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1.
Article in Korean | WPRIM (Western Pacific) | ID: wpr-53388

ABSTRACT

PURPOSE: The purpose of this study was to evaluate the predictive value of the measured factors that can be used in an emergency department to assess patients with blow-out fractures (BOFs) who are expected to undergo surgical management. METHODS: This study was conducted on patients with BOFs who attended an emergency department in a tertiary teaching hospital from December 2013 to November 2016. The medical records and radiology findings, such as facial computed tomography (CT), were reviewed retrospectively. The depth of floor displacement (DFD) and cranial-caudal dimension (CCD), which were measured using facial CT, were evaluated to determine the power of the CT parameters as predictors expecting surgical management in BOF patients. Statistical analysis was conducted with SPSS statistics ver. 23.0. RESULTS: The final 44 BOF patients were included in the study. Among them, 21 patients had undergone surgery. From this study, using a threshold DFD value of 0.5 cm, the accuracy of DFD was 86.36%, and the sensitivity and specificity in predicting surgery in BOF patients was 100% and 73.91%, respectively. Using a threshold CCD value of 0.4 cm, the accuracy of CCD was 88.64%, and the sensitivity and specificity in predicting surgery in BOF patients was 100% and 78.26%, respectively. CONCLUSION: With the aid of DFD and CCD, which was measured from facial CT, BOF patients who may require surgical management can be detected easily and more promptly by emergency physicians in emergency settings.


Subject(s)
Humans , Emergencies , Emergency Medicine , Emergency Service, Hospital , Hospitals, Teaching , Medical Records , Methods , Orbital Fractures , Prognosis , Retrospective Studies , Sensitivity and Specificity
2.
Article in Korean | WPRIM (Western Pacific) | ID: wpr-180941

ABSTRACT

PURPOSE: This study examined the availability of the age shock index in an assessment of high risk patients with acute cholecystitis in an emergency department. METHODS: Consecutive data of patients who presented to the emergency department with acute cholecystitis during the period, January 2012 and March 2017, were reviewed retrospectively. Univariate and multivariate analyses were performed to determine the relationship between the severity of acute cholecystitis and the clinical factors. RESULTS: A total of 242 patients with acute cholecystitis were included in this study. From univariate analyses, age, Murphy's sign, symptom duration, heart rate, respiratory rate, age shock index, hypertension, diabetes, leukocytes, C-reactive protein and blood urea nitrogen were found to be related to the severity of acute cholecystitis. From multivariate analysis, the symptom duration (OR, 4.271; 95% CI, 2.672-6.827), respiratory rate (OR, 1.482; 95% CI, 1.189-1.847), age shock index (OR, 1.609; 95% CI, 1.060-2.442, 10-point interval), leukocytes (OR, 1.283; 95% CI, 1.156-1.424), and diabetes (OR, 4.590; 95% CI, 1.507-13.976) had a positive relationship with the severity of acute cholecystitis. CONCLUSION: The age shock index, which is calculated easily using the patient's age, heart rate, and systolic blood pressure, can be a predicting factor of severe acute cholecystitis in an emergency department.


Subject(s)
Humans , Blood Pressure , Blood Urea Nitrogen , C-Reactive Protein , Cholecystitis , Cholecystitis, Acute , Diagnosis , Emergencies , Emergency Service, Hospital , Heart Rate , Hypertension , Leukocytes , Multivariate Analysis , Respiratory Rate , Retrospective Studies , Risk Assessment , Shock
3.
Article in English | WPRIM (Western Pacific) | ID: wpr-648768

ABSTRACT

The use of high-pressure air instruments has become more common. Consequently, there have been a number of cases of orbital emphysema caused by contact with high-pressure air. In this case, a 62-year-old male patient visited an emergency medical center after his left eye was shot by an air compressor gun that was used to wash cars. Lacerations were observed in the upper and lower eyelids of his left eye. Radiological examinations revealed orbital emphysema, optic nerve transection, pneumocephalus, and subcutaneous emphysema in the face, neck, shoulder, and mediastinum. Canalicular injury repair was performed, and the emphysema resolved. However, there was near-complete vision loss in the patient's left eye. Because most optic nerve transections occur after a severe disruption in bone structure, pure optic nerve transections without any injury of the bone structure, as in the present case, is extremely rare.


Subject(s)
Humans , Male , Middle Aged , Compressed Air , Emergencies , Emphysema , Eyelids , Lacerations , Mediastinum , Neck , Optic Nerve Injuries , Optic Nerve , Orbit , Pneumocephalus , Shoulder , Subcutaneous Emphysema
4.
Article in Korean | WPRIM (Western Pacific) | ID: wpr-39495

ABSTRACT

BACKGROUND: In patients with foreign bodies in their digestive systems, old age is associated with higher rates of incidence and complications. Therefore, we compared the characteristics of geriatric patients with nongeriatric patients who were found to have with foreign bodies in their digestive systems. METHODS: We retrospectively analyzed 497 cases of foreign bodies in the digestive system over the period from 2010 through 2014. Patients were divided into two groups: nongeriatric (20-64 years, n=404) and geriatric (> or =65 years, n=93). RESULTS: The geriatric patients had more underlying diseases (12.0% vs. 3.0%), took longer to arrive at the hospital (8.92+/-21.31 hours vs. 4.50+/-14.76 hours, p<0.001), and had higher complication rates (4.3% vs. 0.2%, p<0.001), and longer hospital stays (4.88+/-4.26 days vs. 3.08+/-2.97 days, p<0.001). The following factors were significantly different between the geriatric and nongeriatric patients: type (p<0.001) and the locations (p=0.001) of the foreign bodies and their management (p=0.001). In the geriatric patients, the detected foreign bodies were more frequently located in the esophagus (46.0% vs. 17.4%), especially in the upper esophagus (30.0% vs. 14.5%). Smooth-shaped foreign bodies (18.0% vs. 5.0%) and food lumps (16.0% vs. 3.3%) were also frequently detected in the geriatric patients. CONCLUSION: In comparison with nongeriatric patients, the geriatric patients had more smooth-shaped shaped foreign bodies such as food lumps in their esophagi, and this patient group also showed higher rates of admission and complications. Thus, differences between geriatric and nongeriatric patients should be considered carefully in evaluating foreign bodies in the digestive system to prevent late diagnosis and further complications.


Subject(s)
Humans , Delayed Diagnosis , Digestive System , Emergencies , Esophagus , Foreign Bodies , Geriatrics , Incidence , Length of Stay , Retrospective Studies
5.
Article in Korean | WPRIM (Western Pacific) | ID: wpr-217709

ABSTRACT

PURPOSE: Reexpansion pulmonary edema (REPE) is a rare but potentially lethal complication of treatment for pneumothorax. This study was designed to compare the frequency of REPE after treatment of primary spontaneous pneumothorax (PSP) with 6 French (Fr) small bore catheterization and 14-20 Fr chest tube thoracostomy. METHODS: The medical records of PSP patients treated with thoracostomy from January 2010 to May 2015 were reviewed retrospectively. We compared the group treated using a 6 Fr small bore catheter with the group treated using a 14-20 Fr chest tube for clinical and demographic factors. The main outcome was the frequency of REPE between the two groups. RESULTS: A total of 196 patients were enrolled. No significant differences in catheter indwelling time, lengths of hospital stay, and treatment failures were observed between the two groups. REPE developed in 21 patients (10.7%). The frequencies of REPE after 6 Fr small bore catheter and 14-20 Fr chest tube were 6.0% (7 of 114 patients) and 17.1% (14 of 82 patients), respectively (p=0.015). In logistic regression analysis, drainage via 14-20 Fr chest tube showed significant correlation with the occurrence of REPE (odds ratio=3.03, p=0.038). CONCLUSION: A 6 Fr small bore catheter offers a safe and effective alternative to a chest tube for treatment of pneumothorax. We suggest that drainage via a small bore catheter should be considered as the initial treatment of choice for PSP patients in terms of frequency of development REPE.


Subject(s)
Humans , Catheterization , Catheters , Chest Tubes , Demography , Drainage , Length of Stay , Logistic Models , Medical Records , Pneumothorax , Pulmonary Edema , Retrospective Studies , Thoracostomy , Thorax , Treatment Failure
6.
Article in Korean | WPRIM (Western Pacific) | ID: wpr-204388

ABSTRACT

PURPOSE: The purpose of this study is to determine the educational suitability of the video-laryngoscope in teaching endotracheal intubation to students. METHODS: Medical students participated in a course on the use of a Macintosh direct laryngoscope and McGrath MAC videolaryngoscope for intubation. The course comprised a 1-hour lecture and 30 minutes of practice on a manikin. After the course, in each of the three simulated patient scenarios-normal airway, cervical spine fixation, and tongue edema-time to intubate, success rate, and chance of complications were measured. A questionnaire was administered before and after the course to determine the suitability of intubation by video-laryngoscope for a medical education course. Also, changes in the perception and stance on the video-laryngoscope were evaluated. RESULTS: Time to intubate decreased as attempts were repeated. The first-attempt success rate in the cervical spine fixation scenario was higher using the video-laryngoscope (p=0.028). Rates if tooth injury were lower in the cervical spine fixation (p=0.005) and tongue edema scenarios (p=0.021) using the video-laryngoscope. Based on the questionnaires, students responded positively with regard to their knowledge of the video-laryngoscope, its practical value, and its suitability for medical education (p<0.001). Also, the preference for the video-laryngoscope was greater (p=0.044). Students felt that repeated attempts and feedback on intubation were helpful. CONCLUSION: The students' evaluations and surveys showed positive results to intubation by video-laryngoscope. Thus, based on its suitability for medical education it is reasonable to consider learning intubation using the video-laryngoscope.


Subject(s)
Humans , Clinical Competence , Education, Medical, Undergraduate/methods , Intubation, Intratracheal/methods , Laryngoscopes , Laryngoscopy/education , Manikins , Surveys and Questionnaires , Video Recording , Video-Assisted Surgery/education
7.
Article in Korean | WPRIM (Western Pacific) | ID: wpr-139401

ABSTRACT

PURPOSE: A transient ischemic attack (TIA) is a brief episode of neurological dysfunction resulting from focal cerebral ischemia not associated with permanent cerebral ischemia and short-term risk of stroke after TIA is high. Inflammatory markers play an important role in acute brain ischemia. The purpose of this study was to investigate the association between the inflammatory markers and short-term risk of stroke in patients with TIA and low ABCD2 score. METHODS: The authors conducted a retrospective study of patients diagnosed with TIA in the emergency department (ED) from June 2006 to April 2013. A total of 282 patients diagnosed as TIA with low ABCD2 score were enrolled. Patients were divided into two groups according to occurrence of stroke within 90 days. We analyzed demographic characteristics, laboratory data, and comorbidities of each group. RESULTS: The median age of patients was 50.0(45.8-58.0) years, with 44.3% males. Based on the occurrence of stroke within 90 days, the patients were divided into 42 patients with stroke and 240 patients with non-stroke. Patients with stroke showed a high median age (p=0.027), white blood cell count (p=0.031), neutrophil to lymphocyte ratio (NLR) (p=0.033), C-reactive protein (p=0.005), and glucose (p=0.010). Results of multivariate analysis showed that NLR was a significant predictor of short-term prognosis (odds ratio 2.785, 95% confidence interval 1.453-5,340). CONCLUSION: NLR in the ED may be used as a rapid and easy to measure inflammatory marker for prediction of short-term prognosis in patients with transient ischemic attack and low ABCD2 score.


Subject(s)
Humans , Male , Biomarkers , Brain Ischemia , C-Reactive Protein , Comorbidity , Emergency Service, Hospital , Glucose , Ischemic Attack, Transient , Leukocyte Count , Lymphocytes , Multivariate Analysis , Neutrophils , Prognosis , Retrospective Studies , Risk Assessment , Stroke
8.
Article in Korean | WPRIM (Western Pacific) | ID: wpr-139399

ABSTRACT

PURPOSE: We validated the performance of the San Francisco Syncope Rule (SFSR) for accurate identification of Korean emergency department (ED) syncope patients who will experience a short term serious outcome. METHODS: This retrospective study included patients over 16 years old who fulfilled the inclusion criteria according to the definition of syncope and visited the ED from January 2010 to June 2013. The authors excluded patients with alcohol or illicit drugs use seizure, stroke or transient ischemic attack, head trauma followed by loss of consciousness, or hypoglycemia. The patients were divided into two groups according to the SFSR for the purpose of performing a comparative analysis. The authors calculated sensitivity, specificity, positive predictive value, and negative predictive value of SFSR and analyzed other variables, except five predictor variables of SFSR. RESULTS: Of 1,235 visits screened, 409 were included. The average age of enrolled patients was 55.2+/-20.1 and male population accounted for 45.0%(n=184). A total of 93(27.7%) patients experienced serious outcomes; 41 of 287(14.3%) patients with a serious outcome were not identified as high risk according to the rule. The rule performed with a sensitivity of 55.9%, specificity of 77.8%, positive predictive value of 42.6%, and negative predictive value of 85.7%. CONCLUSION: In this retrospective validation study based on the standardized reporting guidelines for ED syncope risk stratification research, the SFSR performed with significantly lower sensitivity than previously reported. The results suggest that application of the original rule has limited generalizability and conduct of future studies will be needed in order to refine the SFSR.


Subject(s)
Adolescent , Humans , Male , Craniocerebral Trauma , Emergencies , Emergency Service, Hospital , Hypoglycemia , Ischemic Attack, Transient , Retrospective Studies , Seizures , Sensitivity and Specificity , Illicit Drugs , Stroke , Syncope , Unconsciousness
9.
Article in Korean | WPRIM (Western Pacific) | ID: wpr-139396

ABSTRACT

PURPOSE: A transient ischemic attack (TIA) is a brief episode of neurological dysfunction resulting from focal cerebral ischemia not associated with permanent cerebral ischemia and short-term risk of stroke after TIA is high. Inflammatory markers play an important role in acute brain ischemia. The purpose of this study was to investigate the association between the inflammatory markers and short-term risk of stroke in patients with TIA and low ABCD2 score. METHODS: The authors conducted a retrospective study of patients diagnosed with TIA in the emergency department (ED) from June 2006 to April 2013. A total of 282 patients diagnosed as TIA with low ABCD2 score were enrolled. Patients were divided into two groups according to occurrence of stroke within 90 days. We analyzed demographic characteristics, laboratory data, and comorbidities of each group. RESULTS: The median age of patients was 50.0(45.8-58.0) years, with 44.3% males. Based on the occurrence of stroke within 90 days, the patients were divided into 42 patients with stroke and 240 patients with non-stroke. Patients with stroke showed a high median age (p=0.027), white blood cell count (p=0.031), neutrophil to lymphocyte ratio (NLR) (p=0.033), C-reactive protein (p=0.005), and glucose (p=0.010). Results of multivariate analysis showed that NLR was a significant predictor of short-term prognosis (odds ratio 2.785, 95% confidence interval 1.453-5,340). CONCLUSION: NLR in the ED may be used as a rapid and easy to measure inflammatory marker for prediction of short-term prognosis in patients with transient ischemic attack and low ABCD2 score.


Subject(s)
Humans , Male , Biomarkers , Brain Ischemia , C-Reactive Protein , Comorbidity , Emergency Service, Hospital , Glucose , Ischemic Attack, Transient , Leukocyte Count , Lymphocytes , Multivariate Analysis , Neutrophils , Prognosis , Retrospective Studies , Risk Assessment , Stroke
10.
Article in Korean | WPRIM (Western Pacific) | ID: wpr-139394

ABSTRACT

PURPOSE: We validated the performance of the San Francisco Syncope Rule (SFSR) for accurate identification of Korean emergency department (ED) syncope patients who will experience a short term serious outcome. METHODS: This retrospective study included patients over 16 years old who fulfilled the inclusion criteria according to the definition of syncope and visited the ED from January 2010 to June 2013. The authors excluded patients with alcohol or illicit drugs use seizure, stroke or transient ischemic attack, head trauma followed by loss of consciousness, or hypoglycemia. The patients were divided into two groups according to the SFSR for the purpose of performing a comparative analysis. The authors calculated sensitivity, specificity, positive predictive value, and negative predictive value of SFSR and analyzed other variables, except five predictor variables of SFSR. RESULTS: Of 1,235 visits screened, 409 were included. The average age of enrolled patients was 55.2+/-20.1 and male population accounted for 45.0%(n=184). A total of 93(27.7%) patients experienced serious outcomes; 41 of 287(14.3%) patients with a serious outcome were not identified as high risk according to the rule. The rule performed with a sensitivity of 55.9%, specificity of 77.8%, positive predictive value of 42.6%, and negative predictive value of 85.7%. CONCLUSION: In this retrospective validation study based on the standardized reporting guidelines for ED syncope risk stratification research, the SFSR performed with significantly lower sensitivity than previously reported. The results suggest that application of the original rule has limited generalizability and conduct of future studies will be needed in order to refine the SFSR.


Subject(s)
Adolescent , Humans , Male , Craniocerebral Trauma , Emergencies , Emergency Service, Hospital , Hypoglycemia , Ischemic Attack, Transient , Retrospective Studies , Seizures , Sensitivity and Specificity , Illicit Drugs , Stroke , Syncope , Unconsciousness
11.
Article in Korean | WPRIM (Western Pacific) | ID: wpr-49192

ABSTRACT

PURPOSE: The purpose of this study is to validate the Denver seizure score (DSS) compared with a questionnaire and scoring system for symptoms pertaining to loss of consciousness (QSLOC) in patients with loss of consciousness who visited the emergency department (ED). METHODS: This was an observational study. Patients with loss of consciousness who were admitted from January, 2011, to July, 2013 in an urban ED with approximately 30,000 annual visits were eligible. General characteristics, clinical manifestation, hemodynamic, and laboratory data were collected. DSS and QSLOC were calculated as originally described. The SPSS package with Mann-Whitney U test, Fisher's exact test, and logistic regression was used for analysis of the data. The area under the receiver operating characteristics curve (AUC) was used for discrimination of each score. RESULTS: Based on the historical feature, clinical manifestation, and final diagnosis, the patients were divided into 45 seizure and 52 syncope cases. In the seizure group, there were more males than females (p=0.015) and statistically significant findings were observed for serum bicarbonate (p<0.001), anion gap (p<0.001). AUCs were 0.954 and 0.998 for DSS and QSLOC, respectively. CONCLUSION: Compared to QSLOC, DSS did not show a noticeable difference in differentiating seizure disorder, and for patients who lost consciousness, it can be used in determining procedures and for prediction of both treatment method and prognosis in the emergency department.


Subject(s)
Female , Humans , Male , Acid-Base Equilibrium , Area Under Curve , Consciousness , Diagnosis , Diagnosis, Differential , Discrimination, Psychological , Emergencies , Emergency Service, Hospital , Epilepsy , Hemodynamics , Logistic Models , Observational Study , Prognosis , Surveys and Questionnaires , Retrospective Studies , ROC Curve , Seizures , Syncope , Unconsciousness
12.
Article in Korean | WPRIM (Western Pacific) | ID: wpr-226416

ABSTRACT

BACKGROUND: Incidence rate of ureterolithiasis has been increasing worldwide in general, with an especially rapid increase in the elderly, over 65 years of age. Therefore, the characteristics of geriatric patients diagnosed with uureterolithiasis in an Emergency Center were examined. METHODS: A total of 613 consecutive patients who were diagnosed with ureterolithiasis through computed tomography from January 2012 to March 2014 were analyzed retrospectively. The patients were divided in two groups: the geriatric group and nongeriatric group. RESULTS: Among the 613 patients, there were 64 geriatric patients (> or =65 years, 10.4%) and 549 nongeriatric patients (<65 years, 89.6%). In the geriatric patients, 13 patients (20.3%) appeared without any pain or with atypical types of pain, while 39 of the nongeriatric patients (7.1%) had no pain or atypical symptoms, presenting a statistically significant difference (p<0.001). Gastrointestinal symptoms such as nausea and vomiting were more common in geriatric patients than in nongeriatric patients (42.2% vs. 29.9%, p=0.044), while lower positive rate of microscopic hematuria was reported (78.1% vs. 90.5%, p=0.002). Furthermore, in geriatric patients, the positive rate of costovertebral angle tenderness was lower and distal ureter stones were found to be more common, while urine pH and serum creatinine levels were higher. CONCLUSION: In comparison to nongeriatric patients, geriatric patients with ureterolithiasis showed lower rates of renal colic and hematuria, while showing higher rates of having gastrointestinal symptoms such as nausea and vomiting. Thus, differences between these two groups should be considered in evaluating geriatric patients to prevent complications which may be caused from the late diagnosis of ureterolithiasis.


Subject(s)
Aged , Humans , Creatinine , Delayed Diagnosis , Emergencies , Geriatrics , Hematuria , Hydrogen-Ion Concentration , Incidence , Nausea , Renal Colic , Retrospective Studies , Ureter , Ureterolithiasis , Vomiting
13.
Article in Korean | WPRIM (Western Pacific) | ID: wpr-223357

ABSTRACT

PURPOSE: The purpose of this study is to determine the factors related to delayed answer in interhospital transfer in order to reduce the time required to determine interhospital transfer and to provide optimal care for emergency patients. METHODS: This was a retrospective observational study. Data on request for interhospital transfer of emergency patients were collected from July, 2013 to October, 2013 in an urban emergency department with approximately 40,000 annual visits. Time required for determination, receptionist's department and position, decision maker's department and position, patient's general characteristics, and requesting hospital's characteristics were collected. The SPSS package with Student's t-test, Chi-square, one-way ANOVA, and multivariate logistic regression analysis was used for analysis of the data. RESULTS: When the decision maker's department was emergency medicine, the time required to determine inter-hospital transfer was shortest (p<0.001), and position of emergency medicine member was non-significant (p=0.109). When the decision maker's department was non-emergency medicine, specialist had a shorter time required to determine interhospital transfer than resident (p<0.001), but influence of the position of receptionist was non-significant. CONCLUSION: Decision maker for interhospital transfer request should be an emergency medicine member. If one cannot make a decision, one should consult a specialist, not a resident. Hospitals should implement an organized system to shorten the time for interhospital transfer.


Subject(s)
Humans , Emergencies , Emergency Medical Services , Emergency Medicine , Emergency Service, Hospital , Logistic Models , Observational Study , Retrospective Studies , Specialization , Telephone
14.
Article in Korean | WPRIM (Western Pacific) | ID: wpr-138333

ABSTRACT

PURPOSE: This study investigated the relationship between the laboratory results of patients diagnosed with lower limb arteriosclerosis obliterans (LASO) in an emergency department (ED), general characteristics, clinical manifestation, hematological conditions, and clinical views of severity. Another purpose of the study was to determine the factors that could contribute to clinical severity to facilitate the prediction and diagnosis of LASO in the ED. METHODS: From January 2005 to December 2012 we conducted a retrospective study on patients diagnosed with LASO in the ED. Included in the study were 52 patients diagnosed with LASO through CT. The patients were divided into two groups according to the Fontaine classification-for comparative analysis: "less severe" (for stage II and below) and "more severe" (for stage III and above). Vital signs, clinical findings, laboratory data, and CT findings were analyzed in each patient. The SPSS package with the Mann-Whitney U test, Fisher's exact test, and logistic regression were used for data analysis. A p-value <0.05 was considered statistically significant. RESULTS: The average age of patients diagnosed with LASO was 73.1+/-10.1 and male saccounted for 76.9% of the population (n=40). Based upon the levels of severity by the Fontaine classification, patients were divided into 28 "more severe" and 24 "less severe" cases. The "more severe" LASO patients showed a high pulse rate (p=0.017) and a higher current smoking rate (p=0.04). The laboratory data from "more severe" LASO patients showed significant differences in total white blood cell count (p=0.040), erythrocyte sedimentation rate (p=0.000), and the levels of lactate dehydrogenase (p=0.002), creatine kinase (p=0.000), creatine kinase-MB (p=0.002), myoglobin (p=0.000), and C-reactive protein (p=0.000). The significant factors that could affect clinical severity were erythrocyte sedimentation rate (OR 1.066, 95% CI 1.010-1.125, p=0.021), and the levels of lactate dehydrogenase (OR 1.015, 95% CI 1.002-1.029, p=0.027), creatine kinase-MB (OR 1.229, 95% CI 1.028-1.468, p=0.023), and C-reactive protein (OR 1.533, 95% CI 1.074-2.188, p=0.019). CONCLUSION: The patients diagnosed with more severe LASO showed a high pulse rate, a higher current smoking rate, high levels of inflammation (erythrocyte sedimentation rate and C-reactive protein), and high levels of muscle enzymes (lactate dehydrogenase, creatine kinase, myogolobin, creatine kinase-MB). The factors that could influence clinical severity were erythrocyte sedimentation rate, and the levels of lactate dehydrogenase, creatine kinase-MB, and C-reactive protein.


Subject(s)
Humans , Male , Arteriosclerosis Obliterans , Arteriosclerosis , Blood Sedimentation , C-Reactive Protein , Classification , Creatine , Creatine Kinase , Diagnosis , Emergencies , Heart Rate , Inflammation , L-Lactate Dehydrogenase , Leukocyte Count , Logistic Models , Lower Extremity , Muscles , Myoglobin , Oxidoreductases , Peripheral Arterial Disease , Retrospective Studies , Smoke , Smoking , Statistics as Topic , Vascular Diseases , Vital Signs
15.
Article in Korean | WPRIM (Western Pacific) | ID: wpr-138332

ABSTRACT

PURPOSE: This study investigated the relationship between the laboratory results of patients diagnosed with lower limb arteriosclerosis obliterans (LASO) in an emergency department (ED), general characteristics, clinical manifestation, hematological conditions, and clinical views of severity. Another purpose of the study was to determine the factors that could contribute to clinical severity to facilitate the prediction and diagnosis of LASO in the ED. METHODS: From January 2005 to December 2012 we conducted a retrospective study on patients diagnosed with LASO in the ED. Included in the study were 52 patients diagnosed with LASO through CT. The patients were divided into two groups according to the Fontaine classification-for comparative analysis: "less severe" (for stage II and below) and "more severe" (for stage III and above). Vital signs, clinical findings, laboratory data, and CT findings were analyzed in each patient. The SPSS package with the Mann-Whitney U test, Fisher's exact test, and logistic regression were used for data analysis. A p-value <0.05 was considered statistically significant. RESULTS: The average age of patients diagnosed with LASO was 73.1+/-10.1 and male saccounted for 76.9% of the population (n=40). Based upon the levels of severity by the Fontaine classification, patients were divided into 28 "more severe" and 24 "less severe" cases. The "more severe" LASO patients showed a high pulse rate (p=0.017) and a higher current smoking rate (p=0.04). The laboratory data from "more severe" LASO patients showed significant differences in total white blood cell count (p=0.040), erythrocyte sedimentation rate (p=0.000), and the levels of lactate dehydrogenase (p=0.002), creatine kinase (p=0.000), creatine kinase-MB (p=0.002), myoglobin (p=0.000), and C-reactive protein (p=0.000). The significant factors that could affect clinical severity were erythrocyte sedimentation rate (OR 1.066, 95% CI 1.010-1.125, p=0.021), and the levels of lactate dehydrogenase (OR 1.015, 95% CI 1.002-1.029, p=0.027), creatine kinase-MB (OR 1.229, 95% CI 1.028-1.468, p=0.023), and C-reactive protein (OR 1.533, 95% CI 1.074-2.188, p=0.019). CONCLUSION: The patients diagnosed with more severe LASO showed a high pulse rate, a higher current smoking rate, high levels of inflammation (erythrocyte sedimentation rate and C-reactive protein), and high levels of muscle enzymes (lactate dehydrogenase, creatine kinase, myogolobin, creatine kinase-MB). The factors that could influence clinical severity were erythrocyte sedimentation rate, and the levels of lactate dehydrogenase, creatine kinase-MB, and C-reactive protein.


Subject(s)
Humans , Male , Arteriosclerosis Obliterans , Arteriosclerosis , Blood Sedimentation , C-Reactive Protein , Classification , Creatine , Creatine Kinase , Diagnosis , Emergencies , Heart Rate , Inflammation , L-Lactate Dehydrogenase , Leukocyte Count , Logistic Models , Lower Extremity , Muscles , Myoglobin , Oxidoreductases , Peripheral Arterial Disease , Retrospective Studies , Smoke , Smoking , Statistics as Topic , Vascular Diseases , Vital Signs
16.
Article in Korean | WPRIM (Western Pacific) | ID: wpr-9487

ABSTRACT

BACKGROUND: Doxylamine is an over-the-counter drug that is popular in the treatment of insomnia. Doxylamine is relatively safe but can cause rhabdomyolysis. The aim of this study was to evaluate whether the incidence of rhabomyolysis increased in elderly patients (age> or =65 years) with doxylamine overdose. METHODS: This study included 108 patients admitted to an Emergency Department after doxylamine overdose between January 1, 2000, and March 31, 2013. Age, sex, time ingested before admission, amount of drug ingested, gastric lavage, tachycardia, vomiting, hematuria, blood urea nitrogen, blood creatinine, urine pH, and alcohol ingestion were investigated for the risk factors of rhabdomyolysis. RESULTS: Forty-three patients (47.6%) developed rhabdomyolysis. Of 16 elderly patients, 11 developed rhabdomyolysis. Of the 92 patients <65 years-of-age, 34 developed rhabdomyolysis. Advanced age, alcohol ingestion, and increased blood creatinine level were significantly associated with the development of rhabdomyolysis. CONCLUSION: In elderly patients with doxylamine overdose, the incidence rate of rhabdomyolysis may be increased. A high index of suspicion and evaluation of rhabdomyolysis is warranted in elderly patients with doxylamine overdose.


Subject(s)
Aged , Humans , Blood Urea Nitrogen , Creatinine , Doxylamine , Eating , Emergencies , Gastric Lavage , Hematuria , Hydrogen-Ion Concentration , Incidence , Rhabdomyolysis , Risk Factors , Sleep Initiation and Maintenance Disorders , Tachycardia , Vomiting
18.
Article in Korean | WPRIM (Western Pacific) | ID: wpr-141513

ABSTRACT

PURPOSE: This study was aimed at determining if nutritional risk is associated with increased mortality in severe sepsis patients, and whether or not nutritional risk screening is helpful when assessing mortality risk for these patients in the Emergency Department (ED). METHODS: We conducted an observational study using adult patients (> or =18 years of age) with severe sepsis who were admitted to the ED in a tertiary teaching hospital during a 12-month period. Participant data collected included demographics, sepsis severity scale, laboratory test results and nutritional risk screening results. We divided the patients into two groups: survivors and non-survivors. The endpoint was 28-day hospital mortality. RESULTS: A total of 204 patients participated in this study and 166 had survived and 38 had died by the endpoint. The two participant groups differed with regards to age, gender, Sequential Organ Failure Assessment (SOFA) score, Nutritional Risk Screening Tool (NRST) score, presence of cancer, serum creatinine level, and arterial lactate level. According to the multivariate logistic regression analysis results, the most significant variables for prognosis were the SOFA score (p=0.027), NRST score (p=0.001) and arterial lactate level (p=0.001). CONCLUSION: In ED patients with severe sepsis, nutritional risk is related to 28-day hospital mortality. Nutritional risk screening may be helpful for risk stratification of severe sepsis patients.


Subject(s)
Adult , Humans , Creatinine , Demography , Emergencies , Hospital Mortality , Hospitals, Teaching , Lactic Acid , Logistic Models , Mass Screening , Prognosis , Sepsis , Survivors
19.
Article in Korean | WPRIM (Western Pacific) | ID: wpr-141512

ABSTRACT

PURPOSE: This study was aimed at determining if nutritional risk is associated with increased mortality in severe sepsis patients, and whether or not nutritional risk screening is helpful when assessing mortality risk for these patients in the Emergency Department (ED). METHODS: We conducted an observational study using adult patients (> or =18 years of age) with severe sepsis who were admitted to the ED in a tertiary teaching hospital during a 12-month period. Participant data collected included demographics, sepsis severity scale, laboratory test results and nutritional risk screening results. We divided the patients into two groups: survivors and non-survivors. The endpoint was 28-day hospital mortality. RESULTS: A total of 204 patients participated in this study and 166 had survived and 38 had died by the endpoint. The two participant groups differed with regards to age, gender, Sequential Organ Failure Assessment (SOFA) score, Nutritional Risk Screening Tool (NRST) score, presence of cancer, serum creatinine level, and arterial lactate level. According to the multivariate logistic regression analysis results, the most significant variables for prognosis were the SOFA score (p=0.027), NRST score (p=0.001) and arterial lactate level (p=0.001). CONCLUSION: In ED patients with severe sepsis, nutritional risk is related to 28-day hospital mortality. Nutritional risk screening may be helpful for risk stratification of severe sepsis patients.


Subject(s)
Adult , Humans , Creatinine , Demography , Emergencies , Hospital Mortality , Hospitals, Teaching , Lactic Acid , Logistic Models , Mass Screening , Prognosis , Sepsis , Survivors
20.
Article in Korean | WPRIM (Western Pacific) | ID: wpr-126032

ABSTRACT

PURPOSE: The purpose of this study is to validate the Mortality in Emergency Department Sepsis (MEDS) score in older patients with sepsis who visited the emergency department (ED). METHODS: This was an observational study. Patients 65 years of age or older with sepsis who were admitted from January, 2010, to May, 2011, in an urban ED with approximately 30,000 annual visits were eligible. Demographic, anthropometric, hemodynamic, and laboratory data were collected. MEDS and Geriatric Nutritional Risk Index (GNRI) scores were calculated as originally described. The area under the receiver operating characteristics curve (AUC) was used for discrimination of each score. Univariate and multivariate analyses were performed. The primary end-point was 28-day in-hospital mortality. RESULTS: Of 397 patients, 11.8%(95% confidence interval, 8.7%~15.0%) died. Mortality stratified according to MEDS was as follows: 0 to 4 points, 0.0%; 5 to 7 points, 4.8%; 8 to 12 points, 11.4%; 13 to 15 points, 22.2%; and > or = 16 points, 35.7%. Mortality stratified according to GNRI was as follows: > 98 points, 3.9%; 92 to 98 points, 9.8%; 87 to < 92 points, 6.9%; 82 to < 87 points, 20.0%; and < 82 points, 34.6%. AUCs were 0.707 and 0.734 for MEDS and GNRI, respectively. In multiple logistic regression analysis, GNRI was found to be an independent predictor of 28-day in-hospital mortality, however, MEDS was not. CONCLUSION: The MEDS score performed with moderate accuracy for prediction of 28-day in-hospital mortality in older ED patients with sepsis. These results suggest the need of geriatric-specific risk assessment tools in the ED.


Subject(s)
Humans , Area Under Curve , Discrimination, Psychological , Emergencies , Geriatrics , Hemodynamics , Hospital Mortality , Logistic Models , Multivariate Analysis , Risk Assessment , ROC Curve , Sepsis
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