A National Survey of Current Practice Patterns and Preparedness of Pediatric Emergency Care in Korea

PURPOSE: The goals of this study were to examine the preparedness of Korean emergency department's (ED) in serving pediatric patients and to evaluate the current status of pediatric emergency care in Korea. METHODS: We conducted a cross-sectional, web-based survey. The questionnaire was sent to the directors of 134 Korean emergency medical centers. All correspondence was conducted by e-mail. The questionnaire topics included facility, personnel and equipment for pediatric patients, the pediatric patient consultation system, and policies related to pediatric patient sedation, management of suspicious child abuse cases, and discharge instructions for pediatric patients. RESULTS: A total of 81 medical center directors (60.4%) responded to the survey. In only 3(3.7%) medical centers was there a separate pediatric ED, and 27 of the medical center EDs (33.3%) had no designated pediatric area. Twenty three EDs (28.4%) were equipped with pediatric emergency carts and 48 EDs (59.3%) had pediatric endotracheal tubes suitable for all ages of children. Pediatric department consultations performed at night or on weekends were mainly administered by low-grade (first and second second year) residents, and in 13 EDs, emergency physicians had no way to consult the pediatric department during nights or weekends. Seventy EDs (86.4%) provided no discharge instruction for caregivers. Monitoring for sedated children undergoing radiologic study was unavailable in 53.1% of EDs. CONCLUSION: Significant under-preparedness exists in the current pediatric emergency services that were evaluated in this study. Further research and effort for the establishment of appropriate standards for facility, equipment, personnel and policies supporting pediatric emergency service are strongly needed.

A National Survey of Current Practice Patterns and Preparedness of Pediatric Emergency Care in Korea

PURPOSE: The goals of this study were to examine the preparedness of Korean emergency department's (ED) in serving pediatric patients and to evaluate the current status of pediatric emergency care in Korea. METHODS: We conducted a cross-sectional, web-based survey. The questionnaire was sent to the directors of 134 Korean emergency medical centers. All correspondence was conducted by e-mail. The questionnaire topics included facility, personnel and equipment for pediatric patients, the pediatric patient consultation system, and policies related to pediatric patient sedation, management of suspicious child abuse cases, and discharge instructions for pediatric patients. RESULTS: A total of 81 medical center directors (60.4%) responded to the survey. In only 3(3.7%) medical centers was there a separate pediatric ED, and 27 of the medical center EDs (33.3%) had no designated pediatric area. Twenty three EDs (28.4%) were equipped with pediatric emergency carts and 48 EDs (59.3%) had pediatric endotracheal tubes suitable for all ages of children. Pediatric department consultations performed at night or on weekends were mainly administered by low-grade (first and second second year) residents, and in 13 EDs, emergency physicians had no way to consult the pediatric department during nights or weekends. Seventy EDs (86.4%) provided no discharge instruction for caregivers. Monitoring for sedated children undergoing radiologic study was unavailable in 53.1% of EDs. CONCLUSION: Significant under-preparedness exists in the current pediatric emergency services that were evaluated in this study. Further research and effort for the establishment of appropriate standards for facility, equipment, personnel and policies supporting pediatric emergency service are strongly needed.

Dysphagia Caused by Ossificaion of the Cervical Anterior Longitudial Ligament : Report of Two Cases

We report two cases with progressive dysphagia and foreign body sensation resulted from severe cervical ossification of the anterior longitudinal ligament (OALL). A 63-years-old male presented progressive dysphagia and foreign body sensation with neck pain. Cervical computed tomography (CT) and magnetic resonance images (MRI) revealed diffuseOALL from C2 to C7 with esophageal compression by most severe OALL of C5, C6, C7 and spondylotic stenosis of C5- 6, C6-7. OALL removal of C5, 6, 7 and discectomy with interbody fusion via anterior approach was performed. The other 56-years-old female presented progressive dysphagia with foreign body sensation. Cervical CT and MRI revealed severe OALL of C4, 5, 6, 7 with esophageal compression and surgical removal was performed. In both patients, dysphagia and foreign body sensation was immediately relieved after operation and the distance between trachea and each cervical body was increased than preoperative distance in cervical lateral view.

A multidisciplinary approach for the treatment of child abuse in Korea / 소아과

PURPOSE: To review and determine the complications in 76 child abuse cases recorded by a multidisciplinary hospital-based child protection team between 1987 and 2007. METHODS: We retrospectively reviewed the reports and medical records of child abuse cases maintained by a university hospital-based child protection team. We devised a questionnaire for standardized interviews with the victims' guardians to determine the current physical and mental status of the children; questionnaires were answered by social workers of the child protection team who interviewed the present fosterers of 24 (35.8%) children. RESULTS: Of the 76 children, 6 were infants, 10 were 1-3 years old, were 3-10 years old, and 19 were over 10 years old. Seven children (9.2%) were neglected and 27 (35.5%) and 44 (57.9%) were sexually and physically abused, respectively. In more than half of the cases, the perpetrators were the father or mother of the children. Most children (41 cases, 53.9%) were abused at their homes. The mean follow-up duration from the time of abuse infliction was 54.3+/-49.2 months, and the current mean age of the children was 8.3+/-6.4 years. Moderate and severe developmental delay and physical disability were observed in 6 (25.0%) and 3 (12.5%) cases, respectively. In 13 children (54.2%), the Global Assessment of Functioning Scale (GAF) score was less than 60, which indicates mild mental disability. CONCLUSION: A hospital-based child protection team may witness the different proportion of abuse types and patterns by conducting a nation-wide survey of child abuse cases.

A multidisciplinary approach for the treatment of child abuse in Korea / 소아과

PURPOSE: To review and determine the complications in 76 child abuse cases recorded by a multidisciplinary hospital-based child protection team between 1987 and 2007. METHODS: We retrospectively reviewed the reports and medical records of child abuse cases maintained by a university hospital-based child protection team. We devised a questionnaire for standardized interviews with the victims' guardians to determine the current physical and mental status of the children; questionnaires were answered by social workers of the child protection team who interviewed the present fosterers of 24 (35.8%) children. RESULTS: Of the 76 children, 6 were infants, 10 were 1-3 years old, were 3-10 years old, and 19 were over 10 years old. Seven children (9.2%) were neglected and 27 (35.5%) and 44 (57.9%) were sexually and physically abused, respectively. In more than half of the cases, the perpetrators were the father or mother of the children. Most children (41 cases, 53.9%) were abused at their homes. The mean follow-up duration from the time of abuse infliction was 54.3+/-49.2 months, and the current mean age of the children was 8.3+/-6.4 years. Moderate and severe developmental delay and physical disability were observed in 6 (25.0%) and 3 (12.5%) cases, respectively. In 13 children (54.2%), the Global Assessment of Functioning Scale (GAF) score was less than 60, which indicates mild mental disability. CONCLUSION: A hospital-based child protection team may witness the different proportion of abuse types and patterns by conducting a nation-wide survey of child abuse cases.