Purpose
In 2024, the South Korean government proposed an essential medical care package, including the expansion of medical college admissions, which faced strong opposition from the medical community. Consequently, residents resigned, increasing the workload of the remaining staff and putting public health at risk. This study analyzed changes in the hospitalization patterns of trauma patients during this political conflict period using single-center data from the National Health Insurance Service Ilsan Hospital.
Methods
Data from the entire year 2023 and from March to August 2024 were used for analysis, excluding January and February 2024 when the conflict escalated. The selection criteria included patients with trauma who visited the emergency room, and comparisons were made between the periods before and during the medical conflict.
Results
In 2023, the total number of patients with trauma were 1,182 (an average of 98.5 per month). From March to August 2024, the number dropped to 204 (34.2 per month), reflecting a significant reduction in the monthly average number of patients with trauma. Despite the overall decline, the number of severe trauma cases remained relatively stable, indicating a shift toward more critical patient care. Emergency department length of stay decreased significantly from 295 min in 2023 to 187 min in 2024.
Conclusion
The ongoing strain on emergency and support department risks leads to an irreversible collapse if critical points are reached. To address this, localized trauma centers are needed to relieve the burden on larger medical institutions and improve the efficiency of trauma care systems during crises.

Citations

• Impact of the 2024 Resident Physician Work Stoppage on Acute Hemorrhagic Stroke Admissions: A Single Cerebrovascular-Specialty Hospital Study in South Korea
  Youngsoo Kim, Dougho Park, Haemin Kim, Dahyeon Koo, Sukkyoung Lee, Yejin Min, Daeyoung Hong, Mun-Chul Kim
  Healthcare.2025; 13(17): 2129.     CrossRef

Fournier’s gangrene is infectious, necrotizing, life-threatening fasciitis of the perineal, genital, and perianal regions leading to soft-tissue necrosis and sepsis, and is treated with aggressive surgical debridement and antimicrobial agents. Negative-pressure wound therapy can be used if septic risk is controlled. An 82-year-old woman presented with Fournier’s gangrene and septic shock. After emergency debridement, perineal resection, a colostomy, and daily wound debridement was performed under general anesthesia (1 week). Multiple intubations and extubations under general anesthesia are a risk factor for poor patient outcomes. Therefore, negative-pressure wound therapy was performed under light sedation using noninvasive ventilation in the intensive care unit after extubation and for wound debridement. One month later, the perineum was reconstructed. Procedures performed under light sedation should be considered for patients requiring periodic invasive surgical procedures who are burdened by repeated general anesthesia. The number of general anesthesia sessions was significantly reduced by using noninvasive ventilation.

Purpose
Despite guidelines on the prevention of central venous line-associated bloodstream infection, it is left to the clinical judgment of the attending physician to determine the risk of infection and how long a central line should remain in place. This study aimed to identify risk factors for peripherally inserted central venous catheter (PICC)-associated infection.
Methods
This retrospective study included 1,136 patients with a PICC who were hospitalized at the National Health Insurance Service Ilsan Hospital (January 2015 to January 2022). Electronic medical records were reviewed for patients with positive blood cultures. Patients with suspicion of infection at the PICC insertion site or with unclear infection at other sites were defined as having a PICC-associated infection.
Results
Thirty-five patients (3.08%) had a PICC-associated infection. There were significant differences in hypertension (p = 0.026), lung disease (p = 0.001), PICC duration > 14 days, and antibiotic use before PICC insertion (p = 0.016) between no PICC-associated infection, and infection in the bloodstream. Total parenteral nutrition with PICC was not significantly different between groups. Logistic regression analysis identified hypertension, lung disease, PICC duration > 14 days (OR 2.088, 95% CI 1.032-4.224, p = 0.041), and antibiotic use before PICC insertion (OR 0.159, 95% CI 0.049-0.515, p = 0.002) as independent risk factors for PICC-associated infection.
Conclusion
The study suggested that PICCs maintained longer than 14 days is a risk factor for PICC-associated infection. Antibiotic use prior to PICC insertion was observed as a negative factor for PICC-associated infection.

Purpose
A nationwide study (2012-2017) of preventable trauma death rates (PTDR) showed a 15.3% decrease after Regional Trauma centers were initiated. However, in non-trauma centers with an Emergency Department there is limited data of preventable mortality in trauma patients. Therefore, the purpose of this retrospective study was to investigate preventable mortality in trauma patients in a nonregional trauma center and determine the effect of initiating a Trauma Team.
Methods
There were 46 deaths of trauma patients recorded in the National Health Insurance service Ilsan Hospital (NHISIH) in South Korea from January 2019 to December 2021. These patients’ preventable deaths were analyzed by an expert panel review considering the implementation of the Trauma Team in April 2020.
Results
All deaths were attributable to blunt trauma with an average Injury Severity Score of 26.0 ± 19.2, Revised Trauma Score of 5.05 ± 3.20 and Trauma and Injury Score of 56.6 ± 41.3. The most frequent cause of death was traumatic brain injury followed by respiratory arrest. The most frequent error was delayed transfusion followed by delayed treatment of bleeding. Treatment errors occurred the most in the Emergency Room followed by the Intensive Care Unit. The PTDR of patients before the involvement of a Trauma Team (January 2019 to March 2020) and after the Trauma Team was initiated in April 2020 decreased from 27.27% to 4.27%, respectively (p = 0.021).
Conclusion
The introduction of a dedicated Trauma Team in a non-regional trauma center significantly reduced the overall PTDR in trauma patients.

Citations

• Impact of Resident Shortage on Trauma Care During the 2024 Medical Conflict: A Single Regional Emergency Medical Center Experience and Recommendations
  Jun Hyung Kim, Sungho Lee, Kwanhoon Park, Kang Yoon Lee, Ji Young Jang
  Journal of Acute Care Surgery.2025; 15(1): 13.     CrossRef

Purpose
This study aimed to investigate the characteristics of elderly patients who visited a non-regional trauma center to examine the effects of old age on the clinical outcomes of patients.
Methods
The medical charts of 159 patients with trauma who visited the National Health Insurance Service Ilsan Hospital between March 2020 and February 2022 were retrospectively analyzed.
Results
Of the 159 patients, 41 were assigned to the elderly patient group (EPG) and 118 were assigned to the non-elderly patient group (NEPG). The average age of patients in each group was 75.5 and 38.2 years in the EPG and the NEPG, respectively. Comparing the injury mechanism between the two groups, pedestrian traffic accidents (TA) were the most common (24.4%), followed by slipping (19.5%), motorcycle TA, and bicycle TA (14.6%) in EPG. In the NEPG, motorcycle TA (28.0%) was the most common, followed by car TA (27.1%), and fall injury (16.9%), with a significant difference between the two groups (p < 0.001). The significant differences between the two groups were the injury severity score (ISS; p = 0.004), severe trauma (p = 0.045), intensive care unit admission (p = 0.028), emergency operation (p = 0.034), and mortality (p = 0.013). The statistically significant risk factors for mortality were old age (p = 0.024) and chest injury (p = 0.013).
Conclusion
Patients in the EPG compared with the NEPG group showed different injury mechanisms. The EPG has a higher severity and mortality rate than the NEPG.

Citations

• The road less recovered: Examining the effect of trauma on frailty trajectories in older patients
  Jessica Falon, Priyadharshani Samarasinghe, James Elhindi, Urna Rahman, Aswin Shanmugalingam, Isabella Zappala, Jeremy Hsu
  Journal of Trauma and Acute Care Surgery.2025; 99(6): 904.     CrossRef

The demand for hospitalists is increasing due to decreasing numbers of clinical residents and increased concerns regarding patient safety. However, several limitations in the surgical hospitalist role exist. The personnel of the surgical hospitalist, rapid response team (RRT), surgical critical care, and trauma surgery teams were unified under the admission, critical care, and trauma surgery (ACTs) team at this institution. The ACTs target are patients with severe disease not undergoing general postoperative course, or patients with the potential for severe conversion. Two surgical intensivists are on duty once a week and oversee the intensive care unit (ICU), the back-up treatment of critically ill patients, and the immediate treatment of trauma patients. ACTs also participate in the surgical RRT and select patients with a high probability of severe exacerbation. Between 2019-2021, the cardiopulmonary resuscitation incidence per 1,000 hospitalized patients in the surgical department decreased significantly from 0.81 to 0.55. From March to December 2021, the ACTs team were involved with 101 of 158 surgical patients admitted to the ICU: 62 with postoperative status, 29 with severe trauma, and 10 transferred to the ICU via RRT screening. Based on our experience, the role of the ACTs team can help improve patient safety.

Citations

• Impact of Resident Shortage on Trauma Care During the 2024 Medical Conflict: A Single Regional Emergency Medical Center Experience and Recommendations
  Jun Hyung Kim, Sungho Lee, Kwanhoon Park, Kang Yoon Lee, Ji Young Jang
  Journal of Acute Care Surgery.2025; 15(1): 13.     CrossRef

Purpose
The coronavirus disease 2019 (COVID-19) pandemic continues. It has been reported that patients with bacterial coinfection have a higher mortality rate than patients without coinfection. However, there are no clear standard guidelines for the use of antibacterial drugs. Therefore, the purpose of this study was to determine the usefulness of procalcitonin, a specific indicator of bacterial infection, as a biomarker for predicting death in COVID-19 patients.
Methods
This was a retrospective study of confirmed COVID-19 patients (N = 283) between December 2020 and February 2021 who survived or died. Logistic regression analysis was performed to determine whether there was an association between the level of procalcitonin and death. In addition, receiver operating characteristic curve analysis was performed to determine the usefulness of procalcitonin as a predictor of death.
Results
In the non-survivor group, age, the number of patients transferred from a health care center, segment neutrophil ratio, C reactive protein, ferritin, and procalcitonin were significantly higher in the survivor group. In multivariate analysis, procalcitonin was identified as an independent factor associated with death (hazard ratio 6.162, confidential interval 2.285-26.322, p = 0.014). In addition, the predictive power of procalcitonin level and mortality was statistically significant using receiver operating characteristic curve analysis which gave an area under the curve value of 0.823, a cut-off value of 0.05, a sensitivity of 72.2%, a specificity of 87.5% (p < 0.001).
Conclusion
Measurement of procalcitonin and other biomarkers may be useful to determine whether to use or discontinue use of antibacterial drugs in patients with COVID-19.

Citations

• Role of Inflammatory Markers in Severity, ICU Admission, and Mortality in COVID-19: A Systematic Review and Meta-analysis of 79,934 Patients
  Hiwa O. Abdullah, Sadraldin A. Braim, Maria A. Rasool, Dashne M. Abdalla, Dyari Q. Hamad, Daban K. Ahmad, Ayman M. Mustafa, Fakher Abdullah, Yousif M. Mahmood, Dilan S. Hiwa, Sasan M. Ahmed, Karokh K. Mohammed, Berun A. Abdalla, Shvan H. Moh
  Barw Medical Journal.2024;[Epub]     CrossRef

Purpose
To evaluate the risk factors associated with 30-day mortality in patients with postoperative acute kidney injury who underwent continuous renal replacement therapy (CRRT).
Methods
Retrospective analysis of the medical charts of patients with postoperative acute kidney injury who underwent CRRT in the intensive care unit between April 2012 and May 2019 was conducted.
Results
There were 71 patients whose average age was 64.8 years, and average Acute Physiology and Chronic Health Evaluation 2 score was 26.2. There were 37 patients who had non-trauma emergency surgery, 16 who required trauma surgery, and 18 who had elective major surgery. In most patients, CRRT was started based on Stage 3 Acute Kidney Injury Network criteria, and the mean creatinine level at the time of CRRT initiation (3.62 mg/dL). The median period from surgery to CRRT was 3 days, and the median CRRT application was 4 days. Forty-seven patients died within 30 days of receiving CRRT. Age, elective major surgery, creatinine level on initiation of CRRT, use of norepinephrine upon the initiation of CRRT, and average daily fluid balance/body weight for 3 days following the initiation of CRRT were associated with increasing 30-day mortality in univariate analysis. In multivariate analysis, age, major elective surgery, and norepinephrine use upon initiation of CRRT were identified as independent risk factors for 30-day mortality.
Conclusion
Surgical patients who underwent CRRT postoperatively had a poor prognosis. The risk of death in elderly patients who have undergone major elective surgery, or are receiving norepinephrine upon initiation of CRRT should be considered.

A thyroid storm is a rare complication of hyperthyroidism. Although a thyroid storm rarely presents with symptoms similar to those of an acute abdomen, and in cases where emergency surgery is needed, the thyroid function test is not performed routinely. In this study, we report a case in which hyperthyroidism was diagnosed after surgery in a patient with recurrent refractory peptic ulcer disease. Although peptic ulcer disease and hyperthyroidism rarely coexist, when the patient's initial condition was reviewed in the Emergency Department, the findings were reasonable for panperitonitis due to peptic ulcer perforation, which is considered as a condition suitable for a thyroid storm. This isolated case indicates a logical leap in the correlation between peptic ulcer and thyroid storm. In recurrent refractory peptic ulcer disease, the thyroid function test may be helpful as a routine laboratory test before emergency surgery.