Background: Status epilepticus is a severe neurologic emergency comprising significant morbidity and mortality. This study investigated the epidemiologic features of status epilepticus in Korea from 2010 to 2019. Methods: We used the Healthcare Bigdata Hub of the Korea National Health Insurance Database to identify records with principal diagnostic codes for status epilepticus (G41) using the 10th revision of the International Statistical Classification of Diseases and Related Health Problems from January 2010 to December 2019. This database only included patients with health insurance and not those with medical aid. The annual number of patients, costs, and regional differences were evaluated. The patients hospitalized under the principal diagnostic code for status epilepticus were considered as incident cases. Results: The total number of patients with a diagnosis of status epilepticus increased annually from 3,110 in 2010 to 5,840 in 2019 at a compound annual growth rate of 7.3%. The incidence of status epilepticus per 100,000 population increased steadily from 2.21 in 2010 to 5.33 in 2019. Health care expenditures showed continued growth at a faster rate of 18.4%. When categorized by age groups, the growth rate was markedly higher in age groups >60 years. Conclusions In Korea, the incidence and cost of status epilepticus have increased from 2010 to 2019. Considering a possible underestimation of the incidence owing to data characteristics, the real incidence of status epilepticus may be higher. This trend in the incidence of status epilepticus can be mostly attributed to the increase of status epilepticus in the older population.

Objectives: Previous studies have reported that people with disabilities are more likely to be impoverished and affected by excessive medical costs than people without disabilities. Public transfer income (PTI) reduces financial strain in low-income households. This study examined the impact of PTI on catastrophic health expenditures (CHE), focusing on low-income households and households with Medical Aid beneficiaries that contained people with disabilities. Methods: We constructed a panel dataset by extracting data on registered households with disabilities from the Korea Welfare Panel Study 2012-2019. We then used a generalized estimating equation model to estimate the impacts of PTI on CHE. A subgroup analysis was carried out to assess the moderating effects of family income levels and health insurance types. Results: As PTI increased, the odds ratio (OR) of CHE in households that contained people with disabilities decreased significantly (OR, 0.92; 95% confidence interval [CI], 0.89 to 0.94; p<0.001). In particular, PTI effectively reduced the likelihood of CHE for low-income households (OR, 0.85; 95% CI, 0.81 to 0.89; p<0.001) and those who received medical benefits (OR, 0.78; 95% CI, 0.68 to 0.89; p<0.001). Conclusions This study highlights the positive effect of PTI on decreasing CHE. Household income and the health insurance type were significant effect modifiers, but economic barriers seemed to persist among low-income households with non-Medical Aid beneficiaries. Federal policies or programs should consider increasing the total amount of PTI targeting low-income households with disabilities that are not covered by the Medical Aid program.

Extramedullary plasmacytoma (EMP) is a common plasma cell tumor often involving the upper aerodigestive tract. Although extremely rare, mediastinal involvement is possible. An 81-year-old man was presented to our emergency department with chest and back pain with weakness in both legs. Chest X-ray showed a large mass in the upper right mediastinum; subsequently, computed tomography and magnetic resonance imaging evaluated the mass. He was diagnosed with mediastinal EMP, which progressed to spinal cord compression. The patient was treated with radiotherapy and chemotherapy. Spinal cord compression, due to metastatic tumor, is an emergency clinical situation that requires prompt diagnosis and treatment. Emergency medicine physicians should be aware of the clinical presentation and complications associated with EMP.
Aged, 80 and over ; Back Pain ; Diagnosis ; Drug Therapy ; Emergencies ; Emergency Medicine ; Emergency Service, Hospital ; Humans ; Leg ; Magnetic Resonance Imaging ; Mediastinum ; Multiple Myeloma ; Plasmacytoma* ; Radiotherapy ; Spinal Cord Compression* ; Spinal Cord* ; Thorax

OBJECTIVES: We aimed to evaluate the effect of geographic units of analysis on measuring geographic variation in medical services utilization. For this purpose, we compared geographic variations in the rates of eight major procedures in administrative units (districts) and new areal units organized based on the actual health care use of the population in Korea. METHODS: To compare geographic variation in geographic units of analysis, we calculated the age-sex standardized rates of eight major procedures (coronary artery bypass graft surgery, percutaneous transluminal coronary angioplasty, surgery after hip fracture, knee-replacement surgery, caesarean section, hysterectomy, computed tomography scan, and magnetic resonance imaging scan) from the National Health Insurance database in Korea for the 2013 period. Using the coefficient of variation, the extremal quotient, and the systematic component of variation, we measured geographic variation for these eight procedures in districts and new areal units. RESULTS: Compared with districts, new areal units showed a reduction in geographic variation. Extremal quotients and inter-decile ratios for the eight procedures were lower in new areal units. While the coefficient of variation was lower for most procedures in new areal units, the pattern of change of the systematic component of variation between districts and new areal units differed among procedures. CONCLUSIONS: Geographic variation in medical service utilization could vary according to the geographic unit of analysis. To determine how geographic characteristics such as population size and number of geographic units affect geographic variation, further studies are needed.
Angioplasty, Balloon, Coronary ; Arteries ; Cesarean Section ; Delivery of Health Care ; Female ; Hip ; Hysterectomy ; Korea ; Magnetic Resonance Imaging ; National Health Programs ; Population Density ; Pregnancy ; Small-Area Analysis ; Transplants

There has been a great improvement in height and weight of Korean children owing to economic development over the last 25 years. This study aimed to evaluate the penile length of Korean children today and to compare it with a previous Korean study reported in 1987. The cross-sectional study was conducted with 909 Korean boys aged 0-14 years who had been brought to outpatient clinics of five tertiary hospitals (Busan, Ulsan, and Changwon) between September 2013 and May 2015. The stretched penile length (SPL) was measured and the testicular size was measured using orchidometry (mL). Student's t-test or Mann-Whitney U test was used to compare the result of our study and the study reported in 1987. SPL of Korean children gradually increased from 4.1 ± 0.8 cm at 0-1 year old to 9.6 ± 3.0 cm at 13-14 years old, the most rapidly during the age of 13. While body weight and testicular size significantly increased from 1987 in most of age groups, there were no significant changes in SPL although there was in some age groups. Height decreased in the infants < 1 year old and increased in the children > 6 years old. With the great economic development over the last quarter century in Korea, height, body weight, and testicular size of children significantly increased but there was no significant change in SPL except penile growth pattern.
Ambulatory Care Facilities ; Anthropometry ; Body Height ; Body Weight ; Child* ; Cross-Sectional Studies ; Economic Development ; Humans ; Infant ; Korea ; Male ; Penis ; Tertiary Care Centers ; Ulsan

Acute generalized exanthematous pustulosis is a rare, drug-induced disease that is occasionally accompanied by acute renal failure. It is characterized by the abrupt onset of widespread pustules on an erythematous base and rapid spontaneous healing. We report a case involving a 47-year-old male who presented with exanthematous pustules after taking medication. Azotemia was found in the resulting blood test. We were able to achieve the final diagnosis by skin biopsy. After instructing the patient not to take the previous medication, oral steroids were prescribed. He recovered within 2 weeks with just desquamations remaining.
Acute Generalized Exanthematous Pustulosis ; Acute Kidney Injury ; Azotemia ; Biopsy ; Hematologic Tests ; Humans ; Male ; Middle Aged ; Skin ; Steroids

Internal iliac artery aneurysm (IIAA) is a type of abdominal aneurysm that is a rare cause of lower urinary tract symptoms because of its anatomic location. If diagnosed after rupture, it can be lethal and surgery is mandatory. A 57-year-old male presented with acute urinary retention and syncope. An intra-abdominal mass initially thought to be an aneurysm was apparent by ultrasound. A computed tomography scan of the abdomen confirmed an internal iliac artery aneurysm accompanied by rupture. The patient was discharged without any complications within 20 days after receiving a vascular graft and resection of the aneurysm.
Abdomen ; Aneurysm ; Humans ; Iliac Aneurysm ; Iliac Artery ; Lower Urinary Tract Symptoms ; Male ; Middle Aged ; Rupture ; Syncope ; Transplants ; Urinary Retention

Emphysematous pyelonephritis (EPN) is a necrotizing infection of the renal parenchyma and its surrounding tissues that results in the accumulation of gas in the renal parenchyma, collecting system or perinephric tissue. EPN is a potentially life-threatening condition, which is most commonly associated with poorly controlled diabetes. We describe a case of emphysematous pyelonephritis associated with emphysematous ureteritis and cystitis in a 68-year-old diabetic woman, who was cured with medical treatment and surgical intervention.
Aged ; Cystitis ; Female ; Humans ; Pyelonephritis ; Ureter

OBJECTIVES: The accurate measurement of geographic patterns of health care utilization is a prerequisite for the study of geographic variations in health care utilization. While several measures have been developed to measure how accurately geographic units reflect the health care utilization patterns of residents, they have been only applied to hospitalization and need further evaluation. This study aimed to evaluate geographic indices describing health care utilization. METHODS: We measured the utilization rate and four health care utilization indices (localization index, outflow index, inflow index, and net patient flow) for eight major procedures (coronary artery bypass graft surgery, percutaneous transluminal coronary angioplasty, surgery after hip fracture, knee replacement surgery, caesarean sections, hysterectomy, computed tomography scans, and magnetic resonance imaging scans) according to three levels of geographic units in Korea. Data were obtained from the National Health Insurance database in Korea. We evaluated the associations among the health care utilization indices and the utilization rates. RESULTS: In higher-level geographic units, the localization index tended to be high, while the inflow index and outflow index were lower. The indices showed different patterns depending on the procedure. A strong negative correlation between the localization index and the outflow index was observed for all procedures. Net patient flow showed a moderate positive correlation with the localization index and the inflow index. CONCLUSIONS: Health care utilization indices can be used as a proxy to describe the utilization pattern of a procedure in a geographic unit.
Angioplasty, Balloon, Coronary ; Arteries ; Cesarean Section ; Delivery of Health Care* ; Female ; Hip ; Hospitalization ; Humans ; Hysterectomy ; Insurance ; Knee ; Korea ; Magnetic Resonance Imaging ; National Health Programs ; Patient Acceptance of Health Care* ; Pregnancy ; Proxy ; Small-Area Analysis ; Transplants

Background: The aim of this study was to estimate the 8-year prevalence and mortality statistics of autism spectrum disorder (ASD) according to birth year (2002–2012). Methods: We used the National Health Insurance Service database with 4,989,351 children born from 2002 to 2012 including 35,529 children diagnosed with ASD until 8 years of age.The 8-year cumulative prevalence of ASD was calculated annually (2010–2020) with 8 years of follow-up. The 8-year mortality was estimated using Cox models adjusted for sex, household income, area of residence, and year of birth. Results: Of the 473,494 children born in 2002, 2,467 (5.2 per 1,000 births) were diagnosed with ASD until 2010. The ASD prevalence was 2.6 times higher among boys (1,839; 7.4 per 1,000 boy births) than girls (628; 2.8 per 1,000 girl births). Of the 467,360 children born in 2012, 4,378 (9.4 per 1,000 births) were diagnosed with ASD until 2020. The ASD prevalence was 2.7 times higher among boys (3,246; 13.5 per 1,000 boy births) than girls (1,132; 5.0 per 1,000 girl births). The risk of all-cause mortality was higher among children with ASD than those without (hazard ratio [HR], 2.340; 95% confidence interval [CI], 2.063–2.654), which is substantially higher among girls (HR, 4.223; 95% CI, 3.472–5.135) than boys (HR, 1.774; 95% CI, 1.505–2.090). Conclusion The present study demonstrated that national-level prevalence and mortality statistics of ASD can be estimated effectively using claims data comprising newborns born each year and followed up for to the age of interest. Because this information is essential to establish evidence-based policies, health authorities need to consider producing epidemiological information of ASD continuously using the same methodology.