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  • 1
    Online Resource
    Online Resource
    Developing a Time-Adaptive Prediction Model for Out-of-Hospital Cardiac Arrest: Nationwide Cohort Study in Korea
    JMIR Publications Inc. ; 2021
    In:  Journal of Medical Internet Research Vol. 23, No. 7 ( 2021-7-5), p. e28361-
    Details
    In: Journal of Medical Internet Research, JMIR Publications Inc., Vol. 23, No. 7 ( 2021-7-5), p. e28361-
    Abstract: Out-of-hospital cardiac arrest (OHCA) is a serious public health issue, and predicting the prognosis of OHCA patients can assist clinicians in making decisions about the treatment of patients, use of hospital resources, or termination of resuscitation. Objective This study aimed to develop a time-adaptive conditional prediction model (TACOM) to predict clinical outcomes every minute. Methods We performed a retrospective observational study using data from the Korea OHCA Registry in South Korea. In this study, we excluded patients with trauma, those who experienced return of spontaneous circulation before arriving in the emergency department (ED), and those who did not receive cardiopulmonary resuscitation (CPR) in the ED. We selected patients who received CPR in the ED. To develop the time-adaptive prediction model, we organized the training data set as ongoing CPR patients by the minute. A total of 49,669 patients were divided into 39,602 subjects for training and 10,067 subjects for validation. We compared random forest, LightGBM, and artificial neural networks as the prediction model methods. Model performance was quantified using the prediction probability of the model, area under the receiver operating characteristic curve (AUROC), and area under the precision recall curve. Results Among the three algorithms, LightGBM showed the best performance. From 0 to 30 min, the AUROC of the TACOM for predicting good neurological outcomes ranged from 0.910 (95% CI 0.910-0.911) to 0.869 (95% CI 0.865-0.871), whereas that for survival to hospital discharge ranged from 0.800 (95% CI 0.797-0.800) to 0.734 (95% CI 0.736-0.740). The prediction probability of the TACOM showed similar flow with cohort data based on a comparison with the conventional model’s prediction probability. Conclusions The TACOM predicted the clinical outcome of OHCA patients per minute. This model for predicting patient outcomes by the minute can assist clinicians in making rational decisions for OHCA patients.
    Type of Medium: Online Resource
    ISSN: 1438-8871
    URL: Article
    DOI: 10.2196/28361
    Language: English
    Publisher: JMIR Publications Inc.
    Publication Date: 2021
    detail.hit.zdb_id: 2028830-X
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  • 2
    Online Resource
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    Echocardiographic Assessment of Patients with Pulmonary Tumor Thrombotic Microangiopathy First Diagnosed in the Emergency Department
    MDPI AG ; 2022
    In:  Diagnostics Vol. 12, No. 2 ( 2022-01-20), p. 259-
    Details
    In: Diagnostics, MDPI AG, Vol. 12, No. 2 ( 2022-01-20), p. 259-
    Abstract: Pulmonary tumor thrombotic microangiopathy (PTTM) is a fatal disease that obstructs pulmonary vessels, leading to pulmonary hypertension (PH) and right-sided heart failure causing rapid progressive dyspnea in patients with cancer. This retrospective chart review involved nine patients with PTTM who were first clinically diagnosed in a tertiary emergency department (ED) between January 2015 and June 2021. They underwent laboratory tests, chest radiography, chest computed tomography (CT), and echocardiography. All patients presented with severe and rapidly progressive dyspnea within a few days, a high oxygen demand. The right ventricle (RV): left ventricle ratio was 〉 1 on chest CT, and no life-threatening pulmonary thromboembolism (PTE) was observed. Echocardiographic findings indicated that all patients had moderate-to-severe RV dilatation with a D-shaped LV. The median tricuspid regurgitation maximum velocity was 3.8 m/s, and the median RV systolic pressure was 63 mmHg, indicating severe PH. The median value of tricuspid annular plane systolic excursion was 15 mm, showing a decrease in RV systolic function, and McConnell’s sign was observed in five patients. Two patients immediately underwent chemotherapy and are currently alive. PTTM should be suspected and evaluated using echocardiography in patients with cancer presenting to the ED with acute dyspnea and RV failure without PTE.
    Type of Medium: Online Resource
    ISSN: 2075-4418
    URL: Article
    DOI: 10.3390/diagnostics12020259
    Language: English
    Publisher: MDPI AG
    Publication Date: 2022
    detail.hit.zdb_id: 2662336-5
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  • 3
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    Epidemiology and Outcome of Powered Mobility Device-Related Injuries in Korea
    XMLink ; 2020
    In:  Journal of Korean Medical Science Vol. 35, No. 9 ( 2020)
    Details
    In: Journal of Korean Medical Science, XMLink, Vol. 35, No. 9 ( 2020)
    Type of Medium: Online Resource
    ISSN: 1011-8934 , 1598-6357
    URL: Article
    DOI: 10.3346/jkms.2020.35.e60
    Language: English
    Publisher: XMLink
    Publication Date: 2020
    detail.hit.zdb_id: 2056822-8
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  • 4
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    Gender difference in the clinical outcomes of patients with out-of-hospital cardiac arrest : A report using data from a national Korean registry
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Medicine Vol. 100, No. 48 ( 2021-12-03), p. e27855-
    Details
    In: Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 100, No. 48 ( 2021-12-03), p. e27855-
    Abstract: We explored gender differences in the characteristics and outcomes of patients with out-of-hospital cardiac arrest (OHCA) in Korea. We retrospectively analyzed a nationwide multicenter registry of out-of-hospital cardiac arrest patients that prospectively collected from January to December 2014, and explored the clinical outcomes of 670 successfully resuscitated adult patients with OHCA who were transferred to 27 hospitals. The effect of gender on the 30-day neurologically favorable survival (cerebral performance category 1 or 2) was analyzed after propensity score matching (PSM) of each patient in terms of clinical characteristics. We included 670 patients with OHCA, of whom 482 (72%) were male and 182 (28%) were female. The frequency of witnessed arrests and proportion of home arrests were similar between men and women (73.7% vs 71.3%, P  = .59, and 55.0% vs 60.6% P  = .21, respectively). Women were older than men (mean age, 65.9 vs 59.7 years, P   〈  .001) and less likely to present with an initial shockable rhythm (27.7% vs 45.0%, P   〈  .001). Women were less likely to undergo targeted temperature management (19.1% vs 35.9%, P   〈  .001), coronary angiography (14.9% vs 36.1%, P   〈  .001), or revascularization (7.4% vs 19.3%, P   〈  .001). Compared with men, women exhibited poorer 30-day neurologically favorable survival (69.7% vs 83.0%, P  = .001). However, the gender difference was not significant on PSM or inverse probability of treatment weighting (IPTW) analyses ( P  = .48 and P  = .63, respectively). Female patients with OHCA exhibited poorer clinical characteristics and were less likely to receive treatment than men. After accounting for these differences, clinical outcomes did not differ by gender.
    Type of Medium: Online Resource
    ISSN: 0025-7974 , 1536-5964
    URL: Article
    DOI: 10.1097/MD.0000000000027855
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 2049818-4
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  • 5
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    Prehospital airway management for out‐of‐hospital cardiac arrest: A nationwide multicenter study from the KoCARC registry
    Wiley ; 2022
    In:  Academic Emergency Medicine Vol. 29, No. 5 ( 2022-05), p. 581-588
    Details
    In: Academic Emergency Medicine, Wiley, Vol. 29, No. 5 ( 2022-05), p. 581-588
    Abstract: This study investigated whether prehospital advanced airway management (AAM) is associated with improved survival of out‐of‐hospital cardiac arrest (OHCA) compared with conventional bag–valve–mask (BVM) ventilation. Methods We investigated the neurologically favorable survival of adult patients with OHCA who underwent BVM or AAM using the Korean Cardiac Arrest Research Consortium (KoCARC), a multicenter OHCA registry of Korea. The differences in clinical characteristics were adjusted by matching or weighting the clinical propensity for use of AAM or by least absolute shrinkage and selection operator (LASSO). The primary outcome was 30‐day survival with neurologically favorable status defined by cerebral performance category 1 or 2. Results Of the 9,616 patients enrolled (median age = 71 years; 65% male), there were 6,243 AAM and 3,354 BVM patients. In unadjusted analysis, the 30‐day neurologically favorable survival was lower in the AAM group compared with the BVM group (5.5% vs. 10.0%; hazard ratio [HR] = 1.21, 95% confidence interval [CI]  = 1.16 to 1.27; all p   〈  0.001). In propensity score matching–adjusted analysis, these differences were not found (9.6% vs. 10.0%; HR = 0.98, 95% CI = 0.93 to 1.03, p   〉  0.05). Inverse probability of treatment weighting‐ and LASSO‐adjusted analyses replicated these results. Conclusions In this nationwide real‐world data analysis of OHCA, the 30‐day neurologically favorable survival did not differ between prehospital AAM and BVM after adjustment for clinical characteristics.
    Type of Medium: Online Resource
    ISSN: 1069-6563 , 1553-2712
    URL: Issue
    URL: Article
    DOI: 10.1111/acem.v29.5
    DOI: 10.1111/acem.14443
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 2029751-8
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  • 6
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    Effect of fever or respiratory symptoms on leaving without being seen during the COVID-19 pandemic in South Korea
    The Korean Society of Emergency Medicine ; 2022
    In:  Clinical and Experimental Emergency Medicine Vol. 9, No. 1 ( 2022-03-31), p. 1-9
    Details
    In: Clinical and Experimental Emergency Medicine, The Korean Society of Emergency Medicine, Vol. 9, No. 1 ( 2022-03-31), p. 1-9
    Abstract: Objective Coronavirus disease 2019 (COVID-19) has notably altered the emergency department isolation protocol, imposing stricter requirements on probable infectious disease patients that enter the department. This has caused adverse effects, such as an increased rate of leave without being seen (LWBS). This study describes the effect of fever/respiratory symptoms as the main cause of isolation regarding LWBS after the COVID-19 pandemic.Methods We retrospectively analyzed emergency department visits before (March to July 2019) and after (March to July 2020) the COVID-19 pandemic. Patients were grouped based on existing fever or respiratory symptoms, with the LWBS rate as the primary outcome. Logistic regression analysis was used to identify the risk factors of LWBS. Logistic regression was performed using interaction terminology (fever/respiratory symptom patient [FRP]×post–COVID-19) to determine the interaction between patients with FRPs and the COVID-19 pandemic period.Results A total of 60,290 patients were included (34,492 in the pre–COVID-19, and 25,298 in the post–COVID-19 group). The proportion of FRPs decreased significantly after the pandemic (P 〈 0.001), while the LWBS rate in FRPs significantly increased from 2.8% to 19.2% (P 〈 0.001). Both FRPs (odds ratio, 1.76; 95% confidence interval, 1.59–1.84 (P 〈 0.001) and the COVID-19 period (odds ratio, 2.29; 95% confidence interval, 2.15–2.44; P 〈 0.001) were significantly associated with increased LWBS. Additionally, there was a significant interaction between the incidence of LWBS in FRPs and the COVID-19 pandemic period (P 〈 0.001).Conclusion The LWBS rate has increased in FRPs after the COVID-19 pandemic; additionally, the effect observed was disproportionate compared with that of nonfever/respiratory symptom patients.
    Type of Medium: Online Resource
    ISSN: 2383-4625
    URL: Article
    DOI: 10.15441/ceem.21.105
    Language: English
    Publisher: The Korean Society of Emergency Medicine
    Publication Date: 2022
    detail.hit.zdb_id: 2873699-0
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  • 7
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    Impact of Insurance Benefits and Education on Point-of-Care Ultrasound Use in a Single Emergency Department: An Interrupted Time Series Analysis
    MDPI AG ; 2022
    In:  Medicina Vol. 58, No. 2 ( 2022-02-01), p. 217-
    Details
    In: Medicina, MDPI AG, Vol. 58, No. 2 ( 2022-02-01), p. 217-
    Abstract: Background and Objectives: Point-of-care ultrasound (POCUS) is a useful tool that helps clinicians properly treat patients in emergency department (ED). This study aimed to evaluate the impact of specific interventions on the use of POCUS in the ED. Materials and Methods: This retrospective study used an interrupted time series analysis to assess how interventions changed the use of POCUS in the emergency department of a tertiary medical institute in South Korea from October 2016 to February 2021. We chose two main interventions—expansion of benefit coverage of the National Health Insurance (NHI) for emergency ultrasound (EUS) and annual ultrasound educational workshops. The primary variable was the EUS rate, defined as the number of EUS scans per 1000 eligible patients per month. We compared the level and slope of EUS rates before and after interventions. Results: A total of 5188 scanned records were included. Before interventions, the EUS rate had increased gradually. After interventions, except for the first workshop, the EUS rate immediately increased significantly (p 〈 0.05). The difference in the EUS rate according to the expansion of the NHI was estimated to be the largest (p 〈 0.001). However, the change in slope significantly decreased after the third workshop during the coronavirus disease 2019 pandemic (p = 0.004). The EUS rate increased significantly in the presence of physicians participating in intensive POCUS training (p 〈 0.001). Conclusion: This study found that expansion of insurance coverage for EUS and ultrasound education led to a significant and immediate increase in the use of POCUS, suggesting that POCUS use can be increased by improving education and insurance benefits.
    Type of Medium: Online Resource
    ISSN: 1648-9144
    URL: Article
    DOI: 10.3390/medicina58020217
    Language: English
    Publisher: MDPI AG
    Publication Date: 2022
    detail.hit.zdb_id: 2088820-X
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  • 8
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    Online Resource
    Point-of-care ultrasound compression of the carotid artery for pulse determination in cardiopulmonary resuscitation
    Elsevier BV ; 2022
    In:  Resuscitation Vol. 179 ( 2022-10), p. 206-213
    Details
    In: Resuscitation, Elsevier BV, Vol. 179 ( 2022-10), p. 206-213
    Type of Medium: Online Resource
    ISSN: 0300-9572
    URL: Article
    DOI: 10.1016/j.resuscitation.2022.06.025
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2022
    detail.hit.zdb_id: 2010733-X
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  • 9
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    Are loose-fitting powered air-purifying respirators safe during chest compression? A simulation study
    Elsevier BV ; 2021
    In:  The American Journal of Emergency Medicine Vol. 44 ( 2021-06), p. 235-240
    Details
    In: The American Journal of Emergency Medicine, Elsevier BV, Vol. 44 ( 2021-06), p. 235-240
    Type of Medium: Online Resource
    ISSN: 0735-6757
    URL: Article
    DOI: 10.1016/j.ajem.2020.03.054
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2021
    detail.hit.zdb_id: 2041648-9
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  • 10
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    The effect of norepinephrine on common carotid artery blood flow in septic shock patients
    Springer Science and Business Media LLC ; 2021
    In:  Scientific Reports Vol. 11, No. 1 ( 2021-08-18)
    Details
    In: Scientific Reports, Springer Science and Business Media LLC, Vol. 11, No. 1 ( 2021-08-18)
    Abstract: This study was designed to evaluate the hemodynamic effect of norepinephrine (NE) on the peak systolic velocity (PSV), diameter, and blood flow of the common carotid artery (CCA) using the point-of-care ultrasound (POCUS) in patients with septic shock. The study involved patients above 18 years old with septic shock. Arterial monitoring, carotid ultrasonography, and transthoracic echocardiography were performed before NE administration (T 0 ). When the mean arterial pressure exceeded 65 mmHg after NE administration (T 1 ), the measurement was repeated. Twenty-four patients (median age 67 [interquartile range: 54–77] years; 42% female) with septic shock were examined in this study. Before (T 0 ) and after (T 1 ) NE administration, the PSV (mean, standard deviation [SD]) changed from 85.3 (21.1) cm/s to 83.5 (23.5) cm/s (p = 0.417); this change was not significant. However, the diameter and blood flow of the CCA increased significantly from 0.6 (0.09) cm and 0.75 (0.27) L/min to 0.66 (0.09) cm and 0.85 (0.27) L/min, respectively (p  〈  0.001). The diameter of the left ventricular outflow tract (LVOT) remained unchanged, but the velocity time integral of the LVOT increased significantly from 21.7 (4.39) cm to 23.6 (5.14) cm. There was no significant correlation between changes in blood flow of the CCA and changes in cardiac output (coefficient −0.365, p = 0.079). In conclusion, NE increased the diameter and blood flow of the CCA significantly, without changing the PSV in patients with septic shock.
    Type of Medium: Online Resource
    ISSN: 2045-2322
    URL: Article
    DOI: 10.1038/s41598-021-96082-4
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 2615211-3
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