Woochan Jeon

Playground Equipment Related Injuries in Preschool-Aged Children: Emergency Department-based Injury In-depth Surveillance

In this study, we investigated playground equipment related injuries in preschool-aged children. This was a retrospective observational study using Emergency Department based Injury In-depth Surveillance, (2011–2014). We included the preschool-aged children with playground equipment related injuries. We surveyed the mechanism and incidence of injuries, and estimated the odds ratio (OR) of traumatic brain injury (TBI) and upper/lower extremities fracture. There were 6,110 patients, mean age was 4.14 ± 1.95 years old. Slide and swing related injuries were 2,475 (40.5%) and 1,102 (18.0%). Fall down (48.5%) was the most common mechanism. The OR of TBI in children 0–2 years old was 1.88 times higher than children 3–7 years old, and in swing was 4.72 (OR, 4.72; 95% confidence interval [CI], 2.37–9.40) times higher than seesaw. The OR of upper extremity fracture in children 3–7 years old was 3.07 times higher than children 0–2 years old, and in climbing was 2.03 (OR, 2.03; 95% CI, 1.63–2.52) times higher than swing. The OR of lower extremity fractures in horizontal bars, tightropes, and trampolines was 2.95 (OR, 2.95; 95% CI, 1.55–5.61) times higher than swing. The most common mechanism and playground equipment were fall down and slide. TBI was associated to younger children (0–2 years old) and swing. Fracture of upper extremities was associated to older children (3–7 years old) and climbing. Fracture of lower extremities was associated to others such as horizontal bars, tightropes, and trampolines.

The Clinical Differences between Urgent Visits and Non-Urgent Visits in Emergency Department During the Neonatal Period

As neonates are brought to the emergency department (ED) for various complaints, it is challenging for emergency physicians to clinically determine the urgency of the visit. We sought to explore clinical characteristics associated with urgent visits to the ED. We conducted a retrospective study by reviewing medical records of neonatal visits to a tertiary pediatric regional emergency center for 5 years. Cases of patients who were discharged after checking only chest or abdominal X-ray or discharged without workup, were classified as non-urgent visits. Cases where more examinations were performed, or when the patient was hospitalized, were classified as urgent visits. Various clinical features and process in the ED were compared between the groups. Of the 1,008 cases enrolled in this study, 856 (84.9%) were urgent and 152 (15.1%) were non-urgent visits. After adjustment by multiple logistic regression analysis, non-urgent visits were associated with self-referrals rather than physician-referrals (odds ratio [OR], 5.96), visits in the evening rather than at night or daytime (OR, 2.51), patient visits from home rather than from medical facilities (OR, 2.19; 95). Fever and jaundice were the most common complaints (25.7% and 24.5%, respectively), and their OR of non-urgent visit was relatively low (adjusted OR 0.03 and 0.03, respectively). However, other common complaints, such as vomiting and cough (7.4% and 7.1%, respectively), were more likely to be non-urgent visits (adjusted OR 2.96 and 9.83, respectively). For suspected non-urgent visits, emergency physicians need to try to reduce unnecessary workup and shorten length of stay in ED.

Effectiveness of a compressive device in controlling hemorrhage following radial artery catheterization

Objective The purpose of this study was to evaluate the effectiveness of a compressive device in controlling hemorrhage following radial artery catheterization. Methods A prospective randomized trial was conducted on subjects receiving the standard taping method (group S) compared to a compressive device method (group C) after removal of the cannula in radial artery catheterization. Primary outcomes were the success rate of hemostasis and complication rate after cannula removal. Secondary outcomes were the cost of compression and the level of convenience. Results A total of 250 subjects were enrolled in this study. Hemostasis after removal was successful in 122 of 125 (97.6%) subjects in group S and 116 of 125 (92.8%) subjects in group C (P=0.18). Complication rates in group S and group C were 55.2% (69/125) and 48% (60/125), respectively (P=0.35). The cost of compression for group C (approximately 6,740 Korean won) was approximately two times cheaper than for group S (approximately 14,140 Korean won). The level of convenience was significantly higher in group C than in group S (7.4±2.1 vs. 3.7±1.9, p < 0.001). Conclusion These findings suggest that hemostasis using a compressive device may be a suitable alternative method to the standard taping method in controlling hemorrhage following radial artery cannulation.

The characteristics of pediatric emergency department visits in Korea: An observational study analyzing Korea Health Panel data

Objective We investigated the characteristics of pediatric emergency department (ED) patients in Korea and determined factors associated with hospital admission after ED treatment. Methods Korea Health Panel data from 2008 through 2013 were analyzed retrospectively; we included patients under 18 years old who visited the ED at least once. We collected patient and household epidemiologic data such as sex, age group, region of residence, disability, chronic disease, household income quintile, national health insurance type, use of private insurance, and annual frequency of ED visits. We also examined data related to each ED visit, such as reason for visit, medical service provided, and hospital size/ownership. We then investigated which factors were correlated with case disposition (discharge home or hospital admission) after ED treatment. Results In total, 3,160 pediatric ED visits occurred during the six-year period. Males (57.5%) and children aged 0–5 years (47.7%) made more visits than females and older children, respectively. The proportion of ED visits for disease (67.7%) was much higher than for injury or poisoning (32.2%), and 452 cases (14.3%) required hospital admission. For hospital admission, the odds ratio (OR) of females was 0.73 compared to males, and the OR of children aged 6–11 was 0.68 compared to children aged 0–5. The OR of capital residents was 0.69 compared to province residents, and the OR of the highest income quintile was 0.51 compared to the lowest quintile. The OR of children with private insurance coverage was 0.49 compared to those lacking private insurance, and the OR of ED visits due to disease was 1.82 compared to visits due to injury/poisoning. Conclusion This analysis of clinical and demographic characteristics of pediatric ED visits and hospital admissions can serve as the foundation of future prospective studies required for establishing appropriate policies for the Korean pediatric emergency medical system.

Factors associated with satisfaction with pediatric emergency department services in Korea: analysis of Korea Health Panel Data 2010 to 2012

Objective We aimed to investigate the factors related to satisfaction with the pediatric emergency department service in Korea. Methods This study examined data from the Korea Health Panel Data from 2010 to 2012. Pediatric patients who visited the emergency department at least once between 2010 and 2012 in Korea were included. Data were collected on patient satisfaction with the emergency department service, and factors related to the patient characteristics, emergency department service process, and medical institution. We compared the dissatisfied and satisfied groups, and calculated the odds ratios for satisfaction according to each variable. Results A total of 1,505 emergency department visits from 947 pediatric patients during the 3-year period were analyzed. We estimated that about 79.5% of patients in the population were satisfied. The odds of expressing satisfaction were higher among males than in females, and among patients who were hospitalized after emergency department treatment compared to those who were transferred to another hospital. Conversely, the odds of expressing satisfaction were lower among patients who had a chronic disease, a financial source other than National Health Insurance, experienced hospitalization within 1 year. Conclusion Our study results might be helpful for establishing a satisfactory pediatric emergency medical service system. In the future, further prospective studies evaluating the causal relationships between the relevant factors and patient satisfaction are warranted.

The effect of distraction by dual work on a CPR practitionerʼs efficiency in chest compression: A randomized controlled simulation study

Background: In the clinical setting, the dispersed practitioners’ attention often leads to decreased competence in their performance. We aimed to investigate the effect of distracted practitioners on the quality of chest compression during cardiopulmonary resuscitation. Methods: A randomized controlled crossover simulation study was conducted. Participants were recruited from among doctors, nurses, and paramedics working in a university tertiary hospital. The paced auditory serial addition test (PASAT) was used as a tool for distracting participants. In the crossover design, each participant played 2 scenarios with a 20-minute time gap, by a random order; 2-minute continuous chest compressions with and without PASAT being conducted. The primary outcome was the percentage of compression with an adequate compression rate. Secondary outcomes were the percentage of compression with adequate depth, the percentage of compression with full chest wall recoil, mean compression rate (per minute), mean compression depth, and subjective difficulty of chest compression. Results: Forty-four participants were enrolled, and all of them completed the study. It was found that the percentage of compression with an adequate compression rate was lower when the PASAT was conducted. Although there was no difference in the percentage of compression with adequate depth (P = .88), the percentage of compression with complete chest recoil was lower when PASAT was conducted. In addition, while the mean compression rate was higher when PASAT was conducted, the mean compression depth was not significantly different (P = .65). The subjective difficulty was not different (P = .69). Conclusions: Health care providers who are distracted have a negative effect on the quality of chest compression, in terms of its rate and chest wall recoil. Trial registration: www.ClinicalTrials.gov, NCT03124290.

Usefulness of end-tidal carbon dioxide as an indicator of dehydration in pediatric emergency departments: A retrospective observational study

Abstract Physician assessment of hydration status is one of the most important factors in the management of dehydration in the pediatric emergency department (ED). Overestimating dehydration may lead to overtreatment with intravenous fluids or unnecessary hospitalization, whereas underestimation may lead to delayed therapy and aggravation of symptoms. Various methods to estimate hydration status have been proposed, including use of physical findings, body weight, and laboratory results. These methods are subjective, invasive, or inappropriate for application in the ED. A few studies have investigated the use of end-tidal carbon dioxide (ETCO2) as an acidosis parameter in cases of gastroenteritis and diabetic ketoacidosis. We aimed to evaluate the usefulness of ETCO2 as an objective and noninvasive dehydration parameter for children. A retrospective observational study was conducted in the regional emergency center of a tertiary university hospital for a period of 1 year. We included patients from the ED whose primary diagnosis was acute gastroenteritis. Among these, we enrolled patients with recorded ETCO2 and bicarbonate concentration (HCO3−) levels. We collected information of clinical characteristics, vital signs, clinical dehydration scale (CDS) scores, laboratory test results, and final disposition. Correlations between ETCO2 and HCO3− as well as CDS scores were analyzed. A total of 105 children were finally enrolled in the study. All participants underwent laboratory testing and were mildly to severely dehydrated, with mean serum HCO3− 20.7 ± 3.5 mmol/L. A total 95 (90.5%) patients had a CDS score <5, which is considered mild dehydration, and 10 (9.5%) patients had CDS ≥5, considered moderate-to-severe dehydration. The mean ETCO2 level was 32.1 ± 6.1 mmHg. Pearson correlation indicated a weak link between ETCO2 and HCO3− (correlation coefficient = 0.32), despite being statistically significant (P = .001). In addition, ETCO2 and CDS score showed a weak negative correlation (r = −0.20, P < .05). ETCO2 can be considered a simple, noninvasive parameter for identifying dehydration among patients in the pediatric ED. Though weak, ETCO2 showed a correlation with HCO3− level as well as CDS. In the future, a prospective study with a large number of pediatric patients is warranted.

445: A Comparative Study Between Newly Developed Wave-Form and Traditional Straight-Form Splints

Department of Emergency Medicine, Inje University, Ilsan Paik Hospital, Goyang, Korea, Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea, University of Minnesota School of Medicine, Department of Emergency Medicine, Minneapolis, Minnesota, United States Sehui Kim, M.D., Woochan Jeon, MD., Jisook Lee, M.D., Choung Ah Lee, M.D., Sangcheon Choi, M.D., Yoonseok Jung, M.D., Giwoon Kim, M.D., Chung, Won Gabriel, M.D.