Epidemiology and outcomes of traumatic brain injury in Korean children according to age and development

Objective@#Traumatic brain injury (TBI) is one of the major causes of death and disability in children. Understanding the epidemiologic characteristics of TBI in children is the first step for developing preventative strategies, optimizing care systems, and rehabilitating the injury. @*Methods@#This is a cross-sessional study based on the Emergency Department-based Injury In-depth Surveillance (EDIIS) in Korea. We identified children (aged 0 to 18 years) who presented with TBI in emergency departments between January 2011 and December 2018. Subjects were classified into four groups according to age and development: infant and toddler group (0-2 years), pre-school group (3-5 years), school-aged group (6-11 years), and adolescent group (12-18 years). Epidemiologic characteristics and outcomes were compared according to age groups, and temporal variability in incidence was evaluated. @*Results@#During the 8-year study period, 45,734 children with TBI were included in the analysis. A higher incidence of TBI was observed in males, road accidents, and school/educational facilities as compared to the lesser-aged group (all P<0.01). Motor vehicle collisions were more common in the older group, but falls were more common in the younger group. Compared to the infant/toddler group, the adolescent group had higher intracranial injuries (8.1% vs. 16.8%; adjusted odds ratio [AOR], 1.8; 95% confidence interval [CI], 1.6-2.0) and mortality rate (0.2% vs. 1.3%; AOR, 2.0; 95% CI, 1.3-3.0). @*Conclusion@#The epidemiological characteristics of TBI in children are different for each group. It is necessary to develop differentiated preventative strategies and treatment systems based on the age groups of children.

Clinical course of compressed air injury with pneumocephlaus and orbital emphysema: a case report

Orbital emphysema with pneumocephalus is an unusual condition encountered in non-fracture craniofacial trauma. We report a case of orbital emphysema with disseminated pneumocephalus without any fracture, due to an orbital trauma caused by compressed air.

Clinical course of compressed air injury with pneumocephlaus and orbital emphysema: a case report

Orbital emphysema with pneumocephalus is an unusual condition encountered in non-fracture craniofacial trauma. We report a case of orbital emphysema with disseminated pneumocephalus without any fracture, due to an orbital trauma caused by compressed air.

The clinical usefulness of radiologic report monitoring system of CT and MRI in emergency department: analysis of missed and incidental findings

Objective@#This study was undertaken to establish a radiologic report monitoring system (RRMS) for missed and incidental findings (MIFs) in computed tomography (CT) and magnetic resonance imaging (MRI) reports, to help determine the clinical significance of MIFs in the emergency department (ED). @*Methods@#Patients presenting to our ED in 2017 were subjected to RRMS. Preliminary reports and final reports were subsequently compared based on the clinical significance of the MIFs. If required, the patient was contacted and instructed to revisit the ED. @*Results@#Totally, 12,132 CT and MRI exams were performed during the study period, and 321 cases (2.6%) encompassed MIFs. We attempted to contact 228 cases (1.9%) who had clinically significant MIF findings; 9 patients were instructed to return to the ED, whereas 105 cases were instructed to report to the outpatient department. Hospitalization was required for 12 patients: 2 cases required surgical intervention, 2 cases had an additional procedure, and 8 cases required medical hospitalization. @*Conclusion@#This study applied RRMS for a timely assessment of MIFs, determine rearrangements required, and present an active response to the MIFs determined in the ED. To improve patient care and safety, we hereby propose monitoring MIFs using the RRMS or similar methods.

Does the large amount of ascites lateralize the inferior epigastric artery in liver cirrhosis?

OBJECTIVE: The most common cause of hemorrhage after paracentesis is direct needle puncture of the inferior epigastric artery (IEA). This study examined the relationship between the amount of the ascites and the location of the IEA in liver cirrhosis. METHODS: Abdominal computed tomography (CT) examinations of patients with liver cirrhosis were reviewed retrospectively and divided into two groups according to the amount of ascites. The distances between the midline and the IEAs of both sides were measured at the umbilicus, McBurney's point, anterior superior iliac spine, and mid-inguinal level. Branching of the IEAs, abdominal wall and mesenteric varices in the abdomen below the umbilicus level were recorded. RESULTS: A total of 120 abdominal CTs were reviewed. The distances from the midline to the IEA in the large ascites group were longer than those in the small ascites group at the level of the right McBurney's point (44.5±14.6 mm vs. 39.6±11.8 mm, P=0.043) and left McBurney's point (48.6±15.3 mm vs. 43.3±11.5 mm, P=0.035). The incidence of abdominal wall varices was higher in the large ascites group (21.7% vs. 5.0%, P=0.014). CONCLUSION: In patients with liver cirrhosis, the large amount of ascites might be associated with lateralizing the location of the IEA. Moreover, it may be necessary to confirm the blood vessels in the abdominal wall and mesentery near the puncture site by bedside ultrasound before the paracentesis.

Rectal Perforation with Pneumoperitoneum Caused by Compressed Air

Compressed air can cause serious damage to internal organs. The stomach is an organ that is rarely perforated due to its elasticity. However, intestines are weaker and thinner compared to the stomach. A 40-year-old male came to the emergency room with severe abdominal pain due to dyspnea. The patient experienced abdominal pain right after his coworker shot compressed air into the patient's pants. The patient suffered from a rigid abdomen, and bed-side ultrasonography was carried out as soon as possible. Pneumoperitoneum was diagnosed by portable X-ray. After computed tomography, emergency paracentesis was carried out for decompression. After emergency paracentesis, the patient's symptoms and vital signs were stabilized. After the procedure, the patient had an emergency laparotomy.

Analysis of Prognostic Factors Affecting Admission in Acute Alcohol-intoxicated Patients with Traumatic Brain Injury Visiting Emergency Room

PURPOSE: This study analyzed the prognostic factors affecting admission in acute alcohol-intoxicated traumatic brain injury (TBI) patients visiting the emergency room. METHODS: A multicenter, retrospective observational study was conducted on 821 acute alcohol-intoxicated adult trauma patients, who visited 10 university hospital emergency centers from April to November 2016. The primary outcome was hospital admission. The secondary outcome was in-hospital mortality. RESULTS: One hundred sixty-eight patients diagnosed with acute alcohol-intoxicated TBI were analyzed. The increase in blood alcohol concentration was associated significantly with a mild decrease in admission (adjusted odds ratio, 0.993; 95% confidence interval, 0.989 to 0.998; p=0.01). Moderate to severe TBI patients showed a significant increase in admission compared to mild TBI patients (adjusted odds ratio, 12.449; 95% confidence interval, 3.316 to 46.743; p < 0.001). CONCLUSION: This study showed that the admission was inversely correlated with the blood alcohol concentration and is correlated directly with the increase in the severity in TBI. Therefore, emergency physicians may be required to identify the severity of TBI rapidly and accurately in acute alcohol-intoxicated trauma patients visiting the emergency room.

Adverse Drug Reactions in Adult Patients Visiting an Emergency Department: Based on Spontaneous Reporting System

PURPOSE: Adverse drug reaction (ADR) is known to be a substantial reason for emergency departments (ED) visits. Additionally, it also is a frequent occurrence in ED. The aim of the study was to compare the characteristics between ADRs that occurred in ED and ADRs that occur elsewhere based on the spontaneous reporting system in a hospital. METHODS: In this retrospective observational study, the data was collected by the spontaneous ADR reporting system within an electronic medical record system during a 24-month period. ADR of patients aged more than 18 years were included in this study. RESULTS: Patients with ADR was older in ED (42.6±14.5 vs. 53.9±17.2, p<0.001) and they were administered with less medications (2.0±1.3 vs. 4.4±4.4, p<0.001). The proportion of ADR reported by doctors in ED was higher than that in non-ED (41.2% vs. 28.2%, p<0.001). The proportion of the severe ADR was not significantly different between the ED and non-ED groups (2.9% vs. 3.8%, p=0.701). The most common symptom of ADRs in ED and non-ED groups were cutaneous (52.9%) and gastrointestinal (42.2%), respectively; the most common implicated medication was analgesics (62.7%) and analgesics (41.5%), respectively. CONCLUSION: The characteristics of ADR in ED is different from that in non-ED locations. Further studies are needed to differentiate education and prevention strategies of ADR in ED from those in non-ED locations.

Comparison of the GlideRite to the conventional malleable stylet for endotracheal intubation by the Macintosh laryngoscope: a simulation study using manikins

OBJECTIVE: To compare the effectiveness of the GlideRite stylet with the conventional malleable stylet (CMS) in endotracheal intubation (ETI) by the Macintosh laryngoscope. METHODS: This study is a randomized, crossover, simulation study. Participants performed ETI using both the GlideRite stylet and the CMS in a normal airway model and a tongue edema model (simulated difficult airway resulting in lower percentage of glottic opening [POGO]). RESULTS: In both the normal and tongue edema models, all 36 participants successfully performed ETI with the two stylets on the first attempt. In the normal airway model, there was no difference in time required for ETI (TETI) or in ease of handling between the two stylets. In the tongue edema model, the TETI using the CMS increased as the POGO score decreased (POGO score was negatively correlated with TETI for the CMS, Spearman’s rho=-0.518, P=0.001); this difference was not seen with the GlideRite (rho=-0.208, P=0.224). The TETI was shorter with the GlideRite than with the CMS, however, this difference was not statistically significant (15.1 vs. 18.8 seconds, P=0.385). Ease of handling was superior with the GlideRite compared with the CMS (P=0.006). CONCLUSION: Performance of the GlideRite and the CMS were not different in the normal airway model. However, in the simulated difficult airway model with a low POGO score, the GlideRite performed better than the CMS for direct laryngoscopic intubation.

Comparison of the GlideRite to the Conventional-malleable-stylet for Endotracheal Intubation by the Macintosh-laryngoscope: A Simulation Study Using Manekins

PURPOSE: The purpose of this study is to compare the effectiveness of the GlideRite with the conventional-malleable-stylet (CMS) in endotracheal intubation (ETI) using the Macintosh-laryngoscope. METHODS: This study is a randomized crossover simulation study. Participants performed ETI using both the GlideRite and the CMS in the normal airway and in a tongue edema (simulated difficult airway resulting in lower percentage of glottis opening [POGO]) model. RESULTS: In both the normal and the tongue edema models, all 36 participants performed ETI successfully using the two stylets on the first attempt. In the normal airway model, there was no difference in time required for ETI (T(ETI)) or ease of handling between the two stylets. In the tongue edema model, the T(ETI) increased as POGO score decreased with the CMS (POGO score showing negative correlation with T(ETI) for the CMS, Spearman's rho=-0.518, p=0.001) but not for the GlideRite (rho=-0.208, p=0.224). The T(ETI) was shorter with the GlideRite than the CMS, but without statistical significance (15.1 vs. 18.8 seconds, p=0.385). Ease of handling was superior with the GlideRite compared to the CMS (p=0.006). CONCLUSION: Performance of the GlideRite and the CMS was not different in the normal airway model. However, in the simulated difficult airway model with a low POGO score, the GlideRite performed better than the CMS for direct laryngoscopic intubation.

Kojic Acid Peptide: A New Compound with Anti-Tyrosinase Potential

BACKGROUND: Kojic acid was used for decades in the cosmetic industry as an antimelanogenic agent. However, there are two major drawbacks of Kojic acid, one is cytotoxicity and second are instability on storage. These limitations led the scientist to synthesize the active Kojic acid peptides. OBJECTIVE: In the present study, we synthesize and investigate the effect of five Kojic acid peptides to overcome the limitation of Kojic acid. METHODS: The peptide was analyzed and purified by high-performance liquid chromatography and matrix-assisted laser desorption ionization time of flight mass spectroscopy. Further, the tyrosinase activities of the Kojic acid and Kojic acid peptides were compared. The toxicity was measured and the melanin content is recorded in B16F10 mouse melanoma cells. RESULTS: Maximum tyrosinase activity was measured by Kojic acid peptides. Therefore, Kojic acid peptides were subjected to melanin assay and cytotoxicity assay and finally the stability of the Kojic acid peptide was measured. CONCLUSION: It was observed that this newly synthesized Kojic acid peptide is stable and potent to inhibit the tyrosinase activity and melanin content of B16F10 mouse melanoma cells without exhibiting cell toxicity. Together, these preliminary results suggest that a further exploration is being needed to establish Kojic acid peptide as antimelanogenic agent.

Effects of combination therapy of docetaxel with selenium on the human breast cancer cell lines MDA-MB-231 and MCF-7

PURPOSE: The anticancer property and cytoprotective role of selenium in chemotherapy have been reported. However, the combination effects of selenium on chemotherapy for advanced breast cancer have not yet been clearly defined. The purpose of this study was to investigate the combined effects of selenium on chemotherapy using docetaxel on breast cancer cell lines. METHODS: Under adherent culture conditions, two breast cancer cell lines, MDA-MB-231 and MCF-7, were treated with docetaxel at 500pM and selenium at 100nM, 1microM, or 10microM. Changes in cell growth, cell cycle duration, and degree of apoptosis after 72 hours in each treated group were evaluated. RESULTS: In the MDA-MB-231 cells, the combination therapy group (docetaxel at 500pM plus selenium at 10microM) showed a significantly decreased percentage of cell growth (15% vs. 28%; P = 0.004), a significantly increased percentage of late apoptosis (63% vs. 26%; P = 0.001), and an increased cell cycle arrest in the G2/M phase (P = 0.001) compared with the solitary docetaxel therapy group. Isobologram analysis demonstrated the synergistic effect of the combination therapy in the MDA-MB-231 cells. However, in the MCF-7 cells, no significant differences in the percentage of cell growth apoptosis, the percentage of apoptosis, and the pattern of cell cycle arrest were noted between the combination therapy groups and the solitary docetaxel therapy group. CONCLUSION: Our in vitro study indicated that the combination of selenium with docetaxel inhibits cell proliferation through apoptosis and cell arrest in the G2/M phase in MDA-MB-231 breast cancer cells.

Prospective Evaluation of the Recognition of Stroke In the Emergency Room (ROSIER) Scale in Emergency Department

PURPOSE: Early assessment and rapid intervention in patients with acute stroke can reduce mortality and complication. We conducted a prospective evaluation of the Recognition Of Stroke In the Emergency Room (ROSIER) scale for use in patients with suspected stroke. METHODS: We studied 312 patients with suspected acute stroke who were admitted to the emergency department within 7 months from August 2013 to February 2014. Emergency physicians used the ROSIER scale as a stroke recognition tool, compared with the Face Arm Speech Test (FAST). Patients meeting the inclusion criteria were evaluated for both the FAST and the ROSIER scale and compared with the final discharge diagnoses. Then, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), area under curve of the FAST, and the ROSIER scale were calculated. RESULTS: The patient group consisted of 141 males and 171 females with an average age of 60 years; 112 (35.9%) patients had ROSIER scale > or =1 indicating a stroke, 98 (31.4%) of these patients had stroke as a final diagnosis. The FAST showed sensitivity of 85.8%, specificity of 92.5%, PPV of 86.6%, and NPV of 92.0%. The ROSIER scale showed relative sensitivity of 86.7%, specificity of 93.0%, PPV of 87.5%, and NPV of 92.5%. CONCLUSION: In this study, the ROSIER scale was a useful stroke recognition tool for potential stroke patients, but showed no significant superiority over the FAST.

The Effect of Counting Numbers out for Giving Breaths on the Interrupting Time and Fraction of Chest Compressions in 2-rescuer Cardiopulmonary Resuscitation: A Manikin Pilot Study

PURPOSE: The aim of this study was to estimate the effect of counting numbers out for giving breaths on the interruption time (IT) of chest compressions (CCs) and chest compression fraction (CCF) in the 2-rescuer cardiopulmonary resuscitation (CPR). METHODS: Thirty medical students were enrolled in this randomized control simulation study, and were randomly divided into the control group and the study group. Both groups performed 2-rescuer CPR for 5-cycles with giving breaths using a bag-mask. Only participants in the study group were instructed to count numbers out for each breath verbally ("one, two") at the end point of each inspiration period and immediately perform CCs at the point of counting "two". RESULTS: However, no differences in terms of depth, rate, incorrect location, and duty cycle of CCs, as well as ventilation volume of each breath, time to delivery of two breaths, and counts of breathing during 1 minute were observed between the two groups. CONCLUSION: The study group had significantly shorter IT and higher CCF compared with the control group. And no significant differences in the other measured parameters of CPR quality were observed between the two groups.

Is There a Difference in the Effect of Thrombolytic Therapy according to the Presence of Diffusion-Weighted Imaging (DWI)-Fluid Attenuated Inversion Recovery (FLAIR) Mismatching in Patients with Acute Ischemic Stroke?

PURPOSE: We performed this study to investigate whether there is difference in the effect of intravenous (IV) thrombolysis according to the presence of diffusion-weighted imaging- fluid-attenuated inversion recovery (DWI-FLAIR) mismatch among acute ischemic stroke patients who visited the emergency department (ED) within 3 hours from the onset of symptom. METHODS: Among ED patients presenting with an acute ischemic stroke between January 2011 and May 2013, those who underwent MRI and received IV thrombolytic therapy were included in this retrospective study. Patients were divided into DWI-FLAIR mismatch and match groups and compared for their initial NIHSS (National Institutes of Health Stroke Scale), NIHSS 24-hour after the thrombolytic therapy, NIHSS on discharge, early neurologic improvement (ENI), and major neurologic improvement (MNI). RESULTS: During study period, 50 patients were finally included among 213 acute ischemic stroke patients. DWI-FLAIR mismatch group showed significantly more reduction in NIHSS 24-hour after the thrombolytic therapy and NIHSS on discharge than the match group (5.5 vs. 1.2, p<0.001, 6.0 vs. 2.3, p<0.01, respectively). Moreover, ENI and MNI occurred significantly more in DWI-FLAIR mismatch group than match group (27/36 vs. 2/14, p<0.001, 12/36 vs. 0/14, p=0.012, respectively). CONCLUSION: Among acute ischemic stroke patients who visited ED within 3 hours from the onset of symptom, those patients who had DWI-FLAIR mismatch on MRI showed significantly better response to IV thrombolytic therapy than DWI-FLAIR match group in terms of neurologic outcome.

Prospective Evaluation of the Pediatric Appendicitis Score with Right Lower Quadrant Abdominal Pain Registry

PURPOSE: Acute appendicitis is one of the most common surgical emergencies in the emergency department (ED) and various scoring systems such as the Alvarado score or the pediatric appendicitis score (PAS) have been developed to aid diagnosis. This study was designed to evaluate the diagnostic value of PAS in South Korea children, prospectively. METHODS: All patients visiting our ED with right lower quadrant (RLQ) abdominal pain or RLQ tenderness were enrolled in our registry. Patients under age of 18, whose guardian agreed with the informed consent were included in this study. Those who were diagnosed at previous hospitals were excluded. Appendicitis was confirmed by operative and histopathological findings. A follow up call was made to verify final outcome within 14 days. RESULTS: We collected data on 1648 patients and a total of 512 patients participated in the study. The mean age was 11.9 years. Seventy four patients (14.5%) had pathology-proven appendicitis and negative appendectomy was performed in three patients (3.9%). Statistical analysis showed that with PAS > or =4, sensitivity 70.1%, specificity 60.4%, and area under curve (AUC) 0.708. With the Alvarado score > or =5, sensitivity 72.7%, specificity 67.2%, and AUC 0.748. CONCLUSION: Usefulness of PAS in diagnosis of pediatric acute appendicitis is limited. PAS showed no significant superiority over the Alvarado score. Therefore, it seems reasonable to use both scores for evaluation of pediatric acute appendicitis in South Korea.

Adalimumab Induced Acute Exacerbation of Rheumatoid Arthritis Related Interstitial Lung Disease

A 69-year-old woman with 6 years history of seropositive rheumatoid arthritis (RA) and asymptomatic interstitial lung disease (ILD) began taking adalimumab for ongoing arthritis despite intakes of sulfasalazine and hydroxychloroquine for treatment. ILD progressed noticeably after 10 weeks of starting adalimumab. We discontinued adalimumab and added methylprednisolone 40 mg, and the patient's clinical findings gradually improved. The beneficial and adverse effects of tumor necrosis factor-alpha (TNF-alpha) inhibitors on RA associated ILD are unclear but this case reports adalimumab could abruptly exacerbate known ILD. We emphasize cautions on the use of adalimumab, one of the TNF-alpha inhibitors, in elderly RA patients with preexisting ILD.

Clinical Features of Negative Hematuria in Urolithiasis Patients in the Emergency Department

PURPOSE: To determine the clinical features of urolithiasis-patients; specifically negative hematuriapatients (NHP) versus positive hematuria patients (PHP) in an emergency department (ED). METHODS: Patients with urolithiasis who had visited an ED over the past two years were retrospectively analyzed. Only patients analyzed through both urinalysis and computed tomography were included (1005 patients). NHP was present in 125(12.4%) of these patients. The clinical features of NHP and PHP were assessed in regard to several factors: sex, age, onset to ED visit time, associated symptoms, costovertebral angle tenderness (CVAT), stone size, stone location, length of stay in the ED, repeated drug rate, admission rate, and revisit rate within 72 hours. RESULTS: There were no significant differences in sex, age, onset to ED visit time, associated symptom, CVAT, and stone size between NHP and PHP. However, in NHP there was a slight dominance in renal and ureterovesical junction (UVJ) according to stone location. Compared with PHP, NHP increased the length of stay in the ED (150.0+/-52.3 min vs. 132.7+/-48.6 min; p=0.001), repeated drug rate (80% vs. 69.4%; p=0.015) and admission rate (12.8% vs. 6.4%; p=0.015). There was no significant difference in revisit rate within 72 hours between NHP and PHP (8.3% vs. 4.7%; p=0.161). CONCLUSION: Compared with the conventional PHP, NHP increased the length of stay in an ED, increased the repeated drug rate, and was associated with a high admission rate in an ED setting.

Clinical Features of Negative Hematuria in Urolithiasis Patients in the Emergency Department

PURPOSE: To determine the clinical features of urolithiasis-patients; specifically negative hematuriapatients (NHP) versus positive hematuria patients (PHP) in an emergency department (ED). METHODS: Patients with urolithiasis who had visited an ED over the past two years were retrospectively analyzed. Only patients analyzed through both urinalysis and computed tomography were included (1005 patients). NHP was present in 125(12.4%) of these patients. The clinical features of NHP and PHP were assessed in regard to several factors: sex, age, onset to ED visit time, associated symptoms, costovertebral angle tenderness (CVAT), stone size, stone location, length of stay in the ED, repeated drug rate, admission rate, and revisit rate within 72 hours. RESULTS: There were no significant differences in sex, age, onset to ED visit time, associated symptom, CVAT, and stone size between NHP and PHP. However, in NHP there was a slight dominance in renal and ureterovesical junction (UVJ) according to stone location. Compared with PHP, NHP increased the length of stay in the ED (150.0+/-52.3 min vs. 132.7+/-48.6 min; p=0.001), repeated drug rate (80% vs. 69.4%; p=0.015) and admission rate (12.8% vs. 6.4%; p=0.015). There was no significant difference in revisit rate within 72 hours between NHP and PHP (8.3% vs. 4.7%; p=0.161). CONCLUSION: Compared with the conventional PHP, NHP increased the length of stay in an ED, increased the repeated drug rate, and was associated with a high admission rate in an ED setting.

Initial Electrocardiographic Findings Associated with Failed Resolution of ST-segment Elevation after Thrombolytic Therapy in Acute ST-segment Elevation Myocardial Infarction (STEMI)

PURPOSE: Electrocardiography is a non-invasive tool for use in prediction of reperfusion and outcome of acute myocardial infarction. We attempted to determine initial electrocardiographic findings associated with failed resolution of ST-segment elevation (STE) among patients with ST-segment Elevation Myocardial Infarction (STEMI) treated with a thrombolytic agent. METHODS: This retrospective study included patients with STEMI who were treated with a thrombolytic agent at the emergency department between October 2008 and March 2011. During the study period, among 331 patients with STEMI, 43 patients were enrolled. Resolution of STE was evaluated by comparison of initial electrocardiography (ECG) with follow-up ECG, taken 90 minutes after thrombolytic therapy. Determination of success or failure of resolution of STE was based on the electrocardiographic criteria of the American College of Cardiology and the American Heart Association (ACC/AHA). Patients were divided into two groups according to these criteria, and initial electrocardiographic findings were compared for the two groups. RESULTS: Of a total of 43 patients, 22(55.16%) demonstrated failed resolution of STE after thrombolytic therapy. The risk of failed resolution of STE was approximately nine times higher in the anterior location of STE, compared to the inferior location of STE (OR 9.09, 95% CI, 1.46-94.69, p<0.01). In addition, the absence of reciprocal ST depression was associated with a six times higher risk of failed resolution of STE, compared with the presence of reciprocal ST depression (OR 6, 95% CI, 1.17-39.23, p=0.01). However, other electrocardiographic findings, including abnormal Q-wave, wide QRS complex, and QTc prolongation did not differ statistically between the two groups. CONCLUSION: Failed STE resolution after thrombolytic therapy was more frequent in STEMI patients with ST elevation in an anterior location or without reciprocal ST depression.