Gun Tak Lee

Background Point-of-care ultrasound-carotid artery compression (POCUS-CAC) is a technique using ultrasound to assess carotid artery compressibility during pulse checks. We expanded the use of POCUS-CAC during ongoing chest compressions for identifying circulatory status at the subsequent rhythm check. Methods A prospective, single-center study was conducted on patients aged ≥18 years presenting to the emergency department with cardiac arrest between June 2022 and October 2023. POCUS-CAC was performed at approximately 30 s intervals during ongoing chest compressions whenever clinically feasible. A POCUS-CAC assessment was classified as ROSC-compatible if the carotid artery remained non-compressible during both the systolic and diastolic phases of chest compressions. Circulatory status at the subsequent rhythm check was determined according to the 2020 American Heart Association guidelines. The diagnostic performance was evaluated using conventional diagnostic performance measures, with 95% confidence intervals estimated using patient-level cluster bootstrap resampling. Results Among 37 patients, 296 POCUS-CAC assessments were analyzed. POCUS-CAC during ongoing chest compressions demonstrated 90.6% sensitivity, 84.9% specificity, and 87.2% accuracy for identifying circulatory status at the subsequent rhythm check. In exploratory longitudinal analyses, diagnostic performance remained generally consistent across the first three assessments within cardiopulmonary resuscitation cycles. Conclusions POCUS-CAC during ongoing chest compressions showed favorable diagnostic performance for identifying circulatory status at the subsequent rhythm check. Serial POCUS-CAC assessments may provide additional information regarding changes in circulatory status during ongoing CPR. Further prospective multicenter studies are needed to validate these findings.

This study aimed to develop an interpretable machine learning-based scoring system for predicting sepsis and septic shock among febrile patients at emergency department (ED) triage using longitudinal data. This retrospective, single-center study included adult patients, presented to ED of tertiary academic hospital with fever from January 2016 to December 2021. Using the AutoScore framework, we developed a novel scoring system for predicting sepsis and septic shock at the triage stage, incorporating nine variables and a maximum score of 29. The predictive performance of our score was assessed by calculating the area under the receiver operating characteristic curve (AUROC), and its performance was compared with that of two existing scoring systems: the quick Sequential Organ Failure Assessment (qSOFA) and the Modified Early Warning Score (MEWS). Our model incorporated nine variables including initial vital signs, age, baseline platelet count, total bilirubin, and creatinine levels. Among these, initial systolic blood pressure was identified as the most important predictor. AUROC of our model was 0.844 (95% confidence interval [CI], 0.812–0.875) in predicting septic shock and 0.703 (95% CI, 0.687–0.720) for sepsis. Compared to qSOFA ≥ 2 (AUROC: 0.605) and MEWS ≥ 5 (AUROC: 0.678), our scoring system demonstrated superior predictive performance for septic shock. For comparable specificity levels (ranging from 0.50 to 0.95), our scoring system achieved higher sensitivity than MEWS. Our scoring system is an interpretable and practical scoring tool for predicting sepsis and septic shock among patients with documented fever at ED triage using patient’s longitudinal data.

Background: Sepsis remains a leading cause of mortality worldwide. This study evaluated the independent and combined effects of age and chronic comorbidities on clinical outcomes in patients with septic shock. Methods: We conducted a multicenter retrospective observational study to evaluate the factors associated with 28-day mortality in the Korean Shock Society registry between 2015 and 2023. Adults with suspected infection and refractory hypotension or hypoperfusion within 6 h of emergency department (ED) arrival were included. Patients were grouped by age (p for interaction = 0.008) suggested that the age-related gradient in mortality differed depending on comorbidity burden. Conclusions: Age and comorbidities were both significantly associated with septic shock mortality, and their significant interaction demonstrates effect modification, indicating that the prognostic impact of comorbidities differs by age group and that age-related mortality gradients are influenced by comorbidity burden.

Objective: Trauma is one of the leading causes of obstetric morbidity and mortality, and incorrect seat belt use is a major determinant of adverse outcomes. This study evaluated the impact of structured education on proper seat belt use during pregnancy and examined preferences for future interventions.Methods: This prospective pilot study was conducted at a single center in Korea, over an 8-week period. Pregnant women between 20 and 37 weeks of gestation who visited the outpatient obstetrics and gynecology department were enrolled. A pre-education survey assessed baseline seat belt practices. Participants then received structured education, and a post-education survey 1 month later evaluated changes in awareness and behavior.Results: Sixty participants were included in the final analysis. Most reported obtaining seat belt information from unverified sources, particularly online communities. Many indicated a preference for structured education delivered by obstetricians, especially early in pregnancy. After the intervention, knowledge of proper seat belt use increased from 21.7% to 85.0% (P<0.001), and correct seat belt usage rose from 16.7% to 88.3% (P<0.001). Seat belt use while driving also improved markedly, increasing from 19.5% to 78.0% (P<0.001), demonstrating the program’s effectiveness in enhancing awareness and behavior.Conclusion Education on seat belt use during pregnancy significantly improved both knowledge and correct usage among pregnant women. Routine, formal educational programs are recommended to promote maternal and fetal safety.

Accurate, real-time blood pressure (BP) monitoring is critical in emergency and critical care, but current methods are limited. Invasive arterial catheteri

Background: Arterial pH reflects both metabolic and respiratory distress in cardiac arrest and has prognostic implications. However, it was excluded from the 2024 update of the Utstein out-of-hospital cardiac arrest (OHCA) registry template. We investigated the rationale for including arterial pH into models predicting clinical outcomes.Methods: Data were sourced from the Korean Cardiac Arrest Research Consortium, a nationwide OHCA registry (NCT03222999). Prediction models were constructed using logistic regression, random forest, and eXtreme Gradient Boosting frameworks. Each framework included three model types: pH, low-flow time, and combined models. Then the area under the receiver operating characteristic curve (AUROC) of each predicting model was compared. The primary outcome was 30-day death or neurologically unfavorable status (cerebral performance category ≥3).Results: Among the 15,765 patients analyzed, 92.2% experienced death or unfavorable neurological outcomes. The predicting performance of the models including pH (AUROC=0.92–0.94) were comparable to the models including low-flow time in all frameworks (0.93–0.94) (all P>0.05). Inclusion of pH into low-flow time models consistently showed higher AUROCs than individual models in all frameworks (AUROC=0.93–0.95, all P<0.05). Conclusions: The predicting performance of models including arterial pH was comparable to models including low-flow time, and addition of arterial pH into low-flow time models could increase the performance of the models.

Background: Since its introduction, telemedicine for patients with chronic diseases has been studied in various clinical settings. However, there is limited evidence of the effectiveness and medical safety of the nationwide adoption of telemedicine. Objective: This study aimed to analyze the effects of telemedicine on chronic diseases during the COVID-19 pandemic under a temporary telemedicine policy in South Korea using national claims data. Methods: Health insurance claims data were extracted over 2 years: 1 year before (from February 24, 2019, to February 23, 2020) and 1 year after the policy was implemented (from February 24, 2020, to February 23, 2021). We included all patients who used telemedicine at least once in the first year after the policy was implemented and compared them with a control group of patients who never used telemedicine. The comparison focused on health care use; the medication possession ratio (MPR); and admission rates to general wards (GWs), emergency departments (EDs), and intensive care units (ICUs) using difference-in-differences analysis. A total of 4 chronic diseases were targeted: hypertension, diabetes mellitus (DM), chronic obstructive pulmonary disease (COPD), and common mental disorders. Results: A total of 1,773,454 patients with hypertension; 795,869 patients with DM; 37,460 patients with COPD; and 167,084 patients with common mental disorders were analyzed in this study. Patients diagnosed with hypertension or DM showed increased MPRs without an increase in GW, ED, or ICU admission rates during the policy year. Moreover, patients in the DM group who did not use telemedicine had higher rates of ED, GW, and ICU admissions, and patients in the hypertension group had higher rates of GW or ICU admissions after 1 year of policy implementation. This trend was not evident in COPD and common mental disorders. Conclusions: The temporary telemedicine policy was effective in increasing medication adherence and reducing admission rates for patients with hypertension and DM; however, the efficacy of the policy was limited for patients with COPD and common mental disorders. Future studies are required to demonstrate the long-term effects of telemedicine policies with various outcome measures reflecting disease characteristics.

Gun Tak Lee, M.D., Byuk Sung Ko, M.D., Da Seul Kim, M.D., Minha Kim, M.D., Jong Eun Park, M.D., Sung Yeon Hwang, M.D., Daun Jeong, M.D., Chi Ryang Chung, M.D., Hyunggoo Kang, M.D., Jaehoon Oh, M.D., Tae Ho Lim, M.D., Bora Chae, M.D., Won Young Kim, M.D., and Tae Gun Shin, M.D. on behalf of the Korean Shock Society. Ann Lab Med -0001;0:. https://doi.org/10.3343/alm.2023.0425

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Since its introduction, telemedicine for patients with chronic diseases has been studied in various clinical settings. However, there is limited evidence of the effectiveness and medical safety of the nationwide adoption of telemedicine. Objective: This study aimed to analyze the effects of telemedicine on chronic diseases during the COVID-19 pandemic under a temporary telemedicine policy in South Korea using national claims data. Methods: Health insurance claims data were extracted over 2 years: 1 year before (from February 24, 2019, to February 23, 2020) and 1 year after the policy was implemented (from February 24, 2020, to February 23, 2021). We included all patients who used telemedicine at least once in the first year after the policy was implemented and compared them with a control group of patients who never used telemedicine. The comparison focused on health care use; the medication possession ratio (MPR); and admission rates to general wards (GWs), emergency departments (EDs), and intensive care units (ICUs) using difference-in-differences analysis. A total of 4 chronic diseases were targeted: hypertension, diabetes mellitus (DM), chronic obstructive pulmonary disease (COPD), and common mental disorders. Results: A total of 1,773,454 patients with hypertension; 795,869 patients with DM; 37,460 patients with COPD; and 167,084 patients with common mental disorders were analyzed in this study. Patients diagnosed with hypertension or DM showed increased MPRs without an increase in GW, ED, or ICU admission rates during the policy year. Moreover, patients in the DM group who did not use telemedicine had higher rates of ED, GW, and ICU admissions, and patients in the hypertension group had higher rates of GW or ICU admissions after 1 year of policy implementation. This trend was not evident in COPD and common mental disorders. Conclusions: The temporary telemedicine policy was effective in increasing medication adherence and reducing admission rates for patients with hypertension and DM; however, the efficacy of the policy was limited for patients with COPD and common mental disorders. Future studies are required to demonstrate the long-term effects of telemedicine policies with various outcome measures reflecting disease characteristics.

This study aimed to compare the accuracy of real-time trans-tracheal ultrasound (TTUS) with capnography to confirm intubation in cardiopulmonary resuscitation (CPR) while wearing a powered air-purifying respirator (PAPR). This setting reflects increased caution due to contagious diseases. This single-center, prospective, comparative study enrolled patients requiring CPR while wearing a PAPR who visited the emergency department of a tertiary medical center from December 2020 to August 2022. A physician performed the TTUS in real time and recorded the tube placement assessment. Another healthcare provider attached waveform capnography to the tube and recorded end-tidal carbon dioxide (EtCO₂) after five ventilations. The accuracy and agreement of both methods compared with direct laryngoscopic visualization of tube placement, and the time taken by both methods was evaluated. Thirty-three patients with cardiac arrest were analyzed. TTUS confirmed tube placement with 100% accuracy, sensitivity, and specificity, whereas capnography demonstrated 97% accuracy, 96.8% sensitivity, and 100% specificity. The Kappa values for TTUS and capnography compared to direct visualization were 1.0 and 0.7843, respectively. EtCO₂ was measured in 45 (37–59) seconds (median (interquartile range)), whereas TTUS required only 12 (8–23) seconds, indicating that TTUS was significantly faster (p < 0.001). No significant correlation was found between the physician’s TTUS proficiency and image acquisition time. This study demonstrated that TTUS is more accurate and faster than EtCO₂ measurement for confirming endotracheal tube placement during CPR, particularly in the context of PAPR usage in pandemic conditions.