Analysis of Prognostic Factors Affecting Admission in Acute Alcohol-intoxicated Patients with Traumatic Brain Injury Visiting Emergency Room

PURPOSE: This study analyzed the prognostic factors affecting admission in acute alcohol-intoxicated traumatic brain injury (TBI) patients visiting the emergency room. METHODS: A multicenter, retrospective observational study was conducted on 821 acute alcohol-intoxicated adult trauma patients, who visited 10 university hospital emergency centers from April to November 2016. The primary outcome was hospital admission. The secondary outcome was in-hospital mortality. RESULTS: One hundred sixty-eight patients diagnosed with acute alcohol-intoxicated TBI were analyzed. The increase in blood alcohol concentration was associated significantly with a mild decrease in admission (adjusted odds ratio, 0.993; 95% confidence interval, 0.989 to 0.998; p=0.01). Moderate to severe TBI patients showed a significant increase in admission compared to mild TBI patients (adjusted odds ratio, 12.449; 95% confidence interval, 3.316 to 46.743; p < 0.001). CONCLUSION: This study showed that the admission was inversely correlated with the blood alcohol concentration and is correlated directly with the increase in the severity in TBI. Therefore, emergency physicians may be required to identify the severity of TBI rapidly and accurately in acute alcohol-intoxicated trauma patients visiting the emergency room.

A Nationwide Survey of Korean Emergency Department Triage Systems and Scales; A First Step Towards Reform of the Emergency Medical Service System

PURPOSE: As a first step towards reform of the emergency medical service system, we aimed to assess the current status of our emergency department triage systems and illustrated the current status and problems of the Korean emergency department triage system. METHODS: We conducted e-mail and telephone surveys of the triage officers of all 136 emergency medical centers in Korea. RESULTS: All 136 emergency departments responded to the survey. In Korea, a triage scale derived from the 'emergency symptoms based on the requirements of the Emergency Medical Service Act' is the most-used triage scale. We identified factors showing significant association with use of verified triage vs. unverified scales, including level of triage scale, type of hospital, type of emergency department, perception of problems regarding the triage scale, educational performance, and number of annual visits. CONCLUSION: Results of our survey showed that in Korea various kinds of triage scale are in use and the reliability and validity of more than half of them are unverified. Reform of the Korean national triage system is in progress and our survey findings should be helpful in guiding reorganization of the national triage systems of many countries.

A Qualitative Study for development of an Informed Consent Form using an iPad in an Emergency Department

PURPOSE: This study identifies best practices for informed consent for emergent computed tomography (CT) scans and development of a new document used to explain the informed consent using an iPad in an emergency department (ED). METHODS: Literature review, semi-structured interviews, and observations of informed consent were used for development of a new process for informed consent. Participants were ED physicians, residents, and senior nurses. Interviews were conducted for identification of agreed best practice and to derive new structural documents for classification of the information into relevant sections. RESULTS: Interviews identified a variety of perceived current deficits in informed consent, including difficult contents and missing explanation of the possible adverse events, such as radiation hazards. Participants provided examples of poor informed consent that were thought to have led to patient dissatisfaction; these included delay for patients who do not agree to undergo CT scan due to brief or inaccurate explanation. The interviewers' responses were used to reach a unifying 'best practice' for the content of informed consent. Their opinions were also used in implementation of a new tool for informed consent using the iPad. CONCLUSION: A new informed consent was developed using an iPad in order to provide a more efficient and organized template, which includes visual information necessary to facilitate understanding. Additional video clips were also developed in order to provide adjuvant materials for detailed explanations.