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성애진 ( Ae Jin Sung ), 이경우 ( Kyung Woo Lee ), 소병학 ( Byung Hak So ), 이미진 ( Mi Jin Lee ), 김현 ( Hyun Kim ), 박경혜 ( Kyung Hye Park ), 박정배 ( Jeong Bae Park ), 염석란 ( Seok Ran Yeom ), 오성범 ( Seong Beom Oh ), 유지영 ( Ji You) 대한임상독성학회 2012 대한임상독성학회지 Vol.10 No.1
Purpose: The purpose of this study was to examine the occurrence of toxic exposure cases in Korean emergency centers using a toxic exposure surveillance system-based report form and to provide guidelines for the prevention and treatment of toxic exposures. Methods: We retrospectively reviewed the medical records of toxic exposure patients who had visited emergency centers from January 2009 to December 2009. Epidemiology data points for the toxic exposure cases included age, gender, type of exposure, number and kind of substances involved, reason and route of poison exposure, manage-ment of the patients in the emergency departments, and the clinical outcome. Results: A total of 3,501 patients from 12 emergency departments were enrolled in the study. 50.0% of the total exposure patients were male and 63.0% of the total cases were fatal. Acute intoxication occurred in 91.3% of the total patients and suicidal intent was the most common (43.3%) reason for exposure. The most common route of exposure was ingestion (75.9%). Of the total cases, pesticides were involved in 26.3%, sedatives/hypnotics/antipsychotics were involved in 22.0%, and bites and envenomations were involved in 15.7%. Conclusion: We provided a database of patients who were admitted to emergency departments after poisoning incidents. We recommend that toxicology professionals develop a classification scheme for toxicants which is adequate for Korean domestic circumstances and initiate a toxic surveillance system for all types of exposures. With support of a psychiatric surveillance system for suicidal patients and establishment of social mediation for pesticide poisoning, major reductions in poison exposures can be achieved.
성애진 ( Ae Jin Sung ), 류현욱 ( Hyun Wook Ryoo ), 서강석 ( Kang Suk Seo ), 박정배 ( Jeong Bae Park ), 정제명 ( Jae Myung Chung ), 이원기 ( Won Kee Lee ), 조용근 ( Yong Keun Cho ), 서준석 ( Jun Seok Seo ), 제동욱 ( Dong Wook Je ), 김창호 () 대한응급의학회 2007 大韓應急醫學會誌 Vol.18 No.6
Purpose: To stratify the risk of syncope by analyzing related risk factors of patients with possibly serious etiology who visit the emergency room with syncope. Methods: We studied 201 patients who visited the emergency room of Kyungpook National University Hospital with syncope from January 2004 to December 2006. We defined serious etiology as arrhythmia, angina pectoris, myocardial infarction, septic shock, meningitis, cerebral infarction, subarachnoid hemorrhage, brain tumor, significant hemorrhage, and malfunction of cardiac pacemaker requiring immediate treatment and intervention. We analyzed the relationship between 81 risk factors and serious etiology to stratify the risk for patients with syncope. Results: The patient group consisted of 105 males and 96 females with an average age of 56.4±20.7 years. Fifty-four patients had serious etiology. Among the 81 risk factors, those identified through univariate and multivariate analysis as having high predictive sensitivity and specificity were shortness of breath (odds ratio [OR]: 18.34, 95% confidence interval [CI]: 5.59-60.16); abnormal electrocardiography OR: 10.29, 95% CI: 1.43-74.33); hematocrit <28.3% (OR: 9.64, 95% CI: 3.47-26.73); age ≥47 years (OR: 6.24, 95% CI: 1.14-34.17); and admission via an out-patient department or by transfer from outside hospital (OR: 4.07, 95% CI: 1.15-14.36). Conclusion: Risk factors correlated with serious etiology for syncope are shortness of breath, abnormal electrocardiography, hematocrit <28.3%, age ≥47 years, and admission via an out-patient department or transfer from an outside hospital.
박성욱 ( Sung Wook Park ), 임용수 ( Yong Su Lim ), 김진주 ( Jin Joo Kim ), 김재광 ( Jae Kwang Kim ), 양혁준 ( Hyuk Jun Yang ), 현성열 ( Sung Yoel Hyun ), 류일 ( Eell Ryoo ), 성애진 ( Ae Jin Sung ) 대한응급의학회 2008 大韓應急醫學會誌 Vol.19 No.6
Purpose: Biochemical markers can help predict neurological outcome in post-resuscitation patients. This prospective study evaluated the prognostic value of serum S100B protein and neuron-specific enolase (NSE) time courses in predicting unfavorable neurological outcomes. Methods: We serially measured serum S100B protein and NSE levels 12 times during the 96 h after the return of spontaneous circulation (ROSC) in 40 patients. Neurological outcome was assessed at 6 months after cardiac arrest. Patients were divided into good (CPC 1 to 2) and poor (CPC 3 to 5) neurological outcome groups and assessed for cerebral performance category scores. We compared the two groups at each serum value and calculated cut-off values. Results: Serum S100B protein levels over the study period, except at 4 hours, and NSE levels from 14 hours after ROSC were significantly higher in the poor neurological outcome group (n=32) than the good neurological outcome group (n=8). The most predictive serum S100B protein and NSE times were at 14 hours (cut off value=0.16 μg/L, sensitivity 81.8%, specificity 100%, AUC=0.938) and 54 hours (cut off value=19.21 μg/L, sensitivity 86.4%, specificity 100%, AUC=0.932). Conclusion: Serum S100B protein and NSE levels are early and useful markers for assessing neurological outcome after successful resuscitation from cardiac arrest.
정영보 ( Young Bo Chung ), 김진주 ( Jin Joo Kim ), 김재혁 ( Jae Hyuk Kim ), 임용수 ( Yong Su Lim ), 조진성 ( Jin Sung Cho ), 현성열 ( Sung Ryul Hyun ), 성애진 ( Ae Jin Sung ), 양혁준 ( Hyuk Jun Yang ) 대한응급의학회 2011 大韓應急醫學會誌 Vol.22 No.1
Purpose: To determine the correlation and agreement between perpheral venous and arterial values in emergency department patients Methods: The study was conducted at an urban teaching hospital emergency department with an annual volume of 80,000 patient visits. Prospective comparison of paired peripheral venous and arterial values were evaluated from October, 2009 to February, 2010. Peripheral venous and arterial samples were taken as simultaneously as possible when patients who were deemed by the attending doctor to require an peripheral arterial sample presented in the emergency department. Collected information included age, sex, vital signs, emergency department initial diagnosis, lactate, pH, base excess, bicarbonate, pO2, and pCO2. Statistical methods were Shapiro-Wilk test, Spearman rho test, linear regression analysis, and Bland-Altman plots. Results: Among the 546 patients, 50 were excluded and 496 were included. The majority (59.5%) of patients were male. Correlation constant (rho) of pH and lactate were 0.907 and 0.901, respectively. Mean difference and CI (confidence interval) of pH were -0.04 and -1.34~1.56, respectively. Mean difference and CI of lactate were 0.11 mmol/L and -0.15~0.07 mmol/L, respectively. Conclusion: Moderate correlation and agreement between perpheral venous and arterial pH, lactate, base excess, and CO2 was evident. Especially, peripheral venous pH, lactate correlated very well and had reasonable agreement with peripheral arterial values to serve as substitutes.
Purpose: This study aimed to determine new criteria for detecting independent factors with high sensitivity in cases of cervical spine injury. We compared the sensitivity, the specificity, and the false negative predictive value (NPV) of plain radiographs with those of computed tomography for cervical spine injury in patients with minor head injury. Methods: We retrospectively reviewed the cases of 357 patients who underwent both cervical plain radiographs and computer tomography from January 2006, to September 2008. Patients were divided into two groups: the cervical spine injury group and the no cervical spine injury group. New criteria were organized based on variables that had significant differences in the logistic regression test. Results: Among the 357 patients, 78 patients had cervical spine injuries. The average age was 43.9±15.2 yrs old, and the male-to-female ratio was 1.90. The most common mechanism of injury was motor vehicle accidents. There was a significant difference in loss of consciousness, Glasgow Coma Scale (GCS)=14, neurologic deficit, posterior neck tenderness, and abnormality of the cervical plain radiographs between the two groups on the logistic regression test. New criteria included the above five variables. If a patient has at least variable, the area under the ROC curve of the new criteria was 0.850, and the sensitivity and the false NPV were 87.2% and 5.2%, respectively. Conclusion: New criteria included loss of consciousness, GCS=14, neurologic deficit, posterior neck tenderness, and abnormality of the cervical plain radiographs. If the patient had at least 1 variable, he or she could have a of cervical spine injury with a sensitivity of 87.2% and a false NPV of 5.2%. (J Korean Soc Traumatol 2009;22:154-60)
소병학 ( Byung Hak So ), 이미진 ( Mi Jin Lee ), 김현 ( Hyun Kim ), 문정미 ( Jeong Mi Moon ), 박경혜 ( Kyung Hye Park ), 성애진 ( Ae Jin Sung ), 염석란 ( Seok Ran Yeom ), 오성범 ( Seong Beom Oh ), 유지영 ( Ji Young You ), 이경우 ( Kyung Wo) 대한임상독성학회 2010 대한임상독성학회지 Vol.8 No.2
Purpose: The aim of this study was to investigate toxic exposures in emergency centers with using a toxic exposure surveillance system-based report form as a preliminary study. Methods: We retrospectively reviewed the medical records of toxic exposure patients who visited emergency centers from January to December 2008. Results: 3,157 patients from 11 emergency centers were enrolled. Males were involved in 47.9% of the total cases of exposure and in 60.1% of the cases of fatal exposure. Suicidal intent was the most common (61.0%) reason and most (87.4%) fatal exposures were suicidal. Pesticides were involved in 30.7% of the cases and sedative/hypnotics/ antipsychotics were involved in 20.5%. The substances most frequently involved in fatalities were pesticides, and a 48.4% fatality rate was recorded for paraquat exposure. Conclusion: The toxic exposure data showed the preliminary poisoning events in emergency centers. It is recommended that toxicology professionals should develop a toxic surveillance system and serial reporting should be performed.
제동욱 ( Dong Wook Je ), 김창호 ( Chang Ho Kim ), 성애진 ( Ae Jin Sung ), 서준석 ( Jun Seok Seo ), 류현욱 ( Hyun Wook Ryoo ), 박정배 ( Jeong Bae Park ), 정제명 ( Jae Myung Chung ), 서강석 ( Kang Suk Seo ) 대한응급의학회 2007 大韓應急醫學會誌 Vol.18 No.6
Purpose: To compare differences in overall satisfaction with emergency department (ED) services with the results obtained 10 years previously, in order to study effects of several component factors on patients` willingness to re-visit and to give recommendations. Methods: This study was performed with questionnaires from 318 patients and proxies who were admitted to the emergency ward through the emergency medical center from February 19th, 2007 to March 18th, 2007. Evaluation of data was by frequency analysis, chi-square test, t-test, multiple regression analysis, and path analysis. Results: During a one month study period, 244 patients and proxies (77% of those eligible) completed on-site questionnaires. Sociodemographic factors had no statistically significant influence on satisfaction with ED services. In multiple regression analysis to evaluate the correlation of various factors with satisfaction, the regression coefficients were 0.435(p<0.001) for reliability, 0.248(p<0.001) for accessibility, 0.179(p<0.001) for kindness, and 0.133(p=0.004) for environmental respectively. In path analysis, the direct effect of overall satisfaction on patient willingness for re-visit was 0.582. The direct effect of overall satisfaction reliability on willingness to give recommendations were 0.594, and 0.250 respectively. Conclusion: In slight contrast to the study performed 10 years previously, the factors with the most correlation to overall satisfaction with ED services in this study were environment, kindness of hospital personnel, accessibility, and reliability of medical personnel. We confirmed that overall satisfaction is the most important factor influencing willingness for re-visit and willingness to recommend services, but found that the component factors vary as the point of survey or hospital conditions changes.
Purpose: The prevalence of intoxication and toxidromes, such as altered mental status, from Sedatives/hypnotics is high. Many patients have been transferred to a higher-level emergency center. This study was designed to analyze the clinical features of these patients and to compare patients transferred from a regional hospital with patients who directly visited a higher-level emergency center. Methods: A retrospective study was conducted on 298 sedative/hypnotic intoxication patients examined from January 2008 to December 2012. After excluding patients intoxicated from other category medications and missing data on medical records, 158 acute intoxication patients were enrolled in the study and divided into transferred and direct-visit groups. Gastric lavage patients (n=108) were also subdivided into two groups by irrigation site. Clinical features, treatments, and complications were investigated. Results: There were no significant differences between the two groups in initial clinical manifestations, laboratory data, and toxicological information, except for charcoal treatment and complications from pneumonia. The use of charcoal was significantly lower in the group transferred from a regional medical center. The transferred group showed a higher incidence of pneumonia than the direct-visit group (10/54(18.5%) vs. 5/104(4.8%), respectively, p=0.007). In the subgroup analysis of gastric lavage patients, there was also a higher incidence of pneumonia in the regional hospital lavage group compared to the higher-level emergency center lavage group (8/32(25.0%) vs. 5/76(6.6%), respectively, p=0.011). From a comparative analysis of pneumonic complications and mental status, pneumonia patients showed a higher incidence of painful responses and unresponsive mentality (6(40.0%) and 4(26.7%), respectively, p<0.001). Conclusion: In acute sedative/hypnotic intoxication patients, transferred patients, including regional hospital gastric lavage patients, showed a higher incidence of pneumonia. Pneumonic complication patients showed a higher incidence of a decreased mentality. Therefore, for patients transferred or treated for an altered mental status, precautions for complications from pneumonia must be considered.
Purpose: Organophosphate poisoning is a worldwide concern and there have been many reports describing the factors affecting the severity and prognosis resulting from its toxicity. This study aims to investigate if C-reactive protein is a useful independent predictor of mortality in organophosphate poisoning patients. Methods: This retrospective study targeted organophosphate intoxication patients who were admitted to the emergency department of Samsung Changwon Hospital from January 1st, 2006 to December 31st, 2010. The data was retrospectively collected from clinical records and laboratory files, and using multivariate logistic analysis, the total population data was retrospectively analyzed for its association with mortality. Results: A total of 70 patients were enrolled in this study. Of the 70, 53 survived and 17 died. Significant clinical factors such as age, mean arterial pressure, Glasgow coma scale score, respiratory rate, PaO2/FiO2, hematocrit, albumin, glucose and C-reactive protein (measured 24 hours after admission) were associated with mortality. The fatality rate resulting from organophosphate poisoning was 24.3%, and there was an increase observed in the mortality rate of patients with higher C-reactive protein at 24 hours after admission. Conclusion: The initial serum C-reactive protein and acetylcholinesterase results had no significant association with the severity of acute organophosphate poisoning. However, Creactive protein results after 24 hours were significant independent predictors of mortality in the total population of patients afflicted with acute organophosphate poisoning.
김창호 ( Chang Ho Kim ), 박정배 ( Jung Bae Park ), 류현욱 ( Hyun Wook Ryoo ), 서강석 ( Kang Suk Seo ), 서준석 ( Jun Seok Seo ), 정제명 ( Jae Myung Chung ), 제동욱 ( Dong Wook Je ), 성애진 ( Ae Jin Sung ) 대한외상학회 2007 大韓外傷學會誌 Vol.20 No.2
Purpose: This research was conducted to study whether the specific location of pelvic-bone fractures could increase the risk for injury to the urinary bladder, urethra, or lower gastrointestinal tract. Methods: We retrospectively reviewed the data of 234 patients with pelvic-bone fractures who visited the emergency department of Kyungpook National University Hospital from January 2004 to December 2006. The location of the pelvic-bone fracture was divided into 8 parts. The association of fracture location with injury to the urinary bladder, urethra, or lower gastrointestinal tract was analyzed with Fisher`s-exact test and multiple logistic regression. Results: Nineteen(19) patients had urinary bladder injury, 8 had urethral injury, and 9 had lower gastrointestinal tract injury. The following fracture locations were found to be significant; urinary bladder: sacroiliac (SI) joint (p<0.001), symphysis pubis (p=0.011), and sacrum (p=0.005); urethra: SI joint (p=0.020); lower gastrointestinal tract: symphysis pubis (p=0.028). After the multiple logistic regression analysis, the primary and the independent predictors for each of the injuries were as follows; urinary bladder: sacroiliac joint (p=0.000, odds ratio [OR]=10.469); lower gastrointestinal tract: symphysis pubis (p=0.037, OR=7.009). Conclusion: Consideration of further workup for injuries to the lower gastrointestinal and urinary tract is needed for some locations of pelvic-bone fractures because certain pelvic-bone fracture locations, especially the sacroiliac joint and the symphysis pubis, are associated with increased risk for injury to the lower gastrointestinal and urinary tracts. (J Korean Soc Traumatol 2007;20:90-95)