Factors associated with discharge of children from the emergency department after interfacility transfer

Purpose To investigate the factors associated with discharge of children from the emergency department (ED) after interfacility transfer. Methods We reviewed consecutive children who visited the ED via interfacility transfer from January 2014 to December 2015. The children were divided into two groups according to whether they were discharged from the ED or not (the discharge and admission groups), and their characteristics were compared. Multivariable logistic regression analysis was performed to identify the factors associated with discharge of children from the ED after interfacility transfer. Results Of the 999 transferred children, 426 (42.6%) were discharged. Compared to the admission group, these children showed older age, more frequent transfers from clinics and arrivals between 16 h and 20 h, shorter stay in the ED, and less frequent surgical abdomen. We found that age (3 to 6 years; adjusted odds ratio [OR], 1.8; 95% confidence interval [CI], 1.3-2.6, compared with 0 to 2 years), diagnosis (trauma; OR, 2.4; 95% CI, 1.5-4.0, compared with gastrointestinal diseases), and referring hospital (primary clinic; OR, 5.4; 95% CI, 3.1-9.4, compared with tertiary hospitals) were the factors. Conclusion The children who aged 3 to 6 years, had trauma or underwent transfers from primary clinics were more likely to be discharged at the ED. Considering these factors, we should reduce unnecessary transfers

Letter to the Editor: A Case of Posterior Inferior Cerebellar Artery Infarction after Cervical Chiropractic Manipulation

Stephen, Perle, HanSuk Jung, JooHyun Ham, and HwanTak Choi's letter responding to an article by Jeong and Hwang positing that chiropractic manipulation can injure the neck vessels.https://doi.org/10.13004/kjnt.2019.15.e

The effect of medically-attended injury experience on the use of home safety equipment

Purpose To assess the effect of medically-attended injury (MAI) on the use of home safety equipment, we analyzed the differences in parents’ perception and attitude about injury prevention, and use of home safety equipment depending on the children’s MAI experiences. Methods From March 2018 through February 2019, we surveyed parents of children aged 5 years or younger via a mobile phone. The parents were divided into the MAI and non-MAI groups. The mobile survey focused on the perception and attitude about injury prevention, and use of home safety equipment (if not used, barriers). Results Of the 204 parents, 75 (36.8%) reported their children’s MAI, comprising the MAI group. This group used the safety equipment more frequently than the non-MAI group (odds ratio, 7.03; 95% confidence interval, 3.39-14.59; P < 0.001). No significant differences between the 2 groups were found in the perception and attitude about injury prevention, barriers to the use of the equipment, and the type of the equipment in use. Conclusion Parents’ experience in their children’s MAIs was associated with the use of home safety equipment, but it did not affect their perception and attitude about injury prevention. A visit to the emergency department with MAI is an opportunity for education on injury prevention and changes of the attitude

The effects of home safety intervention on guardians’ behaviors of injury prevention in injured children: a double blind randomized controlled study

Purpose The optimal time for home safety intervention for children’s injury prevention is during the injury-related visits to emergency departments. The authors investigated the effect of home safety equipment provision on the guardians’ perception of injury prevention and attitude toward it, and the use of home safety equipment. Methods We conducted a double blind randomized controlled study on guardians of children aged 7 years or younger who visited the emergency department with accidental injuries. After completing the structured, pre-intervention survey on home safety, the guardians were randomly assigned to receive either home safety equipment (the intervention group) or stationery (the control group) in the same opaque boxes enclosing pamphlets about home safety education. After 4 weeks, the guardians were contacted for the post-intervention survey. The questionnaires for the latter survey consisted of the same contents with 2 added questions regarding the use of new home safety equipment after intervention. Logistic regressions were conducted to identify factors associated with the outcome (i.e., behavioral change). Results From April through October 2019, we approached 972 guardians. Of these, 59 guardians answered both pre- and post-intervention surveys. No differences were found in the perception and attitude, and use of home safety equipment between the intervention and control groups at the pre- and post-intervention surveys. No variables were associated with the primary outcome. Conclusion Provision of home safety equipment may be inadequate to improve guardians’ behaviors about prevention of domestic injuries

Appropriateness of transport of children via emergency medical service providers according to the decision-maker on referred hospitals

Purpose We aimed to investigate the appropriateness of transport of children via emergency medical service providers (EMSP) according to the decision-maker on referred hospitals (EMSP [EMSP group] vs. guardians [user group]). Methods We analyzed first aid records by EMSP for children aged 15 years or younger in Gyeonggi province, Korea, from January 2012 through December 2013. We obtained the following data: scene, symptom, type (high-level [regional/local emergency medical centers] or not) and location (out-of-province or not) of referred hospitals, injury, level of consciousness (alert or not), and prehospital triage results by EMSP (emergent/less emergent or not). Results A total of 50,407 children were included, of whom 37,626 (74.6%) belonged to the user group. Overall, the most common scene, symptom, and type and location of referred hospitals were home (57.0%), pain (33.3%), and inside-the-province and local emergency medical centers (44.2%), respectively. The user group showed less frequent injury (P < 0.001), decreased level of consciousness (P < 0.001), and no significant difference in the triage results (P = 0.074). This group showed more frequent transport to high-level and out-of-province emergency medical centers (P < 0.001), and longer transport (P < 0.001). Conclusion The user group showed more frequent transport to high-level or remote referred hospitals without more critical prehospital triage results. Guardian-directed transport of children might be associated with the inappropriate transport of children via EMSP

Spectral Doppler ultrasound in the major arteries of normal conscious immature micropigs

Spectral waveform analysis of blood flow velocity in the major arteries of six healthy, conscious immature micropigs was determined using Doppler ultrasonography. Doppler spectral tracings were recorded from the external iliac artery, femoral artery, and renal arcuate artery. Tracings were also taken from three parts of the common carotid artery and two parts of the abdominal aorta. Spectral Doppler parameters included peak systolic velocity, early diastolic velocity, peak systolic velocity-to-end diastolic velocity ratio, resistive index, and pulsatility index. In addition, the diameter of major arteries and indirect blood pressure were measured. These results from spectral Doppler analysis in major arteries may be useful as reference ranges in the future studies of vascular hemodynamics in immature micropigs

Three-dimensional CT angiography of the canine hepatic vasculature

Eight Beagle dogs were anesthetized and were imaged using a single channel helical CT scanner. The contrast medium used in this study was iohexol (300 mg I/ml) and doses were 0.5 ml/kg for a cine scan, 3 ml/kg for an enhanced scan. The flow rate for contrast material administration was 2 ml/sec for all scans. This study was divided into three steps, with unenhanced, cine and enhanced scans. The enhanced scan was subdivided into the arterial phase and the venous phase. All of the enhanced scans were reconstructed in 1 mm intervals and the scans were interpreted by the use of reformatted images, a cross sectional histogram, maximum intensity projection and shaded surface display. For the cine scans, optimal times were a 9-sec delay time post IV injection in the arterial phase, and an 18-sec delay time post IV injection in the venous phase. A nine-sec delay time was acceptable for the imaging of the canine hepatic arteries by CT angiography. After completion of arterial phase scanning, venous structures of the liver were well visualized as seen on the venous phase

Triage results of children who visited the emergency department via emergency medical service providers: an observational study in a regional emergency medical center

Purpose We aimed to investigate the triage results and the degree of agreement between prehospital and hospital stages of pediatric patients who visited the emergency department (ED) via emergency medical service providers (EMSP) in comparison with adult patients. Methods We retrospectively reviewed 8,152 pediatric patients who visited a regional emergency medical center ED via EMSP from January 2015 to December 2015. Pediatric patients were defined as younger than 15 years according to the Korean Triage and Acuity Scale (KTAS). Given the difference of the triage tools of the prehospital (EMSP) and hospital (KTAS) stages, we performed the re-triage into “critical” and “non-critical”. Comparisons of characteristics between pediatric and adult patients were made using chi-square tests. The degree of agreement between the tools was analyzed using κanalysis. Results Of 8,152 patients, 654 (8.0%) were pediatric patients. Direct medical control was more frequently performed to adult patients (P < 0.001). Critical patients were more common among adults (12.2% by KTAS, 24.8% by EMSP) than children (3.5% by KTAS, 14.1% by EMSP). The κ value of pediatric patients was lower than that of adult patients (0.09 [poor]; 95% confidence interval [CI], 0.01-0.18 vs. 0.38 [fair]; 95% CI, 0.35-0.40). Conclusion Pediatric patients transferred by EMSP showed lower severity and degree of agreements of the triage results between prehospital and hospital stages than adult patients. It is necessary to pay particular attention to pediatric triage in a pre-hospital setting