bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Manikin Study to Compare Video‐Optical Intubation Stylet versus Macintosh Laryngoscope Used by Novice in Normal and Simulated Difficult Airway Intubation
Authors: Tsui KL , Hung CY , Kam CW 
Published: December 2017

ObjectiveTo compare Macintosh laryngoscope with video‐optical intubation stylet on rates and time durations of successful tracheal intubation in normal and simulated difficult airway.DesignCrossover experimental study.SettingIntubation training laboratory.MethodsA group of novices (58 medical students) attempted intubation on manikin under normal and simulated difficult airway (grade 3 larygnoscopic view) settings using both Macintosh laryngoscope and video‐optical intubation stylet. The success rate, duration to intubate and occurrence of complications (oesophageal intubation and incisor breakage) when using the two different devices were measured and compared. The time results were analysed by paired t‐test and categorical results by chi square test or Fisher's exact test.ResultsThe success rate to intubate difficult airway using video‐optical intubation stylet (0.92) was significantly higher than using Macintosh laryngoscope (0.59) (p=0.002). The mean time taken to intubate difficult airway using video‐optical intubation stylet was significantly shorter than using Macintosh laryngoscope by 10.90 seconds (p=0.004). Oesophageal intubation rate was significantly higher when using Macintosh laryngoscope to intubate difficult airway compared to video‐optical intubation stylet (p=0.002). There was no significant difference on the rate of incisor breakage between the two instruments.ConclusionsNovice can learn to use both Macintosh laryngoscope and video‐optical intubation stylet to intubate successfully after a short training. Video‐optical intubation stylet is an effective “Plan B” instrument because it shortens the duration and increases the rate of successful intubation in difficult airway situations.
Nuchal Pain Predicts Subarachnoid Haemorrhage in Severe Headache Patients
Authors: Lui CT , Tsui KL , Kam CW 
Published: December 2017

Objective To find out predicting symptom(s) of non-traumatic subarachnoid haemorrhage in conscious patients without neurological deficit presenting with the primary complaint of severe headache. Design Case control study. Setting Regional public hospital, Hong Kong. Subjects Non-traumatic subarachnoid haemorrhage (ICD 9 coding 430) patients, who were conscious and with normal neurological examination, presenting to the accident and emergency department with severe headache between April 2005 to March 2007 were searched from the hospital database. The control group was recruited prospectively from the accident and emergency department during the period from November 2007 to April 2008. Results A total of 33 cases were compared to 57 controls to study on five selected symptoms and the likelihood to predict risk of subarachnoid haemorrhage. All five symptoms were significant by univariate analysis at significance level of 25%: nuchal pain (p<0.001), transient syncope (p=0.137), dizziness (p=0.026), vomiting (0=0.016) and presence of precipitating events (coitus, defecation or quarrel) (p=0.132). Only nuchal pain was statistically significant in the multivariate logistic regression analysis (OR=11.44; 95% CI=2.14 to 61.19) with age and gender controlled. Conclusions The presence of nuchal pain as a presenting symptom significantly increases the likelihood of non-traumatic subarachnoid haemorrhage by ten times among severe headache patients with normal neurological examination. Other symptoms like transient syncope, dizziness and vomiting are non-specific and do not predict a higher chance of occurrence of subarachnoid haemorrhage.
The Impact of Enhanced Intensive Care on Outcome of Major Trauma Patients in a Regional Hospital in Hong Kong
Authors: Chan ANL , Lit ACH 
Published: December 2017

ObjectivesTo describe an updated epidemiology of major trauma cases presenting to a regional hospital in Hong Kong and to analyse the impact of enhanced intensive care on the outcome of major trauma patients.MethodsThis was a retrospective comparative study. In late 2004, we amended our trauma care system with enhancement of intensive care in the management of major trauma patients. An 18-month period was chosen before and after the amendment respectively and patients' data and crude mortality rate between the two periods were compared. Stratified analyses based on mechanism of injury, injury severity and physiological parameters were also performed. Finally, a TRISS analysis was included.ResultsAltogether 163 and 155 patients were included in our study from the two periods respectively. The majority involved blunt injury and one third of them had injury severity score (ISS) greater than 15. Road traffic accidents and fall from height remained as the two leading causes of major trauma. The median length of stay in the intensive care unit increased for one day (p<0.01) in the later period but the median total length of stay in hospital remained the same. The mortality rate decreased from 10.4% to 9.7% (p=0.82).ConclusionWith enhanced intensive care, there is an apparent decrease in mortality of major trauma patients but its significance needs to be determined with a larger scale study.
Atrial Myxoma Presenting with Aphasia Alone: A Case Report
Authors: Saritas A , Emet M , Kocaturk H , Aslan S , Cakir ZG 
Published: December 2017

Atrial myxomas are the most common primary heart tumours. Symptoms are produced by mechanical interference with cardiac function or embolization. Neurological symptoms may occur approximately in one third of the patients. We report a patient who was admitted to the emergency department with only a complaint of complete aphasia and without other neurological signs and symptoms. Transthoracic echocardiography demonstrated a large mobile mass sized 4 × 4.5 cm prolapsing into the left ventricle through the mitral valve from the left atrium, suggesting the diagnosis of atrial myxoma. After surgery, aphasia resolved completely. Our objective is to inform clinicians that aphasia alone can be a symptom of atrial myxoma.
Adult Acute Epiglottitis: Predictors for Airway Intervention and Intensive Care Unit Admission
Authors: Lam PK , Choi YF , Wong TW , Lau CC 
Published: December 2017

Objectives(1) to characterise the clinical features of acute epiglottitis in adults in Hong Kong; (2) to identify predictors for airway intervention and uneventful recovery without intensive care unit (ICU) admission. Modified Early Warning Score (MEWS) was also applied in risk stratification.MethodsA retrospective cohort study of 122 consecutive laryngoscopically confirmed cases admitted to Pamela Youde Nethersole Eastern Hospital from 1998 to 2007.ResultsThe mean patient age was 51 years (range 18–84 years) and the male‐to‐female ratio was 1.9 to 1. Sore throat, dysphagia and odynophagia were the commonest symptoms and the median MEWS on presentation was 1 (range 0–10). Nine patients (7.4%) required airway intervention (5 orotracheal intubations, 2 nasotracheal intubations and 2 tracheostomies) and one patient died. Univariate analysis showed that recurrent attack (OR 35.0, 95% CI 2.77–442.69, p=0.013), dyspnoea (OR 17.41, 95%CI 2.09–144.79, p=0.001), stridor (OR 30.0, 95%CI 2.42–372.65, p=0.016) and MEWS equal to or greater than 4 (OR 5.81. 95%CI 1.16–29.17, p=0.049) were significantly associated with airway intervention. Only stridor remained a reliable predictor in multivariate analysis (OR 88.46, 95%CI 5.48–1427.45, p=0.001). Performance of MEWS in prediction for airway intervention was evaluated with the Receiver Operating Characteristic (ROC) curve. The area under curve (AUC) was 0.71 (95%CI 0.503–0.909). Forty‐five patients did not require ICU admission (36.9%). Multiple logistic regression showed that absence of hoarseness (OR 3.10, 95%CI 1.10–8.79, p=0.033), absence of fever (OR 3.2, 95%CI 1.25–8.16, p=0.015) and MEWS <1 (OR 7.07, 95%CI 1.31–38.07, p=0.023) were predictors of uneventful recovery without ICU care.ConclusionA selective approach should be adopted in airway management but those with stridor on presentation should have their airway secured without delay. MEWS cannot replace clinical judgement but a low MEWS on presentation may help in identifying low risk patients who can be managed safely without ICU admission.
Traumatic Liver Injury in Hong Kong: The Management Strategy and Outcome
Authors: Chong CN , Cheung YS , Lee KF , Rainer TH , Lai BSP 
Published: December 2017

IntroductionManagement of liver injury is challenging and evolving. The aim of this article is to review the outcome of traumatic liver injury in Chinese people in Hong Kong.Materials & methodsRecords of 40 patients with hepatic injury who received treatment at the Prince of Wales Hospital between December 2000 and May 2005 were reviewed. Demographic data, severity of liver injury, Injury Severity Score (ISS), haemodynamic status and Glasgow Coma Scale (GCS) score on admission, investigations made, concomitant injuries, management scheme, and outcome of patients were analysed.ResultsThere were 23 male and 17 female patients with a mean age of 31.3 (SD=15.4) years. Road traffic accident was the most common injury mechanism (65%). Half of the patients were treated by non‐operative management (NOM). None of them required surgery during subsequent management. Patients in the operative management (OM) group had a significantly higher ISS (p=0.026), but there was no significant difference in the mortality rate between the OM and NOM groups. Patients with stable haemodynamic status and who were treated non‐operatively had a significantly shorter hospital stay (p=0.006). High grade liver injury (OR=8.0, 95% CI=1.2 to 53.8, p=0.03) and ISS greater than 25 (OR=21.6, 95% CI=2.0 to 225.3, p=0.01) were independent risk factors for mortality on multivariate analysis.ConclusionsNon‐operative management of liver injury can be safely accomplished in haemodynamically stable patients, with the possible benefit of a shorter hospital stay.
The Role of Serum Ferritin, Pro‐Brain Natriuretic Peptide and Homocysteine Levels in Determining Ischaemic Stroke Subtype, Severity and Mortality
Authors: Üstündağ M , Orak M , Güloğlu C , Öztürk E , Tamam Y , Kale E 
Published: December 2017

BackgroundIn ischaemic stroke, there are many biochemical and immunological reactions secondary to a reduced cerebral blood flow. The purpose of this study is to investigate the correlation between stroke subtype, stroke severity, mortality, and serum ferritin, pro‐brain natriuretic peptide (pro‐BNP), homocysteine values before a specific treatment is given to stroke patients in the emergency department.MethodsConsecutive acute ischaemic stroke patients admitted between December 2007 and April 2008 were enrolled into the study. Serum ferritin, pro‐BNP and homocysteine levels were studied before specific treatment was carried out. Stroke subtypes were determined according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) and Oxfordshire Community Stroke Project (OCSP) criteria. The severity of stroke was determined by the National Institutes of Health Stroke Scale (NIHSS). Fifteen healthy individuals who matched the study group in terms of sex and age were chosen as control.ResultsNinety‐two patients were included in the study. There was a significant difference in the serum ferritin, pro‐BNP and homocysteine levels between patients who died and those who survived (p=0.013, p<0.001 and p=0.003 respectively). Serum ferritin, pro‐BNP and homocysteine levels were higher in all stroke subtypes than in the control group. Comparing among stroke subtypes, only serum pro‐BNP levels were higher in the cardioembolic stroke group than in the atherothrombotic stroke and lacunar stroke groups (p=0.003 and p<0.001 respectively); and only serum pro‐BNP levels were higher in the total anterior circulation infarct group than in the posterior circulation infarct and lacunar infarct groups (p=0.010 and p=0.017 respectively). Pro‐BNP levels were significantly higher in patients with NIHSS score >15 than NIHSS=8‐15 and NIHSS=1‐7 (p=0.016 and p<0.001 respectively).ConclusionFerritin, pro‐BNP and homocysteine levels were raised in acute ischaemic stroke patients. However, only serum pro‐BNP level is clinically useful in predicting stroke subtype, severity and mortality that could provide an insight to the choice of treatment.
Early Diagnosis of Acute Myocardial Infarction by Bedside Multimarker Test at an Emergency Department in Hong Kong
Authors: Ho CH , Cheng W , Chu G , Ho HF 
Published: December 2017

IntroductionCardiac biomarker measurement can aid diagnosis of acute myocardial infarction. The present study evaluates the efficacy and efficiency of point‐of‐care multimarkers measurement of myoglobin, creatine kinase (CK‐MB) and troponin in identifying patients with acute myocardial infarction.MethodWe prospectively enrolled consecutive patients (N=105) in the emergency department who were being evaluated for possible acute myocardial infarction. Point‐of‐care testing (POCT) of myoglobin, CK‐MB and troponin I (TnI) was performed in all patients. Central laboratory measurement of troponin I was also performed simultaneously. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio and receiver operating characteristic (ROC) curve were evaluated.ResultThe specificity and positive likelihood ratio of TnI (POCT) and TnI (laboratory) were 98%, 13.0 and 98%, 21.8 respectively. The areas under curve of the ROC curve of TnI (POCT) and TnI (laboratory) were 0.692 and 0.725 respectively.ConclusionA high positive likelihood ratio for acute myocardial infarction through point‐of‐care testing can help timely diagnosis and just‐in‐time appropriate management for patients presenting with chest pain.
Full Text Publication Rates of Studies Presented at an Asian Emergency Medicine Scientific Meeting
Authors: Tan PCF , Graham CA 
Published: December 2017

PurposeStudy findings can reach a worldwide audience only after a paper is published in the peer‐reviewed literature; this is regarded by many as the definitive contribution to global exchange of knowledge. The abstract to publication (A:P) rates for free papers presented at an emergency medicine meeting in Asia has not been investigated before. The purpose of this study was to determine the full publication rate of abstracts presented as oral presentations at the Third Asian Conference on Emergency Medicine (ACEM) in Hong Kong in 2004.MethodsA detailed literature search of the MEDLINE database was performed using first and last authors' names and appropriate key words up to January 2008.ResultsA total of 54 free paper abstracts were presented at this conference as oral presentations. Ten (18.5%) abstracts had subsequently been published as full articles by the end of January 2008. The full‐text articles were published in eight different journals.ConclusionsThe A:P ratio of abstracts for oral presentations at ACEM 2004 was 18.5%, lower than that of similar meetings in the US and Australasia. It is normal for less than half of the abstracts presented at meetings to be published as full papers in refereed journals, largely due to the inability to overcome the barriers that present at each stage towards publication. Lack of researcher time due to pressure of clinical work and English language skills may play an important role in Asia.
An Analysis of Escalator‐Related Injuries in an Emergency Department
Authors: Lee DH , Kim CW , Kim SE , Lee SJ 
Published: December 2017

BackgroundEscalator‐related injuries have been considered uncommon and most likely to occur in children. In this study, we described the epidemiology of these injuries with focus on the aged population in order to determine whether escalators are safe for the aged, and to obtain information to help in preventing escalator‐related injuries.MethodsA prospective survey was taken to identify the number and nature of these injuries from May 2004 to December 2008. We enrolled patients who had sustained escalator‐related injuries. A standard list of questions and answers were recorded by the emergency physician. A total of 104 questionnaires were completed during the study period.ResultsThe average patient age was 59.2±24.0 years (range 1‐94). There were 64 (61.5%) females. Only 11 (10.6%) were younger than 15 years old, and 59 (56.7%) were aged 65 or above; 35 (59.3%) of the aged people were injured while standing on the escalator. However, out of the 45 patients younger than age 65, 22 (48.9%) were injured from walking on a moving escalator. Head injury was the commonest site of injury overall and all were due to fall or slipping down.ConclusionsEscalator‐related injuries are not as rare as previously believed and the aged population 65 years old or above is the highest risk group. In particular, walking on a moving escalator was the main cause of injury in people under age 65. Therefore, primary prevention strategies are needed to prevent users from walking on escalators, especially young people, and educate aged people the safe utilization of escalators to prevent slip and fall injuries.
The Value of Point‐Of‐Care Fatty Acid Binding Protein in Patients with Chest Pain in Determining Myocardial Infarction in the Emergency Setting
Authors: Cete Y , Eken C , Eray O , Goksu E , Kiyan S , Atilla R 
Published: December 2017

IntroductionDetecting patients in the early hours of acute myocardial infarction is still a challenge for emergency physicians. Fatty acid binding protein (FABP) was thought to be released into the intravascular space earlier than cardiac troponins. The aim of this study was to determine the diagnostic value of point‐of‐care FABP test either in diagnosing or excluding myocardial infarction during the initial admission of patients presenting with typical chest pain to the emergency department.MethodsThis study was performed in a tertiary care emergency department. Patients with typical chest pain were included into the study. Point‐of‐care FABP was studied during the initial admission and two hours after admission. Patients were diagnosed as myocardial infarction or not ultimately by ECG and troponin levels.ResultsA total of 224 patients were included into the study, 73 of them (32.6%) were diagnosed as acute myocardial infarction. FABP had a sensitivity and specificity of 41.0% (95%CI 29.7 to 53.2) and 100% (95%CI 97.6 to 100) and myoglobin had a sensitivity and specificity of 57.5% (95%CI 45.4 to 69.0) and 90.7% (95%CI 85.0 to 95.0) during the initial admission. Cardiac troponin T had a sensitivity of 45.2% (95%CI 33.7 to 57.2) and specificity of 100% (95%CI 97.0 to 100) during the initial admission. Two hours after admission, FABP had a sensitivity of 56.0% (95%CI 40.0 to 71.0) and specificity of 99.0% (95%CI 96.4 to 100) respectively.ConclusionsPoint‐of‐care FABP is good at diagnosing acute myocardial infarction in patients presenting with chest pain. However, FABP was found to be not better than either myoglobin or cardiac troponin T in excluding acute myocardial infarction in patients presenting with chest pain.
A Simplified Appendicitis Score in the Diagnosis of Acute Appendicitis
Authors: Goh PL 
Published: December 2017

IntroductionScoring systems such as the Modified Alvarado Score (MAS) can help in the early diagnosis of acute appendicitis (AA) but is cumbersome to use and has not found widespread popularity. A more robust, user‐friendly Simplified Appendicitis Score (SAS) was investigated.MethodsPatients presenting with suspected AA were prospectively enrolled. The performance of the SAS (using only 5 variables – migratory pain, right lower quadrant tenderness, rebound pain, fever >37.3 degrees Celsius and leucocytosis >12,000/uL) was analysed and compared to the MAS.ResultsOut of 238 patients enrolled over four months, 95 (39.9%) patients underwent appendectomy, of which 81 patients had histologically proven AA. A MAS of ≥8 was 92.4% specific for ruling in AA, while a score of <5 was 91.4% sensitive in ruling out AA. A SAS of ≥6 was 91.7% specific for ruling in AA, while a score of <4 was 90.1% sensitive in ruling out AA.ConclusionsThe performance of the MAS can be maintained by omitting the two subjective variables – “anorexia” and “nausea/vomiting”, and increasing the leucocytosis cut‐off level. A SAS using only 5 variables performed as well as the original MAS.
The Impact of Emergency Medicine Ward in Acute Intoxication Management
Authors: Ko S , Chan HY , Ng F 
Published: December 2017

Background The Emergency Medicine Ward (EMW) was established in Caritas Medical Centre (CMC) in November 2007 under the management of emergency physicians. With the support from the psychiatric team and medical social workers, it provided effective management for intoxicated patients as an alternative to traditional inpatient service. Objective The aim of this study was to evaluate the impact of the EMW in the management of acute intoxication. Method A retrospective comparative study with data retrieved from all admitted intoxicated and suspected intoxicated patients was carried out over two separate half-year periods in 2007 and 2008, before and after the establishment of the EMW. Data on patient demographics, reason of exposure, substance involved, treatment, psychiatric service offered, clinical outcome, hospital length of stay (LOS) and 28-day hospital re-admission were compared. Results A total of 316 intoxicated patients were admitted to CMC with 165 in the 2007 group and 151 in the 2008 group. Both groups shared similar basic epidemiological data. There was a marked reduction in hospital LOS from 80.1 hours to 45.9 hours (p<0.01), a markedly increased proportion of patients receiving psychiatric service from 47.9% to 71.5% (p<0.01) and a significant decline in the access time of psychiatric assessment from 27.4 hours to 10.6 hours (p<0.05). There were no statistically significant difference in treatment, patient clinical outcome and 28-day hospital re-admission. Conclusions The establishment of EMW achieved a significant reduction in hospital LOS of intoxicated patients without jeopardizing patient outcome. The results also illustrate that EMW can provide a good platform for the integration of psychiatric service for these patients.
Mass Casualty Incident Involving Pepper Spray Exposure: Impact on the Emergency Department and Management of Casualties
Authors: Oh JJ , Yong R , Ponampalam R , Anantharman V , Lim SH 
Published: December 2017

Introduction Exposure to pepper spray in an urban shopping complex resulted in 13 casualties being treated at a tertiary public hospital emergency department (ED). This report describes the ED's organisation in response to the disaster, and clinical management of those affected. Results Thirteen casualties – 11 acute, 2 delayed – presented with symptoms ranging from ocular, respiratory and skin irritation to nausea, vomiting and giddiness. The culprit agent was determined basing on the index patient's history and physical findings. All cases were decontaminated at the ED's on-site Hospital Decontamination Station. Nine adults were monitored overnight in the Emergency Observation Ward under the Toxic Inhalation Protocol and discharged well. The index case was treated symptomatically with improvement, but discharged against medical advice three hours later. No ED re-attendances were recorded. Conclusions The effects of pepper spray exposure are brief and self-limiting, but ED management can pose challenges in a mass casualty situation.