Prognosis predictability of combination between lactate and SMART-COPin elderly hospitalized patients with community-acquired pneumoniain the emergency department

Objective@#Community-acquired pneumonia (CAP) in older patients is a potentially life-threatening infection with a poorprognosis. Therefore, is important to predict the mortality rate of CAP for older patients. This study examined the effectsof predictive increases on CAP mortality by adding a biomarker to known CAP severity prediction tools. @*Methods@#A retrospective analysis of information was conducted on patients older than 65 years, who were treated withCAP in five emergency departments from October 2016 to February 2017. The primary outcome was the 28-day mortality.The following were calculated for each patient: qSOFA (quick Sequential Organ Failure Assessment), A-DROP (Age,Dehydration, Respiratory failure, Orientation, blood Pressure), CURB-65 (Confusion, Urea level, Respiratory rate, Bloodpressure, age≥65 years), SMART-COP (Systolic blood pressure, Multilobar infiltrates, Albumin, Respiratory rate,Tachycardia, Confusion, Oxygen and pH), NLR (neutrophil:lymphocyte ratio), PLR (platelet:lymphocyte ratio), and CAR(high-sensitivity C-reactive protein:albumin ratio). The prognostic value for the 28-day mortality was determined by multivariatelogistic regression analysis. @*Results@#The 28-day mortality was 12.0% of 693 CAP patients. Multivariate logistic regression analysis showed that lactate(odds ratio [OR], 1.589; P<0.001) and CAR (OR, 1.208; P=0.006) were correlated with the 28-day mortality. NLR(OR, 1.00; P=0.983) and PLR (OR, 1.00; P=0.784) were not correlated. The area under curve (AUC) was significant asCAR 0.649, lactate 0.737, and SMART-COP 0.735 (P<0.001), and the AUC of lactate+SMART-COP increased significantlyto 0.784 compared to SMART-COP (P=0.014). @*Conclusion@#A combination of lactate and SMART-COP can be used as a tool to assess the severity of older hospitalizedCAP patients who visited emergency departments.

Factors Affecting Collaborations between a Tertiary-level Emergency Department and Community-based Mental Healthcare Centers for Managing Suicide Attempts

Background@#Community-based active contact and follow-up are known to be effective in reducing the risk of repeat suicide attempts among patients admitted to emergency departments after attempting suicide. However, the characteristics that define successful collaborations between emergency departments and community-based mental healthcare centers in this context are not well known. @*Methods@#This study investigated patients visiting the emergency department after suicide attempts from May 2017 to April 2019. Patients were classified in either the successful collaboration group or the failed collaboration group depending on whether or not they were linked to a community-based follow-up intervention. Clinical features and socioeconomic status were considered as independent variables. Logistic regression analysis was performed to identify factors influencing the collaboration. @*Results@#Of 674 patients, 153 (22.7%) were managed successfully via the targeted collaboration. Completion of hospital-based psychological counseling (adjusted odds ratio [aOR], 233.55; 95% confidence interval [CI], 14.99–3,637.67), supported out-of-pocket expenses (aOR, 11.17; 95% CI, 3.03–41.03), Korean Triage and Acuity Scale 1–3 (aOR, 4.31;95% CI, 1.18–15.73), suicide attempt associated with mental disorder (aOR, 0.15; 95% CI, 0.04–0.52), and self-discharge against medical advice (aOR, 0.12; 95% CI, 0.02–0.70) were independent factors influencing the collaboration. @*Conclusion@#Completion of hospital-based psychological counseling was the most highly influential factor determining the outcome of the collaboration between the emergency department and community-based mental healthcare center in the management of individuals who had attempted suicide. Completion of hospital-based psychological counseling is expected to help reduce the risk of repeat suicide attempts.

The role of the neutrophil-to-lymphocyte ratio for the prediction severity in women with acute pyelonephritis in the emergency department

Objective@#It is difficult to predict medical outcomes for acute pyelonephritis (APN) in women. A delay in diagnosis and treatment results in rapid progression to circulatory collapse, multiple organ failure, and death. We investigated the value of procalcitonin (PCT) and neutrophil-to-lymphocyte ratio (NLR) in APN patients hospitalized through the emergency room. @*Methods@#We retrospectively evaluated women with APN presenting in the emergency room from January 2014 to May 2018. Inflammatory biomarkers, including PCT and NLR, were measured, and the severity of pyelonephritis was assessed using the Surviving Sepsis Campaign definitions (Sepsis-3). Multivariable logistic regression analysis was used to evaluate the risk factors associated with septic shock and the prediction for septic shock was compared using a receiver operating characteristic (ROC) curve. @*Results@#A total of 357 female patients with APN were included. The median level of PCT and NLR was higher in the septic shock group compared with other groups. Multivariate logistic regression analysis showed that age and PCT were risk factors for septic shock. When the ROC curve of septic shock was compared, PCT showed a higher area under the curve than NLR (NLR 0.65 vs. PCT 0.80). @*Conclusion@#The initial NLR in the emergency room showed significant differences depending on the severity as classified by Sepsis-3 definitions. However, NLR was not found to be associated with septic shock in female patients with APN.

Outcome and status of postcardiac arrest care in Korea: results from the Korean Hypothermia Network prospective registry

Objective@#High-quality intensive care, including targeted temperature management (TTM) for patients with postcardiac arrest syndrome, is a key element for improving outcomes after out-of-hospital cardiac arrest (OHCA). We aimed to assess the status of postcardiac arrest syndrome care, including TTM and 6-month survival with neurologically favorable outcomes, after adult OHCA patients were treated with TTM, using data from the Korean Hypothermia Network prospective registry. @*Methods@#We used the Korean Hypothermia Network prospective registry, a web-based multicenter registry that includes data from 22 participating hospitals throughout the Republic of Korea. Adult comatose OHCA survivors treated with TTM between October 2015 and December 2018 were included. The primary outcome was neurological outcome at 6 months. @*Results@#Of the 1,354 registered OHCA survivors treated with TTM, 550 (40.6%) survived 6 months, and 413 (30.5%) had good neurological outcomes. We identified 839 (62.0%) patients with preClinsumed cardiac etiology. A total of 937 (69.2%) collapses were witnessed, shockable rhythms were demonstrated in 482 (35.6%) patients, and 421 (31.1%) patients arrived at the emergency department with prehospital return of spontaneous circulation. The most common target temperature was 33°C, and the most common target duration was 24 hours. @*Conclusion@#The survival and good neurologic outcome rates of this prospective registry show great improvements compared with those of an earlier registry. While the optimal target temperature and duration are still unknown, the most common target temperature was 33°C, and the most common target duration was 24 hours.

The role of the neutrophil-to-lymphocyte ratio for the prediction severity in women with acute pyelonephritis in the emergency department

Objective@#It is difficult to predict medical outcomes for acute pyelonephritis (APN) in women. A delay in diagnosis and treatment results in rapid progression to circulatory collapse, multiple organ failure, and death. We investigated the value of procalcitonin (PCT) and neutrophil-to-lymphocyte ratio (NLR) in APN patients hospitalized through the emergency room. @*Methods@#We retrospectively evaluated women with APN presenting in the emergency room from January 2014 to May 2018. Inflammatory biomarkers, including PCT and NLR, were measured, and the severity of pyelonephritis was assessed using the Surviving Sepsis Campaign definitions (Sepsis-3). Multivariable logistic regression analysis was used to evaluate the risk factors associated with septic shock and the prediction for septic shock was compared using a receiver operating characteristic (ROC) curve. @*Results@#A total of 357 female patients with APN were included. The median level of PCT and NLR was higher in the septic shock group compared with other groups. Multivariate logistic regression analysis showed that age and PCT were risk factors for septic shock. When the ROC curve of septic shock was compared, PCT showed a higher area under the curve than NLR (NLR 0.65 vs. PCT 0.80). @*Conclusion@#The initial NLR in the emergency room showed significant differences depending on the severity as classified by Sepsis-3 definitions. However, NLR was not found to be associated with septic shock in female patients with APN.

Outcome and status of postcardiac arrest care in Korea: results from the Korean Hypothermia Network prospective registry

Objective@#High-quality intensive care, including targeted temperature management (TTM) for patients with postcardiac arrest syndrome, is a key element for improving outcomes after out-of-hospital cardiac arrest (OHCA). We aimed to assess the status of postcardiac arrest syndrome care, including TTM and 6-month survival with neurologically favorable outcomes, after adult OHCA patients were treated with TTM, using data from the Korean Hypothermia Network prospective registry. @*Methods@#We used the Korean Hypothermia Network prospective registry, a web-based multicenter registry that includes data from 22 participating hospitals throughout the Republic of Korea. Adult comatose OHCA survivors treated with TTM between October 2015 and December 2018 were included. The primary outcome was neurological outcome at 6 months. @*Results@#Of the 1,354 registered OHCA survivors treated with TTM, 550 (40.6%) survived 6 months, and 413 (30.5%) had good neurological outcomes. We identified 839 (62.0%) patients with preClinsumed cardiac etiology. A total of 937 (69.2%) collapses were witnessed, shockable rhythms were demonstrated in 482 (35.6%) patients, and 421 (31.1%) patients arrived at the emergency department with prehospital return of spontaneous circulation. The most common target temperature was 33°C, and the most common target duration was 24 hours. @*Conclusion@#The survival and good neurologic outcome rates of this prospective registry show great improvements compared with those of an earlier registry. While the optimal target temperature and duration are still unknown, the most common target temperature was 33°C, and the most common target duration was 24 hours.

Usefulness of the neutrophil-to-lmphocyte ratio as a prognostic predictor in elderly patients admitted to the intensive care unit through emergency department

OBJECTIVE@#The purpose of this study was to test the hypothesis that an increase in the neutrophil-to-lymphocyte ratio (NLR) increases the risk of in-hospital density in patients aged 65 and older, who are hospitalized in intensive care through the emergency rooms.@*METHODS@#A retrospective medical record study was conducted on elderly patients who were admitted to intensive care units via the emergency room. The exclusion criteria were data loss, intensive care unit reentry, cerebrovascular accidents, hematologic disease, and trauma cases.@*RESULTS@#The study included 526 patients; the mean age was 79, and 261 (49.6%) were male. The in-hospital mortality was 18.4% (97 patients). The initial NLR was higher in the non-survivor group than the survivor group, but the difference was not statistically significant (9.82±11.02 vs. 11.48±6.11, P=0.080). In multivariate logistic analysis, the initial NLR had no statistical significance, and the odd ratio was increased from one day later. Comparing the receiver operating characteristic curve of the NLR and Acute Physiology and Chronic Health Evaluation II (APACHE II) and Simplified Acute Physiology Score II (SAPS II) scores, the NLR showed an increase in the area of under curve (AUC) value over time as well as the highest AUC with the SAPS II scores.@*CONCLUSION@#In elderly adults, early NLR was found to have weak power to predict in-hospital mortality. Over time, the NLR values more than two days after intensive care unit admission may be useful in predicting the in-hospital mortality for older patients. This may be due to the delay in the immune response and the complex medical history.

Assessment of serum biomarkers and coagulation/fibrinolysis markers for prediction of neurological outcomes of out of cardiac arrest patients treated with therapeutic hypothermia

OBJECTIVE: Despite increased survival in patients with cardiac arrest, it remains difficult to determine patient prognosis at the early stage. This study evaluated the prognosis of cardiac arrest patients using brain injury, inflammation, cardiovascular ischemic events, and coagulation/fibrinolysis markers collected 24, 48, and 72 hours after return of spontaneous circulation (ROSC).METHODS: From January 2011 to December 2016, we retrospectively observed patients who underwent therapeutic hypothermia. Blood samples were collected immediately and 24, 48, and 72 hours after ROSC. Neuron-specific enolase (NSE), S100-B protein, procalcitonin, troponin I, creatine kinase-MB, pro-brain natriuretic protein, D-dimer, fibrin degradation product, antithrombin-III, fibrinogen, and lactate levels were measured. Prognosis was evaluated using Glasgow-Pittsburgh cerebral performance categories and the predictive accuracy of each marker was evaluated. The secondary outcome was whether the presence of multiple markers improved prediction accuracy.RESULTS: A total of 102 patients were included in the study: 39 with good neurologic outcomes and 63 with poor neurologic outcomes. The mean NSE level of good outcomes measured 72 hours after ROSC was 18.50 ng/mL. The area under the curve calculated on receiver operating characteristic analysis was 0.92, which showed the best predictive power among all markers included in the study analysis. The relative integrated discrimination improvement and category-free net reclassification improvement models showed no improvement in prognostic value when combined with all other markers and NSE (72 hours).CONCLUSION: Although biomarker combinations did not improve prognostic accuracy, NSE (72 hours) showed the best predictive power for neurological prognosis in patients who received therapeutic hypothermia.

Differences in youngest-old, middle-old, and oldest-old patients who visit the emergency department

OBJECTIVE: As aging progresses, clinical characteristics of elderly patients in the emergency department (ED) vary by age. We aimed to study differences among elderly patients in the ED by age group. METHODS: For 2 years, patients aged 65 and older were enrolled in the study and classified into three groups: youngest-old, ages 65 to 74 years; middle-old, 75 to 84 years; and oldest-old, ≥85 years. Participants’ sex, reason for ED visit, transfer from another hospital, results of treatment, type of admission, admission department and length of stay were recorded. RESULTS: During the study period, a total 64,287 patients visited the ED; 11,236 (17.5%) were aged 65 and older, of whom 14.4% were 85 and older. With increased age, the female ratio (51.5% vs. 54.9% vs. 69.1%, P < 0.001), medical causes (79.5% vs. 81.3% vs. 81.7%, P=0.045), and admission rate (35.3% vs. 42.8% vs. 48.5%, P < 0.001) increased. Admissions to internal medicine (57.5% vs. 59.3% vs. 64.7%, P < 0.001) and orthopedic surgery (8.5% vs. 11.6% vs. 13.8%, P < 0.001) also increased. The ratio of admission to intensive care unit showed no statistical significance (P=0.545). Patients over age 85 years had longer stays in the ED (330.9 vs. 378.9 vs. 407.2 minutes, P < 0.001), were discharged home less (84.4% vs. 78.9% vs. 71.5%, P < 0.001), and died more frequently (6.3% vs. 10.4% vs. 13.0%, P < 0.001). CONCLUSION: With increased age, the proportion of female patients and medical causes increased. Rates of admission and death increased with age and older patients had longer ED and hospital stays.

Factors Associated with Vancomycin-Resistant Enterococcus Colonization in Patients Transferred to Emergency Departments in Korea

BACKGROUND: Vancomycin-resistant enterococci (VRE) infections have become a major healthcare-associated pathogen problem worldwide. Nosocomial VRE infections could be effectively controlled by screening patients at high risk of harboring VRE and thereby lowering the influx of VRE into healthcare centers. In this study, we evaluated factors associated with VRE colonization in patients transferred to emergency departments, to detect patients at risk for VRE carriage. METHODS: This study was conducted in the emergency department of a medical college-affiliated hospital in Korea. Every patient transferred to the emergency department and admitted to the hospital from January to December 2016 was screened for VRE using rectal cultures. In this cross-sectional study, the dependent variable was VRE colonization and the independent variables were demographic and clinical factors of the patients and factors related to the transferring hospital. Patients were divided into two groups, VRE and non-VRE, and previously collected patient data were analyzed. Then we performed logistic regression analyses of characteristics that differed significantly between groups. RESULTS: Out of 650 patients, 106 (16.3%) had positive VRE culture results. Significant variables in the logistic analysis were transfer from geriatric long-term care hospital (adjusted odds ration [aOR]: 8.017; 95% confidence interval [CI]: 1.378–46.651), hospital days (4–7 days; aOR: 7.246; 95% CI: 3.229–16.261), duration of antimicrobial exposure (1–3 days; aOR: 1.976; 95% CI: 1.137–3.436), and age (aOR: 1.025; 95% CI: 1.007–1.043). CONCLUSION: VRE colonization in patients transferred to the emergency department is associated primarily with factors related to the transferred hospitals rather than demographic and clinical characteristics.

Variability of extracorporeal cardiopulmonary resuscitation utilization for refractory adult out-of-hospital cardiac arrest: an international survey study

OBJECTIVE: A growing interest in extracorporeal cardiopulmonary resuscitation (ECPR) as a rescue strategy for refractory adult out-of-hospital cardiac arrest (OHCA) currently exists. This study aims to determine current standards of care and practice variation for ECPR patients in the USA and Korea. METHODS: In December 2015, we surveyed centers from the Korean Hypothermia Network (KORHN) Investigators and the US National Post-Arrest Research Consortium (NPARC) on current targeted temperature management and ECPR practices. This project analyzes the subsection of questions addressing ECPR practices. We summarized survey results using descriptive statistics. RESULTS: Overall, 9 KORHN and 4 NPARC centers reported having ECPR programs and had complete survey data available. Two KORHN centers utilized extracorporeal membrane oxygenation only for postarrest circulatory support in patients with refractory shock and were excluded from further analysis. Centers with available ECPR generally saw a high volume of OHCA patients (10/11 centers care for >75 OHCA a year). Location of, and providers trained for cannulation varied across centers. All centers in both countries (KORHN 7/7, NPARC 4/4) treated comatose ECPR patients with targeted temperature management. All NPARC centers and four of seven KORHN centers reported having a standardized hospital protocol for ECPR. Upper age cutoff for eligibility ranged from 60 to 75 years. No absolute contraindications were unanimous among centers. CONCLUSION: A wide variability in practice patterns exist between centers performing ECPR for refractory OHCA in the US and Korea. Standardized protocols and shared research databases might inform best practices, improve outcomes, and provide a foundation for prospective studies.

Contrast-induced Nephropathy in Major Trauma Patients

PURPOSE: Occult injuries are diagnosed using computed tomography (CT), often with intravenous (IV) contrast CT, in major trauma patients. The contrast dye is known to be potentially nephrotoxic. Thus, we measured the incidence and risk factors for contrast-induced nephropathy (CIN) in major trauma patients. METHODS: A retrospective review was performed on 247 patients who were treated by the activated trauma team between June 2012 and July 2014. The exclusion criteria were underlying renal failure, no IV contrast CT administered, and no creatinine (Cr) follow-up within 72 hours. We examined age, gender, initial vital signs, the Glasgow Coma Scale (GCS), initial Cr levels, Cr level within 72 hours after admission, the IV contrast CT number, Injury Severity Score (ISS). CIN was defined as 25% relative or 0.5 mg/dL absolute increase in serum Cr within 72 hours of presentation. RESULTS: One hundred forty-three patients were included in this study. CIN manifested in 12 patients (8.4%). The injury severity was associated with CIN (ISS≥16, p=0.003; GCS≤8, p<0.001; death, p<0.001). Initial Cr levels, elderly patients, and initial hypotension were not statistically significant (p=0.065, 0.176, and 0.402, respectively). The number of IV contrast CTs administered was also not associated with the occurrence of CIN (p=0.331). CONCLUSION: We found an 8.4% incidence of CIN in multiple trauma patients exposed to IV contrast. The number of IV contrasts, age, initial systolic blood pressure, and initial Cr levels were not associated with CIN. Only injury severity was associated with CIN occurrence; therefore, physicians should pay more attention to severely-injured patients.

Drowning-Related Injuries: Fallen from the Bridge for the Purpose of Suicide

PURPOSE: Jumping off a bridge is one method of suicide. In a recent report, out of the 37 patients with cardiac arrest after drowning, 5 (36%) patients suffered severe traumatic injuries. The objective of this study was to report these injuries, without cardiac arrest, in patients after jumping off a bridge with the purpose of suicide. METHODS: We retrospectively reviewed the charts of all patients admitted to the emergency department in a tertiary care hospital after drowning in the Han River between 1997 and 2012. We analyzed the results of imaging studies. Each injury was described as one of the six body regions, similar to the method of the Injury Severity Score. RESULTS: A total of 469 patients were admitted to the emergency department from drowning. Sixty-six patients had jumped off a bridge with the purpose of suicide. Forty patients experienced cardiac arrest. In cardiac arrest patients, 25 patients (62.5%) underwent radiologic examinations. Only 2 patients (5.0%) received damage on the cervical spine and face. All non-cardiac arrest patients underwent imaging studies. Nine patients (34.6%) showed evidence of injuries. Most injuries occurred in the chest; four patients suffered the following injuries: rib fracture, pneumothorax, pneumomedistinum, and thoracic spine fracture. One patient had abdominal damage, an intra-abdominal hematoma. Last one patient suffered an injury to the chest and abdomen. CONCLUSION: In drowning patients with the purpose of suicide, variable damage could not be ruled out. It is especially not confined to a specific area, and damage to various parts of the body should be considered.

High white blood cell count and erythrocyte sedimentation rate are associated with perforated appendicitis in children

PURPOSE: To investigate the predictors of perforated appendicitis (PA) in pediatric patients with appendicitis seen in the emergency department. METHODS: We retrospectively reviewed 564 pediatric patients ( 13.5 × 109/L (odds ratio [OR], 3.27; confidence interval [CI], 1.49–7.18; P = 0.003) and ESR > 15 mm/h (OR, 3.18; 95% CI, 2.13–4.74; P < 0.001) are independent predictors of PA. CONCLUSION: WBC count and ESR might be better predictors of PA in pediatric patients with appendicitis in the emergency department than the Alvarado score and CRP concentration.

Factors associated with administration of analgesics for children with forearm fracture

PURPOSE: Analgesia is essential for the treatment of children's fracture. We aimed to investigate the factors associated with administration of analgesics in children with forearm fracture. METHODS: We retrospectively reviewed medical records of children (< 20 years) with forearm fracture who visited 2 tertiary hospital emergency departments from 2014 to 2015. We analyzed factors, such as gender, age, whether the mother accompanied the visit, visiting time and route, mechanism of injury, duration of symptoms, complicated fracture, manual reduction, surgery, and type and route of analgesics. We also performed logistic regression analysis to identify the factors associated with administration of analgesics. RESULTS: Of 179 children with forearm fracture, 48 (26.8%) were administered analgesics. These children showed older age, shorter duration of symptoms, and more frequent visit with their mothers, visit during the day, use of emergency medical services, and surgery. After logistic regression analysis, we found use of emergency medical service (adjusted odds ratio [OR], 8.73; 95% confidence interval [CI], 3.16–24.08; P < 0.001), visit with the mother (OR, 6.23; 95% CI, 1.68–23.09; P = 0.006), age (OR, 1.18; 95% CI, 1.05–1.32; P = 0.004), and duration of symptoms (OR, 0.99; 95% CI, 0.986–0.999; P = 0.035) as the factors associated with administration of analgesics. CONCLUSION: The factors associated with administration of analgesics might be communicating skill-related factors, such as older age and shorter duration of symptoms. Children with poor communicating skill may need more aggressive analgesia in the emergency department.

Impact of Middle East respiratory syndrome outbreak on the use of emergency medical resources in febrile patients

OBJECTIVE: Outbreaks of transmissible respiratory infection are suspected to have significant effects on the health of pediatric and geriatric patients. The objective was to assess the impact of the Middle East respiratory syndrome (MERS) outbreak on the use of emergency resources. METHODS: An ecologic analysis of emergency department (ED) records between September and December 2015, was performed. Data was obtained from the National Emergency Department Information System database for Korea. All demographic and diagnostic data from patients presenting with febrile symptoms as a main complaint were collected. The data were compared to the equivalent period in the three years preceding the MERS outbreak in Korea. RESULTS: Following the MERS outbreak, there was an increase in overall ED visits by febrile patients and the proportion of visits by febrile patients, relative to total ED attendances. This effect was more prominent in the children under five years. The duration of the chief complaint before ED arrival and the length of ED stay were significantly increased among younger pediatric patients. Decreased body temperature on arrival was observed in younger pediatric patients. CONCLUSION: MERS outbreak appears to have had a significant effects on ED use by febrile patients. The use of emergency care services by pediatric patients makes them more vulnerable to an outbreak of a transmissable disease. An effective strategy to control emergency center visits by non-urgent febrile patients and provide proper medical services is urgently needed.

Part 4. Post-cardiac arrest care: 2015 Korean Guidelines for Cardiopulmonary Resuscitation

No abstract available.

Factors Associated with False-positive ST-segment Elevation Myocardial Infarction Activated by Emergency Physician

PURPOSE: Rapid activation of the cardiac catheterization laboratory (CCL) is fundamental in the treatment of ST-segment elevation myocardial infarction (STEMI), and it is recommended that emergency department physicians activate CCL as soon as possible, however false positive activation is a major concern. The aim of this study is to assess the relationship between false positive activation and clinical factors available at the time of diagnosis. METHODS: All subjects with CCL activation by an emergency physician between August 2009 and May 2012 were included in this study. False-positive CCL activation was defined as absence of a clear culprit lesion on coronary angiography or by assessment of electrocardiographic and biomarker data in the absence of angiography. RESULTS: Of 222 STEMI activations by emergency physicians, 55 (25%) were false-positive STEMI. Coronary spasm, cardiomyopathy, known CAD, and heart failure were the most common diagnoses among false-positive STEMI. A history of cardiomyopathy (adjusted odds ratio, 13.393; 95% CI, 2.550-70.334; p=0.002), systolic blood pressure<100 mmHg at presentation (adjusted odds ratio, 2.817; 95% CI, 1.129-7.026; p=0.026), no chest pain on admission (adjusted odds ratio, 2.460; 95% CI, 1.162-5.209; p=0.019), and prior coronary disease (adjusted odds ratio, 3.966; 95% CI, 1.828-8.606; p<0.001) independently increased the odds of false-positive STEMI activations. CONCLUSION: False-positive CCL activations were relatively common according to the definition in this study. Various patient-level characteristics were significantly associated with false-positive CCL activation.

The Appropriateness of Modified Trauma Team Activation Protocol for Trauma Patients in Emergency Department

PURPOSE: Rapid multidisciplinary trauma care by trauma team is essential for severely injured patients. Different protocols for trauma team activation are used in each hospital. Correct trauma triage is needed to ensure appropriate use of medical resources. The aim of this study was to evaluate the performance of our modified protocol for trauma team activation. METHODS: This is an observational, retrospective cohort study. Injured patients with trauma team activation (TTA) or who had been admitted to a surgical intensive care unit were investigated from 1st March 2010 to 31st May 2012. The TTA protocol was analyzed with respect to sensitivity, positive predictive value (PPV), and overtriage (1-PPV). Undertriage (1-sensitivity) was defined as no TTA despite severe injury (Injury Severity Score (ISS) >15). RESULTS: A total of 229 patients were included. There were 201 patients with TTA and 28 patients without TTA. Of the 201 patients with TTA, 104 were identified as severely injured (ISS>15), yielding sensitivity of 79%, PPV of 51%, and overtriage of 49%. Undertriage was 21% (n=28) when considering all severely injured patients (n=132). Among 12 criteria of our TTA protocol, 'injury in two or more body regions' accounted for 85.6% of the overtriage. Of the patients with undertriage, 75% represented isolated head injury and 28.5% from interhospital transfer. CONCLUSION: The rate of overtriage of TTA protocol in our hospital is appropriate, but the rate of undertriage is relatively high. We believe, to decrease the overtriage of all and undertriage in patients with injury in an isolated specific body region, more research for evaluation of effects of protocol excluding the criteria of 'injury in two or more body regions' is needed.

Predictive Variables of Pneumonia Among Adult Submersion Victims without Out-of-hospital Cardiac Arrest

PURPOSE: Pneumonia is a serious and relatively common complication among submersion victims without out-of-hospital cardiac arrest (OHCA). The purpose of this study was to investigate the risk factors of pneumonia among adult submersion victims without OHCA. METHODS: All adult submersion victims without OHCA who visited our hospital between 2004 and 2013 were included. This study was conducted retrospectively, with collection of data by review of medical records. Among total submersion victims (310 patients), 191 patients did not suffer OHCA. We investigated the characteristics of the patients and classified them according to two groups based on the presence of pneumonia. We then compared clinical variables between the two groups. RESULTS: A total of 191 adult submersion patients without OHCA; 157 patients did not have pneumonia during their hospital stay; 34 patients had pneumonia. In respective analysis, alert mentality, pH and core temperature showed correlation with pneumonia. However, in logistic regression analysis with these 3 variables, only pH was a risk factor of pneumonia. All patients with pneumonia except one were discharged with full recovery. CONCLUSION: The risk of pneumonia among adult submersion victims without OHCA is higher when the lower pH is checked. Further studies are needed in order to evaluate the other risk factors of pneumonia for early prediction and proper management.