title: Tracheal rapid ultrasound exam (T.R.U.E.) for confirming endotracheal tube placement during emergency intubation.
abstract: OBJECTIVE
  This study aimed to assess the diagnostic accuracy and timeliness of using tracheal ultrasound to examine endotracheal tube placement during emergency intubation.
  
  
  METHODS
  This was a prospective, observational study, conducted at the emergency department of a national university teaching hospital. Patients received emergency intubation because of impending respiratory failure, cardiac arrest, or severe trauma. The tracheal rapid ultrasound exam (T.R.U.E.) was performed during emergency intubation with the transducer placed transversely at the trachea over the suprasternal notch. Quantitative waveform capnography was used as the criterion standard for confirmation of tracheal intubation. The main outcome was the concordance between the T.R.U.E. and the capnography.
  
  
  RESULTS
  A total of 112 patients were included in the analysis, and 17 (15.2%) had esophageal intubations. The overall accuracy of the T.R.U.E. was 98.2% (95% confidence interval [CI]: 93.7-99.5%). The kappa (κ) value was 0.93 (95% CI: 0.84-1.00), indicating a high degree of agreement between the T.R.U.E. and capnography. The sensitivity, specificity, positive predictive value, and negative predictive value of the T.R.U.E. were 98.9% (95% CI: 94.3-99.8%), 94.1% (95% CI: 73.0-99.0%), 98.9% (95% CI: 94.3-99.8%) and 94.1% (95% CI: 73.0-99.0%). The median operating time of the T.R.U.E. was 9.0s (interquartile range [IQR]: 6.0, 14.0).
  
  
  CONCLUSIONS
  The application of the T.R.U.E. to examine endotracheal tube placement during emergency intubation is feasible, and can be rapidly performed.
authors.affiliation: Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan. erichaochang@gmail.com
authors.forename: Hao-Chang
authors.initials: HC
authors.lastname: Chou
authors.forename: Wen-Pin
authors.initials: WP
authors.lastname: Tseng
authors.forename: Chih-Hung
authors.initials: CH
authors.lastname: Wang
authors.forename: Matthew Huei-Ming
authors.initials: MH
authors.lastname: Ma
authors.forename: Hsiu-Po
authors.initials: HP
authors.lastname: Wang
authors.forename: Pei-Chuan
authors.initials: PC
authors.lastname: Huang
authors.forename: Shyh-Shyong
authors.initials: SS
authors.lastname: Sim
authors.forename: Yen-Chen
authors.initials: YC
authors.lastname: Liao
authors.forename: Shey-Yin
authors.initials: SY
authors.lastname: Chen
authors.forename: Chiung-Yuan
authors.initials: CY
authors.lastname: Hsu
authors.forename: Zui-Shen
authors.initials: ZS
authors.lastname: Yen
authors.forename: Wei-Tien
authors.initials: WT
authors.lastname: Chang
authors.forename: Chien-Hua
authors.initials: CH
authors.lastname: Huang
authors.forename: Wan-Ching
authors.initials: WC
authors.lastname: Lien
authors.forename: Shyr-Chyr
authors.initials: SC
authors.lastname: Chen
mesh_terms: D000368:Aged; D004630:Emergencies; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D008297:Male; D011446:Prospective Studies; D015203:Reproducibility of Results; D013997:Time Factors; D014132:Trachea / Q000000981:diagnostic imaging*; D014463:Ultrasonography