bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Development of Emergency Medicine in South Korea: Academic Productivity in Highly Cited Journals
Authors: Lee J , Kang HG , Lim TH , Oh J , Cho Y , Cho JH 
Published: December 2017

Introduction The purpose of this study was to examine the number of publications by South Korean emergency physicians in highly cited journals and the increase in their numbers. It also sought to assess the impact factors of such publications. Methods The present study was a retrospective quantitative literature review of the publications by South Korean emergency physicians from 1996 to 2011 in the category of “emergency medicine” in the science edition of Journal Citation Reports 2011. We analysed the total number of articles published by South Korean emergency physicians and their impact factors. Results Between 1996 and 2011, the number of South Korean board-certified emergency physicians increased from 51 to 958, and 230 articles were published in 14 highly cited journals. The total impact factor (IF) of the original articles published during that period was 227.86, and the mean IF was 1.93. More than 10 articles had been published annually in the past 5 years in highly cited journals and there were over 400 South Korean board-certified emergency physicians. Conclusions Emergency medicine in South Korea started about 20 years ago, but academic productivity, indicated by at least ten articles annually in highly cited journals, was only achieved in the last five years. The mean IF of these articles was similar to that in other highly productive countries. (Hong Kong j.emerg.med. 2014;21:205-212)
The Reliability of Modified Termination of Resuscitation Rules after Arrival at the Emergency Department
Authors: Kuo Ci , Kuo Cw , Hsu Sc , Lin Cc , Weng Ym 
Published: December 2017

Introduction Pre-hospital termination of resuscitation (TOR) is not a usual practice in many cities. The current study aimed to examine the reliability of the modified basic life support (ED-BLS) and advanced life support (ED-ALS) rules for TOR after patient arrival at the emergency department (ED). Methods In this retrospective cohort study, adult non-traumatic cardiac arrest patients who received pre-hospital basic life support and defibrillator (BLS-D) mode of service in Taoyuan County in northern Taiwan during the study period were assessed. Data were retrieved from web-based registry records. Results Of the 1612 patients included, 40 (2.5%) achieved survival to discharge. The ED-ALS rule showed higher specificity (ED-ALS rule: 82.5% {95% confidence interval [CI]: 68.1-91.3} vs. ED-BLS rule: 50.0% {95%CI: 35.2-64.8}) and positive predictive value (ED-ALS rule: 99.0% {95% CI: 97.9-99.5} vs. ED-BLS rule: 98.6% {95%CI: 97.8-99.1}) than the ED-BLS rule in terms of predicting no survival to discharge after patient arrival at the ED. Among patients who fulfilled all criteria for the ED-BLS and ED-ALS rule, 20 (1.4%) and seven (1.0%) survived to discharge, respectively. Application of the ED-BLS and ED-ALS rules could have reduced further resuscitation efforts after arrival at the ED by 86.4% and 43.1%, respectively. Conclusion For non-traumatic out-of-hospital cardiac arrest patients who receive BLS-D service, the ED-ALS rule has a higher specificity and PPV than the ED-BLS rule to predict no survival to discharge after patient arrival at the ED. Using the ED-ALS rule to terminate resuscitation after arrival at the ED should be prospectively validated. (Hong Kong j.emerg.med. 2014;21:283-290)
Could C-Reactive Protein be a Potential Biomarker of Complicated Acute Appendicitis?
Authors: Lai Cy , Leung Yk , Graham Ca 
Published: December 2017

Introduction The purpose of this study is to evaluate the diagnostic value of C-reactive protein (CRP) to identify complicated appendicitis (defined as perforation, abscess or gangrenous appendicitis) versus simple appendicitis. Methods A retrospective study was performed in the emergency department (ED) of Prince of Wales Hospital in the New Territories of Hong Kong. The clinical records of patients admitted to the surgical wards via the ED over 17 months were reviewed by a research assistant. We included all patients aged >13 years who had a provisional diagnosis of “acute appendicitis” or “right lower quadrant pain”. We excluded patients with pregnancy, previous appendicectomy, incomplete medical records or no CRP levels determined before operation and those who discharged themselves from hospital against medical advice after admission. The outcome of this study was the CRP level in relation to the presence of complicated appendicitis. ROC curve analysis was employed to identify the optimum cut-off level of CRP which had the best sensitivity and specificity to identify complicated appendicitis compared to simple appendicitis. Results Forty-two patients were diagnosed to have acute appendicitis, 31 of whom had complicated appendicitis. CRP level was higher in the group of complicated appendicitis (p<0.05). We identified an optimum cut-off value for CRP of 40.1 mg/L to discriminate between complicated and non-complicated appendicitis. The sensitivity and specificity of CRP to identify complicated appendicitis were 71.0% and 100% respectively at this cut-off level. Conclusion High CRP levels could possibly predict the diagnosis of complicated appendicitis and facilitate more appropriate surgical care. This finding needs to be confirmed in prospective and larger multicentre studies. (Hong Kong j.emerg.med. 2014;21:354-360)
The Role of CT and MRI in Suspected Acute Cervical Spine Trauma
Authors: Friesen B , Brownlee R 
Published: December 2017

Objective To evaluate the accuracy of computed tomography (CT) in evaluation of patients with acute cervical spinal injury. Design Retrospective case series. Setting Three major public emergency departments in the southern hemisphere. Methods We performed a retrospective review of patients with neck injury aged at least 16, with CT cervical spine examinations performed for blunt trauma over a 6 month period (1 January 2011 to 30 June 2011) and magnetic resonance imaging (MRI) cervical spine performed for same indications over two and a half years (12 January 2010 to 22 June 2012). Results Acute cervical spine trauma was present on CT in 35 of 783 patients (4.5%) and on MRI in 98 of 206 patients (48%). Eleven of the 35 patients (31%) with CT confirmed trauma did not meet the Hanson criteria; the majority were at least 60 years of age and none had unstable injuries. CT is 100% sensitive in excluding an unstable injury if there is no soft tissue abnormality or fracture (with MRI as gold standard). An abnormal CT (including subtle paravertebral fat stranding) is often non-specific and often cannot reliably confirm an unstable ligamentous injury. Close attention to soft tissue axial and sagittal soft tissue CT reconstructions is important, as abnormalities can be subtle. Conclusions An unstable injury can often be excluded if CT is completely normal, without the need for MRI. (Hong Kong j.emerg.med. 2014;21:368-372)
Clinical Efficacy of Metoclopramide to Treat Pain and Nausea in Renal Colic Patients: A Prospective Randomised, Double-Blind, Controlled Trial
Authors: Kaya F Baloglu , Cevik Aa , Acar N , Kaya S , Zeytin At , Can C , Metintas S 
Published: December 2017

Introduction This study aimed to evaluate the clinical efficacy of intravenous metoclopramide for the relief of pain and nausea among the emergency department patients with renal colic. Methods Patients were randomised into three groups: tenoxicam (20 mg); tenoxicam (10 mg) plus metoclopramide (10 mg); and metoclopramide (10 mg). Changes in pain and nausea were examined at the 10th, 20th and 30th minute after treatment. The development of side effects would be recorded. After the 30th minute, the need for additional pain and nausea relief was evaluated. Results Totally 80 patients were enrolled in each group. There was significant mean pain score difference as measured by visual analog scale (VAS) from 0 minute to 10th, 20th and 30th minute post-treatment for all treatment groups (p<0.001). There was no significant difference in mean VAS decrease from 0 minute to the 30th minute: tenoxicam group: 36 mm [95% confidence interval (CI) 28-43 mm] vs. tenoxicam plus metoclopramide: 45 mm (95% CI 38-52 mm) vs. metoclopramide group: 37 mm (95% CI 30-45 mm) (p=0.163). Similarly, no significant differences in mean nausea scores between the three groups were demonstrated at the 10th, 20th and 30th minute after treatment (p=0.236, 0.330 and 0.652 respectively). After the 30th minute, 43 (53%) patients needed additional pain relieving agent in the tenoxicam group compared to 27 (33%) patients in the tenoxicam-metoclopramide group and 33 (41%) patients in the metoclopramide group (p=0.030). No significant adverse drug reaction events were encountered. Conclusion Metoclopramide is as effective as tenoxicam to treat pain and nausea for patients with renal colic in the emergency department. (Hong Kong j.emerg.med.2015;22:93-99)
A Prospective Validation of National Early Warning Score in Emergency Intensive Care Unit Patients at Beijing
Authors: Liu Fy , Qin J , Wang Rx , Fan Xl , Wang J , Sun Cy , Cao T , Liang X 
Published: December 2017

Introduction National Early Warning Score (NEWS) was launched in 2012 by the Royal College of Physicians in UK with an aim to improve the assessment of critical patients and timely detection of clinical deterioration. Objective To assess the performance of NEWS in emergency intensive care unit (EICU) patients in Beijing, PROC. Design prospective cohort study. Setting EICU in a university hospital. Methods The inclusion criteria were patients who stayed in the EICU beds under Department of Emergency Medicine, Xuanwu Hospital of Capital Medical University. Data of patients on admission were collected and calculated NEWS. Main outcome measure was death within 24 hours. The ability to predict mortality was assessed by area under the receiver operating characteristic curve (AUROC) analysis. Results Data on 540 consecutive EICU patients were collected from 1st January, 2013 to 31st March, 2013. Scores of 7 or more were associated with increased risk of death (OR=16.8; 95% CI 6.6-42.9). The AUROC for death within 24 h of admission was 0.85 (95% CI 0.79-0.90). Conclusions NEWS is applicable and feasible for EICU patients in Beijing. This study shows that the prediction power of NEWS for death within 24 hours of acutely ill patients attending Xuan Wu Hospital is comparable to that reported for the United Kingdom patients. (Hong Kong j.emerg.med. 2015;22:137-144)
Outcome after Implementation of Sepsis Guideline in the Emergency Department of a University Hospital in Hong Kong
Authors: Yang Mlc , Graham Ca , Rainer Th 
Published: December 2017

Introduction Internationally, standard care of patients with severe sepsis consists of early detection, early antimicrobial therapy, and aggressive intravenous fluid therapy to maintain tissue oxygenation and perfusion. In this retrospective study, we aimed to examine the management of patients with severe sepsis in a local university hospital emergency department before and after the implementation of a sepsis management guideline. Method We collected data on the management and outcome of patients during a three-month period before the implementation of a sepsis guideline (October-December 2009). We then collected similar data one year after the implementation (October-December 2010). Key sepsis management areas and in-hospital mortality rates were compared, as were length of resuscitation, three-month mortality rate, hospital length of stay (LOS) and intensive care unit (ICU) LOS. Results Data from 115 patients were collected in the pre-implementation group, while data on 102 patients were collected for the post-implementation group. There were more patients with hypoperfusion in the post-implementation cohort (25.2% vs. 40.2%, p=0.019). There was no difference in background characteristics, average lactate value, average MAP or number of hypotensive patients between the two groups. Significantly more antibiotics were given after the intervention (13.0% vs. 23.5%, p=0.045) and more patients had a lactate level measured (43.0% vs. 73.5%; p<0.001). There was a trend towards better survival for a subgroup of patients with hypoperfusion (48.0% vs. 29.2%, p=0.060). Conclusions Implementation of a sepsis guideline leads to more antibiotics being given and more lactate measurement in the emergency department. (Hong Kong j.emerg.med. 2015;22:163-171)
Clinical Outcomes of Trauma Patients after Implementation of a Standardised Diversion Protocol for Trauma Patients in Two Regional Hospitals in Hong Kong
Authors: Mok YT , Ma HM , Leung M , Yeung HC , Lit ACH , Luk HT 
Published: December 2017

IntroductionDespite recent advance in prehospital trauma diversion, patients are triaged to the nearest medical facility before transferred to designated trauma centre. A new standardised diversion protocol for trauma patients was implemented on 1st April 2011 to facilitate trauma care. Severely‐injured patients were transferred to designated trauma centre directly from emergency department of the regional hospital after initial resuscitation.ObjectiveThis study was undertaken to examine clinical outcomes of trauma patients after implementation of the new standardised diversion protocol for trauma patients in the emergency department.MethodThis was a before‐and‐after interventional study on trauma patients presenting to the emergency department in critical or emergency conditions during the study period from 1st April 2011 to 31st March 2012. Patients presented in the two‐year period before implementation of the trauma protocol were used as historical control. Medical records of eligible cases were reviewed. Main outcome measures were 30‐day mortality, length of hospital stay and time to definitive care. Mortality data was compared with oversea standard by TRISS methodology.ResultsThere were 153 eligible patients in the study group and 355 in the historical control group. After new arrangement of trauma diversion, W‐statistics improves from ‐1.26 to 0.09. Z‐statistics was ‐2.03 before and 0.09 after implementation. M‐statistics were 0.91 before and 0.88 after the new protocol. Mean time to definitive care was shortened by 33.4 minutes in the subgroup who were transferred to trauma centre after trauma team activation (p=0.005).ConclusionA trend of improved outcomes and shorter time to definitive care are observed after implementation of the new trauma diversion protocol. (Hong Kong j.emerg.med. 2015;22:201‐209)
Resident as Teacher: General needs Assessment in Emergency Medicine
Authors: Gan HN , Goh YGK , Tiah L 
Published: December 2017

IntroductionIncreasingly, residents are involved in the education of medical students, their peers and other health professionals. This study focused on the general needs assessment of the emergency medicine (EM) residents in developing a resident‐as‐teacher curriculum.MethodsAn anonymous and voluntary survey, which consisted of multiple choice and free text questions, was sent to all emergency physicians (EPs) working in the 7 restructured hospitals in Singapore.ResultsA total of 68 (60%) EPs completed the online survey. Overall, 19 (28%) EPs have undergone formal training in teaching. Majority of the EPs felt that it was important for the residents to acquire competent teaching skills at the end of their residency training. All of the EPs were in consensus that there should be formal instruction to the residents on how to teach. The four themes which emerged from the barriers to developing teaching skills in residents were time constraints, lack of faculty development, attitudes of both faculty and residents and a non‐conducive work environment with high service requirements.ConclusionsTo develop the resident as an all rounded Emergency Physician, structured training and formal instruction for the developing of teaching and feedback skills must be included in the residency training. However in order for the new curriculum to be successful and achieve its primary objective of developing the residents' competencies in teaching, barriers hindering both the faculty and residents have to be addressed. Finally, faculty development needs to be done to equip the faculty with the appropriate teaching and feedback tools. (Hong Kong j.emerg.med. 2015;22:226‐234)
Effect of Pulse Therapy with Glucocorticoids and Cyclophosphamide in Patients with Paraquat Poisoning
Authors: Ghorbani A , Masoumi K , Forouzan A , Rahmani AH , Rahim F , Taeybi B Taherinezhad , Feli M 
Published: December 2017

IntroductionParaquat (PQ) is a widely used herbicide with a high mortality rate when ingested. The aim of the present study was to assess the effectiveness of repeated cyclosphosphamide (CP) and methylprednisolone (MP) combination in the treatment of PQ poisoning.DesignRandomised, double‐blinded, placebo‐controlled trial.MethodsEligible participants were 47 patients with moderate to severe PQ poisoning within 24 hours of hospitalisation. Patients were allocated in a random fashion, 24 as the intervention and 23 as the control group. All patients received two cycles of eight hours of haemoperfusion with charcoal, and underwent emergency haemodialysis. After the dialysis, the intervention group received 15 mg/kg CP for two days and 1g MP for three days. The control group received routine supportive care. Outcome parameters, including mortality, incidence of hypoxia, hepatitis and renal failure were compared between the two groups.ResultsThere were no significant differences between the two groups with regard to age, sex, baseline liver function test, creatinine, time from poisoning to dialysis, and time from poisoning to the hospitalisation. Although the incidence of hepatitis and acute renal failure did not differ significantly between the two groups, the incidence of hypoxia and mortality rate was lower in the intervention group. The number need‐to‐treat to reduce one mortality was 2.8.ConclusionThe results suggest that CP and MP repeated treatment can reduce the mortality rate in moderate to severe PQ intoxication.
Streamlined Liner of the Pharynx Airway: Randomised Comparison of Size Selection Strategies with Regard to Patient Height versus Thyroid Cartilage Width
Authors: Ahn EJ , Kang H , Choi GJ , Yang SY , Shin HY , Baek CW , Jung YH , Woo YC , Han SS 
Published: December 2017

Introduction Streamlined Liner of the Pharynx Airway (SLIPA) is a disposable supraglottic airway. There are two strategies to select the size of SLIPA: by height and width of thyroid cartilage. This study compared the utility of the two strategies in selecting the optimal size. Methods One hundred forty-two patients were randomly divided into two groups with size selection by height (H) and the maximal width of the thyroid cartilage (T). The SLIPA size was selected by height in group H, and by the width of thyroid cartilage in group T. After inserting SLIPA, the investigator made note of the oropharyngeal leakage pressure (OLP) and the degree of insertion difficulty. We set the OLP as a primary outcome. In cases of an OLP <15 cmH2O, the investigator manipulated the apparatus to try to reposition it. If air still leaked, another attempt was made using a SLIPA one size larger until an OLP >15 cmH2O was achieved in up to three attempts. After insertion, the investigator measured the inspiratory and expiratory tidal volume. Post-operatively, the presence of blood or regurgitated fluid on the device was evaluated. Results OLP for group T was higher than that of group H (p=0.009). The need for manipulation and the leak fraction was higher in group H than in group T (p=0.008 and 0.034, respectively). The degree of insertion difficulty, number of trials and incidence of blood and regurgitated fluid on the device were similar between the two groups. Conclusions Both the width and height of thyroid cartilage can be used for selecting the optimal SLIPA size. (Hong Kong j.emerg.med. 2015;22:303-311)
A Comparison of the Performance of Different Age-Based Paediatric Weight Estimation Formulae in Hong Kong Children
Authors: So Jlt , Chow Epf , Cattermole Gn , Graham Ca , Rainer Th 
Published: December 2017

ObjectiveTo evaluate the performance of five existing age-based weight estimation formulae - the original and updated Advanced Paediatric Life Support (APLS) formulae, Luscombe formula, Best Guess formula, Chinese Age Weight Rule (CAWR) - as well as a new two-part weight estimation formula, the Chinese Age Weight Rule-3 (CAWR-3), in Hong Kong children presenting to the emergency department (ED).MethodsData based on children aged 1-12 who presented to the ED of a tertiary referral centre in Hong Kong over a six-month period. Actual weight was compared against estimated weight from the weight estimation formulae. Level of agreement was assessed by Bland-Altman analysis using mean percentage difference (MPD) and 95% limits of agreement (LOA). Root mean squared error (RMSE) and proportions of weight estimates within 10%, 15% and 20% of actual weight were calculated.ResultsA total of 4600 children were included. The CAWR-3 outperformed the five existing weight estimation formulae. The CAWR-3 had the least MPD in age 4-12 (MPD +3.2%), as well as the second least MPD in age 1-12 (MPD -0.7%). The CAWR-3 had narrowest 95% LOA in age 1-3 (95% LOA -32.6% to 21.9%) and the second narrowest 95% LOA in age 1-12 (95% LOA -37.5% to 36.1%). The CAWR-3 had the smallest RMSE of 6.33 kg in age 4-12 and the smallest RMSE of 4.90 kg in age 1-12. Furthermore, the CAWR-3 had the highest proportion of weight estimates within 10%, 15% and 20% of actual weight.ConclusionThe CAWR-3 outperforms the five existing age-based weight estimation formulae in Hong Kong children presenting to the emergency department.
A Retrospective Study of Patients with Minor Head Injury to Compare the Canadian CT Head Rule and the New Orleans Criteria
Authors: Lo Ws , Shih Yn , Leung Cs , Cheung Lw , Leung M , Yeung Hc , Lit Ach 
Published: December 2017

ObjectiveTo compare the performance of the Canadian CT Head Rule (CCHR) and the New Orleans Criteria (NOC) in minor head injury patients.MethodThis retrospective cohort study collected data and CT head reports of all minor head injury patients from 1 January 2008 to 31 December 2010. We compared the sensitivity, specificity, positive and negative predictive values of both rules in predicting clinically important brain injury on CT and the need of neurosurgical intervention.ResultsWe reviewed 474 patients with minor head injury. Seventy seven patients had clinically important brain injury and 11 underwent neurosurgical intervention. The sensitivity of the CCHR and NOC in predicting clinically important brain injury were 80% (95% confidence interval [CI] 70-88%) and 92% (95% CI 86-98%), respectively; and the specificity of the CCHR and NOC were 39% (95% CI 33-44%) and 17% (95% CI 13-21%), respectively. The sensitivity of the CCHR and NOC in predicting the need of neurosurgical intervention were 80% (95% CI 55-100%) and 100% (95% CI 100-100%), respectively; and the specificity of the CCHR and NOC were 36% (95% CI 31-41%) and 15% (95% CI 12-19%), respectively. The negative predictive values (NPV) of the CCHR and NOC for clinically important brain injury were 88% (95%CI 83-94%) and 91% (95%CI 84-98%); and for the need of neurosurgical intervention were 99% (95% CI 96-100%) and 100% (95% CI 100-100%). Amongst those missed cases, 88% in the CCHR group and 83% in the NOC group reported loss of consciousness.ConclusionsThe NOC is more sensitive but less specific than the CCHR in predicting both outcomes. Both rules have excellent NPV to rule out the need of neurosurgical intervention.