Analysis of Disaster Medical Response: The Sejong Hospital Fire.

This paper provides a field report on a fire that broke out on January 26, 2018 at Sejong Hospital in Miryang, South Korea, engendering the establishment of a committee to investigate the hospital fire response. This field report analyzes the disaster medical response. The official records of the disaster response from each institution were examined. On-site surveys were conducted through interviews with government officials and other health care workers regarding communication during the disaster response without using a separate questionnaire. All medical records were abstracted from hospital charts. There were 192 casualties: 47 victims died, seven were seriously injured, and 121 suffered minor injuries. Emergency Medical Services (EMS) arrived three minutes after the fire started, while news of the fire reached the National Emergency Medicine Operation Center based in Seoul in 12 minutes. The first disaster medical assistance team (DMAT) was dispatched 63 minutes after the National Emergency Medicine Operation Center was notified. The disaster response was generally conducted in accordance with disaster medical support manuals; however, these response manuals need to be improved. Close cooperation among various institutions, including nearby community public health centers, hospitals, fire departments, and DMATs, is necessary. The response manuals should be revised for back-up institutions, as the relevant information is currently incomplete.

Incidence and Risk Period of Periprosthetic Femoral Fracture After Cementless Bipolar Hemiarthroplasty in Elderly Patients.

BACKGROUND: The purpose of this study was to investigate the periprosthetic femoral fracture (PFF) after cementless bipolar hemiarthroplasty incidence, noting fracture types and the results of treatment in elderly patients. METHODS: We retrospectively reviewed 1563 elderly patients (1177 women and 386 men) who underwent cementless bipolar hemiarthroplasty for femoral neck fracture (1061 patients) or intertrochanteric fracture (502 patients). The type of fracture was classified according to the Vancouver classification. The average age was 79.6 years (range, 65-103 years). Clinical and radiologic evaluations were performed and Kaplan-Meier survivorship was analyzed. RESULTS: Thirty-seven PFFs (2.4%) occurred during a mean follow-up of 44.4 months. Two-thirds of PFFs (67%) occurred within 1 year. Most PFFs (22/27), which occurred within 2 years, were Vancouver type B fractures. After that, type A fractures were predominant (7/9). Based on Kaplan-Meier survivorship with PFF as the end point, the incidence rate was 1.7% (95% confidence interval [CI] = 1.6%-1.8%) at 12 months, 2.2% (95% CI = 2.1%-2.3%) at 36 months, and 3.8 % (95% CI = 3.6%-4.0%) at 144 months postoperatively. CONCLUSION: After cementless bipolar hemiarthroplasty in elderly patients, a caution should be paid to prevent PFF particularly during 1-year postoperatively.

Plasma neutrophil gelatinase-associated lipocalin as a predictive biomarker for the detection of acute kidney injury in adult poisoning.

CONTEXT: Acute kidney injury (AKI) is a serious complication in intoxicated patients. Recently, a new biomarker - neutrophil gelatinase-associated lipocalin (NGAL) - was used to predict AKI in patients who were critically ill or had sepsis. OBJECTIVE: To evaluate the utility of plasma NGAL as an early predictor of AKI in adults with acute poisoning. MATERIALS AND METHODS: This retrospective, observational, cohort study was conducted between December 2013 and November 2014. A total of 157 consecutive adult patients who presented to the emergency department (Level 1 regional center) of Kyungpook National University Hospital, a tertiary teaching hospital in Daegu, Korea, within 24 h of poisoning were included. Initial plasma NGAL levels and laboratory parameters were concurrently measured upon hospital arrival. AKI was defined according to Acute Kidney Injury Network criteria. Development of AKI was predicted using plasma NGAL levels and by analyzing the area under the receiver operating characteristic curve (AUC). RESULTS: The overall rate of AKI was 14.6% (n = 23). Plasma NGAL levels in the AKI group were higher than those in the non-AKI group (median, 310 vs. 86 ng/mL; p < 0.001). Additionally, baseline NGAL levels allowed for better prediction of AKI than initial creatinine levels. The AUC of plasma NGAL was 0.895 (95% confidence interval [CI]: 0.832-0.941), with a cut-off value of 227 ng/mL (sensitivity, 76.2%; specificity, 95.8%). Plasma NGAL had a higher predictive capacity for AKI than serum creatinine (AUC 0.741, 95% CI: 0.662-0.810), base deficit (AUC 0.795, 95% CI: 0.701-0.870), lactate (AUC 0.781, 95% CI: 0.690-0.856), and anion gap (AUC 0.636, 95% CI: 0.535-0.730). CONCLUSION: Plasma NGAL may serve as a good predictor of AKI in cases of adult poisoning.