Rectus sheath hematoma with spontaneous inferior epigastric artery injury (IEAI) is rarely found and can often be mistaken for something else causing abdominal pain. We present the case of rectus sheath hematoma with spontaneous IEAI caused by coughing in a 61-year-old woman. She presented to our emergency department with a chief complaint of rightlower quadrant pain after severe coughing. An abdominal computed tomography scan with contrast enhancement demonstrated rectus sheath hematoma with active hemorrhage; angiography with selective embolization of the right inferior epigastric artery was performed successfully without complication. Even if a patient with nontraumatic abdominal pain had no anticoagulant therapy or coagulopathy, an abdominal contrast-enhanced computed tomography scan is essential for early diagnosis of spontaneous IEAI. Arteriography with selective embolization of the injured arteries is useful and highly effective in the control of ongoing hemorrhage owing to IEAI.
Abdominal Pain ; Angiography ; Arteries ; Cough ; Early Diagnosis ; Emergency Service, Hospital ; Epigastric Arteries* ; Female ; Hematoma* ; Hemorrhage ; Humans ; Middle Aged ; Rupture

Epidural hematoma with Brown-Sequard syndrome caused by an epidural injection is a rarely found condition in the emergency department (ED). We report an unusual case of Brown-Sequard syndrome in a 55-year-old man who presented at the ED with right-sided weakness and contralateral loss of pain and temperature sensation after a cervical epidural injection for shoulder pain. Cervicla spine magnetic resonance imaging showed an epidural hematoma from C4 to C6. After admission, his right hemiparesis and contralateral sensory loss improved within eight days, and surgical decompression was not required. Diagnosing spinal lesions in the ED is challenging, especially in patients with acute neurological signs requiring immediate evaluation for stroke. In this case, definite hemiparesis and some contralateral sensory loss were noted. Therefore, a potential spinal lesion was suspected rather than a stroke. This case emphasized the importance of conducting a focused neurological examination after history taking.

PURPOSE: This study investigated the association between the initial red cell distribution width (RDW) and mortality in patients with severe trauma. METHODS: We conducted a retrospective analysis between January and December 2014. Severe adult trauma patients (age≥18, Injury Severity Score≥16), who were treated in our emergency department, were included in this study. We classified patients into four groups in accordance with their RDW (group 1: RDW≤12.3%, group 2: 12.4%≤RDW≤12.6%, group 3: 12.7%≤RDW≤13.2%, group 4: 13.3%≤RDW). They were compared based on the characteristics of their groups. We also compared the baseline characteristics of patients who survived and did not survive. Univariate and multivariate Cox proportional hazard analyses were performed to determine the association between mortality and each variable. RESULTS: We enrolled 364 severe trauma adult patients. The mortality rate was 8.9%, 16.2%, 12.6%, and 20.4% for RDW groups 1, 2, 3, and 4, respectively; there was no statistical significance. The RDW of patients who survived (n=311) and did not survive (n=53) were 12.7% (12.4-13.3%) and 12.9% (12.5-13.6%), respectively, but this was also not statistically significant (p=0.075). Univariate Cox proportional hazard analysis showed a significant difference between the mortality and initial RDW, but a multivariate analysis did not show an independent association between initial RDW and mortality (hazard ratio, 0.729; confidence interval, 0.508-1.047; p=0.087). Moreover, multivariate analysis did not also show a significant difference between RDW quartile groups according to route of hospital visit. CONCLUSION: There was no independent association between the initial RDW and mortality in patients with severe trauma.
Adult ; Emergencies* ; Emergency Service, Hospital* ; Erythrocyte Indices* ; Humans ; Mortality* ; Multivariate Analysis ; Retrospective Studies

PURPOSE: Bystander cardiopulmonary resuscitation (CPR) is an important factor in improving the survival rate and neurologic prognosis for out-of-hospital cardiac arrest patients. Here, we aimed to establish factors related to CPR education, such as timing of education, interval from the most recent education session, and contents, that may influence CPR willingness. METHODS: In February 2012, an interview survey of 1,000 Daegu citizens was conducted via organized questionnaire, administered by trained interviewers. Subjects were aged 19 years or older and selected by a quota sampling technique. Social and population characteristics, factors related to CPR, and factors related to CPR education, were investigated. The chi-square test and multivariate logistic regression analysis were used to evaluate education-related factors that may affect the willingness to perform CPR. RESULTS: The adjusted odds ratio (OR) for CPR willingness was 3.38 (95% confidence interval [CI], 2.3–5.0) among the respondents in the didactic plus practice group. The adjusted OR for CPR willingness was 7.68 (95% CI, 3.21–18.35) among the respondents receiving over 4 CPR education sessions. The adjusted OR for CPR willingness, in accordance with the time interval from the last CPR education session, was 4.47 (95% CI, 1.29–15.52) for intervals under 6 months and 3.80 (95% CI, 1.91–7.56) for intervals between 6 months and 1 year. If automated external defibrillator (AED) training was included in CPR education, the adjusted OR for CPR willingness was 5.98 (95% CI, 2.30–15.53). CONCLUSION: Including practice sessions and AED training in public CPR education, more frequent CPR revision and short time intervals in between CPR education sessions are associated with greater willingness to perform CPR.
Cardiopulmonary Resuscitation* ; Daegu ; Defibrillators ; Education* ; Heart Arrest ; Humans ; Logistic Models ; Odds Ratio ; Out-of-Hospital Cardiac Arrest ; Population Characteristics ; Prognosis ; Surveys and Questionnaires ; Survival Rate

PURPOSE: This study aims to investigate how variability of bystander cardiopulmonary resuscitation (CPR) willingness may change depending on special situations and to find out factors that enhance CPR willingness in each situation and ways to increase the ratio of bystander CPR. METHODS: A population-based, nationwide study using a structured questionnaire via telephone survey regarding CPR was done in 2015 (n=1,000). A stratified cluster sampling was conducted to assess the impact of age and gender on CPR willingness. The contents of the questionnaire consisted of basic characteristics, CPR training experience, and status. Additionally, respondents were presented with five hypothetical scenarios of cardiopulmonary arrest; family member, stranger, elderly person, preschool child, and pregnant woman. RESULTS: Willingness to perform CPR was low for pregnant women (52.1%) or elders (59.3%), moderate for strangers (73.3%) or children (71.3%), but high for a family members (90.4%). Age, awareness of CPR, training experience of CPR, CPR training by manikin practice, recent CPR training (≤2 years), experience of bystander CPR, family history of severe illness, and awareness of Good Samaritan law all influenced the willingness to perform CPR on bystander in each scenario. CONCLUSION: The willingness of bystander CPR decreased in special situations, especially for elderly and pregnant woman. However, recent CPR training group were more willing in the elderly, and CPR experienced group also showed increased tendency in pregnant woman. It is expected that the rate of bystander CPR can be increased by emphasizing that performing bystander CPR for children, pregnant women, and elders is not different from the general population.
Aged ; Attitude to Health ; Cardiopulmonary Resuscitation* ; Child ; Child, Preschool ; Female ; Heart Arrest ; Humans ; Jurisprudence ; Manikins ; Pregnant Women ; Surveys and Questionnaires ; Telephone

Objective: We aimed to investigate the characteristics and prognostic factors of coronavirus disease 2019 (COVID-19) patients in the emergency departments (EDs) in Daegu, Korea, the region with the second regional outbreak worldwide. Methods: We conducted a retrospective observational multicenter study using a population-based COVID-19 registry of EDs. We included the demographic, clinical and laboratory data. Cox proportional hazard regression analysis was performed to identify the prognostic factors of mortality. Results: A total of 241 patients were included in this study. In the Cox hazard regression model (hazard ratio [95% confidence interval]), age (65-79 years: 3.531 [1.529-8.156], ≥80 years: 5.335 [2.229-12.770]), respiratory rate (RR) (>20 breaths/min: 2.025 [1.205-3.403], ≤11 breaths/min: 111.292 [30.845-401.555]), lymphocyte counts <1.0×109/L (2.611 [1.494-4.739]), blood urea nitrogen (BUN) levels>23 mg/dL (2.047 [1.233-3.399]), aspartate aminotransferase (AST) levels>40 IU/L (1.785 [1.009-3.158]) and neutrophil counts>6.3×109/L (1.638 [1.014-2.644]) were associated with mortality. Conclusion Age, RR, lymphocyte counts, BUN levels, AST levels and neutrophil counts were prognostic factors in COVID-19 patients in the ED. These factors can help effectively treat and reduce mortality through optimized management of COVID-19 patients, in places with limited emergency medical resources such as massive regional outbreaks.

Objective: This study aimed at analyzing the clinical characteristics of patients visiting the emergency department (ED) and pre-triage clinic during the coronavirus disease 2019 (COVID-19) pandemic era in Daegu, South Korea. Methods: We conducted a retrospective observational study by using the medical records of patients who visited the ED and pre-triage clinic from February 22 to March 31, 2020 and comparing them with the corresponding period in 2019. Results: The number of patients visiting the ED per day decreased from 122 (115-138) to 77 (66-93). The percentage of patients with respiratory infection increased from 6.6% to 15.4% (P<0.001). The length of the ED stay increased from 269 (150-562) to 559 (293-941) minutes, especially in patients with fever (P<0.001). The rate of injured and less urgent patients decreased from 24.7 to 13.2 and 53.4% to 50.2%, respectively (P<0.001). Sixty-one-point nine percent of patients visiting the ED were triaged and discharged at the pre-triage clinic without entering the ED. Conclusion In the COVID-19 pandemic era, there was an increase in the proportion of patients with fever and respiratory symptoms and a decrease in the proportion of injured patients. At the pre-triage clinic, a significant number of patients with suspected COVID-19 or less urgent conditions were treated and discharged without their having to enter the ED.

Objective: The characteristics and prognosis of out-of-hospital cardiac arrest (OHCA) patients can vary due to a variety of factors, including the time of the day. We tried to identify the characteristics and prognosis of OHCA in a Korean metro city based on the time of the day. Methods: This citywide retrospective observational study was conducted from January 1, 2015, to November 31, 2020, in Daegu, Korea on patients over 18 years of age who were suspected of having a medical etiology of OHCA. We evaluated the characteristics and outcomes of OHCA, according to the time of day, divided into dawn (00:00-05:59), morning (06:00-11:59), afternoon (12:00-17:59), and night (18:00-23:59). The outcome variables were survival to hospital discharge and favorable neurological outcomes. Results: The median age of the total of 4,783 OHCA patients in the study was 72.0 years of which 3,096 (64.7%) were males. The number of patients who survived was 317 (7.8%) and 301 (6.3%) were discharged with favorable neurological outcomes. There were 672 (14.0%) patients admitted at dawn, 1,607 (33.6%) in the morning, 1,379 (28.8%) in the afternoon, and 1,125 (23.5%) at night. After adjusting for the possible confounding variables, compared with the morning group, the survival to hospital discharge was low in the afternoon and the night (adjusted odds ratio [aOR], 0.69; 95% confidence interval [CI], 0.48-0.98 and aOR, 0.48; 95% CI, 0.32-0.74). In addition, favorable neurological outcomes were also low in the afternoon and the night compared with the morning (aOR, 0.59; 95% CI, 0.40-0.85 and aOR, 0.62; 95% CI, 0.41-0.93). Conclusion Diurnal differences in OHCA outcomes were observed. Identification of the diurnal OHCA characteristics will be necessary to devise an appropriate regional emergency medical services strategy.

BACKGROUND: Heatstroke is one of the most serious heat-related illnesses. However, establishing public policies to prevent heatstroke remains a challenge. This study aimed to investigate the most relevant climate elements and their warning criteria to prevent outdoor heatstroke (OHS). METHODS: We investigated heatstroke patients from five major hospitals in Daegu metropolitan city, Korea, from June 1 to August 31, 2011 to 2016. We also collected the corresponding regional climate data from Korea Meteorological Administration. We analyzed the relationship between the climate elements and OHS occurrence by logistic regression. RESULTS: Of 70 patients who had heatstroke, 45 (64.3%) experienced it while outdoors. Considering all climate elements, only mean heat index (MHI) was related with OHS occurrence (p=0.019). Therefore, the higher the MHI, the higher the risk for OHS (adjusted odds ratio, 1.824; 95% confidence interval, 1.102–3.017). The most suitable cutoff point for MHI by Youden’s index was 30.0°C (sensitivity, 77.4%; specificity, 73.7%). CONCLUSION Among the climate elements, MHI was significantly associated with OHS occurrence. The optimal MHI cutoff point for OHS prevention was 30.0°C.

Objective: Trauma death is one of the most preventable deaths by various efforts in the healthcare sector. The establishment of a regional trauma center will aid in efforts to reduce mortality. On the other hand, the effects of trauma centers on pediatric trauma in Korea are not fully understood. This study compared the clinical outcomes of severe pediatric trauma patients before and after the regional trauma center was set into action. Methods: A cross-sectional, retrospective analysis was performed on the medical records in a single regional emergency and trauma center from November 2014 to October 2016 and from January 2017 to December 2018. The general demographic information, injury details, and clinical outcome data were collected. The cases were divided into two groups, the before and after groups, and comparisons were made. Results: Seventy-three patients were included in the study. Thirty-seven patients were in the before group, and 36 were in the after group. The mortality (21.6% to 5.6%, P=0.04) and interhospital transfer rate (27.0% to 8.3%, P=0.03) were lower in after group than in the before group. On the other hand, the time to receive a transfusion, operation, and intensive care unit (ICU) admission did not differ significantly. The lengths of the emergency department, ICU, and hospital stay were also similar in the two groups. Conclusion For severe pediatric trauma patients, the mortality and transfer rates decreased after implementing the trauma center. On the other hand, the implementation itself was not identified as a major factor, and the time required to receive a definite treatment or length of stay did not change significantly.