Changes in pediatric injury-related visits during coronavirus disease 2019 pandemic at a single regional emergency medical center in Korea

Purpose@#This study was aimed to investigate the changes in pediatric injury-related visits at an emergency department (ED) during coronavirus disease 2019 pandemic. @*Methods@#We retrospectively compared injury-related visits to an ED in Korea by children aged 15 years or younger during February 2020-December 2021 (pandemic period), and the visits during February 2018-December 2019. Clinical characteristics, injury mechanisms, diagnostic codes, and ED outcomes were noted. We performed 2 sub-analyses of the pandemic period: biannual changes in the visits, and monthly trends of proportions of concussion and superficial injury as diagnostic codes using linear regression. @*Results@#Despite a 51.2% reduction in injury-related visits during the pandemic, the proportion of the visits increased (25.2% vs. 40.0%; P < 0.001). Overall, increases were noted in proportions of use of emergency medical services and high acuity (P < 0.001). Among the diagnostic codes, brain injuries, fracture and dislocation, and laceration increased while superficial injuries, burn, intoxication, and foreign body ingestion decreased (P < 0.001). As the pandemic prolonged, injury-to-ED time shortened and ED length of stay lengthened while the abovementioned trends remained unchanged. Linear regression showed that the proportions of concussion and superficial injury respectively increased and decreased by 0.01% per month (P < 0.001). @*Conclusion@#The changes in pediatric injury-related visits at the ED during the coronavirus disease 2019 pandemic may serve as a basis for distributing emergency medicine resources in future infectious disease outbreaks.

The effects of home safety intervention on guardians’ behaviors of injury prevention in injured children: a double blind randomized controlled study

Purpose@#The optimal time for home safety intervention for children’s injury prevention is during the injury-related visits to emergency departments. The authors investigated the effect of home safety equipment provision on the guardians’ perception of injury prevention and attitude toward it, and the use of home safety equipment. @*Methods@#We conducted a double blind randomized controlled study on guardians of children aged 7 years or younger who visited the emergency department with accidental injuries. After completing the structured, pre-intervention survey on home safety, the guardians were randomly assigned to receive either home safety equipment (the intervention group) or stationery (the control group) in the same opaque boxes enclosing pamphlets about home safety education. After 4 weeks, the guardians were contacted for the post-intervention survey. The questionnaires for the latter survey consisted of the same contents with 2 added questions regarding the use of new home safety equipment after intervention. Logistic regressions were conducted to identify factors associated with the outcome (i.e., behavioral change). @*Results@#From April through October 2019, we approached 972 guardians. Of these, 59 guardians answered both pre- and post-intervention surveys. No differences were found in the perception and attitude, and use of home safety equipment between the intervention and control groups at the pre- and post-intervention surveys. No variables were associated with the primary outcome. @*Conclusion@#Provision of home safety equipment may be inadequate to improve guardians’ behaviors about prevention of domestic injuries.

The effects of home safety intervention on guardians’ behaviors of injury prevention in injured children: a double blind randomized controlled study

Purpose@#The optimal time for home safety intervention for children’s injury prevention is during the injury-related visits to emergency departments. The authors investigated the effect of home safety equipment provision on the guardians’ perception of injury prevention and attitude toward it, and the use of home safety equipment. @*Methods@#We conducted a double blind randomized controlled study on guardians of children aged 7 years or younger who visited the emergency department with accidental injuries. After completing the structured, pre-intervention survey on home safety, the guardians were randomly assigned to receive either home safety equipment (the intervention group) or stationery (the control group) in the same opaque boxes enclosing pamphlets about home safety education. After 4 weeks, the guardians were contacted for the post-intervention survey. The questionnaires for the latter survey consisted of the same contents with 2 added questions regarding the use of new home safety equipment after intervention. Logistic regressions were conducted to identify factors associated with the outcome (i.e., behavioral change). @*Results@#From April through October 2019, we approached 972 guardians. Of these, 59 guardians answered both pre- and post-intervention surveys. No differences were found in the perception and attitude, and use of home safety equipment between the intervention and control groups at the pre- and post-intervention surveys. No variables were associated with the primary outcome. @*Conclusion@#Provision of home safety equipment may be inadequate to improve guardians’ behaviors about prevention of domestic injuries.

The effect of medically-attended injury experience on the use of home safety equipment

Purpose@#To assess the effect of medically-attended injury (MAI) on the use of home safety equipment, we analyzed the differences in parents’ perception and attitude about injury prevention, and use of home safety equipment depending on the children’s MAI experiences. @*Methods@#From March 2018 through February 2019, we surveyed parents of children aged 5 years or younger via a mobile phone. The parents were divided into the MAI and non-MAI groups. The mobile survey focused on the perception and attitude about injury prevention, and use of home safety equipment (if not used, barriers). @*Results@#Of the 204 parents, 75 (36.8%) reported their children’s MAI, comprising the MAI group. This group used the safety equipment more frequently than the non-MAI group (odds ratio, 7.03; 95% confidence interval, 3.39-14.59; P < 0.001). No significant differences between the 2 groups were found in the perception and attitude about injury prevention, barriers to the use of the equipment, and the type of the equipment in use. @*Conclusion@#Parents’ experience in their children’s MAIs was associated with the use of home safety equipment, but it did not affect their perception and attitude about injury prevention. A visit to the emergency department with MAI is an opportunity for education on injury prevention and changes of the attitude.

The effect of medically-attended injury experience on the use of home safety equipment

Purpose@#To assess the effect of medically-attended injury (MAI) on the use of home safety equipment, we analyzed the differences in parents’ perception and attitude about injury prevention, and use of home safety equipment depending on the children’s MAI experiences. @*Methods@#From March 2018 through February 2019, we surveyed parents of children aged 5 years or younger via a mobile phone. The parents were divided into the MAI and non-MAI groups. The mobile survey focused on the perception and attitude about injury prevention, and use of home safety equipment (if not used, barriers). @*Results@#Of the 204 parents, 75 (36.8%) reported their children’s MAI, comprising the MAI group. This group used the safety equipment more frequently than the non-MAI group (odds ratio, 7.03; 95% confidence interval, 3.39-14.59; P < 0.001). No significant differences between the 2 groups were found in the perception and attitude about injury prevention, barriers to the use of the equipment, and the type of the equipment in use. @*Conclusion@#Parents’ experience in their children’s MAIs was associated with the use of home safety equipment, but it did not affect their perception and attitude about injury prevention. A visit to the emergency department with MAI is an opportunity for education on injury prevention and changes of the attitude.

Status and Analysis of the Accidental Out-of-Hospital Deliveries Transferred by Emergency Medical Service Providers

PURPOSE: Accidental out-of-hospital deliveries are generally associated with high rates of perinatal morbidity and mortality. To determine the status of accidental out-of-hospital deliveries transferred by emergency medical services (EMS), we analyzed the records of EMS runsheets in two South Korean provinces, Gyeonggi and Gangwon. METHODS: The EMS runsheets of patients who were more than 20 weeks pregnant and had delivery-related symptoms between January 2012 and December 2013 in Gyeonggi and Gangwon province were reviewed retrospectively. We analyzed the characteristics of accidental out-of-hospital deliveries by comparing these with those non out-of-hospital deliveries. RESULTS: There were 1,426 urgent dispatches during the study period. In 137 (9.6%) out-of-hospital deliveries, which took place prior to arriving at the hospital, and 48 of these were attended by EMS providers. The accidental out-of-hospital deliveries were more frequent during night time and more common among multiparous and younger age women; however, these observation was without any significance with respect to premature birth. The rate of the accidental out-of-hospital deliveries was not significantly different between rural and urban areas. Twenty cases of complication, including 10 arrests of neonates and EMS providers managed them by the following intervention: reduction of nuchal cord, umbilical cord clamping and cut, warming-up of and stimulating the neonates warms, using oropharyngeal suction, O₂ supplication, and neonatal cardiopulmonary resuscitation. CONCLUSION: As the rate of accidental out-of-hospital deliveries in patients who were transferred by EMS is higher than the rate of out-of-hospital deliveries in general, EMS providers should be fully trained. Moreover, there is the need for more completive records and continuous education.

Appropriateness of transport of children via emergency medical service providers according to the decision-maker on referred hospitals

PURPOSE: We aimed to investigate the appropriateness of transport of children via emergency medical service providers (EMSP) according to the decision-maker on referred hospitals (EMSP [EMSP group] vs. guardians [user group]). METHODS: We analyzed first aid records by EMSP for children aged 15 years or younger in Gyeonggi province, Korea, from January 2012 through December 2013. We obtained the following data: scene, symptom, type (high-level [regional/local emergency medical centers] or not) and location (out-of-province or not) of referred hospitals, injury, level of consciousness (alert or not), and prehospital triage results by EMSP (emergent/less emergent or not). RESULTS: A total of 50,407 children were included, of whom 37,626 (74.6%) belonged to the user group. Overall, the most common scene, symptom, and type and location of referred hospitals were home (57.0%), pain (33.3%), and inside-theprovince and local emergency medical centers (44.2%), respectively. The user group showed less frequent injury (P < 0.001), decreased level of consciousness (P < 0.001), and no significant difference in the triage results (P = 0.074). This group showed more frequent transport to high-level and out-of-province emergency medical centers (P < 0.001), and longer transport (P < 0.001). CONCLUSION: The user group showed more frequent transport to high-level or remote referred hospitals without more critical prehospital triage results. Guardian-directed transport of children might be associated with the inappropriate transport of children via EMSP.

Factors associated with discharge of children from the emergency department after interfacility transfer

PURPOSE: To investigate the factors associated with discharge of children from the emergency department (ED) after interfacility transfer. METHODS: We reviewed consecutive children who visited the ED via interfacility transfer from January 2014 to December 2015. The children were divided into two groups according to whether they were discharged from the ED or not (the discharge and admission groups), and their characteristics were compared. Multivariable logistic regression analysis was performed to identify the factors associated with discharge of children from the ED after interfacility transfer. RESULTS: Of the 999 transferred children, 426 (42.6%) were discharged. Compared to the admission group, these children showed older age, more frequent transfers from clinics and arrivals between 16 h and 20 h, shorter stay in the ED, and less frequent surgical abdomen. We found that age (3 to 6 years; adjusted odds ratio [OR], 1.8; 95% confidence interval [CI], 1.3–2.6, compared with 0 to 2 years), diagnosis (trauma; OR, 2.4; 95% CI, 1.5–4.0, compared with gastrointestinal diseases), and referring hospital (primary clinic; OR, 5.4; 95% CI, 3.1–9.4, compared with tertiary hospitals) were the factors. CONCLUSIONS: The children who aged 3 to 6 years, had trauma or underwent transfers from primary clinics were more likely to be discharged at the ED. Considering these factors, we should reduce unnecessary transfers.

Triage results of children who visited the emergency department via emergency medical service providers: an observational study in a regional emergency medical center

PURPOSE: We aimed to investigate the triage results and the degree of agreement between prehospital and hospital stages of pediatric patients who visited the emergency department (ED) via emergency medical service providers (EMSP) in comparison with adult patients. METHODS: We retrospectively reviewed 8,152 pediatric patients who visited a regional emergency medical center ED via EMSP from January 2015 to December 2015. Pediatric patients were defined as younger than 15 years according to the Korean Triage and Acuity Scale (KTAS). Given the difference of the triage tools of the prehospital (EMSP) and hospital (KTAS) stages, we performed the re-triage into “critical” and “non-critical” Comparisons of characteristics between pediatric and adult patients were made using chi-square tests. The degree of agreement between the tools was analyzed using κ analysis. RESULTS: Of 8,152 patients, 654 (8.0%) were pediatric patients. Direct medical control was more frequently performed to adult patients (P < 0.001). Critical patients were more common among adults (12.2% by KTAS, 24.8% by EMSP) than children (3.5% by KTAS, 14.1% by EMSP). The κ value of pediatric patients was lower than that of adult patients (0.09 [poor]; 95% confidence interval [CI], 0.01–0.18 vs. 0.38 [fair]; 95% CI, 0.35–0.40). CONCLUSIONS: Pediatric patients transferred by EMSP showed lower severity and degree of agreements of the triage results between prehospital and hospital stages than adult patients. It is necessary to pay particular attention to pediatric triage in a pre-hospital setting.

Fall-Down Injuries in children in Treated at the Emergency Department; Preventable Aspects

PURPOSE: This study was conducted in order to evaluate the epidemiological characteristics of children with fall-down injuries according to age groups and to analyze the major trauma groups that were treated at the emergency room (ER). METHODS: Among 1,222 children under age 6 who were treated at the ER from January 2008 to December 2009, a retrospective study was conducted through examination of medical records. The children were classified by age into 3 groups: infant, toddler, and pre-schooler. In each group, the differences between the causative factors that led to the fall-down injuries were analyzed. Also, ISS (Injury Severity Score) score above 4 was classified as major trauma, and an ISS score 0-1 was classified as a minor trauma. The relationship between major trauma and age group was also analyzed. RESULTS: Through an analysis of child fall-down injuries, men (56.6%), toddler (47.3%), head-related symptoms (72.9%), furniture-related traumas (80.2%), and falls from less than a 1-m height (69.9%) were found to be common factors. Furthermore, in radiological studies, fractures and brain hemorrhages accounted for 16.9% of major traumas, and simple skull fractures were the most common (21.4%). Distributed according to age group, the factors relevant to fall injuries were fall height and head-related symptoms for infants, accident site, fall height and head-related symptoms for toddlers, and accident site for pre-schoolers (p<0.05). Also, head-related symptoms and fall height were independent factors of major trauma in all age groups. However, major traumas (17.3%) were related to dumped trauma, fall height and accident site (p<0.05). CONCLUSION: This study was mainly about head-related injuries, and toddler were most common victims. The relevant factors for the major trauma were falling height for infants, accident site and falling height for toddlers, and accident site, falling height for pre-schoolers.

Characteristics of elderly patients with acute poisoning

PURPOSE: Poisoning is a major health problem for the elderly, and poisoning can cause fatal side effects. However, the characteristics and clinical features of elderly patients with acute poisoning have not been well studied in the previous domestic research. So, we tried to analyze the clinical characteristics and toxic substances of the patients who were 65 years old or older and who were admitted to the regional emergency medical center due to acute poisoning. METHODS: We retrospectively reviewed the medical records and poisoning protocols of the patients who were 65 years of age or older and who had with acute poisoning and who visited the ED in our emergency center from January 2005 to December 2009. We collected the demographic information, the gender, the underlying diseases, the causes and toxic substances, the initial presentation, the treatment and the outcomes. RESULTS: A total of 2179 poisoned patients visited the hospital during 5 years, and among them 244 were 65 years of age or older (11.2%). The mean age was 75.6+/-6.9 years and the male:female ratio was 1:1.7. The most common cause of poisoning was suicide (73.4%) and the most common source of poisonous substances was their own drugs. Of the substances used for poisoning, benzodiazepine was the most common drug (25.8%), followed by sedatives other than benzodiazepine (25.4%), insecticide (12.7%), chemical agents (12.3%) and herbicides (8.2%). The most common initial presentation was mental change (64.8%). CONCLUSION: In this Korean study, unlike the foreign studies, the most common cause of poisoning in elderly patients was intentional poisoning. The admission rate was 68.8% and mortality rate was 10.2%.

The Effectiveness of Transvaginal Ultrasonography Performed by Emergency Physicians

PURPOSE: The aim of this study was to examine the diagnostic accuracy and effectiveness of transvaginal ultrasonography (TVUS) performed by emergency physicians (EPs') in the emergency department. METHODS: In this study, female patients with lower abdominal pain who had risks for obstetric and gynecologic diseases were assessed. The accuracy and effectiveness of TVUS performed by emergency physicians was determined by comparing EPs' interpretations of TVUS with the interpretations of TVUS by OGs CT findings, and surgical pathologic results. RESULTS: Forty-one patients were included in the study. The diagnosis was changed in 48.8% of the patients after the TVUS had been performed by an EPs'. When the accuracy of diagnosis was compared pre- and post-TVUS, the accuracy of post-TVUS (80.5%) was higher than the pre-TVUS (39.0%). The agreement between the sonographic findings of EPs' and OGs' was substantial (accuracy=81.3~93.8%; kappa=0.611~0.811; p<0.05). The accuracy of TVUS performed by EPs' in obstetric and gynecologic diseases was 90.6%. The sensitivity and specificity were 100% and 90.9%, respectively, and the positive and negative predictive values were 96.8% and 100%, respectively. CONCLUSION: TVUS performed by EPs' is of considerable help in establishing the correct diagnosis with a high degree of accuracy.

Overview of Poisoning Admission in Korea: based on the hospital discharge injury surveillance data

Purpose: There has been no nationwide surveillance survey of poisoning cases in Korea. This study examined the clinical characteristics of poisoning admissions in order to obtain preliminary data for future planning. Methods: This study retrospectively reviewed the data on poisoning admissions of 150 hospitals based on the hospital discharge injury surveillance data of Center for Disease Control and Prevention in Korea from January to December in 2004. The demographic data, poisons used, causes of poisoning, reasons for attempted suicide and mortality rate was investigated according to the age group. The factors associated with mortality were also evaluated. Results: A total 836 patients admitted for poisoning were analyzed. Their mean age was 46.5+/-19.5 years (male 415, female 421). The most frequent age group was the 4th and 5th decades. The most common poisons involved were pesticides (45%) and medications (23%). The majority (64%) involved intentional poisoning except for those in the 1st decade. The most common reason for the attempted suicide was family problems. However, individual disease was the most common reason in those over 60 years. The overall mortality rate was 8.7% (73/836). Pesticides and being elderly (over 65 years old) were strongly correlated with fatality. Conclusion: The incidence of intentional poisoning increases from the 2nd decade making it a preventable injury. "Overall, the incidence of intentional poisoning increases from the 2nd decade". Therefore, there is a need to frame a prevention policy corresponding to each factor related to fatality, such as an elderly population and pesticides.

The effects of acute exercise on plasma concentration of follicular stimulating hormoen(FSH), estradiol, progesterone in women / 대한산부인과학회잡지

No abstract available.