Comparison of Blood Culture Parameters between 2 and 10 mL Aerobic Bottles from Patients with Sepsis / 대한임상미생물학회지

Background@#Blood volume is the most important parameter for an optimal blood culture; however, the effect of blood volume on blood culture is not clearly understood from patients with sepsis. @*Methods@#Blood cultures were obtained from 1,049 patients (≥ 15 years old) who visited the emergency department (ED). Two sets of 20 mL each was collected from each patient, 12 mL of which was transferred to 2 and 10 mL FA Plus (aerobic) bottles (bioMérieux, USA) and the remaining into an FN Plus (anaerobic) bottle. Medical records were reviewed to confirm the diagnosis and clinical significance of the blood culture isolates. The positive rate and time-todetection (TTD) were compared between the 2 and 10 mL groups. @*Results@#Among the 2,098 sets collected, 612 sets (29.2%) were excluded due to inadequate (either too much or too little) blood volume. The positive rate of clinically significant pathogens was lower in the 2 mL group (6.1%) than in the 10 mL group (7.5%) (P = 0.003) among the 1,486 sets. However, there was no significant difference in the positive rate (11.0% vs. 12.5%, P= 0.152) and TTD (15.7 hours vs. 14.2 hours, P = 0.299) among the 585 (39.4%) patients with sepsis. @*Conclusion@#The positive rate and TTD were similar between the 2 and 10 mL groups from patients with sepsis who visited the ED, suggesting a high concentration of bacteremia in this group. Therefore, a smaller blood volume should be carefully considered in patients with sepsis in the ED.

Comparison of Blood Culture Parameters between 2 and 10 mL Aerobic Bottles from Patients with Sepsis / 대한임상미생물학회지

Background@#Blood volume is the most important parameter for an optimal blood culture; however, the effect of blood volume on blood culture is not clearly understood from patients with sepsis. @*Methods@#Blood cultures were obtained from 1,049 patients (≥ 15 years old) who visited the emergency department (ED). Two sets of 20 mL each was collected from each patient, 12 mL of which was transferred to 2 and 10 mL FA Plus (aerobic) bottles (bioMérieux, USA) and the remaining into an FN Plus (anaerobic) bottle. Medical records were reviewed to confirm the diagnosis and clinical significance of the blood culture isolates. The positive rate and time-todetection (TTD) were compared between the 2 and 10 mL groups. @*Results@#Among the 2,098 sets collected, 612 sets (29.2%) were excluded due to inadequate (either too much or too little) blood volume. The positive rate of clinically significant pathogens was lower in the 2 mL group (6.1%) than in the 10 mL group (7.5%) (P = 0.003) among the 1,486 sets. However, there was no significant difference in the positive rate (11.0% vs. 12.5%, P= 0.152) and TTD (15.7 hours vs. 14.2 hours, P = 0.299) among the 585 (39.4%) patients with sepsis. @*Conclusion@#The positive rate and TTD were similar between the 2 and 10 mL groups from patients with sepsis who visited the ED, suggesting a high concentration of bacteremia in this group. Therefore, a smaller blood volume should be carefully considered in patients with sepsis in the ED.

Educational Intervention to Improve Blood Culture Indicators in a Secondary-Care Hospital / 대한임상미생물학회지

Background@#Blood culture is essential for diagnosis of sepsis. However, usually the available blood volume is not sufficient to meet the guidelines. Thus, periodic monitoring and feedback are essential to improve the quality of blood cultures. @*Methods@#We analyzed blood cultures requested between November 2018 and June 2019, and provided educational intervention and coaching for phlebotomists at the end of February 2019. Then, we evaluated the impact of education on blood cultures in a secondary­‑­care hospital. Blood volume, positive rate, contamination rate, and time to detection (TTD) were compared between the pre- (November 2018 to February, 2019) and post-intervention periods (March to June, 2019). @*Results@#The average blood volume increased significantly from 5.4 mL to 7.1 mL (P < 0.0001) (35.2%) after intervention. Accordingly, the proportion of optimal blood volume (8–12 mL) increased from 9.1% to 37.8% (P < 0.0001). Before the intervention, the positivity rate was 9.6% and the contamination rate was 0.5%, whereas after the intervention, the positivity rate decreased to 9.1% and the contamination rate increased to 1.1%. TTD improved from 14.7 hours to 13.1 hours (P = 0.0420). @*Conclusion@#The educational intervention of the phlebotomy team improved the quality of blood cultures, especially blood volumes and TTD. However, the positivity rate did not increase, suggesting that it is affected not only by the blood volumes but also by the severity of the underlying illnesses of the patient in a secondary-care hospital.

Accuracy of medical directors for indirect medical oversight on prehospital care

Objective@#This study aimed to evaluate the accuracy of the assessment of medical directors for indirect medical oversight on prehospital care. @*Methods@#Medical directors assessed the same prehospital care run sheets with six cases of cardiac arrest, four cases of withholding or interruption of cardiopulmonary resuscitation (CPR) and six cases of severe trauma patients. Demographics of the medical directors and the accuracy of their assessment for the prehospital care run sheets were investigated. @*Results@#Board certified emergency physician was 14 of the total 21 medical directors (58%). Eleven medical directors were educated for the medical director course of the Korean council of emergency medical services physicians. The accuracy of the assessment of the medical directors was 50% in the assessment of electrocardiogram using an automated external defibrillator (AED) in cardiac arrest. Pulse check, respiration check, AED monitoring and the reason of interruption for CPR were lower than 60% for withholding or interruption of CPR. The lowest accurate assessment of medical directors was the appropriate treatment for trauma, with 36.5% in severe trauma. @*Conclusion@#Lower accuracy in some assessments of the medical directors for indirect medical oversight on prehospital care was identified. Education and quality control are needed for medical directors to provide high-quality indirect medical oversight.

A survey of work status of a local emergency medical services (EMS) personnel and the perception between EMS personnel and medical directors about on-line medical oversight

Objective@#This study investigated the current work status of emergency medical services (EMS) personnel and the differences in perception between EMS personnel and medical directors (MD) regarding on-line medical oversight in a province. @*Methods@#A total of 1,781 EMS personnel and 51 medical directors were surveyed. The questionnaire consisted of the basic demographic data, work status, perception of on-line medical oversight, and the upcoming national pilot project of the expanding firefighter EMS personnel’s clinical scope. The survey was conducted from May 17 to 27, 2019. @*Results@#The response rates for EMS personnel and MD were 73.7% and 65.3%, respectively. Of the local EMS personnel, 86.8% were male. The average age and field career was 33.5±6.2 years and 50 months, respectively. The proportion of nurse and 1st-grade emergency medical technicians were 30.6% and 35.7%. The EMS personnel and MD answered ‘on-scene basic life support’ and ‘patient’s refusal of transport’, respectively, as the most unnecessary medical oversight. Both responded to the main problem of current medical oversight as ‘request for unnecessary medical oversight.’ EMS personnel responded that all items in the national pilot project of expanding firefighter EMS personnel’s clinical scope would be helpful, while MD reported that only ‘use of epinephrine in anaphylactic patient’ and ‘use of pre-hospital 12 lead electrocardiogram in chest pain patient’ would helpful (P<0.01). @*Conclusion@#There was a certain difference in perception of the most unnecessary medical oversight and the upcoming national pilot project of expanding the clinical scope of firefighter EMS personnel between EMS personnel and MD.

A survey on the perception of emergency medical services (EMS) providers and medical directors toward EMS provider’s field skill proficiency

Objective@#This study aimed to investigate the perception of emergency medical service (EMS) providers and medical directors toward the field skill proficiency of EMS providers. We further examined differences in perception according to the certification and hospital career of individuals. @*Methods@#This survey was conducted enrolling all active EMS providers in Busan, Ulsan, and Gyeongnam, as well as emergency physicians who participated in direct medical direction. Pre-developed questionnaires were sent as text messages to individual EMS providers and emergency physicians using an internet-based survey tool (Google Forms).Questionnaires were composed of 25 items in 7 categories: “airway management”, “ventilatory support”, “circulatory support”, “field assessment and management of trauma patients”, “field assessment and management of patients with chest pain”, “field assessment and management of patients with neurologic symptoms”, and “other items”. The response was based on a five-point Likert scale, where 0 score indicated no experience at all. @*Results@#The questionnaire was distributed to 1,781 EMS providers and 52 medical directors; of these, 1,314 (73.7%) EMS providers and 34 (65.3%) medical directors completed the survey. EMS providers rated themselves as above average (3 points) for most of the questions. However, the majority responded that they had no experience or low proficiency in endotracheal intubation and prehospital delivery (median 2; interquartile range [IQR], 0-3). Conversely, medical directors assessed the EMS provider’s proficiency as above average in use of I-gel, recognition of hypoglycemia, field management of trauma patients, use of oropharyngeal and nasopharyngeal airway, use of laryngeal mask airway, and optimal oxygen supply (median, 4; IQR, 3-4), but responded with low scores for most other questions. Based on the EMS provider certification, nurses scored themselves more proficient than level-1 emergency medical technicians (EMTs) for intravenous access (P<0.001), whereas level-1 EMTs recognized themselves more proficient than nurses for endotracheal intubation (P<0.001), use of Magill forceps (P=0.004), and pediatric cardiopulmonary resuscitation (P<0.001). @*Conclusion@#This study recognized the discrepancies in the perception of EMS provider’s field skill proficiency, as perceived by EMS providers and medical directors, and between level-1 EMTs and nurses. We propose that regional EMS authorities need to make persistent efforts to narrow these perception gaps through effective educational programs for EMS providers and medical directors.

A survey of work status of a local emergency medical services (EMS) personnel and the perception between EMS personnel and medical directors about on-line medical oversight

Objective@#This study investigated the current work status of emergency medical services (EMS) personnel and the differences in perception between EMS personnel and medical directors (MD) regarding on-line medical oversight in a province. @*Methods@#A total of 1,781 EMS personnel and 51 medical directors were surveyed. The questionnaire consisted of the basic demographic data, work status, perception of on-line medical oversight, and the upcoming national pilot project of the expanding firefighter EMS personnel’s clinical scope. The survey was conducted from May 17 to 27, 2019. @*Results@#The response rates for EMS personnel and MD were 73.7% and 65.3%, respectively. Of the local EMS personnel, 86.8% were male. The average age and field career was 33.5±6.2 years and 50 months, respectively. The proportion of nurse and 1st-grade emergency medical technicians were 30.6% and 35.7%. The EMS personnel and MD answered ‘on-scene basic life support’ and ‘patient’s refusal of transport’, respectively, as the most unnecessary medical oversight. Both responded to the main problem of current medical oversight as ‘request for unnecessary medical oversight.’ EMS personnel responded that all items in the national pilot project of expanding firefighter EMS personnel’s clinical scope would be helpful, while MD reported that only ‘use of epinephrine in anaphylactic patient’ and ‘use of pre-hospital 12 lead electrocardiogram in chest pain patient’ would helpful (P<0.01). @*Conclusion@#There was a certain difference in perception of the most unnecessary medical oversight and the upcoming national pilot project of expanding the clinical scope of firefighter EMS personnel between EMS personnel and MD.

Comparison of radiation exposure by area before and after emergency center remodeling

OBJECTIVE: Radiation is used extensively in emergency centers. Computed tomography and X-ray imaging are used frequently. Portable X-rays, in particular, cause a significant amount of indirect radiation exposure to medical personnel. The authors' emergency center was remodeled, and a comparative study of radiation exposure was carried out in certain places that had experienced radiation for a long time. METHODS: The cumulative radiation dose was measured 20 times in the 24 hours prior to remodeling, and the cumulative radiation dose was measured again 20 times across the 24-hour period. The measurement points were fixed at the emergency doctor's seat (Zone A), charge nurse's seat (Zone B), and section nurse's seat (Zone C). During the 24-hour cumulative radiation measurement period, the number of portable X-ray shots was recorded in the emergency center. RESULTS: The mean of the 24-hour cumulative radiation measurements in zone A was 3.36±0.07 µSV and 4.54±0.07 µSV before and after remodeling, respectively (P<0.001). Regarding the number of portable X-rays performed during the measurement, a higher number of trials in the Pearson correction correlated with a higher radiation measurement. CONCLUSION: In an emergency medical center, there is a higher level of low-dose radiation exposure compared to that experienced from natural radioactivity. Regarding the number of portable X-rays, the cumulative radiation dose measured 24 hours after remodeling increased and can be assumed to be related to the environment.

Is the National Early Warning Score applicable to patients with trauma?

OBJECTIVE@#The National Early Warning Score (NEWS) is used widely to detect deteriorating patients in a range of clinical situations. This study examined the ability of the NEWS to predict poor outcomes in trauma patients.@*METHODS@#This was a retrospective observational study using a dataset collected prospectively from trauma patients who visited the emergency department of a tertiary referral center in the southern area of the Republic of Korea. The area under the receiver operating curves (AUC) of the Revised Trauma Score (RTS) and NEWS were compared. The primary outcome was in-hospital mortality.@*RESULTS@#Among 17,661 patients finally enrolled, 66.3% were male, and the median age was 49 (34-64). The AUC of the NEWS and RTS were 0.878 (95% confidence interval [CI], 0.873–0.883) and 0.827 (95% CI, 0.821–0.833) (AUC difference, 0.051; 95% CI, 0.025–0.077; P<0.01), respectively. The sensitivity and specificity of the NEWS were 74.0% and 91.2%, respectively, at a cutoff of four, and those of the RTS were 67.7% and 96.1%, respectively, at 7.55.@*CONCLUSION@#The NEWS showed better performance in predicting the in-hospital mortality of patients with trauma compared to the RTS.

Establishment of peripheral intravenous catheter for pediatric patients in the emergency department: who and how?

PURPOSE: Peripheral intravenous cannulation (PIC) for children is technically difficult. We aimed to investigate factors associated with the primary success of PIC for children in the emergency department (ED). METHODS: This prospective observational study was conducted on children younger than 3 years who visited the ED from September 2014 to August 2015. The children undergoing primary success, defined as success at the first attempt, comprised the success group. Using a case report form, information about the children (age, sex, and weight), practitioners' occupation (doctors, nurses, emergency medical technicians [EMTs]), treatment venue, insertion site of PIC, presence of guardians, and use of auxiliary devices were collected and compared between the success and failure groups. Multivariable logistic regression models were constructed to identify factors associated with the primary success. RESULTS: Of 439 children, 271 underwent the primary success (61.7%). The success group showed older age, heavier weight, and higher proportion of EMT. No differences were found in treatment venue, insertion site, and presence of the guardian. We found that patients' age (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.003–1.1), and practitioners' occupation (EMT; OR, 3.0; 95% CI, 1.9–4.7, compared with doctors) were the factors associated with the primary success. CONCLUSION: Practitioners' occupation (EMT) and children's age (older) may be associated with the primary success of PIC. It may be helpful to have specialized personnel when performing PIC on children in the ED.

Non-aneurysmal and non-traumatic subarachnoid hemorrhage after attempted suicide by incomplete hanging

Hanging is a common method of suicide that is being reported more frequently in many countries. Several complications including injuries to the cervical spine, neck vessels, and brain can occur after attempted suicide by hanging. There are only a few reports of brain computed tomography and magnetic resonance imaging of hanging victims. The most common abnormality was diffuse cerebral edema. A subarachnoid hemorrhage is an atypical complication by suicidal hanging. We report a case of a female patient who presented to an emergency department with altered mental status after attempting suicide by incomplete hanging. The patient was diagnosed with a non-aneurysmal and non-traumatic subarachnoid hemorrhage. This case shows that spontaneous subarachnoid hemorrhage can develop due to a sudden elevation of intracranial pressure, as occurs with hanging.

Comprehensive Analysis of Blood Cultures Using BacT/Alert 3D FA Plus and FN Plus Media

BACKGROUND: We prospectively evaluated the performance of blood culture resin media, FA Plus and FN Plus, of the BacT/Alert 3D System (bioMérieux Inc., USA) in a tertiary university-affiliated hospital. METHODS: We obtained 2,994 blood culture sets. The positivity and time to detection (TTD) were compared between FA Plus and FN Plus for clinically significant microorganisms. We then categorized patients into two groups based on antibiotic treatment before blood culture to observe the difference of positivity between two groups. RESULTS: Among 2,994 sets received, 371 (12.4%) yielded 385 clinically significant pathogens. Comparing FA Plus to FN Plus media, lactose non-fermenters (18 vs. 1; P0.05). CONCLUSIONS: Complementary detection of microorganisms was observed between FA Plus and FN Plus. Gram-positive cocci including S. aureus grew faster in FA Plus. In addition, the rate of positivity was not affected by prior antibiotic therapy in BacT/Alert 3D resin media.

Scientific Framework for Research on Disaster and Mass Casualty Incident in Korea: Building Consensus Using Delphi Method

We aimed to determine the scientific framework for research on disaster and mass casualty incident (MCI) in Korea, especially Korean terminology, feasible definition, and epidemiologic indices. The two staged policy Delphi method was performed by instructors of National Disaster Life Support (NDLS(R)) with the constructed questionnaire containing items based on the literature review. The first-stage survey was conducted by 11 experts through two rounds of survey for making issue and option. The second-stage survey was conducted by 35 experts for making a generalized group based consensus. Experts were selected among instructors of National Disaster Life Support Course. Through two staged Delphi survey experts made consensus: 1) the Korean terminology "jaenan" with "disaster" and "dajung-sonsang-sago" with "MCI"; 2) the feasible definition of "disaster" as the events that have an effect on one or more municipal local government area (city-county-district) or results in > or = 10 of death or > or = 50 injured victims; 3) the feasible definition of MCI as the events that result in > or = 6 casualties including death; 4) essential 31 epidemiologic indices. Experts could determine the scientific framework in Korea for research on disaster medicine, considering the distinct characteristics of Korea and current research trends.

Usefulness of Blood Cultures in Children Aged Under 3 Years with Fever at the Emergency Department

PURPOSE: Blood cultures are commonly performed in evaluation of febrile children without an obvious source of infection. Pediatric clinicians treat patients with a positive blood culture before final identification of the organism. This study sought to determine the yield and the clinical usefulness of blood cultures in pediatric patients younger than 3 years with fever at the emergency department. METHODS: We conducted a retrospective review of all children between the ages of 1 and 36 months with a body temperature of at least 38.0degrees C who underwent blood culture in the emergency department (ED) from January 2008 to December 2010. RESULTS: Bacteria growth occurred in 126(10.3%) out of 1,219 blood cultures. True positives (TPs), defined as true pathogens, were observed in 2.5% of cultures, representing 23.8% of positives. False positives (FPs), defined as contaminants, were observed in 7.9% of cultures, representing 76.2% of positives. Patients with TP cultures had lower mean pH (7.36+/-0.17 vs 7.41+/-0.08, p=0.031), higher mean base deficit (4.9+/-6.0 mmol/L vs 2.9+/-2.5 mmol/L, p=0.012), and higher mean C-reactive protein (CRP) level (3.3+/-3.7 mg/dL vs 1.8+/-3.2 mg/dL, p=0.034) than those with FP cultures. CONCLUSION: True positive results were observed relatively infrequently in blood cultures of febrile children younger than 3 years in the ED; therefore, changes in treatment of pediatric patients with fever are uncommon. However, bacteria identified by blood cultures are likely to be the true pathogen in a pediatric patient with a large base deficit or a high CRP level.

Compliance with Blood Volumes Collected for Blood Cultures between Physicians and Phlebotomists / 대한임상미생물학회지

BACKGROUND: Blood culture is essential for the diagnosis and management of bloodstream infections. Blood volume is a key parameter determining the success of blood cultures. Studies comparing compliance between physicians and phlebotomists regarding optimal blood culture procedure are very rare in Korea. METHODS: After educating physicians (interns) and phlebotomists about the correct procedure for blood culturing, the blood volumes of forty-three percent of randomly selected aerobic and anaerobic culture sets for adult patients (> or =18 years old) were compared between these two groups over a period of three months. Physicians obtained blood from all admitted patients except those in the emergency department, where phlebotomists performed blood collection. RESULTS: The numbers of blood culture sets requested during the study period were 3,238 and 2,136 for the physician and phlebotomist groups, respectively. The blood volumes of blood culture sets were significantly higher for the phlebotomists (16.7 mL) than for the physicians (9.2 mL). The positive rate of blood culture was also higher for the phlebotomist group (10.3% vs. 7.9%). The contamination rates (0.8%) were the same for both groups. CONCLUSION: Although the patients' medical conditions, antibiotics prescriptions, or duration of hospitalization may have affected the positive rate of blood cultures, this rate might also have been influenced by the blood volume. The compliance of phlebotomists was greater than that of physicians regarding the blood volume collected for blood cultures.

Comparison of Chlorhexidine-Alcohol and Povidone-Iodine for Skin Antisepsis and the Effect of Increased Blood Volume in Blood Culture / 대한임상미생물학회지

BACKGROUND: Reducing skin contamination rate and improving the positive rate in blood culture is essential for the correct diagnosis and management of sepsis. Chlorhexidine-alcohol was compared with povidone-iodine for the efficiency of disinfection. Positive rates were compared between the collection of 10 mL and 20 mL of blood per sample. METHODS: The study population included adult patients > or = 18 years old requested for blood culture in the Emergency Department. Povidone-iodine (10%) was used for antiseptic skin preparation from March to June 2011, and 0.5% chlorhexidine-alcohol from July to October 2011. The standard for blood collection was 10 mL in the first period and 20 mL in the second period. The dedicated phlebotomists had been educated on the optimal skin preparation and sample collection. RESULTS: After 10% povidone-iodine application, 31 of 2,755 samples (1.1%) were considered to be contaminated; whereas, a total of 60 of 3,064 samples (2.0%) were contaminated (P=0.011) after application of 0.5% chlorhexidine-alcohol. The positive rate of blood culture was 12.5% (345/2,755) in the first period versus 17.1% (524/3,064) in the second period (P<0.001). CONCLUSION: Both disinfectants appeared acceptable for skin preparation for blood culture collection, although chlorhexidine-alcohol had a higher contamination rate than povidone-iodine. The positive rate of blood culture was in accordance with the amount of sample collected. Continuous education and monitoring are needed for the proper collection and management of blood culture.

Epidemiology of Traumatic Head Injury in Korean Children

The aim of this study was to elucidate the epidemiology of traumatic head injury (THI) among Korean children. A prospective, in-depth trauma survey was conducted in five teaching hospitals. Data from all of the children who attended the emergency department (ED) were analyzed. From June 2008 to May 2009, 2,856 children with THI visited the 5 EDs. The average age of the subjects was 5.6 (SD +/- 4.9) yr old, and 1,585 (55.5%) were 0-4 yr old. The male-to-female ratio was 2.3 to 1 (1,979 vs 877). Consciousness levels of the subjects were classified according to the Glasgow Coma Scale (GCS), and 99.1%, 0.6%, and 0.4% were determined as mild, moderate, or severe injury, respectively, according to the GCS categorization. Most injuries occurred at home (51.3%), and the most common mechanism of injury was collision (43.2%). With regard to outcome, 2,682 (93.9%) patients were sent home, and 35 (1.2%) were transferred to another hospital. A total of 133 (4.7%) patients were hospitalized, and 38 (1.3%) underwent surgery. The incidence and characteristics of pediatric THI in Korea are affected by sex, location and injury mechanism.

The Characteristics of Injured Pregnant Patients Visiting Seven Emergency Departments

PURPOSE: In Korea, few studies have compared outcomes in injured pregnant women to their non-pregnant counterparts. The purpose of this study is to describe the characteristics of patients injured during pregnancy who visited seven emergency departments in South Korea. METHODS: The Korean Traumatic Brain and Spine Injury Research Network (KTBSIRN) database, based on 7(emergency department) from June, 2008 to September, 2010 was used to derive data on all injured patients between 12 and 49 years of age. Data were divided into two comparison groups: pregnant and non-pregnant women. For comparison of characteristics and admission by pregnancy, we selected patients using the statistical matching method according to hospital, age, and injury mechanism after comparison with all enrolled patients. Then, members of the pregnant women group were divided into two subgroups: or =20 weeks gestational age. RESULTS: A total of 13,449 women were identified in a total of 76,596 injuries. Among them, 164(1.22%) women were pregnant. Fewer alcohol-related injuries were observed in pregnant women compared with non-pregnant women. Transportation was the leading mechanism of ED injury visits by pregnant women (52.4%). Emergency Medical Service (EMS) usage (22.0% vs. 14.6%, p<.0.008) and admission (14.0% vs. 7.9%, p<.0.001) were more common in pregnant women than in non-pregnant women. However, no significant difference was observed in injury severity scores. After matching, adjusted odds ratio of pregnancy for admission was 2.8(95% CI: 1.46~5.53). Less than half the number of pregnant women underwent an obstetric exam and non-stress test (NST) for the fetus (44.5% and 27.4%, respectively). CONCLUSION: Injured pregnant women who visited the ED were used more medical resources but showed no significant difference in injury severity. Despite maternal and fetal risk after injury, obstetric exam including fetal monitoring was not performed appropriately. Therefore, establishment of standards for injured pregnant women is needed in many EDs.

Effect of a SMS (short message service) System on Emergency Department Overcrowding

PURPOSE: Emergency departments (ED) are always overcrowded. Overcrowding is an important problem associated with emergency department treatment and patient satisfaction. Overcrowding can be caused by specific and complex issues and is affected by multiple influences. In an effort to reduce the degree of overcrowding, we evaluated relationships within the SMS (short message service) specialist's notification system. METHODS: This study involved establishment of a SMS specialist's notification system and other activity for resolution of emergency department overcrowding. We conducted a comparative analysis of ED patients from January 2010 to December 2010, before establishment of the system, and from January 2011 to December 2011, after establishment of the system. Data on ED patients were obtained from electronic medical records and the clinical data warehouse. Data were compared for mean length of stay and patient admission number. RESULTS: Results of comparison showed that the mean length of stay for discharge, admission, operation, and transfer had been effectively reduced. Mean residence time for patients in each administration sector was reduced 80.3, 462.3, 127.3, and 89.3 minutes, respectively, after overcrowding had been diminished. Significant differences for mean residence time were observed in each sector (p<0.001). In addition, comparison of before and after adoption of the SMS specialist's notification system for each clinical department showed that mean length of stay of patients admitted to the emergency department was significantly shorter after its adoption. CONCLUSION: By establishing a SMS specialist notification system, overcrowding can be resolved and length of stay can be shortened, which would result in improved satisfaction of both patients and emergency department professionals.

Pericardial Effusion after Central Venous Catheterization of Subclavian Vein

Central venous catheterization of a subclavian vein is commonly used in emergency departments for hemodynamic monitoring of patients undergoing shock. Though central venous catheterization has many advantages, it can cause various complications such as bleeding, pneumothorax, infection, or endocarditis. We report a 62-year-old female who had a pericardial effusion complication caused by central venous catheterization of the right subclavian vein. A computed tomography scan revealed a contrast-enhanced pericardium and catheter tubegraphy, which suggested the malpositioning of the catheter tip in the pericardial space. After removing the central venous catheter, pericardial effusion spontaneously resolved and the patient had no further adverse events from hemopericardium.