Usefulness of Early Warning Scores, ROX index, and CURB-65 in the prognostic evaluation of patients with COVID-19

Objective@#Early identification of COVID-19 in patients is important to prevent significant worsening of the disease. This study was undertaken to verify whether MEWS (Modified Early Warning Score), NEWS(National Early Warning Score), ROX index, and CURB-65, which are early diagnostic tools for severe respiratory diseases, could be applied to patients visiting the emergency room for COVID-19. @*Methods@#This retrospective observational study included patients who visited an emergency medical center from September 1 to October 31, 2020, and from January 1 to February 28, 2021. Based on the vital signs and blood tests during the emergency room visit, severity evaluation tools and early diagnostic tools for severe cases were used and compared according to their area under the curve (AUC) values. The primary outcome was in-hospital mortality, while the secondary outcomes were intensive care unit admission rate and the need for mechanical ventilation based on these four tools (MEWS, NEWS, ROX index, and CURB-65). @*Results@#A total of 667 patients were analyzed. No significant difference was determined between the non-survivor group and survivor group in the MEWS values (P=0.13), but statistically significant differences were observed for NEWS (5 vs. 1, P<0.05), CURB-65 (2 vs. 1, P<0.05), and ROX index (16.61 vs. 23.1, P<0.01). The AUC value of NEWS for death prediction indicated a good predictive power at 0.80, while that of MEWS showed a low predictive power at 0.57, which was statistically significant. Moreover, the AUC values of CURB-65 and ROX index did not differ significantly from values obtained for NEWS. @*Conclusion@#As early diagnostic tools for predicting death in COVID-19 patients, NEWS, ROX index, and CURB-65 showed excellent discrimination ability, whereas MEWS showed statistically and significantly lower discrimination ability.

The characteristics of the patients who visited the emergency department with fever, after the chronification of COVID-19 pandemic

Objective@#This study examined the characteristics of patients visiting the emergency department (ED) with fever after the chronification of the coronavirus disease 2019 (COVID-19) pandemic. @*Methods@#This retrospective observational study analyzed the medical records of patients who visited the ED with fever from May 1 to October 31, 2021, and the corresponding period in 2019. This study was conducted at a single center in Seoul, Korea. @*Results@#There was no statistical difference in the comorbidities of the patients of the two groups: the AC (after the COVID-19 pandemic) group and the BC (before the COVID-19 pandemic) group. As for the level of consciousness at the time of ED arrival, there was a significantly larger decrease in consciousness (verbal response or less) in the AC group than in the BC group (P=0.002). In the case of the National Early Warning Score (NEWS), the proportion was higher in the AC group in the moderate-risk and high-risk groups (P=0.003). The median time from symptom onset to ED arrival was 15.7 hours in the BC group and 13.8 hours in the AC group, and there was no significant difference (P=0.137). When leaving the ED, the AC group had a higher admission rate to the ward and intensive care unit than the BC group. There was no statistical difference in the in-hospital mortality between the two groups (2.9% and 2.4%, respectively; P=0.62). @*Conclusion@#Patients who visited the emergency room with fever after one year of the COVID-19 pandemic showed a similar time from symptom onset to ED arrival compared to patients who visited before the COVID-19 pandemic. In addition, there was no difference in in-hospital mortality among these patients compared to those with fever before the COVID-19 pandemic.

Usefulness of the Glasgow Blatchford Score and Pre-Rockall Score as a tool for predicting the need for endoscopic treatment in vulnerable patients with upper gastrointestinal bleeding

Objective@#Predictive tools such as the Glasgow Blatchford Score (GBS) and Pre-Rockall Score (PRS) have been used to foresee risks for gastrointestinal patients. This study was undertaken to determine the usefulness of the various available predictive tools in a vulnerable population. @*Methods@#Data of patients with vulnerable upper gastrointestinal bleeding, who visited the emergency room from January 1, 2017 to December 31, 2018, were retrospectively examined. The GBS and PRS values were determined for all patients. Predictions of therapeutic endoscopy were evaluated with the area under curve (AUC) in the receiver operatory characteristic (ROC) curve. @*Results@#A total of 152 patients were included in the study, 46 of whom required therapeutic endoscopes. In the area below the ROC curve, higher GBS values were obtained as compared to PRS in predicting therapeutic endoscopy (AUC, 0.726; 95% confidence interval [CI], 0.648-0.795 vs. 0.705; 95% CI, 0.626-0.776; P=0.689, respectively), transfusion (AUC, 0.861; 95% CI, 0.796-0.912 vs. 0.715; 95% CI, 0.637-0.786; P=0.001, respectively), and 30-day mortality (AUC, 0.698; 95% CI, 0.618-0.770 vs. 0.622; 95% CI, 0.540-0.699; P=0.351, respectively). Considering GBS 0, we determined with 100% sensitivity and 4.72% specificity that endoscopic treatment is redundant. @*Conclusion@#Compared to PRS, GBS excelled in predicting interventional treatment (endoscopy, transfusion) of vulnerable upper gastrointestinal patients, as well as the 30-day mortality. GBS is more useful in predicting low-risk patients that do not require treatment endoscopy, and is therefore a suitable procedure for outpatient care.

Effects on workers in hospital dedicated to infectious diseases from coronavirus disease 2019 outbreak: emotional change and stress comparison between occupations

Objective@#The coronavirus disease 2019 (COVID-19) outbreak is currently ravaging the world and is a major threat to public health. Healthcare workers (HCWs) are at a high risk of acquiring and transmitting COVID-19. Hence, HCWs are also experiencing emotional and behavioral changes. The purpose of this study was to compare emotional changes and stress between occupations and to investigate the impact of emotions of HCWs during the COVID-19 outbreak. @*Methods@#An anonymous, self-administered, previously validated questionnaire was given to HCWs at a hospital dedicated to infectious diseases in Korea during the COVID-19 outbreak. The participants were asked to evaluate stress factors, depressive moods, trauma, reasons for continuing to work, things that helped them work, coping strategies to reduce stress, motivators that could help them work during future outbreaks, and what they would like to do after the outbreak was over. @*Results@#The total number of participants was 400. The average age of participants was 34.69±9.44. Stress and depressive moods showed variations in the job-to-job comparisons. Ethical duty and the professionalism of the HCWs pushed them to continue with their jobs. The news of a decline in the number of patients was helpful to HCWs. The implementation of personal hygiene programs helped in reducing stress. The provision of adequate personal protective equipment was a factor that would encourage them to work during any future outbreak. The participants wanted to go on a trip after the outbreak was over. @*Conclusion@#Our findings indicate that the COVID-19 outbreak had a significant emotional impact on HCWs. The concerns of HCWs may affect their work efficiency in an outbreak and should be addressed by incorporating appropriate management strategies while planning to combat an outbreak.

Usefulness of the Glasgow Blatchford Score and Pre-Rockall Score as a tool for predicting the need for endoscopic treatment in vulnerable patients with upper gastrointestinal bleeding

Objective@#Predictive tools such as the Glasgow Blatchford Score (GBS) and Pre-Rockall Score (PRS) have been used to foresee risks for gastrointestinal patients. This study was undertaken to determine the usefulness of the various available predictive tools in a vulnerable population. @*Methods@#Data of patients with vulnerable upper gastrointestinal bleeding, who visited the emergency room from January 1, 2017 to December 31, 2018, were retrospectively examined. The GBS and PRS values were determined for all patients. Predictions of therapeutic endoscopy were evaluated with the area under curve (AUC) in the receiver operatory characteristic (ROC) curve. @*Results@#A total of 152 patients were included in the study, 46 of whom required therapeutic endoscopes. In the area below the ROC curve, higher GBS values were obtained as compared to PRS in predicting therapeutic endoscopy (AUC, 0.726; 95% confidence interval [CI], 0.648-0.795 vs. 0.705; 95% CI, 0.626-0.776; P=0.689, respectively), transfusion (AUC, 0.861; 95% CI, 0.796-0.912 vs. 0.715; 95% CI, 0.637-0.786; P=0.001, respectively), and 30-day mortality (AUC, 0.698; 95% CI, 0.618-0.770 vs. 0.622; 95% CI, 0.540-0.699; P=0.351, respectively). Considering GBS 0, we determined with 100% sensitivity and 4.72% specificity that endoscopic treatment is redundant. @*Conclusion@#Compared to PRS, GBS excelled in predicting interventional treatment (endoscopy, transfusion) of vulnerable upper gastrointestinal patients, as well as the 30-day mortality. GBS is more useful in predicting low-risk patients that do not require treatment endoscopy, and is therefore a suitable procedure for outpatient care.

Effects on workers in hospital dedicated to infectious diseases from coronavirus disease 2019 outbreak: emotional change and stress comparison between occupations

Objective@#The coronavirus disease 2019 (COVID-19) outbreak is currently ravaging the world and is a major threat to public health. Healthcare workers (HCWs) are at a high risk of acquiring and transmitting COVID-19. Hence, HCWs are also experiencing emotional and behavioral changes. The purpose of this study was to compare emotional changes and stress between occupations and to investigate the impact of emotions of HCWs during the COVID-19 outbreak. @*Methods@#An anonymous, self-administered, previously validated questionnaire was given to HCWs at a hospital dedicated to infectious diseases in Korea during the COVID-19 outbreak. The participants were asked to evaluate stress factors, depressive moods, trauma, reasons for continuing to work, things that helped them work, coping strategies to reduce stress, motivators that could help them work during future outbreaks, and what they would like to do after the outbreak was over. @*Results@#The total number of participants was 400. The average age of participants was 34.69±9.44. Stress and depressive moods showed variations in the job-to-job comparisons. Ethical duty and the professionalism of the HCWs pushed them to continue with their jobs. The news of a decline in the number of patients was helpful to HCWs. The implementation of personal hygiene programs helped in reducing stress. The provision of adequate personal protective equipment was a factor that would encourage them to work during any future outbreak. The participants wanted to go on a trip after the outbreak was over. @*Conclusion@#Our findings indicate that the COVID-19 outbreak had a significant emotional impact on HCWs. The concerns of HCWs may affect their work efficiency in an outbreak and should be addressed by incorporating appropriate management strategies while planning to combat an outbreak.

Validation of the Broselow tape in Korean children using data from a nationwide anthropometric survey: a cross-sectional study

Purpose@#In Korea, the Broselow tape (BT) is widely used to estimate weight in resuscitation. Validation of BT in Korean children is essential because the tool was developed based on children’s weight and height in the United States. The validation was previously performed in a small-scale dataset. The authors aimed to validate BT using the 2005 Korean nationwide anthropometric survey data. @*Methods@#From the population used for the survey, we sampled children aged 0-12 years. The weights estimated by BT were compared with measured weights of the children using Bland-Altman analysis with results recorded as percentage differences. We measured the accuracy of BT, defined as within a 10% error of the measured weight, and the concordance of the color-coded zones derived from the estimated and measured weights. The accuracy and concordance were further assessed according to the age groups and body mass index-for-age Z-score ( 2, overweight or obese). @*Results@#A total of 108,128 children were enrolled. The mean age was 55.2 ± 37.5 months. The bias was –5.4% (P < 0.001), and the limits of agreement were –28.3% and 17.6%, respectively. The accuracy and concordance of BT were 64.4% and 67.2%, respectively. Differences of no more than 1 color-coded zone between estimated and measured weights accounted for 89.8% and 84.1% of the under- and overweight (or obese) children, respectively. @*Conclusion@#BT accurately estimates weight in approximately two-thirds of Korean children. In addition, adjustment of 1 color-coded zone may be considered in children with extreme weight.

Clinical characteristics and risk factors for mortality of patients hospitalized with COVID-19 in Korea

Objective@#The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus-2, is a global concern. This study aimed to examine the clinical characteristics, demographics and outcomes of COVID-19 patients in the emergency department (ED) and explore clinical predictors of in-hospital mortality. @*Methods@#This single-center, retrospective, observational study used 1,003 adult patients with laboratory-confirmed COVID-19 who went to the ED and were admitted to the hospital between February 28 and September 30, 2020. @*Results@#The median age of the included patients was 55 (37-68) years, and 533 were women (53.1%). Severe COVID-19 was noted in 173 patients (17.2%); seven patients (0.7%) received mechanical ventilation. The mortality rate was 2.1%. Multivariable Cox regression analysis found the risk factors associated with in-hospital death of patients (age >70 years [hazard ratio (HR), 27.411; P70 years, hypoalbuminemia, CURB-65≥3 and thrombocytopenia on admission were independent risk factors for mortality in patients hospitalized with COVID-19. Early detection of these predictors and application of CURB-65 score in the ED may provide guidance for appropriate risk stratification at triage and disposition of patients at increased risk of poor prognosis.

Usefulness of initial red blood cell distribution width as a prognostic factor for predicting 30-day mortality in acute decompensated heart failure patients

OBJECTIVE: This study evaluated the efficacy of the initial red blood cell distribution width (RDW) level in the emergency department (ED) to predict the 30-day mortality in patients with acute decompensated heart failure (ADHF). METHODS: A retrospective analysis study of patients who visited the ED and were diagnosed with ADHF from January 2015 to December 2016 was conducted. The patients were divided into the 30-day survival group and non-survival group. The data were obtained from the medical records of the patients, and the blood test results were taken from the initial blood test at the ED. The data and blood test results were compared between the 30-day survival and non-survival groups. Multivariate logistic regression analysis was performed to determine the risk factors for mortality. RESULTS: A total of 626 patients were included. The mean age was 78.5 years and the overall mortality was 15.5%. The non-survival group had higher RDW levels than the survival group (18.0% vs. 14.6%). In a multivariate logistic regression analysis, RDW (odds ratio, 2.242; 95% confidence interval [CI], 1.673−3.005; P<0.001) were considered to be a useful factor for predicting the prognosis. The area under the receiver operating characteristic curve of RDW to predict mortality was 0.848 (95% CI, 0.811–0.886; P<0.001), and the sensitivity and specificity of predicting mortality was 76.3% and 78.1%, respectively, after setting the RDW cutoff value to 15.95%. CONCLUSION: The initial RDW level is a useful prognostic marker for predicting the 30-day mortality in ADHF patients.

Evaluation of clinical usefulness of pneumococcal urinary antigen test: single center experience

OBJECTIVE: A pneumococcal urinary antigen (PUA) test, which can be performed quickly and easily, is performed frequently in emergency rooms because of its high sensitivity and specificity. On the other hand, it is a relatively expensive test, and it is not known how it affects the clinicians' prescription of antibiotics. This study evaluated the clinical utility of the PUA test. METHODS: This study was conducted retrospectively on patients aged ≥18 years, who underwent a PUA test and were hospitalized with a diagnosis of pneumonia in an emergency room from January to December 2016. The patients were divided into a PUA test positive group and negative group, and the clinical characteristics and antibiotic regimen were compared. RESULTS: A total of 533 patients were enrolled, of which 54 were positive and 479 were negative. The antibiotic prescriptions were similar in the positive and negative groups. After the PUA test result, only two of the positive group used the antibiotics recommended by the Infectious Diseases Society of America and the American Thoracic Society for Streptococcus pneumoniae. Furthermore, there was an appropriate change in eight patients after the blood culture test, but the PUA test result was judged to be meaningful in only two patients. CONCLUSION: The results of the PUA test did not affect the clinician's antibiotic prescription significantly. A prescription standard for the PUA test is needed, and it should be performed after admission rather than in the emergency room.

A Study on the Change of Emergency Department Use Behavior of the Homeless Patients after the Implementation of the ‘Seoul Type Citizen Sympathy Emergency Room Project’

PURPOSE: This study shows the change in emergency room use behavior by homeless patients after implementation of the ‘Seoul Type Citizen Sympathy Emergency Room Project’ in July 2015. METHODS: A retrospective study was conducted in a public hospital between January 2014 and December 2014 and January 2016 and December 2016. Homeless patients who visited the emergency room in 2014 and 2016 were compared based on age, gender, mode of insurance, admission, revisit within 48 hours, length of stay (LOS) in the emergency department (ED), total cost, and major diagnostic category. RESULTS: A total of 3,642 homeless patients were enrolled during the study period, of which 1,876 visited in 2014 and 1,766 in 2016. Fewer homeless patients in 2016 revisited within 48 hours (p=0.046). Homeless in 2016 had a shorter ED LOS (p < 0.001) and lower total cost (p=0.040). More homeless patients who visited due to alcohol revisited within 48 hours in 2016 (p=0.036). Moreover, these patients did not have a different ED LOS (p=0.060) or total cost (p=0.475). Medicaid homeless patients were less connected compared health insurance by screening, brief intervention, referral to treatment program. CONCLUSION: Comparison of homeless patients who visited the emergency room in 2014 and 2016 revealed fewer total homeless patients in 2016, as well as less revisits within 48 hours, shorter ED LOS and lower total cost. These findings indicate that the ‘Seoul Type Citizen Sympathy Emergency Room Project’ was effective in the emergency room, but improvements for alcohol and medicaid homeless patients are needed.

Epidemiology of prehospital emergency medical service use in Korean children

OBJECTIVE: The aim of this study was to elucidate the epidemiology of pediatric patients transported by the National 119 Rescue Services in Korea. METHODS: We enrolled all pediatric patients (<16 years old) who used the National 119 Rescue Services in Korea between January 2006 and December 2008, and analyzed the 119 ambulance patient care record databases. RESULTS: The total number of the cases was 238,644 for 3 years. The median age was 6 years old and 59.0% were male, and the 2- to 5-year-old group was the largest (31.0%). The peak transport times were in the afternoon (from 12:00 p.m. to 17:59 p.m., 36.3%), on Saturday and Sunday (15.9% and 15.7%), and in summer (June to August, 27.3%). The ratio of disease versus injury as the cause of the transports was 42.3% vs. 57.7%. Among the 16 metropolitan cities and provinces, Gyeonggi (25.7%), Seoul (17.6%), and Incheon (7.0%) account for almost half of the all transported children. Regarding the annual transport rates per 100,000 children standardized by age, and gender to the Korean child population, Jeju was the largest (1,650.2) followed by Gangwon (1,201.3), and Jeonnam (1,178.1). CONCLUSION: This report presents comprehensive epidemiologic data of pediatric patients transported by 119 rescue services in Korea.

Ambient Particulate Matter and Emergency Department Visit for Chronic Obstructive Pulmonary Disease

PURPOSE: This study aimed to explore the association between increased level of ambient particulate matter and emergency room visits for chronic obstructive pulmonary disease (COPD) exacerbations. METHODS: A retrospective study was conducted. We enrolled patients who lived in Seoul, Korea and were diagnosed with COPD in the emergency room between January 2012 and December 2014. Meteorological factors [daily highest temperature, lowest temperature, mean temperature, diurnal temperature, rainfall, relative humidity, amount of sunshine and particulate matter less than 10 µm (PM 10)] between December 2011 and December 2014 in Seoul were acquired from the Korea Meteorological Administration. We used a multiple Poisson regression model with daily patient's number of COPD as a response variable and meteorological factors as explanatory variable. Variable selection was done via an Elastic net. RESULTS: There was a total of 1,179 emergency visits for acute exacerbations of COPD patients. PM10 (before 4, 10, 11, 15, 16, 17, 22, 24, 27, 28 day), rainfall (before 1, 6, 8, 16, 18 day), relative humidity (before 2, 8), and daily temperature difference (5, 10, 15 day) had a relationship and a lag effect with COPD exacerbations. CONCLUSION: This study showed that an increased concentration of PM10 was associated with COPD exacerbations. A future study that reinforces the limitation of this study is necessary to get a helpful index for an adequate response of medical institution and efficient placement of medical personnel.

Analysis of Epidemiologic Characteristics between Patients Visited from Residential Aged Care Facilities and Elderly Patients Visited from Home Admitted to the Emergency Department with Disease

PURPOSE: In recent years, the number of elderly patients visiting from residential aged care facilities (RACFs) has been increasing. We analyzed a comparison of characteristics between patients who visited the ER with diseases from RACFs and those who visited from home. METHODS: A retrospective study was conducted in a public hospital between January 2013 and December 2014. The subjects included patients who visited the ED from RACFs and elderly patients who visited the ED from home. Comparisons of the following parameters were made between the two groups: gender, age, mode of insurance, mode of ED visit, mobile status, Charlson comorbidity index (CCI), chief complaint, final results in the ED, and length of stay (LOS) in the ED and hospital. RESULTS: A total of 7,603 patients were enrolled during the study period. There were 6,401 elderly patients who visited from home and 1,202 patients who visited from RACFs. Patients from RACFs were older than those from home (79.90±8.01 vs. 75.78±7.26, p<0.001). More patients from RACFs were on Medicaid (56.6% vs. 27.9%, p<0.001), took more ambulance (86.3% vs. 49.4%, p<0.001), more bedridden (68.2% vs. 6.4%, p<0.001), and higher CCI (2.38±1.99 vs. 1.45±1.84, p<0.001). Compared with patients from home, those from RACFs showed a significantly higher proportion of admission (63.2% vs. 32.9%, p<0.001), ED LOS (403.03±361.77 vs. 277.07±258.82, p<0.001), and hospital LOS (19.65±18.58 vs. 15.67±15.63, p<0.001). Patients from RACFs showed especially longer ED LOS from discharged ED than those from home (388.87±422.88 vs. 221.90±215.30, p<0.001). CONCLUSION: Compared with elderly patients from home, patients from RACFs also had higher admission rate and longer ED LOS, as well as hospital LOS. Patients from RACFs had long ED LOS. The findings in this study suggest that there could be ED overcrowding in the near future.

A Clinical Review of Geriatric Patients With Rib Fractures Seen in an Emergency Department

BACKGROUND: Almost every study of rib fractures in the elderly show associated injuries resulting in admission to thoracic or cardiovascular surgery. In Korea, no studies have compared these elderly patients with younger patients. METHODS: This study is based on patients who were diagnosed as having rib fracture at the Emergency Department of the Seoul Medical Center from March 2013 to April 2011. The medical records and radiological examinations of 192 cases were reviewed. Two groups were created-older than 65 years and younger than 64 years. Comparisons were made between the two groups including place of injury, time of injury, associated injuries, and the final result in the Emergency Department. RESULTS: The final patient sample size was 192. The elderly group had 142 patients with the average age being 48.77+/-9.70 years and 75.4% males. The young group had 50 patients with the average age at 75.90+/-7.21 years and 25% males. The most common place of injury was road (p=0.007) in the young group and home (p=0.002) in the elderly group. The most common mechanisms of injury were slipping (47.4%), traffic accidents (18.2%), falling (14.1%), and assault (9.4%). Falling was more prevalent in the young group than in the elderly group (p=0.011). Rib fractures occurred at night (p<0.001), on Saturdays, on Sundays, and in the winter in the young group and in the morning(p=0.002), on Mondays, on Fridays, and in the winter in the elderly group. Associated injuries, in descending order, were chest, limb, head, and spine. CONCLUSION: This study found that several selected factors of an injury-place, mechanism, time, and associated injuries, differ by age.

Family Presence during Invasive Procedures in Pediatric Emergency Department: Comparison of General Attitude of Medical Staffs and Guardians

PURPOSE: The objective of this study was to understand and compare the general attitude of medical staff and guardians toward family presence (FP) in the pediatric emergency department (PED). METHODS: A cross-sectional study was conducted in PEDs in Korea. Doctors and nurses who worked in PEDs and guardians who brought children(< or =15 years old) to the PED were asked to complete a structured questionnaire. A 5-point Likert scale was used as the scoring method. The influence of invasiveness of procedures and socio-demographic factors associated with favorable attitude toward FP were assessed. RESULTS: A total of 206 medical staff and 194 guardians were enrolled. The proportion of guardians with a favorable attitude toward FP was higher than that of the medical staff (99.5% vs. 51.4%). Healthcare providers believed that FP could be "helpful to calm down children and/or guardian (s)", and expressed concern that FP could cause "breakage of rapport when procedure fails". Most guardians believed that FP could be "helpful to support the child emotionally". The invasiveness of procedures was negatively related to the proportion of favorable medical staff toward FP, but did not influence that of the guardians. Previous experience with FP (odds ratio=2.04, 95% confidence interval 1.19-4.22) and occupation (OR=0.17, 95% CI 0.07-0.38) of the medical staff showed a negative association with a favorable attitude toward FP. CONCLUSION: We found discrepancies in general attitude toward FP between guardians and medical staff. Previous experience with FP and occupation of medical staff showed an association with a favorable attitude toward FP.

Family Presence during Invasive Procedures in Pediatric Emergency Department: Comparison of General Attitude of Medical Staffs and Guardians

PURPOSE: The objective of this study was to understand and compare the general attitude of medical staff and guardians toward family presence (FP) in the pediatric emergency department (PED). METHODS: A cross-sectional study was conducted in PEDs in Korea. Doctors and nurses who worked in PEDs and guardians who brought children(< or =15 years old) to the PED were asked to complete a structured questionnaire. A 5-point Likert scale was used as the scoring method. The influence of invasiveness of procedures and socio-demographic factors associated with favorable attitude toward FP were assessed. RESULTS: A total of 206 medical staff and 194 guardians were enrolled. The proportion of guardians with a favorable attitude toward FP was higher than that of the medical staff (99.5% vs. 51.4%). Healthcare providers believed that FP could be "helpful to calm down children and/or guardian (s)", and expressed concern that FP could cause "breakage of rapport when procedure fails". Most guardians believed that FP could be "helpful to support the child emotionally". The invasiveness of procedures was negatively related to the proportion of favorable medical staff toward FP, but did not influence that of the guardians. Previous experience with FP (odds ratio=2.04, 95% confidence interval 1.19-4.22) and occupation (OR=0.17, 95% CI 0.07-0.38) of the medical staff showed a negative association with a favorable attitude toward FP. CONCLUSION: We found discrepancies in general attitude toward FP between guardians and medical staff. Previous experience with FP and occupation of medical staff showed an association with a favorable attitude toward FP.

The Effect of Emergency Explanation System Modified from Medical Check-up Form

PURPOSE: This study was conducted in order to evaluate the effect of a newly developed explanation handout in the emergency department (ED) between patient and guardian. METHODS: From August 24, 2013 to September 24, 2013, interviews were conducted to patient accompanying guardian, discharged from Seoul Medical Center ED. Four groups were divided according to non-handout or handout in addition to patient or guardian. Each group consisted of 50 candidates and allocated according to a random table. The explanation handout could be easily applicable automatically through the Electronic Medical Record. It contains the results of laboratory tests along with cautions by diagnosis. After discharge explanation, a survey was conducted in each group using questionnaires for evaluation of the effect on medical service satisfaction. RESULTS: A total of 97 candidates(49 patients, 48 guardians) in the non-handout group, and 99 candidates(50 patients, 49 guardians) in the handout group were enrolled. No statistical difference in epidemiology, except explanation time, was observed between the two groups. The handout group showed a higher score in all factors, however, explanation by physician (p<0.001), mean 3.61(+/-0.72) to 3.87(+/-0.73), understanding of medical status (p<0.001), mean 3.51(+/-0.75) to 4.11(+/-0.71), medical evaluation and treatment (p=0.001), mean 3.59(+/-0.72) to 3.92(+/-0.75), kindness of physician (p<0.001), mean 3.74(+/-0.81) to 4.09(+/-0.67), overall satisfaction (p<0.001), mean 3.60(+/-0.75) to 3.97(+/-0.75), willingness of revisit (p=0.023), mean 3.87(+/-0.73) to 4.09(+/-0.61), and willingness of recommendation (p<0.001), mean 3.66(+/-0.82) to 4.09(+/-0.66) showed statistically meaningful results. In a sub-analysis, statistically meaningful results were reanalyzed between patient and guardian. In the non-handout group, guardian showed higher scores in mean value in all factors, however, statistically meaningful results were observed for all factors, except understanding of medical status and medical evaluation and treatment. By application of the handout, 99 patients and 97 guardians showed higher scores in mean value in all factors. Patients showed statistically meaningful results in all factors but just in understanding of medical status in guardian. CONCLUSION: Results of this study showed that the explanation handout effectively increased medical service satisfaction. The effect of the explanation handout was more prominent in patients than guardians.

The Effect of Emergency Explanation System Modified from Medical Check-up Form

PURPOSE: This study was conducted in order to evaluate the effect of a newly developed explanation handout in the emergency department (ED) between patient and guardian. METHODS: From August 24, 2013 to September 24, 2013, interviews were conducted to patient accompanying guardian, discharged from Seoul Medical Center ED. Four groups were divided according to non-handout or handout in addition to patient or guardian. Each group consisted of 50 candidates and allocated according to a random table. The explanation handout could be easily applicable automatically through the Electronic Medical Record. It contains the results of laboratory tests along with cautions by diagnosis. After discharge explanation, a survey was conducted in each group using questionnaires for evaluation of the effect on medical service satisfaction. RESULTS: A total of 97 candidates(49 patients, 48 guardians) in the non-handout group, and 99 candidates(50 patients, 49 guardians) in the handout group were enrolled. No statistical difference in epidemiology, except explanation time, was observed between the two groups. The handout group showed a higher score in all factors, however, explanation by physician (p<0.001), mean 3.61(+/-0.72) to 3.87(+/-0.73), understanding of medical status (p<0.001), mean 3.51(+/-0.75) to 4.11(+/-0.71), medical evaluation and treatment (p=0.001), mean 3.59(+/-0.72) to 3.92(+/-0.75), kindness of physician (p<0.001), mean 3.74(+/-0.81) to 4.09(+/-0.67), overall satisfaction (p<0.001), mean 3.60(+/-0.75) to 3.97(+/-0.75), willingness of revisit (p=0.023), mean 3.87(+/-0.73) to 4.09(+/-0.61), and willingness of recommendation (p<0.001), mean 3.66(+/-0.82) to 4.09(+/-0.66) showed statistically meaningful results. In a sub-analysis, statistically meaningful results were reanalyzed between patient and guardian. In the non-handout group, guardian showed higher scores in mean value in all factors, however, statistically meaningful results were observed for all factors, except understanding of medical status and medical evaluation and treatment. By application of the handout, 99 patients and 97 guardians showed higher scores in mean value in all factors. Patients showed statistically meaningful results in all factors but just in understanding of medical status in guardian. CONCLUSION: Results of this study showed that the explanation handout effectively increased medical service satisfaction. The effect of the explanation handout was more prominent in patients than guardians.

The Comparisons of the Management and Pain Control for Appendicitis between Adults and Children in the Emergency Department

PURPOSE: Appendicitis is one of the most common causes of acute abdominal pain presenting to the emergency department (ED). Emergency physicians are responsible for correct diagnosis and management of pain associated with appendicitis before surgery. We analyzed the comparison of management and pain control for appendicitis between adults and children in the ED. METHODS: This study was a retrospective case control study, conducted in two EDs of a teaching hospital from 2011 to 2012. Patients who were diagnosed as appendicitis based on the radiologic modality were enrolled. We analyzed the clinical characteristics of the patients, who were adults and children diagnosed with appendicitis, respectively. We also analyzed the predictors of pain control for the appendicitis patients by multiple logistic regression. RESULTS: A total of 2,130 patients were enrolled during a two-year period. The median age of the patients was 33 years (IQR 19~47) and 22.8% of patients were under 18 years of age; 54.6% were men. Ultrasonography was performed on 10.8% of patients and computed tomography (CT) on 89.4%. Significant difference in overall pain management was observed between children and adults (adult 29.5% vs children 20.6%, p=0.001). Adult patients younger than 65 years old, male, and those who underwent CT scan received more analgesics than others. Significant difference of the type of analgesics was observed between adults patients and pediatric patients. The use of analgesics did not affect the outcome, such as complication, unplanned revisit. CONCLUSION: Both adults and children with acute appendicitis still did not receive enough pain medication in the ED, even after being diagnosed.