Gender and Intentionality Disparities in the Epidemiology and Outcomes of Falls from Height in Korean Adults

PURPOSE@#This study investigated the characteristics of adult patients who had fallen from a height and presented to an emergency room (ER) according to gender and intentionality, with the goal of reducing the harm caused by these injuries.@*METHODS@#A retrospective analysis was conducted of fall-from-height patients aged ≥19 years from the in-depth surveillance study of injured patients visiting ERs conducted under the supervision of the Korea Centers for Disease Control and Prevention from 2011 to 2016. Patterns were analyzed according to gender and intentionality.@*RESULTS@#There were 29,838 men (68.5%) and 13,734 women (31.5%), with mean ages of 50.3±15.7 years and 57.2±19.9 years, respectively. The most common height of the fall was ≥1 m to 4 m in men (n=15,863; 53.2%) and <1 m in women (n=7,293; 53.1%). The most common location where the fall occurred was the workplace for men (n=10,500 male; 35.2%) and residential facilities for women (n=7,755; 56.5%). Most falls from height were unintentional (n=41,765; 97.1% vs. n=1,264; 2.9% for intentional falls). Suicide was the most frequent reason for intentional falls, and the age group of 19–30 years predominated in this category (n=377; 29.9%). For intentional falls, the most common interval before presentation to the ER was 0–6 hours (n=370; 29.3%) and the most common height was ≥4 m (n=872; 69.0%).@*CONCLUSIONS@#Among men, falls from height most often occurred from ≥1 m to 4 m, at the workplace, and during the course of paid work, whereas among women, they were most common from <1 m, in residential facilities, and during daily activities. Intentional falls most often occurred with the purpose of suicide, in the age group of 19–30 years, with an interval of 0–6 hours until treatment, from ≥4 m, and in residential facilities. Alcohol consumption was more common in intentional falls.

Epidemiological and Clinical Characteristics of Elderly Fall Patients Visit to the Emergency Department: A Comparison by Gender

PURPOSE@#This study was to analyze clinical and epidemiological characteristics of elderly patients who were admitted to the emergency department (ED) due to falls by separating male and female.@*METHODS@#We retrospectively analyzed the fall patients aged 65 years or older from the data of the in-depth surveillance study of injured patients visit to the ED under the supervision of the Korea Centers for Disease Control and Prevention (KCDC) from 2011 to 2016 by separating male and female.@*RESULTS@#A total of 361,588 elderly fall patients were analyzed and, among them, 14,429 (37.3%) were males and 24,208 (62.7%) were females. Male and female showed similar frequency of damage happening season. However, they showed falling accident mostly on winter. The time of injury occurrence is mostly from 12:00 to 18:00 with 4,949 (34.3%) male and 8,564 (35.4%) female. Most falls occurred in daily activities, accounting for 7,614 (52.8%) in males and 14,957 (61.8%) in females, respectively. Unintentional damage accounted for the most part and 7,395 (51.2%) of male and 15,343 (63.4%) of female were injured indoors. Head and neck were the most common site of injuring, with 8,392 (58.2%) in males and 7,851 (32.4%) in females. According to ED examination outcomes, most of the patients were discharged, while the majority of the hospitalized patients were admitted to the general patient room.@*CONCLUSIONS@#The elderly falls occurred mostly from 12:00 to 18:00, during winter and to elderly women. Also, they happened unintentionally indoors in everyday life, mostly. Proved clinical, epidemiological characteristics from this research will be used as useful indicator at validity research of development of prevent program of falling accident for elderly people.

Extracorporeal Membrane Oxygenation and Continuous Renal Replacement Therapy for Treatment of Calcium Channel Blockers, Angiotensin II Receptor Blockers, and Metformin Overdose

An overdose of antihypertensive agents, such calcium channel blockers (CCBs) and angiotensin II receptor blocker (ARBs), and the antihyperglycemic agent, metformin, leads to hypotension and lactic acidosis, respectively. A 40-year-old hypertensive and diabetic man with hyperlipidemia and a weight of 110 kg presented to the emergency room with vomiting, dizziness, and hypotension following an attempted drug overdose suicide with combined CCBs, ARBs, 3-hydroxy-3-methylglutaryl-coemzyme A reductase inhibitors, and metformins. A conventional medical treatment initially administered proved ineffective. The treatment was then changed to simultaneous extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT), which was effective. This shows that simultaneous ECMO and CRRT can be an effective treatment protocol in cases of ineffective conventional medical therapy for hypotension and lactic acidosis due to an overdose of antihypertensive agents and metformin, respectively.

A Case of a Herbicide Poisoning Induced Methemoglobinemia Patient Treated with High-dose Vitamin C

Methemoglobinemia is a condition in which the iron portion of hemoglobin, which binds to oxygen, is oxidized to produce methemoglobin, which increases blood concentration. There are many causes of methemoglobinemia, the most common being food, drugs, and chemicals. A 75-year-old male patient who had taken an herbicide did not notice any nonspecific symptoms. However, after 4 hours, his methemoglobin levels increased to 17.1%, while after 7 hours it increased to 26.5%, at which time intravenous administration of methylene blue 1 mg/kg (an antidote) was started. After a total of five doses of methylene blue at 1 mg/kg due to reactive methemoglobinemia for about 36 hours, the methemoglobin levels increased to 23.7%. Because no more methylene blue could be administered, 10 g of ascorbic acid (vitamin C) was administered intravenously. After 82 hours, ascorbic acid 10 g was administered six times for repeated reactive methemoglobinemia. No additional reactive methemoglobinemia was observed. The ventilator and endotracheal tube were successfully removed on day 5 after admission.

In vitro Protective Effects of Glehnia Littoralis on Alpha-amanitin Induced Hepatotoxicity

PURPOSE: Glehnia littoralis has been used to treat ischemic stroke, phlegm, cough, systemic paralysis, antipyretics and neuralgia. The pharmacological mechanisms of Glehnia littoralis include calcium channel block, coumarin derivatives, anticoagulation, anti-convulsive effect, as well as anti-oxidant and anti-inflammatory effects. Alpha-amanitin (α-amanitin) is a major toxin from extremely poisonous Amanita fungi. Oxidative stress, which may contribute to severe hepatotoxicity was induced by α-amanitin. The aim of this study was to investigate whether Glehnia littoralis ethyl acetate extract (GLEA) has the protective antioxidant effects on α-amanitin -induced hepatotoxicity. METHODS: Human hepatoma cell line HepG2 cells were pretreated in the presence or absence of GLEA (50, 100 and 200µg/ml) for 4 hours, then exposed to 60µmol/L of α-amanitin for an additional 4 hours. Cell viability was evaluated using the MTT method. AST, ALT, and LDH production in a culture medium and intracellular MDA, GSH, and SOD levels were determined. RESULTS: GLEA (50, 100 and 200µg/ml) significantly increased the relative cell viability by 7.11, 9.87, and 14.39%, respectively, and reduced the level of ALT by 10.39%, 34.27%, and 52.14%, AST by 9.89%, 15.16%, and 32.84%, as well as LDH by 15.86%, 22.98%, and 24.32% in culture medium, respectively. GLEA could also remarkably decrease the level of MDA and increase the content of GSH and SOD in the HepG2 cells. CONCLUSION: In the in vitro model, Glehnia littoralis was effective in limiting hepatic injury after α-amanitin poisoning. Its antioxidant effect is attenuated by antidotal therapy.

Two Cases of Bronchial Injury in Patients with Blunt Chest Trauma

Traumatic bronchial injury (TBI) is rare and often fatal, usually a result of blunt or penetrating chest trauma. Clinical manifestations of TBI include pneumothorax, pneumomediastinum, subcutaneous emphysema and continuous air leakage despite thoracostomy with negative pressure. However, TBI is initially difficult to diagnose because its signs are similar to other chest traumas. Delayed diagnosis of TBI can result in sepsis, bronchial stenosis, hypoxic injury, and eventually can cause death. We experienced two patients with TBI, possibly a result of blunt chest trauma. We did not diagnose TBI in the emergency room because we did not suspect it. During surgery, we discovered right bronchial rupture, so performed end to end anastomosis of bronchus in two patients. This report discusses the rare occurrence of TBIs due to chest trauma; our aim is to increase awareness of this diagnosis in the trauma center.

Top of the Basilar Syndrome after 2nd Cervical Spine Fracture

Top of the basilar (TOB) syndrome occurs with occlusion of the rostral portion of the basilar artery that supplies blood to the midbrain, thalamus, and temporal and occipital lobes. Symptoms associated with TOB include decreased alertness, abnormal eye movement, dysarthria, and disorders of cerebellar function. A 47-year-old man was transferred to our hospital to manage C2 vertebral fracture sustained in a traffic accident. He was alert on arrival; however, he lapsed into semicoma. He was diagnosed with TOB. Thrombolytic agents could not be administered due to a contraindication in cervical spine fracture. Brain magnetic resonance imaging showed acute infarction of the pons, cerebellum, and posterior cerebral artery territory. This rare case demonstrates that C2 vertebral fracture can result in TOB.

Spontaneous Femoral Artery Pseudoaneurysm Rupture in Systemic Lupus Erythematosus Patient

Femoral artery pseudoaneurysm, a very uncommon disease, is usually reported trauma, iatrogenic vascular intervention, and nail fixation in the treatment of fracture. The femoral artery is a major vessel for blood supply to the lower extremities. If the femoral artery is injured, the patient will experience cardiovascular collapse and hypovolemic shock due to massive hemorrhage. We report on the case of a 49-year-old male patient who had been diagnosed with systemic lupus erythematosus (SLE), who was admitted to our hospital with progressive swelling of the right thigh without any trauma history. A computed tomographic scan with arterial enhancement showed a large pseudoaneurysm of the right femoral artery, which was then treated successfully with great saphenous vein graft surgery.

Diagnostic Accuracy of Bone Scan Compared to Computed Tomography of Thorax Fractures of Chest Trauma Patients

PURPOSE: Thorax computed tomography (CT) is the diagnostic test for chest trauma patients in the emergency department. Thorax CT has high diagnostic accuracy for rib, sternum fractures. However, rib, sternum fractures are often missed by thorax CT. In this study, the accuracy of thorax CT as a diagnostic test of rib, sternum fractures was examined by comparing the diagnosis of rib, sternum fractures by bone scan. METHODS: A total of 112 patients who had visited the emergency department due to chest trauma and who had undergone both thorax CT and bone scan from January 1, 2010, to June, 30, 2013 were examined. We examined the patients'characteristics, vital signs and cause of trauma through a retrospective analysis of medical records, and thorax CT and bone scan were read by a radiologist and a nuclear medicine specialist. RESULTS: Among 112 patients, 62 patients (55.3%) were male, 50 patients (44.7%) were female, and mean age was 56. There were 59 patients who had no fracture on thorax CT and were regarded as contusion. In 59 patients, 28 patients (47.5%) were diagnosis rib, sternum fractures detected by bone scan. Sex (p=0.188), age (p=0.624), and cause of trauma (p=0.389) were not significant predictors for rib, sternum fractures. However, combined fracture (p=0.043) showed significant correlation. In this study, the sensitivity, specificity, positive predictive value, and negative predictive value of thorax CT in diagnosis of rib, sternum fractures were 64.5%, 93.9%, 96.2%, and 52.5%. CONCLUSION: Thorax CT has low sensitivity (64.5%) and low negative predictive value (52.5%) in detection of rib, sternum fractures. Although thorax CT shows no thorax fracture, when patients have persistent pain or they need accurate diagnosis, we may recommend bone scan for detection of rib, sternum fractures and accurate diagnosis.

Experience of a Medical Assistance for Disaster Caused by a Typhoon of Haiyan in the Philippines

PURPOSE: On November 8, 2013, Typhoon Haiyan attacked the Philippines, causing damage to many houses and trees as well as loss of many lives. A medical team from our hospital and university was sent to Philippines in order to provide medical assistance. We wish to describe our experiences of disaster medicine and discuss problems and improvement points. METHODS: We analyzed the characteristics of patients who received medical treatment administered by us at Tagobon city in the Philippines for five days. RESULTS: We provided medical services to 951 patients for five days. Most patients visited us for medical treatment not trauma. Almost all chief complaints were associated with respiratory, gastrointestinal, dermatologic, and ophthalmologic symptoms. We mainly treated the patients with medications. CONCLUSION: During the subacute period after the disaster, most patients complained of medical and dermatologic problems due to lack of sanitation rather than traumatic complications. Medical assistance for disaster should be administered appropriately according to the types of diseases that occurduring each period after disaster.

Blood Gases during Cardiopulmonary Resuscitation in Predicting Arrest Cause between Primary Cardiac Arrest and Asphyxial Arrest / 대한구급학회지

BACKGROUND: If acid-base status and electrolytes on blood gases during cardiopulmonary resuscitation (CPR) differ between the arrest causes, this difference may aid in differentiating the arrest cause. We sought to assess the ability of blood gases during CPR to predict the arrest cause between primary cardiac arrest and asphyxial arrest. METHODS: A retrospective study was conducted on adult out-of-hospital cardiac arrest patients for whom blood gas analysis was performed during CPR on emergency department arrival. Patients were divided into two groups according to the arrest cause: a primary cardiac arrest group and an asphyxial arrest group. Acid-base status and electrolytes during CPR were compared between the two groups. RESULTS: Presumed arterial samples showed higher potassium in the asphyxial arrest group (p < 0.001). On the other hand, presumed venous samples showed higher potassium (p = 0.001) and PCO2 (p < 0.001) and lower pH (p = 0.008) and oxygen saturation (p = 0.01) in the asphyxial arrest group. Multiple logistic regression analyses revealed that arterial potassium (OR 5.207, 95% CI 1.430-18.964, p = 0.012) and venous PCO2 (OR 1.049, 95% CI 1.021-1.078, p < 0.001) were independent predictors of asphyxial arrest. Receiver operating characteristic curve analyses indicated an optimal cut-off value for arterial potassium of 6.1 mEq/L (sensitivity 100% and specificity 86.4%) and for venous PCO2 of 70.9 mmHg (sensitivity 84.6% and specificity 65.9%). CONCLUSIONS: The present study indicates that blood gases during CPR can be used to predict the arrest cause. These findings should be confirmed through further studies.

Methemglobinemia from Antifreeze Containing Sodium Nitrite

Sodium nitrite is commercially used as a coloring agent, food preservative, and corrosion inhibitor. Accidental poisoning with sodium nitrite from contaminated food and water causes gastrointestinal irritation, vasodilatation, and methemoglobinemia with subsequent tissue hypoxia. We describe an outbreak case of sodium nitrite-induced methemoglobinemia following the ingestion of noodles contaminated with industrial antifreeze. The eEight patients involved initially complained that their noodles tasted 'unpleasant' and soon afterwards experienced nausea, vomiting, dizziness, and fatigue. Some of them noted cyanosis on their lips and fingers. Subsequent investigations demonstrated a high methemoglobin concentration which was corrected by the intravenous administration of methylene blue three hours after the onset of symptoms. The patients made a prompt, uncomplicated recovery and were discharged home 4 four days later. Industrial antifreeze contains sodium nitrite and calcium nitrite. Because an accidental poisoning of industrial antifreeze causes fatal methemoglobinemia, emergency physicians should promptly identify its symptoms and institute treatment with methylene blue promptly. In addition, industrial agencies must caution construction businesses against such contamination events.

Validation of the Pentax-AWS Airwayscope as a Prehospital Intubation Device by Korean Level 1 Emergency Medical Technicians; A Simulation Study Using an Airway Training Manikin

PURPOSE: Tracheal intubation in the pre-hospital setting may be lifesaving in severely ill and injured patients. The aim of the current study was to evaluate whether use of the video laryngoscope, when used by Korean level 1 emergency medical technicians, resulted in faster or more secure facilitation of tracheal intubation, compared with the conventional laryngoscope with the immobilized cervical spine lying on the ground. METHODS: Thirty two level 1 EMTs working as 119 rescuers performed tracheal intubation on a manikin using the Macintosh laryngoscope (McL) and the Pentax-AWS(R) airwayscope (AWS) "on-the-bed" and "on-the-ground" in simulations with or without cervical spine immobilization. We compared intubation time, dental injury, and visual analog scale for both types of laryngoscope. RESULTS: In the McL trial, four participants failed on the bed, and 11 failed on the ground with cervical immobilization. In the AWS trial, all participants successfully secured the airway regardless of cervical spine immobilization both on the bed and on the ground. With the AWS, intubation time was not lengthened due to cervical spine immobilization either on the bed or on the ground. The AWS score was better than the McL on the visual analog scale in ease of handling the laryngoscope both on the bed and on the ground. And use of the AWS resulted in the lowest number of dental compressions. CONCLUSION: We conclude that the AWS is an effective and safe device for use in pre-hospital intubation with cervical spine immobilization, not only on the bed but also on the ground, when used by Korean level 1 EMTs. However, conduct of further studies is required in order to validate the clinical relevance of these findings.

Coordinate Regulation of Vibrio vulnificus Heme Receptor HupA Expression by Cyclic AMP-receptor Protein and Ferric Uptake Regulator

Vibrio vulnificus causes rapid progressing fulminant infections in susceptible individuals, especially those with elevated serum iron levels. This ferrophilic bacterium can directly acquire iron from heme-containing proteins, such as, hemoglobin, via its heme receptor protein HupA. This study was undertaken to determine the roles of cyclic AMP-receptor protein (Crp) as an activator and of ferric uptake regulator (Fur) as a repressor in regulating hupA expression at various iron and glucose concentrations. Under severely iron-deficient conditions, hupA expression in the absence of Crp was induced albeit at low levels and repressed by the addition of iron. In contrast, hupA expression in the presence of Crp was increased by the addition of iron. Under moderately iron-deficient and iron-sufficient conditions, iron addition repressed hupA expression in the presence of Fur, but not in the absence of Fur. Glucose addition repressed hupA expression in the presence of Fur but not in the absence of Fur. Furthermore, a mutation in cyaA encoding adenylate cyclase required for cAMP synthesis hupA expression, and this repression was prevented by the exogenous addition of cAMP. These results indicate that hupA expression is under the coordinate control of cAMP or Crp, which responds to glucose availability, and of Fur, which responds to iron availability, and that Crp is not essential for the constitutional expression of hupA, but is required for the optimal expression of hupA, whereas Fur is essential for the prevention of hupA over-expression.

Clinical Experiences Treating Edifenphos and Iprobenfos Intoxication Patients

Organophosphate fungicides include edifenphos, iprobenfos and tolclofos-methyl. Edifenphos inhibits cell wall synthesis by reduction in chitin synthase activity and inhibits the action of acetylcholinesterase. Thus, exposure to this chemical results in excessive salivation, lacrimation, urination, defecation, gastrointestinal motility and emesis symptoms, just like other organophosphate insecticides. Although edifenphos is an organophosphate fungicide, it is the only agricultural chemical which inhibits the action of pralidoxime and atropine, an activity which in turn, inhibits treatment. Thus, we have to treat these cases as soon as possible with atropine and pralidoxime, using the same approach as used for exposure to other organophosphate insecticides. In this report we evaluate the results of treatment of 4 patients who were intoxicated by fungicides (3 cases with edifenphos and 1 case with iprobenfos).

Changes in Preventable Death Rates and Traumatic Care Systems in Korea

PURPOSE: This study was performed in order to determine the changes over time in preventable and potentially preventable traumatic death rates, and to assess the factors that affected the deaths of trauma patients which occurred in Korean pre-hospital and hospital settings. METHODS: All trauma deaths occurring either in the emergency department (ED) or after admission at twenty Korean hospitals between August 2009 and July 2010 were retrospectively analyzed. The deaths were initially reviewed by a team of multidisciplinary specialists and classified into non-preventable, potentially preventable, and preventable deaths. Only preventable and potentially preventable deaths were the subject of our analysis. Structured data extraction included patient demographics, vital signs, injury severity, probability of survival, preventability of mortality, reported errors in the evaluation and management of the patient, and classification of error types (system, judgment, knowledge). RESULTS: During the study period, 446 trauma victims died in the ED or within 7 days after admission. The mean age was 52 years, 74.1% were men and the mean time from injury to death was 35.6 hours. The most common cause of death was head injury (44.7%) followed by hemorrhage (30.8%) and multi-organ failure (8.0%). The rates of preventable/potentially preventable deaths were 35.2% overall and 29.8% when limited to patients surviving to admission. Of all death classifications, 31.2% were potentially preventable and 4.0% were preventable. Errors leading to preventable death occurred in the emergency department (51.2%), pre-hospital setting (30.3%) and during inter-hospital transfer (60.8%). Most errors were related to clinical management (48.4%) and structural problems in the emergency medical system (36.5%). CONCLUSION: The preventable death rates for Korean trauma victims were higher than those found in other developed countries, possibly due to poorly established emergency medical systems for trauma victims in pre-hospital and hospital settings. A system wide approach based on the emergency medical system and well-developed in-hospital trauma teams should be adopted in order to improve the quality of care of trauma victims in Korea.

Comparison of Severity in Organophosphate Insecticide Poisoning Patients Treated with Tracheostomy

PURPOSE: This study investigated the effect on survival rate for organophosphate intoxication patients who received tracheostomy. This research was conducted to help identify appropriate treatment of patients who received a trachostomy. METHODS: This research was retrospectively conducted using the medical records of 141 patients who arrived at the Chosun University Hospital emergency medical center between Jan 2007 and Dec 2010, suffering from organophosphate intoxication. They were placed in two groups including one which received trachostomy as part of their treatment and one that did not. The effect of each variable on mortality was evaluated by regressionanalysis. RESULTS: Of 141 patients with organophosphate intoxication, 105 of them did not tracheostomy and 16 were dead cohorts (15.2%). Their size of pupil was 1mm. Factors such as amount of organophosphate ingested, PAM time after ingestion, average body temperature, arrival time, atropinization time after ingestion, AST/ALT, Bun/Cr all appeared to be significant factors in death cohorts (P<0.05). 36 patients among the total had tracheostomy and 11 ones of them were in dead cohort (30.6%) and their average age was 58 years. The facts affect the state of patients in dead cohort include the amount of intoxication which between 327.27+/-194.1 ml, performing intubation 686 mins after intubation, reaching to the hospital after 580mins, injecting PAM 744 mins after intoxication, injecting atropine 627 mins after intoxication. The largest cases of patient's state was found to be stupor with 14 patients (38.9%) the level of Cholinesterase in blood appeared to be significant in dead cohort as 391.00+/-353.9 IU/L (P<0.05). CONCLUSION: Further planned studies are necessary on the use of tracheostomy for treatment of poisoning victims, especially those intoxicated by organophosphorus insecticides.

Two Cases of Post Traumatic Cerebral Infarction in Head Injury

We present cases of post traumatic infarction after head injury. Two patients were admitted to our emergency room after traffic accidents. They developed neurological deficiency after a few hours to days after the accidents. In both cases, an initial computed tomography scan of the head was normal. A follow-up computed tomography obtained later revealed a hypodense lesion at cerebral hemisphere and a diffusion-weighted magnetic resonance imaging disclosed an area of infarction. The patients were conservatively medicated. One patient died due to a medical complication and the other patient fully recovered in several weeks. Hospital admission, careful observation and early diffusion-weighted magnetic resonance examination should be considered for patients with persistent neurological deficits.

Analysis of the Factors that Influence the Severity of Injury of Pedestrian Traffic Accident Patients in an Emergency Department

PURPOSE: Pedestrian traffic accident (TA) deaths account for 40% of Korea's annual TA fatalities. With that in mind, we reviewed the cases of traumatic pedestrian TA patients admitted to emergency medical centers in Korea. We analysed factors affecting the severity of injury in order to investigate risk factors for subsequent traumatic threats. METHODS: Prospective methods were applied using a prepared trauma recording format. Trauma records included patient factors (age, gender, occupation, underlying disease), accident factors (time of accident, weather conditions, transportation time, vehicle type causing the accident, influence of alcoholic on both drivers and victims, accident location), and other factors (means of initial hospital admittance transportation). We reviewed medical records to obtain data for vital signs, Glasgow coma scale (GCS), abbreviated injury scale (AIS), injury severity score (ISS), and trauma and injury severity score (TRISS). We divided subjects into 3 groups according to their ISS scores: mild (1-8 points), moderate (9-15 points), severe (>==16 points). These groups were compared with each other regarding degree of severity? RESULTS: We analyzed data for 23,392 traumatized patients that presented at an EMC. Of the 23,392, 252 (3.1%) were pedestrian TA patients. Among this pedestrian cohort, males 156 patients (male 61.9% and female 38.1%; p=0.332). Mean age was 43.1 (+/-19.9). Severity was greater in those over 40 years of age compared those under 40 (p=0.000). Farmer's had the greatest severity than patients in other occupations (p=0.004). Those with an underlying disease showed a higher degree of severity (p=0.028). The most common accident site was city roads (85.7%) but the degree of severity at such sites did not was not significantly greater (p=0.052). Sports utility vehicle (SUV) had the highest rate of accident severity (p=0.004). Cases involving drunken drivers had victims with higher severity (p=0.005). CONCLUSION: Factors that increase the rate of fatalities pedestrian TAs are: older age, underlying illness, working in the agricultural sector, driving an SUV, the patient being in a drunken state.

Analysis of the Risk Factors Influencing the Severity of Injury in Pediatric Multiple Trauma Patients

PURPOSE: The purpose of this study is, first, to analyze the risk factors that influence the severity of injury in pediatric multiple trauma patients and, second, to present solutions for the problems related to the treatment of such patients. Our living situations are so complicated that the danger of accidents is truly open to children who are not prepared. We need to draw attention to the increased numbers of various accidents involving children. METHODS: We studied patients who visited the Emergency Medical Center at Chosun University Hospital from January 1, 2006, to December 31, 2008. Using medical records, we evaluated the general characteristics: the mechanism of injury, the vital signs, the revised trauma score (RTS), the injury severity score (ISS), and the hemoglibin value, which was checked at the time of visit, and the presence or the absence of emergent on regular surgery. We divided the level of injury as follows: light level (1-8 points), mid level (9-15 points), and serious level (above 16 points). We analyzed the medical data by using SPSS 17.0 for windows. RESULTS: The average age of the patients examined was 8.6 years. The number of 6- to 11-year-old patients was 96, which was the largest, but the degree of injury severity was the highest among infant (0-2 years), according to ISS 7.95(+/-6.85). The frequency of accidents was highest on sunny days, and most accidents occurred from 16:00 to 20:00. The cause of multiple trauma for children was the greatest in the traffic accident, (95 patients, 49.0%). In addition, the trauma caused by traffic accidents showed the highest ISS value (9.02+/-6.42) and the most serious degree (P=0.004). The ISS level of injury (8.40+/-6.64) for patients moved from a secondary hospital was higher than that (6.49+/-5.57) for patients who visited the medical center directly. The severity of injury was highest for patients who used a 119 ambulance (8.84+/-5.80). According to the injured parts of body, Injuries to the arms and the feet most frequent (79 patients, 40.7%), but the level of injury was the highest for internal organs and chest, 16.42+/-8.56 and 11.23+/-6.97, respectively. CONCLUSION: We used Abbreviated Injury Scale (AIS) in order to examine the characteristics by injured body part for pediatric multiple trauma patients. Because the degree of injury was the highest for internal organs or the chest, we need to more seriously examine and provide for patients who are suspected of having injuries to the internal organs or the chest. We need to quickly determine the need for surgery in patients with serious injuries to the arms and the feet, which is the greatest in frequency. In particular, we need to consider the surgical care of patients who are not very high in the severity of injury to their brains.