bluuebunny/crossref_metadata_2025 huggingface dataset:
Epidemiological Survey and Mspss Scores of 260 Suicide Attempters Presenting to Two Emergency Departments in Turkey
Authors: Cevik Y , Kelleci M , Golbasi Z , Caykoylu A , Das M
Published: December 2017

Introduction

The aim of this study was to determine the epidemiological characteristics of suicide attempt cases who were admitted to the emergency departments and to determine their level of social support and related factors by using multidimensional scale of perceived social support (MSPSS).

Methods

This study was conducted simultaneously in two different centres between February 23 and June 31, 2009. Totally 260 suicidal cases who were admitted to the emergency departments were included in the study after obtaining the consents. Related derived data were collected with a questionnaire. The questionnaire determined epidemiological characteristics of suicide attempters by using MSPSS derived data. The data were analysed with percentage, mean, t test, ANOVA, and Scheffe test.

Results

About 70% of all cases were female and 63.1% of them were between 16 and 25 years of age. The main causes leading to suicide attempts were family problems (41.9%), financial problems (11.2%), and peer suicide attempts (5.4%). Drug use was the most common suicide method both in males and females. The MSPSS score was 52.47±17.81 (mean±SD, range=12-84). While being a member of a broken family, being widow/divorced, previously diagnosed mental disorder affected social support scores negatively, being a student or having a high level of education affected scores positively.

Conclusion

Family problems, financial problems, 16-25 age group, female sex, being divorced/widowed, being a member of broken family, chronic physical and psychological problems, and lower level of perceived social support are main characteristics associated with suicide attempts. (Hong Kong j.emerg.med. 2011;18:412-420)
The Diagnosis is Made Only with Suspicion: Miller Fisher Syndrome
Authors: Sever M , Aksay E , Gulec F
Published: December 2017

Miller Fisher syndrome (MFS) is an uncommon variant of Guillain-Barré syndrome (GBS) characterised by external ophthalmoplegia, ataxia, and areflexia. This syndrome is observed in about 5% of all GBS cases. Miller-Fisher syndrome can be distinguished from GBS by a few clinical features. As the laboratory findings are not specific for MFS, the diagnosis is made only with suspicion of the disease. The aim of this report was to remind the MFS to emergency physicians and to emphasize the differential characteristics and treatment of this neurological emergency. We reported the clinical features of two patients who were diagnosed to have MFS in the emergency department. Emergency physicians should not underestimate the flu like illness together with the typically clinical triad of MFS in the possibility of variant MFS. The first dose IVIG therapy in the ED may be an important factor for early recovery of the patients who have clinically severe findings. (Hong Kong j.emerg.med. 2011;18:428-431)
Asphyxia Due to Accidental Nitrogen Gas Inhalation: A Case Report
Authors: Tür F Çalιşkan , Aksay E
Published: December 2017

Intoxications resulting from asphyxiate gases, such as nitrogen can cause hypoxia and even death. We present a case of a patient with nitrogen intoxication due to inadvertent industrial exposure. In this case, the patient survived and the outcome was different from those reported in the literature. For patients presenting to the emergency department from a workplace with a history of loss of consciousness after using of self‐contained breathing apparatus, possibility of nitrogen or other simple asphyxiate gas intoxication should be considered seriously.
FARES Method to Reduce Acute Anterior Shoulder Dislocation: A Case Series and an Efficacy Analysis
Authors: Tsoi LCH , Wong MCK
Published: December 2017

Objective

Anterior shoulder dislocation is a common large joint dislocation. There is no standard method for reduction. A new technique (FARES method) was introduced by a Greek group in late 2009.

Design

Case series analysis.

Setting

An emergency department.

Methods

A survey was conducted from April to June 2010 in the emergency department primarily to collect data on the methods of reduction of anterior shoulder dislocation and their efficacies.

Results

Nine cases of anterior shoulder dislocation were documented. All 9 cases were reduced successfully regardless of the reduction methods used. FARES method was found to be popular in the studying emergency department. Six out of the 9 cases were using the FARES method at their first attempt (the rest two case using Spaso; one using traction‐counter traction). No pre‐medication was needed in all FARES' cases. In all 6 cases using the FARES method, the shoulder could be reduced within 2 minutes.

Conclusions

Our experience concords with overseas' in which the FARES method is efficacious and fast.
Direct Observation as a Focused Teaching Tool for Doctors Newly Posted to the Emergency Department
Authors: Tan ECC , Tiah L , Chong WCC
Published: December 2017

Introduction

The emergency department (ED) is a high risk working environment with clinical and operational protocols in place to attenuate the risks for doctors new to the ED. We implemented a structured direct observation program for new ED doctors who were not Emergency Medicine trainees.

Method

An ED consultant observed each new ED doctor directly over two weeks without intervention in the clinical encounters. A structured form documented the doctor's performance in pre-defined areas relevant to patient care as well as mastery of operational procedures. Individual strengths and weaknesses were noted. Feedback was provided at the end of each session. After two weeks, the doctors completed a survey form with questions pertaining to their perceived level of competence in areas related to patient care and their experience with the direct observation program.

Results

There was an overall improvement in their perceived levels of competence in most areas pertaining to patient care. Most felt that this program was useful. Only a minority found it stressful. None felt that it was a waste of time.

Conclusion

Implementation of direct observation as a focused teaching tool is well received by both junior doctors and Emergency physicians. It provides early insight and feedback into the strengths and weaknesses of the junior doctors and helps new ED doctors to adapt quickly to the work process of the ED.
Opipramol Overdose Presented with Wide-Complex Tachycardia to the Emergency Department
Authors: Sogut O , Yalcin S , Kaya H , Gokdemir MT , Sezen Y
Published: December 2017

Opipramol is an antidepressant and anxiolytic drug similar in structure to tricyclic antidepressants (TCAs) but it is primarily used for the treatment of generalized anxiety disorders. Unlike many TCAs, opipramol has no reuptake-inhibiting properties. Opipramol acts as a high affinity sigma receptor agonist. Opipramol acts as a low to moderate affinity antagonist for the dopamine-2 (D2), 5-hydroxtryptamine (5-HT2), histamine 1 (H1), histamine 2 (H2), and muscarinic acetylcholine receptors accounting for its antihistamine effects, and muscarinic anticholinergic properties. Here, we report a rare case of opipramol overdose case involving a 18-year-old woman, presenting to our emergency department (ED) with loss of consciousness and wide-complex tachycardia. A firm diagnosis of opipramol overdose was made on the basis of clinical, laboratory and electrocardiogram findings.
Epiglottitis in a Vaccinated Child: A Lifesaving Diagnosis
Authors: Atik A , Krilis M
Published: December 2017

Epiglottitis is inflammation and cellulitis of the soft tissues above the glottis – the epiglottis, vallecula, arytenoid cartilage and aryepiglottic folds. It is a life-threatening emergency which is most commonly caused by the bacteria Haemophilus influenzae type b. The incidence of epiglottitis has declined dramatically since the introduction of the Haemophilus influenzae type b vaccine and can thus be easily overlooked in the emergency setting. Our case highlights the importance of epiglottitis as a differential diagnosis in the child with acute respiratory distress.
Incidental Radiological Finding of Charm Needles
Authors: Pothiawala S
Published: December 2017

The charm needles, or susuks, are small, needle-shaped metallic talismans inserted subcutaneously in different parts of the body. This is a traditional practice, occasionally encountered in the Southeast Asian region. This case report describes two patients who were evaluated in the emergency department and incidentally found to have charm needles on the plain radiographs. These needles are not visible externally and have not been reported to cause any adverse effects. Emergency physicians should be aware of the existence of this traditional practice and chances of its incidental detection on radiographs. This would help avoid misdiagnosis and further investigations. It would also avoid susuks being considered as foreign bodies responsible for the patient's symptoms.
The Minimum Clinically Significant Difference in Acute Nontraumatic Thoracoabdominal Pain in Adult Emergency Department Patients in Turkey
Authors: Degerli V , Karcioglu O , Larkin GL , Karaduman S , Korkmaz T , Tunc MA
Published: December 2017

Objectives

To determine the minimum clinically significant difference (MCSD) in visual analog scale (VAS) pain scores for acute non‐traumatic thoracoabdominal pain (TAP) in the emergency department (ED) and to determine its association with sociodemographic features, location and duration of pain.

Methods

An observational survey of adult ED patients with TAP lasting less than 48 hours was conducted over a six‐week period. Demographic information and the duration and location of pain were recorded. Patients indicated their pain level on a 100‐mm VAS at baseline and at 20, 40, and 60 minutes thereafter. Subjects were also asked to rate their pain as ‘much less’, ‘a little less’, ‘about the same’, ‘a little more’, or ‘much more’ at the 20‐, 40‐, and 60‐minute time points. MCSD was calculated as the difference between the subsequent and preceding VAS scores if a patient reported pain as ‘a little less’ or ‘a little more’.

Results

Data was available for 306 of the 374 patients with TAP who presented during the study period. For pain comparisons (n=428) categorised as ‘a little less’ or ‘a little more’, the MCSD was 24.2 mm (95% CI 22.6‐25.7 mm). The MCSD value was not significantly different among the factors of gender, age, level of education, duration, or location of pain.

Conclusions

The MCSD of ED patients with nontraumatic thoracoabominal pain in Turkey is 24.2 mm. The MCSD is not affected by gender, age, level of education, location, or duration of pain.
Critical Thinking Dispositions of Emergency Nurses in Turkey: A Cross‐Sectional Study
Authors: Kaya H , Yalniz N
Published: December 2017

Introduction

This cross‐sectional descriptive study was conducted to determine the critical thinking dispositions of emergency nurses and any influencing factors related to critical thinking. The study is considered to respond to this need and contribute to the relevant literature.

Method

The study was conducted with the participation of 248 emergency nurses. The study data were collected using an information form covering characteristics of the nurses and the California Critical Thinking Disposition Inventory. The data were analyzed using independent‐samples t test, independent‐samples one‐way variance analysis (F‐test), and Pearson correlation test.

Results

The critical thinking dispositions of the emergency nurses in the study group were found to be at medium level (246.76±23.24). It was found that the female emergency nurses had higher levels of critical thinking dispositions than that of male nurses. The emergency nurses with graduate degrees had higher levels of critical thinking dispositions than that of the nurses with other educational levels. It was demonstrated that age, marital status, experience, or participation in in‐service emergency training and certificate program did not affect the critical thinking dispositions of the nurses.

Conclusion

The results of the study reveal that the emergency nurses who are required to make quick and correct decisions. They need to develop their critical thinking skills and further studies should be conducted with more representative sample group.
Recurrent Obturator Hernia as a Cause of Nonspecific Abdominal Pain: A Case Report
Authors: Yoon YH , Moon SW , Cho HJ , Lee SW , Choi SH , Hong YS
Published: December 2017

Many patients visit the emergency department (ED) with abdominal pain. Sometimes, physicians are faced with diagnostic challenges, particularly for older patients. We recently had an elderly female patient who visited the ED several times with non‐specific abdominal pain caused by an unusual hernia. One year before, an 81‐year‐old female visited our ED complaining of abdominal pain radiating to the right inguinal/femoral area. An incarcerated obturator hernia was found on an abdomino‐pelvic computed tomography (CT) scan, and she underwent a laparoscopic hernioplasty. However, 1 year later, she revisited complaining of abdominal pain similar to the previous episode. Eventually, the diagnosis of recurrent obturator hernia was made, and a second operation was performed. An obturator hernia may be the cause of non‐specific abdominal pain and small bowel obstruction in elderly emaciated females. Recognising the clinical signs and characteristics of this disease is necessary for a prompt diagnosis and treatment.
The Effect of Animation‐Assisted Informed Consent Using Tablet Personal Computer for Contrast‐Enhanced Computed‐Tomography in Emergency Department
Authors: Hong JY , Kim CW , Noh H , Lee DH , Kim SE , Lee SJ
Published: December 2017

Introduction

Informed consent is essential patient's right even in overcrowded emergency department (ED). We compared the effect of animation‐assisted informed consent using tablet PC with the standard informed consent for contrast‐enhanced computed‐tomography (CT) in ED.

Methods

We included 150 patients scheduled to undergo contrast‐enhanced CT in ED from November 2010 through January 2011. Participants were randomised to either animation‐assisted information (AAI) (n=75) or standard verbal information (SVI) group (n=75). AAI was provided by tablet personal computer (PC); and SVI by clinicians. All participants completed 10‐point scale questionnaires after the CT scan. The questionnaires included two main categories – understanding and satisfaction of informed consent.

Results

Participants in the AAI group had a better understanding of purpose (8.95±1.48 vs. 8.32±1.88, p=0.026) and methods (8.93±1.43 vs. 8.37±1.83, p=0.048) of CT scans compared to participants in the SVI group. Every score in satisfaction categories was significantly higher in the AAI group. In the SVI group, relatively low‐educated participants had a lower score in understanding when compared with university‐educated participants (7.53±2.28 vs. 8.52±1.40, p=0.029). Regardless of education level, understanding score was high in the AAI group (8.73±1.27 vs. 8.57±1.50, p=0.71).

Conclusions

Participants receiving animation assisted informed consent with tablet PC shows a higher degree of understanding and satisfaction compared with patients receiving standard verbal informed consent. Particularly in patients with lower education, animation‐assisted informed consent may be better for understanding of contrast‐enhanced CT.
The Weighty Issue: The Impact of Body Mass Index (BMI) in Asian Trauma Patients
Authors: Teo YX , Teo LT , Go KTS , Yeo YT , Vasu A , Chiu MT
Published: December 2017

Background

The controversy surrounding the impact of Body Mass Index (BMI) on the outcome of trauma patients has been widely studied in the West. However, no such studies have looked at an Asian trauma population. The aim of our study was to investigate the impact of BMI on mortality, morbidity, severity and pattern of injury in trauma patients of multicultural Singapore.

Methods

In this prospective study, we recruited all trauma patients admitted to Tan Tock Seng Hospital over a 13 month period. Both the international World Health Organization (WHO) and Asian modified classifications of BMI were used for the purpose of our study. Patient demographics, co-morbidities, mechanism of injury, injury severity score (ISS), body regions injured, morbidity and mortality were collected using inpatient medical records.

Results

964 patients with a mean age of 50.5 years were recruited. Majority of injuries sustained were due to falls. There was no association between Asian BMI and ISS. Head, neck and cervical injuries occurred less commonly in the overweight and obese group, but BMI does not confer protection from truncal injury. BMI was not a significant risk factor for morbidity or mortality.

Conclusion

Being overweight does not appear to increase severity of injury in Asian trauma patients. BMI as an independent risk factor does not contribute to trauma mortality or morbidity. We conclude that BMI is not a significant contributing factor to adverse trauma outcomes in Asians.
Patients with Bacteraemia Discharged from the Department of Emergency Medicine: Distribution of Organisms and Associated Characteristics
Authors: Lehn A , Sowden D , Anstey C , Stephensen B , Newman H
Published: December 2017

Introduction

Although blood cultures are commonly used to investigate febrile patients presenting to an emergency department, treatment decisions usually have to be made before the results are available.

Methods

We performed a retrospective analysis of consecutive patients presenting with community-acquired bacteraemia at the emergency department of Nambour Hospital, Queensland, Australia between 2000 and 2008. We determined their clinical characteristics, the distribution of organisms and also assessed patient characteristics associated with discharge from the emergency department.

Results

A total of 885 patients with 915 presentations of community-acquired bacteraemia were included. While having bacteraemia, 33 patients (3.6%) were discharged from the emergency department. Age, mode of presentation, altered mental state, presence of immunocompromise, presence of respiratory distress, C reactive protein, Charlson score, age score and estimated 10 years survival were significant factors discriminating the admitted from discharged patients. The most commonly found organism in blood cultures of discharged patients was Staphylococcus aureus (27.3%), whereas in admitted patients it was E. coli (27.7%). Methicillin-resistant Staphylococcus aureus accounted for 1.7% of cases of community-acquired bacteraemia.

Conclusions

Emergency physicians only rarely discharge patients with community-acquired bacteraemia using current assessment tools and decision-making rules. However, they tend to discharge younger self-presenting patients with good baseline function.
Mitogen-activated protein kinase pathways in sepsis treatment
Authors: Wang YH , Liu Y , Zhou RB
Published: December 2017

Sepsis is a characteristic set of systemic reactions to overwhelming infection that remains a major cause of death in critically ill patients. Endotoxins or lipopolysaccharides from gram-negative bacteria play a major role in the pathogenesis by inducing an over-production of inflammatory cytokines, which usually triggers beneficial inflammatory responses but causes tissue injury and lethal multiple organ failure in excessive amounts. The production of inflammatory cytokines depends on the activation of many intracellular signaling pathways, including nuclear factor-κB (NF-κB) pathway and three mitogen-activated protein kinase (MAPK) pathways. This review of important MAPK pathways underscores the essential role of MKP-1 in the negative control of sepsis. Herein is a summary of the roles of MAPK pathways in the production of inflammatory cytokines and the possibility of targeting these pathways for the treatment of sepsis.
Anton's Syndrome Presenting as Vertigo
Authors: Chan DYS , Ong YS
Published: December 2017

Anton's syndrome is a rare cause of vertigo. Its diagnosis may be hindered by confabulatory claims of normal vision by the patient. Any cause of cortical blindness may result in Anton's syndrome, the commonest being a posterior circulation stroke. Here, we highlight a case of Anton's syndrome that was a result of a left vertebral artery thrombosis, presenting initially with vertigo. The patient had a background of previously undiagnosed bilateral posterior communicating artery and right vertebral artery hypoplasia.
Deep Venous Thrombosis Caused by a Huge Uterine Myoma
Authors: Lee DH , Kim CW , Kim SE , Lee SJ
Published: December 2017

Cases of deep venous thrombosis (DVT) and pulmonary thromboembolism (PTE) related to the isolated risk factor of uterine myoma are very rare. In a setting of emergency department (ED), it is unlikely that uterine myoma would be suspected as the primary cause of symptoms in a patient with thromboembolism. We presented a 44-year-old woman who visited the ED for DVT presenting with right lower leg swelling with an underlying cause of a huge uterine myoma. Various aetiologies, including obstetric and gynaecological causes (especially uterine myoma), should be considered in female patients visiting the ED with suspected DVT or PTE.
An Unusual Cause of Stroke: Internal Carotid Artery Occlusion as a Complication of Ovarian Hyperstimulation Syndrome
Authors: Bayram B , Limon O , Limon G , Akay S
Published: December 2017

Ovarian hyperstimulation syndrome (OHSS) is a rare iatrogenic complication of ovarian stimulation. Thromboembolic events are the most feared complication of OHSS. Most of the thrombotic events (75%) are of the venous origin. Stroke represents a rare but life-threatening complication of severe OHSS. A 29-year old woman was admitted to our emergency room, with left sided weakness, difficulty in breathing and nausea. The patient was given the diagnosis of OHSS and right middle cerebral artery infarction. Here we emphasise that the development of ovulation induction is a newly recognised cause of cerebral stroke in an otherwise healthy woman.
Spinal Epidural Abscess in a Child with Eczema: A Case Report and Literature Review
Authors: Tsang YP , Sy MY , Wong TW
Published: December 2017

Spinal epidural abscess is rare in children. Early recognition is important to prevent or minimise neurological complications. We report a case of paediatric spinal epidural abscess. An 8-year-old girl, with a history of poorly controlled atopic eczema over the back of neck, presented with back pain and subsequently fever and worsening backache. Diagnosis was made only after computed tomography. Emergency operation with drainage of the abscess was done and vancomycin was given for 5 weeks. The patient made an uneventful recovery with no neurological complications. Bacteraemia from skin excoriation due to chronic eczema was the presumed aetiology.
The Way to a Man's Heart is through his Stomach – Peanuts in the Pericardium! a Rare Case of Traumatic Gastropericardial Fistula
Authors: Biswas S , Cahill P , Sherck J
Published: December 2017

Pneumopericardium is most commonly iatrogenic and in cases of gastropericardial fistula, the stomach is usually intrathoracic. We report a case of penetrating trauma induced gastropericardial fistula from an intraabdominal stomach resulting in pneumopericardium. The diagnosis was confirmed during laparotomy. Pneumopericardium, if small, can be managed conservatively, but immediate release is required if tension occurs. Gastropericardial fistula carries a high mortality and should be surgically repaired.
A 4 Year Retrospective Analysis of Our Patients with Mushroom Poisoning
Authors: Koksal O , Armagan E , Inal T , Ayyildiz T , Oner N
Published: December 2017

Objective

This study presented the demographic, clinical and laboratory data for the patients who presented to our emergency department (ED) with mushroom poisoning.

Methods

We retrospectively examined the data for adult patients with mushroom poisoning that presented to the ED of Uludag University, Faculty of Medicine between 1 January 2007 and 31 December 2010.

Results

A total of 53 patients were enrolled in the study. The mean age was 46.58±15.47. 52.8% of the patients were female, while 47.2% were male. These patients were typically admitted in the autumn. The most commonly seen symptoms were gastrointestinal such as nausea and vomiting. The time to symptom onset was <6 hours for 30.2% of the patients and >6 hours in 69.8% of the patients. While 73.5% of the patients received gastric lavage, activated charcoal and intravenous fluid therapy, 15.1% received penicillin, N‐acetylcysteine and intravenous fluid therapy. For the remaining patients (11.4%) silibinin, dialysis and plasmapheresis were administered. While 35.8% of the patients were hospitalised, 64.2% were discharged from the ED. The median duration of stay in the ED was 6 hours (range: 1‐27 hours); the median duration of stay among inpatients was 6 days (range: 1‐36 days). Three of the hospitalised patients died, and two underwent hepatic transplantation.

Conclusions

Mushroom poisoning remains an important issue that is encountered in rural areas during the rainy autumn season in our region. The condition may be fatal, but can be prevented by early and appropriate treatment.
A Changing of the Abbreviated Injury Scale that Improves Accuracy and Simplifies Scoring
Authors: Wang MD , Cai WW , Qiu WS , Qiu F , Lv WS
Published: December 2017

Objective

We present here a changing of the abbreviated injury scale (AIS). It is called the changed injury severity score (CISS), and significantly outperforms the venerable but dated the injury severity score (ISS) and the new injury severity score (NISS) as a predictor of mortality.

Methods

The CISS is defined as a change of AIS values by raising each AIS severity score (1-6) by a power of 4.12 divided by 30.33 and then summing the three most severe (i.e. highest AIS) regardless of body regions. CISS values were calculated for every patient in two large independent data sets: 3455, 3900 patients treated during a five-year period at the class A grade III comprehensive hospitals in Affiliated Hospital of Hangzhou Normal University (Hangzhou) and Zhejiang Provincial People's Hospital (Zhejiang). The power of CISS to predict morality was then compared with previously calculated NISS values of the same group patients in the two hospitals.

Results

We found CISS was more accurate than NISS to predict the survival. The receiver operating characteristic (ROC) of NISS and CISS in Hangzhou were 0.919 and 0.937 respectively (p=0.026), whereas for Zhejiang were 0.917 and 0.940 respectively (p=0.022). Moreover, CISS provided a better fit throughout its entire range of prediction. Hosmer-Lemeshow (H-L) statistic for NISS and CISS in Hangzhou were 24.00 (p=0.002) and 19.38 (p=0.007), whereas in Zhejiang were 22.70 (p=0.001) and 18.43 (p=0.005) respectively.

Conclusions

CISS is a modified version of NISS/ISS with better statistical property and can be considered in trauma research.
Patient Perceptions of HIV Testing in a Non-Urban Emergency Department's Express Care
Authors: Minak J , Syverud SA , Dillingham RA , Dort KR , Gessner AE
Published: December 2017

Introduction

This study evaluated participants' acceptance of rapid Human Immunodeficiency Virus (HIV) testing in the express care of an emergency department (ED) located in a semi-rural, low HIV prevalence area.

Methods

This was a cross-sectional survey performed in an ED's express care that serves an area with an estimated HIV prevalence of <1%. The survey included 10 questions with answers recorded on a 5-point Likert scale ranging from “strongly disagree” to “strongly agree.” Adult English speaking patients, ages 18 to 64 years, who provided consent, were included. Participants were offered a finger-stick rapid HIV screening test but testing was not required for participation.

Results

A total of 117 participants were enrolled with 71 tested for HIV with no positive results. Participants demonstrated a preference for testing at a PCP's office, although testing in the ED was acceptable to them. They denied negative emotional response about an offer of HIV testing in the ED and did not desire more information about HIV or testing.

Conclusions

Despite the low prevalence and semi-rural study area, participants were receptive to HIV testing in the ED.
The Association between Facial Fracture Patterns and Traumatic Head Injury in Injured Motorcycle Riders According to Helmet Use Status
Authors: Kong DY , Kim HJ , Kang TK , Oh SC , Cho SJ , Choi SW , Ryu SY
Published: December 2017

Objective

This study was undertaken to identify the association between facial fracture patterns and traumatic head injury in injured motorcycle riders.

Methods

Retrospective study design. We reviewed the medical records of patients who underwent facial bone computed tomography (CT) and brain CT simultaneously among the injured motorcycle riders between May 2009 and July 2011. Data collected included age, sex, Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), facial fracture patterns, head protective device (helmet) use, alcohol intake, time of accident and seat position. Facial fracture patterns were grouped as upper, mid, and lower face. Traumatic head injury (THI) included skull fracture, brain haemorrhage and diffuse axonal injury.

Results

Of the 154 patients included, 138 (89.6%) were male, 57 (37%) had facial fracture, 69 (44.8%) wore helmets and 30 (19.5%) had THI. Their mean age was 29.0+15.0 years. After multivariate logistic regression analysis, THI was associated with GCS, seat position of riders and accident time. THI was correlated with the combination of upper and midfacial fractures in helmeted group and isolated upper facial fracture or the combination of upper and midfacial fractures in unhelmeted group. The rest of facial fracture patterns were not correlated with THI regardless of helmet.

Conclusions

The combination of upper and midfacial fractures are the risk factor of THI regardless of helmet. The patients with the combination of upper and midfacial fractures should be further evaluated for head injury regardless of helmet.
The Role of Oxidative Status in Initial Evaluation of Paediatric Patients with Graded Traumatic Brain Injury
Authors: Kaya H , Sogüt O , Gokdemir MT , Albayrak L , Taskιn A
Published: December 2017

Introduction

The purposes of this study were (a) to investigate the oxidative and antioxidative status in paediatric patients with varying severity of traumatic brain injury (TBI) during the early post‐traumatic period; (b) to correlate injury severity with the oxidative and antioxidative status of patients; and (c) to identify early predictors of outcome in patients with TBI.

Methods

Fifty‐two consecutive paediatric patients with isolated TBI and 31 age‐ and sex‐matched healthy controls were enrolled. Patients were divided into two groups based on their Glasgow Coma Scale (GCS) scores recorded upon admission to the emergency department within the first 24 hours after injury. Twenty‐three patients with moderate to severe TBI and 29 patients with mild TBI (GCS scores of >13) were included. The primary outcome variable was hospital mortality. Plasma total oxidant status (TOS), total antioxidant status (TAS), and the oxidative stress index (OSI) were assessed as predictors of early oxidative changes in serum using a novel automated measurement method.

Results

Compared to patients with mild TBI, TOS and OSI values were markedly elevated in patients with moderate to severe TBI. However, TAS levels did not show significant changes in either group of patients. Both GCS scores and Revised Trauma Scores were negatively correlated with the TOS and OSI, but neither was significantly correlated with the TAS. The TOS and OSI were significantly higher in non‐survivors than in survivors. However, there was no significant difference in TAS levels between survivors and non‐survivors.

Conclusion

Paediatric patients with isolated TBI are exposed to extensive oxidative stress, which varies with injury severity.
Who are Prone to Develop Adverse Effects with Oral Tramadol? a Retrospective Cohort Study
Authors: Li TY , Li YK , Chan CM
Published: December 2017

Objective

Oral tramadol is a commonly prescribed analgesic in Hong Kong. Significant adverse effects are frequently observed in our locality. Our study aims to describe the rate of significant adverse effect that warrant discontinuation of oral tramadol and identify the risk factors for development of adverse effect.

Design

Retrospective cohort study.

Methods

Adult patients aged greater than 18 years old admitted to the emergency medicine ward of a large-scale local hospital in Hong Kong being prescribed with oral tramadol during in-hospital stay were recruited. Significant adverse effects during the hospital stay were observed as the outcome of interest.

Results

A total of 575 subjects were recruited. 29.9% experienced significant adverse effects likely related to tramadol. Age (p=0.006; odds ratio [OR] = 1.017, 95% confidence interval [CI] = 1.005-1.029) and sex (p=0.006; OR=1.696, 95% CI= 1.166-2.465) were statistically significant predictors of adverse effects after oral tramadol.

Conclusion

Our study suggests that female and increasing age patients are significant predictors for the development of adverse effect after taking oral tramadol. Possible adverse effects should be explained to the patients careful especially the higher risk groups. (Hong Kong j. emerg.med. 2014;21:3-9)
Altered Mental Status in Emergency Department Patients with Cancer
Authors: Yaka E , Kaya S , Pekdemir M , Yilmaz S , Uygun K , Kama A
Published: December 2017

Introduction

Although cancer patients with acute altered mental status (AMS) often present to the emergency department (ED), there is lack of documentation for survival in ED cancer patients with related causes of AMS (structural or metabolic causes). The aim of this study was to evaluate reasons for acute AMS of cancer patients in the ED and their prognostic value for survival.

Methods

Medical records of cancer patients presenting to ED with acute AMS were reviewed. Patients were divided into 3 groups with respect to AMS etiologies: metabolic causes (Group 1), structural causes (Group 2) and both (Group 3). Median survival time was calculated from the ED presentation and Kaplan-Meier survival curve was generated to demonstrate survival in the three groups.

Results

Forty-nine patients had only metabolic causes of AMS (Group 1), 21 of whom had more than one metabolic abnormality. Forty-six patients had only structural causes (Group 2) and 7 had both metabolic and structural causes (Group 3). Survival probability at one month was 33% for all patients, 25% for Group 1, 48% for Group 2 and 0% for Group 3 (p=0.11). In Group 1, 32% of patients with only one metabolic disorder and 14% of those with more than one metabolic disorder were alive at one month (p=0.197).

Conclusions

Regardless of aetiology, cancer patients presented with AMS to the ED usually have poor outcomes. Survival in our ED cancer patients with AMS is not related to the either structural or metabolic causes of AMS. (Hong Kong j.emerg.med. 2014;21:10-15)
A 2-Hour Accelerated Chest Pain Protocol to Assess Patients with Chest Pain Symptoms in an Accident and Emergency Department in Hong Kong
Authors: Ko HF , Lee HY , Ho HF
Published: December 2017

Background

The present study is a follow up analysis of ASPECT study. We aimed to prospectively validate a 2-hour accelerated chest pain protocol (ACPP) to assess patients presenting to emergency department with chest pain symptoms suggestive of acute coronary syndrome.

Methods

This observational study was carried out between June 2009 and July 2010. Patients were included if they were older than 18 years old and presented with at least 5 minutes duration of chest pain. The ACPP included modified Thrombolysis in Myocardial Infarction score, electrocardiograph and point-of-care troponin I at presentation and 2-hour after. Primary endpoint was major adverse cardiac event (MACE) at 45-day of initial hospital attendance.

Results

A total of 384 Chinese patients were recruited and completed 45-day follow up. Forty-five (11.7%) had 45-d MACE. The ACPP identified 124 (32.3%) low risk patients who could be discharged early. No MACE occurred within 45 days among these patients, giving a sensitivity of 100% (95% CI 90-100), a negative predictive value of 100% (96-100), and a specificity of 36.6% (31.5-42).

Conclusions

The ACPP is able to identify very low risk chest pain patients who might be suitable for early discharge without increasing risk of developing MACE. The observation period can be shortened to 2-hour of ED presentation. The variables are objective and easily available. This 2-hour Hong Kong Chest Pain Rule is applicable to Chinese population and has the potential to change the current practice in Emergency Departments in Hong Kong and China. (Hong Kong j.emerg.med. 2013;20: 261-269)
Undetectable Troponin I at Presentation Using a Contemporary Assay does not Rule Out Myocardial Infarction
Authors: Kelly AM
Published: December 2017

Objective

Chest pain is a common reason for presentation to emergency departments (ED). Recent evidence suggests that an undetectable troponin level at ED presentation can rule out the presence of myocardial infarction (MI). The aim of this study was to externally validate that finding using a troponin I (TnI) assay.

Methods

Unplanned sub-study of a prospective observational cohort study of patients presenting to ED with chest pain without electrocardiogram evidence of ischaemia who underwent a ‘rule out’ acute coronary syndrome process. Clinical, investigational and outcome data were collected. Primary outcome of interest was diagnostic accuracy for type I MI at index visit.

Results

685 patients were studied; median age 62, 60% male. Two hundred and seventeen had an undetectable TnI at ED presentation. There were two non-ST elevation myocardial infarctions in the group (2/217, 0.9%, 95% CI 0.16-3.6%). Sensitivity of undetectable TnI for ruling out type I MI was 98. 2% (99% CI 92.9-99.7%) with negative predictive value of 99.1% (96.4-99.8%).

Conclusion

Approximately 1% of patients with an undetectable TnI at ED presentation were diagnosed with a type I MI. An undetectable initial TnI using a contemporary sensitive TnI assay does not safely exclude MI in an ED chest pain cohort. (Hong Kong j.emerg.med. 2014;21:31-36)
Concomitant Pharyngeal Perforation and C6 Spinal Fracture in a Patient with Ankylosing Spondylitis
Authors: Liu TJ , Lu SC , Chu MM , Chang ST
Published: December 2017

A direct blunt injury to the cervical spine is a clinically crucial issue and misdiagnosis of adjacent tissue lesion of neck may lead to poor outcomes. We present a patient with ankylosing spondylitis, who suffered from a perforation in pharynx following a neck injury. The extent of the occult right pharyngeal wall perforation may have initially been less and hence undetectable by radiological screening, either X-ray radiology or computed tomography. The combination of continuation of oral feeding and ligamentous ossification/fragility of the cervical spine accounted for the resultant pharyngeal perforation. (Hong Kong j.emerg.med. 2014;21:44-47)
Case Report: A Rare Cause of Respiratory Distress in a Paediatric Emergency Department Patient
Authors: Güzel A , Günaydin M , Bernay F , Paksu Ş
Published: December 2017

A 5-month-old boy presented with respiratory distress. Computed tomography revealed a cystic mass in the right upper thorax compressing on the trachea. The mass was removed surgically and proven histologically to be an enteric cyst. (Hong Kong j.emerg.med. 2014;21:55-56)
The Attitude of the Medical Students of the University of Hong Kong towards Emergency Medicine
Authors: Leung LP , Wong TW , Tong HK
Published: December 2017

Introduction

Understanding how medical students view the Specialty of Emergency Medicine is important. The knowledge helps the leaders in Emergency Medicine better plan the development of the specialty. In the medical literature, few studies primarily investigated this subject. Most were on the career choice of medical students. This study aimed at addressing this knowledge gap.

Methods

It was a cross‐sectional questionnaire survey of the year 3 to 5 medical students studying at the Li Ka Shing Faculty of Medicine, the University of Hong Kong. The questionnaire measuring their attitude consisted of 16 items in 3 domains: overall merits of Emergency Medicine, the role and function of emergency physicians and the career prospect in Emergency Medicine. Descriptive statistics were used for data analysis. Their attitude was represented by an attitude score with 80 being most positive and 16 most negative.

Results

A total of 298 students participated in the survey. The response rate was 64.5%. The overall median attitude score was 59. Year 5 students had a statistically significant higher score. Emergency Medicine ranked third in their first specialty choice after qualification. There was no statistical relationship between a student's attitude score and the specialty choice.

Conclusion

The students' overall attitude towards Emergency Medicine was positive. Senior students held a more positive attitude. A student's specialty choice after qualification did not seem to relate to their attitude towards the specialty. (Hong Kong j.emerg.med. 2014;21:67‐72)
From ICU to Emergency Department: 9-Year Experience with Non-Invasive Ventilation for COPD
Authors: Ibrahim I , Phua J , Goh EL , Mahadevan M , Lim TK
Published: December 2017

Introduction

Non-invasive ventilation (NIV) has been shown to be beneficial for chronic obstructive pulmonary disease (COPD) patients with persistent respiratory acidosis during acute exacerbations. This clinical study described the experience of implementing an NIV program in the emergency department for COPD patients.

Methods

In the pre-implementation phase, patients who presented to the emergency department were transferred to the intensive care unit for NIV. Following the NIV program, patients had NIV commenced in the emergency department. We reported the change in hospital outcomes pre and post-implementation.

Results

A total of 153 patients received NIV, 34 in the pre-implementation phase and 119 patients in the post-implementation phase. The mean pH was 7.22±0.07 and the Acute Physiology and Chronic Health Evaluation (APACHE) II score was 18.9±4. Hospital mortality was lower in the post-implementation phase (1.7% versus 11.8%; p=0.008). The median door-to-NIV time was shorter in the post-implementation phase (64 minutes; interquartile range [IQR] 35-113) versus (457 minutes; IQR 143-1320).

Conclusions

NIV program in the emergency department is feasible and is associated with better hospital outcomes in patients with COPD. (Hong Kong j.emerg.med. 2014;21:140-147)
A Pilot Study on the Repair of Contaminated Traumatic Wounds in the Emergency Department Using Sterile versus Non-Sterile Gloves
Authors: Ghafouri HB , Zoofaghari SJ , Kasnavieh MH , Ramim T , Modirian E
Published: December 2017

Background

Although the use of sterile gloves for minor and major surgical repairs is the current standard of care, use of non-sterile and clean gloves has been shown to be safe in certain procedures. In this study, we compared the infection rates of contaminated lacerations repaired with sterile versus non-sterile gloves.

Materials and methods

A prospective, randomised, two-centre pilot trial included patients that attended the emergency department with any type of visible contaminated soft tissue lacerations. The patients were selected according to convenience sampling technique and divided into two groups using random number table. Age, sex, and characteristics of the wound were assessed by a physician. According to that, the physician used sterile gloves or non-sterile, clean gloves for wound repair. Clinical data were analysed by chi-square test and paired-t test where appropriate. A p value =/< 0.05 was considered as statistically significant.

Results

Two hundred and twenty two recruited subjects with visible contaminated simple wounds were randomised to 2 groups. Males constituted 89.2% of the patients. The sites of lacerations were extremities in 50.5% of patients, head or neck in 48.4% of patients, and trunk in 1.1% of patients. Overall infection rate was 3.2%. The infection rates in the sterile gloves group and the clean gloves group were 2.02% and 4.6%, respectively (relative risk=2; odds ratio=2.3). Incidence of infection was not significantly different between two groups (p=0.322).

Conclusion

It seems that uses of clean gloves rather than sterile gloves do not increase the risk of infection in the repair of contaminated simple wounds in emergency department setting. (Hong Kong j. emerg.med. 2014;21:148-152)
Enterovirus Type 71-Related Brainstem Encephalitis: A Case Report and Literature Review
Authors: Chen DD , Li JH , Wang HW , Hou Y
Published: December 2017

Enterovirus type 71 ( EV71) infections are mainly found in infants. The severe cases are characterised by nervous system damage, acute circulatory and respiratory failures. So far, there has been no report of EV71 infection involving central nervous system in teenagers or young adults. We first reported a case of 15-year-old Han Chinese male who was infected by EV71, developed neurogenic pulmonary oedema rapidly, and had the risk factors including hyperglycaemia, significant leukocytosis and acute flaccid paralysis. The nucleic acids for EV71 were positive by Reverse transcriptase polymerase chain reaction (RT-PCR). The patient didn't belong to high risk population. Maculopapular rashes and blisters were also not found in hand, foot and mouth. These might be responsible for the failure to make an early diagnosis. (Hong Kong j.emerg.med. 2014;21:176-180)
Serial Measurement of Heart-Type Fatty Acid Binding Protein for the Rapid Diagnosis of Acute Coronary Syndromes in the Emergency Department
Authors: Limon O , Atilla R , Oray NC , Limon G , Doylan O
Published: December 2017

Introduction

We aimed to investigate the diagnostic accuracy of heart-type fatty acid binding protein (H-FABP) at admission and the third and sixth hour after admission in patients presenting to the emergency department (ED) with chest pain or equivalent symptoms.

Methods

This prospective study was performed over two months in the ED. Patients presenting with ischaemic-type chest pain or other symptoms suggestive of myocardial ischaemia were included in the study. A bedside, point-of-care, quantitative H-FABP level was measured. If the initial electrocardiography (ECG) was non-diagnostic, the patients were observed for six hours. During the observation period, serial H-FABP measurements were obtained at admission, the third hour and the sixth hour; serial measurements of total creatine kinase (CK), CK-MB, troponin I and myoglobin were recorded at admission and the sixth hour.

Results

A total of 183 patients were included in the study. Initial H-FABP was measured in a joint group of ST segment elevation myocardial infarction (STEMI) and non ST segment elevation myocardial infarction (NSTEMI) patients, with a sensitivity of 80.9%, specificity of 19.2%, positive predictive value (PPV) of 23% and negative predictive value (NPV) of 77.1%. The third-hour H-FABP was measured in the NSTEMI group, with a sensitivity of 46.7%, specificity of 80.2%, PPV of 42.4% and NPV of 82.6%. The sixth-hour H-FABP had a sensitivity of 33.3%, specificity of 73.9%, PPV of 24.2% and NPV of 81.5%.

Conclusion

H-FABP is superior to myoglobin for diagnosing myocardial infarction in a joint group of STEMI and NSTEMI patients. The third-hour NPV value for H-FABP indicates that, for safety considerations, the cardiac observation time should not be shortened. (Hong Kong j.emerg.med. 2014;21:213-221)