BACKGROUND: This research is to determine the chief complaints and related features of elderly patients who are presented to emergency department with medical problems. METHODS: Medical records of patients, 65 years or above, who visited Uijeongbu Hospital Emergency Center between January 1, 2012 and June 30, 2012 were reviewed retrospectively. Age, gender, mode of transportation to the hospital, chief complaints, and diagnosis were among the subjects analyzed. RESULTS: Elderly patients with medical problems, 3,468 visited the emergency department, constituting 12.66% from 27,396 patients in total during the research period. Patients aged 70 to 74 were 28.45%, composing the most among the age groups. Ambulance was the mode of transportation used by 43.06% of the patients and 42.96% of them stayed overnight, while 11.13% stayed in the intensive care units. The most frequent chief complaints were abdominal pain (16.81%), dyspnea (13.96%), and fever (11.16%). The most common diagnosis for patients with abdominal pain was gastritis (20.75%), chronic heart failure (26.03%) for dyspnea, and pneumonia (28.96%) for fever. The main diagnoses of in-patients according to the order of frequency were cerebral vascular accident (16.38%), pneumonia (12.48%), and chronic heart failure (6.04%). CONCLUSION: The number of elderly patients who stayed overnight and stayed in the intensive care units have increased comparing to younger patients. The top 10 most frequent chief complaints accounted for 78.92% by medical elderly patients. The results of this research could be used for the development of geriatric emergency medicine training programs and critical pathway for interns and residents.
Abdominal Pain ; Aged ; Ambulances ; Critical Pathways ; Dyspnea ; Emergencies ; Emergency Medicine ; Fever ; Gastritis ; Heart Failure ; Humans ; Intensive Care Units ; Medical Records ; Pneumonia ; Retrospective Studies ; Transportation

The highly toxic sodium monofluoroacetate (SMFA) was banned as a rodenticide in this country in the 1980s. The fluoroacetate metabolite, fluorocitric acid blocks cellular metabolism by inhibiting the Klebs cycle, producing widespread clinical effects including respiratory, neurologic, cardiologic, and fluid-electrolyte abnormalities. We report the case of intentional ingestion of a derivative product, beta-fluoroethyl acetate. A 79-yr-old female was brought to the emergency room without any problem. At 2hours post ingestion, she had a generalized tonic-clonic seizure and then, was unresponsive to painful stimuli. At 6hours post ingestion, she died from refractory ventricular fibrillation. We report this patient to increase awareness of beta-fluoroethylacetate toxicity.
Eating* ; Emergency Service, Hospital ; Female ; Humans ; Metabolism ; Poisoning ; Seizures ; Sodium ; Ventricular Fibrillation

BACKGROUND: With increasing life expectancy, the number of injured elderly patients has been increasing. We evaluated the clinical characteristics of severely injured elderly patients who presented to the Emergency Department and identified risk factors associated with mortality. METHODS: Injured patients over 18 years of age who visited the Emergency Department with trauma team activation were investigated. We divided the patients into two groups according to age, an older adult group (> or =65 years) and a younger adult group (<65 years). We compared the mechanism of injuries, injury severity score (ISS), abbreviated injury scale > or =3 of each body area, and mortality between the two groups. RESULTS: Among 177 severely injured patients, there were 138 younger adults (78%) and 39 older adults (22%). The average ISS of the older adults was higher than the younger adults (20.66 vs. 16.37). The incidences of severe injuries (ISS>15) in the younger adults and the older adults were 50.0% and 71.1%, respectively, and critical injuries (ISS>25) were 16.7% and 36.8%, respectively. Chest injuries and subdural hematoma occurred more often in the older adults. Mortality was higher in the older adults (28.2%) than in the younger adults (8.7%). CONCLUSION: The average ISS was higher in older adults than in younger adults, and older adults were significantly more likely to suffer severe trauma, especially chest injuries and subdural hematoma. The rate of mortality was greater for older adults (28.2%) than younger adults (8.7%).
Abbreviated Injury Scale ; Adult ; Aged* ; Emergencies* ; Emergency Service, Hospital* ; Hematoma, Subdural ; Humans ; Incidence ; Injury Severity Score ; Life Expectancy ; Mortality ; Risk Factors* ; Thoracic Injuries

Herniation of intra-abdominal contents into the pericardial cavity is rare. We observed a delayed intrapericardial diaphragmatic hernia presenting as a tamponade secondary to a previous pericardioperitoneal window for drainage of a pericardial effusion. The diagnosis of an intrapericardial hernia should be considered in patients presenting with gastrointestinal and/or cardiorespiratory symptoms following surgical procedures involving the diaphragm.
Cardiac Tamponade* ; Diagnosis ; Diaphragm ; Drainage ; Hernia ; Hernia, Diaphragmatic* ; Humans ; Pericardial Effusion

OBJECTIVE: Acute ischemic stroke (AIS) requires time-dependent reperfusion therapy, and early recognition of AIS is important to patient outcomes. This study was conducted to identify the clinical features and risk factors of AIS patients that are missed during the early stages of diagnosis. METHODS: We retrospectively reviewed AIS patients admitted to a hospital through the emergency department. AIS patients were defined as ischemic stroke patients who visited the emergency department within 6 hours of symptom onset. Patients were classified into two groups: an activation group (A group), in which patients were identified as AIS and the stroke team was activated, and a non-activation group (NA group), for whom the stroke team was not activated. RESULTS: The stroke team was activated for 213 of a total of 262 AIS patients (81.3%), while it was not activated for the remaining 49 (18.7%). The NA group was found to be younger, have lower initial National Institutes of Health Stroke Scale scores, lower incidence of previous hypertension, and a greater incidence of cerebellum and cardio-embolic infarcts than the A group. The chief complaints in the A group were traditional stroke symptoms, side weakness (61.0%), and speech disturbance (17.8%), whereas the NA group had non-traditional symptoms, dizziness (32.7%), and decreased levels of consciousness (22.4%). Independent factors associated with missed stroke team activation were nystagmus, nausea/vomiting, dizziness, gait disturbance, and general weakness. CONCLUSION: A high index of AIS suspicion is required to identify such patients with these findings. Education on focused neurological examinations and the development of clinical decision tools that could differentiate non-stroke and stroke are needed.
Cerebellum ; Consciousness ; Diagnosis ; Dizziness ; Education ; Emergencies* ; Emergency Service, Hospital* ; Gait ; Humans ; Hypertension ; Incidence ; National Institutes of Health (U.S.) ; Neurologic Examination ; Reperfusion ; Retrospective Studies ; Risk Factors* ; Stroke*

Background: The coronavirus disease 2019 (COVID-19) pandemic may increase the total number of suicide attempts and the proportion of low-rescue attempts. We investigated the factors affecting low-rescue suicide attempts using the risk-rescue rating scale (RRRS) among patients who visited the emergency department (ED) after attempting suicide before or during the COVID-19 pandemic. Methods: We retrospectively investigated suicide attempts made by patients who visited our ED from March 2019 to September 2020. Patients were classified into two groups based on whether they attempted suicide before or during the COVID-19 pandemic. Data on demographic variables, psychiatric factors, suicide risk factors and rescue factors were collected and compared. Results: A total of 518 patients were included in the study, 275 (53.1%) of whom attempted suicide during the COVID-19 pandemic. The proportion of patients who made low-rescue suicide attempts differed before and during the COVID-19 pandemic (37.1% vs. 28.8%) (P = 0.046). However, the proportions of patients who made high-risk suicide attempts and high-lethality suicide attempts did not significantly differ between the two periods.The independent risk factors for low-rescue suicide attempts were age and the COVID-19 pandemic (odds ratio [OR], 1.02; 95% confidence interval [CI], 1.00–1.03; P = 0.006) (OR, 1.52; 95% CI, 1.03–2.25; P = 0.034). Conclusion The COVID-19 pandemic was associated with low-rescue suicide attempts in patients visiting the ED after attempting suicide. Thus, we need to consider the implementation of measures to prevent low-rescue suicide attempts during similar infectious disease crises.

Background: The coronavirus disease 2019 (COVID-19) pandemic may increase the total number of suicide attempts and the proportion of low-rescue attempts. We investigated the factors affecting low-rescue suicide attempts using the risk-rescue rating scale (RRRS) among patients who visited the emergency department (ED) after attempting suicide before or during the COVID-19 pandemic. Methods: We retrospectively investigated suicide attempts made by patients who visited our ED from March 2019 to September 2020. Patients were classified into two groups based on whether they attempted suicide before or during the COVID-19 pandemic. Data on demographic variables, psychiatric factors, suicide risk factors and rescue factors were collected and compared. Results: A total of 518 patients were included in the study, 275 (53.1%) of whom attempted suicide during the COVID-19 pandemic. The proportion of patients who made low-rescue suicide attempts differed before and during the COVID-19 pandemic (37.1% vs. 28.8%) (P = 0.046). However, the proportions of patients who made high-risk suicide attempts and high-lethality suicide attempts did not significantly differ between the two periods.The independent risk factors for low-rescue suicide attempts were age and the COVID-19 pandemic (odds ratio [OR], 1.02; 95% confidence interval [CI], 1.00–1.03; P = 0.006) (OR, 1.52; 95% CI, 1.03–2.25; P = 0.034). Conclusion The COVID-19 pandemic was associated with low-rescue suicide attempts in patients visiting the ED after attempting suicide. Thus, we need to consider the implementation of measures to prevent low-rescue suicide attempts during similar infectious disease crises.

Purpose: Alcohol is one of the most commonly co-ingested agents in deliberate self-poisoning (DSP) cases presenting at the emergency department (ED). The increased impulsivity, aggressiveness, and disinhibition caused by alcohol ingestion may have different clinical features and outcomes in cases of DSP. This study investigates whether alcohol co-ingestion affects the clinical features and outcomes of DSP patients in the ED. Methods: This was a single-center retrospective study. We investigated DSP cases who visited our ED from January 2010 to December 2016. Patients were classified into two groups: with (ALC+) or without (ALC–) alcohol co-ingestion. The clinical features of DSP were compared by considering the co-ingestion of alcohol, and the factors related to discharge against medical advice (AMA) of DSP were analyzed. Results: A total of 689 patients were included in the study, with 272 (39.5%) in the ALC+ group. Majority of the ALC+ group patients were middle-aged males (45-54 years old) and arrived at the ED at night. The rate of discharge AMA from ED was significantly higher in the ALC+ group (130; 47.8%) compared to the ALC– group (p=0.001). No significant differences were obtained in the poisoning severity scores between the two groups (p=0.223). Multivariate analysis revealed that alcohol co-ingestion (odds ratio [OR]=1.42; 95% confidence interval [CI], 1.01-1.98), alert mental status (OR=1.65; 95% CI, 1.17-2.32), past psychiatric history (OR=0.04; 95% CI, 0.01-0.28), age >65 years (OR=0.42; 95% CI, 0.23-0.78), and time from event to ED arrival >6 hrs (OR=0.57; 95% CI, 0.37-0.88) were independent predictive factors of discharge AMA (p=0.043, p=0.004, p=0.001, p=0.006, and p=0.010, respectively). Conclusion Our results determined a high association between alcohol co-ingestion and the outcome of discharge AMA in DSP patients. Emergency physicians should, therefore, be aware that DSP patients who have co-ingested alcohol may be uncooperative and at high risk of discharge AMA.

PURPOSE: In this study, we analyzed clinical manifestations of and ways to manage malaria. METHODS: The medical records of the patients confirmed as malaria by using peripheral blood smear at Ui jungbu St. Mary's hospital from April 1997 to November 2001 were reviewed retrospectively. RESULTS: Of the 170 patients, there were 111 males and 59 females, and their mean ages were 32.3+/-14.5, 34.9+/-18.1 years, respectively. Malaria occurred throughout the year and peaked during the sixth to ninth months (84.1%). All cases were vivax malaria. All 170 patients had fever, but tertian fever was seen in only 81 (48%) patients. Laboratory abnormalities were hemoglobin below 12 g/dL in 70 (41.2%) patients, WBC below 4000/mm3 in 49 (28.9%), platelet count below 120,000/mm3 in 142(83.5%). Of the 92 patients who underwent ultrasonography of the abdomen, splenomegaly was seen in 81 (89%)patients. The time from onset of symptoms to admission ranged from 2 to 30 days with a mean 8.1+/-5.5 days. All patients responded promptly to drug therapy. One patient developed recurrent malaria 120 days after the first attack. Another patient experienced multifocal splenic infarction. CONCLUSION: All patients with malaria had fever and chills. The most common laboratory findings were thrombocytopenia and anemia. All patients responded promptly to drug therapy. As cases of malaria in Korea are increasing, early diagnosis and treatment, as well as prevention, are important.
Abdomen ; Anemia ; Chills ; Drug Therapy ; Early Diagnosis ; Female ; Fever ; Humans ; Korea ; Malaria ; Malaria, Vivax* ; Male ; Medical Records ; Platelet Count ; Retrospective Studies ; Splenic Infarction ; Splenomegaly ; Thrombocytopenia ; Ultrasonography

Objective: The number of deaths due to acute poisoning (AP) is on the increase. It is crucial to predict AP patient mortality to identify those requiring intensive care for providing appropriate patient care as well as preserving medical resources. The aim of this study is to predict the risk of in-hospital mortality associated with AP using an artificial neural network (ANN) model. Methods: In this multicenter retrospective study, ANN and logistic regression models were constructed using the clinical and laboratory data of 1,304 patients seeking emergency treatment for AP. The ANN model was first trained on 912/1,304 (70%) randomly selected patients and then tested on the remaining 392/1,304 (30%). Receiver operating characteristic curve analysis was used to evaluate the mortality prediction of the two models. Results: Age, endotracheal intubation status, and intensive care unit admission were significant predictors of mortality in patients with AP in the multivariate logistic regression model. The ANN model indicated age, Glasgow Coma Scale, intensive care unit admission, and endotracheal intubation status were critical factors among the 12 independent variables related to in-hospital mortality. The area under the receiver operating characteristic curve for mortality prediction was significantly higher in the ANN model compared to the logistic regression model. Conclusion This study establishes that the ANN model could be a valuable tool for predicting the risk of death following AP. Thus, it may facilitate effective patient triage and improve the outcomes.