Association of Knee Osteoarthritis with Metabolic Syndrome in Koreans Aged 50-Years or Older

BACKGROUND: Recent studies have reported the association of knee osteoarthritis (KOA) with metabolic risk factors. The objective of this study was to evaluate the association between KOA and metabolic syndrome (MetS).METHODS: The study subjects were 966 Korean adults aged ≥50 years who participated in a free-of-charge health examination provided to residents of a non-urban area. We ascertained KOA and MetS on the basis of the clinical diagnostic criteria of the American Rheumatism Association and the modified National Cholesterol Education Program's Adult Treatment Panel III, respectively. The association between KOA and MetS was evaluated using a multiple logistic regression analysis after adjusting for covariates.RESULTS: The overall prevalence rates of KOA and MetS were 34.9% and 48.7%, respectively, with higher prevalence rates in the women than in the men (P < 0.001). The risk of MetS was significantly higher in the subjects with KOA than in those without KOA (odds ratio [OR], 1.35; 95% confidence interval [CI], 1.03–1.77). Among the components of MetS, only abdominal obesity showed a significant association with KOA (OR, 1.48; 95% CI, 1.12–1.95). When the analyses were repeated to determine sex-specific relationships, the associations of KOA with MetS (P=0.069) and abdominal obesity (P=0.022) were evident in the women, but not in the men.CONCLUSION: The findings of this study suggest that women with KOA must be evaluated and managed for MetS, with special attention to abdominal obesity.

Standardized Approaches to Syncope Evaluation for Reducing Hospital Admissions and Costs in Overcrowded Emergency Departments

PURPOSE: The evaluation of syncope is often disorganized and ineffective. The objective of this study was to examine whether implementation of a standardized emergency department (ED) protocol improves the quality of syncope evaluation. MATERIALS AND METHODS: This study was a prospective, non-randomized study conducted at a 1900-bed, tertiary teaching hospital in South Korea. We compared two specific periods, including a 12-month observation period (control group, January-December 2009) and a 10-month intervention period after the implementation of standardized approaches, comprising risk stratification, hospital order sets and establishment of a syncope observational unit (intervention group, March-December 2010). Primary end points were hospital admission rates and medical costs related to syncope evaluation. RESULTS: A total of 244 patients were enrolled in this study (116 patients in the control group and 128 patients in the intervention group). The admission rate decreased by 8.3% in the intervention group (adjusted odds ratio 0.31, 95% confidence interval 0.13-0.70, p=0.005). There was a cost reduction of about 30% during the intervention period [369000 Korean won (KRW), interquartile range (IQR) 240000-602000 KRW], compared with the control period (542000 KRW, IQR 316000-1185000 KRW). The length of stay in the ED was also reduced in the intervention group (median: 4.6 hours vs. 3.4 hours). CONCLUSION: Standardized approaches to syncope evaluation reduced hospital admissions, medical costs and length of stay in the overcrowded emergency department of a tertiary teaching hospital in South Korea.

Evaluating the Accuracy of Emergency Medicine Resident Interpretations of Abdominal CTs in Patients with Non-Traumatic Abdominal Pain

Abdominal computed tomography (CT) is widely used as a diagnostic tool in emergency medicine (EM) to accurately diagnose abdominal pain. EM residents must be able to offer preliminary interpretations of CT imaging. In this study, we evaluated the preliminary interpretation ability of a sample of emergency residents presented with adult abdominal CT images, and compared their results with those of radiology residents. We conducted a prospective observational study from November 16, 2008 to June 30, 2009. During this time, we gathered preliminary interpretations of consecutive abdominal CT made by emergency and radiology residents. We assessed the discrepancy rates of both samples by comparing their findings to the final reports from attending radiologists. A total of 884 cases were enrolled in the present study. The discrepancy rates of emergency and radiology residents were 16.7% and 12.2%, respectively. When female genital organs, peritoneum, adrenal glands, or the musculoskeletal system were abnormal, we found that emergency residents' preliminary interpretations of CT images were insufficient compared to those of radiology residents. Therefore more formal education is needed to emergency residents. If possible, the preliminary interpretations of radiology attending physicians are ideal until improving the ability of interpretations of emergency residents in abdomen CT.

Improving Survival Rate of Patients with In-Hospital Cardiac Arrest: Five Years of Experience in a Single Center in Korea

The aim of this study was to describe the cause of the recent improvement in the outcomes of patients who experienced in-hospital cardiac arrest. We retrospectively analyzed the in-hospital arrest registry of a tertiary care university hospital in Korea between 2005 and 2009. Major changes to the in-hospital resuscitation policies occurred during the study period, which included the requirement of extensive education of basic life support and advanced cardiac life support, the reformation of cardiopulmonary resuscitation (CPR) team with trained physicians, and the activation of a medical emergency team. A total of 958 patients with in-hospital cardiac arrest were enrolled. A significant annual trend in in-hospital survival improvement (odds ratio = 0.77, 95% confidence interval 0.65-0.90) was observed in a multivariate model. The adjusted trend analysis of the return of spontaneous circulation, six-month survival, and survival with minimal neurologic impairment upon discharge and six-months afterward revealed similar results to the original analysis. These trends in outcome improvement throughout the study were apparent in non-ICU (Intensive Care Unit) areas. We report that the in-hospital survival of cardiac arrest patients gradually improved. Multidisciplinary hospital-based efforts that reinforce the Chain of Survival concept may have contributed to this improvement.

Diagnostic Patterns in the Evaluation of Patients Presenting with Syncope at the Emergency or Outpatient Department

PURPOSE: Patterns of syncope evaluation vary widely among physicians and hospitals. The aim of this study was to assess current diagnostic patterns and medical costs in the evaluation of patients presenting with syncope at the emergency department (ED) or the outpatient department (OPD) of a referral hospital. MATERIALS AND METHODS: This study included 171 consecutive patients with syncope, who visited the ED or OPD between January 2009 and July 2009. RESULTS: The ED group had fewer episodes of syncope [2 (1-2) vs. 2 (1-5), p=0.014] and fewer prodromal symptoms (81.5% vs. 93.3%, p=0.018) than the OPD group. Diagnostic tests were more frequently performed in the ED group than in the OPD group (6.2+/-1.7 vs. 5.3+/-2.0; p=0.012). In addition, tests with low diagnostic yields were more frequently used in the ED group than in the OPD group. The total cost of syncope evaluation per patient was higher in the ED group than in the OPD group [823000 (440000-1408000) won vs. 420000 (186000-766000) won, p<0.001]. CONCLUSION: There were some differences in the clinical characteristics of patients and diagnostic patterns in the evaluation of syncope between the ED and the OPD groups. Therefore, a selective diagnostic approach according to the presentation site is needed to improve diagnostic yields and to reduce the time and costs of evaluation of syncope.

Factors Influencing Prehospital and Inhospital Time Delays for Ischemic Stroke Patients

PURPOSE: This study was designed to investigate the time delay in the prehospital and inhospital course of acute ischemic stroke patients at an emergency department (ED). METHODS: We collected data from medical records retrospectively, including baseline characteristics, mode of arrival, arrival time, and neurological symptoms, from January 2006 to October 2008. Time data were also collected; from symptom onset to ED visit (prehospital delay), ED visit to brain imaging (imaging delay), and from ED visit to treatment (treatment delay). We designed multivariate Cox-regression models to predict factors influencing prehospital and ED time for ischemic stroke. RESULTS: In total, 946 ischemic stroke patients were enrolled. Diabetes mellitus was associated with a longer prehospital delay. Heart disease, hyperlipidemia, and use of an emergency medical service (EMS) were associated with a shorter prehospital delay. Female gender, night time visits, and abnormal speech were associated with a longer imaging delay. Hypertension, use of EMS, multiple symptoms, and prehospital delay within 3 hours were associated with a shorter delay. Abnormal speech was also a significant factor for a longer treatment delay. Tingling sense or numbness, multiple symptoms, and a prehospital delay within 3 hours were related to a shorter treatment delay. CONCLUSION: The time delay in the prehospital and ED course of acute ischemic stroke patients was associated with multiple factors including gender, comorbidities, use of EMS, arrival time, acute symptom onset within 3 hours, neurological symptoms, and multiple neurological symptoms.

Characteristics of Frequent Users of Emergency Department

PURPOSE: Crowding causes dysfunction in the emergency department (ED) and is associated with poor quality of patient care, dissatisfaction of the physicians, and increased financial burden of medical care. Frequent use is often considered a major contributor to ED crowding. The present study sought to verify the relationship between the frequent ED users and ED crowding, and to ascertain the severity of the frequent ED users. METHODS: One-year ED visit data from a tertiary teaching hospital located in an urban area were analyzed. Frequent ED users were defined as four or more ED visits per year. Crowding indicators were defined as the length of stay and the percentage of patients staying over 6 hours. Severity indicators were defined as operation within 24 h, admission to intensive care unit, and expiry in the ED. RESULTS: The 2.7% of patients who had four or more ED visits were responsible for 11.9% of visits. The median length of stay of frequent users was significantly longer (6.18 h) than that of infrequent users (3.42 h). The percentage of patients who stayed more than 6 h was significantly larger in the frequent user group than infrequent user group (51.4% vs. 32.9%, respectively; OR=2.158; 95% CI, 2.041~2.281). However, the severity of frequent users was lower than that of infrequent users (3.0% vs. 5.3%, respectively; OR=0.553; 95% CI, 0.472~0.648). CONCLUSION: Frequent users presenting to an ED located in an urban area were more likely to stay longer in the ED, and were less likely to be severe. Active interventions to reduce ED crowding are required.

Characteristics of Frequent Users of Emergency Department

PURPOSE: Crowding causes dysfunction in the emergency department (ED) and is associated with poor quality of patient care, dissatisfaction of the physicians, and increased financial burden of medical care. Frequent use is often considered a major contributor to ED crowding. The present study sought to verify the relationship between the frequent ED users and ED crowding, and to ascertain the severity of the frequent ED users. METHODS: One-year ED visit data from a tertiary teaching hospital located in an urban area were analyzed. Frequent ED users were defined as four or more ED visits per year. Crowding indicators were defined as the length of stay and the percentage of patients staying over 6 hours. Severity indicators were defined as operation within 24 h, admission to intensive care unit, and expiry in the ED. RESULTS: The 2.7% of patients who had four or more ED visits were responsible for 11.9% of visits. The median length of stay of frequent users was significantly longer (6.18 h) than that of infrequent users (3.42 h). The percentage of patients who stayed more than 6 h was significantly larger in the frequent user group than infrequent user group (51.4% vs. 32.9%, respectively; OR=2.158; 95% CI, 2.041~2.281). However, the severity of frequent users was lower than that of infrequent users (3.0% vs. 5.3%, respectively; OR=0.553; 95% CI, 0.472~0.648). CONCLUSION: Frequent users presenting to an ED located in an urban area were more likely to stay longer in the ED, and were less likely to be severe. Active interventions to reduce ED crowding are required.

A Retrospective Study about Characteristics of Out-of-hospital Cardiac Arrest Caused by Non-traumatic Subarachnoid Hemorrhage / 대한구급학회지

BACKGROUND: Subarachnoid hemorrhage is a fatal disease relatively common in the East Asian population. It can lead to cardiac arrest in several pathologic processes. We attempted to elucidate the characteristics of out-of-hospital cardiac arrest caused by non-traumatic subarachnoid hemorrhage. METHODS: We conducted a retrospective, observational study in which patients who had visited Samsung medical center emergency room for out-of-hospital cardiac arrest from January, 1999 to December 2008 were enrolled. A total of 218 OHCA patients who had achieved ROSC were investigated by review of medical charts. Excluding those who had worn trauma, we analyzed 22 patients who had been diagnosed for SAH by brain non-contrast CT scan. RESULTS: Median age of aneurysmal SAH-induced OHCA patients was 61 (IQR 54-67) years. Fourteen patients (64%) were female and 15 patients (68%) were witnessed. Besides, 7 patients (32%) had complained of headache before collapse. We also found 11 patients (50%) had been diagnosed with hypertension previously. All of them showed unshockable rhythm (asystole 60%, PEA 40%) initially. Their median duration of ACLS was 10 minutes. Majority of patients died within 24 hours and survivors showed poor neurologic outcome. CONCLUSIONS: Subarachnoid hemorrhage is a relatively uncommon cause of cardiac arrest, and the outcome of OHCA induced by SAH is very poor. However, emergency physicians have to consider the possibility of SAH when trying to determine the cause of arrest, especially when treating patients who have the characteristics described above.

Diagnostic Patterns and Medical Costs in the Evaluation of Syncope Patients Visiting an Emergency Department

PURPOSE: Syncope is a common clinical problem. However, diagnosis of the cause of syncope is not simple due to a wide variety of forms of syncope. The aim of this study was to assess current diagnostic methods and the associated medical costs which accompany the evaluation of patients suffering syncope who admitted to an emergency department (ED). METHODS: This study is a prospective, observational, single center study. Patients included in the study visited the ED of a single, tertiary hospital between January and December 2009, and were diagnosed with syncope. We investigated the diagnostic yields (DY) for the tests that were employed and evaluated factors related to medical costs. RESULTS: A total of 124 patients were enrolled in this study. Blood tests, chest radiography, postural blood pressure (BP) measurement and computerized tomography of the brain were performed in over 60% of cases, but DY for each of these tests was less than 3%, except for postural BP measurement (7.4%). The test which demonstrated a relatively high DY was the head-up tilt test (68.1%). The ratio of the cost of each test among the total medical costs required by all patients (constituent ratio) was highest for brain imaging tests (12.2%). The total cost of syncope evaluation per patient was 1,454,000+/-2,865,000 won. Factors including hospital admission and diagnosis of cardiac syncope resulted in significantly higher total medical costs for those patients. CONCLUSION: Among the tests performed in the ED for syncope evaluation, blood tests, chest x-ray and brain imaging tests were commonly used but resulted in relatively low diagnostic yield. Independent factors which increased medical costs were hospital admission and diagnosis of cardiac syncope.

Factors Affecting the Delay of a Decision to Admit Severe Trauma Patients and the Effect of a Multidisciplinary Department System: a Preliminary Study

PURPOSE: Prolonged stay in the emergency department (ED), which is closely related with the time interval from the ED visit to a decision to admit, might be associated with poor outcomes for trauma patients and with overcrowding of the ED. Therefore, we examined the factors affecting the delay in the decision to admit severe trauma patients. Also, a multidisciplinary department system was preliminarily evaluated to see if it could reduce the time from triage to the admission decision. METHODS: A retrospective observational study was conducted at a tertiary care university hospital without a specialized trauma team or specialized trauma surgeons from January 2009 to March 2010. Severe trauma patients with an International Classification of Disease Based Injury Severity Score (ICISS) below 0.9 were included. A multivariable logistic regression analysis was used to find independent variables associated with a delay in the decision for admission which was defined as the time interval between ED arrival and admission decision exceeded 4 hours. We also simulated the time from triage to the decision for admission by a multidisciplinary department system. RESULTS: A total of 89 patients were enrolled. The average time from triage to the admission decision was 5.2+/-7.1 hours and the average length of the ED stay was 9.0+/-11.5 hours. The rate of decision delay for admission was 31.5%. A multivariable regression analysis revealed that multiple trauma (odds ratio [OR]: 30.6, 95%; confidence interval [CI]: 3.18-294.71), emergency operation (OR: 0.55, 95%; CI: 0.01-0.96), and treatment in the Department of Neurosurgery (OR: 0.07, 95%; CI: 0.01-0.78) were significantly associated with the decision delay. In a simulation based on a multidisciplinary department system, the virtual time from triage to admission decision was 2.1+/-1.5 hours. CONCLUSION: In the ED, patients with severe trauma, multiple trauma was a significant factor causing a delay in the admission decision. On the other hand, emergency operation and treatment in Department of Neurosurgery were negatively associated with the delay. The simulated time from triage to the decision for admission by a multidisciplinary department system was 3 hours shorter than the real one.

Diagnostic Usefulness of a Relative Increase in the Ratio Between D-dimer and C-reactive Protein in Pulmonary Thromboembolism Disorder

PURPOSE: In spite of its high sensitivity, the D-dimer test has a limited role in diagnosis of pulmonary thromboembolism (PTE) due to its low specificity. This study was designed to evaluate the diagnostic accuracy of an index for PTE with addition of C-reactive protein (CRP) in patients showing increased D-dimer level. METHODS: We carried out a retrospective study in a tertiary emergency department and enrolled patients who did blood sampling for D-dimer and CRP at the same time among patients suspected of PTE between December 2000 and October 2008. PTE was confirmed by imaging studies, chest computed tomography and angiography. We analyzed D-dimer and CRP levels and correlated them with PTE. RESULTS: A total of 362 patients were enrolled; 67 had PTE. Areas under the curve (AUC) of the Receiver Operating Characteristic (ROC) curve of D-dimer for PTE were smaller than those for a relative increase in the ratio of D-dimer to CRP (RDDCRP). CONCLUSION: The diagnostic accuracy of D-dimer for PTE can be increased by normalizing D-dimer levels to CRP levels.

Utility of Brain Computed Tomography in Detecting Fractures of the Temporal Bones Correlated with Patterns of Fracture on High-Resolution Computed Tomography

PURPOSE: The clinical utility of brain computed tomography (CT) in detecting temporal bone fracture is not well established. We performed this study to determine the utility of brain computed tomography (CT) in detecting fractures of the temporal bones in correlation with fracture patterns. We used high resolution computed tomography (HRCT) as the gold standard for diagnosing temporal bone fracture and its pattern. METHODS: From January 2007 to December 2009, patients who underwent both brain CT and HRCT within 10 days of head trauma were investigated. Among them, 58 cases of temporal bone fracture confirmed by HRCT were finally included. Fracture patterns (transverse or non-transverse, otic capsule sparing or otic capsule violating) were determined by HRCT. Brain CT findings in correlation with fracture patterns were analyzed. RESULTS: Among 58 confirmed cases of temporal bone fracture by HRCT, 14 cases (24.1%) were not detected by brain CT. Brain CT showed a significantly lower ability to detect temporal bone fracture with transverse component than without transverse component (p=0.020). Moreover, brain CT showed lower ability to detect otic capsule violating pattern than otic capsule sparing pattern (p=0.015). Among the 14 cases of temporal bone fracture that were not detected by brain CT, 4 cases lacked any objective physical findings (facial palsy, hemotympanum, external auditory canal bleeding) suggesting fractures of the temporal bones. CONCLUSION: Brain CT showed poor ability to detect temporal bone fracture with transverse component and otic capsule violating pattern, which is associated with a poorer clinical outcome than otic capsule sparing pattern. Routine use of HRCT to identify temporal bone fracture is warranted, even in cases without evidence of temporal bone fracture on brain CT scans or any objective physical findings suggestive of temporal bone fracture.

Prognosis of In-Hospital Cardiac Arrest and Severe Comorbidities

PURPOSE: The purpose of our study was to evaluate the relevance of a patient's critical comorbidities to his survival rate, along with factors that influence the prognosis of patients who went through in-hospital cardiac arrest. We also investigated the association between the physical burden of the patients' comorbidities and the prognosis of inhospital arrest patients using the Deyo-Charlson score. METHODS: We retrospectively reviewed data for 1,094 patients with in-hospital cardiopulmonary arrest between January 2003 and June 2009 according to the Utstein-style guidelines. Severe comorbidities included congestive heart disease, chronic renal failure, severe liver disease, pulmonary disease, and hematologic or metastatic solid malignancy. Multivariate Cox regression analysis and logistic regression models were used to assess the hazard ratio and survival factors. RESULTS: The hazard ratio of patients with severe liver disease or hematologic or metastatic solid cancer were 1.42 (95% CI, 1.14-1.76, p=0.002) and 1.60 (95% CI, 1.36-1.88, p<0.001), respectively. Shorter CPR duration and subsequent intervention were significant prognostic factors in patients with severe comorbidities. The Deyo-Charlson score was one of the independent prognostic factors in the overall study population. CONCLUSION: The six month survival rate of patients with a history of severe liver disease or hematologic or solid metastatic cancer that underwent in-hospital cardiac arrest is low.

A Study on Bioethical Consideration to Prospective Clinical Research Papers published in Journal of Korean Society of Emergency Medicine

PURPOSE: There is increasing concern about ethical conduct of human research in the field of medicine. The purpose of this study was to assess the ethical review process by institutional review boards for human research articles published in the journal of Korean Society of Emergency Medicine. METHODS: We reviewed human research papers published in the journal of Korean Society of Emergency Medicine from the 1st edition, 1990 to the 6th edition, 2006. A checklist was used to review the articles. RESULTS: The total number of prospective clinical research paper was 250. Among them, there were 63 papers (25.2%) in which the obtaining of informed consent was described in the article. Only two studies (0.8%) published in the journal were noted to have IRB approval. Invasive techniques were employed in 134 studies (53.6%). Among the 134, only 22 (16.4%) mentioned that informed consent taken was given during the study. Studies which may have involved discrimination totaled 21 (8.4%), and the number of studies that may have violated the patients' right to privacy was 20 (8%). The number of studies that may have a conflict of interest but was not declared was 12 (4.8%). CONCLUSION: There should be greater concern about the ethical conduct of research in studies with human research subjects in the journal of the Korean Society of Emergency Medicine.

The Need for an Additional Pelvic CT in Cases of Acute Osseous Pelvic Injury that Has Already Been Diagnosed by Abdominal CT

PURPOSE: Abdominal CT (computed tomography) is a principal diagnostic imaging modality for torso trauma at the Emergency Department (ED). When acute osseous pelvic injuries are detected by abdominal CT, additional three-dimensional (3D) reconstruction pelvic CT is often performed. We compared abdominal CT with pelvic CT to provide information about acute osseous pelvic injuries. METHODS: A retrospective investigation of patients' electronic medical records during the five year period between January 1, 2004 and December 31, 2008 among Korean soldiers who underwent pelvic CT after abdominal CT at the ED was conducted. Axial images of abdominal CT were compared with axial images and 3D reconstruction images of pelvic CT. RESULTS: Sixteen patients underwent subsequent pelvic CT after abdominal CT. Axial images of abdominal CT showed the same results in terms of fracture detection and classification when compared to axial images and 3D reconstruction images of pelvic CT. Pelvic CT (including 3D reconstruction images) followed by abdominal CT neither detected additional fracture nor changed the fracture type. CONCLUSION: This study has failed to show any superiority of pelvic CT (including 3D reconstruction images) over abdominal CT in detecting acute osseous pelvic injury. When 3D information is deemed be mandatory, 3D reconstructions of abdominal CT can be requested rather than obtaining an additional pelvic CT for 3D reconstruction.

Correlation Between the Osmolar Gap and Serum Ethanol Level and the Accuracy of Estimated Ethanol Level in Trauma Patients and Non-Trauma Patients

PURPOSE: The osmolar gap increases in proportion to the ethanol level. Some previous studies have shown that the correlation between the osmolar gap and the ethanol level is weak in trauma patient by using an indirect comparison with other patients. We conducted a direct comparison of the correlation of the osmolar gap to the ethanol level between trauma patients and non-trauma patients. We also analyzed the accuracy of the estimated ethanol level between the two groups. METHODS: The research candidates were adult patients who had visited the emergency department of our hospital from December 2003 to November 2008. By using a retrospective chart review, we classified them into three subgroups: non-trauma without shock, trauma without shock, and trauma with shock. In each group, we compared the correlation between the osmolar gap and the measured ethanol level, and we analyzed the accuracy of the estimated ethanol level by using Lin's concordance correlation coefficient. RESULTS: Four hundred forty-seven patients were enrolled in this study. For correlation of the osmolar gap and the measured ethanol level, Pearson's correlation coefficient was 0.916 in all patients, 0.939 in non-trauma without shock patients, 0.917 in trauma without shock patients, and 0.844 in trauma with shock patients. In the analysis of the accuracy of the estimated ethanol level by using Lin's concordance correlation coefficient, the accuracy in trauma with shock patients was lower than that in non-trauma without shock patients. CONCLUSION: We found that the correlation between the osmolar gap and the measured ethanol level in the patient group with trauma was lower than it was in the patient group without trauma. Moreover trauma patients with shock had a lower accuracy of the estimated ethanol level than non-trauma patients.

The Clinical Characteristics of Amusement-park-related Injuries

PURPOSE: There are no reports on amusement-park-related injuries in Korea. Thus, the objective of this study was to describe traumatic injury patterns that occurring in an amusement park. METHODS: The medical records of an infirmary were retrospectively reviewed. From January 1, 2008, to December 31 2008, patients who were transferred to the nearest emergency departments of hospitals for the purpose of further test and treatment were enrolled. Demographics, injury types and involved parts of the body were analyzed. RESULTS: A total of 3,608 patients visited an infirmary for traumatic injury and about two-thirds had soft tissue injuries. Of those, 191 patients (5.3%) were transferred to the emergency department of a hospital. Of the patients who were transferred to a hospital, laceration and contusion were the responsible injuries for about half. Laceration was the most common injury in pediatric patients, and a sprain or a strain was the most common in adult patients. The most commonly injured parts of the body were the extremities in adult patients. However, in pediatric patients, injuries of the head, face and neck were similar to injuries of the extremities. CONCLUSION: Soft tissue injury was the most common amusement-park-related injury. Laceration was the most common reason to transfer a patient to a hospital. There were differences in injury type and injured part of the body between adult and pediatric patients.

Does the Alcohol Pretreatment Change Blood Ethanol Level in Blood Test?

PURPOSE: Ethanol is the most common toxic substance encountered clinically and is becoming increasingly important in forensic medicine. Generally, pre-treatment with an alcohol disinfectant such as isopropyl alcohol for blood sampling could influence evaluations and affect legal evidence. This study was performed to determine whether isopropyl alcohol affects the serum ethanol level. METHODS: Volunteers were prohibited from drinking alcohol and taking medication for 48 hours prior to participating. Pregnant volunteers and volunteers with abnormal liver enzymes or abnormal kidney function were excluded. Enrolled subjects had their blood collected from each arm to measure the alcohol concentration, one side was disinfected with povidone iodine and the other with isopropyl alcohol. After waiting one hour, they ingested 20g of alcohol and waited. After one hour, the serum ethanol levels were measured using the same method as the first sampling. RESULTS: Ten volunteers enrolled for this study. Without the alcohol intake, all serum ethanol levels were in the nondetectable range(<3 mg/dL) for both samples with either isopropyl alcohol or povidone iodine. After drinking alcohol, the serum ethanol level varied among individuals; the mean value of the serum ethanol levels in the alcohol preparation group was 21.08+/-4.85 mg/dL, which was significantly greater than that of the povidone iodine preparation group (19.71+/-5.47 mg/dL) (p=0.006). However, the Bland-Altman analysis showed that the precision of both groups was 1.230 mg/dL, which was less than the measurement error of the equipment (3.48 mg/dL). Therefore, there was no significant difference between the two groups with regard to the measurement error. CONCLUSION: Before alcohol intake, there was no influence on the blood alcohol concentration from the alcohol disinfection, and the result was reliable. After alcohol intake, the possible influence of pre-treatment alcohol on the serum ethanol level was less than the measurement error of the equipment used.

Experience with Percutaneous Cardiopulmonary Support in Cardiopulmonary Arrest and Postresuscitation Care

PURPOSE: Percutaneous cardiopulmonary support (PCPS) provides hemodynamic stability under various clinical settings, including cardiopulmonary arrest. We compared a single center's experience with performing PCPS during cardiopulmonary resuscitation (CPR) and post-resuscitation care to evaluate the prognostic factors for survival. METHODS: We retrospectively reviewed 83 patients with cardiopulmonary arrest who received PCPS during or within 6 hours of CPR from January, 2004, to December, 2007. Venoarterial bypass systems were used in all cases with femoral cannulation. RESULTS: The mean duration of CPR was 37.2+/-26.4 min and the mean time interval from CPR to PCPS insertion was 73.1+/-107.9 min. The mean duration of PCPS was 73.4+/-110.6 h. Of the 83 patients, 48 underwent PCPS during CPR before recovery of spontaneous circulation and 35 received PCPS during post-resuscitation care for hemodynamic support. Forty-eight patients (57.8%) were successfully weaned off of the PCPS and 34 patients (41.0%) were discharged from the hospital. Among the survivors, 29 patients (34.9%) had no neurological deficits. In multivariate regression analysis, the duration of CPR and defibrillation of pulseless ventricular tachycardia or fibrillation before PCPS were significant prognostic factors for survival (p=0.007 and p=0.015, respectively). In subgroup analysis of the 48 patients who received PCPS before resuscitation with conventional CPR, the duration of CPR that was equal to the time interval from CPR to PCPS insertion was also a significant factor for survival (p=0.011) with a survival rate of 27.1%. CONCLUSION: The duration of CPR is very important for survival. Application of PCPS in CPR can shorten the duration of CPR and maintain hemodynamic stability. Therefore, PCPS is a good resuscitative tool in CPR and post-resuscitation care with an acceptable survival rate and outcome when conventional measures fail.