The Prevalence and Emergency Department Utilization of Patients Who Underwent Single and Double Inter-hospital Transfers in the Emergency Department: a Nationwide Population-based Study in Korea, 2016–2018

Background@#Inter-hospital transfer (IHT) for emergency department (ED) admission is a burden to high-level EDs. This study aimed to evaluate the prevalence and ED utilization patterns of patients who underwent single and double IHTs at high-level EDs in South Korea. @*Methods@#This nationwide cross-sectional study analyzed data from the National Emergency Department Information System for the period of 2016–2018. All the patients who underwent IHT at Level I and II emergency centers during this time period were included. The patients were categorized into the single-transfer and double-transfer groups. The clinical characteristics and ED utilization patterns were compared between the two groups. @*Results@#We found that 2.1% of the patients in the ED (n = 265,046) underwent IHTs; 18.1% of the pediatric patients (n = 3,556), and 24.2% of the adult patients (n = 59,498) underwent double transfers. Both pediatric (median, 141.0 vs. 208.0 minutes, P < 0.001) and adult (median, 189.0 vs. 308.0 minutes, P < 0.001) patients in the double-transfer group had longer duration of stay in the EDs. Patient's request was the reason for transfer in 41.9% of all IHTs (111,076 of 265,046). Unavailability of medical resources was the reason for transfer in 30.0% of the double transfers (18,920 of 64,054). @*Conclusion@#The incidence of double-transfer of patients is increasing. The main reasons for double transfers were patient's request and unavailability of medical resources at the firsttransfer hospitals. Emergency physicians and policymakers should focus on lowering the number of preventable double transfers.

The Prevalence and Emergency Department Utilization of Patients Who Underwent Single and Double Inter-hospital Transfers in the Emergency Department: a Nationwide Population-based Study in Korea, 2016–2018

Background@#Inter-hospital transfer (IHT) for emergency department (ED) admission is a burden to high-level EDs. This study aimed to evaluate the prevalence and ED utilization patterns of patients who underwent single and double IHTs at high-level EDs in South Korea. @*Methods@#This nationwide cross-sectional study analyzed data from the National Emergency Department Information System for the period of 2016–2018. All the patients who underwent IHT at Level I and II emergency centers during this time period were included. The patients were categorized into the single-transfer and double-transfer groups. The clinical characteristics and ED utilization patterns were compared between the two groups. @*Results@#We found that 2.1% of the patients in the ED (n = 265,046) underwent IHTs; 18.1% of the pediatric patients (n = 3,556), and 24.2% of the adult patients (n = 59,498) underwent double transfers. Both pediatric (median, 141.0 vs. 208.0 minutes, P < 0.001) and adult (median, 189.0 vs. 308.0 minutes, P < 0.001) patients in the double-transfer group had longer duration of stay in the EDs. Patient's request was the reason for transfer in 41.9% of all IHTs (111,076 of 265,046). Unavailability of medical resources was the reason for transfer in 30.0% of the double transfers (18,920 of 64,054). @*Conclusion@#The incidence of double-transfer of patients is increasing. The main reasons for double transfers were patient's request and unavailability of medical resources at the firsttransfer hospitals. Emergency physicians and policymakers should focus on lowering the number of preventable double transfers.

Accuracy of Disease Codes Registered for Anaphylaxis at Emergency Department

PURPOSE: This study was conducted to investigate the frequency and clinical characteristics of anaphylaxis patients who are registered inaccurately with other disease codes. METHODS: Study subjects presenting at the emergency department (ED) were retrospectively collected using disease codes to search for anaphylaxis patients in a previous studies. The study group was divided into an accurate and inaccurate group according to whether disease codes were accurately registered as anaphylaxis codes. RESULTS: Among 266 anaphylaxis patients, 144 patients (54%) received inaccurate codes. Cancer was the most common comorbidity, and the radio-contrast media was the most common cause of anaphylaxis in the accurate group. Cutaneous and respiratory symptoms manifested more frequently in the inaccurate group, while cardiovascular and neurological symptoms were more frequent in the accurate group. Blood pressure was lower, and shock and non-alert consciousness were more common in the accurate group. Administration of intravenous fluid and epinephrine use were more frequent in the accurate group. Anaphylaxis patients with a history of cancer, shock, and epinephrine use were more likely to be registered as anaphylaxis codes accurately, but patients with respiratory symptoms were more likely to be registered with other disease codes. CONCLUSION: In cases of anaphylaxis, the frequency of inaccurately registered disease codes was higher than that of accurately registered codes. Anaphylaxis patients who were not treated with epinephrine at the ED who did not have a history of cancer, but had respiratory symptoms were at increased risk of being registered with disease codes other than anaphylaxis codes.

Feasibility and Safety of Mild Therapeutic Hypothermia in Poor-Grade Subarachnoid Hemorrhage: Prospective Pilot Study

Therapeutic hypothermia (TH) improves the neurological outcome in patients after cardiac arrest and neonatal hypoxic brain injury. We studied the safety and feasibility of mild TH in patients with poor-grade subarachnoid hemorrhage (SAH) after successful treatment. Patients were allocated randomly to either the TH group (34.5°C) or control group after successful clipping or coil embolization. Eleven patients received TH for 48 hours followed by 48 hours of slow rewarming. Vasospasm, delayed cerebral ischemia (DCI), functional outcome, mortality, and safety profiles were compared between groups. We enrolled 22 patients with poor-grade SAH (Hunt & Hess Scale 4, 5 and modified Fisher Scale 3, 4). In the TH group, 10 of 11 (90.9%) patients had a core body temperature of 95% of the 48-hour treatment period. Fewer patients in the TH than control group (n = 11, each) had symptomatic vasospasms (18.1% vs. 36.4%, respectively) and DCI (36.3% vs. 45.6%, respectively), but these differences were not statistically significant. At 3 months, 54.5% of the TH group had a good-to-moderate functional outcome (0–3 on the modified Rankin Scale [mRS]) compared with 9.0% in the control group (P = 0.089). Mortality at 1 month was 36.3% in the control group compared with 0.0% in the TH group (P = 0.090). Mild TH is feasible and can be safely used in patients with poor-grade SAH. Additionally, it may reduce the risk of vasospasm and DCI, improving the functional outcomes and reducing mortality. A larger randomized controlled trial is warranted.

Early Predictors of Critical Cases for the Patients Who Visited Emergency Department due to Gas Inhalation: Early Predictors of Severity in Gas Inhalation

PURPOSE: To define early predictors of critical cases involving patients who visited the emergency department (ED) due to gas inhalation, with the goal of identifying patients who require intensive monitoring and treatment. METHODS: The retrospective study was carried out for patients who visited the ED at Ulsan University Hospital due to gas inhalation from March 2014 to February 2016. General demographics, mechanism of accident, critical symptoms, vital signs, blood lab test results, severity, and clinical manifestation were investigated. Patients were divided into a critical group and non-critical group, and predictors of critical cases were investigated by comparing both groups. RESULTS: Of the 180 patients, 26 patients were in the critical group. In this group, more patients displayed altered mentality and cardiac arrest (both p<0.001). The critical group also showed significantly higher fractions for low-blood pressure (systolic blood pressure<90 mmHg; p<0.001), number of critical symptoms (p<0.001), transport by emergency medical services (p=0.003), and consultation involving other departments (p<0.001). Patients in the critical group showed higher Korean Triage and Acuity Scale (KTAS) level (p<0.001), lactate value (p=0.001), and carboxy-hemoglobin value (p=0.017) as well as older age (p=0.001), lower pH (p=0.001), and HCO₃⁻ value (p<0.001). Multiple regression analysis revealed that predictors of critical cases were older age and higher KTAS level (both p<0.001). CONCLUSION: Patients admitted to the ED for treatment of gas inhalation, who were older and had a higher KTAS level, require intensive monitoring and treatment.

Early Experiences with Mobile Electronic Health Records Application in a Tertiary Hospital in Korea / 대한의료정보학회지

OBJECTIVES: Recent advances in mobile technology have opened up possibilities to provide strongly integrated mobile-based services in healthcare and telemedicine. Although the number of mobile Electronic Health Record (EHR) applications is large and growing, there is a paucity of evidence demonstrating the usage patterns of these mobile applications by healthcare providers. This study aimed to illustrate the deployment process for an integrated mobile EHR application and to analyze usage patterns after provision of the mobile EHR service. METHODS: We developed an integrated mobile application that aimed to enhance the mobility of healthcare providers by improving access to patient- and hospital-related information during their daily medical activities. The study included mobile EHR users who accessed patient healthcare records between May 2013 and May 2014. We performed a data analysis using a web server log file analyzer from the integrated EHR system. Cluster analysis was applied to longitudinal user data based on their application usage pattern. RESULTS: The mobile EHR service named M-UMIS has been in service since May 2013. Every healthcare provider in the hospital could access the mobile EHR service and view the medical charts of their patients. The frequency of using services and network packet transmission on the M-UMIS increased gradually during the study period. The most frequently accessed service in the menu was the patient list. CONCLUSIONS: A better understanding regarding the adoption of mobile EHR applications by healthcare providers in patient-centered care provides useful information to guide the design and implementation of future applications.

Forensic Analysis of the Cause of Death and Death on Arrival of Patients at the Emergency Room / 대한법의학회지

From January 2007 to June 2012, 55 autopsy cases were reviewed, in which death occurred outside the hospital and the patients were declared dead on arrival at the emergency departments, in order to compare the clinical and postmortem examination diagnoses of death-on-arrival patients in tertiary hospitals in Busan, Yangsan and Ulsan city. Of 22 non-traumatic deaths, 21 occurred from natural causes and 1 from unknown cause (sudden infant death syndrome, SIDS). Clinical diagnoses were cardiovascular diseases or "non-traumatic" / "unknown" while autopsy diagnoses were majorly cardiovascular diseases, especially coronary artery diseases (72.7%). Of 33 unnatural deaths, the cause of death was blunt trauma in 4 patients, sharp-force injury in 6, falling in 10, gunshot injury in 1, traffic accidents in 3, asphyxia in 2, drowning in 2, fire-related death in 1, and intoxication in 4. There were no definite discrepancies between clinical and autopsy diagnoses, except for 5 non-traumatic deaths and 2 unnatural deaths. These results suggest that the role of the emergency department may be crucial in postmortem investigations.

Development of Mobile Electronic Health Records Application in a Secondary General Hospital in Korea / 대한의료정보학회지

OBJECTIVES: The recent evolution of mobile devices has opened new possibilities of providing strongly integrated mobile services in healthcare. The objective of this paper is to describe the decision driver, development, and implementation of an integrated mobile Electronic Health Record (EHR) application at Ulsan University Hospital. This application helps healthcare providers view patients' medical records and information without a stationary computer workstation. METHODS: We developed an integrated mobile application prototype that aimed to improve the mobility and usability of healthcare providers during their daily medical activities. The Android and iOS platform was used to create the mobile EHR application. The first working version was completed in 5 months and required 1,080 development hours. RESULTS: The mobile EHR application provides patient vital signs, patient data, text communication, and integrated EHR. The application allows our healthcare providers to know the status of patients within and outside the hospital environment. The application provides a consistent user environment on several compatible Android and iOS devices. A group of 10 beta testers has consistently used and maintained our copy of the application, suggesting user acceptance. CONCLUSIONS: We are developing the integrated mobile EHR application with the goals of implementing an environment that is user-friendly, implementing a patient-centered system, and increasing the hospital's competitiveness.

Clinical Characteristics of Unstable Pelvic Bone Fractures Associated with Intra-abdominal Solid Organ Injury

PURPOSE: This study analyzed the characteristics of unstable pelvic bone fractures associated with intraabdominal solid organ injury. METHODS: Medical records were retrospectively collected from January 2000 to December 2010 for patients with unstable pelvic bone fractures. Unstable pelvic bone fracture was defined as lateral compression types II and III, antero-posterior compression types II and III, vertical shear and combined type by young classification. Subjects were divided into two groups, with (injured group) and without (non-injured group) intra-abdominal solid organ injury, to evaluate whether the characteristics of the fractured depended on the presence of associated solid organ injury. Data included demographics, mechanism of injury, initial hemodynamic status, laboratory results, revised trauma score (RTS), abbreviated injury scale (AIS), injury severity score (ISS), amount of transfusion, admission to the intensive care unit (ICU), and mortality. RESULTS: The subjects were 217 patients with a mean age of 44 years and included 134 male patients(61.8%). The injured group included 38 patients(16.9%). Traffic accidents were the most common mechanism of injury, and lateral compression was the most common type of fracture in all groups. The initial blood pressure was lower in the injured group, and the ISS was greater. The arterial pH was lower in the injured group, and shock within 24 hours after arrival at the emergency department was more frequent in the injured group. The amount of the transfused packed red blood cells within 24 hours was higher in the injured group than the non-injured group. Invasive treatment, including surgery and angiographic embolization, was more common in the injured group, and the stay in the ICU was longer in the injured group. CONCLUSION: A need exists to decide on a diagnostic and therapeutic plan regarding the possibility of intraabdominal solid organ injury for hemodynamically unstable patients with unstable pelvic bone fractures and multiple associated injuries.

Hemopericardium Following Acupuncture

Acupuncture-related hemopericardium is a rare but potentially fatal complication. We describe a hemopericardium that occurred shortly after acupuncture in a 55-year-old woman. A chest CT scan and echocardiography revealed a hemopericardium, and pericardiocentesis was then immediately and successfully performed. Subsequently, her clinical course improved. This case increases the attention of emergency physicians for acupuncture-related complications, especially hemopericardium, and the necessity of rapid diagnosis and management.

Hemopericardium Following Acupuncture

Acupuncture-related hemopericardium is a rare but potentially fatal complication. We describe a hemopericardium that occurred shortly after acupuncture in a 55-year-old woman. A chest CT scan and echocardiography revealed a hemopericardium, and pericardiocentesis was then immediately and successfully performed. Subsequently, her clinical course improved. This case increases the attention of emergency physicians for acupuncture-related complications, especially hemopericardium, and the necessity of rapid diagnosis and management.

A Case of the Nutcracker Syndrome Presenting as Left Flank Pain

The nutcracker syndrome does not occur frequently. The condition usually results from compression of the left renal vein between the superior mesenteric artery and the abdominal aorta, and leads to varicocele, flank pain and lateralizing hematuria. With a full review of the literature, we now report and discuss a case of nutcracker syndrome in which a 30-year-old female visited the emergency center for left flank pain. She experienced complete recovery after conservative treatment.

Characteristics of Stable Pelvic Bone Fractures with Intra-abdominal Solid Organ Injury

PURPOSE: This study analyzed the characteristics of stable pelvic bone fractures with intra-abdominal solid organ injury. METHODS: Medical records were retrospectively reviewed from January 2000 to December 2009 of patients with stable pelvic bone fractures. A stable pelvic bone fracture according to Young's classification is defined as a lateral compression type I and antero-posterior compression type I. Subjects were divided into two groups, one with (injured group) and one without (non-injured group) intra-abdominal solid organ injury, to evaluate the dependences of the characteristics on the presence of an intra-abdominal solid organ injury. Data including demographics, mechanism of injury, initial hemodynamic status, laboratory results, Revised Trauma Score (RTS), Abbreviated Injury Scale (AIS), Injury Severity Score (ISS), amount of transfusion, admission to intensive care unit (ICU), and mortality were analyzed. RESULTS: The subjects were 128 patients with a mean age of 42 years old, of whom were 67 male patients (52.3%). The injured group had 21 patients(16.4%), and the most frequent injured solid organ was the liver. Traffic accident was the most common mechanism of injury and lateral compression was the most common type of fracture in all groups. Initial systolic blood pressure was lower in the injured group, and the ISS was greater in the injured group. Arterial pH was lower in the injured group, and shock within 24 hours after arrival at the emergency department was more frequent in the injured group. Transfused packed red blood cells within 24 hours were 8 patients(38.1%) in the injured group and 11 patients(10.3%) in the non-injured group. Conservative treatment was the most common therapeutic modality in all groups. Stay in the ICU was longer in the injured group, and three mortalities occurred. CONCLUSION: There is a need to decide on a diagnostic and therapeutic plan regarding the possibility of intra-abdominal solid organ injury for hemodynamically unstable patients with stable pelvic bone fractures and for patients with stable pelvic bone fractures along with multiple associated injuries.

Esophageal Hiatal Hernia with GastricPerforation : A Case Report

Esophageal hiatal hernia occurs when a portion of the stomach prolapses through the esophageal hiatus into the thoracic cavity. The most common symptoms are epigastric or substernal pain, nausea, vomiting and dyspepsia, but most people with hiatal hernia are asymptomatic or have nonspecific symptoms. Hiatal hernia is usually discovered as an incidental finding on upper gastrointestinal studies or gastroscopy. We now report a case of type II paraesophageal hiatal hernia with gastric perforation. It is important to consider panperitonitis caused by perforation of a herniated stomach when the patient with hiatal hernia has acute abdominal pain.

Drug-Induced Anaphylactic Shock at the Emergency Department

PURPOSE: This study was conducted to investigate the characteristics of drug induced anaphylaxis and anaphylactic shock in patients who were admitted to the emergency department. METHODS: We retrospectively collected the data on patients with drug induced anaphylaxis and who were admitted to the emergency department from January 2001 to June 2009. The study group was divided into the non-shock and shock groups according to whether the systolic blood pressure more than 90 mmHg. The initial demographic data, the causes of drug-induced anaphylaxis, the clinical manifestations, the treatment and the prognosis were reviewed for 72 patients. RESULTS: The mean age of the study subjects was 47.9+/-14.2 years old and there were 40 male patients and 32 female patients. There were 26 patients in the non-shock group and 46 in the shock group. The mean age was older in the shock group than in the non-shock group (51.5+/-15.1 vs 42.5+/-10.6, p-0.002). A history of drug allergy was more common in the shock group, but no difference was found for the comorbid chronic diseases between the two groups. Radio-contrast media was the most common cause, followed non-steroidal anti inflammatory drugs and antibiotics, but there is no difference in the causes between the two groups. The symptoms of cyanosis, syncope, sweating and dizziness were more frequently manifested in the shock group. The administration of intravenous fluid and injection of subcutaneous epinephrine at the emergency department were more frequent in the shock group than in the non-shock group. CONCLUSION: For the patients who were admitted to the emergency department with drug induced anaphylaxis, the mean age was older and the symptoms of cyanosis, syncope, sweating, dizziness were more frequent in the anaphylactic shock patients than in the non-shock group. More treatments were given at the emergency department to the anaphylactic shock patients.

Retention of CPR Skills by Nursing Students Received Training in AHA BLS Course for Healthcare Providers

PURPOSE: After initial cardiopulmonary resuscitation (CPR) training, CPR performance declines substantially over time. We undertook this study to evaluate the retention of CPR skills by nursing students who received training in the American Heart Association (AHA) basic life support (BLS) course for healthcare providers. METHODS: Third-year nursing students at Ulsan College received training in an 8-hour AHA BLS course. The sequence of CPR actions follows those of the AHA 2005 guidelines. Six months later, skill retention was tested in some of the students without previous notice. Performance in fifteen discrete skills was tested in a scenario format. Resuscitation skills were measured using skill-reporting manikin connected to a PC using Ambu(R) MegaCode Simulation Software and Philips'AED Trainer-2(R). Each of the tests was recorded in video-tapes and the results were analysed by two emergency physicians. RESULTS: Sixty participants were trained and 22 of them were chosen for testing after 6 months. Although not statistically significant, assessing responsiveness (n=17, 77.3%), correct hand placements for compressions (n=17, 77.3%), delivering adequate compression (n=15, 68.2%), turning on the AED (n=18, 81.8%), and placing pads correctly (n=17, 77.3%) tended to be better than the performance of the other discrete skills. The chest compression rate and depth were 105.6+/-26.4/min and 45.5+/-11.3mm, respectively. These two skills were performed correctly 59.1% and 59.1% in all the participants, respectively. CONCLUSION: This study confirmed the generally poor 6- month retention of CPR skills and demonstrated the need for reeducation in nursing students. Further studies are needed to identify the appropriate re-training interval for different occupations.

Comparison of Intraperitoneal and Retroperitoneal/Pelvic Contrast Extravasation: The Characteristics and Prognosis of the Each Patient Group with Arterial Embolization according to the Abdominal Computed Tomography Scanning after Blunt Trauma

PURPOSE: This study compared the characteristics of and the prognosis for intraperitoneal and retroperitoneal/pelvic contrast extravasation, which had been confirmed by enhanced abdominal CT scan, after blunt trauma in patients who had undergone angiographic embolization. METHODS: From January 2001 to March 2009, data were retrospectively collected regarding patients who had undergone contrast extravasation (CE) on CT scanning and arterial embolization after blunt trauma. The study patient group was divided into the intraperitoneal and the retroperitoneal/pelvic groups according to the area of contrast extravasation. We reviewed the initial demographic data, the location of injury, the solid organ injury, the embolized vessel, and the clinical outcome. RESULTS: The mean age of the study subjects was 40.2+/-2.6 years old, and there were 24 male patients. The intraperitoneal group included 10 patients, and retroperitoneal/pelvic group was comprised of 17 patients. The amount of transfusion from presentation to intervention and during the first 24 hours was greater in the retroperitoneal/pelvic group than in the intraperitoneal group. The intraperitoneal group showed a higher frequency and severity of liver injury than the retroperitoneal/pelvic group. Angiography revealed that the hepatic artery (n=4) was the most frequently embolized vessel in the intraperitoneal group, while the internal iliac artery (n=6), followed by the renal artery (n=4), internal pudendal artery (n=3), and the gluteal artery (n=2), were the most frequently injured vessels in the retroperitoneal/pelvic group. CONCLUSION: In patients with intra-abdominal contrast extravasation found on CT scanning and arterial embolization after blunt trauma, the need for transfusion was less in the intra-abdominal group than in the retroperitoneal/pelvic group. Liver injury was also more frequent and severe in the intraperitoneal group than in the retroperitoneal/pelvic group.

Comparison of Survival in Pelvic Bone Fractures with Arterial Embolization

PURPOSE: This study was to evaluate the effect of arterial embolization on survival in patients with pelvic bone fractures and arterial bleeding. METHODS: From January 2001 to December 2007, in all, 18 patients with pelvic bone fractures that had been treated with interventional arterial embolization were included in this retrospective study. The Injury Severity Score (ISS), the Revised Trauma Score (RTS), the initial hemodynamic status, the blood gas analysis, blood transfusion data, and mortality were the main outcome measurements. RESULTS: Pelvic bone fractures were classified into lateral compression (LC), antero-posterior compression (APC), vertical shear (VS), and combined (CM) type according to the Young-Burgess classification. The Survivor group included 11 patients (61.1%), and the non-survivor group included 7 patients (38.9%). The mean ages for the survivor and the non-survivor groups were 40.0 and 45.6 years (p=0.517). The types of pelvic bone fractures were LC 11 (61.1%), APC 6 (33.3%), and VS 1 (5.6%): LC 7 (63.6%), and APC 4 (36.4%) in the survivor group and LC 4 (57.1%), APC 2 (28.6%), and VS 1 (14.3%) in the non-survivor group. The internal iliac artery was the predominant injured vessel among both the survivors (n = 5, 45.5%) and the non-survivors (n = 4, 57.1%). No differences in initial blood pressures, ISS, and RTS existed between the two groups, but the arterial pH was lower in the non-survivor group (pH 7.09 (+/-0.20) vs 7.30 (+/-0.08), p=0.018). The number of transfused 24-hour units of packed RBC was greater in the non-survivor group (24.1+/-12.5 vs 14.4+/-6.8, p=0.046). CONCLUSION: No differences in initial blood pressure and trauma scores existed between survivors and nonsurvivors with pelvic bone fractures, who had been treated with arterial embolization, but arterial pH was lower the in non-survivors.

Acute Appendicitis with Superior Mesenteric Vein Thrombosis and Portal Vein Thrombosis

Superior mesenteric vein thrombosis and portal vein thrombosis are rare conditions that are difficult to diagnose due to vague symptoms, but they are usually fatal when they occur. Appendicitis is the one of the most common causes of superior mesenteric vein thrombosis, via venous drainage from the appendiceal area into the portal system. We report a case of superior mesenteric vein thrombosis and portal vein thrombosis secondary to appendicitis presenting with diarrhea, low abdominal pain, and jaundice. The patient was treated with antibiotics and anticoagulants, without fatal complications, but developed a chronic sequela of portal vein thrombosis. It is important to consider thrombosis of the superior mesenteric vein and portal vein in patients who have intra-abdominal infection with specific or non-specific symptoms.

Bilateral Fatigue Fractures of the Femoral Neck

Stress fractures occur as a result of repetitive loading, which can lead to mechanical failure and fracture of the bone. They occur most commonly in the tibia and are progressively less common in the tarsals, metatarsals, femur, fibula, pelvis, sesamoids, and spine. Femoral neck stress fractures are unusual but not rare. Most cases of them occur in the elderly, in athletic individuals, or in military trainees. But, they often not initially considered when assessing hip pain. Patients often stoically persevere with mobilization, increasing the risk of fracture displacement with its associated morbidity of delayed union, non-union, and avascular necrosis. Radiographic evaluation may be unremarkable, especially if obtained within 1 week of the onset of symptoms. The diagnosis is often missed initially because of that reasons. Bilateral fatigue fractures of the femoral neck with no known medical conditions are very rare. We present the rare case of an apparently healthy military male recruit with bilateral femoral neck fatigue fractures diagnosed by using MRI.