Proper seat belt use saves lives; however, the use rate decreased in Korea. This study aimed to measure the magnitude of the preventive effect of seat belt on case-fatality across drivers and passengers. We used the Emergency Department based Injury In-depth Surveillance (EDIIS) database from 17 EDs between 2011 and 2012. All of adult injured patients from road traffic injuries (RTI) in-vehicle of less than 10-seat van were eligible, excluding cases with unknown seat belt use and outcomes. Primary and secondary endpoints were in-hospital mortality and intracranial injury. We calculated adjusted odds ratios (AORs) of seat belt use and driving status for study outcomes adjusting for potential confounders. Among 23,698 eligible patients, 15,304 (64.6%) wore seat belts. Driver, middle aged (30-44 yr), male, daytime injured patients were more likely to use seat belts (all P < 0.001). In terms of clinical outcome, no seat belt group had higher proportions of case-fatality and intracranial injury compared to seat belt group (both P < 0.001). Compared to seat belt group, AORs (95% CIs) of no seat belt group were 10.43 (7.75-14.04) for case-fatality and 2.68 (2.25-3.19) for intracranial injury respectively. In the interaction model, AORs (95% CIs) of no seat belt use for case-fatality were 11.71 (8.45-16.22) in drivers and 5.52 (2.83-14.76) in non-driving passengers, respectively. Wearing seat belt has significantly preventive effects on case-fatality and intracranial injury. Public health efforts to increase seat belt use are needed to reduce health burden from RTIs.
Accidents, Traffic/mortality/*prevention & control ; Adult ; Aged ; Craniocerebral Trauma/prevention & control ; Databases, Factual ; Emergency Service, Hospital ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Motor Vehicles ; Odds Ratio ; Republic of Korea/epidemiology ; Seat Belts/*utilization ; Young Adult

BACKGROUND: Intraperitoneal(IP) vancomycin has been widely used for the treatment of peritonitis or exit-site infection associated with continuous ambulatory peritoneal dialysis(CAPD). However, some previous reports in the literature have suggested that IP administration of certain vancomycin may be associated with chemical peritonitis in CAPD patients. METHODS: Between 1 February 1994 and 1 February 1997, 35 consecutive CAPD patients requiring treatment with intraperitoneal vancomycin for either exit-site infection or peritonitis in the Yeungnam University Hospital were recruited retrospectively into the study. We compared retrospectively the incidence of chemical peritonitis after using two different preparations of vancomycin from different pharmaceutical companies, namely vancocin CP(R) and vancomycin(R). RESULTS: Thirty-three cases(all 26 cases given vancocin CP(R) and 7 out of the 9 cases given vancomycin(R)) showed improvement. None of them developed fever, abdominal pain or cloudy dialysate. Out of the 9 cases given IP vancomycin(R), two who currently did not have abdominal pain and cloudy dialysis effluent develolped these symptom and sign at 5 and 6 hours after administration of IP vancomycin. The chemical peritonitis may be secondary to prolonged contact of the peritoneal membrane with one or more of the impurities present in vancomycin preparation. CONCLUSION: In summary, it is necessary for the nephrologists to be aware of the possible chemical peritonitis which can be caused by the impurities of certain brand of vancomycin.
Abdominal Pain ; Dialysis ; Fever ; Humans ; Incidence ; Membranes ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis* ; Retrospective Studies ; Vancomycin*

PURPOSES: There have been many efforts to improve the service of emergency centers. In spite of these, no evidence is showing any landmark advancement of emergency services, especially in the hospital stage, exists. We need some efficient standard criteria to evaluate emergency service in the hospital stage, and a useful method might utilize the overcrowding index. We want to know the change in the overcrowding index at a regional emergency center after injury area administration. Injury area means an area in which only an assigned duty physician manages patients with injuries such as those from traffic accidents, falls, assualts, collisions, lacerations, amputations, burns, intoxication, asphyxia, drowning, animal bites, sexual assualts, etc. METHODS: We started to operate an injury area in our emergency department from late 2004, and from January to June in 2004 and in 2005, we collected patients' data, age, sex, assigned department, and result from hospital order communication system to figure out overcrowding indices and result indices. We found the daily number of patients, the turnover rate, the admission rate, the ICU admission rate, the emergency operation rate, the ED stay duration, and the ED patient volume to be overcrowding indices. Also we found the withdrawal rate, the transfer rate, and mortality to be result indices. We compared these indices between 2004 to 2005 by using a t-test. RESULTS: There was a significant increase in the daily number of visiting patients in 2005, overcrowding indices, such as the turnover rate, the admission rate, the ICU admission rate, and the emergency operation rate, also showed statistically significant increases in 2005 (P<0.001). As for the result indices, there was a noticeable decrease in the number of withdrawals (11.77/day in 2004 to 4.53/day in 2005). CONCLUSION: Operating an injury area in a mildly overcrowded local emergency center is beneficial. Evaluating the effect of operating an injury area and it's impact on hospital finances by conducting a similar study analyziing patients for a longer duration would be valuable.
Accidents, Traffic ; Amputation ; Animals ; Asphyxia ; Burns ; Drowning ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Lacerations ; Mortality

Human uterus has been known as a immune privileged site for the product of conception. At the feto-maternal interface, Fas system is a underlying main mechanism of maternal immune acceptance. To date, the TRAIL (TNF-related apoptosis-inducing ligand) system is known to be another pivotal mechanism. OBJECTIVE: To clarify the protein expression of TRAIL ligand and receptors in the normal and pathologic (preeclampsia, hydatidiform mole) placenta, chorioamnion, decidua. METHODS: we investigated the expression of TRAIL system in the above-mentioned tissues by using Western Hybridization. RESULTS: All tissues expressed TRAIL ligand and only a DcR2 among TRAIL receptors (DR4, DR5, DcR1, DcR2). CONCLUSION: we demonstrated the expression of TRAIL ligand and DcR2 protein at the feto-maternal interface of the normal and pathologic pregnancies. Further study regarding the expression of other receptors and quantitative analysis between normal and pathologic pregnancies should be followed.
Apoptosis* ; Decidua ; Female ; Fertilization ; Gestational Trophoblastic Disease* ; Humans* ; Placenta ; Pregnancy ; Receptors, TNF-Related Apoptosis-Inducing Ligand ; Uterus

PURPOSE: No valuable early marker exists for the prognosis of patients resuscitated from out-of-hospital cardiac arrest (OHCA). We compared post-resuscitation levels of several biochemical candidates and correlated them with outcomes of cardiopulmonary resuscitation (CPR). METHODS: Eligible resuscitated patients with OHCA were prospectively enrolled from December 1, 2004 to November 30, 2005. Demographic data were collected and early levels of biochemical candidates were measured both at the time of initiation of CPR and immediately after the return of spontaneous circulation (ROSC), including those of ischemia-modified albumin (IMA), procalcitonin, and S-100 protein. The ROSC over 20 minutes, survival from the emergency room (ER), survival after 1 month, and Glasgow Outcome Scale (GOS) after 1 month were evaluated for outcome. Levels of early biochemical candidates were correlated with those outcomes. RESULTS: 126 patients were eligible for analysis. 81 (64.3%) were male, and the mean age was 59.6+/-17.2 years. The rate of ROSC, survival from ER, and survival after 1 month were 40.5%, 33.3%, and 8.7%, respectively. 4 patients whose GOS was more than 4 showed good neurological outcome. The levels of S-100 protein were significantly lower in the survival group than in the non-survival group after 1 month: 1.6+/-0.8 versus 3.9+/-4.9 microgram/L at the time of initiation of CPR (p<0.01), and 1.6+/-1.1 versus 4.5+/-5.0 microgram/L immediately after ROSC (p=0.01), respectively. IMA and procalcitonin did not show any predictive value. CONCLUSION : The levels of S-100 protein was found to be useful as an early biochemical marker for prognosis following OHCA. S-100 concentrations were significantly lower in the survival group than in the non-survival group after 1 month after successful resuscitation from OHCA.
Biomarkers* ; Cardiopulmonary Resuscitation ; Emergency Service, Hospital ; Glasgow Outcome Scale ; Heart Arrest ; Humans ; Ischemia* ; Male ; Out-of-Hospital Cardiac Arrest* ; Prognosis* ; Prospective Studies ; Resuscitation ; S100 Proteins*

PURPOSE: No valuable early marker exists for the prognosis of patients resuscitated from out-of-hospital cardiac arrest (OHCA). We compared post-resuscitation levels of several biochemical candidates and correlated them with outcomes of cardiopulmonary resuscitation (CPR). METHODS: Eligible resuscitated patients with OHCA were prospectively enrolled from December 1, 2004 to November 30, 2005. Demographic data were collected and early levels of biochemical candidates were measured both at the time of initiation of CPR and immediately after the return of spontaneous circulation (ROSC), including those of ischemia-modified albumin (IMA), procalcitonin, and S-100 protein. The ROSC over 20 minutes, survival from the emergency room (ER), survival after 1 month, and Glasgow Outcome Scale (GOS) after 1 month were evaluated for outcome. Levels of early biochemical candidates were correlated with those outcomes. RESULTS: 126 patients were eligible for analysis. 81 (64.3%) were male, and the mean age was 59.6+/-17.2 years. The rate of ROSC, survival from ER, and survival after 1 month were 40.5%, 33.3%, and 8.7%, respectively. 4 patients whose GOS was more than 4 showed good neurological outcome. The levels of S-100 protein were significantly lower in the survival group than in the non-survival group after 1 month: 1.6+/-0.8 versus 3.9+/-4.9 microgram/L at the time of initiation of CPR (p<0.01), and 1.6+/-1.1 versus 4.5+/-5.0 microgram/L immediately after ROSC (p=0.01), respectively. IMA and procalcitonin did not show any predictive value. CONCLUSION : The levels of S-100 protein was found to be useful as an early biochemical marker for prognosis following OHCA. S-100 concentrations were significantly lower in the survival group than in the non-survival group after 1 month after successful resuscitation from OHCA.
Biomarkers* ; Cardiopulmonary Resuscitation ; Emergency Service, Hospital ; Glasgow Outcome Scale ; Heart Arrest ; Humans ; Ischemia* ; Male ; Out-of-Hospital Cardiac Arrest* ; Prognosis* ; Prospective Studies ; Resuscitation ; S100 Proteins*

PURPOSE: This study was aimed to develop secondary triage rule for decision of interfacility transfer to higher level of trauma center for patients with traumatic brain injury (TBI). METHODS: In a prospective observational study from August 2006 to December 2007 conducted in an urban tertiary emergency department, data were obtained from patients more than 15 years old and with TBI. Primary outcome was defined as meaningful positive CT findings. Secondary outcome was defined as meaningful intervention. Non-adjusted univariated logistic regression model was derived from result of chi-square test and adjusted model was derived using stepwise selection manner. Hosman-Lemeshow test for the goodness of fit was used. RESULTS: Total number of eligible patients with traumatic brain injury was 653. Primary outcome was positive in 103 patients and secondary outcome was positive in 42 patients. In univariate logistic regression, risk factors were age over 65(OR: 2.40), history of cerebrovascular disease(OR: 7.08), fall over two meter(OR: 6.28), pedestrian struck(OR: 18.5), headache(OR: 2.18), vomiting(OR: 3.03), disorientation(OR: 5.37), any evidence of open fracture(OR: 24.03), Glasgow coma sacle less than 13(OR: 4.97), Racoon's eye sign (OR: 2.50). These 10 risk factors were statistically significant in adjusted model which was derived using stepwise selected manner. Hosman-Lemeshow test for the goodness of fit was used and chi-square was 1.307(p=0.86). This decision rule had a sensitivity of 93.48%, a specificity of 41.13%, and a negative predictive value of 97.32%. CONCLUSION: A sensitive clinical decision rule with high negative predictive value for detection of abnormal CT lesions which need transfer to higher level of trauma center was developed.
Brain Injuries ; Coma ; Emergencies ; Eye ; Humans ; Logistic Models ; Prospective Studies ; Risk Factors ; Sensitivity and Specificity ; Trauma Centers ; Triage

No abstract available.
Angiolipoma*

PURPOSE: This study was performed to evaluate the effects of prehospital emergency care use by 119 rescue services on the outcome of acute ST-elevation myocardial infarction (STEMI). METHODS: All patients who visited 23 hospital emergency departments and who were finally diagnosed with STEMI between January and December 2008 were enrolled. They were divided into two groups: use of 119 rescue service or non-use. The propensity score matching method was used considering factors known to be influential for the use of 119 rescue services (age, gender, educational status, chief complaints, cardiogenic shock, respiratory rate, heart rate). Hospital mortality was defined as patient death in the hospital following admission. The comparative odds ratio (OR) and confidence interval (CI) of mortality between the 119 use and non-use groups were determined. RESULTS: Of the 1,118 STEMI patient, no statistical differences were evident in gender and age. Patients who used the 119 rescue services displayed lower educational status and rare complaint of chest pain is rare (36.6% vs 63.4%). But syncope and cardiac arrest were more frequent in the 119 user group than non-user group (syncope: 84.6% vs 15.4%, respectively; cardiac arrest: 76.0% vs 24.0%, respectively). Propensity score matching system was performed and extracted 390 patients in each group. The extracted patients were not statistically different in demographic findings and influencing factors of 119 service use. Hospital mortality did not differ between the 119 user and non-user groups (OR=1.294, 95% CI:0.612-2.735). Increased hospital mortality of STEMI patients was correlated with increased age (OR=1.036, 95% CI:1.012-1.060), prehospital ECG monitoring (OR=2.601, 95% CI:1.011-6.693), and cardiogenic shock (OR=4.736, 95% CI:2.482-9.037). CONCLUSION: The use of prehospital mobile units did not influence on hospital mortality of acute ST-elevation myocardial infarction.
Ambulances ; Chest Pain ; Educational Status ; Electrocardiography ; Emergencies ; Emergency Medical Services ; Heart ; Heart Arrest ; Hospital Mortality ; Humans ; Myocardial Infarction ; Odds Ratio ; Propensity Score ; Respiratory Rate ; Shock, Cardiogenic ; Syncope

PURPOSE: This study was performed to evaluate the effects of prehospital emergency care use by 119 rescue services on the outcome of acute ST-elevation myocardial infarction (STEMI). METHODS: All patients who visited 23 hospital emergency departments and who were finally diagnosed with STEMI between January and December 2008 were enrolled. They were divided into two groups: use of 119 rescue service or non-use. The propensity score matching method was used considering factors known to be influential for the use of 119 rescue services (age, gender, educational status, chief complaints, cardiogenic shock, respiratory rate, heart rate). Hospital mortality was defined as patient death in the hospital following admission. The comparative odds ratio (OR) and confidence interval (CI) of mortality between the 119 use and non-use groups were determined. RESULTS: Of the 1,118 STEMI patient, no statistical differences were evident in gender and age. Patients who used the 119 rescue services displayed lower educational status and rare complaint of chest pain is rare (36.6% vs 63.4%). But syncope and cardiac arrest were more frequent in the 119 user group than non-user group (syncope: 84.6% vs 15.4%, respectively; cardiac arrest: 76.0% vs 24.0%, respectively). Propensity score matching system was performed and extracted 390 patients in each group. The extracted patients were not statistically different in demographic findings and influencing factors of 119 service use. Hospital mortality did not differ between the 119 user and non-user groups (OR=1.294, 95% CI:0.612-2.735). Increased hospital mortality of STEMI patients was correlated with increased age (OR=1.036, 95% CI:1.012-1.060), prehospital ECG monitoring (OR=2.601, 95% CI:1.011-6.693), and cardiogenic shock (OR=4.736, 95% CI:2.482-9.037). CONCLUSION: The use of prehospital mobile units did not influence on hospital mortality of acute ST-elevation myocardial infarction.
Ambulances ; Chest Pain ; Educational Status ; Electrocardiography ; Emergencies ; Emergency Medical Services ; Heart ; Heart Arrest ; Hospital Mortality ; Humans ; Myocardial Infarction ; Odds Ratio ; Propensity Score ; Respiratory Rate ; Shock, Cardiogenic ; Syncope