A patient who was diagnosed with arachnoid web due to weakness in the limb: a case report

Arachnoid web is a very rare disease that occurs when the normal flow of cerebrospinal fluid is disturbed due to abnormal formation of the arachnoid membrane in the arachnoid space. Consequently, symptoms appear in the form of various myelopathies, such as loss of strength and sensation in the upper and lower extremities, or bladder control disorders. In general, surgical treatment can be considered if symptoms are exhibited. Arachnoid web requires a high consideration of appropriate diagnosis and treatment methods. However, due to its extremely rare occurrence in actual clinical practice, it is difficult to differentiate from other diseases such as herniated intervertebral disc or subdural tumor causing spinal myelopathy. This would effectively lead to a completely different direction of treatment. To date, there have been no case reports of Arachnoid web in Korea, except for collecting and reporting the focal anterior displacement of the thoracic spine, which is a similar lesion in the spinal cord. This article therefore provides information through case reports and literature review.

Traumatic brain injury in patients aged ≥65 years versus patients aged ≥80 years: a multicenter prospective study of mortality and medical resource utilization

Objective@#This study aimed to determine whether there is a difference in mortality and medical resource utilization between geriatric (aged ≥65 years) and super-geriatric patients (aged ≥80 years) with traumatic brain injury (TBI). @*Methods@#We obtained comprehensive data (demographics, injury characteristics, injury severities, and outcomes) of geriatric and super-geriatric TBI patients from an emergency department-based injury surveillance system database from 2011 to 2016. Multivariate logistic regression analysis was performed to compare the mortality and nonroutine discharge (NRDC) status between both groups. @*Results@#Among 442,533 TBI patients, 48,624 were older than 65 years. A total of 48,446 patients (37,140 geriatric and 11,306 super-geriatric) without exclusion criteria were included in the final analysis. Both overall in-hospital mortality (adjusted odds ratio, 1.88; 95% confidence interval [CI], 1.28 to 2.74; P=0.001) and NRDC (adjusted odds ratio, 1.35; 95% CI, 1.07 to 1.71; P=0.011) were significantly higher in the super-geriatric group. In the stratified analysis, there were no significant differences in NRDC rate for all stratifications of treatment timing (emergency department vs. ward admission), but mortality remained to be significant for all stratifications. @*Conclusion@#Super-geriatric TBI patients showed a significantly higher risk-adjusted overall mortality and more inadequate medical resource utilization than did geriatric TBI patients. However, super-geriatric patients were more likely to undergo NRDC after admission; thus, further research about age-related health inequalities is needed in the treatment of super-geriatric patients.

A patient who was diagnosed with arachnoid web due to weakness in the limb: a case report

Arachnoid web is a very rare disease that occurs when the normal flow of cerebrospinal fluid is disturbed due to abnormal formation of the arachnoid membrane in the arachnoid space. Consequently, symptoms appear in the form of various myelopathies, such as loss of strength and sensation in the upper and lower extremities, or bladder control disorders. In general, surgical treatment can be considered if symptoms are exhibited. Arachnoid web requires a high consideration of appropriate diagnosis and treatment methods. However, due to its extremely rare occurrence in actual clinical practice, it is difficult to differentiate from other diseases such as herniated intervertebral disc or subdural tumor causing spinal myelopathy. This would effectively lead to a completely different direction of treatment. To date, there have been no case reports of Arachnoid web in Korea, except for collecting and reporting the focal anterior displacement of the thoracic spine, which is a similar lesion in the spinal cord. This article therefore provides information through case reports and literature review.

Traumatic brain injury in patients aged ≥65 years versus patients aged ≥80 years: a multicenter prospective study of mortality and medical resource utilization

Objective@#This study aimed to determine whether there is a difference in mortality and medical resource utilization between geriatric (aged ≥65 years) and super-geriatric patients (aged ≥80 years) with traumatic brain injury (TBI). @*Methods@#We obtained comprehensive data (demographics, injury characteristics, injury severities, and outcomes) of geriatric and super-geriatric TBI patients from an emergency department-based injury surveillance system database from 2011 to 2016. Multivariate logistic regression analysis was performed to compare the mortality and nonroutine discharge (NRDC) status between both groups. @*Results@#Among 442,533 TBI patients, 48,624 were older than 65 years. A total of 48,446 patients (37,140 geriatric and 11,306 super-geriatric) without exclusion criteria were included in the final analysis. Both overall in-hospital mortality (adjusted odds ratio, 1.88; 95% confidence interval [CI], 1.28 to 2.74; P=0.001) and NRDC (adjusted odds ratio, 1.35; 95% CI, 1.07 to 1.71; P=0.011) were significantly higher in the super-geriatric group. In the stratified analysis, there were no significant differences in NRDC rate for all stratifications of treatment timing (emergency department vs. ward admission), but mortality remained to be significant for all stratifications. @*Conclusion@#Super-geriatric TBI patients showed a significantly higher risk-adjusted overall mortality and more inadequate medical resource utilization than did geriatric TBI patients. However, super-geriatric patients were more likely to undergo NRDC after admission; thus, further research about age-related health inequalities is needed in the treatment of super-geriatric patients.

Interpersonal violence epidemiology and mortality by violence victim-perpetrator relationships

OBJECTIVE: The aim of this study was to investigate the interpersonal violence (IPV) epidemiology and mortality according to the violence victim-perpetrator relationships. METHODS: A retrospective cross-sectional study was done using the comprehensive data of the emergency department (ED)-based Jeju Injury Surveillance System from all EDs in Jeju Island. The demographic characteristics of the victims, the types of perpetrators (spouse, family members, acquaintance, and stranger), injury characteristics and clinical outcomes from the injury were collected. The IPV epidemiology was reported by descriptive statistics. Multivariate Poisson regression was used to analyze the association between the mortality and violence victim-perpetrator relationships. RESULTS: Among the 23,508 violent injury patients enrolled from January 1, 2008, and December 31 of 2016, 19,879 (84.6%) were analyzed; 16 (0.08%) died at the ED. The types of perpetrators were the spouse (10.1%), family members (3.9%), acquaintances (43.4%), and strangers (42.7%). The mortality of the violence victims was increased significantly by the spouse (incidence rate ratio [IRR], 6.336; P=0.043) or family members (IRR, 11.089; P=0.016) compared to strangers. On the other hand, there was no difference between the acquaintances and strangers. CONCLUSION: The epidemiology and mortality of IPV were associated with the violence victim-perpetrator relationships. Therefore, it is necessary to develop and apply prevention programs considering these differences, particularly for intimidate/ family violence because of its high fatality.

Comparison of Injury Patterns between All-terrain Vehicles and Motorbike Riders in Jeju Island

PURPOSE: As the usage rate of all-terrain vehicles (ATV) the number of injuries caused by ATVs is also surging. This has led to an increase in social attention to the safety of ATVs and the law for ATV safety standards was revised in 2009 and 2011. The purpose of this study was to evaluate the characteristics of ATV injury compared with motorbike injury after implementation of the ATV safety policy. METHODS: A retrospective cross-sectional observation study was conducted using emergent department (ED)-based indepth injury surveillance system data from 2011 January to 2014 December. Demographics, injury-related characteristics, injury severity, and outcomes of patients related to ATV and motorbike injury visiting our ED were analyzed. Multivariate logistic regression was used for major adverse event (MAE), which was defined as any intensive care, emergent operation, or death between ATV and motorbike related injury adjusted for covariates. RESULTS: During the study period, there were 101 ATV- and 584 motorbike-related injuries. Females had more ATV-related injuries (63.4% vs 32.9%, p<0.001) during leisure activities (93.1%) with higher helmet usage (73.3% vs 62.0%, p=0.01) and lower usage in terms of emergency medical service (23.8% vs 46.4%, p<0.001), automobile insurance (10.9% vs 54.1%, p<0.001) compared with motorbike-related injuries. MAE in ATV-related injuries was less likely in a univariate logistic model (unadjusted odd ratios [ORs] 0.489, 95% confidential intervals [Cis] 0.282 to 0.848), but the multivariate logistic model showed no significant difference (adjusted ORs 1.018, 95% CIs 0.376 to 1.414). CONCLUSION: Results of this study showed no significant difference in occurrence of clinical major adverse events between motorbikes and ATVs-related injury on Jeju Island. However, considering the high injury prevalence in young age, female, and passengers during leisure activities, development of an education and injury prevention program will be needed for this vulnerable population.

Characteristics and Risk Factors of Pediatric Eye Injury Patients in Emergency Department: Multicenter Cross-Sectional Study

PURPOSE: This study was conducted in order to determine the characteristics and risk factors of pediatric eye injury patients in the emergency department and to offer strategies for prevention of pediatric eye injury. METHODS: This prospective study was conducted by use of a standardized eye injury survey of patients under the age of 16 years who were treated for ocular injury at nine emergency medical centers, from March to September of 2010. The following data were collected; general characteristics of the study population, type and location of injury, causative activities, and materials of injury. Risk factors associated with open-globe injury were analyzed by logistic regression. RESULTS: A total of 1,151 patients were enrolled in the study; 75% were male. The highest incidence was observed between the age of 11 and 16 years (34.5%); 79.2% of patients had closed globe injury. The most common type of injury was contusion (65.4%) in closed globe injury and penetration (5.1%) in open-globe injury. Eye injury occurred most commonly at home (48.6%), followed by school/institution (19.4%). The most common causative activity and material were play (42.4%) and person/animal/plant (17%). Application of eye protective equipment (odds ratio: 24.33; 95% CI: 11.32~52.29) was found to be a statistically significant factor for occurrence of an open-globe injury. CONCLUSION: Establishment of safety measures considering gender and age is important since characteristics of pediatric eye injury differ based on such risk factors. The risk of open-globe eye injury increased with application of personal protective equipment, therefore, public education and promotion to use protective equipment of adequate level would be considered important.

Scientific Framework for Research on Disaster and Mass Casualty Incident in Korea: Building Consensus Using Delphi Method

We aimed to determine the scientific framework for research on disaster and mass casualty incident (MCI) in Korea, especially Korean terminology, feasible definition, and epidemiologic indices. The two staged policy Delphi method was performed by instructors of National Disaster Life Support (NDLS(R)) with the constructed questionnaire containing items based on the literature review. The first-stage survey was conducted by 11 experts through two rounds of survey for making issue and option. The second-stage survey was conducted by 35 experts for making a generalized group based consensus. Experts were selected among instructors of National Disaster Life Support Course. Through two staged Delphi survey experts made consensus: 1) the Korean terminology "jaenan" with "disaster" and "dajung-sonsang-sago" with "MCI"; 2) the feasible definition of "disaster" as the events that have an effect on one or more municipal local government area (city-county-district) or results in > or = 10 of death or > or = 50 injured victims; 3) the feasible definition of MCI as the events that result in > or = 6 casualties including death; 4) essential 31 epidemiologic indices. Experts could determine the scientific framework in Korea for research on disaster medicine, considering the distinct characteristics of Korea and current research trends.

Tangalle Sri Lanka Emergency Medical Center: To Implement a New Operating and Management System Through Means of Surveys

PURPOSE: This study was conducted in the base hospital of Tangalle, Sri Lanka, in order to improve a new emergency operating system. METHODS: Emergency staff and patients were surveyed based on the five point Likert scale. Doctors and nurses were asked to rate their level of satisfaction regarding their relationship with patients. Patients were asked to rate their level of satisfaction with doctors, facilities, and the environment in the hospital. RESULTS: Doctors were overall satisfied with their job, scoring an average of 3.7. They were displeased with limitation of autonomous decision making on medical treatment, which they gave a score of 2.80. Nurses were generally satisfied with emergency services, with a score of 4.53. Nurses feel discomfort in non-specialized training (3.02). They also sense a lack of opportunities in their hospital (3.12). Patients' findings indicate that most patients were satisfied (4.2) and were displeased with wait time (3.429) and the attention that was given to each patient (3.92). When asked if they would recommend their physician to others and were willing to come back to their physician, outcomes were generally positive, receiving scores of 4.1, respectively. CONCLUSION: Findings showed that in order to create a well-structured system in the emergency centers around the Tangalle area, it is crucial to meet the needs of both patients and the emergency staff. Patients must have a sense of rapid treatment as well as privacy. Training should be provided to the staff so that they are better informed in quality care and up to date on recent studies.

The Demand and Causes of Emergency Medical Service Utilization of Visitors on Jeju Island, South Korea

PURPOSE: Providing proper emergency medical services (EMS) for domestic or international visitors to popular destinations is becoming increasingly important. Jeju Island is the most visited spot in South Korea. The number of people visiting Jeju Island has increased every year, and this was over ten times the registered population on Jeju Island. The purpose of this study was to describe EMS use behavior and to estimate demand for EMS for visitors on Jeju Island. METHODS: A retrospective observational study was conducted on Jeju Island, with 580,000 citizens. EMS is a fire-based system with a single tiered intermediate service level by a single centralized dispatch center, 29 ambulances, and approximately 130 EMS providers. We collected all ambulance run-sheet data, which included comprehensive information as well as patients' address identification, monthly number of visitors, and census data of Jeju Island from January, 2010 to December, 2012. RESULTS: Among 90,674 EMS transports, 7,209 (8%) were excluded because of unknown address of patients, and of all 83,456 (100%) patients using EMS, 9,733 (12%) were visitors and 73,732 (88%) were residents. The percentage of females was higher for visitors than residents (45% vs. 43%, p<0.001) and the mean age was younger in visitors (38+/-19 vs. 54+/-22, p<0.001). Injury was much higher for visitors than residents (63% vs. 38%, p<0.001). The estimated monthly number of EMS use per 10,000 people was 3.7 (95% CI 3.5 to 3.9) in visitors and 35.7 (95% CI 34.9 to 36.5) in residents, with a ratio of 0.104 (95% CI 0.099 to 0.108). The trend of ratio by year was not significant (p=0.630). The correlation between monthly EMS use in visitors and monthly number of unregistered population was significant (Pearson's correlation 0.844). CONCLUSION: Determining EMS use behavior and the demand of EMS in visitors is a critical task. Our results are of interest in preparing and providing the provision of EMS for visitors.

Validation of Pre-Hospital Stroke Screens by Ambulance Service Personnel: A Prospective Observation Study

PURPOSE: We evaluated the validity of Pre-Hospital stroke screening (PHSS) by 119 ambulance rescuers in Korea. METHODS: Patients at least 20 years old with presumed stroke were transported to six emergency medical centers and prospectively enrolled during a 12-month period. A total of 119 ambulance rescuers applied the Cincinnati Pre-Hospital Stroke Scale (CPHSS) and the Los Angeles Pre-Hospital Stroke Screen (LAPHSS). Emergency physicians (EPs) further assessed the patients with CPHSS and LAPHSS. The final diagnoses were divided into stroke and other disease categories through a review of hospital records. The sensitivity and specificity of the two screening tools were analyzed for predicting stroke. The CPHSS and LAPHSS scores from all patients were compared between the 119 ambulance rescuers and EPs. RESULTS: The 119 ambulance rescuers referred 348 suspected stroke patients, of whom 164(47.1%) had their stroke confirmed. For all kinds of stroke, the sensitivity and specificity of the CPHSS were 86.3%[95% confidence interval (CI) 58.6~76.1] and 65.9%(95% CI 57.0~74.0), respectively, and those of the LAPHSS were 70%(95% CI 61.0~78.0) and 67.8%(95% CI 58.6~76.1), respectively. The Kappa value between the 119 ambulance rescuers and EPs was k=0.619(95% CI 0.523~0.715) for the CPHSS and k=0.392(95% CI 0.275~0.510) for the LAPHSS. CONCLUSION: CPHSS and LAPSS performed by 119 ambulance rescuers had considerable validity in Korea.

Specific Activity Types at the Time of Event and Outcomes of Out-of-Hospital Cardiac Arrest: A Nationwide Observational Study

This study aimed to describe the characteristics of out-of-hospital cardiac arrest (OHCA) according to specific activity types at the time of event and to determine the association between activities and outcomes according to activity type at the time of event occurrence of OHCA. A nationwide OHCA cohort database, compiled from January 2008 to December 2010 and consisting of hospital chart reviews and ambulance run sheet data, was used. Activity group was categorized as one of the following types: paid work activity (PWA), sports/leisure/education (SLE), routine life (RL), moving activity (MA), medical care (MC), other specific activity (OSA), and unknown activity. The main outcome was survival to discharge. Multivariate logistic analysis for outcomes was used adjusted for potential risk factors (reference = RL group). Of the 72,256 OHCAs, 44,537 cases were finally analyzed. The activities were RL (63.7%), PWA (3.1%), SLE (2.7%), MA (2.0%), MC (4.3%), OSA (2.2%), and unknown (21.9%). Survival to discharge rate for total patients was 3.5%. For survival to discharge, the adjusted odds ratios (95% confidence intervals) were 1.42 (1.06-1.90) in the SLE group and 1.62 (1.22-2.15) in PWA group compared with RL group. In conclusion, the SLE and PWA groups show higher survival to discharge rates than the routine life activity group.

The Characteristics of Injured Pregnant Patients Visiting Seven Emergency Departments

PURPOSE: In Korea, few studies have compared outcomes in injured pregnant women to their non-pregnant counterparts. The purpose of this study is to describe the characteristics of patients injured during pregnancy who visited seven emergency departments in South Korea. METHODS: The Korean Traumatic Brain and Spine Injury Research Network (KTBSIRN) database, based on 7(emergency department) from June, 2008 to September, 2010 was used to derive data on all injured patients between 12 and 49 years of age. Data were divided into two comparison groups: pregnant and non-pregnant women. For comparison of characteristics and admission by pregnancy, we selected patients using the statistical matching method according to hospital, age, and injury mechanism after comparison with all enrolled patients. Then, members of the pregnant women group were divided into two subgroups: or =20 weeks gestational age. RESULTS: A total of 13,449 women were identified in a total of 76,596 injuries. Among them, 164(1.22%) women were pregnant. Fewer alcohol-related injuries were observed in pregnant women compared with non-pregnant women. Transportation was the leading mechanism of ED injury visits by pregnant women (52.4%). Emergency Medical Service (EMS) usage (22.0% vs. 14.6%, p<.0.008) and admission (14.0% vs. 7.9%, p<.0.001) were more common in pregnant women than in non-pregnant women. However, no significant difference was observed in injury severity scores. After matching, adjusted odds ratio of pregnancy for admission was 2.8(95% CI: 1.46~5.53). Less than half the number of pregnant women underwent an obstetric exam and non-stress test (NST) for the fetus (44.5% and 27.4%, respectively). CONCLUSION: Injured pregnant women who visited the ED were used more medical resources but showed no significant difference in injury severity. Despite maternal and fetal risk after injury, obstetric exam including fetal monitoring was not performed appropriately. Therefore, establishment of standards for injured pregnant women is needed in many EDs.

Comparison of Clinical Characteristics of Pulmonary Tuberculosis between General and Homeless Patients

PURPOSE: We compared characteristics and outcomes of pulmonary tuberculosis in homeless and non-homeless patients. METHODS: A retrospective, cross-sectional study was conducted in a Seoul municipal medical center between January 2007 and December 2011. All adult patients diagnosed with pulmonary tuberculosis were included. We classified these patients into homeless and non-homeless and compared the disease characteristics, risk factors, mortality, treatment completion rate, and resistance rate. RESULTS: All 157 patients were diagnosed with pulmonary tuberculosis (75 homeless and 82 non-homeless). Most homeless patients were male (97.3%) and had higher emergency medical service (EMS) use (77.3%). Additionally, most homeless patients used alcohol l(76%) and smoked (77.3%). When compared with the non-homeless group, the homeless group had a higher in-hospital mortality rate (14.7%; adjusted odds ratio (OR), 4.69; 95% confident interval (CI), 1.03-21.34), and were more likely to be admitted for (adjusted OR=3.27(1.07-9.97)), but not to complete tuberculosis treatment (adjusted OR=9.10(2.24-36.98)). CONCLUSION: Pulmonary tuberculosis showed higher mortality in homeless than non-homeless patients. Additionally, homeless had a lower treatment completion rate and fewer resistant microorganisms.

Effect of Emergency Department Video-nystagmography for Patients with Dizziness

PURPOSE: We evaluated the effects of emergency department (ED)-based video-nystagmography (VNG) testing on consultation with other departments and length of ED stay of patients with dizziness. METHODS: A before-and-after study was performed at a tertiary ED from May 13, 2011 to May 12, 2012. Adult patients (age> or =15 years) with dizziness were enrolled, excluding patients with incomplete information. We defined the before- and after-phase according to implanting of the ED-based VNG test. The VNG test was performed by an internship physician supervised by 2nd or 3rd grade emergency medicine residents. Primary outcome was any consultation to other specialty departments and the secondary outcome was the length of stay at the ED. The adjusted odds ratios (ORs) with 95% confidence interval (95% CI) for outcomes by phase were estimated using multivariate logistic regression analysis adjusting for potential co-variates. RESULTS: Of 1,485 eligible patients, 1,449 patients (male: 37.0%, mean age: 59.2+/-15.5 years) were enrolled (415 in the before-phase and 1,034 in the after-phase). The final diagnosis group was stroke (4.8%), peripheral vestibulopathy (44.9%), other specific disease (29.0%), and non-diagnostic symptom (21.4%). The consultation request was more reduced in the after-phase (38.1%) than the before-phase (52.5%). The LOS was not changed between both phases (7.4+/-7.5 hours versus 7.4+/-7.3 hours, p=0.76). The adjusted OR (95% CI) for the consultation of after-phase compared to before-phase was 0.46(0.35, 0.61), while the adjusted OR (95% CI) for LOS was 1.39(0.99, 1.95). CONCLUSION: Implementation of ED-based VNG test significantly reduced the consultation with other specialty departments, while LOS was not affected.

Comparison between Emergency Patient Poisoning Cases and the Tox-Info System Database

PURPOSE: The Tox-Info system is a poisonous substance information database developed by the Korean National Institute of Food and Drug Safety Evaluation. The aim of this study was to estimate the coverage effectiveness of the Tox-Info system by comparing the toxic substances included in the database with the distribution of the toxic substances implicated in the cases of intoxicated patients presenting to emergency departments. The secondary aim of the study was to propose any additional substances that should be added to the database. METHODS: We retrospectively reviewed the medical records of patients suffering with toxic exposure who had visited any of 12 selected emergency departments in Korea from January 2010 to December 2011. The identified toxic substances were classified into groups including prescription drugs, agricultural chemicals, household products, animals or plants, herbal drugs, and others. We calculated the coverage rate of the Tox-Info database relative to the number of intoxication cases and the type of toxic substances involved. RESULTS: A total of 5,840 intoxicated patient records were collected. Their mean age was 46.6+/-20.5 years and 56.2% were female. Of the total intoxication cases, 87.8% of the identified toxic substances were included in the Tox-Info database, while only 41.6% of all of the types of identified toxic substances were included. Broken down by category, 122 prescription drugs, 15 agricultural chemicals, 12 household products, 14 animals or plants and 2 herbal drugs involved in poisoning cases were not included in the Tox-info database. CONCLUSION: This study demonstrated the clinical usefulness of the Tox-Info system. While 87.8% of the substances involved in the cases were included in the Tox-Info database, the database should be continuously updated in order to include even the most uncommon toxic substances.

Effects of using Prehospital Emergency Care by 119 Rescue Services on Outcome of ST-elevation Myocardial Infarction Patients

PURPOSE: This study was performed to evaluate the effects of prehospital emergency care use by 119 rescue services on the outcome of acute ST-elevation myocardial infarction (STEMI). METHODS: All patients who visited 23 hospital emergency departments and who were finally diagnosed with STEMI between January and December 2008 were enrolled. They were divided into two groups: use of 119 rescue service or non-use. The propensity score matching method was used considering factors known to be influential for the use of 119 rescue services (age, gender, educational status, chief complaints, cardiogenic shock, respiratory rate, heart rate). Hospital mortality was defined as patient death in the hospital following admission. The comparative odds ratio (OR) and confidence interval (CI) of mortality between the 119 use and non-use groups were determined. RESULTS: Of the 1,118 STEMI patient, no statistical differences were evident in gender and age. Patients who used the 119 rescue services displayed lower educational status and rare complaint of chest pain is rare (36.6% vs 63.4%). But syncope and cardiac arrest were more frequent in the 119 user group than non-user group (syncope: 84.6% vs 15.4%, respectively; cardiac arrest: 76.0% vs 24.0%, respectively). Propensity score matching system was performed and extracted 390 patients in each group. The extracted patients were not statistically different in demographic findings and influencing factors of 119 service use. Hospital mortality did not differ between the 119 user and non-user groups (OR=1.294, 95% CI:0.612-2.735). Increased hospital mortality of STEMI patients was correlated with increased age (OR=1.036, 95% CI:1.012-1.060), prehospital ECG monitoring (OR=2.601, 95% CI:1.011-6.693), and cardiogenic shock (OR=4.736, 95% CI:2.482-9.037). CONCLUSION: The use of prehospital mobile units did not influence on hospital mortality of acute ST-elevation myocardial infarction.

Effects of using Prehospital Emergency Care by 119 Rescue Services on Outcome of ST-elevation Myocardial Infarction Patients

PURPOSE: This study was performed to evaluate the effects of prehospital emergency care use by 119 rescue services on the outcome of acute ST-elevation myocardial infarction (STEMI). METHODS: All patients who visited 23 hospital emergency departments and who were finally diagnosed with STEMI between January and December 2008 were enrolled. They were divided into two groups: use of 119 rescue service or non-use. The propensity score matching method was used considering factors known to be influential for the use of 119 rescue services (age, gender, educational status, chief complaints, cardiogenic shock, respiratory rate, heart rate). Hospital mortality was defined as patient death in the hospital following admission. The comparative odds ratio (OR) and confidence interval (CI) of mortality between the 119 use and non-use groups were determined. RESULTS: Of the 1,118 STEMI patient, no statistical differences were evident in gender and age. Patients who used the 119 rescue services displayed lower educational status and rare complaint of chest pain is rare (36.6% vs 63.4%). But syncope and cardiac arrest were more frequent in the 119 user group than non-user group (syncope: 84.6% vs 15.4%, respectively; cardiac arrest: 76.0% vs 24.0%, respectively). Propensity score matching system was performed and extracted 390 patients in each group. The extracted patients were not statistically different in demographic findings and influencing factors of 119 service use. Hospital mortality did not differ between the 119 user and non-user groups (OR=1.294, 95% CI:0.612-2.735). Increased hospital mortality of STEMI patients was correlated with increased age (OR=1.036, 95% CI:1.012-1.060), prehospital ECG monitoring (OR=2.601, 95% CI:1.011-6.693), and cardiogenic shock (OR=4.736, 95% CI:2.482-9.037). CONCLUSION: The use of prehospital mobile units did not influence on hospital mortality of acute ST-elevation myocardial infarction.

Association between Case Volume of Cardiopulmonary Resuscitation and Implementation of Therapeutic Hypothermia

PURPOSE: Therapeutic hypothermia (TH) is recommended as a strategic post-resuscitation care for favorable neurologic outcomes. However, information concerning the implementation of TH and associated number of cardiopulmonary resuscitation (CPR) volumes is lacking. METHODS: We conducted a telephone survey using a designed questionnaire from March to December, 2009. Information of target hospitals was collected from a national registry of out of hospital cardiac arrest (2006-2007). Hospital name, service levels of emergency department (ED; level 1-4), case volume of cardiopulmonary resuscitation given at each ED (high versus low volume by 34 cases per year derived from a previous sensitivity analysis study), population (metropolis exceeding one million residents), and year when TH was adopted were recorded. Demographics and factors associated with adaptation of TH were analyzed and odds ratios were calculated using a multivariate logistic regression model. RESULTS: A total of 39,833 OHCA cases for 2 years were transported to 840 hospitals. Of these hospitals, 461 (55.8%) were included for final analysis. Thirty four of the hospitals (7.4%) had adopted TH. Of these, 16 hospitals housed a high-volume ED (odds ratio=2.93). Twenty four hospitals were located in a metropolis (odds ratio=3.05) and 25 hospitals were ED level 1 or 2. CONCLUSION: Only 7.4% of surveyed Korean hospitals had adopted TH in Korea by the end of 2009. Hospitals with high-volume EDs adopted TH early, when adjusting for population and ED level.

Diagnostic Test Performance Characteristics of ST-segment Elevation Myocardial Infarction by Level 1 Emergency Medical Technicians Before vs After an Electrocardiogram Education Program

PURPOSE: Pre-hospital diagnosis and activation of a treatment protocol for ST-segment elevation myocardial infarction (STEMI) is the standard of care in developed countries. But the ability of Korean emergency medical technicians (EMTs) to interpret the 12-lead electrocardiogram (ECG) has not been established. The aim of this study was to compare the diagnostic performance of STEMI done by EMTs before and after an ECG education program. METHODS: Seventy three Level-1 EMTs were enrolled from 2006 to 2008 in an eight-week clinical training program. Daily case discussion sessions for interpretation of interpretation of STEMI and acute myocardial infarction, respectively, were followed. before and after the training. EMTs were tested on whether ST elevation was present on the ECG. Correct answer rates of EMTs before and after the education session were compared. We calculated sensitivity, specificity, and accuracy of diagnosis for STEMI. The paired t test was used for statistical analysis. RESULTS: The correct answer rate for all ECG s was 26.8+/-19.3% before education and 45.3+/-26.2% after education. For STEMI ECGs, it was 23.3+/-28.7% before education and 49.7+/-36.2% after education (p<0.001). The performance of EMTs in identifying STEMI on the ECG had a sensitivity of 24.0%, a specificity of 28.9%, and an accuracy of 27.6% before education. After education, these scores were improved to 48.6%, 44.3%, and 45.5% respectively. CONCLUSION: There is significant improvement in ECG interpretation for STEMI through an ECG education program, but accuracy for diagnosis of STEMI by Korean emergency medical technicians was low.