Jae Yun Jung

A new age-based formula for estimating weight of Korean children

OBJECTIVESnThe objective of this study was to develop and validate a new age-based formula for estimating body weights of Korean children.nnnMETHODSnWe obtained body weight and age data from a survey conducted in 2005 by the Korean Pediatric Society that was performed to establish normative values for Korean children. Children aged 0-14 were enrolled, and they were divided into three groups according to age: infants (<12 months), preschool-aged (1-4 years) and school-aged children (5-14 years). Seventy-five percent of all subjects were randomly selected to make a derivation set. Regression analysis was performed in order to produce equations that predict the weight from the age for each group. The linear equations derived from this analysis were simplified to create a weight estimating formula for Korean children. This formula was then validated using the remaining 25% of the study subjects with mean percentage error and absolute error. To determine whether a new formula accurately predicts actual weights of Korean children, we also compared this new formula to other weight estimation methods (APLS, Shann formula, Leffler formula, Nelson formula and Broselow tape).nnnRESULTSnA total of 124,095 childrens data were enrolled, and 19,854 (16.0%), 40,612 (32.7%) and 63,629 (51.3%) were classified as infants, preschool-aged and school-aged groups, respectively. Three equations, (age in months+9)/2, 2×(age in years)+9 and 4×(age in years)-1 were derived for infants, pre-school and school-aged groups, respectively. When these equations were applied to the validation set, the actual average weight of those children was 0.4kg heavier than our estimated weight (95% CI=0.37-0.43, p<0.001). The mean percentage error of our model (+0.9%) was lower than APLS (-11.5%), Shann formula (-8.6%), Leffler formula (-1.7%), Nelson formula (-10.0%), Best Guess formula (+5.0%) and Broselow tape (-4.8%) for all age groups.nnnCONCLUSIONnWe developed and validated a simple formula to estimate body weight from the age of Korean children and found that this new formula was more accurate than other weight estimating methods. However, care should be taken when applying this formula to older children because of a large standard deviation of estimated weight.

Manikin-Integrated Digital Measuring System for Assessment of Infant Cardiopulmonary Resuscitation Techniques

The process of cardiopulmonary resuscitation (CPR) involves various components that must be followed to deliver high quality of CPR. While the components commonly apply to CPR for all ages from infant to adult, there are several different suggestions for infant CPR such as two-thumb CPR and two-finger CPR. However, the comprehensive evaluation based on all these components has been difficult in the absence of proper evaluation tool. Here, we developed a new manikin-integrated, digital measuring system that objectively estimates overall performance of infant CPR by evaluating individual CPR components one by one including different hand placements. The system collects and analyzes data to present estimations in digital scores according to a new evaluation index constructed based on the previously verified one. The feasibility of the system was validated through simulations with beginners and experts in first aid, resulting in statistically significant differences between the two groups with the indication of specific weaknesses for each group which may provide a basis for creating customized CPR training strategy in compliance with the personal level. We believe that the system would become a valuable assessment tool not only for infant CPR but also for the CPR technique, in general, by reflecting every component in the evaluation.

Bacteremia prediction model using a common clinical test in patients with community-acquired pneumonia.

PURPOSEnThe aim of this study was to construct a bacteremia prediction model using commonly available clinical variables in hospitalized patients with community-acquired pneumonia (CAP).nnnBASIC PROCEDURESnA prospective database including patients who were diagnosed with CAP in the emergency department was analyzed. Independent risk factors were investigated by using multivariable analysis in 60% of the cohort. We assigned a weighted value to predictive factor and made a prediction rule. This model was validated both internally and externally with the remaining 40% of the cohort and a cohort from an independent hospital. The low-risk group for bacteremia was defined as patients who have a risk of bacteremia less than 3%.nnnMAIN FINDINGSnA total of 2422 patients were included in this study. The overall rate of bacteremia was 5.7% in the cohort. The significant factors for predicting bacteremia were the following 7 variables: systolic blood pressure less than 90 mm Hg, heart rate greater than 125 beats per minute, body temperature less than 35 °C or greater than 40 °C, white blood cell less than 4000 or 12,000 cells per microliter, platelets less than 130,000 cells per microliter, albumin less than 3.3 g/dL, and C-reactive protein greater than 17 mg/dL. After using our prediction rule for the validation cohorts, 78.7% and 74.8% of the internal and external validation cohorts were classified as low-risk bacteremia groups. The areas under the receiver operating characteristic curves were 0.75 and 0.79 for the internal and external validation cohorts.nnnPRINCIPAL CONCLUSIONSnThis model could provide guidelines for whether to perform blood cultures for hospitalized CAP patients with the goal of reducing the number of blood cultures.

Change of hemopexin level is associated with the severity of sepsis in endotoxemic rat model and the outcome of septic patients

PURPOSEnThe purpose of the study is to uncover the role of hemopexin (HPX) as anti-inflammatory mediator in animals and humans.nnnMATERIALS AND METHODSnWe injected rats with 5 and 10 mg/kg of lipopolysaccharide to induce low- and high-grade endotoxemia (LGE and HGE), respectively, and we measured serum levels of tumor necrosis factor α, interleukin 6, and HPX at 0, 1, 3, and 6 hours after the injection. In a clinical study, we measured the initial serum HPX concentrations of septic shock patients. We evaluated the correlation between HPX levels and sepsis severity in rats and the predictive value of the HPX level for 28-day mortality of patients.nnnRESULTSnIn rats, serum interleukin 6 and tumor necrosis factor α concentrations were lower in LGE than in HGE, whereas the HPX level in HGE at 6 hours was significantly lower than in LGE (0.88, interquartile range [0.79-1.00] vs 1.33, interquartile range [1.29-1.49] mg/mL, P= .002). In patients, the initial serum HPX level in nonsurvivors was significantly lower than in survivors (0.75 vs 1.02 mg/mL, P< .001). Multivariate logistic regression analysis revealed that HPX exhibited independent prognostic value for 28-day mortality, and its levels were closely related to Acute Physiology and Chronic Health Evaluation II scores.nnnCONCLUSIONSnLow serum HPX levels are related to sepsis severity and could indicate poor prognosis for septic shock patients.

N-terminal pro-brain natriuretic peptide can be an adjunctive diagnostic marker of hyper-acute phase of Kawasaki disease.

AbstractThe purpose of this study was to determine whether the serum N-terminal pro-brain natriuretic peptide (NT-proBNP) level could be a useful marker for Kawasaki disease in the pediatric emergency department (PED) and in the presence of fever duration of 4xa0days or less (hyper-acute phase of Kawasaki disease). Medical records of patients who were 1xa0month to 15xa0years old of age and presented at the PED with suspected Kawasaki disease from January 1, 2010, to December 31, 2014, were collected retrospectively. Two hundred thirty-nine patients with a history of fever for 4xa0days or less were diagnosed with Kawasaki disease, as well as 111 patients with other febrile diseases, and were enrolled. The NT-proBNP level was significantly higher in patients with Kawasaki disease (Kawasaki disease vs. other febrile disease group, 444.8 (189.7–951.5) vs. 153.4 (68.9–287.6)xa0pg/mL; pxa0<xa00.001), and a cutoff value of 244.7xa0pg/mL yielded a sensitivity and specificity of 68.6 and 70.3xa0%, respectively. The area under the curve of the NT-proBNP for predicting Kawasaki disease was 0.763 (95xa0% CI 0.712–0.814).n Conclusion: NT-proBNP might be an adjunctive laboratory marker for hyper-acute phase of Kawasaki disease in the PED.What is Known:• N-terminal pro-brain natriuretic peptide level has been reported as a useful marker for diagnosis in patients with the acute phase of Kawasaki disease.• But, in the cases of less than 5xa0days of fever, the appropriate level of NT-proBNP for differentiating Kawasaki disease in PED has not been yet evaluated.What is New:• NT-proBNP might be an adjunctive laboratory marker for hyper-acute phase of Kawasaki disease.

Effectiveness of education in point-of-care ultrasound-assisted physical examinations in an emergency department: A before-and-after study

Abstract Implementation of point-of-care ultrasonography (POCUS)-assisted physical examination (PE) in emergency departments (EDs) was conducted in the ED of an urban tertiary teaching hospital. This study examines the effect of POCUS implementation in emergency medicine departments by using a systematic education program on image acquisition to analyze decision making. Educating staff on POCUS involved a technique related to image acquisition and then accurately diagnosing subsequent POCUS results. The quasi-experimental, uncontrolled before-and-after study was performed to evaluate the education effect. POCUS orders for eligible patients, length of stay (LOS) in ED, and return visits (RVs) to ED between the “before” period (March 1, 2015 to February 28, 2016) and the “after” period (March 1, 2016 to February 28, 2017) were compared. Piecewise regression was used to assess trend differences of LOS and RVs between the periods. A total of 16,942 and 16,287 patients were included in the before and after periods of education, respectively. During the study periods, 966 (6%) and 2801 (18%) POCUS were ordered, respectively (rate differenceu200a = u200a12%; Pu200a<u200a.001). Before the education, the median LOS was 6.55 (interquartile rage [IQR]: 6.2–6.75) and the trend slope of LOS was −0.01. After the education, the median LOS was 5.25 (IQR: 4.85–5.45) and the trend slope (the change of which was considered significant, at a P value of .012) was −0.15. Before the education, the median RV rate was 6.4% (IQR: 6.15–6.65) and the trend slope of RVs was −0.01. After the education, the median RVs was 5.25% (IQR: 4.95–5.35) and the trend slope of RVs was also significant, at −0.11. The education of POCUS-PE in ED successfully increased use of POCUS, and reduced the LOS and RV rate in ED.

Epidemiology of prehospital emergency medical service use in Korean children

OBJECTIVEnThe aim of this study was to elucidate the epidemiology of pediatric patients transported by the National 119 Rescue Services in Korea.nnnMETHODSnWe enrolled all pediatric patients (<16 years old) who used the National 119 Rescue Services in Korea between January 2006 and December 2008, and analyzed the 119 ambulance patient care record databases.nnnRESULTSnThe total number of the cases was 238,644 for 3 years. The median age was 6 years old and 59.0% were male, and the 2- to 5-year-old group was the largest (31.0%). The peak transport times were in the afternoon (from 12:00 p.m. to 17:59 p.m., 36.3%), on Saturday and Sunday (15.9% and 15.7%), and in summer (June to August, 27.3%). The ratio of disease versus injury as the cause of the transports was 42.3% vs. 57.7%. Among the 16 metropolitan cities and provinces, Gyeonggi (25.7%), Seoul (17.6%), and Incheon (7.0%) account for almost half of the all transported children. Regarding the annual transport rates per 100,000 children standardized by age, and gender to the Korean child population, Jeju was the largest (1,650.2) followed by Gangwon (1,201.3), and Jeonnam (1,178.1).nnnCONCLUSIONnThis report presents comprehensive epidemiologic data of pediatric patients transported by 119 rescue services in Korea.

Sonographic aorta/IVC cross-sectional area index for evaluation of dehydration in children

OBJECTIVEnCurrent studies have not found sufficient evidence to encourage the use of ultrasound for assessing dehydration in children. We introduce a new sonographic parameter, the aorta/inferior vena cava (IVC) cross-sectional area index (Ao/IVCA) measured just inferior to the xiphoid process, for the effective evaluation of dehydration in children.nnnMETHODSnThis is a prospective, observational study. We enrolled children who presented to the pediatric emergency department (PED) between May 2014 and January 2015. We measured the maximum diameter of the aorta from inner wall to inner wall, and the long and short axis diameters of IVC using a convex array transducer. Ao/IVCA was calculated and compared with aorta/IVC maximal diameter index (Ao/IVCD) and the clinical dehydration scale (CDS).nnnRESULTSnA total of 34 children were enrolled. We found a statistically significant correlation between Ao/IVCA and CDS (R(2) = 0.30; P <.001). Ao/IVCD did not correlate significantly with CDS (R(2) = 0.08; P =.11). The ability of Ao/IVCA and Ao/IVCD to predict CDS ≥1 was assessed using the receiver operating characteristic analysis. The area under the receiver operating characteristic curve for Ao/IVCA was larger than that for Ao/IVCD (0.87 vs 0.75, P= .04). The cut-off value of Ao/IVCA that yielded the maximum value of Youden index was 1.81 (sensitivity: 72%, specificity: 89%).nnnCONCLUSIONSnAo/IVCA might be a promising index for the assessment of dehydration. The diagnostic performance of Ao/IVCA for dehydration might be higher than that of the method that uses the maximum diameter of IVC and the aorta.

Validation of the new diagnosis grouping system for pediatric emergency department visits using the International Classification of Diseases, 10th Revision.

Objective A clinically sensible diagnosis grouping system (DGS) is needed for describing pediatric emergency diagnoses for research, medical resource preparedness, and making national policy for pediatric emergency medical care. The Pediatric Emergency Care Applied Research Network (PECARN) developed the DGS successfully. We developed the modified PECARN DGS based on the different pediatric population of South Korea and validated the system to obtain the accurate and comparable epidemiologic data of pediatric emergent conditions of the selected population. Methods The data source used to develop and validate the modified PECARN DGS was the National Emergency Department Information System of South Korea, which was coded by the International Classification of Diseases, 10th Revision (ICD-10) code system. To develop the modified DGS based on ICD-10 code, we matched the selected ICD-10 codes with those of the PECARN DGS by the General Equivalence Mappings (GEMs). After converting ICD-10 codes to ICD-9 codes by GEMs, we matched ICD-9 codes into PECARN DGS categories using the matrix developed by PECARN group. Lastly, we conducted the expert panel survey using Delphi method for the remaining diagnosis codes that were not matched. Results A total of 1879 ICD-10 codes were used in development of the modified DGS. After 1078 (57.4%) of 1879 ICD-10 codes were assigned to the modified DGS by GEM and PECARN conversion tools, investigators assigned each of the remaining 801 codes (42.6%) to DGS subgroups by 2 rounds of electronic Delphi surveys. And we assigned the remaining 29 codes (4%) into the modified DGS at the second expert consensus meeting. The modified DGS accounts for 98.7% and 95.2% of diagnoses of the 2008 and 2009 National Emergency Department Information System data set. This modified DGS also exhibited strong construct validity using the concepts of age, sex, site of care, and seasons. This also reflected the 2009 outbreak of H1N1 influenza in Korea. Conclusions We developed and validated clinically feasible and sensible DGS system for describing pediatric emergent conditions in Korea. The modified PECARN DGS showed good comprehensiveness and demonstrated reliable construct validity. This modified DGS based on PECARN DGS framework may be effectively implemented for research, reporting, and resource planning in pediatric emergency system of South Korea.

Effectiveness of a radiation reduction campaign targeting children with gastrointestinal symptoms in a pediatric emergency department.

Abstract Children feature more active cellular division and a smaller body area, which leads to a greater radiation dosage accumulation. We tried to reduce radiation hazards by reducing unnecessary radiological studies in a pediatric emergency department (PED) through the radiation reduction campaign. Our campaign involved a reduction from 2 (erect and supine) to 1 ordered abdominal plain radiograph (erect). This quasi-experimental, uncontrolled before-and-after study aimed to evaluate the campaign effect. We compared simple radiograph orders, length of stay (LOS) in PED, and return visit (RV) to PED between the before period (June 1, 2011–May 30, 2014) and the after period (June 1, 2014–May 30, 2015). Piecewise regression was used to assess rate differences between the periods. A total of 10,729 and 3515 patients were included before and after the campaign, respectively. During study periods, 9647 (90%) and 2710 (77%) total abdominal radiographs were ordered, respectively (rate difference = 13%; Pu200a<u200a0.001), and the slopes of rate changes were 0.03 and −0.71, respectively (Pu200a=u200a0.056). The total abdominal erect and supine film rate slope decreased from −0.19 to −2.86 (Pu200a=u200a0.004). The RV rate did not change (220 [2%] vs 56 [2%], respectively; Pu200a=u200a0.104). The slope of total RV rate changed from −0.01 to −0.05 (Pu200a=u200a0.132), and the slope of LOS changed from 0.001 to −0.352 (Pu200a=u200a0.243). The campaign to reduce abdominal radiograph orders in pediatric patients successfully reduced the abdominal plain film X-ray rate without on the RV rate and the LOS.