Factors associated with Parental Knowledge and Attitudes towards Concussions in the Republic of Korea.

Background: This study investigated the status and evaluated factors associated with knowledge and attitudes regarding concussions among Korean parents of children aged 6-18 years. Methods: A cross-sectional online survey was employed to collect data from a panel of parents in the Republic of Korea in 2023. To assess knowledge and attitudes regarding concussions, participants completed a validated questionnaire. The outcome variables of the total knowledge and total attitude scores, which ranged from 0 to 30 and 7 to 49, respectively, were categorized into three levels based on approximately 33% increments. We conducted multivariable ordinal logistic regression analyses with the participants' and their children's demographics and characteristics as covariates. Results: A total of 260 parents responded to the survey and demonstrated moderate concussion-related knowledge (median total score, (Inter Quartile Range (IQR) 18-22.5)). The respondents exhibited favorable attitudes toward concussions (median total score, 39 (IQR 34-43)). Multivariate ordinal regression analysis for outcomes revealed that, except for the careers of healthcare providers (adjusted odds ratio (AOR) 3.15, 95% confidence interval (CI), 1.13-8.75), no factors were associated with parental concussion-related knowledge. Among the factors, none exhibited a statistically significant association with concussion-related parental attitudes. Conclusion: Our results confirmed the knowledge-attitude gap regarding concussions among Korean parents and novel strategies are warranted to improve parental knowledge and attitudes.

Bystander CPR and Long-Term Survival in Older Adults With Out-of-Hospital Cardiac Arrest.

BACKGROUND: Most studies on bystander cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest (OHCA) have focused on in-hospital or short-term survival. OBJECTIVES: The purpose of this study was to examine the association between bystander CPR and long-term survival outcomes for OHCA. METHODS: Within the Cardiac Arrest Registry to Enhance Survival, we identified 152,653 patients with OHCA ≥65 years of age or older. Using multivariable hierarchical logistic regression, we first examined the association between bystander CPR and in-hospital survival. Then, among those surviving to discharge and linked to Medicare files, we evaluated the association between bystander CPR and long-term mortality over 5 years using multivariable Cox regression. RESULTS: Overall, 58,464 (38.3%) received bystander CPR. Patients receiving bystander CPR were more likely to have an OHCA that was witnessed, in a public location, and with an initial shockable rhythm. Bystander CPR was associated with a 24% higher likelihood of surviving to hospital discharge (10.2% vs 5.5%; adjusted relative risk: 1.24 [95% CI: 1.19-1.29]; P < 0.001), and this survival benefit was similar (interaction P = 0.24) for those who were 65 to 74, 75 to 84, and ≥85 years of age. Among patients surviving to hospital discharge (median follow-up of 31 months), bystander CPR was additionally associated with lower long-term mortality vs those without bystander CPR (adjusted hazard ratio: 0.78 [95% CI: 0.73-0.84]; P < 0.001), and this benefit was also consistent across age groups (interaction P = 0.13). CONCLUSIONS: In older adults with OHCA, bystander CPR was associated with higher rates of in-hospital survival. This survival benefit was not attenuated by competing mortality risks but increased in magnitude after hospital discharge.

Long-Term Outcomes for Out-of-Hospital Cardiac Arrest in Elderly Patients: An Analysis of Cardiac Arrest Registry to Enhance Survival Data Linked to Medicare Files.

BACKGROUND: Most studies on out-of-hospital cardiac arrest have primarily focused on in-hospital or short-term survival. Little is known about long-term outcomes and resource use among survivors of out-of-hospital cardiac arrest. METHODS: In this observationsl study, we describe overall long-term outcomes for patients from the national Cardiac Arrest Registry to Enhance Survival linked to Medicare files to create the Cardiac Arrest Registry to Enhance Survival: Mortality, Events, and Costs for Cardiac Arrest survivors dataset. Cardiac Arrest Registry to Enhance Survival data between 2013 and 2019 were linked to Medicare data using probabilistic matching algorithms. Overall long-term mortality, readmissions, and index hospitalization costs are reported for the overall cohort. RESULTS: Among 56 425 patients who were 65 years of age or older in Cardiac Arrest Registry to Enhance Survival who survived to hospital admission, 26 875 (47.6%) were successfully linked to Medicare files. Mean (+SD) cost of the index hospitalization was $23 262+$24 199 and the median cost was $14 636 (interquartile range, $9930-$30 033). Overall, 8676 (32.3%) survived to hospital discharge with 38.0% discharged home, 11.8% to hospice care, and the remaining 50.2% to other inpatient, skilled nursing care, or rehabilitation facilities. Mortality after discharge was initially high (27.0% at 3 months) and then increased gradually, with 1- and 3-year mortality of 37.1% and 50.1%, respectively. During the first year, 40.1% were readmitted at least once, with 19.7% readmitted on > 1 occasion. CONCLUSIONS: The Cardiac Arrest Registry to Enhance Survival: Mortality, Events, and Costs for Cardiac Arrest survivors registry includes rich data on postdischarge outcomes and resource utilization. Use of this dataset will enable future investigations on the long-term effectiveness, costs, and cost-effectiveness of various interventions for out-of-hospital cardiac arrest in elderly patients.

Effects of pre-hospital re-arrest on outcomes based on transfer to a heart attack centre in patients with out-of-hospital cardiac arrest.

AIM: We aimed to investigate the interaction effects between transfer to a heart attack centre [HAC] and prehospital re-arrest on the clinical outcomes of patients with out-of-hospital cardiac arrest [OHCA]. METHODS: We included adult patients with OHCA of presumed cardiac aetiology from January 2012 to December 2018. The main exposure variable was prehospital re-arrest, defined as recurrence of cardiac arrest with a loss of palpable pulse upon hospital arrival. The other exposure variable was the resuscitation capacity of the receiving hospital [HAC or Non-HAC]. The outcome variable was neurological recovery. A multivariable logistic regression was performed to determine the interaction effects. RESULTS: The final analysis included 6935 patients. Of these, 21.9% (n = 1521) experienced prehospital re-arrest, whereas 41.3% (n = 2866) were transferred to a non-HAC. The prehospital re-arrest group associated with poor neurological recovery (adjusted odds ratio [AOR], 0.25; 95% confidence interval [CI], 0.21-0.29;). Transfer to an HAC had beneficial effects on neurological recovery (AOR, 3.40 [95% CI, 3.04-3.85]. In the interaction model, wherein prehospital re-arrest patients who were transferred to a non-HAC were used as reference, the AOR of prehospital re-arrest patients who were transferred to an HAC, non-re-arrest patients who were transferred to a non-HAC, and non-re-arrest patients who were transferred to a non-HAC was 2.41 (95% CI, 1.73-3.35), 3.09 (95% CI, 2.33-4.10), and 11.07 (95% CI, 8.40-14.59) respectively (interaction p = 0.001). CONCLUSION: Transport to a heart attack centre was beneficial to the clinical outcomes of patients who achieved prehospital ROSC after OHCA. The magnitude of that benefit was significantly modified by whether prehospital re-arrest had occurred.

Effects of telephone-assisted cardiopulmonary resuscitation on the sex disparity in provision of bystander cardiopulmonary resuscitation in public locations.

PURPOSE: Telephone-assisted cardiopulmonary resuscitation (TA-CPR) is an effective community intervention to increase bystander CPR rates. This study evaluated the effect of TA-CPR on the provision of bystander CPR as a function of the patient's sex. METHODS: Adult (aged ≥ 18 years) patients who collapsed in a public location between January 2013 and December 2017 and received emergency medical service (EMS) treatment for out-of-hospital cardiac arrest (OHCA) of presumed cardiac aetiology were included in the study. The main exposures were TA-CPR and the patients' sex. The primary outcome was the implementation of bystander CPR by laypersons. Multivariable logistic regression analysis was conducted, stratified based on the provision of TA-CPR, to examine the effect on bystander CPR according to patient sex. RESULTS: In the final analysis, 15,840 patients with OHCAs were included. Patients who received TA-CPR accounted for 32.6% (5167/15,840) of the sample. Overall, 84.4% (814/964) of the women and 86.9% (3653/4203) of the men received bystander CPR in the TA-CPR group (P < 0.001). In the non-TA-CPR group, 40.5% (912/2252) of women and 47.3% (3653/8421) of men received bystander CPR (P < 0.001). In the multivariable logistic regression analysis, there was no significant difference in the odds ratio (OR) of bystander CPR according to patient sex in the TA-CPR group (adjusted OR [AOR], 0.83; 95% confidence interval [CI], 0.68-1.01). Women were less likely to receive bystander CPR if the bystanders are not directed by TA-CPR (AOR: 0.79; 95% CI, 0.70-0.87). CONCLUSIONS: TA-CPR attenuated the sex disparity in bystander CPR provided in public places.

Community-level socioeconomic status and outcomes of patients with out-of-hospital cardiac arrest: A systematic review and meta analysis.

BACKGROUND: The aim of this systematic review and meta-analysis was to investigate the associations of community-level socioeconomic status (SES) on outcomes of patients with out-of hospital cardiac arrest (OHCA). METHODS: A systematic literature review was conducted using PubMed, EMBASE, and the Cochrane database according to guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We included literature that presented the outcomes based on community-level SES among patients with OHCA. SES indicators included economic indicators such as income, wealth, and occupation, as well as combined indicators, where any of these indicators were integrated. Outcomes were bystander cardiopulmonary resuscitation (CPR) and survival to discharge. RESULTS: From 1394 titles, 10 cross-sectional observational studies fulfilled inclusion and exclusion criteria, representing 118,942 patients with OHCA. The odds ratios (ORs) of bystander CPR and survival to discharge for lower community-level SES patients were lower than those for higher community-level SES by economic SES indicators (bystander CPR OR 0.67; 95% CI 0.51-0.89, survival to discharge OR 0.60; 95% CI 0.35-1.02). Based on combined SES indicators the results showed similar patterns (bystander CPR OR 0.80; 95% CI 0.75-0.84, survival to discharge OR 0.76; 95% CI 0.63-0.92). CONCLUSION: In this meta-analysis, community-level SES was significantly associated with bystander CPR and survival among patients with OHCA.

Characteristics of injuries according to types of personal mobility devices in a multicenter emergency department from 2011 to 2017: A cross-sectional study.

ABSTRACT: Personal mobility devices (PMDs) have emerged as new factors in motor vehicle accidents, and related injuries are increasing. We aimed to describe the characteristics of PMD-related injuries presented to emergency departments (EDs) through a cross-sectional study for 7 years.This study is a multicenter cross-sectional study using the Emergency Department-based Injury In-Depth Surveillance database in South Korea. We identified all PMD-related injuries from 2011 to 2017 based on text searching. We categorized them into 3 groups based on their distinguishable characteristics: electric standing scooter (E-scooter), electric self-balancing wheel (E-wheel), and electronic board (E-board).A total of 448 PMD-related injuries were observed during the observation period. E-scooter-, E-wheel-, and E-board-related injuries occurred in 284, 138, and 26 cases, respectively. Most patients were between the ages of 19 and 59 years (69.2%), men (66.3%), and injured because of leisure activity (61.2%). The mechanism of injury was mostly traffic accidents (75.2%), but regarding injuries involving E-wheel and E-board, 25.4% and 30.8% of patients slipped from the device. The most commonly injured body part was the head, which accounted for 58.1% of E-scooter injuries, 38.4% of E-wheel injuries, and 53.9% of E-board injuries. Only 6 of all patients wore a helmet at the time of accident.PMD users and PMD-sharing programs are increasing, and more accidents are expected in the future. As PMDs are convenient to move and more people are willing to use them, proper riding and safety rules based on the type of PMD are needed to reduce the risk of injury. The results of this study can be used as basic data for developing safety policies.

Association between Survival and Time of On-Scene Resuscitation in Refractory Out-of-Hospital Cardiac Arrest: A Cross-Sectional Retrospective Study.

It is estimated that over 60% of out-of-hospital cardiac arrest (OHCA) patients with a shockable rhythm are refractory to current treatment, never achieve return of spontaneous circulation, or die before they reach the hospital. Therefore, we aimed to identify whether field resuscitation time is associated with survival rate in refractory OHCA (rOHCA) with a shockable initial rhythm. This cross-sectional retrospective study extracted data of emergency medical service (EMS)-treated patients aged ≥ 15 years with OHCA of suspected cardiac etiology and shockable initial rhythm confirmed by EMS providers from the OHCA registry database of Korea. A multivariable logistic regression analysis was conducted for survival to discharge and good neurological outcomes in the scene time interval groups. The median scene time interval for the non-survival and survival to discharge patients were 16 (interquartile range (IQR) 13-21) minutes and 14 (IQR 12-16) minutes, respectively. In this study, for rOHCA patients with a shockable rhythm, continuing CPR for more than 15 min on the scene was associated with a decreased chance of survival and good neurological outcome. In particular, we found that in the patients whose transport time interval was >10 min, the longer scene time interval was negatively associated with the neurological outcome.

Temporal trends in out-of-hospital cardiac arrest outcomes in men and women from 2008 to 2015: A national observational study.

BACKGROUND: We compared the temporal trends in survival and neurological outcomes after out-of-hospital cardiac arrest (OHCA) in men and women. METHODS: A nationwide, population-based observational study enrolled adults with OHCA of presumed cardiac origin from 2008 to 2015. The main outcomes were survival and neurological recovery. We performed trend analyses of potential risk factors and outcomes. Adjusted odd ratios (aOR) were calculated using multivariate logistic regression analysis after adjusting for confounders. To assess whether outcomes had improved over time in both sexes, we calculated the yearly risk-adjusted survival rates and neurological recovery rate for the study period. RESULTS: We included 121,900 patients in the final analysis. Women comprised 36.2% of the patients. During the study, survival improved in both sexes, from 3.2% to 7.9% in men and from 1.8% to 3.7% in women. Neurological recovery improved in men from 1.1% to 5.9% and in women from 0.7% to 2.3%. The risk-adjusted survival rates increased significantly in men from 3.2% in 2008 to 5.7% in 2015 (p for trend <0.01); these rates did not increase to the same degree in women (from 1.8% in 2008 to 3.4% in 2015; p for trend <0.01). After adjusting for confounders, the risk-adjusted neurological recovery rate increased from 1.1% in 2008 to 4.3% in 2015 (p for trend <0.01) in men. This improvement trend was lower in women (from 0.7% in 2008 to 1.5% in 2015, p for trend <0.01). CONCLUSIONS: The outcomes of OHCA improved in both sexes during the study period. The degree of improvement in outcomes was higher in men than in women.

Variability in the effects of prehospital advanced airway management on outcomes of patients with out-of-hospital cardiac arrest.

OBJECTIVE: To investigate variations in the effects of prehospital advanced airway management (AAM) on outcomes of out-of-hospital cardiac arrest (OHCA) patients according to regional emergency medical service (EMS) systems in four Asian cities. METHODS: We enrolled adult patients with EMS-treated OHCA of presumed cardiac origin between 2012 and 2014 from Osaka (Japan), Seoul (Republic of Korea), Singapore (Singapore), and Taipei (Taiwan). The main exposure variable was prehospital AAM. The primary endpoint was neurological recovery. We compared outcomes between the prehospital AAM and non-AAM groups using multivariable logistic regression with an interaction term between prehospital AAM and the four Asian cities. RESULTS: A total of 16,510 patients were included in the final analyses. The rates of prehospital AAM varied among Osaka, Seoul, Singapore, and Taipei (65.0%, 19.2%, 84.9%, and 34.1%, respectively). The non-AAM group showed better outcomes than the AAM group (adjusted odds ratio [aOR] for neurological recovery 0.30; 95% confidence interval [CI], 0.24-0.38]). In the interaction model for neurological recovery, the aORs for AAM in Osaka and Singapore were 0.12 (95% CI, 0.06-0.26) and 0.21 (95% CI, 0.16-0.28), respectively. In Seoul and Taipei, the association between prehospital AAM and neurological recovery was not significant (aOR 0.58 [95% CI, 0.31-1.10] and 0.79 [95% CI, 0.52-1.20], respectively). The interaction between prehospital AAM and region was significant (P=0.01). CONCLUSION: The effects of prehospital AAM on outcomes of OHCA patients differed according to regional variability in the EMS systems.

Association between health insurance status and transfer of patients with return of spontaneous circulation after out-of-hospital cardiac arrest.

AIM: To explore the factors related to the probability of inter-hospital transfer to a heart attack centre in patients with return of spontaneous circulation after out-of-hospital cardiac arrest (OHCA) in the Republic of Korea. METHODS: This cross-sectional observational study used data from a Korean national emergency medical service OHCA database for cases between 2015 and 2017. Adult OHCA patients with a presumed cardiac origin who initially presented at a non-heart-attack centre were included in the analysis. The main exposure variable was health insurance type (national health insurance versus medical aid), which was used as a proxy measure of individual socioeconomic status. The primary outcome was emergency department disposition (transfer to a heart attack centre versus no transfer). A multivariate logistic analysis using propensity score matching was conducted. We also analysed the associations between patient transfer and neurologic recovery as well as survival to discharge. RESULTS: Of 7804 eligible OHCA patients, 1804 23.0%) were transferred to a heart attack centre. Patients on medical aid were less likely to be transferred (adjusted odds ratio [OR], 0.75; 95% confidence interval [CI], 0.59-0.95 in a matched cohort) compared with patients with national health insurance. Transfer to a heart attack centre was significantly associated with a lower risk of death (adjusted OR, 0.38; 95% CI, 0.33-0.45) and better neurologic recovery (adjusted OR, 0.46; 95% CI, 0.38-0.56). CONCLUSION: Socioeconomic status appears likely to influence the probability of transfer to a heart attack centre after resuscitation.

The effects of route of admission to a percutaneous coronary intervention centre among patients with out-of-hospital cardiac arrest.

AIM: Patients with OHCA who are not transported directly to a percutaneous coronary intervention (PCI)-capable hospital may eventually undergo an inter-hospital transfer (IHT). The aim of the present study was to investigate the effects of route of admission to a PCI centre among patients with OHCA. METHODS: We included patients with OHCA of presumed cardiac aetiology that were admitted to a PCI centre between January 2015 and December 2016. The exposure variable was route of admission: direct versus indirect. The 'direct' group was defined as patients who were transferred directly from the field to a PCI centre by emergency medical service (EMS) providers. The 'indirect' group was defined as patients who underwent IHT from a non-PCI centre to a PCI centre. The primary outcome was neurological recovery. We evaluated the effects of route of admission using multivariable logistic regression analysis after adjusting for potential confounders. RESULTS: There were total of 4363 eligible patients: 3488 (78.2%) in the direct group and 975 (21.8%) in the indirect group. Neurologic recovery was better in the direct group (38.0%) than in the indirect group (29.0%). After adjusting for potential confounders, indirect admission was negatively associated with outcomes (adjusted odds ratio [aOR] 0.70; 95% confidence interval [CI] 0.58-0.85). CONCLUSIONS: The route of admission to a PCI centre is associated with neurological recovery among resuscitated patients with OHCA of presumed cardiac aetiology. This has implications for regionalized EMS transport and IHT protocols for patients with OHCA.

The effect of automatic external defibrillator with a real-time feedback on quality of bystander cardiopulmonary resuscitation: A before-and-after simulation study.

High-quality bystander cardiopulmonary resuscitation (CPR) and early defibrillation in the community are important for survival in out-of hospital-cardiac-arrest, but maintaining the quality of CPR in bystanders is difficult. We aimed to determine the effect of an automated external defibrillator (AED) with real-time feedback on the quality of bystander CPR in a community setting. A before-and-after simulation study was designed. Trainees of basic life support education were recruited for the simulation experiment. Each team consisted of two bystanders with different roles (initial witness and CPR supporter). 82 teams performed simulation scenarios with the real-time feedback function of AED disabled initially, and then repeated it with feedback function enabled. Quality measures of chest compression depth and no-flow fraction were compared between each of the two simulation scenarios. CPR quality data from 82 teams were analysed. The mean percentage of chest compressions with adequate depth was significantly higher in simulations with real-time feedback (78.1% vs. 89.3%, p < 0.01). Similarly, no-flow fractions were lower in simulation scenarios with real-time feedback (32.0% vs. 30.3% p = 0.05). In a subgroup with the lowest percentage of adequate depth performance in the initial simulation without real-time feedback, a mean increase of 47.7% (95% CI 31.3-64.0) in the fraction of chest compressions with adequate depth was seen with real-time feedback. Use of an AED with real-time feedback improves the quality of bystander CPR in a simulated community setting. The positive effect of real-time feedback is greatest among people with a low level of CPR skill.

The influence of behavioural and socioeconomic factors on the community injury rates of adolescents assessed by the south Korean emergency medical services: an ecological approach.

BACKGROUND: Aim of this study is to determine if peer group risk behaviors and neighbourhood socioeconomic status (SES) would ecologically affect injury incidence according to place and gender among adolescents (aged 13-15) in South Korea. METHODS: Three variables from the Korea Youth Risk Behavior Survey (2014) were used to represent peer group risk behaviours; current alcohol consumption (cAlc), the experience of violence or bullying (VicVB), and having undergone education for injury prevention (Edu-IP). The Korea Census Data (2010) was used for neighborhood SES; the degree of urbanization, the proportion of high educational attainment, and the proportion of low residential environment. The nationwide and regional Incidence-Rates of Injury assessed by EMS (IRI-EMS) were calculated according to age and gender based on the number of injuries from EMS record (2014). A linear regression model was used to examine associations. RESULTS: The nationwide total and inside-school IRI-EMS were 623.8 and 139.3 per 100,000 population, respectively. The range of the regional IRI-EMS showed a maximum of about 4 times the difference from 345 to 1281 per 100,000 population depending on the region. The low residential environment had a significant effect on the increase of total IRI-EMS (ß = 7.5, 95% CI 0.78-14.21). In the case of boys, the IRI-EMS inside-school was increased as the percentage of VicVB was higher (ß = 17.0, 95% CI 1.09-32.91). In the case of girls, the IRI-EMS outside-school was increased in rural compared to urban location (ß = 211.3, 95% CI 19.12-403.57). CONCLUSION: The incidence rate of outside-school was higher than that of inside-school, and incidence rate of boys was higher than that of girls. Peer group risk behaviors were significant only in the injury of boys. Among the SES factors, rural area was a significant factor in girls, especially outside-school injury. Moreover, the rate of households not in an apartment was significant in all outside-school injury and outside-school injury of boys. Our study suggests that among native South Korean adolescents, neighbourhood SES and peer group risk behavior have different effects depending on the injury context such as place of occurrence or gender.

Factors associated with the provision of targeted temperature management: A balanced factorial experiment.

AIM: This study examined the influence of patient attributes and provider or organizational factors on the decision to apply targeted temperature management (TTM) to resuscitated out-of-hospital cardiac arrest (OHCA) patients. METHODS: A balanced factorial experiment was conducted among emergency medicine physicians (EMPs). Sixteen OHCA patient scenarios with balanced factors were presented. The balancing factors were dichotomous categories of patient age (45 ±â€¯2 vs. 70 ±â€¯2 years), patient sex (men vs. women), socioeconomic status (SES; higher vs. lower), and guardian attitudes (positive vs. reluctant) regarding TTM. Information on participant and organizational characteristics was collected. The outcome variable was a score (0-100) based on responses to questions that indicated how likely the participants were to apply TTM. RESULTS: Seventy-five EMPs completed the experiment. The median score for the likelihood of TTM application was 85 (interquartile range, 70-95). Scores differed significantly for patient age (90% vs. 80%, p = 0.001), SES (90% vs. 80%, p = 0.001), and guardian attitude regarding TTM (90% vs. 70%, p = 0.001). The likelihood of TTM application was associated with EMP experience with TTM (more or <50 times) (90% vs. 80%, p = 0.001). EMPs working in hospitals with commercial TTM devices or operating protocols were more likely to use TTM than those working in hospitals without TTM devices or protocols (88 vs. 80 and 90 vs. 80; p = 0.001, respectively). CONCLUSION: Patient demographics and provider and organizational factors significantly affected the decision to apply TTM.

Dispatcher-Assisted Cardiopulmonary Resuscitation Program and Outcomes After Pediatric Out-of-Hospital Cardiac Arrest.

OBJECTIVES: A dispatcher-assisted bystander cardiopulmonary resuscitation (DA-BCPR) is expected to influence the outcomes of pediatric out-of-hospital cardiac arrest (OHCA). Our objective was to measure the effect size of a DA-BCPR on survival outcomes according to location of the event. METHODS: All emergency medical service treated OHCA patients younger than 19 years in Korea from January 2012 through December 2013 were analyzed. Patients with OHCA witnessed by emergency medical service providers and those with missing outcome information were excluded. Patients were categorized into the following categories: No-BCPR, BCPR without dispatcher assistance (BCPR-NDA), and BCPR-DA. The primary outcome was survival to hospital discharge. Multivariable logistic regression analysis was performed to calculate the adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for outcomes by exposure group (reference, No-BCPR group) with and without an interaction term between exposure and location of arrest. RESULTS: A total of 1013 eligible patients were analyzed. Among these patients, 16.6% received BCPR-NDA, 23.2% received BCPR-DA, and 60.2% received no BCPR. After adjusting for potential confounders, compared with N0-BCPR group, AORs for survival were 1.79 (95% CI, 1.03-3.12) in BCPR group, 1.71 (95% CI, 0.85-3.46) in BCPR-NDA group, and 1.39 (95% CI, 0.72-2.69) in BCPR-DA group. The AORs for survival of BCPR-NDA and BCPR-DA in public location were 3.30 (95% CI, 1.12-9.72) and 2.95 (95% CI, 1.00-8.67), whereas BCPR-NDA and BCPR-DA in private locations were 1.62 (95% CI, 0.68-3.88) and 1.15 (95% CI, 0.53-2.51). CONCLUSION: The DA-CPR was associated with better outcomes in pediatric OHCA patients whose arrest occurred in public locations, but no improvement in outcomes was identified in patients whose arrest occurred at private locations.

Factors Associated with the Transfer Decision in Resuscitated Patients with Out-of-Hospital Cardiac Arrest Presenting to a Hospital with Limited Targeted Temperature Management Capability in Korea.

This study aimed to identify factors associated with the decision to transfer resuscitated patients with out-of-hospital cardiac arrest (OHCA) who were initially examined at hospitals with limited targeted temperature management capability (HLTC) in Korea. We included adult patients with OHCA who were initially transported to HLTC from 2012 to 2015. We limited the study population with OHCA who were admitted or transferred. Potential factors associated with the transfer decision were categorized as patient- or hospital-level characteristics. The primary outcome was emergency department disposition: transfer out versus admission to HLTC. A stepwise multivariable logistic regression analysis was conducted to identify factors associated with the outcome. Of the 64,696 patients with OHCA, 37,705 (58.3%) were initially transported to HLTC. Approximately 44.7% of patients were transferred out. In terms of patient-level factors, age, socioeconomic status, and initial electrocardiogram rhythm were associated with the transfer decision. Hospital factors, such as percutaneous coronary intervention capability of HLTC (adjusted odds ratio = 0.16; 95% confidence interval = 0.14-0.19) and location of the metropolitan or urban hospital, were negatively associated with the transfer decision. Several hospital and patient factors were associated with the decision to transfer out patients with OHCA who were initially examined at HLTC.

The Pyramid of Injury: Estimation of the Scale of Adolescent Injuries According to Severity.

OBJECTIVES: Due to their developmental characteristics, adolescents have a higher probability than other age groups of experiencing injuries caused by accidents, violence, and intentional self-harm. The severity and characteristics of injuries vary by the intentionality and mechanism of injury; therefore, there is a need for a national-level estimate of the scale and the severity of injuries in adolescents that takes these factors into account. METHODS: By using data from the Emergency Department-based Injury In-depth Surveillance Data, National Emergency Department Information System, the Korean National Hospital Discharge In-depth Injury Survey, and cause of death statistics, we calculated the emergency department (ED) visit rate, hospitalization rate, and death rate of injuries per 100 000 adolescents for each injury mechanism. The calculated rates were used to generate the injury pyramid ratio (ratio of death rate to hospitalization rate to ED visit rate) to visualize the scale and the severity of the injury. RESULTS: The mortality rate in adolescents due to injury was 10/100 000; the corresponding rates for hospitalization and ED visits were 1623 and 4923, respectively, resulting in an injury pyramid ratio with the general pyramid form, with a 1:162:492 ratio of deaths to hospitalizations to ED visits. The mortality rate due to suicide/intentional self-harm was 5/100 000, while 35 were hospitalized for this reason and 74 made ED visits. The pyramid ratio of 1:7:15 for intentional self-harm/suicide showed a steep pyramidal form, indicating considerable lethality. The mortality rate due to motor vehicle collisions (MVCs) was 3/100 000; 586 were hospitalized for this reason, while 1023 made ED visits. The pyramid ratio of 1:195:341 for MVCs showed a gradual pyramid form, indicating that the lethality was low and the scale of injury was high. CONCLUSIONS: The main categories of injuries in adolescents were visualized in pyramid form, contributing to an understanding of the scale of each injury by mechanism in terms of levels of death, hospitalization, and ED visits. These findings will be helpful for understanding how to prioritize injuries in adolescents.

Epidemiologic Characteristics of Injured School-age Patients Transported via Emergency Medical Services in Korea.

BACKGROUND: The purpose of this study was to identify the characteristics of injuries of school-aged children transported via emergency medical services (EMS) that occurred in schools by comparing with injuries that occurred outside of school. METHODS: Data from the 119 EMS from 2012 to 2014 were analyzed. School and non-school injuries were analyzed in children 6 to 17 years of age. The epidemiologic characteristics were assessed according to school-age groups; low-grade primary (6-8 years), high-grade primary (9-13 years), middle (13-15 years) and high (15-17 years) school. Gender-stratified multivariable logistic regression analysis was conducted to estimate the risks of school injury in each age group. RESULTS: During the study period, a total of 167,104 children with injury were transported via 119 ambulances. Of these injuries, 13.3% occurred at schools. Boys accounted for 76.9% of school injuries and middle school children accounted for a significantly greater proportion (39.6%) of school injuries (P < 0.001). The most frequent mechanisms of injury at school were falls (43.8%). The peak times for school injury occurrence were lunch time (13:00-13:59) in all age groups. Multivariate regression identified the risky age groups as high-grade primary (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.09-1.20) and middle school-aged boys (OR, 1.82; 95% CI, 1.74-1.90) and middle school-aged girls (OR, 1.30; 95% CI, 1.21-1.40). CONCLUSION: Notable epidemiologic differences exist between in- and out-of-school injuries. The age groups at risk for school injuries differ by gender.