A Clinical Review of Geriatric Patients With Rib Fractures Seen in an Emergency Department

BACKGROUND: Almost every study of rib fractures in the elderly show associated injuries resulting in admission to thoracic or cardiovascular surgery. In Korea, no studies have compared these elderly patients with younger patients. METHODS: This study is based on patients who were diagnosed as having rib fracture at the Emergency Department of the Seoul Medical Center from March 2013 to April 2011. The medical records and radiological examinations of 192 cases were reviewed. Two groups were created-older than 65 years and younger than 64 years. Comparisons were made between the two groups including place of injury, time of injury, associated injuries, and the final result in the Emergency Department. RESULTS: The final patient sample size was 192. The elderly group had 142 patients with the average age being 48.77+/-9.70 years and 75.4% males. The young group had 50 patients with the average age at 75.90+/-7.21 years and 25% males. The most common place of injury was road (p=0.007) in the young group and home (p=0.002) in the elderly group. The most common mechanisms of injury were slipping (47.4%), traffic accidents (18.2%), falling (14.1%), and assault (9.4%). Falling was more prevalent in the young group than in the elderly group (p=0.011). Rib fractures occurred at night (p<0.001), on Saturdays, on Sundays, and in the winter in the young group and in the morning(p=0.002), on Mondays, on Fridays, and in the winter in the elderly group. Associated injuries, in descending order, were chest, limb, head, and spine. CONCLUSION: This study found that several selected factors of an injury-place, mechanism, time, and associated injuries, differ by age.

The Effect of Emergency Explanation System Modified from Medical Check-up Form

PURPOSE: This study was conducted in order to evaluate the effect of a newly developed explanation handout in the emergency department (ED) between patient and guardian. METHODS: From August 24, 2013 to September 24, 2013, interviews were conducted to patient accompanying guardian, discharged from Seoul Medical Center ED. Four groups were divided according to non-handout or handout in addition to patient or guardian. Each group consisted of 50 candidates and allocated according to a random table. The explanation handout could be easily applicable automatically through the Electronic Medical Record. It contains the results of laboratory tests along with cautions by diagnosis. After discharge explanation, a survey was conducted in each group using questionnaires for evaluation of the effect on medical service satisfaction. RESULTS: A total of 97 candidates(49 patients, 48 guardians) in the non-handout group, and 99 candidates(50 patients, 49 guardians) in the handout group were enrolled. No statistical difference in epidemiology, except explanation time, was observed between the two groups. The handout group showed a higher score in all factors, however, explanation by physician (p<0.001), mean 3.61(+/-0.72) to 3.87(+/-0.73), understanding of medical status (p<0.001), mean 3.51(+/-0.75) to 4.11(+/-0.71), medical evaluation and treatment (p=0.001), mean 3.59(+/-0.72) to 3.92(+/-0.75), kindness of physician (p<0.001), mean 3.74(+/-0.81) to 4.09(+/-0.67), overall satisfaction (p<0.001), mean 3.60(+/-0.75) to 3.97(+/-0.75), willingness of revisit (p=0.023), mean 3.87(+/-0.73) to 4.09(+/-0.61), and willingness of recommendation (p<0.001), mean 3.66(+/-0.82) to 4.09(+/-0.66) showed statistically meaningful results. In a sub-analysis, statistically meaningful results were reanalyzed between patient and guardian. In the non-handout group, guardian showed higher scores in mean value in all factors, however, statistically meaningful results were observed for all factors, except understanding of medical status and medical evaluation and treatment. By application of the handout, 99 patients and 97 guardians showed higher scores in mean value in all factors. Patients showed statistically meaningful results in all factors but just in understanding of medical status in guardian. CONCLUSION: Results of this study showed that the explanation handout effectively increased medical service satisfaction. The effect of the explanation handout was more prominent in patients than guardians.

The Effect of Emergency Explanation System Modified from Medical Check-up Form

PURPOSE: This study was conducted in order to evaluate the effect of a newly developed explanation handout in the emergency department (ED) between patient and guardian. METHODS: From August 24, 2013 to September 24, 2013, interviews were conducted to patient accompanying guardian, discharged from Seoul Medical Center ED. Four groups were divided according to non-handout or handout in addition to patient or guardian. Each group consisted of 50 candidates and allocated according to a random table. The explanation handout could be easily applicable automatically through the Electronic Medical Record. It contains the results of laboratory tests along with cautions by diagnosis. After discharge explanation, a survey was conducted in each group using questionnaires for evaluation of the effect on medical service satisfaction. RESULTS: A total of 97 candidates(49 patients, 48 guardians) in the non-handout group, and 99 candidates(50 patients, 49 guardians) in the handout group were enrolled. No statistical difference in epidemiology, except explanation time, was observed between the two groups. The handout group showed a higher score in all factors, however, explanation by physician (p<0.001), mean 3.61(+/-0.72) to 3.87(+/-0.73), understanding of medical status (p<0.001), mean 3.51(+/-0.75) to 4.11(+/-0.71), medical evaluation and treatment (p=0.001), mean 3.59(+/-0.72) to 3.92(+/-0.75), kindness of physician (p<0.001), mean 3.74(+/-0.81) to 4.09(+/-0.67), overall satisfaction (p<0.001), mean 3.60(+/-0.75) to 3.97(+/-0.75), willingness of revisit (p=0.023), mean 3.87(+/-0.73) to 4.09(+/-0.61), and willingness of recommendation (p<0.001), mean 3.66(+/-0.82) to 4.09(+/-0.66) showed statistically meaningful results. In a sub-analysis, statistically meaningful results were reanalyzed between patient and guardian. In the non-handout group, guardian showed higher scores in mean value in all factors, however, statistically meaningful results were observed for all factors, except understanding of medical status and medical evaluation and treatment. By application of the handout, 99 patients and 97 guardians showed higher scores in mean value in all factors. Patients showed statistically meaningful results in all factors but just in understanding of medical status in guardian. CONCLUSION: Results of this study showed that the explanation handout effectively increased medical service satisfaction. The effect of the explanation handout was more prominent in patients than guardians.