Recognition of Association Between Blood Stasis Syndrome and Traumatic Injury among Doctors of Korean Medicine:A Cross-Sectional Observation Study

Objective： To investigate the diagnostic indicators and herbal treatments for blood stasis syndrome（BSS） patients with traumatic injuries and to identify the association between BSS and traumatic injury in Korea. Methods： Two-hundred and four patients with traumatic injury were recruited from the Gangnam and Daejeon branches of Jaseng Hospital of Oriental Medicine between June 2014 and December 2014. Two independent doctors of Korean medicine（DKMs） determined the diagnosis of BSS or non-BSS based on the subjects＇ signs and symptoms. The scores assigned to BSS symptoms and DKMs＇ reasons for diagnosing BSS in patients with traumatic injury were investigated. Both medication and herbal prescription records from a 3-month period were collected for all patients diagnosed with BSS by both DKMs. Results： A total of 169 of 204（82.8%） patients received consistent diagnosis related to BSS by two DKMs. Among them, 54.4%（92 cases） were diagnosed with BSS, and 45.6%（77 cases） were not diagnosed with BSS. DKMs most frequently cited symptoms of recent traumatic injury as justifications for BSS diagnoses, and also selected pain-related indicators such as abdominal pain, sharp pain and nocturnal pain as important reasons in diagnosing BSS. In addition, an inconsistency in the pattern identification theory with respect to traumatic injury was observed. Although only 92 cases（54.4%） of patients were diagnosed with BSS, 77.6% of them were prescribed decoctions for BSS. Conclusions： DKMs considered traumatic injury could cause BSS, and utilized decoction for BSS in patients with traumatic injury without confirming a diagnosis of BSS because they assumed the main symptoms or pathologies of traumatic injury to be closely related to BSS.

Inter-observer Reliability of Indicators and Decision of Pattern Identification Using Diagnostic Flowchart with Traditional Korean Medicine

Objective： To evaluate the consistency of patterns and pattern identification（PI）, and the improvement in the diagnosis of blood stasis after the standard operating procedures（SOPs） were enhanced by using a diagnostic flowchart. Methods： A total of 358 subjects who were admitted by the Jaseng Hospital of Korean Medicine between June 2013 and December 2014 were included in the study. Each patient was independently diagnosed by two experts from the same department. In 2014, the SOPs included the use of a diagnostic flowchart for each indicator. Inter-observer consistency was assessed by simple percent agreement and by the kappa and AC1 statistics. Results： The improvements in inter-observer agreement for the indicators（for al patients） and PI were greater in 2014 than in 2013. In 2013, the j-value measure of agreement between the two experts ranged from ＂poor＂（κ=–0.051） to ＂good＂（κ=0.968）. The AC1 measure of agreement between the experts was generally high for the indicators and ranged from –0.010 to 0.978. In most cases, agreement was considerably lower when it was assessed by the j-values compared with the AC1 values. In 2014, the j-value measure of agreement on the indicators（for the subjects） general y ranged from poor to good, with the values ranging from –0.007 to 0.994. Moreover, the AC1 measure of agreement between the experts was general y high for al of the indicators and ranged from ＂moderate＂（AC1=0.408） to ＂excel ent＂（AC1=0.996）. Conclusions： In four examinations, there was moderate agreement between the clinicians on the PI indicators of blood stasis. To improve clinician consistency（e.g., in the diagnostic criteria used）, it is necessary to analyse the reasons for inconsistency and to improve clinician training.（Trial registration No. KCT0000916）

Diagnostic Indicators for Blood Stasis Syndrome Patients with Gynaecological Diseases

Objective： To investigate the important diagnostic indicators for blood stasis syndrome （BSS） in patients of childbearing age with gynaecological diseases. Methods： A partial least squared-discriminant analysis （PLS-DA） were applied to BSS symptoms data of patients with gynaecological diseases, and the diagnostic indicators used by doctors of Korean medicine （DKMs） among BSS patients with gynaecological diseases were also investigated. Results： A total of 103 patients of childbearing age with gynaecological diseases and 40 healthy controls were enrolled. Among the 103 patients, 63 （61.7%） and 40 （38.8%） were diagnosed with BSS and non-BSS, respectively, and BSS patients exhibited a more severe extent of disease. A score plot of PLS-DA showed clearly different patterns among the 3 groups. Based on the variable importance on projection of PLS-DA model, menstrual pains, dark lumps in the menstrual blood, ileocoecal tenderness and resistance, sharp pains, and sublingual varicosities were selected as the top five most important indicators. Moreover, more than 75% of DKMs chose dark lumps in menstrual blood, menstrual pain, and dark menstrual blood as the diagnostic indicators of BSS in patients with gynaecological diseases, and more than 49% of them also considered sharp pains, dark red tongue, sublingual varicosities, and tendency to bruise easily as diagnostic indicators of BSS. Conclusion： DKMs focused on menstrual symptoms and certain gynaecological symptoms to diagnose BSS patients of childbearing age with female diseases.