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A New Modified Scoring System to Assess the Prognosis of Patients with Community-Acquired Pneumonia.

Seung Woo PARK ; Seong Beom OH ; Il Kug CHOI

Journal of the Korean Society of Emergency Medicine.2015;26(5):387-393.

PURPOSE: An accurate, objective scoring system to assess the severity of community-acquired pneumonia (CAP) could be helpful to physicians in predicting patient mortality and improving decisions regarding hospitalization. However reports on the severity scoring system for prediction of mortality in patients with CAP in Korea are rare. The aim of this study was to propose a new modified severity scoring system based on a previously validated A-DROP for CAP and to compare it with pneumonia severity index (PSI), CURB- 65 and A-DROP. METHODS: The medical records of 364 patients admitted with CAP via ED from January 2013 through August 2014 were reviewed retrospectively. The demographic data, comorbidities, laboratories, PSI class, CURB-65 score, and A-DROP score were reviewed. The authors investigated a modification factor by comparing the survivors with the nonsurvivors. RESULTS: The study subjects were composed of 264 men and 100 women, with a mean age of 66.2+/-15.2 years. The overall 30-day mortality was 9.6%. The areas under the receiver operating characteristic (ROC) curves for prediction of 30-day mortality in patients with CAP were 0.803 (95% confidence interval (CI): 0.739-0.868), 0.734 (95% CI: 0.652-0.816) and 0.747 (95% CI: 0.662-0.833) for PSI, CURB-65 and A-DROP respectively. The new DROP-70 scoring system which includes age> or =70 years is a simple modified version of the A-DROP. The area under the ROC curves of DROP-70 was 0.774 (95% CI: 0.698-0.850). CONCLUSION: A new severity scoring system, DROP-70, could be a useful index for predicting 30-day mortality in patients with community-acquired pneumonia.
Comorbidity ; Female ; Hospitalization ; Humans ; Korea ; Male ; Medical Records ; Mortality ; Pneumonia* ; Prognosis* ; Retrospective Studies ; ROC Curve ; Survivors

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Observation of Emergency Department Adult Patient Presenting Primary Symptoms of Upper Digestive Tract Oreign Body Ingestion.

Myung Bo SHIM ; Jae Wook PARK ; Hong In PARK ; Jin Kun BAE ; Sang Mo JE ; Tae Nyoung CHUNG ; Eui Chung KIM ; Sung Wook CHOI ; Ok Jun KIM

Journal of the Korean Society of Emergency Medicine.2015;26(5):379-386.

PURPOSE: The purpose of this study is to search for factors which can help in deciding on proper treatment for patients who visit the Emergency department (ED) with symptoms of foreign body ingestion. METHODS: This study was a retrospective review of medical records of ED patients with primary symptoms of foreign body ingestion. The patients' demographic data, elapsed time since the ingestion, type of foreign body, symptoms, and the method of removal were analyzed. Receiver operating characteristic (ROC) curve was used for analysis of whether these factors can be used to decide on proper treatment. RESULTS: Among 321 patients, a foreign body was removed successfully in 285 patients and the foreign body was not found in the remaining 36 patients. Of the successfully treated cases, 76 were removed grossly, 133 were removed using a laryngoscope, 74 were removed with endoscopy, and 2 were removed spontaneously. Comparing the group in which a foreign body was found and the other group, there was a significant difference in elapsed time since the onset of symptoms (p=0.013) and the type of foreign body (p=0.001). There was no significant reliable factor which can predict the existence of a foreign body. CONCLUSION: There was no significant factor which can predict the existence of a foreign body. Considering that the foreign body was found in most suspected patients, and that numerous patients in which a foreign body was not found had shown signs of complications due to foreign body, constructive treatment should be advocated.
Adult* ; Eating* ; Emergencies* ; Emergency Service, Hospital* ; Endoscopes ; Endoscopy ; Foreign Bodies ; Gastrointestinal Tract* ; Humans ; Laryngoscopes ; Medical Records ; Retrospective Studies ; ROC Curve

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Early Detection and Staging of Acute Kidney Injury in Non-traumatic Rhabdomyolysis in Emergency Department.

Kisoon RYU ; Jae Yun AHN ; Mi Jin LEE ; Woo Young NHO ; Seong Hun KIM

Journal of the Korean Society of Emergency Medicine.2015;26(5):370-378.

PURPOSE: Acute kidney injury (AKI) is a common, serious complication in rhabdomyolysis patients. Early recognition and adequate therapy in rhabdomyolysis-related AKI are essential to reducing mortality. However, existing biomarkers, such as plasma creatinine, have several limitations for early detection of AKI. Novel parameters have recently been studied for greater reliability in prediction and staging of AKI in critically ill patients in the emergency department. The aim of this study is to evaluate the role of certain parameters for early prediction and staging of AKI in adults with acute non-traumatic rhabdomyolysis. METHODS: Eighty eight patients with adult non-traumatic rhabdomyolysis, who were admitted to the emergency intensive care unit (ICU) from Dec 2013 to Nov 2014, were enrolled in this observational cohort study. AKI was defined according to the Acute Kidney Injury Network (AKIN) criteria. Diagnostic characteristics of initial laboratory parameters were analyzed using the area under the receiver operating characteristic (ROC) curve. RESULTS: Of the 88 patients, 60 patients (68.2%) developed AKI during the ICU stay. The ROC curve for plasma neutrophil gelatinase-associated lipocalin (NGAL) showed the highest sensitivity (81.7%) and specificity (78.6%) among initial parameters. In pairwise comparison, the areas under the curve (AUCs) for plasma NGAL and serum creatinine were 0.868 (95% confidence interval [CI]: 0.779-0.931) and 0.765 (95% CI: 0.662-0.849), respectively. A statistically significant difference was observed in both (p=0.047). Plasma NGAL levels increased significantly as the stage of AKI progressed, using AKIN criteria (p<0.001). CONCLUSION: Plasma NGAL can be a reliable parameter for early prediction and approximate staging of AKI in adult non-traumatic rhabdomyolysis in the emergency department.
Acute Kidney Injury* ; Adult ; Biomarkers ; Cohort Studies ; Creatinine ; Critical Illness ; Diagnosis ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Intensive Care Units ; Lipocalins ; Mortality ; Neutrophils ; Plasma ; Rhabdomyolysis* ; ROC Curve ; Sensitivity and Specificity

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Relationship between Re-visits and Complaints' Characters of Out Patient Department and Emergency Department in One Tertiary Hospital.

Ju Hee JI ; Young Woo SEO ; Tae Chang JANG ; Kyung Woo LEE ; Gyun Moo KIM

Journal of the Korean Society of Emergency Medicine.2015;26(5):358-369.

PURPOSE: Emergency department (ED) and Outpatient department (OPD) are similar to some extent, but there are differences. The difference is complaints that can be encountered during practice. The aim of this study was to investigate complaints of OPD and ED and factors associated with Re-visits. METHODS: We retrospectively investigated 431 official complaints of visitors and 426 re-visitors in one tertiary university hospital OPD and ED between January 1, 2011 and December 31, 2014. RESULTS: ED complaints were 18 times more common than OPD. The two groups differed in chronic disease, follow up duration and frequency, transportation, visiting day of the week, visiting time, relation between patient and claimant, claimant age, related department, medical department, method of expression, major reason for complaints, treatment result, and re-visit. The factors associated with ED re-visits were chronic disease, follow up duration and frequency, treatment result, and expression method. CONCLUSION: Doctors, particularly emergency physicians in the ED, were the subject of the most common complaints. Patients had more complaints about the subjective time delay than the ED retention time. Emergency physicians should be more alert for first visit patients.
Chronic Disease ; Emergencies* ; Emergency Medical Services ; Emergency Service, Hospital* ; Follow-Up Studies ; Humans ; Office Visits ; Outpatients ; Personal Satisfaction ; Retrospective Studies ; Tertiary Care Centers* ; Transportation

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Investigation of Emergency Department Violence: Resident Survey.

Gon SEO ; Hong Chul BAE ; Jun Young HONG ; Je Hyeok OH ; Dong Hoon LEE ; Sung Eun KIM ; Song Ee PARK ; Chan Woong KIM

Journal of the Korean Society of Emergency Medicine.2015;26(5):349-357.

PURPOSE: The Korean Intern Resident Association and Korean Society of Emergency Medicine announced the 'Hospital violence response system' to secure patient safety and provide a health care provider countermeasures against hospital violence. The aim of this study is to investigate the response to hospital violence in the ER and which measures could improve the current status. METHODS: Emergency medicine residents in the Seoul, Incheon, Kyung-gi area participated in the survey. The questionnaire included 4 categories (1. Awareness of protocol, 2. Experience and countermeasure for hospital violence, 3. Understanding of protocol, 4. Suggestions to improve against hospital violence) RESULTS: Among 362 candidates, 236 (65.2%) participated in the survey. Only 7.6% of residents have not experienced hospital violence. In the group of people who were aware of the protocol, participants tended to be more familiar with processes of the hospital violence response protocol, and willing to deal with violence using a better systematic support. People did not counteract to hospital violence because the process was thought to be too complicated. Only 63 participants were actively involved in an official course for countermeasure. Participants suggested that police should deal more appropriately with hospital violence. CONCLUSION: The hospital violence response protocol is thought to have a positive effect on appropriate management of hospital violence. However, a multi-disciplinary approach to hospital violence from the hospital, police, and judicial authority should be developed.
Emergencies* ; Emergency Medicine ; Emergency Service, Hospital* ; Gyeonggi-do ; Health Personnel ; Humans ; Incheon ; Internship and Residency ; Patient Safety ; Police ; Seoul ; Violence*

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A CASE OF SURVIVOR WHO SHOWED ALPHA COMA APTER AN ATTEMPTED SUICIDE BY HANGING.

Sung Tae AHN ; Yong Joo LEE ; Kwang Je BAEK ; Jun Sik KIM ; Il Keun LEE ; Choong Kun HA

Journal of the Korean Society of Emergency Medicine.1997;8(1):113-119.

A case of survivor who showed alpha coma after an attempted suicide by hanging was reported. A 44 years old women was admitted to the hospital because of respiratory arrest following a hanging attempt on July 3, 1996. She was found pendant completely. On admission she was comatose and the pupils were not reactive to light. The systolic pressure was 100 mmHg, and diastolic pressure was 80mmHg and she had no self respiration and immediately an endotracheal intubation was instituted. After three hours from the onset, the weak spontaneous respiration was restored and the pupils reacted briskly to light. On the 1st day the brain computed tomography (CT) revealed no abnormal findings. An electroencephalogram (EEG) showed widespread alpha activity without occipital dominance a moderate amount of regular, 8 approximately 10 Hz, 10 approximately 30 microvolt potentials. This alpha rhythm had persisted until 24 hours from the onset. At 36 hours later she was still comatose, presenting flaccid quadriplegia with no responses to stimulations. On the 2nd hospital day she was drowsy and on the 3rd day she had become conscious. She showed gradual progress towards complete nerologic recovery. This is the first presentation of a survivor from alpha coma caused by anoxic encephalopathy following a hanging attempt in Korea.
Adult ; Alpha Rhythm ; Anoxia ; Blood Pressure ; Brain ; Coma* ; Electroencephalography ; Female ; Humans ; Hypoxia, Brain ; Intubation, Intratracheal ; Korea ; Pupil ; Quadriplegia ; Respiration ; Suicide ; Suicide, Attempted* ; Survivors*

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CONGENITAL CYSTIC ADENOMATOID MALFORMATION TREATED WITH EMERGENCY OPERATION.

Myung Kyu PARK

Journal of the Korean Society of Emergency Medicine.1997;8(1):109-112.

Congenital cystic adenomatoid malformation is rare form of disease causing in the lung. The main symptoms and signs are cyanosis, tachypnea, and other form of respiratory distress at or shortly after birth. In auscultation, decreased breath sound is audible and in chest X-ray, shifting of mediastinum, pulmonary herniation and depression of diaphragm are visualized with cystic shadow. We have experienced a case of cystic adenomatoid malformation of lung. After emergency operation, patients were recovered uneventfully.
Auscultation ; Cyanosis ; Cystic Adenomatoid Malformation of Lung, Congenital* ; Depression ; Diaphragm ; Emergencies* ; Humans ; Lung ; Mediastinum ; Parturition ; Tachypnea ; Thorax

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A CASE OF BRONCHIAL RUPTURE CAUSED BY BLUNT TRAUMA.

Jin Yong JEONG ; Jong Bum KWEON ; Sung Bo SIM ; Kuhn PARK

Journal of the Korean Society of Emergency Medicine.1997;8(1):103-108.

Traumatic rupture of the major airways may be caused by blunt or penetrating injury. The incidence of blunt trauma has risen dramatically in this century with the increase in modern high-velocity transportation. Clinical presentation of bronchial injuries in blunt trauma is varied, and the initial diagnostic evaluation is often misleading. The emphasis in management of these injuries is on early diagnosis and intervention. We experienced a case of bronchial rupture caused by blunt trauma. A 5-year-old male visited Emergency Room complaining of severe dyspnea and chest pain after traffic accident. Chest X-ray showed left tension pneumothorax. After emergent closed-thoracostomy, persistent air leakage and collapse of the left lung were noted. Chest CT revealed cut-off of left main bronchus and "dropped lung". Bronchoscopic examination confirmed the rupture of left main bronchus including proximal part of upper lobe bronchus. The patient underwent left upper lobectomy and bronchoplasty by using interrupted 4-0 Vicryl sutures. The postoperative course was uneventful.
Accidents, Traffic ; Bronchi ; Chest Pain ; Child, Preschool ; Dyspnea ; Early Diagnosis ; Emergency Service, Hospital ; Humans ; Incidence ; Lung ; Male ; Pneumothorax ; Polyglactin 910 ; Rupture* ; Sutures ; Thorax ; Tomography, X-Ray Computed ; Transportation

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NEUROLEPTIC MALIGNANT SYNDROME-LIKE STATE DUE TO DEPOT OF CHLORPROMAZINE: A Case Report.

Young Ho JIN ; Jae Baek LEE

Journal of the Korean Society of Emergency Medicine.1997;8(1):98-102.

The neuroleptic malignant syndrome(NMS) results primarily from an imbalance of central neurotransmitters and typically occurs after acute or chronic neuroleptic drug use rather than after neuroleptic overdosage. It is a rare and serious iatrogenic syndrome that is characterized by hyperthermia, muscle rigidity, autonomic dysfunctions and altered mental status. We have observed a case of NMS-like state due to depot of chlorpromazine(CPZ) and have experienced symptomatic and supportive treatment, which including body surface cooling, fluid administration, diuretics, and diazepam. So, in order to provide interests with this clinical situation for emergency physician, pathophysiology is discussed with references to the possibility of NMS in our case and symptomatology and managements are also reviewed.
Chlorpromazine* ; Diazepam ; Diuretics ; Emergencies ; Fever ; Muscle Rigidity ; Neuroleptic Malignant Syndrome ; Neurotransmitter Agents

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A CLINICAL DESCRIPTION OF 17 SURVIVORS AFTER PARAQUAT POISONING.

Seong Joong KIM ; Young Soo LEE

Journal of the Korean Society of Emergency Medicine.1997;8(1):93-97.

STUDY OBJECTIVES: To describe the clinical and laboratory findings of 17 patients who survived after paraquat poisoning DESIGN: Retrospective chart review Setting : Two University Hospital EDs METHODS: We reviewed the medical records of 17 patients, who survived after paraquat poisoning at Asan Medical Center and Ajou University Hospital from October 1994 to September 1995. RESULTS: There were 11 males and 6 females aged 5-60 years(mean, 30.6). On the amount of paraquat ingestion, the patients who swallowed the diluted chemical were 5, ingested but not swallowed the chemical were 3, swallowed one mouthful of the chemical were 7, swallowed two mouthful of the chemical was 1, and who swallowed four mouthful of the chemical was 1. The causes of poisoning were accidental ingestion in 6 patients and suicidal attempt in 11 patients. Mean initial WBC count was 11088(+/-4485)/microliter. Elevated serum creatinine levels were shown in 4 cases and mean peak serum level was 2.37(+/-.22)mg/dL. Elevated serum SGOT levels were shown in 8 cases, and mean peak serum level was 80.5(+/-7.5)IU/L. Elevated serum SGPT levels were shown in 8cases, and mean peak serum level was 151.1(+/-09.8)IU/L. 10 patients were poisoned in drunken state. There was no patient showing abnormal finding in the chest roentgenogram. CONCLUSION: Survivors of paraquat poisoning tend to be recovered from mild renal and hepatic dysfunction.
Alanine Transaminase ; Aspartate Aminotransferases ; Chungcheongnam-do ; Creatinine ; Eating ; Female ; Hospitals ; Humans ; Male ; Medical Records ; Mouth ; Paraquat* ; Poisoning* ; Retrospective Studies ; Survivors* ; Thorax

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