Clinical Guidance for Point-of-Care Ultrasound in the Emergency and Critical Care Areas after Implementing Insurance Coverage in Korea

Point-of-care ultrasound (POCUS) is a useful tool that is widely used in the emergency and intensive care areas. In Korea, insurance coverage of ultrasound examination has been gradually expanding in accordance with measures to enhance Korean National Insurance Coverage since 2017 to 2021, and which will continue until 2021. Full coverage of health insurance for POCUS in the emergency and critical care areas was implemented in July 2019. The National Health Insurance Act classified POCUS as a single or multiple-targeted ultrasound examination (STU vs. MTU). STU scans are conducted of one organ at a time, while MTU includes scanning of multiple organs simultaneously to determine each clinical situation. POCUS can be performed even if a diagnostic ultrasound examination is conducted, based on the physician's decision. However, the Health Insurance Review and Assessment Service plans to monitor the prescription status of whether the POCUS and diagnostic ultrasound examinations are prescribed simultaneously and repeatedly. Additionally, MTU is allowed only in cases of trauma, cardiac arrest, shock, chest pain, and dyspnea and should be performed by a qualified physician. Although physicians should scan all parts of the chest, heart, and abdomen when they prescribe MTU, they are not required to record all findings in the medical record. Therefore, appropriate prescription, application, and recording of POCUS are needed to enhance the quality of patient care and avoid unnecessary cut of medical budget spending. The present article provides background and clinical guidance for POCUS based on the implementation of full health insurance coverage for POCUS that began in July 2019 in Korea.

Clinical Guidance for Point-of-Care Ultrasound in the Emergency and Critical Care Areas after Implementing Insurance Coverage in Korea

Point-of-care ultrasound (POCUS) is a useful tool that is widely used in the emergency and intensive care areas. In Korea, insurance coverage of ultrasound examination has been gradually expanding in accordance with measures to enhance Korean National Insurance Coverage since 2017 to 2021, and which will continue until 2021. Full coverage of health insurance for POCUS in the emergency and critical care areas was implemented in July 2019. The National Health Insurance Act classified POCUS as a single or multiple-targeted ultrasound examination (STU vs. MTU). STU scans are conducted of one organ at a time, while MTU includes scanning of multiple organs simultaneously to determine each clinical situation. POCUS can be performed even if a diagnostic ultrasound examination is conducted, based on the physician's decision. However, the Health Insurance Review and Assessment Service plans to monitor the prescription status of whether the POCUS and diagnostic ultrasound examinations are prescribed simultaneously and repeatedly. Additionally, MTU is allowed only in cases of trauma, cardiac arrest, shock, chest pain, and dyspnea and should be performed by a qualified physician. Although physicians should scan all parts of the chest, heart, and abdomen when they prescribe MTU, they are not required to record all findings in the medical record. Therefore, appropriate prescription, application, and recording of POCUS are needed to enhance the quality of patient care and avoid unnecessary cut of medical budget spending. The present article provides background and clinical guidance for POCUS based on the implementation of full health insurance coverage for POCUS that began in July 2019 in Korea.

Clinical Guidance for Point-of-Care Ultrasound in the Emergency and Critical Care Areas after Implementing Insurance Coverage in Korea

Point-of-care ultrasound (POCUS) is a useful tool that is widely used in the emergency and intensive care areas. In Korea, insurance coverage of ultrasound examination has been gradually expanding in accordance with measures to enhance Korean National Insurance Coverage since 2017 to 2021, and which will continue until 2021. Full coverage of health insurance for POCUS in the emergency and critical care areas was implemented in July 2019. The National Health Insurance Act classified POCUS as a single or multiple-targeted ultrasound examination (STU vs. MTU). STU scans are conducted of one organ at a time, while MTU includes scanning of multiple organs simultaneously to determine each clinical situation. POCUS can be performed even if a diagnostic ultrasound examination is conducted, based on the physician's decision. However, the Health Insurance Review and Assessment Service plans to monitor the prescription status of whether the POCUS and diagnostic ultrasound examinations are prescribed simultaneously and repeatedly. Additionally, MTU is allowed only in cases of trauma, cardiac arrest, shock, chest pain, and dyspnea and should be performed by a qualified physician. Although physicians should scan all parts of the chest, heart, and abdomen when they prescribe MTU, they are not required to record all findings in the medical record. Therefore, appropriate prescription, application, and recording of POCUS are needed to enhance the quality of patient care and avoid unnecessary cut of medical budget spending. The present article provides background and clinical guidance for POCUS based on the implementation of full health insurance coverage for POCUS that began in July 2019 in Korea.

Tension Pneumopericardium after Pericardiocentesis

Pneumopericardium is defined as the presence of air inside the pericardial space. Usually, it is reported as a complication of blunt or penetrating chest trauma, but rare iatrogenic and spontaneous cases have been reported. Pneumopericardium is relatively stable if it does not generate a tension effect on the heart. However, it may progress to tension pneumopericardium, which requires immediate pericardial aspiration. We report a case of iatrogenic pneumopericardium occurred in a 70-year-old man who presented dyspnea at emergency department. The patient underwent pericardiocentesis for cardiac tamponade due to large pericardial effusion, and iatrogenic tension pneumopericardium occurred due to misuse of the drainage device. After evacuating the pericardial air through the previously implanted catheter, the patient became stable. We report this case to increase the awareness of this fatal condition and to help increase the use of precautions against the development of this condition during emergency procedures.

Comparison of Intubation Success Rate and Times Required for Intubation by Glottic Exposure Methods with Glidescope(R) / 대한구급학회지

BACKGROUND: The glottis can be exposed by a Glidescope(R) during endotracheal intubation using either the epiglottis or valleculae elevation method. We compared the epiglottis and valleculae elevation methods for endotracheal intubations performed with a Glidescope(R) using differences in success rate, time spent for tracheal intubation and percent of glottic opening. METHODS: Forty medical students without experience using a Glidescope(R) participated in this prospective, randomized study in which they intubated a tracheal tube into a manikin. All participants performed tracheal intubation using the 2 forementioned methods. Twenty students exposed the vocal cord by placing the blade tip in the valleculae (valleculae elevation method; VEM). The other 20 students directly elevated the epiglottis with the blade (epiglottis elevation method; EEM). We separated intubating time into 3 parts: turnaround time to exposing the vocal cord, tube passing time and first ventilating time. RESULTS: The success rate of tracheal intubation using VEM (86.7%, 104/120) was higher than that using EEM (65.8%, 79/120) (p < 0.001). VEM resulted in a lower total intubation time (VEM vs. EEM, 23.5 +/- 5.3 vs. 29.0 +/- 8.7, p = 0.001). The key factor of this difference was the tube passing time (VEM vs. EEM, 7.4 +/- 2.5 vs. 12.8 +/- 7.4, p < 0.001). CONCLUSIONS: Exposing the vocal cord by using VEM during tracheal intubation with a Glidescope(R) can increase the success rate of tracheal intubation and shorten the time of endotracheal intubation in novices.

Bibliometric Analysis of the Journal of the Korean Society of Clinical Toxicology

PURPOSE: The purpose of this study was to examine the research characteristics and the trend of the Journal of the Korean Society of Clinical Toxicology by bibliometric analysis. METHODS: This study was a retrospective quantitative literature review of the publications. We collected data from the internet homepage of the Korean Society of Clinical Toxicology. Among 228 publications, a total of 225 articles were included in this analysis. The data were analyzed from different perspectives, including article types, study design, number of authors, type of toxic material, and the top five ranking prolific authors and the affiliated organization were identified. RESULTS: A total of 225 articles were analyzed; 98(43.6%) were original articles, 115(51.1%) were case reports, and 12(5.3%) were reviews. Among the original articles, nine were prospective studies and 89 were retrospective studies, which were assorted according to study design; there were two(2.0%) cross sectional studies, 93(94.9%) cohort studies, and three(3.1%) etc. The median number of authors per article was five and the top five ranking authors and affiliated organizations published 31.1% and 32.8% of total articles, respectively. The most abundant topic was pesticides, followed by natural poisons and poisons encountered in the work place. CONCLUSION: Since its foundation, the Journal of the Korean Society of Clinical Toxicology has published 19 issues and 228 articles and has played a key role in development of toxicology research in Korea. However, low ratio of original articles and a decrease in the number of recent articles indicates that greater effort is needed in clinical research. In addition, further interest of many experts and various institutions is necessary.

Factors Affecting Cardiopul-monary Resuscitation Hands-off Time in an Emergency Room

PURPOSE: The importance of minimizing hands-off time (HOT) during the performance of cardiopulmonary resuscitation (CPR) is emphasized in the new guidelines. This study analyzes the proportion and effects of each HOT result as observed in an Emergency room (ER). METHODS: We prospectively reviewed 45 video records of CPR performed in an ER resuscitation room from October 2007 to September 2008. We measured the total CPR time, the time to first chest compression (initial assessment time; IAT) and the time required to perform each step of the CPR procedure including pulse check and switchig compressors, echocardiography, efibrillation, X-ray, endotracheal intubation, central venous catheter insertion and needle thoracostomy. RESULTS: The median values recorded included the following: total CPR time was 15.7 min (Interquartile range: 7.51~27.8 min), fractions of HOT (HOTF) in CPR was 11.0% (Interquartile range: 6.9~15.1%), the ratio of IAT in total HOT was 16.8% (Interquartile range: 6.4~34%), pulse check and switching compressors in total HOT were 64.4% (Interquartile range: 52~78%), echocardiography was 13.5% (Interquartile range: 7.7~21.2%), defibrillation was 18.1% (Interquartile range: 8.9~24.6%), endotracheal intubation was 12.2% (Interquartile range: 4.2~17.2%) and X-ray was 15.1% (Interquartile range: 12.7~21.0%). We found that the duration of CPR didn't increase HOTF (HOTF within 15 min of the total CPR time is 7.2% and after 15 min HOFT was counted 6.3%). CONCLUSION: During the year of in-hospital CPR data we observed, the pulse check and switch compressor procedure followed the CPR guideline, but the echocardiography, defibrillation and endotracheal intubation resulted in increased HOT. In order to reduce HOT during the performance of CPR, it is necessary to follow the guideline of each step of the procedure.

Factors Related to Successful Endotracheal Intubations with Glidescope(R)

PURPOSE: The aim of this study was to analyze factors affecting success of endotracheal intubation (ETI) in emergency department (ED) patients, and to investigate usefulness of expected difficult direct laryngoscopy for expectation of a bad Glidescope(R) view. METHODS: ETI data using Glidescope(R) were collected at two EDs over a period of 64 months. We accessed intubator's training level, expected difficulty with laryngoscopy, method, and glottis exposure grade. Based on these variables, we analyzed the intubation success rates. And we examined the correlation between glottis exposure grade using Glidescope(R) and factors for expectation of difficult direct laryngoscopy. RESULTS: A total of 613 ETIs attempts using Glidecope(R) were recorded. The overall success rate was 83.4%. In logistic regression analysis, expected difficult laryngoscopy, intubator's training level, and glottic exposure grade were independent predictive factors for successful ETI using Glidescope(R). The Cormack-Lehane grade I via Glidescope(R) was observed in 89.1% of total ETI attempts. In subgroup analysis, bad glottis exposure status showed a significantly low success rate irrespective of intubator's training level. Among the predicting factors for difficult laryngoscopy, morbid obesity, limited neck extension, and limited mouth opening showed an association with the degree of glottic exposure via Glidescope(R). CONCLUSION: The glottic exposure grade was the most important factor related to successful ETI using Glidescope(R). Morbid obesity, limited neck extension, and limited mouth opening showed a significant association with bad glottis exposure under Glidescope(R), Therefore, we need to identify these findings. Even if in good glottis view, junior physicians showed a lower rate of ETI success using Glidescope, therefore, measurements to improve the ability of junior physicians should be implemented.

Ultrasonography of Suspected Ileocolic Intussusceptions Performed by Emergency Medicine Residents

PURPOSE: The aim of this study was to evaluate the sensitivity and specificity of ultrasonography of suspected ileocolic intussusception performed by emergency medicine (EM) residents who participated in a 2-hour focused ultrasound training program for intussusception. METHODS: This was a 16-month retrospective, observational study. Pediatric patients with suspected ileocolic intussusception who underwent ultrasound performed by second or third year EM residents were included in the study. The gold standard was a diagnostic work-up performed by a radiologist or clinical follow-up, compared with the results of ultrasonography performed by EM residents. RESULTS: A total of 38 patients were enrolled. The sensitivity of ultrasound performed by emergency medicine residents for prediction of ileocolic intussusception was 92.86%(66.13% to 99.82%), the specificity was 91.67%(73.00% to 98.97%), the positive likelihood ratio was 11.14(2.93 to 42.34), and the negative likelihood ratio was 0.08(0.01 to 0.52). CONCLUSION: Emergency residents can identify ileocolic intussusceptions with only minimal training, which could substitute for ultrasonography performed by radiologists when they are not immediately available.

Accidental Injuries from Explosion of a Compressed Natural Gas Bus

PURPOSE: During August 2010, a natural gas fuel cylinder on a bus exploded in downtown Seoul, injuring 20 citizens. This kind of blast injury has never been reported in Korea before. Thus, the goal of this study was to review the clinical features of these victims to help physicians manage similar cases and to understand the risk factors associated with blast injuries in everyday life. METHODS: Twenty (20) victims who visited nearby emergency departments, and 3 peoples left hospital without care. Seventeen (17) victims were included in this study, and the following factors were investigated: age, sex, type of hospital, diagnosis of injury, injury mechanism, position of victim (in-bus/out of bus), classification of injury severity with START (simple triage and rapid treatment), and classification of injury according to the mechanism of the blast injury. RESULTS: The victims included 8 males (47%), 9 females (53%). The mean age was 37.5+/-12. Thirteen (13) victims were transferred to two tertiary hospitals, and 4 were transferred to two secondary hospitals. The types of injury were 3 fractures, 2 ligaments injuries, 6 contusions, 4 abrasions, and 3 open wounds (one of them was combined fracture). According to START classification, 17 victims were 1 immediate, 11 minor, 5 delayed, and no death. Classifications according to the mechanism of the blast injury were 1 primary injury, 6 secondary injuries (2 of them combined other mechanism), 3 tertiary injuries and 9 quaternary injuries. CONCLUSION: Trauma care physicians should be familiar with not only the specific types of injuries from blast accidents, but also the potential accidents that may occur in public facilities.

Comparison of Cervical Spine Movement by Airway Equipment during Orotracheal Intubation: A Manikin Pilot Study / 대한구급학회지

BACKGROUND: In patients with limited cervical spine movement, equipment for orotracheal intubation should achieve sufficient laryngeal exposure with the least cervical spine movement. This study was designed to compare movement of the cervical spine during the orotracheal intubation with various intubating equipment. METHODS: Twelve emergency physicians & residents with a total experience of >50 cases of endotracheal intubation in two emergency centers were assigned to perform orotracheal intubation with four different airway devices, including the Macintosh laryngoscope (ML), DCI video laryngoscope (DCI), Airway Scope (AWS) and Levitan Scope (LS), using the same manikin (Ambu(R) airway management trainer) in random sequences. Movement of the C-spine was examined by measuring the angle formed by two lines which are parallel to the anterior surface of the C2 and C7 vertebrae bodies. The angle was measured when Cormack-Lehane grade II glottis exposure was achieved during intubation. RESULTS: Mean cervical spine movements were 37.6 +/- 9.2degrees, 32.2 +/- 14.2degrees, 32.2 +/- 6.45degrees and 17.4 +/- 10.0degrees with the ML, DCI (p = 0.347), AWS (p = 0.094), and LS (p < 0.001), respectively, compared to that of ML. Cervical spine movement by LS was 54% less than that by ML. LS produced less cervical spine movement in comparison to DCI (p = 0.013) and AWS (p = 0.001). CONCLUSIONS: The Levitan Scope produced less movement of the cervical spine when compared to the Macintosh laryngoscope, DCI video-laryngoscope and Airway Scope during orotracheal intubation in a single airway training manikin model.

The Effect of Personal Protection Equipment Level C on Airway Management with Advanced Airway Devices: A Manikin Study

PURPOSE: Personal protection equipment (PPE) is compulsory for the safety of physicians and patients in the presence of biological hazards. In particular, such equipment is required for airway management of patients with highly contagious respiratory diseases. However, there are only a few studies about the effect of PPE on airway management with various advanced airway devices including the newly developed video-laryngoscope. We conducted a study on the effect of PPE level C on airway management with five different types of advanced airway devices including the laryngeal mask airway (LMA), direct laryngoscope (DL), airwayscope (AWS), video-laryngoscope made by Stortz (DCI), and the Levitanscope (LE). METHODS: Twenty-two emergency physician and residents in two emergency centers were trained to do trials with PPE and without PPE while performing airway management with five different airway devices. The procedures were done on two types of manikins. We compared the time from the start of the procedure to the first successful ventilation for each device and for each type of manikin. A short questionnaire was used to examine participants' subjective experiences. RESULTS: For both types of manikin, there were no significant differences in performance time between the group not wearing PPE and the PPE wearing group for any device. However, when compared with the other devices, the performance time for the LMA was faster than the other devices, and the Levitanscope(R) took a significantly longer time in both groups. According to the questionnaires, the most comfortable & uncomfortable airway devices were the LMA and the Levitanscope(R). CONCLUSION: When PPE level C was compared with the no protection state, there were no significant statistical time differences for performing advanced airway management with any particular airway device.

Exposure to Power Frequency Magnetic Fields in the Emergency Department

PURPOSE: We use many electronic devices for treating patients in our emergency department. Several studies have reported an association between electromagnetic field exposure and risk of cancer and other diseases. Our purpose was to measure the intensity of power-frequency magnetic fields in the emergency department and evaluate the conditions exceeded regulation guidelines for power-frequency magnetic fields. METHODS: Extremely low frequency magnetic fields were measured at 78 ordinary working spots in our tertiary hospital's emergency department (ED) and evaluated according to national regulatory guidelines and SWEDAC. Each spot was measured four times. During measurement, every electrical device in the emergency department was turned on. RESULTS: The average intensity of the magnetic fields in our emergency department was 0.99+/-1.27 mG. The maximum intensity was 8.3 mG, which was found in the pediatric section. CONCLUSION: The power-frequency magnetic field intensities of the various sections of our ED did not exceed national regulatory guidelines. However, pediatric and the minor emergency section showed magnetic fields intensities far above 2 mG. We found these high values outside the pediatric and waiting sections, where the electrical cabinet panel was located. We conclude that the electrical cabinet panel should be shielded and that similar studies are needed for other emergency departments.

The Current Status and Activities of Emergency Physician-Performed Ultrasonography in Seoul and Gyeong-gi do

PURPOSE: There have been reports that have focused on the usefulness of ultrasonography (US), yet there are no reports on its current status and activities. This study evaluated the current status and activities of US in Seoul and Gyeong-gi do. METHODS: This study was conducted using a questionnaire developed by emergency physicians who were experienced in workshops for emergency US. The activities of US were established by assessing the average frequency of US examination among 5 clinical situations as recommended by the American College of Emergency Physicians (ACEP). We assessed the association between these activities and the variables using linear regression analysis and regression trees. RESULTS: The overall response rate was 85.2%. The average frequencies of US examination are as follows: multiple trauma (75.1+/-29.5%), right upper abdominal pain (57.6+/-29.6%), cardiac arrest (54.4+/-30.6%), suspected ureter stone (42.4+/-31.6%), other abdominal pain (41.6+/-29.2%), chest pain or dyspnea (35.8+/-27.3%), right lower abdominal pain (33.6+/-28.9%), hypotension (33.3+/-27.8%), procedures (21.3+/-22.6%), intussusceptions (17.1+/-26.5%), central line access (16.2+/-21.4%), testicular torsion (14.7+/-23.7%) and assessing a pregnancy or a fetus (9.1+/-10.8%). The average percentage of current activities was 52.6%. The factors associated with current activities are as follows: the presence of supervisor for US training (p=0.030), the quality of the US machine (p=0.007), the number of patients (p=0.001) and the accreditation system for emergency US (p=0.014). CONCLUSION: The current status and activities of US are varied. The factors associated with current activities are the presence of a supervisor for US training, the accreditation system for emergency US, the quality of the US machine and the number of patients. It is important to improve these factors to effectively use US.

Effect of Emergency Auto-Consultation System (EACS) on Length of Stay of Specialty Consultation Patients in the Emergency Department

PURPOSE: The length of stay (LOS) for patients in the emergency department (ED) provides an important measure of both ED overcrowding and patient satisfaction. Specialty consultation is one of the major factors that contributes to longer LOS. The aim of the study was to examine the effectiveness of a computer-based emergency auto-consultation system (EACS) in reducing additional LOS caused by specialty consultation. METHODS: The EACS was developed for use in managing specialty consultation in the ED. Each clinical department provides a daily list of 4 residents and 1 specialist as the doctors on duty. The ED doctors then use the EACS to contact the departments required for a specialty consultation: Clicking the department's name on the computer screen activates the short message service (SMS) calling system, which sends a message with the registration numbers and names of the relevant patients every 10 min to the mobile phones of individuals assigned as doctors on duty, in the order listed. The doctors who receive the SMS are asked to arrive at the ED within 10 minutes. If the the firstlisted doctors on duty do not show up in 10 minutes, an SMS is sent to the next group of doctors on duty on the list. In 50 minutes, therefore, 5 groups of doctors on duty will have received the SMS in the order listed. Each clinical department estimated the response time of doctors on duty 2 months before the adoption of the EACS versus afterward. The LOS of patients admitted to the ED was also compared before and after the adoption of the EACS. A questionnaire was used to survey the health professionals working in the ED about the changes in the intensity of labor and the needs of the EACS. RESULTS: The number of patients participating in the study were 2,035 and 2,216, respectively, before and after the adoption of the EACS. The EACS significantly decreased both the response time of doctors on duty (34.8+/-35.5 min vs. 9.7+/-16.8 min, p=0.000) and the LOS (155.3+/-126.7 min vs. 144.6+/-110.7 min, p=0.003). In the survey, 44.7% of ED health care professionals responded that their intensity of labor were improved, and most of them agreed that the EACS should be required in the ED. CONCLUSION: The computer-based EACS decreased LOS by reducing the response time of doctors on duty, and it also increased satisfaction among the ED health professionals.

A Preliminary Study of Gender Difference on Clinical Presentation of Acute Ischemic Stroke: A Single Center Study

PURPOSE: To attain improvement in prognosis of patients suffering acute ischemic strokes (AIS), it is crucial to diagnose these swiftly and accurately. It is generally believed that female patients have a less favorable outcome, but there has not yet been sufficient data to confirm this opinion. The authors herein conducted a study to determine whether the symptoms of AIS differ between males and females. METHODS: A retrospective study was conducted on 322 consecutive patients who were diagnosed with AIS on the basis of MRI findings during the last two years. Demographic findings and clinical features were collected from emergency room records in order to evaluate gender differences. RESULTS: There were 148 female patients (45.8% of total) in our study, and the average age of affection for females was significantly higher than males. Our data did not achieve statistical significance; however, we observed the following tendencies: the time from symptom onset to admission was delayed in female group; both traditional and nontraditional symptoms were more prevalent in the male group; and atypical symptoms were observed in the female group. CONCLUSION: No gender difference was observed in the incidence of acute ischemic stroke. However, the proportion of atypical symptoms was relatively higher in female patients. Factors resulting in delay clinical attention and contributing to the observed discrepancy between genders in AIS diagnosis should be validated and investigated further.

Toxicants Reported in Research on Fatal Toxic Exposure in Korea

PURPOSE: With the very wide range of known toxicants, the correct early management of fatal toxic exposure can be delayed. Past epidemiologic data on fatal toxic exposure would be helpful to emergency physician. The aim of this study was to investigate reports of toxicants on fatal toxicology research during the past two decades in Korea, with a focus on emergency symptoms. METHODS: This study analyzed basic information and abstracts of about 200,000 articles from approximately 500 journals between 1980 to 2003, which were retrieved from Medical Research Information Center and Research Information Center for Health and focused on fatal toxicology related to emergency medicine. The search terms used were the names of toxicants and related terms. RESULTS: A total of 88 toxicants were found to be related to research on fatal toxic exposure. The number of articles increased sharply after 1995. Frequently involved toxicants were carbon monoxide (in 93 articles), followed by paraquat (in 84), and organophosphate pesticide (in 37). Original articles exceeded case reports in number for these three most frequent toxicants. Articles on paraquat were more numerous than those on organophosphate pesticide or carbon monoxide especially after the late 1980s. CONCLUSION: The result suggest that over a 24-year-period, carbon monoxide, paraquat, and organophosphate pesticides have been prominent in both the incidence and severity of fatal toxic exposure in Korea, which underscore the need for review of them.

Urinary Calculi Frequently Detected on Ultrasonography?

PURPOSE: Transabdominal sonography has been widely used in the diagnosis of suspected urinary calculi, assisted by secondary findings from urinary tract obstruction, but this method shows low specificity and relatively high incidence of false-positives. Recently, detection of stone itself with new Doppler finding and bladder distension on sonography has demonstrated high sensitivity. METHODS: We performed prospective transabdominal ultrasonography for emergency department patients with acute urinary colic pain over a 3 month period. With adequate bladder distension by intravenous hydration and initial spontaneous voiding drive, stones itself could be tracked along the entire length of urinary tract by emergency physician who received short-term education course. RESULTS: One hundred and thirty one patients enrolled; 86 received a sonographic exam and 57 showed urinary calculi. The detection rate of urinary calculi was 71.3%. The most common sonographic feature used in the diagnosis of urinary calculi was a distinct echogenic stone appearance within the dilated urinary tract with posterior acoustic shadowing. CONCLUSION: We concluded that detection of urinary calculi by transabdominal ultrasonography could be very useful in mbination with secondary sonographic finding from urinary tract obstruction in the evaluation of suspected urinary colic.

Prediction of Endotracheal Tube Size for Korean Children with Broselow Tape

PURPOSE: Broselow Tape was designed to estimate endotracheal tube size on the basis of the body length of emergency pediatric patients. It was validated from the United States. We assess the accuracy of the Broselow Tape method for the prediction of endotracheal tube (ETT) size in Korean children. METHODS: We reviewed pediatric anesthetic charts at a tertiary care hospital for one year, and in addition we collected data on gender, age, height, weight and fifth fingernail width for children visiting two tertiary emergency departments over four months. The inclusion criteria were that patients were American System of Anesthesiology (ASA) grade I or II, and that they were within the measuring range of Broselow Tape. The comparison of two data pairs was by cluster analysis and included stratification based on propensity scores, adjusting, and grouping. RESULTS: Five hundred ninety-seven children and 537 pediatric anesthetic charts were included in this study. The mean ETT size as predicted by the Browslow tape method and as actually intubated were 5.12 mm and 5.11 mm (p=0.3851), respectively. The mean ETT size predicted by the 5th fingernail-width method and the age-based method were 5.48 mm (p<0.0001) and 4.95 mm (p<0.001). CONCLUSION: There was no difference between the ETT size predicted by Browslow tape method and actual tube size. We conclude that Broselow Tape can be used to predict ETT size for Korean children.

The Study of Accuracy of Death Statistics

PURPOSE: In order to examine the accuracy of death statistics, the present study compared the underlying causes of death on death certificates with the underlying causes of death published by the National Statistical Office. METHODS: A retrospective survey was performed comparing death certificates issued by a university hospital for one year in 2003, the dead patients' medical records, and death statistics for 2003 published by the National Statistical Office. We compared the underlying causes of death on death certificates, the underlying cause of death as classified by the National Statistical Office, and the underlying causes of death in medical records, in order to analyze their degree of coincidence and the causes of any inconsiste RESULTS: The inconsistency rate between the underlying causes of death as listed on death certificates and the underlying causes of death in the published statistics was 26%. The most frequent reason for discrepancies was a switch from one diagnosis name to another (58.7%), and the next most frequent was a change from the general categories of death due to old age or unknown cause to a diagnosis name (41.3%). The inconsistency rate between the actual underlying causes of death and the underlying causes of death on death certificates was 18.9%, with the most frequent reason for inconsistency being the recording of an uncertain cause of death such as old age or unknown cause (53.3%), and next most frequent being the recording of an interim result as the underlying cause of death (38.7%). The inconsistency rate between the underlying causes of death in medical records and the underlying causes of death in statistics was 8.1%: the most frequent reason for inconsistency was a change to a diagnosis name irrelevant to the patient's underlying disease (60.9%). and next most frequent was a change of the patients' underlying disease to one that was not related to the patient's death (34.4%). The proportion of cases with concordance between the underlying cause of death on the death certificate and the actual underlying cause of death, but with discrepancy between the actual underlying cause of death and the underlying cause of death in statistics, was 6.2%. Inconsistency both between the underlying cause of death listed on the death certificate and the actual underlying cause of death and between actual underlying cause of death and the underlying cause of death published in statistics occurred in 11.3% of cases, marking a significant difference. CONCLUSION: The overall accuracy rate of statistics on the causes of death was 91.9%, and the concordance rate between the actual underlying causes of death and the underlying causes of death in published statistics was high whenever death certificates were issued listing the actual underlying causes of death.