Purpose: We aimed to evaluate whether pediatric emergency practice has improved since the introduction of pediatric specialist care (PSC). Methods: Retrospective observational study was conducted using the data retrieved from the emergency department (ED) of a tertiary university hospital in Cheongju, Korea. Patients younger than 19 years who visited the ED from January 2019 through December 2023 were enrolled in this study. Hospitalization (overall and intensive care unit [ICU]), in-hospital mortality, and return visit within 24 hours were compared between the periods before (January 2019-January 2021) and after (June 2021-December 2023) the introduction of PSC. Adjusted odds ratios with 95% confidence intervals were calculated for the outcomes using multivariable logistic regression. Results: During the study period, a total of 36,162 patients visited the ED. The visits increased from 12,196 before to 22,387 after the introduction of PSC (increase by 83.6%). Annual numbers of the visits have increased since 2020 and reached 10,942 in 2023. After the introduction of PSC, decreases were noted in the hospitalization (adjusted odds ratio, 0.67; 95% confidence interval, 0.62-0.72) and return visit within 24 hours (0.73; 0.61-0.88). Hospitalization to the ICU increased (2.90; 2.29-3.69), while there was no significant difference in the in-hospital mortality (1.31; 0.77-2.25). Conclusion After the introduction of PSC, overall hospitalization and return visit decreased, while hospitalization to the ICU increased without a difference in the in-hospital mortality. Multidisciplinary efforts are needed to continue providing the pediatric specialist-centered emergency practice.

Objective: Epinephrine is a first-line drug for anaphylaxis, but a poor prognosis can occur if not administered properly. This study compared the clinical features of patients with anaphylaxis in the emergency department (ED) according to epinephrine administration. Methods: This was a retrospective cross-sectional study using ED-based data retrieved from a tertiary university hospital. Patients diagnosed with anaphylaxis between 2018 and 2020 were enrolled in this study. The patients with anaphylaxis were classified according to epinephrine administration, and the clinical features were compared. The adjusted odds ratios (AORs) with a 95% confidence interval (CI) were calculated for the main factors associated with epinephrine use. Results: Among 205 eligible patients with anaphylaxis, 157 (76.6%) were treated with epinephrine. The main contributing factors influencing epinephrine use were patients with cardiovascular symptoms (AOR=2.97; 95% CI, 1.26-7.01) and patients transferred from other hospitals (AOR=0.37; 95% CI, 0.16-0.85). Conclusion The major factors influencing epinephrine use in the ED when patients with anaphylaxis presented with cardiovascular symptoms were identified. It is essential to prevent potentially fatal consequences in patients with anaphylaxis through appropriate epinephrine administration.

Objective: Frequent emergency department (ED) visit is a global public health problem that can delay proper management and reduce the quality of medical services. While many researches were done on adult frequent ED users, studies lack on pediatric patients. This study was designed to identify the characteristics of the frequent pediatric ED users and risk factors related to pediatric frequent ED visits. Methods: This was a retrospective observational study using ED-based data derived from pediatric patients at a tertiary university hospital. The main exposure variable was frequent pediatric ED visits, which were defined as more than 4 visits within a year (January 1-December 31, 2019). Characteristics and risk factors for frequent pediatric ED users were evaluated using forward stepwise regression analysis. Results: During the study period, 10,050 pediatric ED visits (8,313 patients) were identified. Of which, 550 (5.5%) were frequent ED visits (114 patients, 1.4%). The independent risk factors for frequent pediatric ED visits were age <1 year (adjusted odds ratio [AOR], 2.79; 95% confidence interval [CI], 1.32-5.93), visiting during spring and winter (AOR, 5.72; 95% CI, 3.36-9.75) and visiting due to medical problem (AOR, 1.66; 95% CI, 1.02-3.08). Primary diagnosis of unspecified convulsions, acute lower respiratory infection, other specified medical care, and arrhythmia were associated with frequent pediatric ED visits. Conclusion Age <1 year, visiting ED during spring and winter, visiting ED due to medical problem can increase the risk of frequent ED visit by pediatric patients.

Objective: Resuscitation-related gastric inflation is associated with inadequate ventilation and the risk of gastric regurgitation in out-of-hospital cardiac arrest (OHCA) patients. This study aims to estimate resuscitation-related gastric inflation values by using multi-detector computed tomography (MDCT) scanning. Methods: MDCT imaging data were obtained from OHCA patients undergoing resuscitation from January 2014 to December 2020. Thirty age- and sex-matched healthy controls that underwent an MDCT scan were included. Gastric air volume (GAV), total gastric volume (TGV), and GAV/gastric content volume (GCV) ratio values were estimated. Results: In healthy controls (n=30), GAV and TGV values were in the range 5.0-35.0 mL, and 202.0-1,002.0 mL, respectively. The mean GAV and TGV values of OHCA patients (n=97) were 251.0 mL (range, 55.5-896.0) and 878.0 mL (range, 430.5-1,696.0), respectively. Significant between-group differences were determined in the mean GCV, GAV, and GAV/GCV ratio values. In OHCA patients, the cut-off value for abnormal GAV was defined as 56.5 mL (mean value plus two times standard deviation). Patients with abnormal GAV findings on MDCT scans had a longer duration from arrest to the return of spontaneous circulation, low body mass index, and increased rates of lactic acidosis. Conclusion Our results indicate an association between gastric air accumulation after resuscitation with longer recovery from arrest to return of spontaneous circulation, low body mass index, and increased lactic acidosis.

Objectives: Given that cardiopulmonary resuscitation (CPR) is an aerosol-generating procedure, it is necessary to use a mechanical ventilator and reduce the number of providers involved in resuscitation for in-hospital cardiac arrest in coronavirus disease (COVID-19) patients or suspected COVID-19 patients. However, no study assessed the effect of changes in inspiratory time on flowrate and airway pressure during CPR. We herein aimed to determine changes in these parameters during CPR and identify appropriate ventilator management for adults during CPR. Methods: We measured changes in tidal volume (Vt), peak inspiratory flow rate (PIFR), peak airway pressure (Ppeak), mean airway pressure (Pmean) according to changes in inspiratory time (0.75 s, 1.0 s and 1.5 s) with or without CPR. Vt of 500 mL was supplied (flowrate: 10 times/min) using a mechanical ventilator. Chest compressions were maintained at constant compression depth (53 ± 2 mm) and speed (102 ± 2/min) using a mechanical chest compression device. Results: Median levels of respiratory physiological parameters during CPR were significantly different according to the inspiratory time (0.75 s vs. 1.5 s): PIFR (80.8 [73.3 – 87.325] vs. 70.5 [67 – 72.4] L/min, P < 0.001), Ppeak (54 [48 – 59] vs. 47 [45 – 49] cmH2O, P < 0.001), and Pmean (3.9 [3.6 – 4.1] vs. 5.7 [5.6 – 5.8] cmH2O, P < 0.001). Conclusions Changes in PIFR, Ppeak, and Pmean were associated with inspiratory time. PIFR and Ppeak values tended to decrease with increase in inspiratory time, while Pmean showed a contrasting trend. Increased inspiratory time in low-compliance cardiac arrest patients will help in reducing lung injury during adult CPR.

Objective: This study examined whether the preventive effects of the safety belt on traumatic brain injury (TBI) from motor vehicle collisions (MVCs) differ according to the occupants’ age. Methods: This study was a retrospective, observational study. This study evaluated the crash data from 2011 to 2016 obtained from the Emergency Department-based Injury In-depth Surveillance registry. The injured occupants were categorized by age into young adults (age, 18-35 years; n=35,032), middle-aged adults (age, 36-55 years; n=34,507), and older adults (aged older than 55 years, n=21,895). The primary (TBI), secondary (intensive care unit [ICU] admission), and tertiary endpoint (mortality) were set. Multivariate logistic regression analysis was performed, and the adjusted odds ratios (aORs) of subgroups were calculated for study outcomes adjusted for any potential confounders. Results: Among 91,434 patients, 61,205 used seat belts at the time of the crashes. Compared to the unbelted group, the belted group was less likely to have a TBI. A comparison of the aOR of subgroups for TBI revealed the odds ratio reduction to be the highest in young adults (aOR, 0.39; 95% confidence interval [CI], 0.32-0.47), followed by middle-aged adults (aOR, 0.39; 95% CI, 0.33-0.47) and older adults (aOR, 0.49; 95% CI, 0.42-0.56). In addition, seat belt use had a preventive effect on ICU admission and mortality at all subgroups, the effect of which decreased with age. Conclusion The protective effects of seat belts on TBI, ICU admission, and mortality from MVCs were reduced with age.

Objective: This study examined whether the preventive effects of the safety belt on traumatic brain injury (TBI) from motor vehicle collisions (MVCs) differ according to the occupants’ age. Methods: This study was a retrospective, observational study. This study evaluated the crash data from 2011 to 2016 obtained from the Emergency Department-based Injury In-depth Surveillance registry. The injured occupants were categorized by age into young adults (age, 18-35 years; n=35,032), middle-aged adults (age, 36-55 years; n=34,507), and older adults (aged older than 55 years, n=21,895). The primary (TBI), secondary (intensive care unit [ICU] admission), and tertiary endpoint (mortality) were set. Multivariate logistic regression analysis was performed, and the adjusted odds ratios (aORs) of subgroups were calculated for study outcomes adjusted for any potential confounders. Results: Among 91,434 patients, 61,205 used seat belts at the time of the crashes. Compared to the unbelted group, the belted group was less likely to have a TBI. A comparison of the aOR of subgroups for TBI revealed the odds ratio reduction to be the highest in young adults (aOR, 0.39; 95% confidence interval [CI], 0.32-0.47), followed by middle-aged adults (aOR, 0.39; 95% CI, 0.33-0.47) and older adults (aOR, 0.49; 95% CI, 0.42-0.56). In addition, seat belt use had a preventive effect on ICU admission and mortality at all subgroups, the effect of which decreased with age. Conclusion The protective effects of seat belts on TBI, ICU admission, and mortality from MVCs were reduced with age.

PURPOSE: Because primary hyperparathyroidism (PHPT) is difficult to recognize, it has a high likelihood of being underdiagnosed. In this study, we estimated the incidence of PHPT and evaluated PHPT diagnosis in Korea. METHODS: To calculate the prevalence of PHPT, we examined the medical records of patients that were hospitalized for urolithiasis between 2013 and 2016 at a single institute, and then identified those who were diagnosed with PHPT from the same group. A Korea-wide insurance claim database was used to ascertain the number of urolithiasis patients and the number of parathyroidectomies performed in Korea. The incidence of PHPT in the Korean population was estimated using the ratio of patients who presented with urolithiasis as the initial symptom of PHPT. RESULTS: During the 4-year study period, 4 patients from the 925 urolithiasis patients enrolled in this study (0.4%) were diagnosed with PHPT. During this same period, there were 85,267 patients with urolithiasis in Korea, and the estimated number of PHPT patients was 341, which was 0.4% of 85,267. Considering that 12% to 23% of patients with PHPT are initially diagnosed with urolithiasis, the total number of PHPT patients was estimated to range from 1,483 to 2,842. The number of patients who underwent parathyroidectomy due to PHPT was 1,935 during the study period. CONCLUSION: The number of patients we estimated to have PHPT corresponded closely with the number of patients undergoing parathyroidectomy during the study period. Considering the number of nonsymptomatic PHPT patients, PHPT may be properly diagnosed in Korea.
Diagnosis ; Humans ; Hyperparathyroidism, Primary* ; Incidence ; Insurance ; Korea* ; Medical Records* ; Parathyroidectomy ; Prevalence* ; Urolithiasis

BACKGROUND AND PURPOSE: Decreasing the time delay for thrombolysis, including intravenous thrombolysis (IVT) with tissue plasminogen activator and intra-arterial thrombectomy (IAT), is critical for decreasing the morbidity and mortality of patients experiencing acute stroke. We aimed to decrease the in-hospital delay for both IVT and IAT through a multidisciplinary approach that is feasible 24 h/day. METHODS: We implemented the Stroke Alert Team (SAT) on May 2, 2016, which introduced hospital-initiated ambulance prenotification and reorganized in-hospital processes. We compared the patient characteristics, time for each step of the evaluation and thrombolysis, thrombolysis rate, and post-thrombolysis intracranial hemorrhage from January 2014 to August 2016. RESULTS: A total of 245 patients received thrombolysis (198 before SAT; 47 after SAT). The median door-to-CT, door-to-MRI, and door-to-laboratory times decreased to 13 min, 37.5 min, and 8 min, respectively, after SAT implementation (P<0.001). The median door-to-IVT time decreased from 46 min (interquartile range [IQR] 36–57 min) to 20.5 min (IQR 15.8–32.5 min; P<0.001). The median door-to-IAT time decreased from 156 min (IQR 124.5–212.5 min) to 86.5 min (IQR 67.5–102.3 min; P<0.001). The thrombolysis rate increased from 9.8% (198/2,012) to 15.8% (47/297; P=0.002), and the post-thrombolysis radiological intracranial hemorrhage rate decreased from 12.6% (25/198) to 2.1% (1/47; P=0.035). CONCLUSIONS: SAT significantly decreased the in-hospital delay for thrombolysis, increased thrombolysis rate, and decreased post-thrombolysis intracranial hemorrhage. Time benefits of SAT were observed for both IVT and IAT and during office hours and after-hours.
Ambulances ; Cerebral Infarction ; Humans ; Intracranial Hemorrhages ; Mortality ; Stroke* ; Thrombectomy ; Thrombolytic Therapy ; Tissue Plasminogen Activator

Tensiomyography (TMG) is used to evaluate the contraction characteristics of the thigh muscles according to gender. Our hypothesis is that male's maximal displacement (Dm) will be lower than the control because the Dm increases when the muscle becomes stiff or hypertrophied. TMG evaluated 15 males and 12 females. The biceps femoris, semitendinosus, vastus lateralis, vastus medialis, and rectus femoris were evaluated. The TMG parameters obtained for each muscle were Dm and contraction time (Tc). And we calculated contraction velocity (Vc) as the rate of the radial displacement occurring during the time period of Tc with respect to Tc. Dm and Vc values of biceps femoris muscles were significantly lower in males than in controls, whereas Dm and Vc values of vastus medialis muscles were significantly lower in females than males. The Tc values of males were significantly higher in right and bilateral sum than females. This is the first report on TMG assessment by gender. We found that it is the most effective in finding muscle contraction characteristics according to gender and can induce the difference between the Dm and Vc of each muscle.
Female ; Humans ; Lower Extremity* ; Male ; Muscle Contraction ; Muscles ; Quadriceps Muscle ; Thigh