Association between the Korean Triage and Acuity Scale level and severity of children with dyspnea in the emergency department

Purpose@#Triage tools play a vital role in classifying the severity of children in emergency departments (EDs). We investigated the association between the Korean Triage and Acuity Scale (KTAS) and severity of dyspnea in the ED. @*Methods@#We conducted a retrospective study of children aged 3-14 years with dyspnea who visited the ED from January 2015 through December 2021. They were divided into severe (KTAS level 1-3) and non-severe (KTAS level 4-5) groups. Between the groups, we compared the clinical characteristics, including age, sex, associated symptoms, vital signs, route of visit, treatment at ED, and outcomes. @*Results@#Among a total of 468 children with dyspnea, 267 and 201 were assigned to the severe and non-severe groups, respectively. The severe group had higher frequencies of fever (21.7% vs. 13.9%; P = 0.031), cough (53.2% vs. 43.3%; P = 0.034), systemic steroids (42.3% vs. 25.9%; P < 0.001), intravenous fluids (47.6% vs. 25.4%; P < 0.001), oxygen therapy (16.5% vs. 6.5%; P = 0.001), inotropics (4.1% vs. 1.0%; P = 0.042), and hospitalization (24.7% vs. 11.9%; P = 0.002). The severe group also showed a higher mean heart rate, respiratory rate, and temperature, and lower mean oxygen saturation (all Ps < 0.001). Among these findings, fever, heart rate, respiratory rate, temperature, intravenous fluids, oxygen therapy, inotropics, and hospitalization remained significantly different between the groups after defining the severe group as a KTAS level 1-2. @*Conclusion@#This study shows the association between KTAS and severity of dyspnea in the ED. Therefore, KTAS may reflect not only the initial clinical conditions but also emergency measures and outcomes in children with dyspnea who visit EDs.

Clinical predicting factors that can distinguish superficial and deep injuries in penetrating neck injury?

Objective@#The frequency of penetrating neck injuries has gradually increased with the development of industry and the rising crime rates. There have been few studies with penetrating neck injuries reported in Korea. Thus, we analyzed clinical factors that could differentiate between superficial and deep injuries in patients with penetrating neck injuries. @*Methods@#We investigated the medical records of 90 patients with penetrating neck injuries who visited the emergency department between January 2010 and March 2020. To identify the degree of injuries, we compared age, sex, onset and arrival time, onset-to-arrival time, initial vital signs, Glasgow Coma Scale, Revised Trauma Score, cause, mechanism, location and number of injuries, anatomical zone, alcohol intake and psychiatric history were classified as early clinical factors. @*Results@#Among 90 patients, 51 had superficial injuries, and 39 had deep injuries. The early clinical factors showing statistically significant differences were the Glasgow Coma Scale, Revised Trauma Score, cause of injury and anatomical zones. As the Glasgow Coma Scale increased by 1 point, deep injuries decreased by 0.807 times compared to superficial injuries. Homicidal injuries were 3.233 times deeper than suicidal injuries. @*Conclusion@#If the Glasgow Coma Scale is low or the cause of injury is homicide, the possibility of a deep penetrating injury is high. Therefore, it is important to treat the patient carefully, considering these factors.

Prediction for serious bacterial infection in febrile children aged 3 years or younger: comparison of inflammatory markers, the Laboratory-score, and a new laboratory combined model

PURPOSE: To compare the efficacy of inflammatory markers, the Laboratory-score, and a new laboratory combined model for predicting serious bacterial infection (SBI) in young febrile children.METHODS: The presence of SBI was reviewed in previously healthy children aged 3 years or younger with fever (> 38℃) who visited the emergency department from 2017 through 2018. Areas under the curves (AUCs) of the receiver operating characteristic curve for SBI were compared with individual inflammatory markers (white blood cells [WBC] count, erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], procalcitonin [PCT], and urine WBC count), the Laboratory-score, and a laboratory combined model. The latter model was developed using logistic regression analysis including ESR, CRP, and PCT.RESULTS: Of the 203 enrolled children, SBI was diagnosed in 58 (28.6%). For SBI prediction, the Laboratory-score showed 51.7% sensitivity (95% confidence interval [CI], 38.2%–65.0%) and 83.5% specificity (95% CI, 76.4%–89.1%). The AUC of the Laboratory-score (0.76) was significantly superior to the values of all individual inflammatory markers (WBC, 0.59 [P = 0.032]; ESR, 0.69; and CRP, 0.74 [P < 0.001]) except that of PCT (0.77, [P < 0.001]). The AUC of the laboratory combined model (0.80) was superior to that of the Laboratory-score (0.76) (P < 0.001).CONCLUSION: In this study, the new laboratory combined model showed good predictability for SBI. This finding suggests the usefulness of combining ESR, CRP, and PCT in predicting SBI.

Factors associated with hospitalization via emergency department in children with acute bronchiolitis

PURPOSE: In infants and young children, acute bronchiolitis is a leading cause of hospitalization via emergency departments (EDs). We aimed to investigate factors associated with hospitalization via ED in children with acute bronchiolitis. METHODS: We reviewed medical records of children aged 36 months or younger with acute bronchiolitis who visited the ED from January to December 2017. The following clinical data were collected and analyzed: age, sex, premature birth history, symptoms, fever duration, presence of respiratory distress and radiographic lesion, and inflammatory markers. RESULTS: Of 780 children enrolled, 463 (59.4%) were hospitalized via the ED. The factor associated with the hospitalization were age ≤ 12 months (odd ratio [OR], 45.34; confidence interval [CI], 17.50-117.44), fever lasting ≥ 3 days (OR, 13.66; 95% CI, 6.46-28.87), respiratory rate ≥ 24 breaths per minute (OR, 6.88; 95% CI, 4.21-11.26), radiographic lesion (OR, 5.70; 95% CI, 2.62-12.40), and chest retraction (OR, 2.45; 95% CI, 1.11-5.41). CONCLUSION: In children with acute bronchiolitis who visit EDs, those having younger age, longer fever duration, respiratory distress or radiographic lesion may need hospitalization.

Association between the Korean Triage and Acuity Scale level and hospitalization of children with abdominal pain in the emergency department

PURPOSE: The Korean Triage and Acuity Scale (KTAS) is a triage tool for patients in the emergency department (ED). We aimed to investigate the association between the KTAS level and hospitalization of children with abdominal pain, a common chief complaint in the ED. METHODS: This study retrospectively reviewed medical records of children aged 3 to 14 years who visited the ED with abdominal pain as a chief complaint. KTAS level (1–3 vs. 4–5), age, gender, presence of associated symptoms (vomiting, diarrhea, hematochezia, and fever), and disposition (rapid discharge, discharge after intravenous hydration, and hospitalization) were collected and compared between the children with KTAS 1–3 and 4–5. RESULTS: Of 1,050 children enrolled, 618 (58.9%) were classified as KTAS 1–3, and 36 (3.4%) were hospitalized. Vomiting was the most common associated symptom in both groups (63.6%), and 41.5% underwent discharge after intravenous hydration. The children with KTAS 1–3 were more frequently hospitalized (5.0% vs. 1.2%, P < 0.001). CONCLUSION: The KTAS may be reliable to predict the hospitalization of children with abdominal pain in the ED with additional consideration of the associated symptoms.

Increased Prevalence of Ossification of Posterior Longitudinal Ligament and Increased Bone Mineral Density in Patients with Ossification of Nuchal Ligament

OBJECTIVE: There are also few studies demonstrating the relationship between ossification of nuchal ligament (ONL) and ossification of posterior longitudinal ligament (OPLL). We compared the prevalence, location, and type of OPLL between patients with ONL and matched patients without ONL.We also compared the bone mineral densities (BMDs) between the 2 groups. METHODS: total of 124 cervical ONL patients were enrolled in this study. The control group of 124 patients was matched with 124 patients with ONL by age and sex on a 1:1 basis to minimize confounding factors. We reviewed the prevalence, location, and type of OPLL in both groups. RESULTS: The prevalence of OPLL was almost 2.5 times greater in patients with ONL than those without ONL. The mean value of BMD in patients with ONL was greater at the lumbar spine (L1-L4) than in patients without ONL. The mean T score of the lumbar spine was 0.25±1.68 in the patients with ONL and -0.73±1.64 in the patients without ONL. CONCLUSION: The prevalence of OPLL in patients with ONL was significantly higher than in patients without ONL. Because ONL is innocuous and may be seen more readily than OPLL on simple cervical radiographs, clinicians should consider the possibility of coexisting OPLL when ONL, especially extensive ONL, is detected in patients with neck pain, radiculopathy, or myelopathy, to facilitate proper treatment.

The Clinical Significance of Ossification of Ligamentum Nuchae in Simple Lateral Radiograph : A Correlation with Cervical Ossification of Posterior Longitudinal Ligament

OBJECTIVE: Ossification of the ligamentum nuchae (OLN) is usually asymptomatic and incidentally observed in cervical lateral radiographs. Previous literatures reported the correlation between OLN and cervical spondylosis. The purpose of this study was to elucidate the clinical significance of OLN with relation to cervical ossification of posterior longitudinal ligament (OPLL). METHODS: We retrospectively compared the prevalence of OPLL in 105 patients with OLN and without OLN and compared the prevalence of OLN in 105 patients with OPLL and without OPLL. We also analyzed the relationship between the morphology of OLN and involved OPLL level. The OPLL level was classified as short (1-3) or long (4-6), and the morphologic subtype of OLN was categorized as round, rod, or segmented. RESULTS: The prevalence of OPLL was significantly higher in the patients with OLN (64.7%) than without OLN (16.1%) (p=0.0001). And the prevalence of OLN was also higher in the patients with OPLL (54.2%) than without OPLL (29.5%) (p=0.0002). In patients with round type OLN, 5 of 26 (19.2%) showed long level OPLL, while in patients with larger type (rod and segmented) OLN, 22 of 42 (52.3%) showed long level OPLL (p=0.01). CONCLUSION: There was significant relationship between OLN and OPLL prevalence. This correlation indicates that there might be common systemic causes as well as mechanical causes in the formation of OPLL and OLN. The incidentally detected OLN in cervical lateral radiograph, especially larger type, might be helpful to predict the possibility of cervical OPLL.

Pyogenic Pancreatic Abscess Mimicking Pancreatic Neoplasm: A Four-Case Series / 대한소화기학회지

A pyogenic pancreatic abscess mimicking pancreatic neoplasm in the absence of acute pancreatitis is rare. We report four patients who each presented with a pancreatic mass at the pancreas head or body without acute pancreatitis. The presenting symptoms were abdominal pain, fever, or weight loss. Abdominal CT scans showed low-density round masses at the pancreas head or body with/without lymphadenopathy. In each case, a PET-CT scan showed a mass with a high SUV, indicating possible malignancy. Comorbid diseases were identified in all patients: chronic pancreatitis and thrombus at the portal vein, penetrating duodenal ulcer, distal common bile duct stenosis, and diabetes mellitus. Diagnoses were performed by laparoscopic biopsy in two patients and via EUS fine needle aspiration in one patient. One patient revealed a multifocal microabscess at the pancreatic head caused by a deep-penetrating duodenal ulcer. He was treated with antibiotics and a proton-pump inhibitor. The clinical symptoms and pancreatic images of all the patients were improved using conservative management. Infective causes should be considered for a pancreatic mass mimicking malignancy.

The Comparison of Sagittal Spinopelvic Parameters between Young Adult Patients with L5 Spondylolysis and Age-Matched Control Group

OBJECTIVE: To compare spinopelvic parameters in young adult patients with spondylolysis to those in age-matched patients without spondylolysis and investigate the clinical impact of sagittal spinopelvic parameters in patients with L5 spondylolysis. METHODS: From 2009 to 2012, a total of 198 young adult male patients with spondylolysis were identified. Eighty age-matched patients without spondylolysis were also selected. Standing lateral films that included both hip joints were obtained for each subject. Pelvic incidence (PI), sacral slope (SS), pelvic tilt, lumbar lordosis angle, sacral inclination, lumbosacral angle, and sacral table angle were measured in both groups. A comparative study of the spinopelvic parameters of these two groups was performed using SPSS 15.0 (SPSS Inc., Chicago, IL, USA). RESULTS: Among the aforementioned spinopelvic parameters, PI, SS and STA were significantly different between patients with spondylolysis and those without spondylolysis. PI and SS were higher in the spondylolysis group than in the control group, but STA was lower in the spondylolysis group than in the control group. CONCLUSION: PI and SS were higher in the spondylolysis group than in the control group, but STA was lower in the spondylolysis group than in the control group. Patients with spondylolysis have low STA at birth, which remains constant during growth; a low STA translates into high SS. As a result, PI is also increased in accordance with SS. Therefore, we suggest that STA is an important etiologic factor in young adult patients with L5 spondylolysis.

Delayed Retroperitoneal Hemorrhage due to Lumbar Artery Pseudoaneurysm after Lumbar Posterolateral Fusion

A 55-year-old female patient presented with lower back pain and neurogenic intermittent claudication and underwent L3-L4 posterolateral fusion. To prepare the bone fusion bed, the transverse process of L3 and L4 was decorticated with a drill. On the 9th post-operative day, the patient complained of a sudden onset of severe abdominal pain and distension. Abdominal computed tomography revealed retroperitoneal hematoma in the right psoas muscle and iatrogenic right L3 transverse process fracture. Lumbar spinal angiography showed the delayed hematoma due to rupture of the 2nd lumbar artery pseudoaneurysm and coil embolization was done at the ruptured lumbar artery pseudoaneusyrm. Since then, the patient's postoperative progress proceeded normally with recovery of the hemodynamic parameters.

Association between Serum Homocysteine Concentrations and Bone Mineral Density in Middle Aged Women / 대한폐경학회지

OBJECTIVES: Hyperhomocysteinemia is known to be related with the early onset of osteoporosis. This study was to examine the association between serem homocysteine levels and bone mineral density (BMD) in middle aged women. METHODS: The study included 409 women who underwent bone density tests in the health screening centers from January 2009 to october 2010. Serum homocysteine levels and BMD were measured. RESULTS: Postmenopause group (n = 109) showed significantly lower BMD score in lumbar spine and femoral neck and significantly higher serum homocysteine concentration compared to premenopause group (n = 300). However, after adjusting for age, body mass index, and the menopausal condition in total 409 women, there were no significant correlations between serum homocysteine levels and BMD. CONCLUSION: Measurement of serum homocysteine levels may not be useful, but adjunctive for the risk assessment of osteoporosis in middle aged women.

Emergency Department Based Hypertension Screening Test

PURPOSE: To identify a useful screening test leading to diagnosis of hypertension in the emergency department (ED). METHODS: This was a retrospective medical record review of adult patients (18> or =years of age) admitted to the ED at a tertiary care educational hospital, between January 1, 2010 and February 28, 2010. Only those patients with a triage systolic blood pressure greater than or equal to 140 mmHg, or a diastolic blood pressure greater than or equal to 90 mmHg, were enrolled. Data including baseline characteristics, basic metabolic panel (BMP), urinalysis, electrocardiogram (ECG), chest radiograph, and whether or not they were diagnosed with hypertension, were obtained. Multivariate analysis was performed to determine an appropriate screening test for diagnosis of hypertension. RESULTS: Of the 447 enrolled patients, 81(18.1%) were diagnosed with hypertension. Age above 35 years (Odds ratio [OR]=8.263; 95% Confidence interval (CI), 1.034-66.062; p=0.046), diagnosis of diabetes mellitus (DM) (OR=3.99; 95% CI, 1.582-10.064; p=0.003), left ventricular hypertrophy (LVH) (OR=4.348; 95% CI, 1.968-9.607; p<0.001), and suspected stage II hypertension (OR=2.699; 95% CI, 1.151-6.329; p=0.022) were independently associated with a positive hypertension diagnosis. The area under the Receiver operating characteristic (ROC) curve for a positive diagnosis of hypertension was 0.687(95% CI, 0.642-0.730). CONCLUSION: Age above 35 years, existence of DM or LVH, and suspected stage II hypertension may be useful data points for screening and diagnosis of hypertension in the ED.

Emergency Department Based Hypertension Screening Test

PURPOSE: To identify a useful screening test leading to diagnosis of hypertension in the emergency department (ED). METHODS: This was a retrospective medical record review of adult patients (18> or =years of age) admitted to the ED at a tertiary care educational hospital, between January 1, 2010 and February 28, 2010. Only those patients with a triage systolic blood pressure greater than or equal to 140 mmHg, or a diastolic blood pressure greater than or equal to 90 mmHg, were enrolled. Data including baseline characteristics, basic metabolic panel (BMP), urinalysis, electrocardiogram (ECG), chest radiograph, and whether or not they were diagnosed with hypertension, were obtained. Multivariate analysis was performed to determine an appropriate screening test for diagnosis of hypertension. RESULTS: Of the 447 enrolled patients, 81(18.1%) were diagnosed with hypertension. Age above 35 years (Odds ratio [OR]=8.263; 95% Confidence interval (CI), 1.034-66.062; p=0.046), diagnosis of diabetes mellitus (DM) (OR=3.99; 95% CI, 1.582-10.064; p=0.003), left ventricular hypertrophy (LVH) (OR=4.348; 95% CI, 1.968-9.607; p<0.001), and suspected stage II hypertension (OR=2.699; 95% CI, 1.151-6.329; p=0.022) were independently associated with a positive hypertension diagnosis. The area under the Receiver operating characteristic (ROC) curve for a positive diagnosis of hypertension was 0.687(95% CI, 0.642-0.730). CONCLUSION: Age above 35 years, existence of DM or LVH, and suspected stage II hypertension may be useful data points for screening and diagnosis of hypertension in the ED.

Methemoglobinemia and Seizure Following Indoxacarb Poisoning

Indoxacarb is an oxadiazine insecticide with selective lethality through blockade of neuronal voltage-dependent sodium channels. It has a low mammalian toxicity, and few cases of human toxicity after indoxacarb ingestion can be found in the literature. A 36 year-old male patient visited our ED after a generalized tonic clonic seizure, which was witnessed by his mother. His past medical history was nonspecific. On initial presentation, he showed a decreased level of consciousness with a Glasgow coma score of 5/15 (E1V1M3), unprotected airway, hypoxia, and cyanosis. The saturation gap and cyanosis after intubation and mechanical ventilation was strongly suggestive of methemoglobinemia due to poisoning. Finally, the methemogobin (metHb) level was 27.4%. Therefore, the patient received 100 mg of methylene blue (2 mg/kg, 1% solution) and 50 g of charcoal. The insecticide was found to be ingested xenobiotic (Steward Gold(R); 5% indoxacarb; 95% inert ingredients and other components). On the second hospital day, the patient became alert. The patient's metHb level was 0.1%. The endotracheal tube was removed. On the fifth hospital day, he was discharged in good condition. Herein we present a case of indoxacarb poisoning with methemoglobiemia and seizure, which are unusual presentations.

Prediction of Systemic Complications from Caustics Ingestion Through Arterial Blood Gas Analysis

PURPOSE: The aim of this study was to analyze the risk factors of systemic complications by caustic substances according to arterial blood gas analysis (ABGA). METHODS: The medical records of patients who visited our emergency department for caustic ingestion from January 2000 to December 2011 were reviewed. There were 129 patients included in this study, with a mean age of 45.4 years, and 46.9% of the patients were men. We performed a univariate analysis of factors associated with systemic complication and a logistic regression analysis of these predictive factors. RESULTS: The most frequent caustic ingested was base (53.8%). Systemic complications were found in 29 patients (22.5%) and advanced age, a low partial pressure of oxygen (PaO2), low bicarbonate ion (HCO3-), low oxygen saturation (SaO2), high anion gap (AG), acid ingestion, and severe acidosis were associated with systemic complications. Low SaO2, high AG, and severe acidosis were independent predictive factors of systemic complications. ED: HIGHLIGHT: Please spell out HCO3. CONCLUSION: Parameters of ABGA such as SaO2, AG, and pH predict the development of systemic complications by caustic ingestion. Therefore, these data have a role in the prognosis and treatment of caustic ingestion.

Cardiac Toxicity in Patients with Antidepressant Intoxication

PURPOSE: Although cardiac toxicity is a key parameter of significant toxicity, in antidepressant intoxication, there are few studies on the cardiac toxicity of serotonin reuptake inhibitor and the intoxication with the new generation of antidepressants. The aim of this study is to investigate the relative cardiac toxicity of serotonin reuptake inhibitor and intoxication with the new generation of antidepressants as compared with that of tricyclic antidepressant intoxication. METHODS: We retrospectively reviewed the medical records of 109 antidepressant intoxicated patients who visited the Emergency Department from January, 2005 to December, 2009 to collect and analyze the demographic and clinical data. Sixteen patients were excluded. The enrolled seventy eight patients were classified into three groups: the tricyclic antidepressant group (TCA) (n=32), the selective serotonin reuptake inhibitor subgroup (SSRI) (n=28) and the new generation antidepressant subgroup (NGA) (n=18). RESULTS: The demographic and clinical data of the SSRI and NGA groups were not significantly different from that of the TCA group. The QRS duration of the SSRI subgroup (86.4+/-12.0 msec) and the NGA subgroup (91.8+/-11.9 msec) was not significantly different from that of the TCA group (90.0+/-13.5msec) (p=0.598). CONCLUSION: Intoxication with SSRI and the new generation antidepressants seemed to show significant cardiac toxicity, like what is seen in tricyclic antidepressant intoxication. Clinicians must pay attention to SSRI and new generation antidepressant intoxication.

Laparoscopic Splenectomy in a Case of Stable Blunt Abdominal Trauma

Splenic rupture is a frequent surgical emergency in blunt abdominal trauma patients. There are several treatment options, including conservative treatment, a partial splenectomy, splenorrhaphy, and a splenectomy for splenic injury. Although reports on the safety and the efficacy of an elective laparoscopic splenectomy are abundant in the literature, a laparoscopic splenectomy for a ruptured spleen has only been reported in a few cases. We report a case of a laparoscopic splenectomy in the patient with Grade III traumatic splenic injury. To our knowledge, this is the first report in which a laparoscopic splenectomy was performed in Korea for the treatment of a traumatic splenic injury.

Evaluation of the Risk Factors for Aspiration Pneumonitis Following Drug Intoxication

PURPOSE: It is known that aspiration pneumonitis is associated with high mortality and morbidity following overdose. However, until now, few domestic studies on this subject have been conducted. The main aim of this study is to investigate the risk factors associated with aspiration pneumonitis in intubated patients following overdose. METHODS: Among 654 adult overdosed patients who visited our institution from Jan. 2006 to June 2008, we enrolled 70 intubated patients within 24 hours after their overdose, and we reviewed the medical records to collect the data. This data was processed by univariate analysis, followed by multiple logistic regression analysis. P values <0.05 were deemed statistically significant. RESULTS: In our study, a high incidence of pneumonitis was seen in the patients with an older age, a lower GCS and a high poisoning severity score or a high comorbidity score (p<0.05). Compared with the non-pneumonitis group, the pneumonitis group had a higher incidence of intubation (6% vs 61.8%, respectively, p<0.05). The main cause of intubation was a decreased mentality (68.6%). Older age, a high comorbidity score, irrigation without airway protection, relative hypoxemia and hyperkalemia were the risk factors of aspiration pneumonitis in the intubated overdosed patients (p<0.05). Among these factors, age, a high potassium level and airway protection might be significant predictors of aspiration penumonitis (p<0.05). CONCLUSION: Older age, a high potassium level and irrigation without proper airway protection may be the significant factors that can predict aspiration pneumonitis in patients who are intubated within 24 hours after overdose, although the further investigations on this are needed.

Clinical Significance of Delayed re-evaluation in Initial Symptoms Following Snakebite Injury

PURPOSE: Antivenin is a standard therapy in snakebite victims. While the required antivenin dose can be easily estimated, based on the initial symptoms, this strategy may be unsuccessful if the initial symptoms progressively worsen. The purpose of this study was to identify the progression rate of the initial symptoms following snakebite and its associated factors. METHODS: The medical records of 44 patients treated for snakebite from give the actual dates of the study period were retrospectively examined. Thirty-two of these patients were enrolled. Demographic data, local wound grade and local effect score at initial presentation (G-0 and LES-0, respectively) and 12 hours after admission (G-12 and LES-12, respectively) were reviewed, along with laboratory data. RESULTS: The 32 patients had an average age of 54.0+/-14.5 years and were predominantly male (n=26) and presented mainly during summer. Compared to G-0 and LES-0, re-evaluated G-12 and LES-12 were significantly increased despite initial administration of proper antivenin dosage (p=0.001 and p=0.000, respectively). Total amounts of antivenin correlated with LES-12 (correlation co-efficiency 0.558, p<0.05). However, factors associated with symptom progression were not revealed. CONCLUSION: Initial snakebite symptoms might progressively worsen within hours despite acceptable initial antivenin therapy. Therefore, re-evaluation within several hours must be considered if when the initial snakebite symptoms are minimal or mild.

Language Lateralization in Patients with Temporal Lobe Epilepsy : A Comparison between Volumetric Analysis and the Wada Test

OBJECTIVE: Determining language lateralization is important for the presurgical evaluation of patients with medically intractable epilepsy. The Wada test has been the gold standard for lateralization of language dominance before epilepsy surgery. However, it is an invasive test with risk, and have some limitations. METHODS: We compared the volumetric analysis with Wada test, and studied the clinical potential of volumetric analysis to assess language laterality in large surgical candidates with temporal lobe epilepsy (TLE). To examine the efficacy of volumetric analysis to determine language lateralization during presurgical evaluation, we compared the volumetric analysis of the bilateral planum temporale with the results of Wada test in 59 patients with chronic intractable TLE (rTLE, n=32; lTLE, n=27) who underwent epilepsy surgery. We measured the gray matter volumes of planum temporale (PT) of each patients using the VoxelPlus2 program (Mevisys, Daejeon, Korea). RESULTS: Overall congruence of the volumetric analysis with the Wada test was 97.75% in rTLE patients and 81.5% in lTLE patients. There were more significant leftward asymmetry of the PT in rTLE patients than lTLE patients. In lTLE patients, relatively high proportion (37%) of the patients showed bilateral or right hemispheric language dominance. CONCLUSION: These results provide evidence that the volumetric analysis of the PT could be used as an alternatives in language lateralization. Also, the results of the Wada test suggested that there was considerable plasticity of language representation in the brains of patients with intractable TLE and it was associated with an earlier age of brain injury.