Comparison among frailty screening tools in the emergency department: a systematic review

Objective@#It is important to identify high-risk elderly patients in the emergency department (ED), and various screening tools should be used. This study aimed to find the most appropriate tool by comparing frailty screening tools used in the ED. @*Methods@#The authors searched PubMed, EMBASE, Cochrane library, and KoreaMed databases for medical literature. Two or more frailty screening tools were studied. Sensitivities and values of the area under the receiver operating characteristic curve of each tool used in individual studies were compared. @*Results@#After the screening process, six studies using 12 tools were selected. Most of the tools had low sensitivities. The sensitivities were 90% or more in case of the Clinical Frailty Scale (CFS) and Program of Research to Integrate Services for the Maintenance of Autonomy (PRISMA-7). Seniors at Risk (ISAR) tools for frailty screening, Vulnerable Elders Survey (VES-13) and Geriatric (G8) tools were identified for predicting postoperative mortality, and CFS, Fried and Stable, Unstable, Help to walk, Bedbound (SUHB) tools were used for determining bad composite outcomes. The areas under the curve values predicting outcome were as follows: 0.63-0.67 for death, 0.52-0.64 for postoperative death, 0.52-0.68 for postoperative adverse outcome, 0.55-0.64 for poor prognosis, 0.65-0.69 for activity daily living disability, 0.66-0.78 for functional decline, 0.58-0.61 for hospitalization, 0.57-0.59 for fall, and 0.77-0.91 for frailty screening. @*Conclusion@#It was difficult to select the most appropriate tool among the 12 frailty tools included in this review. However, Fatigue, Resistance, Ambulation, Illnesses, Loss of weight (FRAIL), Study of Osteoporotic Fracture (SOF), CFS, VES-13, and PRISMA-7 were relatively useful in the ED.

The impact of emergency department expansion on crowding and patient flow

Objective@#Overcrowding in the emergency department (ED) has been a long-standing global problem, but has yet to be resolved. This study was undertaken to investigate whether expansion of the ED can affect overcrowding. @*Methods@#This was a retrospective study comparing two 10-month periods: before (September 2015 to June 2016) and after (September 2017 to June 2018) the ED expansion in an urban tertiary hospital. The ED expansion included expansion of the ambulatory area and establishment of a 25-bedded emergency ward dedicated to patients admitted through the ED. @*Results@#Comparing the two study periods, we noted an increase in the number of patients visiting the ED, from 77,078 to 87,027. Moreover, the proportion of patients who returned home untreated significantly decreased from 11.5% to 0.9% (P<0.001). The number of adult patients increased from 40,814 to 60,720; in particular, the number of ambulatory patients increased from 18,648 to 42,944. Conversely, waiting time for X-ray and computed tomography increased (10.0 to 17.0 minutes, and 35.0 to 48.0 minutes, respectively). Other areas with increased time duration include median ED length of stay of total patients (193.0 minutes to 205.8 minutes), and time from consultation to admission decision (122.3 to 161.4 minutes). However, the boarding time decreased from 239.2 to 190.9 minutes. @*Conclusion@#The ED expansion allowed more patients to be treated, and the boarding time of admitted patients was reduced through operation of the emergency ward. However, due to increase in the number of visiting patients, the time required for medical treatment increased concurrently.

Systematic Review of Vitamin B12 Regimen for Patient with Subacute Combined Degeneration of the Spinal Cord Following Nitrous Oxide Abuse

PURPOSE@#The purpose of this study is to evaluate the effectiveness of vitamin B12 treatment in subacute combined degeneration (SCD) caused by nitrous oxide (Nâ‚‚O) abuse.@*METHODS@#Relevant literature was accessed through PubMed, EMBASE, Scopus, and KoreaMed. All the literature that was relevant to human use of vitamin B12 treatment for SCD caused by Nâ‚‚O abuse was included. Case reports were excluded if the treatment regimens were not precisely described. The literature search was conducted by two investigators during September 2019 for the final publication period. The languages of the publications were restricted to English and Korean.@*RESULTS@#Twenty-three published articles that contained 24 cases were included. Sixteen cases among them were treated with intramuscular vitamin B12 of 1 mg/day and the rest received different doses or routes. Although most cases described significant clinical improvements, one case showed no beneficial effect due to the patient's noncooperation. Another case showed adverse events, including spinal myoclonus, following vitamin B12 therapy.@*CONCLUSION@#Vitamin B12 has been broadly used for the treatment of SCD caused by Nâ‚‚O abuse. However, most of the relevant studies were case reports that reported various regimens of vitamin B12 administration. Further studies are needed to establish a standard regimen of vitamin B12 because the incidence of Nâ‚‚O abuse may increase in South Korea.

The effect of time target on overcrowding and clinical quality in the ED: a systematic review and meta-analysis

OBJECTIVE: Many studies have reported the effectiveness of the ‘time target’ on reducing emergency department (ED) overcrowding and improving clinical quality. This study examined the effects of introducing the time target on ED overcrowding and clinical quality using meta-analysis. METHODS: The electronic databases including PubMed (Medline), Cochrane Library, and Embase until June 2017 were searched. The search keywords were ‘time target,’‘national emergency access target,’‘four-hour rule,’ and ‘shorter stays in ED’. Two investigators selected and reviewed articles according to the predefined inclusion and exclusion criteria. The quality of the articles was evaluated using the RoBANS checklist. The data were abstracted by predetermined criteria and meta-analysis was performed using RevMan software. RESULTS: Of 721 articles, 16 studies were included in the final analysis. A meta-analysis of four studies on the ED length of stay (LOS) showed that the mean EDLOS was reduced by 0.64 hours (95% confidence interval [CI], 0.34–0.94) since the introduction of the time target. Other studies also showed that the EDLOS was reduced. There was no definite trend in the hospital admission rate. Meta-analysis of nine studies on the clinical quality revealed a total odds ratio of 1.02 (95% CI, 0.74–1.32). Time taken until the visitation of a doctor and the initiation of treatment were both reduced. The rate of “left without being seen” was decreased. CONCLUSION: EDLOS was reduced and no significant association was observed between mortality and the application of a time target since the introduction of time target. ‘Rate of revisiting,’‘time to clinician,’‘time to treatment,’ and ‘rate of left without being seen’ was reduced.

Fomepizole for Ethylene Glycol or Methanol Poisoning in Children

PURPOSE: The purpose of this study is to evaluate the effectiveness and adverse effect of fomepizole in the management of acute ethylene glycol or methanol poisoning in children. METHODS: Databases such as PubMed, Embase, Cochrane library, and KoreaMed were searched using terms related to fomepizole, ethylene glycol, methanol and pediatric. All studies, regardless of study design, reporting effectiveness or safety endpoints in children were included. Reference citations from identified publications were reviewed. Only reports written in English or Korean languages were included. The reference search was performed by two authors. RESULTS: Twenty-two relevant literatures were finally included. They were one narrative review, 4 retrospective case series, and 17 case reports (19 cases). Case reports were classified as 5 fomepizole only, 8 fomepizole with other therapies, and 6 no fomepizole. All patients from the literatures were fully recovered without long term sequelae. Adverse effects of fomepizole were reported including anaphylaxis, thrombophlebitis and nystagmus. CONCLUSION: There are insufficient literatures regarding fomepizole treatment in children with ethylene glycol or methanol poisoning. The benefits or harms are not clearly established based on the clinical evidences. More prospective comparative studies are required in the future.

Clinical Outcome Comparison of Everolimus- and Biolimus-eluting Stents in Patients with Acute Myocardial Infarction / 대한내과학회지

BACKGROUND/AIMS: We compared the efficacy and safety of the second-generation everolimus-eluting stent (EES) and the third generation biolimus-eluting stent (BES) in patients with acute myocardial infarction (AMI). METHODS: We analyzed 629 consecutive patients (mean age 65.1 +/- 11.2 years, 426 males) with AMI undergoing percutaneous coronary intervention from February 2008 to April 2012. They were divided into two groups according to stent type (EES group, n = 426; BES group, n = 203). The primary end-point was 2-year major adverse cardiac events (MACEs), defined as the composite of all-cause death, myocardial infarction, target vessel revascularization, non-target vessel revascularization and target lesion revascularization. The secondary end-point was 2-year target lesion failure (TLF). RESULTS: There were no significant differences in baseline characteristics, except that the patients with EES had a significantly higher prevalence of diabetes mellitus (34.7 vs. 22.7%, p = 0.002) and were older (67.1 +/- 11.3 vs. 64 +/- 12.9 years, p = 0.039) compared with the patients with BES. After propensity score matching, 2-year clinical outcomes showed no differences in composite MACEs or TLF between the two groups. Multivariate Cox regression analysis showed that stent type was not a predictor of 2-year mortality or MACEs. However, older age (hazard ratio [HR] 1.037, 95% confidence interval [CI] 1.014-1.060, p = 0.001), diabetes mellitus (HR 2.247, 95% CI 1.426-3.539, p = 0.001) and a left ventricular ejection fraction < or = 45% (HR 3.007, 95% CI 1.978-4.573, p = 0.001) were independent predictors for 2-year MACEs in patients undergoing EES or BES. CONCLUSIONS: Patients with BES had similar clinical 2-year outcomes compared with EES patients with AMI.

The Effect of Clinical Pathway for Patient with Postpartum Hemorrhage in the Emergency Department

PURPOSE: Postpartum hemorrhage (PPH) is a major cause of maternal death. The aim of this study is to analyze the effect of clinical pathway (CP) and off-hours effects in PPH patients who visit the emergency department. METHODS: A retrospective study of PPH patients who visited the emergency department between December 1, 2005 and February 28, 2014 was conducted. A multidisciplinary team was designed for PPH in August 1, 2009. We compared time to intervention, volume of transfusion, length of stay (LOS), and uterus preservation rate between the before CP group and after CP group. RESULTS: A total of 143 post CP groups were compared with 101 before CP visits. Time to operation was less compared with the pre CP group (77 min (22-140) vs 47.5 min (13-114) p=0.011). Volume of transfusion and admission to intensive care units (ICU) were increased in the post CP group. (2 (0-16) vs 2 (0-25) p=0.045, 20 (19.8%) vs 54 (37.8%) p=0.003) LOS of ICU was lower than in the pre CP group and uterus preservation was higher than in the pre CP group. (0 day (0-43) vs 0 day (0-6) p=0.015, 82 (81.2%) vs 129 (90.2%) p=0.042) Time to angiographic embolization was less in the post-CP group with on-duty visits than in post-CP with off hours visits. (38.50 min (16-112) vs 71.0 min (28-633), p=0.025) CONCLUSION: A clinical pathway for PPH is associated with improvement of uterine preservation rate and reduced LOS of ICU. However this CP could not eliminate off-hour effects from time to intervention.

Prognostic Value of Preoperative Positron Emission Tomography-Computed Tomography in Surgically Resected Gastric Cancer / 대한소화기학회지

BACKGROUND/AIMS: The diagnostic value of PET-CT, in gastric cancer is well known, but the prognostic value of pretreatment PET-CT has not been adequately evaluated. This study aimed to investigate the preoperative prognostic value of PET-CT in gastric cancer patients. METHODS: A total of 107 patients underwent surgical treatment for gastric cancer from April 2007 to December 2010 at Dong-A University Medical Center after confirming the presence of F-18 fluorodeoxyglucose (FDG) uptake on preoperative PET-CT. Among these patients, the following subjects were excluded: follow-up loss (13), palliative resection (5), neoadjuvant chemotherapy (1), and unrelated death (1). The remaining 87 patients were included in this study and data were collected by retrospectively reviewing the medical records. The median follow-up duration, defined as the period from operation to last imaging study date, was 34.2+/-14.8 months. FDG uptake values were represented by maximal standardized uptake value (SUVmax). In order to assess the correlation between SUVmax and recurrence, Kaplan-Meier's survival analysis with log-rank test and cox proportional hazard model were performed. Receiver operating characteristic (ROC) curve was employed to determine the optimal cutoff value of SUVmax. RESULTS: The result of Kaplan-Meier's survival analysis with log-rank test were significantly different between high SUVmax group and low SUVmax group (p=0.035), the cutoff value of which was 5.6. However, in multivariate analysis with cox proportional hazard model, T-staging, N-staging and SUVmax did not show statistical significance (p=0.190, p=0.307, and p=0.436, respectively). CONCLUSIONS: High SUVmax on PET-CT in gastric cancer can be a useful prognostic factor.

Prognostic Value of Preoperative Positron Emission Tomography-Computed Tomography in Surgically Resected Gastric Cancer / 대한소화기학회지

BACKGROUND/AIMS: The diagnostic value of PET-CT, in gastric cancer is well known, but the prognostic value of pretreatment PET-CT has not been adequately evaluated. This study aimed to investigate the preoperative prognostic value of PET-CT in gastric cancer patients. METHODS: A total of 107 patients underwent surgical treatment for gastric cancer from April 2007 to December 2010 at Dong-A University Medical Center after confirming the presence of F-18 fluorodeoxyglucose (FDG) uptake on preoperative PET-CT. Among these patients, the following subjects were excluded: follow-up loss (13), palliative resection (5), neoadjuvant chemotherapy (1), and unrelated death (1). The remaining 87 patients were included in this study and data were collected by retrospectively reviewing the medical records. The median follow-up duration, defined as the period from operation to last imaging study date, was 34.2+/-14.8 months. FDG uptake values were represented by maximal standardized uptake value (SUVmax). In order to assess the correlation between SUVmax and recurrence, Kaplan-Meier's survival analysis with log-rank test and cox proportional hazard model were performed. Receiver operating characteristic (ROC) curve was employed to determine the optimal cutoff value of SUVmax. RESULTS: The result of Kaplan-Meier's survival analysis with log-rank test were significantly different between high SUVmax group and low SUVmax group (p=0.035), the cutoff value of which was 5.6. However, in multivariate analysis with cox proportional hazard model, T-staging, N-staging and SUVmax did not show statistical significance (p=0.190, p=0.307, and p=0.436, respectively). CONCLUSIONS: High SUVmax on PET-CT in gastric cancer can be a useful prognostic factor.

Performance of Reperfusion Therapy and Hospital Mortality in ST-Elevation Myocardial Infarction Patients with Non-Chest Pain Complaints

PURPOSE: ST-elevation myocardial infarction (STEMI) patients may visit the emergency department (ED) complaining of sensations of pain other than the chest. We investigated our performance of reperfusion therapy for STEMI patients presenting with non-chest pains. MATERIALS AND METHODS: This was a retrospective observational cohort study. STEMI patients who underwent primary percutaneous coronary intervention (PCI) were divided into a chest pain group and a non-chest pain group. Clinical differences between the two groups and the influence of presenting with non-chest pains on door-to-electrocardiograms (ECG) time, door-to-balloon time, and hospital mortality were evaluated. RESULTS: Of the 513 patients diagnosed with STEMI, 93 patients presented with non-chest pains. Patients in the non-chest pain group were older, more often female, and had a longer symptom onset to ED arrival time and higher Killip class than patients in the chest pain group. There was a statistically significant delay in door-to-ECG time (median, 2.0 min vs. 5.0 min; p<0.001) and door-to-balloon time (median, 57.5 min vs. 65.0 min; p<0.001) in patients without chest pain. In multivariate analysis, presenting with non-chest pains was an independent predictor for hospital mortality (odds ratio, 2.3; 95% confidence interval, 1.1-4.7). However, door-to-ECG time and door-to-balloon time were not factors related to hospital mortality. CONCLUSION: STEMI patients presenting without chest pain showed higher baseline risk and hospital mortality than patients presenting with chest pain. ECG acquisition and primary PCI was delayed for patients presenting with non-chest pains, but not influencing hospital mortality. Efforts to reduce pre-hospital time delay for these patients are necessary.

Improving Communication Skill Competency in the Emergency Department through Role Play and Direct Observation

PURPOSE: Good communication between patient and medical staff in an emergency department (ED) fosters patient satisfaction and improves healthcare outcomes. Assessment and implementation of training is key in providing better patient care. The purpose of this study is to evaluate the effect of providing communication skills training to ED physicians and nurses using problem identification, role playing and direct observation. METHODS: The ED faculty in collaboration with an external communications expert group developed a communication skills training manual. The training group participated in simulated patient scenarios followed by video feedback and debriefing sessions. The participants were assessed on their communication skills while delivering care to live patients in real clinical situations before and after the training. The communication skills of the training group were compared with those of the control group. RESULTS: A total of 28 residents and nurses from two departments were enrolled in this study. Pre- to post-training scores (scale 1-5) for the training group improved from 3.0 [2.8, 3.9] to 3.9 [3.1, 4.3] (p=0.025). However, the pre- and post-score difference between the training and control groups was not statistically significant. CONCLUSION: Role play training has been found to be effective in improving communication skills. However, future research is required to develop a more effective training method and determine how to facilitate training implementation in complex clinical healthcare settings, such as the ED.

Clinical Review of Toxic Alcohol Poisoning Cases in Korea

PURPOSE: Toxic alcohols are responsible for accidental and suicide motivated poisonings, resulting in death or permanent sequelae for the afflicted patients. Major therapeutic modalities in these cases include treatment with alcohol dehydrogenase inhibitors and extracorporeal elimination. There have been a number of case reports of toxic alcohol intoxication in Korea. The purpose of this study was to review the clinical characteristics of patients suffering toxic alcohol intoxication. METHODS: We retrospectively reviewed the medical records of patients who presented with toxic alcohol intoxication at 8 emergency departments (ED) from Jun 2005 to Nov 2011. Patients who ingested methanol, isopropyl alcohol, ethylene glycol, and other alcohols except ethanol, were included in this study. The clinical characteristics of these patients were analyzed to include anion and osmolar gap, and estimated concentration of alcohol in the body. RESULTS: During the study period, 21 patients were identified who had ingested toxic alcohol (methanol; 12 patients, ethylene glycol; 9 patients). At ED arrival, the mean anion gap was 18.7+/-6.9 and the osmolar gap was elevated in 13 patients. Oral and IV ethanol were administrated to 11 patients in order to inhibit alcohol dehydrogenase. Extracorporeal elimination procedures such as hemodialysis were performed in 9 patients. There were no fatalities, but the one patient suffered permanent blindness. CONCLUSION: This study found that ethylene glycol and methanol were the substances ingested which produced toxic alcohol intoxication. The patients presented with high anion gap metabolic acidosis and were typically treated with oral ethanol and hemodialysis.

Species Belonging to Genus Protodaedalea in Korea

One rare and interesting species collected from Seorak-san, Inje-gun; Yeonyeop-san, Hongcheon-gun; Daeam-san, Yanggu-gun, Gangwon-do; Pocheon-gun, Gyeonggi-do; Songni-san, Boeun-gun; Joryeong-san, Goesan-gun, Chungcheongbuk-do and Sobaeksan, Yeongju-si, Gyeongsangbuk-do is described and illustrated in detail. The species "Protodaedalea hispida Imazeki" and genus "Protodaedalea Iamzeki" has not been previously recorded in Korean fungal flora. The specimens have been deposited in the Herbarium Conservation Center of the National Academy of Agricultural Sciences.

Tectella patellaris from Korea

One rare and interesting species collected from Gyeryong-san, Chungnam Province is described and illustrated in detail. The species "Tectella patellaris (Fr.) Murr." and genus "Tectella Earle" is a first record for Korean fungal flora. Specimens cited here have been deposited in the Herbarium Conservation Center of National Academy of Agricultural Sciences.

Notes on Some New Species of Psathyrella

This study contains descriptions and illustrations of three new and noteworthy taxa of the genus Psathyrella from Korea. Among them, Psathyrella pervelatoid, P. koreana, and P. utriformcystis are new to science. All collections cited here are deposited in the Herbarium Conservation Center of National Academy of Agricultural Sciences.

Isolation and Identification of Aspergillus Section Fumigati Strains from Arable Soil in Korea

63 strains of Aspergillus section Fumigati were isolated from 17 samples of arable soil in a central province of Korea. Based on the results of genotypic and phenotypic analyses, they were identified as Aspergillus fumigatus, A. lentulus, Neosartorya coreana, N. fennelliae, N. fischeri, N. glabra, N. hiratsukae, N. laciniosa, N. pseudofischeri, N. quadricincta, N. spinosa and N. udagawae. Among these, N. fennelliae, N. hiratsukae, N. quadricincta, and N. udagawae had not been previously recorded in Korea. The diversity of Aspergillus section Fumigati species from arable soil in Korea is also addressed.

Assessment of Severity Scoring Systems for Predicting the Prognosis of Early Goal Directed Therapy (EGDT) Enrolled Patients

PURPOSE: Mortality in emergency department sepsis (MEDS), sepsis-related organ failure assessment (SOFA), multiple organ dysfunction score (MODS), and serum lactate levels have shown their efficacy in the early detection of patients with a bad prognosis. However, those studies did not consider differences in treatment protocols and could not rule out the interference of these differences in treatment modalities. Hence, we aimed to assess the performance of MEDS, MODS, SOFA, and serum lactate levels for predicting a bad prognosis in patients scheduled for identical, standardized treatment protocols, EGDT. METHODS: Medical records of patients who visited a tertiary level teaching hospital and were enrolled in an EGDT program between October 2009 and May 2010, were retrospectively reviewed. MEDS, SOFA, and MODS scores were calculated and recorded along with serum lactate levels. Receiver operating characteristics (ROC) curves of those predictors of mortality were plotted, Bivariate correlation analyses with overall lengths of admission and ICU lengths of stay were done for surviving patients. RESULTS: None of the diagnostic methods (serum lactate level, MEDS, SOFA, MODS) showed a significant difference on ROC analysis (p=0.819, 0.506, 0.811, 0.873, respectively). Bivariate correlation analyses of MEDS, SOFA, MODS and overall lengths of admission showed significant results (p=0.048, 0.018, and 0.003, respectively. Pearson correlation coefficients were, 0.263, 0.312, and 0.381). Only MEDS showed a significant correlation with intensive care unit (ICU) length of stay (p=0.032, Pearson correlation coefficient = 0.332). CONCLUSION: Neither MEDS, SOFA, MODS, nor serum lactate level can predict mortality in EGDT-enrolled patients. MEDS may be correlated with ICU length of stay.

The Clinical Features and Risk Factors of Seizure After Doxylamine Intoxication

PURPOSE: Doxylamine is antihistamine drug that is used as a hypnotic. It is also used for suicidal attempts because it can be easily purchased at the pharmacy without a prescription. There were many articles about the complications after doxylamine intoxication such as a rhabdomyolysis, but only a few articles have reported on seizure. We reviewed the cases of doxylamine intoxication with seizure that were treated in the emergency department. METHODS: We reviewed the medical records of the patients who were over 15 years old and who were intoxicated by doxylamine at 3 emergency medical centers from January 2006 to June 2010. We reviewed the patients' age, gender, the dose of doxylamine ingested, if gastrointestinal decontamination was done, the time from intoxication to hospital arrival, the seizure history, treatment of seizure, the electroencephalography (EEG) results, the brain computed tomography (CT) results and the blood test results. RESULTS: There were 168 patients who were intoxicated by doxylamine during the study period. Twelve patients had a seizure episode. The differences between the patients who developed seizure and the patients who did not were the dose and the serum levels of sodium and creatinine. The only clinically meaningful difference was the amount of doxylamine. The amount of doxylamine ingested (>29 mg/kg) predicted the development of seizure with a sensitivity of 75% and a specificity of 92% on the ROC curve. One patient among the seizure patients expired in the emergency department. CONCLUSION: In case of doxylamine intoxicated patients, there is close relationship between seizure and ingested amount, so close observation needs to be done for the patients who ingest too much because doxylamine can cause death. Further prospective studies are needed for doxylamine intoxicated patients with a seizure episode.

The Effect of Symptom Recognition on Pre-hospital Delay in Patients with Acute Coronary Syndrome

PURPOSE: This study was performed to determine the association of symptom recognition with pre-hospital delay in patients with acute coronary syndrome (ACS), and to determine the factors influencing symptom recognition. METHODS: A prospective study from June 1, 2009 to July 31, 2009 was performed. The pre-hospital delay was calculated by subtraction of the hospital-arrival time from the symptom-onset time. The pre-hospital delay of the patients that recognized the symptoms as cardiovascular in origin was compared to the patients that did not recognize the symptoms as cardiac in origin. In addition, the socioeconomic indexes and risk factors were evaluated. RESULTS: Eighty three subjects were enrolled from a total of 205 patients suspected of having an ACS during the study period. No statistical differences were identified in the comparison of the pre-hospital delay by socioeconomic and risk factors of ischemic heart disease. The median pre-hospital delay of the patients that recognized the symptoms as cardiac was 2.9 hours compared to 11.9 hours among the patients that did not recognize the symptoms as cardiac; this difference was statistically significant (p=0.003). There were statistically significant differences in symptom recognition between the patients that had a history of cardiovascular disease and those that did not (p=0.037), and between the patients that took aspirin and those that did not (p=0.014). In addition, the severity of symptoms differed between the patients that recognized their symptoms and those that did not; this difference was statistically significant (p=0.019). Only the severity of symptoms was statistically significant by the logistic regression analysis (p=0.018). CONCLUSION: The pre-hospital delay was shorter, if patients that recognized the symptoms as cardiac in origin. A history of cardiovascular disease, taking aspirin and severity of symptoms were factors influencing the recognition of symptoms.

Predicting the Airway Patency using the Parameters of Soft-tissue Lateral Neck Radiography in Adult Patients with Acute Epiglottitis

PURPOSE: We wanted to predict the high risk group that requires urgent airway intervention by using the parameters of the soft-tissue lateral neck radiographs of adult acute epiglottitis patients. METHODS: This retrospective study was conducted in two teaching hospitals. The patients who were diagnosed with acute epiglottitis from June, 2007 to May, 2009 were enrolled and their medical records and x-ray films were reviewed. The width of the epiglottis at the widest point (EW), the width of the arytenoid at the widest point (AW), the prevertebral soft tissue distance at the third cervical spine (PSTD), the shortest distance from the epiglottis to the hypopharyngeal wall (EHD) and the shortest distance from the epiglottic root to the arytenoids'tip (EAD) were investigated and we performed regression analyses of these parameters of the patients in the high risk group that required urgent airway intervention. RESULTS: A total of 42 patients were enrolled. Dyspnea and hoarseness were more frequent in the high risk group that required urgent airway intervention (p=0.008, 0.040, respectively). The EW was significantly longer (p=0.001) in the high risk group. The EHD and EAD were significantly shorter (p=0.012, <0.001, respectively) in the high risk group. Only the EAD showed significant correlation with the percent of airway patency on linear regression analysis (p=0.003) and the EAD was the only significant predictor for the high risk group on multivariate logistic regression analysis (p=0.043). The receiver operating characteristics curve of the EW/EAD for the high risk group was obtained and it showed the best predictive power (AUC: 0.977, p<0.001). CONCLUSION: The EAD noted on soft-tissue lateral neck radiography is an important predictor of high risk patients who require urgent airway intervention. The cut-off value of the EW/EAD for the predicting the high risk group is 2.44 (sensitivity 100%, specificity 85.7%).