Optimal timing for performing percutaneous transhepatic gallbladder drainage to severe acute cholecystitis patients who visit the emergency department

Objective@#Severe acute cholecystitis is an infectious disease that requires immediate gallbladder drainage. Although percutaneous transhepatic gallbladder drainage (PTGBD) is the most common method of gallbladder drainage, the optimal timing remains unclear. @*Methods@#This study is a retrospective analysis of patients diagnosed with severe acute cholecystitis who underwent PTGBD between July 2018 to June 2021. This study investigated the effect of time from emergency department arrival to PTGBD (tPTGBD) on patient prognosis. @*Results@#Totally, 48 patients were included in this study. Based on the cutoff value calculated using the Youden index, the group with tPTGBD of <5.93 hours had a shorter hospital stay (10 vs. 13.5 days, P=0.021), lower portion of progression (27:5 [15.6%] vs. 7:9 [56.3%], P=0.004), even they had a higher initial SOFA score (6 vs. 4.6, P=0.049). However, no statistical difference was obtained for the length of ICU stay between both groups (1 vs. 2, P=0.617). @*Conclusion@#Executing PTGBD to severe acute cholecystitis patients within 5.93 hours after presenting at the emergency department is associated with reduced progression and hospital stay.

Time Interval from Intubation to Return of Spontaneous Circulation in Out-of-hospital Cardiac Arrest Patient with Brain Hemorrhage

PURPOSE: This study was conducted to investigate the relationship of time interval from intubation to return of spontaneous circulation (ROSC) in out-of-hospital cardiac arrest (OHCA) patients according to the presence or absence of intracranial hemorrhage (ICH). METHODS: This retrospective study used data from a prospectively collected OHCA registry for patients treated from January 2008 to December 2016. Non-traumatic adult OHCA patients who underwent brain computed tomography were included, while patients who achieved a prehospital ROSC or required advanced airway management were excluded. Utstein variables, initial blood gas analysis, electrolyte levels, and the time interval from intubation to ROSC were used to compare the ICH and non-ICH groups. RESULTS: A total of 448 patients were analyzed. The ICH group was younger and had more females than the non-ICH group. The time interval from intubation to ROSC was significantly shorter in the ICH group than the non-ICH group. The median time and interquartile range were 3 (2 to 7) minutes in the ICH group and 6 (3 to 10) minutes in the non-ICH group. The patient age, gender, potassium level, and time interval from intubation to ROSC were significant variables in the multivariable analysis. In a multivariable logistic regression model that included these variables, the area under the receiver operating characteristic curve was 0.838. CONCLUSION: OHCA patients with ICH achieve ROSC after intubation in a shorter amount of time than those without ICH.

Clinical Insights for Early Screening of Pulmonary Tuberculosis in Homeless Patients Who Visited Emergency Department

PURPOSE: In 2014, Korea ranked as the first among the Organization for Economic Cooperation and Development countries on the prevalence, incidence, and mortality of pulmonary tuberculosis (TB). The prevalence of TB among the homeless was 6.4% in the United State and 7.1% in South Korea. The aim of this study is to develop predicting indicators of TB by analyzing homeless people who visit the public hospital emergency department (ED). METHODS: We analyzed 7,500 homeless individuals who visited a public hospital ED between January 1, 2001 and May 31, 2014. A total of 4,552 patients were included, and of these, 145 homeless patients were infected with TB. We conducted univariate and multivariate analysis of clinical variables obtained from the initial check list and later lab analysis, and made a scoring system by weighing each variable. Then applying this scoring system, the area under the receiver (AUC) operating characteristic curve (ROC) was calculated. RESULTS: The prevalence of TB was 3.2%. The initial meaningful predictor variables were as follows: Being homeless, abnormal heart rate, abnormal respiratory rate, no alcohol intake, hypoalbuminemia, and CRP elevation. The AUC of ROC curve from these predictor variables were 0.815. CONCLUSION: We developed a novel scoring system to screen TB patients in a vulnerable social group who visit the ED. We can detect potential TB patients early and effectively control TB, preventing the spread of TB. Prospective internal and external validation is necessary by using the scoring system of TB among the homeless.

Low Serum Selenium Level is Associated with Poor Prognosis of Cardiac Arrest Victims

PURPOSE: Selenium plays a major role in the intracellular antioxidant system. The aim of this study was to determine whether a low serum selenium level is associated with poor neurological outcome for victims of cardiac arrest. METHODS: We enrolled consecutive patients who were admitted to the emergency intensive care unit (ICU) of a tertiary referral center for post-resuscitation care after cardiac arrest from May 2008 to April 2010. Data were collected with respect to demographic information, variables of cardiac arrest and resuscitation, and application of therapeutic hypothermia. We examined neurologic findings and measured serum selenium level at admission to the ICU. In addition, we also calculated severity scores. The Glasgow-Pittsburgh cerebral performance categories (CPCs) were used for evaluation of neurological outcome. According to the six-month CPCs, patients were divided into two groups: the good prognosis (CPC 1-2) group and the poor prognosis (CPC 3-5) group. We then compared data between the two groups. RESULTS: Among 52 enrolled patients, 17 were classified as the good prognosis group and 35 as the poor prognosis group. Glasgow coma scale (odds ratio [OR]=0.343, 95% confidence intervals [CI], 0.124-0.947, p=0.039), intact pupilary reflex (OR=0.045, 95% CI, 0.004-0.561, p=0.016), and serum selenium level (OR=0.959, 95% CI, 0.921-0.999, p=0.045) showed an independent association with poor neurological outcome for victims of cardiac arrest. CONCLUSION: Low serum selenium level showed an association with poor neurological outcome for victims of cardiac arrest.

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

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

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

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

Effects of using Prehospital Emergency Care by 119 Rescue Services on Outcome of ST-elevation Myocardial Infarction Patients

PURPOSE: This study was performed to evaluate the effects of prehospital emergency care use by 119 rescue services on the outcome of acute ST-elevation myocardial infarction (STEMI). METHODS: All patients who visited 23 hospital emergency departments and who were finally diagnosed with STEMI between January and December 2008 were enrolled. They were divided into two groups: use of 119 rescue service or non-use. The propensity score matching method was used considering factors known to be influential for the use of 119 rescue services (age, gender, educational status, chief complaints, cardiogenic shock, respiratory rate, heart rate). Hospital mortality was defined as patient death in the hospital following admission. The comparative odds ratio (OR) and confidence interval (CI) of mortality between the 119 use and non-use groups were determined. RESULTS: Of the 1,118 STEMI patient, no statistical differences were evident in gender and age. Patients who used the 119 rescue services displayed lower educational status and rare complaint of chest pain is rare (36.6% vs 63.4%). But syncope and cardiac arrest were more frequent in the 119 user group than non-user group (syncope: 84.6% vs 15.4%, respectively; cardiac arrest: 76.0% vs 24.0%, respectively). Propensity score matching system was performed and extracted 390 patients in each group. The extracted patients were not statistically different in demographic findings and influencing factors of 119 service use. Hospital mortality did not differ between the 119 user and non-user groups (OR=1.294, 95% CI:0.612-2.735). Increased hospital mortality of STEMI patients was correlated with increased age (OR=1.036, 95% CI:1.012-1.060), prehospital ECG monitoring (OR=2.601, 95% CI:1.011-6.693), and cardiogenic shock (OR=4.736, 95% CI:2.482-9.037). CONCLUSION: The use of prehospital mobile units did not influence on hospital mortality of acute ST-elevation myocardial infarction.

Effects of using Prehospital Emergency Care by 119 Rescue Services on Outcome of ST-elevation Myocardial Infarction Patients

PURPOSE: This study was performed to evaluate the effects of prehospital emergency care use by 119 rescue services on the outcome of acute ST-elevation myocardial infarction (STEMI). METHODS: All patients who visited 23 hospital emergency departments and who were finally diagnosed with STEMI between January and December 2008 were enrolled. They were divided into two groups: use of 119 rescue service or non-use. The propensity score matching method was used considering factors known to be influential for the use of 119 rescue services (age, gender, educational status, chief complaints, cardiogenic shock, respiratory rate, heart rate). Hospital mortality was defined as patient death in the hospital following admission. The comparative odds ratio (OR) and confidence interval (CI) of mortality between the 119 use and non-use groups were determined. RESULTS: Of the 1,118 STEMI patient, no statistical differences were evident in gender and age. Patients who used the 119 rescue services displayed lower educational status and rare complaint of chest pain is rare (36.6% vs 63.4%). But syncope and cardiac arrest were more frequent in the 119 user group than non-user group (syncope: 84.6% vs 15.4%, respectively; cardiac arrest: 76.0% vs 24.0%, respectively). Propensity score matching system was performed and extracted 390 patients in each group. The extracted patients were not statistically different in demographic findings and influencing factors of 119 service use. Hospital mortality did not differ between the 119 user and non-user groups (OR=1.294, 95% CI:0.612-2.735). Increased hospital mortality of STEMI patients was correlated with increased age (OR=1.036, 95% CI:1.012-1.060), prehospital ECG monitoring (OR=2.601, 95% CI:1.011-6.693), and cardiogenic shock (OR=4.736, 95% CI:2.482-9.037). CONCLUSION: The use of prehospital mobile units did not influence on hospital mortality of acute ST-elevation myocardial infarction.

Differences of alexithymic trend according to military service duration in army enlisted men / 신경정신의학

No abstract available.

Differences of alexithymic trend according to military service duration in army enlisted men / 신경정신의학

No abstract available.