In Hye Kang

Background: This study aimed to evaluate the association between comorbidity and hospital admission, hospital length of stay (LOS), and in-hospital mortality among adult trauma patients across the injury severity spectrum in South Korea, and to assess whether these associations vary according to injury severity. Methods: We conducted a retrospective cohort study using the national Community-Based Severe Trauma Survey (2019–2023). Adult patients (≥18 years) with trauma were included after excluding records with missing key exposure or outcome variables. Comorbidity was defined using the ICD-10–based Elixhauser comorbidity framework. In addition to a binary classification (any vs. none), comorbidity burden was categorized into 0, 1, 2, and ≥3 conditions to evaluate dose–response relationships. The primary outcomes were hospital admission, LOS, and in-hospital mortality. Multivariable logistic regression models were used for admission and mortality, and regression models were applied for LOS, adjusting for demographic characteristics, injury mechanism, physiologic status, and system-level factors. Effect modification by injury severity was assessed using interaction terms and ISS-stratified analyses. Results: Among 49,259 patients, 32,999 (67.0%) had at least one comorbidity. Patients with comorbidities were older, had higher injury severity, and showed higher admission rates, longer LOS, and higher in-hospital mortality compared with those without comorbidities. After adjustment, comorbidity remained independently associated with increased odds of admission, prolonged LOS, and in-hospital mortality. A dose–response relationship was observed, with increasing comorbidity burden associated with progressively worse outcomes (p for trend < 0.001). In addition, substantial heterogeneity was identified across individual comorbidities, with conditions such as metastatic cancer, liver disease, coagulopathy, renal disease, and fluid and electrolyte disorders showing stronger associations with adverse outcomes. The magnitude of these associations varied across ISS strata, indicating injury severity-dependent effects. Conclusions: In this nationwide cohort, comorbidity burden and type were important determinants of acute-care utilization and in-hospital mortality among trauma patients. Incorporating comorbidity information into early risk stratification may improve prognostic accuracy and support more efficient resource allocation and clinical decision-making across the trauma care continuum.

Background/Objectives: Rapid and accurate electrocardiogram (ECG) interpretation is essential for timely recognition of ST-elevation myocardial infarction (STEMI) and initiation of reperfusion therapy in the emergency department (ED). We evaluated the diagnostic performance of a real-time artificial intelligence (AI) ECG interpretation system and its pragmatic impact when integrated into routine ED workflows. Methods: This prospective, single-center pragmatic observational study was conducted in a regional emergency medical center ED in Busan, Republic of Korea (1 January–31 December 2024). Consecutive adults (≥18 years) undergoing 12-lead ECG for cardiovascular-related symptoms were enrolled (N = 1524). A predefined alternating-day protocol allocated visits to physician-only interpretation days (physician-days, N = 763) or AI output disclosure days (AI-days, N = 761). Diagnostic performance for STEMI was assessed using paired ECG-level comparisons between physician-alone interpretation and AI output against a blinded expert-panel reference standard; clinical impact outcomes included reperfusion-related time metrics, hospital length of stay (LOS), and in-hospital mortality. Results: Against the expert reference standard, AI showed higher STEMI sensitivity than physician-alone interpretation (96.7% vs. 68.3%; McNemar p = 0.027), while specificity was lower (75.9% vs. 84.5%; p = 0.018). In pragmatic day-level comparisons, door-to-balloon time was shorter on AI-days (40.0 ± 19.81 vs. 47.34 ± 21.90 min; p = 0.001), and time to PCI was significantly reduced among patients with atypical presentations (42.3 ± 18.21 vs. 57.1 ± 20.11 min; p = 0.013). Among admitted patients, hospital LOS was shorter on AI-days (13 ± 9.21 vs. 17 ± 10.31 days; p = 0.010), whereas in-hospital mortality did not differ significantly between groups (17.0% vs. 16.77%; p = 0.191). Conclusions: Real-time AI-ECG integration in the ED was associated with improved STEMI detection sensitivity and shorter reperfusion-related time metrics, particularly in atypical presentations, and with reduced hospital LOS among admitted patients. Short-term mortality was comparable between groups. Further multicenter studies are warranted to confirm generalizability and to balance benefits against potential false-positive-related operational impacts.

Background/Objectives: Rapid and accurate electrocardiogram (ECG) interpretation is essential for timely recognition of ST-elevation myocardial infarction (STEMI) and initiation of reperfusion therapy in the emergency department (ED). We evaluated the diagnostic performance of a real-time artificial intelligence (AI) ECG interpretation system and its pragmatic impact when integrated into routine ED workflows. Methods: This prospective, single-center pragmatic observational study was conducted in a regional emergency medical center ED in Busan, Republic of Korea (1 January–31 December 2024). Consecutive adults (≥18 years) undergoing 12-lead ECG for cardiovascular-related symptoms were enrolled (N = 1524). A predefined alternating-day protocol allocated visits to physician-only interpretation days (physician-days, n = 763) or AI-output disclosure days (AI-days, n = 761). Diagnostic performance for STEMI was assessed using paired ECG-level comparisons between physician-alone interpretation and AI output against a blinded expert-panel reference standard; clinical impact outcomes included reperfusion-related time metrics, hospital length of stay (LOS), and in-hospital mortality. Results: Against the expert reference standard, AI showed higher STEMI sensitivity than physician-alone interpretation (96.7% vs. 68.3%; McNemar p = 0.027), while specificity was lower (75.9% vs. 84.5%; p = 0.018). In pragmatic day-level comparisons, door-to-balloon time was shorter on AI-days (40.0 ± 19.81 vs. 47.34 ± 21.90 min; p = 0.001), and time to PCI was significantly reduced among patients with atypical presentations (42.3 ± 18.21 vs. 57.1 ± 20.11 min; p = 0.013). Among admitted patients, hospital LOS was shorter on AI-days (13 ± 9.21 vs. 17 ± 10.31 days; p = 0.010), whereas in-hospital mortality did not differ significantly between groups (17.0% vs. 16.77%; p = 0.191). Conclusions: Real-time AI-ECG integration in the ED was associated with improved STEMI detection sensitivity and shorter reperfusion-related time metrics, particularly in atypical presentations, and with reduced hospital LOS among admitted patients. Short-term mortality was comparable between groups. Further multicenter studies are warranted to confirm generalizability and to balance benefits against potential false-positive–related operational impacts.

Background: This study aims to verify whether the blood flow velocity and the diameter size, measured through intra-carotid artery Doppler measurements performed on sepsis patients visiting the emergency department, are useful as tools for predicting the risk of early death. Methods: As a prospective study, this research was performed on sepsis patients who visited a local emergency medical center from August 2021 to February 2023. The sepsis patients’ carotid artery was measured using Doppler imaging, and they were divided into patients measured for the size of systolic and diastolic mean blood flow velocity and diameter size: those measured for their qSOFA (quick sequential organ failure assessment) score and those measured using the SIRS (systemic inflammatory response syndrome) criteria. By measuring and comparing their mortality prediction accuracies, this study sought to verify the usefulness of blood flow velocity and the diameter size of the intra-carotid artery as tools to predict early death. Results: This study was conducted on 1026 patients, excluding 45 patients out of the total of 1071 patients. All sepsis patients were measured using systolic and diastolic blood flow velocity and diameter by Doppler imaging of the intra-carotid artery, assessed using qSOFA and evaluated using SIRS criteria. The results of the analysis performed to compare the mortality prediction accuracy were as follows. First, the hazard ratio (95% CI) of the intra-carotid artery was significant (p < 0.05), at 1.020 (1.004–1.036); the hazard ratio (95% CI) of qSOFA was significant (p < 0.05), at 3.871 (2.526–5.931); and the hazard ratio (95% CI) of SIRS showed no significant difference, at 1.002 (0.995–1.009). After 2 h of infusion treatment, the diameter size was 4.72 ± 1.23, showing a significant difference (p < 0.05). After 2 h of fluid treatment, the blood flow velocity was 101 m/s ± 21.12, which showed a significant difference (p < 0.05). Conclusions: Measuring the mean blood flow velocity in the intra-carotid arteries of sepsis patients who visit the emergency department is useful for predicting the risk of death at an early stage. And this study showed that Doppler measurement of the diameter size of the carotid artery significantly increased after performing fluid treatment after early recognition.