Is increased Mean platelet volume associated with neurologic outcome after non-traumatic subarachnoid hemorrhage?

Objective@#This study evaluated the clinical usefulness of mean platelet volume (MPV) for predicting functional outcomes in subarachnoid hemorrhage (SAH) patients. @*Methods@#This is a retrospective analysis of patients who were diagnosed with SAH in the emergency room. Based on their modified Rankin Scale (mRS) score, patients were divided into two groups: 0-2 (good outcome) and 3-6 (poor outcome). Univariable and multivariable analyses were performed to investigate whether MPV, along with other multiple factors, was associated with poor prognosis. Receiver operating characteristic (ROC) curve analysis was performed to determine the value of MPV as a predicting factor of neurological prognosis. Compared to other factors, Hunt Hess grade (HHG) and modified Fisher grade (mFG) considerably influenced the outcomes in both groups (Model 1; model including all factors). Hence, a new model (Model 2) was constructed, comprising multiple factors excluding these two factors. @*Results@#A total of 143 patients were included in this study. Although MPV was different between the two groups, it was not a significant factor in Model 1 in the multivariable analysis. In Model 2, MPV (odds ration [OR], 1.71; 95% confidence interval [CI], 1.05-2.8), age (OR, 1.06; 95% CI, 1.03-1.1), and surgical treatment (OR, 0.37; 95% CI, 0.15-0.87) were significant factors related to poor outcomes. Area under the curve (AUC) of Model 1 was 0.93, 0.85 in HHG; 0.78 in Model 2, 0.65 in mFG, and 0.62 in MPV. @*Conclusion@#Although MPV differed significantly between the good and poor outcome groups, it is insufficient to predict poor outcomes in SAH patients as an independent biomarker.

The difference of the HEART score for predicting cardiovascular disease according to obesity index in emergency department

Objective@#The HEART score is a fast and simple cardiovascular disease (CVD) prediction tool useful in the emergency department (ED). This study evaluates the predictive value of the HEART score when applying other obesity indices such as waist circumference (WC) or waist-to-height ratio (WHtR) instead of body mass index (BMI). @*Methods@#Data were prospectively collected from the pre-made registry of patients who had visited the ED with chest pain. Based on their final diagnoses and coronary imaging study results, patients were classified as acute coronary syndrome (ACS), non-ACS, significant coronary arterial stenosis (SCS), and non-SCS. We compared the HEART score for each group and modified it with variable obesity indices. Multivariable logistic regression and the area under the curve were calculated to determine the most suitable obesity index for the HEART score in predicting ACS or SCS. In addition, we compared the gender-dependent relationship between obesity and ACS or SCS. @*Results@#Of the total 689 patients examined, 281 were diagnosed with ACS. The odds ratio (OR) of the HEART score for ACS was 12.1. The ORs were 13.2 and 11.2 when the HEART score was modified with WC or WHtR, respectively. Obesity was determined as the meaningful factor to predict ACS (OR: BMI, 2.38; WC, 3.39) and SCS (OR: BMI, 3.07; WC, 4.03) in women but not men. @*Conclusion@#The HEART score showed good predictive value regardless of obesity index modification. Furthermore, obesity is associated with CVD in women with chest pain, but not in men.

Reliability of Korean Triage and Acuity Scale: Interrater Agreement between Two Experienced Nurses by Real-Time Triage and Analysis of Influencing Factors to Disagreement of Triage Levels

BACKGROUND: All emergency centers in Korea use the Korean Triage and Acuity Scale (KTAS) as their initial triage tool. However, KTAS has been used without verification of its reliability. In this study, we assess the interrater agreement of KTAS by two independent nurses in real-time and analyse the factors which have an effect on the disagreement of KTAS levels. METHODS: This study was a prospective observational study conducted with patients who visited an emergency department (ED). Two teams, each composed of two nurses, triaged patients and recorded KTAS level and the main complaint from the list of 167 KTAS complaints, as well as modifiers. Interrater reliability between the two nurses in each team was assessed by weighted-kappa. Pearson's χ² test was conducted to determine if there were differences between each nurse's KTAS levels, depending on whether they chose the same complaints and the same modifiers or not. RESULTS: The two teams triaged a total of 1,998 patients who visited the ED. Weighted-kappa value was 0.772 (95% confidence interval [CI], 0.750–0.794). Patients triaged by different chosen complaints showed (38.0%) higher inconsistency rate in KTAS levels than those triaged by the same complaint (10.9%, P < 0.001). When nurses chose the same complaint and different modifiers, the ratio of different levels (50.5%) was higher than that of the same complaint and same modifier (8.1%, P < 0.001). CONCLUSION: This study showed that KTAS is a reliable tool. Selected complaints and modifiers are confirmed as important factors for reliability; therefore, selecting them properly should be emphasized during KTAS training courses.

Utility of the APACHE II Score as a Neurologic Prognostic Factor for Glufosinate Intoxicated Patients

PURPOSE: The incidence of glufosinate poisoning is gradually increasing, and it can be fatal if severe poisoning occurs. However, factors useful for predicting the post-discharge neurological prognosis of patients who have ingested glufosinate have yet to be identified. Our objective was to evaluate the utility of the acute physiology and chronic health evaluation (APACHE) II score measured in the emergency department for predicting the neurological prognosis. METHODS: From April 2012 to August 2014, we conducted a retrospective study of patients who had ingested glufosinate. The outcome of the patients at discharge was defined by the Cerebral Performance Category Score (CPC). The patients were divided into a good prognosis group (CPC 1, 2) and a poor prognosis group (CPC 3, 4, 5), after which the APACHE II scores were compared. The Hosmer-Lemeshow test and the area under the receiver operating characteristic (ROC) curve from patients determined calibration and discrimination. RESULTS: A total of 76 patients were enrolled (good prognosis group: 67 vs poor prognosis group: 9). The cut-off value for the APACHE II score was 12 and the area under the curve value was 0.891. The Hosmer and Lemeshow C statistic χ2 was 7.414 (p=0.387), indicating good calibration for APACHE II. CONCLUSION: The APACHE II score is useful at predicting the neurological prognosis of patients who have ingested glufosinate.

Usefulness of Neurtiophil Gelatinase-Associated Lipocalin as a Prognosis Predictor in Heart Failure Patients in Emergency Department

PURPOSE: We aimed to investigate the clinical use of plasma neutrophil gelatinase-associated lipocalin (NGAL) in the emergency department (ED), especially for predicting the prognosis of heart failure. METHODS: In a retrospective study, patient selection was based on those who visited the ED between January 2015 and September 2015 and were diagnosed with heart failure and underwent laboratory tests, including B-type natriuretic peptide (BNP) and NGAL. They were divided in two groups, according to the presence or absence of the following events: one or more intubations, admission of intensive care unit (ICU), coronary angiography, renal replacement therapy, extracorporeal membrane oxygenation, intra-aortic balloon pumping, cardiopulmonary resuscitation (CPR), or death. RESULTS: We studied 63 patients with heart failure. The absence group consisted of 29 subjects, and the presence group consisted of 34 subjects. Patients who were younger, had a history of diabetes mellitus, had high level of serum creatinine, low estimated glomerular filtration (eGFR), high creatine kinase (CK) or high NGAL were associated with higher incidence of events and were statistically significant (p<0.001, 0.02, 0.005, 0.035, 0.03, 0.003). In the case of BNP, the presence group showed a higher value compared with the absence group, but was not statistically significant. In a multivariated logistic regression, age (OR=0.868, 95% confidence interval 0.788-0.956, p=0.004) and NGAL (OR=1.004, 95%CI 1.001-1.007, p=0.021) were considered as meaningful factors for predicting the event. CONCLUSION: NGAL elevation in this study showed to be a meaningful factor, indicating a prognosis to those patients who visited the ED and were diagnosed as heart failure.

Factors Affecting Cardiopul-monary Resuscitation Hands-off Time in an Emergency Room

PURPOSE: The importance of minimizing hands-off time (HOT) during the performance of cardiopulmonary resuscitation (CPR) is emphasized in the new guidelines. This study analyzes the proportion and effects of each HOT result as observed in an Emergency room (ER). METHODS: We prospectively reviewed 45 video records of CPR performed in an ER resuscitation room from October 2007 to September 2008. We measured the total CPR time, the time to first chest compression (initial assessment time; IAT) and the time required to perform each step of the CPR procedure including pulse check and switchig compressors, echocardiography, efibrillation, X-ray, endotracheal intubation, central venous catheter insertion and needle thoracostomy. RESULTS: The median values recorded included the following: total CPR time was 15.7 min (Interquartile range: 7.51~27.8 min), fractions of HOT (HOTF) in CPR was 11.0% (Interquartile range: 6.9~15.1%), the ratio of IAT in total HOT was 16.8% (Interquartile range: 6.4~34%), pulse check and switching compressors in total HOT were 64.4% (Interquartile range: 52~78%), echocardiography was 13.5% (Interquartile range: 7.7~21.2%), defibrillation was 18.1% (Interquartile range: 8.9~24.6%), endotracheal intubation was 12.2% (Interquartile range: 4.2~17.2%) and X-ray was 15.1% (Interquartile range: 12.7~21.0%). We found that the duration of CPR didn't increase HOTF (HOTF within 15 min of the total CPR time is 7.2% and after 15 min HOFT was counted 6.3%). CONCLUSION: During the year of in-hospital CPR data we observed, the pulse check and switch compressor procedure followed the CPR guideline, but the echocardiography, defibrillation and endotracheal intubation resulted in increased HOT. In order to reduce HOT during the performance of CPR, it is necessary to follow the guideline of each step of the procedure.

An Analysis of the Factors which Influence UF during Peritonitis in PD Patients / 대한신장학회잡지

No abstract available.

Analysis of skeletal facial asymmetry with submentovertex cephalometric radiograph / 대한치과교정학회지

This study was performed to investigate the midline having the least difference between the right and left structure among the lines that had been used in the submentovertex analysis and secondarily to know the distribution of asymmetry and it's degree existed normal persons and asymmetric patients. The subjects consisted of 40 normal adult patients and 40 asymmetric adult patients. The computerized anaylses from submentovertex cepholometric radiograph were carried out. The results were as follows; 1. The right and left difference of the perpendicular bisecting line between right and left foramen spinosum was larger than the other midlines in the anterior area and it was decreased gradually as it progressed posteriorly. Specially the difference of this line was the smallest in the area where there was foramen spinosum. 2. The right and left difference of the perpendicular line through crista gali to the line between right and left foramen spinosum was smaller than the other midlines in the anterior area and it was increased gradually as it progressed posteriorly. 3. The right and left difference of the line between crista gali and anterior process of atlas was constant and smaller than the other midlines. 4. Asymmetry was a common finding in both normal and asymmetry group and left or right dominance of asymmetry was not statistically significant. 5. When the analyses were undertaken after submentovertex radiogram was divided into cranial base, upper face and lower face, the more inferior part showed relative asymmetry than the more superior part.