All emergency centers in Korea use the Korean Triage and Acuity Scale (KTAS) as their initial triage tool. However, KTAS has been used without verification of its reliability. In this study, we assess the interrater agreement of KTAS by two independent nurses in real-time and analyse the factors which have an effect on the disagreement of KTAS levels. This study was a prospective observational study conducted with patients who visited an emergency department (ED). Two teams, each composed of two nurses, triaged patients and recorded KTAS level and the main complaint from the list of 167 KTAS complaints, as well as modifiers. Interrater reliability between the two nurses in each team was assessed by weighted-kappa. Pearson's χ² test was conducted to determine if there were differences between each nurse's KTAS levels, depending on whether they chose the same complaints and the same modifiers or not. The two teams triaged a total of 1,998 patients who visited the ED. Weighted-kappa value was 0.772 (95% confidence interval [CI], 0.750-0.794). Patients triaged by different chosen complaints showed (38.0%) higher inconsistency rate in KTAS levels than those triaged by the same complaint (10.9%, P < 0.001). When nurses chose the same complaint and different modifiers, the ratio of different levels (50.5%) was higher than that of the same complaint and same modifier (8.1%, P < 0.001). This study showed that KTAS is a reliable tool. Selected complaints and modifiers are confirmed as important factors for reliability; therefore, selecting them properly should be emphasized during KTAS training courses.

Background: During COVID-19 pandemic, the emergency department was challenged to treat patients with COVID-19-related symptom. Therefore, the aim of this study was to investigate treatment delay and prognostic outcomes in ST-segment elevation myocardial infarction (STEMI) patients during COVID-19 pandemic due to isolation or precaution and compare it with pre-COVID-19 period. Methods: This was a retrospective observation study using multicenter data with different case mix. Anonymized data were collected through each center’s electronic medical data of common case report form. Primary outcomes were number and rate of in-hospital mortality within 28 days. Secondary outcomes were door-to-balloon time and length of stay in the emergency department. Kaplan-Meier estimation and COX proportional hazard regression analysis were performed to determine impact of predictors on 28-day in-hospital mortality. Results: Door-to-balloon time was longer in STEMI patients with COVID-19-related symptom(s) than those without symptom during the COVID-19 period (97.0 (74.8, 139.8) vs. 69.0 (55.0, 102.0) minutes, p < 0.001). However, there was no significant statistical difference in door-to-balloon time between STEMI patients with and without COVID-19- related symptom(s) during the pre-COVID-19 period (73.0 (61.0, 92.0) vs. 67.0 (54.5, 80.0) minutes, p = 0.2869). The 28-day mortality rate did not show a statistically significant difference depending on symptoms suggestive of COVID-19 during the pre-COVID-19 period (15.4% vs. 6.8%, p = 0.1257). However, it was significantly higher during the COVID-19 period (21.1% vs. 6.7%, p = 0.0102) in patients with COVID-19 suggestive symptoms than in patients without the symptoms. Conclusion: In Korea, symptoms suggestive of COVID-19 during the pandemic had a significant effect on the increase of door-to-balloon time and 28-day mortality in STEMI patients. Thus, health authorities need to make careful decision in designating symptoms indicated for isolation in emergency department based on opinions of various medical field experts.

Background: Red blood cells (RBCs) are a limited resource, and the adverse effects of transfusion must be considered. Multiple randomized controlled trials on transfusion thresholds have been conducted, leading to the establishment of a restrictive transfusion strategy. This study aimed to investigate the status of RBC transfusions in critically ill patients.Methods: This cohort study was conducted at five university hospitals in South Korea. From December 18, 2022, to November 30, 2023, 307 nontraumatic, anemic patients admitted to intensive care units through the emergency departments were enrolled. We determined whether patients received RBC transfusion, transfusion triggers, and the clinical results.Results: Of the 154 patients who received RBC transfusions, 71 (46.1%) had a hemoglobin level of 7 or higher. Triggers other than hemoglobin level included increased lactate levels in 75 patients (48.7%), tachycardia in 47 patients (30.5%), and hypotension in 46 patients (29.9%). The 28-day mortality rate was not significantly reduced in the group that received transfusions compared to the non-transfusion group (21.4% vs. 26.8%, P=0.288). There was no difference in the intensive care unit and hospital length of stay or the proportion of survival to discharge between the two groups. The prognosis showed the same pattern in various subgroups.Conclusions: Despite the large number of RBC transfusions used in contradiction to the restrictive strategy, there was no notable difference in the prognosis of critically ill patients. To minimize unnecessary RBC transfusions, the promotion of transfusion guidelines and research on transfusion criteria that reflect individual patient conditions are required.

Background and Objectives: Emergency physicians practice in high-pressure environments and face occupational stressors that may affect their mental health. This study was designed to evaluate the prevalence of depression among emergency physicians in South Korea and examined environmental, sociolegal, and individual factors associated with depressive symptoms in the post-pandemic period. Materials and Methods: This nationwide cross-sectional study analyzed data from the 2025 Korean Emergency Physician Survey. Screening positive for depressive symptoms was defined as a Patient Health Questionnaire-9 (PHQ-9) score ≥ 10, indicating moderate-to-severe depressive symptom severity. Measures included the PHQ-9, the Korean Epworth Sleepiness Scale (KESS), and the Adult APGAR, a brief self-administered instrument assessing overall wellness. Multivariable logistic regression was performed to identify factors associated with depression after adjusting for demographic, clinical, and work-related variables. Results: Of the 1050 physicians who responded (response rate: 37.5%), 743 emergency physicians completed the PHQ-9 section (completion rate: 70.8%; mean age, 43.2 ± 7.78 years; 86.5% male), and 111 (14.9%) screened positive for depressive symptoms. Objective workload indicators, including total work hours and number of night shifts, did not differ between physicians with and without depression. However, emergency physicians screening positive for depression reported higher perceived burdens related to staffing shortages and patient-related stressors. Protective factors included being married (adjusted odds ratio [AOR], 0.22; 95% confidence interval [CI], 0.08–0.58), longer sleep duration (AOR, 0.65; 95% CI, 0.50–0.86), better sleep quality (AOR, 0.45; 95% CI, 0.27–0.74), fixed mealtimes (AOR, 0.60; 95% CI, 0.39–0.93), and higher Adult APGAR scores (AOR, 0.72; 95% CI, 0.60–0.86). Factors associated with increased odds of depression included a history of cancer (AOR, 14.63, 95% CI, 2.53–84.61), current alcohol consumption (AOR, 2.54, 95% CI, 1.14–5.68), daytime sleepiness (AOR, 1.17; 95% CI, 1.04–1.31), and more frequent verbal abuse during the previous 12 months (AOR, 1.25; 95% CI, 1.08–1.44). Conclusions: Depression was prevalent and was associated with perceived work burden, sleep health, lifestyle regularity, and psychosocial factors. Interventions should address sleep quality, workplace safety, and social support.

Introduction: Since the characteristics of frequent emergency department (ED) users are heterogeneous, it is impossible to mitigate the overcrowding of the ED without the basic data of diagnoses and risk factors of frequent ED users. Our study will provide invaluable information that will help predict patient demand for medical resources while also providing important information that can be used to improve emergency medical services. Methods This is the cross-sectional observational study using records from The Korea Health Insurance Review Agency. Frequent ED users were defined as patients who visited an ED more than 7–17 times per calendar year and highly frequent ED users were defined as patients who visited an ED eighteen or more times during the same period. The diseases were ranked by prevalence in each of the three ED frequency groups (less frequent, frequent, and highly frequent ED user groups). Our study then developed two logistic regression models comparing frequent users with less frequent users and highly frequent users with frequent users. Standardized ß values were used to rank risk factor importance. Results Although less frequent ED users composed 98.98% of all patients, they only consisted of 92.27% of all ED visits. Compared with less frequent users, a greater proportion of frequent ED users were aged 65 years or older and were insured by Medicaid or Veterans Affair Health Care Program. Frequent ED users were also most strongly defined by wound dressing follow-up visits and liver diseases (standardized ß value of 3.29 and 2.31). However, this study did not show highly frequent ED users differed from frequent ED users in regard to the different disease categories. Conclusion The diagnoses and risk factors related to frequent ED visits in Korea identified in this study will be an important reference for future research aimed at reducing ED overcrowding. By further analyzing the risk factors associated with frequent ED use, non-emergency administrative systems or medical facilities can be utilized to reduce the overload on the ED.