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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 purpose of this study was to identify the degree of satisfaction with indirect medical oversight programs and its determinants. Methods: Gumi 119 rescuers participated in indirect medical oversight programs, including Emergency Medical Services (EMS) record review, weekly visiting education, and monthly EMS conference from March 2012 to February 2013. Data were collected using a mail survey with a selfadministered questionnaire. The degree of satisfaction with the programs was categorized according to two groups (1=satisfied, 2=unsatisfied). Then the Mann-Whitney U test and Fisher`s exact test were performed in order to find statistically significant factors influencing satisfaction. Results: Cronbach αof questionnaires was 0.869. Among the 59 questionnaires, 55(93.2%) were returned. No differences in sex, age, career, EMS record review, monthly conference, linkage with direct medical direction, and improvement of confidence in ER medical team were observed between the two groups. Qualification, weekly visiting program, and improvement in reliability to hospital showed statistical significance (p=0.017, 0.040 and 0.001, respectively). Conclusion: The level of qualification of 119 rescuers and weekly visiting education at the fire department by doctors has had a significant influence on satisfaction with indirect medical oversight.
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.
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)
이수형 ( Soo Hyung Lee ), 박홍인 ( Hong In Park ), 최마이클승필 ( Michael Sung Pil Choe ), 제동욱 ( Dong Wook Je ), 노우영 ( Woo Young Nho ), 김성훈 ( Seong Hun Kim ), 이미진 ( Mi Jin Lee ), 안재윤 ( Jae Yun Ahn ), 문성배 ( Sung Bae Moon ) 대한임상독성학회 2016 대한임상독성학회지 Vol.14 No.2
Purpose: In patients with altered mentality caused by drugs or unknown causes, ammonia is checked to facilitate differential diagnosis or diagnose hepatic coma. This helps early prevention and treatment of brain damage due to hyperammonemia. This study was conducted to evaluate clinical characteristics of intoxicated adult patients with hyperammonemia. Methods: We evaluated 95 patients with hyperammonemia among intoxicated patients above the age of 15 who visited our ED from January 2013 to December 2015. We analyzed the demographic characteristics and type of poisoning substance, reason for ingestion, toxicological characteristics such as elapsed time from ingestion to hospital visit, lab, clinical progression and complications. Data were evaluated using the student`s t test or Mann-Whitney U test for continuous variables, and Chi-square test and Fisher`s exact test for frequency analysis of categorical variables. Results: When compared to healthy individuals, patients with hyperammonemia showed statistical significance on their SOFA score (p=0.016) and poison severity score (p<0.001). Additionally, patients with hyperammonemia showed significantly different initial serum AST level (p=0.012) and maximum serum AST level during the hospital stay (p=0.026) when compared to healthy individuals. Moreover, individuals with sustained hyperammonemia compared to transient hyperammonemia showed clinically significant SOFA scores (p<0.001), poison severity scores (p=0.007), mortality rates in the ICU (p=0.021), as well as different duration of hospital stay (p=0.037), serum creatinine level (p=0.002), erythrocyte sedimentation rate (p=0.025), and serum myoglobin (p=0.015). Conclusion: Most poisoning-induced hyperammonemia cases were transient and recovered without special treatment. Therefore, hyperammonemia is almost non-specific among poisoning patients.
이경화 ( Kyung Wha Lee ), 박용석 ( Yong Seok Park ), 최마이클승필 ( Michael Sung Pil Choe ), 제동욱 ( Dong Wook Je ), 김성훈 ( Seong Hun Kim ), 노우영 ( Woo Young Nho ), 박홍인 ( Hong In Park ), 신수정 ( Su Jeong Shin ), 이미진 ( Mi Jin L) 대한응급의학회 2018 大韓應急醫學會誌 Vol.29 No.2
Objective: Syncope is mostly benign, but it can also be caused by a life-threatening situation. In Korea, no studies have investigated application of the Canadian Syncope Risk Score (CSRS) to patients with syncope; therefore, this study was started to evaluate the usefulness of CSRS. Methods: A total of 222 patients who visited the emergency room with syncope for one year from January 2016 to December 2016 were enrolled in this study. Patients were divided into two groups, a serious adverse events (SAE) group and a non-serious adverse events group. The scores of the nine CSRS variables were added and the CSRS was then calculated after the addition. Results: The CSRS score for patients with SAE ranged from 0 to 8. The CSRS score was 18.6%, 31.7%, 55.6%, and 58.8% for 0, 1, 2, and 3, respectively. In the case of CSRS 0 and 1, 17 patients (81.0%) and 11 patients (84.6%) were non-cardiac. In the case of CSRS 2, 7 were non-cardiac (70.0%). In the case of CSRS 3, 6 cases (60.0%) were cardiogenic and 4 cases (40.0%) were non-cardiogenic. The area under the receiver operating characteristic curve of CSRS to predict SAE was 0.71. Setting the CSRS cutoff value to 0, we found that sensitivity and specificity of predicting SAE was 67.19% and 67.09%, respectively. Conclusion: CSRS may be difficult to predict for acute intracranial disease or acute hemorrhagic disease requiring transfusion; therefore, it is necessary to supplement it further.
김영갑 ( Young Gab Kim ), 이주택 ( Ju Taek Lee ), 박상현 ( Sang Hyun Park ), 이찬희 ( Chan Hee Lee ), 최마이클승필 ( Sung Pil Choe ), 제동욱 ( Dong Wook Je ), 이창재 ( Chang Jae Lee ), 고대이 ( Taei Ko ), 조혜정 ( Hye Jung Jo ) 대한임상독성학회 2013 대한임상독성학회지 Vol.11 No.2
Purpose: The purpose of this study is to verify the influence of a massive hydrofluoric acid spill on community health through patients who claimed to have been exposed. Methods: We analyzed 2459 patients who visited our emergency department with the claim of exposure to hydrofluoric acid, and retrospective analyses were performed. We analyzed changes in numbers of visitors per day from the day of the accidental hydrofluoric acid spill, symptoms presented by the 1924 patients, and general characteristics. Comparisons of symptoms and hematologic characteristics were made between the initially set evacuation zone(1.3 km radius parameters from the spill) and the outer zone. Results: A total of 2,459 patients who claimed exposure visited our ED from 27 September 2012 to 23 October 2012, and there was a significant increase in the number of visiting patients from day 8 of the hydrofluoric acid spill. The most common complaints were a sore throat, 729(37.9%) and no specific symptom with health concern, 547 (28.4%). Statistically significant findings were pulmonary symptoms (p=0.001), nasal symptoms (p=0.001), diarrhea (p=0.023), and skin symptoms (p=0.007). In hematologic study, a statistically significant difference was observed in white blood cell count (p=0.018), creatine phosphokinase (p<0.001), erythrocyte sediment rate (p=0.013), and phosphorus (p<0.001). Conclusion: A significant increase in the number of patients was observed one week after the accidental spill of hydrofluoric acid. The most frequent symptoms were sore throat, headache, cough, and sputum. Statistically significant increase in creatine phosphokinase level and decrease in phosphorus level were noted in patients within the evacuation zone.
이주택 ( Ju Taek Lee ), 박상현 ( Sang Hyun Park ), 이찬희 ( Chan Hee Lee ), 김영갑 ( Yung Kap Kim ), 이창재 ( Chang Jae Lee ), 제동욱 ( Dong Wook Je ), 고대이 ( Ta Ei Ko ), 최마이클승필 ( Michael Sung Pil Choe ), 김옥준 ( Ok Jun Kim ) 대한응급의학회 2013 大韓應急醫學會誌 Vol.24 No.6
Purpose: This study examined the effect of indirect medical oversight on the quality of prehospital emergency care by emergency medical technicians. Methods: Indirect medical oversight was applied for a year and 119 rescue run sheets were retrospectively analyzed before and after the program to study the effect of an indirect medical oversight program in one city. The general characteristics of patients who visited hospitals before and after the program were analyzed, along with patient evaluation records, personal data, outbreak patterns, transfer information, direct medical oversight, and emergency medical services (EMS) mobilization reports. In addition, by comparing medical records and the 119 rescue run sheets, changes in the accuracy of 119 rescue run reports, the adequacy of patient classification, and the adequacy of medical direction were analyzed. After gathering these data, statistical analysis was performed and the level of significance was defined as p<0.05. Results: After executing the indirect medical oversight, there was significant improvement in the accuracy of 119 rescue run sheets (p<0.001) and in the consistency of severity classification in 119 rescue run sheets compared with medical records (p=0.016). The adequacy of direct medical oversight request also showed improvement after the indirect medical oversight took effect (p<0.001). However, there was no statistical significance in prehospital procedures. Conclusion: Indirect medical oversight significantly improved the quality of emergency medical service by emergency medical technicians. However, the further application and improvement of indirect medical oversight programs are required for the development of prehospital emergency medical care.
김철수 ( Chul Soo Kim ), 박홍인 ( Hong In Park ), 이중호 ( Jung Ho Lee ), 정운혁 ( Woon Hyuk Jung ), 이수형 ( Soo Hyung Lee ), 노우영 ( Woo Young Nho ), 김성훈 ( Seong Hun Kim ), 제동욱 ( Dong Wook Je ), 최마이클승필 ( Michel Sung Pil Cho) 대한응급의학회 2016 大韓應急醫學會誌 Vol.27 No.6
Purpose: We aimed to evaluate whether the modified Alvarado score-which is currently being used to diagnose acute appendicitis-can be applicable in the diagnosis of diseases in pregnant women. Methods: We retrospectively analyzed the medical records of 252 pregnant women who visited our emergency department (ED) with a chief complaint of abdominal pain and a suspicion of acute appendicitis, and ultimately underwent appendix ultrasonography or appendix magnetic resonance imaging (MRI). The modified Alvarado score was calculated for each pregnant woman. A receiver operating characteristic (ROC) curve was drawn for each subject, those in the first trimester, second trimester, and third trimester, from which the best cut-off value, sensitivity and specificity were induced. Results: For all 252 pregnant women who visited our ED, the area under the curve was 0.742 (p<0.001), with sensitivity and specificity of 75.41% and 62.30%, respectively, when using the value of 5 as the cut-off point for the modified Alvarado score. The area under the curve was 0.811 (p<0.001) for those in their first trimester and 0.749 (p<0.001) for those in the second trimester, while it was 0.641, with the p-value of 0.109, for those in the third trimester. Conclusion: There is a limitation using the modified Alvarado score alone in pregnant woman, and if there is uncertainty in the diagnosis, other imaging studies, such as appendix ultrasonography or appendix MRI, should be considered.