Geographic information systems are useful tools for analyzing and explaining the changing spatial structures of medical services. This study identified underserved areas for out-ofhospital cardiac arrest (OHCA) using a geospatial methodology and provided a visual map of the spatial imbalances of OHCA. This study used geocoding of OHCA locations, emergency medical service (EMS) incidents, and administrative districts to demonstrate a technique for identifying underserved areas for EMS-assessed OHCA. We created a 1 km hexa-grid across Jeju Island and calculated the OHCA ratio (OHCA cases/total EMS incidents) for each grid. Underserved areas were detected through a hexagrid-based geospatial analysis (Getis-Ord Gi* statistics). A total of 366,155 EMS incidents occurred during the study period. Among these, 6,806 were EMS-assessed OHCA cases. An analysis of 1,903 overlapping grids revealed that the mean distance between grids with OHCA was 28.0±15.8 km. The mean EMS-assessed OHCA ratio (EMS-assessed OHCA cases/total EMS incidents) for each grid was 0.021±0.059. Based on the Getis-Ord Gi* OHCA ratio, 118 hot spot grids (z-score≥1.96) and 19 cold spot grids (z-score≤-1.96) were identified. This study proposed a geospatial methodology to define and identify underserved areas of EMS-assessed OHCA cases using hexa-grid-based hot- and cold-spot analysis.

PURPOSE: Patients' gender, which can be one of the most important determinants of traumatic brain injury (TBI) outcomes, is also likely to interact with many other outcome variables of TBI. This multicenter descriptive study investigated gender differences in epidemiological, clinical, treatment, mortality, and variable characteristics in adult TBI patients. METHODS: The selection criteria were defined as patients who had been diagnosed with TBI and were admitted to the hospital between January 1, 2016 and December 31, 2018. A total of 4468 adult TBI patients were enrolled at eight University Hospitals. Based on the list of enrolled patients, the medical records of the patients were reviewed and they were registered online at each hospital. The registered patients were classified into three groups according to the Glasgow coma scale (GCS) score: mild (13-15), moderate (9-12), and severe (3-8), and the differences between men and women in each group were investigated. The risk factors of moderated and severe TBI compared to mild TBI were also investigated. RESULTS: The study included 3075 men and 1393 women and the proportion of total males was 68.8%. Among all the TBI patients, there were significant differences between men and women in age, past history, and GCS score. While the mild and severe TBI groups showed significant differences in age, past history, and clinical symptoms, the moderate TBI group showed significant differences in age, past history, cause of justice, and diagnosis. CONCLUSION To the best of our knowledge, this multicenter study is the first to focus on gender differences of adult patients with TBI in Korea. This study shows significant differences between men and women in many aspects of adult TBI. Therefore, gender differences should be strongly considered in TBI studies.
Adult ; Brain Injuries ; Brain Injuries, Traumatic/epidemiology* ; Female ; Glasgow Coma Scale ; Humans ; Male ; Prospective Studies ; Sex Factors

OBJECTIVE: A small epidural hematoma (EDH) that has been diagnosed to be nonsurgical by initial brain computed tomography (CT) can increase in size and need surgical removal, resulting in a poor prognosis. However, there have been few studies, which focused delayed operated EDH. Therefore, we analyzed the clinical factors to determine the predicting factors of delayed operated EDH. METHODS: Between January 2011 and January 2014, 90 patients, who were admitted due to EDH, were enrolled in this study. None of the patients were indicated for operation initially. Based on the presence of surgery, we classified the patients into a delayed-surgery group (DG) and a non-surgical group (NG). Additionally, we analyzed them according to the following: time interval between the trauma and the initial CT, gender, age, medical history, drinking, change of mean arterial pressure (MAP), volume of EDH and other traumatic brain lesion. RESULTS: Among the 90 patients, the DG was 19 patients. Compared with NG, the DG revealed increased MAP, less presence of drinking, and a short time interval (DG vs. NG: +9.684 mm Hg vs. -0.428 mm Hg, 5.26% vs. 29.58%, 1.802 hours vs. 5.707 hours, respectively, p<0.05). Analyzing the time interval with receiver operating characteristic, there was 88.2% sensitivity and 68.3% specificity at the 2.05-hour cut-off value (area under the curve=0.854). CONCLUSION: According to our results, the time interval between the trauma and the initial CT along with blood pressure change are potential predicting factors in the cases of delayed operation of EDH.
Arterial Pressure ; Blood Pressure ; Brain ; Craniocerebral Trauma ; Drinking ; Hematoma* ; Hematoma, Epidural, Cranial ; Humans ; Neurosurgery ; Prognosis ; ROC Curve ; Sensitivity and Specificity ; Tomography, X-Ray Computed