Donghyun Kim, Junsang Yoo, Ye Rim Lee, Ji Sim Yoon, Seung Jin Maeng, Minha Kim, Sejin Heo, Jong Eun Park, Gun Tak Lee, Se Uk Lee, Taerim Kim, Sung Yeon Hwang, Hee Yoon, Won Chul Cha, Hansol Chang
In Press, Received September 23, 2025 Accepted December 29, 2025 Available online February 27, 2026
Objective Emergency department (ED) physicians face substantial cognitive and physical demands, yet workload data applicable to real-world staffing and operational decisions remain limited. This study aimed to quantify perceived workload across diverse ED tasks using the NASA Task Load Index (NASA-TLX) and to determine how workload varies by physician experience, patient acuity, and clinical context. A secondary aim was to generate practical insights that may inform resource allocation and experience-based task distribution in the ED.
Methods We conducted an observational survey of interns, residents, and specialists working in the ED of a tertiary hospital between June and July 2022. NASA-TLX questionnaires were administered to assess workload across common procedures and patient-care tasks. Analyses were stratified by physician experience, Korean Triage and Acuity Scale (KTAS) level, and chief complaint. Nonparametric methods were used to evaluate differences in workload patterns.
Results Sixty physicians participated (30 interns, 30 residents/specialists). Procedures with high technical complexity, such as thoracentesis and lumbar puncture, showed the highest workload among interns. Among residents, workload decreased from postgraduate year 1 to 3 but rose again in year 4, reflecting increased supervisory responsibilities. Higher patient acuity (KTAS 1–2) and neurological chief complaints were consistently associated with elevated workload across all experience levels.
Conclusion Perceived workload in the ED varies significantly by task type, experience level, and patient acuity. These findings provide actionable data that may support evidence-based staffing decisions, workload redistribution, and training strategies to optimize physician performance and mitigate cognitive overload in resource-limited emergency departments.
Objective Trauma is one of the leading causes of obstetric morbidity and mortality, and incorrect seat belt use is a major determinant of adverse outcomes. This study evaluated the impact of structured education on proper seat belt use during pregnancy and examined preferences for future interventions.
Methods This prospective pilot study was conducted at a single center in Korea, over an 8-week period. Pregnant women between 20 and 37 weeks of gestation who visited the outpatient obstetrics and gynecology department were enrolled. A pre-education survey assessed baseline seat belt practices. Participants then received structured education, and a post-education survey 1 month later evaluated changes in awareness and behavior.
Results Sixty participants were included in the final analysis. Most reported obtaining seat belt information from unverified sources, particularly online communities. Many indicated a preference for structured education delivered by obstetricians, especially early in pregnancy. After the intervention, knowledge of proper seat belt use increased from 21.7% to 85.0% (P<0.001), and correct seat belt usage rose from 16.7% to 88.3% (P<0.001). Seat belt use while driving also improved markedly, increasing from 19.5% to 78.0% (P<0.001), demonstrating the program’s effectiveness in enhancing awareness and behavior.
Conclusion Education on seat belt use during pregnancy significantly improved both knowledge and correct usage among pregnant women. Routine, formal educational programs are recommended to promote maternal and fetal safety.
Objective This study aimed to develop and validate MEDIVAL (Medical Documentation Validation), a progressive chain-of-thought (CoT) evaluation framework for automated assessment of large language model (LLM)-generated emergency department documentation, designed to align with expert clinical judgment in acute care settings. Methods We designed a three-tier evaluation framework incorporating persona-based, error-enhanced, and insight-integrated strategies. The framework was tested across four LLMs (GPT-4o, GPT-4.1, Claude-3.5, Claude-3.7) on 33 emergency department records reviewed by four expert emergency physicians. Each model applied the three CoT strategies across five criteria: appropriateness, accuracy, structure/format, conciseness, and clinical validity. Model outputs were compared with expert ratings using Spearman correlation coefficients. Differences were analyzed with the Friedman test and Wilcoxon signed rank test with Bonferroni correction. Reproducibility was assessed through intraclass correlation coefficient (ICC) analysis. Results All models demonstrated stronger alignment with expert ratings as CoT complexity increased, with Claude-3.7 (r=0.712, P<0.001) and GPT-4o (r=0.702, P<0.001) showing the highest correlations under the insight-integrated strategy. GPT-4.1 showed the greatest relative improvement (43.3% increase, r=0.457 to r=0.655, P<0.001). Significant overall differences were observed across strategies (χ2 (2)=48.39, P<0.001), though the error-enhanced and insight-integrated approaches differed only modestly yet significantly (P=0.002). High reproducibility was confirmed (ICC >0.919), with Claude-3.5 achieving the most consistent results (ICC, 0.997–0.998). Conclusion MEDIVAL demonstrates that progressive CoT strategies systematically improve automated evaluation of emergency department documentation while maintaining excellent reproducibility. This framework offers a viable prescreening tool to reduce expert workload and support reliable artificial intelligence integration into emergency medicine workflows.
Performance Evaluation of the 2020 European Society of Cardiology 0-hour/1-hour Algorithm Using High-sensitivity Cardiac Troponin I for Non-ST-segment Elevation Acute Coronary Syndrome and Mortality Assessment Based on 1-year Real-world Data Changhee Ha, Yeon Jae Lee, Jong Do Seo, Hanah Kim, Hee-Won Moon, Mina Hur, Young Hwan Lee, Sang O Park, Kyeong Ryong Lee, Hyun-Joong Kim, Yeo-Min Yun Annals of Laboratory Medicine.2026; 46(1): 52. CrossRef
Association between emergency department crowding and mortality: a nationwide analysis stratified by emergency department levels: a retrospective cohort study Minha Kim, Jin-Hee Lee, Minyoung Choi, Doyeop Kim, Hanseok Chang, Sejin Heo, Seung Jin Maeng, Tae Gun Shin, Eunsil Ko, Hansol Chang BMC Emergency Medicine.2026;[Epub] CrossRef
Brecha entre demanda asistencial y disponibilidad médica en servicio de Urgencias Hugo Ariel Cabrera Britez Revista Científica de Salud "Ciensa".2026; : 1. CrossRef
Pediatric emergency care: Determinants and systematic barriers Pankaj Soni, Amit Agrawal World Journal of Clinical Pediatrics.2025;[Epub] CrossRef
Beyond Annual Averages: Rethinking Metrics For Emergency Department Crowding And Capacity Planning JeongWook Lim, Jisun Lee, Song-Hee Kim, Taehui Kim, Hyo Jin Kim, Mi Gyeong Yoo, Chun Song Youn, Yun-Suk Pak The Journal of Emergency Medicine.2025; 79: 591. CrossRef
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Objective This study analyzed trends in emergency department (ED) visits in South Korea using the National Emergency Department Information System (NEDIS) data from 2018 to 2022.
Methods This was a retrospective observational study using data from the NEDIS database from 2018 to 2022. Age- and sex-standardized ED visits per 100,000 population, as well as age- and sex-standardized rates for mortality, admission, and transfer, were calculated.
Results The standardized ED visits per 100,000 population was approximately 20,000 from 2018 to 2019 and decreased to about 18,000 in 2022. The standardized mortality rate ranged from 1.4% to 1.7%. The admission rate (18.4%–19.4%) and the transfer rates (1.6%–1.8%) were similar during the study period. Approximately 5.5% of patients were triaged as Korean Triage and Acuity Scale score 1 or 2. About 91% of patients visited the ED directly and 21.7% of patients visited the ED with an ambulance. The ED length of stay was less than 6 hours in 90.3% of patients and the ED mortality rate was 0.6%. Acute gastroenteritis was the most common diagnosis. Respiratory virus symptoms, such as fever and sore throat, were also common chief complaints.
Conclusion ED visits decreased during the 5-year period, while admission, transfer, and death rates remained relatively stable.
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Objective As of 2018, approximately 1.2 million pediatric patients visited emergency departments (EDs) in Korea, showing a steady increase. Given the distinct differences between children and adults, it is vital to examine the epidemiological characteristics of pediatric patients visiting the ED.
Methods This study retrospectively analyzed the ED use patterns of pediatric patients <18 years old in Korea from January 1, 2018, to December 31, 2022, using data from the National Emergency Department Information System (NEDIS).
Results Most pediatric ED patients were boys, with an average age of 6.6±5.3 years. Patients younger than 1 year and those in critical condition had longer ED stays and more frequently required hospital admission and used the 119-ambulance service. The primary symptom was fever, and the most common discharge diagnosis was gastroenteritis. Following the declaration of the COVID-19 pandemic in 2020, ED visits decreased by 49%. Meanwhile, there was an increase in in-hospital mortality rate/age- and sex-standardized mortality rate per 100,000 ED visits, Admission and transfer rates remained similar between before and after the start of the pandemic.
Conclusion Through this analysis, we identified the characteristics of pediatric patients visiting EDs in Korea. We observed a sharp decline in ED visits after the start of the COVID-19 pandemic. From there, ED visits slowly increased but remained below prepandemic levels for 3 years. This research will serve as a foundational resource for appropriately allocating and preparing pediatric ED resources.
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Objective We evaluated the performance of diastolic shock index (DSI) and lactate in predicting vasopressor requirement among hypotensive patients with suspected infection in an emergency department.
Methods This was a single-center, retrospective observational study for adult patients with suspected infection and hypotension in the emergency department from 2018 to 2019. The study population was split into derivation and validation cohorts (70/30). We derived a simple risk score to predict vasopressor requirement using DSI and lactate cutoff values determined by Youden index. We tested the score by the area under the receiver operating characteristic curve (AUC). We performed a multivariable regression analysis to evaluate the association between the timing of vasopressor treatment and 28-day mortality.
Results A total of 1,917 patients were included. We developed a score, assigning 1 point each for the high DSI (≥2.0) and high lactate (≥2.5 mmol/L) criteria. The AUCs of the score were 0.741 (95% confidence interval [CI], 0.715–0.768) at hypotension and 0.736 (95% CI, 0.708–0.763) after initial fluid challenge in the derivation cohort and 0.676 (95% CI, 0.631–0.719) at hypotension and 0.688 (95% CI, 0.642–0.733) after initial fluid challenge in the validation cohort, respectively. In patients with scores of 2 points, early vasopressor therapy initiation was significantly associated with decreased 28-day mortality (adjusted odds ratio, 0.37; 95% CI, 0.14–0.94).
Conclusion A prediction model with DSI and lactate levels might be useful to identify patients who are more likely to need vasopressor administration among hypotensive patients with suspected infection.
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Objective Coronavirus disease 2019 (COVID-19) has notably altered the emergency department isolation protocol, imposing stricter requirements on probable infectious disease patients that enter the department. This has caused adverse effects, such as an increased rate of leave without being seen (LWBS). This study describes the effect of fever/respiratory symptoms as the main cause of isolation regarding LWBS after the COVID-19 pandemic.
Methods We retrospectively analyzed emergency department visits before (March to July 2019) and after (March to July 2020) the COVID-19 pandemic. Patients were grouped based on existing fever or respiratory symptoms, with the LWBS rate as the primary outcome. Logistic regression analysis was used to identify the risk factors of LWBS. Logistic regression was performed using interaction terminology (fever/respiratory symptom patient [FRP]×post–COVID-19) to determine the interaction between patients with FRPs and the COVID-19 pandemic period.
Results A total of 60,290 patients were included (34,492 in the pre–COVID-19, and 25,298 in the post–COVID-19 group). The proportion of FRPs decreased significantly after the pandemic (P<0.001), while the LWBS rate in FRPs significantly increased from 2.8% to 19.2% (P<0.001). Both FRPs (odds ratio, 1.76; 95% confidence interval, 1.59–1.84 (P<0.001) and the COVID-19 period (odds ratio, 2.29; 95% confidence interval, 2.15–2.44; P<0.001) were significantly associated with increased LWBS. Additionally, there was a significant interaction between the incidence of LWBS in FRPs and the COVID-19 pandemic period (P<0.001).
Conclusion The LWBS rate has increased in FRPs after the COVID-19 pandemic; additionally, the effect observed was disproportionate compared with that of nonfever/respiratory symptom patients.
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Objective This study aimed to confirm the accuracy of a machine-learning-based model in predicting the 30-day mortality of patients with pneumonia and evaluating whether they were required to be admitted to the intensive care unit (ICU).
Methods The study conducted a retrospective analysis of pneumonia patients at an emergency department (ED) in Seoul, Korea, from January 1, 2016 to December 31, 2017. Patients aged 18 years or older with a pneumonia registry designation on their electronic medical record were enrolled. We collected their demographic information, mental status, and laboratory findings. Three models were used: the pre-existing CURB-65 model, and the CURB-RF and Extensive CURB-RF models, which were machine-learning models that used a random forest algorithm. The primary outcomes were ICU admission from the ED or 30-day mortality. Receiver operating characteristic curves were constructed for the models, and the areas under these curves were compared.
Results Out of the 1,974 pneumonia patients, 1,732 patients were eligible to be included in the study; from these, 473 patients died within 30 days or were initially admitted to the ICU from the ED. The area under receiver operating characteristic curves of CURB-65, CURB-RF, and extensive-CURB-RF were 0.615 (0.614–0.616), 0.701 (0.700–0.702), and 0.844 (0.843–0.845), respectively.
Conclusion The proposed machine-learning models could predict the mortality of patients with pneumonia more accurately than the pre-existing CURB-65 model and can help decide whether the patient should be admitted to the ICU.
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Objective Reversible cerebral vasoconstriction syndrome (RCVS) is an underestimated cause of thunderclap headache that shares many characteristics with subarachnoid hemorrhage (SAH). This fact makes the two easily confused by emergency physicians. This study evaluated the clinical manifestations, radiological features, and outcomes of patients with RCVS.
Methods The electronic medical records of 18 patients meeting the diagnostic criteria of RCVS at our emergency department between January 2013 and December 2014 were retrospectively reviewed.
Results The mean patient age was 50.7 years, and 80% were women. Patients with RCVS encountered physicians 4.7 times before receiving an accurate diagnosis. The mean duration of symptoms until diagnosis was 9.3 days. All but one patient experienced severe headache of 8 to 10 on a numerical rating scale. A total of 44% of patients had nausea, and 66% of patients experienced worsening of the headache while gagging, leaning forward, defecating, urinating, or having sexual intercourse. The most frequently affected vessels were the middle cerebral arteries, which demonstrated a characteristic diffuse “string of beads” appearance. Four cases were complicated by SAH.
Conclusion Patients with RCVS have a unique set of clinical and imaging features. Emergency physicians should have a high index of suspicion for this clinical entity to improve its rate of detection in patients with thunderclap headache when there is no evidence of aneurysmal SAH.
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Reversible Cerebral Vasoconstriction Syndrome G. R. Ramazanov, T. A. Magomedov, M. S. Solovtsova, E. V. Shevchenko, E. A. Kovaleva Russian Sklifosovsky Journal "Emergency Medical Care".2024; 13(3): 492. CrossRef
Reversible cerebral vasoconstriction syndrome: A narrative review for emergency clinicians Anthony Spadaro, Kevin R. Scott, Alex Koyfman, Brit Long The American Journal of Emergency Medicine.2021; 50: 765. CrossRef
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Clinical manifestations and pathogenesis of reversible cerebral vasoconstriction syndrome M. Yu. Afanasyeva, V. V. Goldobin, E. G. Klocheva Medical alphabet.2020; (22): 22. CrossRef
The Thunderclap Headache: Approach and Management in the Emergency Department Drew Long, Alex Koyfman, Brit Long The Journal of Emergency Medicine.2019; 56(6): 633. CrossRef
Influence of Climate on the Incidence of RCVS – A Retrospective Study From Taiwan Yen‐Cheng Shih, Shih‐Pin Chen, Jong‐Ling Fuh, Yen‐Feng Wang, Shuu‐Jiun Wang Headache: The Journal of Head and Face Pain.2019; 59(4): 567. CrossRef
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