ABSTRACT
Objective@#This study examined whether the changes in reimbursement coverage of brain magnetic resonance image (MRI) affected practice for patients who visited the emergency department with dizziness as the chief complaint. @*Methods@#Among the 5,423 patients who visited the emergency department for dizziness in 2017, 2019, and 2021, 4,497 patients were included in the study retrospectively and investigated by brain diffusion-weighted MRI and the presence of cerebral infarction on brain diffusion-weighted MRI. This study examined whether there was a significant difference before and after the change. @*Results@#In 2017, 2019, and 2021, 1,489, 1,570, and 1,438 patients with dizziness visited the emergency department, respectively. The number of patients who underwent a brain MRI scan gradually increased from 237 (15.9%) in 2017 to 628 (40.0%) in 2019 and 948 (65.9%) in 2021 (P<0.001). The number of positive findings on brain MRI scan increased gradually from 30 patients (2.0%) in 2017 to 47 patients (3.0%) in 2019 and 53 patients (3.7%) in 2021 (P=0.025). The ratio of positive findings of brain MRI scans to the number of patients who underwent brain MRI scans decreased gradually to 12.7% in 2017, 7.5% in 2019, and 5.6% in 2021 (P=0.001). @*Conclusion@#The changes in the reimbursement coverage of brain MRI affect the number of brain MRI scans and the detection of cerebral infarction.
ABSTRACT
Objective@#This study compared the epidemiological changes before and after the coronavirus disease 2019 (COVID-19) outbreak in out-of-hospital cardiac arrest patients in a single center. This study analyzed the long-term impact of the COVID-19 pandemic. @*Methods@#Eight hundred and sixty-one out-of-hospital cardiac arrest patients were included in the analysis. Out-of-hospital cardiac arrest patients from January 20, 2018, to January 19, 2020, were used as the control group, and those between January 20, 2020, and January 19, 2022, were used as the study group. The collected data were evaluated using a Student t-test, chi-square test, and logistic regression analysis. @*Results@#During the COVID-19 pandemic, the number of cardiac arrests witnessed at the field level decreased. In the transport stage, mechanical CPR increased and the method for securing the airway had many changes. Transport distances, response times, and on-scene times have increased. Survival discharge from hospital decreased from 9.5% to 5.8% (P=0.045), and good neurological outcomes decreased from 8% to 4% (P=0.017). According to multivariate logistic regression analysis, good neurological outcomes (adjusted odds ratio, 0.299; 95% confidence interval, 0.116-0.772) were significantly lower after the onset of COVID-19. @*Conclusion@#With the outbreak of COVID-19, there have been many changes in the pre-hospital stages of out-of-hospital cardiac arrest patients, and the neurological outcomes have also deteriorated. This continued throughout the pandemic period.