The Profile of Early Sedation Depth and Clinical Outcomes of Mechanically Ventilated Patients in Korea.

BACKGROUND: Current international guidelines recommend against deep sedation as it is associated with worse outcomes in the intensive care unit (ICU). However, in Korea the prevalence of deep sedation and its impact on patients in the ICU are not well known. METHODS: From April 2020 to July 2021, a multicenter, prospective, longitudinal, noninterventional cohort study was performed in 20 Korean ICUs. Sedation depth extent was divided into light and deep using a mean Richmond Agitation-Sedation Scale value within the first 48 hours. Propensity score matching was used to balance covariables; the outcomes were compared between the two groups. RESULTS: Overall, 631 patients (418 [66.2%] and 213 [33.8%] in the deep and light sedation groups, respectively) were included. Mortality rates were 14.1% and 8.4% in the deep and light sedation groups (P = 0.039), respectively. Kaplan-Meier estimates showed that time to extubation (P < 0.001), ICU length of stay (P = 0.005), and death (P = 0.041) differed between the groups. After adjusting for confounders, early deep sedation was only associated with delayed time to extubation (hazard ratio [HR], 0.66; 95% confidence interval [CI], 0.55-0.80; P < 0.001). In the matched cohort, deep sedation remained significantly associated with delayed time to extubation (HR, 0.68; 95% CI, 0.56-0.83; P < 0.001) but was not associated with ICU length of stay (HR, 0.94; 95% CI, 0.79-1.13; P = 0.500) and in-hospital mortality (HR, 1.19; 95% CI, 0.65-2.17; P = 0.582). CONCLUSION: In many Korean ICUs, early deep sedation was highly prevalent in mechanically ventilated patients and was associated with delayed extubation, but not prolonged ICU stay or in-hospital death.

Clinical evaluation of usefulness and effectiveness of sitting type continuous passive motion machines in patients with total knee arthroplasty: a study protocol for a single-blinded randomized controlled trial.

BACKGROUND: Total knee arthroplasty (TKA) is an important management strategy for patients with knee osteoarthritis (OA) refractory to conservative management. Postoperative range of motion (ROM) exercise is important to recover patients' activities of daily living. Continuous passive motion (CPM) is a machine that provides passive ROM exercises of the knee joint in a pre-defined arc of motion. The short- and long-term effects of CPM exercise are controversial. We hypothesized that the inconsistent results of the CPM exercise are due to poor fitting of CPM machines and measurement errors. This study aims to present a protocol for investigating a new type of CPM machine that could be applied in a sitting position in comparison with the conventional type of CPM machine for patients with unilateral TKAs. METHODS: This study presents the protocol of a prospective, multicenter, single-blinded, three-armed randomized controlled trial (RCT). One hundred and twenty-six patients receiving unilateral TKAs will be recruited at the physical medicine and rehabilitation clinics of two urban tertiary medical hospitals. The patients were randomly divided into three groups with a 1:1:1 allocation. The intervention group will receive two weeks of post-operative rehabilitation using a new type of CPM machine. The control group will receive 2 weeks of post-operative rehabilitation using conventional CPM machines. The third group will receive post-operative rehabilitation with both types of CPM machines. The primary outcome will be the change in the passive ROM of the affected knee joint from baseline to 2 weeks after baseline assessment. The secondary outcomes will be pain and functional measurements, and will include patient-reported outcomes and performance tests surveyed at multiple time points up to 3 months after TKA. DISCUSSION: This is the first RCT to investigate the effect of a new type of CPM machine. The results of this RCT will determine whether the position of the patients during CPM exercise is important in post-operative rehabilitation protocols after TKAs and will provide evidence for the development of proper rehabilitation guidelines after TKAs. TRIAL REGISTRATION: Clinical Research Information Service of Republic of Korea, KCT0005520, Registered on 21 October 2020, https://cris.nih.go.kr/cris/search/detailSearch.do/21750.

Importance of pulse pressure after extracorporeal cardiopulmonary resuscitation.

BACKGROUND: Recent reports have revealed better clinical outcomes for extracorporeal cardiopulmonary resuscitation (ECPR) than conventional cardiopulmonary resuscitation (CPR). In this retrospective study, we attempted to identify predictors associated with successful weaning off extracorporeal membrane oxygenation (ECMO) support after ECPR. METHODS: The demographic and clinical data of 30 ECPR patients aged over 18 years treated between August 2016 and January 2019 were analyzed. All clinical data were retrospectively collected. The primary endpoint was successful weaning off ECMO support after ECPR. Patients were divided into two groups based on successful or unsuccessful weaning off ECMO support (Weaned (n = 14) vs. Failed (n = 16)). RESULTS: Univariate logistic regression analysis showed that age, CPR duration, ECMO complications, and loss of pulse pressure significantly predicted the results of weaning off ECMO support. However, multivariate logistic regression analysis showed that only CPR duration and loss of pulse pressure independently predicted unsuccessful weaning from ECMO support. CONCLUSION: We conclude that long CPR duration and loss of pulse pressure after ECPR predict unsuccessful weaning from ECMO. However, unlike CPR duration, loss of pulse pressure during post-ECPR was related to subsequent management. In patients with reduced pulse pressure after ECPR, careful management is warranted because this reduction is closely associated with unsuccessful weaning off ECMO support after ECPR.

Three unsuspected CT diagnoses of COVID-19.

PURPOSE: Coronavirus disease 2019 (COVID-19) is caused by a novel strain of coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that has quickly spread around the globe. Health care facilities in the USA currently do not have an adequate supply of COVID-19 tests to meet the growing demand. Imaging findings for COVID-19 are non-specific but include pulmonary parenchymal ground-glass opacities in a predominantly basal and peripheral distribution. METHODS: Three patients were imaged for non-respiratory-related symptoms with a portion of the lungs in the imaged field. RESULTS: Each patient had suspicious imaging findings for COVID-19, prompting the interpreting radiologist to suggest testing for COVID-19. All 3 patients turned out to be infected with COVID-19, and one patient is the first reported case of the coincident presentation of COVID-19 and an intraparenchymal hemorrhage. CONCLUSION: Using imaging characteristics of COVID-19 on abdominal or neck CT when a portion of the lungs is included, patients not initially suspected of COVID-19 infection can be quarantined earlier to limit exposure to others.

The dark side of mobile work during non-work hours: moderated mediation model of presenteeism through conservation of resources lens.

Owing to the development of Information and Communication Technology (ICT) and the inevitability of telecommuting in the COVID-19 environment, the boundary between working and non-working hours has become blurred. mWork, that is, ICT-based off-hour work, which has increased through the pandemic, affects employees' work attitudes, such as presenteeism. Hence, we designed a study to investigate the antecedents and mechanisms of employee presenteeism from the perspective of the conservation of resources theory. We supported our hypothesis using a sample of 325 Korean office workers obtained through three rounds of time-delay surveys. The results show that presenteeism is higher among employees with high mWork. In addition, employees' mWork increases sleep deprivation and presenteeism, and the exchange ideology of employees reinforces the positive effect of sleep deprivation on presenteeism. Additionally, the higher the level of exchange ideology, the stronger the mediating effect of mWork on presenteeism through sleep deprivation. This study verified the conservation of resources theory by identifying the mechanism by which mWork affects an employee's life, which in turn affects their work, and provides practical implications for managing productivity loss due to presenteeism.

The characteristics and clinical outcomes of trauma patients transferred by a physician-staffed helicopter emergency medical service in Korea: a retrospective study.

Purpose: Helicopter transport with medical teams has been proven to be effective, with improvements in patient survival rates. This study compared and analyzed the clinical characteristics and treatment outcomes of trauma patients transported by doctor helicopters according to whether patients were transferred after a clinical evaluation or without a clinical evaluation. Methods: This study retrospectively reviewed data from the Korean Trauma Data Bank of trauma patients who arrived at a regional trauma center through doctor helicopters from January 1, 2014, to December 31, 2022. The patients were divided into two groups: doctor helicopter transport before evaluation (DHTBE) and doctor helicopter transport after evaluation (DHTAE). These groups were compared. Results: The study population included 351 cases. At the time of arrival at the trauma center, the systolic blood pressure was significantly lower in the DHTAE group than in the DHTBE group (P=0.018). The Injury Severity Score was significantly higher in the DHTAE group (P<0.001), and the accident to trauma center arrival time was significantly shorter in the DHTBE group (P<0.001). Mortality did not show a statistically significant between-group difference (P=0.094). Surgical cases in the DHTAE group had a longer time from the accident scene to trauma center arrival (P=0.002). The time from the accident to the operation room or from the accident to angioembolization showed no statistically significant differences. Conclusions: DHTAE was associated with significantly longer transport times to the trauma center, as well as nonstatistically significant trends for delays in receiving surgery and procedures, as well as higher mortality. If severe trauma is suspected, air transport to a trauma center should be requested immediately after a simple screening test (e.g., mechanism of injury, Glasgow Coma Scale, or Focused Assessment with Sonography in Trauma), which may help reduce the time to definitive treatment.

Unraveling the Link between Perceived ESG and Psychological Well-Being: The Moderated Mediating Roles of Job Meaningfulness and Pay Satisfaction.

Enhancing corporate accountability in areas such as environment, social, and governance (ESG) has solidified its role in the discussion on improving corporate resilience and growth. ESG management activities not only augment corporate sustainability and risk control but also influence the professional roles and personal lives of members through their perceived ESG. Historically, most ESG research has centered on the interrelation of corporate ESG endeavors and outcomes, while studies focusing on the influence of perceived ESG on members have been sparse. In this light, our investigation, rooted in the conservation of resources theory, aimed to delineate the mechanistic link between perceived ESG and members' psychological well-being. This study employed a stratified random sampling technique and collected data across three waves, each spaced four weeks apart. Our sample comprised 325 Korean employees working in administrative, technical, service, and sales roles. This study recruited 325 Korean employees across three time-lagged phases and found that ESG comprehension enhances job meaningfulness, subsequently amplifying psychological wellness. Intriguingly, as pay satisfaction escalates, the mediating role of job meaningfulness between perceived ESG and well-being intensifies. Our study underscores that for organizations to harness perceived ESG to boost psychological well-being via job meaningfulness, managing pay satisfaction is imperative. These findings highlight a crucial policy implication: policymakers must actively promote ESG awareness and incorporate it into employee compensation strategies. This integration is essential to cultivating a healthier, more engaged workforce and driving long-term organizational success.

Radiologic assessment of the optimal point for tube thoracostomy using the sternum as a landmark: a computed tomography-based analysis.

Purpose: This study aimed at developing a novel tube thoracostomy technique using the sternum, a fixed anatomical structure, as an indicator to reduce the possibility of incorrect chest tube positioning and complications in patients with chest trauma. Methods: This retrospective study analyzed the data of 184 patients with chest trauma who were aged ≥18 years, visited a single regional trauma center in Korea between April and June 2022, and underwent chest computed tomography (CT) with their arms down. The conventional gold standard, 5th intercostal space (ICS) method, was compared to the lower 1/2, 1/3, and 1/4 of the sternum method by analyzing CT images. Results: When virtual tube thoracostomy routes were drawn at the mid-axillary line at the 5th ICS level, 150 patients (81.5%) on the right side and 179 patients (97.3%) on the left did not pass the diaphragm. However, at the lower 1/2 of the sternum level, 171 patients (92.9%, P<0.001) on the right and 182 patients (98.9%, P= 0.250) on the left did not pass the diaphragm. At the 5th ICS level, 129 patients (70.1%) on the right and 156 patients (84.8%) on the left were located in the safety zone and did not pass the diaphragm. Alternatively, at the lower 1/2, 1/3, and 1/4 of the sternum level, 139 (75.5%, P=0.185), 49 (26.6%, P<0.001), and 10 (5.4%, P<0.001), respectively, on the right, and 146 (79.3%, P=0.041), 69 (37.5%, P<0.001), and 16 (8.7%, P<0.001) on the left were located in the safety zone and did not pass the diaphragm. Compared to the conventional 5th ICS method, the sternum 1/2 method had a safety zone prediction sensitivity of 90.0% to 90.7%, and 97.3% to 100% sensitivity for not passing the diaphragm. Conclusions: Using the sternum length as a tube thoracostomy indicator might be feasible.

Comparison of Prognostic Performance between Procalcitonin and Procalcitonin-to-Albumin Ratio in Post Cardiac Arrest Syndrome.

(1) Background: Post-cardiac arrest syndrome (PCAS) is a type of global ischemic reperfusion injury that occurs after the return of spontaneous circulation (ROSC). The procalcitonin to albumin ratio (PAR) has been studied as an independent prognostic factor of various diseases. There are no previous studies of PAR in patients with PCAS. We assessed if PAR is more effective than procalcitonin (PCT) in predicting prognosis for patients with PCAS. (2) Methods: This retrospective cohort study included a total of 187 patients with PCAS after non-traumatic out-of-hospital cardiac arrest (OHCA) between January 2016 and December 2020. Multivariate logistic regression analysis was conducted to assess the association between PAR and PCAS prognosis. The predictive performance of PAR was compared with PCT via the receiver-operating characteristic (ROC) analysis and DeLong test.; (3) Results: PAR at 24 and 48 h after hospital admission were independently associated with one-month neurological outcome (OR: 1.167, 95% CI: 1.023-1.330; OR: 1.077, 95% CI: 1.012-1.146, p < 0.05). By ROC analysis, PAR showed better performance over PCT at 48 h after admission in predicting one-month CPC (0.763 vs. 0.772, p = 0.010). (4) Conclusions: Our findings suggest that PAR at 48 h after admission is more effective in predicting a one-month neurological outcome than PCT at 48 h after admission in patients with PCAS after OHCA.

Saline versus Plasma Solution-A in Initial Resuscitation of Patients with Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial.

BACKGROUND: Although saline is commonly used during cardiopulmonary resuscitation (CPR) or post-cardiac arrest care, it has detrimental effects. This trial aimed to evaluate the efficacy of a balanced crystalloid solution (Plasma Solution-A [PS]) in out-of-hospital cardiac arrest (OHCA) patients and compare it with the efficacy of saline. METHODS: A randomized, unblinded clinical trial was conducted using PS and saline for intravenous fluid administration during CPR and post-cardiac arrest care of non-traumatic OHCA patients admitted to the emergency department of a tertiary university hospital. Patients received saline (saline group) or PS (PS group) within 24 h of hospital arrival. The primary outcomes were changes in arterial pH, bicarbonate, base excess (BE), and chloride levels within 24 h. The secondary outcomes were clinical outcomes including mortality. RESULTS: Of the 364 patients, data from 27 and 26 patients in the saline and PS groups, respectively, were analyzed. Analysis using a linear mixed model revealed a significant difference in BE change over time between the groups (treatment-by-time p = 0.044). Increase in BE and bicarbonate levels from 30 min to 2 h was significantly greater (p = 0.044 and p = 0.024, respectively) and the incidence of hyperchloremia was lower (p < 0.001) in the PS group than in the saline group. However, there was no difference in clinical outcomes. CONCLUSION: Use of PS for resuscitation resulted in a faster improvement in BE and bicarbonate, especially in the early phase of post-cardiac arrest care, and lower hyperchloremia incidence than the use of saline, without differences in clinical outcomes, in OHCA patients.

Comparison of pediatric injury patterns before and during the COVID-19 pandemic in Korea: a retrospective study.

Purpose: The COVID-19 pandemic led to significant changes in the lifestyle patterns of children and affected the patterns of pediatric injuries. This study analyzed the changing patterns of pediatric injury overall and by age groups, based on the datasets before and during the COVID-19 pandemic. Methods: This study is based on the data of patients who presented with injuries at 23 hospital emergency departments participating in the Emergency Department-based Injury In-depth Surveillance (EDIIS) conducted by the Korea Disease Control and Prevention Agency. The surveillance data was categorized by injury mechanism, location, activity, and severity. We analyzed the injury patterns of pediatric patients aged 0 to 15 years. Subgroup analysis was conducted by age group in children aged 7 to 15 years, 1 to 6 years, and <1 year. Results: When comparing the COVID-19 pandemic period to the pre-COVID-19 period, the total number of pediatric patients with injuries decreased by 38.7%, while the proportions of in-home injuries (57.9% vs. 67.9%), and minor injuries (38.9% vs. 39.7%) increased. In the 7 to 15 years group, bicycle riding injuries (50.9% vs. 65.6%) and personal mobility device injuries (2.4% vs. 4.6%) increased. The 1 to 6 years group also showed an increase in bicycle accident injuries (15.8% vs. 22.4%). In the <1 year group, injuries from falls increased (44.5% vs. 49.9%). Self-harm injuries in the 7 to 15 years group also increased (1.6% vs. 2.8%). Conclusions: During the COVID-19 pandemic period, the overall number of pediatric injuries decreased, while injuries occurring at home and during indoor activities increased. Traffic accidents involving bicycles and personal mobility devices and self-harm injuries increased in the 7 to 15 years group. In the <1 year group, the incidence of falls increased. Medical and societal preparedness is needed so that we might anticipate these changes in the patterns of pediatric injuries during future infectious disease pandemics.

Severity of grinder injuries and related factors compared with other high-rotation cutting tool injuries: a multicenter retrospective study from 2011 to 2018.

Purpose: This study aimed to identify the characteristics of patients injured by high-rotation cutting tools and the factors related to the severity of their injuries. Methods: Adult patients (≥18 years), who presented to the emergency department (ED) after a high-rotation cutting tool injury and who were registered in the Korean Emergency Department-based Injury In-depth Surveillance (2011-2018) database, were included. Patients' demographic characteristics, injury-related factors, and Injury Severity Scores were collected. All included cases were categorized into two groups according to the tool that caused the injury: grinder versus nongrinder. The characteristics of the two groups were compared, and the factors associated with the severity of injuries were investigated. Results: Among 8,697 ED visits, 4,603 patients had been using a grinder and 4,094 had been using a nongrinder tool. The most frequently injured body part while using a grinder was the hand (46.4%), followed by the head (23.0%). While using a nongrinder tool, the most frequently injured body part was also the hand (64.0%), followed by the lower leg (11.4%). The odds of a severe injury were affected by patient age (odds ratio [OR], 1.024; 95% confidence interval [CI], 1.020-1.028) and using a grinder (OR, 2.073; 95% CI, 1.877-2.290). The odds of a severe injury using a grinder were higher in arm injuries (OR, 1.60; 95% CI, 1.40-1.83) and multiple-part injuries (OR, 1.998; 95% CI, 1.639-2.437). The odds of a severe injury using a grinder were lower for head injuries (OR, 0.481; 95% CI, 0.297-0.781). Conclusions: Injuries from grinders were more likely to affect the head and neck than nongrinder injuries, despite the lower severity. The current lack of regulations on grinders in occupational safety and health standards warrants relevant legislation and the development of applicable safety equipment.

Factors associated with the injury severity of falls from a similar height and features of the injury site in Korea: a retrospective study.

Purpose: This study aimed to determine the risk factors associated with the severity of fall-related injuries among patients who suffered a fall from similar heights and analyze differences in injury sites according to intentionality and injury severity. Methods: The Emergency Department-based Injury In-depth Surveillance (EDIIS) data collected between 2019 and 2020 were used in this retrospective study. Patients with fall-related injuries who fell from a height of ≥6 and <9 m were included. Patients were categorized into the severe and mild/moderate groups according to their excessive mortality ratio-adjusted Injury Severity Score (EMR-ISS) and the intention and non-intention groups. Injury-related and outcome-related factors were compared between the groups. Results: In total, 33,046 patients sustained fall-related injuries. Among them, 543 were enrolled for analysis. A total of 256 and 287 patients were included in the severe and mild/moderate groups, respectively, and 93 and 450 patients were included in the intention and non-intention groups, respectively. The median age was 50 years (range, 39-60 years) and 45 years (range, 27-56 years) in the severe and mild/moderate groups, respectively (P<0.001). In multivariable analysis, higher height (odds ratio [OR] 1.638; 95% confidence interval [Cl], 1.279-2.098) and accompanying foot injury (OR, 0.466; 95% CI, 0.263-0.828) were independently associated with injury severity (EMR-ISS ≥25) and intentionality of fall (OR, 0.722; 95% CI, 0.418-1.248) was not associated with injury severity. The incidence of forearm injuries was four (4.3%) and 58 cases (12.9%, P=0.018) and that of foot injuries was 20 (21.5%) and 54 cases (12.0%, P=0.015) in the intention versus non-intention groups, respectively. Conclusions: Among patients who fell from a similar height, age, and fall height were associated with severe fall-related injuries. Intentionality was not related to injury severity, and patients with foot injury were less likely to experience serious injuries. Injuries in the lower and upper extremities were more common in intentional and unintentional falls, respectively.

Changes in incidence and severity of commercial motorcycle accidents due to the use of delivery service platforms in Korea: a retrospective cohort study.

Purpose: Recently, a sharp increase in the use of delivery services has led to an increase in motorcycle accidents. This study aimed to identify the characteristics of the commercial motorcycle injured patients and factors related to the severity during the past 10 years. Methods: Patients (15-64 years old) who visited the emergency department with commercial motorcycle accidents injury registered in the Korean Emergency Department-based Injury In-depth Surveillance (2011-2020) database, were included. All included cases were categorized into two groups according to the period: group 1 (2011-2015) and group 2 (2016-2020). General characteristics and the factors associated with severity were investigated. Results: Among 8,123 emergency department visits, patients in group 1 were 3,071, and patients in group 2 were 5,052. The odds for severity were affected by patients age (odds ratio [OR], 1.008; 95% confidence interval [CI], 1.004-1.013), and overnight/morning (00:00-12:00; OR, 1.243; 95% CI, 1.091-1.415). The odds for severity were higher in head and neck injury (OR, 8.357; 95% CI, 7.410-9.424) and torso injury (OR, 4.122; 95% CI, 3.610-4.708). The odds for the severity of accidents based on excess mortality ratio-adjusted Injury Severity Score (EMR-ISS) after 2015 were significant (OR, 1.491; 95% CI, 1.318-1.687). Hospitalization in the intensive care unit and death were associated with accidents after 2015 (OR, 2.593; 95% CI, 2.120-3.170). Conclusions: Commercial motorcycle accidents have increased significantly over the past decade. There were statistical differences in severity based on EMR-ISS and the hospitalization in intensive care unit and death.

Creativity in the South Korean Workplace: Procedural Justice, Abusive Supervision, and Competence.

Innovation is now a feature of daily life. In a rapidly changing market environment and amid fierce competition, organizations pursue survival and growth through innovation, and the key driver of innovation is the creativity of employees. Because the value of creativity has been emphasized, many organizations are looking for effective ways to encourage employees to be creative at work. From a resource perspective, creativity at work can be viewed as a high-intensity job demand, and organizations should encourage it by providing and managing employee resources. This study is an attempt to empirically investigate how competence and abusive supervision affect the relationship between procedural justice and creativity from the conservation of resources perspective. Findings from two-wave time-lagged survey data from 377 South Korean employees indicate that procedural justice increases creativity through the mediation of competence. Furthermore, abusive supervision has a negative moderating effect on the relationship between procedural justice and competence. The findings show that competence moderates the relationship between procedural justice and creativity and that the lower the level of abusive supervision, the greater the effect of procedural justice on competence and creativity.

Impact of obesity on the severity of trauma in patients injured in pedestrian traffic accidents.

Purpose: Studies on the relationship between obesity and injuries, especially those sustained in pedestrian traffic accidents, are lacking. We aimed to assess the effects of obesity on the severity of injury at the time of admission to the emergency room in patients who experienced pedestrian traffic accidents. Methods: This study included trauma patients registered in the Korean Trauma Database from July 1, 2018 to December 31, 2020, whose mechanism of injury was pedestrian traffic accidents and who were treated at a single institution. Those aged below 15 years were excluded. Patients were assigned to nonobese and obese groups based on a body mass index of 25 kg/m2. An Injury Severity Score of 25 or greater was considered to indicate a critical injury. Results: In total, 679 cases of pedestrian traffic accidents were registered during the study period, and 543 patients were included in the final analysis. Of them, 360 patients (66.3%) and 183 patients (33.7%) were categorized as nonobese and obese, respectively. The median age was significantly higher in the nonobese group than in the obese group (60 vs. 58 years). Multivariate analysis demonstrated that the odds ratio for critical injury in obese patients was 1.59 (95% confidence interval, 1.01-2.48) compared with nonobese patients. Conclusions: Obesity affected the likelihood of sustaining severe injuries in pedestrian traffic accidents. Future studies should analyze the effects of body mass index on the pattern and severity of injuries in patients with more diverse injury mechanisms using large-scale data.

Epidemiology and clinical characteristics of posttraumatic hospitalized patients with symptoms related to venous thromboembolism: a single-center retrospective study.

Purpose: The aim of this study was to investigate the epidemiology of trauma inpatients with venous thromboembolism (VTE) symptoms diagnosed using computed tomographic angiography (CTA) in Korea. Methods: In total, 7,634 patients admitted to the emergency department of Gachon University Gil Medical Center, a tertiary hospital, and hospitalized between July 1, 2018 and December 31, 2020 were registered for this study. Of these patients, 278 patients who underwent CTA were enrolled in our study. Results: VTE was found in 120 of the 7,634 patients (1.57%), and the positive diagnosis rate of the 278 patients who underwent CTA was 43.2% (120 of 278). The incidence of VTE was statistically significantly higher among those with severe head and neck injuries (Abbreviated Injury Scale, 3-5) than among those with nonsevere head and neck injuries (Abbreviated Injury Scale, 0-2; P=0.038). In a subgroup analysis, the severe and nonsevere head and neck injury groups showed statistically significant differences in known independent risk factors for VTE. In logistic regression analysis, the adjusted odds ratio of severe head and neck injury (Abbreviated Injury Scale, 3-5) for VTE was 1.891 (95% confidence interval, 1.043-3.430). Conclusions: Trauma patients with severe head and neck injuries are more susceptible to VTE than those with nonsevere head and neck injuries. Thus, physicians must consider CTA as a priority for the diagnosis of VTE in trauma patients with severe head and neck injuries who show VTE-associated symptoms.

Age group analysis of patients with dog bite injuries who visited a single regional emergency medical center and factors affecting wound infections.

Purpose: The aim of this study was to analyze by age group the characteristics of patients with dog bite injuries, as well as determine which factors were associated with wound infections in those patients. Methods: We reviewed patients with dog bite injuries who presented to Gachon University Gil Medical Center in Incheon, Korea from January 1, 2014 to December 31, 2018. They were classified by age group: children (0-18 years), adults (19-59 years), or elderly (≥60 years). Event profiles, wound characteristics, and infections were compared across these age groups. Multivariable logistic regression was used to identify factors associated with wound infections. Results: Of the total 972 dog bite injuries, 272 (28.0%) were in children, 606 (62.3%) were in adults, and 94 (9.7%) were in the elderly. The median age was 30 years (interquartile range, 16-48 years) and the majority of patients (60.5%) were female. The most common place of injury was at home (73.8%) and indoors (77.0%). In children, the head and neck were the most frequent sites of injury (43%), while the most frequent site in adults and the elderly (50.8% and 59.6%, respectively) was the upper extremity. The odds ratio (OR) for wound infection was 3.997 (95% confidence interval [CI], 1.279-12.491; P=0.017) for head and neck injuries and 3.881 (95% CI, 1.488-10.122; P=0.006) for lower extremity injuries. The OR for wound infection was 4.769 (95% CI, 2.167-10.494; P<0.001) for significant injuries. Elderly patients had a higher risk for wound infection than other age groups (OR, 2.586; 95% CI, 1.221-5.475; P=0.013). Conclusions: When analyzing patients with dog bite injuries, differences across age groups were found, with the elderly at the highest risk for significant injury and wound infection. It is recommended that age-specific approaches and strategies be used to prevent dog bite wound infections.

Disaster Response to a Mass Casualty Incident in a Hospital Fire by Regional Disaster Medical Assistance Team: Characteristics of Hospital Fire.

OBJECTIVE: A disaster in the hospital is particularly serious and quite different from other ordinary disasters. This study aimed at analyzing the activity outcomes of a disaster medical assistance team (DMAT) for a fire disaster at the hospital. METHODS: The data which was documented by a DMAT and emergent medical technicians of a fire department contained information about the patient's characteristics, medical records, triage results, and the hospital which the patient was transferred from. Patients were categorized into four groups according to results of field triage using the simple triage and rapid treatment method. RESULTS: DMAT arrived on the scene in 37 minutes. One hundred and thirty eight (138) patients were evacuated from the disaster scene. There were 25 patients (18.1%) in the Red group, 96 patients (69.6%) in the Yellow group, and 1 patient (0.7%) in the Green group. One patient died. There were 16 (11.6%) medical staff and hospital employees. The injury of the caregiver or the medical staff was more severe compared to the family protector. CONCLUSIONS: For an effective disaster-response system in hospital disasters, it is important to secure the safety of medical staff, to utilize available medical resources, to secure patients' medical records, and to reorganize the DMAT dispatch system.

Toward more useful pressure-controlled discography: in vitro evaluation of injection speed, sensor location, and tube length.

OBJECTIVE: Pressure-controlled manometric discography is used by clinicians to evaluate discogenic pain. However, some would improve diagnostic accuracy. The goal of this study was to investigate potential confounding factors that might affect discographic results. Pressure differences depending on different speed of injection, lengths of connecting tubing and locations of sensors were evaluated using an in vitro model system. METHODS: Two sets of automated discography devices were arranged to record post-syringeal pressure pressures (PSPs) and intradiscal pressures (IDPs) in an "air chamber disk model" representing intradiscal pressure. PSPs and IDPs were measured simultaneously while varying injection speeds, and using intrasyringeal and extrasyringeal pressure sensors and contrast medium-filled tubing of different lengths. All pressure/volume curves were collected and viewed dynamically, and stored for further analysis. RESULTS: At injection speed of 0.1 cc/second, the mean pressure difference (mean ΔP) between PSP and IDP was 38.1 psi. As injection speed was reduced, mean ΔP was proportionally decreased. Mean ΔP was 5.3 psi at injection speed of 0.01 cc/second and 0.7 psi at 0.005 cc/second. Mean ΔP values were significantly higher when pressures were recorded using intrasyringeal sensor: at injection speed of 0.1 cc/second, PSP and IDP values were 82.9 and 30.1 psi, respectively, compared with 50.6 and 12.5 psi measured by extrasyringeal sensor. Mean ΔP due to increased length of tubing was not significant. CONCLUSION: Discography can be better performed with low speed injection (≤0.01 cc/second), using an extrasyringeal sensor. Difference of length of connecting tubings did not cause significant pressure differences. These data suggest that automated discography is a helpful adjunct to improve diagnostic accuracy, due to extrasyringeal location of pressure sensor and greater control of injection speed.