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OBJECTIVE: Fall from height (FFH) is a major public health problem that can result in severe injury, disability, and death. This study investigated how the characteristics of jumpers and fallers differ. METHODS: This was a retrospective study of FFH patients enrolled in an Emergency Department-based Injury In-depth Surveillance (EDIIS) registry between 2011 and 2018. Depending on whether the injury was intentional, FFH patients who had fallen from a height of at least 1 m were divided into two groups: jumpers and fallers. Patient characteristics, organ damage, and death were compared between the two groups, and factors that significantly affected death were identified using multivariable logistic analysis. RESULTS: Among 39,419 patients, 1,982 (5.0%) were jumpers. Of the jumpers, 977 (49.3%) were male, while 30,643 (81.9%) of fallers were male. The jumper group had the highest number of individuals in their 20s, with the number decreasing as age increased. In contrast, the number of individuals in the faller group rose until reaching their 50s, after which it declined. More thoracoabdominal, spinal, and brain injuries were found in jumpers. The in-hospital mortality of jumpers and fallers was 832 (42.0%) and 1,268 (3.4%), respectively. Intentionality was a predictor of in-hospital mortality, along with sex, age, and fall height, with an odds ratio of 7.895 (95% confidence interval, 6.746-9.240). CONCLUSION: Jumpers and fallers have different epidemiological characteristics, and jumpers experienced a higher degree of injury and mortality than fallers. Differentiated prevention and treatment strategies are needed for jumpers and fallers to reduce mortality in FFH patients.
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This study aimed to evaluate the effects of bystander cardiopulmonary resuscitation (CPR) and dispatcher-assisted CPR (DA-CPR) on outcomes after out-of-hospital cardiac arrest (OHCA). We conducted a prospective observational study using the Korean Cardiac Arrest Research Consortium registry database and enrolled adults aged > 20 years who sustained OHCA. The study population comprised 13,864 patients from October 1, 2015, to June 30, 2021. All enrolled patients were transported to the emergency room and resuscitated by the emergency medical personnel. Patients with terminal illnesses, pregnancy, "do not resuscitate" cards, and insufficient recorded information were excluded. Good neurologic outcomes were noted in 6.5%, 9.9%, and 9.6% of patients in the "no bystander", "standard bystander", and "compression-only bystander" CPR groups, respectively, and differed significantly (p < 0.001). Survival to discharge differed significantly (p < 0.001) between groups at 10.8%, 13.1%, and 13.2%, respectively. In a multivariable model, the interaction between "compression-only" and DA-CPR showed a positive effect on good neurological outcomes and survival to discharge with an odds ratio of 1.93 (Confidence interval, CI 1.28-2.91, p = 0.002) and 1.74 (CI 1.24-2.44, p = 0.001), respectively. In conclusion, the interaction between compression-only CPR and DA-CPR is significantly associated with good neurological and survival outcomes after OHCA. Education for bystanders and dispatchers should adhere to the current guidelines to improve outcomes among OHCA victims.
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Reanimación Cardiopulmonar , Servicios Médicos de Urgencia , Paro Cardíaco Extrahospitalario , Adulto , Humanos , Paro Cardíaco Extrahospitalario/terapia , Sistema de Registros , Estudios ProspectivosRESUMEN
OBJECTIVE: Postdischarge case management for self-harm or suicide attempters often fails; therefore, this study aimed to investigate the effects of mobile messenger counseling (MMC) on the postdischarge case management results among this patient group. METHODS: A retrospective analysis was done with data collected from March 2015 to February 2020 that included self-harm or suicide attempters who had visited a Korean emergency department and were discharged. If patients consented, postdischarge case management and MMC were conducted from March 2017. The primary outcome was the rate of successful case management, which reflects the patients either connecting to a local psychiatric healthcare center or undergoing a follow-up at a neuropsychiatric outpatient department at least once following discharge. Using univariate and multivariate logistic regression analyses, we evaluated MMC's effects on these patients' postdischarge case management. RESULTS: Of 913 patients, 604 participated in this study. In terms of successful case management, the MMC group showed a significantly higher rate than the non-MMC one (28.3% vs. 16.1%, P=0.001). A multivariate analysis demonstrated that access to postdischarge MMC (odds ratio, 2.149; 95% confidence interval, 1.357-3.403; P=0.001) and giving consent for case management while in the emergency department were significantly associated with successful case management (odds ratio, 8.917; 95% confidence interval, 5.610-14.173; P<0.001). CONCLUSION: The use of MMC for self-harm or suicide attempters is associated with higher case management success rates by increasing their chances of connecting to a psychiatric healthcare center or a neuropsychiatric outpatient department.
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BACKGROUND AND PURPOSE: Out-of-hospital cardiac arrest (OHCA) is one of the most common causes of death in many countries. For OHCA patients to have a good clinical outcome, bystander cardiopulmonary resuscitation (CPR) is extremely significant. It is necessary to study the various characteristics of bystanders to improve bystander CPR quality. We aimed to evaluate the correlation between bystanders' gender and clinical outcomes of patients with OHCA. METHODS: We conducted an observational study by using a prospective, multicenter registry of OHCA resuscitation, provided by the Korean Cardiac Arrest Research Consortium registry from October 2015 to June 2017. The following data were collected: patient's age, patient's gender, witnessed by a layperson, characteristics of the bystanders (age grouped by decade, gender, CPR education, compression method, and perception of automated external defibrillators), arrest place, emergency medical services arrival time, and initial electrocardiogram rhythms. Outcome variables were prehospital return of spontaneous circulation, survival discharge, and cerebral performance category status at discharge. RESULTS: A total of 691 patients were included in the study. There were significant differences in the initial shockable rhythm and previous CPR training between bystander's gender. Characteristics such as age, patient's gender, witnessed by a layperson, bystander's gender, initial shockable rhythm, and arrest place were significantly associated with neurologic outcome at discharge, using univariable analysis. However, in the multivariate logistic model, there was no significant correlation between bystander's gender and neurologic outcome. In the subgroup analysis using the multivariate logistic model with 291 patients without missing values of CPR education and bystander' age, there was a significant difference in neurologic outcome depending on bystander's CPR education status. CONCLUSION: There was no difference in the neurologic outcomes of OHCA patients based on bystanders' gender. However, according to subgroup analysis, there was a difference in the neurologic outcome depending on the status of bystanders' CPR education and females received less CPR education than males. Therefore, more active CPR education is required.
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Reanimación Cardiopulmonar , Paro Cardíaco Extrahospitalario/terapia , Adulto , Anciano , Anciano de 80 o más Años , Reanimación Cardiopulmonar/educación , Reanimación Cardiopulmonar/estadística & datos numéricos , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Enfermedades del Sistema Nervioso/etiología , Enfermedades del Sistema Nervioso/prevención & control , Paro Cardíaco Extrahospitalario/mortalidad , Paro Cardíaco Extrahospitalario/fisiopatología , Proyectos Piloto , Estudios Prospectivos , Sistema de Registros , República de Corea/epidemiología , Factores Sexuales , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
BACKGROUND: This study aimed to examine the characteristics of older adults patients who suffered a head injury after a ground-level fall in comparison to non-head injury patients as well as the factors associated with severity in those with head injury only. METHODS: Patients were classified into two groups, the head injury group and the non-head injury group. The characteristics were compared and factors associated with head injury were evaluated. Factors relating to severe injury in the head injury group were also investigated. RESULTS: The head injury group comprised 42 % of a study subjects. Male sex; fall time of 18:00-23:59; fall location of medical facility, transportation area, and public or commercial facility; fall in an outdoor area; fall during daily activity; alcohol ingestion; fall from stairs; non-slippery floor conditions; concrete flooring; sloped flooring; and presence of obstacles on the floor were risk factors for head injury in the older adults after a ground-level fall. Male sex and age over 70 years; fall time of 00:00-05:59; fall in a residential facility; fall in an indoor area; fall during daily activity; fall from stairs; non-slippery floor conditions; and presence of obstacles on the floor were factors associated with severe injury in the head injury group. CONCLUSIONS: Male sex with advanced age, indoor fall, and the presence of obstacles on the floor were risk factors for severe injury in the head injury group in older adults individuals who suffered a ground-level fall. It is necessary to develop appropriate ground-level fall prevention programs by evaluating the individual and environmental characteristics of older adults patients.
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Accidentes por Caídas , Traumatismos Craneocerebrales , Actividades Cotidianas , Anciano , Traumatismos Craneocerebrales/diagnóstico , Traumatismos Craneocerebrales/epidemiología , Traumatismos Craneocerebrales/etiología , Pisos y Cubiertas de Piso , Humanos , Masculino , Factores de RiesgoRESUMEN
BACKGROUND: Most unintentional injuries that occur at home are preventable. However, it may be difficult to sufficiently reduce the number of falls occurring at home by only identifying risk factors focused on specific age groups. Therefore, this study aimed to identify the risk factors (especially age and places where injuries occurred at home) for intracranial injury (ICI) caused by unintentional falls at home. METHODS: Using the Emergency Department (ED)-Based Injury In-depth Surveillance, we analyzed the data of patients who visited the ED due to unintentional falls at home. Risk factors were identified using multivariable logistic regression according to age groups and interactions between place of injury occurrence and age groups, and sex and age groups were assessed. RESULTS: In total, 232,124 patients were included in the analysis; older adults had a higher adjusted odds ratio (aOR) 14.05 (95% confidence interval [CI], 12.74-15.49) of ICI than infants. The corridor was associated with ICI in the male pediatric group (aOR, 2.71; 95% CI, 1.08-6.84) and the balcony with the female pediatric group (aOR, 2.04; 95% CI, 1.03-4.04). In the adult group, aOR of kitchen was 1.38 (95% CI, 1.02-1.88) in females and 0.56 (95% CI, 0.48-0.66) in males. CONCLUSION: In this study, we identified the risk factors of ICI caused by falls at home using ED-based injury surveillance data. The risk of ICI was different among places of occurrence in the home depending on the age groups and sex.
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Accidentes por Caídas , Traumatismos Craneocerebrales/patología , Adolescente , Adulto , Anciano , Estudios de Casos y Controles , Niño , Preescolar , Traumatismos Craneocerebrales/etiología , Bases de Datos Factuales , Servicio de Urgencia en Hospital , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , República de Corea , Estudios Retrospectivos , Factores de Riesgo , Adulto JovenRESUMEN
AIM: In South Korea, the law concerning automated external defibrillators (AEDs) states that they should be installed in specific places including apartment complexes. This study was conducted to investigate the current status and effectiveness of installation and usage of AEDs in South Korea. METHODS: Installation and usage of AEDs in South Korea is registered in the National Emergency Medical Center (NEMC) database. Compared were the installed number, usage, and annual rate of AED use according to places of installation. All data were obtained from the NEMC database. RESULTS: After excluding AEDs installed in ambulances or fire engines (n = 2,003), 36,498 AEDs were registered in South Korea from 1998 through 2018. A higher number of AEDs were installed in places required by the law compared with those not required by the law (20,678 [56.7%] vs. 15,820 [43.3%]; P <.001). Among them, 11,318 (31.0%) AEDs were installed in apartment complexes. The overall annual rate of AED use was 0.38% (95% CI, 0.33-0.44). The annual rate of AED use was significantly higher in places not required by the law (0.62% [95% CI, 0.52-0.72] versus 0.21% [95% CI, 0.16-0.25]; P <.001). The annual rate of AED use in apartment complexes was 0.13% (95% CI, 0.08-0.17). CONCLUSION: There were significant mismatches between the number of installed AEDs and the annual rate of AED use among places. To optimize the benefit of AEDs in South Korea, changes in the policy for selecting AED placement are needed.
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Reanimación Cardiopulmonar , Servicios Médicos de Urgencia , Paro Cardíaco Extrahospitalario , Bases de Datos Factuales , Desfibriladores , Humanos , Paro Cardíaco Extrahospitalario/terapia , República de CoreaRESUMEN
OBJECTIVE: To investigate the feasibility of mobile videocall guidance to facilitate AED use by laypersons. Design, setting, and participants. A total of 90 laypersons were randomized into three groups: the mobile video call-guided, voice call-guided, and non-guided groups. Participants were exposed to simulated cardiac arrest to use an AED, and guided by video calls, voice calls, or were not guided. We recorded the simulation experiments as a videoclip, and other researchers who were blinded to the simulation assessed the performance according to the prespecified checklist after simulations. Outcomes measure and analysis. We compared the performance score and time intervals from AED arrival to defibrillation among the three groups and analyzed the common errors. RESULTS: There was no significant difference among the three groups in terms of baseline characteristics. Performance scores in the checklist for using AED were higher in the mobile video call-guided group, especially in the category of "Power on AED" and "Correctly attaches pads" than in the other groups. However, the time interval to defibrillation was significantly longer in the mobile video call-guided group. CONCLUSIONS: Mobile video call guidance might be an alternative method to facilitate AED use by laypersons. Therefore, further well-designed research is needed to evaluate the feasibility of this approach in OHCA.
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Teléfono Celular , Simulación por Computador , Desfibriladores , Investigación Cualitativa , Adulto , Femenino , Humanos , Masculino , Factores de Tiempo , Grabación en Video , Adulto JovenRESUMEN
This study aimed to investigate whether the initial red cell distribution width (RDW) at the emergency department (ED) is associated with poor neurological outcomes in out-of-hospital cardiac arrest (OHCA) survivors. We performed a prospective observational analysis of patients admitted to the ED between October 2015 and June 2018 from the Korean Cardiac Arrest Research Consortium registry. We included OHCA patients who visited the ED and achieved return of spontaneous circulation. Initial RDW values were measured at the time of the ED visit. The primary outcome was a poor neurological (Cerebral Performance Category, or CPC) score of 3-5. A total of 1008 patients were ultimately included in this study, of whom 712 (70.6%) had poor CPC scores with unfavorable outcomes. Higher RDW quartiles (RDW 13.6-14.9%, RDW ≥ 15.0%), older age, female sex, nonshockable initial rhythm at the scene, unwitnessed cardiac arrest, bystander cardiopulmonary resuscitation (CPR), medical history, low white blood cell counts and high glucose levels were associated with poor neurological outcomes in univariate analysis. In multivariate analysis, the highest RDW quartile was independently associated with poor neurological outcomes (odds ratio 2.04; 95% confidence interval 1.12-3.69; p = 0.019) at hospital discharge after adjusting for other confounding factors. Other independent factors including age, initial rhythm, bystander CPR and high glucose were also associated with poor neurological outcomes. These results show that an initial RDW in the highest quartile as of the ED visit is associated with poor neurological outcomes at hospital discharge among OHCA survivors.
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Índices de Eritrocitos , Enfermedades del Sistema Nervioso/sangre , Paro Cardíaco Extrahospitalario/sangre , Paro Cardíaco Extrahospitalario/terapia , Adulto , Anciano , Reanimación Cardiopulmonar , Servicios Médicos de Urgencia , Servicio de Urgencia en Hospital , Eritrocitos/citología , Femenino , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Enfermedades del Sistema Nervioso/etiología , Paro Cardíaco Extrahospitalario/mortalidad , Alta del Paciente , Modelos de Riesgos Proporcionales , Estudios Prospectivos , República de Corea , Sensibilidad y Especificidad , Resultado del TratamientoRESUMEN
RATIONALE: Procalcitonin (PCT) is used as a biomarker for identifying the occurrence of sepsis. Previous studies have reported high levels of PCT with acetaminophen intoxication without evidence of infection. Here, we report two patients with acetaminophen intoxication with high levels of PCT without showing any symptoms of bacterial infection. PATIENT CONCERNS: This case study examined two unrelated patients with acetaminophen intoxication admitted to emergency at different times. The first patient was admitted to the emergency department after ingesting approximately 8000âmg (153.8âmg/kg) of acetaminophen. On admission, C-reactive protein (CRP), glutamic oxaloacetic transaminase (GOT), and glutamic pyruvic transaminase (GPT) were normal. PCT and acetaminophen levels were 31.89âng/mL and below 0.5âµg/mL, respectively. The second patient was admitted to the emergency department 8âh after ingesting â¼23,600âmg (280.6âmg/kg) of acetaminophen. By the second day of admission, GOT and GPT increased to 2508 and 1473âIU/L, respectively. PCT was 45.66âng/mL with acetaminophen level at 116.9âµg/mL. Both patients were clear of symptoms associated with bacterial infection. DIAGNOSIS: Acetaminophen intoxication. INTERVENTIONS: N-acetylcysteine was given intravenously to both patients for 20âh per protocol. OUTCOMES: Both patients were discharged without complications. LESSONS: Observations suggests that elevated levels of PCT in patients intoxicated with acetaminophen may be associated with involvement of other organs impacted by cytokine stimuli from sterile inflammation resulting from hepatic damage rather than PCT secretion directly caused by hepatic cell damage.
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Acetaminofén/toxicidad , Acetilcisteína/administración & dosificación , Sobredosis de Droga/tratamiento farmacológico , Polipéptido alfa Relacionado con Calcitonina/metabolismo , Acetilcisteína/uso terapéutico , Alanina Transaminasa/análisis , Aspartato Aminotransferasas/análisis , Proteína C-Reactiva/análisis , Sobredosis de Droga/diagnóstico , Servicio de Urgencia en Hospital , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Adulto JovenRESUMEN
Point-of-care ultrasound (POCUS) is a useful tool that is widely used in the emergency and intensive care areas. In Korea, insurance coverage of ultrasound examination has been gradually expanding in accordance with measures to enhance Korean National Insurance Coverage since 2017 to 2021, and which will continue until 2021. Full coverage of health insurance for POCUS in the emergency and critical care areas was implemented in July 2019. The National Health Insurance Act classified POCUS as a single or multiple-targeted ultrasound examination (STU vs. MTU). STU scans are conducted of one organ at a time, while MTU includes scanning of multiple organs simultaneously to determine each clinical situation. POCUS can be performed even if a diagnostic ultrasound examination is conducted, based on the physician's decision. However, the Health Insurance Review and Assessment Service plans to monitor the prescription status of whether the POCUS and diagnostic ultrasound examinations are prescribed simultaneously and repeatedly. Additionally, MTU is allowed only in cases of trauma, cardiac arrest, shock, chest pain, and dyspnea and should be performed by a qualified physician. Although physicians should scan all parts of the chest, heart, and abdomen when they prescribe MTU, they are not required to record all findings in the medical record. Therefore, appropriate prescription, application, and recording of POCUS are needed to enhance the quality of patient care and avoid unnecessary cut of medical budget spending. The present article provides background and clinical guidance for POCUS based on the implementation of full health insurance coverage for POCUS that began in July 2019 in Korea.
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Cuidados Críticos , Servicio de Urgencia en Hospital , Cobertura del Seguro , Sistemas de Atención de Punto , Ultrasonografía , Cuidados Críticos/estadística & datos numéricos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Humanos , Cobertura del Seguro/estadística & datos numéricos , Pautas de la Práctica en Medicina , República de Corea , Ultrasonografía/estadística & datos numéricosRESUMEN
OBJECTIVE: This study aimed to describe the conceptualization, development, and implementation processes of the newly established Korean Cardiac Arrest Resuscitation Consortium (KoCARC) to improve out-of-hospital cardiac arrest (OHCA) outcomes. METHODS: The KoCARC was established in 2014 by recruiting hospitals willing to participate voluntarily. To enhance professionalism in research, seven research committees, the Epidemiology and Preventive Research Committee, Community Resuscitation Research Committee, Emergency Medical System Resuscitation Research Committee, Hospital Resuscitation Research Committee, Hypothermia and Postresuscitation Care Research Committee, Cardiac Care Resuscitation Committee, and Pediatric Resuscitation Research Committee, were organized under a steering committee. The KoCARC registry was developed with variables incorporated in the currently existing regional OHCA registries and Utstein templates and were collected via a web-based electronic database system. The KoCARC study population comprises patients visiting the participating hospitals who had been treated by the emergency medical system for OHCA presumed to have a cardiac etiology. RESULTS: A total of 62 hospitals volunteered to participate in the KoCARC, which captures 33.0% of the study population in Korea. Web-based data collection started in October 2015, and to date (December 2016), there were 3,187 cases compiled in the registry collected from 32 hospitals. CONCLUSION: The KoCARC is a self-funded, voluntary, hospital-based collaborative research network providing high level evidence in the field of OHCA and resuscitation. This paper will serve as a reference for subsequent KoCARC manuscripts and for data elements collected in the study.
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BACKGROUND: Falls from low-height can cause severe injuries in the elderly population. This study was conducted to determine characteristics of injuries from low-height falls. METHODS: We retrospectively review surveillance data on injured patients who presented to six emergency departments from January 2011 to December 2015. Study subjects were divided into severe group and non-severe group based on severity of injury. The general and clinical characteristics were compared between the two groups and analyzed factors related with severe injuries. RESULTS: Of 1,190 elderly patients, severe group comprised 82 patients (7%). The severe group was 2 years younger than the non-severe group. In the severe group, 61% was men and 34% in the non-severe group. In the non-severe, the injuries more commonly occurred at residential facilities and indoors than those in the severe group. Paid work during injury occurrence was 15%, and the more patients presented with non-alert consciousness in the severe group. The most common regions of major injury were head and neck in the severe group. CONCLUSION: Paid work, non-alert consciousness, and major injury to head and neck are relating factors to severe injuries in the elderly population.
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Accidentes por Caídas , Anciano , Anciano de 80 o más Años , Servicio de Urgencia en Hospital , Femenino , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , República de Corea , Estudios Retrospectivos , Heridas y LesionesRESUMEN
AIM: The aim of the present study was to evaluate the clinical characteristics, including floor characteristics and factors, related to severe injury from outdoor falls in older adults. METHODS: Patients were divided into two groups based on injury severity: the severe group and non-severe group. The clinical and general characteristics were compared between the two groups, and factors associated with severe injury were investigated. RESULTS: Approximately 5% (364/7635) of older people involved in outdoor falls were classified into severe injury. The proportion of men and the rate of alcohol ingestion were higher in the severe group compared with that in the non-severe group. Falling from stairs was a more frequent mechanism of fall in the severe group compared with that in the non-severe group. Non-slippery floor condition had a higher proportion in the severe group than that in the non-severe group. Head and neck were the predominantly injured regions in both groups. Discharge was the most common result of emergency department treatment in the non-severe group, whereas admission to intensive care unit was the main result in the severe group. Multivariate logistic analysis showed that male sex and falls from stairs rather than slipping down on the same level were associated with severe injury. CONCLUSIONS: Floor characteristics did not influence injury severity; however, the risk of severe injury from outdoor falls in older adults was high in men and those who fell from stairs. Geriatr Gerontol Int 2018; 18: 80-87.
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Accidentes por Caídas/estadística & datos numéricos , Índices de Gravedad del Trauma , Anciano , Femenino , Humanos , Masculino , Factores de RiesgoRESUMEN
BACKGROUND: This retrospective study aimed to evaluate the ability of the delta neutrophil index (DNI) to predict histologically normal appendicitis preoperatively and to differentiate between simple and complicated appendicitis. METHODS: The data from 650 patients were divided into positive and negative appendectomy groups (histologically normal appendicitis). The patients in the acute appendicitis group were further sub-divided into simple and complicated appendicitis groups. RESULTS: The DNI was significantly higher in the positive group than in the negative appendectomy group (0.4 vs. -0.4, p < 0.001) as well as in the complicated group compared with that in the simple appendicitis group (1.2 vs. 0.3, p < 0.001). The DNI independently predicted a positive appendectomy and an acute complicated appendicitis in multivariate logistic regression analysis [odds ratio (OR) 2.62, 95% confidence interval (CI) (1.11~6.16), p = 0.028 and odds ratio (OR) 4.10, 95% confidence interval (CI) (2.94~5.80), p < 0.001]. The optimum cut-off for a positive appendectomy and acute complicated appendicitis were 0.2 [area under curve (AUC) 0.709] and 0.6 (AUC 0.727). CONCLUSIONS: We suggest that obtaining a preoperative DNI is a useful parameter to aid in the diagnosis of histologically normal appendicitis and to differentiate between simple and complicated appendicitis.