Poisoning patients’ clinical features according to the blood level of propranolol

Purpose@#Propranolol is widely prescribed to psychiatric patients to control adrenergic symptoms. However, propranolol poisoning can be fatal due to cardiovascular complications. We analyzed associations between blood levels of propranolol and patients’ clinical features, with the aim of predicting progression to severe complications. @*Methods@#Data were collected from patients aged 18 years or older who presented to the emergency department with propranolol poisoning between January 2016 and May 2022. We retrospectively analyzed their medical records and compared blood levels of propranolol between those who had cardiovascular complications and those who did not. @*Results@#Two hundred patients were included in this study. The blood levels of propranolol were significantly higher in patients with hypotension, bradycardia, and prolonged QT intervals, with median values of 247.0 ng/mL (interquartile range [IQR], 56.5–333.8 ng/mL), 275.8 ng/mL (IQR, 154.3–486.4 ng/mL), and 159.0 ng/mL (IQR, 33.9–310.8 ng/mL), respectively. In the predictive analysis of cardiovascular complications using a receiver operating characteristic curve, the area under the curve was 0.729 with a cut-off value of 72.40 ng/mL (sensitivity, 0.667; specificity, 0.819). In addition, the correlation coefficient between blood levels and the amount of drug described during the history-taking at the time of presentation was 0.634, which was found to have a significantly higher relationship. @*Conclusion@#Because blood levels of propranolol can be used as predictors of exacerbation in patients with propranolol poisoning, patients with blood levels above 72.40 ng/dL require careful treatment and observation from their initial presentation at the emergency department.

Effect of ETCO2 monitoring of poisoning patients with decreased mental state in ED

Purpose@#This study aimed to analyse the effect of End-Tidal Carbon Dioxide (ETCO2) monitoring on patients who had been poisoned and presented in the emergency department with decreased consciousness. @*Methods@#The data of patients over 18 years old presenting with poisoning from 2016 to 2020 was collected from the emergency department. We retrospectively analyzed their medical records, and defined patients with a Glasgow Coma Scale (GCS) score of 9 or less as having decreased consciousness. We divided the patients into two groups, one with ETCO2 monitoring and the other without, and the difference between the two groups was compared. @*Results@#168 patients participated in this study and 83 (49.4%) of them belonged to the ETCO2 monitoring group. In this group, the interval between arterial blood tests was statistically significantly longer and the rate of intubation was lower. In addition, in the monitoring group, the incidence of pneumonia and the rate of poor prognosis was not significantly higher. @*Conclusion@#Although ETCO2 monitoring does not directly affect the prognosis of poisoned patients with decreased consciousness, it should be actively done as it can help to adequately treat patients while avoiding invasive techniques or unnecessary intubation.

The effect of ambulatory ability on the prognosis of elderly sepsis patients as an indicator of frailty

Objective@#The vulnerable and frail elderly individuals are at a compounded risk of worsening, rather than recovering, from external stress such as sepsis. Ambulation is majorly considered as a phenotype and determining factor of frailty. This study was undertaken to determine whether inability of ambulation is predictive for the prognosis of elderly patients afflicted with sepsis. @*Methods@#Data were collected retrospectively from the medical records of an emergency medical center, from 1 November 2016 to 28 February 2017. Patients older than 65 years, who underwent blood culture or with a diagnosis of sepsis or septic shock and with Sequential Organ Failure Assessment (SOFA) score above 2 points, were included in the study. The predictive ability of the clinical factors was analyzed by comparing with the primary outcome of in-hospital mortality. @*Results@#A total of 105 patients were included in the study; 58 (55.2%) male and 47 (44.8%) female patients, with median age 78 years (range, 65-96 years). Of these, 89 (84.8%) patients were independently ambulatory before presentation. The median SOFA score was 3 (2-12), and 20 (19%) patients had expired in the hospital. Logistic regression revealed that inability of ambulation is not predictive of mortality (odds ratio, 0.872; 95% confidence Interval, 0.176-4.309; P=0.866). However, correlation analysis with the SOFA score revealed an association with inability of ambulation (r=0.277, P=0.004), and multiple regression analysis also showed that ambulation affects the SOFA score (t=2.435, P=0.017; t=-2.521, P=0.013). @*Conclusion@#Inability of ambulation does not predict in-hospital mortality, but affects the SOFA score of elderly patients afflicted with sepsis or in septic shock.

The effectiveness of the capnographic unit and ultrasonography for confirmation of nasogastric tube location at the emergency room

Objective@#This study was designed to verify the effectiveness of capnography and ultrasound for confirmation of the location of the nasogastric tube (NGT) in the emergency room (ER). @*Methods@#In this prospective single-blinded study, carried out on 137 patients over 19 years of age, the NGT location was confirmed by capnography in 63 patients and by ultrasound in 74 patients. The capnography and ultrasound scans were performed in random order, while auscultation was performed and chest X-rays were taken for all patients. Capnography was performed by checking the end-tidal carbon dioxide (ETCO2) level and the wave form after inserting the NGT. An ultrasound scan was conducted on the neck, gastroesophageal junction and stomach. The X-ray results were interpreted by a doctor who had not inserted the NGT. @*Results@#The sensitivity and specificity of auscultation were 98.43% and 10%, respectively. After 30 cm of NGT was inserted ETCO2 was measured through the capnography, and was found to be ranging from 0-23. When the capnography showed an ETCO2 value of less than 4, the tube was considered to be inserted in the stomach. In such a case, the specificity was 100%, but the sensitivity was only 46.43%. The sensitivity and specificity of the ultrasound were 92.96% and 66.67%, respectively. In addition, the positive predictive value was confirmed to be 100% and 98.51% when using capnography and ultrasound, respectively. @*Conclusion@#When the NGT is inserted in the ER, it is possible to use ultrasound and capnography for confirmation of its location. However, in some patients, when neither method can confirm the location, a chest X-ray will still be needed.

Intravenous zoletil administration for the purpose of suicide

Zoletil is a combination of tiletamine hydrochloride and zolazepam hydrochloride used as a veterinary anesthetic. Although zoletil abuse is widely known, zoletil poisoning for the purpose of suicide is very rare. We present a case of a 39-year-old man who attempted suicide by intravenously injecting a large amount of zoletil, resulting in decreased mental status and severe respiratory depression. Intubation and mechanical ventilation were applied. After 30 hours in the hospital, all symptoms of poisoning improved. Because zoletil can cause severe respiratory depression, close observation and aggressive securement of an airway is mandatory

The effect of ambulatory ability on the prognosis of elderly sepsis patients as an indicator of frailty

Objective@#The vulnerable and frail elderly individuals are at a compounded risk of worsening, rather than recovering, from external stress such as sepsis. Ambulation is majorly considered as a phenotype and determining factor of frailty. This study was undertaken to determine whether inability of ambulation is predictive for the prognosis of elderly patients afflicted with sepsis. @*Methods@#Data were collected retrospectively from the medical records of an emergency medical center, from 1 November 2016 to 28 February 2017. Patients older than 65 years, who underwent blood culture or with a diagnosis of sepsis or septic shock and with Sequential Organ Failure Assessment (SOFA) score above 2 points, were included in the study. The predictive ability of the clinical factors was analyzed by comparing with the primary outcome of in-hospital mortality. @*Results@#A total of 105 patients were included in the study; 58 (55.2%) male and 47 (44.8%) female patients, with median age 78 years (range, 65-96 years). Of these, 89 (84.8%) patients were independently ambulatory before presentation. The median SOFA score was 3 (2-12), and 20 (19%) patients had expired in the hospital. Logistic regression revealed that inability of ambulation is not predictive of mortality (odds ratio, 0.872; 95% confidence Interval, 0.176-4.309; P=0.866). However, correlation analysis with the SOFA score revealed an association with inability of ambulation (r=0.277, P=0.004), and multiple regression analysis also showed that ambulation affects the SOFA score (t=2.435, P=0.017; t=-2.521, P=0.013). @*Conclusion@#Inability of ambulation does not predict in-hospital mortality, but affects the SOFA score of elderly patients afflicted with sepsis or in septic shock.

The effectiveness of the capnographic unit and ultrasonography for confirmation of nasogastric tube location at the emergency room

Objective@#This study was designed to verify the effectiveness of capnography and ultrasound for confirmation of the location of the nasogastric tube (NGT) in the emergency room (ER). @*Methods@#In this prospective single-blinded study, carried out on 137 patients over 19 years of age, the NGT location was confirmed by capnography in 63 patients and by ultrasound in 74 patients. The capnography and ultrasound scans were performed in random order, while auscultation was performed and chest X-rays were taken for all patients. Capnography was performed by checking the end-tidal carbon dioxide (ETCO2) level and the wave form after inserting the NGT. An ultrasound scan was conducted on the neck, gastroesophageal junction and stomach. The X-ray results were interpreted by a doctor who had not inserted the NGT. @*Results@#The sensitivity and specificity of auscultation were 98.43% and 10%, respectively. After 30 cm of NGT was inserted ETCO2 was measured through the capnography, and was found to be ranging from 0-23. When the capnography showed an ETCO2 value of less than 4, the tube was considered to be inserted in the stomach. In such a case, the specificity was 100%, but the sensitivity was only 46.43%. The sensitivity and specificity of the ultrasound were 92.96% and 66.67%, respectively. In addition, the positive predictive value was confirmed to be 100% and 98.51% when using capnography and ultrasound, respectively. @*Conclusion@#When the NGT is inserted in the ER, it is possible to use ultrasound and capnography for confirmation of its location. However, in some patients, when neither method can confirm the location, a chest X-ray will still be needed.

Intravenous zoletil administration for the purpose of suicide

Zoletil is a combination of tiletamine hydrochloride and zolazepam hydrochloride used as a veterinary anesthetic. Although zoletil abuse is widely known, zoletil poisoning for the purpose of suicide is very rare. We present a case of a 39-year-old man who attempted suicide by intravenously injecting a large amount of zoletil, resulting in decreased mental status and severe respiratory depression. Intubation and mechanical ventilation were applied. After 30 hours in the hospital, all symptoms of poisoning improved. Because zoletil can cause severe respiratory depression, close observation and aggressive securement of an airway is mandatory

Characteristics and outcomes of public bath-related out-of-hospital cardiac arrests in South Korea

Objective@#To analyze the differences in characteristics and outcomes between public bath (PB)- related and non-PB-related out-of-hospital cardiac arrest (OHCA) patients in South Korea. @*Methods@#We performed a retrospective observational analysis of collected data from the Smart Advanced Cardiac Life Support (SALS) registry between September 2015 and December 2018. We included adult OHCA patients (aged >18 years) with presumed OHCA of non-traumatic etiology who were attended by dispatched emergency medical services. SALS is a field advanced life support with smartphone-based direct medical direction. The primary outcome was the survival to discharge rate measured at the time of discharge. @*Results@#Of 38,995 cardiac arrest patients enrolled in the SALS registry, 11,889 were included in the final analysis. In total, 263 OHCAs occurred in PBs. Male sex and bystander cardiopulmonary resuscitation proportions appeared to be higher among PB patients than among non-PB patients. Percentages for shockable rhythm, witnessed rate, and number of underlying disease were lower in the PB group than in the non-PB group. Prehospital return of spontaneous circulation (11.4% vs. 19.5%, P=0.001), survival to discharge (2.3% vs. 9.9%, P<0.001), and favorable neurologic outcome (1.9% vs. 5.8%, P=0.007) in PB patients were significantly poorer than those in non-PB patients. @*Conclusion@#Patient characteristics and emergency medical services factors differed between PB and non-PB patients. All outcomes of PB-related OHCA were poorer than those of non-PB-related OHCA. Further treatment strategies should be developed to improve the outcomes of PBrelated cardiac arrest.

Outcome and status of postcardiac arrest care in Korea: results from the Korean Hypothermia Network prospective registry

Objective@#High-quality intensive care, including targeted temperature management (TTM) for patients with postcardiac arrest syndrome, is a key element for improving outcomes after out-of-hospital cardiac arrest (OHCA). We aimed to assess the status of postcardiac arrest syndrome care, including TTM and 6-month survival with neurologically favorable outcomes, after adult OHCA patients were treated with TTM, using data from the Korean Hypothermia Network prospective registry. @*Methods@#We used the Korean Hypothermia Network prospective registry, a web-based multicenter registry that includes data from 22 participating hospitals throughout the Republic of Korea. Adult comatose OHCA survivors treated with TTM between October 2015 and December 2018 were included. The primary outcome was neurological outcome at 6 months. @*Results@#Of the 1,354 registered OHCA survivors treated with TTM, 550 (40.6%) survived 6 months, and 413 (30.5%) had good neurological outcomes. We identified 839 (62.0%) patients with preClinsumed cardiac etiology. A total of 937 (69.2%) collapses were witnessed, shockable rhythms were demonstrated in 482 (35.6%) patients, and 421 (31.1%) patients arrived at the emergency department with prehospital return of spontaneous circulation. The most common target temperature was 33°C, and the most common target duration was 24 hours. @*Conclusion@#The survival and good neurologic outcome rates of this prospective registry show great improvements compared with those of an earlier registry. While the optimal target temperature and duration are still unknown, the most common target temperature was 33°C, and the most common target duration was 24 hours.

Outcome and status of postcardiac arrest care in Korea: results from the Korean Hypothermia Network prospective registry

Objective@#High-quality intensive care, including targeted temperature management (TTM) for patients with postcardiac arrest syndrome, is a key element for improving outcomes after out-of-hospital cardiac arrest (OHCA). We aimed to assess the status of postcardiac arrest syndrome care, including TTM and 6-month survival with neurologically favorable outcomes, after adult OHCA patients were treated with TTM, using data from the Korean Hypothermia Network prospective registry. @*Methods@#We used the Korean Hypothermia Network prospective registry, a web-based multicenter registry that includes data from 22 participating hospitals throughout the Republic of Korea. Adult comatose OHCA survivors treated with TTM between October 2015 and December 2018 were included. The primary outcome was neurological outcome at 6 months. @*Results@#Of the 1,354 registered OHCA survivors treated with TTM, 550 (40.6%) survived 6 months, and 413 (30.5%) had good neurological outcomes. We identified 839 (62.0%) patients with preClinsumed cardiac etiology. A total of 937 (69.2%) collapses were witnessed, shockable rhythms were demonstrated in 482 (35.6%) patients, and 421 (31.1%) patients arrived at the emergency department with prehospital return of spontaneous circulation. The most common target temperature was 33°C, and the most common target duration was 24 hours. @*Conclusion@#The survival and good neurologic outcome rates of this prospective registry show great improvements compared with those of an earlier registry. While the optimal target temperature and duration are still unknown, the most common target temperature was 33°C, and the most common target duration was 24 hours.

Severity Predictors of Elderly Poisoning Patients Admitted to an Emergency Medical Center

PURPOSE@#This study examined the clinical characteristics of severe elderly poisoning patients to determine the factors that can prevent them.@*METHODS@#Data were collected from patients over 65 years of age presenting to the emergency center with poisoning from 2013 to 2018. Their medical records were analyzed retrospectively, and patients with a poisoning severity score of three or more were defined as the severe poisoning group. The risk factors were evaluated by univariate and multivariate analysis.@*RESULTS@#This study analyzed 292 patients, of whom 37 (12.7%) belonged to the severe poisoning group. The severe poisoning group showed a significantly higher association with pesticide poisoning and intentional suicide attempts. Loneliness and somatization were the cause of the suicidal ideas. No significant differences in age, sex, drinking, ingestion time, poisonous materials other than pesticides, and neuropsychological consultation were observed between the two groups.@*CONCLUSION@#The severe elderly poisoning patients were the result of intentional poisoning for suicide. Loneliness and somatization were the most influential causes of suicidal poisoning. Therefore, psychiatric screening and frequent medical treatment for elderly people are required to prevent severe poisoning in elderly patients.

Utility of Spinal Injury Diagnosis Using C-Spine Lateral X-Ray and Chest, Abdomen and Pelvis Computed Tomography in Major Trauma Patients with Impaired Consciousness

PURPOSE@#The regional emergency medical centers manage the patients with major blunt trauma according to the process appropriate to each hospital rather than standardized protocol of the major trauma centers. The primary purpose of this study is to evaluate the effectiveness and influence on prognosis of additional cervical-thoracic-lumbar-spine computed tomography (CTL-spine CT) scan in diagnosis of spinal injury from the victim of major blunt trauma with impaired consciousness.@*METHODS@#The study included patients visited the urban emergency medical center with major blunt trauma who were over 18 years of age from January 2013 to December 2016. Data were collected from retrospective review of medical records. Sensitivity, specificity, positive predictive value, and negative predictive value were measured for evaluation of the performance of diagnostic methods.@*RESULTS@#One hundred patients with Glasgow coma scale ≤13 underwent additional CTL-spine CT scan. Mechanism of injury was in the following order: driver, pedestrian traffic accident, fall and passenger accident. Thirty-one patients were diagnosed of spinal injury, six of them underwent surgical management. The sensitivity of chest, abdomen and pelvis CT (CAP CT) was 72%, specificity 97%, false positive rate 3%, false negative rate 28% and diagnostic accuracy 87%. Eleven patients were not diagnosed of spinal injury with CAP CT and C-spine lateral view, but all of them were diagnosed of stable fractures.@*CONCLUSIONS@#C-spine CT scan be actively considered in the initial examination process. When CAP CT scan is performed in major blunt trauma patients with impaired consciousness, CTL-spine CT scan or simple spinal radiography has no significant effect on the prognosis of the patient and can be performed if necessary.

Experience of the Simulation Based Hospital Disaster Preparation Training Program by the Polls of before and after Training Program

PURPOSE: The objective of this study is to develop an adequate local disaster preparation program that integrates multiple institutes, ultimately saving time, human resources, and expenses. METHODS: The study proceeded in the orders of polls to the medical team before the drill and the lecture which were education on disaster, equipment, how to deal with the various situtuation, and performed the drill, debriefing session, and then reevaluated by polls after the drill. RESULTS: Among the 57 medical staffs, a comparison was made of the polls between before and after the simulation with respect to the treatment ability depending on disaster triage, understanding of disaster data transferring system, test on disaster understanding (p<0.001). However, the difference by work career was not statistically significant (p=0.206, p=0.665). CONCLUSION: We were able to develop a new program with a great response and understanding enabling us to adequately prepare for disasters. We may increase our ability to deal with such situations through unified training, not only within the hospital but also with local institutes through this well-structured program.

Risk Factors for Aspiration Pneumonia in Acute Benzodiazepine Overdose

PURPOSE: Aspiration pneumonia is an important complication of drug intoxication with decreased mental status. The purpose of the study is to investigate the risk factors of aspiration pneumonia in the patients of benzodiazepine overdose with or without co-ingestion of other drugs. METHODS: A retrospective chart review of patients who visited the emergency department between January 2012 and December 2014 was conducted. Demographic data, time from ingestion to visit, initial vital signs, symptoms, mental status, medical history, laboratory results, chest radiological findings and co-ingested medications were recorded. Multiple logistic analyses were performed to verify the association between variables and the development of aspiration pneumonia. RESULTS: A total of 249 patients presented to the emergency department with benzodiazepine overdose. Aspiration pneumonia had developed in 24 patients (9.6%). Univariate analysis revealed time from ingestion to visit was longer, Glasgow coma scale score was lower, hypoxia was presented, leukocytosis was shown, types of ingested drugs was high, less activated charcoal was applied and tricyclic antidepressants was taken in patients that developed aspiration pneumonia. Time from ingestion to visit (odds ratio (OR) 1.121, 95% confidence interval (CI), 1.057-1.189, p=0.000), GCS score (OR 0.724. 95% CI, 0.624-0.839, p=0.000), oxygen saturation (OR 0.895, 95% CI, 0.835-0.959, p=0.002), and co-ingestion of TCA (OR 4.595, 95% CI, 1.169-18.063, p=0.029) were identified as risk factors of morbidity of aspiration pneumonia upon multiple logistic regression analysis. CONCLUSION: Time from ingestion to visit, low GCS score, low oxygen saturation and co-ingestion of TCA were risk factors of the development of aspiration pneumonia in benzodiazepine overdose patients.

Analysis of Clinical Characteristics by Gender in Children and Adolescents with Intentional Poisoning at Emergency Department

PURPOSE: The aim of this study is to investigate the difference between male and female in some clinically meaningful aspects and to prevent intentional poisoning in children and adolescents. METHODS: Retrograde medical records review of patients who visited the emergency department of two secondary hospitals for drug ingestion from March 2010 through March 2013 was performed. Unintentional ingestion or ingestion by others was excluded. RESULTS: A total of 138 cases were reported, male 25.4% (n=35), female 74.6% (n=103). The reason for poisoning was intentional in 132 cases (95.7%) and misuse in six cases (4.3%). In female patients, non-prescription drugs was the most common cause of intentional poisoning (68.9%). Male patients tend to use life substances for intentional poisoning more frequently (20.0%) than female (3.9%). Seven male patients and 12 female patients had previous psychiatric history and 34.3% of male and 41.7% of female were consulted to the psychiatric department. CONCLUSION: Female adolescents are more likely to ingest drugs intentionally for suicide attempt than males of comparable ages. The drugs they ingested were, in many cases, obtained with ease from the drug store nearby and, remarkably, most of the drugs they obtained in that way were acetaminophen-containing. This suggests that some guidelines or control in the pharmacy that restrict children or adolescents from obtaining potentially or possibly life-threatening drugs might be necessary. In addition, education regarding drugs is thought to be necessary in school for teenagers as they tend to misuse them with incorrect acknowledgement.

Clinical Manifestations of Chemical Eye Injury

PURPOSE: The purpose of this study is to investigate the clinical characteristics of patients admitted to emergency rooms with ocular chemical injuries, the substances responsible for such injuries, in order to improve their prevention and treatment. METHODS: The subjects of this study were 73 patients admitted to the hospital with ocular chemical injuries from January 1, 2009 to December 31, 2010. The subjects were divided into groups based on the PSS (poisoning severity score) grade of their injuries, where grades 0 and 1 were classified as the low group (low PSS) and grades 2 and 3 were classified as the high group (high PSS). There were 28 subjects in the low PSS group (38.3%) and 45 subjects in the high PSS group (61.6%). The results were retrospectively reviewed by examining the medical records of the patients. RESULTS: Upon their arrival to the hospital, the most common symptoms were red eye (50.7%), pain (39.7%), and eye irritation (39.7%). Red eyes were more frequently observed from 27 persons (60%) in the high PSS group (p=0.04). The most common causative substances were chemicals and adhesives/glues for both groups (21 cases each). Among the 15 patients exposed to acids or alkalis, 13 patients belonged to the high PSS group. Only two patients visited the hospital after having washed their eyes. CONCLUSION: Worse damage was observed from work-related exposure (including alkali or acid exposure), causing red eye and ocular chemical injuries. Onsite first aid was lacking.

A Case of Carbon Dioxide Poisoning by Malfunction of a Carbon Dioxide- Based Fire Extinguishing System

Carbon dioxide is a colorless, odorless, nonirritating gas with many practical uses. In particular, because it can displace oxygen from the environment, it is used as a fire extinguisher. We describe an incident that occurred as a result of malfunction of a carbon dioxide-based fire extinguishing system in our hospital. Twelve casualties reached our emergency department. Symptoms of exposure included nausea, dizziness, loss of consciousness, vomiting, chest discomfort, and seizure. Results of initial arterial blood gas analysis showed acidosis in five patients. A new pneumonic infiltration at the left. upper lung field was observed in one patient, while sinus tachycardia in electrocardiography (ECG) was observed in another patient. Oxygen was initially supplied to all casualties, until symptoms of intoxication had disappeared. Three patients were admitted to the hospital, but were discharged without complication. Despite occurrence of massive casualties, with significant symptoms due to unintentional exposure to high concentrations of carbon dioxide, patients' symptoms were relieved by supportive care.

Clinical Predictors of Abnormalities in Headache Patients as Confirmed by Three-Dimensional Computed Tomographic Angiography

PURPOSE: Headache patients with an alert mental state and normal neurologic examination findings who visit the emergency department (ED) should be differentially diagnosed for the presence of cerebral vessel disease. Hence, the purpose of this study was to analyze the abnormal three-dimensional cerebral computed tomographic angiography (3D-CTA) findings of mentally alert patients presenting headache, and investigate the clinical factors predictive of an intracranial abnormality. METHODS: A total of 227 patients visiting the ED presenting headache and possessing an alert mental status were enrolled in this study and examined by 3D-CTA from January 2008 to December 2008. We compared the results of the 3D-CTA and the final clinical diagnosis for each patient. The patient participants were divided into two groups: an abnormal group, as confirmed by 3D-CTA, and a non-abnormal group. We compared the vital signs, past hypertension history, clinical manifestations, and the clinical factors predictive of abnormality between the two groups. RESULTS: Of the total patients, 44 were identified with abnormal findings by non-enhanced CT, and 61 patients were identified with abnormal findings by 3D-CTA. SAH was found in 29 patients and unruptured aneurysm was discovered in 17 patients using 3D-CTA. The time interval between onset of headache to arrival at the ED was shorter in the SAH group (p=0.012), and sudden bursting headache was observed in 22 subarachnoid hemorrhage (SAH) patients (p<0.001). Statistically significant differences were observed between the two groups for symptoms of nausea, vomiting, neck stiffness and seizure. According to the results of the multivariate logistic regression analysis, sudden bursting headache and neck stiffness were independent predictable variables that affected the abnormal 3D-CTA group. According to the results of the multivariate logistic regression analysis, sudden bursting headache and neck stiffness were independent predictable variables for the abnormal 3D-CTA group. CONCLUSION: Sudden bursting headache, neck stiffness, vomiting, and advanced age were independent predictable variables observed in the abnormal 3D-CTA group.

Clinical Predictors of Abnormalities in Headache Patients as Confirmed by Three-Dimensional Computed Tomographic Angiography

PURPOSE: Headache patients with an alert mental state and normal neurologic examination findings who visit the emergency department (ED) should be differentially diagnosed for the presence of cerebral vessel disease. Hence, the purpose of this study was to analyze the abnormal three-dimensional cerebral computed tomographic angiography (3D-CTA) findings of mentally alert patients presenting headache, and investigate the clinical factors predictive of an intracranial abnormality. METHODS: A total of 227 patients visiting the ED presenting headache and possessing an alert mental status were enrolled in this study and examined by 3D-CTA from January 2008 to December 2008. We compared the results of the 3D-CTA and the final clinical diagnosis for each patient. The patient participants were divided into two groups: an abnormal group, as confirmed by 3D-CTA, and a non-abnormal group. We compared the vital signs, past hypertension history, clinical manifestations, and the clinical factors predictive of abnormality between the two groups. RESULTS: Of the total patients, 44 were identified with abnormal findings by non-enhanced CT, and 61 patients were identified with abnormal findings by 3D-CTA. SAH was found in 29 patients and unruptured aneurysm was discovered in 17 patients using 3D-CTA. The time interval between onset of headache to arrival at the ED was shorter in the SAH group (p=0.012), and sudden bursting headache was observed in 22 subarachnoid hemorrhage (SAH) patients (p<0.001). Statistically significant differences were observed between the two groups for symptoms of nausea, vomiting, neck stiffness and seizure. According to the results of the multivariate logistic regression analysis, sudden bursting headache and neck stiffness were independent predictable variables that affected the abnormal 3D-CTA group. According to the results of the multivariate logistic regression analysis, sudden bursting headache and neck stiffness were independent predictable variables for the abnormal 3D-CTA group. CONCLUSION: Sudden bursting headache, neck stiffness, vomiting, and advanced age were independent predictable variables observed in the abnormal 3D-CTA group.