Byung Joon Choi

Background: Incarcerated patients with neurological complaints present substantial diagnostic and care-delivery challenges in emergency departments (EDs). We delineate the clinical spectrum, severity, and outcomes among incarcerated patients managed in an ED with an embedded neuro-emergency expert model. Methods: A retrospective observational study of adult ED visits for neurological symptoms was conducted from September 2018 to June 2025 at a government-designated regional emergency center serving multiple correctional facilities. Incarceration was confirmed in the electronic medical record. Extracted variables included demographics, chief complaint, comorbidities, triage and acuity scale, Glasgow Coma Scale (GCS), neuroimaging, ED diagnoses, and outcomes (hospital admission, ICU care, ED/in-hospital mortality). Results: Sixty-five patients were included (median age 57.0 years [IQR 47.0–64.5]; 95% male). Chief complaints were altered mental status (36.9%), hemiparesis (21.5%), and seizures (13.8%). On arrival, 40.0% had GCS ≤ 12, including 23.1% with severe impairment (GCS 3–8). Non-contrast head CT was obtained in 95.4% and diffusion-weighted MRI in 38.5%. Frequent diagnoses were psychiatric/functional neurological disorder (16.9%), metabolic encephalopathy (15.4%), and acute ischemic stroke (12.3%). Serious conditions (stroke, hypoxic brain injury, central nervous system infection, status epilepticus, and neuroleptic malignant syndrome) were diagnosed in 41.5%. Hospital admission occurred in 63.1% (ICU care in 47.7%); in-hospital mortality was 10.8%. Conclusions: ED visits by incarcerated individuals with neurological complaints were often linked to serious diagnoses, ICU use, and mortality, challenging assumptions of exaggeration. Over two in five had stroke, hypoxic brain injury, central nervous system infection, or status epilepticus. The findings support rapid, systematic, bias-aware evaluation with early neurological involvement, clear imaging triggers, safety protocol, and expedited transfers from correctional facilities.

Background: In Korea, many stroke patients receive medical care in geriatric hospitals after the acute management phase. However, the clinical characteristics of stroke patients admitted to geriatric hospitals have not been well-defined. This study aimed to investigate the medical and neurological complications as well as in-hospital mortality rates of stroke patients admitted to a geriatric hospital. Methods: Between January 2004 and December 2006, all stroke patients admitted to a geriatric hospital were prospectively registered. Demographic and clinical data, including the development of major complications after admission and in-hospital mortality and causes of death during the follow-up period until December 2008, were collected and analyzed.Results: A total 252 patients (mean age, 75.8±8.2 years; male, 41.7%) were included. Patients with ischemic stroke (79.4%) outnumbered those with hemorrhagic stroke (20.6%) by nearly fourfold. During the study period, 55.6% of patients experienced one or more major complications, with pneumonia (36.9%) being the most common. Logistic regression analysis identified age, indwelling catheterization, modified Rankin scale (mRS) score on admission, and length of hospital stay as independent risk factors for complications. In-hospital mortality rates at 1 month, 3 months, 6 months, and 1 year were 5.0%, 11.5%, 19.4%, and 31.0%, respectively. Age, mRS score and male sex were independent predictors of in-hospital mortality as determined by the Cox proportional hazards model.Conclusions: Pneumonia was the most prevalent complication and leading cause of death. Age and functional status were independent predictor of both complications and in-hospital mortality.