No abstract available.

BACKGROUND: Vancomycin-resistant enterococci (VRE) infections have become a major healthcare-associated pathogen problem worldwide. Nosocomial VRE infections could be effectively controlled by screening patients at high risk of harboring VRE and thereby lowering the influx of VRE into healthcare centers. In this study, we evaluated factors associated with VRE colonization in patients transferred to emergency departments, to detect patients at risk for VRE carriage. METHODS: This study was conducted in the emergency department of a medical college-affiliated hospital in Korea. Every patient transferred to the emergency department and admitted to the hospital from January to December 2016 was screened for VRE using rectal cultures. In this cross-sectional study, the dependent variable was VRE colonization and the independent variables were demographic and clinical factors of the patients and factors related to the transferring hospital. Patients were divided into two groups, VRE and non-VRE, and previously collected patient data were analyzed. Then we performed logistic regression analyses of characteristics that differed significantly between groups. RESULTS: Out of 650 patients, 106 (16.3%) had positive VRE culture results. Significant variables in the logistic analysis were transfer from geriatric long-term care hospital (adjusted odds ration [aOR]: 8.017; 95% confidence interval [CI]: 1.378–46.651), hospital days (4–7 days; aOR: 7.246; 95% CI: 3.229–16.261), duration of antimicrobial exposure (1–3 days; aOR: 1.976; 95% CI: 1.137–3.436), and age (aOR: 1.025; 95% CI: 1.007–1.043). CONCLUSION: VRE colonization in patients transferred to the emergency department is associated primarily with factors related to the transferred hospitals rather than demographic and clinical characteristics.
Bacterial Infections ; Colon* ; Cross-Sectional Studies ; Delivery of Health Care ; Emergencies* ; Emergency Service, Hospital* ; Enterococcus* ; Humans ; Infection Control ; Korea* ; Logistic Models ; Long-Term Care ; Mass Screening ; Vancomycin Resistance ; Vancomycin-Resistant Enterococci

PURPOSE: Scoring systems such as the Modified Alvarado Score (MAS), Eskelinen score (ES), Lintula score (LS), nd Ohmann score (OS) can be helpful in the early diagnosis of acute appendicitis (AA). We analyze and compare the diagnostic value of each scoring system and investigate the optimal cut off point. METHODS: A total of 62 adult patients admitted for suspicion of acute appendicitis in a tertiary hospital emergency department were analyzed prospectively. Each scoring system was calculated at admission and compared to the final diagnosis. Receiver operating characteristic (ROC) curves were used to determine the appropriate cutoff scores of scoring systems. The sensitivity and specificity, and area under the ROC curve were calculated. RESULTS: The area under curve of the Ohmann score was higher than those of the other scoring systems (OS: 0.79, MAS: 0.73, ES: 0.65, LS: 0.67). In pairwise comparison of the ROC curve of two scoring systems, OS was found to have significantly higher predictive power than ES and LS. However, no difference was observed between MAS and OS. CONCLUSION: No single score may be used alone to dictate or decline surgery. However, the scoring system may provide helpful information for primary or emergency physicians to determine whether the patient should undergo surgical consultation may provide helpful information for use by primary or emergency physicians in determination of whether the patient should undergo surgical consultation.
Adult ; Appendicitis ; Area Under Curve ; Early Diagnosis ; Emergencies ; Humans ; Prospective Studies ; ROC Curve ; Sensitivity and Specificity ; Tertiary Care Centers

Anti-glomerular basement membrane antibody mediated rapidly progressive glomerulonephritis(anti- GBM antibody mediated RPGN) is defined by the clinical picture of renal failure developing over days or weeks and the histological appearance of crescents and linear immune deposits mediated by the circulating autoantibodies. We report a case of anti-GBM antibody mediated RPGN with review of literature. A 59-year-old female patient was admitted to the Chungang Gil Hospital because of fever and acute deterioration of renal function. On admission, hemoglobin was 7.39g/dL, hematocrit was 20.9%, and BUN/Cr were 39.7 and 5.23mg/dL respectively. Urinalysis showed albumin (1+) with many RBCs. Renal biopsy revealed the presence of segmental or circumferential cellular crescents associated with smooth linear staining of glomerular basement membrane with antibody to IgG. High titer of circulating antibody to glomerular basement membrane antigen was demonstrated by the ELISA. High doses of corticosteroid with plasmapheresis were administered, but her renal function was progressively deteriorated.
Autoantibodies ; Basement Membrane* ; Biopsy ; Enzyme-Linked Immunosorbent Assay ; Female ; Fever ; Glomerular Basement Membrane ; Glomerulonephritis* ; Hematocrit ; Humans ; Immunoglobulin G ; Middle Aged ; Plasmapheresis ; Renal Insufficiency ; Urinalysis

PURPOSE: To investigate the predictors of perforated appendicitis (PA) in pediatric patients with appendicitis seen in the emergency department. METHODS: We retrospectively reviewed 564 pediatric patients (< 16 years) who visited the emergency department and subsequently had pathologically confirmed appendicitis from 2005 through 2014. Clinical features, inflammatory markers, including the white blood cell (WBC), neutrophil, and lymphocyte counts, neutrophil-to-lymphocyte ratio, C-reactive protein (CRP) concentration, erythrocyte sedimentation rate (ESR), and the Alvarado score were compared between the patients with and without PA regarding their predictability of PA. RESULTS: Of 564 pediatric patients with appendicitis, 204 (36.2%) had PAs. The patients with PA had longer duration of symptoms and median length of hospital stay, more frequent nausea and vomiting, and higher median WBC and neutrophil counts, neutrophil-to-lymphocyte ratio, ESR, and CRP concentration. Overall, WBC count showed the highest sensitivity of 79.9% and negative predictive value of 82.6%, and CRP concentration had the highest area under the receiver operating characteristic curve of 0.72. Multivariable logistic analysis showed that WBC count > 13.5 × 109/L (odds ratio [OR], 3.27; confidence interval [CI], 1.49–7.18; P = 0.003) and ESR > 15 mm/h (OR, 3.18; 95% CI, 2.13–4.74; P < 0.001) are independent predictors of PA. CONCLUSION: WBC count and ESR might be better predictors of PA in pediatric patients with appendicitis in the emergency department than the Alvarado score and CRP concentration.
Appendicitis* ; Blood Sedimentation ; C-Reactive Protein ; Child* ; Emergencies ; Emergency Service, Hospital ; Humans ; Length of Stay ; Leukocyte Count* ; Leukocytes* ; Lymphocyte Count ; Nausea ; Neutrophils ; Pediatrics ; Prognosis ; Retrospective Studies ; ROC Curve ; Vomiting

The purpose of this study was to evaluate the influence of different types of PLGA scaffolds on the formation of human auricular and septal cartilages. The scaffolds were formed in tubular shape from 110,000 g/mol PLGA (poly lactic glycolic acid) and 220,000 g/mol one. Elastic cartilage was taken from the ear of a patient aged under 20 years old and hyaline cartilage from the nasal septum. The chondrocytes cells were then isolated by Klausburn method. After second passages, the chondrocytes were seeded on the PLGA scaffolds followed by in vitro culture for one week. The cells-PLGA scaffold complex was implanted at the back of nude mouses for 8 weeks. The tissue engineered cartilages were separated from nude mouse and examined histologically after staining with the Hematoxylin Eosin and Verhoeff. The formation of extracellular matrix and the porosity of the scaffolds were examined by scanning electron microscopy. The pores were well formed and uniformly distributed in both 110,000 g/mol and 220,000 g/mol PLGA scaffolds. The extracellular matrix was formed better in 110,000 g/mol PLGA compared to 220,000 g/mol one. And hyaline cartilage was proliferated better in vitro culture than elastic cartilage. After 8 weeks in vivo culture, cartilage was well formed with 110,000 g/mol PLGA, however lumen was collapsed. In contrast with 220,000 g/mol PLGA scaffold, neocartilage was formed in minimal amount while the architecture of scaffold was well preserved. Elastic cartilage seems to be better than hyaline one in terms of neocartilage formation. From the analysis after Verhoeff staining the cartilages, the neocartilage from elastic cartilage was proved to be elastic cartilage. In summary, there was no significant difference between elastic cartilage and hyaline cartilage in their morphologies, proliferation rates and the degree of cartilage formation since they were tissue engineered, however marked difference was found in neocartilage formation and preservation of scaffold architecture between 110,000 g/mol PLGA scaffold and 220,000 one. From the present findings, it is concluded that the influence of scaffold materials is significantly higher than that of different types of cells on the formation of new tissues.
Animals ; Cartilage* ; Chondrocytes* ; Ear ; Elastic Cartilage ; Eosine Yellowish-(YS) ; Extracellular Matrix ; Hematoxylin ; Humans* ; Hyalin* ; Hyaline Cartilage ; Mice ; Mice, Nude ; Microscopy, Electron, Scanning ; Nasal Septum ; Porosity ; Young Adult

Background: Community-based active contact and follow-up are known to be effective in reducing the risk of repeat suicide attempts among patients admitted to emergency departments after attempting suicide. However, the characteristics that define successful collaborations between emergency departments and community-based mental healthcare centers in this context are not well known. Methods: This study investigated patients visiting the emergency department after suicide attempts from May 2017 to April 2019. Patients were classified in either the successful collaboration group or the failed collaboration group depending on whether or not they were linked to a community-based follow-up intervention. Clinical features and socioeconomic status were considered as independent variables. Logistic regression analysis was performed to identify factors influencing the collaboration. Results: Of 674 patients, 153 (22.7%) were managed successfully via the targeted collaboration. Completion of hospital-based psychological counseling (adjusted odds ratio [aOR], 233.55; 95% confidence interval [CI], 14.99–3,637.67), supported out-of-pocket expenses (aOR, 11.17; 95% CI, 3.03–41.03), Korean Triage and Acuity Scale 1–3 (aOR, 4.31;95% CI, 1.18–15.73), suicide attempt associated with mental disorder (aOR, 0.15; 95% CI, 0.04–0.52), and self-discharge against medical advice (aOR, 0.12; 95% CI, 0.02–0.70) were independent factors influencing the collaboration. Conclusion Completion of hospital-based psychological counseling was the most highly influential factor determining the outcome of the collaboration between the emergency department and community-based mental healthcare center in the management of individuals who had attempted suicide. Completion of hospital-based psychological counseling is expected to help reduce the risk of repeat suicide attempts.

PURPOSE: To describe systemic complications of unconscious patients' survival six hours following cardiopulmonary resuscitation (CPR), and to evaluate the relationship between several variables and death. METHODS: We conducted a retrospective analysis of 153 cases of non-traumatic cardiac arrest that received CPR in a tertiary emergency department from April 1997 to June 2007. We carried out analyses on survival cases, and studied general characteristics and systemic complications to ascertain relationships between the survival and death groups. RESULTS: Sixty of 153 patients initially survived, but the survival rate quickly decreased to 30.1% within the first three days and then decreased slowly thereafter. In the 153 patients, hyperamylasemia occurred in 101 patients (66.0%), acute liver injury in 75(49.0%), sepsis in 67(43.8%), seizure and refractory shock in 66(43.1%), pneumonia in 65(42.5%), acute renal failure (ARF) in 64(41.8%), acute respiratory distress syndrome (ARDS) in 30(19.6%), and disseminated intravascular coagulation (DIC) in 26(17.0%). Of nine types of complications encountered, the incidences of hyperamylasemia, ARDS, ARF, refractory shock and DIC were significantly higher in patients who died than in those who survived (73.1% vs 55.0%, 28.0% vs 6.7%, 54.8% vs 21.7%, 66.7% vs 6.7%, and 23.7% vs 6.7%, respectively). CONCLUSION: Systemic complications occurred with high frequency in comatose survivors after cardiopulmonary resuscitation. Hyperamylasemia, ARDS, ARF, refractory shock and DIC were significantly associated with death.
Acute Kidney Injury ; Cardiopulmonary Resuscitation ; Coma ; Dacarbazine ; Disseminated Intravascular Coagulation ; Emergencies ; Heart Arrest ; Humans ; Hyperamylasemia ; Incidence ; Liver ; Pneumonia ; Respiratory Distress Syndrome, Adult ; Retrospective Studies ; Seizures ; Sepsis ; Shock ; Survival Analysis ; Survival Rate ; Survivors ; Unconscious (Psychology)

PURPOSE: Analgesia is essential for the treatment of children's fracture. We aimed to investigate the factors associated with administration of analgesics in children with forearm fracture. METHODS: We retrospectively reviewed medical records of children (< 20 years) with forearm fracture who visited 2 tertiary hospital emergency departments from 2014 to 2015. We analyzed factors, such as gender, age, whether the mother accompanied the visit, visiting time and route, mechanism of injury, duration of symptoms, complicated fracture, manual reduction, surgery, and type and route of analgesics. We also performed logistic regression analysis to identify the factors associated with administration of analgesics. RESULTS: Of 179 children with forearm fracture, 48 (26.8%) were administered analgesics. These children showed older age, shorter duration of symptoms, and more frequent visit with their mothers, visit during the day, use of emergency medical services, and surgery. After logistic regression analysis, we found use of emergency medical service (adjusted odds ratio [OR], 8.73; 95% confidence interval [CI], 3.16–24.08; P < 0.001), visit with the mother (OR, 6.23; 95% CI, 1.68–23.09; P = 0.006), age (OR, 1.18; 95% CI, 1.05–1.32; P = 0.004), and duration of symptoms (OR, 0.99; 95% CI, 0.986–0.999; P = 0.035) as the factors associated with administration of analgesics. CONCLUSION: The factors associated with administration of analgesics might be communicating skill-related factors, such as older age and shorter duration of symptoms. Children with poor communicating skill may need more aggressive analgesia in the emergency department.
Analgesia ; Analgesics* ; Child* ; Emergencies ; Emergency Medical Services ; Emergency Service, Hospital ; Forearm* ; Fractures, Bone ; Humans ; Logistic Models ; Medical Records ; Mothers ; Odds Ratio ; Pain Management ; Retrospective Studies ; Tertiary Care Centers ; Wounds and Injuries

PURPOSE: This study was conducted to determine the predictive value of the C-reactive protein (CRP) and kidney computed tomography (CT) in the emergency department (ED) for predicting the severity of acute pyelonephritis. METHODS: One hundred thirty-nine patients who were diagnosed with acute pyelonephritis between January 2007 and June 2008 were enrolled in this study. The patient underwent a kidney CT in the ED and the CT findings were classified as normal, a focal wedge-shaped lesion, a multi-focal wedge-shaped lesion, a mass-effect lesion, and abscess formation. The symptoms, vital signs, past history, initial laboratory findings, serum CRP in the ED, and the length of the hospital stay based on the kidney CT grade in the ED were compared. RESULTS: Among the 139 patients, 138 were females and the mean age was 48.5+/-17.7 years. We classified the CT grades as follows: grade 1, normal (n=20); grade 2, focal wedge-shaped lesion (n=25); grade 3, multi-focal wedgeshaped lesion (n=45); grade 4, mass-effect lesion (n=42); and grade 5, abscess formation (n=7). Statistically significant differences in leukocyte count, neutrophil ratio, ESR, CRP, and length of hospital stay existed between the CT grades. Patients were classified into two groups based on the CT grade (the mild group [grades 1 and 2], and the severe group [grades 3~5]). The leukocyte count, neutrophil ratio, ESR, CRP, maximal body temperature, duration of fever, duration of pyuria >3 days, and length of hospital stay were greater in the severe group. Based on the results of multivariate logistic regression analysis, the CRP level was shown to be an independent predictor that affected the severe group. The area under the ROC curve for CRP was 0.775 (95% CI, 0.695~0.854). CONCLUSION: The CRP level in the ED was an independent predictor that affected the severe group. Thus, the initial CRP level with the kidney CT grade may be used as a prognostic indicator of acute pyelonephritis in the ED.
Abscess ; Body Temperature ; C-Reactive Protein ; Emergencies ; Female ; Fever ; Humans ; Kidney ; Length of Stay ; Leukocyte Count ; Logistic Models ; Neutrophils ; Pyelonephritis ; Pyuria ; ROC Curve ; Tomography, Spiral Computed ; Vital Signs