Area-Level Socioeconomic Inequalities in Intracranial Injury-Related Hospitalization in Korea:A Retrospective Analysis of Data From Korea National Hospital Discharge Survey 2008–2015

Background@#Although inequality in traumatic brain injury (TBI) by individual socioeconomic status (SES) exists, interventions to modify individual SES are difficult. However, as interventions for area-based SES can affect the individual SES, monitoring or public health intervention can be planned. We analyzed the effect of area-based SES on hospitalization for TBI and revealed yearly inequality trends to provide a basis for health intervention. @*Methods@#We included patients who were hospitalized due to intracranial injuries (ICIs) between 2008 and 2015 as a measure of severe TBI with data provided by the Korea National Hospital Discharge Survey. Area-based SES was synthesized using the 2010 census data. We assessed inequalities in ICI-related hospitalization rates using the relative index of inequality and the slope index of inequality for the periods 2008–2009, 2010–2011, 2012–2013, and 2014–2015. We analyzed the trends of these indices for the observation period by age and sex. @*Results@#The overall relative indices of inequality for each 2-year period were 1.82 (95% confidence interval, 1.5–2.3), 1.97 (1.6–2.5), 2.01 (1.6–2.5), and 2.01 (1.6–2.5), respectively. The overall slope indices of inequality in each period were 38.74 (23.5–54.0), 36.75 (21.7–51.8), 35.65 (20.7–50.6), and 43.11 (27.6–58.6), respectively. The relative indices of inequality showed a linear trend for men (P = 0.006), which was most evident in the ≥ 65-year age group. @*Conclusion@#Inequality in hospitalization for ICIs by area-based SES tended to increase during the observation period. Practical preventive interventions and input in healthcare resources for populations with low area-based SES are likely needed.

Trends in hospital visits and healthcare costs of gout and seropositive rheumatoid arthritis in Korea from 2010 to 2017 using National Healthcare Claims

Background/Aims@#We examined temporal trends in the rate of gout and seropositive rheumatoid arthritis (RA) hospital visits and healthcare costs in Korea. @*Methods@#We conducted a serial cross-sectional analysis of Korean national healthcare claims. We calculated the annual increase in hospital visits (emergency department [ED] visits, outpatient visits, and hospitalizations) and total healthcare costs per visit. @*Results@#From 2010 to 2017, the annual rates of ED visits, outpatient visits, and hospitalizations for gout increased from 6.28 to 21, from 638.38 to 1059.55, and from 12.37 to 15.6 per 100,000 persons, respectively. Before 2013, ED visits for gout were most common in patients over 70 years old, but they were most common in those aged between 30 and 49 years after 2013. The number of patients with ED visits, outpatient visits, and hospitalizations for RA from 2010 to 2017 increased from 1.25 to 1.87, from 219.04 to 307.49 and from 8.44 to 12.32 per 100,000 persons, respectively. However, there was no increase in the prevalence of ED visits for RA in any age group except for those older than 70 years. The cost per ED visit for gout significantly decreased from 496.3 to 273.6 US dollar during the study period. There was no significant change in the cost per ED visit for RA between 2010 and 2017. @*Conclusions@#There was a large increase in ED visits for gout during the study period. Further studies are needed to analyze the reason behind increased ED visits for gout and suggest ways on how to improve gout care.

Risk Factors for Intracranial Injury Caused by Falls at Home in Korea Using Data from the Emergency Department-based Injury In-depth Surveillance (2011–2018)

Background@#Most unintentional injuries that occur at home are preventable. However, it may be difficult to sufficiently reduce the number of falls occurring at home by only identifying risk factors focused on specific age groups. Therefore, this study aimed to identify the risk factors (especially age and places where injuries occurred at home) for intracranial injury (ICI) caused by unintentional falls at home. @*Methods@#Using the Emergency Department (ED)-Based Injury In-depth Surveillance, we analyzed the data of patients who visited the ED due to unintentional falls at home. Risk factors were identified using multivariable logistic regression according to age groups and interactions between place of injury occurrence and age groups, and sex and age groups were assessed. @*Results@#In total, 232,124 patients were included in the analysis; older adults had a higher adjusted odds ratio (aOR) 14.05 (95% confidence interval [CI], 12.74–15.49) of ICI than infants. The corridor was associated with ICI in the male pediatric group (aOR, 2.71; 95% CI, 1.08–6.84) and the balcony with the female pediatric group (aOR, 2.04; 95% CI, 1.03–4.04). In the adult group, aOR of kitchen was 1.38 (95% CI, 1.02–1.88) in females and 0.56 (95% CI, 0.48–0.66) in males. @*Conclusion@#In this study, we identified the risk factors of ICI caused by falls at home using ED-based injury surveillance data. The risk of ICI was different among places of occurrence in the home depending on the age groups and sex.

Risk Factors for Intracranial Injury Caused by Falls at Home in Korea Using Data from the Emergency Department-based Injury In-depth Surveillance (2011–2018)

Background@#Most unintentional injuries that occur at home are preventable. However, it may be difficult to sufficiently reduce the number of falls occurring at home by only identifying risk factors focused on specific age groups. Therefore, this study aimed to identify the risk factors (especially age and places where injuries occurred at home) for intracranial injury (ICI) caused by unintentional falls at home. @*Methods@#Using the Emergency Department (ED)-Based Injury In-depth Surveillance, we analyzed the data of patients who visited the ED due to unintentional falls at home. Risk factors were identified using multivariable logistic regression according to age groups and interactions between place of injury occurrence and age groups, and sex and age groups were assessed. @*Results@#In total, 232,124 patients were included in the analysis; older adults had a higher adjusted odds ratio (aOR) 14.05 (95% confidence interval [CI], 12.74–15.49) of ICI than infants. The corridor was associated with ICI in the male pediatric group (aOR, 2.71; 95% CI, 1.08–6.84) and the balcony with the female pediatric group (aOR, 2.04; 95% CI, 1.03–4.04). In the adult group, aOR of kitchen was 1.38 (95% CI, 1.02–1.88) in females and 0.56 (95% CI, 0.48–0.66) in males. @*Conclusion@#In this study, we identified the risk factors of ICI caused by falls at home using ED-based injury surveillance data. The risk of ICI was different among places of occurrence in the home depending on the age groups and sex.

Accuracy of high-sensitivity troponin-T in patients visited emergency department with or without symptoms suggestive of acute myocardial infarction

OBJECTIVE: A method of early diagnosis of acute myocardial infarction (AMI) using high-sensitivity cardiac troponin-T (hs-TnT) has been introduced. This study was conducted to evaluate the accuracy of hs-TnT in patients with suspected AMI. METHODS: Patients who were more than 20 years old with symptoms of AMI and who underwent hs-TnT and coronary angiography or echocardiography were included. Risk factors associated with AMI and basic characteristics were collected. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were evaluated. The effects of time from symptom onset to emergency department (ED) visit on test accuracy were analyzed. RESULTS: The final analysis included 102 patients, of which 37 were AMI. The sensitivity and specificity of the hs-TnT was 59.5% (95% confidence interval [CI], 42.1% to 75.2%) and 67.7% (95% CI, 54.9% to 78.8%), respectively. In patients with typical chest pain, the sensitivity and specificity of the hs-TnT was 58.1% (95% CI, 39.1% to 75.5%) and 73.2% (95% CI, 57.1% to 85.8%), respectively. The NPV and sensitivity increased, and the PPV and specificity decreased as time from symptom onset to ED visit increased. CONCLUSION: The accuracy of the hs-TnT test was not as good in patients who visited the ED for symptoms suggestive of AMI. Therefore, to rule-in or rule-out AMI by using hs-TnT in ED, it is necessary to consider the electrocardiogram and clinical features, or to check variations by repeated measurement of hs-TnT.

Epidemiologic Characteristics of Injured School-age Patients Transported via Emergency Medical Services in Korea

BACKGROUND: The purpose of this study was to identify the characteristics of injuries of school-aged children transported via emergency medical services (EMS) that occurred in schools by comparing with injuries that occurred outside of school. METHODS: Data from the 119 EMS from 2012 to 2014 were analyzed. School and non-school injuries were analyzed in children 6 to 17 years of age. The epidemiologic characteristics were assessed according to school-age groups; low-grade primary (6–8 years), high-grade primary (9–13 years), middle (13–15 years) and high (15–17 years) school. Gender-stratified multivariable logistic regression analysis was conducted to estimate the risks of school injury in each age group. RESULTS: During the study period, a total of 167,104 children with injury were transported via 119 ambulances. Of these injuries, 13.3% occurred at schools. Boys accounted for 76.9% of school injuries and middle school children accounted for a significantly greater proportion (39.6%) of school injuries (P < 0.001). The most frequent mechanisms of injury at school were falls (43.8%). The peak times for school injury occurrence were lunch time (13:00–13:59) in all age groups. Multivariate regression identified the risky age groups as high-grade primary (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.09–1.20) and middle school-aged boys (OR, 1.82; 95% CI, 1.74–1.90) and middle school-aged girls (OR, 1.30; 95% CI, 1.21–1.40). CONCLUSION: Notable epidemiologic differences exist between in- and out-of-school injuries. The age groups at risk for school injuries differ by gender.

The Effect of Emergency Medical Service Use and Inter-hospital Transfer on Prehospital Delay among Ischemic Stroke Patients: A Multicenter Observational Study

The time between symptom onset and arrival at an emergency department (ED) (S2D) is a crucial time for optimal intravenous reperfusion care for ischemic stroke. We aimed to analyze the effect of emergency medical services (EMS) utilization and inter-hospital transfer on S2D in Korea. Ischemic stroke patients were prospectively enrolled from November 2007 to December 2012 in 23 tertiary and teaching hospital EDs in Korea. Of 31,443 adult ischemic stroke patients, 20,780 were categorized into 4 groups based on modes of EMS utilization and inter-hospital transfer: direct transport to destination ED by EMS (EMS direct; n=6,257, 30.1%), transfer after transport to another ED by EMS (EMS indirect; n=754, 3.6%), direct transport to the ED without using EMS (non-EMS direct; n=8,928, 43.0%), and transfer after visiting another hospital without using EMS (non-EMS indirect; n=4,841, 23.3%). Our primary outcome variable was of S2D within 2 hr (S2D < or =2 hr) and found that 30.8% of all patients and 52.3%, 16.4%, 25.9%, and 13.9% of EMS direct, EMS indirect, non-EMS direct, and non-EMS indirect, respectively, achieved S2D < or =2 hr. Adjusted odds ratio for S2D < or =2 hr were 6.56 (95% confidence interval [CI], 5.94-7.24), 2.27 (95% CI, 2.06-2.50), and 1.07 (95% CI, 0.87-1.33) for EMS direct, non-EMS direct, and EMS indirect, respectively. Patients directly transported to destination hospitals by the EMS show the highest proportion of therapeutic time window for optimal care in ischemic stroke.

Impacts of Urbanization on Delay in Transferred Ischemic Stroke Patients

PURPOSE: Inter-hospital transport poses a number of challenging issues, including prolonging the time interval from symptoms to optimal reperfusion therapy after ischemic stroke. It is unclear whether urbanization is associated with outcomes of inter-hospital transfer including length of stay at the referring hospital (D1LOS). METHODS: A prospective stroke registry from 23 Emergency Departments (ED) from 2007 to 2012 over the nation was collected. Ischemic stroke patients who arrived at the first ED within 24 hours of onset (S2D1) were enrolled. Patients were excluded if time intervals or address were incorrect or missing. Main exposure was urbanization level; urban > or =10,000 and rural <10,000 population. Primary outcome was D1LOS. The secondary outcomes were symptoms to door of the first ED (S2D1) and transfer time to the final ED (T2D2). We compared the D1LOS, S2D1, and T2D2 with median and inter-quartile range (IQR) by urbanization level. RESULTS: Of 5,909 patients transferred from other hospitals, 2,289 patients were analyzed; 1,441 (63%) patients in urban areas, 848 (37%) patients in rural areas were included. The D1LOS and S2D1 in urban was longer than those in rural; 100 minutes (IQR 50~208) for urban VS 82.5 minutes (IQR 48~170.5) for rural (p=0.01) and 66 minutes (IQR 30~240) for urban VS 90 minutes (IQR 30~330) for rural (p=0.001). T2D2 in urban was shorter than that in rural; 54 minutes (IQR 36~78), 40 minutes (IQR 25~65) (p< or =0.00), respectively. CONCLUSION: Urban EDs showed longer D1LOS before transferring patients to the hospital for definite care. Strategy for reducing delay due to inter-hospital transport should differ according to urbanization.

Effectiveness of a Cardiopulmonary Resuscitation Team with an Emergency Physician for In-Hospital Cardiac Arrest

PURPOSE: Emergency physicians are usually more experienced in emergency situations; therefore, a cardiopulmonary resuscitation team with an emergency physician as a leader would be operated effectively. The aim of this study is to evaluate the effectiveness of a cardiopulmonary resuscitation that includes an emergency physician. METHODS: A retrospective analysis for in-hospital arrests that occurred in the general ward was conducted based on the in-hospital cardiopulmonary resuscitation registry of a tertiary care university hospital in Korea from January 1, 2005 through December 31, 2010. We compared outcomes of cardiopulmonary resuscitation performed by a team that included an emergency physician with those by a cardiopulmonary resuscitation team that included a non-emergency physician. RESULTS: Survival rates at discharge were 29.6% for the emergency physician team and 17.7% for the non-emergency physician team. The good neurologic outcome rates at discharge were 20.6% and 10.6%, respectively. In multivariate analysis with adjustment for pre-arrest patient condition and arrest variables, survival rate did not differ significantly between the two groups. However, the good neurologic outcomes showed an association with the emergency physician team. CONCLUSION: For in-hospital cardiac arrest, outcomes for patients who were rescued by the emergency physician-directing CPR team might be comparable or better, compared with those by the non-emergency physician team.