Despite the great socioeconomic burden of stroke, there have been few reports of stroke statistics in Korea. In this scenario, the Epidemiologic Research Council of the Korean Stroke Society launched the “Stroke Statistics in Korea” project, aimed at writing a contemporary, comprehensive, and representative report on stroke epidemiology in Korea. This report contains general statistics of stroke, prevalence of behavioral and vascular risk factors, stroke characteristics, pre-hospital system of care, hospital management, quality of stroke care, and outcomes. In this report, we analyzed the most up-to-date and nationally representative databases, rather than performing a systematic review of existing evidence. In summary, one in 40 adults are patients with stroke and 232 subjects per 100,000 experience a stroke event every year. Among the 100 patients with stroke in 2014, 76 had ischemic stroke, 15 had intracerebral hemorrhage, and nine had subarachnoid hemorrhage. Stroke mortality is gradually declining, but it remains as high as 30 deaths per 100,000 individuals, with regional disparities. As for stroke risk factors, the prevalence of smoking is decreasing in men but not in women, and the prevalence of alcohol drinking is increasing in women but not in men. Population-attributable risk factors vary with age. Smoking plays a role in young-aged individuals, hypertension and diabetes in middle-aged individuals, and atrial fibrillation in the elderly. About four out of 10 hospitalized patients with stroke are visiting an emergency room within 3 hours of symptom onset, and only half use an ambulance. Regarding acute management, the proportion of patients with ischemic stroke receiving intravenous thrombolysis and endovascular treatment was 10.7% and 3.6%, respectively. Decompressive surgery was performed in 1.4% of patients with ischemic stroke and in 28.1% of those with intracerebral hemorrhage. The cumulative incidence of bleeding and fracture at 1 year after stroke was 8.9% and 4.7%, respectively. The direct costs of stroke were about ₩1.68 trillion (KRW), of which ₩1.11 trillion were for ischemic stroke and ₩540 billion for hemorrhagic stroke. The great burden of stroke in Korea can be reduced through more concentrated efforts to control major attributable risk factors for age and sex, reorganize emergency medical service systems to give patients with stroke more opportunities for reperfusion therapy, disseminate stroke unit care, and reduce regional disparities. We hope that this report can contribute to achieving these tasks.
Adult ; Aged ; Alcohol Drinking ; Ambulances ; Atrial Fibrillation ; Cerebral Hemorrhage ; Emergency Medical Services ; Emergency Service, Hospital ; Epidemiology ; Female ; Hemorrhage ; Hope ; Humans ; Hypertension ; Incidence ; Korea ; Male ; Mortality ; Prevalence ; Reperfusion ; Risk Factors ; Smoke ; Smoking ; Stroke ; Subarachnoid Hemorrhage ; Writing

PURPOSE: In 2014, Korea ranked as the first among the Organization for Economic Cooperation and Development countries on the prevalence, incidence, and mortality of pulmonary tuberculosis (TB). The prevalence of TB among the homeless was 6.4% in the United State and 7.1% in South Korea. The aim of this study is to develop predicting indicators of TB by analyzing homeless people who visit the public hospital emergency department (ED). METHODS: We analyzed 7,500 homeless individuals who visited a public hospital ED between January 1, 2001 and May 31, 2014. A total of 4,552 patients were included, and of these, 145 homeless patients were infected with TB. We conducted univariate and multivariate analysis of clinical variables obtained from the initial check list and later lab analysis, and made a scoring system by weighing each variable. Then applying this scoring system, the area under the receiver (AUC) operating characteristic curve (ROC) was calculated. RESULTS: The prevalence of TB was 3.2%. The initial meaningful predictor variables were as follows: Being homeless, abnormal heart rate, abnormal respiratory rate, no alcohol intake, hypoalbuminemia, and CRP elevation. The AUC of ROC curve from these predictor variables were 0.815. CONCLUSION: We developed a novel scoring system to screen TB patients in a vulnerable social group who visit the ED. We can detect potential TB patients early and effectively control TB, preventing the spread of TB. Prospective internal and external validation is necessary by using the scoring system of TB among the homeless.
Area Under Curve ; Emergencies* ; Emergency Service, Hospital* ; Heart Rate ; Hospitals, Public ; Humans ; Hypoalbuminemia ; Incidence ; Korea ; Mass Screening* ; Mortality ; Multivariate Analysis ; Organisation for Economic Co-Operation and Development ; Prevalence ; Prospective Studies ; Respiratory Rate ; ROC Curve ; Tuberculosis, Pulmonary*

Vitamins are essential micronutrients for maintenance of tissue functions. Vitamin deficiency is one of the most serious and common health problems among both chronic alcoholics and the homeless. However, the vitamin-level statuses of such people have been little studied. We evaluated the actual vitamin statuses of alcoholic homeless patients who visited an emergency department (ED). In this study the blood levels of vitamins B1, B12, B6, and C of 217 alcoholic homeless patients were evaluated retrospectively in a single urban teaching hospital ED. Vitamin C deficiency was observed in 84.3% of the patients. The vitamin B1, B12, and B6 deficiency rates, meanwhile, were 2.3%, 2.3%, and 23.5%, respectively. Comparing the admitted patients with those who were discharged, only the vitamin C level was lower. (P=0.003) In fact, the patients' vitamin C levels were markedly diminished, vitamin C replacement therapy for homeless patients should be considered in EDs.
Adult ; Alcoholic Intoxication/*complications ; Ascorbic Acid/blood/therapeutic use ; Ascorbic Acid Deficiency/*complications/drug therapy/epidemiology ; Emergency Service, Hospital ; Female ; *Homeless Persons ; Humans ; Male ; Middle Aged ; Republic of Korea/epidemiology ; Retrospective Studies ; Vitamin B Complex/blood

PURPOSE: Differential diagnosis of acute abdominal pain of the childbearing age woman is a difficult challenge to the emergency physician. Clinical scoring systems for pelvic inflammatory disease (PID) and acute appendicitis have already been introduced. We want to validate these scoring systems externally. METHODS: This study was conducted at a single urban teaching hospital emergency department from May 2011 to September 2013. Retrospective analysis of a prospectively collected registry for reproductive-aged women was performed. RESULTS: A total of 1432 patients were registered. Among them, 322 patients diagnosed as PID (177 patients) or acute appendicitis (145 patients) were finally analyzed in this study. Among the PID and acute appendicitis scored, lower and higher cut-off points were 3 and 8 for PID risk score, and 6 and 10 for appendicitis risk score. PID risk score of PID patients was 7.0 (+/-1.9), acute appendicitis patients was 4.3 (+/-2.1), and other patients was 4.0 (+/-2.2) (p<0.001). Appendicitis risk score of PID patients was 5.7 (+/-1.9), acute appendicitis patients was 9.0 (+/-2.1), and other patients was 5 (+/-1.6) (p<0.001). The areas under the receiver operating characteristic curves were 0,832 and 0,950 for diagnosis of PID with PID risk score and acute appendicitis with appendicitis risk score, respectively. CONCLUSION: These scoring systems have appropriate diagnostic power for diagnosis of PID and acute appendicitis.
Abdominal Pain* ; Appendicitis* ; Diagnosis ; Diagnosis, Differential ; Emergencies ; Emergency Service, Hospital* ; Female ; Hospitals, Teaching ; Humans ; Pelvic Inflammatory Disease* ; Prospective Studies ; Retrospective Studies ; ROC Curve

PURPOSE: Differentiating gynecological emergency surgery indications among reproductive-age female patients presenting with acute abdominal pain is challenging for emergency department (ED) physicians. We evaluated the clinical demographics of female patients diagnosed with gynecological surgery indications in the ED and found clinical predictors associated with surgical indications overall and with each surgical indication. METHODS: We conducted a prospective review study of the hospital registries of reproductive-aged women who presented with abdominal pain but without underlying disease from April 2008 to October 2010. These registries included information concerning the patient's basic characteristics, medical history, gynecologic history, symptoms, physician's examination, and laboratory results. Using a multivariate logistic regression analysis, we found a number of statistically significant factors indicating a gynecological emergency necessitating surgery. RESULTS: A total of 1047 cases involving female patients of reproductive age were initially included. We found 89 patients(8.50%) who were diagnosed as having gynecological surgery indications: 50(4.78%) were diagnosed with hemorrhagic ovarian cyst rupture, 16(1.53%) with ectopic pregnancy, and 23(2.20%) with ovarian torsion. Pain of more than 14 days from the last menstrual period (OR, 2.332; 95% CI, 1.406-3.968; p=0.001), bilateral lower abdominal tenderness (OR, 0.467; 95% CI, 0.288-0.758; p=0.002), rebound tenderness (OR, 0.54; 95% CI, 0.329-0.887; p=0.015), normal C-reactive protein value (CRP) (OR, 3.286; 95% CI, 1.717-6.290; p<0.001), and positive human chorionic gonadotropin test (OR, 0.058; 95% CI, 0.024-0.142; p<0.001) were related to gynecologic emergency surgery indication in a patient with abdominal pain. CONCLUSION: Clinical findings of the last menstrual period, bilateral abdominal tenderness, rebound tenderness, CRP value, and urine hCG result can be helpful in exclusion of gynecologic emergency surgical indications.
Abdominal Pain* ; C-Reactive Protein ; Chorionic Gonadotropin ; Demography ; Emergencies* ; Emergency Service, Hospital* ; Female ; Gynecologic Surgical Procedures ; Humans ; Logistic Models ; Ovarian Cysts ; Pregnancy ; Pregnancy, Ectopic ; Prospective Studies ; Registries ; Rupture

PURPOSE: In the emergency department (ED), identification of the obstetrical and gynecologic history for diagnosis of child-bearing aged women who present with abdominal pain is very important. We compared the usefulness of self-registry using a tablet computer and a traditional paper registry for taking history of child-bearing aged women. METHODS: We reviewed the prospective registries of child-bearing aged women presenting with abdominal pain without underlying disease to the ED of the Seoul Metropolitan Boramae Medical Center. We used a paper version of this registry from April 2008 to April 2011. From May 2011 to October 2012, we used the Smart Medical Registry (SMR), where the patient used a tablet computer to record her own data. The registries of child-bearing aged women included information on the patient's basic information, medical history, gynecologic history, symptoms, physician's examination, and laboratory results. We performed statistical analysis of the difference between the paper registry and SMR. RESULTS: A total of 1193 patients were registered. Among them, 835 patients were registered using the SMR. There were no statistically significant differences in the patients' basic information and diagnostic classification. However, the SMR group reported more recent history of pelvic inflammatory disease (p<0.01), higher number of abortions (p<0.01), and higher number of sexual partners (p<0.01). CONCLUSION: Using the tablet computer based self-survey, patients had a more positive tendency toward answering privacy sensitive items. Therefore, it might be more useful and effective in obtaining sensitive, private information from patients.
Abdominal Pain* ; Classification ; Diagnosis ; Emergencies* ; Emergency Medicine ; Emergency Service, Hospital* ; Female ; Humans ; Medical History Taking ; Pelvic Inflammatory Disease ; Privacy ; Registries ; Seoul ; Sexual Partners

PURPOSE: Differentiating gynecological emergency surgery indications among reproductive-age female patients presenting with acute abdominal pain is challenging for emergency department (ED) physicians. We evaluated the clinical demographics of female patients diagnosed with gynecological surgery indications in the ED and found clinical predictors associated with surgical indications overall and with each surgical indication. METHODS: We conducted a prospective review study of the hospital registries of reproductive-aged women who presented with abdominal pain but without underlying disease from April 2008 to October 2010. These registries included information concerning the patient's basic characteristics, medical history, gynecologic history, symptoms, physician's examination, and laboratory results. Using a multivariate logistic regression analysis, we found a number of statistically significant factors indicating a gynecological emergency necessitating surgery. RESULTS: A total of 1047 cases involving female patients of reproductive age were initially included. We found 89 patients(8.50%) who were diagnosed as having gynecological surgery indications: 50(4.78%) were diagnosed with hemorrhagic ovarian cyst rupture, 16(1.53%) with ectopic pregnancy, and 23(2.20%) with ovarian torsion. Pain of more than 14 days from the last menstrual period (OR, 2.332; 95% CI, 1.406-3.968; p=0.001), bilateral lower abdominal tenderness (OR, 0.467; 95% CI, 0.288-0.758; p=0.002), rebound tenderness (OR, 0.54; 95% CI, 0.329-0.887; p=0.015), normal C-reactive protein value (CRP) (OR, 3.286; 95% CI, 1.717-6.290; p<0.001), and positive human chorionic gonadotropin test (OR, 0.058; 95% CI, 0.024-0.142; p<0.001) were related to gynecologic emergency surgery indication in a patient with abdominal pain. CONCLUSION: Clinical findings of the last menstrual period, bilateral abdominal tenderness, rebound tenderness, CRP value, and urine hCG result can be helpful in exclusion of gynecologic emergency surgical indications.
Abdominal Pain* ; C-Reactive Protein ; Chorionic Gonadotropin ; Demography ; Emergencies* ; Emergency Service, Hospital* ; Female ; Gynecologic Surgical Procedures ; Humans ; Logistic Models ; Ovarian Cysts ; Pregnancy ; Pregnancy, Ectopic ; Prospective Studies ; Registries ; Rupture

PURPOSE: In the emergency department (ED), identification of the obstetrical and gynecologic history for diagnosis of child-bearing aged women who present with abdominal pain is very important. We compared the usefulness of self-registry using a tablet computer and a traditional paper registry for taking history of child-bearing aged women. METHODS: We reviewed the prospective registries of child-bearing aged women presenting with abdominal pain without underlying disease to the ED of the Seoul Metropolitan Boramae Medical Center. We used a paper version of this registry from April 2008 to April 2011. From May 2011 to October 2012, we used the Smart Medical Registry (SMR), where the patient used a tablet computer to record her own data. The registries of child-bearing aged women included information on the patient's basic information, medical history, gynecologic history, symptoms, physician's examination, and laboratory results. We performed statistical analysis of the difference between the paper registry and SMR. RESULTS: A total of 1193 patients were registered. Among them, 835 patients were registered using the SMR. There were no statistically significant differences in the patients' basic information and diagnostic classification. However, the SMR group reported more recent history of pelvic inflammatory disease (p<0.01), higher number of abortions (p<0.01), and higher number of sexual partners (p<0.01). CONCLUSION: Using the tablet computer based self-survey, patients had a more positive tendency toward answering privacy sensitive items. Therefore, it might be more useful and effective in obtaining sensitive, private information from patients.
Abdominal Pain* ; Classification ; Diagnosis ; Emergencies* ; Emergency Medicine ; Emergency Service, Hospital* ; Female ; Humans ; Medical History Taking ; Pelvic Inflammatory Disease ; Privacy ; Registries ; Seoul ; Sexual Partners

PURPOSE: Homeless patients usually live outside and are therefore frequently exposed to injury and tetanus infection. Thus, after visits to an emergency department (ED) due to injury, homeless patients need to be vaccinated for the prevention of tetanus infection with tetanus immunoglobulin regardless of tetanus antibody titer or previous vaccination history. Because the exact history of previous tetanus vaccination in homeless patients is unclear, the tetanus antibody titer between homeless patients and general patients was assessed. METHODS: Subjects who visited the ED after injury from October 2008 to February 2010 were enrolled. All participants answered questions on age, gender, previous vaccination or prophylaxis history, and military service. The Tetanus Immunoglobulin G ELISA (Enzyme-linked immunosorbent assay) method was used for the analysis of serum samples. Propensity score-matched analysis was used to control for age, gender, previous vaccination or prophylaxis history, and military service. RESULTS: A total of 1325 samples were analyzed. There was 83 samples from homeless patients and 1242 samples from general patients. After matched analysis using the propensity score, 56 subjects were matched. The geometric mean titer of tetanus antibody was 0.204+/-0.392 IU/mL in homeless patients and 0.105+/-0.143 IU/mL in general patients (p=0.078). The proportion of patients with a safe tetanus antibody titer was 66.1 percent of homeless patients and 23.2 percent of general patients (p<0.001). CONCLUSION: Homeless patients had a higher mean titer and a statistically higher proportion had a safe titer compared to general patients.
Emergencies ; Enzyme-Linked Immunosorbent Assay ; Humans ; Immunoglobulin G ; Immunoglobulins ; Methods ; Military Personnel ; Propensity Score ; Tetanus* ; Vaccination

PURPOSE: Homeless patients usually live outside and are therefore frequently exposed to injury and tetanus infection. Thus, after visits to an emergency department (ED) due to injury, homeless patients need to be vaccinated for the prevention of tetanus infection with tetanus immunoglobulin regardless of tetanus antibody titer or previous vaccination history. Because the exact history of previous tetanus vaccination in homeless patients is unclear, the tetanus antibody titer between homeless patients and general patients was assessed. METHODS: Subjects who visited the ED after injury from October 2008 to February 2010 were enrolled. All participants answered questions on age, gender, previous vaccination or prophylaxis history, and military service. The Tetanus Immunoglobulin G ELISA (Enzyme-linked immunosorbent assay) method was used for the analysis of serum samples. Propensity score-matched analysis was used to control for age, gender, previous vaccination or prophylaxis history, and military service. RESULTS: A total of 1325 samples were analyzed. There was 83 samples from homeless patients and 1242 samples from general patients. After matched analysis using the propensity score, 56 subjects were matched. The geometric mean titer of tetanus antibody was 0.204+/-0.392 IU/mL in homeless patients and 0.105+/-0.143 IU/mL in general patients (p=0.078). The proportion of patients with a safe tetanus antibody titer was 66.1 percent of homeless patients and 23.2 percent of general patients (p<0.001). CONCLUSION: Homeless patients had a higher mean titer and a statistically higher proportion had a safe titer compared to general patients.
Emergencies ; Enzyme-Linked Immunosorbent Assay ; Humans ; Immunoglobulin G ; Immunoglobulins ; Methods ; Military Personnel ; Propensity Score ; Tetanus* ; Vaccination