Objective Emergency department (ED) triage determines patient prioritization, early risk recognition, and allocation of limited resources. Artificial intelligence (AI) has been explored to support triagerelated decision-making, but the evidence remains heterogeneous. This scoping review aimed to map applications of AI-assisted triage in EDs and summarize reported outcomes, safety, equity, and implementation challenges.
Methods This scoping review followed Arksey and O’Malley’s framework. Scopus, PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and manual searching were used. Original empirical studies published in English between 2015 and 2026 were included if they evaluated AI tools supporting ED triage, risk stratification, resource prediction, or patient-flow decision-making.
Results Of 1,865 records identified, 27 studies met the inclusion criteria. Included studies used machine learning, deep learning, natural language processing (NLP), artificial neural networks, interpretable machine learning, AI-informed decision-support systems, and large language models (LLMs). AI was applied to acuity classification, admission prediction, intensive care unit (ICU) admission prediction, mortality prediction, sepsis detection, waiting-time estimation, and patient-flow optimization. Conventional machine learning and NLP models generally reported promising predictive performance, particularly when structured triage variables were combined with unstructured clinical text. However, fewer studies evaluated prospective validation, workflow integration, measurable clinical and operational impact, equity, or post-deployment monitoring. Evidence on LLMs remains preliminary, with concerns about undertriage, inconsistency, hallucination, local adaptability, and the need for supervised use.
Conclusion AI-assisted triage may support ED decision-making and patient-flow management. Future implementation should prioritize supervised human–AI collaboration, prospective validation, explainability, fairness assessment, clinician training, workflow integration, and continuous monitoring.
Objective To evaluate the association between the lactate-to-albumin ratio (LAR) and the development of post-contrast acute kidney injury (PC-AKI) in patients undergoing intravenous contrast-enhanced computed tomography (CT) in the emergency department (ED), and to compare its discriminative performance with other biomarker ratios.
Methods This retrospective observational study included adult patients who underwent contrastenhanced CT in a tertiary ED between January 2022 and January 2025. Patients with available baseline and 48–72-hour post-contrast serum creatinine measurements were analyzed. LAR, blood urea nitrogen–to–albumin ratio (BAR), C-reactive protein–to–albumin ratio (CAR), and neutrophil-tolymphocyte ratio (NLR) were calculated using laboratory values obtained at ED presentation. Logistic regression analyses were performed, and receiver operating characteristic curves were constructed.
Results A total of 695 patients were included, and PC-AKI occurred in 43 (6.2%). Patients with PCAKI were older and had higher hemoglobin, creatinine, blood urea nitrogen, C-reactive protein, and lactate levels, as well as lower albumin and estimated glomerular filtration rate values (all p<0.05). LAR, BAR, CAR, and NLR differed between groups. In multivariable analysis, LAR (OR=3.898; 95% CI: 2.799–5.430; p<0.001), BAR (OR=1.635; 95% CI: 1.171–2.283; p=0.004), and NLR (OR=1.820; 95% CI: 1.359–2.438; p<0.001) were associated with PC-AKI. LAR showed an area under the curve of 0.854, with a sensitivity of 88.4% and a negative predictive value of 98.9% at a cut-off of >0.51.
Conclusion LAR measured at ED presentation was associated with the development of PC-AKI following contrast-enhanced CT and demonstrated higher discriminative performance compared with other evaluated ratios. These findings suggest that LAR may be useful for risk stratification in this clinical context.
Objective This scoping review aimed to examine studies of nonagentic large language models (LLMs), LLM-based agents, and multiagent systems in emergency medicine and to identify current research trends and major gaps by analyzing their scope of clinical application, system structures, evaluation approaches, and input data characteristics.
Methods The Web of Science, Scopus, PubMed, and CINAHL were searched for literature published from March 8, 2021, to March 7, 2026. English-language full-text studies published during this period were included if they addressed the application, evaluation, or benchmarking of nonagentic LLMs, LLM-based agents, or multiagent systems in emergency medicine or the emergency department. Additional studies were identified through reference tracking and supplementary searching. In total, 35 studies were analyzed.
Results Of the 35 included studies, 26 were application studies, 6 were framework studies, and 3 were benchmark studies. Nonagentic LLMs were the most common system type (n=25), followed by LLM-based agents (n=7) and multiagent systems (n=3). Inputs were predominantly text-based, and evaluation mainly relied on expert comparison, retrospective record review, vignette-based comparison, and task-specific performance metrics. In contrast, workflow-level, prospective, and safety- and trustworthiness-oriented evaluations were limited.
Conclusion LLMs in emergency medicine have shown potential for task-level decision support and documentation. However, the current literature remains focused on nonagentic LLM-based task support, whereas studies that reflect the dynamic workflow of real emergency departments remain limited. Future research should expand toward workflow-aware design, operational evaluation, multimodal data integration, multiagent-based role coordination, and validation of safety and trustworthiness.
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An Evidence-Based Framework for Patient-Facing Artificial Intelligence Integration in the Emergency Department Tehreem Rehman, Philip Jarrett, Joshua Lesko, James Augustine, Bradley D. Shy, Rohit B. Sangal, Nicholas Genes, Donald U. Apakama, Ethan E. Abbott, Abhi Mehrotra, Richard Andrew Taylor JACEP Open.2026; 7(5): 100466. CrossRef
Objective This study integrated a machine learning–based Score for Emergency Risk Prediction (SERP), developed using objective mortality endpoints, with the Patient Acuity Category Scale (PACS) and evaluated its effectiveness in clinical use.
Methods This single-center, retrospective cohort study included all emergency department (ED) patients from a large tertiary hospital between January 1, 2018, and December 31, 2019. Using a reclassification framework, SERP was incorporated into PACS to derive two enhanced triage models. PACS+ model 1 down-triaged patients with low predicted 30-day mortality risk and up-triaged those with high risk. PACS+ model 2 up-triaged only high-risk patients, whereas low-risk patients retained their original category. Predictive performance in the test cohort was assessed using the area under the receiver operating characteristic curve (AUC) and decision curve analysis.
Results The derivation cohort included 97,188 ED visits, and the test cohort included 97,212 ED visits. In the derivation set, the mean age of the patients was 58.97±18.41 years, and 47,993 (49.4%) were female. Overall, 19.9%, 57.4%, 22.5%, and 0.2% of patients were triaged to PACS categories P1–P4, respectively. The 30-day mortality rate was 2.8% in the derivation set and 2.7% in the test cohort. For 30-day mortality prediction, PACS+ model 1 (AUC, 0.828; 95% confidence interval [CI], 0.820–0.836) and PACS+ model 2 (AUC, 0.812; 95% CI, 0.805–0.818) outperformed PACS (AUC, 0.722; 95% CI, 0.714–0.729). PACS+ model 1 consistently achieved greater net benefit across the range of clinical thresholds.
Conclusion Integrating machine learning–based SERP with PACS improved 30-day mortality prediction in ED triage.
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Emergency Medicine Practice and Administration | Education & Simulation
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 Hyperkalemia is a potentially life-threatening condition among patients presenting to the emergency department (ED). However, most epidemiological studies have focused on those with end-stage renal disease (ESRD), and recent large-scale data on the incidence and management of hyperkalemia in non-ESRD ED patients remain limited. Methods This was a retrospective cohort study of adults (≥18 years) without ESRD who presented to the ED with hyperkalemia between January 1, 2016, and December 31, 2024. Patients were identified using ICD-10 codes from the Epic Cosmos database. The primary outcome was the incidence of hyperkalemia among all ED visits. Secondary outcomes included admission rates, cardiac arrest, hemodialysis, and administration of medications used to treat hyperkalemia. Data were analyzed using summary statistics and odds ratios with 95% confidence intervals. Results Among 246,235,769 ED visits, 803,186 (0.33%) had an ICD-10 code for hyperkalemia, and 539,033 (67.11%) of these patients were admitted to the hospital. Cardiac arrest occurred in 18,044 cases (2.25%). Sodium bicarbonate was administered in 38.75% of patients, calcium gluconate or chloride in 32.64%, sodium zirconium cyclosilicate in 24.68%, sodium polystyrene sulfonate in 23.12%, and patiromer in 3.04%. Only 2.99% received hemodialysis. Conclusion Among adult ED patients without ESRD, hyperkalemia was uncommon but clinically important, with two-thirds requiring admission and approximately 2% experiencing cardiac arrest. Sodium bicarbonate and calcium were frequently administered, while hemodialysis was rare.
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Treatment of Hyperkalemia-Induced-Cardiac-Arrest by Dynamic Electrocardiogram and Point-of-Care-testing Potassium: A Case Report Jiaozhen Chen, Jizhen Chen, Xinran Dang, Jiali Chen, Yusuo Chen, Yuanli Lei Clinical Medicine Insights: Case Reports.2026;[Epub] CrossRef
Objective Sepsis is a leading cause of acute kidney injury (sepsis-associated acute kidney injury, SA-AKI) and is associated with multiorgan failure, cardiovascular events, and increased mortality. While research has generally focused on critically ill patients in intensive care units (ICUs), most sepsis cases are managed outside the ICU. This study investigated renal dysfunction as an early risk marker in patients presenting to the emergency department (ED) with severe infection and at risk for early sepsis. Methods This post hoc analysis of patients presenting to the ED used data from the Acutelines cohort (2020–2023). Kaplan-Meier curves and univariable and multivariable Cox regression analyses were performed to assess the association between AKI and all-cause mortality, as well as in-hospital mortality and cardiovascular death, adjusting for potential confounders. Results In total, 2,045 patients presented with sepsis at the ED, of whom 246 (12%) had AKI. The overall mortality rate was 25% over a median follow-up of 346 days. AKI was associated with higher all-cause mortality (38% vs. 26%; P<0.001). After adjustment for sex, age, comorbidities, and sepsis severity, AKI remained independently associated with all-cause mortality (hazard ratio [HR], 1.44; 95% confidence interval [CI], 1.14–1.82; P=0.003), in-hospital mortality (HR, 1.65; 95% CI, 1.16–2.34; P=0.006), and cardiovascular death (HR, 2.50; 95% CI, 1.39–4.48; P=0.001). Similar outcomes were observed in a subanalysis excluding ICU patients. Conclusion SA-AKI at ED presentation is independently associated with increased all-cause, in-hospital, and cardiovascular mortality. These findings underscore the need for earlier recognition across care settings and the implementation of structured follow-up to improve patient outcomes.
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Machine Learning-Based Subtype Classification of Sepsis-Associated Acute Kidney Injury and Differential Responses to Renal Replacement Therapy Hongkun Zhang, Shengzhi Wang, Tao Zhang, Baisen Wang, Ziqi Jiang, Zhenqi Guo Journal of Intensive Care Medicine.2026;[Epub] CrossRef
Daun Jeong, Minyoung Choi, Seung Jin Maeng, Hanbeom Yoon, Jong Eun Park, Gun Tak Lee, Sung Yeon Hwang, Tae Gun Shin, Sung Phil Chung, Tae Ho Lim, on behalf of the Korean Shock Society
In Press, Received October 15, 2025 Accepted December 29, 2025 Available online January 14, 2026
Objective Sepsis remains a major clinical challenge because of its complex, heterogeneous, and multidimensional clustering patterns. This study aimed to investigate the association between vasopressor administration and machine learning–derived clusters based on initial vital signs and lactate measurements obtained in emergency department (ED) and intensive care unit (ICU) settings.
Methods A retrospective cohort analysis was performed using data from the Korean Shock Society Septic Shock (KOSS) Registry (septic shock in the ED) and the Marketplace for Medical Information in Intensive Care (MIMIC)-IV database (ICU patients with suspected infection). To derive clusters, k-means clustering was applied to six initial vital signs and serum lactate measurements. The primary outcome was vasopressor administration. Secondary outcomes included second vasopressor administration and 28-day mortality.
Results A total of 17,500 patients were included in the analysis (KOSS cohort, n=7,130; MIMIC-IV cohort, n=10,370). K-means clustering identified three distinct clusters in each cohort. In the KOSS cohort, Cluster 3 was characterized by the lowest mean arterial pressure (MAP) (62 mmHg [IQR, 53–71]) and the highest diastolic shock index (DSI) (2.6 [2.3–3.0]). This cluster was associated with the highest rates of vasopressor administration (93.9%), second vasopressor administration (33.5%), and 28-day mortality (25.3%) (all p<0.001). Comparable physiological and clinical patterns were observed in the MIMIC-IV cohort, in which Cluster 3 likewise demonstrated the lowest MAP (68 mmHg [60–76]) and highest DSI (2.0 [1.8–2.3]). This group similarly exhibited the poorest outcomes, including vasopressor administration (41.0%), second vasopressor administration (16.7%), and 28-day mortality (29.0%).
Conclusion Machine learning–derived clusters based on initial vital signs and serum lactate levels demonstrated different patterns of vasopressor use and mortality. The clinical utility of this approach for guiding timely or targeted vasopressor therapy requires prospective validation.
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Systematic Review
Emergency Medicine Practice and Administration | Public Health & Policy
Objective This study systematically reviews the causes, effects, and potential solutions to emergency department (ED) crowding, with emphasis on challenges amplified by the COVID-19 pandemic. Methods Following PRISMA guidelines, we searched MEDLINE, CINAHL, and the Web of Science for peer reviewed studies published from January 1, 2018, to January 31, 2025, that investigated ED crowding. Studies were included if they evaluated crowding causes, consequences, or interventions, using metrics such as ED length of stay, boarding, or left without being seen. Four reviewers independently screened titles, abstracts, and full texts. Study quality was assessed using the SIGN critical appraisal tools. This review was registered in PROSPERO (No. CRD420251117676). Results Of 23,408 studies identified, 226 met inclusion criteria. Most studies were retrospective (83%) and of low (62%) or acceptable (35%) quality. Crowding was primarily driven by input (high patient volumes, limited primary care access), throughput (staffing shortages, laboratory and imaging delays), and output (boarding, late discharges) factors. Adverse effects included increased mortality, treatment delays, prolonged inpatient stays, higher rates of patients leaving without being seen, and reduced patient satisfaction. Effective strategies included provider-in-triage, nurse-initiated orders, and split-flow models. Output-focused interventions, such as active bed management and early discharge protocols, required system-wide coordination. The COVID-19 pandemic shifted patient volumes and led to innovative solutions such as drivethrough clinics and repurposed spaces to alleviate surges. Conclusion ED crowding is a persistent global issue with significant clinical and operational consequences. While promising interventions exist, high-quality evidence remains limited, underscoring the need for system-level and multifaceted solutions.
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A Global and Local SHAP-Driven Interpretable Framework for Early Hospital Admission Prediction With Machine Learning at Emergency Department Triage Adam E Brown, Chance W Marostica, Nicole R Hodgson, Wayne A Martini Cureus.2026;[Epub] CrossRef
Crowding in real-time: an artificial intelligence-based model to manage crowding in the emergency department (CRAMMED Study) E. E. Schippers, S. P. Willemsen, L. A. M. Collée, K. L. M. Koenraadt, S. Schol-Gelok BMC Emergency Medicine.2026;[Epub] CrossRef
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.
Objective Abdominal pain is the most common emergency department (ED) chief complaint, with many patients experiencing recurrent episodes due to non–life-threatening etiologies such as disorders of gut-brain interaction. This pilot study aimed to characterize patients with recurrent low-risk abdominal pain, focusing on pain severity, management, biopsychosocial factors, opioid use, and 30-day return visits. Methods This prospective, observational pilot study enrolled adult ED patients with recurrent abdominal pain at a single academic center between July 2022 and June 2023. Inclusion required at least one similar episode in the prior year with symptom resolution between episodes. Exclusions included unstable clinical status or high-risk conditions. Patient-reported outcomes, social determinants of health, and clinical data were collected. Primary outcomes included pain severity, opioid use, and 30-day return visit rates. Results A total of 101 participants were enrolled (mean age, 43.7 years; 65.3% female; 69.3% Black). Pain severity was high (triage pain score, 7.1±2.6). Frequent prior computed tomography imaging was noted in 56.4% of participants. Opioids were administered in 50 participants (49.5%), while Patient-Reported Outcomes Measurement Information System (PROMIS)-29 scores highlighted risks of anxiety (T-score, 56.0±11.1) and pain interference (T-score, 60.8±8.2). Return visits occurred in 11 participants (10.9%) within 30 days. Conclusion In this pilot study, patients with recurrent low-risk abdominal pain showed high symptom burden and healthcare utilization. Targeted interventions addressing biopsychosocial factors and improving pain management are needed to reduce ED revisits and improve outcomes.
Objective Abdominal pain is one of the most common emergency department (ED) complaints, with many patients experiencing recurrent episodes due to cannabinoid hyperemesis syndrome (CHS), a syndrome characterized by pain and vomiting in the setting of chronic cannabis use. This pilot study aimed to demonstrate the ability to enroll patients with CHS, characterize patient-reported outcomes (PROs), and estimate 30-day revisit rates. Methods This prospective observational study enrolled adult ED patients with CHS at an academic center and community affiliate. The inclusion required a prior diagnosis of CHS and ED clinician judgment that symptoms at time of enrollment were likely due to CHS. Exclusions included unstable clinical status or other high-risk conditions. Primary outcomes included characterization of symptoms, assessment of multiple domains of PROs, measurement of the use of both computed tomography (CT) scans and opioid analgesia, and frequency of 30-day ED return visits. Results A total of 18 participants were enrolled (mean age, 34 years; 10 female patients, 55.6%). Automated chart reviews were completed for each outcome of interest at 30 days and at 12 months. Pain severity was high (mean triage pain score, 6.2±4.3) and prior CT imaging was noted in 13 patients (72.2%) in the past 5 years. Opioids were administered in four patients (22.2%), while the 29-Item Patient-Reported Outcome Measurement Information System (PROMIS-29) scores highlighted high risk of anxiety (mean T-score, 56.11±11.45) and how pain interfered with normal activities of living (mean T-score, 62.24±11.11). Return visits occurred in three patients (16.7%) within 30 days. Conclusion ED patients with CHS show a significant burden on PROs and high 30-day revisit rates. Future studies should consider interventions that address PROs and reduce ED revisits.
Objective Acute painful conditions are a common reason for emergency department (ED) referral, and a broad variety of analgesic drugs can be used. Among them, ketorolac is a nonsteroidal anti-inflammatory drug (NSAID) that has been increasingly used in the past two decades. To clarify the evidence for using ketorolac in EDs, a systematic review and meta-analysis was performed. Methods A search was performed in PubMed for English-language articles published on or before February 2023. Only randomized controlled trials in adult patients with acute painful conditions treated in an ED were selected. A meta-analysis was performed to evaluate the effectiveness of ketorolac in different pain conditions. Results Forty randomized controlled trials were selected, including studies focused on acute renal colic, headache, traumatic and nontraumatic musculoskeletal pain, and biliary colic. In these studies, ketorolac was mainly compared to opioids and showed a similar analgesic efficacy. On the other hand, ketorolac does not seem to have a stronger analgesic effect than other NSAIDs. Conclusion This systematic review indicates that ketorolac may be a valuable alternative to opioids for inducing analgesia in adult ED patients. This meta-analysis showed no significant difference in efficacy between ketorolac and other drugs. Nevertheless, the evidence comparing its efficacy with other common NSAIDs is sparse and should be further explored in future studies.
Objective We previously developed and validated an artificial intelligence-based electrocardiogram (ECG) analysis tool (ECG Buddy) in a Korean population. This study investigated the performance of this tool in a US population, specifically assessing the left ventricular (LV) dysfunction score and LV ejection fraction (LVEF)-ECG feature for predicting LVEF <40%. The study used N-terminal pro-B-type natriuretic peptide (NT-ProBNP) as a comparator.
Methods We identified emergency department (ED) visits from the MIMIC-IV dataset with information on LVEF <40% or ≥40% and matched 12-lead ECG data recorded within 48 hours of the ED visit. The performance of ECG Buddy’s LV dysfunction score and the LVEF-ECG feature was compared with those of NT-ProBNP using area under the receiver operating characteristic curve (AUC) analysis.
Results A total of 22,599 ED visits was analyzed. The LV dysfunction score had an AUC of 0.905 (95% confidence interval [CI], 0.899–0.910), with a sensitivity of 85.4% and specificity of 80.8%. The LVEF-ECG feature had an AUC of 0.908 (95% CI, 0.902–0.913), sensitivity of 83.5%, and specificity of 83.0%. NT-ProBNP had an AUC of 0.740 (95% CI, 0.727–0.752), with a sensitivity of 74.8% and specificity of 62.0%. The ECG-based predictors demonstrated superior diagnostic performance compared to NT-ProBNP (all P<0.001). In the sinus rhythm subgroup, the LV dysfunction score achieved an AUC of 0.913 and LVEF-ECG had an AUC of 0.917, both outperforming NT-ProBNP (AUC, 0.748; 95% CI, 0.732–0.763; all P<0.001).
Conclusion ECG Buddy demonstrated superior accuracy compared with NT-ProBNP in predicting LV systolic dysfunction, validating its utility in a US ED population.
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Objective This study used a nationwide database to identify and analyze factors that influence emergency department (ED) length of stay (LOS) and improve the efficiency of emergency care. Methods This retrospective study analyzed data from the National Emergency Department Information System (NEDIS) database in Korea: 25,578,263 ED visits from 2018 to 2022. Patient demographics, clinical characteristics, and ED operational variables were examined. Univariate and multivariate logistic regression analyses were used to assess the associations between the variables and prolonged ED LOS, defined as 6 hours or more. Results Among the 25,578,263 patients, the median ED LOS was 2.1 hours (interquartile range, 1.050–3.830 hours), with 12.6% experiencing a prolonged ED LOS. Elderly patients (aged ≥65 years) were significantly more likely than younger patients to experience prolonged ED LOS (adjusted odds ratio [aOR], 1.415; 95% confidence interval [CI]: 1.411–1.419). Patients transferred from other hospitals (aOR, 1.469; 95% CI, 1.463–1.474) and those arriving by emergency medical services (aOR, 1.093; 95% CI, 1.077–1.108) also had high odds of prolonged LOS. Conversely, pediatric patients had a low likelihood of extended stay (aOR, 0.682; 95% CI, 0.678–0.686). Severe illness, including sepsis (aOR, 1.324; 95% CI, 1.311–1.340) and COVID-19 infection (aOR, 1.413; 95% CI, 1.399–1.427), was strongly associated with prolonged LOS. Conclusion Prolonged ED LOS is influenced by a combination of patient demographics, clinical severity, and systemic factors. Targeted interventions for older adults, severe illness, and operational inefficiencies such as hospital transfers are essential for reducing ED LOS and improving overall emergency care delivery.
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Characteristics and clinical outcomes of cancer patients presenting to the emergency department in Korea: a retrospective descriptive study Hyun Bin Kim, Eun Ji Seo Journal of Korean Biological Nursing Science.2026; 28(1): 206. 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
Operational Challenges and Management Strategies Affecting Emergency Department Length of Stay: A Literature Review Vindy Vanessa Wennas Indonesian Journal of Innovation Multidisipliner Research.2026; 4(2): 5167. CrossRef
Patient and emergency department factors influencing surgery timing in patients with hip fracture Aejin Sung, Dong Hoon Kim, Dong-Hee Kim, Jin Hee Jeong Scientific Reports.2025;[Epub] CrossRef
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Christopher D. Yang, Christine K. Kim, Melissa M. Chang, Pooya Khosravi, Ajeet Pal Bayo Bhatia, Amanda dos Santos, Kyle Dornhofer, Megan Guy, Edmund Hsu, Soheil Saadat, John Christian Fox
Clin Exp Emerg Med 2025;12(3):188-197. Published online September 6, 2024
Objective To evaluate the current body of literature pertaining to the use of ocular point-of-care ultrasound (POCUS) in the emergency department (ED).
Methods A comprehensive literature search was conducted on Scopus, Web of Science, MEDLINE, and Cochrane Central Register of Controlled Trials (CENTRAL) databases. Inclusion criteria were studies written in English and primary clinical studies involving ocular POCUS scans in an ED setting. Exclusion criteria were nonprimary studies (e.g., reviews or case reports), studies written in a non-English language, nonhuman studies, studies performed in a nonemergency setting, studies involving non-POCUS ocular ultrasound modalities, or studies published more than 10 years prior. Data extraction was guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) recommendations.
Results The initial search yielded 391 results with 153 duplicates. Of the remaining 238 studies selected for retrieval and screening, 24 met the inclusion criteria. These 24 included studies encompassed 2,448 patients across prospective, retrospective, cross-sectional, and case series study designs. The majority of included studies focused on the use of POCUS in the ED to measure optic nerve sheath diameter as a proxy for papilledema and metabolic aberrations, while a minority of studies used ocular POCUS to assist in the diagnosis of orbital fractures or posterior segment pathology.
Conclusion The vast majority of studies investigating the use of ocular POCUS in recent years emphasize its utility in measuring optic nerve sheath diameter and fluctuations in intracranial pressure, though additional outcomes of interest include pathology of the posterior segment, orbit, and globe.
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Clin Exp Emerg Med 2025;12(2):148-155. Published online July 19, 2024
Objective Acute vestibular syndrome (AVS) is a common symptom experienced by emergency department (ED) patients. Differentiating a peripheral from central etiology poses a challenge, and clinical practice lacks a uniform diagnostic approach. This study aims to provide insight on incidence and diagnostics in ED patients presenting with AVS in the Netherlands.
Methods This was a multicenter retrospective cohort study of ED patients presenting with AVS in one of two hospitals during a 3-year period. The primary endpoints were incidence, diagnostics, and diagnosis at ED presentation versus follow-up. The secondary endpoint was type of therapy.
Results Among the 500 AVS cases included, the annual incidence was 0.1%. Eighty-five ED patients (17.0%) were diagnosed with stroke, 285 (57.0%) did not experience stroke, and 130 (26.0%) exhibited an unsure etiology. At follow-up, diagnosis was revised in 145 patients (29.0%), with stroke missed in 29 (5.8%). A triad of clinical tests (head impulse test, observation of nystagmus, test of skew; HINTS) was completed for 106 patients (21.2%), computed tomography (CT) scans were collected in 342 patients (68.4%), and magnetic resonance imaging scans were collected for 153 patients (30.6%). Antiplatelet therapy was prescribed in 135 cases. In 69% of these, the initial diagnosis was revised to no stroke. Among eight patients who received thrombolysis, the initial diagnosis was revised for three. Of those patients in whom stroke was initially not identified, 23 (79%) received suboptimal treatment in lieu of antiplatelet therapy.
Conclusion The annual incidence of AVS in this Dutch ED cohort is 0.1%. ED diagnosis is often uncertain, with one-third of diagnoses later revised. This study substantiates that clinical practice lacks a uniform diagnostic pathway, with an overuse of CT imaging and underuse of HINTS. Further research on an optimal diagnostic approach is warranted to improve treatment of AVS.
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Objective About one million United States emergency department (ED) visits annually are due to acute decompensated heart failure (ADHF) symptoms. Characterizing the presentation of ED symptoms among ADHF patients may improve clinical care; however, sex and age differences in ED chief complaints have not been thoroughly investigated. In this paper, we describe differences in chief complaints and comorbid conditions for ED patients with ADHF diagnoses, stratified by sex and age. Methods We conducted a retrospective analysis of adults presenting to North Carolina EDs using the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT), a statewide syndromic surveillance system, between 2010 and 2016, screening for patients with a diagnosis of ADHF. We evaluated frequencies of chief complaint categories for ED visits and comorbid conditions, stratified by sex and age, and computed standardized differences. Results The most common chief complaints were dyspnea (19.1%), chest pain (13.5%), and other respiratory complaints (13.4%). In the 18–44 years age group, women were more likely than men to report nausea/vomiting (6.7% vs. 4.1%) and headache (4.2% vs. 2.0%). In those 45–64 and ≥65 years, complaints were similar by sex. When stratified by age group alone, the 18–44 and 45–64 years age groups had more complaints of chest pain, whereas balance issues, weakness, and confusion were more common in the ≥65 years age group. Conclusion Differences in atypical ADHF symptoms were seen in in ED patients based on sex and age. Understanding the variation in ADHF symptoms among ED patients can facilitate the identification of ED patients with ADHF and improve management of ADHF-related symptoms.
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Chaemoon Lim, Jung-Hwan Oh, Jeong Rae Yoo, Seo Young Ko, Jeong Ho Kang, Sung Kgun Lee, Wooseong Jeong, Gil Myeong Seong, Hyun Jung Lee, Chul-Hoo Kang, Ji Hyun Moon, In-seok Son, Hyun Ju Yang, Min-su Oh, Sung Wook Song
Clin Exp Emerg Med 2025;12(1):56-65. Published online May 23, 2024
Objective This study aimed to investigate the characteristics and epidemiological trends of pediatric injuries among patients visiting emergency departments on Jeju Island, Korea. Methods Using a community-level serial cross-sectional analysis, we targeted pediatric patients 18 years or younger who visited emergency departments for injuries over a 10-year period. A comprehensive examination of injury characteristics and epidemiological trends was performed using the data sourced from the Jeju Injury Surveillance System. This included an evaluation of the annual incidence and overall trends in pediatric injury cases. Results The study found toddlers (42.5% of cases) to be the most frequently injured age group. Male patients were more prone to injuries, with a male to female ratio of 1.7:1. Injuries among visitors accounted for 17.3% of cases, with a seasonal spike in summer, evenings, and weekends. Most incidents occurred at home, were predominantly accidental in nature, with adolescents more likely to require emergency medical system services. The common mechanisms of injuries were blunt force (49.2%), slips/falls (22.0%), and motor vehicle collisions (13.2%), leading to bruises, cuts, and sprains. Over the decade, a general increase in pediatric injuries was observed. Accidental injuries initially surged but later stabilized; however, self-harm/suicide and assault/ violence injuries showed a concerning upward trend. Age-specific analysis revealed increasing trends in infants and adolescents. Conclusion The results of the present study underscore the crucial need for targeted injury prevention and resource allocation strategies, particularly for high-risk groups and time of injury, to effectively mitigate pediatric trauma on Jeju Island.
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Objective Chronic obstructive pulmonary disease (COPD) is associated with exacerbations and high risk of serious outcomes. Our goal was to determine the appropriateness of the emergency department (ED) management of COPD exacerbations.
Methods This observational cohort study incorporated a health records review and included COPD exacerbation cases seen at two large academic EDs. We included all patients with the primary diagnosis of COPD exacerbation. From the electronic medical record, demographic and clinical data were abstracted, and the Ottawa COPD Risk Score (OCRS) was calculated for each. Short-term serious outcomes included intensive care unit admission, intubation, myocardial infarction, noninvasive positive pressure ventilation (NIV), and death at 30 days. Cases were judged for appropriateness of treatment according to explicit indications and standards developed a priori.
Results We enrolled 500 cases with mean age of 71.9 years, 51.2% female patients, 50.2% admitted, and 4.4% death. The calculated OCRS score was >2 for 70.8% of patients. The treatments provided were inhaled β-agonists (82.6%), inhaled anticholinergics (76.6%), corticosteroids (75.2%), antibiotics (71.0%), oxygen (63.8%), NIV (8.8%), and intubation (0.6%). Overall, 50.0% of cases were judged to have had inadequate management due to missing treatments. Specifically, the proportion of missing treatments were inhaled β-agonist (17.0%), inhaled anticholinergic (22.6%), corticosteroids (24.4%), antibiotics (12.8%), and NIV (2.0%).
Conclusion Adequate treatment of COPD exacerbation was lacking in 50.0% of patients in these two large academic EDs. Concerning were the number of patients not receiving corticosteroids or antibiotics. Implementation of explicit treatment standards should lead to improved patient care of this common and serious condition.
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Objective Emergency department observation units (EDOUs) transition patients from the ED to dedicated areas where they can receive continuous monitoring. Understanding patient return visits after EDOU discharge is important for optimizing healthcare. The objective of this study was to investigate the correlations between demographic and clinical features and the likelihood of returning to the ED within 30 days following an initial EDOU assessment. Methods This retrospective, observational, cohort study of adult EDOU subjects was conducted between February 1, 2018, and January 31, 2023. Adult patients who were evaluated in an EDOU and returned to an ED within 30 days were compared with those who were assessed in the EDOU but did not return to the ED within 30 days. The analysis took into account multiple visits by the same subject and made adjustments for variables of sex, ethnicity, insurance status, primary diagnosis, and disposition using a generalized linear mixed model. Results A total of 14,910 EDOU encounters was analyzed, and 2,252 patients (15%) returned to the ED within 30 days. The analysis took into account several variables that indicated a significant association with the likelihood of returning to the ED within 30 days. These were sex (P<0.001), ethnicity (P=0.005), race (P<0.001), insurance status (P<0.001), primary diagnosis (P<0.001), and disposition (P<0.001). Emergency severity index and length of stay were not associated with ED return. Conclusion Understanding these factors may guide interventions, enhance EDOU care, and reduce resource strain. Further research should explore these associations and the long-term intervention impacts on improved outcomes.
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Objective Emergency care systems worldwide have been significantly affected by the COVID-19 pandemic. This study investigated the trend of emergency department (ED) visits for emergency care–sensitive conditions (ECSCs) in Korea before and during the pandemic. Methods We performed a longitudinal study using the national ED database in Korea from January 2019 to December 2021. We calculated the number and incidence rate of visits for ECSCs per 100,000 ED visits, and the incidence rate ratio of 2021 relative to the value in 2019. The selected ECSCs were intracranial injury, ischemic heart disease, stroke, and cardiac arrest. Results The number of ED visits for all causes decreased by about 23% during the pandemic. The number of ED visits for intracranial injuries decreased from 166,695 in 2019 to 133,226 in 2020 and then increased to 145,165 in 2021. The number of ED visits for ischemic heart disease and stroke decreased in 2020 but increased to 2019 levels in 2021. In contrast, the number of ED visits for cardiac arrest increased from 23,903 in 2019 to 24,344 in 2020 and to 27,027 in 2021. The incidence rate and incidence rate ratio of these four ECSCs increased from 2019 to 2021, suggesting increasing relative proportions of ECSCs in total ED visits. Conclusion During the COVID-19 pandemic, the number of cardiac arrests seen in the EDs increased, but that of other ECSCs decreased. The decrease in ED visits for ECSCs was not as pronounced as the decrease in ED visits for all causes during the pandemic. Further studies are needed to determine clinical outcomes in patients with ECSC during the pandemic.
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Objective This study investigated the associations between paraspinal muscle measurements on chest computed tomography and clinical outcomes of elderly patients with community-acquired pneumonia (CAP). Methods This single-center, retrospective, observational study analyzed elderly patients (≥65 years) with CAP hospitalized through an emergency department between March 2020 and December 2022. We collected their baseline characteristics and laboratory data at the time of admission. The paraspinal muscle index and attenuation were calculated at the level of the 12th thoracic vertebra using chest computed tomography taken within 48 hours before or after admission. Univariable and multivariable logistic regression analyses were conducted to evaluate the association between paraspinal muscle measurements and 28-day mortality. Receiver operating characteristic (ROC) curve and area under the curve (AUC) analyses were used to evaluate the prognostic predictive power. Results Of the 338 enrolled patients, 60 (17.8%) died within 28 days after admission. A high paraspinal muscle index was associated with low 28-day mortality in elderly patients with CAP (adjusted odds ratio, 0.994; 95% confidence interval, 0.992–0.997). The area under the ROC curve for the muscle index was 0.75, which outperformed the pneumonia severity index and the CURB-65 (confusion, urea, respiratory rate, blood pressure, age ≥65 years) metric, both of which showed an AUC of 0.64 in predicting mortality. Conclusion A high paraspinal muscle index was associated with low 28-day mortality in patients aged 65 years or older with CAP.
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Objective Emergency department (ED) triage systems are used to classify the severity and urgency of emergency patients, and Korean medical institutions use the Korean Triage and Acuity Scale (KTAS). During the COVID-19 pandemic, appropriate treatment for emergency patients was delayed due to various circumstances, such as overcrowding of EDs, lack of medical workforce resources, and increased workload on medical staff. The purpose of this study was to evaluate the accuracy of the KTAS in predicting the urgency of emergency patients during the COVID-19 pandemic. Methods This study retrospectively reviewed patients who were treated in the ED during the pandemic period from January 2020 to June 2021. Patients were divided into COVID-19–screening negative (SN) and COVID-19–screening positive (SP) groups. We compared the predictability of the KTAS for urgent patients between the two groups. Results From a total of 107,480 patients, 62,776 patients (58.4%) were included in the SN group and 44,704 (41.6%) were included in the SP group. The odds ratios for severity variables at each KTAS level revealed a more evident discriminatory power of the KTAS for severity variables in the SN group (P<0.001). The predictability of the KTAS for severity variables was higher in the SN group than in the SP group (area under the curve, P<0.001). Conclusion During the pandemic, the KTAS had low accuracy in predicting patients in critical condition in the ED. Therefore, in future pandemic periods, supplementation of the current ED triage system should be considered in order to accurately classify the severity of patients.
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Symptomatic urolithiasis is a common cause of emergency department visits, with noncontrast computed tomography considered the imaging gold standard. According to the current guidelines, point-of-care ultrasound (POCUS) is limited to evaluating hydronephrosis as a secondary sign of acute ureteral stones. However, the use of POCUS to detect ureteral stones may lead to decreased radiation to the patient and a more rapid diagnosis. This case series describes 10 patients with suspected symptomatic urolithiasis who were diagnosed accurately by emergency physicians using POCUS to detect obstructive ureteral stones. In three of the cases, POCUS significantly changed the patient’s management. This article also describes the proper techniques for the emergency physician to learn to master POCUS for ureteral stone detection.
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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 With general aging of the population, emergency department (ED) utilization by elderly patients is increasing. In this study, we analyzed data on ED visits of patients aged 65 years and older in Korea.
Methods The study is a retrospective analysis of National Emergency Department Information System (NEDIS) data from 2018–2022, focusing on patients aged 65 years and older who visited EDs across Korea. ED utilization data were analyzed using Korean Triage and Acuity Scale (KTAS) scores. The patients were divided into three age groups, and common chief complaints and diagnoses were identified. Age- and sex-standardized ED visits per 100,000 population and outcomes were also analyzed.
Results During the study period, there was a total of 9,803,065 elderly patient ED visits. The mean patient age was 76.4±7.6 years, and 47.6% were men. The ED mortality rate and in-hospital mortality rate were 1.8% and 4.6%, respectively. The KTAS scores 1–2 group accounted for 11.0% of patients, KTAS score 3 group for 42.5%, KTAS scores 4–5 group for 37.2%, and KTAS score unknown group for 9.4%. When patients were categorized into three age groups, the oldest group exhibited the highest rates of KTAS score 1, severe illness diagnoses, and mortality. The most frequently reported chief complaint was abdominal pain, and the most common diagnosis was light headedness. When analyzing the data by year, the COVID-19 outbreak had a discernible impact on ED visits and clinical outcomes.
Conclusion Over the past 5 years, ED visits for elderly patients have averaged 26,050 per 100,000 population per year, with a temporary decline during the COVID-19 pandemic and a subsequent upward trend.
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