PURPOSE: Rapid multidisciplinary trauma care by trauma team is essential for severely injured patients. Different protocols for trauma team activation are used in each hospital. Correct trauma triage is needed to ensure appropriate use of medical resources. The aim of this study was to evaluate the performance of our modified protocol for trauma team activation. METHODS: This is an observational, retrospective cohort study. Injured patients with trauma team activation (TTA) or who had been admitted to a surgical intensive care unit were investigated from 1st March 2010 to 31st May 2012. The TTA protocol was analyzed with respect to sensitivity, positive predictive value (PPV), and overtriage (1-PPV). Undertriage (1-sensitivity) was defined as no TTA despite severe injury (Injury Severity Score (ISS) >15). RESULTS: A total of 229 patients were included. There were 201 patients with TTA and 28 patients without TTA. Of the 201 patients with TTA, 104 were identified as severely injured (ISS>15), yielding sensitivity of 79%, PPV of 51%, and overtriage of 49%. Undertriage was 21% (n=28) when considering all severely injured patients (n=132). Among 12 criteria of our TTA protocol, 'injury in two or more body regions' accounted for 85.6% of the overtriage. Of the patients with undertriage, 75% represented isolated head injury and 28.5% from interhospital transfer. CONCLUSION: The rate of overtriage of TTA protocol in our hospital is appropriate, but the rate of undertriage is relatively high. We believe, to decrease the overtriage of all and undertriage in patients with injury in an isolated specific body region, more research for evaluation of effects of protocol excluding the criteria of 'injury in two or more body regions' is needed.
Body Regions ; Cohort Studies ; Craniocerebral Trauma ; Emergency Service, Hospital* ; Humans ; Critical Care ; Retrospective Studies ; Triage

BACKGROUND AND OBJECTIVES: Although circadian variation in the onset of acute myocardial infarction (AMI) has been reported in a number of studies, not much is known about the impact of circadian variation on 12-month mortality. The aim of this study was to investigate the impact of circadian variation on 12-month mortality in patients with AMI. SUBJECTS AND METHODS: Eight hundred ninety two patients (mean age 67+/-12; 66.1% men) with AMI who visited Kyungpook National University Hospital from November 2005 to December 2007 were included in this study. Patients were divided into groups based on four 6-hours intervals: overnight (00:00-05:59); morning (06:00-11:59); afternoon (12:00-17:59) and evening (18:00-23:59). RESULTS: Kaplan-Meier survival curves showed 12-month mortality rates of 9.6%, 9.1%, 12.1%, and 16.7% in the overnight, morning, afternoon, evening-onset groups, respectively (p=0.012). Compared with the morning-onset AMI group, the serum creatinine levels (p=0.002), frequency of Killip class > or =3 (p=0.004), and prescription rate of diuretics (p=0.011) were significantly higher in the evening-onset AMI group, while the left ventricular ejection fraction (p=0.012) was significantly lower. The proportion of patients who arrived in the emergency room during routine duty hours was significantly lower in evening-onset groups irrespective of the presence or absence of ST-segment elevation (p<0.001). According to univariate analysis, the 12-month mortality rate in the evening group was significantly higher compared to the morning group (hazard ratio 1.998, 95% confidence interval 1.196 to 3.338, p=0.008). CONCLUSION: Patients with evening-onset AMI had poorer baseline clinical characteristics, and this might affect the circadian impact on 12-month mortality. Further studies are needed to clarify the role of circadian variation on the long-term outcome of AMI.
Circadian Rhythm ; Creatinine ; Diuretics ; Emergencies ; Humans ; Kaplan-Meier Estimate ; Myocardial Infarction ; Prescriptions ; Stroke Volume

PURPOSE: The purpose of this study is to estimate the accuracy of diagnosing a radio-lucent soft tissue foreign body with using ultrasound according to the different sizes and depth of the foreign bodies in an experimented model. METHODS: In the forefeet of swine, we made 45 incisions (4 in each forefeet) of 2 mm, 5 mm and 10 mm sized toothpicks at depths of 1 cm, 2 cm and 3 cm each. 15 incisions without foreign bodies were cannulated, simulating damage to the soft tissue made by a non captured foreign body. The twelve emergency physicians kept records not only for the presence or absence of a foreign body, but also for the depth of it. We then calculated the sensitivity, specificity, PPV (positive predictive value) and NPV (negative predictive value) according to the sizes of the toothpicks and the depths. RESULTS: The sensitivity, specificity, PPV and NPV of all the depths and sizes were under 80%. The results of the staff and residents were not significantly different. The result of a 3 cm depth was especially poor. CONCLUSION: In our model, ultrasound performed by emergency physicians was neither sensitive nor specific for diagnosing a soft tissue foreign body of various sizes and depths.
Emergencies ; Foreign Bodies ; Sensitivity and Specificity ; Swine

BACKGROUND AND OBJECTIVES: There are limited data examining triggering activities and circadian distribution at the onset of acute aortic dissection (AAD) in the context of diagnostic and anatomical classification. The aim of this study was to further investigate this relationship between triggering activities and circadian distribution at the onset of AAD according to diagnostic and anatomic classification. SUBJECTS AND METHODS: A total of 166 patients with AAD admitted to Kyungpook National University Hospital between July 2001 and June 2009 were included. To assess the influence of diagnostic and anatomical classification, we categorized the patients into intramural hematoma (IMH) group (n=67)/non-IMH group (n=99) and Stanford type A (AAD-A, n=94)/type B (AAD-B, n=72). To evaluate circadian distribution, the day was divided into four 6-hour periods: night (00-06 hours), morning (06-12 hours), afternoon (12-18 hours), and evening (18-00 hours). RESULTS: Most (72%) AAD episodes were related to physical (53%) and mental activities (19%), with about one-third occurring during the afternoon, and only 12% occurring at night. No differences in triggering activities or circadian distribution were observed among the groups. Waking hours including morning, afternoon, and evening correlated with triggering activities (p=0.003). These relationships were observed for the non-IMH (p=0.008) and AAD-B (p=0.003) cases. The remaining categories had similar relationships, but did not reach statistical significance. CONCLUSION: Our findings suggest differences in the relationship between triggering activities and the circadian distribution of the onset of AAD according to diagnostic and anatomical classification.
Aorta ; Circadian Rhythm ; Hematoma ; Humans

BACKGROUND AND OBJECTIVES: Data on the usefulness of a combination of different electrocardiography (ECG) abnormalities in risk stratification of patients with acute pulmonary embolism (PE) are limited. We thus investigated 12-lead ECG patterns in acute PE to evaluate the role of the ECG score in risk stratification of patients with acute PE. SUBJECTS AND METHODS: One hundred twenty-five consecutive patients (63+/-14 years, 56 men) with acute PE who were admitted to Kyungpook National University Hospital between November 2001 and January 2008 were included. We analyzed ECG patterns and calculated the ECG score in all patients. We evaluated right ventricular systolic pressure (RVSP) (n=75) and RV hypokinesia (n=80) using echocardiography for risk stratification of acute PE patients. RESULTS: Among several ECG findings, sinus tachycardia and inverted T waves in V(1-4) (39%) were observed most frequently. The mean ECG score and RVSP were 7.36+/-6.32 and 49+/-21 mmHg, respectively. The ECG score correlated with RVSP (r=0.277, p=0.016). The patients were divided into two groups {high ECG-score group (n=38): ECG score >12 and low ECG-score group (n=87): ECG score < or =12} based on the ECG score, with the maximum area under the curve. RV hypokinesia was observed more frequently in the high ECG-score group than in the low ECG-score group (p=0.006). Multivariate analysis revealed that a high ECG score was an independent predictor of high RVSP and RV hypokinesia. CONCLUSION: Sinus tachycardia and inverted T waves in V(1-4) were commonly observed in acute PE. Moreover, the ECG score is a useful tool in risk stratification of patients with acute PE.
Blood Pressure ; Echocardiography ; Electrocardiography ; Heart Ventricles ; Humans ; Hypokinesia ; Multivariate Analysis ; Pulmonary Embolism ; Tachycardia, Sinus

BACKGROUND AND OBJECTIVES: The gender differences among Korean patients with coronary spasm have not been defined. We thus determined the gender differences among Korean patients with coronary spasm. SUBJECTS AND METHODS: Patients with chest pain and/or syncope who were admitted to Kyungpook National University Hospital between January 2001 and August 2008 were included. Provocation of coronary vasospasm with intracoronary ergonovine maleate was performed when baseline coronary angiography showed no significant stenosis or there was a strong clinical suspicion of coronary spasm. The clinical characteristics were analyzed from 104 consecutive patients (56+/-9 years of age; 21 females) who were diagnosed with coronary spasm. RESULTS: Female patients were younger (52+/-7 vs. 57+/-10 years, p=0.046) with lower rates of smoking and alcohol consumption histories than male patients (19% vs. 65%, p<0.001; and 43% vs. 89%, p<0.001, respectively). The other clinical characteristics were not significantly different, except for the triglyceride levels. CONCLUSION: The majority of patients with coronary spasm were males who were smokers and alcohol consumers. The female patients had lower rates of smoking and alcohol consumption, and they were younger than the male patients. Further studies are needed to investigate the relevance of gender differences in the pathogenesis of coronary spasm.
Alcohol Drinking ; Chest Pain ; Constriction, Pathologic ; Coronary Angiography ; Coronary Vasospasm ; Ergonovine ; Female ; Humans ; Male ; Maleates ; Sex Characteristics ; Smoke ; Smoking ; Spasm ; Syncope

BACKGROUND AND OBJECTIVES: The prognosis and natural history of bradycardia related to drugs such as beta-blockers and non-dihydropyridine calcium channel blockers are not well known. SUBJECTS AND METHODS: We retrospectively analyzed 38 consecutive patients (age 69+/-11, 21 women) with drug-related bradycardia (DRB) between March 2005 and September 2007. A drug-associated etiology for the bradycardia was established based on the medical history and patient response to drug discontinuation. The mean follow-up duration was 18+/-8 months. RESULTS: The initial electrocardiogram (ECG) showed sinus bradycardia (heart rate < or =40/min) in 13 patients, sinus bradycardia with junctional escape beats in 18 patients, and third-degree atrioventricular (AV) block in seven patients. Drug discontinuation was followed by resolution of bradycardia in 60% of patients (n=23). Among them, five (17.8%) patients resumed taking the culprit medication after discharge and none developed bradycardia again. Bradycardia persisted in 10 (26.3%) patients despite drug withdrawal, and a permanent pacemaker was implanted in seven of them. Third-degree AV block, QRS width, and bradycardia requiring temporary transvenous pacing were significantly associated with the bradycardia caused by drugs. CONCLUSION: Beta-blockers were the most common drugs associated with DRB. However, in one quarter of the cases the DRB was not associated with drugs; in these patients permanent pacemaker implantation should be considered.
Arrhythmias, Cardiac ; Atrioventricular Block ; Bradycardia ; Calcium Channel Blockers ; Dichlororibofuranosylbenzimidazole ; Electrocardiography ; Follow-Up Studies ; Humans ; Natural History ; Prognosis ; Retrospective Studies ; United Nations

BACKGROUND/AIMS: Halitosis is a symptom that bothers patients more socially than medically and its pathogenic mechanisms are unclear and treatment armamenterium is limited. Clinicians generally ignored active interventions. Since halitosis is closely associated with volatile sulfur compounds (VSCs), we used a Halimeter and gas chromatography to measure VSCs in patients with Helicobacter-pylori (H. pylori)-associated gastric diseases. METHODS: We categorized 72 patients with H. pylori infection into two groups based on their endoscopic findings: a non-erosive mucosal group (NE, n=24) and an erosive mucosal group (E, n=48). Halitosis was objectively assessed by applying either a Halimeter to breath air or gas chromatography to gastric juice. Simultaneously, the expression of VSC-generating enzyme was measured with reverse-transcriptase PCR using mRNA isolated from biopsy tissues. RESULTS: The levels of VSCs in exhaled breaths or aspirated gastric juices differed significantly between the NE and E groups (p<0.00001), suggesting that VSCs might reflect eroded epithelial damage induced by H. pylori infection. The expressions of cystathionine beta-synthase (CBS) and cystathionine gamma-lyase (CSE) were broadly consistent with the degree of mucosal injury. CONCLUSIONS: Erosive changes in esophagogastroduodenal mucosa were strongly correlated with increased VSC levels, suggesting that halitosis might result from H. pylori-associated erosive lesions.
Biopsy ; Chromatography, Gas ; Cystathionine beta-Synthase ; Cystathionine gamma-Lyase ; Cytochrome P-450 CYP1A1 ; Gastric Juice ; Halitosis ; Humans ; Hydrogen Sulfide ; Mucous Membrane ; Polymerase Chain Reaction ; RNA, Messenger ; Stomach Diseases ; Sulfur ; Sulfur Compounds

BACKGROUND: Serum gamma-glutamyl transferase activity (GGT) is able to catalyse low-density lipoprotein oxidation in coronary atherosclerotic plaques and has a role in the pathogenesis of atherosclerosis. GGT has been shown to be an independent risk factor for cardiac mortality in patients with a previous myocardial infarction. The purpose of this study is to determine the prognostic value of GGT within its normal range at an acute stage in patients with acute myocardial infarction. METHODS: In a retrospective study, GGT and other cardiac risk factors were evaluated in 192 patients (M/F=143/49; mean age: 60.8+/-11.8 years) who were diagnosed with an acute myocardial infarction at the emergency room. We compared the serum GGT values for each patient with or without a cardiac event, including cardiac death, non-fetal myocardial infarction and unstable angina, after an acute myocardial infarction for a mean follow-up of 16.5+/-10.8 months. RESULTS: During the follow-up period, 17 patients underwent cardiac death and experienced an acute myocardial infarction and 23 patients had unstable angina. Although the mean GGT values were significantly different from patients with cardiac events (29.5+/-10.0 U/L vs 25.0+/-11.2 U/L, p=0.024), serum GGT was not an independent cardiac risk factor for a cardiac event based on multivariate analysis adjusted for age, sex, alcohol and known cardiovascular risk factors. CONCLUSIONS: Serum GGT within its normal range at an acute stage in patients that experienced an acute myocardial infarction is not an independent prognostic marker.
Angina, Unstable ; Atherosclerosis ; Death ; Emergency Service, Hospital ; Follow-Up Studies ; Humans ; Lipoproteins ; Mortality ; Multivariate Analysis ; Myocardial Infarction* ; Plaque, Atherosclerotic ; Reference Values ; Retrospective Studies ; Risk Factors ; Transferases*

BACKGROUND AND OBJECTIVES: The left ventricular ejection fraction (LVEF) and volume (LVV) are important variables in patients with coronary artery disease. Quantitative gated myocardial SPECT (QGS) permits the simultaneous assessment of perfusion, LVEF and LVV. However, the presence of a perfusion defect may influence the LVEF and LVV measured by QGS. SUBJECTS AND METHODS: 67 subjects (M/F=47/20; mean age: 60.2+/-12.4 years) underwent both QGS with Tc-99m MIBI and 2-D echocardiography (Echo) at less than 7 days apart. The LVEF and LVV were measured by Echo, using the modified Simpson's method, and by QGS, using the automatic software, AutoQUANT(TM). The QGS rest images were used to compare with the Echo. RESULTS: The correlations between the QGS and Echo for LVEF, LVEDV and LVESV were good in all 67 subjects (r=0.781, 0.754 and 0.906, respectively, p<0.0001). In patients with no perfusion defect (n=34), the correlations between the QGS and Echo for LVEF, LVEDV and LVESV were good (r=0.689, 0.593 and 0.586, p<0.0001). In patients with a perfusion defect (n=33), the LVEF between the QGS and Echo was well correlated (r=0.777, p<0.0001), but the LVEF was higher by 7.1+/-8.7% from the Echo results. The LVEDV and LVESV by both QGS and Echo were also well correlated (r=0.804 and 0.929, respectively, p<0.0001), but the LVEDV and LVESV were higher from QGS by 17.9+/-34 and 16.9+/-25 mL, respectively. A Bland-Altman analysis showed the agreement between the QGS and Echo in patients without perfusion defect was better than for those with a perfusion defect. CONCLUSION: The perfusion defect from QGS might affect the measurements of the LVEF and LVV; therefore, the QGS and Echo values are not interchangeable.
Coronary Artery Disease ; Echocardiography ; Humans ; Perfusion* ; Stroke Volume* ; Tomography, Emission-Computed, Single-Photon* ; Ventricular Function, Left