bluuebunny/crossref_metadata_2025_split huggingface dataset:
Short Term Prognostic Value of the Rapid B-Type Natriuretic Peptide Assay on Length of Hospitalisation in Congestive Heart Failure Patients Presenting to an Emergency Department in Hong Kong: A Prospective Observational Study
Authors: Law KK , Yau WH , Ho HF 
Published: December 2017

Introduction Congestive heart failure is a common disease presentation to the emergency department (ED) and most of these patients require hospitalisation for treatment. The aim of this study was to assess the predictive value of B-type natriuretic peptide (BNP) level measured at the ED with respect to the length of hospital stay (LOS) in patients presenting with congestive heart failure (CHF). We also compared whether the BNP level could be a better predictor of LOS than clinical parameters and attempted to establish a cut-off point of BNP level which could differentiate those CHF patients with short hospital stay from the whole population of CHF patients. Method Patients with clinical features compatible with congestive heart failure were recruited into the study. Point-of-care test for BNP level was performed. The LOS, 6-month readmission and mortality were retrieved from the computer Clinical Management System of the hospital. Pearson's correlation coefficient was used to test the association of BNP level and the LOS, 6-month readmission and mortality rate. Result One hundred and twelve (112) patients were recruited into this study and 20 of them succumbed during hospitalisation. The data of the remaining 92 patients were analysed. The correlation coefficient of BNP level and LOS was 0.088. The correlation coefficient of BNP level and readmission within 6 months was 0.130 while the correlation coefficient of BNP level and 6-month mortality was 0.121. The correlation coefficient of other clinical features and LOS ranged from −0.098 to 0.247. The mean LOS of patients with BNP less than 400 pg/ml was 93.29 hours (95%CI=57.38 to 129.19). The mean LOS of patients with BNP greater than 400 pg/ml was 181.05 hours (95%CI=126.01 to 236.08). Patients with BNP level less than 400 pg/ml tended to have a shorter LOS than those with BNP level greater than 400 pg/ml (p=0.046). Conclusion CHF patients with BNP level measured in the emergency department greater than 400 pg/ml tend to have a longer LOS than patients with BNP level less than 400 pg/ml. BNP is not a good predictor for readmission and mortality of these patients.
Evaluation of the Modified Acute Physiology and Chronic Health Evaluation Scoring System for Prediction of Mortality in Patients Admitted to an Emergency Department
Authors: Labaf A , Zarei MR , Jalili M , Talebian MT , Hoseyni HS , Mahmodi M 
Published: December 2017

Objective To evaluate the ability of the Modified Acute Physiology and Chronic Health Evaluation (M-APACHE II) scoring system for the prediction of mortality in patients admitted to a tertiary emergency department in Iran. Methods During the study period, all patients aged >12 years who had been admitted to the emergency department of a tertiary hospital in Tehran, Iran were enrolled in the study. Traumatic and poisoned patients and those who died immediately after arriving at the emergency room were excluded. Using the M-APACHE II, risk of mortality was calculated for each patient. Finally, expected and observed mortalities were compared and the accuracy of M-APACHE II for prediction of mortality was determined using receiver operating characteristics (ROC) analysis. Results During the study period, 389 cases including 236 males (60.7%) were enrolled into the study. The mean age of the patients was 60.6±19.4 years (range 14 to 98 years). 117 patients died (30%) while the M-APACHE II predicted 129 deaths. The greatest discrepancy between observed and expected deaths occurred at M-APACHE II scores ≥21. The constructed area under the ROC curve basng on predicted and observed death was 0.938 (95% confidence interval 0.915-0.961). Conclusion M-APACHE II is an accurate scoring system for predicting mortality in patients admitted to the emergency department. However, further studies are needed to confirm our findings.
Predictors of Mortality in Blunt Multi-Trauma Patients: A Retrospective Review
Authors: Ustundag M , Aldemir M , Orak M , Guloglu C 
Published: December 2017

PurposeThe purpose of this study was to identify risk factors predicting mortality in multiple blunt trauma patients so as to prompt appropriate management during trauma resuscitation.MethodTo assess risk factors potentially related to mortality in multiple blunt trauma patients, we reviewed the medical records of 1419 multiple blunt trauma patients who were admitted to the emergency department. The patients were divided into two groups; the survival group (n=1308) and the death group (n=111). Initial data collected on arrival in the emergency department were analyzed.ResultsIn the study, 67.4% (n=956) of 1419 patients were male, 32.6% (n=463) were female. The average age was 21.19±0.50 years (range 1-92). After controlling for the factors significantly related to outcome (all p<0.05), death due to multiple blunt trauma was more likely in patients who were of older age, who had major chest injury, who had intra-abdominal solid organ injury and who had low Glasgow Coma Scale (GCS) score and low Revised Trauma Score (RTS).ConclusionWe conclude that older age, major chest injury, intra-abdominal solid organ injury, low GCS and low RTS were identified as possible risk factors for mortality in multiple blunt trauma patients.
Bicycle-Related Crashes in Hong Kong: Is it Possible to Reduce Mortality and Severe Injury in the Metropolitan Area?
Authors: Sze NN , Tsui KL , Wong SC , So FL 
Published: December 2017

BackgroundCycling is not the primary mode of commuter transport in Hong Kong, yet cyclists are exposed to a high risk of injury and fatality in road crashes. It is essential to identify the significant factors contributing to severe injury among cyclists in Hong Kong.AimTo evaluate the effects of significant factors, including demographics, temporal distribution, cyclist behavior, road conditions, and weather, on the risk of severe and life-threatening injury among cyclists in road crashes in Hong Kong.MethodThe study was nested on a database known as Road Casualty Information System (RoCIS) which is a linked database between police traffic accident investigations reports and hospital injury records. A total of 682 victims were identified during the study period from 1 January 2004 to 31 December 2006. In particular, injured body part, demographics, helmet use, alcohol intoxication, weather conditions, road type and geometry, and collision characteristics of 682 trauma patients were the attributing variables of concern. The primary outcome measure was the injury severity of trauma patients which was classified into three levels: slight injury [Injury severity Scale (ISS) </=8], severe injury (ISS >/=9), and life-threatening injury (ISS >/=25). A multinomial logit regression model was established to evaluate the significance of factors contributing to severe and life-threatening injuries among cyclists in road crashes.ResultsThe results indicated that middle-aged and elderly (35-54, RRR=2.48; and 55 or above, RRR=4.39) casualties and favourable weather conditions (2.56) significantly increased the risk of severe injury among cyclists. The presence of severe head injury (RRR=509.24), severe trunk injury (RRR=79.24), and the involvement of motor vehicles (RRR=27.18) substantially increased the risk of life-threatening injury to cyclists.ConclusionsMiddle-aged casualties, the presence of head injuries, and the involvement of motor vehicles all increase the risk of more severe injury in bicycle-related crashes. Safety education and countermeasures should target at middle-aged and elderly cyclists and discourage cycling on the motorway.
Poison Exposure in the Emergency Department: A Singaporean Experience
Authors: Chiu LQ , Lim BL , Vasu A , Phua DH , Goh HK 
Published: December 2017

IntroductionPoison exposure is a significant problem in emergency departments (EDs) with high admission rates. Our study aims were to describe the demographics, exposure patterns and clinical outcomes of our ED patients as well as to explore predictors of Intensive Care Unit (ICU) / High Dependency (HD) admission.MethodsIn this retrospective study, we recruited patients aged over 16 years who presented with poison exposure to our ED over one year. We collected demographical and clinical data using our hospital databases. Primary outcomes were mortality rate and disposition status. Secondary outcomes were predictors for ICU/HD admission. Logistic regression was applied to identify these predictors.ResultsWe recruited 615 patients from an ED attendance of 162,159. Four hundred and nineteen (68%) patients were females; the majority [410 (66.7%)] was Chinese. The median age was 33 years [interquartile range (IQR): 24‐44]. Four hundred fifty‐six (74.1%) and 159 (25.9%) exposures were intentional or accidental respectively. There were no mortalities. The majority [466 (75.8%)] was admitted to the general ward and only 24 (3.9%) cases were ICU/HD admissions. We identified four factors associated with ICU/HD admission. Odds ratios (95% confidence intervals) for hypotension (systolic blood pressure <90 mmHg), pupillary changes, previous psychiatric history and tricyclic antidepressant overdose were 19.7 (5.57‐69.65), 31.9 (7.01‐145.76), 3.1 (1.08‐9.07) and 30.1 (9.40‐96.52) respectively.ConclusionsPoison exposure is an infrequent ED occurrence with high admission rates but low mortality. Our study identified risk factors for ICU/HD admission that could be used in future studies to triage at‐risk patients for treatment escalation.
Hong Kong Poison Information Centre: Annual Report 2009
Authors: Chan YC , Tse ML , Lau FL 
Published: December 2017

ObjectiveTo report and analyse the poisoning data of Hong Kong Poison Information Centre (HKPIC) in 2009.MethodsIn 2009, all poisoning cases received by HKPIC were retrieved from its database (PICMS) for analysis.ResultsTotally 4338 poisoned cases were analysed. There were 1955 male patients (45.1%), 2,367 female patients (54.6%) and 16 patients with no gender specified. More than two‐third of cases (68.6%) were between 20 and 59 years old. Common causes of exposure were suspected self harm/suicidal attempt, abusive use and unintentional exposure. Paracetamol, ketamine, zopiclone, benzodiazepine and household products were the common poisons exposed. Majority of the patients were managed supportively, with 13.6% and 13.1% treated by decontamination and antidotes respectively. Most cases had uneventful recovery; about 1% of the poison exposure resulted in death and about 5% of the exposure had major outcomes.ConclusionsThe 2009 annual report provides updated epidemiological information on poisoning pattern in Hong Kong and emphasized some changes in comparing with our previous reports.
A Case of Unintentional Methadone Overdose Followed by Hypoglycaemia
Authors: Fung HT , Cheung KH , Lam SK , Wong OF , Leung KL , Leung SH 
Published: December 2017

Methadone overdose is expected to result in intoxication simulating the other opioids. We report a case of hypoglycaemia following accidental methadone ingestion. A 21‐year‐old woman presented to a local accident and emergency department 10 hours after ingestion of 800 mg of methadone. She was found to have coma, respiratory suppression, hypotension, prolonged QTc and hypoglycaemia. The hypoglycaemia was reversed by dextrose replacement. The patient required intubation and inotropic support because of cardio‐respiratory instability. She eventually recovered without consequence. To date, this is the first reported case of methadone overdose induced hypoglycaemia.
Clinical Characteristics of Patients with Pseudo-Subarachnoid Haemorrhage who were Successfully Resuscitated from Out-of-Hospital Cardiopulmonary Arrest
Authors: Ahn JH , Choi SC , Jung YS , Min YG 
Published: December 2017

Introduction Pseudo-subarachnoid haemorrhage (PSAH) is a rare neuroradiological finding seen in patients with diffuse cerebral edemas. We investigated clinical characteristics and risk factors for the development of PSAH. Method The successfully resuscitated patients in emergency department were classified into two groups: those with pseudo-SAH [PSAH (+)] and those without pseudo-SAH [PSAH (-)]. Clinical variables were analysed. Results Pseudo-SAH was found in 31.6% of patients. PSAH was more common in males (p=0.042). The mean age was 39.9±10.3 years in the PSAH (+) group and 54.4±22.0 years in the PSAH (-) group (p=0.038). Outcomes measured by Cerebral Performance Category score were also significantly different between the two groups (p=0.037). Logistic regression analysis found that serum lactate concentration and duration of anoxia were associated with the development of PSAH (with odds ratios and p values of 1.92, p=0.01 and 1.13, p=0.02, respectively). Conclusions PSAH itself is a phenomenon that could be seen in post-resuscitation encephalopathy as a consequence of severe anoxic insult.
Does Intravenous Magnesium Benefit Patients of Cardiac Arrest? a Meta-Analysis
Authors: Chen F , Lin Q , Chen G , Wang X , Lin S 
Published: December 2017

Objective Evidence shows that magnesium has anti-arrhythmic roles. However, clinical trials suggest that there are conflicting outcomes of cardiac arrest patients given magnesium. The study aimed to examine the effects of magnesium sulfate therapy on cardiac arrest patients using a meta-analysis. Methods We searched the MEDLINE (1966-July 2011), OVID (1980-July 2011), EMBASE (1980-July 2011), Chinese bio-medical literature & retrieval system (1978-July 2011), Chinese medical current contents (1995-July 2011), and Chinese medical academic conference (1994-July 2011). Studies were included if (1) the study design was a randomised controlled trial (RCT); (2) the study population included cardiac arrest patients who received cardiopulmonary resuscitation and either intravenous magnesium or placebo (0.9% normal saline); (3) the study provided data on return of spontaneous circulation (ROSC) and survival to hospital discharge. Relative risk (RR) and 95% confidence interval (CI) were used to pool the effect. Results The study included six RCTs with a total of 531 participants from cardiac arrest. The pooled data demonstrated that ROSC and hospital discharge rates in patients treated with magnesium were 35.5% (95% CI=29.7%-41.3%) and 10.4% (95% CI=6.7%-14.1%) compared with placebo (ROSC rate: 31.3%, 95% CI=25.8%-36.8%; hospital discharge rate: 8.5%, 95% CI=5.2%-11.8%). Administration of intravenous magnesium sulfate could not significantly increase ROSC (RR=1.14, 95% CI=0.91-1.43, P=0.26) and survival to hospital discharge (RR=1.22, 95% CI=0.74-2.02, P=0.43) compared with placebo. Conclusions Administration of magnesium sulfate does not improve ROSC and survival to hospital discharge in patients of cardiac arrest.
Comparison of the Efficacies of Topical Anaesthetics in the Reduction of the Pain during Peripheral Intravenous Cannulation: A Randomised Trial
Authors: Armagan E , Kocabas E , Koksal O , Simsek G , Bal H 
Published: December 2017

ObjectiveThis study aimed to compare the efficacies of two different topical anesthetic agents and placebo in the reduction of the pain observed during intravenous (IV) cannulation.MethodsStudy enrolled a total of 129 healthy male donors and IV cannulation was performed to antecubital region. The donors were assigned into three groups. Prilocaine‐lidocaine mixture cream (E), lidocaine spray (X) and Placebo cream (P) were given to patients. After the administration the donors were waited for approximately 45 minutes. The pain experienced by the donors after the insertion of 16 gauge cannula in arms was recorded as “pain experienced at minute 0, 5 and 15” on 100 mm visual analog scale (VAS).ResultsIn the first group, there was no significant difference between mean VAS scores recorded after the administration of prilocainelidocaine mixture cream and lidocaine spray before IV cannulation. Mean VAS value was 9.1 mm with prilocaine‐lidocaine mixture cream and 9.3 mm with lidocaine spray. In the second group, we detected significant difference between mean VAS scores recorded after the administration of lidocaine spray and placebo cream. Mean VAS value was 9.8 mm with lidocaine spray and 24.3 mm with placebo (p<0.05). In the third group, we found statistically significant difference between VAS scores recorded after the administration of prilocaine‐lidocaine mixture cream and placebo cream. Mean VAS value was 8.8 mm with prilocaine‐lidocaine mixture cream and 33.0 mm with placebo cream (p<0.05).ConclusionAlthough both agents administrated before IV cannulation were superior to placebo in adult patients in this study, we can state that these drugs were not superior to each other and showed similar efficacy.
Comparison of the Accuracy of Local and International Prediction Models for Massive Transfusion in Major Trauma Patients
Authors: Poon KM , Lui CT , Tsui KL 
Published: December 2017

ObjectiveTo validate a local prediction model (Rainer's score) for massive transfusion in trauma patients and compare its accuracy with international prediction models (TASH score and ABC score) using local trauma data.MethodsPatients were recruited retrospectively from the trauma registry of a regional trauma centre during the period from January 2005 to December 2010. Patients with Injury Severity Score (ISS) ≥9 and aged ≥12 years were included. Burn and drowning patients, patients with known severe anemia (haemoglobin <7 g/dL) and renal failure were excluded. Massive transfusion was defined as delivery of ≥10 units of packed red blood cells within 24 hours. The sensitivity specificity positive and negative predictive values, positive and negative likelihood ratio and accuracy were calculated for different prediction models. The overall discriminatory capacities of models were compared using the area under the receiver operating characteristic (ROC) curve.ResultsA total of 1030 patents met the inclusion criteria and 27 patients required ≥10 units packed cells within 24 hours. The accuracy was the best in the TASH score (97.3%) when compared to the Rainer's score (96.5%) and ABC score (95.1%). Sensitivity was better in Rainer's score (33.3%) and ABC score (33.3%) than in the TASH score (25.9%). The area under ROC curve for TASH score, Rainer's score and ABC score were 0.911, 0.886 and 0.809 respectively.ConclusionsWe validate the prediction model (Rainer's score) by a set of local, non‐university institution data. Rainer's score has high accuracy (97%) in predicting the need for massive transfusion and is comparable to TASH score and ABC score.
How Do Adult and Paediatric Intussusceptions Differ? a 10‐Year Retrospective Study
Authors: Wong KB , Lui CT , Fung HT 
Published: December 2017

IntroductionIntussusception in adult is considered to be an uncommon surgical condition. Our study aims to gather the epidemiology data of intussusception in local population and to compare the clinical characteristics, investigation and management between adult and paediatric intussusceptions.MethodsThis is a retrospective study of patients who were diagnosed intussusception from January 2001 to June 2011 in the study centre. Demographic data, clinical presentation, investigation and management were compared between adult and paediatric patients.ResultsThere were 79 patients included in the study period. Twenty‐two of them (27.8%) were adults (aged at least 18 years) while 57 (72.2%) of them were paediatrics patients (age <18 years). Forty‐three (54.4%) of them were male and 36 (45.6%) of them were female. Mean age of intussusception in adult and paediatric groups were 56.1 years and 23.9 months respectively. The median duration of onset of the presentation of adult patient was 3.5 days which is longer than that of paediatrics group (1 day) (p<0.001), per‐rectal bleeding occurred in 18.2% (4/22) of adult patients while 47.4% (27/57) of paediatric intussusception had per‐rectal bleeding (p=0.017). There was also significantly more vomiting (78.9%, 45/57) in paediatric intussusception compared with 31.8% in adults (p<0.001). A total of 72.7% (16/22) of adult intussusception were diagnosed by CT scan while 94.7% (54/57) of paediatrics was diagnosed by ultrasound by radiology department. 77.3% (17/22) of the adult intussusceptions had a neoplastic leading point. All the adult intussusception required surgical management while only 21.1% (12/57) of the paediatrics group required surgical reduction with or without bowel resection. The median length of stay (LOS) of adult group was 9 days which is longer than that of the paediatrics group (4 days) (p<0.001).ConclusionsIntussusception in adult patients lacks classical presentation of per‐rectal bleeding and vomiting and the onset is commonly sub‐acute when compared with paediatrics cases. Most of the adult intussusceptions have pathological leading points that warrant surgical management.
New Era of CPR: Application of I-Technology in Resuscitation
Authors: Chan TK , Wan KA , Chan JCK , Lam HKC , Wong YT , Kan PG 
Published: December 2017

Introduction The present study evaluated the performance and acceptance of a cardiopulmonary resuscitation (CPR) feedback application for the iPhone (“PocketCPR®”) designed to improve chest compression performance. Methods We randomly assigned participants into two groups to perform chest compression with (study group) or without (control group) using the “PocketCPR®” on a manikin. The participants performed totally four sets of chest compression simulating two CPR scenarios. In the first scenario, no advanced airway was inserted while in the second scenario, advanced airway was inserted. We measured and compared the rate and depth of chest compression between the groups in both scenarios. Participants in study group also finished a questionnaire on the use of feedback application. Results The mean compression depth of the study group was significantly deeper both in the first scenario (5.22 cm; 4.56 cm, p=0.002; 5.30 cm; 4.56 cm, p=0.001) and the second scenario (5.34 cm; 4.56 cm, p<0.001; 5.35 cm; 4.49 cm, p<0.001). However, the mean compression rate of study group was significantly slower than the control group both in the first scenario (105.19; 118.58, p<0.001; 105.23; 119.36, p<0.001) and the second scenario (106.10; 121.08, p<0.001, 106.61; 117.42, p=0.002). Conclusion A mobile phone feedback application “PocketCPR®” improves chest compression quality by increasing the compression depth in laboratory setting. Further study is indicated to demonstrate its benefit in clinical setting.