ABSTRACT
Background@#It is difficult to diagnose patients with poisoning and determine the causative agent in the emergency room. Usually, the diagnosis of such patients is based on their medical history and physical examination findings. We aimed to confirm clinical diagnoses using systematic toxicological analysis (STA) and investigate changes in the diagnosis of poisoning. @*Methods@#The Intoxication Analysis Service was launched in June 2017 at our hospital with the National Forensic Service to diagnose intoxication and identify toxic substances by conducting STA. Data were collected and compared between two time periods: before and after the initiation of the project, i.e., from June 2014 to May 2017 and from June 2017 to May 2020. @*Results@#A total of 492 and 588 patients were enrolled before and after the service, respectively. Among the 588 after-service patients, 446 underwent STA. Among the 492 before-service patients, 69.9% were diagnosed clinically, whereas the causative agent could not be identified in 35 patients. After starting the service, a diagnosis was confirmed in 84.4% of patients by performing a hospital-available toxicological analysis or STA.Among patients diagnosed with poisoning by toxins identified based on history taking, only 83.6% matched the STA results, whereas 8.4% did not report any toxin, including known substances. The substance that the emergency physician suspected after a physical examination was accurate in 49.3% of cases, and 12% of cases were not actually poisoned. In 13.4% of patients who visited the emergency room owing to poisoning of unknown cause, poisoning could be excluded after STA. Poisoning was determined to be the cause of altered mental status in 31.5% of patients for whom the cause could not be determined in the emergency room. @*Conclusion@#A diagnosis may change depending on the STA results of intoxicated patients.Therefore, appropriate STA can increase the accuracy of diagnosis and help in making treatment decisions.
ABSTRACT
Background@#It is difficult to diagnose patients with poisoning and determine the causative agent in the emergency room. Usually, the diagnosis of such patients is based on their medical history and physical examination findings. We aimed to confirm clinical diagnoses using systematic toxicological analysis (STA) and investigate changes in the diagnosis of poisoning. @*Methods@#The Intoxication Analysis Service was launched in June 2017 at our hospital with the National Forensic Service to diagnose intoxication and identify toxic substances by conducting STA. Data were collected and compared between two time periods: before and after the initiation of the project, i.e., from June 2014 to May 2017 and from June 2017 to May 2020. @*Results@#A total of 492 and 588 patients were enrolled before and after the service, respectively. Among the 588 after-service patients, 446 underwent STA. Among the 492 before-service patients, 69.9% were diagnosed clinically, whereas the causative agent could not be identified in 35 patients. After starting the service, a diagnosis was confirmed in 84.4% of patients by performing a hospital-available toxicological analysis or STA.Among patients diagnosed with poisoning by toxins identified based on history taking, only 83.6% matched the STA results, whereas 8.4% did not report any toxin, including known substances. The substance that the emergency physician suspected after a physical examination was accurate in 49.3% of cases, and 12% of cases were not actually poisoned. In 13.4% of patients who visited the emergency room owing to poisoning of unknown cause, poisoning could be excluded after STA. Poisoning was determined to be the cause of altered mental status in 31.5% of patients for whom the cause could not be determined in the emergency room. @*Conclusion@#A diagnosis may change depending on the STA results of intoxicated patients.Therefore, appropriate STA can increase the accuracy of diagnosis and help in making treatment decisions.
ABSTRACT
OBJECTIVE: The aim of this study was to develop professionalism competency for residents and medical students in the field of emergency medicine. METHODS: Twenty emergency medicine specialists working at a university hospital were recruited for the modified Delphi method. Seventy-three items were generated and classified into five domains: 13 items in patient care, 19 in communication and cooperation, nine in social accountability, 24 in professionalism, and eight in education and research. Two-step surveys were conducted. RESULTS: Items with a low content validity ratio (< 0.42) were deleted, or combined when the meanings of the items were similar or duplicated through two-step surveys. Finally, 59 items for residents were used: 12 items in patient care, 11 in communication and cooperation, six in social accountability, 23 in professionalism, and seven in education and research. In addition, 23 items for medical students were settled: six items in patient care, five in communication and cooperation, none in social accountability, 11 in professionalism, and one in education and research. CONCLUSION: The items related to social accountability and communication and cooperation with society were considered less important by the panels. In addition, there was a tendency to clearly distinguish between resident and student levels in professionalism competency. Based on the results of this study, it is important to form a basis for developing educational programs of professionalism of emergency medicine for senior medical students and residents.