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Necrotizing Enterocolitis - A Survey by the Korean Association of Pediatric Surgeons - (괴사성 장염 - 대한소아외과학회회원 대상 전국조사 -)

  • Lee, Suk-Koo;Kim, D.Y.;Kim, S.G.;Kim, W.K.;Kim, I.K.;Kim, S.Y.;Kim, S.C.;Kim, J.E.;Kim, J.C.;Park, K.W.;Park, W.H.;Seo, J.M.;Song, Y.T.;Oh, S.M.;Oh, J.T.;Lee, N.H.;Lee, D.S.;Lee, S.C.;Jun, Y.S.;Chung, S.Y.;Chung, S.E.;Choi, K.J.;Choi, S.O.;Choi, S.H.;Han, S.J.
    • Advances in pediatric surgery
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    • v.12 no.1
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    • pp.70-85
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    • 2006
  • A nationwide survey on necrotizing enterocolitis (NEC) was undertaken among members of the Korean Association of Pediatric Surgeons. The members were required to complete a questionnaire and the case registration form for each patient during the three-year period from July 2001 to June 2004. Eighty one patients were included in the questionnaire, but only 71 patients were registered from 22 members in 16 hospitals. At the same time survey on focal intestinal perforation (FIP) was undertaken and 17 patients were registered from 11 members in 10 hospitals. Total 19,041 newborns were admitted to neonatal intensive care unit during the study period. Eighty one patients (17.27 %) were underwent surgery among 469 babies who were managed under the impression of NEC. The male to female ratio was 2.1:1. The premature were 60.6 %. The most common site of involvement was ileum. Overall and operation survival of NEC were 72 % and 79 %, respectively. The survival was lower in smaller babies, multiple segments involvement and involvement of both the small and large intestine. But there was no difference in survival according to sex or prematurity. The FIP showed very similarity with NEC in terms of incidence, and the age of diagnosis and operation. But the survival was much better and 100 %. The results showed the clinical characteristics of NEC and the trend of management in NEC in Korea. In the future we hope we can discuss about this topic in prospective manner.

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A Study on the Knowledge Related to Children's Pain of pediatric Nurses According to their Career (아동병동 간호사의 경력에 따른 아동 통증지식에 대한 연구)

  • Choi, Seon-Il;Choe, Myoung-Ae
    • Journal of Korean Biological Nursing Science
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    • v.7 no.1
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    • pp.69-87
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    • 2005
  • Purpose : The purpose of this study was to identify pediatric nurses's knowledge related to children's pain and pediatric nurses' career including educational experience and to examine whether there is a difference of their knowledge according to their career. Method : Subjects of this study was 115 pediatric nurses of one university hospital who understood purpose of this study and accepted to participate in this study. Subjects responded questionnaire by self report. The data were gathered for 7 days during the period from October 20 to October '2:7, 2003. The pediatric nurses' knowledge and attitude survey regarding pain developed by Manworren(2001) was used to identify the knowledge related to children's pain of pediatric nurses. Nurses' career consisted of level of education, presently working ward, duration of experience at clinic, pediatric clinic and presently working ward and educational experience related to children's pain during undergraduate courses, ward orientation and continuing education. Educational experience regarding children's pain was measured by whether they had education related to children's pain during undergraduate courses, ward orientation and continuing education or not and their perception on the contents of education was measured by 5 point Likert type scale. SPSS Windows was used to analyze the data. Scores of the knowledge regarding children's pain and career including educational experience of pediatric nurses were presented as mean and standard deviation. Mean percentage of correct answers responded by the subjects was presented under the category of introduction, assessment, pharmacological and nonpharmacological intervention for children's pain. The difference of scores of the knowledge regarding children's pain according to nurses' career was analyzed using t-test, ANOVA and Tukey as a post hoc. Statistical significance was accepted at the level of p<.05. Result : Pediatric nurses had deficient knowledge related to children's pain on the whole and did not trust pain complaint and underestimated the pain. They were short of concrete practical knowledge about pain assessment and pharmacological and nonpharmacological intervention for children's pain. They were excessively concerned with side effect and addiction of analgesic drugs and had a negative view point on nonpharmacological pain intervention. About 50% of the subjects received education regarding children's pain while their undergraduate courses. The number of nurses who received education regarding children's pain while their undergraduate courses was found to be greater among the recently graduated nurses. In ward orientation and continuing education, only less than 10% of the nurses received education regarding children's pain. Nurses perceived their experienced educational content deficient; experienced educational content consisted of pain introduction, assessment and pharmacological and nonpharmacological intervention for children's pain while their undergraduate course, ward orientation and continuing education. There were no significant differences of the knowledge regarding children's pain of pediatric nurses according to level of education, duration of experience at clinic, pediatric clinic and presently working ward. Scores of the knowledge regarding children's pain of nurses at neonatal ward were significantly greater than those of nurses at pediatric intensive care unit. Scores of the knowledge regarding children's pain of pediatric nurses who received education during their undergraduate course were significantly greater than those who did not receive it during their undergraduate courses. Also scores of the knowledge regarding children's pain of pediatric nurses who received one kind of educational experience were significantly greater than those who had no educational experience. Conclusion : Pediatric nurses had deficient knowledge of children's pain and underestimated the pain of children. Also they were short of concrete practical knowledge on pain assessment and intervention for children's pain.

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Frequency of Platelet Transfusions and Outcome in Neonates with Thrombocytopenia (혈소판 감소증이 있는 신생아에서 혈소판 수혈 횟수와 예후)

  • Lim, Suk-Hwan;Kook, Jin-Hwa;Cho, Chang-Yee;Choi, Young-Youn;Hwang, Tai-Ju
    • Clinical and Experimental Pediatrics
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    • v.45 no.8
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    • pp.961-966
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    • 2002
  • Purpose : We compared the underlying or associated diseases according to the frequency of platelet transfusions in neonates with thrombocytopenia to know the factors predicting which patients will require multiple platelet transfusions. We also compared mortality. Methods : A retrospective study was performed in 72 neonates who received the platelet transfusions in neonatal intensive care unit(NICU) between August 1996 and July 2001. Group I received one platelet transfusion and group II received two or more. We compared the frequency of underlying or assodiated diseases such as sepsis/disseminated intravascular coagulopathy(DIC), respiratory distress syndrome(RDS), intraventricular hemorrhage(IVH), patent ductus arteriosus (PDA), necrotizing enterocolitis(NEC), liver or renal disease, and mortality between two groups. Results : Of the 72 patients, 29(40.2%) received one and 43(59.7%) received two or more transfusions; 16(22.2%) received four or more. There were no statistically significant differences in gestational age, birth weight, sex, and maternal history between two groups. C-section rate was higher in group II(20.7% vs. 55.8%, P<0.05) and the incidence of PDA was higher in group I (55.2% vs. 30.2%, P<0.05). Otherwise, there were no statistically significant differences in the incidence of sepsis/DIC, RDS, IVH, RDS, CLD, NEC, liver or renal disease, pulmonary hemorrhage and hypoxic ischemic encephalopathy, and mortality between group I and group II. Conclusion : There was no significant difference in clinical morbidity and mortality according to the frequency of platelet transfusion in neonates with thrombocytopenia. Further study is needed to know the predicting factor for multiple platelet transfusions in neonates with thrombocytopenia.

Antithrombin-III as an early prognostic factor in children with acute lung injury (급성 폐손상 소아 환자에서 조기 예후 인자로서의 antithrombin-III)

  • Lee, Young Seung;Kim, Seonguk;Kang, Eun Kyeong;Park, June Dong
    • Clinical and Experimental Pediatrics
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    • v.50 no.5
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    • pp.443-448
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    • 2007
  • Purpose : To evaluate the potential prognostic value of the antithrombin-III (AT-III) level in the children with acute lung injury (ALI), we analyzed several early predictive factors of death including AT-III level at the onset of ALI and compared the relative risk of them for mortality. Methods : Over a 18-month period, a total of 198 children were admitted to our pediatric intensive care unit and 21 mechanically ventilated patients met ALI criteria, as defined by American-European consensus conference, i.e., bilateral pulmonary infiltrates and $PaO_2/FiO_2$ lower than 300 without left atrial hypertension. Demographic variables, hemodynamic and respiratory parameters, underlying diseases, as well as Pediatric Risk of Mortality-III (PRISM-III) scores and Lung Injury Score (LIS) at admission were collected. AT-III levels were measured within 3 hours after admission. These variables were compared between survivors and non-survivors and entered into a multiple logistic regression analysis to evaluate their independent prognostic roles. Results : The overall mortality rate was 38.1% (8/21). Non-survivors showed lower age, lower lung compliance, higher PEEP, higher oxygenation index (OI), lower arterial pH, lower $PaO_2/FiO_2$, higher PRISM-III score and LIS, and lower AT-III level. PRISM-III score, LIS, OI and decreased AT-III level (less than 70%) were independently associated with a risk of death and the odds ratio of decreased AT-III level for mortality is 2.75 (95% confidence interval; 1.28-4.12) Conclusion : These results suggest that the decreased level of AT-III is an important prognostic factor in children with ALI and the replacement of AT-III may be considered as an early therapeutic trial.

Comparison of the Clinical Performance between Two Pulse Oximeters in NICU: Nellcor $N-595^{(R)}$ versus Masimo $SET^{(R)}$ (신생아 중환자실에서 맥박산소측정기의 감지도 비교: Nellcor $N-595^{(R)}$ versus Masimo $SET^{(R)}$)

  • Lee, Heun-Ji;Choi, Jang-Hwan;Min, Sung-Ju;Kim, Do-Hyun;Kim, Hee-Sup
    • Neonatal Medicine
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    • v.17 no.2
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    • pp.245-249
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    • 2010
  • Purpose: Numerous false alarms by pulse oximetry, which is widely used in neonatal intensive care unit, can delay response to true alarms. Masimo $SET^{(R)}$ was introduced lately, to overcome false alarms by motion. We compared the clinical performance of two devices (Nellcor $N-595^{(R)}$ and Masimo $SET^{(R)}$) for the evaluation of the false alarm frequency during usual motion artifacts and stable state. Methods: A total of 20 preterm infants weighing 1,000-2,500 g were enrolled in the study. The sensors of two devices were placed on the different feet on the same infants, and both devices were programmed to emit an alarm for episode of hypoxemia (SpO2$\leq$85%). The false alarms were defined as episodes of poor correlation with ECG heart rate, poor waveforms, and the absence of obvious signs of hypoxia. We compared the frequency of false alarms between the two devices. Results: The mean chronological age was 20.8 days and the mean body weight was 1,668 g on the study day. The frequency of total false alarm was significantly fewer for Masimo $SET^{(R)}$ pulse oximetry (48 in Nellcor $N-595^{(R)}$, 27 in Masimo $SET^{(R)}$) although the false alarm during usual motion artifacts was not significantly between two devices (32 in Nellcor $N-595^{(R)}$, 19 in Masimo $SET^{(R)}$). Conclusion: The Masimo $SET^{(R)}$ pulse oximetry has fewer false alarm rates and identified more true hypoxic events than Nellcor $N-595^{(R)}$ pulse oximetry. Therefore, it is useful for adequate oxygen therapy and helps to decrease unnecessary handling by clinicians and nurses.

Comparison of the Therapeutic Effects of $Curosurf^{(R)}$ and $Newfactan^{(R)}$ in Respiratory Distress Syndrome (신생아 호흡 곤란 증후군에서 $Curosurf^{(R)}$$Newfactan^{(R)}$의 치료 효과 비교)

  • Hong, Suk-Woo;Lee, Eun-Ho;Kim, Seung-Yeon;Park, Ho-Jin
    • Neonatal Medicine
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    • v.15 no.2
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    • pp.142-151
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    • 2008
  • Purpose : The aim of this study was to compare the clinical effects of modified porcine (Curosurf$^{(R)}$) and bovine (Newfactan$^{(R)}$) surfactants in the treatment of neonatal respiratory distress syndrome. Methods : Between April 2004 and December 2006, 65 neonates (birth weight ${\leq}$2,500 g and gestational age ${\leq}$35 weeks) with neonatal respiratory distress syndrome were treated in our neonatal intensive care unit with surfactant. Thirty-one neonates received Curosurf$^{(R)}$ and 34 neonates received Newfactan$^{(R)}$. The neonates were not enrolled if they had major congenital anomalies or meconium aspiration syndrome. We compared the changes in respiratory parameters after surfactant instillation, the incidences of acute and chronic complications, and the mortality between the two treatment groups. Results : Neonatal and maternal demographic characteristics were not different between the groups. The patterns of change in the respiratory parameters after surfactant instillation were not statistically different between the groups. The incidences of surfactant reinstillation and acute complications, such as pneumothorax, patent ductus arteriosus, pulmonary hemorrhage, and grade 3-4 intraventricular hemorrhage, were not different between the neonates who received Curosurf$^{(R)}$ and the neonates who received Newfactan$^{(R)}$. There were no statistically significant differences in the duration of mechanical ventilation, oxygen therapy, hospitalization, prevalence of bronchopulmonary dysplasia, periventricular leukomalacia, retinopathy of prematurity, necrotizing enterocolitis, and mortality between the groups. Conclusion : In the present comparative study, no significant differences in the clinical effects of Curosurf$^{(R)}$ and Newfactan$^{(R)}$ were observed.

Analysis of Prenatal and Postnatal Factors Associated with Complications and Prognosis in Premature Infants with Leukemoid Reaction (백혈병양반응을 보인 미숙아의 합병증과 예후에 관한 산전과 산후 인자에 대한 분석)

  • Kwon, Se-Ho;Lee, Byoung-Kook;Lee, Heun-Ji;Na, So-Young;Lee, Jung-Ha;Park, Su-Yeon;Kang, Eun-Kyeung;Kim, Do-Hyeon;Lee, Kwan;Kim, Hee-Sup
    • Neonatal Medicine
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    • v.15 no.2
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    • pp.151-159
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    • 2008
  • Purpose : This study determined the prenatal and postnatal factors associated with complications and prognosis in premature infants with leukemoid reaction. Methods : We retrospectively reviewed the medical records of premature infants with gestational ages <37 weeks and low birth weights (<2,500 g) who were admitted immediately after birth to the neonatal intensive care unit at the Dongguk University Ilsan Hospital between June 2005 and July 2006. A leukemoid reaction was defined as an absolute neutrophil count (ANC) >30,000/$mm^3$. The infants who had leukemoid reaction comprised the study group, while the remainder of infants made up the control group. The relationships between maternal and neonatal variables and ANC were studied. Results : Leukemoid reaction was detected in 3.1% of the study infants (8 of 252). Factors more frequently associated with infants with leukemoid reaction were as follows: maternal chorioamnionitis, high levels of maternal and infant C-reactive protein, gestational age <37 weeks, birth weight <2,500 g, low Apgar score, prolonged ventilator support, and a high incidence of bronchopulmonary dysplasia (BPD). However, there were no significant differences with respect to the antenatal usage of steroids, the incidences of patent ductus arteriosus, necrotizing enterocolitis, intraventricular hemorrhage, retinopathy of prematurity, and mortality between the two groups. Conclusion : Leukemoid reaction in premature infants was associated with chorioamnionitis and high levels of serum C-reactive protein in mothers and infants, and BPD in infants. These findings suggest that leukemoid reaction is secondary to inflammation caused by infection.

The Effect of Creeping Bentgrass Growth on Greenspeed (그린잔디의 생육이 그린스피드에 미치는 영향)

  • Kwon, Il-Woo;Lee, Dong-Hee;Choi, Byuong-Man;Tae, Hyun-Sook;Shin, Dong-Hyun
    • Asian Journal of Turfgrass Science
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    • v.25 no.2
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    • pp.223-228
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    • 2011
  • This research was performed to investigate change of green speed according to growth of grass, for this, the method of effective green management for improvement of green speed was searched by investigating green density, soil moisture, surface hardness, and mowing height every day for 6 months. As the result of the study, reliability between, green density, soil moisture, surface hardness, mowing height and green speed were measured to be respectively 0.4742, 0.5690, 0.4632, 0.2806, i.e. soil moisture is considered as the factor which affects green speed the most. Therefore, it will be an advantageous environment to maintain soil moisture a little bit low to improve green speed within the range that does not disrupt the growth of green. In case of green density, it is considered to be effective to get a fast green speed when obtaining enough density during May~June, the most vigorous growth period and at the same time green up period. Surface hardness was confirmed that management work as rolling is a considerably effective method to increase hardness. However, rolling gives high stress to the green, combining another management work as regular hilling could be a good alternative. Reliability of green preview and green speed was 0.2806, lower than soil moisture or surface hardness. Through the results, it was confirmed that management of mowing height to be low less than 3.00 mm is helpful to improve green speed, timely, and it is advantageous to manage green speed when adjusting mowing height during the vigorous growth period of bent grass. However, considering the range of mowing height was not various, being 2.9~3.4 mm, henceforth research on investigation of green speed at more various mowing heights would be necessary. Consequently, except mowing height, other three factors, i.e. green density, soil moisture and surface hardness were investigated to have considerable level of reliability on green speed, and it is considered that each factor affects green speed respectively according to green condition and time. Accordingly, in order for the manager to maintain high speed all year round, intensive care for each factor per time unit considering green growth condition is considered to be necessary.

Investigation of False Positive Rates Newborn Screening using Tandem Mass Spectrometry (TMS) Technology in Single Center (단일기관에서 이중 질량 분석법(tandem mass spectrometry technology)을 이용한 선천성 대사이상 검사의 위양성율에 대한 연구)

  • Kim, Hyunsoo;Shin, Son Moon;Ko, Sun Young;Lee, Yeon Kyung;Park, Sung Won
    • Journal of The Korean Society of Inherited Metabolic disease
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    • v.16 no.1
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    • pp.18-23
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    • 2016
  • Objective: Newborn screening leads to improved treatment and disease outcomes, but false-positive newborn screening results may impact include parental stress and anxiety, perception of child as unhealthy, parent-child relationship dysfunction, and increased infant hospitalizations. The purpose of this study was to investigate of the false positive rates and the causative factors of false positive results in Tandem Mass Spectrometry (TMS) in single center. Methods: Records were reviewed for all 18,872 subjects who were born in Cheill General Hospital, during January 1st, 2012 to December 31st, 2014. 17,292 neonates (91.62%) were tested for tandem mass screening almost in 2-5th day of life. Newborn babies whose first results were abnormal had been tested repeatedly by same methods in 7-14 day. If the results were abnormal again, further evaluation was performed. TMS analysis included data for the 43 disorders screened for using TMS broken down into three categories: fatty acid oxidation disorders, organic acidurias, and aminoacidopathies. The impact of several factors on increased false positive rates was analyzed using a multivariate analysis: time from birth to sample collection, birth weight, birth height, BMI, gender, gestational age, delivery type. Results: Males of the subjects were 8942 (51.7%), female 8350 (48.3%), the mean gestational age was $38.6{\pm}1.7$ weeks, the average birth weight $3,155.6{\pm}502.4g$, the average birth height $49.1{\pm}2.9cm$, and the average BMI $13.0{\pm}3.8(kg/m^2)$. Vaginal delivery cases were 9713 (56.2%), caesarean section 7,579 (43.8%). The average date of the inspection was $2.8{\pm}1.1$ days. 224 cases were identified as TMS positive. All the subjects were false positive (222/17,292, 1.30%) except 2 cases (1 male; benign phenylketonuria and 1 female; Short chain acyl-CoA dehydrogenase deficiency). The false positive rates were 0.61% in fatty acid oxidation disorders, 0.25% in organic acidurias, and 0.45% in aminoacidopathies. In our study, the date of inspection got late, the false positive rates got higher. Because almost the cases of late test date were in treatment in neonatal intensive care unit so their test date was affected by their medical conditions. False positive rate was higher in extreme immaturity${\leq}27$ weeks than newborns of gestational age >27 weeks [OR=6.957 (CI=1.273-38.008), p<0.025] and extremely low birth weight<1,000 g than newborns of birthweight ${\geq}1,000g$ [OR=5.616 (CI=1.134-27.820), p<0.035]. Conclusion: False positive rate of TMS was 1.30% in Cheil General Hospital. Lower gestational age and birth weight impacted on increased false positive rates. Better understanding of factors that influence the reporting of screening tests, and the ability to modify these important factors, may improve the screening process and reduce the need for retesting. of screening tests, and the ability to modify these important factors, may improve the screening process and reduce the need for retesting.

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Significance of Serum Ferritin in Multiple Trauma Patients with Acute Respiratory Distress Syndrome (다발성 외상 환자에서 발생되는 급성 호흡 곤란 증후군의 예측 인자로서 혈청 페리틴의 의의)

  • Ji, Yae-Sub;Kim, Nak-Hee;Jung, Ho-Geun;Ha, Dong-Yeup;Jung, Ki-Hoon
    • Journal of Trauma and Injury
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    • v.20 no.2
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    • pp.57-64
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    • 2007
  • Purpose: Clinically, acute respiratory distress syndrome (ARDS) occurs within 72 hours after acute exposure of risk factors. Because of its high fatality rate once ARDS progresses, early detection and management are essential to reduce the mortality rate. Accordingly, studies on early changes of ARDS were started, and serum ferritin, as well the as injury severity score (ISS), which has been addressed in previous studies, thought to be an early predictive indicator for ARDSMethods: From March 2003 to March 2005, we investigated 50 trauma patients who were admitted to the intensive care unit in Dongguk University Medical Center, Gyeongju. The patients were characterized according to age, sex, ISS, onset of ARDS, time onset of ARDS, serum ferritin level (posttraumatic $1^{st}\;&\;2^{nd}$ day), amount of transfused blood, and death. Abdominal computed topography was performed as an early diagnostic tool to evaluate the onset of ARDS according to its diagnostic criteria. The serum ferritin was measured by using a $VIDAS^{(R)}$ Ferritin (bioMeriux, Marcy-1' Etoile, France) kit with an enzyme-linked fluorescent assay method. For statistical analysis, Windows SPSS 13.0 and MedCalc were used to confirm the probability of obtaining a predictive measure from the receiver operating characteristics (ROC) curve. Results: The ISS varied from 14 to 66 (mean: 33.8) whereas the onset of ARDS could be predicted with the score above 30 (sensitivity: 90.0%, specificity: 60.0%, p<0.05). On the posttraumatic $1^{st}$ day, the serum ferritin levels were measured to be from 31 mg/dL to 1,200 mg/dL (mean: 456 mg/dL), and the onset of ARDS could be predicted when the value was over 340 mg/dL (sensitivity: 80.0%, specificity: 65.0%, p<0.05). On the posttraumatic $2^{nd}$ day, the serum ferritin levels were measured to be from 73 mg/dL to 1,200 mg/dL (mean: 404 mg/dL), and the onset of ARDS could be predicted when the value was over 627 mg/dL (sensitivity: 60.0%, specificity: 92.5%, p<0.05). The serum ferritin levels and the ISS were significantly higher on the posttraumatic $1^{st}$ and $2^{nd}$ day in the ARDS group, suggesting that they are suitable indices predicting the onset of ARDS, however relationship between the serum ferritin levels and the ISS was not statistically significant. Conclusion: In this study, we discovered increasing serum ferritin levels in multiple- trauma patients on the posttraumatic $1^{st}$ & $2^{nd}$ day and concluded that both the serum ferritin level and the ISS were good predictors of ARDS. Although they do not show statistically significant relationship to each other, they can be used as independent predictive measures for ARDS. Since ARDS causes high mortality, further studies, including the types of surgery and the methods of anesthesia on a large number of patients are essential to predict the chance of ARDS earlier and to reduce the incidence of death.