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Background: There is a lack of data regarding the incidence and associated factors of pneumothorax following thoracentesis conducted in emergency department (ED) settings. The present study aims to determine the incidence of pneumothorax following thoracentesis in ED settings and evaluate the association of specific demographics, clinical, and procedure factors with thoracentesis-related pneumothorax. Methods: We retrospectively reviewed the medical records of 3,067 thoracentesis cases in the ED of a tertiary care, university-affiliated hospital between January 2009 and December 2014. To evaluate the factors associated with the occurrence of pneumothorax following thoracentesis, matched controls were used with a case to control ratio of 1:5. Results: Of the 3,067 cases that received thoracentesis, 19 cases of pneumothorax were observed (0.62%). Patients with pneumothorax had significantly lower weight and body mass index (BMI) than those without pneumothorax (51.0 vs . 61.2 kg, 20.0 vs . 22.6; P Conclusions: The incidence of pneumothorax following thoracentesis was very low in the present study. However, clinicians should be aware of the risk of pneumothorax in underweight patients during thoracentesis. Further prospective studies are required to clarify the results of the present study.

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., Graphical Abstract

Background: To determine the prognostic value of the initial APACHE II score in the ED compared with the classic APACHE II score in the ICU and to check the usefulness of the MEDS score together for more rapid risk stratification of septic patients admitted to the ICU via the ED. Methods: We prospectively checked the ini tial APACHE II and MEDS scores of all the patients who had systemic inflammatory response syndrome in the ED and the classic APACHE II scores after admission to the ICU, as well 6 months later. We enrolled the only sepsis cases in the final diagnosis after reviewing the medical records. We evaluated the predictive abilities of the initial APACHE II and MEDS scores compared with the classic APACHE II score. Results: During 6 months, 58 patients diagnosed with sepsis were enrolled. Twenty-four (41.4%) patients died within 28 days of admission and 34 patients survived. The mortality group had a significantly higher mean classic APACHE II score (19 ± 6.7 vs. 15 ± 5.0, p ＜ 0.01) and a higher mean MEDS score (16.67 ± 2.70 vs. 8.91 ± 3.11, p ＜ 0.01) than the survivor group. The initial APACHE II score at the ED was not significantly different between the two groups. ROC analysis showed the discriminative power of the MEDS score in predicting mortality was much better than the APACHE II score (areas under the curves of the APACHE II score in the ED and ICU, and the MEDS scores were 0.668, 0.807, and 0.967, respectively; p ＜ 0.01). Conclusions: The initial APACHE II score in the ED did not predict mortality better than the classic APACHE II score. However, the MEDS score predicted the poor prognosis of septic patients more rapidly and accurately in the ED than the APACHE II model.