Use of the Korean Triage and Acuity Scale for poor outcome prediction among emergency department patients with suspected infection

Objective@#The Korean Triage and Acuity Scale (KTAS) is a triage tool for patients in the emergency department (ED). This study aimed to evaluate the ability of the KTAS to predict poor outcomes in South Korean ED patients with a suspected infection. We also compared the effectiveness of KTAS with that of the National Early Warning Score (NEWS) and Modified Early Warning Score (MEWS) in predicting poor outcomes. @*Methods@#We conducted a single-center retrospective study that included adult patients with a suspected infection who were admitted to the ED between January 2019 and December 2019. Patients who received a prescription for antibiotics and associated culture tests in the ED were considered to have an infection. Poor outcomes were evaluated by in-hospital mortality, general ward admission, and intensive care unit (ICU) admission. A receiver operating characteristics (ROC) curve analysis was performed to evaluate and compare KTAS, NEWS, and MEWS. @*Results@#Of the 4,127 patients in the study, in-hospital mortality was reported in 154 (3.7%) patients. The median KTAS was lower in the non-survivors than in the survivors (2.51 vs. 3.35). Multivariate logistic regression analysis showed that the KTAS was associated with in-hospital mortality, ward admission, and ICU admission. The area under the ROC curve (AUROC) values for predicting in-hospital mortality associated with the KTAS, NEWS, and MEWS were 0.776 (95% confidence interval, 0.747-0.803), 0.829 (0.759-0.811) and 0.739 (0.694-0.786), respectively. @*Conclusion@#Our results showed that the KTAS was associated with in-hospital mortality, ward admissions, and ICU admissions among ED patients with a suspected infection. Thus, KTAS may be reliable in predicting a poor outcome in ED patients with a suspected infection.

The difference of the HEART score for predicting cardiovascular disease according to obesity index in emergency department

Objective@#The HEART score is a fast and simple cardiovascular disease (CVD) prediction tool useful in the emergency department (ED). This study evaluates the predictive value of the HEART score when applying other obesity indices such as waist circumference (WC) or waist-to-height ratio (WHtR) instead of body mass index (BMI). @*Methods@#Data were prospectively collected from the pre-made registry of patients who had visited the ED with chest pain. Based on their final diagnoses and coronary imaging study results, patients were classified as acute coronary syndrome (ACS), non-ACS, significant coronary arterial stenosis (SCS), and non-SCS. We compared the HEART score for each group and modified it with variable obesity indices. Multivariable logistic regression and the area under the curve were calculated to determine the most suitable obesity index for the HEART score in predicting ACS or SCS. In addition, we compared the gender-dependent relationship between obesity and ACS or SCS. @*Results@#Of the total 689 patients examined, 281 were diagnosed with ACS. The odds ratio (OR) of the HEART score for ACS was 12.1. The ORs were 13.2 and 11.2 when the HEART score was modified with WC or WHtR, respectively. Obesity was determined as the meaningful factor to predict ACS (OR: BMI, 2.38; WC, 3.39) and SCS (OR: BMI, 3.07; WC, 4.03) in women but not men. @*Conclusion@#The HEART score showed good predictive value regardless of obesity index modification. Furthermore, obesity is associated with CVD in women with chest pain, but not in men.

Acute Heart Failure after Oral Intake of Liquid Nicotine

A 32-year-old female patient was admitted to the hospital after drinking 10 mg of liquid nicotine. She complained of dizziness, nausea, and abdominal pain. The blood pressure was low but the heart rate and respiratory rate were within a normal range. Cardiac enzymes were increased. Echocardiography taken in the emergency room showed akinesia in the apex and the anterior wall, hypokinesia in the inferior and the posterior wall, and severe left ventricular systolic dysfunction with an ejection fraction of 20%. Blood pressure was continuously low after hydration so continuous intravenous norepinephrine and dobutamine were administrated. The patient was admitted to the intensive care unit for closed monitoring. Follow-up echocardiography was performed 4 days after admission. The heart was restored and the ejection fraction was recovered to 65%. There are not many studies about the toxicity of electronic cigarette’s nicotine and there are even fewer reports on the toxicity that occurs when liquid nicotine is orally taken. This is a report of a patient of an acute heart failure after intake of liquid nicotine used in the electronic cigarette.