Effects of Weekend on the Prognoses for Patients Visiting to Emergency Medical Centers

PURPOSE: Despite the increased number of patients visiting emergency rooms on weekends, the level of staffing is often lower than it is on weekdays. It is uncertain whether in-hospital mortality rates among patients depend on when they visited the hospital on a weekend or on a weekday. METHODS: We analyzed 21,645 patients who visited our emergency department in 2003. We compared death within 48 hours after a visit to the emergency room between patients who visited on weekends and those with visited on weekdays. The odds of death within 48 hours for patients who visited on a weekend were analyzed by using a multivariate logistic regression. The severity of illness was adjusted by using triage and the Charlson comorbidity score. RESULTS: Compared with patients who visited on weekdays, the number of patients who visited on weekends was increased in 30%. The mortality rates were not statistically different for patients who visited on weekends and patients who visited on weekdays (3.1% vs 2.8%, p=0.399). However, two diagnoses (pneumonia and spontaneous subarachnoid hemorrhage) were associated significantly with a weekend effect. CONCLUSION: Visiting the emergency department on weekends was not associated with a higher mortality than visiting the emergency department on weekdays.

Efficacy of Extracorporeal Extraction Treatment in Paraquat Poisoning

PURPOSE: The value of extracorporeal extraction in treating paraquat poisoning was questioned; some saved their patients by applying hemoperfusion, but others failed. This study was designed to investigate the efficacy of extracorporeal extraction treatment for patients suffering from paraquat poisoning. METHOD: The serum concentrations after ingestion of paraquat by 52 patients were serially checked. Of those 52, 42 were treated with hemoperfusion, and 34 of 42 patients were treated with continuous veno-venous hemodialysis (CVVH) after hemoperfusion. We evaluated the mortality, the survival time, and the hourly elimination rate of paraquat to investigate the efficacy of extracorporeal extraction. Also, we evaluated factors which affected the efficacy of the extracorporeal extraction. RESULT: There was no difference between the hemoperfusion group and the non-hemoperfusion group in mortality, time of survival, and elimination rate of paraquat (p>0.1). The total mortality was 50.0% (26/52) with no difference between the hemoperfusion group and the hemoperfusion +CVVH group. The mortality was closely related with the development of acute renal failure. Hemoperfusion, when applied before the collapse of the renal function, is effective in reducing mortality even in severe poisoning. Hemoperfusion had value in enhancing the hourly elimination rate of circulating paraquat in cases with renal collapse, but had little value in reducing mortality. CONCLUSION: The efficacy of extracorporeal extraction in treating patients with paraqaut poisoning was not proven in this study. However we suggest that early extracorporeal extraction may be effective in treating paraquat poisoning, even in severe cases, due to its possible detoxicating effect and toxin removal.