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Objective This study aimed to examine trends in the incidence and outcomes of bicycle-related injuries in emergency departments (ED) in South Korea. Methods We analysed data from the National Emergency Department Information System database for adult patients (≥20 years) with bicycle-related injuries presenting to EDs in South Korea between January 2012 and December 2014. Riders and bicycle passengers whose injuries were associated with bicycle use were included. Serious outcomes were defined as death at the ED, need for emergency operation, or intensive care unit admission. Results The number of people who commute to work by bicycle increased by 36% from 205,100 in 2005 to 279,544 in 2015. Of 529,278 traffic-related trauma cases, 58,352 (11.0%) were bicycle-related, which increased from 7,894 (10.2%) in the first half of 2012 to 12,882 (12.2%) in the second half of 2014 (p < 0.001). However, the proportion of serious outcomes decreased from 5.0% to 4.2% during the study period (p < 0.001). Serious outcomes were most frequent in the elderly (65–74 years) and older elderly (≥75 years) groups and decreased for all but the elderly age group from 10.3% to 9.8% (p = 0.204). The helmet use rate increased from 14.2% to 20.3% (p < 0.001) but was the lowest in the older elderly group (3.6%) without change during the study period (from 4.7% to 3.7%, p = 0.656). A lack of helmet use was significantly associated with serious outcomes (odds ratio, 1.811; 95% confidence interval, 1.576–2.082). Conclusions Although the incidence of bicycle-related injuries increased, the proportion of serious outcomes decreased, possibly due to increased helmet use. Public education on safety equipment use is required, especially in elderly populations.

Direct laryngoscopy using a Macintosh laryngoscope is the most widely used approach; however, this skill is not easy for novices and trainees. We evaluated the performance of novices using a laryngoscope with a three-dimensional (3D)-printed ergonomic grip on an airway manikin. Forty second-year medical students were enrolled. Endotracheal intubation was attempted using a conventional Macintosh laryngoscope with or without a 3D-printed ergonomic support grip. Primary outcomes were intubation time and overall success rate. Secondary outcomes were number of unsuccessful attempts, first-attempt success rate, airway Cormack-Lehane (CL) grade, and difficulty score. In the easy airway scenario, intubation time, and the overall success rate were similar between two group. CL grade and ease-of-use scores were significantly better for those using the ergonomic support grip (P < 0.05). In the difficult airway scenario, intubation time (49.7±37.5 vs. 35.5±29.2, P = 0.013), the first-attempt success rate (67.5% vs. 90%, P = 0.029), number of attempts (1.4±0.6 vs. 1.1±0.4, P = 0.006), CL grade (2 [2, 2] vs. 2 [1, 1], P = 0.012), and ease-of-use scores (3.5 [2, 4] vs. 4 [3, 5], P = 0.008) were significantly better for those using the ergonomic support grip. Linear mixed model analysis showed that the ergonomic support grip had a favorable effect on CL grade (P

Background Digital surveillance using internet search queries can improve both the sensitivity and timeliness of the detection of a health event, such as an influenza outbreak. While it has recently been estimated that the mobile search volume surpasses the desktop search volume and mobile search patterns differ from desktop search patterns, the previous digital surveillance systems did not distinguish mobile and desktop search queries. The purpose of this study was to compare the performance of mobile and desktop search queries in terms of digital influenza surveillance. Methods and results The study period was from September 6, 2010 through August 30, 2014, which consisted of four epidemiological years. Influenza-like illness (ILI) and virologic surveillance data from the Korea Centers for Disease Control and Prevention were used. A total of 210 combined queries from our previous survey work were used for this study. Mobile and desktop weekly search data were extracted from Naver, which is the largest search engine in Korea. Spearman's correlation analysis was used to examine the correlation of the mobile and desktop data with ILI and virologic data in Korea. We also performed lag correlation analysis. We observed that the influenza surveillance performance of mobile search queries matched or exceeded that of desktop search queries over time. The mean correlation coefficients of mobile search queries and the number of queries with an r-value of ≥ 0.7 equaled or became greater than those of desktop searches over the four epidemiological years. A lag correlation analysis of up to two weeks showed similar trends. Conclusion Our study shows that mobile search queries for influenza surveillance have equaled or even become greater than desktop search queries over time. In the future development of influenza surveillance using search queries, the recognition of changing trend of mobile search data could be necessary.

Objective We tried to evaluate the accuracy of the heel drop test in patients with suspected appendicitis and tried to develop a new clinical score, which incorporates the heel drop test and other parameters, for the diagnosis of this condition. Methods We performed a prospective observational study on adult patients with suspected appendicitis at two academic urban emergency departments between January and August 2015. The predictive characteristics of each parameter, along with heel drop test results were calculated. A composite score was generated by logistic regression analysis. The performance of the generated score was compared to that of the Alvarado score. Results Of the 292 enrolled patients, 165 (56.5%) had acute appendicitis. The heel drop test had a higher predictive value than rebound tenderness. Variables and their points included in the new (MESH) score were pain migration (2), elevated white blood cell (WBC) >10,000/μL (3), shift to left (2), and positive heel drop test (3). The MESH score had a higher AUC than the Alvarado score (0.805 vs. 0.701). Scores of 5 and 11 were chosen as cut-off values; a MESH score ≥5 compared to an Alvarado score ≥5, and a MESH score ≥8 compared to an Alvarado score ≥7 showed better performance in diagnosing appendicitis. Conclusion MESH (migration, elevated WBC, shift to left, and heel drop test) is a simple clinical scoring system for assessing patients with suspected appendicitis and is more accurate than the Alvarado score. Further validation studies are needed.

Objective This study was aimed at a serial evaluation and comparison of the prognostic values of Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHE) II scores for neurologic outcomes in comatose, out-of-hospital cardiac arrest (OHCA) survivors, treated with targeted temperature management (TTM). Methods We analysed a prospective cohort of comatose OHCA patients, with TTM, admitted to an emergency intensive care unit (ICU), between January 2010 and December 2015. SOFA and APACHE II scores were calculated initially, and then at day 1, 2, 3, 5, and 7 after ICU admission. Primary and secondary outcomes were the 28-day neurologic outcome and the 28-day mortality, respectively. Prognostic value of the SOFA and APACHE II scores was analysed using the receiver operating characteristic curve. Results Of the 143 selected patients, 62 survived and 34 had good neurologic outcomes at day 28. There was no significant difference in the SOFA and extracerebral SOFA scores between the good and poor neurologic outcome groups. However, the APACHE II scores were significantly higher in the good outcome group; they displayed good discriminatory power in predicting poor outcomes, unlike the SOFA scores. The APACHE II score at day 3 had the highest prognostic value for predicting poor neurologic outcomes with an area under the cure of 0.793, and with a cut-off value of 20, the APACHE II score predicted poor neurologic outcomes with a sensitivity of 43.75%, a specificity of 94.12%, a positive predictive value of 94.59%, and a negative predictive value of 41.56%. Conclusions Identifying APACHE II score might assist as one piece of multimodal prognostic approach for the assessment of neurologic outcomes in OHCA survivors treated with TTM.

In the third sentence of the second paragraph of the Methods, Korean characters were inadvertently changed to questions marks during the typesetting process. The publisher apologizes for the error. The correct sentence is: "Using the survey results, the definition of ILI and meetings of the authors, we picked 12 queries: new influenza (신종인플루엔자 in Korean), influenza (인플루엔자), new flu (신종플루), flu (플루), swine flu (돼지독감), bird flu (조류독감), H1N1 (H1N1), bad cold (독감), Tamiflu (타미플루), fever (열), cough (기침), and sore throat (인후통)."

BackgroundIn South Korea, there is currently no syndromic surveillance system using internet search data, including Google Flu Trends. The purpose of this study was to investigate the correlation between national influenza surveillance data and Google Trends in South Korea.MethodsOur study was based on a publicly available search engine database, Google Trends, using 12 influenza-related queries, from September 9, 2007 to September 8, 2012. National surveillance data were obtained from the Korea Centers for Disease Control and Prevention (KCDC) influenza-like illness (ILI) and virologic surveillance system. Pearson's correlation coefficients were calculated to compare the national surveillance and the Google Trends data for the overall period and for 5 influenza seasons.ResultsThe correlation coefficient between the KCDC ILI and virologic surveillance data was 0.72 (pConclusionsIn our study, we found that the Google Trends for certain queries using the survey on influenza correlated with national surveillance data in South Korea. The results of this study showed that Google Trends in the Korean language can be used as complementary data for influenza surveillance but was insufficient for the use of predictive models, such as Google Flu Trends.

OBJECTIVE: To evaluate the utilization trends of advanced radiology, i.e. computed tomography (CT) and magnetic resonance imaging (MRI), examination in an emergency department (ED) of an academic medical center from 2001 to 2010. PATIENTS AND METHODS: We assessed the overall CT and MRI utilization, and the ED patient encounters. Each examination was evaluated according to the patient's age and anatomically relevant regions. RESULTS: During the study period, 737,760 patient visited the ED, and 156,287 CT and 35,018 MRI examinations were performed. The number of annual ED patients increased from 63,770 in 2001 to 94,609 in 2010 (P = 0.018). The rate of CT utilization increased from 105.5 per 1000 patient visits in 2001 to 289.2 in 2010 (P60 (P60 (P