Background and Objectives: The coronavirus infection 2019 (COVID-19) pandemic has affected emergency department (ED) management. Its viral transmission necessitates the use of isolation rooms and personal protective equipment for treating suspected patients, such as those with fever. This delays the time until the first encounter with the patients, thereby increasing the length of stay (LOS) in the ED. We aimed to compare delays in the ED LOS and clinical processes between the COVID-19 period and pre-COVID-19 period. Moreover, we intended to evaluate if the aforementioned delay affected patient outcomes. Materials and Methods: We conducted a single-center, retrospective study in Korea. Patients with fever were compared between the “COVID-19 period” from March 2020 to August 2020 and the “pre-COVID-19 period” from March 2019 to September 2019. We compared the overall ED LOS and individual time variable, including initial diagnostic tests (laboratory tests, radiography), specific diagnostic test (computed tomography), and treatment processes (antibiotics). A logistic regression analysis was conducted to identify the association between hospital admission and patient data. Results: We enrolled 931 and 749 patients during pre- and COVID-19 periods, respectively. Patients with fever remained in the ED for a longer duration during the COVID-19 period (pre-COVID-19:207.7 ± 102.7 min vs. during COVID-19: 223.5 ± 119.4 min, p = 0.004). The total time for performing laboratory tests and radiography displayed significant differences between the two periods, particularly from the time of patient arrival in the ED to the time of issuing the order. The time until antibiotic administration was delayed in the COVID-19 period (pre-COVID-19:195.8 ± 103.3 min vs. during COVID-19: 216.9 ± 108.4 min, p = 0.003). The logistic regression analysis for hospital admission identified ED LOS as an independent factor in both periods. Conclusions: The delay until encountering patients with fever resulted in longer ED LOS during the COVID-19 period; however, it possibly did not increase the hospital admission rates.

Background: Emergency department has been shown to be suitable for conducting screening and interventions for at-risk drinking groups. Simple screening test is needed for crowded environments such as the emergency department. Objective: This study explores the validity of screening test for at-risk drinking, which was a newly developed abbreviated version of the alcohol use disorder identification test, among patients in the emergency department. Method: A survey was conducted at the emergency department of an academic tertiary hospital in South Korea during 4 months. All patients, who visited the emergency department and were between 19 and 65 years of age, answered the alcohol use disorder identification test questionnaire. In this study, at-risk drinking was identified using alcohol use disorder identification test. Results: The screening test was completed by 178 patients in this study. At-risk drinking group comprises 78 patients (43.8%). The cut-off values of screening test for at-risk drinking were 3 for males and 2 for females. As a result, the sensitivity/specificity was 98.0/93.5 and 96.4/79.6 for men and women, respectively. Area under the receiver operating characteristics of screening test for at-risk drinking was 0.9 and 0.9 in men and women, respectively. Conclusion: screening test for at-risk drinking is a useful test that easily identifies at-risk drinking. It is expected that this test can facilitate screening for at-risk drinking in emergency department setting.

Cervical spinal cord injury is a well-known cause of cardiac arrest in trauma victims. Unless trauma is definitively suspected, emergency medical services teams perform resuscitation in the pre-hospital stage without cervical spine immobilization. During advanced cardiovascular life support (ACLS), intubation with cervical spinal immobilization causes difficulty in accessing the airway, thus, immobilization tends to not be performed, unless the patient is a clear case of trauma. We report two patients with out-of-hospital cardiac arrests (OHCA) due to cervical fractures that have occurred without clear trauma. In these cases, pre-existing cervical spine lesions was additional informed and identification of the cervical spine fractures was delayed. Emergency medical physicians tend to neglect cervical spine injury when the likelihood of trauma is unclear in a patient presenting with OHCA. These cases urge physicians to consider the possibility of cervical spinal injuries, even in cases of minor trauma. If there is a possibility of cervical spinal injury, imaging should not be delayed and should be followed by appropriate treatment.

Infectious aortitis has various causes, presents mainly with an aneurysm, and is fatal without surgical intervention. This case report describes an 89-year-old woman who developed fever and back pain which initially diagnosed infectious aortitis confirmed through contrast-enhanced computed tomography (CT). Pyogenic spondylitis and psoas abscess, which were not visible through CT at admission, were identified as the cause of infectious aortitis confirmed through positron emission tomography (PET). After percutaneous drainage and intravenous antibiotics, the patient was discharged in good condition and without surgical intervention. This case report emphasizes the critical role of PET in identifying the cause of infectious aortitis and demonstrates the effectiveness of successive treatment with antibiotics and timely radiologic intervention.