Hyun Noh

Initial Base Deficit as Predictors for Mortality and Transfusion Requirement in the Severe Pediatric Trauma Except Brain Injury

Objective: The initial base deficit (BD) is an important indicator of shock in adult trauma patients, but its value is unclear in pediatric trauma patients. This study assessed the ability of the initial BD to predict mortality and blood transfusion requirements in children except severe brain injury patients. Methods: This study was a retrospective review of pediatric patients with severe trauma arriving at the emergency department of a university hospital from January 1998 to June 2005. Blood pressure, the initial BD, and the Injury Severity Score were assessed as independent predictors of mortality and the blood transfusion requirement using multiple regression analysis. Results: The study group constituted 102 patients. According to the multiple regression analysis results, the initial systolic blood pressure, Injury Severity Score, and blood transfusion requirement were not independent predictors of mortality (P = 0.104, 0.959, 0.386, respectively). By contrast, the initial BD was an independent predictor, with an odds ratio of 13.6 for BD of −8 mEq/L or less (confidence interval [CI], 3.51-35.23, P = 0.037), and systolic blood pressure and BD were independent predictors of blood transfusion requirement; the odds ratio for hypotension was 3.2 (CI, 0.51-8.32, P = 0.044), and the odds ratio was 15.3 for BD values of −8 or less (CI, 2.24-51.43, P = 0.003). Conclusion: The initial BD in pediatric trauma patients except severe brain injury was an independent predictor of mortality and blood transfusion requirement within 24 hours. Mortality and blood transfusion requirement were significantly high when initial BD was less than −8 mEq/L.

Epidemiology of prehospital emergency medical service use in Korean children

OBJECTIVE The aim of this study was to elucidate the epidemiology of pediatric patients transported by the National 119 Rescue Services in Korea. METHODS We enrolled all pediatric patients (<16 years old) who used the National 119 Rescue Services in Korea between January 2006 and December 2008, and analyzed the 119 ambulance patient care record databases. RESULTS The total number of the cases was 238,644 for 3 years. The median age was 6 years old and 59.0% were male, and the 2- to 5-year-old group was the largest (31.0%). The peak transport times were in the afternoon (from 12:00 p.m. to 17:59 p.m., 36.3%), on Saturday and Sunday (15.9% and 15.7%), and in summer (June to August, 27.3%). The ratio of disease versus injury as the cause of the transports was 42.3% vs. 57.7%. Among the 16 metropolitan cities and provinces, Gyeonggi (25.7%), Seoul (17.6%), and Incheon (7.0%) account for almost half of the all transported children. Regarding the annual transport rates per 100,000 children standardized by age, and gender to the Korean child population, Jeju was the largest (1,650.2) followed by Gangwon (1,201.3), and Jeonnam (1,178.1). CONCLUSION This report presents comprehensive epidemiologic data of pediatric patients transported by 119 rescue services in Korea.

Rate of and risk factors for early recurrence in patients with febrile seizures.

Objective Patients with febrile seizures (FSs) are observed in emergency departments or admitted to hospitals because of the possibility of recurrence. There are no guidelines regarding the observation time for recurring FS. The aim of this study was to identify the rate, time, risk factors, and cumulative probability of early recurrence. Patients and Methods This study was a retrospective chart review of patients visiting an emergency department with FS from January to December 2011. Early recurrence was defined as FS recurring within 7 days after the first episode. Patients were divided into 2 groups: early recurrence and nonearly recurrence. The 2 groups were compared in terms of demographics, clinical data, and laboratory findings to identify risk factors for early recurrence. The cumulative probability over time was determined. Results In total, 228 patients were identified. The recurrence rate was 17.5% (40/228), and the median time to recurrence was 6.0 hours (interquartile range, 1.1–13.0 hours). The overall cumulative probability of early recurrence was 8.8% within 6 hours, 12.7% within 12 hours, and 15.8% within 24 hours. Most recurrences (90.0%) occurred within 24 hours of the first FS. Early recurrence occurred frequently in patients with nongeneralized-type seizures or seizures of 15-minute duration or longer. Conclusions The majority of recurrent FSs occurred in the first 24 hours. The type and duration of seizures were significant risk factors for early recurrence.

Validation of the new diagnosis grouping system for pediatric emergency department visits using the International Classification of Diseases, 10th Revision.

Objective A clinically sensible diagnosis grouping system (DGS) is needed for describing pediatric emergency diagnoses for research, medical resource preparedness, and making national policy for pediatric emergency medical care. The Pediatric Emergency Care Applied Research Network (PECARN) developed the DGS successfully. We developed the modified PECARN DGS based on the different pediatric population of South Korea and validated the system to obtain the accurate and comparable epidemiologic data of pediatric emergent conditions of the selected population. Methods The data source used to develop and validate the modified PECARN DGS was the National Emergency Department Information System of South Korea, which was coded by the International Classification of Diseases, 10th Revision (ICD-10) code system. To develop the modified DGS based on ICD-10 code, we matched the selected ICD-10 codes with those of the PECARN DGS by the General Equivalence Mappings (GEMs). After converting ICD-10 codes to ICD-9 codes by GEMs, we matched ICD-9 codes into PECARN DGS categories using the matrix developed by PECARN group. Lastly, we conducted the expert panel survey using Delphi method for the remaining diagnosis codes that were not matched. Results A total of 1879 ICD-10 codes were used in development of the modified DGS. After 1078 (57.4%) of 1879 ICD-10 codes were assigned to the modified DGS by GEM and PECARN conversion tools, investigators assigned each of the remaining 801 codes (42.6%) to DGS subgroups by 2 rounds of electronic Delphi surveys. And we assigned the remaining 29 codes (4%) into the modified DGS at the second expert consensus meeting. The modified DGS accounts for 98.7% and 95.2% of diagnoses of the 2008 and 2009 National Emergency Department Information System data set. This modified DGS also exhibited strong construct validity using the concepts of age, sex, site of care, and seasons. This also reflected the 2009 outbreak of H1N1 influenza in Korea. Conclusions We developed and validated clinically feasible and sensible DGS system for describing pediatric emergent conditions in Korea. The modified PECARN DGS showed good comprehensiveness and demonstrated reliable construct validity. This modified DGS based on PECARN DGS framework may be effectively implemented for research, reporting, and resource planning in pediatric emergency system of South Korea.