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Background@#This study aimed to investigate the impact of the coronavirus disease 2019 (COVID-19) outbreak on the Emergency Medical Service (EMS) system in South Korea. The study focused on the differences in EMS time intervals following the COVID-19 outbreak, particularly for patients with fever. @*Methods@#A retrospective analysis of EMS patient transportation data from 2017 to 2022 was conducted using the national EMS database. @*Results@#Starting from the year 2020, coinciding with the COVID-19 outbreak, all EMS time intervals experienced an increase. For the years 2017 to 2022, the mean response time interval values were 8.6, 8.6, 8.6, 10.2, 12.8, and 11.4 minutes, and the mean scene time interval values were 7.1, 7.2, 7.4, 9.0, 9.8, and 10.9 minutes. The mean transport time interval (TTI) values were 12.1, 12.3, 12.4, 14.2, 16.9, and 16.2 minutes, and the mean turnaround time interval values were 27.6, 27.9, 28.7, 35.2, 42.0, and 43.1 minutes. Fever (≥ 37.5°C) patients experienced more pronounced prolongations in EMS time intervals compared to non-fever patients and had a higher probability of being non-transported. The mean differences in TTI between fever and non-fever patients were 0.8, 0.8, 0.8, 4.3, 4.8, and 3.2 minutes, respectively, from 2017 to 2022. Furthermore, the odds ratios for fever patients being transported to the emergency department were 2.7, 2.9, 2.8, 1.1, 0.8, and 0.7, respectively, from 2017 to 2022. @*Conclusion@#The study findings highlight the significant impact of the COVID-19 outbreak on the EMS system and emphasize the importance of ongoing monitoring to evaluate the burden on the EMS system.
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Objective@#It is unknown whether artificial intelligence-based computer-aided detection (AI-CAD) can enhance the accuracy of chest radiograph (CR) interpretation in real-world clinical practice. We aimed to compare the accuracy of CR interpretation assisted by AI-CAD to that of conventional interpretation in patients who presented to the emergency department (ED) with acute respiratory symptoms using a pragmatic randomized controlled trial. @*Materials and Methods@#Patients who underwent CRs for acute respiratory symptoms at the ED of a tertiary referral institution were randomly assigned to intervention group (with assistance from an AI-CAD for CR interpretation) or control group (without AI assistance). Using a commercial AI-CAD system (Lunit INSIGHT CXR, version 2.0.2.0; Lunit Inc.). Other clinical practices were consistent with standard procedures. Sensitivity and false-positive rates of CR interpretation by duty trainee radiologists for identifying acute thoracic diseases were the primary and secondary outcomes, respectively. The reference standards for acute thoracic disease were established based on a review of the patient’s medical record at least 30 days after the ED visit. @*Results@#We randomly assigned 3576 participants to either the intervention group (1761 participants; mean age ± standard deviation, 65 ± 17 years; 978 males; acute thoracic disease in 472 participants) or the control group (1815 participants; 64 ± 17 years; 988 males; acute thoracic disease in 491 participants). The sensitivity (67.2% [317/472] in the intervention group vs. 66.0% [324/491] in the control group; odds ratio, 1.02 [95% confidence interval, 0.70–1.49]; P = 0.917) and false-positive rate (19.3% [249/1289] vs. 18.5% [245/1324]; odds ratio, 1.00 [95% confidence interval, 0.79–1.26]; P = 0.985) of CR interpretation by duty radiologists were not associated with the use of AI-CAD. @*Conclusion@#AI-CAD did not improve the sensitivity and false-positive rate of CR interpretation for diagnosing acute thoracic disease in patients with acute respiratory symptoms who presented to the ED.
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Background@#Death by suicide is a major public health problem. To provide multidisciplinary support to patients who attempted suicide, emergency department (ED)-based psychiatric screening and intervention programs were offered. We traced the long-term survival outcome of patients visiting the ED after suicide attempts using the national death certificate registration database. @*Methods@#A retrospective observational study was conducted using a database of patients from “Psychiatric Crisis Response Centers” (PCRC) of 27 EDs between January 2013 and August 2015. Patients who visited the ED after attempting suicide were screened and interviewed by social workers from the PCRC. The database was merged with the national death certificate database to trace the death and cause of death of the patients until December 2018. The characteristics and outcomes were compared based on the patient’s compliance with the follow-up case management program. @*Results@#Of the 12,544 interviewed patients, the data of 9,587 patients were successfully matched with data from the death certificate database. Death by suicide was higher in the noncompliance group (4.5% vs. 12.4%, P < 0.001); however, death caused by factors other than suicide did not differ between groups (4.8% vs. 4.9%, P = 0.906). @*Conclusion@#Suicide resulted in a lower long-term mortality rate among patients who complied with the follow-up case management session in the ED-based brief psychiatric intervention and follow-up program.
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Background@#The coronavirus disease 2019 (COVID-19) pandemic has caused health problems and distress among healthcare workers (HCWs), so supportive measures to promote their health and relieve distress are needed. @*Materials and Methods@#We conducted two rounds of Delphi surveys with 20 COVID-19-related frontline healthcare professionals and public officials. The surveys evaluated means of supporting HCWs’ health by improving health care systems and working environments in terms of effectiveness and urgency. The validity of the measures was assessed by calculating the content validity ratio. @*Results@#The top-priority measures to support HCWs were “secure isolation units capable of treating severe cases” in the facility infrastructure category, “secure nursing staff dedicated for patients in the intensive care units” in the personnel infrastructure category, “improve communication between central office and frontline field” in the cooperation system category, “support personal protective equipment and infection control supplies” in the aid supplies category, and “realization of hazard pay” in the physical/mental health and compensation category. @*Conclusion@#There was consensus among the experts on the validity and priorities of policies in the facility, personnel, cooperation, supplies, and compensation categories regarding measures to promote COVID-19 related HCWs’ health.
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OBJECTIVES@#We investigated the awareness, experience, approval, intention to use, and the desired type of telemedicine among Korean general public. @*METHODS@#From November to December 2020, we conducted an online self-reported survey on awareness, experience, approval, and intent to use telemedicine services among Korean residents aged 20 years or older. A total of 2,097 participants completed the survey. @*RESULTS@#Of the 2,097 participants, 1,558 (74.3%) were aware of, 1,198 (57.1%) approved of, and 1,474 (70.3%) had the intention to use telemedicine. Participants from regions other than the Seoul metropolitan area and Daegu–Gyeongbuk Province (adjusted odds ratio [aOR], 1.29; 95% confidence interval [CI], 1.02 to 1.63), households with a monthly household income of US$6,000 or more (aOR, 1.44; 95% CI, 1.01 to 2.08), participants who had a college/university or associate’s degree (aOR, 1.35. 95% CI, 1.04 to 1.75) or a master’s degree or above (aOR, 1.73; 95% CI, 1.20 to 2.50), and housewives (aOR, 1.30; 95% CI, 1.03 to 1.64) had higher odds of approval. Elderly participants, those with a chronic disease (aOR, 1.26; 95% CI, 1.04 to 1.54), those who had experienced delays of healthcare services (aOR, 1.94; 95% CI, 1.27 to 2.96), and those who had experience with telemedicine (aOR, 4.28; 95% CI, 1.69 to 10.82) were more likely to intend to use telemedicine services. Regarding types of telemedicine, teleconsultation between doctors showed the highest approval rate (73.1%). @*CONCLUSIONS@#In the context of the coronavirus disease 2019 pandemic, more than 70% of participants had already used or intended to use telemedicine at some point. Groups with a substantial need for telemedicine were more in favor of telemedicine.
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Objective@#This study analyzed the association of transport time interval (TTI) with survival rate and neurologic outcome in out-of-hospital cardiac arrest (OHCA) patients without return of spontaneous circulation (ROSC) and the interaction effect of TTI according to prehospital airway management. @*Methods@#A retrospective observational study based on the nationwide OHCA database from January 2013 to December 2017 was designed. Emergency medical service (EMS)-treated OHCA patients aged ≥18 years were included. TTI was categorized into four groups of quartiles (≤4, 5–7, 8–11, ≥12 minutes). The primary outcome was favorable neurologic outcome at discharge. The secondary outcome was survival to discharge from the hospital. Multivariable logistic regression was used to analyze outcomes according to TTI. A different effect of TTI according to the administration of prehospital EMS advanced airway was evaluated. @*Results@#In total, 83,470 patients were analyzed. Good neurologic recovery decreased as TTI increased (1.0% for TTI ≤4 minutes, 0.9% for TTI 5–7 minutes, 0.6% for TTI 8–11 minutes, and 0.5% for TTI ≥12 minutes; P for trend <0.05). The adjusted odds ratio of prolonged TTI (≥12 minutes) was 0.73 (95% confidence interval, 0.57–0.93; P<0.01) for good neurologic recovery. However, the negative effect of prolonged TTI on neurological outcome was insignificant when advanced airway or entotracheal intubation were performed by EMS providers (adjusted odds ratio, 1.17; 95% confidence interval, 0.42–3.29; P=0.76). @*Conclusion@#EMS TTI was negatively associated with the neurologic outcome of OHCA without ROSC on scene. When advanced airway was performed on scene, TTI was insignificantly associated with the outcome.
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Background@#Emergency departments (EDs) generally receive many casualties in disaster or mass casualty incidents (MCI). Some studies have conceptually suggested the surge capacity that ED should have; however, only few studies have investigated measurable numbers in one community. This study investigated the surge capacity of the specific number of accommodatable patients and overall preparedness at EDs in a metropolitan city. @*Methods@#This cross-sectional study officially surveyed surge capacity and disaster preparedness for all regional and local emergency medical centers (EMC) in Seoul with the Seoul Metropolitan Government's public health division. This study developed survey items on space, staff, stuff, and systems, which are essential elements of surge capacity. The number of patients acceptable for each ED was investigated by triage level in ordinary and crisis situations. Multivariate linear regression analysis was performed on hospital resource variables related to surge capacity. @*Results@#In the second half of 2018, a survey was conducted targeting 31 EMC directors in Seoul. It was found that all regional and local EMCs in Seoul can accommodate 848 emergency patients and 537 non-emergency patients in crisis conditions. In ordinary situations, one EMC could accommodate an average of 1.3 patients with Korean Triage and Acuity Scale (KTAS) level 1, 3.1 patients with KTAS level 2, and 5.7 patients with KTAS level 3. In situations of crisis, this number increased to 3.4, 7.8, and 16.2, respectively. There are significant differences in surge capacity between ordinary and crisis conditions. The difference in surge capacity between regional and local EMC was not significant. In both ordinary and crisis conditions, only the total number of hospital beds were significantly associated with surge capacity. @*Conclusion@#If the hospital's emergency transport system is ideally accomplished, patients arising from average MCI can be accommodated in Seoul. However, in a huge disaster, it may be challenging to handle the current surge capacity. More detailed follow-up studies are needed to prepare a surge capacity protocol in the community.
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Objective@#Delivery of prehospital defibrillation for shockable rhythms by emergency medical service providers is crucial for successful resuscitation in out-of-hospital cardiac arrest (OHCA) patients. The optimal range of prehospital defibrillation attempts for refractory shockable rhythms is unknown. This study evaluated the association between the number of prehospital defibrillation attempts and neurologic outcomes in OHCA patients. @*Methods@#A retrospective observational study was conducted using the nationwide OHCA registry. Adult OHCA patients who were treated by emergency medical service providers due to presumed cardiac origin with initial shockable rhythm were enrolled from 2013 to 2016. The final analysis was performed on patients without on-scene return of spontaneous circulation. The number of prehospital defibrillation attempts was categorized as follows: 2–3, 4–5, and ≥6 attempts. The primary outcome was a good neurologic recovery at hospital discharge. Multivariate logistic regression analysis was performed to evaluate the association between neurologic outcomes and the number of prehospital defibrillation attempts. @*Results@#A total of 4,513 patients were included in the final analysis. The numbers of patients for whom 2–3, 4–5, and ≥6 defibrillation attempts were made were 2,720 (60.3%), 1,090 (24.2%), and 703 (15.5%), respectively. Poorer outcomes were associated with ≥6 defibrillation attempts: survival to hospital discharge (adjusted odds ratio, 0.38; 95% confidence interval, 0.21–0.65) and good neurologic recovery (adjusted odds ratio, 0.42; 95% confidence interval, 0.21–0.84). @*Conclusion@#Six or more prehospital defibrillation attempts were associated with poorer neurologic outcomes in OHCA patients with an initial shockable rhythm who were unresponsive to on-scene defibrillation and resuscitation.
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Background@#Emergency departments (EDs) generally receive many casualties in disaster or mass casualty incidents (MCI). Some studies have conceptually suggested the surge capacity that ED should have; however, only few studies have investigated measurable numbers in one community. This study investigated the surge capacity of the specific number of accommodatable patients and overall preparedness at EDs in a metropolitan city. @*Methods@#This cross-sectional study officially surveyed surge capacity and disaster preparedness for all regional and local emergency medical centers (EMC) in Seoul with the Seoul Metropolitan Government's public health division. This study developed survey items on space, staff, stuff, and systems, which are essential elements of surge capacity. The number of patients acceptable for each ED was investigated by triage level in ordinary and crisis situations. Multivariate linear regression analysis was performed on hospital resource variables related to surge capacity. @*Results@#In the second half of 2018, a survey was conducted targeting 31 EMC directors in Seoul. It was found that all regional and local EMCs in Seoul can accommodate 848 emergency patients and 537 non-emergency patients in crisis conditions. In ordinary situations, one EMC could accommodate an average of 1.3 patients with Korean Triage and Acuity Scale (KTAS) level 1, 3.1 patients with KTAS level 2, and 5.7 patients with KTAS level 3. In situations of crisis, this number increased to 3.4, 7.8, and 16.2, respectively. There are significant differences in surge capacity between ordinary and crisis conditions. The difference in surge capacity between regional and local EMC was not significant. In both ordinary and crisis conditions, only the total number of hospital beds were significantly associated with surge capacity. @*Conclusion@#If the hospital's emergency transport system is ideally accomplished, patients arising from average MCI can be accommodated in Seoul. However, in a huge disaster, it may be challenging to handle the current surge capacity. More detailed follow-up studies are needed to prepare a surge capacity protocol in the community.
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Objective@#Delivery of prehospital defibrillation for shockable rhythms by emergency medical service providers is crucial for successful resuscitation in out-of-hospital cardiac arrest (OHCA) patients. The optimal range of prehospital defibrillation attempts for refractory shockable rhythms is unknown. This study evaluated the association between the number of prehospital defibrillation attempts and neurologic outcomes in OHCA patients. @*Methods@#A retrospective observational study was conducted using the nationwide OHCA registry. Adult OHCA patients who were treated by emergency medical service providers due to presumed cardiac origin with initial shockable rhythm were enrolled from 2013 to 2016. The final analysis was performed on patients without on-scene return of spontaneous circulation. The number of prehospital defibrillation attempts was categorized as follows: 2–3, 4–5, and ≥6 attempts. The primary outcome was a good neurologic recovery at hospital discharge. Multivariate logistic regression analysis was performed to evaluate the association between neurologic outcomes and the number of prehospital defibrillation attempts. @*Results@#A total of 4,513 patients were included in the final analysis. The numbers of patients for whom 2–3, 4–5, and ≥6 defibrillation attempts were made were 2,720 (60.3%), 1,090 (24.2%), and 703 (15.5%), respectively. Poorer outcomes were associated with ≥6 defibrillation attempts: survival to hospital discharge (adjusted odds ratio, 0.38; 95% confidence interval, 0.21–0.65) and good neurologic recovery (adjusted odds ratio, 0.42; 95% confidence interval, 0.21–0.84). @*Conclusion@#Six or more prehospital defibrillation attempts were associated with poorer neurologic outcomes in OHCA patients with an initial shockable rhythm who were unresponsive to on-scene defibrillation and resuscitation.
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Purpose@#The objective of this study was to modify and validate an emergency department (ED) triage system with improved prediction performance on hospital outcomes by modifying the Korean Triage and Acuity Scale (KTAS). @*Materials and Methods@#We performed a retrospective observational study at three academic universities in South Korea. The KTAS code, determined by the chief complaint and the selected modifier of a patient, was used to derive the Modified KTAS (MKTAS). We calculated the area under the receiver operating characteristics curve (AUC) and the test characteristics to evaluate the performance of MKTAS to predict hospital mortality, critical outcome, and admission. @*Results@#A total of 272402 and 128831 ED visits were used for the derivation and validation of MKTAS, respectively. Compared to KTAS, MKTAS had significantly higher AUC values for the prediction of hospital mortality [MKTAS 0.826 (0.818–0.835) vs. KTAS 0.794 (0.784–0.803)], critical outcome [MKTAS 0.836 (0.830–0.841) vs. 0.798 (0.792–0.804)], and admission [MKTAS 0.725 (0.723– 0.728) vs. KTAS 0.685 (0.682–0.688)]. The sensitivity for predicting hospital mortality and critical outcome, as well as the specificity for predicting admission, were significantly improved. @*Conclusion@#MKTAS was derived by modifying the KTAS, and then validated. Compared with KTAS, MKTAS showed better discriminating ability to predict hospital outcomes. Continuous efforts to evaluate and modify widely used triage systems are required to improve their performance.
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Purpose@#In Korea, the Broselow tape (BT) is widely used to estimate weight in resuscitation. Validation of BT in Korean children is essential because the tool was developed based on children’s weight and height in the United States. The validation was previously performed in a small-scale dataset. The authors aimed to validate BT using the 2005 Korean nationwide anthropometric survey data. @*Methods@#From the population used for the survey, we sampled children aged 0-12 years. The weights estimated by BT were compared with measured weights of the children using Bland-Altman analysis with results recorded as percentage differences. We measured the accuracy of BT, defined as within a 10% error of the measured weight, and the concordance of the color-coded zones derived from the estimated and measured weights. The accuracy and concordance were further assessed according to the age groups and body mass index-for-age Z-score ( 2, overweight or obese). @*Results@#A total of 108,128 children were enrolled. The mean age was 55.2 ± 37.5 months. The bias was –5.4% (P < 0.001), and the limits of agreement were –28.3% and 17.6%, respectively. The accuracy and concordance of BT were 64.4% and 67.2%, respectively. Differences of no more than 1 color-coded zone between estimated and measured weights accounted for 89.8% and 84.1% of the under- and overweight (or obese) children, respectively. @*Conclusion@#BT accurately estimates weight in approximately two-thirds of Korean children. In addition, adjustment of 1 color-coded zone may be considered in children with extreme weight.
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Objective@#The Trauma and Injury Severity Score (TRISS) has been used to predict trauma patient mortality and to assess the quality of trauma care systems. The goal of this investigation was to develop a modified trauma-related injury severity score (termed the TRISS-D) for predicting disability in acute trauma patients. @*Methods@#We used data collected by emergency medical services and entered into the Korea Centers for Disease Control and Prevention severe trauma database. The TRISS-D was based on age category (0–14, 15–54, ≥55 years), the Revised Trauma Score, and the Injury Severity Score. The outcome measures were severe disability and worsening disability. Worsening disability was defined as a lower Glasgow Outcome Scale score at hospital discharge than before the traumatic incident. Two types of cases were examined: those with penetrating or blunt injuries (group 1) and those with severe head injuries (group 2). We assessed the discriminatory power of the TRISS-D by calculating the area under a receiver operating characteristic curve (AUROC). @*Results@#The database comprised 14,791 patients; overall, 3,757 (25%) had severe disability and 6,018 (41%) had worsening disability. For severe disability, the AUROC (95% confidence interval) for the TRISS-D was 0.948 (0.944–0.952) in group 1 and 0.950 (0.946–0.954) in group 2. The corresponding values for worsening disability were 0.810 (0.803–0.817) and 0.816 (0.809–0.823), respectively. @*Conclusion@#The TRISS-D showed excellent discriminatory power for severe disability and very good discriminatory power for worsening disability.
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Objective@#The Trauma and Injury Severity Score (TRISS) has been used to predict trauma patient mortality and to assess the quality of trauma care systems. The goal of this investigation was to develop a modified trauma-related injury severity score (termed the TRISS-D) for predicting disability in acute trauma patients. @*Methods@#We used data collected by emergency medical services and entered into the Korea Centers for Disease Control and Prevention severe trauma database. The TRISS-D was based on age category (0–14, 15–54, ≥55 years), the Revised Trauma Score, and the Injury Severity Score. The outcome measures were severe disability and worsening disability. Worsening disability was defined as a lower Glasgow Outcome Scale score at hospital discharge than before the traumatic incident. Two types of cases were examined: those with penetrating or blunt injuries (group 1) and those with severe head injuries (group 2). We assessed the discriminatory power of the TRISS-D by calculating the area under a receiver operating characteristic curve (AUROC). @*Results@#The database comprised 14,791 patients; overall, 3,757 (25%) had severe disability and 6,018 (41%) had worsening disability. For severe disability, the AUROC (95% confidence interval) for the TRISS-D was 0.948 (0.944–0.952) in group 1 and 0.950 (0.946–0.954) in group 2. The corresponding values for worsening disability were 0.810 (0.803–0.817) and 0.816 (0.809–0.823), respectively. @*Conclusion@#The TRISS-D showed excellent discriminatory power for severe disability and very good discriminatory power for worsening disability.
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OBJECTIVE@#The purpose of this study was to compare the biomedical demands between a manual stretcher cart (Manual Cot) and a novel powered stretcher cart (Power Cot) during simulated routine stretcher handling activities.@*METHODS@#A randomized cross-over design mannequin simulation study was planned. Fourteen participants sequentially performed routine stretcher handling tasks, including unloading, lowering, raising, and loading tasks with the Manual Cot and Power Cot. The biomechanical workload of each participant was assessed by measuring the muscle activity of four muscles (bilateral L4/5 erector spinae and rectus femoris) through an 8-channel electromyogram (EMG) measurement system by attaching the surface EMG. The time required to perform each task was measured, and after the end of the simulation, the participants were given a subjective questionnaire consisting of seven items (five-point Likert scale) on the usefulness and usability of the two stretcher carts.@*RESULTS@#Fourteen participants, six males and eight females, performed four routine stretcher handling scenarios. The median total task times for the Manual Cot and Power Cot were similar (95 seconds; range, 49-105 vs. 94 seconds; range, 84–140; P=0.063). For the lowering, raising, and loading tasks, the effects of Power Cot were significantly lower than the normalized muscle voluntary contraction (%) cumulative sum of the back or thigh (P<0.05). Compared to Manual Cot, the use of Power Cot resulted in a decrease in total muscle activity of 18.0–63.5% in the back muscles and 6.7-83.9% in the thigh muscles during the task simulation. The participants preferred the Power Cot in terms of usefulness in subjective perceptions.@*CONCLUSION@#This simulation study identified that the Power Cot reduced the physical stress of emergency medical services workers without any significant performance time delay when performing stretcher-handling activities.
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OBJECTIVE: This study aimed to compare the demographic characteristics and trauma service structures and processes of hospitals in 15 countries across the Asia Pacific, and to provide baseline data for the integrated trauma database: the Pan-Asian Trauma Outcomes Study (PATOS).METHODS: Medical directors and emergency physicians at PATOS-participating hospitals in countries across the Asia Pacific were surveyed through a standardized questionnaire. General information, trauma care system data, and trauma emergency department (ED) outcomes at each hospital were collected by email and analyzed using descriptive statistics.RESULTS: Survey data from 35 hospitals across 15 countries were collected from archived data between June 2014 and July 2015. Designated trauma centers were identified as the highest hospital level for trauma patients in 70% of surveyed countries. Half of the hospitals surveyed had special teams for trauma care, and almost all prepared activation protocol documents for these teams. Most hospitals offered specialized trauma education programs, and 72.7% of hospitals had a hospital-based trauma registry. The total number of trauma patients visiting the ED across 25 of the hospitals was 300,376. The overall survival-to-discharge rate was 97.2%; however, it varied greatly between 85.1% and 99.7%. The difference between survival-to-discharge rates of moderate and severe injury groups was highest in Taiwan (41.8%) and lowest in Thailand (18.6%).CONCLUSION: Trauma care systems and ED outcomes vary widely among surveyed hospitals and countries. This information is useful to build further detailed, systematic platforms for trauma surveillance and evidence-based trauma care policies.
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Humans , Asia , Asian People , Cross-Sectional Studies , Education , Electronic Mail , Emergencies , Emergency Service, Hospital , Epidemiology , Physician Executives , Taiwan , Thailand , Trauma CentersABSTRACT
OBJECTIVE: Head elevation at an angle of 30° during cardiopulmonary resuscitation (CPR) was hemodynamically beneficial compared to supine position in a previous porcine cardiac arrest experimental study. However, survival benefit of head-up elevation during CPR has not been clarified. This study aimed to assess the effect of head-up tilt position during CPR on 24-hour survival in a porcine cardiac arrest experimental model.METHODS: This was a randomized experimental trial using female farm pigs (n=18, 42±3 kg) sedated, intubated, and paralyzed on a tilting surgical table. After surgical preparation, 15 minutes of untreated ventricular fibrillation was induced. Then, 6 minutes of basic life support was performed in a position randomly assigned to either head-up tilt at 30° or supine with a mechanical CPR device, LUCAS-2, and an impedance threshold device, followed by 20 minutes of advanced cardiac life support in the same position. Primary outcome was 24-hour survival, analyzed by Fisher exact test.RESULTS: In the 8 pigs from the head-up tilt position group, one showed return of spontaneous circulation (ROSC); all eight pigs expired within 24 hours. In the eight pigs from the supine position group, six had the ROSC; six pigs survived for 24 hours and two expired. The head-up position group showed lower 24-hour survival rate and lower ROSC rate than supine position group (P<0.01).CONCLUSION: The use of head-up tilt position with 30 degrees during CPR showed lower 24-hour survival than the supine position.
Subject(s)
Female , Humans , Advanced Cardiac Life Support , Agriculture , Animal Experimentation , Cardiopulmonary Resuscitation , Electric Impedance , Head , Heart Arrest , Models, Theoretical , Supine Position , Survival Rate , Swine , Ventricular FibrillationABSTRACT
OBJECTIVE: Assessing the severity of injury and predicting outcomes are essential in traumatic brain injury (TBI). However, the respiratory rate and Glasgow Coma Scale (GCS) of the Revised Trauma Score (RTS) are difficult to use in the prehospital setting. This investigation aimed to develop a new prehospital trauma score for TBI (NTS-TBI) to predict mortality and disability.METHODS: We used a nationwide trauma database on severe trauma cases transported by fire departments across Korea in 2013 and 2015. NTS-TBI model 1 used systolic blood pressure < 90 mmHg, peripheral capillary oxygen saturation < 90% measured via pulse oximeter, and motor component of GCS. Model 2 comprised variables of model 1 and age >65 years. We assessed discriminative power via area under the curve (AUC) value for in-hospital mortality and disability defined according to the Glasgow Outcome Scale with scores of 2 or 3. We then compared AUC values of NTS-TBI with those of RTS.RESULTS: In total, 3,642 patients were enrolled. AUC values of NTS-TBI models 1 and 2 for mortality were 0.833 (95% confidence interval [CI], 0.815 to 0.852) and 0.852 (95% CI, 0.835 to 0.869), respectively, while AUC values for disability were 0.772 (95% CI, 0.749 to 0.796) and 0.784 (95% CI, 0.761 to 0.807), respectively. AUC values of NTS-TBI model 2 for mortality and disability were higher than those of RTS (0.819 and 0.761, respectively) (P < 0.01).CONCLUSION: Our NTS-TBI model using systolic blood pressure, motor component of GCS, oxygen saturation, and age was feasible for prehospital care and showed outstanding discriminative power for mortality.
Subject(s)
Humans , Hypoxia , Area Under Curve , Blood Pressure , Brain Injuries , Capillaries , Fires , Glasgow Coma Scale , Glasgow Outcome Scale , Hospital Mortality , Hypotension , Korea , Mortality , Observational Study , Oxygen , Quality Improvement , Respiratory RateABSTRACT
BACKGROUND: This study aimed to evaluate the current overall preventable trauma death rate (PTDR) in Korea and identify factors associated with preventable trauma death (PTD). METHODS: The target sample size for review was designed to be 1,131 deaths in 60 emergency medical institutions nationwide. The panels for the review comprised trauma specialists working at the regional trauma centers (RTCs); a total of 10 teams were formed. The PTDR and factors associated with PTD were analyzed statistically. RESULTS: Of the target cases, 943 were able to undergo panel review and be analyzed statistically. The PTDR was 30.5% (6.1% preventable and 24.4% possibly preventable). Those treated at a RTC showed a significantly lower PTDR than did those who were not (21.9% vs. 33.9%; P = 0.002). The PTDR was higher when patients were transferred from other hospitals than when they directly visited the last hospital (58.9% vs. 28.4%; P = 0.058; borderline significant). The PTDR increased gradually as the time from accident to death increased; a time of more than one day had a PTDR 14.99 times higher than when transferred within one hour (95% confidence interval, 4.68 to 47.98). CONCLUSION: Although the PTDR in Korea is still high compared to that in developed countries, it was lower when the time spent from the accident to the death was shorter and the final destined institution was the RTC. To reduce PTDR, it is necessary to make an effort to transfer trauma patients to RTCs directly within an appropriate time.
Subject(s)
Humans , Developed Countries , Emergencies , Korea , Mortality , Sample Size , Specialization , Trauma Centers , Wounds and InjuriesABSTRACT
BACKGROUND: Traumatic brain injury (TBI) is one of the leading causes of pediatric disability that results in many emergency department visits. The risk of TBI is high while playing sports. The aim of this study was to examine the demographics and clinical characteristics of sports-related TBI. METHODS: We performed a multicenter observational study using the Emergency Department–Based Injury In-Depth Surveillance database in Korea. Patients aged 5 to 18 years old, who sustained unintentional, sports-related head injuries between January 2011 and December 2016 were included. The type of sports was the main variable of interest, and it was classified into 6 categories. The primary outcome was TBI, and the secondary outcome was intracranial injury and hospital admission. A multivariable logistic regression analysis was performed to calculate the adjusted odds ratios (aORs) with 95% confidence intervals for the outcomes by sports type. RESULTS: Of the 1,537,617 injured patients, 10,717 (0.7%) patients were included in the study. Most of the patients were male (87.5%), and the most prevalent sports type was field sports (51.2%). The proportion of TBI, intracranial injury, and admission were 15.7%, 1.2%, and 3.5%, respectively. The aORs of TBI, intracranial injury, and admission in bicycle and street sports compared to field sports were 1.77 (1.37–2.28), 4.99 (2.62–9.50), and 2.27 (1.42–3.61) respectively. CONCLUSION: This is the first nationwide epidemiologic study of pediatric sports-related TBI in Korea. The ratios of TBI, intracranial injury and admission were highest in bicycle and street sports. Prevention strategies for pediatric sports-related TBI can be developed according to sports types.