Novel Simulation Model That Realizes Arterial and Venous Blood Flow for Ultrasound-Guided Central Venous Catheter Insertion in Children.

OBJECTIVE: We developed and validated a realistic simulation model for ultrasound-guided central venous catheter insertion in children that is easy to build and inexpensive and can automatically reproduce arterial and venous blood flow. METHODS: The simulation model was constructed with a chicken breast, two DWP-385 water pumps, two types of tubes and a controller. An elastic rubber tourniquet and a silicone tube were connected to each water pump, which generated different continuous flows mimicking those of the pediatric internal carotid artery and internal jugular vein, respectively. Both tubes were inserted into a piece of chicken breast and connected to the controller. Then, we provided a simulation program of ultrasound-guided central venous catheter insertion using our novel model to resident emergency medicine physicians. We also collected data on their knowledge and confidence levels regarding the procedure before and after the simulation via questionnaires utilizing a 5-point Likert scale. RESULTS: The flow patterns of the artery and vein were well demonstrated with our model. A total of 11 resident physicians were enrolled. The knowledge and confidence regarding the discrimination of arteries and veins were significantly improved after training with our simulation model (p-value < 0.01). The subjective similarity and usefulness of our model also scored high on the questionnaire (median: 4; interquartile range in both categories: 4-5). CONCLUSION: Our novel simulation model is useful and realistic for ultrasound-guided central venous catheter insertion training. Clinical impact: This controlled motor system can be applied to many simulation models of artery and vein circulation.

Two-Thumb Encircling Technique With a Novel Compression Assist Device Provides Safe and Effective Chest Compressions in Infants.

OBJECTIVE: Currently, 2-thumb encircling technique is recommended in 2-rescuer infant cardiopulmonary resuscitation (CPR). However, many complications can occur during CPR. Therefore, we developed a novel compression assist device (Reheart) that can reduce chest compression area and determined whether using our device provides better compression quality. METHODS: A novel compression assist device consists of 2 parts. The upper part was designed to put 2 thumbs together in the thumb sleeves, and the lower part was designed based on a circular rubber plate with a 2.0-cm diameter to confine compression area. Infant manikin CPR simulations using the 2-thumb encircling technique with Reheart and without Reheart were sequentially performed by participants in randomized crossover fashion. RESULTS: A total of 32 health care providers were included. The average age of the participants was 30.2 ± 3.5 years, and 21 participants (65.6%) were male. The accuracy in the Reheart group was better than that in the conventional group (proportion of compression on target area, 52.5% ± 13.2% vs 35.4% ± 17.6%; P < 0.001). The difference in the rates of chest compressions between the 2 groups was not significant (119.6 ± 14.4 vs 120.7 ± 14.0 compressions/min, P = 0.59). The depth of chest compressions was also not significantly different between the 2 groups (34.5 mm [33.6-34.9 mm] vs 34.2 mm [33.0-34.9 mm], P = 0.32). CONCLUSIONS: Our new compression assist device can help provide safe and effective chest compressions during 2-rescuer infant CPR.

Factors Associated with Triage Modifications Using Vital Signs in Pediatric Triage: a Nationwide Cross-Sectional Study in Korea.

BACKGROUND: Previous studies on inter-rater reliability of pediatric triage systems have compared triage levels classified by two or more triage providers using the same information about individual patients. This overlooks the fact that the evaluator can decide whether or not to use the information provided. The authors therefore aimed to analyze the differences in the use of vital signs for triage modification in pediatric triage. METHODS: This was an observational cross-sectional study of national registry data collected in real time from all emergency medical services beyond the local emergency medical centers (EMCs) throughout Korea. Data from patients under the age of 15 who visited EMC nationwide from January 2016 to December 2016 were analyzed. Depending on whether triage modifications were made using respiratory rate or heart rate beyond the normal range by age during the pediatric triage process, they were divided into down-triage and non-down-triage groups. The proportions in the down-triage group were analyzed according to the triage provider's profession, mental status, arrival mode, presence of trauma, and the EMC class. RESULTS: During the study period, 1,385,579 patients' data were analyzed. Of these, 981,281 patients were eligible for triage modification. The differences in down-triage proportions according to the profession of the triage provider (resident, 50.5%; paramedics, 47.7%; specialist, 44.9%; nurses, 44.2%) was statistically significant (P < 0.001). The triage provider's professional down-triage proportion according to the medical condition of the patients showed statistically significant differences except for the unresponsive mental state (P = 0.502) and the case of air transport (P = 0.468). CONCLUSION: Down-triage proportion due to abnormal heart rates and respiratory rates was significantly different according to the triage provider's condition. The existing concept of inter-rater reliability of the pediatric triage system needs to be reconsidered.

Effect of endotracheal intubation and supraglottic airway device placement during cardiopulmonary resuscitation on carotid blood flow over resuscitation time: An experimental porcine cardiac arrest study.

BACKGROUND: Supraglottic airway devices (SGDs) are widely used during the resuscitation of out-of-hospital cardiac arrest (OHCA). The effect of SGDs on carotid blood flow (CBF) as resuscitation time passes is controversial. We assessed the effects of endotracheal intubation (ETI) and 3 types of SGD placement on CBF over time in prolonged resuscitation through an experimental porcine cardiac arrest study. METHODS: We conducted a randomized crossover study using 12 female pigs. After 4 min of untreated ventricular fibrillation, 3 pairs of ETI for 3 min and each type of SGD placement, including Combitube, I-gel, and laryngeal mask airway, for 3 min were conducted. The order of the 3 pairs of ETI and SGD were randomly assigned for each pig. We measured physiological parameters including CBF and mean arterial pressure (MAP). We compared CBF and MAP between the last 1 min of the insertion period for each of the 3 types of SGD and the preceding ETI period. Trends of CBF and MAP according to ETI and SGD transition were also plotted during the prolonged resuscitation duration. RESULTS: CBF decreased after inserting I-gel and Combitube compared to ETI (mean difference (95% CI): -685 ml (-1052 to -318) for Combitube, -369 ml (-623 to -114) for I-gel). MAP subsequently decreased after transitioning airway devices as resuscitation was prolonged, regardless of the device type. The mean CBF during the transition from ETI to SGD decreased by -480 ml (95% CI: -675 to -286), but the decrease in CBF during the transition from SGD to ETI was only -4 ml (95% CI: -182 to 175). CONCLUSION: SGD placement was associated with decreased carotid blood flow during cardiopulmonary resuscitation in an experimental porcine model. As time passed during prolonged resuscitation, reduction in CBF was aggravated after the transition to SGD placement compared to the reduction after the transition to ETI. This study was approved by the study institution IACUC 16-0140-S1A0.

Efficacy of low-dose nebulized epinephrine as treatment for croup: A randomized, placebo-controlled, double-blind trial.

OBJECTIVE: Croup treatment usually involves a single dose of systemic dexamethasone combined with nebulized epinephrine. However, the optimal dose of l-epinephrine remains unclear. We examined whether a low dose (0.1 mg/kg) was inferior to the conventional dose (0.5 mg/kg) of 1:1000 nebulized l-epinephrine in patients with moderate to severe croup. METHODS: This randomized double-blind clinical non-inferiority trial was conducted in three pediatric emergency departments from May 2015 to October 2017. Children 6 months to 5 years old with moderate to severe croup (Westley scale scores 3-11) were eligible. Subjects were randomly assigned to the conventional dose (0.5 mg/kg: maximum 5 mg) or low dose (0.1 mg/kg; maximum 1 mg) group. All subjects received 0.6 mg/kg dexamethasone. Croup scores and other vital signs were measured before and at 30, 60, 90, and 120 min after nebulized l-epinephrine administration. The primary outcome was the change in croup score after 30 min. RESULTS: The final analysis included 84 patients. The groups did not differ significantly in terms of demographic parameters. At 30 min after treatment with nebulized l-epinephrine, the croup scores in both groups were significantly reduced from the baseline values (p < 0.05) and did not differ between the two groups (p = 0.42). Neither blood pressure nor heart rate differed between the two groups. CONCLUSIONS: Low-dose 1:1000 l-epinephrine was not inferior in croup score reduction to the conventional dose in patients with moderate to severe croup. Clinical trial No: NCT01664507, KCT0002318.

Dog-bite injuries in Korea and risk factors for significant dog-bite injuries: A 6-year cross-sectional study.

INTRODUCTION: An accurate understanding of the current status of dog-bite injuries in Korea is essential for establishing preventive strategies. There have been no national reports about dog-bite injuries in Korea. This study investigated dog-bite injuries in Korea that were registered in the nationwide injury surveillance database and analysed the risk factors for significant dog-bite injury. METHODS: A multicentre cross-sectional study was conducted using the emergency department (ED)-based Injury In-depth Surveillance (EDIIS) registry in Korea between 2011 and 2016. We defined significant injury as death, admission, surgery, or fracture or amputation. A multivariable logistic regression model was used to obtain the adjusted odds ratios (aORs) for the factors associated with significant dog-bite injuries. RESULTS: Among 1,537,617 injured patients, 9,966 (6.5 per 1,000 injured patients) presented to the ED for dog-bite injuries (5.6 in 2011 to 7.6 in 2016, P for trend < 0.001), and 489 (4.9%) were significant injuries. In the age-specific analysis, there were increasing trends only among teenagers (12-18 years) and adults (> 18 years). Being elderly (≥ 60 years) (aOR: 2.70, 95% CI: 2.15-3.39), having injuries to multiple anatomic sites (aOR: 4.37, 95% CI: 2.96-6.45), being bitten outdoors (aOR: 2.71, 95% CI: 2.20-3.34), and being bitten by a relative's dog (aOR: 2.37, 95% CI: 1.09-5.17) were strongly associated with significant dog-bite injury. CONCLUSION: Dog-bite injuries are increasing in Korea, especially in teenagers and adults. A relative's or neighbour's dog may be more dangerous than a stranger's dog. Preventive strategies are needed to prevent dog-bite injuries in adults and children.

Educational Effectiveness of an Easily Made New Simulator Model for Ultrasound-Guided Vascular Access and Foreign Body Management Procedures on Pediatric Patients.

OBJECTIVES: This study aimed to introduce an easily made chicken breast simulator for ultrasound (US)-guided vascular access, foreign body (FB) detection, and hydrodissection in pediatric patients and to validate the effectiveness for training using this phantom tissue model. METHODS: The authors made the tissue phantom simulator using a chicken breast and rubber tourniquet for vascular access and fragments of a tongue blade and steel clip for FB detection and hydrodissection using a very simple method. We provided training on US-guided vascular access (following the tip [FTT] method), FB detection, and hydrodissection using this model for novice physicians to learn US-guided procedures for pediatric patients. In addition, we provided a questionnaire to solicit their thoughts on their knowledge and confidence to perform these procedures before and after training and to learn their thoughts on the similarity to actual patients and usefulness of this model on a 10-point Likert scale. RESULTS: A total of 16 emergency residents participated in this study. We obtained US images during vascular access (FTT) and FB detection/ hydrodissection procedures using this phantom tissue model. Residents' knowledge of and confidence to perform US-guided FTT method and FB detection/hydrodissection procedures after training increased to a statistically significant degree (P < 0.001 in all items). The median Likert scores regarding the similarity to actual patients and usefulness of this model were 8.5 (interquartile range, 7.5-9) and 10 (interquartile range, 8-10), respectively. CONCLUSIONS: The model for US-guided procedures used in this study can be constructed by simple and easy methods, presents realistic procedural images, and was useful for training novice physicians to conduct US-guided procedures on pediatric patients.

Epidemiology of playground equipment related/unrelated injuries to children: A registry-based cohort study from 6 emergency departments in Korea.

The aim of study was to understand the epidemiology of playground injury and to find the factors related to the clinically significant injuries. This retrospective observational study enrolled children (age 0-18 years old) who visited the emergency departments (ED) of 6 hospitals in Korea.We obtained and analyzed the data from the ED injury surveillance system, which was supported by the Korea Centers for Disease Control. Clinically significant injury (Cs injury) was defined as the injuries that caused hospital admission for more than one day. The factors associated with injury and clinical outcome were compared between admitted and discharged patient groups. Multivariable logistic regression and the population attributable fraction were used to identify significant factors for hospitalization.A total of 1458 patients were enrolled. The proportion of patients who visited ED due to injuries unrelated to the playground equipment use was 57.8%. The majority of Cs injury was upper extremity fractures (68.1%). The risk factors for admission were the 6- to 11-year old age group (OR 5.7, 95% CI 1.3-25.0) and public playground (OR 2.4, 95% CI 1.1-5.3); the population attributable factor of these factors was 51.3% and 36.0%, respectively.This study shows that approximately 60% of the patients visited ED due to injury unrelated to the playground equipment use. The risk factors of Cs injuries were ages 6 to 11 and public playgrounds. The results of the study can be helpful to formulate the prevention policy against playground injury.

Association of dispatcher-assisted bystander cardiopulmonary resuscitation with survival outcomes after pediatric out-of-hospital cardiac arrest by community property value.

OBJECTIVE: We aimed to demonstrate the association of bystander cardiopulmonary resuscitation (BCPR) with survival outcomes after pediatric out-of-hospital cardiac arrest (OHCA) by community property value groups. METHODS: This observational study enrolled all emergency medical services (EMS)-treated pediatric OHCAs in Korea between 2012 and 2015. Enrolled patients were divided into three groups: BCPR with dispatcher-assistance (DA), BCRP-without-DA, and no-BCPR. Patients were categorized based on tertiles for property tax per capita of community in which the cardiac arrest occurred. The endpoint was survival to discharge. To test the interactive effects between BCPR and community property value on study endpoints, a multilevel logistic regression model with an interaction term was used. RESULTS: A total of 2020 patients were enrolled (37.0% BCPR-with-DA, 14.5% BCPR-without-DA, and 48.5% no-BCPR). BCPR-with-DA and BCPR-without-DA were more likely to have higher rates of survival to discharge compared to no-BCPR (8.6% and 13.0% vs. 3.5%; AORs (95% CIs): 2.23 (1.33-3.74) and 2.87 (1.57-5.25)). By interaction analysis with community property tax per capita, the AORs for survival in BCPR-with-DA and BCPR-without-DA groups were 2.56 (1.03-6.38) and 3.48 (1.10-10.9) for high value communities, 2.25 (0.95-5.31) and 3.76 (1.53-9.23) in middle communities, and 1.88 (0.88-3.99) and 1.54 (0.57-4.17) in low value communities (interaction, p = 0.68). CONCLUSION: In pediatric OHCAs, BCRP was associated with improved survival outcomes. The survival benefits of BCPR did not differ significantly by community property value.

Effects of dispatcher-assisted bystander cardiopulmonary resuscitation on neurological recovery in paediatric patients with out-of-hospital cardiac arrest based on the pre-hospital emergency medical service response time interval.

OBJECTIVES: We investigated the effect of bystander cardiopulmonary resuscitation (BCPR) with dispatcher assistance (DA) on neurological outcomes based on the response time interval (RTI) of the pre-hospital emergency medical service (EMS) among paediatric patients with out-of-hospital cardiac arrest (OHCA). METHODS: This retrospective registry study was conducted on paediatric patients (<19 years old) with OHCA who were assessed by EMS providers between 2012 and 2016. The primary outcome was good neurological recovery based on BCPR with or without DA and the EMS RTI. Differential effects of BCPR with DA based on the EMS RTI were analysed by multivariable logistic regression analysis with interaction terms. RESULTS: Adjusted odds ratios (AORs) and corresponding 95% confidence intervals (95% CIs) for good neurological recovery were 2.22 (1.27-3.88) for BCPR with DA and 1.51 (0.77-2.97) for BCPR without DA compared to no BCPR. The faster EMS RTI group (<5 min) had better neurological recovery than the later EMS RTI group (≥5 min) (AOR: 1.87 [1.04-3.29]). The AORs for good neurological recovery following BCPR with DA based on the EMS RTI were 2.52 (0.91-6.97) in the faster EMS RTI group and 2.17 (1.13-4.19) in the later EMS RTI group compared to the no BCPR group. CONCLUSION: BCPR with DA and a faster EMS RTI were significantly associated with good neurological recovery in paediatric patients with OHCA. When the EMS RTI was delayed, the association of BCPR with DA with good neurological recovery was preserved in paediatric patients with OHCA.

Long-term changes in computed tomography and ultrasound utilization in a pediatric emergency department.

OBJECTIVE: Many studies have proposed reducing unnecessary use of computed tomography (CT), and ongoing studies in pediatric populations are aiming to decrease radiation dosages whenever possible. We aimed to evaluate the long-term changes in the utilization patterns of CT and ultrasound (US) in pediatric emergency departments (PEDs). METHODS: This retrospective study reviewed the electronic medical data of patients who underwent CT and/or US in the PED of a tertiary referral hospital from 2000 to 2014. We compared the changes in utilization patterns of brain and abdominal CT scans in pediatric patients and analyzed changes in abdominal US utilization in the PED. RESULTS: During the study period, 196,371 patients visited the PED. A total of 12,996 brain and abdominal CT scans and 12,424 abdominal US were performed in the PED. Comparison of CT use in pediatric patients before and after 2007 showed statistically decreasing trends after 2007, expressed as the coefficient values of the differences in groups. The numbers of brain and abdominal CT scans showed a significant decreasing trend in children, except for abdominal CT in adolescents. The abdominal US/CT ratio in the PED showed a statistically significant increase (2.68; 95% confidence interval, 1.87 to 3.49) except for the adolescent group (5.82; 95% confidence interval, -2.06 to 13.69). CONCLUSION: Overall, CT use in pediatric patients has decreased since 2007. Pediatric US use has also shown a decreasing trend; however, the abdominal US/CT ratio in pediatric patients showed an increasing trend, except for adolescents.

Validation of the "Pain Block" concrete ordinal scale for children aged 4 to 7 years.

Pain scales using faces are commonly used tools for assessing pain in children capable of communicating. However, some children require other types of pain scales because they have difficulties in understanding faces pain scales. The goal of this study was to develop and validate the "Pain Block" concrete ordinal scale for 4- to 7-year-old children. This was a multicenter prospective observational study in the emergency department. Psychometric properties (convergent validity, discriminative validity, responsivity, and reliability) were compared between the "Pain Block" pain scale and the Faces Pain Scale-Revised (FPS-R) to assess the validity of the "Pain Block" scale. A total of 163 children (mean age, 5.5 years) were included in this study. The correlation coefficient between the FPS-R and the Pain Block scale was 0.82 for all participants which increased with age. Agreement between the 2 pain scales was acceptable, with 95.0% of the values within the predetermined limit. The differences in mean scores between the painful group and nonpainful group were 3.3 (95% confidence interval, 2.6-4.1) and 3.8 (95% confidence interval, 3.1-4.6) for FPR-S and Pain Block, respectively. The pain scores for both pain scales were significantly decreased when analgesics or pain-relieving procedures were administered (difference in Pain Block, 2.4 [1.4-3.3]; and difference in FPS-R, 2.3 [1.3-3.3]). The Pain Block pain scale could be used to assess pain in 4- to 7-year-old children capable of understanding and counting up to the number 5, even if they do not understand the FPS-R pain scale.

Protective effect of hemopexin on systemic inflammation and acute lung injury in an endotoxemia model.

BACKGROUND: Hemopexin (HPX) has been identified as an anti-inflammatory agent, but its role in endotoxemia is unclear. The purpose of this study was to determine whether HPX suppresses systemic and lung inflammation in a mouse model of endotoxemia. MATERIALS AND METHODS: At 30 min of intraperitoneal administration of lipopolysaccharide (LPS; 10 mg/kg), either distilled water (LPS-only treated animals) or HPX (5 mg/kg) was injected into mice via the tail vein, and the survival rates were analyzed after 36 h. Furthermore, the serum levels of tumor necrosis factor-α, interleukin-6 (IL-6), and HPX were determined at 0, 3, and 6 h, and the expression levels and DNA binding activities of phosphorylated cytoplasmic inhibitor κB-α, nuclear factor-κB (NF-κB), and the p65 subunit of NF-κB were evaluated and compared with the rates of histologic lung injury after 6 h. RESULTS: Serum tumor necrosis factor-α and interleukin-6 levels were decreased in HPX-treated animals at 3 and 6 h (P < 0.05). HPX suppressed the NF-κB pathway (P < 0.05) and reduced acute lung injury at 6 h, and 36 h after initial treatment, the survival rate was higher in HPX-treated animals than that in LPS-treated animals (P < 0.05). CONCLUSIONS: HPX downregulated proinflammatory cytokine production and acute lung injury as well as improved survival rates in a mouse model of endotoxemia. These effects were associated with HPX-mediated suppression of the NF-κB pathway.

Characteristics of bystander cardiopulmonary resuscitation for paediatric out-of-hospital cardiac arrests: A national observational study from 2012 to 2014.

OBJECTIVES: This study evaluated the associations between the provision of bystander cardiopulmonary resuscitation (BCPR) and both the relationship of bystanders with paediatric out-of-hospital cardiac arrest (OHCA) victims and the community educational level. METHODS: This observational study was conducted using the Korean national OHCA registry of paediatric OHCAs (<19years old) between 2012 and 2014. The main factor was the relationship between the bystander and the OHCA victim. The primary endpoint was the provision of BCPR. The association between BCPR provision and community educational level was also examined. Multivariable logistic regression and interaction analyses were performed to determine whether community educational level affected BCPR provision. RESULTS: Among the 1477 enrolled patients, 725 (49.1%) received BCPR. Family members provided BCPR in 458 (57.4%) cases. The adjusted odds ratios and corresponding 95% confidence intervals (AORs, 95% CIs) for the provision of BCPR by family members or first responders compared with strangers were 1.75 (1.31-2.34) and 8.90 (5.00-15.84). The AORs for BCPR provision in communities with the middle and lowest educational levels compared with the highest were 0.70 (0.53-0.92) and 1.11 (0.79-1.55). The interaction analysis showed that the AORs of family members or first responders providing BCPR compared with strangers were 1.32 (0.79-2.19) and 5.90 (1.98-17.63), 1.98 (1.31-2.98) and 10.88 (4.20-28.16), and 1.87 (1.18-2.96) and 9.89 (3.88-25.21) in communities with the lowest, middle and highest educational levels, respectively. CONCLUSION: In paediatric OHCA cases, family members were more likely than strangers to perform BCPR except in communities with the lowest educational level.

An assessment of the accuracy of a novel weight estimation device for children.

BACKGROUND: We sought to validate the accuracy and assess the efficacy of a newly developed electronic weight estimation device (ie, the rolling tape) for paediatric weight estimation. METHODS: We enrolled a convenience sample of children aged <17 years presenting to our emergency department who volunteered to participate in the study. The children's heights and weights were measured, and three researchers estimated these values using the rolling tape and Broselow tape at 5 min intervals. The weight estimates of researcher 1, researcher 2 and the Broselow tape were compared with measured values, and mean percentage error (MPE), root mean square error (RMSE) and percentage of estimates within 10% of the actual measured values were calculated. For 30 randomly selected subjects, we compared the time interval from the start of the measurement to the time that orders for epinephrine, defibrillation dose and instrument size could be given in a simulated arrest scenario. RESULTS: We enrolled 906 children (median age 4.0 years). For researcher 1, researcher 2 and the Broselow tape, MPE values were 0.11% (RMSE 2.61 kg), 1.41% (RMSE, 2.61 kg) and 1.72% (RMSE 5.41 kg), respectively, and the percentages of children with predictions within 10% of their actual weight were 75.1%, 75.7% and 60.6%, respectively. In the 30 simulated cases, the mean time for measurement to ordering was significantly shorter (25.8 s vs 35.5 s, p<0.001) for the rolling tape compared with the Broselow tape method. CONCLUSIONS: The rolling tape is a good weight estimation tool for children compared with other methods. The rolling tape method significantly decreased the time from weight estimation to orders for essential drug dose, instrument size and defibrillation dose for resuscitation.

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

The 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 4 days or less (hyper-acute phase of Kawasaki disease). Medical records of patients who were 1 month to 15 years 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 4 days 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) pg/mL; p < 0.001), and a cutoff value of 244.7 pg/mL yielded a sensitivity and specificity of 68.6 and 70.3 %, respectively. The area under the curve of the NT-proBNP for predicting Kawasaki disease was 0.763 (95 % CI 0.712-0.814). 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 5 days 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.

12th WINFOCUS world congress on ultrasound in emergency and critical care.

TABLE OF CONTENTS: A1 Point-of-care ultrasound examination of cervical spine in emergency departmentYahya Acar, Onur Tezel, Necati SalmanA2 A new technique in verifying the placement of a nasogastric tube: obtaining the longitudinal view of nasogastric tube in addition to transverse view with ultrasoundYahya Acar, Necati Salman, Onur Tezel, Erdem CevikA3 Pseudoaneurysm of the femoral artery after cannulation of a central venous line. Should we always use ultrasound in these procedures?Margarita Algaba-Montes, Alberto Oviedo-García, Mayra Patricio-BordomásA4 Ultrasound-guided supraclavicular subclavian vein catheterization. A novel approach in emergency departmentMargarita Algaba-Montes, Alberto Oviedo-García, Mayra Patricio-BordomásA5 Clinical ultrasound in a septic and jaundice patient in the emergency departmentMargarita Algaba-Montes, Alberto Oviedo-García, Mayra Patricio-BordomásA6 Characterization of the eyes in preoperative cataract Saudi patients by using medical diagnostic ultrasoundMustafa Z. Mahmoud, Abdelmoneim SuliemanA7 High-frequency ultrasound in determining the causes of acute shoulder joint painMustafa Z. MahmoudA8 Teaching WINFOCUS Ultrasound Life Support Basic Level 1 for Providers in resource-limited countriesAbbas Ali, Alrayah Mustafa, Ihab Abdelrahman, Mustafa Bahar, Osama Ali, H. Lester Kirchner, Gregor ProsenA9 Changes of arterial stiffness and endothelial function during uncomplicated pregnancyAjda Anzic, Paul LeesonA10 Cardiovascular haemodynamic properties before, during and after pregnancyAjda Anzic, Paul LeesonA11 An old man with generalized weaknessMaryam Bahreini, Fatemeh RasooliA12 Ultrasonography for non-specific presentations of abdominal painMaryam Bahreini, Houman HosseinnejadA13 Introduction of a new imaging guideline for suspected renal colic in the emergency department: effect on CT Urogram utilisationGabriel Blecher, Robert Meek, Diana Egerton-WarburtonA14 Transabdominal ultrasound screening for pancreatic cancer in Croatian military veterans: a retrospective analysis from the first Croatian veteran's hospitalEdina Catic Cuti, Stanko Belina, Tihomir Vancina, Idriz KovacevicA15 The challenge of AAA: unusual case of obstructive jaundiceEdina Catic Cuti, Nadan RustemovicA16 Educational effectiveness of easy-made new simulator model for ultrasound-guided procedures in pediatric patients: vascular access and foreign body managementIkwan Chang, Jin Hee Lee, Young Ho Kwak, Do Kyun KimA17 Detection of uterine rupture by point-of-care ultrasound at emergency department: a case reportChi-Yung Cheng, Hsiu-Yung Pan, Chia-Te KungA18 Abdominal probe in the hands of interns as a relevant diagnostic tool in revealing the cause of heart failureEla Curcic, Ena Pritisanac, Ivo Planinc, Marijana Grgic Medic, Radovan RadonicA19 Needs assessment of the potential utility of point-of-care ultrasound within the Zanzibar health systemAbiola Fasina, Anthony J. Dean, Nova L. Panebianco, Patricia S. HenwoodA20 Ultrasonographic diagnosis of tracheal compressionOliviero Fochi, Moreno Favarato, Ezio BonanomiA21 The role of ultrasound in the detection of lung infiltrates in critically ill patients: a pilot studyMarijana Grgic Medic, Ivan Tomic, Radovan RadonicA22 The SAFER Lasso; a novel approach using point-of-care ultrasound to evaluate patients with abdominal complaints in the emergency departmentYoungrock Ha, Hongchuen TohA23 Awareness and use of clinician-performed ultrasound among clinical clerkship facultyElizabeth Harmon, Wilma Chan, Cameron Baston, Gail Morrison, Frances Shofer, Nova Panebianco, Anthony J. DeanA24 Clinical outcomes in the use of lung ultrasound for the diagnosis of pediatric pneumoniasAngela Hua, Sharon Kim, James TsungA25 Effectiveness of ultrasound in hypotensive patientsIsa Gunaydin, Zeynep Kekec, Mehmet Oguzhan AyA26 Moderate-to-severe left ventricular ejection fraction related to short-term mortality of patients with post-cardiac arrest syndrome after out-of-hospital cardiac arrestJinjoo Kim, Jinhyun Kim, Gyoosung Choi, Dowon ShimA27 Usefulness of abdominal ultrasound for acute pyelonephritis diagnosis after kidney transplantationJi-Han LeeA28 Lung ultrasound for assessing fluid tolerance in severe preeclampsiaJana Ambrozic, Katja Prokselj, Miha LucovnikA29 Optic nerve sheath ultrasound in severe preeclampsiaGabrijela Brzan Simenc, Jana Ambrozic, Miha LucovnikA30 Focused echocardiography monitoring in the postoperative period for non-cardiac patientsAsta Maciuliene, Almantas Maleckas, Algimantas Krisciukaitis, Vytautas Maciulis, Andrius MacasA31 POCUS-guided paediatric upper limb fracture reduction: algorithm, tricks, and tipsSharad MohiteA32 Point-of-care lung ultrasound: a good diagnostic tool for pneumonia in a septic patientZoltan Narancsik, Hugon MozinaA33 A case of undergraduate POCUS (r)evolutionSara Nikolic, Jan Hansel, Rok Petrovcic, Una Mrsic, Gregor ProsenA34 The Graz Summer School for ultrasound: from first contact to bedside application: three-and-a-half-day undergraduate ultrasound training: résumé after two years of continuous developmentSimon Orlob, Markus Lerchbaumer, Niklas Schönegger, Reinhard KaufmannA35 Usefulness of point-of-care ultrasound in the emergency room in a patient with acute abdominal painAlberto Oviedo-García, Margarita Algaba-Montes, Mayra Patricio-BordomásA36 Use of bedside ultrasound in a critically ill patient. A case reportAlberto Oviedo-García, Margarita Algaba-Montes, Mayra Patricio-BordomásA37 Diagnostic yield of clinical echocardiography for the emergency physicianAlberto Oviedo-García, Margarita Algaba-Montes, Mayra Patricio-BordomásA38 Focused cardiac ultrasound in early diagnosis of type A aortic dissection with atypical presentationChun-I Pan, Hsiu-Yung Pan, Chien-Hung WuA39 Detection of imperforated hymen by point-of-care ultrasoundHsiu-yung Pan, Chia-Te KungA40 Developing a point-of-care ultrasound curriculum for pediatric nurse practitioners practicing in the pediatric emergency departmentSarah Pasquale, Stephanie J. Doniger, Sharon Yellin, Gerardo ChiricoloA41 Use of transthoracic echocardiography in emergency setting: patient with mitral valve abscessMaja Potisek, Borut Drnovsek, Bostjan LeskovarA42 A young man with syncopeFatemeh Rasooli, Maryam BahreiniA43 Work-related repetitive use injuries in ultrasound fellowsKristine Robinson, Clara Kraft, Benjamin Moser, Stephen Davis, Shelley Layman, Yusef Sayeed, Joseph MinardiA44 Lung ultrasonography in the evaluation of pneumonia in childrenIrmina Sefic Pasic, Amra Dzananovic, Anes Pasic, Sandra Vegar ZubovicA45 Central venous catheter placement with the ultrasound aid: two years' experience of the Interventional unit, Division of Intensive Care Medicine, KBC ZagrebAna Godan Hauptman, Marijana Grgic Medic, Ivan Tomic, Ana Vujaklija Brajkovic, Jaksa Babel, Marina Peklic, Radovan RadonicA46 Duplicitas casui: two patients admitted due to acute liver failureVedran Radonic, Ivan Tomic, Luka Bielen, Marijana Grgic MedicA47 A pilot survey on an understanding of Bedside Point-of-Care Ultrasound (POCUS) among medical doctors in internal medicine: exposure, perceptions, interest, and barriers to trainingPeh Wee MingA48 Unusual case of defecation syncopeNur hafiza Yezid, Fatahul Laham MohammedA49 A case report of massive pulmonary embolism; a multidisciplinary approachZainal Abidin Huda, Wan Nasarudin Wan Ismail, W.Yus Haniff W.Isa, Hashairi Fauzi, Praveena Seeva, Mohd Zulfakar Mazlan.

Therapeutic hypothermia and outcomes in paediatric out-of-hospital cardiac arrest: A nationwide observational study.

OBJECTIVES: This study aimed to analyse the association between mild therapeutic hypothermia (MTH) and outcomes in paediatric patients who survived out-of-hospital cardiac arrest (OHCA) by using their initial electrocardiogram (ECG) rhythm, which is the key factor used to predict prognosis in paediatric OHCA. METHODS: This cross-sectional observational study utilised the registry of paediatric OHCA patients who survived to admission from 2008 to 2014 in the national OHCA database. MTH was defined as all cooling methods applied after the return of spontaneous circulation. Primary and secondary outcomes were survival to discharge and good neurologic recovery, respectively. Multivariable logistic regression analysis with an interaction term between MTH and the initial ECG at the scene was conducted to calculate adjusted odds ratios (AORs) and 95% confidence intervals (CIs) after adjusting for potential confounders. RESULTS: Among the 663 enrolled patients, the rates of survival to discharge and good neurological recovery in the MTH and non-MTH groups were similar, at 48.1% vs. 40.2% (P=0.17, AOR 1.05 [0.59-1.88]) and 22.2% vs. 8.7% (P=0.45, AOR 1.22 [0.59-2.51]). In the interaction model, the AORs of MTH in shockable rhythm vs. non-shockable rhythm for survival to discharge (AOR 0.62 [0.15-2.52] vs. 1.17 [0.62-2.2]) and good neurological recovery (0.42 [0.12-1.45] vs. 2.22 [0.83-5.98]) were not significantly different. CONCLUSION: MTH and the effect of MTH across the initial ECG at the scene were not significantly associated with survival or good neurologic recovery in paediatric OHCA survivors.

Smartphone-Based Urine Reagent Strip Test in the Emergency Department.

BACKGROUND: Although a smartphone could be used for a urine reagent strip test, few studies have reported on the reliability of the test in a clinical setting. The objective of our study was to access the smartphone-based urine reagent strip test in the clinical emergency department (ED). MATERIALS AND METHODS: We developed a smartphone-based urine reagent strip reader for a rapid and accurate screening of leukocyte esterase (LE) and nitrite (NIT) in urine. The developed reader was evaluated with the clinical urine samples (n = 81). The detection performance of the reader for LE and NIT was evaluated to assess reliability of the reader; turnaround times (TATs) for analysis and the time for the entire study procedure were also calculated to assess the efficiency of the reader. A photometric analyzer (model US-3100R Plus(®); Eiken Chemical, Ltd., Tokyo, Japan) was used as a reference. RESULTS: The proposed reader showed high accuracy (85.2% for LE and 97.5% for NIT), exhibiting close agreement with the true values (κ = 0.903 for LE; κ = 1.000 for NIT). The reader also exhibited a lower median TAT for analysis than the photometric analyzer (3.0 min versus 33.0 min; p < 0.001). This reduction of TAT in the reader was even more evident considering the required time for delivery of urine samples for the photometric analyzer (3.0 min versus 62.0 min; p < 0.001). CONCLUSIONS: Our results demonstrated the clinical capability of a smartphone-based urine reagent strip test, and this reader is expected to enable a more rapid and reliable colorimetric test for screening of LE and NIT at the clinical setting and the point of care.