of true HEV infection may not be excluded.

In November 2021, 14 international travel-related severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) B.1.1.529 (omicron) variant of concern (VOC) patients were detected in South Korea. Epidemiologic investigation revealed community transmission of the omicron VOC. A total of 80 SARS-CoV-2 omicron VOC-positive patients were identified until December 10, 2021 and 66 of them reported no relation to the international travel.There may be more transmissions with this VOC in Korea than reported.