Repository Collection: null

Inter-rater reliability of the Korean Triage and Acuity Scale performed between the prehospital and hospital stages

2025-08-19T07:27:14Z

Title: Inter-rater reliability of the Korean Triage and Acuity Scale performed between the prehospital and hospital stages Author(s): Jiwan Woo; Sang-Hun Lee; Tae kwon Kim; Jonghoon Yoo; Woo ik Choi; Jeong Hee Ju; Kyung-Woo Lee Abstract: Objective: In Korea, patient evaluation faces limitations because of the differences in the triage system between the prehospital and hospital stages. To solve this problem, the Korean Triage and Acuity Scale (KTAS), a severity classification tool used in hospitals, is also used at the prehospital stage. Prehospital KTAS (pre-KTAS) is a new triage method used at this stage. However, there are few studies on the degree of agreement between prehospital and hospital evaluations. Therefore, we sought to evaluate the agreement between the pre-KTAS and KTAS triage. Method: We conducted a retrospective observational study of patients who visited the emergency department at Keimyung University Dongsan Hospital via emergency medical services from November to December 2023. We compared the agreement between the pre-KTAS and KTAS triage and examined the differences according to certain subgroups. Results: Triage was performed on 503 patients, and a moderate agreement was observed between the pre-KTAS and KTAS triage results (weighted kappa, 0.572; 95% confidence interval [CI], 0.513-0.632; P<0.001). The agreement rate tended to be higher in patients with the same main symptoms (weighted kappa, 0.601; 95% CI, 0.537-0.666) or apparent symptoms such as fever (weighted kappa, 0.690; 95% CI, 0.590-0.791) and change of consciousness (weighted kappa, 0.627; 95% CI, 0.412-0.843). Conclusion: The agreement between the pre-KTAS and KTAS triage results appears to be moderate. The agreement is higher when there is an objective finding or matching of the main symptoms.

지역사회 코로나바이러스-19 감염증 대유행이 급성심근경색의 응급실 대응에 미치는 영향: 다기관 후향 연구

2025-06-18T05:55:09Z

Title: 지역사회 코로나바이러스-19 감염증 대유행이 급성심근경색의 응급실 대응에 미치는 영향: 다기관 후향 연구 Author(s): Young Wook Kim; Sungbae Moon; Hyun Wook Ryoo; Jae Yun Ahn; Jung Bae Park; n Lee; Sang Hun Lee; Sangchan Jin; You Ho Mun; Jung Ho Kim; Tae Chang Jang Abstract: Objective: The Daegu region experienced the first wave of the pandemic at the beginning of the coronavirus disease 2019 (COVID-19) outbreak in Korea. Other non-COVID-19-related treatments during a community outbreak, such as cardiovascular diseases, were expected to impact emergency departments. In acute myocardial infarctions, time is an important factor affecting the patient outcome. This study examined how community COVID-19 outbreak affected STsegment elevated myocardial infarction (STEMI) care in emergency departments. Method: A retrospective analysis was performed on patients visiting five emergency departments in the Daegu area who were diagnosed with STEMI from February 18 to April 17 each year from 2018 to 2020. The demographic characteristics, prehospital variables, in-hospital time variables, and treatment results were collected. The cases were divided into the pre-COVID period and the COVID period for comparison. Results: The study included 254 patients (194 pre-COVID, 60 during COVID). The symptom-to-door time did not differ. Although the door-to-first doctor time was shortened (4 min vs. 2 min, P=0.01), the rate of coronary angiogram along with the door-to-angiogram time and the door-to-balloon time did not change. The length of stay in the emergency department was delayed during COVID-19 (median, 136 min vs. 404 min; P<0.01). The in-hospital length of stay and mortality were similar in both groups. Conclusion: The time to treat STEMI was not delayed significantly during the first wave of the COVID-19 outbreak in the Daegu area compared with the pre-pandemic period. Mortality did not change. The length of stay was elongated significantly in the emergency department but not in the hospital.

Analysis of the Association between Telomere Length and Neurological Disability in Stroke Types

2025-02-17T05:01:06Z

Title: Analysis of the Association between Telomere Length and Neurological Disability in Stroke Types Author(s): Sang-Hun Lee; Tae-Kwon Kim; Jong-Hoon Yoo; Hyung-Jong Park; Jae-Hyun Kim; Jae-Ho Lee Abstract: Background and Objectives: The association between neurological disability, prognosis, and telomere length (TL) in patients with stroke has been investigated in various ways. However, analysis of the type of stroke and ischemic stroke subgroups is limited. In this study, we aimed to determine the association between TL and neurological disability according to stroke type. Materials and Methods: This prospective study included patients with stroke who visited a single-center emergency department (ED) between January 2022 and December 2023. The association between TL and neurological disabilities, using the Modified Rankin Scale (mRS) and National Institutes of Health Stroke Scale (NIHSS), was evaluated according to the patient’s stroke type and subgroup of ischemic stroke. Multivariate analysis was performed to determine the association between neurological disabilities in patients with ischemic stroke and the subgroups. Results: A total of 271 patients with stroke were enrolled. The NIHSS score was found to be higher at the time of ED visit (adjusted odds ratio [OR], 5.23; 95% confidence interval [CI], 1.59–17.2, p < 0.01) and 1 day later (adjusted OR, 7.78; 95% CI, 1.97–30.70, p < 0.01) in the ischemic stroke group with a short TL. In the other determined etiology (OD) or undetermined etiology (UD) group, the NIHSS was higher in the short TL group at the ED visit (adjusted OR, 7.89; 95% CI, 1.32–47.25, p = 0.02) and 1 day after (adjusted OR, 7.02; 95% CI, 1.14–43.47, p = 0.04). Conclusions: TL is associated with neurological disability in early ischemic stroke and is prominent in the UD and OD subgroups.

Impact of the life-sustaining treatment decision act on organ donation in out-of-hospital cardiac arrests in South Korea: a multi-centre retrospective study

2025-02-17T05:01:01Z

Title: Impact of the life-sustaining treatment decision act on organ donation in out-of-hospital cardiac arrests in South Korea: a multi-centre retrospective study Author(s): Min Jae Kim; Dong Eun Lee; Jong Kun Kim; In Hwan Yeo; Haewon Jung; Jung Ho Kim; Tae Chang Jang; Sang-Hun Lee; Jinwook Park; Deokhyeon Kim; Hyun Wook Ryoo Abstract: Background: The demand for organ transplants, both globally and in South Korea, substantially exceeds the supply, a situation that might have been aggravated by the enactment of the Life-Sustaining Treatment Decision Act (LSTDA) in February 2018. This legislation may influence emergency medical procedures and the availability of organs from brain-dead donors. This study aimed to assess LSTDA’s impact, introduced in February 2018, on organ donation status in out-of-hospital cardiac arrest (OHCA) patients in a metropolitan city and identified related factors. Methods: We conducted a retrospective analysis of a regional cardiac arrest registry. This study included patients aged 16 or older with cardiac arrest and a cerebral performance category (CPC) score of 5 from January 2015 to December 2022. The exclusion criteria were CPC scores of 1–4, patients under 16 years, and patients declared dead or transferred from emergency departments. Logistic regression analysis was used to analyse factors affecting organ donation. Results: Of the 751 patients included in this study, 47 were organ donors, with a median age of 47 years. Before the LSTDA, there were 30 organ donations, which declined to 17 after its implementation. In the organ donation group, the causes of cardiac arrest included medical (34%), hanging (46.8%), and trauma (19.2%). The adjusted odds ratio for organ donation before the LSTDA implementation was 6.12 (95% CI 3.09–12.12), with non-medical aetiology as associated factors. Conclusion: The enactment of the LSTDA in 2018 in South Korea may be linked to reduced organ donations among patients with OHCA, underscoring the need to re-evaluate the medical and legal aspects of organ donation, especially considering end-of-life care decisions.