Application of the Mortality in Emergency Department Sepsis (MEDS) Scoring System in the Evaluation of Suspected Sepsis in an Emergency Department

PURPOSE: Recent guidelines for sepsis treatment emphasizes the need for early recognition of disease, leading to the development of the MEDS scoring system. However, there has been no prospective validation or comparison against other scoring systems. Therefore, we prospectively validated the MEDS scoring system and compared it withMultiple Organ Dysfunction Score (MODS) and Sepsisrelated Organ Failure Assessment (SOFA) scoring systems. METHODS: MEDS, MODS, and SOFA scores of 288 patients who were suspected to have systemic infection were calculated at the times of their emergency department visits, and clinical data of the patients were reviewed after six months. Results: MEDS, MODS, and SOFA scoring systems were all valid in the prediction of mortality according to logistic regression analysis. The results of probit analysis revealed significant and direct relationships between the scores and the mortality rate and demonstrated the parallelism of the mortality prediction of the three scoring systems. The cut-off values for the MEDS scoring system successfully divided subjects into five groups according to their risk for death. And the MEDS score well predicted the admission to ward or intensive care unit in survived patients. CONCLUSION: MEDS, MODS, and SOFA scor all were good predictors of outcome for patients with suspected sepsis and showed the same degree of predictive power. The MEDS scoring system, however, featured ease of calculation and definite clinical cut-off values which were useful in guiding decisions about treatment options. It also was well correlated with the prognosis of survived patients. We believe it to be the most useful and appropriate clinical prediction tool in cases of suspected sepsis in the emergency department.

A Diagnostic Utility of Fitz-Hugh-Curtis Syndrome by Using Contrast Enhanced Abdominopelvic Computerized Tomo-graphy

PURPOSE: Fitz-Hugh-Curtis (FHC) syndrome is characterized by right upper quadrant pain due to perihepatitis with pelvic inflammatory disease (PID). It is diagnosed by using its typical symptoms, but final diagnosis is made by confirmation of the presence of laparoscopically visualized perihepatic violin string like adhesions. However, laparoscopy is difficult to perform in the emergency department. Recently, on computerized tomography (CT) a linear enhancement of the liver capsule was detected in a patient with FHC syndrome. We present a review of a series of 11 cases in female of FHC syndrome diagnosed by CT. METHODS: We reviewed the medical records and the CT findings of 11 cases of FHC syndrome diagnosed during 7 months in the emergency department. The clinico radiologic criteria of our hospital is as follows: First, right upper quadrant pain. Second, linear enhancement of the liver capsule in the contrast enhancement phase of CT. Third, no pathologic findings for the liver, the gallbladder and the biliary tract in CT. RESULTS: Eleven patients were diagnosed during 7 months by using criteria. The mean age was 30.2 (range: 16~46) years. Seven patients had a history of PID within 6 months. Seven of the 9 patients who take a pelvic examination were positive in C. trachomatis PCR (polymerase chain reaction), and another patient had a positive N. gonorrhoeae cervix culture. One patient who showed negative in both the C. trachomatis PCR and the N. gonorrhoeae cervix culture had cultured E. coli in urine and blood culture. CONCLUSION: CT makes easy the previously difficult diagnosis of FHC syndrome in female patients capable of pregnancy with right upper quadrant abdominal pain.

What time do you have?

PURPOSE: In the emergency medical field, a small error of time can make a huge difference because many difficult decisions depend on time. The purpose of this study was to confirm errors on the timepieces used by the medical system and to emphasize the importance of accurate time. METHODS: The timepieces of physicians, nurses, firefighters, paramedics, emergency department wall clocks, order communication system (OCS) computers, defibrillators, ECG machines, patient monitoring devices were investigated in 5 emergency medical centers. The time in OCS main server and 1339 emergency medical information center were checked by phone. The time on each timepieces was compared with the time of coordinated universal time korea (UTCK). The types of timepieces were confirmed and how often they set the time. RESULTS: There were 203 timepieces in 236 subjects. The timepieces had a mean error of 12 minutes 14 seconds. The errors were smaller in timepieces worn by the personnels compared to time on various devices used in the emergency department. The maximum error, 16 hours 20 minutes 31 seconds was found on patient monitoring devices. CONCLUSION: The timepieces used in the emergency medical care are often inaccurate. This can create medical or medicolegal problems. We should recognize the importance of maintaining accurate time and put an effort in reducing the errors of our timepieces.

An Imperforate Hymen with Lower Abdominal Pain and Acute Urinary Retention: A case report

A 13-year-old girl was transferred from a private clinic to our emergency department due to lower abdominal pain and acute urinary retention. Radiologic evaluation showed an imperforate hymen with hematocolpometra. In the emergency department, an imperforate hymen is a rare cause of acute urinary retention. Usually, the diagnosis of a congenital inperforate hymen can be made by inspection of the perineum; however, in many cases, an extensive radiologic evaluation must be performed because of misdiagnosis. The emergency physician should consider an imperforate hymen in girls with lower abdominal pain and urinary retention.