While the Korean Triage and Acuity Scale (KTAS) was introduced in 2016 as a tool to identify patients at risk of catastrophic events, including death in the ED, the triage system for the pre-hospital stage still lacks evidence. The pre-hospital stage is characterized by time-sensitive and complex scenarios, where rapid and accurate decision-making is paramount to optimize patient outcomes. Despite the vital role of pre-hospital care providers, the invalidated and subjective current triage system consisting of 4-stages is still used at the pre-hospital stage, and hence, it needs to be modified to be more objective, standardized, and reliable. To improve the Korean emergency medical system, the pre-hospital KTAS (Pre-KTAS) was developed in 2020, and then two pilot projects were conducted in 2022 and 2023. This paper not only reveals the results of the first and second pilot projects for Pre-KTAS but also highlights the potential benefits of using this newly developed triage tool in the pre-hospital setting. Furthermore, this paper suggests ways to improve the emergency medical system (EMS) in Korea by improving patient safety, resource allocation, and overall emergency response efficiency.

Acquired fluconazole resistance (FR) in bloodstream infection (BSI) isolates of Candida albicans is rare. We investigated the FR mechanisms and clinical features of 14 fluconazole non-susceptible (FNS; FR and fluconazole-susceptible dose-dependent) BSI isolates of C. albicans recovered from Korean multicenter surveillance studies during 2006–2021. Mutations causing amino acid substitutions (AASs) in the drug-target gene ERG11 and the FR-associated transcription factor genes TAC1 , MRR1, and UPC2 of the 14 FNS isolates were compared with those of 12 fluconazole-susceptible isolates. Of the 14 FNS isolates, eight and seven had Erg11p (K143R, F145L, or G464S) and Tac1p (T225A, R673L, A736T, or A736V) AASs, respectively, which were previously described in FR isolates. Novel Erg11p, Tac1p, and Mrr1p AASs were observed in two, four, and one FNS isolates, respectively. Combined Erg11p and Tac1p AASs were observed in seven FNS isolates. None of the FR-associated Upc2p AASs were detected. Of the 14 patients, only one had previous azole exposure, and the 30-day mortality rate was 57.1% (8/14). Our data show that Erg11p and Tac1p AASs are likely to contribute to FR in C. albicans BSI isolates in Korea and that most FNS C. albicans BSIs develop without azole exposure.

Purpose: This study aimed to evaluate the role of postoperative radiotherapy (PORT) in intracranial solitary fibrous tumor/hemangiopericytoma (SFT/HPC). Materials and Methods: A total of 133 patients with histologically confirmed HPC were included from eight institutions. Gross total resection (GTR) and subtotal resection (STR) were performed in 86 and 47 patients, respectively. PORT was performed in 85 patients (64%). The prognostic effects of sex, age, performance, World Health Organization (WHO) grade, location, size, Ki-67, surgical extent, and PORT on local control (LC), distant metastasis-free survival (DMFS), progression-free survival (PFS), and overall survival (OS) were estimated by univariate and multivariate analyses. Results: The 10-year PFS, and OS rates were 45%, and 71%, respectively. The multivariate analysis suggested that PORT significantly improved LC (p < 0.001) and PFS (p < 0.001). The PFS benefit of PORT was maintained in the subgroup of GTR (p=0.001), WHO grade II (p=0.001), or STR (p < 0.001). In the favorable subgroup of GTR and WHO grade II, PORT was also significantly related to better PFS (p=0.028). WHO grade III was significantly associated with poor DMFS (p=0.029). In the PORT subgroup, the 0-0.5 cm margin of the target volume showed an inferior LC to a large margin with 1.0-2.0 cm (p=0.021). Time-dependent Cox proportion analysis showed that distant failures were significantly associated with poor OS (p=0.003). Conclusion This multicenter study supports the role of PORT in disease control of intracranial SFT/HPC, irrespective of the surgical extent and grade. For LC, PORT should enclose the tumor bed with sufficient margin.

OBJECTIVE: Despite increased survival in patients with cardiac arrest, it remains difficult to determine patient prognosis at the early stage. This study evaluated the prognosis of cardiac arrest patients using brain injury, inflammation, cardiovascular ischemic events, and coagulation/fibrinolysis markers collected 24, 48, and 72 hours after return of spontaneous circulation (ROSC).METHODS: From January 2011 to December 2016, we retrospectively observed patients who underwent therapeutic hypothermia. Blood samples were collected immediately and 24, 48, and 72 hours after ROSC. Neuron-specific enolase (NSE), S100-B protein, procalcitonin, troponin I, creatine kinase-MB, pro-brain natriuretic protein, D-dimer, fibrin degradation product, antithrombin-III, fibrinogen, and lactate levels were measured. Prognosis was evaluated using Glasgow-Pittsburgh cerebral performance categories and the predictive accuracy of each marker was evaluated. The secondary outcome was whether the presence of multiple markers improved prediction accuracy.RESULTS: A total of 102 patients were included in the study: 39 with good neurologic outcomes and 63 with poor neurologic outcomes. The mean NSE level of good outcomes measured 72 hours after ROSC was 18.50 ng/mL. The area under the curve calculated on receiver operating characteristic analysis was 0.92, which showed the best predictive power among all markers included in the study analysis. The relative integrated discrimination improvement and category-free net reclassification improvement models showed no improvement in prognostic value when combined with all other markers and NSE (72 hours).CONCLUSION: Although biomarker combinations did not improve prognostic accuracy, NSE (72 hours) showed the best predictive power for neurological prognosis in patients who received therapeutic hypothermia.
Biomarkers ; Brain Injuries ; Creatine ; Discrimination (Psychology) ; Fibrin ; Fibrinogen ; Heart Arrest ; Humans ; Hypothermia, Induced ; Inflammation ; Lactic Acid ; Phosphopyruvate Hydratase ; Prognosis ; Retrospective Studies ; ROC Curve ; Troponin I

PURPOSE: We compared the oncologic outcomes of breast-conserving surgery plus radiation therapy (BCS+RT) and modified radical mastectomy (MRM) under anthracycline plus taxane-based (AT) regimens and investigated the role of adjuvant radiation therapy (RT) in patients with pathologic N1 (pN1) breast cancer treated by mastectomy. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 2,011 patients with pN1 breast cancer who underwent BCS+RT or MRM alone at 12 institutions between January 2006 and December 2010. Two-to-one propensity score matching was performed for balances in variables between the groups. RESULTS: The median follow-up duration for the total cohort was 69 months (range, 1 to 114 months). After propensity score matching, 1,074 patients (676 in the BCS+RT group and 398 in the MRM-alone group) were analyzed finally. The overall survival, disease-free survival, locoregional failure-free survival, and regional failure-free survival (RFFS) curves of the BCS+RT group vs. MRM-alone group were not significantly different. The subgroup analysis revealed that in the group with both lymphovascular invasion (LVI) and histologic grade (HG) III, the BCS+RT showed significantly superior RFFS (p=0.008). Lymphedema (p=0.007) and radiation pneumonitis (p=0.031) occurred more frequently in the BCS+RT group than in the MRM-alone group, significantly. CONCLUSION: There are no differences in oncologic outcomes between BCS+RT and MRM-alone groups under the AT chemotherapy regimens for pN1 breast cancer. However, BCS+RT group showed superior RFFS to MRM-alone group in the patients with LVI and HG III. Adjuvant RT might be considerable for pN1 breast cancer patients with LVI and HG III.
Anthracyclines ; Breast Neoplasms ; Breast ; Cohort Studies ; Disease-Free Survival ; Drug Therapy ; Follow-Up Studies ; Humans ; Lymphedema ; Mastectomy ; Mastectomy, Modified Radical ; Mastectomy, Segmental ; Medical Records ; Propensity Score ; Radiation Pneumonitis ; Retrospective Studies

OBJECTIVE: As aging progresses, clinical characteristics of elderly patients in the emergency department (ED) vary by age. We aimed to study differences among elderly patients in the ED by age group. METHODS: For 2 years, patients aged 65 and older were enrolled in the study and classified into three groups: youngest-old, ages 65 to 74 years; middle-old, 75 to 84 years; and oldest-old, ≥85 years. Participants’ sex, reason for ED visit, transfer from another hospital, results of treatment, type of admission, admission department and length of stay were recorded. RESULTS: During the study period, a total 64,287 patients visited the ED; 11,236 (17.5%) were aged 65 and older, of whom 14.4% were 85 and older. With increased age, the female ratio (51.5% vs. 54.9% vs. 69.1%, P < 0.001), medical causes (79.5% vs. 81.3% vs. 81.7%, P=0.045), and admission rate (35.3% vs. 42.8% vs. 48.5%, P < 0.001) increased. Admissions to internal medicine (57.5% vs. 59.3% vs. 64.7%, P < 0.001) and orthopedic surgery (8.5% vs. 11.6% vs. 13.8%, P < 0.001) also increased. The ratio of admission to intensive care unit showed no statistical significance (P=0.545). Patients over age 85 years had longer stays in the ED (330.9 vs. 378.9 vs. 407.2 minutes, P < 0.001), were discharged home less (84.4% vs. 78.9% vs. 71.5%, P < 0.001), and died more frequently (6.3% vs. 10.4% vs. 13.0%, P < 0.001). CONCLUSION: With increased age, the proportion of female patients and medical causes increased. Rates of admission and death increased with age and older patients had longer ED and hospital stays.
Aged ; Aging ; Emergencies* ; Emergency Service, Hospital* ; Female ; Humans ; Intensive Care Units ; Internal Medicine ; Length of Stay ; Orthopedics

OBJECTIVE: Outbreaks of transmissible respiratory infection are suspected to have significant effects on the health of pediatric and geriatric patients. The objective was to assess the impact of the Middle East respiratory syndrome (MERS) outbreak on the use of emergency resources. METHODS: An ecologic analysis of emergency department (ED) records between September and December 2015, was performed. Data was obtained from the National Emergency Department Information System database for Korea. All demographic and diagnostic data from patients presenting with febrile symptoms as a main complaint were collected. The data were compared to the equivalent period in the three years preceding the MERS outbreak in Korea. RESULTS: Following the MERS outbreak, there was an increase in overall ED visits by febrile patients and the proportion of visits by febrile patients, relative to total ED attendances. This effect was more prominent in the children under five years. The duration of the chief complaint before ED arrival and the length of ED stay were significantly increased among younger pediatric patients. Decreased body temperature on arrival was observed in younger pediatric patients. CONCLUSION: MERS outbreak appears to have had a significant effects on ED use by febrile patients. The use of emergency care services by pediatric patients makes them more vulnerable to an outbreak of a transmissable disease. An effective strategy to control emergency center visits by non-urgent febrile patients and provide proper medical services is urgently needed.
Body Temperature ; Child ; Coronavirus Infections* ; Disease Outbreaks ; Emergencies* ; Emergency Medical Services ; Emergency Service, Hospital ; Fever ; Humans ; Information Systems ; Korea ; Middle East Respiratory Syndrome Coronavirus ; Middle East* ; Overall

PURPOSE: Jumping off a bridge is one method of suicide. In a recent report, out of the 37 patients with cardiac arrest after drowning, 5 (36%) patients suffered severe traumatic injuries. The objective of this study was to report these injuries, without cardiac arrest, in patients after jumping off a bridge with the purpose of suicide. METHODS: We retrospectively reviewed the charts of all patients admitted to the emergency department in a tertiary care hospital after drowning in the Han River between 1997 and 2012. We analyzed the results of imaging studies. Each injury was described as one of the six body regions, similar to the method of the Injury Severity Score. RESULTS: A total of 469 patients were admitted to the emergency department from drowning. Sixty-six patients had jumped off a bridge with the purpose of suicide. Forty patients experienced cardiac arrest. In cardiac arrest patients, 25 patients (62.5%) underwent radiologic examinations. Only 2 patients (5.0%) received damage on the cervical spine and face. All non-cardiac arrest patients underwent imaging studies. Nine patients (34.6%) showed evidence of injuries. Most injuries occurred in the chest; four patients suffered the following injuries: rib fracture, pneumothorax, pneumomedistinum, and thoracic spine fracture. One patient had abdominal damage, an intra-abdominal hematoma. Last one patient suffered an injury to the chest and abdomen. CONCLUSION: In drowning patients with the purpose of suicide, variable damage could not be ruled out. It is especially not confined to a specific area, and damage to various parts of the body should be considered.
Abdomen ; Body Regions ; Drowning ; Emergency Service, Hospital ; Heart Arrest ; Hematoma ; Humans ; Injury Severity Score ; Methods ; Multiple Trauma ; Pneumothorax ; Retrospective Studies ; Rib Fractures ; Rivers ; Spine ; Suicide* ; Tertiary Healthcare ; Thorax

PURPOSE: Occult injuries are diagnosed using computed tomography (CT), often with intravenous (IV) contrast CT, in major trauma patients. The contrast dye is known to be potentially nephrotoxic. Thus, we measured the incidence and risk factors for contrast-induced nephropathy (CIN) in major trauma patients. METHODS: A retrospective review was performed on 247 patients who were treated by the activated trauma team between June 2012 and July 2014. The exclusion criteria were underlying renal failure, no IV contrast CT administered, and no creatinine (Cr) follow-up within 72 hours. We examined age, gender, initial vital signs, the Glasgow Coma Scale (GCS), initial Cr levels, Cr level within 72 hours after admission, the IV contrast CT number, Injury Severity Score (ISS). CIN was defined as 25% relative or 0.5 mg/dL absolute increase in serum Cr within 72 hours of presentation. RESULTS: One hundred forty-three patients were included in this study. CIN manifested in 12 patients (8.4%). The injury severity was associated with CIN (ISS≥16, p=0.003; GCS≤8, p<0.001; death, p<0.001). Initial Cr levels, elderly patients, and initial hypotension were not statistically significant (p=0.065, 0.176, and 0.402, respectively). The number of IV contrast CTs administered was also not associated with the occurrence of CIN (p=0.331). CONCLUSION: We found an 8.4% incidence of CIN in multiple trauma patients exposed to IV contrast. The number of IV contrasts, age, initial systolic blood pressure, and initial Cr levels were not associated with CIN. Only injury severity was associated with CIN occurrence; therefore, physicians should pay more attention to severely-injured patients.
Aged ; Blood Pressure ; Creatinine ; Follow-Up Studies ; Glasgow Coma Scale ; Humans ; Hypotension ; Incidence ; Injury Severity Score ; Multiple Trauma ; Renal Insufficiency ; Retrospective Studies ; Risk Factors ; Vital Signs

PURPOSE: This study was conducted to evaluate the impact of supraclavicular lymph node radiotherapy (SCNRT) on N1 breast cancer patients receiving post-lumpectomy whole-breast irradiation (WBI) and anthracycline plus taxane-based (AT) chemotherapy. MATERIALS AND METHODS: We performed a case-control analysis to compare the outcomes of WBI and WBI plus SCNRT (WBI+SCNRT). Among 1,147 patients with N1 breast cancer who received post-lumpectomy radiotherapy and AT-based chemotherapy in 12 hospitals, 542 were selected after propensity score matching. Patterns of failure, disease-free survival (DFS), distant metastasis-free survival (DMFS), and treatment-related toxicity were compared between groups. RESULTS: A total of 41 patients (7.6%) were found to have recurrence. Supraclavicular lymph node (SCN) failure was detected in three patients, two in WBI and one in WBI+SCNRT. All SCN failures were found simultaneously with distant metastasis. There was no significant difference in patterns of failure or survival between groups. The 5-year DFS and DMFS for patients with WBI and WBI+SCNRT were 94.4% versus 92.6% (p=0.50) and 95.1% versus 94.5% (p=0.99), respectively. The rates of lymphedema and radiation pneumonitis were significantly higher in the WBI+SCNRT than in the WBI. CONCLUSION: We did not find a benefit of SCNRT for N1 breast cancer patients receiving AT-based chemotherapy.
Breast Neoplasms* ; Breast* ; Case-Control Studies* ; Disease-Free Survival ; Drug Therapy* ; Humans ; Lymph Nodes ; Lymphatic Irradiation ; Lymphedema ; Mastectomy, Segmental* ; Neoplasm Metastasis ; Propensity Score ; Radiation Pneumonitis ; Radiotherapy ; Radiotherapy, Adjuvant ; Recurrence