The impact of the three-level collaboration exercise on collaboration and leadership during scenario-based hospital evacuation exercises using flexible surge capacity concept: a mixed method cross-sectional study.

BACKGROUND: Hospitals play a crucial role in responding to disasters and public health emergencies. However, they are also vulnerable to threats such as fire or flooding and can fail to respond or evacuate adequately due to unpreparedness and lack of evacuation measures. The United Nations Office for Disaster Risk Reduction has emphasised the importance of partnerships and capacity building in disaster response. One effective way to improve and develop disaster response is through exercises that focus on collaboration and leadership. This study aimed to examine the effectiveness of using the 3-level collaboration (3LC) exercise in developing collaboration and leadership in districts in Thailand, using the concept of flexible surge capacity (FSC) and its collaborative tool during a hospital evacuation simulation. METHODS: A mixed-method cross-sectional study was conducted with 40 participants recruited from disaster-response organisations and communities. The data from several scenario-based simulations were collected according to the collaborative elements (Command and control, Safety, Communication, Assessment, Triage, Treatment, Transport), in the disaster response education, "Major Incident Medical Management and Support" using self-evaluation survey pre- and post-exercises, and direct observation. RESULTS: The 3LC exercise effectively facilitated participants to gain a mutual understanding of collaboration, leadership, and individual and organisational flexibility. The exercise also identified gaps in communication and the utilisation of available resources. Additionally, the importance of early community engagement was highlighted to build up a flexible surge capacity during hospital evacuation preparedness. CONCLUSIONS: the 3LC exercise is valuable for improving leadership skills and multiagency collaboration by incorporating the collaborative factors of Flexible Surge Capacity concept in hospital evacuation preparedness.

The Feasibility of Implementing the Flexible Surge Capacity Concept in Bangkok: Willing Participants and Educational Gaps.

The management of emergencies consists of a chain of actions with the support of staff, stuff, structure, and system, i.e., surge capacity. However, whenever the needs exceed the present resources, there should be flexibility in the system to employ other resources within communities, i.e., flexible surge capacity (FSC). This study aimed to investigate the possibility of creating alternative care facilities (ACFs) to relieve hospitals in Bangkok, Thailand. Using a Swedish questionnaire, quantitative data were compiled from facilities of interest and were completed with qualitative data obtained from interviews with key informants. Increasing interest to take part in a FSC system was identified among those interviewed. All medical facilities indicated an interest in offering minor treatments, while a select few expressed interest in offering psychosocial support or patient stabilization before transport to major hospitals and minor operations. The non-medical facilities interviewed proposed to serve food and provide spaces for the housing of victims. The lack of knowledge and scarcity of medical instruments and materials were some of the barriers to implementing the FSC response system. Despite some shortcomings, FSC seems to be applicable in Thailand. There is a need for educational initiatives, as well as a financial contingency to grant the sustainability of FSC.

Hypertensive crisis in patients with obstructive sleep apnea-induced hypertension.

BACKGROUND: Hypertensive crisis is an urgent/emergency condition. Although obstructive sleep apnea (OSA) in resistant hypertension has been thoroughly examined, information regarding the risk factors and prevalence of hypertensive crisis in co-existing OSA and hypertension is limited. This study thus aimed to determine prevalence of and risk factors for hypertensive crisis in patients with hypertension caused by OSA. METHODS: The inclusion criteria were age of 18 years or over and diagnosis of co-existing OSA and hypertension. Those patients with other causes of secondary hypertension were excluded. Patients were categorized by occurrence of hypertensive crisis. Factors associated with hypertensive crisis were calculated using multivariate logistic regression analysis. RESULTS: There were 121 patients met the study criteria. Of those, 19 patients (15.70%) had history of hypertensive crisis. Those patients in hypertensive crisis group had significant higher systolic and diastolic blood pressure at regular follow-ups than those without hypertensive crisis patients (177 vs. 141 mmHg and 108 vs. 85 mmHg; p value < 0.001 for both factors). After adjusted for age, sex, and Mallampati classification, only systolic blood pressure was independently associated with hypertensive crisis with adjusted odds ratio (95% CI) of 1.046 (1.012, 1.080). CONCLUSIONS: The prevalence of hypertensive crisis in co-existing OSA and hypertension was 15.70% and high systolic blood pressure or uncontrolled blood pressure associated with hypertensive crisis in patients with OSA-associated hypertension.

Comparison of Accuracy and Speed in Computer-Assisted Versus Conventional Methods for Pediatric Drug Dose Calculation: A Scenario-Based Randomized Controlled Trial.

Pediatric emergency care is prone to medication errors in many aspects including prescriptions, administrations, and monitoring. This study was designed to assess the effects of computer-assisted calculation on reducing error rates and time to prescription of specific emergency drugs. We conducted a randomized crossover experimental study involving emergency medicine residents and paramedics in the Department of Emergency Medicine at Ramathibodi Hospital. Participants calculated and prescribed medications using both the conventional method and a computer-assisted method. Medication names, dosages, routes of administration, and time to prescription were collected and analyzed using logistic and quantile regression analysis. Of 562 prescriptions, we found significant differences between computer-assisted calculation and the conventional method in the calculation accuracy of overall medications, pediatric advanced life support (PALS) drugs, and sedative drugs (91.17% vs 67.26%, 86.54% vs 46.15%, and 89.29% vs 57.86%, respectively, P < .001). Moreover, there were significant differences in calculation time for overall medications, PALS drugs and sedative drugs (25 vs 47 seconds, P < .001), and computer-assisted calculation significantly decreased the gap in medication errors between doctors and paramedics (P < .001). We conclude that computer-assisted prescription calculation provides benefits over the conventional method in accuracy of all medication dosages and in time required for calculation, while enhancing the drug prescription ability of paramedics.

Characteristics of Pediatric Emergency and Risk Factors for Life-saving Interventions.

Pediatric emergency patients are vulnerable population and require special care or interventions. Nevertheless, there is limited data on the prevalence and risk factors for life-saving interventions. This study is a retrospective analytical study. The inclusion criteria were children aged 15 years or under who were triaged as level 1 or 2 and treated at the resuscitation room. Factors associated with LSI were executed by logistic regression analysis. During the study period, there were 22 759 ER visits by 14 066 pediatric patients. Of those, 346 patients (2.46%) met the study criteria. Triage level 1 accounted for 16.18% (56 patients) with 29 patients (8.38%) with LSI. Trauma was an independent factor for LSI with adjusted odds ratio (95% CI) of 4.37 (1.49, 12.76). In conclusion, approximately 8.38% of these patients required LSI. Trauma cause was an independent predictor for LSI.

IQ-CPR Meter for Chest Compression Monitoring During Simulated Cardiopulmonary Resuscitation; a Comparative Study.

INTRODUCTION: Adequate chest compression is crucial for cardiopulmonary resuscitation (CPR). There are several chest compression monitoring devices with different costs. This study aimed to evaluate the agreement rate of Improved Quality of Cardiopulmonary Resuscitation meter (IQ-CPR meter) and automated external defibrillator (AED) in chest compression quality monitoring. METHODS: In this comparative study, participants were instructed to perform chest compression on the CPR manikins with the set rate of 110 times/minute for two minutes. The CPR manikins had two monitors: AED (R series®, Zoll company) and IQ-CPR meter. AED showed the depth and speed of chest compression on the screen, while IQ-CPR meter showed the depth of each chest compression by color light for quality of chest compression depth. Video-based analysis was used to compare the chest compression quality monitoring between the 2 devices. RESULTS: There were 27 participants in the study with a mean age and body mass index (standard deviation; SD) of 26.00 (5.65) years, and 22.93 (3.62) kg/m2 (70.37% male). The median (1st to 3rd quartile range) of chest compression experience was 3 (1.00-6.50) years. The mean (SD) of chest compression rate was 107 (5.29) times/minute. Based on Cohen's Kappa correlation, agreement between the IQ-CPR meter and the AED was 66.54%. CONCLUSION: The IQ-CPR meter had fair agreement with the computerized chest compression monitoring device with lower cost and simple, real time audiovisual feedback.

Clinical Predictors Influencing the Length of Stay in Emergency Department Patients Presenting with Acute Heart Failure.

Background and objectives: Acute heart failure is a common problem encountered in the emergency department (ED). More than 80% of the patients with the condition subsequently require lengthy and repeated hospitalization. In a setting with limited in-patient capacity, the patient flow is often obstructed. Appropriate disposition decisions must be made by emergency physicians to deliver effective care and alleviate ED overcrowding. This study aimed to explore clinical predictors influencing the length of stay (LOS) in patients with acute heart failure who present to the ED. Materials and Methods: We conducted prognostic factor research with a retrospective cohort design. Medical records of patients with acute heart failure who presented to the ED of Ramathibodi Hospital from January to December 2015 were assessed for eligibility. Thirteen potential clinical predictors were selected as candidates for statistical modeling based on previous reports. Multivariable Poisson regression was used to estimate the difference in LOS between patients with and without potential predictors. Results: A total of 207 patients were included in the analysis. Most patients were male with a mean age of 74.2 ± 12.5 years. The median LOS was 54.6 h (Interquartile range 17.5, 149.3 h). From the multivariable analysis, four clinical characteristics were identified as independent predictors with an increase in LOS. These were patients with New York Heart Association (NYHA) functional class III/IV (+72.9 h, 95%Confidence interval (CI) 23.9, 121.8, p = 0.004), respiratory rate >24 per minute (+80.7 h, 95%CI 28.0, 133.3, p = 0.003), hemoglobin level <10 mg/dL (+60.4 h, 95%CI 8.6, 112.3, p = 0.022), and serum albumin <3.5 g/dL (+52.8 h, 95%CI 3.6, 102.0, p = 0.035). Conclusions: Poor NYHA functional class, tachypnea, anemia, and hypoalbuminemia are significant clinical predictors of patients with acute heart failure who required longer LOS.

Diagnostic properties of a portable near-infrared spectroscopy to detect intracranial hematoma in traumatic brain injury patients.

Traumatic brain injury (TBI) is a major public health issue worldwide. A portable near-infrared spectroscopy (NIRS) is a non-invasive device to detect intracranial hematoma. The advantages of the NIRS include real time results and non-radiation exposure. However, sensitivity and specificity of the NIRS for intracranial hematoma are varied. This study aimed to evaluate the diagnostic properties of the NIRS in TBI patients to detect intracranial hematoma. This study was a diagnostic and prospective study conducted at the Emergency Department. The inclusion criteria were adult patients (age of 18 years or over) with moderate to high risk of all degrees of traumatic brain injury within 24 h after the injury. The primary endpoint of the study was a description of diagnostic properties of the NIRS compared with the CT brain. There were 47 patients enrolled in the study. Most of patients had Glasgow Coma Scale of 15 (44 patients; 93.62 %). Of those, 11 patients (23.40 %) had intracranial hematoma: subdural hematoma (n = 9), epidural hematoma (n = 1), intracerebral hematoma (n = 1), and subarachnoid hemorrhage (n = 3). One patient had subdural hematoma, epidural hematoma, intracerebral hematoma and subarachnoid hemorrhage. There were 31 patients had abnormal findings by the NIRS but only 11 patients had bleeding detected by the CT brain. There were 16 patients had negative results on both the NIRS and the CT brain. The sensitivity and specificity of the NIRS compared with the CT brain was 100 % and 44.4 %, respectively. The area under the ROC curve of the NIRS was 0.722. The median time to complete the NIRS examination was 3 min. In conclusion, the NIRS has high sensitivity and negative predictive value for intracranial hematoma detection in mild TBI patients with extra-axial hematomas.

Are full-face helmets the most effective in preventing head and neck injury in motorcycle accidents? A meta-analysis.

Motorcycles are the most common type of vehicle involved in traffic deaths in developing countries. Although helmets can provide protection against injury, there is limited evidence available regarding which type of helmet best protects against head and neck injuries in this setting. This review was conducted based on articles in the PubMed, Scopus, and Web of Science databases. We compared full-face helmets with other types of helmet with regard to head and neck injury prevention in road accidents involving motorcyclists. Of 702 studies, six were eligible with a total of 6,529 participants. When compared with partial and open helmets, the odds ratio of full-face helmets was 0.356 (95% CI of 0.280, 0.453) and 0.636 (95% CI of 0.453, 0.894), respectively, for reduction of head and neck injuries. In conclusion, full-face helmets reduced head and neck injuries in motorcycle accidents to a greater extent than other types of helmet. Policy makers should recommend that motorcyclists use full-face helmets.

Adrenaline use as a poor predictor for the return of spontaneous circulation among victims of out-of-hospital cardiac arrest according to a national emergency medical services database.

OBJECTIVE: This study aimed to determine additional predictors of cardiopulmonary resuscitation success using a national emergency medical services (EMS) database. METHODS: This retrospective study was conducted by retrieving data from the Information Technology of Emergency Medical Service, a national EMS database. The inclusion criteria were adult patients (18 years old or over) who suffered from out-of-hospital cardiac arrest and received emergency life support. The outcome was a return of spontaneous circulation (ROSC). Predictors for ROSC were determined using multivariate logistic regression analysis. RESULTS: During the study period, 1070 patients met the study criteria, among whom 199 (18.60%) belonged to the ROSC group. Five factors were eligible for multivariate logistic regression analysis for predicting ROSC. Accordingly, only adrenaline administration was independently and negatively associated with ROSC with an adjusted odds ratio of 0.722 (95% confidence interval: 0.522, 0.997) and a Hosmer-Lemeshow Chi-square of 5.84 (P = 0.665). CONCLUSIONS: Adrenaline use may be a poor predictor for ROSC during out-of-hospital cardiac arrest.

Bag-Valve Mask versus Endotracheal Intubation in Out-of-Hospital Cardiac Arrest on Return of Spontaneous Circulation: A National Database Study.

BACKGROUND: Out-of-hospital cardiac arrest is the main issue for pre-hospital emergency care. There are several airway managements during the out-of-hospital cardiopulmonary resuscitation (CPR) such as endotracheal intubation (ETI) or alternative airway device: bag-valve mask (BVM). Data comparing both methods showed inconclusive results on survival and limited results on CPR outcome. This study aimed to add additional results on comparing the ETI and BVM in cardiac arrest outside hospitals; focused on the CPR outcome. METHODS: This study was a retrospective, analytical study. The inclusion criteria were adult patients (age of 18 years or over) with out-of-hospital cardiac arrest, who received emergency life support, and received either BVM or ETI. Data were retrieved from the Information Technology of Emergency Medical Service. The outcome was a return of spontaneous circulation (ROSC). RESULTS: During the study period, there were 1070 patients with out-of-hospital cardiac arrest who met the study criteria. Of those, 800 patients (74.77%) received BVM, while the other 270 patients (25.23%) received ETI. There were five significant factors between both groups including mean distance to scene, proportions of response time less than 8 mins, defibrillation, intravenous fluid administration, and adrenaline administration. There was no significant difference on the outcome: ROSC. The BVM group had slightly higher rate of ROSC than the ETI group (19.63% vs 15.56%; p value 0.148). CONCLUSION: The BVM and ETI had comparable ROSC rate for out-of-hospital cardiac arrest victims. However, the study population of the BVM group had less severe conditions and received faster treatment than the ETI group.

Prehospital prediction of severe injury in road traffic injuries: A multicenter cross-sectional study.

BACKGROUND: To develop and validate a risk stratification model of severe injury (SI) and death to identify and prioritize road traffic injury (RTI) patients for transportation to an appropriate trauma center (TC). METHODS: A 2-phase multicenter-cross-sectional study with prospective data collection was collaboratively conducted using 9 dispatch centers (DC) across Thailand. Among the 9 included DC, 7 and 2 DCs were used for development and validation, respectively. RTI patients who were treated and transported to hospitals by advanced life support (ALS) response units were enrolled. Multiple logistic regression was used to derive risk prediction score of death in 48 h and SI (new injury severity score ≥ 16). Calibration/discrimination performances were explored. RESULTS: A total of 5359 and 2097 RTIs were used for development and external validation, respectively. Seven and 9 predictors among demographic data, mechanism of injury, physic data, EMS operation, and prehospital managements were significant predictors of death and SI, respectively. Risk prediction models fitted well with the developed data (O/E ratios of 1.00 (IQR: 0.69, 1.01) and 0.99 (IQR: 0.95, 1.05) for death and SI, respectively); and the C statistics of 0.966 (0.961, 0.972) and 0.913 (0.905, 0.922). The risk scores were further stratified as low, moderate and high risk. The derive models did not fit well with external data but they were improved after recalibrating the intercepts. However, the model was externally good/excellent discriminated with C statistics from 0.896 (0.871, 0.922) to 0.981 (0.971, 0.991). CONCLUSION: Risk prediction models of death and SI were developed with good calibration and excellent discrimination. The model should be useful for ALS response units in proper allocation of patients.

Predicting Difficult Intubation in Emergency Department by Intubation Assessment Score.

BACKGROUND: The difficult intubation is associated with failure of emergency tracheal intubation. This study aimed to develop and validate a model for predicting difficult intubation in emergency department (ED). METHODS: A cross-sectional study was conducted in the ED. We collected data from all consecutive adult patients who underwent emergency tracheal intubation. Patients were excluded if they were intubated by low experience intubator. The difficult intubation was defined by grade III or IV of Cormack and Lehane classification. We used multivariable regression model to identify significant predictors of difficult intubation and weighted points proportional to the beta coefficient values. The ability to discriminate was quantified by using the area under receiver operating characteristics curve (AuROC). The bootstrapping method was used to validate the performance. RESULTS: A total of 1,212 intubations were analyzed. One hundred and fifty-seven intubations were enrolled in difficult intubation group. Five independence predictors were identified, and each was assigned a number of points proportional to its beta coefficient: male gender (one), large tongue (two), limit mouth opening (two), poor neck mobility (two), and presence of obstructed airway (three). Intubation assessment score model was created and applied to all subjects. The AuROC was 0.81 (95% confidence interval (CI): 0.77 - 0.85) for the development dataset, and 0.80 (95% CI: 0.76 - 0.85) for the validation dataset. We defined three risk groups: low risk (zero to one points), intermediate risk (two to three points), and high risk (above three points), and the difficult intubation rate was 4.7%, 22.5%, and 53.6%, respectively. CONCLUSIONS: Intubation assessment score model was constructed from patients' simple characteristics and performed well in predicting difficult intubation and can discriminate between with and without difficult intubation.

Clinical predictive score of intracranial hemorrhage in mild traumatic brain injury.

BACKGROUND: Mild traumatic brain injury (TBI) is a common condition at the Emergency Medicine Department. Head computer tomography (CT) scans in mild TBI patients must be properly justified in order to avoid unnecessary exposure to X-rays and to reduce the hospital/transfer costs. This study aimed to evaluate which clinical factors are associated with intracranial hemorrhage in Asian population and to develop a user-friendly predictive model. METHODS: The study was conducted retrospectively at the Emergency Medicine Department in Ramathibodi Hospital, a university-affiliated super tertiary care hospital in Bangkok, Thailand. The study period was between September 2013 and August 2016. The inclusion criteria were age >15 years and having received a head CT scan after presenting with mild TBI. Those patients with mild TBI and no symptoms/deterioration after 24 h of clinical observation were excluded. The predictive model and prediction score for intracranial hemorrhage was developed by multivariate logistic regression analysis. RESULTS: During the study period, there were 708 patients who met the study criteria. Of those, 100 patients (14.12%) had positive head CT scan results. There were seven independent factors that were predictive of intracranial hemorrhage. The clinical risk scores to predict intracranial hemorrhage are developed with an accuracy of 92%. The score of >3 had the likelihood of intracranial hemorrhage by 1.47 times. CONCLUSION: Clinical predictive score of >3 was associated with intracranial hemorrhage in mild TBI.

Is a mechanical-assist device better than manual chest compression? A randomized controlled trial.

BACKGROUND: Chest compression quality is a determinant of survival from sudden cardiac arrest. The CPR RsQ Assist Device (CPR RAD) is a new cardiopulmonary resuscitation device for chest compression. It is operated manually but it does not pull up on the chest on the up stroke. The aim of this study was to compare the CPR RAD with standard manual compression in terms of chest compression quality in a manikin model. METHODS: Participants were randomly assigned to either the device or manual chest compression group. Each participant performed a maximum of 4 minutes of hands-only compression with or without the device. During chest compression, the following quality parameters from the manikin were recorded: compression rate, compression depth, and correctness of hand position. RESULTS: Duration of chest compression was significantly higher in device users compared with manual compression (223.93±36.53 vs 179.67±50.81 seconds; P<0.001). The mean compression depth did not differ in a statistically significant way between manual compression and device at 2 minutes (56.42±6.42 vs 54.25±5.32; P=0.052). During the first and second minutes, compression rate was higher in cases of standard compression (133.21±15.95 vs 108±9.45; P<0.001 and 127.41±27.77 vs 108.5±9.93; P<0.001). There was no statistically significant difference in the percentage of participants who employed compression that was too shallow or exhibited incorrect hand position. CONCLUSION: The CPR RAD is more effective in chest compression compared with manual chest compression, as using the device led to better results in terms of fatigue reduction and correct compression rate than standard manual compression.

The RAMA Ped Card: Does it work for actual weight estimation in child patients at the emergency department.

BACKGROUND: In emergency conditions, the actual weight of infants and young children are essential for treatments. The RAMATHIBODI Pediatric Emergency Drug Card or RAMA Ped Card has also been developed to estimate actual weight of the subjects. This study aimed to validate the RAMA Ped Card in correctly identifying the actual weight of infants and young adults. METHODS: This study was a prospective study. We enrolled all consecutive patients under 15 years of age who visited the emergency department (ED). All eligible patients' actual weight and height were measured at the screening point of the ED. The weight of each patient was also measured using the unlabeled RAMA Ped Card. The Cohen's kappa values and agreement percentages were calculated. RESULTS: During the study period, there were 345 eligible patients. The RAMA Ped Card had a 61.16% agreement with the actual weight with a kappa of 0.54 (P<0.01), while the agreement with the actual height had a kappa of 0.90 and 91.59% agreement. Sub-group analysis found kappa scores with good range in two categories: in cases of accidents and in the infant group (kappa of 0.68 and 0.65, respectively). CONCLUSION: The RAMA Ped Card had a fair correlation with the actual weight in child patients presenting at the ED. Weight estimation in infant patients and children who presented with accidents were more accurate.

Is a mobile emergency severity index (ESI) triage better than the paper ESI?

This study aims to evaluate the mobile emergency severity index (ESI) tool in terms of validity compared with the original ESI triage. The original ESI and mobile ESI were used with patients at the Department of Emergency Medicine, Ramathibodi Hospital, Thailand. Eligible patients were evaluated by sixth-year medical students/emergency physicians using either the original or mobile ESI. The ESI results for each patient were compared with the standard ESI. Concordance and kappa statistics were calculated for pairs of the evaluators. There were 486 patients enrolled in the study; 235 patients (48.4%) were assessed using the mobile ESI, and 251 patients (51.6%) were in the original ESI group. The baseline characteristics of patients in both groups were mostly comparable except for the ED visit time. The percentages of concordance and kappa statistics in the original ESI group were lower than in the mobile group in all three comparisons (medical students vs gold standard, emergency physicians vs gold standard, and medical students vs emergency physicians). The highest kappa in the original ESI group is 0.69, comparing emergency physicians vs gold standard, while the lowest kappa in the application group is 0.84 comparing the medical students vs gold standard. Both medical students and emergency physicians are more confident with the mobile ESI application triage. In conclusion, the mobile ESI has better inter-rater reliability, and is more user-friendly than the original paper form.

Clinical Factors Predictive for Intracranial Hemorrhage in Mild Head Injury.

Patients with mild head injuries, a GCS of 13-15, are at risk for intracranial hemorrhage. Clinical decision is needed to weigh between risks of intracranial hemorrhage and costs of the CT scan of the brain particularly those who are equivocal. This study aimed to find predictors for intracranial hemorrhage in patients with mild head injuries with a moderate risk of intracranial hemorrhage. We defined moderate risk of mild head injury as a GCS score of 13-15 accompanied by at least one symptom such as headache, vomiting, or amnesia or with alcohol intoxication. There were 153 patients who met the study criteria. Eighteen of the patients (11.76%) had intracranial hemorrhage. There were four independent factors associated with intracranial hemorrhage: history of hypertension, headache, loss of consciousness, and baseline GCS. The sensitivity for the presence of intracranial hemorrhage was 100% with the cutoff point for the GCS of 13. In conclusion, the independent factors associated with intracranial hemorrhage in patients with mild head injury who were determined to be at moderate risk for the condition included history of hypertension, headache, loss of consciousness, and baseline GCS score.

The RAMA Ped Card: Does it work for actual weight estimation in child patients at the emergency department / 世界急诊医学杂志（英文）

BACKGROUND:In emergency conditions, the actual weight of infants and young children are essential for treatments. The RAMATHIBODI Pediatric Emergency Drug Card or RAMA Ped Card has also been developed to estimate actual weight of the subjects. This study aimed to validate the RAMA Ped Card in correctly identifying the actual weight of infants and young adults. METHODS:This study was a prospective study. We enrolled all consecutive patients under 15 years of age who visited the emergency department (ED). All eligible patients' actual weight and height were measured at the screening point of the ED. The weight of each patient was also measured using the unlabeled RAMA Ped Card. The Cohen's kappa values and agreement percentages were calculated. RESULTS:During the study period, there were 345 eligible patients. The RAMA Ped Card had a 61.16％ agreement with the actual weight with a kappa of 0.54 (P<0.01), while the agreement with the actual height had a kappa of 0.90 and 91.59％ agreement. Sub-group analysis found kappa scores with good range in two categories:in cases of accidents and in the infant group (kappa of 0.68 and 0.65, respectively). CONCLUSION:The RAMA Ped Card had a fair correlation with the actual weight in child patients presenting at the ED. Weight estimation in infant patients and children who presented with accidents were more accurate.