Stroke Incidence in Survivors of Carbon Monoxide Poisoning in South Korea: A Population-Based Longitudinal Study

김혁훈,최상천,정윤석,민영기,윤덕용,이성은 대한응급의학회 2020 대한응급의학회 학술대회초록집 Vol.2020 No.2

Introduction Carbon monoxide (CO) poisoning is a suspected risk factor for stroke. However, the association between stroke occurrence and carbon monoxide poisoning remains unclear. This nationwide study in Korea analyzed the in-cidence of stroke in survivors of CO poisoning. Material & Method In this nationwide, population-based longitudinal study, the database of the Health Insurance Review and Assessment Service was searched to identify patients diagnosed with CO poisoning from 2012 to 2018. Their incidence of ischemic and hemorrhagic strokes, the patterns of stroke incidences, the annual incidence rates in sequential time, the standardized incidence ratio (SIR), and the effects of hyperbaric oxygen therapy (HBOT) were analyzed. Result Of the 29 301 patients diagnosed with CO poisoning during the study period, 984 (3.36%) were diagnosed with stroke after CO poisoning, with approximately 50% occurring within 1 year after CO poisoning. The overall SIR for stroke was 19.49 (95% confidence interval [CI], 17.92*21.12) during the first year, decreasing to 5.64 (95% CI, 4.75- 6.66) during the second year. Overall stroke hazard ratio (HR) in the patients admitted to the ICU for CO poisoning was 2.28 (95% CI, 1.19-2.27), compared with 2.35 (95% CI, 1.94-2.84) for ischemic stroke and 1.76 (95% CI, 1.11?2.78) for hemorrhagic stroke. Cumulative HRs did not differ between patients who were and were not treated with HBOT for stroke. Conclusion CO poisoning is a high-risk factor for the development of stroke, evidenced by high incidences of stroke after CO poisoning. Practical strategies for preventing stroke after CO poisoning are needed, because stroke after CO poisoning affects adults of almost all ages, significantly increasing their socioeconomic burden.

Serum markers and development of delayed neuropsychological sequelae after acute carbon monoxide poisoning: anion gap, lactate, osmolarity, S100B protein, and interleukin-6

김혁훈,최상천,박은정,Eunhui yoon,민영기,샘슨램포탕 대한응급의학회 2018 Clinical and Experimental Emergency Medicine Vol.5 No.3

Objective Reliable biomarkers of delayed neuropsychological sequelae (DNS) after acute carbon monoxide (CO) poisoning are lacking. This study investigated the associations between potential serum markers and the development of DNS after acute CO poisoning. Methods Retrospective chart reviews were conducted for patients diagnosed with acute CO poisoning during a 28-month period. The patients were divided into two groups according to the presence or absence of having developed DNS. Multivariate analysis was performed to identify predictors of DNS after CO poisoning. Results Of a total of 102 patients, 10 (9.8%) developed DNS. The levels of serum osmolarity, S100B protein, and serum lactate, as well as serum anion gap, were statistically significant in univariate analysis. Multiple logistic regression analysis showed that anion gap (adjusted odds ratio [AOR], 1.36; 95% confidence interval [CI], 1.11 to 1.88), serum lactate level (AOR, 1.74; 95% CI, 1.26 to 2.75), and serum S100B protein level ([AOR, 7.02×105; 95% CI, 4.56×102 to 9.00×1010] in model 1, [AOR, 3.69×105; 95% CI, 2.49×102 to 2.71×1011] in model 2) were independently associated with DNS development. Conclusion Based on our preliminary results, serum lactate level, serum anion gap, and serum S100B protein level in the emergency department could be informative predictors of DNS development in patients with acute CO poisoning. These markers might have the potential to improve early recognition of DNS in patients with acute CO poisoning.

학교에서 발생할 수 있는 응급상황에 대한 보건교사의 교육 요구도와 응급상황 인식 정도 조사: 일반적 특성에 따른 차이를 중심으로

김혁훈,안정환,이슬기,민영기,최상천,정윤석 대한응급의학회 2011 대한응급의학회지 Vol.22 No.5

Purpose: The study investigated the educational needs and perceptions of school nurses regarding emergency situations in the school and compared differences in the educational needs and perceptions about emergency situations according to the general characteristics of school nurses. Methods: Using a written survey of randomly selected sample, we questioned 100 school nurses over a 3-month period from January 2011 to March 2011. The survey involved 11 medical conditions and 16 injury-related conditions. It contained questions about the need for education and perceptions of emergency situations. We also determined school nurses' general characteristics including sex,age, grades of school where they worked, years of teaching career, years of clinical experience, number of classes,marital status, number of children, gender of their children,age of their children, the existence of older families. Results: Two hundred two (84%) school nurses responded. For most conditions, there were significant differences between the scores of educational needs regarding, and perceptions about, emergency situations, except for three conditions (fracture of extremity, cerebral contusion, and tooth trauma). According to the general characteristics of school nurses, only the grade of school where they worked influenced the educational needs for cerebral contusion and orbital contusion. Conclusion: The emergency conditions that need first aid education in Korean school nurses are different from the conditions identified in other foreign countries. Primary education and promotion of first aid is considered necessary. The perceptions about emergency situations and the educational need regarding emergency situations show consistency. Only the grade of school where nurses worked affected the educational needs of school nurses. Further studies about the frequency of emergency situations in each school grade are required.

코로나-19가 응급실에 내원하는 중독환자의 특성에 미치는 영향: 단일 삼차 대학병원에서의 후향적 연구

심문기,김혁훈,민영기,안정환 대한응급의학회 2023 대한응급의학회지 Vol.34 No.3

Objective: The coronavirus disease 2019 (COVID-19) virus has adversely affected people in socioeconomic fields as well as mental health, thereby increasing suicidal attempts. This study analyzes the altered characteristics of drug-poisoned patients visiting the emergency department (ED) during the COVID-19 pandemic era in South Korea. Methods: This was a retrospective observational study using medical records of adults who visited the ED for intoxication. Data obtained were compared before and after the COVID-19 pandemic era. Results: In all, data from 1,102 drug-poisoned patients (586/516 during the pre-/post-COVID-19 periods, respectively) were included in the study. Despite a decrease in total ED visits, the pandemic period saw an increase in the proportion of poisoned patients visiting the ED. Young, female, and psychiatric patients accounted for a significant portion. Months, holidays, time zones, and urbanization showed no difference in the incidence of intoxication. Financial difficulty and couple and family troubles were determined to be frequent causes of intoxication during the COVID-19 pandemic. Comparing the drugs intoxicated, pesticide ingestion was decreased, while the ingestion of other less-fatal drugs was comparatively increased. Although there was an increase in the admission rate of poisoned patients, the severity during admission and outcomes at discharge were not worse after the COVID-19 pandemic era. Conclusion: The COVID-19 crisis has seriously impacted people, especially female, young-aged, and psychiatric patients.

Use of alternative airway device for intractable soft palate bleeding.(case)

민승준,김혁훈 대한응급의학회 2016 대한응급의학회 학술대회초록집 Vol.2016 No.2

Incidence patterns of nervous system diseases after carbon monoxide poisoning: a retrospective longitudinal study in South Korea from 2012 to 2018

이방실,김혁훈,최상천,민영기 대한응급의학회 2021 Clinical and Experimental Emergency Medicine Vol.8 No.2

Objective To analyze the incidence patterns of nervous system diseases in survivors of carbon monoxide (CO) poisoning using nationwide claims data from South Korea. Methods A national cohort was abstracted from a database that includes patients diagnosed with CO poisoning between January 2012 and December 2018. For all nervous system diseases, we investigated the frequency, pattern of incidence, effect of intensive care unit admission, and the standardized incidence ratios (SIRs) to estimate the risk of nervous system disease after CO poisoning. Results Of 26,778 patients, 18,720 (69.9%) were diagnosed with nervous system diseases after CO poisoning. The most common disease was disorders of sleep initiation and maintenance (n=701, 3.74%), followed by tension-type headache (n=477, 2.55%) and anoxic brain injury (n=406, 2.17%). Over half of the nervous system diseases occurred within the first year after CO poisoning. The cumulative hazard ratio for nervous system diseases in patients admitted to the intensive care unit was 2.25 (95% confidence interval [CI], 2.07–2.44). Among the frequent nervous system diseases after CO poisoning, patients had a higher risk of disorders of initiating and maintaining sleep (SIR, 1.61; 95% CI, 1.52–1.71), tension-type headache (SIR, 2.41; 95% CI, 2.23–2.61), anoxic brain injury (SIR, 58.76; 95% CI, 53.95–63.88), and post-zoster neuralgia (SIR, 1.94; 95% CI, 1.70–2.20). Conclusion Patients who experience CO poisoning are at higher risk for several nervous system diseases. Therefore, monitoring for specific nervous system diseases is important after CO poisoning within the first year.

Incidence Pattern of Neurological Diseases after Carbon Monoxide Poisoning: Retrospective Longitudinal Study in South Korea from 2012 to 2018

이방실,김혁훈 대한응급의학회 2020 대한응급의학회 학술대회초록집 Vol.2020 No.2

Introduction Neurological sequelae after carbon monoxide (CO) poisoning have recently become a critical issue. Epidemiologic data of delayed neurological sequelae such as incidence, time of development, and duration vary widely in the literature. We aim at analyzing nationwide claims data from South Korea for incidence patterns of neurological disorders in survivors of carbon dioxide poisoning. Material & Method A national cohort was abstracted from database that includes the patients diagnosed with carbon monoxide poisoning from January 1st, 2012 to December 31st, 2018. We investigated for whole nervous system diseases: the frequency, the pattern of incidence, the effect of admission to intensive care unit (ICU), and the standardized incidence ratios (SIR) to estimate the risk of nervous system disease in survivors after CO poisoning. Result Among the total of 26,778 patients, 18,720 (69.9%) patients were diagnosed with nervous system diseases after the carbon monoxide poisoning. The most common disease was disorders of sleep initiating and maintaining (n = 701, 3.74%), followed by tension-type headache (n = 477, 2.55%), and anoxic brain injury (n = 406, 2.17%). More than half of nervous system disease occurred within first year after CO poisoning. The cumulative hazard ratio for nervous system diseases in patients admitted to the ICU was 2.25 (95% confidence interval (CI), 2.07 to 2.44). Among the frequent nervous system diseases occurred after CO poisoning, patients had higher risk of disorders of initiating and maintaining sleep (SIR 1.61, 95% CI 1.52-1.71), tension-type headache (SIR 2.41, 95% CI 2.23-2.61), anoxic brain injury (SIR 58.76, 95% CI 53.95-63.88), and post-zoster neuralgia (SIR 1.94, 95% CI 1.70-2.20). Conclusion In poisoned patients with carbon monoxide, it needs to consider that nervous system diseases followed after carbon monoxide poisoning have relatively early peak incidence patterns and patients had higher risk for several nervous system diseases. Therefore, close surveillance for specific nervous system disease is important in patients after CO poisoning within the first year.

심폐소생술 전화 지도를 포함한 119구급상황관리센터 이용 현황 분석

김창성,김혁훈,김기운,이슬기,김수태,최상천,조준필 대한응급의학회 2018 대한응급의학회지 Vol.29 No.4

Objective: Analyses of the status of 119 emergency situation control center (119 ESCC) usage are lacking. Therefore, this study investigated the status of the 119 ESCC usage, including dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) instructions. Methods: The emergency activity daily reports and emergency instruction sheets of 119 ESCC from January to December 2016 were reviewed. For more accurate status analysis, the computerized data of the 1339 Emergency Medical Information Center from January to December 2011 were also reviewed. Results: In 2016, the total usage of the 119 ESCC was 1,393,876 calls, which was 27.8% lower than the 1,930,977 calls in 2011. Of the 1,393,876 eligible calls, the most common call was hospital guidance (n=743,799, 53.4%), followed by first aid (n=397,620, 28.5%), disease consultation (n=150,128, 10.8%), medical oversight (n=81,174, 5.8%), and interhospital transfer (n=5,123, 0.4%). Regarding the user number per 10,000 persons, Daejeon was the greatest at 57.2, whereas Changwon was the lowest at 11.5. A total number of DA-CPR was 19,439. The time from the call to chest compression were 173±88.6 seconds in the subjects having previous cardiopulmonary resuscitation training and 184.0± 88.2 in the subjects having no such training (P<0.001). Conclusion: The ratio of first aid instructions, including DA-CPR, among total usage of the 119 ESCC increased but the overall usage of the 119 ESCC decreased. Therefore, further efforts will be needed to improve the quality and professionality of the information provided through the operation of 119 ESCC.

A comparison of sinus conversion rates and body weight after 6mg adenosine administration in supraventricular tachycardia

안주호,양희원,김혁훈 대한응급의학회 2022 대한응급의학회 학술대회초록집 Vol.2022 No.2

Predictors of poor prognosis in patients with heat stroke

천재권,최상천,김혁훈,양희원,김창성 대한응급의학회 2019 Clinical and Experimental Emergency Medicine Vol.6 No.4

Objective The predictors of poor prognosis in heat stroke (HS) remain unknown. This study investigated the predictive factors of poor prognosis in patients with HS. Methods Data were obtained and analyzed from the health records of patients diagnosed with heat illness at Ajou university hospital between January 2008 and December 2017. Univariate and multivariate analyses were performed to identify the independent predictors of poor prognosis. Results Thirty-six patients (median age, 54.5 years; 33 men) were included in the study. Poor prognosis was identified in 27.8% of the study population (10 patients). The levels of S100B protein, troponin I, creatinine, alanine aminotransferase, and serum lactate were statistically significant in the univariate analysis. Multiple regression analysis revealed that poor prognosis was significantly associated with an increased S100B protein level (odds ratio, 177.37; 95% confidence interval, 2.59 to 12,143.80; P=0.016). The S100B protein cut-off level for predicting poor prognosis was 0.610 μg/L (area under the curve, 0.906; 95% confidence interval, 0.00 to 1.00), with 86% sensitivity and 86% specificity. Conclusion An increased S100B protein level on emergency department admission is an independent prognostic factor of poor prognosis in patients with HS. Elevation of the S100B protein level represents a potential target for specific and prompt therapies in these patients.