Journal of Korean Medical Science最新文献

{"title":"Current Practice in the Diagnosis and Management of <i>Mycoplasma pneumoniae</i> Infections: A Survey of Korean Physicians in 2024.","authors":"Young June Choe, Hyeon-Jong Yang, Joon Kee Lee, Hye-Kyung Cho, Heungsup Sung, Gwang Cheon Jang, In Young Yoo, Byung-Wook Eun, Soo-Han Choi, Byung Ok Kwak, Hwan Soo Kim, Eun Lee, Kyunghoon Kim, Eun-Ae Yang, Seo Hee Yoon, Bongjin Lee, Jeong-Yong Lee, Yae-Jean Kim","doi":"10.3346/jkms.2026.41.e229","DOIUrl":"10.3346/jkms.2026.41.e229","url":null,"abstract":"<p><strong>Background: </strong>Macrolide-resistant <i>Mycoplasma pneumoniae</i> (MRMP) is a growing concern in pediatric pneumonia. This study investigated current diagnostic and treatment practices for <i>M. pneumoniae</i> infections among Korean pediatricians, focusing on variations and challenges related to MRMP management.</p><p><strong>Methods: </strong>A cross-sectional online survey was conducted among Korean pediatricians, including general pediatricians and subspecialists in September 2024. The survey assessed diagnostic methods, antibiotic choices, corticosteroid use, and factors influencing treatment decisions.</p><p><strong>Results: </strong>A total of 452 pediatricians participated in the survey. Polymerase chain reaction was the preferred diagnostic method (92.0%), although serologic tests were also commonly used (37.4%). Macrolides were the dominant first-line treatment (89.0%), with clarithromycin and roxithromycin being equally favored. Doxycycline was the most frequent second-line choice (67.0%). Corticosteroid use varied among specialties, with up to 94% of respondents using them occasionally or almost always. Treatment guidelines were the primary factor influencing antibiotic choices (76.5% for first-line, 59.7% for second-line).</p><p><strong>Conclusion: </strong>This study reveals diverse practices and a need for standardized guidelines in managing <i>M. pneumoniae</i> infections, particularly in the context of rising MRMP prevalence. Clearer recommendations on diagnostic testing, antibiotic selection, and corticosteroid use are crucial to optimize patient care and mitigate the spread of resistance.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"41 36","pages":"e229"},"PeriodicalIF":3.2,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13574553/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148969240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retraction Analysis in Social Media Research: A Scopus Based Data From 2011 to 2025.","authors":"Burhan Fatih Kocyigit, Maidan Mukhamediyarov, Ainur B Qumar, Yuliya Fedorchenko, Olena Zimba","doi":"10.3346/jkms.2026.41.e235","DOIUrl":"10.3346/jkms.2026.41.e235","url":null,"abstract":"<p><strong>Background: </strong>Social media has significantly impacted communication and information flow, making it a key academic topic today. As the field grows, the number of retractions has increased. This study aims to identify trends in research ethics by examining the bibliometric characteristics of retracted social media-related papers.</p><p><strong>Methods: </strong>This descriptive study examined publications in the Scopus database labeled with \"social media\" and categorized under the \"Retracted\" document category. The study language was restricted to English, no time constraints were imposed, and all records from the initial retracted publication through 2025 were included. Distributions by country, institution, journal, author, keyword, year, and reasons for retraction were evaluated.</p><p><strong>Results: </strong>A total of 141 retracted papers were detected. No significant increase in publication counts was detected from 2011 to 2025 (<i>P</i> = 0.053); however, a statistically significant rise in retraction numbers was identified (<i>P</i> = 0.008). The majority of retractions originated predominantly in Asia, particularly in China and India. The predominant retraction reason was \"Investigation by Journal/Publisher\" (n = 92). This was followed by \"Unreliable Results and/or Conclusions\" (n = 65) and \"Concerns/Issues Regarding Referencing/Attributions\" (n = 61).</p><p><strong>Conclusion: </strong>The findings reveal a significant increase in retractions within social media research, particularly in the 2020s. Retractions concentrated in certain countries and journals, primarily due to editorial investigation, suspicious results, and concerns related to referencing. The results underscore the field's persistent methodological and ethical challenges. Enhancing research integrity, editorial oversight, and transparency is crucial for mitigating ethical risks and improving the scientific reliability of future social media research.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"41 36","pages":"e235"},"PeriodicalIF":3.2,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13574552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148969381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the Correlation of Calprotectin and SES-CD Score at the Time of Diagnosis and Follow-up After Diagnosis in Pediatric Patients With Crohn's Disease in Korea.","authors":"Yiyoung Kwon, Seo Hee Kim, Yoo Min Lee, Eun Sil Kim, Eun Hye Lee, Sujin Choi, Byung-Ho Choe, Hyo-Jeong Jang, In Sook Jeong, Juyoung Kim, Dae Yong Yi, Soon Chul Kim, Yeoun Joo Lee, So Yoon Choi, Yoon Lee, Yon Ho Choe, Ben Kang","doi":"10.3346/jkms.2026.41.e234","DOIUrl":"10.3346/jkms.2026.41.e234","url":null,"abstract":"<p><strong>Background: </strong>Crohn's disease (CD) requires reliable tools for monitoring intestinal inflammation. Fecal calprotectin (FC) has emerged as a promising non-invasive biomarker. This study aimed to evaluate the correlation between FC and endoscopic activity in pediatric CD confined to the colon and to establish FC cutoff values corresponding to disease severity and remission.</p><p><strong>Methods: </strong>We conducted a multicenter, retrospective, cross-sectional study including 154 pediatric patients (< 19 years) with Paris classification L2, B1 CD from 15 centers in Korea (2017-2022). Simple Endoscopic Score for Crohn's Disease (SES-CD) and FC were assessed simultaneously at diagnosis and follow-up.</p><p><strong>Results: </strong>At diagnosis, the median FC was 1,355.0 mg/kg and SES-CD 14.0, with 39.6% classified as severe. At follow-up, the median FC was 126.0 mg/kg and SES-CD 2.0, with 50.7% achieving remission. FC correlated most strongly with SES-CD (<i>r</i> = 0.56, <i>P</i> < 0.001). Receiver operating characteristic (ROC) analysis showed acceptable diagnostic accuracy (area under the ROC curves of 0.785 at diagnosis and 0.738 at follow-up). Optimal FC cutoffs were 1,585.0 mg/kg for predicting severe disease (sensitivity 73.8%, specificity 74.2%) and 195.0 mg/kg for predicting remission (sensitivity 78.2%, specificity 61.8%).</p><p><strong>Conclusion: </strong>FC strongly correlates with endoscopic activity in pediatric colonic CD, surpassing clinical indices and serum markers. The identification of clinically meaningful cutoff values may reduce the need for repeated endoscopy and support the use of FC as a surrogate marker in real-world pediatric practice.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"41 36","pages":"e234"},"PeriodicalIF":3.2,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13574557/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148969306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Socioeconomic Disparities in Post-Discharge Suicide Risk Among Individuals With Schizophrenia: A Population-Based Cohort Study in Korea.","authors":"Kyoung-Hoon Kim, Minha Hong","doi":"10.3346/jkms.2026.41.e239","DOIUrl":"10.3346/jkms.2026.41.e239","url":null,"abstract":"<p><strong>Background: </strong>The relationship between socioeconomic status (SES) and suicide in individuals with schizophrenia is complex and not fully understood. This population-based cohort study examined the association between SES and post-discharge suicide risk among individuals with schizophrenia in South Korea.</p><p><strong>Methods: </strong>Using data from the National Health Insurance Claims Database, as well as national mortality records, this study included 17,565 adults newly hospitalized for schizophrenia between 2017 and 2018. SES was proxied by insurance type-health insurance (HI) versus medical aid (MA). The association between insurance type and suicide risk was examined using Cox's proportional hazards model.</p><p><strong>Results: </strong>During the follow-up period, patients receiving MA-indicating lower SES-had a significantly higher risk of suicide (hazard ratio, 1.135; 95% confidence interval, 1.096-1.175), compared with those with HI, even after adjusting for age, sex, comorbidities, and outpatient follow-up within seven days post-discharge. While early outpatient visits were associated with reduced suicide risk, this effect was notably lower among MA recipients.</p><p><strong>Conclusion: </strong>These findings highlight persistent disparities in suicide outcomes within a universal healthcare system and underscore the need for targeted post-discharge interventions addressing structural barriers faced by socioeconomically disadvantaged individuals with schizophrenia.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"41 36","pages":"e239"},"PeriodicalIF":3.2,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13574554/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148969384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Home-Based Cardiac Rehabilitation Using a Smart Ring and Telephone Counselling: A Randomized Controlled Trial.","authors":"Chul Kim, So Myong Jun, Jeong Yeol Yoo, Ha Young Cho, Dong Woon Jeon, Seung Jin Oh, Se-Jung Yoon, Jong-Kwan Park, Hancheol Lee, Ji-Yong Jang, Hyeongsoo Kim, Jang Woo Lee","doi":"10.3346/jkms.2026.41.e260","DOIUrl":"10.3346/jkms.2026.41.e260","url":null,"abstract":"<p><strong>Background: </strong>Home-based cardiac rehabilitation (HB-CR) is a promising alternative to center-based cardiac rehabilitation as it can address several barriers impeding CR implementation because of its enhanced accessibility. However, to date, HB-CR has not garnered adequate attention due to a lack of communication between patients and medical staff. In this study, we aimed to investigate the effectiveness of HB-CR by monitoring the pulse rate (PR) using a smart ring equipped with photoplethysmography.</p><p><strong>Methods: </strong>Patients with cardiovascular disease were educated on structured HB-CR methods following a symptom-limited cardiopulmonary exercise test (CPET), and were instructed to wear the device during the exercise session. The recorded PR was uploaded to a website via a smartphone and monitored by medical staff. Patients were randomly assigned to one of two groups: intervention or control group. The intervention group received weekly telephone counselling and was encouraged to maintain optimal levels of physical activity. In contrast, the control group only recorded their exercise data without additional interventions. After 3 months of training, the CPET was performed.</p><p><strong>Results: </strong>Among the 64 randomized patients (32 in each group), an intention-to-treat analysis showed that peak oxygen consumption increased over time in both the groups, with a significantly greater improvement in the intervention group. The group-by-time interaction for peak oxygen consumption was statistically significant (estimated mean difference, 2.0 mL/kg/min; 95% confidence interval, 0.7-3.3; <i>P</i> = 0.004).</p><p><strong>Conclusion: </strong>HB-CR using a smart device was effective in improving oxygen consumption. However, appropriate monitoring and timely counselling by medical professionals are important for improved outcomes.</p><p><strong>Trial registration: </strong>Clinical Research Information Service Identifier: KCT0005893.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"41 36","pages":"e260"},"PeriodicalIF":3.2,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13574560/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148969284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating Korean Lung-RADS Category 2b: Diagnostic Performance and Interreader Agreement in Lung Cancer Screening.","authors":"You Na Kim, Seulgi You, Joo Sung Sun, Kyung Joo Park, Seohyeon Park","doi":"10.3346/jkms.2026.41.e231","DOIUrl":"10.3346/jkms.2026.41.e231","url":null,"abstract":"<p><strong>Background: </strong>Korean Lung Computed Tomography Screening Reporting and Data System (Lung-RADS) category 2b was introduced to reduce false positives in a tuberculosis-endemic setting. Although its clinical validity has been partly demonstrated, interreader agreement in applying category 2b remains unclear. The aim of this study was to evaluate the diagnostic performance and interreader agreement of the modified classification.</p><p><strong>Methods: </strong>This retrospective study included 1,371 participants who underwent low-dose chest computed tomography (CT) scans as part of the Korean national lung cancer screening program between September 2019 and January 2024 at a single tertiary hospital. Korean Lung-RADS incorporates category 2b for nodules that are likely benign-such as tuberculous granulomas or intrapulmonary lymph nodes-even if their size corresponds to category 3 or 4. All CT scans were interpreted using Korean Lung-RADS (version 1.0 until 2021, version 1.1 from 2022 through 2023, and version 2022 implemented in 2024). To compare diagnostic performance, all category 2b nodules were reclassified into original Lung-RADS categories based on nodule size and type, and diagnostic metrics were evaluated for both systems. To assess interreader agreement, three thoracic radiologists independently reviewed nodules initially categorized as 2b to determine whether they would also assign category 2b. Diagnostic performance was compared using McNemar and Park's permutation tests, whereas interreader agreement was analyzed using the Fleiss κ statistic.</p><p><strong>Results: </strong>Category 2b nodules were found in 29 of the 1,371 participants (2.1%). Among them, one (3.5%) was diagnosed with lung cancer, whereas the remaining 28 (96.6%) were benign. Interreader agreement for 2b categorization was fair (Fleiss κ = 0.35; 95% confidence interval, 0.17-0.56). In terms of diagnostic performance, Korean Lung-RADS demonstrated significantly higher specificity (92.5% vs. 90.4%, <i>P</i> < 0.001) and comparable sensitivity (89.3% vs. 92.9%, <i>P</i> = 1.00) compared with the original Lung-RADS.</p><p><strong>Conclusion: </strong>Korean Lung-RADS category 2b contributes to reducing false positives in lung cancer screening. However, its subjective nature results in fair interreader agreement, underscoring the need for greater standardization to improve consistency in its application.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"41 36","pages":"e231"},"PeriodicalIF":3.2,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13574556/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148969287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case 25: A 37-Year-Old Woman With Fanconi Anemia and a Hepatic Mass.","authors":"Min Gon Kang, Kwon Yong Tak, Kyoung Il Min, Ji Won Han","doi":"10.3346/jkms.2026.41.e230","DOIUrl":"10.3346/jkms.2026.41.e230","url":null,"abstract":"","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"41 36","pages":"e230"},"PeriodicalIF":3.2,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13574558/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148969312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in Osteoporotic Humerus Fractures and Refractures, and Mortality Rates: Analysis of NHIS Claims Data From 2006-2022.","authors":"Tae-Young Kim, Kyoung Jin Kim, Jae-Hwi Nho, Hyun-Bin Kim, Jaiyong Kim, Jihye Kim, Hoyeon Jang, Jun-Il Yoo","doi":"10.3346/jkms.2026.41.e242","DOIUrl":"10.3346/jkms.2026.41.e242","url":null,"abstract":"<p><strong>Background: </strong>Osteoporotic fractures have become a significant public health concern due to their high prevalence and associated morbidity and mortality. Humerus fractures, specifically, have gained attention as they are the third most common type of osteoporotic fracture. However, there is limited research on the trends and outcomes of humerus fractures, as well as the rates of refractures and mortality in this population.</p><p><strong>Methods: </strong>This study aimed to analyze claims data from the National Health Insurance Service from 2006 to 2022 to investigate the trends in osteoporotic humerus fractures, refractures, and mortality rates in Korea. The study included all individuals aged 50 years and older who were diagnosed with a humerus fracture and had available data for one-year outcome ascertainment. Statistical analysis was performed to determine the incidence rates, trends over time, and associated mortality rates.</p><p><strong>Results: </strong>Among 197,086 humerus fracture cases, incidence increased sharply from 2006-2010 then plateaued through 2022. Female predominance was consistent at 2.5-fold throughout. One-year mortality improved in females, with standardized mortality decreasing from 9.6% to 5.5% during 2006-2021, but remained approximately 2-fold higher in males. Advanced age was the strongest predictor of mortality, with hazard ratios increasing exponentially from 2.19 at age 60 to 11.53 at age ≥ 85. Refracture rates increased 4-fold in females (17 per 1,000 to 67 per 1,000 from 2007-2021), with higher rates in younger age groups. Most strikingly, pronounced socioeconomic disparities persisted: Medical Aid beneficiaries showed the highest fracture incidence, approximately 2-fold higher than the highest workplace insurance group, with some years approaching 2.5-fold. A socioeconomic gradient was most evident among regional insurance beneficiaries and was more attenuated among workplace insurance beneficiaries.</p><p><strong>Conclusion: </strong>This comprehensive analysis demonstrates that advanced age is an important determinant of one-year mortality after humerus fracture, whereas lower socioeconomic status is associated primarily with higher fracture incidence. The persistently high refracture rate through 2021 underscores the need for improved secondary fracture prevention and fracture referral services.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"41 35","pages":"e242"},"PeriodicalIF":3.2,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13550979/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148906315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mortality and Risk Factors After Hip Fracture in Patients Aged 50 Years and Older: A Minimum 10-Year Follow-up Using Jeju Island Cohort Study.","authors":"Young-Ho Roh, Joseph Yang, Yong-Geun Park, Kwang Woo Nam, Yong-Chan Ha","doi":"10.3346/jkms.2026.41.e233","DOIUrl":"10.3346/jkms.2026.41.e233","url":null,"abstract":"<p><strong>Background: </strong>Hip fractures are associated with a high mortality rate; however, long-term follow-up studies are limited. This study aimed to evaluate mortality and its associated risk factors in patients with hip fractures over a minimum follow-up period of 10 years within a prospective cohort.</p><p><strong>Methods: </strong>Data were obtained from a cohort of hip fractures on Jeju Island (2002-2011). Mortality was assessed in patients with at least 10 years of follow-up. Among 1,952 eligible patients, survival outcome was confirmed for 1,840 patients with 112 lost to follow-up. Mortality rates were estimated using Kaplan-Meier analysis. Risk factors were examined with log-rank tests and Cox proportional hazards regression, including sex, age, fracture type, subsequent fracture, surgical intervention and comorbidity.</p><p><strong>Results: </strong>Among 1,840 patients, 1,545 deaths and 295 survivors were identified. Cumulative mortality was 17.1% at 1 year, 32.9% at 3 years, 46.7% at 5 years, and 71.4% at 10 years. Kaplan-Meier analysis showed significant differences by age (<i>P</i> < 0.001), type of fracture (<i>P</i> < 0.001), surgical treatment (<i>P</i> = 0.004), and comorbidity (<i>P</i> < 0.001). Multivariate Cox regression identified age, sex, surgery and comorbidity as independent predictors: advanced age, male sex, non-operative management and high comorbidity burden were significantly associated with increased mortality.</p><p><strong>Conclusion: </strong>Hip fracture patients exhibit steadily increasing mortality, exceeding 70% at 10 years. Advanced age, male sex, lack of surgical treatment and high comorbidity burden are independent risk factors. Strategies targeted at these high-risk groups are essential to improve long-term survival.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"41 35","pages":"e233"},"PeriodicalIF":3.2,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13550981/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148906340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Automated Diagnosis of Infantile Skull Fractures From X-Ray Images Using an Ensemble Deep Learning Model.","authors":"Heui Seung Lee, Jaewoong Kang, So Eui Kim, Lyo Min Kwon, Ji Hee Kim, Bum-Joo Cho","doi":"10.3346/jkms.2026.41.e232","DOIUrl":"10.3346/jkms.2026.41.e232","url":null,"abstract":"<p><strong>Background: </strong>To develop an artificial intelligence (AI)-assisted model for detecting skull fractures in neonates and infants using plain radiographs, enhancing diagnostic accuracy while minimizing radiation exposure.</p><p><strong>Methods: </strong>A retrospective dataset of skull X-rays from 1,184 patients with head trauma (2010-2021) was collected. Images underwent preprocessing, including background removal, Gaussian blurring, binarization, and CLAHE-based contrast enhancement. Three convolutional neural network architectures (ResNet-50, DenseNet-121, EfficientNet-B5) were trained, with DenseNet-121 optimized using CLAHE. An ensemble model combining anterior-posterior (AP) and lateral views was constructed. The model's performance was evaluated using internal (4,298 images) and external (460 images) datasets.</p><p><strong>Results: </strong>DenseNet-121 with CLAHE preprocessing achieved the highest mean area under the curve (AUC) of 0.926 for the AP view and 0.911 for the lateral view, demonstrating robust performance. The ensemble model, which combined both AP and lateral views, further enhanced the model's diagnostic performance. It achieved an overall AUC of 0.938, with a classification accuracy of 91.6% on the external validation dataset. Expert annotation by neurosurgeons and radiologists significantly improved the model's reliability, enabling accurate differentiation between skull fractures and normal anatomical structures, such as cranial sutures, reducing false positives.</p><p><strong>Conclusion: </strong>This study presents a highly accurate AI model for pediatric skull fracture detection, incorporating CLAHE-enhanced preprocessing, deep learning, and expert-annotated data. The model improves clinical decision-making, reduces unnecessary computed tomography scans, and provides valuable anatomical insights into the challenges of distinguishing fractures from normal cranial variations.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"41 35","pages":"e232"},"PeriodicalIF":3.2,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13550980/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148906322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}