Background: The 2020 European Society of Cardiology (ESC) 0-hr/1-hr algorithm using high-sensitivity cardiac troponin I (hs-cTnI) for non-ST-segment elevation acute coronary syndrome (NSTE-ACS) aims at early diagnosis and shorter emergency department (ED) stays. While this algorithm has been well-established in controlled studies, real-world implementation remains challenging. We evaluated the algorithm’s clinical performance and risk stratification capability in patients with chest pain or discomfort. Methods: We measured hs-cTnI in 4,678 patients suspected of NSTE-ACS between August 2022 and July 2023, using an Atellica IM Analyzer (Siemens Healthineers, Erlangen, Germany). We categorized patients into rule-in, observe, or rule-out groups according to the algorithm and assessed its diagnostic performance for NSTE-ACS. The final diagnosis of NSTE-ACS was adjudicated by two independent physicians. Additionally, we evaluated 30-day all-cause mortality, hazard risk, and ED length of stay across the three groups. Results: The algorithm categorized 3,408 (72.9%), 573 (12.2%), and 697 (14.9%) patients into the rule-out, observe, and rule-in groups, respectively. Among 90 patients diagnosed as having NSTE-ACS, none were falsely categorized into the rule-out group. Survival analysis revealed significant differences (P < 0.001), with Cox hazard ratios of 2.38 (95% confidence interval: 1.20–4.71) and 6.39 (3.45–11.86) in the observe and rule-in groups, respectively. ED stays shortened in the order of rule-out, observe, and rule-in groups (P < 0.001). Conclusions The 2020 ESC 0-hr/1-hr algorithm demonstrates excellent diagnostic accuracy without false rule-outs and effective risk stratification, and contributes to efficient ED throughput, supporting its clinical utility in real-world emergency settings.

Objective: This study examined whether the European Society of Cardiology (ESC) 0/1-hour algorithm using a high-sensitivity troponin I (hs-cTnI) assay can effectively classify patients presenting with chest pain at the emergency department. Methods: This study conducted a retrospective chart review of patients presenting with chest pain suspicious of myocardial ischemia. hs-cTnI was measured at presentation and after one hour. The patients were classified into three groups using hs-cTnI: rule out, observation, and rule in according to the ESC 0/1-hour algorithm to evaluate the diagnostic performance of acute myocardial infarction (AMI). This study evaluated the negative predictive value (NPV), positive predictive value (PPV), sensitivity, specificity, and the proportion of patients assigned to the observation. Results: Among 384 patients, 77 were diagnosed with AMI. Following classification using the ESC 0/1-hour algorithm, there were 206 (53.6%), 77 (20.1%), and 101 (26.3%) patients were classified as “rule-out,” “rule-in,” and “observation,” respectively. In “rule-out,” the NPV and sensitivity for AMI were 99.0% (95% confidence interval [CI], 96.5-99.9) and 97.4% (95% CI, 90.9-99.7), respectively. In “rule-in,” the PPV and specificity for AMI were 83.1% (95% CI, 72.9-90.7) and 95.8% (95% CI, 92.9-97.7). Conclusion The ESC 0/1-hour algorithm allows for quick and accurate categorization of patients presenting with ischemic chest pain into the “rule-out” or “rule-in” group for the diagnosis of AMI. Therefore, applying this accelerated algorithm for evaluating chest pain in the emergency department in Korean patients would be helpful.

Objective: The present study aimed to verify the efficacy of calcium ions as a prognostic factor for massive transfusion (MT) in patients with upper gastrointestinal bleeding (UGIB), including those of variceal and non-variceal origin. Methods: This retrospective cohort study included adult patients with acute UGIB hospitalized through the prehospital emergency department between January 2018 and December 2022. The primary outcome was the need for MT. Secondary outcomes comprised hospital mortality, the need for angiographic intervention or surgery, length of hospital stay, and length of intensive care unit stay. Multivariate analysis using logistic regression was performed for possible candidates and included ionized calcium levels for predicting MT. Results: According to the multivariate logistic regression assessment, the primary outcome was independently correlated with hemoglobin (odds ratio [OR]=0.702; 95% confidence interval [CI], 0.554-0.889) and ionized calcium levels (OR=0.009; 95% CI, 0.0002-0.469). The optimal cutoff point for ionized calcium levels was determined to be a value of 1.105, with a sensitivity of 0.88 and a specificity of 0.488. Using this value, the lower ionized calcium group needed a nearly six-fold increase in MT compared to the upper group. However, the secondary outcomes did not show any statistical differences. Conclusion The statistical review in the present study indicates that low ionized calcium levels in UGIB patients, regardless of liver cirrhosis as a comorbidity, are a novel independent prognostic factor for MT. Quick measurement of ionized calcium levels using a blood gas analyzer will enable practitioners to rapidly identify UGIB patients who need urgent care in minutes.

Background: Three automobile company workers (one from Factory D and two from Factory E) were diagnosed with amyotrophic lateral sclerosis. The Korean Epidemiologic Investigation and Evaluation Committee determined that there is considerable scientific evidence supporting the association between amyotrophic lateral sclerosis and combined exposure to heavy metals, organic solvents, and diesel exhaust at the manufacturing plant. Case presentation: Patient A, who primarily engaged in engine processing and completed vehicle inspection at Factory D, was exposed to considerable amounts of heavy metals and organic solvents during medium- and large-engine processing, welding, and painting for over 23 years. Additionally, the patient was likely exposed to diesel exhaust for 33 years from forklifts delivering engines in the workshop. Patients B and C, who were responsible for engine assembly, ignition testing, and engine shipment at Factory E since around 1990, were exposed to lead and benzene from gasoline during engine ignition tests in the engine department for 15 and 16 years, respectively. They also encountered welding fumes, heavy metals, and organic solvents during welding and painting tasks. In addition, Patients B and C were continuously exposed to diesel exhaust from logistics vehicles on standby during work hours for 25 and 30 years, respectively. Conclusions Although the specific level of lead exposure causing amyotrophic lateral sclerosis remains undetermined, numerous studies have consistently reported a relationship between lead exposure and disease development. Limited evidence suggests that exposure to organic solvents and diesel exhaust may increase the risk of amyotrophic lateral sclerosis. Therefore, the Epidemiological Investigation and Evaluation Committee concluded that the three patients’ work-related exposure to heavy metals, organic solvents, and diesel exhaust is significantly supported by scientific evidence as a cause of their amyotrophic lateral sclerosis.

Background: Three automobile company workers (one from Factory D and two from Factory E) were diagnosed with amyotrophic lateral sclerosis. The Korean Epidemiologic Investigation and Evaluation Committee determined that there is considerable scientific evidence supporting the association between amyotrophic lateral sclerosis and combined exposure to heavy metals, organic solvents, and diesel exhaust at the manufacturing plant. Case presentation: Patient A, who primarily engaged in engine processing and completed vehicle inspection at Factory D, was exposed to considerable amounts of heavy metals and organic solvents during medium- and large-engine processing, welding, and painting for over 23 years. Additionally, the patient was likely exposed to diesel exhaust for 33 years from forklifts delivering engines in the workshop. Patients B and C, who were responsible for engine assembly, ignition testing, and engine shipment at Factory E since around 1990, were exposed to lead and benzene from gasoline during engine ignition tests in the engine department for 15 and 16 years, respectively. They also encountered welding fumes, heavy metals, and organic solvents during welding and painting tasks. In addition, Patients B and C were continuously exposed to diesel exhaust from logistics vehicles on standby during work hours for 25 and 30 years, respectively. Conclusions Although the specific level of lead exposure causing amyotrophic lateral sclerosis remains undetermined, numerous studies have consistently reported a relationship between lead exposure and disease development. Limited evidence suggests that exposure to organic solvents and diesel exhaust may increase the risk of amyotrophic lateral sclerosis. Therefore, the Epidemiological Investigation and Evaluation Committee concluded that the three patients’ work-related exposure to heavy metals, organic solvents, and diesel exhaust is significantly supported by scientific evidence as a cause of their amyotrophic lateral sclerosis.

Background: Three automobile company workers (one from Factory D and two from Factory E) were diagnosed with amyotrophic lateral sclerosis. The Korean Epidemiologic Investigation and Evaluation Committee determined that there is considerable scientific evidence supporting the association between amyotrophic lateral sclerosis and combined exposure to heavy metals, organic solvents, and diesel exhaust at the manufacturing plant. Case presentation: Patient A, who primarily engaged in engine processing and completed vehicle inspection at Factory D, was exposed to considerable amounts of heavy metals and organic solvents during medium- and large-engine processing, welding, and painting for over 23 years. Additionally, the patient was likely exposed to diesel exhaust for 33 years from forklifts delivering engines in the workshop. Patients B and C, who were responsible for engine assembly, ignition testing, and engine shipment at Factory E since around 1990, were exposed to lead and benzene from gasoline during engine ignition tests in the engine department for 15 and 16 years, respectively. They also encountered welding fumes, heavy metals, and organic solvents during welding and painting tasks. In addition, Patients B and C were continuously exposed to diesel exhaust from logistics vehicles on standby during work hours for 25 and 30 years, respectively. Conclusions Although the specific level of lead exposure causing amyotrophic lateral sclerosis remains undetermined, numerous studies have consistently reported a relationship between lead exposure and disease development. Limited evidence suggests that exposure to organic solvents and diesel exhaust may increase the risk of amyotrophic lateral sclerosis. Therefore, the Epidemiological Investigation and Evaluation Committee concluded that the three patients’ work-related exposure to heavy metals, organic solvents, and diesel exhaust is significantly supported by scientific evidence as a cause of their amyotrophic lateral sclerosis.

Objective: The present study aimed to verify the efficacy of calcium ions as a prognostic factor for massive transfusion (MT) in patients with upper gastrointestinal bleeding (UGIB), including those of variceal and non-variceal origin. Methods: This retrospective cohort study included adult patients with acute UGIB hospitalized through the prehospital emergency department between January 2018 and December 2022. The primary outcome was the need for MT. Secondary outcomes comprised hospital mortality, the need for angiographic intervention or surgery, length of hospital stay, and length of intensive care unit stay. Multivariate analysis using logistic regression was performed for possible candidates and included ionized calcium levels for predicting MT. Results: According to the multivariate logistic regression assessment, the primary outcome was independently correlated with hemoglobin (odds ratio [OR]=0.702; 95% confidence interval [CI], 0.554-0.889) and ionized calcium levels (OR=0.009; 95% CI, 0.0002-0.469). The optimal cutoff point for ionized calcium levels was determined to be a value of 1.105, with a sensitivity of 0.88 and a specificity of 0.488. Using this value, the lower ionized calcium group needed a nearly six-fold increase in MT compared to the upper group. However, the secondary outcomes did not show any statistical differences. Conclusion The statistical review in the present study indicates that low ionized calcium levels in UGIB patients, regardless of liver cirrhosis as a comorbidity, are a novel independent prognostic factor for MT. Quick measurement of ionized calcium levels using a blood gas analyzer will enable practitioners to rapidly identify UGIB patients who need urgent care in minutes.

Objective: The present study aimed to verify the efficacy of calcium ions as a prognostic factor for massive transfusion (MT) in patients with upper gastrointestinal bleeding (UGIB), including those of variceal and non-variceal origin. Methods: This retrospective cohort study included adult patients with acute UGIB hospitalized through the prehospital emergency department between January 2018 and December 2022. The primary outcome was the need for MT. Secondary outcomes comprised hospital mortality, the need for angiographic intervention or surgery, length of hospital stay, and length of intensive care unit stay. Multivariate analysis using logistic regression was performed for possible candidates and included ionized calcium levels for predicting MT. Results: According to the multivariate logistic regression assessment, the primary outcome was independently correlated with hemoglobin (odds ratio [OR]=0.702; 95% confidence interval [CI], 0.554-0.889) and ionized calcium levels (OR=0.009; 95% CI, 0.0002-0.469). The optimal cutoff point for ionized calcium levels was determined to be a value of 1.105, with a sensitivity of 0.88 and a specificity of 0.488. Using this value, the lower ionized calcium group needed a nearly six-fold increase in MT compared to the upper group. However, the secondary outcomes did not show any statistical differences. Conclusion The statistical review in the present study indicates that low ionized calcium levels in UGIB patients, regardless of liver cirrhosis as a comorbidity, are a novel independent prognostic factor for MT. Quick measurement of ionized calcium levels using a blood gas analyzer will enable practitioners to rapidly identify UGIB patients who need urgent care in minutes.

Objective: This study evaluates the impact of the coronavirus disease 2019 (COVID-19) pandemic on emergency medical service (EMS) responses and out-of-hospital cardiac arrest (OHCA) outcomes. Methods: This is a retrospective comparison study analyzing the OHCA data of a university medical center in Seoul during the COVID-19 pandemic period (January 2020-January 2021) and non-pandemic period (January 2019-January 2020). The EMS response time and OHCA outcomes were compared between both periods. Based on the weekly mean number of confirmed cases and their EMS response time, patients were classified into six groups and OHCA outcomes were compared. Results: This study evaluated 309 OHCA patients (non-pandemic period of 146, pandemic period of 163). Significant delays in the EMS response and transport time were observed during the pandemic period. However, no significant differences were obtained in the rate of return of spontaneous circulation (ROSC) and survival at discharge (12.4% in pandemic vs. 13.8% in non-pandemic; P=0.722). According to the weekly mean COVID-19 incidence when patients were over 100, there was a significant increase in the EMS response and transport time, whereas ROSC and survival rate were dramatically decreased. Conclusion During the pandemic, the EMS service for OHCA patients was worse than before, with delayed and reduced survival for OHCA patients. We further determined that an increase in the number of COVID-19 cases (especially when weekly mean numbers were over 100) dramatically delayed the EMS response time. This resulted in a very low survival rate of OHCA patients.

Objective: Acute renal infarction is a rare and easily misdiagnosed disease. Scarce research has been conducted on the predictive factors and prognosis of acute renal infarction due to its rarity. In this study, we analyzed the clinical and laboratory findings of a patient diagnosed with renal infarction to predict clinical outcomes. Methods: In this retrospective clinical study, we collected and analyzed the medical records data of 61 acute renal infarction patients diagnosed in the emergency department (ED) of Konkuk University Hospital, Seoul, South Korea from January 2007 to December 2020. Results: Lactate dehydrogenase (LDH; 93.3%, 28 of 30 patients) and D-dimer (77.8%, 28 of 36 patients) levels of the acute renal infarction patients were higher than the normal. Proteinuria was found in 26 of 47 patients. The only significant prognostic factor for the occurrence of acute kidney injury (AKI) in acute renal infarction is the ratio of the infarction volume to the total renal volume. Age, occurrence of AKI, and proteinuria were correlated with the progression of chronic kidney disease (CKD). Conclusion The ratio of the infarction volume to the total renal correlated with occurance of AKI. Age, AKI, and proteinuria were correlated with the progression of CKD.