The Usefulness of Non-face-to-face Communication Device for Medical Consents in the Emergency Department During COVID-19 Pandemic / 의료커뮤니케이션

Purpose@#: Since the era of COVID-19, face-to-face contact has been reduced to prevent the spread of infectious diseases around the world, and hospitals are applying various methods to prevent the spread of infection. However, when writing a consent form essential during the treatment process, it had to be done face-to-face. We developed a non-face-to-face communication device to enable real-time consent writing. This study aims to evaluate the usefulness of the non-face-to-face communication device when writing a consent form. @*Methods@#: From December 28, 2021 to February 2, 2022, electronic medical records of patients visited the severance hospital emergency center and had a central venous catheter inserted were collected retrospectively. There were 56 consent forms included in the study, 43 face-to-face and 13 non-face-to-face. We checked the difference between the details explained in the non-face-to-face consent form and the face-to-face by the average score and the explanation of each item. The score was measured from a minimum of 0 points to a maximum of 13 points, with 1 point for explained items and 0 points for unexplained. @*Results@#: The average score for the face-to-face consent form was 4.3, and for the non-face-to-face was 3.0 (p=0.148). There was no significant difference in the explanation of each item. @*Conclusion@#: It was confirmed writing a consent form through the non-face-to-face communication device can perform a similar role compared to the face-to-face. It is expected unnecessary contact can be reduced by applying the device to hospital rooms, and enabling a non-face-to-face rounds system for new infectious diseases.

A case of subacute combined degeneration of the spinal cord showing enhancement on T1-weighted MR images

Vitamin B12 deficiency results in the occurrence of systemic diseases in our nervous system. One of the most common manifestations of Vitamin B12 deficiency is subacute combined degeneration (SCD), which is characterized by paralysis and sensory changes of limbs, and disturbance of gait and position sense. SCD can be caused by the abuse of Happy Balloon, which comprises nitrous oxide and is used as a party hallucinogen. Diagnosis of SCD is achieved by combining the clinical symptoms, laboratory study, electrophysiological study and imaging findings. However, neurological symptoms observed during laboratory examinations are insufficient to diagnose SCD without the characteristic magnetic resonance imaging (MRI) findings. This is due to ambiguity of the symptoms and delayed report time of laboratory results in the emergency department. The ‘Inverted V sign’, observed towards the rear of the cervical and thoracic spine in T2 emphasis MRI images, is the most prominent finding of SCD. In most cases, the T1 image shows the same signal strength as the surrounding tissue. In the current report, we present an SCD case with an enhanced T1 phase of the MRI.

Causative Substance and Time of Mortality Presented to Emergency Department Following Acute Poisoning:2014-2018 National Emergency Department Information System (NEDIS)

Purpose@#The purpose of this study was to investigate the cause of acute fatal poisoning and the time of death by analyzing the National Emergency Department Information System (NEDIS) of South Korea. @*Methods@#The NEDIS data from 2014 to 2018 excluding non-medical visits were used for this study. The patients with acute poisoning were extracted using diagnostic codes. The toxic substances were classified into pharmaceuticals, pesticides, gases, artificial poisonous substances, and natural toxic substances. Patients were classified according to the time of death, place of death, and region. In each case, the most causative substances of poisoning were identified. @*Results@#There were 380,531 patients including poisoning-related diagnoses, of which 4,148 (1.1%) died, and the WHO age-standardized mortality rate was 4.8 per 100,000. Analysis of 2,702 death patients whose primary diagnosis was acute poisoning, the most common cause of poisoning death was pesticides (62%), followed by therapeutic drugs, gas, and artificial toxic substances. Herbicides were the most common pesticides at 64.5%. The proportion of mortality by time, hyperacute (7 d) were 9.8%. @*Conclusion@#This study suggests that the most common cause of poisoning death was pesticides, and 60% of deaths occurred within 24 hours. The 71% of mortality from pesticides occurred within 6-24 hours, but mortality from gas was mostly within 6 hours. According to the geographic region, the primary cause of poisoning death was varied to pesticides or pharmaceuticals.

Relationship of computed tomography and emergency department revisits in febrile elderly patients

Objective@#The number of elderly people visiting emergency rooms is rapidly increasing. Fever is one of the common complaints of patients who come to the emergency room, and it is often difficult to determine its cause in elderly patients only through basic examinations and tests. This study sought to verify the relationship between computed tomography and emergency department revisits of febrile elderly patients. Methods: This study is a retrospective medical record analysis study. Patients who came to our emergency room between September 2016 and September 2019, aged 65 years or more, and with body temperature higher than 37.8°C at the time of presentation or during their stay in the emergency room were enrolled. Patient age, sex, vital signs at triage, laboratory tests, whether computed tomography (CT) was conducted or not were analyzed. The primary outcome was set as revisits to the emergency department within 72 hours after discharge, due to any reason. @*Results@#Three thousand two hundred and forty patients were enrolled and of these 289 patients revisited the emergency department (ED). In the revisit (-) group, CT was performed on 44.09% of patients and 54.67% of patients in the revisit (+) group thus showing a statically significant difference. @*Conclusion@#This study showed that in elderly patients with fever presenting to the ED, patients who underwent a CT had 1.558 higher odds of revisit to the ED compared to patients who did not undergo a CT. From this result, it should be considered that the decision to discharge the febrile elderly patients based on the results of CT examination may not be appropriate.

Relationship of computed tomography and emergency department revisits in febrile elderly patients

Objective@#The number of elderly people visiting emergency rooms is rapidly increasing. Fever is one of the common complaints of patients who come to the emergency room, and it is often difficult to determine its cause in elderly patients only through basic examinations and tests. This study sought to verify the relationship between computed tomography and emergency department revisits of febrile elderly patients. Methods: This study is a retrospective medical record analysis study. Patients who came to our emergency room between September 2016 and September 2019, aged 65 years or more, and with body temperature higher than 37.8°C at the time of presentation or during their stay in the emergency room were enrolled. Patient age, sex, vital signs at triage, laboratory tests, whether computed tomography (CT) was conducted or not were analyzed. The primary outcome was set as revisits to the emergency department within 72 hours after discharge, due to any reason. @*Results@#Three thousand two hundred and forty patients were enrolled and of these 289 patients revisited the emergency department (ED). In the revisit (-) group, CT was performed on 44.09% of patients and 54.67% of patients in the revisit (+) group thus showing a statically significant difference. @*Conclusion@#This study showed that in elderly patients with fever presenting to the ED, patients who underwent a CT had 1.558 higher odds of revisit to the ED compared to patients who did not undergo a CT. From this result, it should be considered that the decision to discharge the febrile elderly patients based on the results of CT examination may not be appropriate.

The effect of lecturing about communication skill with standardized patient for medical students / 의료커뮤니케이션

Background@#: Effective communication between doctors and patients is very important not only for diagnosis and treatment but also for building trust. Although teaching communication skills is very important in medical schools, there are limitations such as the number of students and the uncertainty of the patient population. Therefore, this study evaluates the effect of Fishbowl method to teach communication skills to medical students, which involves the medical students communicating with standardized patients in front of a large classroom and being observed by rest of the students. @*Methods@#: This study involves 10 weeks of educating 126 fourth grade medical students and graduates. During this period, total 8 classes were taken by subjects, where each class lasts 2 hours and is conducted by observing treatments of the standardized patients on 14 clinical topics by randomly selected medical students and giving feedback on the communication skills of the selected medical students. The educational effect was evaluated based on the scores of the clinical performance examination before and after the classes. @*Results@#: The scores assessed for medical history taking before and after the training are increased by 2.45 (p<0.001) and the scores for patient-doctor relationship is increased by 7.56 (p<0.001). @*Conclusions@#: It is expected to improve the communication skills of medical students by large scale lectures with standardized patients.

The effect of paramedic’s emergency patient simulation training - course using standardized communication tools and simulation / 의료커뮤니케이션

Background@#: Since primary emergency treatment should be performed appropriately and promptly, efficient and accurate communication between paramedics and medical staff is paramount to a successful primary emergency treatment and patient handover. The problem of the training program in Korea is that it concentrates more on in-class lectures, often delivered by non-medical specialists, who may lack in practical experience and without proper communication training. To solve this problem, we have devised a simulation based training that focuses on event debriefings and two-way communication. @*Methods@#: 62 paramedics from 3 stations enrolled in the study. 4 different courses with different emergency situations were created and each course was taken twice resulting in a total of 8 classes. All courses were based on actual cases. The curriculum consisted of subject lectures with guidelines, skill practice courses, and simulation courses based on hands-on method. In simulation courses, paramedics use standardized check list to communicate with medical specialists. All curriculums except subject lectures include debriefing, which allows free talking with educators comprised of medical specialists. In order to measure the educational impact, all students performed self-assessment through a structured questionnaire before and after the training. @*Results@#: Regardless different situations and paramedics’ education level, their performance and communication skills have improved after simulation training course. Paramedics mentioned learning skills in simulation course through communication with medical staffs as the biggest advantage. @*Conclusion@#: Receiving the simulation training with standardized communication tools is effective at enhancing the communication between the paramedics and medical staff.

Usefulness of transparent mask for communication in emergency room / 의료커뮤니케이션

Background@#It is important to communicate accurately in the emergency department. Due to COVID-19 pandemic, a mask is mandatory to protect medical staffs and patients from infectious diseases, and the mask is known to disturb speech intelligibility. The objective of this study is to find out if a transparent mask can affect communication. @*Methods@#: We conducted a randomized pre- and post-test trial with 40 participants in a real emergency room environment. The reader puts on a mask and read aloud sentences which are frequently used between medical staffs and patients or among medical staffs. The type of mask was randomly assigned to the reader which was transparent or non-transparent. Frequently used 5 sentences between medical staffs and patients and 5 sentences among medical staffs from prepared 100 sentences were randomly selected and recited. Participants were told to write down the sentences they heard. Each sentence written down was graded 0 or 1. After writing down 10 sentences, reader puts on another type of mask and the same experiment was done. The order of transparenton-transparent mask was randomly allocated to each participant. @*Results@#: In frequently used sentences between medical staffs and patient, average score with a transparent mask was 4.88, and with a non-transparent mask was 4.50(p=0.001). In frequently used sentences among medical staffs, average score with a transparent was 4.77, and with a non-transparent mask was 4.05(p<0.001). @*Conclusions@#This study showed the transparent mask improves speech intelligibility when communicating in an emergency room.

The experience of remote videoconferencing to enhance emergency resident education using Google Hangouts

OBJECTIVE: It is difficult for emergency residents to attend all the lectures that are required because of the limited labor time. The Google Hangouts program for has been used as a remote videoconference to overcome the limit to provide equal opportunities and reduce the time and costs since 2015. This article reports the authors' experiences of running a residency education program using Google Hangouts. METHODS: From 2015, topics on the emergency radiology were lectured to emergency residents in three different hospitals connected by Google Hangouts. From 2017, electrocardiography analysis, emergency radiology, ventilator application, and journal review were selected for the remote videoconference. The residents' self-assessment score, and a posteducation satisfaction questionnaire were surveyed. RESULTS: Twenty-nine emergency residents responded to the questionnaire after using the Google Hangouts. The number of participants before and after Hangout increased significantly in other two hospitals. All the residents answered that the score on achieving the learning goal increased before and after the videoconference lectures. All the residents answered that the training program is more satisfactory after using the Google Hangouts than before. CONCLUSION: All emergency residents were satisfied and were more confident after the remote videoconference education using the Google Hangouts than before.

Empathy and Quality of Life in Korean Emergency Physicians

PURPOSE: Empathy in medical practice is related to medical communication and clinical competence. In previous studies, low quality of life and other factors play an integral role in low empathy among physicians. We evaluated the relationships between empathy, quality of life, and other factors among Korean emergency physicians. METHODS: The survey was conducted using email to emergency physicians. The respondents completed a questionnaire including demographic information, the Jefferson Scale of Empathy, and the Brief version of the World Health Organization Quality of Life assessment instrument. Correlation analyses were performed, along with sub-analyses according to gender. RESULTS: A total of 180 questionnaires were analyzed. The median value of the empathy scale was 89.0, and quality of life 64.8. Empathy was positively correlated with quality of life, age, and work experience as a specialist in total samples and males. Only work experience as a specialist showed correlation with empathy in females. Quality of life showed no association with age, work experience, and work load. However, quality of life showed negative correlation with age and work experience in female physicians. CONCLUSION: The more experienced specialist emergency physicians are, and the better quality of life they have, the higher level of empathy scale they have. Therefore, good quality of life could lead to good empathy, and vice versa. Good quality of life and good empathy could lead to the better outcome in emergency care. However, because the female physicians show different patterns of empathy and quality of life, further study is needed.

The Poisoning Information Database Covers a Large Proportion of Real Poisoning Cases in Korea

The poisoning information database (PIDB) provides clinical toxicological information on commonly encountered toxic substances in Korea. The aim of this study was to estimate the coverage rate of the PIDB by comparing the database with the distribution of toxic substances that real poisoning patients presented to 20 emergency departments. Development of the PIDB started in 2007, and the number of toxic substances increased annually from 50 to 470 substances in 2014. We retrospectively reviewed the medical records of patients with toxic exposure who visited 20 emergency departments in Korea from January to December 2013. Identified toxic substances were classified as prescription drug, agricultural chemical, household product, animal or plant, herbal drug, or other. We calculated the coverage rate of the PIDB for both the number of poisoning cases and the kinds of toxic substances. A total of 10,887 cases of intoxication among 8,145 patients was collected. The 470 substances registered in the PIDB covered 89.3% of 8,891 identified cases related to poisoning, while the same substances only covered 45.3% of the 671 kinds of identified toxic substances. According to category, 211 prescription drugs, 58 agricultural chemicals, 28 household products, and 32 animals or plants were not covered by the PIDB. This study suggested that the PIDB covered a large proportion of real poisoning cases in Korea. However, the database should be continuously extended to provide information for even rare toxic substances.

Primary Repair of Spontaneous Intramural Esophageal Dissection: A Case Report

Intramural esophageal dissection (IED) is a laceration between the mucosal and submucosal layers without perforation. Spontaneous IED is relatively common in elderly female patients on anticoagulation medication, while secondary IED is associated with endoscopic procedures or foreign body impaction. Although conservative management is regarded as the primary treatment for IED, there are several reported cases treated by endoscopic intervention or esophagectomy. We experienced rare spontaneous IED in a young male patient who was treated exclusively with primary repair of the esophagus. To the best of our knowledge, this is the first case report in which the patient recovered completely with only primary repair.

Is Atropine Necessary for Cardiopulmonary Resuscitation?

PURPOSE: According to the 2010 guidelines for cardiopulmonary resuscitation (CPR) of the American Heart association, administration of atropine for non-shockable rhythm is no longer recommended, however, there are insufficient data in humans. This study was conducted to evaluate the results of CPR, whether the combined administration of atropine and epinephrine (Atropine combined group, AG) compared with epinephrine only injection (epinephrine only group, EG) for patients with non-shockable rhythm. METHODS: A total of 449 patients who underwent CPR in the emergency department from 2009 to 2012 were included. Retrospective analysis was performed according to atropine administration during CPR. We investigated Return of Spontaneous Circulation (ROSC), sustained ROSC, 30-day survival, and 30-day neurological outcome using Utstein templates. RESULTS: There were 178 (48.9%) patients in the AG. There were no significant differences in the baseline characteristics. The two groups had similar rates of ROSC, sustained ROSC, and 30-day survival. However, AG had a significantly poor neurological outcome compared to EG, with an adjusted odds ratio of 0.074 (95% CI 0.012-0.452, p=0.005). CONCLUSION: The combination therapy of atropine and epinephrine during CPR showed poor neurological outcome compared with epinephrine alone. Atropine is not useful for adults with non-shockable rhythm in terms of 30-day neurological outcome.

Assessing Safety Attitudes among Healthcare Providers after a Hospital-Wide High-Risk Patient Care Program

PURPOSE: Cardiopulmonary resuscitation (CPR) is commonly performed in high-risk, high intensity situations and is therefore a good procedure around which to develop and implement safety culture strategies in the hospital. The purpose of this study was to evaluate the impact of a hospital-wide quality improvement program on the management of sudden cardiac arrests by assessing healthcare providers' attitudes towards patient safety. MATERIALS AND METHODS: This study was designed as a prospective cohort study at a single academic medical center. The comprehensive hospital-based safety program included steps to identify areas of hazard, partner units with the Resuscitation Committee, and to conduct a Safety Attitudes Questionnaire (SAQ). The SAQ evaluated 35 questions in seven domains to assess changes in patient safety culture by comparing the results before and after the hospital-wide high risk patient care improvement program. RESULTS: The response rates of the pre- and post-SAQ survey were 489 out of 1121 (43.6%) and 575 out of 1270 (45.3%), respectively. SAQ survey responses revealed significant improvement in all seven domains of the questionnaire (p-values of 0.006 and lower). In a subgroup analysis, doctors and nurses showed improvement in five domains. Both doctors and nurses did not show improvement in the "sharing information" domain. CONCLUSION: A hospital-wide quality improvement program for high-risk, high reliability patient care involving CPR care was shown to be associated with a change in healthcare providers' attitudes towards patient safety. Through an immersive and active program on CPR care, change in healthcare providers' attitudes towards patient safety was initiated.

Task and Time Analysis of Intern Physicians in the Emergency Department: Multicenter Cross-sectional Study

PURPOSE: This study was conducted in order to describe how intern physicians in the emergency department (ED) spent their time, and the frequency of tasks performed by them. METHODS: This was an observational, time-motion study for 15 intern physicians in 15 emergency centers. Observers in each hospital shadowed interns for a 60-minute period, two times, both day and night shift. They recorded time spent on various activities, type and number of activities. The proportion of activity that can be replaced by other staff members was calculated. RESULTS: Average number of duty hours of interns was 80.9 hours (63~87.8) per week. A total of 662 activities were observed during 30 hours. Interns' activities were classified as direct patient care 28.2%, personal time 24.2%, documentation 17.0%, procedures 16.7%, communication 8.1%, transportation 2.6%, indirect patient care 2.0%, learning activity 0.8%, and administrative work 0.4%. The proportion of procedural task showed negative correlation with the number of emergency medical technicians (r=-0.710, p=0.003). The proportion of activity that can be replaced by staff members other than doctors was 24.3% (0~47%) of time, except personal or learning activity. CONCLUSION: Results of this study showed that only 24.3% of interns' activity in the emergency department could be replaced by staff members other than doctors. Because the proportion of activities that could be replaced was variable among hospitals, each hospital should perform task analysis of interns' activity in order to forecast alternative manpower.

Characteristics of Geriatric Trauma Patients Transferred from Long-term Care Hospitals: A Propensity Score Matched Analysis

PURPOSE: Transfer from long-term care (LTC) hospitals to the emergency department (ED) of larger hospitals has increased due to limited capability for management of patients needing special diagnostic tools or emergency treatment in the LTC hospital. We investigated the characteristics of geriatric trauma patients transferred from LTC hospitals to the ED. METHODS: A retrospective analysis included data on geriatric trauma patients (age> or =65) who visited two EDs in Korea. All data of patients transferred from the LTC hospital were compared with those of patients who visited the ED from home. Patients visiting from home were selected according to age, sex, and main diagnosis, using the statistical matching method. RESULTS: A total of 44 patients were transferred, and 132 patients were selected after matching. No differences in mechanism of injury, injury severity score (ISS), outcomes, transfusion, length of hospital stay, or mortality were observed between the two groups. The odds ratios (OR) of transferred patients for stroke and dementia were 5.027 (95% confidence interval (CI) 1.292-16.915) and 13.941 (95% CI: 5.112-38.015), respectively. In addition, the OR of transferred patients for dependent activities of daily living was 8.165 (95% CI: 2.886-23.104). Thirty five transferred patients (79.5%) had been injured in the LTC hospital (p<0.001). CONCLUSION: The transferred patients had more stroke, dementia, and dependent activities, but showed no significant difference in severity or prognosis. Most transferred patients had been injured in the hospital. Greater attention to hospitalized patients and system development are required in order to prevent injuries in the LTC hospital.

Clinical Significance of National Patients Sample Analysis: Factors Affecting Mortality and Length of Stay of Organophosphate and Carbamate Poisoned Patients / 대한의료정보학회지

OBJECTIVES: This study considered whether there could be a change of mortality and length of stay as a result of inter-hospital transfer, clinical department, and size of hospital for patients with organophosphates and carbamates poisoning via National Patients Sample data of the year 2009, which was obtained from Health Insurance Review and Assessment Services (HIRA). The utility and representativeness of the HIRA data as the source of prognosis analysis in poisoned patients were also evaluated. METHODS: Organophosphate and carbamate poisoned patients' mortality and length of stay were analyzed in relation to the initial and final treating hospitals and departments, as well as the presence of inter-hospital transfers. RESULTS: Among a total of 146 cases, there were 17 mortality cases, and the mean age was 56.8 +/- 19.2 years. The median length of stay was 6 days. There was no inter-hospital or inter-departmental difference in length of stay. However, it significantly increased when inter-hospital transfer occurred (transferred 11 days vs. non-transferred 6 days; p = 0.037). Overall mortality rate was 11.6%. The mortality rate significantly increased when inter-hospital transfer occurred (transferred 23.5% vs. non-transferred 7.0%; p = 0.047), but there was no statistical difference in mortality on inter-hospital and inter-department comparison at the initial treating facility. However, at the final treating facility, there was a significant difference between tertiary and general hospitals (5.1% for tertiary hospitals and 17.3% for general hospitals; p = 0.024), although there was no significant inter-departmental difference. CONCLUSIONS: We demonstrated that hospital, clinical department, length of stay, and mortality could be analyzed using insurance claim data of a specific disease group. Our results also indicated that length of stay and mortality according to inter-hospital transfer could be analyzed, which was previously unknown.

Criminal Responsibility in Emergency Care

PURPOSE: When a criminal act occurs during emergency care, it becomes fatal to both the patient and doctor. Criminal acts during emergency care and judged by the Supreme Court of Korea were analyzed and investigated to decrease and prevent medical malpractice. METHODS: After assessing the Medical Act in Korea and Act on Emergency Care in Korea, a pattern of emergency care was categorized and applicable provisions were analyzed. Emergency medical malpractice cases were collected from previous reports and an internet site managed by the Supreme Court of Korea (http://glaw.scourt.go.kr). RESULTS: The patterns of emergency care can be categorized into "general emergency care", "interhospital patient transfer", and the "request for medical treatment sent to another department or hospital". Furthermore, inerthospiatl patient transfer can be categorized into "after request for emergency care" and "after medical treatment." There were ten medical malpractice cases in emergency care in which criminal responsibility occurred. There were six cases related to general emergency care and four related to interhospital patient transfer. CONCLUSION: Though the emergency care cases in which criminal responsibility occurred were few, the results critically impacted the patient and doctor. Therefore, emergency physicians must do their best to decrease and prevent medical negligence. In addition, a nation has a primary responsibility to save lives and must support emergency care.

Criminal Responsibility in Emergency Care

PURPOSE: When a criminal act occurs during emergency care, it becomes fatal to both the patient and doctor. Criminal acts during emergency care and judged by the Supreme Court of Korea were analyzed and investigated to decrease and prevent medical malpractice. METHODS: After assessing the Medical Act in Korea and Act on Emergency Care in Korea, a pattern of emergency care was categorized and applicable provisions were analyzed. Emergency medical malpractice cases were collected from previous reports and an internet site managed by the Supreme Court of Korea (http://glaw.scourt.go.kr). RESULTS: The patterns of emergency care can be categorized into "general emergency care", "interhospital patient transfer", and the "request for medical treatment sent to another department or hospital". Furthermore, inerthospiatl patient transfer can be categorized into "after request for emergency care" and "after medical treatment." There were ten medical malpractice cases in emergency care in which criminal responsibility occurred. There were six cases related to general emergency care and four related to interhospital patient transfer. CONCLUSION: Though the emergency care cases in which criminal responsibility occurred were few, the results critically impacted the patient and doctor. Therefore, emergency physicians must do their best to decrease and prevent medical negligence. In addition, a nation has a primary responsibility to save lives and must support emergency care.

Usefulness of the Pediatric Risk of Mortality Score III as a Predictor of Severity or Mortality for Injured Children

PURPOSE: The primary prevention and proper initial treatment of childhood injuries is important, as it encompasses a bigger social and economic burden than cancer and ischemic heart disease. The Pediatric Risk of Mortality III (PRISM III) scoring system, used to evaluate the severity or mortality of pediatric patients in critical condition, was investigated for children with injuries in an emergency department (ED). METHODS: A retrospective analysis included data on 293 injured children (age<16) who visited the ED in two hospitals from March 2010 to February 2012. Physiologic and laboratory data were collected to calculate the PRISM III score and the Injury Severity Score (ISS). The correlation was analyzed between PRISM III scores, the Revised Trauma Scale (RTS), and ISS. The PRISM III score and ISS were assessed for their ability to predict mortality by comparing their receiver operating characteristic (ROC) curves. RESULTS: The median PRISM III score was 5.0 (Interquartile Range, 5.0-9.0) and correlated with RTS and ISS (the Spearman's rho were -0.19 (p=0.001) and 0.20 (p=0.001), respectively. Five children did not survive after ED admission. The area under the ROC (AUC) was 1.00 for PRISM III (95% confidence interval [CI], 0.99-1.00), and the cutoff value was placed over 20 to predict mortality. The AUC of ISS and RTS was 0.99 (95% CI, 0.98-1.00) and 0.99 (95% CI, 0.98-1.00), respectively. CONCLUSION: The PRISM III score excellently predicts the mortality of injured children in the ED, and can be used to sort minor pediatric trauma patients in the ED. However, the PRISM III score had no great difference or advantage compared with RTS. The development of other tools for effective prognosis is needed to efficiently predict mortality and severity in the ED.