Acute and Critical Care

Original Article

Rapid response system
Prospective external validation of a deep-learning-based early-warning system for major adverse events in general wards in South Korea: Taeyong Sim, Eun Young Cho, Ji-hyun Kim, Kyung Hyun Lee, Kwang Joon Kim, Sangchul Hahn, Eun Yeong Ha, Eunkyeong Yun, In-Cheol Kim, Sun Hyo Park, Chi-Heum Cho, Gyeong Im Yu, Byung Eun Ahn, Yeeun Jeong, Joo-Yun Won, Hochan Cho, Ki-Byung Lee; Acute Crit Care. 2025;40(2):197-208. Published online May 30, 2025; DOI: https://doi.org/10.4266/acc.000525

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Background
Acute deterioration of patients in general wards often leads to major adverse events (MAEs), including unplanned intensive care unit transfers, cardiac arrest, or death. Traditional early warning scores (EWSs) have shown limited predictive accuracy, with frequent false positives. We conducted a prospective observational external validation study of an artificial intelligence (AI)-based EWS, the VitalCare - Major Adverse Event Score (VC-MAES), at a tertiary medical center in the Republic of Korea.
Methods
Adult patients from general wards, including internal medicine (IM) and obstetrics and gynecology (OBGYN)—the latter were rarely investigated in prior AI-based EWS studies—were included. The VC-MAES predictions were compared with National Early Warning Score (NEWS) and Modified Early Warning Score (MEWS) predictions using the area under the receiver operating characteristic curve (AUROC), area under the precision-recall curve (AUPRC), and logistic regression for baseline EWS values. False-positives per true positive (FPpTP) were assessed based on the power threshold.
Results
Of 6,039 encounters, 217 (3.6%) had MAEs (IM: 9.5%, OBGYN: 0.26%). Six hours prior to MAEs, the VC-MAES achieved an AUROC of 0.918 and an AUPRC of 0.352, including the OBGYN subgroup (AUROC, 0.964; AUPRC, 0.388), outperforming the NEWS (0.797 and 0.124) and MEWS (0.722 and 0.079). The FPpTP was reduced by up to 71%. Baseline VC-MAES was strongly associated with MAEs (P<0.001).
Conclusions
The VC-MAES significantly outperformed traditional EWSs in predicting adverse events in general ward patients. The robust performance and lower FPpTP suggest that broader adoption of the VC-MAES may improve clinical efficiency and resource allocation in general wards.

Citations

Citations to this article as recorded by

Clinical Context Is More Important than Data Quantity to the Performance of an Artificial Intelligence-Based Early Warning System
Taeyong Sim, Eunyoung Cho, Jihyun Kim, Ho Gwan Kim, Soo-Jeong Kim
Journal of Clinical Medicine.2025; 14(13): 4444. CrossRef
Artificial intelligence and machine learning approaches for patient safety in complex surgery: a review
Mohamed Mustaf Ahmed, Zhinya Kawa Othman, Uthman Okikiola Adebayo, Omar Kasimieh, Olalekan John Okesanya, Shuaibu Saidu Musa, Francesco Branda, Victor C. Cañezo , Edgar G. Cue, Don Eliseo Lucero Prisno III
Patient Safety in Surgery.2025;[Epub] CrossRef

Case Report

Cardiology
Acute fulminant myocarditis following influenza vaccination requiring extracorporeal membrane oxygenation: Youn-Jung Kim, Jun-Il Bae, Seung Mok Ryoo, Won Young Kim; Acute Crit Care. 2019;34(2):165-169. Published online November 7, 2018; DOI: https://doi.org/10.4266/acc.2017.00045

15,211 View
214 Download
27 Web of Science
29 Crossref

Abstract PDF

The inactivated influenza vaccination is generally safe with mostly mild side effects. We report a rare but fatal adverse event following influenza vaccination. A previously healthy 27-yearold woman who received the influenza vaccination 3 days before presenting to the emergency department had rapidly aggravating dyspnea and mental deterioration. She was diagnosed as having acute fulminant myocarditis with refractory cardiogenic shock, which was successfully managed with veno-arterial extracorporeal membrane oxygenation. The cardiac function of the patient recovered in 3 weeks.

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