ABSTRACT
PURPOSES: There have been many efforts to improve the service of emergency centers. In spite of these, no evidence is showing any landmark advancement of emergency services, especially in the hospital stage, exists. We need some efficient standard criteria to evaluate emergency service in the hospital stage, and a useful method might utilize the overcrowding index. We want to know the change in the overcrowding index at a regional emergency center after injury area administration. Injury area means an area in which only an assigned duty physician manages patients with injuries such as those from traffic accidents, falls, assualts, collisions, lacerations, amputations, burns, intoxication, asphyxia, drowning, animal bites, sexual assualts, etc. METHODS: We started to operate an injury area in our emergency department from late 2004, and from January to June in 2004 and in 2005, we collected patients' data, age, sex, assigned department, and result from hospital order communication system to figure out overcrowding indices and result indices. We found the daily number of patients, the turnover rate, the admission rate, the ICU admission rate, the emergency operation rate, the ED stay duration, and the ED patient volume to be overcrowding indices. Also we found the withdrawal rate, the transfer rate, and mortality to be result indices. We compared these indices between 2004 to 2005 by using a t-test. RESULTS: There was a significant increase in the daily number of visiting patients in 2005, overcrowding indices, such as the turnover rate, the admission rate, the ICU admission rate, and the emergency operation rate, also showed statistically significant increases in 2005 (P<0.001). As for the result indices, there was a noticeable decrease in the number of withdrawals (11.77/day in 2004 to 4.53/day in 2005). CONCLUSION: Operating an injury area in a mildly overcrowded local emergency center is beneficial. Evaluating the effect of operating an injury area and it's impact on hospital finances by conducting a similar study analyziing patients for a longer duration would be valuable.
Subject(s)
Animals , Humans , Accidents, Traffic , Amputation, Surgical , Asphyxia , Burns , Drowning , Emergencies , Emergency Service, Hospital , Lacerations , MortalityABSTRACT
PURPOSE: Alcohol consumption is an important risk factor for injury. It is controversial, however, whether alcohol also has an effect on the severity of injury. We tried to evaluate the effect of alcohol on the severity of injury, especially on the severity of blunt injury due to traffic accidents, falls, collisions, and so on. METHODS: We used the ED-based injury registry in a regional emergency center. During two months, 831 victims were registered. We enrolled 397 patients who were over 15 years and had been injured by blunt trauma. We classified them into two groups by alcohol consumption. Positive alcohol consumption was defined as that positively confirmed by the victims or guardians, or that suspected on physical examination. The injury severity was measured by using the New Injury Severity Score, the Revised Trauma Score, the Trauma and Injury Severity Score (TRISS), the probability of survival of TRISS, and the International Classification of Disease 10th-version-based Injury Severity Score. RESULTS: Alcohol consumption was significantly larger in males than in females, in intentional injuries than in accidental injuries, in injury mechanisms other than traffic accident injuries, and in nighttime injuries than daytime injuries. However, the injury severity for the two groups was not significantly different. In the subgroup analysis, alcohol did not seem to affect the severity of injury due to any of the individual injury mechanisms. CONCLUSION: Alcohol consumption has no significant effect on the severity of blunt injuries.
Subject(s)
Female , Humans , Male , Accidents, Traffic , Alcohol Drinking , Classification , Emergencies , Injury Severity Score , Physical Examination , Risk Factors , Wounds and Injuries , Wounds, NonpenetratingABSTRACT
BACKGROUND: This study was conducted to evaluate the survival benefit of the bronchial arterial embolization (BAE) for patients presenting with non-traumatic hemoptysis. METHODS: The clinical data were retrospectively collected from the medical records and the Order Communicating Systems (OCS). The information dealing with death was collected from national death certificates. After enrolled patients were divided with two group such as BAE group (patients who were managed with BAE) and non-BAE group (patients who were managed with conservative modality), the survival benefit of BAE was estimated during the observational period of 24 months through using the Kaplan-Meier survival graph and the Cox-proportional hazard regression analysis. RESULTS: The number of total cases was 272. Of these, BAE group involved 63 and non-BAE group involved 209. 69 cases had the malignant pulmonary lesions, 149 cases had non-malignant chronic lung lesion such as the mycobacteria infection, fungus ball, or bronchiectasis (BE), and 54 cases had the other pathologic conditions. For each sub-groups such as 'malignant lung lesion' group, 'non-malignant chronic lung lesion' group as well as about all cases, the adjusted hazard ratios (HRs) of BAE for death was not significantly different compared to the conservative management. But the adjusted HRs as to underlying causes such as 'malignant lung lesion' group and 'the other conditions' group increased significantly compared to 'non-malignant chronic lung lesion' group. CONCLUSION: There was no significant survival benefit by BAE procedure on survival in patients presenting with non-traumatic hemoptysis.
Subject(s)
Humans , Bronchiectasis , Death Certificates , Embolization, Therapeutic , Emergencies , Fungi , Hemoptysis , Lung , Medical Records , Retrospective Studies , Survival AnalysisABSTRACT
The emergence of multiple drug resistant Mycobacterium leprae has emphasized the need for early decision of effective antileprosy drug in the treatment for leprosy patients. Mutations in the genes associated with multiple drug resistance in Mycobacterium leprae isolates from 17 South Korean patients, who were already confirmed to have mutations in folP1 gene, were investigated using a PCR - single strand conformation polymorphism (SSCP) - DNA sequencing assay. Two strains, which has double mutations, were found in the two unrelated patients : one missense mutation in folP1 (Arg 55 for Pro) and in rpoB (Gly 522 for Ser), and in folP1 (Ala 53 for Thr) and in gyrB (Asn 426 for Asp), respectively. The patients were treated with the long monotheraphy of dapsone or with the inappropriate regimen of antileprosy drugs. These results emphasize the importance of multi-drug theraphy in order to prevent mult-idrug resistance and assist in the choice of the appropriate regimens for treating leprosy.
Subject(s)
Humans , Dapsone , Drug Resistance, Multiple , Korea , Leprosy , Mutation, Missense , Mycobacterium leprae , Mycobacterium , Polymerase Chain Reaction , Sequence Analysis, DNAABSTRACT
PURPOSE: The homeless patients in our country get their medical services in government facilities. Supposedly, they have clinical characteristics different from those of general population, but most published papers dealing with the homeless have focused on sociologic problems. With the necessity for epidemiologic data, we decided to find clinical patterns for the homeless who visited our emergency medical center. METHODS: Between December 1999 and July 2001, 3,905 homeless patients visited the Seoul Municipal Boramae Hospital. Based on their medical records and radiologic images, we categorized and compared their complaints, medical needs, and clinical findings. RESULTS: The number of male patients dominated over female patients (M:F=13.7:1), 70.9% were in their thirties, forties, and fifties, and 47% of the patients had been brought to the center by police while the others had been referred from institutions for the homeless, smaller hospitals, or mental health institutions. The common reason for visit was altered mentality due to acute alcohol intoxication (18.6%), followed by medical follow-up (15.4%), gastrointestinal symptoms (12.3%), and neurologic problems (10.6%). Of the patients 36.1% were sent to institutions, but 31.8% were returned to the streets, 9.7% were admitted to a ward, and 2.6% died. The main causes of death were pneumonia and intracranial hemorrhage. CONCLUSION: Most homeless patients were relatively young men. Alcohol-related symptoms and gastrointestinal troubles overwhelmingly led the homeless to the hospital. Many homeless patients returned to the streets or other institutions. Later, more sophisticated studies are expected for homeless-patients management.