Journal of Yeungnam Medical Science

Original articles

The characteristics of elderly suicidal attempters in the emergency department in Korea: a retrospective study: Ji-Seon Jang, Wan-Seok Seo, Bon-Hoon Koo, Hey-Geum Kim, Seok-Ho Yun, So-Hey Jo, Dae-Seok Bai, Young-Gyo Kim, Eun-Jin Cheon; J Yeungnam Med Sci. 2024;41(1):30-38. Published online December 29, 2023; DOI: https://doi.org/10.12701/jyms.2023.01004

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Abstract PDF Supplementary Material: Background
Although Korea ranks first in the suicide rate of elderly individuals, there is limited research on those who attempt suicide, with preventive measures largely based on population-based studies. We compared the demographic and clinical characteristics of elderly individuals who attempted suicide with those of younger adults who visited the emergency department after suicide attempts and identified the factors associated with lethality in the former group.
Methods
Individuals who visited the emergency department after a suicide attempt from April 1, 2017, to January 31, 2020, were included. Participants were classified into two groups according to age (elderly, ≥65 years; adult, 18–64 years). Among the 779 adult patients, 123 were elderly. We conducted a chi-square test to compare the demographic and clinical features between these groups and a logistic regression analysis to identify the risk factors for lethality in the elderly group.
Results
Most elderly participants were men, with no prior psychiatric history or suicide attempts, and had a higher prevalence of underlying medical conditions and attributed their attempts to physical illnesses. Being sober and planning suicide occurred more frequently in this group. In the elderly group, factors that increased the mortality rate were biological male sex (p<0.05), being accompanied by family members (p<0.05), and poisoning as a suicide method (p<0.01).
Conclusion
Suicide attempts in elderly individuals have different characteristics from those in younger adults and are associated with physical illness. Suicides in the former group are unpredictable, deliberate, and fatal. Therefore, tailored prevention and intervention strategies addressing the characteristics of those who are elderly and attempt suicide are required.

Clinical investigation on acute pyelonephritis without pyuria: a retrospective observational study: Hyung Keun Song, Dong Hyuk Shin, Ji Ung Na, Sang Kuk Han, Pil Cho Choi, Jang Hee Lee; J Yeungnam Med Sci. 2022;39(1):39-45. Published online August 11, 2021; DOI: https://doi.org/10.12701/yujm.2021.01207

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Abstract PDF: Background
The current guidelines for the diagnosis of acute pyelonephritis (APN) recommend that APN be diagnosed based on the clinical features and the presence of pyuria. However, we observed that some of the patients who are diagnosed with APN do not have characteristic clinical features or pyuria at the initial examination. We performed this study to investigate the characteristics of APN without pyuria.
Methods
A retrospective, cross-sectional study was conducted on 391 patients diagnosed with APN based on clinical and radiologic findings, between 2015 and 2019. The clinical features, laboratory results, and computed tomography (CT) findings were compared between patients with normal white blood cell (WBC) counts and those with abnormal WBC counts (WBC of 0–5/high power field [HPF] vs. >5/HPF) in urine.
Results
More than 50% of patients with APN had no typical urinary tract symptoms and one-third of them had no costovertebral angle (CVA) tenderness. Eighty-eight patients (22.5%) had normal WBC counts (0–5/HPF) on urine microscopy. There was a negative correlation between pyuria (WBC of >5/HPF) and previous antibiotic use (odds ratio, 0.249; 95% confidence interval, 0.140–0.441; p<0.001), and the probability of pyuria was reduced by 75.1% in patients who took antibiotics before visiting the emergency room.
Conclusion
The diagnosis of APN should not be overlooked even if there are no typical clinical features, or urine microscopic examination is normal. If a patient has already taken antibiotics at the time of diagnosis, imaging studies such as CT should be performed more actively, regardless of the urinalysis results.

Impact of an emergency department resident strike during the coronavirus disease 2019 (COVID-19) pandemic in Daegu, South Korea: a retrospective cross-sectional study: Yo Han Cho, Jae Wan Cho, Hyun Wook Ryoo, Sungbae Moon, Jung Ho Kim, Sang-Hun Lee, Tae Chang Jang, Dong Eun Lee; J Yeungnam Med Sci. 2022;39(1):31-38. Published online August 10, 2021; DOI: https://doi.org/10.12701/yujm.2021.01130

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Abstract PDF

Background
To prepare for future work stoppages in the medical industry, this study aimed to identify the effects of healthcare worker strikes on the mortality rate of patients visiting the emergency department (ED) at six training hospitals in Daegu, Korea.
Methods
We used a retrospective, cross-sectional, multicenter design to analyze the medical records of patients who visited six training hospitals in Daegu (August 21–September 8, 2020). For comparison, control period 1 was set as the same period in the previous year (August 21–September 8, 2019) and control period 2 was set as July 1–19, 2020. Patient characteristics including age, sex, and time of ED visit were investigated along with mode of arrival, length of ED stay, and in-hospital mortality. The experimental and control groups were compared using t-tests, and Mann-Whitney U-test, chi-square test, and Fisher exact tests, as appropriate. Univariate logistic regression was performed to identify significant factors, followed by multivariate logistic regression analysis.
Results
During the study period, 31,357 patients visited the ED, of which 7,749 belonged to the experimental group. Control periods 1 and 2 included 13,100 and 10,243 patients, respectively. No significant in-hospital mortality differences were found between study periods; however, the results showed statistically significant differences in the length of ED stay.
Conclusion
The ED resident strike did not influence the mortality rate of patients who visited the EDs of six training hospitals in Daegu. Furthermore, the number of patients admitted and the length of ED stay decreased during the strike period.

Citations

Citations to this article as recorded by

Impact of junior doctor strikes on patient flow in the emergency department: a cross-sectional analysis
Svenja Ravioli, Raeesa Jina, Omar Risk, Fleur Cantle
European Journal of Emergency Medicine.2024; 31(1): 53. CrossRef
What Do Trainees Want? The Rise of House Staff Unions
Debra Malina, Lisa Rosenbaum
New England Journal of Medicine.2024; 390(3): 279. CrossRef
Experience of operating a medical humanities course at one medical school during the COVID-19: a retrospective study
Yu Ra Kim, Hye-won Shin, Young Hwan Lee, Seong-Yong Kim
Journal of Yeungnam Medical Science.2023; 40(2): 179. CrossRef
A deliberative framework to assess the justifiability of strike action in healthcare
Ryan Essex
Nursing Ethics.2023;[Epub] CrossRef
Study on the Learning Environment of Medical Students in the COVID-19
Yu Ra Kim, Hye Jin Park, Saeyoon Kim
Keimyung Medical Journal.2023; 42(2): 80. CrossRef

Case report

Recurrent hemoptysis in a 26-year-old woman with a ground-glass opacity lesion of the lung: Jong Ha Kim, Sin-Youl Park; Yeungnam Univ J Med. 2020;37(1):59-62. Published online September 4, 2019; DOI: https://doi.org/10.12701/yujm.2019.00304

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Abstract PDF

Hemoptysis is a major reason for emergency department (ED) visits. Catamenial hemoptysis (CH), a rare condition of thoracic endometriosis, can cause recurrent hemoptysis but is difficult to diagnose in the ED due to the scarcity of cases and nonspecific clinical findings. We report a case of a 26-year-old woman who presented to the ED with recurrent hemoptysis since 2 years without a definite cause. Her vital signs and blood test findings were unremarkable. Chest computed tomography (CT) did not show any specific lesions other than a non-specific ground-glass opacity pattern in her right lung. She was on day 4 of her menstrual cycle and her hemoptysis frequently occurred during menstruation. Although there was no histological confirmation, based on her history of hemoptysis during menstruation and no other cause of the hemoptysis, the patient was tentatively diagnosed with CH and was administered gonadotropin-releasing hormone. She had no recurrence of hemoptysis for 3 months. While CH is difficult to diagnose in the ED, the patient’s recurrent hemoptysis related to menstruation was a clue to the presence of CH. Therefore, physicians should determine the relationship between hemoptysis and menstruation for women of childbearing age presenting with repeated hemoptysis without a definite cause.

Citations

Citations to this article as recorded by

Thoracic Endometriosis: A Review Comparing 480 Patients Based on Catamenial and Noncatamenial Symptoms
Nura Fitnat Topbas Selcuki, Salih Yilmaz, Cihan Kaya, Taner Usta, Ahmet Kale, Engin Oral
Journal of Minimally Invasive Gynecology.2022; 29(1): 41. CrossRef
Characteristics and Outcomes of a Sample of Patients With COVID-19 Identified Through Social Media in Wuhan, China: Observational Study
Dong Liu, Yuyan Wang, Juan Wang, Jue Liu, Yongjie Yue, Wenjun Liu, Fuhai Zhang, Ziping Wang
Journal of Medical Internet Research.2020; 22(8): e20108. CrossRef
Cyclical Hemoptysis and Pelvic Pain in a Young Female: A Sign of Thoracic Endometriosis Syndrome
Areeg Bala, Raghda A Salim, Smit Deliwala, Michele Obeid, Ghassan Bachuwa
Cureus.2020;[Epub] CrossRef

Original Articles

Could immediate treatment change the management method of digital tendon musculotendinous junction avulsion?: a systematic review: Sam Guk Park; Yeungnam Univ J Med. 2017;34(2):200-207. Published online December 31, 2017; DOI: https://doi.org/10.12701/yujm.2017.34.2.200

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Abstract PDF: BACKGROUND
We conducted a systematic review of the literature to investigate the correlation between the interval to treatment and management of tendon avulsion ruptures in the musculotendinous junction (MTJ) of the forearm. METHODS: A thorough literatures search for studies of tendon avulsion injuries at the forearm was conducted using PubMed, MEDLINE, CINAHL, and Cochrane databases in accordance with the PRISMA guidelines. In total, five case series and 15 case reports accounting for 87 injured tendons involving 60 patients were selected for the analysis. RESULTS: Twenty-six patients had 44 tendon injuries associated with avulsion amputations, 31 patients had 38 tendon ruptures associated with closed avulsion injuries and three patients had five tendon ruptures associated with open avulsion injuries. Eighteen of the 49 (37%) patients were immediately treated for tendon ruptures and one of the 32 (3%) tendon ruptures treated via elective surgery was directly repaired. Additionally, 18 of the 30 (60%) tendons were directly repaired and 12 of the 30 (40%) tendons were transferred or side-to-side repaired in the immediately treated series. In contrast, one of the 28 (4%) tendon ruptures were directly repaired and 27 of the 28 (96%) tendons were transferred or side-to-side repaired in the electively treated series. CONCLUSION: In managing digital tendon avulsions at the MTJ, an immediate treatment could provide an opportunity to repair the ruptured tendon directly to the muscle.

Nephropathy related to computed tomography in emergency department patients with serum creatinine <1.5 mg/dL.: Jong Ha kim, Sin Youl Park, Chong Gun Kim; Yeungnam Univ J Med. 2015;32(2):90-97. Published online December 31, 2015; DOI: https://doi.org/10.12701/yujm.2015.32.2.90

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Abstract PDF: BACKGROUND
Contrast-induced nephropathy (CIN) can cause serious adverse effects. To reduce the occurrence of CIN related computed tomography (CT) in emergency patients, we assessed the respective roles of serum creatinine (SCr) alone and estimated glomerular filtration rate (eGFR) as an early predictor for CIN related CT. METHODS: For patients with SCr <1.5 mg/dL who underwent CT in emergency department (ED) between September 2012 and October 2013, we assessed the prevalence of CIN and its adverse effects. The Modification of Diet in Renal Disease Study (MDRD) and Cockcroft-Gault (CG) formula was used for the calculation of eGFR. Practical calculation was performed by electronic medical record (EMR) system for MDRD and internet calculating service for CG. And we investigated the prevalence of CIN in eGFR <60 mL/min/1.73 m2 before CT. RESULTS: A total of 1,555 patients were enrolled. The prevalence of CIN after CT was 4.6% and it showed correlation with renal deterioration, increased in-hospital mortality, and prolonged hospitalization. Despite baseline SCr <1.5 mg/dL, among enrolled patients, 11.3% as MDRD equation and 29.5% as CG formula were <60 mL/min/1.73 m2 and in this condition, the prevalence of CIN was significantly high (odds ratio was 2.87 [1.64-5.02] as MDRD equation and 2.03 [1.26-3.29] as CG formula). CONCLUSION: Just SCr <1.5mg/dL was not appropriate to recognize preexisting renal insufficiency, but eGFR using MDRD equation was useful in predicting the risk of CIN related CT in ED. Using EMR, calculation of eGFR can be easier and more convenient.

Case Report

Successful emergency transcatheter aortic valve implantation.: Jung Hee Lee, Ah Young Ji, Young Ju Kim, Changho Song, Moo Nyun Jin, Sun Wook Kim, Myeong Ki Hong, Geu Ru Hong; Yeungnam Univ J Med. 2014;31(2):144-147. Published online December 31, 2014; DOI: https://doi.org/10.12701/yujm.2014.31.2.144

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Abstract PDF: Despite the necessity of surgical aortic valve replacement, many patients with symptomatic severe aortic stenosis (AS) cannot undergo surgery because of their severe comorbidities. In these high-risk patients, percutaneous transcatheter aortic valve implantation (TAVI) can be safely accomplished. However, no study has shown that TAVI can be performed for patients with severe AS accompanied by acute decompensated heart failure. In this case report, 1 patient presented a case of severe pulmonary hypertension with decompensated heart failure after diagnosis with severe AS, and was successfully treated via emergency TAVI. Without any invasive treatment, acute decompensated heart failure with severe pulmonary hypertension is common in patients with severe AS, and it can increase mortality rates. In conclusion, TAVI can be considered one of the treatment options for severe as presented as acute decompensated heart failure patients with pulmonary hypertension.

Review

What is Emergency Medicine and Its Agenda for Future.: Byung Soo Do, Sam Beom Lee; Yeungnam Univ J Med. 2002;19(2):92-98. Published online December 31, 2002; DOI: https://doi.org/10.12701/yujm.2002.19.2.92

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Abstract PDF: Emergency medicine(EM) is the specialty of evaluating, stabilizing and initiating treatment for patients with life or limb-threatening illnesses or injuries. Techniques unique to the specialty of EM are the triage systems, quick stabilization methods, and emergency surgery procedures. The field of EM encompasses areas such as emergency department management, disaster planning and management, the management of emergency medical service(EMS) systems, research into such areas as brain and heart resuscitation, trauma and disaster management, survival medicine, and environmental emergencies(cold and heat injuries, poisioning, decompression sickness and barotrauma). Today, in addition to providing emergency care, the emergency specialists have moral and legal obligations to assess and report probable cases of child and spouse abuse, sexual assault, and alcohol and drug abuse. Future, the EM should provide surveillance, identification, intervention, and evaluation of injury and disease, therefore EM will remain as a key component of evolving community health care system.

Original Articles

Clinical Presentation of th patients with Non-traumatic Chest Pain in Emergency Department.: Jun Young Chung, Sam Beom Lee, Byung Soo Do, Jong Seon Park, Dong Gu Shin, Young Jo Kim; Yeungnam Univ J Med. 1999;16(2):283-295. Published online December 31, 1999; DOI: https://doi.org/10.12701/yujm.1999.16.2.283

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Abstract PDF: BACKGROUND
Patients with acute non-traumatic chest pain are among the most challenging patients for care by emergency physicians, so the correct diagnosis and triage of patients with chest pain in the emergency department(ED) becomes important. To avoid discharging patients with acute myocardial infarction(AMI) without medical care, most emergency physicians attempt to admit almost all patients with acute chest pain and order many laboratory tests for the patients. But in practice, many patients with non-cardiac pain can be discharged with simple tests and treatment. These patients occupy expensive intensive care beds, substantially increasing financial cost and time of stay at ED for the diagnosis and treatment of myocardial ischemia and AMI. Despite vigorous efforts to identify patients with ischemic heart disease, approximately 2% to 5% of patients presented to the ED with AMI and chest pain are inadvertently discharged. If the cause for the chest pain is known, rapid and accurate diagnosis can be implemented, preventing wastes in time and money and inadvertent discharge. Methods and Results: The medical records of 488 patients from Jan. 1 to Dec. 31, 1997 were reviewed. There were 320(angina pectoris 140, AMI 128) cases of cardiac diseases, and 168(atypical chest pain 56, pneumothorax 47) cases of non-cardiac diseases. The number of associated symptoms were 1.1+/-0.9 in non-cardiac diseases, 1.4+/-1.1 in cardiac diseases and 1.7+/-1.1 in AMI(p<0.05). In laboratory finding the sensitivity of electrocardiography(EKG) was 96.1%, while the sensitivity of myoglobin test ranked 45.1%. Admission rate was 71.6% in for cardiac diseases and 50.6% for non-cardiac diseases(p<0.01). Mortality rate was 8.8% in all cases, 13.8% in cardiac diseases, 0.6% in non-cardiac diseases, and 28.1% especially in AMI. CONCLUSION: In conclusion, all emergency physicians should have thorough knowledge of the clinical characteristics of the diseases which cause non-traumatic chest pain, because a patient with any of these life-threatening diseases would require immediate treatment. Detailed history on the patient should be taken and physical examination performed. Then, the most simple diagnostic approach should be used to make an early diagnosis and to provide treatment.

Analysis of Arrival Information and Status of the Patients in Emergency Department.: Sam Beom Lee, Byung Soo Do; Yeungnam Univ J Med. 1999;16(2):277-282. Published online December 31, 1999; DOI: https://doi.org/10.12701/yujm.1999.16.2.277

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Abstract PDF: BACKGROUND
For effective and systematic management of patients in the emergency department (ED), the data on patient arrival and status in DE of Yeungnam University Hospital were evaluated, MATERIALS AND METHODS: During the seven days form Apr. 1 to. 7 , 1998, the general patient information such as onset time and place, factors associated with transportation. causes of admission, cared department and patient disposition were recorded. RESULTS: Total of 464 patients visited the ED during the seven days, and the mean number of patients per day was 66.3 Male to female ratio was 1:0.71. Daily staying patients were 17.3 and 83.6 patients were cared totally each day. The methods of transportation and distribution of patients according to region and event were as follows: visit by walk (57.3%), transportation by car(58.0%),place of event in residence(85.3%), regional distribution in Taegu(81.5%), and direct visit(97.4%). Cause of admission due to diseases was 74.6%. The percentages of department which cared the patients were internal medicine 26.6%, pediatrics 16.8%, orthopedics 8.6%, neurology 8.2%, neurosurgery 7.8% and other department including emergency medicine 8.2%, respectively. Patient dispositions were admission 38.4%, discharge 61.0% and death on arrival(DOA) 0.6%, but referred-patient-to -another-hospital was zero. CONCLUSION: Improvements in several aspects of ED's caring system such as "fast tracking" system and reinforcement of disease and trauma caring system, would be helpful for effective management of emergency patients.

Status of the Use and Assessment of Order-Communicating System(OCS) in Emergency Care Center.: Sam Beom Lee, Jun Young Chung, Byung Soo Do; Yeungnam Univ J Med. 1997;14(1):85-93. Published online June 30, 1997; DOI: https://doi.org/10.12701/yujm.1997.14.1.85

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Abstract PDF

Hospital information system has been widely used and increased recently for a variety of many aspects. And Order-Communication System(OCS), as like as hospital information system, has been used in many medical care facilities, which is simple and easily accessible, useful system. Also then the use of OCS in emergency care center in YUMC has been introduced sine 1996. 10, above 70% of availability is notice at present and increasing in the use rate, is considered that is very simple and accurate, time-saving, widely applicable system. So authors say that, after the use of OCS in emergency care center, interhospital exchange of the patient's information and also accomplishment of EMSS can be possible.

Citations

Citations to this article as recorded by

A CAOPI System Based on APACHE II for Predicting the Degree of Severity of Emergency Patients
Young-Ho Lee, Un-Gu Kang, Eun-Young Jung, Eun-Sil Yoon, Dong-Kyun Park
Journal of the Korea Society of Computer and Information.2011; 16(1): 175. CrossRef

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