Vitamin D deficiency as a risk factor for sudden cardiac arrest: A multicenter case-control study.

BACKGROUND AND AIMS: Vitamin D is known to influence the risk of cardiovascular disease, which is a recognized risk factor for sudden cardiac arrest (SCA). However, the relationship between vitamin D and SCA is not well understood. Therefore, this study aims to investigate the association between vitamin D and SCA in out-of-hospital cardiac arrest (OHCA) patients compared to healthy controls. METHODS AND RESULTS: Using the Phase II Cardiac Arrest Pursuit Trial with Unique Registration and Epidemiologic Surveillance (CAPTURES II) registry, a 1:1 propensity score-matched case-control study was conducted between 2017 and 2020. Serum 25-hydroxyvitamin D (vitamin D) levels in patients with OHCA (454 cases) and healthy controls (454 cases) were compared after matching for age, sex, cardiovascular risk factors, and lifestyle behaviors. The mean vitamin D levels were 14.5 ± 7.6 and 21.3 ± 8.3 ng/mL among SCA cases and controls, respectively. Logistic regression analysis was used adjusting for cardiovascular risk factors, lifestyle behaviors, corrected serum calcium levels, and estimated glomerular filtration rate (eGRF). The adjusted odds ratio (aOR) for vitamin D was 0.89 (95% confidence interval [CI] 0.87-0.91). The dose-response relationship demonstrated that vitamin D deficiency was associated with SCA incidence (severe deficiency, aOR 10.87, 95% CI 4.82-24.54; moderate deficiency, aOR 2.24, 95% CI 1.20-4.20). CONCLUSION: Vitamin D deficiency was independently and strongly associated with an increased risk of SCA, irrespective of cardiovascular and lifestyle factors, corrected calcium levels, and eGFR.

Area-Level Socioeconomic Inequalities in Intracranial Injury-Related Hospitalization in Korea: A Retrospective Analysis of Data From Korea National Hospital Discharge Survey 2008-2015.

BACKGROUND: Although inequality in traumatic brain injury (TBI) by individual socioeconomic status (SES) exists, interventions to modify individual SES are difficult. However, as interventions for area-based SES can affect the individual SES, monitoring or public health intervention can be planned. We analyzed the effect of area-based SES on hospitalization for TBI and revealed yearly inequality trends to provide a basis for health intervention. METHODS: We included patients who were hospitalized due to intracranial injuries (ICIs) between 2008 and 2015 as a measure of severe TBI with data provided by the Korea National Hospital Discharge Survey. Area-based SES was synthesized using the 2010 census data. We assessed inequalities in ICI-related hospitalization rates using the relative index of inequality and the slope index of inequality for the periods 2008-2009, 2010-2011, 2012-2013, and 2014-2015. We analyzed the trends of these indices for the observation period by age and sex. RESULTS: The overall relative indices of inequality for each 2-year period were 1.82 (95% confidence interval, 1.5-2.3), 1.97 (1.6-2.5), 2.01 (1.6-2.5), and 2.01 (1.6-2.5), respectively. The overall slope indices of inequality in each period were 38.74 (23.5-54.0), 36.75 (21.7-51.8), 35.65 (20.7-50.6), and 43.11 (27.6-58.6), respectively. The relative indices of inequality showed a linear trend for men (P = 0.006), which was most evident in the ≥ 65-year age group. CONCLUSION: Inequality in hospitalization for ICIs by area-based SES tended to increase during the observation period. Practical preventive interventions and input in healthcare resources for populations with low area-based SES are likely needed.

A scoping review of remote facilitation during simulation-based healthcare education.

BACKGROUND: Remote facilitation is a synchronous distance education method where instructors facilitate a lesson, in real-time, in physically separate conditions. In this scoping review, we aimed to describe types of remote facilitation used in a healthcare simulation, the influences on learner outcomes, and related factors. METHODS: We accessed PubMed, EMBASE, CINAHL, ERIC, and Web of Science using our search strategies. Five reviewers performed the review using the Preferred Reporting Items for Systematic Reviews and Meta Analysis extension for Scoping Reviews (PRISMA-ScR) framework, and the Johanna Briggs Institute (JBI) guidelines. RESULTS: We included a total of 29 articles presenting 28 simulation studies. The most common tool was videoconferencing (n = 26, 89.7%). Knowledge improvement was the most frequently measured outcome. There was no significant difference in learning outcomes between the two teaching modes. There were differences in learners' preferences and satisfaction with remote facilitators before and after COVID-19. CONCLUSIONS: Our scoping review indicates that remote facilitation has been widely accepted in many healthcare professions using various types of simulation modalities. Remote facilitation can be used to overcome logistical problems of synchronous multi-location education, and to improve learner knowledge, skills, and confidence measured by instructor evaluation or self-assessment.

Unintended beneficial effects of COVID-19 on influenza-associated emergency department use in Korea.

BACKGROUND: Non-pharmaceutical interventions, including hand hygiene, wearing masks, and cough etiquette, and public health measures such as social distancing, used to prevent the spread of coronavirus disease 2019 (COVID-19), could reduce the incidence rate of respiratory viral infections such as influenza. We evaluated the effect of COVID-19 on the incidence of influenza in Korea. METHODS: This retrospective study included all patients who visited five urban emergency departments (EDs) during the influenza epidemic seasons of 2017-18, 2018-19, and 2019-20. Influenza was defined as ICD-10 codes J09, J10, and J11, determined from ED discharge records. The weekly incidence rates of influenza per 1000 ED visits during the 2019-20 season, when COVID-19 became a pandemic, were compared with those of 2017-18 and 2018-19. The actual incidence rate of the 2019-20 season was compared with the predicted value using a generalized estimation equation model based on 2017-18 and 2018-19 data. RESULTS: The weekly influenza incidence rate decreased from 101.6 to 56.6 between week 4 and week 5 in 2020 when the first COVID-19 patient was diagnosed and public health measures were implemented. The weekly incidence rate during week 10 and week 22 of the 2019-20 season decreased most steeply compared to 2017-18 and 2018-19. The actual influenza incidence rate observed in the 2019-20 season was lower than the rate predicted in the 2017-18 and 2018-19 seasons starting from week 7 when a COVID-19 outbreak occurred in Korea. CONCLUSIONS: The implementation of non-pharmaceutical interventions and public health measures for the COVID-19 epidemic effectively reduced the transmission of influenza and associated ED use in Korea. Implementing appropriate public health measures could reduce outbreaks and lessen the burden of influenza during future influenza epidemics.

Joinpoint Regression About Injury Mortality and Hospitalization in Korea.

BACKGROUND: Injury is a social problem that causes health and property losses, and it is important to identify the size and trend of injury for efficient prevention and management. Therefore, this study analyzed the trends in injury mortality and hospitalization rates from 2005 to 2019 in Korea. METHODS: Using mortality data by Statistics Korea and Korea National Hospital Discharge In-depth injury survey by the Korea Disease Control and Prevention Agency (KDCA), age standardized rates were calculated for death and hospitalization to analyze trends and annual changes with the joinpoint regression model. In addition, annual changes in the hospitalization rate of the transport accident and fall injuries by age group were analyzed, which are the major causes of injuries. RESULTS: From 2005 to 2019, the injury mortality rate has been on the decline, but the injury hospitalization rate has been on the rise. The annual rate of change varied depending on the injury mechanism, but the mortality rate tended to decrease or remain similar level, while the rate of hospitalization has steadily increased. In addition, by age group, injury mortality and hospitalization rates were high in the elderly. In particular, the hospitalization rate of the elderly was higher when comparing the hospitalization rate of the children in transport accidents and falls. Pedestrian transport accidents tended to decrease under the age of 15, but remained similar for those aged 65 and older, and bicycle accidents tended to increase in both groups. In addition, hospitalization rates were higher in the fall, with both groups showing a statistically significant increase in hospitalization rates caused by falls. CONCLUSION: This study analyzed the trend of injury mortality and hospitalization and found that transport accidents and falls may vary depending on the means or age of the accident. Since injury is a big social problem that is a burden of disease, safety education and legal sanctions for injury prevention should be further improved in the future, especially by prioritizing vulnerable groups by age and detailed mechanisms of injury.

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

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

Risk Factors for Intracranial Injury Caused by Falls at Home in Korea Using Data from the Emergency Department-based Injury In-depth Surveillance (2011-2018).

BACKGROUND: Most unintentional injuries that occur at home are preventable. However, it may be difficult to sufficiently reduce the number of falls occurring at home by only identifying risk factors focused on specific age groups. Therefore, this study aimed to identify the risk factors (especially age and places where injuries occurred at home) for intracranial injury (ICI) caused by unintentional falls at home. METHODS: Using the Emergency Department (ED)-Based Injury In-depth Surveillance, we analyzed the data of patients who visited the ED due to unintentional falls at home. Risk factors were identified using multivariable logistic regression according to age groups and interactions between place of injury occurrence and age groups, and sex and age groups were assessed. RESULTS: In total, 232,124 patients were included in the analysis; older adults had a higher adjusted odds ratio (aOR) 14.05 (95% confidence interval [CI], 12.74-15.49) of ICI than infants. The corridor was associated with ICI in the male pediatric group (aOR, 2.71; 95% CI, 1.08-6.84) and the balcony with the female pediatric group (aOR, 2.04; 95% CI, 1.03-4.04). In the adult group, aOR of kitchen was 1.38 (95% CI, 1.02-1.88) in females and 0.56 (95% CI, 0.48-0.66) in males. CONCLUSION: In this study, we identified the risk factors of ICI caused by falls at home using ED-based injury surveillance data. The risk of ICI was different among places of occurrence in the home depending on the age groups and sex.

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

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

Preventable Trauma Death Rate after Establishing a National Trauma System in Korea.

BACKGROUND: This study aimed to evaluate the current overall preventable trauma death rate (PTDR) in Korea and identify factors associated with preventable trauma death (PTD). METHODS: The target sample size for review was designed to be 1,131 deaths in 60 emergency medical institutions nationwide. The panels for the review comprised trauma specialists working at the regional trauma centers (RTCs); a total of 10 teams were formed. The PTDR and factors associated with PTD were analyzed statistically. RESULTS: Of the target cases, 943 were able to undergo panel review and be analyzed statistically. The PTDR was 30.5% (6.1% preventable and 24.4% possibly preventable). Those treated at a RTC showed a significantly lower PTDR than did those who were not (21.9% vs. 33.9%; P = 0.002). The PTDR was higher when patients were transferred from other hospitals than when they directly visited the last hospital (58.9% vs. 28.4%; P = 0.058; borderline significant). The PTDR increased gradually as the time from accident to death increased; a time of more than one day had a PTDR 14.99 times higher than when transferred within one hour (95% confidence interval, 4.68 to 47.98). CONCLUSION: Although the PTDR in Korea is still high compared to that in developed countries, it was lower when the time spent from the accident to the death was shorter and the final destined institution was the RTC. To reduce PTDR, it is necessary to make an effort to transfer trauma patients to RTCs directly within an appropriate time.

Pan-Asian Trauma Outcomes Study (PATOS): Rationale and Methodology of an International and Multicenter Trauma Registry.

BACKGROUND: Trauma is a major health burden and a time-dependent critical emergency condition among developing and developed countries. In Asia, trauma has become a rapidly expanding epidemic and has spread out to many underdeveloped and developing countries through rapid urbanization and industrialization. Most casualties of severe trauma, which results in significant mortality and disability are assessed and transported by prehospital providers including physicians, professional providers, and volunteer providers. Trauma registries have been developed in mostly developed countries and measure care quality, process, and outcomes. In general, existing registries tend to focus on inhospital care rather than prehospital care. METHODS: The Pan-Asia Trauma Outcomes Study (PATOS) was proposed in 2013 and initiated in November, 2015 in order to establish a collaborative standardized study to measure the capabilities, processes and outcomes of trauma care throughout Asia. The PATOS is an international, multicenter, and observational research network to collect trauma cases transported by emergency medical services (EMS) providers. Data are collected from the participating hospital emergency departments in various countries in Asia which receive trauma patients from EMS. Data variables collected include 1) injury epidemiologic factors, 2) EMS factors, 3) emergency department care factors, 4) hospital care factors, and 5) trauma system factors. The authors expect to achieve a sample size of 67,230 cases over the next 2 years of data collection to analyze the association between potential risks and outcomes of trauma. CONCLUSION: The PATOS network is expected to provide comparison of the trauma EMS systems and to benchmark best practice with participating communities.

Validation of the criteria for early critical care resource use in assessing the effectiveness of field triage.

BACKGROUND: This study aimed to validate the criteria for early critical care resource (CCR) use as an outcome predictor for seriously injured patients triaged in the field by comparing the effectiveness of the criteria for early CCR use with that of criteria defined by an Injury Severity Score (ISS) >15. METHODS: We analysed data from seriously injured trauma patients who were triaged using a field triage protocol by emergency medical service providers (EMS-ST patients). Early CCR use was defined as the use of any of the following treatment modalities or outcomes: advanced airway management, blood transfusion, or interventional radiology (<4h), emergency operation or cardiopulmonary resuscitation, or thoracotomy (<24h), or admission for spinal cord injury. The primary endpoint was inhospital mortality. We generated area under the receiver operating characteristic (AUROC) curves to compare the value of the early CCR use criteria with that of the ISS >15 criteria in the discrimination between survivors and non-survivors. RESULTS: Of the 14,352 adult EMS-ST patients, 9299 were enrolled in this study. Approximately 19.6% required early CCR use, and 18.0% had an ISS >15. The rate of in-hospital mortality was 9.4%. The AUROC values for the performances of the early CCR use and ISS>15 criteria in the prediction of in-hospital mortality were 0.89 (95% confidence interval [CI] 0.85-0.91) and 0.84 (95% CI 0.79-0.86), respectively (p<0.01). CONCLUSION: The early CCR use criteria demonstrated better performance than the ISS >15 criteria in the prediction of mortality in EMS-ST patients.

The effect of contextual factors on unintentional injury hospitalization: from the Korea National Hospital Discharge Survey.

BACKGROUND: It has been suggested that health risks are affected by geographical area, but there are few studies on contextual effects using multilevel analysis, especially regarding unintentional injury. This study investigated trends in unintentional injury hospitalization rates over the past decade in Korea, and also examined community-level risk factors while controlling for individual-level factors. METHODS: Using data from the 2004 to 2013 Korea National Hospital Discharge Survey (KNHDS), trends in age-adjusted injury hospitalization rate were conducted using the Joinpoint Regression Program. Based on the 2013 KNHDS, we collected community-level factors by linking various data sources and selected dominant factors related to injury hospitalization through a stepwise method. Multilevel analysis was performed to assess the community-level factors while controlling for individual-level factors. RESULTS: In 2004, the age-adjusted unintentional injury hospitalization rate was 1570.1 per 100,000 population and increased to 1887.1 per 100,000 population in 2013. The average annual percent change in rate of hospitalizations due to unintentional injury was 2.31% (95% confidence interval: 1.8-2.9). It was somewhat higher for females than for males (3.25% vs. 1.64%, respectively). Both community- and individual-level factors were found to significantly influence unintentional injury hospitalization risk. As community-level risk factors, finance utilization capacity of the local government and neighborhood socioeconomic status, were independently associated with unintentional injury hospitalization after controlling for individual-level factors, and accounted for 19.9% of community-level variation in unintentional injury hospitalization. CONCLUSION: Regional differences must be considered when creating policies and interventions. Further studies are required to evaluate specific factors related to injury mechanism.

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

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

Comparison of Emergency Medical Services and Trauma Care Systems Among Pan-Asian Countries: An International, Multicenter, Population-Based Survey.

OBJECTIVE: Knowledge on the current trauma systems in Asian countries is limited. The objective of this study was to describe the emergency medical services (EMS) and trauma care systems among countries participating in the Pan-Asian Trauma Outcomes Study (PATOS) Clinical Research Network. METHODS: The PATOS network consists of 33 participating sites from 14 countries. Standardized data was collected from each site using an EMS survey form and included general information (population, population density, urbanization, EMS service fee, etc.), dispatcher system, trauma care practice, trauma education program, existence of a trauma registry, and data on EMS transfers. Data is described with simple descriptive statistics. RESULTS: All countries included urban sites. Nine countries included rural sites and only one country included wilderness site. Of the 33 sties, 18 sites had physician-based EMS systems. EMS services were free in 9 countries. Twelve sites had dispatch centers operated by government health departments. EMS dispatcher certification was required in 29 sites. Thirty-two sites had EMS documented protocols for trauma and 31 sites had field triage tools. Thirty sites had designated trauma centers. Twenty-one sites had helicopter EMS systems. Thirty-one sites require certification for trauma education programs. Only 23 sites maintained EMS-based trauma registries. In 20 sites, EMS medical directors reviewed and assured trauma registry quality. Of patients transported by EMS rate of injured patients ranged from 15% to 59%. CONCLUSION: Substantial variability exists in EMS systems in Asia, especially for injured patients. Futures studies are required to assess the impact of this variability on patient outcomes.

Assessment of Competence in Emergency Medicine among Healthcare Professionals in Cameroon.

Development of a competence-based curriculum is important. This study aimed to develop competence assessment tools in emergency medicine and use it to assess competence of Cameroonian healthcare professionals. This was a cross-sectional, descriptive study. Through literature review, expert survey, and discrimination tests, we developed a self-survey questionnaire and a scenario-based competence assessment tool for assessing clinical knowledge and self-confidence to perform clinical practices or procedures. The self-survey consisted of 23 domains and 94 questionnaires on a 5-point Likert scale. Objective scenario-based competence assessment tool was used to validate the self-survey results for five life-threatening diseases presenting frequently in emergency rooms of Cameroon. Response rate of the self-survey was 82.6%. In this first half of competence assessment, knowledge of infectious disease had the highest score (4.6 ± 0.4) followed by obstetrics and gynecology (4.2 ± 0.6) and hematology and oncology (4.2 ± 0.5); in contrast, respondents rated the lowest score in the domains of disaster, abuse and assault, and psychiatric and behavior disorder (all of mean 2.8). In the scenario-based test, knowledge of multiple trauma had the highest score (4.3 ± 1.2) followed by anaphylaxis (3.4 ± 1.4), diabetic ketoacidosis (3.3 ± 1.0), ST-elevation myocardial infarction (2.5 ± 1.4), and septic shock (2.2 ± 1.1). Mean difference between the self-survey and scenario-based test was statistically insignificant (mean, -0.02; 95% confidence interval, -0.41 to 0.36), and agreement rate was 58.3%. Both evaluation tools showed a moderate correlation, and the study population had relatively low competence for specific aspects of emergency medicine and clinical procedures and skills.

Alcohol Intake and Reduced Mortality in Patients with Traumatic Brain Injury.

BACKGROUND: The purpose of our study was to determine whether alcohol intake influences short-term mortality in patients with traumatic brain injury (TBI), using a comprehensive trauma database. METHODS: We collected data from 7 emergency departments (EDs) between June 1, 2008 and May 31, 2010, using the same data form. Cases were included if they met the following criteria: (i) older than 15 and (ii) injuries including TBI. Demographics and outcomes were compared between patients with and without alcohol intake. We present the risk of mortality using hazard ratios and 95% confidence intervals. RESULTS: A total of 76,596 trauma patients visited the EDs during the study period; 12,980 patients were older than 15 and had TBI. There were 4,009 (30.9%) patients in the alcohol-intake group, of whom 3,306 (82.5%) patients were male, 1,450 (36.2%) patients were moved by ambulance, and 1,218 (30.4%) patients' injuries were intentional. The most frequent injury mechanism was falling down with alcohol intake and blunt injury without alcohol intake. Mortality rate was 1.0% with alcohol intake and 2.0% without alcohol intake. After adjusting for all factors related to mortality, the hazard ratio of mortality was 0.72 in the alcohol-intake group. CONCLUSIONS: Mortality rate due to TBI in the alcohol-intake group appears to be lower compared to that in the no-alcohol-intake group after adjusting for main confounding variables.

The association between acute alcohol consumption and discharge against medical advice of injured patients in the ED.

PURPOSES: A paucity of data exists on the prevalence and predictors of discharging injured patients against medical advice from emergency departments. The aim of this study is to investigate the association between acute alcohol use and being discharged against medical advice. METHODS: We performed a prospective, observational study of injured patients enrolled into the Korean Centers for Disease and Prevention injury surveillance program in 7 tertiary, academic, and teaching hospitals from June 1, 2008, to November 31, 2011. Injured patients were assigned to 1 of 3 groups: discharged against medical advice, regular discharge, and transferred or admitted. Multivariable logistic regression models were used to analyze the association between acute alcohol use and being discharged against medical advice. RESULTS: A total of 125,327 patients were enrolled, and 3473 (2.8%) were discharged against medical advice. The proportion of acute alcohol use was significantly higher among the patients who were discharged against medical advice (40.1%) than the regular discharged (16.6%) or transferred/admitted (15.5%) patients. In a regression model, acute alcohol use increased the risk of being discharged against medical advice (adjusted odds ratio, 1.86; 95% confidence interval, 1.70-2.03). In addition, we identified the interaction between acute alcohol use and intention of injury. Acute alcohol use had a significant association with the discharge against medical advice with the unintentional injury (adjusted odds ratio, 2.56; 95% confidence interval, 2.30-2.84). CONCLUSION: Patients with acute alcohol use before sustaining an injury are at increased risk of being discharged against medical advice from the emergency departments.

Epidemiology of Emergency Medical Services-Assessed Mass Casualty Incidents according to Causes.

To effectively mitigate and reduce the burden of mass casualty incidents (MCIs), preparedness measures should be based on MCIs' epidemiological characteristics. This study aimed to describe the epidemiological characteristics and outcomes of emergency medical services (EMS)-assessed MCIs from multiple areas according to cause. Therefore, we extracted the records of all MCIs that involved ≥ 6 patients from an EMS database. All patients involved in EMS-assessed MCIs from six areas were eligible for this study, and their prehospital and hospital records were reviewed for a 1-year period. The EMS-assessed MCIs were categorized as being caused by fire accidents (FAs), road traffic accidents (RTAs), chemical and biological agents (CBs), and other mechanical causes (MECHs). A total of 362 EMS-assessed MCIs were identified, with a crude incidence rate of 0.6-5.0/100,000 population. Among these MCIs, 322 were caused by RTAs. The MCIs involved 2,578 patients, and 54.3% of these patients were women. We observed that the most common mechanism of injury varied according to MCI cause, and that a higher number of patients per incident was associated with a longer prehospital time. The highest hospital admission rate was observed for CBs (16 patients, 55.2%), and most patients in RTAs and MECHs experienced non-severe injuries. The total number of deaths was 32 (1.2%). An EMS-assessed MCI database was established using the EMS database and medical records review. Our findings indicate that RTA MCIs create a burden on EMS and emergency department resources, although CB MCIs create a burden on hospitals' resources.

Pregnancy, prenatal care, and delivery of mothers with disabilities in Korea.

The aim of this study was to investigate the whole picture regarding pregnancy, prenatal care, obstetrical complications, and delivery among disabled pregnant women in Korea. Using the data of National Health Insurance Corporation, we extracted the data of women who terminated pregnancy including delivery and abortion from January 1, 2010 to December 31, 2010. Pearson's chi-square test and Student-t test were conducted to examine the difference between disabled women and non-disabled women. Also, to define the factors affecting inadequate prenatal care, logistic regression was performed. The total number of pregnancy were 463,847; disabled women was 2,968 (0.6%) and 460,879 (99.4%) were by non-disabled women. Abortion rates (27.6%), Cesarean section rate (54.5%), and the rate of receiving inadequate prenatal care (17.0%), and the rate of being experienced at least one obstetrical complication (11.3%) among disabled women were higher than those among non-disabled women (P < 0.001). Beneficiaries of Medical Aid (OR, 2.21) (P < 0.001) and severe disabled women (OR, 1.46) (P = 0.002) were more likely to receive inadequate prenatal care. In conclusion, disabled women are more vulnerable in pregnancy, prenatal care and delivery. Therefore, the government and society should pay more attention to disabled pregnant women to ensure they have a safe pregnancy period up until the delivery.