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Objective This study investigated the hospital diagnoses and characteristics of uncooperative prehospital patients suspected of acute stroke who could not undergo a prehospital stroke screening test (PHSST). Methods This retrospective observational study was conducted at a single academic hospital with a regional stroke center. We analyzed three scenario-based prehospital stroke screening performances using the final hospital diagnoses: (1) a conservative approach only in patients who underwent the PHSST, (2) a real-world approach that considered all uncooperative patients as screening positive, and (3) a contrapositive approach that all uncooperative patients were considered as negative. Results Of the 2,836 emergency medical services (EMS)-transported adult patients who met the prehospital criteria for suspicion of acute stroke, 486 (17.1%) were uncooperative, and 570 (20.1%) had a confirmed final diagnosis of acute stroke. The diagnosis in the uncooperative group did not differ from that in the cooperative group (22.0% vs. 19.7%, P=0.246). The diagnostic performances of the PHSST in the conservative approach were as follows: 79.5% sensitivity (95% confidence interval [CI], 75.5%–83.1%), 90.2% specificity (95% CI, 88.8%–91.6%), and 0.849 area under the receiver operating characteristic curve (AUC; 95% CI, 0.829–0.868). The sensitivity and specificity were 83.3% (95% CI, 80.0%–86.3%) and 75.2% (95% CI, 73.3%–76.9%), respectively, in the real-world approach and 64.6% (95% CI, 60.5%–68.5%) and 91.9% (95% CI, 90.7%–93.0%), respectively, in the contrapositive approach. No significant difference was evident in the AUC between the real-world approach and the contrapositive approach (0.792 [95% CI, 0.775–0.810] vs. 0.782 [95% CI, 0.762–0.803], P>0.05). Conclusion We found overestimation (false positive) and underestimation (false negative) in the uncooperative group depending on the scenario-based EMS stroke screening policy for uncooperative prehospital patients suspected of acute stroke.

Jeju is the largest island in Korea and one of its key tourist attractions. As the number of foreign tourists steadily increases, so does the number of injuries incurred there. Accordingly, this study aimed to describe and compare the characteristics of injuries suffered by foreign tourists versus those of domestic tourists. As a cross-sectional study of a retrospective medical record survey, the study was conducted with reference to the Jeju Injury Surveillance System from the 11-year period of January 2008 to December 2018. The following factors were investigated: demographic data, mechanism of injury, place of occurrence, activity when injured, patient outcome, and mortality. A total of 92,095 injured Jeju Island visitors was recorded during this time, a number that included 88,050 Koreans and 4,045 foreigners. The gender ratio showed similar patterns between the two groups and there were no significant age differences. In both groups, the most common mechanism of injury was collisions/cuts. Also, more foreigners experienced falls than Koreans. Regarding the location, Koreans had the most road accidents, while foreigners were most likely to be injured at outdoor locations, such as seas and rivers. Furthermore, more foreigners experienced severe injuries requiring hospitalization. Notably, this study showed the differences in injury between foreign and Korean tourists visiting Jeju Island and its findings lend support to targeted safety promotion programs.

Objective This study aimed to determine whether there is a difference in mortality and medical resource utilization between geriatric (aged ≥65 years) and super-geriatric patients (aged ≥80 years) with traumatic brain injury (TBI). Methods We obtained comprehensive data (demographics, injury characteristics, injury severities, and outcomes) of geriatric and super-geriatric TBI patients from an emergency department-based injury surveillance system database from 2011 to 2016. Multivariate logistic regression analysis was performed to compare the mortality and nonroutine discharge (NRDC) status between both groups. Results Among 442,533 TBI patients, 48,624 were older than 65 years. A total of 48,446 patients (37,140 geriatric and 11,306 super-geriatric) without exclusion criteria were included in the final analysis. Both overall in-hospital mortality (adjusted odds ratio, 1.88; 95% confidence interval [CI], 1.28 to 2.74; P=0.001) and NRDC (adjusted odds ratio, 1.35; 95% CI, 1.07 to 1.71; P=0.011) were significantly higher in the super-geriatric group. In the stratified analysis, there were no significant differences in NRDC rate for all stratifications of treatment timing (emergency department vs. ward admission), but mortality remained to be significant for all stratifications. Conclusion Super-geriatric TBI patients showed a significantly higher risk-adjusted overall mortality and more inadequate medical resource utilization than did geriatric TBI patients. However, super-geriatric patients were more likely to undergo NRDC after admission; thus, further research about age-related health inequalities is needed in the treatment of super-geriatric patients.

Purpose To evaluate the severity of trauma, many scoring systems and predictive models have been presented. The quick Sequential Organ Failure Assessment (qSOFA) is a simple scoring system based on vital signs, and we expect it to be easier to apply to trauma patients than other trauma assessment tools. Methods This study was a cross-sectional study of trauma patients who visited the emergency department of Jeju National University Hospital. We excluded patients under the age of 18 years and unknown outcomes. We calculated the qSOFA, the Modified Early Warning Score (mEWS), Revised Trauma Score (RTS), and Injury Severity Score (ISS) based on patients’ initial vital signs and assessments performed in the emergency department (ED). The primary outcome was mortality within 14 days of trauma. We analyzed qSOFA scores using multivariate logistic regression analysis and compared the predictive accuracy of these scoring systems using the area under the receiver operating characteristic curve (AUROC). Results In total, 27,764 patients were analyzed. In the multivariate logistic regression analysis of the qSOFA, the adjusted odds ratios with 95% confidence interval (CI) for mortality relative to a qSOFA score of 0 were 27.82 (13.63–56.79) for a qSOFA score of 1, 373.31 (183.47–759.57) for a qSOFA score of 2, and 494.07 (143.75–1698.15) for a qSOFA score of 3. In the receiver operating characteristic (ROC) curve analysis for the qSOFA, mEWS, ISS, and RTS in predicting the outcomes, for mortality, the AUROC for the qSOFA (AUROC [95% CI]; 0.912 [0.871–0.952]) was significantly greater than those for the ISS (0.700 [0.608–0.793]) and RTS (0.160 [0.108–0.211]). Conclusions The qSOFA was useful for predicting the prognosis of trauma patients evaluated in the ED.

Mondini-like dysplasia is a rare congenital inner ear malformation (IEM) and the most common anomaly associated with recurrent bacterial meningitis in children. Early diagnosis of Mondinilike dysplasia is crucial for preventing recurrent bacterial meningitis. We report a case of a 15-year-old girl with unrecognized Mondini-like dysplasia that was early diagnosed in the Emergency Department at the first episode of bacterial meningitis. Assessing hearing function in children who have their first episode of meningitis is crucial. Abnormal hearing test results are critical diagnostic findings that help to suspect an IEM. In addition, high-resolution computed tomography of the temporal bones is an excellent diagnostic tool for IEM.