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Rapid and accurate differential diagnosis of infections, sepsis, and septic shock is essential for preventing unnecessary antibiotic overuse and improving the chance of patient survival. To address this, a 3D gold nanogranule decorated gold‐silver alloy nanopillar (AuNG@Au‐AgNP) based surface‐enhanced Raman scattering (SERS) biosensor is developed, capable of quantitatively profiling immune‐related soluble proteins (interleukin three receptor, alpha chain: CD123, programmed cell death ligand 1: PD‐L1, human leukocyte antigen–DR isotype: HLA‐DR, and chitotriosidase: ChiT) in serum samples. The 3D bimetallic nanoarchitecture, fabricated using anodized aluminum oxide (AAO), features a uniform structure with densely packed nanogaps on the heads of Au‐Ag alloy nanopillars, enabling fast, simple, and replicable production. The proposed biosensor achieves accurate results even with low detection limits (4–6 fM) and high signal consistency (relative standard deviation (RSD) = 1.79%) within a one‐step multi‐analytes identification chip with a directly loadable chamber. To enhance the diagnostic performance, a support vector machine (SVM) based machine learning algorithm is utilized, achieving 95.0% accuracy and 95.8% precision in classifying healthy controls, infections with and without sepsis, and septic shock. This advanced 3D plasmonic bimetallic alloy nanoarchitecture‐based SERS biosensor demonstrates clinical usefulness for sepsis diagnosis and severity assessment, providing timely and personalized treatment. The advanced 3D plasmonic bimetallic alloy nanoarchitecture‐based SERS biosensor is developed for differential diagnosis and severity prediction of sepsis, capable of detecting immune‐related serum proteins with high sensitivity (4–6 fM) and reproducibility. Combined with a machine learning algorithm achieving 95% accuracy, this outstanding biosensor enables effective clinical diagnosis of sepsis, supporting timely and personalized treatment.

Muscle mass depletion is associated with mortality and morbidity in various conditions including sepsis. However, few studies have evaluated muscle mass using point-of-care ultrasound in patients with sepsis. This study aimed to evaluate the association between thigh muscle mass, evaluated using point-of-care ultrasound with panoramic view in patients with sepsis in the emergency department, and mortality. From March 2021 to October 2022, this prospective observational study used sepsis registry. Adult patients who were diagnosed with sepsis at the emergency department and who underwent point-of-care ultrasounds for lower extremities were included. The thigh muscle mass was evaluated by the cross-sectional area of the quadriceps femoris (CSA-QF) on point-of-care ultrasound using panoramic view. The primary outcome was 28 day mortality. Multivariable Cox proportional hazard model was performed. Of 112 included patients with sepsis, mean CSA-QF was significantly lower in the non-surviving group than surviving group (49.6 [34.3–56.5] vs. 63.2 [46.9–79.6] cm 2 , p = 0.002). Each cm 2 increase of mean CSA-QF was independently associated with decreased 28 day mortality (adjusted hazard ratio 0.961, 95% CI 0.928–0.995, p = 0.026) after adjustment for potential confounders. The result of other measurements of CSA-QF were similar. The muscle mass of the quadriceps femoris evaluated using point-of-care ultrasound with panoramic view was associated with mortality in patients with sepsis. It might be a promising tool for determining risk factors for mortality in sepsis patients in the early stages of emergency department.

Background Timely and accurate triage is crucial for the emergency department (ED) care. Recently, there has been growing interest in applying large language models (LLMs) to support triage decision-making. However, most existing studies have evaluated these models using simulated scenarios rather than real-world clinical cases. Therefore, we evaluated the performance of multiple commercial LLMs for non-critical triage support in ED using real-world clinical conversations. Methods We retrospectively analyzed real-world triage conversations prospectively collected from three tertiary hospitals in South Korea. Multiple commercial LLMs—including OpenAI GPT-4o, GPT-4.1, O3, Google Gemini 2.0 flash, Gemini 2.5 flash, Gemini 2.5 pro, DeepSeek V3, and DeepSeek R1—were evaluated for the accuracy in triaging patient urgency based solely on unsummarized dialogue. The Korean Triage and Acuity Scale (KTAS) assigned by triage nurses was used as the gold standard for evaluating the LLM classifications. Model performance was assessed under both a zero-shot prompting condition and a few-shot prompting condition that included representative examples. Results A total of 1,057 triage cases were included in the analysis. Among the models, Gemini 2.5 flash achieved the highest accuracy (73.8%), specificity (88.9%), and PPV (94.0%). Gemini 2.5 pro demonstrated the highest sensitivity (90.9%) and F1-score (82.4%), though with lower specificity (23.3%). GPT-4.1 also showed balanced high accuracy (70.6%) and sensitivity (81.3%) with practical response times (1.79s). Performance varied widely between models and even between different versions from the same vendor. With few-shot prompting, most models showed further improvements in accuracy and F1-score. Conclusions LLMs can accurately triage ED patient urgency using real-world clinical conversations. Several models demonstrated both high sensitivity and acceptable response times, supporting the feasibility of LLM in non-critical triage support tools in diverse clinical environments. These findings apply to non-critical patients (KTAS 3–5), and further research should address integration with objective clinical data and real-time workflow.

Survival benefits of prehospital advanced airway and epinephrine in out-of-hospital cardiac arrest (OHCA) patients are controversial, but few studies evaluated this together. This study evaluated association of prehospital advanced airway and epinephrine with survival outcomes in OHCA patients. This was observational study using a prospective multicentre KoCARC registry. Adult OHCA patients between October 2015 and December 2021 were included. The variables of interest were prehospital managements, which was classified into basic life support (BLS)-only, BLS + advanced airway, and BLS + advanced airway + epinephrine. In total, 8217 patients were included in analysis. Survival to discharge and good neurological outcomes were lowest in the BLS + advanced airway + epinephrine group (22.1% in BLS-only vs 13.2% in BLS + advanced airway vs 7.5% in BLS + advanced airway + epinephrine, P  < 0.001 and 17.1% in BLS-only vs 9.2% in BLS + advanced airway vs 4.3% in BLS + advanced airway + epinephrine, P  < 0.001, respectively). BLS + advanced airway + epinephrine group was less likely to survive to discharge and have good neurological outcomes (aOR 0.39, 95% CI 0.28–0.55, P  < 0.001 and aOR 0.33, 95% CI 0.21–0.51, P  < 0.001, respectively) than BLS-only group after adjusting for potential confounders. In prehospital settings with intermediate EMS providers and prehospital advanced airway insertion is performed followed by epinephrine administration, prehospital management with BLS + advanced airway + epinephrine in OHCA patients was associated with lower survival to discharge rate compared to BLS-only.

Background Sepsis is a life-threatening condition caused by a dysregulated host response to infection, with significant biological heterogeneity. Transcriptomic profiling offers insights into immune-related gene expression patterns that may inform patient stratification. This study aimed to identify transcriptomic signatures of sepsis or septic shock. Method Eleven adult patients who presented to the emergency department with sepsis or septic shock were enrolled at a tertiary hospital in Korea. Serial whole-blood samples were collected on days 1, 3, and 7. RNA sequencing was performed using Illumina paired-end protocols. Principal component analysis (PCA) was performed on normalized transcriptomic data to derive a gene signature. Enrichment scores were calculated using single-sample gene set enrichment analysis and validated in external bulk and single-cell RNA-seq datasets. Results PCA identified first principal component (PC1) as the major axis of variation, separating samples by sepsis severity and timepoint. Clustering of the top 50 PC1 contributing genes identified three transcriptomic subgroups with distinct expression patterns. Enrichment scores for this gene set increased with severity and declined over time. In multiple external sepsis cohorts, enrichment scores showed consistent trends and were significantly associated with 28-day mortality. Functional analysis revealed predominant neutrophil-associated pathways, as further supported by external single-cell RNA-seq validation. Conclusions We identified a neutrophil-driven transcriptomic signature associated with sepsis severity and temporal immune dynamics. These findings suggest that longitudinal transcriptomic profiling may provide additional insight into the evolving host immune response during sepsis.

AbstractIntroductionIdentifying patients with at a high risk of progressing to septic shock is essential. Due to systemic vasodilation in the pathophysiology of septic shock, the use of diastolic blood pressure (DBP) has emerged. We hypothesized that the initial shock index (SI) and diastolic SI (DSI) at the emergency department (ED) triage can predict septic shock. MethodThis observational study used the prospectively collected sepsis registry. The primary outcome was progression to septic shock. Secondary outcomes were the time to vasopressor requirement, vasopressor dose, and severity according to SI and DSI. Patients were classified by tertiles according to the first principal component of shock index and diastolic shock index. ResultsA total of 1267 patients were included in the analysis. The area under the receiver operating characteristic curve (AUC) for predicting progression to septic shock for DSI was 0.717, while that for SI was 0.707. The AUC for predicting progression to septic shock for DSI and SI were significantly higher than those for conventional early warning scores. Middle tertile showed adjusted Odd ratio (aOR) of 1.448 (95% CI 1.074–1.953), and that of upper tertile showed 3.704 (95% CI 2.299–4.111). ConclusionThe SI and DSI were significant predictors of progression to septic shock. Our findings suggest an association between DSI and vasopressor requirement. We propose stratifying lower tertile as being at low risk, middle tertile as being at intermediate risk, and upper tertile as being at high risk of progression to septic shock. This system can be applied simply at the ED triage.

Acute pulmonary embolism (APE) is a major cause of death from cardiovascular disease. Right ventricular systolic dysfunction (RVD) caused by APE is closely related to a poor outcome. Early risk stratification of APE is a vital step in prognostic assessment. The objective of this study was to investigate the usefulness of computed tomographic pulmonary angiography (CTPA) measured right ventricular (RV)/ left ventricular (LV) diameter ratio by the emergency department (ED) specialists for early risk stratification of APE patients in ED. The retrospective data of 229 APE patients were reviewed. Two ED specialists measured both RV and LV diameters on a single transverse scan perpendicular to the long axis of the heart. The patients were divided into two groups, RV/LV diameter ratio <1 and ratio >1. CTPA measured RV/LV diameter ratio were analyzed and compared with sPESI score, cardiac biomarkers such as N-Terminal Pro-B-Type Natriuretic Peptide (NT-pro-BNP), high sensitivity cardiac troponin T (hs-cTnT), and RVD measured by echocardiography (Echo). The mean age in RV/LV > 1 group was significantly higher than that of the other group (67.81±2.7 years vs. 60.68±3.2 years). Also, there were more hypertension patients (44.4% vs. 33.3%), and mean arterial pressure (MAP) was lower. A significantly higher ICU admission rate (28.05% vs. 11.61%) was shown in RV/LV >1 group, and five patients expired only in RV/LV > 1 group. RVD by Echo demonstrated the highest sensitivity, specificity, and negative predictive value (NPV) (values of 94.3%, 81.1%, 95.5%). RV/LV >1 diameter ratio by CTPA showed usefulness equivalent to cardiac biomarkers. RV/LV >1 patients' cardiac enzymes were higher, and there were more RVD in RV/LV >1 group. Simple measurement of RV/LV diameter ratio by ED specialist would be a help to the clinicians in identifying and stratifying the risk of the APE patients presenting in the ED.

Although rib fractures are a risk factor, not all rib fracture patients will develop delayed hemothorax. This study aimed to evaluate risk factors which can identify rib fracture patients in the emergency department who may develop delayed hemothorax. Adult patients seen in the emergency room between January 2016 and February 2021 with rib fractures caused by blunt chest trauma were included in this retrospective observational study. Patients who underwent chest tube insertion within 2 days and those without follow-up chest radiographs within 2–30 days were excluded. We used a stepwise backward-elimination multivariable logistic regression model for analysis. A total of 202 patients were included in this study. The number of total (P < 0.001), lateral (P = 0.019), and displaced (P < 0.001) rib fractures were significantly associated with delayed hemothorax. Lung contusions (P = 0.002), and initial minimal hemothorax (P < 0.001) and pneumothorax (P < 0.001) were more frequently associated with delayed hemothorax. Age (adjusted odds ratio (aOR) 1.03, 95% confidence interval (CI) 1.00–1.06, P = 0.022), mechanical ventilator use (aOR 9.67, 95% CI 1.01–92.75, P = 0.049), initial hemothorax (aOR 2.21, 95% CI 1.05–4.65, P = 0.037) and pneumothorax (aOR 2.99, 95% CI 1.36–6.54, P = 0.006), and displaced rib fractures (aOR 3.51, 95% CI 1.64–7.53, P = 0.001) were independently associated with delayed hemothorax. Age, mechanical ventilation, initial hemo- or pneumothorax, and displaced rib fractures were risk factors for delayed hemothorax. Patients with these risk factors, and especially those with ≥2 displaced rib fractures, require close chest radiography follow-up of 2–30 days after the initial trauma.

Background This study investigated the clinical value of interleukin-6 (IL-6), pentraxin 3 (PTX3), and procalcitonin (PCT) in patients with sepsis and septic shock diagnosed according to the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). Methods Serum levels of IL-6, PTX3, and PCT were measured in 142 enrolled subjects (51 with sepsis, 46 with septic shock, and 45 as controls). Follow-up IL-6 and PTX3 levels were measured in patients with initial septic shock within 24 h of hospital discharge. Optimal cut-off values were determined for sepsis and septic shock, and prognostic values were evaluated. Results Serum IL-6 levels could discriminate sepsis (area under the curve [AUC], 0.83–0.94, P  <  0.001; cut-off value, 52.60 pg/mL, 80.4% sensitivity, 88.9% specificity) from controls and could distinguish septic shock (AUC, 0.71–0.89; cut-off value, 348.92 pg/mL, 76.1% sensitivity, 78.4% specificity) from sepsis. Twenty-eight-day mortality was significantly higher in the group with high IL-6 (≥ 348.92 pg/mL) than in the group with low IL-6 (< 348.92 pg/mL) ( P  = 0.008). IL-6 was an independent risk factor for 28-day mortality among overall patients (hazard ratio, 1.0004; 95% confidence interval, 1.0003–1.0005; p  = 0.024). In septic shock patients, both the initial and follow-up PTX3 levels were consistently significantly higher in patients who died than in those who recovered (initial p  = 0.004; follow-up P  <  0.001). Conclusions The diagnostic and prognostic value of IL-6 was superior to those of PTX3 and PCT for sepsis and septic shock.

This study aimed to describe the timely strategies used to prevent the spread of the emerging coronavirus disease 2019 (COVID-19) and present the activities performed in a regional base hospital in South Korea, from the identification of the index patient until the pandemic declaration. This is a descriptive study detailing the step-by-step guidelines implemented to manage COVID-19 in a regional tertiary base hospital from January to March 2020. We described our three-phase response to the COVID-19 outbreak as per the national and global quarantine procedures applied during each critical event and highlighted the activities implemented from the perspective of public health crisis preparedness involving emerging infectious diseases. During the COVID-19 outbreak in Korea, we improved and implemented a rapid and flexible screening system for visiting patients using patient history and radiological testing and created a separate isolation zone for patients under investigation. This active identification-isolation strategy has been effectively applied in the COVID-19 outbreak. The step-by-step enforced strategies to prevent the spread of COVID-19, though not perfect, adequately reduced the risk of transmission of the highly contagious infectious disease in the hospital while maintaining the emergency medical system.