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7 "Yu Hyeon Choi"
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Original Articles
Pediatrics
Multicenter validation of a deep-learning-based pediatric early-warning system for prediction of deterioration events
Yunseob Shin, Kyung-Jae Cho, Yeha Lee, Yu Hyeon Choi, Jae Hwa Jung, Soo Yeon Kim, Yeo Hyang Kim, Young A Kim, Joongbum Cho, Seong Jong Park, Won Kyoung Jhang
Acute Crit Care. 2022;37(4):654-666.   Published online October 26, 2022
DOI: https://doi.org/10.4266/acc.2022.00976
  • 3,085 View
  • 187 Download
  • 3 Web of Science
  • 5 Crossref
AbstractAbstract PDFSupplementary Material
Background
Early recognition of deterioration events is crucial to improve clinical outcomes. For this purpose, we developed a deep-learning-based pediatric early-warning system (pDEWS) and aimed to validate its clinical performance. Methods: This is a retrospective multicenter cohort study including five tertiary-care academic children’s hospitals. All pediatric patients younger than 19 years admitted to the general ward from January 2019 to December 2019 were included. Using patient electronic medical records, we evaluated the clinical performance of the pDEWS for identifying deterioration events defined as in-hospital cardiac arrest (IHCA) and unexpected general ward-to-pediatric intensive care unit transfer (UIT) within 24 hours before event occurrence. We also compared pDEWS performance to those of the modified pediatric early-warning score (PEWS) and prediction models using logistic regression (LR) and random forest (RF). Results: The study population consisted of 28,758 patients with 34 cases of IHCA and 291 cases of UIT. pDEWS showed better performance for predicting deterioration events with a larger area under the receiver operating characteristic curve, fewer false alarms, a lower mean alarm count per day, and a smaller number of cases needed to examine than the modified PEWS, LR, or RF models regardless of site, event occurrence time, age group, or sex. Conclusions: The pDEWS outperformed modified PEWS, LR, and RF models for early and accurate prediction of deterioration events regardless of clinical situation. This study demonstrated the potential of pDEWS as an efficient screening tool for efferent operation of rapid response teams.

Citations

Citations to this article as recorded by  
  • Predicting cardiac arrest after neonatal cardiac surgery
    Alexis L. Benscoter, Mark A. Law, Santiago Borasino, A. K. M. Fazlur Rahman, Jeffrey A. Alten, Mihir R. Atreya
    Intensive Care Medicine – Paediatric and Neonatal.2024;[Epub]     CrossRef
  • Volumetric regional MRI and neuropsychological predictors of motor task variability in cognitively unimpaired, Mild Cognitive Impairment, and probable Alzheimer's disease older adults
    Michael Malek-Ahmadi, Kevin Duff, Kewei Chen, Yi Su, Jace B. King, Vincent Koppelmans, Sydney Y. Schaefer
    Experimental Gerontology.2023; 173: 112087.     CrossRef
  • Predicting sepsis using deep learning across international sites: a retrospective development and validation study
    Michael Moor, Nicolas Bennett, Drago Plečko, Max Horn, Bastian Rieck, Nicolai Meinshausen, Peter Bühlmann, Karsten Borgwardt
    eClinicalMedicine.2023; 62: 102124.     CrossRef
  • A model study for the classification of high-risk groups for cardiac arrest in general ward patients using simulation techniques
    Seok Young Song, Won-Kee Choi, Sanggyu Kwak
    Medicine.2023; 102(37): e35057.     CrossRef
  • An advanced pediatric early warning system: a reliable sentinel, not annoying extra work
    Young Joo Han
    Acute and Critical Care.2022; 37(4): 667.     CrossRef
Pediatrics
Clinical implications of discrepancies in predicting pediatric mortality between Pediatric Index of Mortality 3 and Pediatric Logistic Organ Dysfunction-2
Eui Jun Lee, Bongjin Lee, You Sun Kim, Yu Hyeon Choi, Young Ho Kwak, June Dong Park
Acute Crit Care. 2022;37(3):454-461.   Published online July 29, 2022
DOI: https://doi.org/10.4266/acc.2021.01480
  • 2,510 View
  • 166 Download
  • 1 Crossref
AbstractAbstract PDF
Background
Pediatric Index of Mortality 3 (PIM 3) and Pediatric Logistic Organ Dysfunction-2 (PELOD-2) are validated tools for predicting mortality in children. Research suggests that these tools may have different predictive performance depending on patient group characteristics. Therefore, we designed this study to identify the factors that make the mortality rates predicted by the tools different.
Methods
This retrospective study included patients (<18 years) who were admitted to a pediatric intensive care unit from July 2017 to May 2019. After defining the predicted mortality of PIM 3 minus the predicted mortality rate of PELOD-2 as “difference in mortality prediction,” the clinical characteristics significantly related to this were analyzed using multivariable regression analysis. Predictive performance was analyzed through the Hosmer-Lemeshow test and area under the receiver operating characteristic curve (AUROC).
Results
In total, 945 patients (median [interquartile range] age, 3.0 [0.0–8.0] years; girls, 44.7%) were analyzed. The Hosmer-Lemeshow test revealed AUROCs of 0.889 (χ2=10.187, P=0.313) and 0.731 (χ2=6.220, P=0.183) of PIM 3 and PELOD-2, respectively. Multivariable linear regression analysis revealed that oxygen saturation, partial pressure of CO2, base excess, platelet counts, and blood urea nitrogen levels were significant factors. Patient condition-related factors such as cardiac bypass surgery, seizures, cardiomyopathy or myocarditis, necrotizing enterocolitis, cardiac arrest, leukemia or lymphoma after the first induction, bone marrow transplantation, and liver failure were significantly related (P<0.001).
Conclusions
Both tools predicted observed mortality well; however, caution is needed in interpretation as they may show different prediction results in relation to specific clinical characteristics.

Citations

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  • COMPARISON OF PEDIATRIC INDEX OF MORTALITY (PIM)-3 AND PEDIATRIC SEQUENTIAL ORGAN FAILURE ASSESSMENT (pSOFA) SCORES TO PREDICT MORTALITY IN PEDIATRIC INTENSIVE CARE UNIT
    ANKIT KUMAR PAWAR, GAURAV KUMAR PRAJAPATI, KANCHAN CHOUBEY, RASHMI RANDA
    Asian Journal of Pharmaceutical and Clinical Research.2024; : 81.     CrossRef
Case Reports
Neurology/Pulmonary
Extensive and Progressive Cerebral Infarction after Mycoplasma pneumoniae Infection
Yu Hyeon Choi, Hyung Joo Jeong, Bongjin Lee, Hong Yul An, Eui Jun Lee, June Dong Park
Korean J Crit Care Med. 2017;32(2):211-217.   Published online December 29, 2016
DOI: https://doi.org/10.4266/kjccm.2016.00283
  • 7,102 View
  • 175 Download
  • 3 Web of Science
  • 3 Crossref
AbstractAbstract PDF
Acute cerebral infarctions are rare in children; however they can occur as a complication of a Mycoplasma pneumoniae (MP) infection due to direct invasion, vasculitis, or a hypercoagulable state. We report on the case of a 5-year-old boy who had an extensive stroke in multiple cerebrovascular territories 10 days after the diagnosis of MP infection. Based on the suspicion that the cerebral infarction was associated with a macrolide-resistant MP infection, the patient was treated with levofloxacin, methyl-prednisolone, intravenous immunoglobulin, and enoxaparin. Despite this medical management, cerebral vascular narrowing progressed and a decompressive craniectomy became necessary for the patient’s survival. According to laboratory tests, brain magnetic resonance imaging, and clinical manifestations, the cerebral infarction in this case appeared to be due to the combined effects of hypercoagulability and cytokine-induced vascular inflammation.

Citations

Citations to this article as recorded by  
  • Stroke associated with Mycoplasma hominis infection: a case report
    Anthoula C. Tsolaki, Galaktion Konstantinidis, Stavroula Koukou, Fotini Michali, Despina Georgiadou, Thomas Tegos, Nikolaos D. Michalis
    Journal of Medical Case Reports.2021;[Epub]     CrossRef
  • Thrombosis associated with mycoplasma pneumoniae infection (Review)
    Jingwei Liu, Yumei Li
    Experimental and Therapeutic Medicine.2021;[Epub]     CrossRef
  • Multiple anatomic sites of infarction in a pediatric patient with M. pneumoniae infection, a case report
    Devon W. Hahn, Claire E. Atkinson, Matthew Le
    BMC Pediatrics.2021;[Epub]     CrossRef
Neurosurgery
Severe Rhabdomyolysis in Phacomatosis Pigmentovascularis Type IIb associated with Sturge-Weber Syndrome
Bongjin Lee, Hyung Joo Jeong, Yu Hyeon Choi, Chong Won Choi, June Dong Park
Korean J Crit Care Med. 2015;30(4):329-335.   Published online November 30, 2015
DOI: https://doi.org/10.4266/kjccm.2015.30.4.329
  • 7,178 View
  • 79 Download
  • 1 Crossref
AbstractAbstract PDF
Phacomatosis pigmentovascularis (PPV) is a rare syndrome characterized by concurrent nevus flammeus (capillary malformation) and pigmentary nevus. According to current research, the major pathophysiologic mechanism in PPV is venous dysplasia with resultant compensatory collateral channels and venous hypertension. Arterial involvement is rare. We herein report our experience on renovascular hypertension, intermittent claudication, and severe rhabdomyolysis due to diffuse stenosis of multiple arteries in a patient with PPV type IIb associated with SWS.

Citations

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  • Oral healthcare management of a child with phakomatosis pigmentovascularis associated with bilateral Sturge‐Weber syndrome
    Mariana Leonel Martins, Aline Dos Santos Letieri, Michele Machado Lenzi, Michelle Agostini, Gloria Fernanda Castro
    Special Care in Dentistry.2019; 39(3): 324.     CrossRef
Infection
Kawasaki Disease with Acute Respiratory Distress Syndrome after Intravenous Immunoglobulin Infusion
Yu Hyeon Choi, Bong Jin Lee, June Dong Park, Seung Hyo Kim
Korean J Crit Care Med. 2014;29(4):336-340.   Published online November 30, 2014
DOI: https://doi.org/10.4266/kjccm.2014.29.4.336
  • 6,540 View
  • 78 Download
  • 1 Crossref
AbstractAbstract PDF
Kawasaki disease (KD) is an acute systemic vasculitis of unknown etiology. We report a case of KD with acute respiratory distress syndrome (ARDS) after intravenous immunoglobulin (IVIG) infusion. Lung manifestations associated with KD have previously been reported in the literature. Although IVIG infusion is an effective therapy for acute KD, there are some reported complications related to IVIG infusion: hypotension, aseptic meningitis, acute renal failure, hemolytic anemia, etc. The case of KD reported here was treated with IVIG and aspirin. A few days after recovery from KD, the patient developed fever and maculopapular rash. A diagnosis of relapse KD was made and retreated with IVIG infusion. However, the patient developed ARDS four days after the second IVIG infusion. The patient recovered from ARDS after nine days of ICU care, which included high frequency oscillation ventilation with inhaled nitric oxide, steroid treatment and other supportive care.

Citations

Citations to this article as recorded by  
  • French national diagnostic and care protocol for Kawasaki disease
    C. Galeotti, F. Bajolle, A. Belot, S. Biscardi, E. Bosdure, E. Bourrat, R. Cimaz, R. Darbon, P. Dusser, O. Fain, V. Hentgen, V. Lambert, A. Lefevre-Utile, C. Marsaud, U. Meinzer, L. Morin, M. Piram, O. Richer, J.-L. Stephan, D. Urbina, I. Kone-Paut
    La Revue de Médecine Interne.2023; 44(7): 354.     CrossRef
Original Article
Cardiology/Pediatric
Effectiveness of Bradycardia as a Single Parameter in the Pediatric Acute Response System
Yu Hyeon Choi, Hyeon Seung Lee, Bong Jin Lee, Dong In Suh, June Dong Park
Korean J Crit Care Med. 2014;29(4):297-303.   Published online November 30, 2014
DOI: https://doi.org/10.4266/kjccm.2014.29.4.297
  • 4,461 View
  • 51 Download
  • 3 Crossref
AbstractAbstract PDF
BACKGROUND
Various tools for the acute response system (ARS) predict and prevent acute deterioration in pediatric patients. However, detailed criteria have not been clarified. Thus we evaluated the effectiveness of bradycardia as a single parameter in pediatric ARS.
METHODS
This retrospective study included patients who had visited a tertiary care children's hospital from January 2012 to June 2013, in whom ARS was activated because of bradycardia. Patient's medical records were reviewed for clinical characteristics, cardiologic evaluations, and reversible causes that affect heart rate.
RESULTS
Of 271 cases, 261 (96%) had ARS activation by bradycardia alone with favorable outcomes. Evaluations and interventions were performed in 165 (64.5%) and 13 cases (6.6%) respectively. All patients in whom ARS was activated owing to bradycardia and another criteria underwent evaluation, unlike those with bradycardia alone (100.0% vs. 63.2%, p = 0.016). Electrocardiograms were evaluated in 233 (86%) cases: arrhythmias were due to borderline QT prolongation and atrioventricular block (1st and 2nd-degree) in 25 cases (9.2%). Bradycardia-related causes were reversible in 202 patients (74.5%). Specific causes were different in departments at admission. Patients admitted to the hemato-oncology department required ARS activation during the night (69.3%, p = 0.03), those to the endocrinology department required ARS activation because of medication (72.4%, p < 0.001), and those to the gastroenterology department had low body mass indexes (32%, p = 0.01).
CONCLUSIONS
Using bradycardia alone in pediatric ARS is not useful, because of its low specificity and poor predictive ability for deterioration. However, bradycardia can be applied to ARS concurrently with other parameters.

Citations

Citations to this article as recorded by  
  • Effect of Diurnal Variation of Heart Rate and Respiratory Rate on Activation of Rapid Response System and Clinical Outcome in Hospitalized Children
    Lia Kim, Kyoung Sung Yun, June Dong Park, Bongjin Lee
    Children.2023; 10(1): 167.     CrossRef
  • Eleven years of experience in operating a pediatric rapid response system at a children’s hospital in South Korea
    Yong Hyuk Jeon, Bongjin Lee, You Sun Kim, Won Jin Jang, June Dong Park
    Acute and Critical Care.2023; 38(4): 498.     CrossRef
  • Pediatric triage modifications based on vital signs: a nationwide study
    Bongjin Lee, June Dong Park, Young Ho Kwak, Do Kyun Kim
    Clinical and Experimental Emergency Medicine.2022; 9(3): 224.     CrossRef
Case Report
Disseminated Neonatal Herpes Simplex Virus Infection
Bongjin Lee, Jinsol Hwang, Yu Hyeon Choi, Young Joo Han, Young Hun Choi, June Dong Park
Korean J Crit Care Med. 2013;28(4):331-335.
DOI: https://doi.org/10.4266/kjccm.2013.28.4.331
  • 3,176 View
  • 50 Download
  • 1 Crossref
AbstractAbstract PDF
Disseminated neonatal herpes simplex virus (HSV) infection is one of the most severe neonatal infections, and can have devastating consequences without early proper treatment. However, the administration of acyclovir can often be delayed because the symptoms and signs of HSV infection are non-specific and because HSV polymerase chain reaction (PCR) results may be negative early in the course of HSV infection. We report a case of disseminated neonatal HSV infection that was diagnosed by type 1 HSV PCR on day 8 of admission. Despite delayed administration of acyclovir, the patient was cured and subsequently discharged after 30 days of admission. Fortunately, this patient was treated successfully, but delayed administration of acyclovir has the potential to lead to significant problems. Considering the seriousness of neonatal HSV infection, empirical acyclovir therapy should be considered if HSV infection is suspected.

Citations

Citations to this article as recorded by  
  • A Case of Herpes Simplex Virus Type 2 Encephalitis of a Newborn Delivered by a Mother without Prenatal Screening
    Eun Seob Lee, Joon Young Kim, Kon Hee Lee, Jung Won Lee, Yong Ju Lee, Yeon Joung Oh, Ji Seok Bang, Tae-Jung Sung
    Korean Journal of Perinatology.2014; 25(3): 195.     CrossRef

ACC : Acute and Critical Care