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1.
Article | WPRIM | ID: wpr-831702

ABSTRACT

Background@#In response to the disaster of coronavirus disease 2019 (COVID-19) pandemic, Seoul Metropolitan Government (SMG) established a patient facility for mild condition patients other than hospital. This study was conducted to investigate the operation and necessary resources of a community treatment center (CTC) operated in Seoul, a metropolitan city with a population of 10 million. @*Methods@#To respond COVID-19 epidemic, the SMG designated 5 municipal hospitals as dedicated COVID-19 hospitals and implemented one CTC cooperated with the Boramae Municipal Hospital for COVID-19 patients in Seoul. As a retrospective cross-sectional observational study, retrospective medical records review was conducted for patients admitted to the Seoul CTC. The admission and discharge route of CTC patients were investigated. The patient characteristics were compared according to route of discharge whether the patient was discharged to home or transferred to hospital. To report the operation of CTC, the daily mean number of tests (reverse transcription polymerase chain reaction and chest X-ray) and consultations by medical staffs were calculated per week. The list of frequent used medications and who used medication most frequently were investigated. @*Results@#Until May 27 when the Seoul CTC was closed, 26.5% (n = 213) of total 803 COVID-19 patients in Seoul were admitted to the CTC. It was 35.7% (n = 213) of 597 newly diagnosed patients in Seoul during the 11 weeks of operation. The median length of stay was 21 days (interquartile range, 12–29 days). A total of 191 patients (89.7%) were discharged to home after virologic remission and 22 (10.3%) were transferred to hospital for further treatment.Fifty percent of transferred patients were within a week since CTC admission. Daily 2.5–3.6consultations by doctors or nurses and 0.4–0.9 tests were provided to one patient. The most frequently prescribed medication was symptomatic medication for COVID-19 (cough/ sputum and rhinorrhea). The next ranking was psychiatric medication for sleep problem and depression/anxiety, which was prescribed more than digestive drug. @*Conclusion@#In the time of an infectious disease disaster, a metropolitan city can operate a temporary patient facility such as CTC to make a surge capacity and appropriately allocate scarce medical resource.

2.
Article in Korean | WPRIM | ID: wpr-758475

ABSTRACT

OBJECTIVE: This study aimed to achieve expert consensus for the evaluation of Emergency medical system operation fund (EMSOF) support projects using the Delphi method in Korea. METHODS: The Delphi study was performed in June 2018. Experts who are members of the policy committee of the Korean Society of Emergency Medicine (KSEM) participated in the study. Respondents were asked to express their level of agreement of appropriateness for the following 6 categories for 21 projects: project contents, amount of support, indicators, performance, overall evaluation, and need to maintain. With a possible score of 9 points, the project categories were classified into 3 groups, inappropriate, moderate and appropriate, based on the median score of the respondents' ratings in each question. RESULTS: Sixteen of the 18 policy committee members participated in the survey. Their average professional work years were 8.2 years. All 21 projects were evaluated as appropriate for content. Amount of support and indicators were evaluated as moderate. Only 5 out of the 21 projects were evaluated as having appropriate indicators. No projects were evaluated as ineffective. Comprehensive evaluation of the projects was evaluated as moderate, and no project was evaluated as inappropriate in fund support. CONCLUSION: Overall, the contents of the EMSOF assistance project were rated high; however, there was a disagreement on the amount of support and evaluation indicators for each project. The results of this study are expected to be used as basic data to improve the use of EMSOF.


Subject(s)
Committee Membership , Consensus , Delphi Technique , Emergencies , Emergency Medicine , Financial Management , Korea , Methods , Resource Allocation , Surveys and Questionnaires
3.
Article in English | WPRIM | ID: wpr-765120

ABSTRACT

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.


Subject(s)
Brain Injuries , Child , Craniocerebral Trauma , Demography , Emergencies , Emergency Service, Hospital , Epidemiologic Studies , Epidemiology , Humans , Korea , Logistic Models , Male , Observational Study , Odds Ratio , Sports
4.
Article in English | WPRIM | ID: wpr-764995

ABSTRACT

BACKGROUND: Although coronary artery disease (CAD) is a major cause of out-of-hospital cardiac arrest (OHCA), there has been no convinced data on the necessity of routine invasive coronary angiography (ICA) in OHCA. We investigated clinical factors associated with obstructive CAD in OHCA. METHODS: Data from 516 OHCA patients (mean age 58 years, 83% men) who underwent ICA after resuscitation was obtained from a nation-wide OHCA registry. Obstructive CAD was defined as the lesions with diameter stenosis ≥ 50% on ICA. Independent clinical predictors for obstructive CAD were evaluated using multiple logistic regression analysis, and their prediction performance was compared using area under the receiver operating characteristic curve with 10,000 repeated random permutations. RESULTS: Among study patients, 254 (49%) had obstructive CAD. Those with obstructive CAD were older (61 vs. 55 years, P < 0.001) and had higher prevalence of hypertension (54% vs. 36%, P < 0.001), diabetes mellitus (29% vs. 21%, P = 0.032), positive cardiac enzyme (84% vs. 74%, P = 0.010) and initial shockable rhythm (70% vs. 61%, P = 0.033). In multiple logistic regression analysis, old age (≥ 60 years) (odds ratio [OR], 2.01; 95% confidence interval [CI], 1.36–3.00; P = 0.001), hypertension (OR, 1.74; 95% CI, 1.18–2.57; P = 0.005), positive cardiac enzyme (OR, 1.72; 95% CI, 1.09–2.70; P = 0.019), and initial shockable rhythm (OR, 1.71; 95% CI, 1.16–2.54; P = 0.007) were associated with obstructive CAD. Prediction ability for obstructive CAD increased proportionally when these 4 factors were sequentially combined (P < 0.001). CONCLUSION: In patients with OHCA, those with old age, hypertension, positive cardiac enzyme and initial shockable rhythm were associated with obstructive CAD. Early ICA should be considered in these patients.


Subject(s)
Constriction, Pathologic , Coronary Angiography , Coronary Artery Disease , Coronary Vessels , Diabetes Mellitus , Heart Arrest , Humans , Hypertension , Logistic Models , Out-of-Hospital Cardiac Arrest , Prevalence , Resuscitation , Risk Factors , ROC Curve
5.
Article in English | WPRIM | ID: wpr-785630

ABSTRACT

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.


Subject(s)
Asia , Asian Continental Ancestry Group , Cross-Sectional Studies , Education , Electronic Mail , Emergencies , Emergency Service, Hospital , Epidemiology , Humans , Physician Executives , Taiwan , Thailand , Trauma Centers
6.
Article in English | WPRIM | ID: wpr-785614

ABSTRACT

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)
Advanced Cardiac Life Support , Agriculture , Animal Experimentation , Cardiopulmonary Resuscitation , Electric Impedance , Female , Head , Heart Arrest , Humans , Models, Theoretical , Supine Position , Survival Rate , Swine , Ventricular Fibrillation
7.
Article in English | WPRIM | ID: wpr-785603

ABSTRACT

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)
Hypoxia , Area Under Curve , Blood Pressure , Brain Injuries , Capillaries , Fires , Glasgow Coma Scale , Glasgow Outcome Scale , Hospital Mortality , Humans , Hypotension , Korea , Mortality , Observational Study , Oxygen , Quality Improvement , Respiratory Rate
8.
Article in English | WPRIM | ID: wpr-758424

ABSTRACT

PURPOSE: This study examined the association between the prothrombin time (PT) prolongation during cardiopulmonary resuscitation (CPR) and the outcome after an out-of-hospital cardiac arrest (OHCA). METHODS: From the Cardiac Arrest Pursuit Trial with Unique Registration and Epidemiologic Surveillance database, CPR-attempted and adult OHCAs with a cardiac etiology transported to emergency departments (EDs) from January to December 2014 were included. The PT was measured immediately after arrival to the ED during CPR, and PT prolongation was categorized into 3 groups, the normal group (international normalized ratio [INR] < 1.1), mild group (1.1≤INR < 1.4), and severe group (1.4≤INR). The primary and secondary outcomes were survival to hospital discharge and a good cerebral performance scale (CPC) of 1 or 2. The potential confounders were adjusted for calculating the adjusted odds ratios (AORs) and 95% confidence intervals (CIs) in multivariable logistic regression analysis. RESULTS: The survival and good CPC rates were 17.2% and 11.8% in the normal group, 12.2% and 4.5% in the mild group, and 3.6% and 0.6% in the severe group, respectively (p < 0.01). The AORs (95% CIs) on survival were 0.72 (0.41 to 1.27) for the mild group and 0.28 (0.11 to 0.69) for the severe group. The AORs (95% CIs) for good CPC were 0.41 (0.19 to 0.91) for the mild group and 0.14 (0.02 to 0.83) for the severe group. CONCLUSION: The PT prolongation measured at the ED was found to be associated with poor outcomes in adult OHCAs with cardiac etiology.


Subject(s)
Adult , Cardiopulmonary Resuscitation , Emergency Service, Hospital , Epidemiological Monitoring , Heart Arrest , Humans , Logistic Models , Observational Study , Odds Ratio , Out-of-Hospital Cardiac Arrest , Prothrombin Time , Prothrombin
9.
Article in Korean | WPRIM | ID: wpr-758423

ABSTRACT

PURPOSE: Pedestrian injury is one of the most frequent injury mechanism in pediatrics. This study aimed to measure the association between time of pedestrian injury and injury severity among pediatric patients. METHODS: We used the Emergency Department based Injury In-depth Surveillance (EDIIS) database from 23 emergency departments between 2013 and 2016. All pediatric (≤15 years old) patients with pedestrian injury were eligible, excluding cases with unknown outcomes. Primary and secondary endpoints was severe injury. We calculated adjusted odds ratios (AORs) of time of injury (8 am to 2 pm, 2 pm to 8 pm, 8 pm to 8 am) to investigate out-comes while adjusting for potential confounders. RESULTS: Among 6,748 eligible patients, 4,184 (62.0%) suffered pedestrian injury at 2 pm to 8 pm, 1,566 (23.2%) at 8 am to 2 pm, and 998 (14.8%) at 8 pm to 8 am. Among them, 52 (0.8%) had case-fatalities, 572 (8.5%) had severe injuries, and 1,246 (18.5%) were admitted to hospital. In terms of severe injury, the 8 am to 2 pm group (10.5%) had higher proportions of severe injury compared to the 2 pm to 8 pm (8.0%; AOR {95% confidence interval [CI]}, 0.73 [0.60 to 0.89]) and 8 pm to 8 am (7.2%; AOR [95% CI], 0.65 [0.49 to 0.88]) groups. CONCLUSION: Pediatric pedestrian injury was frequent at 2 pm to 8 pm and was more severe at 8 am to 2 pm. Public health efforts to decrease pediatric pedestrian injury are needed to reduce health burden.


Subject(s)
Emergency Service, Hospital , Humans , Odds Ratio , Pedestrians , Pediatrics , Public Health , Wounds and Injuries
10.
Article in Korean | WPRIM | ID: wpr-714042

ABSTRACT

OBJECTIVE: The aim of this study was to evaluate the characteristics of the emergency medical services (EMS) response and clinical information on mass casualty chemical incidents in Korea. METHODS: This retrospective observational study analyzed the integrated data of the EMS rescue records and EMS-treated severe trauma registry from January 2012 to December 2013. Two databases were integrated using the unique accident identification number. Chemical incidents were defined by an in-depth review of the EMS rescue records according to a previous study. Mass casualty incidents were defined as more than 6 injured individuals. The rescue, EMS, and hospital variables of mass casualty chemical incidents were analyzed. RESULTS: A total of 8 mass casualty chemical incidents and 73 patients were included. The mean responded rescue vehicles and EMS vehicles were 2.4 and 3.5, respectively. The 4 incidents were an oil spill due to traffic accidents and most patients suffered minor trauma. A carbon monoxide leak caused the largest number of patients (23 people). The explosion caused by flammable polyethylene leaks showed the highest severity. In that explosion, the mortality rate was 40% and 8 patients had a disability at discharge. CONCLUSION: This study evaluated the characteristics of the EMS response and clinical information on mass casualty chemical incidents in Korea.


Subject(s)
Accidents, Traffic , Carbon Monoxide , Chemical Hazard Release , Emergency Medical Services , Explosions , Humans , Korea , Mass Casualty Incidents , Mortality , Observational Study , Petroleum Pollution , Polyethylene , Retrospective Studies
11.
Article in English | WPRIM | ID: wpr-718403

ABSTRACT

BACKGROUND: In cardiac arrest, the survival rate increases with the provision of bystander cardiopulmonary resuscitation (CPR), of which the initial response and treatment are critical. Telephone CPR is among the effective methods that might increase the provision of bystander CPR. This study aimed to describe and examine the improvement of neurological outcomes in individuals with out-of-hospital acute cardiac arrest by implementing the nationwide, standardized telephone CPR program. METHODS: Data from the emergency medical service-based cardiac arrest registry that were collected between 2009 and 2014 were used. The effectiveness of the intervention in the interrupted time-series study was determined via a segmented regression analysis, which showed the risk ratio and risk difference in good neurological outcomes before and after the intervention. RESULTS: Of 164,221 patients, 148,403 were analyzed. However, patients with unknown sex and limited data on treatment outcomes were excluded. Approximately 64.3% patients were men, with an average age of 63.7 years. The number of bystander CPR increased by 3.3 times (95% confidence interval [CI], 3.1–3.5) after the intervention, whereas the rate of good neurological outcomes increased by 2.6 times (95% CI, 2.3–2.9 [1.6%]; 1.4–1.7). The excess number was identified based on the differences between the observed and predicted trends. In total, 2,127 cases of out-of-hospital cardiac arrest (OHCA) after the intervention period received additional bystander CPR, and 339 cases of OHCA had good neurological outcomes. CONCLUSION: The nationwide implementation of the standardized telephone CPR program increased the number of bystander CPR and improved good neurological outcomes.


Subject(s)
Cardiopulmonary Resuscitation , Emergencies , Heart Arrest , Humans , Male , Odds Ratio , Out-of-Hospital Cardiac Arrest , Survival Rate , Telephone
12.
Article in English | WPRIM | ID: wpr-715764

ABSTRACT

BACKGROUND: Injury is a major public health problem and accounts for 10% of the global burden of disease. This study intends to present the temporal trend in the injury burden in Korea and to compare the burden size by injury mechanism and age group. METHODS: This study was a nationwide population-based observational study. We used two data sets, the death certificates statistics and the Korean National Hospital Discharge Survey data (2004–2012). We calculated age-standardized disability-adjusted life year (DALY) from years of life lost (YLL) and years lived with disability (YLD) and trend analysis. RESULTS: The DALYs of road injury decreased (P = 0.002), falls did not exhibit a trend (P = 0.108), and self-harm increased overall (P = 0.045). In the road injury, the YLLs decreased across all 4 age groups (0–14, 15–49, 50–79, ≥ 80) and the YLDs decreased in the 0–14-year-old group. In total, the DALYs of road injuries decreased in the 0–14-year-old group. In the fall injury, although the YLLs decreased in the over 80-year-old group, the YLDs increased in the 50–79-year-old group and the over 80-year-old group. The burden of self-harm injury was high in the age group 15 years and over, especially in the 15–49-year-old group. CONCLUSION: The leading causes of the injury burden were road injuries, falls, and self-harm. The burden of road injury and self-harm have recently shown a gradual decreasing tendency. On the other hands, that of fall injuries are continually high in the age group over 50 years of age.


Subject(s)
Accidental Falls , Accidents, Traffic , Aged, 80 and over , Dataset , Death Certificates , Hand , Health Care Surveys , Humans , Korea , Observational Study , Public Health , Suicide
13.
Article in English | WPRIM | ID: wpr-646627

ABSTRACT

OBJECTIVE: This study evaluated whether emergency medical service (EMS) use was associated with early arrival and admission for definitive care among intracerebral hemorrhage (ICH) patients. METHODS: Patients with ICH were enrolled from 29 hospitals between November 2007 and December 2012, excluding those patients with subarachnoid hemorrhage, traumatic ICH, and missing information. The patients were divided into four groups based on visit type to the definitive hospital emergency department (ED): direct visit by EMS (EMS-direct), direct visit without EMS (non-EMS-direct), transferred from a primary hospital by EMS (EMS-transfer), and transferred from a primary hospital without EMS (non-EMS-transfer). The outcomes were the proportions of participants within early (<1 hr) definitive hospital ED arrival from symptom onset (pS2ED) and those within early (<4 hr) admission from symptom onset (pS2AD). Adjusted odds ratios were calculated to determine the association between EMS use and outcomes with and without inter-hospital transfer. RESULTS: A total of 6,564 patients were enrolled. The adjusted odds ratios (95% confidence intervals) for pS2ED were 22.95 (17.73–29.72), 1.11 (0.67–1.84), and 7.95 (6.04–10.46) and those for pS2AD were 5.56 (4.70–6.56), 0.96 (0.71–1.30), and 2.35 (1.94–2.84) for the EMS-direct, EMS-transfer, and non-EMS-direct groups compared with the non-EMS-transfer group, respectively. Through the interaction model, EMS use was significantly associated with early arrival and admission among direct visiting patients but not with transferred patients. CONCLUSION: EMS use was significantly associated with shorter time intervals from symptom onset to arrival and admission at a definitive care hospital. However, the effect disappeared when patients were transferred from a primary hospital.


Subject(s)
Cerebral Hemorrhage , Emergencies , Emergency Medical Services , Emergency Service, Hospital , Hospitals , Humans , Intracranial Hemorrhages , Observational Study , Odds Ratio , Patient Admission , Subarachnoid Hemorrhage, Traumatic
14.
Article in English | WPRIM | ID: wpr-165874

ABSTRACT

Following natural disasters, rapid health needs assessments are required to quickly assess health status and help decision making during the recovery phase. The Korean Centers for Disease Control and Prevention (KCDC) developed the Public Health Assessment for Emergency Response (PHASER) Toolkit which was optimized for a weather disaster in Korea. The goal of this study is to assess public health needs following the 2012 typhoons Bolaven and Tembin in both urban and rural areas in Korea. We conducted pilot trials using the PHASER toolkit to assess health needs following typhoons Bolaven and Tembin in Paju and Jeju during summer 2012. We sampled 400 households in Jeju and 200 households in Paju using a multistage cluster sampling design method. We used a standardized household tracking sheet and household survey sheet to collect data on the availability of resource for daily life, required health needs, clinical results and accessibility of medical services. The primary outcomes were clinical results and accessibility of medical service after the typhoons. We completed surveys for 190 households in Paju and 386 households in Jeju. Sleeping disorders were identified in 6.8% (95% confidence interval [CI], 2.8%–10.8%) surveyed in Paju and 17.4% (95% CI, 12.8%–22.0%) in Jeju. We used the PHASER toolkit to assess healthcare needs rapidly after 2 typhoons in Korea. Sleeping disorders were frequently identified in both Paju and Jeju following the 2 typhoons.


Subject(s)
Cyclonic Storms , Decision Making , Delivery of Health Care , Disasters , Emergencies , Family Characteristics , Korea , Mental Health Services , Methods , Needs Assessment , Public Health , Weather
15.
Article in English | WPRIM | ID: wpr-643741

ABSTRACT

OBJECTIVE: We aimed to develop an International Classification of Diseases (ICD) 10th edition injury code-based disability-adjusted life year (DALY) to measure the burden of specific injuries. METHODS: Three independent panels used novel methods to score disability weights (DWs) of 130 indicator codes sampled from 1,284 ICD injury codes. The DWs were interpolated into the remaining injury codes (n=1,154) to estimate DWs for all ICD injury codes. The reliability of the estimated DWs was evaluated using the test-retest method. We calculated ICD-DALYs for individual injury episodes using the DWs from the Korean National Hospital Discharge Injury Survey (HDIS, n=23,160 of 2004) database and compared them with DALY based on a global burden of disease study (GBD-DALY) regarding validation, correlation, and agreement for 32 injury categories. RESULTS: Using 130 ICD 10th edition injury indicator codes, three panels determined the DWs using the highest reliability (person trade-off 1, Spearman r=0.724, 0.788, and 0.875 for the three panel groups). The test-retest results for the reliability were excellent (Spearman r=0.932) (P<0.001). The HDIS database revealed injury burden (years) as follows: GBD-DALY (138,548), GBD-years of life disabled (130,481), and GBD-years of life lost (8,117) versus ICD-DALY (262,246), ICD-years of life disabled (255,710), and ICD-years of life lost (6,537), respectively. Spearman’s correlation coefficient of the DALYs between the two methods was 0.759 (P<0.001), and the Bland-Altman test displayed an acceptable agreement, with exception of two categories among 32 injury groups. CONCLUSION: The ICD-DALY was developed to calculate the burden of injury for all injury codes and was validated with the GBD-DALY. The ICD-DALY was higher than the GBD-DALY but showed acceptable agreement.


Subject(s)
International Classification of Diseases , Methods , Quality-Adjusted Life Years , Weights and Measures , Wounds and Injuries
16.
Article in English | WPRIM | ID: wpr-85714

ABSTRACT

To effectively mitigate and reduce the burden of mass casualty incidents (MCIs), preparedness measures should be based on MCIs' epidemiological characteristics. This study aimed to describe the epidemiological characteristics and outcomes of emergency medical services (EMS)-assessed MCIs from multiple areas according to cause. Therefore, we extracted the records of all MCIs that involved > or = 6 patients from an EMS database. All patients involved in EMS-assessed MCIs from six areas were eligible for this study, and their prehospital and hospital records were reviewed for a 1-year period. The EMS-assessed MCIs were categorized as being caused by fire accidents (FAs), road traffic accidents (RTAs), chemical and biological agents (CBs), and other mechanical causes (MECHs). A total of 362 EMS-assessed MCIs were identified, with a crude incidence rate of 0.6-5.0/100,000 population. Among these MCIs, 322 were caused by RTAs. The MCIs involved 2,578 patients, and 54.3% of these patients were women. We observed that the most common mechanism of injury varied according to MCI cause, and that a higher number of patients per incident was associated with a longer prehospital time. The highest hospital admission rate was observed for CBs (16 patients, 55.2%), and most patients in RTAs and MECHs experienced non-severe injuries. The total number of deaths was 32 (1.2%). An EMS-assessed MCI database was established using the EMS database and medical records review. Our findings indicate that RTA MCIs create a burden on EMS and emergency department resources, although CB MCIs create a burden on hospitals' resources.


Subject(s)
Accidents, Traffic/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , Biohazard Release/statistics & numerical data , Chemical Hazard Release/statistics & numerical data , Child , Child, Preschool , Cross-Sectional Studies , Databases, Factual , Emergency Medical Services , Female , Hospitals , Humans , Infant , Infant, Newborn , Male , Mass Casualty Incidents/statistics & numerical data , Middle Aged , Retrospective Studies , Young Adult
17.
Article in Korean | WPRIM | ID: wpr-68480

ABSTRACT

PURPOSE: The aim of this study was to evaluate the association between coronary angiography (CAG) with or without percutaneous coronary intervention (PCI) and the survival outcome of patients successfully resuscitated from out-of-hospital cardiac arrest. METHODS: We used the Cardiac Arrest Pursuit Trial with Unique Registration and Epidemiological Surveillance database, which is out of hospital cardiac arrest (OHCA) cohort of 27 emergency departments in Korea, between February 2014 and January 2015. The inclusion criteria were all OHCA patients who receive cardiopulmonary resuscitation in an emergency department and return of spontaneous circulation. Univariable analysis and multivariable logistic regression analysis were conducted to assess the associations between CAG and outcomes (favorable neurological outcome and survival-to-discharge). Moreover, similar analysis was conducted between PCI and no-PCI subgroups within the CAG group. RESULTS: Of the 1,616 patients, 707 patients were return of spontaneous circulation. The number of patients who conducted CAG was 204 (28.9%) and the number of patients who conducted PCI was 75 (10.6%). In OHCA patients, the CAG group had a more significant good survival discharge outcome with an odds ratio (OR) of 4.61 (95% confidence interval [CI], 2.64-8.05) and good neurologic outcomes with an OR of 7.82 (95% CI, 4.37-14.00). In CAG patients, the PCI group had no significant relationship with survival discharge with an OR of 0.99 (95% CI, 0.36-2.70) and with neurologic outcomes with an OR of 1.15 (95% CI, 0.46-2.88) compared with no PCI group. CONCLUSION: In OHCA patients, the CAG group had a more significant good prognosis (survival discharge rate and good neurologic outcomes) compared with the no-CAG group. In CAG patients, the PCI group had no significant association with good prognosis compared with the no-PCI group.


Subject(s)
Cardiopulmonary Resuscitation , Cohort Studies , Coronary Angiography , Emergency Service, Hospital , Heart Arrest , Humans , Korea , Logistic Models , Odds Ratio , Out-of-Hospital Cardiac Arrest , Percutaneous Coronary Intervention , Prognosis
18.
Article in Korean | WPRIM | ID: wpr-115327

ABSTRACT

PURPOSE: A trauma protocol for transport bypassing hospital for severe trauma patients was developed and implemented in Korea in 2012 using the field triage decision scheme of Centers for Disease Control and Prevention of US. The aim of this study is to evaluate the compliance with the protocol in severe trauma between metropolitan versus non-metropolitan area. METHODS: Severe trauma patients were identified by the new protocol and collected from a trauma registry and EMS run sheet in one metropolitan and one non-metropolitan province from October 2012 (one month). Data variables included demographic, clinical information on vital signs and mental status, injury related variables like mechanisms, geographic information on place of the event, and distance to nearest, bypassed, and destination hospitals. Exposures are metropolitan versus non-metropolitan ambulances defined. Study end point was compliance-direct transport (C-DT), compliance-bypassing transport (C-BT), violation-non-bypassing transport (V-NT), and violation-bypassing transport (V-BT). The protocol violation with number of V-NT and V-BT divided by number of eligible patients were compared between metropolitan and non-metropolitan ambulances. RESULTS: Of the 863 patients with severe trauma were identified by the protocol. No statistical difference in demographics and clinical parameters except injury mechanism and distance to destination hospital. Between metropolitan versus non-metropolitan area. The C-DT, C-BT, V-NT, and V-BT were 27.4%, 18.5%, 20.2%, and 33.4% respectively. V-NT rate was significantly lower in metropolitan than in nonmetropolitan (8.2% versus 30.6%, p=0.001), while V-BT rate was significantly higher in metropolitan than in non-metropolitan (46.2% versus 23.3%, p=0.001), respectively. CONCLUSION: Protocol violation rates were significantly different in non-bypassing and inappropriate bypassing to hospital between metropolitan versus non-metropolitan ambulances when using the bypassing hospital trauma protocol.


Subject(s)
Ambulances , Compliance , Demography , Emergency Medical Services , Humans , Korea , Multiple Trauma , Transportation , Triage , Vital Signs
19.
Article in English | WPRIM | ID: wpr-183082

ABSTRACT

The regional incidence rates of out-of-hospital cardiac arrest (OHCA) were traditionally calculated with the residential population as the denominator. The aim of this study was to estimate the true incidence rate of OHCA and to investigate characteristics of regions with overestimated and underestimated OHCA incidence rates. We used the national OHCA database from 2006 to 2010. The nighttime residential and daytime transient populations were investigated from the 2010 Census. The daytime population was calculated by adding the daytime influx of population to, and subtracting the daytime outflow from, the nighttime residential population. Conventional age-standardized incidence rates (CASRs) and daytime corrected age-standardized incidence rates (DASRs) for OHCA per 100,000 person-years were calculated in each county. A total of 97,291 OHCAs were eligible. The age-standardized incidence rates of OHCAs per 100,000 person-years were 34.6 (95% CI: 34.3-35.0) in the daytime and 24.8 (95% CI: 24.5-25.1) in the nighttime among males, and 14.9 (95% CI: 14.7-15.1) in the daytime, and 10.4 (95% CI: 10.2-10.6) in the nighttime among females. The difference between the CASR and DASR ranged from 35.4 to -11.6 in males and from 6.1 to -1.0 in females. Through the Bland-Altman plot analysis, we found the difference between the CASR and DASR increased as the average CASR and DASR increased as well as with the larger daytime transient population. The conventional incidence rate was overestimated in counties with many OHCA cases and in metropolitan cities with large daytime population influx and nighttime outflow, while it was underestimated in residential counties around metropolitan cities.


Subject(s)
Age Factors , Aged , Aged, 80 and over , Female , Geography , Humans , Incidence , Male , Middle Aged , Out-of-Hospital Cardiac Arrest/epidemiology , Republic of Korea/epidemiology , Seasons , Survival Rate , Time Factors
20.
Article in English | WPRIM | ID: wpr-56485

ABSTRACT

Proper seat belt use saves lives; however, the use rate decreased in Korea. This study aimed to measure the magnitude of the preventive effect of seat belt on case-fatality across drivers and passengers. We used the Emergency Department based Injury In-depth Surveillance (EDIIS) database from 17 EDs between 2011 and 2012. All of adult injured patients from road traffic injuries (RTI) in-vehicle of less than 10-seat van were eligible, excluding cases with unknown seat belt use and outcomes. Primary and secondary endpoints were in-hospital mortality and intracranial injury. We calculated adjusted odds ratios (AORs) of seat belt use and driving status for study outcomes adjusting for potential confounders. Among 23,698 eligible patients, 15,304 (64.6%) wore seat belts. Driver, middle aged (30-44 yr), male, daytime injured patients were more likely to use seat belts (all P < 0.001). In terms of clinical outcome, no seat belt group had higher proportions of case-fatality and intracranial injury compared to seat belt group (both P < 0.001). Compared to seat belt group, AORs (95% CIs) of no seat belt group were 10.43 (7.75-14.04) for case-fatality and 2.68 (2.25-3.19) for intracranial injury respectively. In the interaction model, AORs (95% CIs) of no seat belt use for case-fatality were 11.71 (8.45-16.22) in drivers and 5.52 (2.83-14.76) in non-driving passengers, respectively. Wearing seat belt has significantly preventive effects on case-fatality and intracranial injury. Public health efforts to increase seat belt use are needed to reduce health burden from RTIs.


Subject(s)
Accidents, Traffic/mortality , Adult , Aged , Craniocerebral Trauma/prevention & control , Databases, Factual , Emergency Service, Hospital , Female , Humans , Logistic Models , Male , Middle Aged , Motor Vehicles , Odds Ratio , Republic of Korea/epidemiology , Seat Belts/statistics & numerical data , Young Adult
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