Prevalence of Carbon Monoxide Poisoning and Hyperbaric Oxygen Therapy in Korea: Analysis of National Claims Data in 2010–2019

This study aimed to investigate the prevalence of carbon monoxide (CO) poisoning and the provision of hyperbaric oxygen therapy (HBOT) in South Korea. We used data from the Korea Health Insurance Review and Assessment service. In total, 44,361 patients with CO poisoning were identified across 10 years (2010–2019). The prevalence of CO poisoning was found to be 8.64/10,000 people, with a gradual annual increment. The highest prevalence was 11.01/10,000 individuals, among those aged 30–39 years. In 2010, HBOT was claimed from 15 hospitals, and increased to 30 hospitals in 2019. A total of 4,473 patients received HBOT in 10 years and 2,684 (60%) were treated for more than 2 hours. This study suggested that the prevalence of both CO poisoning and HBOT in Korea gradually increased over the past 10 years, and disparities in prevalence were observed by region.

Epinephrine use and the occurrence of biphasic reaction in patients treated for anaphylaxis in the emergency department

Objective@#Although anaphylaxis can result in poor outcomes, studies on the factors influencing the biphasic reaction of anaphylaxis have been limited. In this study, we evaluated the clinical information of patients at high risk for the biphasic reaction of anaphylaxis. @*Methods@#This retrospective observational study was conducted in the emergency department (ED) of a single tertiary center. We enrolled patients diagnosed with and treated for anaphylaxis from January 2014 to December 2020. We gathered the electronic medical data of the patients who satisfied the diagnostic criteria for anaphylaxis and were treated with epinephrine. The enrolled patients were divided into those showing either a uniphasic reaction or a biphasic reaction depending on the need for multidose epinephrine. @*Results@#The cohort included 255 patients of anaphylaxis (48.6%, male). Of these patients, 59 (23%) showed a biphasic reaction. Patients displaying a biphasic reaction had a longer median time from their ED visit to the administration of the first dose of epinephrine compared to those showing a uniphasic reaction-8 (4-13) vs. 7 (3-12) minutes. Patients showing a biphasic reaction were statistically associated with a longer time from their visit to the ED to epinephrine administration (odds ratio [OR], 1.073; 95% confidence interval [CI], 1.011-1.140; P=0.021), lower mean arterial pressure (OR, 0.971; 95% CI, 0.951-0.991; P=0.006), lower pulse rate (OR, 0.973; 95% CI, 0.954-0.991; P=0.004), and a lower rate of food allergen (OR, 0.406; 95% CI, 0.169-0.976; P=0.044). @*Conclusion@#The delayed administration of epinephrine upon ED arrival was associated with biphasic reactions in addition to lower mean arterial pressure and pulse rate, and exposure to non-food allergen. This study presents evidence supporting the prompt use of epinephrine in patients with anaphylaxis. However, further prospective studies in this regard would be needed.

The Usefulness of Non-face-to-face Communication Device for Medical Consents in the Emergency Department During COVID-19 Pandemic / 의료커뮤니케이션

Purpose@#: Since the era of COVID-19, face-to-face contact has been reduced to prevent the spread of infectious diseases around the world, and hospitals are applying various methods to prevent the spread of infection. However, when writing a consent form essential during the treatment process, it had to be done face-to-face. We developed a non-face-to-face communication device to enable real-time consent writing. This study aims to evaluate the usefulness of the non-face-to-face communication device when writing a consent form. @*Methods@#: From December 28, 2021 to February 2, 2022, electronic medical records of patients visited the severance hospital emergency center and had a central venous catheter inserted were collected retrospectively. There were 56 consent forms included in the study, 43 face-to-face and 13 non-face-to-face. We checked the difference between the details explained in the non-face-to-face consent form and the face-to-face by the average score and the explanation of each item. The score was measured from a minimum of 0 points to a maximum of 13 points, with 1 point for explained items and 0 points for unexplained. @*Results@#: The average score for the face-to-face consent form was 4.3, and for the non-face-to-face was 3.0 (p=0.148). There was no significant difference in the explanation of each item. @*Conclusion@#: It was confirmed writing a consent form through the non-face-to-face communication device can perform a similar role compared to the face-to-face. It is expected unnecessary contact can be reduced by applying the device to hospital rooms, and enabling a non-face-to-face rounds system for new infectious diseases.

Simulation study: the development of a respiratory barrier enclosure with negative pressure and the analysis of its protective effect during intubation

Objective@#Within the last 2 years, coronavirus disease 2019 has spread rapidly across several continents, with 100 million confirmed infected patients. Physical barrier enclosure, also called “aerosol-box,” is a solution for the shortage of protective devices and spaces. In this study, we examined the safety of the novel barrier enclosure. @*Methods@#We simulated droplets by nebulizing 1% glycerol+99% ethanol solution. Two experienced physicians performed intubation under two conditions, such as the isolator condition (applying isolator without negative condition) and the negative pressure condition (applying isolator with the negative condition). We compared two conditions with two control groups, including negative control (room air) and positive control (synthetizing droplet air). During the procedure, particles were counted for 30 seconds, and this was repeated 10 times. At each condition, depending on the result of the normality test (Shapiro-Wilk test), an independent t-test was used when normality was satisfied, and a Mann-Whitney U-test was used when normality was not satisfied. @*Results@#The total number of particles in the positive control was 308,788 (175,936-461,124). The total number of particles for both conditions was significantly less than the positive control. Total number of particles in the isolator condition was 30,952 (27,592-33,244, P=0.001) and that in the negative pressure condition was 27,890 (27,165-29,786, P=0.001). @*Conclusion@#The novel barrier significantly reduces synthetizing droplets exposure during intubation. Application of negative pressure through the isolator results in an additional decrease in particle exposure. Studies involving a larger population of operators and prolonged procedures are required.

Systematic review for economic benefit of poison control center

Purpose@#The purpose of this study was to conduct a systematic review to investigate the socio-economic benefits of the poison control center (PCC) and to assess whether telephone counseling at the poison control center affects the frequency of emergency room visits, hospitalization, and length of stay of patients with acute poisoning. @*Methods@#The authors conducted a medical literature search of the PubMed, EMBASE, and Cochrane Library databases. Two reviewers evaluated the abstracts for eligibility, extracted the data, and assessed the study quality using a standardized tool. Key results such as the cost-benefit ratio, hospital stay days, unnecessary emergency room visits or hospitalizations, and reduced hospital charges were extracted from the studies. When meta-analysis was possible, it was performed using RevMan software (RevMan version 5.4). @*Results@#Among 299 non-duplicated studies, 19 were relevant to the study questions. The cost-benefit ratios of PCC showed a wide range from 0.76 to 36 (average 6.8) according to the level of the medical expense of each country and whether the study included intentional poisoning. PCC reduced unnecessary visits to healthcare facilities. PCC consultation shortened the length of hospital stay by 1.82 (95% CI, 1.07-2.57) days. @*Conclusion@#The systematic review and meta-analysis support the hypothesis that the PCC operation is cost-beneficial. However, when implementing the PCC concept in Korea in the future, it is necessary to prepare an institutional framework to ensure a costeffective model.

Risk factors to predict post-contrast acute kidney injury after contrast-enhanced computed tomography in the emergency department

Objective@#This study aimed to investigate the risk factors of post-contrast acute kidney injury (PAKI) and the usefulness of the Mehran score for predicting PAKI in patients who underwent contrast-enhanced abdominopelvic computed tomography (CE-APCT) in the emergency department (ED). @*Methods@#This was a retrospective observational study. Patients who underwent CE-APCT and had a follow-up creatinine test within 72 hours in the period January to June, 2017, were enrolled for the study. PAKI is defined as a 25% or higher increase in the level of serum creatinine (sCr) within 72 hours after receiving contrast, or an increase in the level of sCr by 0.5 mg/dL. The odds ratio (OR) of risk factors and incidence of PAKI after CE-APCT were analyzed according to the Mehran risk group, and compared to expected incidence. Univariate and multivariate logistic regression analyses were performed for each risk factor. @*Results@#A total of 1,718 patients were enrolled in the study. Of these, 203 patients (11.8%) developed PAKI, and 2 patients (0.1%) required dialysis. Hypotension (systolic blood pressure <80 mmHg) was determined to be statistically significant (P=0.029; OR, 3.181) among the considered risk factors of PAKI. In the group having abnormal estimatedglomerular filtration rate (<90 mL/min/1.73 m2), the age and rate of the underlying disease (congestive heart failure, hypertension) was found to be higher in the PAKI group. The receiver operating curve of Mehran score (area under the curve: 0.521 in model A, 0.520 in model B) was statistically not significant in the univariate analysis. A higher Mehran score was associated with a higher proportion of patients who underwent prophylactic treatment. @*Conclusion@#There are no definite useful risk factors, including the Mehran score, for predicting PAKI in patients who underwent contrast-enhanced computed tomography in the ED.

Risk factors to predict post-contrast acute kidney injury after contrast-enhanced computed tomography in the emergency department

Objective@#This study aimed to investigate the risk factors of post-contrast acute kidney injury (PAKI) and the usefulness of the Mehran score for predicting PAKI in patients who underwent contrast-enhanced abdominopelvic computed tomography (CE-APCT) in the emergency department (ED). @*Methods@#This was a retrospective observational study. Patients who underwent CE-APCT and had a follow-up creatinine test within 72 hours in the period January to June, 2017, were enrolled for the study. PAKI is defined as a 25% or higher increase in the level of serum creatinine (sCr) within 72 hours after receiving contrast, or an increase in the level of sCr by 0.5 mg/dL. The odds ratio (OR) of risk factors and incidence of PAKI after CE-APCT were analyzed according to the Mehran risk group, and compared to expected incidence. Univariate and multivariate logistic regression analyses were performed for each risk factor. @*Results@#A total of 1,718 patients were enrolled in the study. Of these, 203 patients (11.8%) developed PAKI, and 2 patients (0.1%) required dialysis. Hypotension (systolic blood pressure <80 mmHg) was determined to be statistically significant (P=0.029; OR, 3.181) among the considered risk factors of PAKI. In the group having abnormal estimatedglomerular filtration rate (<90 mL/min/1.73 m2), the age and rate of the underlying disease (congestive heart failure, hypertension) was found to be higher in the PAKI group. The receiver operating curve of Mehran score (area under the curve: 0.521 in model A, 0.520 in model B) was statistically not significant in the univariate analysis. A higher Mehran score was associated with a higher proportion of patients who underwent prophylactic treatment. @*Conclusion@#There are no definite useful risk factors, including the Mehran score, for predicting PAKI in patients who underwent contrast-enhanced computed tomography in the ED.

The prognostic value of 1-hour bundle completion in septic shock patients

OBJECTIVE@#Since 2018, the surviving sepsis campaign recommended one-hour bundle therapy in septic shock patients. On the other hand, evidence for the effectiveness of bundle therapy has not been established. The object of this study was to determine the prognostic value of one-hour bundle completion in septic shock patients.@*METHODS@#This prospectively collected registry-based, retrospective observational study, between January 2016 and December 2018. A one-hour bundle in septic shock was defined by the serum lactate measurements, blood cultures, administration of antibiotics, and adequate fluid administration within one hour from emergency department admission. Eligible septic shock patients were included in the analysis, and the prognostic abilities of the completion of the one-hour bundle and each item were analyzed. The primary outcome was the 28-day mortality.@*RESULTS@#The study included 381 patients, and the overall 28-day mortality was 24.7%. The overall one-hour bundle completion rate was 11.3%, and each completion rate of serum lactate measurement, blood cultures, administration of antibiotics, and adequate fluid administration were 85.8%, 74.3%, 19.4%, and 48.6%, respectively. On the other hand, overall bundle completion as well as each bundle were not associated with the 28-day mortality except for adequate fluid administration (odds ratio [OR], 0.67 [95% confidence interval (CI), 0.30–1.50]; OR, 1.33 [95% CI, 0.66–2.70]; OR, 1.50 [95% CI 0.85–2.64]; OR, 1.17 [95% CI 0.66–2.07]; and OR, 0.54 [95% CI, 0.34–0.87], respectively). Multivariate logistic regression analysis showed that adequate fluid administration was independently associated with the 28-day mortality (OR, 0.22 [95% CI, 0.09–0.55]; P=0.001).@*CONCLUSION@#In this study, most of the one-hour bundle completions were not associated with 28-day mortality. Although adequate fluid administration was associated with the 28-day mortality, multicenter interventional study will be needed to generalize this result.

Usefulness of Serial Measurement of the Platelet Volume Indices to Predict 30-day Mortality in Patients with ST Segment Elevation Myocardial Infarction

PURPOSE: Among the survivors of a ST elevation myocardial infarction (STEMI), higher platelet volume indices (mean platelet volume, MPV; platelet distribution width, PDW) are associated with impaired reperfusion and ventricular dysfunction. This study examined the relationship between the platelet volume indices and 30-day mortality with STEMI patients who underwent primary percutaneous coronary intervention (PCI). METHODS: This retrospective cohort study included patients presenting to the emergency department with STEMI between January 2011 and May 2016. The platelet volume indices were measured serially, using an automatic hematology analyzer, from admission to 24 hours after admission. The prognostic value of MPV, PDW for the 30-day mortality was determined by Cox proportional hazards model analysis. RESULTS: A total of 608 STEMI patients, who underwent reperfusion, were enrolled in this study. According to the multivariable Cox proportional hazard model, higher MPV (hazard ratio [HR], 1.414; 95% confidence interval [CI], 1.024-1.953; p=0.035) and PDW (HR, 1.043; 95% CI, 1.006-1.083; p=0.024) values at time-24 (24 hours after admission) were significant risk factors for the 30-day mortality. A MPV value >8.6 fL (HR, 5.953; 95% CI, 2.973-11.918; p56.1% (HR, 5.117; 95% CI, 2.640-9.918; p<0.001) at time-24 were associated with an increased risk of 30-day mortality. CONCLUSION: The platelet volume indices without an additional burden of cost or time, can be measured rapidly and simply. Higher MPV and PDW levels predict independently the 30-day mortality in patients with STEMI after PCI.