1.Risk of injury after emergency department visit for acute peripheral vertigo: a matched-cohort study
Hayoung KIM ; Sihyoung LEE ; Joonghee KIM
Clinical and Experimental Emergency Medicine 2020;7(3):176-182
Objective:
Peripheral vertigo is one of the most common causes of the emergency department (ED) visits. It can impair balance and might predispose patients to injuries after discharge. The purpose of this study was to determine whether peripheral vertigo is associated with an increased risk of trauma.
Methods:
This matched-cohort study used the nationally representative dataset of de-identified claim information of 1 million randomly sampled individuals from a real Korean population, from 2002 to 2013. The exposure cohort included patients who visited EDs for new-onset peripheral vertigo without prior or concurrent injury. Each patient was randomly matched to five unexposed individuals (also without previous injury) by incidence density sampling. The primary outcome was a new injury within 1 year. The secondary outcomes were various injury subtypes. The time-dependent effect of the exposure was modeled using the extended Cox model. Age, sex, comorbidities, and household income level were included as covariates.
Results:
A total of 776 and 3,880 individuals were included as the exposure and comparison cohorts, respectively. The risks of trunk injury and upper extremity injury were significantly higher in the exposure cohort. Extended Cox models with multivariable adjustment showed significantly increased risk for up to 1 year, with the first 1-month; 1 month to 3 months; and 3 months to 1 year hazard ratios of 5.23 (95% confidence interval [CI], 2.83–9.64); 1.50 (95% CI, 1.02–2.20); and 1.37 (95% CI, 1.11–1.68), respectively.
Conclusion
Patients visiting EDs for acute peripheral vertigo are at a higher risk of a new injury for up to a year.
2.Epidemiology of sepsis in Korea: a population-based study of incidence, mortality, cost and risk factors for death in sepsis
Joonghee KIM ; Kyuseok KIM ; Heeyoung LEE ; Soyeon AHN
Clinical and Experimental Emergency Medicine 2019;6(1):49-63
OBJECTIVE: To investigate the epidemiology of sepsis in Korea and identify risk factors for death in sepsis.METHODS: We conducted a longitudinal, population-based epidemiological study of sepsis in Korea from 2005 to 2012 using the National Health Insurance Service-National Sample Cohort, a population-based cohort representing 2.2% of the Korean population. The primary objective was to assess the incidence, mortality and cost of sepsis. The secondary objective was to identify the risk factors for death in sepsis. Claim records of admitted adult patients (aged ≥15 years) were analyzed. Sepsis was defined as 1) bacterial or fungal infection or the conditions they often complicate, 2) prescription of intravenous antibiotics, and 3) presence of any organ dysfunction. Comorbidities were defined using the Charlson/Deyo method. Risk factors for 6-month mortality were assessed using multivariable logistic regression.RESULTS: A total of 22,882 cases were identified. Both incidence and 6-month mortality increased from 265.7 (95% confidence interval [CI], 254.7 to 277.1) to 453.1 (95% CI, 439.0 to 467.5) per 100,000 person-years (P-trend <0.001) and from 26.5% (95% CI, 24.4% to 28.8%) to 30.1% (95% CI, 28.4% to 31.9%), respectively. After standardization, the increasing trend of incidence was slower but still significant (P-trend <0.001), while that for mortality was not (P-trend 0.883). The average cost increased by 75.5% (P-trend <0.001). Multivariable logistic regression identified various risk factors for mortality.CONCLUSION: The burden of sepsis in Korea was high and is expected to increase considering the aging population. Proactive measures to curtail this increase should be sought and implemented.
Adult
;
Aging
;
Anti-Bacterial Agents
;
Cohort Studies
;
Comorbidity
;
Epidemiologic Studies
;
Epidemiology
;
Humans
;
Incidence
;
Korea
;
Logistic Models
;
Methods
;
Mortality
;
National Health Programs
;
Prescriptions
;
Risk Factors
;
Sepsis
3.Effect of albumin on the outcomes in septic patients with hypoalbuminemia in the emergency department: a propensity score-matched retrospective cohort study
Ji Eun HWANG ; Jae Hyuk LEE ; Joonghee KIM ; Inwon PARK
Journal of the Korean Society of Emergency Medicine 2022;33(5):448-459
Objective:
A low albumin concentration is known to be associated with poor prognosis in patients with sepsis, but the benefits of albumin administration in these patients are unclear. This study was performed to investigate the effect of albumin administration on the outcomes of patients suffering from sepsis or septic shock.
Methods:
This was a retrospective, propensity score-matched cohort study of septic patients with an initial serum albumin level < 3.0 g/dL admitted to the emergency department (ED) of an urban tertiary university hospital. Patients who received 20% albumin within 24 hours of admission to the ED were compared with those who did not. We performed a 1:1 propensity score-matched analysis. The primary outcome was the 28-day mortality rate and the secondary outcomes were the Sequential Organ Failure Assessment (SOFA) score at 24, 48, and 72 hours, the need for mechanical ventilation and renal replacement therapy (RRT), and admission to the intensive care unit (ICU).
Results:
A total of 1,284 patients were included in the study, and the overall mortality rate was 29.4%. After propensity score matching, 192 patients in the albumin group and 192 in the control group were included in the final analysis. There was no significant difference in the 28-day mortality rates. The SOFA scores at 24, 48, and 72 hours were higher in the albumin group than in the control group. The rates of RRT and admission to the ICU were also higher in the albumin group.
Conclusion
In patients with sepsis and hypoalbuminemia, albumin replacement was not associated with higher 28-day mortality, but was associated with the higher SOFA scores, higher rates of RRT application and admission to the ICU.
4.AI-ECG Supported Decision-Making for Coronary Angiography in Acute Chest Pain: The QCG-AID Study
Jiesuck PARK ; Joonghee KIM ; Soyeon AHN ; Youngjin CHO ; Yeonyee E. YOON
Journal of Korean Medical Science 2025;40(12):e105-
This pilot study evaluates an artificial intelligence (AI)-assisted electrocardiography (ECG) analysis system, QCG, to enhance urgent coronary angiography (CAG) decision-making for acute chest pain in the emergency department (ED). We retrospectively analyzed 300 ED cases, categorized as non-coronary chest pain (Group 1), acute coronary syndrome (ACS) without occlusive coronary artery disease (CAD) (Group 2), and ACS with occlusive CAD (Group 3). Six clinicians made urgent CAG decision using a conventional approach (clinical data and ECG) and a QCG-assisted approach (including QCG scores). The QCG-assisted approach improved correct CAG decisions in Group 2 (36.0% vs. 45.3%, P = 0.003) and Group 3 (85.3% vs. 90.0%, P = 0.017), with minimal impact in Group 1 (92.7% vs. 95.0%, P = 0.125). Diagnostic accuracy for ACS improved from 77% to 81% with QCG assistance and reached 82% with QCG alone, supporting AI's potential to enhance urgent CAG decisionmaking for ED chest pain cases.
5.AI-ECG Supported Decision-Making for Coronary Angiography in Acute Chest Pain: The QCG-AID Study
Jiesuck PARK ; Joonghee KIM ; Soyeon AHN ; Youngjin CHO ; Yeonyee E. YOON
Journal of Korean Medical Science 2025;40(12):e105-
This pilot study evaluates an artificial intelligence (AI)-assisted electrocardiography (ECG) analysis system, QCG, to enhance urgent coronary angiography (CAG) decision-making for acute chest pain in the emergency department (ED). We retrospectively analyzed 300 ED cases, categorized as non-coronary chest pain (Group 1), acute coronary syndrome (ACS) without occlusive coronary artery disease (CAD) (Group 2), and ACS with occlusive CAD (Group 3). Six clinicians made urgent CAG decision using a conventional approach (clinical data and ECG) and a QCG-assisted approach (including QCG scores). The QCG-assisted approach improved correct CAG decisions in Group 2 (36.0% vs. 45.3%, P = 0.003) and Group 3 (85.3% vs. 90.0%, P = 0.017), with minimal impact in Group 1 (92.7% vs. 95.0%, P = 0.125). Diagnostic accuracy for ACS improved from 77% to 81% with QCG assistance and reached 82% with QCG alone, supporting AI's potential to enhance urgent CAG decisionmaking for ED chest pain cases.
6.AI-ECG Supported Decision-Making for Coronary Angiography in Acute Chest Pain: The QCG-AID Study
Jiesuck PARK ; Joonghee KIM ; Soyeon AHN ; Youngjin CHO ; Yeonyee E. YOON
Journal of Korean Medical Science 2025;40(12):e105-
This pilot study evaluates an artificial intelligence (AI)-assisted electrocardiography (ECG) analysis system, QCG, to enhance urgent coronary angiography (CAG) decision-making for acute chest pain in the emergency department (ED). We retrospectively analyzed 300 ED cases, categorized as non-coronary chest pain (Group 1), acute coronary syndrome (ACS) without occlusive coronary artery disease (CAD) (Group 2), and ACS with occlusive CAD (Group 3). Six clinicians made urgent CAG decision using a conventional approach (clinical data and ECG) and a QCG-assisted approach (including QCG scores). The QCG-assisted approach improved correct CAG decisions in Group 2 (36.0% vs. 45.3%, P = 0.003) and Group 3 (85.3% vs. 90.0%, P = 0.017), with minimal impact in Group 1 (92.7% vs. 95.0%, P = 0.125). Diagnostic accuracy for ACS improved from 77% to 81% with QCG assistance and reached 82% with QCG alone, supporting AI's potential to enhance urgent CAG decisionmaking for ED chest pain cases.
7.AI-ECG Supported Decision-Making for Coronary Angiography in Acute Chest Pain: The QCG-AID Study
Jiesuck PARK ; Joonghee KIM ; Soyeon AHN ; Youngjin CHO ; Yeonyee E. YOON
Journal of Korean Medical Science 2025;40(12):e105-
This pilot study evaluates an artificial intelligence (AI)-assisted electrocardiography (ECG) analysis system, QCG, to enhance urgent coronary angiography (CAG) decision-making for acute chest pain in the emergency department (ED). We retrospectively analyzed 300 ED cases, categorized as non-coronary chest pain (Group 1), acute coronary syndrome (ACS) without occlusive coronary artery disease (CAD) (Group 2), and ACS with occlusive CAD (Group 3). Six clinicians made urgent CAG decision using a conventional approach (clinical data and ECG) and a QCG-assisted approach (including QCG scores). The QCG-assisted approach improved correct CAG decisions in Group 2 (36.0% vs. 45.3%, P = 0.003) and Group 3 (85.3% vs. 90.0%, P = 0.017), with minimal impact in Group 1 (92.7% vs. 95.0%, P = 0.125). Diagnostic accuracy for ACS improved from 77% to 81% with QCG assistance and reached 82% with QCG alone, supporting AI's potential to enhance urgent CAG decisionmaking for ED chest pain cases.
8.Impact of an Emergency Department Isolation Policy for Patients With Suspected COVID-19 on Door-toElectrocardiography Time and Clinical Outcomes in Patients With Acute Myocardial Infarction
Jinhee KIM ; Joo JEONG ; You Hwan JO ; Jin Hee LEE ; Yu Jin KIM ; Seung Min PARK ; Joonghee KIM
Journal of Korean Medical Science 2023;38(50):e388-
Background:
Rapid electrocardiography diagnosis within 10 minutes of presentation is critical for acute myocardial infarction (AMI) patients in the emergency department (ED).However, the coronavirus disease 2019 (COVID-19) pandemic has significantly impacted the emergency care system. Screening for COVID-19 symptoms and implementing isolation policies in EDs may delay the door-to-electrocardiography (DTE) time.
Methods:
We conducted a cross-sectional study of 1,458 AMI patients who presented to a single ED in South Korea from January 2019 to December 2021. We used multivariate logistic regression analysis to assess the impact of COVID-19 pandemic and ED isolation policies on DTE time and clinical outcomes.
Results:
We found that the mean DTE time increased significantly from 5.5 to 11.9 minutes (P < 0.01) in ST segment elevation myocardial infarction (STEMI) patients and 22.3 to 26.7 minutes (P < 0.01) in non-ST segment elevation myocardial infarction (NSTEMI) patients.Isolated patients had a longer mean DTE time compared to non-isolated patients in both STEMI (9.2 vs. 24.4 minutes) and NSTEMI (22.4 vs. 61.7 minutes) groups (P < 0.01). The adjusted odds ratio (aOR) for the effect of COVID-19 duration on DTE ≥ 10 minutes was 1.93 (95% confidence interval [CI], 1.51–2.47), and the aOR for isolation status was 5.62 (95% CI, 3.54–8.93) in all patients. We did not find a significant association between in-hospital mortality and the duration of COVID-19 (aOR, 0.9; 95% CI, 0.52–1.56) or isolation status (aOR, 1.62; 95% CI, 0.71–3.68).
Conclusion
Our study showed that ED screening or isolation policies in response to the COVID-19 pandemic could lead to delays in DTE time. Timely evaluation and treatment of emergency patients during pandemics are essential to prevent potential delays that may impact their clinical outcomes.
9.Relationship between the time to positivity of blood culture and mortality according to the site of infection in sepsis.
Young Woo UM ; Jae Hyuk LEE ; You Hwan JO ; Joonghee KIM ; Yu Jin KIM ; Hyuksool KWON
Journal of the Korean Society of Emergency Medicine 2018;29(5):474-484
OBJECTIVE: The time to positivity (TTP) of blood culture reflects bacterial load and has been reported to be associated with outcome in bloodstream infections. This study was performed to evaluate the relationship between the TTP of blood culture and the mortality rates associated with sepsis and septic shock according to the site of infection. METHODS: We performed a retrospective cohort study on patients with sepsis and septic shock. The rates of blood culture positivity and mortality as well as the relationship between the TTP and 28-day mortality rate were compared among patients with different sites of infection, such as the lungs, abdomen, urogenital tract, and other sites. RESULTS: A total of 2,668 patients were included, and the overall mortality rate was 21.6%. The rates of blood culture positivity and mortality were different among the different infection sites. There was no relationship between the TTP and mortality rates of total, lung, and urogenital infections. Patients with abdominal infections showed a negative correlation between the TTP and 28-day mortality rate. In patients with abdominal infections, a TTP < 20 hours was independently associated with 28-day mortality compared with patients with negative blood culture (hazard ratio, 1.73; 95% confidence interval, 1.16–2.58). However, there was no difference in mortality rates of patients with a TTP≥20 hours and a negative blood culture. CONCLUSION: The shorter TTP in patients with abdominal infections in sepsis and septic shock was associated with a higher 28-day mortality rate.
Abdomen
;
Bacterial Load
;
Cohort Studies
;
Humans
;
Lung
;
Mortality*
;
Retrospective Studies
;
Sepsis*
;
Shock, Septic
10.Non-Inferiority Analysis of Electrocardiography Analysis Application vs. Point-of-Care Ultrasound for Screening Left Ventricular Dysfunction
Jin Hee KIM ; Jae Yun JUNG ; Joonghee KIM ; Youngjin CHO ; Eunkyoung LEE ; Dahyeon SON
Yonsei Medical Journal 2025;66(3):172-178
Purpose:
Point-of-care ultrasound (POCUS) is widely used for heart function evaluation in emergency departments (EDs), but requires specific equipment and skilled operators. This study evaluates the diagnostic accuracy of a mobile application for estimating left ventricular (LV) systolic dysfunction [left ventricular ejection fraction (LVEF) <40%] using electrocardiography (ECG) and tests its non-inferiority to POCUS.
Materials and Methods:
Patients (aged ≥20 years) were included if they had both a POCUS-based EF evaluation and an ECG within 24 hours of their ED visit between January and May 2022, along with formal echocardiography within 2 weeks before or after the visit. A mobile app (ECG Buddy, EB) estimated LVEF (EF from EB) and the risk of LV dysfunction (LV-Dysfunction score) from ECG waveforms, which were compared to NT-proBNP levels and POCUS-evaluated LVEF (EF from POCUS). A non-inferiority margin was set at an area under the curve (AUC) difference of 0.05.
Results:
Of the 181 patients included, 37 (20.4%) exhibited LV dysfunction. The AUCs for screening LV dysfunction using POCUS and NT-proBNP were 0.885 and 0.822, respectively. EF from EB and LV-Dysfunction score outperformed NT-proBNP, with AUCs of 0.893 and 0.884, respectively (p=0.017 and p=0.030, respectively). EF from EB was non-inferior to EF from POCUS, while LV-Dysfunction score narrowly missed the mark. A subgroup analysis of sinus-origin rhythm ECGs supported the non-inferiority of both EF from EB and LV-Dysfunction score to EF from POCUS.
Conclusion
A smartphone application that analyzes ECG image can screen for LV dysfunction with a level of accuracy comparable to that of POCUS.