Background: Inter-hospital transfers of severely injured patients are inevitable due to limited resources. We investigated the association between inter-hospital transfer and the prognosis of pediatric injury using the Korean multi-institutional injury registry. Methods: This retrospective observational study was conducted from January 2013 to December 2017; data for hospitalized subjects aged < 18 years were extracted from the Emergency Department-based Injury in Depth Surveillance database, in which 22 hospitals are participating as of 2022. The survival rates of the direct transfer group and the interhospital transfer group were compared, and risk factors affecting 30-day mortality and 72-hour mortality were analyzed. Results: The total number of study subjects was 18,518, and the transfer rate between hospitals was 14.5%. The overall mortality rate was 2.3% (n = 422), the 72-hour mortality was 1.7% (n = 315) and the 30-day mortality rate was 2.2% (n = 407). The Kaplan-Meier survival curve revealed a lower survival rate in the inter-hospital transfer group than in the direct visit group (log-rank, P < 0.001). Cox proportional hazards regression analysis showed that interhospital transfer group had a higher 30-day mortality rate and 72-hour mortality (hazard ratio [HR], 1.681; 95% confidence interval [CI], 1.232–2.294 and HR, 1.951; 95% CI, 1.299–2.930) than direct visit group when adjusting for age, sex, injury severity, and head injury. Conclusion Among the pediatric injured patients requiring hospitalization, inter-hospital transfer in the emergency department was associated with the 30-day mortality rate and 72-hour mortality rate in Korea.

In mid-2022, as the wave of pediatric coronavirus disease 2019 (COVID-19) cases escalated in South Korea, a public-private partnership was made to establish a Pediatric COVID-19 Module Clinic (PMC). We describe the utilization of the first prototype children’s modular clinic in Korea University Anam Hospital functioning as the COVID-19 PMC. Between August 1 and September 30, 2022, a total of 766 children visited COVID-19 PMC. Daily number of patient visits to the COVID-19 PMC ranged between 10 and 47 in August; and less than 13 patients per day in September 2022. Not only the model provided timely care for the COVID-19 pediatric patients, but it also enabled safe and efficacious care for the non-COVID-19 patients in the main hospital building while minimizing exposure risk to severe acute respiratory syndrome coronavirus 2 transmission. Current description highlights the importance of spatial measures for mitigating in-hospital transmission of COVID-19, in specifically on pediatric care.

With the age of exposure to illegal substances decreasing and abuse of drugs such as methamphetamine increasing, substance abuse is no longer limited to adults. We report a Korean case of a 17-year-old girl with acute methamphetamine poisoning. The girl visited the emergency department for vomiting and loss of consciousness, with needle marks found on both arms. QT prolongation was confirmed on the initial electrocardiogram, so that we suspected drug addiction and proceeded with toxicologic tests. A lethal dose of methamphetamine was confirmed. We discontinued QT prolonging drugs, and closely monitored the girl in the pediatric emergency intensive care unit until the QT prolongation was resolved. This case highlights the recognition of pediatric methamphetamine poisoning in emergency departments.

Purpose: Patients with atopic dermatitis (AD) experience a chronic relentless course which may affect emotional and behavioral problems. Moreover, AD could affect serious psychosocial problems due to its disfiguring skin conditions, particularly in adolescents who are under various stresses. The aim of this study was to investigate behavioral problems in children and adolescents with AD and to identify associated clinical factors. Methods: A total of 69 subjects with AD were enrolled in this study. The severity of AD was assessed using the SCORAD (Scoring of Atopic Dermatitis) index and divided into 2 groups: mild-to-moderate and severe groups. Behavioral problems were assessed by using the Korean Child Behavior Checklist (K-CBCL). Results: The severe AD group had higher total behavior problem scores and internalizing scores than the mild-to-moderate group. Social problem and attention problem scores were slightly higher in the severe AD group than in the mild-to-moderate AD group. The DSM (diagnostic and statistical manual of mental disorders)-anxiety, obsessive compulsive problems, and sluggish cognitive tempo problems were more frequently observed in the severe AD group. Longer disease duration was an independent risk factor of internalizing problems in subjects with AD. Conclusion This study showed that subjects with severe AD had higher total behavioral problem scores, particularly internalizing scales. Their behavioral problems may have poor compliance and consequently poor outcomes as well. Clinicians should be aware that children and adolescents with severe AD have more behavioral problems and that an interdisciplinary approach with medical and psychological supports is necessary for proper management.

Purpose: Congenital heart disease (CHD) is a known risk factor for acquired cardiovascular and cerebrovascular diseases. However, available evidence on CHD is limited mostly to Western populations. This study aimed to evaluate the prevalence of vascular events and all-cause mortality in Korean patients with CHD and to further corroborate CHD as a predictor of vascular events and all-cause mortality. Materials and Methods: The claims data of the Korean National Health Insurance Service (NHIS) were retrospectively reviewed. Information regarding diagnostic codes, comorbidities, medical services, income level, and residential area was also collected. Outcomes of interest included stroke, myocardial infarction (MI), all-cause mortality, and major adverse cardiovascular events (MACE). Results: We included 232203 patients with CHD and 3024633 individuals without CHD as a control group through age- and sexmatched 1:10 random sampling. The prevalences of hypertension, congestive heart failure, ischemic heart disease, hyperlipidemia, and atrial fibrillation were significantly higher in the CHD group, which had a more than two-fold higher incidence of vascular events and all-cause mortality, than in the group without CHD. Multivariable models demonstrated that CHD was a significant risk factor for stroke, MI, all-cause mortality, and MACE. Conclusion In conclusion, this nationwide study demonstrates that Korean patients with CHD have a high incidence of comorbidities, vascular events, and mortality. CHD has been established as an important predictor of cardiovascular events. Further studies are warranted to identify high-risk patients with CHD and related factors to prevent vascular events.

Background: Discoid lupus erythematosus (DLE) with alopecia of the scalp can result in permanent hair loss. Therefore, it is important to evaluate skin lesions and establish appropriate treatment plans for scalp DLE with alopecia. Objective: We aimed to investigate the dermoscopic features of scalp DLE with alopecia and to determine the correlation between dermoscopic findings and treatment efficacy. Methods: Thirty-one patients histopathologically diagnosed with scalp DLE and alopecia were included. We reviewed clinical photographs and dermoscopic findings of the patients and evaluated their treatment responses. Results: The most frequent dermoscopic features of DLE with alopecia were follicular keratotic plugs (96.8%), white scales (71.0%), telangiectatic vessels (67.7%), and pigmentation (64.5%); followed by absent follicular openings (48.4%), white structureless areas (35.5%), follicular red dots (16.1%), and perifollicular whitish halo (12.9%). After at least 6 months of treatment, hair regrowth was observed in 22 patients (71.0%). Dermoscopic findings showed that white structureless areas, perifollicular whitish halo, absent follicular openings (especially when the alopecic patch involved ＞25% of the scalp), and moderate to severe telangiectatic vessels were associated with absence of hair regrowth. Conclusion Dermoscopy is a promising tool for evaluating lesions and predicting therapeutic outcomes in scalp DLE with alopecia. It may contribute to the establishment of appropriate treatment plan by determining whether hair loss is reversible.

A 3-month-old male infant was transferred to our hospital due to bicytopenia. His bone marrow biopsy showed irregular bony trabeculae with cartilaginous core, which was consistent with osteopetrosis. In the genetic test, c.242del (p.Pro81Argfs*85) in TCIRG1 was found to be homozygotic, thus he was diagnosed with malignant infantile osteopetrosis. At 6 months of age, he received double-unit umbilical cord blood transplantation (UCBT) with the conditioning regimen including busulfan, cyclophosphamide, and rabbit anti-thymocyte globulin. Initially, single UCB was infused to the patient, but the post infusion viability of the UCB was unexpectedly low. Thus, another UCB was additionally infused. Cyclosporine and mycophenolate mofetil were used for graft-versus-host disease (GVHD) prophylaxis. Neutrophils and platelets were engrafted on day +13 and +33, respectively. With engraftment, he showed overall grade 4 acute GVHD involving the skin and gut, which was refractory to corticosteroids. Despite treating with low-dose weekly methotrexate (10 mg/m2) and oral beclomethasone, his symptoms persisted. After treating with ruxolitinib 2.5 mg/day for 2 weeks, and 5 mg/day thereafter, his diarrhea stopped in 2 weeks and his skin symptoms gradually improved over 3 months. The short tandem repeats showed 100% donor chimerism at 1 and 3 months after UCBT. Currently, 4 months after UCBT, he is 10 months old. The oral prednisolone has been tapered to 0.6 mg/kg/day, and the dose of ruxolitinib was decreased to 2.5 mg/day without recurrence of GVHD. We plan to taper off the immunosuppressive agents if his GVHD symptoms do not recur.

Background and Objectives: While diuretics are sometimes used in atrial septal defect (ASD) treatment, their effect on ASD size reduction remains unclear. We aimed to evaluate the efficacy of diuretics in ASD size reduction in pediatric patients. Methods: We retrospectively reviewed the medical records of patients with secundum ASD (size ≥10 mm), between 2005 and 2019. Patients were divided into two groups based on the diuretic administration. Results: Of the 73 enrolled patients, 40 received diuretics. The initial age at ASD diagnosis (2.8±1.7 vs. 2.5±2.0 years, p=0.526) and follow-up duration (22.3±11.4 vs. 18.7±13.2 months, p=0.224) were not significantly different between the groups. The ASD diameter at the initial diagnosis (13.7±2.0 vs. 13.5±3.4 mm, p=0.761) and the indexed ASD diameter (25.5±5.9 vs. 26.9±10.3 mm/m2 , p=0.493) were also not significantly different between two groups. The ASD diameter significantly increased in the non-diuretic group during follow-up (0.0±2.9 vs. +2.6±2.0 mm, p<0.001). The indexed ASD diameter significantly decreased in the diuretic group during follow-up (−5.7±6.5 vs. +0.2±3.9 mm/m 2 , p<0.001). In the linear mixed model analysis, diuretic use was associated with ASD diameter decrease (p<0.001) and indexed ASD diameter reduction (p<0.001) over time. Device closure was more frequently performed in the diuretic (75.0%) than in the non-diuretic group (39.4%). Conclusions Patients receiving diuretics are less likely to undergo surgery. The diuretics administration may be associated with the use of smaller ASD devices for transcatheter treatment through ASD size reduction.

Chronic spontaneous urticaria (CSU) is defined as the occurrence of spontaneous wheals, angioedema, or both for >6 weeks in the absence of specific causes. It is a common condition associated with substantial disease burden both for affected individuals and societies in many countries, including Korea. CSU frequently persists for several years and requires high-intensity treatment; therefore, patients experience deteriorations in quality of life and medication-associated complications. During the last decade, there have been major advances in the pharmacological treatment of CSU and there is an outstanding need for evidence-based guidelines that reflect clinical practice in Korea. The guidelines reported here represent a joint initiative of the Korean Academy of Asthma, Allergy and Clinical Immunology and the Korean Dermatological Association, and aim to provide evidence-based guidance for the management of CSU in Korean adults and children. In Part 1, disease definition, guideline scope and development methodology as well as evidence-based recommendations on the use of antihistamines and corticosteroids are summarized.

Chronic spontaneous urticaria (CSU) is defined as the occurrence of spontaneous wheals, angioedema, or both for >6 weeks in the absence of specific causes. It is a common condition associated with substantial disease burden both for affected individuals and societies in many countries, including Korea. CSU frequently persists for several years and requires high-intensity treatment; therefore, patients experience deteriorations in quality of life and medication-associated complications. During the last decade, there have been major advances in the pharmacological treatment of CSU and there is an outstanding need for evidence-based guidelines that reflect clinical practice in Korea. The guidelines reported here represent a joint initiative of the Korean Academy of Asthma, Allergy and Clinical Immunology and the Korean Dermatological Association, and aim to provide evidence-based guidance for the management of CSU in Korean adults and children. In Part 1, disease definition, guideline scope and development methodology as well as evidence-based recommendations on the use of antihistamines and corticosteroids are summarized.