Dong Ryul Ko

Use of Bedside Sonography for Diagnosing Acute Epiglottitis in the Emergency Department A Preliminary Study

The purpose of this study was to investigate the ability of sonography to identify acute epiglottitis in the emergency department.

Usefulness of the Delta Neutrophil Index as a Promising Prognostic Marker of Acute Cholangitis in Emergency Departments.

Purpose: Recent technological advances have led to analyses of the delta neutrophil index (DNI), which reflects the fraction of circulating immature granulocytes, using specific automated blood cell analyzers. We evaluated the significance of the DNI as a prognostic marker for early severity in patients with acute cholangitis. Methods: We retrospectively analyzed patients initially diagnosed with acute cholangitis at emergency department admission, followed by diagnostic confirmation, during a set period. The DNI was determined on each day of hospitalization. Clinical outcomes were the incidence of shock requiring vasopressor/inotrope and 28-day mortality. Results: We included 461 patients who met our inclusion criteria. According to multivariate Cox proportional hazard models, higher DNI at admission (hazard ratio [HR]: 1.102; 95% confidence interval [CI]: 1.053–1.153; P < 0.001), day 1 (HR: 1.069; 95% CI: 1.018–1.122; P = 0.008), and day 2 (HR: 1.118; 95% CI: 1.053–1.186; P < 0.001) were significant risk factors for 28-day mortality. Among patients with acute cholangitis, a DNI > 4.9% at admission (HR: 5.632; 95% CI: 1.977–16.045; P = 0.001) and day 1 (HR, 9.973; 95% CI: 2.666–37.302; P < 0.001) and higher DNI ( > 2.5%) on day 2 (HR, 16.942; 95% CI: 2.15–133.496; P = 0.007) were associated with increased 28-day mortality. Conclusion: Higher DNI levels are predictive markers of hemodynamic instability and 28-day mortality in patients with acute cholangitis. The accuracy of DNI for predicting hemodynamic instability and 28-day mortality is superior to that of other parameters.

Effects of Paraquat Ban on Herbicide Poisoning-Related Mortality

Purpose In Korea, registration of paraquat-containing herbicides was canceled in November 2011, and sales thereof were completely banned in November 2012. We evaluated the effect of the paraquat ban on the epidemiology and mortality of herbicide-induced poisoning. Materials and Methods This retrospective study analyzed patients treated for herbicide poisoning at 17 emergency departments in South Korea between January 2010 and December 2014. The overall and paraquat mortality rates were compared pre- and post-ban. Factors associated with herbicide mortality were evaluated using logistic analysis. To determine if there were any changes in the mortality rates before and after the paraquat sales ban and the time point of any such significant changes in mortality, R software, version 3.0.3 (package, bcp) was used to perform a Bayesian change point analysis. Results We enrolled 2257 patients treated for herbicide poisoning (paraquat=46.8%). The overall and paraquat poisoning mortality rates were 40.6% and 73.0%, respectively. The decreased paraquat poisoning mortality rate (before, 75% vs. after, 67%, p=0.014) might be associated with increased intentionality. The multivariable logistic analysis revealed the paraquat ban as an independent predictor that decreased herbicide poisoning mortality (p=0.035). There were two major change points in herbicide mortality rates, approximately 3 months after the initial paraquat ban and 1 year after complete sales ban. Conclusion This study suggests that the paraquat ban decreased intentional herbicide ingestion and contributed to lowering herbicide poisoning-associated mortality. The change point analysis suggests a certain timeframe was required for the manifestation of regulatory measures outcomes.

A bibliometric analysis of research productivity of emergency medicine researchers in South Korea

Objective During the past 20 years, over 1,400 doctors have been certified as emergency physicians in Korea. The number of scientific publications in the field of emergency medicine has also increased. This study aims to evaluate the research productivity of academic emergency physicians in South Korea. Methods Articles published from 1996 to 2015 by authors affiliated with Korean emergency departments were retrieved using Pubmed, Embase, and Web of Science. Research productivity was analyzed quantitatively to ascertain the number of articles for publication type and year. The performance of these articles was also analyzed qualitatively using impact factor, citation number, and Hirsch index. Bibliometric analysis was performed by researching Web of Science, Scopus, and Google Scholar. Results A total of 858 articles with 293 Korean authors as the first or corresponding authors were published across 191 journals. The number of publications increased continuously. The most common publication type was original article (n=618), the most commonly studied research topic was resuscitation medicine (n=110), and the average impact factor of the original articles was 2.158. The highest h-index was 17 and, using Web of Science, the maximum number of citations was found to be 85. Conclusion This study suggests that the research productivity of Korean authors in the emergency medicine field has progressed steadily during the last 10 years. However, qualitative indexes, such as the number of citations and h-index value, remain low.

Usefulness of the delta neutrophil index as an ancillary test in the emergency department for the early diagnosis of suspected acute promyelocytic leukemia

Abstract The delta neutrophil index (DNI) reflects the fraction of circulating immature granulocytes. We evaluated the usefulness of DNI values in patients with acute myeloid leukemia (AML) to distinguish the acute stage of acute promyelocytic leukemia (APL). We analyzed patients retrospectively who were first diagnosed with AML upon admission to the emergency department (ED). Thirty of the 134 patients (22.4%) were diagnosed with APL on ED admission. The univariate analysis and multivariate logistic regression models revealed that DNI values differed significantly between APL and non-APL AML patients on days 0, 1 and 2. Increased predictability for APL was associated with a DNI greater than 24.2% on ED admission, greater than 23.6% on day 1 and greater than 44% on day 2 in patients with AML. DNI values of patients with AML could discriminate the acute stage of APL from AML for immediate initiation of all-trans retinoic acid therapy.

Flipped-classroom training in advanced cardiopulmonary life support

Background The effects of the flipped classroom have been demonstrated in various fields of education in recent years. Training in emergency medicine is also beginning to gradually implement the flipped classroom; however, its practical effect in emergency medicine contexts is not yet clear. Objective The present study investigates the effects of the flipped classroom on advanced cardiopulmonary life support (ACLS) training implemented among practicum students in emergency medicine. Methods The study randomly assigned into control and experimental conditions 108 fourth year students in the College of Medicine at Yonsei University, in Seoul, who were scheduled to take clinical practice in emergency medicine between March and July 2017. Students were taught about ACLS in either a traditional lecture-based classroom (control condition) or a flipped classroom (experimental condition); then, simulation training with ACLS scenarios was carried out. Finally, each student was rated on performance using a rating form developed in advance. Results ACLS simulation scores of the students in the flipped classroom were 70.9±10.9, which was higher than those of the students in the traditional classroom (67.1±11.3); however, this difference was not statistically significant (p = 0.339). In addition, the difference in student satisfaction as measured on a survey was statistically insignificant (p = 0.655). Conclusions Competency assessment after simulation-based training in ACLS undergone by senior medical students randomly assigned to flipped and traditional classrooms showed no statistical difference in competency between the two groups.

Simulated internal jugular vein cannulation using a needle-guiding device

Background: Using a two‐dimensional ultrasound‐guided approach does not guarantee success during the first attempt at internal jugular vein cannulation. Our randomized, parallel simulation study examined whether a new disposable device could improve the success rate of the first attempt at ultrasound‐guided internal jugular vein cannulation of a simulated internal jugular vein. Methods: Eighty‐eight participants were randomized to perform needle insertion for internal jugular vein cannulation of a phantom using the ultrasound‐guided approach with (case group) or without (control group) this new device. The primary outcome was the success rate of the first attempt. The secondary outcome was the frequency of mechanical complications such as arterial puncture and posterior wall puncture, procedure time, and level of difficulty. Results: Among 44 participants using the device, 33 (75.0%) achieved successful cannulation on the first attempt. However, only 12 (27.3%) of the 44 participants not using the device recorded success during the first attempt (risk difference, 0.477; 95% confidence interval [CI] 0.294–0.661; P < 0.001). The number of attempts was significantly lower (risk difference, −3.955; 95% CI, −5.014 to −3.712; P < 0.001) when participants performed cannulation with the device (1.63 ± 1.71) than without the device (5.59 ± 5.78). Our study also showed that participants were comfortable when performing the ultrasound‐guided approach with the new device (risk difference, −1.955; 95% CI, −2.016 to −1.493; P < 0.0001). Conclusions: The new disposable device was effective for successful first attempts at needle insertion during ultrasound‐guided internal jugular vein cannulation. Future clinical trials are needed to assess the effectiveness of this device.