The characteristics of the patients who visited the emergency department with fever, after the chronification of COVID-19 pandemic

Objective@#This study examined the characteristics of patients visiting the emergency department (ED) with fever after the chronification of the coronavirus disease 2019 (COVID-19) pandemic. @*Methods@#This retrospective observational study analyzed the medical records of patients who visited the ED with fever from May 1 to October 31, 2021, and the corresponding period in 2019. This study was conducted at a single center in Seoul, Korea. @*Results@#There was no statistical difference in the comorbidities of the patients of the two groups: the AC (after the COVID-19 pandemic) group and the BC (before the COVID-19 pandemic) group. As for the level of consciousness at the time of ED arrival, there was a significantly larger decrease in consciousness (verbal response or less) in the AC group than in the BC group (P=0.002). In the case of the National Early Warning Score (NEWS), the proportion was higher in the AC group in the moderate-risk and high-risk groups (P=0.003). The median time from symptom onset to ED arrival was 15.7 hours in the BC group and 13.8 hours in the AC group, and there was no significant difference (P=0.137). When leaving the ED, the AC group had a higher admission rate to the ward and intensive care unit than the BC group. There was no statistical difference in the in-hospital mortality between the two groups (2.9% and 2.4%, respectively; P=0.62). @*Conclusion@#Patients who visited the emergency room with fever after one year of the COVID-19 pandemic showed a similar time from symptom onset to ED arrival compared to patients who visited before the COVID-19 pandemic. In addition, there was no difference in in-hospital mortality among these patients compared to those with fever before the COVID-19 pandemic.

Usefulness of Early Warning Scores, ROX index, and CURB-65 in the prognostic evaluation of patients with COVID-19

Objective@#Early identification of COVID-19 in patients is important to prevent significant worsening of the disease. This study was undertaken to verify whether MEWS (Modified Early Warning Score), NEWS(National Early Warning Score), ROX index, and CURB-65, which are early diagnostic tools for severe respiratory diseases, could be applied to patients visiting the emergency room for COVID-19. @*Methods@#This retrospective observational study included patients who visited an emergency medical center from September 1 to October 31, 2020, and from January 1 to February 28, 2021. Based on the vital signs and blood tests during the emergency room visit, severity evaluation tools and early diagnostic tools for severe cases were used and compared according to their area under the curve (AUC) values. The primary outcome was in-hospital mortality, while the secondary outcomes were intensive care unit admission rate and the need for mechanical ventilation based on these four tools (MEWS, NEWS, ROX index, and CURB-65). @*Results@#A total of 667 patients were analyzed. No significant difference was determined between the non-survivor group and survivor group in the MEWS values (P=0.13), but statistically significant differences were observed for NEWS (5 vs. 1, P<0.05), CURB-65 (2 vs. 1, P<0.05), and ROX index (16.61 vs. 23.1, P<0.01). The AUC value of NEWS for death prediction indicated a good predictive power at 0.80, while that of MEWS showed a low predictive power at 0.57, which was statistically significant. Moreover, the AUC values of CURB-65 and ROX index did not differ significantly from values obtained for NEWS. @*Conclusion@#As early diagnostic tools for predicting death in COVID-19 patients, NEWS, ROX index, and CURB-65 showed excellent discrimination ability, whereas MEWS showed statistically and significantly lower discrimination ability.

Effects on workers in hospital dedicated to infectious diseases from coronavirus disease 2019 outbreak: emotional change and stress comparison between occupations

Objective@#The coronavirus disease 2019 (COVID-19) outbreak is currently ravaging the world and is a major threat to public health. Healthcare workers (HCWs) are at a high risk of acquiring and transmitting COVID-19. Hence, HCWs are also experiencing emotional and behavioral changes. The purpose of this study was to compare emotional changes and stress between occupations and to investigate the impact of emotions of HCWs during the COVID-19 outbreak. @*Methods@#An anonymous, self-administered, previously validated questionnaire was given to HCWs at a hospital dedicated to infectious diseases in Korea during the COVID-19 outbreak. The participants were asked to evaluate stress factors, depressive moods, trauma, reasons for continuing to work, things that helped them work, coping strategies to reduce stress, motivators that could help them work during future outbreaks, and what they would like to do after the outbreak was over. @*Results@#The total number of participants was 400. The average age of participants was 34.69±9.44. Stress and depressive moods showed variations in the job-to-job comparisons. Ethical duty and the professionalism of the HCWs pushed them to continue with their jobs. The news of a decline in the number of patients was helpful to HCWs. The implementation of personal hygiene programs helped in reducing stress. The provision of adequate personal protective equipment was a factor that would encourage them to work during any future outbreak. The participants wanted to go on a trip after the outbreak was over. @*Conclusion@#Our findings indicate that the COVID-19 outbreak had a significant emotional impact on HCWs. The concerns of HCWs may affect their work efficiency in an outbreak and should be addressed by incorporating appropriate management strategies while planning to combat an outbreak.

Effects on workers in hospital dedicated to infectious diseases from coronavirus disease 2019 outbreak: emotional change and stress comparison between occupations

Objective@#The coronavirus disease 2019 (COVID-19) outbreak is currently ravaging the world and is a major threat to public health. Healthcare workers (HCWs) are at a high risk of acquiring and transmitting COVID-19. Hence, HCWs are also experiencing emotional and behavioral changes. The purpose of this study was to compare emotional changes and stress between occupations and to investigate the impact of emotions of HCWs during the COVID-19 outbreak. @*Methods@#An anonymous, self-administered, previously validated questionnaire was given to HCWs at a hospital dedicated to infectious diseases in Korea during the COVID-19 outbreak. The participants were asked to evaluate stress factors, depressive moods, trauma, reasons for continuing to work, things that helped them work, coping strategies to reduce stress, motivators that could help them work during future outbreaks, and what they would like to do after the outbreak was over. @*Results@#The total number of participants was 400. The average age of participants was 34.69±9.44. Stress and depressive moods showed variations in the job-to-job comparisons. Ethical duty and the professionalism of the HCWs pushed them to continue with their jobs. The news of a decline in the number of patients was helpful to HCWs. The implementation of personal hygiene programs helped in reducing stress. The provision of adequate personal protective equipment was a factor that would encourage them to work during any future outbreak. The participants wanted to go on a trip after the outbreak was over. @*Conclusion@#Our findings indicate that the COVID-19 outbreak had a significant emotional impact on HCWs. The concerns of HCWs may affect their work efficiency in an outbreak and should be addressed by incorporating appropriate management strategies while planning to combat an outbreak.

A study of factors influencing the length of stay in the emergency department of patients who were admitted after a self-poisoning suicidal attempt

Objective@#A suicide attempt by self-poisoning is a common cause of admissions to the emergency department (ED). Management of such intentiona poisoning often requires complicated medical procedures, resulting in a longer length of stay (LOS) as compared to other cases that require treatment in the ED. This study aimed to determine the factors affecting a longer LOS in self-poisoning patients. @*Methods@#This was a retrospective study wherein all the medical charts of patients who visited the ED of one hospital, from August 2016 to July 2019, because of intentional self-poisoning, were reviewed. @*Results@#Most of the patients visited the ED involuntarily and there were almost twice as many female patients as males. Almost half of the patients were referred to the psychiatry department. A comparison of various factors within the LOS groups revealed significant differences in mental status, guardian co-visitation, patient gender, psychiatric referral, and poisoning substance. Moreover, the LOS had a stronger association with the pre-consultation period than the consultation to decision-making period. @*Conclusion@#To reduce the LOS, it seems important to make a rapid decision on whether to observe the patient in the ED and wait until the workup is completed or to admit and then evaluate the patient in the ward. If the clinicians cannot obtain enough information to evaluate the patient for appropriate management, short-term admission may be an option to reduce the LOS and to provide a stable evaluation.

Clinical characteristics and risk factors for mortality of patients hospitalized with COVID-19 in Korea

Objective@#The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus-2, is a global concern. This study aimed to examine the clinical characteristics, demographics and outcomes of COVID-19 patients in the emergency department (ED) and explore clinical predictors of in-hospital mortality. @*Methods@#This single-center, retrospective, observational study used 1,003 adult patients with laboratory-confirmed COVID-19 who went to the ED and were admitted to the hospital between February 28 and September 30, 2020. @*Results@#The median age of the included patients was 55 (37-68) years, and 533 were women (53.1%). Severe COVID-19 was noted in 173 patients (17.2%); seven patients (0.7%) received mechanical ventilation. The mortality rate was 2.1%. Multivariable Cox regression analysis found the risk factors associated with in-hospital death of patients (age >70 years [hazard ratio (HR), 27.411; P70 years, hypoalbuminemia, CURB-65≥3 and thrombocytopenia on admission were independent risk factors for mortality in patients hospitalized with COVID-19. Early detection of these predictors and application of CURB-65 score in the ED may provide guidance for appropriate risk stratification at triage and disposition of patients at increased risk of poor prognosis.

Analysis of characteristics of patients who come to ‘emergency medical center via one-stop treat system for heavily drunken people’

Objective@#This study described the effectiveness of the one-stop treat system (OTS) and the improvements characterizing the patients who come to an emergency medical center via the one-stop treat system for heavily drunken people @*Methods@#An observational retrospective study was conducted on patients, aged 19 years or older, who visited the emergency department (ED) from January 2014 to December 2017 with alcohol intoxication (AI). The subjects were divided into two groups, that is, AI patients who come to ED directly or those who came via OTS. We compared and analyzed the characteristics of two groups including gender, age, date, mode of the ED visit, level of consciousness, diagnosis, ED length of stay (LOS), hospital LOS, and final outcomes. @*Results@#A total of 8,144 patients were enrolled in the study. There were 2,221 AI patients who visited ED directly and 5,923 AI patients who visited ED via OTS. Patients arriving via OTS had more medical or surgical problems than the patients who came directly from the ED. Discharged patients via OTS showed a longer ED LOS (312 minutes [range, 169-520 minutes], P<0.001). Compared with patients who came directly from ED, the patients via OTS showed a higher admission rate (10.7% vs. 3.4%, respectively; P<0.001), and a higher death rate in ED (0.6% vs. 0%, respectively; P<0.001). @*Conclusion@#Compared the characteristics of the patients from ED directly in 2014-2017, the patients via OTS had higher severity and admission rate, and a longer ED LOS. Our findings suggest that we should pay attention to patients via OTS because the patients have high severity of illness.

Predictor of 30-day mortality in elderly patients with nursing-home acquired pneumonia at the emergency department

Objective@#This study evaluated the usefulness, as a risk factor of 30-day mortality, in patients residing in nursing-homes (NHs) or long-term care facilities with the diagnosis of pneumonia. @*Methods@#We conducted a retrospective study in a public hospital between January 2017 and December 2017. The subjects included elderly patients residing in NHs and diagnosed with pneumonia in the emergency room. Data on age, gender, comorbidities, laboratory findings, pneumonia severity index score (PSI), and CURB-65 (Confusion, Urea, Respiratory rate, Blood pressure, and Age 65 or older) were entered into an electronic database. @*Results@#A total of 439 patients were enrolled during the study period. The mean age was 82.1±8.0 years; 195 (44.4%) were men, and 30-day mortality was 21.8%. On multivariate Cox proportional hazard analysis, cerebrovascular accidents (hazard ratio [HR], 0.53; 95% confidence interval [CI], 0.33-0.87; P=0.012), chronic renal disease (HR, 2.28; 95% CI, 1.11-4.67; P=0.024), malignancy (HR, 1.69; 95% CI, 1.04-2.76; P=0.034), lactate (HR, 1.02; 95% CI, 1.01-1.03; P<0.001), albumin (HR, 0.52; 95% CI, 0.36-0.73; P<0.001), and red cell distribution width (RDW; HR, 1.11; 95% CI, 1.03- 1.19; P=0.007) were independently associated with 30-day mortality. Areas under the curve of PSI, RDW, albumin, lactate, and PSI+RDW+albumin+lactate were 0.690 (95% CI, 0.629-0.751), 0.721 (95% CI, 0.666-0.775), 0.668 (95% CI, 0.607-0.728), 0.661 (95% CI, 0.597-0.726), and 0.801 (95% CI, 0.750-0.852), respectively. @*Conclusion@#RDW, albumin, lactate and especially the combination of PSI and these factors appear to be major determinants of 30-day mortality in NH residents with pneumonia.

Evaluation of clinical usefulness of pneumococcal urinary antigen test: single center experience

OBJECTIVE: A pneumococcal urinary antigen (PUA) test, which can be performed quickly and easily, is performed frequently in emergency rooms because of its high sensitivity and specificity. On the other hand, it is a relatively expensive test, and it is not known how it affects the clinicians' prescription of antibiotics. This study evaluated the clinical utility of the PUA test. METHODS: This study was conducted retrospectively on patients aged ≥18 years, who underwent a PUA test and were hospitalized with a diagnosis of pneumonia in an emergency room from January to December 2016. The patients were divided into a PUA test positive group and negative group, and the clinical characteristics and antibiotic regimen were compared. RESULTS: A total of 533 patients were enrolled, of which 54 were positive and 479 were negative. The antibiotic prescriptions were similar in the positive and negative groups. After the PUA test result, only two of the positive group used the antibiotics recommended by the Infectious Diseases Society of America and the American Thoracic Society for Streptococcus pneumoniae. Furthermore, there was an appropriate change in eight patients after the blood culture test, but the PUA test result was judged to be meaningful in only two patients. CONCLUSION: The results of the PUA test did not affect the clinician's antibiotic prescription significantly. A prescription standard for the PUA test is needed, and it should be performed after admission rather than in the emergency room.

Usefulness of initial red blood cell distribution width as a prognostic factor for predicting 30-day mortality in acute decompensated heart failure patients

OBJECTIVE: This study evaluated the efficacy of the initial red blood cell distribution width (RDW) level in the emergency department (ED) to predict the 30-day mortality in patients with acute decompensated heart failure (ADHF). METHODS: A retrospective analysis study of patients who visited the ED and were diagnosed with ADHF from January 2015 to December 2016 was conducted. The patients were divided into the 30-day survival group and non-survival group. The data were obtained from the medical records of the patients, and the blood test results were taken from the initial blood test at the ED. The data and blood test results were compared between the 30-day survival and non-survival groups. Multivariate logistic regression analysis was performed to determine the risk factors for mortality. RESULTS: A total of 626 patients were included. The mean age was 78.5 years and the overall mortality was 15.5%. The non-survival group had higher RDW levels than the survival group (18.0% vs. 14.6%). In a multivariate logistic regression analysis, RDW (odds ratio, 2.242; 95% confidence interval [CI], 1.673−3.005; P<0.001) were considered to be a useful factor for predicting the prognosis. The area under the receiver operating characteristic curve of RDW to predict mortality was 0.848 (95% CI, 0.811–0.886; P<0.001), and the sensitivity and specificity of predicting mortality was 76.3% and 78.1%, respectively, after setting the RDW cutoff value to 15.95%. CONCLUSION: The initial RDW level is a useful prognostic marker for predicting the 30-day mortality in ADHF patients.

A Study on the Change of Emergency Department Use Behavior of the Homeless Patients after the Implementation of the ‘Seoul Type Citizen Sympathy Emergency Room Project’

PURPOSE: This study shows the change in emergency room use behavior by homeless patients after implementation of the ‘Seoul Type Citizen Sympathy Emergency Room Project’ in July 2015. METHODS: A retrospective study was conducted in a public hospital between January 2014 and December 2014 and January 2016 and December 2016. Homeless patients who visited the emergency room in 2014 and 2016 were compared based on age, gender, mode of insurance, admission, revisit within 48 hours, length of stay (LOS) in the emergency department (ED), total cost, and major diagnostic category. RESULTS: A total of 3,642 homeless patients were enrolled during the study period, of which 1,876 visited in 2014 and 1,766 in 2016. Fewer homeless patients in 2016 revisited within 48 hours (p=0.046). Homeless in 2016 had a shorter ED LOS (p < 0.001) and lower total cost (p=0.040). More homeless patients who visited due to alcohol revisited within 48 hours in 2016 (p=0.036). Moreover, these patients did not have a different ED LOS (p=0.060) or total cost (p=0.475). Medicaid homeless patients were less connected compared health insurance by screening, brief intervention, referral to treatment program. CONCLUSION: Comparison of homeless patients who visited the emergency room in 2014 and 2016 revealed fewer total homeless patients in 2016, as well as less revisits within 48 hours, shorter ED LOS and lower total cost. These findings indicate that the ‘Seoul Type Citizen Sympathy Emergency Room Project’ was effective in the emergency room, but improvements for alcohol and medicaid homeless patients are needed.

Analysis of Epidemiologic Characteristics between Patients Visited from Residential Aged Care Facilities and Elderly Patients Visited from Home Admitted to the Emergency Department with Disease

PURPOSE: In recent years, the number of elderly patients visiting from residential aged care facilities (RACFs) has been increasing. We analyzed a comparison of characteristics between patients who visited the ER with diseases from RACFs and those who visited from home. METHODS: A retrospective study was conducted in a public hospital between January 2013 and December 2014. The subjects included patients who visited the ED from RACFs and elderly patients who visited the ED from home. Comparisons of the following parameters were made between the two groups: gender, age, mode of insurance, mode of ED visit, mobile status, Charlson comorbidity index (CCI), chief complaint, final results in the ED, and length of stay (LOS) in the ED and hospital. RESULTS: A total of 7,603 patients were enrolled during the study period. There were 6,401 elderly patients who visited from home and 1,202 patients who visited from RACFs. Patients from RACFs were older than those from home (79.90±8.01 vs. 75.78±7.26, p<0.001). More patients from RACFs were on Medicaid (56.6% vs. 27.9%, p<0.001), took more ambulance (86.3% vs. 49.4%, p<0.001), more bedridden (68.2% vs. 6.4%, p<0.001), and higher CCI (2.38±1.99 vs. 1.45±1.84, p<0.001). Compared with patients from home, those from RACFs showed a significantly higher proportion of admission (63.2% vs. 32.9%, p<0.001), ED LOS (403.03±361.77 vs. 277.07±258.82, p<0.001), and hospital LOS (19.65±18.58 vs. 15.67±15.63, p<0.001). Patients from RACFs showed especially longer ED LOS from discharged ED than those from home (388.87±422.88 vs. 221.90±215.30, p<0.001). CONCLUSION: Compared with elderly patients from home, patients from RACFs also had higher admission rate and longer ED LOS, as well as hospital LOS. Patients from RACFs had long ED LOS. The findings in this study suggest that there could be ED overcrowding in the near future.

Ambient Particulate Matter and Emergency Department Visit for Chronic Obstructive Pulmonary Disease

PURPOSE: This study aimed to explore the association between increased level of ambient particulate matter and emergency room visits for chronic obstructive pulmonary disease (COPD) exacerbations. METHODS: A retrospective study was conducted. We enrolled patients who lived in Seoul, Korea and were diagnosed with COPD in the emergency room between January 2012 and December 2014. Meteorological factors [daily highest temperature, lowest temperature, mean temperature, diurnal temperature, rainfall, relative humidity, amount of sunshine and particulate matter less than 10 µm (PM 10)] between December 2011 and December 2014 in Seoul were acquired from the Korea Meteorological Administration. We used a multiple Poisson regression model with daily patient's number of COPD as a response variable and meteorological factors as explanatory variable. Variable selection was done via an Elastic net. RESULTS: There was a total of 1,179 emergency visits for acute exacerbations of COPD patients. PM10 (before 4, 10, 11, 15, 16, 17, 22, 24, 27, 28 day), rainfall (before 1, 6, 8, 16, 18 day), relative humidity (before 2, 8), and daily temperature difference (5, 10, 15 day) had a relationship and a lag effect with COPD exacerbations. CONCLUSION: This study showed that an increased concentration of PM10 was associated with COPD exacerbations. A future study that reinforces the limitation of this study is necessary to get a helpful index for an adequate response of medical institution and efficient placement of medical personnel.

The Usefulness of Plasma Neutrophil Gelatinase-Associated Lipocalin in Acute Pyelonephritis

PURPOSE: Plasma neutrophil gelatinase-associated lipocalin (NGAL) is a biomarker that shows correlation with the severity of acute infection and acute kidney injury (AKI). This study was conducted in order to determine the predictive value of NGAL in the emergency department for predicting the severity of acute pyelonephritis. METHODS: A retrospective study was conducted between October 2012 and May 2013. A total of 46 patients diagnosed with acute pyelonephritis were enrolled in this study. Plasma NGAL was measured upon admission to the hospital and clinical and laboratory data, CT were collected. Based on these data, we classified our patients according to two groups (high NGAL group: NGAL > or =400 ng/mL vs low NGAL group: NGAL <400 ng/mL) and we evaluated the correlation between clinical data, laboratory data, and CT. RESULTS: Among the 46 patients, there were 45 female patients and the mean age was 59.0+/-20.4 years. Statistically significant differences in CT grades, hospital stay, SIRS, and shock were observed between the NGAL groups. The area under the ROC curve for CT severity by NGAL was 0.890(95% CI, 0.796-0.985), which was better than CRP and MDRD GFR. NGAL levels showed correlation with CRP (r=0.508; p<0.001) and MDRD GFR (r=-0.766, p<0.001). CONCLUSION: NGAL is a useful specific biomarker predicting severity of acute pyelonephritis.

Plasma Lactate and Base Deficit: Early Predictors of Morbidity in Burn Patients

PURPOSE: Plasma lactate and base deficit has been used as a marker to determine the status of tissue perfusion in trauma and clinically ill patients and also to predict the outcome of these patients. This study was performed to investigate the effect of plasma lactate and base deficit in predicting burn patients outcome. METHODS: A retrospective review was performed on 102 patients from January 2012 to December 2013 who were admitted as severe burn patients to our burn care unit. Plasma lactate and base deficit were measured upon admission to the hospital and SIRS score, hospital day, ABSI and TBSA were collected after admission. RESULTS: 102 patients were enrolled. Initial base deficit, hospital day, burn surface area and ABSI score showed statistical differences between low SIRS group and high SIRS group. The SIRS score, hospital day and ABSI score showed statistical differences between high base deficit group and low base deficit group (P0.05). CONCLUSION: In this study, initial base deficit but not plasma lactate, was predictor of morbidity following burn injury.

The Role of PCR Waveform by Plethysmography in Electric Burns

PURPOSE: A vast array of injuries result from high voltage electrical damage. The compartment syndrome of forearm prone to have high risk of major amputations, especially in arc burn. Early decompressing fasciotomy has been recommended for the prevention of limb amputations. There are controversies about the effect of fasciotomy. We tried to Pressure Cuff Recording (PCR) wave forms of Plethysmography for the monitoring early signs of vascular compromises in decision of early selective fasciotomy. We investigated the role of PCR wave forms to reduce major amputation rate. METHODS: We reviewed 875 burned limb of 520 electric current damage victims (fasciotomy or amputation were performed, PCR wave forms evaluated) during the last 14 years (from Jan. 1, 1996 to Jun. 30, 2009). We analysed the differences of amputation rates by the currency, input/output, burn types, effects of PGE1 adminstration, fasciotomy time, converting of PCR wave forms. RESULTS: There was no major amputations among low tension victims (minor amputation rate; 0.3%). The minor and major amputation rate were 19.5% and 27.0 in high tension injury. The flash burns rarely made the amputations, but arc burns had 12.1% of minor and 41.2% of major amputations. The direct contact burns had 24.7% of minor and 21.3% of major amputations. Most of the victims had their hand as input and foot as output. The minor and major amputation rate were 26.2% and 10.9% in none-fasciotomy, 8.8% and 48.0% in within 8 hours, 10.0% and 52.9% in 8-24 hours, 9.3% and 63.0% in over 24 hours fasciotomy group. Final normal type (N type) of PCR result had only 3.1% of minor amputations and 3.1% of major amputations. Final obstructive type (O type) had 37.6% of minor amputations, 60.8% of major amputations. Initial stenotic type (S type) of converted to N type had 6.6% amputation, but to O type had 98.7% amputation. CONCLUSION: The early selective fasciotomy are essential to reduce major amputations in high tension injuries, especially in arc burns. The PCR wave form converting to obstructive type could be helpful to predict the possible amputation. The PCR wave form is a good tool to monitor early signs of vascular compromise around fasciotomy. It plays as the index of immediate fasciotomy decision.

High Voltage Electrical Injury and Prevention

PURPOSE: High voltage electrical injury mainly occurs in the industrial field. It can cause serious complications and sequelae that lead to high social and economic costs. We investigated the causes of this to try to help prevent these injuries. METHODS: We reviewed 128 patients who incurred high voltage electrical injury during a 3-years period from Jan. 1, 2006 to Dec. 31, 2008. We performed a retrospective analysis of the medical records to review the epidemiology. We also performed a survey by telephone. The survey questions addressed the following: the duration of work, wearing safety equipment, the reason for working without safety equipment, did they receive safety education, was the safety education adequate, recognition of a high tension wire before working and did they understand the effect of high voltage on the human body. RESULTS: The safety education was relatively carried out well. But most patients did not wear safety equipment even though they knew they had to wear it (92%). The major reason was discomfort of wear it (72%). The hand was the most common injury site (80%). Most injuries occurred with 22,900 volt or less (92%). In spite of safety education, many patients were unaware of the effects of electrical injury on their body. CONCLUSION: Strengthened safety education can play a significant role in preventing high voltage electrical injury. At this point, the doctors who are experienced in treating high voltage electrical injury must actively participate in this safety education. We suggest that handy safety equipment can lessen the incidence of high voltage electrical injury. It is essential to develop a handy safety glove for 22,900V with considering that the hand was the most common injury site and the most frequent voltage for injury was 22,900 volt or less.

Study of Practical Application of Medical Assistants in Burn Center

PURPOSE: Complications and mortality rate of burn injuries are recently decreasing owing to development of systematic and special burn therapy. Whereas we are suffering from the lack of the medical manpower in burn center. In the future we might need more medical assistants to compensate these shortages. In this study we tried to search the path through these difficulties by considering the practical application of medical assistants. METHODS: We compared Korea's current situation of burn treatment with other countries in various references. Also we studied and compared recent situation of medical assistants in Korea and U.S.A. We took special considerations for Korean emergency medical technician, physical therapist and occupational therapist. RESULTS: Our study showed that we are practically using emergency medical technician, physical therapist and occupational therapist as medical assistants in various fields including burn centers. Emergency medical technician, physical therapist and occupational therapist as medical assistants can be excellent medical substitutes for shortage of manpower in our burn centers. Compared with U.S.A's current situation we are quite lacking of certain certified programs for such medical assistants. Burn therapists can be promoted from medical assistants through certain certified educational programs. CONCLUSION: We think that emergency medical technician, physical therapist and occupational therapist, who have certification concerning certain medical experience, should undergo certified educational program for burn therapy and should be used as a actual burn therapists to overcome the shortage of manpower in our burn centers.

The Incidence and Risk Factors of Psychiatric Complications in Electrical Injury

PURPOSE: Electrical injuries may cause many psychiatric complications such as depression, acute stress disorder, post-traumatic stress disorder (PTSD), etc. The purpose is to search the incidence of psychiatric complications in electrical injury and to compare its associated risk factors with other burn and trauma. METHODS: We reviewed the medical records of 709 electrically injured patients who were admitted to Hanil General Hospital from 2002 to 2007. Psychiatric complications were defined as depression, acute stress disorder and PTSD according to DSM-IV. We sorted the medical records into demographics, hospitalization, electrical voltage, injured type, extent or site of burn and type of amputation. RESULTS: Total incidence of psychiatric complications was 27.5% (Depression; 15.8%, acute stress disorder or PTSD; 17.6%). High voltage injured patients had psychiatric complications 2.38 times higher than low voltage. Incidence of psychiatric complications were 1.83 times in 6~10% of BSA, 2.01 times in 11~20% and 2.41 times in 21~30% higher than in 0~5% of BSA. If the site of burn included face, psychiatric complications occurred 1.96 times more than other sites. Patients with history of minor and major amputation showed 2.39 and 7.70 times incidence of psychiatric complications, respectively. CONCLUSION: The risk factors of psychiatric complications were high voltage electrical injury, facial burn, extent of burn and history of amputation. If the patients have risk factors, earlier psychiatric consultation may help to manage the psychiatric complications of electrical injury.

Application of Brain Computerized Tomography to High Voltage Electrical Burns

PURPOSE: High voltage electrical injuries can cause many complications of central nervous system. We tried to define the indication range of brain CT (computerized tomography) in high voltage electrical injuries. METHODS: We performed a retrospective analysis of 51 high voltage electrical injured patients who were confirmed by brain CT, they had visited our emergency department from January 2005 to December 2007. All patients were classified by brain CT findings, presences of combined injuries and neurologic symptoms. RESULTS: 48 patients were confirmed normal in brain CT findings. 3 patients had brain lesions that were associated with secondary trauma. There was no abnormal CT finding in the 23 patients who did not have loss of consciousness, falling and combined injuries. CONCLUSION: If patient with electrical injury did not have neurologic symptoms or sufficient mechanical force, brain CT is not recommended. The results of this study may help emergency physicians to avoid unnecessary brain CT examination in the emergency triage to a high voltage electrical injury patients.