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Objective@#Acute cholangitis is a clinical condition caused by infection of an obstructed biliary system, which is normally managed with intravenous fluids, antibiotics, and biliary drainage. Although endoscopic retrograde cholangiopancreatography (ERCP) is the preferred method of biliary drainage, guidelines for biliary drainage time remain unclear. @*Methods@#The current research is a retrospective study of patients with acute cholangitis who had undergone ERCP between January 2016 and December 2019. We investigated the effect of the time taken from visit to the emergency department and commencement of the ERCP, on hospital length of stay. @*Results@#A total of 441 patients were included in this study. No association was observed between the severity of acute cholangitis and ERCP time. However, the length of hospital stay was significantly shorter for patients who underwent ERCP less than 12 hours after arrival at the emergency department. @*Conclusion@#Conducting ERCP within 12 hours of arrival is associated with reduced hospital stays, regardless of the severity of acute cholangitis.
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Objectives@#To determine basic patient characteristics and biomarkers to help in the early diagnosis of Coronavirus disease 2019 (COVID-19) pneumonia in patients with pneumonia who visited the emergency department (ED). @*Methods@#This retrospective study evaluated patients diagnosed with community-acquired pneumonia (CAP) or COVID-19 pneumonia in ED at four tertiary medical centers between February 1 and March 31, 2020. Parameters related to the differential diagnosis between CAP and COVID-19 were investigated. Clinical characteristics and laboratory results of biomarkers were analyzed. @*Results@#In total, 81 patients presented to the ED with COVID-19 pneumonia. Multivariate logistic regression analysis showed that monocyte count [odds ratio (OR): 0.996; 95% confidence interval (CI): 0.994–0.999] and pneumonia severity index (PSI) [OR: 1.025; 95% CI: 1.002–1.049] were associated with diagnosis of COVID-19 pneumonia. The area under the curve comprising the combination of monocyte and PSI was 0.789. @*Conclusion@#Differential diagnosis of COVID-19 pneumonia from pneumonia patients who visited the emergency room can be made by monocyte count and PSI score.
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Objectives@#To determine basic patient characteristics and biomarkers to help in the early diagnosis of Coronavirus disease 2019 (COVID-19) pneumonia in patients with pneumonia who visited the emergency department (ED). @*Methods@#This retrospective study evaluated patients diagnosed with community-acquired pneumonia (CAP) or COVID-19 pneumonia in ED at four tertiary medical centers between February 1 and March 31, 2020. Parameters related to the differential diagnosis between CAP and COVID-19 were investigated. Clinical characteristics and laboratory results of biomarkers were analyzed. @*Results@#In total, 81 patients presented to the ED with COVID-19 pneumonia. Multivariate logistic regression analysis showed that monocyte count [odds ratio (OR): 0.996; 95% confidence interval (CI): 0.994–0.999] and pneumonia severity index (PSI) [OR: 1.025; 95% CI: 1.002–1.049] were associated with diagnosis of COVID-19 pneumonia. The area under the curve comprising the combination of monocyte and PSI was 0.789. @*Conclusion@#Differential diagnosis of COVID-19 pneumonia from pneumonia patients who visited the emergency room can be made by monocyte count and PSI score.
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Background@#When an emergency-care patient is diagnosed with an emerging infectious disease, hospitals in Korea may temporarily close their emergency departments (EDs) to prevent nosocomial transmission. Since February 2020, multiple, consecutive ED closures have occurred due to the coronavirus disease 2019 (COVID-19) crisis in Daegu. However, sudden ED closures are in contravention of laws for the provision of emergency medical care that enable the public to avail prompt, appropriate, and 24-hour emergency medical care. Therefore, this study ascertained the vulnerability of the ED at tertiary hospitals in Daegu with regard to the current standards. A revised triage and surveillance protocol has been proposed to tackle the current crisis. @*Methods@#This study was retrospectively conducted at 6 level 1 or 2 EDs in a metropolitan city where ED closure due to COVID-19 occurred from February 18 to March 26, 2020. The present status of ED closure and patient characteristics and findings from chest radiography and laboratory investigations were assessed. Based on the experience from repeated ED closures and the modified systems that are currently used in EDs, revised triage and surveillance protocols have been developed and proposed. @*Results@#During the study period, 6 level 1 or 2 emergency rooms included in the study were shut down 27 times for 769 hours. Thirty-one confirmed COVID-19 cases, of whom 7 died, were associated with the incidence of ED closure. Typical patient presentation with respiratory symptoms of COVID-19 was seen in less than 50% of patients, whereas abnormal findings on chest imaging investigations were detected in 93.5% of the study population. The chest radiography facility, resuscitation rooms, and triage area were moved to locations outside the ED, and a new surveillance protocol was applied to determine the factors warranting quarantine, including symptoms, chest radiographic findings, and exposure to a source of infection. The incidence of ED closures decreased after the implementation of the revised triage and surveillance protocols. @*Conclusion@#Triage screening by emergency physicians and surveillance protocols with an externally located chest imaging facility were effective in the early isolation of COVID-19 patients. In future outbreaks of emerging infectious diseases, efforts should be focused toward the provision of continued ED treatment with the implementation of revised triage and surveillance protocols.
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PURPOSE: Rib and sternal fractures are common complications of chest compressions during cardiopulmonary resuscitation (CPR). The aim of this study is to investigate skeletal chest injuries following chest compressions and factors associated with skeletal chest injuries. METHODS: A retrospective study was conducted for 10 years from January 2005 to February 2015. Skeletal chest injuries in patients who underwent computerized tomography (CT) after return of spontaneous circulation (ROSC) were analyzed. The exclusion criteria were patients with insufficient medical records, under 18 years old, traumatic cardiac arrest, and out-of-hospital cardiac arrest. RESULTS: During the period 106 patients were included. The CT scan after ROSC showed that 47 patients (44.3%) had rib fractures, and 20 patients (18.9%) had sternal fractures. The rib fracture group showed higher age (73 vs 61, p<0.001), longer CPR time (10 vs 6 min, p<0.001), and higher incidence of sternal fracture (34% vs 6.8%, p<0.001). The sternal fracture group showed longer CPR time (10 vs 7, p<0.05) and higher incidence of rib fractures (80% vs 4.7%, p<0.001). In multivariate logistic regression analysis, age (OR 1.087; 95% CI 1.041 to 1.134, p<0.001), CPR time (OR 1.200; 95% CI 1.087 to 1.323, p<0.001), and sternal fracture (OR 4.524; 95% CI 1.259 to 16.697, p=0.021) showed significant association with rib fracture. CONCLUSION: Rib and sternal fractures are frequent complications in patients who underwent CPR. In hospital cardiac arrest patients with older age, longer CPR time, and sternal fracture needed more precaution for rib fractures and other complications.