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"Ju Ok Park"

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"Ju Ok Park"

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Education & Simulation

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Entrustable professional activity–aligned workplace-based assessments in the emergency department: perceptions of emergency medicine residents and assessors
Clin Exp Emerg Med. 2025;12(4):391-399.   Published online December 26, 2025
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Entrustable professional activity–aligned workplace-based assessments in the emergency department: perceptions of emergency medicine residents and assessors
Clin Exp Emerg Med. 2025;12(4):391-399.   Published online December 26, 2025
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Objective
Workplace-based assessment (WBA) plays a crucial role in assessing entrustable professional activities (EPAs) in the competency-based medical education era. This pilot study explored the perceptions of residents and assessors of two WBAs for three Korean Society of Emergency Medicine EPAs.
Methods
Eight emergency medicine (EM) residents underwent WBAs, with mini-clinical evaluation exercises (mini-CEX) conducted by nine EM faculty members and multisource feedback (MSF) provided by two internal medicine faculty members and four emergency room nurses, for a total of 69 assessments. We conducted an anonymous online survey to gather feedback on experiences, perceptions, and recommendations for improving WBA, such as mini-CEX and MSF, with responses scored on a 5-point Likert scale.
Results
Of the 23 initial participants, 15 (65.2%) responded, including 5 residents and 10 assessors. EM faculty viewed mini-CEX favorably, noting its strong integration of supervision and effectiveness in assessing resident performance. EM residents reported comfort issues during assessments, preferring immediate feedback and multiple assessors. MSF was generally perceived positively but showed discrepancies in the utilities of rating scales and feedback types, indicating potential areas for improvement.
Conclusion
Two WBAs for three Korean Society of Emergency Medicine EPAs were found to be feasible and acceptable in the context of Korean EM residency training. However, perceptions varied between assessors and residents, necessitating clear communication about WBA objectives and processes. Our findings are useful for shaping future EPA-based training programs, balancing traditional and WBA methods, and enhancing feedback quality.
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Trauma

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Factors associated with parental knowledge and attitudes toward pediatric concussions in Korea
Clin Exp Emerg Med. 2024;11(4):372-378.   Published online March 15, 2024
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Factors associated with parental knowledge and attitudes toward pediatric concussions in Korea
Clin Exp Emerg Med. 2024;11(4):372-378.   Published online March 15, 2024
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Objective
This study investigated the status and evaluated factors associated with knowledge and attitudes regarding pediatric concussions among Korean parents of children aged 6 to 18 years. Methods A cross-sectional online survey was employed to collect data from a panel of parents in Korea in 2023. To assess knowledge and attitudes regarding concussions, participants completed a validated questionnaire. The outcome variables of total knowledge score (range, 0–30) and total attitude score (range, 7–49) were categorized into tertiles. We conducted multivariable ordinal logistic regression analyses with participants and their children based on demographic information and characteristics as covariates. Results A total of 260 parents responded to the survey and demonstrated moderate concussion-related knowledge (median total score, 21; interquartile range [IQR], 18–22.5). The respondents exhibited favorable attitudes toward concussions (median total score, 39; IQR, 34–43), except the attitude of the importance of reporting concussion. Multivariable ordinal regression analysis for outcomes revealed only career of healthcare provider (adjusted odds ratio, 3.15; 95% confidence interval, 1.13–8.75) to be associated with parental concussion-related knowledge. No factors exhibited a significant association with parental attitudes toward concussions. Conclusion Our results confirmed the knowledge-attitude gap regarding pediatric concussions among Korean parents. Effective strategies are warranted to improve parental knowledge and attitudes.

Citations

Citations to this article as recorded by  Crossref logo
  • Evaluation of the information fidelity of discharge instructions for pediatric patients with mild traumatic brain injury in emergency departments
    Ji Na Yang, Ki Ok Ahn, Hang A Park
    Pediatric Emergency Medicine Journal.2026; 13(1): 45.     CrossRef
  • Traumatic brain injury from diaper change-related falls in children younger than 3 years: an evaluation of South Korean national emergency department registry data
    Minha Kim, Sejin Heo, Seung Jin Maeng, Taerim Kim, Hansol Chang, Se Uk Lee, Sung Yeon Hwang, Won Chul Cha, Hee Yoon
    BMC Pediatrics.2026;[Epub]     CrossRef
  • 4,356 View
  • 60 Download
  • 1 Web of Science
  • 2 Crossref

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Comparison of trauma systems in Asian countries: a cross-sectional study
Clin Exp Emerg Med. 2019;6(4):321-329.   Published online December 31, 2019
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Comparison of trauma systems in Asian countries: a cross-sectional study
Clin Exp Emerg Med. 2019;6(4):321-329.   Published online December 31, 2019
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Objective
This study aimed to compare the demographic characteristics and trauma service structures and processes of hospitals in 15 countries across the Asia Pacific, and to provide baseline data for the integrated trauma database: the Pan-Asian Trauma Outcomes Study (PATOS).
Methods
Medical directors and emergency physicians at PATOS-participating hospitals in countries across the Asia Pacific were surveyed through a standardized questionnaire. General information, trauma care system data, and trauma emergency department (ED) outcomes at each hospital were collected by email and analyzed using descriptive statistics.
Results
Survey data from 35 hospitals across 15 countries were collected from archived data between June 2014 and July 2015. Designated trauma centers were identified as the highest hospital level for trauma patients in 70% of surveyed countries. Half of the hospitals surveyed had special teams for trauma care, and almost all prepared activation protocol documents for these teams. Most hospitals offered specialized trauma education programs, and 72.7% of hospitals had a hospital-based trauma registry. The total number of trauma patients visiting the ED across 25 of the hospitals was 300,376. The overall survival-to-discharge rate was 97.2%; however, it varied greatly between 85.1% and 99.7%. The difference between survival-to-discharge rates of moderate and severe injury groups was highest in Taiwan (41.8%) and lowest in Thailand (18.6%).
Conclusion
Trauma care systems and ED outcomes vary widely among surveyed hospitals and countries. This information is useful to build further detailed, systematic platforms for trauma surveillance and evidence-based trauma care policies.

Citations

Citations to this article as recorded by  Crossref logo
  • Association of prehospital optimal blood pressure and peripheral oxygen saturation with hospital outcomes in sports-related and recreation-related traumatic brain injury (SRR-TBI) in Asia
    Jirayu Chantanakomes, Wasin Pansiritanachot, Sattha Riyapan, Sang Do Shin, Kyoung Jun Song, Wen-Chu Chiang, Sabariah Faizah Jamaluddin, Kentaro Kajino
    Emergency Medicine Journal.2026; 43(4): 238.     CrossRef
  • Association between prehospital time and trauma outcomes: A multicenter cohort study from the Pan-Asian Trauma Outcomes Study (PATOS)
    Pimpan Usawasuraiin, Chaisiri Angkurawaranon, Theerapon Tangsuwanaruk, Chanchanok Aramrat, Nattikarn Meelarp, Nutchar Wiwatkunupakarn, Rudklao Sairai, Sang Do Shin, Wen Chu Chiang, Parinya Tianwibool
    The American Journal of Emergency Medicine.2026; 106: 115.     CrossRef
  • Effect of a generalized early mobilization and rehabilitation protocol on outcomes in trauma patients admitted to the intensive care unit: a retrospective pre–post study
    Tsuyoshi Ichikawa, Asuka Tsuchiya, Yusuke Tsutsumi, Tatsuya Okawa, Daisuke Kubo, Yu Horimizu, Ryo Tsutsui, Hina Shukumine, Kento Noda, Katsuhiro Mizuno
    Critical Care.2025;[Epub]     CrossRef
  • Audiometric and vestibular outcomes following temporal bone fractures: a retrospective analysis of a major trauma center cohort in China
    Caijuan Wu, Qiang He
    Frontiers in Medicine.2025;[Epub]     CrossRef
  • Trauma systems in Asian countries: challenges and recommendations
    Dinesh Bagaria, Amila S. Ratnayake, Aireen Madrid, Tamara J. Worlton
    Critical Care.2024;[Epub]     CrossRef
  • Disparity in guideline adherence for prehospital care according to patient age in emergency medical service transport for moderate to severe trauma
    Eun Seon Ahn, Ki Hong Kim, Jeong Ho Park, Kyoung Jun Song, Sang Do Shin
    Injury.2024; 55(9): 111630.     CrossRef
  • The effect of time to neurosurgical or neuroradiological intervention therapy on outcomes and quality of care after traumatic brain injury, a registry-based observational study
    Wasin Pansiritanachot, Sattha Riyapan, Sang Do Shin, Jirayu Chantanakomes, Netiporn Thirawattanasoot, Wichayada Rangabpai, Bongkot Somboonkul, Joo Jeong, Kyoung Jun Song, Wen-Chiu Chiang, Sabariah Faizah Jamaluddin, Kentaro Kajino
    International Journal of Emergency Medicine.2024;[Epub]     CrossRef
  • A Review of Nurses’ Perceptions of Traumatic Haemorrhagic Shock Management in Emergency Nursing
    Cecilia Amponsem-Boateng, Jonathan Boakye-Yiadom, Ninon P. Amertil
    Open Journal of Nursing.2023; 13(11): 824.     CrossRef
  • Association between Scene Time Interval and Survival in EMS-Treated Major Trauma Admitted to the Intensive Care Unit: A Multinational, Multicenter Observational Study
    Duy Bui Van, Kyoung Jun Song, Sang Do Shin, Young Sun Ro, Joo Jeong, Huy Le Bao, Cong Nguyen Duc, Ki Hong Kim
    Prehospital Emergency Care.2022; 26(4): 600.     CrossRef
  • The preventability of trauma-related death: A two-year cohort study in a trauma center in middle Taiwan
    Chao-Ying Wu, Chun-Chih Chou, Hao-Chun Hsu, Matthew Huei-Ming Ma, Yi-Ching Ho, Chen-Chiang Lin, Yi-Jung Chen, Wen-Chu Chiang
    Injury.2022; 53(9): 3039.     CrossRef
  • 12,199 View
  • 171 Download
  • 12 Web of Science
  • 10 Crossref

Injury & Prevention

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Effect of alcohol use on emergency department length of stay among minimally injured patients based on mechanism of injury: multicenter observational study
Clin Exp Emerg Med. 2018;5(1):7-13.   Published online March 30, 2018
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Effect of alcohol use on emergency department length of stay among minimally injured patients based on mechanism of injury: multicenter observational study
Clin Exp Emerg Med. 2018;5(1):7-13.   Published online March 30, 2018
Close
Objective
This study aimed to evaluate the effect of alcohol use on emergency department (ED) length of stay (LOS) among minimally injured patients by mechanism of injury. Methods This was a retrospective study of injury surveillance data for injured patients (except poisoning), aged over 18 years, discharged home from the ED, and treated at seven academic EDs in Korea during 2008 to 2012. Patients were divided into alcohol-related and alcohol-unrelated groups based on self-report. We used multivariable quantile regression models for the analysis and adjusted covariates including age, sex, consciousness status, severity of injury, emergency medical service use, the season, day and time of visit, and hospital. To determine if there were different effects of alcohol use across mechanism of injury, all analyses were stratified by each mechanism.
Results
Among 192,200 patients, 95,807 patients were analyzed. The number of participants in the alcohol-related group was 16,249 (17.0%). In the multivariable quantile regression model, the alcohol-related group had significantly longer ED LOS at the 10th (7 minutes; 95% confidence interval [CI], 6 to 8), 50th (21 minutes; 95% CI, 19 to 23), and 90th (81 minutes; 95% CI, 74 to 87) percentiles when compared to the alcohol-unrelated group. The effect of alcohol use on increased ED LOS was most prominent in motor vehicle injuries.
Conclusion
We found that alcohol use was associated with increased emergency ED LOS. Furthermore, if we limited our attention to the effect of alcohol use on the number of patients, the burden of alcohol use on the ED would have been underestimated.

Citations

Citations to this article as recorded by  Crossref logo
  • Factors affecting patient length of stay in the emergency unit: A scoping review
    Firman Firman, Andi Masyitha Irwan, Amy Buckenmeyer
    International Emergency Nursing.2025; 80: 101607.     CrossRef
  • Triage and length of stay in emergency department visits due to alcohol intoxication: A retrospective chart review
    Sunmi Lee, Hyunjin Oh
    Australasian Emergency Care.2023; 26(1): 90.     CrossRef
  • Psychoactive substances and previous hospital admissions, triage and length of stay in rural injuries: a prospective observational study
    Thomas Wilson, Torben Wisborg, Vigdis Vindenes, Ragnhild Elèn Gjulem Jamt, Stig Tore Bogstrand
    Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.2023;[Epub]     CrossRef
  • A nationwide injury database analysis of severity and mortality in alcohol-related injury, South Korea
    Seung Taeg Seong, Jae Hee Lee, Duk Hee Lee
    Journal of Public Health.2022; 30(9): 2283.     CrossRef
  • Modeling the length-of-stay of patients with geriatric diseases or alcohol use disorder using phase-type distributions with covariates
    Wanlu Gu, Neng Fan, Haitao Liao
    IISE Transactions on Healthcare Systems Engineering.2021; : 1.     CrossRef
  • The effects of the COVID-19 lockdown and alcohol restriction on trauma-related emergency department cases in a South African regional hospital
    Mncedisi Junior Manyoni, Muhammed Irfaan Abader
    African Journal of Emergency Medicine.2021; 11(2): 227.     CrossRef
  • Correlation between alcohol use disorders, blood alcohol content, and length of stay in trauma patients
    Wirachin Hoonpongsimanont, Ghadi Ghanem, Soheil Saadat, Maria Nguyen, Christine Louis, PreetK Sahota, Leila Danishgar, Christy Carroll, Cristobal Barrios, Shahram Lotfipour
    Journal of Emergencies, Trauma, and Shock.2021; 14(1): 42.     CrossRef
  • Analysis of Factors Associated With Length of Stay of Opioid-Related Emergency Department Visits
    Keshab Subedi
    Cureus.2021;[Epub]     CrossRef
  • Drug and alcohol use in Tanzanian road traffic collision drivers
    Adeline Dozois, Paulina Nkondora, Erin Noste, Juma A. Mfinanga, Hendry R. Sawe, Michael S. Runyon
    African Journal of Emergency Medicine.2021; 11(4): 390.     CrossRef
  • Effect of alcohol intake on the severity of injuries caused by slipping down
    Kyoung Sung Yun, Jin-Seong Cho, Yong Su Lim, Jae Ho Jang, Hyuk Jun Yang, Woo Sung Choi
    Clinical and Experimental Emergency Medicine.2020; 7(3): 170.     CrossRef
  • 8,912 View
  • 128 Download
  • 13 Web of Science
  • 10 Crossref

Emergency Medical Services

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Effect of emergency medical service use on time interval from symptom onset to hospital admission for definitive care among patients with intracerebral hemorrhage: a multicenter observational study
Clin Exp Emerg Med. 2017;4(3):168-177.   Published online September 30, 2017
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Effect of emergency medical service use on time interval from symptom onset to hospital admission for definitive care among patients with intracerebral hemorrhage: a multicenter observational study
Clin Exp Emerg Med. 2017;4(3):168-177.   Published online September 30, 2017
Close
Objective
This study evaluated whether emergency medical service (EMS) use was associated with early arrival and admission for definitive care among intracerebral hemorrhage (ICH) patients. Methods Patients with ICH were enrolled from 29 hospitals between November 2007 and December 2012, excluding those patients with subarachnoid hemorrhage, traumatic ICH, and missing information. The patients were divided into four groups based on visit type to the definitive hospital emergency department (ED): direct visit by EMS (EMS-direct), direct visit without EMS (non-EMS-direct), transferred from a primary hospital by EMS (EMS-transfer), and transferred from a primary hospital without EMS (non-EMS-transfer). The outcomes were the proportions of participants within early (<1 hr) definitive hospital ED arrival from symptom onset (pS2ED) and those within early (<4 hr) admission from symptom onset (pS2AD). Adjusted odds ratios were calculated to determine the association between EMS use and outcomes with and without inter-hospital transfer. Results A total of 6,564 patients were enrolled. The adjusted odds ratios (95% confidence intervals) for pS2ED were 22.95 (17.73–29.72), 1.11 (0.67–1.84), and 7.95 (6.04–10.46) and those for pS2AD were 5.56 (4.70–6.56), 0.96 (0.71–1.30), and 2.35 (1.94–2.84) for the EMS-direct, EMS-transfer, and non-EMS-direct groups compared with the non-EMS-transfer group, respectively. Through the interaction model, EMS use was significantly associated with early arrival and admission among direct visiting patients but not with transferred patients. Conclusion EMS use was significantly associated with shorter time intervals from symptom onset to arrival and admission at a definitive care hospital. However, the effect disappeared when patients were transferred from a primary hospital.

Citations

Citations to this article as recorded by  Crossref logo
  • Emergency Medical Services Compliance With Prehospital Stroke Quality Metrics Is Associated With Faster Stroke Evaluation and Treatment
    J. Adam Oostema, Adrienne Nickles, Justin Allen, Ghada Ibrahim, Zhehui Luo, Mathew J. Reeves
    Stroke.2024; 55(1): 101.     CrossRef
  • A Narrative Review of Interhospital Transfers for Intracerebral Hemorrhage
    Neha S. Dangayach, Masha Morozov, Ian Cossentino, John Liang, Deeksha Chada, Devin Bageac, Laura Salgado, Wheatonia Malekebu, Christopher Kellner, Joshua Bederson
    World Neurosurgery.2024; 190: 1.     CrossRef
  • Epidemiology of hypertensive intracerebral hemorrhages in the Republic of Tatarstan
    M. M. Iachkurinskikh, D. R. Khasanova, V. I. Danilov
    Russian Neurosurgical Journal named after Professor A. L. Polenov.2024; 16(3): 125.     CrossRef
  • Emergency Medical Services Stroke Care Performance Variability in Michigan: Analysis of a Statewide Linked Stroke Registry
    J. Adam Oostema, Adrienne Nickles, Zhehui Luo, Mathew J. Reeves
    Journal of the American Heart Association.2023;[Epub]     CrossRef
  • ANÁLISIS DE LOS INDICADORES DE GESTIÓN DEL SERVICIO MÓVIL DE ATENCIÓN DE URGENCIAS DE CEARÁ
    Natália Pinheiro Fabricio Formiga, Lucilane Maria Sales da Silva, José Hiago Feitosa de Matos, Emiliana Bezerra Gomes, Kelly Fernanda Silva Santana, Francisco Edilson Ferreira, Maria Veraci Oliveira Queiroz
    Cogitare Enfermagem.2023;[Epub]     CrossRef
  • ANÁLISE DOS INDICADORES DE GESTÃO DO SERVIÇO DE ATENDIMENTO MÓVEL DE URGÊNCIAS DO CEARÁ
    Natália Pinheiro Fabricio Formiga, Lucilane Maria Sales da Silva, José Hiago Feitosa de Matos, Emiliana Bezerra Gomes, Kelly Fernanda Silva Santana, Francisco Edilson Ferreira, Maria Veraci Oliveira Queiroz
    Cogitare Enfermagem.2023;[Epub]     CrossRef
  • ANALYSIS OF THE MANAGEMENT INDICATORS OF THE MOBILE EMERGENCY CARE SERVICE OF CEARÁ
    Natália Pinheiro Fabricio Formiga, Lucilane Maria Sales da Silva, José Hiago Feitosa de Matos, Emiliana Bezerra Gomes, Kelly Fernanda Silva Santana, Francisco Edilson Ferreira, Maria Veraci Oliveira Queiroz
    Cogitare Enfermagem.2023;[Epub]     CrossRef
  • 2022 Guideline for the Management of Patients With Spontaneous Intracerebral Hemorrhage: A Guideline From the American Heart Association/American Stroke Association
    Steven M. Greenberg, Wendy C. Ziai, Charlotte Cordonnier, Dar Dowlatshahi, Brandon Francis, Joshua N. Goldstein, J. Claude Hemphill, Ronda Johnson, Kiffon M. Keigher, William J. Mack, J. Mocco, Eileena J. Newton, Ilana M. Ruff, Lauren H. Sansing, Sam Schu
    Stroke.2022;[Epub]     CrossRef
  • Accuracy and Implications of Hemorrhagic Stroke Recognition by Emergency Medical Services
    J. Adam Oostema, Todd Chassee, William Baer, Allison Edberg, Mathew J. Reeves
    Prehospital Emergency Care.2021; 25(6): 796.     CrossRef
  • Influence of time to admission to a comprehensive stroke centre on the outcome of patients with intracerebral haemorrhage
    Luis Prats-Sánchez, Marina Guasch-Jiménez, Ignasi Gich, Elba Pascual-Goñi, Noelia Flores, Pol Camps-Renom, Daniel Guisado-Alonso, Alejandro Martínez-Domeño, Raquel Delgado-Mederos, Ana Rodríguez-Campello, Angel Ois, Alejandra Gómez-Gonzalez, Elisa Cuadrad
    European Stroke Journal.2020; 5(2): 115.     CrossRef
  • 10,538 View
  • 143 Download
  • 9 Web of Science
  • 10 Crossref

Injury & Prevention

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International Classification of Diseases 10th edition-based disability adjusted life years for measuring of burden of specific injury
Clin Exp Emerg Med. 2016;3(4):219-238.   Published online December 30, 2016
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International Classification of Diseases 10th edition-based disability adjusted life years for measuring of burden of specific injury
Clin Exp Emerg Med. 2016;3(4):219-238.   Published online December 30, 2016
Close
Objective
We aimed to develop an International Classification of Diseases (ICD) 10th edition injury code-based disability-adjusted life year (DALY) to measure the burden of specific injuries.
Methods
Three independent panels used novel methods to score disability weights (DWs) of 130 indicator codes sampled from 1,284 ICD injury codes. The DWs were interpolated into the remaining injury codes (n=1,154) to estimate DWs for all ICD injury codes. The reliability of the estimated DWs was evaluated using the test-retest method. We calculated ICD-DALYs for individual injury episodes using the DWs from the Korean National Hospital Discharge Injury Survey (HDIS, n=23,160 of 2004) database and compared them with DALY based on a global burden of disease study (GBD-DALY) regarding validation, correlation, and agreement for 32 injury categories.
Results
Using 130 ICD 10th edition injury indicator codes, three panels determined the DWs using the highest reliability (person trade-off 1, Spearman r=0.724, 0.788, and 0.875 for the three panel groups). The test-retest results for the reliability were excellent (Spearman r=0.932) (P<0.001). The HDIS database revealed injury burden (years) as follows: GBD-DALY (138,548), GBD-years of life disabled (130,481), and GBD-years of life lost (8,117) versus ICD-DALY (262,246), ICD-years of life disabled (255,710), and ICD-years of life lost (6,537), respectively. Spearman’s correlation coefficient of the DALYs between the two methods was 0.759 (P<0.001), and the Bland-Altman test displayed an acceptable agreement, with exception of two categories among 32 injury groups.
Conclusion
The ICD-DALY was developed to calculate the burden of injury for all injury codes and was validated with the GBD-DALY. The ICD-DALY was higher than the GBD-DALY but showed acceptable agreement.

Citations

Citations to this article as recorded by  Crossref logo
  • Incidence and Characteristics of Psychiatric Disorders in Adolescent and Young Adult Patients with Malignant Brain Tumors
    Eun Sang Yi, Yunseop Kim, Chaeeun Cho, Jimin Kim, O Kyu Noh, Jun Eun Park
    Journal of Adolescent and Young Adult Oncology.2026; 15(3): 179.     CrossRef
  • Epidemiological trend of lung cancer burden caused by residential radon exposure in China from 1990 to 2019
    Chengzhi Wang, Lei Shi
    European Journal of Cancer Prevention.2024; 33(3): 232.     CrossRef
  • Using machine learning to detect sarcopenia from electronic health records
    Xiao Luo, Haoran Ding, Andrea Broyles, Stuart J Warden, Ranjani N Moorthi, Erik A Imel
    DIGITAL HEALTH.2023;[Epub]     CrossRef
  • Data resource profile: the Korea National Hospital Discharge In-depth Injury Survey
    Yeon-Kyeng Lee, Sung Ok Hong, Soo-Jung Park, Mijin Park, Kyunghae Wang, Mini Jo, Jeongah Oh, Sin Ae Lee, Hyeon Ju Lee, Jungeun Oh, Dosang Lim, Sanghui Kweon, Youngtaek Kim
    Epidemiology and Health.2021; 43: e2021052.     CrossRef
  • The Burden of High‐Energy Musculoskeletal Trauma in High‐Income Countries
    P. Hoogervorst, D. W. Shearer, T. Miclau
    World Journal of Surgery.2020; 44(4): 1033.     CrossRef
  • Relating factors to severe injury from outdoor falls in older people
    Hey Youn Jung, Sun Hyu Kim, Sang Cheal Lee, Sunpyo Kim, Gyu Chong Cho, Min Joung Kim, Ji Sook Lee, Chul Han
    Geriatrics & Gerontology International.2018; 18(1): 80.     CrossRef
  • Trend in Disability-Adjusted Life Years (DALYs) for Injuries in Korea: 2004–2012
    Yoonjic Kim, Yu Jin Kim, Sang Do Shin, Kyoung Jun Song, Jungeun Kim, Jeong Ho Park
    Journal of Korean Medical Science.2018;[Epub]     CrossRef
  • 17,872 View
  • 146 Download
  • 11 Web of Science
  • 7 Crossref

Emergency Medicine Practice and Administration | Patient Safety

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Patients who leave the emergency department against medical advice
Clin Exp Emerg Med. 2016;3(2):88-94.   Published online June 30, 2016
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Patients who leave the emergency department against medical advice
Clin Exp Emerg Med. 2016;3(2):88-94.   Published online June 30, 2016
Close
Objective
Discharge against medical advice (DAMA) from the emergency department (ED) accounts for 0.1% to 2.7% of all ED discharges. DAMA carries a risk of increased mortality and readmissions. Our aim was to investigate the general characteristics of DAMA patients and the differences between them and non-DAMA patients.
Methods
We reviewed data collected by the National Emergency Medical Center between 2010 and 2011. Subjects were categorized into 2 groups, namely, the DAMA group and the non-DAMA group. We compared these groups with respect to age, gender, trauma or non-trauma status, type of hospital, health insurance, level of consciousness on admission, and diagnosis.
Results
Of 8,000,529 patients, 222,389 (2.78%) left against medical advice. The risk factors for DAMA across all age groups were as follows: no medical insurance (odds ratio [OR], 1.993), initial response to voice (OR, 2.753) or pain (OR, 2.101), trauma admission (OR, 1.126), admission to a local emergency medical center (OR, 1.215), and increased age. A high risk of DAMA was observed among patients with immune, endocrine, psychiatric, neurological, circulatory diseases, and external causes of morbidity and mortality.
Conclusion
Although DAMA cases account for only a small percentage of hospital discharges, they are important because DAMA patients have high readmission and mortality rates. It is therefore important to understand the general characteristics and predictors of DAMA in order to improve patient outcome and minimize the economic burden on the healthcare system.

Citations

Citations to this article as recorded by  Crossref logo
  • Prevalence, causes, and predictors of discharge against medical advice (DAMA) in an emergency setting: an updated systematic review and meta-analysis
    Theeb Ayedh Alkahtani, Asaad Shujaa
    Saudi Journal of Emergency Medicine.2025; 2(1): 32.     CrossRef
  • Prevalence, Predictors and Reasons for Discharge Against Medical Advice Among Patients With Chronic Disease During COVID‐19
    Raya T. Al‐Bataineh, Ahmad H. Ghaith
    The International Journal of Health Planning and Management.2025; 40(2): 300.     CrossRef
  • A Retrospective review of Leave against Medical Advice (LAMA) cases in the Emergency Department: Factors and Solutions
    Angad Tikhile, Shweta Tyagi, Sanjay Mulay, Rajesh Ursekar
    Current Medical Issues.2025; 23(1): 8.     CrossRef
  • Discharge Against Medical Advice From the Emergency Department: Results From a Private Hospital in Beirut
    Danielle Abou Khater, Joelle Kalaji, Alain Tanios, Charbel Ghosn, Robert Fakhoury, Mariana Helou
    Cureus.2025;[Epub]     CrossRef
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Trauma

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Preventable deaths in patients with traumatic brain injury
Clin Exp Emerg Med. 2015;2(1):51-58.   Published online March 31, 2015
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Preventable deaths in patients with traumatic brain injury
Clin Exp Emerg Med. 2015;2(1):51-58.   Published online March 31, 2015
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Objective
The objective of this study is to evaluate the rate of and etiology for preventable deaths in patients with traumatic brain injuries (TBIs).
Methods
We conducted a retrospective, multicenter review of patients with TBIs who died within 7 days of their traumatic event from June 2008 to May 2009. Three board certified emergency physicians independently reviewed every case using a structured survey format. Cases were considered preventable deaths only if all physicians independently agreed the death was preventable. Management errors contributing to the preventable death were determined.
Results
Forty-one patients who died from TBI were eligible. Preventable deaths were identified in nine (22%; 95% confidence interval [CI], 11 to 28) cases. Fifty-six management errors were identified including 36 (64%; 95% CI, 50 to 77) in the emergency department and 13 (23%; 95% CI, 13 to 36) in the prehospital phase. Thirty (54%; 95% CI, 40 to 67) management errors were process-related, and 26 (46%; 95% CI, 33 to 60) were structure-related.
Conclusion
An important and measurable rate of preventable mortality occurs in the initial care of TBI patients. Errors were common and most occurred in the emergency department. In addition, errors were common in the prehospital phase but did not always lead to mortality. When analyzed by type of problem, both process-related and structure-related errors occurred in similar proportions.

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  • 156 Download
  • 10 Web of Science
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