• Journal of Trauma and Injury
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• v.22 no.2
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• pp.172-178
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• 2009

Purpose: We performed this study to determine how the emergency trauma team affects the treatment of patients with multiple severe trauma and to discuss the effect and the direction of the emergency trauma team's management. Methods: We performed a retrospective analysis of 518 patients who visited our emergency department with severe trauma from August 2006 to July 2008. We divided the severe trauma patients into 2 groups : patients before and after trauma team management (Group 1 and Group 2). Then, we compared demographic characteristics, mechanisms of injury, and treatment outcomes (lengths of stay in the ED, admission ratio, and in-hospital mortality) between the 2 groups. In the same way, patients with multiple severe trauma were divided into 2 groups, that are patients before and after trauma team management (Group 3 and Group 4) and analyzed. Results: There was no significant difference, except mean age, between groups 1 and 2. In group 4 patients, compared to group 3 patients, the lengths of stay in the ED were lower (p value < 0.001), and the admission ratio were higher (p value = 0.017), but there was no significant difference in the in-hospital mortality between the groups 3 and 4. Conclusion: When patients with multiple severe trauma visit the ED, the emergency trauma team' management can decrease the lengths of stay in the ED and increase the admission ratio, but does not produce a decrease in the in-hospital mortality rate. Further investigations of emergency trauma team management are needed to improve treatment outcomes for patients with multiple severe trauma.

• Quality Improvement in Health Care
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• v.2 no.1
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• pp.58-67
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• 1995

Background: This paper describes an effort to provide baseline informations for appropriate utilization of emergency room in a tertiary hospital. Methods: Authors have evaluated that the admissions in the emergency room were medically necessary by objective criteria, Appropriateness Evaluation Protocol(AEP), for one month in a tertiary hospital. Data were analysed by chi-square test and multiple logistic regression to exmaine statistical significances at the level of 0.05. Results: The prevalence of inappropriate decisions for admission was found to be 47.8%(154/322). Whether the physician decided the patient to admit or not was affected by type of services, number of departments involved, patients' medical condition, route of visit, and a day of the week visited. Level of appropriateness of admission is significantly related to patients' age, type of services, and a day of the week visited. Conclusion: We found that substantial proportion of admissions through emergency room are medically unnecessary and that non-medical factors are related to physician's for admission decisions and level of appropriateness of admission. This suggests that policy measures be required to relieve the overcrowding problem and to reduce non-emergent utilization of emergency room in a tertiary hospital.

• Journal of Trauma and Injury
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• v.26 no.2
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• pp.47-52
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• 2013

Purpose: Injury severity score (ISS), a widely used scoring system, is used to define the severity of trauma in multiple-trauma patients. Nevertheless, ISS cut-off value for predicting the outcome of multiple-trauma patients has not been confirmed. Thus, this study was performed to determine the more useful method for predicting the outcome for multiple-trauma patients: the ISS or the number of anatomical Abbreviated injury scale (AIS) injury regions. Methods: for 195 consecutive patients who a regional emergency medical center, we analyzed the ISS and the number of anatomical AIS injury region. The patients were divided into four groups based on the ISS and the number of anatomical AIS regions. We compared intensive-care-unit (ICU) admission days and hospitalization days and ICU stay ratio (ICU admission days/hospitalization days) between the four groups. Results: In the groups with an ISS more than 17, the results were not significantly different statistically the group with 2 anatomical AIS injury regions and more than 3 anatomical AIS injury regions. Also, in the group with an ISS of 17 or less, the results were the same as those for patients with an ISS more than 17 (p>0.05). Among the patients with 2 anatomical AIS injury regions, patients with an ISS more than 17 patients had more ICU admission days and a higher ICU stay ratio than patients with an ISS 17 or less. Also, Among the patients with 3 anatomical AIS injury regions, the results were the same as those for patients with 2 anatomical AIS injury regions. Conclusion: Patients with high ISS, regardless of the number of anatomical AIS injury regions had significantly longer ICU stays and higher ICU admission ratio. Thus, the ISS may be a better method than the number of anatomical AIS injury regions for predicting the outcomes for multiple-trauma patients.

• Journal of the Korean Burn Society
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• v.22 no.2
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• pp.25-29
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• 2019

Purpose: This study was performed to investigate the effect of plasma lactate clearance as predictive factor of major burn patients. Methods: A retrospective review was performed on 119 patients from January 2014 to December 2018, who were admitted as severe burn patients to ICU unit. Plasma lactate was measured upon admission to the hospital and 24hrs after admission. And, hospital day, ICU day, TBSA (Total Body Surface Area) and numbers of surgical intervention were collected after admission. Results: Higher lactate clearance showed negative statistical correlation with survival, hospital day, ICU day & number of surgical interventions. Conclusion: In this study, 24hr lactate clearance might be used as predictor of clinical prognosis following major burn injury.

• Journal of The Korean Society of Emergency Medicine
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• v.29 no.5
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• pp.408-414
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• 2018

Objective: Patients with low acuity who need hospitalization may be at risk if they do not receive proper treatment in overcrowded emergency rooms. This study was conducted to investigate factors affecting the hospitalization of patients with low acuity of Korean Triage and Acuity Scale (KTAS). Methods: This study was a retrospective chart review analysis of patients aged 15 years or older who had triaged as KTAS 4 and 5 grades when visiting a local emergency medical center from January 1, 2016 to December 31, 2017. Multivariate logistic analysis was performed to analyze the effects of age, sex, reasons for visiting, visiting route, ambulance utilization, KTAS grade and major category on patient admission. Results: A total of 10,540 patients were enrolled and the odds ratio (OR) increased with age from those aged over 34 years (P<0.001). Patients that triaged as KTAS grade 5 (adjusted OR, 1.57; 95% confidence interval [CI], 1.36-1.82), had a condition caused by disease (adjusted OR, 2.31; 95% CI, 2.00-2.68), and visited by using an ambulance (public: adjusted OR, 1.05; 95% CI, 0.91-1.22; private: adjusted OR, 4.60; 95% CI, 3.85-5.49) were more likely to be hospitalized. Individuals in the "general" major category were more likely to be hospitalized than those falling into other major categories (P<0.001). Conclusion: The factors influencing the hospitalization of patients with low acuity were age, reasons for visiting, visiting route, ambulance utilization, KTAS grade and major category on patient admission.

• Journal of The Korean Society of Clinical Toxicology
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• v.13 no.2
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• pp.55-61
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• 2015

Purpose: Many studies have examined the mechanisms of impaired glucose homeostasis after organophosphate (OP) exposure, however no study has evaluated the clinical utility of blood glucose measurements in patients with OP poisoning. The current study was conducted to evaluate the initial glucose level at presentation and the glycemic variables during the first 3 days after admission as a predictor of mortality. Methods: This retrospective observational case series included 228 patients with a history of OP poisoning. Among other clinical data, information on the initial glucose level at presentation and mean glucose level, delta glucose level, and the presence of a hypoglycemic event during the first 3 days of admission, was collected. Results: Survivors had lower initial glucose levels at presentation and glucose variability during the first 3 days of admission compared to non-survivors. The frequency of hypoglycemic events was higher in non-survivors. In multivariate analysis, the initial glucose level (> 233 mg/dl) was an independent predictor of mortality, along with age. Conclusion: The initial glucose level at presentation can be helpful in prediction of mortality in cases of OP intoxication at bedside. The physician should pay attention to patients with a glucose level >233 mg/dl at presentation after ingestion of OP.

• Health Policy and Management
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• v.19 no.3
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• pp.27-44
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• 2009

The length of stay in emergency departments has been used as a quality indicator to reflect the overall efficiency of emergency care. Identifying characteristics associated with length of stay is critical to monitor overcrowding and improve efficient throughput function of emergency departments. This study examined the level of waiting time for initial assessment by physician and length of stay in emergency departments. Furthermore, we investigated the characteristics of patients' attendance associated with length of stay. An observational study was performed for a sample of 1,526 patients visiting ten nation-wide emergency departments. A structured form was designed to collect information about patients' demographics, route of admission, time and mode of arrival, triage level, cause of attendance, initial assessment time by physician, departure time, and disposition. Multiple regression analysis was performed to determine factors associated with length of stay. The average length of stay was 209.4 minutes (95% confidence interval [CI]=197.1-221.7), with a mean waiting time for initial assessment of 5.9 minutes (95% CI=5.1-6.7). After controlling for emergency department characteristics, increasing age, longer waiting times, attendance due to diseases, higher acuity, multiple diagnoses($\geq$2) and requiring admission or transfer to other health care facilities were positively associated with length of stay in emergency departments. The findings suggest that both patients' characteristics and the flow between emergency departments and parent hospitals should be taken into account in predicting length of stay in emergency departments.

• Journal of Trauma and Injury
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• v.24 no.2
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• pp.89-94
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• 2011

Purpose: A few studies have assessed the factors affecting the prognoses for major trauma patients and those improving the circumstances when dealing with the trauma system. In that light, we analyzed factors, such as pre-hospital factors, the time to admission, the length of stay in the emergency department (ED) and emergency operation, influencing the outcomes for trauma patients. Methods: The patients who visited our emergency department from April 1, 2009, to February 29, 2011, due to major trauma were enrolled in the study. The inclusion criterion was a revised trauma score (RTS) < 7 or injury severity score (ISS) ${\geq}$ 16. We used reviews of medical records, to analyze each step of emergency medical care with respect to patients' sex, age, visit time and visit date. Continuous variables were described as a median with an interquartile range, and we compared the variables between the survival and the mortality groups by using the Mann-Whitney U test. Fisher's exact test was used for nominal variables. Using the variables that showed statistical significance in univariate comparisons, we performed a logistic regression analysis, and we tested the model's adequacy by the using the Hosmer-Lemeshow method. Results: A total of 261 patients with major trauma satisfied either the RTS score criterion or the ISS score criterion. Excluding 12 patients with missing data, 249 patients were included in this study. The overall mortality rate was 16.9%. Time to ED arrival, time to admission, time of ED stay, RTS, ISS, and visit date being a holiday showed statistically significant differences between the survival and the mortality groups in the univariate analysis. RTS, ISS, length of ED stay, and visit date being a holiday showed statistical significance in the multivariate analysis. Conclusion: The mortality rate did not show a significant relationship with the time to ED arrival, use of 119, on time to admission. Rather, it elicited a quite significant correlation with the trauma scoring system (RTS and ISS), the time of ED stay, and the visit date being a holiday.

• Journal of Trauma and Injury
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• v.20 no.2
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• pp.101-105
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• 2007

Purpose: This study aimed to find any difference in the clinical or the anatomical findings of vertebral artery dissection (VAD) between the trauma and the non-trauma groups. Methods: We retrospectively reviewed the clinical data and radiologic images of VAD patients. We compared data on symptoms, neurologic deficit, National institutes of health stroke scale (NIHSS) at admission, Rankin score (RS) at admission and discharge, and radiological findings including anatomical features, between the trauma and the non-trauma groups. Results: From January 1997 to May 2006, 42 patients were enrolled and 13 patients (31%) had a history of earlier trauma. Focal neurologic deficit (trauma group 11/13 vs. non-trauma group 11/29), cerebral stroke (10/13 vs. 9/29), and extradural lesions of dissection (6/13 vs. 3/28) were more common in the trauma group than non-trauma group (p=0.007, p=0.017, p=0.018, respectively) and NIHSS at admission and discharge were significantly higher (p=0.012, p=0.001, respectively). Dissecting aneurysms were less frequent in the trauma group (2/13 vs. 19/29, p=0.006). Subarachnoid hemorrhage and unfavorable prognostic value (Rankin score at discharge ${\geq}$ 2) showed no differences between the groups (p=0.540, p=0.267, respectively). Conclusion: In VAD patients after trauma, focal neurologic deficit due to ischemic stroke and a steno-occlusive pattern are more frequent than they are in non-trauma patients. The location of dissection was most frequent at the extradural vertebral artery in the trauma group. NIHSS was higher in the trauma groups but the incidence of an unfavorable prognostic value (RS ${\geq}$ 2) was not significantly different between the groups.

• Journal of Korean Academy of Nursing
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• v.49 no.1
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• pp.26-35
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• 2019

Purpose: The aim of this study was to identify the predictive validity of the Korean Triage and Acuity Scale (KTAS). Methods: This methodological study used data from National Emergency Department Information System for 2016. The KTAS disposition and emergency treatment results for emergency patients aged 15 years and older were analyzed to evaluate its predictive validity through its sensitivity, specificity, positive predictive value, and negative predictive value. Results: In case of death in the emergency department, or where the intensive care unit admission was considered an emergency, the sensitivity, specificity, positive predictive value, and negative predictive value of the KTAS were 0.916, 0.581, 0.097, and 0.993, respectively. In case of death in the emergency department, or where the intensive or non-intensive care unit admission was considered an emergency, the sensitivity, specificity, and positive predictive value, and negative predictive value were 0.700, 0.642, 0.391, and 0.867, respectively. Conclusion: The results of this study showed that the KTAS had high sensitivity but low specificity. It is necessary to constantly review and revise the KTAS level classification because it still results in a few errors of under and over-triage. Nevertheless, this study is meaningful in that it was an evaluation of the KTAS for the total cases of adult patients who sought help at regional and local emergency medical centers in 2016.