PURPOSE: The aim of this study was to identify the predictive validity of the Korean Triage and Acuity Scale (KTAS). METHODS: This methodological study used data from National Emergency Department Information System for 2016. The KTAS disposition and emergency treatment results for emergency patients aged 15 years and older were analyzed to evaluate its predictive validity through its sensitivity, specificity, positive predictive value, and negative predictive value. RESULTS: In case of death in the emergency department, or where the intensive care unit admission was considered an emergency, the sensitivity, specificity, positive predictive value, and negative predictive value of the KTAS were 0.916, 0.581, 0.097, and 0.993, respectively. In case of death in the emergency department, or where the intensive or non-intensive care unit admission was considered an emergency, the sensitivity, specificity, and positive predictive value, and negative predictive value were 0.700, 0.642, 0.391, and 0.867, respectively. CONCLUSION: The results of this study showed that the KTAS had high sensitivity but low specificity. It is necessary to constantly review and revise the KTAS level classification because it still results in a few errors of under and over-triage. Nevertheless, this study is meaningful in that it was an evaluation of the KTAS for the total cases of adult patients who sought help at regional and local emergency medical centers in 2016.
Adult ; Classification ; Emergencies ; Emergency Service, Hospital ; Emergency Treatment ; Humans ; Information Systems ; Intensive Care Units ; Methods ; Sensitivity and Specificity ; Triage

PURPOSE: Nodules located in the upper pole of the thyroid may carry a greater risk for malignancy than those in the lower pole. We conducted a study to analyze the risk of malignancy of nodules depending on location. METHODS: The records of patients undergoing thyroid-nodule fine-needle aspiration cytology (FNAC) at an academic thyroid cancer unit were prospectively collected. The nodules were considered benign in cases of a benign histology or cytology report, and malignant in cases of malignant histology. Pathological findings were analyzed based on the anatomical location of the nodules, which were also scored according to five ultrasonographic classification systems. RESULTS: Between November 1, 2015 and May 30, 2018, 832 nodules underwent FNAC, of which 557 had a definitive diagnosis. The prevalence of malignancy was not significantly different in the isthmus, right, or left lobe. Among the 227 nodules that had a precise longitudinal location noted (from 219 patients [155 females], aged 56.2±14.0 years), malignancy was more frequent in the middle lobe (13.2%; odds ratio [OR], 9.74; 95% confidence interval [CI], 1.95 to 48.59). This figure was confirmed in multivariate analyses that took into account nodule composition and the Thyroid Imaging, Reporting, and Data System (TIRADS) classification. Using the American College of Radiologists TIRADS, the upper pole location also demonstrated a slightly significant association with malignancy (OR, 6.92; 95% CI, 1.02 to 46.90; P=0.047). CONCLUSION: The risk of thyroid malignancy was found to be significantly higher for mid-lobar nodules. This observation was confirmed when suspicious ultrasonographic features were included in a multivariate model, suggesting that the longitudinal location in the lobe may be a risk factor independently of ultrasonographic appearance.
Biopsy, Fine-Needle ; Classification ; Diagnosis ; Humans ; Information Systems ; Multivariate Analysis ; Odds Ratio ; Prevalence ; Prospective Studies ; Risk Factors ; Thyroid Gland ; Thyroid Neoplasms ; Thyroid Nodule

PURPOSE: Women with dense breast are known to be at high risk for breast cancer, but their prevalence and number of Korean women are unknown. The current study was to investigate the distribution of mammographic breast density by age of women undergoing screening mammography, and to estimate the prevalence of Korean women with dense breasts, quantitatively. MATERIALS AND METHODS: For obtaining a nationwide representative sample, 6,481 mammograms were collected from 86 screening units participated in the National Cancer Screening Program for breast cancer. Based on the American College of Radiology Breast Imaging Reporting and Data System classification, breast density was evaluated by six breast radiologists, qualitatively. We applied these breast density distributions to age-specific counts of the Korean women population derived to mid-year 2017 to estimate the number of Korean women with dense breasts. RESULTS: Overall, 54.4% (95% confidence interval [CI], 52.9% to 55.8%) of women 40 to 69 years of age had heterogeneously or extremely dense breasts, and this proportion was inversely associated with age. Based on the age distribution of Korean women, we estimated that 6,083,000 women (95% CI, 5,919,600 to 6,245,600) age 40-69 years in Korean have dense breasts. Women aged 40-49 years (n=3,450,000) accounted for 56.7% of this group. CONCLUSION: More than half of Korean women aged 40 and over have dense breasts. To prevent breast cancer effectively and efficiently, it is necessary to develop a new personalized prevention strategy considering her status of breast density.
Age Distribution ; Breast Neoplasms ; Breast ; Classification ; Cross-Sectional Studies ; Early Detection of Cancer ; Female ; Humans ; Information Systems ; Korea ; Mammography ; Mass Screening ; Prevalence

BACKGROUND: We evaluated the effects of neurofeedback as an augmentation treatment on depressive symptoms and functional recovery in patients with treatment-resistant depression (TRD). METHODS: We included 24 adult patients with TRD and 12 healthy adults. 24 TRD patients were assigned to the neurofeedback augmentation group (n = 12) and the medication-only (treatment as usual [TAU]) group (n = 12). The neurofeedback augmentation group underwent combined therapy comprising medication and 12–24 sessions of neurofeedback training for 12 weeks. To assess the serum levels of brain-derived neurotrophic factor (BDNF) in both groups, pre- and post-treatment blood samples were obtained. Patients were evaluated using the Hamilton Depression Rating Scale (HAM-D), Beck Depression Inventory (BDI), Clinical Global Impression-Severity (CGI-S), 5-level version of European Quality of Life Questionnaire 5-Dimensional Classification (EQ-5D-5L), and Sheehan Disability Scale (SDS) at baseline, and at the 1-, 4-, and 12-week. RESULTS: From baseline to week 12, neurofeedback training reduced mean scores on HAM-D, BDI-II, CGI-S, and SDS, and increased mean EQ-5D-5L tariff score. In the neurofeedback augmentation group, the response and remission rates were 58.3% and 50.0%, respectively, at week 12. Changes in HAM-D, EQ-5D-5L tariff score, and SDS were significantly larger in the neurofeedback group than in the medication-only (TAU) group. No significant difference in BDNF level was found pre- vs. post-treatment in any of the groups. CONCLUSION: Despite the small sample size, these results suggest that neurofeedback treatment may be effective as an augmentation treatment, not only for depressive symptoms, but also for functional recovery, in patients with TRD. TRIAL REGISTRATION: Clinical Research Information Service Identifier: KCT0004183 ClinicalTrials.gov Identifier: NCT04078438
Adult ; Brain-Derived Neurotrophic Factor ; Classification ; Depression ; Depressive Disorder, Major ; Humans ; Information Services ; Neurofeedback ; Pilot Projects ; Quality of Life ; Sample Size

OBJECTIVE: We aimed to investigate the influence of area-level factors on adolescent suicide and to determine which variables differ according to age and sex.METHODS: We selected variables that were available for collection through an online database from 2005 to 2015 in the Korean Statistical Information Service and the Korea Labor Institute. We used administrative districts of Korea in 2017 for geographical classification. We examined the relationships between regional suicide rates and area-level variables in male and female subjects aged 10–14 years and 15–19 years. In addition, we analyzed area-level variables in adolescents aged 15–19 years according to sex.RESULTS: Our findings indicated that several area-level variables affected adolescent suicide rates, varying according to age and sex. Economic problems were shown to be more associated with suicide in male adolescents than in female adolescents. On the other hand, social fragmentation and health services were shown to be more associated with suicide in females.CONCLUSION: Suicide in adolescents was attributable to area-level factors such as economic status, social fragmentation, and community health services. By identifying area-level variables affecting adolescent suicide rates, we will be able to contribute to implement mental health policies related to adolescent suicide.
Adolescent ; Classification ; Community Health Services ; Female ; Hand ; Health Services ; Humans ; Information Services ; Korea ; Male ; Mental Health ; Suicide

BACKGROUND: To date, there have been few reports on the nationwide population-based epidemiology of Dupuytren's disease (DD). We investigated the prevalence and incidence of DD in Korea using the large dataset provided by the Korean Health Insurance Review and Assessment Service. This study is the second nationwide epidemiological study of DD after the study in Taiwan. METHODS: Records of patients diagnosed with DD between 2007 and 2014 were extracted from the large dataset by diagnostic code searching (International Classification of Disease 10th revision code M72.0) and were included in the study. We calculated the prevalence and incidence of DD based on the total population of Korea provided by the Korean Statistical Information Service. Diseases associated with DD and the trends in surgery for DD were also analyzed. RESULTS: A total 16,630 patients were diagnosed with DD during the study period. The mean annual prevalence was 32.2 per 100,000 population (41.8 per 100,000 for men; 22.5 per 100,000 for women). The mean annual incidence was 1.09 per 100,000 population (1.80 per 100,000 for men; 0.38 per 100,000 for women). The common diseases associated with DD were hypertension (30.5%), diabetes mellitus (26.7%), hyperlipidemia (20.4%), ischemic heart disease (7.9%), and cerebrovascular disease (4.6%). The mean annual proportion of the patients who had surgery for DD was 5.24% of all DD patients. CONCLUSION: The prevalence and incidence of DD in Korea were 100–1,000 times lower than those in western countries; however, it was slightly larger than that in Taiwan.
Cerebrovascular Disorders ; Classification ; Comorbidity ; Dataset ; Diabetes Mellitus ; Dupuytren Contracture* ; Epidemiologic Studies ; Epidemiology* ; Humans ; Hyperlipidemias ; Hypertension ; Incidence ; Information Services ; Insurance, Health ; Korea* ; Male ; Myocardial Ischemia ; Prevalence ; Taiwan

PURPOSE: Understanding changes in pathogen and pneumonia prevalence among pediatric pneumonia patients is important for the prevention of infectious diseases. METHODS: We retrospectively analyzed data of children younger than 18 years diagnosed with pneumonia at 117 Emergency Departments in Korea between 2007 and 2014. RESULTS: Over the study period, 329,380 pediatric cases of pneumonia were identified. The most frequent age group was 1–3 years old (48.6%) and the next was less than 12 months of age (17.4%). Based on International Classification of Diseases, 10th revision diagnostic codes, confirmed cases of viral pneumonia comprised 8.4% of all cases, pneumonia due to Mycoplasma pneumoniae comprised 3.8% and confirmed cases of bacterial pneumonia 1.3%. The prevalence of confirmed bacterial pneumonia decreased from 3.07% in 2007 and 4.01% in 2008 to 0.65% in 2014. The yearly rate of pneumococcal pneumonia also decreased from 0.47% in 2007 to 0.08% in 2014. A periodic prevalence of M. pneumoniae pneumonia (MP) was identified. CONCLUSION: The increased number of patients with pneumonia, bacterial pneumonia, pleural effusion, and empyema in 2011 and 2013–2014 resulted from an MP epidemic. We provide evidence that the frequency of confirmed cases of bacterial pneumonia and pneumococcal pneumonia has declined from 2007 to 2014, which can simultaneously reflect the effectiveness of the pneumococcal conjugate vaccine.
Child ; Communicable Diseases ; Community-Acquired Infections ; Emergencies* ; Emergency Service, Hospital* ; Empyema ; Humans ; Information Systems* ; International Classification of Diseases ; Interrupted Time Series Analysis ; Korea* ; Mycoplasma pneumoniae ; Pleural Effusion ; Pneumonia* ; Pneumonia, Bacterial ; Pneumonia, Mycoplasma ; Pneumonia, Pneumococcal ; Pneumonia, Viral ; Prevalence* ; Retrospective Studies

BACKGROUND: In 2013, Infection & Chemotherapy changed the main language of its articles to English so that they could be submitted to PubMed Central. This study presents the recent status of journal metrics for Infection & Chemotherapy and introduces scholarly journal publishing policies or guidelines that have recently appeared. MATERIALS AND METHODS: A variety of journal metrics were analyzed based on the Web of Science Core Collection, including the nationality of authors the proportion of funded articles to original articles , manually calculated impact factor, the titles of journals in which articles were cited”, and the Hirsch index. RESULTS: Out of 181 articles of Infection & Chemotherapy published between 2015 and 2018, the highest number of authors were from Korea (165, 91.2%). There were articles from 11 other countries. The proportion of funded articles to original articles has increased yearly and has reached 46.7% in 2018. The manually calculated impact factor of the year 2017 was 1.728, which corresponded to 21.5% of the 2017 Journal Citation Reports (JCR) category of “infectious diseases”. There were 196 source journal titles that cited Infection & Chemotherapy in the 2015–2018 issues. The Hirsch index was 15. CONCLUSION: The metrics results above demonstrate that over the years, Infection & Chemotherapy was developed into a top-level international-level journal so that it could be utilized by researchers across the world. The adoption of new policies including author taxonomy, an open data policy, a clinical data sharing policy, the principles of transparency and best practice in scholarly publishing 3rd edition will help increase the transparency of the authorship and the scientific integrity of the articles.
Authorship ; Classification ; Drug Therapy* ; Ethnic Groups ; Financial Management ; Humans ; Information Dissemination ; Journal Impact Factor ; Korea ; Practice Guidelines as Topic ; Publications* ; Republic of Korea

BACKGROUND: In 2013, Infection & Chemotherapy changed the main language of its articles to English so that they could be submitted to PubMed Central. This study presents the recent status of journal metrics for Infection & Chemotherapy and introduces scholarly journal publishing policies or guidelines that have recently appeared. MATERIALS AND METHODS: A variety of journal metrics were analyzed based on the Web of Science Core Collection, including the nationality of authors the proportion of funded articles to original articles , manually calculated impact factor, the titles of journals in which articles were cited”, and the Hirsch index. RESULTS: Out of 181 articles of Infection & Chemotherapy published between 2015 and 2018, the highest number of authors were from Korea (165, 91.2%). There were articles from 11 other countries. The proportion of funded articles to original articles has increased yearly and has reached 46.7% in 2018. The manually calculated impact factor of the year 2017 was 1.728, which corresponded to 21.5% of the 2017 Journal Citation Reports (JCR) category of “infectious diseases”. There were 196 source journal titles that cited Infection & Chemotherapy in the 2015–2018 issues. The Hirsch index was 15. CONCLUSION: The metrics results above demonstrate that over the years, Infection & Chemotherapy was developed into a top-level international-level journal so that it could be utilized by researchers across the world. The adoption of new policies including author taxonomy, an open data policy, a clinical data sharing policy, the principles of transparency and best practice in scholarly publishing 3rd edition will help increase the transparency of the authorship and the scientific integrity of the articles.
Authorship ; Classification ; Drug Therapy* ; Ethnic Groups ; Financial Management ; Humans ; Information Dissemination ; Journal Impact Factor ; Korea ; Practice Guidelines as Topic ; Publications* ; Republic of Korea

PURPOSE: Trauma is a leading cause of death, even in previously healthy and disease-free individuals, and the mortality rate is very high in neck trauma patients. On the other hand, there have been few studies related to neck injuries. This study examined the characteristics and treatment results of trauma-related neck injuries using the data from Korean National Emergency Department Information System. METHODS: Neck trauma patients were classified using the 6th Korean Standard Disease Classification system. The patients' demographic factors, number of surgeries, and clinical results were investigated. Statistical analysis was conducted using SPSS to evaluate the annual differences in the demographic factors; mortality according to the site of injury and type of surgery; and mechanisms of injury. RESULTS: From 2011 to 2014, 2,458 neck trauma patients were treated in hospitals in South Korea. The number of patients admitted to regional and local emergency medical centers was 883 (35.9%) and 1,502 (61.1%), respectively. No significant annual differences were observed in age, sex ratio, location of treatment center, mortality, and injury site (vascular, tracheal, or esophageal). In addition, no significant differences in the cause of injury, performed surgery (%), and mortality according to the injured organ were observed. CONCLUSION: This study revealed no annual changes in neck injury patients or differences in mortality according to injured organs. This study can be used as a basis for national research on organ-specific injuries, and may help predict the demand for future support projects for the establishment of regional trauma centers.
Cause of Death ; Classification ; Demography ; Emergencies* ; Emergency Service, Hospital* ; Hand ; Humans ; Information Systems* ; Korea ; Mortality ; Neck Injuries ; Neck* ; Sex Ratio ; Trauma Centers ; Wounds and Injuries