Comparison of Appropriate Piperacillin/Tazobactam Doses in Korean Obese Patients with Cancer Based on Different Body Size Descriptor Equations in a Tertiary Care Hospital

BACKGROUND: Piperacillin/tazobactam (TZP) is an antibiotic against a broad spectrum of gram-positive, gram-negative, and aerobic and anaerobic strains of bacteria. Due to changes in its pharmacokinetic and pharmacodynamic parameters by TZP-treated patients' renal functions and obesity, it is important to administrate and monitor TZP based on their renal functions and Body Mass Index (BMI) levels. The purpose of this study was to determine the appropriateness of administration doses of TZP based on renal functions of obese cancer patients in a tertiary hospital. METHODS: This study was retrospectively conducted with obese cancer patients with BMI ≥ 30 kg/m₂ in a tertiary hospital, Korea from September 2004 to August 2014. Data were collected through Electronic Medical Record (EMR) which contained laboratory data and TZP dosing of each patient. RESULTS: Among 7,058 patients during the study period, 102 prescriptions were selected based on inclusion and exclusion criteria and classified by their renal functions. Although TZP should be used based on patients' renal functions to adjust its dose, its initial dose and dosing interval were consistently used without considering patients' renal functions on a regular basis. Especially, in the comparison with FDA dosing standard of TZP, approximately twice patients with 20 mL/min ≤ CrCl ≤ 40 mL/min received domestically 4.5 g instead of 2.25 g as the TZP starting dose. CONCLUSION: The appropriate doses of TZP were administered to almost all of obese cancer patients; however, the recommended TZP dose was different between Korea and other countries by twice the amount. Further related studies are necessary to clearly determine the results, to optimize TZP treatment for obese patients with cancer in clinical practice, and to design and develop new TZP formulations for them in pharmaceutical industry.

Factors Affecting Acute Pain Management for Ureter Stone Patients in the Emergency Department

PURPOSE: The most important step for patients who come to the emergency department with ureter stones is acute pain management. There have been insufficient studies on what factors affect acute pain management for ureteral colic the most. In this study, patients with ureteral colic were divided into two groups: one group, in which the pain was first managed with an analgesic, and another group with unmanaged pain, to find factors that most affect additive analgesics administration for ureter stones. METHODS: There were 121 patients, eventually confirmed for the presence of ureter stones through a computed tomography CT scan, included in this study. When ureter stones were suspected after the initial patient evaluation, initial pain was assessed through numerical rating scale (NRS) and the first analgesic was administered once. Pain was reassessed through NRS after 30 minutes. At that time, if the pain was managed, the patient was assigned to Group 1. If the pain persisted, another analgesic was administered for the second and third time, and the patient was assigned to Group 2. Finally, ureter stones were identified through CT scan. RESULTS: There were 58 patients (47.9%) in Group 1 and 63 patients (52.1%) in Group 2. There were no statistically significant differences in average age, serum creatinine, size of ureter stone, and severity of hematuria between the two groups. The differences in NRS measured initially and after 30 minutes were statistically significant (7.6+/-1.4 vs. 8.6+/-1.2, p<0.001; 1.4+/-1.3 vs. 6.6+/-1.9, p<0.001, respectively). The presence of hydronephrosis and perirenal edema were also statistically significant (p<0.001, p=0.007). The affecting factor for the administration of additive analgesics was hydronephrosis (odds ratio 7.213, p<0.001). CONCLUSION: Hydronephrosis is an important factor in the treatment of patients with additive analgesics. It can also be used as a predictive index to assess the severity of pain in patients with ureter stones.

Utility of the DECAF Score in Patients Admitted to Emergency Department with Acute Exacerbation of Chronic Obstructive Pulmonary Disease / 대한구급학회지

BACKGROUND: Exacerbations of chronic obstructive pulmonary disease (COPD) are common and can be fatal. However, it is difficult to predict the in-hospital mortality, severity and prognosis of patients. Prognostic tools are needed to assess exacerbations of COPD in the emergency department. Towards this end, we compared DECAF (dyspnea, eosinopenia, consolidation, acidemia, atrial fibrillation) score with other prognostic tools available in the emergency department. METHODS: Consecutive patients admitted to the emergency department with exacerbations of COPD were recruited. We compared the DECAF score to CAPS (chronic obstructive pulmonary disease and asthma physiology score), BAP (blood urea nitrogen, altered mental status, pulse)-65 class and CURB (confusion, urea, respiratory rate, blood pressure)-65 score and assessed in-hospital mortality, endotracheal intubation, admission to the intensive care unit and admission to the hospital. RESULTS: The in-hospital mortality rate was 4.9%. The DECAF score showed excellent discrimination for in-hospital mortality (AUROC = 0.72, p = 0.002), endotracheal intubation (AUROC = 0.92, p < 0.001), admission to the intensive care unit (AUROC = 0.90, p < 0.001) and admission to the hospital (AUROC = 0.83, p < 0.001). CONCLUSIONS: The DECAF score is a simple and effective prognostic tool for assessing cases involving exacerbation of COPD in the emergency department. Emergency physicians should consider hospital admission if the DECAF score is more than 1 and consider admission to the intensive care unit and endotracheal intubation if the DECAF score is more than 3.

Typhoid Fever Complicated by Intussusception, Splenic Infarction, and Hepatitis

Salmonella typhi infections usually manifest with high fever and gastrointestinal symptoms, however, occurrence of severe complications in other organs, such as pneumonitis, bronchitis, hepatitis, nephritis, encephalitis, and osteomyelitis, is possible. Although common surgical complications include ileal perforation and gastrointestinal haemorrhage, few cases of intussusception have been reported. Splenic infarction is another uncommon complication. In this report, we present a case of typhoid fever complicated with simultaneous small bowel intussusception and splenic infarction. A 27-year-old male patient with no previous history of interest underwent examination for fever, acute abdominal pain, and watery diarrhea of seven days duration. Findings on the initial examination indicated fever of 39.1degrees C, a distended abdomen with direct and rebound tenderness of diffuse localization, and rigidity. Abdominal computed tomography showed hepatomegaly, multiple lymphadenopathies, multiple segmental splenic infarctions, and small bowel ileus with intussusception, however, findings from the small bowel enema study showed spontaneous resolution of the intussusception. Despite antibiotic therapy, abdominal symptoms continued, therefore, the patient underwent exploratory laparotomy with suspicion of intestinal perforation. Surgical findings included multiple enlarged lymphadenopathies and coarse appearance of the liver, but no perforation was found. Results of the Widal test showed positivity for flagellar (H), somatic (O) and A antigens (1:640 dilutions each). Blood cultures showed Salmonella typhi. lymph nodes and biopsy showed mesenteric lymphadenitis, with enlarged lymph nodes due to distension of the sinusoids by macrophages, which showed erythrophagocytosis and tingible bodies. In addition, liver biopsy showed a granulomatous aggregate comprised of macrophages with an epithelioid configuration. After intravenous administration of antibiotics, the patient showed progressive improvement and was discharged for outpatient department follow up.

Two Cases of Poisoning with Veratrum Maackii

Veratrum alkaloids in Veratrum maackii may cause significant gastrointestinal symptoms, bradycardia, hypotension, and arrythmia. We experienced successful outcomes in two patients who were victims of poisoning due to ingestion of Veratrum maackii, which was mistaken for Allium victorialis var. platyphyllum. One patient developed hypotension and prolongation of QT interval in electronicardiogram (ECG) and was treated with administration of vasopressor and magnesium. The other patient developed bradycardia and was treated with administration of atropine. Both patients were kept under close observation, and received supportive care, and both patients were discharged without any symptoms or complications.

Massive Scrotal Hematoma with Active Bleeding Caused by Sparganum

Development of swelling and pain without trauma in a scrotal hematoma is very rare. We report on a case of scrotal hematoma with active bleeding caused by sparganosis. A 75-year-old male patient who presented with left scrotal swelling and moderate pain that started one day ago was admitted to the emergency department. On the computed tomography (CT) scan, a hematoma of greater than 10 cm was observed in the left scrotum and contrast extravasation was observed on the post-enhanced CT scan. Therefore, we concluded massive left scrotal hematoma with active bleeding. The patient underwent immediate surgery, and approximately 200 cc of hematoma was evacuated, and a movable whitish colored sparganum was found and removed. In cases involving development of scrotal hematoma without trauma, confirmed by surgery, sparganosis should be suspected, and should be removed.

Predictive Factors of Re-expansion Pulmonary Edema of Patients with Large Spontaneous Pneumothorax after Chest Tube Insertion

PURPOSE: Reexpansion pulmonary edema (REPE) is rare but sometimes fatal complications can follow chest tube insertion for treatment of pneumothorax. The study assessed the medical records of patients who developed large pneumothroax and searched for the predictive factors and prediction equation for REPE. METHODS: The medical records of patients treated at an emergency department for pneumothorax from January 1, 2008 to December 31, 2009 were reviewed retrospectively. We compared the group that developed REPE with the group that did not develop REPE for clinical and demographic factors. Logistic regression analysis was used to identify predictive factors and prediction equation. We used receiver operator characteristic (ROC) curve analysis to identify optimal cut-off value and assessed the validity of the prediction equation. RESULTS: We screened out 92 large pneumothorax patients among 578 pneumothorax patients. Twenty two cases developed REPE. The calculated prediction equation was 28.955+0.147xsymptom duration before chest tube insertion (days)+0.048xsize of pneumothorax(%)-0.359xSaO2 (%). The results of assessment of the prediction equation using ROC curve analysis were Area under the ROC curve=0.834 and sensitivity 90.9% and specificity 70.0% at the cut-off value 0.210. CONCLUSION: In patients with large pneumothorax, time interval between symptom development and chest tube insertion, size of pneumothorax, and oxygen saturation rate of peripheral artery blood were identified as predictive factors. The prediction equation that we developed for REPE showed good predictability.

Comparison between Tissue Adhesive and Suture by Using Modified Hollander Score for Facial Wounds Treated in the Emergency Department

PURPOSE: The object of this study is to compare the patient satisfaction in the view of scarring, cost, and hospital stay between the conventional suture method and a method using Histoacryl(R) (2-N-butylcyanoacrylate) adhesive for treating facial lacerations in the emergency department. METHODS: This study is a randomized prospective trial, which was conducted from December 2009 to January 2010. The participants include 109 patients who visited the emergency room in Deajon Eulji Medical Center. The ages ranged from 1 to 59 (mean age of 18.7), and all had facial lacerations of less than 3 cm. In order to treat the facial lacerations, an emergency medicine doctor used tissue adhesive (2-N-butylcyanoacrylate, Histoacryl(R)) for 41 patients in the experimental group, and a plastic surgeon performed conventional suturing for 68 patients in the control group. The ER-stay and the primary treatment fee were compared in the two groups, and the scarring was evaluated 10 to 11 months from suturing by using the Modified Hollander Method and the 10-cm scaled VAS (visual analogue scale: score 0=no scar, score 10=very severe scar). RESULTS: The ER stay was 76 minutes for the experimental group and 107 minutes for the control group, showing that statistically significantly less time of 31 minutes was taken in the experimental group. The cost of the experimental group was 40000 won (50.1%) more expensive than the control group, with an average cost of 121900 won for the experimental group and 81200 won for the control group. As for scar evaluation, 10.56 months after suturing, the experimental group showed a better result with a score of 2.6 compared to a score of 3.4 in the control group; however, this difference was not statistically significant (p<0.05). As to a detailed evaluation of scar characteristics, the experimental group had a statistically significantly better result in scar elevation, with a score of 0.6 compared to a score of 1.65 for the control group. CONCLUSION: If appropriate patients are selected, the method using tissue adhesive directly applied by an EM doctor not only decreases ER stay but also creates similar patients satisfaction, with statistically better result in scar elevation, compared to the conventional suture method; thus, ultimately general patient satisfaction is increased.

Comparison between Tissue Adhesive and Suture by Using Modified Hollander Score for Facial Wounds Treated in the Emergency Department

PURPOSE: The object of this study is to compare the patient satisfaction in the view of scarring, cost, and hospital stay between the conventional suture method and a method using Histoacryl(R) (2-N-butylcyanoacrylate) adhesive for treating facial lacerations in the emergency department. METHODS: This study is a randomized prospective trial, which was conducted from December 2009 to January 2010. The participants include 109 patients who visited the emergency room in Deajon Eulji Medical Center. The ages ranged from 1 to 59 (mean age of 18.7), and all had facial lacerations of less than 3 cm. In order to treat the facial lacerations, an emergency medicine doctor used tissue adhesive (2-N-butylcyanoacrylate, Histoacryl(R)) for 41 patients in the experimental group, and a plastic surgeon performed conventional suturing for 68 patients in the control group. The ER-stay and the primary treatment fee were compared in the two groups, and the scarring was evaluated 10 to 11 months from suturing by using the Modified Hollander Method and the 10-cm scaled VAS (visual analogue scale: score 0=no scar, score 10=very severe scar). RESULTS: The ER stay was 76 minutes for the experimental group and 107 minutes for the control group, showing that statistically significantly less time of 31 minutes was taken in the experimental group. The cost of the experimental group was 40000 won (50.1%) more expensive than the control group, with an average cost of 121900 won for the experimental group and 81200 won for the control group. As for scar evaluation, 10.56 months after suturing, the experimental group showed a better result with a score of 2.6 compared to a score of 3.4 in the control group; however, this difference was not statistically significant (p<0.05). As to a detailed evaluation of scar characteristics, the experimental group had a statistically significantly better result in scar elevation, with a score of 0.6 compared to a score of 1.65 for the control group. CONCLUSION: If appropriate patients are selected, the method using tissue adhesive directly applied by an EM doctor not only decreases ER stay but also creates similar patients satisfaction, with statistically better result in scar elevation, compared to the conventional suture method; thus, ultimately general patient satisfaction is increased.

The Utility of Bispectral Index Scores for Sedative Intoxication in the Emergency Department

PURPOSE: This study was designed to determine the utility of bispectral index scores (BIS) compared to Glasgow coma scale (GCS) or Observer's Assessment of Alertness/Sedation Scale (OAA/S), in measuring changes in consciousness, prognosis and management of sedative-intoxication patients. METHODS: Sedative intoxication patients, who came to the emergency department with a severe deficit in consciousness, or a GCS less than 12, were analyzed. Patients' consciousness states were evaluated using OAA/S and GCS and compared with BIS scores. Patients' consciousness recovery time and hospitalization were recorded to see if these could be predicted by BIS using regression analysis. BIS, OAS/S and GCS were compared with regard to intubation, admission and ICU admission. Furthermore, usefulness and cut-off values of BIS were evaluated for those intubated. RESULTS: Of 128 sedative intoxication patients, 32 were enrolled for this study. Mean age was 50.94+/-18.01. They took 20.76+/-16.95 times over the average recommended dose. OAA/S and GCS ranged between 1~4 and 4~12, respectively; BIS was 39~88. The Spearman bivariate correlation coefficient was 0.619 between OAA/S and BIS and 0.651 between GCS and BIS, both showing a positive correlation (p0.05). BIS was an effective index for intubation (p=0.012) showing a sensitivity of 91% and a specificity of 50% when the boundary value was set to 65.5. When set to 77.5, sensitivity and specificity were 59%, 100%, respectively. CONCLUSION: In sedative intoxication patients, BIS is useful in determining the degree of sedation, predicting time to recovery of consciousness and as an objective index of intubation.

A Study on Estimating the Blood Pressure by Using the Pulse Wave Transit Time in Shock Patients Who Received Vasopressor Drugs / 대한구급학회지

BACKGROUND: Blood pressure is clinically used for monitoring shock patients and as a therapeutic indicator for them. Non-invasive blood pressure measurement has weak points such as the use of a cuff and it is a discontinuous measurement. A method of measuring the blood pressure by using the PWTT (pulse wave transit time) has been studied to make up for those weak points. If blood pressure monitoring can be done by using the difference of the PWTT between different points in the body, then this method will be a quite useful to monitor the BP of seriously ill patients. This study aimed to verify whether or not the PWTT has a significant correlation with the blood pressure of shock patients who received vasopressor infusion and whether this method is clinically applicable. METHODS: The study subjects were 20 shock patients who were hospitalized in intensive care units and they had received vasopressor, and we measured the PWTT and we analyzed its correlation with the SBP (systolic blood pressure) and DBP (diastolic blood pressure), as measured by non-invasive monitoring. We then determined the effects of the PWTT on the SBP and DBP. RESULTS: From the results of correlation analysis between the PWTT and the SBP and DBP, the SBP displayed a statistically significant negative correlation with the PWTT of 18 patients, while no significant correlation between the PWTT and DBP was observed. At the same time, from the results of the regression analysis of the blood pressures and the PWTT of each patient, it was found that the PWTT had a negative effect on the SBP of all the patients, except two. CONCLUSIONS: The PWTT has a negative correlation with the SBP of the patients who received vasopressor infusion.

Multi-loculated empyemas after acupuncture

There are several reported possible complications of acupuncture including hepatitis, pneumothorax, and cardiac tamponades, but the development of empyema is unusual. All the previously described cases of empyemas were due to acupuncture needles being inadvertently left in the thoracic cavities. We describe a thirty seven years old female patient who developed empyema after multiple acupuncture sessions whose disease course was unique because the empyema developed without an acupuncture needle being left in the thoracic cavity. This case demonstrates that an acupuncture needle being left in the thoracic cavity is not necessary for the development of empyema after acupuncture sessions as previously described.

The Usefulness of Serum S-100 beta Levels as a Screening Test for Pediatric Minor Head Trauma

PURPOSE: It is well known that serum S-100 beta protein levels increased in adults after brain injury. However, there is no definite clinical data in children with isolated minor head trauma. The present study was conducted to validate S-100 beta protein levels as a screening test for brain damage in children with minor head trauma. METHODS: Serum S-100 beta protein levels were measured in 48 pediatric patients with minor head trauma. All patients had brain computed tomography (CT) scan to confirm brain injury. Data were analyzed using a contingency table and a receiver operating characteristic (ROC) curve to determine the diagnostic value of S-100 beta protein levels. RESULTS: Twelve (25%) patients had abnormal brain CT findings. Using a concentration cutoff value of 0.12 ug/L, patients with abnormal brain CT findings were identified by S-100 beta protein levels measurement with a sensitivity level of 100% and a specificity 38.9%. The area under the ROC curve for S-100 beta protein levels was 0.758 (95% CI, 0.606- 0.910). The number of high risk factors were 2.35+/-1.23 in the positive group and 1.53+/-0.76 in the negative group (p=0.011). CONCLUSION: Serum S-100 beta protein levels in children with minor head trauma were similar to those of adults. Our study supports the contention that rapid assessment of serum S-100 beta protein levels may reduce the use of brain CT in children with minor head trauma.

A case of the Colon Perforated Patient Visited Emergency Department for Pneumomediastinum

Bleeding and perforation are serious and commonly observed complications of colonofibroscopy. Pneumoretroperitoneum and pneumomediastinum are also infrequently reported as complications of colonofibroscopy. Clinical symptoms of pneumomediastinum are variable, with chest pain being the most common symptom, and a definitive diagnosis can be made by chest X-ray. Most cases can be successfully managed with only conservative treatment. Infrequently surgical managements are required. We report an unusual case of pneumoretroperitoneum and pneumomediastinum as a complication of colonofibroscopy. Pneumomediastinum was treated successfully and simply with only antibiotics and fasting.

Cardiac Tamponade presenting to the Emergency Department after Pinning of a Clavicle Fracture

Aortic rupture caused by migration of a clavicular pin is a rare complication sometimes seen after clavicular fracture. There are many reviews of the complications of pin migration following surgery on the shoulder girdle. It is uncommon, though, for clavicular pin migration to result in aortic rupture and a subsequent cardiac tamponade. This unusual injury can be presented as acute shock symptoms after the previous pinning operation of a clavicle fracture, and it manifests characteristics that can be detected through computed tomography (CT) and focused by abdominal sonography for trauma (FAST). We report a case in which a patient suffered an aortic rupture induced cardiac tamponade caused by clavicular pin migration following surgery for a clavicular midshaft fracture.

A Case of Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy with Cardiac Arrest in the Emergency Department

Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is a heart muscle disorder characterized by patch replacement of right ventricular myocardium by adipose and fibrous tissue and by electrical instability of the right ventricular myocardium. ARVD/C is rare in South Korea but is an important cause of cardiac arrest in young patients. The clinical manifestations of ARVD/C vary from sudden cardiac death of previously asymptomatic patients to chronic symptoms in patients with recurrent palpitations and/or right or biventricular failure. Diagnosis is based on several major and minor criteria involving structural, histologic, eletrocardiographic, arrhythmic, and genetic factors. Therapy is directed to prevent and/or treat malignant vetricular tachyarrhythmias with medications, implantable cadioverter defibrillator, radiofrequency ablation, and surgery in selected cases. We experienced a case of ARVD/C with ventricular fibrilltion in the emergency department. The electrocardiography of postresuscitation showed QRS prolongation and inversion of T waves in the right precordial leads. Echocardiography revealed a dilated right atrium and right ventricle, and right ventricular dysfunction. Multislice computed tomography and cardiac magnetic resonance imaging showed multifocal fat infiltration involving right ventricular myocardium, right ventricular trabeulae, and the right ventricular side of the ventricular septum with dilatation of the right ventricle and right ventricular outflow tract and abundant epicardial fat. An implantable cardioverter defibrillator was implanted, and the patient was transferred to another hospital.

Usefulness of Fluorine-18 FDG-PET In the Diagnosis of Vertebral Pathologic Fracture / 대한척추외과학회지

STUDY DESIGN: A prospective study of the reproducibility of F-18 FDG-PET. OBJECTIVES: The purpose of this study was to determine whether F-18 FDG-PET had value in distinguishing between vertebral pathologic fractures and osteoporotic compression fractures. SUMMARY OF LITERATURE REVIEW: There were many reports in the literature about vertebral pathologic disease studied with F-18 FDG-PET, but few about the distinction between pathologic and benign causes in fractured vertebrae. MATERIALS AND METHODS: Twenty-nine patients with vertebral fractures that did not result from major trauma, who were admitted to our hospital from December 2002 to May 2004, were included in this study; and all of them were evaluated with MRI and F-18 FDG-PET. Their final diagnoses were confirmed by biopsy (n=12) or clinical follow-up (n=17). There were 18 cases of vertebral compression fractures, 11 cases of pathologic fractures (4 cases of tumor lesions and 7 cases of pyogenic spondylitis). F-18 FDG-PET images of those patients were interpreted as vertebral compression fractures or pathologic fractures by one nuclear medicine specialist and one radiology specialist without any clinical or radiologic information. The sensitivity and specificity of MRI and F-18 FDG-PET for the diagnosis of vertebral pathologic fractures were calculated and compared. RESULTS: Twenty-four (82.8 %) of 29 cases demonstrated a coincidence between MRI and F-18 FDG-PET interpretations. The sensitivity of F-18 FDG-PET for the diagnosis of vertebral pathologic fractures was 90.9 % and the specificity was 88.9 %. The sensitivity of MRI was 81.8% and the specificity was 83.3%. F-18 FDG-PET demonstrated a higher sensitivity and specificity, and these were statistically insignificant differences. CONCLUSIONS: F-18 FDG-PET is a useful method for determining the differential diagnosis of vertebral pathologic fractures, with high sensitivity and specificity.

The Study of Rescuer's Fatigue by Changes of Compression-Vetilation Ratio using Manikin Model of the One-Rescuer CPR / 대한구급학회지

BACKGROUND: The point of this study is focused on the rescuer's fatigue may increase as the ratio of chest compression-ventilation increases. METHODS: 10 students of emergency medical service and resucue had participated in this study. Cardiopulmonary resuscitation (CPR) was carried out with Laerdal's ResusciAnne with 4 types of compression-ventilation ratio (C-V ratio), and the data was recorded. The rescuer's fatigue was subjectively estimated with the visual analogue scale (VAS), objective fatigue was measured by median frequency which was acquired from the electromyography (EMG) signal, heart rate and the serum lactate level was measured. Statistical analysis was accomplished within each C-V ratios. RESULTS: As C-V ratio increased from 15 : 2 to 30 : 2, the quality of chest compression was improved. Subjective fatigue was increased significantly when C-V ratio increased to 30 : 2 from 15 : 2 and to 60 : 2 from 45 : 2. Gradual downward transition of the median frequency on EMG was shown as a result of increments of C-V ratio. Significant serum lactate accumulation had shown on ratio of 60 : 2 compare to other ratios. CONCLUSIONS: Fatigue of the rescuers will be aggravated by increase of C-V ratio. Rapid rescuer change is preferable when C-V ratio is increased.

The Association of Meteorological and Day-of-the-week Factors with Patient Visits to Emergency Centers

PURPOSE: The aim of this study was to determine the relationships between weather and calendar variables and the admission volume at the emergency center in Daejon city. PATIENTS AND METHODS: Daily patient volume from January to November 2003 was matched with calendar and weather variables. Calendar variables included season, day of the week, holidays, and the day after a holiday. Weather variables included daily maximum, minimum, and average temperatures and other factors such as snowfall and rainfall. RESULTS: The average daily admission volume was 282 +/- 54 persons (187~605), and the most highly significant calendar and weather variables related with admission volume were holidays and maximal temperature, respectively. A regression model was calculated as follows: the daily patient volume = 214 + 2 x (maximal temperature) + 113 x (holiday) + 26.8 x (day after a holiday). This equation could estimate about 62.6% of the daily patient volumes. CONCLUSION: This study suggests that the temperature and a holiday may influence the number of visiting patients. Thus, the staffing level should be set appropriately by considering the estimated patient volume.

Effect of Meteorological Phenomena on the Development of Spontaneous Pneumothorax

PURPOSE: This study examined the influence of meteorological phenomena on the development of spontaneous pneumothorax (SP). METHODS: We conducted this study from January to November 2004. We obtained the daily SP incidence from data requested by the National Health Insurance office from general hospital in Daejon, and we got the meteorological data from the Daejon Regional Meteorologic office. The difference in meteorological phenomena between cluster days (3 or more SP) and no SP days was analyzed using a generalized additive model (GAM) that used a specialized form of the non-parametric, non-linear regression test. RESULTS: Five hundred sixty-six SP patients were included. There were 369 male patients and 74 female patients. SP patients were associated with significantly lower atmospheric pressure and with broad swings of daily atmospheric pressure for 4-7 days prior to the hospital visits. More clouds had gathered for several days before cluster days than had gathered on days with no SP. CONCLUSION: Development of SP is related with meteorological phenomena. SP occurs when lower atmospheric pressure, broad swings of atmospheric pressure, and cloudy weather are collectively exprienced for several days before the hospital visit.