Evaluation of Eye Injury Cases in a Single Emergency Department

PURPOSE: After cataracts, eye injuries are the second leading cause of visual impairment worldwide. But most eye injuries are preventable simply by wearing appropriate eye protection. In this study we evaluate factors leading to eye injury in a sample of emergency department (ED) patients. METHODS: This study was conducted with 424 isolated eye injury patients who visited our ED from January to December of 2008. The following data were reviewed; date of visit, characteristics of subjects, existing use of eyewear, relationship of injury to work, causative activity, location where the injury occurred, type of injury, disposition at ED discharge, length of hospital stay, and the existence of sequelae. Severe eye injuries were classified based on the type of injury, disposition at ED, remaining visual loss, and sequelae. RESULTS: Among the total 424 isolated eye injury patients, 411 cases were analyzed. Eye injuries occurred most frequently at home (22.6%), in a factory workplace (21.2%), or an outdoor agricultural workplace (18.2%). The incidence of eye injuries peaked in the fifth decade of life. Among the 306 (74.5%) cases that were workplace unrelated, the main causative activities were assault (18.0%), injury associated with play (14.1%), sports (11.1%), and lawn mowing (9.2%). CONCLUSION: The most common location where the eye injury occurred was at home. Eye injuries prevention in the workplace is well promoted, but in fact, eye injuries were more common at home and during non-occupational activities. We suggest that public education programs which highlight non-occupational eye injury risk and prevention measures should be instituted to reduce preventable eye injuries.

Clinical Study of Pediatric Ocular Injury Patients Visiting an Emergency Medical Center

PURPOSE: Ocular injury is a significant problem in pediatric patients. The aim of this investigation was to evaluate clinical characteristics of pediatric eye injury for the purpose of offering preventive strategies. METHODS: This retrospective study was carried out by evaluating the records of patients under the age of 15 years who were treated for ocular injury at the Kyungpook National University Hospital emergency medical center, from January 2003 to December 2008. A total of 477 patients were included in the study. Age, sex, date of injury, location where injury occurred, cause of injury, diagnosis, any effects on visual acuity, and any complications, were analyzed. RESULTS: Ocular injury occurred more frequently in boys (72.3%) than in girls, and the highest incidence was seen in ages 11 to 15 years (37.3%). Ocular injury frequently occurred in the home or at school. The most common cause of injury was due to instruments (51.6%). Surgery was necessary in 71 patients (14.9%), complication developed in 48 patients (10.1%), and 40 patients (8.4%) suffered from decreased visual acuity. CONCLUSION: It's important to monitor boys, in particular, who are engaged in physical activities in the home and at school. Appropriate education and application of personal protective equipment are important methods to aid in prevention of pediatric ocular trauma, especially with children in the home and with adolescents engaged in sporting activities.

Necessity for a Whole-body CT Scan in Alert Blunt Multiple Trauma Patients

PURPOSE: Whole-body CT is a very attractive diagnostic tool to clinicians, especially, in trauma. It is generally accepted that trauma patients who are not alert require whole-body CT. However, in alert trauma patients, the usefulness is questionable. METHODS: This study was a retrospective review of the medical records of 146 patients with blunt multiple trauma who underwent whole body CT scanning for a trauma workup from March 1, 2008 to February 28, 2009. We classified the patients into two groups by patients' mental status (alert group: 110 patients, not-alert group: 36 patients). In the alert group, we compared the patients' evidence of injury (present illness, physical examination, neurological examination) with the CT findings. RESULTS: One hundred forty six(146) patients underwent whole-body CT. The mean age was 44.6+/-18.9 years. One hundred four (104, 71.2%) were men, and the injury severity score was 14.0+/-10.38. In the not-alert group, the ratios of abnormal CT findings were relatively high: head 23/36(63.9%), neck 3/6(50.0%), chest 16/36(44.4%) and abdomen 9/36(25%). In the alert group, patients with no evidence of injury were rare (head 1, chest 6 and abdomen 2). Nine(9) patients did not need any intervention or surgery. CONCLUSION: Whole-body CT has various disadvantages, such as radiation, contrast induced nephropathy and high medical costs. In multiple trauma patients, if they are alert and have no evidence of injury, they rarely have abnormal CT findings, and mostly do not need invasive treatment. Therefore, we should be cautious in performing whole-body CT in alert multiple trauma patients.

The Factors that Predict Using Mechanical Ventilation for Patients with Organophosphate Intoxication

PURPOSE: The purpose of this study is to investigate the factors that predict using mechanical ventilation for patients with organophosphate intoxication. METHODS: We retrospectively reviewed the medical records of 111 patients with acute organophosphate intoxication and who were treated in our emergency center from January 2000 to December 2008. We compared the toxicologic characteristics, the laboratory findings and the APACHE II scores between the Mechanical Ventilation group (MV group) and the non-Mechanical Ventilation group (the non MV group). RESULTS: Sixty three patients were in the MV group and 48 patients were in the non MV group. In the MV group, the patients had an older age (p<0.001), a larger amount of ingestion (p<0.001), a lower initial serum cholinesterase level (p=0.003), a higher APACHE II score (p<0.001) and they ingested a more toxic agent (p=0.001). There were no significant differences in gender, the type of visit and the arrival time between the MV group and the non MV group. CONCLUSION: We suggest that the patient's age, the amount of organophosphate ingestion, the toxicity of the agent, the initial serum cholinesterase level and the APACHE II score are important factors to determine if mechanical ventilation will be applied for patients with organophosphate intoxication.

Study of the Length of Needle Thoracostomy Catheter Needed for Patients with Chest Trauma

PURPOSE: This study was conducted to evaluate the length of the catheter used in a needle thoracostomy for emergency decompression of a tension pneumothorax by measuring the chest wall thickness (CWT) in patients with chest trauma METHODS: A retrospective review of 201 patients with chest trauma who had been transported the emergency department in a tertiary university hospital in a metropolitan area between 1 January and 31 February 2007 was performed. The average CWT at the second intercostal space (ICS) in the midclavicular line (MCL) was measured by using a chest computed tomography scan. RESULTS: As the left and the right mean CWTs were 3.4+/-1.0 cm and 3.4+/-1.0 cm, respectively, there was no significant statistical difference between them. The mean CWT of female patients was significantly higher than that of male patients (p=0.001). The mean CWT of patients under the age of 65 years was significantly thicker than that of the patients over the age of 65 years (p 5 cm. CONCLUSION: A 5 cm-length catheter in a needle thoracostomy may be insufficient for emergency decompression of a tension pneumothorax, so a catheter longer than 5 cm in length is needed.

Comparison of Skills and Knowledge after Basic Life Support Training over a 6 Month Interval on Preclinical Medical Students

PURPOSE: The following study was performed to compare basic life support (BLS) skills and knowledge over a 6 months interval in preclinical medical students. METHODS: Upon initial instruction, 112 first-year medical students at a teaching hospital were given instructions in BLS, their knowledge performance was evaluated by written test and skills test via checklist designed by instructors and PC SkillReporting System(R) (Laerdal, Norway). Their performance was re-evaluated 6 months after initial BLS training in an identical fashion. Evaluation was performed on 103 out of 112 students who had taken initial BLS training. RESULTS: The results of written test showed that the students evaluated right after taking initial BLS training have better knowledge of BLS compared to students evaluated 6 months after taking initial BLS training (p<0.001). Results of skills test evaluated by checklist showed decrease in adequate performance of students evaluated 6 months after BLS education in 12 out of 18 items compared to students who have just received initial BLS training. The decreases were statistically significant in 6 items. Total scores after 6months were also lower compared with initial scores (p<.0.001). The results of the skills test using PC Skill Reporting System(R) demonstrated that the percentage of adequate ventilation volume, compression rate, hands-off time, and hand position were each 18.4%, 46.6%, 47.6%, 84.2% initially and 5.8%, 32.0%, 32.0%, 76.1% at 6 months after initial training. Students performed significantly worse 6 months post training in 4 out of 7 items (p<0.05). CONCLUSION: Knowledge and skills of preclinical medical students decreased significantly after a 6 month period compared to knowledge and skills after initial training. Therefore, retraining of BLS is required within 6 months, but more study is required to determine appropriate intervals and methods of retraining.

Diagnostic Usefulness of Computed Tomography Compared to Conventional Chest X-Ray for Chest Trauma Patients

PURPOSE: Early diagnosis and management of therapeutic interventions are very important in chest trauma. Conventional chest X-rays (CXR) and computed tomography (CT) are the diagnostic tools that can be quickly implemented for chest trauma patients in the emergency department. In this study, the usefulness of the CT as a diagnostic measurement was examined by analyzing the ability to detect thoracic injuries in trauma patients who had visited the emergency department and undergone CXR and CT. METHODS: This study involved 84 patients who had visited the emergency department due to chest trauma and who had undergone both CXR and CT during their diagnostic process. The patients' characteristics and early vital signs were examined through a retrospective analysis of their medical records, and the CXR and the CT saved in the Picture Archiving Communication System (PACS) were examined by a radiologist and an emergency physician to verify whether or not a lesion was present. RESULTS: Pneumothoraxes, hemothoraxes, pneumomediastina, pulmonary lacerations, rib fractures, vertebral fractures, chest wall contusions, and subcutaneous emphysema were prevalently found in a statistically meaningful way (p<0.05) on the CT. Even though their statistical significance couldn't be verified, other disorders, including aortic injury, were more prevalently found by CT than by CXR. CONCLUSION: CT implemented for chest trauma patients visiting the emergency department allowed disorders that couldn't be found on CXR to be verified, which helped us to could accurately evaluate patients.

Job Stress, Job Satisfaction of Emergency Residents and Its Related Factors

PURPOSE: The rate of volunteering by emergency residents is currently low in Korea because of the relatively high job stress. We aimed to investigate the job stress and job satisfaction of emergency residents and we wanted to identify the related factors. METHODS: Data was collected by conducting a cross-sectional mail survey. This mail was sent to 397 emergency residents in Korea. Among them, 226 persons answered the questionnaire and 220 responses were analyzed, with excluding 6 incomplete answers. RESULTS: Age, gender, the marriage status and the type of training hospital showed no statistically significant differences in relation to job stress and job satisfaction. XXXXBut the grade of the residents, satisfaction as emergency residents, thoughts of changing their job, thoughts of leaving the emergency department, their social and economic positions and the type of work-shift showed significant differences for job stress and job satisfaction. XXX Among the job stresses, the mean scores of the job factor, the environmental factor and the reward factor were 3.45+/-0.90, 3.63 +/-0.67 and 3.55+/-0, respectively. Among job satisfaction, the mean scores of the job factor, the relationship factor and the reward factor were 3.59+/-0.67, 2.46+/-0.74 and 2.53+/-0.80, respectively CONCLUSION: The job stress of emergency residents is excessive, and especially for the environmental and reward factors, and the degree of job satisfaction is low. Management of crowding, improving the environment by changing the type of work-shift type, eradicating violence in the emergency department and adequate rewards are needed to reduce this job stress. Efforts to increase the treatment capability and positively improve the relationship of residents with other medical specialists should be made to enhance emergency residents' job satisfaction.

Validation of the Simplified Motor Score for the Triage after Traumatic Brain Injury

PURPOSE: The Glasgow Coma Scale (GCS), though it is widely used for triage, has been criticized as being unnecessarily complex. Recently, a 3-point Simplified Motor Score (SMS, defined as obeys commands=2; localizes pain=1; withdrawals to pain or worse=0) was developed from the motor component of the GCS and was found to have a similar test performance for triage after traumatic brain injury when compared with the GCS as the criterion standard. The purpose of this study was to validate the SMS. METHODS: We analyzed the patients who visited Kyungpook National University Hospital emergency center after traumatic brain injury from 2006 January to 2006 June. The test performance of the GCS, its motor component, and SMS relative to three clinically relevant traumatic brain injury outcomes (abnormal brain CT scans, Abbreviated Injury Scale (AIS)> or =4, and mortality) were evaluated with areas under the receiver operating characteristic curves (AUCs). RESULTS: Of 504 patients included in the analysis, 25.6% had an abnormal brain CT scans, 13.1% had AIS> or = 4, and 5.0% died. The AUCs for the GCS, its motor component, and SMS with respect to the abnormal CT scans were 0.776, 0.715, and 0.716, and respectively, those for AIS> or =4 and mortality, were 0.969, 0.973, and 0.968, and 0.931, 0.909, and 0.909, respectively. CONCLUSION: The 3-point SMS demonstrated similar test performance when compared with the 15-point GCS score and its motor component for triage after traumatic brain injury in our populations.

Study of Out-of-hospital Cardiac Arrest Patients for whom 119 Rescuers used an Automated External Defibrillator in the Metropolitan Area

PURPOSE: To report characteristics of out-of-hospital cardiac arrest (OHCA) patients in whom 119 rescuers used an automated external defibrillator (AED) in the metropolitan area METHODS: 1,689 OHCA patients were transferred to hospitals by 119 rescuers between 1 January and 31 December, 2006. Among them, 106 OHCA patients for whom 119 rescuers used an AED were enrolled retrospectively. RESULTS: Shockable rhythm with AED use was 70.8%, witnessed arrest was 46.2%, and bystander cardiopulmonary resuscitation (CPR) was 6.6%. The most common location of cardiac arrest was in the home, at 74.5%. Response time was 7.1(+/-3.9) minutes. Chest compression during transport was done by 119 rescuers in 87.7% of cases, and assisted ventilations such as advanced airway management and bag valve mask ventilation were performed by 119 rescuers in 17.0%. Initial ECG findings at ED were asystole(59.4%), PEA(25.5%), VF/pulseless VT(8.5%), sinus rhythm(4.7%), and others(1.9%). The most common etiology of cardiac arrest was presumed cardiac origin in 68.9% of cases. Sustained return of spontaneous circulation (ROSC) was 26.4%. The proportion of patients discharged alive was 11.3%. CONCLUSION: The performance of bystander CPR and usage of AED, and appropriate CPR done by 119 rescuers were unsatisfactory in metropolitan Daegu. There is a marked need to establish basic life support education in the areas of bystander CPR, and a quantitative and qualitative development of 119 rescue capability.

Comparison and Analysis of Overall User Satisfaction over 10 years in an Emergency Medical Center

PURPOSE: To compare differences in overall satisfaction with emergency department (ED) services with the results obtained 10 years previously, in order to study effects of several component factors on patients' willingness to re-visit and to give recommendations. METHODS: This study was performed with questionnaires from 318 patients and proxies who were admitted to the emergency ward through the emergency medical center from February 19th, 2007 to March 18th, 2007. Evaluation of data was by frequency analysis, chi-square test, t-test, multiple regression analysis, and path analysis. RESULTS: During a one month study period, 244 patients and proxies (77% of those eligible) completed on-site questionnaires. Sociodemographic factors had no statistically significant influence on satisfaction with ED services. In multiple regression analysis to evaluate the correlation of various factors with satisfaction, the regression coefficients were 0.435(p<0.001) for reliability, 0.248(p<0.001) for accessibility, 0.179(p<0.001) for kindness, and 0.133 (p=0.004) for environmental respectively. In path analysis, the direct effect of overall satisfaction on patient willingness for re-visit was 0.582. The direct effect of overall satisfaction reliability on willingness to give recommendations were 0.594, and 0.250 respectively. CONCLUSION: In slight contrast to the study performed 10 years previously, the factors with the most correlation to overall satisfaction with ED services in this study were environment, kindness of hospital personnel, accessibility, and reliability of medical personnel. We confirmed that overall satisfaction is the most important factor influencing willingness for re-visit and willingness to recommend services, but found that the component factors vary as the point of survey or hospital conditions changes.

Predictive Factors of Serious Etiology in Patients with Syncope

PURPOSE: To stratify the risk of syncope by analyzing related risk factors of patients with possibly serious etiology who visit the emergency room with syncope. METHODS: We studied 201 patients who visited the emergency room of Kyungpook National University Hospital with syncope from January 2004 to December 2006. We defined serious etiology as arrhythmia, angina pectoris, myocardial infarction, septic shock, meningitis, cerebral infarction, subarachnoid hemorrhage, brain tumor, significant hemorrhage, and malfunction of cardiac pacemaker requiring immediate treatment and intervention. We analyzed the relationship between 81 risk factors and serious etiology to stratify the risk for patients with syncope. RESULTS: The patient group consisted of 105 males and 96 females with an average age of 56.4+/-20.7 years. Fifty-four patients had serious etiology. Among the 81 risk factors, those identified through univariate and multivariate analysis as having high predictive sensitivity and specificity were shortness of breath (odds ratio [OR]: 18.34, 95% confidence interval [CI]: 5.59-60.16); abnormal electrocardiography (OR: 10.29, 95% CI: 1.43-74.33); hematocrit or =47 years (OR: 6.24, 95% CI: 1.14-34.17); and admission via an out-patient department or by transfer from outside hospital (OR: 4.07, 95% CI: 1.15-14.36). CONCLUSION: Risk factors correlated with serious etiology for syncope are shortness of breath, abnormal electrocardiography, hematocrit or =47 years, and admission via an out-patient department or transfer from an outside hospital.

Relation between Location of Pelvic bone Fractures and the Injury to the Urinary bladder, Urethra or Lower gastrointestinal tract

PURPOSE: This research was conducted to study whether the specific location of pelvic-bone fractures could increase the risk for injury to the urinary bladder, urethra, or lower gastrointestinal tract. METHODS: We retrospectively reviewed the data of 234 patients with pelvic-bone fractures who visited the emergency department of Kyungpook National University Hospital from January 2004 to December 2006. The location of the pelvic-bone fracture was divided into 8 parts. The association of fracture location with injury to the urinary bladder, urethra, or lower gastrointestinal tract was analyzed with Fisher's-exact test and multiple logistic regression. RESULTS: Nineteen(19) patients had urinary bladder injury, 8 had urethral injury, and 9 had lower gastrointestinal tract injury. The following fracture locations were found to be significant; urinary bladder: sacroiliac (SI) joint (p<0.001), symphysis pubis (p=0.011), and sacrum (p=0.005); urethra: SI joint (p=0.020); lower gastrointestinal tract: symphysis pubis (p=0.028). After the multiple logistic regression analysis, the primary and the independent predictors for each of the injuries were as follows; urinary bladder: sacroiliac joint (p=0.000, odds ratio [OR]=10.469); lower gastrointestinal tract: symphysis pubis (p=0.037, OR=7.009). CONCLUSION: Consideration of further workup for injuries to the lower gastrointestinal and urinary tract is needed for some locations of pelvic-bone fractures because certain pelvic-bone fracture locations, especially the sacroiliac joint and the symphysis pubis, are associated with increased risk for injury to the lower gastrointestinal and urinary tracts.

Advanced Trauma Life Support

Among the deaths from trauma, 50% were dead at the scene, 30% in several hours, and 20% in a few weeks by multiple organ failure. The 30% occurring in several hours may be saved with rapid assessment and management of injuries. Trauma deaths could be reduced through an organized trauma system and standardized and systemic approach by physicians involved in the initial assessment and management of trauma. This is likely to present emergent and general traumatic care to increase the ability of treating trauma patients on the base of Advanced Trauma Life Support (ATLS) by the American College of Surgeons (ACS). Thus, both legal and systemic reform with an establishment of trauma centers or use of the ATLS program in intra-hospital trauma team is necessary to maximize operation of the medical team. Introduction of and emphasis on the skill oriented ATLS program in the medical school curriculum is also needed to prepare for real situations rather than knowledge-orientated education.

The Analysis of Medical Services during Summer Universiade

PURPOSE: The purpose of this study is to supply basic data for medical supports of the international games held in Korea and to design adequate plans for medical support systems in the international games. METHODS: We analyzed patients who visited the medical facilities during Summer Universiade Daegu 2003. A total of 3,363 individuals used the Athlete's Village Polyclinic during the Game, but a total of 1,079 cases were treated with traditional oriental medicine and were excluded. Standard charts were available for the 2,248 cases. Data were collected regarding patients' sex, age, participation role, chief complaint, diagnosis, visits of medical departments, management, and disposition. We classified patients according to acuity scoring criteria (a four-tier triage system), economies, and the data compared. Significant athlete injuries were triaged immediately by physicians stationed at the event scene. RESULTS: In the analysing, we used 2,248 cases, including some repeat visits. There were 987 visits by athletes, 937 visits by officials, 236 visits by staffs, and 88 visits by others. Musculoskeletal diseases were the primary chief complaint. Curiously, the lower income group visited the Polyclinic more often than the high income group. CONCLUSION: Most Polyclinic staffs were volunteers, providing encouragement and enthusiasm to patients. In this study, patient were contacted with emergency physicianbased medical service. For the future plans of the medical supports for similar events, effective medical plans should be finalized by considering multiple factors.

An Analysis of Disaster Recognition in Medical Personnel and 119 Rescuers after Daegu Subway Disaster

PURPOSE: Disaster is defined as hazards that impact on human lives, causing adverse physical, social, economic or even political effects that exceed abilitiesto rapidly and effectively respond. The purpose of this study, conducted in 2003 and in 2005, was to improve regional disaster plans through a disaster-recognition survey conducted among medical personnel and rescuers in Daegu, Korea. METHODS: This study was carried out using a questionnaire to gauge disaster awareness among medical personnel and 119 rescuers in the Daegu area. We compared responses obtained from medical personnel with those obtained from 119 rescuers. One way ANOVA was used for comparisons. Statistical significance attributed to a pvalue less than 0.05. RESULTS: Many medical personnel and 119 rescuers showed a poor understanding of the disaster response system with regard to activities and triage systems at disaster sites, communication between facilities emergency response exercises in mock disasters, and laws and regulations related to regional governments and facilities. This lack of understanding was especially evident among medical personnel. CONCLUSION: This study revealed that medical personnel and rescuers in Daegu had little understanding of and ability to cope with actual disaster conditions. In view of the close cooperation required in disaster situations between regional medical facilities, rescue workers and government agencies, disaster training and education are imperative. If these groups can work together well, any disaster can be dealt with rapidly and effectively.

Learning Styles in Medical School / 한국의학교육

PURPOSE: The purpose of this study is to investigate the learning styles of students at Kyungpook National University(KNU) School of Medicine and to assess its implications on teaching-learning methods in medical school. METHODS: 571 students in all years of medical school were invited to complete a questionnaire via online. For this study, Felder's Index of Learning Styles(ILS) was used, which included 49 items. Felder's ILS measures the learner's relative preference for each of the five dichotomous learning style dimensions. RESULTS: 242(42.3%) students completed the questionnaire. More than 80% preferred sensitive information and more than 60% preferentially took in visual information. Both males and females preferred sensing and visual learning materials. On average, The students at KNU school of Medicine were reflective, sensing, visual, global and inductive. CONCLUSION: From these results, we suggested some effective methods of teaching-learning based on the students' preferences and some perspectives for future works.

The Validation of the Admission Systemic Inflammatory Response Syndrome Score as the Trauma Score

PURPOSE: Multiple trauma is one of the major causes of deaths and physical disabilities of the young. Thus, a trauma scoring system which is easy, fast, and accurate is the most important factor for reducing the mortality due to multiple trauma. As studies have shows the systemic inflammatory response syndrome (SIRS) score is useful in estimating the severity of and determining the prognosis of the disease, so we investigated the usefulness of the SIRS score as a trauma score. METHODS: This study was a retrospective analysis of data collected from January 2002 to December 2002. Three hundred sixity nine trauma patients who were admitted to the emergency department were included. Patients who were transferred from other hospitals, children under the age of 15 years and patients transferred to other hospitals for ICU care and emergency operations were excluded. The SIRS score was defined according to the criteria of the American College of Chest Physicians and the Society of Critical Care Medicine (ACCP/SCCM). Patients were grouped by using the SIRS score(0 to 4) calculated at admission. RESULTS: Among the 369 trauma patients, 174 patients (47.2%) had a SIRS score > or =2 at admission, and 30 of the 369 patients expired. The admission SIRS score was significantly correlated with the injury severity score (ISS). The mortality rate and the length of stay (LOS) significantly increased as the admission SIRS score increased. Analysis of the variance, adjusting for age and ISS, should that are SIRS score> or =2 was a significant predictor of mortality and LOS. CONCLUSION: The admission SIRS score has been shown to be useful in estimating the severity of and the prognosis for a trauma. If we apply it to the trauma patients who visit ED, it should provide a more useful means for determining the severity of the trauma and the prognosis for the patient.

Clinical Review of Elderly Patients Who Visited the Emergency Department with Altered Mental Status

PURPOSE: The number of geriatric patients admitted to the emergency department (ED) is growing as the elderly population grows. The altered mental status of the elderly is more difficult to evaluate and manage than others. The purpose of this study was to determine the etiologies of altered mental status in elderly patients visiting the ED. METHODS: A retrospective study was made of 119 patients who visited the ED of Kyungpook National University Hospital for altered mental status from January 2001 to June 2002. RESULTS: The results of this study showed that extracranial causes (67.8%) were more than intracranial causes (31.9%): metabolic (35.3%), cerebrovascular (29.4%), extracranial infection (16.0%), cardiovascular (8.4%), drugs/toxins (8.4%), and intracranial infection (2.5%). The group with underlying disease or with brain imaging done showed more intracranial causes than extracranial causes. The results showed that the age, the initial Glasgow coma scale (GCS) score, a new positive finding on a brain image, and the causes of the mental change had significant influence on improvement of the mental status and on the survival rate (p < 0.05). CONCLUSION: Initial evaluation of the underlying disease, the GCS score, an early study of brain imaging, and a search for possible metabolic causes, as well as others should be done simultaneously to deliver high quality care to elderly patient. Knowledge of the most frequent causes of altered mental status in elderly patients may assist the emergency physician in the approaching these potentially ill patients and managing their care.

Comparison of MR Findings and Clinical Features according to Underlying Disease in Metabolic Encephalopathy

PURPOSE: Metabolic encephalopathy is not an infrequent condition. However it is very difficult to diagnose and treat because of its various causes and clinical manifestations. Our purpose was to clarify the cause of metabolic encephalopathy by evaluation of MR findings and clinical features. METHODS: We reviewed MR images and clinical features for 25 patients with metabolic encephalopathy who showed abnormal signal changes on the MR images with neurologic deterioration. RESULTS: The 25 patients had underlying diseases such as chronic liver disease (n=16) or renal failure (n=9). The MR findings showed significant differences in the involved sites according to the underlying disease. In 10 of the 16 patients with liver disease, corpus callosal involvement was observed. Red nucleus involvement was seen in 6 patients, dentate nucleus involvement in 5 patients. These lesions were seen to have a high signal intensity on the diffusion weighted image. Contrary to liver disease, encephalopathy with renal disease showed typical central pontine myelinolysis in 6 of the 9 patients and a relatively benign clinical course. CONCLUSION: Our results showed that the typically involved site and clinical manifestations depended on the underlying disease. We think that involvement of the corpus callosum, the red nucleus, and the dentate nucleus is a typical pattern of injury in metabolic encephalopathy with chronic liver disease and that these findings will be helpful for diagnosing and treating metabolic encephalopathy.