Clinical differentiation between intestinal ischemia and acute gastroenteritis in the emergency department

Objective@#This study aimed to identify predictive factors for suspected intestinal ischemia (II) when compared with those of acute gastroenteritis (AGE) in the emergency department (ED). @*Methods@#This single-center retrospective case-control study included 71 patients with II and 355 with AGE who visited the ED from 2014 to 2021. We attempted to compare the initial clinical presentation and laboratory examination findings of the II and AGE patients. The data in this study were analyzed using the chi-square test, Student t-test, and logistic regression analysis. @*Results@#The analyses showed that patients with II accounted for only about 0.018% of patients visiting the ED. The logistic regression analysis results revealed that age >51 years (odds ratio [OR], 9.75; 95% confidence interval [CI], 3.84-24.75), onset-to-visit time 51 years; onset-to-visit time is <48 hours; symptoms of lower abdominal pain and hematochezia are present, there is PMHx of A-fib, hyperglycemia, and hypoalbuminemia; and diarrhea, febrile feeling/chill, and fever are absent.

Impact of discharge against medical advice on emergency department revisits and prognosis among pneumonia patients recommended to be hospitalized in a general ward

Objective@#This study examined the clinical consequences of a discharge against medical advice (DAMA) among pneumonia patients recommended to be hospitalized in a general ward and identified the risk factors related to a revisit after DAMA. @*Methods@#This retrospective observational study included pneumonia patients who presented at a university hospital emergency department (ED) and were recommended to be hospitalized in a general ward between January 2017 and December 2019. A multivariate logistic regression analysis was performed to identify the risk factors related to a revisit after DAMA and mortality. @*Results@#In the ‘revisit after DAMA’ group, the mortality rate was higher than the ‘no DAMA admission’ group (6.9% vs. 2.1%, P=0.009). Among all admitted patients, DAMA was a risk factor for mortality (odds ratio [OR], 6.185; P=0.023). In the ‘revisit after DAMA’ group, sex (OR, 6.590; P=0.005), C-reactive protein (CRP) score (OR, 1.149; P=0.022), febrile symptoms (OR, 6.569; P=0.004), and dyspnea (OR, 5.480; P=0.002) were risk factors of revisit. Furthermore, in the ‘revisit after DAMA’ group, the CRP score of the 2nd ED visit was higher than that of the 1st ED visit (6.55±6.27 vs. 8.20±7.31, P=0.014). @*Conclusion@#This study shows that DAMA is one of the risk factors for mortality. When DAMA patients revisit, the severity of their pneumonia was observed to have increased.

The impact of the COVID-19 pandemic on emergency department length of stay and outcomes of pneumonia patients

Objective@#This study aimed to investigate the impact of the coronavirus disease 2019 (COVID-19) outbreak on the emergency department length of stay (ED-LOS) and outcomes of patients admitted with pneumonia. @*Methods@#This was a retrospective observational study that included adult pneumonia patients admitted to the emergency department during the period from February to July 2019 and the corresponding period in 2020. After the COVID-19 outbreak, many changes occurred in medical systems, causing prolonged ED-LOS. We divided ED-LOS into pre-, mid-, and post-ED-LOS and compared ED-LOS, hospital LOS and in-hospital mortality rates of pneumonia patients during the above-mentioned periods. In addition, a multivariable logistic regression analysis was performed to identify the risk factors leading to in-hospital mortality in 2020. @*Results@#A total of 365 patients were included in the study. Pre-ED-LOS, mid-ED-LOS, post-ED-LOS, and in-hospital mortality in the 2020 group were significantly higher than those of the 2019 group (P<0.05). Mid-ED-LOS (odds ratio [OR], 1.474; P=0.001) and post-ED-LOS (OR, 1.098; P=0.024) were identified as being independently associated with an increased risk of in-hospital mortality in 2020. @*Conclusion@#Our study shows that ED-LOS and in-hospital mortality increased after the COVID-19 pandemic. Mid-ED-LOS and post-ED-LOS were independently associated with an increased risk of in-hospital mortality in patients with pneumonia in 2020.

Impact of decreased intensive care unit bed capacity on the emergency department length of stay and clinical outcomes of critically ill patients

Objective@#This study aimed to investigate the impact of reduced bed capacity in the intensive care unit (ICU) on emergency department (ED) length of stay (LOS) and prognosis of critically ill patients. @*Methods@#This retrospective observational study included patients who presented to a university hospital ED and were admitted to the ICU between August 2017 and July 2019. In our center, the number of beds in the traumatic ICU was maintained, while the number of beds in the non-traumatic ICU was reduced. We comparatively assessed ED LOS and the mortality rate between traumatic and non-traumatic patients over 2 years (1 year before and after the reduced number of beds in the non-traumatic ICU) to determine the impact of reduced ICU bed capacity. Also, a multivariate logistic regression analysis was performed to identify the risk factors related to in-hospital mortality. @*Results@#A total of 2,945 patients were included in this study. In the traumatic ICU patient group, the ED LOS did not change (2.62 [1.95-3.72] hours vs. 2.78 [2.01-3.92] hours, P=0.079) after reducing the number of ICU beds; and no significant difference in mortality rate was noted (19.5% vs. 17.6%, P=0.417). In the non-traumatic ICU patient group, both ED LOS (prolonged by 1.69 hours, 3.46 [2.17-5.66] hours vs. 5.15 [3.43-8.37] hours, P<0.001) and mortality rate (21.6% vs. 25.8%, P=0.003) were significantly increased after reducing the number of ICU beds. In the multivariate logistic regression analysis, ED LOS was identified as a risk factor for in-hospital mortality (odds ratio, 1.035; P<0.001). @*Conclusion@#In this study, the reduced ICU bed capacity resulted in prolonged ED LOS of critically ill patients, which consequently contributed to increased in-hospital mortality.

Impact of decreased intensive care unit bed capacity on the emergency department length of stay and clinical outcomes of critically ill patients

Objective@#This study aimed to investigate the impact of reduced bed capacity in the intensive care unit (ICU) on emergency department (ED) length of stay (LOS) and prognosis of critically ill patients. @*Methods@#This retrospective observational study included patients who presented to a university hospital ED and were admitted to the ICU between August 2017 and July 2019. In our center, the number of beds in the traumatic ICU was maintained, while the number of beds in the non-traumatic ICU was reduced. We comparatively assessed ED LOS and the mortality rate between traumatic and non-traumatic patients over 2 years (1 year before and after the reduced number of beds in the non-traumatic ICU) to determine the impact of reduced ICU bed capacity. Also, a multivariate logistic regression analysis was performed to identify the risk factors related to in-hospital mortality. @*Results@#A total of 2,945 patients were included in this study. In the traumatic ICU patient group, the ED LOS did not change (2.62 [1.95-3.72] hours vs. 2.78 [2.01-3.92] hours, P=0.079) after reducing the number of ICU beds; and no significant difference in mortality rate was noted (19.5% vs. 17.6%, P=0.417). In the non-traumatic ICU patient group, both ED LOS (prolonged by 1.69 hours, 3.46 [2.17-5.66] hours vs. 5.15 [3.43-8.37] hours, P<0.001) and mortality rate (21.6% vs. 25.8%, P=0.003) were significantly increased after reducing the number of ICU beds. In the multivariate logistic regression analysis, ED LOS was identified as a risk factor for in-hospital mortality (odds ratio, 1.035; P<0.001). @*Conclusion@#In this study, the reduced ICU bed capacity resulted in prolonged ED LOS of critically ill patients, which consequently contributed to increased in-hospital mortality.

Poisoning due to consumption of horse chestnut seed

Horse chestnut (Aesculus hippocastanum) is a common tree found on roads and parks. The shape of the fruit is very similar to that of the edible Korean chestnut (Castanea crenata); thus, people can eat it by mistake. However, reports of the side effects and toxicity from ingestion are very rare. A 46-year-old male who had no unusual findings in the past had eaten horse chestnut seed which he had mistaken to be Korean chestnut. He visited the emergency department (ED) with complaints of epigastric pain, nausea, and sweating. Blood tests showed a slight increase in the levels of liver enzymes, serum amylase, and pancreatic amylase. During the monitoring, he complained of palpitations, and electrocardiogram showed atrial fibrillation. On the following day after conservative treatment, blood testing and electrocardiogram showed normal findings. He was discharged from the ED as he did not complain of any further symptoms. When a patient who has eaten horse chestnut visits the ED, blood examination and electrocardiogram monitoring are needed, and conservative treatment is required.

Delayed death after chlorfenapyr poisoning

Chlorfenapyr is a widely used insecticide, that is very lethal if ingested. It exhibits delayed toxicity in which there are few symptoms at first which suddenly worsen after a few days. A 66-year-old female patient ingested about 90 mL of chlorfenapyr liquid hydrating agent (Chlofenapyr 10%) and showed stable vital signs with no specific symptoms and findings other than a mild fever, vomiting, and nausea. From the 3rd day of ingestion, creatine kinase was high, and rhabdomyolysis was suspected. From the 4th day of ingestion, pancreatic enzymes began to gradually increase. A diffusion-weighted image showed a multifocal high signal intensity in the white matter and corpus callosum area. On the 8th day after ingestion, she suffered a high fever and a heart attack and died. Thus, if a patient is suspected of taking chlorfenapyr, he/she needs active treatment and monitoring even if he/she does not exhibit any symptoms.

Changes in arterial blood gas analysis results according to body mass index in patients with acute dyspnea admitted through emergency department, and usefulness for predicting prognosis

OBJECTIVE@#This study examined the change tendency in the arterial blood gas analysis (ABGA) results according to the body mass index (BMI) of patients admitted through the emergency department (ED) with dyspnea, as well as the risk factors for intensive care unit (ICU) admission and in-hospital mortality in obese patients.@*METHODS@#A retrospective study was conducted on 768 patients, who were admitted to the ED for dyspnea during 2017 and underwent ABGA. The patients were divided into four groups according to their BMI. Multivariate logistic regression analysis was used to determine the risk factors of ICU admission and in-hospital mortality in obese patients using the ABGA results.@*RESULTS@#A higher BMI was associated with a lower pH (P<0.001) and higher arterial carbon dioxide pressure (PaCO2, P=0.001), hematocrit (P=0.009), and lactate concentration (P=0.012). In the obese group, low pH (odds ratio [OR], 5.780; P<0.001 and OR, 16.393; P=0.013), high PaCO2 (OR, 1.123; P=0.005), high lactate concentration (OR, 1.886; P=0.015), and base excess reduction (OR, 1.267; P=0.001) were the risk factors for ICU admission, whereas pH<7.33 (OR, 14.493; P=0.014) and high lactate concentration (OR, 1.462; P=0.008) were the risk factors for in-hospital mortality. The pH (area under the curve [AUC], 0.817; AUC, 0.890) and lactate concentration (AUC, 0.762; AUC, 0.728) were useful for predicting the ICU admission and in-hospital mortality.@*CONCLUSION@#A higher BMI in the subjects was associated with a lower pH and higher lactate concentration. In addition, pH and lactate concentration were significant risk factors for ICU admission and in-hospital mortality.

The effect of change in medical care protocol for primary headache patients visiting the emergency medical center

OBJECTIVE@#University hospitals nationwide are experiencing a shortage of neurology residents and excessive workloads; new measures are required because a lack of neurologists in the emergency department (ED) leads to ED overcrowding. This study examined the effects of emergency medicine doctors taking over the role of neurologists in the treatment of primary headache patients visiting the ED.@*METHODS@#A study group of primary headache patients, who visited a single university hospital ED between 1 June and 31 October 2017 and were treated by an emergency medical doctor, was selected. The control group consisted of patients who met the same conditions as the study group and visited the ED during the same period in 2016 but were treated by a neurologist. The following variables between the two groups were compared: length of stay in the ED, medical expenses in the ED, and the time taken to decide on neuroimaging tests.@*RESULTS@#This study was conducted on 300 patients in the control group and 94 patients in the study group. The study group showed a shorter time to decide on neuroimaging tests (64.4%, 95% confidence interval [CI], P<0.001), shorter length of stay in the ED (15.2%, 95% CI, P<0.001), and lower medical expenses (12.8%, 95% CI, P=0.011).@*CONCLUSION@#When emergency medicine doctors take over the neurologic medical care of primary headache patients in ED, it can be expected to reduce ED overcrowding and medical expenses.

Usefulness of combined chest and abdominal computed tomography for identification of infection sources in febrile patients without clinical clue

OBJECTIVE: This study examined the utility of combined chest and abdominal computed tomography (CT) for the identification of infection sources in acute febrile patients without clinical clues. The groups for whom combined CT was helpful and not were compared. In addition, the factors that affected the positive infection sources and predictors of the presence of infection sources when performing combined CT was investigated. METHODS: Acute febrile patients without clinical clues from a basic examination and the confirmation procedure were investigated prospectively for 6 months. A range of factors, such as demographic factors, duration of fever, vital signs, presence of prior medical treatment, inflammatory markers, and several sepsis prediction tools, were analyzed. RESULTS: Of the 87 patients, 32 (36.8%) tested positive for infection sources on combined CT, whereas 55 (63.2%) tested negative. The mean age, heart rate, procalcitonin (PCT) level, and proportion of the patients aged ≥65 years showed significant differences between the infection source-positive group and infection source-negative group (P=0.027, P=0.008, P=0.035, and P=0.026, respectively). The factors that affected the positive results for infection sources on combined CT included age (odds ratio [OR], 1.047; P=0.011), absence of chronic disease (OR, 0.157; P=0.045), and heart rate (OR, 1.056; P=0.030). Analysis of the receiver-operating characteristic curve showed that age (area under the curve [AUC], 0.630; P=0.041) and heart rate (AUC, 0.659; P=0.008) were significant predictive factors of positive results for infection sources. On the other hand, their predictive powers were poor, and PCT did not show a significant result (AUC, 0.565; P=0.351). CONCLUSION: In patients with underlying chronic disease, older age, increased heart rate due to fever, or a high PCT level, combined CT can be used to identify infection sources when its possible clinical benefits are considered to be high.

A Case of Zaltoprofen Induced Kounis Syndrome

Kounis syndrome is defined as the occurrence of acute coronary syndrome associated with vasoactive mediators, such as histamines in the setting of hypersensitivity and allergic reactions or anaphylactic insults. The condition can be caused by various drugs, foods, or environmental factors that cause allergic reactions. A 35-year-old male visited the emergency room with anaphylaxis accompanied by chest pain approximately 20 minutes after taking zaltoprofen, a nonsteroidal anti-inflammatory drug. After acute treatment for the anaphylaxis, the patient was stabilized and all symptoms disappeared, but the ischemic changes in the electrocardiogram and elevation of the cardiac enzymes were observed. The emergency cardiac angiography and echocardiography were all normal. The allergic reaction of this patient to zaltoprofen was believed to cause a temporary coronary arterial vasospasm, inducing Type 1 Kounis syndrome. Thus far, there have been case reports of Kounis syndrome caused by a range of nonsteroidal anti-inflammatory drugs, but there are no reports of the condition being caused by zaltoprofen. According to the pathophysiology, both cardiac and allergic symptoms must be solved simultaneously, so rapid treatment and diagnosis are needed. Doctors treating acute allergic reactions and anaphylaxis patients must check the cardiovascular symptoms thoroughly and consider the possibility of Kounis syndrome.

Changes in medical care due to the absence of internal medicine physicians in emergency departments

OBJECTIVE: Especially in emergency departments (EDs), a lack of internal medicine (IM) residents in charge causes difficulties in medical care and ED overcrowding. Thus, protocols without IM residents in EDs is needed. This study aimed to investigate changes in medical care when emergency medicine residents replaced the roles of IM residents. METHODS: This study was conducted at a single-site ED of a university medical center. The study group contained patients admitted to the IM department between September and December 2015, during which IM residents were absent in the ED. The control group contained patients admitted to the IM department between September and December 2014, during which IM residents were present in the ED. Changes in medical care between the presence and absence of IM residents in the ED were studied by comparing admission rates from the ED, length of ED stay, duration of hospitalization, and concordance of diagnoses between admission and discharge by the IM department. RESULTS: The study group contained 2,341 patients; the control group contained 2,215 patients. Admission rates from the ED increased by 53.4% (95% confidence interval [CI], P < 0.001); lengths of stay decreased by 15.1% (95% CI, P < 0.001); and durations of hospitalization in the pulmonology department decreased by 38.4% (95% CI, P=0.001). Concordance of diagnoses between admission and discharge decreased by 14.2% in the cardiology department (95% CI, P=0.021). CONCLUSION: Lengths of stay were reduced without critical declines in diagnostic concordance rates when emergency medicine physicians, instead of IM residents in the ED, decided upon admissions of IM patients.

Two Cases of Tetramine Intoxication from Neptunea contricta

Even though Neptunea contricta appears similar to Batilus cornutus and Rapana venosa, they are different in tetramine content which inhibits the neuronal calcium channel. Therefore, mistaking Neptunea contricta for Batilus cornutus or Rapana venosa, can result in the occurrence of toxic symptoms. Three patients developed nausea, epigastric pain, chest pain, dizziness, blurred vision, dyspnea, hypertension and tachycardia after eating Neptunea contricta. Moreover, consumption of one only piece was sufficient to cause symptoms because each Neptunea contricta has 17.3 mg of tetramine. Accordingly, care should be taken when patients are consuming more than 5 pieces because toxic symptoms such as dyspnea can occur. Moreover, correct species identification is important because the quantity of tetramine varies among sea snail species. Finally, it is important to educate people to remove the salivary glands completely before consuming Neptunea contricta.

A Pneumonia Patient with Worsening Respiratory Distress by Chilaiditi Syndrome: A Case Report

Chilaiditi sign refers to the presence of bowel gas under the right diaphragm which is similar in appearance to a pneumoperitoneum on radiography, and is caused by abnormal anatomic positioning of the colon or small bowel between the liver and the diaphragm. When symptoms are present, this condition is known as Chilaiditi syndrome. The most common symptoms are gastrointestinal. It has been less commonly associated with chronic, recurrent respiratory distress. We report acute respiratory distress without gastrointestinal symptoms exacerbated by Chilaiditi syndrome in a pneumonia patient with no history of chronic respiratory disease.

Acute Kidney Injury after Intravenous Injection of an Organophosphate Compound

Poisoning may result from self-injection. Previous reports have described acute cholinergic crisis, intermediate syndrome, and delayed toxicity resulting from parenteral organophosphate administration. These complications have been managed with antidotal and conservative treatment. Acute kidney injury was not listed among the complications. We report a case of acute kidney injury after intravenous injection with an unknown liquid. After chemical composition analysis, organophosphate dichlorvos has been identified as the injected liquid substance. A 50-year-old man injected this into his left arm. He visited the emergency department with a mental change accompanied by seizure. During admission, there were no typical cholinergic symptoms or intermediate syndrome; however, there was a development of acute oliguric kidney injury. The patient was treated successfully with a combination of hemodialysis, hemoperfusion, and conservative management. The manifested seizure, altered mental state, and acute kidney injury could have been caused by several types of poisoning. Based on patient history, which was obtained during the early treatment period, there was no information of what the injected material may have been, and there were no signs of a typical organophosphate toxidrome. However, the patient was successfully treated with rapid initiation of renal replacement treatment, without the use of antidotes. Poisoning by unknown causative substances poses a diagnostic challenge to emergency physicians. In many cases, treatment may be delayed while the physician tries to identify the toxin. However, the basic toxicology principle of focusing on the patient treatment rather than the poisonous substance should not be forgotten.

Factors Affecting at 30 Days Mortality after Admission in Severe Trauma patients with Initial Hypotension in the Emergency Department: A Single Center Study

PURPOSE: Early assessment of injury severity is important in management of major trauma patients. In general, hypotensive major trauma patients show more severe outcomes from injuries compared with normotensive major trauma patients. In this study, we analyzed the clinical features of severe trauma patients with initial hypotension and attempted to determine the prognostic factors of mortality in these patients. METHODS: A retrospective study was conducted within our hospital. Review of trauma registry data identified 679 major trauma patients (Injury severity score, ISS>15). From January 2011 to December 2013, all major trauma patients with initial systolic blood pressure lower than 90 mmHg were included (N=77). The patients were divided into two groups - those who survived and those who expired - and the differences in initial and final values were compared between the two groups. RESULTS: Out of a total of 77 patients, 55 patients survived and 22 patients died. The data showed almost no difference in heart rate between the two groups. The expired group showed low Glasgow Coma Scale (GCS) score, systolic blood pressure, revised trauma score, initial pH, and follow-up pH, as well as higher age, ISS, initial lactate, prothrombin time (PT), international normalized ration (INR), and follow-up lactate, compared with the survived group. In multivariate logistic analysis, age (p=0.034, OR 1.071), GCS (p=0.006, OR 0.61), initial base excess (p=0.042, OR 0.57), and follow-up base excess (p=0.041, OR 0.799) were independently associated with mortality. CONCLUSION: The patient's age, initial GCS, initial base excess and follow-up values of base excess were good prognostic factors for mortality in the expired major trauma patients with initial hypotension.

Task and Time Analysis of Intern Physicians in the Emergency Department: Multicenter Cross-sectional Study

PURPOSE: This study was conducted in order to describe how intern physicians in the emergency department (ED) spent their time, and the frequency of tasks performed by them. METHODS: This was an observational, time-motion study for 15 intern physicians in 15 emergency centers. Observers in each hospital shadowed interns for a 60-minute period, two times, both day and night shift. They recorded time spent on various activities, type and number of activities. The proportion of activity that can be replaced by other staff members was calculated. RESULTS: Average number of duty hours of interns was 80.9 hours (63~87.8) per week. A total of 662 activities were observed during 30 hours. Interns' activities were classified as direct patient care 28.2%, personal time 24.2%, documentation 17.0%, procedures 16.7%, communication 8.1%, transportation 2.6%, indirect patient care 2.0%, learning activity 0.8%, and administrative work 0.4%. The proportion of procedural task showed negative correlation with the number of emergency medical technicians (r=-0.710, p=0.003). The proportion of activity that can be replaced by staff members other than doctors was 24.3% (0~47%) of time, except personal or learning activity. CONCLUSION: Results of this study showed that only 24.3% of interns' activity in the emergency department could be replaced by staff members other than doctors. Because the proportion of activities that could be replaced was variable among hospitals, each hospital should perform task analysis of interns' activity in order to forecast alternative manpower.

Current Duty Hours of Emergency Resident Physicians in Korea: Multicenter Cross-sectional Study

PURPOSE: This study was conducted in order to determine the current status of duty hours of emergency resident physicians in Korea. METHODS: The training committee of the Korean Society of Emergency Medicine surveyed using a questionnaire on resident training status, which contained the total number of duty hours during four weeks of July (first to 28th day) according to the grades of the resident physician. The proportions of both irregular working hours and independent working hours without supervision of a board certified physician were also evaluated. RESULTS: Responses from 80 hospitals out of 97 training hospitals were analyzed. The average number of duty hours of emergency resident physicians was 63.7+/-10.7 hours/week. The proportion of hospitals for which the average number of duty hours exceeded 80 hours/week was 16.1%. Irregular working hours consisted of 63.9%. Residents in 15(18.7%) hospitals worked 3.7~73.5% of their duty hours without supervision of a board certified physician. The higher grade resident had fewer working hours (p<0.001). No statistical difference was observed in the rate of both irregular work and unsupervised work according to the grade. CONCLUSION: Results of this study showed that nine(11.3%) hospitals had average duty hours above 80 hours/week. In Korea, training hospitals should prepare to minimize the impact of duty hour restriction in the near future, as well as to improve training quality.

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.

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.