Quick Sequential Organ Failure Assessment Score and the Modified Early Warning Score for Predicting Clinical Deterioration in General Ward Patients Regardless of Suspected Infection

Background@#The quick sequential organ failure assessment (qSOFA) score is suggested to use for screening patients with a high risk of clinical deterioration in the general wards, which could simply be regarded as a general early warning score. However, comparison of unselected admissions to highlight the benefits of introducing qSOFA in hospitals already using Modified Early Warning Score (MEWS) remains unclear. We sought to compare qSOFA with MEWS for predicting clinical deterioration in general ward patients regardless of suspected infection. @*Methods@#The predictive performance of qSOFA and MEWS for in-hospital cardiac arrest (IHCA) or unexpected intensive care unit (ICU) transfer was compared with the areas under the receiver operating characteristic curve (AUC) analysis using the databases of vital signs collected from consecutive hospitalized adult patients over 12 months in five participating hospitals in Korea. @*Results@#Of 173,057 hospitalized patients included for analysis, 668 (0.39%) experienced the composite outcome. The discrimination for the composite outcome for MEWS (AUC, 0.777;95% confidence interval [CI], 0.770–0.781) was higher than that for qSOFA (AUC, 0.684;95% CI, 0.676–0.686; P < 0.001). In addition, MEWS was better for prediction of IHCA (AUC, 0.792; 95% CI, 0.781–0.795 vs. AUC, 0.640; 95% CI, 0.625–0.645; P < 0.001) and unexpected ICU transfer (AUC, 0.767; 95% CI, 0.760–0.773 vs. AUC, 0.716; 95% CI, 0.707–0.718; P < 0.001) than qSOFA. Using the MEWS at a cutoff of ≥ 5 would correctly reclassify 3.7% of patients from qSOFA score ≥ 2. Most patients met MEWS ≥ 5 criteria 13 hours before the composite outcome compared with 11 hours for qSOFA score ≥ 2. @*Conclusion@#MEWS is more accurate that qSOFA score for predicting IHCA or unexpected ICU transfer in patients outside the ICU. Our study suggests that qSOFA should not replace MEWS for identifying patients in the general wards at risk of poor outcome.

Evaluating the Outcome of Multi-Morbid Patients Cared for by Hospitalists: a Report of Integrated Medical Model in Korea

BACKGROUND: The lack of medical personnel has led to the employment of hospitalists in Korean hospitals to provide high-quality medical care. However, whether hospitalists' care can improve patients' outcomes remains unclear. We aimed to analyze the outcome in patients cared for by hospitalists. METHODS: A retrospective review was conducted in 1,015 patients diagnosed with pneumonia or urinary tract infection from March 2017 to July 2018. After excluding 306 patients, 709 in the general ward who were admitted via the emergency department were enrolled, including 169 and 540 who were cared for by hospitalists (HGs) and non-hospitalists (NHGs), respectively. We compared the length of hospital stay (LOS), in-hospital mortality, readmission rate, comorbidity, and disease severity between the two groups. Comorbidities were analyzed using Charlson comorbidity index (CCI). RESULTS: HG LOS (median, interquartile range [IQR], 8 [5–12] days) was lower than NHG LOS (median [IQR], 10 [7–15] days), (P < 0.001). Of the 30 (4.2%) patients who died during their hospital stay, a lower percentage of HG patients (2.4%) than that of NHG patients (4.8%) died, but the difference between the two groups was not significant (P = 0.170). In a subgroup analysis, HG LOS was shorter than NHG LOS (median [IQR], 8 [5–12] vs. 10 [7–16] days, respectively, P < 0.001) with CCI of ≥ 5 points. CONCLUSION: Hospitalist care can improve the LOS of patients, especially those with multiple comorbidities. Further studies are warranted to evaluate the impact of hospitalist care in Korea.

Minimum inhibitory concentration and minimum bactericidal concentration of antibacterial fluoride varnish / 대한치과재료학회지

The aim of this study was to investigate the antibacterial effect of fluoride varnish with antibacterial agents on Streptococcus mutans (S. mutans). Experimental fluoride varnish (EFV) with 5% NaF was fabricated. Five antibacterial agents were tested with 1 mM and 10 mM concentrations, respectively: Bakuchiol (BAK), Bavachalcone (BCC), Isobavachromene (IBC), and Bavachromene (BCM). MIC and MBC test was performed by antibacterial agents with and without EFV using 1.1 × 10¹⁰ CFU/ml of S. mutans. Cell viability test were performed using MTT test. Statistical analysis was done with ANOVA and Duncan's multiple range test at α=0.05. In the antibacterial agents without EFV, the MIC of BAK, BCC, and IBC was the lowest (0.015 mM), and the MBC of BAK was the lowest (0.031 mM). For the antibacterial agents with EFV, the MIC (0.031 mM) and MBC (0.062 mM) of BAK was the lowest, respectively. In MTT test, 1 mM BCM showed the highest cell viability (P < 0.05). This study suggest that BAK can be applied the fluoride varnish under the control of the concentration to develop antibacterial fluoride varnish.

Comparison of sedation outcome according to the dose of chloral hydrate in children requiring laceration repair

PURPOSE: To compare the sedation outcome according to the dose of per os chloral hydrate in children who underwent laceration repair in the emergency department (ED). METHODS: This retrospective study was performed to the children who underwent sedation using chloral hydrate for laceration repair in the ED from January 2015 through November 2015. A total of 370 children aged younger than 6 years underwent the sedation. We compared the induction time, duration of sedation, and ED length of stay (EDLOS) between the single dose (50 mg/kg) and additional dose (plus 25 mg/kg) groups. RESULTS: Of 370 children, 335 (90.5%) were sedated successfully, 284 (76.8%) were sedated with initial dose (the single dose group), and 51 (13.8%) were sedated with additional dose (the additional dose group). The induction time and EDLOS were longer in the additional dose group (induction time: 31.0 ± 17.2 minutes vs. 96.2 ± 25.4 minutes, P < 0.001; EDLOS: 137.2 ± 35.5 minutes vs. 193.0 ± 36.0 minutes, P < 0.001). The duration of sedation showed no difference between the 2 groups (44.4 ± 24.0 minutes vs. 42.0 ± 20.8 minutes; P = 0.500). No one had serious adverse reactions. CONCLUSION: Additional dose of chloral hydrate can increase the induction time and EDLOS without increasing the duration of sedation and causing serious adverse reactions. This information may improve the efficiency of ED workflow when shared with parents of the children.

Administration and Efficiency Comparison of Chloral Hydrate during Pediatric Sedation

PURPOSE: In most emergency department (ED), sedation is required before carrying out an invasive procedure on a pediatric patient. In the ED setting, it is essential to determine the optimal dose and administration route of CH for successful sedation. The aim of this study was to determine the optimal dose of CH for an invasive procedure and to examine the effectiveness of the drug's different administration routes. Furthermore, in this study, we performed simple survey using questionnaire which composed of Likert-scale to evaluate satisfaction of medical staffs in ED with administration routes. METHODS: This study was conducted prospectively. The study participants were pediatric patients under 8 years old who visited the ED in two tertiary hospitals in South Korea within a period of 12 months. RESULTS: Overall, 300 patients were included in this study. The age, sex, and weight of the patients were not shown to influence the sedation time. Chloral hydrate dosage is the independent factor to influence the both sedation and discharge time (p<0.01). In the comparison of the groups, groups 1, 2, and 5 showed no significant difference. On the other hand, groups 3 and 4 were shown to be statistically significantly different from group 1. CONCLUSION: Up to 100 mg/kg CH is safe to use in the emergency department for pediatric patients, but the initial dose of 50 mg/kg for oral administration should be considered in advance because it can provide safe and effective sedation with a lower possibility of causing an adverse effect.

The Relationship of the Facial Injury Location and the Traumatic Brain Hemorrhage

PURPOSE: Several studies have reported that facial fractures were associated with traumatic brain injuries or cervical injuries. The purpose of this study was to analyze the relationship between the location of facial injury and traumatic brain hemorrhage in order to support future decisions for image evaluation in facial injury patients. METHODS: In this retrospective cohort study, we evaluated facial injury patients without external head trauma who visited the emergency department at our hospital between January 1, 2014 and October 31, 2014. We divided the cohort into 2 groups: Facial injury patients with associated traumatic brain hemorrhage and those without traumatic brain hemorrhage. We compared the factors related to traumatic brain hemorrhage, such as facial injury locations, mechanism of accident, types of wounds, altered mentality, headache, and loss of consciousness between the two groups. RESULTS: In 873 patients, 73 (8.36%) presented traumatic brain hemorrhage and the other 800 had no traumatic brain hemorrhage on a brain computed tomography (CT) scan. The rate of headache, loss of consciousness, altered mentality, traffic accident, fall down, fracture, temporal injury, frontal injury, multiple facial area injury, and upper facial area (frontal and upper orbital area) injury were higher in the traumatic brain hemorrhage group than in the non-traumatic brain hemorrhage group (p<0.05). The risk factors of traumatic brain hemorrhage were headache, loss of consciousness, altered mentality, facial bone fracture, and temporal area injury of the face. CONCLUSION: If a facial injury patient has any of the following factors temporal area injury, facial bone fracture, altered mentality, headache, and loss of consciousness, we have to evaluate the brain CT scan even if the patient had no external head injury.

Indication of Hospitalization by Comparing Admission Group with Non-admission Group in Influenza: An Observatory Study at a Single Regional Emergency Medical Center

PURPOSE: Influenza is a self-limiting acute respiratory disease, but can be complicated by pneumonia, encephalitis, or myocarditis. If diagnosed, symptomatic treatment of upper respiratory symptoms, early initiation of antiviral therapy, and careful observation of complication occurrence is vital. However, admission of influenza patients can increase the risk of in-hospital infection to previously admitted patients. For this reason, admission or discharge criteria are required. METHODS: This was a retrospective observational study. The characteristics of hospitalized cases were compared with those of discharged cases. Medical records from November 1, 2013 to February 28, 2014 were reviewed and the patient characteristics, clinical symptoms and signs, and other clinical variables were analyzed. RESULTS: A total of 242 patients who showed positive RAT and underwent laboratory and radiologic testing were enrolled in this study. Among them, 203 patients were discharged from the ER and 39 patients were hospitalized, 32 patients in GW and 7 patients in ICU. In the hospitalized group, compared to the discharged group, the average age, complaint of dyspnea, incidence of leukocytosis, level of ESR and CRP, incidence of hypoxemia, and incidence of acute lesion on chest x-ray was high with statistical significance. CONCLUSION: Admission would be considered for patients with ILI with the findings mentioned above.

The Measurement of Korean Pediatric Subglottic Transverse Diameter Using Computed Tomography Imaging and Validation of the Formulas for the Appropriate Cuffed Endotracheal Tube

PURPOSE: It has been established that the subglottic transverse diameter (SD-T) is the narrowest portion of the pediatric airway. In this study, we aimed to measure SD-T using computed tomography (CT) among Korean pediatrics, and compare and verify the measured SD-T with several formulas for appropriate size of the cuffed endotracheal tube (ETT) in pediatrics. METHODS: This is a retrospective study of 364 children from 0 month to 10 years undergoing facial CT scan. The CT scans were performed in children with spontaneous respiration. We obtained SD-T by these CT scans, and compared them with the Motoyama's formula [internal diameter (ID, mm)=(age/4)+3.5], the formula by Khine et al [ID (mm)= (age/4)+3.0], and the formula by Kim et al [outer diameter (OD, mm)=0.01×age (month)+0.02×height (cm)+3.3]. The obtained ID by these formulas was converted to correspond with OD. RESULTS: SD-T had a strong association with age (Estimate=0.029, R²=0.853, p<0.001), weight (Estimate=0.108, R²=0.698, p<0.001), and height (Estimate=0.048, R²=0.854, p<0.001), according to a linear regression analysis. There was no difference of SD-T between males and females (p=0.636). The intraclass coefficients of OD by the Motoyama's formula and the formula by Khine et al with OD of the cuffed ETT by measured SD-T were high (0.910, p<0.001, 0.897, p<0.001). CONCLUSION: Age based formulas for the appropriate cuffed ETT could be sufficient for emergency endotracheal intubation in Korean pediatrics.

Ectopic Human Fasciola hepatica Infection by an Adult Worm in the Mesocolon

We report here an ectopic case of Fasciola hepatica infection confirmed by recovery of an adult worm in the mesocolon. A 56-year-old female was admitted to our hospital with discomfort and pain in the left lower quadrant of the abdomen. Abdominal CT showed 3 abscesses in the left upper quadrant, mesentery, and pelvic cavity. On surgical exploration, abscess pockets were found in the mesocolon of the sigmoid colon and transverse colon. A leaf-like worm found in the abscess pocket of the mesocolon of the left colon was diagnosed as an adult fluke of F. hepatica. Histologically, numerous eggs of F. hepatica were noted with acute and chronic granulomatous inflammations in the subserosa and pericolic adipose tissues. Conclusively, a rare case of ectopic fascioliasis has been confirmed in this study by the adult worm recovery of F. hepatica in the mesocolon.

A Case of Chlorfluazuron Insectisides Poisoning with Mental Change

Benzoylureas are chemical compounds best known for their use as insecticides. Diflubenzuron is one of the more commonly used benzoylurea pesticides. Others include chlorfluazuron, flufenoxuron, hexaflumuron, and triflumuron. They act as insect growth regulators by inhibiting synthesis of chitin in the body of the insect. They have low toxicity in mammals because mammals have no chitin. Chlorfluazuron insecticides, which are mixed with solvent naphatha, are commonly used. Thus we assume that in the presented case mental change outcome of poisoning was connected with toxic effects of solvent naphtha rather than with chlorfluazuron action. Components of solvent naphtha, particularly trimethylbenzenes, exert strong irritant action on the gastric mucosa and are very well absorbed from the gastrointestinal tract. We report on a 67-year-old man with stuporous mentality after intentional ingestion of approximately 200 ml of liquid chlorfluazuron in a suicide attempt. He was discharged after conservative treatments including gastric irrigation, charcoal, mechanical ventilation, hydration, and antibiotics for aspiration pneumonia without complications.

A Case Report of Spider Bite by Tarantula

A total of 631 species of spiders have been reported in Korea. However, there are no spiders with noxious venom such as Latrodectus sp. Because of this, to date, no serious medical problems due to spider bites have been reported in Korea, and only two cases of spider bite were officially reported. However, as the number of earning spiders from other countries is increased, the number of cases of spider bite has also shown a recent increase. A 17-year-old man presented with numbness of both extremities after being bitten by a spider which he had as a pet. The spider is called an Indian ornamental tree spider (Poecilotheria regalis sp.), one kind of tarantula species. Herein, we report on a case of a spider bite by a tarantula.

Non-invasive Hemoglobin Measurement in Emergency Patients

PURPOSE: At present, the hemoglobin count is one of the most commonly performed clinical laboratory tests in the emergency department. However, the conventional method is invasive and permits only intermittent assessments. The aim of this study was to determine whether non-invasive hemoglobin measurements (SpHb) produce comparably accurate results to laboratory hemoglobin tests (tHb) in patients presented to the emergency department. METHODS: From May to July 2009, 217 patients who required hemoglobin tests after presenting to the emergency department of a hospital were enrolled. We measured hemoglobin values using the conventional method (tHb), and the non-invasive method (SpHb). The study population was classified into two groups: 'non-bleeding' and 'bleeding'. The concordance between tHb and SpHb was analyzed by the Pearson's correlation coefficient. RESULTS: A total of 217 data pairs were collected from 217 subjects, 193(88.9%) non-bleeding patients, 24(11.1%) bleeding patients. A total of 114 subjects were male (52.5%). The Pearson's correlation coefficient between tHb and SpHb was 0.814(p=0.000). In the 'non-bleeding' and 'bleeding' groups, the Pearson's correlation coefficients between tHb and SpHb were 0.779(p=0.000) and 0.788(p=0.000) respectively. CONCLUSION: Non-invasive SpHb measurement provides clinically acceptable accuracy compared to the conventional laboratory method (tHb) in the setting of the emergency department.

Paddle-skin Coupling Material Usage in Emergency Institutes in South Korea

PURPOSE: While the use of coupling material (CM) during defibrillation is known to decrease transthoracic impedance more so than other materials elsewhere, the situation in Korea is unclear. The study assessed the use of paddleskin CM during defibrillation in South Korean emergency institutes (EIs) and measured the impedances. METHODS: From October 15 to October 19, 2009, 112 EIs (all of regional emergency medical centers (EMCs), specialized care centers, and local EMCs) were surveyed. Institute members were queried about their current use of paddleskin CMs during defibrillation. Indications for use were studied by means of a World Wide Web search, descriptions on the CM packaging, and telephone conversations with CM manufacturers and related people. Impedance measurements were recorded from April 13 to August 3, 2009. RESULTS: During defibrillation, 27 different CMs were used in the 108 EIs. Only nine institutes used CMs directly for defibrillation. Impedence of nine CMs could not be measured. The impedance values were 1.69, 1.71, 2.00, and 6.12 ohm for four CMs used for defibrillation; 6.66 and 11.94 ohm for two CMs used for electrodes; 9.71, 9.82, 11.57, 13.68, 13.89, 14.36, 18.31, and 19.66 ohm for eight CMs used for ultrasonography; and 14.05, 17.71, 35.44, and 41.15 ohm for four other CMs. CONCLUSION: More education and public information about the use of CMs for defibrillation are needed.

A Case of Intoxication of Ingested Formalin

Formalin is a water-soluble, colorless, pungent, irritating and highly reactive gas. A 40% solution of formaldehyde in water, also known as formalin, is used as a disinfectant, antiseptic, deodorant, tissue fixative and embalming fluid. Ingestion can lead to immediate deleterious effects on almost all systems of the body including gastrointestinal tract, central nervous system, cardiovsacular system and hepato-renal system, causing gastrointestinal hemorrhage, cardiovsacular collapse, unconsciousness or convulsions, severe metabolic acidosis and acute respiratory distress syndrome. We treated a 39-year-old woman who ingested 300 ml formalin in a suicidal attempt. Despite hemodialysis, death occurred after 23 h.

A Preliminary Study of an Emergency Department-based In-depth Injury Surveillance System of Preschool Children Injury

PURPOSE: To describe the use of an emergency department (ED)-based, in-depth injury surveillance system to determine the incidence and mechanism of preschool children injury. METHODS: We prospectively studied and registered injured children under 7 years old, (n=5,921) whose injuries resulted in ED treatment from August 2006 to July 2008. We upgraded the checklist surveillance items, included place, accident mechanism, and agent factors. The ED physicians recorded the injury data on checklists in real time as they gave the ED orders. The recorded data were stored in computer networks and automatically coded, which enabled access to the raw data sources. The statistical data were calculated in detail by using relative frequency distribution from the raw data. RESULTS: A total of 29,548 injured patients visited the ED from August 2006 to July 2008. Preschool children injuries, except those from traffic accidents, were 5,921(20.0%). The most common sources of injuries were from blunt trauma (37%), slips(17%), and falls(16%). Among those admitted to our hospital, fall injuries and inhalation of foreign body accidents accounted for 7.6% and 7.5%, respectively. The larger proportion of fall injuries occurred from a height of less than 1 meter(82.2%). The frequency of injury mechanism differed according to age: fall(35%), blunt(19%), and burn(14%) were noted under 1 year old, compared to blunt(34%), fall(14%), and slip(13%) from between 1 to under 3 years of age, and blunt(37%), slip(19%), and fall (11%) between 3 to under 7 years of age. CONCLUSION: The ED-based preschool children injury surveillance system could provide a useful and efficient method to determine injury incidence and injury-related factors.

Availability of Bedside N-terminal Pro-Brain Natriuretic Peptide Measurement as Prognostic Marker About Development of Major Adverse Cardiovascular Events in Patients of Acute Coronary Syndromes

PURPOSE: Natriuretic peptide levels are known to be associated with cardiac output and ventricular function. Recently it has been suggested that N-terminal pro-brain natriuretic peptide (NT-pro-BNP) is available as a prognostic marker for acute coronary syndrome patients. We compared NTpro- BNP levels between patients with and without major adverse cardiovascular events (MACEs) who visited the emergency room due to acute coronary syndrome. METHODS: We designed a case-only study with study subjects recruited retrospectively by medical chart review. Patients who visited the emergency room from 1 May 2006 to 31 February 2007 and were diagnosed with acute coronary syndrome were enrolled. Subjects who did not receive bedside measurement of NT-proBNP levels were excluded. To analyze by subtype of acute coronary syndrome, we classified study subjects into the following group: ST elevation myocardial infarction, non-ST elevation myocardial infarction, or unstable angina. RESULTS: The level of NT-proBNP was 2,592+/-917 pg/ml in MACEs patients, and 1,289+/-1,261 pg/ml in patients without MACEs, a statistically significant difference (p<0.0001). The MACEs patients showed higher level of NT-proBNP than patients without MACEs in the ST elevation myocardial infarction group (p=0.439), the non-ST elevation myocardial infarction group (p=0.004), and the unstable angina group (p=0.009). CONCLUSION: Initial bedside NT-pro-BNP levels are higher in MACEs patients. Although the study size was small and the result should be carefully interpreted, it supports the hypothesis that NT-pro-BNP can as a marker to evaluate MACEs in acute coronary syndrome.

Outcome of Pediatric Out-of-Hospital Cardiac Arrest

PURPOSE: We analyzed the characteristics and outcome of pediatric out-of-hospital cardiac arrest. METHODS: Pediatric out-of-hospital cardiac arrest from January 2000 to December 2005 at two tertiary hospitals were described and evaluated using the Utstein style. We reviewed the records retrospectively and analyzed the outcome variables which were any return of spontaneous circulation (ROSC), sustained ROSC, survived event, and survival to hospital discharge. Neurologic outcome was assessed by the Pediatric Cerebral Performance Category (PCPC) scale. RESULTS: The study included 62 children with out-of-hospital cardiac arrest. Any ROSC was achieved in twenty patients (32.3%). Sustained ROSC of any ROSC group was achieved in sixteen patients (80.0%). Of the sustained ROSC group, fourteen patients (87.5%) were admitted to hospital, and only four patients (28.6%) of survived event group survived to hospital discharge. The prevalent etiology were injuries. Although 35 children (56.5%) of the arrests occurred at home with family members present, only 1 patients received bystander CPR. Nonshockable rhythm (96.8%) were showed more than shockable rhythm (3.2%). In any ROSC group, time to initiation of CPR was 9.3 minutes,duration of total CPR was 20.4 minutes. CONCLUSION: Mortality of pediatric out-of-hospital cardiac arrest was high and neurologic outcome was poor. Factors that increased survival rate were prevention of injuries, enhanced education programs of bystander CPR, rapid initiation of CPR.

The Clinical Usefulness of Halo Sign on CT Image of Trauma Patients

PURPOSE: This research was performed to determine which clinical signs and symptoms of brain injury are sensitive indicators of skull fracture (SF) and intracranial injury (ICI) in head injured children. METHODS: We conducted a prospective study of minor head trauma in children younger than 2 years of age for a 1-year period. Skull radiographs, brain computed tomography (CT), and data forms, including mechanism of injury, symptoms, physical findings, and hospital course, were completed for each child. RESULTS: Of 137 study subjects, 17 (12.4%) had SF/ICI. Falls were the most common mechanism of injury, and heights of fall above 1 meter were associated with incidence of SF/ICI (p<0.05). Scalp abnormalities were not associated with incidence of SF/ICI. As for clinical symptoms, lethargy and a grouping of features (irritability & vomiting) were associated with incidence of SF/ICI (p<0.05). The incidence of seizure, loss of consciousness, vomiting, irritability, and scalp abnormality did not differ significantly between those with normal radiologic findings and those with SF/ICI. Among asymptomatic patients, 11 (14.5%) patients had SF/ICI, and among patients with normal scalp findings, 9 (12.7%) patients had SF/ICI. CONCLUSION: Clinical signs and symptoms, except for lethargy and a grouping of features (irritability & vomiting), were not sensitive predictors of SF/ICI. Nevertheless, SF/ICI occurred among normal children. In such a case, a liberal policy of CT scanning is warranted.

Comparison of Hypotensive with Non-hypotensive Group in Severe Trauma Patients

PURPOSE: There have been many reports that point to the increasing death and emergency operation rate in traumatic hemorrhagic shock patients. The purpose of this study was to discover the clinical difference between the hypotensive traumatic patients and the non-hypotensive traumatic patients that had been managed in intensive care unit (ICU). METHODS: We retrospectively reviewed the medical records of 122 patients admitted to ICU for trauma from January 2001 to December 2002. We compared the hypotensive (systolic blood pressure (SBP) < 90 mmHg) group with the non-hypotensive group about age, diastolic blood pressure, initial hemoglobin, Injury Severity Score (ISS), Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), transfusion volume at emergency department, blood pH, blood base deficit, duration of admission, ICU stay, death rate, transfusion volume and others. RESULTS: There was no difference between two groups in age, causes of injury, situation whether or not the patient was directly transported from the scene and ISS. But there were differences between two groups in initial hemoglobins, GCS, RTS, blood pH, blood base deficit, duration of admission, ICU stay, and death rate. It was documented that the ICU stay correlated with systolic blood pressure, diastolic blood pressure, initial hemoglobin, blood base deficit, ISS, GCS, and RTS but not correlated with transfusion volume in emergency department. CONCLUSION: Systolic blood pressure is not the sensitive parameter of blood loss. Various kinds of indices of hypotensive group are more severe than non-hypotensive group. If traumatic patients are hypotensive blood pressure on arrival at emergency department, we should be careful of the state of these patients.

Use of Malaria Antibody Test Kit and Clinical Features in Malaria Patients

PURPOSE: Distinguishing malaria from severe infection among febrile patients in emergency room is difficult, so we tried to analyze the clinical manifestations of malaria and the results of using devices as a quick way to detect malaria among febrile patients visiting an emergency medical center (EMC). METHODS: We retrospectively reviewed the clinical records of patients visiting a local EMC from January 2001 to December 2004 and confirmed as having vivax malaria by using a peripheral blood smear and Malaria antibody test (Immunochromatographic assay). RESULTS: All of the 108 included patients were infected with Plasmodium vivax and suffered from high fever, but tertian fever was seen in only 41 patients (37.9%). Various symptoms included headache, myalgia, abdominal pain, and so on. Laboratory findings noted thrombocytopenia, anemia, elevated alanin aminotransferase, and coagulopathies. Malaria antibody test was used in all cases for early diagnosis in the EMC. Compared with the peripheral blood smear, malaria antibody test identified 103 cases as positive, and five cases as negative. The diagnostic sensitivity of the malaria antibody test is 95.3%. CONCLUSION: Since south Korea is a malaria endemic area, for patients visiting an emergency room with a high fever, accompanied by thrombocytopenia and anemia, malaria must be included in the differential diagnosis whether the fever is tertian or not. The Malaria antibody test can be done by even an unskilful person, so it is a very helpful screening test and an early detection tool for malaria.