• Journal of The Korean Society of Emergency Medicine
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• v.29 no.5
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• pp.415-422
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• 2018

Objective: This study compared the prognosis of patients who visited the trauma center directly (direct visit group) with those transferred from the non-trauma center (transferred group). Methods: The patients, who were 18 or older with Injury Severity Score of 15 or more in the trauma center at Busan, were studied from October 2015 to October 2016. To compare the treatment time between the direct visit and transferred group, first treatment time, final treatment time, and time to visit the trauma center were examined. To compare the prognosis, this study compared the 48-hour, 7-day, and in-hospital mortality rate as well as the duration of intensive care unit (ICU) and total hospital stay. To analyze the factors affecting the outcome of transferred group, the physician's level and procedures that had been performed at the non-trauma center were examined. Results: The mortality was similar in the direct visit and transferred group (48-hour 7.6% vs. 4.6%, P=0.111; 7-day 11.1% vs. 7.2%, P=0.89; and in-hospital 14.6% vs. 11.3%, P=0.214). The length of ICU and total hospital stay were similar in the two groups. The mortality was higher in the patients in the transferred group when using intubation, transfusion, and pressure intensifier. The intubated patients showed higher mortality according to logistic regression. Conclusion: The mortality, length of ICU, and hospital stay were similar but the time to visit the trauma center and the final treatment time were longer in transferred group. Stabilizing the patient at the near non-trauma center may be more helpful for some patients.

• Journal of Trauma and Injury
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• v.20 no.2
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• pp.77-82
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• 2007

Purposes: There have been many efforts to improve the service of emergency centers. In spite of these, no evidence is showing any landmark advancement of emergency services, especially in the hospital stage, exists. We need some efficient standard criteria to evaluate emergency service in the hospital stage, and a useful method might utilize the overcrowding index. We want to know the change in the overcrowding index at a regional emergency center after injury area administration. Injury area means an area in which only an assigned duty physician manages patients with injuries such as those from traffic accidents, falls, assualts, collisions, lacerations, amputations, bums, intoxication, asphyxia, drowning, animal bites, sexual assualts, etc. Methods: We started to operate an injury area in our emergency department from late 2004, and from January to June in 2004 and in 2005, we collected patients' data, age, sex, assigned department, and result from hospital order communication system to figure out overcrowding indices and result indices. We found the daily number of patients, the turnover rate, the admission rate, the ICU admission rate, the emergency operation rate, the ED stay duration, and the ED patient volume to be overcrowding indices. Also we found the withdrawal rate, the transfer rate, and mortality to be result indices. We compared these indices between 2004 to 2005 by using a t-test. Results: There was a significant increase in the daily number of visiting patients in 2005, overcrowding indices, such as the turnover rate, the admission rate, the ICU admission rate, and the emergency operation rate, also showed statistically significant increases in 2005 (P<0.001). As for the result indices, there was a noticeable decrease in the number of withdrawals (11.77/day in 2004 to 4.53/day in 2005). Conclusion: Operating an injury area in a mildly overcrowded local emergency center is beneficial. Evaluating the effect of operating an injury area and it's impact on hospital finances by conducting a similar study analyziing patients for a longer duration would be valuable.

• Journal of Trauma and Injury
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• v.24 no.1
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• pp.31-36
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• 2011

Purpose: This study was conducted to evaluate the correlations among pulmonary contusion severity, trauma score and cardiac troponin I (cTnI) level. Methods: We prospectively evaluated patients with multiple injuries who had been admitted to the emergency department (ED) from July 2007 to July 2008. We first measured the total creatinine kinase (CK), the MB fraction of CK (CK-MB), TnI, and myoglobin within 2 hours after the injury. We then checked the electrocardiogram, x-ray, and computed tomography (CT) results. Finally, we assessed the injuries as variables and then compared the results for patients with elevated TnI levels (group A) and patients whose TnI levels fell within the normal range (group B). Results: Eighty-six of the 92 patients admitted to the ED were enrolled. The pulmonary contusion score (PCS) was well correlated with $PaO_2/FiO_2$. TnI levels were correlated with PCS. When TnI levels were above 0.86 ng/ml, the mortality was estimated with 100% sensitivity and 86.1% specificity. Conclusion: Pulmonary contusion severity is correlated with TnI level. When the PCS is high and the cTnI level is elevated in multiple-injury patients, we recommend continuous cardiac monitoring and further evaluation

• Quality Improvement in Health Care
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• v.12 no.1
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• pp.114-123
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• 2006

Background : Patients who were discharged from the emergency department(ED) may revisit. These patients are divided into two groups; one is expected scheduled condition, the other is unexpected condition. These patients of inappropriate revisits to the ED would be unsatisfied, difficult to make rapport and take legal action as a result of additional medical charges. The purpose of this study was to reduce inappropriate revisits to the ED with a new method which was developed by analyzing inappropriate revisits in 2002. Methods : This study was conducted in a tertiary hospital consisting of 1,278 beds. The most common cause of inappropriate revisits was the medical team's lack of explanation about a disease. Thus we decided that the effective method was to offer full explanations to patients to understand the clinical pathway of a disease. We made four types of stickers to explain most common 4 diseases in 2003. An emergency physician completed 'discharge explanation report' and explained it to patients in 2004. Results : In 2002 inappropriate revisited patients were 164, patients with four diseases were 79. During the same period of 2003, inappropriate revisited patients were 56 (-65.9%), four disease patients were 6 (-92.4%) and in 2004 inappropriate revisited patients were 52, four disease patients were 19. Causes of revisits were lack of explanation about a disease in 35 patients (44.3%) in 2003, and 5 patients (83.3%) in 2003, and 16 patients (84.2%). Conclusions : Application of 'explanation stickers' at discharge reduced inappropriate revisits from 34.5% in 2002 to 15.9% in 2003. Application of 'Discharge explanation report' by emergency physician reduced inappropriate revisits from 15.9% in 2003 to 13.5% in 2004. Reduction of inappropriate revisits elevated the quality of medical treatment, and decreased patients' dissatisfaction in ED.

• Journal of The Korean Society of Clinical Toxicology
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• v.4 no.1
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• pp.25-31
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• 2006

Purpose: In the year of 2005, it enforced the basic study for establishing program of Poison Control Center by National Institute of Toxicologic Research. The object of our survey is to analyze the characteristics of intoxication from the City of Goyang by same protocol. Methods: We retrospectively reviewed the data of medical records of the intoxication patient in the two hospitals of the Goyang from 2004 June 1st to 2005 May 31th. The investigation protocol applied the TESS report form which was used from the Basic study for establishing program of Poison Control Center. Results: The intoxication patients were total 269 persons, the patients of A hospital were 184 persons, B hospital were 185 persons. The most common intoxication materials were medicines, in afterwords it was an agricultural chemical. The most common place of intoxication was the home. The intentional suicidal attempts in the reason of intoxication were 51.2%. The rate of the patients who discharges from the emergency department was 50.4% and death rate was 4.3%. Conclusion: We concluded that the continuous and systemic report and analysis should be accomplished from the Goyang area.

• Journal of The Korean Society of Clinical Toxicology
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• v.12 no.2
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• pp.54-62
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• 2014

Purpose: The purpose of this study was to compare prescription patterns and clinical features according to clinical departments in sedative-hypnotic intoxication. Methods: This was a retrospective study of histories, substances of poisoning, acquisition routes, clinical courses, and outcomes of patients treated for acute intoxication in a single emergency medical center from January, 2011 to December, 2013. Results: A total of 769 patients were treated for acute intoxication, 281 patients ingested sedative hypnotics during the study period. Among 281 patients, 155 patients were prescribed by psychiatric department and 80 patients were prescribed by non-psychiatric department. Benzodiazepines were more likely to be prescribed by psychiatrists, and zolpidem was preferred by non-psychiatrists (p<0.001). Non-psychiatrists were more likely to prescribe short acting benzodiazepines than psychiatrists (p<0.001). However, there was no statistically significant difference in the clinical outcomes, including prevalence of admission to ICU, ventilator care, and length of stay in ICU. In patients prescribed by non-psychiatrists, there were more patients prescribed without psychiatric diagnosis and diagnosed as major depression disorder after hospitalization. Conclusion: To promote rational prescribing of sedative hypnotics, proper psychiatric evaluation should be performed before prescribing, and educational programs including the contents of interactions and side effects of sedative hypnotics are needed.

• Journal of The Korean Society of Emergency Medicine
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• v.29 no.5
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• pp.455-464
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• 2018

Objective: Machine learning is not yet widely used in the medical field. Therefore, this study was conducted to compare the performance of preexisting severity prediction models and machine learning based models (random forest [RF], gradient boosting [GB]) for mortality prediction in pneumonia patients. Methods: We retrospectively collected data from patients who visited the emergency department of a tertiary training hospital in Seoul, Korea from January to March of 2015. The Pneumonia Severity Index (PSI) and Sequential Organ Failure Assessment (SOFA) scores were calculated for both groups and the area under the curve (AUC) for mortality prediction was computed. For the RF and GB models, data were divided into a test set and a validation set by the random split method. The training set was learned in RF and GB models and the AUC was obtained from the validation set. The mean AUC was compared with the other two AUCs. Results: Of the 536 investigated patients, 395 were enrolled and 41 of them died. The AUC values of PSI and SOFA scores were 0.799 (0.737-0.862) and 0.865 (0.811-0.918), respectively. The mean AUC values obtained by the RF and GB models were 0.928 (0.899-0.957) and 0.919 (0.886-0.952), respectively. There were significant differences between preexisting severity prediction models and machine learning based models (P<0.001). Conclusion: Classification through machine learning may help predict the mortality of pneumonia patients visiting the emergency department.

• Journal of The Korean Society of Emergency Medicine
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• v.29 no.5
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• pp.529-550
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• 2018

Objective: This study investigated the most common errors on death certificates written by resident trainees of the emergency department and evaluated the effects of education on how to write a death certificate. Methods: A casebook of 31 deaths was prepared based on actual death cases in the emergency room in 2016. Ten residents completed 31 death certificates for the death casebook without any prior notice and then received education on 'How to write the death certificate.' They completed the death certificates again for the same casebook after receiving the education and the number of errors on all death certificates was again determined and divided into major and minor errors. The average number of error types was compared before and after the education. Results: Major errors occurred in 55% of all death certificates, but decreased to 32% after education. Minor errors decreased from 81% before education to 54% after education. The most common major error was 'unacceptable cause of death' (mean${\pm}$standard deviation [SD], $10.2{\pm}8.2$), and the most common minor error was 'absence of time interval' (mean${\pm}$SD, $24.0{\pm}7.7$), followed by 'absence of other significant conditions' (mean${\pm}$SD, $14.6{\pm}6.1$) before education. Conclusion: Education on 'how to write a death certificate' can help reduce errors on death certificates and improve the quality of death certificates.

• The Journal of Churna Manual Medicine for Spine and Nerves
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• v.4 no.2
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• pp.75-83
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• 2009

Objectives : By recording basic data of musculoskeletal patients visiting the emergency room of an oriental medicine hospital. we can understand their characteristics and gain better insight about them. Method : We performed a retrospective study of 551 patients who visited the emergency room of an oriental medicine hospital, from November 1,2008 to October 31, 2009. Result : 1. Of 551 total patients, the male to female ratio was almost same and the 3rd decade of life was the peak age group. 2. The majority of patients visited emergency room between 10:00 and 24:00(midnight). 3. Most patients visited on a Saturday or Sunday. 4. By monthly distribution, the patients increased slightly during January, May and October. 5. The majority of patients visited the emergency room within 24 hours of onset. 6. The patients were categorized as follows : lumbar sprain 66.06%, cervical sprain 16.25%, ankle sprain 9.04%. 7. Admission rate was 21.96%. Conclusion : Assuming that this research will continue adding patient's data continuously, this work will help up to understand the features of musculoskeletal patients who visiting the emergency room of the oriental medicine hospital.

• Journal of Trauma and Injury
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• v.22 no.1
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• pp.1-4
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• 2009

Purpose: This study was conducted to evaluate the length of the catheter used in a needle thoracostomy for emergency decompression of a tension pneumothorax by measuring the chest wall thickness (CWT) in patients with chest trauma Methods: A retrospective review of 201 patients with chest trauma who had been transported the emergency department in a tertiary university hospital in a metropolitan area between 1 January and 31 February 2007 was performed. The average CWT at the second intercostal space (ICS) in the midclavicular line (MCL) was measured by using a chest computed tomography scan. Results: As the left and the right mean CWTs were $3.4{\pm}1.0cm$ and $3.4{\pm}1.0cm$, respectively, there was no significant statistical difference between them. The mean CWT of female patients was significantly higher than that of male patients (p=0.001). The mean CWT of patients under the age of 65 years was significantly thicker than that of the patients over the age of 65 years (p<0.001). Of the studied patients, 12 (6.0%) a CWT > 5 cm. Conclusion: A 5 cm-length catheter in a needle thoracostomy may be insufficient for emergency decompression of a tension pneumothorax, so a catheter longer than 5 cm in length is needed.