- Factors Associated with Radiologic Tests in Patients with Radial Head Subluxation
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Ikwan Chang, Do Kyun Kim, So Young Park, Dongbum Suh, Jae Yun Jung, Young Ho Kwak
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J Trauma Inj. 2014;27(2):13-19.
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 Abstract
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- PURPOSE
In general, X-ray examinations are not recommended for radial head subluxation (pulled elbow) patients. The purpose of this study was to determine the frequency of X-ray examinations and to investigate the factors associated with the decision to perform an X-ray examination on a patient with a pulled elbow.
METHODS
Patients who visited the pediatric emergency department (ED) of one tertiary hospital from January 1, 2011, to December 31, 2012, with a diagnosis of radial head subluxation at discharge were enrolled in this study. Through retrospective chart reviews, factors that could have influenced the decision to perform an X-ray examination and their statistical relevance were analyzed.
RESULTS
A total 308 patients were enrolled, and 101 patients (32.8%) underwent X-ray examinations. Among the 252 patients with a typical pulled elbow, 65 underwent X-ray examination. This result showed statistical significance compared to atypical pull-elbow group (25.8% vs. 64.3%, p<0.001). Factors associated with the decision to perform an X-ray examination were analyzed using the Chi-square test and the Fisher's exact test. The mechanism of injury and consultation with an orthopedic surgeon (p=0.001) showed statistical significance. In the multivariable logistic regression, the odds ratio (OR) for the injury mechanism was 4.7 (95% CI: 1.8~8.8, p<0.001) and that for consultation with an orthopedic surgeon was 8.0 (95% CI: 1.6~40.7, p=0.004).
CONCLUSION
One third of patients with a pulled elbow underwent X-ray examination, and patients with an atypical mechanism of injury underwent more frequent X-ray examinations than did patients with a typical mechanism of injury. The factors that could have influenced the decision to perform an X-ray examination were mechanism of injury and consultation with an orthopedic surgeon.
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Summary
- Physician-staffed Helicopter Transport for Mountain-rescued Emergency Patients: a Pilot Trial
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Jeong Ho Park, Sang Do Shin, Eui Jung Lee, Chang Bae Park, Yu Jin Lee, Kyoung Soo Kim, Myoung Hee Park, Han Bum Kim, Do Kyun Kim, Woon Yong Kwon, Young Ho Kwak, Gil Joon Suh
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J Trauma Inj. 2012;25(4):230-240.
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Abstract
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- PURPOSE
We aimed to compare the transport time, the proportion of direct hospital visit and the emergency procedures between the current mountain rescue helicopter emergency medical service (HEMS) and physician-staffed mountain-rescue HEMS.
METHODS
During weekends from October 2, to November 21, 2010, 9 emergency physicians participated as HEMS staff in the mountain-rescue HEMS program of the Seoul fire department. Patient demographic data, transport time, proportion of direct hospital visits, and emergency procedures were recorded. We also collected data on HEMS mountain-rescued patients from June 1, to September 1, 2010, and we compared them to those for the study patients. After an eight-week trial of the HEMS, we performed a delphi survey to determine the attitude of the physician staff, as well as the feasibility of using a physician staff.
RESULTS
Twenty-four(24) patients were rescued from mountains by physician-staffed HEMS during the study period, and 35 patients were rescued during the pre-study period. Patient demographic findings were not statistically different between the two groups, but the transport time and the emergency procedures were. During the study period, the time from call to take-off was 6.1+/-4.1 min (vs. 12.1+/-8.9 min during the pre-study period, p-value=0.001), and the time from call to arrival at the scene was 15.0+/-4.8 min (vs. 22.3+/-8.1 min during the pre-study period, p-value=0.0001). The proportions of direct hospital visit were not different between the two groups, but more aggressive emergency procedures were implemented in the study group. The delphi survey showed positive agreement on indications for HEMS, rapidity of transport and overall satisfaction.
CONCLUSION
A pilot trial of physician-staffed HEMS for mountain rescue showed rapid response and more aggressive performance of emergency procedures with high satisfaction among the attending physicians.
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Summary
- A Nationwide Study on the Epidemiology of Head Trauma and the Utilization of Computed Tomography in Korea
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So Young Park, Jae Yun Jung, Young Ho Kwak, Do Kyun Kim, Dong Bum Suh
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J Trauma Inj. 2012;25(4):152-158.
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Abstract
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To understand the epidemiology of head trauma and the utilization of brain CT in Korea, we analyzed a national sampling data set, the National Patient Sample obtained from the Health Insurance Review and Assessment Service.
METHODS
We retrospectively collected and analyzed demographic and clinical data on enrolled patients from the National Patient Sample based on medical claims data for 2009. The data included patient's age, sex, treatment date, diagnosis codes, procedure codes related with CT, holiday or night consultation fee, and fee for emergency management services.
RESULTS
In 2009, the estimated population with head trauma was 819,059(1.8%), and the rate of brain CT utilization was 22.4%. Children ages 5 to 15 were the most commonly injured group(22.8%), but had the lowest brain CT utilization(16.5%). The mean age of the estimated population with head trauma was 34.9+/-0.5 years old, and male patients accounted for 60.5% of that population. Intracranial injury was found in 8.6% of all head traumas, and the rate of intracranial injury in children was lower than it was in adults(4.1% vs. 10.9%, p<0.001). Twenty-three percent of patients with head trauma visited the emergency department (ED). More patients with head trauma visited medical facilities in the daytime on weekdays(66.5% vs. 33.5%, p<0.001), but head CT was performed more frequently at night or on weekends/holidays(16.1% vs. 34.7%, p<0.001). There is low incidence of head trauma in the winter in children (p<0.001). In the multivariate logistic regression analysis, patients who were adults, female, or ED visitors were more likely to undergo brain CT (odds ratio (OR): 1.65, 95% confidence interval (CI): 1.47-1.84; OR: 1.40, 95% CI: 1.27-1.54; OR: 7.80, 95% CI: 6.91-8.80, respectively).
CONCLUSION
In this study, we analyzed the national epidemiologic trend for head trauma, and the pattern of utilization of brain CT.
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Summary
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