The prognostic performance of the L/A ratio was superior to that of a single lactate measurement for predicting 28-day mortality of critically ill sepsis patients. L/A ratio can be a useful prognostic factor regardless of initial lactate level and the presence of hepatic or renal dysfunction.

BackgroundDuring the 2011/2012 winter influenza season in the Republic of Korea, influenza A (H3N2) was the predominant virus in the first peak period of influenza activity during the second half of January 2012. On the other hand, influenza B was the predominant virus in the second peak period of influenza activity during the second half of March 2012. The objectives of this study were to compare the clinical and epidemiological characteristics of patients with laboratory-confirmed influenza A or influenza B.Methodology/Principal FindingsWe analyzed data from 2,129 adult patients with influenza-like illnesses who visited the emergency rooms of seven university hospitals in Korea from October 2011 to May 2012. Of 850 patients with laboratory-confirmed influenza, 656 (77.2%) had influenza A (H3N2), and 194 (22.8%) influenza B. Age, and the frequencies of cardiovascular disorders, diabetes, hypertension were significantly higher in patients with influenza A (H3N2) (P<0.05). The frequencies of leukopenia or thrombocytopenia in patients with influenza B at initial presentation were statistically higher than those in patients with influenza A (H3N2) (P<0.05). The rate of hospitalization, and length of hospital stay were statistically higher in patients with influenza A (H3N2) (P<0.05), and of the 79 hospitalized patients, the frequency of diabetes, hypertension, cases having at least one of the comorbid conditions, and the proportion of elderly were significantly higher in patients with influenza A (H3N2) (P<0.05).ConclusionsThe proportion of males to females and elderly population were significantly higher for influenza A (H3N2) patients group compared with influenza B group. Hypertension, diabetes, chronic lung diseases, cardiovascular disorders, and neuromuscular diseases were independently associated with hospitalization due to influenza. Physicians should assess and treat the underlying comorbid conditions as well as influenza viral infections for the appropriate management of patients with influenza.

Influenza epidemics occur annually with variations in size and severity. Hospital-based Influenza Morbidity & Mortality was established to monitor influenza epidemics and their severity, which is composed of two surveillance systems: emergency room-based and inpatient-based surveillance. Regarding emergency room-based surveillance, influenza-like illness index (influenza-like illness cases per 1,000 emergency room-visiting subjects), number of laboratory-confirmed cases and the distribution of influenza types were estimated weekly. Inpatient-based surveillance included monitoring for hospitalization, complications, and mortality. The emergency room influenza-like illness index correlated well with the number of laboratory-confirmed influenza cases, and showed a bimodal peak at Week 4 (179.2/1,000 emergency room visits) and Weeks 13-14 (169.6/1,000 emergency room visits) of 2012. Influenza A was the predominant strain during the first epidemic peak, while influenza B was isolated exclusively during the second peak. In 2011-2012 season, the mean admission rate of emergency room-visiting patients with influenza-like illness was 16.3% without any increase over the epidemic period. Among the hospitalized patients with influenza, 33.6% (41 out of 122 patients) were accompanied by complications, and pneumonia (28.7%, 35 out of 122 patients) was the most common. Most fatal cases were caused by influenza A (96.2%) after the first epidemic peak. In conclusion, Hospital-based Influenza Morbidity & Mortality was effective for monitoring the trends in circulating influenza activity concurrently with its severity. In the 2011-2012 season, the influenza epidemic persisted for a ≥ 5-month period, with a bimodal peak of influenza A and B in sequence. Overall, influenza A was more severe than influenza B.

BackgroundA well-constructed and properly operating influenza surveillance scheme is essential for public health. This study was conducted to evaluate the distribution of respiratory viruses in patients with influenza-like illness (ILI) through the first teaching hospital-based surveillance scheme for ILI in South Korea.MethodsRespiratory specimens were obtained from adult patients (≥18 years) who visited the emergency department (ED) with ILI from week 40, 2011 to week 22, 2012. Multiplex PCR was performed to detect respiratory viruses: influenza virus, adenovirus, coronavirus, respiratory syncytial virus, rhinovirus, human metapneumovirus, parainfluenza virus, bocavirus, and enterovirus.ResultsAmong 1,983 patients who visited the ED with ILI, 811 (40.9%) were male. The median age of patients was 43 years. Influenza vaccination rate was 21.7% (430/1,983) during the 2011–2012 season. At least one comorbidity was found in 18% of patients. The positive rate of respiratory viruses was 52.1% (1,033/1,983) and the total number of detected viruses was 1,100. Influenza A virus was the dominant agent (677, 61.5%) in all age groups. The prevalence of human metapneumovirus was higher in patients more than 50 years old, while adenovirus was detected only in younger adults. In 58 (5.6%) cases, two or more respiratory viruses were detected. The co-incidence case was identified more frequently in patients with hematologic malignancy or organ transplantation recipients, however it was not related to clinical outcomes.ConclusionThis study is valuable as the first extensive laboratory surveillance of the epidemiology of respiratory viruses in ILI patients through a teaching hospital-based influenza surveillance system in South Korea.

This study aimed to address the impact of 1-hr bundle achievement on outcomes in septic shock patients. Secondary analysis of multicenter prospectively collected data on septic shock patients who had undergone protocolized resuscitation bundle therapy at emergency departments was conducted. In-hospital mortality according to 1-h bundle achievement was compared using multivariable logistic regression analysis. Patients were also divided into 3 groups according to the time of bundle achievement and outcomes were compared to examine the difference in outcome for each group over time: group 1 (≤1 h reference), group 2 (1–3 h) and group 3 (3–6 h). In total, 1612 patients with septic shock were included. The 1-h bundle was achieved in 461 (28.6%) patients. The group that achieved the 1-h bundle did not show a significant difference in in-hospital mortality compared to the group that did not achieve the 1-h bundle on multivariable logistic regression analysis (<1 vs. >1 h) (odds ratio = 0.74, p = 0.091). However, 3- and 6- h bundle achievements showed significantly lower odds ratios of in-hospital mortality compared to the group that did not achieve the bundle (<3 vs. >3 h, <6 vs. >6 h, odds ratio = 0.604 and 0.458, respectively). There was no significant difference in in-hospital mortality over time for group 2 and 3 compared to that of group 1. One-hour bundle achievement was not associated with improved outcomes in septic shock patients. These data suggest that further investigation into the clinical implications of 1-h bundle achievement in patients with septic shock is warranted.

Purpose: Visit to the emergency department of the pediatric patients has increased steadily every year. The number of pediatric patients visiting the emergency department has increased steadily each year. It is believed that through recurrent visits (re-visit), many of them are using the emergency room, understanding the characteristics of pediatric patients to re-visit to the emergency department and should help to improve the quality of emergency service. Due to this increase and the rise in recurrent visits by pediatric patients, it is important to understand the characteristics and needs of this group, as well as to improve the quality of emergency service.Methods: Patients under the age of 6 years with 6 months of history visiting local emergency centers were included in this study. It was practically observed medical record. Medical records of these patients were observed. During the study period, there were 9,448 visitations including re-visits; a total of 7,480 visits were confirmed as re-visits via patient surveys.Results: A total of 9,448 pediatric patients, under the age of 6 (32.4%), made visitations to an emergency medical center during a 6-month period, of which, 7,480 visits were attributed to revisits, and thus, overlapped. Among these with confirmed revisitations, patients with no more revisitation are 5,273, one-time revisitation are 1,428, two revisitations are 458, three revisitations are 199, and four or more revisitations are 122. The rate of revisitations is higher in in the younger age group. Conclusion:In this study, we found the characteristics of pediatric patients with revisitations to the emergency department; young age correlated to higher revisits. The use of EMS system increases in the group of patients with many re-visits, medical illnesses, hospitalization rates, and allergies.

Clarity, Scienti¢cValidity, and Potential Sig-ni¢cance. Each submission is scored by three people and the cumulative results lead to a ranking order, from which the leading submissions are selected for publication. Given the di⁄culties of oralpresentation for those who have less £uency in English, some excellent pieces of work will be delivered in poster form, as opposed to oral delivery. Submissions felt to fall below a particular standard on aggregate scoring, or felt to be inappropriate for presentation by two of the three judges, are rejected. For this Congress, almost 500 submissions were received, with a 10% rejection rate. Each abstract is placed into a category, either at the request of the author or on the advice of the reviewers. All those published retain the original abstract identi¢cation number assigned to them on initial submission.

Abstracts: 11th World Congress, Osaka, Japan matic injuries due to accidents repeatedly aroused our attention to make a further evaluation of their underlying disease. Through a series of examinations and review of their medical records, some related underlying lesion were identified. Case Studies: We report three cases that met the above criteria including: 1) brain tumor (311395-1); 2) epilepsy (2537552-0); and 3) alcoholic cirrhosis of the liver (736597-4). All of the patients suffered from trauma repeatedly (at least five times in one year, as chart record) during their daily work. Discussion: Due to lack of insight and treatment, these patients were highly vulnerable to accidents in their daily work. Further consultations of each related special ward including social worker was arranged. Besides, their families were notified to take care of the patient, because their underlying disease increased the risk of recurrent trauma. Conclusion:The result emphasizes the importance to evaluate trauma patients thoroughly, from head-to-heel and for previous problems before they are discharge from Emergency Department. Recurrent trauma could be prevented if the underlying factors could be identified and controlled effectively. The rapid industrialization of Korea in the recent years has introduced high-rise, residential buildings and mass transportation systems, which gave rise to the possibility of large-scale, man-made disasters. In actuality, a number of such disasters already have occurred, particularly in large urban areas, causing massive numbers of human casualties. As a result, the existing disaster management plan in Korea has been modified considerably. This paper will describe large-scale disasters in metropolitan areas that involved human casualties and the changes in the disaster plans of Korea that resulted.The existing disaster plans allocated jurisdiction for disaster management to various organizations or administrative authorities. The lack of coordination in the managing authorities adversely affected the efforts for rescue and treatment of the injured persons, and created obstacles for timely disaster reports and the adoption of efficient disaster management measures.Under the revised disaster management plan, administrative authorities are given jurisdiction over disaster management. A disaster management center ("Disaster Center") is to be established directly under the control of the central government, and is empowered to declare a disaster area. Disaster reports are to be made only to fire stations, so that the reporting can be channeled through a uniform system. An emergency rescue headquarters is to be established under the direct control of the head of the local government. The Disaster Center is responsible for disaster management, rescue, and compensation, while the Disaster Prevention Committee is responsible for providing administrative assistance and other professional advice. The new plan mandates compulsory disaster prevention drills at least twice each year. Hopefully, the new plan wi...