Purpose: Fluid therapy for diarrhea-induced dehydration inadvertently increases emergency department length of stay (EDLOS). To prevent this delay, we investigated the usefulness of triage using point-of-care (POC) lactate in infants with diarrhea. Methods: This study was performed on infants with diarrhea who visited the emergency department from January 2019 through December 2020. According to the POC lactate concentration and the Korean Triage and Acuity Scale (KTAS) level, the infants were separately divided into the low (< 2 mmol/L), moderate (2-3.9), and high (≥ 4) lactate groups and the mild (KTAS 4-5) and severe (1-3) groups, respectively. Using these 2 group designations, we compared variables regarding the emergency medicine resource use and outcomes. To predict the prolonged EDLOS (≥ median value) we performed logistic regression and receiver operating characteristic analyses. Results: A total of 540 infants were included. The median of EDLOS was 169 minutes (interquartile range, 103-220). Fluid therapy was more frequently performed in the high lactate group than in the low-moderate lactate groups (85.0% vs. 60.4%-73.6%; P = 0.025). The high lactate and severe groups respectively showed higher rates of hospitalization (40.0% vs. 3.8%-7.6% [P < 0.001] and 10.9% vs. 1.4% [P = 0.015]), and longer median EDLOS (259 minutes vs. 147-178 [P < 0.001] and 185 vs. 131 [P = 0.001]) compared to the low-moderate lactate and mild groups. Compared to the KTAS, lactate is more strongly associated with the prolonged EDLOS (lactate, adjusted odds ratio, 4.80 [95% confidence interval, 1.87-15.34] vs. KTAS, 3.52 [1.90-6.54]). The areas under curve for lactate and for the KTAS were 0.66 (0.60-0.73) and 0.62 (0.55-0.69), respectively (P = 0.058). Conclusion In infants with diarrhea, POC lactate can be a predictor of emergency medicine resource use and outcomes.

Objective: Pesticide poisoning is one of the leading causes of death, and it is important to classify high-risk patients. Lactate measurement could be used to assess the triage level and decide and prioritize treatment even within the same triage group. This study investigates whether point-of-care lactate measurement helps to triage pesticide poisoning patients in the emergency department (ED). Methods: This retrospective study was done for pesticide poisoning patients between January 2018 to December 2021. Demographic data and laboratory results were collected by reviewing medical records. Statistical analysis was performed by dividing patients into death and survival groups. Univariable and multivariable logistic regression analyses were done. Receiver operating characteristic curves were obtained for variables with significant differences, and area under the curves (AUC) were calculated and compared. Results: Among the 288 patients evaluated, there were 24 (8.33%) mortalities and 264 (91.67%) survivals during hospitalization. Age, the Acute Physiology and Chronic Health Evaluation II (APACHE-II) score, pH and base excess, and lactate levels were analyzed via univariable and multivariable logistic regression tests. We found that old age and high lactate were independent factors in predicting mortality for pesticide poisoning patients. AUCs with 95% confidence interval for age and lactate were 0.784 (0.653-0.915) and 0.803 (0.674-0.932), respectively. Conclusion Lactate measurement may be useful during triage of alert and consciousness patients presenting with pesticide poisoning and having stable vital signs in ED. This study has several limitations, and it is necessary to reconfirm the results through a well-designed prospective study.

Objective: After the coronavirus disease 2019 (COVID-19) outbreak, there have been some changes in the way the medical system deals with suspected infectious diseases. These changes may also affect non-COVID-19 patients. Acute appendicitis is a common disease that requires emergent surgical intervention in pediatric patients, and delayed diagnosis and treatment may cause some complications. This study analyzed the impact of the COVID-19 pandemic on the incidence of complicated appendicitis in pediatric patients presenting to emergency departments in South Korea. Methods: The target group (post-COVID group) included patients aged under 15 years and diagnosed with acute appendicitis between February 23 and November 30, 2020. Patients diagnosed during the same period in 2019 were selected as the control group (pre-COVID group). The difference in the incidence of complicated appendicitis before and after the COVID-19 outbreak was investigated, and the association with various variables was analyzed using the odds ratios and 95% confidence intervals. Results: The study enrolled a total of 94 patients: 54 in the pre-COVID group and 40 in the post-COVID group. There was no statistically significant variation in the incidence of complicated appendicitis (31.5% vs 35.0%, P=0.723) between the groups. In-hospital time was longer in the post-COVID group (7 hours vs. 10.5 hours, P=0.014), but pre-hospital time showed no significant difference (16 hours vs. 22 hours, P=0.768). In the multivariable logistic regression analysis, pre-hospital time (odds ratio [OR], 1.08; P=0.004), erythrocyte sedimentation rate (OR, 33.24; P<0.001), and the presence of fever (OR, 21.11, P=0.002) showed a significant correlation. Conclusion Post the COVID-19 pandemic outbreak, there was no difference in the incidence of pediatric complicated appendicitis in South Korea.

Purpose: In patients with glufosinate poisoning, severe neurological symptoms may be closely related to a poor prognosis, but their appearance may be delayed. Therefore, this study aimed to determine whether the Acute Physiology and Chronic Health Evaluation II (APACHE II) score could predict the neurological prognosis in patients with glufosinate poisoning who present to the emergency room with alert mental status. Methods: This study was conducted retrospectively through a chart review for patients over 18 years who presented to a single emergency medical center from January 2018 to December 2022 due to glufosinate poisoning. Patients were divided into groups with a good neurological prognosis (Cerebral Performance Category [CPC] Scale 1 or 2) and a poor prognosis (CPC Scale 3, 4, or 5) to identify whether any variables showed significant differences between the two groups. Results: There were 66 patients (67.3%) with good neurological prognoses and 32 (32.8%) with poor prognoses. In the multivariate logistic analysis, the APACHE II score, serum amylase, and co-ingestion of alcohol showed significant results, with odds ratios of 1.387 (95% confidence interval [CI], 1.027–1.844), 1.017 (95% CI, 1.002–1.032), and 0.196 (95% CI, 0.040–0.948), respectively. With an APACHE II score cutoff of 6.5, the AUC was 0.826 (95% CI, 0.746–0.912). The cutoff of serum amylase was 75.5 U/L, with an AUC was 0.761 (95% CI, 0.652–0.844), and the AUC of no co-ingestion with alcohol was 0.629 (95% CI, 0.527–0.722). Conclusion The APACHE II score could be a useful indicator for predicting the neurological prognosis of patients with glufosinate poisoning who have alert mental status.

Background: Inflammasomes are key in the initiation of inflammatory responses and serve to de-fend the organism. However, when the immune system is imbalanced, these complexes contribute to tumor progression. The purpose of this study was to investigate the effect of non-canonical inflammasomes on glioma malignancy. Methods: We performed bioinformatics analysis to confirm the expression of canonical andnon-canonical inflammasome-related molecules according to the degree of malignancy through immunohistochemical examination of glioma tissues obtained with patient consent from our institution. Results: Bioinformatics analysis confirmed that the expression levels of non-canonical inflam-masome-related molecules were significantly higher in tumor tissues than in normal tissues, and they also increased according to malignancy, which adversely affected the survival rate. Furthermore, in gliomas, positive correlations were found between N-form gasdermin-D, a key molecule associated with the non-canonical inflammasome, and other related molecules, including NLRP3, caspase-1, caspase-4, and caspase-5. These results were verified by immunohistochemical examination of glioma tissues, and the expression levels of these molecules also increased significantly with increasing grade.In addition, the features of pyroptosis were confirmed. Conclusion This study identified the potential of non-canonical inflammasomes as aggressiveness markers for gliomas and presented a perspective for improving glioma treatment.