Epidemiological characteristics of disasters in past Korea based on the concept of mass casualty incidents

Objective@#The aim of this study was to investigate the epidemiological characteristics of disasters to analyze typical disasters in Korea based on the concept of mass casualty incidents (MCIs). @*Methods@#We reviewed literature from data sources including the National Emergency Management Agency, the National Police Agency, and other agencies. We analyzed cases of MCIs to investigate their epidemiological characteristics such as natural disasters, types of man-made disasters, incidence, casualties, and mortalities by descriptive methods. @*Results@#From 1985 to 2012, the incidence of man-made MCIs (4,827,893 cases) with the number of the deceased at 160,908 was higher than that of natural disasters (532 cases) with the number of deceased at 4,129. These included 219 cases (41.0%) of heavy rains with the number of deceased at 2,067 (50.1%), 161 cases (30.1%) of gales with the deceased numbering 64 (1.6%), 58 cases (10.9%) of heavy snowfall with the number of deceased at 673 people (16.3%), 51 cases (9.6%) of typhoon with 1,290 people deceased (31.2%), and 43 other cases (8.1%). Man-made disasters from 1999 to 2011 included 3,055,487 cases (85.7%) of traffic accidents with 89,967 (92.5%) deceased, 496,631 cases (13.9%) of fire with the deceased victims numbering 6,130 (6.3%), and 12,924 cases (0.4%) of maritime disasters with the deceased at 1,150 people (1.2%). @*Conclusion@#The concept of disasters has to be changed to reflect the contemporary situation in Korea. The epidemiological characteristics of MCIs as conventional disasters revealed that man-made disasters such as traffic accidents, fires, and natural disasters such as heavy rain, snowfall, and gales occur most frequently and result in the most casualties.

Botryoid Wilms Tumor in a Neonate Presenting with Fetal Hydronephrosis: A Case Report

Botryoid Wilms tumor, a very rare variant of Wilms tumor, arises from the pelvocalyceal system, and its occurrence in the fetal or neonatal period has never been reported in the literature. Herein, we report an exceedingly rare and challenging case of botryoid Wilms tumor in a neonate who initially presented with fetal hydronephrosis. Postnatal ultrasonography revealed multiple lobulating hypoechoic masses with varying degrees of intralesional vascularity within the dilated pelvocalyceal system. To our knowedge, this is a case report of botryoid Wilms tumor of the youngest child in English literature.

Development of a modified trauma and injury severity score to predict disability in acute trauma patients

Objective@#The Trauma and Injury Severity Score (TRISS) has been used to predict trauma patient mortality and to assess the quality of trauma care systems. The goal of this investigation was to develop a modified trauma-related injury severity score (termed the TRISS-D) for predicting disability in acute trauma patients. @*Methods@#We used data collected by emergency medical services and entered into the Korea Centers for Disease Control and Prevention severe trauma database. The TRISS-D was based on age category (0–14, 15–54, ≥55 years), the Revised Trauma Score, and the Injury Severity Score. The outcome measures were severe disability and worsening disability. Worsening disability was defined as a lower Glasgow Outcome Scale score at hospital discharge than before the traumatic incident. Two types of cases were examined: those with penetrating or blunt injuries (group 1) and those with severe head injuries (group 2). We assessed the discriminatory power of the TRISS-D by calculating the area under a receiver operating characteristic curve (AUROC). @*Results@#The database comprised 14,791 patients; overall, 3,757 (25%) had severe disability and 6,018 (41%) had worsening disability. For severe disability, the AUROC (95% confidence interval) for the TRISS-D was 0.948 (0.944–0.952) in group 1 and 0.950 (0.946–0.954) in group 2. The corresponding values for worsening disability were 0.810 (0.803–0.817) and 0.816 (0.809–0.823), respectively. @*Conclusion@#The TRISS-D showed excellent discriminatory power for severe disability and very good discriminatory power for worsening disability.

Development of a modified trauma and injury severity score to predict disability in acute trauma patients

Objective@#The Trauma and Injury Severity Score (TRISS) has been used to predict trauma patient mortality and to assess the quality of trauma care systems. The goal of this investigation was to develop a modified trauma-related injury severity score (termed the TRISS-D) for predicting disability in acute trauma patients. @*Methods@#We used data collected by emergency medical services and entered into the Korea Centers for Disease Control and Prevention severe trauma database. The TRISS-D was based on age category (0–14, 15–54, ≥55 years), the Revised Trauma Score, and the Injury Severity Score. The outcome measures were severe disability and worsening disability. Worsening disability was defined as a lower Glasgow Outcome Scale score at hospital discharge than before the traumatic incident. Two types of cases were examined: those with penetrating or blunt injuries (group 1) and those with severe head injuries (group 2). We assessed the discriminatory power of the TRISS-D by calculating the area under a receiver operating characteristic curve (AUROC). @*Results@#The database comprised 14,791 patients; overall, 3,757 (25%) had severe disability and 6,018 (41%) had worsening disability. For severe disability, the AUROC (95% confidence interval) for the TRISS-D was 0.948 (0.944–0.952) in group 1 and 0.950 (0.946–0.954) in group 2. The corresponding values for worsening disability were 0.810 (0.803–0.817) and 0.816 (0.809–0.823), respectively. @*Conclusion@#The TRISS-D showed excellent discriminatory power for severe disability and very good discriminatory power for worsening disability.

Disasters and the disaster medicine

The definition of a disaster varies across research institutions, although it is generally regarded as a sudden event that demands more resources than the community can offer. Disaster medicine originates from military medicine. It is a new field of medicine that has much in common with emergency medicine, but focuses more on disaster management, targeting populations. It plays a key role both in the pre-event period by helping with disaster preparedness and in the event of a disaster by providing disaster medical services, including on-scene emergency life-saving interventions, thereby contributing to a decrease in the preventable mortality rate. Triage is a system used to sort mass disaster victims according to severity, enabling resources to be allocated, distributed, and utilized more efficiently. During disasters, a hospital should respond to the surge in patients in accordance with the standards and principles of disaster medicine by activating its emergency operation plan, converting the usual medical system into the emergency system, and putting disaster response teams into operation. Disaster medicine is the key discipline for all aspects of preparedness and response to conventional disasters, and even to chemical, biological, radiological, nuclear, and explosive events.

Disasters and the disaster medicine

The definition of a disaster varies across research institutions, although it is generally regarded as a sudden event that demands more resources than the community can offer. Disaster medicine originates from military medicine. It is a new field of medicine that has much in common with emergency medicine, but focuses more on disaster management, targeting populations. It plays a key role both in the pre-event period by helping with disaster preparedness and in the event of a disaster by providing disaster medical services, including on-scene emergency life-saving interventions, thereby contributing to a decrease in the preventable mortality rate. Triage is a system used to sort mass disaster victims according to severity, enabling resources to be allocated, distributed, and utilized more efficiently. During disasters, a hospital should respond to the surge in patients in accordance with the standards and principles of disaster medicine by activating its emergency operation plan, converting the usual medical system into the emergency system, and putting disaster response teams into operation. Disaster medicine is the key discipline for all aspects of preparedness and response to conventional disasters, and even to chemical, biological, radiological, nuclear, and explosive events.

A Study on the Disaster Medical Response during the Mauna Ocean Resort Gymnasium Collapse

PURPOSE: To investigate and document a disaster medical response during the collapse of the Gyeongju Mauna Ocean Resort gymnasium, which occurred on February 17, 2014. METHODS: The official records of each institution were verified to select the study population. All the medical records and emergency medical service records were reviewed by an emergency physician. Personal or telephonic interviews were conducted without a separate questionnaire if the institutions or agencies crucial to disaster response did not have official records or if information from different institutions was inconsistent. RESULTS: One hundred fifty-five accident victims, who were treated at 12 hospitals mostly for minor wounds, were included in this study. The collapse killed 10 people. Although the news of the collapse was disseminated in 4 minutes, it took at lease 69 minutes for a dispatch of 4 disaster medical assistance teams to take action; 4.5% of patients were treated on-site, 56.7% were transferred to 2 nearest hospitals, and 42.6% were transferred to hospitals with poor preparation to handle disaster victims. CONCLUSION: In the collapse of the Gyeongju Mauna Ocean Resort gymnasium, the initial triage and distribution of patients were inefficient, with delayed arrival of medical assistance teams. These problems had also been noted in prior mass casualty incidents. Government agencies are implementing improvements, and this study could aid the implementation process.

A study on the disaster medical response during the Mauna Ocean Resort gymnasium collapse

OBJECTIVE: To investigate and document the disaster medical response during the Gyeongju Mauna Ocean Resort gymnasium collapse on February 17, 2014. METHODS: Official records of each institution were verified to select the study population. All the medical records and emergency medical service run sheets were reviewed by an emergency physician. Personal or telephonic interviews were conducted, without a separate questionnaire, if the institutions or agencies crucial to disaster response did not have official records or if information from different institutions was inconsistent. RESULTS: One hundred fifty-five accident victims treated at 12 hospitals, mostly for minor wounds, were included in this study. The collapse killed 10 people. Although the news of collapse was disseminated in 4 minutes, dispatch of 4 disaster medical assistance teams took at least 69 minutes to take the decision of dispatch. Four point five percent were treated at the accident site, 56.7% were transferred to 2 hospitals that were nearest to the collapse site, and 42.6% were transferred to hospitals that were poorly prepared to handle disaster victims. CONCLUSION: In the Gyeongju Mauna Ocean Resort gymnasium collapse, the initial triage and distribution of patients was inefficient and medical assistance arrived late. These problems had also been noted in prior mass casualty incidents.

Characteristics of Emergency Medical Service Provider Responded Chemical, Biological, Radiological, and Nuclear Incidents: Pilot Analysis of National Emergency Medical Service Rescue Records

PURPOSE: The aim of this study was to evaluate the characteristics of Emergency Medical Service (EMS) provider responded chemical, biological, radiological, and nuclear (CBRN) incidents in Korea. METHODS: Nationwide EMS rescue records from Jan 2012 to Dec 2014 were analyzed. All EMS rescue records were integrated according to the unique accident ID. Cases related to animal rescue, hive removal, and suicide-related were excluded. CBRN-associated keywords were extracted by literature review and pilot survey. In-depth review of cases containing CBRN-associated keywords in the activity summary were conducted by trained emergency medical technicians, and predefined information was abstracted. Descriptive analyses were performed to characterize the EMS provider responded CBRN incidents. RESULTS: A total of 1,571,293 cases were included, and 1,335,205 cases had a unique accident ID; 515,417 cases were excluded because of their association with animal rescue, hive removal, and suicide attempts; 19,663 cases contained CBRN-associated keywords in the activity summary, and in-depth review identified 1,862 cases as CBRN incidents. Among them 1,856 cases were chemical incidents, and 6 cases were radiological incidents; 144 cases were resulted to victims. In chemical incidents, ammonia, hydrogen chloride, sulfuric acid, hydrogen fluoride, and nitric acid were the top 5 toxic substances. In chemical incidents with victims, the proportion of explosion/implosion, and suffocation in sealed space was more prevalent than chemical incidents without victims. Median scene time of all CBRN incidents was 41 minutes (interquartile range 18.0-57.0). CONCLUSION: We evaluated the characteristics of CBRN incidents responded by EMS in Korea.

The Scene Time Interval and Basic Life Support Termination of Resuscitation Rule in Adult Out-of-Hospital Cardiac Arrest

We validated the basic life support termination of resuscitation (BLS TOR) rule retrospectively using Out-of-Hospital Cardiac Arrest (OHCA) data of metropolitan emergency medical service (EMS) in Korea. We also tested it by investigating the scene time interval for supplementing the BLS TOR rule. OHCA database of Seoul (January 2011 to December 2012) was used, which is composed of ambulance data and hospital medical record review. EMS-treated OHCA and 19 yr or older victims were enrolled, after excluding cases occurred in the ambulance and with incomplete information. The primary and secondary outcomes were hospital mortality and poor neurologic outcome. After calculating the sensitivity (SS), specificity (SP), and the positive and negative predictive values (PPV and NPV), tested the rule according to the scene time interval group for sensitivity analysis. Of total 4,835 analyzed patients, 3,361 (69.5%) cases met all 3 criteria of the BLS TOR rule. Of these, 3,224 (95.9%) were dead at discharge (SS,73.5%; SP,69.6%; PPV,95.9%; NPV, 21.3%) and 3,342 (99.4%) showed poor neurologic outcome at discharge (SS, 75.2%; SP, 89.9%; PPV, 99.4%; NPV, 11.5%). The cut-off scene time intervals for 100% SS and PPV were more than 20 min for survival to discharge and more than 14 min for good neurological recovery. The BLS TOR rule showed relatively lower SS and PPV in OHCA data in Seoul, Korea.

Prehospital Cardiopulmonary Resuscitation by 119 Emergency Medical Technician (EMT) for Increasing the Rate of Return of Spontaneous Circulation; National-Wide 119 EMT Survey

PURPOSE: The out-of-hospital cardiac arrest (OHCA) survival rate of patients in Korea is lower than the global average and it might be caused by an extremely low rate of return of spontaneous circulation in the prehospital field. The authors identified obstacles that disturb on-scene performance of cardiopulmonary resuscitation (CPR) for a certain period from 119 emergency medical technicians (EMTs) through a nation-wide paper survey. METHODS: A total of 1273 first grade EMTs and nurses were surveyed. CPR time performed on the scene (without transfer), CPR experiences, self-assessment of CPR skill performance, and both obstacles to performance of CPR on the scene and solutions to overcoming them for continuous on-scene CPR were investigated using a 28-item questionnaire. RESULTS: The average for work experience and the number of CPR experiences of subjects was 6.8+/-4.5 years and 1.9+/-1.7 times/month, respectively. Survey results for CPR times on the scene showed an average of 4.2+/-2.4 minutes, approximately two periods of CPR (30:2x5 cycles). Obstacles to CPR on the scene were investigated as complaints of family members in 791(62.1%) and fatigue lowering CPR quality due to lack of human resources in 536(41.0%); 627(49.3%) of the subjects answered that they had received complaints due to a long stay on the scene. CONCLUSION: In order to increase the survival rate of OHCA patients, CPR on the scene is needed during a certain period in order to achieve a return of spontaneous circulation. Education, amelioration of guidelines, and support for the EMT administrative system are also needed.

Prehospital Cardiopulmonary Resuscitation by 119 Emergency Medical Technician (EMT) for Increasing the Rate of Return of Spontaneous Circulation; National-Wide 119 EMT Survey

PURPOSE: The out-of-hospital cardiac arrest (OHCA) survival rate of patients in Korea is lower than the global average and it might be caused by an extremely low rate of return of spontaneous circulation in the prehospital field. The authors identified obstacles that disturb on-scene performance of cardiopulmonary resuscitation (CPR) for a certain period from 119 emergency medical technicians (EMTs) through a nation-wide paper survey. METHODS: A total of 1273 first grade EMTs and nurses were surveyed. CPR time performed on the scene (without transfer), CPR experiences, self-assessment of CPR skill performance, and both obstacles to performance of CPR on the scene and solutions to overcoming them for continuous on-scene CPR were investigated using a 28-item questionnaire. RESULTS: The average for work experience and the number of CPR experiences of subjects was 6.8+/-4.5 years and 1.9+/-1.7 times/month, respectively. Survey results for CPR times on the scene showed an average of 4.2+/-2.4 minutes, approximately two periods of CPR (30:2x5 cycles). Obstacles to CPR on the scene were investigated as complaints of family members in 791(62.1%) and fatigue lowering CPR quality due to lack of human resources in 536(41.0%); 627(49.3%) of the subjects answered that they had received complaints due to a long stay on the scene. CONCLUSION: In order to increase the survival rate of OHCA patients, CPR on the scene is needed during a certain period in order to achieve a return of spontaneous circulation. Education, amelioration of guidelines, and support for the EMT administrative system are also needed.

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.

Comparing the fully-automated external defibrillator and semi-automated external defibrillator used by laypersons: A simulation study

PURPOSE: This study compared the performance between the fully-automated external defibrillator (F-AED) and the semi-automated external defibrillator (S-AED) when used by laypersons. METHODS: Thirty-three laypersons participated in a mannequin simulation study as part of Cardio-Pulmonary Resuscitation (CPR) training courses. After 30 minutes of didactic education for the Automated External Defibrillator (AED), they watched a video on how to use the fully-automated external defibrillator (F-AED) and a semi-automated external defibrillator (S-AED) instead of a hands-on education. Laypersons performed the S-AED first, then the F-AED. Performances and shock delivery time intervals were recorded and evaluated. RESULTS: The performances in shock delivery were better with the F-AED, although the overall performance was statistically insignificant. In terms of shock delivery interval, the F-AED was shorter than the S-AED (54.48+/-2.84 sec vs. 64.76+/-3.57 sec, respectively, p<0.01). In the post survey, F-AED had a higher preference (F-AED vs. S-AED 23(70%) vs. 5(15%), respectively, p<0.001). CONCLUSION: The F-AED had a better performance and shorter shock delivery time interval than the S-AED. The F-AED should thus be considered for use, outside of the hospital, on cardiac arrest patients for early defibrillation.

Incidence and Mortality Rates of Disasters and Mass Casualty Incidents in Korea: A Population-Based Cross-Sectional Study, 2000-2009

The objective of study was to evaluate the incidence and mortality rates of disasters and mass casualty incidents (MCIs) over the past 10 yr in the administrative system of Korea administrative system and to examine their relationship with population characteristics. This was a population-based cross-sectional study. We calculated the nationwide incidence, as well as the crude mortality and injury incidence rates, of disasters and MCIs. The data were collected from the administrative database of the National Emergency Management Agency (NEMA) and from provincial fire departments from January 2000 to December 2009. A total of 47,169 events were collected from the NEMA administrative database. Of these events, 115 and 3,079 cases were defined as disasters and MCIs that occurred in Korea, respectively. The incidence of technical disasters/MCIs was approximately 12.7 times greater than that of natural disasters/MCIs. Over the past 10 yr, the crude mortality rates for disasters and MCIs were 2.36 deaths per 100,000 persons and 6.78 deaths per 100,000 persons, respectively. The crude injury incidence rates for disasters and MCIs were 25.47 injuries per 100,000 persons and 152 injuries per 100,000 persons, respectively. The incidence and mortality of disasters/MCIs in Korea seem to be low compared to that of trend around the world.

Prognostic Value of an Initial Strong Ion Gap in Critically Ill Patients at the Emergency Department

PURPOSE: This study was performed to determine whether the anion gap, the base excess, the lactate, and the strong ion gap obtained in the emergency department correlate with the prognosis and whether the strong ion gap is the most useful marker compared to the prognostic ability of the anion gap, the base excess, and the lactate. METHODS: We reviewed the records of 106 patients admitted to the intensive care unit via the emergency department. We measured the anion gap, the base excess, and the lactate and we calculated strong anion gap by using a formula. We divided the patients into survivors and nonsurvivors and compared the prognostic abilities of the four variables by using the Student's t-test and receiver operator characteristic curves. RESULTS: The mean age of the patients was 67+/-14, and the numbers of males and females were similar (58 males vs 48 females). The number of survivors was 92 (86.7%), and that of nonsurvivors was 14 (3.2%). The anion gap ( 24.8+/-8.8 vs. 16.4+/-4.8 mmol/L, p value=0.000), the base excess (-11.9+/-8.7 vs. -3.49+/-6.5 mmol/L, p value = 0.001), the lactate (9.1+/-7.7 vs. 4.5+/-3.1 mmol/L, p value = 0.011 ) and the strong ion gap (16.6+/-3.6 vs. 10.9+/-3.7, p value=0.000) of the nonsurvivors were higher. All of the four varibles were associated with the prognosis, but among them, the strong ion gap discriminated most strongly with an area under the receiver operator characteristic curve of 0.866 (95% confidence interval, 0.787 to 0.92). CONCLUSION: The initial emergency-department acid-base variables, the anion gap, the base excess, the lactate and the strong ion gap have prognostic abilities, but the strong ion gap is the variable that most strongly predicts of mortality.

Accuracy of Echocardiography in the Emergency Medicine Department

PURPOSE: At the Emergency Department (ED), echocardiography of patients with chest pain, dyspnea, and syncope is essential to identify the underlying etiology such as acute coronary diseases or other cardiac diseases. Therefore, we studied the accuracy and the clinical value of echocardiography for use by the emergency physician as a tool for the identification and evaluation of cardiac diseases. METHOD: From first, September, 2003 to first, November, 2003, we collected the case histories of 40 patients with suspected cardiac diseases, on whom formal echocardiography had been performed within 2 hours after their initial ED echocardiography. The emergency physicians had a 4-hour didactic training course by cardiologists and 1 month of practical training at a formal echocardiography center, then, they performed the echocardiography using an Acuson ASPENT M ultrasound system with a 3.5-MHz phased-array transducer. Data from the emergency physicians and from the formal echocardiographers were analyzed using the wilcoxson sign test, and the correlation coefficient and p value were calculated. RESULT: There were 28 male patients (70.0%) and 12 female patients (30.0%) and the average age of all patients was 60.9+/-15.5 years. The left ventricular end diastolic diameters (LVEDD) from ED and formal echocardiography were, respectively, 44.6+/-7.9 mm and 48.7+/-6.6 mm (p=0.000), the interventricular septum thicknesses (IVS) were 11.6+/-3.6 mm and 10.9+/-3.0 mm (p=0.064), the left ventricular posterior wall thicknesses (LVPW) were 10.9+/-3.4 mm and 10.1+/-2.00 mm (p=0.178), the ejection fractions (EF) were 59.7+/-15.8% and 60.0+/-16.4%(p=0.312), the left atrium diameters were 36.5+/-6.3 mm and 37.0+/-5.8 mm (p=0.770), the aortic root diameters were 29.2+/-4.0 mm and 33.6+/-3.7 mm (p=0.001), and the inferior vena cava diameters (IVC) were 15.9+/-8.1 mm and 13.3+/-2.5 mm (p=0.444). Except for the LVEDD and the aortic root diameters, there were no significant differences between ED and formal echocardiography, and the presences of regional wall motion abnormalities (RWMA), relaxation abnormalities, right atrium enlargement (RAE), and right ventricle abnormalities were all concordant between the two groups. The correlation coefficients and the p values between ED and formal echocardiography were, respectively, 0.806 and 0.000 for LVEDD, 0.662 and 0.000 for IVS thickness, 0.725 and 0.000 for LVPW thickness, 0.922 and 0.000 for EF, 0.729 and 0.001 for left atrium diameter, 0.331 and 0.037 for aortic root diameter, and 0125 and 0.443 for IVS diameter. CONCLUSION: We suggest that ED echocardiography, like formal echocardiography, with additional focused training can measure and assess the structural and the functional parameters of the heart.

Clinical Study of Anaphylactic Patients with Bee stings Who Visited the Emergency Department

PURPOSE: There have been few studies of bee-sting anaphylaxis in patients visiting the Emergency Department. Thus, this study was performed to observe the general characteristics and the various clinical presentations of beesting anaphylaxis. METHODS: The study was performed for two years between January 2001 and December 2002. The objects of the study were 42 patients who were diagnosed as having anaphylaxis due to bee stings among patients who visited Pundang Jae-Saeng Hospital's Emergency Department. Emergency medicine residents directly followed the beesting anaphylaxis protocol. RESULTS: Males were 33 cases (78.6%), and female wewe 9 cases (21.4%). Severe anaphylaxis occurred in 25 cases (59.5%) and mild anaphylaxis in 17 cases (40.5%). The most frequent month was September with 12 cases (28.6%), and the most frequent place was the mountains with 15 cases (35.7% ). Of the 18 cases (42.9%) presenting with a prior bee-sting history, the incidence of severe anaphylaxis was 14 cases (77.8%) whilst of the 24 cases (57.1%) without any prior history, the incidence was 11 (45.8%)(p= 0.037). CONCLUSION: The history of a previous beesting is more related to the incidence of severe anaphylaxis, and of those patients presenting with systemic symptoms, the incidence rate of severe anaphylaxis is higher at 59.5%. Thus, it seems reasonable to treat patients presenting with systemic symptoms from bee stings or with a history of previous bee stings with early administration of epinephrine and to keep them under close observation.

Clinical Value of a Video Otoscope in Diagnosis of Acute Otitis Media

PURPOSE: Acute otitis media(AOM) has variable clinical symptoms and is diagnosed with injection, bulging, and decreased mobility of tympanic membrane. There are many misdiagnoses because children who are suspected of having acute otitis media are uncooperative during diagnosis with an otoscope. An inaccurate diagnosis of acute otitis media when using an otoscope results in wasted of medical resourses and increased tolerance to antibiotics. Therefore, this study was conducted to evaluate the usefulness of a video otoscope as a tool of diagnosis of acute otitis media. METHODS: Among 416 patients who visited Pundang Jesaeng Hospital Emergency Medical Center with a complaint of otalgia from 1 October 2002 to 30 September 2003, we studied 51 patients who were followed up at the otorhinolaryngology depatment. Emergency Medicine residents recorded the findings for tympanic membrane by using an otoscope and by using a video otoscope. we used kappastatistics to carry out a prospective study in which the accuracy of diagnosis of AOM was analyzed by comparison with the confirmed diagnosis by an otolaryngologic specialist. RESULTS: In this study, the number of males was 24 (47%) and that of females was 27 (53%). Of the 51 Patients, 22 (43%) presented with rhinorrhea, 15 (29%) with cough, 11 (22%) with sputum, 10 (20%) with fever, 8 (16%) with a sore throat, 7 (14%) with otorrhea, 4 (8%) with hearing difficulty, 3 (6%) with irritability, 3 (6%) with tinnitus, 3 (6%) with vomiting and 2 (4%) with dizziness. A comparison of the diagnostic accuracy of AOM between otolaryngologic specialist and residents in emergency department, when was undertaken by using kappa statistics, and a diagnostic agreement of 65% (kappa=0.28) for the otoscope, and 76 %( kappa=0.45) for the video otoscope. The diagnostic sensitivity of acute otitis media by video otoscope was 75%, and specificity was 82%. CONCLUSION: When the tympanic membrane of the patient suspected of a having AOM is examined in an emergency medical center, video otoscopy should be a useful diagnostic tool for AOM owing to its high diagnostic accuracy.

Diagnostic Value of Elevated Liver Transaminase in Hemodynamically Stable Patients with Blunt Abdominal Trauma

PURPOSE: A patient at the emergency department (ED) with blunt abdominal trauma may still have the possibility of liver injury, even though they are hemodynamically stable. Computed tomography (CT) scanning or ultrasonography (US) is available if they are hemodynamically stable. However ultrasonography (US) has technical differences between physicians depending on their skill and computed tomography (CT) is expensive and time consuming, while liver transaminase is widely available, relatively inexpensive. Therefore, we studied diagnostic value of liver transaminase as a screening test for liver injury in hemodynamically stable patients with blunt abdominal trauma. METHODS: From March 2000 to February 2001, we treated 44 hemodynamically stable patients with suspected blunt abdominal trauma who were patients with elevated liver transaminase. An evaluation protocol including patient's age, sex, injury mechanism, history, physical examination, Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), Injury Severity Scale (ISS), liver transaminase, abdominal US and abdominal CT was prospectively performed on all patients by residents and the staff of the emergency department. Based on the confirmed diagnosis of abdominal CT, patients were divided into two groups: group I with liver injury and group II without liver injury. We analysed the two groups by using the t-test and the chisquare test, and calculated the sensitivity, the specificity and the predictive value of serum aspartate aminotransferase (AST) and serum alanine aminotransferase (ALT) by using multiple cutoff values. RESULTS: There were 34 male patients (76.3%) and 10 female patients (23.7%) and the average age of all patients was 37 years. Triage RTS and GCS were, respectively, 11.7+/-0.7 and 13.9+/-2.1 in group I, and 11.4+/-1.2 and 13.2 +/-3.5 in group II, the differences between the two groups were statistically insignificant. The ISS was 26.8+/-9.4 in group I and 21.1+/-8.0 in group II, and the differences was statistically significant. AST and ALT were, respectively, 288.0+/-113.7 IU/L and 177.9+/-95.8 IU/L in group I and 148.1+/-84.8 IU/L and 95.1+/-59.8 IU/L in group II. The maximum value of the highest sensitivity and minimal specificity of AST and ALT, calculated using the receiver operator curve, were AST > 256.3 IU/L and/or ALT > 122.0 IU/L, for which the sensitivity and the specificity were 61.1% and 84.6%, and the positive and the negative predictive values were 73.3% and 75.8%, respectively. CONCLUSION: We recommend that all patient with suspected blunt abdominal trauma be evaluated using serum liver transaminase as a screening test for liver injury even though they are hemodynamically stable. If AST > 256.3 IU/L and/or ALT 122.0 >IU/L, they should be evaluated with abdominal CT to confirm liver injury.