The effect of changes in reimbursement coverage on the number of brain MRI scan in patients with dizziness in the emergency department

Objective@#This study examined whether the changes in reimbursement coverage of brain magnetic resonance image (MRI) affected practice for patients who visited the emergency department with dizziness as the chief complaint. @*Methods@#Among the 5,423 patients who visited the emergency department for dizziness in 2017, 2019, and 2021, 4,497 patients were included in the study retrospectively and investigated by brain diffusion-weighted MRI and the presence of cerebral infarction on brain diffusion-weighted MRI. This study examined whether there was a significant difference before and after the change. @*Results@#In 2017, 2019, and 2021, 1,489, 1,570, and 1,438 patients with dizziness visited the emergency department, respectively. The number of patients who underwent a brain MRI scan gradually increased from 237 (15.9%) in 2017 to 628 (40.0%) in 2019 and 948 (65.9%) in 2021 (P<0.001). The number of positive findings on brain MRI scan increased gradually from 30 patients (2.0%) in 2017 to 47 patients (3.0%) in 2019 and 53 patients (3.7%) in 2021 (P=0.025). The ratio of positive findings of brain MRI scans to the number of patients who underwent brain MRI scans decreased gradually to 12.7% in 2017, 7.5% in 2019, and 5.6% in 2021 (P=0.001). @*Conclusion@#The changes in the reimbursement coverage of brain MRI affect the number of brain MRI scans and the detection of cerebral infarction.

The impact of COVID-19 through epidemiological changes in out-of-hospital cardiac arrest patients: a study in a single emergency medical center

Objective@#This study compared the epidemiological changes before and after the coronavirus disease 2019 (COVID-19) outbreak in out-of-hospital cardiac arrest patients in a single center. This study analyzed the long-term impact of the COVID-19 pandemic. @*Methods@#Eight hundred and sixty-one out-of-hospital cardiac arrest patients were included in the analysis. Out-of-hospital cardiac arrest patients from January 20, 2018, to January 19, 2020, were used as the control group, and those between January 20, 2020, and January 19, 2022, were used as the study group. The collected data were evaluated using a Student t-test, chi-square test, and logistic regression analysis. @*Results@#During the COVID-19 pandemic, the number of cardiac arrests witnessed at the field level decreased. In the transport stage, mechanical CPR increased and the method for securing the airway had many changes. Transport distances, response times, and on-scene times have increased. Survival discharge from hospital decreased from 9.5% to 5.8% (P=0.045), and good neurological outcomes decreased from 8% to 4% (P=0.017). According to multivariate logistic regression analysis, good neurological outcomes (adjusted odds ratio, 0.299; 95% confidence interval, 0.116-0.772) were significantly lower after the onset of COVID-19. @*Conclusion@#With the outbreak of COVID-19, there have been many changes in the pre-hospital stages of out-of-hospital cardiac arrest patients, and the neurological outcomes have also deteriorated. This continued throughout the pandemic period.

Clinical and Epidemiological Characteristics of Severe Poisoning Patients and Analysis of Prognostic Factors

Purpose@#This study examined the clinical and epidemiological characteristics of intensive care unit (ICU) patients admitted or died in the emergency medical center with acute-poisoning to investigate the variables related to the prognosis. @*Methods@#The data were collected from poisoning patients admitted or died in the emergency medical center of a general hospital located in Seoul, from January 2014 to February 2020. The subjects of this study were 190 patients. The medical records were screened retrospectively, and the clinical and epidemiological characteristics of the patients in the emergency room (ER) and ICU were examined to investigate the contributing factors that influence the poor prognosis. @*Results@#The study analyzed 182 patients who survived after being admitted to the intensive care unit (ICU). The results are as follows. The mental change (87.4%) was the most common symptom. Sedative poisoning (49.5%) was the commonest cause.For most patients, pneumonia (26.9%) was the most common complication. Hypotension (23.7%), tachycardia (42.1%), fever (15.8%), seizures (10.5%), dyspnea (2.6%), high poisoning severity score (PSS), type of toxic material, mechanical ventilator application (39.5%), inotropes application (39.5%), and pneumonia (55.3%) were correlated the LOS over 5 days in the ICU. 8 patients died. In the case of death pesticides and carbon monoxide were the main toxic materials; tachycardia, bradycardia, and hypotension were the main symptoms, and a mechanical ventilator and inotropes were applied. @*Conclusion@#Patients with unstable vital signs, high PSS, and non-pharmaceutical poisoning had a prolonged LOS in the ICU and a poor prognosis.

Clinical and Epidemiological Characteristics of Severe Poisoning Patients and Analysis of Prognostic Factors

Purpose@#This study examined the clinical and epidemiological characteristics of intensive care unit (ICU) patients admitted or died in the emergency medical center with acute-poisoning to investigate the variables related to the prognosis. @*Methods@#The data were collected from poisoning patients admitted or died in the emergency medical center of a general hospital located in Seoul, from January 2014 to February 2020. The subjects of this study were 190 patients. The medical records were screened retrospectively, and the clinical and epidemiological characteristics of the patients in the emergency room (ER) and ICU were examined to investigate the contributing factors that influence the poor prognosis. @*Results@#The study analyzed 182 patients who survived after being admitted to the intensive care unit (ICU). The results are as follows. The mental change (87.4%) was the most common symptom. Sedative poisoning (49.5%) was the commonest cause.For most patients, pneumonia (26.9%) was the most common complication. Hypotension (23.7%), tachycardia (42.1%), fever (15.8%), seizures (10.5%), dyspnea (2.6%), high poisoning severity score (PSS), type of toxic material, mechanical ventilator application (39.5%), inotropes application (39.5%), and pneumonia (55.3%) were correlated the LOS over 5 days in the ICU. 8 patients died. In the case of death pesticides and carbon monoxide were the main toxic materials; tachycardia, bradycardia, and hypotension were the main symptoms, and a mechanical ventilator and inotropes were applied. @*Conclusion@#Patients with unstable vital signs, high PSS, and non-pharmaceutical poisoning had a prolonged LOS in the ICU and a poor prognosis.

The Prognostic Abilities of Severity Scoring Systems for Patients with Septic Shock

PURPOSE: The aim of the study was to validate abbreviated mortality in emergency department sepsis (MEDS) scoring system by comparing it with original MEDS score and to assess the prognostic value of other prognostic factor for sepsis patients including multiple organ dysfunction score (MODS), sepsis-related organ failure assessment (SOFA) score, and serum procalcitonin level. METHODS: Adult patients visiting emergency department (ED) with evidence of septic shock were enrolled to the study. MEDS score, MODS, and SOFA score were calculated based on initial clinical data. Receiver-operating characteristics (ROC) analyses were used to assess the prognostic factors for predicting mortality. Kaplan-Meier survival analyses (KMSA) were used to determine whether the prognostic factors had correlation with survival time. RESULTS: Only MODS showed significant predicting power for mortality (p=0.003, area under curve=0.625). Estimated median survival of all the patients calculated by KMSA was 11.0 (standard error 1.7) days, and predefined criteria of all prognostic factors showed significant differences in survival time. CONCLUSION: MEDS, abbreviated MEDS, MODS, and SOFA scoring systems were useful factors for predicting survival time of septic shock patients visiting ED.

Multivariate Analysis of Predictive Factors for the Severity in Stable Patients with Severe Injury Mechanism

PURPOSE: For determining the prognosis of critically injured patients, transporting patients to medical facilities capable of providing proper assessment and management, running rapid assessment and making rapid decisions, and providing aggressive resuscitation is vital. Considering the high mortality and morbidity rates in critically injured patients, various studies have been conducted in efforts to reduce those rates. However, studies related to diagnostic factors for predicting severity in critically injured patients are still lacking. Furthermore, patients showing stable vital signs and alert mental status, who are injured via a severe trauma mechanism, may be at a risk of not receiving rapid assessment and management. Thus, this study investigates diagnostic factors, including physical examination and laboratory results, that may help predict severity in trauma patients injured via a severe trauma mechanism, but showing stable vital signs. METHODS: From March 2010 to December 2011, all trauma patients who fit into a diagnostic category that activated a major trauma team in CHA Bundang Medical Center were analyzed retrospectively. The retrospective analysis was based on prospective medical records completed at the time of arrival in the emergency department and on sequential laboratory test results. PASW statistics 18(SPSS Inc., Chicago, IL, USA) was used for the statistical analysis. Patients with relatively stable vital signs and alert mental status were selected based on a revised trauma score of more than 7 points. The final diagnosis of major trauma was made based on an injury severity score of greater than 16 points. Diagnostic variables include systolic blood pressure and respiratory rate, glasgow coma scale, initial result from focused abdominal sonography for trauma, and laboratory results from blood tests and urine analyses. To confirm the true significance of the measured values, we applied the Kolmogorov-Smirnov one sample test and the Shapiro-Wilk test. When significance was confirmed, the Student's t-test was used for comparison; when significance was not confirmed, the Mann-Whitney u-test was used. The results of focused abdominal sonography for trauma (FAST) and factors of urine analysis were analyzed using the Chi-square test or Fisher's exact test. Variables with statistical significance were selected as prognostics factors, and they were analyzed using a multivariate logistics regression model. RESULTS: A total of 269 patients activated the major trauma team. Excluding 91 patients who scored a revised trauma score of less than 7 points, 178 patients were subdivided by injury severity score to determine the final major trauma patients. Twenty-one(21) patients from 106 major trauma patients and 9 patients from 72 minor trauma patients were also excluded due to missing medical records or untested blood and urine analysis. The investigated variables with p-values less than 0.05 include the glasgow coma scale, respiratory rate, white blood cell count (WBC), serum AST and ALT, serum creatinine, blood in spot urine, and protein in spot urine. These variables could, thus, be prognostic factors in major trauma patients. A multivariate logistics regression analysis on those 8 variables showed the respiratory rate (p=0.034), WBC (p=0.005) and blood in spot urine (p=0.041) to be independent prognostic factors for predicting the clinical course of major trauma patients. CONCLUSION: In trauma patients injured via a severe trauma mechanism, but showing stable vital signs and alert mental status, the respiratory rate, WBC count and blood in the urine can be used as predictable factors for severity. Using those laboratory results, rapid assessment of major trauma patients may shorten the time to diagnosis and the time for management.

The Improvement of Tongue Mobility and Articulation after Frenotomy in Patient with Ankyloglossia / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Ankyloglossia, manifested by the short and lingual frenulum, can affect tongue mobility and articulation. The purpose of this study is to evaluate the improvement of tongue mobility and articulation in patients with akyloglossia, which is treated by frenotomy. SUBJECTS AND METHOD: A prospective study was done for 81 patients with ankyloglossia undergoing frenotomy, and who were aged between 2 to 10 years old. Outcomes were assessed by measuring tongue mobility, analyzing the articulatory evaluation and reviewing patient questionnaires. RESULTS: The mean length of tongue elevation improved from 7.4 mm preoperatively to 16.3 mm postoperatively (p<0.05). Similarly, the mean length of tongue protrusion improved from 15.0 mm to 26.0 mm (p<0.05). The mean articulation score improved from 8.5 to 9.9 (p<0.05). Parents' subjective satisfaction scores improved from 2.3 to 3.2 (p<0.05). CONCLUSION: Tongue mobility and articulation improved after frenotomy in patients with ankyloglossia.

A Case of Middle Ear Effusion due to Lipoma on the Eustachian Tube / 대한이비인후과학회지

Lipoma of the head and neck region rarely occurs, if any, on the posterior triangle of neck. We have experienced a lipoma on Eustachian tube, which caused recurrent middle ear effusion. A 42-year-old female patient was presented with right aural fullness and hearing disturbance. She had a history of several cases of right middle ear effusion in the past and insertions of ventilation tubes to relieve each of them. A yellowish round mass was found on the pharyngeal orifice of the right Eustachian tube by fiberoptic nasopharyngoscopy. It was removed via endoscopic endonasal approach and there is no evidence of recurrence along about 3 months after the surgery. This would be a good case for the importance of nasopharyngeal examination in patient with middle ear effusion.

Analysis of Structural Changes of the Inferior Turbinate in Patients with Deviated Nasal Septum by Using Computed Tomography / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Compensatory hypertrophy of the inferior turbinate is frequently observed in case of nasal septal deviation. In case of surgical treatment, some advocate that septoplasty must be accompanied by reduction of inferior turbinate. So, the authors analyzed the structural change of the inferior turbinate in nasal septal deviation using the CT scan. SUBJECTS AND METHOD: The CT films of 154 patients who had undergone septoplasty were reviewed retrospectively. All subjects had only Cshaped septal deviation and had no abnormality. Inferior turbinate was divided equally into three portions as anterior, middle and posterior portions. The thickness of mucosa and bone of the inferior turbinate and the degree of inferior conchal bone medialization were measured. RESULTS: In the anterior and middle portion, the degree of medialization at concave side of inferior conchal bone was significantly increased compared to the convex side. In addition, the thickness of bone and mucosa at the concave side was significantly thicker than those of the convex side (p<0.05). However, no significant differences were found in the posterior portion. CONCLUSION: In the nasal septal deviation, the degree of medialization of inferior conchal bone and the thickness of bone and mucosa at the concave side were significantly greater than those of the convex side in the anterior and middle portion.

Long-Term Follow-Up of Immunotherapy in Allergic Rhinitis to House Dust Mite / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study was to evaluate the long-term effect of immunotherapy on the allergic rhinitis patients to house dust mite (HDM) patients. SUBJECTS AND METHOD: Sixty-five patients were treated for allergic rhinitis in the allergy clinic. Every patient underwent immunotherapy for 3 to 5 years and did not receive any additional treatments after the completion of the initial one. The survey on the symptom improvement and the patients' satisfaction was carried out 3 and 10 years after the immunotherapy treatment. The results of skin prick test for each individual were analyzed before, 3 and 10 years after the immunotherapy, respectively. RESULTS: Overall symptom improvement surveyed 10 years after the immunotherapy decreased compared with that taken after 3 years of the treatment (p<0.05). In particular, symptom improvements on sneezing, itching sensation, and rhinorrhea was significantly decreased after 10 years (p<0.05). Patients' satisfaction level was 64.6% after 3 years and 49.2% after 10 years of the immunotherapy treatment. Skin prick test reactivity was significantly decreased after 3 years of the treatment compared to before the treatment. Although skin prick test reactivity measured in 10 years after immunotherapy increased compared with that measured in 3 years after, there was little statistical significance when compared with the reactivity before the treatment. CONCLUSION: The immunotherapy has long term efficacy on allergic rhinitis to HDM. However, the efficacy decreased after the discontinuance of the immunotherapy treatment.