• Journal of The Korean Society of Emergency Medicine
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• v.29 no.5
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• pp.437-448
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• 2018

Objective: Acute ischemic stroke (AIS) requires time-dependent reperfusion therapy, and early recognition of AIS is important to patient outcomes. This study was conducted to identify the clinical features and risk factors of AIS patients that are missed during the early stages of diagnosis. Methods: We retrospectively reviewed AIS patients admitted to a hospital through the emergency department. AIS patients were defined as ischemic stroke patients who visited the emergency department within 6 hours of symptom onset. Patients were classified into two groups: an activation group (A group), in which patients were identified as AIS and the stroke team was activated, and a non-activation group (NA group), for whom the stroke team was not activated. Results: The stroke team was activated for 213 of a total of 262 AIS patients (81.3%), while it was not activated for the remaining 49 (18.7%). The NA group was found to be younger, have lower initial National Institutes of Health Stroke Scale scores, lower incidence of previous hypertension, and a greater incidence of cerebellum and cardio-embolic infarcts than the A group. The chief complaints in the A group were traditional stroke symptoms, side weakness (61.0%), and speech disturbance (17.8%), whereas the NA group had non-traditional symptoms, dizziness (32.7%), and decreased levels of consciousness (22.4%). Independent factors associated with missed stroke team activation were nystagmus, nausea/vomiting, dizziness, gait disturbance, and general weakness. Conclusion: A high index of AIS suspicion is required to identify such patients with these findings. Education on focused neurological examinations and the development of clinical decision tools that could differentiate non-stroke and stroke are needed.

• Journal of Trauma and Injury
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• v.34 no.2
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• pp.87-97
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• 2021

Purpose: This study examined emergency medical service (EMS) transportation patterns for adult trauma patients before and after establishing a level 1 regional trauma center (RTC) and to evaluate the transportation approach after prehospital severity screening. Methods: This was a retrospective observational study of trauma patients aged ≥18 years admitted via EMS to the emergency department or a level 1 RTC, 1 year before to 3 years after RTC establishment. Patients with an Injury Severity Score (ISS) in the patient registration system were selected. Analyses were performed to determine transportation pattern changes by comparing patients pre- and post-RTC establishment and by yearly comparisons over the 4-year study period using the Mann-Whitney U test and chi-square test. Results: Overall, 3,587 patients were included. The mean ISS was higher in the post-RTC group (n=2,693; 10.63±8.90, median 9.00) than in the pre-RTC group (n=894; 9.44±8.20, median 8.00; p<0.001). The mean transportation distance (9.84±13.71, median 5.80 vs. 13.12±16.15 km, median 6.00; p<0.001) was longer in the post-RTC group than in the pre-RTC group. Furthermore, proportionally fewer patients were transported from an area in the same city as the RTC after establishment (86.1% vs. 78.3%; p<0.001). Yearly comparisons revealed a gradually increasing trend in the hospital death rate (ptrend=0.031). Conclusions: After establishing a level 1 RTC, the EMS transportation of severe trauma patients increased gradually along with the long-distance transportation of minor trauma patients. Therefore, improved prehospital EMS trauma severity assessments and level 1 RTC involvement in patient classification in the prehospital phase are necessary.

• Korean Circulation Journal
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• v.53 no.9
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• pp.635-644
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• 2023

Background and Objectives: The History, Electrocardiography, Age, Risk factors, and Troponin (HEART) pathway was developed to identify patients at low risk of a major adverse cardiac event (MACE) among patients presenting with chest pain to the emergency department. Methods: We modified the HEART pathway by replacing the Korean cut-off of 25 kg/m² with the conventional threshold of 30 kg/m² in the definition of obesity among risk factors. The primary outcome was a MACE within 30 days, which included acute myocardial infarction, primary coronary intervention, coronary artery bypass grafting, and all-cause death. Results: Of the 1,304 patients prospectively enrolled, MACE occurred in 320 (24.5%). The modified HEART pathway identified 37.3% of patients as low-risk compared with 38.3% using the HEART pathway. Of the 500 patients classified as low-risk with HEART pathway, 8 (1.6%) experienced MACE, and of the 486 low-risk patients with modified HEART pathway, 4 (0.8%) experienced MACE. The modified HEART pathway had a sensitivity of 98.8%, a negative predictive value (NPV) of 99.2%, a specificity of 49.0%, and a positive predictive value (PPV) of 38.6%, compared with the original HEART pathway, with a sensitivity of 97.5%, a NPV of 98.4%, a specificity of 50.0%, and a PPV of 38.8%. Conclusions: When applied to Korean population, modified HEART pathway could identify patients safe for early discharge more accurately by using body mass index cut-off levels suggested for Koreans.

• The Korean Journal of Emergency Medical Services
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• v.25 no.1
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• pp.147-158
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• 2021

Purpose: This study was conducted as a direct investigation of the data in the dispatch logbooks and status of patient transportation provided by private emergency transport companies in Busan. Methods: This study was conducted using SPSS 23.0 version for a total of 1,000 processed records of private emergency ambulance services in Busan from September 23, 2017 to November 5, 2019. Results: First, 100% of the emergency patient transfers by private emergency ambulances were carried out between medical institutions; 76.4% of all transfer patients had emergency conditions, and 86.0% had serious diseases. Second, 59.3% of the emergency patients were located at distances less than 10 km and 43.2%, at more than 10 km from the medical institutions. Third, 63.5% of the passengers were accompanied by first-class emergency rescuers according to the severity of the condition. Fourth, 92.7% of the reasons for the selection of medical institutions were transferred to places where professional care was available, accounting for most of the reasons for the selection. Finally, the medical institutions were selected according to the severity of the patient's condition; 76.5% patients were transported to institutions with a large number of doctors, and 42.9% of those were transported to specialized care institutions. Conclusion: This study collected data from 1,000 dispatch records of private emergency transport companies in Busan; these records reflect the government's policies to improve the emergency patient transfer system. The current status of emergency patient transfer offered by private transport companies was analyzed. All of the emergency patient transfers were carried out between medical institutions, and 76% of the transferred patients had emergency conditions.

• Journal of radiological science and technology
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• v.19 no.2
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• pp.51-57
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• 1996

Radiography should be used judiciously and should not delay patients resuscitation. In the patient with emergency multiple trauma, three radiography should be obtained-cervical spine, anteroposterior(AP) chest, and AP pelvis. These examinations can be done in the resuscitation area, usually with a portable X-ray unit, but should not interrupt the resuscitation process. A retrospective study was carried on 157 emergency multiple trauma patients who were admitted to Yong Dong Severance Hospital from January, to December in 1995. I analyzed the types of X-ray examinations in emergency multiple trauma patients, and classified the patients by disoriented group of mentality. The results were as follows: 1. The subjects were 7.1%(157patients) of 2,208 trauma patients(7.3%) in total 30,085 emergency patients. 2. Male to female ratio was 2.57 : 1. The age distribution was highest from 31 years to 40 years(28.0% ). 3. The peak time of patient's entrance in emergency center was between 8 : 00 pm and 2 : 00 am(36.9%), and second peak time was between 2 : 00 pm and 8 : 00 pm (29.3%). 4. According to the injury type, traffic accident, motorcycle accident and falling down were 71.3%, 8.3% and 20.4% respectively. 5. According to the exposure rate of Computed Tomography, chest CT, cervical CT pelvis CT and brain CT were 39.5%, 24.2%, 69.4% and 51.6% respectively.

• Journal of Korean Public Health Nursing
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• v.13 no.2
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• pp.70-83
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• 1999

This study was designed to evaluate the prevalence and significant features of accidental patients and to evaluate the degree of satisfaction on emergency care who visited emergency room. The subject of this study was a total of 243 accidental patients and 249 patients with disease visiting emergency room of 4 university hospitals in Seoul. The data was collected from guestionnaire during the period of January to february 1999. The results were summarized as follows. 1. Distribution of the general characteristics (age, sex, educational status, marrital status and job) in the accidental patients were significantly different from that of the control group. The most common group of age was 20-30 years of age and males predominated over female. 2. CD Fourty two $\%$ of accidental patients arrived within 30 mins. (2) Fifty seven $\%$ of patients was first-aided one. (3) An ambulance was the most frequently used transportation. (4) The time interval from arrival to initial emergency care was 10 mins. (5) Admission rates of the patients after treatment was $72.0\%$. (6) Time interval from arrival to completion was 3-4 hours. 3. The Mean score of the accidental patents' degree of satisfaction on emergency services was $3.26\pm0.64$ which was not significantly different from that of control group.

• The Journal of Korean Society for School & Community Health Education
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• v.17 no.3
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• pp.61-70
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• 2016

Objectives: The purpose of this study was to verify about characteristics about patients using the emergency room of a general hospital of a partial area residents. Methods: The analysis of the data was used by SAS program(ver. 9.2). Chi-square test was used in analyzing degree of emergency of patients visiting the emergency room of a general hospital. Using cluster analysis, subjects were classified into 3groups. Results: Urgent and emergent patients at the age of 40 or greater were significantly higher than in under 10 years. the rates of urgent and emergent patients in male(3.2% and 3.3%) were significantly higher than in female(2.5% and 2.2%)(ｐ<0.001). Urgent patients were the highest at 11 p.m.-3 a.m. and on Thursday and in winter. Emergent patients were the highest at 4 a.m.-8 a.m. and on wednesday and in winter. Patients as cause of disease was the highest in illness. Conclusion: Policy establishment and measures of government and public health authority were needed for emergent diseases at the age of 40 or greater of male and at midnight time and on thursday and wednesday and in winter.

• Journal of The Korean Society of Clinical Toxicology
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• v.5 no.1
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• pp.1-7
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• 2007

Purpose: The aim of this study was to evaluate the characteristics and the prognostic factors of carbamate poisoned patients who visited emergency departments. Methods: From August 2005 to July 2006, we investigated the demographic feature, dose of exposure, time of exposure, alcohol intake, route of exposure, reason of exposure, site of exposure, pre-existing medical condition, time from exposure to emergency department (ED), transfer from other hospitals, vital sign at ED arrival, symptom or sign at ED arrival, and result of care of the patients who visited the ED of thirty-eight hospitals in Korea. According to the result of care, we divided the patients into two groups, the survival and the dead. To evaluated the prognostic factors, we calculated the odds ratio of each factor for the survival. Results: Among the sixty-eight patients, fifty-five patients (80.9%) were survival and thirteen patients (19.1%) were dead. The patients in the dead were older than the patients in the survival. The Glasgow coma scale (GCS) of the patients in the dead was lower than the GCS in the survival. The odds ratio of the GCS at ED arrival for the survival was 1.58 (95% CI; 1.23-2.05). Other factors showed no statistical significances. Conclusion: The GCS at emergency department arrival was the prognosis factor of the carbamate poisoned patients who visited emergency departments. If the carbamate poisoned patients showed altered mentalities, they should be provided intensive care, immediately.

• Journal of Yeungnam Medical Science
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• v.39 no.1
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• pp.31-38
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• 2022

Background: To prepare for future work stoppages in the medical industry, this study aimed to identify the effects of healthcare worker strikes on the mortality rate of patients visiting the emergency department (ED) at six training hospitals in Daegu, South Korea. Methods: We used a retrospective, cross-sectional, multicenter design to analyze the medical records of patients who visited six training hospitals in Daegu (August 21-September 8, 2020). For comparison, control period 1 was set as the same period in the previous year (August 21-September 8, 2019) and control period 2 was set as July 1-19, 2020. Patient characteristics including age, sex, and time of ED visit were investigated along with mode of arrival, length of ED stay, and in-hospital mortality. The experimental and control groups were compared using t-tests, and Mann-Whitney U-test, chi-square test, and Fisher exact tests, as appropriate. Univariate logistic regression was performed to identify significant factors, followed by multivariate logistic regression analysis. Results: During the study period, 31,357 patients visited the ED, of which 7,749 belonged to the experimental group. Control periods 1 and 2 included 13,100 and 10,243 patients, respectively. No significant in-hospital mortality differences were found between strike periods; however, the results showed statistically significant differences in the length of ED stay. Conclusion: The ED resident strike did not influence the mortality rate of patients who visited the EDs of six training hospitals in Daegu. Furthermore, the number of patients admitted and the length of ED stay decreased during the strike period.

• Journal of Trauma and Injury
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• v.30 no.2
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• pp.41-46
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• 2017

Purpose: To determine the incidence of post-concussion syndrome (PCS) in Korean patients after minor traumatic brain injury. Methods: We conducted an observational cohort study of a convenience sample of patients presenting to the emergency department of a major academic Korean hospital. Patients who visited the Emergency Department for head trauma were screened. A researcher questioned the subject regarding his or her symptoms. Subjects were contacted by phone approximately 2 weeks after their Emergency Department visit and questioned about subsequent symptoms and subsequent visits for medical care. Results: Only 8% of subjects reported any post-concussion symptoms. Only 0.4% had three or more symptoms which might have met criteria for PCS. The median peak onset of symptoms was 3 days after injury. Conclusion: The incidence of PCS is Korean patients is much lower than that documented for patients in the United States or other western countries. On the other hand, this study results could give an idea that mild trauma could also cause the PCS. Further study is needed to replicate this finding and investigate possible explanations for this difference.