Thai Journal of Emergency Medicine

Impact of Appropriateness for Empirical Antibiotics in Patients with Sepsis in the Emergency Department

2025-07-09T14:25:36+07:00

Background
Sepsis has a worldwide impact on the healthcare system. The primary problem in treating sepsis is the emergence of multidrug-resistant microbials caused by the improper use of antibiotics. The mortality associated with the inappropriate use of empirical antibiotics consequently adds a burden to the healthcare system. This study aims to investigate the clinical impact of appropriate empirical antibiotics in sepsis patients presenting to the emergency department.
Methods
A retrospective cohort study was conducted among patients with sepsis who received empirical antibiotics in the emergency department. Patients were stratified based on laboratory culture results and the appropriateness of empirical antibiotic therapy. The impact of empirical antibiotic use was evaluated with respect to 30-day mortality, length of hospital and intensive care unit (ICU) stay, admission costs, and overall patient survival.
Results
Appropriate empiric antibiotic use in the culture-negative sepsis (CNS) group was associated with a significant reduction in 30-day mortality (risk ratio [RR], 0.26; 95% confidence interval [CI], 0.15–0.46; P < 0.01). In contrast, appropriate empiric antibiotic use in the culture-positive sepsis (CPS) group was not significantly associated with decreased mortality (RR, 0.88; 95% CI, 0.74–1.05; P = 0.08). The length of hospital stay was significantly longer among patients with inappropriate empiric antibiotic use in the CNS group, whereas no significant difference was observed in the CPS group. Length of ICU stay and admission costs did not differ significantly between appropriate and inappropriate empiric antibiotic use in either group.
Conclusions
Appropriate empiric antibiotic use in patients with culture-negative sepsis (CNS) was associated with a significant reduction in 30-day mortality. In contrast, in patients with culture-positive sepsis (CPS), appropriate empiric antibiotic use did not significantly reduce mortality.

The Consistency of Severity Assessment of Emergency Patients Between the Emergency Dispatch Center and the ESI MOPH ED Triage System at Maharat Nakhon Ratchasima Hospital

2025-06-01T12:59:33+07:00

Introduction
A significant number of patients currently seek services at the emergency room of Maharaj Hospital. Improving the triage system for assessing the severity of emergency cases, is essential to reducing losses associated with emergency conditions.
Objectives
This study aimed to evaluate the consistency between the severity level assessments of emergency patients conducted by the emergency dispatch center and those performed using the ESI MOPH ED Triage criteria at Maharaj Nakorn Ratchasima Hospital.
Method
This descriptive retrospective study analyzed patient data from the Emergency Medical Information System (ITEMS). The study included data from 2,872 emergency cases reported via the emergency dispatch center and subsequently treated at Maharaj Nakorn Ratchasima Hospital. Statistical methods used included frequency, percentage, Weighted Cohen’s Kappa statistics, and a 95% confidence interval
Results
The consistency of severity level assessments between the emergency dispatch center and the ESI MOPH ED Triage system showed that 78.38% of cases were consistent with the criteria, 6.69% were below the criteria (Under Triage), and 14.94% were above the criteria (Over Triage). Regarding the Response Code (RC) compared to the ESI MOPH ED Triage system, 82.45% of cases were consistent with the criteria, 4.56% were below the criteria, and 12.99% were above the criteria. Furthermore, the accuracy of the Incident Dispatch Code (IDC) compared to the RC indicated that 90.70% were accurate, while 4.67% were below the criteria and 4.63% were above the criteria.
Conclusion
The triage consistency between IDC and ESI, which use different criteria, is relatively high. The consistency between RC and the ESI system is even higher due to the involvement of real-time team evaluations during operations. Additionally, the consistency of patient triage assessments based on IDC and RC at Maharaj Hospital is exceptionally high.

AssessingtheaccuracyandagreementofChatGPTIntegrated with Voice Commands in Emergency Severity Index (ESI) Triage for Emergency Patients at Warin Chamrap Hospital

2025-10-17T15:21:50+07:00

Background
Emergency department (ED) triage is critical for patient safety and optimal resource use. This study assessed the accuracy and agreement of Thai voice–enabled ChatGPT in Emergency Severity Index (ESI) triage compared with emergency physicians and triage nurses.
Methods
Cross-sectional study conducted in the ED of Warinchamrap Hospital, Thailand, from 1 April to 31 May 2025. Consecutive ED patients (n = 387) underwent triage by an expert emergency physician panel (reference standard), by triage nurses, and by ChatGPT-4o using data from the standardized triage form entered via Thai voice commands and/or typing. Agreement across the five ESI levels was assessed with weighted κ (kappa). Binary classification performance for critical (ESI 1–2) versus non-critical (ESI 3–5) was reported as sensitivity, specificity, PPV, NPV, and Area under the Receiver Operating Characteristic curve (AuROC). Directional misclassification (over-/under-triage) was tested with the McNemar test.
Results
For classifying emergent cases (ESI 1–2), ChatGPT showed sensitivity 97.6%, specificity 95.9%, PPV 94.8%, NPV 98.1%, and AuROC 97% (95%CI 95.0–99.0), while the nurse showed sensitivity 92.3%, specificity 75.7%, PPV 74.6%, NPV 92.7%, and AuROC 84% (95%CI 81.0–87.0). Agreement with physicians was weighted kappa =0.915 (95%CI 0.844–0.986) (almost perfect agreement) for ChatGPT and 0.607 (95%CI 0.536–0.678) (substantial agreement) for the nurse. ChatGPT showed over-triage 2.6% (10 cases) and under-triage 3.4% (13 cases), total 5.9% (23 cases), McNemar p = 0.270 the nurse showed over-triage 23.3% (90 cases) and undertriage 5.2% (20 cases), total 28.4% (110 cases), McNemar p < 0.001.
Conclusions
ChatGPT with Thai voice commands demonstrated 97% discriminative ability and very high agreement with physicians. Its potential should be applied as a decision-support tool to reduce triage errors and be useful where staffing is limited.

FactorsPredictingJobRetentionAmongEmergency Physicians in Ministry of Public Health Hospitals

2025-12-20T11:46:54+07:00

Introduction
Emergency physicians are essential in managing critically ill patients in hospitals under Thailand’s Ministry of Public Health (MOPH). However, high workloads, workplace stress, and inadequate compensation contribute to resignations and job instability, posing a challenge to health system sustainability.
Objectives
To identify personal and organizational factors predicting job retention among emergency physicians and propose policy recommendations to strengthen workforce sustainability.
Methods
This analytic survey included 238 emergency physicians from a national population of 614 (as of July 1, 2025). Data were collected using a four-part questionnaire: demographics, organizational factors, job retention, and open-ended responses. Content validity was high (IOC=0.94), with excellent reliability (Cronbach’s alpha=0.959). Descriptive statistics and stepwise multiple regression were applied.
Results
Participants were mostly female (61.3%), median age 35 years, holding professional-level positions (75.2%). The most common income was 70,001–90,000 THB (38.2%). “Work relationships” scored highest (3.92±0.72), while “compensation and benefits” scored lowest (3.08±0.76). Average job retention was 3.07±1.02, indicating uncertainty. Significant predictors were working in tertiary hospitals (β=0.16, p=0.006), longer tenure (β=0.13, p=0.027), income 30,001–50,000 THB (β=0.11, p=0.042), and f inancial adequacy with savings (β=-0.12, p=0.030). Organizational factors included work–life balance (β=0.34, p<0.001) and leadership policies (β=0.22, p=0.002). The model explained 34% of variance in retention (R²=0.34, p<0.001).
Conclusion
Job retention among emergency physicians is shaped by both personal and organizational factors, especially work–life balance and leadership. To sustain this critical workforce, the MOPH should strengthen organizational structures, provide supportive systems, and adopt fair policies aligned with actual working conditions.