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"Mortality"

Original Articles

Critical Care

Renal dysfunction as a marker of adverse outcomes in early sepsis in the emergency department
Tamar J. van der Aart, Jan C. ter Maaten, Raymond J. van Wijk, Stephan J.L. Bakker, Hjalmar R. Bouma, Marco van Londen
Clin Exp Emerg Med 2026;13(2):178-187.   Published online January 28, 2026
DOI: https://doi.org/10.15441/ceem.25.136

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Renal dysfunction as a marker of adverse outcomes in early sepsis in the emergency department
Clin Exp Emerg Med. 2026;13(2):178-187.   Published online January 28, 2026
DOI: https://doi.org/10.15441/ceem.25.136
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Renal dysfunction as a marker of adverse outcomes in early sepsis in the emergency department
Clin Exp Emerg Med. 2026;13(2):178-187.   Published online January 28, 2026
DOI: https://doi.org/10.15441/ceem.25.136
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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.
  • 1,126 View
  • 43 Download

Trauma

Impact of concomitant injuries on clinical outcomes in patients with isolated versus non-isolated traumatic brain injury
Kyung Won Park, Sung Wook Song, Woo Jeong Kim, Jeong Ho Kang, Ji Hwan Bu, Sung Kgun Lee, Seo Young Ko, Soo Hoon Lee, Chang Bae Park, Jin Gu Lee, Jong Yeon Kang, Jaeyoon Ha, Jiwon Kim
Clin Exp Emerg Med 2025;12(4):358-368.   Published online January 15, 2025
DOI: https://doi.org/10.15441/ceem.24.331

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Impact of concomitant injuries on clinical outcomes in patients with isolated versus non-isolated traumatic brain injury
Clin Exp Emerg Med. 2025;12(4):358-368.   Published online January 15, 2025
DOI: https://doi.org/10.15441/ceem.24.331
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Impact of concomitant injuries on clinical outcomes in patients with isolated versus non-isolated traumatic brain injury
Clin Exp Emerg Med. 2025;12(4):358-368.   Published online January 15, 2025
DOI: https://doi.org/10.15441/ceem.24.331
Close
Objective
Traumatic brain injury (TBI) often occurs alongside injuries to other body regions, worsening patient outcomes. This study evaluates the impact of concomitant injuries on clinical outcomes in patients with isolated versus non-isolated TBI.
Methods
This retrospective cross-sectional analysis was conducted using data from the Emergency Department-based Injury In-depth Surveillance (EDIIS) for 180,058 TBI patients admitted to 23 tertiary hospitals from January 1, 2020, to December 31, 2022. Patients were categorized into isolated TBI group (iTBI; n=127,673) and non-isolated TBI group (niTBI; n=52,385) based on injury diagnostic codes. Clinical outcomes—24-hour and 30-day mortality, hospital admission, and interhospital transfer—were compared. Multivariate logistic regression analyses adjusted for potential confounders were performed.
Results
The niTBI patients exhibited significantly higher 24-hour mortality (1.5% vs. 0.4%), 30-day mortality (2.6% vs. 1.0%), hospital admissions (24.5% vs. 8.4%), and interhospital transfers (3.6% vs. 1.1%) than iTBI patients (all P<0.001). Concomitant injuries increased the adjusted odds of 24-hour mortality (adjusted odds ratio [aOR], 1.456; 95% confidence interval [CI], 1.286–1.648) and 30-day mortality (aOR, 1.111; 95% CI, 1.022–1.208). Thoracic injuries were the most significant predictor of adverse outcomes in niTBI patients, increasing the odds of 24-hour mortality by nearly sixfold (aOR, 5.958; 95% CI 5.057–7.019).
Conclusions
Concomitant injuries significantly worsen clinical outcomes in TBI patients, with thoracic injuries being the most critical predictor of mortality. These findings highlight the importance of comprehensive trauma assessments and targeted prevention strategies to improve survival rates and optimize resource allocation for patients with multiple injuries.
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  • 115 Download

Cardiovascular

Derivation and validation of a simple prognostic risk score to predict short-term mortality in acute cardiogenic pulmonary edema: the SABIHA score
Kenan Toprak, Mustafa Kaplangöray, Mesut Karataş, Zuhal Fatma Cellat, Yakup Arğa, Rüstem Yılmaz, Mustafa Begenc Tascanov, Asuman Biçer
Clin Exp Emerg Med 2025;12(3):223-234.   Published online January 15, 2025
DOI: https://doi.org/10.15441/ceem.24.314

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Derivation and validation of a simple prognostic risk score to predict short-term mortality in acute cardiogenic pulmonary edema: the SABIHA score
Clin Exp Emerg Med. 2025;12(3):223-234.   Published online January 15, 2025
DOI: https://doi.org/10.15441/ceem.24.314
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Derivation and validation of a simple prognostic risk score to predict short-term mortality in acute cardiogenic pulmonary edema: the SABIHA score
Clin Exp Emerg Med. 2025;12(3):223-234.   Published online January 15, 2025
DOI: https://doi.org/10.15441/ceem.24.314
Close
Objective
Acute cardiogenic pulmonary edema (ACPE) is a frequently encountered medical emergency associated with high early mortality rates, but existing tools to predict short-term outcomes for risk stratification have several limitations. Our aim was to derive and validate a simple clinical scoring system using baseline vital signs, clinical and presenting characteristics, and readily available laboratory tests for accurate prediction of short-term mortality in individuals experiencing ACPE.
Methods
This retrospective cohort study comprised 1,088 patients with ACPE from six health centers. Subjects were randomly allocated into derivation and validation cohorts at a 4:3 ratio for comprehensive examination and validation of the prognostic model. Independent predictors of mortality (P<0.05) from the multivariable model were included in the risk score. Discriminant ability of the model was tested by receiver operating characteristic analysis.
Results
In the derivation cohort (623 patients), age, blood urea nitrogen, heart rate, intubation, anemia, and systolic blood pressure were identified as independent predictors of mortality in multivariable analysis. These variables were used to develop a risk score ranging from 0 to 6 by scoring each of these factors as 0 or 1. The SABIHA (systolic blood pressure, age, blood urea nitrogen, invasive mechanical ventilation requirement, heart rate, and anemia) score provided good calibration with a concordance index of 0.879 (95% confidence interval, 0.821–0.937). While the probability of short-term mortality was 80.0% in the high-risk group, this rate was only 3.3% in the low-risk group. The SABIHA score also performed well on the validation set.
Conclusion
A simple clinical score consisting of routinely obtained variables can be used to predict short-term outcomes in patients with ACPE.
  • 4,691 View
  • 199 Download

Review Article

Toxicology

A narrative review of contemporary lethal pesticides: unveiling the ongoing threat of pesticide poisoning
Sangchun Choi, Gi Woon Kim, Hoon Lim
Clin Exp Emerg Med 2024;11(4):335-348.   Published online January 29, 2024
DOI: https://doi.org/10.15441/ceem.23.167

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A narrative review of contemporary lethal pesticides: unveiling the ongoing threat of pesticide poisoning
Clin Exp Emerg Med. 2024;11(4):335-348.   Published online January 29, 2024
DOI: https://doi.org/10.15441/ceem.23.167
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A narrative review of contemporary lethal pesticides: unveiling the ongoing threat of pesticide poisoning
Clin Exp Emerg Med. 2024;11(4):335-348.   Published online January 29, 2024
DOI: https://doi.org/10.15441/ceem.23.167
Close
Following the 2011 ban on paraquat sales, Korea has witnessed a significant reduction in the mortality rate associated with acute pesticide poisoning. Traditionally, paraquat and diquat, alongside several highly toxic organophosphates, carbamates, and organochlorine insecticides, have been recognized as culprits in causing fatalities among patients with acute pesticide poisoning. However, despite global efforts to curtail the use of these highly toxic pesticides, certain pesticides still exhibit a level of lethality surpassing their established clinical toxicity profiles. Understanding the clinical progression of these pesticides is paramount for physicians and toxicologists, as it holds the potential to enhance patient prognoses in cases of acute poisoning. This review aims to address the persistence of such highly lethal pesticides, which continue to pose a grave threat to victims of acute poisoning.

Citations

Citations to this article as recorded by  Crossref logo
  • Diagnostic challenges in surfactant poisoning: A case of dishwashing detergent ingestion in a dementia patient
    Ayaka Suzuki, Yoshihiro Aoki, Kensuke Takahashi, Shuhei Yamano, Koichi Hayakawa, Osamu Tasaki
    Journal of Family Medicine and Primary Care.2026; 15(3): 1421.     CrossRef
  • Microalgae as a multifunctional solution for sustainable agriculture: Starting with soil improvement
    Yuxin Wang, Zhongfei Zhang, Huixing Liu, Shufang Yang, Han Sun, Yingman Zhang, Yifeng Zhang
    Resources, Conservation & Recycling Advances.2026; 30: 200343.     CrossRef
  • Environmental dynamics of pesticides: sources, impacts on amphibians, nanoparticles, and endophytic microorganism remediation
    Meesala Krishna Murthy
    Environmental Science and Pollution Research.2025; 32(13): 7860.     CrossRef
  • Burden of non-CO poisoning in 204 countries and territories, 1990–2021: results from the global burden of disease study 2021
    Rong Lei, Chaofu Yue, Feng Yue, Hong Gao, Xing He, Qinyong Yan, Zhigang Yang, Wei Bao, Caimei Hu, Qingsong Ma, Mei Yang
    Frontiers in Public Health.2025;[Epub]     CrossRef
  • Tubulointerstitial injury and renal outcome after minimum lethal dose of diquat intoxication
    ZhiPeng Zhao, ShuLing Yue, Jie Feng, HongRui Cui, LiJun Sun, Guang Yang, LiHong Zhang, Tao Wang
    International Urology and Nephrology.2024; 56(10): 3411.     CrossRef
  • 15,062 View
  • 214 Download
  • 4 Web of Science
  • 5 Crossref

Original Article

Critical Care

Comparison of modified quick Sequential Organ Failure Assessment models as triage tools for febrile patients
Dong-Young Lee, Seung Ryu, So-Young Jeon, Jung-Soo Park, Yeon-Ho You, Won-Joon Jeong, Yong-Chul Cho, Hong-Joon Ahn, Chang-Shin Kang, Se-Kwang Oh
Clin Exp Emerg Med 2024;11(3):286-294.   Published online January 29, 2024
DOI: https://doi.org/10.15441/ceem.23.125

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Comparison of modified quick Sequential Organ Failure Assessment models as triage tools for febrile patients
Clin Exp Emerg Med. 2024;11(3):286-294.   Published online January 29, 2024
DOI: https://doi.org/10.15441/ceem.23.125
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Comparison of modified quick Sequential Organ Failure Assessment models as triage tools for febrile patients
Clin Exp Emerg Med. 2024;11(3):286-294.   Published online January 29, 2024
DOI: https://doi.org/10.15441/ceem.23.125
Close
Objective
Effective triage of febrile patients in the emergency department is crucial during times of overcrowding to prioritize care and allocate resources, especially during pandemics. However, available triage tools often require laboratory data and lack accuracy. We aimed to develop a simple and accurate triage tool for febrile patients by modifying the quick Sequential Organ Failure Assessment (qSOFA) score.
Methods
We retrospectively analyzed data from 7,303 febrile patients and created modified versions of qSOFA using factors identified through multivariable analysis. The performance of these modified qSOFAs in predicting in-hospital mortality and intensive care unit (ICU) admission was compared using the area under the receiver operating characteristic curve (AUROC).
Results
Through multivariable analysis, the identified factors were age (“A” factor), male sex (“M” factor), oxygen saturation measured by pulse oximetry (SpO2; “S” factor), and lactate level (“L” factor). The AUROCs of ASqSOFA (in-hospital mortality: 0.812 [95% confidence interval, 0.789–0.835]; ICU admission: 0.794 [95% confidence interval, 0.771–0.817]) were simple and not inferior to those of other more complex models (e.g., ASMqSOFA, ASLqSOFA, and ASMLqSOFA). ASqSOFA also displayed significantly higher AUROC than other triage scales, such as the Modified Early Warning Score and Korean Triage and Acuity Scale. The optimal cutoff score of ASqSOFA for the outcome was 2, and the score for redistribution to a lower level emergency department was 0.
Conclusion
We demonstrated that ASqSOFA can be employed as a simple and efficient triage tool for emergency febrile patients to aid in resource distribution during overcrowding. It also may be applicable in prehospital settings for febrile patient triage.

Citations

Citations to this article as recorded by  Crossref logo
  • Development and validation of a bacteremia prediction score for adult emergency department patients using hybrid machine learning and regression
    Minha Kim, Min Joon Seo, Jong Eun Park, Minyoung Choi, Hansol Chang, Sejin Heo, Seung Jin Maeng, Gun Tak Lee, Sung Yeon Hwang, Sejoong Ahn, Tae Gun Shin
    Scientific Reports.2026;[Epub]     CrossRef
  • 7,290 View
  • 105 Download
  • 1 Web of Science
  • 1 Crossref

Systematic Reviews

Trauma | COVID-19

The impact of COVID-19 on mortality in trauma patients undergoing orthopedic surgery: a systematic review and meta-analysis
Husna Dharma Putera, Valentina Halim, Roselina Panghiyangani
Clin Exp Emerg Med 2023;10(3):315-326.   Published online May 15, 2023
DOI: https://doi.org/10.15441/ceem.22.403

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The impact of COVID-19 on mortality in trauma patients undergoing orthopedic surgery: a systematic review and meta-analysis
Clin Exp Emerg Med. 2023;10(3):315-326.   Published online May 15, 2023
DOI: https://doi.org/10.15441/ceem.22.403
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The impact of COVID-19 on mortality in trauma patients undergoing orthopedic surgery: a systematic review and meta-analysis
Clin Exp Emerg Med. 2023;10(3):315-326.   Published online May 15, 2023
DOI: https://doi.org/10.15441/ceem.22.403
Close
Objective
The global spread of the COVID-19 pandemic has affected all aspects of medicine, including orthopedic trauma surgery. This study aims to investigate whether COVID-19 patients who underwent orthopedic surgery trauma had a higher risk of postoperative mortality.
Methods
ScienceDirect, the Cochrane COVID-19 Study Register, and MEDLINE were searched for original publications. This study adhered to the PPRISMA 2020 statement. The validity of the studies was evaluated using a checklist developed by the Joanna Briggs Institute. Study and participant characteristics, as well as the odds ratio, were extracted from selected publications. Data were analyzed using RevMan ver. 5.4.1.
Results
After applying the inclusion and exclusion criteria, 16 articles among 717 total were deemed eligible for analysis. Lower-extremity injuries were the most common condition, and pelvic surgery was the most frequently performed intervention. There were 456 COVID-19 patients (6.12%) and 134 deaths among COVID-19 patients, revealing an increase in mortality (29.38% vs. 5.30%; odds ratio, 7.72; 95% confidence interval, 6.01–9.93; P<0.001).
Conclusion
Among COVID-19 patients who received orthopedic surgery due to trauma, the postoperative death rate increased by 7.72 times.

Citations

Citations to this article as recorded by  Crossref logo
  • 2025 ICM: Risk Factors for Surgical Site Infection (SSI)/Periprosthetic Joint Infection (PJI)
    Nathanael Heckmann, Amir Human Hoveidaei, Seyed Mohammad Javad Mortazavi, Sayid Omar Ahmed, Mohammadali Enayatollahi, Arash Aali Rezaie, Mauro J. Salles, Azlina Amir Abbas, Vinay K. Aggarwal, Derek F. Amanatullah, Bülent Atilla, Wael Barsoum, Natividad Be
    The Journal of Arthroplasty.2025; 41(1): S6.     CrossRef
  • The impact of pulmonary tuberculosis on SARS-CoV-2 infection: a nationwide cohort study
    Sang Hwan Lee, Yun Jin Kim, Jaehoon Oh, Hyunggoo Kang, Kyung Hun Yoo, Byuk Sung Ko, Tae Ho Lim, Bo-Guen Kim, Hyun Lee, Sang-Heon Kim, Jang Won Sohn, Ho Joo Yoon, Hayoung Choi, Yongil Cho, Dong Won Park
    Frontiers in Medicine.2024;[Epub]     CrossRef
  • 6,519 View
  • 143 Download
  • 2 Web of Science
  • 2 Crossref

Critical Care

Mortality among adult patients with sepsis and septic shock in Korea: a systematic review and meta-analysis
Myeong Namgung, Chiwon Ahn, Yeonkyung Park, Il-Youp Kwak, Jungguk Lee, Moonho Won
Clin Exp Emerg Med 2023;10(2):157-171.   Published online March 7, 2023
DOI: https://doi.org/10.15441/ceem.23.005

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Mortality among adult patients with sepsis and septic shock in Korea: a systematic review and meta-analysis
Clin Exp Emerg Med. 2023;10(2):157-171.   Published online March 7, 2023
DOI: https://doi.org/10.15441/ceem.23.005
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Mortality among adult patients with sepsis and septic shock in Korea: a systematic review and meta-analysis
Clin Exp Emerg Med. 2023;10(2):157-171.   Published online March 7, 2023
DOI: https://doi.org/10.15441/ceem.23.005
Close
Objective
To evaluate mortality from sepsis and septic shock in Korea during the past 10 years, we conducted a systematic review and meta-analysis.
Methods
We searched six databases for studies on mortality from sepsis and septic shock in adult patients. Primary outcomes were 28- or 30-day mortality and in-hospital mortality from sepsis and septic shock. To assess the risk of bias, we used the Newcastle-Ottawa Scale and Risk of Bias 2 tools. The protocol is registered in PROSPERO (No. CRD42022365739).
Results
A total of 61 studies were included. The mortality rates from sepsis and septic shock at 28 or 30 days were 22.7% (95% confidence interval [CI], 20.0%–25.6%; I2=89%) and 27.6% (95% CI, 22.3%–33.5%; I2=98%), respectively, according to the Sepsis-3 criteria. Furthermore, in accordance with the Sepsis-3 criteria, the in-hospital mortality rates were 28.1% (95% CI, 25.2%–31.1%; I2=87%) and 34.3% (95% CI, 27.2%–42.2%; I2=97%), respectively.
Conclusion
The mortality rates from sepsis and septic shock in Korea are high. In the case of septic shock, the in-hospital mortality rate is approximately 30%.

Citations

Citations to this article as recorded by  Crossref logo
  • Red Blood Cell Transfusion Beyond Restrictive Thresholds in Patients With Septic Shock and an Elevated Lactate Level: A Multicenter Observational Study
    Kyung Hun Yoo, Gil Joon Suh, Woon Yong Kwon, Sung-Hyuk Choi, Sung Phil Chung, Won Young Kim, Kyuseok Kim, Yoo Seok Park, Tae Gun Shin, Byuk Sung Ko, Tae Ho Lim, Yongil Cho
    Journal of Korean Medical Science.2026;[Epub]     CrossRef
  • Free Thyroxine as a Predictor of Mortality in Critically Ill Septic Patients—A Retrospective Study
    Matei Florin Negruț, Vlad Pastor, Robert Bolcaș, Oana Antal, Robert Szabo, Cristina Petrișor
    Diagnostics.2026; 16(5): 680.     CrossRef
  • Comparison of prognosis in emergency department elderly septic shock patients with initial hypotension versus delayed hypotension
    Chaeeun Lee, Gil Joon Suh, Sung-Hyuk Choi, Sung Phil Chung, Won Young Kim, Tae Ho Lim, Sangchun Choi, Tae Gun Shin, Sangun Nah, Sangsoo Han
    European Journal of Emergency Medicine.2026; 33(3): 169.     CrossRef
  • Clinical Profiles, Interventions, and Outcomes of Sepsis and Septic Shock in a Saudi Arabian Tertiary ICU: A Five-Year Retrospective Analysis
    Amer Asiri, Khaled Abdulwahab Amer, Mushary Alqahtani, Lena A. Almathami, Osama Ayed Asiri, Sultan Saad Alnasser, Ahmed Ali Khuzayyim, Bander Abdullah Alqahtani, Fatimah Mohammed Asiri, Hatem Mostafa Asiri
    Healthcare.2026; 14(5): 680.     CrossRef
  • Papaverine Mitigates Acute Kidney Injury in Feces-Induced Polymicrobial Sepsis Through Regulation of the HMGB1–RAGE Axis
    Mehmet Fatih Dasiran, Ahmet Akbaş, Bakiye Akbaş, Ejder Saylav Bora, Hatice Aygun, Oytun Erbas
    Medicina.2026; 62(4): 621.     CrossRef
  • Knowledge, attitudes, and practices of pre-hospital emergency medical care practitioners regarding sepsis recognition: a cross-sectional study in Qatar
    Michael Steven Paul Lewis, Paula J. W. Smith, Ian Lucas Howard, Hassan Farhat, Guillaume Alinier
    BMC Emergency Medicine.2026;[Epub]     CrossRef
  • Outcomes and risk factors in HIV-positive patients with sepsis: a retrospective study
    Qiang Gao, Tingting Wang, Shun Tan, Yu Tian, An Zhang
    European Journal of Medical Research.2025;[Epub]     CrossRef
  • Prognostic Value of the AST/ALT Ratio in Patients with Septic Shock: A Prospective, Multicenter, Registry-Based Observational Study
    Sungwoo Choi, Sangun Nah, Gil Joon Suh, Sung-Hyuk Choi, Sung Phil Chung, Won Young Kim, Tae Ho Lim, Sangchun Choi, Tae Gun Shin, Sangsoo Han
    Diagnostics.2025; 15(14): 1773.     CrossRef
  • Epidemiology and outcomes of septic shock in Japan: a nationwide retrospective cohort study from a medical claims database by the Japan Sepsis Alliance (JaSA) study group
    Taro Imaeda, Takehiko Oami, Tatsuro Yokoyama, Satoshi Nakagawa, Hiroshi Ogura, Nobuaki Shime, Yutaka Umemura, Asako Matsushima, Kiyohide Fushimi, Taka-aki Nakada
    Critical Care.2025;[Epub]     CrossRef
  • Epidemiology of sepsis in emergency departments: insights from the National Emergency Department Information System (NEDIS) database in Korea, 2018–2022
    Tae Gun Shin, Eunsil Ko, So-hyun Han, Taehui Kim, Dai Hai Choi
    Clinical and Experimental Emergency Medicine.2025; 12(3): 185.     CrossRef
  • Predicting septic shock in patients with sepsis at emergency department triage using systolic and diastolic shock index
    Yumin Jeon, Sungjin Kim, Sejoong Ahn, Jong-Hak Park, Hanjin Cho, Sungwoo Moon, Sukyo Lee
    The American Journal of Emergency Medicine.2024; 78: 196.     CrossRef
  • An observational study on the impact of overcrowding towards door-to-antibiotic time among sepsis patients presented to emergency department of a tertiary academic hospital
    Evelyn Yi Wen Chau, Afliza Abu Bakar, Aireen Binti Zamhot, Ida Zarina Zaini, Siti Norafida Binti Adanan, Dazlin Masdiana Binti Sabardin
    BMC Emergency Medicine.2024;[Epub]     CrossRef
  • Ischemia-Modified Albumin, Lactate, and Combination for Predicting Mortality in Patients with Septic Shock in the Emergency Department
    Bo-Yeong Jin, Sukyo Lee, Woosik Kim, Jong-Hak Park, Hanjin Cho, Sungwoo Moon, Sejoong Ahn
    Biomedicines.2024; 12(7): 1421.     CrossRef
  • Temperature trajectories and mortality in hypothermic sepsis patients
    Dongkwan Han, Seung Hyun Kang, Young Woo Um, Hee Eun Kim, Ji Eun Hwang, Jae Hyuk Lee, You Hwan Jo, Yoon Sun Jung, Hui Jai Lee
    The American Journal of Emergency Medicine.2024; 84: 18.     CrossRef
  • Comparison of Early and Late Norepinephrine Administration in Patients With Septic Shock
    Chiwon Ahn, Gina Yu, Tae Gun Shin, Youngsuk Cho, Sunghoon Park, Gee Young Suh
    CHEST.2024; 166(6): 1417.     CrossRef
  • Diagnostic Accuracy of Plasma Renin Concentration and Renin Activity in Predicting Mortality and Kidney Outcomes in Patients With Septic Shock and Hypoperfusion or Hypotension: A Multicenter, Prospective, Observational Study
    Gun Tak Lee, Byuk Sung Ko, Da Seul Kim, Minha Kim, Jong Eun Park, Sung Yeon Hwang, Daun Jeong, Chi Ryang Chung, Hyunggoo Kang, Jaehoon Oh, Tae Ho Lim, Bora Chae, Won Young Kim, Tae Gun Shin
    Annals of Laboratory Medicine.2024; 44(6): 497.     CrossRef
  • The mortality of patients with sepsis increases in the first month of a new academic year
    Sukyo Lee, Sungjin Kim, Sejoong Ahn, Hanjin Cho, Sungwoo Moon, Young Duck Cho, Jong-Hak Park
    Clinical and Experimental Emergency Medicine.2024; 11(2): 161.     CrossRef
  • Efficacy of neutrophil-lymphocyte ratio, serum lactate, and lactate clearance in predicting mortality in patients with sepsis admitted to a tertiary care hospital: A prospective observational study
    Shiv Akshat, Avishek Roy, Vinay Gandhi Mukkelli, Rahul Kumar Anand, Dalim Kumar Baidya, Bikash Ranjan Ray, Manish Soneja, Lokesh Kashyap, Puneet Khanna, Praveen Aggarwal
    Indian Journal of Medical Sciences.2024; 77: 85.     CrossRef
  • Early management of adult sepsis and septic shock: Korean clinical practice guidelines
    Chul Park, Nam Su Ku, Dae Won Park, Joo Hyun Park, Tae Sun Ha, Do Wan Kim, So Young Park, Youjin Chang, Kwang Wook Jo, Moon Seong Baek, Yijun Seo, Tae Gun Shin, Gina Yu, Jongmin Lee, Yong Jun Choi, Ji Young Jang, Yun Tae Jung, Inseok Jeong, Hwa Jin Cho, A
    Acute and Critical Care.2024; 39(4): 445.     CrossRef
  • Nutritional support for sepsis: is there a single concept?
    I.N. Pasechnik, A.A. Shchuchko, M.S. Kurochkin, T.V. Novikova
    Russian Journal of Anesthesiology and Reanimatology.2024; (6): 70.     CrossRef
  • Assessment of organ failure in sepsis patients in the emergency department: clinical evaluation, Sequential Organ Failure Assessment (SOFA) score, and future perspectives
    Tae Gun Shin
    Clinical and Experimental Emergency Medicine.2024; 11(4): 327.     CrossRef
  • Advances in metabolomics in critically ill patients with sepsis and septic shock
    Swarnima Pandey
    Clinical and Experimental Emergency Medicine.2024; 12(1): 4.     CrossRef
  • Hemodynamic management of septic shock: beyond the Surviving Sepsis Campaign guidelines
    Gil Joon Suh, Tae Gun shin, Woon Yong Kwon, Kyuseok Kim, You Hwan Jo, Sung-Hyuk Choi, Sung Phil Chung, Won Young Kim
    Clinical and Experimental Emergency Medicine.2023; 10(3): 255.     CrossRef
  • Prognostic accuracy of initial and 24-h maximum SOFA scores of septic shock patients in the emergency department
    Tae Han Kim, Daun Jeong, Jong Eun Park, Sung Yeon Hwang, Gil Joon Suh, Sung-Hyuk Choi, Sung Phil Chung, Won Young Kim, Gun Tak Lee, Tae Gun Shin
    Heliyon.2023; 9(9): e19480.     CrossRef
  • The Pattern of Admission, Clinical Characteristics, and Outcomes Among Patients Admitted to the Intensive Care Unit of a Tertiary Hospital in Tanzania: A 5-Year Retrospective Review
    Nadeem Kassam, Philip Adebayo, Iris Matei, Eric Aghan, Samina Somji, Samwel Kadelya, Yasson Abha, Frank Swai, Mangaro Mabusi, Kamran Hameed, Hanifa Mbithe, Alyyah Thawer, Mandela Makakala, Fatma Bakshi, Harrison Chuwa, Masolwa Ng'wanasayi, Casmir Wambura,
    Patient Related Outcome Measures.2023; Volume 14: 383.     CrossRef
  • Modified Cardiovascular Sequential Organ Failure Assessment Score in Sepsis: External Validation in Intensive Care Unit Patients
    Byuk Sung Ko, Seung Mok Ryoo, Eunah Han, Hyunglan Chang, Chang June Yune, Hui Jai Lee, Gil Joon Suh, Sung-Hyuk Choi, Sung Phil Chung, Tae Ho Lim, Won Young Kim, Jang Won Sohn, Mi Ae Jeong, Sung Yeon Hwang, Tae Gun Shin, Kyuseok Kim
    Journal of Korean Medical Science.2023;[Epub]     CrossRef
  • 18,728 View
  • 357 Download
  • 28 Web of Science
  • 26 Crossref
Original Articles

COVID-19

The impact of the COVID-19 pandemic on in-hospital mortality in patients admitted through the emergency department
Changgyun Kim, Juncheol Lee, Yongil Cho, Jaehoon Oh, Hyunggoo Kang, Tae Ho Lim, Byuk Sung Ko
Clin Exp Emerg Med 2023;10(1):92-98.   Published online January 18, 2023
DOI: https://doi.org/10.15441/ceem.22.359

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The impact of the COVID-19 pandemic on in-hospital mortality in patients admitted through the emergency department
Clin Exp Emerg Med. 2023;10(1):92-98.   Published online January 18, 2023
DOI: https://doi.org/10.15441/ceem.22.359
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The impact of the COVID-19 pandemic on in-hospital mortality in patients admitted through the emergency department
Clin Exp Emerg Med. 2023;10(1):92-98.   Published online January 18, 2023
DOI: https://doi.org/10.15441/ceem.22.359
Close
Objective
The COVID-19 pandemic might have adversely affected outcomes of patients in emergency departments (EDs). The aim of this study is to evaluate the impact of the COVID-19 pandemic on in patients admitted through the emergency department.
Methods
This study is a single-center, retrospective, observational cohort study. We compared the prognosis of patients admitted through the ED before the COVID-19 pandemic (November 2018 to June 2019) and after COVID-19 (November 2020 to June 2021). The primary outcome was in-hospital mortality. Multivariable logistic regression analysis was performed to determine whether the COVID-19 pandemic was independently associated with patient prognosis.
Results
The number of patients admitted through the ED before and after COVID-19 was 5,333 and 4,625, respectively. The mean ED length of stay before and after COVID-19 was 401 and 442 minutes, respectively (P<0.001). The number of in-hospital deaths before and after COVID-19 were 269 (5.0%) and 322 (7.0%), respectively (P<0.001). Multivariable logistic regression analysis showed that the COVID-19 period was significantly associated with higher in-hospital mortality (adjusted odds ratio, 1.37; 95% confidence interval, 1.12–1.67; P=0.002).
Conclusion
In the COVID-19 period, in-hospital mortality increased compared to that before COVID-19 among hospitalized ED patients.

Citations

Citations to this article as recorded by  Crossref logo
  • The Role of Augmented Reality in Advancing Medical Training Techniques: A Pilot RCT Study on Cricothyroidotomy
    Hyunchung Cho, Jongchul Kim, Sumin Kim, Hansol Chang, Sejin Heo, Minha Kim, Se Uk Lee, Wonchul Cha, Taerim Kim
    Yonsei Medical Journal.2026; 67(7): 553.     CrossRef
  • Comparison of the Characteristics of Korean Older Adults Who Returned to the Emergency Department Within 30 Days Before and During COVID-19: A Retrospective Study
    JuHee Lee, Hyun Sim Lee, Ji Young Choi, Hyun Soo Chung, Somin Sang, Jee-Hye Yoo
    Journal of Emergency Nursing.2025; 51(4): 721.     CrossRef
  • Impact of the COVID-19 pandemic on the emergency transportation of older patients: a population-based descriptive study in Osaka prefecture, Japan
    Kenta Tanaka, Yusuke Katayama, Tetsuhisa Kitamura, Hisaya Domi, Jun Oda, Tetsuya Matsuoka
    Frontiers in Public Health.2025;[Epub]     CrossRef
  • Impact of Point-of-Care Lactate Testing for Sepsis on Bundle Adherence and Clinical Outcomes in the Emergency Department: A Pre–Post Observational Study
    Sukyo Lee, Juhyun Song, Sungwoo Lee, Su Jin Kim, Kap Su Han, Sijin Lee
    Journal of Clinical Medicine.2024; 13(18): 5389.     CrossRef
  • Predictability of the emergency department triage system during the COVID-19 pandemic
    Se Young Oh, Ji Hwan Lee, Min Joung Kim, Dong Ryul Ko, Hyun Soo Chung, Incheol Park, Jinwoo Myung
    Clinical and Experimental Emergency Medicine.2024; 11(2): 195.     CrossRef
  • Impact of an Emergency Department Isolation Policy for Patients With Suspected COVID-19 on Door-to-Electrocardiography Time and Clinical Outcomes in Patients With Acute Myocardial Infarction
    Jinhee Kim, Joo Jeong, You Hwan Jo, Jin Hee Lee, Yu Jin Kim, Seung Min Park, Joonghee Kim
    Journal of Korean Medical Science.2023;[Epub]     CrossRef
  • Epidemiologic trends of patients who visited nationwide emergency departments: a report from the National Emergency Department Information System (NEDIS) of Korea, 2018–2022
    Hyun Ho Yoo, Young Sun Ro, Eunsil Ko, Jin-Hee Lee, So-hyun Han, Taerim Kim, Tae Gun Shin, Seongjung Kim, Hansol Chang
    Clinical and Experimental Emergency Medicine.2023; 10(S): S1.     CrossRef
  • Characteristics of pediatric emergency department visits before and during the COVID-19 pandemic: a report from the National Emergency Department Information System (NEDIS) of Korea, 2018–2022
    Jin Hyuck Hong, So Hyun Paek, Taerim Kim, Seongjung Kim, Eunsil Ko, Young Sun Ro, Jungeon Kim, Jae Hyun Kwon
    Clinical and Experimental Emergency Medicine.2023; 10(S): S13.     CrossRef
  • 7,183 View
  • 170 Download
  • 7 Web of Science
  • 8 Crossref

Critical Care

A combination of the Modified Early Warning Score and the Korean Triage and Acuity Scale as a triage tool in patients with infection
Seung Ryu, Se Kwang Oh, Bong Kyu Lee, So Young Jeon
Clin Exp Emerg Med 2023;10(1):60-67.   Published online January 3, 2023
DOI: https://doi.org/10.15441/ceem.22.339

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A combination of the Modified Early Warning Score and the Korean Triage and Acuity Scale as a triage tool in patients with infection
Clin Exp Emerg Med. 2023;10(1):60-67.   Published online January 3, 2023
DOI: https://doi.org/10.15441/ceem.22.339
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A combination of the Modified Early Warning Score and the Korean Triage and Acuity Scale as a triage tool in patients with infection
Clin Exp Emerg Med. 2023;10(1):60-67.   Published online January 3, 2023
DOI: https://doi.org/10.15441/ceem.22.339
Close
Objective
We evaluated the utility of the Korean Modified Early Warning Score (KMEWS), which combines the Modified Early Warning Score (MEWS) and the Korean Triage and Acuity Scale (KTAS), as a triage tool to screen for infection in patients who visit the emergency department.
Methods
We retrospectively reviewed data extracted from electronic medical records. Patients aged ≥18 years with an infection who were admitted to the hospital via the emergency department between January 2018 and December 2019 were eligible for inclusion. The KMEWS score was calculated as the sum of the KTAS level and the MEWS score. We generated receiver operating characteristic curves and determined the area under the receiver operating characteristic curve (AUC) for the KMEWS, KTAS, MEWS, and Mortality in Emergency Department Sepsis (MEDS) scales. The primary outcome was septic shock, and secondary outcomes were intensive care unit admission and in-hospital mortality.
Results
The AUC values (95% confidence interval) for predicting septic shock were as follows: KMEWS, 0.910 (0.902–0.918); MEWS, 0.896 (0.887–0.904); KTAS score, 0.809 (0.798–0.819); and MEDS, 0.927 (0.919–0.934). The AUC values (95% confidence interval) for predicting in-hospital mortality were as follows: KMEWS, 0.752 (0.740–0.764); MEWS, 0.717 (0.704–0.729); KTAS score, 0.764 (0.752–0.776); and MEDS, 0.844 (0.834–0.854). The AUC values (95% confidence interval) for predicting intensive care unit admission were as follows: KMEWS, 0.826 (0.816–0.837); MEWS, 0.782 (0.770–0.793); KTAS score, 0.821 (0.810–0.831); and MEDS, 0.839 (0.829–0.849).
Conclusion
The KMEWS, which is a combination of the MEWS and the KTAS scores, might be a useful triage tool in emergency department patients who present with infection, particularly for predicting septic shock.

Citations

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  • Evaluating the National Early Warning Score (NEWS) in triage: A machine learning perspective
    Arian Zaboli, Francesco Brigo, Serena Sibilio, Magdalena Massar, Gabriele Magnarelli, Gloria Brigiari, Gianni Turcato
    International Emergency Nursing.2025; 80: 101602.     CrossRef
  • Development and validation of a transformer model-based early warning score for real-time prediction of adverse outcomes in the emergency department
    Hansol Chang, Jong Eun Park, Daehwan Lee, Kiwon Lee, Se Yong Jekal, Ki Tae Moon, Sejin Heo, Doyeop Kim, Gun Tak Lee, Sung Yeon Hwang, Won Chul Cha, Wonhee Kim, Tae Ho Lim, Tae Gun Shin
    Scientific Reports.2025;[Epub]     CrossRef
  • Association between initial patient acuity and the predictive performance of the MREMS: A nationwide retrospective cohort study
    Álvaro Astasio-Picado, José Luis Martín-Conty, Begoña Polonio-López, Cristina Rivera-Picón, Alberto López Ballesteros, Alberto José Aragón Granados, Diego Villalobos Buitrago, Paula Álvarez Buitrago, Samanta Diaz-Gonzalez, Juan Dueñas-Ruiz, Francisco Mart
    The American Journal of Emergency Medicine.2025; 97: 84.     CrossRef
  • Predictive validity of resource-adjusted Korean Triage and Acuity Scale in pediatric gastrointestinal tract foreign body patients
    Jin Hee Lee, Jin Hee Jung, Hyun Noh, Mi Jin Kim
    Scientific Reports.2024;[Epub]     CrossRef
  • A model study for the classification of high-risk groups for cardiac arrest in general ward patients using simulation techniques
    Seok Young Song, Won-Kee Choi, Sanggyu Kwak
    Medicine.2023; 102(37): e35057.     CrossRef
  • 8,707 View
  • 209 Download
  • 6 Web of Science
  • 5 Crossref

Trauma

Survival benefit of direct transport to trauma centers among patients with unintentional injuries in Korea: a propensity score-matched analysis
Dong Jun Lee, Seok Hoon Ko, Jongkyeong Kang, Myung Chun Kim, Han Zo Choi
Clin Exp Emerg Med 2023;10(1):37-43.   Published online September 29, 2022
DOI: https://doi.org/10.15441/ceem.22.318

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Survival benefit of direct transport to trauma centers among patients with unintentional injuries in Korea: a propensity score-matched analysis
Clin Exp Emerg Med. 2023;10(1):37-43.   Published online September 29, 2022
DOI: https://doi.org/10.15441/ceem.22.318
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Survival benefit of direct transport to trauma centers among patients with unintentional injuries in Korea: a propensity score-matched analysis
Clin Exp Emerg Med. 2023;10(1):37-43.   Published online September 29, 2022
DOI: https://doi.org/10.15441/ceem.22.318
Close
Objective
This study investigated the characteristics and survival rates of patients with unintentional severe trauma who visited a regional trauma center (TC) or a non-TC.
Methods
This retrospective, national, population-based, observational, case-control study included patients with abnormal Revised Trauma Score from January 2018 to December 2018. We divided hospitals into two types, TC and non-TC, and compared several variables, including in-hospital mortality. Propensity score matching was used to reduce the effect of confounding variables that influence survival outcome variables.
Results
Of the 25,743 patients, 5,796 visited a TC and 19,947 visited a non-TC. Compared to patients treated at non-TCs, patients treated at TCs were more likely to have a higher Injury Severity Score (TC, 11.5; non-TC, 7.4; P<0.001), higher rate of surgery or transcatheter arterial embolization (TC, 39.2%; non-TC, 17.6%; P<0.001), and higher admission rate (TC, 64.7%; non-TC, 36.9%; P<0.001) through the emergency department. After propensity score matching, 2,800 patients from both groups were analyzed. Patients in the TC had a higher survival rate than patients that were not treated in the TC (TC, 83.0%; non-TC, 78.6%; P=0.003).
Conclusion
This study using Korean emergency medical services data showed that initial transport to trauma centers was associated with mortality reduction. Further research is required because of limitations with use of single-year data and retrospective design.

Citations

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  • Intentionally self-injured patients have lower mortality when treated at trauma centers versus non-trauma centers in South Korea
    Jin Woo, Han Zo Choi, Jongkyeong Kang
    Trauma Surgery & Acute Care Open.2024; 9(1): e001258.     CrossRef
  • The Association Between Inter-Hospital Transfers and the Prognosis of Pediatric Injury in the Emergency Department
    Darjin Jung, Jin Hee Jung, Jin Hee Kim, Jie Hee Jue, Joong Wan Park, Do Kyun Kim, Jae Yun Jung, Eui Jun Lee, Jin Hee Lee, Dongbum Suh, Hyuksool Kwon
    Journal of Korean Medical Science.2023;[Epub]     CrossRef
  • 7,855 View
  • 231 Download
  • 2 Web of Science
  • 2 Crossref

Critical Care

In-hospital mortality in the emergency department: clinical and etiological differences between early and late deaths among patients awaiting admission
Gabriele Valli, Elisabetta Galati, Francesca De Marco, Chiara Bucci, Paolo Fratini, Elisa Cennamo, Carlo Ancona, Nicola Volpe, Maria Pia Ruggieri
Clin Exp Emerg Med 2021;8(4):325-332.   Published online December 31, 2021
DOI: https://doi.org/10.15441/ceem.21.020

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In-hospital mortality in the emergency department: clinical and etiological differences between early and late deaths among patients awaiting admission
Clin Exp Emerg Med. 2021;8(4):325-332.   Published online December 31, 2021
DOI: https://doi.org/10.15441/ceem.21.020
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In-hospital mortality in the emergency department: clinical and etiological differences between early and late deaths among patients awaiting admission
Clin Exp Emerg Med. 2021;8(4):325-332.   Published online December 31, 2021
DOI: https://doi.org/10.15441/ceem.21.020
Close
Objective
Given that there are no studies on diseases that occur by waiting for hospitalization, we aimed to evaluate the main causes of death in the emergency room (ER) and their relationship with overcrowding.
Methods
Patients who died in the ER in the past 2 years (pediatrics and trauma victims excluded) were divided into two groups: patients who died within 6 hours of arrival (emergency department [ED] group) and patients who died later (LD group). We compared the causes of death, total vital signs, diagnostic tests performed, and therapy between the groups. We assessed for possible correlation between the number of monthly deaths per group and four variables of overcrowding: number of patients treated per month, waiting time before medical visit (W-Time), mean intervention time (I-Time), and number of patients admitted to the ward per month (NPA).
Results
During the two years, 175 patients had died in our ER (52% in ED group and 48% in LD group). The total time spent in the ER was, respectively, 2.9±0.2 hours for ED group and 17.9± 1.5 hours for LD group. The more frequent cause of death was cardiovascular syndrome (30%) in ED group and sepsis (27%) and acute respiratory failure (27%) in LD group. Positive correlations between number of monthly deaths and W-Time (R2 0.51, P<0.001), I-Time (R2 0.73, P< 0.0001), and NPA (R2 0.37, P<0.01) were found only in LD group.
Conclusion
Patients with sepsis and acute respiratory failure die after a long stay in the ER, and the risk increases with overcrowding. A fast-track pathway should be considered for hospital admission of critical patients.

Citations

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  • Non-Surgical Causes of Death in the Emergency Department: A Five-Year Monocentric Clinicopathological Study
    Adrian-Iosif Moldoveanu, Diana Maria Orzata, Gabriel Veniamin Cozma, Radu Gheorghe Dan, Ovidiu Alexandru Mederle, Flavia Zara
    Medicina.2026; 62(2): 293.     CrossRef
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    Saravana Kumar, Gunaseelan Vikneswaran, Jitendra Suryavamshi, Srinath Kumar, Manzoor Shaik, G K Reshma, M R Suresh, Alben Sigamani, V C Shanmuganandan, Alexander Thomas, A N Venkatesh, Imron Subhan, M Rajadurai, Sateesh Kumar Kailasam, B Nivetha, K U Sham
    International Journal for Quality In Health Care.2026;[Epub]     CrossRef
  • Standardized Perioperative Protocols Are Associated With Reduced Length of Stay and Readmission in Cushing Disease: Results From the Multicenter RAPID Study
    Carter M. Suryadevara, Jorge E. Salcedo-Sifuentes, Andrew S. Little, Kevin C. J. Yuen, Michelle Magana Mendoza, Paul Gardner, Georgios Zenonos, Julie M. Silverstein, Albert H. Kim, James J. Evans, Garni Barkhoudarian, Juan C. Fernandez-Miranda, William T.
    Neurosurgery.2026;[Epub]     CrossRef
  • Neutrophil to lymphocyte ratio (NLR) and short-term mortality risk in elderly acute medical patients admitted to a University Hospital Emergency Department
    Gioacchino Galardo, Luca Crisanti, Andrea Gentile, Marco Cornacchia, Francesca Iatomasi, Iacopo Egiddi, Emanuele Puscio, Danilo Menichelli, Francesco Pugliese, Daniele Pastori
    Internal and Emergency Medicine.2025; 20(2): 553.     CrossRef
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    Paul-André Poislane, Mathilde Papin, Damien Masson, Nicolas Goffinet, Arthur David, Quentin Le Bastard, Hugo De Carvalho
    Scientific Reports.2025;[Epub]     CrossRef
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    Andrew J. Bouland, Juan A. March
    JACEP Open.2025; 6(3): 100161.     CrossRef
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    Bei Huang
    Exploratory Research in Clinical and Social Pharmacy.2025; 19: 100626.     CrossRef
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    Mia Werrett, Joanna McIlveen, Mim Fox
    Hospitals.2025; 2(3): 15.     CrossRef
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    Filipe Ricardo Carvalho, Paulo Jorge Gavaia, António Brito Camacho
    International Journal of Medical Informatics.2024; 192: 105657.     CrossRef
  • Comment on: "30 days mortality prognostic value of POCT bio-adrenomedullin and proenkephalin in patients with sepsis in the emergency department"
    Gabriele VALLI, Francesca DE MARCO, Silvia CASALBONI, Maria P. RUGGIERI
    Italian Journal of Emergency Medicine.2023;[Epub]     CrossRef
  • Can Acute Care Biomarkers Change Patient’s Management in Sepsis?
    Salvatore Di Somma, Luca Crisanti
    Eurasian Journal of Emergency Medicine.2022; 21(2): 79.     CrossRef
  • Characteristics and timing of mortality in children dying in pediatric intensive care: a 5-year experience
    Edin Botan, Emrah Gün, Emine Kübra Şden, Cansu Yöndem, Anar Gurbanov, Burak Balaban, Fevzi Kahveci, Hasan Özen, Hacer Uçmak, Ali Genco Gençay, Tanil Kendirli
    Acute and Critical Care.2022; 37(4): 644.     CrossRef
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    Silvia Casalboni, Gabriele Valli, Ferdinando Terlizzi, Marina Mastracchi, Giacomo Fidelio, Francesca De Marco, Caterina Bernardi, Anastasia Chieruzzi, Alessia Curcio, Francesco De Cicco, Nicola Colella, Ilaria Dafne Papasidero, Emanuele Tartarone, Maria P
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    Sookyung Park, Hansol Chang, Weon Jung, Se Uk Lee, Sung Yeon Hwang, Hee Yoon, Won Chul Cha, Tae Gun Shin, Min Seob Sim, Ik Joon Jo, Taerim Kim
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    Ilaria Dafne Papasidero, Gabriele Valli, Dario Marin, Alberto Del Sasso, Antonio De Magistris, Elisa Cennamo, Silvia Casalboni, Francesca De Marco, Roberta Rocchi, Brice Ndogmo Beumo, Valeria Cusani, Mariarosa Gaudio, Oliver Hartmann, Andreas Bergman, Mar
    Medicina.2022; 58(12): 1852.     CrossRef
  • Usefulness of High-Sensitivity Troponin I in Risk Stratification and Final Disposition of Patients with Acute Heart Failure in the Emergency Department: Comparison between HFpEF vs. HFrEF
    Luca Crisanti, Gabriele Valli, Elisa Cennamo, Alessandro Capolino, Paolo Fratini, Claudio Cesaro, Gloria Adducchio, Antonio De Magistris, Ferdinando Terlizzi, Maria Pia Ruggieri, Enrico Mirante, Claudio Savoriti, Kalyarat Sukruang, Valentina Valeriano, Fr
    Medicina.2022; 59(1): 7.     CrossRef
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  • 222 Download
  • 14 Web of Science
  • 16 Crossref
A comparison of scoring systems for predicting mortality and sepsis in the emergency department patients with a suspected infection
Manita Thodphetch, Boriboon Chenthanakij, Borwon Wittayachamnankul, Kamphee Sruamsiri, Theerapon Tangsuwanaruk
Clin Exp Emerg Med 2021;8(4):289-295.   Published online December 31, 2021
DOI: https://doi.org/10.15441/ceem.20.145

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A comparison of scoring systems for predicting mortality and sepsis in the emergency department patients with a suspected infection
Clin Exp Emerg Med. 2021;8(4):289-295.   Published online December 31, 2021
DOI: https://doi.org/10.15441/ceem.20.145
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A comparison of scoring systems for predicting mortality and sepsis in the emergency department patients with a suspected infection
Clin Exp Emerg Med. 2021;8(4):289-295.   Published online December 31, 2021
DOI: https://doi.org/10.15441/ceem.20.145
Close
Objective
We aimed to compare the modified National Early Warning Score (mNEWS), quick Sequential Organ Failure Assessment (qSOFA) score, modified Systemic Inflammatory Response Syndrome (mSIRS) score, and modified Search Out Severity (mSOS) score in predicting mortality and sepsis among patients suspected of first observed infections in the emergency department. The modified scores were created by removing variables for simplicity.
Methods
This was a prospective cohort study that enrolled adult patients presenting at the emergency department with signs and symptoms suggesting infection. The mNEWS, qSOFA score, mSIRS score, and mSOS score were calculated using triage data. The SOFA score was a reference standard for sepsis diagnosis. All patients were monitored for up to 30 days after the initial visit to measure each scoring system’s ability to predict 30-day mortality and sepsis.
Results
There were 260 patients included in the study. The 30-day mortality prediction with mNEWS ≥5 had the highest sensitivity (91.18%). The highest area under the receiver operating characteristic curve (AUC) for the 30-day mortality prediction was mNEWS (0.607), followed by qSOFA (0.605), mSOS (0.550), and mSIRS (0.423). The sepsis prediction with mNEWS ≥5 had the highest sensitivity (96.48%). The highest AUC for the sepsis prediction was also mNEWS (0.685), followed by qSOFA (0.605), mSOS (0.480), and mSIRS (0.477).
Conclusion
mNEWS was an acceptable scoring system screening tool for predicting mortality and sepsis in patients with a suspected infection.

Citations

Citations to this article as recorded by  Crossref logo
  • Early Recognition of Sepsis in Prehospital Settings
    William C. Tirado
    Advanced Emergency Nursing Journal.2025; 47(2): 152.     CrossRef
  • Evaluating Sepsis Mortality Predictions from the Emergency Department: A Retrospective Cohort Study Comparing qSOFA, the National Early Warning Score, and the International Early Warning Score
    German Alberto Devia-Jaramillo, Lilia Erazo-Guerrero, Vivian Laguado-Castro, Juan Manuel Alfonso-Parada
    Journal of Clinical Medicine.2025; 14(14): 4869.     CrossRef
  • Performance of Early Sepsis Screening Tools for Timely Diagnosis and Antibiotic Stewardship in a Resource-Limited Thai Community Hospital
    Wisanu Wanlumkhao, Duangduan Rattanamongkolgul, Chatchai Ekpanyaskul
    Antibiotics.2025; 14(7): 708.     CrossRef
  • Predictive performance of clinical scores and survival outcomes in critically ill patients with sepsis: a prospective longitudinal study at a tertiary medical centre in Ethiopia
    Girum Tesfaye Kiya, Zeleke Mekonnen, Elsah Tegene Asefa, Edosa Kejela, Edosa Tadasa, Esayas Kebede Gudina, Tilahun Yemane, Gemeda Abebe
    PeerJ.2025; 13: e20109.     CrossRef
  • Prognostic value of REDS, SOFA, and D-dimer in critically ill COVID-19 patients with sepsis
    Dejana Bajic, Milica Plazacic, Andrea Mihajlovic
    Srpski arhiv za celokupno lekarstvo.2025; 153(11-12): 542.     CrossRef
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    Venkat Reddy, Harshitha Reddy, Rinkle Gemnani, Sunil Kumar, Sourya Acharya
    Cureus.2024;[Epub]     CrossRef
  • Comparing 11 early warning scores and three shock indices in early sepsis prediction in the emergency department
    Rex Pui Kin Lam, Zonglin Dai, Eric Ho Yin Lau, Carrie Yuen Ting Ip, Ho Ching Chan, Lingyun Zhao, Tat Chi Tsang, Matthew Sik Hon Tsui, Timothy Hudson Rainer
    World Journal of Emergency Medicine.2024; 15(4): 273.     CrossRef
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    German Devia Jaramillo, Lilia Erazo Guerrero, Natalia Florez Zuñiga, Ronal Mauricio Martin Cuesta
    Journal of Clinical Medicine.2024; 13(24): 7787.     CrossRef
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    Xia Qiu, Yu-Peng Lei, Rui-Xi Zhou
    Expert Review of Anti-infective Therapy.2023; 21(8): 891.     CrossRef
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    Sung-Yeon Hwang, In-Kyu Kim, Daun Jeong, Jong-Eun Park, Gun-Tak Lee, Junsang Yoo, Kihwan Choi, Tae-Gun Shin, Kyuseok Kim
    Journal of Clinical Medicine.2023; 12(19): 6402.     CrossRef
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    Megan De Silva, William Chadwick, Navindhra Naidoo
    Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.2023;[Epub]     CrossRef
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    Heesu Park, Tae Gun Shin, Won Young Kim, You Hwan Jo, Yoon Jung Hwang, Sung-Hyuk Choi, Tae Ho Lim, Kap Su Han, Jonghwan Shin, Gil Joon Suh, Gu Hyun Kang, Kyung Su Kim
    Clinical and Experimental Emergency Medicine.2022; 9(2): 84.     CrossRef
  • Audit of a computerized version of the Manchester triage system and a SIRS-based system for the detection of sepsis at triage in the emergency department
    Ken Dewitte, Elyne Scheurwegs, Sabrina Van Ierssel, Hilde Jansens, Karolien Dams, Ella Roelant
    International Journal of Emergency Medicine.2022;[Epub]     CrossRef
  • 15,863 View
  • 339 Download
  • 15 Web of Science
  • 13 Crossref

Toxicology

Artificial neural network approach for acute poisoning mortality prediction in emergency departments
Seon Yeong Park, Kisung Kim, Seon Hee Woo, Jung Taek Park, Sikyoung Jeong, Jinwoo Kim, Sungyoup Hong
Clin Exp Emerg Med 2021;8(3):229-236.   Published online September 30, 2021
DOI: https://doi.org/10.15441/ceem.20.113

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Artificial neural network approach for acute poisoning mortality prediction in emergency departments
Clin Exp Emerg Med. 2021;8(3):229-236.   Published online September 30, 2021
DOI: https://doi.org/10.15441/ceem.20.113
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Artificial neural network approach for acute poisoning mortality prediction in emergency departments
Clin Exp Emerg Med. 2021;8(3):229-236.   Published online September 30, 2021
DOI: https://doi.org/10.15441/ceem.20.113
Close
Objective
The number of deaths due to acute poisoning (AP) is on the increase. It is crucial to predict AP patient mortality to identify those requiring intensive care for providing appropriate patient care as well as preserving medical resources. The aim of this study is to predict the risk of in-hospital mortality associated with AP using an artificial neural network (ANN) model.
Methods
In this multicenter retrospective study, ANN and logistic regression models were constructed using the clinical and laboratory data of 1,304 patients seeking emergency treatment for AP. The ANN model was first trained on 912/1,304 (70%) randomly selected patients and then tested on the remaining 392/1,304 (30%). Receiver operating characteristic curve analysis was used to evaluate the mortality prediction of the two models.
Results
Age, endotracheal intubation status, and intensive care unit admission were significant predictors of mortality in patients with AP in the multivariate logistic regression model. The ANN model indicated age, Glasgow Coma Scale, intensive care unit admission, and endotracheal intubation status were critical factors among the 12 independent variables related to in-hospital mortality. The area under the receiver operating characteristic curve for mortality prediction was significantly higher in the ANN model compared to the logistic regression model.
Conclusion
This study establishes that the ANN model could be a valuable tool for predicting the risk of death following AP. Thus, it may facilitate effective patient triage and improve the outcomes.

Citations

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  • Comparison of Predictive Models for Keloid Recurrence Based on Machine Learning
    Yan Hao, Mengjie Shan, Hao Liu, Yijun Xia, Xinwen Kuang, Kexin Song, Youbin Wang
    Journal of Cosmetic Dermatology.2025;[Epub]     CrossRef
  • Neural network-based strategies for automatically diagnosing of COVID-19 from X-ray images utilizing different feature extraction algorithms
    Farida Siddiqi Prity, Nishu Nath, Antara Nath, K. M. Aslam Uddin
    Network Modeling Analysis in Health Informatics and Bioinformatics.2023;[Epub]     CrossRef
  • Machine Learning Model Development and Validation for Predicting Outcome in Stage 4 Solid Cancer Patients with Septic Shock Visiting the Emergency Department: A Multi-Center, Prospective Cohort Study
    Byuk Sung Ko, Sanghoon Jeon, Donghee Son, Sung-Hyuk Choi, Tae Gun Shin, You Hwan Jo, Seung Mok Ryoo, Youn-Jung Kim, Yoo Seok Park, Woon Yong Kwon, Gil Joon Suh, Tae Ho Lim, Won Young Kim
    Journal of Clinical Medicine.2022; 11(23): 7231.     CrossRef
  • 8,152 View
  • 90 Download
  • 3 Web of Science
  • 3 Crossref

Emergency Medical Services | Epidemiology

Emergency department utilization and risk factors for mortality in older patients: an analysis of Korean National Emergency Department Information System data
Soyoon Kim, Hyunggoo Kang, Yongil Cho, Heekyung Lee, Sung Woo Lee, Jinwoo Jeong, Won Young Kim, Su Jin Kim, Kap Su Han
Clin Exp Emerg Med 2021;8(2):128-136.   Published online June 30, 2021
DOI: https://doi.org/10.15441/ceem.20.098

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Emergency department utilization and risk factors for mortality in older patients: an analysis of Korean National Emergency Department Information System data
Clin Exp Emerg Med. 2021;8(2):128-136.   Published online June 30, 2021
DOI: https://doi.org/10.15441/ceem.20.098
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Emergency department utilization and risk factors for mortality in older patients: an analysis of Korean National Emergency Department Information System data
Clin Exp Emerg Med. 2021;8(2):128-136.   Published online June 30, 2021
DOI: https://doi.org/10.15441/ceem.20.098
Close
Objective
With trends in population aging an increasing number of older patients are visiting the emergency department (ED). This study aimed to identify the characteristics of ED utilization and risk factors for in-hospital mortality in older patients who visited EDs.
Methods
This nationwide observational study used National Emergency Department Information System data collected during a 2-year period from January 2016 to December 2017. The characteristics of older patients aged 70 years or older were compared with those of younger patients aged 20 to 69 years. Risk factors associated with in-hospital mortality were analyzed by multivariable logistic regression.
Results
A total of 6,596,423 younger patients and 1,737,799 older patients were included. In the medical and nonmedical older patient groups, significantly higher proportions of patients were transferred from another hospital, utilized emergency medical services, had Korean Triage and Acuity Scale scores of 1 and 2, required hospitalization, and required intensive care unit admission in the older patient group than in the younger patient group. ED and post-hospitalization mortality rates increased with age; in particular, older medical patients aged 90 or older had an in-hospital mortality rate of 9%. Older age, male sex, transfer from another hospital, emergency medical service utilization, a high Korean Triage and Acuity Scale score, systolic blood pressure <100 mmHg, respiratory rate >20/min, heart rate >100/min, body temperature <36°C, and altered mental status were associated with in-hospital mortality.
Conclusion
Development of appropriate decision-making algorithms and treatment protocols for high risk older patients visiting the ED might facilitate appropriate allocation of medical resources to optimize outcomes.

Citations

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  • Development and Internal Validation of an Early Warning Predictive Model for Critically Ill Patients in the Emergency Department Utilizing Easily Obtainable Clinical Indicators
    Xurui Li, Jian Lv, Hui Guo, Hongling Li, Qian Zhao, Huijun Qi, Jianguo Li
    Risk Management and Healthcare Policy.2026; Volume 19: 1.     CrossRef
  • Emergency department presentations for suicide and self-harm in Korea, 2020–2024: an epidemiological study using the National Emergency Department Information System (NEDIS) database
    Yuri Choi, Jinwoo Jeong, Borami Lim, Myeong Il Cha
    Clinical and Experimental Emergency Medicine.2026; 13(1): 98.     CrossRef
  • Impact of the 2024 Korean medical workforce crisis on transfers in a pediatric emergency center: including comparative analyses with adults
    Sung-Ha Kim, Jin Hee Kim, Jae-Hyun Kwon, Soo Hyun Park, Min-Jung Kim, Young-Hoon Byun, Ho-Young Song, So-Hyun Paek, Inge Roggen
    PLOS One.2026; 21(5): e0348189.     CrossRef
  • Hypothermia and Mortality Among Children in the Emergency Department
    Lucy Campbell, Aarthi Kottapalli, Leslie Hueschen, Jonathan R. Higgins, Erin J. Meyer, Laura F. Sartori, Paria M. Wilson, Naghma S. Khan, Alexander Rogers, Sriram Ramgopal
    Pediatrics.2026;[Epub]     CrossRef
  • Factors associated with hospitalization among older patients with mild traumatic injuries presenting to the emergency department in Korea: a retrospective observational study
    Songhee Jeong, Younghui Hwang
    Journal of Korean Biological Nursing Science.2026; 28(2): 353.     CrossRef
  • Commentary on “Predictive value of the Hemoglobin, Albumin, Lymphocyte and Platelet score for mortality in geriatric patients presenting to the emergency department”
    Zeinab Mohseni Afshar, Mohammad Barary, Farhad Bagherian, Arefeh Babazadeh, Soheil Ebrahimpour
    Geriatrics & Gerontology International.2025; 25(6): 830.     CrossRef
  • Comparison of early warning scores for predicting outcomes in adult and older patients in emergency department: Multicenter study
    Sung Jin Bae, Ho Sub Chung, Yunhyung Choi, Yoon Hee Choi, Ji Yeon Lim, Keon Kim, Dong Hoon Lee
    The American Journal of Emergency Medicine.2025; 96: 91.     CrossRef
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    Jonghyuk Kim, Sewoong Hwang
    Applied Sciences.2025; 15(13): 7156.     CrossRef
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    Kyongmin Sun, Youjin Lee, Jungsil Lee
    BMC Emergency Medicine.2025;[Epub]     CrossRef
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    Eun Deok Cho, Bomgyeol Kim, Do Hee Kim, Sang Gyu Lee, Suk-Yong Jang, Tae Hyun Kim
    BMC Emergency Medicine.2023;[Epub]     CrossRef
  • Emergency department utilization in elderly patients: a report from the National Emergency Department Information System (NEDIS) of Korea, 2018-2022
    Sun Young Lim, You Hwan Jo, Seongjung Kim, Eunsil Ko, Young Sun Ro, Jungeon Kim, Sumin Baek
    Clinical and Experimental Emergency Medicine.2023; 10(S): S26.     CrossRef
  • Epidemiology of suicide attempts and self-harm in emergency departments: a report from the National Emergency Department Information System (NEDIS) of Korea, 2018–2022
    Kwang Yul Jung, Taehui Kim, Young Sun Ro
    Clinical and Experimental Emergency Medicine.2023; 10(S): S69.     CrossRef
  • Epidemiologic trends of patients who visited nationwide emergency departments: a report from the National Emergency Department Information System (NEDIS) of Korea, 2018–2022
    Hyun Ho Yoo, Young Sun Ro, Eunsil Ko, Jin-Hee Lee, So-hyun Han, Taerim Kim, Tae Gun Shin, Seongjung Kim, Hansol Chang
    Clinical and Experimental Emergency Medicine.2023; 10(S): S1.     CrossRef
  • Mortality and incidence rate of acute severe trauma patients in the emergency department: a report from the National Emergency Department Information System (NEDIS) of Korea, 2018–2022
    Jung-Youn Kim, Young-Hoon Yoon, Sung Joon Park, Won Pyo Hong, Young Sun Ro
    Clinical and Experimental Emergency Medicine.2023; 10(S): S55.     CrossRef
  • Epidemiology of stroke in emergency departments: a report from the National Emergency Department Information System (NEDIS) of Korea, 2018–2022
    Sung Eun Lee, Hyo Jin Kim, Young Sun Ro
    Clinical and Experimental Emergency Medicine.2023; 10(S): S48.     CrossRef
  • Acute myocardial infarction diagnosed in emergency departments: a report from the National Emergency Department Information System (NEDIS) of Korea, 2018–2022
    Shin Ahn, Eunsil Ko, Young Sun Ro
    Clinical and Experimental Emergency Medicine.2023; 10(S): S42.     CrossRef
  • Factors Associated with Emergency Department Visits and Consequent Hospitalization and Death in Korea Using a Population-Based National Health Database
    Junhee Park, Yohwan Yeo, Yonghoon Ji, Bongseong Kim, Kyungdo Han, Wonchul Cha, Meonghi Son, Hongjin Jeon, Jaehyun Park, Dongwook Shin
    Healthcare.2022; 10(7): 1324.     CrossRef
  • 10,436 View
  • 129 Download
  • 18 Web of Science
  • 17 Crossref

Injury & Prevention | Geriatrics

Traumatic brain injury in patients aged ≥65 years versus patients aged ≥80 years: a multicenter prospective study of mortality and medical resource utilization
SooJin Bae, Sung Wook Song, Woo Jeong Kim, YoungJoon Kang, Kyeong Won Kang, Chang Bae Park, Jeong Ho Kang, Ji Hwan Bu, Sung Kgun Lee, Seo Young Ko
Clin Exp Emerg Med 2021;8(2):94-102.   Published online June 30, 2021
DOI: https://doi.org/10.15441/ceem.20.045

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Traumatic brain injury in patients aged ≥65 years versus patients aged ≥80 years: a multicenter prospective study of mortality and medical resource utilization
Clin Exp Emerg Med. 2021;8(2):94-102.   Published online June 30, 2021
DOI: https://doi.org/10.15441/ceem.20.045
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Traumatic brain injury in patients aged ≥65 years versus patients aged ≥80 years: a multicenter prospective study of mortality and medical resource utilization
Clin Exp Emerg Med. 2021;8(2):94-102.   Published online June 30, 2021
DOI: https://doi.org/10.15441/ceem.20.045
Close
Objective
This study aimed to determine whether there is a difference in mortality and medical resource utilization between geriatric (aged ≥65 years) and super-geriatric patients (aged ≥80 years) with traumatic brain injury (TBI).
Methods
We obtained comprehensive data (demographics, injury characteristics, injury severities, and outcomes) of geriatric and super-geriatric TBI patients from an emergency department-based injury surveillance system database from 2011 to 2016. Multivariate logistic regression analysis was performed to compare the mortality and nonroutine discharge (NRDC) status between both groups.
Results
Among 442,533 TBI patients, 48,624 were older than 65 years. A total of 48,446 patients (37,140 geriatric and 11,306 super-geriatric) without exclusion criteria were included in the final analysis. Both overall in-hospital mortality (adjusted odds ratio, 1.88; 95% confidence interval [CI], 1.28 to 2.74; P=0.001) and NRDC (adjusted odds ratio, 1.35; 95% CI, 1.07 to 1.71; P=0.011) were significantly higher in the super-geriatric group. In the stratified analysis, there were no significant differences in NRDC rate for all stratifications of treatment timing (emergency department vs. ward admission), but mortality remained to be significant for all stratifications.
Conclusion
Super-geriatric TBI patients showed a significantly higher risk-adjusted overall mortality and more inadequate medical resource utilization than did geriatric TBI patients. However, super-geriatric patients were more likely to undergo NRDC after admission; thus, further research about age-related health inequalities is needed in the treatment of super-geriatric patients.

Citations

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  • Impact of concomitant injuries on clinical outcomes in patients with isolated versus non-isolated traumatic brain injury
    Kyung Won Park, Sung Wook Song, Woo Jeong Kim, Jeong Ho Kang, Ji Hwan Bu, Sung Kgun Lee, Seo Young Ko, Soo Hoon Lee, Chang Bae Park, Jin Gu Lee, Jong Yeon Kang, Jaeyoon Ha, Jiwon Kim
    Clinical and Experimental Emergency Medicine.2025; 12(4): 358.     CrossRef
  • Trauma in the Geriatric and the Super-Geriatric: Should They Be Treated the Same?
    Khaled El-Qawaqzeh, Tanya Anand, Qaidar Alizai, Christina Colosimo, Hamidreza Hosseinpour, Audrey Spencer, Michael Ditillo, Louis J. Magnotti, Collin Stewart, Bellal Joseph
    Journal of Surgical Research.2024; 293: 316.     CrossRef
  • Effect of low fibrinogen level on in-hospital mortality and 6-month functional outcome of TBI patients, a single center experience
    Omid Yousefi, Amirmohammad Farrokhi, Reza Taheri, Hadis Ghasemi, Sina Zoghi, Asma Eslami, Amin Niakan, Hosseinali Khalili
    Neurosurgical Review.2024;[Epub]     CrossRef
  • Traumatic brain injury in elderly population: A global systematic review and meta-analysis of in-hospital mortality and risk factors among 2.22 million individuals
    Zixuan Ma, Zhenghui He, Zhifan Li, Ru Gong, Jiyuan Hui, Weiji Weng, Xiang Wu, Chun Yang, Jiyao Jiang, Li Xie, Junfeng Feng
    Ageing Research Reviews.2024; 99: 102376.     CrossRef
  • Outcome after decompressive craniectomy in older adults after traumatic brain injury
    Thomas Kapapa, Stefanie Jesuthasan, Franziska Schiller, Frederike Schiller, Dieter Woischneck, Stefanie Gräve, Eberhard Barth, Benjamin Mayer, Marcel Oehmichen, Andrej Pala
    Frontiers in Medicine.2024;[Epub]     CrossRef
  • Novel application of the Rotterdam CT score in the prediction of intracranial hypertension following severe traumatic brain injury
    Ahmed Ismail Kashkoush, Tamia Potter, Jordan C. Petitt, Song Hu, Kyle Hunter, Michael L. Kelly
    Journal of Neurosurgery.2023; 138(4): 1050.     CrossRef
  • In-hospital mortality and risk factors among elderly patients with traumatic brain injury: protocol for a systematic review and meta-analysis
    Zixuan Ma, Jiyuan Hui, Chun Yang, Jiyao Jiang, LI Xie, Junfeng Feng
    BMJ Open.2023; 13(3): e065371.     CrossRef
  • Trends in traumatic brain injury–related emergency department visits in Korea: a report from the National Emergency Department Information System (NEDIS) 2018–2022
    Hang A Park, Borami Lim, Young Sun Ro
    Clinical and Experimental Emergency Medicine.2023; 10(S): S63.     CrossRef
  • Predictors of Mortality, Withdrawal of Life-Sustaining Measures, and Discharge Disposition in Octogenarians with Subdural Hematomas
    Ahmed Kashkoush, Jordan C. Petitt, Husayn Ladhani, Vanessa P. Ho, Michael L. Kelly, Mira Ghneim, Jennifer S. Albrecht, Karen Brasel, Anna Livaris, Jill B. Watras, Christopher P. Michetti, James M. Haan, Kelly Lightwine, Robert D. Winfield, Sasha D. Adams,
    World Neurosurgery.2022; 157: e179.     CrossRef
  • 8,294 View
  • 129 Download
  • 10 Web of Science
  • 9 Crossref

Psychosocial

Suicidal intent as a risk factor for mortality in high-level falls: a comparative study of suicidal and accidental falls
Byung Hee Kang, Kyoungwon Jung, Yo Huh
Clin Exp Emerg Med 2021;8(1):16-20.   Published online March 31, 2021
DOI: https://doi.org/10.15441/ceem.20.019

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Suicidal intent as a risk factor for mortality in high-level falls: a comparative study of suicidal and accidental falls
Clin Exp Emerg Med. 2021;8(1):16-20.   Published online March 31, 2021
DOI: https://doi.org/10.15441/ceem.20.019
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Suicidal intent as a risk factor for mortality in high-level falls: a comparative study of suicidal and accidental falls
Clin Exp Emerg Med. 2021;8(1):16-20.   Published online March 31, 2021
DOI: https://doi.org/10.15441/ceem.20.019
Close
Objective
Suicide is a major issue in South Korea, and falling is a common method of suicide. Further, accidental falls are a common cause of death. However, whether suicidal falls differ from accidental falls is inconclusive. This study aimed to compare suicidal and accidental falls to identify risk factors for mortality.
Methods
From March 2010 to December 2016, patients admitted to our hospital because of falls were reviewed retrospectively. Characteristics and outcomes were compared between suicide and accident groups. Injury distribution was compared using the Injury Severity Score and Abbreviated Injury Scales. Multivariate analysis was performed to identify risk factors, including suicide intent, for mortality.
Results
Of 242 patients, 42 were included in the suicide group and 200 were included in the accident group. The suicide group showed higher fall heights and injuries of greater severity. The accident group was younger and included a higher number of men. The suicide group showed a higher mortality (23.8% vs. 6.5%, P=0.001) and a higher proportion of injuries in the lower extremities or abdomen. In the multivariate analysis, Glasgow Coma Scale score (0.575 [0.433–0.764], P<0.001), body mass index (1.638 [1.194–2.247], P=0.002), suicide intent (9.789 [1.026–93.404], P=0.047) and Injury Severity Score (1.091 [1.000–1.190], P=0.049) were identified as risk factors for mortality.
Conclusion
Suicidal falls were associated with poorer outcomes and a greater tendency to land feet first relative to accidental falls. Suicide intent was a risk factor for mortality.

Citations

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  • Differentiating injury patterns and outcomes in accidental, suicidal and occupational falls from heights
    Christoph Beyersdorf, Bjoern Hussmann, Niklas Wergen, Rolf Lefering, Erik Schiffner, Uwe Maus, Carina Jaekel, TraumaRegister DGU
    European Journal of Trauma and Emergency Surgery.2026;[Epub]     CrossRef
  • Vertebral injury patterns in suicidal vs homicidal falls: A forensic and physical therapy collaborative framework
    Asma Sattar, Mamona Ansari, Maryam Rafique, Hafiz Muhammad Abbas Malik, Akbar Ali
    Forensic Insights and Health Sciences Bulletin.2026; : 21.     CrossRef
  • Fracture Patterns in Fatal Free Falls: A Systematic Review of Intrinsic and Extrinsic Risk Factors and the Role of Postmortem CT
    Filip Woliński, Kacper Kraśnik, Łukasz Bryliński, Jolanta Sado, Justyna Sagan, Katarzyna Brylińska, Grzegorz Teresiński, Tomasz Cywka, Robert Karpiński, Jacek Baj
    Journal of Clinical Medicine.2025; 14(17): 6305.     CrossRef
  • Forensic Differentiation of Accidental and Intentional Falls from Height: A Systematic Review of Injury Patterns, Severity Scores, and Classification Indicators
    Abdulkreem Abdullah Al-Juhani, Naif Abdulaziz Aljohani, Abdulaziz A. Binshalhoub, Rodan Mahmoud Desoky, Rimaz M. Alotaibe
    The Saudi Journal of Forensic Medicine and Sciences.2025; 5(1): 6.     CrossRef
  • Do the management and functional outcomes of the surgically treated spinal fractures change in suicidal jumpers?
    Başar Burak Çakmur, Altuğ Duramaz, Kadriye Nur Çakmur, Altan Duramaz
    European Spine Journal.2024; 33(10): 3695.     CrossRef
  • Assessing Fall Mortality by Field-Relevant Categories at an Urban Level I Trauma Center
    Christopher Gross, Josué Menard, Jennifer Mull, Yohan Diaz-Zuniga, David Skarupa, Marie Crandall
    Journal of Surgical Research.2024; 300: 279.     CrossRef
  • Factors associated with the injury severity of falls from a similar height and features of the injury site: a retrospective study
    Dae Hyun Kim, Jae-Hyug Woo, Yang Bin Jeon, Jin-Seong Cho, Jae Ho Jang, Jea Yeon Choi, Woo Sung Choi
    Journal of Trauma and Injury.2023; 36(3): 187.     CrossRef
  • Characteristics of fall-from-height patients: a retrospective comparison of jumpers and fallers using a multi-institutional registry
    Jinhae Jun, Ji Hwan Lee, Juhee Han, Sun Hyu Kim, Sunpyo Kim, Gyu Chong Cho, Eun Jung Park, Duk Hee Lee, Ju Young Hong, Min Joung Kim
    Clinical and Experimental Emergency Medicine.2023; 11(1): 79.     CrossRef
  • Suicidological analysis of Moscow and Saint Petersburg in the context of the pandemic
    Vsevolod A. Rozanov, Natalia V. Semenova, Alexandr Ja. Vuks, Victoria V. Freize, Larisa V. Malyshko, Georgy P. Kostyuk, Vladimir D. Isakov, Orazmurad D. Yagmurov, Alexandr G. Sofronov, Nikolay G. Neznanov
    Ekologiya cheloveka (Human Ecology).2022; 29(4): 241.     CrossRef
  • 8,522 View
  • 126 Download
  • 7 Web of Science
  • 9 Crossref

Pulmonary

Predicting 30-day mortality of patients with pneumonia in an emergency department setting using machine-learning models
Soo Yeon Kang, Won Chul Cha, Junsang Yoo, Taerim Kim, Joo Hyun Park, Hee Yoon, Sung Yeon Hwang, Min Seob Sim, Ik Joon Jo, Tae Gun Shin
Clin Exp Emerg Med 2020;7(3):197-205.   Published online September 30, 2020
DOI: https://doi.org/10.15441/ceem.19.052

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Predicting 30-day mortality of patients with pneumonia in an emergency department setting using machine-learning models
Clin Exp Emerg Med. 2020;7(3):197-205.   Published online September 30, 2020
DOI: https://doi.org/10.15441/ceem.19.052
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Predicting 30-day mortality of patients with pneumonia in an emergency department setting using machine-learning models
Clin Exp Emerg Med. 2020;7(3):197-205.   Published online September 30, 2020
DOI: https://doi.org/10.15441/ceem.19.052
Close
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.

Citations

Citations to this article as recorded by  Crossref logo
  • Implementation of machine learning in emergency departments: A systematic review
    Banafshe Hosseini, Atushi Patel, Megan Landes, Samuel Vaillancourt, Muhammad Mamdani, Kevin Maruthananth, Neha Matharu, Zuha Pathan, Krishihan Sivapragasam, Onlak Ruangsomboon, Becky Skidmore, Andrew D Pinto
    DIGITAL HEALTH.2026;[Epub]     CrossRef
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Critical Care

Mortality difference between early-identified sepsis and late-identified sepsis
Woon Jee, Sion Jo, Jae Baek Lee, Youngho Jin, Taeoh Jeong, Jae Chol Yoon, Boyoung Park
Clin Exp Emerg Med 2020;7(3):150-160.   Published online September 30, 2020
DOI: https://doi.org/10.15441/ceem.19.009

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Mortality difference between early-identified sepsis and late-identified sepsis
Clin Exp Emerg Med. 2020;7(3):150-160.   Published online September 30, 2020
DOI: https://doi.org/10.15441/ceem.19.009
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Mortality difference between early-identified sepsis and late-identified sepsis
Clin Exp Emerg Med. 2020;7(3):150-160.   Published online September 30, 2020
DOI: https://doi.org/10.15441/ceem.19.009
Close
Objective
The aim of the study was to compare the mortality rates of patients with early-identified (EI) sepsis and late-identified (LI) sepsis.
Methods
We performed a retrospective chart review of patients admitted to the emergency department and diagnosed with sepsis. EI sepsis was defined as patients with a Sequential Organ Failure Assessment (SOFA) score ≥2, based on 3 parameters of the SOFA score (Glasgow coma scale, mean arterial pressure, and partial pressure of oxygen/fraction of inspired oxygen ratio), measured within an hour of emergency department admission. The remaining patients were defined as LI sepsis. The primary outcome was in-hospital mortality.
Results
Of the total 204 patients with sepsis, 113 (55.4%) had EI sepsis. Overall mortality rate was 15.7%, and EI sepsis group had significantly higher mortality than LI sepsis (23.0% vs. 6.6%, P=0.003). The patients with EI sepsis, compared to those with LI sepsis, had higher SOFA score (median: 4 vs. 2, P<0.001); Acute Physiology and Chronic Health Evaluation (APACHE) II score (median: 14 vs. 10, P<0.001); were more likely to progress to septic shock within 6 hours after admission (17.7% vs. 1.1%, P<0.001); were more likely to be admitted to the intensive care unit (2.2% vs. 1.1%, P=0.001).
Conclusion
Mortality was significantly higher in the EI sepsis group than in the LI sepsis group.

Citations

Citations to this article as recorded by  Crossref logo
  • Association of all glycemic spectrum with the risk of sepsis and mortality: two cohort studies in the UK and USA
    Yanqing Liu, Yanting Cao, Ying Chen, Ning Li, Weiping Li, Xue Wang, Chao Deng, Caie Wang, Yang Yang
    International Journal of Surgery.2026; 112(3): 6804.     CrossRef
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    Nikita Nunes Espat, Philip Lee, Samuel Baum, Brian Chin, Ruth Zagales, Zackary Yates, Quratulain Amin, Kathleen R. Schuemann, Adel Elkbuli
    The American Journal of Emergency Medicine.2025; 95: 133.     CrossRef
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    Loren Shamalov, Madison Heath, Elissa Lynch, Daniel A. Green, Angela Gomez-Simmonds, Daniel E. Freedberg
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    Myeong Namgung, Chiwon Ahn, Yeonkyung Park, Il-Youp Kwak, Jungguk Lee, Moonho Won
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    Byuk Sung Ko, Seung Mok Ryoo, Eunah Han, Hyunglan Chang, Chang June Yune, Hui Jai Lee, Gil Joon Suh, Sung-Hyuk Choi, Sung Phil Chung, Tae Ho Lim, Won Young Kim, Jang Won Sohn, Mi Ae Jeong, Sung Yeon Hwang, Tae Gun Shin, Kyuseok Kim
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  • 8,550 View
  • 161 Download
  • 8 Web of Science
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Use of the National Early Warning Score for predicting in-hospital mortality in older adults admitted to the emergency department
Inyong Kim, Hwan Song, Hyo Joon Kim, Kyu Nam Park, Soo Hyun Kim, Sang Hoon Oh, Chun Song Youn
Clin Exp Emerg Med 2020;7(1):61-66.   Published online March 31, 2020
DOI: https://doi.org/10.15441/ceem.19.036

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Use of the National Early Warning Score for predicting in-hospital mortality in older adults admitted to the emergency department
Clin Exp Emerg Med. 2020;7(1):61-66.   Published online March 31, 2020
DOI: https://doi.org/10.15441/ceem.19.036
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Use of the National Early Warning Score for predicting in-hospital mortality in older adults admitted to the emergency department
Clin Exp Emerg Med. 2020;7(1):61-66.   Published online March 31, 2020
DOI: https://doi.org/10.15441/ceem.19.036
Close
Objective
The National Early Warning Score (NEWS), based on the patients’ vital signs, detects clinical deterioration in critically ill patients and is used to reduce the incidence of in-hospital cardiac arrest. However, although mortality prediction based on vital signs may be difficult in older patients, the effectiveness of the NEWS has not yet been evaluated in this population. This study aimed to test the hypothesis that an elevated NEWS at admission increases the mortality risk in older patients admitted to the emergency department (ED).

Methods
We conducted a single-center retrospective study, including patients admitted to the ED between November 2016 and February 2017. We included patients aged >65 years who were admitted to the ED for any medical problem. The NEWS was calculated at the time of ED admission. The primary outcome was in-hospital mortality.

Results
In total, 3,169 patients were included in this study. Median age was 75 years (interquartile range [IQR], 70 to 80 years), and 1,557 (49.1%) patients were male. The in-hospital mortality rate was 5.1% (161 patients). Median NEWS was higher in non-survivors than in survivors (5 [IQR, 3–8] vs. 1 [IQR, 0–3], P<0.001). Multivariate logistic analysis showed that the NEWS was associated with in-hospital mortality, after adjusting for other confounders. The area under the curve of the NEWS for predicting in-hospital mortality was 0.820 (95% confidence interval, 0.806 to 0.833).

Conclusion
Our results show that the NEWS at admission is associated with in-hospital mortality among patients aged >65 years.

Citations

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Validation of quick sequential organ failure assessment score for poor outcome prediction among emergency department patients with suspected infection
Young Wha Sohn, Hye Young Jang, Suyeon Park, Youngjoo Lee, Young Shin Cho, Junbum Park, Heajin Chung, Sang-Il Kim
Clin Exp Emerg Med 2019;6(4):314-320.   Published online December 31, 2019
DOI: https://doi.org/10.15441/ceem.18.070

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Validation of quick sequential organ failure assessment score for poor outcome prediction among emergency department patients with suspected infection
Clin Exp Emerg Med. 2019;6(4):314-320.   Published online December 31, 2019
DOI: https://doi.org/10.15441/ceem.18.070
Download Citation

Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.
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Validation of quick sequential organ failure assessment score for poor outcome prediction among emergency department patients with suspected infection
Clin Exp Emerg Med. 2019;6(4):314-320.   Published online December 31, 2019
DOI: https://doi.org/10.15441/ceem.18.070
Close
Objective
The quick sequential organ failure assessment (qSOFA) score, which includes mentation, systolic blood pressure, and respiratory rate, was developed to identify serious sepsis in out-of-hospital or emergency department (ED) settings. We evaluated the ability of the qSOFA score to predict poor outcome in South Korean ED patients with suspected infection.
Methods
The qSOFA score was calculated for adult ED patients with suspected infection. Patients who received intravenous or oral antibiotics in the ED were considered to have infection. In-hospital mortality rate, admission rate, intensive care unit (ICU) admission rate, length of hospital stay (LOS), and lactate levels were compared between the qSOFA score groups. Receiver operating characteristic curves and area under the receiver operating characteristic curve values for in-hospital mortality were calculated according to qSOFA cut-off points and lactate levels.
Results
Of 2,698 patients, in-hospital mortality occurred in 134 (5.0%). The mortality rate increased with increasing qSOFA score (2.2%, 6.4%, 17.5%, and 42.4% for qSOFA scores 0, 1, 2, and 3, respectively, P<0.001). The admission rate, ICU admission rate, LOS, and lactate level also increased with increasing qSOFA score (all P<0.001). The area under the receiver operating characteristic curve values for predicting in-hospital mortality associated with qSOFA score, lactate ≥2 mmol/L, and lactate ≥4 mmol/L were 0.719 (95% confidence interval [CI], 0.670 to 0.768), 0.657 (95% CI, 0.603 to 0.710), and 0.632 (95% CI, 0.571 to 0.693), respectively.
Conclusion
Patients with a higher qSOFA score had higher admission, ICU admission, and in-hospital mortality rates, longer LOS, and higher lactate level. The qSOFA score showed better performance for predicting poor outcome than lactate level.

Citations

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  • Clinical utility of biomarkers for outcomes prediction in adults with suspected sepsis presenting to the emergency department: a synthesis of current evidence
    Mari Imamura, Sinead N Duggan, Thenmalar Vadiveloo, Jamie G Cooper, Callum T Kaye, Paul Manson, Gianni Virgili, Lorna Aucott, Mike Clarke, Miriam Brazzelli
    Health Technology Assessment.2026; : 1.     CrossRef
  • Outcome-Specific Prognostic Performance of Pneumonia Severity Assessment Tools for Predicting a Spectrum of Multiple Clinical Events
    Abuzer Özkan, Ahmet Taha Özatak, Soner Yeşilyurt
    Bratislava Medical Journal.2026;[Epub]     CrossRef
  • The Role of qSOFA, Derived Neutrophil-to-Lymphocyte Ratio, MEWS, and PIRO Scores in Predicting the Severity of Odontogenic Infections in Young and Adult Patients
    Serban Talpos Niculescu, Robert Avramut, Tareq Hajaj, Raluca Maracineanu, Antonis Perdiou, Roxana Talpos Niculescu, Marius Pricop, Horatiu Urechescu, Florin Urtila, Roxana Radu, Nicoleta Nikolajevic Stoican, Malina Popa
    Biomedicines.2025; 13(3): 532.     CrossRef
  • Sodium level in patients with sepsis: what is the predictive value?
    Zain Sayed, Ahmed A. Obiedallah, Soheir M. Kasem, Abdelraouf M.S. Abdelraouf, Kareem S.M. Ismail, Alaa O. Ahmed
    Research and Opinion in Anesthesia & Intensive Care.2025; 12(1): 35.     CrossRef
  • Lactate Enhanced Quick Sequential Organ Failure Assessment Score (Lqsofa) as a Tool to Predict the Prognosis in Patients of Sepsis in Surgical Intensive Care Unit
    Akash Sharma, Nitin Garg, Rahul Patel, Pooja Sharma
    International Journal of Recent Surgical and Medical Sciences.2025; 11: e015.     CrossRef
  • Comparative analysis of Glasgow Coma Scale, quick Sepsis-related Organ Failure Assessment, base excess, and lactate for mortality prediction in critically ill emergency department patients
    Gürbüz Meral, Şenol Ardıç, Serkan Günay, Kadir Güzel, Ahmet Köse, Hülya Gençbay Durmuş, Serhat Uysal, Aydın Coşkun
    Turkish Journal of Emergency Medicine.2024; 24(4): 231.     CrossRef
  • 9,064 View
  • 119 Download
  • 3 Web of Science
  • 6 Crossref

Emergency Medicine Practice and Administration

Concordance between the underlying causes of death on death certificates written by three emergency physicians
Hyeji Lee, Sun Hyu Kim, Byungho Choi, Minsu Ock, Eun Ji Park
Clin Exp Emerg Med 2019;6(3):218-225.   Published online September 30, 2019
DOI: https://doi.org/10.15441/ceem.18.050

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Concordance between the underlying causes of death on death certificates written by three emergency physicians
Clin Exp Emerg Med. 2019;6(3):218-225.   Published online September 30, 2019
DOI: https://doi.org/10.15441/ceem.18.050
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Concordance between the underlying causes of death on death certificates written by three emergency physicians
Clin Exp Emerg Med. 2019;6(3):218-225.   Published online September 30, 2019
DOI: https://doi.org/10.15441/ceem.18.050
Close
Objective
This study was conducted to evaluate the concordance between the underlying causes of death (UCOD) on the death certificates written by three emergency physicians (EPs). We investigated errors on the death certificates committed by each EP.
Methods
This study included 106 patients issued a death certificate in the emergency department of an academic hospital. Three EPs reviewed the medical records retrospectively and completed 106 death certificates independently. The selection of the UCOD on the death certificates by each EP (EP-UCOD) was based on the general principle or selection rules. The gold standard UCOD (GS-UCOD) was determined for each patient by unanimous consent between three EPs. We also compared between the EP-UCOD and the GS-UCOD. In addition, we compared between UCODs of three EPs. The errors on the death certificates were investigated by each EP.
Results
The rates of concordance between EP-UCOD and the GS-UCOD were 86%, 81%, and 67% for EP-A, EP-B, and EP-C, respectively. The concordance rates between EP-A and EP-B were the highest overall percent agreement (0.783), and those between EP-A and EP-C were the lowest overall percent agreement (0.651). Although each EP had differences in the errors they committed, none of them listed the mode of dying as UCOD.
Conclusion
This study confirmed that each EP wrote death certificates indicating different causes of death for the same decedents; however, the three EPs made fewer errors on the patients’ death certificates compared with those reported in previous studies.

Citations

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  • Nationwide estimates of all-cause and cause-specific mortality among individuals with gender dysphoria in Sweden, 2001–2023: a register-based cohort study
    Kristen D. Clark, Richard A. White, Sarah S. Jackson, Alkistis Skalkidou, Thomas Frisell, Fotios C. Papadopoulos
    eClinicalMedicine.2026; 98: 104088.     CrossRef
  • Do Death Certificate Errors Decrease as Clinical Experience in an Emergency Department Increases?
    Jung Jun Kim, Sun Hyu Kim, Sangyup Chung, Byeong Ju Park, Soobeom Park, Song Yi Park
    Journal of Korean Medical Science.2024;[Epub]     CrossRef
  • Causes of death in children with congenital anomalies up to age 10 in eight European countries
    Anke Rissmann, Joachim Tan, Svetlana V Glinianaia, Judith Rankin, Anna Pierini, Michele Santoro, Alessio Coi, Ester Garne, Maria Loane, Joanne Given, Abigail Reid, Amaia Aizpurua, Diana Akhmedzhanova, Elisa Ballardini, Ingeborg Barisic, Clara Cavero-Carbo
    BMJ Paediatrics Open.2023; 7(1): e001617.     CrossRef
  • Factors Associated with Major Errors on Death Certificates
    Sangyup Chung, Sun-Hyu Kim, Byeong-Ju Park, Soobeom Park
    Healthcare.2022; 10(4): 726.     CrossRef
  • Errors in pediatric death certificates issued in an emergency department
    Byeong Ju Park, Sun Hyu Kim
    Pediatric Emergency Medicine Journal.2022; 9(1): 17.     CrossRef
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  • 131 Download
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  • 5 Crossref

Trauma | Emergency Medical Services

New prehospital scoring system for traumatic brain injury to predict mortality and severe disability using motor Glasgow Coma Scale, hypotension, and hypoxia: a nationwide observational study
Min Chul Gang, Ki Jeong Hong, Sang Do Shin, Kyoung Jun Song, Young Sun Ro, Tae Han Kim, Jeong Ho Park, Joo Jeong
Clin Exp Emerg Med 2019;6(2):152-159.   Published online June 28, 2019
DOI: https://doi.org/10.15441/ceem.18.027

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New prehospital scoring system for traumatic brain injury to predict mortality and severe disability using motor Glasgow Coma Scale, hypotension, and hypoxia: a nationwide observational study
Clin Exp Emerg Med. 2019;6(2):152-159.   Published online June 28, 2019
DOI: https://doi.org/10.15441/ceem.18.027
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New prehospital scoring system for traumatic brain injury to predict mortality and severe disability using motor Glasgow Coma Scale, hypotension, and hypoxia: a nationwide observational study
Clin Exp Emerg Med. 2019;6(2):152-159.   Published online June 28, 2019
DOI: https://doi.org/10.15441/ceem.18.027
Close
Objective
Assessing the severity of injury and predicting outcomes are essential in traumatic brain injury (TBI). However, the respiratory rate and Glasgow Coma Scale (GCS) of the Revised Trauma Score (RTS) are difficult to use in the prehospital setting. This investigation aimed to develop a new prehospital trauma score for TBI (NTS-TBI) to predict mortality and disability.
Methods
We used a nationwide trauma database on severe trauma cases transported by fire departments across Korea in 2013 and 2015. NTS-TBI model 1 used systolic blood pressure <90 mmHg, peripheral capillary oxygen saturation <90% measured via pulse oximeter, and motor component of GCS. Model 2 comprised variables of model 1 and age >65 years. We assessed discriminative power via area under the curve (AUC) value for in-hospital mortality and disability defined according to the Glasgow Outcome Scale with scores of 2 or 3. We then compared AUC values of NTS-TBI with those of RTS.
Results
In total, 3,642 patients were enrolled. AUC values of NTS-TBI models 1 and 2 for mortality were 0.833 (95% confidence interval [CI], 0.815 to 0.852) and 0.852 (95% CI, 0.835 to 0.869), respectively, while AUC values for disability were 0.772 (95% CI, 0.749 to 0.796) and 0.784 (95% CI, 0.761 to 0.807), respectively. AUC values of NTS-TBI model 2 for mortality and disability were higher than those of RTS (0.819 and 0.761, respectively) (P<0.01).
Conclusion
Our NTS-TBI model using systolic blood pressure, motor component of GCS, oxygen saturation, and age was feasible for prehospital care and showed outstanding discriminative power for mortality.

Citations

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  • Pragmatic Early Predictors of Survival After Trauma
    Alexandra M.P. Brito, Leah C. Tatebe, Castigliano M. Bhamidipati, Francis X. Guyette, Stephen R. Wisinewski, James F. Luther, Jason L. Sperry, Martin A. Schreiber
    Journal of Surgical Research.2025; 314: 245.     CrossRef
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    Francesca Pisano, Federico Bilotta
    Journal of Head Trauma Rehabilitation.2024; 39(4): 273.     CrossRef
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    Diego Moreno-Blanco, Erik Alonso, Ancor Sanz-García, Elisabete Aramendi, Raúl López-Izquierdo, Rubén Perez García, Carlos del Pozo Vegas, Francisco Martín-Rodríguez
    Clinical Medicine.2024; 24(3): 100208.     CrossRef
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    Mahmoud D. Al-Fadhl, Marie Nour Karam, Jenny Chen, Sufyan K. Zackariya, Morgan C. Lain, John R. Bales, Alexis B. Higgins, Jordan T. Laing, Hannah S. Wang, Madeline G. Andrews, Anthony V. Thomas, Leah Smith, Mark D. Fox, Saniya K. Zackariya, Samuel J. Thom
    Journal of Clinical Medicine.2024; 13(13): 3915.     CrossRef
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    Subas Ali, Talha Bhatti, Shehzadi Rimsha, Rabia Masroor Hashmi, Sumayah Khan, Waqas Rind, Raja Muhammad Mussab
    Cureus.2024;[Epub]     CrossRef
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    Hui Dang, Wenlong Su, Zhiqing Tang, Shouwei Yue, Hao Zhang
    Frontiers in Neuroscience.2023;[Epub]     CrossRef
  • Prehospital Guidelines for the Management of Traumatic Brain Injury – 3rd Edition
    Al Lulla, Angela Lumba-Brown, Annette M. Totten, Patrick J. Maher, Neeraj Badjatia, Randy Bell, Christina T. J. Donayri, Mary E. Fallat, Gregory W. J. Hawryluk, Scott A. Goldberg, Halim M. A. Hennes, Steven P. Ignell, Jamshid Ghajar, Brian P. Krzyzaniak,
    Prehospital Emergency Care.2023; 27(5): 507.     CrossRef
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    Tatyana Mollayeva, Andrew Tran, Vincy Chan, Angela Colantonio, Mitchell Sutton, Michael D. Escobar
    Scientific Reports.2022;[Epub]     CrossRef
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    Anand P. Nair, E. P. Unnikrishnan
    Kerala Surgical Journal.2021; 27(1): 33.     CrossRef
  • Identification of Serious Adverse Events in Patients with Traumatic Brain Injuries, from Prehospital Care to Intensive-Care Unit, Using Early Warning Scores
    Francisco Martín-Rodríguez, Raúl López-Izquierdo, Alicia Mohedano-Moriano, Begoña Polonio-López, Clara Maestre Miquel, Antonio Viñuela, Carlos Durantez Fernández, Jesús Gómez Correas, Gonçalo Marques, José Luis Martín-Conty
    International Journal of Environmental Research and Public Health.2020; 17(5): 1504.     CrossRef
  • 11,096 View
  • 202 Download
  • 8 Web of Science
  • 10 Crossref

Critical Care | Epidemiology

Epidemiology of sepsis in Korea: a population-based study of incidence, mortality, cost and risk factors for death in sepsis
Joonghee Kim, Kyuseok Kim, Heeyoung Lee, Soyeon Ahn
Clin Exp Emerg Med 2019;6(1):49-63.   Published online February 20, 2019
DOI: https://doi.org/10.15441/ceem.18.007

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Epidemiology of sepsis in Korea: a population-based study of incidence, mortality, cost and risk factors for death in sepsis
Clin Exp Emerg Med. 2019;6(1):49-63.   Published online February 20, 2019
DOI: https://doi.org/10.15441/ceem.18.007
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Epidemiology of sepsis in Korea: a population-based study of incidence, mortality, cost and risk factors for death in sepsis
Clin Exp Emerg Med. 2019;6(1):49-63.   Published online February 20, 2019
DOI: https://doi.org/10.15441/ceem.18.007
Close
Objective
To investigate the epidemiology of sepsis in Korea and identify risk factors for death in sepsis.
Methods
We conducted a longitudinal, population-based epidemiological study of sepsis in Korea from 2005 to 2012 using the National Health Insurance Service-National Sample Cohort, a population-based cohort representing 2.2% of the Korean population. The primary objective was to assess the incidence, mortality and cost of sepsis. The secondary objective was to identify the risk factors for death in sepsis. Claim records of admitted adult patients (aged ≥15 years) were analyzed. Sepsis was defined as 1) bacterial or fungal infection or the conditions they often complicate, 2) prescription of intravenous antibiotics, and 3) presence of any organ dysfunction. Comorbidities were defined using the Charlson/Deyo method. Risk factors for 6-month mortality were assessed using multivariable logistic regression.
Results
A total of 22,882 cases were identified. Both incidence and 6-month mortality increased from 265.7 (95% confidence interval [CI], 254.7 to 277.1) to 453.1 (95% CI, 439.0 to 467.5) per 100,000 person-years (P-trend <0.001) and from 26.5% (95% CI, 24.4% to 28.8%) to 30.1% (95% CI, 28.4% to 31.9%), respectively. After standardization, the increasing trend of incidence was slower but still significant (P-trend <0.001), while that for mortality was not (P-trend 0.883). The average cost increased by 75.5% (P-trend <0.001). Multivariable logistic regression identified various risk factors for mortality.
Conclusion
The burden of sepsis in Korea was high and is expected to increase considering the aging population. Proactive measures to curtail this increase should be sought and implemented.

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    Seung Jin Maeng, Jong Eun Park, Gun Tak Lee, Sung Yeon Hwang, Minha Kim, Sejin Heo, Tae Ho Lim, Sung Phil Chung, Sung-Hyuk Choi, Tae Gun Shin
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    Myeong Hee Kim, So Young Kang, Woo-In Lee, Min Young Lee
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    Sumin Baek, Inwon Park, Seonghye Kim, Young Woo Um, Hee Eun Kim, Kyunghoon Lee, Jae Hyuk Lee, You Hwan Jo
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    Lowell Ling, Jack Zhenhe Zhang, Lok Ching Chang, Lok Ching Sandra Chiu, Samantha Ho, Pauline Yeung Ng, Manimala Dharmangadan, Chi Ho Lau, Steven Ling, Man Yee Man, Ka Man Fong, Ting Liong, Alwin Wai Tak Yeung, Gary Ka Fai Au, Jacky Ka Hing Chan, Michele T
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    Tae Gun Shin, Eunsil Ko, So-hyun Han, Taehui Kim, Dai Hai Choi
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    Tobias Schupp, Kathrin Weidner, Jonas Rusnak, Schanas Jawhar, Jan Forner, Floriana Dulatahu, Jonas Dudda, Lea Marie Brück, Ursula Hoffmann, Thomas Bertsch, Ibrahim Akin, Michael Behnes
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    Lavi Oud, John Garza
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    Chan Hee Park, Jeong Woo Lee, Hak Jae Lee, Dong Kyu Oh, Mi Hyeon Park, Chae-Man Lim, Suk-Kyung Hong, Chae-Man Lim, Sang-Bum Hong, Dong Kyu Oh, Gee Young Suh, Kyeongman Jeon, Ryoung-Eun Ko, Young-Jae Cho, Yeon Joo Lee, Sung Yoon Lim, Sunghoon Park, Chae-Ma
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    Kyuseok Kim
    Clinical and Experimental Emergency Medicine.2022; 9(4): 269.     CrossRef
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    Jin Hee Kim, Dong-Hyun Jang, You Hwan Jo, Gil Joon Suh, Woon Yong Kwon, Jae Hyuk Lee, Jonghwan Shin, Inwon Park, Che Uk Lee, Sang-Min Lee
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    Vignesh Raman, Kevin B. Laupland
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    A la Woo, Dong Kyu Oh, Chan-Jeoung Park, Sang-Bum Hong, Aleksandar R. Zivkovic
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  • 14,461 View
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Efficacy of quick Sequential Organ Failure Assessment with lactate concentration for predicting mortality in patients with community-acquired pneumonia in the emergency department
Hwan Song, Hyung Gi Moon, Soo Hyun Kim
Clin Exp Emerg Med 2019;6(1):1-8.   Published online February 20, 2019
DOI: https://doi.org/10.15441/ceem.17.262

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Efficacy of quick Sequential Organ Failure Assessment with lactate concentration for predicting mortality in patients with community-acquired pneumonia in the emergency department
Clin Exp Emerg Med. 2019;6(1):1-8.   Published online February 20, 2019
DOI: https://doi.org/10.15441/ceem.17.262
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Efficacy of quick Sequential Organ Failure Assessment with lactate concentration for predicting mortality in patients with community-acquired pneumonia in the emergency department
Clin Exp Emerg Med. 2019;6(1):1-8.   Published online February 20, 2019
DOI: https://doi.org/10.15441/ceem.17.262
Close
Objective
Community-acquired pneumonia (CAP) is a major cause of sepsis, and sepsis-related acute organ dysfunction affects patient mortality. Although the quick Sequential Organ Failure Assessment (qSOFA) is a new screening tool for patients with suspected infection, its predictive value for the mortality of patients with CAP has not been validated. Lactate concentration is a valuable biomarker for critically ill patients. Thus, we investigated the predictive value of qSOFA with lactate concentration for in-hospital mortality in patients with CAP in the emergency department (ED).
Methods
From January 2015 to June 2015, 443 patients, who were diagnosed with CAP in the ED, were retrospectively analyzed. We defined high qSOFA or lactate concentrations as a qSOFA score ≥2 or a lactate concentration >2 mmol/L upon admission at the ED. The primary outcome was all-cause in-hospital mortality.
Results
Among the 443 patients, 44 (9.9%) died. Based on the receiver operating characteristic (ROC) analysis, the areas under the curves for the prediction of mortality were 0.720, 0.652, and 0.686 for qSOFA, CURB-65 (confusion, urea, respiratory rate, blood pressure, and age), and Pneumonia Severity Index, respectively. The area under the ROC curve of qSOFA was lower than that of SOFA (0.720 vs. 0.845, P=0.004). However, the area under the ROC curve of qSOFA with lactate concentration was not significantly different from that of SOFA (0.828 vs. 0.845, P=0.509). The sensitivity and specificity of qSOFA with lactate concentration were 71.4% and 83.2%, respectively.
Conclusion
qSOFA with lactate concentration is a useful and practical tool for the early prediction of in-hospital mortality among patients with CAP in the ED.

Citations

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  • Comparison of Shock Indexes, Lactate Level, and Base Deficit in Predicting Mortality in Community-Acquired Pneumonia: A Retrospective Analysis
    İlter Ağaçkıran, Merve Ağaçkıran
    Anatolian Journal of Emergency Medicine.2025; 8(4): 182.     CrossRef
  • Comparative Effectiveness of CURB-65 and qSOFA Scores in Predicting Pneumonia Outcomes: A Systematic Review
    Abdulhadi Gelaidan, Mohanad Almaimani, Yara A Alorfi, Anas Alqahtani, Nawaf G Alaklabi, Shahad M Alshamrani, Raneem Rambo, Joury A Mujahed, Ruba Y Alsulami, Mohammed Namenkani
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    Xiaojing Wu, Ting Sun, Ying Cai, Tianshu Zhai, Yijie Liu, Sichao Gu, Yun Zhou, Qingyuan Zhan
    Frontiers in Public Health.2023;[Epub]     CrossRef
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    Arturo Artero, Manuel Madrazo, Mar Fernández-Garcés, Antonio Muiño Miguez, Andrés González García, Anxela Crestelo Vieitez, Elena García Guijarro, Eva María Fonseca Aizpuru, Miriam García Gómez, María Areses Manrique, Carmen Martinez Cilleros, María del P
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    Manuel Madrazo, Ian López‐Cruz, Rafael Zaragoza, Laura Piles, José María Eiros, Juan Alberola, Arturo Artero
    International Journal of Clinical Practice.2021;[Epub]     CrossRef
  • Comparison of Different Scoring Systems for Prediction of Mortality and ICU Admission in Elderly CAP Population
    Chunxin Lv, Yue Chen, Wen Shi, Teng Pan, Jinhai Deng, Jiayi Xu
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    Katherine Adams, Mark W. Tenforde, Shreya Chodisetty, Benjamin Lee, Eric J. Chow, Wesley H. Self, Manish M. Patel
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    Julien Goutay, Juliette Perche, Aurelia Toussaint, Elodie Drumez, Michael Howsam, Claire Bourel, Benoit Brassart, Alexandre Pierre, Morgan Caplan, Arthur Durand, Marion Houard, Saad Nseir, Raphael Favory, Sébastien Preau, Samuel A. Tisherman
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  • Clinical Value of Whole Blood Procalcitonin Using Point of Care Testing, Quick Sequential Organ Failure Assessment Score, C-Reactive Protein and Lactate in Emergency Department Patients with Suspected Infection
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  • 14,194 View
  • 257 Download
  • 21 Web of Science
  • 16 Crossref

Gastrointestinal

Comparison of the National Early Warning Score+Lactate score with the pre-endoscopic Rockall, Glasgow-Blatchford, and AIMS65 scores in patients with upper gastrointestinal bleeding
Daejin Kim, Sion Jo, Jae Baek Lee, Youngho Jin, Taeoh Jeong, Jaechol Yoon, Boyoung Park
Clin Exp Emerg Med 2018;5(4):219-229.   Published online December 31, 2018
DOI: https://doi.org/10.15441/ceem.17.268

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Comparison of the National Early Warning Score+Lactate score with the pre-endoscopic Rockall, Glasgow-Blatchford, and AIMS65 scores in patients with upper gastrointestinal bleeding
Clin Exp Emerg Med. 2018;5(4):219-229.   Published online December 31, 2018
DOI: https://doi.org/10.15441/ceem.17.268
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Comparison of the National Early Warning Score+Lactate score with the pre-endoscopic Rockall, Glasgow-Blatchford, and AIMS65 scores in patients with upper gastrointestinal bleeding
Clin Exp Emerg Med. 2018;5(4):219-229.   Published online December 31, 2018
DOI: https://doi.org/10.15441/ceem.17.268
Close
Objective
We compared the predictive value of the National Early Warning Score+Lactate (NEWS+L) score with those of other parameters such as the pre-endoscopic Rockall score (PERS), Glasgow-Blatchford score (GBS), and albumin, international normalized ratio, altered mental status, systolic blood pressure, age older than 65 years score (AIMS65) among patients with upper gastrointestinal bleeding (UGIB).
Methods
We conducted a retrospective study of patients with UGIB during 2 consecutive years. The primary outcome was the composite of in-hospital death, intensive care unit admission, and the need for ≥5 packs of red blood cell transfusion within 24 hours.
Results
Among 530 included patients, the composite outcome occurred in 59 patients (19 in-hospital deaths, 13 intensive care unit admissions, and 40 transfusions of ≥5 packs of red blood cells within 24 hours). The area under the receiver operating characteristic curve of the NEWS+L score for the composite outcome was 0.76 (95% confidence interval, 0.70 to 0.82), which demonstrated a significant difference compared to PERS (0.66, 0.59–0.73, P=0.004), but not to GBS (0.70, 0.64–0.77, P=0.141) and AIMS65 (0.76, 0.70–0.83, P=0.999). The sensitivities of NEWS+L scores of 3 (n=34, 6.4%), 4 (n=92, 17.4%), and 5 (n=171, 32.3%) were 100%, 98.3%, and 96.6%, respectively, while the sensitivity of an AIMS65 score of 0 (n=159, 30.0%) was 91.5%.
Conclusion
The NEWS+L score showed better discriminative performance than the PERS and comparable discriminative performance to the GBS and AIMS65. The NEWS+L score may be used to identify low-risk patients among patients with UGIB.

Citations

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  • Mortality prediction among ED patients with upper gastrointestinal bleeding: Comparison of NEWS-2 and conventional risk scores
    Harun Yildirim, Murtaza Kaya, Suleyman Cosgun
    The American Journal of Emergency Medicine.2026; 101: 14.     CrossRef
  • Predictive Value of the Combination of Lactate and qSOFA Score for Clinical Outcomes in Cirrhotic Patients with Esophagogastric Variceal Bleeding
    Mengyun Li, Nan Geng, Zhao Liu, Wen Pan, Chunlian Lai, Yingying Cui, Yixin Miao, Yueke Zhu, Benyong Yan, Haoqi Li, JingJing Wang, Bo Liu
    International Journal of General Medicine.2026; Volume 19: 1.     CrossRef
  • Evaluating the Performance of Four Risk Assessment Scores in Nonvariceal Upper Gastrointestinal Bleeding
    Omer Kheir, Mohammed Ghamdi, Sheikha Dossary, Anwar B Alotaibi, Elrasheed M Elsabani, Hanin Fahad, Mona Alfaifi
    Cureus.2025;[Epub]     CrossRef
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    Necip Gökhan Güner, Fatih Çatal, Yusuf Yürümez, Fatih Güneysu, Furkan Bostancı
    BMC Emergency Medicine.2025;[Epub]     CrossRef
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    Elrasheed M Elsabani, Badr A Badr, Mohammad Dhalaan , Anwar Alotaibi, Abdulrahman Alrujaib , Rabab Alahmed, Abdulrahman Alabbadi, Omer Kheir
    Cureus.2024;[Epub]     CrossRef
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    Anabela Rodrigues, Luciana Ricca Gonçalves, Tiago Gregório, Cilénia Baldaia, Gustavo C. Santo, João Gouveia
    Journal of Clinical Medicine.2024; 13(22): 6842.     CrossRef
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    Özkan Abuzer
    Disaster Medicine and Public Health Preparedness.2023;[Epub]     CrossRef
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    Sion Jo, Taeoh Jeong, Boyoung Park
    Emergency Medicine Journal.2023; 40(6): 444.     CrossRef
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    Mustafa Can Guzelce, Nese Colak, Gucluhan Ucar, Ertug Orhan
    ESC Heart Failure.2023; 10(6): 3604.     CrossRef
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    Carlos Durantez-Fernández, José L. Martín-Conty, Begoña Polonio-López, Miguel Ángel Castro Villamor, Clara Maestre-Miquel, Antonio Viñuela, Raúl López-Izquierdo, Laura Mordillo-Mateos, Felipe Fernández Méndez, Cristina Jorge Soto, Francisco Martín-Rodrígu
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    Mark Holland, John Kellett
    European Journal of Internal Medicine.2022; 98: 15.     CrossRef
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    Sion Jo
    The American Journal of Emergency Medicine.2021; 39: 247.     CrossRef
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    Lan Chen, Han Zheng, Lijun Chen, Sunying Wu, Saibin Wang
    Journal of Multidisciplinary Healthcare.2021; Volume 14: 2067.     CrossRef
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    Nitesh Kumar, Diwakar Verma, Kapil Gupta, Madhu Kiran, Shatrughan Pareek, Mahish Mehta
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  • Prehospital Point-Of-Care Lactate Increases the Prognostic Accuracy of National Early Warning Score 2 for Early Risk Stratification of Mortality: Results of a Multicenter, Observational Study
    Francisco Martín-Rodríguez, Raúl López-Izquierdo, Juan F. Delgado Benito, Ancor Sanz-García, Carlos del Pozo Vegas, Miguel Ángel Castro Villamor, José Luis Martín-Conty, Guillermo J. Ortega
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    Stephen Gerry, Timothy Bonnici, Jacqueline Birks, Shona Kirtley, Pradeep S Virdee, Peter J Watkinson, Gary S Collins
    BMJ.2020; : m1501.     CrossRef
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    Kathryn Oakland
    Best Practice & Research Clinical Gastroenterology.2019; 42-43: 101613.     CrossRef
  • 11,068 View
  • 159 Download
  • 16 Web of Science
  • 17 Crossref

Critical Care

Korean Shock Society septic shock registry: a preliminary report
Tae Gun Shin, Sung Yeon Hwang, Gu Hyun Kang, Won Young Kim, Seung Mok Ryoo, Kyuseok Kim, You Hwan Jo, Sung Phil Chung, Young Seon Joo, Jin Ho Beom, Sung-Hyuk Choi, Young Hoon Yoon, Woon Yong Kwon, Tae Ho Lim, Kap Su Han, Han Sung Choi, Gil Joon Suh
Clin Exp Emerg Med 2017;4(3):146-153.   Published online September 30, 2017
DOI: https://doi.org/10.15441/ceem.17.204

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Korean Shock Society septic shock registry: a preliminary report
Clin Exp Emerg Med. 2017;4(3):146-153.   Published online September 30, 2017
DOI: https://doi.org/10.15441/ceem.17.204
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Korean Shock Society septic shock registry: a preliminary report
Clin Exp Emerg Med. 2017;4(3):146-153.   Published online September 30, 2017
DOI: https://doi.org/10.15441/ceem.17.204
Close
Objective
To evaluate the clinical characteristics, therapeutic interventions, and outcomes of patients with septic shock admitted to the emergency department (ED). Methods This study was a preliminary, descriptive analysis of a prospective, multi-center, observational registry of the EDs of 10 hospitals participating in the Korean Shock Society. Patients aged 19 years or older who had a suspected or confirmed infection and evidence of refractory hypotension or hypoperfusion were included. Results A total of 468 patients were enrolled (median age, 71.3 years; male, 55.1%; refractory hypotension, 82.9%; hyperlactatemia without hypotension, 17.1%). Respiratory infection was the most common source of infection (31.0%). The median Sepsis-related Organ Failure Assessment score was 7.5. The sepsis bundle compliance was 91.2% for lactate measurement, 70.3% for blood culture, 68.4% for antibiotic administration, 80.3% for fluid resuscitation, 97.8% for vasopressor application, 68.0% for central venous pressure measurement, 22.0% for central venous oxygen saturation measurement, and 59.2% for repeated lactate measurement. Among patients who underwent interventions for source control (n=117, 25.1%), 43 (36.8%) received interventions within 12 hours of ED arrival. The in-hospital, 28-day, and 90-day mortality rates were 22.9%, 21.8%, and 27.1%, respectively. The median ED and hospital lengths of stay were 6.8 hours and 12 days, respectively. Conclusion This preliminary report revealed a mortality of over 20% in patients with septic shock, which suggests that there are areas for improvement in terms of the quality of initial resuscitation and outcomes of septic shock patients in the ED.

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    Sejoong Ahn, Bo-Yeong Jin, Sukyo Lee, Sungjin Kim, Sungwoo Moon, Hanjin Cho, Kap Su Han, You Hwan Jo, Kyuseok Kim, Jonghwan Shin, Gil Joon Suh, Woon Yong Kwon, Tae Gun Shin, Han Sung Choi, Sangchun Choi, Yoo Seok Park, Sung Phil Chung, Won Young Kim, Hong
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    Ling Yan Leung, Hsi-Lan Huang, Kevin KC Hung, Chi Yan Leung, Cherry CY Lam, Ronson SL Lo, Chun Yu Yeung, Peter Joseph Tsoi, Michael Lai, Mikkel Brabrand, Joseph H Walline, Colin A Graham
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Renal & Genitourinary | Medical Emergencies

A retrospective study of emergency department potassium disturbances: severity, treatment, and outcomes
Adam J Singer, Henry C Thode Jr, W Frank Peacock
Clin Exp Emerg Med 2017;4(2):73-79.   Published online June 30, 2017
DOI: https://doi.org/10.15441/ceem.16.194

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A retrospective study of emergency department potassium disturbances: severity, treatment, and outcomes
Clin Exp Emerg Med. 2017;4(2):73-79.   Published online June 30, 2017
DOI: https://doi.org/10.15441/ceem.16.194
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A retrospective study of emergency department potassium disturbances: severity, treatment, and outcomes
Clin Exp Emerg Med. 2017;4(2):73-79.   Published online June 30, 2017
DOI: https://doi.org/10.15441/ceem.16.194
Close
Objective
Disturbances in potassium (K) levels are relatively common and may be associated with significant morbidity and mortality; however, treatments vary. Our purpose was to determine the incidence, treatments, and outcomes associated with hyperkalemia and hypokalemia in emergency department (ED) patients.
Methods
We performed a structured, retrospective review of electronic medical records of consecutive adult ED patients with K measured while in the ED. Demographic, clinical, and laboratory data as well as treatments, disposition, and in-hospital complications were collected. Univariate and multivariate analyses, presented as adjusted odds ratios, were used to compare outcomes by K levels.
Results
Of 100,260 visits in 2014, an ED K level was ordered in 48,827 (49%). A total of 1,738 patients (3.6%) were excluded because of sample hemolysis. The K was low (<3.5 mEq/L) in 5.5%, normal (3.5 to 5.0 mEq/L) in 90.9%, and elevated (>5.0 mEq/L) in 3.6% of patients. Patients with hyperkalemia were older (64 vs. 49 years, P<0.001) and more likely male (58% vs. 40%, P<0.001). Treatment for hyperkalemia varied greatly. After adjusting for confounders, both hyperkalemia and hypokalemia were associated with inpatient hospitalization and death. At least one medication was used to manage hyperkalemia in 11.5% of patients with a K of 5.1 to 5.4 mEq/L, 36.4% of those with a K 5.5 to 6 mEq/L and 77.0% of the cohort with K >6 mEq/L.
Conclusion
Hyperkalemia or hypokalemia occur in 1 of 11 ED patients and are associated with inpatient admission and mortality. Treatment of hyperkalemia varies greatly suggesting the need for evidence-based treatment guidelines.

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    John Dewey, Joshua Mastenbrook, Laura D Bauler
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Clinical Laboratory

High-sensitivity C-reactive protein/albumin ratio as a predictor of in-hospital mortality in older adults admitted to the emergency department
Jaehun Oh, Soo Hyun Kim, Kyu Nam Park, Sang Hoon Oh, Young Min Kim, Han Joon Kim, Chun Song Youn
Clin Exp Emerg Med 2017;4(1):19-24.   Published online March 30, 2017
DOI: https://doi.org/10.15441/ceem.16.158

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High-sensitivity C-reactive protein/albumin ratio as a predictor of in-hospital mortality in older adults admitted to the emergency department
Clin Exp Emerg Med. 2017;4(1):19-24.   Published online March 30, 2017
DOI: https://doi.org/10.15441/ceem.16.158
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High-sensitivity C-reactive protein/albumin ratio as a predictor of in-hospital mortality in older adults admitted to the emergency department
Clin Exp Emerg Med. 2017;4(1):19-24.   Published online March 30, 2017
DOI: https://doi.org/10.15441/ceem.16.158
Close
Objective
The objective of this study was to test the hypothesis that an elevated high-sensitivity C-reactive protein (hs-CRP)/albumin ratio at admission increases the risk of mortality in older patients admitted to the hospital via the emergency department (ED).
Methods
We performed a retrospective analysis of patients admitted to the ED with any medical problem between May 2013 and October 2013 who were older than 65 years. The hs-CRP and albumin levels were measured at the time of admission to the ED. The primary outcome was all-cause in-hospital mortality. Multivariate logistic analysis was performed.
Results
A total of 811 patients were finally included in this study. The mean age was 76±7 years, and 438 subjects (54%) were male. The in-hospital mortality rate was 9.0% (73 patients). The hs-CRP/albumin ratio was higher in nonsurvivors than in survivors (34.2±37.6 vs. 16.2±25.5, P<0.001). Multivariate logistic analysis showed that the hs-CRP/albumin ratio was associated with all-cause in-hospital mortality after adjusting for other confounding factors (odds ratio, 1.011; 95% confidence interval [CI], 1.003 to 1.020). The prognostic value of the hs-CRP/albumin ratio for predicting mortality (area under the curve, 0.728; 95% CI, 0.696 to 0.758) was greater than that of hs-CRP alone (area under the curve, 0.706; 95% CI, 0.674 to 0.738; P<0.001).
Conclusion
The hs-CRP/albumin ratio at admission to the ED is associated with all-cause in-hospital mortality among patients older than 65 years. The hs-CRP/albumin ratio may serve as a surrogate marker of disease severity.

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Critical Care

Association between persistent tachycardia and tachypnea and in-hospital mortality among non-hypotensive emergency department patients admitted to the hospital
Michael A Puskarich, Utsav Nandi, Ben G Long, Alan E Jones
Clin Exp Emerg Med 2017;4(1):2-9.   Published online March 30, 2017
DOI: https://doi.org/10.15441/ceem.16.144

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Association between persistent tachycardia and tachypnea and in-hospital mortality among non-hypotensive emergency department patients admitted to the hospital
Clin Exp Emerg Med. 2017;4(1):2-9.   Published online March 30, 2017
DOI: https://doi.org/10.15441/ceem.16.144
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Association between persistent tachycardia and tachypnea and in-hospital mortality among non-hypotensive emergency department patients admitted to the hospital
Clin Exp Emerg Med. 2017;4(1):2-9.   Published online March 30, 2017
DOI: https://doi.org/10.15441/ceem.16.144
Close
Objective
Vital sign trends are used in clinical practice to assess treatment response and aid in disposition, yet quantitative data to support this practice are lacking. This study aimed to determine the prognostic value of vital sign normalization.
Methods
Secondary analysis of a prospective cohort of adult emergency department (ED) patients admitted a single urban tertiary care hospital. A random sample of 182 days was chosen, and a manual review of all admissions was undertaken. Persistent tachycardia or tachypnea was defined as failure to decrease to a normal value in the ED. Elevated upon admission was defined as an abnormal value at the last set of vital signs documented. The primary outcome was in-hospital mortality.
Results
4,878 patients were enrolled and 4.5 (±3.8) sets of vital signs were checked per patient. 1,770 patients were tachycardic and 1,499 were tachypneic. Among tachycardic patients, 941 (53%) were persistently tachycardic and 1,074 (61%) were tachycardic upon admission. Among tachypneic patients 639 (42%) were persistently tachypneic and 768 (51%) were tachypneic upon admission. Mortality was higher in patients persistently tachycardic (5.7% vs. 3.1%, P=0.008) or tachycardic upon admission (5.5% vs. 3.0%, P=0.014). Similar results were found in tachypneic patients (8.3% vs. 4.5%, P=0.003; 7.8% vs. 4.4%, P=0.006).
Conclusion
Persistent tachycardia and tachypnea are associated with an increased risk of mortality in ED patients admitted to the hospital. Further study is necessary to determine if improved recognition or earlier interventions can affect outcomes.

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Toxicology

Clinical outcomes of adverse cardiovascular events in patients with acute dapsone poisoning
Kyung Sik Kang, Hyung Il Kim, Oh Hyun Kim, Kyoung Chul Cha, Hyun Kim, Kang Hyun Lee, Sung Oh Hwang, Yong Sung Cha
Clin Exp Emerg Med 2016;3(1):41-45.   Published online March 31, 2016
DOI: https://doi.org/10.15441/ceem.15.088

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Clinical outcomes of adverse cardiovascular events in patients with acute dapsone poisoning
Clin Exp Emerg Med. 2016;3(1):41-45.   Published online March 31, 2016
DOI: https://doi.org/10.15441/ceem.15.088
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Clinical outcomes of adverse cardiovascular events in patients with acute dapsone poisoning
Clin Exp Emerg Med. 2016;3(1):41-45.   Published online March 31, 2016
DOI: https://doi.org/10.15441/ceem.15.088
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Objective
Adverse cardiovascular events (ACVEs) account for a large proportion of the morbidities and mortalities associated with drug overdose emergencies. However, there are no published reports regarding outcomes of ACVEs associated with acute dapsone poisoning. Here, the authors retrospectively analyzed ACVEs reported within 48 hours of treatment in patients with acute dapsone poisoning and assessed the significance of ACVEs as early predictors of mortality.
Methods
Sixty-one consecutive cases of acute dapsone poisoning that were diagnosed and treated at a regional emergency center between 2006 and 2014 were included in the study. An ACVE was defined as myocardial injury, shock, ventricular dysrhythmia, cardiac arrest, or any combination of these occurring within the first 48 hours of treatment for acute dapsone poisoning.
Results
Nineteen patients (31.1%) had evidence of myocardial injury (elevation of serum troponin-I level or electrocardiography signs of ischemia) after dapsone overdose, and there were a total of 19 ACVEs (31.1%), including one case of shock (1.6%). Fourteen patients (23.0%) died from pneumonia or multiple organ failure, and the incidence of ACVEs was significantly higher among non-survivors than among survivors (64.3% vs. 21.3%, P=0.006). ACVE was a significant predictor of mortality (odds ratio, 5.690; 95% confidence interval, 1.428 to 22.675; P=0.014).
Conclusion
The incidence of ACVE was significantly higher among patients who died after acute dapsone poisoning. ACVE is a significant predictor of mortality after dapsone overdose, and evidence of ACVE should be carefully sought in these patients.

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