Purpose: This study utilizes the NEDIS (National Emergency Department Information System) database to suggest a predictive model for snakebite and envenomation in Korea by analyzing the geographical distribution and seasonal variation of snakebite patients visiting the ER. Methods: This was a retrospective study on snakebite patients visiting the ER using the NEDIS database from January 2014 to December 2019. The subjects include patients with the KCD (Korea Standard Classification of Disease) disease code T63.0 (Toxic effect of contact with snake venom). Geographical location, patient gender, patient age, date of ER visit, treatment during the ER stay, and disposition were recorded to analyze the geographical distribution and seasonal variation of snakebite patients in Korea. Results: A total of 12,521 patients were evaluated in this study (7,170 males, 54.9%; 5,351 females, 40.9%). The average age was 58.5±17.5 years. In all, 7,644 patients were admitted with an average admission time of 5.04±4.7 days, and 2 patients expired while admitted. The geographical distribution was Gyeongsang 3,370 (26.9%), Cheonra 2,692 (21.5%), Chungcheong 2,667 (21.3%), Seoul Capital area 1,999 (16.0%), Kangwon 1,457 (11.6%), and Jeju 336 (2.7%). The seasonal variation showed insignificant incidences in winter and higher severity in spring and summer than in fall: winter 27 (0.2%), spring 2,268 (18.1%), summer 6,847 (54.7%), and fall 3,380 (27.0%). Conclusion Patients presenting with snakebites and envenomation in the emergency room were most common in the Gyeongsang area and during summer. The simple seasonal model predicted that 436 snakebites and 438 envenomation cases occurred in July and August. The results of this study can be applied to suitably distribute and stock antivenom. Appropriate policies can be formed to care for snakebite patients in Korea.

PURPOSE: Widely used fiberglass splints are made from straight-form material. These prove difficult to mold at joints and form wrinkles, causing complications such as pain, pressure sores, and peripheral nerve palsy. We compared the usefulness of wave-form splints with straight-form splints and the level of satisfaction of these designs from care providers and wearers. METHODS: Eighty-nine (n=89) emergency physicians and orthopedic surgeons participated in this study. The subjects (acting as care providers and mock patients) used wave-form and straight-form material to construct and wear short leg splints, long arm splints, and sugar tong splints. The clinicians were surveyed on their satisfaction as providers and wearers. All questions were measured on scores from 0 and 10(10=maximum score). After splints were removed, subjects were surveyed on the extent of splint wrinkling with scores from 1 to 3(3=maximum wrinkling). RESULTS: Provider satisfaction scores for wave-form splints versus straight-form splints in short leg splint applications were 7.76+/-1.30 vs 6.74+/-1.25 (p=0.000). Provider satisfaction scores for wave-form splints versus straight-form splints in long arm splint applications were 7.73+/-1.33 and 6.73+/-1.59 (p=0.004), respectively. The subjects felt more comfortable wearing wave-form splints, compared to straight-form splints (7.79+/-1.49 vs. 6.79+/-1.58, respectively; p=0.004) and more satisfied (8.03+/-1.35 vs. 7.18+/-1.33, respectively; p=0.003). The frequencies of wrinkle occurrence in wave-form and straight-form splints were 29.7% and 42.2%, respectively (p=0.02). CONCLUSION: Wave-form splints may be more practical for molding and wearing than traditional straight-form splints.
Arm ; Casts, Surgical ; Emergencies ; Fungi ; Glass ; Immobilization ; Joints ; Leg ; Orthopedics ; Paralysis ; Peripheral Nerves ; Pressure Ulcer ; Splints

As neonates are brought to the emergency department (ED) for various complaints, it is challenging for emergency physicians to clinically determine the urgency of the visit. We sought to explore clinical characteristics associated with urgent visits to the ED. We conducted a retrospective study by reviewing medical records of neonatal visits to a tertiary pediatric regional emergency center for 5 years. Cases of patients who were discharged after checking only chest or abdominal X-ray or discharged without workup, were classified as non-urgent visits. Cases where more examinations were performed, or when the patient was hospitalized, were classified as urgent visits. Various clinical features and process in the ED were compared between the groups. Of the 1,008 cases enrolled in this study, 856 (84.9%) were urgent and 152 (15.1%) were non-urgent visits. After adjustment by multiple logistic regression analysis, non-urgent visits were associated with self-referrals rather than physician-referrals (odds ratio [OR], 5.96), visits in the evening rather than at night or daytime (OR, 2.51), patient visits from home rather than from medical facilities (OR, 2.19; 95). Fever and jaundice were the most common complaints (25.7% and 24.5%, respectively), and their OR of non-urgent visit was relatively low (adjusted OR 0.03 and 0.03, respectively). However, other common complaints, such as vomiting and cough (7.4% and 7.1%, respectively), were more likely to be non-urgent visits (adjusted OR 2.96 and 9.83, respectively). For suspected non-urgent visits, emergency physicians need to try to reduce unnecessary workup and shorten length of stay in ED.
Cough ; Emergencies* ; Emergency Service, Hospital* ; Fever ; Humans ; Infant, Newborn ; Jaundice ; Length of Stay ; Logistic Models ; Medical Records ; Retrospective Studies ; Thorax ; Vomiting

Injury of the nail bed is commonly encountered in the emergency department. Despite the importance of initial management, difficulties such as long duration of operation and need of skill hinder the practice. Tissue repair with tissue adhesives, like 2-N-butylcyanoacrylate (Histoacryl(TM)), is a common replacement for suture repair. Here we describe a case of nail bed injury, which was repaired with Histoacryl(TM), and the method of repair.
Emergencies ; Nails ; Sutures ; Tissue Adhesives

PURPOSE: This study was conducted to compare the safety and effectiveness of intravenous ketamine-midazolam (KM) and ketamine-propofol (KP) combination for the lumbar puncture (LP) procedure in children. METHODS: This was a retrospective analysis of patients aged ≤18 years old who received intravenous injection of KM or KP for undergoing LP in the pediatric emergency department. To investigate the effectiveness of KM and KP, we compared the sedation success rate, induction time, procedure time and total sedation time. In addition, adverse events and complications were recorded to assess the safety of the agents. RESULTS: A total 61 patients were enrolled in study. Twenty-eight patients were given KM and 33 patients received KP. All sedations were successful in both groups. While the mean induction time in KM was shorter than in the KP group (3±4 vs. 6±5 minutes, p=0.02), the total sedation time in the KP group was significantly shorter than that in the KM group (33±26 vs. 61±43 minutes, p < 0.01). There were no adverse effects such as hypotension, bradycardia or hypoxic event. CONCLUSION: This study showed that intravenous KM and KP are hemodynamically stable and have few side effects when applied for pediatric sedation during lumbar puncture. Although KM has a shorter induction time than KP, KP has a shorter duration of sedation. Both of these materials can be considered useful agents for sedation when conducting painful procedures in children.
Bradycardia ; Child ; Conscious Sedation ; Emergency Service, Hospital ; Humans ; Hypotension ; Injections, Intravenous ; Ketamine ; Midazolam ; Propofol ; Retrospective Studies ; Spinal Puncture

Background: We aimed to investigate changes in the clinical characteristics of pediatric poisoning patients who visited the emergency department (ED) before and during the coronavirus disease 2019 (COVID-19) pandemic. Methods: Poisoning cases below age 18 who visited the ED from January 2018 to December 2021 were retrospectively analysed. The study period was then divided into pre-COVID-19 and COVID-19 pandemic to compare poisoning patterns. Results: During the study period, 86,153 visits to the pediatric ED had been recorded, with 625 patients being included the final analysis. During the COVID-19 period, the proportion of poisoned patients increased from 0.62% to 0.98%. The average age of the patients was higher in the COVID-19 period, with 53.4% of the cases being intentional (pre-COVID-19, 32.5%; P < 0.001). Moreover, 70.4% of poisoning cases during the COVID-19 period were caused by drugs (pre-COVID-19, 60.6%; P = 0.038). More patients underwent decontamination and laboratory investigation during the COVID-19 period than during the previous period (P= 0.007 and P < 0.001, respectively). The length of ED stay and the proportion of hospitalisation were significantly greater during the COVID-19 period. After analysing accidental poisoning cases, we found that antipyreticsonsteroidal anti-inflammatory drugs and respiratory drugs were more common in the pre-COVID-19 group, whereas iron/vitamins, cardiovascular drugs and hormones were more common in the COVID-19 group. After analysing intentional poisoning cases, we found that 73.6% and 76.4% of the patients in the pre-COVID-19 and COVID-19 group had a history of psychiatric disease, respectively. Although no difference was observed in the frequency of previous first suicide attempts, 19.0% of the patients in the COVID-19 group attempted suicide more than three times. Conclusion During the COVID-19 pandemic, intentional poisoning cases, especially in adolescence, increased and were treated more. Many of the patients with intentional poisoning had a history of mental illness or suicide in the past. Therefore, it seems that policy consideration for mentally vulnerable adolescents during this new pandemic period is necessary.

PURPOSE: Falling is one of the most common causes of injury for preschool children. Here, we aim to identify the characteristics and risk factors of injuries by falling-down in preschool children. METHODS: Between January 2010 and December 2011, we enrolled patients under the age of 7 years, who were injured by falling down and visited an urban regional emergency center. We retrospectively surveyed the medical record of these patients, including age, sex, place and height of fall, type of floor, guardian's witness, traumatic brain injury (TBI), and fracture of extremities. RESULTS: The odds ratios sex (male), age (under 2 years old), height of fall, type of floor (hard), and guardian's witness (presence) that resulted in TBI were 1.35 (95% confidence interval [Cl], 0.72?2.55; p=0.352), 3.83 (95% Cl, 1.78?8.65; p<0.05), 6.38 (95% Cl, 3.27–12.44;p<0.05), 3.58 (95% Cl, 0.47–27.30; p=0.218), and 1.47 (95% Cl, 0.63–3.43; p=0.377), respectively. The odds ratios sex (male), age (over 2 years old), height of fall, type of floor (soft), and guardian's witness (absence) that resulted in fractures were 1.19 (95% Cl, 0.78–1.81; p=0.433), 3.10 (95%Cl, 1.99–4.84; p<0.05), 1.98 (95%Cl, 1.19–3.29; p<0.05), 2.41 (95% Cl, 1.29–4.54; p<0.05), and 1.15 (95%Cl, 0.72–1.85, p=0.554), respectively. CONCLUSION: In preschool children who experienced an injury from falling down, TBI was increased with younger patients and higher height of fall, but it was not related with patient's sex, type of floor, and guardian's witness; conversely, fractures were increased with older patients, higher height of fall, and soft floor, but not related with patient's sex and guardian's witness.
Accidental Falls ; Brain Injuries ; Child* ; Child, Preschool ; Emergencies ; Extremities ; Humans ; Medical Records ; Odds Ratio ; Retrospective Studies ; Risk Factors*

PURPOSE: This study reports the clinical features of infant, child, school aged and adolescent patients treated for acute poisoning in nationwide emergency departments (EDs). METHODS: We retrospectively analyzed clinical data pertaining to patients under 19 years of age who were treated for acute poisoning in nationwide EDs from 2013 to 2015. The data were collected by the National Emergency Department Information System (NEDIS). All patients were divided into three groups: ‘Infant and child group’ (0 to 5 years), ‘school age group’ (6 to 12 years) and ‘adolescent group’ (13 to 18 years). General characteristics, Korea Standard Classification of Disease 7(th) (KCD-7) codes and results of care were collected. RESULTS: There were 14,500 pediatric poisoning cases during the study period. The distribution of patient age was bimodal with two peaks among infant, child and adolescent group. The proportion of alert mentality at the ED visit of the infant and child group was 99.3%, while that of the adolescent group was 86.4%. The proportion of intentional intoxication was higher in the adolescent group (40.7%) than other age groups. Among children less than 13 years of age, various poisonous substances and therapeutic drugs were common. CONCLUSION: There were some clinical differences in acute poisoning patients between age groups. It is necessary to establish a preventive plan considering characteristics by age. Since the KCD-7 code has limitations in analyzing the characteristics of poisoning patients, it is necessary to consider the registration system of poisoning patients.
Adolescent ; Child ; Classification ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Infant ; Information Systems* ; Korea ; Pediatrics ; Poisoning* ; Retrospective Studies*

PURPOSE: Upper gastrointestinal bleeding (UGIB) is a common medical emergency condition in the emergency department (ED). Patients with UGIB show a wide range of clinical severity, from mild bleeding to death. The objective of this study was to evaluate methods for risk stratification of active UGIB in the ED. METHODS: We retrospectively reviewed patients with UGIB who were admitted to the ED of a tertiary care, university-affiliated hospital center from January 2011 to December 2011. Our study subjects were patients over 20 years old who complained of symptoms and signs of gastrointestinal tract bleeding and underwent endoscopic gastroduodenoscopy (EGD) evaluation. However, patients diagnosed with variceal gastrointestinal bleeding, disseminated malignancy, coagulopathy, and lower gastrointestinal bleeding and patients who did not undergo EGD within 6 hours were excluded. The Blatchford score and the clinical Rockall score were calculated for the enrolled patients. In cases where the value of each score was greater than 0, the scores were considered high risk. Active UGIB was defined as a symptom of patients who underwent emergency endoscopic intervention such as ligation or sclerotherapy. We compared the proportions of patients identified as high risk using chi tests. The areas under the receiver operating characteristic (AUROC) curve for detection of patients requiring emergency endoscopic intervention were calculated for both the Blatchford score and the clinical Rockall score. RESULTS: The numbers of patients with high risk according to the Blatchford score and the clinical Rockall were 220 (93.6%) and 192 (81.7%) of 235 patients, respectively. The number of patients with active UGIB was 96 (40.9%) of 235 patients. The sensitivity and specificity of risk stratification based on the Blatchford score was 100% (96/96) and 10.8% (15/139) (p=0.001), respectively, while those based on the clinical Rockall score were 80.2% (77/96) and 17.3% (24/139) (p>0.05). The AUROC curves of the Blatchford score and the clinical Rockall score were 0.617 (95% CI; 0.546-0.688) and 0.495 (95% CI; 0.420-0.571), respectively. CONCLUSION: The Blatchford score could be more useful as a risk stratification tool than the clinical Rockall score for active UGIB patients in the ED. The Blatchford score would be preferable as a clinical tool that can discriminate patients who need emergency endoscopic intervention for control of UGIB.
Emergencies ; Emergency Service, Hospital* ; Endoscopy ; Gastrointestinal Hemorrhage ; Gastrointestinal Tract ; Hemorrhage* ; Humans ; Ligation ; Retrospective Studies ; ROC Curve ; Sclerotherapy ; Sensitivity and Specificity ; Tertiary Healthcare

In this study, we investigated playground equipment related injuries in preschool-aged children. This was a retrospective observational study using Emergency Department based Injury In-depth Surveillance, (2011–2014). We included the preschool-aged children with playground equipment related injuries. We surveyed the mechanism and incidence of injuries, and estimated the odds ratio (OR) of traumatic brain injury (TBI) and upper/lower extremities fracture. There were 6,110 patients, mean age was 4.14 ± 1.95 years old. Slide and swing related injuries were 2,475 (40.5%) and 1,102 (18.0%). Fall down (48.5%) was the most common mechanism. The OR of TBI in children 0–2 years old was 1.88 times higher than children 3–7 years old, and in swing was 4.72 (OR, 4.72; 95% confidence interval [CI], 2.37–9.40) times higher than seesaw. The OR of upper extremity fracture in children 3–7 years old was 3.07 times higher than children 0–2 years old, and in climbing was 2.03 (OR, 2.03; 95% CI, 1.63–2.52) times higher than swing. The OR of lower extremity fractures in horizontal bars, tightropes, and trampolines was 2.95 (OR, 2.95; 95% CI, 1.55–5.61) times higher than swing. The most common mechanism and playground equipment were fall down and slide. TBI was associated to younger children (0–2 years old) and swing. Fracture of upper extremities was associated to older children (3–7 years old) and climbing. Fracture of lower extremities was associated to others such as horizontal bars, tightropes, and trampolines.
Brain Injuries ; Child* ; Child, Preschool ; Emergencies* ; Emergency Service, Hospital ; Extremities ; Fractures, Bone ; Humans ; Incidence ; Lower Extremity ; Observational Study ; Odds Ratio ; Play and Playthings ; Retrospective Studies ; Upper Extremity ; Wounds and Injuries