Current Status and Key Issues of Data Management in Tertiary Hospitals: A Case Study of Seoul National University Hospital / 대한의료정보학회지

Objectives@#In the era of the Fourth Industrial Revolution, where an ecosystem is being developed to enhance the quality of healthcare services by applying information and communication technologies, systematic and sustainable data management is essential for medical institutions. In this study, we assessed the data management status and emerging concerns of three medical institutions, while also examining future directions for seamless data management. @*Methods@#To evaluate the data management status, we examined data types, capacities, infrastructure, backup methods, and related organizations. We also discussed challenges, such as resource and infrastructure issues, problems related to government regulations, and considerations for future data management. @*Results@#Hospitals are grappling with the increasing data storage space and a shortage of management personnel due to costs and project termination, which necessitates countermeasures and support. Data management regulations on the destruction or maintenance of medical records are needed, and institutional consideration for secondary utilization such as long-term treatment or research is required. Government-level guidelines for facilitating hospital data sharing and mobile patient services should be developed. Additionally, hospital executives at the organizational level need to make efforts to facilitate the clinical validation of artificial intelligence software. @*Conclusions@#This analysis of the current status and emerging issues of data management reveals potential solutions and sets the stage for future organizational and policy directions. If medical big data is systematically managed, accumulated over time, and strategically monetized, it has the potential to create new value.

Machine Learning-Based Prediction of Korean Triage and Acuity Scale Level in Emergency Department Patients / 대한의료정보학회지

OBJECTIVES: Triage is a process to accurately assess and classify symptoms to identify and provide rapid treatment to patients. The Korean Triage and Acuity Scale (KTAS) is used as a triage instrument in all emergency centers. The aim of this study was to train and compare machine learning models to predict KTAS levels. METHODS: This was a cross-sectional study using data from a single emergency department of a tertiary university hospital. Information collected during triage was used in the analysis. Logistic regression, random forest, and XGBoost were used to predict the KTAS level. RESULTS: The models with the highest area under the receiver operating characteristic curve (AUROC) were the random forest and XGBoost models trained on the entire dataset (AUROC = 0.922, 95% confidence interval 0.917–0.925 and AUROC = 0.922, 95% confidence interval 0.918–0.925, respectively). The AUROC of the models trained on the clinical data was higher than that of models trained on text data only, but the models trained on all variables had the highest AUROC among similar machine learning models. CONCLUSIONS: Machine learning can robustly predict the KTAS level at triage, which may have many possibilities for use, and the addition of text data improves the predictive performance compared to that achieved by using structured data alone.

Effect of Prothrombin Time Prolongation on Survival Outcome in Out-of-hospital Cardiac Arrest: A Multicenter Observational Study

PURPOSE: This study examined the association between the prothrombin time (PT) prolongation during cardiopulmonary resuscitation (CPR) and the outcome after an out-of-hospital cardiac arrest (OHCA). METHODS: From the Cardiac Arrest Pursuit Trial with Unique Registration and Epidemiologic Surveillance database, CPR-attempted and adult OHCAs with a cardiac etiology transported to emergency departments (EDs) from January to December 2014 were included. The PT was measured immediately after arrival to the ED during CPR, and PT prolongation was categorized into 3 groups, the normal group (international normalized ratio [INR] < 1.1), mild group (1.1≤INR < 1.4), and severe group (1.4≤INR). The primary and secondary outcomes were survival to hospital discharge and a good cerebral performance scale (CPC) of 1 or 2. The potential confounders were adjusted for calculating the adjusted odds ratios (AORs) and 95% confidence intervals (CIs) in multivariable logistic regression analysis. RESULTS: The survival and good CPC rates were 17.2% and 11.8% in the normal group, 12.2% and 4.5% in the mild group, and 3.6% and 0.6% in the severe group, respectively (p < 0.01). The AORs (95% CIs) on survival were 0.72 (0.41 to 1.27) for the mild group and 0.28 (0.11 to 0.69) for the severe group. The AORs (95% CIs) for good CPC were 0.41 (0.19 to 0.91) for the mild group and 0.14 (0.02 to 0.83) for the severe group. CONCLUSION: The PT prolongation measured at the ED was found to be associated with poor outcomes in adult OHCAs with cardiac etiology.

Ingested Gastrointestinal Foreign Body in Children: Retrospective Review in a Pediatric Emergency Department

PURPOSE: Foreign body ingestion is a commonly encountered problem in the pediatric emergency department (ED). This retrospective review aimed to investigate data gathered on the presentation and management of foreign body ingestions in children presented to ED. METHODS: This is a retrospective review of patients presented to the Seoul National University Hospital Pediatric ED between January 2005 and May 2009. The hospital electronic medical record database was used to identify children less than 15 years of age who presented with foreign body ingestion. RESULTS: Two hundred and fifteen children were reviewed for this study. The age of the patients ranged from 0 months to 14 years and the median age was 28 months. The most common foreign body ingested was coins (23.3%). At the time of presentation, most of the foreign bodies were located in the stomach (38.6%). One hundred and thirty four patients (62.3%) were managed expectantly and received no other treatment. At endoscopic examination, the foreign body was visible in seventy-one patients and removal was successful in sixty-nine patients (success rate 97.2%). Two patients required surgical removal of the ingested foreign body. One hundred patients (46.5%) were referred to our pediatric ED from other institutions, mostly for endoscopy. Two patients developed significant complications as a result of the ingestion and management of the foreign body. CONCLUSION: Most children presented with ingested foreign body followed an uneventful course and complications following management were rare. Primary and emergency physicians should be familiar with the recommended guidelines in the management of foreign body ingestion in children.