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Objective Fall from height (FFH) is a major public health problem that can result in severe injury, disability, and death. This study investigated how the characteristics of jumpers and fallers differ. Methods This was a retrospective study of FFH patients enrolled in an Emergency Department-based Injury In-depth Surveillance (EDIIS) registry between 2011 and 2018. Depending on whether the injury was intentional, FFH patients who had fallen from a height of at least 1 m were divided into two groups: jumpers and fallers. Patient characteristics, organ damage, and death were compared between the two groups, and factors that significantly affected death were identified using multivariable logistic analysis. Results Among 39,419 patients, 1,982 (5.0%) were jumpers. Of the jumpers, 977 (49.3%) were male, while 30,643 (81.9%) of fallers were male. The jumper group had the highest number of individuals in their 20s, with the number decreasing as age increased. In contrast, the number of individuals in the faller group rose until reaching their 50s, after which it declined. More thoracoabdominal, spinal, and brain injuries were found in jumpers. The in-hospital mortality of jumpers and fallers was 832 (42.0%) and 1,268 (3.4%), respectively. Intentionality was a predictor of in-hospital mortality, along with sex, age, and fall height, with an odds ratio of 7.895 (95% confidence interval, 6.746–9.240). Conclusion Jumpers and fallers have different epidemiological characteristics, and jumpers experienced a higher degree of injury and mortality than fallers. Differentiated prevention and treatment strategies are needed for jumpers and fallers to reduce mortality in FFH patients.

Abstract This study aimed to evaluate the effects of bystander cardiopulmonary resuscitation (CPR) and dispatcher-assisted CPR (DA-CPR) on outcomes after out-of-hospital cardiac arrest (OHCA). We conducted a prospective observational study using the Korean Cardiac Arrest Research Consortium registry database and enrolled adults aged > 20 years who sustained OHCA. The study population comprised 13,864 patients from October 1, 2015, to June 30, 2021. All enrolled patients were transported to the emergency room and resuscitated by the emergency medical personnel. Patients with terminal illnesses, pregnancy, “do not resuscitate” cards, and insufficient recorded information were excluded. Good neurologic outcomes were noted in 6.5%, 9.9%, and 9.6% of patients in the “no bystander”, “standard bystander”, and “compression-only bystander” CPR groups, respectively, and differed significantly (p

Abstract Background This study aimed to examine the characteristics of older adults patients who suffered a head injury after a ground-level fall in comparison to non-head injury patients as well as the factors associated with severity in those with head injury only. Methods Patients were classified into two groups, the head injury group and the non-head injury group. The characteristics were compared and factors associated with head injury were evaluated. Factors relating to severe injury in the head injury group were also investigated. Results The head injury group comprised 42 % of a study subjects. Male sex; fall time of 18:00–23:59; fall location of medical facility, transportation area, and public or commercial facility; fall in an outdoor area; fall during daily activity; alcohol ingestion; fall from stairs; non-slippery floor conditions; concrete flooring; sloped flooring; and presence of obstacles on the floor were risk factors for head injury in the older adults after a ground-level fall. Male sex and age over 70 years; fall time of 00:00–05:59; fall in a residential facility; fall in an indoor area; fall during daily activity; fall from stairs; non-slippery floor conditions; and presence of obstacles on the floor were factors associated with severe injury in the head injury group. Conclusions Male sex with advanced age, indoor fall, and the presence of obstacles on the floor were risk factors for severe injury in the head injury group in older adults individuals who suffered a ground-level fall. It is necessary to develop appropriate ground-level fall prevention programs by evaluating the individual and environmental characteristics of older adults patients.

Objective Postdischarge case management for self-harm or suicide attempters often fails; therefore, this study aimed to investigate the effects of mobile messenger counseling (MMC) on the postdischarge case management results among this patient group. Methods A retrospective analysis was done with data collected from March 2015 to February 2020 that included self-harm or suicide attempters who had visited a Korean emergency department and were discharged. If patients consented, postdischarge case management and MMC were conducted from March 2017. The primary outcome was the rate of successful case management, which reflects the patients either connecting to a local psychiatric healthcare center or undergoing a follow-up at a neuropsychiatric outpatient department at least once following discharge. Using univariate and multivariate logistic regression analyses, we evaluated MMC’s effects on these patients’ postdischarge case management. Results Of 913 patients, 604 participated in this study. In terms of successful case management, the MMC group showed a significantly higher rate than the non-MMC one (28.3% vs. 16.1%, P=0.001). A multivariate analysis demonstrated that access to postdischarge MMC (odds ratio, 2.149; 95% confidence interval, 1.357–3.403; P=0.001) and giving consent for case management while in the emergency department were significantly associated with successful case management (odds ratio, 8.917; 95% confidence interval, 5.610–14.173; P

Purpose This study investigated the characteristics of adult patients who had fallen from a height and presented to an emergency room (ER) according to gender and intentionality, with the goal of reducing the harm caused by these injuries. Methods A retrospective analysis was conducted of fall-from-height patients aged ≥19 years from the in-depth surveillance study of injured patients visiting ERs conducted under the supervision of the Korea Centers for Disease Control and Prevention from 2011 to 2016. Patterns were analyzed according to gender and intentionality. Results There were 29,838 men (68.5%) and 13,734 women (31.5%), with mean ages of 50.3±15.7 years and 57.2±19.9 years, respectively. The most common height of the fall was ≥1 m to 4 m in men (n=15,863; 53.2%) and

Pancreatic injuries due to trauma in children are rare. An early diagnosis is difficult as the signs and symptoms are insidious, but delays in diagnosis can lead to significant complications. We report a case of a child who visited the emergency department with aggravating abdominal pain. The physicians first diagnosed the abdominal pain as being caused by a disease in the emergency department, but the patient was subsequently diagnosed with pancreatic injury. Clinicians should be aware of a possible trauma in children who complain of vague abdominal pain even in the absence of corresponding history.

Purpose This study was to analyze clinical and epidemiological characteristics of elderly patients who were admitted to the emergency department (ED) due to falls by separating male and female. Methods We retrospectively analyzed the fall patients aged 65 years or older from the data of the in-depth surveillance study of injured patients visit to the ED under the supervision of the Korea Centers for Disease Control and Prevention (KCDC) from 2011 to 2016 by separating male and female. Results A total of 361,588 elderly fall patients were analyzed and, among them, 14,429 (37.3%) were males and 24,208 (62.7%) were females. Male and female showed similar frequency of damage happening season. However, they showed falling accident mostly on winter. The time of injury occurrence is mostly from 12:00 to 18:00 with 4,949 (34.3%) male and 8,564 (35.4%) female. Most falls occurred in daily activities, accounting for 7,614 (52.8%) in males and 14,957 (61.8%) in females, respectively. Unintentional damage accounted for the most part and 7,395 (51.2%) of male and 15,343 (63.4%) of female were injured indoors. Head and neck were the most common site of injuring, with 8,392 (58.2%) in males and 7,851 (32.4%) in females. According to ED examination outcomes, most of the patients were discharged, while the majority of the hospitalized patients were admitted to the general patient room. Conclusions The elderly falls occurred mostly from 12:00 to 18:00, during winter and to elderly women. Also, they happened unintentionally indoors in everyday life, mostly. Proved clinical, epidemiological characteristics from this research will be used as useful indicator at validity research of development of prevent program of falling accident for elderly people.

Objective This study aimed to describe the conceptualization, development, and implementation processes of the newly established Korean Cardiac Arrest Resuscitation Consortium (KoCARC) to improve out-of-hospital cardiac arrest (OHCA) outcomes. Methods The KoCARC was established in 2014 by recruiting hospitals willing to participate voluntarily. To enhance professionalism in research, seven research committees, the Epidemiology and Preventive Research Committee, Community Resuscitation Research Committee, Emergency Medical System Resuscitation Research Committee, Hospital Resuscitation Research Committee, Hypothermia and Postresuscitation Care Research Committee, Cardiac Care Resuscitation Committee, and Pediatric Resuscitation Research Committee, were organized under a steering committee. The KoCARC registry was developed with variables incorporated in the currently existing regional OHCA registries and Utstein templates and were collected via a web-based electronic database system. The KoCARC study population comprises patients visiting the participating hospitals who had been treated by the emergency medical system for OHCA presumed to have a cardiac etiology. Results A total of 62 hospitals volunteered to participate in the KoCARC, which captures 33.0% of the study population in Korea. Web-based data collection started in October 2015, and to date (December 2016), there were 3,187 cases compiled in the registry collected from 32 hospitals. Conclusion The KoCARC is a self-funded, voluntary, hospital-based collaborative research network providing high level evidence in the field of OHCA and resuscitation. This paper will serve as a reference for subsequent KoCARC manuscripts and for data elements collected in the study.

Purpose The dose of drug and the size of instrument are determined based on children’s weight. We aimed to validate the finger counting method (FCM) for weight estimation in Korean children using the Monte Carlo simulation. Methods We estimated the weight of Korean children aged 1 to 9 years by the FCM. These measurements were compared with the weight extracted by the Monte Carlo simulation applied to the “2007 Korean Children and Adolescents Growth Standard.” Pearson correlation coefficients (r) were measured to assess the correlation between the weight extracted by the simulation and that estimated by FCM. Bland-Altman analyses were performed to assess the agreement between the weight extracted by the simulation and that estimated by FCM and 2 other well-known pediatric weight estimation formulas (the Advanced Pediatric Life Support and Luscombe formulas). Results Data regarding 9,000 children’s weight selected by age and gender was randomly extracted using the simulation. We found a positive correlation between the weight estimated by the FCM and the weight extracted (in boys, r = 0.896, P < 0.001; in girls, r = 0.899, P < 0.001). The FCM tended to underestimate weight in the children aged 7 years or old. Conclusion This article suggests the usefulness of FCM in weight estimation, particularly in children younger than 7 years. With appreciation of the limitation in older children, the FCM could be applied to emergency practice.

Abstract Background This retrospective study aimed to evaluate the ability of the delta neutrophil index (DNI) to predict histologically normal appendicitis preoperatively and to differentiate between simple and complicated appendicitis. Methods The data from 650 patients were divided into positive and negative appendectomy groups (histologically normal appendicitis). The patients in the acute appendicitis group were further sub-divided into simple and complicated appendicitis groups. Results The DNI was significantly higher in the positive group than in the negative appendectomy group (0.4 vs. −0.4, p

Objective Cardiopulmonary resuscitation (CPR) training can improve performance during simulated cardiac arrest; however, retention of skills after training remains uncertain. Recently, hands-only CPR has been shown to be as effective as conventional CPR. The purpose of this study is to compare the retention rate of CPR skills in laypersons after hands-only or conventional CPR training. Methods Participants were randomly assigned to 1 of 2 CPR training methods: 80 minutes of hands-only CPR training or 180 minutes of conventional CPR training. Each participant’s CPR skills were evaluated at the end of training and 3 months thereafter using the Resusci Anne manikin with a skill-reporting software. Results In total, 252 participants completed training; there were 125 in the hands-only CPR group and 127 in the conventional CPR group. After 3 months, 118 participants were randomly selected to complete a post-training test. The hands-only CPR group showed a significant decrease in average compression rate (P=0.015), average compression depth (P=0.031), and proportion of adequate compression depth (P=0.011). In contrast, there was no difference in the skills of the conventional CPR group after 3 months. Conclusion Conventional CPR training appears to be more effective for the retention of chest compression skills than hands-only CPR training; however, the retention of artificial ventilation skills after conventional CPR training is poor.

ObjectiveTherapeutic hypothermia (TH) has become the standard strategy for reducing brain damage in the postresuscitation period. The aim of this study was to investigate current TH performance and outcomes in out-of-hospital cardiac arrest (OHCA) survivors using data from the Korean Hypothermia Network (KORHN) registry. MethodsWe used the KORHN registry, a web-based multicenter registry that includes 24 participating hospitals throughout the Republic of Korea. Adult comatose OHCA survivors treated with TH between 2007 and 2012 were included. The primary outcomes were neurological outcome at hospital discharge and in-hospital mortality. The secondary outcomes were TH performance and adverse events during TH. ResultsA total of 930 patients were included, of whom 556 (59.8%) survived to discharge and 249 (26.8%) were discharged with good neurologic outcomes. The median time from return of spontaneous circulation (ROSC) to the start of TH was 101 minutes (interquartile range [IQR], 46 to 200 minutes). The induction, maintenance, and rewarming durations were 150 minutes (IQR, 80 to 267 minutes), 1,440 minutes (IQR, 1,290 to 1,440 minutes), and 708 minutes (IQR, 420 to 900 minutes), respectively. The time from the ROSC to coronary angiography was 1,045 hours (IQR, 121 to 12,051 hours). Hyperglycemia (46.3%) was the most frequent adverse event. ConclusionMore than one-quarter of the OHCA survivors (26.8%) were discharged with good neurologic outcomes. TH performance was appropriately managed in terms of the factors related to its timing, including cooling start time and rewarming duration.

Objective To determine if the over-the-head two-thumb encircling technique (OTTT) provides better quality cardiopulmonary resuscitation (CPR) than the conventional two-finger technique (TFT) when performed by a lone rescuer in an in-hospital infant cardiac arrest setting. Methods This prospective, randomised crossover design study recruited 50 nurses who voluntarily performed lone rescuer infant CPR for 2 min on a manikin. Participants who performed OTTT stood at the head of the manikin to compress the chest and provide bag-valve mask ventilations, whereas those who performed TFT stood by the side of the manikin to compress the chest and provide pocket-mask ventilations. Mean hands-off time, mean compression depths and rates, proportion of effective compressions and complete recoil, and fatigue score changes were assessed during the test, and a survey on the ease of use of the techniques was conducted after the test. Results Hands-off time, total ventilation volume and number of ventilations were not significantly different between the two techniques. OTTT resulted in greater depth of compressions (p<0.001), greater proportion of effective compressions (p<0.001), smaller proportion of complete recoil (p=0.001), and smaller fatigue score change (p=0.003) than TFT. In addition, subjects reported that compression, ventilation and changing compression to ventilation were easier using OTTT than TFT. Conclusions OTTT performed by a lone rescuer in an in-hospital infant cardiac arrest setting resulted in greater compression depth, with no increase in hands-off time, compared with TFT. OTTT may therefore be a suitable alternative to TFT in the in-hospital infant cardiac arrest setting. [ABSTRACT FROM AUTHOR]

Background The 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation (CPR) recommend that chest compression be rotated every 2 min to prevent rescuer fatigue. However, the quality of chest compression using 2-min switched CPR tends to decrease rapidly due to rescuer fatigue. We aimed to compare the effectiveness of use of 2-min switched CPR and rescuer-limited CPR (the person performing compressions is allowed to switch with another rescuer prior to 2 min if feeling fatigued) in the setting of inhospital cardiac arrest. Methods Using a randomised cross-over trial design, 90 medical students were grouped into pairs to perform four cycles of 2-min switched CPR and rescuer-limited CPR (495 s per technique). During each trial, the total number of compressions performed, mean depth of compression and proportion of effective compressions performed (compression depth >5 mm) were recorded for identification of significant differences and changes in pulse rate and RR were measured to determine the extent of exhaustion. Results Compared with 2-min switched CPR, the mean compression was deeper (51 vs 47 mm, p<0.001), total number of compressions greater (476 vs 397, p=0.003) and proportion of effective compressions greater (56% vs 47%, p=0.004) during rescuer-limited CPR. Subgroup analysis by 30-s unit showed more consistent compression quality during rescuer-limited CPR. No significant differences in change in pulse rate and RR were found between the two techniques. Conclusions Rescuer-limited CPR yields a greater number of effective compressions and more consistent quality of CPR than 2-min switched CPR. Rescuer-limited CPR might be a suitable alternative for treating inhospital cardiac arrest. [ABSTRACT FROM AUTHOR]

Background The purpose of this study is to compare the cardiopulmonary resuscitation (CPR) team dynamics and performance between a conventional simulation training group and a script-based training group. Methods This was a prospective randomised controlled trial of educational intervention for CPR team training. Fourteen teams, each consisting of five members, were recruited. The conventional group (C) received training using a didactic lecture and simulation with debriefing, while the script group (S) received training using a resuscitation script. The team activity was evaluated with checklists both before and after 1 week of training. The videotaped simulated resuscitation events were compared in terms of team dynamics and performance aspects. Results Both groups showed significantly higher leadership scores after training (C: 58.2±9.2 vs 67.2±9.5, p=0.007; S: 57.9±8.1 vs 65.4±12.1, p=0.034). However, there were no significant improvements in performance scores in either group after training. There were no differences in the score improvement after training between the two groups in dynamics (C: 9.1±12.6 vs S: 7.4±13.7, p=0.715), performance (C: 5.5±11.4 vs S: 4.7±9.6, p=0.838) and total scores (C: 14.6±20.1 vs S: 12.2±19.5, p=0.726). Conclusion Script-based CPR team training resulted in comparable improvements in team dynamics scores compared with conventional simulation training. Resuscitation scripts may be used as an adjunct for CPR team training. [ABSTRACT FROM AUTHOR]

The incidence of out-of-hospital cardiac arrest (OHCA) gradually increased during the coronavirus disease 2019 (COVID-19) pandemic, and the number of cases requiring termination of resuscitation (TOR) also rose. This study aimed to analyze the reasons for TOR of OHCA cases over 2 years (2019–2020). This retrospective observational study was conducted using data gathered from prehospital emergency medical service (EMS) care reports generated in Seoul between 01 January 2019, and 31 December 2020. We included OHCA cases reported to the EMS system in this study. Patients who experienced cardiac arrest for a non-medical cause and received cardiopulmonary resuscitation (CPR) from EMS paramedics at the scene were excluded. The variables of demographics and comorbidities, arrest location, identity of the bystander, cause of cardiac arrest, first monitored electrocardiographic (ECG) rhythm, and reason for TOR were investigated. We compared data for 1 year before and after the start of the COVID19 pandemic. A total of 10,872 OHCAs with TOR were included in this study; of these, 6238 cardiac arrest cases were terminated without resuscitation attempts during the COVID-19 period compared to 4634 during the pre-COVID-19 period. During the COVID-19 period, the proportion of women in the total population decreased, while the median age increased (p < 0.001). Patients with comorbidities, the frequency of asystole rhythm at first monitoring, and the number of witnessed cardiac arrests significantly increased (p < 0.001). The proportion of TOR cases due to decisions made by a medical director and refusal of CPR by family members also significantly increased, while that due to clear evidence of death decreased (p < 0.001). In conclusion, there was a significant change in the reason for TOR before and after the COVID-19 pandemic in Korea. [ABSTRACT FROM AUTHOR]

In older patients, ground-level falls are the most common cause of injury. Many intrinsic and extrinsic factors influence ground fall injuries. However, the characteristics and severity of ground fall injuries have not been compared according to the activity levels. We compared the characteristics of ground fall injuries by the activity level to establish a preventive strategy for ground fall injuries in older patients. We retrospectively reviewed the records of older patients who were admitted to six university hospitals for ground-level fall injuries from 2011 to 2020. The patients were classified into active and inactive groups. Active activities were defined as paid work, exercise and leisure activities. General and clinical characteristics of both groups for ground-level fall injury were analyzed. Propensity score matching analysis (1:1) was performed for baseline characteristics (sex, age and alcohol consumption). A total of 33,924 patients were enrolled, of which 4887 (14.4%) were classified in the active group. Injury severity was not different between the active and inactive groups. The main factors significantly associated with ground fall injuries during activities in elderly patients were male sex, age from 65 to 74 years and 75 to 84 years compared to greater than 85 years, an injury time other than 00:00-05:59, alcohol consumption, sloping floor and floor type other than concrete. After propensity score matching analysis, the factors associated with ground-level fall injuries in older patients when they were active were a time of injury from 06:00-17:59 compared to 00:00-05:59, slippery floor, slope, the absence of obstacles and type of floor other than concrete. We should establish preventive strategies for reducing ground-level fall injuries in older patients during activity, which could include wearing compatible footwear, caution on sloping areas, and maintenance of unpaved roads. [ABSTRACT FROM AUTHOR]