Changes in characteristics of drug intoxication after COVID-19 pandemics: a retrospective study in a tertiary university-affiliated hospital

Objective@#The coronavirus disease 2019 (COVID-19) virus has adversely affected people in socioeconomic fields as well as mental health, thereby increasing suicidal attempts. This study analyzes the altered characteristics of drug-poisoned patients visiting the emergency department (ED) during the COVID-19 pandemic era in South Korea. @*Methods@#This was a retrospective observational study using medical records of adults who visited the ED for intoxication. Data obtained were compared before and after the COVID-19 pandemic era. @*Results@#In all, data from 1,102 drug-poisoned patients (586/516 during the pre-/post-COVID-19 periods, respectively) were included in the study. Despite a decrease in total ED visits, the pandemic period saw an increase in the proportion of poisoned patients visiting the ED. Young, female, and psychiatric patients accounted for a significant portion. Months, holidays, time zones, and urbanization showed no difference in the incidence of intoxication. Financial difficulty and couple and family troubles were determined to be frequent causes of intoxication during the COVID-19 pandemic. Comparing the drugs intoxicated, pesticide ingestion was decreased, while the ingestion of other less-fatal drugs was comparatively increased. Although there was an increase in the admission rate of poisoned patients, the severity during admission and outcomes at discharge were not worse after the COVID-19 pandemic era. @*Conclusion@#The COVID-19 crisis has seriously impacted people, especially female, young-aged, and psychiatric patients.

Incidence patterns of nervous system diseases after carbon monoxide poisoning: a retrospective longitudinal study in South Korea from 2012 to 2018

Objective@#To analyze the incidence patterns of nervous system diseases in survivors of carbon monoxide (CO) poisoning using nationwide claims data from South Korea. @*Methods@#A national cohort was abstracted from a database that includes patients diagnosed with CO poisoning between January 2012 and December 2018. For all nervous system diseases, we investigated the frequency, pattern of incidence, effect of intensive care unit admission, and the standardized incidence ratios (SIRs) to estimate the risk of nervous system disease after CO poisoning. @*Results@#Of 26,778 patients, 18,720 (69.9%) were diagnosed with nervous system diseases after CO poisoning. The most common disease was disorders of sleep initiation and maintenance (n=701, 3.74%), followed by tension-type headache (n=477, 2.55%) and anoxic brain injury (n=406, 2.17%). Over half of the nervous system diseases occurred within the first year after CO poisoning. The cumulative hazard ratio for nervous system diseases in patients admitted to the intensive care unit was 2.25 (95% confidence interval [CI], 2.07–2.44). Among the frequent nervous system diseases after CO poisoning, patients had a higher risk of disorders of initiating and maintaining sleep (SIR, 1.61; 95% CI, 1.52–1.71), tension-type headache (SIR, 2.41; 95% CI, 2.23–2.61), anoxic brain injury (SIR, 58.76; 95% CI, 53.95–63.88), and post-zoster neuralgia (SIR, 1.94; 95% CI, 1.70–2.20). @*Conclusion@#Patients who experience CO poisoning are at higher risk for several nervous system diseases. Therefore, monitoring for specific nervous system diseases is important after CO poisoning within the first year.

Incidence patterns of nervous system diseases after carbon monoxide poisoning: a retrospective longitudinal study in South Korea from 2012 to 2018

Objective@#To analyze the incidence patterns of nervous system diseases in survivors of carbon monoxide (CO) poisoning using nationwide claims data from South Korea. @*Methods@#A national cohort was abstracted from a database that includes patients diagnosed with CO poisoning between January 2012 and December 2018. For all nervous system diseases, we investigated the frequency, pattern of incidence, effect of intensive care unit admission, and the standardized incidence ratios (SIRs) to estimate the risk of nervous system disease after CO poisoning. @*Results@#Of 26,778 patients, 18,720 (69.9%) were diagnosed with nervous system diseases after CO poisoning. The most common disease was disorders of sleep initiation and maintenance (n=701, 3.74%), followed by tension-type headache (n=477, 2.55%) and anoxic brain injury (n=406, 2.17%). Over half of the nervous system diseases occurred within the first year after CO poisoning. The cumulative hazard ratio for nervous system diseases in patients admitted to the intensive care unit was 2.25 (95% confidence interval [CI], 2.07–2.44). Among the frequent nervous system diseases after CO poisoning, patients had a higher risk of disorders of initiating and maintaining sleep (SIR, 1.61; 95% CI, 1.52–1.71), tension-type headache (SIR, 2.41; 95% CI, 2.23–2.61), anoxic brain injury (SIR, 58.76; 95% CI, 53.95–63.88), and post-zoster neuralgia (SIR, 1.94; 95% CI, 1.70–2.20). @*Conclusion@#Patients who experience CO poisoning are at higher risk for several nervous system diseases. Therefore, monitoring for specific nervous system diseases is important after CO poisoning within the first year.

Epidemiology and regional differences of acute poisonings of eight cities in Gyeonggi-do province in Korea using data from the National Emergency Department Information System of Korea

Objective@#We aimed to analyze the differences in epidemiological aspects and clinical courses of acute poisonings in each region of the Gyeonggi-do province in Korea. @*Methods@#This retrospective study analyzed data from the National Emergency Department Information System of Korea. We retrospectively reviewed cases of acute poisonings between April 2006 and March 2015 recorded at 13 emergency departments in eight different cities of Gyeonggi-do province in Korea. The differences in the incidence, age distribution, causative agent, and clinical course of poisonings among regions were the main outcomes measured. @*Results@#The proportion of poisonings in the ≤9 age group was high in Yongin (17.44%) and that in ≥65 age group was high in Gwangmyeong (21.76%). The proportion of cases involving carbon monoxide was high in Ansan (8.82%) in patients hospitalized and the proportion of cases involving pesticides was high in Pyeongtaek (52.78%) in patients admitted to the intensive care unit. The admission rate of poisoned patients was high in Osan (36.02%). @*Conclusion@#In this study, differences in the characteristics of poisoned patients between 8 cities were noted. Therefore, hospitals need to arrange treatment resources for poisoned patients according to the characteristics of the specific region. The results of this study may serve as evidence for new strategies to prepare for the acute poisonings in hospitals.

Predictors of poor prognosis in patients with heat stroke

OBJECTIVE: The predictors of poor prognosis in heat stroke (HS) remain unknown. This study investigated the predictive factors of poor prognosis in patients with HS.METHODS: Data were obtained and analyzed from the health records of patients diagnosed with heat illness at Ajou university hospital between January 2008 and December 2017. Univariate and multivariate analyses were performed to identify the independent predictors of poor prognosis.RESULTS: Thirty-six patients (median age, 54.5 years; 33 men) were included in the study. Poor prognosis was identified in 27.8% of the study population (10 patients). The levels of S100B protein, troponin I, creatinine, alanine aminotransferase, and serum lactate were statistically significant in the univariate analysis. Multiple regression analysis revealed that poor prognosis was significantly associated with an increased S100B protein level (odds ratio, 177.37; 95% confidence interval, 2.59 to 12,143.80; P=0.016). The S100B protein cut-off level for predicting poor prognosis was 0.610 μg/L (area under the curve, 0.906; 95% confidence interval, 0.00 to 1.00), with 86% sensitivity and 86% specificity.CONCLUSION: An increased S100B protein level on emergency department admission is an independent prognostic factor of poor prognosis in patients with HS. Elevation of the S100B protein level represents a potential target for specific and prompt therapies in these patients.

Pilot study on a rewarming rate of 0.15°C/hr versus 0.25°C/hr and outcomes in post cardiac arrest patients

OBJECTIVE: Cerebral hemodynamic and metabolic changes may occur during the rewarming phase of targeted temperature management in post cardiac arrest patients. Yet, studies on different rewarming rates and patient outcomes are limited. This study aimed to investigate post cardiac arrest patients who were rewarmed with different rewarming rates after 24 hours of hypothermia and the association of these rates to the neurologic outcomes.METHODS: This study retrospectively investigated post cardiac arrest patients treated with targeted temperature management and rewarmed with rewarming rates of 0.15°C/hr and 0.25°C/hr. The association of the rewarming rate with poor neurologic outcomes (cerebral performance category score, 3 to 5) was investigated.RESULTS: A total of 71 patients were analyzed (0.15°C/hr, n=36; 0.25°C/hr, n=35). In the comparison between 0.15°C/hr and 0.25°C/hr, the poor neurologic outcome did not significantly differ (24 [66.7%] vs. 25 [71.4%], respectively; P=0.66). In the multivariate analysis, the rewarming rate of 0.15°C/hr was not associated with the 1-month neurologic outcome improvement (odds ratio, 0.54; 95% confidence interval, 0.16 to 1.69; P=0.28).CONCLUSION: The rewarming rates of 0.15°C/hr and 0.25°C/hr were not associated with the neurologic outcome difference in post cardiac arrest patients.

Survival of in-hospital cardiac arrest patients before and after the implementation of the act on decisions on life-sustaining treatment: the well-dying law

OBJECTIVE: The act on decisions on life-sustaining treatment, the well-dying law (WDL), has been implemented in Korea since February of 2018 so that a patient may die with dignity in his or her death bed. On the other hand, there has been an increase in in-hospital cardiac arrest patients, resulting in poor outcomes due to strict regulations of withdrawal of life support. This study examined the survival of in-hospital cardiac arrest patients before and after implementation of the WDL. METHODS: The in-hospital cardiac arrest data registry from the authors' in-hospital cardiac arrest committee and electronic medical records were reviewed retrospectively. The baseline characteristics, cardiac arrest variables, and cardiac arrest outcomes were compared before and after implementation of the WDL. Multivariate logistic regression was conducted to analyze the association of the implementation of the WDL and return of spontaneous circulation (ROSC) of in-hospital cardiac arrest patients. RESULTS: This study analyzed 183 patients before and 346 patients after the implementation of the WDL. The ROSC (115 [62.8%] vs. 158 [45.7%]), 24-hour survival (53 [29.0%] vs. 60 [17.3%]), and survival discharge (25 [13.7%] vs. 29 [8.4%]) were higher in the before period than in the after period. Multivariate logistic regression analysis showed that the WDL was associated with a lower ROSC (odds ratio [OR], 0.56; 95% confidence interval [CI], 0.37–0.85; P<0.01) and lower survival at 24 hours (OR, 0.53; 95% CI, 0.31–0.93; P=0.03), but not a lower survival discharge (OR, 0.84; 95% CI, 0.39–1.83; P=0.67). CONCLUSION: The implementation of the WDL has been associated with a lower ROSC and lower survival at 24 hours in in-hospital cardiac arrest patients.

Comparison of Mortality Rate according to Hospital Level among Patients with Poisoning Based on Korean Health Insurance and Assessment Service

PURPOSE: Mortality rate in the health services research field is frequently considered as a proxy for measuring healthcare quality. We compared the mortality rate and hospitalization levels among patients with poisoning. METHODS: A population-based study of hospital size and level based on the Korean health insurance and assessment service was conducted to identify the impact of hospital level on patient mortality. RESULTS: We analyzed a total of 16,416 patients, of which 7,607 were from tertiary hospitals, 8,490 were from general hospitals, and 319 were from hospitals. The highest mortality rate of diagnosis regarding poisoning was T60.31 (other herbicides and fungicides, 16%), followed by T60.0 (organophosphate and carbamate insecticides, 12.7%). There was no statistical difference in mortality among hospital levels for gender. Among age groups, tertiary hospitals had lower mortality than general hospitals and hospitals for patients aged more than 70 years (11.9% mortality at tertiary vs 14.2% at general and 23% at hospital; p=0.003, adjusted z score=−6.9), general hospitals had lower mortality than tertiary hospitals and hospitals for patients aged 18 to 29 (0.6% at general vs 2.4% at tertiary and 3.7% at hospital; p=0.01, adjusted z score=−4.3), and hospitals had lower mortality than tertiary hospitals and general hospitals for patients between 50 and 59 years of age (0% at hospital vs 6.4% at general and 8.3% at tertiary; p=0.004). CONCLUSION: Overall, there was no significant difference between mortality and hospital level among poisoned patients. However, to establish an efficient treatment system for patients with poisoning, further studies will be needed to identify the role of each facility according to hospital level.

Analysis of the 119 emergency situation control center usage including dispatcher-assisted cardiopulmonary resuscitation instructions

OBJECTIVE: Analyses of the status of 119 emergency situation control center (119 ESCC) usage are lacking. Therefore, this study investigated the status of the 119 ESCC usage, including dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) instructions. METHODS: The emergency activity daily reports and emergency instruction sheets of 119 ESCC from January to December 2016 were reviewed. For more accurate status analysis, the computerized data of the 1339 Emergency Medical Information Center from January to December 2011 were also reviewed. RESULTS: In 2016, the total usage of the 119 ESCC was 1,393,876 calls, which was 27.8% lower than the 1,930,977 calls in 2011. Of the 1,393,876 eligible calls, the most common call was hospital guidance (n=743,799, 53.4%), followed by first aid (n=397,620, 28.5%), disease consultation (n=150,128, 10.8%), medical oversight (n=81,174, 5.8%), and interhospital transfer (n=5,123, 0.4%). Regarding the user number per 10,000 persons, Daejeon was the greatest at 57.2, whereas Changwon was the lowest at 11.5. A total number of DA-CPR was 19,439. The time from the call to chest compression were 173±88.6 seconds in the subjects having previous cardiopulmonary resuscitation training and 184.0±88.2 in the subjects having no such training (P < 0.001). CONCLUSION: The ratio of first aid instructions, including DA-CPR, among total usage of the 119 ESCC increased but the overall usage of the 119 ESCC decreased. Therefore, further efforts will be needed to improve the quality and professionality of the information provided through the operation of 119 ESCC.

Association between prehospital i-gel insertion and PCO₂ in patients with out-of-hospital cardiac arrest

OBJECTIVE: This study examined the initial partial pressure of carbon dioxide (PCO₂) as a possible indicator of prehospital ventilation and its association with prehospital i-gel in out-of-hospital cardiac arrest (OHCA) patients. METHODS: The demographics and arrest parameters, including i-gel insertion and initial arterial blood gas analysis, of OHCA patients who visited the emergency department were analyzed retrospectively. Linear regression analysis was performed to examine the association between i-gel insertion and the initial PCO₂. RESULTS: A total of 106 patients were investigated. Fifty-six patients had prehospital i-gel insertion and 50 patients did not have a prehospital advanced airway. The initial PCO₂ was higher in the i-gel group than the no advanced airway group (105.2 mmHg [77.5–134.9] vs. 87.5 mmHg [56.8–115.3], P=0.03). Prehospital i-gel insertion was associated with a higher initial PCO₂ level (βcoefficient, 20.3; 95% confidence interval, 2.6–37.9; P=0.03). CONCLUSION: Prehospital insertion of i-gel was associated with higher initial PCO₂ values in OHCA patients compared to no advanced airway.

Patients who leave the emergency department against medical advice

OBJECTIVE: Discharge against medical advice (DAMA) from the emergency department (ED) accounts for 0.1% to 2.7% of all ED discharges. DAMA carries a risk of increased mortality and readmissions. Our aim was to investigate the general characteristics of DAMA patients and the differences between them and non-DAMA patients. METHODS: We reviewed data collected by the National Emergency Medical Center between 2010 and 2011. Subjects were categorized into 2 groups, namely, the DAMA group and the non-DAMA group. We compared these groups with respect to age, gender, trauma or non-trauma status, type of hospital, health insurance, level of consciousness on admission, and diagnosis. RESULTS: Of 8,000,529 patients, 222,389 (2.78%) left against medical advice. The risk factors for DAMA across all age groups were as follows: no medical insurance (odds ratio [OR], 1.993), initial response to voice (OR, 2.753) or pain (OR, 2.101), trauma admission (OR, 1.126), admission to a local emergency medical center (OR, 1.215), and increased age. A high risk of DAMA was observed among patients with immune, endocrine, psychiatric, neurological, circulatory diseases, and external causes of morbidity and mortality. CONCLUSION: Although DAMA cases account for only a small percentage of hospital discharges, they are important because DAMA patients have high readmission and mortality rates. It is therefore important to understand the general characteristics and predictors of DAMA in order to improve patient outcome and minimize the economic burden on the healthcare system.

Characteristics of Adjustment Disorder Patients as Suicidal Attempters Visited Emergency Department: Significance of Adjustment Disorder and Suicide

PURPOSE: The aim of the current study was to examine the characteristics of suicidal attempters who visited the emergency department (ED) with a psychiatric diagnosis of adjustment disorder. METHODS: Suicidal attempters who had visited the ED were retrospectively selected between January 2015 and December 2015. Sex, age, marital status, psychiatric diagnosis, causes of suicidal attempt, methods of suicidal attempt, influence of alcohol, and results of ED management were reviewed in the medical records. RESULTS: A total of 468 suicide attempters who had visited the ED were interviewed by psychiatrists, and 323 cases were included. Adjustment disorder is the most common diagnosis among these patients (N=202, 62.5%). There was no statistical difference between the adjustment disorder group and the non-adjustment disorder group with respect to marital status, psychiatric diagnosis, causes of suicidal attempt, methods of suicidal attempt, and results of ED management. The number of patients under the influence of alcohol who visited the ED was higher in the adjustment disorder group (p=0.04). CONCLUSION: Adjustment disorder is the most common diagnosis among suicidal attempters who visit the ED. Suicidal attempt in the adjustment disorder group is likely an impulsive decision, but their admission results are just as poor as the non-adjust disorder group.

Educational Needs and Perceptions of School Nurses Regarding Emergency Situations in School: Focus on Differences Based on the General Characteristics of School Nurses

PURPOSE: The study investigated the educational needs and perceptions of school nurses regarding emergency situations in the school and compared differences in the educational needs and perceptions about emergency situations according to the general characteristics of school nurses. METHODS: Using a written survey of randomly selected sample, we questioned 100 school nurses over a 3-month period from January 2011 to March 2011. The survey involved 11 medical conditions and 16 injury-related conditions. It contained questions about the need for education and perceptions of emergency situations. We also determined school nurses' general characteristics including sex, age, grades of school where they worked, years of teaching career, years of clinical experience, number of classes, marital status, number of children, gender of their children, age of their children, the existence of older families. RESULTS: Two hundred two (84%) school nurses responded. For most conditions, there were significant differences between the scores of educational needs regarding, and perceptions about, emergency situations, except for three conditions (fracture of extremity, cerebral contusion, and tooth trauma). According to the general characteristics of school nurses, only the grade of school where they worked influenced the educational needs for cerebral contusion and orbital contusion. CONCLUSION: The emergency conditions that need first aid education in Korean school nurses are different from the conditions identified in other foreign countries. Primary education and promotion of first aid is considered necessary. The perceptions about emergency situations and the educational need regarding emergency situations show consistency. Only the grade of school where nurses worked affected the educational needs of school nurses. Further studies about the frequency of emergency situations in each school grade are required.